Soapbox
Your say about nursing issues
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 044 - 046
Article Text
Documentation dilemma
In June of last year I was summoned to jury duty, however due to my teaching commitments and personal study I was able to postpone it until November. The month was quite traumatic, but a great learning experience nevertheless. I found it interesting to see what can happen during a court case; it was certainly not in the style of LA Law!
Sitting in the juror's box was such a strange feeling, and work was the furthest thing from my mind. To think that you are one of twelve who can have a major influence on another person's future. This is the 'real thing'. One of the main things highlighted during the month was the importance of documentation.
For one particular case, all 12 jurors believed the accused was guilty but the Crown case did not provide evidence to prove that it was beyond reasonable doubt, due to the presentation of unclear documentation by two witnesses. Interestingly, official records and a memo book with personal notes written by one witness were used as evidence. The defence lawyer continually asked questions about information believed to be missing or poorly described-a bit hard since the incident was nearly 16 months prior to the court case. Whilst sitting there listening, I was reminded of the many nursing notes I have written in the past, as well as the sessions on law and documentation during my nursing education and, later, those I have given to students. I had heard and read of the importance of documentation, but I am now fully aware of its significance. I realise how easy it is to think that your documentation is fine, but I ask you to take time to examine what you have written and ensure that what has really happened is clearly represented.
I will now be more vigilant and intend to never place myself in the situation where my documentation is sub-standard, as did those two witnesses.
Margaret Dashorst, Dover Gardens, South Australia
Rural nursing-at the crossroads?
At any gathering of nurses the conversation quickly turns into what is euphemistically called 'talking shop'. Most nurses enjoy talking about their area of work and relating a few anecdotes, usually laced with that special brand of weird humour only nurses would understand.
These conversations are rarely dull and are always full of the rich diversity of nursing practice. It seems whenever I talk to other nurses they have different clinical backgrounds and contrasting career experiences from my own. Such is the uniqueness of nursing practice. Many nurses describe themselves in terms which link them to their special area of work. Some examples of these descriptors are: theatre nurse, intensive care nurse, paediatric nurse, medical or surgical nurse, aged care nurse, academic nurse, community nurse, and remote area nurse. A long time member of these identifiable nursing groups is the rural nurse, whose work is primarily in health care settings outside of the major metropolitan and urban areas. These nurses have not sought nor enjoy a high profile within the profession and as such have an unwarranted image problem. This results, in part, from the high profile acute care nursing has in the profession and to the myths associated with rural nurse practice. Rural nurses have been tainted by the broad brush categorisations so often made by those who think a picnic in a city park is like a visit to the country.
Rural life is often associated with rural poverty, slow talking and conservative thinking people, run down amenities and antiquated ways of life. Rural nurses, by association, are viewed by many urban people in the same light. It is true to say that much of rural Australia has suffered a considerable set-back in economic as well as social standards, and that this has impacted directly on the health and well being of rural people. Rural nurses have weathered these storms along with their respective communities and have not only maintained the provision of high quality health care in very difficult circumstances, but have been proactive with innovative models of nursing and primary health care designed to improve health care service delivery and rural community standards of health.
The myths about rural nurses being 'poor country cousins' when compared to other groups of nurses need to be buried. Rural nurses have an important role to play in this respect. They need a strong and united voice to tell others of their work, their values and their achievements. Rural nurses recognize this only too well; the road ahead for rural health is a bumpy one and there is considerable room for improvement in the provision of health care services to rural and remote Australians. They are now receiving some long overdue assistance with this goal. First by changes to federal government rural health policy, and second by the establishment of professional nursing organisations like the Association for Australian Rural Nurses (AARN) who can represent the interests of rural nurses. In 1991 the National Rural Health Strategy was endorsed by all Australian Health Ministers. This strategy is designed specifically to address a number of crucial rural health issues, and has as its aim the achievement of optimal health for all people in rural and remote Australia. Since that time there has been a considerable amount of activity directed towards achieving this aim.
