Friday, April 22, 2016

'What we do goes above and beyond the medical'

By Louise Kinross

Three years ago Elyse Poulin (left) began her career as a newly minted nurse on Holland Bloorview’s complex continuing care unit. She works with children and teens with the most complex medical problems and disabilities—many of whom use ventilators or other life-saving equipment—and their families. BLOOM talked with Elyse about the challenges, frustrations and rewards of her work in children’s rehab.

BLOOM: Why did you go into nursing?

Elyse Poulin: I got into nursing because I liked that every day I was going to make a change in someone’s life—whether it was big or small. It was making a difference and having an impact.

BLOOM: You work with children who’ve experienced catastrophic trauma or been born with very complex medical and developmental problems. What are some of the challenges?

Elyse Poulin: One of the challenges is the degree of accountability, and while this is a good thing, it’s also very stressful. No matter what the situation is, you’re the one that is with the client 24/7 at bedside. If you feel a certain plan of care for a child is not appropriate you need to take the initiative to advocate on their behalf and implement the changes that are going to lead to a better outcome. Physicians here always support the nurses, but they only know what we report to them and document. You need to speak up and hold a strong voice. 

BLOOM: What is it like working with children who have the most serious medical problems and disabilities?
Elyse Poulin: Our clients have an array of circumstances. Right now we have more transitional clients and we’re seeing them go home and live with their families and resume their lives as they were before the hospital, or to the best of their abilities given their circumstances. It’s definitely difficult seeing children who have long-term disabilities and illnesses that impede their ability to rehabilitate and go home. In those cases, their norm is staying at Holland Bloorview and we become like a second family to the child and their family. Sometimes it’s difficult knowing that they’re here because there aren’t enough supports in the community. 

With some parents you develop very close relationships and you’re there with their child when they can’t be. The collaboration is nice, but it does come with an extra feeling of responsibility and accountability above and beyond what a nurse might normally experience.
BLOOM: What are other challenges?
Elyse Poulin: You have to remember that while work/life balance is difficult to maintain, if you neglect yourself then eventually that will be reflected in your work. Our clients and families rely on us to be positive for them and to be that extra little bit of encouragement that they need during stressful times. We need to be the anchor in their lives, and to do so we need to stay positive and healthy.
BLOOM: There must be difficult times because of the degree of stress that families are under?
Elyse Poulin: Sometimes families are very upset about their personal circumstances and it may show in how they communicate with us. The challenge is to respond with sincerity and I just hope that by the end of my shift I can turn their frown upside down. 

Sometimes we go through this internal struggle because we want families to remain positive, but we have to deliver news that is not positive, and the truth can hurt. In those cases, if the family reacts negatively, it is hard to not take it personally. You have to recognize that no matter what you do, sometimes their mindset is their mindset. You definitely wish you could change the outcome of everybody’s situation.

I feel like I’m a soldier of health care. It’s my duty to protect clients and keep them healthy and happy, even if that means sacrificing myself, my energy. Helping families get through difficult situations can be incredibly taxing on us, but it’s always worth it in the end. 
There’s a holistic approach to what we do here that goes above and beyond the medical aspect of things. That’s why I feel it’s one of the most rewarding fields I could be in. 
We get to see children assume some sort of normality or a new norm and overcome barriers. We see them learn a new way of living life and they teach us new and different ways of living. Seeing them get to go home with a big smile on their face and knowing you’ve been a player in their ability to continue on with their lives is rewarding.
BLOOM: If you could tell parents one thing, what would it be?
Elyse Poulin: That we’re here to be a partner in your child’s care and to work with you, not against you. We are always actively advocating and wanting the best for your children. Sometimes there are barriers within the healthcare system that tie our hands. But we are listening and we want everything you want and more.
BLOOM: What are the most important qualities a nurse in this area needs?
Elyse Poulin: Empathy, partnership. You need to be an educator, an advocate, a leader and a role model.
BLOOM: How do you manage the emotional side of this work?
Elyse Poulin: That all comes down to working with a good team and communicating with your team and managers. I feel like there’s a very strong bond on our unit. We’re always there for each other and we’re all incredibly good team players. There’s always someone to talk to and management does a great job of addressing concerns as soon as they’re brought to their attention.
I also think it’s important to get involved with different opportunities that arise off the unit so you feel your voice or concerns are heard, rather than just taking them home.
If you wish you had done something differently during your shift, you need to know there will be an opportunity in the future to change your actions based on what you’ve learned. That’s all part of being a nurse. Not everything goes smoothly, but you learn as you go.
BLOOM: Is there anything you do during the day to make sure you’re taking care of yourself emotionally?
Elyse Poulin: Make sure you take your break. You need to take that hour to laugh, rest and nourish yourself.
BLOOM: What advice would you give a nurse beginning in children’s rehab?
Elyse Poulin: It’s not all about medical, bedside, task-oriented things. It’s above and beyond that. It’s engaging in all aspects of these children’s daily routines and being part of their active rehabilitation back to what they had or to what they can attain. You have to look at the bigger picture, not just the task at hand. Always ask yourself: ‘Where did they come from and where are they going?’ Every client brings a unique story with them.
BLOOM: Have your views on disability changed since you began working here?
Elyse Poulin: I was told at a young age that I had learning disabilities. I heard the word ‘disability’ and thought that meant I had the inability to do certain things. I came from a small town and the supports were limited. But I always believed in myself and that if I wanted something badly enough, I would obtain it, and I did. When I started at Holland Bloorview I noticed that everyone here had that same mentality. It reinforced the feelings I already had about disability and reminded that where there’s a will, there’s a way.
I also learned that despite whatever illness or disability a child may have, there’s always a way to help them communicate. Some of the technological advances I’ve seen come out of here have been so cool. The more unique a child’s way of communicating, the more it draws me in. Whether it’s with their eyes, or fingers, or with technology.
BLOOM: The relationships you have with children and families here are different than in acute-care, right?
Elyse Poulin: Yes, we play a more active role with the client and the family. In acute-care it seems very in and out. Here, there’s a partnership. The relationship is longer. And it’s not just a partnership, it’s a friendship. 
BLOOM: If you could change one thing about your job, what would it be?
Elyse Poulin: The length of shifts. I do 12-hour and eight-hour shifts. I think if we only did eight-hour shifts across the board it would allow for greater continuity of care and be less taxing physically and mentally. 
In the photos above and below, Elyse is with Zoey Lamarche, 3, and her mother Amanda.