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May 12 is International Nurses Day, a day to celebrate the nurses who bring calm and care when it matters most. At Rocky Bay, one of those people is Howard Keane, our Training Officer and former nurse whose career spans 48 years across a variety of disciplines and continents. And whose impact is felt far beyond the training room.
This year’s theme for International Nurses Day is “Empowered nurses save lives”, which strongly reflects Howard’s work. His many years of dedication on the frontline of nursing has equipped him with the tools and insights to help others. From induction through to on-the-job training, Howard is there – teaching, demonstrating, and making sure knowledge is grounded in real-world practice.
“Support workers need to feel confident to walk into a home and provide care safely,” Howard said. “The theory is important, but the understanding comes from practice.”
New team members don’t just learn what to do, they learn why it matters.
“I train support workers in all clinical matters,” Howard explained. “That includes medication management, epilepsy and midazolam, diabetes and blood glucose levels, complex bowel care, mealtime management and PEG feeding (for people who receive their nutrition through peg tubes – usually due to severe dysphagia therefore too high risk for swallowing – or they may have lost their swallowing reflex completely).”
Howard’s work spans not only Rocky Bay staff, but also external organisations, including schools, community providers, justice facilities, and aged-care services.
A career shaped by people
Howard’s nursing career began in England in the late 1970s. He jokes that he was sent into nursing by the job centre – but the truth runs deeper. His mother and sister were nurses, and experiences within his own family shaped his early interest in mental health.
He trained as a hospital-based nurse in psychiatry at a time when nursing was hierarchical and male nurses were uncommon outside mental health settings. Since then, Howard’s career has grown to include postgraduate qualifications in paediatrics and nurse education, along with many years working in emergency departments, palliative care, drug and alcohol services, corrective services, and remote and regional hospitals.
Despite the technical skills and knowledge nursing requires, Howard said the most meaningful part of his career has always been people.
“The teams I’ve worked with, the patients, their families – especially being there for people during crisis or vulnerability,” he reflected. “That’s what stays with you.”
Even now, decades on, Howard vividly remembers the first patient he ever cared for who died, alongside countless other moments of humanity, humour and heartbreak along the way.
“Support workers need to feel confident to walk into a home and provide care safely. The theory is important, but the understanding comes from practice.”
From emergency departments to prison clinics
Throughout his career, Howard has seen an extraordinary cross-section of society, from homeless patients, to aristocrats, to notorious criminals.
“In nursing, it doesn’t matter who someone is or what they’ve done,” he said. “They’re still a person, and you’re there to provide care.”
During the 80s, Howard spent some time in private clinics in Chelsea, London, where he met some high-profile personalities. Trust and confidentiality came with the job, and through this area of nursing, Howard learned about the intricacies of people’s real lives behind the public eye.
While working in an emergency department, Howard saw every extreme and witnessed the unpredictable in the fast-paced nature of frontline care, which included moments that defy belief.
“You see everything,” he said with a smile. “Some of it you just couldn’t make up! When you work in ED for 10 years, you certainly see all sorts of very amusing things. Things I can share? Well, probably not!” Howard explained that the time he spent in ED was “the greatest fun”, but it was also hard work, and an environment where you see the very best but also the very worst in people – a side of society which he said can “dampen your spirits a bit.” Like all professions, nursing has its fair share of challenges, but as Howard simply said, it’s about “separating those emotions and doing your job.”
This sentiment certainly rang true for Howard when faced with the large number of homeless people who frequented ED, saying that it was tough having to send them back to the streets after treatment. But what many may not realise, is that aside from the care provided, staff offered “special homeless kits” to those that needed it, which included sleeping bags and other essentials.
Another unique workplace Howard spent time was in prison, where he initially worked part-time while in ED. He spent 18 months in a Sydney facility as well as a remand centre in WA. He encountered many high-profile criminals, including those who you wouldn’t want to meet even in your worst nightmares.
But regardless of their background or media profile, Howard’s mindset is simple. If they are a patient, they receive care. Black humour, he explained, has always been an important coping tool in nursing – shared behind the scenes to relieve stress as well as helping to bond teams together. “You need that relief,” said Howard. “You see some terrible things, real trauma. Relief and a bit of laughter is a way of coping within your own networks. I’m under no illusion that when I go on a plane, the air stewards behind that curtain are talking about us at the back. And it’s the same for nurses, we’re like “Did you see that?” I guess every team does that to an extent. I think the public perception is that we’re all very straight, and serious. But we’re human, and we have a good sense of humour!”
The challenges of nursing and changing perceptions
Nursing has long been shaped by demanding conditions, though the nature of these challenges has evolved significantly over time.
Although often viewed through a romanticised lens, “cycling to work with everything rosy,” historically there was a strong emphasis on bedside care and discipline. Howard described a “military style” system shaped by rigid hierarchy, where matrons and ward sisters enforced strict control, often accompanied by “a lot of bullying.” Despite this, care occurred in a more controlled environment, and patients were “very grateful… and very compliant.” This contributed to a perception of nursing as orderly, respectful, and relatively harmonious.
Howard explains the contrast to today, where contemporary nursing exists within a far more complex and demanding healthcare landscape. “There are higher levels of impatience and, at times, violence,” said Howard. “At the same time, nursing has evolved into a highly skilled discipline. It became a profession, leading to university-based education and advanced theoretical knowledge.
