Practice nurse in Australia: Current issues and future directions

School of Primary Health Care, Monash University, Melbourne, VIC, Australia.
The Medical journal of Australia (Impact Factor: 4.09). 08/2007; 187(2):108-10.
Source: PubMed


Almost 60% of general practices now employ at least one practice nurse. Australian Government initiatives to support the expansion of practice nursing are not consistently based on strong evidence about effectiveness, outcomes or efficiencies. Reviews from other countries suggest that practice nurses can achieve good health outcomes, but there is little information about the Australian practice-nurse workforce, funding models to support their work, scope of their practice, or its outcomes. Australian practice nursing lacks a career structure and an education framework to advance nurses' skills and knowledge. To maximise the contribution of nurses in primary care, a more systematic approach is needed, with a stronger evidence base for policy to support effective outcomes.

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Available from: Helen Keleher, Oct 06, 2015
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    • "In 2009–10, Government practice nurse incentives totalled AU$55.3 million [12]. To date, studies of the Australian practice nurse workforce have been mainly descriptive, with little focus on models of practice or determining impact on health outcomes [13]. "
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    ABSTRACT: Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient's depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. Classification of patients' depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement.
    BMC Family Practice 01/2014; 15(1):10. DOI:10.1186/1471-2296-15-10 · 1.67 Impact Factor
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    • "Overall the results suggest that practice nurses would benefit from greater contact with professional bodies and efforts to develop and support a career structure for Australia's practice nurses would be welcomed by nurses, including clear definitions of the scope of different levels of practice. Although there is a steady growth in studies that build a picture of the work of practice nurses in Australia (Halcomb et al. 2005, 2006, 2009; Keleher et al. 2007; Phillips et al. 2009; Australian General Practice Network 2010; Parker et al. 2010; Joyce and Piterman 2011), there remains scope for further research. In particular, studies are needed to clarify how the scope of practice and assigned roles of both Division 1 and Division 2 nurses relate to their educational preparation and competency standards. "
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    ABSTRACT: There is little understanding about the educational levels and career pathways of the primary care nursing workforce in Australia. This article reports on survey research conducted to examine the qualifications and educational preparation of primary care nurses in general practice, their current enrolments in education programs, and their perspectives about post-registration education. Fifty-eight practice nurses from across Australia completed the survey. Over 94% reported that they had access to educational opportunities but identified a range of barriers to undertaking further education. Although 41% of nurses said they were practising at a specialty advanced level, this correlated with the number of years they had worked in general practice rather than to any other factor, including level of education. Respondents felt a strong sense of being regarded as less important than nurses working in the acute care sector. Almost 85% of respondents reported that they did not have a career pathway in their organisation. They also felt that while the public had confidence in them, there was some way to go regarding role recognition.
    Australian Journal of Primary Health 01/2011; 17(3):227-32. DOI:10.1071/PY10074 · 0.96 Impact Factor
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    • "General practice nurses are employed to undertake a range of functions, some of which are allocated specific practice nurse item numbers for the purposes of Medicare reimbursement; for example, immunisations, wound care, cervical screening and some health checks (Mills & Fitzgerald 2008). GPs also rely on the general practice nurse to assist with procedures that have associated general practitioner Medicare item numbers such as health care assessments, care planning and the management of recall systems (Keleher et al. 2007). The Australian Government invests heavily in professional development programs for general practice nurses directed at skill development for procedures that have specific Medicare item numbers (Porritt 2007). "
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    ABSTRACT: The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.
    Worldviews on Evidence-Based Nursing 09/2009; 6(4):219-28. DOI:10.1111/j.1741-6787.2009.00163.x · 2.38 Impact Factor
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