6 May 1999

NSW Nurse Practitioners get new powers

Nurses in some areas of NSW are now allowed to make diagnoses, prescribe medicines, order diagnostic tests such as x-rays and perform some surgical procedures. The NSW government has left open the possibility of more nurse practitioners where rural communities can prove a lack of doctors is restricting basic health care.

Under the NSW program, 40 nurses have received training and will be paid more for their additional skills and duties.

The QNU is actively campaigning for the nurse practitioner role to be recognised in Queensland, particularly given the decentralised nature of the state.

In many small communities, nurses are the only health professionals and already provide a wide range of services to their communities. Nurses in remote areas must deal with situations presented to them. In many communities, even emergency medical help can be many hours away.

Nurses already provide the bulk of health care in rural and remote Queensland and it is important they are provided with the legislative and professional framework to do an even better job.

The QNU was successful in 1996 in securing amendments to the Health (Drugs and Poisons) Regulations acknowledging the role of nurses in dispensing medication in isolated areas, however, we maintain that this needs to go further. Discussions have commenced with Queensland Health on the best way of implementing this role for nurses in Queensland.

One of the major issues to be addressed is the training that needs to be provided to support this role. Training should not just be 'front end', that is, it should not simply be provided before a nurse takes up a nurse practitioner role, but should also include on-going professional development. This professional development need has to be specifically budgeted for as the remote and isolated nature of many communities also means training can only be done outside the community. Costs, such as for travel and accommodation and for adequate relief staff, need to be factored into this budgeting process.

Doctors, through the Australian Medical Association and the Rural Doctors Association, have opposed the role of nurse practitioner by pointing out that it has only been introduced where primary health care is inadequate.

This is exactly the point! It would be ideal to provide full-time access to a general practitioner to every Australian community and every Australian. However, the reality is somewhat different. Not only have there been on-going difficulties in attracting GPs to many rural and remote areas, many communities themselves do not have the population to support the full-time presence of a doctor.

It is important also to recognise that it is not the intention of such a scheme to replace doctors. The procedures and services that nurse practitioners provide are restricted and can only be put in place with adequate expenditure on training and where it has otherwise proved impractical to provide appropriate doctor coverage.

Despite opposition from doctors, the support for nurse practitioners has been high as evidenced by newspaper editorials and letters to the editor from both nurses and the public. A recent editorial in the 'Courier Mail', commenting on opposition to the proposal by the Rural Doctors Association of Queensland President, Dr Tony Balston, stated:

" It is somewhat ironic that such opposition should come from a member of a profession that has been singularly unable - or unwilling - to provide medical care for so many remote communities. There would be more sympathy for Doctor Balston's cause if more doctors were to show the same selflessness demonstrated by remote area nurses." (Courier Mail, 25-8-98, Editorial, P 14).

Supporters of such a scheme include the Queensland Centre for Public Health, which has indicated that such a scheme would be extremely beneficial in areas where there is a shortage of GPs.

Many nursing academics also support such a scheme. The QNU is concerned to see that any such scheme in Queensland is properly implemented and resourced, and we will be ensuring that this is the case before any proposal is put into practice. Members will be kept up to date on the progress of this exciting initiative.