Nurse In Australia

Survey for Overseas Nurses working in Australia

admin — Tue, 15 Nov 2011 15:00:45 +0000

From Tiffany Lynch, School of Nursing at the University of Adelaide:

I am trying to reach as many overseas trained nurses as possible to try and help improve the registration process for them in Australia.

I am currently conducting a survey to gain quantitative data on the experiences of nurses in meeting the English language requirements. I have a Government grant as well as University of Adelaide scholarship for this research and the results of my survey will be used to inform the English language testing policy for Nursing Registration in Australia.

Please click on the link below to help with this survey. Participation is anonymous.

Survey Link: http://health.adelaide.edu.au/nursing/research/survey/

Head of Nursing awarded Order of Australia

Ross — Sun, 19 Jun 2011 12:37:57 +0000

Professor Helen Edwards, the head of QUT’s School of Nursing and Midwifery, has been recognised with a Medal of the Order of Australia this week.

She received the award in recognition of her “service to nursing education and research, and to professional associations.”

Professor Edwards has worked in tertiary education for 28 years, and has led the School of Nursing and Midwifery at QUT since 1997.

Under Professor Edwards’ direction, the school has developed a leading reputation nationally and internationally. It is now known for its extensive range of courses, positive graduate outcomes, industry links, a quality PhD program and excellent research profile.

Professor Edwards’ own research has focussed on clinical and educational interventions related to ageing and chronic disease. In particular, Professor Edwards’ research interests include self-management; wound healing; quality of life and family care giving; and intervention trials.

Based on her research, she has authored 80 refereed articles, seven book chapters, and 15 research reports. She co-edited the medical-surgical textbook that has been adopted by most Australian nursing schools, Medical-Surgical Nursing: Assessment and Management of Clinical Problems.

Professor Edwards has been a director of Queensland Villages, an organisation that manages three retirement villages in Queensland.

She is the director for the Queensland Dementia Training and Study Centre and a member of the Dementia Collaborative Research Centre – Carers and Consumers. She is also a program leader for the Cooperative Research Centre for Wound Management Innovation.

Professor Edwards said she was originally drawn to nursing because she wanted “to do something active to help people when ill and vulnerable – and it seemed an exciting and challenging thing to take on 40 years ago.”

She said she felt humbled by this award.

“I see the award as being the culmination of working within a very supportive environment and with great teams of committed people.”

A Closer Look At Australia’s Private Healthcare Systems

admin — Wed, 23 Mar 2011 14:35:31 +0000

This guest post is brought to you by NIB Health Insurance

It is well known among many health professionals that good health can be the key to happiness and helps to increase the ability to live a longer life. Perhaps one of the most important factors in maintaining or improving people’s health is the services provided in healthcare. One aspect of healthcare that can help ensure this and protect you from the unknown is health insurance.

Here in Australia, the healthcare system focuses not only on the physical and mental health of the people but also their general state of well-being. There are two parts of the healthcare system: public and private.

The public healthcare system is run by our government and is paid by our very own taxes. The public healthcare system covers the basic things such as getting simple medical tests, seeing a doctor or being treated in a public hospital without paying anything. However this can still have a number of limitations.

For instance, you won’t be able to choose which hospital or which doctor to treat you. You won’t be assisted immediately because they have to prioritize those in the waiting list, requiring you to wait. (except for emergency cases).

That is why more people prefer private health insurance. In fact, more than 4.7 million Australians are registered with private health insurance providers. Private insurance covers services such as optical and dental services that fall outside what Medicare covers.

There are many private health insurance providers in the market but let us put the spotlight on one of Australia’s highly-trusted health insurers, NIB Health Insurance. They have been in the industry for more than 50 years and cover over 800,000 costumers all around Australia. They offer various health insurance options such as individual health insurance, couple health insurance and family health insurance.

What’s impressive about them is that they tailor-fit the insurance especially for you, choosing what to include and exclude depending on your needs. This helps to make your health insurance more affordable.

