JULIANE SAMARA - PALLIATIVE CARE NP
Fifth generation born and bred in Canberra, Juliane comes from a large extended family, and has been married for 31 years to a very supportive husband. They have three adult children and three grandsons.
At the age of five Juliane owned a beautiful red cape with white fur trim, and whenever she went to visit someone in the hospital, she insisted on wearing it, pretending to be one of the nurses going to work. In her teenage years Juliane avidly read the “Cherry Ames” series of books by Helen Wells and continued to think about becoming a nurse, however she did not enjoy studying and so decided to leave school at the end of year 10. Juliane went onto completing a childcare certificate before working in several administrative roles including paying parliamentary travel allowances, being an after-hours manager at the local cinema, and working for an IT security company doing website maintenance and business development.
In 2002, Juliane realised that she had at least 20 years of work ahead of her, she was not enjoying being behind a desk all day and she really wanted to make a difference. Her father-in-law had been diagnosed with lymphoma and Juliane spent a lot of time with him – during this time, her dream of becoming a nurse resurfaced. So, she decided to resign from her job and entered the world of nursing.
Juliane talks about her decision to become a nurse:
After enrolling in a university bridging course, I was accepted to study Bachelor of Nursing at University of Canberra. I studied full time and worked nights and weekends in residential aged care which was a fantastic way to get clinical experience. During my final semester, my father-in-law relapsed, and we knew he was dying. I remember a conversation with him in his last days - he told me that he believed I would be a good nurse and would make a real difference to people at the end of their life. I helped care for him while he was dying and knew from then that I wanted to work in cancer nursing and eventually become a palliative care nurse.
Why did you decide to become a NP and how did you decide on your scope of practice?
I had started studying for a master’s degree in cancer nursing when I realised that I was becoming frustrated with not being able to provide care to patients from beginning to end. Patients in the chemotherapy unit were often unwell or had adverse reactions to treatment and doctors often could not come until the end of their busy clinics. This was causing additional delays and burden for patients and the nurses. We often had to wait for a doctor to be available to order a test or write a prescription. I knew that I had the clinical skills and knowledge to be able to make safe and appropriate decisions in patient care and treatment, and I wanted to be able to reduce the time patients spent in the unit so they could be at home with their families. I thought it would be much better for them (and more efficient for the organisation) if one person could manage problems from start to finish, so I decided to change over to the nurse practitioner master’s degree.
Tell us about your current role
I work with the Calvary Community Specialist Palliative Care team and my role is to provide consultancy palliative care in residential aged care facilities. I am really fortunate to work with Nikki Johnston, who has been a palliative care nurse practitioner for more than 8 years and is a wonderful mentor. Between us, we visit 28 residential aged care facilities in the ACT and we have just finished the INSPIRED trial introducing a new model of care through palliative care needs rounds, which is making a real difference to older people at the end of life.
I love every aspect of being a nurse practitioner and feel that I am finally working to my full potential as a nurse. The elderly in residential aged care have complex medical conditions; they are very vulnerable and deserve to be treated with dignity and respect at the end of their lives. I think they really appreciate having someone who will take the time to get to know them and their family members. We find out what really matters to them physically, spiritually and emotionally, complete advance care plans and help to manage their symptoms so that they have good quality of life until they die. Families also get a lot of comfort knowing that palliative care specialists are providing expert advice, education and support to the nurses and carers so that they can provide the best care possible in the last months of life.
Why did you choose Palliative Care and Oncology as your scope of practice?
I worked in oncology from the very beginning of my nursing career and really loved all aspects of cancer nursing. In my specialist nurse role, I was providing supportive care for adults with brain tumours and gynaecological cancers. These cancers have very low survival rates, and so a large part of my work was really palliative care. After I was endorsed as a nurse practitioner there were no available NP positions in our local cancer unit. When I was offered the opportunity to join the Calvary palliative care team for the INSPIRED trial, I was very excited about the work involved and the potential to fill a huge gap in aged care and make a real difference.
Although I was sad about leaving cancer nursing, I thought it was time for a new challenge and a great opportunity to fulfil my dream of becoming a palliative care nurse. Many of the elderly people I see have a cancer diagnosis in addition to their other chronic illnesses, so it is great to be able to put my skills and oncology experience to good use. Now I can’t imagine doing anything else!
What are you hoping to achieve in your current role as a NP?
I am very passionate about using my skills to improve quality of life and death for the elderly in residential aged care. It’s also important to me that I support and mentor other nurses and carers. I always look for opportunities to share knowledge and teach them new skills, so they can recognise clinical deterioration and effectively manage symptoms for their residents. I am interested in continuing to be involved in research so that my practice is evidence-based, and we can help others to provide quality palliative care.
What advice do you have for anyone wanting to become a NP?
Follow your dream and don’t let anything stop you. Find a good mentor, make sure you have a strong support network and remember that even though it is hard work, it will be worth it in the end. Nurse Practitioners have such a huge role to play in delivering and improving health services, we need to grow our NP workforce!