Why Western NSW

I'm Isabella Dark and I'm a Registered Nurse at Gilgandra MPS.

I am a new graduate Registered Nurse, I finished uni last year. So I did 6 months at Dubbo Base Hospital and 6 months out here at Gilgandra, so that's a supported program that we do for our first year out of uni, just so we can get our competencies marked off and learn the skills in a safer environment.

I moved from Wollongong at the beginning of the year to Dubbo. I've really enjoyed being out in the country, it's quite relaxed, everyone's really nice, I've made lots of friends, no traffic - that's good. Yeah, just really love how relaxed it is, how easy going and just really loving that change from the city and the busyness of that.

[Music]

I grew up out this way so I've seen changes not just what we're about to see in intensive care at Dubbo into the new unit, I was here as a junior doctor when in the previous unit and the previous emergency department and I also grew up out here as a boy, so I've seen Dubbo grow from the signs into town of about 28 000 population to what I think is probably in excess of 50,000 population now in the surrounding areas so I have have some family growing up experience here

I came here as a junior doctor to work almost exactly 25 years ago and in more recent years I had the opportunity to come back on a regular basis to to work in the intensive care unit again here at Dubbo at this time as a specialist.  It's rewarding in the sense that the hospital itself is big enough that you see everything that you need to see in terms of career satisfaction and or case mix, but hospital's small enough that you know everybody else in the hospital so what that means in terms of dealing with your medical, surgical, anaesthetic, emergency, physician, obstetric colleagues is that you know all of these people quite well and with that relationship it makes it a lot easier in dealing with patients.

People tend to be very supportive of each other and and there's a clear focus on making sure that when we're in trouble with someone who's unwell that people work very well together to try and deal with that. So that's just the medical staff I think you also in a place this size tends to know the nursing staff around the place and the allied health staff around the place the clerical staff around the place. Everybody tends to get to know each other and that makes it a very warm and friendly place to work, but particularly from a primary medical work point of view the collegiality is really special in a place of this size.

The other things that make a satisfy for me as a specialist that certainly compared to when i was a junior doctor here 25 years ago the middle grade of residence and registrars and and that includes training registrars has grown enormously so that's very helpful as a specialist in terms of having those people to help you with the work but it's incredibly rewarding for me as a specialist because they are keen and enthusiastic they they like to be taught. The education programs that are in place for them and the ability to teach  and learn both me to them and and also from them to me is great.  So they they rotate through some of the Sydney hospitals but there's also a good bunch of locally and local people who work here so so the middle grade registrar residence staff are great.

The other thing I'd say about the registrars is that because a number of them rotate from hospitals like Prince Alfred, it also gives us a professional link, with hospitals like Prince Alfred so I not only enjoy collegiality here I enjoy a working relationship with a number of specialists in the trainees at the larger hospitals for example Prince Alfred in Sydney and that's very that can be very helpful at times,  you don't feel - at least I don't feel here in any way that I'm isolated from from collegial support and certainly compared to 25 years ago when I worked here the the advent of things like telehealth video links just even simple things like mobile phone technology has made us essentially all virtually next door so the opportunity to tap into the resources at bigger hospitals when you need to do that that's really straightforward.

They also tend to be very supportive of you in a rural area which is which is fantastic.

[Music]

[Music] The rural generalist nurse education program was developed through some identified gaps that were found in the onboarding process and then transitioning nurses from new staff all the way through to advanced clinicians.

In collaboration with the organisational development unit from the workforce and culture directorate, the quality clinical safety and nursing directorate and the virtual rural generalist service -  11 key areas were identified to be addressed through this program.

The resources were developed in collaboration with the rural generalist nurse education team, virtual doctors and other clinical experts within the district. 

Initially the resources developed included a workbook and powerpoint presentations that were delivered locally at facilities.

Through evaluation and feedback we were able to evolve the program to now include e-learning workbooks in my health learning, videos of the assessments taking place and quick reference guides available on the intranet.

As part of this process we developed qr codes for staff to easily access the information 24 hours a day. Staff can easily scan the qr codes and be taken to the rural generalist nurse education pages on the district's intranet.

Those intranet pages contain all the modules and information that is taught in the program. 

An example of this would be using the qr code to access the RGnet pages on plastering and there they have a number of videos showing a number of different plaster of paris backslabs that are relevant, appropriate and safe for the rural generalist nurse to apply. 

Additionally, they can access all the assessment videos in one location -  they scan the appropriate qr code and this takes them to an external youtube channel that is private for the district where they can see all these assessment videos in one go.

