CLINICAL NURSE SPECIALIST PROFILES

This new section of the website is for CNSs to highlight their roles and experiences. Due to the cancellation of our 2020 forum and the postponement of the 2021 conference,  we have lost those valuable opportunities for networking that occurs at these face to face meetings. 

We welcome members to submit their profiles

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Name - Mandy Pagan

Area of Specialisation - Wound

Qualifications - RN, MN (Distinction)

Location - Southland Hospital, Invercargill, Southern DHB

Background / nursing history
I completed my Diploma as a Registered Comprehensive Nurse at the Southland Polytechnic in 1990, as a new graduate I worked in Brisbane Australia in medical and surgical wards. During my work in Brisbane I was exposed to the Outpatient venous leg ulcer clinic and was hooked on wound care!   I returned to NZ in November 1992 to marry Steve and was employed by Southland Hospital in the Surgical Ward for four years, undertaking the infection control representative role for the ward. I then moved to the Orthopaedic Ward for 5-months before being prompted to apply for the Infection Control Nurse role in 1997 in which I worked for 9 years. I took maternity leave in 1999 and 2002 for my two beautiful sons returning to work part time.
How came to CNS role
During my time in surgical ward I worked with enrolled nurse and mentor Marie Plank (then Wilson) who had the same passion for wound care, and we started the first Wound Management Group. We then developed the first Skin Care and Wound Management Manual in 1997 and updated this in 2000. In 2005 I wrote a proposal for a Wound Specialist role for Southland Hospital which was accepted at 0.4 FTE, I was successful in applying for this role and worked also in infection control until the FTE was increased in 2006. The wound CNS role is currently 0.8FTE Monday to Thursday.
Education
On returning to NZ I completed my Bachelor of Nursing Degree in 2001, and from 2004 I have held Professional Development Portfolios which I believe are essential in CNS roles. In 2007 I completed the HEMI Advanced Wound Care Course. Since there were no post graduate wound courses in NZ I obtained my Diploma in Wound Care via Monash University in Melbourne in 2010. I then completed my Clinical Masters with Distinction in 2014.
Research and innovations
As part of my research paper in 1999 I was part of a research team to review: “The Rate of Phlebitis and Contributing Factors Related to Indwelling Peripherally Inserted Intravenous Catheters” in surgical and medical wards at Southland Hospital. This work won best poster presentation at the 2001 Australian Intravenous Nurses Society. 
Our nurse-led wound clinic provides critical reflection and innovative practice; this led to the development of a wound supplemental pressure device called the ‘Southland Snail’. In 2008 I published this in the Australian Wound Practice and Research Journal and won the Comfeel Australasian Literary Award for best case study. The ‘Southland Snail’ is referenced in the 2011 Trans-Tasman Venous Leg Ulcer Guidelines. In 2009 I received the Southland Nursing Excellence Award.
In 2011 I co-authored an article titled “Lower leg haematomas: Potential for complications in older people” in the Wound Practice and Research Journal.
In 2015 I co-authored an article for LOGIC NZ College of Primary Health Care Nurses titled “Implementing the Clinical Practice Guideline for the Prevention and Management of Venous Leg Ulcers”.
In 2015 I published my master’s literature review titled “Wound programmes in residential aged care: A systematic review” in the Wound Practice and Research Journal; this work was awarded the Coloplast Biatain Australasian Literary Award for best literature review.
In 2016 I was involved in the update of the Trans-Tasman Venous Leg Ulcer Guidelines and was Chair on three Working Groups; this volunteer work was over 6-months and involved research appraisal and data extraction and writing guideline recommendations.
In 2018 I co-authored an article titled “Wound Care in the Pharmacy Environment” in Pharmacy Today.        
In 2018 I was the research lead conducting a pilot study, from my published literature review, implementing a skin and wound programme in two Southland aged care facilities. I then published this research in 2019 in the Wound Practice and Research Journal.
During 2019 I worked with Careerforce and ACC in contributing to on-line pressure injury modules.
From 2019 I remain involved in capturing data for an Australian research study on venous leg ulcers to determine risk factors for delayed wound healing and leg re-ulceration. This study will help determine if these risk factors transpose to our NZ population. 
Member of CNSSNZ, affiliations, professional leadership, national involvement?
I am a current member of the CNSSNZ, Nursing Research Section, NZ College of Primary Health Care Nurses, and the Southland Medical Foundation. From 2005 I have been a member of the NZ Wound Care Society holding varying roles from current President, Vice-President 2017 – 2019, Committee member, ongoing Southland Regional Coordinator, Leg Ulcer Advisory Group co-ordinator from 2007, newsletter editor, Education Advisory Group 2016 – 2019 and Conference Organizing Committee 2006-2007, 2018-2019 and 2020-2021. The Society work provides networking with other CNSs and a national wound care perspective. The Society’s focus is on healthcare professional education and improving consumer outcomes, I am proud to be part of developing an ACC proposal and conducting the first successful NZ Wound Awareness Week last year. 
In 2014-2015 I applied and was accepted onto Pharmac Wound Advisory Group to review wound product ranges in NZ. I have presented (abstracts, posters, conducted workshops) at over 15  conferences. In 2018 I was the NZ Representative on the Trans-Tasman judging panel for the Australia-NZ 3M Skin Safety Awards. 
Mentoring, resource, empowerment
In 2005 I started my wound role and was challenged by the SDHB Maori Health Leader how I would show cultural inclusion in my practice; I then founded and formed the SDHB Cultural Practice Group. This group brings primary and secondary health professionals together for support and sharing practice successes and concerns. This group has been successfully running for 16 years.
From 2007 to 2017 I provided post-graduate mentoring for the Southern Institute of Nursing programme. After obtaining my Monash University diploma I was employed part-time as a Unit Advisor for their on-line learning programme. 
In 2019 I was invited by my master’s mentor to work part-time for the Canterbury Centre for Postgraduate Nursing Studies as a moderation marker for Nursing Research Methods.
From August to November 2020 I was contracted by the Southern DHB to develop and mentor a new Vascular CNS into Southland’s first Diabetic Foot Clinic.
The difference you make in your practice as a CNS (why you have a passion for the role)?
I have always loved clinical work and working alongside the patient, their family/whanau and healthcare professionals. I strive to be solution focused and apply motivational interviewing when working with people; we learn so much from our patients and to share their journey is a privilege.  I find practical learning more effective than lecturing and hence we open our nurse led clinics to teach these skills. I am privileged to work with such amazing nurses in our clinic who share their learning. As a clinical nurse specialist, we can focus on our core area of expertise, unfortunately the nurse practitioner role has become broader and there is now no NP role in wound care available.   As a CNS I have autonomy and have developed my role according to our population needs; hence I have placed a strong focus on primary health care work in this role. This means I can see patients in their homes, including aged care facilities and run clinics in Invercargill and Gore Outpatient settings. 
Where to from here – future planning / aspirations
It is exciting to see the developments in wound care and part of my role includes ongoing product evaluations. As part of my NZ Wound Care Society volunteer work we are currently exploring a debridement certification course in NZ; since this is a competency that organisations find challenging to endorse. I will also be working again on updating the Trans-Tasman venous leg ulcer guidelines this year which takes considerable time and commitment. 
I would love to participate in future education based research. The opportunity to undertake my research in aged care and being able to empower healthcare assistants was fantastic and more work is needed here. As a CNS the quote by Benjamin Franklin summarises my work ethos.
“Tell me and I forget,
Teach me and I may remember,
Involve me and I learn.”
 

