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Jane Laidlaw is an experienced and compassionate Nurse Practitioner. Jane has been a registered nurse since 1990 and moved to Tasmania from England to raise her family and enjoy the wonderful lifestyle here. When not at work, exercising, or with her family, Jane is learning. It is quite obvious when you meet Jane that she is passionate about her ongoing education. In 2019 she launched Mission Health – a nurse-led drop in clinic providing free healthcare for the vulnerable and homeless in Launceston.
Tell us about yourself?
I am Jane Laidlaw, an experienced Nurse Practitioner who trained in the hospital system in England. I completed my RN training in 1986. I moved to Tasmania in 2002 with my family to experience the wonderful lifestyle here. I have loved studying and I have completed certification in immunisation, a Graduate Certificate in General Practice and a Master in Nursing to become a Nurse Practitioner in 2015.
I was drawn to nursing from a very early age because I loved helping people and this passion has never waned. I recall applying to several hospitals and eventually studied in Bristol.
Tasmania is the most glorious state of Australia – lifestyle is focused on natural attractions such as Cradle Mountain, Freycinet National Park and Cataract Gorge. Despite being a regional area there are good opportunities for nurses here both in the community and tertiary settings
What is general practice nursing?
General practice nursing is a diverse role which is a growing area within the healthcare and covers many areas of nursing practice including women’s and men’s health, aged care, infection control, chronic disease management including cardiovascular, asthma and diabetes care, immunisation, cancer management, mental health, maternal and child health, health promotion, population health, wound management, illness prevention and much more. The role is so varied and the presentation can often be very complex. What I enjoy most about nursing in general practice is the relationship with the patient – it is ongoing.
What are the main types of patients you see in your current position and what is your role in their care?
Patients seen in general practice are the whole age range. This can be initial health checks of a 6-week baby and the mother. I see children for minor illnesses such as ear problems or other health concerns. I provide immunisations for travel as well as those recommended on the National Immunisation Program. I see patients for assessment of health issues and order investigations. I provide contraception advice as well as cervical screening and STI counselling. No day is the same and it is very rewarding.
What type of services do you offer to these individuals as a nurse practitioner?
My role is diverse and some of the aspects I will clearly state the involvement of the NP. General health assessments may include a respiratory condition such as COPD. A health assessment would include the ability to function in day to day life, symptoms currently experienced, smoking status, medication review and inhaler technique. Tailoring these assessments to the need of the individual is crucial and providing education and supportive literature to their level of understanding.
STI testing can be opportunistic as part of a routine check-up – such as a cervical screening (formerly pap smear) appointment or as a presentation when a patient is concerned for their wellbeing following an at-risk sexual activity. Either type of appointment involves assessing the risk and discussing options to provide testing. The opportunity presents to discuss contraception methods and
How does the dynamic work in practice between GP’s and NP’s?
A Nurse Practitioner and GP can work concurrently together – in the practices I work I have a great working relationship where I can discuss issues I feel are outside my scope of practice. At both practices, some patients request to see the NP but GPs have their own patients.
Most challenging and difficult aspects of your work as a nurse practitioner?
The biggest challenge I face is that patients and other health care professionals do not really understand the role.
An example of this – I explained to a patient I am a nurse practitioner. The patient said, “If I realised I was seeing just a nurse I would have booked to see a Dr”. My response was – all nurses are highly trained and as a nurse practitioner I am even further qualified to provide prescriptions, order pathology or Xrays and ultrasounds. Eventually, at the end of the consult, the patient left saying “thank you Dr!”
When I receive electronic results I receive from 3 providers- all are addressed differently :
Dr Laidlaw
RN Laidlaw
Jane Laidlaw
I receive feedback letters following referrals made in a similar manner! This amazing role as an NP is unfortunately poorly understood in Australia (despite known success stories in USA, New Zealand and the UK). State and Governmental changes are important to effect the necessary change as well as bodies such as the Australian College of Nurse Practitioners.
