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My journey, my patient’s journey

emotional-intelligenceHere’s another blog by West Coast mental health nurse Teniah Howell. This blog is cross-posted with permission  from the Nurses Station blog “The Tea Room”. You can read Teniah’s previous post here.

The topic of emotional intelligence has come up multiple times in my journey through nursing school and into the “real world” of nursing. When the topic was first mentioned to me, I had never heard of such a thing before, and really never considered the need to become competent in this area.

Emotional intelligence, essentially, is the ability to recognise your own feelings, emotions, and responses, as well as those of others. Now, we recognise these emotions in different ways – some people journal, some people simply contemplate, and others discuss with trusted mentors/supervision/work place support etc. The importance in understanding where we are at in our own lives allows us to more easily interpret the emotions and responses of the patients we work alongside. It is easier to help our patients find strategies for coping that work for them, if we have first acknowledged and recognised our own strengths and abilities to cope. Nurses cannot relate to patients and help them if they are themselves in an emotionally unstable place.

One thing that I have noticed in my own practice, is that in order to truly develop a therapeutic relationship with a patient, I must be able to differentiate between my own thoughts/emotions and the situation. I have to be able to know what I think and believe about myself and yet not push my own thoughts and beliefs onto my patient. I have to be able to recognise that my patient’s strengths and ways of coping will be different than my own. In my experience this ties into the idea that we all possess a “shared humanness”. While we share a lot of the same emotions, experiences, desires etc.; each one of us is unique and individual. While we all have different strengths and ways of coping with the challenges of life, we all still share the experience of being human. Therefore, we can offer each other grace, knowing that we are in many ways the same.

A patient’s journey can be made easier by having a nurse who will walk alongside them, who understands that human experience; a nurse who has her/himself faced challenges and experienced a range of emotions; a nurse who can relate to them, and also recognise their uniqueness. It takes an emotionally intelligent, competent nurse to do this. It takes someone who has explored their own thoughts and beliefs; someone who is not only able to recognise their own strengths, but can also recognise the individual strength of their patient.


Katrina Coleman – Young nurse of the year

DSC_0005The NZNO Young Nurse of the Year for 2014 is Katrina Coleman, 27, a Plunket nurse in Newtown, Wellington. She works with a large number of new migrant families, and helping improve their health outcomes is just as likely to see her advocating to move them to better housing, as assessing children’s growth and development. The communities have changed since Plunket began over a century ago, but Katrina’s work today in building trust with families, and connecting them with the people and services they and their children need to thrive has a lot in common with those first Plunket nurses. It draws on every bit of her nursing experience across mental health, hospital and public health.

Katrina has won the NZNO young nurse of the year award, but it’s clear the real winners are the new migrant families she works with in Newtown. She learned early on to adapt her schedule to their needs: “I do four to five home visits in the morning, and then four to five in the afternoon, and I remind everyone that I’m coming that morning. Often the people I’m seeing, their lives are so incredibly complex that even if I tell them the day before, they may forget.”

She acknowledges the high number of home visits is unusual for many communities: “It is a high amount of home visiting in Newtown – but it’s definitely the way to maintain engagement. If you imagine being a Somali mum with seven kids under 7, arranging transport to get to a Plunket clinic is just not able to be a high priority, because how could it be? It’s about making the service accessible and comfortable – arranging visits at their home, at a time they choose.”

Newtown is the most diverse community in Wellington, and one of New Zealand’s new migrant centres. Along with Somali families, Katrina works with families from Ethiopia, India, China, the Middle East – some New Zealand/European, and very few Maori and Pacific Islanders. For many, Katrina is often their only link: “We’ve seen women at the most vulnerable time of their life when they’re scared and sometimes they don’t have any real option but to trust you, because they don’t have anyone else.” You only have to imagine for a moment that you’re a newly arrived mum in Newtown, you don’t speak English, you can’t read or write, and you have no local connections, to get a small insight into the difficulties her clients face – and the significance of Katrina’s role.

