The day I got my epipen

Ok. So it was actually only this week. Ironic really when I work in an Allergy Clinic. 

I've always had allergies. I'm the poster girl for ' the atopic march '. Eczema at 6 weeks of age, allergic rhinitis at 6 and then asthma at 11. As a baby nurse I developed hives using latex gloves and so I avoided them. 

This week , after having hundreds of exposures to my sons latex basketball , my immune system finally had enough and sent me into anaphylaxis. Not fun. Of course , being a nurse , I didn't go to the hospital. I didn't have an epipen. I took Zyrtec and salbutamol and rode it out. It was stupid of me and I won't do it again. I now have two epipens. I am taking double dose antihistamines and a preventer for my asthma. I have great doctors and nurses looking after me. 

It got me thinking. How many times ,as nurses, do we advise our patients to do one thing and then don't do it ourselves ? I'd never ,ever advise my patients to 'ride out' an anaphylaxis. I'd tell them to dial 000 as soon as symptoms start. Why did I not think my health was equally as important? In truth I didn't really think it was that serious. It was only after the event I got a little bit nervous. But I also didn't want to go to ED. I've worked in ED's and didn't really want to spend hours there when I thought I'd be ok. Lots of nurses avoid hospitals. When we do go we don't tell anyone what we do. Is it because we get treat differently ? Is it because we feel like we're wasting our colleagues time ? Is it because we don't want to intimidate those caring for us ?

I don't know the answers but I do know that as nurses our health is just as important as our patients. We do ourselves , and our families, a disservice by not looking after our health and seeking help. I hope I've learned my lesson. My family and myself deserve for me to be as well as I can. 

  

A new venture

So I've published my first few articles on the Ausmed international site. Have a look below and let me know what you think. They are short and to the point and  are supposed to be read in 5 minutes over a quick cuppa. 

Thanks

Abbie 

https://www.ausmed.com/articles/supporting-children-clinical-procedures-important/#more-1310

https://www.ausmed.com/articles/supporting-children-clinical-procedures-techniques-can-use/#more-1318

https://www.ausmed.com/articles/paediatric-eczema-care/#more-1172

Emotional Resilience- how I survive

So I've been thinking alot about 'Emotional Resilience ' recently. How can some nurses survive the emotional roller coaster and others not ? What does it mean to be emotionally resilient ?

I just want to really reflect on how its been for me. What I've learnt and how I've learnt to cope. It would be great if readers could also share ideas and experiences. I think  sharing helps us to understand and learn new skills and support each other.

One of the hardest experiences I've ever had to deal with was fairly recently. A 4 week old baby came in to ED with traumatic ,inflicted injuries.My role was as a resus nurse alongside a junior nurse from Paeds ED and two adult resus nurses. I was so lucky to have two of my most trusted and experienced Paeds ED Consultants there too. The baby was so sick and the potential for serious, life long damage was very real and unknown at that time. The family were present and  at that point  we had no idea who had inflicted the injuries-we just knew this baby had injuires that were non-accidental. It was a tough situation for all of us. At one point, while I was standing by his infant warmer, the Consultant came over and put his arm around me. There were no words.

The baby was stabilised and transferred to PICU(He actually did really well and was discharged into the care of a Foster Carer a few weeks later)

We had a team debrief that same day and all team members involved(there were a couple of nursing students there too) were present. We were able to ask questions of the Consultant and also reflect on how we felt and how we would deal with these feelings over the next few days. I drove home that night absolutely drained. I was exhausted. We had a birthday dinner for a member of our family planned at our house and ,although I definitely didn't feel like entertaining,I put on my best smile and carried on. It wasn't until 11 pm that I finally was able to talk to my hubby about what had happened and let him know how hard the resus had been.

For the next couple of days that baby weighed heavily on my mind. It was good to able to chat to colleagues about what had happened and gain support from them.I reflected on my role in that resus. Whilst I was there to nurse the baby,I felt a big part of my role ,as the most senior nurse,was to support the staff. I was working alongside a junior RN,who was excellent,but still only very young and not long out of college. I was also working with some very experienced ED nurses but who had not had much experience with paediatric trauma and most definitely not with child protection. I allowed the junior RN to lead the care and I supported her. We debriefed together and shared our experiences with each other.

I was able to continue on after a few days with no problems. I continued to be compassionate,good nurse. I was able to relax at home and laugh and live(and love) my life.

In previous blog posts I have alluded to different times in my career where I maybe haven't been able to cope as well. I had experiences in paediatric oncology that have been difficult and actually had a profound affect on my home life and nursing career.At one point I was so drained I left nursing nursing for a while. How is it that I can cope with some terrible situations much better now?

