Distance Education

Most of my education has been by one form or other of distance education.  My first 2 years of schooling were Grade 1 and Grade 2 at Meadows Primary School, then just as I was starting Grade 3, we moved out bush.  Our farm was 20km from the nearest bus stop, and the school was a 1 1/4 hour bus ride from that bus stop.  Rather than spend such a huge chunk of time sitting on a bus each school day, I was introduced to the South Australian Correspondence School (now SA Open Access College) and began my lifelong love affair with distance learning.  Every fortnight I would receive a package from the Correspondence School, which I would complete in 2 or 3 days then have the rest of the fortnight off.  Compared to the boredom and lack of intellectual stimulation of the classroom environment, it was Utopia!  It wasn't until Year 11 that I had to spend more than a week to complete each fortnight's package, and my grade sheets showed A's across the board.

I left school at the end of Year 11 to start work as a farm labourer, shearer, grain handler, truck driver, and fence fixer.  The plan was to get together enough resources to acquire my own land and become a farmer.  I was given the opportunity to do some cereal sharefarming in the mid 1980's which was to be my foot in the door.  Unfortunately both crops I was involved in financing failed, and I saw the writing on the wall.  Now what to do?  I decided to go back to school and complete Year 12, then go to university.  Year 12 was a culture shock, as I was 21 in a crowd of 17-year-olds, and had not set foot in a classroom since early 1974.  However, my independent study skills learned from the Correspondence School helped me to do well and complete Year 12 with a 96% grade.

Then came four years at university trying to find out what I wanted to do.  A year of Electronic and Electrical Engineering, a year of Mechanical Engineering, and two years of Surveying left me still confused what I was going to do.  During all of this, I was a volunteer Ambulance Officer, and in my second year of Surveying I starting going out with the daughter of a GP.  I spend many hours with this GP (and the daughter of course!!) discussing health care etc, and she suggested I should try medicine as a career.  So I applied, but was knocked back as a bad risk due to three uncompleted degrees already.  The Dean of the School of Medicine at Adelaide University suggested I acquire a nursing degree, then if I achieved high grades he would give me a place in medical school.

Three years later I graduated with a Bachelor of Nursing with the highest grade point average of my class over the three years.  Much of what I learned during my nursing degree was self-directed as I quickly found the lectures and tutorials were pitched at the lowest common denominator and were unbelievably boring.  So I spent much of the three years teaching myself from textbooks and journal articles, just like I used to do with the Correspondence School.  It worked for me, as I achieved a high enough grade (High Distinction average) to go to medical school.  Unfortunately for entering medical school, but fortunately for my life in general, I married Anita shortly after graduation and decided to stick with nursing for the time being as I was sick of being a penniless student.

My next educational endeavour was two years later when I was working is a busy metropolitan ED, and began a graduate program for Emergency Nursing.  This was almost entirely by distance education, and left me with a graduate certificate in Emergency Nursing.

Then after yet another change in my career, I ended up working as a Remote Area Nurse in Oodnadatta SA.  It didn't take me long to realise that I knew almost nothing that I needed to know to be effective, so it was back to distance education to fill the gaps.  I enrolled in the Master of Remote Health Practice and completed it over 3 years, then the Master of Remote Health Management over two more years.  The possibility of becoming a Remote Nurse Practitioner became achievable in 2010, so I then completed a bridging course to convert my first Masters to a Master of Remote Health (Nurse Practitioner).

What's next?  Well right now I'm refreshing my ALS certification via an online unit with CRANAplus, and in the next few months it is possible that I'll have the opportunity to start a PhD program.  So the love affair with learning, and in particular distance education, continues.  I am thrilled that my children have had the opportunity to do some of their schooling via Alice Springs School of the Air, as it has exposed them to the self-discipline, challenges and rewards of distance education.  If the skills they acquire through this form of learning are as useful to their lives as they have been in mine, then they will be fortunate indeed.

Making a difference

One of the things that makes work worthwhile is the opportunity to make a difference.  In my experience, this is a factor which is often underestimated, or perhaps undervalued, by managers.  It goes part of the way to explain why throwing money at remote health jobs does little to resolve the chronic shortage of personnel.  In fact, in some ways throwing increased money at remote staff has the effect of attracting mercenaries who are only 'in it for the money'.

So if it's not the money, and let's face it, the salary package for a Remote Area Nurse is among the best you can get in the profession, then what is it that keeps people in the field?  Well, my opinion is based on my experience as a Remote Area Nurse, as a remote Health Centre Manager, and as a manager of volunteers.  I think it depends to a large extent on the ability to make a difference, and to see and feel that you are doing so.  For many nurses, life is one of boredom and drudgery, doing the same work over and over again in a never-ending cycle until their backs pack up or they burn out physically and emotionally.  For a few, the rewards that come from helping a patient to find the road to health and follow it make up for all the failures.  It's all very well to patronise struggling nurses and tell them to 'focus on the successes and let the rest slide by'.  Unfortunately that ignores the reality of human nature, where we feel deeply our failures and they erode our confidence underneath the veneer of professional cheerfulness.  Making a difference to people is what makes the difference to us.  This is true of many endeavours, but I think it is most relevant when caring is part of the job description.

