Francis Edwards is a paediatric nurse who specialises in palliative care. He splits his working week between two roles, as liaison nurse at Bristol Children's Hospital for two days and lead practitioner for hospice palliative care at Ty Hafan children's hospice in Wales for three days.
Mr Edwards says, 'I came into paediatric nursing from adult nursing because of its holistic nature. During my training I spent nine weeks in a children's hospital and loved the approach to family-centred care. I'd been working in adult palliative care and was able to do a shortened course of paediatric training, because I was already qualified. I went into paediatric oncology (cancer care), which led me to children's palliative care.
'For me, palliative care is about living not dying. It's about the treatment of symptoms, which might be physical, social, spiritual or psychological. A child's pain might be manifested in a physical way, but there might also be pain within the family. That side of pain is more hidden in adults, but there's a lot of honesty in children's nursing. The way I understand it, working in adult palliative care with adults is about reconciling their past relationships. In children's, it's about helping children say goodbye to their futures and family. It's very powerful work.
'My day at the Bristol Children's Hospital begins with a ward-round on the intensive care unit. My role here is not to deliver care, but to guide and advise other professionals. One issue I focus on is trying to prevent children arriving in intensive care inappropriately. For example, they might end up on a ventilator, which was not what the family wanted.
'Paediatric nurses have to complete paperwork, such as keeping good records of interactions with children and families. My paperwork is slightly different, as I write practice guidance and policy documents, and deliver training to staff.
'Ty Hafan is less formal. Children come to stay here with or without their families - not to die, as people often think is the case with a hospice - but often for respite. Over August, we had many children left so parents could take siblings on holiday. I don't do rounds, I spend more time with families talking through issues to do with the deterioration of their child and how we're going to manage that clinically.
'It is very difficult to be around sick children every day, but the key to success is clinical supervision. You need to look after yourself as a paediatric nurse, and talking through what has happened every month with a supervisor is key.
'Working in paediatrics is also about boundary-setting. I have to recognise what belongs to me and what belongs to the family. They need me to be friendly, but not be their friend. Once you cross that boundary you start to see that child as your own and can become entangled in emotions.
'Parents need you to be clear and creative in the thinking and care you give. You need to be like the wizard Gandalf in Lord of the Rings for families. He can advise on what works well or doesn't work, but he can't make the journey. The family has to make the journey themselves.'
2014-present: Specialist Advisor, Care Quality Commission
2013-present: Lead practitioner, hospice palliative care, Ty Hafan children's hospice
2012-2013: External Clinical Manager, Bluebell Wood, Sheffield
2011-2012: Interim Director of Care, Richard House 2011-present Paediatric Palliative Care Liaison Nurse, Bristol Royal Children's Hospital
2010-present: Freelance Nurse Consultant
2008-2010: Nurse Consultant in Children's & Young People's Palliative Care, North Scotland
2001-2008: Clinical Nurse Specialist (Paediatric Oncology and Palliative Care) Community Based, Brighton
1999-2001: Freelance Nurse Consultant & Acting Ward Manager, Brighton Health Care
1983-1999: Various nursing posts
Registered General Nurse training, Brighton School of Nursing, 1991*
Registered Sick Children's Nurse training, Brighton and Sussex Medical School, 1993*
B.Sc(Hons) Paediatric Cancer Nursing, Royal Marsden Hospital 1997
*These routes no longer exist
Paediatric nursing is a broad profession practiced in hospitals, community settings or in the home. Nurses can train by studying a nursing degree, which takes three years full-time. Graduates become registered nurses and work in the NHS.
Alternative routes into nursing include becoming an NHS healthcare assistant, after which the NHS may support part-time pre-registration nursing qualifications. Another option is to do an NHS apprenticeship and follow a work-based qualification.
After qualifying, nurses can specialise in areas of paediatrics, such as neonatal intensive care, oncology, cystic fibrosis, renal, respiratory, or cardiac nursing or become a school nurse. Nurses working in a district general hospital may need more generalist skills, while those working in specialist children's hospitals will have more scope for a specialism.