Judith A. Vessey, PhD, DPNP, RN, FAAN
Boston College and Children’s Hospital, Boston
Objectives



Describe the evolution of pediatric nursing as a
specialty practice discipline
Discuss historic events and policy and practice
issues that have impacted the development of
pediatrics as a nursing specialty
Given national pediatric nursing education survey
results, develop strategies to strengthen
competencies in pediatric nursing practice
THE EVOLUTION OF PEDIATRIC NURSING AS A
SPECIALTY PRACTICE DISCIPLINE
•Specialized care for children was developed in response to
profound societal needs
•Prior to the 19th c, children needed for agrarian lifestyle
•Little to no understanding of disease and illness
•High childhood mortality
•Mid 19th c.: the industrial revolution and major social upheaval
•Populations of major cities grew exponentially
•by 1840, 30% under the age of ten
•Public health was extremely poor
•Working conditions were abysmal
•Children would go to work as young as six or seven
•Housing was substandard
1850
▼
Great Ormond Street Hospital
 Goals:
 Providing inpatient medical treatment to ill children and
advice to mothers of sick children who were not admitted
 Promoting the advancement of medical science
 Employing (the hospital) as a school for the education and
training of women in the special duties of children's nursing
1852
▼
“The instruction of young women in the care and
management of sick children sets the pattern of
development in sick children’s nursing for the next
100 years.”
C. West
1854
▼
• “Sick children require special nursing“
• “Sick children's nurses require special training"
• She insisted that her nurses keep the child:
"well amused by occupations and interest”
Miss Woods,Superintendent
“Whatever you do, do not have children’s wards in a general
hospital, but mix them up with the adults for where adults are
mixed with them, the woman in the next bed, if the patients
are judiciously distributed, often becomes the child’s best
protector and nurse.”
F. Nightingale
1859
▼
Children’s Hospitals in the US
1855:
1869:
1880:
1894:
Children's Hospital of Philadelphia
Children’s Hospital, Boston
Children's Hospital in San Francisco
Floating Hospital for Children
By the end of the 19th century, virtually every major city had a
children’s hospital
1855
▼
1869
▼
1880
▼
1894
▼
Henry Street Settlement
•Children also were a major emphasis of public health nursing
•Public health nursing was initiated by Lillian Wald in 1883-- the
Henry Street Settlement House
•Other community activists complemented nursing’s
contributions
•Lina Rogers: stared school nursing in 1902
• Public health efforts had little involvement with organized
pediatric nursing
1893
▼
1902
▼
Training Schools
•1878: first school of pediatric nursing opened in Boston
•1895: second school was the CHOP Ingersoll Training School
•These and similar schools taught little that wasn't acute care
•1886: pediatric nursing began appearing in nursing texts
•1917: Standard Curriculum for Schools of Nursing stated content to be
included in pediatric nursing classes
•1923: The Committee for the Study of Nursing Education, commissioned by
the Rockefeller Foundation, published their recommendations in Nursing
and Nursing Education in the United States (the Goldmark Report)
•Harsh criticism for the state of nursing
Federal MCH Initiatives
•White Conference on Children
•Children’s Health Bureau
•Sheppard-Towner Maternity and Infancy Act
•Social Security Act—Title V
•Maternal-Child Services
•Crippled Children’s Services
•Title XIX:
Social Security Act of 1965
•First comprehensive federal entitlement for children’s
health
1909 ‘12
▼ ▼
1921 1929
▼
▼
1935
▼
1965
▼
Loretta Ford & Henry Silver
and the birth of the
Pediatric Nurse Practitioner Movement
1964
▼
Federal Activities Helping to Shape
Child Welfare & Healthcare
•1965: Head Start
•1972: Special Supplemental Food Program for Women, Infants, &
Children (WIC)
•1973: EPSDT enacted
•1975: SSI for Children with Disabilities
•1981: Maternal-Child Block Grants
•1984: Emergency Medical Services for Children
•1994: Healthy Start Program
•1996: Temporary Assistance for Needy Families (TANF)
•1997: State Children’s Health Insurance Program (S-CHIP)
1965
▼
1997
▼
Pediatric Nursing Professional Organizations
•Interdisciplinary Groups:
•1965: Association for the Care of Children’s Health
•Independent Specialty Pediatric Nursing groups:
•1971: Association of Child & Adolescent Psychiatric Nurses
•1973: NAPNAP
•1973: APON
•1969-79: NASN
•1984: NANN
•Independent General Pediatric Nursing group:
•1990:Society for Pediatric Nurses
•Subspecialty groups within other pediatric nursing organizations
1965
▼
1990
▼
Pediatric Certification and Licensure
•PNP certification
•Change to NCLEX
•General pediatric nursing certification
197778
▼ ▼
1989
▼
THE IMPACT OF HISTORICAL EVENTS ON THE
DEVELOPMENT OF PEDIATRIC NURSING
Strengths
Weaknesses
SWOT
Opportunities
Threats
Strengths
Strengths
•Family-centered care & care
coordination, medical homes
•Symptom assessment
•Managing prematurity
•School health
•Pediatric nurse practitioners
Weaknesses
SWOT
Opportunities
Threats
Weaknesses
•Lack of a central professional
identity
•Lack of integrated partnerships
•Children’s hospitals free-standing
•Change in focus of MSN programs
•Cost of pediatric nursing
Strengths
SWOT
Opportunities
Threats
Strengths
Weaknesses
SWOT
Opportunities
Threats
•NCLEX
•Aging population
•Many areas of practice were, but
are not now, the strict purview of
pediatric nursing are
Strengths
Weaknesses
SWOT
Threats
Opportunities
•Academic-practice partnerships
•Endowed chairs
•CTSA grants
•Embrace the changes in occurring in
children’s hospitals
•Magnet status
•Clinical inquiry
•Nurse residencies
•Integrated health systems
•Patient Protection & Affordable Care Act
mm
STRATEGIES TO STRENGTHEN PEDIATRIC
COMPETENCIES