The Scope of Nursing in Australia: A Snapshot of the Challenges and Skills Needed
- 5.24 Enrolled Nurse - School/Child Health Services
- 5.25 Enrolled Nurse - Tertiary
- 5.26 Registered Nurse - Tertiary
- 5.27 Enrolled Nurses - Private Sector
- 5.28 Registered Nurse - Private Sector
- 5.29 Registered Nurse - Prison Services
- 5.30 Enrolled Nurse - Prison Services
5.24 Enrolled Nurse - School/Child Health Services
Laura works as an enrolled nurse in a school in Western Australia. The school is an education support school that take students who have both physical and mental handicaps. Laura describes the type of nursing she does as community nursing, which involves prevention through empowering and educating people. However, Laura finds that "...my role in the school and my role as a community nurse is often questioned." (37:5:69-70).
Laura comments that there are no typical days. The only routine will be the commencement of her day where she will join teaching staff in the staff room in order to open up lines of communication and make herself accessible. Laura finds that this also provides her with an opportunity to find out about any problems that particular students may be experiencing. Laura will then have a brief meeting with the other nurse who is working at the school that day, "....but from then on... it can be very planned, or it can be very unplanned" (37:8:174-5). A large portion of Laura's work will involve health promotion and student advocacy. She conducts information sessions for students on topics such as school bullying, building self-esteem and a feel safe program. Laura will also attend to playground accidents and school outings.
Laura's employer is a local hospital, rather than the school. She finds that working as a community nurse with health promotion as her focus is in contrast with the hospital's medical model. She finds this to be a great challenge because the hospital's set up does not provide for Laura's unique work environment.
Models of Working with Others
Laura interacts with school psychologists, physiotherapists, occupational and speech therapists. Laura's role of caring for and educating members of the school community about health issues extends to the teaching and therapy staff as well as the families who also act as carers for the students.
Skills
- Communication
- Advocacy
- Basic first aid
- CPR
- Medication
- Updating knowledge base
- Assessment
Challenges
- Apathy - building staff morale
- Nursing staff that lack the necessary skills
- Working as a community nurse under a hospital - medical model
Education
Laura strongly believes that nursing should incorporate more education about community nursing and the benefits that arise from preventative and primary health. She finds that new registered nurses entering her area of work are often unwilling to be involved in duties that might be seen as unconventional or beyond the scope of regular nursing and feels that an emphasis in educating nurses about a community approach to nursing in school and child health services would be advantageous.
5.25 Enrolled Nurse - Tertiary
Theresa is a Nursing Laboratory Technical Officer at a Victorian tertiary institution that educates registered nurses. Theresa has enrolled nurse qualifications and finds that she utilises her skills and knowledge in a somewhat unconventional setting. She acts as a support person for the student nurses, in particular with regard to their laboratory practicals.
Theresa states that "no day here is typical" (7:9:198) and she finds that her workplace can sometimes be as stressful as an acute environment. Often her work will involve the task of setting up and dismantling laboratories with the necessary equipment for student practicals. She has to know what equipment is required, how to set it up and anticipate the needs of both students and instructors. Theresa is in the process of implementing self-directed labs and provides assistance to students who utilise these facilities. She sets up policies, procedures and inventory systems for the laboratories.
Theresa liases with equipment sales representatives, many of who are also nurses, for the purpose of recommending and purchasing new equipment for the laboratories. She must remain up-to-date with the latest equipment that is available and being utilised in the workplace.
Models of Working with Others
Theresa works closely with lecturers and staff, who provide her with an outline of their needs for each practical. Theresa is a mentor for student nurses; she tries to create a sense of team among the students because she sees this as an important quality for student nurses.
In addition to student nurses, Theresa also interacts with re-entry nurses and students from other disciplines. She provides an intermediate reference point for students who have general or specific queries or concerns about coursework within nursing laboratories.
