The nurse practitioner role is now well established in Australia, with these nurses driving clinical leadership and innovation, across a diversity of care settings. The aged care sector, however, was slower than other areas to create positions for nurse practitioners.
The ANMF argues this is an area in which nurse practitioners can make a significant contribution to the health and welfare of frail elderly people, as well as achieve savings for aged care funders.
The Australian government’s 2010-11 federal Budget included funding of just over $17 million for a four year project to “explore appropriate models of practice for Nurse Practitioners in aged care” (Australian Government Department of Health, 2016). The 30 organisations selected for the initiative received funding to develop, and then test a model for nurse practitioners that could be applied to their work in aged care practice.
The stated aims of this initiative were to:
- identify effective, economically viable and sustainable models of practice,
- facilitate the growth of the aged care nurse practitioner workforce, and
- improve access to primary health care for clients of residential and community aged care services. (Australian Government Department of Health, 2016)
As a professional nursing and midwifery organisation, the ANMF was excited about this project as we were already convinced nurse practitioners would be able to play an effective role in coordinating the chronic and complex care of elderly people, in community and residential aged care settings. What we needed was hard evidence to back our assertions when arguing the case to policy makers and funders of aged care services. However, while the initiative was completed in mid-2014, we have been waiting for publication of the study outcomes.
Funding was also provided in the initial federal Budget measure for an evaluation of the extent to which the various models, developed by the 30 organisations, met the aims outlined above. A team of researchers from the University of Canberra and the Australian National University undertook independent evaluation throughout the period of the initiative (Davey et al. 2015). A document outlining the summary of findings from the evaluation has only recently been made publicly available. Not surprisingly these findings confirm the valuable contribution nurse practitioners are making to aged care. Members are encouraged to read the full report (reference cited). To whet your appetite, highlights taken from the report are listed below.
- spent considerably more time with the elderly people than did general practitioners;
- being attached to the facilities, were more accessible than general practitioners and thus able to initiate more timely care;
- visited elderly people in their homes and thereby increased access to care for those who were not mobile or not able to drive themselves to services;
- undertook more comprehensive assessments of the older person than other registered nurses, meaning better quality of the clinical information to be used by the broader healthcare team;
- ability to order diagnostic tests or initiate appropriate medicines meant more timely treatment of acute episodes of care. In many instances this prevented the older person needing to be transferred to an acute facility and/or circumvented complications of the condition;
- were able to review medicine regimes, and in some cases, to reduce unnecessary poly pharmacy;
- were reported to bring greater confidence, more knowledge and stronger networks when dealing with specialised services;
- played strong coordination roles in bringing together health professionals and family members; and, provided valuable translation of information into language the elderly person and their family could understand; and,
- in their understanding of the importance of advance care planning, were able to help people document plans for end of life choices.
From an economic perspective, nurse practitioners in aged care demonstrated they save dollars for government funders through their timely and accurate care interventions. Economic efficiencies were gained through reductions in: unnecessary transfers to acute health facilities, ambulance costs, hospital bed days and thus hospital costs. The study estimated that “if all aged care facilities had nurse practitioners visiting, the savings from reductions in hospital bed days would have been $97 million in 2013-14” (Davey et al. 2015). For the elderly person and their family, being able to remain in their place of residence for treatment, avoids disruption and enhances wellbeing and safety.
The ANMF continues advocating for more nurse practitioner positions to provide clinical leadership in improving care for elderly people in community and residential aged care
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers
Australian Government Department of Health Ageing and Aged Care. Nurse Practitioner – Aged Care Models of Practice Initiative. Retrieved 7 October 2016 from: https://agedcare.health.gov.au/toolsand-resources/agedcare-workforce-fund/nurse-practitioner-agedcare-models-of-practiceinitiative
Davey, R., Clark, S., Goss, J., Parker, R., Hungerford, C., and Gibson, D. 2015. National Evaluation of the Nurse Practitioner – Aged Care Models of Practice Initiative: Summary of Findings. Centre for Research & Action in Public Health. UC Health Research Institute. University of Canberra. Canberra. Available from: www.canberra.edu.au/research/institutes/health-research-institute/annual-reports/reports/NPACM-Summary-of-Findings-Dist-Low-res.pdf