Career evolution

Opportunities for growth in primary health care nursing 

by Lynette Smith, Primary Times writer 

Source: APNA Primary Times Summer 2024-5

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Ann Packham and Kylie Curtis have had very different careers. Kylie always wanted to be a nurse, and Ann, as a teenager, thought ‘that’s disgusting!’ What they share, however, is a curiosity about the causes of health crises and a desire to provide holistic care. This has kept both of them searching for professional roles within primary health care where they can intervene early and make a difference to the lives of their patients. 

Ann Packham 

General practice nurse EM Medical, Wollongong  

‘When I started as a primary health care nurse, I thought I’d just be sticking needles into people,’ says Ann Packham. ‘I didn’t expect to be so involved at every level of a person’s health and wellbeing.’ 

Listening to Ann talk about her career, it’s clear that work needs to be meaningful. Straight out of school she joined a bank. She helped people to achieve their goals, as she says – starting a business, for example, or getting finance for their home. It was work that made a real difference to people at every stage of their life. 

Seeing the culture of banking change in the 2000s made her look elsewhere, though. Her first job after leaving the bank was an office role in a school. ‘They threw me into a classroom of boys with both physical and intellectual special needs,’ she says. Discovering what a difference it made to the kids, she realised that she wanted to help people with their health and wellbeing. 

That led to a nursing degree. Ann discovered a thirst for knowledge (something she says she didn’t have when she was in high school) and loved the challenge. They didn’t talk about primary health care nursing though, she says, and assumed she’d find a place somewhere in a hospital. But as an Assistant in Nursing in a local hospital, Ann kept wondering about her patients, ‘How did you get here? What was happening before that led you to here?’  

It’s exactly these kinds of questions that makes Ann such a good fit for primary health care. After ‘kissing a few frogs,’ as she says, she’s now working as a general practice nurse in Wollongong. 

‘As a general practice nurse, I get to do it all,’ Ann says. Immunisations, wound care, cervical screening, blood collection, and a great deal more. But she’s also the practice’s champion for infection control, quality improvement and the cold chain.  

Above all, she loves doing health assessments and chronic disease care plans, which is where she sees the ‘art of primary healthcare’ come to the fore. Her life experience, observation skills and a ‘customer orientation’ mean that Ann can see the big picture but also the small signs that tell where the actual problem is – for example, the older man whose family thought had onset of dementia, when the issue was that his ears were blocked with wax. 

‘This is not about ticking boxes,’ Ann says. ‘I’ve played an integral part in helping people to manage their health,’ which is more than collecting health data but also educating people to get better health outcomes for them, rather than using scare tactics. 

Her clinic knows the value she brings doing health assessments and care plans and they give her the time to do them, even though the current funding model doesn’t reward that. For her part, Ann understands the impact of her work on the bottom line and is of the view that ‘if you look after your patients, they’ll look after the business.’ 

‘We need better understanding about primary health care and the role that nurses play,’ Ann says. The evolution of her own career shows that she needed to discover that for herself. She believes more needs to be done to make these pathways known to students, nurture them in these roles, and, importantly, remunerate them in a way that reflects the value they create for individuals and the community: ‘A lot of people won’t be able to work as a practice nurse, no matter how much they might love it, because they can’t afford it.’ 

‘The autonomy is great. The relationships are incredible. And I’m empowering patients.’ It’s never too late to discover the joy that comes from making a difference. 

 

Kylie Curtis  

Mental Health and Chronic Disease Leader at Harmony Nursing Australia, Adelaide  

‘I knew from when I was 5 years old that I wanted to be a nurse,’ says Kylie Curtis ‘and my goal has never changed.’ In 1998, she began in Berri Hospital in South Australia’s Riverland, working as a registered nurse across a broad scope of practice typical of rural hospitals.  

She soon discovered she had an aptitude for helping people with complex, mental health needs, and completed postgraduate study in mental health nursing. Working at the hospital, she watched as some people with mental health issues came in again and again because treatment options were limited.  

‘Someone might come into ED thinking they were having a heart attack whereas they were actually suffering from a panic attack, so I knew I needed to understand in a holistic way the role of mental health in someone’s health and wellbeing and find ways to intervene early.’ 

With no mental health team in Berri Hospital, Kylie worked in the community, where she built up her skills in early intervention and health promotion. In 2015 she fulfilled her goal of becoming the clinical practice consultant in mental health at Berri Hospital working with an integrated mental health inpatient unit and community team – she also completed her masters in mental health nursing in 2018. 

Kylie’s career up to the age of 45 is remarkable but also characteristic of many primary health care nurses: observant, curious, and tenaciously pursuing answers and better ways of doing things. It’s a career of constant purposeful evolution. The change that she feels is significant, though – her late career change – happened in Adelaide in 2019 where she pivoted out of the public health system into private health services so that she could specialise further in health care, early intervention and trauma-informed practice. 

Since then, she has been team leader of a mental health hospital avoidance program, providing early intervention, acute care, and preventative strategies, in a wrap-around response integrated with other primary health care services. During the pandemic, she managed the COVID hotels, supporting people with tailored intervention strategies through telehealth and face-to-face care. Interested in trauma-informed health care, Kylie also worked with a health care provider supporting 45 patients from culturally and linguistically diverse communities with biopsychosocial assessment, short intervention strategies, behaviour support, and mental health care plans.  

Since 2022, Kylie has been at Harmony Nursing Australia, where she provides assessment, prevention and early intervention health care to veterans in crisis accommodation. Her role also includes risk management and leadership for community nursing staff, as well as clinical care for a mental health and chronic disease program at the Andrew Russell Veterans Living Centre. 

‘I really value integrated, holistic care and advocate for recovery and capacity building,’ says Kylie ‘so people can cope with trauma and the stresses of life.’ The concept of a ‘social prescription’ is exciting to her and she’s keen to see this unfold across health care. 

That word ‘integrate’ comes up in Kylie’s conversation a lot. A nurse needs to integrate skills and knowledge when dealing with a patient experiencing an acute mental health crisis. Continuous pathways of care for people depend on integrated services and systems. Right now, any integration that happens occurs in the mind of an experienced nurse who, if she moves on or burns out, takes that understanding of the whole pathway with her.  

Over the years, Kylie has observed increased stress-related mental illness. She observes that there are ‘a lot of new and different traumas in society right now and fewer clinicians to help these people.’   

The primary health care sector is rich in opportunities for anyone interested, as Kylie’s career shows. She advises anyone starting in the field to ‘experience everything you can in a variety of settings and focus on the difference you can make for people,’ she says. ‘Change is hard but the opportunities for growth are so rewarding.’