Paediatric nursing is like detective work…

Meet Catelyn Richards, Paediatric Registered Nurse, MACN & ACN Communications Coordinator for Melbourne

About me

I’m a Registered Nurse and Early Career Researcher. My passions bestride the intersection of public health, human rights and environmental sustainability. I initially elected to pursue nursing because I am passionate about social justice – and I believe that the delivery of healthcare is one of the most pivotal ways one can contribute to society. It was this same philosophy that drew me to working in paediatrics – where I felt as though the biggest contribution I could make to the world was in promoting children’s health.

After working on a social justice campaign in 2013, and living in the Solomon Islands, I ventured back to undertake my Bachelor of Nursing at Monash University. At this point in my life, I clearly remember making a decision that I wanted to DO nursing school… I didn’t want to just ‘turn up for classes’ (#Psgetdegrees), but to chew on the word ‘study’ in every aspect this verb prescribed … to live and breathe my course … to blunder about campus with friends… to be completely immersed in my training.

Finishing this course was one of the most pivotal moments of my life, not simply for the qualification, but because it bookmarked a moment where a cherished goal had reached its fruition… and had resulted in an acquisition of knowledge so great that I had fundamentally become a different person. I’m sure many of you can relate: where your beliefs are moulded, stretched and shifted to an extent where your training has become a lens through which you see the world. And this was indeed how I felt at the closure of my nursing education in 2016.

Paediatric Nursing

I’d always loved working with children but had heard along the grapevine that playing with children and nursing children are completely different things.

So while I was training I applied to do two paediatric rotations (both of which I was successful in obtaining) to gain experience in this speciality. Despite really loving my placements, I still had no concrete plans leading up to my graduate nurse applications. I’d been told many things that had made me challenge my gut instinct of pursuing paediatric nursing: that it was very very competitive, that you had to use all of your preferred spots to get into a paediatric speciality, that early career nurses don’t suit paediatrics… but the one that I’ll remember the most was that it was unwise to jump straight into doing specialised nursing before consolidating my ‘general’ nursing skills. Funnily, these warnings were somewhat meritorious – which I’ll explain a little later.

I remember the moment where I finally made the decision – I was on a train heading to a hospital tour for the hospital that I’d planned to put as my top preference (spoiler alert: this grad placement wasn’t in paediatrics). I remember looking down at my calendar request to see where I needed to meet the director of the graduate program… only to realise I’d mucked up the times and I was an hour late. No… not just late… I’d completely missed the tour.

Now, when you realize that you’re just one person in about 3000 applicants… applying for one of the most competitive hospitals in the state…. And you just stood up a private tour with the DIRECTOR OF THE GRADUATE PROGRAM… you acknowledge that it’s borderline impossible to enter with a clean slate, you cut your losses, and you change your preferences. And that is how I came to choose a paediatrics speciality.

That train ride revealed many things to me: (I plan to someday publish a book entitled: “CHECK THE FREAKING CALENDAR INVITE BEFORE THE DAY OF THE TOUR– and other colourful lessons”)… but probably the most profound lesson was that I wasn’t even disappointed that I’d potentially blown my chance with this hospital. Embarrassed, yes. But not disappointed. And it was at this moment that I realized two things:

1. Disappointment is evidence you have invested hope into something. If you meet a setback with ambivalence – it was probably something you never truly cared about in the first place
2. My narrative was my own. And I wanted to be a paediatrics nurse.

So I leapt… I got the gig… and ‘nursing,’ for me, is now synonymous with ‘children’s nursing’. I can’t imagine my practice any other way. I love my job. I loved it as soon as I started. I currently work in a general medical ward, similar to that which you would see in most country hospitals (with the benefit of having opportunities to escalate care quickly if I should need to).

