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NurseClick REFLECTIONS OF A PERIOPERATIVE NURSE BUILDING A RESILIENT NURSING WORKFORCE BREAST CANCER IN WOMEN

Australian Army Nurses

MARCH 2017


IN THIS EDITION

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WELCOME

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SNAPSHOT @ACN

In the news – national

In the news – world

Australian College of Nursing update

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IN FOCUS @ACN

IN FOCUS @ACN

EDUCATION @ACN

IN FOCUS @ACN

Honouring our brave colleagues

Australian Army Nurses

Reflections of a perioperative nurse

Vital Signs

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IN FOCUS @ACN

REPRESENTATION @ACN

IN FOCUS @ACN

NMBA UPDATE

Making a difference

Representation profiles

Breast cancer in women

Adjunct Professor Kylie Ward FACN, ACN CEO

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Last chance to have your say on the code of conduct


WELCOME

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Welcome! Adjunct Professor Kylie Ward FACN, CEO of ACN

Welcome to the March edition of NurseClick. Nurses have a proud, selfless and heroic history of military service, both in times of conflict and peace. In this edition of NurseClick, we feature a number of insightful articles that pay tribute to the many nurses, in our past and present, who have served in honour of our profession. Last month marked the 75th anniversary of the sinking of the SS Vyner Brooke and the Bangka Island massacre. In our highly informative piece, Honouring our brave colleagues, we commemorate the courage, service and sacrifice of the Australian Army nurses who lost their lives as a result of these tragic events. During the Bangka Day Memorial Service at the Australian War Memorial, The Hon Dr Brendan Nelson AO, honoured the incredible bravery of these nurses through a moving commemorative address. In an extract from this address, Dr Nelson pays tribute to all of our military colleagues who have provided care during war, armed conflict and peacekeeping operations. At the Australian College of Nursing (ACN), we are dedicated to building a resilient nursing workforce to tackle the changing landscape of the Australian health care system. In her regular column, Vital Signs, our wonderful Nurse Educator Trish Lowe MACN, encourages nurses to build resilience in order to maintain productive workplaces and extend their professional careers.

Organisational culture can have a serious impact on professional resilience within the nursing workforce. Reflecting upon her own journey as an early career perioperative nurse, our fabulous Higher Education Manager Emma Woodhouse MACN outlines how positive learning experiences can come out of challenging work environments in her insightful piece, Reflections of a perioperative nurse. ACT Chief Nurse Veronica Croome is an inspirational nurse leader who has overseen the implementation of a number of initiatives aimed at improving workplace culture within the nursing profession at both a state and federal level. In our ongoing CNMO feature series this month, we congratulate Ronnie on her many achievements and celebrate her distinguished career. Sonya Nicholl MACN, Melinda Hassall MACN and Alison Belcastro-Tortell MACN are highly accomplished nurse leaders who are also working to make a difference in our communities. Reflecting upon their experiences representing ACN at an international immunisation workshop late last year, these three exceptional nurses identify innovative actions to improve adult immunisation rates across the country in their article, Advancing immunisation practices to improve public health. I hope you enjoy this inspiring read.

Publishing details Publisher Australian College of Nursing Editor Sally Coen Design Nina Vesala Emma Butz Enquiries t 02 6283 3400 e publications@acn.edu.au Advertising t 02 6283 3417 e samuel.eaton@acn.edu.au

© 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 are representative only and do not depict the actual subjects and events described in the articles. Cover image: Australian War Memorial ACN publishes The Hive, NurseClick and the ACN Weekly eNewsletter.

STUDYING WITH ACN IS YOUR KEY TO SUCCESS With 14 Graduate Certificates and over 70 single units to choose from, what will you study? READ MORE

Advancing nurse leadership www.acn.edu.au


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In the news national

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Amphetamines may speed the aging process, study finds

New study shows more time walking means less time in hospital

A bit of mussel could help kids with ADHD

Newly identified genes may help diagnose autism and disability

Older Australians can reduce their time spent in hospital by walking an extra 4300 steps or three kilometres per day, according to research published in the Medical Journal of Australia.

A unique group of fatty acids extracted from the New Zealand green-lipped mussel can help with ADHD, hyperactivity and learning problems, researchers from Swinburne University say.

A University of Newcastle study found for every 1000 extra daily steps taken, the number of days required in hospital per year dropped by 9%.

Children treated with capsules of the mussel extract over 14 weeks were better behaved at home and had reduced hyperactivity compared to a placebo group, the study found.

A new study has identified 38 new genes that are strongly associated with autism and intellectual disability. Some of the genes appear to be primarily associated with autism, and others primarily associated with intellectual disability. The study also found evidence reinforcing the importance of 53 previously identified genes in autism and intellectual disability.

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An Australian study has now linked amphetamine use to premature ageing after finding illegal drugs like 'ice' and 'speed' dramatically age the cardiovascular system. The University of Western Australia study, found chronic amphetamine use resulted in the hardening of the arteries. Read more

Two new drug therapies might cure every form of tuberculosis Tuberculosis, the world’s leading infectious killer, may have finally met its match. Two new drug therapies may be able to cure all forms of tuberculosis – even the ones most difficult to treat. Read more

X-ray images just as useful when viewed on smartphone, study finds Smartphone photos taken of X-ray images can help medical professionals diagnose common lung problems in babies just as effectively as the standard films do, new research has shown. A study at the Royal Women’s Hospital in Melbourne examined how standard X-ray films of babies suffering a suspected collapsed lung compared to photos of those X-rays taken on mobile phones. Read more

Review of accreditation systems within the NRAS The Council of Australian Governments (COAG) Health Council is conducting an independent review of accreditation systems within the National Registration and Accreditation Scheme (NRAS). A discussion paper has been released inviting submissions for the review. Consultation forums are also being held in each state and territory throughout March. Read more

WA success in the superbug war Perth researchers have uncovered a potential way to combat antibiotic-resistant superbugs that cause 700,000 deaths a year globally. They have discovered a protein which causes multi-drug resistance by masking bacteria against the body’s immune system and key types of antibiotics. Read more

Breakthrough in pancreatic cancer research An Australian-led team of researchers has made a breakthrough in the understanding of a rare and unpredictable form of pancreatic cancer. Using whole genome sequency, researchers found as many as one in five patients with pancreatic neuroendocrine tumours had a clear genetic predisposition for their cancers, even though they had no family history of the disease. Read more


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In the news world Being a tattoo artist is a pain in the neck, study finds

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Getting a tattoo may hurt but giving one is no picnic either. That's the finding of the first study ever to directly measure the physical stresses that lead to aches and pains in tattoo artists.