As part of the program evolution we now have virtual education available for staff by moving the resources online. We have freed up time from the clinical nurse educators to be able to provide support and coaching in real time, and this is done at the bedside.

The rural generalist nurse education program has been really beneficial to me as a new grad it has really helped broaden my scope and practice my assessment skills.

I think I'll be able to better communicate with everybody in the team and use the skills that I've learned through bedside coaching and through the program to be able to communicate with the doctors about my findings through the assessment and using the handover tool, so can confidently and effectively communicate information.

If you have the opportunity to get into the program, take everything that is been provided, because it for me i found it really beneficial to be able to develop new skills and also use these in everyday nursing practices and has provided me lots of opportunity to grow and develop.

This program has been a great example of the collaboration that can be achieved across groups within the district it has allowed us to develop a program that has set a foundation for new staff into our rural and remote facilities and start them on their journey to become a rural generalist nurse

[Brett Chambers]

We've got a problem which happens right around Australia and actually across the world where we've got people spread out over very large geographical area and it's not cost effective or feasible to have a pharmacist at each of our health services in our district. So what we've done is we're using virtual Healthcare so things like video conferencing to take pharmacists to the patients at the bedside and we're able to help patients and doctors and nursing staff to safely use medications at their Hospital.

I remember a case where I saw a patient at one of our small rural hospitals and he'd come in becoming increasingly unwell unable to keep food down and it turns out it was actually caused by one of his medications. And you know the doctor called me and said I think this is related to medications, I'm not really sure. When through interviewing the patient and going through his story and looking at his laboratory results it was clear to me that it was caused by a medication and were able to quickly fix that, reduce the dose right down and and get him out of Hospital.

[Sonia Bonham - Gilgandra Hospital, Regional Nurse Education Western NSW LHD]

The modules, uh it's a framework so if someone entered into our facility and was starting the ARGN program, they would enrol online through My Health Learning and get access to a workbook and some learning modules and some videos and when they were happy that they understood the content then an educator like myself or a CNE would come out to the sites and we'd work one-on-one and just go through their understanding of that and do a verification to make sure that they're at a standard a level of adept, that then provided them with these skills to be able to work autonomously in our facilities, but part of a team.

[Isabella Dark - Registered Nurse, Gilgandra Hospital]

It's an amazing change. I didn't think that I would like it at the beginning but moved out here and within a month I knew that I wanted to stay and not go home, so just branch out and have a go. It's easy to make friends, get involved in the community. It's great, everyone's welcoming, it's a great change so if you're considering it, do it.

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[Music]

So here we are in the new Western Cancer Center Dubbo We're standing in the radiation therapy suites and we're looking at opening this in the next few weeks

[Radiation Therapy Suite]

Additionally next door to the radiation bunker will be a new pet scanner looking at opening in the next few months and upstairs a 16 bed chemotherapy unit which is doubling the size of the chemotherapy services in Dubbo.

[Wellness Centre]

Next door to the chemotherapy suite will be a wellness centre which will provide allied health and other non-medicalservices which people living with cancer and their families will need from across the whole the west of new south wales.

Within the new cancer center there'll also be a clinical trials unit which will be looking at providing clinical trials locally to try to stop the amount of people needing to travel to sydney to access these very critical parts of cancer treatment

[Treatment Area]

It's really exciting to be standing within the new Western Cancer Centre Dubbo in the treatment area. We will give anti-cancer treatments this area located on floor 1, along with the clinics where you will see the doctors for your appointments. Down on the ground floor is the radiation therapy unit and that's where you'll go for your radiation therapy.

[Car Parking]

We have car parking close by and that will continue to increase in number as the car park is developed on the western side of the campus just near us but at the moment we'll need to park in the main car park and come through the unit.

The Western Cancer Centre here in Dubbo has really amazing world-class equipment so that'll allow patients with tumors in all different anatomical sites to receive their treatment here. Treatment can go for several weeks and that's a real great  advantage of this centre that patients are no longer travelling to Orange, Sydney, Newcastle or Canberra to get radiotherapy treatment,  They can have it here closer to home so the whole family patient carers are all benefited from patients receiving this sophisticated treatment locally.

[Training Pathways]

This cancer centre will provide benefits not just to this community but to the staff within the hospital it's able to provide people with training pathways which were not there previously.

The new ortho voltage machine will provide a comprehensive training center for radiation not just for radiation nurses but radiation therapists and radiation oncologists in Dubbo.

We'll be looking at trying to provide more allied health training pathways and opening up greater opportunities for people to move to Dubbo and live in Dubbo and further their careers.

We're bringing an amazing team of radiation oncology professionals out to a regional area from all over Australia and they all feel really honoured to be part of delivering this sophisticated advanced treatment to cancer patients in regional areas. It's been a long project that is finally come to fruition and uh we can't wait to get in and serve the community.

[Music]

The 4Ts: A primary care model for rural communities and their clinicians

[Amelia Haigh - 4Ts Project Lead]

The Four T’s model is a single employer model providing whole of healthcare in small rural communities.  The Four Ts are four small rural communities in Central New South Wales. The towns are Tottenham, Tullamore, Trundle and Trangie with  approximately less than 1,500 people in each town. All four communities are situated very closely within about 30 to 45 minutes of each other and in less than two hours from the nearest base hospital.

[Dr Shannon Nott - Rural Director Medical Services, Western NSW LHD]

The Four Ts is an ecosystem of one practice across multiple communities where our staff, our key clinicians, our administrative staff are able to work together to meet the community's need. It takes away that administrative burden, it takes away the challenges of running a business and it allows us to bring in people who are experts in providing care and focus on patients.

[Amelia Haigh - 4Ts Project Lead]

Essentially what that has meant for the four communities of Tottenham, Tullamore, Trundle and Trangie has access to a primary care clinic co-located with their local Multipurpose Health Service. The primary care clinics operate just like a GP practice with a GP, a primary care nurse an administration staff member and also a medical centre manager. This network services across all of those communities and there's telehealth support where the doctor might not be available on site.

[Dr Shannon Nott - Rural Director Medical Services, Western NSW LHD]

It's been a really, rewarding experience working under this current model.

[Dr Jason Maher - 4Ts Rural Generalist (Trundle)

It is a little bit different in management, but in reality when you're sitting down with your patient and exploring their health issues it's just like any other general practice really.

I like it that I do get a little bit of work in within the hospital as well and in the emergency department and I get to have the resources of the hospital which is really helpful for a GP so we get those resources we can admit our patients if we need to it's a very, very good place to work in that regard too.

[Dr Shannon Nott - Rural Director Medical Services, Western NSW LHD]

So what we want to be able to do through this program is not only provide fantastic care for our patients but also a model of care that clinicians and the top clinicians across our country want to work in.

[Dr Mark Grey - 4Ts Rural Generalist (Trundle)]

It harks back to the Golden Age of medicine in a lot of ways where you're looking after people from the cradle to the grave and you're feeling a welcome part and an important part of the community by providing those services.

[Dr Ash Labib - 4Ts Rural Generalist (Trangie)]

Then we came and test the country. Once you choose the country, you taste it, you love it and you stay with it, like me, I'm in 22 years. The people, the people here are friendly, warming. The life the life is like it's quiet, it's not rushing like the city so we like it.

[Dr Jason Maher - 4Ts Rural Generalist (Trundle)

On a daily basis I don't have strangers coming in to talk with me about their health issues, I have people that matter to me and that is the most gratifying part of my job. But it's living in the community that attracted me to come back from the coast and living in the city to live and work within a small community, it's a lovely place to live and it's a lovely place to bring up children as well, so that was the big draw card for me.

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I'm a university trained nurse back in 1989,  I've been in Dubbo for nearly 30 years working as a perioperative nurse I've also done ED, Pediatrics and intensive care

Two years ago I was recruited in this position of a transitional nurse endoscopist at Dubbo Health Service and 18 months down the track I've become accredited as a nurse endoscopist in the Western New South Wales Local Health District.

Nursing is just my favourite, I you know people say if you had your time over again would you not be a nurse, no I would always be a nurse because I, I hate floating my own boat but I'm a caring sort of a person I always take the patients on face value, put them at the top of the ladder, never did I think I would be a surgical assistant for a general surgeon or a nurse endoscopist - the first in New South Wales

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[Dr Greg Button - Director of Emergency Medicine OHS]

We've had the opportunity this year to implement the staff wellness, or support dog program. Alot of things are done in hospitals are for the patients.

So we decided to focus on the staff particularly after COVID and all the stress is caused. 

To be able to bring dogs in for them to be able to have time out with the dogs on their breaks, take them for a walk, play with them, pat them, but also for those that are going through s particularly bad trauma or something like that, sometimes they just need some time out away from the whole clinical side of it and these give them that opportunity just to go sit down and take that time.

