Nurses and midwives have the cleanest hands of all healthcare workers in Australia.

Recent figures released by Hand Hygiene Australia (HHA) show that nurses and midwives wash their hands more often than other health-care workers, with the highest compliance rates found among RNs at 73.9%, and student nurses and midwives at 68%.

Doctors had the second lowest score for hand hygiene, with a compliance rate of just 52.5%

The HHA found that healthcare workers were more likely to wash their hands after the completion of a procedure and after touching a patient.

A total of 546 public and private hospitals were monitored for compliance to hand hygiene best practices by HHA.

According to the National Health and Medical Research Council  there are around 200,000 healthcare-associated infections in Australian acute healthcare facilities each year.

Do these results surprise you? Why is it that doctors aren’t as careful with hand hygiene?

Image credit: AJC1 via Flickr

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The Australian Nursing Federation (ANF) says the federal government need to provide more incentives for nurses and midwives who move to regional, remote, and rural locations.

Doctors receive up to $120,000 to move and as much as $47,000 each year to remain, yet nurses and midwives are not provided with federal incentive packages at all.

A lot of the time, as we’re sure you know, nurses provide the bulk of the healthcare in regional and remote areas, but there is not the same level of support for them.

Some incentives are paid to nurses and midwives on a state by state basis but these are much lower than those paid to doctors.

ANF federal secretary, Lee Thomas, says rural Australians deserve the same healthcare options as everyone else and an incentives program would boost numbers of nurses in those communities.

“Why should someone in a regional or remote setting be forced to drive long distances or wait for weeks to see a GP when they could potentially have access to a highly experienced nurse or midwife?”

“We are calling on the federal government to support the nursing and midwifery (and) help boost access to healthcare by attracting more nurses.”

We would love to hear from nurses or midwives who work in rural areas.

Are you offered any incentives? If not, would it make a difference or do you love working in the community for other reasons.

Did you used to work in a rural area, would financial incentives have encouraged you to stay?

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This post was proudly brought to you by the NSW Nurses’ Association.

In my group of friends at university when I was studying nursing, I was one of the few who knew that Paediatrics was where I was heading. I didn’t know what area of Paediatrics but I knew that my nursing career was headed in the direction of looking after sick children. In fact, in my year 12 year book I even said that it was where I wanted to be in 10 years time.

I was lucky enough after a 12 month new grad (nurse transition) program that had no paediatrics in it to get a job at a children’s hospital. I cried when I was offered the position!

People often say to me that it takes a special person to look after sick children and yes I guess that is true but as I always say, I get so much more from the job than I could ever give to it.

There is something unique about looking after children for so many reasons

1. children are so brutally honest….. if you are fat, thin, tall, funny or even sick, a sick child will tell you in the bluntest manner. I am always amused when a child tells me I have a big bottom…. they are telling the truth, and the look on their parents face is worth it every time. Total embarrassment. I always giggle!
2. as the nurse, we see sick children at their worst but also parents at their worst. Being able to be a part of that is something very special because more often than not we see that turn around into a celebration and it is great to be there for that.
3. we get to go fun things at  work and it is accepted. Whether it be dress up in costume, wear pigtails in your hair, sing or dance or be silly. We are often celebrating a fundraiser, a special day or a hospital event and we always get involved and do it. It’s a great part of the job.
4. A hospitalised child is often the worst experience  that will effect their family and often we have 16 children in that situation in our ward alone. It is wonderful to be able to help these families to deal with the trauma of that. Their child may be in for something simple or perhaps a long road of visits but being there is something quite rewarding. Knowing that you make the smallest difference is one of the reasons we go to work every day.
5. adolescents will give you a challenging day just as much as a baby but getting to combine a little of both in each and every work day is truly rewarding

Would I recommend a job in the field of paediatrics?

I could not speak more highly of it as a career. You still get to chose between medical, surgical, intensive care, recovery, theatre, emergency or community but you also get to be involved in the lives of people who appreciate what we do in more ways than they could ever express. Helping a child return home to their families really does give you that warm fuzzy feeling.

It’s a sound that rings through your ears and your heart momentarily stops.  You think to yourself “OMG, is it real?” No matter what time of day, no matter what you are doing, you are always on alert for THAT sound….. the one that makes your heart race, jump to attention and head in whatever direction it is coming from.

alert lamp

Fortunately for me, working in a Children’s Hospital, more often than not the arrest buzzer is set off by mistake because a parent has leaned on it, pushed it thinking it was the regular nurse call bell or because a sibling has wondered what that red light does when you push it!   However, on those days when the arrest buzzer goes off and it’s for real, not only do we deal with whatever situation we find whether it be a respiratory arrest, seizure or other emergency, the shrill cry of a scared parent often follows.

In fact, not only does the adrenalin kick in and we do whatever is required to help the child in question, we are also instantly aware that a child’s mother, father, relative etc who is at the bedside wants to know how we can fix this.  As in any area of nursing, we do all that we can and then we help the parents in any way possible before we then look after ourselves.

Looking after the nurses after a situation where resuscitation is required cannot not effect you in one way or another.  Some people go for a cigarette, some people need to talk then and there, some choose to discuss it at home and others need a more formal debriefing of a situation to know that regardless of the outcome, we did the best we could.

The first time I saw a patient have an arrest was when I was 17 years old. It was 1975 and I was a 1st year nurse with all of 6 months experience in the care of sick people.

I was working on night duty in a nephrology/oncology ward. The ward was divided into 3 sections and I was in-charge of one of them under the supervision of an RN. My section was the least acute, but still it seems ridiculous to think back and remember that hospital management thought it perfectly okay to leave a 17 year-old in charge of 12 fairly sick patients. But so it was and we didn’t think anything of it at the time.

This particular night was my 5th on night duty and I knew all my patients pretty well. There was one gentleman in particular that I had connected with – as we nurses often do. This man was in renal failure and quite unwell. He would spend most of his nights awake, so I would often sit with him and we would quietly chat and share jokes while the other patients slept fitfully. I liked him and he liked me.

Well it was about 6am on this chilly winter morning and I was looking forward to the dawn and the end of my shift. I was doing my usual 6am rounds, checking the all-important fluid balances and doing observations. The patients were rousing sleepily about me.

As I headed towards my favourite patient I could immediately see that something wasn’t right. He was lying on his back and I could hear gurgling noises coming from him! I moved quickly and the first thing I did was roll him onto his side and grab the suction equipment as I thought he was choking. But as I started to suction I realised that he was arresting. With a hot and frightened rush of adrenaline and with shaking hands I grabbed his buzzer and buzzed 3 times. The ward emergency signal.

My favourite patient was a big man and I was a rather petit teenager, but at that moment I seemed to have added strength and with some effort I rolled him onto his back. With a racing heart and sweaty palms I realised that the CPR was up to me and so I started it, all the while silently hoping the RN would answer the emergency buzzer as quickly as possible.

Time seemed to stand still and I seemed to move in slow motion while I initiated CPR. I remember feeling hot and cold flushes as I desperately tried to remember all I had been taught. I hadn’t even seen an arrest before let alone be the nurse to find someone having an arrest and be the one to begin CPR! Fortunately I remembered what I was supposed to do, and even though time seemed to drag, the RN and the other nurse were with me within a very short time. The code was called, the RN took over, the resus team arrived and I faded into the background to finish my shift, shattered and shaking. I went home feeling as if I been in a car crash!

When I returned to work that night I found out that my favourite patient didn’t survive his arrest and I felt as if I had let him down and hadn’t done a good enough job in trying to resusitate him. Fortunately, even though debriefing wasn’t something that was commonly done, the RN was able to reassure me that he had been a very sick man and that I had done exactly as I should have. And that was the end of it.