Fast facts about my role as a paediatric nurse

• I predominantly care for children with exacerbation of asthma, infants with bronchiolitis (sometimes neonates, depending on the flow of the hospital), gastro, dehydration (usually secondary to viral illness), pyrexia of unknown origin, tonsillitis, post-operative (again depending on the flow of the hospital), excessive crying of the infant, constipation exacerbations, suspected sepsis, newly diagnosed type 1 diabetics and a cluster of other infrequent autoimmune diseases.

 

• On a typical day I’ll have four patients on day duty, and six patients on night duty. I work 12hour shifts so I only have two duty types; day or night, and my EBA break entitlement is 3 x 30 minutes.

 

• In my hospital, we are very well supported. We have our Assistant Unit Manager, Clinical Nurse Specialists (who have specialist knowledge but take patient loads), A Clinical Nurse Educator (who assists with our learning and development and supports student or graduate nurses) and our Nurse Unit Manager is very present and approachable.

 

• Our medical team consists of an intern (usually), a resident, a registrar (sometimes two of each), and the consultant. They are also very, very very approachable and only in very few incidents have I felt that my concerns weren’t taken seriously.

Considerations in paediatric nursing.

If you are someone who is considering paediatrics as a speciality or are simply interested in what it entails these are some of the things I have come to understand over time:

• Working in paediatrics is like detective work. Your patients often have never experienced pain or serious illness before (I for one wasn’t treated at a hospital until my 20s). You only get clues to decipher; a change in facial expression here, a hand flap there… does their cry mean they’re hungry? Do they need a nappy change? They’re scared and want to go home? Uncomfortable? In a lot of pain? You are gifted with a code un-encrypting guide, however, (and I don’t use the word ‘gift’ lightly), in the form of parents. Which brings me to my next point:

 

• In paediatrics, quite often we are nursing not only a patient but also their parents. They are an excellent resource for helping to interpret their child – but this also comes with challenges. There are often pressures put on you by families. Not because they want to make your life difficult – but because they are worried about their child. Something that I try to remember is that what parents, the doctors and I all have in common is that we are all worried about the patient and want what is best for them. Though we may have differing (sometimes conflicting opinions) on what this looks like, ultimately we all want the same thing.

 

• A paediatric patient deteriorates quickly. You cannot ignore those hourly checks. You cannot ignore abnormal patient behaviour. You cannot ignore your gut feeling. You learn to hone in on your assessment skills, particularly in respiratory assessment – as most paediatrics patients are more likely to have a respiratory arrest (rather than cardiac).

 

Paediatric nursing is also highly rewarding. Particularly in my work, where I often care for a patient from their admission, (when they are flat, lethargic and lifeless) through to their discharge (where they are wiggling, giggling and dancing to get out the door). Children don’t judge me for walking around the ward singing. They love it when I come in and pull faces at them. They reward creative explanations of medical equipment/procedures with compliance.

You are kept on your toes, challenged daily and always have reason to smile.

You are kept on your toes, challenged daily and always have reason to smile. For this reason not only do I love the patient group I work with, but I also love working with my colleagues. Even the most stern of medical consultants are uplifted by the spirit of working with children. I have found nothing but the motivation, engagement and diligence among my colleagues – not only my nursing peers but also my medical ones. And I am confident that the people I work with will always do what they believe is best for the child.

On days where I have fallen out of love with my job, it only takes a rambling tangent from a three-year-old, a smile from a stoic infant or a cuddle with a six week old to refill my cup and remind me of the importance of my work. Many of the modern medical interventions that I deliver daily, would have (at one time in history) resulted in mortality or morbidity for a child of the past.

I can’t honestly guarantee that I’d have much success finding employment if ever I tried to transition back to adult nursing – and hence as mentioned earlier, the warnings about jumping into a speciality may have merit. But the reason I don’t know whether I’d have success or not… is because I’ve never tried to transition back to adult nursing. I simply love what I do so much, and it was always going to be a cosy fit for me. So I encourage anyone considering a speciality to entertain the idea and to be honest with their inner ‘calling.’ There is a lot to be said for trusting your gut and taking a risk. Indeed, I’m certainly glad I did.