Jodie’s Nurse-led Wound Clinic

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Nurse-led clinics give a nurse management of their practice, their resources and their patients, and nurses such as Jodie Gartner, pictured here, say it’s a rewarding experience. Jodie’s wound clinic in Melbourne’s Hawthorn East is one of 11 nurse-led clinics in an APNA research study funded by the federal government. The clinic is based at the Junction Place Medical Centre, and runs two days a week, during which Jodie assess wounds, determines aetiology, writes up management plans, educates patients and changes dressings.
Jodie says she feels like a ‘valued partner’ in the general practice team, and enjoys the opportunity to specialise and build knowledge. She works another two days at the clinic as a practice nurse, and other nurses at the clinic can cover her patients if she’s away.
Jodie said that without the wound clinic, local patients would be sent further away to wound clinics or vascular surgeons, making some patients less likely to follow a regular care regime due to transport issues.
“I’ve been a practising nurse for a long time so you end up learning a lot of different things – you do a lot but you can feel like you’re not an expert in anything,” she says.
“This has allowed me to really focus in on an area and follow patients from start to finish. It’s been great for me. I’m looked at in the practice as a leader in this field.
“There are doctors here who bring their parents and their children in to see me if they’ve got wounds. I do feel I have their respect as a wound care nurse.”
Not all of the 11 doctors at the busy family clinic use her services, she says, but she respects their choice and she enjoys giving her mostly elderly patients her best efforts to help them recover from their wounds.
Her goals are to increase by 20 per cent the number of patients with complex wounds accessing best practice, evidence based wound care services at Junction Place Medical Centre; and to increase the profitability of the clinic by 40 per cent.
The Junction Place Medical Centre is a GP-owned one, which has a practice manager, 11 doctors, 3 division one practice nurses, a phlebotomist and 7 reception staff. It also has a nurse coordinated aged health assessment clinic and provides training placements for both medical and nursing students.
Read more about APNA and their nurse-led clinic project herehttp://bit.ly/2aLUHPL .

Wanting more complex nursing work?

 

 

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Here at APNA, we know some of our general practice nurse members feel the frustration of not working to their full scope of practice. Our recent workforce survey showed 161 respondents had talked to employers in the past year about doing more complex clinical activities within their scope of practice. Of these, 45 said more complex roles were then negotiated – great news for their career development and for their employers’ services. However, the remainder said their employers didn’t want to extend their roles. This graph below shows that over a third of our 1076 nurse respondents feel underutilised. Watch out for the next Primary Times to read the full results of the workforce survey. For information on expanding your practice, go to http://bit.ly/29Suc9J. And watch this space to read more on APNA’s government-funded research into nurse-led clinics.

Tasmanian Vicki Allan: I love the diversity of my job

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Meet our Nurse of the Year finalist Vicki Allan, from Bellerive, Hobart, Tasmania. Vicki works as a clinical care coordinator for a practice owned by a nurse practitioner. She’s been described as an expert problem solver with a passion for people; an inspiring leader and an empowering manager and mentor. She was recognised in this year’s APNA Nurse Awards for developing new systems to manage chronic diseases.
“My job is amazing,” she says. “The business I work for is a health hub, which consists of a multidisciplinary team of over 30 practitioners, including dietitian, OT, physios, exercise physiologist, personal trainers, and many more.”
“The thing I love about this job is its diversity – there’s no time to be bored. My role is to assist the director with program development, business, development, and nurse-led clinics. I also teach fitness classes and consult as a health and wellness coach.”
She says nurses in primary health are in a perfect position to assist patients with prevention of chronic disease.
“It is extremely important, as nurses will often have more time to spend with a patient than the GP does.”
Read more stories of APNA nurses at http://www.apnanurses.asn.au/

Nurses, firefighters and ambos the most ethical professions, says new index

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Nurses are among the most ethical professionals in Australia, a new index shows. The first-ever survey of more than 1000 people by the Governance Institute of Australia’s new Australian Ethics Index scored nurses at 82, compared to GPs at 71, financial planners at seven, and federal politicians at a dismal negative 33. This won’t be news to followers of the Roy Morgan Image of Professions survey, which has rated nurses as its most trusted professionals for 22 years running. The new Governance Institute index was topped by firefighters and paramedics.

Well done to our hardworking and dedicated nurses, who do their jobs with such good humour, diligence and integrity. Here’s a picture of APNA’s 2016 award finalist Georgie Waugh, general practice nurse in the rural community of Mungindi, on the border of NSW and Qld. She was recognised in this year’s APNA Nurse Awards for her leadership as an advocate for her local community.

