Australia could do so much more with its nurse practitioners

The Australian health care system wastes the contribution of nurse practitioners. DIBP Images

Nurse practitioners provide a level of health services beyond that of registered nurses. They diagnose and treat health conditions, order and interpret blood and radiology tests, and prescribe medications.

In some countries, these high-level skills are an integral part of the health-care system. In Australia, they could be too - if only the nurse practitioner career path were less problematic.

Employers complain that new graduates are not ready to function autonomously. And newly qualified nurse practitioners struggle to get their employers to value their contribution to health services.

Many nurse practitioners continue working in their previous nursing roles because their employers cannot or choose not to create new roles for them - and there’s never enough funding.

An unworkable model

Nurse practitioners are at the highest level of the Australian nursing hierarchy. Aside from a small number of remote area nurses who were “grandfathered” into the role when it was in its infancy, the vast majority of nurse practitioners worked their way up a traditional career path.

They progressed through the ranks, from registered nurse to the promotional roles of clinical nurse, clinical nurse specialist, or clinical nurse consultant. This often decades-long process required the nurse to stay in one area of specialty, and in some cases, in the same ward, for many years.

It’s now clear, a decade after the first nurse practitioners graduated, that this model is unworkable.

Nurse practitioners who practice in subspecialities find it difficult or impossible to move into other specialties; most simply have no option to transfer their employment without starting over at the bottom of the heap.

At the same time, young, hardworking and academically talented nurses are not admitted to university nurse practitioner courses simply because they haven’t reached a certain level on the pay scale (as if their career progression were completely under their control).

Nurse practitioner students in university courses wonder if it’s worth it. They can be denied endorsement by the Australian Health Practitioner Regulation Agency simply because they can’t meet a subjective definition of “advanced practice”, which is based on their current employment, even after completing a master’s level course.

With this level of frustration and dysfunction among nurse practitioners, students, aspiring nurse practitioners, educators, regulators and employers, it’s hard to defend the status quo.

Moving forward

The system needs to change in dramatic and fundamental ways.

University-based nurse practitioner courses should be centred around a broad knowledge base that would allow nurse practitioners to be primary care providers.

They may undertake further training to specialise, but the primary care door would never close. This means that all nurse practitioners would be able to transfer among different jobs, bringing their expertise to meet health needs wherever they may be.

Younger nurses should be allowed to choose the nurse practitioner role early in their careers; they shouldn’t be forced to the sidelines based on a subjective hierarchy. Their youth would allow them to provide nurse practitioner-level care for a few decades longer than the original cohort.

And regulatory and accrediting agencies must abandon their emphasis on subjective interpretations of advanced practice. What’s the use of having a university course for nurse practitioners, if endorsement depends on the applicant’s current rung on the employment ladder?

Accreditors should value nurse practitioner courses that provide more clinical hours and rigorous primary care content. A qualification exam could also enforce a minimum level of general knowledge and competence required to practice safely as a nurse practitioner.

To make these changes would be no small undertaking.

In my role as a lecturer and nurse practitioner course coordinator, I emphasise to students that the role is about meeting the health needs of Australians, not about meeting their needs for career progression or status.

But the current system doesn’t work for nurse practitioners or the people who need their care.

Many nurse practitioner students want to transition to a primary care model. To do this, they need the support of employers, education providers, accreditors, regulators, and the trailblazing nurse practitioners who came before them.