Episode Summary

The President of the Australian Primary Health Care Nurses Association (APNA) Denise Lyons discusses the benefits of primary health nursing, her work with Navajo and Torres Strait Islander Communities and different pathways available to nurses outside of the hospital. 

Episode: 53

Guest: Denise Lyons
Duration: 19:06
Soundcloud: Listen to Episode 53

Episode Transcript

Esther Bacon: Welcome  to  the  nurse  and  midwife  support  podcast.  I'd  like  to  begin  by  acknowledging  that  this  land  has  always  been  a  place  of  storytelling  and  that  I  pay  respect  to  aboriginal  and  Torres  Strait  Islander  people  as  the  original  storytellers  and  creators  of  culture  who  have  shared  knowledge  and  wisdom  for  over  sixty  five  thousand  years.  And  I  acknowledge  that  we  learn  from  this  land  and  its  ongoing  custodians,  both  past  and  present.  This  podcast  series  is  all  about  hearing  and  learning  from  the  stories  of  fellow  nurses  and  midwives  and  what  things  they  do  to  feed  positive  well-being.  My  guest  today  is  Denise  Lyons.  She  is  a  highly  experienced  nurse  with  over  forty  years  in  the  profession,  including  more  than  twenty  five  years  dedicated  to  primary  care.  Currently,  she  serves  as  a  primary  care  nurse  practitioner  in  general  practice  in  Newcastle,  New  South  Wales,  where  she  is  committed  to  improving  the  health  and  well-being  of  her  community.  As  an  elected  board  director  and  now  president  of  the  Australian  Primary  Health  Care  Nurses  Association,  APNA,  Denise  is  dedicated  to  strengthening  the  voice  of  primary  health  care  nurses  nationwide.  Welcome,  Denise,  and  thanks  for  being  here  today.  

Denise Lyons: For  having  me.  I  really  appreciate  the  invitation.  

Esther Bacon: You're  welcome.  So  we  start  with  just,  um,  looking  at  your  career  today,  your  nursing  career.  What  made  you  want  to  become  a  nurse?  You  know,  where  did  you  train,  and  what  was  your  kind  of  pathway  into  becoming  the  nurse  that  you  are  today?  

Denise Lyons: Well,  I  grew  up  in  the  United  States  in  the  in  the  northeastern  part,  and  my  father  worked  as  a  volunteer  first  responder.  So  we  had  a  little  radio  in  our  house  that  would  make  these  beep  beep  beep  sounds,  and  it  would  go  off  and  it  would  be  an  alert  calling  for,  you  know,  local  first  responders  to  attend.  So  I  think  I  think  he  was  a  real  role  model  for  me  in  seeing  someone  who  wanted  to  help  the  community,  who  wanted  to  there  and  be,  you  know,  engaged  in  the  community.  And,  you  know,  he  did  that  my  entire  childhood  to  be  running  out  the  door  fighting  a  fire  or  driving  an  ambulance.  And  I  

That  was  an  inspiration  for  me  to  want  to  to  help  the  community,  and  I  think  nursing  was  a  really  good  opportunity  to  do  that.  Um,  back  in  those  days  in  the  United  States,  education  had  already  moved  to  the  university  sector.  And  I  happened  to  have  a  neighbor  who  was  a  nursing  academic  who  encouraged  me  and  supported  me  also  kind  of  as  a  mentor.  

Esther Bacon: Fantastic.  And  whereabouts  did  you  train?  

Denise Lyons: So  I  trained  in  New  York  State.  In  the  middle  of  New  York  State,  we  had  some  fierce  winters.  I  can  tell  you  snow  snow  piles  of  snow  as  high  as  the,  you  know,  edge  of  your  roof.  We  had  some  But  I  trained  in  in  New  York  in  university  and  and  then  spent  a  couple  years  in  my  twenties  as  a  traveling  nurse.  So  I  did  my  first  year  at  a  children's  hospital  in  Washington,  DC  Mhmm.  And  then  took  off  traveling  all  over  the  country  working  in  pediatric  wards,  pediatric  units  all  over  the  United  States,  and  loved  that  opportunity  to  look  at  different  ways  of  working  and  learning  about  different  communities  and  just  enjoyed  that  so  much  in  my  twenties,  that  opportunity  to  to  experience  the  United  States,  really,  from,  you  know,  from  sea  to  shining  sea.  

