Category Archives: Blog

Crisis? What Crisis?

I’m a nurse. Every day at work somebody is in crisis.

Every. Single. Day.

People have life threatening injuries and illnesses. People experience suicidal ideation and sometimes act on those thoughts. People experience delirium, dementia and psychosis – they lose touch with reality. People behave in unexpected and challenging ways.

All of these people are in crisis. They are having the worst day(s) of their life.

When you are part of the clinical team trying to help out these people it’s always useful to acknowledge and clarify the nature of the person’s crisis. It’s surprising what the individual’s perception of the crisis is. I’ve met a person who was desperately unwell – ICU unwell – who’s subjective crisis was that the cat was home alone without anyone to feed it. That was the crisis she wanted me to respond to. I’ve met quite a few people who need urgent medical/surgical interventions, but who perceive their biggest crisis as being unable to smoke a cigarette right now. I’ve had the peculiar privilege of spending time with people who have survived suicide attempts, who have experienced a crisis related to abuse, financial problems, relationship breakdown, and loss of job/role/independence/sense-of-self. An existential crisis in mind, body and spirit.

All of these people are in crisis. It is their crisis.

It is important to ascribe ownership. The nurse/midwife/physician/other clinician is not experiencing the crisis; they are responding to the crisis. We (the clinicians) have not been immunised against crises, but we do have the responsibility to do whatever we can to not get overwhelmed by them. Also, truth of the matter is, I’m not sure how long you would last if you responded to every day at work as an adrenaline-filled, too-busy-to-wee, emotional rollercoaster. That be the road to burnout and breakdown, my friend.

So, what do we do?

We use Jedi Mind Tricks, pithy sayings and clinical supervision. That’s what we do.

Clinical Supervision
I’ve written about clinical supervision before (here and here). Despite the name, it’s not about scrutiny. Clinical supervision is about reflecting on clinical practice with a trusted colleague, and asking simple questions of yourself: what did I do?; what were the outcomes?; how did I feel?; what lessons did I learn?.

The idea of clinical supervision is to acquire and refine clinical skills.

Pithy Sayings
A lot of us use and repeat pithy sayings such as the ED adage: “In the event of a cardiac arrest [or any other patient crisis for that matter], the first pulse you should take is your own.”

If you recognise your own anxiety you’re more capable of managing it. Intentional slow breathing is an excellent intervention for this. You can do it while you’re scanning the patient/file/environment.

Breath. Slowly.

It is not a crisis. A crisis is when there’s a fire, storm-surge, tsunami, earthquake or explosion that requires evacuation of staff and patients. If the hospital is not being evacuated it’s not a crisis. It’s just another day at work.


Jedi Mind Tricks
The other thing I like to do when feeling anxious is impersonate a calm person. It’s like a Jedi mind trick. “This not the anxious nurse you’re looking for. This is a calm nurse.”

When impersonating a calm person  I conjure-up a person who was a CNC when I was a student nurse at the Royal Adelaide Hospital. Part of the apprenticeship model of nursing education at the time was to give students experience in RN roles. I had been thrown into the Team Leader role on a day when the neuro ward was especially busy. There were emergency admissions, a stack of post-op patients – two of whom were really unwell, a person dying in the side room, and an inexperienced unqualified overwhelmed drongo (me) coordinating the whole thing. We were in trouble. We needed more nurses and a proper team leader.

I sought-out the CNC – a smart-as-a-whip young woman not much older than me (i was quite youngish 25 years ago). The CNC spent all of about 5 minutes with me prioritising the ward’s workflow:

  • “First things first. No need to shower/clean anyone unless they’re incontinent.” There goes about 50% of the morning’s workload in an instant.
  • “Don’t bother with routine 4-hourly obs unless the person looks unwell. Only the post-op patients and the clinically unwell patients need their obs done.” There goes another 10% of the work.
  • “Let’s get Fiona (the most experienced and skilled nurse on the shift) to look after the two dodgy post-op patients and nobody else.” The biggest concern was instantly taken care of.
  • “Bring all the nurses in here (a cramped nurses station overlooking 2 bays of 6 patients each) and tell them the plan. Make sure they all drink water and coordinate their breaks.” Got it. To look after the patients you need to look after the nurses.
  • “After you’ve told the nurses the plan, tell the patients/visitors who aren’t critically unwell the plan. They’ll understand we’re abnormally busy if we tell them.” Open, honest communication? Who’d have thought?
  • “Slow down your breathing. Use your humour. You’ll be fine. Come and grab me if you need.” My racing thoughts slowed. Panic evaporated.

