Usha Nair

• Worked under support and supervision of the Neonatal Fellow and Consultant in areas such as Emergency department ( WEC), Delivery suites, Post Natal Wards (PNW), Neonatal Intensive Care Unit ( NICU) & Special Care Nursery( SCN).
• My role in each of these units were quite unique. As a team member attended to emergency review of infants who are presented to ER with concerns that had required complete history taking and assessment , running relevant investigations. These infants were either sent home with advice or admitted to wards depending on examination findings and investigative reports.
• Worked along ER team and collectively forming care pathways including OPD or specialist referrals.
• Delivery suites / Operating Theaters ( OT) - attending to high risk deliveries requiring extensive planning and organizing personnel, equipment and skills. These sometimes occurred as exclusive emergencies, with minimal time at hand for pre preparation.
• Some of the high risk deliveries attended and assisted are: Shoulder dystocia, Instrumental deliveries, trial of labour after cesarean section, Maternal high risk factors (Obesity, Sepsis, Pre-eclampsia)
• Infants at these unexpected difficult deliveries can present with uncertain and prolonged transitional challenges.
• Anticipation of need for advanced resuscitation prompts escalation of management, knowing when to call for additional help and code.
• Equipment preparation in an unfamiliar environment is well thought about and prepped.
• Assessment of these infants at perineum for suitability of delayed clamp cord clamping is made swiftly to enable timely resuscitation.
• Timely communication with team Fellows and consultants for expedited admission to NICU if required is made.
• Follow up visit by neonatal team is planned and referral placed if infant can stay with Mother and ensures this is completed.
• Infants in PNW are usually from infants from NICU or SCN step down, also from high risk deliveries follow up list. Frequently we also get referrals from Midwives for concerns that would require Neonatal team / pediatrician assessment.
• These referral include assessment of birth findings that could be benign to conditions that require and escalated hemodynamic monitoring and support.
• Attending to neonatal met calls across the hospital clinical and non clinical area , which demands rapid response, quick and accurate, expedited targeted assessments. These infants are then triaged based on examination findings to either stay with Mother in the PNW or transferred for further management in SCN or NICU.
• Role in NICU and SCN : Medical management of critically unwell infant beginning from comprehensive assessment to clinical decision making to implementing & evaluation of care.
• Patient presentation to the team and taking clinical notes on ward rounds. Reviewing infants during the shift and also to attend to review calls from bedside clinicians, carrying out proposed review plans of pathology investigations, inter disciplinary referrals and seeking specialty opinions is the structure of a typical day's work in NICU.
• In addition to the above, specialist skills supporting and managing hemodynamics of critically unwell infant.
• Performing skills such as : Intubation, gaining intravenous access ( peripheral, central, Peripherally inserted central catheters), placing monitoring tapping of pneumothorax, insertion of intercostal catheters, umbilical line insertion, lumbar puncture, suprapubic catheter specimen collection, insertion of indwelling urinary catheter & collecting body fluids for pathology as per unit policies and protocols.
• Managing infants who are critically unwell requiring high level of care with high frequency oscillatory ventilations, use of nitric oxide, supporting hemodynamics using inotropes, fluids, managing fluids and nutritional intake.
• Regular and frequent reviews of these infants in the unit who might require alteration to the level of support is carried out.
• Attending regular in services educations, and contributing to daily handover.
• Devoted special emphasis to punctuality and worked to maintain outstanding attendance record.
• Worked flexible hours across night, weekend and holiday shifts.
• In consultation with mentors, created plans and communicated deadlines to complete projects on time.
• Adhered to unit policies and protocols in all the procedures that are carried out, followed infection control protocols across.
• Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.

Commenced working in PICU post 10 years of Adult Intensive Care Nursing in a level 6 Hospital in Melbourne.

During the first three years of PICU training/ work I completed Masters of Advanced Nursing Practice ( Paediatric Critical care) as speciality.

Working at The Royal Children’s Hospital (RCH) as a critical care paediatric registered nurse for four years and promoted to clinical nurse specialist in Paediatric intensive care ( PICU) with specialities such as general medical, surgical, exclusive cardiac surgery , burns, transplants and oncology services for a total of ten years.

