Belonging

I’ve often said to other remote area nurses that we haven’t done ourselves any favours by doing the work that we do as we often feel we don’t fit in anywhere anymore. I read something recently that reinforced that opinion. In a book called “Other People’s Country” by Maureen Helen, her account of her work in remote Western Australia in the nineties, she speaks with a nurse who’s leaving after many years working in the same community: “It was to have been my big adventure,” she said wryly. ‘I’d planned it for a couple of years and thought I was lucky to get this job. But I hate the heat. And I miss my family, ‘she confides. ‘Sometimes I can’t remember why I came. everything’s so different. It’s like a foreign country, isn’t it? I feel as if I can’t talk to people who’ve never been here because they don’t understand. And people who live up here permanently are so comfortable they’re almost smug.”

Trauma

How many times do we hear the news of a traumatic death in the media? We might stop for a moment and think how shocking it is or we might not even do that, we might be too busy to ponder anything except the task at hand. I remember when I worked in hospital I often thought, after I’d nursed someone with a broken leg, that never again would I say “oh, that’s good they just got a broken leg” after hearing about an accident. Until you see injury and death up close you don’t realize just how physical it is, how weighty and wearing on all involved.

A year into my remote area nursing I was called to a stabbing where a short while later the victim died. I couldn’t sleep properly for weeks. The sheer physicality of the event had lodged in my imagination, I couldn’t get free of the movie that kept replaying in my mind.

I saw a visiting psychiatrist who told me that the murder had ticked every box indicating it was indeed traumatic, but as I spoke to him throughout the week he was visiting the community, he told me in his opinion, I’d been more traumatised by a sequence of events involving bullying by two nurse colleagues in a hospital prior to me working as a RAN.

What traumatises us is as unique to each of us, as is what contribute to our recovery, and the time and the journey our healing takes.

For me, I’ve always needed to get out into nature on my own and just be. It somehow seems to put emotional upsets into a larger, calmer context. Pictured here was my favourite getting out into nature spot in Aurukun, the landing, where I often walked to after work and sat until sunset or the mosquitoes came out.

Mental Health

I just finished reading a book called “Madness: a memoir” by Melbourne doctor, Kate Richards. It’s an honest and poignant account of her experience with mental illness. She ends the book by saying…”I’m grateful to be living in a country where medication and therapy are mostly available and affordable. However even in Australia, we are still not caring for the most vulnerable members of our communities. Those who, through no fault of their own, are not as lucky as I have been to respond to medication or to be able to find the right kind of therapy. These people are of all ages and backgrounds, and we ignore their suffering because most of us don’t understand their ways of seeing the world or we are afraid of their difference or embarrassed by their appearance and because we don’t see their injuries. No-one ever wakes up one morning and thinks, today I’d like to go mad, lose my job and friends, and end up odd-looking and living on the streets, anymore than they think, today I’d like to get cancer.”

Aurukun has the highest number of mental health clients in Cape York and is serviced well by visiting mental health teams. The RFDS built a Wellbeing Centre (pictured here) in the grounds of the clinic a few years ago which offers support, counselling and education. But providing services is just one way to support “vulnerable members of our communities”, having, and showing, kindness and compassion, firstly on ourselves in our demanding work as remote area nurses and then to others is the key to our continuing mental health and our patients healing.

Sleep Deprivation

When I applied to work in a remote clinic I assumed that being on call after hours would be like doing night shift. It wasn’t. With night duty you know what hours you are rostered to work, with remote area after hour call outs, nothing is certain. You quickly learn that you could be woken up several times a night, rarely for real emergencies.Nurses are often told to educate the community on what an emergency is, but at 3am arguing with someone who’s woken you with a toothache,simply guarantees that you lose more sleep than if you just get out of bed and go and see them.

The US National Sleep Foundation recommends that adults need between seven and nine hours sleep a night. Continued lack of uninterrupted sleep results in sleep deprivation with potentially fatal effects.Remote area nurses usually have fatigue leave (if they don’t work in a single nurse post) which is supposed to make up for lost sleep. While we all value it, it is rarely a substitute for sleep. If staffing is short or clinic demands many, a nurse repeatedly on call can be functioning at a much reduced level of competence. When important decisions have to be made for patients health one has to wonder if the added responsibility put upon them to “educate” the community about what an emergency is, is a wise thing?

Among the many results of lack of sleep are an increased risk of accidents and injury, impaired attention, alertness, concentration, reasoning, memory and problem solving. It can lead to health problems such as heart disease, stroke, diabetes and depression. Judgement can be impaired, especially in regard to being able to assess what lack of sleep is doing to oneself. Also hurting their ability to make sound judgments because of a reduced ability to assess situations accurately and act on them wisely.

Before deciding to work in remote areas nurses do well to assess how well they function without sleep.

Fatigue Leave

Most nurses who work in Australian remote locations have to take turns at being on call for emergency after hours call outs, from the clinic where they work. If a community is large, or staff few, a nurse can quickly become exhausted from being called out several times during the night. In Queensland a nurse is allowed a 10 hour break from any call out after midnight, it’s called fatigue leave and is a welcome relief, to sleep in and just stay at home.

Here’s an excerpt from my journal in late 2008:
” On call last night, did overtime with a vomiting child, a nose bleed that had stopped by the time they got to the clinic, a cut foot and a crying baby. I got into bed after midnight…now enjoying the luxury of fatigue leave, sitting in bed with coffee, books and my own company. I’ve opened the curtains to let light in. I can see straight out onto the clinic grounds, the wind is scattering gum leaves and dried palm fronds, sunlight and shadows making interesting patterns through the eucalyptus trees when I half close my eyes, all from the safety of my bed, my haven. This is day number six in a nine in a row stint and I’m already weary of people and their needs.”