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Janine Spence's day begins early, very early, huddled in a blanket studying for her Masters degree before her children wake. Her working day is filled with children and families as co-ordinator of B4 School Checks and outreach immunisation for mostly vulnerable families without their own GP.

NAME: Janine Spence 

JOB TITLE: B4 School Check Coordinator/Immunisation Coordinator/Outreach Nurse

LOCATION: Child Health Team, Whanganui Regional Health Network

4.45AM: WAKE

No alarm needed, I just automatically wake up. I’m a morning person. A soon as my feet hit the floor, the cats arrive expecting food. It’s cold this morning, so I grab some thermal socks, wrap a blanket around my legs, and settle in to study for my Master’s in nursing for the next 2–3 hours.

7.30AM: WAKE BOYS

I read the paper while I’m drinking my second cup of tea and preparing soldiers for the boys. Even though they are 9 and 11, it’s their favorite breakfast … I enjoy them, too – especially when I don’t get distracted and get the yolk still runny.

8.15AM: TIME TO LEAVE HOME

Two different schools to drop the boys at, then it’s on to work. Arrive at my desk at 8.30. Just time to check most important-looking emails then leave office to attend a paediatric multidisciplinary team (MDT) meeting at the district health board (DHB) paediatric ward.

9.30 AM: BACK TO OFFICE

First meeting of the day done and dusted, so I take a five minute stroll back to the office. Our weekly child health clinic has started, so I check to see if anyone is waiting and – surprise, surprise – no one has turned up yet. The clinic offers outreach immunisations and Before School Checks (B4SC) to families who either have no GP or are unable to see their own GP. I am also a qualified hearing/vision tester, so I can provide a one-stop shop service that works well for our vulnerable families for whom multiple appointments to several services would be too hard. Often these are the hard-to-reach families, so our “did not arrive” (DNA) rate is high, and as a result, we tend to triple book many slots.

9.45 AM: FAMILY ARRIVES

First family has arrived. Pop out to reception, introduce myself, and welcome them to the service. I outline the B4SC check process to the parents and child, give them the booklet, and explain that I will be checking the child’s weight and height, teeth, ears, and eyes and will be playing some games with the child. It’s a small room, so it’s pretty cramped today with mum and dad plus three kids under five.

This wee one needs her four-year immunisations, so I pop out and ask my colleague to draw everything up so we can do a double swoop on her. The next few minutes are spent going over the antigens in the vaccine and the likely side effects. Once immunised, she gets a cuddle from mum, a certificate, stickers, and balloons. Then I go through the check data with her parents.

11.00AM: HEADS MEETING

I chair the Health Education Disability Sector (HEaDs) meeting and there is lots of lively discussion about the options available for the children on today’s agenda.

NOON: TEAM MEETING

We meet today to plan the next month’s off-site clinics, review a policy, and update the team with changes. I eat a snack and apple and have another cup of tea. I suddenly realise that my morning tea was missed and haven’t had anything out of my water bottle.

2.00PM: BACK AT DESK

Time to review some of the completed checks put on my desk today with “post-it” notes stuck on the ones that need my close attention. As I review, I sort them in to several piles: one for follow-up, one for filing, and ones needing referrals that have not been identified or actioned by the practitioner.

In between the paperwork, I complete a hearing test on a child who doesn’t attend early childhood education. She passes her vision with flying colours but fails the sweep audiology. She passes her typanometry, so she needs a referral to the audiology department for more testing. I discuss with mum as to whether the child has had any recent upper respiratory tract infections or hay fever, then reassure her that the audiology appointment will most likely occur within the next three months.

It’s then back to the paperwork.

4.00PM: WHOOPS

I remember that I have interviews tomorrow for a new position within the organisation and haven’t had a chance to review the questions. I’d better take them home and look at them later.

4.25PM: LAST MINUTE IMMUNISATIONS

A family of four children and their mum turns up for catch-up immunisations. Luckily we have previously determined catch-up schedules for these kids, so I am able to discuss with mum what is needed and the timeframes. She has previously declined all immunisations but has now changed her mind. The children range from 12 weeks up to 8 years, so it takes us until 5pm to immunise all four.

5.00PM: RUSH OUT DOOR

I grab my interview questions and rush out the door. The boys have swim club, so it’s straight there to meet them and my long-suffering husband.

6.15PM: TEA

I’m home for tea; thankfully, it is already sorted by my aforementioned husband. It’s time to do the dishes, check homework, and listen to everyone’s day’s happenings. I sign permission slips, check home emails, and reply to the more important ones.

7.15 PM: BoT MEETING

I’m out the door to a board of trustees meeting for my youngest son’s school. I’m the finance person, so I have to present the latest info and discuss the way forward for the upcoming new budget.

9.30PM: HOME

The meeting is finished. I say goodnight to boys, who are both awake, and then do the dishes, a load of washing, and tidy up the kitchen and lounge. I then have a Facebook chat with the older two kids. Then I shower and I’m into bed when I remember the interview questions … so I get up out of bed, make a cup of tea, and settle down again to re-read them.

10.45PM: BED

I catch the late news, clean my teeth again, and then go back to bed.