The Development of the Role of Independent Nurse Practitioners in Australia - Essay Example

Role of Independent Nurse Practitioners in Australia Name Course Name and Code Instructor’s Name Date Introduction This paper provides a discussion on the impact of historical factors, social factors, political factors and economic factors on nursing practitioner role and the impact of nurse practitioner on health organization, a health client and the society. The paper will elucidate how nurse practitioner role evolved in Australia and some of the historical factors that contributed to ints emergence and evolution. Furthermore, the paper discusses how social factors impacting on the Australian population have contributed to the evolution of this role. In addition, the paper provides an analysis on political contribution to the development of this role. Moreover, the economic factors that have helped to shape this role in Australian context is also discussed. This will be followed by a discussion of the effect of nurse practitioner role on health organization, a health client and the society. This will help in providing information as to how nurse practitioner role has helped to shape and change the healthcare system in Australia based on its impacts on health organization, a health client and the society. Historical factors contributing/impacting on this role Nursing practice in Australia is regulated at the state level. Regulations in regard to controlled substances are under the responsibility of each state government. In rural and remote areas of Australia, nurses have been practicing independently to provide health services (Gardner et al., 2009). Many states in Australia recognise the role played by advanced practice nurses (Courtenay & Carey, 2008). However, in order to be recognised the creation of the position if nursing practitioner and their practice must involve the Board of Nursing. The need for improving accessibility to healthcare in remote areas was one of the main reasons why nurse practitioners were introduced in Australia. The practitioners were first introduced in Australia in 1990. It is widely accepted that the New South Wales (NSW) was the first state to introduce legislation that recognized and developed roles for nurse practitioners (Hurst & Marks-Maran, 2010). Different states and territories have since implemented legislations giving nurse practitioners varying roles and independency. The need for consistency in the role of nurse practitioner resulted in federal government implementing legislations that allowed the nurse practitioners to access PBS and MBS in 2010. It has been argued the Medcare Australia Act 1973 which limits nurse practitioners accessibility to provider numbers is responsible for the slow uptake of nurse practitioners Australia (Middleton et al., 2010). This act limits the role of nurse practitioners by denying them the right to carry out presicription and ordering for tests at costs that are rebated (Elsom, Happell, & Manias, 2009). Although this act changed recently to make provision for nurse practitioners, the act still prevents nurse practitioners from practicing effectively. Currently nursing practice in Australia is moving toward independent private practice. This move is aimed at supporting autonomy of individual nurse practitioner and improving patient care. Australian attention has thus been drawn toward the roles that nurse practitioners can undertake in delivering health care (Courtenay & Carey, 2008). Even though the attention has occurred at national level, the adoption of the role of the nurse practitioner varies between jurisdictions (Jennings et al., 2008). It is accepted that New South Wales (NSW) has led the development of nurse practitioner role in Australia (Newman et al., 2008). Other states such as Queensland, Victoria and South Australia have undertaken pilot studies on the role of nurse practitioners (Middleton et al., 2010). The pilots are aimed at ensuring that the services nurse practitioners provide meet the expectation of the community and are safe and effective. The impact of social factors on nursing practitioner role Studies have indicated that nurse practitioners are instrumental in the provision of primary health care and acute care (Elsom, Happell, & Manias, 2009). Both Australian and international experience indicate that nurse practitioners provide specific service that is highly regarded and in demand. The service offered by nurse practitioners allows many people who are under serviced such as women, children, homeless, rural and remote communities and elderly to access quality health care. Studies have also indicated that nurse practitioners are effective in managing common injuries and illnesses and stable chronic conditions (Hurst & Marks-Maran, 2010). It is argued that nurse practitioners are helping a lot in reaching out to vulnerable groups in the society who could be otherwise be sidelined in terms of health care using the traditional dependency on medical doctors to provide services such as prescription of drugs (Chiarella, 1996). Most studies examining the efficacy of the nurse practitioner role has mainly been based on comparing the nurse practitioner service outcomes to that of medical service. This line of thinking is based on the fear by doctors that nurse practitioners are their replacement (Jennings et al., 2008). In recent times, nurse practitioner research is tending to incline toward holistic health service research. Political factors contributing/impacting on this role Given the fat that nurse practitioners in Australia are regulated by state instead of being regulated at national level, it is difficult to track the number of nurse practitioners in the country (Middleton et al., 2010). The influence of nurse practitioner to Australian community is also hard to track given the discrepancies that