Health: PERSONAL NOTES

Two reports published last week showed that many intensive care beds have been closed and seriously ill patients are being turned away. One of the reasons given is a shortage of nurses who have the appropriate training.

Helene Smith (right), 37, is senior sister on Lydia ward, a six-bed intensive care (IC) unit, and manager of a 24-bed surgical ward at the Royal Alexandra Hospital for Sick Children in Brighton.

Training: five years. ICU experience: 12 years.

Annual earnings: £21,000.

The job: "Today I was supposed to be on the surgical side but the IC duty nurse - she's 22 weeks pregnant - started bleeding. So I was in ICU looking after a child who'd had major surgery. I did a long day: from 7.15am to 9.45pm.

"For one patient we have one qualified nurse on all the time. I work a 37-and-a-half- hour week but often it's more like 45 hours because of staff sickness, vacancies, the nature of the job.

"Some children have had major operations, others serious infections: bronchiolitis has been particularly bad this winter; we've had to ventilate about 12 cases so far. We get other respiratory problems, acute asthma attacks. And meningitis has been bad: we've had three cases; two children died.

"The boy today was 15, born without a complete oesophagus. He needed another operation to prevent food refluxing out of his tummy. Afterwards he was on a ventilator, on a morphine pump, on three different types of drips.

"There's still a lot of basic care in this job: washing, changing, feeding if need be, turning. And a lot of observation: checking drips, watching monitors, watching the child.

"I spent a long time with this boy talking about his body image - they had to make another incision, another scar, because they couldn't use the old one."

Job pros: "Working with children and their families. Relationships can get very close; we've made it a lovely environment, it's colourful and not at all clinical."

Job cons: "Once the bronchiolitis season starts you will have two or three children in all the time; then an outlying hospital rings up and asks you to take a two-year-old who needs ventilating. You have to find an extra nurse to cover and if you can't you have to say no."