BCEN Updates

CPEN Spotlight: Experts Talk About How Pediatric Emergency Nursing is Evolving

Keeping credentialing programs—including the Certified Pediatric Emergency Nurse (CPEN)—accurate, current and relevant is a prime mission of BCEN. And BCEN’s subject matter expert volunteers play a major role in bringing a diversity of expertise, experiences and perspectives to that process.

As a result of BCEN’s recent CPEN/Pediatric Emergency Nursing Role Delineation Study (RDS), the revised CPEN Exam Content Outline will go into effect on August 8, 2023. (Until then, the current CPEN outline is in effect.)

We invited a few members of the CPEN/Pediatric Emergency Nursing RDS Advisory Committee to highlight some of the key findings from the January 2023 CPEN RDS report, including their perspectives on upcoming changes to the CPEN exam content outline and how the pediatric emergency nursing specialty is evolving.


Antonio “Tony” D’Amato, MS, RN, FNP-BC, CPEN, has been a Clinical Nurse Educator at New York-Presbyterian Hospital’s Pediatric Trauma Center since 2018, and for 11 years prior to that, he was a Clinical Nurse III and Charge Nurse in NYP’s Pediatric Emergency Department. Tony has been a CPEN since 2009.




Tommee Leah Duran, BSN,RN, CPEN, is an emergency RN with Banner Health in Fallon, Nevada and also works pediatric ER at Renown Regional Hospital in Reno. She previously worked at Seattle Children’s and Children’s of Mississippi, and earned the CPEN in 2021.



A list of specific updates to the CPEN Exam Content Outline follows our interview with Tommee and Tony.

Time and again, we hear that the uniqueness of treating pediatric emergency patients isn’t well understood. That is, it requires not just emergency expertise or pediatric expertise, but a combination of the two. What do you most want RNs to know about how CPEN certification contributes to better care for pediatric emergency patients?

Tony: Pediatric emergency nursing is unique because its nurses are exposed to an array of diverse conditions not typically seen in other care areas. The variety of patients and rare conditions encountered therein makes pediatric emergency nursing a true specialty. In fact, it is no stretch to say that no two pediatric emergency patients are alike.

CPEN certification uniquely contributes to better pediatric care because the knowledge and expertise that helps a pediatric emergency nurse manage such situations diverges with the singular experience of caring for the unique physiologic and developmental needs of pediatric patients in order to effectively manage those distinct challenges.

Tommee: I think that it’s important to remember that pediatric nursing care differs greatly from nursing care of adult patients. Parents who bring their children to the emergency department are scared and stressed. It is important to prepare yourself to best care for their child during that time. Becoming certified with your CPEN helps ensure adequate knowledge and practice for pediatric emergency nursing care.

What’s unique about triage and assessment in pediatric emergency patients? What is the significance of splitting the former Triage & Assessment domain into two distinct domains in the new CPEN Exam Content Outline?

Tony: Triage is a crucial aspect of pediatric emergency nursing because of the unique physiological and developmental differences in the pediatric patient. Pediatric emergency nurses must quickly and accurately assess incoming patients and prioritize patient care based on need and acuity. Many lives have been saved by an alert pediatric emergency nurse whose extensive training and previous experience help identify and treat a life-threatening situation.

While assessment skills are used in triage, we felt the need to split these into two distinct domains because while the triage process eventually ends, patient assessment is an ongoing and dynamic process. The nurse is constantly assessing and reassessing the patient and monitoring for potential changes in the patient’s condition, ever ready to adjust his or her care routine to address the need as it arises.

Tommee: As all emergency nurses know, triage and assessment are large portions of a patient’s treatment. For pediatrics, these include the parents’ perception of the child’s behavior, symptoms, and condition, as well as the patient’s family dynamics. This is also where the patient’s vaccination status is acknowledged, which is imperative with the ever-changing infectious diseases in our society. There are numerous different aspects that come into play with the pediatric patient.

For the first time, the CPEN content outline will include a separate, dedicated Professional Issues domain. What prompted this update? Why are professional issues such an important part of a specialty body of knowledge?

Tommee: This was something we saw as an emerging domain in pediatric emergency nursing. Topics such as consent, nurse burnout, and nursing medication diversion—these are things we see in everyday practice and are incredibly relevant to proper care.

