It’s high time to let PHC nurses show what they can do

Government, Health, Politics, Top 5

It’s high time to let PHC nurses show what they can do

Aug 31, 2023

Australia’s primary health care (PHC) nurses are one of our health system’s biggest assets – but they aren’t working to their full potential. A recent APNA survey tells us that despite the widespread under-utilisation of PHC nurses, recent progress in using nurses effectively has virtually stalled.

If we can’t get more of our nurses working to their full scope of practice, PHC runs the risk of losing nurses to other, higher areas of health care that will use their skills. This is a critical issue at a time when PHC already faces nurse shortages.

The APNA Workforce Survey has provided a comprehensive picture of the working conditions and professional concerns of PHC nurses across Australia for more than 15 years. It is the only national survey focusing exclusively on nurses who work in primary health care. In 2022 we saw more than 4000 responses, the biggest response ever.

The 2022 Workforce Survey has given us many unique insights about the PHC nurse cohort – one of its strongest signals is that progress in improving PHC nurse utilisation has almost stopped. According to the survey, one in three (33%) of all PHC nurses were not utilised often or most of the time during the previous 12 months. This is a drop of less than 2% from the previous year.

It was a different story during the COVID-19 pandemic. At the start of the pandemic, almost 45% of all PHC nurses reported being underutilised. However, between 2019 and 2021 we saw a fall of more than 11% to 35%. It took a multi-year global pandemic to shift the dial and see PHC underutilisation rates drop.

Despite this fall, underutilisation rates are still significant. If a pandemic won’t give all PHC nurses a chance to work to full scope of practice, then what will? Underutilisation has been reported across the whole range of PHC workplaces, from general practice to aged care. In general practice nurses are prevented from working independently to their full scope of practice by outdated Medicare billing protocols which require that a doctor be present for Medicare to be charged for the care provided.

Not every patient needs to see a doctor every time they visit a practice. Many patients can and are managed by the nurse for chronic disease, lifestyle and preventative care, immunisations, dressings and care coordination. However, under the current system, the doctor needs to provide a “tick off” so that Medicare Benefits Schedule billing can occur.

Ironically, in aged care, it’s the shortage of qualified nurses that prevents them working to their full scope of practice. This shortage means that skilled aged care nurses are run off their feet ensuring high priority issues, such as medications, behaviour management, and wound management services, are provided, and do not have the opportunity to provide person-centered care. For example, a single nurse will have oversight of dozens of residents requiring well-being checks, medications, skin care assessments as well providing support and supervision of personal care workers.

If nurses in aged care had the time and resources to provide advanced levels of care individualised to the needs of each resident, this would help improve the overall health of their patients and reduce the burden on the health system.

This waste of nursing skill, knowledge and enthusiasm occurs at all stages of a nurse’s career, regardless of their experience. Nurses are often treated the same way no matter how experienced they are.

This underutilisation of nurse skills represents a poor return on investment given their level of training and experience and is a significant lost opportunity for the Australian health system, patients, employers, and for nurses.

To be frank, we simply can’t afford to have highly skilled, experienced and motivated PHC nurses sitting underutilised when there is so much more they could be doing, including cardiovascular education and management, vaccinations, wound care and primary health care screening.

PHC nurses account for around one in seven of the 640,000 registered health professionals in Australia. It is critical that this group be empowered to do more to create a healthier Australia as we return our focus to the challenges of an ageing population and rising rates of chronic disease.

We are already facing a looming shortage of nurses in all fields; the Federal Health Department projects a shortage of 85,000 nurses by 2025 and 123,000 nurses in Australia by 2030. In addition, the Albanese Government’s commitment for registered nurses available 24/7 in aged care facilities by July 2023 will require an additional 14,000 nurses. We need to be smarter about how we use the PHC nurses, both registered nurses and enrolled nurses, that we do have.

The Albanese Government’s talk of Medicare reforms around a multidisciplinary model of care may help to improve PHC nurse utilisation. We’ve seen some good initial moves in this regard, but nurses need more workplace reforms so that the entire health system can enjoy the benefits of PHC nurses working to full scope of practice.

PHC nurses are ready, willing and able to do more. They are highly motivated, highly educated and highly experienced. We call on Federal Health Minister Mark Butler to support them with a firm commitment for full scope of practice and allow them to help reduce the pressure on the health system.