imaginations

I work in paeds onc. We tell all our parents, including parents going to transplant/BMT that their parenting style should not be altered by their child's diagnosis or treatment and that they should continue to enforce their usual limits and boundaries around their child's behaviour. Spending 3+ months in hospital with a child undergoing transplant, stuck in the one room with them, can be draining for these families and limit setting helps them cope during the experience and when their child is well enough to be discharged, or in remission. It also makes things easier and fairer on other children in the family. If the child is well enough to throw toys, the child is well enough to have limits set around appropriate behaviour.

I have also worked at Sydney Kids (in areas you expressed interest in). Would be happy to answer questions via PM.

Have you thought about volunteering as an RN with St. Johns Ambulance? This will give you the opportunity to learn and practice skills in first response and emergency care as an RN and network with health professionals from a variety of backgrounds. This should give you two benefits when looking for RN work without a new graduate year: 1) clinical experience and CPD in the role of an RN 2) the opportunity to network with health professionals who may be able to hook you up with a job interview in the future, especially if you commit to and apply yourself in your St. John division. Also consider volunteering as a registered nurse for charities which use RNs, where you will be able to work in the role of an RN, such as Canteen, Camp Quality, Camp Sabbaba or HeartKids, which all use RNs for their kids camps. At this stage, heading toward two years post graduation, you really need to stand out when applying for RN jobs as managers and recruiters reviewing your application will wonder why you've not been able to get a job. You need to demonstrate that you have all the skills and attributes of an RN when applying for jobs. At this point, your academic record is not going to be the strongest evidence of that and you will need to demonstrate that you are capable of succeeding as an RN, rather than just have the potential to succeed. Thus you need evidence i.e. work in the role of an RN. It's a tough market out there for new nurses but it's not impossible. Good luck!

There are a lot of Kiwi nurses who do grad programs in Australia (there were two in mine and at least one in the year before me). However I have a feeling it is more complex in the reverse. Good luck!

You should be able to find this information on each hospital's website. The process in Victoria might have changed since I was a grad and it isn't impossible that you have to go through the Matching process for some private providers (particularly some of the bigger ones like Healthscope and Ramsay). However that doesn't stop you from thoroughly investigating all your options. It doesn't look good to recruiters and graduate coordinators to get a phone call about information that can be found on their website. If you are going to phone, make sure that you have done your research and have intelligent questions to ask. Otherwise you'll be writing yourself off before even submitting your application. Remember, it's a competitive market and you need to stand out.

I recently contacted Nursing Network Agency to enquire about a position advertised on the MyCareer website and was not impressed by their recruitment staff at all. The woman I spoke with was rude, not clear about specifications and requirements for the role I was enquiring about and provided details that differed from the role advertised (e.g. the role was advertised as casual and she stated it was full time; the role was advertised as available, she stated that it was not and so forth). After sharing my qualifications and experience, she tried to recruit me for a position that I was clearly unqualified for and that she obviously needed to fill very quickly. She was not impressed when she stated that I did not feel qualified to take on that role. She also tried to pressure me into joining the agency despite not being able to provide me with any information about available work that suited my requirements. Based on this I would recommend avoiding this agency: Australian Nursing Agencies | Nurse Sydney | Nursing Agency in Sydney and UK

My interview was several years ago now and is blurred in my memory with a very similar interview I did in third year for an AIN position in the same facility. There were six questions (I believe this was standard then, I don't know how the process has changed). - The first asked about me, my background and why I wanted the position - There was at least one prioritisation of care question (e.g. you have three patients; one has a low blood sugar, one is being called for theatre and the third, with acute asthma, has dropping SpO2 - how would you manage this situation?) - A question about how you would manage a specific case of workplace bullying / poor workplace culture - A question about how you would manage another nurse's poor practice (e.g. not washing their hands / using gloves appropriately) - A question about appropriate PPE for a certain circumstance Once again, your university should provide you with practice questions, hospitals will be having information evenings where you can ask these sorts of questions and past grads in the hospitals that you are interested in will have better recollection of what they were asked and the types of answers you should be thinking about. To stand out from the crowd (and there will be a crowd) you need to do your research and prepare will for your interview. It's the point on which you will be selected for your ideal graduate job or dismissed from the recruitment pool.

You need to do your research. Find out the names of hospitals, get on their websites and research their graduate programs. You need to be proactive in the competitive employment environment that is graduate nursing in Australia. Victoria is a hard market (though likely not harder than QLD) and the process is one that you need to understand very well in order to succeed in getting a job there. Make sure you look outside the Vic Health match system as well as private providers such as Ramsay and Healthscope, some of whom will likely provide critical care options for grads.

Your university should be able to provide you with practice questions (there is a common scheme and format of the questions asked across NSW Health) and a general guide to answering them. Practice practice practice your answers and have responses prepared for that can be flexed and fitted to the different categorise of questions (prioritising care, OH&S, behavioural, 'tell me about yourself' etc) with appropriate e.g.s for each.

