'I come from a family of nurses'
By Louise Kinross
Caroline Ivorra (left) is a registered nurse on Holland Bloorview’s brain injury rehab team. She works with children who are hospitalized as a result of brain trauma or illness. Both of her parents are nurses, and her mother Marion worked for years on our complex continuing care unit. Thanks to physiotherapist Kelly Brewer for suggesting Caroline for our series of candid interviews with clinicians and researchers.
BLOOM: How did you get into nursing in children’s rehab?
Caroline Ivorra: Before nursing I worked at an insurance company but it wasn’t stimulating enough for me, so I decided to go back to school as a mature student. I come from a family of nurses and my mother used to work here so that was an influence. While I was a student I worked here as a health care provider for our respite camp one summer. That opened my eyes to the idea of working on the floor with children. As much as I came to work, it didn’t feel like work. I learned a lot from the kids, from the resilience they have. And the colleagues were great.
BLOOM: What does a typical day look like now?
Caroline Ivorra: I come in and get my three patient assignment for the day, and receive the hand-over report from the previous shift. Then I’ll read through my patients’ care plans to see what needs to be done intervention-wise. Because I’m on the brain-injury unit, we often have behavioural plans, so I’ll read through those tips and strategies. Based on what I read, I plan and prioritize for the day. Then I’ll go and check on patients, introduce myself, prepare their medications, help them get up and have breakfast and send them off to school or therapy. Then I interact with the physicians and therapists. A therapist may have to show me a new exercise they’re working on that they’d like us to bring up to the floor. Then we bring the kids up for lunch and help them change or toilet or have a break. We bring them back to school or therapy in the afternoon. If a child isn’t feeling well or I want them to see the doctor, I might keep them on the unit.
BLOOM: What’s the biggest challenge?
Caroline Ivorra: Sometimes behaviours are quite challenging. Brain injury can cause agitation. It can change a person’s comprehension and ability to process and focus. You have to learn how to give a child one task at a time, or how to ask a question to get an appropriate response. If the child gets angry at you, it’s not because of you. It’s part of trying to work through their healing and rehab. Behaviour is challenging because sometimes a patient is so set in their mind and you can’t change it. But you try to manoeuvre and figure out a way to cooperate.
The skills and meds and stuff you can learn. But a behaviour can be different from one hour to the next and from one day to the next.
BLOOM: How do you cope with that?
Caroline Ivorra: Sometimes I’ll ask my colleagues for help. They may have had this client or dealt with similar situations, so that team effort really helps. Over the years I’ve learned not to personalize things as much.
BLOOM: You’re working with some families whose children were healthy before being in a catastrophic accident. They’re in a great deal of distress. How do you support them?
Caroline Ivorra: By talking about it. Sometimes yes, I’ll cry too. It can be hard. I try to support the family as best I can by listening. Sometimes they just want to talk and have someone listen. I may not have the answers in terms of why this happened, and I may not be able to say what the future will hold. But at least I can support them with the tools and resources we do have. [I try] to empower them.
BLOOM: What do you love about your job?
Caroline Ivorra: The kids. I learn so much from them. They’re happy and they will joke and play and have fun, even though they’re in hospital. We all try to make it as normal as possible for them with day-to-day activities and encourage them with what they can do.
BLOOM: What have you learned from the families?
Caroline Ivorra: You can get the same results doing things different ways. Some families like things done a certain way, and another family likes it a different way. As long as a task gets done, there’s not a right or wrong way, as long as you keep the patient safe.
BLOOM: So you’re talking about being flexible to preferences families have?
Caroline Ivorra: Yes, learning to be flexible. At school you learn from a textbook and then you work with real life and say: ‘Oh well, that’s not what the textbook said.’ There are little things about how to dress or seat a child in their chair or their routines that make a world of difference for a family.
BLOOM: You’ve been here almost four years now.
Caroline Ivorra: I came directly out of nursing school.
BLOOM: Has the work changed you as a person?
Caroline Ivorra: It’s opened up my eyes a lot, I think, to this world of possibilities. I believe that now, working here I really believe that. I see what these kids can do and I’m like ‘Wow!’
BLOOM: What would you tell a nurse just starting here?
Caroline Ivorra: That it’s hard. I wouldn’t say it’s an easy job, or that it comes easy. But with patience and an open mind you’ll get through it and you’ll get the satisfaction and the gains. I was super scared when I first started.
BLOOM: If you could change one thing in the health system, what would it be?
Caroline Ivorra: To have more staff so the clients could have more one-to-one. You have three patients and you might need to be more with one child than the others because of the care required, or because a family member is at the bedside. So I would want to have three of me so I could be with each family all the time.
BLOOM: How did your parents’ nursing influence you?
Caroline Ivorra: My dad was a scrub nurse at Toronto General and my mom worked here. But they’ve also done work with Doctors Without Borders and the Red Cross and travelled. For three years they worked in Northern Ontario on a reserve. I think seeing all of those opportunities, and everything they’ve done, drove me into the field.
