remoteareanurse

Here's the two I most often have to bite my tongue on: 1. Are you familiar with the concept of karma? Because if I were you, I'd be really worried that when I get old and sick I'll end up with YOU for my nurse. 2. Being a professional means that no matter what else is going on in your life, when you walk onto this ward you pin a believable smile on your face and do NOT take out your mood on your patients or co-workers.

In the mid 1980's, while working in a small, remote hospital, the three most senior nurses carried pagers when off duty because the hospital was so small that there was only 1 RN and 1 EN per shift, so if there was an emergency extra hands would be required. One evening I was just starting to cook tea when my pager went off. I rang the hospital and was told there was a cardiac arrest in Casualty.I told Mark, my husband, that he had to drive me to the hospital quickly, and explained why. Right in the middle of an exhausting rescuscitation someone answered the phone and called out to me that Mark was on the line and needed to speak to me. We all paused momentarily, and everyone looked at me. They told me later that I instantly went white as a sheet. What on earth could be so important that Mark would ring me in the middle of a cardiac arrest? It had to be one of the kids. Oh my god, something REALLY bad has happened to one of the kids. Someone grabbed the vent bag out of my hands and said "Go- quickly!" I flew to the phone. "What is it?" I quavered. "Well, I was just wondering", said Mark. "Did you want those carrots cut into little sticks, or little circles?". He got quite offended that I hung up on him.

I had such a chuckle reading the replies above. Paeds can be really challenging, usually because of the parents, and its easy to become a bit jaded and cynical, as you can see from these very experienced paed nurses above. I'll just bet they're all fantastic nurses, and I equally bet they don't let that cynicism show at work (they're actually big soft marshmallows who will always go the extra mile for the kids and their patients.) It is really easy to get offended/judgmental/frustrated with parents/caregivers. We are nursing them as much as we are the kids. Just step back from the situation and think about the following factors: 1. Just because you're an inexperienced/ineffective/inept parent doesn't mean you don't love your child. 2. The hardest job in the world is being a parent. The easiest thing in the world is to criticise someone else's parenting. 3. Anyone who has kids will tell you that there is nothing more scary than your child being sick or in pain. We'd all rather endure ten times more pain ourselves than have our kids suffer for even a second, and every parent's greatest fear is the loss of their child. So most challenging behaviours from parents come from fear. You can't remove that fear, but you can show them that they can trust you to be acting in their child's best interests and to involve them in all decisions and care. 4. The greatest honour any parent can do you is to entrust you with their child's welfare. 5. Kids are pretty adaptable, parents not so much. We're a bit set in our ways and views. 6. There are very few situations that are not improved by some humour. A big belly laugh is a huge stress reliever and goes a long way towards establishing liking and trust. 7. And the other big stress reliever is a big bawl. Unfortunately as parents we know that our kids will freak if they see us crying, so sometimes you need to facilitate a private, quiet, safe space and let them go for it. 8. You are meeting these parents at one of the most stressful times in their lives. Try to remember that. I would really hate to be judged by someone who had only met me when I was ranting with road rage in my car! Hope this helps. Paeds is hugely rewarding, and although we often joke that it would be easy without the parents, the reality is that we have to deal with them and often whether they are a help or a hindrance comes down to how we do that. So make your life easier and do it well!

I really endorse all that janfrn and myfavouritescar have said. You've already got some invaluable experience, and most importantly, you're passionate about it. The only thing I'd add is that always remember you're not just nursing the child- half the battle is establishing a trusting relationship with the parent/caregiver. I see lots of nurses struggle with this. If you have kids, you'll know that there is NOTHING more stressful than having one of your children be sick or in pain, and often this causes parents to react in ways that can seem quite inappropriate. Never take the behaviour personally, yes there are some dreadful parents out there, but the vast majority love their kids and just want them to be better. Treat them with respect, communicate openly and respectfully with them and let them see that you're all on the same team with the one aim- to help their child. Congratulations on this fantastic opportunity, relax and enjoy yourself, there are few things more fun than paeds, and you'll get loads of hugs and undying gratitude from kids and parents, its so rewarding.

I can't believe I didn't work this out until I had my own kids. One of the scariest things for a kid is having to talk to a total stranger. So don't talk to them or question them. Introduce yourself to them and the parent(s) together, " Hi, I'm (name), your nurse" in their general direction, then address all questions and talk to the parent/caregiver. They will relax hugely once they realise they're not expected to speak to you. Let them initiate the conversation- most will when they're ready, some never will. And if you are talking to them, DON'T LIE (eg. this won't hurt/ only a little sting), don't give them options that don't exist (eg. is it ok if I look in your ear? should be 'I am just going to look in your ear') and the calmer and more relaxed and matter-of-fact you are the better they'll be. And learn how to effectively hold and immobilise a child, because often the kindest way to do something is to immobilise and do it fast, far less traumatic than ten minutes of trying to get them to co-operate, meanwhile they're getting more and more wound up and scared. Good luck , hang in there. I LOVE paeds- I always say that if I'm going to nurse someone who is behaving like a four year old, I'd far rather they WERE a four year old! lol.

Watching someone press on a bruise makes my legs go all funny- I can't watch! Also people cracking their knuckles gives me the horrors. Absolutely fine with vomit, poo, sputum, maggots, anything. Go figure.

As a former Director of Nursing I can tell you that if you've demonstrated your skills in this unit your resume is almost irrelevant at this point. I will ALWAYS take the nurse whose skills I know over the one whose skills I read about on a resume. Your greatest advantage in this situation is your experience in this ER and the recommendation of your preceptor. Relax!

If you didn't feel like that you would be dangerously overconfident. The day you feel like there's nothing for you to learn is the day you should leave nursing. Hang in there, it does get better. And don't beat yourself up about mistakes, just learn from them and don't make the same mistake twice. Any nurse, no matter how experienced, who says they don't make mistakes is either a moron or a liar!

Years ago someone told me something that I always try to remember in situations like this. They said "You have no power to alter the behaviour of others. The only thing you can control is your reaction to it." I've found this to be incredibly powerful. If I know I have done absolutely nothing with which to reproach myself, I let it go. This person has no right to affect you emotionally- make a choice and don't let them.

Potassium MagnesiumSulphate is right, you need to narrow it down, and climate is a good way to do that. And although only big cities have specialty ICUs, your skills would be hugely appreciated in country hospitals, especially remote ones where there is often a significant delay in evacuating critical patients. One of the things you should consider is the opportunity to work with our indigenous population, which can be frustrating and at times heartbreaking, but also hugely rewarding and interesting. I worked in the Torres Strait for a while when my children were small and its a fantastic experience for the whole family, the TS Islanders adore kids and are SO good to them, and the islands are paradise on earth. The outback is also beautiful and unique in another way, and I've found traditional aboriginal people to be so generous in sharing their culture, traditions and knowledge, and although schools might not be so great in these areas, your children will receive their education in very different ways which will really benefit them. If you do plan to go remote, make sure your accident and emergency skills are solid, because many of these towns have limited or poor medical support and you'll need to feel confident in assessing and treating emergencies. Hope this helps, let us know what you decide.

Very drunk patient in the medical tent at music festival: "I am super intelligent you know." Me (thinking 'the evidence would indicate otherwise"): really?- do you know what you're IQ is? Him: Yeah- its 45!