Friday 15th July 2005
Raising the bar on nursing
Nurses are a determined and resilient breed and the pressure has only made the profession stronger. Nurses are becoming more highly skilled and qualified, and are demanding voice and sway in the health debate. We also explore nurse roles highlighting the advance of the profession.
Lorna’s NP role fills a void
A nurse practitioner in community women’s health, Lorna Scott provides a diverse and much-needed service to the women in the Lower Hunter .
Lorna Scott says that her advanced clinical role as an NP in community women’s health may lead to reductions in pregnancies among the young, disadvantaged women in her care due to her capacity to prescribe the pill. ‘Before I was authorised to prescribe the pill, I could only refer these girls to a GP. The next time I saw them was for a pregnancy test because they could not afford the fees for a GP visit,’ she said.
Lorna is one of 53 nurse practitioners in NSW whose senior clinical role extends to duties traditionally the realm of medical practitioners, such as the prescription of some medications, diagnostic testing and referral to specialists.
‘It’s an advanced clinical role that is a mark of respect for the nursing profession. It provides a strong career path for nurses wanting to advance their clinical career,’ said Lorna. ‘Previously, if you wanted to advance your career there were limited options clinically. You couldn’t fully maintain a clinical focus but had to move in a management or educational direction.’
Nurse practitioners can work in a variety of settings in hospitals and community health. Lorna works for Lower Hunter Community Health, caring for women across a large rural region spanning Maitland, Dungog, Cessnock and Singleton shires.
She said the role of a nurse practitioner is particularly important in rural and remote regions where services are limited and communities can be very close-knit.
There are a number of issues in the Lower Hunter area affecting women’s access to medical services. Lorna said, ‘Women on low incomes often cannot afford to visit a GP who doesn’t bulk bill especially for regular screening like pap smears and bulk billing rates are low here. There is also a shortage of GPs.
‘My role fills a real need in a rural area like the Lower Hunter, which can be shown by the demand for the service,’ said Lorna.
As a nurse practitioner, Lorna is able to spend more time with her patients than a GP. New clients are given a one-hour appointment. ‘I provide a comprehensive range of services to my patients. This may include advice on contraceptive options, discussion on safe sex, a pap smear, testing for Chlamydia, pelvic examination, breast check, blood pressure check and prescription for the pill,’ she said.
‘When my clinical role was more limited there was a lot of duplication for patients – I was able to discuss contraception but couldn’t prescribe it so the client would be referred to their GP. I still do this for women who have a regular GP. The problem lies with those women who don’t have a GP. It’s important for women to have a regular GP for ongoing health care but at times that can be difficult with the shortage of GPs, especially in the rural areas.’
Lorna describes her clinic as “the back of her car”. ‘I am adaptable in practice and go to locations that are acceptable and accessible for clients. This includes regular clinics in community health centres, neighbourhood centres, home visits for women with disabilities and specific needs clinics for women who are developmentally delayed. There have been times where I’ve set up clinic in a shearing shed,’ she said. In a week, Lorna travels 350 kilometres as she covers the Lower Hunter region.
In a typical day Lorna will see between 8 and 14 clients who require a diverse range of services including pregnancy tests, pap spears, breast checks, pelvic examinations, advice on contraception, menopause, menstrual problems, incontinence, counselling for domestic violence, sexual assault, and relationship counselling. ‘It’s often the case that women come in under the guise of wanting a pap smear or check-up but they have an underlying need to talk about broader issues,’ she said. ‘You need to apply a holistic approach to women’s health.’
Lorna also provides education sessions to health staff, women’s groups and schools. And then there’s an abundance of paperwork and pathology follow-ups to keep up with.
Lorna qualified as a nurse practitioner in July 2001. There are two paths to obtaining qualification as a nurse practitioner. A nurse can be authorised based on extensive clinical experience, qualifications and undergoing a clinical viva, or by achieving an approved
Masters in nurse practitioner. Lorna achieved authorisation based on her extensive clinical experience, postgraduate qualifications in women’s health and clinical viva. ‘I wanted to further my career and enhance my clinical practice and knowledge,’ said Lorna.
The role of nurse practitioner has sparked some criticism from doctors’ groups but Lorna explains her role is not replacing a GP’s, it’s very much a complementary role. ‘Most of the women I see were not seeing a GP, anyway. In fact, I’m seeing increasing cases of GPs referring women to me for women’s health issues because they feel more comfortable seeing a nurse.
‘I have a good relationship with local GPs and specialists. We share mutual respect and recognition of each other’s skills. I don’t work in isolation, I work closely with other health professionals such as allied health, medical specialists and GPs.
‘There are times when I’ll seek advice from a GP or specialist and vice versa.
But at end of the day, I am responsible for my clinical decisions. ,’ said Lorna.