NPs push the boundaries

As the nurse practitioner role gains momentum in Australia, they are moving into specialised and diverse areas. Linda Belardi speaks to three trailblazers

Lieutenant-Commander Morag Ferguson is Australia’s first military nurse practitioner with the Royal Australian Navy. She is one of a small group of trailblazing nurses working in the specialty of dive medicine.

Based at HMAS Stirling in Perth, Ferguson is responsible for ensuring the care and safety of all submariners and divers during their regular pressurised escape training.

In collaboration with a specialist medical officer, she responds to any emergencies that might occur during a diver’s ascent from a 20-metre deep vertical escape tower.

Ferguson says the controlled scenarios replicate emergency rescue techniques that a diver would need to use to escape from a submarine in trouble.

Once the trainee diver hits the surface, they are immediately observed for any signs of difficulty.

“What we look for are things like have they blacked out? Are they neurologically intact? Can they recall time and place? And if there are any signs of a possible decompression illness we would put them straight in the hyperbaric chamber,” Ferguson tells Nursing Review.

There are two hyperbaric chambers, one at the base and another at the top of the escape tower to respond to a possible emergency, but Ferguson says incidents are rare. The first 20 minutes after a pressurised escape is crucial and two medics are present at all times during their training.

After a three-year stint as at the HMAS Stirling medical centre as a NP, Ferguson was transferred to the submarine and underwater medicine unit last year. She says the inclusion of NP as part of the unit has filled an important gap in an area where it is difficult to recruit staff.

“The role has ensured that a consistent level of healthcare can be delivered in an area of extended medical vacancies. While I am not taking the place of the underwater medical officer, my position has ensured a constant level of healthcare for patients,” she says.

Ferguson says the military divers have responded well to a NP. “As long as patients are satisfied with the outcome they don’t mind if it is myself or a doctor who provides the care.”

The escape and rescue centre is the only submarine escape training facility in the southern hemisphere, and one of only six operational worldwide. All submariners are required to complete the pressurised escape training every three years.

Ferguson says very few nurses would be exposed to this area of medicine in Australia.

Despite working more than 20 years as a nurse, she says dive medicine is a highly specialised environment and unlike any other nursing role in both her civilian and military career. “No two days are the same and anything could happen, so you always have to be prepared.”

Following Ferguson’s appointment in 2009, the ADF has since hired another NP. Ferguson says she would like to see an expansion of the number of NPs with the ADF to catch up with other countries such as Britain, Canada and the US where NPs along with physician assistants are integral to the delivery of healthcare in the armed forces.

“The success of my role is proving that there are very few places where we wouldn’t be able to work within the military environment.”

CASE STUDY: Help for remote patients

Nicole Ramsamy hopes her recent appointment to Weipa, Cape York’s largest community, will help increase timely access to healthcare for indigenous and non-indigenous people in the area.

As Queensland’s first indigenous nurse practitioner Ramsamy is passionate about remote indigenous health.

Based at Weipa Hospital, she case manages patients through the outpatients department as well as in the community, and conducts regular visits to the nearby small towns of Mapoon and Napranum.

In contrast to highly specialised NP roles, Ramsamy treats a broad range of clients and conditions in the community ranging from women’s health, sexual health and palliative care.

She also plays an advocacy role in the community and co-ordinates care services for patients.

Ramsamy is the second nurse practitioner for Cape York, joining Kym Boyes, who specialises in women’s health at Cooktown.

“The best thing about the nurse practitioner role in my setting is that I can do a lot of follow-up visits. I can go back into the community and ensure that patients have actually improved and that the management plan that I have put in place is working,” says Ramsamy.

In the context of rural medical shortages, the NP can also begin to manage the clients’ needs immediately, instead of waiting for a GP visit or for a patient to be seen by the RFDS.

“The NP role in these settings needs to be embraced. Having a nurse practitioner in remote environments allows a lot of the simple things to be addressed in a legal scope of practice. I can take the service directly to the people that need it and chat to them about their health where they’re most comfortable,” she said.

CASE STUDY: Working with specialist surgeons

As an experienced clinical nurse specialist on a busy 54-bed orthopaedic ward, Greg Boddy felt he had gone as far as he could go.

Looking to extend his clinical skills, the Brisbane nurse undertook a full-time master’s degree to become a nurse practitioner, and has just become Australia’s second NP in orthopaedics.

After his endorsement, Boddy entered into a collaborative arrangement with a knee surgeon at Brisbane Private Hospital, and from January has been working at the Queensland Knee Surgery Clinic seeing patients both before and after surgery.

In addition to providing traditional nursing care such as changing dressings, Boddy also requests X-rays and blood tests, prescribes anti-inflammatories and monitors treatment outcomes.

“I run two clinic rooms simultaneously during which I see all of the patients pre-operation,” he said.

“I conduct a full medical workup, order pathology tests and from a nursing perspective, deliver a lot of education about what the patients can expect from their knee replacement.”

Boddy says having a NP frees up the surgeon to concentrate on the most complex tasks and patients have responded well to the education and preparation that a nurse can provide pre-op.

Working in an advanced practice role has challenged Boddy to extend his skills and professional responsibilities. “Nursing teaches you very good skills of problem identification but then you refer on to the doctor. As a nurse practitioner, you assess what is the best outcome based on the evidence and the literature and then you implement it, in some cases independently but most often collaboratively.

“I consult with the surgeon across all key areas of patient care and with members of the wider healthcare team, including physicians, physiotherapists, nurses, anaesthetists.”

Boddy believes this is just the beginning of a bigger role for NPs in private hospitals across the country. “I can see a time in private health where surgeons have their own nurse practitioner attached to them.”

See also the impact of NPs from a longitudinal study here: [[Story:12-310712]] Do you have an idea for a story?
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