The amazing life of a rural and remote graduate nurse!

Meet rural and remote graduate nurse Renee Mewett!

Join our new FB group Rural & Remote Nursing | The Australian Outback

Who are you?

My name is Renee Mewett and I’m a 2020 Queensland Health Graduate Registered Nurse working rurally in a small hospital in Monto, QLD. I originally grew up and lived at the beachside town of Hervey Bay but made the move to Monto to pursue my graduate year in a rural setting for what I knew would be a challenging and exciting start to my nursing career! 

What made you choose nursing?

From a young age I’ve always been interested in all things medical and through my own interactions with nurses and witnessing interactions between family when they required care, it just seemed to click that nursing was the career for me. I loved the idea of a career where no day would be the same and the endless career opportunities that come with being a nurse really meant that I was choosing a career for a lifetime where I could constantly try and experience new ventures.

Where did you study

When I graduated high school, I had applied for direct acceptance into the University for my Bachelor of Nursing Science degree. I applied to my local university- USC Fraser Coast Campus and completed my three-year degree in my hometown. I was fortunate that I could complete all my placements locally in the Fraser Coast and Wide Bay region.

During my undergraduate degree, I completed 800 clinical hours of placement consisting of Aged-Care, Theatre, Rural, Mental Health IPU, Acute Medical and Renal Unit placements.

Where I work?

I work 0.8 in a small rural hospital in Monto, QLD as a Queensland Health Graduate for the Wide Bay Hospital and Health service.  The hospital is made up of a 14-bed sub-acute ward + A&E department. The hospital is staffed by nurses (3 for an early shift, 2 for late and night shift) with an In-Charge TL RN on for each of the 3 rotating shifts with an on-call doctor to manage ward-based patients and any emergency presentations we have.  Our doctors (3) work a rotating roster for on-call and during the day can be found in the GP practice across from the hospital Monday-Friday.

The listed on-call doctor is then on call for the afternoon and night and can be contacted and come in as required. We have onsite x-ray facilities for both emergency and less urgent imaging including chest, abdominal and limb x-ray. We have allied health professional (OT, PT, DT, SW) that visit once a week/fortnight to assess and implement treatment plans for our inpatients and some outpatients.

My graduate program had a structured 1-week orientation completed at the health services larger regional hospital – Bundaberg Base and then it was straight to Monto to start work. We’ve had 5 structured study and skills days that the rural graduates have travelled to Bundaberg to complete.

What made you choose rural and remote?

During my degree as a student RN, I was afforded the opportunity to travel to the outer rural districts and experience a rural placement before graduating which really helped cement my choice to going rural for my graduate year. As a student, I got to witness how advanced you could progress your skills rurally and knew this was where I wanted to start my nursing career. I loved that there was such a variety in day to day life as a rural nurse that truly help me choose to go rural.

What I do as a rural and remote graduate nurse?

In a small rural hospital, they always say “you become the jack of all trades” and I can safely say that my experience as a Graduate RN rurally has proved that saying true! I certainly had to hit the ground running. Through my graduate year, I have worked both ward-based and in emergency. I do in-charge team leader shifts as the sole RN on shift staffed with 1 or 2 other nurses and during those shifts, I am in charge of managing/overseeing the hospital including all inpatients, outpatient clinics and emergency presentations. 

I’ve nursed patients from 2 weeks old to 100 years old and all those in-between.

The wide variety of experiences I have been involved in have both tested and furthered my confidence as a new RN.  From delivering Acute Medical care to dealing with Medical Emergencies, right through to Rehabilitation and Palliative care plus all things in-between, life as a Rural New Grad has been filled with non-stop new experiences, where no day has been the same!

As a small facility that is 3hrs away by road from the nearest bigger regional hospital, we often have to fly patients out by plane or helicopter that are too unwell or need further acute inventions that aren’t available in Monto. In doing this I’ve gained great experience in dealing with aeromedical transfers and communicating and collaborating with the wonderful RFDS teams.

Royal Flying Doctor Service

In my graduate year, I’ve encountered many patients who required transfer to a larger tertiary hospital due to their level of acuity or the requirement for diagnostic tests and treatments that aren’t available in Monto’s small hospital. These transfers are completed through RSQ (Retrieval Services Queensland) and occur via either a helicopter or fixed-wing plane from RFDS.  Patients that have been flown out during my graduate year include acute cardiac, trauma, sepsis, acute medical and deteriorating patients. All of these patients required further tests and treatments that were not available/practical in the rural setting.

