Organisation: Princess Margaret Hospital for Children
Job Title: Clinical Nurse
Location: Perth
Eligible for registration in the category of Registered Nurse by the Nursing and Midwifery Board
of Australia
I hold a current registration as a Registered Nurse Division 1 with the Australian Health
Practitioner Regulation Agency (AHPRA); number NMW0001574594.
Advanced level of skill in area of specialty
Having gained extensive professional experience in peri-operative settings over the past 6 years at
the Princess Margaret Hospital, I have worked within the operating theatre since August 2010.
During this time I have performed a broad range of different roles, including scrub, scout,
coordinator of lists in all paediatric specialties (except cardiothoracic), after hours emergency
coordinator and CDN. In addition, I have been acting in a Clinical Nurse position within this
environment since December 2014, a period of around 7 months.
My special interest and passion for general surgery/urology has ensured my successful integration
in the general surgery team and I have built good rapport with surgeons and other nurses during
this time. I have gained significant hands on experience in a broad range of general surgical
techniques for both elective and emergency procedures which have ranged from basic to complex
and can perform my role with the utmost confidence and efficiency.
My now advanced skills and extensive knowledge and understanding of this specialty allow me to
implement preparation processes and assist for the full range of surgical procedures within the
hospital. I am able to confidently perform the scrub and scout roles for all specialty procedures, to
anticipate the potential requirements of the surgeons in my planning and provide solutions to
problems that arise pertaining to equipment and assembly of equipment. This extends to the
planning of provision of complex care to patients in general surgery and includes provision of
specialised equipment, consumables and trays for particular procedures such as renal transplants,
complex removal of tumors in lung or abdomen, neuroblastomas and nuss procedures to name a
few.
I have a strong knowledge base of the many etiological factors which contribute to conditions
requiring general surgical intervention, a sound anatomical knowledge and an excellent and
demonstrated understanding of surgical processes for the range of procedures undertaken. This
knowledge along with my experience and exposure in this clinical area has enabled me to develop
invaluable practical skills, making me a highly valuable resource in the general surgical area. It has
also allowed me to share those skills through training of nurses into the general surgical area and
guiding them into competence in this area to support us and surgeons.
Along with my hands-on skills, I have also had experience in the trialing of new products for the
general surgical area. One example of this was the trialing of new sized stirrups for older children’s
operations which weren’t available within the current hospital. I undertook the organisation of the
trial to determine if the stirrups would be useful in the move to the new hospital early next year. I
communicated with all parties concerned before ensuring everyone knew where the equipment
could be found and asking surgeons to trial the new equipment and then provide feedback. After
many follow ups and reminders to surgical staff, I successfully collated the feedback and made the
recommendation based on that feedback to the hospital. The new stirrups have now been ordered
for delivery to the new hospital. Aligning with this type of task, I have an excellent knowledge of
and experience with the Product Evaluation and Standardisation Committee (PESC) in the process
of attainment of new products and a strong knowledge of the Therapeutic Goods Administration
(TGA) process of registration of products.
My skills and knowledge in this area are such that I have undertaken training and mentoring for
new and student nurses in this area and have received some excellent feedback from them based
on their experiences. In addition, I have organised and delivered in-service training sessions
around a range of skills, including the use of rarely used equipment like the Grays retractor and
resectoscopes. This session was to expose theatre nurses to the equipment should they be in a
position to use it and gave them hands on practice during the session to reinforce their learning.
As a trained laser safety officer, I have an expert knowledge of the principles and techniques
required to perform this procedure safely. Understanding the importance of this equipment, I
organised for a representative to come and educate staff on our new urology holmium laser for
renal stones. This training received positive feedback from participants and management alike.
With my sound and up to date knowledge of all instrumentation and consumables required in
general surgery, the ability to teach others and conduct workshops, sound knowledge of the
ordering process for stock and urgent items, overall technical understanding and advance theatre-
based skills, I will continue to make a positive contribution to the surgical team.
Demonstrated well developed communication skills, including teaching, negotiation and conflict
resolution skills
I possess excellent communication and interpersonal skills and have demonstrated these through
teaching of others, communicating with patients, families and visitors, communicating across
multidisciplinary teams and with culturally diverse people at all levels. Within my Acting Clinical
Nurse role, I have communicated with a diverse range of health professionals which extends
outside of the theatre area. These have included company reps selling specialised equipment and
consumables, surgeons, hospital management, health and safety, the anaesthetic department,
technicians and non-clinical staff.
