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Emeritus Professor Rhonda Nay has agreed to write for The Nurse Break about her nursing career, passion for justice for older people and those with dementia, lessons learnt, rewards and more. With 50+ years of experience, she has been pivotal to the careers of so many and led significant changes to how nursing care is provided today, this is well worth your attention and reading!
Read Part 2 “How The Nursing Profession Has Changed Over The Years”
About Professor Nay
Emeritus Professor Rhonda Nay, is a highly respected researcher, teacher, practitioner and administrator. She has become one of Australia’s most well-known Nursing Academics, particularly in the field of person-centered care, dementia and the aged care workforce. Prior to retirement Professor Nay held several senior roles over 25 years at La Trobe University in Melbourne. She was also the Director of its Australian Institute for Primary Care & Ageing. In addition, Professor Nay was Director of the Australian Centre for Evidence-Based Aged Care, the Victoria & Tasmania Dementia Training Studies Centres and the Victoria hub of the Dementia Research Centre.
A brief history of my career
Secretary or Nurse
Let me provide a brief history of my career to set the rewards in context. I commenced nurse training in 1969, by default. I had no desire to be a nurse. But apparently the nuns did not like me and after being forced to change schools three times within three years my Dad was tired of buying uniforms I think, and I left school at thirteen. This really left two options: secretary or nurse. I started a secretarial course, hated the thought of sitting in one spot, and did the Nurses’ Entrance Exam. This exam was an alternate entry to nursing for those who had not met the normal school completion criteria. I passed the exam and was admitted to nurse training.
Pregnancy and Death
I commenced at a rural hospital and after one year transferred to a Sydney hospital. After another year I became pregnant and had to leave. The next two years were spent in WA where I delivered a son and then a little girl who died.
How death made me empathetic
I saw many years later how the pain of my baby’s death helped me be a far more empathetic nurse and I think helped many others through their pain. The staff ignored my wishes, believed they knew what was best for me and prevented me from fulfilling my wish to hold my baby until her last breath. I committed myself to always listening to and supporting a patient’s wishes and never thinking I knew what was best for them. This was probably my initiation into my lifelong commitment to person-centred care.
Nursing Homes and Perceived Failure
In between I worked as an EN in a nursing home before returning to NSW. I worked as an EN for a few months in a hospital and then returned to complete my training at another rural hospital. I graduated in 1975, commenced midwifery in Sydney but left for childcare reasons. Again, I worked in a nursing home before moving bush, working in a hospital and then returning to Nursing Home work to accommodate my childcare responsibilities.
Nursing Homes provided greater flexibility in rostering than did hospitals. However, working in a nursing home was perceived as a failure; no accomplished nurse would choose to work there. I was no different at that stage; I preferred acute care but had to work around parenting.
University and PhD
During this time, I gained mature-age entry to university and completed a BA, MLitt and finally PhD. I had come to appreciate aged care nursing and was disturbed by the way older people were treated. I focused my university work on ageing and aged care and developed, what was to become, my career-long passion to pursue the human rights of older people – especially those living with dementia.
Start of my academic career
A position as Tutor in Human Bioscience at the University started my academic career; I moved from there to Lecturer in Nursing at, what was then, a College of Advanced Education (CAE) and during my time there: was promoted to Senior Lecturer; appointed Head of Nursing; and Acting Dean. The CAE amalgamated with the nearby university and I moved from Head of Nursing to Associate Dean of the Faculty and then Acting Dean. Opportunity beckoned and, after some interesting politics, I was appointed Foundation Chair/Professor of Gerontic Nursing at La Trobe University and Director of the Gerontic Nursing Professorial Unit/Clinical School at a large Melbourne Sub-Acute Hospital.
18 Years at La Trobe University
During my 18 years at La Trobe I served as Director of the Australian Centre for Evidence Based Aged Care, Head of Nursing and Midwifery, Director of the Institute for Social Participation and Director of the Australian Institute for Primary Care and Ageing. To reflect my interdisciplinary role my position title was changed to Professor of Interdisciplinary Aged Care. This change also enabled me to advocate for what I believed in without being in constant conflict with the then directions of the Nursing School. I had the opportunity to serve on numerous Boards and Committees and work with world leaders in nursing, older person care and those living with dementia.
Faculty restructuring, re-allocation of my Centre’s resources to less successful areas of the faculty, health and family issues accumulated and resulted in my unplanned retirement in 2013. Since then I have continued to work largely pro-bono but with a short stint as Interim Prof and Chair of the Nursing Discipline at SCU.
Important Lessons and Rewards
It is hard to select specific rewards from my nursing career when I believe my whole career was an unexpected privilege. I will attempt to identify some exemplars, but the greatest reward was to feel I was making positive differences to at least some lives. In my view there is no greater privilege than to assist when a person is extremely vulnerable, in a person’s first breath or their last; to feel you have helped make this the best possible experience for all involved. That right there is magic!
Not my forte but…
When I was Head of Nursing and Midwifery, I was visiting the Women’s’ Hospital when I noticed a man sharing his time between his neonatal twins. He was clearly distressed, and I suggested to staff that they co-bed twins so he did not have to keep leaving one: I was certainly no neonatal expert but evidence demonstrated the importance of touch to wellness and there have been studies showing the adverse impact separating twins.
The neonatal nurse researched the topic and it was decided that co-bedding would become the norm.
