September 2019
Mental Health special feature + Nurse Practitioners integral to improving mental health outcomes + Avoid burnout: self-care strategies for nurses + Gaming community key to youth mental health + Combatting night shift burnout
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HealthTimes - September 2019 | Page 03
September 2019 We hope you enjoy perusing the range of opportunities included in this issue. If you are interested in pursuing any of these opportuities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au DISTRIBUTION 46,300
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Page 04 | HealthTimes.com.au
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Nurse Unit Managers Northeast Health Wangaratta
Northeast Health Wangaratta (NHW) is a busy sub-regional integrated health service of 241 beds and is the major referral facility for the greater part of North East Victoria. NHW provides a wide range of acute specialist medical and surgical services including; an emergency department, critical care unit, obstetrics and gynaecology, paediatrics and cancer services. NHW is experiencing a period of expansion and will shortly commence a significant redevelopment program. They are seeking two senior nursing professionals for these important roles. Nurse Unit Manager – Critical Care & Dialysis Unit The Nurse Unit Manager of Critical Careand Dialysis is a senior member of the Nursing Division and has direct operational responsibility for the provision of high quality and safe patient services through leadership, coaching, team building, change management, and effective human and financial resource management. Nurse Unit Manager – Medical Ward / Paediatric Services The primary role of the Medical / Paediatrics Unit Manager is to provide clinical leadership, operational management and strategic direction for the Medical and Paediatric Units. The Medical / Paediatrics Unit Manager will ensure the delivery of a cost effective service focused on high quality patient outcomes and excellence in the provision of Medical and Paediatric services. To be eligible for these roles you will hold current registration as a Registered Nurse / Midwife with the Nursing and Midwifery Board of Australia / AHPRA and have a minimum of five years post registration experience in acute services. You will be able to demonstrate strong leadership and management skills as well as highly developed communication / interpersonal, negotiation and conflict resolution skills. Remuneration is in line with Victorian Public Sector Nurses and Midwives Enterprise Agreement. If you have the background and skills for these exciting roles then we would like to hear from you. For more information please visit our website at:
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or contact Jo Lowday on: 0400 158 155. To make an application you will be required to submit: a Cover Letter incorporating a response to the Key Selection Criteria, your full CV and a completed HRS Application Form available on the HRS web site. Applications can be made online or sent by email to:
hrsa@hrsa.com.au
Applications close: 13 October, 2019
www.hrsa.com.au HealthTimes - September 2019 | Page 05
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HealthTimes - September 2019 | Page 09
Avoid burnout: self-care strategies for nurses
N
ursing has been voted the most trusted profession for the past 22 years, but the impact of this high expectation often leads to stress and burnout. Nurses are at a higher risk of burnout out than other professions for many reasons, including high-stress work environments, shift work and long hours, understaffing, low pay scales, high responsibility and a lack of support from health care teams. Burnout is more than work-related stress that results in a bad day. Burnout is a complete lack of physical and mental energy after a period of chronic, job-related stress. Robbie Bedbrook, general practice and sexual health nurse, runs workshops in the Australian health care space on self-care and burnout, and advocates for nurses to protect their mental wellbeing. The important safeguards against stress and burnout, said Mr Bedbrook, include seeking help, using entitlements, avoiding multitasking, making lifestyle adjustments and tending to self-care. Seek help and find a support network “If you’re already feeling the weight of burnout or compassion fatigue, it’s important to seek help for this. “Our mental wellbeing is one of our most precious resources as a nurse! “A great place to start is ‘Nurse and Midwife Support’, a dedicated phone-service for nurses and midwives who need help. “It is staffed by nurses and midwives trained in counselling and is completely anonymous. “Another great option is to see your GP, who should provide some counselling and potentially a Mental Health Care Plan
Page 10 | HealthTimes.com.au
to see a psychologist. This tip can also be a preventative one to teach you strategies to cope!” Use your entitlements It’s important to take annual leave, RDOs, sick-days, and meal breaks. “These are all in place to give us space to recharge and protect our physical and mental health, so use them! “You are not a selfish healthcare worker if you take your breaks or choose not to accept that over time; that might be the culture of your workplace but working yourself to burnout has nothing to do with being a nurse. “Moreover, these entitlements were hardearned by the giants of nursing who came before us, and we should honour them by using them!” Avoid multitasking mindfulness at work
and
practice
Trying to focus on more than a few tasks at a time overwhelms the brain, leads to anxiety and reduces performance, said Mr Bedbrook. “Learn about mindfulness and try to integrate this philosophy into your practice by doing one thing at a time. “If you’re performing a clinical task, that’s your focus. If you’re administering medications, don’t take phone calls or perform handover or provide counselling or mobilise patients. “Not only will this allow the brain to perform at its best, but it also helps us find enjoyment in work. If it’s not an emergency it’s okay to say to someone, ‘I’ll get to that later.’”