I think experience does play a big part. I think you learn alot about yourself when you are a  nurse. I am older and can compartmentalise things much better. I can literally mentally 'put things in boxes' to store away for reflection another time if I need to. That doesn't mean I don't deal with issues ,its just sometimes,when you're in 'the moment' like a resus or just half way through your shift, you need to be able to continue on and not stop to think .

On reflection, when I look back at some of the most tricky resus's or situations, I can remember having senior nurses there to support and guide me. In my early career I remember two particularly difficult situations with very sick children(one died,one survived) and on each occasion, the ward sister(NUM) was present. They let me run the resus but supported me all the way and helped me reflect afterwards. I think as senior nurses this is absolutely one of our most important roles- support not take over. Guide not instruct.

I have been lucky throughout my career to be surrounded by great 'teams'. That is work colleagues,friends and family. Having a good team around is so helpful in maintaining sanity. We all know clinicians can laugh(have black humour) even in the most tricky situations. Nurses provide a great sounding board. I cannot talk to friends and family about some of the things we see and do like I can talk to my colleagues or nursing friends. No-one understands like a nurse.


I also think having something else in your life helps too. I now have two kids and a busy life outside work. When I was a new grad I was consumed by work. That doesn't mean that you have to have kids or family to  be emotionally resilient but its so helpful to have 'something' else. It can be friends,pets,volunteering or a hobby-anything just so that work is not all you are. I honestly think this makes you a better nurse.

Learning to leave work behind is really important. One of my very first ward Sisters used to tell us to leave work behind as we walked over the hospital crest painted on the floor in the hospital foyer. Its a good tip. I now like to have the journey home (in the car or by train)to reflect on my day. Of course some days its easier that others. Sometimes it just takes a little more time.I've also learned that's OK too.

Having fun at work is important . There is nothing wrong with enjoying a lovely morning tea with staff or laughing with patients. I once had a mum of a child with cancer say to me " How can you nurses be so happy all the time when you work here? Why aren't you crying?" My answer ? "Because how is crying all the time going to help our patients? How do you think we could come to work and care for your little boy if we were crying all the time ?" Of course there are times when I'm so overwhelmed at work I do cry. Not weeping and hysterical but maybe teary. When you see a baby being put in a body bag as you stand alongside their parents, how can you not tear up ?

I once asked my husband to tell me if it ever seemed that to me a child dying was normal. That would be the day I resigned. I have worked with nurses that are so 'hardened'. I never ever want to be like that. I want to retain my humanity.I count my blessings every day. I'm so grateful for all that I have. Nursing has done that for me. Nursing puts life into perspective.


Let me know what you think. Its good to talk..........

I have a Sari .....

I have a Sari. It was given to me by the matriarch of the refugee family I work with. I love it. Its red with a green trim and is beautiful. I love it not because of the colours or how I look when I wear it,I love it because of everything it symbolises.

To me that Sari symbolises the unique and privileged relationship I have with an amazing refugee family from Bhutan. It symbolises the difference in cultures that I am witnessing. It symbolises generosity beyond measure. It symbolises hope against terrible odds.

This week the world has been rocked by terrible images of a dead little boy. A child fleeing terror in his homeland and his mother,despite not being able to swim,seeing NO other alternative but to get onto a small boat to seek safety in another land. There has been uproar and petitions and tears. Rightly so. What has happened to this little boy is despicable. It is inhumane.

What I find so frustrating it that is has taken this one terrible image to galvanise people into action. This baby died like millions before him. For many years people have fled terror. For many years the world has shut its eyes and turned its back. This little boy may not have died if there had been a safer way for him to reach a peaceful place. He may not have died if the media hadn't dehumanised asylum seekers. He may not have died if people had not bought into the mass hysteria of 'illegals' taking all of our jobs. He may not have died if we had mobilised and stood up to our government and made them take notice.

In Australia just last week the Victorian government tried to implement 'random visa checks'. Essentially stopping any one and checking visas. Who do you think they would target ? White Caucasian people like me? I have a visa. I most certainly do not carry it.  It is likely they would have targeted non Caucasians. Social media went wild. Within one hour hundreds of people mobilised to protest in the CBD. The government backed down. There will be no random visa checks.

In Australia our government proudly proclaims - 'we stopped the boats' . Nope-they just pushed terrified starving people back into international waters. They 'process' asylum seekers offshore in 'camps' no better than concentration camps.They tell them they will NEVER be re-settled in Australia and have attempted to send them to countries with questionable human rights records.

 Children are abused and women raped in Naru and on Christmas Island. Men die of preventable illnesses or are beaten to death. Human Rights lawyers fight tirelessly to offer the government an alternative. A cheaper sustainable way to take in refugees has been offered. Over 90 % of those desperate enough to arrive by boat are found to be in genuine need of asylum. They are not 'illegals'. It is not illegal to seek asylum. They are desperate ,afraid people.

