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Skilled in the everyday arts

The role of the outpatient department nurse may not be the stuff of TV dramas, but it is essential to ensuring the smooth running of this busy part of the hospital.

The role of the outpatient department nurse may not be the stuff of TV dramas, but it is essential to ensuring the smooth running of this busy part of the hospital.

Outpatients
Outpatient nurses need good communication and observation skills. Picture: iStock

If you are a children’s nurse working with highly dependent children in stressful clinical areas, such as critical care, emergency departments and acute wards, you may think children’s outpatient departments are for staff who can’t cope with the fast lane or who seek a pre-retirement career option.

The stereotypical outpatient department nurse is a portly figure, stuck in a routine, who chatters with colleagues before reluctantly weighing patients, or undertaking urinalysis or blood pressure measurement, while children and families have an interminable wait.

Think again, my nursing colleagues: each day it the children’s outpatient department at Leeds General Infirmary five or six qualified and support staff are on duty. They engage with, on average, 200-250 children and young people in 25 clinic rooms.

Each week, 28 different speciality teams run clinics and many teams are interdisciplinary. The clinic nurse must have a broad range of child health knowledge, as well as the skills to understand the needs of children and families in frightening and stressful situations.

Limited time

More children and young people attend the outpatient department than are admitted to hospital, and routine is necessary in order to manage large numbers of children and families in limited time.

Recording height, weight, blood pressure and urinalysis are essential, but there are other objectives. Within a few minutes each nurse must be able to bond with the child and family members, make relevant clinical observations, provide pertinent information, manage expectations and help navigate patients through their appointments so they leave with a clear idea of what will happen in future.

Attending hospital can be unsettling. By asking seemingly trivial questions, such as ‘What is the name of your toy?’, ‘What school do you go to?’, ‘What are you doing in the holidays?’, a skilled clinic nurse can identify verbal and non-verbal cues and causes for concern.

A young teenager may be uneasy about undressing in front of strangers, for example, or an 8-year-old may ask quietly ‘am I going to need an operation and have to come into hospital to stay?’ Those with long-term conditions may be worried about fitting in with their peer groups, changes in treatment plans or what the future holds for them.

Safeguarding

Observation is fundamental in these brief minutes. How does the patient look? Does the child look grubby? Are there signs of abuse or neglect? Are there safeguarding concerns?  

The outpatient nurse advocates on behalf of the patient with a number of teams. Patients requiring invasive procedures, medical photography or X-ray may benefit from a swift introduction to the play specialist, who can give more focused attention and support. If a family emerges from a medical consultation feeling distressed or confused, referral to a specialist nurse is appropriate.

Constant visual scanning of the waiting area can identify frustration. Being aware of who is waiting and confirming people have booked in if they have been waiting a long time can pre-empt complaints.

Delays often occur and are a source of additional stress. Keeping families informed about when they can expect to be seen requires the ability to communicate calmly. As resolution is not always possible, the nurse should show parents how to make a formal complaint.

Outpatient nurses have an essential and highly-skilled role in ensuring the pathway for children and their families is as smooth as possible. Their role is crucial to ensure a good patient experience.


About the authors

Sue Fallon is a staff nurse in the children’s outpatient department of Leeds General Infirmary
Sandra Garbutt is a senior charge nurse in the children’s outpatient department of Leeds General Infirmary

 

 

 

 

 

 

 

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