The South Australian Nurse Practitioner Project: A Midwife'S Perspective On A New Initiative

[VIEWPOINT]

THE SOUTH AUSTRALIAN NURSE PRACTITIONER PROJECT:

A MIDWIFE'S PERSPECTIVE ON A NEW INITIATIVE Midwifery education in Australia is currently the focus of intense debate both within and outside the field of midwifery. Proposed changes arsing from these debates centre principally around the issue of midwifery as a separate profession from nursing. This paper describes a case in point as to how changes in attitude and practice are occurring. As a midwife representing the Australian College of Midwives Inc.- SA Branch (ACMISA) on the Advisory Committee of the South Australian Nurse Practitioner Project, I provide an insight into some of the debates around midwifery and its relationship with this project. ACMI was a member of the Ministerial Advisory Committee established following the initiative of the Executive of the Department of Human Services (DHS) (formerly the South Australian Health Commission) in forming the Nurse Practitioner Project. The Terms of Reference for this committee included the development of an operational framework for the development and implementation of the Nurse Practitioner role in South Australia. A collaborative approach was seen as essential to enable nurses to best serve their communities by functioning at an advanced level of practice. The ACMI and midwives generally fully support the Nurse Practitioner Project for nurses. By Jennifer Pauline Byrne.

•

CURRENTLY,

THROUGHOUT

Canada, New Zealand and Great Britain.

AUSTRALIA, a number of universities are

in S e p t e m b e r 1998, I was invited to

in the process of developing a three-year

represent the (ACMI-SA) on the Nurse

undergraduate degree in midwifery. This

Practitioner Project (NPP) Advisory

evolution is regarded by the A C M I and a

Committee

number of other health professionals as a

Department of Human Services in South

c a t e g o r i c a l reason lor m i d w i f e r y

established

by

the

in

Australia. I have been a midwife for 25

Australia to be r e g a r d e d as a s e p a r a t e

years during which time I have conducted

health profession. Internationally, mid-

a private practice as a childbirth educator

wifery is recognised as a separate profes-

a n d lactation consultant and lectured in

sion in many countries such as Holland,

the higher education sector.

Jennifer Pauline Byrne RN RM IBCLC BN MNSt FRCNA is a Midwifery Course Coordinator in the School of Nursing at Flinders University, Adelaide, Australia. Collegian Vol 7 No 3 2000

37

represent the views of midwives as a profession, not as a speciality o( nursing, in the same way that the medical representatives were there to represent the medical profession. ! was soon to understand however, that the view of many of the members of the Advisory Panel was that midwifery is a specialisation of nursing. T h e current regulatory process which insists midwives must first u n d e r t a k e a nursing qualification does not equate with midwifery being a specialisation of nursing- T h e development of the three-year u n d e r g r a d u a t e degree in midwifery will ensure midwifery is seen more broadly as a profession in its own right. In the early stages of the N P P when 'defining features' were being developed, many of the examples given of the potential role of the Nurse Practitioner were midwifery examples. T h e r e seemed to be no question that midwives were able, in their profession, to undertake an autonomous role, working in c o l l a b o r a t i o n with o t h e r h e a l t h p r o f e s s i o n a l s , s u c h as o b s t e t r i c i a n s . During the development of the NPP and, quite unrelated to it, the National Health

The Committee

a n d Medical Research Council released

and guidelines. management

the report 'Review of Services Offered By

m e m b e r s , n o t all of w h o m were at the

a r r a n g e m e n t s to e n a b l e plans to be

M i d w i v e s ' ( N H M R C 1999) t h a t m a d e

lirst or subsequent meetings. A large pro-

effectively implemented.

certain recommendations supporting mid-

T h e Advisory Committee consisted of 60

4. D e t e r m i n e

optimal

5. Ensure effective communication with

wives u n d e r t a k i n g p r e s c r i b i n g , referral

es representing different nursing organisa-

h e a l t h units and professional h e a l t h

a n d o r d e r i n g p a t h o l o g y tests. T h i s was

t i o n s s u c h as t h e R o y a l C o l l e g e of

o r g a n i s a t i o n s so as to p r o v i d e full

quite timely, as these were some of the

Nursing Australia, the Australian Nursing

opportunity for active participation in

issues the N P P were attempting to define

Federation and the Nurses Board of South

the

for Nurse Practitioners.

Australia, the three South Australian

Practitioner role in South Australia.

portion of the panel was made up of nurs-

Universities, and rural and mental health

6.

nursing organisations. There was also rep-

development

of

the

Nurse

Establish Reference Croups to examine identified key issues.