Her work brings her into the homes of families living in appalling conditions, and a large part of her day is spent working with other agencies to get families’ basic needs met: “I remember sitting with a family last year who had been placed in a horrendous house, they had six kids under six. I was sat on the couch, and the mother said to me – ‘can you help me, there are rats living in my couch’ – the couch I was sitting on. You can imagine, I jumped pretty quickly. The situations people are living in, the poverty is appalling and often, these are people who don’t have a voice.”

She says some of the mums are illiterate: “They will ask me to fill in these forms for everything, not only for health services. It’s not in the role, but at the end of the day that’s why my relationship is strong – it’s about leaving my objectives of the visit at the door and doing what they need me to do, whether it’s filling in a form or looking for lice in people’s hair. It’s not always glamorous. It means having hard conversations with providers of social housing, but I refuse to back down when I’m advocating for a family.”

It goes beyond the Well Child schedule, but she does it because it’s a determining factor to a child being sick or well: “I can truly say there are families I visit now who would be sick every time I saw them, they’re now in insulated homes, they’ve access to kindy – and their overall health outcomes are improved.”

And it’s how she builds her relationship with a family – and the community. “I always knew when I started the role that it wasn’t just about building the relationship with families but with the broader community. In some cases, I’m the only NZ European person they know, or the only person who can link them in to the system.”

Which means maintaining boundaries can be a problem: “They say – can you stay and look after the kids I need to take this one to the doctors. Or can you drive my parent to the hospital. And I have to say no, and you can see this realisation – that we’re not friends, I’m doing a job. It’s an honour that people trust me with their parents and sick children, but it’s important I maintain those boundaries.”

Along with connecting families with services, she works to connect families with the people who have the resources and help they need. Not least, this means drawing on the Newtown Plunket committee of volunteers:  “We came up with the idea of Christmas parcels  – sunblock, beach towels, food and gifts. But the winter ones are the best, they have slippers, warm clothes, blankets and nutritious winter food – brand new and donated stuff. Newtown is an amazing place – we got $1000 of toys from the City Mission last year – just incredible generosity.”

And with the help of Plunket volunteers, she launched the Link database at the beginning of the year – a way for women of the same culture to be linked with each other. The idea started when one of her clients, a mum with two children under two, had come out of violent relationship but had no social support, spoke little English, and couldn’t leave the house as she had agoraphobia: “It was tragic – she was in an awful place. I knew another Chinese mum who was unhappy in her marriage, she was brought here soon after getting married, and she was living in huge apartment building, she knew no one, she had no transport. I wondered if it would be beneficial to link these two mums together. So I got consent, and over the next 6 months I saw the most incredible transformation in these women’s lives – the mum with agoraphobia was able to get out of the house. The other mum had a purpose to leave the house, and every time I see these families now you can see the change in these women, in how happy they are with their children and how connected they are in the community. I thought – this is totally the most amazing thing I’ve ever achieved.”

She says that sometimes it doesn’t work out because of social hierarchy, but the link database is now offered to all Wellington mums, and run by a Plunket volunteer.

Katrina is celebrating her 3-year anniversary as a Plunket nurse in Newtown this month and describes the community support system she’s helped set up as a ‘finely oiled machine’ – though is quick to acknowledge others: “I can’t take credit for the generosity of the people of Newtown. For example, the other day The Warehouse gave me 27 brand new winter jackets. They wanted to help – it’s amazing how many people will say yes when you ask. And five years before I stared, Jess, the Plunket nurse here laid a huge foundation – she built a lot of that trust building in the community – I picked up on her vision and her dream for Newtown. It’s a great place.”

“I came from public health nursing from Waikato – it’s so isolated there, getting to hospital appointments is a nightmare. Here we’re right in the thick of it. If you’ve got a hospital appointment – you can walk there.”

Her enthusiasm isn’t worn by the challenges – instead, it’s clear she loves the job, and thrives on helping the people she works with: “There’s a huge aspect of social work involved in it. Possibly some of the nurses before me would have said ‘this isn’t my job’. I truly believe I have a working relationship with the migrant families – I decided I was going to be “that” person. It’s about triaging the need, meeting their needs one by one.”

