Different Types of Pediatric Nurses

It takes a certain strength of character to insert an IV catheter into the vein of a scared child one moment, and then expertly turn a latex surgical glove into an inflatable chicken the next. Pediatric nurses not only deliver quality care to young patients with cancer, severe injuries, and other ailments but they also console, entertain, and comfort them.

Nurses inspired by the opportunity to provide medical care to young patients can choose from various specializations in pediatric nursing. By learning about the different types of pediatric nurses and the benefits of earning an advanced nursing degree, clinicians can decide which of these specializations best aligns with their unique interests and talents.

Pediatric nurses deliver medical care to children at all stages, from infancy to adolescence. Often working in multidisciplinary teams, these expert clinicians address the distinct needs of growing children.

In pediatric care, nurses need to understand the unique physiological and emotional characteristics of their young patients. Treatments that health care providers use can vary significantly between children and adults. Some medications that are safe for adults, for example, can be dangerous for children.

Pediatric nurses play a key role in ensuring that young patients receive the highest standard of care. Additionally, some pediatric nurses engage in clinical research to find evidence-based treatments for childhood diseases or to build knowledge about conditions that affect young patients.

Pediatric nurses can be registered nurses (RNs) or nurses with more advanced training. Clinicians interested in becoming pediatric nurse practitioners (PNP) or pediatric-focused advanced practice registered nurses (APRNs), for example, need to earn an initial nursing degree and an RN license, as well as a graduate degree in nursing, such as a Master of Science in Nursing (MSN) with a PNP specialization. PNPs and pediatric-focused APRNs must also pass a national certification exam with a focus on one of the following areas:

• Family care
• Neonatal care
• Pediatric primary care
• Pediatric acute care
• Psychiatric-mental health care

PNPs and APRNs specializing in pediatrics provide a range of care, including disease prevention and management, health restoration, and acute and critical care. They can focus on a particular area of children’s health, such as oncology, anesthesia, or neurology.

While some PNPs and pediatric-focused APRNs treat children of all ages, others specialize in certain age groups, such as adolescent or neonatal patients. Below are common types of pediatric nurses.

When young patients have nonemergency health issues, the first person they often see is a primary care pediatric nurse practitioner. These expert clinicians often develop long-term relationships with their young patients, monitoring their health over the years and watching them grow.

Primary care pediatric nurse practitioners help their young patients recover when they’re ill and stay healthy when they’re well. Addressing children’s everyday health issues, primary care PNPs focus on the prevention and management of common pediatric acute illnesses and chronic conditions, health maintenance, health promotion, and patient education. These nurses may prescribe a range of treatments, including pharmacological and nonpharmacological care.

The responsibilities of primary care pediatric nurse practitioners range from administering childhood vaccinations, to teaching families about nutritious diets, to diagnosing and treating diabetes.

When performing annual checkups, primary care pediatric PNPs learn the following patient information:

• Individual and family medical histories
• Present health
• Treatment preferences
• Personality and lifestyle

Primary care pediatric nurse practitioners answer any health-related questions that young patients and caregivers may have, and they may direct them to specialists, such as pediatric eye or allergy doctors.

Other duties of primary care PNPs may include:

• Recommending and performing screenings for heart defects, blood and metabolic disorders, autism, and developmental delays
• Treating unexpected health problems, such as viruses, rashes, and infections
• Teaching caregivers about various aspects of children’s health, including appropriate nutrition, activity levels, screen time, developmental milestones, in-home safety, car seats, and unintentional injuries
• Managing pediatric chronic conditions including diabetes, depression, asthma, and obesity
• Screening for and managing pediatric patients’ mental health issues
• Prescribing medication and making referrals for psychotherapy
• Giving behavioral counseling to address attention-deficit hyperactivity disorder (ADHD), dangerous risk-taking behaviors, and poor academic performance

Primary care pediatric nurse practitioners work in a wide range of family and community settings in the following types of practices:

• Ambulatory
• Subspecialty
• School-based clinics
• Hospitals
• Private practices

To practice, primary care PNPs need a Certified Pediatric Nurse Practitioner – Primary Care (CPNP-PC) certification. This involves passing the CPNP-PC exam after graduating from an MSN or a Doctor of Nursing Practice (DNP) degree program focused on pediatric primary care.

Accredited by the National Commission for Certifying Agencies (NCCA), the CPNP-PC exam contains 175 multiple-choice questions and lasts three hours. The exam covers a range of topics that apply to pediatric primary care, such as:

• Illness prevention
• Developmental guidance
• Immunizations
• Physical exams
• Diagnostic testing
• Child and caregiver education
• Family-centered care coordination
• Legal and ethical issues

A type of pediatric nurse that works with a unique patient population, neonatal nurse practitioners specialize in the care of premature and unhealthy newborns. The babies they treat can have a range of medical issues, such as:

• Infections
• Heart abnormalities
• Congenital malformations
• Low birth weight
• Respiratory stress

Such conditions place infants at significant risk and in need of intensive care and monitoring. In collaboration with other clinicians, neonatal nurse practitioners provide this advanced treatment during the first month of these babies’ lives. For long-term and ongoing health problems, neonatal NPs may deliver care up until their patients reach 2 years of age.

