My Scope of Practice: A Passion for Pediatrics

    Most of the time, a child’s pain can be cured with a bandage and a kiss. However, pain management is far more complex for Kristine Rogers, ARNP, MS, CWOCN. Kris is responsible for pain management and skin care, overseeing treatment of neonates and patients up to 21 years old for conditions from diaper dermatitis to chronic pain. She also manages ostomy care and assesses skin breakdown in adults hospitalized for postoperative cardiac care.

Now that she has established a dermatitis protocol, Kris wants to develop programs that improve the care network and provide excellent caregiver education for those involved with the patients to whom she is so devoted.

    “I always wanted pediatrics,” says Kris. “I didn’t know there was anything else. I have been a pediatric nurse since 1991 and employed my entire career at All Children’s Hospital, a 216-bed freestanding facility with a 60-bed neonatal ICU. My partner, Susan Senecal, RN, MSN, and I work as Clinical Nurse Specialists from interdisciplinary referrals and physician consults, assessing, evaluating treatment, and recommending changes when necessary. Our daily caseload is usually 25 to 30 patients — 75% are treated for pain. Skin conditions we manage include diaper dermatitis, which can be severe and quite painful, skin tears, IV extravasation, ostomies, and pressure ulcers, primarily Stage I and Stage II.”

    Kris explains that infants are not as prone to pressure ulcers as adults, probably related to their capillary closing pressure, which renders them less likely to develop ischemia. However, sometimes a child is so ill, he or she cannot be moved at all. In those instances, Kris says, “We are concerned when the patient is turned, not knowing what we’ll find on the other side. Even though a child’s skin heals more rapidly, our young patients may be hemodynamically unstable and nutritionally compromised. You have to heal the patient before you can heal the skin.”

    As members of the Pain Management Team, Kris and Susan are responsible for assessing pain, evaluating analgesic efficacy, and facilitating epidurals and patient-controlled analgesia (PCA) pumps for all of the inpatients in the hospital. “Since the hospital added skin/wound care and ostomy management to the team’s tasks, my duties extend beyond managing pain,” Kris says. “We often are involved in the care of patients with severe trauma and multisystem involvement. For example, patients with traumatic spinal cord injuries must use braces and/or cervical collars. Part of our job is to prevent skin breakdown related to these devices.”

    The number of patients with skin care issues continued to increase after Kris joined the Pain Management Team. She recognized the need for more expertise and fulfilled it by seeking certification. “I’d already earned my Masters degree in 2000 from the University of South Florida,” she says. “Those qualifications and the fact that I wanted a web-based program led me to webWOCnurse.”

    The School of Nursing at Metropolitan State University in St. Paul, Minn., partnered with the webWOC Nursing Education Program to offer online discussions and live classes sufficiently rigorous to prepare its students for the national WOC Nursing certification exams. Kris completed the course in 2004 and is a certified CWOCN but says that every day is a new learning opportunity. “I’m recently certified, so I am still testing the waters. Nurses practicing in our specialty have a solid knowledge base, but in pediatrics we see different issues. Therefore, I use my preceptors and other colleagues and the WOCN online forums as resources. My ambition is to become the hospital expert in wound and ostomy care. My goal is to develop a better educational network, both for staff and the families of our patients.”

    Kris views each case as unique and patient situations can be challenging because “a great idea doesn't always work as well as you hope.” Another challenge is ensuring that patients make a smooth transition from hospital to home. “Most of our pediatric patients are acute and their stays are short, but some are sick for months. Sometimes, services and supplies are not covered for outpatients. In those situations, we work with Social Services and a home care company to secure what is needed.”

    Kris finds developing a trusting relationship when treating pain and skin problems is not easy, but very gratifying. “I like patient care and family education,” she says. “I want the family to feel comfortable asking me for help. I find it very rewarding. Also, the supportive environment at All Children’s makes it easier to do your job well. The hospital assisted me throughout my WOCN education.” Kris also notes that being a parent gives her a greater appreciation and empathy for what patients and their families are experiencing.

    “WOC nursing is not for everyone,” Kris says. “If it is your interest, you should go for it. For me, combining pain management and skin care is a perfect match. It provides the opportunity to treat patients holistically, which defines nursing for me in my scope of practice.”