If there were one thing you could change about being a nurse practitioner what would that be?
I would have a list! Top of the list would be ordering obstetric ultrasounds without having to get a GP to countersign. This is one of the most common investigations I order and I can order virtually every other ultrasound without a countersignature. This is one of the mysteries of being an NP. I can prescribe Morphine but I am unable to prescribe an Aspirin to a DVA patient.
Second would be in a similar vein- female patients over the age of 40 have presented to me with a breast lump. I can organise the ultrasound of the breast and biopsy but not the mammogram which means there is a need for a countersignature from a GP
What pathway would you like to see the future of your profession take over the next 10 years?
The future I see is for General Practice nurses to lead the way with more and more nurse-led clinics. These could be in speciality areas such as heart failure, lung disease and diabetes to name a few. Many GPs in our vicinity is ageing and it is unlikely that there will be sufficient GPs to manage the increasing needs. I would love to see more Nurse Practitioners in GP practices and more stepping into areas such as disability sectors, aged care facilities and providing outreach services to communities and groups which are marginalised.
Training in setting up such clinics and funding would be needed of course.
What was the hospital training system like in the UK?
The hospital training in the UK was 3 years in length. It involved blocks of study then practicum in the wards but you were considered part of the ward staff. Due to this, you were paid a small wage. I recall having at least 10 placements which were diverse from surgical to community and psychiatry to obstetric.
On reflection, there were definite advantages of having early exposure to patients but I do recall sometimes floundering when being asked to perform a task I was less familiar with. Often the role was very task orientated sometime without an adequate knowledge base.
Personally, I feel that increased evidence-based care was missing but I feel that students nowadays can become qualified, in some instances with insufficient face to face exposure.
Nurse-led clinic for the homeless of Launceston. Tell us about this?
As part of my life I go to the gym most mornings and in June 2018 I noticed a white car and it became clear that someone was living in that car. At that moment I was horrified. I was aware of overt homelessness in our big cities seeing individuals in their sleeping bags but naively I believed this did not occur in Tasmania.
This remained at the forefront of my mind and in September 2018 I attended the annual Australian Nurse Practitioner’s conference in Canberra and I heard a continued theme “Where are the gaps in health care locally?” At that point, I started writing about a homeless clinic in Launceston. The pros and cons. If it were possible. I returned home with a new determination. I discussed this with the business manager at the practice who had links with City Mission’s CEO and we organised to meet. City Mission’s CEO said that they had long hoped for collaboration to provide some health care services for their client group and this had never come to fruition. At the same time as planning was underway, 2 senior lecturers at the University of Tasmania were having similar thoughts and a 3-way collaboration transpired.
A local practice was closing and some equipment was gathered – this included BP equipment, examination couch, examination light, dressings and much more. A 12 week pilot of a Thursday morning clinic was proposed with a plan of services to be offered. This started on the 14 March 2019. Initially, we probably saw a few people each week and perhaps this was because there was a need to develop rapport and build trust.
My role is as a nurse practitioner providing assessment, diagnosis and treatment of minor illness such as UTIs, chest infections, providing prescriptions, organising investigation and patient education. Due to the level of complexities of this cohort, I am highly aware of potential requests for drugs of addiction. Any medication I prescribe I ensure that I have undertaken many safeguarding checks to meet quality in prescribing guidelines. As a nurse practitioner, there are some limitations of my scope of practice so I have to try to organise some health care options.
Many of this group are homeless or have insecure living arrangements which mean that they rely on organisations such as City Mission for food parcels, showers and a hot meal. Some of the impacts have included being able to provide an iron infusion to a woman who was at risk of homelessness, suturing a patient who would ordinarily attend the emergency room as well as removal and reinsertion of a long term contraceptive device (Implanon). These are standouts where much of the work involves chronic disease management and trying to help meet that persons needs on that day.
From a numbers perspective in 2019, there were 179 episodes of care provided. To October 2020 there has already been 230 seen in 2020. This is encouraging as it means that the vulnerable are accessing health care.
