Nurse Practitioners: their role in the QLD health workforce

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1 Nurse Practitioners: their role in the QLD health workforce Sharyn Plath - Nurse Practitioner Redcliffe Hospital Emergency Department (RN, Midwife, BN/Hons, Grad Cert Intercultural Studies, Masters of Nurse Practitioner, MRCNA) Are you remotely interested? Mt Isa August 2007

2 Why a Nurse Practitioner? Pressure of health service aging population rise in chronic illness more informed & demanding health care consumer Structure of health service unprecedented knowledge advances & technology development the health service workforce is: Highly specialised expensive to train broad base

3 Why a Nurse Practitioner.. NP is already a senior specialist clinician with many years of experience; clinical career path Workforce reform models are driven by community need rather than discipline interests Models of reform must be responsive to patient safety and economic imperatives

4 NP Regulation in Australia Nationally agreed NP definition Legislative title protection Nationally agreed NP practice competency standards Master s level qualification with nationally agreed education standards Rigorous processes for authorisation

5 The nurse practitioner is. Linked to a model of health service reform A new level of health care provider who works as an autonomous member of a collaborative team Manages a case load Practices in a service model designed by a multidisciplinary service team

6 The nurse practitioner service model Provides a lower cost service for a broad base of patients Can reduce waiting times e.g. outreaching to under-serviced areas, nurse-led outpatient clinics, emergency dept patients Potential to improve timely management for patients with chronic illness (diabetes, chronic heart failure, chronic kidney disease)

7 NP scope of practice includes requesting diagnostic tests and making diagnoses referral of patients to other health professionals conducting interventions / prescribing medication The NP is legally accountable for all aspects of their practice

8 NP core role has three dimensions 1. Dynamic Practice Extensive experience & skill in clinical work Use of evidence based practice Expertise in processes leading to diagnosis, treatment and referral Measures to maintain clinical expertise Readiness to adapt extended knowledge and skills in unknown situations

9 NP core role 2. Professional Efficacy Significant autonomy & accountability NPs are crafting a new & different health service firmly grounded in discipline of nursing partnering with other disciplines maintaining cultural awareness Senior member of multidisciplinary team

10 NP core role 3. Clinical Leadership - Personal & professional Collaborative practice Knowledge of legal & ethical dimensions Shaping policy through the nursing profession - critique and influence at the systems level of health-care

11 Close Nurse Practitioners: their role in the QLD health workforce? - experienced specialist clinicians, highly educated and regulated - dynamic part of health service reform - meeting patient needs / service gaps across acute and chronic services - will expand as the service need demands

12 Questions? Redcliffe Caboolture

13 Nurse Practitioner or APN... An analysis framework to distinguish NP and APN roles is based on three dimensions: Service model: - APN is Consultant - NP is specialist/focused/clinical service Role parameters: - APN develops within local systems/education/research - NP has national standards Legislative structure: - APN has expanded practice - NP has expanded and extended practice Glenn Gardner G, Chang A, Duffield C 2007 Making nursing work: breaking through the role confusion of advanced practice nursing Journal of Advanced Nursing 57(4):

14 Clinical mix (ED RDH) Category 4 & 5 predominantly, but also includes Category 3: - Soft tissue injuries Fractures / Dislocations Acute traumatic wounds / Burns Skin infections / Cellulitis Earache / Sore throat / local eye infections Envenomation (excluding snake bite) Asthma Back pain Lower leg DVT Painful joints gout, teno-synovitis, OA, bursitis Incidental presentations such as lumps, plaster problems, referrals, certificates ROOM to increase, decrease or vary casemix is a dynamic process

15 ANMC NP Definition A Nurse Practitioner is a registered nurse, educated & authorised to function autonomously and collaboratively in an advanced and expanded clinical role. The Nurse Practitioner role includes assessment and management of patients using nursing knowledge and skills and may include but is not limited to the direct referral of clients to other health care professionals, prescribing medications, and ordering diagnostic investigations.

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