It's an `exciting time' to join nursing profession

The babies seem too tiny, too thin-skinned and transparent to be hooked up to the myriad tubes, drains and ventilators.

Undaunted, junior ward sister Juliette McSweeney smiles as she walks through the Intensive Care Unit of the Children's Hospital, Temple Street. When friends ask her about the downside, she says "it's not like you're just looking at sick children, you're helping them.

"I don't know that I always wanted to be a nurse, but I was the oldest of eight children and I was involved in caring for my younger brothers. I also did two weeks' work experience in a nursing home, a really happy place, looking after long-term patients - elderly people."

From Dromohane outside Mallow, Co Cork, Ms McSweeney applied for nurse training in "every hospital in the country". Offered a place in the Richmond Hospital, in Dublin, she went to live in the nurses' home in September 1985. The regime was very strict but she enjoyed sharing rooms with fellow trainees.

The staff of the Richmond Hospital moved to Beaumont Hospital during her three-year training period. "During that time I spent six weeks in a children's ward and loved it. I also decided during those years that nursing probably wasn't for me. It was hard, heavy work and the system was a little like a conveyor belt. You were constantly battling to get the basic work done. I remember thinking it was sad that the only people you got to know were the chronically ill and dying."

Nonetheless, Ms McSweeney decided to try for the one area of nursing that had interested her - children's nursing. Within five months she had a place in Temple Street hospital. The training comprised 18 months on the ward with some block release.

"When I first walked in the front door, I loved it. There was noise, chat, music, games, compared to the hush of walking into an adult hospital." During her training, she was paid as a first-year staff nurse and she spent time on the various wards.

Qualification soon led to a job with the hospital. Although she was particularly interested in intensive care, she began work on a surgical orthopaedic ward. In July 1991, her wish was fulfilled and she moved to intensive care.

However, the Middle-East was beckoning - it's a rite of passage for many nurses. So, it was off to a small town with an unpronounceable name, 100 miles outside Riyadh, in Saudi Arabia. "I was recruited to work in a special care baby unit but it was only an empty building when I arrived. I helped order stocks and set the unit up - it did open before I left, six months later."

Back in Temple Street, Ms McSweeney decided to progress her career by doing a six-month paediatric ICU course in Our Lady's Hospital for Sick Children, Crumlin, in 1997. The course gave her confidence and explained the "why" behind the "how" of many procedures she was already familiar with.

Now a junior ward sister, her 12-hour shift begins at 7.45 a.m. Seven nursing staff look after the patients in five intensive care beds and four high-dependency beds. Patients range in age from tiny premature babies to 15- and 16-year olds. There is one-to-one care for those in intensive care and one nurse for two high-dependency patients.

Each morning, the person who was in charge during the night gives a detailed briefing to the day person. "Then we have a sit-down session where staff hand over on a one-to-one basis. The session is also used for planning and for educational purposes, as we have students working with us." All of the equipment - bedside drips, drains, oxygen, ventilators, the resusitation trolley - must be checked each morning. "Every child is attached to at least one monitor, be it heart, respiratory, blood pressure, oxygen saturation . . .," she explains.

Parents are free to visit their children at any time and they are encouraged to participate in the care of their children. Nurses are involved in all of the medical procedures, says Ms McSweeney, and they must also be available to listen, counsel and support patients and their families. "At the end of the day, you are wrecked, not physically, it's a different kind of tiredness."

As we talk, nurses are coming into the room to put their votes in the ballot box - industrial action over pay and recognition is in the offing - but Ms McSweeney is happy she chose the right career.

Training as a children's nurse used to be offered to both school leavers and, also as a post-registration qualification to nurses who were already registered with An Bord Altranais. School leavers must now apply for a three-year college-associated diploma in general, psychiatric or mental handicap nursing and then apply for an 18-month post-registration course in paediatric nursing. The college-associated diploma will be replaced by a degree in 2002.

The director of nursing at Temple Street hospital, Ms Rita O'Shea, says they are in negotiation with the Bord and the Department of Health about a reintroduction of the direct entry route.

There are almost 400 children's nurses in Temple Street, which is one of the State's three dedicated children's hospitals (many hospitals around the State have paediatric units). Paediatric nurses require special skills including acute observation and communication skills as patients may not be able to describe their symptoms but the Commission on Nursing noted that sick children's nursing appears to have a particularly low profile as a separate discipline. Ms O'Shea is concerned that the Commission's recommendation that sick children's nursing be offered at post-registration level only serves to render the specialism more invisible.

In the past, there were concerns about career progression, says Ms O'Shea, but now there are a variety of specialisms on offer, including renal, diabetic, dermatology, theatre, ICU and community nursing. "There are now many avenues open to sick children's nurses, it is a very exciting time to be a nurse," she says.