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About Sickkids
About SickKids

May 10, 2012

The evolution of nursing

As we recognize our nurses this Nursing Week, we salute them for their continued commitment to children’s health and reflect on how this profession has evolved over the years.

In 1875, Elizabeth McMaster founded The Hospital for Sick Children (SickKids) to address a gap in the health care system. Almost half of recorded deaths at the time were in children under 10 years old. McMaster, who later became a nurse, recognized the need for specialized care for children and took action.

Today, nurses at SickKids remain committed to providing the best possible care to children and their families, but their role has evolved significantly since 1875. The traditional role of nursing has been considered at the bedside and while bedside nurses will always be essential to quality patient care, nurses also demonstrate leadership through their integral roles in research, education, technology, hospital management and global health. SickKids President & CEO, Mary Jo Haddad, began her career as a nurse. SickKids nurses continue to adapt to the complex and ever-changing health-care system, and strive to improve the health of children locally, provincially, nationally and internationally.

Nursing in 2012:

Nurses as educators

Whether they are teaching patients and families about their condition and its treatment, training new nurses about best practices, or educating the clinical team about issues such as patient safety, nurses are key educators in the health-care system. They also play a leading role in sharing their knowledge and expertise with community partners and on an international scale.

“We are constantly striving to provide excellent patient care by enhancing the knowledge and expertise of our staff.  That curiosity is embedded in who we are at SickKids, it’s in the air we breathe. As an Advanced Nursing Practice Educator, a large part of my role is focused on training new nurses, continuing education, and quality improvement initiatives that are geared at patient safety and care,” says Carrie Morgan, Advanced Nursing Practice Educator on the Cardiac Unit. “To help improve the transition from hospital to homecare, we are partnering with Saint Elizabeth Healthcare to share paediatric knowledge and skills with community nurses, promote better communication between SickKids health-care providers and homecare providers and increase supports available to patients and families.”

Nurses as scientists

Paediatric pain and symptom management is a research focus for many SickKids nurses. By studying the effects of pain on children with various medical conditions, nurse-scientists not only enhance clinicians’ understanding of the impact of pain in children, but are also able to develop strategies to improve its management.

Dr. Jennifer Stinson, Scientist and Nurse Practitioner in the Chronic Pain Program at SickKids, focuses her research on how web- and smartphone-based technology can be used to improve the assessment and management of pain in children with chronic and life-threatening health conditions. “This is an ideal approach for youth with health conditions as they love technology and most teens have a phone or computer,” she says. “My research group has developed web-based interventions to help teens with chronic health conditions like arthritis, haemophilia and cancer to learn how to better manage their condition and symptoms such as pain. The program provides disease-specific information, strategies to help teens learn how to manage their condition and symptoms and provides opportunities for them to connect with other teens with similar conditions. In our pilot study for teens with arthritis, the program significantly increased their knowledge about arthritis and reduced their pain.”

Nurses as nurse practitioners

Patients and families often require the specialized knowledge, skill and support of a paediatric nurse practitioner who have specialized training in management of acute and chronic illness and injury and can prescribe medications. They are resourceful and self-motivated to work within a family-centered model of care in collaboration with patients, physicians, and other health-care providers and thus, help people stay healthy. Nurse practitioners not only address the immediate medical needs of the patient and family, but also engage in patient advocacy and health promotion, consult with Public Health agencies, educate other health-care providers, and create and update standards of practice and guidelines.

“Taking a holistic approach to care, as nurse practitioners we are mindful about our patients and families, the availability of resources, and the community our patients are from. After working in many areas of the hospital, I wanted to share my experience and expertise and contribute more, so I decided to become a nurse practitioner. In this role, I am able to take on leadership roles to better address continuity and coordination of care, shorten length of stay in hospital, lower complication rates and improve access to timely delivery of care for my patients and their families,” says Ray Lam, Nurse Practitioner in Infectious Diseases. “I believe as nurse practitioners, we need to be active participants and be at the forefront of affecting and changing policies and protocols that directly and indirectly impact the care of our patients. This is only achievable through our involvement in research and on reflection and assessment of evidence-based practice.”

Nurses in informatics and technology

Technology is embedded in every part of a nurse’s job, from programming an IV pump to using a computer application to chart patient care.  Nurses must know how to apply new technologies in for the tools to benefit the patients. Nurses have taken on critical new roles in integrating new computer applications and medical device technologies into their practices and processes.
“Because of where nurses are situated on the health-care team, we have a solid understanding of both patient needs and health-care provider needs,” says Helen Edwards, Director of Clinical Informatics and Technology Assisted Programs at SickKids. “Throughout patients’ stay in the hospital, it’s the nurses that have the most contact with patients. And it’s these nurses who are able to best work with the other staff members to identify the technological needs of the health-care team. They can also play a leading role in the design, training and implementation of new technologies and medical devices.”

Nurses in global health

Nurses are involved in global health projects that align with SickKids’ vision of Healthier Children. A Better World. SickKids is working with partners in Ghana in the first-ever Paediatric Nursing Certificate Program. This global collaboration aims to reduce infant and child mortality by strengthening nursing services in Ghana. It will build paediatric expertise in Ghana, and ultimately enhance the country’s the health-care system.  

“As a paediatric nurse with many years of experience, I was honoured to have the opportunity to engage with the nurses in Ghana and at SickKids to design, develop and deliver the paediatric nursing course to the first group of nurses in the paediatric certificate course in Ghana. As I taught, I learned how to adapt my knowledge to the environment of a developing country and enhanced my respect for the nurses who work in the often difficult conditions in their health-care settings,” says Karen Breen-Reid, Advanced Nursing Practice Educator, in Paediatric and Respiratory Medicine, and Infectious Diseases at SickKids. “Imagine providing care for infants and children when there is a limited supply of water for bathing and washing hands, when pain is managed by distraction and families cannot pay for simple dressings and medication their child needs to recover from what would be a minor illness here. I and my nursing colleagues from SickKids guided the nurses in the program to develop their skills, knowledge and confidence to lead improvements in the care of infants and children. The first graduates of the program have gone on to be leaders in paediatric nursing in their communities. They will be the teachers and guides for other nurses participating in the course carrying on the work we have started with them. I have an overwhelming feeling of pride in what we have achieved and hope that this program can continue in the future in Ghana and be expanded to other countries in Africa for the benefit of all their children.”

Nurses as Managers


Nurse managers have a holistic understanding of patient care and the needs of the health-care team. The health-care system is complex, and nurse managers are essential in promoting collaboration across the health-care team, ensuring quality patient care and efficient use of hospital resources. The blended perspective allows them to make business decisions based on the big picture, while still considering the specific concerns of patient families.

“I will always be a nurse first; for those who work with me, there is no doubt that I know what it’s like to be at the bedside. There is an art and science to providing patient care and having an intricate knowledge of nursing is an asset to managers. In order to provide the best care possible to the patients and families in the NICU, the operational side needs to be in sync with the clinical aspect of caring for patients and families. Creating a culture where nurses feel empowered to achieve a higher standard of care is key, as is collaboration among other members of the team such as doctors, social workers, dietitians and pharmacists,” says Audra Jesso, Senior Manger of Clinical Programs in the NICU.