Consider what you’re eating and exercise Foods high in processed sugar can lead to anxiety and excessive tiredness, all which contribute to burnout. “Try to pack snacks for your shift that are low in processed sugar and high in nutrients, such as fruit, home-made bliss balls and nuts. “Activity and exercise are also wonderful ways to reduce stress, practice mindfulness and improve physical and mental health. “A wonderful place to find motivation and structure is the Australian College of Nursing’s Nurse Strong campaign!” Have yourself
compassion
for
Empathy is the cornerstone of nursing, but it is active work that takes a toll. “Talk to yourself the way you talk to others and care for yourself the way you provide care for others. “Self-care is individual. It’s not a checklist that looks good on social media. Find the activities that recharge you, and this won’t be the same for everyone,” said Mr Bedbrook. Jade Stewart, a third-year registered nurse, recognised early that the demands of nursing were negatively impacting her wellbeing. “12-hour shifts and successive night duty were taking its toll as a ward nurse. “As a result, I opted out of full-time hospital work. “After leaving a full-time hospital-based roster, I initially picked up work with an agency but found that stressed me out even more. “I now get shifts through uPaged and know
when and where I work, which has reduced my stress significantly. “I realised pretty quickly that as nurses, we care, sometimes a little too much, about our patients, and it’s really easy to take all the work and patient troubles home. “The downside of that is that we carry a bit of a burden ourselves. “I have a great nursing mentor who told me that if I looked after myself first, I’d be able to take better care of my patients.” Taking breaks, practising mindfulness and eating well are important self-care strategies for Ms Stewart. “On longer breaks, I go for a walk outside to get some fresh air and sunshine and drink water. “Reflection has been a great self-care practice for me, especially after a traumatic event on the ward, sharing that experience with the team has proven to be a huge help. “I avoid processed sugar, so I don’t get any sugar lows, limit my caffeine intake and never have any six hours before I intend to sleep. “If I’m working nights, rather than focusing on a perceived inability to fall asleep, I focus on what time I’m going to wake up and how fantastic I’ll feel when I do. “Inevitably, I wake up feeling great a minute or two before my alarm goes off. “I always make sure I shower as soon as I get home from a shift. “Psychologically it’s like washing off the stress of the shift, and it helps me draw a line between when work ends, and home life starts. “I actually visualise the thoughts of the day washing off.”