There has been little social outcry. There has been little media coverage.

We have failed this little boy with our silence. We have failed him because we turned our back and refused to take action.

Two years ago I got tired of 'liking' Facebook pages and signing petitions about refugees. I felt a fraud. So I made it my business to do something about it. There are lots of options out there for those willing to look.

Get up and do something .People power changes lives.

My Sari symbolizes the day I decided to stop just 'saying' and actually began 'doing'.

I do my best thinking at the beach....

I do my best thinking at the beach. I've always been lucky enough to live, the most part of my life, in close proximity to some amazing beaches.I think they are good for the soul.

I walked the dogs today at one of our local beaches and after a busy couple of weeks full of illness in the family,I had space to think. I got to contemplating the blog and why I felt the need to write one. I think it stemmed from a love of being a nurse.

I know lots of nurses(obviously) and I know lots of nurses that hate being a nurse. I know lots of nurses that cant wait to do something else. I know nursing is not for everyone. Its challenging and hard work. The hours are sometimes terrible and to be totally honest,sometimes its just down right messy.

The thing is, I know all of this and I still love it. I have worked in really hard positions,with some very challenging patients and families.I have worked night duty and late/earlies. I've missed lunch breaks and I've been too busy to pee for a whole 12 hour shift(my poor bladder !). I've also been so tired I've had to pull over the car to get a coffee so I could actually make it home without falling asleep at the wheel. I know all of my nursing colleagues absolutely have been through the same thing.

The reason I love it, I think,is the utterly privileged position we get to have with people at often the most hardest time of their lives. A patient asked me yesterday how anyone could bear to work with kids with cancer. How could you remain happy and sane? The answer is, we can make a terrible experience better. We can be excellent nurses to our patients.We can be compassionate and patient,we can be considerate and respectful. We can make patients feel valued and that we have time.

I once knew a nurse that seemed to take great pleasure in turning on all the lights in the bays at 6 am on the kids cancer ward. Regardless of the families sleeping or not. Regardless of the type of night the kids had had. All because she needed to 'read the drips'. I have seen nurses bathe elderly, frail ladies in their bed with absolutely no regard to dignity. Talking over them, leaving them exposed. I have seen nurses barely acknowledge their patients,never making eye contact. Eye rolling if asked for anything.

We've all seen these nurses. These are not great nurses. These nurses give nursing a terrible name. We can make bad situations better.

I don't work shifts now. I looked for a '9-5' job with weekends free and evenings spent with my kids. I no longer work in such a high pressured environment like the Emergency Department or Paediatric Oncology. I work with children with eczema. These children are no less important. We don't always have to  work in the high profile departments to make a difference.My families have often tried everything they know to make their kids better. What I do is not hard-I just point them in the right direction. I take the time to listen .I allow them to tell me of all their frustrations and I acknowledge them.

Of course I don't love it every day. Sometimes I have a headache. Sometimes I feel like being at home with my family. Sometimes patients are just awkward and unlikeable,to be truthful.But each day is a new one. Each patient is different. And I get to start anew everyday.Most days are great.

I believe nursing to be a privilege . It's not for everyone. To those of us that get to be nurses,we should be great ones!

Its how you make them feel

This is my most favourite 'Maya Angelou' quote of all time. I love it. I'm pretty sure its not aimed specifically at nurses  but it absolutely plays an integral part of being a great nurse.

As a nurse you have the ability to make your patient feel like the most important person.It takes a skilled clinician to be crazy busy,with a million things to do before handover,to take time out to focus solely on your patient.

A while ago I read the 'FISH' philosophy book( http://www.fishphilosophy.com ). One thing they talk about is 'being there'. Its about being present, in the moment. Its about making that person feel important no matter how busy you are. Its about taking the time to take their issues seriously.I think we can take this and apply it to our every day nursing lives( and every day lives too for that matter).

To a parent,their child is the most important thing ever. There have been many occasions when I've had a busy shift in ED. Had really sick kids to care for and often distraught parents too. Quite often once I've finished with the sicker kids,my next patient would be a child who could have quite easily ( and safely) been seen by a GP or even just managed at home. It can be frustrating and exacerbating. It's time consuming. But, to those parents, their child is important. To me,that child needs to be important too.I need to put aside my frustration and treat the family and child with respect and empathy. Because that's what they will remember when their child is actually sick and does need to be in a hospital. I never want a parent to feel like they can't come back if they need to.

That's not to say I don't get irritated or frustrated. Of course I do but I really try to take a step back and breath before I walk into that room.

