Liver nurse embraces pioneer role
*Saroj Nazareth fought long and hard to become Australia’s first nurse practitioner in hepatology. Now she’s paving the way for others to follow, as she tells Sue Cartledge.
Royal Perth Hospital’s Saroj Nazareth is the first nurse practitioner (NP) in Australia working in the area of hepatology. She is also Western Australia’s first ever nurse practitioner, and is already acting as a mentor and role model to other senior RNs wanting to follow the NP career path.
Nazareth, a clinical nurse consultant in the hepatology and gastroenterology department, completed the final stages in April 2005, but was not registered to practice until November.
She is one of a breed of career nurses who don’t want to move into administration when they’ve reached the top rung as an RN. Nazareth has been nursing for over 20 years, coming to Australia in 1984 after training ICU and paediatrics in the UK.
When she joined the hepatology department at RPH, it was fairly small. Under the head of the liver service, Dr Wendy Chang, it grew, until by 2003 it was one of Australia’s largest, dealing patients with viral hepatitis.
Completing a Master’s in Applied Science in Nursing from Curtin University in 2000, Nazareth was already running the service’s outpatient clinics, and could see how becoming a nurse practitioner with an autonomous role would work for RPH and the liver service.
However, WA did not pass enabling legislation for NPs until 2003. In the meantime, Nazareth completed a second Master’s, in clinical specialisation, and at last, in April 2005, was recognised as WA’s first nurse practitioners.
“We were the pioneers,” she says of the team at RPH’s liver service. “it was very hard being the first, but we knew what we wanted, and we knew we had to be patient.”
“It was not easy to get the doctors on board – the idea of a nurse practitioner was still new in Australia and very new in WA; we needed to get the radiologist, the pharmacist, the microbiologist on board to get the protocols through and approved by the hospital’s protocol committee.
“We’ve been setting a pathway for the others to follow. Now when the others apply - 10 RNs at RPH are working towards NP status – it will be easier because the doctors know what it’s about and how we got the protocols right.”
Nazareth runs the RPH outpatient clinics for the liver service. She see mainly people affected by viral hepatitis, and is able to offer them complete care, assessing them, ordering radiology and pathology tests, reviewing the test, offering treatments, prescribing appropriate medications and referring them to specialists
“I can follow the patient the whole way through; if they come into casualty or admitted by the specialist, I can monitor their progress.
“Being a nurse practitioner is the most satisfying extension of your clinical practice. It’s a collaborative practice – that’s the best thing –I’m not working alone; I’m working with the doctors, allied health workers, psychologists, dieticians, social workers - a collaborative model of care.”
As well as running the clinics at the hospital and in the nearby prison, Nazareth has an important role as an educator. She teaches about viral hepatitis at ward level, but she also educates GPs and the general public.
To increase access to the service for people at disadvantage, (such as indigenous communities, ethnic minorities and people in rural areas), she takes GP education sessions every couple of months. She and a hepatologist fly to an area such as Esperance, a hundred kilometres from Perth and hold weekend seminars for as many as 30 GPs.
For minorities such as Perth’s Vietnamese population, she and her team hold public education sessions in churches and halls in the suburbs. Nazareth says the GP and Vietnamese sessions are working well, but it’s still hard provide access to people in Aboriginal communities.
She also sees the service needs to offer people access to drug and alcohol treatments.
Her main problem is finding enough time in the week to meet all the facets of her role.
“It’s very exciting. I’m really lucky; I really enjoy what I’m doing. I really love this work.
“It’s very rewarding – I have a good relationship with the others in this multidisciplinary team. We get on really well, and the work is very rewarding.
“The best things is to be able to give o much more to the patient; we can give them complete care. It’s a very exciting future for nurses to become practitioners.”
