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

Abstract

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.

A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia

“…Common barriers evident across several studies include: other health professionals negative perceptions or lack of awareness of the NP role [16, 18, 45] (micro-level); the inflexibility of the MBS and PBS funding model [16, 45, 46] (macro-level); workload issues, unclear career pathways and lack of peer or management support [41, 45, 46] (meso- and micro-level). Meanwhile, these were potentially balanced against enablers like: building support networks and local teamwork [16, 18, 45] (meso-level); and clarity of leadership and organisational structure [41, 45] (meso- and micro-level). Some studies broke down barriers and enablers into different levels similar to the structure used in this study, such as the healthcare system, organisational, team and individual practitioner levels [41] or the policy, workplace and personal levels [45].…”

“…Meanwhile, these were potentially balanced against enablers like: building support networks and local teamwork [16, 18, 45] (meso-level); and clarity of leadership and organisational structure [41, 45] (meso- and micro-level). Some studies broke down barriers and enablers into different levels similar to the structure used in this study, such as the healthcare system, organisational, team and individual practitioner levels [41] or the policy, workplace and personal levels [45]. For the most part, there is a considerable degree of cross-over between categories in this and previous studies, although the importance of community understanding and support was more apparent at the meso-level, as was the value placed on negotiation and advocacy of roles (micro-level) by informants in this study.…”

Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review

“…Eight factors were reported in the included studies as influencing scope of practice. These were education [ 15 , 36 – 49 ], competency [ 15 , 36 – 38 , 41 – 44 , 46 , 47 , 50 ], professional identity [ 36 , 51 , 52 ], role confusion [ 15 , 37 , 39 , 42 , 44 ], legislation and regulatory policies [ 47 , 50 , 53 , 54 ], organisational structure [ 36 – 38 , 42 , 44 , 46 , 55 ], financial factors [ 36 , 37 , 41 , 42 , 44 – 48 , 52 , 56 , 57 ], and professional and personal factors [ 48 , 52 ]. The factors identified in the literature have been reported verbatim, without interpretation or modification.…”

Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions

“…With no restrictions on activities covered by funding, the PNIP may provide the opportunity for PNs to be increasingly involved in chlamydia testing and management, freeing up time for GPs to deal with more complex cases and increasing access to testing for young people [ 33 ]. However, whilst implementation of the funding model is still in the early stages and its impact on PN roles is yet to be formally evaluated, it has been suggested that the PNIP may be seen by GPs and practice managers as limiting the work PNs can perform since there are no longer financial incentives attached to “specific” activities [ 34 ]. Further work may be needed to inform and support GPs and practice managers in understanding how the scheme can work to the advantage of not only themselves, but to PNs and most importantly patients.…”