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Debora Webster-Bain – Emergency & Aesthetic Nurse Practitioner
About
Debora has been nursing for 48 years and was endorsed as a critical care Emergency Department nurse practitioner in 2007 and I worked for over 12 years as an ED Nurse Practitioner (NP) until 2015.
She switched to a private practice Nurse practitioner (aesthetic and skin cancer checks) in 2016 creating KT Skin Rejuvenation, after her only child was killed in road trauma, as she could no longer cope with working in an ED /hospital environment.
In her new scope of practice in aesthetics, she has recently done work for AHPRA advocating for more regulation, better ethical standards and improved training standards in the aesthetic industry. She hopes to add prescribing medicinal cannabis to her scope of practice later this year so she can assist her patients who are also struggling with chronic illness issues.
Tell us about your Emergency Nursing Career and your stint in Jamaica!
I started my nursing career as a 17year old in Sydney in 1973, when hospital training was still in vogue, at Sydney Hospital, which was the first ever established hospital in Australia.
After I completed my training in 1976, I went on a working holiday and ended up working at an Emergency Department in Montego Bay in Jamaica for 3 years. I was a new graduate who was only 20 years old and in charge of my shift …how different to nursing these days !!This is where I started to develop my love for emergency nursing.
Upon my return to Australia, I worked in a variety of ED’s in Sydney and then moved to Melbourne and worked at Austin Hospital ED/ICU for 9 years, where I completed my Graduate Diploma of Critical Care in 1998.
ED nurse practitioner pilot project?
In 2000, I switched to working at Sunshine Hospital emergency department and in 2005, Sunshine Hospital got funding for the Victorian Government, emergency department Nurse Practitioner (NP) project, which was funded to support 13 critical care emergency department nurses to complete their Masters’ degree and autonomously manage fast Track patients. I was their first Emergency Department Nurse Practitioner Candidate(NPC) in the network. Six months later I was joined by my colleague Ian who became our only paediatric nurse practitioner candidate.
My scope of practice initially was minor injuries and minor complaints, but that was gradually increased for me to manage women’s health issues. Ian and I learnt our scope of practice, whilst we were concurrently doing our Masters of NP.
We were supported and trained over the years by 14 very wonderful ED physicians. The other 12 NPC’s who were also a part of the Vic NP project, took turns to organise monthly lectures by other willing ED physicians, on the variety of injuries and complaints that we were likely to manage, so we all supported each other as well. Ian and I were both endorsed on the same day in 2007.
Early Pregnancy Assessment Service (EPAS)
Sunshine Hospital services the Western suburbs of Melbourne and as the population grew, our presentations for women with bleeding in early pregnancy increased significantly. Unfortunately, the service that was offered there for these women in the early 2000’s was quite lacking, as no ultrasound was offered in ED after hours, unless an ectopic pregnancy was suspected and the Early Pregnancy Assessment Service (EPAS) had been closed down by a bureaucrat.
This left the O&G service overwhelmed with obstetrics and gynaecology patients on the labour and Gyny wards and it was very difficult for the registrars to come down to ED to see the bleeding in early pregnancy or diagnosed miscarriage patients.
I witnessed patients waiting many hours to see a O&G registrar, then they were often sent home to have a pelvic ultrasound done the next day and then they had to return to ED for go to their GP for the diagnosis.Then potentially return to ED another day and wait hours to be seen again. This left families extremely stressed, frustrated and anxious as to whether their pregnancies were still viable, with very little explanation given as to what was happening to them and no emotional support given.
Ultrasound Course
So, I completed a fast track O&G ultrasound course, which is the same course that O&G registrars do, so that I could offer a pelvic transabdominal ultrasound service to these women. As part of my Master degree, I did a project on how to offer better emotional support to these women. This started me on a journey learning how to advocate for a more sensitive management of threatened or inevitable miscarriage patients.
This then led to the ED team and O&G consultants suggesting that a EPAS service could be run in ED, by myself, so with the support of two consultant O&G consultants, I ran the EPAS every morning that I was on for 4 days a week.
I used to scan women to check the viability of their pregnancy, organised formal scans, counselled and educated them, advocated that an intern not a registrar could consent this woman for medical or surgical management of their miscarriage, so that women didn’t have to wait hours and hours for a registrar to attend and I referred women back to their GP for safe management of a no intervention or what’s known as expectant management of their miscarriage, or incomplete miscarriage for serial Bhcg blood levels.
The EPAS lasted about 3 years in the emergency department but then was moved and reopened upstairs back into the O&G outpatient department.. But with all the experience that I had gained, I was allowed to continue to offer an informal transabdominal pelvic ultrasound to any woman who presented to ED on my shift. I would scan women from 8 weeks to 19 weeks, unless they had symptoms of ectopic pregnancy and then I would organise a formal scan as soon as possible, so this ability to do an ultrasound scan gave many families peace of mind that at that time, their pregnancy was still viable.
I also developed counselling strategies and developed educational pamphlets on bleeding in early pregnancy that nursing and medical staff could also give these to women and their family.
What are the most rewarding experiences that you have had in Emergency Nursing?
During my 15year career in ED, I also did many lectures about offering a more sensitive approach to managing bleeding in early pregnancy and miscarriage patients, to ED nursing and medical staff. I lectured nationally and internationally on this topic and lectured international medical graduates.
Because of this work, I was then approached to made a DVD on this topic called “Precious Ten” which was an educational video on the sensitive management of miscarriage patients funded by the Victorian government and this DVD was given to every ED in Victoria to train doctors and nursing staff on how to look after these patients. I recently filmed the lecture that I used to give on miscarriage management is now on the AUSMED education site, on the internet for the next 3 years, so that was a great thing to have done, as I am still very passionate about this topic.
Aesthetic Nursing
As a way to try to recover from the death of my only child, I switched to a gentler line of work and I started a private practice called KT Skin Rejuvenation, named after my son’s initials, where for the past 6 and 1/2 years I have offered not only simple aesthetic treatments but also for medical treatments for such conditions has teeth and jaw grinding pain, excessive sweating and skin cancer checks. I do enjoy helping people in a different way and not under the time restraints that I used to feel working in ED.
I will soon add prescribing medicinal cannabis to my scope of practice in the next few months, as many people talk to me about their chronic pain,anxiety symptoms and medical conditions when I am doing aesthetic consultations.
I feel very proud of the variety of work that being an Nurse Practitioner has given me and I would tell others to step forward and do the hard, but very rewarding work that being a Nurse Practitioner can bring.
