clinical practice
clinical practice
Australia will need to find other solutions . One option is to look to nurses to take on tasks for which they are suitably skilled but have historically been undertaken by doctors .
How nurses can help In the United Kingdom , the United States , The Netherlands and Canada , advanced nursing – where nurses have postgraduate education and training to take on more specialised tasks and roles – has been relied on for years .
At the most advanced level of nursing , a nurse practitioner is a trained registered nurse who provides advanced nursing care either independently and autonomously , or with a doctor . Nurse practitioners can assess and diagnose health problems , order and interpret diagnostic tests , prescribe medicines , refer patients to other health professionals and even admit them to hospitals .
Nurse practitioners have been practising in Australia since 2000 , starting in emergency care , with more than 1,400 practising in total in Australia by 2019 . However , unlike other countries , Australian nurse practitioners must work in collaboration with a doctor . If they were to practise more independently , nurse practitioners could expand health-care access for thousands of Australians , including those living in rural and remote areas .
A recent NSW Health report presented a framework for specialised rural nurse practitioners that shows how care might be provided to focus on local community needs . For people living with a disability , or chronic and complex conditions , nurse practitioners can provide services in their communities , such as diagnosis , treatment plans , dialysis and make referrals to a specialist , including via telehealth . This could reduce the need for long-distance travel or a long wait time to access a GP .
Don ’ t we have a shortage of nurses ? It is true , nurses are leaving the workforce in the thousands . One-fifth of nurses in Australia intend to leave nursing in the next 12 months . Keeping them requires better working conditions .
But it ’ s not just about reducing burnout , stress and workloads . Nurses want career development , the opportunity to extend their scope of practice with advanced training , and for these complex care skills to be recognised and used .
Access to opportunities for career development and progression is a key driver of nurse retention .
Why haven ’ t nurse practitioners already solved the workforce crisis ? Nurse practitioners are registered nurses who have additional postgraduate education and clinical training in their speciality area .
Nurse practitioners are currently required to work in collaboration with a doctor to deliver care , which limits the extent to which they can resolve the workforce gaps we face . A nurse practitioner can prescribe medications , for example , but must do so with oversight via a sign-off from a doctor .
The federal government ’ s nurse practitioner workforce plan aims to
“ Nurses make up more than 50 % of the health workforce and have untapped and under-used skills that would ease the skills gap .
remove barriers to patients accessing a nurse practitioner . The plan is looking at whether nurse practitioners should provide Medicare-funded services , create additional nurse-led care items and remove the requirement for them to collaborate with doctors in delivering care .
The federal government ’ s current proposals may therefore see nurse practitioners working completely independently , in a similar way to that overseas .
But despite evidence showing nurse practitioners provide safe health care , the proposal has been met with concern from some doctors that increased independence may risk patient safety and lead to more fragmented care . They also argue it would be unfair for patients who can ’ t see a doctor and who must see a nurse practitioner instead .
What should happen next ? Delivering better quality primary health care in Australia ultimately means we need to make better use of our health services and align it with our changing population needs .
To achieve this , we will need to grow our nurse practitioner workforce and use them more effectively . Enabling nurse practitioners to use all their skills independently might also help to stem the loss of nursing workforce .
But expanding the scope of any profession must be done in a way that improves collaboration , team-based working and patient-centred care . Health care is safest and most effective when health professionals work together – and with patients – to make decisions about care . So it ’ s important for the plan to include incentives that make collaboration more likely between nurse practitioners and doctors . ■
Reema Harrison is an associate professor at Macquarie University Laurel Mimmo is an honorary post-doctoral fellow at Macquarie University This article is republished from The Conversation under a Creative Commons license .
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