Nursing is a team sport

Nursing is an incredibly complicated job that combines so may different elements in to a single role. You don’t have to be great at everything, but you have to be a good all-rounder. One thing you can’t be lacking in is team work. Don’t play well with others? Can’t accept help? Don’t seem to be able to find ways to get out of your own way to give some else a hand? You may not cut it as a nurse.

Working in a busy hospital setting can be stressful, it can be busy and sometimes, despite all your best efforts, everything goes to hell and you never get to your break. Or you don’t finish what you were planning to do. Or you miss home time and have to stay back to finish your notes. Or you realise you haven’t been to the toilet for six hours. It happens. When it starts happening all the time, then something is up. When it starts happening to others all the time – you have to start looking at the workplace, the staff and the culture.

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A large responsibility falls on senior nurses. Their role is two fold: to lead from the front in setting the tone for teamwork; and to set the example when it comes to self-care. Graduate nurses and students will always look to the example set by the most senior staff on the ward. If you are coordinating a nursing shift, you are often under the pump. Bed managers want you to clear your decks, theatre are always wanting to clear their recovery ward and get patients off their hands, the emergency department are desperate for you to clear their beds, families want information, your boss wants your time and your nurses want leadership. It can be stressful. There is a lot to coordinate. There can feel like no time to think. What there is always time for, is time to help.

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The more you can get around your staff, the better. Just because you were in the right place at the right time to score some epaulettes, a red collar or a clipboard doesn’t mean you can’t muck in and help. Your coordinating a shift – you aren’t above helping with the most basic of nursing tasks. I’ve seen Director’s of Nursing treading the lino of a busy hospital in a crisis stripping beds and taking observations. Get over yourself. Where this is critical is when it comes to helping graduate nurses and new staff. Desperate to seem like they are on top of it, they will refuse help or view it as an acknowledgement of their lack of ability. The more normalised helping is, coming form the leaders on a ward, the easier it is for graduates to accept help. This will help them from floundering, build the culture of helping and guide them on what is expected when they aren’t the new graduate.

The next key thing a leader on a ward MUST do is take meal breaks. We’ve all seen coordinators eating al desko while sorting out transfers, paperwork, admissions or the like. That’s great. Its really inspiring to see their dedication. Their refusal to step away from the fray. Their reluctance to hand over the reigns to another profssoinal, to admit that they are expendable to the machinations of the ward. We’ve paid witness their inability to manage their time effectively. Their lack of awareness of OH&S legislation and patiently negotiated Enterprise Bargaining Agreements outlining their entitlements. Their lack of leadership when it comes to setting a correct example in ensuring that you have taken the appropriate steps for maintain your own well-being. We’ve seen them ignore patient safety by taking an allotted break; and fail to show the new nurses and graduates that one of the most important things you can do as a nurse is look after your most important resource – yourself.

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Now, if it is UNSAFE to leave your ward environment due to a change in condition, a catastrophe or inappropriate staffing, then you still have a major role to play. You need to call nursing management above you and demand they come and relieve you so that you can take your break. If this is a regular problem due to workload, you need to show leadership and ensure that all nurses working through breaks apply to be paid for that time. Unless you are in a senior hospital management position that prohibits you from leaving the facility during your shift, your break is probably not paid for. Which means it is your time.

Now, if you feel like donating your time to your health service and government department, on top of your contribution through taxes, that is noble – because that is what you are doing. It is also crazy. You are not helping your patients or your fellow staff by not taking a break. If anything, you are undermining them by suggesting they should stay on the ward too, or suggesting they aren’t as “dedicated” as you are. You are also undermining your Enterprise Bargaining Agreement and giving management no reason to improve staffing as you always seem to “manage”. you are cutting your nose off to spite your face. No body likes that.

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Taking your breaks and helping other professionals may seem like small things, but when you are working in a high-pressure environment, they mean big things. Helping those around you, if you are a senior nurse or not, helps morale. It helps the professionals around you know that you think beyond your workload, your six patients. It points out that your not so absorbed with your own workload that you can’t lend five minutes to someone to help with a turn or a wash or some post-operative observations. It points out that you are a team player.

On the flip-side – don’t exploit people that do offer you help. I worked a shift recently where I did more work with a group of patients than the nurse that was allocated their care. I wasn’t the only one that noticed this – my fellow colleagues on the shift and the manager did too. Its not a good look. It hinged somewhere between a lack of time management and a keenness to reduce a workload beyond what is reasonable. Don’t be one of those people that refuses to accept help when it is offered – but don’t be one of those people that tries to get others to do the tasks you aren’t that interested in or are less than great. Acting like that puts you well offside with your colleagues to the point that come the day you really need some help, and you are really under the pump – they might just blow you off. Professionally, of course.

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The reason it is so important to embed such small concepts in to ever day practice is that in nursing, when things go really bad – they can go REALLY bad. If you’ve got a strong, committed and engaged team that genuinely respects each other; when things go badly, there will be no question that the team will kick in to gear.

When you’ve instilled in all nurses that looking after their own well-being is more important than paperwork or six hourly observations being thirty minutes late – then you’ll have well balanced, well rested, well fed individuals who will work harder and more efficiently because of their breaks, not in spite of them.

When graduates know that taking their coffee break is critical to managing their time, because their supervising nurse does it – they won’t baulk at doing it.They won’t learn the bad habits of eating meals while writing notes or skipping breaks to provide care.

When a nurse knows that they can help a colleague who is under the pump without being exploited, or shooed away – they’ll keep offering.

When everyone is working together and playing on the same team with the same rules, goals and expectations – those busy, pressurised environments become fun, engaging professional challenges.

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When you’ve got a great group around you that values team work – you enjoy your shift and have great patient outcomes.  There is no place for individuals, egos or selfishness when nursing is a team sport.

Young Crew and Severe Injury

I have spent some time working with young people on a program attempting to engage them on the concept of choices and consequences, particularly around partying and road safety. It was hard work. It was enjoyable work. Most importantly, it was work that allowed me to hang out with young people and hope that they cared about what I had to say. It sometimes felt a lot like high school.

When you’re in high school you are desperate for people to like you. To talk to you. To think that you are worthy of their attention and they you have something interesting and useful to say. There is so much at stake. What if they hate me? What if what I say sucks? My work allowed me to return to those anxieties, but at seemingly much higher stakes. I wasn’t just hanging out at lunchtime with young crew, I was trying to convince them that keeping their limbs on was worth their attention.

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Until recently I worked on a project that involved coordinating and delivering a program that focused on reducing youth trauma – particularly trauma resulting from drinking or high risk behaviour. I was basically trying to teach teenagers how to not be stupid. And really, the focus is predominately on young men not being stupid. In 2016, a staggering 71% of trauma patients through the major trauma centre in WA (15-24 year old age bracket) were young men. And primarily young men that had taken stupid, high risk choices. From my home region – young people accounted for 25% of people killed or seriously injured on our local roads between 2004 and 2013. The excuses of the excesses of youth, the difficulties in delivering programmes or vagrancies of funding can’t be excuses for not trying to educate this group.

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I was involved in a really fun program to deliver. I am also the first person to admit it wasn’t always perfect. It could always have been improved, expanded, built upon. Health promotion is most effective when delivered as part of a structured program that is embedded in to multiple areas; rather than one-off field trips – but when you only have the capacity to deliver the one-offs, you have to decide whether one-off interventions are better than no interventions. We endeavoured to ensure the program was delivered in conjunction with other projects and programs, but occasionally it was purely stand-alone. I know what the research says, but sometimes you can only do what you can do.

A major challenge involved in running a project like this, was stakeholder management. So many stakeholders, all very important to the project, all with different needs, goals and motivations for their involvement. There were tense moments during development and delivery that would have been easier to manage with less people to worry about, but that may have reduced the efficacy of the program or the internal and external support. It was a delicate balancing game.

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After navigating the stress of just getting the project up and running – my main joy was delivering the actual program days. Delivering programs to young people takes a significant amount of energy. You have to just go for it and second best will not do. Program days would first involve juggling presenters and pretending on top of everything; then once that was under control the real fun would begin. It would be my turn to hurtle head first in to an awaiting pack of rabid youths, desperate to make my mark, or at the very least, a smeary smudge against the windshield of their youthful egos.

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That is where when head back to high school. Now, this was not peer-education. I’m old. Like grey hair, married with children old. I am so not lit. Sure, I’ve met young people and some of them have even spoken to me in a consensual two way conversation – but I am O. L. D. The young crew I was speaking to were generally in the sticky, messy part of the teenage dream, where parties, booze, sex and risk taking come crashing together with awkwardness, naivety and acne. I’m old enough (if I’d made some dramatic life choices) to be their dad. Or at least their uncle. In fact, for one of the kids – I was their uncle. Now, that was a tough day of trying to balance role duality. The challenges of working in regional areas.

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So, how do you make yourself relevant when speaking to young people without making yourself a grade-A example of an epic toolie? The first step is to sincerely acknowledge that you are not their peer, you are old and you do not know what they are going through. Aside from the fact that this is 90% the truth, it helps establish that you aren’t trying to be cool – you’re trying to be useful.

One thing that was VERY successful for me and a I recommend to anyone working with young people: don’t be afraid to ridicule yourself. It helps reduce the feeling that you are holier than thou and preaching to the group. I never felt that I lost standing mixing strong messages with some self targeted ribbing. One of the most talked about slides from my presentations has been my then and now picture. I use it to introduce the concept of choices and consequences to the program – mainly my poor choices in hair style and fashion.

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Another tip: find a concept and deliver it well. We worked hard on the choices and consequences concept – reduce your risks, help your mates, beware the ripple effect. Trying to convince a group of young people that a potentially silly error could lead to ongoing and possibly lifelong effects is a tough sell – one that can be achieved through making what you are talking about real, relatable and raw. A participant has to be able to put themselves or someone they know in the picture.

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The ripple effect was one of the key tenements of the program. It sprung in to existence from almost nowhere one day and became a core principle of explaining the concept of road trauma to young people. We don’t give young people much credit – they can be portrayed as lazy and self-absorbed. An unfair generalisation that doesn’t allow for the fact that there is great compassion and empathy in amongst our young crew. I would often explain the concept that health workers – the paramedics, doctors and nurses that dealt with front-line trauma are not robots. They are people, with families, and friends and lives that went on beyond delivering emergency health care. The concept that their decisions may actually impact on me and my children’s lives proved to be surprisingly effective in gaining their attention.

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Another pointer: tell real stories. Scenarios are great. Real life is even better. I have, unfortunately, lost far too many friends and peers through road accidents. Some were drinking driving. Some were speeding. Some remain unexplained, many, many years later. All were young men. All were tragedies. All ripped the heart and soul out of families, communities, sporting groups. There is nothing like the jarring finality of the loss of a young life through road trauma. There is a jarring reality when you stand in front of a group of young people and speak candidly about how hard it can be to see the mother of a dead friend, even years later. Explain the times you catch yourself day dreaming about the possible children a mate could have had, what type of dad he may have been, what type of partner. Retelling the reality of a life lost aids with cut-through.

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There was great opportunities to learn from the groups. Not just from what they were saying, but their actions, their responses, their feedback. There is something really exposing about presenting to young people (if you care). You are putting yourself out there – and they will provide direct and cutting feedback if what you are serving up isn’t to standard. The groups I spoke to had no qualms in questioning what was presented, how it was presented. They were fair but harsh critics – and they demand the best of you as a presenter.

The content we delivered was hard going and the manner it was interactive, challenging and occasionally fun. There can be a misconception that if you are learning about a serious topic you can’t enjoy yourself. It is widely accepted that children learn best through play. Surely adults and young adults are the same. This week I was reading an article by Dorothy Lucardie, who highlights that having fun and experiencing enjoyment were recognised by adult learners and teachers as a significant motivators to attendance and learning the knowledge and skills; while fun and enjoyment were considered a mechanism that encouraged concentration by learners and helped in the absorption of learning. We shouldn’t be afraid of making learning about serious topics fun. Why not engage a group, have them invested and involved when talking about the challenges of managing a trauma patient?

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The element of fun, some self-depreciation and relatability and acknowledging that while I definitely wasn’t a peer, I was at least worth listening to – meant that I had a lot of fun delivering this program and excellent feedback from my harsh, teen critics. Delivering alongside some exceptional presenters made my job that little bit easier, and definitely ensured that we had maximum impact on participants. This project was heavily evaluated, and the feedback forms were always glowing – but the biggest things that I would take from delivering the program were the unexpected outcomes, the remembrances, and the relationships with my fellow presenters.

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The value in presenting that program was always the things on top of the content. The outcomes no-one knew would exist. Two male students chose to study nursing after attending the project, changing their study preferences in perhaps the biggest professional compliment I have ever received. One student spent the day seemingly ignoring the key points of the program, before everything clicked in the final 15 minutes of the day. He solemnly shook my hand at the end of the day, staying back explicitly to do so – and still welcomes me in the street 2 years after he attended the program. The young people who remind me they were participants as they serve me coffee in local cafes, thanking me for the program. The parents who approach me and tell me their child raved about the program at home and that they hope it continues. Those were the things that made it really worthwhile, and are the things that cannot be captured on an evaluation or wider expansion of a program. The intangibles, the connections you make, the moments of realisation in a participant’s eyes. You can’t capture that – but it makes it worth throwing so much of yourself in to it.

How can you ride a motorbike?

“You’re a nurse – how can you ride a motorbike?”

I’ve been asked this question hundreds of times by incredulous family, co-workers and strangers. The risks, the amputations, the deaths – they’re horrific! How could I take such a risk? Well, avoiding the clichés of life is full of risks and I definitely am not one trying to live fast and die young – I’m just not that worried about motorcycle related trauma.

Through circumstance, timing and career, I’ve not seen that much motorcycle related trauma to scare me away. Sugar on the other hand – sugar is a nightmare!

Working as a nurse, especially in the Northern Territory, exposed me to the dangers of sugar. It’s terrible. It puts motorcycles to shame. I’ve seen horrific lower leg amputations carried out on the lower limbs of diabetics with a poorly controlled condition. Many more amputations than what I have seen relating to road-trauma.

I’ve seen toe amputations progress to forefoot to foot to lower leg to above knee – almost in the blink of an eye.

The amputations, mixed in with cases of peripheral vascular disease and diabetic neuropathy that have had led to patients having small, somewhat insignificant foot ulcers infiltrated and colonised by maggots have turned my stomach and made me think long and hard about the sugar intake in my life. Much harder than whether to take my motorbike to work or not. There’s nothing like picking maggots one-by-one out of a wound to make you start soul-searching about what went wrong here.

Don’t get me wrong – road-trauma, especially motorcycle related trauma is incredibly confronting, destructive and depressing.

Amputations, decapitations, burns and fractures. Terrible, but not that common. A 2012 paper from the Journal of Foot and Ankle research found that between 2006 and 2007 53% of Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) were related to type 2 diabetes (8% to trauma, 18% to peripheral arterial disease) (Lazzarini, O’Rourke, Russell, Clark, & Kuys, 2012) and that 65 diabetics were having amputations every day in Australia in 2005 (Australian Diabetes Council, 2013).

So – how can I ride a motorbike with what I’ve seen as a nurse? Easily – how do you eat that biscuit?

 

Australian Diabetes Council. (2013). Diabetes Facts from http://www.australiandiabetescouncil.com/diabetes-education/diabetes-facts

Lazzarini, P. A., O’Rourke, S. R., Russell, A. W., Clark, D., & Kuys, S. S. (2012). What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? Journal of Foot and Ankle Research, 5(1), 12. doi: 10.1186/1757-1146-5-12

“Why are you a male nurse? Couldn’t you become a doctor?”

registered_nurseEvery male nurse that has ever worked, has heard these words or similar. Some before they even have the chance to graduate!

Some hear it from confused patients who are struggling with the concept that a young, athletic man would do “women’s work” when there are so many “better” options.

Some hear it from colleagues.

Some hear it from family members, perhaps clinging to the faint hope that one of their own will end up with that lovely Dr. before their name and all the glitz and glamour that goes with it.

Sometimes you get it from people you meet at parties and bbqs. I’d be able to afford medical school if I had a dollar for every time this conversation played out:

“So where do you work?”

“Ah.. the hospital.”

“Oh, wonderful – you a doctor?”

“Um, no, just a nurse.”

Just a nurse. Just. A. Nurse.

male-nurse-comparison.pngSuch a simple, yet incredible devaluing statement that I know I made many times. Just a nurse: just wasn’t smart enough to be a doctor; just couldn’t eat healthy enough to be a dietician; just didn’t own the right jogging shoes to be a physiotherapist.

Now, calm down angry hordes of physiotherapists and dieticians. At least you got a mention. I didn’t bother with Occupational Therapists or Health Promotion. We’ve all got valuable contributions to make within health care. We are valuable. We are not just anything.

It’s such a simple statement that carries so much weight. Nurses, and particularly men who work as nurses need to start taking ownership of the profession. Be passionate and proud of it. For too long I referred to myself as “just a nurse” or as a “male nurse”.

What the hell is a “male nurse” anyway? Do we have “female nurses”? Why are we differentiating? This term needs to go the way of the “lady doctor” and be thoroughly shown the door! I am a nurse. I happen to be a man. They are not related in anyway. They are not gender exclusive roles. Neither is my marital status, sexuality, how many children I have or what I do on the weekend related to my ability to be a nurse.

s-9611e9bbda960201e4bbbcaf9259764b14074abf.gifMen become nurses for a reason. There are very few that fell in to the profession. You will rarely find a man that wasn’t sure what to do after school so thought they’d try nursing. You wouldn’t take the road of nursing, as a bloke, unless you didn’t at least have a strong desire to. You’d study commerce. Or engineering. Or mechanics. Or surf. Or find some other way of earning money that didn’t involve entering nursing. You wouldn’t enter a female dominated profession where you will have your motives, sexuality and personality so constantly questioned.

I didn’t become a nurse to get through the “back door” of medicine. I didn’t do it to date the nurses in my uni class. I didn’t do it so I could see people naked. I didn’t do it because I am gay. There are much easier ways to do the first three things, and well, again, not sure what nursing and sexuality have in common but that wasn’t involved here. Nurses need to sell their profession when we are asked about.

Nursing is a female dominated profession that has struggled to develop and promote its professional standing. A large part of this is because of gendered expectations, obligations and barriers that are placed in front of the majority of the nursing workforce, often by men in administrative roles or neighbouring professions.

Hospitals and health systems are battle grounds for power and status, and its no surprise the profession with a mainly female workforce struggles to maintain its standing. Its important that men who are nurses champion the role of nurses as professionals and raise the standings of our work – but not at the expense of our female colleagues. We can’t drive nursing up by driving men to the top. Though this is what happens.

I became a nurse to be challenged, to help people, to connect with people on a very human level. I wanted to interact with other human beings, to help them through the moments when they are most vulnerable, scared or alone.

Nursing is such a privileged profession – we see people at their worst and try to help them back to where they want to be. We hold people’s hands as they slowly slip across from this life to the other side. We catch the arrest as it happens and set the wheels in motion – sometimes saving that life, sometimes just missing. We see families come together and see others destruct.

All this happens while surrounded by other amazing professionals who support us, challenge us, annoy us and validate us as professionals.

Nursing is such a fulfilling, challenging and diverse profession that requires dedication, intelligence and diligence – make sure the next person that asks you about it knows that.