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Roundtable Round-up: Nurse Practitioner Candidate Emma Collins

3 Dec 2021

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.”

Nurse prac­ti­tion­er candidacy

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.

Issues she’ll raise on the Roundtable

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.

Nav­i­gat­ing 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.