Life as a nurse: 'My patients go through hell'
Nurses are under more scrutiny than ever before. Following the Stafford Hospital scandal the profession has been forced to defend itself against accusations it has forgotten how to care. But what is life really like for those on the frontline?
Everyone can have a bad day at work: unreasonable requests from a boss, perhaps a mountain of work that never seems to shrink.
But for ward sister Louise Baxendale, a bad day means the death of a teenager.
She is the lead nurse for London's University College Hospital's 18-bed teenage cancer ward, part of the hospital's specialist adolescent unit, the biggest of its kind in Europe.
It means each and every day is spent caring for 13 to 19-year-olds sick, in pain and struggling to come to terms with their condition.
Figures from the Teenage Cancer Trust, which partly funds the unit, show seven teenagers a day are diagnosed with the disease.
Leukaemia and Hodgkin's lymphoma are the most common cancers among this age group.
Bowel cancer, which last week claimed the life of Stephen Sutton, the 19-year-old who help raise £3.2m for charity, is seen - although is much rarer.
'My favourite job'
So what attracted Louise, 35, to such a demanding role?
"I have been a nurse for 13 years and this is my favourite job," she says.
"I have worked in A&E and with people with respiratory conditions, but when I started here I just realised it was what I wanted to do.
"The patients are such characters and the care you give can make a real difference."
She adds: "The thing you have to do is be upbeat. There is no room for negativity. Of course, that can be hard and it is difficult getting it right."
Louise describes how treating three different patients in the course of just one day proves her point.
The first, she says, had just been given a cancer diagnosis and were scared and upset. In the next room there was a patient at the end of life. They had chosen to die on the unit with their family and the nurses and other health staff they had got to know around them.
But the next room could not have been more different.
The patient was at the end of treatment and planning for a fancy dress party they were going to attend. Understandably, the patient was - in Louise's words - so excited they were "on the ceiling".
"The thing is you meet patients at all stages of the journey, but you can make a difference to all of them," says Louise.
"You have to shape yourself to your patient. You have to get to know them really well to make a difference. I came into nursing to make a difference.
"Sometimes it is just the simple things like tucking them in with a blanket can mean the world."
Care and safety
I spent time with Louise on National Nurses Day last Monday - two days before the death of Stephen Sutton. As ward sister she divides her time between management tasks and providing care.
That in itself provides challenges. "You have to do a lot of juggling. There may be a meeting to go to, a shelf that needs fixing, HR asking me questions.
"But my number one priority is always care and safety. That comes first and if it means saying 'hang on I can't deal with those requests I'm needed on the ward' then so be it."
Louise's day starts before 8am - often ending after 6pm - with the handover meeting with the night staff, followed by a bed meeting with the rest of the paediatric and adolescent nursing teams to check on what staffing levels are like.
While debate continues about staffing ratios on adult general wards, in the teenage cancer unit - and the general teenage ward which is linked to it but run by another ward sister Rebecca Mortimer - staffing ratios are already strictly monitored.
On the cancer ward there is often one nurse to two or three patients sometimes one to one, while on the general ward, which sees a wide variety of patients from road traffic accident victims to diabetes patients, it is one to four or five during the day.
Spending time with patients
After staffing levels have been checked - the trust has an in-house bank of nurses which it can deploy when there are shortages - it is then back on to the ward to help out with the care being provided.
That involves giving medications including the chemotherapy drugs that many patients are on, but part of it is also about spending time with patients.
"You do develop a relationship with them," says Louise. "Sometimes they just need to talk to you. I have done jigsaws with patients. It is about making life as normal as it can be and injecting fun where you can.
"We have the physios come in and during one session the other week we had all the staff doing the limbo under a tape."
To help the teenagers cope with their stay in hospital - which can last weeks even months at a time - there is an activity room. It is equipped with everything a teenager would need. There is a pool table, flat-screen TV and DVD, an Xbox console and arts and crafts facilities.
Louise says: "It very popular, especially the Xbox with the boys. They love playing FIFA. We have to nag them to get off it. It can be midnight or even later and then want to have another game. We have to tell them no. Then in the mornings they won't get up. You've got to remember they are teenagers after all."
'I'll miss the nurses'
One of them is 17-year-old Dami Oguntoyinbo, who has been on the unit almost constantly since last August after being diagnosed with leukaemia. Seventy days after having a bone marrow transplant he is on the brink of being discharged.
"I can't wait to get out, obviously. About the only thing I'll miss is the nurses. They have been great. It is really tough. After my transplant I was really ill and had to stay in my room. They really looked after me, kept my spirits up."
Of course, Dami is one of the lucky ones, as Louise admits.
"Not all of them do survive. That is very difficult to deal with as you get to know your patients really well. You have to stay strong.
"Burnout is a real issue for us nurses. That is why the team is so important. We all look after each, keep an eye out for each other. But we know we have to be there for our patients.
"These are children who are going through hell."