Nursing - Inpatient Services
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Intensive Care Unit
Overview
The Intensive Care Unit at Sydney Children's Hospital (SCH) is one of three Paediatric ICU's (PICU) in NSW. It has 10 to 12 beds with a high dependency facility.
Admission to the PICU may be elective eg post operatively or on an emergency basis and patients are accepted from across the state and occasionally from interstate or overseas.
In 2002/03, 664 patients were admitted to the PICU - 372 were 'medical' admissions (55 required surgical intervention) and 292 'surgical' admissions.
Staff profile
There are around 69 registered nurse (full time equivalent) positions in the unit plus ancillary staff including technical aides, cleaners and porters.
A nurse manager and medical director manage the PICU. The four PICU medical intensivists rotate on weekly service. There are two medical registrars on shift at all times. A medical PICU fellow is also present during the week and on-call.
Rostering choices
- Full time
- Part time
- Casual
- 12 hour or eight hour shift rostering patterns
- Four or six hour shifts if desired
- Self-rostering
Casemix
- Neonates (medical and surgical) - adolescents.
- Surgical patients including neurosurgery, ear, nose and throat, craniofacial surgery, plastic reconstructive surgery, orthopaedics and renal
- Multi trauma patients
- General medical patients
- Cardiology / cardiac surgery
All methods of invasive and non-invasive ventilation are utilised, as are other modalities of treatment such as haemofiltration.
Staff induction and support
- Individualised preceptorship program
- Ongoing support from clinical nurse educators, a nurse educator, clinical nurse consultant and an equipment co-ordinator
Education
- Specialist Transition Programme to PICU - a 12 month structured program with seven study days for 2nd year RNs and/or RNs who have never worked in paediatrics or PICU
- Regular in-service program
- Hospital-wide education forums
- Study leave to attend conferences and seminars
- Access to the PICU Graduate Certificate and Neonatal ICU Graduate Certificate at The College of Nursing (Australia)
- Four hour professional development component within the six week roster
- Access to the campus library
Adolescent Unit
The Adolescent Unit has 18 beds, including a two-bed secure area, and provides care to patients between the ages of 12 and 18 years with medical, surgical and mental health diagnoses.
The nurse to patient ratio from 1:1 to 1:4/5 is variable according to patient needs.
Shifts include an eight-hour morning and evening shift beginning at 0700 and 1315 hours respectively and a 10-hour night shift from 2130 to 0730 hours.
Staff are supported by:
- a clinical nurse educator, nurse educator for mental health and clinical nurse consultants in a variety of specialty areas
- a preceptor including an extended period of time, based on individual need, for nurses without paediatric experience
- access to a four day Mental Health Program for those without previous mental health experience.
Newly graduated registered nurses undertake a four month rotation through the unit as part of their support transition program.
General Medical Unit
The General Medical Unit is a busy 24-bed general medical ward with isolation facilities.
Casemix includes:
- Neonates to adolescents
- General medical patients including those with respiratory diseases such as asthma, pneumonia and cystic fibrosis
- Patients requiring isolation.
Patients from any area in the hospital including high dependency, oncology and cardiac units, may be transferred to the unit if isolation is required, enabling nurses to care for children with a diversity of clinical needs.
The unit has 31 full time equivalent registered nurses including a nursing unit manager and clinical nurse educator.
An individualised preceptorship program is in place for new staff.
Nursing students and trainee enrolled nurses regularly rotate throughout the ward.
Emergency Department
The emergency department, one of only two such departments in the state, is a level six tertiary referral trauma centre which provides emergency services to children aged 0-16 from Sydney and Greater New South Wales. There are, on average, 30,000 presentations a year. A close working relationship with the state-wide paediatric retrieval service, Newborn Emergency Transport Service (NETS) and the air ambulance exists to provide high level specialist care for critically ill children.
The department is committed to best practice in paediatric emergency care with a supportive and motivating nursing culture and there is a strong commitment to quality, with staff encouraged to actively participate in projects.
Opportunities exist for nurses to develop skills in:
- Trauma
- Advanced paediatric life support
- Triage
- Acute mental Health
- Advanced practice eg plastering, ventilation
- Disaster/critical incident management
Ongoing professional support for nurses, including guidance in the planning and development of their career paths, is provided by a full time nurse educator. The department supports the pursuit of relevant tertiary education and is able to support staff in the completion of academic projects.
Sydney Children's Hospital Emergency Department is the hub for The Greater Eastern and Southern Child Health Network. A clinical nurse consultant is employed to co-ordinate the Network's projects.
