Gabby Hawkins, enrolled nurse

Gabby Hawkins is the only enrolled nurse working in the urology department at Dunedin hospital, alongside four registered nurses, the locums, and the surgeons. It is a busy department and there is always a lot to do with patients coming in for biopsies, finding out about x-ray results, and undergoing procedures.

After graduating as an enrolled nurse, Gabby worked for more than two years at a rest home, then applied to the urology department where she has been for the past 18 months. Gabby has a wide variety of tasks in her role and is learning a lot about delivering safe care from the clinic’s registered nurses and clinical nurse specialists. One of the biggest shifts in the new scope is how enrolled and registered nurses work together now that direction and delegation has changed. Enrolled nurses must work with access to, and seek guidance from, registered nurses or other registered health professionals when they need to.

Gabby has been trained by the clinical nurse specialists to set up for the clinic’s procedures, and works within the Enrolled Nurse Scope of Practice, and will be guided by the new standards of competence. “The nursing care I provide to patients ensures they are prepared, and I assess and monitor them throughout to ensure they are safe throughout the procedure. I bring the patient in and I’m in the room while the surgeon is having a chat with them about the procedure. I assist the surgeon by handing them the non-sterile equipment. With our flexible cystoscopy, I connect the camera on top for them and I connect up their fluid, as part of the bladder investigation.

“I also assist with prostate biopsies to ensure care is coordinated for the patient and they are supported with information they may need prior and during the biopsy. I set up all the equipment, the lidnocaine, and the biopsy gun. I help the patient get up again and get dressed and support them after the proceedure providing them with information post the biopsies to recap what the surgeon has told them.”

On a regular clinic day, there are three procedures at the start of the morning, three at the start of the afternoon, and then patients are seen face-to-face for the rest of the day.

Gabby recognises her responsibility to seek guidance under the new scope and says she is always asking questions of the registered nurses, two of whom are clinical nurse specialists. “I go to all of them for advice if I have questions about things that patients are coming in for that I haven’t encountered yet, like different cancer diagnoses. A lot of that is asking them what I should be doing in that sort of situation.”

Seeking advice and guidance is a key part of the new enrolled nurse scope. Gabby says the registered nurses are there to provide support which she really values. “They are extremely helpful, they answer all the questions, and the surgeons are really helpful as well.”Gabby works within an interdisciplinary healthcare team where she participates in regular meetings and patient reviews where patient information is shared, and she learns what is being planned for specific cases.

As part of the new scope of practice, when a patient’s condition changes, enrolled nurses will need to escalate what is happening to either a registered nurse or another registered health professional. Gabby is aware of this and takes steps to seek help. “With our prostate biopsies, sometimes a patient will have a vasovagal syncope or fainting episode and they almost pass out. I’ll be in the room, it’s happened a couple of times, so when I recognise this is happening, I call for a registered nurse to assist me with that.”

Gabby is accountable for her practice, and believes that good communication between enrolled nurses and registered nurses, teamwork, and working effectively together are very important for safe care.

Her work in urology is very different to her first enrolled nursing job where she was at a rest home in the north-east valley in Dunedin, where she was under the guidance of a registered nurse who ensured that Gabby was able to deliver safe care. She recognises the knowledge and experience she gained there helped her transition to a new area of practice and prepared her for working within a healthcare team and her responsibilities of being accountable to her practice.

For now, Gabby is enjoying the challenge of a different role and all that it offers.

“I’ve learnt so much about the urinary system. It’s really good to get all the training that I do.”

Gabby plans to continue working in the urology department and learning all she can. At some point, she would like to see a bridging programme introduced for enrolled nurses to become registered nurses, and if that happens, she will seriously consider taking on that next challenge.

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