Creating the Right Culture in Pediatric Nursing


Recruitment and retention of Pediatric Registered Nurses to optimize quality of care and improve outcomes in pediatric health care

Health care professionals harbor shared expectations about their occupational culture. According to a study undertaken by Roberts-Turner, Hinds, Nelson, Pryor, Robinson, & Jichuan (2014), the shared expectations in a positive occupational climate include teamwork, occupational safety, decorum in inter-employee relations, and respectful interactions with management. Positive occupational cultures enhance professional commitment and promote employees’ satisfaction. The study by Kabene, et al., (2006) holds that pediatric nursing contexts, pediatric registered nurses (RNs) expect to work in an environment that promotes teamwork, safety and productive relational outcomes with their leaders and management, in the interest of providing the best care for the children and the families the nurses serve. However, according to a journal article by Clinton (2014), pediatric registered nurses (RNs), classified as nurses who provide nursing care to infants, children and up to adolescents, experience barriers that prevent their pediatric units in different hospitals from operating optimally. In the United States, the practice of pediatric medicine is growing exponentially. In 2015, over 350,000 registered and certified pediatric nurses were practicing in the United States against a demand of 751,000 licensed and certified pediatric nurses. A study by Mixer et al., (2015) reported that high demand coupled with the low supply of licensed pediatric nurses means that pediatric nurses could move easily from one employer to another. The study findings indicated that the pediatric nursing workforce record approximately 48% annual turnovers, and the turnovers occurred within 5 years after employment. A study by Smith, Rubinson, & Webb (2011) reported that pediatric medical institutions are facing challenges recruiting and retaining the best pediatric nurses in their organization. Therefore, this article seeks to provide a framework on how the right culture of incorporating evidence-based best practices can be created in the recruitment and retention of pediatric registered nurses to optimize quality of care and improve outcomes in pediatric health care. 

Creating the right culture for pediatric units in healthcare organizations requires understanding the professional underpinnings in pediatric nursing. The argument in a study undertaken by Banaszak-Holl et al. (2015) is that professional underpinnings in pediatric nursing are informed by evidence-based best practices unique to the provision of nursing care to children. Adams (2016) article adds that these best practices prevail in all pediatric organizations, where health care leaders are geared towards creating the right culture for a pediatric nursing institution guided by evidence-based practices in the field of pediatric nursing. Therefore, it is worth first understanding the unique best practices in pediatric nursing and the elements of quality of care and patient outcomes before evaluating the use of recruitment and retention practices to create the right culture in pediatric nursing contexts.

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Best Practices in Recruitment of Pediatric Nurses

The acquisition and retention of pediatric nurses, according to the study by Kabene, et al. (2006), requires the human resource function to make certain considerations to ensure the human resource processes for recruitment adhere to the best evidence-based best practices for pediatric nursing organizations.

Medical error-free treatment, as provided for under a journal article by (Carter & Tourangeau, 2012), is another best practice that is required for pediatric nursing. One best practice focus in pediatric nursing is to minimize medical errors arising from the inability to accurately discern the medical needs of a child patient. Clinton (2014) article emphasizes that the quality of care in pediatric units is directly proportional to the ability of nursing personnel to minimize and even prevent unnecessary deaths in pediatric units. According to the study by Janhunen, Kankkunen, & Kvist (2017), realizing medical error-free treatment is crucial, since18% of deaths in pediatric institutions are attributable to medical errors ranging from catheter-related bloodstream infections to delayed admission of emergency cases to intensive care units. The article by Friedman et al., (2013) further adds that in the administration and care for bloodstream catheters, pediatric nurses are tasked with the proper selection of catheter sites, the use of adequate aseptic techniques to maintain catheters, and the timely removal or replacement of intravenous catheters. Consequently, pediatric units should focus on the recruitment of professionally competent pediatric nurses on these areas to avert the chances of medical errors associated with both professional and personal incompetence of the nurses that can lead to significant undesirable medical outcomes in pediatric units.