The Federal Government is helping to encourage people to avail and maintain private health insurance earlier in their lives. This is called the Lifetime Health Cover. Under this, every person who joins any private hospital cover aged 31 and below will be paying lower premiums compared to those who are over 31 years old who will be charged 2% annual loading for every delayed year they had before joining a private health insurance. Nib also offers hospital covers that meet all the requirements of Lifetime Health Cover.

Each one of us should find a health insurance plan that is best suited to cover you and your family needs. It is better to be ready than sorry.

(Thanks to the author for this weeks guest post. Please note, views and opinions of any of our guest authors do not necessarily reflect those of this website.)

Photo credit

Reflections on Miscarriage at Triage

admin — Thu, 17 Feb 2011 09:48:19 +0000

A front page news article today describes a situation where a lady presented to an Emergency Department in Melbourne with a “threatened and incomplete miscarriage” at 10 to 12 weeks.

Unfortunately for this lady, she miscarried the foetus into the waiting room toilets while waiting for medical r/v.

The story is extremely damning of the hospital involved, check out the title of the story: “Hospital shame as (patient) miscarries baby in toilet”

This story has brought a whole host of opinions out of the woodwork, and a common theme is absolute and utter disbelief by the public that “this sort of thing can happen in this day and age!”.

And so, some reflections:
Firstly, I’d like to throw in a disclaimer – this article is written by a health care professional for reading by other health care professionals – it is not intended to belittle or minimise the family’s loss.

Having said that, I’d like to suggest that any kind of PV spotting / bleeding at triage is a tricky situation.

Often in fact, it does not rank very highly as a medical emergency. If the bleeding or spotting is minimal, and in particular if the person’s vitals are all stable, they might rank fairly low on the triage scale.
Unfortunately, it ranks extremely highly on people’s emotional-meters, and members of the public often feel that any kind of PV spotting or bleeding in pregnancy should warrant an immediate medical team review, ushering of the patient straight through to acute cubes, and some kind of immediate treatment.
The reality is that in the vast, vast majority of cases, the patient’s life is not at risk. It’s not a life and death situation for the mother. And for the child? As harsh as this sounds, what is going to happen naturally at this point is pretty much unpreventable. The person might miscarriage, they might not. Getting the person in sooner or later is unlikely to change the inevitable.

And so, there’s often this perception that “woah, the hospital let this poor mother sit in a waiting room and miscarry without doing anything about it!”.

Let me ask this: what would you like done about it?

If this story causes absolute disgust amongst the general public, as suggested in some of the reader’s comments, what is it in fact that you would like done differently?

I’ve had this discussion with members of the public before and have been cut down as being heartless and unsympathetic, but let me assure you that I am neither. I am a realist, and the reality is that although the situation is important to the person involved, it is hard enough getting people in to acute beds with really serious stuff, particularly when faced with the ever problematic situation of in-patients taking up acute emergency beds in the public system.

Despite all this, I always try to get any potential miscarriage into some kind of bed, even a corridored one to try and avoid what happened in this story, but this is for humane reasons more than anything else. It can be difficult to do this, particularly on busy shifts, and especially when the mother is 100% stable. It’s impossible to predict which ones will progress to miscarriage, particularly when bleeding is light.

When do we Hurry Things Up?

The situation is always escalated if there’s any element of danger – if the bleeding is really heavy for instance, if the patient is symptomatic in any way (ie light-headed, dizzy etc), or if they are hypotensive. Any patient in this kind of situation ranks higher on the triage scale and generally speaking gets into a bed much quicker.

What’s interesting with the Melbourne story is that the hospital have responded by basically saying “We’re shocked that this has happened”

Staff are being interviewed, protocols are being reviewed, people are putting on grave faces and nodding to each other.

To be frank however, this is not the first time something like this has happened. Just google “miscarriage in waiting room” and you will be amazed at how common this is. And how outraged the public is each time. And how there are promises for investigations, enquiries, interviews.

Grave faces.

The situation is unfortunate, yet it has also been highly sensationalised, playing on the fact that it’s a highly emotive situation.

