NurseClick DECADES OF LEADERSHIP BREAST CANCER CARE FOR THE COMMUNITY GOT A QUESTION ABOUT SCOPE OF PRACTICE?
IN THIS EDITION
IN FOCUS @ACN
In the news
Australian College of Nursing update
On the job
IN FOCUS @ACN
INDIGENOUS HEALTH @ACN
Breast cancer care for the community
Adjunct Professor Kylie Ward FACN, ACN CEO
The National Nursing Forum
Non-remuneration and recency of practice
IN FOCUS @ACN
IN FOCUS @ACN
Decades of leadership
Ask our ENL's
NMBA UPDATE Got a question about scope of practice?
Adjunct Professor Kylie Ward FACN, CEO of ACN
Welcome to the July edition of NurseClick. Nursing is an extremely challenging and rewarding profession that provides endless opportunities for professional and personal growth. In this edition of NurseClick, we feature a number of insightful articles that explore the diverse career pathways available in this contemporary profession. At the forefront of care delivery, nurses work across all areas of the Australian health and aged care system. Reflecting on her experiences during clinical placement, one of our Graduate Certificate students, Genevieve Edney, expresses her excitement to be able to expand her scope of practice and explore a new field of nursing practice in her engaging feature article, My stomal therapy clinical placement. Nursing is an exciting profession that is subject to rapid technological growth and constant change. In her beautifully honest personal reflection, The most powerful lesson of my nursing career, one of our dedicated nurse educators Sharron Smyth-Demmon MACN delves into the changing landscape of our health care system and argues that despite technological advancements, humanity and compassion should always remain at the heart of nursing. The need to strike the right balance between the art of caring and the science of nursing is exemplified by ACT Chief Nurse Veronica Croome in our tribute to her upon her upcoming retirement. In this article, we speak candidly with Ronnie as she
reflects on an impressive 44 year career. We thank Ronnie for being a strong nurse leader who has paved the way for ACT to be leading in models of care and scope of practice for nurses and midwives. The importance of compassion and empathy within the nursing profession is touched on this month by Barbara Hasenoehrl MACN in her compelling piece, Breast cancer care for the community. Originally published in our 2016 Community and Primary Health Care Nursing Week eBook, Barbara’s story perfectly describes our privileged position as nurses to support and empower patients during some of the most challenging moments of their lives. Going home at the end of a shift with the feeling that she’s made a difference in someone’s life, is what Sharon Bilney believes is the best part of being a nurse. In our NAIDOC Week feature article, Sharon speaks about her experiences as a nurse to encourage young Aboriginal and Torres Strait Islander peoples to explore nursing as a career option. Our Emerging Nurse Leader (ENL) Program empowers current and future nurse leaders to achieve their career goals and aspirations through personal and professional development. In this edition of NurseClick, we asked some of our ENL’s to tell us what inspired them to join the nursing profession. I hope you enjoy the read!
Publisher Australian College of Nursing Editors Sally Coen Olivia Congdon Karen Watts Design Nina Vesala Emma Butz Enquiries 02 6283 3400 firstname.lastname@example.org Advertising 02 6283 3417 email@example.com
© Australian College of Nursing 2017 The opinions expressed within are the authors’ and not necessarily those of ACN or the editor. No part of this publication can be reproduced without permission from ACN. Information is correct at time of print. All files marked ‘Stock photo’ or credited to iStock or ThinkStock are representative only and do not depict the actual subjects and events described in the articles. Cover image: ThinkStock ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.
is now available for all of our gradua te certificate cour ses
STUDY WITH ACN With 14 graduate certificates and over 70 single units to choose from, what will you study? Advancing nurse leadership www.acn.edu.au
In the news national Ice addiction treatment in high demand
The growing use of the drug ice is driving a surge in the number of Australians seeking treatment for amphetamine use.
Essential oils to combat insect-borne diseases
Gigantic portions feeding obesity problem
World-first trial in preventing heart attacks and chest pain
A James Cook University team working in collaboration with the University of New Caledonia says a simple chemical process can transform essential oils into an effective mosquito repellent.
Australians' unhealthy penchant for pizza and cake could be helping to fuel the obesity epidemic as portion sizes grow to gigantic proportions.
A world-first trial involving Adelaide researchers may help to prevent sudden heart attacks and ongoing chest pain linked to a newly diagnosed condition called, Myocardial infarction with nonobstructive coronary arteries.
The average size of a slice of cake now contains almost 1000 kilojules more than it did two decades ago, according to a new study.
New data from the Australian Institute of Health and Welfare shows a 175% increase in the number of treatments that were delivered for amphetamine use over five years. Read more
Water fluoridation: dental and other human health outcomes The 2016 NHMRC Evidence Evaluation shows that water fluoridation helps to reduce tooth decay in children and adults. There is no reliable evidence that water fluoridation at current Australian levels causes health problems. Read more
Poor bone health costing Australia billions, report finds Failure to prevent fractures as a result of poor bone health is costing the nation billions of dollars each year, according to a new report. New analysis released by Osteoporosis Australia estimates fractures caused by brittle bones will cost the health system nearly $22 billion by 2022. Read more
Antibiotic allergy tests helping stop spread of superbugs Girls are missing school during their periods A report released in July, containing interviews with organisations working in multiple remote Australian communities, reveals anecdotal evidence girls are missing school during their periods. Read more
Hundreds of patients who thought they were allergic to penicillin have been given the all-clear thanks to doctors at Victoria's first antibiotic allergy testing centre. Read more
Sleep apnoea research paves way to targeted new therapies Recent discoveries about the range of causes of sleep apnoea may pave the way for more personalised treatment, experts at Sydney's Neuroscience Research Australia have said. Their research shows poor muscle control affects a third of all sleep apnoea patients. This could be improved through specific training exercises of the tongue and middle part of the throat. Read more
In the news world Obesity causes poor artery health in kids Heart attacks could be decades in the making, with a new Finnish study linking high blood pressure in obese children to a stiffening of their arteries later in life.
