I do my best thinking at the beach....

I do my best thinking at the beach. I've always been lucky enough to live, the most part of my life, in close proximity to some amazing beaches.I think they are good for the soul.

I walked the dogs today at one of our local beaches and after a busy couple of weeks full of illness in the family,I had space to think. I got to contemplating the blog and why I felt the need to write one. I think it stemmed from a love of being a nurse.

I know lots of nurses(obviously) and I know lots of nurses that hate being a nurse. I know lots of nurses that cant wait to do something else. I know nursing is not for everyone. Its challenging and hard work. The hours are sometimes terrible and to be totally honest,sometimes its just down right messy.

The thing is, I know all of this and I still love it. I have worked in really hard positions,with some very challenging patients and families.I have worked night duty and late/earlies. I've missed lunch breaks and I've been too busy to pee for a whole 12 hour shift(my poor bladder !). I've also been so tired I've had to pull over the car to get a coffee so I could actually make it home without falling asleep at the wheel. I know all of my nursing colleagues absolutely have been through the same thing.

The reason I love it, I think,is the utterly privileged position we get to have with people at often the most hardest time of their lives. A patient asked me yesterday how anyone could bear to work with kids with cancer. How could you remain happy and sane? The answer is, we can make a terrible experience better. We can be excellent nurses to our patients.We can be compassionate and patient,we can be considerate and respectful. We can make patients feel valued and that we have time.

I once knew a nurse that seemed to take great pleasure in turning on all the lights in the bays at 6 am on the kids cancer ward. Regardless of the families sleeping or not. Regardless of the type of night the kids had had. All because she needed to 'read the drips'. I have seen nurses bathe elderly, frail ladies in their bed with absolutely no regard to dignity. Talking over them, leaving them exposed. I have seen nurses barely acknowledge their patients,never making eye contact. Eye rolling if asked for anything.

We've all seen these nurses. These are not great nurses. These nurses give nursing a terrible name. We can make bad situations better.

I don't work shifts now. I looked for a '9-5' job with weekends free and evenings spent with my kids. I no longer work in such a high pressured environment like the Emergency Department or Paediatric Oncology. I work with children with eczema. These children are no less important. We don't always have to  work in the high profile departments to make a difference.My families have often tried everything they know to make their kids better. What I do is not hard-I just point them in the right direction. I take the time to listen .I allow them to tell me of all their frustrations and I acknowledge them.

Of course I don't love it every day. Sometimes I have a headache. Sometimes I feel like being at home with my family. Sometimes patients are just awkward and unlikeable,to be truthful.But each day is a new one. Each patient is different. And I get to start anew everyday.Most days are great.

I believe nursing to be a privilege . It's not for everyone. To those of us that get to be nurses,we should be great ones!

Its how you make them feel

This is my most favourite 'Maya Angelou' quote of all time. I love it. I'm pretty sure its not aimed specifically at nurses  but it absolutely plays an integral part of being a great nurse.

As a nurse you have the ability to make your patient feel like the most important person.It takes a skilled clinician to be crazy busy,with a million things to do before handover,to take time out to focus solely on your patient.

A while ago I read the 'FISH' philosophy book( http://www.fishphilosophy.com ). One thing they talk about is 'being there'. Its about being present, in the moment. Its about making that person feel important no matter how busy you are. Its about taking the time to take their issues seriously.I think we can take this and apply it to our every day nursing lives( and every day lives too for that matter).

To a parent,their child is the most important thing ever. There have been many occasions when I've had a busy shift in ED. Had really sick kids to care for and often distraught parents too. Quite often once I've finished with the sicker kids,my next patient would be a child who could have quite easily ( and safely) been seen by a GP or even just managed at home. It can be frustrating and exacerbating. It's time consuming. But, to those parents, their child is important. To me,that child needs to be important too.I need to put aside my frustration and treat the family and child with respect and empathy. Because that's what they will remember when their child is actually sick and does need to be in a hospital. I never want a parent to feel like they can't come back if they need to.

That's not to say I don't get irritated or frustrated. Of course I do but I really try to take a step back and breath before I walk into that room.

When my boy was two he had Coxsackie disease (Hand,foot and mouth disease). He had a fever and a mouth full of ulcers. He refused to drink. I took him to the GP(a locum as mine was away). The GP tried to look in his mouth. My boy jumped off my knee and hid in the corner. The GP looked at me disgusted- she said if he wasn't so naughty she'd be able to look in his mouth. Actually ,no. If he wasn't so scared and sore,she may have been able to look in his mouth. If she had an ounce of understanding on how to deal with kids,she may have been able to look in his mouth.
She made me feel terrible. Like I was wasting her time cos she didn't have the skill to look after my child. I never want to make my patients feel like that woman made me feel.