Esther Bacon: And  I'd  expect  it  would  be  very  varied  

Denise Lyons: It  was.  

Esther Bacon: You  know,  from  one  town  to  the  next,  um,  in  different  communities.  And  you've  written  in  previous  editorials  that  you  in  your  during  your  time  working  in  the  states,  worked  with  the  Navajo  communities.  And  then  once  you  moved  to  Australia,  you've  worked  in  the  Torres  Strait,  and  you've  been  written  as  saying  that  it  really  taught  you  about  diversity  and  resilience.  So  can  you  tell  us  a  little  bit  about  that  and  what  those  experiences  brought  for  you?  

Denise Lyons: Definitely.  Working  with  in  with  the  Navajo  Nation  in  the  United  States.  So  the  Navajo  Nation  is  kind  of  where  four  states  meet.  They  call  it  four  corners.  So  Arizona,  Colorado,  in  that  space,  it's  very  remote.  And  working  out  there  was  a  very  formative  experience  for  me  as  a  young  nurse.  The  communities  that  I  worked  with  were  geographically  remote  with  significant  barriers  to  accessing  health  care,  distance,  poverty,  and  and  justifiable  historical  mistrust  of  health  systems.  Mhmm.  What  struck  me  working  there  that  was  the  resilience  of  the  community,  the  strength  in  the  family  structures,  and  the  cultural  continuity,  and  the  deep  connection  to  land  and  tradition.  And,  um,  it  it  did  teach  me  a  lot  about  how  working  delivering  health  care  effectively  requires  more  than  clinical  knowledge.  It  requires  a  lot  of  humility  and  listening  and  understanding  that  health  is  experienced  in  a  cultural  and  historical  and  social  context.  And  in  Navajo  communities,  you  know,  these  concepts  of  well-being  were,  you  know,  very  holistic  and  and  tied  to  to  balance.  So  we  we  would  have  medicine  men  come  into  the  hospital  with  feathers  and  and  herbs  and  and  do  chanting.  And  I  don't  know  if  you've  ever  heard  Navajo.  I  can't  

Esther Bacon: hear  it.  Yeah.  

Denise Lyons: Yeah.  Gives  me  goosebumps  still.  But,  you  know,  that  physical,  spiritual,  family,  environment  tie  was  just  so  clear  and  so  strong.  Yeah.  I  loved  it.  And  and,  actually,  later  when  I  worked  in  the  Torres  Strait  during  COVID,  I  I  saw  some  parallels  there.  There  was  Mhmm.  Again,  challenges,  you  know,  very  challenges  around  remoteness  and  and  inequity,  but  also  immense  cultural  strength.  Incredible.  And  strong  such  strong  kinship  networks  and  a  really  profound  sense  of  identity  and  connection  to  place  among  Torres  Strait  Islander  peoples.  It  was  a  great  experience.  And  I  guess  I  just  really  love  working  in  community,  and  that's  where  primary  health  care  nursing  sits  is  in  communities  Mhmm.  Where  people  live  and  work.  And  and  I  just  was  so  drawn  to  it  from  away  from  the  sort  of  acute  kind  of  nursing  where  people  come  into  your  space.  I  see  permanent  health  care  as  nursing  that  goes  out  to  meet  people  where  they  are.  

Esther Bacon: Yeah.  Did  you  find,  um,  when  you  worked  in  the  Navajo  communities  and  also  in  the  Torres  Strait,  did  you  find  it  difficult  to  connect  with  the  local  community?  Was  there  that  was  there  fear  and  sort  of,  I  know,  resistance,  um,  to  providing  the  care  that  you  wanted  to?  Was  that  kind  of  a  major  hurdle,  or  did  you  find  that  teams  were  already  established  there  that  you  could  kind  of  slot  into  and  and  do  the  work  that  you  were  there  to  do?  