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Member Stories

Heather’s story

Heather Gale

 

 

 

 

 

 

Heather Gale, Practice Nurse, Bowral

I have been Nursing for 30 years having split that time between the acute care and primary care sectors. I am a RN/Midwife, with Post graduate qualifications in Nurse Education and Master of Nursing. I have been a Practice Nurse for the last 8 years in a permanent part time role. The remainder of my week is spent Teaching at the University of Wollongong.
I share my Practice Nurse roles with 7 other Nursing colleagues, among them are 1 Nurse Practitioner, 4 RNs, 1 EEN, and 1 EN. Working with an average of 14 Doctors in any given week, each Practice Nurse has a significant role to play both unique to their scope of practice and to the contribution they make to the Practice patients in partnership with the Patients’ GP.
Our roles can include chronic disease management and patient education, complete INR management, health assessments, well women’s health including pap smears, minor operation assistance, aural health, childhood immunisation and travel vaccination, parent infant support services and general recall and reminder procedures to name a few. But such is the variety and scope of Nurse Practice in GP Land!

I am specifically supported to offer Lactation Consultation appointments, and receive internal referrals regarding the same in addition to a growing drop in service. I also offer general early parenting support and advice, as a follow up for issues raised by parents and babies at an immunisation appointment.

It is in General Practice that I have developed the most as a Nurse Professional. My exposure, education and training around advanced Nursing Skills has been an unsurpassed highlight in my nursing career thus far, as has working closely with GPs who love to share their medical knowledge, particularly in their knowledge of drugs and their efficacy, pathology, and differential diagnoses.

My Professional Development is empowered and enabled by the work of APNA in it’s concern for, and practical support of, the Practice Nurse workforce, and the tireless work of our Local PHN.

I love my work and sharing my working life with my nursing students.

Enrolled Nurse Supervision and Standards of Practice Changes

APNA often gets a number of enquiries around supervision (specifically for Enrolled Nurses) and standards of practice. Below is a brief update around Standards of Practice and supervision.
As you may know, the Nursing and Midwifery Board of Australia (NMBA) recently updated Registered and Enrolled Nurses standards of practice. To practice in Australia, you must meet the NMBA’s professional standards. The revised standards can be found here.
They focused strongly on supervision of Enrolled Nurses. Below is a summary of supervision requirements for Enrolled Nurses.

Supervision of Enrolled Nurses by a Registered Nurse is a requirement of the Enrolled Nurse Standards for Practice.

  • Supervision by a person other than a Registered Nurse is not consistent with the professional standards of the profession and may contravene requirements. Professional supervision relates to the quality and safety of care and is provided by a member of the same profession.
  • A general practitioner or other Doctor, may have management responsibilities, but a member of the nursing profession, namely a Registered Nurse, must undertake professional supervision of an Enrolled Nurse. It is the obligation of the employing general practice to ensure that appropriate supervisory arrangements are in place.
  • Supervision and delegation of work to an Enrolled Nurse can be direct or indirect, and will vary depending on the abilities, education, qualifications, scope of practice, experience of the Enrolled Nurse, and contextual factors such as the geographical setting and size of the practice. Click here to read more around context of practice.

What does supervision of enrolled nurses mean?

Supervision of enrolled nurses by registered nurses can be direct or indirect depending on: the competence of the enrolled nurse for the scope of nursing practice; the condition of the person receiving nursing care; and the context in which the care is given. At all times, the enrolled nurse remains accountable for their own actions and is responsible to the registered nurse for all delegated functions

Direct and Indirect Supervision

Direct Supervision is provided when the Registered Nurse is actually present, observes, works with and directs the person who is being supervised.

Indirect Supervision is provided when the Registered Nurse is easily contactable but does not directly observe the activities. A Registered Nurse who is employed elsewhere may be contracted to provide indirect supervision of an Enrolled Nurse working in general practice. Under these circumstances regular telephone and electronic communication must be employed.

The employer must ensure that supervisory arrangements are in place. Registered Nurses should be aware of their legal responsibility in regard to supervision of Enrolled Nurses.

Another arrangement for indirect supervision of an Enrolled Nurse may occur in a general practice that has multiple sites. The Registered Nurse provides indirect supervision for Enrolled Nurses employed in that practice. In this type of situation the Registered Nurse may move between clinics giving supervision to an Enrolled Nurse/s. This model is particularly applicable to practices located in rural or remote settings, or multiple sites where geographical distances make direct supervision impractical. Registered Nurses should be aware of their legal responsibility in regard to supervision of Enrolled Nurses.

Some of the nurse regulatory authorities have produced policy statements and guidelines for delegation to and supervision of enrolled nurses and these must be considered by employers of enrolled nurses. The Australian Nursing and Midwifery Council has guidelines on delegation and supervision.

There are also decision making frameworks to assist registered nurses and enrolled nurses make decisions about the way that nursing work is delegated to enrolled nurses. Click here to view these and read more.

Celebrating the most trusted profession

Nurses at the heart of primary health care on International Nurses Day

On the eve of International Nurses Day nurses in Australia have been acknowledged in the most meaningful way, a way that demonstrates respect for clinical expertise and generous care provision.

In Roy Morgan’s annual Image of Professions Survey 2016 nurses have been rated as the most honest and ethical profession for the 22nd year in a row with 92% of respondents agreeing, the same majority as in 2015.

There is a good reason why nursing is a sought after career with vast opportunities to explore so many different challenging and stimulating settings. And statistics show nurses are in high demand.