Skills
- Patience
- Interpersonal skills
- Time management
- Prioritising
- Anticipating needs
- Nursing skills and knowledge
Challenges
- Possessing and acquiring expensive modern equipment on a tight budget
- Finding time for further personal study and education
Education
Theresa thinks there needs to be more clinical practice for students. She feels that:
...we try and create here in the labs, as close to... the .. the umm, health settings as we possibly can to compensate for the lack of hours ... constantly... the umm... students are saying, "it just wasn't long enough.... there was so much more... and I was just starting to get into the rhythm of things and that's it we were finished"....and that's also why, umm.. my manager umm.... and I ..have set up the... self directed labs ....also....and encouraged the students to ... use them as much as possible(7:14:334-340).
Theresa believes that nursing education should occur within close proximity to acute hospitals, allowing students to interchange between studying nursing and completing clinical practice. She thinks that nurse educators in health care facilities could do some sessional work with students while nursing academics in the universities could provide some specialty education to nurses in the hospitals. Theresa considers that more interaction and collaboration between facilities such as the university and the education of staff in a health setting will be beneficial for nursing education at all levels.
5.26 Registered Nurse - Tertiary
Jane is a registered nurse, who has the position of nurse educator in a Queensland Hospital. She runs the orientation program for all new staff and is particularly involved in continuing education and trouble shooting for the new graduate nurse program.
A typical day requires Jane to liase and negotiate with nursing staff working on the wards and other nurse educators. She runs a number of projects including transition and education programs for all levels of nurses. A lot of her time is spent in front of a computer to organise and publish education programs and utilise email to communicate with nurses on the ward.
Jane sees herself as having a facilitative role within the hospital:
... as an educator I have a very strong belief that my job is to make nursing as easy as possible for nurses.......to give them the information that they need and to help them to cope as best they can ...... (3:13:336-9).
Model of Working with Others
The isolation from the wards means that Jane has to research information and take it upon herself to up skill and increase her knowledge base. Jane's position in the hospital also sees her interact with all the new staff to the hospital, and she sees her role as an initial contact person for those staff. Jane works in concert with the other educators and has a collaborative role with the nurse practice coordinators who are responsible for the new graduates on the wards.
Skills
- Communication
- Sales/marketing
- Administrative
- Written communication
Challenges
- Time/ time management
- Maintaining enthusiasm
- Lack of job stability
Education
Jane believes nurses need time to learn nursing in a clinical setting without the stress of having to make the decisions of a registered nurse: "I very strongly believe that I would never go back to ....... the hospital based training...... but I do think that they need umm......... a less.....stressful....... clinical component..." (3:15:406-8). She supports the view of graduate nurses being given 12 months experience before having the expectation and responsibility of working as a registered nurse.
Jane rated interpersonal skills as highly important in the educational preparation of nurses. Jane also identified sales/promotional skills as important for nurses to learn so that they may encourage patient education and awareness of the health issues that affect them.
5.27 Enrolled Nurses - Private Sector
Both enrolled nurses, Claire and Tim work in the theatre of their respective West Australian and South Australian private hospitals. While both nurses are responsible for the set up and maintenance of anaesthetic equipment, Claire has the additional qualification of anaesthetic technician.
Claire and Tim refer to the unique, specialised culture that exists in theatre practice. Claire finds it to be very demanding, particularly when she is on-call. The pace of their day is fast and the stress level is high because of the constant risk that something may go wrong during the operation. A typical day for Claire and Tim involves setting up and maintaining theatre equipment, including the anaesthetic machine, recording fluid balances, and assisting the anaesthetist. Claire is also involved in ordering stock and purchasing equipment, as well as educating registered nurses about theatre work. Claire and Tim see their observation skills as being paramount to their job. They are constantly observing the patient and their surroundings and feel they must often anticipate potential problems and be quick to react.
Models of Working with Others
Claire and Tim interact regularly with anaesthetists, surgeons, registered nurses, orderlies, and ward staff. While Claire finds that some surgeons and anaesthetists can be difficult to work with, she feels there is a mutual respect between herself and other professionals, including the registered nurses.
Claire and Tim both express an enhanced responsibility for the unconscious patient. They feel they must be a good advocate for the patient, being constantly aware of where the surgeon is leaning, placing instruments, and how the patient is responding to the anaesthetic.
Skills
- Multi-skilled
- Observation and anticipation
- Maintaining a cheerful, helpful disposition
- Communication
- Interpersonal
- Clinical skills
- General nursing skills
- Problem solving
- Anaesthesia knowledge
Challenges
- Updating your knowledge base
- Dealing with theatre culture
- Impatient people
- Fatigue
- Maintaining motivation and enthusiasm
- Working in an emotionally tough and high stress environment
- Feeling under valued by the hospital
Education
Tim suggests that nursing education should more effectively combine hospital and university training. He feels there is much that simply cannot be taught in the classroom. Tim states:
In the real world industrial parity, staff being paid and treated like people who are actually worth what they do, and they can also start educating people in a realistic sense because .... nursing will always be a hands on profession. (24:6-7:145-151).
Claire thinks that it would be good to include some theatre experience as part of the enrolled nurse's training course, even if that means observation or working with the staff development workers in theatre. She also approves of the hospital's recent implementation of an enrolled nurse career structure which will provide greater incentive for enrolled nurses to do more training and education.
5.28 Registered Nurse - Private Sector
Working in metropolitan Victoria, Carol is a registered nurse. She is a continence nurse advisor and is employed by a private community nursing practice. Carol conducts home visits to see adults who are experiencing either urinary or faecal incontinence or may have a bladder or bowel dysfunction.
Carol's work environment varies from hospitals and clinics to client's homes. A typical day may involve visiting clients in all three settings. Carol allows a couple of hours for an initial home visit which normally involves Carol interviewing the client and family carer. She will explain to the client that: "...it's a bit like a detective story and I'm trying to work out why they have this problem .... so I'll be asking lots of questions and.... not to feel too ...hopefully overwhelmed by all of that....and then once we work out what's going on then we'll know what are the things we can do to improve it....." (6:4:58-61). If necessary, Carol will then conduct a physical examination of the client.
The societal views on the subject of incontinence means that Carol must be mindful of how to broach the topic without upsetting the client, as well as overcome difficulties that arise when clients are in denial about their incontinence. Carol also has clients who do not speak English, creating further challenges, even with an interpreter present, to communicate with clients who are already in denial about their incontinence.
Models of Working with Others
Carol works in a multi-disciplinary team that includes a continence physiotherapist. She also interacts with other professionals within the community health care setting, such as urologists, GPs and gynaecologists. Carol works as a member of this team, however, she is often called upon to provide advice and education to members of the medical profession, particularly general practitioners.
Skills
- Diplomacy, counselling, educator
- Have sound medical and general nursing knowledge and then layer onto that specialised skills
- Assessment skills
- Planning
- Public speaking and education
- Listening being sensitive to and maintaining rapport with clients
- Flexibility - being prepared for all eventualities when you knock on a client's door.
Challenges
- Government funding - have to submit statistics and achieve KPIs
- Managing a person with limited finance
- Time management - finding time to write reports
Education
Carol feels that "...the tertiary education does prepare a clinical nurse.... for.... the things that you have to do..." (6:8:188-9). She would like to see a continence nursing course offered through tertiary institutions that allows for an educator to be present for physical assessment, who looks at professional issues. She sees continence nursing requires the establishment of an independent nurse practitioner role.
Carol believes that continence management is a huge part of most nurses' practice but remains an area that is not well understood or covered.
5.29 Registered Nurse - Prison Services
Brenda is a South Australian registered nurse working in prison services in a rural setting.
Brenda's work environment plays a large role in the type of nursing and issues that she faces on a daily basis. Brenda does all the nursing diagnosis, treatment and medication in the prison. The pace of her work in the prison is busy. On a typical shift, there will be Brenda and one other registered nurse on duty. They will see up to 40 prisoners a day which will often involve conducting assessments, diagnosing, medicating and documenting each visit. In addition, Brenda conducts medication rounds and assists in the doctor's parade, transfers and admissions of prisoners. No doctor is in the prison at all times, and consequently Brenda is the first reference point for any medical emergency or situation within the prison. She will often attend to injuries sustained from fights, overdoses or self harm attempts such as 'slashers' or 'sorry cuts'. One challenge for her is knowing what emergency equipment to physically take to the prison cell and then the ability to work on the floor of the confined space that she finds herself in.
