Back in Australia

So it’s been a while since I last made a post, and life has changed yet again, this time I write from Melbourne, Australia.

I finally received my nursing papers to enable me to work in the U.K. It was a lengthy process and ironically I received those papers the week I returned to Australia. I have opted to pay the hefty U.K registration fee as who knows where life may take me next!

 Meanwhile, I have managed to secure a wonderful position as practice nurse in the heart of Melbourne. It’s a busy clinic with more than 10 doctors and 3 other practices nurses to complete the team.

 I was employed initially with an outlook to becoming the team leader ( a sort of mentor) but it was difficult to  apply that role as the other nurses had been there for a number of years and were thick as thieves. I was not really accepted as such in the beginning.  The fact that I was to do this mentoring role in a softly- softly manner made it even more difficult, not allowing the other nurse to know that this was my role!

 How did I cope?.. well, it was hard at first!  Luckily I have a tough hide and can take most things in my stride. There was no orientation to the job. The nurses expected me to know where everything was and have knowledge of all the procedures they undertook. One of my colleagues threw a folder on my desk and said “all the info ‘s in there”.

More often than not I worked alone, not part of a team. If I was doing procedures, no one would be washing and sterilising instruments behind me, I would have to do that myself after the morning had finished.   If stock came in, I would have to deal with it by myself, no one came to assist.

 I had never worked with this sort of team before!  In my past positions, nurses always worked together to get things done efficiently, with mostly friendly and helpful attitudes, true teamwork.

I could go on about the deficiencies of it all, but that would just be going over old ground. Let’s just say I was resented as the newcomer coming in trying to change the order of things.

 But change DID have to happen. So many procedures that give a clinic its accreditation had been sadly neglected. My first job was to make the treatment room respectable, clean and functional.

There was too much stock of some items and not enough of others. Daily/weekly/ monthly checks (oxygen,drugs etc) were not being done. There was haphazard storage and  illogical placing of things. Things that were used every day were placed  on high shelves, and old, old stock that was no good to anyone was plentiful!

It took me 4 months to get it up to scratch. Now it runs really well. The doctors know where everything is and everything is in its place, the counters are clean, and everything is labelled and all equipment is calibrated..

And that is just the start.  The past few months have been all about the physical aspects of the job.. That is just good  management. Now that I have a few months under my belt ... it’s time to introduce leadership.

But that’s another story.

Australian Nurses wishing to work in the UK

Well, it's been a while since I last made an entry into this blog!.
I have since moved lock, stock and barrel.. to England, where I have been living for the past year.
During this time I have been trying to become a nurse here, getting my qualifications recognised for the British system...and let me tell you it's no easy thing.

I will go through the process with you in case you are wanting to do something similar.

If you are considering going to England, get the process started NOW as the average length of time for the whole thing is about 18 months... yes, 18 months!.....can you believe it?

There are many documents you will have handy at home no doubt, but there will be others that only a university can supply and being in the same country as that University helps a lot.
Since 2008, all nurses coming to practice in the UK have to undergo a lot more screening than they used to. There was a time when you just presented your nursing registration and off you went to your first job. Not any more.
All candidates must undergo the IELTS examination. This is an English language test that all doctors and nurses who did not train in the UK or EU must take, regardless if your native tongue is English. Nice little revenue maker there!
The pass mark is 7.0 out of 10 and you must sit for the Academic test, not the General test.
You can do the test in Australia, but be warned that the certificate only lasts for 2 years, so if your process is not completed in that time, you will have to sit the exam again.
 I would advise  you to study some of the IELTS websites for free practice tests. Just knowing what you will be up against helps tremendously. Although I speak , read and write English very well, I found the test to be rigourous in that there is virtually no time to re-check your work, and the test takes place over 4 hours. So you see, a little prep will go a long way in getting you as good score.

As well as the IELTS test, you need to register yourself with the  British Nursing and Midwifery Council. They will then send you an application pack.
 You can read about the complex registration process here.

 Just to get the registration pack costs  £140. The IELTS test costs about $300.
 So already you are out of pocket!

From the NMC website:

How to apply to register as a nurse

 

You will have to pay an administration fee when you apply

You should also send us certified (signed by a solicitor) photocopies of your

registration certificate

passport (details page)

birth certificate

marriage, civil partnership or deed poll certificate (if you do not use the name on

your birth certificate)

You should also send us your International English Language Testing System (IELTS)

candidate number and test score.
 