I saw and participated in quite a few more arrests after that one and I have to admit that I never got used to them and found them all a nerve-wracking experience. However, all those subsequent arrests have faded from my memory, but the arrest of my favourite patient is as clear today as it was 35 years ago.

My memories aren’t just because of my fear and anxiety over participating in my first medical emergency though that of course is a big part of it.

It was also because a patient I had connected to died and I couldn’t help him. This particular experience really brought home to me what nursing is all about. It’s the sort of experience that made some of the 17 year-olds I worked with hand in their resignations!

For me it gave me a deeper understanding of what nursing is all about.

Nursing is about connecting with people, caring for them, helping them and saying good bye. And the goodbyes can be either  happy and sad.

So that was my first arrest! how about yours?

photo courtesy of www.hospital.com

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I am sure everyone has by now heard about the murder that occurred in Chatswood on the 27.4.10.

This murder took place around the corner from my workplace (that is a scary thought in its self) but reports state that the murder may have been by the victim’s patient.

The report doesn’t say that she works in the mental health field but it does say that they suspect that it was one of her mental health outpatients.

It is very worrying to think that the patients we look after, whether we work in mental health or not, can get a hold of where we live, who our family members are and our personal details. How does this happen? How is it that our personal details are so accessible to the people that we look after?

I have a very close friend that works at Long Bay as a mental health nurse. She once told me that they are not to bring in their mobile phones to ensure their security and to keep as little detail of their personal life out of the facility. This may make it harder for her patients to track her down in the outside world but in reality all they need to know is her full name and they can track down her address, phone number, and who her family is. It is not hard.

When I was in training I did a placement at Rozelle Acute Mental Health Hospital and one of the nurses there told me about how she had to move house because one of her patients stalked her when he was discharged.

According to law our work place is not allowed to disclose any personal details to anyone, including fellow work mates but in today’s day and age is this enough?  When this law was passed we didn’t have internet and whilst back then this may have been enough to protect nurses from patients or their relatives from finding us but now it is all too easy to look someone up on the internet and find all of their details. So how are we supposed to protect ourselves? Would it be wrong if nurses remained anonymous at work? Or, we use nick names instead of our real names?  And our  name badges have our selected names on it instead of our real names?

How are we to protect ourselves from patients finding us and causing emotional/physical  harm?

Do you have any suggestions? Have you experienced a scary situation with a patient or their relative? Please share your stories or Ideas.

Image source (http://www.fotosearch.com.au/photos-images/stalking.html)

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This is the second part of this article. Please go to Part 1 if you have missed it.

The DAA suggests that we catch the problem early and monitor food intake in our residents. Every facility, no matter which provider they belong to, should have some kind of a food intake monitoring form. If you are concerned with intake you don’t need a GP or dietician approval to start one of these, you simply state in the residents notes that you are concerned about nutritional intake and you want to start investigating, thus you are commencing a food intake form. This is where who ever is the person to feed this resident/pt needs to be diligent in documenting exactly what he/she ate for that meal. All 3 shifts must do this for however many days the form stipulates.  Then, when you have evidence that intake has in fact decreased you can raise your concern with the GP or dietician. They will be pleasantly surprised that you have already completed the form and have the data waiting for them. Then you can start other investigations like find out if they are in pain, are no longer able to eat on their own, have problems swallowing, are becoming depressed, decreased cognitive ability etc.

The other way you know if someone is getting malnutrition is by regularly weighing them. They may have a great appetite but may not be absorbing  anything. At our facility we weigh people monthly and have a special obs form that it goes into and I as the care manager type it onto a special excel program that our IT department developed, and it  shows me if someone is starting to become malnutritioned. When I can see someone is starting to lose weight, according the amount of weight the person has lost I am to follow certain directives to try and reverse the malnutrition process. You don’t need a fancy system however to tell you there is a problem, all you have to do is weigh them and write it down somewhere in their file, if there is a weight loss do some investigating, consult their GP and their family maybe they have an explanation, or have noticed something that you haven’t.  There are also a huge range of great products now that help boost protein and caloric intake which I am sure you provider already has or can easily order, and these days they come in lots of different flavours that your residents will love.