When my boy was two he had Coxsackie disease (Hand,foot and mouth disease). He had a fever and a mouth full of ulcers. He refused to drink. I took him to the GP(a locum as mine was away). The GP tried to look in his mouth. My boy jumped off my knee and hid in the corner. The GP looked at me disgusted- she said if he wasn't so naughty she'd be able to look in his mouth. Actually ,no. If he wasn't so scared and sore,she may have been able to look in his mouth. If she had an ounce of understanding on how to deal with kids,she may have been able to look in his mouth.
She made me feel terrible. Like I was wasting her time cos she didn't have the skill to look after my child. I never want to make my patients feel like that woman made me feel.

A few months ago I ended up taking my hubby to ED at 3 am. He had a massive tooth abscess and was having fevers and rigours. He had a vasovagal attack and I couldn't get him off the floor at one point. He had seen a dentist and was commenced on antibiotics. He obviously needed more than a simple dose of oral antibiotics. I worked in ED,I know what people said about going to the ED with a 'toothache'. I knew we'd not be a priority.The nurse we saw was amazing. He showed empathy and gave great explanations to my non medical husband. He put him at ease. Took his blood and gave him pain relief and fluids. He was busy. It was 3 am. He never once made us feel like we were wasting his time. We were extremely grateful.


I recently had a mum of a young baby in my clinic. Her girl had eczema. To me it was fairly mild. She was crying and said she couldn't cope with her baby being so sick. I have eczema ,I know its a nightmare, but to me, there are worse things to have. To that mum,at that time,that was the worst thing to happen to her baby. Who am I to tell her different? Of course I tried to normalise her experiences of eczema but it is my job to help her cope. Two weeks later,she was in a different place-able to cope ,with a good treatment plan. If I'd have made her feel uncomfortable,I'd have never helped her to get to that place. I'd not have been able to have that follow up clinic with her as she'd have never come back.

I read a fantastic blog by a student nurse recently-
http://www.nurseuncut.com.au/nurses-are-amazing-souls-a-young-patients-perspective.

In it a young student and cancer survivor talks about the impact nurses have had on him. He talks about the nurses who put in his IV,hung his chemo,held his hand. It made me so proud to be a nurse. His post really gets to the crux of why we are nurses. To be there with the patient. To be present.


Its sometimes tough being a nurse. We give an awful lot of ourselves yet we still are expected to remain professional and able to function. We need to learn resilience. Maybe that will be the subject of my next blog post......

From assignments to blogs

I think this journey with blogging is going to teach me a thing or two.

 Up until now I have only ever written Uni assignments. I have just been accepted as a writer for a nursing education site. Both of these platforms need evidence  and references. They need a structure. A beginning,middle and an end.

I have done a little research into blogging before starting my own. The advice is to 'choose a style'. To go for a more informal type of writing. To make your blogs flow and keep your reader interested.


This is so different from assignments and article writing that its going to be tricky I think. Of course I think my articles are interesting!! But they are different from my blog. Let me explain- my blogs will be evidence/experienced based but I will not have a long list of references listed in alphabetical order at the end. I will not really have an introduction and a formal conclusion. Of course if someone wants more conclusive evidence then I'm happy to point you in the right direction. Lets just see how it goes !


One more thing. I absolutely cannot use this laptop - the 'e' key is missing and its driving me insane!!!!!

Becoming a Nurse Practitioner

I never imagined myself as a Nurse Practitioner. In my previous role on the project I had actually written a Nursing Workforce paper that included the role of a NP. I considered it for about 30 seconds then dismissed it! I just didn't think it was for me.

Of course when the opportunity arose to be an NP in a Children's Emergency I didn't dismiss it and was totally amazed when I got the job. I had an initial hurdle with Uni. The first university I applied to rejected the application as I didn't have a nursing degree. I had qualified in the 'olden' days before degrees- I had a diploma.They did offer me a place on the post graduate certificate course then I could go on to do my Masters. As my Candidate position was supported I had no choice but to be accepted onto a Masters course in the first place otherwise I would have to forgo my position.

I was very relieved to find Flinders University not only recognised my original qualification,but also took into account my experience as a nurse. I was accepted onto the course and breathed a short lived sigh of relief before the hard graft of a Masters in Nursing ( Nurse Practitioner) overtook my entire life! My candidate position allowed two semesters supported( fees paid and two days per week to study). My final Semester was still in the candidate position but I was expected to study in my own time. It was hard work. I had never taken chemistry at university or even in Grade 12 + 13 so to tackle Pharmacology at Masters Level was insanely difficult for me. I had to work very hard to pass the subject but I did and even did better than I thought I would.I missed out on holidays with the kids and spent weekends studying. I made sure I put time aside to do nice things too but was very disciplined with my days off and my study time. I handed in assignments early and studied really hard.


