Nursing; Carer or Career

By Maxine Millar

This book is a memoir, the story of my life in nursing, mostly psychiatric. It contains case histories, tragedies and comedies. Detailed, are some of the changes I have seen in nursing. Principally, nurses are burdened by unnecessary and overwhelming paperwork at work and it follows them home. Paperwork makes nursing expensive and inefficient. Less patients are treated at far greater expense. This wasn't the case when I first started nursing. In my opinion. I give the causes, reasons, motives and methods as to how this began and continues and the how as to reversing it. Most importantly, nurses need to make the changes. Not managers or 'experts' or academics or committees.

• Language: English
• Publisher: Maxine Millar
• Release date: Dec 31, 2023
• ISBN: 9798215775097

Maxine Millar

Maxine lives in New Zealand, on a life style block. She now writes full time.

Book preview

Foreword

READ THIS FIRST in order to understand this book. The New Zealand Health System is based on the British model. There is a Public Health System paid for by higher taxes, not just Health Insurance. Everyone has access to health care but the quality varies. So do the waiting times.

Running in parallel is a Private Health System funded by Health Insurance which allows the insured to jump the queues for appointments, tests etc, have their operation in a private hospital and generally get better and faster treatment. But for dire emergencies like accidents, the Insured can use both systems.

So can the Uninsured. Most Uninsured use the public hospital system but the Uninsured can also use the private system by paying the full costs in the Private Health System.

I have worked in both systems but mainly in the Public Health System.

My experience in Nursing is forty-six years. I have worked in mainly Psychiatric but also in General Hospitals in New Zealand and Australia. I worked in a typhoid ward in Melbourne along with Drug and Alcohol Wards, an Adolescent Unit, Nursing Homes and Forensic Units. I worked in Forensic Units in New Zealand as well; Top Security, Medium and Low Security. I nursed Psychiatric patients in General Hospitals, worked in a General/Surgical ward in a Psychiatric Hospital and I worked as a private nurse in people’s homes in London, England. I trained in Sunnyside Hospital in Christchurch, New Zealand and before that I was a nurse aide. Clearly, I loved variety and new things. I started nursing aged eighteen, part time as a nurse aide. I am no longer Registered and am officially retired from Nursing but I will always be a nurse. It becomes a state of mind.

This account has been written by a nurse, based on practical experience of nursing across four decades and three countries. I am not a researcher, nor an academic and this was not written for academics. It was written for nurses and anyone else who is interested in nursing, from the point of view of a patient, relative or friend. It is more of a memoire, containing my opinions based on my own experiences and those expressed to me by the thousands of patients I have nursed, seen and chatted to.

I refer to nurses as she because it is easier and takes less typing than all the alternatives. I refer to generic patients as he on the few occasions when I’m speaking ‘in general’ instead of a specific person. I do this to make things easier for me. I am not seeking to offend others. I speak of patients as patients instead of the ‘politically correct,’ ‘client.’ I am being accurate. A client pays for their service and thus has some control over it. A patient has less control and this is one of the points of this whole book.

Among Mental Health nurses, there used to be a lot of men, but moving the training from hospital, where it was a paid job, to universities and technical institutes where you have to pay to train, has vastly reduced the numbers of men in nursing training. This is not good for the profession, especially in mental health. It takes away balance, role models, the male perspective and patient choices.

All case histories have had all identifying information changed in order to protect their confidentiality. The only information that is guaranteed to be correct is diagnosis and methods of treatment.

My rather severe criticism of the PDRP (Professional Development and Recognition Program), if challenged, can be backed up. I have my final one, all the marking, all the reasons for the fails and all the corrections. In addition, I have all the original peer review fails and the Politically Corrected additions. I can back up what I say.

Chapter One; Getting my first nursing job

I was newly arrived in Melbourne, Australia. I had temporary accommodation with friends; now I needed a job. I went to the employment bureau and looked at the advertisements. All in paper. It was 1977. No computers. I saw not a single Add for Psychiatric Nurse. Bother. I looked at several things I could probably do and finally joined the queue to enquire. The queue was via a person. No computer screens.

As I sat down, I handed over the list I had made of a few things I had noticed and the conversation began with something like this,

What experience do you have? What did you do last?

I’ve just qualified as a psychiatric nurse.

Have you got your Victorian registration?

Yes. (just).

Well why don’t you do that?

There are no jobs advertised.

They’re so short they don’t bother to advertise. How long do you want to work for?