Stage 2

When we receive the documents listed above and the required fee... we will send you an

application pack, which contains

your application form

your post-registration experience form

 

two employment references

 

transcript of training form

 registration authority/licensing body form

You must not photocopy the application forms

You should send certified photocopies of all your supporting documents as we cannot return original documents. If any of these documents are not in English, you will need to translate them.

You must fill in the application form in English. No one else must fill in the form for you.

Make sure all the forms are signed and dated.

You must return the completed application forms and supporting documents within six months

If you cannot do this, we will close your file and keep your application fee.

If you ask us for a second pack, you will have to pay a second fee.

If you have difficulty meeting the six month deadline, you should ask for an extension.

We will only give you one extension.

Your application forms and documents should be sent by post or special delivery.

 We cannot accept faxed or emailed applications.

Please do all this from Australia!.. you can get a Justice of the Peace to sign your  photocopied documents for free. In England, there is no such thing as a Justice of the Peace.. they have Notaries. These Notaries are in private practice and charge £5 (that's nearly $8 AUD) to countersign ONE document.
You will need a TRANSCRIPT of your university studies. This is no ordinary transcript they are looking for . This is an extremely detailed  transcript about how many hours you spent doing each course. I was very lucky to have a very switched on girl at Edith Cowan University to do all this for me. An ordinary transcript is not sufficient.

Nothing at all can be sent by email, which is partly why the process takes so long. Even if you think you have completed all the necessary forms (believe me they will say everything is there) expect to get a letter 6 WEEKS LATER to tell you they want some other sort of supporting evidence. Once you have sent that, expect a letter 6 WEEKS LATER to say they need  more documentation.
This goes on ad infinitum.
They are also notorious for losing documentation.
Once all the papers are finally in order, about 6 WEEKS LATER they will let you know whether you are successful in registering.

If you are successful the next step of the process is doing a University course. It's like a short bridging course to make sure you understand how the British health system works and what is expected of nurses. It's called the Overseas Nurses Programme
 Not all Universities have this course on offer. For instance, no university in Northern Ireland has this course.
This compulsory course costs £450.. that's about $800 AUD.
Make sure you book a place early because so many people want to do the course and you may have to wait for a few months before you can do it.
The course takes 3 weeks to complete. You attend the first day, then all of the learning is online with a couple of contact days in between. You'll see that nursing in England is virtually the same as nursing in Australia and you have paid  about $1500 AUD  for the privilege of knowing this!

I am currently doing the Overseas Nurses Programme. I've met some lovely people already, as well as 2 nurses from WA! I know my experience of the process is not an isolated one as many of my fellow students have stated the same thing.. it's a very frustrating process,with lost and missing documents and lengthy periods of non- communicaton from the NMC.
The University staff are also well aware of the short comings of the NMC process.

If you are thinking of coming over here, get the ball rolling now and I hope to see you here soon!

Who can help?

 As a practice nurse,I am often alone with no one to ask about best practice or new methods and ways of delivering patient care. I do have the doctors with me but often I just want to speak to another nurse!

 Luckily, our practice has just employed a delightful second nurse. She is an experienced and wonderful nurse with many years of hospital nursing behind her..and I know this because she is my dear friend of many years! We have worked together in our previous specialty of interventional radiology often assisting the doctors for 6 or 7 hours at a time, inserting complicated stents and wearing heavy lead aprons and jackets  in our role as  circulating nurse and scrub nurse.

 Nurse #2  ( as I will call her ) has been busy as a  full time mother for the past 4 years..and now  she is making a comeback in the field of  general practice. I am thrilled not only that such a kind and caring person has joined our team.. but that I have the opportunity to pass on to her all the knowledge that has been given to me or that I have picked up over the past year. I love to be the mentor, watching people blossom and reach their potential in a new field. I am lucky indeed to have Nurse #2 on board.

Not all of you are blessed with a Nurse #2. Here is a website that has been helpful for me many times. It’s a British website called Practice Nursing Forum. I have found that even though some things are different in the UK (such as immunisation schedules) the nitty gritty of nursing is the same wherever you are. It’s good to share with other practice nurses the dilemmas that are faced every day.  Give it a try, I might see you there.

All in a week’s work

 Not as busy as usual this week as the flu vaccinations come to a more steady flow, which gives me time to do many things that  I have had to  abandon  because of the constant flow of patients.

