Hand washing horrors – we need to do better

Not many nurses would have been surprised to read the findings of this article in the Sydney Morning Herald. Many of us have spent our careers reminding our medical colleagues to perform hand hygiene and usually copping flack for our trouble! I cringe when I reflect on my early training days (over 40 years ago) when the consultant surgeon would do his post op rounds, taking down dressings without a thought to hand hygiene being performed in between patients. Neither myself, as a lowly student, nor my more senior colleagues would consider reminding ‘Sir’ of this oversight! None of us had the courage to speak up for our patients, such was the culture and hierarchical structures of the time.  We are perhaps seeing the consequences of this culture, poor practices and lack of courage to advocate for our patients all these years later with the rise of the ‘super bugs’ and resultant mortality and morbidity. Reading the article, it was encouraging to see that hand hygiene rates are improving, but still a long way to go. All health professionals must take responsibility not only for their own hand hygiene, but in monitoring and encouraging good hand hygiene practices of others. It takes courage to speak up and remind others of correct procedures, but it can be done in a way that is respectful and should not be taken personally. I feel sure if it was a loved one suffering from an infection, we would be quick to act.

 

It is not only in hospitals that poor hand hygiene practices could be improved. I have on several occasions questioned food handlers in delis and fast food outlets who take my money with the same gloved hand they have just used to handle my food order. Last year I  reported a local café to the council for consistently not providing hand towels in the toilets used, not only by customers, but by the café staff! I gave the manager fair warning that I would be reporting him, but to no avail. Needless to say I go elsewhere for my coffee now!

 

On a lighter note, I am both heartened and amused when I see people take out small bottles of alcohol rub and perform hand hygiene in cafes and restaurants – they must be nurses I say to myself! But maybe not, I am hoping the hand hygiene message is getting through to a wider audience.

Menna

Passing the baton to the next generation

2015-09-03 07.12.15The Christmas holidays have given me the opportunity to attack the pile of perioperative nursing journals and catch up with my reading (and accrue some CPD hours!). An article that caught my eye was in the Journal of Perioperative Nursing in Australia (ACORN), (vol 29, issue 4, Summer 2016) by Seri Wilson. Whilst the content was related to Wilson’s research into retirement intentions of baby boomers (BBs) at her hospital, I found some of the statistics presented thought provoking. Wilson cites Australian Institute of Health and Welfare (2014) demographic data stating that in 2014, 38.3% (4 out of 10) of the nursing workforce were aged 50 years of age or over. Whilst these are overall nursing workforce figures, they are probably reflected in many of our perioperative environments. Wilson was making the point that the BB generation, if they haven’t done so already, will soon be leaving the profession and posed the question of whether we are doing enough to hand over to the next generation of nurses.

Being a BB myself, I am well acquainted with others of my vintage who have either retired, are about to retire or are still in the workforce. Many BBs are unable to retire due to financial reasons and there are many who just love their work. Such people were gold dust for me when I was working as a Clinical Nurse Consultant, because I knew that they would support, teach and mentor the new graduate nurses who were embarking on their perioperative careers.

The worry is – what happens when such valuable BBs finally do retire? Will we have enough perioperative nurses to take their place and will we have done enough to pass on the baton of safe patient care to them? It is a point made in Wilson’s conclusion – the need to have an appropriate handover to the next generation.2015-03-13 15.07.07

During my career as a perioperative educator, my passion has been to promote the specialty as a career path for both RNs and ENs. Long gone are the days when all student nurses (like myself) gained clinical experience in the operating theatre, where the seeds of a career in perioperative nursing were sown for me and many of my contemporaries. The reduction in the number of undergraduate nurses being exposed to perioperative nursing means that the pool of future perioperative nurses is also reduced. Many operating theatres are crying out for nursing staff, both RNs and ENs and I know, from talking to colleagues in the tertiary sector, that there are many undergraduates interested in the specialty and a clinical placement in the operating theatre. Unfortunately such interest is often not translated into action with many operating theatres being reluctant to open their doors to potentially the next generation of perioperative nurses. Why? Well, I have heard many reasons – ‘students are too much trouble’; ’we are too busy to spare the time to teach’; ‘don’t have an educator’; ‘we only do lumps and bumps’ etc, etc.