Empathetic treatment is another best practice required in pediatric nursing. Clinton (2014) contends that pediatric nursing faces unique needs and challenges compared to general nursing practice because pediatric nursing contexts entail dealing with both the child and family and pediatric patients have lower emotional and cognitive capacities than adults. In most circumstances, Friedman et al., (2013) article asserts that infants and toddlers admitted in pediatric nursing units cannot comprehend their medical conditions, requiring pediatric nurses to assume the sole role of interpreting the medical needs of the child patient. The journal article by Carter & Tourangeau (2012) adds that pediatric nursing thus requires optimal critical thinking skills, empathy and sensitivity to enhance pediatric safety when dealing with children because the safety of pediatric nursing is undermined by the high dependency tendencies of hospitalized children. Therefore, Kabene, et al. (2006) requires that the recruitment of the pediatric registered nurses should focus on the qualities of empathy and independent judgment, which are core to enabling the pediatric nurses to cater to the highly sensitive needs of the child patients. 

According to a study by Van Camp & Chappy (2017), best practices in pediatric nursing also require appropriate interpersonal skills including patience, compassion, and attention to detail to discern the unspoken needs of nonverbal patients in pediatric units. Most sick infants and toddlers are nonverbal and totally dependent on their caregivers for food and comfort. The findings of the same study by Van Camp & Chappy (2017) further add that school-aged children may be verbal but still lack the emotional and cognitive capacities to engage competently with their caregivers. In this context, Van Camp & Chappy (2017) argue that failure to correctly and timely discern the needs of pediatric patients may lead to unnecessary fatalities. Training the pediatric nurses on the appropriate interpersonal communication skill is therefore important in enabling the pediatric units to be proactive in discerning and responding to the needs of the children patients more effectively. 

Furthermore, trans-cultural competence is another best practice required for pediatric nursing. According to a study article by Banaszak-Holl et al. (2015), pediatric patients admitted in pediatric units come from varied socio-economic backgrounds. The varied socio-economic backgrounds of patients mean that patients and their parents harbor different knowledge and beliefs towards nursing care services. Consequently, the study by Van Camp & Chappy (2017) indicated that pediatric nurses must be culturally competent to discern the unique beliefs and expectations of patients from diverse socio-cultural backgrounds. Absence or limited cultural competence in pediatric nursing may lead to communication breakdowns and counterproductive relationships between patients and nurses, undermining the quality of care and patient outcomes. In applied pediatric settings,  (Carter & Tourangeau, 2012) article adds that best practices involving cultural competence in pediatric nursing include proficiency in the patients’ native languages and harboring positive attitudes towards the foreign norms and beliefs of patients from exotic cultural backgrounds. The study article by Banaszak-Holl et al. (2015) finds that nurses’ trans-cultural competence encompassing both professional and personal competences provides the underpinnings for best practices, requiring that pediatric units should focus on these competencies during their recruitment of pediatric registered nurses.  

Effective patient-nurse collaborations constitute another best practice for pediatric nursing. The findings of the study by Van Camp & Chappy, (2017) A show that approximately 37% of unnecessary deaths in pediatric medical institutions were attributable to poor communication and lack of collaboration between patients and medical personnel. The Van Camp & Chappy, (2017) study further adds that pediatric nurses can create and improve their collaborations with child patients by engaging in friendly, timely, and frequent communications. Mixer et al. (2015) contends that positive relational coordination plays a central role in not only reducing the incidences of medical errors, but in also improving patient satisfaction. Therefore, quality of care and patient outcomes related to relational coordination can be improved by recruiting and retaining pediatric nursing personnel with excellent interpersonal skills.

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Recruitment and Retention for Cultural Fitness

In nursing contexts, high employees’ satisfaction coupled with enhanced professional commitment optimizes quality of care and yields improved patient outcomes. Friedman et al. (2013) further adds that in practical contexts, recruiting for cultural fit means that Human Resource mechanisms for recruitment and hiring processes are fine-tuned to identify and absorb candidates with personal and professional values that align with the cultural norms and values of an organization.

