We’ve recently been to two national forums which, on the face of it, appeared to have very different agendas. However, on reflection we can see that there was a commonality of themes. The first, a two day symposium convened by the Commonwealth Chief Nurse and Midwifery Officer, Deb Thoms, was held in Canberra in March. The aim of the symposium was: to debate the concept of advanced practice based on the research commissioned by the ANMF and conducted by Professor Glenn Gardner and Professor Christine Duffield (2012, 2016) ; and to engage stakeholders in discussion exploring the relevant prescribing models and associated regulatory requirements that would support implementation of nurse and midwife prescribing. Approximately 200 participants discussed advanced practice role development using the domains identified in the research, those being: clinical care; education; research; systems management; and leadership. These generalist attributes were found to be identifying features for advanced practice registered nurses. Group work discussion at the advanced practice forum kept coming back to the concept of specialty versus generalist practice. Many seemed to think that specialising is the only pathway to advanced practice. The research tells us that this isn’t the case. The domains of advanced practice are generalist.
The second forum, the 14th National Rural Health Conference, A World of Rural Health, convened by the National Rural Health Alliance, was held in Cairns in April. There were more than 1,200 delegates in attendance to discuss issues impacting the health and wellbeing of the 6.7 million people in rural and remote Australia. This conference was immediately followed by the 14th WONCA World Rural Health Conference, an international event with over 900 delegates from 37 countries around the world exchanging information on the latest developments and challenges in rural family practice and rural and remote health generally. Although I’m declaring my bias up front, the very best of the plenary speakers for the NRH Conference were both nurses. Central Queensland University Professor of Nursing and Midwifery, Gracelyn Smallwood and Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) CEO, Janine Mohamed, who received a standing ovation. These impressive nursing and midwifery leaders took us on a journey, one looking at the integration of world views on health and wellbeing and the other painting a picture on what it would look like in the future if we truly closed the gap in health inequality.
Nursing and midwifery is represented on the National Rural Health Alliance by the ANMF, CATSINaM, CRANAplus, the Australian College of Nursing Rural Nursing and Midwifery Community of Interest and the Australian College of Midwives Rural and Remote Advisory Committee. These organisations jointly conducted a pre-conference workshop for nurses and midwives, titled ‘Rural and Remote Workforce Sustainability – is it possible?’ which was sponsored by James Cook University. Queensland Branch Secretary, Beth Mohle represented the Federation on the panel for the workshop which was well attended with 64 participants. Following the panel, the group work discussion at the workshop generated five recommendations which were added to the overall conference recommendations. A list of the priority recommendations from the conference can be viewed at: www.ruralhealth.org.au/14nrhc/recommendations
There was much discussion at the rural conference about the importance of generalist practice. It was suggested a number of times that there is a need for a rural generalist nurse pathway. This was spoken about as if it’s a new concept. Nurses working in a rural context of practice have always been rural generalists. What is the purpose of a so-called pathway? Is it a means to require nurses to jump through more hoops to work in rural areas? Is it so we can say that being a rural generalist nurse is a specialty?
The undergraduate nursing curriculum produces a generalist. Then we move into a context of practice and start to define ourselves by ‘specialty’. Are mental health, aged care, rural health, general practice, paediatrics, acute care, remote health, community health all nursing specialty’s or are they a context of practice? What is to be gained by defining ourselves by specialities rather than as a registered nurse working at a particular time in our nursing career, in a particular context of practice? Labelling ourselves only by our current context of practice, restricts our role and scope of practice.
It is the generalist attributes of nursing that define you as a nurse not the context of your practice, which may or may not be a specialty. Be proud of your context of practice but remember we are all, first and foremost, a generalist nurse.
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers
Chang, A., Gardner, G., Duffield, C., Ramis, M-A. 2012. Advanced practice nursing role development: factor analysis of a modified role delineation tool. Journal of Advanced Nursing, 68(6), 1369-1379.
Gardner, G., Duffield, C., Doubrovsky, A., Adams, M. 2016. Identifying advanced practice: A national survey of a nursing workforce. International Journal of Nursing Studies, 55, 60-70.