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GME Best Practices: Pediatric resident/nurse shadowing program

At Penn State Children’s Hospital, pediatric inpatient providers and nurses work together every day to provide safe, high-quality care to the most acutely ill and injured children in central Pennsylvania. In particular, pediatric residents and inpatient nurses work together very closely, often under stressful circumstances. In late 2014 and early 2015, representatives from the Pediatric Residency and the Children’s Hospital inpatient nurses met to brainstorm ways to improve the quality of this critically important but sometimes challenging relationship.

One key realization that emerged from those discussions was that residents had a relatively poor understanding of what it is like to be an inpatient nurse, and that nurses had an equally poor understanding of what it is like to be a pediatric resident. To improve the residents’ understanding of both the knowledge and skills possessed by inpatient nurses as well as the challenges of being an inpatient nurse, Jenny Rex (Clinical Nurse Educator, Pediatric Intensive Care Unit and Pediatric Intermediate Care Unit) and Brandon Smith (Program Director, Pediatric Residency), developed a program for each new pediatric resident to spend an afternoon during their initial orientation period shadowing an inpatient nurse.

This annual shadowing program, which has now been conducted five times, is divided into three sections:

  • Facilitated discussion among the new residents, led by the Pediatric Residency Program Director and a Children’s Hospital nurse leader, focused on the residents’ observations as medical students. The facilitators base the discussion around the four questions below, while adding more specific questions or offering additional answers to assist with the discussion:
    • “Can any of you describe a potentially difficult nurse-physician interaction that you witnessed that went well? Why did it go well?”
    • “Can any of you describe a nurse-physician interaction that you witnessed go poorly? Why did that happen?”
    • “What are some valuable things that bedside nurses bring to patient care?”
    • “What are important things to do (or not to do) when working with inpatient nurses?”
  • One-on-one shadowing of an inpatient nurse. Residents are encouraged to carefully observe what the nurses are doing and to ask questions during downtime. Each resident is provided with a list of potential questions to address while shadowing, including questions about handoffs, patient assessments, time spent with patients/families, a variety of different challenges faced by inpatient nurses, and strategies for optimal communication between residents and nurses.
  • Facilitated discussion among the new residents about what they observed or learned when shadowing.

This program has been very well received by the residents and the nurses. Over time, a number of residents and nurses have requested a similar program that would give Children’s Hospital inpatient nurses the opportunity to shadow pediatric residents. A pilot program for Pediatric Intermediate Care Unit nurses has recently been authorized by Amanda Kells, the nurse manager. It is anticipated that this new program will begin in early 2020.

With questions regarding this program, email Dr. Brandon Smith at

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