This was a real and unexpected reward for me.
Rewards in end of life care…
While working in a nursing home the ambos were attempting to carry a gentleman up the stairs. He fought them vigorously and they requested my assistance. He seemed to trust me, settled and let them do their job. We formed a very close bond. Some years later he was dying and I went to see him in hospital. I was told not to waste my time as he was non-responsive and would not know me. As I walked into his room his eyes lit up and he said ‘Hello sweetheart’. What a reward!
He returned to the nursing home to die and I sat with him each day after my shift. This day I felt his end was near and he was non-responsive. I said to him ‘Come on you old bugger, at least squeeze my hand to say goodbye’. He did nothing. I went home and the next night I was called and told as I was devoted to him I might want to come and sit as his family had gone home for a rest. I went down and sat by his bed. He leaned over squeezed my hand and promptly died. Old bugger got the last word.
Rewards don’t always come easily!
When I completed my PhD on the experience of people living in nursing homes, naively I agreed to be interviewed by a major press reporter. The story was sensationalised and hit every major and many minor papers in Australia. Of course, the focus was on the problems. The response from many nursing homes was immediate and angry. Most families responded positively.
One Nursing Home manager wrote angrily to my VC and demanded I be sacked. He arranged an angry public meeting in a town an hour’s drive away and demanded I attend and address the meeting. I did of course. It is very difficult to teach research methods to an angry crowd in a couple of hours but I did my best.
One man accused me of being a man hater who made up my results. Another Director of Nursing kept insisting I clearly made up the results because I had not researched in his nursing home. I tried to explain that his nursing home was not part of the research and I had not claimed it was. Indeed, as ethically required, I did not identify any homes involved. I was labeled a traitor to nursing. The aggression continued for months.
Although it was a psychologically tough time, I learned a lot about dealing with the press, the response of people to criticism and the resilience required to speak truth and stand for justice. Those I stood for, older people and their families wrote in support of me. Those nursing homes with open minds and hearts took my findings and used them to improve care. My VC listened to my explanation and supported me.
Knowing the person
Brain acquired injury from an hour caught in a spinning drum, he was admitted to the nursing home. He could speak a little but required total care and could not swallow without his nose pinched. I figured he could be more independent if he had a peg on his nose rather than us pinching it. He was. We had a great relationship and laughed a lot despite his plight. I saw an advertisement in a magazine with a peg on a woman’s nose, took it to him and said he had started a new trend. He wanted it on his wall so I pinned it there. The next day I was roundly scolded by another nurse who accused me of making fun of him and being disrespectful. I explained he wanted it and it made him laugh. He demanded it be put back up.
While on clinical supervision of students, we were told one older lady had dementia and to be careful as she was very aggressive. I saw an attendant (large man) carry her exposed into the lounge room populated by male residents and place her unceremoniously onto a mat on the floor. Yes she was kicking and screaming (wouldn’t you?). The students and I selected to be her main nurses and do her dressing, which seemed to be the main time she was ‘aggressive’.
With observation, compassionate and skilled care after a couple of interactions she calmed and we witnessed no ‘aggression’. Out of the blue one day she spoke to me: ‘They think I’m demented but I’m deaf. You are the only ones who treat me as a person; what will happen to me when you leave?’ Please God, now armed with the information we gave them and witnessing good nursing care she received better treatment.
Some of the greatest rewards I experienced were with the students I taught and from whom I learned, the colleagues who shared the values and passion and my amazing team with whom I worked most closely. They will recall – as I do – whenever I mentioned ‘opportunity’ they would groan and say ‘More work’! It is a reward to work with people who have the same vision and passion to achieve it.
Whether it was teaching PCAs, UGs, PGs, Doctoral students, Geriatricians, or DONs; in RACFs, Emergency, ICU; at leadership meetings, advising Ministers of Health/Ageing or teaching A Bachelor of Aged Care (in Japanese) in Japan it was a thrill. It was potentially making a difference.
We didn’t always succeed as we hoped: With Alzheimer’s (SA) and my friend and colleague Susan Koch we worked hard to remove the use of restraint in aged care; our first report and recommendations were completed in 1999. Still it is a scourge on the human rights of many. On a brighter note we provided the Reports on QIs and Star Ratings which are now nationally influential; and the SexAT which guides many on the sexual rights of older people in care.
While my career had me witness a lot of suffering and grief, it also had loads of fun.
I recall being asked to speak at a medical conference and when I received the Flyer I noted all male Profs were listed as Professor so and so but I (the only female) had no title. I spoke with the organising medico and asked why this may be so. His reply was that he was not sure if I preferred Mrs, Ms or Sister. I happily replied “Professor will do thanks’. Poor fellow was sooo apologetic!
On another occasion I was launching a product developed by one of the staff members and the audience was a large multidisciplinary group at a public hospital. I said that I wanted to acknowledge the lead surgical specialist who I understood my staff member had been under during her time at the hospital. The room erupted with laughter. Unbeknownst to me apparently she had been under him quite literally!
The next day I was summoned to appear before the hospital CEO who stated without question the university should sack me for my unprofessional behaviour. I explained that I had no knowledge of the goings on in his hospital and apologised for my inadvertent gaff.
Of course I wasn’t sacked, but a couple of weeks later he was for his ‘poor performance’ as a CEO I believe. Karma indeed.