Guide to Advanced Practice Pediatric Acute Care Nursing

Pediatric acute care nurse practitioners (PACNPs) care for pediatric patients suffering from severe illnesses and injuries in critical care settings such as the pediatric intensive care unit (PICU), emergency departments, trauma centers, and urgent care departments. PACNPs’ typical responsibilities include completing intake assessments and ongoing health evaluations, diagnosing patient conditions, developing and implementing patient care plans, administering treatments, and completing medical procedures.

Due to the high acuity of the conditions they treat, PACNPs tend to work very closely with children and their families throughout their patients’ tenure in the hospital. They typically collaborate as part of a larger team of health care providers, including physicians, registered nurses, and medical assistants. Pediatric acute care nurse practitioners can also engage in program development and take on leadership roles to guide and train other members of the medical team. While most PACNPs work under the supervision of a physician in a hospital setting, some states allow nurse practitioners to practice independently and to have prescriptive authority without physician oversight.

Pediatric acute care nursing is a challenging and fast-paced field that can be stressful due to the severity of the conditions PACNPs encounter and treat on a daily basis, and the emotional difficulties of caring for vulnerable children whose recovery is uncertain. Yet the rewards of the profession include saving the lives of children and/or dramatically improving their well-being, witnessing children’s positive progress and resilience, and making meaningful connections with colleagues and patients’ families. The intellectual challenge of the job can also be energizing for individuals who enjoy being kept on their toes and constantly engaged in work that has a profoundly positive impact on their community.

To become PACNPs, registered nurses must enroll in a Master of Science in Nursing program, a Doctor of Nursing Practice program, or a post-master’s certificate program with a concentration in pediatric acute care nursing. Their graduate nursing program must be accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN) and include at least 600 hours of clinical practicum. After completing their graduate school program, prospective PACNPs must obtain certification through the Pediatric Nursing Certification Board (PNCB) or the American Nurses Credentialing Center (ANCC), and also obtain any requisite state-based licenses prior to practicing as a nurse practitioner. Once they have earned their certification, pediatric acute care nurse practitioners must re-certify through the PNCB or the ANCC by fulfilling a certain number of clinical hours and completing continuing education courses and modules (including a minimum number of hours of pediatric pharmacology), and submitting a certification renewal application.

Where Pediatric Acute Care Nurse Practitioners Work

where-do-pacnps-work-810x300Pediatric acute care nurse practitioners typically work in hospital settings, in departments that provide specialized and/or intensive care to pediatric patients, such as the pediatric intensive care unit (PICU), well-newborn nurseries and neonatal intermediate care units, Pediatric Surgery Departments, and Pediatric Emergency Departments. Pediatric acute care nurse practitioners can also work in general acute care divisions and units such as the Emergency Department, as well as Burn Units, Trauma Units, and Surgical Departments.

Different hospitals are structured differently, depending on the resources and facilities they have available and the communities they serve. Some hospitals may have specific departments devoted to pediatric care, while other large medical centers may have a designated children’s hospital that provides care to all patients from infancy to early adulthood (18 to 21 years of age) through multiple divisions for pediatric oncology, cardiology, pulmonology, gastroenterology, and more. Depending on their work setting, PACNPs may work across several departments, teams, or clinics, or stay within one specialized clinic or care unit. Below is a more in-depth description of some of the main medical environments in which PACNPs work.

Pediatric and Neonatal Intensive Care Units

The pediatric intensive care unit is one of the most common work settings for PACNPs. The goal of the pediatric intensive care unit is to stabilize patients whose lives are in danger due to their health condition, so that they can receive additional treatment from other more specialized care teams; as a result, pediatric intensive care units are also closely linked to other critical care services in hospital settings, such as surgical, pulmonary, cardiovascular, and gastroenterology departments, burn and trauma units, and other specialized, high-level care teams.

Most PICUs treat patients experiencing a wide range of critical illnesses and conditions, ranging from traumatic injuries to severe exacerbations of pulmonary or gastrointestinal conditions. However, in addition to a general PICU, some hospitals also have specialized PICUs that provide more intensive care for certain types of diseases and conditions; examples of such specialized PICUs include Pediatric Cardiac ICUs and Pediatric Pulmonary ICUs.

