Nurse practitioners move into aged care

Aged care providers hope a boost in government funding will be an opportunity for nurse practitioners to showcase their value. Darragh O Keeffe reports.

Nieves Murray is pretty excited about her next staff appointment.

Her organisation, IRT, was one of 30 chosen to be part of $18.7 million government program that will recruit, train and evaluate nurse practitioners (NPs) in various aged care settings across Australia.

IRT has employed NPs in the past, but thanks to the new national program it can now invest sufficiently to test the model and apply it across a regional area, says Murray, the organisation’s chief executive.

“The intention for our program is to have the nurse practitioner work across not just residential care but also our in-home care programs across the whole of the Illawarra, so there will be spread both in terms of geography and sector,” she says.

Murray is enthusiastic about the potential role NPs can play.“Access to GPs in rural and regional areas isn’t what it could be. We believe nurse practitioners will be able to fill a gap and be an important component in the provision of comprehensive care throughout the continuum.”

She also feels the position will offer IRT’s nurses a clear alternative for career progression.

“There are certain paths they can take, some of them move into management, but there really aren’t many opportunities for them to explore and grow in the clinical area. We saw this as an important way to create a permanent career path down that clinical route.”

She also feels that collaborations between nurse practitioners and other healthcare providers, and bodies such as Medicare Locals, will be essential to the model.

Meanwhile, in Victoria, academics at La Trobe University are preparing to implement their NP model, along with their partner Castlemaine Health.

Kathy Tori, who co-ordinates La Trobe’s NP course, says the government’s program will make a difference for older people living in residential and community aged care.

“It offers improved outcomes for clients, because they will be able to access, in a timely manner, professional care in their own community.”

There will also be benefits for the healthcare providers, she says, in that they will now have the resources to finance implementation of a NP.

“A lot of these health facilities were looking towards something else to fill a service gap, and knew what they wanted, but didn’t have the budget,” says Tori, who is an emergency nurse practitioner.
Tori says it is hoped La Trobe’s evaluation of the role shows it to be a financially viable and sustainable model.

That evaluation will include examining call-out times, waiting time for access to care, length of stay in healthcare, and clinical outcomes. “We’ll also be looking at referral patterns to see to whom these patients or clients are being referred to for further care.”

Much like Murray, Tori is eager to identify how NPs can form relationships and support other health professionals.

“Nurse practitioners by themselves can work in an autonomous manner, so we have the education and clinical experience to assess a patient, order relative diagnostics, prescribe them, refer to specialists as well. [However] currently in the rural and regional sectors we need to work in collaboration; we have collaborative partnerships with GPs and other allied health workers. We see this particular project as one of collaboration and support with the local GPs.”

For Helen Gosby, president of the Australian College of Nurse Practitioners, the government’s program may go some way to shedding much-needed light on the current numbers and models of NPs working in aged care.

While there are some 700 NPs currently working in Australia, it is difficult to ascertain what percentage of these is in aged care, she says. “Someone working in aged care might be calling themselves a chronic care nurse practitioner ... Overall numbers are a little hard but with the announcement of the program and setting up models of care, I think we will see where they are [working] and some numbers,” she says.

Gosby also sees great potential in the program’s impact in aged care, where a shortage of enrolled and registered nurses means the clinical oversight provided by a nurse practitioner would be greatly welcomed. “A lot of it is unlicensed care. To actually have someone who’s licensed and regulated looking after them I think is something we need to start looking at.”

Gosby says interest in the nurse practitioner role is increasing, and the numbers are on the rise; most university places are full, she says. However, she acknowledges there is some hesitance among nurses as roles aren’t often forthcoming, “there’s no money to create roles, the nurses virtually create roles themselves,” she says.

Tori also reports growing interest in the role among nurses generally. She says since she took over the nurse practitioner course at La Trobe two years ago, the numbers have gone from single to double digits.