Her work is diverse. It requires her to be a counsellor, someone who will listen to a prisoner's problems and concerns. Brenda's lengthy period of employment at the prison and background as a psychiatric nurse allows her to be more trusted and freely communicate with the prisoners, although she always needs to be aware of the risk of being manipulated for drugs or sick days.
Brenda feels frustrated by issues arising from her employer not being the Department of Correctional Services. She believes that she does not get any support or advocacy from her employer and finds herself spending a lot of energy dealing with issues that surround this fact, in addition to coping with the stress and uncertainty that a prison environment brings. However, despite these frustrations, Brenda finds that working in a prison can be a very rewarding job.
Models of Working with Others
While Brenda works most closely with her fellow registered nurses and officers of the prison, she refers to the autonomous nature of the prison environment and the work that she does. However, there is a wide range of allied health professionals who Brenda regularly interacts with, including doctors, psychiatrists, physiotherapists, drug and alcohol workers, dieticians, diabetic educators, podiatrists and dentists.
Skills
- Counselling
- Nursing
- Psychiatric nursing knowledge
- Knowledge of the prison environment and prison mentality
- Cultural knowledge, particularly in relation to Aboriginality
- Communication
- Assessment
Challenges
- Not working for the Department of Corrective Services
- Staff shortages
- Security issues
- Communicating with some male Aboriginal prisoners
Education
Brenda does not ".... think you could actually train or educate a nurse to go straight into prison nursing" (14:24:660-1). She suggests that students need experience in emergency nursing, consultation, counselling and some understanding of security and cultural issues, before they can enter a prison practice area.
5.30 Enrolled Nurse - Prison Services
Paula is an enrolled nurse working in a rural West Australian prison. Working within an institution, Paula feels the need to utilise her initiative more than in the regular hospital setting. Her days are busy and can be intense when dealing with particular prisoners or attending to emergencies after fights or slashes have occurred.
Paula will usually work a shift with the clinical nurse manager and the medical ward clerk. She assists in data collection, immunisation and assessment of prisoners, which includes the annual assessment of all prisoners. A typical day for Paula will start by going out to the blocks and giving out medication and evaluating prisoners on sick parade. Paula will also provide first aid to prisoners and officers injured during prison fights.
Models of Working with Others
Paula's nursing practice means that she has a different relationship with her clients. She must be on the lookout for prisoners feigning medical conditions for the purpose of seeking drugs or having a day off from work. On the other hand, Paula tries to build a good rapport with the prisoners so that they feel more comfortable talking openly to her when they come to visit her in the medical clinic. Paula describes herself as an Aboriginal Australian which can facilitate cultural communication but simultaneously can inhibit communication with aboriginal males who don't like to talk to women.
Paula must work with the doctor who visits the prison once a week. The doctor is quite willing to teach Paula about medications and assessment which she finds to be very helpful.
Skills
- Communication skills - includes an ability to communicate with aboriginal and Indonesian people through interpreters or sign language.
- Cultural understanding
- Assessment
- Computer skills
- Interpersonal skills
Challenges
- Personal safety and feeling comfortable in the work environment
- Knowledge of the prison system, prison mentality and standing orders
- Ability to work in a crisis situation
- Dealing with cultural and communication issues
- Maintaining an awareness that the workplace is a prison and the clients are prisoners
Education
Paula's view on education is best explained in her own words:
I think to go into that sort of job, you need to have a bit of experience, a general experience in the hospital. I wouldn't recommend that sort of job if you have just finished uni and then you went straight out into a job like that. Because you would really have to go and consolidate some skills before you actually entered a workplace. Because there are a lot of skills that you learn over the years, that's what helps you to be a better nurse out in an environment like that. Plus if you have been around awhile, you do wise up to people, especially people trying to scam things off you or try to get a day off, or try to get drugs out of you. They try to manipulate some way, then at lease, if you have been around awhile in the hospital system and things like that, you will be on to it (30:19:516-25).
Mental health training is an area that Paula believes will be useful for her work. In addition to the clinical training, Paula suggests that theoretical knowledge is also important, as she often finds a need to supplement her experience with conducting research to find relevant written information on a particular subject. Paula intends to become a registered nurse.
Any comments or queries should be sent to: highered@dest.gov.au
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last updated on Tuesday, 04 December 2001
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