HESTA award winner Veronique Murphy, an associate nurse unit manager at Alfred Health, was recently invited by Deakin University to be a guest speaker at the School of Nursing and Midwifery’s awards night. Below is an edited transcript of the speech Murphy gave about her journey from graduation to her current role and the work that led to her award win.
I guess the only way for me to start this speech is to say that I adore nursing and I hope that you all do already, or soon will, love it as much as I do. Because I don’t think nursing is the kind of job to bother with if you don’t love it. There’s far too many bodily fluids.
The theme for this year’s International Nurses Day, 'Nurses: a voice to lead health for all', is something I really believe in. Some of you, I imagine, are already working in the field, and some about to begin but I wanted to share why nursing is such an great job to have, and why we really are 'a voice to lead health for all'.
I came into nursing in a bit of a roundabout way.
After high school, I began university studying global development, the goal was to do international aid and community development work. During this time, I volunteered for some months in Nepal and there I met an American nurse who had spent many years bringing medical aid and knowledge to Nepal. She would visit the hospitals and fundraise for equipment they needed, share resources, and teach things like CPR and hand hygiene.
Through her, I realised that it was all well and good to be learning at university about international politics and history – but real work that created real change would be done with my hands, like a nurse, giving an immunisation, or dressing a wound, delivering antibiotics or nutritional support. I was sold on nursing.
So I came to Deakin University in Burwood to study at the School of Nursing and Midwifery, and got my graduate year at the Alfred. Just after my grad year, I finished off my original degree in global development and then did an internship in South Africa – it was a community health promotion and health research program. I’m now an ANUM on my ward at the Alfred, but I also work part time in a clinic, where we use principles based on a ketogenic diet in the management and reversal of a range of chronic health conditions.
I didn’t actually expect to like hospital-based nursing – and I really didn’t expect to like gen med.
But I did.
I think there's a few things that make nursing a super special job, (despite all the poo), and with a bit of effort, I really do agree that nurses are a 'voice to lead healthcare for all'.
During university and once we start working, I think nurses are very lucky to be part of a profession that places such an emphasis on continuous learning and professional development. I know that that’s something nurses older than us really fought for: the right for us to keep developing our skills in order to lead the way towards safer and higher quality care.
We also get to be part of a profession that places the utmost importance on evidence and evidence-based practice. I love the constant undercurrent of nurses all over the country working to ensure policies and procedures are updated to best match the available evidence. There’s a recognition that the rationale behind any action is just as important as the action – why was that the best way to do it? Is there any way we can do it better? I guess we all know from our exams that we can’t just get away with quick answer – we keep having to tell our professors the ‘why’ – but this is relatively new. For many years, nurses weren’t really able to speak up or question – just do.
Each day you work, you act as a leader, perhaps without even recognising it. You have to integrate a huge range of skills into one role – you’re a little bit physio, part teacher, a bit of a therapist, a bit of an engineer on the bed mechanics and IV pumps that suddenly stop working, a postie, a mum, as well as trying to swat away questions you were really hoping the doctor would answer.
Sometimes I think nursing should actually be retitled to ‘project manager’ – you are constantly coordinating discharges, or coordinating the doctor and the wound nurse and the clinical photographer and the occupational therapist to assess your patient together, your patient who also needs a shower and their IV medication and their breakfast and some pain relief… and if you could, their TV connected.
Nursing is a little bit of everything. Frustrating, yes, sometimes, but also exciting: no two days are the same and you’ll never stop learning.
And a nurse is privy to information about the human condition that few others ever get to hear or see. Have you ever noticed that if you tell people you are studying nursing, suddenly they share their stories with you – the good, the bad, and the ugly? They trust you. We are a profession that is trusted.
And this is why we are so well positioned to be a voice to lead healthcare for all. You know what’s going on, right there at the bedside. All of the emphasis on safety and quality improvement – the point is to make the care we provide at the bedside better. And exposed to the blatantly obvious and the secrets of healthcare, the nurse knows what better bedside care needs to look like.
Patient-centred care begins with the nurse. It’s very easy for a person to get lost in the chaos that is a hospital, seen as their illness, not as a person.
Especially close to my heart when I say this is the nurse’s key role in looking out for patients who can’t necessarily speak for themselves – in gen med especially, the majority of our patients have some form of dementia or cognitive impairment, probably with a delirium on top.
It was this that gave me the idea to make a patient preferences prompt sheet for the acute care environment, which contributed to the HESTA Award I received.
The aim of the tool was to facilitate improvements to patient centred care, especially for patient populations who rely heavily on nursing staff to help keep them safe and comfortable, whilst navigating their way through the unfamiliar acute care setting. I wanted to address specifically our interactions with patients experiencing delirium, dementia or any other communication barriers.
There is no shortage of evidence to say that patient-centred care improves outcomes.
But handover is a busy time and on my ward we felt like a lot of 'non-clinical' information was being lost during handover, in preference, of course, for clinical information like medications, vital signs and cognition. The tool simply gave us on the ward the opportunity to keep track of important non-clinical information, so that we could use it to preserve a sense of personhood for our patients.
The tool was simple: just a structure to keep track of the 'little things'. It has space for patient preferences around food, routine and family, as well as pertinent information about the patient’s past, present and future, and their likes and dislikes.
