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Meet Katy Hunt, a Registered Nurse working in General Practice. She works at two different doctors surgeries. One locally and the other in a slightly larger town 65k away. She lives in a small country town of 500 people in regional Western Australia.
How did you become a General Practice Nurse?
How did I get here? Well, I fell into this job. My then-husband and I, with 2 children, moved to this small town for his job. The town has a small hospital staffed by 1 RN and 1 EN, I have worked all around country WA, and previously worked in 2 small hospitals before and didn’t want to continue with this pathway. (I don’t think quickly enough for emergencies)
Anyway, how did I become a Practice Nurse? Being a small town, I was approached to see if I wanted a job 1 day a week at the local surgery as the nurse. This was in 2008 when the funding model by Medicare was encouraging GP to employ nurses to assist with chronic disease management. The owners of the surgery in the next town also approached me to work 14 hours a week in their surgery.
So a steep learning curve of medicare item numbers, (its hows GP ‘s get paid) how to manage chronic disease, learning about spirometry, resources available within the community, how to entice patients to come and see the doctor and prevent chronic disease.
I now have 2 part-time jobs equalling a full-time role, if not more, as the COVID vaccine role out is happening.
I started nursing straight from high school to Edith Cowan University, did a graduate nurse program at Sir Charles Gairdner Hospital, and then moved onto Narrogin Hospital for 6 months, Kalgoorlie Hospital for 3 years. Then married and husband was moving around Western Australia with his career. We moved 6 times in 10 years, and I worked in various towns. Usually small places with a small hospital.
Highlights of being a General Practice Nurse?
Highlights – difficult to say – memorable occasions are seeing people improve, wounds get better, caring for those that are nursing home type, and knowing that they will eventually die, ensuring they are comfortable and respected. I think the best part of being a nurse is knowing that the patient has the education about what is happening to them. I get a lot of satisfaction from this.
It has changed so much in the last 18 months. At the start of the pandemic, we were learning so much about COVID, what we needed to do for infection control, educating other staff (including the doctors).
Now we are flat out with COVID immunisation. But it is different to normal immunisations. The vaccines are provided to use in multi-dose vials, Pfizer in 6 doses, and Astra Zeneca in 10 doses. At the start of the day, we collaborate with receptionists to ensure that we have the right number of people booked in, to use the vaccines. The paperwork that accompanies vaccination involves careful consent, ensuring that they aren’t unwell, no immune-suppressing therapy, and no previous anaphylactic situations.
Strict supervision for 15 minutes after as well. 3 pieces of documentation, rather than regular flu needle, where we say: want an immunisation, had 1 before, any concerns, record and done!!
What does a typical day as a General Practice Nurse look like for you?
As mentioned before the way GP earns money is via medicare item numbers and chronic disease management.
An example of a diabetic man; recently home from jail, was very stressed as he was concerned about going back to jail. He had stopped all his medication, including his antidepressants. He was concerned about memory loss as well. Careful discussion of his blood results meant I had to explain what diabetes means for him, why he needs to continue all medication, how they work.
Referral to physiotherapy for his back pain, referral to podiatry to check feet, encouraged to see optician. A Mini-mental State Examination showed that he has some memory loss, but is it because he is so distressed, so a referral to a Geriatrician. Explanation of costs involved in all of this.
As a nurse, I can spend more time with the patient, this man was not going to tell the doctor about stopping his medication. I am pleased that I had gained his trust and was able to gain this information. And, therefore a medication review, including all his diabetic medications. I also completed his vital signs and entered data into our computer software.
The last patient of the day was an elderly lady who is extremely distressed about continual chest pain. An ECG was completed, with no changes noted, she was obviously distressed and short of breath. Now I have known this lady since way back in 2008 when I started working at this practice. After establishing that she had no heart damage, and a review of previous many hospital admissions for chest pain, the Doctor and I worked together to reassure her. The doctor changed her medication to assist with her anxiety. I was there to interpret as she is extremely deaf, and so is her husband.
Excision of large lesion on a patient’s arm. I assisted the doctor, by preparing the patient, assisting in the procedure, ensuring documentation was correct prior to sending a sample to the lab, giving the patient instructions on how to care for the wound for the next few days. A nice change in routine in between immunising.
Health assessments of people over 75 is an important part of our role. Mini mental state examinations check for memory loss, referrals for occupational therapy to assist with a safe home. Referrals to physiotherapy to assist with balance.
Education of the public and the General Practice nurse?
Education – it can be as simple as being in the local coffee shop and being asked if we have immunisations available for COVID, to formally educating people about their chronic disease, educating people that live alone to carry a mobile phone or duress alarm in case they fall. Ensuring Wills, Advanced Health Directives etc are completed. Educating people what funding and resources are available to manage their chronic disease, including those individuals eligible for ‘closing the gap’ funding.
Common areas public need education about – vaccinations that adults can have – influenza, whooping cough, tetanus, Varicella, pneumonia prevention etc.
How has COVID19 impacted your role as a General Practice nurse?
At the start of pandemic, I ensured that my education was up to date on how to prevent transmission, how to educate others including the doctors, receptionists, and cleaners that I work with. Then there was a lull in transmission. As I live in rural WA we have not been affected by any outbreaks. There was a catch-up time to try and continue to manage chronic disease that had been less of a focus while the initial lockdown was in place.
Now it is very busy with vaccinations, so much so that our appointment book needs to have time reserved for wound care, chronic disease management, excisions and iron infusions. We plan to complete 6 immunisations for COVID in 1 hour.
General practices send their de-identified data to the government for future planning needs. As the nurse in general practice, this is my role to ensure that data is entered correctly. All the reasons why a patient is attending a GP is “coded” so data can be returned to the government about how many hypertensive people (for example) live in the area and future planning can be accurate.
Computer software is an important aspect of General Practice, making our jobs much easier by using templates, but also data extraction for further steps along the chain. For example, A data extraction program means that every person that receives an immunisation is sent a text message on day 3 to ensure no abnormal side effects.
What are some misconceptions about general practice nursing?
That it’s only doing urine screening, assisting in minor surgery, and Childhood immunisations. Our surgeries do not complete any childhood immunisations as the local public health service do a great job of immunising children. I still complete a lot of influenza immunisations. The doctor does the urine screening! Minor surgery is fun…
What advice do you have for those considering general practice nursing?
Remember that we are here to educate and advise – information is power. Use all your skills to listen to the patient, and ensure you don’t dictate. As nurses we need to equip the patients with information, so they can make the best choice to suit their lifestyle. Every person is different.
What’s next for your career?
I have no idea, I love my job. I walk out at the end of the day knowing that I have made a difference in my patient’s health journey, either by education, compassion, or advocating for the patient. I have at least another 15 years to work. It’s not a physically demanding role, and the rate of pay is not comparable to hospital nursing. It is a very rewarding job working in GP Surgery, either seeing children grow as you administer yearly influenza vaccine or as complex as researching an unusual medical disease and educating patients on their disease, researching the best allied health and specialists to assist.