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Name - Julie Smith

Area of Specialisation - Haematology

Qualifications - RN, MN

Location - Southland Hospital, Invercargill, Southern DHB

Julie has worked for the SDHB for the past 34 years in a variety of roles.  She graduated in 1985 and spent twenty years working in neonatal and post-natal care before moving to the Oncology department to cover maternity leave. From there Julie has developed her passion for haematology nursing, and has covered a variety of roles on her time.  Haematology is a complicated and high acuity area of care.  Julie developed her passion for haematology early on by focusing on the haematology clinics for visiting specialists which lead to her becoming the resource and liaison nurse for the unit. Julie also worked as the palliative care advisory service nurse covering maternity leave and then went on to become the Clinical Nurse Specialist for haematology. 

Julie started her post graduate education journey in 2015 and has just submitted her dissertation for her Masters of Nursing on “healthcare providers’ perceptions of early palliative care and how it applies to haematology and oncology patients”.  Other core papers were long term conditions, advanced health assessment, pharmacology and research methodology. Julie is also an RN prescriber which has made a significant change to her practice as there is no onsite prescriber in the oncology service. She is able to provide appropriate and equitable care in supportive medication, prescribing mainly anti emetics, antibiotics, anti-virals and bowel support.   

Julie works within the regional Southern Blood and Cancer Service where all haematologists and oncologists are based in Dunedin and visit Invercargill for clinics – these occur weekly. There are no medical staff attached to the Oncology/Haematology day unit which is consequently, very much a nurse-led service. Many patients need to visit Dunedin for their first specialist appointment and for first or all chemotherapy treatments and procedures, including radiotherapy. Christchurch take care of our stem cell transplant patients who often are there for several weeks to months - thus there are significant psychosocial stressors impacting on treatment journeys. The Southland service includes all of Southland and up to Queenstown. Dunedin looks after the rest of Central Otago and through to Oamaru.

The CNS haematology role involves holding nurse led clinics for treatment patients, long term follow up for non-malignant and malignant haematology cancers, patients due for chemotherapy in Southland and clinic over flow. Julie also provides input to patients coming back to Southland post treatment and meets with new patients prior to going to Dunedin for treatment. Julie has oversight of these patients and will liaise with any issues with Dunedin haematologists.  

Julie collaborates with many services across the Southern region including hospice, internal medicine, Gps, nursing homes, the emergency department and other CNS in roles like palliative care, oncology and the cancer nurse coordinator.  These services all play a vital role in delivering care to patients through our region and Julie works as part of this team to coordinate and establish care.  Julie encourages her colleagues to be self-directed and critical thinkers and aims to advance nursing in this area.

Julie is aiming to become a Nurse Practitioner (NP) and is keen to broaden her focus in primary health and other areas of care. Julie sees an area in which she could develop is providing care for monitoring patients with low grade haematological conditions in the community.  Not all patients can be seen by a haematologist and so many are cared for in the community by their Gps.  This has been reiterated by Gps that this is an area in which there could be more support at the Haematology evenings Julie has run locally in recent years. Also an area in which she could make a difference is from findings from her dissertation with patients who have an incurable malignancy but don’t met the criteria for specialist palliative care input.

Julie is a member of the Clinical Nurse Specialist Society of NZ (CNSSNZ) and was instrumental in the successful biennial CNSSNZ conference held in 2019. Julie is also an active member of the Southland CNS group and she is valued for her role as a resource for the oncology department at Southland hospital. Julies also provides mentorship to a colleague currently completing post graduate qualifications.

In Julie’s spare time she is a very involved grandmother and is a fabulous singer (as anyone who attended the CNSSNZ biennial conference in Invercargill in 2019) will confirm and has been involved with musical theatre in Invercargill in the past.

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