Also with things like going into debriefs or meetings where they may be a  bit upset, the dogs certainly then play into that and bring the whole tempo of the room down. The response has been phenomenal, and the staff have just been all over them like a rash.

[Mim Eaton - Oramge ED Nurse Unit Manager]

So we often receive a lot of traffic from our staff, they come into our rooms for meetings  or just for general conversations and to have the  dogs with us, has just been fantastic.

People are just overwhelmed at how lovely it is to have an ear to pat or a head to stroke. Or if we have to have difficult conversations or someone's had a stressful day and they need to come and tell us about some stuff it is wonderful to have the dogs around to help support those conversations. It's been brilliant. 

[Dr Greg Button - Director of Emergency Medicine OHS]

So essentially over the three months we want the staff to interact, we want to see what their experiences are and at the end of that we will run a survey and get them to rate how beneficial they found the program, what they found good about the program, if there is  anybody that found anything bad so we can modify if we need to and then depending on those survey results we will sit down with Executive and look at making it a permanent fixture. 

[Mim Eaton - Oramge ED Nurse Unit Manager]

There's been a lot of information over the last few years particularly with COVID about staff wellbeing and everyone is very aware of that they want to do that. Protecting themselves, having that chill out times and being able to unwind and it's very difficult to do that in this environment so that's why this idea was brilliant because it was enabling us to bring that opportunity here.

So although the staff initially didn't like the idea they had to come to our offices because they're not to be in clinical areas, that has transpired into it get's me out of the department, it gets me into a safe space where I can just completely tune off and before you know it, they've got a smile on their face and they go back out on to the floor and that's the whole idea of it, to give people an opportunity to  give people unwind or debrief about something but in a very safe and supported environment.

[Dr Greg Button - Director of Emergency Medicine OHS]

So Royal Melbourne Hospital ED have had a support staff dog program running since about 2018 and I believe they're up to about five or six dogs. So they have them coming in basically every day of the week for staff to be able to interact with them. So that would be my goal, is to get to what they have and I have already had staff express wanting to enrol their dogs on to  the program after the trial. So I don't think it will be long before we build up the numbers, but we will be able to have a different dog each day. 

[Mim Eaton - Oramge ED Nurse Unit Manager]

I mean the benefit of animals is phenomenal, you know everything from decreasing anxiety and blood pressure and improving their own wellbeing. People are very happy when they see the dogs on duty, because we have their little photos up in the department, so that has been a wonderful thing.  

You know, they've like "Ben is here today, fantastic", you know. Which is great it breaks down those barriers. Because when you sit in a managerial role, although you don't ever try to be someone who is not approachable, sometimes that barrier can build up so having this opportunity with the animals here it really breaks down any of those concerns that people might have that they can't come to us and tell  us their problems or anything that is going on in their world which is really great. They are rockstars of the hospital.

(Music)

I came here as a new grad and I've stayed on since. I've always  enjoyed working here - one of the other reasons is that I met my husband in my new grad year - and the team environment here and getting the things I get to do is second to none - you can't get to do it anywhere else.

You can Triage our here, you can canulate, venepuncture, IDCs, SPCs you name it - we can do it out here.

I am a ward nurse generally but obviously in a rural facility I am also an accident and emergency nurse, when there's a trauma or there's a need for it. 

I also do community nursing, we also have dialysis here at this facility, I've also done dialysis nursing and obviously we have palliative patients.  We have a lot of post rehab patients, so we do a lot of wound care.

The variety is on the of the things I enjoy the most about working here, also you have aged care, you have emergency and you have your normal everyday ward work, so every day is something different and you get to experience things you wouldn't see in the city as they would be swept away to a specialist unit.

I have so many more skills my friends wish they would have but don't, they don't get the opportunity with all the junior Doctors down there in the city.

My role is virtual outreach support to the nursing staff in the district, education sessions through the video conference we support the staff because they may have a question about a medication or a procedure.   For this month in May we have approximately a hundred virtual sessions offered.

When I started working here, they supported me for triage, like how to work in a rural ED. First of all if anything comes through the ED, how to handle that, I've done a vaccination course, advanced life support, so if something happens we can administer drugs.

We have excellent support from vCare which is the speciality emergency team based in Dubbo, and all the retrieval teams they can connect us with.

Here in Nyngan we are very lucky - we have the support of our managers and usually on call RN overnight.  

Because of the diverse nursing that I do I've always been able to do those extra courses whether it be palliative care, community nursing, dialysis.

We're using this technology and this education to improve, to help our nurses, support our nurses.

