- Email: [email protected]
General practice nursing education in Australia
General practice nursing education in Australia Tessa Pascoe, formerly Royal College of Nursing, Australia Ronelle Hutchinson, formerly The Royal Australian College of General Practitioners Elizabeth Foley, Royal College of Nursing, Australia Ian Watts, The Royal Australian College of General Practitioners Lyndall Whitecross, The Royal Australian College of General Practitioners Teri Snowdon, The Royal Australian College of General Practitioners Introduction The quality of care delivered by nurses working in Australian general practices rests on a strong foundation of nursing education and training. A national study of nurses working in general practice was conducted using qualitative and quantitative research techniques to explore their role and educational needs. Results from this research suggest that education for general practice nurses is seen by nurses and General Practitioners to be largely non-formal in nature and is seen by GPs and nurses to be tailored towards general practice nursing needs. Such education is often available locally through general practice support organisations; is strongly focused on National Health Priority Areas and clinical care; and is more appropriate for registered rather than enrolled nurses. The educational opportunities currently available to support nursing in general practice are largely ad hoc and vary in relation to quality, appropriateness and accessibility. Nurses working in general practices in Australia need a system of ongoing training and education to support their responsibilities and foster the development of the position as a viable career option for nurses. Key Words: General practice, nursing education, career
Corresponding author: Tessa Pascoe, MRCNA RN RM BN BCommunityEd(Health Promotion), formerly Policy Advisor, Nursing in General Practice Project, Royal College of Nursing, Australia Email: [email protected] Ronelle Hutchinson, PhD (Sociology) Monash, BA (Hons), formerly Policy Advisor, Nursing in General Practice, The Royal Australian College of General Practitioners Elizabeth Foley, FRCNA AFCHSE RN MEd. Director, Policy, Royal College of Nursing, Australia Ian Watts BSW, Dip Soc Plan, Cert in Health Econ (Dist Ed). National Manager, GP Advocacy and Support, The Royal Australian College of General Practitioners Lyndall Whitecross, FRACGP. GP Advisor, The Royal Australian College of General Practitioners Teri Snowdon, BA(Hons) BSW(Hons) NSW, ARMIT. National Manager, Quality Care and Research, The Royal Australian College of General Practitioners Acknowledgements The Nursing in General Practice Project was funded by the Australian Government Department of Health and Ageing
22
Collegian Vol 13 No 2 2006
General practice nurses contribute valuable nursing expertise to the primary health care delivered to patients through general practice. Historically, nursing has not been integrated into Australian general practice as a profession in its own right. Anecdotal evidence suggests general practice nursing in Australia has traditionally been an area of employment undertaken by nurses in order to integrate lifestyle and family commitments with part-time work, with the nurse being viewed as a 'hand maiden' to the doctor in general practice. However, general practice nursing today is being increasingly given greater recognition and support. General practice nursing is supported by the Australian Government through the Nursing in General Practice 2001 Budget Initiative, which included a financial incentive to GPs in rural/remote areas of workforce pressure to employ a general practice nurse, and through recent changes to Medicare which extended this incentive to include urban areas of workforce pressure, and introduced practice nurse MBS items. The Australian Government has given overt recognition that general practice nurses coordinate clinical care tasks, support better management of chronic diseases, undertake population health activities, and provide clinical support which enables GPs to focus on diagnosis and clinical care (Condon et al 2000; Lockwood & Maguire 2000; Patterson et al 1999; Bonawit & Watson 1996). In the United Kingdom (UK) and New Zealand (NZ), general practice nursing appears to have a clearly articulated career trajectory (Atkin & Lunt 1995, 1996a, 1996b; Caldow et al 2001, Docherty 1996; New Zealand Nurses Organisation 2001, 2003a, 2003b, 2002; Trim 1996; Yerrell & Reed 1997). In these countries, general practice nursing has been systematically supported to develop and provide professional infrastructure such as competency standards, role descriptions, career and educational pathways, and professional organisation support. In contrast, Australia appears to lag significantly behind the UK and New Zealand in relation to the recognition and specialisation of the role of the general practice nurse. In recent years, professional support has increased for general practice nurses in Australia with the development of the Australian Practice Nurse Association and the Community and Primary Health Care Network through
General practice nursing education in Australia
Royal College of Nursing, Australia (RCNA). More recently, a number of developments have occurred in Australia, including the commencement of a project to develop national competency standards for general practice nurses and an inaugural National Practice Nurse Conference. Despite these advancements in the recognition of the role of general practice nurses, there exists no published literature or research relating to the current educational system for general practice nurses, nor the education needs of these nurses to facilitate high quality nursing care in Australian general practice. In recognition of the scarcity of research in the area, the Nursing in General Practice Project was a collaborative undertaking by RCNA and the Royal Australian College of General Practitioners (RACGP), funded by the Australian Government Department of Health and Ageing, to explore: the current and future roles of enrolled and registered nurses in Australian general practice; the current educational programs available to support them; and the educational needs of nurses and GPs to facilitate the role for general practice nurses. Specifically, this study aimed to identify the range of formal, non-formal and up-skilling educational programs currently available to nurses working in general practice, and GPs, to provide them with the skills needed to work successfully in a team in general practice. This paper outlines the results of this study pertaining to the education currently available for nursing in general practice in Australia. The capacity for the current educational arrangements to meet the needs of general practice nurses will be discussed, followed by a consideration of nurse and GP views on the opportunity to support nursing in general practice as a viable career option for nurses.