What is your involvement as an NP, with refugee and humanitarian arrivals in Tasmania?
I have been involved for the last 3 years in the refugee program. This has involved integrating refugees and their families into Tasmania from a health care perspective. The challenge that most Australian’s are unaware of is that some refugees have been in a refugee camp for up to 20 years until they find their forever home.
My clinical role involves women’s health care – cervical screening, contraception and pregnancy management, assessment, diagnosis and treatment of minor illness and immunisation. Commonly this patient group has had either no or limited access to immunisation and part of the role in this service is to enable individuals to be immunised to Australian recommendations
The problems experienced by this cohort are many, firstly the language barrier and the cultural differences. Many have experienced torture, rape or other atrocities in their homeland and the mental health scarring can be immense. I have known of a man with a large scar from his shoulder to his elbow and when I asked how he acquired this scar he told me “It was a gift from the Taliban”.
Clearly, there are difficulties adapting to Australian life – some families and individuals seem to adapt better than others. I met a family who could only bring 2 of their 4 children here – although this family moved to another part of Australia I imagine leaving some children in their homeland will provide ongoing distress.
What are the biggest ‘gaps’ in the healthcare system in your view?
Having been born in England the health care is funded differently and there is access to health care for all.
In regional Tasmania, there are very few bulk-billing practices. The challenge with this is that those who really need health care can often ill afford to pay. These individuals often lead chaotic lives and their health problems are significant. Their ability to sort everything in a brief appointment would be impossible. Sadly that means that even if they had some funds the costs would likely be beyond them.
Clearly, I believe that we are not meeting the needs of the most vulnerable- the poverty-stricken, those without a home, refugees and other disenfranchised individuals. I believe more nurse-led services can and would assist this significant shortfall.
Having set up Mission Health it is not only possible but achievable. I am at a stage in my life where I am able to be paid a small amount only for this clinic. I only receive the MBS item numbers at a bulk billed rate- this can mean that my hourly rate would vary between $15-20 an hour!
This clearly means to replicate this service throughout Australia there would need to be significant funding attached to enable a wage for a nurse practitioner. This would provide an acknowledgement that the most vulnerable in society may well have the greatest health care need
Why do some people go without healthcare in Australias’s modern system?
This is a really complex question because some people actively avoid health care due to poor self-awareness, fear, prolonged waiting times and lack of ability to pay. I believe there are many reasons and they can overlap. There are shortages of health care personnel in regional and remote areas. There is sometimes a lack of awareness of available services- this can be due to poor health literacy as well as services seemingly invisible.
Health care services may not be tailored to the needs of the populations of their locality. An example being the provision of culturally appropriate Aboriginal Health services knowing this group is at high risk of many chronic diseases.
Perceived lack of confidentiality can be a barrier and as health care providers it is essential that this is addressed. Some individuals have poor communication skills and can feel disenchanted as their concerns are not being addressed. In remote and rural areas there are significant transport issues
It is in hot debate currently, but what is your perspective of the current medicare arrangements for nurse practitioners?
There certainly is a huge debate on this matter. I believe adding in the NP perspective means that patients get an alternative to the medical model which includes significant amounts of education. NPs across the health care setting can influence change. For this reason alone all the recommendations placed to MBS by the Australian College of Nurse Practitioners should be adopted.
What is one thing you wish you would have known before you started your career in this field?
Prior to starting working as a Nurse Practitioner, I wish I was aware of how many mental health problems I’d encounter and that I feel that my Masters did not equip me for this
What’s one of your greatest accomplishments to date?
Without a doubt, the Mission Health clinic is my greatest professional accomplishment and I believe that its inception has shown me that we can all do more than we anticipate as nurses. I have learnt so much about life and how challenging it can really be. I believe I have learnt that we all need to be kind to all, by turning down a patient’s request they deserve to know why in an empathetic way. The clinic runs each Thursday AM and in the year 2019, we had 326 contacts with patients. In 2020 thus far to October we have seen 404 patients- to me this indicates we are making a difference
How can we work better with other health professionals in the multi-disciplinary environment?