PICUs offer a suite of medical services, including but not limited to mechanical ventilation, dialysis, cardiac and respiratory monitoring, and other critical care life support. PACNPs in pediatric intensive care units work in collaboration with pediatric critical care intensivists and other physicians, pediatric nurse practitioners, critical care nurses (CCRNs), respiratory therapists, nutritionists, physical therapists, social workers, family care specialists, and hospital chaplains. PACNPs, physicians, CCRNs, and other medical staff in PICUs often work in shifts so that patients have constant access to care if needed, and discuss plans of care for each patient on a regular basis. Some pediatric intensive care units have lodging and support services for parents who wish to visit their children in the hospital and participate more closely in their children’s medical care.

PICUs are challenging and fast-paced environments that require PACNPs to be able to multitask and address rapid escalations of patient conditions on a moment’s notice. Jennie Joyner, MSN, PACNP-BC, worked for over three years in the Pediatric Intensive Care Unit at Dell Children’s Medical Center. In an interview with, she described the intense and dynamic nature of her work setting. “The PICU is a fast-paced environment that requires impeccable attention to detail and the ability to stay flexible in the midst of organized chaos at times. You can go from managing a child with status asthmaticus to placing a child on ECMO (Extracorporeal Membrane Oxygenation) post cardiac surgery to preparing for multiple trauma cases to arrive at the same time from a motor vehicle collision,” she said, “The PICU is definitely a great place for those who thrive on adrenaline and those who are able to think and respond quickly, calmly, and effectively in highly stressful situations.”

Jessica Dean Murphy, MSN, PACNP-BC is a Pediatric Acute Care Nurse Practitioner who oversees a 6-bed Pediatric Intensive Care Unit at Sinai Hospital in Baltimore. In an interview with, she explained her daily responsibilities. “I function as an independent practitioner (similar to a physician) to manage a 6 bed pediatric intensive care unit. The scope of practice for a nurse practitioner currently varies state-to-state. I am fortunate that I have always practiced in Maryland, a state that recently passed a Full Practice Authority Act, giving nurse practitioners the ability to be used to the full scope their training intended,” she said, “In my current role, I am responsible for managing critically ill children aged 1 week to 21 years. […] I work as part of a multidisciplinary team including nurses, respiratory therapists, social workers, physical therapists, child life specialists, and attending physicians (doctors).”

Though not formally trained in advanced practice neonatology, pediatric acute care nurse practitioners may also work with infants in well newborn nurseries and neonatal intermediate care units, caring for neonates or slightly older infants with mild to moderate conditions that do not require intensive care. In her interview with, Jennie Joyner explained how her current position involves taking care of late term infants, and described how her pediatric acute care nurse practitioner certification has given her a flexible skills set that has applied to a wide range of work settings. “As a Pediatric Acute Care Nurse Practitioner at St. David’s North Austin, I cover the newborn nursery. Typically in the newborn nursery, I see term and late preterm infants (>35 weeks gestation) from birth through the first few days of life. I have a lot of autonomy in this particular role as a PNP in that I see the babies and families independently,” she said, “I chose to pursue the Pediatric Acute Care NP degree because I knew I wanted to have the ability to practice in an acute care setting but also wanted the flexibility to work in many different environments, where the Neonatal NP route would have limited me to neonates only.”

Dr. Lisa Ring, DNP, CPNP, AC-PC is a Pediatric Nurse Practitioner who worked in the neonatal intermediate care unit at WakeMed Health and Hospitals prior to her current role at Children’s National Health System. In an interview with, she explained the overlap between the training that pediatric nurse practitioners and neonatal nurse practitioners receive. “PNPs are trained and educated to provide health and illness care for pediatric patients, so there is some overlap with the primary and acute care PNP roles for neonates, infants and toddlers,” she said. As a nurse practitioner who is dually certified in pediatric acute care and primary care, Dr. Ring noted that she had additional flexibility in terms of work settings upon completion of her graduate program. “Since I was certified in primary pediatric care, my practice at WakeMed mainly focused on the care and management of newborns in the newborn nursery,” she said.

