Nurses willing and able

Federal Health Minister Nicola Roxon has stirred up a hornet's nest with her proposal to give nurses and other health care professionals the chance to play a greater role in the care of patients.

At its core is the debate about who is best suited to provide primary health care to all Australians. Until now, the GP has been funded as the main provider of primary health care. But, hopefully, not for much longer.

Primary health care is that which is delivered at a community level. It not only deals with resolving illness but also preventing illness and promoting healthy lifestyles.

The better the primary health care, the fewer people who end up in hospitals, so there is ultimately a benefit to our hospitals and how they are resourced.

Nurses in particular provide an enormous range of primary health care services. These include, but are by no means limited to:

• NURSES who are diabetes educators, who give advice and care to patients with diabetes;
• NURSES working in GP clinics who provide an extensive service to the practice's patients;
• NURSES in outback and country towns who are often the only health professional available;
• MIDWIVES who care for expectant mums and deliver their babies.

Australian nurses believe the Government should recognise primary health care extends well beyond the services of a general practitioner and would best be provided by a “multi-disciplinary” model.

This model would use the expertise of a range of health professionals, improve access to services, better use scarce GP time, offer value for money and ultimately deliver improved health outcomes for all of us.

The current system of primary health funding in Australia creates serious barriers to this happening.

As regulated health professionals, registered nurses do not need to be “supervised”. Like doctors, we work within laws that hold us accountable for our actions and protect the public. We do not advocate any health professional acting outside their expertise or qualifications.

Doctors are vitally important to our health care system and we don't want to replace them, but they are not the only ones who can deliver safe and effective care. Nurses recognise that the best way to deliver health care is in a team where the right health professional delivers the most appropriate care.

Just as a GP might refer on to a specialist when he or she needs to, so a nurse would refer a patient to a GP or other health professional. Advanced registered nurses and nurse practitioners are two levels that can provide expanded services through what we call “advanced practice”.

Advanced registered nurses are experienced professionals who are prepared for advanced practice through years of additional tertiary education and who accept responsibility for complex situations. They can in some circumstances seek authorisation or endorsement as a “nurse practitioner”.

The nurse practitioner role is differentiated by their extended education, which allows them to practise in the areas of advanced clinical assessment, to prescribe medications, to refer patients to other health practitioners and to order diagnostics tests such as blood tests and X-rays.

While there are about 300 nurse practitioners in Australia, many face barriers to practise to the full scope of their role.

Some of the restrictions are the inability for patients to receive medicines subsidised under the Pharmaceutical Benefits Scheme if prescribed by a nurse practitioner (as distinct from a doctor) or rebates from Medicare for nurse practitioner services. This limits their practice and reduces patients' access to affordable, high-quality health care.

Nurses in primary health care will not replace other professionals. But why should an elderly person in a nursing home or a child in a remote area have to wait until the next GP visit for a prescription when an advanced registered nurse, experienced in aged care or child and maternal health, knows the issue and the solution?

The legal capacity of professional nurses to make autonomous decisions needs to be acknowledged by changing current federal policy to allow people to access publicly funded primary health care services and medications provided by nurses.

There is huge potential not only to deliver better health for the community, but to improve national productivity by more effectively using our nurses - the largest professional health workforce in the country.