Here is a late addendum to The Book of Nurses.
If you would like to be included in this project I will be happy to include you!
Your story matters.
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 live in Canberra, Australia (the Capital of Australia, even if the rest of the world thinks that must be Sydney). I’ve worked in hospital since 2002, mainly in cancer nursing, palliative care and dabbled in Emergency. I consider myself a ‘generalist’ acute medical nurse and work all over the hospital as a casual these days. With 2/3rds of hospital patients over 65, and most having the usual lifestyle related comorbidities, I consider most hospital nursing to be acute aged care, which is what I enjoy.
I’ve always done research as well as clinical; I started my first project as a new graduate, wondering why there was such a difference between what nurses did (and why), and what the policies said they should do. I started working at the local University in 2007 after I got my Honours (a research thesis on prognosis communication). I’m now partway through my PhD (looking at outcomes for people with dementia related to hospital nursing care), working clinically on weekends.
What made you decide to become a nurse?
Wanted to go to Uni, wanted to be employable (99% employment rate post graduation it was!), wanted to travel, wanted to be useful and make a difference. All still true.
Did you find your training prepared you for what actually goes on at the bedside? What sort of things really opened your eyes when you first began working ‘on the floor’?
Yes and no. I had spent 3 days a week in my final semester working on the ward that I then became a new grad on, so I knew what was what and who was who. Owning the responsibility that comes with Registration; dealing with the finer intricacies of bonding with your manager and team-mates so you might get the leave and roster; gaining special experiences in malaena, medication errors, bone marrow transplants, deaths-door negotiations etc… well that can only come with time, experience, and many tea room reflective conversations! I appreciate the problem solving and information gathering skills and aptitude I gained from Uni. And I am permanently indebted to the nurses and other clinicians who mentored me in my early (and ongoing) years since.
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?
I think that we are losing specialist skills and knowledge from senior nurses. I don’t see their skills, work or responsibilities rewarded, and they are spread too thin. We need senior (floor) nurses for leadership in complex clinical care, not to mention broader skills in management like service evaluation and succession planning.
I hope that a greater critical mass of nurses who are able to step back from daily issues to negotiate how to plan care so that nurses don’t have to bear the brunt of system disorganisation, will make a difference to how nurses work on a daily basis in the long run.
Tell us a story: an amazing, funny, moving or memorable moment from your book of shifts.
A patient was dying – long term cancer patient, complications with 3rd cycle of chemotherapy, multiple comorbidities – had all their family around. It was the first time a relative asked me (a new grad at the time) “is he dying?” And I had the knowledge and confidence both of his disease process, and to read their words and eyes and body language to see that they needed me to simply say ‘yes’, to make it real for them, and to help them cope. There were many family members and a large amount of distress; when the registrar arrived in the middle of this distress, he wasn’t sure exactly what was causing this sudden deterioration, and so he wanted to do a CT to work out what was causing the immediate dying. It was clear to us that this man had only hours to live, that it was very unlikely that the CT would identify anything that would be treatable, particularly in the long term, and that the patient may well die on the table, instead of here in this room with all his loved ones, and we managed to dissuade the doctor. He died peacefully within the hour.
It highlighted to me that when people are distressed, we all want to help. And we will help with whatever skills we have. Sometimes those skills may be greater in diagnosis and treatment, sometimes in being with a person and family. All people need help getting through this distress, and being able to look at the bigger picture, about ‘what are we trying to achieve here’ takes constant attention and skilled conversation.
It reminds me of one of my favourite expressions for nurses (and doctors and others!) used to being constantly moving and doing and busy-ing…..:
“Don’t just do something. Sit there”.
Not just a nurse: what about when you are not at work? What do you get up to in the rest of your life?
Creating sanctuary! House and garden, loving husband and son, our 1969 Mustang, Delphi the dog, ski patrol, wing chun kung fu, friends and family. Of course my favourite life therapy is drumming with Knights of the Spatchcock! Check us out here and please like us on Facebook if you do!
(IF you can not see the video above: here is the link)
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.
1. The ‘us and them’ approach!!!
We’re all in it together!!ED nurses versus the ward nurses. University trained vs Hospital trained. Clinicians vs patients. Community vs hospital. Demented vs sane. Mental vs physical. Teacher vs learner. Management vs clinical. Level 2s Level 1s. Older vs younger. Australian trained vs overseas trained. Nurses vs doctors….
These attitudes become embedded, and all they achieve is animosity and barriers to problem solving. We want the same things, deep down: we all want to reduce suffering of people, for as much good for as many people as we can. Let’s focus on shared goals and how we can contribute, not who’s fault something might be, or how much easier someone else has it, or who’s better than who, or how different one group is from another.
2. Nurses being able to maximise their opportunities. I worked for 7 years doing part time clinical and part time research. You’d think I was trying to move heaven and earth, the amount of difficulty HR and managers had with the paperwork. I see so often nurses achieving some kind of new role, but then not being able to be spared from their clinical roster. And if they are spared, there is no backfill. If they want to work in two different wards (shock horror!) they can’t because some payment system can’t understand it. We need more cushioning in the system to enable nurses to follow their own professional development, and more flexibility to enable choices based on people, not IT systems. For the satisfying careers of individual nurses (so they stay!), and for the health of the health system (we need clever, broad-minded people to make clever, broad-minded decisions!).
3. The dominant medical model that fixates on physical illness above psychosocial health. There is so much evidence that they are interconnected, but we are soooo slow to adapt. ‘Lifestyle’ diseases are the biggest killers in the Western world; that means they are based on personal choice, which is based in your social context. But our whole model is about treating disease, rather than creating wellness. It is shifting…slowly.
4. Bedside nursing. Nurses assess, build rapport, intervene, modify, and evaluate care based on their interactions with patients. Anything that inhibits registered nurses spending quality time with their patients inhibits the effectiveness of their work. This includes adding/replacing with support staff. I am all for a rich workplace with different kinds of employees with different kinds of skills, but RNs should be by the bedside (including expert clinical nurses, whether they be advanced practice nurses or nurse pracititoners). And RNs should advocate for ‘basic’ (also known as ‘essential’) nursing care. Skin integrity, hydration, nutrition, excretion, mobility – none can be nursed from a distance, or through another person. Saying that we can’t get or keep enough RNs so we need to replace them with ENs or AINs (or any ‘slippery slopes’ which create the same effect, eg ENs or AINs are introduced in a supernumery capacity and then bed numbers increase but RN numbers don’t increase by as much) is not good enough when there are a number of issues about retaining RNs (which I might have mentioned in my Piss and Vinegar 1, 2 and 3!) that addressing would aid nurses remaining in the clinical workplace. And may I also add that supervising staff – and/or communicating effectively in teams – is an additional workload, not neccessarily a relief from workload.
The nurses desk: What is the one thing you would like to say to the rest of the nurses or general public out there.
It is an honour to be welcomed into someone elses life at a most fragile and anxious moment, and there is nothing more inspiring than knowing you have made a difference to someone’s experience.
And never, ever forget the healing powers of fresh air, sunshine, laughter, music, loved ones, and a sense of purpose, control and meaning over ones existence.