First time in a children's ward! excited but nervous. Can anyone help me out?

GuEsT78 · Jul 8, 2015

Pediatrics can be great fun. I worked as a guy nurse tech at a major children's hospital, spending 16 months on a Hem-Onc unit (mostly) that had kids from birth to their 10th birthday and another 10 months working with teens having virtually every illness imaginable. I've even written three books on that experience.

What's most important? Probably realizing that kids vary enormously over that age range as well between one another. Adults have typically learned how they're supposed to behave in a hospital, and thus behave roughly the same, however they may feel inside. The same is somewhat true of older children and teens. That means there's some predictability. They know how patients are supposed to act.

That's definitely not true of small children, particularly when their parents aren't around to provide assurance. What they feel is what they do and that can get quite extreme. You'll need to learn to handle that with lots of patience.

I once came on duty at 11 pm. At report the evening nurse said that one little two-year-old girl had been screaming since her parents had left at the start of evening shift, stopping only long enough to recovery her strength to scream again. She kept crying well into the small hours of the night, particularly when I came into her room (she had an infection) to check up on her.

Finally, about 2 am, I saw a magical transformation in just a few seconds. She'd been screaming without even looking at us on the nursing staff. We were the enemy that had stolen away her mother. But at that moment, her eyes still wet with tears, she looked at me with a sort of "well maybe you will do" look. That was the end of her crying. After that, all went well.

Never forget that, for little kids, the complexities of a hospital is far beyond them. They understand nothing that's happening to themâ€”not their sickness nor their often painful treatment. The key question they ask themselves is "Can I trust this adult who does understand all this?" Until they answer that with yes, they can be most difficult. If you focus on liking them and showing it, they'll eventually figure that out and become cooperativeâ€”except perhaps for those terrifying pokes.

It really is amazing. When I first started on Hem-Onc, I was afraid my young patients (average age of four) would hate me. I was, after all, a part of so much of their pain and suffering. I was amazed to discover that wasn't so. I made a point of liking each of them and doing what little I could do. They sensed that and responded accordingly. I wasn't a terrifying monster entering their room in the dark. I was someone who was watching over them. In the midst of all their sickness and pain, they would smile.

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With teens, respecting mattered more than liking. Not quite adults, they still wanted to be treated as adults, however they might define that. That I kept constantly in mind. These aren't children, I reminded myself, you've got to treat them more like you'd want to be treated.

I also found that at puberty, an enormous shift took place. Whereas before, I could treat boys and girls as much the same, when those hormones began to shape their thoughts, I found that, in addition to individual differences, I had two radically different kinds of patients.

Teen boys I never really got a handle on. Being sick enough for hospitalization, often for surgery, triggered a massive fight or flight response in them. But what could they do? Sick as they were, they could neither strike out nor run. They could only grudgingly endure. As a result, I never found a way to break through their often sullen shells. Unlike little children, liking them did no good. They didn't care if a I liked them or not. I typically got them to obey medical orders by adopting the attitude, "You might as well do what I say, because I'm going to keep nagging you until you do." All and all, I was unhappy with the situation, but never found a solution.

The only exceptions were teen boys with disabilities or chronic medical issues. They had long learned to accept the powerless that comes with being badly sick and were marvelous patients. I did feel that things would have gone better with my other teen boys if I could have found a way to get them to accept the fact that they were sick and thus had little power. But there was not enough time for that. I also wanted to empower them, but I couldn't come up with any way to do that. Medical orders were medical orders. I couldn't make them optional. They could not fight. They could not flee. All they could do was sullenly endure. Not good.

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Teen girls operated by a totally different set of rules. With them, tend and befriend trumped fight or flight. Tend meant their doing things that made my job easier and befriend meant being likable and cooperative as patients. Others may have had a different experience, but for me those teen girls were marvelous patients. I needed none of the tiring nagging it took to handle teen boys. In one book I wrote on the experience, I explained that moving between a room with mostly extended-care post-op boys to one with post-op girls was likely traveling between grim and northern European city like Berlin to sunny Italy.

One key issue illustrates that. I was the only guy on the teen unit's day shift, and I suspect the presence of those women was one reason why the teen boys were so sullen. They got no privacy from the otherwise all-female nursing staff, At any moment, one of that staff could charge up to their bed, tossing aside sheets and gown to check on a surgical site. The result was glum. I never took care of a teen guy who didn't guard his privacy zealously. They all wore undies. Thy all kept their gowns tucked in and their sheets pulled up, even on summer days when the air-conditioning wasn't keeping up with the heat. They were like a besieged city.

