Nurse In Australia

Nurses getting older

Ross — Sat, 03 Jan 2009 12:13:53 +0000

It’s been well reported particularly in the last few years that we are experiencing a shift to an aging workforce in the nursing profession. Gradually the average age of nurses has crept up, and this trend is not exclusive to Australia or America - many countries around the world are seeing similar patterns.

Laura Stokowski in Old, but Not Out suggests that by 2010, 40% of nurses will be over the age of 50. As these nurses retire in the ten years to follow, it can be expected that we will see a shortfall that is much worse than the current situation. Additionally, she states:

“One third of nurses over the age of 50 years plan to leave their nursing positions in the next 3 years. Given the high cost of replacing a nurse, it seems inconceivable that healthcare organizations aren’t bending over backwards to keep these nurses.”

And so there has been some debate on retaining older staff, making sure there’s not a mass exodus when nurses hit 60 - 65 years of age.

I’ve been thinking about this from an emergency perspective, and the reality is that people often move on from high pace workloads after a given period of time. Granted, you will find the occasional super-nurse who has worked emergency for 25 years and is still going strong, but for the most part from what I’ve seen, nurses tend to move on to quieter areas, management, education roles or change professions completely.

For me personally I’ve decided it’s not going to be something I do until retirement. I expect over the next year or so to wean my hours down (full time in emergency year after year starts to get draining), with a view to doing something completely different on the side. By doing this I hope to avoid becoming stale and narky (as we all know some nurses are!), and also it’s a good chance to try some new things out.

I’ve been in the game long enough to understand why the workforce is aging, why people aren’t flocking in droves to work as new nurses. Poor community awareness of our roles coupled with stupid work hours, massive responsibility, baseline pay and high stress environments does not make an exciting job-sell to prospective school leavers! Throw in a few other truisms, like the very real chance of being sued, hurting or killing someone through medication errors, and you discover why nursing’s not an appealing profession for many people!

As I eluded to in should I be a nurse, it takes a certain personality type and dedication to put up with the things that we do! Don’t get me wrong, nursing’s been a great ride - but I don’t think it’s something I can do forever. And so I’m wondering if more attention should be given to employing new nurses and training them up in specialty areas, rather than retention of the aging workforce. I’m not suggesting that older nurses are not valuable, but that they have a right to leave when they want! If I’m already feeling that I don’t want to do this forever, I’m certain someone has the right to feel that way even more at 50, 60 years of age.

So I’m throwing my hat in the ring (after thinking about this recently), and I’d like to suggest that the profession needs a name change to reflect the massive changes in job role over the last 30 years. I know this debate has come up before, but the role has changed. Maybe it’s time that it’s reflected in the title. Days of “yes doctor… no doctor…” are gone, as have many other old school practices, but the old school mentality of nurses being people’s handmaidens, servants and run-about people still exists. “Can I have some food?” the relative of a patient asked last night, as they were being unloaded off the ambulance trolley. Where do I begin to answer that question?!

Anyway, I’m interested to hear other people’s thoughts. But I don’t think it’s fair to keep people in the profession when they’ve had enough! Maybe we need to make nursing more appealing to school leavers. More money, less stupid hours, better flexibility, maybe working four days a week shift work for five days pay. I don’t know, maybe we need to brainstorm more incentives or rewards - holidays, travel allowances… and maybe even a name change!

Nurses turn to prostitution

Ross — Mon, 22 Dec 2008 00:41:49 +0000

credit: dtes.people

Ok, so there’s a title I didn’t think I’d ever read!

However, according to some credible news sources in Australia, it appears that stressed out nurses are quitting hospital work and turning to prostitution as a source of income.

I have to say that regardless of claims that prostitution is safer than ever, it stills stands that these two “careers” really don’t go together! With all that we have learned about looking after ourselves and focusing on holistic care, prostituting yourself is a bad idea. Not only physically, but also emotionally, spiritually. If you really want to have no sense of self-worth, wreck your self-esteem and discover what it feels like to be a pure object used for someone else’s gratification, you’ll find it in prostitution. That’s not what nurses stand for, is it?