Highlights of my nature of advanced practice that are evidence based, adhering to units policy procedure guidelines and within scope of practice are listed below.

* Comprehensive patient assessment, compiling detailed history including psychological and cultural factors that would impact patient care.

* Analysing gathered data, formulating individualized patient care plans in consultation with the multidisciplinary team.

* Implementing care in accordance with unit’s policies and protocols and proactively initiating care within scope of practice.

* Evaluating effectiveness of care in a timely manner and making necessary adjustments to strategies within decided and approved plan of care.

* Proficiently performing skills that are super specialised patient specific such as;

a) Accessing Central nervous system Intraventricular pressure devices for specimens and trouble shooting intra cranial pressure monitoring.

b) Adjusting mandibular distraction devices as per order.

c) Maintaining and trouble shooting endotracheal tubes including suctions, securement with tapes and to dental bridges.

d) Maintaining intracardiac invasive pressure monitoring lines (Pulmonary arterial lines, Central venous lines).

e) Routine checks of intracardiac, external, temporary, and permanent pacemakers.

f) Managing and troubleshooting external cardiac ventricular assist devices.

g) Performing 16 lead ECG and atrial paced ECG

h) Care of intercostal catheters, underwater seal drainage.

h) Assisting with obtaining chest X rays, interpreting the X ray, analysing lines and intra pulmonary pathology.

i) Measuring intrabdominal pressure and interpreting its significance and escalating management as required.

K) Insertion of intra-abdominal and intestinal catheters ( Nasogastric and nasojejunal)

l) Establishing peripheral venous access.

j) Insertion of indwelling urinary catheters and managing them.

k) Obtaining body fluids for pathological studies and routine investigations

l) Analyzing and interpreting laboratory results and linking to the pathophysiology.

m) Examines the utility of specific antimicrobial and other pharmaceutical agents and scrutinizing its pharmacodynamics.

n) Assessing efficacy of treatment in regular intervals and documenting accurately and appropriately.

o) Communicating effectively among the team members & with patient families and significant ones.

p) Facilitating process of ethical decision making.

q) Participating in the unit’s educational in services, shared knowledge via informal platforms in the unit through providing direct patient care, have mentored junior RN and new RN’s to the unit.

r) Has always performed and demonstrated a positive professional role modelling.

Commenced work at Pediatric Infant Perinatal Emergency Retrieval Services (PIPER) as Pediatric / Neonatal Retrieval nurse/ Return Nurse and Clinical Coordinator. Duration of this job was five years.

Retrieval of critically unwell infants from referring hospital from across the state and occasionally interstate and international.

Retrieval modes are road ambulance, rotary wing and fixed wing aircrafts.

We provide clinical advice and education, Coordinate, and support retrieval of pregnant women in a timely fashion. Service also included moving convalescing babies to hospitals that closer to their home.

Nature of work that describes the acuity and its advanced nature is explained below.

a) Participates in referral calls, prepares appropriate relevant equipment, as transport equipment for road ambulances differ slightly to that of air transport.

b) Condition specific equipment are packed and departed in time for retrieval.

c) Anticipatory management strategy is created in discussion with Doctor on team, as potential for un expected changes to patient condition can be very detrimental if not adequately proactively prepared for.

d) Treatment or management strategy utilizes problem solving and critical thinking skills.

e) Performs comprehensive patient assessment at the scene of referral, analysis data gathered, discusses the plan of action involving the referral centre, paramedic, and doctor within the team.

f) Implements care, stabilizes patient and transports patient to the receiving hospital

g) Continues to monitor and support patient throughout the transport.

h) Maintains real time documentation or timeline of events for handover and documentation purposes.

i) Evaluates effectiveness of care provided at regular and frequent basis to amend the strategy to maintain safety and provide appropriate care.

j) Completion of transport of a patient ends with complete handover of the patient with referral history, assessment finding, management and effectiveness noted enroute.

k) Attend regular case reviews, conferences, updates on aeromedical safety, in services, unit-based education.

l) Contributed to units quality improvement tasks, reviewing and revising guidelines.

m) Demonstrated ability to work under high pressure, uncertainties and autonomously as required.

n) Always communicated maintaining high level of professionalism and clarity.

