SHIREE WALKER - EMERGENCY NP

Shiree was born and bred in Perth, Western Australia born and lives there to this day.

All of her family live on the West Coast of Australia after her Mum and Dad emigrated to Australia 43 years ago from India and settled in Perth. Shiree is married and has two elderly fur babies who are 13 years old.

Shiree works in the emergency department as a Nurse Practitioner (NP) in both a metro and rural role in Armadale Emergency Department and also at the Northam Emergency Department around two hours from the centre of Perth.

 As well as being an emergency NP for the past five years, Shiree also works as a cosmetic NP once a week, mainly in cosmetic injectables and skin aesthetics and for the past six months has been relieving at Curtin University as the NP course coordinator.

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

Working in my role, I get the best of both worlds, working in a metro and also in a rural setting.

Working in metro you have a lot more access to services and referrals are a little easier for ongoing treatment and follow-ups. Whereas working in rural areas services can be limited at times, and it can be a struggle to get the patients to where they need to be.

In my role at Northam Emergency Department, when we transfer a patient by ambulance to a larger hospital that may mean we  no longer have a paramedic crew in the rural town or that there may be a  delay in getting another ambulance crew to the town.

Depending on the skill mix of staff and the acuity of patients in the ED sometimes I can wind up doing the patient transfer in the ambulance, or I may switch to any number of roles in ED to ensure that we continue to provide the best care for our patients. By being adaptable and forward thinking we are able to ensure that our rural service continues to provide our patients with a high-level quality of care.

At Northam, we are currently in a temporary building (due to renovations) that boasts five bays and two resuscitation bays plus a treatment room, which also works as my very own treatment room.

What is unique about your role in the community?

I think my role at Northam is unique due to my varied nursing history. I am used as a resource for a lot of different patients. I have worked mainly in some of the more prominent hospitals in Perth, so I have gained experience and skills that I feel are valuable for the entire emergency department and the wards.

For post-operative patients who have had major operations in the city and moved back to rural areas, I can help care for their needs while they are close to home. An example of this is when I cared for two patient following breast cancer surgery. Both had problems with their dressings and surgical sites once they arrived home. I was able to provide support for the ladies by reviewing their wounds, liaising with their surgical teams in Perth and providing further discharge education and support.

By treating them via the ED it avoided the need to head into the city or experience long trips in the car for check-ups. Although an Emergency Department should mainly be used for accidents and emergencies, in rural areas it is often used in the absence of out-patient clinics to prevent patient complications or deterioration.

In my line of work, complications can cause issues and treatments can be performed in rural areas rather than heading to metro areas.  I feel like I hover over a range of different specialities and this is one of the unique parts of being an NP in my community.

I am a generalist NP, and while I started my career in primary health care, I am a jack-of-all-trades in the work that I do and the care I provide for my patients. In the course I undertook at Curtin University, we were trained to be a generalist NP, so whilst I can do head to toe assessments and focused assessments, I have been able to develop the skills and knowledge to also work as an Emergency Nurse Practitioner as well as a cosmetic NP. That’s the beauty of being an NP really.

Why did you decide to become a nurse practitioner?

I first started working alongside Pam Morey (Wound Care NP) at Sir Charles Gairdner Hospital, who was in the first group of nurses to complete the NP qualification in WA.  I worked alongside her as a clinical nurse, and I was amazed at her knowledge base, her advanced assessment skills and the amazing work she was doing. This really inspired me to explore the role of an NP.

Then I moved roles and started working alongside a Urology NP (Fran Lee) at Fremantle Hospital and was equally amazed at the skill set and knowledge base of both of these women. This really encouraged me to seek out the NP qualification and get started on the path to gain the qualification myself.

We ran a lot of nurse-led clinics at Fremantle Hospital, and this motivated me to do the NP training to become one of these valued individuals in my clinics.

During my continence/urology clinics I would complete a full assessment of the patient and determine the appropriate treatment for their health condition. Even though I had completed the assessment on the patient, if further pathology or radiological investigations or a prescription was needed I would need to call the junior doctor to complete this task - which seemed crazy.

Being an NP, I can provide the holistic care my patient’s need without any gaps in care and only requiring the extra support from the doctors when things fall outside my scope of practice.

I had a lot of support and encouragement from the NP’s around me and also the doctors from the UK who have worked with NPs before and understood their value in the roles as part of a collaborative approach to patient care.  The support of international doctors and my nursing colleagues and their understanding of the importance of the position has been a massive help in transitioning from RN to NP.

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

In my current role, I would like to encourage other nurses to consider the NP role as a career pathway.  It is an exciting time for Nurse Practitioners and I would encourage any nurse who would like to further their clinical knowledge and skills to consider this as an option for their future. In saying that, I would like to see more permanent positions for NPs in WA.

In the current climate, it can be a challenge to get a permanent position for NPs. But I believe we are making positive steps in building the profile of the NP and the positive contributions we can make to our health care system.

Personally, I am considering doing my PhD. After becoming an NP five years ago, it is something I would like to explore as I want to make a positive impact in the lives of my patients.

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

I used to work in an ice cream shop in high school and then I worked in a toy store while I was at university.

Then I went straight from high school to study nursing and, graduated around my 21st birthday.  There really isn’t anything else I would be doing. I love nurturing and developing new knowledge, and this position allows me to fine tune my skills to help patients in my care.

If you were to use a few words to describe an NP what would they be?

I’m an advanced practice nurse, and I am able to provide a head to toe patient assessment, order relevant tests and interpret the results to develop a diagnosis. I am also able to perform procedures and prescribe medications.

I think it is an exciting time and it is really helping us to push the profession and become autonomous. Now that our profession is at university level, nurses can stand out for their own merits and showcase the fantastic skill set they have. It’s an exciting time to be an NP.