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'I have the best job in the world!': A nurse working in South Auckland in a generalist respiratory role finds her experiences in the hospital and community both humbling and rewarding.

Respiratory clinical nurse specialist (CNS) Nicola Corna's path to becoming a nurse in New Zealand was a little different from most. Born and raised in New Zealand, she moved to South Africa as a teenager and did her nursing training there.

"When I decided to train as a nurse and midwife in the mid-1980s, two of my New Zealand aunts recommended I stay in South Africa and do my training there and I am glad I took their advice. Our four-year training was broad-based, combining the best of hospital training with university papers. I had some great experiences, including delivering babies in remote rural black townships where equipment was very basic. It was a sink or swim method, but it has stood me in very good stead."

Corna returned to New Zealand with her husband and two small children in 1996, having been out of nursing practice for five years. She completed a three-month return-to-nursing and midwifery course at the Waikato Institute of Technology, then decided to work in burns and plastics, an area in which she had limited experience. A move to Auckland in 2001 saw her get a job in Middlemore Hospital's outpatients department where two respiratory physicians Harry Rea and Jeff Garrett--soon recognised her talents in respiratory nursing and offered to support her in this area. She has been in her CNS role for almost five years.

"I think I have the best job in the world," Corna said. "Working across primary and secondary health and case managing patients with respiratory diseases in the community is tremendously rewarding. I also work under an inspiring nurse practitioner (NP), Diana Hart, who, among other achievements, runs a very successful non-invasive ventilation service for approximately 60 home-based patients with mainly obesity-related respiratory failure."

Running a bronchiectasis clinic

Corna also runs a bronchiectasis clinic with advanced practitioner in respiratory physiotherapy Sarah Mooney. This is targeted at transitioning young people from paediatric services to adult services. Mooney had identified that many of these adolescents were falling through the cracks and not attending the adult service when needed. Bronchiectasis often results from severe respiratory infections in childhood, eg pneumonia, which have not always been treated or diagnosed. These infections can damage the still developing lungs of a young person. More than 80 per cent of cases at Counties Manukau are Maori or Pacific people.

"Bronchiectasis is often called a third world condition, exacerbated by poor housing, overcrowding and lack of access to GP services. Patients' conditions improve when we can arrange for them to move into warmer, better insulated houses," Corna said.

In her generalist role, Corna runs both a general respiratory and a sleep clinic once a week and also spends half a day working on the medical wards. She enjoys being part of a very committed and hard-working multidisciplinary team. She is involved in research, mentoring nursing and physiotherapy students, and gives some lectures at Auckland University.

Doing the best for patients

"Everyone on the team wants to do the best they can for our patients. Working in South Auckland is very rewarding and humbling. Whether you are visiting a patient living in a rundown house or a mansion, it is still a privilege to be invited in and to be able to teach people how to manage their illnesses. This education can lead to better health outcomes or assist patients take a better pathway to their deaths. The importance of education is the basis of my nursing philosophy. It's about empowering people to manage their disease, whether in their own homes, in a rest-home or a GP practice. We go wherever we are wanted or needed, and I often case manage people until they die."

Corna believes the Government should give much greater recognition to the issue of sleep apnoea. Although many DHBs have a sleep service, she is concerned many of these services are limited and inadequate to treat the large numbers of people with sleep apnoea. "For every person diagnosed with the condition, there are another 10 who are not. There are strong links between sleep apnoea and car accidents, as well as links with diabetes and heart disease. It is time this health condition was better recognised, diagnosed and adequately funded," she said. (See article p18-19.)


Benefits of belonging to the section

Corna has been a member of NZNO's respiratory nurses' section for the past four years and section chair since last year, having also served as treasurer. It was through the encouragement and mentorship of previous chair Meg Goodman that she first became involved in the section. "Meg encouraged me to join because she wanted a broader respiratory focus on the committee. It would never have occurred to me to join the committee and offer my skills--Meg's direct approach was certainly very effective."

Corna is keen for the committee to have good representation from across the country. However, she is also aware many respiratory nurses are sole practitioners and finding release time to attend meetings can be difficult. The section is also considering moving to college status. Another option would be to form a long-term conditions college, which would represent and include renal, rheumatology and cardiology nurses. The section has around 230 members and holds a symposium every two years, the last one in Tauranga in April. It holds its AGM at the symposium and, in the alternate years, at the annual South Island Respiratory Educators' Forum.

"Despite our small size, we are very active in contributing to submissions, eg to PHARMAC on the issue of inhaler medications. It is also great to be able to network beyond your own workplace. I can phone or email respiratory nurses throughout New Zealand and get an answer to a nursing issue immediately. And, I am a resource for other people too."

Corna graduated with her master's degree early this month. She is considering becoming an NP, but is taking a cautious approach as changes to the Medicines Act are proposed. "Meanwhile, I want to continue making a difference to the people of South Auckland."

By co-editor Anne Manchester
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Title Annotation:PROFILE; Nicola Corna
Author:Manchester, Anne
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Interview
Geographic Code:8NEWZ
Date:Oct 1, 2012
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