Denise Lyons: I  think  there's  justifiable  mistrust  in  those  communities.  Yeah.  And  and  engaging  was  in  both  Navajo  and  Torres  Strait  was  very  much  about  working  with  existing  just  understanding  existing  networks  and  always  having  someone  with  we  didn't  do  a  consultation  in  the  Torres  Strait  without  having  a  Torres  Strait  Islander  health  worker  alongside  us.  So  very  much  a  partnership  model  of  delivering  care  Yeah.  Because,  yeah,  like  I  said,  justifiable  mistrust  

Esther Bacon: exists.  Absolutely.  I'm  working  with  the  community  elders  to,  um,  try  and  embed  trust,  um,  you  know,  that  you're  there  for  the  right  reasons.  Um,  and  so  you  subsequently  went  on  to  train  as  a  nurse  practitioner.  What  did  that  training  look  like  for  you?  Was  that  here  in  Australia,  or  was  that  

Denise Lyons: I  did  get  training  here.  So  I  worked  in  and  out  of  the  state.  There  are  in  the  states,  there's  a  lot  of  nurse  practitioners  working  in  primary  health  care.  Lots  of  people  have  a  a  nurse  practitioner  as  their  primary  health  care  And  so  I  guess  I  I  kinda  grew  up  in  that  context  and  seeing  the  capabilities  that  experienced  nurses  could  could  gain  and  and  use  to  serve  their  communities.  So  I  I've  over  time,  became  increasingly  interested  in  working  at  a  more  advanced  level.  You  know,  I've  heard  that  saying  when  you  know  more,  you  can  do  more.  And  it  when  the  average  primary  health  care  nurse  has  more  than  twenty  years  of  experience  and  many  have  a  postgraduate  qualification.  So  there's  just  a  really  incredibly  experienced  and  intelligent  workforce  out  there  in  primary  health  care.  But  what  appealed  to  me  about  the  nurse  practitioner  role  is  it's  kind  of  a  combination  of  combining  clinical  care  with  emphasis  on  prevention,  so  health  promotion  and  injury  prevention,  education,  and  advocacy.  And  but  also  the  opportunity  to  work,  you  know,  autonomously,  but  also  collaborative  collaboratively  in  the  community  with  other  health  professionals.  So  Mhmm.  I  went  and  did  master's  degree  here  at  the  at  Newcastle  University,  which  has  a  nurse  practitioner  program.  It  was  a  good  program.  There  weren't  that  many  of  us  that  were  primary  health  care  nurses.  Many  of  the  nurses  were  still  were  working  in  the  acute  sector.  So  I  think  we  learned  from  each  other.  You  know,  there's  sometime,  I  think,  not  sometimes  a  great  understanding  about  what  happens  in  the  community  if  you've  always  worked  in  a  hospital,  but  a  lot  does  happen  in  the  community.  And  Yeah.  I  think  what's  exciting  about  the  nurse  practitioner  role  as  we  expand  our  scope  of  practice  and  can  do  more,  it  it  allows  nurses  to  influence  health  the  health  of  the  community  much  early,  earlier  in  their  health  journey.  Yeah.  Yeah.  And  but  also,  as  advanced  practice  nurses,  I  think  we  have  the  ability  not  just  to  care  for  people  when  they're  unwell,  but,  you  know,  to  to  shape  healthier  communities  in  the  first  place,  you  know,  to  try  to  influence  policy  

Esther Bacon:10:41 Yeah.  

Denise Lyons: And,  you  you  know,  the  direction  of  how  we  deliver  care.  

Esther Bacon: Yeah.  And  if  you  know,  because  we  sometimes  get  calls  at  nurse  and  midwife  support  for  people  wanting  to  navigate,  like,  their  next  steps  in  their  career  and  understanding,  you  know,  where  could  a  career  as  a  nurse  practitioner  or  just  more  generally  in  primary  health  care  nursing,  what  kind  of  avenues  do  you  see  most  commonly  and  kind  of  where  could  that  sort  of  career  take  you?  

