Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions

Abstract

Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.

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

“…Most sources described NPs in terms of the educational and practice requirements necessary for endorsement by the Nursing and Midwifery Board of Australia 16,18,29–34 . They conceptualised NPs' role in terms of their scope of practice 8,16,29,30,33–36 . Other sources noted the potential of NPs to improve health care access, health outcomes and consumer satisfaction within rural health services 30 address service gaps 14,32 ; and adapt to changing community needs 14 …”

“…The review revealed that NPs were working in community mental health and drug and alcohol services 8,31,34 ; at remote Aboriginal Medical Services 37 and Aboriginal Community Controlled Health Services 39 ; primary care in rural and remote locations 32,37,38 ; providing nurse‐led assessment and treatment centres and community‐based clinics 20,21,30,36,41,42 ; providing specialist aged care 35 and psychogeriatric services 8 ; NP locum services 14 ; and palliative care 33 . Some NPs worked across multiple health care settings, for example across hospital, residential aged care, general practice and community health 8,41 .…”

“…With respect to factors that enable the implementation of NP roles in rural primary health care, this review found that examples of successful projects or NP‐led models of care were those that addressed an identified unmet population health care need or service gap; had secured community support and sometimes funding as well; and had engaged key stakeholders in the planning and implementation of the NP service 8,29,34,42 . Successful prospective practice models also demonstrated collaboration between health professionals and integration with other service providers 29,30,33,36,39,42 …”

“…16,18,[29][30][31][32][33][34] They conceptualised NPs' role in terms of their scope of practice. 8,16,29,30,[33][34][35][36] Other sources noted the potential of NPs to improve health care access, health outcomes and consumer satisfaction within rural health services 30 address service gaps 14,32 ; and adapt to changing community needs. 14 Several sources reported NPs' descriptions of their role in primary health care that included providing care from a social and holistic perspective; with a focus on wellness, health promotion, prevention of ill health, management of chronic disease and encouraging community participation in health services.…”

“…Whilst there is an absence of research outlining how the role of the NP functions in rural primary health care, articles described the NP role as incorporated into, or forming part of multidisciplinary teams 8,39 ; nongovernment organisations 8,29 ; local health districts (LHD) or health services. 30,36 The review revealed that NPs were working in community mental health and drug and alcohol services 8,31,34 ; at remote Aboriginal Medical Services 37 and Aboriginal Community Controlled Health Services 39 ; primary care in rural and remote locations 32,37,38 ; providing nurse-led assessment and treatment centres and community-based clinics 20,21,30,36,41,42 ; providing specialist aged care 35 and psychogeriatric services 8 ; NP locum services 14 ; and palliative care. 33 Some NPs worked across multiple health care settings, for example across hospital, residential aged care, general practice and community health.…”