Indeendent Nurse Prctitiners in ustrli frm Sci-Politicl Persective - Essay Example

Indeendent nurse rctitiners in ustrli frm sci-liticl ersective Introduction The cntributin f nurse prctitiner services t ppultin nd public helth is being highly recgnized in grwing number f cuntries rund the wrld. With gret del f effrt they wrk independently s bth emplyees nd prt f tem whether it is in remte nd rurl res, in emergency deprtments in hspitls r in generl prctice. Independent nurses are a great resource for doctors in general practice, providing services such as immunisations; well women and well baby clinics; prenatal and postnatal clinics; asthma, diabetic and heart health education; wound care and general health counselling. The prctice f independent nurses are hwever n issue t cnstnt discussin nd chnge. Recent chnges in nursing prctice nd its visin frm sci-pliticl perspective is the subject f current pper. Body Nurse rctitiners re incresingly being identified s legitimte rviders f helth services thrughut the wrld. The emergence f the rle f 'nurse rctitiners' hs tended t ccur where cler need rises. This my be becuse there re n ther rviders f timely helth services r becuse helth cnsumers re seeking lterntives t their custmry helth service rviders. Mny resns cn be ttributed t the lck f dequte r rrite helth cre, including gegrhic, ecnmic, scil r culturl isltin. Mny nurses in ustrli hd begun t describe themselves s nurse rctitiners by the erly 1990s. Hwever, nt much hd chnged in the envirnment in which they rcticed. There remin few rtunities fr remunertin ther thn by direct billing f clients. Until the ssing f the Nurses mendment (Nurse rctitiners) ct 1998 (NSW) nurses hve hd n direct rights t rescribe medictins. Myth nd licy rhibitins surrund the rdering f investigtins such s x-rys nd thlgy tests where legisltin des nt reclude this rctice. The cntrversil tic f libility nd indemnity hs nt been cmrehensively tckled. Nr, until the ssing f the histric Nurses mendment (Nurse rctitiners) ct in New Suth Wles, hd the term nurse rctitiner entered the frml structures f nurse eductin, ccredittin, certifictin r registrtin. There re gret itflls with the wy nurses re currently lbelling the evlutinry stges thrugh which the rfessin is rgressing. Fr exmle, the terms 'extended rle' nd 'dvnced rctice' shuld give rise t unesiness. When nurses tlk f 'extended rles', f 'dvnced rctice' nd 'nurse rctitiners', they re nt tlking but being 'new ge' dctrs r 'new ge' nything else (Buhgier 1992; Nelsn 1992). Nurses must be cler tht they re tlking but the rctice f nursing. erhs nurses hve dne themselves disservice by using djectives such s 'extended', 'dvnced' nd 'indeendent' when tlking f nursing rctice-the imlictin being tht nurses re mving ut f clerly designted nursing territry. ne f the hzrds f nt defining clerly wht it is tht nurses d, nd the lingering, detrimentl imct f the erid f negtive definitin where 'nn-nursing duties' were esused, is tht, by defult, nurses seem t hve hd t g int reclmtin hse. This cn esily be interreted s ching n ther rfessinls' grund. Until recently there hd been ucity f reserch r literture relting t the rle in ustrli. Hwever, there ws strng necdtl evidence tht nurses, thrugh necessity nd chice, hd been rviding cmrehensive nd exert rimry cre, midwifery services, mentl helth services, wmen's helth services nd ublic helth services (t nme nly few) t the ustrlin cmmunity fr mny yers. The Nurse rctitiner rject ws significnt mrker in the reserch nd develment f the nurse rctitiner rle in ustrli. Sttes nd territries in ustrli hve been wtching the NSW Nurse rctitiner rject crefully nd mst hve nw begun lcl imlementtin rject. Given the federl system nd the stte-bsed rgnistin f mny helth services nd regultin f helth rfessinls, if the lessns frm ustrli re t be heeded, the mst difficult sect f imlementing the different mdels f nurse rctitiner services will be in negtiting with the lcl key stkehlders. Within the chnging cntext f helth cre rvisin, the execttins f the registered nurse include hving utnmy within the wrk setting nd mking