MARGARET NICHOLSON - ICU NP

Happily married to a nurse, Nurse Practitioner (NP) Margaret Nicholson lives on acreage in New South Wales and enjoys gardening and relaxing on the beach, and watching her children and grandchildren in the surf. Motivated by her passion for clinical nursing and improvement of patient-focused services, Margaret decided to become an Intensive Care NP, and is actively involved in nurse training programmes as well as advocating for the NP role when she is not busy working at the Liverpool Hospital in Sydney.

Tell us a little bit about your nursing journey.

I have always wanted to be a nurse, since I was 4 years old. I had numerous visits to Balmain Hospital as a child and wanted to follow in the footsteps of the wonderful staff I came in contact with. My Great Aunt was a nurse at Balmain Hospital and my Grandfather wanted to pursue a career in medicine. He didn’t get to follow that, and was sent to war and acted as a medic.

Fast forward to the present, I have been a nurse for 33 years and 26 of those years have been in the Intensive Care Unit (ICU) at Liverpool Hospital in Sydney. I was part of the introduction of the Medical Emergency Team (MET), becoming one of the longest standing members of the team, and was involved in developing the database, reports and the key performance indicators to measure the effectiveness of this system.

Throughout my nursing career, I have held numerous positions, including clinical nurse specialist, research officer, project manager, nurse unit manager and acted in the ICU clinical nurse consultant and equipment officer position.

I have also been actively involved in the Sepsis Kills Inpatient programme as well as the Deteriorating Patient Committee and Tracheostomy Guidelines for New South Wales. I train medical and nursing staff in tracheostomy care and assisted other hospitals in building the case for NPs and mentor new NPs and transitional NPs (in training).

Tell us about your current role as a NP in your community

I am a NP at the Liverpool Hospital, which is a large tertiary referral hospital with over 800 beds. The population it services have a low socio-economic status, and the area is culturally and linguistically diverse with 49% of families in the district speaking a language other than English at home.

In my role, I am part of the MET, and review patients post MET call and ICU discharge. I also lead the Tracheostomy Resource Team at Liverpool Hospital in collaboration with admitting teams, as well as assist with the management of deteriorating paediatric patients at MET calls. Receiving referrals from the Brain Injury Unit to assess readiness and management of tracheostomy weaning is also a part of my role. I have been referred patients to assess if they can have the tracheostomy tube removed, a recent case involved a young girl that was left with a severe traumatic brain injury who was unable to speak because of her tube and was fed through a tube in her stomach. I initiated weaning and managed to get both her tracheostomy tube removed and her feeding tube, she recently sent me photos and an email describing how we have made her life return to normal. I also train staff, carers and patients to look after patients that have to have permanent tracheostomy tubes. I am a resource for caring agencies for troubleshooting and advice.

I also teach patients and their families the benefits of using cognitive aids whilst recovering in the acute phase of brain injury and alternate forms of communication when facial cues are all that can be used.

I find the most rewarding part of my role is working within an amazing team and getting to see patients return to their home with their family, or supporting patients and their family through palliation. My role is unique because I have a broad scope, focusing on acute deterioration, resuscitation, and the management of tracheostomy weaning to decannulation.

What influenced your decision to become a NP? Why did you choose your scope of practice?

Having held many positions in nursing including management, I have always gravitated back to a direct clinical role as this is where I get my greatest satisfaction. In my journey as a clinical nurse, I consolidated my training and experience to become an expert bedside clinician and felt there was more I could offer, and I realised that being a NP would allow me to do that.

I chose my scope of practice because of my years working in and expertise in resuscitation. With my knowledge and experience, I felt empowered to support staff and patients outside of the ICU environment as well as those within ICU to ensure the best care was provided and targeted to their needs.

The inclusion of tracheostomy management into my scope of practice resulted from my expertise in this area as well as a perceived need for improvement in management of patients from the acute environment through to ensuring appropriate support and resources were available for home management of this specialty area.

What are you hoping to achieve in your current role as a NP?

I am hoping to promote the benefits of the NP role so that other ICU’s will take the opportunity and build the positions into their model of care. I want to help other nurses consider the NP pathway as a career choice, so that NP positions continue into the future as an embedded member of the multidisciplinary team.

I would also aim to be involved in continuous improvement of patient experience as new evidence in treatment emerges. I am keen to support my colleagues and become a role model for new staff, replicating the experience that I was fortunate to have during my earlier career.

What advice do you have for anyone wanting to become a NP?

Being a NP is a fantastic and rewarding career path. Stay focused and be determined to develop lifelong learning skills. Make sure to identify the gap a NP position could fill, and work with your Executive team to build a case. It is important to have a mentor that will challenge you in your critical thinking as well as have a great support network. I have been supported by my family and my medical and nursing colleagues throughout this journey, and I could not have achieved this without their support, and for that I am extremely grateful.

How do you think health consumers will benefit from seeing NP?

NPs can provide services including advanced assessment, diagnostics and treatment plans and can refer to other specialists. They also have access to a large network of nurses working in other roles and can make contact for advice and services outside of their own area of expertise.

Research highlights the benefit of NPs, particularly those that report satisfaction surveys which have highlighted an overwhelmingly positive response to NP roles. The NP role has enhanced teamwork with practice facilities and hospitals, the NP is seen as a senior part of the health team and remains a constant usually staying in the position for longer periods and have well developed communication skills, and are able to relay information from their patients to senior medical clinicians when required. They act as a support to junior medical staff, nursing staff and allied health and can provide timely advice. NP services have been identified as able to reduce waiting times, prevent hospital readmissions, and provide services that are consistent with that of a traditional medical provider model. I believe that collaboration between medicine and nursing can positively impact on the health consumer’s experience and outcomes.