The value and influence of research of the nurse practitioner role in health service reform

By Professor Glenn Gardner FRCNA, Clinical Chair, Queensland University of Technology

These are interesting times for nurse practitioners, health service researchers, and legislators. For nurse practitioners there is at last some movement to align state and federal legislation that will remove some of the barriers to their practice.

For health service researchers, such as the team conducting the Australian Nurse Practitioner Project (AUSPRAC) there is opportunity to contribute evidence for legislation and policy development and for legislators there is the challenge to balance the requirements to achieve true health service improvement and the pressure from lobby groups with vested interest in the status quo. The health care consumer must wait patiently to see if they will gain benefit from this current activity.

Recently legislation has been introduced that will give eligible nurse practitioners and midwives access to the Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS).

However, definitions and amendments related to this legislation limit this access and further compromise the clinical reach of nurse practitioner services.

The amendments to legislation require nurse practitioners and midwives to have collaborative arrangements with doctors as a condition for accessing PBS and MBS. The assumption here is that nurse practitioners do not collaborate in their current practice and require legislated imperative to do so before they are able to access these Commonwealth subsidies for their patients.

However, research results from the AUSPRAC study are showing that nurse practitioners are committed and valued members of health service teams and collaboration with all relevant clinicians is part of their practice. Collaboration is also well embedded in the Australian Nurse Practitioner Competency Standards.

The way these amendments are interpreted poses significant issues for the way forward for health service improvement. Research information from AUSPRAC can provide an authoritative voice to challenge and to inform interpretation and policy development around these amendments.

The findings from a national survey of nurse practitioners found that the clinical service of over 70 per cent of nurse practitioners was extremely limited through lack of access to MBS and PBS.

These were nurse practitioner from the full range of service contexts. Yet under the conditions of the new legislation, eligibility criteria limits access to MBS and PBS to those nurse practitioners who work in primary health care.

This is supported by recent as yet unpublished data from AUSPRAC that indicates that the majority of nurse practitioners who work at the interface of hospital and community such as outpatient clinics and outreach programs are not working to the full capacity of their role. Examples of these include nurse practitioners who provide service for the aged and patients with chronic illness, mental illness, and palliative care needs.

Yet despite this evidence, most of these nurse practitioners will not meet the eligibility criteria and thus their patients will not benefit from current reforms aims at health service improvement.

The research findings also show that nurse practitioners whose practice is limited by these legislative restrictions are spending the majority of their time not in direct high level clinical care, for which they are employed, but rather are mostly engaged in indirect care and service related activities such as meetings, administration and documentation.

The AUSPRAC study has over the past three years been studying nurse practitioners and is producing comprehensive findings about all aspects of nurse practitioner work.

These findings have and will continue to provide governments, policy makers and peak nursing bodies with reliable data about the profile, process and outcome of nurse practitioner work.
Trends that are emerging through studying the rollout of nurse practitioner service in Australia are providing evidence that the nurse practitioner is a safe, autonomous, clinician with the potential to make a significant contribution to health service improvement through workforce reform.

Professor Glenn Gardner is one of the researchers on the Australian Nurse Practitioner Project (AUSPRAC), a world-first study that looks at the role of nurse practitioners within the broader health system. 

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