Whilst there may be legitimacy in some of these comments, I feel that operating theatres who are short of staff are really missing the opportunity to ‘grow your own’. Yes, visiting undergraduates can add to an already busy workload, but going the extra mile by allowing a them to follow a patient through surgery or providing a short rotation to the operating theatre, can pay dividends for the future. It does not matter that minor or less complex surgery is performed, the undergraduate does not care, they are fascinated by anything and everything. Whilst a CNC at Randwick Campus Operating Suite (RCOS) I assisted in facilitating a twelve month program for new graduates, the majority of whom stayed on staff following completion. They have become valuable team members and many of them are now senior staff within the RCOS.

So at the start of 2017, I have a challenge for those of you seeking staff. Consider ways in which you can ‘grow your own’.

Here are some ideas to get you started:

  • contact your local university/TAFE and offer options for exposing the undergraduates/EN students to the operating theatre – a patient follow through, a tour, an opportunity to present information about perioperative nursing at the university/TAFE
  • organise an operating theatre open day to which not only undergraduate nurses can be invited, but new graduates and nurses from other departments in the hospital. A number of current perioperative nurses started their careers in other specialties before seeing the light!
  • work with your local NSW Operating Theatre Association (NSW OTA) Zone to consider a united approach to promote the specialty

Many of you will have already tried these and maybe other strategies. Let me know what worked for you and if you haven’t tried these strategies, give it a go. Whilst I am not longer active in the clinical area (though business partner Sally is), through our business we are maintaining our passion to promote perioperative nursing as a career. We will continue to provide education to nurses who seek to enter the perioperative specialty through our Fundamentals program which was the subject of my previous blog. We are keen to run more of these courses in the coming months. So if you know of any colleagues who would benefit from the program, please let us know – we can help them take that first step.

Getting new staff into the perioperative environment is only the first step, we then have to work to educate and support them whilst they settle into their new career. So it is pleasing to see the Nursing and Midwifery Office within NSW Health launch the Transition to Perioperative Practice program. This program, to begin early 2017 and developed by experienced perioperative nurse, Deb Burrows, supported by NSW OTA, will provide new staff embarking on their perioperative careers a structured program, giving them skills and knowledge to provide safe patient care. This will overcome the need for individual hospitals to develop their own education programs and will hopefully encourage operating theatres to take on novice perioperative nurses.

We are at a critical point in perioperative nursing with the BBs moving on and what is required is a steady, ongoing supply of nurses, RNs and ENs – the new generation of perioperative nurses to take their place. The BBs have laid a solid foundation of perioperative practice, it is up to you to build the next generation and ensure the baton is passed on.

Menna Davies

Happy Perioperative Nurses Week 2016

This year, to celebrate Perioperative Nurses’ Week we’re releasing the education resources from one of our popular and recent Twilight Seminars and making it available as a GIFT for download from our website. This gift comes just in time for you to prepare for Wound Awareness Week 16th – 21st October 2016. Whether you work in the medical industry, acute care, community or aged care settings, this downloadable resource will be of interest for everyone.

Wound Assessment: What lies beneath. Bibliography and useful resources

We hope you can use it to advance your knowledge and improve the outcomes of vulnerable patients.

 

 

Lady superintendent Jane Bell, OBE.

Lady superintendent Jane Bell, OBE.

As part of the celebrations, we think it’s important to acknowledge some of the amazing nurses who have paved the way for us!

This is Jane Bell – an extraordinary woman and the first Sister in Charge in the Operating Theatres of the Royal Melbourne Hospital.

 

Looking up to Matron Grace Wilson

Looking up to Matron Grace Wilson

And here’s Matron Grace Wilson, commemorated in a poster on Sydney’s George Street. She’s doing her rounds of the 3rd Australian General Hospital on Lemnos Island in 1915.

 

There are countless more extraordinary nurses who have made a contribution to perioperative nursing care.

Who do you look up to? Let us know and we’ll post a selection of responses.

Very best wishes from Sally & Menna

Perioperative project in the Pacific – collaboration in action


 

group work

group work

What a wonderful few days we have just had in Suva, Fiji presenting at the workshop on implementing the Pacific Perioperative Practice Bundle (PPPB). We have been working with our colleagues within the organisation, Strengthening Specialised Clinical Services in the Pacific (SSCSiP) developing six infection prevention standards which formed the bundle, together with audit tools for each standard. The workshop was aimed at assisting our Pacific perioperative nursing colleagues implement the bundle within their own workplaces.