Within my current role, I have coordinated the lists and theatres successfully through accurate
relaying of information, requesting services and support, organising equipment and services,
having discussions around patient conditions and development of care plans for patients. I have
also provided a range of training and preceptorship opportunities for students, using my
communication skills to pass on my knowledge and hopefully inspire them to take up surgical
nursing in the future. For example, last year I orientated two second year nurses into the theatre
environment. I introduced them to the theatre and emergency procedures that were in place and
then identified some of their learning requirements to make the most of our time together. I
provided them with a range of self-directed learning they could undertake and then stepped them
through a practical session for scrubbing, gowning and gloving to enhance their knowledge in this
area as well. Following on from orientation I then provided clinical support by mentoring one of
the students and allocating a preceptor to the other. This allowed for ongoing support as the
students participated in theatre. Following the completion of the orientation I have since received
positive feedback from staff as well as the students on my outstanding teaching technique.
Throughout my nursing career, I have developed my negotiation and conflict resolution skills and
can confidently diffuse situations, ensuring patient care is paramount. During my coordination of
the surgical lists after hours, there was often conflict over which procedures were scheduled next
and which ones should wait. On more than one occasion, I had the anaesthetist make decisions
but then not have enough time to explain this decision to surgeons. In this situation, I needed to
act on the anaesthetists behalf and give their explanation to the surgeons. On one occasion, I was
placed in the middle of a disagreement by two surgeons over the list and needed to employ my
diffusion techniques to calm the situation down. I explained that the anaesthetist had changed the
order of procedures, not me and that he had asked me to pass on that explanation. I explained
that it was not my role to make these kinds of clinical decisions and that I needed to be guided by
the anaesthetists position. The surgeons knew this to be true and calmed down at that point.
Communication is essential to ensure standards are maintained on many occasions. One situation
arose when a medical student wanted to scrub in to a procedure but was unsure of the process. I
used my communication skills to ask the student to wait for me to show him the correct
procedure, which he did and I was able to ensure it was correct and sign off his competency.
Knowledge and ability to apply AHPRA code of practice and other Legislation related to Nursing.
(Poisons act)
I have a strong working knowledge of a range of relevant legislation and the AHPRA Code of
practice which governs my role. Relevant legislation includes: the Code of Professional Conduct,
the Poisons Act 1964, the Misuse of Drugs Act 1984, the Nurses Act 1992 and a range of
guidelines, including those put out by the Australian College of Operating Room Nurses (ACORN)
and the Australian Health Practitioner Regulation Agency (AHPRA).
The Misuse of Drugs Act 1984 is an important piece of legislation for operating theatre nurses to
understand. On occasion, Anaesthetists will ask for a schedule 8 drug to be retrieved, however
then leave the room before signing for the drug. I teach new theatre nurses that, at that point, it
has to be locked up again due to the opportunity for misuse. Although cumbersome, it is very
important that this step is taken to protect the nurse from allegations of misuse and to reduce the
opportunity for actual misuse by others.
My understanding of the Nurses Act 1992 ensures that I operate squarely within my scope of
practice and am open and transparent in my role.
The professional Code of Ethics is about making a personal commitment to respect, promote,
protect and uphold the fundamental rights of people that are being cared for or worked with and
places value on the provision of quality nursing care to all people. On some occasions during my
role I have been concerned about the number of staff or the experience of nurses which have
been allocated to the theatre area for particular procedures. In the cases where it has been
warranted, I have made an ethical choice to ask for more or more experienced staff to ensure the
quality of care to the patient is sufficient for that particular procedure. In these cases, I have a
good understanding that we may be short staffed, but for some procedures, this really needs to
take precedence over other areas and I see it as my responsibility to insist on this.
My awareness of the fact that products used in theatre must be registered with the Therapeutic
Goods Administration (TGA) was of importance when I was organising stock for the Deflux Gel
which was very low on supply. When I called the company to get more stock, they informed me
that they were no longer supplying the product and gave me a contact within a different company.
This new company was not yet registered with the TGA for the supply of this particular product.
Given this status, every time this product is used, a Special Access Scheme (SAS) form must be
completed to comply with legislation until the company becomes registered with the TGA to
supply it. To streamline this process, I have placed one of the forms with each and every box of the
gel in the pharmacy which contains instructions on its use. This form must be completed by the
surgeon and returned to the folder. This then gets sent to the TGA and the supplier to comply with
legislation.
Proven ability to function in a multi-disciplinary team
Working within the operating theatre, I am constantly functioning and communicating within a
multidisciplinary team of anaesthetists, radiologists, surgeons, CT staff, consultant surgeons,
pathology, nursing staff, orderlies and a range of other people which make procedures happen in
different ways. My role is to liaise with all parties within this team to ensure we are working
together with a focus on patient care. Everyone has defined roles within the outcome and it is
important to work within our scopes of practice and combine to achieve success.