Depression symptoms among men when their partners are pregnant

Soccer headers linked to brain damage

Using an air conditioner in summer may affect sleep quality

Men who are stressed or in poor health have elevated depression symptoms when their partners are pregnant and nine months after the birth of their child, according to the results of a study of expectant and new fathers in New Zealand.

Repeated headers during a soccer player's professional career may be linked to long-term brain damage, according to tentative evidence from UK scientists.

Using an air conditioner helps people sleep better on sweltering nights. However, a team of international researchers have found that when airflow is directed at a human body, even at an insensible velocity, it affects the depth of sleep.

The study examined antenatal depression symptoms and postnatal depression symptoms in 3,523 men who completed interviews while their partner was in the third trimester of pregnancy and nine months after the birth of their child. Read more

Autism detectable in brain long before symptoms appear Brain scans can detect autism long before any symptoms start to emerge, a new international study has found. These findings could lead to an early test and even therapies that work while the brain is more malleable. Read more

The research follows anecdotal reports that players who head balls may be more prone to developing dementia later in life.

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After joint replacement surgery, smokers are at an increased risk of reoperation for infection For patients undergoing total hip or knee replacement, smoking is associated with an increased risk of infectious (septic) complications requiring repeat surgery, according to a study published in the February issue of The Journal of Bone & Joint Surgery.  Read more

Researchers develop potential treatment for fatal kidney disease Researchers have developed a potential drug to treat polycystic kidney disease – an incurable genetic disease that often leads to end-stage kidney failure. Polycystic kidney disease causes numerous fluid-filled cysts to form in the kidney, leading to kidney failure by age 60 for approximately half of sufferers. Read more

Researchers at The Ohio State University measured the muscle exertions of tattoo artists while they were working to draw this conclusion. Read more

What doesn't kill you makes you stronger New research could help explain why brief bodily stresses – going to the sauna or for a run, for example – are good for health and longevity. An international study shows that the same cellular process, called autophagy, that's key for extending lifespan, is also critical to the benefits of temporary stress. Read more

Brighter kids with older mums Children born to older mothers now perform better in cognitive tests than those with younger mums, say researchers from the London School of Economics and Political Science and the Max Planck Institute for Demographic Research. The opposite was true 40 years ago. Read more


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ACN launches new Next Generation COI At ACN, we are committed to fostering our future nurse leaders as they transition from their educational institutions into the workplace. Keeping in line with this commitment, we are excited to announce the introduction of a new Next Generation Community of Interest (COI) to our suite of special interest groups. This new COI will be aimed at supporting undergraduate nursing students and postregistration EN’s and RN’s looking to become future leaders in the nursing industry. This community plans to develop resources and create opportunities to support the next generation of nurse leaders in negotiating their first years in the wonderful profession of nursing. Whether you are a next generation nurse or an experienced nurse interested in supporting these aspiring leaders, we encourage you to join the Next Generation COI today. You can join this new COI by logging in to MyACN or contacting membership@acn.edu.au.

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Australian College of Nursing update

New nursing students must be supported to stay on

Nurses can help close the gap

ACN welcomes all the nursing students who are beginning their tertiary studies around the country and calls for more initiatives to facilitate quality clinical placements for nursing students.

While the recently released Closing the Gap report shows some positive signs, particularly in terms of reduced rates of smoking and infant mortality, ACN continues to be concerned about the significant disadvantage Aboriginal and Torres Strait Islander peoples face in regard to health outcomes.

“Nursing is the largest single health profession in Australia and nurses are integral to all patient care – from dental and cosmetic, to school health, to acute and primary health through to aged care and everything in between,” ACN CEO Adjunct Professor Kylie Ward FACN said. “There are approximately 308,000 nurses and midwives currently employed in Australia but Australian Government research tells us we need to significantly lift our game in terms of supporting graduates to pursue a nursing career.” According to the Australia’s Future Health Workforce – Nurses report, demand for nurses will significantly exceed supply – with a potential shortfall of more than 100,000 nurses by 2030 under current settings.

“This report tells us it is vital to improve retention of nursing students within education, lift employment rates following graduation and increase early career retention,” Adjunct Professor Ward explained. “Access to quality clinical placements continues to be a challenge for education providers across the country. Positive experiential learning is key in supporting nurses to successfully transition from study to practice and novice to expert. “In 2017, the Australian College of Nursing is, for the first time, offering every nursing undergraduate student the opportunity to join ACN as a start-up member. “We want students to be aware of the support and assistance ACN provides to help move from student to career nurse.” Read the full media release on our website.

“Since its inception, the Closing the Gap campaign has helped improve a number of key indicators for Indigenous health, but more needs to be done,” ACN CEO Adjunct Professor Kylie Ward FACN said. “If we are serious about Closing the Gap, we need concerted effort across governments and respectful engagement with Aboriginal and Torres Strait Islander peoples to understand what they need and what will work in terms of health service delivery.” ACN proudly administers the Puggy Hunter Memorial Scholarships Scheme on behalf of the Commonwealth Department of Health. More than 1540 scholarships have been awarded since 2002 in areas such as Aboriginal and Torres Strait Islander health, Allied Health, Dentistry, Medicine and Nursing and Midwifery. The College also delivers a range of rural and remote health scholarships.


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Honouring our brave colleagues “Nurses have a proud, selfless and heroic history of military service, both in times of conflict and peace.”

Last month ACN had the privilege of honouring the bravery and contributions made by members of the AANS on the 75th anniversary of the sinking of the SS Vyner Brooke and the Bangka Island massacre. On Friday 14 February, ACN CEO Adjunct Professor Kylie Ward FACN and ACN Policy Manager Carolyn Stapleton FACN laid a wreath on behalf of our organisation to honour Sister Anne Merle Trennery and her 11 AANS colleagues who lost their lives in the sinking of the SS Vyner Brooke during the Last Post Ceremony at the Australian War Memorial.