HealthTimes - September 2019 | Page 11
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Page 12 | HealthTimes.com.au
HealthTimes - September 2019 | Page 13
Gaming community key to youth mental health
T
he growing cohort of gamers have become a primary focus for mental health groups, with September’s R U OK Day specifically focusing on the youth-based demographic. Katherine Newton, CEO of the national event says the gaming community was a crucial piece of the puzzle, when it came to reaching out to those with a mental illness. Despite its reputation as an isolating activity, gamers in fact have a high level of social connectedness, providing a sense of belonging to those involved. “This social connectedness can help gamers look out for each other both online and offline, and trust their gut-instinct when they notice signs that someone might be struggling with life,” says Ms Newton. She says the signs can be subtle changes in both verbal or non-verbal behaviour. “Someone might tell you they’re having difficulty switching off, or a mate might not be turning up to social events,” she says. “We’re encouraging people to look out for those cues. “We can also make a conscious effort when we know someone is going through a significant life change such as job loss, relationship breakdown, study pressure or perhaps becoming a parent.” Gaming has also proven to be a worthy respite for those experiencing mental health problems, with recent research suggested it improves mental wellbeing for those who take part. According to the Digital Australia 2020 Report from Bond University and the Interactive Games and Entertainment Association, 74 per cent of gamers say they have experienced mental health benefits through gaming. Almost two thirds of players believe gaming reduces their anxiety and more than 65 per cent say being part of the community improves their
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overall social well-being. The study revealed gaming was an inclusive group, which helped with loneliness and social anxiety. It also provided a refuge from external pressures and bullying, the research showed. Conversely, research conducted by R U OK? Revealed that less than half of 18 – 34-year-olds believed they knew what signs to look for that might indicate a person was struggling in life. With more than 12 million Australians playing video games regularly, psychotherapist Karen Phillip says the gaming community is a great place to focus on educating youth about mental health. “Gaming can provide an outlet and release from reality for many young people struggling with mental health issues. “While it isn’t the best choice for support it enables the teen to connect with others with similar interests and as a temporary escape.” Dr Philip says a gamer may be in need of support if they are spending considerable time online thereby forgoing normal life activities. “Also, if the gamer starts speaking very negatively about their life and future, this is a cause of concern. “Any gamer not making forward plans for life can provide a hint of worry. Continual negative talk about life, connecting with others and further aspirations all give us a sign or concern.” Dr Phillip says mental health professionals and organisations may benefit from connection with gamers. “Games are where our young people are congregating and communicating therefore, it is wise to become part of that community as a way to stay connected with so many of our kids. “This way professionals can understand what their conversations and concerns are about which allows us to help and offer support they may need.”
Manager Quality, Experience & Safety Yarram & District Health Service
Yarram and District Health Service (YDHS) is a multipurpose health service providing acute, residential aged care and primary care services based in Yarram, some 220 kilometres south east of Melbourne on the South Gippsland Highway. The acute service program comprises 20 acute inpatient beds, 3 dialysis chairs and a 24-hour, nurse led, Urgent Care Centre. There are two residential aged care facilities which comprise a total of 60 beds inclusive of 12 dementia specific low care beds and 18 high care beds. Reporting to the CEO, the Manager of Quality, Experience & Safety is responsible for managing the accreditation requirements and compliance processes and is the designated Feedback Officer. This role works collaboratively with the organisation's senior leaders, managers and staff to promote a culture that facilitates the delivery of high-quality healthcare through the development, monitoring and evaluation of the YDHS Quality Risk and Patient Experience Frameworks. To meet the requirements of the role you will preferably have: Tertiary qualifications in a health-related field. Experience in a quality and safety leadership role. Excellent interpersonal and communication skills including high level report writing. Ability to collect, analyse and report upon data. For more information about this exciting opportunity please visit our website at:
www.hrsa.com.au or contact Jo Lowday on: 0400 158 155. To make an application you will be required to submit: a Cover Letter incorporating a response to the Key Selection Criteria, your full CV and a completed HRS Application Form available on the HRS web site. Applications can be made online or sent by email to:
hrsa@hrsa.com.au Applications close: 6 October, 2019
www.hrsa.com.au HealthTimes - September 2019 | Page 15