Being present and a force to be reckoned with is the way forward for nursing. Being the largest part of the health force in numbers we are at an advantage to showcase our skills. In 2020 the year of the pandemic it is clear that nurses worldwide are well respected by global populations. Working better within the multidisciplinary team is essential to advocate for patients, communities and populations-
Can you think of a really funny situation you’ve had while working?
I undertook an Addenbrookes Cognition Test with a patient in the year 2005. The patient had cognitive decline was getting most questions wrong such as the day, date and month. After a significant amount of incorrect answers, the patient answered “who is the current US president” as Donald Trump. I was seriously concerned about his poor answers.
The reality is that he may have actually had great insight as Mr Trump had not even been nominated at that stage!
Why should other nurses or students consider general practice nursing as an area to work in?
General Practice nursing is an incredible area of nursing in my view. Every day is different and the breadth and scope are huge. Many nurses consider it to be just dressings and not much else. Practice nursing is evolving and is highly successful in the UK and New Zealand. Whilst it is a relatively new area of nursing in Australia it is becoming increasingly respected and you can influence positive change. There is much education available to underpin this area of nursing now.
If you were invited to do a TED talk, what would be the title and what would you talk about?
If I were invited to do a TED talk I would be firstly terrified! However I think it would have to be titled “ Nurses – you can really make a difference!” I would see the TED talk as an opportunity to mostly discuss the last 2 years of my career when I have collaborated with City Mission a charitable organisation and the University of Tasmania to set up Mission Health – a clinic for the homeless ( or at risk of homelessness) in Launceston.
Apart from nursing what else are you passionate about?
I love our 2 dogs – a poodle and a sprollie (a cross between a Spaniel and Collie) as well as my gloriously supportive family. I do collect Agatha Christie first edition books and have 60 of the 74 she wrote- the challenge being that the final 14 are rare and unless I stumble across any by accident they are likely to cost 10s of thousands of dollars! I also attend the gym 4-5 times a week doing RPM, Pump and Boxercise classes
How do you destress after a shift and self-care?
I find exercise to be an essential component and I regularly go for a massage. Quality family time is essential as well as something that “has your stamp on it”. I collect Agatha Christie books and have quite a plant collection. All these contribute to me smiling on a daily basis
Night shift tips?
Do take some healthy snacks and back in the day when I was “in charge” on night shift we always did “News” so that we all felt part of a team. “News’ would include us all having something to contribute about our day/ family or what we’d done recently
Time management tips?
If you are time-poor (and who isn’t as a nurse!) try to always get time to think about new requests or commitments. Say “please give me 24 hrs to think about that “
Factor in some fun.
Conflict resolution!
Keep in mind that professional respect and integrity are crucial. We do not have to like everyone we work with but sometimes by being respectful and kind you can form great professional allegiance
What’s in your lunch box! What are some food tips/ideas for shifts?
I love apples…an apple a day keeps the Dr away.
If you could give your younger self some advice, what would it be?
There are probably four bits of advice I’d give to the young Jane
- If you don’t ask you don’t get (but keep in mind you may not get and you may have to rethink what you want!)
- When you are offered opportunity take it– it may lead you to new and exciting places. 21-year-old Jane would never have anticipated working with the homeless or with refugees!
- Study often, the initial study is great grounding but the real work starts by taking a leap of faith. Don’t be afraid to step outside your comfort zone and even get into the terror one. I felt terrified of starting the clinic and had to learn lots and quickly. The pressure was incredible studying for a masters whilst working almost full time. Deadlines to meet as well as performing at work commonly meant I was in the terror zone! I believe being in the terror zone increases your determination!
- Dont be afraid of public speaking – as a younger woman I was and continue to be fearful of presenting at study days or conferences. Following the success of Mission Health, I have been asked to present at events. Young Jane, it gets easier, I promise
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