By Nina Hendy

Nurse practitioners will become an increasingly important part of the country’s healthcare landscape after the role attracted Federal Government funding in this year’s budget.

Lengthy reports commissioned by Federal and State governments into the role of the nurse practitioner in the past couple of years give the healthcare sector a clear glimpse into the future, which looks likely to include growing numbers of nurse practitioners in a number of healthcare sectors across the country.

The role has also attracted Federal Government funding in the 2009/10 budget, further cementing expansion plans. The Government will provide $59.7 million over four years to expand the role, and will provide Medicare Benefits Schedule and Pharmaceutical Benefits Scheme support from November 2010. “This measure will provide for the development of a long term and sustainable model for nurse practitioners, helping to improve the flexibility and capacity of Australia’s health workforce. Expanding the role of nurse practitioners will assist in addressing the challenges facing Australia’s health workforce, particularly in regional and remote areas”, the budget reads.But the nurse practitioner role continues to attract its fair share of both praise and controversy.

Overseas in countries like the United States and Canada, nurse practitioners have been helping address workforce shortages for more than two decades. But the nurse practitioner role is new to contemporary Australian health care.

Here in Australia, nurse practitioners are progressively being introduced in all states and territories and there are some differences in the way roles are operating because of the different legislation and regulation in place in each state and territory.

Industry commentators have identified potential opportunities for nurse practitioners to contribute to a range of areas, including rural and remote medicine and mental health. Currently in Victoria, there are now 50 Nurse Practitioners endorsed and working in areas including community health, drug and alcohol, emergency care, renal care and paediatrics.

And while the authorities are sold on the benefits of the role, there are calls for the role to be more clearly defined.

According to the Victorian Government’s definition, a nurse practitioner is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The role includes assessment and management of clients using nursing knowledge and skills and may include but is not limited to, the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations.

The title ‘Nurse Practitioner’ is protected, preventing use of the title by anyone who is not endorsed by the Nurses Board of Victoria. Similar restrictions apply in other states and territories.A report commissioned on behalf of the Victorian Government titled ‘Sustainable Models for Nurse Practitioners in Public Mental Health and Drug Clinical Services: A Research Report’ recommended the need for clarification of the term ‘nurse practitioner’.

The report said this would ensure that the role is better understood and can be distinguished from other medical and nursing roles. The report, which was released in September 2008, also reported on a series of consultations with industry workers. Some people interviewed who work in the mental health area in Victoria believe that negative statements by the medical fraternity appearing in the media could act as an obstacle to the community acceptance of nurse practitioners.

“We keep asking … what is it that NPs can do that other nurses can’t do? Are they trying to be doctors or psychologists?’, were among some of the comments. The role of the nurse practitioner has also attracted opposition from key industry associations, including the Australian Medical Association (AMA) which has said publicly that independent nurse practitioners are no substitute for doctors. Dr Andrew Pesce, president, AMA, has said that any moves to water down the key leadership role of general practitioners would be a backward step.

The national body has long been against the nurse practitioner role. In fact, the AMA released a paper in 2007 titled ‘There is No Substitute for Your Doctor’, which stated that some state and territory governments risk delivering Australia a second class health system if they continue in their efforts to substitute doctors with lesser-trained health workers.

Dr Pesce told the National Press Club in a speech in July that the legislation is risky. “At best, it may assist in meeting unmet need in some areas of our health system by introducing more flexibility into the workforce. At worst, it can fragment care, increase risk of poor outcomes and increase costs through a lack of continuity and coordination,” Dr Pesce said.

The AMA’s concerns are based on hard evidence about how good primary health care should be provided, he said. “That is why we are engaging with the Government to ensure that there is proper collaboration with the patient’s usual doctor, and that there are always clear roles and lines of responsibility for that patient’s care,” Dr Pesce said.

By Nina Hendy

Copyright NCAH