What can we learn from it all? I agree the waiting room is probably not the best place for pregnant mothers with any form of PV bleeding. The really tricky thing is identifying which ones could do with a bed sooner rather than later, particularly when the department is pumping.

Let me ask you this: is there any good place to have a miscarriage?

I’d love to hear people’s thoughts on this subject, please comment below if you feel like it. And I’ll leave you with some of the comments by members of the public as found at the bottom of this original story. You probably won’t be surprised to find that once again there’s a wide perception by many members of the public that those nasty, incompetent, uneducated nurses are the ones truly responsible for this horrible situation, and are in fact the source of all problems in emergency departments.

Comments by the general public on the original story:

It’s not enough for the unit manager to apologize, each individual that was involved need to apologize personally and to accept personal responsibility. Saying you are just following procedure is the same as a soldier claiming they just followed orders. It’s no excuse. I had a similar experience of being referred by my doctor. He rang ahead and gave me a letter and it took 4 hours to get seen at a so called emergency department.

Australian state and central govt should hang its head in shame ( if there is any left, that is)…….

The triage system is a failure with nurses making decisions that they are not properly qualified to make. Doctors are the only ones who should be working triage. Send two doctors into the waiting rooms to assess patients as they arrive instead of making people wait hours on end. I’m sure you would see minor cases delt with on the spot and those that need an emergency bed be placed straight away. The biggest problem is that once the beds are full the doctors wander around aimlessly because they can’t see anymore patients until a bed becomes available. If you have someone taking up a bed because of a minor issue that could have been delt with in the waiting area by a triage doctor then the hospital is wasting resources that could have gone to someone in greater need of a bed and full medical attention. I feel for this family. Nobody should go through this. To experience the joy of giving life then having that life ripped away from you is horrific to say the least.

What professional neglect? Yeah its sad BUT she was given a triage category in the ED based on the potential severity of the condition and risk. Patients with life threatening conditions eg heart attacks and strokes are seen before potential miscarriage because you can do more to safe the lives of those patients rather than a miscarriage. If she got seen by a doctor sooner just to be told, “yeah your having a miscarriage. Dont flush the toilet so we can send it to pathology” then think about it – your mother might be dead because nobody gave oxygen and did an ECG to find out she was having a life threatening arrhythmia. Its all priorities in the ED. Such is life.

It’s a difficult situation and one that isn’t easy to address. As sad as it is, early miscarriages are usually an entirely natural process. I was fortunate when I presented to Emergency that they were able to find me somewhere private. It turned out my pregnancy was ectopic but I still had to wait 48 hours for ‘emergency’ surgery. I understood there were more urgent cases – shootings, stabbings, twisted bowels, etc. You can’t send these women to maternity because the birth of a live child is more important and they wouldn’t want to be in that environment (new mums with new bubs) anyway. I do feel sorry for this woman but on the flip-side, how would you feel if your child was suffering a severe asthma attack or a head injury and not seen straight away because staff were busy dealing with an early miscarriage?

I can’t even describe how annoying it is to go to the emergency room and have a bitter nurse on the other side of the glass looking you up and down and deciding whether they think you’re unwell or injured enough to be put above someone else. I have got into full on arguements with some nurses… strangely enough I kept getting put further and further down the list to get seen (or those I am with) after these occasions… REAL FULLY QUALIFIED DOCTORS SHOULD BE QUESTIONING AND OVERSEEING THIS, not some nurses who hate their jobs and feel like buffering their weight around when panicked individuals come into the emergency department asking for help or to be seen.

This is tragic, no doubt. The Triage nurse is totally to blame, she is fully trained to be able to recognise this for the urgent situation that it is, she failed dismally. The GP had let them know she was on her way, and still they failed. No use putting politics into this. Do you blame the State Labor government or do you blame the Liberal Federal government that completely underfunded health for so many years?? They’ve all screwed it up.. Triage nurse is to blame here, plain and clear.

Your thoughts?