Methodology The RACGP/RCNA Nursing in General Practice Project was designed as a research project using quantitative and qualitative data collection activities. All post-basic nursing educational opportunities available to nurses working in general practice were within the scope of the project. The framework outlined in Measuring Learning in Australia: A Framework for Educational and Training Statistics (Australian Bureau of Statistics 2003) was used to define formal and non-formal education. In this framework, formal learning includes activities that are provided by an identifiable provider, are structured, and involve an evaluation process. Non-formal learning may be taught or non-taught (i.e. self-directed learning), does not involve any evaluation of achievement, and may be structured (such as community-based learning) or unstructured (such as on-thejob training). Information about education to support nursing in general practice was primarily collected through three means: 1. A national telephone survey of 222 general practice nurses which collected quantitative information about current roles, qualifications, educational background, experiences and future aspirations, with the survey sample consisting of both enrolled (15%) and registered (85%) nurses from rural and urban areas of Australia. Nurses were recruited through recruitment notices distributed through the Divisions of General Practices,
RCNA networks and the Australian Practice Nurses Association (APNA) networks. Results from the survey were analysed using the Statistical Package for Social Sciences (SPSS) to generate descriptive statistics and cross-tabulations. 2. A series of 14 focus group workshops comprising a total of 97 GPs and 183 general practice nurses around Australia, in both rural and urban locations, focusing on the two professions’ views, experiences and perceptions about nursing and education in general practice. Separate focus groups of GPs and nurses were held concurrently at each research location with a debriefing session combining both groups provided after the focus groups. Research participants were recruited through notices distributed through the RACGP, Divisions of General Practices, APNA and RCNA. Qualitative data was analysed using grounded theory analysis (Strauss & Corbin 1998) emphasising main themes and issues. 3. Survey research mapped and documented the range of formal and non-formal programs currently available to support nursing in general practice. These programs included educational opportunities available to, but not restricted to, nurses in general practice. Information on these programs (including course contact details, content, delivery mode, length of course, certification, frequency of delivery, targe audience and cost) was collected through a mail questionnaire to a purposive sample of 287 educational providers followed by additional sourcing through snowball sampling (response rate for initial questionnaire 63.8%). An assessment of the quality of educational programs was beyond the scope of the project. Due to the scarcity of research about the role and education needs of nurses working in general practice, there is no reliable data with which to compare the results of the study. Given this, the research was designed to collect information through a variety of different techniques and the triangulation of results from each activity suggested consistency and reliability of data received from each activity.
Results Current status of education for general practice nurses Results from the telephone survey of nurses indicate that a typical general practice nurse is a registered nurse (84.7% of sample) who works on a part-time basis (75.3%). The nurse works in a medium to large practice (93.7%) with more than two GPs and works with at least one other enrolled or registered nurse (64.4%). The nurse is likely to have worked in general practice for less than five full time equivalent years (52.4%). The nurse is likely to have some post-registration formal education, however, over a third of the nurses surveyed had no further formal education to support their role in general practice, as indicated in Table 1. Of those nurses who had achieved post registration formal education, this was likely to be in midwifery (21.5%), immunisation (6.2%) or maternal and child health (3.8%). Collegian Vol 13 No 2 2006
23
Table 1: Formal qualifications achieved since initial registration as a nurse.
