Brave new nursing role

To deal with the predicted increased pressures on the health system the Productivity Commission has recommended the establishment of a new body – a health workforce improvement agency – to help establish new roles in the health workforce.

It is anticipated the agency would be a non-partisan group of experts who would examine the evidence and support positive innovations that could be rolled out more widely.

The NSWNA believes this could provide good opportunities for nurses to provide more cost effective and sensible solutions to many health problems.

It will allow nurse practitioners and midwives to move up professionally and take on roles that are currently monopolised by doctors.

These professionals could provide services that will be funded through Medicare and include the capacity to offer Medicare rebates without doctor referral.

Midwife Hannah Dahlen believes the Productivity Commission report has some very good ideas.

‘There are some huge challenges but the Commission has been brave. The key will be if the federal government is brave enough to fight the AMA and put patient interests first,’ she said.

Hannah believes the Commission is right about the need to change the skills mix in health and to open up Medicare funding to other health professionals like midwives.

‘If we shifted workloads so midwives were the lead professional for the majority of ‘low risk’ childbearing women, which is their area of expertise, and obstetricians used their expertise to focus on childbearing women who are ‘high risk’ we would have better outcomes for women and babies, a more cost effective maternity system and less of a workforce crisis,’ she said.

‘We have and are currently arguing the need for midwives to access Medicare funding and the productivity commission agrees. In New Zealand where midwives have access to public health funding, 79% of women opt for a midwife as their lead carer.’

Helen Bellchambers, an Clinical Researcher in aged care, agrees with the Commission’s position that well trained nurses could take on some roles now limited to doctors.

‘In aged care there is a chronic GP shortage and the scope of practice for RNs has altered in line with community needs over the past 10 years. Also, you don’t have the same back up you do in acute areas. A nurse practitioner or advanced gerentologist nurse is well placed as a conduit between other professions and patients and to give a more immediate response,’ she said.

While welcoming the new opportunities that the commission is recommending for highly skilled nurses, Helen says there needs to be caution about the way roles are defined for those who administer medications in aged care.

‘Medication management is a complex activity, no matter who is in charge. At present, in most facilities, there is a minimum regime that administration of medicine is done by a person with competency in the task. At all levels – assessment, planning, administration – a high level of understanding is required. Any change from that needs to be based on evidence not on costs,’ she said.

Helen Bellchambers says she is puzzled by the resistance of the medical profession to the Commission’s report

‘I’m not convinced the doctors’ attitude is based on sound evidence. It is more of a turf war,’ she said.

Productivity Commission puts national accreditation on the agenda

In another wide-reaching recommendation, the Productivity Commission has proposed the establishment of a national accreditation regime in health to consolidate the current profession-based system.

Brett Holmes says the NSWNA supports the development of national registration standards for health professionals.

‘But on a practical level we believe these bodies will work better if they are professionally-based rather than operating across the entire workforce as recommended by the Commission,’ he said.

‘For example, there should be a national nurses’ registration body rather than one board for the entire health workforce. As the Bundaberg Hospital Royal Commission shows, the quality of education and training and the process of registration are vital to the maintenance of quality.’