Meet Professor Elizabeth Manias, who completed her PhD in 1999! With a Greek heritage and raised in a low socioeconomic area in the South East of Melbourne, she was the only person in her year from high school to begin university studies. She became a Registered Pharmacist before also becoming a nurse and before her PhD in 1999 she was a Clinical Nurse Specialist in Intensive Care. Her areas of speciality now are medication safety, medication adherence, patient safety and quality, and care of the older person.

What are some fun facts about yourself?

I am very lucky that my parents were born on the Greek island of Rhodes. I have several relatives on Rhodes, which means I have many opportunities to visit this beautiful place. I have a Bichon Frise dog called Lilly, who is very playful and happy-natured, but also very opinionated about what she wants. I spend many hours arguing with her during our walks about whether she should sniff out every dog she passes, or whether she should continue walking.

What is a Professor of Nursing? What does a typical day look like for you?

A Professor of Nursing is a person with a PhD qualification, who works in educating nurses and researching in health care. I feel very privileged to be involved in educating the future generation of nurses. The academic structure in Australia involves lecturers, senior lecturers, Associate Professors and Professors. Usually, people start working as lecturers and then move up the academic scale as they become more experienced.

There is no real typical day for me – everyday is different which makes this job very interesting, challenging and rewarding. During the day, I will usually have meetings relating to research committees or school committees where we discuss policy issues, make strategic plans for future activities and monitor current activities of academic staff and students.

I also meet with students who are undertaking Honours, Masters and PhD studies to discuss the progress they make in their research, including recruiting participants for their study, data collection, analysis of data, writing up the work for publication or for their thesis, and planning conference presentations. I also meet with colleagues to plan and write research grant applications, and to plan the conduct and evaluation of research.

Sometimes I have to do conference presentations, which could be for a hospital or professional organisation. I am also involved in meeting with patients, their families, and health professionals to find out what they need in their management of health care activities. Meeting with people to discuss how health care can be improved, and then carrying out and evaluating these plans of care is a very fulfilling part of my daily activities.

Please give us a brief overview of your nursing and pharmacy career and how you transitioned into academia?

After finishing high school, I undertook pharmacy studies and became a registered pharmacist. As I worked as a pharmacist in hospital settings, I was very interested in how nurses interacted with patients and their families, and believed I could make a bigger impact in my practice by becoming a nurse as well. I completed a certificate in critical care, and working as a clinical nurse specialist in intensive care, while doing some locum pharmacy work.

It was doing this point that I started my PhD studies. After completing my PhD studies, I became very interested in further consolidating my research on communication in health care, with particular emphasis on how communication impacts medication safety. For this reason, I decided to pursue a role in academia. As my research and practice more recently has focused on medication management in older people, I acquired my qualification as a Board Certified Geriatric Pharmacist, which also enables me to do medication management reviews for individuals in their homes and in residential aged care facilities.

Can you distinguish these and relate to why this is so important for nurses to understand?

Medication management

Medication management is a cyclical process involving making the decision to prescribe a medication, supplying the medication, assessing the patient before administering the medication, preparing and administering the medication, evaluating the effects of the medication, providing accurate, relevant and complete information about the medication to ensure patient involvement about the medication decision. The key things to understand are effective communication occurs across all aspects and patient engagement is central to the whole process.

Medication adherence

Medication adherence is the extent to which a patient takes their medications according to what has been agreed with the health professional prescribing the medication. The key thing here is that patient should be included in making the decision to prescribe the medication.

Medication safety

Medication safety is the process whereby health professionals collaborate with each other and with patients and their families in effort to reduce medication errors and patient harm arising from using medications.

Medications are not just the business of doctors, pharmacists and other health professionals. It is very important for nurses to understand that supporting patients and their families in various aspects of the medication regimen is a crucial area of responsibility. Nurses work in complex environments that change from moment to moment – given that nurses provide direct care to patients, more so than any other health profession group, they are ideally placed to identify any risks to patient harm and affect change in positive ways.

“Communication processes in health care”, for the everyday nurse, what does this look like?

Communication processes in health care are key to ensuring safe and high quality patient care. For the everyday nurse, these communication processes involve the power struggles that may occur with other health professionals, and with patients and their families. The environment and culture of a particular group of people who work in a clinical setting all affect how communication plays out.

