Nurse practitioners make a difference

FRANK had almost reached his corner shop, 50 metres from home, when he became breathless. Luckily he had the mobile number of his primary care clinician, James, in his pocket.

He rang the number and within hours he was back home stabilised and feeling reassured that he wasn't going to die. Over the next few days he was monitored by the same consultant who had saved his life a few short days before.

Before James came into his life, Frank's life was one of see-sawing between hospital and home, feeling sick most of the time and often helpless. James not only maintains him in a stable condition but has helped him understand and manage his disease. Frank once again has a satisfying and fulfilling life.

James McVeigh is a nurse practitioner and Frank is one of many patients he works with to ensure he is safe and comfortable in his home, rather than breathless and terrified in an emergency department.

James doesn't see what he does as any different to what any expert health practitioner would do in the circumstance. He has undertaken years of graduate study, keeps up-to-date by reading the latest research in professional journals, has international experience in managing people with chronic cardiac conditions, and is an expert lecturer and superb communicator. Yesterday, he was working with a local GP stabilising someone with severe heart failure and advising the GP on the latest medication management of the condition.

Yet, the Australian Medical Association claims that practitioners such as James will "dumb down the system". A recent issue of Australian Doctor magazine expanded on this theme through Dr Rod Pearce, the chairman of the AMA council of general practice, with a piece titled "Hands off general practice", warning pharmacists, physiotherapists and nurses to stay away from primary healthcare. "GPs," Dr Pearce noted, "are not moving over, because others will not achieve the same good outcomes for their patients, will take more time and effort to achieve the same results and will set back the primary care agenda more than a decade."

The reality is that James, and others like him, have no interest in taking over the GP's role, or anyone else's for that matter. They want to work with their healthcare colleagues in a team approach with the patient and family, identifying the most appropriate and effective care for the person in need.

As James puts it: "I certainly work in consultation with GPs and specialists when suggesting management plans for better outcomes. Why wouldn't I?"

And while some GPs continue to see primary healthcare as their sole preserve, it's important to see this has never been the reality across the board. Isolated communities have always relied on the community nurse and the bush nurse before, for consultation, assessment, diagnosis and referral. And midwives have played an important role in managing pregnancy and birth in Australia for many years now.

The present midwifery led birthing centre at Ryde Hospital stands as a fine example of what is possible with community partnership, interdisciplinary leadership and commitment from all levels of bureaucracy.

Opposition to nurse practitioners is rooted in a belief that the structure of the current healthcare workforce is the only blueprint for good care. It's a view which assumes a static population of patients and illness. In fact, we are living through a time of rapid change not only within society but across our professional boundaries. Our healthcare future is not a mirror of the past.

Demographic predictions show us that the bulk of new patients will be over 50 and will have complex conditions which need life-long management. Primary and preventive healthcare will be the areas of greatest demand. And unless we invest in these areas, our already strained hospitals will be stretched to breaking point.

Meeting the needs of these patients is not just a matter of making sure we have enough primary health care practitioners. It's about ensuring that we have a flexible workforce committed to working together and engaging in ongoing education and professional development. After all, we know that every year 7 per cent of our knowledge is renewed, so no health practitioner can afford to rely solely on the knowledge learned in an undergraduate course.

Rather than getting hung up on traditional roles, we need to be thinking about how to tap into the skills and experience of practitioners across healthcare and make sure they are being used to maximum advantage in the maximum areas of need.

In economic terms alone, the evidence is growing that the benefits of a team approach are undeniable. In one recent study a nurse practitioner reduced her patients' readmissions to hospital to just 11 per cent, compared to an average readmission rate for patients with heart failure of between 30-50 per cent.

In social terms the value of enabling people to manage chronic conditions and live independent lives is immeasurable. And nurse practitioners like James will be an increasingly critical part of making that happen in a system where overworked GPs no longer make house calls and five-minute consultations are too often the norm.

Professor Lumby is executive director of The College of Nursing.

Article from www.theaustralian.news.com.au