On Thursday 16 February, ACN Membership Manager Colleen Kinnane MACN laid a wreath at the War Memorial in memory of Sister Lorna Florence Fairweather, who was executed, alongside 20 of her AANS colleagues, in the Bangka Island massacre 75 years ago. ACN would like to take this opportunity to acknowledge all nurses, in our past and present, who have served in honour of our profession. “Nurses have always gone wherever people need help and this proud tradition continues today,” said Adjunct Professor Ward. Thank you to all of the military nurses who have provided care during war, armed conflict and peacekeeping operations. Lest we forget your bravery, service and sacrifice. Visit our website to read our media release about these events.

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Nurses have a proud, selfless and heroic history of military service, both in times of conflict and peace. In 1902 the Australian Army Nursing Service (AANS) was formed when civilian nurses volunteered for wartime military service. Following the AANS formation, thousands of nurses served our country overseas and at home during both World War I and World War II.


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Australian Army Nurses Last month marked the 75th anniversary of the sinking of the SS Vyner Brooke and the Bangka Island massacre. The following passage is an extract from the commemorative address delivered by The Honourable Dr Brendan Nelson AO, Director of the Australian War Memorial, at the Bangka Day 75th Memorial Service on Sunday 12 February.

By Dr Brendan Nelson AO

Australians all let us rejoice, for we are young and free. The first line of our national anthem. We sing it often. We will sing it now. Less often do we pause to reflect upon what it means. The great paradox of life is that it is often that which is most important to us that we are tempted to take for granted – the magic vitality of youth; families who love and support us, giving meaning and context to our lives. So too, Australian citizenship whether conferred by birth or by choice. A nation that gives us political, economic and religious freedoms; where faith coexists with reason, free academic inquiry, an independent judiciary and a free press. A nation reveals itself in certain subtle but powerful ways.

World War, nor was it about Australia’s place in the world. Our vital interests were at stake and one million Australians, including 70,000 women, would mobilise in defence of all that we hold dear. As the Japanese bombed the US Naval base at Pearl Harbour on 7 December 1941, they landed on the Malay Peninsula. The sweeping advance of militarist, Imperial Japan on Singapore was swift, crushing the courageous but inadequate British and allied defence of the Island. On surrender, twenty two thousand Australian troops went into captivity. Eight thousand would not survive their brutal incarceration. Although they protested leaving their patients, 65 Australian Army Nurses embarked on SS Vyner Brooke on the 12 February 1942. Two days later, the desperately overloaded ship was attacked and bombed by Japanese planes, sinking within half an hour of Sumatra.

… We are free, with a greater belief in ourselves and what it means to be an Australian, in no small way as a consequence of the events that bring us here. The massacre of 22 young Australian Army nurses on Radji Beach, Banka Island 75 years ago, survived by only one of them.

Twelve nurses were killed or drowned in the water. Desperately clinging to debris and determined to support one another, especially the injured, 22 would spend from eight to 65 hours in the water before stepping onto the sand of Radji beach, Banka Island. Some were badly injured. All wore their uniforms and Red Cross armbands.

The most important year in Australia’s history was 1788. The next was 1942. The Second World War was no mere extension of the First

The Japanese found them on 16 February 1942. The only survivor of what would follow

Lest we forget was Vivian Bulwinkel who described what happened after the war: …About 10 o’clock on the 16 February 1942 the ship’s officer returned with a party of about 20 Japanese (soldiers). They lined us up – the men, of whom there were about 50, on one side and the 22 nurses and one civilian woman on the other. They then took the men away down the beach behind a bluff…they came back and cleaned their rifles in front of us, and then signed us to march into the sea.  They then started machine-gunning from behind. The bullet that hit me struck at the waistline and just went straight through. The waves washed me back into the sand…all was quiet…the Japanese had disappeared… Prior to their execution, tending the wounded on the beach, the nurses contemplated escape. Matron Irene Drummond spoke softly. She reminded everyone that they could not abandon their remaining patients saying, “Where there is life there is hope.”


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There was no shouting, hysteria or panic. Sister Florence Casson had been severely wounded in the bombing, her leg broken. Unable to walk, she was helped into the sea by her friends. Aware of what was about to happen to them as they walked to the water’s edge, Drummond said to her sisters, “Chins up, girls. I’m proud of you…I love you all.” Three died on the beach before reaching the water, clumped together in death as they had been in life. Irene Drummond was hit with machine gun fire close to the water’s edge, killed instantly by the second bullet. Vivian Bulwinkel heard some pray. Others up to their knees in the bloodstained water called the names of those they loved. But most fell silently until Vivian was hit by the bullet that would bring darkness but not death. The Japanese soldiers then bayoneted all the wounded civilians on the beach and in a fisherman’s hut… Of the 65 nurses thrown into the sea in the sinking of SS Vyner Brooke, 34 suffered brutality, starvation and malnutrition in the women’s camp. Vivian Bulwinkel and her closest friends kept her story secret.

Pat Gunther wrote to her family: Dear Family, Please don’t worry about me. I enlisted of my own free will, knowing I could be going into a war zone. We nurses have been interned with a lot of other women. We have always managed to stay together. I have not been raped, bashed or tortured. If I die, it will be due to malnutrition or malaria. I am still me. All my love Pat Such was their suffering, Pat Gunther also wrote:

Two sisters from the Australian Army Nursing Service

We reached the stage where we envied those who had been lost at sea, and even the nurses who had been massacred. They had not known the misery and wretchedness of life in a Japanese internment camp. It was all over so quickly for them. Pearl Mittelheuser (Mitz) passed away on the 18 August 1942, her best friend Sylvia Muir curled in the foetal positon next to her, unable to cry because of dehydration. Mitz had simply whispered in dying that all she wanted was to once more hear her family call her by name. Pat Gunther had hoped to die in her sleep. She survived. Of the eight nurses who did not, all died in 1945. When Annie Sage, the Matron-in-Chief of the Australian Army Nursing Service at last located the 24 surviving nurses in September 1945 she asked, “But where are the rest?”

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When the Japanese set up the machine guns facing the water, their fate was clear. No order was given – the nurses just started shuffling forward into the sea.

