My Specialty

Pediatric Acute Care Charge Nurse, Tami Hitchcock, Loma Linda University Children’s Hospital

Treating and nurturing sick and injured children

Please tell us about the trajectory of your nursing career.

I’ve always wanted to work in pediatrics. I love kids.  I originally went to UC Riverside and earned a B.S. in biology in order to prepare for medical school. Towards the end of that program, I realized the differences between what doctors and nurses do. Since I wanted the more personal, hands-on approach, I changed course towards the nursing profession.

I began my nursing career at Loma Linda in 2007 as a member of the RN residency program on the acute care pediatric unit. I chose Loma Linda because I had positive memories from when my brother was a patient there. The residency really prepared me to step out as a new nurse. Through that experience, I had mentors who were available for questions and concerns, so I never felt alone. I was able to begin my career with confidence and a solid grounding of skills and knowledge.

When did you first assume charge nurse duties?

A couple of years in, I began serving as a preceptor for new grads and students. A few years after that, I became a team leader and relief charge. Then, after my youngest child was born, I began working as a charge nurse.

What are your responsibilities?

Because our unit is very large, it’s divided into three smaller units with a total of 76 beds. I’m in charge of all three units, managing anywhere between 12 and 21 nurses, plus a fair number of nursing assistants. Our managers create our schedules, but I do the patient assignments.

As charge, when families aren’t following the rules or are otherwise going against the grain, I have to go in and explain our policies. People generally aren’t too happy with me in those moments. Our nurses make it a priority to be compassionate and present for families, but we don’t always have the answers they want to hear.

What common diagnoses and conditions do you frequently see?

It’s a very diverse unit without any specific specialty. We see a great deal of trauma; pre- and post-surgical patients; and infectious diseases like meningitis, Kawasaki disease, influenza, rhinoviruses and enteroviruses. We also deal with cystic fibrosis, short bowel conditions, complications from birth anomalies, new-onset diabetes and seizure disorders. Kids on ventilators are in stepdown, but we do care for patients with trachs.  We have a video monitoring room for patients with seizures; they’re on leads and we can monitor them through our video interface. However, our facility has separate units for oncology and pediatric ICU. I prefer working with the kids who are able to be up and running around.  Sadly, we also frequently see kids who are victims of physical and sexual abuse.

Seeing kids who’ve been abused must be one of the hardest things you experience.

It’s so painful to hear their stories. When they come in, they’re usually closed off and afraid. As you care for them, they begin to light up. Then, as you gain their trust, you can get them to smile and interact more. It’s a real blessing to watch them become open to being cared for by good people they can trust.

Nursing Education

It makes me sad and angry that there are terrible people in the world who can do such awful things to innocent, vulnerable children. If I get a second to pick the kids up, I hold them and rock them, but it’s honestly hard. You think of your own kids and how you’d feel if someone did such things to them. I always come home and hold my kids close.

As the mother of three young children, how does it impact you to see children sick and suffering?

My three daughters are 5, 7 and 10. With many of our patients in the same age group, it definitely affects me.  As a nurse, you just know too much and can always think the worst when your kids get sick. However, being a mother also makes me more compassionate towards the parents we see on the unit.  Due to their stressful situations, they may not be the in the best mood, but I can easily put myself in their shoes. These parents are understandably frightened, confused and exhausted. Compassion is the key to getting through to them to offer support.

What do you love about working with children?

Kids are so innocent, sweet and resilient. They want to play and be happy even when they’re suffering. Even when they’re sick and scared, they’ll get up out of bed, smile and run around if their health allows for it. You just don’t see that in adult patients.  If we can help kids get even a little better, we can give them the capacity to still find joy and pleasure in life.

When kids are sick in the hospital, how do they stay entertained and occupied?

We have a playroom for kids who are not in isolation. There are video games, arts and crafts and lots of toys. Our patients can paint and do art in their beds, and some rooms have Wii or Xbox systems. We can also check out toys for kids who are in isolation. On Tuesdays, we have the Healthy Humor Red Nose Doc clowns, as well as various fun events for kids. Build-A-Bear Workshop brings teddy bears to the hospital, along with supplies for the kids to dress up the bears and play with them.

Other organizations provide people in superhero and other character-based costumes, as well as volunteers who come to the unit to play with the children or hold babies. Christmas brings a lot of toy donations, of course, as well as decorations and gingerbread houses the kids can make. Santa always comes to visit, and local police often arrive with gifts.

There are always special holiday events, including some of the doctors and surgeons dressing up and handing out toys. In the fall, we have seasonal events for the kids that include prizes, arts and crafts, and treats.

How do you care for yourself and encourage your nurses to do the same?

There are always times when you’re not doing well because you’re so busy, but you need time for yourself to relax and recharge. We’re always caring for others; what about us?  My staff feels very comfortable with me and feels free to pull me aside if they’re having issues. We have an employee assistance program for counseling, and I always offer that as a potential avenue to unload and talk things through.

Some things we see are so hard to process and accept. If we have an especially difficult case, we hold debriefings with the chaplain, especially for the nurses who were directly affected.  For strengthening unit camaraderie, we throw parties and showers for staff having babies or getting married. We collect money if the family of a staff member needs support with funeral expenses. We like to show one another we care.  This is our job, of course, but we’re also like a big extended family that spends a lot of time together, often under stressful circumstances.

What happens when a pediatric patient dies?

It doesn’t happen a lot on our unit, but when it does, we bring in the chaplain and schedule debriefings for both day and night staff so that everyone gets the chance to process the experience.

What is it like to have to discipline a staff member?

Fortunately, the managers do more of the formal write-ups. I’ve never had to fire someone — others do that. However, on a day-to day-basis, if someone isn’t quite on track, I approach them in order to help, not criticize. I like to be there as a source of support and education so that our staff can do better. I’m not a fan of punishment. Overall, I think most nurses aren’t making mistakes purposefully; they just need more guidance. Correcting someone isn’t my favorite thing to do, but if you see them improve, you know you’ve helped them.

As a leader, I don’t dictate or yell and scream. Compassion is so important in this role. You can help people be better rather than just telling them what they’re doing wrong.

How and where did you learn your leadership style?

I try to emulate the good mentors and strong role models I’ve had throughout my career. For example, not long ago, we had a nursing director who had a very special demeanor when dealing with upset people. She was able to listen very well to their problems and complaints, make them feel heard and then solve problems without causing a ruckus. She was confident and approachable. I learned a lot from her.

What are your plans for your career? Is there more you’d like to learn?

I’m currently in school to become an acute care pediatric nurse practitioner. With three small children and fulltime work, I take classes one at a time, so I’ll finish in June 2021. I hope to stay at Loma Linda and work in the new facility we’re building.  Pediatrics is my passion, but I haven’t decided on a specialty yet. I am currently leaning towards general pediatrics. Helping abused kids and doing forensics interests me, but I’m not sure I could do that on a daily basis.

What makes you happy and what do you do for fun?

My kids are my life outside of work. All three dance, and one of my favorite things is to go watch them do what they love. I love my family.


Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.


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