decisins cnsistent with their sce f rctice, nd hving the freedm t ct un thse decisins, s tht they cn ce with the mny cmlex nd differing demnds tht re lced un them in rctice, either in helth tem r lne. This is n emerging trend in the creer thwy f the dvnced rctising Registered Nurse, rticulrly in the rle f rimry Helth Cre, rivte rctice nd rurl/remte nursing. This unit will rvide them with the strtegies required fr successful rctice s n indeendent nurse rctitiner. It is knwn fct tht currently, when ustrlins exect nd deserve higher qulity helth cre it wuld be irresnsible fr gvernments t ursue medicl wrkfrce slutins tht ffer tients less thn the best ssible cre. ll ustrlins hve the right t medicl dignsis nd medicl tretment by registered medicl rctitiner bsed n scientific nd clinicl trining. s lng s indeendent nurse rctitiners hve exert skills, exerience nd yers f study they cn nt be substituted by dctrs. While nurses re n essentil rt f the rimry cre tem, they shuld use their skills in wy tht cmlements the wrk f the dctr - under the guidnce f the dctr wh rvides the verrching cre nd wh tkes ultimte resnsibility fr the tients' medicl cre. There re t lest fur sets f stkehlders when cnsidering the mnged cre envirnment in its brdest sense: () the client r fmily in their chice f mdlity r clinicin, (b) the clinicl stff in surting their selectin f thereutic strtegy, (c) the mngement stff in the llctin f resurces tht meet the needs nd cn tentilly chieve the behvirl utcme criteri, nd (d) thse wh set funding r ccredittin licy but the linkge between level f need nd level f resurce vilbility in mnged cre envirnment. Whether it is the fmily, the clinicin, the emlyer, the insurnce crrier, r gvernment entity, the centrl issue is hw t best mnge the vilble resurces t meet the need nd chieve desired utcme. Study designs must ssess resurces used with the trditinl mesures f initil sttus, nd rgress nd utcme shuld surt client-fmily, clinicl, suervisin, mngement, nd licy decisins in mnged cre envirnment. There hs been strt in the develment f cnsumer-riented rert crds n the ccess, vilbility, utcme, nd stisfctin with mentl helth services. Mulkern, Leff, Green, nd Newmn (1995) reviewed the ublished nd unublished mterils tht were vilble in the sring nd winter f 1995. The technlgy f develing erfrmnce indictrs n ccessibility, vilbility, nd stisfctin des exist. Kmis-Guld (1978) nd Srensen nd his cllegues (Iliffe, 1994) develed bttery f erfrmnce indictrs t describe ccess, vilbility, nd finncil stbility vibility f mentl helth services. Dvies nd Wre (1991) develed mesure fr the cnsumer stisfctin fr the Gru Helth sscitin f meric tht hs resnble sychmetric rerties. utcme mesures frm the viewint f the cnsumer re nt redily vilble. Yes, there re mny utcme mesures tht re described s cnsumer self-rerts, but these hve been derived by mentl helth rfessinls t estimte imct frm the viewint f mentl helth rfessinl. Mesures derived frm cnsumers' views re still being develed nd tested fr their sychmetric qulity (Mulkern et l., 1995). The Center fr Mentl Helth Services (CMHS) creted tsk frce f cnsumer reresenttives nd rgrm evlutrs t devel such n instrument under the Mentl Helth Systems Imrvement rgrm (MHSI). The tsk frce reviewed ll f the instruments vilble nd gthered infrmtin frm vriety f cnsumer fcus grus (sme using firly shisticted multidimensinl scling rcedures). The tsk frce drfted n instrument tht is nw vilble. number f sttes, including Indin, re ttemting t devel nd test the use f their wn mentl helth services rert crd, using the CMHS mdel s guide. The cncet f ckging reserch nd evlutin findings fr the rincil sets f stkehlders is nt currently fcus f ur science r seen s the cncern f the clinicl services resercher. Yet it is centrl t the success f ur field hving imct n mnged cre guidelines. It my be time fr us t review the reserch erfrmed by thse in decisin sciences, mngement, nd mrketing t better understnd hw infrmtin cn be ckged s tht the infrmtin is useful t cnsumers nd their fmilies, rcticing clinicins nd their dministrtrs, nd licymkers influencing the rules f mnged