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Matron Olive Dorothy Paschke, Australian Army Nursing Service, disappeared on a raft following the sinking of the SS Vyner Brooke Staff Nurse Vivian Bullwinkel, Australian Army Nursing Service


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Aware of what was about to happen to them as they walked to the water’s edge, Drummond said to her sisters, “Chins up, girls. I’m proud of you…I love you all.”

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Each of them, like each of us had only one life - only one chance to use life in a way that would serve others and our nation. They chose us. From the safe distance of this century, it is tempting – human beings that we are - to settle for the broad brushstrokes of history, headlines, popular imagery and mythology. Our comfortable lives breed easy indifference to individual sacrifices made in our name, devotion to duty and to Australia. This generation of Australians now leaving us, whose sacrifices bring us here, is the greatest generation this nation has produced. Born in the aftermath of the war that was, growing up through the Great Depression and coming to adulthood under the shadows of the war that was coming, they mobilised to defend our nation, its values and vital interests.  They would then undertake the economic and social reconstruction of post war Australia, laying the foundations for the prosperity enjoyed by subsequent generations. Their Australia is one to which we should recommit ourselves – an Australia that enshrines principle above position and values before value; one in which our responsibilities to one another, our nation and its future, transcend and define our rights. We will be at our best in facing different, threatening horizons, if we triumph as these nurses did – over fear. Fear not only of an enemy in war, but in peace – prejudicial fear of the unfamiliar and the unknown.

Sisters of the Australian Army Nursing Service, 2/4 Casualty Clearing Station, 8th Division

On Radji Beach, Irene Drummond urged her friends to hope. Her last act in facing death was to offer them love. The most fragile yet powerful of human emotions is – hope.

We have to believe in a better future - for ourselves, our families and our nation. Hope is inspired and sustained most by reaching out in support of one another, irrespective of the cost to ourselves. Now, we honour women who did so in the face of unimaginable adversity. From this tragedy we are inspired to hope, love and friendship. Hope for – and belief in, our common future. Love for friends and between friends. Love of family and love of Australia. We honour these women whose lives were committed not to themselves but to us, and in their last moments, to one another. We honour all those women who serve and have served this nation not only in its defence forces but in every field of endeavour. More than anything else, it is women who bring to leadership a heightened sensitivity to the needs of future generations. We honour them best by the way we live our lives and shape our nation. Let us inspire the next generation to embrace the world as confident, compassionate people, imbued with this legacy. It is one of courage, endurance and understanding that in facing new emerging and threatening horizons, what we will need most is – one another. For we are young and we are free. Lest we forget.

EDITOR'S NOTE The Honourable Dr Brendan Nelson’s AO commemorative address was retrieved from the Australian War Memorial website. To read the full address, please click here.


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Reflections of a perioperative nurse By Emma Woodhouse MACN, ACN Manager of Higher Education

My first experience of the perioperative environment was as an 18 year old student nurse on a paediatric ward. I was assigned to follow a six week old boy, who needed a ramstedt’s Emma Woodhouse pyloromyotomy. The MACN, ACN Manager things that I vividly of Higher Education recall was the horror of having to squeeze into a very short theatre dress, before the days of scrubs, the overwhelming heat in the theatre and most importantly, the way in which the team worked together almost silently to ensure that this little vulnerable infant had the best possible care.

My love of perioperative nursing was born that day and I was so excited about my next eight-week placement in theatre, whilst still a little worried about the short dresses! I was not disappointed either, as my experience was thoroughly enhanced by my mentor who went out of her way to ensure that I was included in every aspect of surgery. I soon learned what a unique privilege it was to be involved in the surgical team especially in the role of the instrument nurse; it gave me such job satisfaction as a student, I never wanted to leave. When I qualified some two years later, I knew that the only place I wanted to work was in theatre. My lecturers and colleagues all tried to talk me out of it saying that I would never go anywhere and that I needed to consolidate my knowledge on a ward but I was adamant to prove them all wrong, it was theatre or nowhere.

During the surgery the team took the time to explain each step from intubation to the suturing of the wound. The baby recovered in the theatre to keep him warm and the team stayed around to support the recovery nurse. As often happens, the little man experienced some respiratory distress mostly associated with the pain of the incision and again the team worked collaboratively to assist a safe recovery and deliver him into the arms of his anxious parents.

My first job was in a different hospital to where I trained and had a completely different culture, and I began to think that my colleagues were right. I lost all of my confidence, as the surgeons I worked with treated me with very little respect and the aspects of teamwork that I had come to love as a student, were missing. Don’t get me wrong, I worked with some amazing nurses but the overall feeling was very negative, there was shouting in the corridors and a distinct feeling of oppression.


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"Knowing your team, working in an environment of respect and trust, listening, anticipating their needs and having a shared belief in what you do, are the keys to success.� This is where I began to build my professional resilience and realised that in order to change this culture, we needed to collaborate and respect each other. I drew on the things that my mentor taught me as a student and how I wanted this workplace to be. I think the most important thing she taught me was to trust my instinct, have no fear and to be observant of everything and everyone around you. We know this now as situational awareness, one of the aspects of human factors that have been researched all over the world. I learned other human factors (leadership, anticipation and communication) the hard way when I met one surgeon, who I will call Mr S, who would completely change my professional life. He was challenging, he set very high expectations and demanded nothing but the best from the team for his patients. Mr S joined us when laparoscopic surgery was in its earlier stages of evolution, when the surgeons were learning their skills in depth perception and dexterity. Many procedures had to be converted to open in urgent and non-urgent situations, meaning that the team had to be ready for every outcome. For every procedure there had to be a contingency plan, checklists had to be signed and anything that was not available had to be announced before the patient was in the department. I see Mr S as a pioneer of the World Health Organization Surgical Safety Checklist of which I am a staunch advocate.

He was also very ambitious and wanted our hospital to be a centre of excellence. Cameras were installed to be able to live stream our procedures to medical students and visiting surgeons and it was an absolute thrill to be a part of the team that first demonstrated a live laparoscopic splenectomy. The team had to be primed and had to work collaboratively to ensure that we portrayed ourselves as a professional unit as well as ensuring that we worked in the best interest of the patient. At the time it was extremely stressful and challenging. However, as I reflect on this experience some 20 years later as a nurse educator and manager of higher education, I am extremely grateful for all of the skills, knowledge and confidence working with Mr S, and many more like him, gave me. The confidence allowed me to move from workplace to workplace and indeed, country to country. It meant I was able to transfer my skills and expertise in the human factors of perioperative nursing to education and management. Knowing your team, working in an environment of respect and trust, listening, anticipating their needs and having a shared belief in what you do, are the keys to success. All of this, I learned from very humble beginnings as an 18 year old in a very short dress in an operating room.


