Melissa Sweet writes:
Australia could be doing much more to optimise the use of nurse practitioners, especially in the areas of primary healthcare, chronic disease management and residential aged care, according to a senior federal health bureaucrat.
Karen Cook, director of the innovation and reform section in the Health Workforce Reform Branch, said Australia had only about 1,300 nurse practitioners, more than 20 years after this workforce first developed here, and they still were mainly working in acute hospitals.
“The issue that we have got with nurse practitioners in Australia is that we have failed to recognise their true potential, and what they can offer to health services,” she said, during a presentation and interview at the recent Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) conference.
“The issue that we have got with nurse practitioners in Australia is that we have failed to recognise their true potential, and what they can offer to health services,” she said, during a presentation and interview at the recent Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) conference.
She said:
What we need to need to do now is look at how we can best use nurse practitioners in Australia.
For me it’s about primary healthcare, it’s about chronic disease management, it’s about residential aged care.
You can really see where nurse practitioners could add enormous value to health service delivery.
We need to have a conversation about how best to use them and start to think about how best to educate people to be nurse practitioners and to start to develop those models of care.”
Cook said healthcare financing was one of the major barriers to nurse practitioners working outside of acute settings.
“It’s not by chance that we find a lot of nurse practitioners working in emergency departments in acute hospitals, and that’s because they don’t have to worry about the practicalities of running a business and trying to secure a revenue stream from the MBS [Medicare Benefits Schedule],” she said.
“What we need to do with nurse practitioners is find innovative ways to fund their services, and nurse practitioners need to develop their skills in the management of their business as well as the management of health.”
Alarming retention rates
Cook also told the conference of plans for a major review of nursing education, through the National Nursing and Midwifery Education Advisory Network.
This would take considerable time, given the many stakeholders involved, including the Federal Education Department, the tertiary sector, the Council of Deans of Nursing and Midwifery, public and private employers, and professional and industrial bodies.
“There’s a lot of people with what they call skin in the game in this particular one,” she said. “There are a lot of people who are very interested in this piece of work; it’s going to take a lot of time to do this work and to do this work properly.”
As an affiliate member and “long-term friend” of CATSINaM, attending her 12th conference, Cook said the review would be an opportunity to look at cultural safety in nursing education and training, and at increasing the numbers of Aboriginal and Torres Strait Islander nurses and midwives.
“So CATSINaM has a really big role to play in using this as an opportunity, together with LINMEN (Leaders in Indigenous Nursing and Midwifery Education Network), to see if we can’t do something to improve those commencement and completion rates,” she said.
Cook said the review would examine whether nursing education was preparing people for the future, at a time of rapid technological change that was both “exciting and alarming” for healthcare, and creating new models of care and service delivery.
She said new nursing graduates were dropping out of the workforce “at quite an alarming rate”, and it was “high time we looked at whether what we are doing is right”.
Cook said:
We are hearing from a lot of employers about graduates not being work-ready.
We are hearing from graduates that they don’t feel that they are work-ready.
We’ve got to put in place a lot of transition to practice programs to try and bridge those gaps, and then we’re hearing from graduates that even with those programs, they’re still feeling ill prepared, and so we have got high attrition rates in early career nurses.
So there are clearly some issues there that have got to be looked at; if we go back to the undergraduate preparation, and look at are we educating people to be the nurse of the future?”
A hospital without beds
Cook also examined how technology is re-shaping healthcare, pointing to a “hospital without beds”, the Mercy Virtual Care Center () in Chesterfield, Missouri, which is the largest single-hub telemedicine centre in the US.
It provides around-the-clock care via virtual technology and telehealth teams “supplementing the work of local caregivers by providing skilful monitoring and management”.
The Center, which opened in 2015, describes itself as “the first and only facility of its kind”, and says the building’s “pervasive use of glass reflects our culture of openness to new ways of thinking, and new ways of providing care to those who need it”.
The Center’s services include: case management, where nurse case managers collaborate with patients, physicians, and other providers; eSitter, which provides continuous, 24/7 observation of agitated or at risk patients; and TeleICU, which uses advanced analytics and visual technologies in collaboration with bedside caregivers across seven states. It aims to reduce ICU length of stay, save lives and reduce complications.
Other services include a Nurse on Call network, a virtual wellness program for preventing chronic conditions and reducing absenteeism, and TeleStroke, which provides local emergency physicians with around-the-clock access to neurologists. This collaboration aims to allow for immediate intervention, so patients do not have to lose time being transferred to other facilities.
Cook said the implications of such services “for a country like Australia are absolutely enormous”.
“Nurses have a great deal to offer in that space in terms of virtual healthcare,” she said.
“Currently we have got lots and lots of nurses around the country using telehealth. This is taking it to the next step, which is how I come back to: how we prepare nurses to work in those sorts of models of care?
“Technology is moving at such a rapid rate, it feels like we are not quite keeping up in terms of our preparation.”
Watch this interview with Karen Cook
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