Older male partners lower chances of IVF baby success
Exercise may help protect the brain from Alzheimer’s disease
Extreme gardening to help tackle malaria
The success rate of couples going through IVF is dependent on the age of the man – not only the woman, a US study suggests.
Regular exercise may offer some protection against Alzheimer's disease, even for people who are genetically at risk, according to recent research.
Gardening could be a powerful weapon against malaria, culling mosquito populations by cutting off their food supply, say researchers.
Older men were found to have a lower chance of conceiving than younger men with a female partner of the same age. Read more
In the study, people who did more moderateintensity physical activity were more likely to have healthy patterns of glucose metabolism in their brains – a sign of healthy brain activity – than those who did less. Read more
OECD health statistics released The online database OECD Health Statistics 2017 has just been released on June 30. The Organisation for Economic Co-operation and Development (OECD) Health Database offers the most comprehensive source of comparable statistics on health and health systems across OECD countries. Read more
Global blindness set to 'triple by 2050' The number of blind people across the world is set to triple within the next four decades, researchers suggest. These researchers predict cases will rise from 36 million to 115 million by 2050, if treatment is not improved by better funding. Read more
Spreading cancer caught on film The way in which every single cancer cell spreads around the body has been captured in videos by a team in Japan. The normal body tissues show up as green, while the cancer comes out as intense red spots.
A team tested their idea in nine villages in the arid Bandiagara district of Mali, West Africa.
The team, at the University of Tokyo and the RIKEN Quantitative Biology Center, says the technology will help explain the deadly process.
'Exciting' step made in SIDS research
Sharp focus on Alzheimer's may help target drugs
A significant and potentially life-saving step forward in SIDS research has been made by scientists in the US.
Abnormal deposits that build up in the brain during Alzheimer's Disease have been pictured in unprecedented detail by UK scientists.
A study published in the Proceedings of the National Academy of Sciences has found one-third of SIDS deaths appear to be linked to elevated levels of serotonin – a chemical that helps regulate breathing, heart rate and the ability to wake up.
The team at the MRC Laboratory of Molecular Biology says its findings "open up a whole new era" in neurodegenerative disease. Their work could make it easier to design drugs to stop brain cells dying.
Australian College of Nursing update
2018 Emerging Nurse Leader Program now open
Community and Primary Health Care Nursing Week eBook
CEO Sleepout: $2,300 raised for Canberra’s homeless
Applications for the 2018 Emerging Nurse Leader (ENL) program are now open!
Submissions close soon for those wishing to share their stories in the 2017 Community and Primary Health Care Nursing Week (CPHCNW) eBook. CPHCNW is an ACN initiative that celebrates Australia’s community and primary health nurses across the week of 18–24 September.
On Thursday 22 June, ACN CEO Adjunct Professor Kylie Ward FACN, joined 96 other CEOs and business leaders from around the ACT to spend a night sleeping rough for The Vinnies CEO Sleepout.
If you are an ambitious go-getter looking for an opportunity to build your profile as a nurse leader and take your career to the next level then this is the opportunity for you! The prestigious program will support up to 50 current and up-and-coming nurse leaders, from undergraduate students to nurses in their sixth year of nursing practice, to develop their leadership skills and confidence. The program is divided into five stages reflecting the challenges and opportunities nurses face as they progress through their leadership journey. Each stage is nine months and participants are welcome to enter at any stage depending on where they are in their personal journey. Through this program, you’ll gain the support, networks, mentorship and opportunities to best enhance your nursing career. You can apply via this link until 31 August.
Last year, our eBook received wide circulation and exposure across our professional networks and social channels. This year, we are asking for eBook submissions that focus on why community and primary health care nursing is vital to the health and wellbeing of our society. We encourage submissions from across the nursing profession and broader Australian health care workforce. Submissions must be between 100 – 350 words and include a headshot of the author. All accepted submissions will be included in the 2017 eBook, as well as future ACN publications. More information is available on the website. It’s not too late to submit your story!
Adjunct Professor Ward raised $2,387 towards the ACT fundraising total of $421,090, which will assist those without a warm bed this winter. The money raised in ACT has meant another van can be purchased to feed the homeless. ACN staff got into the spirit in the lead up to the Sleepout by wearing their winter woollies and onesies to work and helped to raise funds. “We've had a big week and I appreciate such positivity and motivation from the teams. It's this energy and attitude that makes us great,” Adjunct Professor Ward said. "I was moved when Members and Fellows from many states and territories chipped in and donated for this very important cause." View our media release for more information.
The Event Centre, The Star, Sydney
Cover doesn’t always mean protection. Find out more
IN FOCUS @ACN
Sharron Smyth-Demmon MACN
On the job on The most powerful less of my nursing career
“Nursing has changed in many ways since I started out, but despite the technological, pharmacological and treatment advancements, humanity and compassion must remain at the heart of nursing practice.”
Unlike many of my colleagues, for me, becoming a nurse was never a burning life ambition. Sharon Smyth-Demmon MACN After seeing an advertisement in the local paper I applied almost on a whim and some eight weeks later I found myself in my new role as student nurse. There were times when I wasn’t sure it was for me, but just over three years later I transitioned from student status to registered nurse. There was still no burning ambition, but I was fiercely proud of my profession and had a strong commitment to quality nursing care. The thing I like most about nursing is the patients. I like talking with them, hearing their stories, finding out who they are as people and seeing how best I can help them during the time we have together. That’s what nurses do, isn’t it? Most nurses will tell you about the patients they’ll never forget and for me there have been many. The one that stands head and shoulders above the others however, was Tom.
