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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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.

Items considered for removal from the MBS – the first 23

The first collection of MBS items facing elimination has been released by the MBS Review Taskforce, seen to be “no longer part of contemporary clinical practice”. The 23 items were claimed 52,500 times in 2014-15 at a cost to the government of $6.8 million.

Six clinical expert groups produced this list, and a further 80 groups will draft their own lists of items deemed to be obsolete in the coming months.

Consultation is currently being undertaken on these 23 items.

  1. Intravenous pyelography, with or without preliminary plain films and with or without tomography
  2. Graham’s Test (cholecystography), with preliminary plain films and with or without tomography
  3. Pelvimetry, not being a service associated with a service to which item 57201 applies
  4. Bronchography, 1 side, with or without preliminary plain films and with preparation and contrast injection
  5. Vasoepididymography, 1 side
  6. Peritoneogram (herniography) with or without contrast medium including preparation – performed on a person over 14 years of age
  7. Venography
  8. Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff’s tests)
  9. Glossopharyngeal nerve, injection of an anaesthetic agent
  10. Cryotherapy to nose in the treatment of nasal haemorrhage
  11. Turbinates, cryotherapy;
  12. Division of pharyngeal adhesions
  13. Postnasal space, direct examination of, with or without biopsy
  14. Larynx, direct examination of the supraglottic, glottic and subglottic regions, not being a service associated with any other procedure on the larynx or with the administration of a general anaesthetic
  15. Larynx, direct examination of, with biopsy
  16. Larynx, direct examination of, with removal of tumour
  17. Biliary manometry
  18. Gastric hypothermia by closed circuit circulation of refrigerant for upper gastrointestinal haemorrhage
  19. Gastric hypothermia by closed circuit circulation of refrigerant in the absence of upper gastrointestinal haemorrhage
  20. Sigmoidoscopic examination with diathermy or resection of one or more polyps where the time taken is less than or equal to 45 minutes
  21. Sigmoidoscopic examination with diathermy or resection of one or more polyps where the time taken is greater than 45 minutes
  22. Treatment of habitual miscarriage by injection of hormones each injection up to a maximum of 12 injections, where the injection is not administered during a routine antenatal attendance; an
  23. Bronchospirometry, including gas analysis

Would the removal of these items from the MBS impact your work, or your colleagues work, in primary health care?

Are there items you think could be optioned for removal during this process that shouldn’t be?

AMA’s Position Statement on nurses in general practice

Earlier this week the Australian Medical Association (AMA) published a position statement on nurses in general practice – General Practice Nurse Position Statement 2005. Revised 2015 (see here). This document is a revision of the original statement which was published 10 years ago.

This position statement came as a surprise to APNA, and as the peak professional body representing nurses working in primary health care including general practice it is disappointing we were not consulted in this process. Karen Booth, our President, has now written to the AMA’s President to express our concern around this.

While there are some positive statements about nurses contained in the position statement, it also contains a number of inaccuracies, such as outdated nurse data and a misunderstanding around nurse scope of practice. We have provided this feedback to the AMA and we hope the position statement will be amended.

It is important the role of the primary health care nurse working in general practice is clearly understood by fellow health professionals. Your experience, unfortunately, tells us that this is not the case – in the last APNA salary and conditions survey you told us that only 23% of GPs had a full understanding of nurse scope of practice in general practice and, more worryingly, 4% of GPs had no understanding of scope whatsoever. This lack of understanding is one of the many barriers faced by nurses working in the general practice setting.

Does the AMA’s position statement just add to this lack of understanding? What does the profession need in order to change attitudes and perceptions? Let us know your thoughts.

New Atlas plots variation in healthcare across Australia

On 26 November the Australian Commission on Safety and Quality in Health Care (ACSQHC) launched the first Australian Atlas of Healthcare Variation (see here). The Atlas highlights the variation in healthcare provision across Australia, and importantly highlights the potential overuse of procedures, medication and interventions.

Key highlights of the Atlas are as follows:

  1. Antimicrobial dispensing – significant variation across the country, with the highest rate of total antimicrobial dispensing (Campbelltown, NSW) being almost 12 times more than the area with the lowest rate (Tiwi Islands/ West Arnhem). WA stands out as being more successful than other parts of the country in keeping rates of antimicrobial dispensing relatively low. Internationally, Australia has a very high rate of antimicrobial dispensing (more than twice the rates of the Netherlands for instance)
  2. Diagnostic interventions – wide variation of particular interventions across the country (an example being colonoscopies where the highest rate was 30 times that of the lowest).
  3. Surgical interventions – wide variation across the country (for example women living in regional areas of Australia were over five times more likely to undergo a hysterectomy or endometrial ablation than those living in metropolitan areas)
  4. Interventions for mental health and psychotropic medicines – the greatest variation was seen in in dispensing of prescriptions for psychotropic medicines for those aged 17 years and under (for example the number of prescriptions for attention deficit hyperactivity disorder (ADHD) medicines in the area with the highest rate was 75 times more than in the area with the lowest rate)
  5. Opioid medicines – a wide variety of rates of prescriptions for opioids across the country (the number of prescriptions dispensed was more than 10 times higher in the area with the highest rate compared to the area with the lowest rate)
  6. Interventions for chronic diseases – reflective of the generally poorer health status of indigenous Australians, hospital admission rates for asthma, COPD, heart failure and diabetes-related amputations were markedly higher in remote areas of Australia.

What variations in healthcare provision have you seen or experienced? We would love to know.