Topic: Profile

Practice nurse and clinical manager Rebecca Cade, from Macarthur General Practice has always had an interest in healthcare. Working across a wide range of specialties, her current role includes managing incidents, coordinating practice nursing students within the clinic, and ensuring clinical guidelines are accessible to her team.

How long have you been a practice nurse/clinical manager working in the Macarthur region?

I commenced work at Macarthur General Practice in 2012.

When/why did you decide to pursue a career in nursing and specifically in primary care?

I have always been interested in the healthcare field and did nursing for my Year 10 work experience on a paediatric ward. Nursing appealed to me as I’m someone who gets bored relatively easily. I liked there was an array of different specialty areas to work in and different career paths to explore (clinical versus management).

I spent the first 16 years of my nursing career in the acute care arena (predominantly intensive care and trauma nursing). I made the decision to move into primary care after experiencing some of my own health challenges. Unfortunately, the public health system wasn’t as understanding and/or flexible as I would have liked so I really had no choice but to leave and find another area of nursing that would be more accommodating. 

Tell us about your role in the practice?

My current role is varied and can include anything from incident/complaint management to coordinating the placement of nursing students within our practice.

The main aspect of my role, however, involves ensuring evidence-based guidelines are incorporated into our clinical practice. Research has shown that merely publishing evidence-based guidelines is not a guarantee the recommendations will be incorporated into practice or indeed that clinicians will feel equipped to do so. My role is essentially taking these clinical guidelines and ensuring they are accessible to our clinicians in the most appropriate format. This may mean writing a policy or, for example, developing standardised decision support tools for clinicians to use at the point of care.

As part of this I am responsible for the development of our nurse-led clinics. Ensuring we are fully utilising the skills and experience of our nursing staff is essential. Practice nurses often do not get the chance to fully utilise their skill set – this leads to not only recruitment and retention issues but not letting them practice to their full potential is, quite frankly, a waste of a valuable resource.

Utilising our nurses in nurse-led clinics provides our patients with the opportunity to receive a comprehensive assessment, a tailored treatment plan and education in relation to a particular aspect of their health (for example, osteoporosis). The clinics not only empower patients with the knowledge needed to manage their health condition but frees up our GPs for patients with concerns that cannot be addressed by the practice nurse.

What do you love about your role and what do you find most fulfilling about it?

I love working in an environment where everyone is dedicated to making sure we deliver the best possible care to our patients. Being an independently owned practice means I’m not faced with a lot of the bureaucracy of some facilities and the practice owner/principal GP is open to pretty much any idea that will improve patient care and/or the patient experience, which gives me a lot of freedom within my role.

What is your biggest challenge as a PN/Clinical Manager and how do you overcome this?

The biggest challenge is there are not enough hours in the day to achieve everything I would like. The list of nurse-led clinics that could potentially be implemented to benefit our patients, for example, is endless however they do take considerable time to develop so it’s about constantly prioritising what is most important for our patient group and clinicians in the current clinical climate.

For the last two years, this has meant concentrating on making sure our policies relating to COVID-19 vaccinations and supporting pre-vaccination screening, eligibility assessment, consent forms etc have been up-to-date with the latest, at times, constantly changing, clinical guidelines.

Tell me about your ideal work day

My ideal work day would be one in which I complete something I have been working on! A lot of research and time goes into developing a nurse-led clinic, so it’s always satisfying when the development of a clinic is completed and ready for our nurses to implement.

What do you like to do in your spare time?

The beach is my happy place and I love spending time there although I don’t get there nearly as much as I would like. I also enjoy pottering around the garden at home and am about to start some mini renos within the house (the bathroom is first on the agenda!).

I also have a French Bulldog, Sophie, who I enjoy doing various forms of training (eg obedience, agility) with. Sophie is a qualified pet therapy dog, so we usually attend a visit to local healthcare facilities once a week. These visits are generally for the patients, however more and more facilities are recognising the benefits to staff and are booking visits purely for their staff members.

Do you have any role models and why?

I don’t have any role models in the traditional sense. I tend to admire/respect normal, everyday people who find themselves in adverse situations and deal with it with strength and grace. During my time in intensive care/trauma nursing I met many families who amazed me with the strength they showed in face of unbelievable tragedy.

How do you help educate your patients and colleagues about maintaining good health?