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Vital Signs

Building a resilient nursing workforce Nurses and midwives are required to contend with staff shortages, sub-optimal skill mixes, high patient acuity and ethical dilemmas, on a daily basis. Simultaneously, workforce supply is failing to match attrition rates. The burden of ageing and disease is placing greater demands upon Trish Lowe MACN the health workforce, requiring managers to constantly recruit, orientate and integrate new staff. Enduring these conditions, requires a resilient workforce. Resilience refers to ‘the ability of an individual to effectively cope with, and adapt positively to, adverse situations’ (Hunter and Warren, 2013, cited Brennan, 2017, p. 43). Developing an awareness of the contributing factors and strategies required to build resilience in the health workforce has been found useful in recruiting or retaining staff and overcoming workplace stressors (Hart, Brennan & de Chesnay, 2014). As a result of undertaking an integrative review on the topic, Hay, Brannan and de Chesnay (2014) concluded that ‘challenging workplaces, psychological emptiness, diminishing inner balance and a sense of dissonance’ impact on the extent to which individuals respond to stressors and that ‘cognitive reframing, toughening up, grounding

connections, achieving work life balance and reconciliation’ are effective means by which resilience can be developed (Hay, Brannan & de Chesnay, 2014, p. 724). Cognitive reframing is the process by which nurses reimagine their work environments, allowing a more flexible, adaptable and effective workspace to be conceptualised and a sense of empowerment developed (Hodges et al, 2008; Glass, 2009, cited Hay, Brannan & de Chesnay, 2014, p. 727). Simple measures such as forging meaningful relationships, exhibiting a positive attitude and optimising work-life balance are effective in allowing nurses to refocus their belief systems and maintain perspective (Ablett & Jones, 2007; Glass, 2009, cited Hay, Brannan and de Chesnay, 2014, p. 727). Additionally, Kornhaber and Wilson (2011, cited Hay, Brannan and de Chesnay, 2014, p. 727) found that emotional toughness and detachment acquired through clinical experience had the capacity to guard nurses emotionally, allowing them to provide care during challenging and stressful patient encounters. However, in analysing resilience within a cohort of perioperative nurses, Gillespie et al. (2009, cited Hay, Brannan and de Chesnay, 2014, p. 726) concluded that age, professional experience, and education did not predict resilience; rather it was the personal attributes of hope, self-efficacy, coping, control and competence that explained 60% of the variance. Of these, the strongest explanatory attribute was hope, which when present, allowed nurses to combat organisational challenges and maintain resilience (Gillespie et al, 2009, cited Hay, Brannan and de Chesnay, 2014, p. 726).

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By Trish Lowe MACN


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Vital Signs “Simple measures such as forging meaningful relationships, exhibiting a positive attitude and optimising work-life balance are effective in allowing nurses to refocus their belief systems and maintain perspective” Organisational culture impacts on employee wellbeing. Team-building initiatives, mentoring, peer review, clinical supervision and emotional intelligence training are organisational solutions that have been well appraised in the literature and compliment an individual’s personal attributes and pursuit of resilience in the workplace (Brennan, 2017; Hay, Brannan and de Chesnay, 2014, p. 729). So it seems that a range of preexisting attributes, combined with supportive workplace conditions, provide the optimal setting for resilience building.

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Additionally, nurses and midwives value the ability of critical reflection to transform a situation in which there is obscurity or doubt, into one that is clear and coherent (Dewey 1933, cited McCormack & Crisp 2013, p. 57). As critical reflection is inextricably linked with problem solving, reframing, reconciling and adapting nursing theory to the realities of the

practice environment, it should be strongly encouraged, as both a professional responsibility and another method of building resilience. There is no doubt that challenging workplaces contribute to dissatisfaction, inefficiency and workforce attrition and that organisational strategies such as mentoring, peer review and clinical supervision compliment the personal attributes of staff members in effectively countering this tension. Therefore, nurses and midwives must be encouraged to pursue all means available to build resilience in order to maintain productive workplaces and extend their careers.

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References: Brennan, EJ 2017, ‘Towards resilience and wellbeing in nurses’, British Journal of Nursing, vol. 26, no. 1, pp. 43-47 Hart, PL, Brannan, JD & de Chesnay, M 2014, ‘Resilience in nurse: an integrative review’, Journal of Nursing Management, vol. 22, pp. 720-734. McCormack, B & Crisp, J 2013, ‘Critical inquiry in practice development, in J Crisp et al. (ed) Potter and Perry’s Fundamentals of nursing, 4th edn., Elsevier: Chatswood

Advancing nurse leadership www.acn.edu.au


IN FOCUS @ACN

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Making a difference Get to know ACT Chief Nurse Veronica Croome, who is leading change across our profession. In every state and territory across the country, our Chief Nurse and Midwifery Officers (CNMO’s) provide a vital professional link between the Department of Health, and the Australian nursing and midwifery community. Our CNMO’s play a key role in developing a collaborative and strategic approach to nursing and midwifery at a state and national level. They provide leadership, advice, information and guidance on all issues related to nursing and midwifery. ACN is publishing a series of articles about our CNMO’s throughout the next few editions of NurseClick. This edition, we are profiling, Veronica Croome, ACT Chief Nurse, whose experience and expertise as a nurse leader has seen her achieve remarkable outcomes while in this role.

ACN CEO Adjunct Professor Kylie Ward FACN, ACT Assistant Minister for Health Meegan Fitzharris MLA and ACT Chief Nurse Veronica Croome at our Canberra VIP Cocktail Function last June.

Veronica Croome, ACT Chief Nurse Veronica (Ronnie) Croome was appointed Chief Nurse for ACT Health in January 2009. Ronnie has provided strong strategic leadership for both the nursing and midwifery professions across the ACT while in this role. 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.