I've done lots of emergency courses through the district with training days on site here or just in Dubbo or in other towns and they've help further my skills give me that confidence to be in charge.

We do have more registered nurses starting, here - New Grads - which is also very enjoyable as you get to  help them and  you learn new things off them, things they are learning at uni or they have learned in other facilities, so the team is quite diverse but in a way it is very experienced and very strong.

Working in a small rural facility again, the team is not just the nurses on the ward, its actually the whole facility. I might ring a community nurses today to get an assessment with a patient that's being discharged tomorrow, I might actually speak to the front office staff about something particular about that patient, so actually everyone is involved because it is such a small community and a small facility so my whole team is everyone including the ambulance officers who walk through the door.

They're beautiful out here, I couldn't ask for a better team, they're all lovely, all supportive, you just couldn't find any, any team like it.

In a small rural facility everyone is dependent on eachother , its teamwork - if someone comes in ED everyone comes and helps you, they know what is there role and they support us in those situations, in every situation.

I had some free accommodation over at the units for 12 months and then I brought myself a house here in town - so I'm a permanents stayer.

There s no reason not to even if you don't stay out here forever the skills you'll learn in Western LHD will be transferable back in the city and the things you'll see you'll never see anywhere else.

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So the emergency senior job came up at the hospital here (Dubbo), so it's a primary  practitioner role which not a lot of hospitals have and particularly not a lot of rural Hospitals, so it was a great opportunity to further my skills in emergency physiotherapy.

So I moved out here for that job and it just so happened that my partner moved to Dubbo as well, so that was a bonus.  I've been so supported in my career pathway, as you can tell I'm quite young and I'm in a management position and obviously worked hard to get there, but i've just had the greatest opportunities here at Dubbo in terms of career progression and I think they'll continue to blossom while I’m here.

The work's fantastic, it's really varied so it's different from your larger hospitals in where you're very specialised and you may only see one condition or a couple of conditions but here we get the beauty of the breadth of all conditions that come out from our North Western areas out towards Lightning Ridge, Bourke or for Warren - all of that comes to Dubbo hospital here, so we get to treat a really varied range of  conditions across the lifespan and work with lots of different  specialists and liaise with the city hospitals as well.

A move to Dubbo can make all the difference

[Music]

[Music]

We’re here because we've got a brand-new dialysis unit that opens on the 10th of December.  It's been purpose built for to meet all our needs and our patient's needs and it's been a long time in the planning and it's fantastic.

My name is Trevor McCallister and I have a darling wife Pauline and I have dialysis here three times a week. I've had very good service from their staff here and they have looked after me beautifully for those four odd years.  The facilities here as you are probably aware are pretty tight and pretty inadequate which I suppose would be the word to use.

The challenges are that they come in and they have to usually wait a little while not long but they actually sit on in a chair recliner chair attached to a machine for best part of five to six hours three times a week, every week for the rest of their lives.

We did a lot of consultation with my staff and I was consulted a lot and we all decided we wanted a unit that had lots of windows, that was our number one wish for the patients and that we wanted a central nurse's station so the nurses can see all the patients and they can see us and we can see each other and a dedicated staff area, so and we discussed things like should we have walls between the patients which was sometimes suggested by other agencies and my staff and patients we talked to them and they said no we don't want walls between patients. We have to have some single rooms but we want to open just with curtains and then that's what we've delivered.

So when the government gave us more funding for stages three and four there was the opportunity for us to actually develop and design a new dialysis unit above the current EDSU, which is what we've done.

The new services were getting a purpose-built to standard dialysis unit with lots of natural light, TVs for all the patients, single rooms for those that need it, a home training unit, consult room a dedicated staff area and we also have the up-to-date nurse assist call so we don't currently have that in the old unit, so the nurse is with a patient and needs help they can just hit a button and a certain colour that alarm that light goes on in alarm sounds so another nurse then can look straight up and say oh that nurse needs my help, yes it meets all the guidelines, ticks all the boxes.

Oh I think I'm looking forward to having a brighter facility and they'll have better equipment and that sort of thing to do they work,  so I'm looking forward to seeing all that happen and it'll be nice to be able to look out the window and see what's going on outside.

So it'll be a much better building environment for them I'm sure to lift their spirits because it's so bright and clean and natural and it's just meets all the things that they need to keep their five to six hours that they're here a little bit more beneficial and alive and waiting for this time to come I know it's been a bit of a while and we've not been in the most ideal situation where we are we've still managed to provide the service out and we'll continue to do that, but in a much better environment so I hope you all enjoy it.

[Music]