I help educate our patients about maintaining good health indirectly by developing resources (handouts etc) for our clinical staff to use and distribute to our patients. There are a lot of developed resources available that can be sourced, but I often find these contain too much information. It’s important we don’t overwhelm our patients but provide them with bite sized chunks of information targeted towards their health situation – they are much more likely to be receptive and take on board the information this way.

An enjoyment of and great interest in people has seen Kate Whymark caring for patients all over the globe in her 22 years of nursing and experience in a range of different roles. Having worked as a practice nurse at Wollondilly Medical Centre for the past six years, she looks forward to every day being different and working with her patients to find the perfect solution to their problem.

How long have you been a practice nurse and how long have you been working in the Wollondilly LGA? 

I have been a nurse for 22 years and have worked across three continents and areas of nursing. I have been a practice nurse in the Wollondilly area for the past six years.

When/why did you decide to pursue a career in nursing and specifically in primary care?

I started nursing as I enjoyed caring for people and quickly found health care/disease was very interesting. After having my third child eight years ago, I decided to try a change and get into practice nursing. After many years of hospital work, I decided if teaching patients about prevention can help the outcome, then it’s worth investing my knowledge and care.

Tell us about the role of nurses in primary care

A usual day in the practice can vary from wound care (both chronic and acute), immunisation of adults and children (travel/scheduled vaccines), assessing and triaging patients who are unwell or after injury, general observations and ECGs. I also assist GPs with procedures and preventative health screening for immunisations, cervical screening and disease management.

I complement GPs by ensuring I have a broad knowledge of vaccine schedules and updates, as well as keeping up-to-date with the services available in the area and assisting with referral where needed. I assist with making sure the GPs’ patients are returning as needed for results and screenings. I help the GPs by saving them time and assisting with the set-up of procedures and attending to wound care and other duties to ensure the day can run smoothly with minimal disruptions.

What do you love about nursing/what do you find most fulfilling about your role?

I love that every day is different and every patient is not the same. I have found what works for one patient’s illness or problem may not work for another. I love caring for people and helping those who need it. I most definitely enjoy seeing patients’ illness/injury improve or be resolved.

Tell me about your ideal work day…

An ideal workday for me involves lots of coffee, keeping busy with patient care and seeing to a variety of patient care needs.

What do you like to do in your spare time? 

When I have spare time, I love to read books, go for walks, sample and trial essential oil blends I’ve made, and spend time with my family.

How do you help educate your patients about maintaining good health? 

I help with patient education by having casual conversations and listening to patient problems on their level. I give advice on ways they can resolve issues which may be hindering their health. I often consult with their GP on needs arising or services I feel may be of help to the patient. I am always following up with patients after I have provided them with assistance to see how they are or how the services provided are going.

Practice nurse Patrick Arnold has been a nurse at Thirlmere Medical Practice for 18 months and working as a nurse for 13 years. During this time, he has undertaken a number of roles in nursing but by far the most rewarding for Patrick is his role as a practice nurse.

How long have you been a practice nurse and how long have you been working in the Wollondilly LGA?

I worked for two years in private practice within a metropolitan clinic early in my nursing career and upon returning to nursing 18 months ago have been at the Thirlmere Medical Practice; so… coming up on four years.

I nursed for 13 years (11 as an RN) before taking a break and working in manufacturing. Nursing roles have included ward nurse (neuro/spinal/plastics, orthopedics, cardiac care), ICU, theatres and drug and alcohol. Practice nursing feels like the perfect balance of all of these and is by far the most satisfying role to date.

When/why did you decide to pursue a career in nursing and specifically in primary care?

Having volunteered with the SES while completing the HSC I met a number of ambulance officers and an assortment of eccentric healthcare workers. It was always going to be between the ambulance service or nursing. Nursing won out. My rationale has always been you can do just about anything to make money, so why not do something which helps others and feeds the soul.

Tell us about the role of nurses in primary care

One part of the role is maintaining and operating the treatment room. This involves ensuring equipment, medications and vaccines are all available, calibrated, in date and (where appropriate) cleaned/sanitised. With four doctors on staff and up to three on shift at the same time it can become a juggling act to keep procedures, dressings or diagnostics from overlapping, but that is part of the fun of the role.

