While enjoying a well-deserved lunch break recently, a group of Paediatric Registrars and I discussed the usual topics of family-friendly dinners, recent interesting cases from the birth centre and fun scrub tops. As is typical in a large teaching hospital, this dialogue progressed to staffing levels and skill mix in Paediatrics. Then one of the Registrar’s said,
‘If not a single doctor turned up to work tomorrow I am sure that all of the patients would be fine, but I seriously doubt it if not a single nurse turned up’.
I was touched and humbled by this when another said,
‘I agree, when my own son was in hospital with pneumonia, it was the nurses who made him better, not the doctors’.
I’ve been a Paediatric nurse for almost 28 years, and I’ve seen and heard so much. I am deeply aware that an ‘ordinary’ work day for me might be the most extraordinary day in the life of each family I am caring for. Nurses are the gatekeepers of all that transpires for our patients; everything goes through us, and that is why I love it.
I recently worked a night duty shift with two colleagues, and between us, we had 74 years of Paediatric Nursing experience ….. 74 Years! We’ve seen every disease, every family dynamic and every human emotion possible. We’ve seen incredible innovations in surgical procedures change children’s lives. We’ve seen conditions that were once life-limiting become survivable. We’ve seen the very worst and the very best of human behaviour. We’ve held our colleagues when we receive news that a ‘favourite’ little patient has passed, and we’ve problem-solved a blocked central venous access device in the middle of the night… I could go on.
We know the safe dose of gentamicin to give a febrile neonate off the top of our heads, how fast to infuse it and how to look after the tiny little cannula that took seven attempts to insert. When the NG tube won’t aspirate, we know the tricks to make it work. When the baby on High Flow is unsettled and desaturating, we know how to turn that around. We know that a teen boy will get constipated after extensive orthopaedic surgery, and we act early to prevent it. We know subtleties, nuances, a vibe in a room, a look in a parent’s eyes, a look in a colleague’s eyes, a feeling for which there are no words.
We know that the best possible care for our little patients and their families happens when we respect each other’s expertise, learn from all members, and work as a team.
Top 10 Things Junior Doctors Can Learn From Nurses
1. Interactions and communication are paramount in paediatrics….listen in to the conversations between nurses and families…..take the good and use it, and eavesdrop whenever possible.
2. Our intuition is almost always right. If a nurse isn’t happy with how a child looks….pay attention.
3. The best advocate for a child after their primary carer is their nurse; they are the gatekeepers to everything that happens or doesn’t happen for that child.
4. A child is more than their broken arm or their swollen neck, and their family is beyond frightened….. safety from the fear, after you’ve left the room, rests with us.
5. We have so many tips and tricks for building a relationship with even the most unapproachable toddler or preschooler and know equally well how best to interact with a teenager who feels anxious and powerless.
6. We are good at teaching each other new clinical skills; we do it every day … We are medical educators and can be a supportive and nurturing influence in the professional development of medical students and junior doctors.
7. Nurses spend more time with patients than any other healthcare worker. If you want to know how a patient is really doing, the nurse is the person to ask first. When you arrive on the ward, introduce yourself and ask for the nurse caring for your patient. Then, seek information from them and ask for their thoughts and suggestions.
8. A career in Paediatrics is an honour and a privilege. Take it slow at the start, get it right in the early years, learn the basics and learn them well.
9. We know how things happen in a hospital, where stuff comes from, how stuff gets done, how quickly (or slowly), and by who. We know where the paperwork is kept, where the MRI consent forms live and who to call if a mum needs breastfeeding help. We know how to arrange a community nurse home visit, where the nearest compounding pharmacy is located and how to get a family discounted parking.
10. You will spend your entire career interacting with and working alongside nurses …. Find out what they do and how their clinical skills complement yours, and your daily work life will not only be immensely easier but also so much more fun.
Top 10 Things Parents Can Learn From Nurses
1. We are incredibly devoted to your child, even though we don’t know you yet and we’ve just met…. When we got up for work today, it was solely to care for you and your child. We are very aware that what is an ordinary work day for us is an extraordinary day in the life of your family. Sharing this journey for you is what we love most about our profession.
2. You are safe here with us. Your child’s illness is incredibly frightening … there is safety in our hands.
3. Many childhood illnesses take time to reveal themselves. Observation is one type of treatment. Let us do it, and we will allay your worries. On occasion, this might mean disturbing your child while they sleep.
4. Watching your child become unconscious under general anaesthesia is an unexpectedly emotional experience for most parents… we will walk you through it.
5. It’s often easy to get admitted to hospital but very difficult to get out! Be patient while we ensure your discharge is thorough and you understand the care plan for home.
6. Ice blocks for breakfast, hot chips for lunch and gummy bears for dinner are essential food groups …. Routine will return when the family is well.
7. Please keep your room tidy. If a child is sick enough to be admitted to hospital then they are sick enough to need expert help very fast. Make sure we can get to your child quickly if needed.
8. While your child is the patient, you will be amazed at how much care you need. Caring for children means caring for the entire family. This part will be the most profound for you during your stay.
9. Your child’s physical safety is as important as their clinical needs. Please do not co-sleep with your infant. Place hot drinks out of reach, keep the cot sides up and inform us of any individual who is not permitted to visit.
10. The knowledge within the team caring for you is unimaginable; respect it and the years of study and experience required to obtain it. You won’t find better information looking elsewhere.
This is so beautifully written and so apt. It would be wonderful to see more perspectives from the amazing paediatric and neonatal nurses we rely so much on as doctors. Thank you for publishing Pippa.