Challenges Facing Pediatric Nursing

Abstract

According to the recent 2015 National Nursing Workforce Survey, conducted jointly by the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers there are approximately 3.8 registered nurses (RNs) of whom 3.1 million (81.1%) nurses are actively practicing, making nursing the largest professional group of health care providers (Budden et al., 2016Budden J.S. Moulton P. Harper K.J. Brunell M.L. Smiley R. The 2015 National Nursing Workforce Survey, journal of nursing regulation.. 2016; 7 (Supplement): S1-S90Google Scholar). According to this recent survey, 4.3% of the nurses surveyed identified their primary area of practice as pediatrics, down from 6% reported in the 2013 National Nursing Workforce Survey and from 7.2% from the 2008 Health Resources and Services Administration (HRSA) national survey of registered nurses, which was slightly down from 7.3% from the 2004 HRSA national survey (Budden et al., 2013Budden J.S. Zhong E.H. Moulton P. Cimiotti J.P. The National Council of State Boards of Nursing and the forum of state nursing workforce centers 2013 National Workforce Survey of registered nurses.Journal of Nursing Regulation. 2013; 4: S1-S72Abstract Full Text Full Text PDF Scopus (91) Google Scholar, Health Resources and Services Administration, 2010Health Resources and Services Administration The registered nurse population: findings from the 2008 national sample survey of registered nurses.http://bhpr.hrsa.gov/healthworkforce/rnsurvey2008.htmlDate: 2010Google Scholar). This apparent decline in the number of nurses who identify themselves as working in pediatric health care settings stands in sharp contrast to the following national statistics pertaining to the population of children and adolescents in the United States and the profile of their current needs for health care, especially from pediatric nurses. Recent federal reports indicate that there are 74 million children from birth to 17 years of age who live in the United States constituting 23.3% of the total United States population (Child Stats. Gov, 2015Child Stats. Gov POP1 child population: Number of children (in millions) ages 0–17 in the United States by age, 1950–2015 and projected 2016–2050.http://www.childstats.gov/americaschildren/tables/pop1.aspDate: 2015Google Scholar). Estimates of the 2050 population are projected to rise to nearly 80 million children (Child Stats. Gov, 2015Child Stats. Gov POP1 child population: Number of children (in millions) ages 0–17 in the United States by age, 1950–2015 and projected 2016–2050.http://www.childstats.gov/americaschildren/tables/pop1.aspDate: 2015Google Scholar). Here is a selected sample of the health care needs this U.S. population of children and adolescents currently have:•Approximately 20% (14.6 million) of children and youth have a special health care need CYSHCN) accounting for 80% of expenditures for pediatric health care (HRSA, 2016HRSA Children with special health care needs.http://mchb.hrsa.gov/maternal-child-health-topics/children-and-youth-special-health-needsDate: 2016Google Scholar).•24% of CYSHCN have functional limitations (Bramlett et al., 2009Bramlett M.D. Read D. Bethell C. Blumberg S.J. Differentiating subgroups of children with special health care needs by health status and complexity of health care needs.Maternal Child Health Journal. 2009; 13: 151-163Crossref PubMed Scopus (106) Google Scholar)•Significant gaps in needed health care services exist for C/YSHCN (Child and Adolescent Health Measurement Initiative, n.dChild and Adolescent Health Measurement Initiative (n.d.) Report from the 2009/10 National Survey of children with special health care needs. NS-CSHCN 2009/10. Child and adolescent health measurement initiative, data resource Center for Child and Adolescent Health website. (Retrieved May 8, 2016 from www.childhealthdata.org).Google Scholar, www.childhealthdata.org).•Healthy lifestyle metrics for children and youth are declining as evidenced by rates of overweight, obesity and physical activity (US DHHS, HRSA, MCHB, 2015U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child health USA 2014. U.S. Department of Health and Human Services, Rockville, Maryland2015Google Scholar).•Among industrialized countries, the US ranks 27th in infant mortality rate (US DHHS, HRSA, MCHB, 2015U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child health USA 2014. U.S. Department of Health and Human Services, Rockville, Maryland2015Google Scholar).•Birth defects accounts for 3% of live births and is the 2nd leading cause of infant mortality (US DHHS, Centers for Disease Control and Prevention (CDC) (2008)U.S. Department of Health and Human Services, Centers for Disease Control and Prevention Update on overall prevalence of major birth defects—Atlanta, Georgia, 1978–2005.Morbidity and Mortality Weekly Report. 