Qualification
Total sample %
None
34.1
Certificate 1-1V AQF2
23.5
Hospital certificate
19.6
Postgraduate degree/diploma
11.0
Undergraduate degree
7.8
Masters
2.0
Other
2.0
Total
100
However, 94.6% of the nurses surveyed had gained non-formal education in the past two years, more often than not through seminars and in-services (51.4%). As Table 2 indicates, this nonformal education is likely to be related directly to the roles nurses undertake in general practices. Table 2: Content areas of non-formal education completed in last two years.
Education content areas
Total sample %
to support general practice nursing. Systematic exploration of the database suggests that of these programs, the majority (77.6%) are non-formal in nature and relate directly to the general practice nursing role. Analysis of the education database suggests little consistency in the content, delivery options, frequency of delivery, and accessibility of the formal and non-formal programs across Australia.
General practice nursing – educational needs Results from the telephone survey of nurses indicate a number of areas of education that nurses consider important to support their role in general practice, as outlined in Table 3. Table 3: Content areas of education ranked important by general practice nurses
Education areas
% of sample ranking areas as important
Communication skills
94.1
Infection control
93.7
Confidentiality and national privacy principles
93.7
Legal and ethic issues in general practice
91.9
15.2
First aid and CPR
91.4
Immunisation
12.3
Wound care and management
91.0
Diabetes management
12.1
Cold chain monitoring
90.0
Infection control
11.1
Sterilisation
90.0
Asthma management
10.7
Triage
90.0
Enhanced primary care activities
89.6
Wound care/management
CPR and emergency care
6.9
Legal and ethical issues
2.3
Practice accreditation
87.3 86.0
Other
29.4
Patient advocacy
Total
100
Care of seriously ill patients
82.8
Information technology use in the practice
81.4
While many nurses appear to be accessing non-formal education to support their roles in general practices, a thematic analysis of the focus group qualitative data indicated that the GPs and nurses involved in the research perceived that current education activities for general practice nurses in Australia are: • limited • largely non-formal in nature and are not formally accredited nor evaluated • predominantly delivered by local Divisions of General Practice • often tailored towards nursing within the general practice environment for non-formal education • unlikely to be tailored towards nursing within the general practice environment for formal education • focused on the National Health Priority areas, in particular asthma and diabetes education • likely to be appropriate for registered rather than enrolled nurses • variable in relation to cost, course availability and delivery mode • likely to focus on the clinical components of a nurse’s role in general practice The scoping study of educational providers generated a descriptive database of 417 formal and non-formal educational programs currently available (or proposed for the near future) across Australia 24
Collegian Vol 13 No 2 2006
Management of recall/reminder register
81.4
Dealing with difficult clients
81.0
The general practice nurses and GPs who participated in the focus groups demonstrated overwhelming support for developments in education to support nursing in general practice. A thematic analysis of the focus group qualitative data indicates that nurses and GPs have a number of suggestions of ways in which to increase support for education for nurses including: • tailoring education to the unique needs of nursing within a general practice environment • offering general practice nursing as a career option for nurses and providing education that promotes competence advancement within this career choice • including both clinical and theoretical components in the education provided for general practice nurses • assessing and accrediting the quality of general practice nurse education against appropriate national education standards established by the profession As one general practice nurse suggested, "there needs to be some formal type of training. I am quite happy to do updates but formal training is important. . . to make it a career anyway, and to get the recognition that we really want."
General practice nursing education in Australia
• offering affordable, flexible and appropriate education for general practice nurses • offering education for general practice nurses that is not overly prescriptive, regulated or restrictive, but is flexible and adaptable to the needs of individual practices • developing education that is appropriate for the two levels of general practice nursing: enrolled and registered nursing • recognising the prior learning of nurses working in general practice in any formalised education • encouraging both nurses and GPs to contribute to the development of education for general practice nurses through individuals’ participation and/or the participation of professional colleges • financing education for nurses in a way that does not prove overly burdensome for the nurses themselves or the general practices in which they are employed • enabling nurses to attend education through appropriate support systems in general practices As one GP stated, "I think they do need a career path. . . they are actually locked in now where they can go in general practice and they are stuck here, they don't have any structure that keeps them progressing. Using a series of modules they can keep on expanding their knowledge. I think that this is very important."