We, nurses and patients alike, had a good shift. All the vital stuff was done. It wasn’t a crisis. It was a day at work.

I haven’t seen that CNC (her name is Lee Madden) since 1992, but I think of her every now and then. Whenever I see a crisis unfolding or see/feel anxiety rising, I wonder, “What would a calm person do?” and conjure an image of Lee floating serenely into the space. I channel Lee’s reassuring smile and clear understanding of priorities, and do my best to behave in the way she modelled to an impressionable overwhelmed student nurse.

Crisis? What crisis? I’m impersonating a calm person.



As always, you’re welcome to leave comments below.

Paul McNamara, 5th September 2015
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Living Close to the Water

August 8th is “Dying To Know Day” – an annual day of action dedicated to bringing to life conversations and community actions around death, dying and bereavement. More info about that here:


The first time I read “Field Notes on Death” by Lea McInerney was two years ago when I stumbled across it via the #DyingToKnowDay hashtag. It is a beautiful, poignant piece of writing, where Lea draws on her experience growing-up Catholic in the 1960s/70s, and later becoming a nurse. I’ve re-read Field Notes on Death four or five times over the last couple of years. I re-read it again this morning. Just as I did every other time, I quietly started crying about three quarters of the way through.

I cry too easily. I have been terribly embarrassed by this on many occasions. It’s not that I don’t think men shouldn’t cry, it’s just that I think I cry too easily. Too easily for my liking anyway.

A couple of things happened recently which make feel slightly less embarrassed.

One was seeing the generous, open display of grief shown by Adelaide Football Club players and staff after the death of the team’s coach. For those not familiar with Australian Rules Football, the players are mostly “blokey blokes”. They are men so manly they make other men question their manliness. They’re fit and fearless. Tonka trucks are nowhere near as tough.

These manly young men wept openly in public. Not embarrassed. Not ashamed. They have never been more inspiring. Never been better role models.

The other thing happened at work. I met a lady who was referred because of postnatal depression. My job involves listening mostly, but I ask questions too, in the hope of gaining an understanding of what support strategies would be most useful. When I asked her whether she had been more tearful than usual, she responded:

Where I grew up we have a saying that translates into English as “lives close to the water”. It refers to people who are sensitive. People who cry easily.
I have always lived close to the water. 

It’s a lovely metaphor. Doesn’t everyone want to live close to the water? That’s where you’ll see some of the most beautiful views.


Trinity Inlet, Cairns

In Closing

Field Notes on Death is a great read. I intend to re-read it and re-share it every year on #DyingToKnowDay. I thoroughly recommend it to anyone, and think nurses and other health professionals who are exposed to end of life care/issues will find it especially useful.

In case you missed the subtle hyperlinks to “Field Notes on Death” above, here is the full URL: 



Thanks for reading. As always your comments are welcome below.

Paul McNamara, 8th August 2015
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When it’s illegal to be ethical

Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015) source. Whether nurses deserve that reputation or not, I’m pleased that the other stereotypes of nursing (eg: selfless angel, sexy nurse, Nurse Ratched, subservient nurse, murderous nurse, zombie nurse, etc) haven’t overwhelmed the public perception that most of us are honest and ethical.

“Ethical and honest” is a pretty good reputation for the nursing profession to have. A reputation to be proud of. A reputation worth defending.

