Nursing

WELCOME

Nursing is the foundation upon which health care in hospitals is based, and is influenced by many unpredictable, often complex and inter - related forces that lie outside of the direct control of Nursing. This has been a period of sustained challenge for all nurses as the working environment responds to cultural, societal and budgetary forces. Cancer nursing at Royal Adelaide Hospital shares in the difficulties that beset the nursing workforce but has managed to remain separate from some of the direct pressures that are now endemic. The nursing shortage is one such pressure in which the Cancer Centre currently stands resistant to the direct impact of recruitment and retention difficulties.

Why this is so is not entirely clear, but the philosophy of care cancer nursing staff use in patient care also underpins Cancer Management’s practice towards staff. Staff audit data and anecdotal evidence supports the premise of a supportive and caring environment in the Cancer Centre providing a strong positive association for nurses. Our reputation as “a good place to work” and “cancer nurses are happier” seems to permeate throughout the hospital and results in nurses who have never worked a shift in the unit enquiring about future employment.

This is a very powerful and positive statement about the Cancer Centre and lends support to the premise about staff who are happy are likely to provide better care and will contribute more of their efforts to the workplace -  the strength of the Cancer Centre is undoubtedly reflected in the people who work for it.

Our challenge is how to maintain the unique culture of Cancer Nursing in the face of considerable and far reaching future and present change. The focus on work intensification  - ‘to do more with less,’ has become a fact of working life and we must consider how we can change work practice to enable the important aspects of care to continue. For this to happen, it is essential for nursing in the Cancer Centre to remain united with a shared vision which embraces research, professional development, innovation and high quality, cost effective care. It is also essential for nurses to value and support one another and to encourage and embrace concepts of team and teamwork as integral to the success of the Cancer Centre.

Nurses contribute in vitally important ways to the care and outcomes of the patient, and that in spite of staffing and activity demands, nursing care throughout the Cancer Centre is maintained at a high standard. This has largely been achieved through the efforts of the Cancer Centre Nursing Leadership group in the effective leadership and management of bed and staffing allocation and also through the continued goodwill shown by staff in assisting the organisation by working extra shifts, overtime and double shifts.

The loss of staff from the Cancer Centre through resignation is an ongoing challenge particularly when experienced people leave.  Resignations are generally not due to dissatisfaction with the hospital or the Cancer Centre, and this is significant in providing considerable insight into the culture of care that the Cancer Centre promotes to the patients and staff alike. The major factors in staff loss has been through long term secondment or temporary transfer, overseas travel, promotional opportunities within the Royal Adelaide Hospital or at other health units / organisations, and career change within the health sector. The trend to increasing casualisation of the workforce, has continued but more gradually than before, although many nurses who were utilising maternity leave for their first baby and have returned to the workforce, are now anticipating maternity leave for their second or even third baby.

Activity in all ambulatory areas, but especially in the Women’s Health Centre, Oncology Day Centre and Palliative Care Unit has been very high. A significant component of the activity is now generated directly by cancer patients and provides greater clarity about how the treatment of patient groups has aligned within the hospital, for example, all chemotherapy at Royal Adelaide Hospital is now administered in the Cancer Centre. Factors contributing to the growth in ambulatory activity include the movement of inpatient chemotherapy from the Medical Oncology inpatient setting to the ambulatory setting in 2006, increasing numbers of treatment for High Dose Rate Brachytherapy in the ambulatory setting, a greater awareness of the services provided by the Cancer Centre within the hospital, and a greater awareness by the community of South Australia of cancer health promotion and prevention measures.

Quality improvement occurs routinely and effectively across the Cancer Centre resulting in innovative and outcome based activities. The introduction of a volunteer service for Palliative patients early in 2007 has been a significant success in improving the support provided to palliative patients in the acute setting. Nursing research also takes place with a significant piece of research currently in progress being a collaborative project with The Cancer Council of South Australia in which the cancer patient journey has been a focus. This project is likely to yield some fresh and valuable changes and strategies in the management of Cancer related fatigue.

Finally, Cancer Centre nurses have sought and maintained strong community links including direct involvement with adolescent and teenage cancer through CanTeen and other patient associations. The positive and strong links forged with the community and with the friends and family of patients has seen numerous generous donations and assistance towards patient amenities and support. Without the generous support from individuals and organisations the environment of care that the Cancer Centre provides would be greatly diminished. Nursing has been, and will continue to be an important and integral influence in the perception and reality of patient care for the cancer patient at Royal Adelaide Hospital.