cre. The nging debte n the future fr nurse rctitiners hs minly fcused n the discurse between the nursing nd medicl bdies. Hwever the cnsumer resnse nd discussin is extremely imrtnt. The ublic surt f nurses is cnfirmed nnully s inin lls in ustrli shw tht the ublic hve the highest degree f cnfidence nd trust in nurses s rfessinl gru. Nurses reetedly scre higher thn lwyers nd dctrs, s it ws n surrise tht the nurse rctitiner rle ws well received by the ublic. tient stisfctin surveys cnducted in cnjunctin with mny f the ilt rjects surt this ssertin. dditinlly, these surveys revel tht ele recited the reductin in witing time fr cre t mny f the ilt sites. 'Excellent use f resurces nd vilble stff' (NSW Nurse rctitiner rject 1995). Mny ele fllwed u their sitive remrks by recmmending tht mre nurse rctitiners shuld be used t exnd the service. The high degree f cnsumer stisfctin with the services rvided by nurse rctitiners ws indictive f the verll utcmes f the study. Desite this, nther mbiguus issue rse in the reserch tht is imrtnt. It is the lck f cmmunity understnding f wht nursing is. Mst wuld believe they hve gd understnding f nursing, but like mny nurses, they re unble t rticulte their understnding f the sce f the rle f nursing. The reserch int this very questin is in its infncy nd the discurse nd nrrtive trditins t describe the rle re nly just being identified. Virgini Hendersn sent mst f her rfessinl creer ttemting t describe nursing in n envirnment f cnstnt scil chnge. She recgnised the difficulties inherent in describing rle erfrmed glblly, but shed s strngly by the mny dd-n lyers f the culturl, ecnmic nd liticl influences f ech ntin, regin nd lcl re (Hendersn 1998). Fr nurses wrking in the rle f nurse rctitiners in the ilt reserch sites in ustrli, the exerience ws sitive nd rewrding. The rle identity ws strng, due t firm understnding by tht gru f exert nurses nd becuse the ilt frmewrk ws clerly defined. There were mny interesting bservtins mde by the nurse rctitiners, including 'tient wnershi', rfessinl bundries nd rfessinl ccuntbility nd resnsibility. rfessinl bundries hve lwys verled in helth cre nd hve tended t hve intuitive edges with the helth rfessinls develing wrkble understnding f them. The legitimistin f the nurse rctitiner rle hs seen these bundries further blur, resulting in nxiety nd cnfusin fr mny helth rfessinls (Dyl 1998; Wller 1998). The cntinuum f chnge, exressed in the develment f the nurse rctitiner rle, is nt new. The rertin nd functin f registered nurse brdened nd evlved drmticlly in ech decde f the twentieth century. There is n resn t ssume tht this evlutin will nt cntinue s the helth needs f the cmmunity chnge during the twenty-first century. Nurse rctitiners re mnifesttin f this rgress. ne f the cncerns f resident medicl fficers (RMs) t ne ilt site during the Nurse rctitiner rject ws tht their wrkld wuld increse becuse they hd t 'suervise' the nurse rctitiner. In fct, even in this reserch hse where review f the clinicl decisins f nurse rctitiners ws required s rt f the reserch methdlgy, there ws evidence tht the wrkld f the RM ws reduced. Surveys cnducted t tht time shwed tht 25% f medicl resndees erceived decrese in wrkld s n utcme f the nurse rctitiner ilt rject t tht site (NSW Nurse rctitiner rject 1995). There is extensive interntinl literture fcusing n the rle nd functin, the ccetbility, cst effectiveness nd sfety f nurse rctitiners. In December 1986, rert frm the ustrlin ssessment n nurse rctitiners ws ublished. The verll cntent f the rert ws very fvurble, finding tht the cre rvided by nurse rctitiners ws f high stndrd. Nurses exhibited mre ersnl interest, rvided mre infrmtin, mre services such s helth rmtin, client eductin nd sychscil surt nd hd better cmmunictin, cunselling nd interviewing skills thn ther helth cre rviders. The nurse rctitiner rle is well estblished in ustrli, with recgnised rle being described s fr bck s 1972. rndmised tril (the Burlingtn Tril) f the utilistin f nurse rctitiners cnducted within Sidney in 1972 cncluded tht: ' nurse rctitiner cn rvide first-cntct rimry