I had an amazing clinical support team and extremely supportive family- without the them I doubt I would have remained sane. My fellow NPC and I did experience some colleagues that were less than happy to find training Nurse Practitioners in their midst and to be honest our most vocal opponents were sadly other nurses. Having another NPC to bounce ideas off and to share the experience with was great. We were also invited to be part of an already established NP team whose insight into the NP role proved to be invaluable.

I completed my course at the end of 2012 and was endorsed by AHPRA three months later. Although it involved alot of paperwork and proving my experience I didn't have any real problems with this process. I cried when they called to say I'd been endorsed. It had been such a hard 18 months  and I was aware not everyone got endorsed easily.

Even though I was in the NPC position I had to apply for the NP job. The developing of this role and the subsequent interview took another 8  months but finally I could call myself a Nurse Practitioner.

Anyone who says the path to becoming an NP is easy is lying. It was difficult but not impossible. The NP role seems still to be misunderstood and we are often asked to explain, and sometimes justify ,our role. Once again, with some colleagues, it was a matter of just doing the job and proving yourself. The role developed with us and we most definitely proved ourselves and became valuable assets to the team.

I thoroughly enjoyed my role.It was challenging and rewarding. I learnt valuable skills and almost felt I had to learn a new language when talking to my medical colleagues. They cut us no slack because we were nurses. They expected us to perform to a high standard. I was embraced by the majority of the team and developed their respect. However , I could never see longevity in ED. I loved the work but knew the pace and shift work would never be a long term option for me and my family. When the opportunity came along to work regular hours in a Specialist Allergy Clinic I applied for the job and was actually quite shocked to get it! That is were I currently am and ,once again, am facing a huge learning curve but loving the opportunity to grow as a practitioner.

And so you have it- my whole career to date. It's actually been quite cathartic to write it all down. To be honest I'm pleased its done . I feel like I can now move on to the real reason for the blog- to look at current issues in nursing, to hopeful inspire and encourage other nurses and nursing students and to discover the real 'soul' of nursing.

Abbie

A New World

I remember thinking I would be bored in General Paeds. I seriously worried I would find the pace too slow. Boredom is not a word I use to describe my experiences on the Children's Ward !

This lovely little ward gave me time to breath. I was able to grow as a nurse and really expand my leadership skills-something up until this point I had never done. After a year I applied for a Clinical Nurse position and was successful. This is turn allowed me to undertake the Nurse Unit Manager position for a year covering maternity leave. It was a unique experience for me and one I had never really considered doing before.

The team was small but hard working. We had our share of challenges and some staff were non to happy with my appointment as NUM - the thought of a relative 'newcomer' taking the job did not sit well. It was a new challenge for me and I worked really hard to gain trust. Sometimes you just have to be 'time served' and just prove yourself. The majority of staff were supportive and even some of my most vocal opponents turned out to be the most supportive allies when all was said and done.

I enlisted the help of the senior staff and tried to bring about some positive change. Not only clinically but I also tried to improve the culture of the unit. We implemented the 'FISH' philosophy based on the idea that its OK to have fun at work. You can still do serious work and enjoy it. We worked hard at being inclusive and improving standards of care.

The thing I hated about being a NUM was the 'HR' side of it. I hated disciplining and confrontation. I tried hard to do it well but it was not my most favourite task. I tried to stay professional and maintain a great place to work. I genuinely wanted people to want to come to work. I wanted people to stay.

As a whole it was a good experience. The demographics of the local community was unique. We had many challenging families and I developed a close working relationship with the Department of Communities. Although I had worked in areas of a challenging nature before this almost monthly occurrence of potential child abuse was a difficult environment to navigate. It required some emotional resilience and because of this it was even more important to create a great working environment.

I think that this is not the time to discuss coping techniques for dealing with child abuse but its most definitely  a topic I'd like to discuss later down the line. It remains an ongoing challenge and something I became quite skilled in dealing with ,unfortunately.

I felt unable to return to the ward as a clinical nurse after the challenges of being a NUM. I knew one thing though- management was not a career path I was willing to pursue. I took on some project work for 6 months while I had a chance to re-evaluate my nursing path. I was unsure where to go to from that point and needed some time to think. This sounds easy looking back but it was an awfully stressful time. For a long time I worked one temporary position after another and it was another 2 1/2 years before I had a permanent job again. As the main wage earner in the family this caused huge uncertainty for us.

A new chance came out of the blue. I took a temporary post as a clinical nurse teacher in an emergency department and some funding became available to train up two Nurse Practitioners. Suddenly I found myself heading back to Uni and had no idea what the next few years would bring in this amazing,challenging,completely new role.

Nursing on the other side of the world

Moving across the world was a  huge task. Starting a new job was the easiest part!