Discussion The cumulative results from this research indicate that general practice nurses and GPs do not consider the current educational opportunities for general practice nursing in Australia to be adequate. As this was the first exploratory study undertaken in Australia to explore the current educational system and educational needs for general practice nurses, it is difficult to determine if this is a consistent perception across all Australian general practices. The education currently available to support nurses working in general practice in Australia is largely non-formal in nature. The delivery of the education, the format and the quality of the education is largely not assessed. It is unclear whether the education available to support nursing in general practice is, in fact, valuable, best practice education which allows participants to actually ‘learn’ what is intended. Such education is also not assessed in terms of appropriateness of the content and approach for the general practice context. It is quite possible that some programs provide excellent information and content and are designed and delivered in an expert format for learning but are inappropriate for application in the general practice environment. The education currently available for general practice nursing is largely ad hoc, variable, and accessed opportunistically, and therefore does not create or support a coordinated system of general practice specific education. This is not a situation that fosters reliability and dependability in the training of Australia’s general practice nurses. While it is recognised that nurses in general practice contribute enormously to the care provided to the general public, the educational basis of that care appears to be inconsistent. For nursing in general practice to be a sustainable career option for nurses, a coordinated, reliable system of education
is needed. A system of education which demonstrates confidence in the training, education and up-skilling of the general practice nurse workforce would build a foundation on which nurses in general practice can provide consistent, quality health care to the Australian general public. Such a system of education needs to be developed, maintained and promoted by the general practice nursing profession.
Conclusion General practice nurses in Australia have been supported by limited training, education and up-skilling programs specific to their role in general practice. Nurses appear to be resourceful in accessing the formal education that is available and are proactive in accessing non-formal opportunities. Current general practice nursing education – with its variations in accessibility, quality and applicability – offers little reassurance that the general practice nurse’s role is adequately supported by the current educational opportunities. It is difficult to envisage a move to the future with further role demands without a coordinated system for education for general practice nurses. Nurses and GPs consulted within this research overwhelmingly supported advancements in education to support general practice nursing. It is only through the establishment of a consistent, reliable and high quality post-basic education system that nursing in general practice can become a viable and attractive career option for nurses in Australia. References Atkin K, Lunt N 1995 Training and education in practice nursing: the perspective of the practice nurse, employing general practitioner and family health service authority. Nurse Education Today 15(6): 406-413 Atkin K, Lunt N 1996a Negotiating the role of the practice nurse in general practice. Journal of Advanced Nursing 24(3): 498-505 Atkin K, Lunt N 1996b The role of the practice nurse in primary health care: managing and supervising the practice nurse resource. Journal of Nursing Management 4(2): 85-92 Australian Bureau of Statistics 2003 Measuring learning in Australia: a framework for education and training statistics. ABS, Canberra Bonawit V, Watson L 1996 Nurses who work in general medical practices: a Victorian survey. Australian Journal of Advanced Nursing 13(4): 28-34 Caldow J, Bond C, Russell, E 2001 Independent nursing practice: a national survey of attitudes of practice employed nurses in Scotland. Health Bulletin 59(1): 21-28 Condon J, Willis E, Litt J 2000 The role of the practice nurse: an exploratory study. Australian Family Physician 29(3): 272-277 Docherty B 1996 Nursing in general practice: a New Zealand perspective. Caxton Press, Christchurch Lockwood A, Maguire F 2000 General practitioners and nurses collaborating in general practice. Australian Journal of Primary Health Interchange 6(2): 19-29 New Zealand Nurses Organisation 2001 Job description for practice nurses. NZNO, Wellington New Zealand Nurses Organisation 2002 Accreditation and reaccreditation manual for practice nurses. NZNO, Wellington New Zealand Nurses Organisation 2003a Education policy, standards and career development for practice nurses. NZNO, Wellington New Zealand Nurses Organisation 2003b New Zealand College of Practice Nurses strategic plan 2002 – 2005. NZNO, Wellington Patterson E, Del Mar C, Najman J 1999 A descriptive study of nurses employed by general practitioners in South East Queensland. Australian Journal of Advanced Nursing 17(2): 13-20 Strauss A, Corbin, J 1998 Basics of Qualitative research: Techniques and Procedures for Developing Grounded Theory, 2nd Edition,Thousand Oaks (California): Sage Publications Trim S 1996 Practice nurse accreditation. Primary Health Care New Zealand August 1996: 89 Yerrell P, Reed A 1997 The anachronism of policy for nursing in general practice: conceptualising a way forward. NT Research 2(4): 245-257
