Australian Nurse Practitioners at an Impasse

Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review

“…44 Whilst there is limited evidence of support for NPs by some individual doctors, recent policy statements from medical organisations such as the Royal Australian College of General Practitioners (RACGP) in relation to the NP 10 Year Plan 19 indicate that medical professionals' resistance to the further development of the NP role persists, with the RACGP raising concerns about the Plan and contending that the proposal will result in "fragmented care". 45,46 Whilst the initial vision for NPs was to improve rural and remote populations' access to health care services, the findings of this review highlight that innovative practice opportunities driven by passionate NPs responding to identified unmet need in their communities are significant enabling factors. 8,20,29,34,42 In addition, a commitment to providing equitable care, rather than 'one-size fits-all' service led initiatives initiated by health services, are key components of service delivery, as are organisational structures that have sound succession planning and opportunities for ongoing professional development 29,33,34,39,41,42 A similar finding of inconsistent development and implementation of the NP workforce has been reported in New Zealand, with ad hoc NP-led services being initiated by individual RNs and innovative service leaders, rather than through strategic workforce planning that recognises and responds to community-level needs.…”

“…Although several small reports in this review evaluated the impact of NP models of care on, for example patient outcomes, health care utilisation and staff and/or patient satisfaction, 14,33,36,39 there is a recognised need by NPs, researchers and government (federal and local) for more robust evaluation research demonstrating the contribution and value of the NP role in the primary health care context. 14,40,45,46 Insecure and short-term funding for NPs also impedes the ability to evaluate the longer term impacts of NP models of care, on improved patient outcomes, access to primary health care and financial sustainability. 49 It is important to note that in a role that is primarily 'clinical' with limited if any support for undertaking the research required this is a particularly difficult undertaking.…”