First off, it sounds like your orientation was lacking. As a new grad I had two weeks supernumerary on my first rotation and six weeks on my second rotation (though this was in a critical care area, new grads rotating to other wards had another week supernumerary to learn the new wards ropes). As a new grad I would have really struggled being thrown in the deep end without a lot of support because sorting out all the little things - like knowing where things are kept, when the meal trolleys come around, what phone numbers to call, when the doctors round and so on - take up a lot of time on your planner when they aren't second nature. I would second all the advice on organising your planner (if your ward doesn't have a template you can make up your own by drawing up a table with hours down the rows and each of your patients in a separate column) and reaching out to your educator, NUM, grad program staff but also don't look past your colleagues. I know that nursing culture is not always sunshine and bunnies and that on a busy shift it can hard to find someone that is willing to help you out but it is the role of the team leader and float nurses (if you have them) to make sure the show is running smoothly. It's okay to ask for help and it's okay to be struggling. It's intense and stressful and you are new to this. It's okay not to be getting everything straight away but it's not okay not to be seeking help where you need it. I remember many a-day as a new grad on the ward feeling overwhelmingly stressed/frustrated/useless/like I wasn't doing the best for my patients. The thing that helped - every time - was support from my colleagues, which I didn't always get. Make sure you have good supports outside work and look after your health (mental and physical). I know it sounds superfluous but I can't stress enough how much it makes a positive difference when you've had a good breakfast before a morning shift and have a good lunch sitting in the fridge in the tea room; or how much it helps with the havoc shift work wreaks on your body to exercise, even just for twenty minutes, every week; or how much better it makes you feel to have a sympathetic shoulder to rant or cry on after a crappy day.

You need to consider what you want from a graduate program and do your research. Is a big hospital with a lot of complex cases, rare diseases or trauma important for you? Find out what hospitals tend to deal with those patients. Do you want to work in theatres, ED, ICU or mental health? Find out which hospitals offer those rotations for new grads. Talk to past and current grads about the graduate program support, study requirements, work place culture etc. & apart from that, work on your interview skills because that's what will get you the job you preference first. Also look into non-NSW Health options (private hospital providers such as Ramsay and Healthscope offer a number of graduate programs, as well as numerous aged care providers) in case you miss out on a NSW Health position, which is happening to more and more nursing grads.

This situation is particularly bad in Queensland given the current political environment and the major public service cuts. If you haven't seen what is happening between the Newman government and the medical fraternity in QLD and are wanting to work in the public health system in QLD then you are living under a rock. However there are ways around the citizenship requirements. I don't know how available these options are in QLD but in other states such as NSW a number of non-acute care settings (i.e. not major teaching hospitals) are beginning to offer graduate programs, particularly in the aged-care sector. Also consider private hospital providers such as Ramsay and Healthscope and start doing your research now for what is going to be feasible for employment when you graduate.

I would stay in ICU, hands down. Especially if the acuity and/or census if often low and there is competition to actually get a sick patient. 6 months is nowhere near enough to have have ICU down to a tee. If you like it, then stay!

Hi All, I completed my new graduate year as an RN at a tertiary children's hospital (five months on a speciality ward and seven months in the ICU - where we cared for newborns through to teens). At the termination of the graduate program I was offered ongoing employment in the ICU however I elected to return to study full-time in a field not directly related to nursing. (I had studied part time during the final four months of the year and found it challenging to say the least.) I have since studied full time and excelled, with excellent grades and a number of exciting opportunities, including a scholarship to travel overseas in the new year to conduct research however these are not directly related to clinical nursing. I intend to continue my studies in the new year however I would like to return to nursing part time. I miss babies too much & even the hint of intensive-care related issues on television remind me how much I enjoy working in the ICU. I am looking at seeking a part-time or casual position in a NICU (which consists of special care, high dependency and intensive care cots) at a major, non-children's hospital with mother-baby services. However I am concerned that my experience so far and the fact that I am not seeking full time employment will count against me. In particular, I am concerned that my experience is paediatric, rather than neonatal. In my previous ICU we cared for newborns (and brand brand new bubs) but not a typical NICU population of prems, mec asps etc. Typically these babies were chronic lung or cardiac babies. I have cared for a lot of older infants, ex-prems with chronic lung requiring ongoing ventilatory support but my actual NICU experience is limited to two weeks in a tertiary NICU as a final year student. I hope to be able to sell myself to the NICU nursing manger directly by sending an opening email and resume. I would be interested to hear if you had any thoughts that may help me improve my chances of gaining a position in the NICU in a non-fulltime capacity with my experience to date. Thank you :)

No, it's not. I know plenty of RNs who've gone to medical school. Point is, they didn't expect - or get - credit or recognition of prior learning for being an RN. Everyone comes in from scratch. The reality is - being a doctor is nothing like being a nurse. & in Australia, the pre-reqs required for medicine (bio, chem, physics) are a) not compulsory, simply expected and b) not required for nursing.