Denise Lyons: Interesting  because  I  think  in  the  hospital,  the  career  architecture,  the  career  pathway  is  quite  clear.  You  know,  you  go  there.  You  you  start  as  your  with  your  graduate  program,  and  and  then  you're  mid  career,  and  you  you  have,  you  know,  opportunities  to  do  professional  development  and  advance  your  career,  maybe  do  some  postgraduate  study.  And  then  there's  CNCs  and  CNS.  They're  called  different  things  in  different  places,  but  I  think  that  the  support  and  the  structure  for  that  architecture  is  really  clear.  And  one  thing  that  APNA  has  been  working  on  is  to  try  to  make  that  career  pathway  more  visible.  So  at  APNA  Mhmm.  We  have  a  transition  to  practice  program,  so  almost  like  a  new  graduate  program  with  placements  in  primary  health  care.  And  we  have  mid  career  education  and,  you  know,  education  around  care  planning,  which  is  often  what  you  do  in  in  

Esther Bacon: Yes.  

Denise Lyons: Primary  care  care  planning  and  care  navigation.  We  have  that  education,  healthy  aging  education.  So  a  whole  range  of  educational  opportunities  and  leadership  training  opportunities  to  support  nurses.  And  then  we  have  a  this  is  and  a  lot  of  this  is  Commonwealth  government  funded  through  APNA.  We  have  a  building  nurse  capacity  project  where  we've  supported  nurses  who  want  to  set  up  a  nurse  led  clinic  and  focusing  on  a  specific  area  of  health.  For  example,  there's  up  in  on  the  Mid  North  Coast,  there's  a  couple  of  clinics.  One  is  focusing  on  postnatal  depression  screening.  There's  another  one  that's  focusing  on  diabetes.  There  have  been,  um,  there  have  been  team  teen  clinics  set  up  to  specifically  address  the  needs  of  teenagers  in  our  community  who  might  not  have  good  access.  So  there  there  are  pathways,  but  I  think  we  need  to  do  more  work  on  making  those  pathways  visible  in  primary  health  care  because  people  just  don't  see  it  as  a  career  option.  And  we  we  work  really  hard  to  to  make  sure  that  just  to  encourage  universities  to  offer  a  primary  health  care  subject  in  that  undergraduate  curriculum  and  a  primary  health  care  nursing  placement  so  people  can  go  and  have  an  experience  working  in  not  just  general  practice,  which  is  often  what  people  think  of  when  we  talk  about  primary  care.  But  we're  talking  about  school  nurses.  We're  talking  about  justice  health.  Aged  care  is  where  people  live.  You  know?  It's  it's  it's  Mhmm.  It's  not  a  hospital.  It's  a  primary  health  care  environment.  It's  where  they  live.  And  Yeah.  There  there's  just  a  whole  range  of  primary  health  care  environments  that  people  kind  of  don't  think  of  as,  you  know,  there's  maternal  child  health.  There's  community  health.  There's  so  many  nurses  driving  around  in  cars,  you  know,  managing  people's  wounds,  complex  wound  care  Yeah.  In  the  community  where  people  live  and  work.  And  we  just  want  young  nurses,  new  nurses  to  see  that  as  a  career  option,  a  real  career  option  and  and  and  a  great  one.  Rewarding.  

Esther Bacon: And  I  think  I  think  when  when  we  reflect  back  on,  you  know,  times  in  our  career  where  we  felt  most  fulfilled,  it's  often  attached  to  that  autonomy.  And  for  me,  when  you're  talking  about  that  and  I  think  about  when  I  used  to  do  home  visiting  as  a  midwife,  I  loved  that  part  of  my  career  because  it  was  going  out  to  meet  people  in  their  own  space.  You  got  to  see  these  women  that  you'd  seen  in  the  hospital  within  the  system  in  one  way  because  they  were  birthing.  And  then  when  you  saw  them  at  home,  they  were  cut  like  a  completely  different  person  often,  um,  surrounded  by  their  family,  their  own  comforts,  their  own  cultures,  their  own  routines.  Um,  and  it  really  was,  yeah,  definitely  a  highlight  for  me  working  in  that,  you  know,  that  community  space.  

