On November 26, 2020 – Jackson Heilberg and Amber Duncan sat down on camera and interviewed Ashton Kline who is a well respected Senior Lecturer in Nursing at the Australian Catholic University. We would like to thank our volunteer Mala for helping put this article together.

Meet Ashton Kline

murder, nursing

Ashton has a fascinating nursing career with experience across paediatrics, intensive care, chronic and community health. He’s a Clinical Coordinator and a Senior Lecturer at the Australian Catholic University.

Ashton is also an Ambassador for the Alannah & Madeline Foundation who work to keep children safe from violence. This role is very close to his heart after his mother was murdered by his father. Ashton and his younger brother Grant, who suffers from chronic kidney disease, were forced to become orphans at a young age, and it’s these experiences that lead Ashton to nursing.

Pathway to nursing after tragedy

The circumstances that lead Ashton to nursing is one of heartbreak and inspiration. It’s a moment Ashton remembers very vividly.

“I had become the carer for my younger brother at the age of 15 after my father murdered my mother when I was 15 and my brother at the age of 6 had end stage kidney disease.”

Ashton spent a significant amount of time with his brother Grant at the Royal Children’s Hospital in Melbourne where Grant was being treated for chronic kidney disease. There was one particular Registered Nurse that had a significant impact on Ashton’s life and inspired him into the field.

“He was doing his graduate year at the time. I still remember his name. His name was Shane.”

“I actually remember a particular day where Grant was in quite a significant amount of pain and he cared for us in such a way that was just so compassionate, and so compelling. It made such an impact on both Grant and I in the way that we interacted with the hospital and the way that we responded.”

“That’s exactly what I want to do. I want to be able to make a difference in peoples’ lives at the most vulnerable points. I thought what an honour it is to be able to have that impact on someone.”

From the age of 15, Ashton had a dream to be a nurse at the Royal Children’s Hospital just like Shane. Ashton was also inspired after he came into contact with the Alannah & Madeline Foundation, after he and Grant became orphans.

“The Alannah & Madeline Foundation was established after the Port Arthur massacre to help vulnerable children in situations of violence and really advocate for them, and provide case management support, funding and ongoing support to really nurture and help break that cycle of violence.”

“I was 15 and Grant was 6 at the time. Two scared children that really weren’t able to navigate an adult’s world, essentially kind of on our own.”

Ashton and his brother were removed from their family home just three days after the murder and into foster care.

“To have an organisation (Alannah & Madeline Foundation) that really advocates for you and sees you as a decision maker in your life was something that was quite unheard of. That was really important to us in getting through that particular trauma.”

10 years later, Ashton was asked to become an Ambassador for the Alannah & Madeline Foundation and give back to others going through similar situations.

“I’m able to give back to children that are stuck in that cycle or that cyclical kind of phase of violence. I can show them that there is a real way out of that cycle and a real capacity to break out through the case management and supportive mechanisms that the foundation provides.”

A nurse’s role in domestic violence

Ashton felt challenged when dealing with domestic violence patients due to not only his personal experience, but also a lack of awareness of what resources were available to help families. He also felt a strong need to help, support and guide such families. 

As a result, Ashton strongly encourages nurses to be familiar and comfortable with what resources and help are available to families affected by domestic violence, and focus on really empowering the patients.

“Research things quite thoroughly, and provide significant resources that will be useful for that person, but make sure that you actually empower them themselves. We can’t by any means give someone a resource and say, “Hey, go give this number a call. See you later”.”

“You need to make sure that they are empowered enough to actually make the decisions that they need to make within their life to make those changes.”

Nursing in the early days – rejecting a grad year offer

After Ashton’s experience with Shane, who was his brother’s Registered Nurse, Ashton had a goal to become just like Shane. He was so determined to be just like him that he only put one preference on his graduate year application – the Royal Children’s Hospital! Luckily for Ashton, who also had experience working as an Enrolled Nurse with children, he was offered a graduate role there.

But he rejected it.

“I decided that the graduate year couldn’t actually offer me much from my point of view. I think I’m probably the only person to reject the Royal Children’s in probably the history of graduate years maybe.”

Instead of doing a formal graduate year, Ashton scored a full time job as a Registered Nurse in the neuroscience ward. 

“There weren’t as many graduates coming out back then so it wasn’t as competitive in the market as what it is today.”

“I’d like everyone to know out there that there are options if you don’t get a graduate year. A graduate year is not necessarily the be all and end all, and not necessarily required.”

Ashton took lead of his nursing journey to make sure he didn’t miss out on the learning opportunities you’d get in a traditional graduate program. He attended every educational opportunity he could, and made use of educational and personal leave to upskill as much as possible. He even changed jobs in the same organisation after 6 months to create his own rotations, just like you would in a graduate program.

“No one else is going to drive my journey in nursing. I wasn’t willing to really be a passenger.”

“Even coming out of that year, I had a real thirst for knowledge and I knew that I was kind of behind the eight ball, as opposed to other grads. So it really forced me to keep educating myself, keep driving my knowledge and really upskilling.”