Infant/Toddler Unit
The Infant/Toddler Unit has 18 beds, including four high acuity beds. The age range of patients is from newborn to 10 years with the majority of patients being in the newborn to one year age group.
Casemix is predominantly general surgery, ear, nose and throat and plastics and includes general medical, particularly gastro oesophageal reflux and feeding difficulties.
We promote partnership-in-care with the families and provide accommodation for parents/carers to stay on the ward with their child.
Nurse to patient ratio is dependent on patient acuity with the high acuity ratio 1:3 and non-high acuity 1:4 or 1:5.
We have a highly skilled, supportive and stable team of nurses in the unit including a full time clinical nurse educator who provides an individualised induction program for the new employees, regular and ongoing education including the in-service program.
Ambulatory Care
Ambulatory Care is a busy, multipurpose day surgery unit with 23 beds catering for children (from neonates to adolescents) from across the state who require a general anaesthetic for both medical and surgical procedures.
Care is provided pre and post operatively for a variety of procedures including general and specialty surgery, radiology, dermatology, dental and endoscopy.
The unit functions independently with its own bookings and admissions area which provides an access pathway for both day only and day surgery patients. A pre-operative clinic service is also provided one day a week.
The unit is staffed by a team of enthusiastic paediatric registered nurses experienced in the pre and post operative care of the child. It operates Monday to Friday from 0700 to 1730 hours with extended hours until 1900 hours, three days a week.
Orthopaedic/Neurology Unit
The Orthopaedic/Neurology Unit is a 22-bed paediatric tertiary referral unit providing acute neurological, surgical and medical services to the children of greater New South Wales who are aged between 0-16 years.
The unit also provides an orthopaedic service and a brain injury rehabilitation program. Recent refurbishment to the ward has meant we are able to provide a safe room to nurse the head injury children.
A specialised epilepsy service is complemented by a state of the art inpatient telemetry unit.
Since the unit has the capacity to care for high acuity and/or high dependency patients, excellent opportunities exist to develop advanced skills in areas such as tracheostomy management, ventilation and intracranial pressure monitoring.
Our nurse to patient ratio varies according to patient acuity from 1:3 to 1:4/1:6.
The shifts available in the unit are:
- Eight-hour morning shift (0700 to 1545 hours)
- Eight-hour afternoon shift (1315 to 2200 hours)
- 10-hour night shift (2130 to 0730 hours)
- Family centred flexible staff rostering with the opportunity to negotiate shift times and work four to six hour shifts if required.
Educational support and guidance is provided by the full time clinical nurse educator. All staff on commencement in the unit are allocated a preceptor with whom they work, in a supernumerary capacity, for a negotiated period of time. The unit is also supported by three specialist clinical nurse consultants.
Cardiac/Renal Unit
The Cardiac/Renal Unit is a 16-bed ward that accommodates mainly cardiac, renal, urology, ophthalmology, endocrinology and orthopaedic specialties, although other medical and surgical cases are accepted if indicated. Kidney transplantation and peritoneal dialysis are part of the renal unit.
Patient ratio
The nurse to patient ratio varies from 1:1 to 1:4/5 or 1:6 depending on patient's need, acuity and/or dependency.
Shift hours
- 0700 to 1545 hours
- 1315 to 2200 hours
- 2130 to 0730 hours
Clinical and educational support
Any new staff member is provided a hospital orientation program lasting three days, after which they are assigned a preceptor who takes over their unit orientation and education. The duration of the preceptorship depends on the experience and needs of the staff member.
Clinical support is provided by a clinical nurse educator, clinical nurse specialist and senior nurses, with further and more specific support provided by the clinical nurse consultants and physicians.
Regular inservice education is available at both unit and hospital levels.
Haematology/Oncology Unit
- Staff and Services
- Turnbull Ward
- Day Only Ward
- Outpatient Unit
- Bone Marrow and Stem Cell Transplants
Staff and Services
The Haematology/Oncology Unit, also known as the Centre for Cancer and Blood Disorders, has provided a comprehensive service for children diagnosed with haematologic and malignant disease in New South Wales for more than 30 years. In addition, we have the largest bone marrow transplant program in the region and accept international and interstate patients for complex bone marrow transplants and aphaeresis.
The Centre comprises a multi-disciplinary team of medical, nursing and psychosocial staff. Two clinical nurse specialists provide care in the community and the senior medical staff conduct outreach clinics in Canberra, Newcastle and Campbelltown.
Turnbull Ward
The Turnbull Ward is a 16-bed inpatient ward for children with cancer and blood disorders with four dedicated bone marrow transplant beds. Highly skilled and experienced nurses provide care 24 hours every day.
