At The Royal Children’s Hospital (RCH), nurses in the Cockatoo Ward provide comprehensive care to young patients with neurological, neurosurgical, metabolic and complex gastroenterology and hepatology conditions.

Keep reading for an insight into what a 12-hour shift delivering focused care to a higher-needs patient looks like on Cockatoo.

7am: We start the morning by receiving our patient allocation for the day. I’m allocated a post-op neurosurgery patient, a baby girl diagnosed with hydrocephalus who has recently had an operation called a third ventriculostomy. I receive bedside handover, complete bedside safety checks and introduce myself to the patient and Mum. 

8am: I administer medications and assess the patient, checking her neurological function through limb strength, alertness, pupil reaction and basic vital signs. She needs her post-op blood tests done so I complete a small finger prick to get the tests done with Mum’s support. 

8.30am:  She is due for her morning feed. I move her infusion pumps around so that Mum can cuddle her while feeding. She has multiple lines attached for antibiotics, intravenous therapy and pain relief.  

9am: The Neurosurgery team have completed their morning round on the ward, including on my patient. They plan to reduce the intravenous therapy and keep a strict fluid balance to ensure she doesn’t become dehydrated. They have requested a post-op MRI scan and to complete her final doses of intravenous antibiotics.  

10am: Time for morning tea! Before I go, I update post-op neurosurgery observations and complete another set of vital signs and neurological assessments my patient. She is doing well.  

11am: The medical imaging team wants to arrange an MRI scan around my patient’s feed time so they can swaddle her after and settle her to sleep for the scan. I arrange a time of 4.30pm and talk to Mum to make sure we take her afternoon feed with us and can push her afternoon nap back so she can sleep throughout the scan.  

12pm: Midday vital signs and neurological assessments are being completed. The patient has responded to her pain relief and is much more comfortable. Her head dressing is still clean and dry which is good. She’s tolerating her formula and having some puree, so I make sure to update my fluid balance accordingly. Her intravenous therapy has been cleared to stop and the pain management team have said she can come off her pain relief infusions!  

1.30pm: Lunch time! The patient is doing well, and Mum is happy with her progress. She has some visitors, and her pain is under control. I let my team know her current plan in case she may need anything while I’m gone. 

2:30pm: The occupational therapists and physiotherapists have come around to assess the patient and make sure she is recovering. They check in with me, and upon assessment clear her! The patient’s documentation is up to date and her fluid balance has been maintained.  

4pm: I check her vital signs and her neurological assessment. Mum has raised concern that she is more irritable and upset. Upon assessment, she’s showing signs of pain. I speak to Mum, and we agree that I will get her some more pain medication which she can have every four hours if she is in pain.  

4.30pm: MRI time! I take Mum and the patient downstairs to medical imaging where we will settle her to sleep for her scan. The scan is scheduled to take 45 minutes. She has responded to her pain relief and is happily taking her formula feed. Mum swaddles her and gets her to sleep. She is taken to the scanner where she is put in the correct position. Once settled, Mum heads upstairs to wait for her scan to be finished but I will stay with her to make sure everything is fine.   

4.45pm: While she is in her scan, I take the time to update all documents, charts, fluid balance and write a progress note to outline how her day has gone and what things we have done for the day. The scan is going well. 

5.15pm: Her scan is done! She is still asleep so I take her back upstairs to Mum to give her the good news and settle the patient in her cot so she can finish her nap. The Neurosurgery team will be notified that the scan is done and wait for the results to come through. Results will be relayed to Mum the following day, usually in the morning when the team come around and assess her progress.  

6pm: The patient is awake, hungry, and enjoying apple and pear puree. I finalise her documentation for the day and finish off her notes so that her chart is up to date ahead of handover. 

7pm: The nightshift nurse has started so we handover at the patient’s bedside, Mum reports she is happy with her progress and discusses a plan for overnight.  

7.30pm: Home time. I say goodbye to my patient and Mum and leave the hospital, pleased with how the day went. 

 ​