She acknowledges it’s an intense role, and has worked out tactics for conserving her energy – like not looking too far ahead: “I never look at what my next day is going to look like until I get there because of how big they’ll be – I don’t want to start the day feeling exhausted by the day’s work I’m about to do.”

But while she takes each day at a time, when she decided to work for Plunket, she took the long view: “I always saw the role with Plunket as a long-term commitment – it’s not like working with the hospital when you have short-term, intense relationships of trust. It takes years to become trusted with in the community and when you take on a role with Plunket, you’re aware that you’re going to invest the time with the community as well as the families.”

“I always wanted to be a Plunket nurse – I was sitting in class and remember the Plunket nurse coming in working with well children in the community – I wanted to gain as much experience as I could and I’d recommend that to all new nurses. I worked in mental health and did my first post grad certificate in mental health – it’s priceless in this role, dealing with mums who are struggling with their mental health and have been through so much.”

As for the future, she’s a year away from completing her masters in nursing: “I don’t know where I’ll go next, but I can’t imagine not being in Newtown.  I’m from Hutt Valley originally and I’ve lived on the coast for seven or eight years –I think it helps being so far away. It would be hard to do this job while living in Newtown.”

And news of the award itself still hasn’t sunk in: “I think everyone’s blown away – it’s such an honour. My friends and family are my number one support. They always think you’re the best of the best anyway, but it’s hugely pride evoking.   The award is nice because it makes missing out on family functions and catching up with friends only occasionally all for something.”

The photo shows Plunket nurse Katrina Coleman with Rebecca Brown and her 12 week old daughter, Juniper Johnson. Thanks to Rebecca for allowing us to use this wonderful photo.



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What do you want for your life?

2014.09.08_NZNO_LaunchBlogPost_imageNowadays, more and more New Zealand workers are seeking work / life balance.  Kai Tiaki previously reported the findings of research conducted by the New Zealand Department of Labour which indicated that 40 percent of respondents had experienced difficulties achieving an acceptable level of work / life balance.  Significantly, it found that nurses were amongst the workers experiencing the most difficulty in getting the balance right.

With this in mind, NZNO recently teamed up with Member Advantage to review its member benefits program.  In addition to the NZNO negotiated benefits you’ve already enjoyed, Member Advantage brings you a host of great benefits designed to make your life a little easier and a lot more enjoyable including:

  • Great discounts on hotels worldwide
  • Attractive corporate rates on car rental
  • Competitive foreign exchange rates across 47 currencies and fee-free transfers
  • Savings on over 4,500 experiences and gifts

Click here and log in using your NZNO membership number to discover the benefits available to you.


Building confident nurses

bigstock-D-Knob-Confidence-Level-46141444-583x437Teniah Howell is a newly graduated nurse, NZNO member and advocate for young nurses. She currently works as a mental health nurse on the West Coast having spent the previous 18 months in the medical surgical unit at Grey Hospital. This blog is cross-posted from the Nurses Station blog “The Tea Room”

I have had many recent conversations with young nurses from my graduating class, as well as the new graduates who joined our nursing team in January, about the process of building confidence in nursing practice.

It would seem that for many, confidence is something that progressively builds over time. As our skills, knowledge, and experiences increase, we become more certain that the decisions we make are indeed the right ones. We learn to adapt more quickly, and to trust our instincts. For me personally as a new grad, I found that it took several months to really feel that I could trust my instincts and my decisions and stand strong in advocating for my patient’s care and for the decisions that I believed were the right interventions for my patient. I would say that there was probably a significant jump in my confidence at about five months into my nursing career. I felt at that point that I had learned to trust myself a bit more, and had gained valuable skills and experiences along the way.

At our DHB, the new graduates do a department switch at six months. This meant getting “knocked back” a bit with my confidence as I was then in a completely new environment and relying on skills and judgment that I had not yet developed. I found, however, that this time around my confidence grew faster and within a few months I felt much more capable. In talking to others it would seem this is a common theme.