Additionally, I can’t imagine how gross it must be having to pretend you’re interested (sexually) in complete strangers! While prostitution is not something I’ll ever be checking out personally, I have to say that having worked in nursing for long enough and seen enough naked people, I think it’s fair to assume that you’ll be coming across your fair share of what we see on a regular basis - the reality of how many people look naked! Sweaty, hairy, smelly bodies.. people with hairy moles, missing teeth, skin tags, excess fat… Obviously there are lots of exceptions to this, but you want to invite strangers to strip down and hop in your bed!? I’m a little dumbfounded. Not to mention I’m sure there’s a fair share of losers, creeps and psycho’s that also frequent brothels….

What’s also amazing about this is that the story doesn’t proclaim that a nurse has left the profession to sell themselves on the street, but that several have jumped on the bandwagon, and in my home state of Queensland none the less!

“The mother of two with 10 years’ experience as a registered nurse, who wanted to be known only as Jenna, has told how she and at least four of her colleagues have found new jobs working in brothels.”

Let me just add that there are specific reasons why these people have decided to leave the hospitals and seek alternative income sources, and this post and my thoughts on prostitution and nursing do not really focus on these: that nurses are exhausted, demoralised, under-staffed and stressed.

I agree! I work under these same conditions every shift! It’s tiring physically and mentally to work as a nurse in Queensland right now, not to mention that you work crazy hours with serious ramifications when you mess up, and the pay is not super-great.

Regardless of this…. prostitution? Really?! Check out this personal account by a former prostitute in Australia:

“I know about trafficking first hand. I was enticed into the prostitution trade as a young single mother with bills to pay, and once trapped I was unable to escape until 20 years later.

I wasn’t trapped by force. Some are, because pimps can be pretty vicious - but I had no pimp. I was trapped by the easy money which lulled me into thinking that the physical and mental pain I went through was worth it. It was never worth it. It destroys you. Even though I have now been out of the sex industry for nearly eight years, I am still in recovery and probably always will be.” - Linda Watson

Related posts:
Nurses getting older
Nurses getting screamed at
Should I be a nurse?
My experience of starting nursing
Public perceptions of nursing

Now that I’m here, when can I leave?

Ross — Mon, 27 Oct 2008 14:49:47 +0000

There’s a certain group of patients that come to emergency, mostly vague historians with vague complaints, who don’t want to wait around to see any kind of resolution to their presenting complaint.

credit: adjustafresh

Many of these people don’t have problems that can be diagnosed, solved and cured within a reasonable time frame, they have chronic multi-dimensional problems that need comprehensive work ups and follow up. But that still doesn’t explain why they want to go before seeing their results, hearing some kind of definitive opinion or at least having a plan for follow up.

Tonight for instance, I looked after a lady who came in complaining of 3 days of facial/jaw pain after some sinus surgery a week ago. While she was there she mentioned that she had experienced some mild chest discomfort that had resolved on its own within the last hour or two. She had some significant risk factors, such as age group, ex-smoker and obesity, so it may well have been cardiac in origin. While waiting for her facial CT’s to be reported on, we started a cardiac work up (ECG showed a right bundle branch block -?new ?old, no history), and got on top of her facial pain. Not long after this, she became really difficult to deal with. She kept asking when she could leave, and seemed to be irritated in general at being there.

Why do I see these kinds of people all the time? I’ve actually had people come to me at the triage window and state in an irate voice, “just letting you know I have to be gone by 3pm ‘cos I have an appointment.” What the??! It must not be that much of an EMERGENCY then, is it!!

Is it that the perception of hospitals sometimes doesn’t match up with reality? Maybe it’s because people want a quick fix - get rid of my pain, and I’m out of here thanks! Do people not know that vague complaints like abdo pain take time to investigate? Physical examinations, blood tests, chest and abdo xrays, CT and ultrasound, specialist referrals, medical or surgical opinions, pain relief, IV therapy - if you present to emergency with a complaint that is potentially serious and needs investigating, these things will take time.

Still ringing in my ears is a patient from last week, a guy who presented with abdo pain and didn’t want to wait for any of his tests to come back (because we’d improved on his pain with short acting IV analgesia, none the less!), so he yells, “I’ve had enough of all this crap!” and storms out - total time in the department, around 1 hour.