The bigger part of the role is building rapport with the patient base. I am very lucky to have joined a practice which services quite a close-knit community. By building trust through wound care and education, vaccination, care plans, health assessments etc it puts me in the position to instigate conversations about health issues and preventative options. The advantage of this approach is those who are reluctant to engage with what they deem “unnecessary” medical interventions (like vaccination for example) can have the time to receive and process best practice information and then make an informed decision. If preventative health is viewed and accepted as a positive choice through the wider community, those on the fence are more likely to engage.

The practice nurse complements the general practitioner through the development and management of care plans and the ongoing management of chronic health issues. An experienced nurse should be able to liaise with doctors and provide (where appropriate) triage and the streamlining of service.

What do you love about nursing/what do you find most fulfilling about your role?

Building relationships with our patients. General practice allows the opportunity to foster a sense of community and engage with patients both on an individual and collective level. It is a very satisfying role and one I am glad I came to with the experience I have. Nursing overall has so many moving parts it can often be hard to define what specifically is most satisfying, but it does always seem to boil down to helping people.

What is your biggest challenge as a PN and how do you overcome this?

Vaccinating children. Babies don’t understand what is happening, and it is over so quickly that levels of distress (for both patient and parent) can be managed and pass quickly. With infants, when you build trust with a small child and then “hurt” them, depending on the child and their ability to comprehend what is happening there is a sense of betrayal. Personally, that hits more because it is a child. I think if this part of the job became easy, I would be concerned.

As much as possible I try and distract the child from crying by preparing them for the experience in a gentle, unrushed manner. Failing this, a stuffed toy, lolly or sticker with some kind words goes a long way. Generally, they have settled before they leave the room, but it is definitely an emotionally taxing experience.

Tell me about your ideal work day

The shift starts by checking the vaccine fridge, stock and doctor’s room for re-stocking. Preparation of medications/vaccines as required. Two or three over 75 health assessments and a handful of care plans. We generally have four to five biopsies or excisions through the day and often iron infusions. Add a few chronic wound patients for dressings and you have a full, satisfying day.

What do you like to do in your spare time?

Spend time with my partner and our beautiful dog, Monroe. She is 60+ kg of anxiety and fur, and loves walks and cuddles. Otherwise, when time allows, I enjoy playing music (I play guitar, piano, bass, drums and sing).

Do you have any role models and why?

Obvious choice, but my parents. They have raised me through leading by example. Both are very kind, generous and infinitely patient. I couldn’t find better role models if I tried.

How do you help educate your patients about maintaining good health?

As non-confrontationally as possible. Due to the repeat nature of our patients’ visits, we have the opportunity to have ongoing discussion regarding best practice and health recommendations, generally tailed by follow-up questions and increased engagement over consequent visits.

Many people who are drastically out of shape are very aware of their situation and are embarrassed and/or ashamed (ie bariatric patients). By approaching recommendations or ideas in a manner which ensures the patient does not feel “attacked”, for me, goes a long way towards positive long-term outcomes.

By providing a supportive port of information and assessment I believe we can (over time) help patients reach better health decisions and outcomes.

Practice nurse and lifelong learner Anne Stanley brings a wealth of knowledge and passion to Wintergarden Family Practice in Bowral. Anne is instrumental to the practice through her ongoing contribution to updating policy and procedure, promoting the wellness model of health and her ongoing commitment to practice accreditation. Her vibrant and caring nature along with the years of experience in practice, the classroom and the operating theatre makes her a wonderful role model for future nurses.

How long have you been a practice nurse and how long have you been working in the Wintergarden Family Practice?

I have been a practice nurse at Wintergarden Family Practice for a year. I started at the time COVID-19 vaccination began. I quickly settled into the practice, loved the staff, the environment and the patients, and was invited to take on more work at the practice relieving the other nurse on holidays and other leave. I now work several days per week.

When/why did you decide to pursue a career in nursing and specifically in primary care?

In my last year at school, I was undecided whether to pursue a life in nursing or in teaching. I chose nursing, loving my experiences, learning, friendships and adventures nursing provided to me. After working in intensive care, theatre and recovery areas I decided to move into the world of practice nursing while living in Melbourne.

Following this I was director of an Early Childhood Education Centre attached to Monash University.

Returning to Sydney after several years in Melbourne, I decided to move into the world of education and attained a teaching degree, and Masters in Education while I worked at the University of Sydney for 17 years as a lecturer in the Faculty of Nursing. I also had further clinical experience during that time working with a well-known melanoma specialist in specialist rooms. A further career change in education saw me working as a school counsellor as well as joining the School Immunisation Program at the start of the Gardasil program. At this same time, I was also working in aged care at a local retirement village.