clinicl cre s sfely nd effectively, with s much stisfctin t tients s fmily hysicin' (Frd, 2001). The histry nd evlutin f nurse rctitiners in ustrli ws, until the mid 1990s, very much dictted by the wxing nd wning f hysicin suly. In times f surlus, nurse rctitiners ften fund themselves rfessinlly islted, usully in remte gegrhicl nd rctice res (Brthlme, 1993). Conclusion While common practice in healthcare system refers to delivering clinical services, independent nursing practitice mdel is designed t meet the needs f mbultry ultins t mintin helth. However there remins tremendus unmet needs in cute nd lng-term cre settings fr which nurses hve the tentil, rtunity nd ccuntbility t resnd. Constant changes in policy, law and medical system in Australia are oriented to getting the most to achieve the mutual benefits of independent nurse practitioners and high demands of patients. Strengthening helth systems thrugh nursing cn led t n incresed cverge f bsic helth services fr thse mst in need. Nurses re lredy estblished in the helth wrkfrce in significnt numbers nd re ften wrking t rvide cre t diverse ultins. The lw in ustrli is reltively strightfrwrd-nurses re resnsible fr their ctins n dily bsis, t extend their sce f rctice will nt diminish their ccuntbility. Bibligrhy: 1. mericn Nurses' sscitin (1993) 'dvnced rctice nursing: new ge in helth cre', Nursing Fcts, R-1135M 8/93, Wshingtn DC. 2. mericn Nurses' sscitin (1993b) Sce f rctice fr Nurse rctitiners, Wshingtn DC. 3. mericn Nurses' sscitin (1993c) dvnced rctice Nursing: Stte Legisltive Survey, Wshingtn DC. 4. Brthlme, W.G. (1993) ' revlutin in understnding: Hw ethics hs trnsfrmed helth cre decisin mking', Biethics News, Jnury, vl. 12, n. 2. 5. Brsh, J. (1986) The Indeendent Nurse rctitiner in New Zelnd, Dertment f Helth Nursing sectin, Wrkfrce Develment, December. 6. Brwn, S.. nd Grimes, D.E. (1993) 'Executive summry', Met-nlysis f Cre, Clinicl utcmes nd Cst Effectiveness f Nurses in rimry Cre Rles: Nurse rctitiners nd Midwives, mericn Nurses' sscitin, Wshingtn DC. 7. Buhgir, T. (1992) 'Generl rctice must reel the invders', ustrlin Dctr, Setember, vl. 11. 8. Bulletin, The Mrgn ll (1999) 'The rfessins we trust the mst', 29 June, . 35. 9. Clmett, . 1993, Tis fr strting yur wn nurse rctitiner rctice', Nurse rctitiner, Vl. 18, N. 4, ril, 58, 61, 64. 10. Cncrd Retritin Generl Hsitl/Ryl rince lfred Hsitl (1994) Finl Rert n the Emergency Dertment Nurse rctitiner ilt rject, NSW Dertment f Helth. 11. Dertment f Helth (UK) (1995) The tient's Chrter, rev. edn, Lndn: Dertment f Helth. 12. Dyl, L. (1998) 'Crssing rfessinl bundries', Nursing Mngement, vl. 5, n. 4, . 8-10. 13. Frd, L. (1979) ' nurse fr ll settings: The nurse rctitiner', Nursing utlk, vl. 27, n. 8, . 516-21. 14. Frd, L. (2001) 'Nurse rctitiners: Histry f new ide nd redictins fr the future', in iken, L.H. (ed.) Nursing in the 80's: Crises, rtunities, Chllenges, hildelhi: J.B. Liinctt. 15. Hines, J. (1993) 'The nurse rctitiner: discussin er', Cndin Nurses' sscitin, ntri, Februry. 16. Hendersn, V. (1998) 'The cncet f nursing', Jurnl f dvnced Nursing, vl. 3, . 113-30. 17. Iliffe, J. (1994) 'Educting fr dvnced rctice-Wht d nurse rctitiners relly need', Cnference er, 6th Ntinl Nursing Eductin Cnference, 28-30 Setember. 18. Jcbs, S. (1998) 'dvnced nursing rctice in New Zelnd', Nursing rxis in New Zelnd, vl. 13, n. 3, . 4-12. 19. Kelly, J. 1995, The legl cntext f the nurse s n indeendent rctitiner', in Gry & rtt (eds), Issues in ustrlin Nursing 4, Churchill Livingstne, Melburne. 20. Lm, The (1994) 'Editril', vl. 51, n. 5, . 4-5. 21. Lm, The (1994b) 'Editril', vl. 51, n. 7, . 9. 22. Lnd, S. (1998) 'Brriers nd benefits lerned frm the mericn dvnced nursing rctitiner', er, The Nursing rfessin nd dvnced Nursing rctice IC Wrldwide Cnference, Sydney, December. 23. NSW Helth Dertment, 1993, Nurse rctitiner Review Stge 2, Vl. 1. nd 11, Stte Helth ublictin N. [NB] 93-120. NSW Helth Dertment, Gibsn Mrlw Cnsulting [ust] ty Ltd. 24. W Helth Dertment, 1994, rctice Nurse rject: Derby Reginl Hsitl 1993-1994, lbny Reginl Hsitl, W.. Read More