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The growth of nurse practitioners in Australia has been patchy and largely driven by individuals instead of legislative reform.
Dr Clare Harvey from the school of nursing and midwifery at Flinders University is midway through a five-year longitudinal study on the impact of NPs on the health system.
She says they have spearheaded growth. “There is a lot of good work happening within individual pockets of professionals working together but it’s not necessarily supported by the legislation or the financial arrangements,” she tells NR.
“There are pockets of organisations that are flying with nurse practitioners and others that really do not understand how the role can be implemented. There is still a degree of fear around the role among individuals.”
While there has been significant growth in NPs moving into private practice since 2010, the low value of the Medicare rebates for NP services remains a barrier.“General practices can’t survive on the rebates that are being offered. They have to work above the rebate to actually to make it viable,” says Harvey.
In June, Nursing Review reported on the closure of Australia’s first standalone NP-led clinic, due in part to poor commercial viability.
Professional misunderstanding is also an issue. Despite it being an area of high need, Harvey says rural and remote NPs have been slow to get off the ground.
She says some country hospitals have been constrained by tight budgets and professional tensions over how to introduce a NP model when an advanced practice nurse, such as a clinical nurse consultant or GP is already in place.
“A lot of remote areas nurses have been providing an advanced level of care with the endorsement of the doctors for a long time, so these areas often don’t always see the need to change to a different model.”
Every surveyed NP also identified the Australian Health Practitioners Regulation Agency (AHPRA) endorsement process as a hurdle. NPs reported lengthy processes, unclear requirements and state-based differences.
Harvey says primary healthcare, chronic care and palliative care are predicted to be future growth areas for NPs.
See also feature on innovative roles for Nurse Practitioners [[Story:13-310712]]
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