1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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The focus of this special topics series in MCN, safe nurse staffing and a healthy work environment, are essential for pediatric nurses and their patients. The Society of Pediatric Nurses Guidelines for Safe Staffing for Pediatric Patients (Van Allen, 2012) was based on a literature review of critically important factors that contribute to safe staffing for improved pediatric outcomes. According to their recommendations, "organizations should work to establish practice environments characterized by open communication, teamwork, and effective collaborative problem solving to address nurse staffing issues and ensure safe, effective care for children and families" (Van Allen, p. 600). Recently, Flanders et al. (2020) found positive associations between a staff resilience program and a reduction in nurse turnover, improved engagement, lower levels of compassion fatigue, and higher level of compassion satisfaction (Flanders et al., 2020). The program was based on the American Association of Critical Care Nurses (AACN, 2016) six standards for a healthy working environment. Sarik et al. (2020) found an intervention focused on principles of professionalism, a culture of safety, and respect led to improvement in nurse and patient satisfaction as well as self-reports of decreased incidents of incivility.


The COVID-19 pandemic has shown the best of the best in nursing. Nurses are using scientific evidence to guide care, leading teams of clinicians into uncharted territory, and supporting patients, families, and co-workers at unprecedented levels. Although pediatric nurses have not faced the extent of illness as nurses working with adults and elders, there are lessons to be learned that can strengthen the quality of pediatric work environments. Based on evidence and reflections on nurses' experiences during the COVID-19 pandemic, the following lessons learned can be helpful for any pediatric workplace at any time.


Lesson 1: Teamwork is Dreamwork. Highly effective teams are critical. General McChrystal (2015) shares examples from his time commanding the Joint Operations Task Forces in Iraq in 2004. Principles of a "team of teams" include transparent communication, decentralized and nonhierarchical decision-making authority, trust, and a common purpose (McChrystal, 2015). During the COVID-19 pandemic, health team members have had to trust each other to make the right decisions quickly to save many lives.


Lesson 2: Sense of Duty. A sense of duty or perhaps even a calling is a strong virtue held by many healthcare providers. For example, Dr. Suzanne Koven asked herself, "Why as an older physician would I risk my health to volunteer in a COVID-19 unit?" She reflects on a 1921 poem entitled Complaint by William Carlos Williams featuring a doctor who is summoned late during a snowstorm to a patient's home. The poem begins, "They call me and I go."


Lesson 3: Acts of Selflessness. Nurses demonstrate acts of selflessness on a regular basis and at no other time do we see this as often as during the pandemic. We have routinely heard of nurses and other essential workers putting themselves last to help fight the virus.


Lesson 4: Camaraderie. Caregivers singing and cheering on discharged patients, laughing, and making the most of a terrible situation has become common.


Lesson 5: Gratitude. It is clear that nurses have played a critical role in saving lives during the pandemic. We have learned recognition for one's contribution was particularly important.


These lessons are but a few that must translate to the post-COVID-19 era.




American Association of Critical Care Nurses. (2016). AACN standards for establishing and sustaining healthy work environments: A journey to excellence (2nd edition).[Context Link]


Flanders S., Hampton D., Missi P., Ipsan C., Gruebbel C. (2020). Effectiveness of a staff resilience program in a pediatric intensive care unit. Journal of Pediatric Nursing, 50(1), 1-4.[Context Link]


Koven S. (2020). They call us and we go. New England Journal of Medicine, 382(21), 1978-1979.


McChrystal S. (2015). Team of teams: New rules of engagement for a complex world. Portfolio/Penguin. [Context Link]


Sarik D. A., Thompson R., Cordo J., Nieves Roldan I., Gonzalez J. (2020). Good for nurses, good for patients: Creating a healthy work environment in a pediatric acute care setting. Nurse Leader, 18(1), 30-34.[Context Link]


Van Allen K. (2012). The Society of Pediatric Nurses safe staffing for pediatric patients literature review. Journal of Pediatric Nursing, 27(5).[Context Link]