For Julie Sharrock, the lasting memory of being a Victorian Mental Health Consultation-Liaison (CL) Nurse, is about the exchanges she had with her patients encountering difficult, or even life-ending circumstances.
“All these patients faces, and their families, came into my mind,” she says in relation to her 20-plus years of working in the field.
Now retired, Julie says a large part of her work was working with clients to understand the psychological issues of the situations they were in.
The appeal of working in the area, she says, is obvious.
“[I was] making a difference, you know, to not only the lives of our patients and relatives, but also the nurses, doctors and other healthcare professions… Most of my memories in CL have been exquisitely… privileged and special.”
Trained as a general hospital nurse and working in a variety of acute settings before moving into CL work in the 1990’s, Julie’s journey as a CL nurse is one that has continued after retirement, with the completion of a PhD about the practice area and ongoing volunteer work in CL interest groups.
CL mental health nurses work within general hospital settings as part of a multidisciplinary team to help manage the needs of clients with varying mental health conditions admitted to general wards.
According to Julie the work relies on relationship building and making time to help patients deal with complex situations, “At the start of a shift CL nurses review shared case reviews of their patients, before going to meet with patients. If patients require additional psychological or psychiatric attention, then staff with that expertise accompany the CL nurse.
In addition to meeting with patients, CL nurses will consult with hospital staff, including nurses, doctors or allied health staff.
Consultation can involve education on safe and appropriate mental health management or listening to issues that staff may have in providing this care.
“[We’d be] providing them with support and reflection time to talk about the struggles of their work,” Julie explains.
Other work CL nurses are involved in is consulting with the broader hospital administration on policy for the management of situations involving delirium or aggression, as well as protocols for one-to-one nursing or nursing that involved at-risk patients.
It is a daunting work load, says Julie.
“You just priorities and work through the day, and try and get home on time, which didn’t happen very often.”
Julie admits that the lack of funding to address mental health within the hospital system was an ongoing problem throughout her time in the hospital system, and that this was often compounded when dealing with some staff that were prejudiced against mental health practice.
“I’ve had people glaze over when I’m out to dinner when I tell them I’m a mental health nurse,” Julie adds.
However, the ongoing and sustained emotional engagement with patients over an extended period of time was often its own reward for the 63-year-old.
In one such scenario, she talks about her experience assisting a patient who decided to cease her dialysis treatment for renal failure.
Crucially, it was one of the few ways that a patient could dictate the terms of their end-of-life experience before the discussion around voluntary assisted dying entered the mainstream vernacular.
When the patient, who was living with a personality disorder who Julie described as “a bit chaotic and disorganised,” was introduced to the prospect of psychological help, she wasn’t having a bar of it.
“She said, ‘I’m not talking to any mental health nurse, I hate psych people,’” Julie recalls.
Eventually though, they started interacting, and by the time sessions finished, a strong emotional bond was formed, with Julie crying in the nurse unit manager’s office after their last session in the renal ward before she went on holiday.
When Julie returned, the true impact of her work became apparent, when the patient passed away, though Julie doesn’t recall if the patient chose to stop the dialysis or whether the passing was due to a separate issue.
“One of her relatives contacted me to tell me how the funeral went and everything,” she says now.
“He said, ‘thank you, it was all [the funeral was] organised… it’s the most organised thing she’s done in her life.’
“We reflected on it, and wondered whether, you know, the work that I’d done with her had helped her organise herself and reconcile herself to her death.
“Most people die like they live [but] she did something different in her death, having a disorganised life, all her life. She actually was organised in her death, and it was everything.”
Julie says the emotional satisfaction for the clinician is immense, and hopes her journey has reciprocated the generosity of her clients.
“If they’ve touched me in some way, I hope I’ve touched them or their families, and maybe helped them in their journey in some way — their adjustment, their death, whatever it is they’re dealing with — in some sort of important way that made a difference,” she says.