Tom was a 72-year-old man from the east end of London. He had been diagnosed with stomach cancer and was admitted to his local hospital for a partial gastrectomy. Tom was retired, and had been married to his wife, Kit, for almost 50 years. He had two living children, having lost a daughter to a degenerative disease almost 11 years previously. He had six grandchildren. He and Kit lived in a tiny flat with no garden, and he enjoyed riding his bicycle to his allotment where he pottered around and grew vegetables. He liked deep sea fishing. He was a keen reader and always had at least two books on the go. He loved nature programmes. He had a twinkle in his eye and his family loved him. Tom was barely one-day post operation when an incident occurred on the ward. His granddaughter arrived to visit him and had discovered that he had not been given any post operative analgesia for some eleven hours. She arrived at the nurses station, trying hard to hide her anger and distress at his condition. Nurses were quickly dispatched to see Tom. His family were assembled in the room and the atmosphere in the room was tense. Tom was lying in bed, eyes closed, stiff as a board. He was too afraid to move or breathe deeply for fear of increasing the pain that was searing through his body.
IN FOCUS @ACN
His wife sat silently in the bedside chair. She looked tired and her face was pinched with worry. Tom’s granddaughter held his hand and spoke calmly to him. “It’s alright now, they’ll get you something and you’ll feel better soon. You can have a nice sleep.” One of the nurses spoke to Tom. “You should have told us you had pain, Tom.” The granddaughter looked directly at her. Her rage was palpable. “11 hours. Major surgery yesterday. You should have known.” A look passed between Tom’s wife and granddaughter but the nurses stayed silent, leaving the room to fetch analgesia, which they swiftly and gently administered then left the room. Tom’s son and daughter took their mother to the canteen for a cup of tea and a breath of fresh air. His granddaughter took up her grandmother’s vigil and stayed by Tom’s side as he drifted off to sleep. Tom wasn’t the only person in that room who was in pain. His whole family were right there with him. The diagnosis was bad enough, but it seemed that for his granddaughter in particular, his physical pain was unbearable because it was increasing his suffering and this for her was both inexcusable and intolerable. Why do I remember Tom so clearly? Well, you probably think I’m the nurse in the story, but in fact, I’m the granddaughter. I was a second year student nurse at the
time. I’d looked after lots of people’s family members but for the first time I began to understand what it felt like to be on the other side. I still remember the anger I felt when I arrived to visit and found my grandfather in agony. I didn’t care who was responsible. I just wanted it fixed. The look that passed between my grandmother and I resulted in a lecture from her on my rudeness to the nurses. She was quite right, of course. She usually was. But one of the lessons I took from the experience was to try to understand what’s behind the anger of relatives or patients loved ones. Most of the time it’s coming from a place of concern, care and worry. That doesn’t make it any easier when you’re on the receiving end, but take a deep breath, listen to what they’re saying and try to help. I learned that you don’t wait for a patient to ask for analgesia. I'd already been taught that, of course, and I hoped that my practice reflected this, but the incident reinforced the message loud and clear. Talk to them. Ask questions. Keep an eye on them. You’re their advocate, so take that role seriously and act on their behalf. They might not use words to tell you they’re in pain, so, carry out an assessment, put all your observations together and act accordingly. My grandfather was no shrinking violet in life, but he was also from the ‘stiff upper lip’ generation, as was my grandmother. Pain was to be expected and endured. It’s really not.
I learned that nurses don’t always get it right, and that’s okay. Learn from your mistakes, reflect on what happened. Be honest. What can you do differently to make things better? Don’t let defensiveness and denial be your default position. And if you do something well, reflect on that too and give yourself a pat on the back. Reflection isn’t always about things that go wrong. It’s also about what you do well. Fortunately, the rest of Tom’s stay was uneventful and his care was faultless after that incident. He spoke highly of the nurses and they genuinely seemed to like him. Sadly, the disease had already spread and he died some 15 months later in the local hospice from a secondary cancer. I still miss him. Nursing has changed in many ways since I started out, but despite the technological, pharmacological and treatment advancements, humanity and compassion must remain at the heart of nursing practice. We alleviate suffering. We treat the body and the mind. I knew that before I saw my grandfather in that hospital bed but to this day that incident remains the most powerful lesson of my nursing career. My grandfather taught me a lot of things and because of him I’m a better person. It’s fitting that the most valuable life lesson I would learn from him was how to be a better nurse.
Recommend the flu and whooping cough vaccines to your pregnant patients. health.wa.gov.au WA Department of Health
Our keynote speakers Join inspiring nurse leaders at the 2017 National Nursing Forum!
The 2017 National Nursing Forum (NNF) will inform, inspire and engage delegates through an impressive line-up of keynote speeches from highly renowned leaders in nursing, health and government. Throughout the three-day leadership and educational event, our speakers will share their experiences and ideas on how nurses can make change happen in the health care industry. The NNF is the must-attend annual event for the Australian nursing community. Make sure you are a part of it and join us in Sydney this August! If you would like to register for the 2017 National Nursing Forum, please visit our website.