Career journey

Ashton has worked in many different areas of the Royal Children’s Hospital in Melbourne and did a year at the Royal Children’s Hospital in Queensland. The various experiences he’s gained has enabled him to be exposed to many different areas, so he can impart that knowledge onto nursing students at the Australian Catholic University. 

Ashton then took a year off nursing to care for his brother Grant who had just had a kidney transplant. He found doing nursing both at work and at home was leaving him feeling burnt out. He then took a slight deviation in his career.

“One of the beauties of nursing that many people will be aware of is that nursing opens up many doors. I took a six month contract, and I worked for Slater and Gordon lawyers,  developing a client assist program for them for people with personal injury – acquired brain injury. They wanted someone with a medical background to develop that. So I developed a program and rolled that out nationally.”

“I then worked six months for the Supreme Court, working with case management for clients with acquired brain injury as well.”

After this stint, Ashton then went back to the Royal Children’s Hospital and got a job in their RCH at Home service.

“I had a passion for chronic illness because of the care for my younger brother. I was always interested in the impact of illness on not only the individual, but also families as a result of that.”

“RCH at Home really gave me the opportunity to combine a case management (long term management perspective) of a person’s journey with health and the acute care stuff, so it was split kind of 50-50. So you could do hospital in the home.”

Ashton was responsible for managing six patients long term including children. He recalls having an 8 year old oxygen-dependent child who wasn’t able to attend school as the school hadn’t been trained how to use oxygen.

“One of the things that I was able to do was go out to the school and train them on how to use oxygen so that child could actually attend school for the first time ever.”

“That might not sound like a significant kind of impact to 2 million people I guess but for that family and for that child to be able to attend school, and for me, that’s my job done for my whole life.”

“I’m able to make that impact which is why I signed up to nursing in the first place.”

Chronic illness – why nurses should care

“Why am I particularly interested in chronic illness? I’m particularly interested in chronic illness because it impacts on the whole person. For people with a chronic illness, their life is impacted on a daily basis by that chronic illness.”

Ashton really wants nurses to understand that chronic illnesses should be at the forefront of their care as it impacts a person’s life far greater than most people imagine. 

“When we see patients who have a chronic illness, they come into hospital, and they may be having an exacerbation of a particular chronic illness. We see them for a day. They have to go home and they have to manage that chronic illness themselves, every single hour, every single minute of their life. They never get a chance to go home at the end of their shift and switch off. They have to and they’re forced to manage that. So we need to understand that they are dealing with this every single minute of their life.”

“Regardless of the area that you work in, you are going to come into contact with someone with a chronic illness. And so the reality is that you need to be prepared to manage those chronic illnesses.”

Ashton invites his brother Grant to speak at his lectures so students can see the real impact chronic illnesses, such as chronic kidney disease, have on people’s lives.

“Chronic illness is always there. I think that is one of the things that we forget about as a nurse when we’re treating patients.”

A significant portion of Grant’s life is dedicated to chronic illness just to keep him alive, with him undergoing dialysis six hours a day, three times a week. He also attends other appointments in between.

“As a nurse, we interact with that patient, and we forget that the person is actually managing all of that on a daily basis.”

“It’s really important that we consider what the person has to take into account on a daily basis and what they have to engage in. Because that’s what they’re dealing with. We might just see them as someone who doesn’t comply with their fluid restriction, for example, or someone who eats too much salt and so their sodium levels are through the roof and their potassium levels are out of control.”

“But for them, managing those restrictions on a daily basis is really quite a challenge. Because they just want a normal life. So it’s a battle every day.”

How to work successfully in a multidisciplinary team

Ashton was naïve about working in a multidisciplinary team before he started working at RCH at Home because he never had a great deal of interaction with other teams on the ward.

“RCH at Home for me really opened up my eyes. We had physios on the team. We had occupational therapists on the team. We had social workers on the team. And we would actually drive and manage cases as managers ourselves.”

“You’re actually visiting people in their home, in their environment, and make an impact on their environment, but you were able to go out to their home, determine what their needs were and then come back to the team and actually implement whatever changes they might need or discuss what changes they might need.”

“That really opened my eyes to some of the work that most use, or the work that you can do with the more disciplined routine.”

Ashton’s advice for other nurses working in a multidisciplinary team is firstly to not only respect everyone in the team, but also demand respect for yourself and the skills you bring as a nurse and patient manager.

Secondly, it is important to have a thorough understanding of each team member’s role to make the most of their perspective and expertise.

Thirdly, nurses should drive these conversations with each team member and not be afraid to ask what they want to achieve with the patient.

“Ask, “I don’t really understand much about what you’re doing at the moment, can you just explain, so that I can understand?””

“If you’re afraid to ask those things, then you’re not going to have a full understanding of the patient’s care. I think actually having those conversations is larger than the patient’s care.”

Nursing lecturer

Being a lecturer and educating students is a passion for Ashton. He started off in a sessional Clinical Educator role at the Australian Catholic University, where he visited different hospitals attended by students and provided on-ward education for a year. He was then invited to teach on campus and do sessional tutoring.

After a year, Ashton landed a full-time role at the Melbourne campus where he was for 4 years.