SSCSiP’s project coordinator, Mabel Hazelman Taoi and her team did a wonderful job coordinating the workshop and all the travel and accommodation for the twenty participants – no mean feat when you see where they all came from. You will need to get the map out to locate all fourteen countries of the Pacific region represented – Cook Islands, Fiji, Kiribati, FS Micronesia, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tokelau, Tuvalu and Vanuatu. Some of the participants had travelled for a couple of days with many connecting flights via places such as Honolulu and Auckland! Nothing like our 4 hours direct flight from Sydney!

book signing

book signing

webinar with Jed Duff in Sydney

webinar with Jed Duff in Sydney

We had two and half days with our colleagues working through key elements of the standards and strategies for implementation. Each participant received a copy of the 2nd edition of the perioperative text book, Perioperative Nursing: An Introduction. Our fingers were well and truly crossed that technology would work and with the assistance of ACORN’s Education Officer, Dr Paula Foran, we arranged a live webinar with Dr Jed Duff (ACORN President) back in Sydney. He gave a great presentation on putting knowledge into action with excellent practical information on implementing change. It is one thing to have a bundle of standards, it’s quite another to implement them and we spent a lot of time looking and enablers and barriers to implementing change in the workplace based on Jed’s presentation. Another key element to the bundle were the audit tools and for many of our colleagues this was new territory for them. We were able to practice undertaking audits using the tools by carrying out observations in the local operating theatre, around the hospital and by watching videos.

location, location!

location, location!

One additional topic discussed was the formation of a professional association to connect all the perioperative nurses within the Pacific, encouraging sharing of ideas and progress on implementation. We tapped into the experiences of Phyllis Davis who was instrumental in assisting the perioperative nurses of Papua New Guinea form of their association. Another live webinar with Sydney based Phyllis got the ball rolling and served to inspire the group to the next step.

During our workshop we learnt more about the environments that our colleagues work in and the challenges they face in implementing the standards. Some of them work in large units and some come from small facilities with only one operating theatre and minimal staff. It wasn’t all work and we had a lot of fun along the way, including a night out with the group at a local Chinese restaurant.

a night out with the group - note Vane's NSW OTA shirt!

a night out with the group – note Vane’s NSW OTA shirt!

Mabel receiving one of our gifts

Mabel receiving one of our gifts

Unfortunately we were not in Fiji to join in the celebrations for their victorious, gold medal winning 7s rugby team! That would have been an experience judging by the obvious excitement still bubbling amongst the local population. We left Suva exhausted after a full on couple of days, but feeling very satisfied that we had provided the group with lots of information, strategies and encouragement for the next step of their journey. A journey that will bring a consistency to the standards of perioperative nursing practice to their workplace and ultimately a safer environment for their patients.

lovely necklaces and a Fiji banner as gifts

lovely necklaces and a Fiji banner as gifts

We have already had lots of emails from the group who have already organised meetings with their hospital administration to report on the workshop and submit implementation plans. So lots of positive steps are happening already.

We hope to see a few of the group at the South Pacific Nurses Forum to be held in Honiara, Solomon Islands in early November where Sally and Mabel will present a paper on the PPPB Project.

ACORN 2016 – A memorable gathering

Sally, Heather, Lois Hamlin, Menna and Ruth Melville

Sally, Heather, Lois Hamlin, Menna and Ruth Melville

Menna Davies

Having just returned from the ACORN Conference in Hobart where over 1000 perioperative nurses gathered for 3 days it got me thinking about why, in this electronic age we still find value in meeting together at conferences. Couldn’t we obtain all the information imparted at a conference via webinars, podcasts or YouTube? Why do we spend hundreds of dollars to travel hundreds of kilometres to spend three days with a thousand fellow perioperative nurses? I think the answer is simple, nothing compares to being in the company of like-minded people, who understand the challenges of being a perioperative nurse in 2016 and who also enjoy having a good time! And so it was at ACORN 2016 in Hobart. Phew, what a buzz! Lots of memorable moments.