Pros and Cons of Refinancing: What you need to know
F
or most of us, buying a home is the significant financial decision we’ll ever make. It’s both an exciting and overwhelming undertaking, not to mention a long-term commitment. Home loans can be complex creatures; with various features to consider along with changing interest rates. Plus, over time your personal circumstances will change, perhaps your family has expanded, or you’d like to move house. That’s why it’s important to reassess your home loan every few years to make sure you’re still getting the best loan for your needs (and potentially save yourself thousands of dollars). So what is refinancing? It’s replacing your current loan with a shiny new one – typically with different features, a lower interest rate and lower fees. One way to do this is by tapping into your home’s equity. What’s equity? Your home’s equity is the difference between the value of the home and the amount owing on the loan. Equity increases as your property’s value does, or as you pay off more of the loan, or a bit of both. This equity may give you leverage to help you refinance to a more competitive interest rate on your home loan, and you may also be able to access the money to use for renovations, investment or consolidating debts. What else should I consider? • It’s not just about the rate -While your loan interest rate is an important piece of the home loan puzzle, remember that there are other factors to consider in line with your own
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needs, including the features of the loan and any fees. • Steer clear of ongoing loan service fees - Some lenders charge a fee to service your loan. And while small ongoing fees might seem like an inconsequential charge, they can really add up. In fact, an $8 monthly fee over a 30-year loan term could cost you $2880. • Hidden costs - Costs such as exit fees from your current lender, and set up costs for the new loan. Wondering how much could you save? In just minutes, Bank First’s new switching calculator will show you: » » »
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HealthTimes - September 2019 | Page 17
Nurse Practitioners integral to improving mental health outcomes
M
ental illness is common, with one in five Australians experiencing a mental illness in any given year and almost half (45 per cent) affected in their lifetime. Sadly, 54 per cent of people with a mental illness do not access treatment. Mental Health Nurse Practitioners can help to improve accessibility and affordability of quality mental health care, which can be challenging and confusing for those affected. Sian Pritchard, a Mental Health Nurse Practitioner and Director of Pritchard Health, is a specialist in psychiatry and substance abuse, providing mental health support through a nurse-led model at her primary care clinic in Geelong. The nurse-led, mental health care clinic uses a biopsychosocial assessment, which incorporates the biological, psychological and social domains of health to provide treatment and care in substance abuse and mental illness. “We offer a range of short-term psychological interventions through to longerterm complex care coordination. “This may include anxiety, depression, bipolar disorder, personality disorders, schizophrenia, substance abuse - including smoking cessation plans - and eating disorders. “We also offer unplanned pregnancy counselling,” said Ms Pritchard. Ms Pritchard believes an evidence-based, holistic approach to mental health care is what sets Nurse Practitioners apart. “When we work with people, we consider their mental, physical, spiritual, emotional, social and cultural needs. “As nurses, we practice on an evidencebased background, and as credentialed mental health nurses, we hold additional qualifications in mental health nursing-specific study.
Page 18 | HealthTimes.com.au
“In my opinion, and the evidence does demonstrate, the therapeutic alliance is fundamentally what is going to support someone in their recovery.” There are many therapies and counselling techniques that Nurse Practitioners can employ to treat mental illness, such as cognitive behaviour therapy and motivational interviewing. “Motivational interviewing can assist people in reflecting on current use and supporting them moving towards wanting to make changes to their use for improved health outcomes. “These therapies can be utilised across many spheres, not just when working in the area of anxiety or addiction. “Whatever therapeutic technique I choose, it needs to be tailored to the individual, their situation, and consider how their disease or illness is affecting their ability to lead a fulfilling life,” said Ms Pritchard. Nurse Practitioners undertake master’s level qualifications and have extensions on their scope of practice traditionally reserved for those practising medicine. “I have a mix of counselling and psychotherapy skills complemented by the ability to prescribe, or deprescribe as is often the case, order and interpret investigations, diagnose illness and disease and refer to specialists when required. “I can conduct a diagnostic assessment, plan care and treatment which often includes a referral to work with a credentialed mental health nurse, discuss medication management with GPs or psychiatrists and undertake the responsibility for prescribing medications. “I am also able to refer people to see a specialist for clarity of diagnosis and or medication in complex cases.”