When I hand over to RFDS there is a bit of preparation involved to ensure the patient is safe for transfer. Firstly we complete what is called a “fly-out” pack. This is a folder containing clinical information for the patient such as diagnosis, clinical condition, documentation (QADDS, progress notes, doctor’s letter etc) and travel forms that will all go with the patient to the receiving facility. RSQ will frequently call for clinical updates and to give ETA for when the flight team will arrive.

Depending on whether it is a helicopter or plane, handover to the retrieval team occurs at the hospital (helicopter pad) or the airstrip (plane). We use ISBAR handover and inform the receiving aero-paramedic or doctors about everything related to the patient. The patient is then flown out to the receiving hospital and we call ahead to let them know the patient in their way.

Read our Q&A with the RFDS CEO in QLD (also a nurse!) and all our flight nursing articles HERE

First 6 months – Most challenging things?

My first six months as a new graduate were some of the best and hardest of my life. I felt a whirlwind of emotions both good and bad as I found my footing on my new adventure. Going rural had both the regular challenges that all new graduates experience but also came with its own unique set of challenges. For starters, as a Graduate Nurse in a rural setting, you are not just a nurse. You are administration, admissions, pharmacy, and all things in-between that it takes to run a hospital.

So on-top of learning standard things as a new grad, I had a whole other set of skills I had to learn. One thing I’d like all new graduates to know is that imposter syndrome is real and pretty much all of us experience it. I remember the very first day I started, given my own patient allocation and was handed a set of medication keys- I felt like an imposter. I kept thinking, “I can’t have these keys myself”, and that there should be a “real nurse” in charge of the patients. And it honestly took about a month for me to stop feeling like I was an imposter and that I was actually a Registered Nurse and that I was allowed and capable to do my job.

Something I wish I’d known?

One of the biggest things I’ve realised during my time so far and something I desperately wish I’d known from the beginning is that it is ok to hand tasks over and to not have your shift neatly tied up in a bow for the next shift. I really struggled in the beginning- and admittedly sometimes still do with feeling like it was not ok to hand off tasks at handover for things I hadn’t been able to complete in my shift. I felt like doing so was admitting I was a “bad” nurse who couldn’t complete their work. But I now realise it really is ok and it’s not a bad thing.

Nursing is a 24/7 job and things get busy- really busy some days- which means that there are going to be tasks you weren’t able to do and it’s ok to handover those tasks. Especially as a new graduate where you are still developing your time management skills, it’s important to know that it is ok and to not be so hard on yourself. Be kind to yourself, you are still learning and growing.

What there is to do when not working?

Small towns are certainly small towns but that’s not to say there isn’t anything to explore and do! Monto is located only about a 30-minute drive to the beautiful Cania Gorge National Park which has camping, boating and national park walking trails that have beautiful views and scenery. There is also the various local events/ races and festivals that occur in Monto and surrounding rural districts that make a perfect weekend activity. Moving out to Monto I moved into a rental house with the previous year’s graduate nurse and house shared in town.

Rural VS Metro?

There really is no graduate year quite like a rural/remote one.  The endless learning opportunities and skills advancements that occur really help shape you and grow your confidence in your first year out. 

During my time as a graduate RN, I’ve grown and developed a wide range of skills in such a short time that I feel I wouldn’t have gotten anywhere else!  I’ve completed my ALS (advanced life support), Triage training, cannulation, venepuncture, emergency medicine training including airway management/support, emergency access including IO insertion and so much more!

There have been many skills workshops and education days I’ve gotten to participate in revolving around cardiac nursing, deteriorating adult and paediatric patients and the management required which have all helped consolidate my learning and increased my confidence.

Graduate programs in metro or larger regional centre’s certainly have a lot of positives going for them too but call me biased- I still think rural is the way to go and can offer such a unique start to your nursing career that I think anyone would be silly to miss out on!

Tips for student nurses?

I won’t be the first to say placements aren’t easy, they are often a big wakeup call as to what it is like being a nurse and are a time filled with so much learning that it can be overwhelming. They can really be hard going. But I hope some advice I give may help to make someone’s go a little smoother or easier.

Firstly, invest in quality shoes, you’re going to spend a lot of time on your feet, look after them!

Next up. PLAN, PLAN, PLAN! Start planning around with family or friends with when you will be working, when you might need some help with things like watching the kids, or organising day-care, grocery shopping and other lifestyle activities.

Don’t be afraid to ask for help, use your support systems to get through the hard yakka!

Meal prepping was a godsend when I was on placement! It doesn’t have to be long hours cooking, choosing simple meals that can have a couple of portions extra made and stored away is an easy way to help you maintain nutrition and prevent having to buy food while on shift.