I think in order to ease myself into my new life,the consistency of staying in Oncology was a great decision. The new ward was tertiary once again and was a little bigger with a dedicated Bone Marrow Transplant Unit. The magnitude of Australia really hit home during my fist few months. Patients would not only have this terrible diagnosis of 'cancer' but many had to leave their homes and families in order to receive treatment. The difference this time was, they often had to travel by plane and relocate their whole lives.
I struggled with the lack of facilities for teenagers after my previous experience and found it difficult to understand why babies and young people were nursed side by side. Teenage Cancer facilities in Australia are really only in their infancy and an area which is currently receiving a little attention,thank goodness.

Whilst the nursing was similar I did feel a little as if the holistic care I was used to was lacking.I was used to being much more 'hands on' with my patients and building relationships. Rightly or wrongly I missed this aspect of my day and found the lack of consistency in patient care frustrating.

I remember being astounded by the story of a little boy from an island off the coast of Australia. He had woken one morning unable to walk. His Dad put him in his little rowing boat and paddled for two days to take him to the nearest island with a hospital. From there he was transferred to a regional hospital and then to definitive care in Australia. He had a diagnosis of Rhabdomyosacrcoma. The families lack of visa meant they were unable to leave the hospital grounds. They had never seen electricity or had any experience of money. They'd sit for hours looking out over the city amazed by the enormity of it all. David relapsed whilst on treatment. We had to use a satellite phone at a pre-arranged time to tell his mum who was at home with his little brother. It took a week to get him home to die.

Another family sought treatment for their daughter with a brain tumour. They were completely disillusioned with the treatment in Aus so travelled overseas to seek help. All failed and they brought her home.They were angry. Unable to accept their daughter was dying. I looked after her with great care and respect-she was the same age as my daughter. Finally accepting there was no cure,they started to show me DVDs of her as a well little girl. They were lovely,happy family times. In one video she looked  straight at the camera ,waved and said ' bye bye mummy'. I apologised and left the room. I retreated to the linen cupboard once again and cried. On going back into the room I apologised and allowed them to know I had shed a few tears for them and their baby girl.. They were amazed and told the social worker all about the  nurse who cared their daughter was dying.

I went to her funeral and saw a picture of a little girl and her family I never knew. A girl who lived in the country,in a small town that loved her and raised $1000's in hope of finding a cure. A little girl who loved Spiderman.

I loved oncology but for many reasons,maybe to be discussed later, I decided to look for work nearer to home. This change in direction was totally unexpected. I left oncology for the world of general paeds and a new chapter began
.

My nursing crisis

After my initial experience with Oncology I thought I didn't want to be a nurse any more. I didn't want to be witness to that suffering and I thought 'ignorance is bliss'.

I resigned a year after I got married and went to live in Spain for 6 months. I was a barmaid. I didn't have any responsibilities. If I made a mistake it didn't really matter-someone got the wrong beer- not the end of the world.I had fun. I loved my job. I wanted a baby and to be a mum - nothing else.

We returned from Spain to have our first baby and I thought it was the best job I ever had. I loved it and thrived at being a stay at home mum. There was just that little 'nagging' at the back of my mind. When ever I filled in any forms and it asked for occupation I wanted to say nurse. Both the kids birth certificates list my occupation as 'children's nurse.'

When my little girl was 6 months old I applied for a very part time job. A charity wanted 'children's advocates' to work in children's homes for 2 hours a fortnight on an evening. I applied and got the job. I visited young people as they were first placed in a group home. I went to court with them,attended meetings with them,had dinner with them,listened to them talk and  we watched TV .After three years I was regularly visiting 3 homes on a weekly basis.

When my second baby was 10 months old I applied to work with another charity.This time we were involved in running parent workshops and support services.I worked with some of the most 'difficult to reach' parents in the country. I loved working with young mothers particularly and ran a number of courses in one of the most socially deprived areas in the North East of England. I fitted my work in around the kids and took my baby to the creches with me that were provided by the charity.

Both of these jobs I got because I was a nurse. They weren't directly clinical nursing but the skills were transferable. I started and managed a 'toddler' group that was registered with the local council. I helped to care for my mum who was sick .

We decided to emigrate to Australia at this point and I knew the key to a successful Visa was my nursing.I decided it was time for me to bite the bullet and return to the hospital. I was terrified and vowed to handle it differently this time. I didn't really want to return and saw it as a means to an end.I went back on a casual basis. The plan was to have Orientation on the Oncology ward for 3 days then venture out onto the other wards once my confidence was back. I completed my orientation on my old ward. I didn't leave for another 12 months.

I loved it and had found my passion for clinical nursing once again.

Nursing Children with Cancer

I don't think this will be my only post about this subject but I just wanted to do an introduction to my career first and this one speciality in nursing has played a huge part in my career.

I have worked with children with cancer on three separate occasions . This was my first....