Tony: It’s important to remember that the nurse’s obligation to both patients and their families is not limited to just clinical care. At the end of the day, nurses are humans caring for humans. Ethical issues abound as we care for a diversity of patients with unique ethnic, cultural, and spiritual needs. In order to render truly holistic care, the pediatric emergency nurse must be cognizant of these professional issues. This approach extends to our behaviors and attitudes toward patients, families and even each other.

Regarding the System-Focused Emergencies, Special Considerations, and Multi-System Considerations domains … what is noteworthy coming out of the role delineation study, particularly with respect to what is unique about what you need to know clinically to care for  pediatric patients versus adults? 

Tommee: We found that by bundling the systems together instead of how they are currently separated (i.e., Medical Emergencies, Additional Medical Emergencies, Special Considerations which includes Neonatal Emergencies), it became easier to view and study the material in a systematic method.

Tony: I can’t say enough about how much emphasis was placed on the distinct issues that emergency nurses face in caring for the urgent needs of the pediatric population. The essential skills of a pediatric emergency nurse are very similar to those of their adult emergency nurse counterparts—excellent critical thinking and decision-making abilities, strong communication and interpersonal skills, and the aptitude to remain calm under pressure.

However, the pediatric emergency nurse also must have a keen understanding of pediatric physiology as well as developmental and age-specific care considerations. Having this expertise can make the difference between a rapid, life-saving intervention and the demise of an acutely ill child.

“Having [pediatric emergency] expertise can make the difference between a rapid, life-saving intervention and the demise of an acutely ill child.” – Tony D’Amato

How is the pediatric emergency specialty evolving, including the roles and responsibilities of pediatric emergency nurses and what they need to know?

Tommee: It is important to highlight that the term “pediatric emergency nurse” is not specific to a nurse who works in a pediatric-dedicated emergency facility. The term applies to any nurse who treats pediatric emergencies. This is more inclusive of nurses who work at rural or large medical facilities with an adult/pediatric “mixed” population. If a nurse has the possibility of treating pediatrics in emergency settings and can become CPEN certified, patient outcomes can be improved.

“…the term ‘pediatric emergency nurse’ is not specific to a nurse that works in a pediatric dedicated emergency facility. The term applies to any nurse who treats pediatric emergencies. …If a nurse has the possibility of treating pediatrics in emergency settings and can become CPEN certified, patient outcomes can be improved.” – Tommee Leah Duran

Tony: Pediatric emergency nursing is evolving in a number of important ways. Perhaps the most exciting change involves the innovative, science-based approach to pediatric medical procedures. Even things that the emergency nurse takes for granted, such as peripheral IV placement, are changing as exciting new approaches are being developed. For instance, many pediatric emergency nurses are learning to utilize ultrasound to identify suitable veins for IV placement. Others have been trained to replace dislodged gastrostomy tubes (G-tubes). Still others have been trained in the nuances of clinical debriefing where the care team can discuss and analyze processes in order to identify and remedy systems issues. These are just a few of the new and exciting skills that pediatric emergency nurses are learning and teaching.

Highlights of the Revised CPEN Exam Content Outline (Effective 8/8/23)


  • Single Triage Process & Assessment domain now split into 2 separate domains, Triage Process and Assessment
  • Medical Emergencies: Respiratory, Cardiovascular, and Neurological domain renamed and expanded to become the System-Focused Emergencies domain (which incorporates 10 body systems)
  • Additional Medical Emergencies moved to System-Focused Emergencies
  • Some minor reorganization in the Special Considerations domain
  • Trauma Emergencies domain was subsumed in System-Focused Emergencies and the new Multi-System Considerations domain
  • New Professional Issues domain, whose content (legal issues, nursing practice and patient/family considerations) was previously in Triage Process & Assessment


BCEN appreciates the expertise and generous service of the members of the CPEN RDS Advisory Committee—who, in addition to Tommee and Tony, included Christy Cooper, Colleen Wood, Heather Mons, Lisa Gilmore, and Rebecca Steinmann. Together, they brought 120 years of pediatric emergency nursing experience to the CPEN RDS process. Special thanks also goes to the CPEN Exam Construction and Review Committee and the CPEN item writers

Finally, thank you to every nurse who responded to the CPEN RDS survey. Nurse participation is pivotal to the RDS process, and we encourage members of the BCEN community to complete these important, every-5-years surveys.