Recently we attended the Australian College of Nurse Practitioners (ACNP) annual conference in Melbourne, with the theme Celebrating the past and embracing the future. The nurse practitioner role has developed slowly in Australia, since initial planning to introduce positions into the healthcare workforce began in the early 1990’s. Despite some set-backs over the years, there is cause for celebrating achievements.
The first nurse practitioner appointments were made in New South Wales. In 2001, Ollie Johnson (dec) was appointed the first nurse practitioner to work in a remote area which didn’t have a practicing doctor. Shortly after, Jane O’Connell, was endorsed as an emergency nurse practitioner. Momentum built, with more advanced practice registered nurses gaining the qualifications and demonstrating the necessary experience for endorsement in the role.
Now, in 2015, there are 1,214 endorsed nurse practitioners providing care in Australia. Although frustrating, slowly and steadily building the ranks of nurse practitioners has allowed us to learn many lessons from our international counterparts, many of whom covet our:
- regulated, protected title;
- agreed definition for the role;
- Masters level qualification;
- national standards for nurse practitioner practice, and
- national accreditation standards and process for accreditation of programs.
We did the ground work and built the framework for the nurse practitioner role in Australia. Then, we consistently and persistently promoted and advocated for the role. We had to be thick skinned to deal with negativity and criticism thrown at us by other health professionals, many of whom still articulate their opposition.
In May 2009 the Labor Federal government, with Nicola Roxon as health minister, introduced historic health reform enabling access to the MBS and PBS for nurses and midwives. The resultant Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010 provided the legal framework for those receiving care from nurse practitioners and eligible midwives to access MBS and PBS funding. While the then ANF and ACNP were lead groups among the nursing organisations involved in the Australian government’s advisory groups, we were given absolutely no say at all when it came to determining the dollars for MBS rebate amounts. The PBS too was an extremely laborious negotiation around access to each medicine, with limited ability to influence these decisions. The ‘shared care’ and ‘continuing therapy only’ arrangements continue to restrict nurse practitioner practice unnecessarily - frustrating nurse practitioners and inconveniencing the people for whom they provide care.
The Australian government’s current ‘Healthier Medicare’ initiative, allows the ANMF to work with the ACNP in renewing our efforts to influence changes which will see nurse practitioners being able to practice to their full scope. This initiative includes three priorities:
- • MBS Review Taskforce;
- • Primary Health Care Advisory Group, and
- • review of Medicare compliance rules.
The first and third reviews are yet to include public consultations. Regarding the second, the ANMF Professional team attended a nursing sector specific briefing, and a general forum, with Primary Health Care Advisory Group, as well as making a written submission (http://anmf.org.au/pages/anmfsubmissions). This review has given us another important opportunity to reiterate with government the way primary healthcare should be provided and funded to enable nurses (including nurse practitioners) and midwives to be utilised more fully. This especially relates to the management of chronic and complex physical and mental illness.
Some of the long overdue changes we are advocating for are:
- • funding for designated nurse practitioner positions in the public sector, including in small rural and remote communities,
- • access to ‘request and refer’ MBS provider numbers for nurse practitioners in the public sector, as is the case for medical interns,
- • a substantial increase in payment for MBS items for nurse practitioners in private practice, to enable them to establish viable and sustainable practice,
- • recurrent incentive funding for nurse practitioners in private practice to work in areas of designated District Workforce Shortage,
- • infrastructure funding for nurse practitioners to establish private practice, and
- • allowing nurse practitioners to employ other nurses, in the same way as GPs do, under the Practice Nurse Incentive Payment.
In a presentation at the ANMF South Australian Branch Professional Conference in August, ANMF member and nurse practitioner Sally Hampel, gave a call to action to all nurses to get behind nurse practitioners and the work they do. She said acknowledging and supporting nurse practitioners is advancing the whole of the profession. We agree, and following Sally’s lead we encourage our members to take every opportunity to promote the importance of nurse practitioners. We want you to be persistent and heard – to speak, write, present, Facebook, tweet, blog – do what it takes to make sure everyone knows about nurse practitioners, works with nurse practitioners, and wonder what the health and aged care workforce ever did without them.
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers