Some years ago, I interviewed a nurse practitioner working in a metropolitan hospital who described how she had good support from the medical colleagues with whom she worked – but had also suffered quite a bit over the years from the resistance of organised medicine to nurse practitioners.
She had had to put up with newspaper headlines warning of “third world health care”, and with doctors making derogatory comments in front of patients. At one hospital, some medicos refused to work with her, and the residents once went on strike in protest. “I grew a lot through that process. I learnt a lot about the politics of healthcare,” she told me.
More recently, I interviewed another hospital-based nurse practitioner whose medical colleagues spoke very warmly of her work, including her role in upskilling and training medical staff. The times have changed quite a bit for nurse practitioners working in hospitals at least.
Of course, professional turf wars are not only an issue in Australia. Research into the experiences of pioneer NPs in the US in the 1960s and 1970s identified that they faced many obstacles and stresses, including intense resistance.
Still, Australia has lagged decades behind other countries in developing the NP role, and this seems to Croakey to be little short of a scandal at a time of workforce shortages.
And now that the NP role is finally being extended into the community, what have we seen? More resistance, more headlines of doom and gloom. As is so often the case with health reform, the reaction is being driven by entrenched professional interests, rather than by any sense of what the community needs or wants.
So what does the community think of nurse practitioners?
Associate Professor Rhian Parker, a Senior Research Fellow from the Australian Primary Health Care Research Institute at the Australian National University, is investigating this very issue.
Rhian Parker writes:
General practitioners in many parts of Australia, particularly the ACT and rural and remote communities, are in short supply.
Patients in these areas often need to wait for several weeks for an appointment. Compounding this problem are the rising out-of-pocket costs to see a GP. This makes access to primary health care challenging in many areas of Australia.
The Federal Government has taken steps to address this dire situation by increasingly relying on nurses to ‘fill the gap’. One solution is the employment of nurse practitioners in general practices and other forms of community care.
A nurse practitioner is a registered nurse who has advanced qualifications and experience. As of November 1, nurse practitioners are able to provide services funded under the Medicare Benefits Scheme (MBS) and prescribe medications that are subsidised by the Pharmaceutical Benefits Schedule (PBS).
The Australian Primary Health Care Research Institute (APHCRI) and Health Care Consumers’ Association of the ACT are investigating Australians’ views of the role of nurse practitioners in primary health care services, such as general practice.
Extensive consultations with people across Australia have been undertaken and findings have been used to develop a national survey for health consumers.
The findings from the consultations have revealed that people just want to be able to access primary health care when they need it.
People told us during the consultations that they know their own bodies and therefore they know when they need to see a GP and when they could see another health professional. There was a strong hope that there would be shorter waiting times to see a nurse practitioner for primary health care.
People with long-term medical conditions also hoped that it would be cheaper to see a nurse practitioner compared with a GP, particularly for appointments to renew prescriptions. Furthermore, there was a perception that nurses listen to patients, which engenders trust and confidence and, ultimately, leads to better quality of care.
While people’s response to nurse practitioners was largely positive, some important concerns were raised.
Would they become another ‘layer’ in the health system that the patient would then have to negotiate? What medical procedures were they qualified to carry out? How would they be distinguished from regular nurses in a primary health care setting? Will GPs be willing to give up some of their work and revenue?
Participants recommended that a public information campaign should be conducted to make people aware of nurse practitioners as an option in general practice and made it clear what they can and can’t do.
The findings from these consultations indicate that nurse practitioners should be given a go in primary health care.
Through the national survey we are conducting, all Australians can have their say about whether they would visit a nurse practitioner for primary health care at their general practice.
The online survey will be open until the end of November and is available through https://www.surveymonkey.com/s/nursesinprimaryhealthcare.
• Associate Professor Rhian Parker is a Senior Research Fellow from the Australian Primary Health Care Research Institute at the Australian National University.