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Practice Nursing in Australia: Whose Responsibility?
Guest Editorial Elizabeth Patterson RN, PhD, School of Nursing & Midwifery, Griffith University, Queensland Elizabeth Halcomb RN, PhD, BN(Hons), School of Nursing, University of Western Sydney, New South Wales Patricia Davidson RN, PhD, FRCNA, School of Nursing and Midwifery, Curtin University of Technology, Western Australia
Practice Nursing in Australia: Whose Responsibility? The increasing burden of chronic conditions, shortages in the health care workforce and adverse health outcomes of socially marginalised and disadvantaged populations, challenge contemporary health care systems to provide acceptable, accessible, affordable, equitable and sustainable health care (World Health Organization, 2003). These epidemiological, social, economic and political factors, are driving health policy, practice and research from focussing predominantly on the secondary and tertiary care sectors to looking to the primary care setting for viable and sustainable solutions. Australian general practice has responded to this trend through a range of initiatives, including employing increasing numbers of nurses and developing their scope of practice (Pascoe, Foley, Hutchinson, Watts, Whitecross & Snowden, 2005). Currently in Australia, 60% of general practices employ a practice nurse indicating that they are primed to be a driving force in primary health care (Keleher, Joyce, Parker & Piterman, 2007). In the 2001/02 budget, the Australian Government introduced a range of financial incentives through the Nursing in General Practice Initiative, essentially to improve access to medical services for patients in rural Australia through employing nurses in the general practice setting. Subsequent funding in 2003, through the Strengthening Medicare package, further widened this support to urban areas of workforce shortage to employ practice nurses (Australian Government, 2007). The introduction of new Medical Benefits Scheme items over the past three years for practice nurse activities has further enticed general practitioners to employ more nurses and to expand their role beyond that of the ‘treatment room nurse’, undertaking task based activities, to a range of initiatives including screening and prevention interventions. Largely it is the financial incentives from the Australian government to general practices that are driving the increase in practice nurse numbers and in turn the increasing attention on professional development, practice and policy issues. This impetus from funding in developing the practice nurse role has also been the case in the United Kingdom (Woodard, 2006). Since 2001 several key developments have occurred to develop the professional nursing role in general practice. In 2001, the Australian Practice Nurses Association was established as a representative body and in 2003 the Royal College of Nursing Australia (RCNA) conducted the inaugural annual Australian practice nurse conference in Western Australia. Finally, in 2005, the RCNA developed national competency standards for practice nurses through a project funded by the Department of Health and Ageing. Australian universities have also responded to these developments by creating a number of tertiary education programs targeting practice nurses, as well as 2
Collegian Vol 14 No 4 2007
conducting a range of research activities related to the workforce, roles and clinical practice (Halcomb, Patterson & Davidson, 2006). The research and scholarship of practice nursing, demonstrated through conference presentations, publications and grant acquisitions, has seen a gradual development from localised descriptive, exploratory investigation to national competitively funded projects trialling new and expanded models of practice nursing. Our article Evolution of Practice Nursing in Australia (Halcomb, Patterson & Davidson, 2006) traces the developments of practice nursing to 2005 and asserts that practice nursing is at a critical point in its evolution, needing to drive its own agenda by engaging in high quality clinical outcome driven research in order to inform practice and policy. Over the past few years, acceptance of the growing contribution and importance of practice nursing to primary care in Australia has been demonstrated by the increasing numbers of publications in non-nursing journals such as the Medical Journal of Australia, Australian Family Physician, Australian Health Review and Australian Journal of Primary Health. Despite the developments and enormous gains that have been achieved for practice nurses in Australia in recent times, there are still many issues to address to ensure that they remain a viable, sustainable, effective primary care workforce that is recognised, valued and appropriately remunerated. The recent article by Keleher et al, (2007) identifies the importance of developing a framework for professional education and a career development pathway, as well as linking practice nurse initiatives to the outcomes of clinical care. In particular, these authors argue for a systematic process for developing the practice nurse role and the building of an evidence base to support policy decisions. Of note, many of the changes to the practice nurse role have been driven by agencies and factors external to the nursing profession, particularly the shortage of general practitioners in regional and rural Australia. Although we can be encouraged by the recognition of nurses’ contribution to the health and well-being of communities by policy makers, it is also important that nurses in practice, policy, research and education sectors monitor the evolution of the practice nurse role to ensure that this position develops according to the philosophical, regulatory and professional standards acceptable to nurses and the community. Both the independent and dependent aspects of nursing practice need to be considered in developing the practice nurse position. Although controversial, it is likely that advanced practice nurses, in a nurse practitioner role, could also provide useful services in the Australian primary care setting. In order to achieve the goal of developing a dynamic nursing workforce in primary care, particularly in general practice, professional, educational, regulatory and policy nursing groups need to collaborate