Modern technology and medical advancements have transformed both the role and its perception. And while these developments have improved patient outcomes, they have also increased the complexity of care and intensified workloads. “The biggest pressure now is just the sheer workload,” said Howard. “There are higher expectations of nurses. Training doesn’t prepare them practically for the job, and the emotional toll involved.
As Howard explained, “Sometimes…university-based training doesn’t train people to cope with the actual reality of what nursing is like. When I was in ED they would have debriefing sessions, but often that’s just to do with the clinical situation. Then afterwards, there’s nothing really unless you look for it yourself – or have a good manager. So, you’re always grabbing a little bit of corridor counselling.” This lack of structured, ongoing emotional support contributes to widespread burnout.
Nurses may continue to function competently, he said, yet they might become emotionally detached as a form of self-protection, particularly in high-intensity areas such as palliative care. However, this distancing does not eliminate the emotional pressure, because “you can’t avoid it, you’re only human.”
This disconnect has led to “transitional shock,” where new graduates feel unprepared for practice. As Howard recalls, “You’d find the new grads after about two months… they would be horrified. Horrified and crying.” This highlights a significant gap between theoretical preparation and the lived reality of nursing work.
“Nursing has evolved into a highly skilled discipline. It became a profession, leading to university-based education and advanced theoretical knowledge.”
Howard, aka “Mister Sister”!
Despite highlighting the challenges nurses face, as a keen advocate of the profession, he couldn’t recommend it more. He said it’s an opportunity to have a career for life. “You can become a clinician in your own right in various specialities, in all areas of healthcare. There’s great scope for development and applying that learning and knowledge to very specific areas. It also provides the opportunity to travel.”
Howard explained how his profession feels like a contribution to society. “You feel like you’ve made a difference to people at certain points of their lives,” said Howard. “My work has been rewarding. I’ve always felt a great sense of satisfaction.”
Having worked in many areas, Howard is proud to be a “generalist.” “Medical, surgical, acute medical, haematology, oncology, palliative care, paediatrics, drug and alcohol, and psychiatry – I’ve had a good career.”
We asked Howard what the highlights of his career have been (apart from working at Rocky Bay of course!) The first is the three years he worked in palliative care, supporting people and families through end-of-life. “Seeing what families and people do for each other, that was always very moving,” said Howard. “For me, it was where I could bring a lot of everything that I had learned to play. For example, you need really good assessment skills, which I gained through ED. You need very good communication, and maybe some things I learned in psych as well, with a sort of holistic approach. It was the first time I felt like I could bring a lot to a situation, which only comes with experience.”
The other highlight was working in Alice Springs for two years, working on the medical ward at the hospital, which was predominantly Aboriginal health. “That experience changed me. It was completely different, I loved it,” said Howard.
It was there that Howard earned a name he still treasures – “Mr Sister,” affectionately given to him by Aboriginal women who were used to calling nurses “Sister”! “I loved being in Alice Springs, because the country there is just stunning,” said Howard. “It just feels so different from the rest of Australia. And it was a really good chance to understand some of the health problems that Aboriginal people experience, and to actually spend time with the community – they were the warmest, nicest, funniest people that I’ve ever looked after. And they were very grateful.”
Like all other areas of the profession that Howard worked in, he explained that it came with its own unique challenges. “It would be difficult sometimes, because western medicine wasn’t always understood. I had times when a patient wouldn’t stay for the whole course of antibiotics, they’d go walk about.”
Howard loved his time in Alice Springs that he planned to return after a stint in WA, but then he met his beautiful wife, “and then that was it. I’m still here!”
Howard recommends working in remote communities and travelling if you get the chance. “It’s amazing,” said Howard. “It’s hard, hard work – particularly in the remote communities, but it’s a great experience.”
Empowered nurses save lives
After nearly 50 years in nursing, Howard remains deeply committed to the profession and to his role empowering others. He encourages conversation and peer support, recognising that emotionally supported workers provide safer and more compassionate care. By helping to bridge the gap between theory and real-world practice, Howard helps prepare them for the reality of the job.
“At the end of the day, it’s about relationships,” he said. “Take away all the technology, and care is still about human connection. Rocky Bay is quite unique – there’s a close connection between support worker and customer in terms of communication and relationship, which is fundamental of all care really. I think it’s easy to lose sight of good personal, basic care amongst all the other demands that we have. By providing people with those key skills and knowledge, it’s always the customer that is going to benefit.”
Howard enjoys visiting staff members and customers at our Rocky Bay houses. “It’s great to see some of the team members who I’ve met through induction and see how they’ve developed in their career. Within Rocky Bay there’s a good choice of pathways. People can get onto the Cert III and Cert IV courses, the Emerging Leaders Programme, become lead supports or team leaders, and find their own way of developing within Rocky Bay.”
This International Nurses Day, we thank Howard and all nurses for their resilience and commitment to empowering others. Because when nurses teach, mentor and share their knowledge, they don’t just save lives directly, they enable countless others to do the same.
“I don’t think I’d be here the last three years if I didn’t value the work that was going on,” said Howard. “I really admire and value support workers because it’s not easy, but it’s a rewarding job whatever area you are in. We’ve got some really great people here, and they deserve high-quality training and support. I wouldn’t be here if I didn’t believe in the work.”