During my time in the SA Country Fire Service, I came to realise that most volunteers were giving their time and energy to the organisation because they could make a difference, and that met a need within themselves for their lives to mean something.  This was true even, or perhaps especially, of those who professed to believe religious dogma which was supposed to meet this need.  I used to think it was about the need to belong, and maybe in some ways that's a frequent starting point.  Now I think it is more about making a difference, and being recognised for doing so, that keeps people doing things that others find amazing.  Whether it is fighting fires in your own time, or living and working in a remote community away from family and friends, it is the opportunity to make a difference, and the recognition for doing so that is a potent driver for people sticking with it.

What this means for remote health is that if managers want to be serious about attracting and retaining good staff in the field, they need to stop their senseless bickering and bitchiness about little things that don't make a difference.  They need to focus on making it possible for staff to make a difference.  In Aboriginal communities, this means making a real effort, not the usual token gesture, to include Aboriginal Health Workers as part of the team.  Remote Area Nurses are hampered in their drive to make a difference if they don't have the tools and support they need, and a big part of this is the Aboriginal Health Workers.  Any RAN who doesn't see this needs to do themselves a favour and get the hell out of Aboriginal health ASAP.

To stop the soul-destroying revolving door of acute health care, the health system needs to be reformed to put more money into prevention than it does into cure.  Most of the work in remote Health Centres is acute care arising from preventable causes, yet bugger all is spent on prevention.  Managers tend to express their awareness of this stupidity by blaming the Remote Area Nurses for neglecting prevention, when it is the almost total lack of support and funding for prevention activities that stops it from happening.  You can't make a difference when the cards are stacked against you, and when your own employer is doing the stacking and then blaming you for it, it is not long before no amount of money will compensate for the disillusionment.

So what's the solution?  Give remote health professionals the tools they nned and the support they need to do what most of them are there for, to make a difference.  If you can't do that, or don't know how, then do everyone a favour and get out of remote health and give the job to someone who can.  Either that, or stop pretending that we are in the business of Primary Health Care and rename the health centres "Remote Band-Aid Stations".  Then we can keep wasting time and money and dedicated staff for another 50 years!

Bush Orders - bringing competition to remote areas

One of my long-held beliefs is that people who live in rural and remote areas need to support their local businesses, or risk losing them.  After all, city-based people are not going to drive to the middle of nowhere for the privilege of paying higher prices for a restricted range of lower quality goods.  So if those of us who live outside the cities don't pay up, country businesses will go belly-up.  I'm OK with that, because as far as I'm concerned, the country life is worth the extra expense, especially when you often get to save money in other ways so it balances out.

However, there is a limit.  In Tennant Creek, the sole local supermarket has a captive market which they shamelessly milk for all it's worth.  A regular fortnight's shopping at Tennant Creek will cost me at least $800, and that leaves quite a few items that I can't get at all until I go shopping in Alice Springs.  A comparable shopping trolley full in Alice Springs costs around $500, and includes everything I need.  The quality of fruit and vegetables is highly variable, ranging from OK to inedible, and staples like milk powder and bread are nearly twice the price that they are in Alice Springs.  There have apparently been a number of attempts to start up a bakery in Tennant Creek, but each time the supermarket conducts a price war until the bakery goes broke.  Then the price of bread goes through the roof again.

This is where Bush Orders comes in.  I am a Woolworths customer, so can only talk about their service, but I know Coles do it as well.  Every fortnight I fax a list of what I need to Woolworths in Alice Springs.  The Bush Orders team do the shopping for me, for a $20 fee (which is being scrapped soon) and pack it into boxes.  Meat and bakery items are frozen, fruit and dairy goods chilled, and the rest packed as general goods.  Most times it takes 6 boxes to pack my order (2 frozen, 2 chilled and 2 general).  I then pay $6 per box to have them freighted to Tennant Creek where they are held at the freight depot for me to collect at my convenience.  I could get them delivered to my door, but since I work nights, it's better if I collect them myself.  Then when I get home, it's like Christmas!  Everyone is keen to see what came in the boxes.  I'm caught up in it too, even though I placed the order, because the Bush Orders team usually throw in some freebies as well.

So for me, the benefits of Bush Orders are:

• Avoiding the extortion of a monopoly business
• Ordering groceries eliminates impulse shopping, as all purchases are planned
• I can still buy specials, by referring to the specials catalogue online that applies to Alice Springs
• It saves me having to drive to Alice Springs to buy the items that are not available in Tennant Creek
• I save the cost of the $20 shopping fee just in the bread, and more than recoup the $48 freight on everything else. On top of that, I save over $200 by not having to drive to Alice Springs.

