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!