Elsevier

Collegian

Volume 20, Issue 1, March 2013, Pages 35-41
Collegian

How acceptable are primary health care nurse practitioners to Australian consumers?

https://doi.org/10.1016/j.colegn.2012.03.001Get rights and content

Summary

International evidence indicates that nurses working in primary care can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurse practitioners employed in primary health care perform some tasks previously exclusive to the GP role due to their advanced skills, knowledge and training. In November 2010 Medicare provider rights and Pharmaceutical Benefits Scheme rights were provided for nurse practitioners working in private practice, and in collaboration with a medical practitioner. However, there is limited evidence about how acceptable nurse practitioners are to Australian consumers and what knowledge consumers have of the nurse practitioner role in the delivery of primary health care. The aim of this study was to examine Australian health care consumers’ perceptions of nurse practitioners working in primary health care. This paper reports on the results of seven focus groups (n = 77 participants) conducted around Australia. Focus groups participants were asked how acceptable nurse practitioners are as provides of primary health care. Although there was some confusion about the role of nurse practitioners and how this role differed from other primary health care nurses, participants in the focus groups were very positive about nurse practitioners and would find them acceptable in providing primary health care.

Introduction

There is ‘abundant and consistent’ evidence that health systems with robust primary health care perform better across a range of indicators compared to systems without such a base (Starfield, Shi, & Macinko, 2005). Investment in services in primary health care results in healthier populations and lower overall costs for health care (Starfield, 2009). However, in many Western countries, including Australia, an ageing population and an increase in the prevalence of chronic conditions has presented a challenge to health services and policy makers in providing primary health care services, particularly when confronted with an ageing health workforce (Productivity Commission, 2005). Furthermore, some areas of Australia experience significant primary health care workforce shortages due to difficulties in attracting health professionals to rural and remote areas (Wakerman et al., 2006). There has also been an increasing trend towards the reduction of hours worked by general practitioners (GPs) and a feminisation of the general practice workforce has contributed to the trend of part-time work (Britt et al., 2009). In order to improve accessibility to primary health care, new models are being considered and introduced, which include advanced nursing roles.

It has been suggested that nurse practitioners would be appropriately qualified and experienced to undertake these advanced nursing roles in general practice. Nurse practitioners are registered nurses who can demonstrate that they practice at an advanced level which is complemented by research, education and management, and who have completed a tertiary qualification, namely a masters degree (Nursing & Midwifery Board of Australia, 2010). Advanced practice nursing, which forms the basis of the role of nurse practitioners, involves using extended and expanded skills, having experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the health care that is required. The role of nurse practitioner was designed to improve access and provide cost effective care, target at-risk populations and serve rural and remote communities and to mentor and provide clinical expertise to other health care professionals (Australian College of Nurse Practitioners, 2010). Furthermore, in November 2010, Medicare provider rights for nurse practitioners working in private practice and in collaboration with a medical practitioner were introduced in Australia. Pharmaceutical Benefits Scheme rights were also introduced for those nurse practitioners working in States and Territories who were signatories to the Pharmaceutical Reform Agreement. Therefore, nurse practitioners are now in a position to practise in the primary health care setting. Previous studies have indicated that nurse practitioners are capable of functioning autonomously and collaboratively in extended clinical roles within a multidisciplinary team (Allnutt et al., 2010, Gould et al., 2007, Wasylkiw et al., 2009, Wilson and Shifaza, 2008) and that patients are satisfied with nurse practitioner services (Agosta, 2009, Gagan, 2011, Halcomb et al., 2011, Knudtson, 2000).

Supporting this potential new role is the international evidence which suggests that nurses working in primary health care can provide effective care, achieve positive health outcomes for patients similar to that provided by doctors, and achieve good patient compliance (Keleher, Parker, Abdulwadud, & Francis, 2009). Nurse practitioners employed in primary health care perform some tasks which were previously exclusive to the GP role due to their advanced skills, knowledge and training (Gould et al., 2007, Laurant et al., 2004, Wasylkiw et al., 2009). This includes making autonomous decisions regarding minor acute illness and injury, and management of some diagnosed chronic conditions (Roblin, Becker, Adams, Howard, & Roberts, 2004). Studies have shown that nurse practitioners provide at least equal quality care to general practitioners (GPs) and yield higher satisfaction among patients with no differences in health outcomes (Baldwin et al., 1998, Lemley and Marks, 2009, Williams and Jones, 2006). Hence, primary health care nurses, when adequately trained, provide a feasible alternative in managing minor acute illness and injury and stable chronic conditions and may help provide a solution to the GP workforce shortage by working in under-serviced areas of primary care (Gould et al., 2007, Parker et al., 2009, Wasylkiw et al., 2009).

Despite the fact that the general practice nursing role is growing rapidly in Australia (Australian General Practice Network, 2010) very few nurse practitioners are employed in primary health care settings and there is limited evidence about how acceptable nurse practitioners are to Australian consumers and what knowledge consumers have of the nurse practitioner role in the delivery of primary health care. Australian studies have previously described the acceptability of the general practice nurse role by consumers and concluded that these nurses should enhance the role of the GP and not replace it (Cheek et al., 2002, Hegney et al., 2004). This is the first national study examining Australian health care consumers’ knowledge and opinions of the role and use of nurse practitioners in Australian primary health care. This study was conducted between July 2010 and February 2011. The aim of this study was to examine Australian health care consumers’ perceptions of nurse practitioners working in primary health care. This paper will report on the findings of seven focus groups on how acceptable nurse practitioners are to consumers as providers of primary health care.

Section snippets

Methods

Ethics approval was received from the Human Research Ethics Committee at The Australian National University (ANU) to conduct this project (protocol no. 2010/282). A reference group was appointed to oversee the project progress.

The Health Care Consumers’ Association of the ACT organised and facilitated the recruitment for the focus groups through their national network through various methods including email, newsletters, advertisements in some local newspapers and information provided through

Findings

There were more female participants than male and the majority of participants were aged over 61 years (Table 2). A range of concerns and perceptions were identified by consumers when discussing the acceptability of nurse practitioners as providers of primary health care. These included perceptions of the qualities of nurse practitioners and those of GPs but they also extended to cover issues of choice, questions of access, what kinds of things people thought nurse practitioners should do,

Discussion and conclusion

A limitation of this study is that health care consumer participants from the focus groups had very limited experience of receiving primary health care from nurse practitioners. However, this is likely to be due to the small number of nurse practitioners currently practising in Australia and a smaller subset who are based in primary health care. Nevertheless, this study found that Australian consumers were accepting of appropriately trained nurse practitioners as primary health care providers

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