For Strangers in foreign lands
The hospital cast of characters

First time in the hospital
with your little one?

If so, you're probably feeling like a visitor on another planet; so many people, so much jargon, so much strange equipment, so many decisions to make. Entering an unfamiliar hospital culture can be daunting, and entrusting your child to its care pretty frightening.I hope the short guide that follows will help you to better navigate this foreign land and make sense of the people who inhabit it.

Who are all of the people?

The cast of characters is extensive, and the roles played complex. On most pediatric units, you'll see more people than you anticipated, with exits and entrances that are often confusing. Different hospitals give different names to their various groups of employees, but the functions from one hospital to another tend to be fairly similar. Let me introduce you to them.

The Nursing Staff

Nurses are on the Pediatric unit 24 hours a day, and are responsible for planning and delivering what's called "family centered care." That means that they concern themselves with the needs of your child as you help to define those needs, and they also pay attention to the needs of the rest of the family. They recognize that you are the primary caretaker, and they see one of their roles as a support to your parenting. 

The educational background of the nurses caring for your family is an important consideration. Nurses can become "registered" to practice (thus the R.N. title) after completing a variety of academic programs, and on the pediatric unit, the nurses may represent these different preparations. To be registered, they must have completed either a two year program (housed in or aligned with a community college), a four year college (baccalaureate) degree program, or a graduate school program. Those with master's or doctoral degrees usually have supervisory, educational, or consulting responsibilities, and many have the titles, "nurse practitioner" or "clinical nurse specialist" Those two titles are reserved for nurses in "advanced practice". To further confuse the issue, there are other nurses who have "licensed practical" (L.P.N.) or "licensed vocational" (L.V.N.) titles. These practitioners do not have college backgrounds in nursing, and are not R.N.s. They usually do not administer medications in hospitals, and do not assume the supervision of the pediatric unit.

Your nurse should be your liaison with the health care system of the hospital, your advocate and your guide. Although most hospital nurses are women, men are also in the ranks of the profession, and may provide care to your child. Because nurses rarely wear caps anymore, and because they often wear two piece colored or patterned "scrubs" as uniforms instead of the traditional white dress or pants suit, you'll have to rely on their name pin or badge to identify them. Most hospitals use picture identification badges that should provide you with more information about the people participating in the care of your child. Nurses truly do care 24 hours a day!

Nursing Assistants are also involved in patient care. These practitioners are usually trained in hospitals or through community programs. As their name implies, they assist in nursing care; making beds, helping with baths, positioning , and performing a myriad of other supportive functions. Many assistants have expanded technical roles, and are given different titles such as "patient care associate" (P.C.A.) when educated to draw blood, run electrocardiograms (E.K.G.s) , and start intravenous infusions (I.V.s).

Child Life Specialists are on many pediatric units, paying attention to the reality that your child is first of all a child, and only then a sick child. These "play people" remind us all that children learn about the world through play, and that play is the most appropriate medium for our learning about and helping them to meet their needs.

To be continued...

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Joan Fleitas, Ed.D., R.N.
Associate Professor of Nursing, Lehman College, CUNY
Bronx, New York 10468

Last updated: November 14, 2004