exist in legislation guiding the practice of nurse practitioners (Elsom, Happell, & Manias, 2009). The establishment of the nurse practitioner role and title protection in Australia is characterised by lack of coordination and variability mainly because this development is not carried out nationally but rather at individual state or territory level (Courtenay & Carey, 2008). By 2004, five states had introduced legislations to protect the title of the nurse practitioner and had amended relevant legislation to legitimize the extended role of nurse practitioners. The states include New South Wales (in 1999), South Australia (1999), Victoria (2001) and Western Australia (2003) (Hurst & Marks-Maran, 2010). Queensland state, the state of Tasmania and the Northern Territory are also changing their legislation in order to define the role of nurse practitioner in their jurisdictions (Hurst & Marks-Maran, 2010). This is an indication that the nurse practitioner role of improving health care and provision of health care to marginalised groups is not limited to few states in Australia (Jennings et al., 2008). The commonwealth investigation into nursing in Australia has called for greater consistency in the development of nurse practitioner role. In addition, the longstanding mutual recognition agreements between states and territories require a level of standardization of the role definition and educational requirements for authorization of the nurse practitioner (Elsom, Happell, & Manias, 2009). As a consequence, the task force involved in the implementation of nursing education has included nurse practitioner role in their brief. Currently nurse practitioners are able to access PBS and MBS following the announcement by federal budget in 2009. The start date for this announcement was announced in November 2010. This brought non-medical prescribing into the public domain. This was meant to enhance and bring consistency into the legislation that had been in existence in different states allowing various non-medical practitioners to prescribe drugs. It ought to be noted that legislation in existence in various states differs in relation to formulary and authorization. As mentioned above, national consistency needs to be considered in future legislation for the current nurse practitioner amendments (Hurst & Marks-Maran, 2010). Efforts are currently directed toward development of national consistency around prescribing models, which incorporates a focus on the patient safety and access to medicines (Middleton et al., 2010). It has been argued that Australia is likely to implement a nurse practitioner model similar to that found in UK. In spite the implementation of new legislations allowing nurse practitioners to access to PBS and MBS, it has emerged that nurse practitioners will only be able to carry out prescription, treatment or referral of patients under Medcare by involving doctors (Jennings et al., 2008). The legislations took over 12 months prior to their details emerging. It is argued that these restrictions were mainly influenced by Australian doctor campaigns backed by over 700 general practitioners and the work of advisory group for the government. These legislations allow the nurse practitioners to prescribe, treat and refer patient (Newman et al., 2008). However, the nurse practitioners will be limited by the agreement between them and doctor concerning what they can do and what they cannot do (Elsom, Happell, & Manias, 2009). There are various circumstances under which nurse practitioner can access MBS items. One of such circumstances is when the nurse practitioner is employed in the practice of a doctor’s. This type of access requires that the medical practice have protocols in existence over the circumstances in which the nurse practitioner is involved in provision of care. The second circumstance is where the patient has been formally been referred to the nurse practitioner by a doctor. This includes specialists and the patient’s usual general practitioner. Another circumstance is where a nurse practitioner has a written formal agreement with a doctor (Newman et al., 2008). Under this circumstance, the nurse practitioner is free to treat patients under the MBS and PBS. The agreement in this case limits nurse practitioner to certain ailments and when he/she is expected to consult or refer the patient to a doctor (Hurst & Marks-Maran, 2010). The agreement allows nurse practitioners to treat a considerable large number of patients without having a formal collaborative agreement that covers each individual patient. Under this circumstance, the management and care of the patient is squarely the work of the doctor (Jennings et al., 2008). The final circumstance allows a nurse practitioner to treat a specific patient but she/he is required to provide information about the doctor he/she is working under. This requires that the agreement be established prior to commencement of the treatment. Economic factors contributing/impacting on this role Prior to implementation of the legislation allowing nurse practitioners to access MBS and PBS, there were many delays to treatment, longer waiting times in addition to increased patient suffering. All this translated to increased cost of health care service delivery (Jennings et al., 2008). Furthermore, patients in inaccessible areas of Australia who were under served in terms of medical services had to travel for long distances or had to wait for medical officers to visit their localities to be attended to (Currie, Edwards & Crouch, 2007). This added to expenses that such people had to meet in terms of delays and transport costs (Newman et al., 2008). As a consequence, such factors contributed to adoption and implementation of legislation that allowed expansion of the roles of nurse practitioners to complement the roles played by the medical officers. The