But one moment stood out for me and happened by chance, a case of me being in the right place at the right time. One day a woman approached me during the lunch break, ‘Do you recognise me?’ she asked. It is a question I am often asked, usually by post graduate students who I have facilitated on line and who know me, but who, due to only having an online presence, I rarely get to meet face to face! Unfortunately I did not recognise the woman at first and had to tactfully ask (I have become quite good at this over the years) to give me a clue as to where we may have met before.   ‘I’m Heather Moon’ she replied. I don’t think many people at the conference would have known that Heather Moon is a former ACORN President (1986-89). Fortunately I did (perhaps I have just been around ACORN for more years than I care to remember)! What a treat to meet her again, not many perioperative nurses from that era attend ACORN Conferences and her appearance that day was only by accident. She and her husband, David, had been staying at the conference venue the previous week for another event that he was attending. Returning for a further night’s stay, she saw the signs for the ACORN Conference and thought she would pop in to say hello! Heather comes from Queensland and I tracked down the ACORN Board members from the sunshine state, along with Ruth Melville, IFPN President and also a Queenslander who were equally thrilled to meet her. Current President, Jed Duff met Heather and a number of other conference attendees made her so welcome. She was escorted around the trade exhibition in awe at the array of latest equipment and medical devices. Later that day several of us met Heather and David again at the bar and over a few glasses of wine, shared memories of her time as ACORN President using photos I had as part of a montage prepared for a previous conference.

Sharing memories with Heather

Sharing memories with Heather

Heather was thrilled to have met up with so many perioperative colleagues and friends. We all left energised at meeting one of ACORN’s living treasures. It occurred to me after we had said our farewells, how much we owe our predecessors who nearly forty years ago, paved the way for where ACORN is in 2016 by their administrative skills, vision and commitment. In Heather’s day, ACORN was run by volunteers from each state/territory using telephone (no mobiles), snail mail (no email) and fax as the only means of communication, managing to coordinate the publication of the journal and standards, not to mention the enormous task of organising the national conference. Today, ACORN has a secretariat, email, webinars, video/teleconferences and external conference organisers – how times have changed and how much we take for granted!

When it all comes down to it, the conference is all about the people who attend – the networking, renewing of friendships, making new ones, gaining knowledge, sharing solutions to common challenges, meeting people who have influenced your career, have been your mentors or perhaps people you have mentored and above all lots of fun!

I always return from conferences with new ideas and a renewed approach to my work that I feel makes me more effective and efficient. Stephen Covey, in his influential book ‘The 7 Habits of Highly Effective People’, identifies this as ‘sharpening the saw’ – renewing yourself through making meaningful social connections with others, learning, increasing your capacity to face the challenges of life and work. The analogy – a sharp saw will cut more effectively than a dull one! And I think that is so true. ACORN Conference 2016 – memorable!

Reference:

Covey, S. (1989) The 7 habits of highly effective people. USA:Running Press.

Another reason we continue to celebrate nurses on May 12th

Each year on May 12th as I celebrate International Nurses’ Day I’m reminded of Florence Nightingale’s legacy.

All of us in society, whether we are nurses, patients or family, share a debt of gratitude to Nightingale for laying the foundations of nursing and establishing many of its principles we value today.Florence_Nightingale_monument_London_closeup_607

I was reminded of this recently when I visited the Nightingale Museum housed in the Selimiye Barracks at Scutari, Istanbul. It contains many relics from the Crimean War between Russia and the combined forces of Britain, France and Turkey. This war is remembered not only for the Charge of the Light Brigade but also for the terrible troop losses from disease which led to a Royal Commission into Military Hospitals. Florence Nightingale’s association with the Crimean War is also justly famous because of her attention to the nutritional and hygiene needs of the sick and wounded troops. She fought authority wherever she found it to be misguided. She made a difference.

I was able to visit this most historic museum when I travelled to Greece and Turkey to commemorate Australian and New Zealand nurses’ achievements during WWI. Like Nightingale half a century before them, the nurses of WWI skilfully cared for the physical and emotional needs of our wounded soldiers, and improved their survival rates so that many of these young men could return home and contribute to our growing society. In recent months, I’ve written more about this trip in the Journal of Perioperative Nursing in Australia and I’ve posted some photos on the NSWNMA Blog Nurse Uncut.

So this year, let’s all remember our debt of gratitude to Florence Nightingale for establishing what we know today as the profession of nursing and consider the many ways that nurses contribute to our society.

Would love to read your comments here about how you celebrate International Nurses’ Day – thanks for reading, Sally.