Nurse Practitioners can minimise unnecessary appointments, disruption to care and the cost for repeat services. “I can afford people more time than GPs generally can. “This is never more important than when working with people with mental illness or addiction. “Evidence shows us that even when linked to GPs, people with mental illness have poorer health outcomes than those who do not have a mental illness. “This is often because of the need to have longer appointment times and specific questioning around health issues that are best provided by a specialist mental health nurse.” Patients don’t need a referral to see a Nurse Practitioner and can access Medicare rebates. “People can book an appointment to see me without a referral from their GP. “I can conduct an initial assessment, and then support them to be linked with the most suitable service. “This may be to provide them with a letter to take to their GP to organise a Mental Health Care Plan to see a mental health clinician for up to 10 sessions per year.” The cost of mental health treatment is a barrier for many people, and GPs may not be aware of the options available. “GPs are often confused by the mental health services available and may be unaware of associated costs. “Costs can be a barrier for people accessing psychological care, and I can assist them in finding services they can afford.
“Some GPs have expertise in mental health and addiction. I would argue that many do not. “GPs are also time-poor for many reasons, leaving people to try and tell their story in five to 10-minute consultations. “Doctors and nurses work exceptionally well with each other and complement each other’s skillsets. “The GPs I have worked with are supportive of the skill set of credentialed mental health nurses and Nurse Practitioners.” Working as a mental health Nurse Practitioner is rewarding because there is the ability to make important decisions toward patient treatment, explained Ms Pritchard. “Every day, I enable people to find the right resources to support their recovery is a great day. “Reducing people’s medication and supporting them to manage their illness in other forms is always pleasing. “People with psychotic illnesses generally have shortened life expectancy — anything from 15 to 30 years less than those who live without psychotic illnesses. “Medication is often a contributing factor, as is lifestyle such as smoking, lack of exercise, sunlight, connectedness to the community.” The capability to prescribe and alter medication is an important factor in treating patients as a Nurse Practitioner. “GPs are often not confident to change psychiatric medication, unless they know someone is being supported by a mental health specialist, due to the risk of relapse. “I can order investigations to assess metabolic health. We know this isn’t done well
HealthTimes - September 2019 | Page 19
generally in public mental health services, and it is a vital part of peoples care and treatment if someone is prescribed psychotropic medication.” Nurses are trusted health professionals who are experts at coordination of care, but also treat the physical and mental of their patients. “Nurses are fundamentally better prepared than other mental health professionals to provide physical and mental health care combined due to our undergraduate training. “Credentialed mental health nurses and mental health Nurse Practitioners are vital in Primary Health Care, working collaboratively with GPs and practice nurses and alongside other service providers. “Nurses are excellent at coordinating care, and they know the system well, are the most trusted and highly regarded health professionals while also being able to provide psychotherapy. That should speak volumes.” Unfortunately, mental health nurses and Nurse Practitioners are not adequately supported in Australia, according to Ms Pritchard. “There are many barriers for nurses working in primary care and private practice, not just those practising in the area of mental health. “The Australian health care system is discriminatory against people being able to choose to see nurses as part of their care team in primary health care. “Credentialed mental health nurses and mental health Nurse Practitioners are not able to see people under mental health care plans funded through Medicare.
Page 20 | HealthTimes.com.au
“This disadvantages the community from being able to access mental health nurses. “It also makes it difficult for GPs and psychiatrists who may believe a credentialed mental health nurse or Nurse Practitioner is the best clinician for their patient. “You are also not able to see us using private health funds which is extraordinary considering our practice is evidence-based. “These barriers make it difficult for the community to choose to see nurses as part of their care team.” ACMHN Board Director Tom Ryan agrees: “There’s a widespread and tragically incorrect belief that psychotherapy is the sole province of psychologists. “Unfortunately, that influences organisations such as PHNs and many other providers, to the detriment of the consumer. “Mental health nurses often bring a more eclectic blend of psychotherapy and counselling skills to the workforce than other disciplines. “Nurses have a more holistic approach and an ability to look at physical as well as psychological aspects of a patient’s presentation. “We are generally also familiar with and skilled in managing the more severe and complex presentations. This has actually been quite well recognised but is inadequately supported,” said Mr Ryan. “The Year of the Nurse is 2020. Let’s hope we see some dynamic and major changes to enable nurses to work to their full scope of practice while also enabling the community to access our expertise in Primary Health Care,” said Ms Pritchard.
