PROFESSIONAL ISSUES IN NURSING – CLINICAL EFFECTIVENESS
INTRODUCTION
Fifty-eight million Americans are not listed in any insurance coverage. Only 25% of the total American Population is reported to have insurance coverage in healthcare. Given with no other option, majority of the Americans rely on the services given by primary care.
While the US Congress continues on debating about a universal type of health insurance, more and more people are seeking the assistance of primary care services.
With only 25% of the graduates of medical degrees select the primary care specialty, such as family care, pediatrics, general internal medicine, and obstetrics and gynecology, nurse practitioners become a need to employ to fill the growing demand for primary care workers. (Defining, 2007)
Because of the high demand for health workers, approximately 60% of general practices now hire a minimum of one practice nurse. Some reviews show that practice nursing are able to attain good health outcomes however, very little of the studies show that it does. Australian government supports the widening employment of practice nursing but it is not based on effectiveness of practice nurses. Australian practice nursing has a deficiency in foundation and academic framework to practice the nurse’s skill and knowledge. Australia is spending a substantial amount of money to sustain the practice nurses in order to address the problem of healthcare shortage. (Practice, 2007) However, the effectiveness of the practice nursing is still an ambiguous concept. The question on to what extent were they able to provide effective results to patients remains a concern for the patients and the healthcare in general.
This study will analyze the effectiveness of practice nurses to general practice and to patients as well. This will define the roles and activities a practice nurse play in the healthcare system and how it is viewed by the patients. This study will also check the rates of practice nurses in relation to the licensed nurses, to be able to find out how they were able to fill the high demands of nurses in Australia.
This study will be beneficial to countries who are in demand of healthcare workers and are looking for alternative to fill in the need of nurses.
DISCUSSION
“The term ‘practice nurse’ is generally applied to qualified nurses who are employed by medical general practices.” (Research, 2007) The typical day to day task of a practice nurse is to provide advice during consultations and information on wide health conditions and simple illness. They can also refer to other practice team if situation demands. Practice nurses also perform investigatory experiments, simple surgeries, conduct registration of checks, managing and maintaining the clinics surroundings for illnesses like asthma, diabetes, skin disorders and for healthy men and women. Practice nurses also prescribe contraceptives and give advices on suitable contraceptive devices. They can also do cervical smear and pregnancy tests. They can take blood samples, other specimens and swabs. They maintain the routine tasks such as ear syringing, washing of the eyes, application and removal of dressings, wound treatments and alike. They are the ones who offer specialists and specialists’ information, advices in blood pressures, control of weight gain, cessation from smoking and heart conditions. Practice nurses are also in charge of infant vaccinations and injections. If needed, they are the ones who travel to facilitate immunizations and offer health care advices.
Moreover, they offer first aid offering first aid and emergency treatment. They provide advices to patients with regards to their continuous medical treatments needed. taking accurate and legible notes of all consultations and treatments and recording these in patients’ notes; They update the database with regards to the details of the patients. Practice nurses are also responsible to communicate with other general practices and office staff. (Job, 2007)
Practice nurses target population are children and adolescents with regards to their development to adulthood. They observe the child’s normal or abnormal development, cognitive, psychological, and social behavior. The anatomical development of the child is also included. They are also responsible the same for women and infants and the elderly. (Job, 2007)
Practice nursing in Australia has filled the role of nurses whenever they are unable to accommodate their shifts. Through them, nurses are more able to accommodate family appointments and more serious illnesses. (Research, 2007)
However, there has been a very little appreciation to practice nurses when it comes to their skills or knowledge. It is for the main reason that practice nurses have no formal education to support nurses in an Australian setting. There was a also a period when scholars speculated that practice nurses will diminish the quality of health care or is detrimental to the nurses’ profession since they lack skills and knowledge. (Research, 2007)
One of the factors that might have caused the little recognition to Practice Nurses is the lack of information regarding them in Australia. Australia has well established and ample sources of information for healthcare practitioners. Even though the importance of practice nurses has long been recognized, the information regarding practice nurses are still lacking for effective evaluation. (Practice, 2007)
Data about the activity of practice nurses are also inadequate. The collections done by the health institutions dwell so much on the GPs and provides only a small percentage for the roles and functions of practice nurses. (Practice, 2007)
According to a review article, those speculations seriously underestimate the role of nurses in the health system. Most of the practice nurses activities such as “Health Assessments, Practice Incentive Payments [PIPs] and GP Management Plans; services not claimed on Medicare; and other functions of practice nurses, such as clinical organization, practice administration, and integration.” (Practice, 2007)
However, this speculation of practice nurses in general altered because of the pressing concern of shortage of health workers. In United Kingdom, practice nurses are now deemed essential to their healthcare. (Research, 2007)
General practice nursing has been considered as a nursing specialty since 1970 in New Zealand and 1966 in United Kingdom. (Research, 2007) British research in 1970 stated that practice nurses can take over 25 to 70 percent of their workloads, specially in the areas of health promotion and routine management of chronic diseases such as diabetes, asthma and heart diseases. (Research, 2007)
There were 25000 practice nurses employed in United Kingdom by the year 2003. The purpose of each practice nurse is to assume that the rejected responsibilities of the general practitioners. (Research, 2007)
A study made by Royal Austrian College of General Practitioners (RACGP) and the Royal College of Nursing Australia made in 2004, found out that General Practice nurses in Australia are mostly registered nurses who are employed as part-timers in a bigger general practices. Most of them have experiences working in general practices, thus, they already have specific education in general practice. (Research, 2007)
In 2002, a University of South Australia made a research regarding practice nurses. They concluded that practice nurses are generally unaware of the role of the nurses. However, the patient’s understanding of the nurses care is parallel to “sickness care” , similar to a system that they can access whenever they need are in pain or is suffering from a disease. In this view, patients see nurses as competent assistants of doctors and not just practice nurses. Patients trust to practice nurses is never affected since they are generally not informed about the levels of nursing qualifications, registrations and specialty. However, patients are firm that nurses should not add costs to the doctor’s services to them. (Practice, 2007)
The Australian Government is one of the primary movers in the employment of nurses in general practice. The government committed in providing funds to practice nurses of 104.3 million dollars in 2001-2005 and another 129.7 million dollars in 2005-2009. Majority of the funding is allocated to Practice Incentives Program (PIP) for funds of practices in rural areas which are in need of practical nurses. (Australian, 2006)
The practices of Australian Practice Nurses have come to a critical point. Despite the importance of the Practice Nurses in most of the Healthcare Systems in United Kingdom and New Zealand, the vitality of the practice nurses in Australia is less defined. Practice nurses will be in limelight soon for clinicians, politicians and researchers because of the growing need of healthcare worker and increasing need for multidisciplinary care. (Evolution, 2006) Australian practice nurses need to strengthen their roles and their importance in the Australian context.
In order to improve the Australian practice, nurses need to take the lead in strategic planning for this type of specialty. Nurses should take the leadership in making research both academic and policy perspective. Clinical leaders should encourage and drive the practice nurses to deliver a primary care, which is can not be underestimated. (Evolution, 2006)
A study made by general practice concluded that patients were likewise satisfied with both doctors and nurses. However, they are significantly more satisfied with their consultations with nurses.
The study shows a 78.6 score of satisfaction for nurses while satisfaction for doctors only shows a 76.4 satisfaction. This is because the average time computed for the nurses’s consultation with their patients shows 10 minutes compared to the average time spent for consultation with doctors that shows only 8 minutes. The study concluded that generally, patients are satisfies with the service given by practice nurses. They best serve effectively to patients with mild diseases who requested a same day appointment with them, without any consultation with the doctors. (Job, 2007)
CONCLUSION
There is a need of workforce in the healthcare system in Australia. Because of the shortages, together with the ageing population and growing number of chronic illnesses, the need to think of other alternatives to fill the demand of nurses or to alleviate the efficiency of nurses in general is a growing concern.
International studies have concluded that proper use of nurses can bring great benefits to the health system as a whole. Those are : reduce number of chronic diseases, and “assistance in primary acute care integration.”
Review of research shows that the substitution of nurses to the doctor’s role is also possible. A nurse can take over up to 70% of the total workload of a doctor. The substitution can also improve the health care system in general because it will enhance nurses in their levels of specialty.
Effective research and implementation regarding the projects should be facilitated by general practices. Nurses in general can contribute to the greater output of the health system once trained and given enough examinations.
The achievement of the nurses is linked to the government as well, in terms of funding and incentives. The government plays an important role in encouraging the practice nurses and general practices, to ensure that all the best practices are followed. (Research, 2007)
In order to achieve the acceptance of practice nursing as a specialty in its own right, a documented activity and performance of the role of practice nurses should be made. Documents will encourage people and at the same time prove to the scholars, policy makers and patients, that nurses are capable of the tasks that is provided to them. In this way, more citizens will be encouraged to be employed as nurses and they will be given more recognition.
In summary, the role of practice nurses continues to change in response to the changing needs of society and healthcare. Healthcare’s needs, as customers are now increasing and more demanding, which practice nurses should see as an opportunity to play a vital role in the health system.
Practice nurses have a combined role of being a provider, a teacher , a mentor, an educator, a researcher and an administrator. Consequently, practice nurse should continue to do more research, discover new disciplines and practices not just for healthcare but for universities and other faculties. Members of this profession have a responsibility to advance the performance and the role of practice nurses in healthcare and society in general.
Documented outcomes on this research and outputs will develop confidence to the general public with regards to the employment of practice nurses. Satisfactory results of practice nurses’ activities will lead to new healthcare policies from policy makers, locally and internationally which will be both beneficiary to patients and to the whole health system as well.
Patients on the other hand are satisfied with the service of practice nurses.
As it evolves, it will continue to play a vital role in the shaping the primary care system and society. (Job, 2007)
ACADEMIC WRITING
Practice nurses in Australia. (2007) General Practice and Policy Review. [Online Source] Available at : http://www.mja.com.au/public/issues/187_02_160707/kel10501_fm.html
Australian Divisions of General Practice. (2006) National Practice Nurse Workforce Survey Report [Online Source] Available at : http://www.adgp.com.au/client_images/44225.pdf
Practice nursing in Australia. (2007) Parliament of Australia. [Online Source] Available at : http://www.mja.com.au/public/issues/187_02_160707/kel10501_fm.html
Evolution of Practice Nursing in Australia. (2006) Ingentaconnect. [Online Source] Available at : http://www.ingentaconnect.com/content/bsc/jan/2006/00000055/00000003/art00015
Job description and activities. (2007) Practice Nurse. [Online Source] Available at : http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml
Defining Nurse Practice. (2007) The Internet Journal of Nursing Practice. [Online Source ] Available at : http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml
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