6 7 Children’s community nursing and special school nurses While the vast majority of RFL nurses provide care for patients on hospital wards – one team are out in the community braving all weathers, traffic and the unknown, to look after children in need of care. Dozens of nurses make up the children’s community nursing and special schools nursing service – providing care to children of all ages within their homes, schools and outpatient clinics. The teams have a base at each of our hospital sites, as well as at Cedar House in Enfield and provide a variety of services, including supportive care following a hospital discharge, nursing care for children receiving chemotherapy or continuing care for children with more complex health needs. The teams also provide education for staff based in schools and to parents so, where appropriate, they can take ownership of their child’s care. The community children’s nursing team based at the RFH look after children living in Camden, Islington and south Barnet. They have around 250 children on their case load, from newborns to 17-year-olds, with their needs ranging from intravenous antibiotics for a few days to something much more long term, such as chemotherapy. Madina Ahmed, clinical lead for children’s community and complex nursing services, said there are huge benefits to being based at an acute hospital. “You develop a close working relationship with ward staff, which really benefits the child,” said Madina. “It means we have fewer failed discharges, because we can intervene at the earliest stage if something isn’t in place, preventing the child making an unnecessary return to hospital.” The team also train staff, who may need to administer some emergency care to children while they are at school. For instance, a child who might need urgent seizure medication or a child with a serious allergy. Two members of the team provide nursing care to 270 students at Swiss Cottage School – a school for children with special educational needs aged from four to 19. Madina says her upbringing in Mauritius gave her a love of looking after children. “I grew up around lots of kids and I was often babysitting them,” she said. “So I have always loved kids and that is what drew me to paediatric nursing.” Madina added that the key to children’s nursing is understanding the patient who is in front of you. She said: “You could be looking after a baby, you could be looking after a teenager and that is completely different. You need to be adaptable.” According to Ray Bywater, children’s community nursing manager for BH and CFH, it takes a particular kind of person to excel in the job. “You have to be confident making quick decisions by yourself,” he said. “The members of my team have a lot of clinical responsibility, albeit they will have support from managers where needed. But you are outside, navigating traffic and weather, it’s a completely different role from being on the ward. You have to go into someone’s home and you never know what to expect.” The children’s nursing team based at BH and CFH look after around 230 children living in north Barnet and north Enfield. There are just over six whole time equivalent nurses within the team, looking after children aged up to 16 or 19 for those with a disability. You have to be confident making quick decisions by yourself “ “ The beautiful thing about children’s nursing is that a child can really bounce back “ “ Ray has been a paediatric nurse for 27 years and has managed the children’s community nursing team since 2010. He said the service had grown a lot during this time. “Some of it is because the population has grown but also because the role has expanded,” he added. “We now carry out more procedures which used to be done by other teams, such as gastrostomy – feeding-tube – care. It really is one of the best nursing roles out there. “For the children you look after, you become part of the family – it’s incredibly rewarding. We are helping patients stay out of hospital.” Ray and his team also help parents deliver some aspects of their child’s care. “It wouldn’t be for every family and that’s OK,” he said. “But some families are happy to do it and where we can, we help them take ownership.” The nursing team based at Cedar House in Enfield also provides care for children in schools as well as continuing care for children with longer-term health conditions. Madina said: “The team help keep children with medical needs in education so they don’t miss out on schooling. They might provide care in their homes which means they don’t need to spend time going to the GP or to hospital and can continue with their schooling instead. We do home visits and sometimes clinics within schools.” Additionally, the Cedar House team supports Enfield’s seven special needs schools based across 16 separate sites and they provide continuing care to children who have more complex health needs. Madina said: “The nursing teams make a huge difference, allowing children to go to school and stay in education. They have developed great working relationships with our partners in social services, in education and of course with the families. “It can be a really challenging job but it’s also so rewarding when you see the difference it makes to children’s lives.” L-R: Matron Malvina Benitez-Castillo, children’s community nurses Danielle Gordon, Rachel Koshy, Arlene Clarke, Roshni Barber and children’s community senior health worker Antoinette Fisher Ray Bywater One of the most important qualities a children’s community nurse needs is empathy, according to matron Malvina Benitez-Castillo, who manages the team at North Mid. “We are caring for a family with an unwell child and that can be highly stressful,” said Malvina. “People might not behave as they normally would and as a nurse you have to be understanding and compassionate. “Children’s nurses also often to be patient. You need to be a little bit of a child yourself – it might be best to play with them for 10 minutes first and then you can give them their treatment.” At North Mid, the community children’s nurses team looks after around 150 children living in south Enfield and Haringey. They have a total of six whole time equivalent nurses who provide care for children in their own homes. Malvina added: “Our job is to allow for family life to go on for these children. We give them some normality and as little disruption as possible to their home life and their education. “The beautiful thing about nursing children is that they bounce back. Sometimes you think they seem so unwell, and you worry about how they will pull through. Then the next day they are doing really well. Being a part of that moment with their family is a real privilege.”
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