Disadvantages are:

• It is hard to explore new items that we might like to try, so this has to wait until we travel to a Woolworths store. I can browse Woolworths online, but not the Alice Springs store.
• I have to keep money available in my account for up to 3 weeks as it seems to take that long for Woolworths to deduct the payment.  If I change to using a credit card for these purchases, that will eliminate this delay.
• We end up with a mountain of boxes that need to be disposed of.
• I like impulse shopping!!  Not that it's good for me.

Overall then, Bush Orders allows us to enjoy the services, range and quality available from a major regional supermarket for a relatively minor fee.  While I would like to support local business, I cannot support extortion.  I understand that businesses need to make a profit, but they need to understand that we live in a global economy and if they can't compete, they're out.  If that means no local supermarket, so be it.  The reality of course is that there will always be a supermarket here, and if a second one opens, competition will bring prices down to a fair level.  The supermarket pay their staff a pittance and don't open long hours, and freight is very competitive, so that doesn't justify the high prices.  Therefore I refuse to accept them.  Long live Bush Orders!!

Banking on frustration

I received a call from a bank while sleeping in preparation for night shift.  It seemed a reasonable call.  Let's start at the beginning...   Some time ago I completed an application for a new credit card which would facilitate Bush Orders from our chosen supermarket.  As part of the application, I naturally had to provide financial data to support my request.  And this is where it started to get surreal.

Carefully following the instructions received by phone, and rechecked to make sure I had missed nothing, I gave up some of my sleep after night shift to cycle to work and fax off the necessary documents.  These included the expected things, such as recent payslips to verify my salary.  No problems so far. 

About two hours later, I was woken by another phone call thanking me for the documents, and requesting that I now fax across a copy of my most recent bank statement!!  It seems that this was needed to verify my salary.  OK, so why did they want my payslips??  If they weren't proof of my salary, then want was the point of asking for them?  And why didn't they ask for the bank statement at the outset?  Of course the mindless drone that had the unfortunate job of ringing me didn't know the answers - not surprising as probably no-one in the bank knows!  Anyway, eventually I simmered down enough to get up, get the bank statement, blank out all the details they had no right to see, and cycle back to work to fax it off.  Whew!  Now it's done, just wait for a call to confirm or deny the application.

A week later, another drone rings to ask if I have received a letter asking for 100 points of ID.  Of course I haven't yet received any such mail, so I ask the drone how this works.  Seems I have to front up at the service counter at the nearest branch of the supermarket in question with 100 points of ID in order for my application to proceed.  I mention that this store is situated 507km away and I'm not planning a trip there anytime soon.  "No worries" says the drone.  "It's all explained in the letter, and you'll have 14 days to sort it out".  Well, the letter turned up a couple of days later, and it turns out the 14 days begins when the letter is typed, and 13 of them had passed before I received it.  OK, so I'd better get on the phone, because I'm working night shift again, and couldn't get to the store even if I wanted to.  Another drone takes the call - they must have an endless supply of these creatures!  She assures me that there's no problem and hangs up on me before I've even explained the situation.  Hmmm, I can see this is going to end well!!

Several days later, another drone (yes a different one again) rings me up (yes, waking me again) to ask if I have had a chance to complete the 100 points of ID.  Not wanting to spoil his obviously exciting day, I patiently explained that it is over 1000km round trip to get to the store, so there will be some delay.  He doesn't sound too sure about this, apparently he has been told that 98% of the Australian population live within 50km of one of the stores in question.  Therefore I am mistaken as no-one could possibly live 500km from a store!  He assures me that he will make a note on my application that it will be about a month before I can provide the 100 points of ID.  His final parting shot is that "we can't keep the application open for long".  My response is along the lines of, "Well that's your loss then because I'm not making a special trip of over 1000km just to do some paperwork. You'll just have to wait".  "Have a nice day, sir" says the drone before hanging up, having just ruined my sleep and ensured that I'll have anything but a nice day.

Finally, while sleeping in preparation this night shift that I'm on right now, I get a phone call from the bank.  Guess what, it's another drone!!  How many do they have?  So what do they want now?  Well, it seems that reading the customer's file is not one of their skills, because this drone launched into a spiel about needing to get 100 points of ID blah blah blah ...  So here we go for the fourth time, trying to explain to someone with the IQ of a pet rock why I haven't dropped everything and spent 2 days and several hundred dollars to dash to Alice Springs to present my ID at the store.  By this time I am starting to have serious reservations about doing business with this bank!!  I get through my explanation, then the drone asks sweetly "What would you like me to do".  Suppressing the urge to tell her where to shove my application, I beg her to mark my file DO NOT DISTURB and wait for me to get to the store, which will now be in two weeks or so.  She says to have a nice day, so I thank her for ruining my sleep and please just leave me alone.

So that's where it's at.  Maybe I'll eventually get the card.  I don't really care, as I certainly don't need it.  But it has been an interesting experience, and has reminded me why I bank with a credit union.

Redbank Gorge

One of my favourite places near Alice Springs is Redbank Gorge, about 220km west of Alice Springs in the West MacDonnell Ranges. The road is sealed except for the entry into the gorge carpark, which is about 8km of rutted dirt track. It can be accessed by normal car most of the time, but you'd have to take it very easy. A 4WD is a better option.

