To kick-start Emergency Nurses Week, today we’re hearing from Clinical Nurse Consultant Brett Sellars from Robina Hospital on the Gold Coast.
While Brett’s been in emergency nursing now for 19 years, his first paid gig was actually as a professional chef! “I was a chef working in 5-star hotels all over the place. But when it came time to thinking about family life and children, the lifestyle wasn’t as good. At the time, my wife was a nurse working at the PA [Princess Alexandra Hospital] and one of my best mates from school days was a doctor in an emergency department (ED), so I decided to start my nursing degree,” Brett said.
While studying as a registered nurse he obtained a job as an Assistant in Nursing (AIN) in ED which left him in awe. “I was in awe of the people who worked there. They were so calm. I really liked how they were a well-oiled machine. To an untrained person it was like they had mental telepathy - they all knew their role and that they could rely on the other person to do their job. It was an amazing experience to see them work together to provide care.”
For two years Brett said he took everything in, like osmosis. “I said, this is the world for me. I’m a hyperactive person so I like high end activity. The environment suited me.” Brett was one of the first ever graduate nurses to move straight into a specialty and secured a position at the old Gold Coast Hospital Emergency Department and went on to be part of the commissioning team during the opening of the Robina Hospital ED. He eventually returned to Brisbane working at the PA Hospital Emergency Department to improve his skills in trauma, before moving to Mater Kids Emergency Department to hone his skills in paediatric care.
Returning to the sunny Gold Coast and the brand-new Gold Coast University Hospital Emergency Department, Brett first moved into the role of Business Practice Improvement Officer (BPIO) and then the Service Director role where he learnt there was more than one way to help people.
“You can make change by the care you deliver, listening to the patients and taking a special interest in their episode of care. The second way to make a difference is working out the processes behind change and improvement, including data and analytics.”
“Data can be utilised to help inform decisions - you can look at the info and say: ‘this is the number of presentations we’re getting and the type of patients’ and find out where to direct our energy. But we need to get better at ‘predictable unpredictability’,” he said.
Brett explains that on the Gold Coast, they utilise data to show where the trends in activity are. “As soon as I walk into the department, based on history and information, I know whether I am going to have a good day or a bad day. “We need to pre-emptively respond to something that we know is going to happen 4-5 hours from now.”
In response to recent research indicating that a significant percentage of all ED workload and capacity issues are related to inpatient access block, Brett said we needed to develop escalation pathways and strategies which can distribute the clinical risk and enable a whole of organisation response. “The use of up-to-date information can help to make informed decisions of which strategies to deploy. The next patient could be my relative or yours – we want everyone to have an improved journey and get appropriate care in a timely manner from the most appropriate clinician.”
While he enjoyed learning about data and analytics, eventually, Brett was lured back to the floor.
“As a CNC I think I can make the most change at the bedside. I’m in a unique role now - I understand what the clinicians need but also understand what the executive need as well,” he said.
And then came COVID-19.
“During COVID, it was difficult, very challenging and I saw many of our staff at breaking point at times. The major difference for me working in the Emergency Department during COVID-19, was the fear of the unknown. We were having to process media reports from overseas depicting high mortality rates within clinical staff and the prospect of not having enough resources to meet the needs of the community. We also had to deal with our own mortality and the fear of bringing the virus home to our loved ones.”
“In a senior role, I also had to source the most up to date information so I could adapt the environment to suit our needs and minimise the risk for both the staff and patients. And the rules changed so quickly, day by day, we had to be up to date all the time, so the cognitive load was very high,” Brett said.
Fortunately for Robina, the team is close-knit which helped get them through the pandemic and strengthened already close bonds.
“One of the good things in ED is that we are one big team, one big family. I don’t think many people thought they would work through something like that [a pandemic]. I’ve grown closer to my colleagues just going through that adversity. The friendships you make in ED – they’re different to normal relationships. We’ll be friends for life.”
Brett was also amazed at the level of innovation that the pandemic necessitated. “Ambulant models of care we had tried to do before were established within days – not weeks or months or years. The guys were amazing at adapting to change in a second. I’m super proud of their response.”
Looking forward, Brett hopes that new models and technologies will ease the administrative load. “What I think in the next couple of years is that we’re going to have to automate some processes. We’re smart enough do to it. That way nurses can get back to the bedside and get eyes on the patients, to identify risks before they happen, by using their clinical judgement and their nurses’ gut.”
“I’ve been very blessed to have worked in this ED for nearly half my life. I’ve had very good mentors and work with lots of great clinicians - too many to name.”
“One of the first things I saw when I hit the floor as a graduate nurse, was an interaction a senior nurse had with an elderly gentleman. She had to clean him up, give him a bedside bath, and helped him after he was unwell. She asked me shortly after what was wrong. I said that ‘I feel sorry for that man as he was so helpless and reliant on help.’ She responded to me by saying, ‘out of anyone in the world right now, who would you let bathe you?’ I said, ‘My wife and my mother’. ‘Exactly,’ she said, ‘every time someone allows you into their world to deliver care like that, they are placing you on the same level as some of the most significant people in their life. And that is a privilege.’”
“I’ve never forgotten that. Being an Emergency Department nurse is a privilege.”