Emergency Departments

Pediatric acute care nurse practitioners can also work in Emergency Departments, providing treatment services to and coordinating the care of pediatric patients who come to the ED for traumatic injuries, life threatening illnesses, and other conditions that require immediate care. Pediatric acute care nurse practitioners may work in triage, where patients are evaluated and transferred to the care team(s) that can best address their health issue, or they may work in the trauma or acute care sections of the ED to help stabilize patients before they are transferred to the PICU or other hospital department.

Kristen Campbell, MS, PNP-BC is a Pediatric Nurse Practitioner at New York Methodist Hospital, where she coordinates patient intakes, discharges, and transfers; provides diagnostic assessments of acute and sub acute patients; makes medical diagnoses; writes prescriptions; and conducts emergency care procedures to address lacerations, fractures, and other injuries and illnesses. “As a PNP in the Pediatric ED, I am responsible for assessing the physical and psychological status of acute and sub-acute patients,” she said in an interview with, “On a typical day, our team is made up of an ED attending physician, a pediatric nurse practitioner, a pediatric or emergency medicine resident, a pediatric emergency medicine fellow, two nurses, a tech, and some students. I am fortunate to work with a relatively small and very tight team. Each person has a role but we overlap in our responsibilities constantly, always working together to provide the best and most efficient care for our kids and their families.”

Specialized Care Departments and Clinics

In addition to PICUs, NICUs and nurseries, and Emergency Departments, pediatric acute care nurse practitioners can work in specialized departments within hospitals that serve pediatric patients suffering from specific and complex ailments. As mentioned previously, hospitals are structured differently, and some have entire divisions devoted to helping children struggling with diseases and disorders of a particular type (ex. allergies) or a particular body system (ex. gastrointestinal, cardiovascular, neurological disorders, etc.). Pediatric acute care nurse practitioners may find that their training prepares them well to work in care settings that support pediatric patients struggling with severe or complex conditions affecting one body system.

Shanda Wilson Sandridge, MSN, CPNP-BC is a Pediatric Acute Care Nurse Practitioner who works in the Pediatric Gastroenterology Department at the University of Mississippi Medical Center (UMMC). In this role, she helps her pediatric patients and their families to address digestive disorders, as well as overweight and obesity. In an interview with, she described how she works in several different divisions and clinics in the Gastroenterology Department. “I work in several different roles in the Pediatric Gastroenterology division. I split my time between working with a new Pediatric Obesity Program and the Pediatric Motility Program,” she said, “I also have 1 outpatient clinic where I see patients with general GI complaints such as abdominal pain, GERD, constipation, etc.”

Dr. Ring has worked for over 17 years at Children’s National Health System, where she has served patients across multiple acute care departments, including the Division of Cardiovascular Surgery, the Division of Plastic and Reconstructive Surgery, the Division of Pediatric Surgery within Burn/Trauma Services, and Emergency Medicine. In her interview with, Dr. Ring explained how, while her patient populations and the conditions she treats change according to her work setting, the principles and core care methods of pediatric acute care nursing translate fairly seamlessly across the different roles and acute care settings serving pediatric patients. “Although I have worked with various specialties, I have remained in acute care. I have brought lessons and knowledge learned from and to each position,” she said, “Each clinical role has been structured differently; however, I have been able to apply the foundations of the role of the acute care PNP to each one.”

Prior to her current position in the Gastroenterology Department, Ms. Wilson Sandridge worked in the Pediatric/Fetal Surgery Department at UMMC. In her interview, she described how she collaborated with numerous specialists in order to provide care to pregnant women encountering complications with their pregnancy. “As a Nurse Practitioner in Fetal Surgery, I worked closely on a multidisciplinary team that included Maternal Fetal Medicine (MFM), extracorporeal membrane oxygenation (ECMO) specialist, Neonatologist, Surgeons, Palliative Care, and Social Work. Our job was to take care of pregnant women who were carrying babies with fetal anomalies and ensure that the Mom and Baby were taken care of pre and post-natal,” she told

What Pediatric Acute Care Nurse Practitioners Do

what-do-pediatric-acute-care-nurse-practitioners-do-810x300Pediatric acute care nurse practitioners perform a wide range of essential medical tasks and care coordination responsibilities in both inpatient and outpatient settings. These responsibilities include completing patient intake assessments and ongoing health assessments, providing direct care to address acute conditions and exacerbations of chronic conditions, coordinating the care of multiple patients, and serving as the point of contact between numerous parties involved in a patient’s care (ex. surgeons, pediatricians, critical care registered nurses, social workers, medical assistants, etc.). PACNPs can also lead and train hospital staff, develop medical care and health improvement programs, and participate in nursing education in either academic or hospital settings.