Always take a notepad in your pocket, write down questions you have or something new you just found out. At the end of the day, go through your day’s note and reflect, I found it as a useful way to realise how much I’ve learnt that day.

Everything is a learning experience. You are not expected to know everything, but for everything you don’t know- Find out! Research & and always ask questions.

Use your preceptors, be actively engaged in your learning! You’ll only get out of placement what you put in! Set goals and if there is something you’re particularly interested in seeing, ask! If you show interest, often they’ll be happy to organise it and seek out further opportunities for you! Always introduce yourself as a student RN, and greet everyone from cleaning staff to doctors, you’re a new face on the ward!

Treat everything as a job interview! The people you work and connect with on placement are/can be future employers and colleagues. Always put your best foot forward, they are watching and taking note of whom they see as potential future employees.

Finally: HAVE FUN! Placement is not supposed to be just a stressful, exhausting time, it is supposed to be fun too! It’s a time to embrace and consolidate all the learning you have done thus far and to enjoy yourself. This is the start of your nursing career, make it magic!

For all our other graduate and student nursing articles filled with tips GO HERE

Graduate application and tips

Now, Graduate Programs – Ah the big two words that send excitement and shivers down every nearly finished or just finished student. Now I may as well say the hard truth first, grad programs are extremely competitive and very low numbered compared to the number of graduates applying for them. This means there is a higher chance of not securing one than there is getting one. So this means you need to be smart, strategic and have a Plan A,B,C to Z!

Hospital and health services doing a graduate campaign will release what’s called a ‘Graduate Prospectus’ which contains all the information about when what and how for applying. Download them and really read through them well, it’s up to you to know what you need to do and when. It can be very easy to miss out! You will have the public ones like QHealth and NSWHealth but there are also private ones like Ramsay, Mater, Uniting Care and they all have their own schedule and requirements.

My advice based on what I did (I started early too because it can be a lot of work out and organise). I researched up where I wanted to apply and listed all hospital and health services in a word doc under what campaign they would be in (QHealth and the different hospitals in that for example).

I then wrote down the approximate dates of when different portals opened based on the previous years’ dates if the current one has not yet been released as they’re normally the same give or take a few days. I then started planning my resumes and individual cover letters working towards writing them to address the selection criteria. Read and edit, read and edit! Get friends and family to read it for you.

Make sure to get referees early, I started getting referees from the end of my second year as I knew some applications would be due early in my third year and applications required two recent referees.

Attend any university graduate days, they have different health representatives telling you what they want, and how to do it! Also, any resume workshops could be beneficial if it’s been a while since you last updated or wrote one. Some health services also have their own private graduate information days, definitely attend those, it gets your face out there as its normally the grad coordinator and recruitment doing these days.

If you secure an interview, breathe, and try not to stress too much about it. You have done your degree; you know what you know and you need to have confidence in that! The interviews are not made to trick you or set you up to fail, they just want to know about you and what you’ll bring as an employee so sell it! If in doubt, Remember hand hygiene!! 

An important note I want to get across is- Don’t limit yourself to a grad program, it is not the be-all and end-all! There are many other pathways into the nursing area you want, and sometimes you’ll just have to take a detour before you get there. Working in hospitals also isn’t everything, apply for aged care, GP practices and normal RN jobs, call managers and NUM’s and ask.

You never know until you try and there are thousands and thousands of nurses who missed out on grad programs that are now team leaders, clinical nurses, NUM’s and executives. Your career is what you make of it, and you need to take charge and make it happen. If at first, you do not succeed, then try and try again!

For resume & cover letter help GO HERE

Final comments and advice for students

I’ve certainly had my rough days and working rurally has definitely had its own challenges that I’ve had to overcome such as the quick progression into a leadership role of Team Leader/In-charge RN as a graduate and the distance and lack of availability of resources that are so readily available in larger facilities.  But for me, I know that despite any bad days, I am truly blessed to work in the job I do and to do the work that I do.

Each and every day I have the opportunity to help change someone’s life, whether in a small or big way. And to me, that’s pretty special. I truly believe the knowledge I’ve gained is second to none and has cemented my foundation for my future nursing career.  

My advice to students up and coming is – Go for it, and go for it rurally! 

Future Plans?

For me at the moment I have to say I really have no “be all and end all” plan of what I want to do. My nursing journey as only just begun and there is still so much more to see and explore before I settle on an exact plan- and that right there is the beauty of nursing. I do have some hope that one day I can have worked my way up and go full circle to teaching but that’s after a long career in trying everything nursing has to offer!