This was all about the time COVID-19 appeared and was recognised as a pandemic. So full circle, I am now involved in primary care in general practice at Wintergarden Family Practice and loving it! A major advantage of working in a rural area is that you quickly get to know patients and their families.

I feel privileged to be working with an amazing team of clinical and administrative staff. I have loved my journey and feel there is so much more to learn and be part of and to specifically promote the wellness model of health as a means of illness prevention and assistance with managing chronic disease.

Tell us about the role of nurses in primary care …

Primary care is a huge all-encompassing role where no two days are ever going to be the same. I love the unpredictability of the day and love the challenges which arise during a working week. I enjoy being actively engaged in primary care. While I value the role of everyone in the practice, a special mention goes out to the frontline, that is, the reception staff. They carry a vital, critical role which contributes so much to the daily life of a well-run practice.

As COVID-19 becomes more manageable in general practice, other very important issues (working with the wellness model of health) take a focus including health assessments and management of chronic disease management. Nurses work closely with all practice staff, ensuring patients receive the best management for their health needs. In our practice, a morning meeting on a daily basis prior to opening for the day is part of the overall planning for best outcomes and is part of our care model.

As nurses we are very involved in primary care at Wintergarden Family Practice including assisting with excisions, iron infusions, venesection, INR readings, planning as well as immunisations, management plans, liaising with allied health teams, stock control and ongoing education. These roles are routine and certainly do not cover the entirety of the role of a proactive nurse working in primary care.

What do you love about nursing/what do you find most fulfilling about your role?

I love both nursing and education and have blended both as part of my daily working life. I love being part of a caring, professional team and seeing success for the patient and their family. The satisfaction of knowing we have all been involved in achieving best outcomes for them is fulfilling.

It is only when a dedicated team genuinely cares for each other and the patients entrusted in our care, do we allow the best outcomes to happen. I also love that everything we do is seldom if ever wasted. I have brought many life, nursing and educational pathways into my latest career change and find it fulfilling.

What is your biggest challenge as a practice nurse and how do you overcome this?

Wanting the absolute best outcomes for all patients is paramount in my thought processes and instructs the care I provide. Therefore, while acknowledging there are many challenges in all aspects of life, practice nursing has different challenges which determine how I deal with them.

How we cope with challenges involves several known answers but importantly be open to new strategies to best deal with them. These need to be varied to assist when issues arise. Also being able to step outside the square is beneficial and helps when challenges hit. Having clear and appropriate policies and procedures in place allows a standardised methodology in practice management and care.

Addressing the accreditation process this year was a challenge in the middle of pandemic management but being part of a wonderful team achieving such favourable commentary is paramount to the success of our practice. 

Tell me about your ideal workday…

My ideal workday is one that is busy and meaningful. Having patient contact is important to me and knowing I am part of such a caring knowledgeable team where community is the major focus, is my ideal day.

What do you like to do in your spare time?

I love learning, so part of my spare time is involved in ongoing education and research. I am very fortunate to have a wonderful supportive family, children, and grandchildren to fill my life. I enjoy gardening, reading, and creating healthy recipes.

Do you have any role models and why?

Yes, I do. There are many and varied. Starting with my family, they are role models to me for many reasons and make me aspire to keep achieving new benchmarks. Another is a valued friend, an educational visionary who is doing it ‘his way’ who had a dream about how education should be, had the resilience and drive to make it happen. Also, there are many work colleagues, who have been role models who have been part of my journey for the various qualities they generously shared.

How do you help educate your patients about maintaining good health?

The wellness model of health underpins many health-related programs. Evidence based practices and treatments supporting this model when tailored to the individual patients is where education is vital in providing the best outcome for my patients.

I utilise evidence-based practice using the following principles in my interaction with patients and, it is when the patient accepts ownership of the treatment by becoming actively engaged in their care is when best outcomes can occur.

First, I form a clinical question to identify a problem, and then work closely with the patient to:

• Gather the best evidence
• Analyse the evidence
• Apply the evidence to clinical practice, specifically the patient
• Assess and review the result

Practice nurse Brooke Bajac is a keen learner who loves being able to support people in the region with their everyday healthcare needs, as well as in the fight against COVID-19, in her role at Picton Family Medical Centre and Picton Respiratory Clinic as a practice nurse and nurse team leader.