Watching a patient die

Ross — Fri, 24 Oct 2008 07:44:09 +0000

credit: roujo

Today I watched a man die. A few of us stood around as his heart stopped beating, and did nothing about it. It was kind of surreal, but the mood in the room was quite calm - there was no frenzy of activity with buzzers going off and people running: instead there were three professionals standing up at the top of his bed, discussing the ins and outs of his situation. In his final minute or two our talk was mostly academic, about the physiological responses to hypoxia and such other exciting things. But I’m getting ahead of myself a little, let me explain:

A man who looked to be around his mid to late seventies presented to emergency after collapsing at a care facility. He had a GCS of 3, and the only known history was that of recent renal problems which landed him a stint in ICU.

On arrival: his pupils were non-reactive to light, and he was making no spontaneous respiratory effort. He was being manually bagged with an LMA mask, and was quickly intubated after arrival. He was hypertensive, and had an erratic heart rate with frequent arrhythmias (ventricular runs with rate 90-100, runs of bradycardia at 30-40/min with ectopics, then runs of tachycardia ~110-130).

The usual lines, bloods, fluid, ECG, and neurological checks preceded the obvious CT scan, which subsequently revealed a large intracerebral haemorrhage . Consultation with neurosurgery based on his scans and myriad of other co-morbidities resulted in a prognosis of basically zero, which left him intubated with pupils now completely fixed and dilated, an erratic heart rate, and no spontaneous breaths at all.

We reversed some of his prior drugs such as vecuronium with neostigmine and atropine, to ensure he was not under the effects of earlier drugs, then used the old watch and wait treatment.

credit: littlenelly

Which brings us to watching him die. Gradually he was weaned down off the ventilator, with frequency of breaths lowered from 16 to 14…. 10…. 8…. 4…. and percentage of delivered oxygen lowered from 100% to around the 50% mark. There was no neurological response at all, and no spontaneous breathing: even hypoxic encouragement failed to induce any kind of respiratory effort.

And so we stood around, waiting to see if he would take a breath, all other avenues exhausted at this stage.

Everyone was in agreement with the treatment of this man, yet it remains a kind of surreal moment: our aim is to fix, to heal, to help, to treat…. and also at times to watch the inevitable. And so we made him as comfortable as possible, this disheveled 66 year old man, and contacted the only member of his family we knew of, who did not want to come in.

Part of being able to work well in emergency departments largely depends on the aftermath of this kind of situation: how you deal with bodies, putting them in a bag, removing all the tubes… writing up your notes, making sure your times are accurate, double checking the drugs you gave… liasing with other staff, making sure you were spot on legally. Finalising the paperwork, making sure correct forms are done, talking to the mortuary, arranging to remove the body…. And coming to terms with death yourself.

I’ve been in the game long enough to cope very well with such situations, but everyone handles things differently. Personally I find the only way is to completely remove myself from the situation emotionally, and if anything we tend to keep the mood as upbeat and productive as possible, despite the dire situation. And the reason? There’s a new trauma arriving in 3 minutes - the bay needs to be ready by then……

Loyalty to one GP

Ross — Wed, 22 Oct 2008 13:35:30 +0000

credit: wilding.andrew

I was bemused today when thinking about how many elderly patients have one primary doctor for most of their life. They often feel that they need to be loyal to this GP, and sometimes will refuse to see any other doctor.

These long term relationships can actually be a little one sided at times; I’ve even heard some older patients comment on how they feel they can’t leave. I remember one lady in particular who, when asked who her GP was, responded with: *sigh* “Oh Dr Keller… I don’t like him much, but have been going to him for 30 years!” For the most part, however the person is pleased to have such a wonderful, all powerful, all knowing doctor as their very own!

What I find odd about this relationship is that the elderly patient will take their particular doctor’s word as bond above all other doctors. “But Dr Regas says!…” they will argue to the emergency physicians.

What really sparked my interest in this phenomena today however, was when an elderly lady presented to emergency with complaints of chest pain. Her workup after bloods / ECG etc. resulted in a diagnosis of an inferior MI. She had a really strong cardiac history with previous MI’s, coronary artery bipass grafts and ischaemic heart disease. When I was taking a history from her, she informed me that she had felt some similar pains in her chest one week ago, but didn’t go to her GP because he was away on holiday & she thought she’d see him when he got back!!