A few months ago I ended up taking my hubby to ED at 3 am. He had a massive tooth abscess and was having fevers and rigours. He had a vasovagal attack and I couldn't get him off the floor at one point. He had seen a dentist and was commenced on antibiotics. He obviously needed more than a simple dose of oral antibiotics. I worked in ED,I know what people said about going to the ED with a 'toothache'. I knew we'd not be a priority.The nurse we saw was amazing. He showed empathy and gave great explanations to my non medical husband. He put him at ease. Took his blood and gave him pain relief and fluids. He was busy. It was 3 am. He never once made us feel like we were wasting his time. We were extremely grateful.


I recently had a mum of a young baby in my clinic. Her girl had eczema. To me it was fairly mild. She was crying and said she couldn't cope with her baby being so sick. I have eczema ,I know its a nightmare, but to me, there are worse things to have. To that mum,at that time,that was the worst thing to happen to her baby. Who am I to tell her different? Of course I tried to normalise her experiences of eczema but it is my job to help her cope. Two weeks later,she was in a different place-able to cope ,with a good treatment plan. If I'd have made her feel uncomfortable,I'd have never helped her to get to that place. I'd not have been able to have that follow up clinic with her as she'd have never come back.

I read a fantastic blog by a student nurse recently-
http://www.nurseuncut.com.au/nurses-are-amazing-souls-a-young-patients-perspective.

In it a young student and cancer survivor talks about the impact nurses have had on him. He talks about the nurses who put in his IV,hung his chemo,held his hand. It made me so proud to be a nurse. His post really gets to the crux of why we are nurses. To be there with the patient. To be present.


Its sometimes tough being a nurse. We give an awful lot of ourselves yet we still are expected to remain professional and able to function. We need to learn resilience. Maybe that will be the subject of my next blog post......

From assignments to blogs

I think this journey with blogging is going to teach me a thing or two.

 Up until now I have only ever written Uni assignments. I have just been accepted as a writer for a nursing education site. Both of these platforms need evidence  and references. They need a structure. A beginning,middle and an end.

I have done a little research into blogging before starting my own. The advice is to 'choose a style'. To go for a more informal type of writing. To make your blogs flow and keep your reader interested.


This is so different from assignments and article writing that its going to be tricky I think. Of course I think my articles are interesting!! But they are different from my blog. Let me explain- my blogs will be evidence/experienced based but I will not have a long list of references listed in alphabetical order at the end. I will not really have an introduction and a formal conclusion. Of course if someone wants more conclusive evidence then I'm happy to point you in the right direction. Lets just see how it goes !


One more thing. I absolutely cannot use this laptop - the 'e' key is missing and its driving me insane!!!!!

Becoming a Nurse Practitioner

I never imagined myself as a Nurse Practitioner. In my previous role on the project I had actually written a Nursing Workforce paper that included the role of a NP. I considered it for about 30 seconds then dismissed it! I just didn't think it was for me.

Of course when the opportunity arose to be an NP in a Children's Emergency I didn't dismiss it and was totally amazed when I got the job. I had an initial hurdle with Uni. The first university I applied to rejected the application as I didn't have a nursing degree. I had qualified in the 'olden' days before degrees- I had a diploma.They did offer me a place on the post graduate certificate course then I could go on to do my Masters. As my Candidate position was supported I had no choice but to be accepted onto a Masters course in the first place otherwise I would have to forgo my position.

I was very relieved to find Flinders University not only recognised my original qualification,but also took into account my experience as a nurse. I was accepted onto the course and breathed a short lived sigh of relief before the hard graft of a Masters in Nursing ( Nurse Practitioner) overtook my entire life! My candidate position allowed two semesters supported( fees paid and two days per week to study). My final Semester was still in the candidate position but I was expected to study in my own time. It was hard work. I had never taken chemistry at university or even in Grade 12 + 13 so to tackle Pharmacology at Masters Level was insanely difficult for me. I had to work very hard to pass the subject but I did and even did better than I thought I would.I missed out on holidays with the kids and spent weekends studying. I made sure I put time aside to do nice things too but was very disciplined with my days off and my study time. I handed in assignments early and studied really hard.


I had an amazing clinical support team and extremely supportive family- without the them I doubt I would have remained sane. My fellow NPC and I did experience some colleagues that were less than happy to find training Nurse Practitioners in their midst and to be honest our most vocal opponents were sadly other nurses. Having another NPC to bounce ideas off and to share the experience with was great. We were also invited to be part of an already established NP team whose insight into the NP role proved to be invaluable.