The girls were the opposite. Over the summer when most of the serious orthopedic surgeries took place, the girls could hardly be more casual. Sheets were kicked down. Gowns flounced about and for some undies were optional. The beginning of those summer surgeries was when I started, and I soon worried that, much like I'd feared those little kids on Hem-Onc would connect me with pain of chemotherapy, those teen girls would connect me with all the embarrassment of being a guy caring for totally bed-ridden patients who'd had major back surgery. I feared they'd become as glum and withdrawn as the teen boysâ€”but totally as a result of me.

I scrambled to find a solution. I wasn't aware at the time that what I was doing was establishing a tend and befriend relationship, but that's what I did. I made a unspoken deal with those girls. I'll do everything I could to limit the embarrassment of my guy-given nursing care, if they'd accept what embarrassment that remained. I only came in when I was needed, although that meant little. They were so needy that they were about two-thirds of my workload. Most were in four-bed rooms, so as much as possible, I'd care for each facing away from the others. I did my best to look away when their casualness about gowns and sheets meant exposure. I became lightning quick with bedpan placement, and over time I learned way to make common procedures less embarrassing.

To my surprise my efforts worked. Unlike the teen boys who were rebelling against a system they legitimately hated, these teen girls wanted to cooperate. One illustration amazed me. Those with back surgery often had to lie on their backs, only rolling occasionally from side to side. That meant that often their lunch ended up on their gowns. They'd hit their call light and I would show up. What was I to do? Both they and I knew they often didn't have a scrap of clothing under their gown and yet it had to come off.

The solution for that was simple but, for the girl had every appearance of high risk. I'd stand at the head of their bed, with a new gown alongside their yucky old one. I'd then switch the two gowns, taking care to look the girl in the eyes the entire time, leaving everything below her neck a pink blur. Every time that situation arose, I expected the girl to cross her arms and say something like "Don't touch my gown you pervert. Get a woman for this." But they not only never did that, they often had a most amazing smile when I did my "look them in the eyes" part. Only later did I conclude that they'd not resisted the gown switch because they thought they could trust me and the smile came when they realized they could. For someone interesting in cooperation rather than power, that was a happy solution. I only wish I'd come up with similar solutions for those teen boys.

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There are a host of other issues I could mention. For small children, for instance, it always helps to interact with parents while the child is around watching. If the parents treat you as OK, it makes it much easier for the child to adopt the same attitude. Other attitudes help. I never adopted a belief that my allegedly superior knowledge of patient care trumped a parents much greater love. I knew that their much greater knowledge of their child often meant more than my formal training. If they felt something was going wrong with their child, I took it most seriously. They could see what I could not.

To answer one of your questions, the amount of care parents provide varies enormously between hospitals and depends heavily on family circumstances. I cared for children with cancer in situations where both parents could take weeks off to be with their child full-time and do almost all their care but the purely nursing stuff. Nothing will teach you the value of solid, two-parent families like caring for sick children and seeing its benefits. I've also cared for children whose family situation was such a mess, they were literally abandoned to die all alone and only cared for by nursing staff. That's one of the saddest situations imaginable. You'll simply need to adapt to the situation as it is. I also found no value in judging parents who'd abandoned their child. I suspected most had seriously troubled lives of their own.

One final remark. You don't need to wait for that hospital job to learn more about kids. Look for ways to volunteer with kids programs in general. Children don't become different creatures when they enter a hospital. They're always kids and often that means they're far more adorable, varied, and interesting that all we stick-in-the-mud adults.

--Michael W. Perry

S00147954 · Jul 9, 2015

Wow Michael thank you so much for your comment. I read it all, thank you so much. I've known I've wanted to work with children for a couple of years now at least, so I've done a fair bit of volunteer work - distraction/playing, helping to make things better for the kids by helping with events etc, as well as various other things.

That's one of the things I worry about a lot - that the kids won't like me. More so that the parents won't. I had no idea there was such a huge difference when it comes to ages and genders, especially when it comes to things like privacy/modesty and overall demeanour. that's really interesting. If you have a patient load of, say for example, all older kids does that make your day easier or harder than having younger kids?

One more thing I have to ask, has being a male nurse affected the way you do things - i.e. do you have to take extra precautions when it comes to girls or even children in general? I know how easily some can get the wrong ideas.

You mentioned that some kids are totally abandoned by their families, which is so terribly sad. Is this common for you? how do you handle that sort of thing??

Sorry for all the questions! I just want to be as prepared as possible.