Once at the carpark, there is a strenuous 1.2km walk along the creek bed to get to the gorge. If you like clambering over rocks and wading through deep sand, then you'll enjoy the walk. Otherwise, just keep plugging away at it, as the gorge at the end is well worth the effort. Because the gorge is so narrow, it gets little sunlight, so the water tends to be chilly. This is OK as you have to work hard to swim through the gorge and this keeps you warm. Also, some flotation is a good idea. I'd recommend something like a small car inner tube, or a floatie ring, as anything big like an air mattress won't fit through.

At several points through the gorge, you have to climb over rocks worn smooth by millenia of water flowing over them. This can be tricky, and I would suggest always having someone with you in the gorge. It's not a tourist spot, so if you get injured, you may have quite a wait for someone to come along and find you. Most visitors to Redbank Gorge stop at the entrance and take photos there before leaving. I'd say only about a third of them attempt the swim through, and maybe 5% make it all the way through. There used to be a chain in the rock about 3/4 of the way through, but it was washed away in 2010, and I don;t know if it's been replaced. You can still get through (I have done it since the chain vanished) but it's difficult and most tourists give up at this point.

If taking a camera, make sure it's waterproof, or in a waterproof case.

Finally, keep an eye out for snakes in the water. I've seen one in the six times I've been to the gorge, and due to the cold it was very sluggish and easily avoided. Just make sure you see it first!

Registration inspection looming

I received my registration renewal notice via email recently for the Landcruiser.  Don't know how much it is because I can't open it!  And yes, I elected to have renewals sent to me via email not post.  Whatever the cost, I know it's due for a roadworthy inspection, so once again it's time to check everything over.

• Brakes have been replaced, so no worries there.
• All light bulbs working for once (though a couple will inevitably pack up just as the inspector looks at them as usual!).
• No oil leaks, as all previous leaks have been repaired and no new ones have appeared.
• All new steering joints, so steering is tight.
• New universal joints on the driveshafts.
• All suspension bushes replaced.
• New coolant hoses and fan belts.
• Headlights aimed properly.
• Seats and seatbelts in good condition.
• No rust in the bodywork.  Now what that has to do with road-worthiness is anybody's guess, but I know from bitter experience that some inspectors think it does.  I used to have a Falcon wagon which I kept in top mechanical condition, but it had a small rust spot over the rear wheel arch.  I was informed that I could not re-register the vehicle without having the spot repaired by cutting and welding, and would need re-inspection before painting.  Since this would cost more than the vehicle was worth, I didn't bother.  The infuriating thing is that the spot was there the previous year, exactly the same (and I mean exactly, as I had treated it with rust preventer) and there was no hint of a problem.  I wasted $240 putting in a new windscreen before inspection, and ended up having to scrap the vehicle.  My question is if nonstructural rust is such a major issue, why was it passed the previous year, and why do they pass rusted vehicles in much much worse shape owned by people with darker complexion than me?  I'll leave you to decide your own answer to that.
• Wipers work, horn works, windscreen washer works, all indicators and other lights work.
• Handbrake - well there we may have a problem.  I have completely replaced the handbrake system with new components, and it is still absolutely woeful.  It is the one thing I don't like about the 80 series Landcruiser.  Even brand new, the handbrake just barely passes the NT road-worthiness inspection.  My only hope is to adjust it right up till it has almost seized, have the inspection done, then back it off before driving home.  There's no point taking it to a brake specialist, as it is already new and still doesn't work.  They will simply adjust it up until it almost seizes, and charge me $500 for 5 minutes work with a screwdriver.

Anyway, I guess I'm just about ready for the inspection, so like all drivers of older vehicles, I'll go in with my fingers crossed and hope the inspector is not having a bad day.

Cookbook clinical practice

For many years I have been dismissive of the trend towards what I call "cookbook practice".  This is clinical practice in which all the decisions are pre-set, and the clinician just fills in the blanks and follows the resulting algorithm for treatment or referral.  My objection was based on the idea that clinical judgement is an expected skill/attribute exhibited by practitioners, and they should not have to be spoon-fed.

Recently, I have begun to have my thinking modified by some new data (well, 'new' to me anyway!).  Safety and quality in healthcare has been expensively studied over the years, and it has been found that having clinical guidelines in place significantly reduces the incidence of adverse events.  This may suggest that even good practitioners can benefit from having robust well-founded clinical guidelines to help with decision-making.  I'm still not completely comfortable with the idea, as I worry that guideline-based practice actually reduces the need for clinical judgement.  Maybe clinical guidelines work because practitioners need help making good decisions?  What if we looked at improving their decision-making, and their critical thinking?  Would that not achieve the same or better results?