Ideally, just a couple of months if that’s possible and then I want to go around Australia on holiday. Would anyone take me for a few weeks?

Definitely yes. Go to ***. They’ll take anything vertical.

That last sentence is exactly what he said. I couldn’t forget it. And he was right. He made me an appointment on the spot and told me exactly how to get there.

I went that day and they employed me on the spot. Two days later, I moved into the nurses’ home, which solved accommodation and transport problems, and then I started work. I worked for seven weeks and then went holidaying all around Australia, spending all the money I’d just earned. I had a lovely time. I had a job to go back to in New Zealand and this was a working holiday in between. But the joke was on me because I went back to that hospital twice more. I knew I would always get a job there.

A few days before this, in January 1977, I had entered the office of the Victoria Nursing Council to get my Nursing registration so I could maybe work as a nurse. That was Plan A. I had the exam result slip saying I had passed the course for Psychiatric Nurse. I had not yet graduated in New Zealand. I was due to do that in April. It was January. They registered me, on that little piece of paper. No police check, no references, no nothing. I registered in January in Australia, promptly got a nursing job and went to work with not a single day’s experience as a Staff Nurse. Not until April, three months later, did I register in New Zealand.

But it gets even better. Back at the hospital where I was working, I did explain re the ink just dried on my registration and that I had nil experience as a Staff Nurse. That was the job I had applied for. Staff Nurse. First rung on the ladder. But due to a miscommunication and possibly desperation on their behalf, they gave me a role as a Nursing Sister. Maybe they simply thought they heard what they most needed. That propelled me two steps up the rung. Needing usually several years in between steps.

I had my Nursing Sister’s uniform on and had started work that day, before they realised their error. One of the supervisors came over to check. By that time, I had worked several hours. They decided things could stay as they were because I clearly knew what I was doing and the Charge Nurse on the ward agreed I knew the role. Of course, it came with higher pay. I also now think that getting me to accept a lower position when I had already been employed, was signed up and had started work at a higher position, might have been legally incorrect. If so, I didn’t know that at the time. But they didn’t know I didn’t know, I’m assuming.

And I had a good tactic to make up for any knowledge shortfalls. I was familiar with most of this role because, unlike today, I had trained in a hospital. Student nursing in those ancient days was a learn-on-the-job, paid training. It meant I did know almost all the practical aspects of the Nursing Sister role because much of it was the same as a third-year student nurse. Better still, towards the end of the training, you worked as an ‘Acting Staff Nurse.’ I could be, and was, in charge of wards on the night shifts and on the evening shifts. In charge of the ward and including oversight of student nurses junior to me. The only areas I didn’t know, generally related to paperwork and I quickly solved that one. I set myself to learning who all the ex-New Zealand Charge Nurses were and which wards they were working on and there were a lot of them. So I would simply ring them up ask, How do you do this in Australia? They were very helpful. And in those days, there were written manuals and I checked them first. I managed just fine. There were no problems I couldn’t solve one way or another. It was in keeping with my working ethic anyway as I was always a hands-on worker; never a desk jockey. Everyone thought I was just looking up the difference between how this was done in Australia versus how it was done in New Zealand. Instead of between Student Nurse and Nursing Sister…

Chapter Two: What Was My Last Nursing Role in 2017?

My last nursing role, which I held from 2004 to 2017 was as a Community Psychiatric Nurse. I was called a Keyworker and I had a Caseload of people who were living in the community. I averaged 38-40 clients. A full case load is supposed to be around 25. It was my role to care for my clients. Unwritten, was that it was also my role to keep them out of the overcrowded hospital. I did everything from see them at my local Health Centres, to home visits, to seeing them elsewhere. To some, I would give injections of their medication. Some, I would visit periodically to help them cope with the ongoing problems associated with being mentally ill. So I was a problem solver, a resource finder and maker, a shoulder to cry on, someone to talk to, or whatever else was needed. Some of the best coping methods I know, I learnt from my patients and then pass them on. And use them myself.

As an example of my role in helping patients cope, one of my favourites, for those who are depressed or for some reason have very little energy, is set a timer for say twenty minutes, do something relaxing that you love like reading, puzzles, drawing or such. When the timer goes off, get up and do something either in the order that you can cope with it or in the order of priority. Do a task, part of a task, pick a room to tidy etc. Then go back to the relaxation task when the tiny bit of energy runs out. Set timer. Repeat. A depressed patient taught me this method. It works for the state you are in post Influenza and post Covid too. The state of exhaustion. You can be either physically or emotionally exhausted. It has the same effect of depletion of energy. This works for either or both.

