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May the #Nurseforce be with you: future of primary health care nursing on the agenda

The Australian Primary Health Care Nurses Association (APNA) had a novel approach to potential participants for Nurseforce for the Future, its 10th Annual National Conference for nurses working in primary health care, being held in Brisbane this week, from 10-12 May.

It offered tips on ‘pitching the conference to your boss‘, including an email template explaining that attendance would enhance the would-be participant’s clinical expertise and showcase examples of service innovation, efficient models of care, quality and safety in practice, workforce recruitment and retention, embracing change and leadership in nursing.

These are some of the issues that journalist Marie McInerney will be reporting on from the conference, for the Croakey Conference News Service.

In the Q&A below, APNA President Karen Booth outlines some of the issues facing nurses, nursing and health systems, amid a projected shortfall of about 27,000 primary care nurses by 2025.

These include ongoing frustration in the profession that nurses are not able still to work to full scope of practice, particularly in primary health care, some hope in the potential of the Health Care Homes model (despite lagging enthusiasm elsewhere and nary a mention in this week’s Budget) and heartening news elsewhere in the Budget.

The conference will also feature APNA’s annual awards for leading nurses, and is calling on delegates to “wield the lasso of truth” and don a cape for its Nurseforce Superheroes conference dinner.

You can follow it all on Twitter at #Nurseforce.


Q&A with Karen Booth

Marie McInerney

Q. Your latest (2016) annual report commented that a Parliamentary Breakfast revealed that some MPs and key policy people knew very little about the work of primary care nurses, and the issues facing the profession. Where do primary health care nurses work and what would you like all health policy leaders to know about your work and issues?

Karen Booth

A. Primary health care nurses work in an extremely wide range of settings. According to the APNA Workforce Survey 2017, the five most common areas of employment in primary health care include general practice, community health service, non-governmental organisation, and being self-employed (i.e. working as a consultant or contractor) (see feature image above).

We want health policy leaders to know that we represent the fastest growing area of nursing which makes up 12.5 per cent of the 640,000 registered health professionals in Australia.

With four in five Australians having at least one chronic disease and an increasingly ageing population, Australia’s traditional approach to healthcare needs to change. Recognising the limitations of our current system, there has been an increased emphasis from governments on primary and community care. The Health Care Home model, for example, which the government is currently piloting, aims to keep people with multiple chronic diseases out of the hospital system by better coordinating their care in the community.

These shifts underline the increasing need for, and value of, primary health care nurses. But as we know, Australia faces a projected shortfall of about 27,000 primary care nurses by 2025. For many, primary care nursing isn’t seen as a career of choice.

APNA supports primary health care nurses through increasing their visibility, recognition and influence in the industry. We do this by developing workshops and resources to improve the knowledge, skills and confidence of nurses.

Another key issue we advocate for is changes to models of care so that primary health care nurses can work to full scope of practice and are valued and optimised as part of an interdisciplinary team.

Marie McInerney

Q. What’s your reaction to this week’s Federal Budget – what were you looking for from the Federal Government and what was the result?

Karen Booth

A. We were very pleased to get the news of continued funding for our work, which the Health Department’s Budget statement said “will help nurses move into primary health care, test new ways for nurses to deliver care and better educate nurses about primary health care.”

It was important to have the government’s recognition of the contribution that our members make in primary health care and we welcomed its comments that the health system should make better use of the breadth of skills and experiences that the nursing workforce has in dealing with patients, particularly in multiple primary health care settings.

That funding commitment will support a number of key projects, including to expand the Enhanced Nurse Clinics program, and for our Transition to Practice program that supports  new nursing graduates and those coming from the tertiary sector into primary health care. It will also support chronic disease education for nurses.

There was also great news in the Stronger Rural Health Strategy announcement of an additional 3,000 nurses – as well as the same number of more highly qualified doctors and hundreds of allied health professionals – in the regions over the next 10 years.

And we welcomed news in the ageing plan of health checks for people at ages 45 and 65 – nurses already do a majority of those sorts of health checks, like the aged health assessment and diabetes assessments, so they will have a key role in that.

However, like the Australian Nursing and Midwifery Federation (ANMF), we remain concerned about staffing levels and skills in the aged care sector. Nurses in the sector have a huge workload, huge responsibilities and their numbers are in many cases decreasing.

Marie McInerney

Q. What’s behind the theme for this year’s conference: ‘Nurseforce of the future’?

Karen Booth

A. The APNA national conference provides a platform to recognise and celebrate the achievements of primary health care nurses, and to further cultivate the expertise and collegiality of our nurse workforce—the Nurseforce for the Future.

APNA’s vision is a healthy Australia through best practice primary health care nursing. Health care in the country cannot get better without investing in its Nurseforce. Australia’s Nurseforce is a passionate, capable, scientific, diverse, progressive movement. There are nurses in primary health care Australia-wide trying to optimise their capacity to bring about sustainable, positive health outcomes for individuals, families, communities, and our nation.

Nurseforce for the Future conference is the opportunity to showcase nurses who are responding to their environment and employing innovative, evidence-based approaches to deliver safe, high quality, patient-centred care. We intend to harness the aspirations and expertise of the diverse delegation to pave the way for personal and professional growth.

Marie McInerney

Q. Your APNA Workforce Survey 2017 found that 29 per cent of primary health care nurses felt they could do more in their roles, 11 per cent felt they didn’t get to use their knowledge and skills to the full extent, and of the 22.9 per cent who spoke up to employers, half were not able to negotiate more complex tasks.

What sorts of tasks are they talking about? What are the benefits, risks and barriers to giving primary health care nurses these bigger, more complex roles? Are we seeing a shift?

