ANMJ Featured Story

The ‘Holder of Secrets’: A day in the life of a sexual health nurse

Wednesday 23rd August, 2017

It’s 8.45am Monday morning and already there are five patients waiting for the sexual health walk-in-clinic. Doors open at 9am and patients self-triage to see a doctor or nurse practitioner (NP) if they have symptoms, or a nurse for screening.

My first patient is a male requesting a sexually transmissible infection (STI) and blood borne virus (BBV) screen.

This man has sex with other men (MSM) so we swab his throat for gonorrhoea, his rectum for chlamydia and gonorrhoea (he is told how to do this himself), and collect a urine specimen for chlamydia. We also take blood for HIV, syphilis and hepatitis A and B.

Next up, is a young woman wanting to access emergency contraception, then a middle aged man wanting cryotherapy for his previously diagnosed genital warts. A young woman presents for her second hepatitis B vaccination. Everything is straightforward so far. However a distressed male presents saying he has a long-term female partner of many years, but after too much alcohol at the weekend he has had anal sex without a condom with an unknown male. He says he feels very guilty and is worried about how to tell his long-term partner. There is no judgement as we try to work through the best possible outcome for him. This consultation requires time and empathy. Baseline STI, and BBV screening is attended as well as kidney and liver function tests. He meets the criteria for accessing HIV post exposure prophylaxis, which is a month’s supply of HIV antiretroviral medication and must be started within 72 hours of possible exposure to reduce his risk of contracting HIV. This is outside my scope of practice as an RN so I will refer him to the NP for management. We will also need to discuss protecting his female partner with condoms and repeat testing in three months to cover the HIV window period. Next up, a low risk heterosexual young male presents for the third screen in two months. This requires education and counselling around appropriate timing of screening, in line with current STI guidelines.

As well as my clinical role I work as a Public Health Nurse to assist with partner notification (contact tracing) for notifiable STIs diagnosed in ACT community settings. This includes assisting patients recently diagnosed with chlamydia to contact trace their sexual partners from the past six months. Most patients I phone have attended their contact tracing already, however one young person I contact has not yet been notified that she has chlamydia so I refer her to her GP for treatment and discuss how we can help with contact tracing. Our clinic also offers outreach testing for marginalised groups and tonight I am going to two brothels to offer screening to sex workers via our Sex Workers’ Outreach Program.

All of our nursing team working on the walk-in clinic provide asymptomatic screens, physical assessments, vaccinations, STI management (for example we have standing-orders for chlamydia), contact tracing, result management and advice. Anything outside our scope of practice we refer to our NP or doctors. Most days we are involved in teaching medical students. We also provide sexual health promotion and education, liaise with other community organisations and health professionals and contribute to research projects and quality improvement activities. This week clinic nurses are involved in the Specialist HIV Clinic, an outreach school program where education and screening is provided for year 11 and 12 students and a fast track after-hours M Clinic for men who have sex with men (MSM) wanting an asymptomatic screen. Nurses working at the clinic have post graduate sexual health qualifications and have come from varying backgrounds including theatre nursing, midwifery, women’s health, emergency department and forensics.

What are the attributes of a sexual health nurse? The same for most nursing jobs: kindness, empathy, good communication skills, compassion, respect for confidentiality and a sense of humour. We work autonomously as well as being part of an interdisciplinary team where we can bounce ideas off each other, receive support and have a good laugh. A sexual health nurse also requires a selective memory as he/she is a holder of many secrets. For example a colleague was at a dinner party sitting next to a middle-aged man and his wife. The man kept turning to my colleague and saying ‘I’m sure I know you from somewhere’. Her response was that no she was sure they hadn’t met, knowing too well that this was a patient who had presented to the clinic for a STI screen a month prior, after unprotected sex with a casual female partner.

Being a sexual health nurse is a great job. We are very privileged; within a few minutes of meeting someone, we are privy to intimate information and have the satisfaction of making a little difference to their life.

Anne Baynes is an RN at the Canberra Sexual Health Centre at the Canberra Hospital in the ACT

To read more articles from ANMJ, view the full journal online at https://issuu.com/australiannursingfederation/docs/anmj_september_17_book_issuu