Rising Tensions T h e first newsletter produced by the NPP

r e s e n t a t i o n from c o n s u m e r s , m e d i c a l

7. Determine and implement valid mech-

(NPPSA 1998) made it quite clear the NPP

practitioners, a lawyer, the Department of

anisms to evaluate the impact and out-

was including midwifery under its defini-

H u m a n Services (formerly the South

comes of the Nurse Practitioner role in

tion of Nurse Practitioner. This was unten-

Australian H e a l t h C o m m i s s i o n ) and

South Australia.

able for midwives who see midwifery as a

myself from the ACMI-SA. The

T e r m s of

Reference

8. Provide advice to the Chief Executive of

the

Officer,

Department

of

Human

s e p a r a t e profession to n u r s i n g . As the ACMI-SA representative it became impor-

Advisory Committee were:

Services on the progress of the Nurse

tant for me to ensure that midwifery was

1. Develop an operational framework for

Practitioner Project at regular intervals.

identified a p p r o p r i a t e l y in the project.

Provide a final report on the outcomes

There was close contact with the ACMI-

the development and implementation of the Nurse Practitioner role in South

9

SA Branch during this process. A number

of the project.

of discussions in the ACMI-SA manage-

Australia.

Critical Moments

ment committee and among midwives gen-

At the first meeting of the N P P Advisory

erally c e n t r e d on w h e t h e r midwifery

Committee I c o m m e n t e d that traditional-

should, in fact, sever itself from the N P P

e n a b l i n g o p p o r t u n i t i e s for N u r s e

ly, m i d w i v e s h a v e b e e n

undertaking

altogether, as the project was not giving

Practitioners to implement co-ordinat-

autonomous practice not unlike the Nurse

credence to midwifery as a separate profes-

ed care arrangements in line with the

Practitioner role being designed for nurs-

sion in insisting that midwives be called

Department of Human Services policy

es. 1 believed that the ACMI was there to

Nurse Practitioners. It was generally decid-

2. Identify areas for w h i c h t h e N u r s e Practitioner role is viablc. 3. E n s u r e h e a l t h c a r e is o p t i m i s e d by

38

Collegian Vol 7 No 3 2000

ed that such a move would be a retrograde

Misunderstandings Over Titles

N u r s e s Act was before parliament a n d

step given that there may be funding and

T h e first draft report of the N P P was duly

m i d w i v e s l o b b i e d very s o l i d l y for a

research benefits in the long term from

released for comment early in 1999. T h e

Nurses and Midwives Act". However, this

which midwives could benefit il they were

report did not identify midwifery in any

was

part of t h e project. N e v e r t h e l e s s , there

respect as separate from nursing, which

Australian Nursing Federation, the Nurses

not

supported

by

either

the

were still philosophical c o n c e r n s a b o u t

inherently assumed midwifery was a spe-

Roard

m i d w i f e r y b e i n g i n c l u d e d in a N u r s e

c i a l i s a t i o n ol nursing. T o e n s u r e mid-

D e p a r t m e n t of H u m a n Services, S o u t h

P r a c t i t i o n e r P r o j e c t . T h e q u e s t i o n ol

wifery was identified separately, I request-

Australia.

whether there could be a name change to

ed that where appropriate, "Midwife" be

T h e Advisory Committee consisted of

include Midwifery in the title was met with

inserted after "Nurse Practitioner", in the

key stakeholders in these organisations,

a definite 'No' as this title was given by the

form of 'Nurse Practitioner/Midwife'.

h o w e v e r t h e y would n o t c o n c e d e t h a t

of

South

Australia

or

the

M i n i s t e r of H e a l t h a n d t h e A d v i s o r y

T h e next draft report had "/midwife"

midwifery was a separate profession even

Committee did not have the option within

after every reference to nurse or nurse prac-

in t h e l i g h t of t h e b e g i n n i n g of t h e

its powers to change the name.

titioner. This was most inappropriate as in

n a t i o n a l d e v e l o p m e n t of a t h r e e y e a r

one particular instance it related to order-

u n d e r g r a d u a t e midwifery degree, which

'Advanced Practice' a Key Issue

ing radiotherapy, quite appropriate for an

will result in midwives not n e e d i n g to

A key issue that caused concern for mid-

oncology nurse practitioner, but not some-

become nurses first.

wives

thing a midwife would ever be involved in

was

the

notion

that

'Nurse

Practitioner' equated with 'Advanced

under the definition of a midwife.