I completed my course at the end of 2012 and was endorsed by AHPRA three months later. Although it involved alot of paperwork and proving my experience I didn't have any real problems with this process. I cried when they called to say I'd been endorsed. It had been such a hard 18 months  and I was aware not everyone got endorsed easily.

Even though I was in the NPC position I had to apply for the NP job. The developing of this role and the subsequent interview took another 8  months but finally I could call myself a Nurse Practitioner.

Anyone who says the path to becoming an NP is easy is lying. It was difficult but not impossible. The NP role seems still to be misunderstood and we are often asked to explain, and sometimes justify ,our role. Once again, with some colleagues, it was a matter of just doing the job and proving yourself. The role developed with us and we most definitely proved ourselves and became valuable assets to the team.

I thoroughly enjoyed my role.It was challenging and rewarding. I learnt valuable skills and almost felt I had to learn a new language when talking to my medical colleagues. They cut us no slack because we were nurses. They expected us to perform to a high standard. I was embraced by the majority of the team and developed their respect. However , I could never see longevity in ED. I loved the work but knew the pace and shift work would never be a long term option for me and my family. When the opportunity came along to work regular hours in a Specialist Allergy Clinic I applied for the job and was actually quite shocked to get it! That is were I currently am and ,once again, am facing a huge learning curve but loving the opportunity to grow as a practitioner.

And so you have it- my whole career to date. It's actually been quite cathartic to write it all down. To be honest I'm pleased its done . I feel like I can now move on to the real reason for the blog- to look at current issues in nursing, to hopeful inspire and encourage other nurses and nursing students and to discover the real 'soul' of nursing.

Abbie

A New World

I remember thinking I would be bored in General Paeds. I seriously worried I would find the pace too slow. Boredom is not a word I use to describe my experiences on the Children's Ward !

This lovely little ward gave me time to breath. I was able to grow as a nurse and really expand my leadership skills-something up until this point I had never done. After a year I applied for a Clinical Nurse position and was successful. This is turn allowed me to undertake the Nurse Unit Manager position for a year covering maternity leave. It was a unique experience for me and one I had never really considered doing before.

The team was small but hard working. We had our share of challenges and some staff were non to happy with my appointment as NUM - the thought of a relative 'newcomer' taking the job did not sit well. It was a new challenge for me and I worked really hard to gain trust. Sometimes you just have to be 'time served' and just prove yourself. The majority of staff were supportive and even some of my most vocal opponents turned out to be the most supportive allies when all was said and done.

I enlisted the help of the senior staff and tried to bring about some positive change. Not only clinically but I also tried to improve the culture of the unit. We implemented the 'FISH' philosophy based on the idea that its OK to have fun at work. You can still do serious work and enjoy it. We worked hard at being inclusive and improving standards of care.

The thing I hated about being a NUM was the 'HR' side of it. I hated disciplining and confrontation. I tried hard to do it well but it was not my most favourite task. I tried to stay professional and maintain a great place to work. I genuinely wanted people to want to come to work. I wanted people to stay.

As a whole it was a good experience. The demographics of the local community was unique. We had many challenging families and I developed a close working relationship with the Department of Communities. Although I had worked in areas of a challenging nature before this almost monthly occurrence of potential child abuse was a difficult environment to navigate. It required some emotional resilience and because of this it was even more important to create a great working environment.

I think that this is not the time to discuss coping techniques for dealing with child abuse but its most definitely  a topic I'd like to discuss later down the line. It remains an ongoing challenge and something I became quite skilled in dealing with ,unfortunately.

I felt unable to return to the ward as a clinical nurse after the challenges of being a NUM. I knew one thing though- management was not a career path I was willing to pursue. I took on some project work for 6 months while I had a chance to re-evaluate my nursing path. I was unsure where to go to from that point and needed some time to think. This sounds easy looking back but it was an awfully stressful time. For a long time I worked one temporary position after another and it was another 2 1/2 years before I had a permanent job again. As the main wage earner in the family this caused huge uncertainty for us.

A new chance came out of the blue. I took a temporary post as a clinical nurse teacher in an emergency department and some funding became available to train up two Nurse Practitioners. Suddenly I found myself heading back to Uni and had no idea what the next few years would bring in this amazing,challenging,completely new role.

Nursing on the other side of the world

Moving across the world was a  huge task. Starting a new job was the easiest part!