Collegian Vol 13 No 2 2006
25
Corresponding author: Tessa Pascoe, MRCNA RN RM BN BCommunityEd(Health Promotion), formerly Policy Advisor, Nursing in General Practice Project, Royal College of Nursing, Australia Email: [email protected] Ronelle Hutchinson, PhD (Sociology) Monash, BA (Hons), formerly Policy Advisor, Nursing in General Practice, The Royal Australian College of General Practitioners Elizabeth Foley, FRCNA AFCHSE RN MEd. Director, Policy, Royal College of Nursing, Australia Ian Watts BSW, Dip Soc Plan, Cert in Health Econ (Dist Ed). National Manager, GP Advocacy and Support, The Royal Australian College of General Practitioners Lyndall Whitecross, FRACGP. GP Advisor, The Royal Australian College of General Practitioners Teri Snowdon, BA(Hons) BSW(Hons) NSW, ARMIT. National Manager, Quality Care and Research, The Royal Australian College of General Practitioners Acknowledgements The Nursing in General Practice Project was funded by the Australian Government Department of Health and Ageing
22
Collegian Vol 13 No 2 2006
General practice nurses contribute valuable nursing expertise to the primary health care delivered to patients through general practice. Historically, nursing has not been integrated into Australian general practice as a profession in its own right. Anecdotal evidence suggests general practice nursing in Australia has traditionally been an area of employment undertaken by nurses in order to integrate lifestyle and family commitments with part-time work, with the nurse being viewed as a 'hand maiden' to the doctor in general practice. However, general practice nursing today is being increasingly given greater recognition and support. General practice nursing is supported by the Australian Government through the Nursing in General Practice 2001 Budget Initiative, which included a financial incentive to GPs in rural/remote areas of workforce pressure to employ a general practice nurse, and through recent changes to Medicare which extended this incentive to include urban areas of workforce pressure, and introduced practice nurse MBS items. The Australian Government has given overt recognition that general practice nurses coordinate clinical care tasks, support better management of chronic diseases, undertake population health activities, and provide clinical support which enables GPs to focus on diagnosis and clinical care (Condon et al 2000; Lockwood & Maguire 2000; Patterson et al 1999; Bonawit & Watson 1996). In the United Kingdom (UK) and New Zealand (NZ), general practice nursing appears to have a clearly articulated career trajectory (Atkin & Lunt 1995, 1996a, 1996b; Caldow et al 2001, Docherty 1996; New Zealand Nurses Organisation 2001, 2003a, 2003b, 2002; Trim 1996; Yerrell & Reed 1997). In these countries, general practice nursing has been systematically supported to develop and provide professional infrastructure such as competency standards, role descriptions, career and educational pathways, and professional organisation support. In contrast, Australia appears to lag significantly behind the UK and New Zealand in relation to the recognition and specialisation of the role of the general practice nurse. In recent years, professional support has increased for general practice nurses in Australia with the development of the Australian Practice Nurse Association and the Community and Primary Health Care Network through
General practice nursing education in Australia
Royal College of Nursing, Australia (RCNA). More recently, a number of developments have occurred in Australia, including the commencement of a project to develop national competency standards for general practice nurses and an inaugural National Practice Nurse Conference. Despite these advancements in the recognition of the role of general practice nurses, there exists no published literature or research relating to the current educational system for general practice nurses, nor the education needs of these nurses to facilitate high quality nursing care in Australian general practice. In recognition of the scarcity of research in the area, the Nursing in General Practice Project was a collaborative undertaking by RCNA and the Royal Australian College of General Practitioners (RACGP), funded by the Australian Government Department of Health and Ageing, to explore: the current and future roles of enrolled and registered nurses in Australian general practice; the current educational programs available to support them; and the educational needs of nurses and GPs to facilitate the role for general practice nurses. Specifically, this study aimed to identify the range of formal, non-formal and up-skilling educational programs currently available to nurses working in general practice, and GPs, to provide them with the skills needed to work successfully in a team in general practice. This paper outlines the results of this study pertaining to the education currently available for nursing in general practice in Australia. The capacity for the current educational arrangements to meet the needs of general practice nurses will be discussed, followed by a consideration of nurse and GP views on the opportunity to support nursing in general practice as a viable career option for nurses.