 There was an interesting case this week.  One patient arrived at the surgery with copious bleeding from his leg. The poor person had lost about a litre of blood from a bleeding varicosity. This situation was new to me, never having seen such spurting of blood from a vein rather than an artery. I knew that I had to stem the flow but it was an enigma to me as to why it was happening!

 After calling for the doctor (well , shouting for the doctor!) we managed to bandage the ankle with an assorted array of  bandages and some  cotton wool ( plastering) bandage..and soon he was being whisked away by ambulance  to the Emergency department at the hospital.  

 This got me thinking that I had no first aid kit on hand....a very basic set up of combines, bandages, gloves and adhesive tape would have been  invaluable. We do have all these items, but not to hand.

So my next project is to have a kit ready for all sorts  of emergencies. A plastic sheet would be a good start -a litre of blood is no picnic to clean up!

And I researched bleeding varicosities. I discovered that something as benign as a  bleeding varicose vein  can be fatal if the blood flow is not stopped.

 This is an excerpt from Patient.co.uk that explains the treatment.

First aid for bleeding varicose veins: this happens only rarely, but if a varicose vein does bleed, then you need to stop the bleeding quickly by doing the following:

• Elevate the leg - lie down flat and raise the leg high, so that it is well above the rest of the body (eg rest it on a chair, use lots of pillows or someone can hold the leg high).
• Pressure - put a clean cloth or dressing onto the bleeding area and put firm pressure on it, for at least 10 minutes.
• Call an ambulance if the bleeding is heavy, or does not quickly stop. See a doctor urgently, as you may need treatment to prevent the bleeding from happening again.

So, as well as getting my first aid kit together I have learnt how to manage this situation... looks like I’ll be putting a first aid course onto my learning plan in the near future.

Easy Self Assessment and Creating Learning Plans

 Learning Plans are essential from a CPD point of view..and for tracking  how you’ll go about getting relevant education. Once you’ve done a learning plan for the first time, you’ll see how invaluable and easy it is to get ahead.

First, assess yourself!

If you don’t know where you are.. how do you know which way to go?

 Assessing yourself probably needs to be done every year or so.  The tools I used to assess myself were :

• The Australia Nursing and Midwifery Council’s National Competency Standards (what a mouthful!)
• Competency Standards for Nurse in General Practice (Australian Nursing federation)

 Download and print a copy of these documents (or the one’s relevant to you if you are in a different state/country). Pop the documents in a folder..and then make yourself a good hot drink ..and settle in for an hour or so. Go through each and every competency .and see if you are up to scratch.!

 Here are some of my answers:

Highlight the areas that you don’t understand or areas where  you think you need more education. The learning plan has to be relevant to the work you do... so putting down a plan for “learning about patient care in the intensive care unit”..is not going to get you very far!

One example is this :

Competency Element 2.3

 ”I practice in a way that acknowledges the dignity, culture, values and beliefs  and rights of individuals and groups”

Assessment of self:

We have a number of Aboriginal people coming to our practice. Although I know a fair bit about the culture, I don’t really know how to deliver health care specifically for the needs of Aboriginal people.

 This now goes on my learning plan.  Here is my learning  plan  for the next  18 months:

You can copy this template and create your own learning plan. It’s important to have a date as a goal for the specified learning... this keeps you on track so you don’t lose sight of your goals.. and don’t try to do too much at once!

Areas of learning you may like to consider as a Practice Nurse:

Plastering

Wound management

Spirometry

Audiology

 ECG interpretation

Mental health crisis in the community

Immunisation Competency Certificate

Professional  Portfolio creation and maintenance

Chronic disease management

Managing a Nurse led Clinic

Diabetes clinics

Phlebotomy (blood taking, venipuncture)

Health Assessment

Travel medicine

Sexual Health Certificate

Pap Smear provider Course

Where am I going?

In my role as Practice Nurse I wish to be the best I can be. This means having the skills to deliver up to date and safe nursing care to all my patients. I know this doesn’t happen overnight, and I need a plan of action to get there.

 So, in the past year, what have I learnt?

 The practice nurse has numerous skills and needs to be able to jump from one to the other as smoothly as possible.

For instance, the hospital nurse learns a set of things that are particular to her area of work, say geriatrics or mental health. The practice Nurse has to know a little bit of everything! The work is as diverse as the patients themselves.

 In the past year I have learnt:

 Ear Syringing/irrigation, Immunisation, dressings and wound management, spirometry, audiometry , ECG tracing, travel medicine, writing care plans, performing  health assessments, diabetic assessments and reviews, motivational interviewing . That’s on the procedural side of things!

