Rural health workforce audit 'screams' for health reforms

People living in rural and remote Australia face huge difficulties in accessing comprehensive health care. In addition to distance, one of the most significant barriers is the lack of rural and remote health practitioners. The federal government recently carried out a rural health audit assessing health workforce numbers. This showed a considerable shortage of health care professionals working in rural and remote areas, except perhaps for nurses.

On reading the report one could be lead to assume there is no problem for nursing in rural and remote areas, that nurses and midwives are evenly distributed across regional Australia and in the bush. However, just because their per capita distribution is the same as metropolitan settings, doesn’t mean there are enough of them. The most conservative of estimates puts the rural and remote shortage at 6,000 nurses and midwives needed to even begin to provide an appropriate level of service for people in rural and remote communities.

The audit essentially showed what people living and working in rural and remote settings already know: nurses and midwives are “holding the fort” in delivering rural and remote primary health care.

Despite being the largest workforce in rural health and continually bringing crucial primary health care to people living in rural and remote Australia, the efforts of nurses and midwives to improve access to health services are hampered by legislation and an overall lack of support.

One of the existing problems in the rural and remote health workforce is a high turnover. Nurses and midwives willing to commit to rural and remote communities must be given the support that has been identified as necessary for other health professionals such as doctors, if only to reward their commitment and motivate them to stick around in what is often a challenging working environment.

There are basic steps that could be instituted now which would begin to address some existing disincentives for nurses and midwives, for instance: single nurse posts should be abolished and adequate occupational health and safety measures for nurses and midwives in remote communities established; incentives available to doctors could be made available to nurses, midwives and other health professionals, including locum relief to facilitate professional development; and increasing access to IT resources would enable health practitioners to deliver care and receive appropriate back up where ever they are in Australia..

This type of support will aid in attracting the best health care practitioners to these areas and will reward the commitment of those who are already there. Nurses who commit to rural and remote health deserve the opportunity to safely and effectively deliver quality health care to all people and should not have their efforts frustrated.

Where there is a lack of other health practitioners, nurses and midwives have been setting up alternative health care models and supporting existing community health initiatives to continue to care for their communities. Successful health care models abound, with necessity there is a wellspring of innovation in rural and remote health, and countless examples of nurses bringing their professional skills and experience to ensure people in rural and remote communities have access to health care.

One such program is the Walwa Bush Nursing Centre. This centre was established when the Walwa Bush Nursing Hospital closed its in-patient services in 2001 and the community faced losing access to after hours emergency care. The Walwa Bush Nursing Centre (WBNC) started a collaborative health care delivery model, providing quality, efficient care to the Walwa community alongside and in support of the Walwa Medical Centre.

The Walwa model combines the extensive experience and skills of a nurse practitioner, with a professional nursing team, enabling the centre to offer the Walwa community access to daytime and after-hours primary health care and reducing pressure on the GP. These nurses also extend their service to the community’s preventative health and lifestyle activities and responding to after hours emergency situations, by triaging patients with the local nurse practitioner, which reduces the need for an on-call GP.

These models could easily and should be expanded to operate in many other areas and in other settings - they have demonstrated time and time again a direct benefit to the community in which they are based, and deliver high quality health outcomes, all of which increases health system efficiency and national productivity.

Expansion of such innovative models of patient centred care based on a multidisciplinary approach will deliver more comprehensive health care throughout Australia and to all people.

Nurses and midwives can be central to any effective solutions to the problems of poorer health outcomes in rural and remote areas. They have the dedication, they are currently situated there, and they consistently provide effective health care.

Advanced practice nurses such as remote area nurses and nurse and midwife practitioners offer fantastic opportunities for real and effective health reform if only the existing barriers to wider utilisation of the skills and knowledge these expert practitioners could be removed.

For example, for nurses and midwives to operate efficiently, particularly nurse and midwife practitioners, they must have access to the resources and funding that their medical colleagues receive. At present, nurse and midwife practitioners are able to prescribe medications, but the person they prescribe for must pay the full cost of the medication, with no subsidy from the Pharmaceutical Benefits Scheme.

Medications prescribed by GPs on the other hand are subsidised fully, a sufficient disincentive for most people to see a nurse practitioner when they can get the same drug from a GP for significantly less money because GPs have access to the PBS subsidy. With some medications running into the hundreds of dollars this makes no sense from the point of view of health care economics.

Due to a lack of access to the Medical Benefits Scheme (i.e. Medicare) the patient will again pay much larger out of pocket costs for consultations and tests ordered by nurse and midwife practitioners - as opposed to those ordered by a GP - here again is a financial disincentive for patients to utilise the full services of a nursing or midwifery practitioner.

Reform of the methods of funding these products and services must take place to give the community more complete access the services of nurse and midwife practitioners. It is quite ridiculous given the need to improve access to health care that these highly qualified practitioners are limited in the health care they can deliver because of funding and legislative barriers.

Australians deserve equal access to health care wherever they live and nurses are committed to delivering the very best health care to everyone, everywhere. This commitment is evident in the innovation nurses bring to rural health despite the pressures they face. The recent rural health audit reveals the strength of the nursing contribution to rural and remote health and puts the spotlight on the need to do more to provide equal access to quality health care in rural and remote communities. There is a lot that can be done but only effective health reform will do it.