While neonatal nurses work typically under the supervision of neonatologists, these nurses still maintain independence as clinicians. They apply their clinical judgment to assess, diagnose, and initiate interventions.

The caregivers of at-risk infants often witness infants in pain, struggling to eat, or having trouble breathing. Inevitably, these caregivers may feel overwhelmed or anxious. Neonatal nurse practitioners play an important role in helping these individuals cope. This often involves offering emotional support to the families of at-risk newborns, advocating for their rights and well-being, and educating them on how to care for their infants.

Other key responsibilities of neonatal nurse practitioners include the following:

• Diagnosing and monitoring infants with acute conditions
• Performing physical exams and checking newborns’ vital signs
• Prescribing medications based on newborns’ health
• Collaborating with multidisciplinary teams to develop and implement treatment plans
• Calculating medications and other therapies according to newborns’ weight
• Coordinating care for patient discharge to ensure a seamless transition
• Performing minor procedures such as urinary catheterization and lumbar punctures to obtain cerebrospinal fluids for lab analysis

Neonatal nurses typically work in neonatal intensive care units (NICU) in hospitals. They may also work in transport teams, caring for critically ill newborns while they’re moved to different health care facilities.

Other work settings for neonatal nurse practitioners include the following:

• Emergency rooms
• Delivery rooms
• Clinics that provide follow-up care
• Private practices for physicians or NPs

Additionally, some neonatal nurses may work in universities or other institutions, conducting research on specialized neonatal care.

Neonatal nurse practitioners can become certified through two different certifying bodies: the National Certification Corporation (NCC) or the Pediatric Nursing Certification Board (PNCB). NCC offers the Neonatal Nurse Practitioner exam and PNCB offers the Certified Pediatric Nurse Practitioner – Neonatal exam.

Both exams cover:

• Comprehensive assessment and management of high-risk neonatal patients
• Neonatal pharmacological and nonpharmacological interventions
• Diagnosis of common neonatal conditions
• Promotion of breastfeeding and other healthy behaviors and disease prevention
• Advocacy for neonatal patients and their families
• Cultural competency in neonatal care

Another type of pediatric nurse is a pediatric primary care mental health specialist. These clinicians work to integrate mental health services into young children’s and adolescents’ primary care. This involves collaborating with primary care providers and other health care professionals to identify warning signs and risk factors for mental and behavioral health issues.

The integrative and collaborative approach of pediatric primary care mental health specialists often results in prevention and early interventions. This can prove especially effective for addressing the behavioral and mental health needs of young patients experiencing or at risk for:

• Trauma and stress-related disorders
• Substance use and addiction
• Autism spectrum disorder (ASD)
• Depression
• Anxiety disorders
• Oppositional defiant disorder (ODD)
• ADHD

To ensure that children and adolescents get the mental and behavioral health care they need, pediatric primary care mental health specialists promote the early identification of mental health issues among young people.

To achieve that goal, these mental health experts carry out many responsibilities, such as:

• Conducting mental health assessments using various mental health screening tools
• Delivering evidence-based interventions including psychotherapy and psychopharmacology
• Educating primary care providers on how to identify and address pediatric patients’ mental health problems
• Collaborating with families to develop treatment plans
• Guiding and teaching families how to manage their children’s behavioral and mental health issues
• Working with schools and other community organizations to improve the delivery of mental health services to children and adolescents

In their efforts to integrate mental health services into primary care, pediatric primary care mental health specialists typically work wherever pediatric primary care is delivered.

These settings include both clinical and educational settings, such as:

• Pediatric primary care and family practice environments
• School-based clinics
• Hospitals
• Community health centers

PNCB certifies primary care mental health specialists after successful completion of the following:

• Pediatric nurse practitioner program specializing in mental health
• Pediatric Primary Care Mental Health Specialist (PMHS) exam

The PMHS exam also lasts three hours and has 175 multiple-choice questions covering an array of topics related to mental health care for children, such as:

• Psychiatric disorders that can occur in pediatric patients, such as mood and psychotic disorders
• Behavioral and developmental disorders common among children and adolescents
• Pharmacology for pediatric patients, including side effects
• Therapeutic management and modalities used to treat various mental health conditions and disorders

Acute care pediatric nurse practitioners treat pediatric patients with acute, complex, critical, and chronic conditions. These conditions may range from organ failure to severe injuries from accidents.