Denise Lyons: People  at  home  gives  you  a  sense  of  the  whole  person.  Right?  For  sure.  Is  such  a  privilege  to  being  invited  into  people's  

Esther Bacon: It  is.  

Denise Lyons: Space.  And  you're  right.  Autonomy  we  know  that  autonomy  and  people  working  to  top  of  scope  does  help  with  recruitment  and  retention.  People  stay  longer  in  their  and  we  heaven  knows  we  need  nurses  to  stay  working  because  Yeah.  And,  know,  you  don't  really,  we're  gonna  do  that  more  when  we  love  our  jobs.  And  you  love  your  job  when  you're  able  to  work  to  your  full,  you  know,  capabilities.  

Esther Bacon: Yeah.  Absolutely.  And  so  what's  your  what's  the  kind  of  priorities  do  you  think,  um,  you  know,  as  president  of  APNA,  what's  the  priorities  for  you  and  your  teams  there  at  the  association  moving  forward,  um,  in  primary  health  nursing?  

Denise Lyons: We  want  primary  health  care  nurses  to  be  visible  and  valued  and  respected.  So  we're  doing  a  lot  of  work  around  all  of  those  things,  you  know,  to  to  kind  of  increase  the  visibility  of  the  role  of  primary  care  nurses,  where  they  work,  and  what  they  do.  In  terms  of  valued,  I  think  part  of  our  challenge  of  recruiting  nurses  into  the  primary  care  space  has  definitely  been  around  a  pay  differential  between  the  nurses  Okay.  You  know,  the  hospital  award  and  the  other  than  hospital  award.  So  we  work  closely  with  the,  say,  ANMF  around  work  value.  There's  a  work  value  case  at  the  moment  that  we're  working  on  trying  to,  you  know,  get  recognition  of  the  complexity  of  the  work  that  primary  care  nurses  do  and  the  value  of  that  work.  

Esther Bacon: Absolutely.  Yeah.  And  the  transition  to  practice  program  that  you  offer,  just  to  touch  on  that  if  anyone  was  interested,  is  that  like  an  annual  intake  or  kind  of  a  rolling  recruitment  to  that  

Denise Lyons: You  can  find  information  about  that  on  the  APNA  website.  Yeah.  Okay.  So  there's  some  different  diff  some  sort  of  different  models  to  some  primary  health  network.  So  be  involved  in  that  and  support  their  nurses  transitioning  to  primary  care.  But  we  have  recognized  that  it  is  so  important  to  have  mentors  as  you  move  along  in  your  nursing  career  and  to  have  that  opportunity  for  reflective  practice.  And  sometimes  that's  just  internal  reflection,  but  sometimes  that's  working  things  through  with  a  mentor.  And  so  having  those  support  structures,  um,  in  place  is  definitely  something  that  we  value  and  are  working  towards.  Yeah.  

Esther Bacon: And  that's  definitely  something  that  we  hear  at  NMS  over  the  phones,  that  feeling  of  belonging  and  feeling  of  support  that's  available  to  not  just  early  career  Yeah.  Nurses  and  midwives,  but,  you  know,  as  you  as  you  move  through  your  career  with  different  hurdles,  you  know,  to  overcome  that  having  a  mentor  and  a  trusted  team  around  you  is  is  is  vital  for  thriving,  and,  obviously,  to  to  try  and  keep  those  skilled  practitioners  in  the  workforce  not  wanting  to  leave.  So  to  round  off  our  chat,  we  ask  all  our  guests  what  their  favorite  well-being  activity  is  or  something  that  recharges  them  or  fills  their  cup  back  up  if  they're  feeling  a  bit  depleted.  And  what's  yours,  Denise?  