I have found that confidence is something that grows (almost in a step-ladder type of fashion). It builds on the experiences and skills that you gain as you continue your nursing career. I say this to really encourage those young nurses out there who are starting out and are only just beginning to realise your potential within the nursing team. Remember that it is a process. It will come with time. Offer yourself the grace to recognise that it will take time to build the trust in yourself, and for the team in which you work to trust your judgment as well.

It has also been my experience that the team you work with can either build or break down your confidence depending on how they respond to your nursing practice and your suggestions for patient interventions and care. Working with a nurse who is demoralising and cuts you down every moment of the day can really make you feel small and insignificant. It can be extremely hard to build your confidence in this circumstance. On the contrary, when someone encourages you and says that you have made the right decision, it can do wonders for building your confidence and your trust in your own decision making. I would like to challenge you to be type of nurse that lifts others up. Be the one who helps to build other’s confidence by offering words of encouragement to your colleagues. (Especially the young nurses and student nurses whom you might be working alongside).

I am moving into a new role next week, and will once again be starting off in an area where my experience is limited. As I embark on this new journey, I am aware that at first my confidence may “take a hit”, but through my past experience I know that it will quickly build back up again. I am encouraged by this, and do hope that I will be lucky enough to be supported along the way by my colleagues. We can only hope that if we give good out, we will have good returned to us.

As Mahatma Gandhi said, “Be the change you wish to see in the world.”

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Valuing our vote

NZNO organiser Georgia Choveaux met New Zealand’s oldest woman and retired Karitane Nurse Peg Griffin at Kapiti Rest Home on the day residents voted in the 2014 General Election.

IMG_1219“Last week I was lucky enough to celebrate voting with New Zealand’s oldest person, 110 year old Peg Griffin. I arrived at the rest home with chocolate cake and balloons and left with a much deeper appreciation of the value of my vote.

Peg and her fellow residents have shaped our communities and our country in part because of their vote at each election. The New Zealand we live in today was decided by how people voted yesterday, and Peg knows it.

IMG_1186That is why, when the polling booth came to their rest home, they are queued up – to again decide what they would like to see happen for our communities and our country. They value their vote.

93 year old Kathleen, (another retired nurse) explained to me why she always voted. She grew up in tough times in mining communities on the West Coast. So she always casts her vote to help people.  She has always voted for increased support for those in need, she has witnessed too much hardship over the decades.

IMG_119898 year old Aida explains that she has always voted and knows it’s a privilege. She doesn’t miss voting because she doesn’t want to miss having her say on how things should be. And don’t get her started on those that grizzle but don’t vote!

Another gentleman told me about when his paper-run was all his family had to survive on. It was during the Waterfront Lockout, and legislation had been passed to make it illegal for anyone to help the locked out workers during the bitter dispute.

IMG_1227So every election he marches to the polling booth and hell would have to freeze over before he didn’t vote.
So after Peg voted, for the same party which has had her support across two centuries and two world wars, she cuts the cake to celebrate the value of our vote.

Each of us have a valuable vote, so let’s join Peg, Kathleen, Aida and others in celebrating that – by using it this election. Let’s continue to shape our communities and our country.

IMG_1191Let’s be voters!




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Facing virtual reality

Social media buttonsNZNO is running a series of professional medico-legal forums around the country in October to help NZNO members deal with new virtual realities in their practice.

The digital world is becoming more and more a part of our everyday lives and being able to navigate the implications on our practice and careers is essential.

We’re seeing an increase in issues associated with social media, unauthorised electronic records access and technology use such as mobile phones for clinical communications. And there’s also the issue of patients and visitors using digital media, for example recording nursing staff and midwives, often without their knowledge or consent.

So these forums are designed to raise awareness of the professional issues and explore strategies to manage the risks and opportunities the digital world brings.

It is aimed at nurses and midwives, but anyone working in health care can attend.

Medico-legal forums are a great opportunity for members of the health team to have focussed education about topics that are current issue in their practice. They’re also a chance to network with others and discuss and reflect on issues that affect everyday practice.