Since commencing in the role, Ronnie has overseen the development of a career path for Enrolled Nurses, expansion of the Advanced Practice Nurse role, the employment of Eligible Midwives, the introduction of Assistants in Nursing and the creation of a Clinical Nurse Coordinator role as part of a Ward Leadership program. Ronnie has overseen a number of Enterprise Agreements for Nurses and Midwives in the ACT which have resulted in improved employment conditions, introduced a workload methodology for inpatient units, led the work on a publicly funded homebirth trial and held the important role of Executive Sponsor for the Respect, Equity and Diversity Framework, a government initiative aimed at improving workplace culture.

During her time with ACT Health, Ronnie has been nominated for several awards including finalist in the Telstra Business Women’s Awards (2012) and an ACT Public Service Award for Excellence in 2013. Ronnie was named as an Honoured Friend of CIT in 2014 and delivered the occasional addresses to graduands at the University of Canberra and at the Canberra Institute of Technology. She has served as a Board member on the Wellness Foundation, the Canberra Hospital Foundation and as a council member of the Canberra Institute of Technology. Ronnie is an extremely dedicated nurse leader who will continue to provide a voice for our profession and lead change across the sector. ACN looks forward to continuing to work collaboratively with Ronnie in 2017.


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REPRESENTATION @ACN

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Representation profiles Advancing immunisation practices to improve public health in adults By Sonya Nicholl MACN, Melinda Hassall MACN and Alison Belcastro-Tortell MACN France, United States, Israel and Australia. Sonya Nicholl MACN and Alison Belcastro-Tortell MACN from New South Wales and Melinda Hassall MACN from Queensland were privileged to have been selected to represent ACN and share their immunisation knowledge and expertise in the international arena.

Melinda Hassall MACN, Sonya Nicholl MACN and Alison Belcastro-Tortell MACN

On 15 November 2016, three Australian College of Nursing (ACN) representatives travelled to Paris to represent ACN at an International College of Nursing (ICN) workshop to advance immunisation practices to improve public health in adults. The workshop was a joint Pfizer/ICN initiative and had representation from Russia, Canada, Spain,

The workshop aimed to form a collaborative nurse advocacy group to elevate the role of nurses in adult immunisation, foster policy change, and identify barriers and best practices in nurse-driven adult immunisation. The meeting was also aimed at gaining an understanding of the regional landscape and review opportunities for policy change. Existing tools and resources that promote awareness of adult immunisation and community outreach programs were also under review at this workshop. Pre-workshop reading and worksheets facilitated information sharing and discussions. The workshop commenced with a presentation on the burden of vaccine preventable diseases in


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REPRESENTATION @ACN

adults and the role of adult vaccination in helping to protect adults, followed by a session on barriers to adult vaccination. Interactive moderated discussions ensued on mobilisation for change and nurses as catalysts in improving adult vaccination rates. These were thought-inspiring sessions and initiated fruitful discussions and suggestions.

AGENCY COLLABORATION Suggestions for innovative actions to address low adult immunisation rates and reluctance to be vaccinated, included collaboration with other health agencies. There is evidence that influenza vaccination prevents acute myocardial infarction (Hsu et al, 2016), therefore collaboration with a heart foundation to promote influenza vaccine uptake was seen as a beneficial initiative. As the social and economic consequences of vaccine preventable disease outbreaks can cost billions in health dollar expenditure, it was identified

that immunisation needed to be integrated into the acute care sectors. For example, if an adult receives treatment for an injury, their immunisation needs should also be discussed and met, such as offering a pertussis booster or influenza vaccination. Zoster (shingles) vaccine could also be offered to eligible adults to reduce the socio-economic burden of post-herpetic neuralgia (a debilitating condition associated with the disease) thereby promoting healthy ageing and functional ability in ageing populations. Including immunisation in acute care settings would help promote the primary prevention of vaccine preventable diseases and healthy ageing.

WORKFORCE ADVOCACY An extensive nurse immuniser workforce is needed to improve adult immunisation rates. Nurse immunisers were identified as effective as role models to address adult vaccine refusers’ queries and concerns. Increasingly, an ageing workforce

will be the main port of health care in the future. It was agreed that health care workers should be positive role models by being fully immunised.

Social media promotion through advocacy blogs could also be effective in raising nurse immuniser awareness on current issues.

Adults who are contemplating vaccination may be more likely to be vaccinated if they receive a recommendation from a health care provider. (Mak et al, 2015) It was also agreed that there needs to be a shift in a paediatric-driven immunisation schedule to one that is all inclusive from childhood to the elderly.

A range of non-government organisations and academia that collaborate to help influence and shape policy to improve adult immunisation rates, such as The World Coalition on Adult Vaccines led by the International Federation on Ageing, shares resources and expertise to help raise awareness of adult immunisation around the world. Nurse immunisers should be encouraged to join international networks to increase their knowledge of adult life course immunisation within a public health framework to promote healthy ageing. (International Federation on Ageing, 2017)

Nurse immunisers need to be repositioned to provide ‘life course immunisation’ to enable adults to age with reduced risk to disease and facilitate healthier, more active and more productive ageing. (Thomas-Crusells et al, 2012) The use of promotional posters and brochures in a facility/organisation along with their staff advocating immunisation, was seen as a positive initiative. It was identified that once trained in immunisation, there was limited on the job training afterwards.

BARRIERS Barriers to immunisation were discussed and how they impacted negatively on adult vaccine uptake rates, such as access to a health care provider,


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out of pocket expenses, insufficient knowledge regarding the benefits of vaccination, transient population with multiple health care providers, lack of a universal vaccination register, a strong paediatric immunisation culture, lack of adult autonomy and vaccine immunogenicity in older people, and waning immunity of some vaccines in the more elderly population. As negative health provider attitude towards immunisation can contribute to poor adult vaccine uptake (Barratt and MacIntyre, 2016), clinician leadership and advocacy were identified as key drivers to improve uptake. It was agreed that a nursing standard for adult immunisation should be developed to identify immunisation service delivery gaps, educate staff and facilitate consistent messaging that will progress models to implement adult immunisation strategies. While paediatric immunisation advocates are plentiful, adult immunisation champions are essential to transition from a paediatric immunisation culture to a ‘life course immunisation’ culture.

