community health - Lamp Online

The Lamp spoke to two community health nurses attending annual conference for the first time about what they thought of the conference and what it is like in their current work environment.

Brendan McCulloch EN

“The discussions with the other delegates were the highlight of the conference for me. Nearly every single delegate was extremely passionate about what they do and very proud of where they came from.

The overwork I have witnessed since I started at my current workplace has made me become more passionate about being involved in the union. [There is a] lot of damage that the last two years has done to my team, and I wish to restore a lot of happiness and a sense of family that was at my Centre. People are afraid that if they speak up about burnout…they will get a lot more work, or more complicated work.

We work 300 minutes over a day of face-to-face care. What’s not taken into account are any problems that might come up. Palliative care has increased the acuity, and palliative care staff has decreased in the last 12 months [yet] more people wish to die at home, which has severely increased the workloads on the rest of the team.

They say taking your break is your responsibility, but you are travelling between patients…and before you even start you have to read up and know what you are doing. It’s not unusual for a nurse to stay back after a shift to do notes… If you inform anyone above you, you will be told that you have got poor time management.

(The government’s response to the pandemic is) terrible, absolutely woeful. It was the things they neglected to do.I didn’t feel supported at all when it came to the pandemic. I didn’t feel valued. I felt as if I was expected to handle it, to run around in full PPE to get samples in summer, going inside people’s homes with no air conditioning. There was no choice, and no recognition that this was happening.

I feel as if the new (NSWNMA) leadership wants to change legislation and do something big. We are daring to dream a little bit more this time, and we’re not going to sit down to have a crap sandwich. The fact is we need more funding if we are going to care for an aging population [and] I think we should be a lot more active about fighting the government about what we need. I think the strikes should be to the point where there are actually consequences for the government.”

Elizabeth Tran RN

“At the Thursday night dinner we were on a table of rural and community health nurses, and that was fantastic because community health is isolated. There aren’t nearly as many of us as hospitals, and we spent a lot of time comparing services. (At the conference) Jane Caro was a highlight. Not only was she talking about highlighting some of the problems, but she also had an emphatic take on how we start to make a change.

We are a very new branch and a very small branch and the union has really given us that power to find a voice. Just getting everyone signed on, I rejoice in that. A lot of people have convinced themselves the union hasn’t really done anything for them, and it’s that switch to people thinking, ‘We are the union. We are the ones who find the solutions or make the changes’.

We are inundated with work. 300 minutes a day was a ratio determined 30 years ago…and it has never been reviewed. Now there is an older and larger population which has increased the number of patients with co-morbidities and various cultural needs. We used to average 30 minutes in our patients’ homes and now the average has more than doubled. Logistically compared to when I first started in community health, travel between patients has more than doubled.

People’s morale in the workplace is grave. I keep thinking it couldn’t get any lower and it constantly finds a new way to get lower.

We’ve been going to Liverpool Hospital to join the strike actions. In community health, we can think that our problems are insignificant or the last to be heard, but we have really been finding our own voice in the last few strikes, and that has been really encouraging, finding our place amongst the membership.

I think that we are on the right track…I’d like to see a little bit more compliance with ratios, and then maybe start looking at the isolated rural and community health nurses to have a plan going forward so that we know we are being included in the wider union.”

Thinking about becoming a child and family health nurse? Maureen’s journey from London to Sydney via Switzerland gives some insight into what kind of skills are needed on the job.

“So, you’re a Child & Family Health Nurse, which hospital do you work at?” This is a common question I hear from not just the general public but other nurses too. There are mis-conceptions and lack of awareness around nursing in a Community environment which I have noticed since leaving the hospital system.

My nursing career started in 1973 when as an 18 year old I did my 3 year training at The Royal Free Hospital London England to become a State Registered Nurse. I was a Staff Nurse on a Cardiovascular Ward before moving to sunny Brighton by the sea to specialise in Paediatrics at The Royal Alexandra Hospital for Sick Children, where I gained the title Registered Sick Children Nurse. Returning to London I worked in Paediatrics and completed a short course in Psychiatric nursing (Epsom Surrey) which qualified me to sit the California (USA) State Board nursing exam. I passed, but as I didn’t drive at the time, I felt America was too hard to manage without a car so instead I went to Switzerland. I lived in Lausanne and worked at The Centre Hopitalier Universitaire Vaudois in The Premature Baby Unit, where I worked in French and imagine some of the little babies absorbed some English from me! I then worked in Paediatrics predominantly but when I needed a break would do adult general surgery which I found so easy in comparison!!!

The travel bug had taken hold and the next stop was The Royal Alexandra Hospital for Sick Children but this one was in Camperdown, Sydney Australia where I worked at Wade House 2 (general surgery).

I had met my Australian husband by then. We married in England and I worked again in London at The Devonshire Private Hospital where we specialised in renal transplantation and pioneered the lithotripter machine. Returning to Sydney I worked at Petersham Private Hospital again pioneering the lithotripter!

Following a short break to have my own children, I prepared to return to Nursing by attaining the Bachelor of Health Sciences Nursing, then a Diploma in Counseling and Small Group Work. A friend introduced me to Community Health and I started work as a Generalist Community Nurse, which was a huge role incorporating everything from the “cradle to the grave.” The autonomy of the role suited my experience but I was delighted to specialise only in Child and Family Health Nursing from 2006.

The role of a child and family health nurses is varied and interesting I see myself as a health service representative, assessor and referrer where necessary. Communication skills are valuable when home visiting in my ethnically diverse community, where I use a partnership approach to conduct the developmental check of the baby and psychosocial assessment with the mother. Through talking in a non judgmental, respectful and encouraging manner I explore the mother’s strengths, supports and resilience with particular awareness of the importance of the parent-infant emotional attachment for optimal developmental outcomes for the baby.

Working in clinics extends contact with families for maternal and child health assessments up to the child’s four year health check. Early interventions prevent long term problems and so our referrals e.g. eye clinic, tongue tie clinic, dental clinic, developmental clinics, paediatricians, sleep and settling services, counseling and mental health teams, are important to public health. A particularly enjoyable aspect of my job is facilitation of New Parent groups. Connecting and empowering new parents to develop their own parenting capacity and form social support network is very satisfying. My 44 year journey in nursing has led me to a role that I feel privileged to have found. It is pleasure to work with a team of child and family health nurses, who are as diverse as their clients in age and experience but share enthusiasm, commitment, skill and intelligence in a role which impacts and supports our community to help itself.

Daring to dream in community health

Maureen: child and family health nurse