Before, during and after procedures, my role is to work with surgeons and anaesthetists as well as
other nurses to ensure everything has been planned and is ready for the procedure. We have
trialled the implementation of a pre-operative meeting to discuss any issues that anyone has
before the procedure and as a last check of any special equipment which might be required. This
has worked very well and is looking like it will be implemented permanently within this area.
As a dynamic and relevant team member, I make myself approachable, valuable and welcoming to
both new and experienced staff members and this is essential when running lists for theatre for
example to ensure everyone is working towards a common goal. One example was a time when
surgeons came to me requested information on new equipment they required. They required
some new equipment which was sized to adolescents in terms of accessing their urethra and what
we currently stocked was too large. I worked together with the surgeons, nurses and
representatives from stock companies to ensure we understood one another. I was able to
organised the new equipment required by the surgeons and got positive feedback on using the
equipment during procedures. This consultative process was something I have used on numerous
occasions in terms of equipment upgrades and organisation of new trays for the surgical area.
Another example of my ability to work and contribute within a team was during the Clinical Nurse
meetings discussing the new Sensortrack system being implemented within the new hospital. With
the changeover to the new hospital, all instruments will be housed on a different floor to the
operating theatres and need to be scanned in and out to ensure tracking. I was involved in the
meetings to discuss process and how the new system would work best, and in feeding this back to
the system developers to ensure it all worked together. As a result of this process, the Sensortrack
company are going to modify the system so that works in our new circumstances effectively.
Overall, I have demonstrated over time that I show and expect respect for others, am an open and
honest communicator, I understand my boundaries and scope and I have a role to play in
mentoring and dealing with conflict, all in the best interests of patients. This means I am a
contributor within multidisciplinary teams and an advocate for patients and families as well.
Demonstrated leadership skills
I have developed my leadership skills during both my Acting Clinical Nurse role and my Registered
Nurse role across many years. I have the proven ability to lead projects to delivery in a timely
fashion, such as sourcing new equipment and consumables, and in putting in the time and effort
to change systems or equipment to enhance patient outcomes. I have lead by example within all
roles and this has been especially evident in the operating theatre where I have trained and
mentored other staff and students in the required competencies therein.
My introduction of team briefings before theatre procedures is a good demonstration of my ability
to show leadership in this area, getting other team members on board and demonstrating the
benefits of such meetings to patient outcomes. During these meetings, there is an opportunity for
anyone in the team to highlight any changes that have taken place with the patient or the
procedure, surgeons can voice any concerns they have and anaesthetists can give their opinions as
well. This procedure has been adopted within the UK and the USA with proven positive outcomes
and I would like to see it implemented in general surgery as well.
My role in coordinating the theatre lists after hours has demonstrated my ability to show
leadership and ability to communicate changes, even when I understand that is not going to be
popular with the receiver. This role has developed my skills in decision making, assertiveness when
it is warranted and ensuring all parties are informed of change.
During numerous projects where I was organising new and different equipment for surgeons, my
role was to ensure those surgeons would firstly use the equipment and secondly give me the
feedback I required to determine suitability. On every occasion, I gained agreement from
surgeons, but then had to remind, encourage and support them at every step to actually gain the
feedback I required. I demonstrated leadership through this process by working collaboratively
with surgeons and equipment supplies, through maintaining my presence and consistent approach
and by diligently following up surgeons with their full schedules as required.
Other ways I have demonstrated leadership have included mentoring, training, preceptorship,
intervention into poor behaviour or non-compliance and introduction and adherence to processes
and procedures. As mentioned earlier, this is extremely important within the theatre where there
are very clear procedures around the handling of drugs. I have sat on numerous committees to
influence continuous improvement, particularly in the theatre area, have trained staff and inspired
them to want to remain or return to theatre and identified areas which required improvement and
provided solutions. In addition, I have organised in-service training on rarely used equipment for
all nurses in the area and new equipment such as the new laser as mentioned earlier.
Overall, I demonstrate leadership by doing my job well, managing change, implementing projects,
communicating effectively, inspiring and training others and generally being passionate and
committed to my role.
Understanding of the processes of Quality Improvement and importance of Evidence Based
Practice
During my current and previous roles, I have been intrinsically involved in numerous audits which
feed into the process of quality improvement. These audits have included patient ID and
procedure matching audits, surgeon safety checklist, surgical safety checklist, along with
numerous others. Part of the surgical safety checklist was the implementation of pre surgery
meetings, including the patient identification and procedure matching process. In addition to this,
each patient is marked before being brought to theatre and this needs to be checked off as being
done to decrease the chances of wrong site surgery taking place. Part of my procedure is that if a
patient is brought to theatre and is not marked, they are not allowed into the theatre for their
procedure. I have both implemented and audited this procedure within my role and it is now
embedded in hospital process.
