SURGICAL/CRITICAL CARE
A look at the current pediatric workforce Current challenges could lead to a troubling future by Janette Wider
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s hospitals continue to feel pressure from staffi ng shortages and tight budgets, one must not forget that the pediatric workforce is facing similar chal- lenges, albeit with slight differences. Healthcare Purchasing News had the pleasure of speaking with Danielle A. Altares Sarik, PhD, APRN, CPNP-PC. Altares Sarik is a pediatric nurse scientist and director of Nursing Research and Evidence- Based Practice at Miami- based Nickalus Children’s Hospital. Altares Sarik has expertise in health services and outcomes research. She holds a PhD, MSN, and
Danielle A. Altares Sarik
BSN from the University of Pennsylvania, and a BA from Cornell University. She is a Certifi ed Pediatric Nurse Practitioner in Primary Care and has cared for patients in China, Botswana, and Nicaragua in addi- tion to the U.S.
Altares Sarik is also an active member of
the National Association of Pediatric Nurse Practitioners, where she serves on the Health Policy Committee. She is a Senior Fellow of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and has held multiple visiting scholar and adjunct faculty posi- tions. Her research focuses on the evaluation of healthcare, with a particular emphasis on factors impacting pediatric safety and health outcomes, healthcare delivery, and the nursing workforce. She has served as Primary Investigator or Co-Investigator on multiple studies, including those funded by the Agency for Healthcare Quality (AHRQ), American Nurses Credentialing Center (ANCC), and Health Resources and Services Administration (HRSA).
What does the pediatric workforce look like today? As to the current status of the pediatric workforce Altares Sarik said, “In the pedi- atric world, generally, we have nurses that choose to go into pediatrics, and they tend to stay. We don’t have a lot of nurses that
bounce between pediatrics and adult care. It’s kind of like a calling. But what we’ve seen recently is that we’ve had a lot of attri- tion from our pediatric nursing workforce. And actually, with the pandemic, what we saw was a lot of hospitals stopped allowing nurses to do their training rotations because of concerns with infection risk and COVID. And so, a lot of those nursing students who would normally be exposed to pediatrics during this their schooling didn’t get those opportunities. So, what we are seeing as a consequence of that is we have less peo- ple choosing to opt into a career in pedi- atric nursing, because they’ve never had that exposure.”
She continued, “We’re just seeing less nurses who are choosing as an initial career path to go into pediatrics. And then we’re seeing huge amounts of nurses who are retir- ing, which is the same as the adult work- force, but because it’s a smaller number of nurses who have chosen this career path. Also, we see a lot of our experienced nurses leave. Then what we see is challenges with training the nurses who do want to come in. We’re also seeing less of our medicine colleagues choosing to go into these pedi- atric specialties.” Altares Sarik stressed the training piece of the equation. She said, “For both medicine and nursing, we have training programs and academic programs, and across the board, I’ll speak to nursing just because I know that world much better, but what we’re seeing is we have faculty shortages. In the schools of nursing, it is we’re seeing a lot of our older, more experienced faculty retire, and we actually don’t have enough faculty to replace them. And what that means is not only are we seeing challenges with nurses after they graduate from school, opting to go into pedi- atric careers, what we’re actually seeing is we’re going to lose capacity to train nurses at the undergraduate level or the graduate level, because we just don’t have enough faculty and staff in these academic settings. And so that’s a really big challenge.” Some of the reasons, according to Altares Sarik, for this are pay discrepancy, the
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faculty in schools of nursing tends to be very low and it is hard to therefore attract instructors. Then, the training process is very long. To get a PhD, which is needed to be faculty, one has to go through four or fi ve years of a PhD program. Sometimes a postdoc is required, which is an additional one or two years.
Impact on the future
Altares Sarik painted a troubling picture of the future. When asked about the potential impacts, she said, “If you think about your nursing workforce or your pediatric medi- cal workforce you need to be able to replace those people who are either retiring or leav- ing the profession at the same rate that so that we can reach that balance point. But if we’re not able to recruit enough pediatric nurses in or we’re not able to fi ll our medi- cal specialties, what that means is for future care, we may be in a situation where we don’t have an adequate workforce to pro- vide the care needed to pediatric patients. What that can look like is, if you’re looking for a specialist, increased wait times, maybe longer distances that families and patients have to travel to be able to fi nd specialists.” She continued, “And then if you need to be hospitalized and you’re looking for that kind of unique pediatric care if we don’t have enough pediatric nurses to provide that care, that can look like short- ages, where you have really high staffi ng, you know, really high ratios of patients to nurses where we like to keep those ratios low so that we can have really great hands-on care. And that can provide a lot, or that can lead to a lot, of challenges with just actually being able to provide the care in hospital. Additionally, when you think about community care and primary care what that can look like is longer wait times to get in to see a provider. It can look like maybe not having pediatric providers in some areas or rural areas or underserved areas. And that can be really challenging, especially if you’re not located in a city. That can be a huge barrier to receiving the needed care.”
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