I think in order to ease myself into my new life,the consistency of staying in Oncology was a great decision. The new ward was tertiary once again and was a little bigger with a dedicated Bone Marrow Transplant Unit. The magnitude of Australia really hit home during my fist few months. Patients would not only have this terrible diagnosis of 'cancer' but many had to leave their homes and families in order to receive treatment. The difference this time was, they often had to travel by plane and relocate their whole lives.
I struggled with the lack of facilities for teenagers after my previous experience and found it difficult to understand why babies and young people were nursed side by side. Teenage Cancer facilities in Australia are really only in their infancy and an area which is currently receiving a little attention,thank goodness.

Whilst the nursing was similar I did feel a little as if the holistic care I was used to was lacking.I was used to being much more 'hands on' with my patients and building relationships. Rightly or wrongly I missed this aspect of my day and found the lack of consistency in patient care frustrating.

I remember being astounded by the story of a little boy from an island off the coast of Australia. He had woken one morning unable to walk. His Dad put him in his little rowing boat and paddled for two days to take him to the nearest island with a hospital. From there he was transferred to a regional hospital and then to definitive care in Australia. He had a diagnosis of Rhabdomyosacrcoma. The families lack of visa meant they were unable to leave the hospital grounds. They had never seen electricity or had any experience of money. They'd sit for hours looking out over the city amazed by the enormity of it all. David relapsed whilst on treatment. We had to use a satellite phone at a pre-arranged time to tell his mum who was at home with his little brother. It took a week to get him home to die.

Another family sought treatment for their daughter with a brain tumour. They were completely disillusioned with the treatment in Aus so travelled overseas to seek help. All failed and they brought her home.They were angry. Unable to accept their daughter was dying. I looked after her with great care and respect-she was the same age as my daughter. Finally accepting there was no cure,they started to show me DVDs of her as a well little girl. They were lovely,happy family times. In one video she looked  straight at the camera ,waved and said ' bye bye mummy'. I apologised and left the room. I retreated to the linen cupboard once again and cried. On going back into the room I apologised and allowed them to know I had shed a few tears for them and their baby girl.. They were amazed and told the social worker all about the  nurse who cared their daughter was dying.

I went to her funeral and saw a picture of a little girl and her family I never knew. A girl who lived in the country,in a small town that loved her and raised $1000's in hope of finding a cure. A little girl who loved Spiderman.

I loved oncology but for many reasons,maybe to be discussed later, I decided to look for work nearer to home. This change in direction was totally unexpected. I left oncology for the world of general paeds and a new chapter began
.

My nursing crisis

After my initial experience with Oncology I thought I didn't want to be a nurse any more. I didn't want to be witness to that suffering and I thought 'ignorance is bliss'.

I resigned a year after I got married and went to live in Spain for 6 months. I was a barmaid. I didn't have any responsibilities. If I made a mistake it didn't really matter-someone got the wrong beer- not the end of the world.I had fun. I loved my job. I wanted a baby and to be a mum - nothing else.

We returned from Spain to have our first baby and I thought it was the best job I ever had. I loved it and thrived at being a stay at home mum. There was just that little 'nagging' at the back of my mind. When ever I filled in any forms and it asked for occupation I wanted to say nurse. Both the kids birth certificates list my occupation as 'children's nurse.'

When my little girl was 6 months old I applied for a very part time job. A charity wanted 'children's advocates' to work in children's homes for 2 hours a fortnight on an evening. I applied and got the job. I visited young people as they were first placed in a group home. I went to court with them,attended meetings with them,had dinner with them,listened to them talk and  we watched TV .After three years I was regularly visiting 3 homes on a weekly basis.

When my second baby was 10 months old I applied to work with another charity.This time we were involved in running parent workshops and support services.I worked with some of the most 'difficult to reach' parents in the country. I loved working with young mothers particularly and ran a number of courses in one of the most socially deprived areas in the North East of England. I fitted my work in around the kids and took my baby to the creches with me that were provided by the charity.

Both of these jobs I got because I was a nurse. They weren't directly clinical nursing but the skills were transferable. I started and managed a 'toddler' group that was registered with the local council. I helped to care for my mum who was sick .

We decided to emigrate to Australia at this point and I knew the key to a successful Visa was my nursing.I decided it was time for me to bite the bullet and return to the hospital. I was terrified and vowed to handle it differently this time. I didn't really want to return and saw it as a means to an end.I went back on a casual basis. The plan was to have Orientation on the Oncology ward for 3 days then venture out onto the other wards once my confidence was back. I completed my orientation on my old ward. I didn't leave for another 12 months.

I loved it and had found my passion for clinical nursing once again.