THE HON TANYA PLIBERSEK MP Deputy Leader of the Opposition, Deputy Leader of the Federal Parliamentary Labor Party, Shadow Minister for Education, Shadow Minister for Women, and the Federal Member for Sydney
MR ROBERT NIEVES JD, MBA, MPA, BSN, RN Vice President Health Informatics, Elsevier Clinical Solutions
MS JANINE MOHAMED Nurse and Chief Executive Officer, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM)
MS VERONICA CROOME ACT Chief Nurse, ACT Health
MS JACQUI CROSS Chief Nursing and Midwifery Officer, Nursing and Midwifery Office, Ministry of Health
ADJUNCT PROFESSOR DEBORA PICONE AM FACN (DLF) Chief Executive Officer, Australian Commission on Safety and Quality in Health Care
MS SUZIE HOITINK MACN Founder of the Clear Complexions Clinics and Head of Nursing
ADJUNCT ASSOCIATE PROFESSOR ANNA SHEPHERD MACN (ASSOCIATE) Chief Executive Officer, Regal Home Health and Adjunct Associate Professor at The University of Sydney Nursing School
MR ASHTON BISHOP Chief Executive Officer, Step Change
ADJUNCT PROFESSOR DEBRA THOMS FACN (DLF) Commonwealth Chief Nursing and Midwifery Officer
WITH THANKS TO THE SUPPORT OF OUR VALUED FORUM PARTNERS AND SPONSORS
IN FOCUS @ACN
Non-remuneration and recency of practice By Trish Lowe MACN
Despite the National Registration Accreditation Scheme (Australian Government, 2016) approaching its seventh anniversary, confusion continues to surround Trish Lowe MACN mandatory registration standards and the extent to which they impact on individual nurses and midwives. ACN provides education for nurses and midwives, regarding their professional responsibilities under all mandatory standards, particularly those pertaining to Continuing Professional Development (Nursing and Midwifery Board of Australia (NMBA, 2016a) and Recency of Practice (NMBA, 2016b). Throughout this process, clarification regarding the responsibilities of nurses and
midwives working in 'non-remunerated' roles are commonly sought. According to the most recent version of the Nursing and Midwifery Board of Australia, Recency of Practice, registration standard (1 June, 2016), nurses and midwives must be able to demonstrate: evidence of registration, recent practice experience (and the ability to demonstrate nursing and midwifery knowledge and skills) or the â€œcompletion of postgraduate education leading to an award or qualification that is relevant to the practice of nursing and/or midwifery,â€? (NMBA 2016b, p. 1). In recognition of the multi-faceted nature of contemporary nursing and midwifery roles, the term, 'practice,' is no longer restricted to the provision of direct clinical care. It also incorporates working in non-clinical roles impacting on the delivery of health care, such as management, research or policy development (NMBAb, 2016).
IN FOCUS @ACN
“ACN provides education for nurses and midwives, regarding their professional responsibilities under all mandatory standards”
Nurses and midwives working in clinical roles are required to undertake sufficient practice to demonstrate currency. Practice hours can be accrued in several ways. National Boards consider 450 practice hours within the past five years to provide an appropriate balance between ensuring practitioners maintain the knowledge and skills required to practice safely, while flexibly accommodating part-time work, study or leave (NMBA, 2015). Therefore, completion of a minimum of 450 hours of practice within the past five years remains the benchmark. Alternatively, successful completion of an NMBA approved program, assessment or period of supervised practice, may also be acceptable (NMBA, 2016b). Practice is defined as, “any role, whether remunerated or not, in which the individual uses their skills and knowledge as a nurse or midwife," (NMBA 2016b, p. 4). The inference that nurses and midwives continue to meet the standard, while engaged in, “non-remunerated,” roles, causes confusion. Nurses and midwives regularly act in unpaid positions, volunteer for community organisations (such as local surf clubs) and may be required to utilise their nursing and midwifery skills, as partners, parents and family members.
Questions abound as to whether this activity is acceptable under the standard. However, it has been determined by the NMBA that caring for family members – no matter how complex the health need – does not constitute sufficient demonstration of nursing and midwifery skill to meet the standard, nor does the provision of health care advice (e.g. breastfeeding help lines) or the administration of first aid. The reasons for this determination are that with correct training, non-nurses and midwives could undertake these responsibilities, and that the hours spent engaging in these voluntary activities, would be difficult to verify. So, recognition of whether nursing or midwifery registration is required to fulfil a voluntary role, helps clarify its worth under the Recency of Practice standard. For example, to volunteer as Crew Nurse for Mercy Ships, or act as a voluntary member of a professional organisation, requires the candidate to demonstrate certain criteria, such as national registration and an appropriate level of expertise. Providing home care, phone counselling or first aid, do not. Understanding the ways in which nurses and midwives best meet the mandatory
registration standards, taking into account the complexities of their individual circumstances, can be challenging. If in doubt, nurses and midwives are strongly encouraged to contact the AHPRA office in their state or territory, to seek advice. Failure to do so, may lead to an inability to renew registration or the imposition of restrictions or conditions, upon registration. Registration standards, codes or guidelines are used to determine the outcome of disciplinary proceedings. Therefore, nurses and midwives are behoved to develop a thorough working knowledge of their professional responsibilities under the mandatory registration standards, and adhere to them at all times.
References The Department of Health 2016, National Registration and Accreditation Scheme (NRAS), accessed 19 June 2017, <http://www. health.gov.au/internet/main/publishing.nsf/content/work-nras> Nursing and Midwifery Board of Australia 2015, Common FAQs: Recency of practice, accessed 19 June 2017, <file:///C:/Users/ user/AppData/Local/Temp/AHPRA---FAQ---Recency-of-practiceregistration-standard---30-October-2015.PDF> Nursing and Midwifery Board of Australia 2016a, Continuing Professional Development-Registration Standard, accessed 19 June 2017, <file:///C:/Users/user/AppData/Local/Temp/Nursing-andMidwifery-Board---Registration-standard---Continuing-professionaldevelopment---1-June-2016.PDF>
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Nursing and Midwifery Board of Australia 2016b, Recency of PracticeRegistration Standard, NMBA, Canberra ACT, accessed 19 June 2017, <file:///C:/Users/user/AppData/Local/Temp/Nursing-and-MidwiferyBoard---Registration-standard---Recency-of-practice---1-June-2016. PDF>
Barbara’s inspiring story features in our 2016 Community and Primary Health Care Nursing Week eBook. This year, we’re asking nurses to share a story that focuses on why community and primary health care nursing is vital to the health and wellbeing of our society.