You may not be able to stop everyone from becoming malnutritioned, but you can reduce the numbers with very small simple steps. Simple observations in behaviour, intake, and surroundings will prove very useful in aiding you to look after our frail and aged.

How do you feel about the statistics of malnutrition in our elderly? How have you helped a person from becoming malnutritioned? Have you witnessed some poor practices that have resulted in malnutrition?

I recently had the experience of being able to teach my sister how to care for her daughter when she was hospitalised recently. This was good for the following reasons: my niece enjoyed and preferred to be cared for by her mother, my sister felt empowered as she was able to help in a direct way, she felt more aware of her daughter’s condition and needs, and the nurses had less direct care to provide as this role was now being shared with us (the rellies) and the nurses.

In my nursing experience, it has always been worthwhile to involve family members in the care of their family member who is the patient. In most cases where patients have chronic illness, the family have often been providing care at home. So, this enables them to continue to provide care for the patient while they are hospitalised. This creates a win/win outcome as both the patient and the relative/s are happy; and I have some of my time freed up so I can provide care to the patients that don’t have relatives to care for them.
I always treat a patient with a family that provides patient care as a bonus and never just expect that they will automatically continue to provide that care as they may actually require some respite from doing that. I find it is best to simply offer the family the opportunity to provide care if they show an interest in doing so. I have however observed over the years that I have been nursing that there is a diminishing level of care that can now be delivered at the bedside by the nurses as a result of the diminishing staffing level that is allocated to provide that care.
So, I feel we should all welcome and show our appreciation when a patient comes with rellies that want to provide care. I recently saw a story on TV about robot technology and how the Japanese baby boomers don’t have enough nurses to look after them as they are all getting on in years and are now looking to robots to fill this role (just like ROBONURSE).

As a nurse, I find the role of providing care to another person satisfying as it enables me to connect on a deeper level. I am certain our patients will not get this same connection from being cared for by a robot. I believe as nurses we should all encourage family members to provide care for their loved one (the patient) whenever possible and practical.

What have your experiences been with dealing with your patient’s relatives who want to provide care for their loved one?

Rich

Photo from www.photoxpress.com by jeancliclac

Whenever I am asked what I do for a living I commonly get one of two responses, either “Oh, well, if you’re a nurse, I have this rash…” or “Wow, I have so much respect for you and what you do”.

Although, obviously the latter response is very flattering and the respect that the general public have for my profession is appreciated, I often wonder if the non-medico person knows what it is I do and, in fact, what it is they have respect for.

I think that the recent series of ads by the NSW Nurses’ Association, such as Kim’s story and Scott’s story help to display to the community the high level of technical competency and the wide range of communication and management skills we require to be effective members of a multidiciplinary team. This kind of publicity also displays the diverse areas in which nurses work.

Additionally, we as nurses meet a wide range of patients and their families from varying socio-economic and cultural backgrounds and consequently get the opportunity to see the world from a wide range of perspectives and learn from people who we may not normally meet.

I think an important aspect of my role as a nurse  is the responsibility I have for my patients and the people I may meet who could be suffering for some reason or another. We constantly act as advocates for our patients rights and this role also carries out into the community. This is apparent by actions taken by nurses such as supporting the abolishment of the Australian Building and Construction Commission (ABCC) which directly threatens the workers rights of Australia by helping bosses get away with bad safety practices and stop unions from doing their jobs.

The other nurses and I also support the Close the Gap campaign which calls on federal, state and territory governments to commit to closing the life expectancy gap between indigenous and non-indigenous Australians within a generation.

Does anyone else have any other campaigns or social issues they support? Or any stories to share about what they think the public think about the nursing profession?

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