Unlike other types of pediatric nursing care, treatments provided by acute care PNPs are generally short term, for young patients experiencing sudden illnesses or injuries. This frequently involves caring for children in unstable and critical conditions, which can shift rapidly. Such situations can be demanding and tense. However, they often give acute care pediatric nurses the chance to see the immediate impact of their work as their young patients progress from critical condition to stable condition, and ultimately recover.

Additionally, acute care pediatric nurse practitioners possess in-depth knowledge of how illnesses, diseases, and injuries can affect a child’s development. They use this knowledge to make strategic decisions about which interventions to prescribe.

To restore the health of children facing critical, chronic, and complex illnesses and injuries, acute care PNPs carry out numerous duties, including:

• Conducting physical assessments
• Stabilizing patients with acute symptoms
• Documenting ongoing primary care needs
• Diagnosing acute and complex illnesses and complications
• Prescribing and evaluating therapeutic interventions
• Managing ongoing complex therapies across different care settings
• Collaborating with interdisciplinary teams to ensure top-notch, evidence-based care
• Using a family- and patient-centered approach

Because of the nature of the care they provide, acute care PNPs tend to practice in fast-paced, dynamic environments. Their work settings include:

• Hospitals
• ICUs
• Subspecialty clinics
• Emergency departments
• Patients’ homes
• Trauma units
• Urgent care centers

To become a certified acute care pediatric nurse practitioner, clinicians need to graduate from an MSN or DNP degree program focused on pediatric primary care. Then, they must pass the Certified Pediatric Nurse Practitioner – Acute Care (CPNP-AC) exam.

This three-hour, 175 multiple-choice test covers a range of relevant topics, including:

• Documenting the health history of children with acute, complex, and critical conditions
• Using patient data in diagnoses
• Interpreting laboratory and diagnostic results
• Evaluating therapeutic interventions and making modifications based on patient outcomes
• Educating patients and caregivers on the benefits and potential adverse reactions to interventions
• Maintaining patient safety
• Analyzing research and applying it in clinical practice

Delivering nursing care to children and adolescents requires a unique skill set. The various types of pediatric nurses need a broad knowledge of developmental issues, pharmacology, and childhood diseases. They must also tend to the needs of young patients and their caregivers, balancing care with guidance on how to manage different health conditions.

Pediatric nursing isn’t for everyone. However, many clinicians find pediatric nursing especially fulfilling, and they thrive in it. Below are some key skills and competencies needed to succeed as a pediatric nurse.

Understanding childhood development plays a crucial role in a pediatric nurse’s ability to accurately assess and diagnose their young patients. Knowledge of milestones related to growth patterns, motor skills, and language development allows pediatric nurses to select appropriate interventions for their patients.

Additionally, providing holistic care depends on a pediatric nurse’s familiarity with developmental delays and disorders in children. It also requires pediatric nurses to understand children’s cognitive and behavioral development in relation to attention span, self-regulation, and social skills.

For example, developing a holistic treatment plan for a 6-year-old girl diagnosed with ADHD requires a pediatric nurse to know that the condition may make the child impulsive, unfocused, and hyperactive. The nurse will also need to know that ADHD may affect the child’s self-esteem and social skills.

With that knowledge, the nurse can make the decision to involve the child’s parents in creating a treatment plan that includes medication and behavioral therapy. The nurse will also know to recommend that the parents inform the girl’s school about the diagnosis, so they can implement strategies to support the child as well.

Pediatric patients and their families frequently feel scared and confused. Often, young patients lack the vocabulary or emotional maturity to clearly express their fears and needs related to their health. With empathy, however, pediatric nurses can develop trust and rapport with patients and their families, and provide the reassurance they need to find calm and lower their stress levels.

Empathy also helps pediatric nurses build more complex cultural understandings of their patients. This empowers clinicians to deliver responsive and personalized care.

The ability to listen actively and communicate effectively also enables pediatric nurses to build strong relationships with patients and families. Strong relationships are key to providing compassionate, patient-centered care.

With finely tuned interpersonal skills, pediatric nurses can convey information clearly and with sensitivity. Interpersonal skills also empower pediatric nurses to discover the preferences, concerns, and needs of young patients and their families, enabling pediatric nurses to better tailor and personalize care plans.

For example, pediatric nurses with strong communication skills can explain treatment options in ways that children can understand and in ways that reduce their anxiety. A pediatric nurse’s listening skills can enable them to better understand a young patient’s point of view and the family’s treatment goals. This allows pediatric nurses to design care plans most in sync with their patients’ needs and desires.

Pediatric nurses typically work in multidisciplinary teams to deliver comprehensive care to their patients. Within these teams, pediatric nurses may collaborate with pediatricians, physical therapists, and social workers, among others. Pediatric nurses greatly benefit from knowing how to get along with and work well with others.

When pediatric nurses have flexible attitudes and demonstrate respect for the expertise and opinions of their colleagues, they empower their teams to deliver the highest standard of care.