“I love the energy that you get from students and the drive that gives you the passion that students have for the knowledge sometimes, and the energy that you get from a classroom environment.”

“I realised in my nursing career that I could make an impact on a small number of families and patients and so forth. But what I realised in education is that I could impact nationally, 2500 students per year for example.”

“Being able to impart the passion that I have for the type of nursing that I have, and the way that I teach chronic illness, and the way that I teach clinical reasoning etc. is just enormous. So being able to make that impact…I can’t get that elsewhere.”

Changes to nursing education – is university too easy?

Ashton says the nursing curriculum is moving away from an understanding of the impact of illness on people to the technicalities of nursing. However, he warns it’s important not to lose the fundamental underpinnings of a person and believes this is where there’s a loss in the curriculum.

Regarding nursing being too easy and universities churning out too many graduates?

“Let’s start this one by saying that all views presented are my own, and not representative of the Australian Catholic University or any other organisation, just to be clear.”

“Essentially, I do think that there was a shortage of nurses. But the shortage of nurses is not at a graduate level. I think what happened with that was that the number of university places increased to try and fill that shortage, but what has happened is that it’s resulted in a huge number of graduates being pumped out into the system, but with a lack of mentorship through those middle years of nursing being available.”

“So as a result of these kind of systemic issues within nursing, perhaps, yes, there are, it is a little too easy to get into nursing.”

Ashton says although ATAR scores have dropped to get into nursing, he doesn’t think university is too easy. He also believes degrees should include more clinical placement beyond the 800 hours required to graduate, and that the hours should be dispersed across the degree rather than in a block.

“I think that the industry would benefit much more from having students out there on a weekly basis, ingrained in organisations and so forth a little more, where we could embrace the old hospital training system with the new system and have an integrated approach.”

“It would mean students are being exposed to the culture of nursing, the environment of nursing and the workforce that they’re going to be a part of much sooner. So you wouldn’t really have the ‘smack in the face’ that you have once you graduate.”

Nurses eating their young

“I actually really see a need for a shift in the culture and investment in the culture of nursing. I really dislike the fact that there’s a culture of eating our young in nursing, and a culture of not really nurturing our young, and helping them develop and refine, but rather, putting them through their paces and having them earn their stripes so to speak.”

Ashton strongly believes there needs to be an amalgamation of the senior nurse and junior nurse, so there’s more mentoring to support nurses throughout their career.

Nursing students – key to success

Ashton maintains that it doesn’t matter what grade a student gets; if they have kindness and compassion, the rest will follow. The other characteristics of great nursing students are being adaptable and flexible to constantly changing situations.

He also believes COVID-19 has had a positive impact on junior nurses as they will be more skilled in infection control principles and knowledge.

“One of the things that this year has taught us in nursing is that we weren’t very good at infection control and we didn’t actually have a really good understanding of infection control. So I think it’s certainly really increased that kind of knowledge within our junior nurses, and I think that will stand them in really good stead.”

“The other thing is that it’s taught junior nurses that they have to be adaptable, that they will be nursing infectious patients, and that they will be putting themselves potentially at risk in the workforce if they choose to work in a particular environment for example.”

“I think prior to this year, there was a notion that there was a pretence of being protected from that. I think that’s been really brought home this year and you’re in it, or you’re not.”

Why nursing students aren’t paid?

One of the biggest struggles for nursing students is completing 800+ hours of unpaid clinical placement and having enough time to complete paid work to make a living. But Ashton says if nursing students are paid for doing clinical placement, then there’s an expectation for them to perform at a certain level.

“You have to be prepared if you’re getting paid that you’ll be able to perform a duty, and some students can’t perform that duty. So it’s an unfair expectation or unrealistic expectation to expect that all students will be paid.”

“When you look at Singapore for example, students get paid something like $50 a day for their placement experience, but they are part of the nursing workforce from day one. So they are literally allocated to patients and expected to perform the duties of a junior nurse from the get go.”

“There would be an expectation if students were paid, that you would perform those duties. I think that totally goes against the educational kind of principle.”

Advice to students and junior nurses

Nursing students need to manage their expectations and be willing to receive realistic feedback, Ashton says.

“I get a lot of students who come back after a placement and say, “I’m really unhappy with the feedback that I’ve received because I was only at level three and I thought that I was at level five.”

“Realistically, if you’re at level five for all clinical placements then there would be no point in you being educated essentially. So the whole point of clinical placement is to improve. So take that feedback on board and whatever experience you’re allocated to, do make the most of it.”

Ashton’s biggest piece of advice to nursing students and junior nurses is to have patience with yourself.

“I think as junior nurses, we put an enormous amount of pressure on ourselves to feel that we have to know everything.”

“Certainly, when I commenced the year that I did straight out of university, I felt that I am now this licensed RN that I have to know absolutely everything there is to know about nursing. And so if I don’t, I’m an absolute failure.”

“So have patience with the journey that nursing will take you on. You’ve got years of learning. And if you ever stop learning, then get out of nursing. Because, honestly, your time is done. So have patience with yourself, and don’t try and fool yourself that you have to know everything.”