Norma O’Keeffe

Registered Advanced Nurse Practitioner (RANP) in Children’s Pain and Rheumatology in CHI at Temple Street.

I am a RANP in Children’s Pain and Rheumatology in Temple Street. I have had an interest in pain since my time working in PICU in Crumlin and was lucky enough to get the Children’s Pain CNS post here 20 years ago and two years ago I was appointed as ANP.  Initially it was predominately looking after the children post-surgery, ensuring they have adequate analgesia and that their pain is properly assessed. However, the role evolved hugely since then and includes caring for children with arthritis and chronic pain as well as those undergoing painful procedures at ward level.

Pain is invisible and there is no machine available to say exactly what size or shape it is. Also it is different for everyone.

I get up at 6.30 am. I used to drive to work every day but in recent months I have been using the train from Hazelhatch to Drumcondra which usually works well for me.  The only time I miss the car is if I get a call from my daughter’s school to collect her due to illness but thankfully this is rare.  It is certainly a lot less stressful travelling on the train (even if you have to stand for the journey) rather than sitting in traffic on the N4.

Every day is different, but I do usually go through e-mails and phone messages first thing in the morning.  Depending on the time of year, there can be anything up to ten messages from parents to follow up on. Coming up to school exams and holidays are usually particularly busy as parents and children seek advice on how to cope with pain, stress and disrupted sleep.  Most mornings I also try and catch up with Andrea, our admin support, to discuss patients who need to be booked into clinic; clinic outcomes and GP letters etc.

I totally underestimated the administration/non-clinical side of an ANP role and how time consuming it can be, but I now work hard at not procrastinating these tasks. Mid-morning, I usually head to the wards to review the children who are on morphine pumps or epidurals.   I also see any children who are admitted with more complex chronic pain both as in-patients and outpatients.  Unlike pain post-surgery or a trauma, complex chronic pain is more difficult to treat as it tends to affect all areas of the child’s life including their sleep, school, sport and social activities.  Every day at 1pm we have ward pain rounds with the Anaesthetists.    At this time we agree a plan of action for each patient for the next 24 hours. Twice a week I have an ANP clinic where I see children who are referred to me with ongoing pain.

The best part of my job is definitely caring for children as they are usually great at showing their appreciation, which brings a smile to any face and makes for a fun and enjoyable workplace.  Seeing real improvements in a child’s life based on the care we provide brings fantastic job satisfaction, especially in children who have been unable to participate in school, sport or social activities for a long time due to pain.

Part of my role involves exploring with children and parents what biopsychosocial issues may be aggravating their pain and examining suitable ways of improving pain without having to rely on medication that makes them feel sleepy, groggy and affects their concentration.

The most challenging and distressing aspect of my role is dealing with children where we are unable to resolve their pain. This, needless to say, is very disheartening and emotionally draining to see that, despite our best efforts, these children are not reporting any improvement in their pain.  Understandably, their parents can be anxious and tense, seeking a medical explanation for this pain which isn’t always available despite numerous tests and investigations.  Occasionally this results in friction and can generate considerable stress, especially when they take their frustrations out on us. While I try and keep a level head at all times, dealing with these difficult emotional situations calmly and kindly can be demanding.

My proudest achievement was getting the RANP position and completing a Masters Degree a few years back. I know that I’m fortunate as I really love my job and know the importance of celebrating our successes with my colleagues. Outside work, I enjoy doing things that keep the mind and body healthy and love getting out in the fresh air. I’m fortunate to have a great family and fantastic friends who are marvelous at listening to my woes. I used to be a night owl on my phone or laptop but I know that this isn’t great for my health or stress levels so I now make a better effort at practicing what I preach to my patients. To relax and unwind I love cooking or going out for a meal and having a nice glass of wine.

With regard to things that make me laugh, I have three grown up daughters and find them very witty at times especially their reflections on the world and its problems. Also there is nothing like the Young Offenders and Derry Girls to make me laugh.

I know it sounds clichéd but after 20 years, I love being part of the Temple Street team. There is always something going on and something to celebrate.  It would be great if we treasure this team spirit and its ‘can do’ attitude in the new children’s hospital.