Today’s society doesn’t seem to have this same connection. While it’s great to find a good GP, we certainly don’t feel the same bond or the need to prove loyalty to said doctor. The days of “Dr Jones has treated all our family for 50 years!” seems to be a thing of the past. Seeing a fill in doctor from time to time isn’t a major hassle, and people just won’t go back to a bad GP.

Obviously it’s important to have a primary GP for many reasons such as consistency and continuum of care, but there is a bond that seemed to exist back in the day that just isn’t there these days.

Interesting how times seem to change… or maybe the role of a doctor is different today?

Sharps and needlesticks

Ross — Mon, 20 Oct 2008 14:09:42 +0000

I’ve been fortunate enough to make it this far in my career without having a needlestick injury.

credit: pikimota

Correction, as a student nurse I discovered that 23g needles for intramuscular injections have caps that are very tight sometimes! So (pre-mastering of technique) I pulled from the end of the cap until it flung off, and I jabbed myself with a clean needle.

Not such a big deal: lesson learned, technique improved!

But thankfully I’ve never had the misfortune of being stuck with a dirty needle. I’ve come across some terrible, terrible work practices though which have left me quite amazed that I made it through without being stuck!

The last hospital I worked at had one doctor in particular (using older style cannula’s with no retractable sharp) who was notorious for putting an IV in, pulling out the sharp, and tossing it wherever he felt like at the time (IV trolley, hidden under gauze, on the floor, in the patients bedding - I’m not kidding). He then proceeded to take bloods and wander off, leaving his mess behind (including the hidden sharp for some lucky finder!)

I’ve seen a few people get stuck from trying to recap, particularly when using small needles.

credit: mendrakis

For the last few years my health facility has used IVC’s with retractable needles, so you press a button after you withdraw the sharp and it retracts into itself. Lately though we’ve been trialling a different type where the withdrawn stylet is covered by a cap as it’s pulled out.

This type also includes an extension set that primes itself with the patient’s blood, so there’s less setup time and a lower risk of needlestick injury.

What are your experiences with sharps? Have you had better or worse experiences with different style IVC’s?

When patients aren’t funny

Ross — Mon, 20 Oct 2008 13:27:00 +0000

credit: dotbenjamin

There are always patients who try and have a funny comeback for every question that you ask them.

Often after delivering the supposed ‘witty and amusing retort’, they look at you as if they were the first person ever to come up with such an amazing line. The problem is, we hear these lines just about every single day!

What am I talking about? Some examples:

Nurse: “Are you allergic to anything?”

Patient:

“Only women!”
“I’m allergic to needles!”
“Hospitals!
“Hard work!
“Doctors!”

It probably wouldn’t matter hearing this kind of thing once in a while, but day after day… shift after shift… when you’ve worked hours and hours straight without a break…. not so funny any more!

Don’t get me wrong - I’m well aware of the need to lighten up some tough situations, but c’mon people! Get some new material!

Is it really an emergency?

Ross — Mon, 20 Oct 2008 09:25:01 +0000

photo credit: viva la vibs

There has been a lot written on emergency departments and the frequency of patients who attend for frivolous and stupid complaints. Certainly this has become a part of my day to day life, and there have been many times when I have wished that the Australasian Triage Score system had a category 6, 7 or 8….

Here’s a few presentations that actually rocked up to the triage desk this week:

“I’ve had a sore throat for 2 days…”
“My daughter fell onto her hand, it’s not sore but I’d like it checked out…”
“He’s vomited twice in the last couple hours…” (20y/o male)
“This tooth has been bugging me for a few months, now it’s REAL bad!…”
“I’m on holiday and my script has run out…”

Suburban Emergency has a great post called Never mind that’s worth checking out. It’s a bit of a rebuttal aimed at someone who suggested the ED is the best place to go instead of a GP, and outlines why this is not a particularly good idea.

credit: gemsling

It seems universal that emergency departments are used inappropriately, regardless of the health care system / payment structure and regulations that apply to each particular country. The NSW Health Deparment has a blurb on their web site which describes the purpose of emergency departments in Australia as follows:

The main function of an emergency department, or ED, is to treat patients who are suffering from an acute serious illness or injury that would lead to severe complications if not treated quickly. The ED is not designed to provide ongoing care. Patients requiring urgent attention will always be seen first. Treatment in the ED is based on clinical need and not your financial situation or whether you have health insurance.
Non-emergency conditions are best treated by your local doctor or after hours medical centre because:
- You are more likely to see the same doctor each time
- You usually won’t have to wait as long to be seen
- It frees up emergency departments to treat emergency cases

I guess that unfortunately a massive portion of the general public have been so busy visiting the emergency department, they haven’t had the time to visit the web site & find out if it’s appropriate for them to go or not….