While the ACMI-SA branch and midwives generally fully support the Nurse

Practice'. T h e Committee did not have a

A further draft became more selective

Practitioner Project for nurses and com-

clear definition ol 'Advanced Practice',

as to w h e r e "midwife" was included. In

m e n d its d e v e l o p m e n t , t h e A C M I - S A

h o w e v e r the inference was of specialist

fact, in the Final Report (1999) a footnote

Branch and many midwives still have con-

p r a c t i c e with a d v a n c e d e d u c a t i o n in a

has been included at the request of the

cerns about midwifery being included in

specialist field. While this is quite appro-

ACMI-SA to the effect

t h e NPP. H o w e v e r , u n d e r t h e c i r c u m -

priate for the generalisl nurse w h o then

...wherever this document includes midwifery,

stances and in this particular time of mid-

specialises and undertakes further educa-

it ieill be explicit and slate nursing/midwifery or

wifery d e v e l o p m e n t , t h e r e p r o b a b l y is

tion in a specialised area, il is not appro-

Nurse Practitioner/Midwife. Where midwifery is

not a choice since to boycott proceedings

priate lor midwifery. Midwifery has an

not included in the text, the reference is to nursing

may have a d e t r i m e n t a l effect on mid-

International Definition endorsed by the

only. T h e Definition of a M i d w i f e was

wifery.

International Confederation of Midwives, the World Health Organisation and the College

ol

Obstetricians

and

C y n a e c o l o g i s t and a S c o p e of Practice

also i n c l u d e d in the a p p e n d i x and t h e exemplar for midwifery included in the

What Next?

document related to a continuity of carer

Stage 2 oi the Nurse Practitioner Project

model of midwifery.

involves the implementation plan for the

Towards a Resolution of Issues

organisations, employers and D H S to put

W h i l e major steps were made in relation

in place the appropriate processes ready

to midwifery being identified separately

for Nurse Practitioners. ACMl now has a

in the Final Report of the N P P not all

role to e n s u r e Australian midwives are

m e m b e r s of the panel a g r e e d as a foot

represented appropriately and enabled to

note in the Report stated It should be recog-

reach their full potential in the same way

nised thai some members of the Nurse Practitioner

nurses will be as a result of the develop-

role and requires individuals, professional

( I C N 1990, W H O 1992) that stales, in part, a midwife at the completion of her e d u c a t i o n is able to practise fully as a m i d w i f e . T h e b e g i n n i n g m i d w i f e will develop from novice to expert in her role. T h e e x p e r i e n c e d midwife may be in a position to e n g a g e in 'advanced critical t h i n k i n g ' , but ihc s p h e r e a n d s c o p e of midwifery practice is the same at all levels ol experience, from beginning to expert midwives. T h e r e f o r e , t h e idea t h a t m i d w i v e s would fit into the 'advanced' role of the

Project Advisory Committee do not agree with the

m e n t of t h e N u r s e P r a c t i t i o n e r r o l e .

position advanced by IJJC Australian College of

ACMl

Midwives, and continue to believe that midwifery

A u s t r a l i a n m i d w i v e s are b o t h m e e t i n g

is an area of specialised nursing practice. The

international standards of best practice

Advisory Committee and the Nurse Practitioner

and setting new benchmarks for the mid-

committed

to

ensuring

project are not appropriate vehicles for resolution of wifery profession.

Nurse Practitioner has inherent problems

the debate around this issue, in the interests of

for midwives. Similar concern was raised

advancing

by midwives in relation to a publication

Committee opposing the ACMl

by the Nurses Board of South Australia

at/reed to distinguish between midwifery and spe-

released during this debate 'Authorisation

cialised nursing in this report as requested by the

of Advanced Practice Project Final Report

ACML (NPP 1999)

the project, those members of the position, have

1999' (NBSA 1999) that outlined the role of advanced practice for nurses. T h e pub-

is

Ongoing Debates

lication included midwifery as a speciali-

D u r i n g t h e d e v e l o p m e n t of t h e N P P

sation of nursing, interestingly without a

a n o t h e r i m p o r t a n t h i s t o r i c a l e v e n t in

midwife being on the editorial panel.

South Australia was under way. T h e 1999

References Authorisation of Advanced Practice Project final Report ( i 999) Nurses Board of South Australia D e f i n i t i o n ol the M i d w i f e International Confederation of Midwives (1990) and the World Health Organisation (1992) National 1 Icalth and Medical Research Council (1999). Rt'i'ieic of Savnes Offered by iWittunvcs. ACPS Canberra Nurse Practitioner Project Report (1999) D e p a r t m e n t ol Human Services South Australia Nurse Practitioner Project South Australia Newsletter #1 Dec 1998. Collegian Vol 7 No 3 2000

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