Andrew Jull: crafting care

When Andrew Jull meets UniNews for an interview, he is wearing remarkable multi coloured shoes, a paisley velvet waistcoat, floral shirt and yellow and black plaid trousers.

The professor of nursing, promoted to personal chair in 2017, says he gave himself permission to break the unspoken rules of the male wardrobe – with its greys, blues and blacks – around a decade ago.

Like his wardrobe, his career choice suggests he’s comfortable challenging convention.

Reflecting on what propelled him to embark on a nursing career, he confirms this was among his reasons.

In the 1980s, friends and flatmates who were second-wave feminists “challenged some of the masculine roles I’d grown up with”, he says. His decision “came down to wanting to be part of a movement for change”, he says, “and to show that men could be caring, to disrupt masculine role models. It was political.”

Besides, he was “bumming around” doing a degree he felt wasn’t particularly relevant. “I needed a career.”

Andrew has since spent decades in nursing practice and research, and the theme of this year’s International Nurses Day – empowering nurses to do what they are trained to do, which is to save lives – resonates with him.

He clearly prioritises the importance of caring for others and the personal fulfilment that comes with it. However, he says chronic understaffing of nursing in New Zealand is putting patients’ lives at risk.

It’s also causing what he calls “moral injury” to nurses. Burnout is an obvious harm, but being prevented from providing good quality care due to resource constraints also causes “vicarious trauma, maybe even PTSD”, he says.

He believes nursing care is rooted in simple, respectful actions, and he recalls the best shift he experienced as a nurse as an example.

Assigned a six-bed room in an orthopaedic ward, he was caring for a group of older women who had “a reputation for being demanding and difficult”.

He introduced himself to the women and helped one with a bedpan. “Then I got a flannel and moistened it, wrung it out and gave it to her, and she asked me what that was for. I said, ‘so that you can cleanse your hands’. She said, ‘nobody has ever done that for me!’

“The whole vibe in the room changed. It was like she was the switch for all the other women in that room. And we had a blast. They were so funny.”

Such simple respectful actions can shift power, build trust and shape patient experience, he says.

“Caring for people is a privilege. We get to do stuff that the general person in the street would not be allowed to do. We work with people’s bodies in a way that is invasive and reinforces vulnerability. And people have to be able to trust us.

“If we can’t do simple things like call them by their right name, pronounce their name the way they pronounce it, then why would they trust us with all those other intimacies?”

While Andrew has reached the highest levels of his profession, there were some rocky moments in the beginning. During his first year of training, at age 24, he was shown through North Shore Hospital’s haematology lab and fainted in front of a fridge full of blood bags.

“I had no problems giving blood,” he recalls. “I had no problems working with deep wounds that exposed the subcutaneous layers, muscle, tendon and bone.”
Yet something about all those packets of blood sent him to the floor, in front of his fellow students.

Following graduation from ATI (now AUT), Andrew began his clinical career at Auckland Hospital (now Auckland City Hospital), working in orthopaedics. These early years coincided with significant changes in New Zealand’s health system, including restructuring hospital services and introducing competitive, efficiency-driven funding models.

He moved into research in 1999, first completing a masters at Victoria University of Wellington: “It was never a question of if I would do research, just when and how.”

His thesis, a systematic review of a drug treatment for venous leg ulcers, was published first in the Cochrane Library and then in the Lancet.

Venous leg ulcers, he explains, occur when blood pumped out of the heart down to the feet has trouble getting back up to the heart. When the valves in the deep veins in the legs fail, inflammation becomes chronic, and tissue breaks down in the form of ulcers. These can be life-changing, both for patients and their families, with everything revolving around the condition.

Andrew’s work has since been informed by his development of New Zealand’s guidelines for the management of people with chronic leg ulcers, and he remains committed to evidence-based nursing practice.

His ambition to find where the evidence was missing and fill the gaps also led to work on the Cochrane Collaboration (now called Cochrane), a global independent network of researchers, professionals and patients that provides evidence-based health information.

He puts much of his research trajectory down to having the right mentors at the right time, including those who pushed him to apply for the HRC Foxley Fellowship in 2002. That funded a year’s research sabbatical at the Clinical Trials Research Unit (CTRU) at the University of Auckland.

The Foxley Fellowship led to more grants, which led to more trials, including a large randomised trial using honey to treat venous leg ulcers – a study involving 368 participants across Auckland, Waikato and Christchurch. It also became his PhD. (The findings? “Better to use it on your toast, not your leg,” says Andrew. “We found that it made no difference in healing or infection rates when used as a first-line treatment.”)

He spent seven years with the CTRU, chasing grant funding for his research and salary; he loved the work but not the precarity, especially once he had three children.

Andrew approached the School of Nursing, where he had longstanding connections, and asked about vacancies, and he was appointed an associate professor in 2009. Until 2019, he split his time between Auckland City Hospital, where he worked as a nurse adviser in quality and safety, and the University.

His research interests have expanded beyond wound care to include childhood weight-gain prevention, gambling addiction, and the development of national weight-management guidelines for adults and children. The recurring theme is emphasising rigorous evidence and translating research findings into practice and policy.

And those children have also grown. Andrew and his wife (whom he met at nursing school and is now a midwife) live in Titirangi, with their youngest, who hopes to study physiotherapy. Their eldest, a son, works as a nurse and their daughter in hospital administration.

He must be chuffed that their children have gone into healthcare?

He chooses his words carefully: “I’m glad that they are kind,” he says. “I’m proud that they like each other. I’m happy that they are finding work that they enjoy.”

– Margo White