Culture-fit recruitment strategies: talent pipeline approach

Dudley, et al. (2015) holds that the challenges related to recruiting and retaining a culturally-fit body of pediatric nurses can be counteracted through the use of customized recruitment and retention strategies. In the context of recruitment, Human Resource Managers in pediatric healthcare institutions can obtain a culturally-fit nursing workforce by employing the pipeline approach of recruitment. In agreement, Janhunen, Kankkunen, & Kvist (2017) add that the pipeline approach involves creating and sustaining a steady pool of talented employees through continuous sourcing programs, where employers recruit their workers periodically from the body of unemployed candidates who have already completed their education and in most cases gained professional. The most talented nurses can be sourced from campus populations. Smith, Rubinson & Webb (2011) hold that campus recruiting strategies involves developing partnerships with reputable learning institutions that allow talented students to conduct internship programs in real-world pediatric institutions enabling. Smith, Rubinson, & Webb (2011) further add that upon completion of their academic studies, the already-identified students can be absorbed into the organizational workforce. 

Interdisciplinary recruitment team

Besides the talent pipeline approach, a culturally-fit workforce can be recruited through the use of a robust interdisciplinary recruitment team. According to Mixer et al. (2015), the work processes in pediatric nursing are dynamic courtesy of the fast evolution of evidence-based practices occasioned by the fast pace of knowledge growth and technological advancements. Therefore, the hiring process must be fine-tuned to move at the same pace as the evolution of evidence-based best practices in pediatrics. For example, Kolko, et al. (2014) requires that latest evidences in child development psychology must be used to inform the recruitment and hiring of pediatric nurses. Janhunen, Kankkunen, & Kvist, 2017 adds that a robust interdisciplinary recruitment team must incorporate experts from not only the field of human resource management, but also from relevant fields including child development psychology, oncology and pediatric medicine, to enable multidisciplinary assessment. Further, Cater & Tourangeau (2012) offers that collegiality in the interdisciplinary hiring team should be optimized to ensure identification and absorption of culturally-fit pediatric nurses, while customized and culture-centered interview questions should be used to complement the robust and multi-perspective efforts of the interdisciplinary recruitment team. 

Employee poaching

Lastly, the traditional practice of employee poaching can be used to recruit culturally-competent pediatric nurses. Mixer et al. (2015) reported that the pediatric care industry hosts several private and public health institutions offering varied salaries and benefits to their employees. The findings of a study by Cater & Tourangeau (2012) indicated 53% of annual turnovers among pediatric nurses were attributable to search for better remunerations in better-paying domestic and overseas health institutions. Further, the study finding of a study by Cater & Tourangeau (2012) indicated that the lowest paid Registered Nurses (RNs) in the pediatric sector earn approximately $43,620 annually while highest paid pediatric RNs receive annual incomes approximating $91,740. Therefore, health institutions lose talented and culturally-fit pediatric nurses to competitors offering better remunerations. In this regard, offering high salaries in the pediatric organization will entice qualified and culturally-fit nurses to join the organization. 

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Culture-Fit Retention Strategies

The pediatric nursing sector is already suffering from workforce shortages. Mixer et al. (2015) reported that the high employees’ turnover further worsens the staff inadequacy. Some pediatric nurses leave organizations in search for better occupational cultures and climates abroad, while others leave their organizations for other occupations outside the health sector. For example, Van Camp & Chappy (2017) study reports that 14% health workers in the United States leave their professions for entrepreneurship pursuits 5 years after their employment. The loss of workers to competitors and to entrepreneurship pursuits means healthcare institutions suffer from persistent shortage of workers. Janhunen, Kankkunen, & Kvist, (2017) study finds that pediatric nurses leave their organizations for three primary reasons including poor employment relationships, difficult work surroundings, and discouraging organizational values and norms. Therefore, retention strategies in pediatric nursing should aim at creating a favorable organizational and occupational culture to prevent or minimize the loss of culturally-fit nurses. 