There is a range of educational opportunities for nurses on the ward and a comprehensive orientation program is provided for all new staff. The Introduction to Paediatric Oncology course and Haematology Program are conducted on a regular basis. There is an active nursing research and journal club. Support continues with ongoing education and professional development opportunities.
Haematology/oncology are unique areas that expose registered nurses to many challenging clinical situations such as:
- Caring for children with a variety of cancer and blood disorder conditions
- The care of central venous access devices
- The administration of chemotherapy and management of the side effects of this therapy
- Caring for febrile and neutropenic children
- Caring for children who have undergone complex surgery procedures
- Looking after children who are undergoing a variety of stem cell transplants.
Day Only Ward
His is a nine-bed medical day-only unit providing a range of services for children with cancer and blood diseases. An anaesthetist provides an anaesthetic or sedation to children having procedures (eg lumbar punctures, bone marrow aspirates) on two afternoons every week. Children have short and long chemotherapy regimes (up to eight hours) in the day-only unit. Blood product transfusions are also administered in the day-only unit. Apheresis, including stem cell and dedicated blood product donation, is provided in the day-only unit.
Outpatient Clinic
Outpatient clinics are held on Tuesdays and Wednesdays every week. Some chemotherapy is administered in this area and all blood tests are undertaken within the clinic. The long-term follow-up clinic is a multi-disciplinary clinic and provides follow-up for children and adults who have received therapy for childhood cancer. A clinical nurse specialist supports this clinic and ensures appropriate follow-up is undertaken.
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Bone Marrow and Stem Cell Transplants
The Centre conducts bone marrow transplantation (BMT) for children with a range of diseases including cancer, leukaemia, marrow failure, transfusion-dependent anaemia, immunodeficiencies and a range of rare metabolic diseases. The BMT program began in 1976 and more than 500 paediatric transplants have been performed. The program accepts referrals from all over Australia and South East Asia. The Australian Cord Blood Bank is part of the Centre and provides both a national and international service for children or adults requiring a stem cell transplant
Medical Day Only
The Medical Day Only Unit is part of the Centre for Children's Cancer and Blood Disorders which operates on Monday to Friday from 0800 until 1630 hours, with late finishes at 1880 hours on two days each week.
It is a unique, varied and challenging working environment that offers staff the opportunity of developing some sophisticated skills and knowledge under the guidance of a highly skilled team of clinicians. The variety of services conducted in this area gives nurses an interesting clinical workload and opportunities to work with several different medical teams.
Services include:
- About 30 patients with haemoglobinopathies who regularly attend for transfusion of red cells.
- Chemotherapy is administered and supportive care for oncology patients, including those who remain in isolation following bone marrow transplant, is provided.
- An anaesthetic list for children requiring lumbar punctures and bone marrow aspirates is run two days a week, with patients recovered in the unit under the supervision of the anaesthetist.
- The apheresis service for the hospital is housed here also. While advanced skills are required to work in this service and may initially appear daunting, specific training and support is provided for all staff until they become proficient.
- Patients requiring infusions or short procedures are also seen in Medical Day Only.
Sleep Unit
The Sleep Unit is a small and very specialised area where children, who present with a variety of problems, have their sleep patterns studied overnight. The unit has a capacity to study three children a night.
The children are admitted in the afternoon and are discharged the following morning on completion of the study with nurses responsible for meeting all the patient's needs including setting up for the study, monitoring overnight and reporting on the study.
One nurse works an eight hour afternoon shift from Monday to Thursday. Two other nurses each work 10 hour night duty shifts on those days.
The unit provides on-the-job training for nurses in this very interesting field.
Recovery Unit
Paediatric Recovery is a busy, high dependency unit providing post-anaesthetic care for any child who requires a general anaesthetic.
The nine-bed unit is run by a team of registered nurses including the nursing unit manager, clinical nurse educator and clinical nurse consultant whose philosophy is to provide a safe, caring environment for the child and family by providing a smooth transition from recovery to ward.
The work environment is friendly, co-operative and conducive to learning, with staff highly supportive of one another. Team nursing is favoured as a way of optimising patient care within the unit.
The nurses are highly skilled and experienced in the care of the unconscious patient, with a main focus on airway management and the ability to act on any airway obstruction requiring resuscitation. Pain management and fluid hydration skills are gained with an emphasis on evidence-based practice.
Rostering is flexible from Monday to Friday only and with no night duty. One on-call evening and/or weekend shift to cover emergency cases is required. Staff may choose to work four 10-hour shifts a week.
Nursing | Clinical Services and Specialties | Reasons to Work with Us | Employment and Vacancies | Support Transition Program for New Graduate Nurses | Undergraduate Clinical Placements | Work Experience