Hitting a brick wall

A country town loses its nurse practitioner

Wendy Swann lasted just over a year as a nurse practitioner in a town of 2,500 people in rural NSW. Despite strong support from patients and other nurses, ignorance and obstruction from within a system that did not know how to support the role made her job impossible, she says.

Yet Wendy remains enthusiastic about the NP role and is seeking to resume work as an NP in a new location.

‘Being a nurse practitioner is about making use of the untapped potential of our profession,’ she told The Lamp.

‘It is very satisfying to be able to care for individuals in a collaborative and accountable way, not just to be seen as operating under the supervision of others.

‘Being a NP is about expanding and maximizing the role of a nurse.’

A trained nurse for 27 years, Wendy was a RN at a district hospital when she became one of the first authorised NPs in NSW.

‘I had been nursing at that hospital for several years, as an RN, educator, and midwife, and was well known to staff and the community.

‘Some members of the Rural Doctors Network were supportive and had been involved in the earlier pilot NP project. However, despite some enthusiasm in the early consultation process, local GPs were not supportive.

‘Nursing management across the board, had difficulty with the relative autonomy of the NP role within the traditional structure.’

Perpetual staff shortages meant Wendy was required to fill shortfalls in staffing. The NP role was funded from the existing nurses’ budget, which made the staff shortage worse.

‘Basically, the health service didn’t know what to do with me, and it became more and more difficult to evolve the role in the environment that existed,’ she explained.

‘The NP project in the area lost momentum as it lost support within upper management. All levels of management were clearly divided on the need to develop and support the new role.

‘In an environment of limited funding and lack of space, there were very few resources to support the role. Computer access was limited and I ended up buying my own computer.

‘I was given shared office space with others who resented the intrusion, and sharing an office restricted patient privacy. My hours of work were limited by budgetary constraints and so as not to attract penalty rates.

‘All my patients and rank and file nurses were really supportive, but eventually I decided I couldn’t continue hitting a brick wall and left the job.’

The hospital’s NP position is still vacant. Wendy went to work for the Flying Doctor Service and is now arranging to move into a NP program in another part of the State.

She believes small towns have the greatest need for NPs yet their health structures are least likely to cope with such a non-traditional role.

‘I strongly feel that nursing management needs as much support and direction as the individual NP, so they can develop the role together, well away from power plays and traditional hierarchies.

‘Nurses in rural and remote areas are the heart and soul of their communities and are often the difference between life and death regardless of the presence of medical care. Patients, rural doctors and health services stand to benefit greatly when the nurses’ role is allowed to develop.

‘Management and critics of NPs need to overcome their suspicion and distrust of the role and embrace it.

‘Nurse practitioners are raising the profile of nursing and will help to make it a more attractive career. Nursing is barely scratching the surface of what it could contribute to health care in this country – Australians haven’t yet seen the full contribution nurses can make.’ ?