The many responsibilities that PACNPs fulfill mean that their workweeks are often quite varied and dynamic, requiring practitioners to balance patient care with ongoing health care improvement initiatives and staff education and training. While challenging, this variety can also present opportunities for professional growth and be highly engaging for individuals who enjoy a fast paced work environment. In her interview with, Dr. Ring explained the many tasks she fulfills in her role on the Cardiovascular Surgery (CVS) unit at Children’s National Health System. “In [my] current role, I collaborate with a team of PNPs, highly trained staff nurses, cardiologists and the CVS surgeons to provide daily care coordination and management for post-operative cardiovascular surgery patients on an in-patient unit,” she said, “I have the opportunity to utilize my experience as an acute care provider to provide daily continuity of care. In this role, I am also able to apply my wound expertise as well as develop and promote efforts to improve clinical practice. I also have the opportunity to teach.”

Below is a more detailed description of the core responsibilities that PACNPs have in both inpatient and outpatient medical settings.

Health Assessments and Diagnoses

One of the core responsibilities of pediatric acute care nurse practitioners is conducting health assessments upon a patient’s admission into an intensive care setting, such as the Emergency Department or a PICU, and taking ongoing assessments to evaluate a patient’s improvement over time. Accurate and holistic health assessments are important because they enable patients to receive customized care that matches the type and severity of their condition.

When completing health assessments, PACNPs conduct a physical exam, interview pediatric patients and their families to get a thorough medical history, and complete any additional tests necessary to get a comprehensive picture of their patients’ physical, psychological, and social health. Kristen Campbell, MSN, PACNP-BC explained how her care of a patient necessarily begins with a thorough physical and mental health evaluation. “As a PNP in the Pediatric ED, I am responsible for assessing the physical and psychological status of acute and sub-acute patients,” she said, “During an assessment, I evaluate a patient’s history, conduct a physical exam, and order and interpret diagnostic tests.”

After completing the health assessment, pediatric acute care nurse practitioners make diagnoses that then determine the type and level of treatment a patient requires. Many PACNPs serve patients across a wide age spectrum, ranging from infancy to young adulthood, and hence they have strong knowledge of the typical health challenges that children, adolescents, and young adults typically encounter. “I diagnose and initiate appropriate treatments for any patient under 21 years of age, whether they are a 3 day old with hyperbilirubinemia or a 20 year old with an ectopic pregnancy,” Ms. Campbell explained.

Direct Care Services

PACNPs perform procedures and administer treatments to stabilize patients who have a life threatening condition or to address severe injuries and illnesses. Typical procedures that PACNPs may perform on the job include but are not limited to endotracheal intubations, pulmonary artery line placements, central line placements, arterial punctures, lumbar punctures, laceration sutures, splinting of injuries, tracheostomies and cricothyrotomies, and nerve blocks. “I independently perform standard emergency room procedures such as laceration repair, splinting of non-displaced or reduced fractures, incision and drainage of abscess, and foreign body removal,” Ms. Campbell said, “I also provide procedural sedation, reduce displaced fractures, and perform lumbar punctures in collaboration with our attending physicians.”

Some of the complex procedures that PACNPs complete do not treat a disease or condition, but instead monitor the progression of a chronic but severe condition. Ms. Wilson Sandridge explained how some of the procedures she completes in the Gastroenterology Department at UMMC allows her to better understand and address certain digestive disorders that her patients encounter. “One of the procedures I perform independently is Anorectal Manometry,” she said, “This test is done on children that have chronic constipation and/or fecal incontinence. After inserting a catheter into the rectum we are able see how the muscles and nerves work in the rectum. If the muscles are not being used correctly, we offer pelvic floor biofeedback or neuromuscular re-education using EMG stickers.”

