Shirley has worked in the nursing profession for over 45 years after starting her nursing training when she was 16 in New Zealand. Graduating and becoming an NZ trained Registered Nurse/Maternity Nurse in 1976, Shirley spent her early years working and travelling, employed in a wide range of roles in NZ, Australia and UK, finally focusing on specialising in the emergency department, and settling in WA in 1996 with her husband and three children.
After spending 10 years working in the ED at Busselton District Hospital, Shirley began her studies to be an NP, qualifying in 2009. Shirley joined Nurse West nursing agency as a casual NP and travelled to different sites in WA to do relief NP work, covering NPs on leave. In 2013, Shirley was the successful candidate for a permanent position at Manjimup Hospital in the small rural town in the Southwest of WA, as NP in the ED.
The hospital is serviced by local GP’s who rotate on call for the ED, and the NP provides a full-time presence delivering health care to the local population in collaboration with the GP’s and nursing staff.
Shirley enjoyed this position for 4 years until she embarked on her current role, which is a secondment back in the “new” Busselton Health Campus, participating in a trial to establish the role of NP in the fast track area of the emergency department.
When she’s not working as an NP, Shirley helps out on a small family-owned vineyard, established 22 years ago with her husband on the outskirts of Dunsborough in the Margaret River wine region. Shirley and her husband Larry live on the lifestyle block, which has 8 acres of vines and a cellar door (which Larry works and manages) and a few sheep, chooks, guinea fowl plus kangaroos and birdlife.
Can you share a little about the community you are working in and the nursing you are providing to patients?
Busselton is a really popular tourist location, particularly for fishing, surfing and holiday homes which means that in the fast track area of our emergency department we see a lot of fractures, lacerations, nasty wounds, hand injuries, sprains and strains, burns, infections, foreign bodies in eyes, ears, noses etc.
We treat adults, children, locals, visitors, and transient workers, I meet a lot of interesting people along the way.
I work in the fast track section which sees many triage 3’s, 4’s and 5’s and entails a lot of suturing, applying plaster casts, wound care, and organising referral for patients who need ongoing specialist care from other services.
Each injury requires assessment, pain relief, relevant investigations such as X-ray, ultrasound, bloods and subsequent treatment, referral and education, as well as communication with the usual GP and documentation.
When the acute department is overly demanding the medical staff can be tied up treating all the triage 1’s, 2’s and 3’s, so the NP keeps the lower triage score patients moving through the department to help reduce long waiting times for the less acute injuries.
What is unique about your role in the community?
As the nurse practitioners role is still very new, many people don’t understand what the role entails, so a lot of my job is educating people about what we do – including the nursing hierarchy.
It is such a new role that people don’t really understand how our role differs to the traditional nursing role. The NP is more focused on assessment, investigations, diagnosis, treatment involving procedures and patient education.
I’ve always loved clinical nursing, and I know from performing various acting roles that management isn’t where I want to be. The nurse practitioner role is very different dependant on the site and health service delivery where you are practising.
At Busselton ED we have a consultant-led service with medical staff on duty 24 hours, and here the NP is focussed on fast track patients.
In Manjimup ED, medical staff are not present 24 hours but are on call for presentations which are beyond the scope of practice of the NP. The numbers of presentations per day in the rural site are fewer, but they still include all the same type of presentations which the larger sites see. The resources at the rural site are far less, and high acuity patients need to be transported by RFDS or ambulance to a tertiary site for ongoing management. AMI’s, toxicology, acute respiratory, burns, traumas, DKA and acute psychosis all have to manage at the small sites before being referred to specialist services. This can be very challenging for all those involved.
What is a typical day in the life of me as an NP?
In Busselton ED I work from 10am to 6pm, which allows for me to help treat the numbers of 3’s, 4’s and 5’s which are greater during those hours.
As part of my role, I log on to a patient tracker to see who is next to be called into the department (within my scope of practice). I perform patient examinations, administer medication which I have prescribed, order investigations such as pathology or X-rays, monitor progress, collaborate with specialists or consultants, deliver patient education, write scripts as needed and refer patients to another service as needed. I can see anything from four to twenty-two patients in an 8-hour day.
At Busselton we don’t have a nurse in fast track, so I do my own dressings and medications plus the doctors periodically request help with nursing care for patients they are seeing and treating in fast track. Wounds can be very time consuming, complex individual situations, ensuring the patient understands the care plan, and proper documentation for the rest of the healthcare team, all make for longer consultations.
I try to involve the patient with their care plan and share information on issues such as smoking cessation, obesity and weight loss and other issues that could help with their long-term health management.
People in lower socio-economic situations tend to use the ED for regular health care, so these patients may also make up fast-track clientele. With the current amphetamine scourge in our society, we see a lot of the fallout from side effects induced by the drug, such as poor dental health, anxiety, and family breakdown.
My role also involves data collection and audits, which have to be done in between patient presentations where time allows. I am constantly trying to improve on our systems and resources to improve patient outcomes. Keeping up to date with current practice is ongoing daily practice.
Why did you decide to become a nurse practitioner?
When I turned 50, my kids were all at university or about to go away to study, and after working in nursing for 34 years, I was frustrated with my role and weary of what I was doing. I decided the way to move forward was to get some education, so I could do my job better and get more satisfaction. We had two NP’s doing their “prac” in our department, and I decided that was exactly what I wanted to be.
Because I was “hospital-trained” and I hadn’t done any uni work, my kids had to show me how to do research and use the computer, but once I started, I really enjoyed what I was doing and quickly loved the study side of the NP role.
I have a lot of clinical expertise, and the academic side of things in studying to be an NP was an exciting change - now I am happy I can treat people autonomously and offer holistic care.
The role of an NP is relatively young, and I am proud to be one of the pioneers in this role. I enjoy sharing my knowledge with future NPs and RN’s exploring the idea of taking on the study in the future.
What are you hoping to achieve in your current role as an NP?
My goal is to work until it is time for me to retire - I love what I do, and as long as I stay healthy I want to continue.
I aim to help establish the NP role as a standard role in the healthcare team, which is acknowledged and valued.