Clinical Nurse Consultant ( Paediatric Outreach). Worked for three years in a tertiary hospital with patient flow across ER, PICU and allergy clinics outpatients. This role required to be ready to attend paediatric and neonatal medical emergency calls across the hospital.

All of these job description required higher level of assessment skills, analysis of data, interpretation of investigations, sound knowledge of pharmacodynamics and safe quality use of medicines.

· As a key member of the team who, with high level autonomy, each patient was attended to was comprehensively assessed for the highlighted problem.

· Analysis of the findings were swiftly discussed with referring or home team and proposed plan of care is discussed.

· In some instances, the actions required used to initiate active resuscitation with airway protection. In such cases further escalation to code blue would be made while continuing to support care.

· Worked along side multidisciplinary team and inter wards to facilitate transfer of children to intensive care units based on assessment and analysis of gathered data.

· Routine review of patients on case load post discharge from intensive care and also from a fresh referral made to follow up.

· Routinely recommended or advised certain modalities of treatment or strategies, which would be further discussed with consulting team.

· Assisted clinicians at bed side to implement care and evaluated care at regular intervals.

· Provided regular in services (Pediatric and neonatal resuscitation) to junior medical staff and new RNs to the hospital.

· Maintained high level professionalism and communication skill

* Worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.

*Worked within applicable standards, policies and regulatory guidelines to promote safe working environment.

*Created plans and communicated deadlines to complete projects on time.

• Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.

Worked for 10 months as a clinical nurse facilitator.

Assisting graduate nurses from Monash University , facilitating their clinical rotation.

Areas of clinical placement covered were:

Emergency Department ( Adult & Pediatric)

Medical and surgical wards ( Adult & pediatric)

Coronary care and intensive care units.

As a team member of the The educational board for the university , my role at the clinical space was to guide and facilitate teach clinical care .

The project pace is set as per the university learning module covered.

Other activities included:

Individual student learning .

Advanced assessment skills and evaluation of care.

Documentation of care accurately and appropriately.

Demonstrating nursing care for in group or individually.

Demonstrated high value patient care, respect, communication discipline and time management skills.

Commenced my work in Adult intensive care while studying post graduation in Adult Critical Care.

* Worked as a RN primarily caring for patients with acute and acute on chronic medical and surgical conditions requiring advanced hemodynamic monitoring .

* Caring for a patient requiring respiratory support ( non invasive and invasive strategies)

* Setting up and organizing for admission and initiating care.

* Monitoring for deterioration and performing regular assessments and carrying out investigation as per order.

* Administering bronchodilators therapies, evaluating effectiveness.

* Prepare and support with definitive airway management ( Intubation and ventilation).

* Monitoring and managing care of patients with pathology involving central nervous system, cardio respiratory , gastro intestinal, metabolic, genitourinary, and accidents - trauma related conditions.

* Special interest in caring for cardiothoracic surgical, category of patients.

* Demonstrated professionalism though out communicating amongst team members, within patient's family, carers and peers

* Educated patients and families on treatment, expected outcomes and discharge instructions, serving as advisory resource to patients and families to facilitate recovery.

*Explained side effects from medications and provided in-depth education to patients on diabetes, asthma, cancer and other diseases.

My first ever overseas job as a RN, after completion of NCLEX examination.

Geriatric nursing :

*Care for frail and elderly patients with long-term, chronic medical conditions that are not related to an acute illness or injury.

*Primarily providing holistic and individualized care for patients and families.

* Responsibly carry out the treatment plans determined by physicians and other members of a multi-disciplinary team.

*Development of Plan of care that enhances the quality of life for those receiving treatment, with a goal of maximizing patient comfort, promoting safety, preventing deterioration, maintaining current functional status, and preventing new problems.

* Carried out regular assessment of patients receiving psychotropic agents. Assisted with formulating modification to their medication management.

*Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.

*Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other conditions.

*Organized and managed care of patients undergoing various therapies and procedures.