Well Child Check Hacks for Nurse Practitioners
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Show notes:
Well-child visits can be very intimidating for new Nurse Practitioners, even if you love working with children. With a million questions to ask, a variety of developmental milestones to consider, vaccination schedules, and more – it’s easy to feel a lot of pressure not to miss anything in these visits.
Approach to Well Child Checks in Primary Care
This week, let’s talk about ways to come into these visits with tools to make it easier for you and to set your mind at ease.
✅ Top things to know for well-child visits
✅ My favorite resources for pedi milestones
✅ How to plan your well-child visit so that you don’t miss anything
✅ How to involve staff to help these visits go more smoothly
✅ A few simple questions to ask at any pediatric visit that will give you tons of information
Don’t feel like you need to know everything perfectly right away. These are visits that take a lot of practice and a lot of time to get comfortable with. Don’t give up! Prepare yourself, develop a strategy, and practice, practice, practice.
Resources mentioned in this episode:
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WEBVTT
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Hey there, welcome to the Real World NP podcast.
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I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
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company for nurse practitioners in primary care.
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I'm on a mission to equip and guide new nurse practitioners so that they can feel
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confident, capable, and take the best care of their patients.
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If you're looking for clinical pearls and practice tips without the fluff, you're in
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the right place.
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Make sure you subscribe and leave a review so you won't miss an episode.
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Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
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slash podcast.
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In this week's episode, I'm going to be talking about approach to well child checks.
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So I'm a family nurse practitioner.
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I love children and pediatric medicine is just like not my forte.
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I just, I felt like, I think it's always been that way, but I think especially
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when I was a new grad, I was so intimidated by pediatric medicine.
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In this episode, I want to talk about kind of some general approaches for well
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child checks that will hopefully put your mind at ease.
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So I think one thing that's super overwhelming for new grads and even experienced providers
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until you get into the hang of it is like how to conduct each of these well child
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checks.
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It feels like there's so many things.
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There are so many things to remember for each age group.
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And there's so many things that, I don't know, you're just worried about
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missing because little kids, I just, you just have to be careful with them,
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right?
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They're very resilient and also you never want to miss anything.
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So I think a couple of things to start.
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So first things first is what are your resources?
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So Bright Futures by the American Academy of Pediatrics is a really great resource.
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They used to have these handout sheets that you could print out that you could
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ask pretty much every question you needed to ask, developmental wise,
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nutrition wise, family wise.
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And then it would have anticipatory guidance, anticipatory guidance,
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excuse me, and you could print those out and hand those out to families.
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They had them in English and Spanish.
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I don't think I ever found them in other languages.
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I haven't found as much access to that recently.
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I don't know if they changed something about it.
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If you're currently using it, please let me know.
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Drop a comment or send us an email.
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But the other resource is that Bright Futures has a little mini booklet that you can use.
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And I just want to say, sorry, basically the booklet is by well child check.
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There's like a set number of visits, right?
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There's the one week, there's a couple of days old, one week old, one month,
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and it goes up from there.
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And then these milestones that these, you know,
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pediatric patients are supposed to come in for those well child checks.
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And so in the Bright Futures pamphlet book,
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you can buy a physical book from their website.
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It's just a quick reference of what are the things that is universal.
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What are the universal screening tests?
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What are the selective screening tests?
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What are the developmental questions we want to be asking?
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Family questions when you want to be asking, et cetera.
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So that's really helpful to have.
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And I guess I just want to say like that's like my main go to resource.
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There is no shame in bringing something in with you to the visit.
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Like when I started as a nurse practitioner, I would literally like,
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luckily I had my EHR, had embedded in it the bright,
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the developmental questions that are in the Bright Futures,
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you know, pieces of information.
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But literally I would look at that list and I would ask each and every one of them.
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And it was clunky and it was slow and I was embarrassed.
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I felt like I had to have this like, I just had to like put all of my ego aside,
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just like really, really eating a big piece of humble pie every time.
