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Grace has been nursing more than 20 years, mostly with paediatric patients and clinical research. She is a Clinical Nurse Consultant at one of Australia’s leading public tertiary children’s hospitals and also runs her own nursing education business! Paediatric ICU nursing is in her blood. We hope you enjoy!
Who am I?
I am a third generation nurse, my grandmother and mother were both nurses and although I didn’t set out to be one myself, I found myself drawn to the profession. I had an experience in my last year of high school that made me realise that I wanted to support people when they were unwell, I felt at the time that nursing was the best place for me to do that.
I completed my graduate year in Shepparton Victoria at Goulburn Valley Health and was given a paediatric rotation. While completing that rotation I met a nurse who relocated from Melbourne and had worked in the paediatric intensive unit at the Royal Children’s Hospital. She suggested to me that I might enjoy working in that environment so my partner and I relocated there and that’s where I’ve remained for over 12 years now!
Other than nursing, I’m a mother to two small children which takes up most of my time now, but when we are able to I still really enjoy travelling and learning about different cultures.
What different areas of nursing have you worked in?
After completing my postgraduate studies in Paediatric Critical Care I was invited to go on a philanthropic mission to Vietnam to assist with educating nurses on how to manage postoperative cardiac children. That really opened up my eyes in so many ways and I learned so much from the experience. I realised what lack of access to healthcare looked like and saw that there are many different ways to approach a problem. Following that experience I found that I had a passion for supporting others so I went into education and was a clinical support nurse for several years.
I also have advanced my skills clinically in the PICU and did paediatric retrievals with PETS, and trained in ECLS management including ECMO and VAD. I remember looking after a neonate with a 25ml Ventricular Assist Device (VAD), it was the first time we had done that in someone so small. Those experiences do make an impression upon you.
The nurses role in ECMO and VAD
Different hospitals have different responsibilities for a nurse caring for a patient receiving ECMO (Extra Corporeal Membrane Oxygenation), at the Royal Children’s Hospital, you manage the whole patient and the circuit as we feel having an understanding of how they both work together is best. Usually there are two trained ECMO nurses to one patient, and you can be very busy, especially on a patient who has gone onto ECMO following cardiac arrest as they can be quite haemodynamically unstable. ECMO is basically a long term (greater than a few hours) cardioplumonary bypass for people who have low cardiac output caused for example; by either a sepsis or following cardiac surgery, or respiratory failure from ARDS (Acute Respiratory Distress Syndrome).
A pump removes blood from the body and oxygenates it then returns it to the body. As a nurse your role is to closely monitor the patients C02 and oxygen to ensure the machine is working properly and you also need to closely monitor for clotting or bleeding which are both risks and can be tricky to manage. Patients are generally kept sedated and ventilated for the course of this treatment.
VAD (Ventricular Assist Device) is an implantable device or cannula attached to a small pump that does the work of the left ventricle in people with severe heart failure, most of the time due to cardiomyopathy. VAD is used as a bridge to heart transplant or to recovery and patients are extubated and awake soon after surgery so they can be up and moving in preparation for a potential transplant. Nurses are monitoring for the same principles of bleeding and clotting and need to be aware of how well the VAD is functioning to ensure that adequate cardiac output is maintained.
Clinical Research Nursing
I’ve found I enjoyed pain and sedation management specifically so that’s became my little specialty over the years. When an opportunity to work as a research nurse in anaesthesia and pain management came up I jumped at that chance, and again it was a steep learning curve but ignited another passion in me that I never knew I had (research). I eventually completed my masters through minor thesis in pain and sedation management in PICU.
Following this I applied to become a Clinical Nurse Consultant in the PICU focusing on quality and safety, and have enjoyed working in this self-directed role.
I have pretty much always said yes to opportunities that come my way, in part because I have a hard time saying no, but it has opened up so many experiences for me.
