Remarkable Q&A With Flight Nurse/Midwife And AUSMAT Humanitarian Nurse

Meet Nadine!

Nadine Tipping is an experienced Registered Nurse/Midwife who has worked in numerous clinical and leadership roles! Currently working as a Flight Nurse/Midwife for Careflight Australia and a member of the National Critical Care and Trauma Response Centre as an AUSMAT humanitarian nurse, she has a lot to share! She is based in Darwin and has responded to crisis in Australia and the Pacific. Some of her international deployments include Cyclone Pamin in Vanuatu (2015), Cyclone Winston in Fiji (2016), and the Measles response looking after critically unwell children in Samoa (2019). Join our new FB group Rural & Remote Nursing | The Australian Outback Similar Humanitarian nursing articles

About

Hi, my name is Nadine and I have been nursing for 22 years. During this time I have taken many opportunities to further develop my career and as a result, have had what I see as an amazing career. Throughout this piece, I hope to highlight how taking opportunities to learn and further develop your career can create opportunities you never knew existed.

Graduate Year

I had just completed my graduate year of nursing in a regional hospital where I had the opportunity to rotate through medical, surgical and rehabilitation wards and finally, I ended up in intensive care (ICU). It was on reaching ICU that I began to consider where I would like my career to take me and although it was a small unit, I thought it would be a good opportunity to develop skills and knowledge in the area. That was until a respected colleague approached me and said, “Nadine, if you want to make the most of your career, you need to go out and explore what nursing has to offer and not just stay in one place because that is where you feel comfortable”. In a profession where permanent contracts are sometimes hard to come by, having the confidence to move around and expose yourself to new opportunities can be a difficult decision to make and for those who have families in tow, job security may impact the decision making process. The way I see it though is that if I didn’t create and take opportunities, I would never have had the experiences that I’ve been fortunate enough to have.

Making Big Decisions & Royal Flying Doctor’s Service

So two months after completing my graduate year I left for the big smoke because, well that’s where you go to get experience. Although I wasn’t keen on city living, I did enjoy the challenges of working in a large ICU and after almost 12 months, I decided to study a Graduate Diploma in Critical Care. It was a challenging year but one I know became the starting point for wanting to continue gaining opportunities to develop my knowledge and skills. I then continued to gain ICU experience but broadened my scope of practice by working in a neonatal ICU and casually in a paediatric ICU. Typically as most children do, I had a couple of television shows which helped me choose nursing as a career (but to be honest, my mum said that I was four when I first said I wanted to be a nurse and I never really gave up on the idea. Except for a short period when I said I wanted to be in stage shows, but my lack of talent in singing and dancing halted that career ). Anyway, one of those shows was the series The Flying Doctors that had previously created an interest in me for following this career path. Having five years of critical care experience behind me (the recommended minimum requirement, with midwifery being the other) and now four years without studying, I decided to complete a Graduate Diploma in Midwifery and was rewarded with a position working for the Royal Flying Doctors Service (RFDS) in Queensland. Read our interview with the CEO of the Royal Flying Doctors Service (QLD) HERE

What are some common misconceptions about flight nursing?

Most jobs are performed as a nurse only flights so you need to be confident in your clinical assessment and being able to perform clinical skills.  It is also physically demanding with the loading of patients, working in a confined space and the physiological effects of flying.  You also need to consider that you are constantly exposed to the elements.  It’s certainly not the most glamorous job, but it is extremely rewarding.