Guest Editorial
to provide leadership and advocacy to support nurses. This support does not merely pertain to professional education and development but also in carving a niche for practice nurses within the primary health care team (Halcomb, 2006; Patterson, 2000). To achieve this goal we have to develop and evaluate models of care that are appropriate to this setting and promote interdisciplinary and collegial practice that focuses on improving patient outcomes. Developing the practice nurse role in Australia is therefore a shared responsibility, dependent on interprofessional cooperation and community engagement. We also need collaboration across the practice, policy, research, education and regulatory sectors of the nursing profession. The RCNA has been a driving force in achieving cross sector collaboration and these activities underscore the importance of engaging in policy development. The contemporary Australian policy environment has primed the health care sector to develop the practice nurse role. In order to ensure that this group is an integrated force in the nursing profession, we need to reach out to our nursing colleagues in this sector to assist them in developing their practice. Therefore developing the practice nursing role is the responsibility of all nurses and we should actively
engage developments to ensure that nurses remain an integrated, yet visible and discrete force in improving health outcomes in the primary care setting. References Australian Government Department of Health & Ageing. Nursing in general practice. Retrieved from http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/ health-pcd-programs-nursing-index.htm Keleher, H., Joyce, C., Parker, R., & Piterman, L. (2007). Practice nurses in Australia: Current issues and future directions. Medical Journal of Australia, 187(2), 108-110. Halcomb, E., Patterson, E., & Davidson, P. (2006). Evolution of practice nursing in Australia. Journal of Advanced Nursing, 53(3), 376-390. Halcomb, E. (2006). Carving a niche for Australian practice nurses in chronic heart failure management”. PhD thesis, Australia: University of Western Sydney. Pascoe, T., Foley, E., Hutchinson, R., Watts, I., Whitecross, L., & Snowdon, T. (2005). The changing face of nurses in Australian general practice. Australian Journal of Advanced Nursing 23(1), 44-50. Patterson, E. A. (2000) Primary health care nursing: A case study of practice nurses. PhD thesis, Australia: Griffith University. Woodard, V. (2006). Comment on Halcomb E, Patterson E & Davidson P. Evolution of practice nursing in Australia. Journal of Advanced Nursing, 53(3), 388-390. World Health Organisation (2003). The World Health Report 2003 - shaping the future. Retrieved from www.who.int/whr/2003/en/
Collegian Vol 14 No 4 2007
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Practice Nursing in Australia: Whose Responsibility? The increasing burden of chronic conditions, shortages in the health care workforce and adverse health outcomes of socially marginalised and disadvantaged populations, challenge contemporary health care systems to provide acceptable, accessible, affordable, equitable and sustainable health care (World Health Organization, 2003). These epidemiological, social, economic and political factors, are driving health policy, practice and research from focussing predominantly on the secondary and tertiary care sectors to looking to the primary care setting for viable and sustainable solutions. Australian general practice has responded to this trend through a range of initiatives, including employing increasing numbers of nurses and developing their scope of practice (Pascoe, Foley, Hutchinson, Watts, Whitecross & Snowden, 2005). Currently in Australia, 60% of general practices employ a practice nurse indicating that they are primed to be a driving force in primary health care (Keleher, Joyce, Parker & Piterman, 2007). In the 2001/02 budget, the Australian Government introduced a range of financial incentives through the Nursing in General Practice Initiative, essentially to improve access to medical services for patients in rural Australia through employing nurses in the general practice setting. Subsequent funding in 2003, through the Strengthening Medicare package, further widened this support to urban areas of workforce shortage to employ practice nurses (Australian Government, 2007). The introduction of new Medical Benefits Scheme items over the past three years for practice nurse activities has further enticed general practitioners to employ more nurses and to expand their role beyond that of the ‘treatment room nurse’, undertaking task based activities, to a range of initiatives including screening and prevention interventions. Largely it is the financial incentives from the Australian government to general practices that are driving the increase in practice nurse numbers and in turn the increasing attention on professional development, practice and policy issues. This impetus from funding in developing the practice nurse role has also been the case in the United Kingdom (Woodard, 2006). Since 2001 several key developments have occurred to develop the professional nursing role in general practice. In 2001, the Australian Practice Nurses Association was established as a representative body and in 2003 the Royal College of Nursing Australia (RCNA) conducted the inaugural annual Australian practice nurse conference in Western Australia. Finally, in 2005, the RCNA developed national competency standards for practice nurses through a project funded by the Department of Health and Ageing. Australian universities have also responded to these developments by creating a number of tertiary education programs targeting practice nurses, as well as 2
