Cardiovascular disease management: time to advance the practice nurse role?

Halcomb, Elizabeth; Davidson, Patricia M.; Griffiths, Rhonda; Daly, John

doi:10.1071/ah080044

Cited by 89 publications

(66 citation statements)

References 30 publications

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“…This acknowledges the environment and culture of each individual practice in its influence on advanced and extended practice. Structural determinants such as legal implications are also supported by other literature [8,9] . In particular Phillips et al, [6] point out that the balance of power and notions of 'proper' hierarchical relationships between the nurses and doctors affects the ability of nurses to extend their practice in relation to decision making in patient care, task or responsibility delegation and overall autonomy.…”

Section: Literature Reviewsupporting

confidence: 66%

Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Francis¹,

Anderson²,

Mills³

et al. 2013

Clinical Nursing Studies

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Rural Australians have poorer access to health services than Australians living in metropolitan areas primarily because of shortages in the health professional workforce. Nurses taking on advanced skills could help this situation by relieving doctors but our understanding of the factors that enhance or inhibit uptake is poorly understood in rural areas of Australia.The aim of this study is to identify the barriers and enablers associated with the implementation of advanced nursing roles in rural general practice specifically although an urban general practice was included to ensure that the diversity of practices were represented. The selection of general practices was based on (1). a standardised classification system that uses geographic location and population base as the key criterion and (2). ease of access for the research team. The general practices were all located within 3 hours drive of the researchers' home base. Using case study design four rural and one metropolitan located general practices were included. The researchers compared recorded nursing activities with job descriptions, educational opportunities and advanced competency standards. Interviews with practice principals, practice managers and nurses were undertaken. Findings are categorised as: personal which includes motivation, knowledge and time; workplace which includes status, guidelines and practice conventions and routines; and policy which includes national payment systems, and scope of practice. The potential for nurses to advance their practice and meet the needs of patients, particularly in the specialist areas of chronic care and health promotion, is still under developed in the rural practices. The findings have led to the development of a framework for the introduction of advancing practice roles for nurses that will meet the needs of a currently, under-served community.

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Section: Literature Reviewsupporting

confidence: 66%

Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Francis¹,

Anderson²,

Mills³

et al. 2013

Clinical Nursing Studies

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show abstract

“…To date, a major barrier to developing the practice nurse role in chronic disease management has been the Australian funding model for services provided by practice nurses (Halcomb, 2008;Halcomb, Davidson, Griffiths & Daly, 2008;Halcomb, Davidson, Salamonson & Ollerton, 2008). Many general practices operate within a small business model, either with solo or small groups of general practitioners (GPs) and practice staff.…”

Section: Introductionmentioning

confidence: 99%

Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers

2010

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The Australian health care system is currently in a state of reform and there is increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting. In particular, item number 10997 was introduced to reimburse practice nurses and Aboriginal health workers (AHWs) for providing monitoring and support to people with a chronic disease for and on behalf of a general practitioner (GP). The uptake of Medicare Item 100997 from 2007 to 2009, to monitor chronic disease interventions provided by general practice nurses has increased dramatically. The rate of uptake of Item 100997 has not been consistent across States and Territories, even allowing for population distributions. Exploring reasons for these regional variations and linking uptake of Medicare Item numbers to patient outcomes is important in developing the nursing role in Australian general practice. ABSTRACTThe Australian health care system is currently in a state of reform and an increasing pressure to provide care in community settings. Rising costs, demands and population ageing underscore the importance of adopting models of health care delivery to address changing epidemiological patterns. Population ageing and the increase of chronic conditions challenge models based on acute care models. Changes to the Medicare benefits schedule have facilitated the development of a range of expanded nursing services in the general practice setting.

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“…Expansion of the PN role can sometimes be challenged by the small business nature of Australian general practice mixed with the GPs' attitudes and perceptions towards the hierarchal roles between doctors and nurses (Halcomb, Patterson, & Davidson, 2006;Phillips et al, 2007;Phillips, et al, 2008). Some barriers to utilising PNs that have been identified in the literature include a lack of training, poor GP understanding of nursing roles, liability concerns, billing structure within the practice, lack of professional nursing standards, PN employment costs, part time or casual employment and lack of space (Gibson & Heartfield, 2005;Halcomb, Davidson, Griffiths, & Daly, 2008;Phillips, et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Culturally and linguistically diverse general practitioners’ utilisation of practice nurses

et al. 2013

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Cardiovascular disease management: time to advance the practice nurse role?

Cited by 89 publications

References 30 publications

Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers

Culturally and linguistically diverse general practitioners’ utilisation of practice nurses

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