NARELLE LUKINS - RURAL & REMOTE EMERGENCY NP

A rural and remote emergency NP, Narelle works at the Margaret River Hospital, Western Australia in the emergency department.

A thriving area with a huge demand for health care services, the hospital has moved from having doctors visit from offsite on demand and now has doctors on site to cater for a growing community and also the needs of visiting tourists to the area.

Narelle has lived with her husband and kids in the beautiful Margaret River for over 14 years and did her NP studies while at the Margaret River Hospital.

Can you share a little about the community you are working in and the nursing you are providing to patients?

My work is carried out in a rural setting and caters to the needs of patients who work in the dairy, beef and wine industry as well as the tourism industry including patients who are involved in accidents relating to mountain biking, surfing and outdoor activities. It’s fair to say in the Margaret River Hospital we see a vast cross-section of issues in the ED.

A lot of the time in the emergency department I work with patients from a farming background - we see a lot of trauma, smaller cases including lacerations, broken bones, falling off bikes, falling off skateboards, and lots of farm mechanics such as bulls hitting people against fences and injuries relating to running belts for wine businesses.

We have a higher trauma count than the average rural hospital since people tend to come on holidays to the Margaret River and head to the ED after taking part in activities that they wouldn’t usually do.

We have lots of restaurants in our area, so we see plenty of chefs who have cut their fingers and a wide range of adventure-style injuries. My partner works in a winery and sees the nice side of things, and I work at the other end when it goes badly!

What is unique about your role in the community?

The most significant change I have found since becoming an NP is that I can improve access to medical care in my community. In the past patients had to wait for a doctor to arrive, now patients have another health care solution, and has reduced the wait times for patients needing medical care.

What makes my role as an NP unique is that, particularly in rural areas, if we have a really sick patient that would ordinarily take all of our resources we can carry on and ensure things are moving along in the delivery of essential medical care. I ring patients and follow up and check on them to ensure they get the extra care they need and contact GP’s to ensure following their ED visit they get the long-term health care support they require.

I work with the nursing and medical team to save the life of the patient and, once stabilised, I move away and keep the emergency department moving. For the community, this means there are fewer delays and more fluid support when they visit the emergency department.

The nurses couldn’t do the prescribing and the complete episode of care and since becoming an NP I can now do this without needing to see additional resources, this really helps our little hospital.

Clinical leadership is also improved for nursing staff, and I present to nurses to promote education and enrich the medical offering at our hospital. We are working on building a strong nursing service and getting the additional theory to back everything up and keeping the staff on top of the latest research is essential and extremely valuable.

Why did you decide to become a nurse practitioner?

I went country in my nursing, and I realised there was a lot of disjointed care and this was a huge challenge in my early days in health care and remains an issue to this day particularly in rural and remote areas.  I felt I needed more knowledge, and the NP role provided this essential information and skill enhancement I craved.  The model helps to provide the complete assessment and education and a plan of care that our patients deserve.

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

The establishment of education in our little emergency department is a focus, and I would like to build this and expand it to other areas.

I’m passionate about getting behind and promoting the NP role in other hospitals across the South West to drive awareness of the NP role in the broader community.

Apart from this, I have three key areas that I am working on to try and make a difference in my community.

At risk group screening - Gonorrhoea, Chlamydia, and syphilis rates are increasing, and the WA strategy is to offer screening to high-risk groups, and one of my challenges at the moment is working to set up opportunistic screening for these at-risk groups and request swabs and follow up on these swabs.

Independence for the aged in our community - I’m also working to help individuals in the later stages of their lives through a program called ‘Stay On Your Feet’. I work with local physios to support and explore ways to keep older people in their homes after a fall so they can get the extra support they might need to keep them balanced and independent.

DNW patients - Another area I am working on is the ‘did not wait patients’ in the ED. I aim to explore this risky group to focus on delivering better health outcomes. I want to ensure these groups have the care they need and want to gain access to prevent issues and provide the support they need - that is a goal.

If you weren’t an NP, what would you be doing?

I would love to be a gardener in a conservatory - I love growing plants, and I would really enjoy the peace and quiet of people not relying on me or needing me throughout the day.

In my career as a RN and now an NP I care for the human and I listen to the entire person. I work backwards from the symptom to find complete solution for my patient’s health care. I don’t treat disease, I treat the human - it is a different ethos.