RIPRN, Remote Nursing and Africa

During my time working there, I also completed a Graduate Certificate in Rural and Isolated Practice (RIPRN) and then a Graduate Certificate in Child and Family Health. It was then I truly got to experience how remote nursing makes a huge difference. The nurses working out in these remote communities were amazing, having to have a little bit of knowledge of everything and anything. Some of these remote nurses were also responsible for being first responders being both community nurse and ambulance response. Being able to support them with running clinics and responding to both health emergencies and major trauma was an extremely fulfilling experience. Also whilst working for the RFDS, I had the opportunity to go and work in Swaziland in Africa. I worked in a maternity ward where an average of 50 babies were born every day. At this point there was no actual midwifery course over there, so having the opportunity to share and impart knowledge whilst continuing to develop my knowledge and skills was a rewarding experience. After almost six years with the RFDS, I decided I wanted to go back and live closer to the family for a while and I was fortunate enough to get a position in a regional emergency department. The thing I loved the most about regional, rural and remote facilities is you never knew what was going to come through the door.

What advice would you have for those interested in rural/remote nursing?

It is uniquely challenging and extremely rewarding.  You get to work autonomously which brings with it a lot of responsibility. You are responsible for caring for people from birth onwards, so my advice would be to get some experience in multiple area’s of nursing before making the move, especially when taking up a remote posting.  Having some critical care experience will also assist you in the role, as you are often the first to respond to major emergencies.  But most importantly you need excellent communication skills.  You need to be able to give a thoroughly clear and concise handover to doctors who can’t physically see the patient, so the more thorough a clinical handover that can be provided will make it easier to provide the appropriate treatment to your patient.

What would you say are some challenges that are unique to rural/remote/humanitarian nursing?

The biggest challenge that exists, is you can only provide appropriate care with the resources you have available.  In the rural and remote setting, you have to understand that you don’t have the same resources available that you would have in larger centres and often you have to make do with the limited resources you have until retrieval of the patient to a larger facility can take place. In the humanitarian setting, especially when responding to countries where they have limited resources, the challenge is accepting that just because you can do something back home, doesn’t mean it’s appropriate to do these procedures in this setting.  It’s an ethical challenge at times and you need to be prepared to make tough decisions which may not always sit comfortably with you.

ANUM…ing

It was a reasonably busy unit and after a short time on the floor, I took the opportunity to become an Associate Nurse Unit Manager (ANUM). I loved this role! Having to know what was going on in the whole department and continuously having to rethink my plan on how to get patients in and out was a challenge I relished. And I also enjoyed managing a team of nurses and watching them learn and develop their skills and come together like a finely oiled machine achieving amazing outcomes together. I still enjoyed getting clinically involved in patient care, but this role created a new insight into how the health care system is run. I also relieved in the Nurse Unit Manager (NUM) role but to be honest, the business side of things and thinking budget etc. wasn’t really where my passion laid. Read our leadership/management Q&A’s HERE

Australian Medical Assistance Team

During this time I completed the training to become a part of the Australian Medical Assistance Team (AUSMAT) and since completing the training I have been fortunate to be chosen to deploy on three separate missions to international emergencies. For those who don’t know, AUSMAT is a World Health Organisation verified Emergency Medical Team made up of doctors, nurses, paramedics, allied health staff and logisticians who are deployed on behalf of the Australian Government to both domestic and international emergencies. They are self-sufficient which means they take everything including a full field hospital; all medical supplies; accommodation and food for staff and patients; and even their water treatment and wastewater management systems so there is no impact on the affected community they are responding to. Not only do they deploy to disasters but recently, you may have seen their involvement in supporting Australians returning home from Covid-19 affected countries.

What were some of your international deployments with Ausmat and what was your role in each?

Cyclone Pam in Vanuatu (2015). I mainly worked in the delivery suite of the Port Villa hospital as a midwife including the aeromedical retrieval of a woman in labour from another island.  I also assisted in the wound care tent that was set up by AUSMAT. Cyclone Winston in Fiji (2016).  During this deployment, I initially worked in an emergency operations centre supporting the Fijian health service in the coordination of mobile field teams.  I then worked as part of the mobile field teams, travelling into affected communities to provide primary health care. Measles response to Samoa (2019).  Definitely the most challenging deployment personally for me as we were caring for large numbers of critical unwell children with complications of measles.  I worked both within the high dependency field hospital set up by AUSMAT and also in the intensive care unit of the Apia Hospital.