These organisations are cosignatories to a media statement calling for amendments to Australian Border Force Act 2015

These organisations are cosignatories to a media statement calling for amendments to Australian Border Force Act 2015

As per media statements released over the last few days [here, here and here], it may soon become illegal to be ethical and honest for nurses, doctors and allied health staff working in Australia’s immigration detention centres.

Australian Border Force Act 2015 acts to silence honesty and to out-trump ethics with a threat of two years jail for advocating for patients. This is very dangerous territory.

Toni Hoffman Australian of the Year Awards 2006. Image source:

Toni Hoffman Australian of the Year Awards 2006. Image source:

Less than a decade ago a nurse in Bundaberg, Toni Hoffman, was commended in a Queensland Public Hospitals Commission of Inquiry thus:

I would also like to pay tribute to certain people whose care, passion or courage was instrumental in bringing to light the matters covered here. First and foremost of those is Ms Hoffman. She might easily have doubted herself, or succumbed to certain pressures to work within a system that was not responsive. She might have chosen to quarantine herself from Dr Patel’s influence by leaving the Base or at least the Intensive Care Unit. Instead, and under the threat of significant detriment to herself, Ms Hoffman persistently and carefully documented the transgressions of Dr Patel.

For being ethical and honest Toni Hoffman won some praise and copped a whole heap of flak. Only Toni can tell us whether her personal costs were offset by the public benefits. However, if a nurse working in any of Australia’s detention centres is faced with comparable ethical concerns, speaking honestly about it could cost them two years in prison.

That’s a high cost to pay.

What’s the sense in making it illegal to be ethical?


As always, your comments are welcome below. If I’ve totally misunderstood the legislation and you can explain to me how preventing health professionals from advocating for their patients is a good idea, you’re VERY welcome to leave a comment.

Paul McNamara, 20th June 2015
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We Bald Nurses

This might be the shortest blog post in the history of humans – it’s a list of bald nurses on Twitter. So far I know of three six:

Ian Miller aka @TheNursePath

Sean Dent aka @iamunafraid

Jesse Spurr aka @Inject_Orange

Austyn Snowden aka @AustynSnowden

Kelsey David Burnham aka @EnlightenedAss

Paul McNamara (me) aka @meta4RN

The proposed #WeBaldNurses motto is Herba non adnatus occupatus platea – the Latin version of “Grass does not grow on a busy street”.

bald-headNursing gentlemen who have heads eschewed of hair are a minority amongst a minority, and need to stick together.

I hope to find more of us – please let me know of anyone who should be added to the list via the comments section below, or via Twitter using the #WeBaldNurses hashtag. I will update the list above PRN.

That’s it for now… a big shout-out to all the nurses out there who are not frittering their money away on shampoo, conditioner, brushes and combs.

Paul McNamara
Originally posted 30th May 2015
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Updated: 31/05/15, 01/06/15




Fun Facts re Nursing and Midwifery

To celebrate International Nurses Day 2015 here is a list of fun facts as they pertain to Nursing and Midwifery. Each fact is of a Tweetable (is that a word?) length, and cites the website from where the fact was attained.


12th May = Florence Nightingale’s birthday = International Nurses Day. 

Florence Nightingale was named after the city in which she was born (Florence, Italy).

Amongst Florence Nightingale’s achievements was the introduction of female nurses into military hospitals. Yes, female nurses. 

Florence Nightingale was a talented statistician who invented a variation of the pie graph.

IND_2015_Eng_posterAs at December 2014 there were 326,782 practicing Nurses + Midwives in Australia.
Source: numbers: 262,636 registered nurses + 60,755 enrolled nurses + 3,391 midwife-only registrations =  326,782

Of Australia’s 32,956 Midwives, 29,620 of them are also Nurses. That’s 89.9%.
Source: numbers: 3,391 midwives+ 30,199 people registered as both a midwife and either a registered nurse and/or an enrolled nurse

Only 0.9% of Australia’s Nurses and Midwives are Aboriginal and/or Torres Strait Islander (2013 figures). 


72% of Australia’s Nurses and Midwives earned their first qualification in Australia.