What are you doing at the moment with your career and what’s your future plans
I recently moved back to rural Victoria, but have kept up a clinical presence at RCH because I enjoy nursing there still. I am working some casual shifts in the local hospital in the special care nursery and paediatrics ward while myself and two colleagues get our business up and running. We are creating a business that will take tailored paediatric education out to regional and rural centres that generally don’t have as much access to this specialised area. Check us out at www.paeds.education
I am also writing and presenting a series of webinars for the paediatric nurse which will be coming up over the next few months.
Advice for nurses wanting to work in paediatrics
Try and get a paediatric rotation in your undergraduate or graduate year, I think this exposure can help you figure out if this area is for you. If this isn’t possible for you then you can still get into the area after your graduate year, there are always opportunities for nurses with passion. It is good to try a few different things though to see what area suits you.
Can you share some night shift tips?
Knowing what we do now about how night shifts may contribute to illness later on in life, I treat my body with great care when on nights. I try and get a nap in the day before the first night, I eat as healthy as I can (despite the cravings for junk food!) and drink plenty of water.
What do you carry on you during a shift?
I’m a minimalist so I carry a pen and my phone (for the calculator), I don’t carry a stethoscope as all the rooms have their own.
What’s in your lunch box!
I try to eat really clean when I’m working so I usually have some soup in a thermos, roasted vegetables, a couple of pieces of fruit and some sugar free chocolate for a treat. I do drink a lot of coffee though, but no ones perfect!
What is one piece of advice for students you would give who are worried about starting a graduate year?
I was really excited to start my graduate year, I love the challenge of learning new skills! I think that the best thing you can do to prepare yourself is to be aware of what your strengths and weaknesses are. Some examples are time management, drug calculations, knowledge base, communication or critical thinking and analysis. If you have an awareness of where you are strong and what areas could be improved then this is a good start and you can seek out opportunities to develop those areas.
Also, don’t be hard on yourself when you make a mistake or find an area for improvement, we are all human and we all make mistakes, we are constantly learning and evolving as nurses so it’s how you take that experience and learn from it that really matters. Generally people make mistakes because they are tired, busy, distracted or they don’t have all the correct information available to them. Think about what led up to the error and how it could be prevented next time, but don’t let it get you down.
Can you think of a really funny situation you’ve had while nursing?
I have laughed a lot in my career, I have a dark sense of humor as most of us tend to develop! Something that wasn’t funny at the time, but I can look back at and laugh is when I was involved in a cardiac arrest and we were quite short staffed so I was doing the work of two people and running everywhere! I had to squat down really quickly to get an item out of the bottom of the resus trolley and the back of my pants just split open! It was not a good time to go and change considering we were performing an active resus, so I just had to keep working with the split in my pants….Everyone was too busy to notice anyway. But I remember thinking, of all the times for this to happen!
What would you be if you weren’t a nurse?
I would be an actor in stage theater!
Pain and Sedation in Critical Care
As I mentioned above I enjoy pain and sedation topics in critical care. I think understanding the role of distress, anxiety and pain and how they all interconnect to create a pleasant or traumatic experience for children is an interesting area. We need to better appreciate the role of procedural anxiety and how it expresses itself as pain in the traumatized child and adolescent.
For example those who have studied chronic pain in adults know that depression and anxiety is present in most patients who suffer from long term chronic back pain, is this a manifestation of long term uncontrolled pain or a cause of it?
Our use of pharmaceutical drugs like opioids and benzos have a limited effect on this type of pain and have been found to be no more beneficial than a placebo. Does this mean that pain is a physical manifestation of the emotional experience (as you will see in children with procedural anxiety). When a child says to you “No, stop, that hurts” that can also mean,”Stop, I’m scared” or “Stop, I don’t understand what is happening”. Taking the time to figure out what a child is actually trying to say may reduce the need for sedation as they will feel heard.
A child that manages a procedure well without the use of an amnesic like midazolam or diazepam will do better in the future because they remember that they were able to cope with it last time. Sometimes these medications are necessary and there are good reasons to use them, but moving forward children will need psychological support to cope with painful or distressing procedures as the medications are not the long term solution. I would love to do more research in this area one day!
Some reading resources