The challenges of providing comprehensive, family-centered care to all children in a rapidly changing health care delivery system continue to grow. The scope of practice of pediatric advanced practice nurses and the diversity of settings in which our practitioners are employed continue to evolve to meet the ever-changing health care needs of children and families (
American Nurses Association, National Association of Pediatric Nurse Practitioners, and Society of Pediatric Nurses, 2015
). In my opinion, our expert pediatric knowledge coupled with the application of both the art and science of nursing make us uniquely qualified to lead in devising solutions for these challenges. The need for our leadership could not be more urgent.Of the more than 74 million children living in the United States (
Child Trends Data Bank, 2015
), 44% (31.4 million) live in low-income families (defined as at or below 200% of the federal poverty threshold [FPT]), and 21% live in poor families, defined as below 100% of the FPT. A majority or 51% of public school students now live in low-income families (). One in five American children struggle with hunger (United States Department of Agriculture, 2014
). Many children are exposed to violence every day in their homes, schools, and communities, often experiencing significant physical, mental, and emotional harm that can have long-term effects well into adulthood (Finkelhor et al., 2015
).Awareness of the prevalence of the tragedy of human trafficking and the large number of children and adolescent victims continues to grow. Recent data show that 33% of sex trafficking victims are minors, 85% are female, and victims who are U.S. citizens greatly outnumber victims who are foreign nationals (
National Human Trafficking Resource Center, 2014
).The United States infant mortality rate continues to be higher than that of many other nations. In 2013, the U.S. infant mortality rate ranked 51st internationally (
Chen et al., 2016
).The prevalence of mental health disorders in children is widespread. According to the
National Institute of Mental Health, nd
, just over 20% of children either currently have or have suffered from a seriously debilitating mental health disorder in their lifetime. Care for these children is complicated by an array of access to care barriers, not the least of which is a lack of a sufficient number of providers skilled in providing children's mental health services.National Institute of Mental Health. (n.d.). Any disorder among children. Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-among-children.shtml
A challenge that cuts across both primary and acute care is the growing population of children with medical complexity. These extraordinary children and their families are struggling to achieve their maximum level of wellness and potential with a combination of complex, rare, functionally limiting and life-threatening health problems. Although children with medical complexity represent only 0.5% of all U.S. children, their care may account for as much as one third of health care spending for all children. Their utilization of emergency departments is high, their hospitalizations are long, and their hospital readmissions are frequent (
Berry, 2015
).There are many more disturbing trends that negatively affect children's well-being. Despite these statistics, I am heartened that whenever and wherever children are facing these and other health care challenges, pediatric advanced practice nurses of all disciplines are present and leading. We are leading in the development of innovative practice and policy solutions, and increasingly we are leading and managing collaborative interprofessional teams. We have dedicated nurse educators who are rising to the challenge of preparing current and future students at all levels with the array of skills and competencies needed to practice in this dynamic environment.
This brings me to my final point. I want to hear from you. It is vital that we document and disseminate the great work that is being done by highly skilled pediatric experts for the benefit of our children. Contact me at [email protected] and share examples of your great work, no matter your role or setting. It is time to take our bushel baskets off and let the light of our leadership, mentorship, and collaborative efforts shine for the benefit of our kids.
References
- Pediatric Nursing: Scope and Standards of Practice.2nd ed. American Nurses Association, Silver Spring, MD2015
- What children with medical complexity, their families, and healthcare providers deserve from an ideal healthcare system.2015 (Retrieved from)
- Why is infant mortality higher in the United States than in Europe?.American Economic Journal: Economic Policy. 2016; 8: 89-124
- Number of children.2015 (Retrieved from)
- Children's exposure to violence, crime, and abuse: An update.Juvenile Justice Bulletin. 2015; (Retrieved from)
- Human trafficking trends (2007-2012).2014 (Retrieved from)
National Institute of Mental Health. (n.d.). Any disorder among children. Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-among-children.shtml
- Current population survey (CPS).2015 (Retrieved from)
- Household food security in the United States in 2014.2014 (Retrieved from)
