As Nurse Practitioner Project Officer at Bendigo Health, Elizabeth Morley’s job places her at the front line of a healthcare revolution.

Thanks to an ageing population and shrinking workforce, the challenges to healthcare delivery throughout Australia are by now well documented, but in case there’s any lingering doubt on the subject, the figures speak for themselves; at present healthcare services require approximately 8.6% of Australia’s workforce. By 2025 they will require around 20%.

As NP project officer at regional Victorian service Bendigo Health (BH), Elizabeth plays a key part in the Victorian Government’s response to this projected shortfall; the development of the nurse practitioner (NP) role. This is no mean feat; the development of new NP models of practice is intended to address a service gap without duplicating services, while it also requires expansion of nursing practice into new areas, including advanced clinical assessment, ordering and interpreting diagnostics, prescribing medications and referring patients to specialists.

Elizabeth’s experience, including renal care, respiratory, rural palliative care, stroke and oncology, reflects the breadth of application for the NP role. The renal NP model addresses increasing Victorian demand for optimum management of chronic kidney disease (CKD), and its implementation should improve outcomes for CKD patients, including delaying disease progression and associated complications, and improved preparation for transplant and dialysis. Another significant aspect of the model is that it will enhance the CKD patient’s capacity to make informed choices in relation to the treatment of their disease.

Improving access to, and management of, home oxygen therapy, and improved management of patients with chronic obstructive pulmonary disease (COPD) is the focus of the respiratory NP model. The improved management of COPD should result in fewer presentations to the emergency department and subsequent admissions to hospital, Elizabeth says, adding that as a result of this and improved oxygen management, significant cost savings are anticipated.

Meanwhile, the local Loddon Mallee region comprises more than 26% of Victoria’s landmass and has many sparsely populated and remote communities, creating a unique challenge for the rural palliative care model, which is based on supporting the existing specialist palliative nursing and other services and local general practitioners caring for people with terminal illness.

From the perspective of the stroke NP model of practice, improved timeliness of stroke diagnosis and treatment in the emergency department and acute stroke unit care, are two outcomes of the NP role, which involves working as a member of the stroke team across the continuum of a stroke patient’s care at Bendigo Health.

Finally, the oncology NP will play a key role working alongside BH’s medical oncologists in clinics in Mildura in the far north-western corner of Victoria and Kerang in northern Victoria. The NP service should not only increase the number of patients who can be seen at the existing clinics but will, over time, facilitate the implementation of additional regional clinics.

Elizabeth says the NP program faces both great challenges and opportunities, and not least among these is the fact that NPs are still relatively new in Victoria. Engagement with stakeholders is therefore fundamental to the development of any NP model of practice, and a key part of her role.

Victoria’s uptake of the new model is impressive so far; the state has seen nearly 100% employment of NPs, due to a partnership approach between health services, candidates and education providers, as well as strategies such as having cohorts of NPs in particular areas at one time and linking the roles to specific initiatives such as Victoria’s Stroke Care strategy and Cancer Action Plan (CAP). Victoria’s Department of Health Nurse Policy area has been providing funds and other resources to health services to develop NP models of practice. It has also been working with other areas such as CAP to identity opportunities to develop NP models strategically; and this needs to continue, she says.

Aside from the ‘big picture’ aspect of her role, much of Elizabeth’s time is devoted to supporting NP candidates at Bendigo Health. She is currently organising an education program to assist candidates to obtain competency in the skill set required for their expansions to nursing practice; she also provides ad hoc support and advice to candidates. Any nurse considering NP as a career path must recognise the length and depth of a journey that is relatively new in Australia and “still very much finding its way,” she says.

Growing recognition of the NP’s role will undoubtedly strengthen its cause, with the implementation of national nursing registration in July this year providing an opportunity to ensure that the title ‘NP’ is protected for use only by those nurses who have met the requirements, and ensuring greater national consistency in the NP role. In any case, from Elizabeth’s perspective, the rewards for undertaking the nurse practitioner journey are “well worth the effort.”

“The most satisfying component of my role has been seeing a NP model of practice begin as a good idea, and grow into a working model of practice that will improve health and wellbeing outcomes for people. I’ve also derived great satisfaction from seeing a nurse commence the NP journey and develop into an endorsed NP.”

By Belinda Smart

Copyright NCAH