The information could then be used as a springboard to start a conversation, guide a person away from the brink of delirium, give ideas to find appropriate activities, promote nutritional intake or contact the right family member at the right time.
Like at 3am, when you’re able to encourage your patient back to bed because you know the name of the person who is looking after their dog.
Because by knowing the little things, you might prevent a code grey, relieve anxiety enough to encourage a person to eat, or be able to guide a patient back to their room, preventing a fall.
Here’s an example.
I had a patient who had trouble producing language due to a brain tumour. He knew he couldn’t speak properly and this visibly upset him when he was trying to speak with the nurses, but his anxiety only made the problem worse.
His visiting cousin showed me photos of the patient six months before – he had been a passionate and dedicated personal trainer. Encouraged by his cousin, I spoke about the gym with the patient, and the patient appeared wonderfully calmer, with an improved mood, and a significant reduction in his dysphasia. By chatting to him about the gym, he calmed down enough to eat dinner and have his medication, even when his family wasn’t around.
But a key part of the project was that the information wasn’t meant just for nurses.
As nurses, we sometimes get more opportunity to learn about the who behind the patient, being with them 24 hours a day. By having a place where all clinicians could learn and record more about the person behind the patient – a person who can’t always speak for themselves – each individual experience could be better based on the patient, not the illness, building higher quality care.
It wasn’t rocket science.
But that’s what quality improvement can look like. It doesn’t have to begin with a state-wide policy shift or program roll out. Every day, as a nurse, you have the opportunity to notice a gap or a weakness, initiate a practice change, and see if it makes a difference. With one patient and then with two. With one other nurse and then with two, and then with your manager.
Quality and safety begins at the bedside – a bedside change, a team dynamic change, a change in the way we manage and report risk… a policy change.
Nurses are a voice to lead health for all.
When I started at the Alfred – one of 100 graduate nurses sitting in an orientation hall – a hospital executive stood at the front of the room. I’ll tell you what he told us because it has always stuck with me.
He said that in spite of the fact that we were new and relatively inexperienced, what we brought were fresh eyes, fresh vision, and a unique perspective. He told us to speak out if we saw something that could be done differently, better, something that should be investigated further or stopped altogether. And soon, you’re all the next wave of exactly that.
To finish off, I wanted to tell a story that I wasn’t expecting to tell because this experience only happened to me about two weeks ago. But it so perfectly represents the pivotal role of the nurse in healthcare that I’d like to share it.
I was in Peru just a couple of weeks ago, travelling alone, when suddenly I partially lost my vision. Everything was blurry. I couldn’t make out faces, signs, symbols. I wouldn’t have been able to see any of you. I wouldn’t have been able to read this speech.
Needless to say I was a tad anxious.
The doctor didn’t speak any English, but the nurse did. She translated for me. The doctor didn’t know what the problem was and so began days of specialists and CT scans in multiple clinics across the city.
Right at the start, the nurse realised I wasn’t going to be able to do this alone. She took charge, making my appointments for me, and even accompanying me to my scans because – well, I couldn’t see, or speak the language. She kept records for my insurance claim and took my mobile number, sending me messages to check in on me between appointments.
By one doctor, I got told I needed quite urgent eye surgery. By another, some eye drops and some anti-inflammatories. I was ready to go home and not about to jump into eye surgery in Peru. Luckily, after about five days of being basically blind, my vision began to improve.
The point is... the nurse.
Travelling alone in a foreign country, blurred vision, barely any Spanish. My night vision was even worse. I could hardly work out what food I was eating… there was a lot of canned tuna that week. I had two doctors giving me completely different diagnoses and they weren’t communicating with one another.
But the nurse was there, helping me every step of the way.
A delirium or dementia, or even simply not speaking English in any hospital – I thought I was scared, I can’t imagine how our patients feel every single day. Most of the time, our patients don’t know where they are, they can’t communicate easily with us, have poor eye sight, poor hearing, they’re fighting an infection and their family (if they have any) aren’t always around.
They’ve got doctors and other clinicians rushing in and out, and I think it’s safe to say many of our patients have been given conflicting information by different practitioners. Don’t eat anything, you’re on the afternoon list. Actually, we won’t operate – have these antibiotics. Don’t wander around too much, you might fall but make sure you get as much exercise as possible.
You’re the nurse and the nurse can hold it all together for the patient. You can speak up for them, when they can’t for themselves. You can make sure their family is updated, you can find out what they like for breakfast to make sure they eat. You can sit down with them and go through the plan for the day, encourage them out of bed for the morning, remind them that their granddaughter is coming to see them that afternoon. You can translate this crazy, rushed, busy world of healthcare into something a little calmer, something that is based on them, and their journey, not the ‘machine’ that is a huge acute care hospital, bright lights and buzzers in every direction.
I’m not saying you won’t be busy or that it is an easy job. I’m just saying that the great thing about nursing is that if your patient needs it, you really can be their advocate.
And because you’re working in a way that sees the person, not just the patient, you really can identify processes that aren’t working and initiate a project to make it better. And when your project is successful, you really can take it up the ladder to initiate hospital and even state wide improvements. Because as a nurse, you really are a voice to lead health for all.Do you have an idea for a story?
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