2008; 57: 1-5PubMed Google Scholar.•Mental health concerns and risks such as being bullied are affecting greater numbers of children and youth according to national reports; 20% of adolescents have a mental health problem (US DHHS, HRSA, MCHB, 2015U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child health USA 2014. U.S. Department of Health and Human Services, Rockville, Maryland2015Google Scholar, Kessler et al., 2005Kessler R.C. Berglund R. Demler O. Jin R. Merikangas K.R. Walters E.E. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication.Archives of General Psychiatry. 2005; 65: 593-602Crossref Scopus (12944) Google Scholar).•Unintentional injuries are major causes of mortality among children and youth (Federal Interagency Forum on Child and Family Statistics, 20Federal Interagency Forum on Child and Family Statistics America's children in brief: Key national indicators of well-being, (2016). U.S. Government Printing Office, Washington, DC2016Google Scholar).•Substance abuse and smoking are preventable, yet are major causes of adolescent morbidity and mortality (Johnston et al., 2016Johnston L.D. O'Malley P.M. Miech R.A. Bachman J.G. Schulenberg J.E. Monitoring the future national survey results on drug use, 1975–2015: Overview, key findings on adolescent drug use. Institute for Social Research, The University of Michigan, Ann Arbor2016Google Scholar).•Children and youth who are economically disadvantaged and/or members of a culturally diverse community are less likely to receive needed health care (Catalyst Center, 2016Catalyst Center The catalyst center: National Center for health insurance and financing for children and youth with special health care needs (CYSHCN).http://cahpp.org/project/the-catalyst-center/Date: 2016Google Scholar, US DHHS, HRSA, MCHB, 2015U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child health USA 2014. U.S. Department of Health and Human Services, Rockville, Maryland2015Google Scholar).•16.5 million children, ages birth to 17 years live in poverty that adversely affects their access to care and nutritional status (US DHHS, HRSA, MCHB, 2015U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child health USA 2014. U.S. Department of Health and Human Services, Rockville, Maryland2015Google Scholar).•Children (immigrant/native born) of immigrant parents are at greater risk to live in poverty and therefore at higher risk for accessing needed health services (US DHHS, HRSA, MCHB, 2015U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau Child health USA 2014. U.S. Department of Health and Human Services, Rockville, Maryland2015Google Scholar). This selected profile of child health needs provides an incomplete picture, yet compelling representation of the challenges our nation faces in addressing the comprehensive health issues of infants, children, adolescents and their families now and in the future. Yet, the nursing workforce projections indicate very significant challenges and obstacles will be encountered in meeting the future demands for health care for this population of children and youth that will impact the pediatric and child health system of care. The projection of the need for RNs by the early next decade is more than half million nurses. Additionally, it is estimated that approximately another half million nurses will retire (American Nurses Association, 2014American Nurses Association Fast facts: The nursing workforce 2014: Growth, salaries, education, demographics & trends.http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/Fast-Facts-2014-Nursing-Workforce.pdfDate: 2014Google Scholar). Consequently, in the not so distant future, more than a million more nurses will be needed to enter the nursing workforce to deliver health care to the U.S. population. The pediatric population will continue to increase at a steady rate whereby there will be approximately 9 million more children by 2050 (Child Stats. Gov, 2015Child Stats. Gov POP1 child population: Number of children (in millions) ages 0–17 in the United States by age, 1950–2015 and projected 2016–2050.http://www.childstats.gov/americaschildren/tables/pop1.aspDate: 2015Google Scholar). We also know that the health challenges affecting infants, children, adolescents and their families will continue to place demands on the system of health care and its professionals. Of notable concern is the capacity of the pediatric nursing workforce to meet the demands for the future in light of the shrinking numbers of pediatric nurses as evidenced by the declines in the percentages of registered nurses who identify themselves primarily as pediatric providers in recent national surveys. There is a pressing, if not an urgent need to confront and strategize a call to action. A forthcoming editorial will discuss more fully the call to action planning needed.