In some ways, it seems analogous to the issue of young drivers on the roads.  This group are horribly over-represented in road crash statistics, so it seems logical that something needs to be done.  Is it more training and guidance for a longer period of time that is required, or is it more effort into creating drivers who think actively about what they are doing and learn good attitudes and habits?  If having L-plates for 2 years proves to be safer, what about 3 years?  If the restrictions of provisional drivers licences make young drivers safer, what's wrong with applying those restrictions to all drivers.  After all, if we did not allow anyone to drive until they were 21, the road crash data for 16-20 year olds would improve dramatically!

I think the answer is the have reasonable guidelines, then teach people how to think properly.  Some sort of attitude test if you like.  If you don't pass, you don't get a licence until you grow up a bit more.  I know some 16 year olds who are more mature than some 46 year olds, and much safer drivers as a result.  Likewise with clinical practice, I think it should be mandatory to pass some sort of critical thinking test before you are allowed near patients.  How that would look in practice, I'm still thinking about.  Watch this space ...

Losing weight

Yesterday I had the dubious pleasure of having an appointment to discuss my blood pressure control.  I spoke with a Registered Nurse, a renal specialist, and a dietician.  It seems that I have reached a plateau in my use of medications, currently at 4 tablets per day.  Now the focus is on shifting the lard from my midriff.  Easier said than done! 

About a year ago, I weighed 112kg and decided I was sick of being unfit and obese.  So I cut out eating bread, not because bread is a bad food, but because I tended to put bad stuff on it.  This was pretty successful, and in 3 months I lost 12kg and kept it off.  Over the next 6 months, I started eating bread again, but less than before and trying to choose healthier fillings.  The weight stayed around 100-102kg, which is where it is today.  The frustrating thing is that it doesn't seem to matter what I do now, I can't crack the 100kg barrier!  I even tried the bread thing again, but no luck this time.

Seems like portion control and physical activity is the way ahead.  So now that I have my new bicyle (see previous posts) I'm riding at least 16km daily.  Portion control is hard, but I'm trying an idea of using smaller plates to fool the eyes.  Time will tell if I can smash through the 100kg barrier and head to my goal of 90kg.  I know that if I can start getting the weight off again, then I will be motivated to keep doing whatever it was that made it happen.  Well, I think I know that anyway.  Here's to seeing what the scales say at the end of June, my next deadline.

Critical thinking presentation

I recently accepted an invitation to speak to a group of staff at TCH about critical thinking in clinical practice. The attached file is the one I used for the presentation. ...  Well, that was the plan anyway.  Seems the file didn't attach!  Maybe this will work instead:  Try this link

Holidays are coming!

I have an app on my iPhone that tells me that we go on holidays in 38 days.  In the Northern Territory we get 4 weeks school holidays in the middle of the year, so this is when our family tries to go on a big trip.

This year the plan is to go to Adelaide, then Brisbane and Fraser Island, back to Adelaide, then off to visit my siblings on Eyre Peninsula before returning home. We have four weeks to fit it all in, so part of the fun starts now with the planning.  There is a long list of people we'd like to catch up with, and we also have to fit in some essential tasks like fitting the new engine into the Landcruiser and getting it tuned correctly.

One of my concerns is security, as recently a Tennant Creek resident returned home from holidays to find his home wrecked and ransacked.  There's not a great deal you can do, except lock everything up and try to make it look as if you're still around.  We have insurance, but that wouldn't make up for losing the things which are dear to us.  Two of our bikes were stolen a few weeks ago, as I have posted about, and that was bad enough.  Anyway, I guess we just have to cope with the concern, otherwise the only solution is to never go anywhere.  If that was the solution, we'd be better off not owning anything!

So the holiday planning is coming along well.  There are so many things to arrange that this year I'm doing something new, I'm using a checklist to make sure I remember everything.  Maybe I'm just getting older, but it does detract a little from my enjoyment of a holiday when I forget something important!

Sleepover

Claire is having her first friend's sleepover for a long time, maybe 2 years or more.  The girls had fun dancing to the Wii, playing various console games, making a campfire in the backyard, making soup over the fire, playing hide-and-seek, eating home-made pizza, and generally having a lot of fun. Now at 1:40 am they are having their showers and getting ready for bed.  Might be a sleep-in in the morning!

Rational thinking

For a long time, I have highly valued rational thinking.  At school I was strongly attracted to the rational disciplines - mathematics, science, chemistry, biology, physics and so on.  Conversely, I was repelled by the fuzziness and subjectivity of humanities and the arts, in which the same piece of work can get different (sometimes vastly different) marks from different teachers.

When I dabbled in religion for a while, mostly to try to find some sense of belonging, I was likewise repelled by the almost total lack of logic and rational thinking.  Despite vehement assurances to the contrary, I finally realised that to accept religion I would have to reject rational thinking, so I did the only same thing I could do, I rejected religion.