Denise Lyons: I  have  two  things.  I've  loved  Pilates,  and  that's  be  that's  become  a  habit,  which  has  been  good  for  this  old  girl  with  her  nursing  back  and  nursing  knees.  Yeah.  But  the  other  thing  is  my  husband  and  I,  about  five  years  ago,  my  partner  and  I  got  involved  in  volunteering  with  guide  dogs,  and  we  do  volunteer  puppy  raising.  So  you  they  have  a  breeding  center  in  Sydney,  and  what  they  need  is  volunteers  who  will  keep  those  puppies  from  when  they  are  weaned  from  their  moms  until  they're  ready  to  sort  of  be  assessed  possibly  go  into  training.  Because,  you  know,  puppies  puppies  are  a  little  wild  for  the  first  twelve  to  fourteen  months  of  their  lives.  So  we've  had  we  we  don't  do  permanent  care  because  it's  too  hard  for  me.  Well,  if  you  have  them  for  twelve  to  fourteen  months,  you're  very  attached.  But  what  we  do  is  temp  care.  We'll  have  them  sometimes  well,  we've  got  one  now  who  is  gonna  be  with  us  for  four  months,  five  months,  and  she's  she's  wonderful  pup.  But  and  we've  had  them  anywhere  from  when  they're  brand  new  and  just  weaned  to  up  to  when  they're  twelve  to  fourteen  months  old.  And  we've  had  them  anywhere  from,  you  know,  a  couple  days  to  a  couple  weeks.  So  we've  had  at  least  forty  or  fifty  dogs  in  our  lives.  Oh  my  goodness.  All  beautiful.  You  know,  guide  dogs  breeding  program  breeds  them  for  this  incredible  temperament  that  they  have.  They  just  love  Yes.  People,  and  they're  just  so  they're  just  such  good  dogs.  So  we  have  these  

Esther Bacon: That's  a  really  beautiful,  like,  concept  and  idea  that  what  doesn't  spring  to  mind  when  you  think  of,  like,  your  own  well-being.  Like,  Pilates  definitely,  

Denise Lyons: you  know,  

Esther Bacon: like,  physical  and  mindful  thing.  But,  actually,  that  is  such  a  lovely  my  next  door  neighbors,  they  foster  greyhounds.  And  I  think  yeah.  It's  that  that  feeling  of,  you  know,  you're  supporting  a  community,  You're  reducing  the  risk  of  that  dog,  you  know,  going  to  a  family  that  wouldn't  suit  it.  And,  obviously,  you're  assisting,  you  know,  the  community,  um,  that  needs  

Denise Lyons: And  you  walk.  They  make  you  walk.  So  you  go  so  you  go  

Esther Bacon: for  more  walks.  You  fit.  But,  you  know,  too,  

Denise Lyons: there  is  that  you  know,  they've  now  started  to  use  dogs  in  in  spaces  where  there's  trauma.  Like,  they  have  a  court  dog  program,  so  they'll  take  dogs  to  to  family  court  just  because,  actually,  petting  a  dog  lowers  your  heart  rate,  kinda  lowers  your  stress  levels.  So  you  still  have  them  at  the  Olympics  just  like  companion  dogs  because,  like,  petting  a  dog  is  just  very  not  for  everyone,  of  course,  you  know,  but  for  some  people,  very  soothing,  very  very  good.  

Esther Bacon: Fantastic.  I  think  every  workplace  should  have  them.  I  was  at  a  nursing  expo  recently,  a  nursing  midwifery  expo,  and  they  did  have  a  a  dog  come  in,  and  I  think  it  was  the  highlight  for  most  of  the  nurses  there.  And  I  I'm  hopeful  that  they  went  back  to  the  rest  of  their  shift  feeling  a  little  bit  calmer  and  and  and  Yeah.  Thank  you  so  much  for  coming  on,  Denise.  It's  been  a  lovely  chat.  Um,  and,  hopefully,  listeners,  you  know,  you  know,  got  from  this  conversation  about  where  primary  health  care  nursing's  going,  what  it  could  serve  to  listeners  if  they  were  interested,  um,  and  how  they  might  get  a  little  bit  more  information  if  if  that's  what  they  wanted  to  pursue.  Um,  and  for  any  listeners  who  need  support  from  nurse  and  midwife  support,  we're  available  twenty  four  seven.  You  can  remain  anonymous.  It's  confidential.  It's  completely  free,  and  you  can  call  us  on  one  eight  hundred  six  six  seven  eight  seven  seven.  Thanks  so  much,  Denise.