The forum sessions are presented by NZNO professional nursing and legal advisers and cost $140 for NZNO members and $175 for others. It is 8 hours of professional development and a certificate for your portfolio will be provided. You may be able to access your PDRP entitlement to attend the forum.

Facing virtual reality forums will be held in Auckland, Tauranga, Palmerston North, Nelson and Dunedin. For more information on a location near you and to register check out Places are limited so get in quickly!



NZ women – voters since 1893

Nurses  – awesome since forever

Black and White Training PhotoYesterday one of our NZNO organisers, Georgia Choveaux visited an inspirational 92 year old retired nurse about voting in her 25th general election.

Cog, as she prefers to be known, is as committed to voting now as she was in her very first election in 1943. She trained to become a nurse during the second world war because she wanted to do her bit and had always liked helping people. She still remembers her salary – 3 pound five and six a month and she says with pride, “Nurses were worth every one of those pennies!”.

At 92 Cog is still voting because she wants to see  changes in the system – and to retain her right to complain. She is very certain you can’t complain if you don’t vote. She explains it is a lot easier for young ones these days to know which way to vote for what is important to them. Back when she became a voter  there was no television so you had to really try hard to keep up.

Cog has kept up with what is going on in the lead up to the 2014 General Election and has worked out who has earned her votes this election. She has changed who she votes for over the years – and given others a try – some times for better or worse in her opinion. Yet, she would never consider not voting. It is too important for her as someone who has always liked helping people.

So, hats off to the many generations of nurses, carers, patient advocates, health champions, kaimahi hauora and professionals for looking after the health of Aotearoa by being voters. Where would we be without you?


The cost of a break

(or: how the nursing team is propping up DHB budgets)

One hundred millionAs I’m sure each one of you knows, we are coming up to a General Election, and while there are many issues to consider as we head for the polling booth (both policy-wise and ‘other’), for most NZNO members, the health system will be on our minds.

DHBs are underfunded and being forced to cut every budget line to the bone. We know this affects the nursing team – in your day to work and in other ways too.

What we don’t often think about is how the way we work financially benefits our employers. Here’s what I mean:

Carol works in a unit that is chronically understaffed, where there’s no cover for sick leave and annual leave and, because the DHB is “making savings”, overtime must be signed off by the CEO in advance.

What that means for the nursing team is that Carol and her colleagues work at least half to an hour of overtime every day without claiming. If they get a morning tea break, they’re lucky, if they get an afternoon tea break it’s like Christmas has come early, and as for lunch breaks, well that’s another story.

Carol knows the DHB MECA clause 7.1 says you are able to have meal break of a minimum of half an hour within the first five hours of work (except in urgent and emergency work). The MECA clause 7.3 says if you are not able to take a meal break after 5 hours you are to be paid at time and a half until you get that meal break.

The reality is that lunch breaks are almost seen as luxury, even though every nurse knows the quality of our practice is improved with getting good breaks.

So, let’s add it up. At a very conservative estimate let’s say that Carol “gifts” her employer one 30 minute lunch break every week.

For an RN or midwife on step 3 of the pay scale that’s $2044 every year. Enough for a decent holiday!

But let’s take those numbers a bit further. With around 50,000 members of the nursing team working in DHBs around the country, and using that very conservative estimate of $2044 per year – that’s over $100 million we’re not claiming!

And that means we are propping up DHBs finances to the tune of $100 million plus every year!

There are a couple of issues here.

Firstly, you are entitled to take breaks, breaks help ensure the quality of your work and you should never feel obliged to just keep on trucking. If you keep on keeping on, you can be sure that your employer will be happy to keep on not paying out staff entitlements. NZNO says to each and every one of you:
“Please claim your entitlements! We have worked hard over the years to negotiate fair collective employment agreements that include breaks and entitlements. If you do not claim you are undermining your collective agreement, and that’s the start of a slippery slope!”

And secondly, why is the government underfunding the DHBs to the extent that DHBs must now rely on the goodwill of the nursing team to try and balance their books?

Both those issues are worth taking into consideration as we head to the polling booth in the next couple of weeks. And they are both issues that you can take collective action about, at work and in your community.