Patient and Parent Education

In addition to providing direct care services, PACNPs also educate patients and their parents or caretakers about the effective management of chronic and/or pediatric conditions such as overweight, obesity, diabetes, asthma. Educating patients and their parents on healthy lifestyle choices and holistic measures to address children’s health challenges is an important part of a pediatric patient’s overall care. While the intensive medical care that PACNPs provide is important for stabilizing children who are experiencing severe and/or life-threatening conditions, once children are discharged from the hospital, making environmental and lifestyle modifications insofar as possible to treat the underlying causes is a crucial part of their overall medical care and wellness plan.

In her interview with, Ms. Murphy explained how the pediatric condition she encounters most frequently is asthma, and how she educates family members around preventing asthma attacks and effectively managing this chronic condition. “The most frequent types of patients that I manage are children with severe, life-threatening asthma attacks, since Baltimore City has a very high asthma rate,” she explained, “These patients and their parents and other family members often require a great deal of education about what things can trigger asthma and how to avoid them, why it is important for family members to not smoke, that smoking outside the home is still harmful to children with asthma because the smoke lasts on clothing, and how important it is to take asthma seriously. […] As part of our team, social workers help offer resources to quit smoking and ensure families can afford their asthma medications. I also talk with the patients’ primary care provider to ensure follow-up and referral to a pulmonologist when necessary.”

Care Coordination

Care coordination is defined as the organization of different health care practitioners, teams, and services around a given patient and his or her conditions to facilitate effective delivery of medical care services. As coordinators of care and leaders in pediatric health care settings, PACNPs direct nurses and medical staff in the care of pediatric patients, monitor the health of patients during their stay in the hospital, communicate regularly with physicians to develop and modify patients’ plans of care, and also organize and collaborate with other parties that support patients, such as medical social workers, hospital administrators, and hospital-based religious support staff.

During her time as a PACNP in the PICU at Dell Children’s Medical Center, Jennie Joyner completed a wide range of tasks and care coordination responsibilities to ensure patients received comprehensive medical support for their conditions. “[My team and I] would manage the entire patient throughout their stay in the PICU, adjusting ventilators, ordering medications, imaging, or therapies. We would also be responsible for consulting other specialties and helping to coordinate care, as well as writing daily progress notes along with admission and discharge notes, and updating parents,” she said, “I would admit patients directly from the ER along with those transferred from other units as needed.”

PACNPs also help coordinate patients’ discharge from an acute care setting to either a hospital ward or home, and their responsibilities can even extend beyond their patient’s discharge from inpatient care. During her time as a PACNP in the Fetal/Pediatric Surgery Department at UMMC, Ms. Wilson Sandridge completed a myriad of tasks in collaboration with multiple critical care teams. “If a patient needed surgery before delivery or immediately after delivery, I would coordinate the delivery with the surgeons, ECMO team, NICU, and MFM (maternal-fetal medicine team) to make sure things were done as smoothly as possible to help decrease complications and delayed care,” she said, “I also followed the baby closely after surgery each day during rounds until he or she was discharged home. Most babies were sent to the NICU after delivery where the neonatology and surgical teams managed the care of the newborn until they were able to be discharged.”

Pediatric acute care nurse practitioners also provide support and guidance to pediatric patients and their families. Acute illness and/or injury can be incredibly stressful for children and their caretakers, and PACNPs make inpatient treatment and the process of recovery less daunting for both parties by educating children and parents about different treatments and procedures, how long patients can expect to stay in the hospital, how the discharge or transfer process will progress, and what resources are available to them in both the hospital and the community for support.

Staff Leadership and Education

In addition to their care coordination responsibilities, which inherently involve leading medical staff in the care of patients, PACNPs can serve as educators for other nurse practitioners, as well as medical students and residents. “I also helped teach residents, medical students, nurses, and NP students during my time in the PICU,” Mrs. Joyner said, “Teaching is a great way to reinforce your own knowledge as well as help others.”

PACNPs can also find opportunities to teach in academic settings. Dr. Lisa Ring is an Adjunct Clinical Professor at The Catholic University of America, where she both helped to develop and subsequently taught classes for their Pediatric Acute Care Nurse Practitioner program. “While in the pediatric ED, I became an item writer for the Pediatric Nurse Certification Board (PNCB). This experience led to my being recruited to participate during the development of the pediatric acute care exam,” she explained, “A few years later, I was asked to both help develop and implement the first acute care PNP track at The Catholic University of America, which I did until 2014 as I wanted to finish my DNP.”