Photo Credit: Pink Sherbert Photography

Remarkable CPR success after hours of downtime

admin — Thu, 20 Jan 2011 05:46:00 +0000

Have you ever heard the saying “they’re not dead until they’re warm and dead“?

It is widely known that cooling the body in particular circumstances can improve your chances of survival and lessen brain damage.

Also, there have been cases where victims have appeared or even been declared clinically dead due to the reduced cardiac output and decreased arterial pressure that follows severe hypothermia, leading to difficulty in detecting any peripheral pulses or respiratory effort in some cases.

Indeed, hypothermia is also one of the treatable, reversible causes of cardiac arrest, according to ACLS guidelines.

No pulse or heartbeat for three-and-a-half hours

Still, I was rather astounded to hear about a recent case involving a British man who allegedly had an extremely long resuscitation period following a hypothermic event, and believe that it gives reason to question what we know so far about CPR and states of life and death in general.

From the Herald:

“A BRITISH man whose heart stopped for three-and-a-half hours was brought back to life by a machine that performed 20,000 life-saving chest compressions.

Engineer Arun Bhasin, 53, was found lying unconscious in Croydon, south London, in December in temperatures of -10 degrees Celsius after falling in the street and hitting his head.

He was rushed to the hospital, but he suffered a cardiac arrest.

He was taken to the Croydon University Hospital where two of the UK’s top experts in resuscitation – Dr. Nigel Raghunath and Dr. Russell Metcalfe-Smith – are based. They put Bhasin on a pioneering new CPR machine, AutoPulse, which performed almost 20,000 life-saving chest compressions to keep his heart and lungs functioning.

Raghunath said, “He was pretty much dead in that he had no pulse or heartbeat for three-and-a-half hours so it is amazing that we got him back. I’ve not seen anything like it in 15 years in A&E.”

What was really amazing to me about this case, was that CPR was continued (albeit on autopilot) in the department for so long. With a positive outcome! Remarkable.

My question therefore is this – Do we ever call “time” to quickly in some cases?

Nurses Strike over Patient Ratio Negotiations

admin — Wed, 24 Nov 2010 05:22:07 +0000

For the first time in 9 years, today thousands of nurses in NSW have walked off the floor and are striking this week over failed nurse/patient ratio negotiations.

The NSW Nurses Association is calling for a major overhaul of the public hospital and healthcare system by trying to introduce mandated nurse/patient ratios. Negotiations on wages and a campaign of four-to-one patient ratios broke down this week, and nurses voted instead to strike.

Staffing Trends

When I started nursing around ten years ago in a private hospital, I worked on a variety of wards like medical, surgical, oncology and orthopaedics.

RN’s were generally allocated around 6 or 7 patients each, and there was an AIN to help between two areas.

On night duty you would have a whole half of the ward, so I guess this equated to around 12 to 14 patients per RN, with an EN on to help answer buzzers etc.

During day shifts you were really kept busy, and the workloads were fairly stressful. Night shift was worse in the first 2 and last 2 hours of the shift, but fairly pleasant in the wee hours of the night.

I did some public nursing early on also, but they had adopted more of a team approach – 2 RN’s (or 1RN + 1EN) would be assigned to a shared 6 bay ward, with sometimes some private rooms tacked on to your load.

Current Nurse / Patient Ratios

Now that I’ve spent the last 8 years or so in Emergency departments, things are a little different, and I’m a little out of touch with ward allocations and ratios. Emergency departments generally are staffed differently and largely dependent on day to day workloads. You have to keep staffing at full levels because you never know how things could change.

So tell me:

How are your nurse/patient ratios where you work?
Do you fly solo or work in a team nursing model?
Are you happy with your workloads, or should all hospitals have set, maximum patient loads to ensure safe work practices for RN’s?