The Federal Government is funding a number of initiatives to ensure these policies are translated into action designed to benefit rural and remote communities in the short and long term. One of these initiatives is the Rural Health Support, Education and Training (RHSET) program, which seeks to improve the standards of rural and remote health care by improving education and training opportunities for the many multidisciplinary health care professionals who provide these services. In recent times rural and remote nurses have played a significant role in the formation of appropriate rural health care policy and in initiatives designed to improve rural health practice for all health workers. The Council of Remote Area Nurses (CRANA) and the recently formed Association of Australian Rural Nurses (AARN) are both national groups which have been provided the opportunity to be included in the decision making process by state and federal governments.
In 1992 the National Rural Health Alliance (NRHA) was established. The Alliance has representatives from CRANA, AARN, Australian Nursing Federation (ANF), Australian Nursing Council (ANC), Rural Doctors Association (RDA), Allied Health Professionals, Country Women's Association (CWA), Australian Council of Health Service Executives (ACHSE), Aboriginal and Torres Strait Islanders (ATSIC) and independent consumers. The purpose of the NRHA is to empower the 'grass roots' level of rural and remote Australia to ensure that appropriate health care policies and strategies are implemented. A National Rural Health Unit is to be established during 1993.
A major task will be to assist in the coordination of rural and remote health care issues. It is vitally important that rural nurses have input into these crucial changes to rural health care. For too long rural health care policies have been formed by urban based policy makers and dictated to rural health service providers as a fait accompli. Rural nurses are at the crossroads of choice. They can continue to see the erosion of rural health by the closure of hospitals and the rationalization of services, or they can be involved in the reshaping and improvement of Australian rural health services. The level of involvement is each individual's choice, however, at the minimum all rural nurses should consider joining the AARN or contacting a member of the AARN executive in their state to discuss issues of concern. Out of AARN has also come a new journal dedicated especially to rural health issues.
The Australian Journal of Rural Health will provide a medium by which issues affecting rural health practice and a wide range of multidisciplinary health professionals can be published. More information about these important changes to rural health can be obtained by contacting Ian Blue who is a member of the AARN executive, at the School of Nursing, University of South Australia, Whyalla Campus on (086) 47 6062 or Fax (086) 47 6014.
Ian Blue, University of South Australia, Whyalla Campus
No more 'only a nurse'
I am concerned about the 'only a nurse' syndrome that I encounter all too frequently. Not all nurses suffer from this particular condition but I have a suspicion that the number who do is considerable. Many nurses who gained a three year certificate in nursing, went back to study to convert this to a Diploma of Nursing and later to a Bachelor of Nursing. For many of these nurses, this was achieved while undertaking full-time work and bringing up a family.
How many other professions have been subjected to these conditions to gain a Bachelor degree? Not many! So why then do I hear nurses downgrade their qualifications by suggesting they have only a degree in nursing, as opposed to some other discipline? I also hear some nurses examining aspects of their role by asking what is it they do that another health professional could not also do? I suggest this is yet another example of the 'only a nurse' syndrome.
I believe it would be equally valid to ask what it is that other health professionals do that can equal that done by the nurse. Nurses, traditionally, have been committed to the principles of lifelong education. They have gained this through diverse working experiences and by undertaking formal continuing education programs. Many nurses hold several certificates. Many have diplomas and degrees in nursing with a considerable number having degrees in other disciplines such as science or arts.
All of this knowledge enriches the discipline of nursing. In addition, nursing is becoming increasingly complex and demanding. For example, areas within medical/ surgical nursing which were once considered to be 'general' nursing, now require specialised knowledge. Similarly, the increased knowledge related to the care of the aged has also developed this area of nursing into a specialisation. Again, the recognition of the necessary nursing expertise associated with this form of care is not always openly acknowledged either by the nurses themselves or by the community.
I strongly believe that the declaration of 'only a nurse' must go. This will happen only if nurses critically identify and acclaim their own practice and that of their colleagues. As a starting point, for this, nurses can openly acknowledge the level of complexity and range of skills associated with the various nurse specialisations and reject, once and for all, the belief in 'only a nurse'.
Morgan Smith, Lyndocb, South Australia
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