Paediatric Oncology. From emergency nursing to this. It was a huge learning curve.I was 22 and had just become engaged. I was excited about my life. I loved my job and I loved my career. I don't really know where to start with this part of my nursing journey. I'll just try the beginning.

The ward was newly furnished and shiny! It had single rooms, a four bedded bay and was attached to a Teenage Cancer Unit. We had 14 beds in total and often had 'outliers'. We had a very busy outpatient department.

I was predominately employed in the children's end but would spend shifts looking after the teenagers and was ' Named Nurse' to some of them as they progressed from child to teenager. We were busy. We were often short staffed. We experienced bed pressure. We experienced heartbreak and sadness but also great happiness.We were a great team .We supported each other. I think in these highly stressful,emotional environments a good team is totally vital.

When I started I was lucky enough to be working with two of my closest friends-we trained together and we ended up working on the same ward. It was vital,I think,to my survival at that time. Another of our nursing students joined us later on and we made a great team.I was there initially for a total of almost 3 years. The ward Sister(or Nurse Unit Manager in Australia) was a bubbly,intuitive,mature manager.She knew us all well and was able to recognise our strengths and weaknesses. She taught me the skill of 'leaving your work at work'. She reminded us all that we had lives outside of nursing and to be good nurses and family members we would not take our work home with us.The hospital foyer had a huge 'crest' painted on the floor and she advised us to leave our work behind us as we crossed the crest. Of course it is easier said than done but it is a good skill to learn. Now I like to have the car or train journey home to reflect on the day and then move on with my day once the journey is over. There are obviously some times when I do 'take it home with me' but I have learnt how to deal with this too. I know sometimes I'm not a robot and I am heartbroken.These situations take a little time to resolve and I have stopped beating myself up over my  occasional inability to 'leave my work at work'.

 I learnt quickly that no-one wants to talk about children who have cancer. No-one wants to think of little kids dying. Early on in my career I would find it so frustrating to hear people talking about old people who had died and how sad it was. I raged internally at the injustice of children dying and found it difficult to feel sorrow when an elderly person died,after living a full life. Of course this sounds harsh and to those loosing a cherished loved one, grief shows no mercy. I know that now but then I struggled.

We had lots of wins. Cancer treatment is an ever evolving field and treatment improves all the time. We were involved in alot of cancer trials and in new and exciting treatments.Children with leukaemia were getting better. They weren't relapsing as often. They had a good prognosis. Bone Marrow Transplants were improving life expectancy. I remember one beautiful girl with AML having no family match for her BMT. The family were tested and were devastated to learn no-one was a match. They thought it was the end of the line for their beautiful Sophie. The BMT donor list was searched. A match was found and she survived.

My first patient that I was a 'named nurse' to was a baby of 12 weeks. Thomas had stage IV Neuroblastoma. The prognosis was poor. The treatment was harsh. His mum and I became very close. We were of a similar age and she had 2 other children. Her family lived a few hours drive away and so they went home during the week and visited at weekends. Her lovely hubby found the situation impossible to deal with and so often closed off from everyone and carried on his life in a fairly mechanical nature. He did what he had to do but had nothing extra to give. He cared for the children at home and went to work.There is no judgement here. I have seen families cope in all different manners and unless we have walked a day in their shoes we cannot possibly know how it feels to be told your baby is dying again and again.

 Thomas was with us in the hospital for over a year. Many,many times we were told he would die. Many times he was so sick,he was 'specialed'( had one to one nursing). I was very often nursing him. Every shift I would go into work thinking he may have died. He had a triple lumen C.V.C and an N.G  tube. At one point he needed twice daily platelet infusions and daily blood transfusions. He had a BMT and had GVHD. He had multiple surgeries.We celebrated his first birthday with little party and a cake he couldn't eat.His family came to visit.His siblings didn't really know him.He survived against all the odds.

I saw him again at the age of 10(I had left oncology and then returned by then). His parents had got married and all three kids had been there. His mum told me when she first went home her little girl(who was 2 at the time) refused to have anything to do with her.It took a long time to rebuild that relationship.He was slightly small in stature but was well and in remission and most definitely alive!

One of my most difficult memories was of another little baby. He had leukaemia but didn't do so well. He got an infection and unfortunately died just after his first birthday. He died in PICU and his mum was too distraught to come up to the ward and empty his room. I helped his aunt empty his room. I emptied his wardrobe and pulled out clothes with the labels still attached. First Birthday presents he had never been able to wear. My heart was breaking.

