When Hannah Farrell walked out of the Royal Belfast Hospital for Sick Children’s Cancer Unit in 2019, she left behind not only her job, but the sense of hope and fulfillment she once found in nursing. Her resignation, prompted by relentless staff shortages and a lack of support from management, echoed a problem that continues to haunt Northern Ireland’s only regional children’s cancer center. Today, as more than half of the unit’s specialist nurses are off work, the impact of these ongoing challenges is being felt by patients, families, and the nurses themselves.
Farrell’s story, first brought to light by BBC News NI, is a sobering account of burnout in a system she describes as broken. "The system took my fight, my joy, my empathy and compassion – I had nothing left to give," Farrell said. "I dreaded every shift because I didn’t know what I was going into, staffing-wise, or what the skill mix would be. Clearly nothing has changed since I handed in my resignation five years ago, so nurses have no choice but to go off sick."
The Children’s Cancer Unit at the Royal Belfast Hospital is a lifeline for families across Northern Ireland, treating young patients facing cancer or complex blood disorders. It’s a place where specialist nurses, trained to administer intricate treatments like chemotherapy, are essential to both survival and comfort. Yet, as of early August 2025, seven out of twelve specialist nurses were off work, leading to postponed treatments for about five children. According to the Belfast Health Trust, those children have since received their care, but the disruption underscores a deeper, systemic issue.
For years, according to Farrell and corroborated by parents and other former staff, routine absences—whether due to maternity leave, long-term sickness, or career breaks—were not backfilled. This led to wards running with fewer staff than needed, piling pressure on those who remained. "When a ward goes into crisis like it did a few weeks ago, the trust takes nurses from other wards, which just puts a band aid on it," Farrell explained. "It’s a quick fix, all we’ve done is impact other wards negatively and we haven’t fixed the problem."
The Belfast Health Trust, in response, pointed to "significant investment" in the unit over the past decade, highlighting increases across all nursing bands and the development of specialist roles. "We want to thank the hard-working nurses and wider staff at the unit for their work, particularly during times of pressure, to ensure the safe and timely care of our patients and the support they provide to families," the Trust said in a statement. They also noted the availability of specialist occupational health services and a range of physical and psychological support for staff. "We encourage staff to raise concerns within their teams and with line managers," the Trust added.
Yet, Farrell’s experience tells a different story. During her five years at the unit, she often faced the trauma of losing patients—some of the sickest children in the region—without being offered counseling. Instead, she paid for it herself. "You’re expected to just pick yourself up and go into the next room – the impact is massive," she said. Farrell still remembers the names and faces of the 56 children who died during her tenure. The emotional toll, she argues, is compounded by a workplace culture that, while promoting an "it’s OK to not be OK" attitude around mental health, expects nurses to give more than they can.
Parents, too, have witnessed the strain on staff. For David and Sara Watson, whose son Adam was treated at the unit from 2019 to 2022, the quality of clinical care was never in doubt, but the pressure on nurses was evident. "This isn’t a new problem – staff are being let down by the Belfast Trust, by the Department of Health and, ultimately, by the health minister. He’s the boss at the end of the day. People need to sit down and study the statistics – why are nurses off sick and why are they leaving?" David Watson said. Adam, who died at age nine, helped establish the B Positive charity to support families and to provide counseling for nurses on the ward—a testament to the need for better support systems.
Sara Watson added, "It’s no way to run a hospital. Any other business would forward plan, especially around maternity leave cover. The powers that be don’t seem to understand the skills required for this ward to function." Caroline and Martin Smyth, whose son Theo received treatment in 2020, echoed these concerns. "The nurses are run off their feet and they are dealing with some of the sickest children in Northern Ireland. The 10-bed ward was always full – yet there wasn’t always a full quota of staff, especially at the weekends," they told BBC News NI.
When the crisis peaked in early August 2025, the Trust’s solution was to redeploy nurses from other wards. While this protected the most time-critical treatments, it left other areas short-staffed and failed to address the underlying shortages. The Trust insists there are currently "no nursing registrant vacancies" at the Children’s Haematology Unit, and that all nursing roles have been reviewed to allow for more flexible deployment of staff and bank workers to cover critical needs. But for many on the front lines, these measures feel reactive rather than proactive.
The Department of Health has acknowledged the challenges, with a spokesperson stating the minister "fully acknowledges the staffing challenges facing the Belfast Trust and wider system." The department praised the Trust’s efforts to manage recent nurse staffing issues and noted that "service delivery is being closely monitored." Still, for those like Farrell and the families she served, assurances and statements ring hollow without tangible change.
Farrell’s account of her final shifts is harrowing. "My last three overnight shifts on the ward were horrendous as too much responsibility was placed on my shoulders. I oversaw a full ward of seriously-ill children, some were dying, and I was supported by a bank and a junior nurse – it just broke me." She remains in touch with colleagues still working at the unit, many of whom, she says, are "operating on the fumes" of their good nature.
As the Children’s Cancer Unit continues to serve as the regional center for pediatric oncology and hematology, the need for skilled, supported staff has never been clearer. The stories of nurses like Farrell, and families like the Watsons and Smyths, make one thing certain: behind every statistic and official statement are real people—nurses stretched thin, families seeking comfort, and children fighting for their lives. The challenge now is whether the system can summon the will to truly fix what’s broken, before more are left burnt out and broken by the weight of care.
