I am an enrolled nurse (Div 2) working in general practice in Bentleigh, Victoria. I work alongside seven  doctors, one registered nurse (Div 1), four administration staff, and an administrative supervisor.

I find my work very rewarding because of the way we work as the team. One of our recent successes has been how we changed the way we manage patients with chronic diease.  With a great deal of effort we developed a systematic process for the care of these patients, which has resulted in higher quality of care.

One of the biggest contributing factors of this recent success has been my ongoing professional development. My invesment in continuing education has also helped make my role as a practice nurse more rewarding.

It is often difficult to find educational opportunities that are open to ENs, as many events are developed for RNs or GPs. A fair bit of research went into finding education that could enchane my work, and making sure course did not conflict with my clinical work.

The cost of attending these events over the past year has been well over $3000. The APNA Schorlaship Scheme has helped me enormously with these costs; I encourage other ENs to access these schorlaships. The Medication Endorsement with Injectables for EN course and the APNA online Immunisation course are two I strongly recommend , as these have enabled me to provide immunisation services with supervision by the RN and the patient's GP.

Undertaking professional development has definitely made me feel more confident in my work. For example, knowing that I am providing the right advice regarding asthma, diabetes, chronic pain, and heart diease is quite a buzz. Completing the asthma educators and spirometry course has meant that I can effectively monitor and assess respiratory conditions and support relief/symptomatic management within our practice.

Courses I have attended include: a five day Diabetes Education Training Workshop at the Royal Prince Alfred Hospital, Sydney; heart diease and diabetes workshops run by the Heart Foundation; chronic pain seminars; workshops at the Melbourne Nurse Clinical Education (PNCE); and Divisional education events where nusrse specialists provide excellent nurse focused education. Being able to access this education significantly impacts on the nursing care I can provide and makes my contribution to the team more subtantial. Of course, the most rewarding aspect is how it also helps our patients.

Keeping abreast of relevant state and national initiatives enables the identification of future directions in primary care and potential opportunities for programs and resource sharing at national, state and local levels. I have compiled a variety of development and provisional resources to support chronic disease management. These resources include multilinual material, computer-based information, visual awareness such as posters in the waiting room and the nurse'sroom, and paper-based information.

My hard work and commitment has been recognised and supported by my practice, nominating me for the APNA Best Practice Awards 2008 in Chronic Disease Management. My  RN conlleague and I have now dedicated ofice space to accommodate the various roles we perform in our practice. These roles include: immunisations; managing recalls and reminders for various aspects of clinical care; undertaking care plans; triage; pathology collection; screning (e.g. random BGLs); 12 lead ECGs; and comprehensive health assessments (75+ yrs, 45-49 years and 4 years).

The extra office space and the excellent teamwork in our practice that has gradually built up over time have meant that I have had a direct influence on the quality of care delivered by our practice, which I find incredibily rewarding!

The best example of improved quality care is how our practice went from less then 5% of SIPs claimed for Diabetes Annual Cycle of Care to over 35% in less than six months.

Undertaking this work meant that I had to:

* Work collaboratively within our team to convince everyone it was worth doing;

* Convince my colleagues that it was a neccessary part of my work;

* Search our practice software to identify the patients who needed this clinical care;

* Participate in the University of Melbourne Patient Engagement and Coaching for Health (PEACH) study;

* Set up prompts within the system so that our GPs would recognise the patients who would benefit from the annual cycle of care;

* Be flexible in my work to accommodate unexpected referrals from the GPs for the cycle of care; and

* Set up procedures, forms and templates to manage recalls and the whole process.

Using the principles of collaboration, effective communication, and respect for autonomy I have managed to work within our team to change clinical practice and help diabetic patients change their behaviour to achieve improved care. Having someone in my position to manage the whole process from the beginning through to the formative times and then to follow-up on issues like referrals, pathology results, and appoinments has helped the process enormously.

It takes a great deal of effort to set up new clinical areas, but putting the time into the procedures and practice policies so that our work complies with accreditation standards is definitely worthwhile. I have been able to contribute to this achivement through my own professional development. I would encourage all PNs to invest in themselves - we really can make a difference!

Christina Panayi