Breast cancer care for the community
Visit our website to find out more about this national campaign and to submit your story for the 2017 eBook!
Community & Primary Health Care Nursing Week
Nurses where you need them 19–25 SEPTEMBER
With thanks to the support of our official sponsors:
Advancing nurse leadership www.acn.edu.au/CPHCN
By Barbara Hasenoehrl MACN
In Australia, one in eight woman are diagnosed with breast cancer in their lifetime (Cancer Australia, 2016). A diagnosis with breast cancer is a challenging Barbara Hasenoehrl and overwhelming MACN experience for the client and their families. An estimated 1,500 clients will be diagnosed with breast cancer in Western Australia in 2016 (Breast Cancer Care WA, 2016). After working in a regional area as a breast care nurse, I have recently joined Breast Cancer Care WA. Here, I work with a highly dedicated team
of trained professionals who work holistically to create personalised solutions to the challenges faced by our clients. Breast Cancer Care WA works as an independent, non-government funded organisation outside traditional health care settings. The team works closely with health care facilities, specialist medical teams and other support services across Western Australia to meet clients and their family’s needs throughout this challenging experience. Our services receive self-referrals as well as referrals by health care providers and other support agencies. Our nursing team consists of five specialist breast care nurses, with one of them being dedicated to supporting metastatic breast cancer clients. Rather than clinical care, our
team of breast care nurses are a valuable source of information and offer emotional support for clients and their families across the continuum of care. Our support is provided free-of-charge over the phone and by email, but we visit clients in hospitals and their homes as well. Another important aspect for the breast care nurses is to provide education sessions about breast cancer, breast awareness and other related topics. The specialist breast care nurses present at local events and conferences, conduct community and workplace presentations as well as talks to other health and medical professionals. Two of the major areas of concern for clients are the emotional side of cancer and financial issues. Our team of specialist breast care nurses is supported by a team of counsellors to provide the
best emotional care to our clients. Breast Cancer Care WA is a charity and can make a difference to families in financial crisis due to the generosity of the Western Australian community and their own fundraising efforts. Our team supported 951 clients in 2015, which was an increase of 15% from the year before. I feel privileged to work with these women and their families on a daily basis and to support and empower them as a member of a truly inspirational team of health professionals. References Breast Cancer Care WA, Breast Cancer Statistics, viewed 24 August 2016, <http://www.breastcancer.org.au/about-breast-cancer/statistics.aspx> Cancer Australia 2016, Breast Cancer in Australia, viewed 24 August 2016, <https://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/ breast-cancer-statistics>
PROFESSIONAL ISSUES @ACN
Pick up your own copy!
ACN is proud to partner with Dr Ruth Rae FACN in a commemorative publication of The History of Australian Nurses in the First World War: An ACN Centenary Commemorative Trilogy (the Trilogy). The Trilogy box set details the important contribution of Australian nurses who served in WWI. Wherever Australian and allied soldiers fought, Australian nurses served. The Trilogy features: • Book one – From Narromine to the Nile (2nd edition) • Book two – Scarlet Poppies (3rd edition) • Book three – Veiled Lives (3rd edition) • ACN First World War Nursing Nominal Roll
The Trilogy offers updated and redesigned editions of Dr Rae’s previous printed publications, Scarlet Poppies and Veiled Lives. Her third book on the topic, From Narromine to the Nile, although available as an e-book, is available in print form for the first time within this box set. In recognition of the importance of the nursing profession to the centenary celebrations the Trilogy also features the ACN First World War Nursing Nominal Roll. The Nominal Roll is an additional, stand-alone document within the box set. It features a list of nurses who served, providing families with a tangible keepsake honouring their relative’s involvement in the war effort. Visit www.acn.edu.au/commemorative_ trilogy for more information and to purchase the Trilogy today!
INDIGENOUS HEALTH @ACN
Celebrating Aboriginal and Torres Strait Islander history, culture and achievements
By Sarah-Kate Melehan
Every year, National Aborigines and Islanders Day Observance Committee (NAIDOC) Week is held in the first week of July. NAIDOC Week is an opportunity to celebrate and acknowledge Aboriginal and Torres Strait Islander history, culture and achievements (Australian Government, 2016). It is also a chance to recognise the contributions that Indigenous Australians make to society (Australian Government, 2016).
or educating a non-Aboriginal person about Aboriginal culture,” Ms Bilney, who belongs to the Kokatha family group, said.
The theme for this year’s NAIDOC Week was Our Languages Matter. This theme is a celebration of “the essential role that Indigenous languages play in both cultural identity, linking people to their land and water, and in the transmission of Aboriginal and Torres Strait Islander history, spirituality and rites, through story and song” (Australian Government, 2016).
“Deciding to become a nurse is a decision that I’ve never regretted,” Ms Bilney said.
Going home with the feeling that she’d made a difference in someone’s life that day is what Sharon Bilney says is the best part of being a nurse. “When I was working at the hospital, it was just so nice to feel as though I’d made a difference, whether it was to an Aboriginal patient that day
The mother of four, who is Manager of Client Services for Port Lincoln Aboriginal Health Service, began her early career working at Port Lincoln Hospital. She also had a two-year stint lecturing in nursing at TAFE South Australia’s Port Lincoln Campus.
“It’s a career that you can have around children and I’ve loved the opportunities that have come with it as well – I loved that I’ve worked in a hospital setting but also been able to lecture and have the chance to mentor and support young Aboriginal students on their path into nursing.” Ms Bilney spoke about her nursing career to help highlight NAIDOC Week, and urge young Indigenous people to explore nursing as a career option. “I highly recommend nursing. Even if you don’t want to work in a hospital, the possibilities and options are endless. Take every opportunity that comes your way,” Ms Bilney said.