Masters in Disaster Health Care

Along with these deployments, I’ve also had the opportunity to go and teach midwifery in Papua New Guinea. Working in developing countries and seeing the difference we could make even in a short period, especially when their health systems were inundated due to emergencies, was an extremely rewarding experience. Having had these opportunities, a new passion developed and I decided to study a Masters in Disaster Health Care. The course gave me an insight into planning responses to mass casualty incidents and how Emergency Medical Teams (EMT’s) function. After completing my Masters, I chose to move to Darwin so I could be closer to where the National Critical Care and Trauma Response Centre (NCCTRC) was located so I could increase my involvement in some of the training and preparation which occurs there.

Moving Forward, Flight Nursing & Covid-19

So now, while I do participate in some activities associated with the NCCTRC, I have also gone back to working in the aeromedical field. I now work for CareFlight working on both the fixed-wing and helicopter providing aeromedical retrieval in the Top End. We are currently facing Covid-19 and planning on how we can effectively run our response and protect our indigenous communities, as we understand the devastating effect Covid-19 would have there. One of the benefits of working in such an organisation, is I get to use parts of all the post-graduate studies I’ve completed in my role every day, as at any stage I could be dealing with trauma; a critical patient; a major incident which puts a strain on the health system; supporting a mother in labour or during childbirth; caring for a small child and having an understanding of their normal growth and development and how it can be affected by their presenting illness; supporting my rural and remote colleagues with managing a critical incident; or planning and responding to major health incidents.

How do nurses get a job in AUSMAT or in Aeromedical Retrieval? 

When deploying with AUSMAT, team selection and skill mix depends on what type of incident we are responding to.  In previous deployments, we have sent teams with the surgical capability to work in theatre, midwives, critical care nurse, those with public health experience, those working in primary health care, infectious disease specialists, paediatric experience and aeromedical experience. To become part of the team, you need to have significant experience in your speciality field and you firstly need to complete Advance MIMMS (Major Incident Medical Management System) training and then you can apply to do the AUSMAT team member training course which teaches you about working in the humanitarian field. To work in aeromedical retrieval, most companies look for nurses who have a minimum of five years of critical care experience, including post-graduate studies in the area and midwifery is now either a prerequisite or is considered highly desirable for working in the field.

What is the key to a long and successful nursing career like yours?

 Variety and getting out of your comfort zone! Although I’ve enjoyed each area I’ve worked in, being able to have a variety of experiences has shaped who I am as a professional and as a person.  Being willing to step out of my comfort zone and take up opportunities as they arise has been a crucial part of my career path.

2020 Year of the Nurse & Midwife

In 2020 the Year of the Nurse and Midwife, I think even Florence Nightingale would be impressed in how far the nursing profession has come, the scope of practice we now have and how respected we are in the community for what we do. I believe that creating opportunities to further develop your knowledge and skills is an important part of nursing. I was fortunate to have that colleague who encouraged me to go out and explore what was available and I found my passion as a result. Find that mentor, that person you look up to and find out how they got to where they are and take opportunities to further develop yourself personally and professionally. And when you have gained that knowledge and experience, be that mentor to someone else and encourage and support your colleagues.

If you were in charge of nursing in Australia and could change anything, what would you change and why?

I am a university-trained nurse and I strongly believe we do not get enough clinical exposure throughout our training.  I would advocate for more clinical time under a more apprenticeship type scheme (yes a paid model!) as I believe this would greater prepare us for the role as a nurse but would also give us greater exposure to the different available areas of nursing.  I believe this will not only strengthen our workforce but will also make us better prepared when we go into independent practice.

What’s next for your career?

 I still love what I’m doing so can’t see myself making any major changes just yet.  I would, however, like to do some more international work in developing countries and perhaps at some stage move more into an educators role.