90% of Australia’s Nurses and Midwives are Clinicians, 3.5% are Educators.

56% of Australia’s Nurses are aged 50 and over. Not that there’s anything wrong with that. 

29% of Australia’s Mental Health Nurses are aged 55 and over. Not that there’s anything wrong with that.

An Australian company, Ausmed Education, host an online guide to Twitter for Spanish-speaking Nurses.


Nine Nurses were on included on the 2015 Australia Day Honours List. 

The Catholic Patron Saint of Mental Health Nurses is Dymphna.

In Australia, 89.6% of Nurses are female, as are 69% of Mental Health Nurses and 98.2% of Midwives.

In Australia, 10.4% of Nurses are male, as are 31% of Mental Health Nurses and 1.8% of Midwives.
Sources: + + 

57.4% of Australia’s Nurses and Midwives have a main job that is hospital-based.
Source: Table 10

42.6% of Australia’s Nurses and Midwives main job that is not based in a hospital.
Source: Table 10

Australia’s registering body does not recognise any Nursing Specialities, but recognises 23 Medical Specialities.
Sources: +

Only one state in Australia (Queensland) has a program  that aims for all Nurses working Mental Health to be Mental Health Nurses. 


The Australian Nursing and Midwifery Federation is Australia’s largest health union.

The Australian Nursing and Midwifery Federation is the second largest trade union in Australia. 

Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015). 


A list of Australia’s blogging Nurses is maintained by NurseUncut.

There are over 50 separate Nursing Organisations in Australia.
Sources: + +



That will do for now. I plan to Tweet each of these fun facts out on International Nurse Day using the #IND2015 hashtag. Do you know of any fun facts that I’ve missed? If so, please add them in comments section below, and I’ll include them on the list.

Paul McNamara, 12th May 2015
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Nurses with Cred

Last week, after a fair bit of a nudge, Australia’s federal government made the National Review of Mental Health Programs and Services available. This infographic from the report caught my eye:

That nursing is the largest single component of Australia’s mental health workforce isn’t a surprise. What is a bit unsettling is that the big bubble with 19,048 in it is mislabeled as “Total mental health nurses”.

That’s not true.

Working in mental health does not make you a mental health nurse, in the same way as driving through Bathurst does not make you a racing car driver. Just because you have a basic licence and you are in the right setting, it doesn’t mean you have the skills to perform safely at a high standard. It doesn’t mean you have cred.

As per AHPRA’s Nursing and Midwifery Board there is no registration category for a specialist mental health nurse, there are only these types of registration:

  1. Registered nurse
  2. Enrolled nurse
  3. Midwife

Compare this with types of registration listed by AHPRA’s Medical Board (sub-speciality fields and full range of speciality titles not included):

  1. Addiction medicine
  2. Anaesthesia
  3. Dermatology
  4. Emergency medicine
  5. General practice
  6. Intensive care medicine
  7. Medical administration
  8. Obstetrics and gynaecology
  9. Occupational and environmental medicine
  10. Ophthalmology
  11. Paediatrics and child health
  12. Pain medicine
  13. Palliative medicine
  14. Pathology
  15. Physician
  16. Psychiatry
  17. Public health medicine
  18. Radiation oncology
  19. Radiology
  20. Rehabilitation medicine
  21. Sexual health medicine
  22. Sport and exercise medicine
  23. Surgery

Medicine and nursing do not correlate on every detail of specialisation, but still… why such a big disparity between the two in terms of registration? Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015) [source], but I wonder if the public is aware of a problem with nursing specialities not being given the similar recognition as medical specialities.

Midwives have made their speciality distinctly different in the eyes of the public and other health professionals. I am sure it is a comfort for many expectant parents to know that the person guiding you through pregnancy, labour, childbirth and early parenthood is a qualified specialist and is acknowledged and registered as such.

However, people receiving support/treatment for a mental health condition will not necessarily have a specialist mental health nurse providing that service. It’s quite the opposite of midwifery – the nurse providing care may have no specialised qualifications in mental health. I wonder how service users and the people who love them feel about that.