Patient Dies After Hospital Visit – Nursing Implications?

admin — Mon, 20 Sep 2010 08:37:24 +0000

Andrew Allan

If you live or work in Australia you may have read a rather sad story this week that featured some fairly damning headlines such as:
“Boy, 16, sent home to die with 40C fever and gastroenteritis” and
“Boy sent home from hospital dies”

The gist of the story (according to the news) is that a 16 year old was assessed at triage by an RN after presenting with recent vomiting and fevers of around 40deg. The triage nurse determined that he was suffering from a viral illness, gave him some hydralyte ice blocks & panadol and sent him home, most likely with the advice to rest up, drink plenty of fluids, take panadol regularly etc.

In the morning, at home, his family found him to have died in his sleep some time during the night.

This story is both unfortunate and sad, on many levels. It’s also very worrying from a professional point of view, and raises several questions like, did the nurse’s decision making have any impact on this outcome?

I’ve worked triage for many years, and it’s a really difficult job. Fortunately where I work at the moment, there’s plenty of doctor’s on shift, so you can always run a query by a senior doctor for advice on those ‘not quite sure’ cases. The hospital in this particular story is a rural one, and is not staffed medically 24hrs/day. At the time the boy was sent home, there was a doctor on call but not one in the department, so the RN had to make a case-by-case decision on each patient whether or not they needed phone advice and/or medical consult.

Media and Sensationalism

I want to comment a little on the specifics of this case, because it’s one that could affect the way rural hospitals in particular are run in the future.

The outcome of this case was very sad. Tragic, in fact. The truth of the matter is that the boy died. We don’t really know the full story though – what did the boy die from?

We could speculate & say well maybe it was meningitis – vomiting coupled with such high temps, but what other symptoms did the boy have? How did he look when he presented? What was the time frame of symptoms? What did his vital signs & assessment reveal? etc. etc.

The media has already played judge and jury in their articles by already slanting their bias and belittling the RN by using statements like “a 16-year-old boy who was given junior-strength Panadol” and “(the nurse) gave us a pamphlet on gastro and told us to go home”. “Boy, 16, sent home to die” is also a severely damning statement to make.

It doesn’t really matter if you use infant panadol drops, junior panadol, or king-kong grade panadol – what matters is that the dose in milligrams is suitable for a particular patient’s weight and/or age. I have no doubt that the nurse involved would have at least given the correct dose of panadol, regardless of whether or not a ‘children’s liquid’ was used. Discussing management of gastro at home & giving patients and family education and documentation to take with them is also actually an appropriate measure to take in many cases. The question is, was it appropriate to do so in this case?

I would like to say one thing regarding triage cases and the media – in many cases, in fact in several that I have been directly involved with personally, the media has proven to be misleading, biased and often factually incorrect in their articles. I have seen this personally – cases where people have been drugged up and abusive and self-discharged, then the news article will read “hospital sent poor sweet lady home” or something like this.

The point I’m trying to make is that we should keep in mind that there are always two sides to a story. Often RN’s and hospitals are not allowed to have their say due to patient confidentiality laws.

Emergency Treatment

Viral illnesses, D&V, Gastro etc – these are really, really common presentations to emergency departments.

Severity of symptoms also range wildly from a child who has vomited once or twice over the last hour, to someone who has had a week of diarrhoea and is panting, dehydrated and really sick, and a whole host of other presentations in between.

Because of this wide range of presentations, treatment also varies and really is a case-by-case thing. Some people really do just need some reassurance, panadol and a good night’s sleep. Others require admission to high dependency. Most require a period of observation, and quite frequently we give IV fluids and/or electrolyte replacement.

Health Minister Kim Hames has backed nursing staff a whole lot more than the media has, stating:

“A properly trained nurse is just as good as a doctor in recognising a potentially serious medical problem. I’ve done work like that for years and years (as a former GP) and if a nurse practitioner called me in for every fever or vomiting you’d never get any sleep.”

Nursing Implications

Often in the past it has taken a death of a patient for system protocols to change. Certainly there will be an investigation in this particular case, and it will be interesting to see the outcome – will there be implications for nursing practice, particularly in rural settings?

What are your thoughts in this specific case?

Have you discharged patient’s prior to medical review? Under what guidelines?

Feel free to comment below