Public perceptions of nursing

Ross — Fri, 17 Oct 2008 01:07:52 +0000

Recently I was involved in a situation where we were left short staffed for a night duty in emergency due to some last minute sick leave. This meant there were three nurses off sick, and only one was able to be replaced.

credit: guillaume.payen

Working one down is achievable if the department is not overly busy, two down is not - particularly when all beds are full.

And so I worked a double shift.. I caught a taxi home to avoid a post-shift rollover with my car, then caught a taxi back to work the following day.

The taxi driver was asking me about when I had last worked etc. as I was probably looking pretty haggard by then! After I told him, his reply was something along the lines of, “oh well - I guess it’s not so bad for a nurse to work tired - it’s not going to matter if you make a mistake giving out headache pills, but it wouldn’t be good for doctors to do that!”

As we were just about pulling up to the hospital, I decided to bite my tongue. But it got me thinking about the perception the general public has about nursing. How do I explain to a taxi driver that my job is not about giving out pills?! How do I explain that my training is extensive, consisting of a university degree, post graduate qualifications in critical care and relentless ongoing education?

Nurses give out all the medications. All of them. Adrenaline, potassium, morphine, GTN, heparin, lignocaine, verapamil…. Antibiotics, anti-inflammatories, inotropes, diuretics, analgesics, anti-psychotics, anti-hypertensives…. We have to know a considerable amount about every drug we give, be ridiculously precise with administration methods and calculations, and know when a doctor has over-ordered or plain stuffed up. (Just last I witnessed a doctor’s order for a lethal dose of IV potassium, don’t think it doesn’t happen!)

credit: B Rosen

We do comprehensive assessments on every patient, and have to prioritise care based on a likely diagnosis. Make no mistake, if the nurse at triage misses that the elderly patient has a potential leaking AAA, the patient can drop dead on the waiting room floor. If an arrest page or alarm goes off, we nurses will give you CPR, hook you up to a cardiac monitor & assess your rhythm, defibrillate and give drugs when necessary - and yes, this can be after working 8, 10, 12, 16 hours straight.

And so, sometimes I’m frustrated by community perception! I understand not everyone feels that way, but it’s not the first time I’ve heard some snide, throw-away comment about nurses being there to give patient’s their food. Most of the time I shrug it off, but just occasionally….

What’s your experience - have you been subjected to this kind of ignorance, or is it just me?!

What makes a nursing student stand out

Ross — Tue, 14 Oct 2008 23:10:15 +0000

From time to time I have nursing students tail me for two, three, five week or longer blocks.

photo credit: b a r t

These are people at varying stages of their studies, but mostly are second or third year students.

While it holds true that there are a lot of factors that make up a ‘good nurse’, there’s one thing that sparks my interest in particular. Some nursing students have it, some don’t. Some nurses who’ve been nursing for a long long time have it - and some don’t!

What is it? The ability to see the bigger picture. To think outside the square. Call it whatever cliche you want, I’m talking about people who have the ability to see outside of their little world of “what task am I finishing now?”

I’m still not entirely sure whether this is something that can be taught, or whether some people just get it. I’m sure there’s some people who could improve this quality, and there’s definitely people who are completely unteachable!

How to think outside the square

Here’s a few things you can think about doing at work to make yourself a better nurse. People who think outside the square tend to do these things automatically:

Be aware of what’s going on with the nurses near you
Have a general awareness of what’s going on in the department as a whole
Offer to give other staff a hand when you notice they’re struggling
Don’t get caught up in rules and regulations for the sake of them - think for yourself, why is that “the policy?”
Don’t be near sighted or lacking peripheral vision - be aware that you are one piece of a larger puzzle
Just because someone ticks you off for some reason or other, don’t allow your words to be dripping with sarcasm and spite - it affects everyone else around you!

What about you - have you had experiences with these kinds of people?