Program Development

Depending on their work setting, PACNPs may also have the opportunity to improve patient outcomes and health care delivery processes on a more administrative level by initiating or engaging in programs that seek to streamline the medical care process, educate patients, and/or better prepare hospital staff to care for patients’ needs efficiently.

During her time as a pediatric nurse practitioner on the Wound Team at CNHS, Dr. Ring helped to improve medical record taking and communication systems within the team, and also participated in the development of a new clinic to facilitate with patient discharges and transfers. “While [working as a PNP on the Wound Team], I developed standardized electronic consult and progress notes to optimize continuity and communication of care,” she said, “I also helped to establish an outpatient wound clinic, where discharged patients could be followed up.”

The Challenges and Rewards of Pediatric Acute Care Nursing

challenges-of-advanced-practice-pediatric-acute-care-nursing-810x300Advanced pediatric acute care nursing is an intense and challenging field for many reasons. The time commitment, the complexity and severity of patients’ health challenges, and the emotional strain of working with children suffering from life threatening conditions and managing their families’ stress can take a physical and mental toll on practitioners. Registered nurses who become pediatric acute care nurse practitioners may also find that the transition from being an RN to being a provider presents a considerable challenge due to the added responsibility of developing and implementing a patient’s plan of care. “The biggest challenge I faced when transitioning from a nurse to nurse practitioner was not having the self-confidence to make critical decisions independently regarding patient care,” Ms. Wilson Sandridge recalled of her first months stepping into a new role as a pediatric nurse practitioner.

On the other hand, the challenge and variety that this position typically offers, and the gratification of saving or dramatically improving the lives of children are reasons that many PACNPs love their job and stay committed to the field in the face of its numerous challenges. “I would say to any prospective students interested in becoming a pediatric NP, that it is a lot of work, but so rewarding and there is so much opportunity to influence positive health outcomes and give holistic care if you open yourself to it,” Mrs. Joyner told, “I have often said I have the best job in the world right now; I get to say ‘Congratulations’ everyday. How many people can say that about their day to day?”

The energy, innocence, and emotional resilience of their patient population also keeps many PACNPs happy and engaged in their job. “The most rewarding aspect of working in pediatric medicine is the kids! I love playing games with a 3 year old to assess his neurological status after a head injury. I love making up stories and singing Frozen’s ‘Let It Go’ to distract a 6 year old as I put in her first stitches,” said Ms. Campbell, “I love that, even at their sickest, most kids still have hope and want to play. No matter how busy or difficult a day is, there will always be another kid that will walk through the door and put a smile on your face.”

Ms. Murphy cited children’s natural optimism and emotional strength, as well as the gratitude she has received from patients and their parents, as primary reasons she remains energized and committed to her work. “Children are extremely resilient, and are much stronger than adults. They can go from the brink of death to asking you to play with them within hours. That has always been and will continue to be my greatest reward,” she said, “I keep every drawing, card, sticker, and any other trinket that I have ever been given by a patient, and I will hold them in my heart forever. Being thanked by parents for helping bring their healthy child back to them is also extremely rewarding.”

Pediatric acute care nurse practitioners, due to their additional training and increased ability to lead medical teams and improve of systems of care within their hospital, can also find a lot of gratification in seeing their work have a deep and far-reaching impact. Dr. Ring noted in her interview how her work to improve medical record-taking and communications between providers and her efforts to establish additional outpatient clinics for patients have been very rewarding. “Due to clinical and family experiences, I have had the opportunity to identify areas where we can make changes to improve patient experiences. To see work that you have collaborated on or helped to facilitate be successful in making a difference is gratifying and reinforces why always being willing to learn and adapt is so important in nursing and healthcare,” she said.

The intellectual challenge and varied nature of the job can provide an ideal work environment for individuals who enjoy consistent opportunities for professional development and growth. In her interview with, Mrs. Joyner explained how she thrived on the fast-paced and at times stressful nature of her job in the PICU. “I loved the variety, the procedures, the critical thinking of the ICU setting, and the physiology. I also do really well under pressure and I am able to make focused decisions in the midst of chaos; that type of mentality is crucial in the ICU setting,” she said.