Head of Nursing
HealthTimes - September 2019 | Page 21
Featuring: Dr James McKenna (USA) Campbell Paul (Australia) Lyndsey Hookway (Australia) Kimberly Seals Allers (USA) Elly Taylor (Australia) Dr Meghan Azad (Canada)
For more information and to register go to www.breastfeedingconferences.com.au
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ADDRESSING DIABETES IN YOUR PRACTICE: 1 DAY COURSE MELBOURNE - 15th NOVEMBER 2019 For more info and to book tickets go to:
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TOPICS COVERED: - Understanding diabetes - Signs & symptoms of diabetes - Diabetes cycle of care - Effective blood glucose monitoring - Diabetes language matters - Diabetes emergencies - Diabetes equipment
HealthTimes - September 2019 | Page 23
Combatting night shift burnout
F
rom an early age, registered nurse, Emma Selby, loved the idea of caring for people, along with the diversity that came with nursing in the 21st century. Enjoying a diverse career, working in critical care both in the metro and remote regions, Ms Selby has spent most of that time working a combinations of mornings, afternoons and nights. “The majority of hospital-based nursing is shift work round the clock,” says Ms Selby. The combination of a heavy workload with irregular hours can wreak havoc with both mental and physical health. “The workloads of nurses can be large,” says Ms Selby. “Working regular night shifts definitely plays a part in physical fatigue. Lack of sleep also plays a part in effecting mental health.” Even so, it’s par for the course for nurses who are expected to work a variety of shifts. “I have always worked a combination of days/nights and weekends. You don’t get a choice of nights shifts – it is an expectation of your workplace. I commenced them from my graduate year 10 years ago.” It often chops and changes too, which can have a detrimental impact on mental health, and bring on burnout. “Sadly, burnout is a huge part of nursing these days. It can be very hard to recognise in the early years of nursing. The workload given to nursing staff can be huge. The lack of sleep plays heavily on you during night duty. The fatigue affects your mood and general wellbeing. Not to mention the risk of human error relating to your fatigue during night shifts.” Which is why it’s essential for nurses to take extra care of their physical and mental health. “This unfortunately takes time and years of experience to recognise and also manage,” says Ms Selby.
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“I personally ensure that I take all meal breaks allocated to me. Nurses are notorious for skipping breaks due to workload.” For Ms Selby, shifting to casual work has also helped. “I now have two small children and no longer wish to do night duty. Great initiatives such as Upaged help to significantly combat the daily struggle of work /life balances, allowing nurses to have the power and to self-manage their workload – and also avoid night shift.” Ms Selby says it’s also crucial to get enough sleep. “I actively try to wind down mind on drive home from work – to prevent thinking about work and help to get to sleep. I also recommend physical exercise, such as yoga and healthy eating. “ For Candice Cannon, working 12 hour shifts in a busy hospital, but during the day as well as nightshifts, left her feeling disconnected from family, friends and the ‘real world’. “Whenever I have my nightshift block commencing I always make sure I go to the beach or get some family and friend catch up time beforehand,” says Ms Cannon. “I also do adult ballet class on my days off for fun and to balance the rigors of an exhausting work schedule, with doing things I love outside of my job.” “I maintain a routine when I’m on nightshift, which can be up to four nights in a row, that includes walking my dog to decompress, a hot shower and a bit of breakfast before I head to bed to rest for the next night duty. “I always make sure that I limit screen time when I hop into bed from nightshifts as it keeps me awake during the day instead of getting the rest I need.” And the end of the day though, the effort required to maintain positive mental and physical health is worth it, says Ms Selby.
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