Primary healthcare nurses must expand their already vital roles

We saw a more intense focus in the latter part of 2015 on managing the health and wellbeing of people with chronic disease.

The Primary Health Care Advisory Group considered how healthcare professionals and providers could better co-ordinate and integrate care for frequent health service users, and the important role primary healthcare plays in supporting those with complex needs in the community. The goal for most people who have a chronic condition is to keep as well as possible and be supported in their home or community. This requires the skills and input of a range of professionals across primary healthcare disciplines, including nurses from the community, general practice and aged care, to name a few.

This year, there will be an even greater emphasis on the skills primary healthcare nurses contribute to meeting these goals.

We will also see a greater emphasis on the co-ordination of care that will help integrate and reduce duplication of services. Nurses in general practice already play a role in care planning and referral to other disciplines to support individual patient health and social needs. Community nurses have a similar role and, whilst there is considerable overlap in the type of work and goals of both settings, there are few touchpoints where those services connect. The story is similar in aged care, where primary healthcare nurses provide crucial hands-on care, planning and co-ordination for vulnerable residents. In 2016, there should be a greater emphasis on connectedness of services and support, not only for the patients and their carers, but also for the team involved in their care, which means a sound understanding of the role of each professional in better managed care and hospital avoidance.

For many people whose illnesses are progressive, nurses are well placed to support patients and their carers in how they would like their care. Furthermore, we are well aware that a large number of people are moving into the aged population category. This increased pressure is already felt across the health sector, and will be felt more and more by the tertiary- and aged-care sectors. The incidence of dementia is growing as a larger proportion of the population lives into old age. Primary healthcare nurses will play a key role in giving guidance about advance care planning, not just for older people but for those with chronic progressive illnesses, starting conversations about the early introduction of a palliative approach to care where needed.

During 2016, the Australian Primary Health Care Nurses Association will host a series of workshops to support primary healthcare nurses in the care of people with chronic health conditions and dementia, and in advance care planning. APNA also offers online learning about the palliative approach to care, which examines palliation across a number of health conditions.

Together with this ‘downstream’ care and the better management of chronic health conditions, there will also be a greater emphasis on keeping people well. We need to shift the focus from care of the sick to a much more ‘upstream’ idea of wellness and preventative health. It is here we can make an impact and focus on the future and containing healthcare costs, to achieve Australia: the healthiest country, by 2020 as per the National Preventative Health Strategy. The coming year will include a greater emphasis on expansion and development of skillsets for nurses to work to their full scope in primary healthcare. In general practices and community health services, nurses are often the key drivers of preventative health activities. I feel that 2016 will include a greater awareness of the benefits of nurse-led clinics to be more productive in delivering preventative health and chronic disease care and co-ordination. The benefit will not just be savings and efficiencies from streamlined primary healthcare services, patients will gain greater and more timely access to managed care and this will help break the cycle of crisis presentations.

To achieve all of this, we need a well-supported and growing primary healthcare nurse workforce. More than 65 per cent of general practices in Australia employ a nurse and the demand for more in this space is high. The demand for aged-care nurses and community nurses is also high and we know it will outstrip supply. There is also a growing demand for nurses in other areas of primary healthcare, including occupational health settings and schools – in particular high schools – to support wellness and mental health programs.

Looking to the future, we need nursing students to have more exposure to primary healthcare through nursing placements. Getting positions for practicum placements in general practice has been difficult. As nurses, we need to make 2016 the year of workforce development and push to take students into our workplaces, so they can benefit from our expertise and gain more awareness of the crucial role of primary healthcare.

The demand for primary healthcare nursing representation in health policy committees and governance rose markedly in 2015 and will continue to rise in 2016. APNA has a number of representatives on Commonwealth Department of Health and National E-Health Transition Authority committees and working groups, and the request for representation at the state level is growing.

Nurses have an expectation that their work will provide personal and professional satisfaction, and that they will be acknowledged for their contribution with good prospects for career development. As nurses and as the professional body, we need to put this on everyone’s radar – nurses, general practitioners, managers, employers and policymakers. Last year, APNA received government funding to develop an education and career framework; this year, that work will expand. The federal government has funded APNA to develop a career and education framework and toolkit that will apply to nurses across primary healthcare. Consultation will commence soon and we will seek input from across the profession.

Nurses are not only key deliverers of hands-on care in primary healthcare settings, we are also managers, co-ordinators, early adopters of technology, and well recognised as important change agents. There will be no time for rest in 2016.

Karen Booth is president of the Australian Primary Health Care Nurses Association. She is also a member of the Primary Health Care Advisory Group.

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