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.
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.
Donna von Blanckensee – CEO CD Program Development
RN, Cert IV TAE, Grad Cert Advising on Chronic Disease Self-Management, Diploma Management
As a registered nurse and CEO of C D Program Development I am privileged to work with primary health care nurses and organisations across Australia, and while the location and size of primary health care organisations may vary, the dedication and commitment to improved patient outcomes and the strengthening of the primary health care team by nurses remains consistent.
In my work within the primary health care setting I continue to witness primary health care nurses increasingly step into leadership roles, roles that are resulting in new and innovative ways of meeting the increasing demands of the primary health care arena. In my role as CEO of CD Program Development I am able work with primary health care organisaitons and their nurses to design and implement patient management strategies that are resuting in more patients screened, identified and effectively managed with regard to their specific health care needs as well as raise the profile of the primary heath care nurse.
One of the many highlights during the last 12 months has been continuing to work with APNA to deliver part of the Foundations of General Practice Nursing workshops held in Adelaide, SA. I was again able to share valuable content, as well as my own passion and enthusiasm for primary health care with a room full of nurses new to general practice nursing. I always leave these workshops feeling confident that primary health care nursing is experiencing new levels of professionalism which will ultimately result in improved patient outcomes.
Carolyn Lally – General Practice Nurse, Virginia Medical Centre, Virginia, South Australia
I have enjoyed working as a primary health care nurse for around seven years, most of it at Virginia Medical Centre in semi-rural location north of Adelaide. I chose to move to general practice as a lifestyle change after many years in a variety of clinical and research positions around Australia – I just wish I had made the change sooner!
Catching up with fellow general practice nurses at education events had highlighted the need for more support for nurses who often feel isolated within their own practice and unsure of where to go for guidance. In early 2014 I started collecting email addresses with the plan to initiate a Nurse Network. A group of four nurses then met over dinner and planned our initial meeting, which was held in August 2014. Early on we approached APNA and came to be part of the Nurse Connect initiative, along with other groups Australia-wide. APNA has been very supportive of the coordinators, who were able to travel to Melbourne in February 2015 to share our ideas and learn some new skills to assist with setting up our networks.
Our group has been highly successful, with 16-30 nurses attending each meeting, and over 70 nurses having attended at least one meeting. We meet every six weeks, and enjoy roundtable discussions and guest speakers on topics that the group has chosen. Although we are well supported by APNA and the Northern Health Network (NHN) – who kindly provide us with a venue, catering and admin support, our group is independent and has evolved to meet its own demands. Our network is very dynamic and feedback so far has been very positive.
What’s your experience with nurse networks in your area? We would love to hear your story.
If you are interested in being involved in a nurse network see here.
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.