To fulfil this demand we need to support and nurture new nurses, take the time to build their experience and reach their potential.

On 12 May each year – International Nurses Day – a service is held in Westminster Abbey in which a lantern is passed from one nurse to the next, symbolising the passing on of knowledge between nurses.

We would like to hear from you – what advice would you offer to new nurses starting in primary health care? What wisdom would you impart to young people who are about to embark on a career in primary health care nursing? 

If you’re an APNA member login and comment below, otherwise email us at editor@apna.asn.au.

What I would tell nurses new to primary health care is…

A healthier Medicare is an opportunity for nurses

The Australian Primary Health Care Nurses Association (APNA) commends the Government’s announcement today of an innovative approach to care for people with chronic and complex conditions delivered through primary health care.

The Healthier Medicare reform targets coordination of care through a trial of Health Care Homes where patients will register with one primary health care provider that will be responsible for their ongoing care coordination, management and support.

The strategy is based on recommendations from the Primary Health Care Advisory Group, on which APNA President Karen Booth sits as the sole nurse representative.

“This is a creative and innovative model that will allow greater flexibility in the delivery of high-quality care in the primary health environment, and forms an exciting opportunity for nurses,” said Ms Booth.

“Nurses play a major role in improving the health journey through preventive care, chronic disease management and curative care.”

This proposal aligns with APNA’s position that nurses are agents of connectivity* in primary health care.

“This is a model that will allow greater participation of nurses in caring for people with chronic, complex and multiple conditions; it empowers nurses in their contribution to chronic disease management and in doing so recognises the prominent role nurses play in primary health care in this country,” said Ms Booth.

APNA congratulates Minister Ley for making a significant step to ensure the security of a health system that will serve Australians into the future.

APNA acknowledges that whilst details of the design and implementation of this initiative are yet to be released, we look forward to being involved in this process representing the interests of our members and nurses working across primary health care in Australia.

What do you think? Tell us below.

*Phillips CB, Pearce CM, Dwan KM, Hall S, Porritt J, Yates R, Kljakovic M, Sibbald B. Charting new roles for Australian general practice nurses: Abridged report of the Australian General Practice Nurses Study. Canberra: Australian Primary Health Care Institute, 2008. Available from aphcri.anu.edu.au and www.apna.asn.au.

Remembering Gayle Woodford

Collectively nurses around Australia have been touched by the death of Gayle Woodford. A random act like this hits close to home, makes us think about our own nursing experience, and reminds us to come together and provide strength and support for each other.

Gayle Woodford was a remote area nurse who had for five years been working at Nganampa Health Council in the remote APY Lands community of Fregon, 1200 kilometres north-west of Adelaide. Those who knew and worked with Gayle have commented on her spirited, passionate, and generous nature, and willingness to give of herself to care for her community. Gayle was also a former APNA member, and together we remember her.

You can read more about Gayle and her family’s response in Gayle Woodford’s family pays tribute to ‘generous and loving’ nurse.

This is something all nurses relate to – whether rural, remote or urban – as our safety in the workplace should be assured.

APNA is calling for regulatory change to protect nurses and other health workers undertaking after hours call-outs. A petition – named ‘Gayle’s Law’ – calling for mandatory two responders to attend all after hours call-outs in government, Indigenous and not for profit health services across Australia has received 100,000 signatures in four days.

This is something we can make a difference to. Be part of this action.

Rest in peace, Gayle Woodford.

Report highlights failure in primary health care

The Grattan Institute, a public policy ‘think tank’, has just published a report entitled ‘Chronic failure in primary care’ (see here). It is disappointing there is little reference to nurses in the report but that aside, it does give a good insight into the problems (and some possible solutions) in Australian primary health care.

Some highlights of the report are as follows:

  • Ineffective management of heart disease, asthma, diabetes and other chronic diseases costs the Australian health system more than $320 million a year in avoidable hospital admissions.
  • Only a quarter of the nearly one million Australians diagnosed with type 2 diabetes get the monitoring and treatment recommended for their condition.
  • Each year there are more than a quarter of a million admissions to hospital for health problems that potentially could have been prevented. Yet each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care.
  • Three quarters of Australians over the age of 65 have at least one chronic condition that puts them at risk of serious complications and premature death. Social, economic and environmental changes are the best way to prevent these diseases, but there are much better outcomes where good quality primary care services are in place.
  • The focus must move away from GP fee-for-service payments for one-off visits; a broader payment for integrated treatment would help to focus care on patients and long-term outcomes.
  • PHNs should be given more responsibility for local primary care services. The evidence shows that a consistent, coordinated approach to specific diseases helps primary care more effectively prevent and manage chronic conditions. In regional areas, clear targets and well-designed incentives for disease prevention are vital.
  • There needs to be a focus on more flexible services, which might include greater use of nurses and allied health staff for assessment, planning, coordination, review and support of people with chronic disease.
  • Practice and incentive payments are not working.

Do you agree there are fundamental problems with our primary health care system? Are there any easy, or even achievable, solutions? We would love to know what you think.