 In the management of the treatment room I have :

 Written a vaccine storage policy, organised the treatment  room to maximum efficiency, kept stock up to date and ordered stock and vaccines as needed, instigated changes in the design or use of the treatment room, managed the autoclave for sterilisation of instruments, liaised with pharmaceutical representatives, recalled patients, organised a diabetic review clinic.

But it doesn’t end there!

 Fortunately, I love to learn new things and as a registered nurse I need to have Continuing Professional Development (CPD). This means on-going learning and keeping up to date with best practice.  I also have a  Learning Plan which  helps me to see

• What skills  I need to improve or get
• How I will get those skills

 It also means that I need to attend educational sessions.

 These are held by various institutions or Pharmaceutical companies... Some  courses are quite expensive  (although you can claim the cost on your tax return each year). For instance, a recent wound management course cost $155.. perhaps some people are unable to meet that cost out of pocket so readily.

 Here is where WAPNA  rises.  As it is locally based, everything we learn here is relevant.

 We have an evening session once a month and two all- day seminars per year.  If I attend all the sessions and seminars for the year, this covers me for all my CPD points needed to remain registered!  And it cost just $30 per annum. This is great value. The members are all local practice nurses so it’s great for networking too.  One of the champions of WAPNA is the educational officer, Rosemarie. She works hard to get the right speakers for our educational sessions and she’s  quick to help out with a request for information. All the committee members are volunteers and they do a fabulous job.

 Another good place for education is the Osborne GP network. As our practice is affiliated with this organisation, generally the educational sessions are free or subsidised by the practice.

One other good place to learn is through the WAGP Network (West Australian General Practitioners Network). The nurses offering educational sessions here are a dynamic bunch of women with heaps of experience and great presentational skills! You’ll never be bored listening to these ladies!  This is also where you do the immunisation competency certificate.  They have many online resources and links with other GP networks around Australia.

Practice nursing is a dynamic, interesting  and exciting profession.  The scope of nursing is phenomenal. You can go as far or as little as you please and still be effective in helping other achieve good outcomes for health and well being.

 If you are new to Practice nursing (especially in WA) I do urge you to look at some of the websites here.  I will try to link you with as many informative websites that I find, because in the end, no doubt we have the same goal... to help each other to be the best we can be.

Where Am I now?

 After 6 years as a hospital based specialty nurse, I took a break in 2006 to do a post graduate degree in Radio and Television production and presentation (WAAPA). After this I worked for 3 years as a radio producer and presenter for various radio stations in WA.  Now, I find myself needing more income to support my lifestyle .. as well as wanting  less stress .. so my decision was to  return to nursing. I quite frankly was over going back to nursing in the hospital based system. I found it rote and lacking in personal  involvement  (which was the initial draw card for getting into nursing in the first place!).  General practice nursing looked inviting (with its amenable hours) and with the help of the Osborne GP Network  I got started  with a  short Introduction to Practice Nursing course. I also joined the West Australian Practice Nurse Association (WAPNA), but more about them later.

The first thing I did was to obtain my Immunisation Competence Certificate, learning about vaccination, both children and adults, as this is a large part of the profession. I did my CPR certificate and started applying for work. Luckily, there was a job going at a surgery not far from home that was looking for a procedures nurse. With my background in Interventional Radiology, this was an easy introduction . Whilst on the job, my colleague was a practice nurse of some 40 years, Jan. This wonderful lady taught me how to be the best Practice nurse I could be. I didn’t realise at the time that she was the President of WAPNA! What a gentle and lovely person Jan is! She has my total respect and gratitude for imparting invaluable knowledge, some of which I hope to pass on here.

Work soon dried up at that workplace and I was on the lookout for another. This was not hard to find and I became a practice nurse in a very disorganised practice just 4 minutes from home. Although disorganised, I loved the work!  Our patients were mostly new migrants or refugees, often with no English language.  We did lots of travel medicine and circumcisions! The practice manager  was  a sweet lady, Andrea, who herself was learning the ropes in that role.  Together with a couple of other nurses working part time, we somehow bungled our way through the day to make our patients’ lives better. There were some things going on there that didn’t feel right to me..and eventually, with no hard feelings,  I  left (along with another nurse) as I  didn’t want to compromise my  nursing practice.

Then I found the marvellous place I’m in today. Seven minutes from home, great people, professional all the way, it fits just like a glove.

So after one year as a Practice Nurse, I’m beginning to feel like I have learnt a thing or two!