Methodology The RACGP/RCNA Nursing in General Practice Project was designed as a research project using quantitative and qualitative data collection activities. All post-basic nursing educational opportunities available to nurses working in general practice were within the scope of the project. The framework outlined in Measuring Learning in Australia: A Framework for Educational and Training Statistics (Australian Bureau of Statistics 2003) was used to define formal and non-formal education. In this framework, formal learning includes activities that are provided by an identifiable provider, are structured, and involve an evaluation process. Non-formal learning may be taught or non-taught (i.e. self-directed learning), does not involve any evaluation of achievement, and may be structured (such as community-based learning) or unstructured (such as on-thejob training). Information about education to support nursing in general practice was primarily collected through three means: 1. A national telephone survey of 222 general practice nurses which collected quantitative information about current roles, qualifications, educational background, experiences and future aspirations, with the survey sample consisting of both enrolled (15%) and registered (85%) nurses from rural and urban areas of Australia. Nurses were recruited through recruitment notices distributed through the Divisions of General Practices,
RCNA networks and the Australian Practice Nurses Association (APNA) networks. Results from the survey were analysed using the Statistical Package for Social Sciences (SPSS) to generate descriptive statistics and cross-tabulations. 2. A series of 14 focus group workshops comprising a total of 97 GPs and 183 general practice nurses around Australia, in both rural and urban locations, focusing on the two professions’ views, experiences and perceptions about nursing and education in general practice. Separate focus groups of GPs and nurses were held concurrently at each research location with a debriefing session combining both groups provided after the focus groups. Research participants were recruited through notices distributed through the RACGP, Divisions of General Practices, APNA and RCNA. Qualitative data was analysed using grounded theory analysis (Strauss & Corbin 1998) emphasising main themes and issues. 3. Survey research mapped and documented the range of formal and non-formal programs currently available to support nursing in general practice. These programs included educational opportunities available to, but not restricted to, nurses in general practice. Information on these programs (including course contact details, content, delivery mode, length of course, certification, frequency of delivery, targe audience and cost) was collected through a mail questionnaire to a purposive sample of 287 educational providers followed by additional sourcing through snowball sampling (response rate for initial questionnaire 63.8%). An assessment of the quality of educational programs was beyond the scope of the project. Due to the scarcity of research about the role and education needs of nurses working in general practice, there is no reliable data with which to compare the results of the study. Given this, the research was designed to collect information through a variety of different techniques and the triangulation of results from each activity suggested consistency and reliability of data received from each activity.
Results Current status of education for general practice nurses Results from the telephone survey of nurses indicate that a typical general practice nurse is a registered nurse (84.7% of sample) who works on a part-time basis (75.3%). The nurse works in a medium to large practice (93.7%) with more than two GPs and works with at least one other enrolled or registered nurse (64.4%). The nurse is likely to have worked in general practice for less than five full time equivalent years (52.4%). The nurse is likely to have some post-registration formal education, however, over a third of the nurses surveyed had no further formal education to support their role in general practice, as indicated in Table 1. Of those nurses who had achieved post registration formal education, this was likely to be in midwifery (21.5%), immunisation (6.2%) or maternal and child health (3.8%). Collegian Vol 13 No 2 2006
23
Table 1: Formal qualifications achieved since initial registration as a nurse.
Qualification
Total sample %
None
34.1
Certificate 1-1V AQF2
23.5
Hospital certificate
19.6
Postgraduate degree/diploma
11.0
Undergraduate degree
7.8
Masters
2.0
Other
2.0
Total
100
However, 94.6% of the nurses surveyed had gained non-formal education in the past two years, more often than not through seminars and in-services (51.4%). As Table 2 indicates, this nonformal education is likely to be related directly to the roles nurses undertake in general practices. Table 2: Content areas of non-formal education completed in last two years.