I have an excellent understanding of the Gecko system and requirements around submission of
procedures relating to the provision of health care and have used this on many occasions
successfully.
Due to the area of health care constantly changing, evidence-based practice is an important
indicator of current knowledge. Most of what we do, even in terms of infection control, is
evidence-based, along with most other process and procedure. I have been a driver of knowledge
sharing within my roles and believe that this is the essence of ensuring evidence based practice is
being implemented. One example of this was my attendance at a Donor Awareness Day, based
around the up to date benefits and knowledge of organ donation. Throughout this day, I collected
knowledge and information, which I then brought back to the hospital to share. One of my
colleagues was in the process of developing a booklet about renal transplants and a large amount
of the information I shared with her was able to be used in the development of the booklet. I then
assisted her to revise the book through my learned information and my first hand theatre
experience.
Surgery on children can be an area where research is coming out all the time. This can change and
inform procedure and give insight into why certain procedures are performed in certain ways. I
make it a priority to ensure I am attending conferences, reading relevant literature including
ACORN articles, attending study days as well as encouraging others to do so. This, along with
online study are areas where a broad range of accumulated knowledge can be the result, ensuring
up to date, evidence based practice is the result across the board.
Current knowledge of legislative and regulatory requirements in the areas of Equal Opportunity,
Disability Services and Occupational Safety & Health, and how these impact on employment,
people management and service delivery
As mentioned earlier, I am aware of a range of legislations which govern my role, including the
Code of Professional Conduct, the Poisons Act 1964, the Misuse of Drugs Act 1984 and the Nurses
Act 1992. In addition, the Equal Opportunity Act 1984 and the Disability Services Act 1993 also
play important roles in the workplace. The Equal Opportunity Act 1984 is designed to promote
recognition and acceptance of the rights and equality of all, regardless of race, religion, sex,
gender, marital status and sexual orientation. This extends not only to the provision of care, but to
the workplace, where employees are protected from discrimination and harassment. As an
employee of the health system it is our responsibility to adhere to these principles and practice
accordingly. At Princess Margaret Hospital, the care we provide should be family centred free from
judgement of how individual families are structured.
Disability Services Act 1993 aims to promote positive outcomes for people with disabilities in
acknowledge their rights to equal opportunities within their communities. Healthcare services
should be flexible and responsive to the individual choices and needs of patients with disability,
their families, carers and significant others. Particularly within theatre, the parents and carers of
children with disabilities become a valuable resource. For example, I cared for an autistic patient
on one occasion both pre and post operatively and was relying heavily on his parents to let me
know how the patient was and whether different characteristics were normal or different for that
particular child. This way, I could determine any changes that were not expected and seek
treatment accordingly. To gain positive outcomes for patients within PMH surgical area, I ensure
all team members involved in the procedure are made aware of the child’s condition if required.
This way, we can all be informed and looking out for issues or problems.
The Occupational Health and Safety Act 1984, along with the Occupational Safety and Health
Regulation 1996 were created to promote the safety and security in the workplace, protecting
people at work against hazards and assisting in securing a safe and hygienic work environment. It
provides a structural guideline for both employer and employee to reduce, eliminate and control
hazards within the workplace. As an employee I understand that it is not only my responsibility to
protect my health and safety but also that of others by following guidelines, reporting hazards,
using protective clothing and equipment and cooperate with safety and health issues.
A few examples of my commitment in this area include:
– Attendance at a Laser Safety Course, selection as Laser safety Officer and making sure correct
signage and protective equipment is used.
– Attendance at a manual handling workshop that has equipped me with the tools to teach others
correct technique, and be an advocate for safe manual handling techniques.
– Maintaining awareness of the process of reporting hazards or incidents including Datix CIMS a
program designed for the notification and management of clinical incidents.
– I am a trained fire warden, aware of alarms and equipment in theatre and evacuation.
– Guidelines for accidental exposure to hazardous substances be it bodily fluids, bodily fluids with
a known Blood bore Virus, toxins, poisons and cytotoxic substances.
– Access to chemical spill kits and how to use them.
– Use and promotion of Personal protective equipment (PPE) in theatre and guidelines when
dealing with infectious patients in theatre, and the cleaning process that follow.
– Safe handling/and disposal of sharps in theatre.