I’ve been a medical, surgical and high-dependency/ICU nurse, and have worked closely with Midwives. I can tell you with confidence that mental health nursing is as different from general nursing as midwifery is. There are some transferable skills, of course, but midwifery, general nursing and mental health nursing each have a completely different model of care, and a very different way of working with people.

It’s not all doom and gloom though: the Australian College of Mental Health Nurses (ACMHN) have a process to credential suitably qualified and experienced mental health nurses.  In the absence of AHPRA being able to discriminate the difference between a general nurse and a mental health nurse, ACMHN are essentially saying, “Leave it to us. We will tell you who is a mental health nurse and who is not.” To be credentialed by the ACMHN, applicants must demonstrate that they:

  1. Hold a current licence to practice as a registered nurse within Australia
  2. Hold a recognised specialist / post-graduate mental health nursing qualification
  3. Have had at least 12 months experience since completing specialist / postgraduate qualification OR have three years experience as a registered nurse working in mental health
  4. Have been practicing within the last three years
  5. Have acquired minimum continuing professional development points for education and practice
  6. Are supported by two professional referees
  7. Have completed a professional declaration agreeing to uphold the standards of the profession. [source]

QHcredential_Page_27There’s more good news: Queensland Health has set targets to work towards a fully qualified, fully credentialed mental health nursing workforce. I wonder if other state health departments are thinking about implementing a similar strategy. It might be important: a program staffed entirely by Credentialed Mental Health Nurses was described as “one of the most innovative services ever funded” [source].

Credentialing + Ability = Credibility.

Credentialed Mental Health Nurses have Cred.

One last thing. It is encouraging that mental health is not the only nursing speciality in Australia that is setting the standard, for saying, “We the specialist nurses will tell you who is a specialist nurse and who is not”.  Under the Credentialing for Nurses initiative, currently there are six specialty nursing organisations working collaboratively to develop consistent, evidence based, recognition for specialist nurses:

  1. Australian College of Operating Room Nurses
  2. Australian College of Children and Young People’s Nurses
  3. Australian College of Mental Health Nurses
  4. College of Emergency Nursing Australasia
  5. Gastroenterological Nurses College of Australia
  6. Palliative Care Nurses Australia

Every speciality area of nursing,  every healthcare organisation, and every patient needs the same thing: Nurses with Cred.


That’s it, as always your comments are welcome.

Paul McNamara, 28th April 2015

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Australian College of Mental Health Nurses, 2015: Credentialing for Practice Program

Corderoy, Amy. (2015, 25th April). Innovative mental health program falling victim to funding freeze. Sydney Morning Herald

Credentialing for Nurses

National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC

Roy Morgan Research. (2015, 28th April). Roy Morgan Image of Professions Survey 2015: Nurses still easily most highly regarded. Finding No. 6188



Health Professionalism and Digital Citizenship

This post is the companian peice to a Prezi of the same name, and serves mostly as a collection point for references and thanks.


The Prezi is intended as an oral presentation, so I do not intend to include a full description of the content here. After watching the Prezi/hearing the presentation regular visitors to will recognise some familiar themes. Let’s not call it self-plagarism (such an ugly term), I would rather think of it as a new, funky remix of a favourite old song. Due to this remixing of old content I’ve included previous blog posts on the reference list.

I am more than just a bit embarrassed at how self-referential the Prezi/my presentation is. Not only does this make me look like a total narcissist, it also calls the credibility of the presentation into question. I’ll need to cop those criticisms on the chin until more Australian mental health nurses provide examples of professional use of social media. When that happens, I intend to replace some of the meta4RN content of the Prezi with that of other Australian mental health nurses.



