“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.