Child Life on the PICC Team: A Reflection on Transitions and Holding a Unique Child Life Role in the Hospital


ACLP Bulletin  |  Spring 2023  |  Vol. 41, No. 2


Annah George, BA, CCLS
Cincinnati Children’s Hospital Medical Center

Untitled (1000 × 50 px) (1300 × 50 px)
Child life specialists know that transitioning to a new unit, team, or population creates its own set of challenges and difficulties. It can present many unknowns and leave you feeling unprepared and doubting your clinical skills. Recently, I made the transition from being the most senior staff member on a four-person outpatient surgery child life team to entering the world of my hospital’s PICC (Peripherally Inserted Central Catheter) team. I was ready for a change in my professional journey and wanted to work with a new patient population and set of challenges. The PICC team had previously used a child life specialist on their team; however, the position had been vacant for several months when I made the transition to this role. I was venturing into a team filled with vascular access professionals who had a different set of priorities, tasks, and personalities to learn and who provided services to patients all over the hospital rather than being part of a designated unit. I was no longer in an area where I felt confident in the population, procedures, and interdisciplinary staff . In this article, my goal is to share some of the difficulties I have faced in making this transition, strategies I have developed to cope and grow through these difficulties, and what I have learned as a professional.

The PICC team at Cincinnati Children’s Hospital consists of a small group of registered nurses who are specially trained to place PICC lines on patients. This procedure is either done at the bedside in one of our multiple critical care units or in an interventional radiology room using a fluoroscopy machine. Patients may need a PICC line for multiple reasons, and patients with a variety of diagnoses may require a PICC line. I quickly transitioned from supporting outpatients in a lower acuity setting to now supporting patients with signifcant diagnoses, in multiple critical care units, some of whom may have just received devastating news. I was unfamiliar with critical care patients at the time I joined the PICC team, and I needed to learn about the NICU, PICU, CICU, and oncology units. I spoke with the child life specialists on those units to help me learn and understand those populations, but I still felt alone on my new team. I was no longer surrounded by like-minded clinicians who shared my credentials and similar training, but rather skilled RNs with different backgrounds and priorities. In the past, I could easily debrief with my child life team and use them as a sounding board for my assessment and intervention ideas. On this PICC team, I quickly realized that I needed to find a new sense of confidence and trust in my clinical skills, as I did not have that group of child life specialists to consult with throughout the day.

I needed to develop strategies to navigate this new position. I had important goals of supporting patients and families, maintaining and growing my clinical skills, and establishing rapport and meaningful relationships with the PICC team. I immediately began providing procedural support for these patients and families when I joined; however, I was unsure of how to best advocate for the patients and how the dynamics of the PICC team would influence the support I provided. I spent much of my time in the first weeks and months observing my new team. I wanted to learn work styles, personalities, dynamics, and workflow. I knew that if I wanted to build a strong working relationship with this team, I first needed to understand them and learn everything I could.

I wanted to integrate slowly and respectfully. In my experience, coming on too strong on a new team can create feelings of animosity, intimidation, and distance. I got to know these nurses as people and as the highly skilled clinicians they are. I began building personal relationships with these nurses and remained as present as possible throughout the day. I stayed in their office during down time to listen to their challenges and work processes, and I accompanied them to procedures even when child life support was not needed. I observed everything they did throughout the day so I could fully understand the best ways to support the whole team. I wanted to make it clear that I was invested in this team and dedicated to providing support for these families. Through building relationships, I found “my people.” I found nurses who had an appreciation for child life, who understood how assessment was used to determine interventions, and with whom I could have open and candid conversations. Having these people allowed me to feel more confident in my support of patients, and I slowly started to feel stronger and more competent in my new role.

The fact that so much of this role was new to me created some clinical challenges. There were times I felt uncomfortable, said something wrong, or felt that I was in the way. This was the first time in my career that I was working with critically ill patients. I needed to regularly ask my new team what various machines and equipment were for, and I learned about equipment, diagnoses, and conditions that were new to me.

I learned to adapt my usually upbeat and energetic approach to be more calming and soothing and to advocate for lower stimulation in these ICU environments. Learning new skills and adapting old ones are growing pains that accompany any new role. I met these challenges with questions. I reached out to staff members that could help me learn and give me guidance on the best ways to understand and support these new populations. I asked questions about what I could do to best advocate for patients during procedures. I frequently asked for feedback from the PICC team on my performance. I asked if my child life practice was meeting their needs and expectations. I listened to all the feedback provided and did my best to utilize this feedback in implementing new techniques and interventions into my practice.

All of these new unknowns, learning, and growth proved to be stressful and exhausting at times. Not only had I transitioned from being the senior staff member on my child life team to the new child life specialist on a team of only nurses, our PICC team was seeing some of the sickest patients in the hospital. I was now entering rooms with patients on ventilators and other lifesaving machines, rooms where codes were being called, and rooms where families were at the lowest point in their lives. This was a huge adjustment, and I needed to find ways to take care of myself. With all of the effort I was putting into supporting families and integrating into my new team, I also needed to put effort into self-care and protecting my emotional health. I continued to utilize “my people” on the PICC team and also found other child life specialists in high acuity areas to debrief with when needed. I found routines to help me compartmentalize the stressors in my day in a way that allowed me to continue to provide support to families. I found that sometimes I needed to take a break from the PICC team office after a difficult case. A brief walk in the hospital concourse or even stepping out to scroll through my phone for a few minutes helped me take some time to reset on my own before our next case. I learned that finding even a few minutes of alone time is important to me when I am almost always surrounded by a team. I also always use the time on my drive home to decompress. I take this time to think about each patient I had that day, what happened, the support I provided, and what was difficult about the situation. I think through and process this while I am completely alone on my drive. Once I pull into my garage, I do my best to leave the stressors of my day in my car.

Within a few months, I started to feel comfortable in my new role. I found that the relationships I was building with these nurses not only benefited me but also benefited the patients and families. My role on the PICC team started to work like a well-oiled machine. The nursing staff had seen my interventions, advocacy, and family centered care. They knew me as a person and began trusting me to fully integrate into the team and to use my best clinical judgment with patients. I fully recognized this when we were attempting to place a PICC on a patient with extreme anxiety who was very distressed even before starting the procedure. This patient was not responding well to my support and was unable to implement
any coping strategies due to their level of upset. The PICC nurse stopped setting up her supplies and asked for my thoughts on how to proceed. I felt confident to advocate to completely stop the procedure to avoid further traumatization for this patient. The PICC nurse and I advocated to the patient’s medical team for a sedation plan that would make the patient more comfortable during the procedure in the future. I felt that the PICC team trusted my assessment of the patient and situation, and we were able to work together successfully to provide better care for our patient. I now feel confident to advocate with my team daily on what I feel would best support each patient and family.

Joining a small, specialized team completely comprised of nurses came with its challenges and a learning curve, but now that I have been with the PICC team for over a year I can say with full honesty that I love my new role. I feel validated and understood in my role and have established meaningful relationships and friendships with my nursing team. Joining a new team or branching out into a new territory can be uncomfortable. For any child life specialist in this situation, remember that growing pains are normal: take your time to adjust, find your people, and have trust in your skills and yourself. It will all be worth it in the long run!