Thanks to all those who contributed to the Prezi/presentation either directly or indirectly. There are too many to name at the moment [I have a deadline looming], but you’ll see glimpses of their names and faces on Twitter, Blogs and Facebook as you look through the Prezi. These are some of the people that make using social media such a pleasure. When I have time, I intend to come back and list all the contributors below:




References for Prezi “Health Professionalism and Digital Citizenship”

Australian College of Nursing (n.d.) Social media guidelines for nurses. Retreived from…for_nurses.pdf

Australian Health Practitioner Regulation Agency. (2014, March 17). Social media policy. Retrieved from

Casella, E., Mills, J., & Usher, K. (2014). Social media and nursing practice: Changing the balance between the social and technical aspects of work. Collegian, 21(2), 121–126. doi:10.1016/j.colegn.2014.03.005

Citizen Kane DVD cover. (n.d.). Retrieved from

Facebook. (2015). Facebook logo. Retrieved from
Ferguson, C., Inglis, S. C., Newton, P. J., Cripps, P. J. S., Macdonald, P. S., & Davidson, P. M. (2014).

Social media: A tool to spread information: A case study analysis of Twitter conversation at the Cardiac Society of Australia & New Zealand 61st Annual Scientific Meeting 2013. Collegian, 21(2), 89–93. doi:10.1016/j.colegn.2014.03.002

Instagram. (2015). Instagram logo. Retrieved from

Li, C. (2015). Charlene Li photo. Retrieved from

lifeinthefastlane. (2013). #FOAMed logo. Retrieved from

McNamara, P., & Meijome, X. M. (2015). Twitter Para Enfermeras (Spanish/Español). Retrieved 11 March 2015, from

McNamara, P. (2014). A Nurse’s Guide to Twitter. Retrieved from

McNamara, P. (2014, May 3) Luddites I have known. Retrieved from

McNamara, P. (2013) Behave online as you would in real life (letter to the editor), TQN: The Queensland Nurse, June 2013, Volume 32, Number 3, Page 4.

McNamara, P. (2013, October 25) Professional use of Twitter and healthcare social media. Retrieved from

McNamara, P. (2013, October 23) A Twitter workshop in tweets. Retrieved from

McNamara, P. (2013, October 1) Professional use of Twitter. Retrieved from

McNamara, P. (2013, July 21) Follow Friday and other twitterisms. Retrieved from

McNamara, P. (2013, June 7) Omnipresent and always available: A mental health nurse on Twitter. Retrieved from

McNamara, P. (2013, January 20) Social media for nurses: my ten-step, slightly ranty, version. Retrieved from

Moorley, C., & Chinn, T. (2014). Using social media for continuous professional development. Journal of Advanced Nursing, 71(4), 713–717. doi:10.1111/jan.12504

New South Wales Nurses and Midwives Association [nswnma]. (2014, July 30). Women now have unmediated access to public conversation via social media for 1st time in history @JaneCaro #NSWNMAconf14 #destroythejoint [Tweet]. Retrieved from

New South Wales nurses and Midwives’ Association. (2014). NSW Nurses & Midwives Association logo. Retrieved from

Nickson, C. P., & Cadogan, M. D. (2014). Free Open Access Medical education (FOAM) for the emergency physician. Emergency Medicine Australasia, 26(1), 76–83. doi:10.1111/1742-6723.12191

Nursing and Midwifery Board of Australia (2010, September 9) Information sheet on social media. Retrieved from

Twitter. (2015). Twitter logo. Retrieved from

Wall Media. (2015). Jane Caro photo. Retrieved from

Wilson, R., Ranse, J., Cashin, A., & McNamara, P. (2014). Nurses and Twitter: The good, the bad, and the reluctant. Collegian, 21(2), 111–119. doi:10.1016/j.colegn.2013.09.003

WordPress. (2015). WordPress logo. Retrieved from

Wozniak, H., Uys, P., & Mahoney, M. J. (2012). Digital communication in a networked world. In J.

Higgs, R. Ajjawi, L. McAllister, F. Trede, & S. Loftus (Eds.), Communication in the health sciences (3rd ed., pp. 150–162). South Melbourne, Australia: Oxford University Press.

YouTube. (2015). YouTube logo. Retrieved from


That’s it. As always your comments are welcome.

Paul McNamara, 14th March 2015