A Day in the Life: Leanne Northrop, an Aged Care Nurse Practitioner

Leanne Northrop is a Nurse Practitioner (NP) at Peninsula Villages, an aged-care facility on the Central Coast, New South Wales. She recently relocated from Western Australia to the Central Coast aged-care facility, and has worked in rural and remote areas, supporting elders and working within various healthcare settings.

Peninsula Villages is said to be one of the few aged-care facilities to have a full-time NP on-site. After experiencing two extended lockdowns during the COVID-19 pandemic, the aged-care facility considers the role of an NP to be the way of the future in aged care. An NP is a Registered Nurse with the experience, expertise and authority to diagnose and treat people of all ages with a variety of acute or chronic health conditions. NPs have completed additional university study at a master’s degree level and are the most senior and independent clinical nurses in our healthcare system.

5:30: I’m up and at ’em. Nothing of importance can be considered before a cup of tea. Lately I have this while I listen to the news since aged care is so prominent, and often is linked with COVID-19 data and directives.

Since so much can turn on a dime these days, it feels better to be prepared! This is also why I make my lunch. It is usually something that can be eaten quickly and won’t make a mess while I type or read.

Then off to work.

08:00: I arrive at the Nurse Practitioner clinic. This is a telling moment.

If clinicians are at the door, charts in hand, their resident may have a pressing need to be seen. It could be something like pain relief, deterioration or both.

If it is a resident waiting at the clinic door, this is usually a good sign as they are up and about and motivated.

Whatever the need is, nothing can happen before I have stuck a swab up my own nose. (Rapid antigen testing must be the residents’ revenge to know the staff enduring this regularly too.)

08:30: It only takes a little while to bring my key resources to hand for the day. The computer gifts me with Therapeutic Guidelines for currently endorsed guidance, PBS to check medications, pathology results and the program for Medicare billing. NPs can prescribe, diagnose, send off for pathology and claim from Medicare and I want to ensure I’m looking at the latest evidence base for all I do.

09:00: Time for the COVID-19 meeting for Senior Leadership. Lately this has been as serious as chest pain. The meeting takes on a sombre atmosphere as we brace for latest statistics in the state, our region, amongst our staff, their close people, our residents and their close people. There is a mutual goal to keep residents safe. We discuss how to care for residents who are deconditioning due to isolation, who don’t want to go to hospital, whose doctors can’t always come in and who are missing chair Tai Chi and Bingo. Covering shifts when our colleagues are sick is a grim challenge too, as we all adapt to fill their boots. There is also the sourcing of RATs, PPE, food delivery, keeping families in touch and coaching to ensure PPE is worn carefully.

It’s a relief to know the team understand and sympathise with how stifling summertime PPE can be, and how it turns us into drooping, pruney, drippy clones with fogged up glasses that residents can’t recognise or understand, and who we can’t see.

09:45: A resident from our Independent Living Unit is waiting for me. He told me he had a terrible toothache, could not eat and wondered if I could pull the tooth out. Tempting as it was, dentistry is not in my scope of practice. Without health cover, or when funds are limited, treatment options are limited, so NP referral was written, a dental service identified and, with advocacy, and an appointment made. With pain relief and a modified diet in the meantime, the gentleman was able to manage.

10:30: Independent Living Unit rounds commence after discussion with the team about their feedback, priorities and concerns. Clinical, care and support staff know the residents so well that they notice small, but significant changes; for example, a person who is unusually pale, or green around the gills, or has blue, cool fingers. When these observations are communicated, we can get underway with assessment and interventions that tie in with the GP visit, and can hopefully keep residents at home and well.

I took my kit to a gentleman who has a wound on his lower leg that has not reduced by the required 25% in one month or healed in three months despite the clinician’s best efforts. The wound was swabbed to rule out infection, photographed, plans made for biopsy and referral to a dermatologist. Skin is so tough but so fragile, tells a million stories and can heal in the most arid health landscape so is always deserving of our best efforts. I also did a Doppler Test to check his lower leg circulation. A healthy Ankle Brachial Index will ensure the man had enough effective circulation to heal skin after any pending interventions.

12:15: Our current group of student nurses had a short NP-led toolbox session by watching the Doppler procedure, and then discussing contemporary wound care products, and the rationale for their use. It feels good to teach new nurses setting out and introducing them to the complex specialty of aged care.

13:00: High care rounds commence after discussion with the team. They are worried about a resident who is unusually agitated. The lady is not allowing interventions or assessment. It was beginning to look like delirium was causing her agitation. Her Advanced Care Directive was for active management and transfer if unwell, so a transfer to ED was initiated.

I went on to review a gentleman who had been suffering frequent falls. The most recent occurred when he bent forward to pick up his binoculars from the floor. He tells me he has taken to birdwatching since he’s been in lockdown. He sustained a laceration to his hand that I was able to suture. This prevented a hospital visit, which is one of our KPIs. It’s been a while since he had a blood test and a medication review to check for anything that may also contribute to a fall, so I, in partnership with the GP, initiated these things.

In all areas, there are medications to be charted, ceased, checked, crushed, injected and explained. Like all nurses my day is full of little parcels of resident and family education. As an NP this often relates to medications no longer in favour (think Valium), or why research recommends a supplement (think vitamin D for bone health and to minimise secondary fractures). It can be challenging (think of inventive ways to explain antibiotic stewardship in full PPE to a person who is hard of hearing and has the right to ask).

13:50–13:55: A socially distanced group of five nurses sang “happy birthday” loudly to one of the team between the first and ground floor. It was quite fun. I’ve never done that before.

14:00–15:00: High Care Quality Meeting. With the multidisciplinary team, trends in skin tears, pressure injuries and falls are reviewed, and preventative interventions considered and implemented. We were pleased to know there are new tracksuit pants and shorts in all sizes, with built-in hip protectors now available. When falls can’t be prevented at least we can try to reduce the ‘harm’ from falls; and there would be the added benefit of not trying to keep track of hip protector pads!

15:45: Time for a cuppa and the paperwork… (although paper actually features less and less, which I’m still getting used to).

Progress notes underpin a person’s condition and care, and our communication and accountability, so I’m keen to contribute.

NPs can also submit a Medicare claim for each visit, which raises funds for the organisation and contributes to sustaining the role, so I’m also keen to ensure this is done!

Finally, there is preparation for a case conference tomorrow with the family of a resident approaching end of life.

It’s a privilege to be part of a person’s journey.

We all want to contribute since it is understood, if not spoken, that we only get one opportunity to make a person’s end of life right.

17:30: Done for the day. Home to play with my daughter’s new puppy and go for a walk.