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#34 WINTER 2021
KEEPING NURSES INFORMED, CONNECTED AND INSPIRED
FREE EDITION
NURSING
WHERE IT
IS NEEDED
THE TRUE POWER OF
COMMUNITY NURSING
Kitty Hutchison MACN
WORKFORCE
SHORTAGE OR
A SUPPLY ISSUE?
Adjunct Professor Alanna Geary
FACN & Dr Craig Phillips MACN
THE BEAUTY OF
BUSH NURSING
Anna Flynn MACN
+MORE
INSIDE
CONTENTS
#34 WINTER 2021
NURSING WHERE IT IS NEEDED
08 14
26 24
ISSN 2202-8765
Distributed quarterly
Editor
Neha Malude
Editorial Team
Rory O'Sullivan
Karen Watts
Editorial Committee
Dr Ruth De Souza FACN
Elizabeth Matters FACN
WELCOME SPECIAL FEATURE
Design
Emma Butz
02 Welcome from the President 08 A year we will never forget
Nina Vesala
02 Welcome from the CEO 21 Championing digital health
Publisher
Australian College of Nursing ACN NEWS & VIEWS REGULAR FEATURE
1 Napier Close, Deakin ACT 2600
02 6283 3400 04 Nursing Now Australia Finale 07 New on neo
acn@acn.edu.au
ABN: 48 154 924 642 04 Mentor Match 18 Engagement in focus: What
04 Transition to Practice program makes nursing in rural, remote
Printing
Elect Printing or regional setting special
06 International Nurses Day
Advertising
29 N
ursing and Climate change:
02 6283 3470 COLUMNISTS Climate change is a health
partnerships@acn.edu.au
05 The complexity of palliative care emergency
© Australian College of Nursing 2021
05 Looking after our community’s 30 Policy: ACN Policy Summit 2021
The opinions expressed within are the youngest 32 DLF: The best of both worlds
authors’ and not necessarily those of
the Australian College of Nursing or
the editors. Information is correct NURSING WHERE IT IS NEEDED 34 O
pinion: A vision for equitable
at time of print.
10 The true power of community mental health
Images marked as stock photos nursing 35 Policy: What is clinical supervision
are representative only and do not
depict the actual subjects and events 12 W
orkforce shortage or a supply really about?
described in the articles.
issue? 36 L
eadership: How ethical
Cover
14 N
urse contribution to the rural leadership translates into positive
Kitty Hutchison MACN
health research agenda health outcomes
16 N
ursing beyond borders 38 Nursing history: A tribute to
We love to see member submissions
in The Hive. If you’re interested in Jeannie Ross Fraser
having your submission considered for 22 Practitioners key to quality
publication, please see our guidelines
care in rural communities 40 Ethics matters: Ethical decision
and themes at
www.acn.edu.au/publications. making in nursing
24 Sunny side up
42 Representation:
For enquiries or to submit an article, 26 The beauty of bush nursing
please email publications@acn.edu.au. A role beyond caring
28 T
hat connection means
ACN publishes The Hive, NurseClick, 43 Novel thoughts: Reviews of
ACN eNewsletter and Collegian. everything
a good read
ACN NEWS AND VIEWS Every year on 12 May, the world honours nurses everywhere for their selfless work, dedication to the profession and compassion for everyone they care for. In a world that continues to be affected deeply by the COVID-19 pandemic since March 2020, nurses continue to provide care in the face of unimaginable difficulty with grace and resilience. To recognise their hard work and contribution, we encouraged them to observe a day of self-care by hosting or participating in the Australian College of Nursing (ACN) National Nurses Breakfast on International Nurses Day (IND). We loved seeing you getting together with your peers to take this day for yourselves and celebrate each other. Festivities began early at a special ACN Breakfast event at Lake Burley Griffin, where our staff and members were joined by ACT Minister for Health Rachel Stephen-Smith and our valued Corporate Partner HESTA. To add to these celebrations, we were extremely proud to have the ACN flags once again flying over the Commonwealth Avenue Bridge. In a special first, the National Carillon was lit up for the week to acknowledge the pivotal contribution of nurses to the health and wellbeing of our communities. 6 | THE HIVE #34
NEW ON
Adjunct Professor Kylie Ward FACN with nurses at Royal Prince
Alfred Hospital in Sydney Local Health District and students
from UTS Health for an interview with Studio 10 on IND
Nurses all over Australia participate in the ACN National Nurses Breakfast 2021 on
International Nurses Day. Thank you for sharing your photos with us!
Welcome to NEW ON neo. In every
edition, we will bring you the most
engaging and popular discussions
and debates from neo, an exclusive
platform through which our members
can showcase their expertise, seek
advice from experienced nurse leaders
and contribute to discussions shaping
the Australian health care landscape.
Here are the top three discussions on
neo this month.
Registered, persecuted,
annihilated. The Sick and the
Disabled under National Socialism.
Free Brisbane exhibition, lecture
and film program
–By Dr Darren O’Brien MACN
Topic: Discussion on the exhibition
that took place at the Royal Brisbane
and Women’s Hospital Education and
Conference Centre.
Confusing question on registration
renewal
–By Darren Jacob MACN
Topic: Seeking opinions on the
nursing registration renewal
questionnaire.
Some great info on imposter
syndrome and what to do about it
–By Debra Pittam MACN
Topic: An article and video resourced
shared by Debra regarding the
conversation about imposter
syndrome and how to overcome it.
PROUDLY SUPPORTED BY Join the conversation via
neo.acn.edu.au or download the
neo app!
WINTER 2021 | 7
NURSING WHERE IT IS NEEDED
NURSE CONTRIBUTION
TO THE RURAL HEALTH
RESEARCH AGENDA
Nurses in rural areas are well positioned to
contribute to rural health research aimed at
redressing health inequities in these communities
N
urses in rural areas are often disease and accessing health services
characterised by their advanced (particularly metropolitan-based specialty
practice skills, generalist clinical health services) were apparent.
experience, expanded scope of
During this time, I commenced a Master
practice and leadership in advocating for
of Public Health through distance
the needs of rural communities (Bish, Kenny
education, which provided me with a
& Nay 2012; Muirhead 2020). Consequently,
toolkit for undertaking both qualitative
they are well positioned to contribute to
and quantitative research, and furthered
research seeking to improve the health and
my understanding of health policy and
welfare of rural communities. This includes
population health. After working across
the need for rigorous research studies of
diverse clinical settings, I grew more
nurse-led chronic disease prevention and
comfortable in my clinical skillset as
management programs in rural areas, as
a rural generalist nurse and sought
supported by the Australian College of
opportunities to undertake research in
Nursing’s (ACN) Position Statement, The
my community. In 2016, I commenced
role of nurses in chronic disease prevention
in the position of Associate Research
and management in rural and remote areas
Fellow with Deakin Rural Health
(Australian College of Nursing 2020).
(Warrnambool, Victoria), a University
It is well established that rural communities Department of Rural Health (UDRH).
experience a higher burden of chronic
UDRHs have been pivotal in leading the
disease and risk factors for chronic disease,
rural health research agenda, and are
and poorer health service accessibility,
well placed — both geographically and
when compared to metropolitan populations
strategically — to grow the capacity of
(Australian Institute of Health and Welfare
rural nurses and other health professionals
2017). However, there is little discussion
to undertake research (Gausia et al.
around what pathways exist for nurses
2015; Humphreys, Lyle & Barlow 2018).
interested in contributing to rural health
Funded by the Rural Health Multi-
research redressing these inequities.
Disciplinary Training (RHMT) program,
As a Registered Nurse, I developed there are now 16 UDRHs across Australia
an interest in rural health research working towards the distribution of the
during my nursing transition to practice health workforce in rural areas and
year undertaken in rural New South undertaking locally responsive research
Wales. Working in a rural community, to meet the needs of rural communities
the challenges of managing chronic (Department of Health 2020).
14 | THE HIVE #34
Although the pace of research can be slower
compared to working clinically as a rural
generalist nurse, there are many rewards.
The valuable contribution of the UDRH encouraged to connect with a UDRH, in-chronic-disease-prevention-management-rural-remote-
areas.pdf
network to rural research was recently university or health service research
Bish M, Kenny A and Nay R. A Scoping Review Identifying
supported by a national evaluation of office to scope for opportunities to be Contemporary Issues in Rural Nursing Leadership. Journal
the RHMT program (Department of involved in health research. They can of Nursing Scholarship 2012; 44: 411-417. Review. DOI:
10.1111/j.1547-5069.2012.01471.x.
Health 2021). Recommendations for also seek post-graduate scholarships.
Department of Health. Evaluation of the Rural Health
strengthening research in rural area Multidisciplinary Training (RHMT) Program 2019-2020,
Although the pace of research can be 2021, accessed 4 March 2021, https://www1.health.gov.
through the UDRH network includes
slower compared to working clinically as au/internet/main/publishing.nsf/Content/rural-health-rhmt-
continuing to build the research capacity evaluation
a rural generalist nurse, there are many
of local health professionals, including Department of Health. Rural Health Multidisciplinary Training
rewards, such as contributing to changing (RHMT) Program, 2020, accessed 4 March 2021, https://
nurses (Department of Health 2021).
clinical practice, influencing policy and www1.health.gov.au/internet/main/publishing.nsf/Content/
rural-health-multidisciplinary-training
Through a UDRH, I have gained supporting health services in meeting the
Gausia K, Thompson SC, Lindeman MA, et al. Contribution
opportunities to further my skills in mixed needs of the communities they serve. of university departments of rural health to rural health
methods research and systematic reviews, research: An analysis of outputs. Australian Journal of Rural
As the demand for health care and need Health 2015; 23: 101-106. DOI: 10.1111/ajr.12142.
and collaborate with health services across
for innovative models of care increases, Humphreys J, Lyle D and Barlow V. University Departments
a range of research projects. This led of Rural Health: Is a national network of multidisciplinary
the role of rural nurses in research
me to commence a Doctor of Philosophy academic departments in Australia making a difference?
will be imperative to improving health Rural & Remote Health 2018; 18: 1-11.
(PhD) in 2019 evaluating an innovative
outcomes for rural communities. Muirhead S BM. Roles of rural and remote registered nurses
Aboriginal community-developed and in Australia: an integrative review. Australian Journal of
governed model of primary health care. Advanced Nursing 2020; 27.
REFERENCES
A PhD is just one research training program Australian Institute of Health & Welfare, Rural and Remote
Health, 2017, accessed 4 March 2021, https://www.aihw.
for nurses to gain research experience.
gov.au/reports/rural-remote-australians/rural-remote-health/
Other pathways include undertaking an contents/health-status-and-outcomes AUTHOR
Honours program following completion Australian College of Nursing, The role of nurses in chronic
disease prevention and management in rural and remote
of the Bachelor of Nursing or a Masters HANNAH BEKS MACN
areas, 2020, accessed 4 March 2021, https://www.acn.
by research program. Rural nurses are edu.au/wp-content/uploads/position-statement-role-nurse-
WINTER 2021 | 15
NURSING WHERE IT IS NEEDED
THE BEAUTY OF
BUSH NURSING
The bush was always an undeniable
addiction. But working as a nurse
in the bush is what opened up
an amazing adventure for me
I
look at the magnet on the fridge. The bush is an undeniable addiction, Darwin; 6 Charlie Xray November was my call
It says, ‘Year of the Nurse and Midwife probably due to my upbringing. I am a dairy sign. The red button was for emergencies
2020’. I graduated in 1984. I think back farmer’s daughter. My mother was a nurse, and if pushed, everyone cleared the airway.
on my career: What have I achieved who had to leave the profession when she
I ran a clinic for a community of
in my 36 years of nursing? What have I married. One of four kids, we got cows in and
approximately 300 people. I had no clue
contributed to the profession? The strong helped milk them if Dad was late. We drove
what I was in for. I adopted a joey, I dealt
women who brought me up, instilled cattle and dipped sheep. We chopped
with chronic disease and domestic violence.
in me that we are all equally deserving wood and the heads off chickens. My father
Tribal fighting was common and petrol
of care, irrespective of background, suggested nursing to me. Perhaps I
sniffing was out of control. I had never
geography and social circumstance. was to finish what my mother started.
heard of rheumatic heart disease. But I
Dad knew that nursing at a university was a
Shared experiences encourage other nurses coped. And that is what nurses do.
happening thing, he was a forward thinker.
to see the value of diversity and flexibility,
Friends asked me to go to Gapuwiyak in
and to be where we need them — in our In 1986, I tasted remoteness for the first
North East Arnhemland — an unknown entity
indigenous communities and supporting time. Alice Springs Airport was a tin shed
for most — in the early 90s. Nurses came and
remote farming families. After all, they are that appeared more like a bus stop than an
went. They missed their lattes and felt lost
the ones hardest hit by nursing shortages. airstrip. I was sent to Mantamaru (Jameson)
without the on-ground support of a doctor,
According to Australian Government in Western Australia. A single sister station
and with limited phone access and regular
Department of Health (2020) workforce data, in one of the most remote communities in
power outages. There was a lot to learn.
there are nearly 345,000 nurses registered the country. I had limited midwifery skills.
in Australia. Less than 1.0% are in very The clinic was a small, shipping container. One moonless night after getting bogged
remote areas, where the working week is There were no telephones, only a radio (I was not the driver), my nursey mate Deb
long and the average age of a nurse is 47. connected to Victor Juliet Yankee (VJY) and I walked 42 kilometres. We walked
26 | THE HIVE #34
I had no idea what I was in for.
But I coped – and that’s what nurses do.
all night, ran hand-in-hand through a river I left and completed the outstation pilot pair of hands. Often, as an agency staff, I
with a known crocodile, shared a cordial program at Oenpelli. I spent countless nights was treated differently and as though I had
bottle as a pillow and found help with the on the roof of the troop carrier, tucked in my little knowledge. I knew how untrue that
road crew manager at five in the morning. swag, at the mercy of the mosquitos but away was and the challenges that I bestowed
We learnt to tell people where you are going. from the crocodiles. Driving was thwarted by upon myself would one day reward me.
the wet season: getting bogged, winching I needed to go back to where I was needed.
In 1992, I attended the launch of the Central
myself out and looking like a half-drowned
Australian Rural Practitioners Association Now, 25 years later, after two farms, three
sewer rat. I fished Saratoga with the locals.
(CARPA) manual, a little handheld bible kids, one divorce, over 25 workplaces,
of potential medical mayhem. We began Unlike the boar that had gone to the water’s I am a nomad. I work in midwifery with
the first e-health, documenting clans edge and had its last drink not five metres kind, strong women, a friendly emergency
and skin names. I trained my first health from where I was sitting, I avoided becoming department, and an incredibly supportive
worker and she is still there today. lunch. A 15-foot crocodile called black Eric agency. I am gaining confidence again
lived (and probably still does) in an adjacent and returning to where nurses are
Local challenges were tough. I delivered
lagoon. Tourists about to swim did not want most in need — the beloved bush.
babies in the clinic and over the radio.
to heed my warning, until we saw the tail
We endured death in the community and REFERENCES
of the monster on the opposite bank. I was
learnt about payback. We buried the Australian Government Department of Health, Health
privileged to regularly sit under rocky ledges workforce data, October 12 2020, Retrieved 17 March 2021,
elderly and too many young people. I still https://hwd.health.gov.au/summary.html#part-2
and admire the artwork and the sun setting
remember the day my heart sank, the day
over the wetlands. I remember thinking
I buried my first paediatric trauma case. AUTHOR
then: ‘What an earth am I doing here?’
That was the tipping point. There was
little support for nurses then and I was Returning to the city left me lost.
ANNA FLYNN FACN
burning out. I had spent eight months on The truth was, I yearned for the bush.
call for 24 hours a day, with no relief. I found workplaces stifling and I was just a
WINTER 2021 | 27
REGULAR FEATURE: LEADERSHIP
How ethical leadership
translates into positive
health outcomes
Exploring the correlation between respectful culture
and quality of patient care in health organisations
H
ealth care organisations To effectively navigate this labyrinth, professionals) or specialty sub-cultures
are increasingly embracing a leadership team needs to adopt (for e.g. emergency department or
values-based health multi-modal methods with flexibility paediatrics). These sub-cultures
care and incorporating based on timely, continual and open need to approach interactions with
values-based recruitment, and core feedback to ensure service provision is other groupings by focusing on the
values are perceived to be central to the respectful and value based. The services provision of person-centred care, by
operationalisation of visions and missions. must be carefully designed through putting the patient at the centre of
A scanning exercise across health care integrative models of care to meet the discussions and decision-making.
organisations shows a recurrent value needs and expectations of all involved.
Therefore, the core values must be
of respect, and one must ask what this
Leadership within health care upheld across each sub-culture; it needs
means in terms of nursing leadership.
organisations has a direct effect on to become the daily expectation and
How does ethical leadership with a staff performance, which influences interaction. Practically, however, there
focus on respect influence performance quality care and the safety of the exist operational restraints such as
and create a positive performance patients (McFadden, Stock & Gowen clinical ‘ownership’ for each stage of the
culture? What does respect mean in III, 2015). It is timely to explore the links journey or the who-funds each-aspect.
terms of leadership; what would this between values-based leadership and
Defining culture is difficult, however, it
look like, and what is the impact on staff performance ranging from safety, quality,
relates to the organisation’s attributes
and patients alike? Answering these satisfaction and engagement, as well as
or its character, and there are definitive
questions requires an exploration of the growing pressure on financial integrity.
links with culture and performance (Scott,
the correlation between a respectful
The senior leadership team must role Mannion, Davies, & Marshall, 2003).
culture and health care outcomes.
model without fault, and set the standard Clinical governance through a shared
Health care leadership is complex and and expectations for values-based value integrates these different cultural
compounded by an ever-changing interactions, providing a person-centred and individual factors to provide an
environment including population approach, hence instilling a culture underpinning person-centred approach
growth and demand for service, whereby staff are engaged and able to to the structures, accountability and
increasing technological advances, be key players in the change agenda effective leadership at all levels.
societal expectations, environmental (McGrath, Bennett, Ben-Tovim,
Therefore, a multi-disciplinary
impacts and the culture of health care Boyages, Lyons & O’Connell, 2008).
multi-departmental team can:
organisations (Park, 1997). Leadership
It is essential that organisational
should approach respect in an • Provide clinical leadership
leadership embraces a collaborative
all-encompassing way that includes • Approach problems as a team
multi-disciplinary team approach.
staff, patients, families, consumers
The complexity is in identifying • Focus on the patient in decision-making
and health care providers. Therefore,
and working with the sub-cultures processes
through the essence of leadership,
within the organisation, such as • Embrace processes to monitor for safety
one must embrace the core value of
professional groupings (for e.g. concerns, quality concerns and overall
respect in engagement with everyone
doctors, nurses or allied health performance (McGrath et al., 2008).
interacting with the health service.
36 | THE HIVE #34
Ethical leadership
can guide health care
professionals to make
value-based decisions for
patients, thus enhancing
the quality of care and
patient safety, which are
essential performance
measures for a health
care organisation.
McGrath et al (2008) purport that performance. Research explains excellence, attraction, recruitment
one of the most complex challenges organisations with employees who and retaining staff, and creating a
associated with this leadership identify with the value offer a strong productive and positive culture.
approach is in sustainability and commitment and will continue to
maintenance. Through transformational be employed long term and aid
REFERENCES
leadership approaches, sustainability through role modelling (Shi-Chi,
is possible through the constant Jen-Chia & Ya-Ling, 2012). Jencks, S. F., & Wilensky, G. R. (2010). The health care
quality improvement initiative: a new approach to quality
enthusiasm of each leader, and assurance in Medicare. Jama, 268(7), 900-903.
This study reports strong interactional
recruitment of new staff based on McFadden, K. L., Stock, G. N., & Gowen III, C. R. (2015).
requirements between the culture
a value-based recruitment process Leadership, safety climate, and continuous quality
and the organisational commitment, improvement: impact on process quality and patient safety.
and this will assist in the long-term Health care management review, 40(1), 24-34.
and this can influence staff’s attitudes
sustainability of values into the future.
and instill in them a strong obligation McGrath, K. M., Bennett, D. M., Ben-Tovim, D. I., Boyages,
S. C., Lyons, N. J., & O'Connell, T. J. (2008). Implementing
Hence, organisational culture requires to uphold the commitment to the and sustaining transformational change in health care:
a two-way relationship with timely, patients and the organisation. lessons learnt about clinical process redesign. Medical
Journal of Australia, 188(6), S32.
open and transparent communication
Effective, accessible and transparent Park, H.T. (1997). Transformational and Transactional
between the leaders and staff
leadership is critical to the success of Leadership Styles of The Nurse Administrators and Job
to ensure long-term impacts on Satisfaction, Organisational Commitment in Nursing Service.
the health sector through its impact Journal of Nurses Academic Society, 27(1):228-241. https://
quality, safety and performance.
on staff, and subsequently patients. doi.org/10.4040/jnas.1997.27.1.228
An ethical leadership style will provide A transformational leader, who inspires Scott, T., Mannion, R., Davies, H., & Marshall, M. (2003).
a significant organisational foundation and empowers staff, can impact the Implementing culture change in health care: theory and
practice. International Journal for Quality in Health Care,
in creating an ethical culture that daily performance of the team by 15(2), 111-118. Doi:10.1093/intqhc/mzg021
reflects the mission and values of a creating a sense of belonging and focus Shi-Chi, H., Jen-Chia, C. & Ya-Ling, T. (2012). The
health care facility, guide the behaviour on respecting the person at the centre. influence of hospital organisational culture on organisational
commitment among nursing executives. African Journal of
of health care professionals and help Business Management, 6(44): 10888-10895. Doi: 10.5897/
In doing so, the actions and
them make value-based decisions AJBM11.1510
conversations have an amended focus
for the best interest of the patients. Wong, C. A., & Cummings, G. G. (2011). The influence of
which will have a positive impact on authentic leadership behaviors on trust and work outcomes
This helps enhance the quality of care
the organisational performance. of health care staff. Journal of Leadership Studies, 3(2),
and patient safety, which are essential 6-23.
performance measures for a health care The underpinning strategy is to develop
organisation (Wong & Cummings, 2011). a leadership culture that promotes and
supports everyday safety measures AUTHOR
The question central to this discussion
(Jencks & Wilensky, 2010). Leaders in
is why having organisational leadership
health care facilities must commit to
that respects individuals and a MARLI MILLAS MACN
creating and maintaining a culture of
leadership structure designed to
safety which will ensure that suitable
role model this underpinning value,
standards are developed for operational
can inherently result in improved
WINTER 2021 | 37You can also read
