A year in the life of a RRT clinical nurse specialist

19 Nov 2022

By Michelle Fielding

I don’t know that I would have ever thought of myself as a problem solver or a critical thinker until I became a Registered Nurse. It was not until I was in-charge of busy tertiary Emergency Department, staring at a crowded waiting room with the likelihood of more patients filtering through, that I realised not everything can be taught through textbooks.

I’ve been working as an Emergency Department (ED) Registered Nurse for seven of my eight year career in this profession. I always knew that emergency nursing was my passion from day one of nursing school. The fast paced, quick decision making and sense of humour required to get through 12 hour shifts was my calling.

Nursing as a profession can take you just about anywhere; from the front line of our overcrowded hospitals, to a tent in the middle of a warzone working for an NGO.  This year, my anywhere was a position as a Clinical Nurse Specialist on a newly formed Rapid Response Team (RRT) at the National Critical Care and Trauma Response Centre (NCCTRC), based in Darwin, Northern Territory (NT). Funded by the Commonwealth Department of Health and Aged Care, the RRT was designed in response to the COIVD-19 pandemic to be deployed nationally to support vaccination, swabbing and contact tracing. I had always mused on the idea of getting out and seeing more of the NT, and this role has been the perfect opportunity to fulfil that dream.

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In February 2022, our first deployment was to Kalkarindji, a small remote community to the west of Katherine. The RRT were working alongside NT Health colleagues, local healthcare practitioners and clinical staff, and engaged frequently with local community leaders. Our team’s core objective was to support the local community and health clinic in managing the COVID-19 outbreak. This was the first time I had experienced the reality of trying to manage the virus outside of an acute setting like the hospital.

Where most metropolitan hospitals across Australia implemented negative-pressured, ante chambered, single isolation rooms to separate the ‘positive’ cases from ‘negatives’, in remote regions of the NT some of the smaller health clinics were relying on a simplified approach by allocating rooms in the clinic for ‘isolation’ to prevent an outbreak.

With a population of approximately 350 people, home isolation restrictions had been implemented by the local health clinic as a method of best protection not only in managing the outbreak, but also a way to meet, engage and offer support to each member of the community.  It doesn’t take long, with only a handful of streets, and visiting the same houses every day to get to know a community like Kalkarindji.

I’ve always had so much respect for anyone in health care that works in the pre-hospital environment. This thought was incredibly present as I was performing COVID-19 swabs in the back of a Ute tray, dressed in full personal protective equipment, on the side of the road in 40 degree heat.

Being a RRT Clinical Nurse Specialist has not only given me the opportunity to use my skills as critical care nurse outside the hospital, but to also be involved in the medical response team for many of the major events held in Darwin this year. From setting up a resuscitation facility tent at the popular music festival, Bassinthegrass, to providing medical assessments on the drivers in the pit lanes of the Merlin Darwin Triple Crown Supercars.

Another career highlight from this year was the opportunity to attend the Garma Festival held in the remote north-east Arnhem Land township of Nhulunbuy.

The NCCTRC was privileged to world alongside the Yothu Yindi Foundation, Miwatj Health Aboriginal Corporation, St John NT, NT Health and Careflight to support a successful festival.
Following extensive planning and logistics in the lead-up to the festival, the NCCTRC assisted in managing screening and monitoring of a potential COVID-19 outbreak, as well as a high-level resuscitation facility.

This was another moment of realisation, building a pathology lab and a resuscitation facility in a remote location isn’t always as simple a walking into a readymade precinct, nor a pop-out tent scenario.  With the assistance of NCCTRC logisticians, who are the backbone of any major deployment, the team had already considered every detail of what might be required in a remote setting, such as weight ratios of medical equipment, and how to build sinks with running tap water in the bush.

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Prior to my role with the RRT, I had never considered all the practical elements that come together to create an environment fit for purpose. You turn up for a shift at the hospital, and all the infrastructure, equipment and resources that you need to save somebody’s life are already in place. In regional and remote communities of the Northern Territory, there is likely no warehouse available if you forget the tubing for the ventilator; if you don’t pack it, you don’t have it.

Clinical (and logistical) challenges aside, there have also been personal challenges this year.  Working in an ED, you spend a lot of time with colleagues who, more often than not have the same personality type as your own. No longer being surrounded by colleagues accustomed to the traditional four walls of a hospital environment, the RRT has been a chance to push myself out of my comfort zone and become part of a different tribe.  A tribe formed from vastly different backgrounds and experiences, but still all working together towards a common goal in disaster preparedness and providing high quality care in all situations.

As we slowly progress to a world of living with COVID-19, the RRT is evolving to respond to all hazards and health emergencies, including providing high level specialised outbreak response, support in community outreach and local response efforts when requested and activated by the Commonwealth Department of Health and Aged Care.

With 2023 just around the corner, I feel privileged to be part of such a remarkable team of highly-trained individuals as we prepare for whatever deployment the RRT sent to respond to and support next.

Michelle Fielding

Michelle Fielding

Michelle Fielding is a Registered Nurse with a speciality in Emergency Medicine, currently working in the Emergency Department at the Royal Darwin Hospital. She has worked in the Darwin for the past 6 years. After successfully completing a New Graduate Program and a Transition to Emergency Specialty at the John Hunter Hospital in Newcastle, NSW, Michelle then went on to complete a Graduate Certificate in Emergency Nursing from Deakin University in 2018. In her current role, she works as a Clinical Coordinator and Team Leader on shift after progressing though resus and completing the Australasian Triage Course. Michelle has continued interests in Emergency and Disaster Medicine, and has a long term career goal to be able to provide and assist developing communities in Australia and overseas.