Somewhere along the way, I was misled by a very common myth about rational thinking.  I assumed that there was such a thing as an autonomous rational mind, and this meant that two people applying rational thought to the same data set would arrive at the same rational conclusion.  After all, is that not true of the pure sciences such as mathematics - there is one right answer and a million wrong ones?  Well, yes and no.  While there may well be only one right answer in an absolute sense, in the real world there may be more than one rational answer.  Let's use the example of my wife choosing a dress to wear to a formal event.  It is likely that in her wardrobe, she has only one dress that really meets the criteria for the event, but if she doesn't like it, the rational choice is for me to agree with her wearing what objectively is 'second best'.  That is not because everything is relative, as I reject that premise, but because priorities and external factors do affect rational decision-making.  If someone holds a gun to your head and demands that you agree that two plus two equals five, is it rational to disagree with him?

So I guess the point is that I grappling with the implications of rational thought being inevitably coloured by subjectivity.  Firstly, I will have to be more accepting of people whose conclusions do not agree with mine about a particular situation.  Secondly, I will need to seek more external validation of my conclusions, so that I can benefit more from the wisdom of others, rather than relying on my own rational thinking.  Finally, I will need to spend more time examining my assumptions and biases, looking more deeply than I have previously to find the real reasons for accepting one idea over another.

And for the hot potato question - have I changed my mind about religion?  Absolutely not.  My problem is not that religion uses a different rational thinking than I do, it is that it is not rational at all.

Leadership

To pass the time on night shift, I was having a discussion with a colleague about various things affecting the nursing profession.  We covered a lot of things, and one of them was leadership.  It is sometimes (or often?) said that nursing suffers from a lack of leadership.  What does that mean?  What is leadership anyway?

In 2009-2010 I had the great privilege of participating in Course 16 of the Australian Rural Leadership Program, so I may have some answers. Or not.

Leadership is about moving forward, taking a group of people towards a shared goal.  It involves inspiration, encouragement, and negotiation.  It requires integrity and commitment, and a healthy dose of self-awareness and self-criticism for the leader.  An effective leader is one who is able to see both the day-to-day realities that impact on outcomes, but also the big picture that shows what it's all about and where we are heading.  He or she needs to be able to communicate the vision, and inspire other people to strive towards achieving it.

If this sounds like a tall order, that's good.  It is a tall order, and the reality is that if we settle for anything less from our leaders, we are shortchanging ourselves.  Leadership is not meant to be easy, although there are some very inspirational leaders who make it look easy.  Don't be fooled by appearances - it is very likely that these people work extremely hard behind the scenes to make things work up front.

So does nursing lack leadership?  I guess that depends on what standards you set, and which branch of the nursing tree you focus on.  The whole organism has some excellent leaders, such as the Commonwealth Chief Nurse (Rosemary Bryant), but the same cannot be said for all of the specialties.  For example, remote health relies on a few dedicated individuals to raise the standards and push for meaningful reform, but the general tone is one of mediocrity and pettiness.  The peak professional body CRANAplus can and does provide some of the leadership required at the big-picture level, but what is often sorely lacking is grass-roots leaders.  People are needed who are willing to step up to the plate and make their own practice exemplary, then accept the challenge to be role models to their peers.  'Tall poppy syndrome' is very real, but leaders have to rise above such petty jealousies and show the way to improve the world around them.  After all, if you can't make a difference by being a good leader, or by following one, what's the point?

Basics card - some thoughts

I don't know if this would work, or have consequences I haven't thought of, but I think all social security money should be via the Basics Card. I don't mean pensions and the like, but income support type payments like unemployment benefits and student payments. As a socialist society, we have a responsibility to support the less fortunate, and I accept the cost of doing so. However I strongly object to supporting a welfare lifestyle, in which people are able to live a life of indolence at my expense. The fact that people below the poverty line can afford to buy alcohol and tobacco, and other drugs, galls me. Especially when my tax dollars are funding this expenditure.
I read recently that the tobacco excise in the NT was to be increased by 25% and some tosser commented on the media that this would amount to child abuse as people would not be able to feed their children as a result. You've got to be kidding!!! What happened to parental responsibility and the need to set priorities? Maybe I should claim that I can't feed my children because I need the money to buy a new computer or upgrade my iPhone!!
The Basics Card can be used to purchase all of the necessities of life so 100% of welfare income should be managed in this way. If people want cash they need to get a job. Sure they won't be able to buy grog or smokes or take a holiday, but so what. Why should the state pay for luxuries anyway?

A bit of concrete

Today's project was to improve the accessibility of our yard for Anita's electric wheelchair.  A few weeks ago, I concreted a slab across under the gates to stop the dogs wriggling under the gates and getting onto the street.  This made it impossible for Anita to get out with her chair unless I was around to assist, so I made a couple of ramps.  Unfortunately, they were too short and steep due to not having enough concrete left over.  So today I had the extra concrete premix to complete the job.

The idea is to reduce the angle so that the wheelchair can safely cross the gateway.  As the chair reaches the top of the up ramp, it acts a bit like a bulldozer as it tips onto the down ramp.  This is because of the type of chair it is (see the picture)

The angle of the two ramps meeting at the top of the beam under the gate needs to be gentle enough so Anita doesn't get thrown out of her chair as she goes over the crest.  I think I have it now, with each ramp being a metre long to traverse a step 100mm high.  By making the ramps long enough, Anita will now be able to inch her way over, where before with the shorter ramps she had to keep up her momentum.  She said it was just a bit too exciting before as she had to hang on for dear life as the chair lurched over the summit and tried to launch her into the gravel.

