Well Child Check Hacks for Nurse Practitioners Transcript

Take me back to Real World NP ➡

Well Child Check Hacks Transcript

Liz Rohr:

Well, hey, there, it's Liz Rohr from Real World NP, and you are watching the Real World NP YouTube channel. We make weekly episodes to help save you time, frustration, and help you take the best care of your patients. In this week's episode, I'm going to be talking about approaches to well child checks. I'm a family nurse practitioner. I love children, and pediatric medicine is just not my forte. I just, I felt like, I think it's always been that way. But I think especially when I was a new grad, I was so intimidated by pediatric medicine. In this episode, I want to talk about kind of some general approaches for well child checks that will hopefully put your mind at ease.

Liz Rohr:

I think one thing that's super overwhelming for new grads, and even experienced providers, until you get into the hang of it is how to conduct each of these well child checks. It feels like there's so many things to remember for each age group. There's so many things that, I don't know, you're just worried about missing because little kids, you just have to be careful with them, right? They're very resilient. And also you never want to miss anything. I think a couple things to start, so first thing's first, is what are your resources? Bright Futures by the American Academy of Pediatrics is a really resource. They used to have these handout sheets that you could print out, that you could ask pretty much every question you needed to ask developmental wise, nutrition wise, family wise.

Liz Rohr:

And then it would have anticipatory guidance, anticipatory guidance, excuse me. You could print those out and hand those out to families. They had them in English, in Spanish. I don't think I ever found them in other languages. I haven't found as much access to that recently. I don't know if they changed something about it. If you're currently using it, please let me know, drop a comment or send us an email. But the other resources that Bright Futures has, a little mini booklet that you can use. I just want to say, sorry, basically the booklet is, by well child check. There's a set number of visits, right?

Liz Rohr:

There's the one week, there's a couple days old, one week old, one month, and it goes up from there. These milestones that these pediatric patients are supposed to come in for those well child checks. In the Bright Futures pamphlet book, you can buy a physical book from their website. It's just a quick reference of what are the things that is universal? What are the universal screening tests? What are the selective screening tests? What are the developmental questions we want to be asking? Family questions when you want to be asking, et cetera. That's really helpful to have. I guess I just want to say that's my main go-to resource. There is no shame in bringing something in with you to the visit.

Liz Rohr:

When I started as a nurse practitioner, I would literally, luckily I had my EHR had embedded in it, the developmental questions that are in the Bright Futures' pieces of information. But literally I would look at the list, and I would ask each and every one of them. It was clunky and it was slow, and I was embarrassed. I felt like I had to have this, I just had to put all of my ego aside, just really eating a big piece of humble pie every time. But you know what? All that matters at the end of the day is that you're giving safe care to patients and they feel well taken care of. If you're a student watching this, pro tip is that you start doing this in your clinical rotations because you get to be a student, right?

Liz Rohr:

You're not the provider that's an end all be all, responsible for it. Not that you necessarily are the only person as a new grad, but start practicing this in your clinicals. Hopefully by the time you graduate, you will feel less clunky with it. It took me a very long time to not feel clunky though in asking all of the pediatric historical questions, developmental milestones, things like that, but it gets there and it's totally okay. In addition to the Bright Futures guide, I have a friend Natalie PNP, you may know her from Instagram. She has an Instagram account. She has a couple of products and services, and one of them is a really fantastic resource. I'm going to link to it down in the description here, but it's basically all of the developmental questions. All of the anticipatory guidance cheat sheets, the vaccination schedules.

Liz Rohr:

It's the thing that you want to have when you're taking care of patients in a well child check. Definitely check that out down below this video. I'm so grateful that she's a pediatric nurse practitioner and has already completed this for us. The other component is vaccinations. I have an interview with a pediatric nurse practitioner from last year and we talked about vaccinations. That's a topic for another day. You can listen to that and we can re-address it if you'd like, but regardless of the conversation around vaccines or no vaccines, there's a vaccination schedule. One potential hack to really help with this potential, depending on your office structure, is that the nurses that you work with can hopefully triage beforehand, "What are the vaccines that are due?"

Liz Rohr:

One of the clinics that I worked in, she would look at my schedule ahead of time. The nurse that I worked with would see the pediatric patients take a look at their vaccines, see what they needed, and then let me know. Ultimately, I'm responsible because I'm the provider and I'm ordering it, but that was a really helpful thing. That is something to potentially suggest in terms of a workflow of your nursing staff if you have them. If you don't have them, potentially you can enroll your medical assistants with your supervisor's approval of, "Is this part of the training that you can help with?" You have to double check a little bit more closely because they don't have that license. Right? But they could get that process started.

