Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr Warrick Bishop and welcome to my podcast and videocast station. I'm delighted to welcome back Kylie Ward for podcast interview number two. Hi Kylie, how are you? Good, thanks Warrick. Pleasure to be here again. Thanks for making a bit more time for us to catch up and when we spoke the first time, for anyone who hasn't listened, we really covered in general terms the role of the Australian College of Nursing, how it... really supports somewhere around 400,000 nurses across Australia. We talked about your own journey into that position of CEO of the ACN. And interestingly, your own personal journey of how you started nursing and your mum as well. So you were studying together. And we really also talked about what some of the qualities and attributes that nurses tend to demonstrate in a daily basis in their workplace. And I think it'd be fair to say we could summarise some of that as tough love. So with all that behind us, what I was very keen to talk about is some of the main challenges that nurses face in 2021 on a daily basis. Now, of course, COVID is front and centre at the moment. Let me put it over to you. Share with me where you think some of the challenges and issues are for nurses here right now. I think some of the greatest challenges right now for nurses is the amount of demand on us as a profession and on nurses individually wherever they are working. Nurses are the most geographically dispersed profession. Nurses often live in the communities that they serve. And most importantly, we're also, as you know, the largest health profession. So of the 700 plus thousand licensed professionals with APRA, nursing is the largest workforce. You know, I've said this many times before that if every nurse stopped working today, there is no health system, there is no aged care system, primary care would be crippled. And so what we have is nurses who are experts in their field and highly specialised. committed to lifelong learning, constantly educating themselves. And then something like, you know, right now we're all faced with COVID is really looking at the public health of the nation and rising to their civic duty. And some of the issues that nurses will be faced with. is not only making sure all of their infection control practices are in place and monitoring for deterioration and looking at all the signs and symptoms. We're very good on assessment in what we do, whether that's in the community aged care or in the hospital sector, but then also the workforce provision. I think one thing that really sets us apart working in both of our professions is that you will have a full or a really strong fleet of expert nurses on a 24 hour system in a health service where every other profession goes down to minimal staffing. So the wellbeing of every patient and every person doesn't work in a nine to five system. And of course, it's that level of expertise to make sure that we save lives, we monitor and we keep looking after people. you know, every day and night. So that does come with challenges in workforce, making sure that there is great skill and skills mix available in every shift, every day, everywhere. And then some of the other challenges that we're facing really right now more than ever with the profession is not only everything that we do to provide care and who are nurses and what they do, but also because people are quite scared and not coping. Nursing and nurses are facing even more occupational violence and under threat. A nurse recently got punched in a vaccination clinic and we're hearing stories every day about the amount of abuse and violence, verbal and nonverbal, that nurses are facing. Not sure if you're aware, but before COVID, nursing is... And I don't even want to say this because it doesn't promote us, but nursing is the most dangerous profession. We experience more violence than prison guards and police officers. And that's only escalated in the experience that nurses are facing right now. That's a terrible thing to hear, actually, Kyle. I didn't realise that. My experience is, as you're aware, I'm a... a specialist cardiologist. I'm sitting in my own consulting room, so it's a very safe environment. Of course, I've passed through medical wards, surgical wards. I know accident and emergency would be a coalface where there could be drunken disorderly behaviour. But to think that nurses are potentially one of the most at-risk professions, that's incredibly disheartening. It's definitely a concern. Two years ago, we released a position statement. We needed to discuss the sexual assault and sexual harassment of nurses by patients. Being that female-dominated profession, you know, there's a blurring of the lines. We've still got a lot of work to do in society to have respect for women in general. You and I both know that. And that, I think, crosses over to us as a profession. Last night I received a call from nurses who are turning up to work. today at a vaccine clinic at a council in Noosa who will be on police escort to provide vaccines. So there are higher risk areas like ED, as you mentioned, and with drug and alcohol and other places, but there's also a cohort of patients who have cognitive impairment. So even in aged care facilities, dementia patients, there's a lot of the grabbing and the abuse. And so what we find is that Every nurse everywhere is potentially at risk and it's how we address that as a profession and really take care of our own. We're seeing nurses get exhausted emotionally and physically, just turning up to do what they need to do but then manage all of that personal attack or abuse. Well, obviously that physical abuse is going to be closely linked with emotional and mental fatigue, no question. What a challenge to try and deal with all that. Because one of the things that I was going to share through my own observation is that with the challenges that nurses face, we see in medicine things are becoming more and more and more specialised and more and more and more complex. And we're dealing with... older and older and sicker patients. And so the requirement to be across very complex issues with complex, difficult drugs is becoming harder and harder. You would have seen that yourself. Absolutely. You know, the polypharmacy, the amount of pharmacology, the adverse reactions, like medicine, we're a licensed profession and regulated. as a profession, dictate our own professional standards and code of conduct and code of ethics. We have researchers and academics driving our practice. And there's an enormous cohort of the community taking a lot of medications for a start and all their interactions and effects. But keeping an eye on... right through the spectrum of any of the physical conditions medicine is very specialized and nursing is also very specialized but for a nurse to be able to do their job well they have to have their their span across the assessment of you know you might work in a renal ward or in a specialty area but you're looking for signs and symptoms of other areas of things that might becoming apparent to then let our colleagues be aware of or to do further investigations. And we haven't even begun to then consider the mental health and wellbeing and what that plays for individuals in their own