If it was our own house, we'd concrete or pave the whole driveway and be done with it.  However, spending that sort of money on a rented house is silly, and while the landlord makes noises about paving the driveway, we'll be long gone before it happens!

Inside the house is pretty wheelchair friendly.  It's just getting into the yard, and then the house that's a bit tricky.  However, with the right ramps in strategic locations, we should be able to manage OK.

Old or new?

There have been times that I have wondered if it is better to buy a new 4WD rather than fix up the old one.  These times usually coincide with being covered with oil and grease, skinning my knuckles and swearing underneath the old one.  Fortunately, or not as the case may be, I usually feel OK about it all by the time I crawl out from under the vehicle and enjoy the thrill of having done the job myself.  So I've never seriously looked at getting a new 4WD.  

But what if I was serious about it?  Well, the first obstacle is the mirth of the lenders when I front up with a request for $40-80K.  Then there is my horror at the repayments if they actually agreed to my request.  It would cost more each month than my mortgage, and all for a depreciating liability that will drop steadily in value as it sucks my bank account dry.  On the plus side, and it's a pretty big plus after 40 years of working on engines (yes I stripped down my first engine at the age of six to work out how it ran, and yes again, it still ran when I reassembled it!) I wouldn't have to work on it to keep it going.  At least I hope I wouldn't have to work on it because I wouldn't be able to.

My current vehicle is in the process of getting a heart transplant, which will end up costing me about $5000.  The  bonus to sweeten the deal is that the transplanted engine has a turbocharger on it.  To fit a turbo kit on my existing engine would cost me around $2500 plus tuning plus pump calibration and probably overhaul, plus the engine rebuild needed before the kit went on.  All that would leave little if any change out of $10,000, so the transplant is economical.  However, there's no way around the fact that I will still have an old-technology engine, with old-technology fuel consumption to match.  While more modern large 4WDs boast fuel consumption of 10-12L/100km with their common-rail diesel engines, I typically count on 17-18L/100km.  The newer engine with a turbo may hopefully do better, say around 14L/100km, but still well short of the what the new technology can achieve.

What it comes down to in the end is the cost of making the change.  A new vehicle may be cheaper to run regarding fuel, but will cost a lot more in servicing and repayments.  My old 4WD is debt-free, so I can drive it for tens of thousands of kilometres for the price of a new vehicle.  So that's the answer for me - the old 4WD stays, and gets some well-earned TLC with the money I save by not buying a new one.  Not to mention going on some more awesome trips!!

The new bike has finally arrived complete with bike lock

When I went to collect our Bush Orders cartons, there were two extra cartons at the freight depot.  Yes, they were the new bikes.  No prizes for guessing what I spent the day doing - assembling, testing and setting up the two bikes.  Then I tormented Laura for a while by texting her at school about her new bike, knowing she couldn't get away to see it for 2 hours

After the girls finished school, Laura, Claire and I rode to the dam, which is about 11km round trip.  We're happy with the new wheels.  Just trying to forget why we needed new ones, and how much it has drained out of our savings!

Working at night - a good idea?

Since I'm currently working in a job that requires shift work, I'm doing mostly night shifts. This had a few disadvantages, as most people would immediately agree.  However, it also has some advantages:

1. A little extra money.  Night shifts attract a little extra bonus pay compared to morning and afternoon shifts.
2. Longer shifts means fewer shifts.  In my current job, night shift is 10 hours compared to 8 hours for the other shifts.  So full time work is 4 days (or nights) per week, leaving 3 days free for other things, including overtime.
3. Less workplace politics.  Night shift is not free of office politics, but it tends to be limited, partly because the audience for troublemakers and stirrers is limited so they gravitate towards the daytime.
4. I can be at home to take my children to school, and pick them up from school.  My sleep time is the six hours in between, plus an hour or two in the evening before work if I'm lucky.
5. Night shifts allow me to be home with my disabled wife during the day.  Then if she has a fall, or needs help with showering, I can attend to her.  Otherwise she'd be alone during the hours that the children are at school and I'm at work.
6. I can plan my days around knowing that I'll either be working at night or on leave or days off.  So if a courier parcel is expected, I know I'll be home to receive it.
7. Many colleagues dislike night shift, so it improves my popularity when I volunteer to work at night.
8. At night there are less doctors around, so I am often able to practice my Nurse Practitioner skills.  The reduces the waiting time for patients and reduces the workload for the night duty doctor.  And I enjoy the challenge and the extra responsibility.
9. When you work a significant amount of night shifts, you get a bonus seventh week of paid annual leave.
10. Attending staff meetings and inservice events is easy, as I know I won't be working.  I just have to juggle my sleep requirements, which is usually not too hard as these events tend to occur close to when I get up to collect the children from school anyway.

