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Trial to expand nursing roles

Having nurses take over more doctors' tasks brings efficiency benefits - but also risks. By Amie Larter

A limited number of public hospitals around Australia are trailing new initiatives where nurses will be performing procedures normally completed by doctors.

In a controversial move, more than 10 nurses within public hospitals throughout Victoria are being trained by and working closely with specialists to screen colonoscopies and cystoscopies. Further trials may even see nurses sedating patients.

Dr Brendan Murphy, CEO of Austin Health, which runs Austin Hospital in Melbourne's north-east, confirmed the organisation was looking at a limited range of advanced practice roles where there was significant unmet demand for diagnostic or screening procedures.

"These include screening colonoscopy for the large number of patients who have had positive tests in the bowel cancer screening program, and checking cystoscopy, for patients who have previously had bladder cancers and need review for recurrence," he said.

"Having these dedicated roles makes an enormous difference in the waiting time for patients and releases the medical specialists to do more complex procedures. This means that we can use our resources much more efficiently."

According to Murphy, patients and hospitals won't be the only beneficiaries, with nurses provided with career development opportunities as a result of the extra duties. He said that for some, expanded roles offered an answer to frustrations over the lack opportunities and extensions.

"By extending the roles of doctors, nurses and allied health professionals, we can make their work more rewarding," he said. "At the same time, we will gradually need to introduce more enrolled nurses, nursing and allied health assistants to work under direct supervision, as we free up RNs and allied health practitioners to take on advanced practice roles.

"This will lead to a more sustainable and satisfied health workforce without any threat to the existing workforce, for whom these changes represent only opportunity."

However, Lisa Fitzpatrick, secretary of the Australian Nursing Federation's Victorian branch, said that the focus of some of these trials may be about "restructuring health professionals to save money under the guise of looming shortages", and that we should be looking at "why specialists were specialists in the first place".

"We need to respect the extra three to six years training by physicians who specialise in urology, gastroenterology and anaesthesia," she said, "and we would be concerned about trying to emulate that expertise in a short course or on-the-job training."

Fitzpatrick also said that patients were entitled to the highest level of expertise the health system could offer.

"It will be little comfort to patients and families if they are the one-in-20,000 patient and something goes wrong because they were considered a 'boring' patient [so their case was delegated to a nurse]."


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