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But you know what, like all that matters at the end of the day
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is that you're giving safe care to patients and they feel well taken care of.
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And if you're a student watching this,
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pro tip is that you start doing this in your clinical rotations
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because you get to be a student, right?
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And you're not the provider that's an end all be all responsible for it.
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Not that you necessarily are the only person as a new grad,
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but start practicing this in your clinicals.
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And hopefully you, by the time you graduate, you will feel less clunky with it.
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It took me a very long time to not feel clunky though,
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in asking all of the pediatric, historical questions,
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developmental milestones, things like that.
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But it gets there and it's totally okay.
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So in addition to the Bright Futures guide,
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I have a friend, Natalie PNP, you may know her from Instagram.
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She has an Instagram account.
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She has a couple of products and services.
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And one of them is a really fantastic resource.
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I'm going to link to it down in the description here,
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but it's basically all of the developmental questions,
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all of the anticipatory guidance, cheat sheets,
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the vaccination schedules.
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It's like the thing that you want to have
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when you're taking care of patients in a wild child check.
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Definitely check that out down below this video.
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I'm so grateful that she's a pediatric nurse practitioner
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and has already completed this for us.
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The other component is vaccinations.
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I have an interview with a pediatric nurse practitioner from last year,
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and we talked about vaccination.
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So that's a topic for another day.
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You can listen to that or we can readdress it if you'd like,
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but regardless of the conversation around vaccines or no vaccines,
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there's a vaccination schedule.
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So one potential hack to really help with this potential,
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depending on your office structure,
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is that the nurses that you work with
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can hopefully triage beforehand what are the vaccines that are due.
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One of the clinics that I worked in,
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she would look at my schedule ahead of time.
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The nurse that I worked with would see the pediatric patients,
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take a look at their vaccines, see what they needed,
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and then let me know.
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Ultimately, I'm responsible because I'm the provider
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and I'm ordering it, but that was a really helpful thing.
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So that is something to potentially suggest in terms of a workflow
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of your nursing staff if you have them.
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If you don't have them,
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potentially you can enroll your medical assistants
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with your supervisor's approval of like,
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is this part of the training that you can help with?
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You have to double check a little bit more closely
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because they don't have that license, right?
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But they could get that process started.
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The other thing is that there's state registries.
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So there are some state, depending on your state,
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there's a registry where the vaccinations from the children
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go to this database.
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And so when they move between clinics,
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you can see what they've had done already.
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So that's another potentially helpful thing
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for those well-trial checks.
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One of the challenging parts is that
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in a number of my clinics I've worked in,
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patients coming from other countries,
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that can be a little bit challenging.
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If they bring their records with them, that's really nice.
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And most of the time, again,
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I really relied on the nursing staff
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to help me outside of the visit
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to take a look at all of those vaccines
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and do their best to figure out kind of the translation
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between are they from Brazil?
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Are they from Dominican Republic?
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Just depends where the patients were from.
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But hopefully they can start to do that
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as soon as they get to the visit.
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They can sign a release form for their previous clinic
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or they can bring in their records
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and the nurses can start reviewing the vaccines.
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The other thing about well-trial checks,
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in terms of the assessment questions,
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most of the time,
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the parents are going to tell you,
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the caregivers, excuse me,
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the caregivers are going to tell you
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what concerns they have, physical or otherwise.
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Physicals are just physicals.
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I mean, it just takes some practice
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where you have to just go through
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and practice and practice and practice
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for them to get faster.
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I think the kind of like hack pearl
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I want to add in about well-trial checks,
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or just about assessment of children in general,
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is that, and I kind of put infants in another category
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because they have like a little bit different needs.
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So like under two,
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it's a slightly different category, right?
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Definitely under one.
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But generally speaking for all children,
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you can assess how they're doing
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by a couple of different things
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in terms of the triage of any medical problems
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that they bring.
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This is like a broad brush statement,
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but it generally speaking holds true.
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When it comes to children,
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you want to ask how they're eating and drinking,
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how they're eliminating and on what cadence.
