Published 2010-10-29
Teamwork amongst urology nurses at NZ hospital - Specialised knowledge not size matters in small urology clinic
Greetings to our urological nursing colleagues in the EAUN! With the invitation to write for your newsletter we would like let you know a little of our urological practice here in Hawke’s Bay, New Zealand.
Our hospital is located on the east coast of the NorthIsland and our main industries are agricultural including a booming wine industry! The current population is 150,000 of which 25% are indigenous Maori. The District Health Board employs 2,500 peoplewhich makes it the largest employer in our region. Hawke’s Bay is also served by a private hospital and two of our urologists also work there providing surgery to those that either have insurance or can afford to pay.
From left: Robyn, Trish and Julia
The urology team provides most elective and acute urological services including paediatric surgery. We do not have the funding, or the population base, to make robotic surgery feasible in this area so we refer our patients to the main centres if they chose this treatment option. We also do not have radiotherapy services available locally, but this option is availablein another centre which is two hours away by car. For those opting to have brachytherapy, the procedure is available even farther away after a four-hour drive.
Up until just recently we have had only two urologists, Mr. David Mason and Mr. Kim Broome in our team. But we are happy to announce we have just employeda third urologist, Dr. Leanne Shaw, who recently completed her fellowship year working overseas with Dr. Tony Mundy in London. With Dr Shaw’s interest and expert knowledge in urethral surgery we are very excited to have her working in our team. We also have a trainee registrar in our service.
Currently, we have six members of the New Zealand Urology Nurses Society working in our area. Three of them work in out patient clinics, namely Julia Nelson,Robyn Madden and Goh Yee Tan, and they coordinate six urologist outpatient clinics each week. There are also two nurse practitioner clinics and two urology nurse clinics. In total we see approximately 140 urology outpatients per week. The registered nurses working in the clinics assist the urologists with anumber of procedures including prepping and assisting with cystoscopy, urethral dilatation, TRUS prostate biopsies, stent removal, urodynamics and testosterone implants.
One registered nurse has responsibility for each clinic, planning and preparing a suitable patient mix of new patients, follow ups, procedures and acute patients.This nurse also phones all booked consultant urologyclinic patients prior to their appointment to confirm their attendance. She also checks if tests have been completed and ensures that the patient has received the relevant information, i.e. attending clinic with a full bladder. The clinic nurses have audited this service and found it cuts down significantly on patients missing appointments.
The nurse-led clinics are held twice a week for patients receiving BCG treatment, GnRH and LHRH analogue assessment and administration, urethraldilatations, flow rates and teaching of intermittent selfc atheterisation. The registered nurse role, in all urology clinics, is to support and assist the consultant whilst caring and advocating for the patient.
We were all delighted when last year two of ourmembers, Julia Nelson and Goh Yee Tan were awarded the “OBEX Best Paper” prize at our nationalNZUNS conference. They gave an excellent presentation of their work wherein they developed an orientation package for registered nurses who are new to the Outpatient Department. They used their $2,500 prize to travel to Perth, Australia where they attended the ANZUNS conference in March 2010.
Trish White, our nurse practitioner, has been in herrole for four years now. She sees a mix of new patients and follow-up appointments in clinics as well as offering a case management service for our more complex urological patients which involves community visits. Trish sees a lot of patients with lower urinary tract symptoms, incontinence, recurrent UTI and prostate cancer. She is also keen on research having published the results of her study, which she completed with her colleague, Helen Crowe fromMelbourne, Australia. Their study titled “Definingurology nursing practice roles in Australia and New Zealand” appeared in the International Journal ofUrological Nursing in 2009.
Our operating theatre is managed by Lynn Brinson who also runs the gynaecology theatre. She coordinates five busy sessions per week in herdepartment. Our urology in-patient unit is small with only, on average, eight in-patient beds. We are very proud of Lynn’s recent achievement of becoming one of New Zealand’s First Surgical Assistant which permits her to assist the Urologists in surgery. Athorough assessment by New Zealand Nursing Council is required before a Registered Nurse can work in this extended scope of practice.
While we are a small provincial urology departmentwe foster team work and have regular Friday morning meetings so we can all discuss the coming week’s surgical lists to ensure patients are ready and well as they can be. Everyone is encouraged to contribute during this meeting and it helps our team run smoothly. We are all very keen to participate in national or international meetings so hopefully, one day, we will be able to attend one of your European meetings!
Authors:
Trish White, Nurse Practitioner Adult Urology,
Trish.White@hawkesbaydhb.govt.nz
Julia Nelson, Registered Nurse Outpatient Clinics
Robyn Madden, Registered Nurse Outpatient Clinics
Hawke’s Bay District Health Board, Hawke’s Bay (NZ)
Article from European Urology Today, volume 22, No. 4
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