Education content areas
Total sample %
to support general practice nursing. Systematic exploration of the database suggests that of these programs, the majority (77.6%) are non-formal in nature and relate directly to the general practice nursing role. Analysis of the education database suggests little consistency in the content, delivery options, frequency of delivery, and accessibility of the formal and non-formal programs across Australia.
General practice nursing – educational needs Results from the telephone survey of nurses indicate a number of areas of education that nurses consider important to support their role in general practice, as outlined in Table 3. Table 3: Content areas of education ranked important by general practice nurses
Education areas
% of sample ranking areas as important
Communication skills
94.1
Infection control
93.7
Confidentiality and national privacy principles
93.7
Legal and ethic issues in general practice
91.9
15.2
First aid and CPR
91.4
Immunisation
12.3
Wound care and management
91.0
Diabetes management
12.1
Cold chain monitoring
90.0
Infection control
11.1
Sterilisation
90.0
Asthma management
10.7
Triage
90.0
Enhanced primary care activities
89.6
Wound care/management
CPR and emergency care
6.9
Legal and ethical issues
2.3
Practice accreditation
87.3 86.0
Other
29.4
Patient advocacy
Total
100
Care of seriously ill patients
82.8
Information technology use in the practice
81.4
While many nurses appear to be accessing non-formal education to support their roles in general practices, a thematic analysis of the focus group qualitative data indicated that the GPs and nurses involved in the research perceived that current education activities for general practice nurses in Australia are: • limited • largely non-formal in nature and are not formally accredited nor evaluated • predominantly delivered by local Divisions of General Practice • often tailored towards nursing within the general practice environment for non-formal education • unlikely to be tailored towards nursing within the general practice environment for formal education • focused on the National Health Priority areas, in particular asthma and diabetes education • likely to be appropriate for registered rather than enrolled nurses • variable in relation to cost, course availability and delivery mode • likely to focus on the clinical components of a nurse’s role in general practice The scoping study of educational providers generated a descriptive database of 417 formal and non-formal educational programs currently available (or proposed for the near future) across Australia 24
Collegian Vol 13 No 2 2006
Management of recall/reminder register
81.4
Dealing with difficult clients
81.0
The general practice nurses and GPs who participated in the focus groups demonstrated overwhelming support for developments in education to support nursing in general practice. A thematic analysis of the focus group qualitative data indicates that nurses and GPs have a number of suggestions of ways in which to increase support for education for nurses including: • tailoring education to the unique needs of nursing within a general practice environment • offering general practice nursing as a career option for nurses and providing education that promotes competence advancement within this career choice • including both clinical and theoretical components in the education provided for general practice nurses • assessing and accrediting the quality of general practice nurse education against appropriate national education standards established by the profession As one general practice nurse suggested, "there needs to be some formal type of training. I am quite happy to do updates but formal training is important. . . to make it a career anyway, and to get the recognition that we really want."
General practice nursing education in Australia
• offering affordable, flexible and appropriate education for general practice nurses • offering education for general practice nurses that is not overly prescriptive, regulated or restrictive, but is flexible and adaptable to the needs of individual practices • developing education that is appropriate for the two levels of general practice nursing: enrolled and registered nursing • recognising the prior learning of nurses working in general practice in any formalised education • encouraging both nurses and GPs to contribute to the development of education for general practice nurses through individuals’ participation and/or the participation of professional colleges • financing education for nurses in a way that does not prove overly burdensome for the nurses themselves or the general practices in which they are employed • enabling nurses to attend education through appropriate support systems in general practices As one GP stated, "I think they do need a career path. . . they are actually locked in now where they can go in general practice and they are stuck here, they don't have any structure that keeps them progressing. Using a series of modules they can keep on expanding their knowledge. I think that this is very important."
Discussion The cumulative results from this research indicate that general practice nurses and GPs do not consider the current educational opportunities for general practice nursing in Australia to be adequate. As this was the first exploratory study undertaken in Australia to explore the current educational system and educational needs for general practice nurses, it is difficult to determine if this is a consistent perception across all Australian general practices. The education currently available to support nurses working in general practice in Australia is largely non-formal in nature. The delivery of the education, the format and the quality of the education is largely not assessed. It is unclear whether the education available to support nursing in general practice is, in fact, valuable, best practice education which allows participants to actually ‘learn’ what is intended. Such education is also not assessed in terms of appropriateness of the content and approach for the general practice context. It is quite possible that some programs provide excellent information and content and are designed and delivered in an expert format for learning but are inappropriate for application in the general practice environment. The education currently available for general practice nursing is largely ad hoc, variable, and accessed opportunistically, and therefore does not create or support a coordinated system of general practice specific education. This is not a situation that fosters reliability and dependability in the training of Australia’s general practice nurses. While it is recognised that nurses in general practice contribute enormously to the care provided to the general public, the educational basis of that care appears to be inconsistent. For nursing in general practice to be a sustainable career option for nurses, a coordinated, reliable system of education
is needed. A system of education which demonstrates confidence in the training, education and up-skilling of the general practice nurse workforce would build a foundation on which nurses in general practice can provide consistent, quality health care to the Australian general public. Such a system of education needs to be developed, maintained and promoted by the general practice nursing profession.
Conclusion General practice nurses in Australia have been supported by limited training, education and up-skilling programs specific to their role in general practice. Nurses appear to be resourceful in accessing the formal education that is available and are proactive in accessing non-formal opportunities. Current general practice nursing education – with its variations in accessibility, quality and applicability – offers little reassurance that the general practice nurse’s role is adequately supported by the current educational opportunities. It is difficult to envisage a move to the future with further role demands without a coordinated system for education for general practice nurses. Nurses and GPs consulted within this research overwhelmingly supported advancements in education to support general practice nursing. It is only through the establishment of a consistent, reliable and high quality post-basic education system that nursing in general practice can become a viable and attractive career option for nurses in Australia. References Atkin K, Lunt N 1995 Training and education in practice nursing: the perspective of the practice nurse, employing general practitioner and family health service authority. Nurse Education Today 15(6): 406-413 Atkin K, Lunt N 1996a Negotiating the role of the practice nurse in general practice. Journal of Advanced Nursing 24(3): 498-505 Atkin K, Lunt N 1996b The role of the practice nurse in primary health care: managing and supervising the practice nurse resource. Journal of Nursing Management 4(2): 85-92 Australian Bureau of Statistics 2003 Measuring learning in Australia: a framework for education and training statistics. ABS, Canberra Bonawit V, Watson L 1996 Nurses who work in general medical practices: a Victorian survey. Australian Journal of Advanced Nursing 13(4): 28-34 Caldow J, Bond C, Russell, E 2001 Independent nursing practice: a national survey of attitudes of practice employed nurses in Scotland. Health Bulletin 59(1): 21-28 Condon J, Willis E, Litt J 2000 The role of the practice nurse: an exploratory study. Australian Family Physician 29(3): 272-277 Docherty B 1996 Nursing in general practice: a New Zealand perspective. Caxton Press, Christchurch Lockwood A, Maguire F 2000 General practitioners and nurses collaborating in general practice. Australian Journal of Primary Health Interchange 6(2): 19-29 New Zealand Nurses Organisation 2001 Job description for practice nurses. NZNO, Wellington New Zealand Nurses Organisation 2002 Accreditation and reaccreditation manual for practice nurses. NZNO, Wellington New Zealand Nurses Organisation 2003a Education policy, standards and career development for practice nurses. NZNO, Wellington New Zealand Nurses Organisation 2003b New Zealand College of Practice Nurses strategic plan 2002 – 2005. NZNO, Wellington Patterson E, Del Mar C, Najman J 1999 A descriptive study of nurses employed by general practitioners in South East Queensland. Australian Journal of Advanced Nursing 17(2): 13-20 Strauss A, Corbin, J 1998 Basics of Qualitative research: Techniques and Procedures for Developing Grounded Theory, 2nd Edition,Thousand Oaks (California): Sage Publications Trim S 1996 Practice nurse accreditation. Primary Health Care New Zealand August 1996: 89 Yerrell P, Reed A 1997 The anachronism of policy for nursing in general practice: conceptualising a way forward. NT Research 2(4): 245-257
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