Practice nurses are undervalued, underpaid and under-recognised for the extraordinary work they do.
One of my first jobs as a wet-behind-the-ears baby doctor was (of all places) the Flying Doctor Service in Broken Hill.
I remember arriving at the tiny airport to see an RFDS plane circling, surrounded by emergency vehicles. The radio was on speaker, and I could hear the remarkably calm voice of the pilot explaining that the landing gear might be faulty.
Over time, I learned to recognise that remarkably calm voice, and cultivate my own.
At the time, I didnât know just how deeply experienced these pilots are. When you have to land a plane in the dark on a road lit by flares â and itâs windy and everything is urgent â and there may just be a mob of kangaroos who decide an airstrip is a perfect place to graze, you need every bit of expertise you can get.
Which is why there are such extraordinarily awesome nurses in outback Australia.
From day one, I introduced myself with the byline: âI went to Sydney University, which means I know a lot of useless trivia, but nothing practical. I want to help, but Iâll need some training. What can I do?â
Bless those nurses, they helped me big-time.
I learned how to do a decent plaster, and clean up after myself, which meant I learned to do a decent NEAT plaster. I learned how to inject squirming babies, and nervous kids, and even the occasional animal. I learned why you need kaleidoscopes, and stickers, and bubbles to manage sick kids who are needle-phobic. I learned about black humour, and practical jokes to relieve the stress. I even learned how to rock a fascinator at a Melbourne Cup fundraiser for the RFDS at the local pub.
Those nurses taught me how to calm people down, and stir people up.
I learned that a regular visit every fortnight to âsee how youâre goingâ often prevented an emergency visit every three weeks.
They taught me how to recognise worms in undernourished kids, domestic violence, dementia and sexual assault. They understood disprivilege, and helped me manage disgust.
Like most young health professionals, I wasnât proud of finding it difficult to tolerate the smell of homeless patients, or vomit, or (weirdly) ear wax, but they never made me feel ashamed, and I learned to cope.
They werenât backward in telling me when Iâd been an idiot. Which, as a young doctor, happened more times than I cared to admit. I took the feedback and learned. Doggedly. They tolerated my ignorance and helped me grow.
Over my career, my professional and personal life has been enriched by the skills of nurses.
In rural practice, there are few safe places to debrief. Confidentiality is hard in a small town, so you cultivate a small group of people where it is safe to talk openly.
When a senior colleague died of a heart attack, and I was still junior and couldnât bring him back, it was the nurses who reassured me that Iâd done all I could and cried with me over his loss.
They taught me how to respectfully disagree and I learned to truly collaborate.
Together we wheeled an old man out on the verandah so he could die looking up at the stars, and found a beautiful shawl to wrap up a baby with anencephaly so the parents could say goodbye.
Fast forward and over the years, Iâve learned the superpowers of practice nurses.
People who know me realise that processes are not my âthingâ. Give me a protocol, a manual, a complex guideline, and my eyes glaze over. I can obviously do it when I need to, but I am much better at crystallising a diagnosis out of complete chaos than reliably following a list.
Nurses, however, are awesome at running multiple protocols simultaneously.
Immunisations, particularly for travel, are unbelievably complex, but Iâve had practice nurses that make it look like a walk in the park, including keeping the fridge reliably at temperature, auditing our processes and documenting everything in my nemesis, the Australian Immunisation Registry.
I live in Canberra, which means we have diplomats who have travelled the world, having weird immunisations according to different national schedules, documented in a variety of documents in languages other than English. For me, this is the stuff of nightmares.
However, the times I most remember are the crises. Including covid. Good practice nurses can herd cats, keeping calm with instructions flying at them from all directions, while keeping the practice stock inventory, and following whatever infection control protocol we are following this week. Importantly, they stand behind our young reception staff and protect them from abuse, and then debrief them.
Practice nurses take the meandering phone calls from the patients with early dementia and make some sort of sense of them. They notice the patient in the waiting room who is about to throw up, collapse or fit. Their skills in wound care are critical, and there are many, many times weâve sat together over an ulcer in a 90-year-old, debating a course of action, and then Iâve asked them to have âa bit of a chatâ, because the old lady looks a bit unkempt and uncared for. Sometimes, nurses can check if they are managing on their own at home, where patients will hold it together for the doctor.
Weâve strategised how to manage the breaking of bad news, so there is time and space for the patient and family to get over the shock.
We are partners.
It makes me angry when I hear GPs characterised as loners with no desire or capacity to collaborate. There are people in this world who would fight with their own shadow, of course, and plenty of arrogant folk who think they are superior to everyone. But most GPs I know are collaborating every day with a variety of specialists, allied health practitioners, social services, carers, consumers and of course, the people in their own teams.
Practice nurses face the same discriminatory attitudes we do.
I noticed recently that the NDSS, which prohibits GPs signing a form to get a rebate for a patientâs insulin pump equipment, allows nurses to sign â unless they work in a GP setting. Perhaps the relevant department thinks our inferior skills rub off on the nurses who work with us. Primary care is not primary school.
In my view, practice nurses are undervalued, underpaid and under-recognised for the extraordinary work they do. Most practice nurses I have had the privilege to work with are awesome.
Personally, though, what I remember most are the practice nurses who have turned up with a cup of tea and asked me if Iâm okay. Sometimes Iâm not. Sometimes, sitting with trauma after trauma after trauma when there are worrying things going on in the background in my own life is hard. I hope I do the same for them, because they deserve it.
And next time I hear how awesome a nurse is who inserts an endoscope, does a fancy cardiovascular procedure or manages a hospital, I will say that the swamp comrades Iâve worked with are doing more complex work with little recognition and extraordinary skill. We couldnât do what we do without them.
Associate Professor Louise Stone is a working GP who researches the social foundations of medicine in the ANU Medical School. She tweets @GPswampwarrior.
