Coming from her training at a large city hospital, Wendy Waters had no idea how the work of a small rural hospital would compare. After 31 years at Yass Health Service, she says it is quite amazing what the nurses do with such limited resources.
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Since she arrived, the hospital has been gradually reduced but the emergency department is always busy with farming and traffic accidents, seasonal campers and boating incidents, and the usual minor lesions and infections.
The hospital has visiting medical officers - local GPs on a 24-hour roster, and casual medical officers who often live onsite in the grand old hospital building.
Ms Waters did all her postgraduate training at Yass in emergency, high dependency and critical care, and soon became a clinical nurse specialist in emergency. She qualified as a nurse practitioner in 2005.
"Most of our registered nurses are advanced practice nurses and are empowered to initiate treatment until a doctor comes," she says. "This is a fairly small town so response time is rapid if there is no doctor onsite. Since I became a nurse practitioner, there is a lot more that I can do, working within a scope of practice with set boundaries.
“Normally I treat lower acuity patients or sometimes higher acuity with phone linkup. I triage, assess, examine, diagnose, treat and discharge. For the more serious cases, we do helicopter or road retrieval to major hospitals."
Emergency nurse practitioners can manage uncomplicated fractures using and interpreting onsite x-ray machines.
Ms Waters also carries out pathology tests and treats minor infections such as middle ear and urinary tract with antibiotics.
Yass Health Service does not include maternity but has a medical ward, palliative care and rehabilitation for patients who are transferred from large general hospitals.
"I love the diversity of emergency work," says Mrs Waters. "Every presentation is different. I have to use judgment and problem-solving skills, ensuring that it's not a disadvantage for people to present to a small country hospital. They are given the highest level of care with our wonderful staff and doctors."
Ms Waters is on the board of the College of Nurse Practitioners. Emergency nurse practitioners are the largest group and often work in metropolitan areas.
"Many city hospital doctors say they would be lost without our nurses because they free up the doctors for higher acuity cases," she says. "Nurse practitioners fill this gap.
“There is now this definitive pathway for nurses to keep working towards excellence in a practice role and be recognised for their work, instead of being lost to management."
As well as her emergency work, Mrs Waters has begun working with Auntie Jean's Mob - a group of indigenous women who invite her to come and talk about women's health issues. She might be discussing vital screenings for women, taking blood pressure and glucose levels, talking about menopause, but they love it and there are plenty of questions.
"We laugh a lot," she says. "They are more informed and can take ownership of their health, so they feel more comfortable about coming to emergency. They know they will be valued and listened to."