Advice to Registered Nurses on Becoming Pediatric Acute Care Nurse Practitioners

advice-for-students-interested-in-pediatric-acute-care-nursing-810x300Registered nurses who wish to become PACNPs must enroll in a graduate nursing program that offers a concentration in pediatric acute care, and is accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). During their program, prospective PACNPs must complete at least 600 hours of clinical practicum in settings that are relevant to pediatric acute care nursing, such as PICUs and other Intensive Care Units, Burn and Trauma Units, Emergency Departments, Surgical Departments, and other medical settings that treat pediatric patients suffering from severe and/or complex injuries and illnesses. After graduating from their graduate nursing program, RNs must then apply for certification through either the Pediatric Nursing Certification Board (PNCB) or the American Nurses Credentialing Center (ANCC). In addition to national certification, PACNPs must obtain and maintain state-based credentials in order to practice pediatric acute care in their state of residence.

In addition to the minimum requirements described above, prospective PACNPs can increase their competitiveness in the job market by gaining additional experience through volunteering in relevant settings, networking proactively with people in their current place of employment and during their clinical practicums, and studying well ahead of time for their certification examinations.

“My best advice is to say yes and be proactive! Take the opportunities that are given to you and seek out the experiences you feel passionately about. The more experience and exposure you get, the more you will learn what your interests are and how to care for others. Spending time in various settings and with different populations will help you find out what fills your cup,” Ms. Campbell said, “Take on volunteer work and externships, but only if you want to. Your heart has to be in it for it to be a worthwhile experience. Learning how to engage patients and families, how to have difficult conversations, and how recognize different levels of acuity will be invaluable as you start your career.”

Dr. Ring similarly encouraged prospective PACNPs to take advantage of any shadowing experiences available in their workplace, and to engage in volunteer experiences in order to build their clinical skills, gain better insight into pediatric acute care as a field, and to make valuable connections with practicing PACNPs. “Many of my opportunities and experiences have come about because of someone I met or from a learning experience I took advantage of,” she said, “Volunteering in an acute care environment will provide a great experience and also give students an opportunity to see how different providers and team members work together. Our organization offers clinical observation opportunities and also has volunteer positions and this is a great way to get your “learning” foot in the door.”

Fully researching and understanding one’s scope of practice as a PACNP in one’s state of residence is also very important. Ms. Wilson Sandridge advised RNs interested in pediatric acute care nursing to research and gain a solid understanding of how the nurse practitioner role has evolved and will continue to evolve in subsequent years in the healthcare industry.

“Stepping into the role of an NP can overwhelming because the roles are so different and vary from state to state. While some states allow NPs to practice independently, others have restricted practice,” she said, “There are national and state organizations that have the sole purpose of advocating for nurses and NPs. These organizations focus on practice issues, public relations, and lobby with state legislatures. My advice is to get involved with these organizations early on so that you can have a better understanding of what is going on around us in healthcare.”

Once they become certified and are practicing in acute care environments, new PACNPs may feel some stress around being leaders in the health care setting, where they are now required to make executive decisions in situations where previously they simply had to implement rather than create a patient’s care plan. Ms. Wilson Sandridge recommended that new PACNPs seek the support of colleagues and their supervisors should they ever have questions or uncertainties around their new role. “Initially it was difficult for me to be ‘the one’ making decisions because for so long in my nursing career, there were other people making the decisions for me,” she noted, “Further into my career as an NP it became much easier to make those difficult decisions and I realized that if there was something I wasn’t sure of, all I have to do is ask.”

PACNPs at all stages of their career should also setup support systems and establish healthy self-care habits in order to maintain resilience and reduce the chance of burnout. “Take time for yourself and know your support system and your outlets. Whether it’s yoga, journaling, meditation, exercise, a good book, date night, dancing, or roller derby (my personal choice), you need to care for yourself to be able to care for others,” Ms. Campbell advised, “You will have days that exhaust you and cases that break your heart, but have confidence in yourself and know that all the challenges are worth it.”

About the Author: Kaitlin Louie is the Managing Editor of, and creates informational content that aims to assist students in making informed decisions about graduate programs. She earned her BA & MA in English from Stanford University.