Communication processes occur during ward rounds, clinical handovers, team meetings, family meetings and informal interactions at the patient bedside, which can affect the quality of care received, and the ability of individuals to be involved in decision making. If communication processes are not optimal, there is an increased chance of adverse events happening, where patients experience harm.

Why are you so passionate about medication safety?

All people at some point in their lives will take medications, and medications are the most common form of intervention used in health care. As a registered nurse and pharmacist, I believe it is my role and responsibility to help other health professionals, and patients and their families to ensure medications are managed safely with attention to high quality care.

One of my more recent studies showed interesting results about patient and family involvement in their medications. In this study, we examined 11,540 medication errors reported to the online facility of 16 hospitals. We found that patients or families were involved in detecting 1,100 (9.5%) medication errors. This result shows the importance of engaging patients and families in discussions about medications, and of how this engagement can help to reduce or prevent medication errors from occurring.

What are the biggest misconceptions about nurse researchers or academia that you’d like to bust?

I think the biggest misconception relates to the benefit and importance of the work of nurse researchers. Every day I am confronted with many examples of the wonderful work undertaken by nurse researchers that make an enormous impact on patient health and wellbeing, and on the whole health care system.

What are the most challenging aspects of being a Professor of Nursing?

My days are often taken up with meeting and teaching commitments, which means precious time for writing grants or journal papers for publication is often relegated to the evenings and weekends. I think when you get to the level of Professor, there are many demands on your time, and being careful about time management is very important.

As a Professor actively involved in doing research, applying for grants is a crucial aspect of my role. Unfortunately, there are low rates of success for research funding through the various funding sources, which may include the National Health and Medical Research Council, the Australian Research Council, and other funding bodies. It is not unusual to see success in funding at around 5-20% which is very disheartening.

Putting together funding applications requires many hours of work, and there is a very high chance that these applications will not be successful in receiving funding. Having a thick skin when receiving assessor comments for grants is an important attribute. While I may think my work is extremely important and will solve key problems of the health care system, it does not mean that the funding body will have the same viewpoint.

What advice do you have for nurses interested in research? What does it involve?

When I first started my PhD, there was only a small group of us in the university where I did my studies. Now, there are many nurses undertaking PhD studies, or doing some form of research or quality improvement in their workplace, which is great. Unfortunately, there is a bit of a stigma with research – many people think research is something outside of delivering care to patients or teaching students. For health care to continually improve, it is very important for every health professional to believe that research is a crucial part of their role.

If nurses are interested in making research a career, they should consider undertaking formal education in a university, and complete a thesis as part of their qualification. In undertaking a thesis, there are two key things for success – it is important to get along with the supervisor allocated to monitor the whole research process, and it is important to be very passionate about the topic being researched. Doing some preparatory work beforehand in identifying the attributes of a potential supervisor and whether you are likely to get on with this person, as well as clarifying the potential topic to investigate will pay dividends in the long run.

What red tape or barriers to improvement in your field do you want to see reduced/removed?

I would like to see the whole health care system to be a more collaborative structure with inclusion of all professional groups in communication activities across all health care settings in the community, hospitals and aged care facilities. I see many examples where certain groups are privileged over others, and the views, expectations and preferences of other groups are not heard or considered.

What’s one of the greatest lessons you’ve learnt in your journey so far?

The biggest lesson I have learned is that nothing I do really matters, if it does not contribute to improving the health care and wellbeing of patients in some way. Every day I keep reflecting on this aspect with my work.

If you were invited to do a TED talk, what would be the title?

As a health professional, how can you make a real difference to patients?

What are some great resources that have helped you along the way?

Happy Academic blog by Kylie Ball. This is a valuable resource for early to mid-career researchers.

The Research Whisperer blog is a very helpful resource about finding funding and doing research in academia.

The Thesis Whisperer blog is excellent for helping students to write their thesis and providing strategies for securing jobs after completing their thesis.

Australian Commission on Safety and Quality in Health Care website provides excellent fact sheets, tips and user guides to help health professionals and consumers. I particularly like the Communicating for Safety resource portal and the medication safety resource.

What’s next for your career?

I have done some policy work during my career and I would like to develop greater awareness of how my work can have an impact on health care policy at local, state and federal levels. I am also extremely interested in how the health system works for priority populations, such as individuals of non-English speaking backgrounds, people living in rural and remote areas, and people with disabilities. I would like to focus more on doing research that centres on these priority populations.