Provision of Career Growth Opportunities

An organizational culture that encourages staff retention, according to Adams (2016) is characterized by presence of career growth opportunities, presence of sufficient work-life balance mechanisms, and presence of adequate knowledge and work infrastructure capacities. It is important for human resource managers to promote workers from within the organization. Vacant job positions should be filled by qualified and culturally-fit candidates from the organization’s workforce. According to Banaszak-Holl et al. (2015), hiring from within the existing workforce allows companies to select the workers that have demonstrated consistent and deep adherence to values and norms prescribed by the organizational culture. Cater & Tourangeau (2012) adds that recruiting from within enables employees to remain committed in their workplace responsibilities in the hope of progressing up the corporate ladder. Pediatric nurses are more likely to remain committed and exercise cultural compliance in pediatric health institutions that offer opportunities for career progression. 

Provision of Work-Life Balance Opportunities

Besides career growth opportunities, Friedman et al. (2013) requires that retention is influenced by the opportunities for work-life balance, since pediatric nurses have other personal engagements outside their professional responsibilities that include caring for children and engaging in vocational travels and recreations. Friedman et al. (2013) add that the work schedules in organizations must allow for flexible juggling between work and life activities. Cater & Tourangeau, (2012) argue that a flexible occupational culture that give nurses time to juggle flexibly between their professional duties and the life commitments make employees feel valued by their employers. Feeling valued by the employers encourages employee loyalty and promotes occupational commitments, reducing employee turnover. 

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Provision of Training and Work-Related Infrastructure

Moreover, provision of relevant employees training and the equipping of pediatric nursing units with adequate facilities encourage retention of employees. A study by Janhunen, Kankkunen, & Kvist (2017) has indicated that most of the new evidence-based practices involve the use of inventive and innovative work processes to improve quality of care and patient outcomes in pediatric nursing. Friedman et al. (2013) gave an example where latest evidence on the molecular sequencing of tumors yielded inventive treatment procedures for pediatric cancer treatment. Banaszak-Holl et al. (2015) add that inventions and innovations in treatment procedures necessitate pediatric nurses to undergo relevant trainings on the use of emerging treatment procedures, and failure to remain up-to-date with developments in healthcare leads to obsolesce of skills, resulting in employees’ dissatisfaction. Employers are responsible for providing constant training and development programs to pediatric nurses, where according to Smith, Rubinson& Webb (2011), the training and development needs of the workers must be matched with the workers’ career goals, while also providing safety infrastructure. Smith, Rubinson & Webb (2011) adds that a combination of training and development opportunities with adequate infrastructure for personnel safety encourage loyalty to employers, reducing pediatric nurses turnover. 

Gaps in Current Research

While the existing research highlights identifiable strategies for cultural-fit recruitment and retention in pediatric nursing institutions, it does not provide a succinct evaluation of the effectiveness of the recruitment and retention strategies in real-world contexts. Cater & Tourangeau (2012) contends that there is shallow knowledge on the factors contributing to cultural fitness in the recruitment and retention of pediatric nurses, where current research fails to pinpoint the interaction between recruitment and retention strategies and the unique contexts of pediatric nursing. Therefore, current literature on culturally-fit pediatric nursing retention and recruitment remains shallow. Future works should therefore be directed on studying the effectiveness of culturally-fit recruitment and retention strategies in the primordial contexts of workforce challenges of pediatric nursing care.


In conclusion, developing the right culture in pediatric nursing institutions involve recruiting and retaining pediatric nurses with desirable professional and personality attributes. In pediatric nursing, developing a culturally-fit workforce is beneficial in optimizing quality of care and subsequently improving patient outcomes. Recruiting and retaining for culture fitness is informed by the targeted patient outcomes and the evidence-based practices contextual to pediatric nursing. The recruitment strategies for culturally fit workforce include the use of talent pipeline approaches, application of employee poaching, and the use of interdisciplinary recruitment teams. On the other hand, retention strategies for culture fitness include provision of training and work-related infrastructure, provision of work-life balance mechanisms, and provision of career growth opportunities. There recruitment and retention strategies can create a favorable environment in pediatric nursing institutions, improving quality of nursing care.  

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