So that's a few reasons why I like night shift.  What's not to like?  Well, let's make that the subject of another post ...

Cheers

Forewarned is fore-armed, or is it?

Sometimes in the Emergency Department we get warning that a seriously unwell person is arriving, and this allows us to prepare the resuscittation room.  Other times, we get little or no warning.  Does this mean we're not ready for the patient?  At first glance it would seem so, but in reality it doesn't make any real difference.  I think this is because we always have the resuscitation room ready, even when we don't have anyone expected to use it.  Sure the drugs aren't drawn up and the chest drain pack hasn't been laid out.  But it only takes a few seconds to do that anyway.

During my career in emergency healthcare, I have noticed that the main effect of a long prior warning time before receiving a seriously injured or unwell patient is that some staff have time to have nightmares.  They get anxious about what to expect, and try to second-guess everything. My own approach is to be prepared for the worst at all times, so that whatever comes in the door I can deal with it.  Doesn't always work, but I don't often 'lose the plot'.

I remember one shift in a busy regional ED where I was Team Leader.  We had more patients coming through the door than we had spaces to put them, so I had to allocate staff and cubicles to deal with the most urgent.  If I had stopped to think about it, I don't think it would have gone very well, but at then end of the shift, we had coped pretty well with the workload.  Because I kept calm and seemed in control, the rest of the team were able to cope with the pressure.  Contrast this with a similar shift where a colleague was Team Leader, who had a tendency to second-guess decisions.  By the end of the shift we were all frazzled and fed-up.  And we didn't even have a patient in the resuscitation area!

So why am I going on about this?  Well, a colleague was recently overheard complaining that the ambulance service hadn't phoned through that they were bringing a fitting patient to our ED.  My opinion, for what it's worth, is that when you are Team Leader, you always have a contingency plan in the back of your head.  Then you don't need to be forewarned.  In fact, if you rely on being forewarned, there's a risk that you become complacent until the phone rings.

It's a bit like relying on the oil pressure warning light to come on before you get your car serviced.  Far better to plan some preventive maintenance.  OK, OK so it's not a perfect analogy, but hopefully you get the point.

That's it for now.

ARB air compressor a disappointment

I finally got around to dismantling the ARB air compressor mounted under the bonnet of the Landcruiser.  Sure enough, the exhaust valve has failed, again.  Last time it failed, I got a new one from ARB for about 70 cents plus $5 postage.  This time is was informed that the old compressor is no longer supported by ARB, and hence I can't get a new valve for it.  They say that they supported it for 3 years, and now I have to buy the new model.  Since I paid $360 for the old one, and hardly had any use out of it, I'm a bit annoyed that I have to discard it for the sake of a 70 cent piece of plastic. 
ARB really should have recalled the old compressors and replaced the flimsy nylon valves with brass or stainless steel, rather than turning their backs on customers who bought their poorly-engineered product. So I'm researching a new air compressor to go in the Cruiser, and chances are it won't be from ARB!!

Landcruiser upgrade

The upgrade on the 80 series is coming along well.  I have completed the replacement of all suspension bushes.  The castor correction bushes were an excellent addition, as they cured the slight wandering tendency arising from the 2-inch suspension lift.  I have replaced a rear universal joint, as I found it to be worn when I was under the vehicle doing the suspension bushes.  It's a case of looking for one problem and finding another!  Anyway, the new uni-joint was on the shelf in the workshop, so it was only a few minutes to make the repair.

When I went to replace the handbrake shoes, I found that Toyota altered the specs in August 1992.  Therefore the new shoes I bought for the previous Cruiser (a 1991 model that got written off by a drunk driver in Alice Springs) don't fit my current vehicle.  So I'm awaiting the arrival of new handbrake shoes in the mail...

What's next?  There's a brand new brass and copper radiator in the workshop, but I think that can go in with the engine swap in June.

Lowlifes on the loose

We had two bicycles stolen from our yard last week.  Apart from the feeling of violation, and the self-recriminations about not locking them to the verandah post, it's the inconvenience that really rankles.  Because we live in a remote town, we cannot easily replace the bikes. We've had to order new ones online, and now we await their delivery.
This event has left us $1650 out of pocket, half of that from my 15 year old daughter replacing her bike that she bought out of her part-time work after school.  Perhaps the most frustrating thing is that my bike had a mounting bracket on it to connect my 6-year-old's tagalong bike.  This bracket is no longer available, so unless I can fabricate one myself, we may have to also replace the tagalong bike.
If we find out who stole the bikes, a quiet discussion using a tyre lever may be in order.  I'm not an advocate of violence, but this has got my blood boiling.  If the lowlifes just get away with it, why would they ever see the need to change their behaviour.  If their behaviour leads to a few broken bones, maybe the behaviour will change?  Anyway, I'm just dreaming, because the reality is that we won't see the bikes again, and the perpetrators will get away with stealing them.  That's life, and we'll make sure we keep the new ones locked up, even when they are hidden in our enclosed yard.