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[hr]The contribution nurses make in general听practice and primary health care will听be critical to ensuring our healthcare听system can meet the growing needs of听an ageing and ever sicker population into听the future. Kathy Bell, CEO of Australian听Primary Health Care Nurses Association听(APNA) explains how an education and听career framework will help ensure the听profession鈥檚 sustainability[hr]
Everyone from governments to health听professionals to consumers agree that we听should aim to keep people as well as possible for as听long as possible, and out of hospital and residential听aged care. To achieve this, we need to get better at听caring for people in the community. Nurses are the听largest and best distributed health profession, and听will increasingly be the key to the delivery of primary听health care, in general practice and other community based听settings.
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[link to="Kathy Bell"]Kathy Bell[/link]
[link to="References"]References[/link]
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There is significant potential for nurses to play a greater role in听primary health care in Australia. Let鈥檚 focus for the moment on听general practice. Starting from a low base 20 or more years ago,听there are now around 11,000 nurses
working in general practice听in Australia, and it鈥檚 one of the fastest growing workforces in the听nation 1. The majority of general practices employ at least one听practice nurse 2, which is a significant development from where听we were in Australia just a couple of decades ago. Primary听health care nurses, including those working in general practice,听play a key role in the management of long-term conditions听and in caring for the sick and ageing in our community. The听care primary health care nurses most commonly provide 鈥撎齪reventative health interventions, chronic disease management听and coordination, and care for the elderly 鈥� is vital in keeping听people well and out of hospital and aged care.
But there are significant barriers to realising the full potential听of the primary health care nursing workforce. Most notably,听we have no national workforce plan to ensure the future听sustainability of the profession. The capacity of the nursing听workforce going forward is not a given. The Health Workforce听2025 3 report predicts a major shortage of nurses in Australia听by 2025, and identifies this as a critical risk. This shortage will听undoubtedly impact on general practice and primary health听care. Although the number of nurses working in general听practice has risen steadily over recent years, many of these听nurses are due to retire in the next ten years. Already, more听than four in five nurses working in general practice are aged听over 40, with the largest cohort being in their fifties 4.
[pullQuote]鈥淭he capacity of the nursing workforce听going forward is not a given. The Health听Workforce 2025 5 report predicts a major听shortage of nurses in Australia by 2025, and听identifies this as a critical risk. This shortage听will undoubtedly impact on general practice听and primary health care.鈥澨齕/pullQuote]
There are established career pathways for听nurses within the tertiary sector, where听opportunities continue to open up for听advanced nursing roles. However, there is no听formal education and training pathway into听general practice
nursing, and no framework听for skills development and career progression听for nurses working in general practice. There听is also no systematic support framework for听re-entry into the profession.
There is no nationally consistent and听supported program for undergraduate nurse听clinical placements in general practice,听nor is there a consistent transition to听practice framework for graduating nurses听and nurses from other settings who enter听general practice. And access to education听and training specific to nursing in general听practice is patchy, variable and inconsistent.
In the absence of appropriate education,听training and transition programs, there are听significant risks that the number of nurses听needed with the appropriate skill sets will听not be available to meet the needs of general听practice in the near future.
We need better defined and supported听pathways into and up through general听practice nursing. This will help us attract听young nurses to the profession and keep听developing their skills and expertise over听time, so they stay in the workforce and keep听contributing more value.
APNA is advocating strongly for government听and stakeholder support for the development听of an education and career framework for听nurses in general practice, as a precursor to听parallel frameworks for other primary health听care settings. What might such a framework听look like, and what might it achieve?
The framework would, first of all, address听the need for a consistent approach to听undergraduate nurse education and training,听to ensure graduating nurses are reasonably听prepared to work in a range of settings, not听only hospitals. In addition to appropriate听curricula, all nursing students should have听the opportunity to undertake well supported听clinical placements in general practice and听other primary health care settings.
The framework would then address transition听to practice issues for nurses entering general听practice. This would ensure that newly听graduated nurses, and nurses moving from听other clinical settings into general听practice, are well supported through听structured education, training and听mentoring. This would enhance the听flexibility and productivity of the nursing听workforce, as nurses could more readily听work where they are most needed.听It would also ensure that general听practices themselves have information听and resources to enable them to听transition nurses into their practice,听whilst ensuring safety and quality for听consumers. We know that many general听practices are currently reluctant to take听on first year nurses in the absence of听such support structures.