Collegian Vol 14 No 4 2007
conducting a range of research activities related to the workforce, roles and clinical practice (Halcomb, Patterson & Davidson, 2006). The research and scholarship of practice nursing, demonstrated through conference presentations, publications and grant acquisitions, has seen a gradual development from localised descriptive, exploratory investigation to national competitively funded projects trialling new and expanded models of practice nursing. Our article Evolution of Practice Nursing in Australia (Halcomb, Patterson & Davidson, 2006) traces the developments of practice nursing to 2005 and asserts that practice nursing is at a critical point in its evolution, needing to drive its own agenda by engaging in high quality clinical outcome driven research in order to inform practice and policy. Over the past few years, acceptance of the growing contribution and importance of practice nursing to primary care in Australia has been demonstrated by the increasing numbers of publications in non-nursing journals such as the Medical Journal of Australia, Australian Family Physician, Australian Health Review and Australian Journal of Primary Health. Despite the developments and enormous gains that have been achieved for practice nurses in Australia in recent times, there are still many issues to address to ensure that they remain a viable, sustainable, effective primary care workforce that is recognised, valued and appropriately remunerated. The recent article by Keleher et al, (2007) identifies the importance of developing a framework for professional education and a career development pathway, as well as linking practice nurse initiatives to the outcomes of clinical care. In particular, these authors argue for a systematic process for developing the practice nurse role and the building of an evidence base to support policy decisions. Of note, many of the changes to the practice nurse role have been driven by agencies and factors external to the nursing profession, particularly the shortage of general practitioners in regional and rural Australia. Although we can be encouraged by the recognition of nurses’ contribution to the health and well-being of communities by policy makers, it is also important that nurses in practice, policy, research and education sectors monitor the evolution of the practice nurse role to ensure that this position develops according to the philosophical, regulatory and professional standards acceptable to nurses and the community. Both the independent and dependent aspects of nursing practice need to be considered in developing the practice nurse position. Although controversial, it is likely that advanced practice nurses, in a nurse practitioner role, could also provide useful services in the Australian primary care setting. In order to achieve the goal of developing a dynamic nursing workforce in primary care, particularly in general practice, professional, educational, regulatory and policy nursing groups need to collaborate
Guest Editorial
to provide leadership and advocacy to support nurses. This support does not merely pertain to professional education and development but also in carving a niche for practice nurses within the primary health care team (Halcomb, 2006; Patterson, 2000). To achieve this goal we have to develop and evaluate models of care that are appropriate to this setting and promote interdisciplinary and collegial practice that focuses on improving patient outcomes. Developing the practice nurse role in Australia is therefore a shared responsibility, dependent on interprofessional cooperation and community engagement. We also need collaboration across the practice, policy, research, education and regulatory sectors of the nursing profession. The RCNA has been a driving force in achieving cross sector collaboration and these activities underscore the importance of engaging in policy development. The contemporary Australian policy environment has primed the health care sector to develop the practice nurse role. In order to ensure that this group is an integrated force in the nursing profession, we need to reach out to our nursing colleagues in this sector to assist them in developing their practice. Therefore developing the practice nursing role is the responsibility of all nurses and we should actively
engage developments to ensure that nurses remain an integrated, yet visible and discrete force in improving health outcomes in the primary care setting. References Australian Government Department of Health & Ageing. Nursing in general practice. Retrieved from http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/ health-pcd-programs-nursing-index.htm Keleher, H., Joyce, C., Parker, R., & Piterman, L. (2007). Practice nurses in Australia: Current issues and future directions. Medical Journal of Australia, 187(2), 108-110. Halcomb, E., Patterson, E., & Davidson, P. (2006). Evolution of practice nursing in Australia. Journal of Advanced Nursing, 53(3), 376-390. Halcomb, E. (2006). Carving a niche for Australian practice nurses in chronic heart failure management”. PhD thesis, Australia: University of Western Sydney. Pascoe, T., Foley, E., Hutchinson, R., Watts, I., Whitecross, L., & Snowdon, T. (2005). The changing face of nurses in Australian general practice. Australian Journal of Advanced Nursing 23(1), 44-50. Patterson, E. A. (2000) Primary health care nursing: A case study of practice nurses. PhD thesis, Australia: Griffith University. Woodard, V. (2006). Comment on Halcomb E, Patterson E & Davidson P. Evolution of practice nursing in Australia. Journal of Advanced Nursing, 53(3), 388-390. World Health Organisation (2003). The World Health Report 2003 - shaping the future. Retrieved from www.who.int/whr/2003/en/
Collegian Vol 14 No 4 2007
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