Liability and collaborative arrangements for nurse practitioner practice in Australia

Abstract

The purpose of this paper is to clarify the relationship between medical practitioners (MPs) and nurse practitioners (NPs) in general, and privately practising NPs (PPNPs) in particular, in relation to collaboration, control and supervision in Australia, as well as to explore the difficulties reported by PPNPs in establishing mandated collaborative arrangements with MPs in Australia. In order for the PPNPs to have access to the Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) in Australia, they are required, by law, to establish a collaborative arrangement with an MP or an entity that employs MPs. This paper begins by describing the history of and requirements for collaborative arrangements, then outlines the nature of successful collaboration and the reported difficulties. It goes on to address some of the commonly held misconceptions in order to allay medical concerns and enable less restrictive access to the MBS and PBS for PPNPs. This, in turn, would improve patient access to highly specialised and expert PPNP care. What is known about the topic? NPs have been part of the Australian health workforce since 1998, but until 2009 their patients did not receive any reimbursement for care delivered by PPNPs. In 2009, the Federal government introduced limited access for PPNPs to the MBS and PBS, but only if they entered into a collaborative arrangement with either an MP or an entity that employs MPs. What does this paper add? The introduction of collaborative arrangements between PPNPs and MPs seems, in some instances, to have created confusion and misunderstanding about the way in which these collaborative arrangements are to operate. This paper provides clarification of the relationship between MPs and NPs in general, and PPNPs in particular, in relation to collaboration, control and supervision. What are the implications for practitioners? A clearer understanding of these issues will hopefully enable greater collegial generosity and improve access to patient care through innovative models of service delivery using NPs and PPNPs.

Predictive factors of the general public’s willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey

“…In Australia, few NPs are employed in primary care and community settings [ 12 , 17 ], and this fact provides context as to why only half of the participants had heard of the NP. Regardless of this limited awareness, no differences observed between respondents with a prior experience of accessing consultations with NPs and those without.…”

“…These schemes ensure the NP can receive remuneration for specific services on the Schedule list [ 10 , 57 ]. While NPs eligibly for MBS and PBS have facilitated the growth of independent (private) NP services the, restrictive nature of the MBS items is counterproductive, limiting the level of remuneration available, increasing the cost of NP service, and ultimately the general public’s acceptance of and utilisation of NP services [ 12 , 17 , 59 , 60 ]. The design of the MBS and PBS and the mandate that NPs must establish collaborative arrangement with an MD or an establishment that employs MDs [ 17 ] are significant barriers to NP providing complete episodes of care, reducing their capacity to function autonomously [ 12 ].…”

“…The NP is a registered nurse with additional qualifications, authorised to integrate advanced nursing and medical clinical skills, to independently assess, diagnose, prescribe medications, and manage patients within an agreed scope of practice [ 9 ]. While the title protection, regulation, qualifications and scope of practice of the NP role differs across countries [ 9 ], in Australia, to be endorsed as an NP, the registered nurse candidate must hold a Master’s degree and 5000 h or 3 year full-time specialised clinical experience [ 12 – 17 ]. The scope of the Australian NP practice includes: managing patient episodes of care, initiation and interpretation of diagnostic and pathology investigations, endorsement to prescribe medications, patient education and health promotion, admission and discharge rights and referrals for specific patient groups [ 10 , 11 , 18 – 21 ].…”

“…The scope of the Australian NP practice includes: managing patient episodes of care, initiation and interpretation of diagnostic and pathology investigations, endorsement to prescribe medications, patient education and health promotion, admission and discharge rights and referrals for specific patient groups [ 10 , 11 , 18 – 21 ]. As increasingly more NPs are getting established in the Australian public sector workforce [ 17 , 22 ] and to a lesser extent in the private, community and primary care settings [ 12 ], the question as to what patients want continues to emerge [ 23 ].…”

“…In Australia, the NP role has only been in place for a relatively short period, achieving legislated title protection in 1998 [ 19 ] with current estimate of 1745 endorsed practitioners nationally [ 17 ]. Given this nascence, it is fair to assume that the public are not familiar with NP role and scope of practice.…”