Finally, the framework would clearly听identify a series of levels of primary听health care nursing, from entry level听through to advanced practice.
[pullQuote]鈥淎PNA is advocating strongly for government and听stakeholder support for the development of an听education and career framework for nurses in general听practice, as a precursor to parallel frameworks for听other primary health care settings.鈥漑/pullQuote]
Nursing in general practice currently听lacks formal recognition of varying听levels of skills and responsibility. The听framework would address this by听defining the skills required for each听level, along with the underpinning听education required, and pathways for听development from one level to the next,听demonstrating how to move across and听upwards. At each level, the skills and听expertise, and also the responsibility,听accountability, and autonomy of the听nurse would increase. This framework听would support nurses and enable them听to see primary health care nursing as a听career choice, not 鈥渏ust a job鈥�, which will听help to build and retain a motivated and听committed workforce. It will also help听employers, including general practices,听to define their workforce needs and听understand what skills and knowledge听they require in their nursing team.听In addition to the education and career听framework, the financing system听for general practice needs serious听attention. Fee-for-service payments听to GPs, alongside limited block grants听for general practice nurses, perversely听reward general practices to maximise听GP consultations and throughput,听instead of rewarding quality team care.听The financing system must be reformed听to support and promote high quality,听person-centred multidisciplinary team听care, and ensure good access for all.
Finally, we need to address the cultural,听institutional and legislative barriers which听prevent primary health care nurses听working across their full scope of practice.听There has been strong opposition by听some professional groups in Australia to听the development of advanced nursing听roles. Primary health care nursing听roles and scope of practice in Australia听are underdeveloped, and the ratio of听primary health care nurses to primary听care physicians is significantly lower, in听Australia compared with a number of听other comparable countries. We need to听address the barriers that currently prevent听the Australian primary health care nursing听workforce from meeting its full potential,听using a lens that focuses on what is best听for the community, not what is best for a听particular professional group.
The primary health care nursing听profession in Australia has come a听long way, but still has a long way to听go if we are to get the best out of our听workforce. Developing and utilising听the full potential of this workforce will听help ensure we can deliver high quality,听accessible and affordable primary health听care to our community into the future.
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[title from="Kathy Bell"]Kathy Bell[/title]
Ms Kathy Bell has been CEO of听the Australian Primary Health Care听Nurses Association (APNA) since听September 2012.
APNA is the peak professional听body for nurses working in听primary health care including听general practice. With more than听4000 members, APNA provides听primary health care nurses with a听voice, access to quality continuing听professional development,听educational resources, support听and networking opportunities.听APNA鈥檚 vision is for a healthy听Australia through best practice听primary health care nursing.
Kathy has worked in health policy听and management in government听and non-government settings for听over 20 years, and has a strong听background and interest in chronic听disease, primary health care, rural听and remote health, and Aboriginal听and Torres Strait Islander health.[top]
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[title from="References"]References[/title]
1 Australian Institute of听Health and Welfare听(AIHW). Australia鈥檚 health听2008. Cat. no. AUS 99.听Canberra: AIHW. Available听at: (Accessed听20 March 2013).
2 2012. 鈥�2012 General听Practice Nurse National听Survey Report鈥�.听Australian Medicare听Local Alliance. Available听from: #National GPN Survey听report [Accessed 20听March 2013].
3 2012. 鈥淗ealth Workforce听2025 鈥� Doctors, Nurses听and Midwives鈥�. Health听Workforce Australia.听Available at: [Accessed听20 March 2013].
4 2012. 鈥�2012 General听Practice Nurse National听Survey Report鈥�.听Australian Medicare听Local Alliance. Available听from: #National GPN Survey听report [Accessed 20听March 2013].
5 2012. 鈥淗ealth Workforce听2025 鈥� Doctors, Nurses听and Midwives鈥�. Health听Workforce Australia.听Available at: [Accessed听20 March 2013].[top]
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