In addition to her passion for nursing, Brooke is instrumental to the practice in her role in leading, coaching and role modeling for the rest of the nursing team on how to carry out their daily tasks in a thoughtful, systemic manner, in order to achieve those wildly important short- and long-term goals for both the patient and for the practice. She exemplifies her practice’s values of #LoveWhatYouDo #MakeADifference #ActWithIntegrity

How long have you been a practice nurse and how long have you been working in the LGA you currently work in?

I have been a practice nurse for one year and two months but have been working as a registered nurse in Wollondilly for two years.

When/why did you decide to pursue a career in nursing and specifically in primary care?

I have a passion for helping people. I especially love caring for the elderly population as I believe they are the most vulnerable. I had epilepsy as a child and I was in and out of hospitals for most of my childhood, I always looked up to the nurses looking after me.

Tell us about the role of nurses in primary care

Every day is very different working in a general practice. We see everything from people with chest pains to people with wounds. However, I have multiple roles within my general practice such as treatment room duties, chronic disease management, respiratory clinic duties and nursing team leader duties.

Treatment room: When I work in the treatment room I assist doctors with procedures such as biopsies, excisions, nail removal and wound suturing. I also assess and attended to wound care both minor and complex. I am skilled in IV cannulation and perform numerous IV treatments such as: iron infusions, venesections, IV fluids and IV antibiotics. I am also responsible for ordering medical supplies, ordering and maintaining vaccines. Other tasks I perform in the treatment room also include ECG, adult and childhood immunisations, INR checks, observations (BP, SP02, HR, RR), ear syringing, suture removal and much more.

Chronic disease management: I am skilled at creating care plans for patients who have chronic disease. I work closely with the patient, their GP, allied health and specialists to help patients achieve their health goals. I also perform other assessments during care planning such as health assessments, diabetes cycle of care and heart health checks.

Respiratory clinic: I also work within a respiratory clinic which is part of our clinic. I have many roles within the respiratory clinic such as swabbing patients, respiratory assessment of patients, COVID-19 vaccinations, care of COVID-19 positive patients and I provide education and advice to unwell patients.

Nursing team leader: As the nurse team leader I manage our nursing staff in both the general practice and respiratory clinic. I do the rostering for general practice and respiratory clinics nurses. I ensure our nursing team are upholding our values. I assist my team with reaching our goals and improving our customer service to our patients. I help coach our nursing team where needed to enhance and improve their performance. I assist our practice principal with the development of procedures and company goals.

What do you love about nursing/what do you find most fulfilling about your role?

I love developing therapeutic relationships with my patients. I love having a direct impact on a person’s health and assisting them to achieve their health goals. The most fulfilling part of my role is to watch my patient’s health improve especially through chronic disease management. It is the best feeling to see a patient three months after their care plan and find that their condition has improved.

What is your biggest challenge as a PN and how do you overcome this?

The COVID-19 pandemic but more specifically COVID-19 vaccinations. I have had many patients who have been very uncomfortable having a COVID-19 vaccine. I overcome this by having one-on-one conversations with the patient and answering any question or concerns they have. If I am unable to answer I specific question I direct them to a doctor. I want my patients to feel safe and comfortable during this experience.

Tell me about your ideal work day.

Every day I come to work I have a great day. But my ideal day would be successfully helping all my patients with their care needs and providing great health outcomes.

What do you like to do in your spare time?

I love to play netball and spend time with my family.

Do you have any role models and why?

I have three main role models in my life. 1) My mother. She is an independent woman who has always put everyone else before herself and her work ethic is amazing. 2) My father. I strive to be the best person I can be because of him. He has taught me the importance kindness and respect. 3) Dr Anna Pham. Dr Anna is an amazing and caring doctor who has achieved so much. She is committed to her staff and patients. I strive every day to be like her.

How do you help educate your patients about maintaining good health?

I re-enforce the importance of seeing your GP on a regular basis. I regularly refer my patients to useful website such as The Heart Foundation. I assess my patients and their needs, for example, in relation to weight gain, diabetes, arthritis etc. Mental health plays a big role in a person’s health outcomes so I always encourage my patients to find someone they can talk to, and I offer my ear if they need it. I also inform my patients about mental health care plans to assist them.