impact of the role of independent nurse practice on contemporary nursing practice Health organizations One of the major influential health organizations that have greatly impacted on the practice of independent nurse practitioners is the Australian Medical Association (AMA) (David, 2010). Although various studies have indicated positive outcome of independent nurse practitioner, AMA has for long been opposed to the idea of having independent nurse practitioners. It has been argued that nurse practitioner model does not exclude either general practitioner or other medical officer (Hurst & Marks-Maran, 2010). It is unfortunate that AMA has been resisting the expansion of nurse practitioner role for self-interest of protecting their members’ income instead of putting the interests of the patients in the forehand. It is argued that sustainable collaborative partnerships could be developed with all health care providers when each other’s unique contribution is acknowledged (Jennings et al., 2008). It is argued that this could be attained via interdisciplinary learning and educational and awareness program (Currie, Edwards & Crouch, 2007). Society Nurse practitioners collaborate with medical colleagues and not for medical officers. They are not dependent on medical staff to indemnify their practice. However, in Australia this is rarely witnessed (Newman et al., 2008). An independent nurse practitioner is expected to order for diagnosis, prescribe and refer patients independently in order to make health care services be accessible in remote areas (Maurice & Byrnes, 2001). Evidence is emerging that medical doctors are paid enormous amounts of money to visit these inaccessible and rural areas (Currie, Edwards & Crouch, 2007). These doctors are involved in duplication of the work carried out by the nurse practitioner mainly because the nurse practitioner is not allowed to access MBS (Hurst & Marks-Maran, 2010). This is bound to change with the signing of a historic legislation by the senate in March 2010. The legislation recognizes and allows nurse practitioners to access MBS and PBS (Wilson, 1999). The legislation provides a wide range of choices for accessing qualitative and safe maternity care among Australian women (Jennings et al., 2008). The legislation is deemed to be instrumental toward nurse practitioner attaining their full independence (Halcomb et al., 2011). It is also argued that the legislation is instrumental toward expanding health care services to many families in Australia who were previously struggling to access such services (Currey, Considine & Khaw, 2011). Changing population needs and service availability have indicated that not all patients are in need of a medical specialist to manage their care (Hurst & Marks-Maran, 2010). Nurse practitioners are thus in a better position given the current legislation to provide care to such population in an autonomous state and make appropriate referrals for patients who require expertise medical colleagues and other health practitioners (Newman et al., 2008). As such, nurse practitioners are expected to transform Australian health care system and ensure improved service provision ones they are granted the mandate to practice independently. A health client People are increasingly becoming health conscious and as such are seeking medical advice even if they are not sick. This implies that the pressure on the limited healthcare providers is on the increase (Hurst & Marks-Maran, 2010). The nurse practitioners are thus fundamental in easing this pressure. The introduction of nurse practitioner in Australia has had a positive impact on the health client in that they are able to access healthcare advice wherever they are since nurse practitioners are accessible in many areas (Hurst & Marks-Maran, 2010). As a consequence many healthy Australians are now able to lead healthy lifestyles since they access advice easily from such Nurse practitioners. Conclusion Independent nurse practitioner concept was introduced in Australia in 1990s. The NSW was the first state to introduce legislation that recognized and developed roles for nurse practitioners. Different states and territories have since implemented legislations giving nurse practitioners varying roles and independency. The need for consistency in the role of nurse practitioner resulted in federal government implementing legislations that allowed the nurse practitioners to access PBS and MBS. The road toward nurse practitioner role development in Australia has been hugely been hampered by varying legislations in different Australian states and territories in addition to AMA which is opposed to independency of nurse practitioners. The inaccessibility of some areas of Australia to medical care, high costs of health care provision and the changing needs of patients have helped in shaping the nurse practitioner role development. In spite the hurdles that nurse practitioners have endured since the introduction of nurse practitioner in Australia, it seems that with recent legislation by the federal government the role of nurse practitioner is becoming clearer in Australia. References Chiarella, M. (1996). Nurse practitioner stage three report. Collegian: Journal of the Royal College of Nursing Australia, 3(4), 25-29 Courtenay, M., & Carey, N. (2008). Nurse independent prescribing and nurse supplementary prescribing practice: national survey. Journal of Advanced Nursing, 61(3), 291-299 Currey, J., Considine, J., & Khaw, D. (2011). Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing. Journal of Advanced Nursing, 67(10), 2275-2283 Currie, J., Edwards, L., & Crouch, R. (2007). A time for international standards? Comparing the Emergency Nurse Practitioner role in the UK, Australia and New Zealand. Accident and Emergency Nursing, 15(4), 210-216 David, S. 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