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INNOVATION IN PRACTICE

CONCLUSION

CONFLICTS OF INTEREST

Immunisation has been described as a ‘low hanging fruit’ for healthy ageing (MacIntyre, 2013). It is evident that new ways of doing business are needed to promote a life course immunisation culture. Adult immunisation programs need new paradigms to engage with all relevant staff (not just nurse immunisers) to improve vaccine uptake.

This workshop raised important considerations for improving adult immunisation rates and reassured the ACN representatives that paediatric and adolescent immunisation programs in Australia are implemented well. However, there needs to be a national shift in focus for a life course immunisation culture to improve adult immunisation rates.

Although the workshop was a Pfizer sponsored event, none of the ACN representatives have any direct business with Pfizer. Ms Nicholl waivered the honorarium fee provided by Pfizer.

For example, tools and resources for nurse managers and medical reception staff, workforce education and training to promote a positive immunisation culture, out of hours clinics to facilitate vaccine access, and robust immunisation policies that will promote consistent and effective program implementation, would support nurse immunisers in their role. Efforts must also be made to expand and educate the nurse immuniser workforce to proactively promote immunisation to not only counteract ‘vaccine preventable diseases’ but to avert ‘vaccine preventable disabilities’ in adults.

It also highlighted the importance of the nursing profession and the leadership nurses provide to immunisation practice and coverage rates within Australia. Australian nurse immunisers are accredited and supported legislatively to practice, whilst nurses working in acute and primary care settings are also actively encouraged to engage families and individuals in discussions about immunisation.

Hsu S Y, Chen F L, Liaw Y P, Huang J Y, Nrof O N, Chao D Y, 2016, 'A Matched Influenza Vaccine Strain Was Effective in Reducing the Risk of Acute Myocardial Infarction in Elderly Persons: A Population-Based Study', Medicine, 95, e2869.

Nurses are further empowered to enact the National Immunisation Strategy through the development of policy and nurse education curriculum and ongoing advocacy on behalf of individuals and families to ensure a safe and effective immunisation program.

REFERENCES Barratt J & Macintyre R 2016, 'Vaccines: Don't forget the elderly', Medical Journal of Australia

International Federation On Ageing 2017, Your Global Point of Contact on Adult Vaccination. World Coalition on Adult Vaccination [Online], Accessed 20 Feburary 2017, <https://www.ifa-fiv.org/project/adult-immunization-advocacy-2/> Macintyre C 2013, 'Elderly vaccination - the glass is half full', Health 5, 80-85 Mak D B, Regan A K, Joyce S, Gibbs R & Effler P V 2015, 'Antenatal care provider's advice is the key determinant of influenza vaccination uptake in pregnant women', Aust N Z J Obstet Gynaecol, 55, 131-7 Thomas-Crusells J, Mcelhaney J E & Aguado M T 2012, 'Report of the ad-hoc consultation on aging and immunization for a future WHO research agenda on lifecourse immunization', Vaccine, 30, 6007-6012.

EDITOR’S NOTE ACN offers an online Immunisation course that is designed for registered nurses working in health areas where administration of immunisation is part of their role. It is also suitable for registered nurses who wish to enhance their career opportunities by becoming a Nurse Immuniser. Visit our website for more information.


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International Women’s Day By Kristen Connell

International Women's Day is celebrated on 8 March every year. This annual campaign aims to raise awareness of the social, economic, cultural and political achievements of women around the world.

ROS TURNLEY MACN Early in her varied career, Ros Turnley MACN spent a number of winters as the sole full-time health professional at Mt Buller, at what was then the Ski Rescue Centre. This position saw Ros not only on call 24 hours a day, seven days a week, but even driving the ambulance when needed. The theme for this year’s International Women’s Day was #BeBoldforChange, and Ros’ willingness to embrace opportunities is a great example of the nursing professions’ passion for growth and change. For many in the community, a nurse is a health professional working in a hospital providing care at their bedside. But the scope of practice and capacity of nurses is so much broader than that – as demonstrated by the path Ros has taken to

be qualified to work in the field of Hypnotherapy, NLP and Counselling. After completing her training at the Alfred Hospital in Melbourne, Ros spent time working as a staff nurse in theatre. Next, was her stint as the on-call nurse at Mt Buller in Victoria. Ros has also worked for a dentist, an oral surgeon, in a private hospital, as an industrial nurse and for 10 years, she was a school nurse. Ros’ training and experience has given her the ability to instinctively notice a change in her patients. She credits much of her ability to the practical skills she gained when starting out and the exceptional mentors she has had over the years. “I am still amazed at how much knowledge nurses have about each individual patient they are looking after and their ability to provide outstanding care to someone who is unwell,” Ros said. Ros’ career trajectory has culminated in her becoming one of Australia’s many successful nurse entrepreneurs, owning and running her own business. “All my professional skills and experience have come together to allow me to help people reach their full potential through personal and professional development,” Ros explained. After her own personal encounter with the

positive effects of Neuro Linguistic Programming (NLP), Ros began years of training to utilise this practice to assist others. Ros explains that NLP is all about empowering patients to be the best person they can be. “NLP is practical and is about your life experience,” Ros said. “lt is the very essence of listening, communicating and healing.” “It consists of models of excellence from experience within language, mathematics, family therapy and the trance work of Ericksonian Hypnosis. It can be applied to all areas of our lives and is especially effective for mind body health as the changes occur at a neurological level of understanding. “The NLP Practitioner utilises these skills for both a conscious and deeper level of understanding. The focus should always be on individual resourcefulness and choice for change.” Ros’ Hypnotherapy and NLP practice has shown her how clinical and complementary medicine both have important roles in patient health. “There are so many areas where nurses can apply their skills, other than in a hospital setting. As consultants, entrepreneurs, managers, educators etc. So many places they can choose to take their career, and it all builds from the clinical base of their study and experience before and after graduation.”

“It is a gift to be able to go into challenging situations where our knowledge, insight and expertise can be powerful in providing comfort and reassurance for body and mind.”


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In 2009, following the Black Saturday fires in Victoria, Ros was involved with a voluntary organisation called Blaze Aid. On her first day of helping repair fences she once again saw the power of being ‘bold’.

ADJUNCT ASSOCIATE PROFESSOR NAOMI DOBROFF MACN

Naomi believes information technology, like the EMR, has potential to improve health outcomes. It can more quickly disseminate the most up to date decision support information to ensure best practice – and therefore influence quality of care.

Ros decided to ask whether her skills might mean there was more she could do to help and this led to creation of a program known as ‘Gift of a Rose’. Ros would take donated roses out to individuals severely affected by the fires, spend time and lend a friendly ear, as people began to assess and move on from their devastating losses. When asked how she would encourage others to enter nursing and pursue a ‘bold’ life and career, Ros turns to favorite statement she has shared with nurses before. “It is a gift to be able to go into challenging situations where our knowledge, insight and expertise can be powerful in providing comfort and reassurance for body and mind.”

Electronic Medical Record (EMR) and how we can transform and support our workforce to work with new technology.”

Current EMR models don’t necessarily match nursing practice and this can create barriers to use and potentially lead to increased workloads. One of the goals of International Women’s Day 2017 was to forge a better working world. The nursing profession is an example of one profession that is successfully taking up this challenge

“Health informatics should support best practice, not change practice purely to match the technology’s requirements or limitations,” Naomi said.

Adjunct Associate Professor Naomi Dobroff MACN has forged a pathway in the relatively new world of health informatics. The Chief Nursing Information Officer at Monash Health, Naomi is helping ensure nurses inform development of technological advances so they support quality patient care and augment, rather than obstruct, best practice.

“The approach of Monash Health is to design an EMR that respects the full scope of practice of the 7,000 nurses and midwives that work for the service and support their workflow.”

This role utilises Naomi’s impressive credentials – which include a Masters in Public Health and an honorary appointment as an Adjunct Associate Professor at Deakin University – and the skills in epidemiology, statistics and sociology she has earned over a long and varied career. “My role is a strategic one aimed at improving the clinical care of patients,” Naomi explained. “I am charged with working with nurses and midwives to explore what our profession needs in an

While the challenge may seem daunting, Naomi believes this is an exciting chance to “forge a better working world”. “Health informatics will change the way the health sector does everything,” she said. “We might see staff tapping in and out of their shift, evidence based care information at their fingertips and the ability to analyse real-time data to improve patient care and outcomes.” Naomi is ACN’s Key Contact for the new Nurse Informatics Community of Interest.

“Health informatics should support best practice, not change practice purely to match the technology’s requirements or limitations.”


IN FOCUS @ACN

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Breast cancer in women Resilience and recovery By Professor Karen-Leigh Edward and Jo-Ann Giandinoto The ACN College Consortium Grant valued at $30,000 is now open for applications. The previous awarding of this grant was in 2014 to Professor Karen-Leigh Edward MACN, Director Nursing Research St Vincent’s Private Hospital Melbourne. The Research Associate was Jo-Ann Giandinoto MACN, also from St Vincent’s Private Hospital. The following is a summary of their research. Breast cancer is the most common cancer in women in the developed and the developing world, comprising of 16% of all female cancers. In 2016, in Australia, breast cancer represented 27% of all new cancers among women (AIHW, 2016). However, the trends in five year survival have increased, where now recovery and survival are part of the treatment plan for these women. Recovery in the context of breast cancer must include psychosocial domains, including physical health, return to function and mental health. And while some of the areas of clinical care in this patient group have been explored, a gap in the evidence base remains since the interplay between these personal and social resources in terms of recovery remains unclear.

In 2013, we undertook a study that aimed to investigate the recovery post-early diagnosis (2 years post-diagnosis) of breast cancer in the psychosocial domains of quality of life, subjective well-being, psychological distress, resilience and depression, and anxiety in a sample of Australian women with a diagnosis of stages I – III breast cancer. We used a quasi-experimental research design employing a longitudinal cohort approach. Between June and October 2013 data was collected (n=50). We found that age was associated with sense of control, including resilience, future perspectives and body image, with older women having a better body image and more positive future perspectives compared to their younger peers. Nursing practice needs to include the identification of resilience factors in women when working with women’s strengths in the trajectory of their recovery. In addition, further research should focus on a comparison of stage I cancer versus stage II or stage III, since stage of cancer may have played a role in the resilience experienced by women in our study. REFERENCE Australian Institute of Health and Welfare (2016). Australian Cancer Incidence and Mortality (ACIM) books: breast cancer. Canberra: AIHW

“Nursing practice needs to include the identification of resilience factors in women when working with women’s strengths in the trajectory of their recovery.”


NMBA UPDATE

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Last chance to have your say on the codes of conduct Consultations on the Code of conduct for nurses and the Code of conduct for midwives (the Codes) is closing soon and the Nursing and Midwifery Board of Australia (NMBA) would like to hear from you.

Now is your chance to review the draft codes and give us your thoughts on their clarity and terminology – and especially whether they capture the conduct required of nurses and midwives in Australia.

The codes of conduct set out the legal requirements, professional behaviour and conduct expectations for all nurses and midwives in all practice settings in Australia. The Codes describe the principles of professional behaviour that guide safe practice, and clearly outline the conduct expected of nurses and midwives by their colleagues and the broader community.

The NMBA looks forward to hearing your feedback on the draft codes and would like to thank those who have already taken our survey.

The draft codes are research-based and their development included literature reviews and an analysis of notification data on conduct, behaviour and boundaries for nurses and midwives.

The consultation closes on 10 March 2017. The new codes of conduct will be finalised and published later this year. To view the draft codes and take the survey please visit our website.

“The codes of conduct set out the legal requirements, professional behaviour and conduct expectations for all nurses and midwives in all practice settings in Australia.”

Nurse and Midwife Support: national health support service launches in March This month will see the launch of Nurse and Midwife Support, the national health support service for nurses, midwives, and nursing and midwifery students. Nurse and Midwife Support will provide confidential advice and referral on health issues for nurses and midwives, as well as offering support and information for employers, educators and concerned others. The service is an NMBA initiative, but is run independently of the NMBA and AHPRA. Phone support will be available 24/7 across Australia, as well as a comprehensive website. The NMBA looks forward to providing nurses and midwives with more information on the service as soon as it becomes available.

Profile for ACN Australian College of Nursing

NurseClick March 2017  

NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles.

NurseClick March 2017  

NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles.