Laura Wrench

I have recently started working at Blue Care as a palliative care community registered nurse. This is a clinical area I have never worked in before, so it has been a large learning curve for me. I work autonomously and as part of a duo team with my fellow registered nurse. Duties performed in this role include:

• Collaborating and liaising with physicians (GPs, acute care hospital doctors and SPaRTa registrars/ consultants), nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
• Participating in multidisciplinary team meetings to discuss patient care plans.
• Provide education to clients and their families using the Care @ Home package
• Provided emotional support and comfort to families during difficult times.
• Utilising nursing clinical skills such as setting up Nikki pumps, inserting Intimas for subcutaneous injection therapy, IDC insertions, managing surgical drains and many more skills
• Counseled patients regarding medication side effects or lifestyle changes necessary for improved health outcomes.
• Documented patient progress notes accurately and efficiently in the electronic medical record system.
• Evaluated effectiveness of interventions through ongoing assessment of patient responses.
• Acted as patient advocate and implemented total patient care through team nursing process.
• Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
• Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
• Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care and support to clients

Working at Nanango Hospital has allowed me to work in a rural and remote setting, where I developed my advanced clinical decision-making skills due to having no doctor on duty on a weekend. Nanango hospital has a dedicated 9-bed ward including a single palliative care room, as well as having an emergency department. Nursing duties included:

• Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualised treatment plans for each patient.
• Developed advanced clinical liaison skills as part of my role, as RNs were required to coordinate care of patients between multiple health care settings such as community setting and and other acute care hospitals
• Performed triage assessments of walk-in patients in a clinic setting.
• Assessed, planned, implemented and evaluated nursing care for assigned patients.
• Monitored vital signs, administered injections, performed cannulation/ phlebotomy and provided assistance with medical procedures.
• Coordinated discharge planning activities including arranging follow up appointments or referrals for additional services.
• Trained and mentored new RNs on best practices, hospital policies and standards of care.

I worked autonomously and as part of a nursing team in a busy 19-x doctor general practice (GP). In this role, I operated as a nurse immuniser and am responsible for understanding the complexities of the immunisation schedule and the difference between private and public vaccinations. I am adaptable and flexible in my practice approach, adapting to practice with paediatric and adult populations and working autonomously to provide safe patient care with limited support on weekend shifts. Regular tasks included:

• triaging patients (via phone and walk-in) – including taking a full history and assessing patient priority and escalation for example, hospitalisation
• maintaining effective communication and targeted practice support for each GP
• safe subcutaneous, intramuscular and oral medication administration
• advanced peripheral IV cannulation skills for patients receiving iron injections / infusions – performing the skill for GPs that cannot successfully cannulate
• chronic disease management and health assessments – supporting patients to achieve their goals and improve their health and wellbeing
• assisting GPs with during patient examinations and medical procedures like biopsies, excisions, IUD insertions minor surgical procedures, taking vital signs, performing ECGs and preparing specimens for laboratory analysis
• teaching practice nurses about best practice in paediatric care and guiding GPs with referrals to paediatric facilities / medical teams
• sterilistion of medical equipment
• ear syringing.

REGISTERED NURSE CANOSSA HOSPITAL

Rehabilitation Ward, Palliative Care and Oncology Day Care Unit October 2022 – June 2023

At Canossa Hospital I worked in three different areas of nursing, which demonstrates my adaptability to practice and ability to learn different nursing skills quickly and efficiently. I worked autonomously and as part of a team to provide safe nursing care to adult patients requiring slow-stream/ fast-stream rehabilitation, palliative care, and oncology treatment in an outpatient setting. Regular tasks include:

• Advanced peripheral IV cannulation, accessing Port-a-Caths, performing PICC line dressings and inserting Intimas subcutaneously.
• Attending to ADLs independently and with the assistance of the AIN on shift
• Managing a patient load of 5 patients independently and with the support of the Clinical Nurse on duty
• Medication safety, recognizing when observations are required prior to medication administration, such as with Digoxin, and recognising when to withhold medication and getting patients medically reviewed prior to administration.
• Attended an annual Advanced Life Support course as there are not always doctors on the ward daily.
• Recognizing a deteriorating patient and the need for the patient to be transferred back to an acute care hospital such as QEII or the PAH
• Maintaining effective communication with other nursing staff, administration staff, patients, and their families in a timely manner.
• Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
• Participated in multidisciplinary team meetings to discuss patient care plans.

At the Qld Children’s Hospital, I worked autonomously in DF and as an RN to provide safe patient care alongside radiologists, registrars and radiographers. In this role I learned to assist radiologists to provide procedural and interventional nursing procedures, including steroid injections, lung/bone/liver/renal biopsies, angiograms and sclerotherapy. I performed the duties of the in-charge nurse on shift and oversaw the work of other nursing staff, including guiding practice and shift management / rostering and was able to merge my previous experience in Qscan Radiology Clinics with my job in paediatric medical imaging. Regular duties included:

• peripheral IV cannulation for all patients requiring contrast for their scan
• representing nursing staff at cardiac meetings for MRI/CT, and CT leadership meetings
• working across all modalities of medical imaging autonomously and in a team
• educating and mentoring all new and junior staff and students
• working alongside the Anaesthetics Dept. to provide safe general anaesthetics to children where required for a scan (induction and PACU experience)
• safe medication administration and observation monitoring for children needing pre-medication for a scan (identifying patients who need a pre-med)
• clinical liaison duties by maintaining effective communication with radiologists, radiographers, administration, anaesthetics and other nursing staff
• communicate with inpatient wards in a timely manner and provide outpatient care.
• Developed a nursing procedure for complex interventional procedure for all nurses to follow and ensuring the procedure is being performed safely and correctly

This role presented me with the opportunity to step away from medical nursing and to work autonomously in an environment that required more interventional / procedural nursing skills, like assisting doctors with injection clinics, lung/bone/liver biopsies and HSGs. I developed experience working alongside radiologists and radiographers and began to enhance my knowledge with human anatomy (as educated by the staff of Qscan). I took on the opportunity to work one-on-one with nuclear medicine radiologists and was able to gain experience in other areas of cardiac nursing, including supporting patients that are sent for stress tests. In this role, I also took up the opportunity to maintain my ALS Certification. Regular role responsibilities included:

• working as an autonomous RN alongside radiologists and radiographers to provide timely and sensitive patient care in an outpatient setting.
• working as part of a multidisciplinary team requiring good time management to ensuring appointment schedules are maintained.
• independently run an MPS clinic and perform cardiac stress tests in a safe and time efficient manner/ peripheral IV cannulation for all patients requiring contrast.
• educating patients over the phone and in-person regarding their procedure
• initiating self-learning to maintain awareness of a new range of procedural nursing techniques like vertebroplasty, spinal injections and biopsies.
• sole responsibility for maintaining and checking emergency trollies and equipment across multiple sites and supporting junior staff to do the same.
• safe medication administration and observation monitoring when caring for a patient requiring IV/oral sedation and pain management and supporting junior staff to do the same.
• provide culturally and age-appropriate care to patients and their families, including paediatrics, elderly, inpatients, walk-ins and many multicultural backgrounds.

This role offered me the opportunity to work in a general medical ward with cardiac patients and telemetry monitoring. I gained experience with ECG monitoring and interpretation, learned how to manage patients with NSTEMIs, ACS, unstable angina and other cardiac ailments. I also received my ALS Certificate via a 2-day workshop. I performed team leader/ clinical liaison duties as acting CN. My role responsibilities were consistent with those undertaken at South Burnett Private Hospital (see below).

This role gave me the opportunity to work with adults in a medical / surgical environment and to learn new skills and knowledge, including challenges associated with working in a rural hospital setting alongside general practitioners. This experience enhanced my time management skills and required me to begin working autonomously, as hospital shifts only had 1 rostered RN at a time. I gained experience in geriatrics, which significantly diversified my skillset (I had previously only worked paediatrics). Regular role responsibilities included:

• providing palliative care to patients and their families
• working effectively in partnership with an EN/EEN or PCA, implementing team leading skills and delegating effectively as the shift coordinator
• effectively communicating with nursing staff, GPs and allied health professionals to ensure optimal and coordinated patient care
• safe medication administration and manual handling techniques
• accurate and timely documentation for medical and surgical patients
• assessing, planning, implementing, and evaluating in everyday nursing practice
• using available professional resources to further develop my own skills and knowledge in nursing practice.
• awareness of and reporting suspected elder abuse
• working within my scope of practice and adhere to the nursing code of ethics.

Here I worked in one of the largest children’s hospitals in Brisbane and Qld. During my time at the Royal Children’s Hospital, I took up opportunities to learn surgical (Surf Ward), medical (Robertson Ward) and community (Ellen Barron) paediatric nursing. I passed the Queensland Health Transition to Practice Nurse Education Program in the paediatric environment, where I gained a strong foundational ability to work with children (and their families) from infancy to adolescence and to assist in the nursing management of various medical conditions. I also began to demonstrate my genuine commitment to continuously learning and practice improvement by joining the hospital’s babies special interest group, dedicated to improving working policy and practice.

• assessing, planning, implementing, and evaluating in everyday nursing practice
• working effectively within a large multidisciplinary team of health professionals, including effective communication
• ·mplementing appropriate team leading skills and delegating effectively once I became shift coordinator.
• safe medication administration and manual handling techniques
• reporting suspicions of abuse or neglect to Child Advocacy
• accurate and timely documentation
• implementing and improving care processes and practices for children and young people
• maintaining a healthy and safe environment for patients and staff
• using available professional resources to further develop my skillset and knowledge.
• preceptor and positive role model to students and new graduates.

In this placement I gained foundational knowledge and skills to implement good breastfeeding techniques for mothers who have challenges feeding. I gained knowledge from families and nursing staff about complex parent issues including postnatal difficulties, breastfeeding and infant feeding management, child growth and development, behaviour management and sleep/settling issues. I worked in close proximity to a community child health nurse / midwife and effectively communicated with members of the multidisciplinary healthcare team to guide and educate families on common parenting challenges. I attended weekly case conferences to discuss family progress in addressing debilitating issues that required community follow-up and attended daily education sessions so that I could effectively leverage the opportunity to learn about community child health nursing.