Journal Information
Vol. 99. Issue 2.
Pages 79-81 (1 August 2023)
Vol. 99. Issue 2.
Pages 79-81 (1 August 2023)
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Current situation and challenges of pediatric nursing
Situación actual y retos de la enfermería pediátrica
Isabel María Morales Gil
Presidenta de la Asociación Española de Enfermería Pediátrica, Málaga, Spain
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Table 1. Competitive examinations for spots in the paediatric nursing NIR programme (2010–2023).
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In Spain, the speciality of paediatric nursing was instituted motivated by the need to guarantee a high quality in the nursing care required by children and adolescents. As early as 1964, the care of young children was already differentiated as a nursing speciality (Decree 3524/1964 of October 22, establishing the paediatric and early childhood speciality) with the purpose of providing specific training in the care of children and adolescents, a population with health problems and care needs that differ from those of adults. Thus, the paediatric and early childhood speciality for health care aides and technicians (HCATs). Since 1964, HCATs and, from 1980 to 1987, once the curriculum was integrated in the university system, graduates of the 2-year nursing diploma could specialise in paediatric nursing.

Later on, in 1987, Royal Decree 992/1987, of 3 July was introduced to regulate the accreditation as a specialised nurse. All specialities that existed to that point were repealed and new specialities proposed, including the speciality in paediatric care, but it was not until 2005, with the publication of Royal Decree on the Nursing Specialities, that the paediatric nursing speciality was included.

In 2008, the National Committee for the Paediatric Nursing Speciality, and advisory body of the Ministry of Health comprised of nurses expert in paediatric care, gathered to develop the training curriculum. In 2010, Order SAS/1730/2010, of 17 June, was introduced, announcing the approval of the paediatric nursing speciality and publishing the educational curriculum (BOE of 29 June), calling for 2 years of full-time training in multidisciplinary paediatrics teaching units (MPTUs) accredited to provide specialised training in paediatric nursing.

Specialised training in paediatric nursing can be accessed through the nursing intern/resident (NIR) programme by passing a nationwide competitive examination held by the Ministry of Health on a yearly basis, which is available to candidates with a 2-year or 4-year degree in nursing or an equivalent title that is recognised either directly or through a credential evaluation process.

The curriculum includes the definition of the scope of practice: “a paediatric nurse specialist is a nurse qualified to provide specialised nursing care independently to children and adolescents at any level of care, including health promotion and prevention services, nursing care or rehabilitation of healthy or ill newborns, infants, children and adolescents as part of a multidisciplinary team and in collaboration with nurses in other specialities. It is also the professional that, with a responsible attitude based on scientific evidence, will lead the nursing care of newborns, children and adolescents, either healthy or experiencing acute or chronic illness or disability, qualified to plan, implement and evaluate health care programmes within the scope of paediatric nursing and carry out research and education projects to improve the quality of care and contribute to the progress of the speciality.”

Thirteen years have passed since the speciality launched, 1934 spots have been made available for the paediatric nursing NIR programme and, so far, 1477 paediatric nurses have become accredited through it (Table 1).

Table 1.

Competitive examinations for spots in the paediatric nursing NIR programme (2010–2023).

Competitive examination  2010  2011  2012  2013  2014  2015  2016  2017  2018  2019  2020  2021  2022  2023  Total 
Andalusia  11  28  28  23  23  24  24  26  26  26  27  27  29  31  353 
Aragon  –  71 
Canary Islands  –  –  –  –  –  –  –  –  –  –  10  11  10  39 
Cantabria  –  –  –  –  –  –  –  –  –  – 
Castilla-La Mancha  13  12  12  12  14  13  14  132 
Catalonia  –  12  12  15  15  15  15  17  17  17  23  27  37  41  263 
Extremadura  –  –  –  –  –  –  –  –  –  –  20 
Galicia  –  –  15  15  15  15  128 
Region of Murcia  –  10  79 
Balearic Islands  –  –  –  –  –  –  36 
Basque Country  –  –  –  –  –  –    10  10  10  14  60 
Principality of Asturias  –  –  39 
Castilla y León  10  13  14  107 
Community of Madrid  33  35  37  37  37  36  35  35  38  38  42  43  43  43  532 
Navarre  –  –  –  –  –  –  –  –  –  –  12 
Valencian Community  –  –  –  –  –  –  –  –  –  –  10  13  16  15  54 
Total SPOTS  52  98  105  106  107  112  114  128  133  133  188  201  223  234  1.934 
Source: Boletín Oficial del Estado (BOE, 2010–2023).