Liz Rohr:

The other thing is that there's state registries. Depending on your state, there's a registry where the vaccinations from the children go to this database. When they move between clinics, you can see what they've had done already. That's another potentially helpful thing for those well child checks. One of the challenging parts is that in a number of my clinics I've worked in, patients coming from other countries. That can be a little bit challenging. If they bring their records with them that's really nice. Most of the time, again, I've really relied on the nursing staff to help me outside of the visit, to take a look at all of those vaccines. And do their best to figure out kind of the translation between, "Are they from Brazil? Are they from Dominican Republic?" Just depends where the patients were from, but hopefully they can start to do that. As soon as they get to the visit, they can sign a release form for their previous clinic, or they can bring in their records and the nurses can start reviewing the vaccines.

Liz Rohr:

The other thing about well child checks in terms of the assessment questions, most of the time the parents are going to tell you, the caregivers, excuse me, the caregivers are going to tell you what concerns they have physical or otherwise. Physicals are just physicals. I mean, it just takes some practice where you have to just go through, and practice and practice for them to get faster. I think the kind of, hack pearl I want to add in about well child checks, or just about assessment of children in general is that. And I kind of put infants in another category because they have a little bit different needs, so under two. It's a slightly different category, right? Definitely under one. But generally speaking for all children, you can assess how they're doing by a couple of different things, in terms of triage of any medical problems that they bring.

Liz Rohr:

This is a broad brush statement, but generally speaking holds true. When it comes to children, they, you want to ask how they're eating and drinking, how they're eliminating and on what cadence. You want to see how they're playing. Are they lethargic? Are they normally playing? For the most part it's, what are they eating and drinking? What's coming in, what's coming out? How is their general behavior? For the most part, you can very quickly triage how severe an illness is based off of that. This is sort of applies to your well child check because sometimes they'll, it will be a totally normal check. Other times it will be, problems will be, and chief [inaudible 00:08:23] complaints will surface, right? Or symptoms will surface. But I always include those types of questions in my well child checks as well is, what is their normal? What are their normal things?

Liz Rohr:

I think another potential hack to work through is, and this, again, depends on your workflow of your clinic. Sometimes I've seen where you can enroll, again, the medical assistants, depending on your staffing, and their training in the support systems, where they can start getting those history questions for you. Whether it's the number of, if it's a infant, if they were breastfeeding, if they're bottle feeding, how many bottles at what interval, diapers, et cetera. You can have a template potentially to ask and have your medical assistant help you with that. But I guess I just primarily want to normalize that these take a while to feel comfortable with. It's totally fine, totally acceptable, to bring in your little clipboard, or your little booklet, or your laptop or whatever it is. And then literally just read through the questions.

Liz Rohr:

Obviously you need to do your full assessment. Right? But when it comes to, I just want to normalize, you do not have to memorize the developmental milestones. That doesn't make an excellent nurse practitioner, right? Memorizing something that you can read off of a piece of paper, that doesn't mean anything. If it takes you a year or more to learn all of these, and be able to just ask them quickly, hopefully, my hope for you is that you can get to a place where you start, if you need to start by looking at all of those pieces of paper, which you probably will, that you will get to at this point. A lot of things that happen when we're new grads is that, you're like, "Oh, I really need to know about X."

Liz Rohr:

You add it to this list. Like, "I'm going to read about this when I get home." Or, "I'm going to practice this when I get home." And we do, right? We read and we practice things, but there's too much to do. There's not enough brain time and too many things to learn. You have to triage what you're focusing on. I just want to encourage you that, just by wrote, doing it over and over again, you will learn it. Right?

Liz Rohr:

By the time you get to that year mark or two year mark or however, I can't even remember at what point I started doing this, but you will be able to ask developmental questions rapid fire, or even as you're doing your physical assessment. Right? Hopefully those are some helpful tips for your well child check. Please let me know what clarifying questions you have. Thank you so much for watching. If you haven't grabbed the Ultimate Resource Guide for the New NP, head over to realworldnp.com/guide. You'll get these videos sent straight to your inbox every week with notes from me, patient stories, and bonuses, I really just don't share anywhere else.