Karen Booth

A. Working on more “complex tasks” would simply mean to work to the full scope of practice. An individual nurse’s scope of practice may vary considerably from that of another nurse. The tasks themselves can vary depending on several factors including the nurse’s experience, qualifications, clinical specialisation and interests, not to mention the demographics and the need within the community or practice. A nurse can always build their clinical and professional capabilities to expand their scope of practice through education and training.

Complex tasks could be within a broad range of areas including immunisation, women’s health, family planning, health coaching, etc. With the growing number of chronic disease patients on the Australian health agenda, a good example of undertaking a more complex task would be working alongside a general practitioner to develop chronic disease management care plans and care coordination.

Primary health care nurses working to the breadth of their scope facilitate better outcomes by improving access and timeliness to care that the patients need when they need it. This enhances productivity for their teams, value for money for health services, and promotes an integrated care model.

It also helps to streamline care and allows health service to offer additional types of services as well as a reduction in waiting times, more timely assessments and referrals. This is particularly important given the increasing burden of chronic disease and the challenges associated with workforce shortages in Australia’s primary health care system.

Optimal use of the nursing skill-set as part of the interdisciplinary team enables other health professionals, such as general practitioners, to focus their time on higher level diagnostic activity, intervention and care decision making.

We have witnessed a growing interest in nurses wanting to better utilise their skill-set and work to their full scope of practice, especially through our Enhanced Nurse Clinics program funded by the Australian Department of Health. Nurse clinics offer an alternative model of care delivery where the nurse is a key provider of care for the patient utilising a holistic, patient-centred and team-based approach to care

Marie McInerney

Q. The APNA strongly endorsed the concept of the Health Care Homes model ahead of its (belated) 2017 rollout, saying nurses would play an “essential role”. Recently, as Croakey reported, former AMA head Dr Steve Hambleton, who led the expert advisory group on Health Care Homes, admitted that “implementation went wrong somewhere” and that the initial enthusiasm for what was promised has been lost.

What’s been the experience so far for primary health care nurses and what benefits and challenges are emerging?

Karen Booth

A. In my opinion, the commencement of Health Care Homes trial in Australia has only just begun and changes within the system will require adequate time for implementation.

Anecdotal feedback so far suggests that under the Health Care Homes model, nurses have greater autonomy to provide coordinated team-based patient care within their scope of practice. That being said, some nurses will require greater support to take on roles in care coordination, health assessments and patient engagement to support a patient-centred approach to care delivery.

Marie McInerney

Q. Another theme at the conference with be issues with recruitment and retention for nurses in Australia. The previous APNA survey found that 47 percent of respondents were actively looking for another job outside nursing and midwifery and only just over half intended to continue with their nursing/midwifery career in primary health care (including general practice) for the foreseeable future. Has that changed since? Why is that and what needs to be done for both retention, and initial recruitment?

Karen Booth

A. In the APNA Workforce Survey 2017, where 1,703 primary health care nurses across Australia responded, 80 percent claimed they are satisfied and will continue to work in primary health care. That marks a 33 percent increase in job satisfaction since our 2016 survey.

From the survey we could credit that the most satisfying aspects of working in primary health care include: caring for patients and their families; collaboration and effective team-based care; creating positive health outcomes and being a value; and being a valued member of the team.

Nonetheless, recruitment and retention of nurses working in primary health care are still key issues. As mentioned above, primary care nursing isn’t seen as a career of first choice. If you look at it from an educational perspective, many academic courses have traditionally focused on preparing nurses for a career in hospitals, with limited opportunities for undergraduate nurses to experience primary health care. From a career development perspective, while the hospital setting offers obvious career progression opportunities, many primary health care nurses have found it hard to navigate and advance their career in a primary care setting. That view is now changing!

This lack of career structure can be a significant impediment to the development of primary health care roles in general practice and community nursing settings. This state of affairs has made it hard for general practices to recruit and retain nurses—and this is where APNA’s Career and Education Framework comes in.

With funding from the Department of Health, APNA was engaged to develop a framework involving extensive engagement across many consultation phases. Nursing in primary health care is a rewarding and attractive career option, and the project promotes clear pathways to support nurses to find suitable opportunities and a fulfilling career.

Marie McInerney

Q. What conference speakers or issues would you like to highlight ahead of the event?

Karen Booth

A. Our event is packed with essential sessions that is particularly relevant for primary health care nurses. Key issues we would like to address through our sessions would be promoting nurses working to the full scope of practice and building a stronger nursing workforce through recruitment and retention. We would also like to focus on how nurse-led models of care could help nurses work to the top of their scope and make their work, their career opportunities and levels of satisfaction more exciting and rewarding.

Sessions to watch out for:

  • Video address from The Hon. Greg Hunt MP, Minister for Health, Commonwealth Department of Health
  • APNA 2018 Nurse Awards
  • Health Promotion and Access with nurse practitioner Lesley Salem
  • Leadership from the Frontline with Major Matina Jewell
  • The Building Blocks for Nurse Clinics: Opportunities for Innovation in Primary Health Care with Linda Govan and a panel of nurses that run their own nurse-led clinics
  • More to Mentoring with Melissa Richardson
  • Models of Care: Heath Care Homes with Janet Quigley, Commonwealth Department of Health, with Nurse Champion Donna Datoon
  • My Health Record Opt Out Update with Commonwealth Department of Health – Australian Digital Health Agency
  • Grow your career in primary health care with Jacqui Richmond with Patrice Cafferky, Robbie Bedbrook and Lou Bromley
  • A Multidisciplinary Team Performing to Top of Scope – Panel discussion with Kotara Family Practice

Marie McInerney will cover the #Nurseforce conference for the Croakey Conference News Service.

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