I held the hand of a 13 year old when he was told he had relapsed and there was little hope of survival.'Am I going to die?' he asked. I couldn't answer. I watched a young man marry his girl friend weeks before he died. The same young man had a frank discussion with me about sperm donation before treatment commenced and how could he ensure his girlfriend had access if she wanted to. One solution- to get married at 18. I blocked my ears(literally) when I couldn't bear to hear a three year old scream in pain any longer. It had gone on for days and no amount of pain killers seemed to help.I sat with a young family from Japan when they were told their little boy had cancer -'shall I tell my family to come' his mother said.

I was 24 and in all honesty I look back at this period in my nursing career and see it as 'dark'. I don't regret it at all and I feel immensely privileged to have been able to work with some of those amazing families. I left after 3 years and stepped away from nursing completely. I was worn out. Even at that young age I was fatigued.

It was over 5 years before I would return to hospital nursing. In that time I would have two children,get married,travel and work in a couple of varied roles. I tried to forget nursing but I could not.

My nursing journey- newly trained and terrified

Who has a career plan? When I look back at my nursing career I can't believe the twists and turns it has taken.

When I first started I was told at interview I'd make a good nurse manager. I was horrified! I said I never wanted to be anything other than a hands on clinical nurse. I honestly didn't have any ambition other than to complete my training and to work with patients. I never had a career plan. I never dreamt I'd be here,where I am today.

Of course looking back,I'm exactly where I said I would be. I am a Nurse Practitioner. I am predominantly clinical but my role is extended or advanced or however you want to think of it. I can prescribe and diagnose and can work with a fair amount of autonomy. I never, ever dreamt this is where my career would take me. I never had a plan.

I live and work in Australia. I was born and bred in the North East of England. I trained in a tertiary hospital( or group of hospitals) that became a NHS Trust.We were trained under a scheme that aimed to bridge the gap between hospital based training and university training. When I started in 1994 there was no option to get a degree in nursing. The concept was fairly new and was highly suspicious to us. Everyone suspected hospital based training was best(!) and that you couldn't get real,proper experience in a University.Everyone was highly suspicious!Now everyone is Uni trained and we have amazing nurses from this training too.

 Luckily we didn't have to wear hats or capes but we did have a pristine 'A' line white dress to wear. We had black shoes and 'skin coloured' tights. I remember being terrified of the 'old fashioned' matrons who patrolled the corridors and tore strips into you for daring to breath the wrong way! There were some dragons.

I think my training was excellent. We had lectures in Uni but had blocks of prac on the wards. We worked shift work along side a mentor and we were lectured by academics.We were largely prepared for the hard graft of hospital/ward nursing and most definitely got our hands dirty,so to speak.One of my mentors held my hand and cried alongside me when I nursed a little girl dying of a brain tumour. She came to the funeral on her day off and guided me through one of the hardest things I had witnessed as a sheltered 19 year old.From the very beginning I had to learn the fine balance between feeling the pain and heart break of death(especially of a child) and being able to be a professional,competent nurse.

My first real job after graduating was on a Paediatric Emergency and Assessment Unit. This was just at the start of the thinking that children should be cared for in specialised Children's Emergencies and be separate from adults in the UK.We were trying to be an Emergency Department and Day Unit rolled into one. It was an amazing place to start. I learnt how to take bloods,insert catheters and NG tubes. I learnt how to assess sick kids,run through fluids,prioritise care and participate in resus's. I learnt early on in my career what it means to 'have no beds',to have no-where to put a patient needing specialised care. I learnt how to triage patients without having the set of guidelines we have now. I learnt to use both subjective and objective assessment skills.

I also had my first experience of seeing a child die right before my eyes. Pre-vaccination,meningicoccal septicaemia was a real threat and I watched a child die from this terrible,devastating illness. A little boy who came in with a fever and a rash and never went home.I learnt how to hide in the linen cupboard and cry before going out once again to 'pick up' the next patient and carry on making them feel like their child was the most important patient in the world.

It was baptism by fire! These early experiences have defined my career and informed the type of person and nurse I am today. They have allowed me to 'roll with the punches' so to speak. I matured beyond my years and saw things no 21 year old should probably ever see.

My choice to move on to the Paediatric Oncology Ward was a bold one and one that almost ended my nursing career early.

Intro -The Soul of Nursing

I think I've always been destined to be a nurse.

From the age of 4 I always said I wanted to be a nurse. My mum was a nursing student but gave it up for love(at that point you couldn't have  both apparently!). My Gran told everyone she was a nurse but was really a cleaner on the maternity ward.

I have been a Children's nurse for 20 years. I am many things. I am a mum,wife,vegetarian,human rights advocate and expat. But before all of these I was a nurse. It is part of my identity and part of my soul.

This blog is intended to be an insight into nursing . Its intended to be informative,compassionate and sometimes funny. All opinions expressed are my own and not those of my employers,past or present.All names have been changed to protect identities.

Thanks you for coming along on this journey with me

Abbie