health. Certainly the activity and the busyness on a general hospital ward. is an intense environment, actually. The TV shows actually do reflect what it's like in some of those places, and it's very busy. And I know that the nurses are looking for things that they sort of feedback to me, like potential drug interactions or alterations in medication because of a patient's particular difficulty. made all the more complex by multiple generic preparations with slightly different names and different packaging. The whole thing is a very difficult process. And look, you know, I take my hat off to the staff that do that on a daily basis, but they're challenges, aren't they? They're definitely challenges. The Australian College of Nursing won the tender at the beginning of the year with the government. to develop the vaccine education. And this is just a great example of where you're at. So we've developed the education for all health professionals. Over 100,000 people have accessed that training. We've just this week released the Moderna training. But interestingly, while we've developed the training to the best practice standards, we've got the fact sheets to support nurses in in many areas, but particularly with the vaccine of all the questions being asked and the fear factor. And so it's not only what you know about something, it's what you need to know about what our patients and communities are concerned about and how to manage those expectations. Nursing is the most trusted and respected and ethical profession. We have been in the Morgant Gallup polls for over 30 years. So I think every nurse needs to take responsibility for what they say and how they say it, because people listen and they do trust us. And you would know that within your own role. And I think that that's then coupled with every nurse will care for someone. And that's how your staffing workload is funded. But we actually care for their family or their loved ones. So you're talking to who's around them and giving them reassurance and information and education as well. Look, one of the burdens I've seen grow over the years has been this burden of paperwork and bureaucracy that seems to be, certainly within hospitals, seems to be growing. And I'm not sure if it's all... to the good, to be honest. And I sometimes lament that we're generating so many forms and bits of paperwork to protocolise and tick boxes that I think sometimes patient care is spent filling out forms. And if you're filling out forms, you're not actually looking at the person we're caring for. I don't know if you get feedback on that or if you've got a comment on that. Yeah, we certainly do because what we're finding, and I mean, We've been, you know, in our careers for a long time and we understand the importance of clinical documentation and that's always been part of the course, but society is becoming more litigious and it's driving a different way of organisations and employers protecting themselves. And it's actually drawing clinicians and especially, you know, in my experience, nurses away from care. And the paper-based system, you know, everybody was always writing in their notes and doing a bit of a summary. And now that that's been in many instances, we've got point-of-care solutions, medical health records. That's great in terms of the way that we can collate big data and have access to records. But it's also the... the type of things that are needing to be recorded and what's being recorded and really why it's being recorded. And what worries me is the amount of hours in a day that a nurse will spend writing in the notes or trying to navigate paper-based or electronic systems just to support the litigious side of things rather than actually talking about the care that's being delivered and what needs to be known in recording. I mean, we're all highly trained. We know our responsibilities, but it really is a major onerous that's being put on clinicians and nurses, which takes us away from direct care. It's a complex balance. There's no question you need to maintain documentation. Yeah. But the time required to do that, if it is impacting patient care, then it really has to be juggled and balanced. We've spoken again and 10 minutes has just flown past, but what I would like to wrap up with is do you have any thoughts around the future of nursing where you see the next five to 10 years or any goals or objectives you have for the ACN at the moment? Over to you. Yeah, thanks. Big questions, all of those. We participated in an international report that's been sent to the World Health Organization on the future of nursing. There's about 27 million nurses around the world and with different regulation, they look and function a little bit differently and particularly in third world countries and very regional and disadvantaged areas, nursing might. practice a bit differently. Australia has some of the best nurses in the world and we're highly regarded and highly sought after internationally. But one of the things that I would say for the nursing profession, health is a human right and for people that are particularly... disadvantaged and whether that's geographically or socially or in any other ways, their best access to health care is often through an interface with the nursing profession and then to get to experts as they need them. And so we very much understand not only is health a human right, but we need to be working to universal health care. You've been a champion focusing on prevention, and that's what everybody should be looking at is preventative medicine, preventative care, building healthy communities. Our systems as we know them are unsustainable moving forward, not only because you can't keep building big hospitals because the staffing doesn't always come, but also in Australia right now, your postcode determines your health outcomes. And we know that those living in regional and rural areas have poorer health outcomes than those in the cities. So I think what we need to do is look at how nursing and medicine and healthcare can move into the future with a focus on primary healthcare, building healthy economies, getting gender equality. That's something that's very important. If you can invest in nursing and nurses around the globe, you can build families and communities. And so I think that we've got many workforce challenges, but the biggest that we face is probably out of our control in looking at the funding models, sticking to a social model, but making sure that access and equity really place us in a good position to be a strong nation going forward. Look, I think that's a future we can all look forward to, actually, Kylie. That's fantastic. Look, I'm going to thank you. It's Warrick Bishop speaking with Kylie Ward, the CEO of the Australian College of Nurses. Thank you so much for joining me, Kylie. Thank you, Warrick. I love talking to you and it's been a pleasure. Thank you. Look, I feel really grateful to have had the chance to share with you, actually, an absolute privilege. I'm going to say thank you one last time. For those listening, I really hope you got as much out of these two podcasts as I have. Till next time, I wish you live as well as possible for as long as possible. Take care and bye for now. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