“NAIDOC week is an important week to celebrate our history and culture.” Ms Bilney said the best thing she had ever done was switch from her previous career in office work to nursing. “Once I knew that I would be able to study at home part-time while I still had my little boy at home with me, I thought the opportunity was just amazing,” she said. “Once I was enrolled, I just wanted to focus on getting through the next five years of study and really achieve that goal of becoming a nurse.” In her final year of study, Ms Bilney received the Federal Government-funded Rural and Remote Undergraduate scholarship, through ACN. ACN CEO Adjunct Professor Kylie Ward FACN, said Ms Bilney was a perfect example of how diverse a career in nursing could be, and how it could be explored at different stages in life. “Sharon was a mum at home caring for her young son when an opportunity came her way to be able to study nursing,” Adjunct Professor Ward said. “On completing her studies, she has had the opportunity to work in a hospital and experience
theatre work, accident and emergency, the surgical and medical wards and has also had the chance to work in palliative care and mental health. “She has also lectured in nursing and been able to mentor young Indigenous students and is now leading the way in providing health care to Aboriginal and Torres Strait Islander people in Port Lincoln.” Reference Australian Government 2016, 2017 national NAIDOC theme, accessed 29 June 2017, < http://www.naidoc.org.au/2017-national-naidoc-theme>
ACN ran a Facebook selfie competition to find out what encouraged visitors to attend our at our Nursing & Health Expo in Perth this June! Check out some of the amazing entries and a special shout out to our winner, Molly Coldwell!
IN FOCUS @ACN
Decades of leadership A tribute to ACT Chief Nurse Veronica Croome upon her retirement
ACN would like to pay tribute to an exceptional nurse leader, Veronica (Ronnie) Croome, upon her retirement as Chief Nurse for ACT Health. Ronnie has provided strong strategic leadership for both the nursing and midwifery professions across the ACT since her appointment to this role in 2009. Working in collaboration with nurses and midwives, government officers, consumers and health care organisations, Ronnie has achieved a number of key objectives for our profession.
We asked Ronnie a few questions about her career and visions for the future of our profession… Why did you decide to pursue a career in nursing? I didn’t decide until almost the day before I left school that I wanted to be a nurse. I had my heart set on being a school teacher but my father, also a school teacher, thought it was a difficult career for a female, so I chose nursing. Secretly, I was keen to move out from home, as most 18 year olds want to do, so nursing meant I had to live in the nurses’ home for three years. What has been a defining moment in your career? Although I consider myself a leader, I do not consider a certain defining moment but rather, a journey that has seen me evolve into my current role as ACT Chief Nurse.
But if I have to mention just one, it was the realisation that sometimes it’s just as important to accept what’s reasonable rather than what’s ideal. What have you enjoyed most about being the ACT Chief Nurse? The fact that every day I feel privileged to be the professional leader of nurses and midwives in the ACT. Looking back on your career and accomplishments, what are you most proud of? I am proud of the many achievements I have been able to be part of, as I see the professions of nursing and midwifery grow. I am proud that nurses and midwives make a difference in the lives of the patients they care for and how special that is. We continually rank in the top spot for the
ACT Chief Nurse Ronnie Croome
most trusted professions and that trust is earned and not taken for granted. In my role as ACT Chief Nurse, I am proud to have overseen the introduction of new models of care, such as nurse led services, like walk in centres and rapid assessment units, publiclyfunded homebirths, the creation of eligible midwife roles, advanced practice nurse positions, care coordinators as part of the ward leadership teams, team based nursing and the establishment of more nurse practitioner roles in primary care. I am also proud that we have provided increased employment opportunities for newly graduated nurses and midwives and more than doubled the number of clinical placements we can now offer undergraduate students.
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“Never be afraid to speak up and to challenge what you think may not be right.”
I was particularly proud to lead a contingent of 100 nurses from ACT Health to the International Council of Nurses Quadrennial Conference in Melbourne in 2013 where we partnered with the University of Canberra to run a symposium about our experience of bridging the gap between academia and clinical practice. How has the nursing profession evolved since you began your career? Technology and the internet have been the big drivers of change in the last 30 years. Nurses now need skills that were not even heard about when I was a newly graduated nurse. And the challenge is to strike the right balance between the art of caring and the science of nursing. What do you think are some of the biggest challenges that nurses face as a profession? I call this the eight things that keep me awake at night. The deteriorating patient, nurses and midwives working within a defined scope of practice, managing patients with challenging behaviors and keeping our staff safe, rosters
and the balance between flexibility and service provision, inadequate documentation, patient confidentiality, lack of resilience and inappropriate use of social media. What are your hopes for the future of nursing? My hope is that we establish and maintain both an affordable and sustainable workforce that is well educated and well supported and is seen by others as having economic benefit to society. Why do you think nurse leadership is important? The Australian College of Nursing has produced some great work around raising the importance of nursing leadership. It is important for patient care and for the future of the profession. Good intelligence, vision and an ability to inspire others to make a difference is what nursing leadership is and should be about. The costs of health care and the cost of the workforce that provides the care are under constant scrutiny in environments that are under enormous pressure. Nursing leadership is the key to managing change and the challenges we
face in the provision of safe, person centred care. What are your words of wisdom for a young nurse looking to make a difference? Never be afraid to speak up and to challenge what you think may not be right. What’s next for you? A quiet life!!! Ronnie is an extremely dedicated nurse leader who has provided a voice for our profession and lead change across the sector throughout her extensive career. ACN would like to thank Ronnie for her significant contributions to nursing and wish her all the best for the next stage of her life.
Editor’s note: Ronnie will be a keynote speaker at this year’s National Nursing Forum. Register today and hear her speak alongside an impressive line-up of presenters from across the profession.
