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This is where we tell your stories, cover topical issues and promote meaningful initiatives
The CRANAplus Nursing and Midwifery Roundtable discusses and reports on key issues affecting rural/remote health. Roundtable Member, Nurse Practitioner Candidate and Nurse Manager Emma Collins from Ceduna outlines the issues she’ll be flagging through the discussion group and shares the moving story of her journey from the bush to the city then back again.
“It’s a bit random how I got here,” Ms Collins says with a laugh. “Both my parents are from Northern Ireland. My dad [Jim] put in for a job in Australia as a diesel mechanic, and he got the job in Leigh Creek, so he and Mum [Rose] moved from a ‑20-degree winter to a 50-degree summer.”
Later, the Collins family moved to the Barossa, and it was here that Emma’s passion for nursing began after completing a placement at Angaston Hospital.
“I always wanted to go back rural, but then I got my grad year at the Royal Adelaide, so I thought that’s a great opportunity, a great foundation – then I didn’t leave for over a decade,” she says.
“In 2018, one of my husband David’s best friends, who like David is a paramedic, moved to Ceduna. David applied for a secondment, I applied for leave without pay from the RAH and soon after I started as an RN at the Ceduna hospital.”
The change was dramatic – a little like adapting to a 70-degree change in temperature.
“I was blown away with the amount that these nurses do,” Ms Collins says, giving an example. “There’s no SA Pathology to send the bloods to on-site so you have to spin the bloods in the blood spinner and then put them in the fridge, and then they get picked up once a day.
“Nurses out here just have to be a jack of all trades. I was really blown away by their confidence. Even though I was a skilled clinician, I had a lot of different things to learn. Because, you know, I didn’t have my resus team there. Being part of the Ceduna team, you sort of were it.”
Ms Collins is now a nurse unit manager (NUM) at the hospital, and personal circumstances have also inspired her to pursue Nurse Practitioner endorsement.
“My dad was really sick last year,” Ms Collins tells CRANAplus. “He got diagnosed with cancer. We had a really long conversation, and it was decided that we would keep him at home and that I would palliate him at home, in the Barossa.”
“[My director] Andrew, my partnering NUM Tanya and my Executive Director of Nursing and Midwifery Julie were incredible. They basically said, ‘Do what you need to do and we will be here when you return’.
“I managed to palliate dad and kept him at home right until the end, and what I experienced was a beautiful palliative care team, but an under-resourced palliative care team.
“When I returned to Ceduna, that week – although it was really raw for me – I had a family in a similar position to me, but no one was medical. We managed to keep him at home up until the day when he passed away and he was in hospital with his family around him.
“That’s sort of pushed me to do my Nurse Practitioner studies, because I realised there’s a gap in our healthcare delivery… It’s not
just the big traumas and the life-threatening presentations. In part, I was driven by creating easier access to healthcare. We rely on locums. We do have one or two resident GPs here, but the access to care – particularly palliative care – is something we could probably do a bit better.”
As part of her NUM role and her candidacy, Emma has led numerous quality improvement projects.
“For example, in a lot of rural areas, there’s just one emergency trolley that has everything in it: paediatrics, airway, breathing, circulation,” she says.
“I did a survey with staff and they were saying they weren’t able to find what they needed quickly enough. I organised a lockable airway trolley, and a circulation trolley that has defib and all of the circulation drugs and circulation needs, with everything labelled and easy to find.”
“I’m making some nurse-initiated pathways for the Eyre and Far North, and hopefully we can all get that similar care and pathways for everything in this health network,” she adds.
Ms Collins says that, during the first meeting, it was great to hear the experiences of fellow Roundtable Members — on both a professional and a personal level.
“I think being able to sit on our Roundtable and share those experiences and have people say ‘us too’ makes you feel some sort of camaraderie,” she says.
Ms Collins joined the Roundtable to raise a few key issues that matter to her and those within her networks. Firstly, she wants to let people know that rural healthcare work represents opportunity.
Since going rural three years ago, she has won a scholarship to go to Auckland for a Renal Society Australasia Conference and to Sydney for Palliative Care Outcomes Collaboration Conference. In October, she had also been shortlisted with two others for the SA Health Young Professional of the Year and had just been announced as a recipient of the Australian College of Nurse Practitioners’ Heather May Herrick Scholarship.
Not only is she a part of the CRANAplus Roundtable but sits on multiple committees including the Country Health Emergency and Trauma Advisory Committee and the College of Emergency Nursing SA Branch/Committee.
“Since I’ve been here I have done chemotherapy training, haemodialysis training,” she adds.
“These are the things that you may get overlooked for or not know about in Adelaide; whereas here I’ve had amazing opportunities and I’ve only been here for three years.”
Secondly, Ms Collins wants to raise awareness of the under-recognised specialist nature of the rural nursing profession.
“I think coming from a metropolitan hospital, I had a wider scope of practice, on paper, than I do here,” she says. “[In Adelaide], I was able to do nurse-initiated medications and fluid, nurse-initiated X‑rays, and nurse initiated pathology.
Thirdly, she wants to raise awareness of staffing issues and shortages — an issue which has been exacerbated by the COVID-19 pandemic.
Emma was working at the old Royal Adelaide Hospital’s Emergency Department during the Ebola pandemic and recalls running through a simulation, during the transition to the new RAH, wearing a HAZMAT suit.
In some ways, COVID-19 brought these simulations to life in Australia, but “COVID-19 is definitely a scale up”, says Ms Collins, who having also worked at the Royal Adelaide’s Communicable Disease Control Branch, speaks from lived experience.
“It’s been really hard, particularly when we’ve had these exposure sites [near Ceduna] recently,” she says. “My director and I worked around 11 or 12 days straight because we just didn’t have the staffing secondary to staff isolating… At one point, we swabbed nearly 300 people over a two-day period.
“Even with gaining agency from interstate, it’s just not as simple as it used to be. Everyone is feeling the same, because no one can get these agencies from interstate, and when we do, they might have to quarantine for two weeks – then who pays for that?”
Throughout the pandemic, the hospital has been provided a point-of-care testing machine by Flinders University and has used negative pressure machines that are “put into the window of the ward room and turned on, whereas in Adelaide you turn a key”.
Faced by these challenges, “Our team has stepped up and has really impressed me,” Ms Collins says.
“One of, or perhaps the only positive of this horrible time is that we’re part of medical history; something that may not happen again in our lifetime,” she adds.
Become a CRANAplus Member for the opportunity to participate in advocacy groups such as the CRANAplus Nursing & Midwifery Roundtable.