Q&A: Recovery and Anaesthetics Nurse

Louise Jones and friend

South Australian nurse Louise Jones joined the profession in 1986. Three years later, she began working at the Women’s and Children’s Hospital in Recovery and Anaesthetics, quickly growing to love the specialties. From 2013, she has held the position of Nurse Unit Manager within the team.

Louise chats to the ANMJ about the ins and outs of the job and making a difference in the lives of patients experiencing some of their worst times.

What appealed to you about working in Recovery and Anaesthetics?

The WCH is unique in that the team is both Anaesthetics and Recovery, two very different skillsets that marry up beautifully and allow us as nurses to have a large knowledge base, with the variety to ensure we are kept on our toes.

I have always felt, and always use in my spiel to new staff, the skills you learn with R&A transcends and covers every aspect of nursing that you will come across throughout your nursing career……ABC it is as simple as that, airway, breathing, circulation.

What training did you need to work in the field?

All education and training is provided within R&A through a substantial orientation program of approximately three months involving being precepted into both specialities. We aim to use regular preceptors to reduce the confusion of having too many ways to do tasks.

I personally have not undertaken any post-graduate course, but there are numerous perioperative post-graduate courses both here in SA and nationally to do, and there is always further progression to the Masters level as well. I have completed APLS as part of the credentialing process for the sedation role and maintain this.

What does an R&A nurse do?

We provide intraoperative anaesthetic care and post-operative stage 1 recovery care to the paediatric and obstetrics/gynaecology patients and stage 2 for the gynaecology patients.

This involves full nursing assessments, completing checklists, assessing the patients, maintaining airways, gaining IV access, pain management, emotional support to the patient and their families, time management, team leader role for RN’s, liaising with the multi-disciplinary team, counselling, and lots of checking, cleaning and restocking . We also provide a service in remote areas, not just within the theatre complex- ie. radiology, the haem/onc ward, and radiotherapy/PET scan at the RAH.

What does a typical day look like?

As the NUM, I have to balance my management role with a clinical support role. I often spend the first part of the morning ensuring overtime/SL/on call has been adjusted on PROACT and other managerial tasks. I also check my calendar so that I can inform the TL of my movements for the day.

I will often assist with tea/meal breaks and will assume a patient load if required. I answer phone calls, attend meetings, rostering both daily allocations and the unit roster.

I liaise heavily with both the Scrub side NUM and the anaesthetists to maintain the relationships of all concerned as together we make a united team with common goals. I also provide ad hoc counselling, mentoring and precepting of the R&A team. As a nurse-led service, I also am lucky enough to provide sedation for cohorts of patients.

What are some common challenges?

From a NUM’s point of view, managing staff, workloads, budgets, and senior manager expectations provides constant daily challenges. I also have climbed the ranks and had to adjust to my role, changing and getting the balance of manager vs colleague at a good ratio. Trying to balance the management side with the clinical can also be a challenge, especially during the pandemic

As a nurse, I think the biggest challenge is providing care for some of the most vulnerable patients that exist – sick children with extremely anxious parents/caregivers/families.

Our urge to invest personally presents daily challenges and it has a huge emotional pull to many of the team. We seek to provide care and comfort and sometimes feel inadequate that we cannot ‘fix’ everything. Therefore, the challenge of avoiding burnout becomes a balancing act

Staff shortages have also had a big impact on the team, not only losing the experience of the staff member, but also having to precept new staff.

What key skills and attributes do you need to succeed in R&A?

Self-belief, good time management, be a team player, an ability to communicate with the patients, their families and the staff, a desire to pass on the knowledge to the next generation of nurses, to promote self-care, a good sense of humour, ability to comply with the policies and protocols, and knowing when to ask for assistance.

What are common misconceptions about working in R&A?

That we have a lot of downtime and we sit around and don’t do a lot. I also think our skill levels are underestimated by the teams outside the perioperative environment and especially doctors who come to our area as trainees and can at times do not know the extent of our skills and knowledge.

What do you love most about the job?

That we can make a difference, are there for people at their worst, and can provide them care and comfort.

Our team is incredible; we are there for each other both work wise and in the emotional support role. They are an incredible bunch whom I know have my back and support me as much as I do them.

I love the challenge of caring for children who cannot often advocate for themselves and being the conduit to ensure they receive the best care possible. The complexity is never boring, you can go from a 1kg baby to a 100kg adult.

Personally, working as a team has always been a drawcard for me and looking to the future and passing on my enthusiasm is becoming a priority to ensure the continued service provisions.

What impact has the COVID-19 pandemic had on the team and delivering care?

COVID has introduced real fear amongst our team and uncertainty about our future. We have had to continuously adapt and redesign our COVID plan. We had to hastily write procedures and protocols that we hoped would keep patients and staff alive! The fear also that there may be a negative outcome due to the delays in instigating a case due to having to undergo these new protocols was extremely challenging for staff to comprehend, let alone accept.

The next step has been having to adjust to staff shortages due to exposures or becoming positive. It was a real fear prior to the borders opening in SA that we just didn’t know what to expect and the fear of the unknown can be very unnerving.

At the moment, I feel wary for the new staff coming into these environments for the first time and getting a ‘different’ kind of learning experience due to reduced surgery, and increased stress levels of those teaching them

However, the positive has been the coming together as a team and cementing the relationships that we have. Trust is vital in this pandemic and it is during times of stress that having a resilient trustworthy team is the best coping mechanism we have.

What advice would you give to a nursing student or early career nurse who aspires to work in R&A?

I honestly believe that the skills you learnt in R&A prepare you for almost every area of nursing.

The fundamental key to nursing is ABC and everything goes from there. All skills learnt will hold you in good stead. Clinical and non-clinical (ie. teaching) opportunities are wide and varied with having R&A on your resume.

I have always advocated that new graduates try not to pigeonhole themselves into one specialty prematurely and that there are so many varied roles under the umbrella of nursing (even though I have not followed that advice in my own career path!)

But if the passion is there from the very beginning that is also a great advantage as you can tailor your career plan to provide yourself with the best opportunity for a successful and fulfilling career. I would advocate for post-graduate diplomas/certificates in your chosen field.

I would also investigate coping strategies for a career that will be full of highs and lows and how self-protection and self-care are vitally important for sanity and career longevity right from the very beginning.

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