New Zealand Rehabilitation Association, Inc.

This month’s interview is with Anne Ronaldson, Nurse Specialist (Rehabilitation) for Rehab Plus, Auckland District Health Board (ADHB) – a post acute regional rehabilitation unit for patients aged 16-65 years.   

To begin with, tell me what your job involves.

Because Rehab Plus is a stand alone facility geographically separate from Auckland City Hospital, my job is probably somewhat different from other Nurse Specialist positions.  A certain amount of the role involves liaising with nursing and medical staff in other services in terms of carrying on with clinical nursing issues when people are transferred to Rehab Plus.  For example, we recently liaised with the transplant unit for somebody who had a liver transplant to carry on with some of the clinical of things, but then building the rehab on top of it.

So you provide the transition from the more acute services to the rehabilitation wards?

Yes. It is something that we’ve been getting much better at and we seem to be seeing a need for nursing staff to become more expert in a wide range of clinical skills 

What about the other end, when you are discharging people from Rehab Plus?  Are you very involved there?

Well, each patient has a core team, which works on their rehab and discharge planning, but discharge planning can be a tricky thing, as you know.  I think I tend to get involved when there are some difficulties around it and things get a bit stalled.  I’m not involved with every patient, but sometimes I’ll get involved if things do not seem to be working well.  Sometimes someone from outside the core team can add some value because you’ve got a bit more professional distance, I suppose, to look at things objectively.  You’re not so emotionally involved, and I think that adds value.

What about your role in terms of leadership in nursing in Rehab Plus?

For the two wards here, we have a nurse educator which is a new position.  We were restructured a couple of years ago. There were two nurse specialists. I was on the general rehab ward, which was more around amputations and orthopaedics, and I had a colleague over in the neurology rehab ward.  So, as a result of the restructure, they took out the second nurse specialist position and put in a nurse educator.  The nurse educator position, I think, has been a really valuable thing for staff retention. It ensures the staff get a bit more support, specifically designed for that purpose.  And the other thing that happened, which was quite big personally for my professional development  was that I began covering the neuro ward, so I had quite a lot of clinical upskilling to do as a result.

So you’re the nurse specialist for two wards really?

Yes, but they’re small wards!  But, yes, the job is a lot bigger as the restructure also involved loss of support roles including the admissions coordinator being reduced to 0.5 FTE. This has meant I have become much more involved in planning admissions and bed management.  I actually find this a really interesting part of my role but it certainly is time consuming.

How do you manage your time between the wards?

Being fair is really important to me – to be fair in giving support across both wards. But the input they each require does vary.  Sometimes ones busier than the other, so it’s about assessing where the need is I suppose – to decide where my time is best spent.

What is your opinion about rehabilitation nursing as a speciality area of clinical practice?

I love it and I’ve done all sorts of nursing: dialysis, coronary care, intensive care – the whole works really.  But I really like rehabilitation.  It’s really developed my ability to listen to people, because you have a longer term relationship with a patient.  You have that ability to get some connections and work out what they want, because often in rehab, as you know, it’s about their whole lives.  It’s not just about the episode of illness.  So for me I think it has made me think outside the square, rather than just on the clinical issues.  But then again, you still have a whole lot of clinical work in rehab as well, which I really enjoy.  It’s a really nice balance.  The work is interesting too.  I think rehab nursing has had a very poor status in terms of nursing.  I think that is changing a little, but I’m not entirely convinced.  Rehab nursing sort of got tied to health care for the elderly, which was not considered as exciting as, you know, doing ECGs etc.  But we actually do quite a bit of clinical stuff, which is good.  So you get to keep up your clinical knowledge, but you also have that wider rehab focus too.

Do you think rehabilitation is an established area of nursing specialisation in New Zealand?

I believe so now, but I guess I’m sitting from a very specific viewpoint.  I’m not sure what it looks like to people outside the rehab wards, but for me it does.  But then again, I think rehab in general has become more of a speciality area. It’s not just nursing, is it?  It is developing as a speciality, but that will involve people not just talking about rehab as some backwater.

Is there any work that needs to occur to further develop rehabilitation nursing as a speciality area in New Zealand?

Well there is the Australasian Rehabilitation Nursing Association (ARNA), who publishes the Journal JARNA – that has been fabulous for supporting the establishment of rehabilitation nursing in Australia, but I suspect it is not so good yet in New Zealand.  We don’t have an NZ branch of ARNA for instance.  I think that probably needs developing… but it would be a time consuming job for one person to do!  It’s easy to get bogged down with day-to-day clinical work.  But I do think we need something like that.  Just the other day I had a call from someone up in Whangarei, so there are people around NZ who are wanting something like that.

Should we put a request in the NZRA Newsletter for expressions of interest to form a rehabilitation nursing special interest group in New Zealand? :-)

That’s a good idea!  I’m happy to be a contact person, but I probably wouldn’t have time to lead something like the development of a group like that.  But I think it’s a really good idea.

Is it possible that there could be a meeting of rehabilitation nurses at some nursing conference in New Zealand at some time?

Well, yes, there could, but the trouble is nursing conference’s aren’t general. They tend to focus on clinical areas like continence or whatever – different specialities.  But what perhaps we could look at is seeing if we could invite nurses to meet as a group at the next NZRA conference – because nurses go to that conference.

What about the possibility of there ever being a nurse practitioner in rehabilitation?

I don’t know. It got talked about with me during the restructuring of our wards. But the trouble is, the way I see nurse practitioners is that they are very specialised in their subject.  Now the problem with rehabilitation, clinically, is that it covers such a huge range of things, it would be really hard to be specialised in it.  That’s another thing about rehabilitation nursing that I like – you’ve got to be a Jack-of-all-trades.  One minute you’re working with some who has had a renal transplant and the next minute with, I don’t know, someone with an amputation.  So to become a clinical expert in the area seems very difficult. And that’s what they want for a nurse practitioner.

Listening to you talk, I’m wonder if this is something that undermines rehabilitation nursing: that the generalist skills required of rehabilitation are less valued that very, very specialist skills in one area of clinical practice.

Yes, in terms of rehabilitation nursing overall I consider I am – (laughs) – very experienced and, you know, have some good skills. But clinically I’ve got to know a lot about diabetes, I know a lot about certain things but there are some things I’m not very good on at all.  And in rehabilitation you will come across everything: multiple sclerosis, Parkinson’s - there’s a whole range of conditions. So I think you are right and maybe the generalisation required does undermine rehab nursing in the other clinical areas.

Soapbox time.  Any last comments about what you want to see happen in rehabilitation in the future?

Well in rehab nursing, I’ve sort of said what I thought, I suppose, that I think there ought to be some more linkages and networking between the nurses, and how that happens is pretty much up to us.  And for rehabilitation in general, it would be good to see it better recognised for the skills that people working in the area do have.  It’s so much more than just the clinical work.  The skill in communicating with patients and families, for instance, is so important.  And it would be good to have that better recognised.

Excellent.  Thanks for your time.