To this number, we must add the professionals who trained in the speciality under the provisions of Decree 3524/1964 of 22 October and who gained direct access to the current official speciality (RD 450/2005); 2554 nurses have obtained their credentials in paediatric nursing through this pathway.

Another route to access the speciality was created through the exceptional pathway contemplated in the second transitional provision of Royal Decree 450/2005, by which accreditation as a specialised paediatric nurse could be obtained by submitting proof of professional experience in the field and successfully passing an examination to demonstrate competence. This examination took place in 2015, and 9857 professionals obtained the corresponding accreditation as a specialised paediatric nurse this way.

At present, taking into account all possible pathways to accreditation, there are a total of 13 888 paediatric nurses, which is clearly insufficient to cover the needs of the child and adolescent population of Spain.

However, the greatest problem is that a substantial number of professionals trained in paediatric nursing do not have the opportunity to work in paediatric care, and therefore, the paediatric population cannot receive quality care from these specialists, who are unquestionably the most qualified for it. In addition, it is a waste of resources, both for these specialists and for the health care system, that investment and effort are put in their education only for them to not work in the field for which they have trained.

Since 2010, the Asociación Española de Enfermería Pediátrica (Spanish Association of Paediatric Nursing [AEEP]) has been advocating for the recognition of the professional category of paediatric nurse and the creation of posts and hiring of nurses specialised in paediatric care, not forgetting the need to create a pool of talent to cover temporary leaves.

There is no question that the slow and uneven development and implementation of the speciality of paediatric nursing in the different autonomous communities in Spain has a negative impact on the care provided to the child and adolescent population. All nurses in paediatric units should be specialists in paediatric nursing, especially in neonatal, intensive care, oncological, burn, palliative care or emergency care settings, among others.

It is also important to understand the impact in certain subsets of the child and adolescent population of the availability of paediatric nurses in health care facilities, both at the primary care and speciality care levels, their important role in health promotion and in the care of paediatric patients with chronic and/or medically complex conditions, improving the quality of care.1–4 Another aspect to consider is the substantial reduction of adverse events in paediatric patients managed by paediatric nurses.5,6

Given the significant advantages that presumably come with having specialised paediatric nurses on staff, we can only interpret the failure to place paediatric nurses in care settings serving children, adolescents and their families at all levels of care a serious mistake on the part of the National Health System. We cannot continue to squander training and talent, frustrating all involved parties, from the trained paediatric nurses and the professionals of training units to all the care settings that await the arrival of paediatric nurses. Decisions regarding staffing must be guided by the scientific evidence and rigorous evaluations of the outcomes of the care delivered by paediatric nurses.

In conclusion, we are advancing slowly, and as paediatric nurses need to continue working and fighting for the development of the paediatric nursing speciality, advocating for an increase in NIR spots, the creation and filling of paediatric nurse positions in every care setting, including schools, and particularly demanding that paediatric nurses fill all the nursing positions in paediatric care services, especially in hospital-based units. There is no question that paediatric units in which specialised paediatric nurses work in collaboration with paediatricians are the ones that can offer the highest quality of care.

For all of the above, from the AEEP we call the agents involved in making these decisions and offer them our collaboration to achieve the actual and prompt establishment of paediatric nursing specialists throughout the Spanish territory.

Conflicts of interest

The authors have no conflicts of interest to declare.

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