by ACN Policy Team
ACN is committed to representing the knowledge and expertise of our Members in policy development throughout the Australian health and aged care system. In this series we want to share what ACN is doing in the policy space with our Members and followers and how your contributions shape our messages to the many consultations that we get involved in.
ACN responds to as many opportunities as possible to give nurses a voice on health policy and regulatory arrangements. This includes having influence on administrative matters such as providing feedback on proposed amendments to the Application for a Medicare provider number and/or Pharmaceutical Benefits Scheme prescriber number for a midwife or nurse practitioner form. ACN coordinated comments received from our Nurse Practitioner (NP) members on the proposed amendments to flag areas for improvement with the Australian Government Department of Health.
We also took the opportunity to reiterate our position in relation to collaborative arrangements stating that no other profession is obliged to have such an arrangement and equally there is no need to specify NP collaborative practice in law. We stressed that many NPs continue to challenge the need for collaborative arrangements where access to Medicare benefits is required for their services, pointing out that the collaboration requirement is contradictory in several ways:
- NPs working in public hospitals work in collaborative arrangements yet are unable to access Medicare despite having a collaborative arrangement due to funding arrangements between state and federal health sectors, nor are they able to access provider numbers in many cases.
- NPs may see clients for a wide range of concerns, as do many other specialist nurses (e.g. Clinical Nurse Consultants, GP Practice Nurses, continence or other specialist nurses) and there is no requirement for other specialist nurses to collaborate and not all client concerns warrant escalation or collaboration with a medical practitioner.
- Medical Practitioners frequently do not understand the need for collaboration, especially on concerns that they would be expecting the NP to manage where it is considered a ‘nursing’ issue. In most cases, services receive client referrals from general practitioners (GPs) as they require NP input, and it is confusing to GPs to then receive requests for collaboration. NPs are capable of determining need for and seeking collaboration or referral for each client episode on an as needed basis, just as GPs or other healthcare professionals – for example physiotherapists – do in their day to day practice.
- NPs are effective at communicating about client assessment, management plans, treatment adjustments and client education and communication is integral to NP practice where there is multidisciplinary input or other healthcare specialists involved in their ongoing care.
Overall, our NP members supported the proposed amendments seeing the changes as positive process improvements and pointed to additional revisions and content modifications. In offering this feedback to the Department, ACN stressed that NPs are autonomous practitioners who work collaboratively in the multi-disciplinary team with other autonomous health practitioners. Therefore, moving forward, regulatory arrangements must not pose a barrier to the utilisation of the NP role.
Please contact the ACN Policy team for more information on Policy@acn.edu.au
This is truly helpful, thanks.
Legislation and regulatory states that NPs practice are legislatively protected to be autonomous with advanced clinical skills, authority to prescribe, order and interpret diagnostic tests and refer patients to other specialists should it be required. Mandated collaborative arrangements undermine NPs capability and scope of practice and it is a backward view of what AUTONOMY should be. Interprofessional collaboration is a necessity in our practice, whether a nurse, medical practitioner or allied health care provider. It should not be mandated and NPs should be free to perform to their full extent of their scope of practice.
The hierarchical method of medicine and the historical doctor-nurse relationship where the doctor makes all decisions is not always the right way to go. It is not about hierarchy, ego or stepping on someone’s toe. Collaboration aims to improve patient care and that includes access to comprehensive health care and NPs are more than capable of doing that. The reality is that there is a shortage of physicians to meet the demands of our ageing population with increasing health care needs. Let’s put these patients on top of our list. We are not the USA, but the NPs in the USA have bridges the gap in access to care for so many diverse communities.