In addition to my caseload, most of our staff took a turn at the Crisis role. I was often the first to see someone by responding to a Crisis Assessment. A crisis could be anything; an anxiety attack, a severe delusional state, homelessness, extreme poverty, a bad methamphetamine reaction, relationship issues, in trouble with Police, severe pain, Post Traumatic Stress Disorder, lack of coping skills, violence (as the victim or perpetrator), life style problems (gang problems, behavioural, drugs or alcohol issues), grief or loss, alone and lonely, abandoned, helpless/hopeless, suicidal, suffering from the consequences of poor insight or judgement and any and all combinations of the above. It was not then ‘just’ mental Illness which was the problem but often that illness, plus something else, that had overwhelmed their usual coping strategies.

I had to assess what the problem was and then find a way to deal with it. To do this, I needed to know the law, local resources, where to find help, how to navigate the Welfare System, how to find Specialists quickly etc. I needed to know what was available in my area and where, from free food to emergency accommodation. I had a lot of information in the back of my diary which I carried with me.

To give some examples of crisis calls, one day I did enjoy the look on the face of one of the Welfare staff as my patient explained to her some pretty drastic reasons for some of the trouble, he was in. At the start of all interviews, I would show my nursing ID. The Welfare staff would then realise that what they were about to hear was the truth. They would also know that I would have a rough idea of what my patient was entitled to and I was here to ensure they got the help they needed. That was generally a benefit for starters.

I had one patient who ran from an abusive relationship with no shoes and just the clothes she was wearing. So, no spare clothes, no possessions, no money, no ID, no driver’s licence, no income, no accommodation, emotional issues and she had suffered considerable emotional trauma. She had physical injuries as well, though minor. The usual reason for her admission to a psychiatric hospital was anxiety, Post Traumatic Stress Disorder, depression and inability to cope. She had all of that this time and she was in her early twenties, with a family who wasn’t interested in her. So lack of support. Women’s Refuge could cope with a lot but some, like her, were beyond their ability to cope with. As with the first problem, before a benefit could be started, was ID. Identity. Proving who you are. She knew someone who could identify her. Once we had that sorted, she could get a benefit and a clothing grant so she had a change of clothes or two. That’s what we were here for.

***

I once responded to a call from the Welfare office itself. They were very concerned for the safety of a man who was threatening to harm himself. It would have been an advantage had the Welfare checked his story. To assess his mental state and his risk was my role. I spoke to him, listened and heard what sounded like the truth inside the overlay of self-pity and manipulation. I suggested to the Welfare Officer that a quick phone call would be helpful. Reluctantly, they phoned the court house he named. He was telling the truth. He was indeed due in court tomorrow. He was in despair. Everything had gone wrong, he said. His girlfriend had kicked him out this morning and she owned the car. Problem. His court date in a city a few hours drive away from here, no money, nothing now except what he stood up in and no wheels. If he did not get to court on time, he would be arrested and have another charge added to however many he already had. That would get him more prison time. He was out on bail. He wanted a bus ticket to get himself to the correct city. He also complained he hadn’t had anything to eat. I gather the Welfare had suggested he might hitch a ride. I disagreed. He could pose a risk to others. There was a reason he was facing years in prison and it wasn’t for something minor. I thought hitch hiking, in his emotional state, was a very bad idea. Especially, it could be a risk for whichever kind hearted soul picked him up.

I encouraged the Welfare to pay the few dollars for a bus ticket. He would be homeless for the night but he said he could cope with that. The Welfare gave him a bus voucher, booked him on the bus and I helpfully drove him to the bus stop. On the way, we stopped at a diary. I didn’t have much cash in my pocket but it was enough to buy him some food. He was very grateful. As we drove, I asked what had happened. Something had gone very wrong in his life. He was articulate and clearly educated. He admitted he didn’t have to worry about accommodation from tomorrow on because he would be incarcerated. He told me he had no support.

Eventually, I got the reason out of him. Drugs. His family had wiped him. He had robbed them as well. He was facing years inside. I could see why he didn’t want any extras charges added on. This problem was straight situational. There were some extras he added which I didn’t believe. I suspected he had robbed his girlfriend, not the other way around. He was too calm, under the upset at his court date. He did not appear to me to be in withdrawal. He probably would be by tomorrow depending on what he was