This is the day-to-day woe of most nurses in my PICU more often than not. We are often described as more of an HDU than an ICU, simply because we typically have more stable patients that unstable or intubated patients. I could go on for hours about the 'most stable' patient I've looked after... Ex-prems now chronic trache-vent dependent stuck in PICU until the previous kid on the ward gets home because the ward only accepts 1 trache kid at a time (and they can't go home quickly because of lack of government funding for ventilated kids). I spent Christmas day opening presents and dressing a seven month trache-vent dependent bub (who was medically fine -- long term vent) because he hadn't made it to the ward yet. He went to the beach in the afternoon and I had NO patient! We've a few kids with neuro issues get trached recently. Came in for handover after a few days off to hear one of them had gone to the beach and had ice cream with mum and dad and the other went up the road for coffee and cake with parents. (Getting kids with traches onto the ward is very political, it seems.)

There is no credit for prior learning in medicine in Australia. You must complete the entire course or you will not be eligible for registration with APHRA as an intern at the completion of your degree (because your degree will not be complete). Try posting this question on the PagingDr forum and see what sorts of responses you get from the experts. Welcome to Paging Dr forum for graduate entry medicine in Australia

I encountered a similar, though not the same situation, last night. A bigger patient (14 year old, 60kg) 20+ days post BMT in renal + respiratory failure. Previous issues with hypertension (preceding transplant and renal failure). Intubated + ventilated for two days following surgical insertion of a permacath for haemo dialysis, pre-op was dependent on bi-level non-invasive. Nil issues with blood pressure in the two preceding days (one pre-op, one post-op - now day two post-op, weaning ventilation to extubate back to non-invasive). Patient 'sedated' with 4mcg/kg/hr Fentanyl (was prev on Fentanyl PCA + background for pain), Propofol (1.4-1.8mcg/kg/hr) & Precedex (0.3-0.6mcg/kg/hr) however awake, settled, communicative and neurologically intact. I noticed a downward trend in mean arterial and systolic pressure (via non-invasive cuff, no invasive monitoring) over about three hours and pulled back on my sedation (over 9 hours the Fentanly was halved, Precedex turned off and Propofol off for periods) however continued to lose blood pressure until both systolic and MAP were well below (as in 10mmgH +) his 10th centiles for age/weight. However, he remained alert, neurologically in tact, pink, warm, well perfused etc. No one (none of the senior nursing staff or the overnight medical staff) could target a reason for his blood pressure drop or explain why he remained so awake/in tact. Very disconcerting experience. Any pointers to help break down the situation? Things I could have/should have been looking for or doing? I'm a new ICU nurse and would appreciate the input :)

In Australia you do not get to skip a year of medical school because you are an RN. You need to take the GAMSAT, have an adequate undergraduate GPA, make the cut off for interview, get through the interview process and be offered a place in medical school -- and then get through the four years of graduate medical school everyone else does.

I don't work in paeds neuro ICU but I worked in paeds neuro/neuro surg for a while and my current PICU gets a lot of neuro kids. How long will patient's be staying in your unit? I guess one thing that we find in our experience with neuro kids is that the ones that get really, really sick are the ones that spend a long time on the unit, have the most deficits and require the most rehabilitation. & we all know that an ICU environment, particularly if you work in an open plan unit, is not really conducive to things that anxiety management, day/night regulation etc. A lot of our long term neuro kids (who've gone from critical to ventilator dependent to trache/vent and a long rehab) have experienced night terrors, hallucinations, day/night confusion and general unhappiness. There's a lot of evidence in the adult ICU world about the relationship between even short ICU stays and post traumatic stress disorders. Maybe you could look at anxiety management in neuro kids?

My local area is having an enterovirus 71 public health crisis at the moment. The symptoms sounds very familiar.

We run our art lines on Alaris GH syringe drivers. We take a discard from the transducer port. We bleed the line back to the transducer until we get 1-2mls frank blood in the syringe (2-3ml of hep saline should bleed back before you get frank blood) and then a sample from the port closest to the patient. We flush back down the line with the pump's purge function. I've only ever seen art lines run on the syringe drivers or on pressure bags (usually post ops or in the adult world.)

I'm very curious (as a new ICU nurse) as to why this is an exclusion criteria?

In Australia we mix all our own meds. All of them. Antibiotics, inotropes, sedation, everything. I don't know what our pharmacists do if they mix all infusions/drugs in the states!

Our kids usually have their chests closed bedside, too. All heart kids have defib etc on the end of their bed and kids with open chests have internal paddles ready to go. We also have a cardiac trolley for emergent CT surgery on the unit however the CT theatres staff bring several trolleys of sterile equipment, too