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My stomal therapy clinical placement By Genevieve Edney
As a student studying stomal therapy, a 40-hour clinical placement is a requirement of one of the units of this course. It felt strange being an ‘undergrad’ of sorts, as I have already been Genevieve Edney working as a registered nurse for some years now and despite having many years experience as a nurse, I still had mixed emotions prior to my placement. I was very nervous and excited at the same time. I took the time over a weekend to do a reconnaissance to my placement. This was essential for me as it helped me know where I was meant to go, gauge the traffic, have some idea where to park or if possible, find out where the closest public transport was; not to mention doing some detective work and finding out about the hospital I was going to spend the next five days of my life. It was useful for me to do some homework on my placement, be prepared for any eventuality and get organised. The hospital was equipped with 227 beds, eight operating theatres, a 15-bed Intensive Care
Unit (ICU), a day procedural and endoscopic unit, a day surgery, a day oncology unit, two cardiac laboratories, an emergency centre and an admissions lounge. Services ranged from breast and endocrine surgery, cardiology, colorectal surgery to gastroenterology, neurology, orthopaedic, pain medicine to vascular surgery and many more. On day one of my placement, I arrived early with my badge on, uniform and that ever-useful nurses pouch where I keep my pens, paper, nursing scissors, alcohol wipes and even a micropore tape. My preceptor warmly greeted me at the door and my nervousness dissipated with her optimistic, upbeat attitude. She then told me to simply follow her lead, as it was my first day after all. Having a great preceptor helps, especially one who has been working as a stomal therapist for over 30 years. I only had five days to learn what she has accumulated in all that time. It also helped that my preceptor was only too willing to impart her knowledge and expertise, who led by example and who did not mind my many questions. So despite the fact that on day one, she told me to ‘follow her lead,’ after a very quick orientation to the wards and a handover from fellow stoma therapists and nursing staff, I was already encouraged to utilise my own nursing experience to assist my preceptor in dealing with the many complex wounds we came across during the day and to apply the theories learned in principles
of stoma care into actual hands-on stoma management. This boosted my confidence and I proceeded with my duties of care in top form. Nothing like rolling up your sleeves and getting right to it. It was certainly a welcome challenge. One of the many highlights of my placement was when my preceptor and I met a patient who had an anterior resection and a loop ileostomy. Prior to meeting the patient, it was important that we read up on the patient's notes, gathered as much information as we could regarding the patient, found out what the multi-disciplinary team and the patient's treating team has written, what the surgeon had assessed and confirmed the order to take out the rod, which was supporting the loop. On meeting the patient, we introduced ourselves, informed the patient what we do and took time providing reassurance and letting the patient know exactly what intervention we were to perform. After obtaining patient consent, I was then allowed to take out the stitches and the rod using an aseptic technique under the watchful eye of my preceptor. And as always, one must never forget to document everything. Another highlight was meeting up with a vascular surgeon and discovering how he checks for a limb's blood flow using a doppler scan. The surgeon pointed out where to locate the different pulses of the lower limb and how crucial it was to check both limbs bilaterally. On this day I also learned how stoma bags can also be useful as
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wound care products particularly when dealing with a dehisced surgical wound, which was oozing lymph fluid. It was certainly a case of being creative with what dressings were available and thinking ‘outside the box’. I also witnessed the importance of patient education and preparation, and how fundamental this was to patient compliance, cooperation and patient outcomes. My preceptor and I met a patient due for a radical cystectomy. The patient presented as extremely anxious and justifiably worried. After explaining who we are and what we do, my preceptor ensured that she had the right body language; sitting next to the patient not across from a table, keeping a warm, friendly but professional approach at all times, and being courteous and respectful of the patient's needs. She allowed as much time and opportunity for the patient to talk about their concerns and fears as they needed, assessing how much information the patient required, asking the patient what they knew about their operation and what they would like to know. My preceptor, in turn, provided simple, clear and straightforward answers without any medical jargon, and educational leaflets and diagrams were used for further patient education. The psychological impact of having a stoma was seriously tackled during this pre-operative stage. The patient talked, we listened. At the end of that meeting, the patient appeared relaxed and less apprehensive of what was to come, being now mentally prepared of what to expect. In the next few days, my preceptor continued to provide counselling, reassurance and education until the day arrived when we had to site the stoma. Stoma siting is used as a necessary prerequisite for stomal therapists not only to build continued rapport and trust but to avoid post-operation stoma management difficulties.
“It was a rewarding experience to be with such dedicated stomal therapists who were so passionate about their work and how they carried out holistic evidence-based patient-centred care.” It was also a precious time for my preceptor to teach me a very important skill on how best to site a stoma. Crucial to stoma siting is knowing exactly what the patient's medical condition is and what exactly the surgical procedure was. Many variables had to be considered: the patient's occupation, lifestyle, hobbies and recreational activities, religion, spiritual beliefs, sexuality, culture, clothing choices, cognitive ability, manual dexterity, vision (the patient must be able to see the stoma), skin allergies (should the patient be patch-tested due to the adhesive properties of stomal products?), and patient participation as much as possible. Stoma siting also had to be done in various positions – we had the patient lying, standing and sitting – to maximise the best stoma placement. Natural abdominal folds were taken into account, and avoiding the belt line, umbilicus, scars, hernias and bony prominences. The patient was asked to cough while lying down as this makes the rectus muscle more visible and thus maximising the most optimum site for a stoma creation. Another focal point was being given the valuable opportunity to observe a gastroenterologist perform a colonoscopy and an endoscopy. Important landmarks of the digestive system were pointed out and I got to see what the ruggae in the stomach looked like, how a villi appears, observe for peristalsis, how polyps were biopsied and how disorders like diverticula shows itself in the colon. There really was nothing like seeing the real thing as opposed to relying on textbooks and
images. It was a fascinating insight into our gut. It was as though I was watching a science-fiction film, although this time, it was for real. For me, it reinforced my appreciation of how incredible the human body truly is and how we must all learn to look after our bodies well. I enjoyed watching the team – nurses and the specialists all working together, like well-oiled parts in sync with each other to ensure the patient remains safe and comfortable, and the procedure was carried out without any hitches. I was also extremely lucky to attend to patients in ICU with stomas and Vacuum Assisted Closure (VAC) dressings, as well as attend the out-patients clinic with my preceptor, dealing with patients post-discharge who came for their follow-up appointments. On one occasion, I was privileged to treat (under supervision) a patient who came in with stoma granulomas. Time for me certainly flew far too quickly and all too soon my clinical placement was over. All in all, it was a rewarding experience to be with such dedicated stomal therapists who were so passionate about their work and how they carried out holistic evidence-based patient-centred care. To see them in action, interacting and liaising with members of the Allied Health team, nursing staff, surgeons and doctors, as well as family members and caregivers, to optimise patient outcomes has strengthened my resolve to continue to incorporate this into my own practice.
