Mary Chiarella. Luke Foley – Nurse-led clinics and primary health care.

Feb 18, 2015

In 2011 I gave the last Oration for what was originally the NSW College of Nursing in the Great Hall of Sydney University. In it I advocated for nurses to be able to work to full scope of practice, particularly in the area of primary and preventive health care, in order to alleviate demands on our overstretched hospital systems. Given we currently have a significant oversupply of nurses in this country, especially in our new graduate population, this seems like an excellent time to deploy nurses into some of these roles, long overdue in Australia but commonplace in other parts of the world. . The first ever NSW College of Nursing Oration was given on the 15th September 1953 by M.I. Lambie, who was not only the first Orator for the College, but the first woman to give an Oration in the Great Hall of Australia’s oldest university. Miss Lambie was the New Zealand Nursing Adviser to the World Health Organisation (WHO) and Chair of the Expert Nursing Committee of WHO. Let me read to you her introductory words as she talks of the problems in health care in the developed world:

These facts have caused increasing demands on hospitals; the rapid turnover in surgical beds together with the larger numbers of elderly and chronic patients has forced consideration to be given to the whole problem of hospitalisation by many authorities. The increased use of hospitals means automatically more staff or the better use of existing staff”[1]. 

Plus ca change, plus la meme chose. She goes on to advocate for the growth in primary health care that is occurring in developing countries “putting more emphasis on the preventive aspect, which in turn will set an example to many of the older countries”. Well sadly not much yet, Miss Lambie, not much yet. I’m afraid the people you were advising didn’t take your excellent advice. Lots of us have been there.

She goes on to say

These are examples whereby preventive means, home education and treatment have reduced the demands for hospital beds. In fact it would not have been possible to treat in this mass way in an institution. The education of the home for this kind of treatment means, however, the preparation of a worker to carry out the program. Funnily we speak of this NEW approach to medicine, and yet in her Notes on Nursing, Florence Nightingale speaks of “the need to nurse the home as well as the family[2]. 

So we come full circle in what is needed for health care in Australia, advocated by Florence Nightingale in the 19th century, advocated by the first NSW College of Nursing Orator, Miss Lambie in the 20th century, and advocated in the 21st century by the (then) Australian Nursing Federation[3]. Let us hope, in the promises of Luke Foley to introduce four nurse-led clinics in NSW should Labor win the next election, that the wise words of our nursing forebears do not have to wait another 62 years before somebody decides to act on them. This is so obvious a solution that one wonders why it is not commonplace, rather than tentative.

Mary Chiarella is Professor of Nursing, Sydney Nursing School, University of Sydney.

[1] Lambie IM (1953) First Annual Oration The changing scene in health work throughout the world in The 50th Anniversary Annual Orations Vol I NSW College of Nursing: Sydney, p.9

[2]  Ibid, p.10

[3] Australian Nursing Federation (2009) Primary health care in Australia: a nursing and midwifery consensus view ANF: Canberra

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