Managing children's pain, improving decision-making

After completing a degree in Biology and Psychology, Jacqueline Hanley was certain she wanted to be part of a professional program, and was leaning towards medicine and physiotherapy until she had an opportunity to take part in a research study where she had the opportunity to see nurses in action.

After enrolling in the BScN program at the University of Toronto's Lawrence S. Bloomberg Faculty of Nursing, she knew she had found a field that met her desire to learn and grow as a professional. Hanley took a job at Toronto’s Hospital for Sick Children after graduating in 2010 but returned to Bloomberg Nursing in 2013 for her Master of Nursing (Clinical) where she penned a particularly moving piece for The Toronto Star about a day in the life of a pediatric nurse at the hospital.

How does a pediatric nurse respond when someone asks how their day was? Writer David Ross sat down with Hanley to learn a bit more about the student behind the writing.

What drove you to write this prose?

I was with my friend and colleague as she drove me home one night after a very draining day at work. It wasn’t a busy day at all, but I was emotionally and physically exhausted. I remember talking to her about how I often had a hard time explaining to my husband, Shaun, what my days were like, and why I came home so worn out. We chatted about how there is just no way to capture what it is about a day that makes it good, or bad, or hard, or happy.  When I wrote this, I was feeling a bit lost and lonely, because nursing is a job that really becomes such a big part of you, and yet I feel that so few people outside the profession understand the role.

Pediatric nursing isn’t defined by changing diapers and dishing out medications, and it’s also not about being a hero or an angel. We hold hands and wipe tears sometimes, and we certainly do enjoy the many moments of cuddling, playing, and chatting. But we also have years of rigorous education behind us. We know our pathophysiology and pharmacology. We react to constantly changing scenarios, and make hundreds of decisions daily – decisions that require a lot of knowledge and skill, decisions that require good judgment and the ability to think critically. We are accountable professionals, individually, and yet work as a team. We use evidence to inform our practice, and do our best to stay up-to-date with an ever-changing health care environment. We work hard to be efficient and knowledgeable while still being compassionate, responsive, and empathetic.

It’s hard to explain the balance of the emotional and psychosocial aspects of the job with the technical and physical aspects. That’s what was going through my head when I began to form this piece of prose. By the time I got home after that car ride with my friend, I had a few lines of the piece floating through my mind, and the next day, I sat down to write out my thoughts. The final piece that you’ve read is almost exactly what I initially wrote out.

You wrote “I know I probably won’t spend my career at the bedside, but I know how much I’ll miss the bedside when I finally walk away.” Where do you see your future in nursing?

My real passion and interest is in pediatric pain, particularly related to working with nurses to improve knowledge and practice. I’m also a huge fan of SickKids itself – the organization and its people offer so much support for nurses who want to pursue their interests and make improvements that benefit our patients. I love being a bedside nurse and directly contributing to patient care, so I don’t ever want to completely lose touch with the clinical aspects of nursing. Ideally, I could work in some type of role that combines pain education, quality improvement, and clinical care or decision-making. I might have to invent an entire job to make that happen, though!

You completed your BScN in 2010. Now you’re working on your MN Clinical. What has driven you to advance your nursing education?

Even when doing my BScN, I had a strong feeling I would want to continue my education and pursue my Masters degree. For the first two or so years of my career on my unit at SickKids, I was focused on developing my skills and expertise as a new nurse and becoming comfortable in the role. As I began to transition out of the role of a novice nurse, I found myself getting a bit restless and looking for more out of my career. I joined the Education Council on my unit and began to do some quality improvement work in the hospital, pursuing my interest in pediatric pain. I founded a Pain Resource Group on the unit, worked toward becoming a Pain Champion within the hospital, and began to precept students and new staff. I knew the MN degree would go a long way towards supporting my career goals of working as a pain expert within the hospital, and exploring more in the areas of nursing research and education.

Nursing is not an easy field to work in, but pediatric nursing can be particularly difficult. What drew you to this field?

I love working with families, and that is a large and necessary part of pediatrics. I love that children provide easy reminders of why we do what we do. We see them grow, reach milestones, and tackle life’s challenges with incredible strength and maturity. It’s a very rewarding area to work in. I also had great experiences with my student placements at SickKids that helped me realize what a fantastic place it is to work. We describe our nurses on the unit as our “unit family” because we really are a sort of family. There’s a phenomenal level of support, friendship, and trust between us. I honestly can’t imagine working anywhere else.

Have you always wanted to be a nurse?

I have always been interested in the sciences and in health, but when I was in high school, I had no experiences with nurses and had no idea what the role really involved. Towards the end of my first degree, I worked on a research study that gave me the opportunity to see nurses in action. I realized then that nursing was what I was looking for. I liked that I could combine my academic interests with my desire to work with people, and participate in education, clinical care, or research. Before that experience, I had seen nursing as a very practical, technical job, and hadn’t recognized the autonomy and professionalism that also defines the role.

Dave Ross is a writer at the University of Toronto's Lawrence S. Bloomberg Faculty of Nursing.