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You want to see how they're playing
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are they lethargic?
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Are they normally playing?
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For the most part is like,
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what are they eating, eating and drink,
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like what's coming in, what's coming out
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and how is their like general behavior?
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Like for the most part,
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you can very quickly triage how severe an illness is
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based off of that.
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And so this is sort of applies
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to your well-trial check
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because sometimes it will be a totally normal check
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and then other times it will be,
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problems will be,
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and chief complaints will surface, right?
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Or symptoms will surface.
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But that's, I always include those types of questions
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in my well-trial checks as well is like,
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you know, what is, what is their normal,
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what are their like normal things?
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I think another potential hack to work through is,
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and that this again depends
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in your workflow of your clinic.
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Some of, sometimes I've seen
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where you can enroll again,
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the medical assistants depending on your staffing
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and their training in the support systems
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where they can start getting
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those history questions for you.
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Whether it's the number of, if it's a infant,
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if they're breastfeeding,
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if they're bottle feeding,
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how many bottles, at what interval,
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diapers, et cetera.
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Like you can have like a template,
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you know, potentially to ask
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and have your medical assistant help you with that.
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But I guess I just primarily want to normalize
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that like these take a while to feel comfortable with
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and it's totally fine,
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totally acceptable to bring in your little clipboard
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or your little booklet or your laptop
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or whatever it is
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and then literally just read through the questions.
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Obviously you need to like do your full assessment, right?
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But when it comes to like,
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I just want to normalize,
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you do not have to memorize the developmental milestones.
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That doesn't make an excellent nurse practitioner, right?
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Memorizing something
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that you can read off of a piece of paper,
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it doesn't like, that doesn't mean anything.
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So if it takes you like a year or more
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to like learn all of these
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and be able to just like ask them quickly,
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like hopefully, my hope for you
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is that you can get to a place where you start,
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if you need to start by looking
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at all of those pieces of paper,
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which you probably will,
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that you will get to this point
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of like just not even like,
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not even that like, you know,
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a lot of things that happen when we're new grads
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is that like, you're like,
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oh, I really need to know about X.
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And so you like add it to this list
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like I'm gonna read about this when I get home
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or I'm gonna practice this when I get home.
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And we do, right?
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We read and we practice things
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but there's too much to do.
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Like there's not enough brain time
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and too many things to learn.
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So you have to triage what you're focusing on.
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And I just want to encourage you
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that like just by rote doing it
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over and over and over again,
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you will learn it, right?
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And by the time you get to that year mark
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or two-year mark or however,
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I can't even remember
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at what point I started doing this
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but you will be able to ask
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developmental questions rapid fire
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or even as you're doing
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your physical assessment, right?
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So hopefully those are some helpful tips
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for your well child check.
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Please let me know
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what clarifying questions you have.
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Thank you so much for watching.
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If you haven't grabbed the ultimate resource guide
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00:11:33.220 --> 00:11:34.100
for the new NP,
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head over to realworldnp.com slash guide.
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You'll get these videos
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00:11:37.960 --> 00:11:39.460
and straight to your inbox every week
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with notes from me,
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patient stories and bonuses
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I really just don't share anywhere else.
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That's our episode for today.
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Thank you so much for listening.
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Make sure you subscribe,
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leave a review and tell all your NP friends
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so together we can help
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as many nurse practitioners as possible
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give the best care to their patients.
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If you haven't gotten your copy
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of the ultimate resource guide for the new NP,
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00:12:05.970 --> 00:12:09.050
head over to realworldnp.com slash guide.
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00:12:09.510 --> 00:12:10.830
You'll get these episodes
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00:12:10.830 --> 00:12:12.730
and straight to your inbox every week
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00:12:12.730 --> 00:12:14.170
with notes from me,
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00:12:14.490 --> 00:12:16.190
patient stories and extra bonuses
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I really just don't share anywhere else.
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Thank you so much again for listening.
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Take care and talk soon.
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