As Australia begins its COVID-19 vaccination roll-out, what’s involved in being a nurse vaccinator?
According to Nurse Practitioner and Immunisation Manager at the Royal Children’s Hospital, Sonja Elia, vaccinations are only one part of a nurse immuniser’s work portfolio.
“It’s actually a lot more complicated than people think,” Sonja says.
“It’s not just about giving vaccines, in fact that is only one part of what we do.”
The ANMJ spoke to four different nurse immunisers, including Sonja, each of whom have extensive experience and work with different sections of the community, to explore the variety of approaches that immunisation requires depending on the work environment.
MANAGING IMMUNISATION WITH PAEDIATRIC PATIENTS
According to Sonja there are a number of differences between immunising children and adults.
“Our population here is kids with underlying medical conditions, that complicate the schedule: Sometimes they can’t have vaccines, sometimes they need extra vaccines, and if children haven’t followed the schedule and then they need catch-up, it becomes a bit trickier,” Sonja says.
“No day is the same.”
Sonja has been a nurse for more than 20 years and before managing immunisation at Melbourne’s Royal Children’s Hospital, treated patients with vaccine preventable conditions such as meningococcal and pneumococcal disease, before deciding to shift into preventative care.
Her current management role is a dynamic one, with Sonja overseeing clinical programs, staff and public education programs, telephone services, research and mentorship as part of the role’s responsibilities, something that Sonja says covers the spectrum of her nursing and professional interests.
“As a nurse, that’s exactly what you hope to be able to do,” she says, adding, “For me, this brings everything together.”
A PLATFORM FOR COMMUNITY-BASED WORK AND OUTREACH
For registered nurse Belinda Tominc who specialises in community outreach, a similar interest in preventative healthcare fuelled her interest in immunisation. Formative to her interest, she spent her graduate on an infectious diseases ward at the Royal Melbourne Hospital.
“There were still people going in with things like measles and hepatitis – all these diseases which are really preventable,” says Belinda about her time there.
Belinda’s career path and interest in community has led to a role with the Young People’s Health Service as a Clinical Nurse Consultant in Youth Health and Immunisation Outreach.
An off-site service run by the Royal Children’s Hospital and situated within the Melbourne City Mission organisation, the Young People’s Health Service focuses on reaching out to young people aged 15-24 years who are experiencing or at risk of homelessness in the inner-city and greater Melbourne community.
Belinda’s professional speciality falls into an area of advanced nursing practice and similarly to Sonja’s position, encompasses leadership, education of other staff and patients, research, as well as advanced nursing assessments and Continuing Professional Development (CPD).
The role began as a pilot program to improve access to immunisations for young people experiencing homelessness, funded by Victoria’s Department of Health. Belinda says that demonstrating the importance of immunisation to the community through data sets and reporting forms another subset of her responsibilities.
“Being able to show the need, and show the impact that it [a nurse immuniser] can have, that’s a big part of my role… and from that, I’ve also worked with other services to improve their immunisation capacity, and show the need that there is [to provide services] for vulnerable young people who haven’t had immunisations.”
Ultimately, it is a role, that with its focus on community outreach and extensive clinical assessment, that Belinda finds deeply rewarding, noting that young people are particularly responsive to preventative health care strategies such as immunisation.
“We really get to listen to the person and what they want to tell us, and I feel it’s very rewarding to hear somebody’s story and to say to them, ‘Well, these are things that we can do now, if you would like to take them up’,” she adds.
A SPECIALTY THAT CROSSES INTO OTHER SPECIALTIES AND DISCIPLINES
Registered nurse and midwife Jane Goldsmith, with more than 30 years of experience, entered the world of immunisation just over a decade ago, when she began to take on some work at her local General Practice.
It was an experience that differed markedly from previous work experiences.
“I was a little bit overwhelmed by primary care,” Jane recalls, adding, “It’s totally different to any other nursing.”
As a result, she quickly sought out further post-graduate training focused on the practice area, before following that up with a certificate in immunisation.
Twelve years later, Jane’s practice has broadened significantly, with her work not only continuing to take her to not only to hospital settings and general practice but local councils and schools as well.
The local government role, with Macedon Ranges Shire Council in Victoria, is the one that most directly negotiates vaccination, with Jane part of a team that delivers scheduled vaccinations to infants, children and school students in the council area.
However, Jane adds her other work, whether it be with young people in schools or as a midwife in regional and city locations across Victoria, also frequently draws upon her knowledge and skill in immunisation as well.
“We know that diseases cross all demographics, and I think that’s what I really enjoy [about immunisation work], when we’re talking influenza or diseases that we haven’t seen for a long time, it’s actually part of global health,” Jane says of her interest in the area.
Jane says she enjoys her role as an immuniser.
“A good day for me is when I have smiling children, that even though it can be painful, it’s actually a very positive experience… particularly four-year olds I love,” she explains, noting a specific spiel that is used to engage that age group.
“We say, ‘Are you a big four-year old? Do you know that you get some special medicine? It doesn’t go in your mouth, it goes in those big strong muscles… it does hurt for a minute but it’s okay,’ and you know? Most four year-olds are fantastic.
“It’s actually working with families, and having them all smile and know that you are playing your part.”
HOW TO BECOME AN IMMUNISER
There are multiple pathways and ways in which you can integrate immunisation into practice, or as a standalone practice.
According to the nurse immunisers interviewed, it’s about recognising your interests, trying things out and understanding the reasons you are interested in immunisation are good determinants for finding the role that suits your skill set and interests.
“It really just depends on why someone is doing the [immunisation] course,” Sonja says.
“The opportunities within the field of immunisation are really quite varied… You can be involved in general practice, you could be working in local government, you could be working in vaccine trials and specifically, research, or you could be involved just in education.”
Meanwhile, Belinda notes, that with both community and immunisation nursing both offering a variety of specialties, it is important to follow your own set of interests.
“You don’t know the jobs that are in the community until you’re in them, so often it’s just a matter of getting your foot in the door,” she says.
“What I did was just follow what I was interested in and that’s led me to a job that I really enjoy.”
The author of this article would like to thank Tracy Murphy for their help and assistance during the story’s production process.
Sonja Elia was our lecturer at La Trobe University during my immunisation course. She is an absolute inspirational presenter, educator and practitioner. Thankyou for sharing some of your wisdom all those years ago. The Royal Children’s Hospital is lucky to have you.