Who’s Who in the Hospital?

Dear Mamas,

Our 4-year-old son was born with an extra kidney, which we found out after he had a couple of unexplained urinary tract infections leading to a series of tests. The pediatrician sent us to a urologist, who recommended we have the kidney removed since it’s assumed to be the cause of the infections.

Our baby is scheduled for the surgery in about 10 days and yesterday we went for a hospital tour. It was very helpful to see the surgical suite, recovery and regular rooms, but we were confused by all the different healthcare workers and their various jobs. I’ve never been in the hospital myself, except to deliver our son, and it all seems a bit overwhelming. Can you help me figure out who’s who?

Many thanks,


Hi Alison,

I’m sure it was scary for you to discover that your little guy was born with a third kidney, but you’d be surprised how common this kind of variation can be. In about one of 500 births, some abnormality occurs in the development of the kidneys or urinary system. It ‘s not really known why; the development of the urinary tract is a complex process that is not fully understood. In most cases these little extras will have no effect on long-term health.

Taking care of the problem now should prevent future infections and the whole episode will fade into the background and make a great family story. Just think of the girls who will be impressed by that scar someday.

You’re right, it does seem like the variety of personnel working in hospitals has mushroomed in recent years. It’s almost impossible to keep track of the players, and we can’t blame you for being confused.

Here’s a breakdown, starting with the physician staff: 

Medical student: Medical students usually spend the first 2 years of medical school in the classroom and the last 2 years seeing patients in the hospital. Chances are if your guy is having surgery at a teaching hospital, there will be a med student asking lots of questions.

Resident: A resident is a doctor who has graduated from medical school and is now training in a specific field. Pediatric residency lasts 3 years, while surgical residency is a minimum of 5. Residents providing care are supervised by fellows and attending physicians.

Fellow: A fellow has completed medical school and residency training, and is getting additional clinical training in a specialty such as pediatric urology.

Attending physician: An attending physician has completed medical training and has primary responsibility for the care of your child. The attending (in your case, the urologic surgeon) may supervise a team of medical students, residents, and fellows, but he/she is the go-to guy.

Hospitalist: Hospitalists are doctors who specialize in caring for patients in the hospital. If a hospitalist is caring for your child, he/she will be in contact with your pediatrician but will manage routine treatment while your child is hospitalized.

Physician assistant (PA): A physician assistant, under the supervision of a doctor, examines patients, diagnoses and treats simple illnesses, orders tests and interprets results, provides preventative health care counseling, assists in surgery, and writes prescriptions. Most PAs have a college degree and have completed a 2- to 3-year training program.

In addition to the physician staff, many kinds of nurses provide varying levels of care:

Licensed practical nurse (LPN): LPNs provide basic care and assistance to patients with tasks like bathing, changing wound dressings, and taking vital signs. An LPN has at least 1 year of training.

Registered nurse (RN): A registered nurse gives medication, performs small procedures such as drawing blood, and follows your child’s condition. RNs have graduated from a nursing program and have a state license.

Advanced practice nurses (APN): An advanced practice nurse is an RN who has received advanced training beyond nursing school. At minimum, APNs have a college degree and a master’s degree in nursing.

In addition to care from doctors and nurses during the hospital stay, kids may also see therapists with special training. Since your stay is likely to be short, you may or may not come in contact with these. 

Child life specialist: A child life specialist works to reduce stress and anxiety while kids are in the hospital. They give kids an opportunity to play, and offer comfort and the chance to talk about feelings.

Health educator: This specialist works as part of a medical team, teaching patients about a particular health condition and how to manage it.

Nutritionist: A nutritionist plans meals for patients based on their medical condition and needs.

Pharmacist: Provides medications for patients, checks for any interactions between drugs, and works with the rest of the medical team to choose appropriate treatments. In hospitals, patients typically don’t interact with the pharmacist.

Physical therapist: Kids may need physical therapy as a result of developmental delays, injuries, long hospitalizations, or after surgery.

Respiratory therapist: A respiratory therapist evaluates, treats, and cares for kids with breathing problems and heart problems that affect the lungs.

Social worker: A social worker focuses on improving the emotional well-being of kids and their families, and helps coordinate health care. In addition to offering emotional support, a social worker can also help facilitate services a child needs at school or at home.

We wish the best of healing to you and your family. DO accept the support and kindness of family and friends — having a child in the hospital can be stressful. DO bring favorite objects like pillows, blankies or teddies from home to create a sense of safety and familiarity. When he’s able to eat after surgery, DO offer some of his favorite foods.

You’ll be amazed by how quickly he bounces back. While you or I might be on pain meds for a week after a similar procedure, kids are typically up and active almost immediately. Follow his comfort level and let his natural body rhythm guide you.

~ The Mamas

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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