Graduate Certificate in Stomal Therapy Nursing ACN’s Graduate Certificate in Stomal Therapy Nursing instils a professional and ethical understanding of clinical practice development into our students, resulting in improved outcomes for patients. This course provides the opportunity to develop the attributes of a specialist nurse, adopting an active role in stomal therapy, wound management and continence management. ACN is proud to be the only online provider of the Graduate Certificate in Stomal Therapy Nursing. CAREER OPPORTUNITIES MAY INCLUDE: • Specialist nursing roles • Clinical education • Management roles COURSE OVERVIEW Guided by the philosophy of the Australian Association of Stomal Therapy Nurses (AASTN) and the core values of the World Council of Enterostomal Therapists (WCET) this course prepares nurses who want to specialise in this field with the knowledge and the clinical skills to excel.
Students are equipped with the broad theoretical framework for the stomal therapy nurse role and the ability to competently provide comprehensive nursing care for clients who have had, or are about to have, stoma formation, wounds or fistulae. The units of study provide the knowledge, skills and attitudes necessary to provide holistic nursing care to promote continence, effectively evaluate stomal therapy interventions with particular attention to the patient’s adaptation in the long term and the ability to effectively assess, manage and evaluate wounds or incontinence in a variety of health care settings.
LEARNING OUTCOMES This course enables students to: • Demonstrate a specialist knowledge base within stomal nursing • Develop specialist clinical practice and advance their clinical decision making skills • Engage in and maintain effective therapeutic relationships • Implement professional, educational and leadership skills to provide support for other clinicians and contribute to patient care
• Critically analyse current literature and nursing practice to provide evidence based contemporary care • Develop confidence and competency in undertaking the professional, ethical and social responsibilities commensurate to the stomal nursing.
Further information, including the units offered and key dates can be found on our website.
Ask our ENL’s Find out more about our 2017 cohort of Emerging Nurse Leaders STAGE 1 ENL
We asked our 2017 Emerging Nurse Leaders (ENL) to tell us what lead them to join our profession…
PRISCILLA BRYAN Having raised two kids and given them the career lecture about doing something that you enjoy, and not something you are good at – I decided to heed my own career advice. After 20+ successful years in corporate roles, I had this very strong urge to give back. I knew I wanted to work in my community and wanted to be a part of something that matters. The motto that drives me is there is nothing I can’t learn, or learn from. Nursing has provided me the platform to do something in my community, appease my appetite for learning and inspires me to do more than I knew that I was capable of.
STAGE 1 ENL
WHAT INSPIRED YOU TO BECOME A NURSE?
You could be one of our next Emerging Nurse Leaders! Applications for the 2018 intake are open until 31 August. Apply online at: www.acn.edu.au/enl
STAGE 2 ENL
SUZANNE LEE VOLEJNIKOVAWENGER Then and now, wanting to care, help, heal and share people’s journeys.
STAGE 3 ENL
I was working as a nutritionist and wanted the opportunity to work with a broader range of patients. I was drawn to nursing as there are so many ways to specialise and so many types of workplaces. Also, I would like to undertake research, and there is great scope for nursing research, as it is a relatively new discipline.
I never knew growing up what I wanted to be when I “grow up”. When I finished Year 12, I was a little lost with what to put down for my preferences. I knew once I started my degree that nursing was for me. I decided on nursing because I have had a handful of hospital admissions. I remember different nurses that looked after me. I wanted to make the difference in someone’s hospital stay, like those nurses did for me. No one wants to be sick or in hospital – if you can make someone’s day just that little bit better then you have done your job.
Got a question about scope of practice? Using the Decision-making framework The Nursing and Midwifery Board of Australia (NMBA) provides resources for nurses and midwives to practise safely. One of these resources is the National decision making framework, which can help you to make decisions in practice.
The national framework could help you make decisions around:
Firstly, the national framework provides a set of principles that are the foundation for the development and evaluation of decisionmaking tools.
• delegating activities to other health care workers.
Secondly, the national framework provides two templates for decision-making tools – one for nursing and one for midwifery.
• determining if a nursing or midwifery activity is in your scope of practice • expanding your scope of practice to include a new activity, and
You can find the Decision-making framework in the Professional Codes and Guidelines section of www.nursingmidwiferyboard.gov. au. In this section of the website you’ll also find helpful factsheets, guidelines and policies for practising as a nurse in Australia.
Have your say on the Midwife standards for practice Consultation on the draft Midwife standards for practice is now open and the NMBA encourages all midwives to have their say on the draft standards. The Midwife standards for practice will replace the National competency standards for the midwife (2006) in providing a framework for assessing a midwife’s competence to practise in Australia. Deakin University has developed the draft Midwife standards for practice on behalf of the NMBA to reflect current evidence-based midwifery practice. The consultation is available on the current consultations section of the NMBA website – have your say today.
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