The Book of Nurses: Tara.

I would really REALLY like you to contribute to the Book of Nurses in celebration of International Nurses Week this year (May 6-12).

Your story matters.
Here’s How.

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OK then, to start off tell us what country/area you live in, how long you have been nursing for, what areas you have worked in and the specialty you currently work in.?

I started my nursing career as a hospital-based student in June, 1989, at the Alfred Hospital in Melbourne. I did external rotations for mid, paeds, psych, community health and District Nursing, and internal rotations through ED, ICU, theatre, radiology, and almost every ward and department in the hospital. In my staffing year (like a graduate year) we had to choose a medical, surgical and specialty rotation – I opted for the stroke unit, road trauma, and (cheating a little), endocrinology, which was also the stroke unit. Almost 23 years later and I’m still there, though we now encompass four other specialties (neurology, renal, rheumatology and infectious diseases) too.

What made you decide to become a nurse?

 

I wish I could say I always wanted to be a nurse, but even though my mother, my aunt, one of my cousins and some great aunts were all nurses, it never occurred to me when I was at school – I wanted to be a psychologist. I’d have made a terrible psychologist, so it’s a good thing I didn’t get the marks to study it. Instead I found my way to nursing through chance, after I dropped out of uni, and it was the best decision I’ve ever made.

 

How have you seen the profession change over the course of your career? Do you see a positive future for the nurses that are graduating now?

 

My first patient load, after nine weeks of preliminary training, was four women about a fortnight post hip replacement – they were all still confined to bed, and none had any significant comorbidities. Quite aside from the changes in best practice and hip replacement management, I’d be hard-pressed to find four patients on my current 32-34 bed ward that were that well – patients are so much more acutely ill now than they were when I started out, getting sicker every year, and only remain inpatients for as long as they absolutely have to be.

 

At the same time health care is far more specialised, technical, and complex – I think it’s particularly difficult for new nurses starting out to nurse the patient as well as the machines! And we have a lot more autonomy, responsibility, and far more paperwork than was the case two decades ago.

 

My hospital has an average nursing age of 27, so I get to spend a lot of time with the next generation of nurses – I think the Victorian public’s in good hands, and I hope that these young women and men find nursing as rewarding and long-term a career as I have.

 

Tell us a story: an amazing, funny, moving or memorable moment from your book of shifts.

Not long after I was registered I was showering an elderly man one morning. I was wearing a rather unflattering light blue dress paired with white gumboots and a flimsy disposable apron. As I was leaning over my patient to wash his back I remember thinking that the water was nice and warm, an instant before I realised that, if I had the shower hose in my hand then that liquid on my leg wasn’t water.

 

I diluted the urine and patted my dress a little dry with one of the towels, but easily a third of my uniform from the waist down was very damp. My plan was to return my (now clean and dry) patient to his room then head to the nurses’ home and change. As I wheeled him out of the bathroom we almost collided with the Stroke unit’s grand round, who were coming to see my patient. The consultant glanced at my staggeringly attractive ensemble and said “Well, you do get involved in the shower, don’t you?”

 

I replied “It’s not all water.” As one, the eight or so doctors took a step back, revealing my NUM as the only non-urinephobic member of the group.

 

Not just a nurse: what about when you are not at work? What do you get up to in the rest of your life?

Inspired by a colleague who had no option but to continue nursing, I started studying in part so that if or when I became burned out in nursing I’d have a career alternative. Without really meaning to, I’ve started acquiring post-grad qualifications – I’ve now got a grad dip and a Master’s in health ethics, a second Master’s in Social Health, and am part way through a PhD exploring why health care practitioners who talk to patients while performing death work do so. I’ve presented at international conferences, really enjoy the academic environment, and had aspired to transition into academia in the next three to five years.

Victoria’s acute public nurses have just come out of an Enterprise Bargaining campaign that lasted nine months from log of claims to agreement – it still has to be formally voted on by members, and the Mental Health EBA is ongoing. I’ve been a job rep with the Australian Nursing Federation since I was first registered, and involved in every campaign since then, but I was considerably more active this time around. Inspired by the leadership, dedication, passion and unity I saw during the campaign, I’m now hoping to work for the Federation after I’ve finished my doctorate. To that end, at the age of forty-two I’m finally getting my drivers’ licence.

I took a six month hiatus from my PhD during the EBA campaign, and found that a little too long without education, so I’ve started a certificate IV in training and assessment.

I read voraciously, particularly when I’m procrastinating – I can read a couple of novels in a day if I’m not doing anything else, and average about 300 books a year (in a roughly 1:5 ratio of non-fiction to fiction) in addition to texts for uni or work. A friend and I have a book review blog, which I’m currently woefully behind on.

And next month I’m going to have my third attempt at the couch-to-5k running program – I love the idea of being a runner, but hate doing it.

Piss and Vinegar: name 3 things that really get under your skin, push your buttons, or generally irritate you at work or outside of work.

If you’re not doing something to fix the problem then you don’t get to complain about it.

Discourtesy – everyone’s busy, everyone has priorities that may not be shared, and often everyone’s stressed, but it takes no longer to be polite, and often gets better results.

I really wish managers could understand that there is a finite amount of room for additional work – if they introduce a new documentation requirement, hold mandatory in-services, require student preceptorship, then I have to either reduce patient care, skip something else (like the falls risk reduction plan, or completing a RiskMan) or stay back late.

 

The nurses’ desk: What is the one thing you would like to say to the rest of the nurses or general public out there.

 

The idea that anyone can perform ‘nursing tasks’ and that the role of educated should centre around the technical end of things, in conflict with the principle of holistic care, comes from the same source that has nursing perceived as women’s work. Much of what we do looks, to the uninformed onlooker, only marginally skilled. Anyone, they reason, could feed a stroke patient, take a blood pressure, shower an impaired woman. After all, family members are taught how to do it, nursing aides (with scant weeks of training) do it in nursing homes, so why pay qualified registered and enrolled nurses to do these mundane tasks?

 

The answer is that, particularly in the acute care setting and increasingly in the rehab and aged care sectors, there’s more involved. An experienced nurse notices how the patient breathes during feeding, if they’re clearing their airway, pooling food in one cheek, tonguing their meds. When taking a blood pressure s/he will also watch the patient’s colour, assess their breathing, notice if he seems unsteady sitting up; will observe whether or not the hemiplegic patient is gaining dexterity and strength, if the depressed patient is starting to engage in self-care, and often the shower is the only private place a patient (above all one in a shared room) can confide. Patients have told me things in a bathroom, feeling supported by the intimacy of the act of being washed, things they have spoken of to no-one else: the victimisation of incest, the rejection of them by their husbands during or after pregnancy, their fear that they are going to die in pain. This connection, borne of a sense of security, comes only from a continuity of contact, and through the development of skills, that a fragmentation of care disables. There’s a reason why study after study confirms that patients have a shorter hospital stay, with fewer complication, a better prognosis, and a more satisfactory admission if their care is performed by experienced nurses than by any other combination of staff