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The Changing Role of Practice Nurses in Australia: an Action Research Study

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The Changing Role of Practice Nurses in Australia: an Action Research Study RESEARCH PAPER The changing role of practice nurses in Australia: an action research study author Jane Mills practice credentialed to provide cervical screening PhD, RN services. Six reflective group meetings were held over a Senior Research Fellow (NHMRC), School of Nursing six‑month time frame facilitated by the lead researcher. and Midwifery, Monash University, Gippsland Campus, During the meetings a variety of creative techniques were Churchill, Victoria, Australia. used to stimulate discussion, The meetings were audio recorded and partially transcribed. Feedback from the [email protected] concurrent data generation and analysis was provided to Mary Fitzgerald participants the following week. PhD, RN Setting Professor of Nursing, School of Nursing, Midwifery A regional division of general practice. and Nutrition, James Cook University, Cairns Campus, Subjects Smithfield, Queensland, Australia. Three registered nurses employed by the general medical practice. Acknowledgement Main outcomes measures This research study was facilitated by a Primary Health The barriers identified by participants in the process Care Research, Education and Development Fellowship, of implementing change in their clinical practice to School of Medicine, James Cook University, Townsville incorporate the provision of cervical screening services. Campus, Queensland, Australia. Results There were three themes identified in the findings from this study that related to the myth of interdisciplinary collaboration in general practice. These were: nurses in KEY words general practice renegotiating their roles; identifying and negotiating gendered patterns of cervical screening; and Australia; general practice; nurse in general practice; multidisciplinary collaboration and retention of practice practice nurse; cervical screening nurses. Another important outcome of this study that relates to change management is the role of practice champions in implementing new models of primary care. Conclusion The potential role of nurses in general medical practice Abstract in Australia has broadened considerably in recent years, Objective mainly due to Australian Government driven initiatives The original aim of the study was to report on the which reward general practitioners for employing nurses; methods used to develop a new model of service a recognition by the nursing profession that general delivery, namely nurse led well women’s clinics. However practice nursing is a specialist area of nursing practice; participants identified several key barriers to an the establishment of a national professional association expansion of their role that had not been accounted for for nurses working in general practice; an increase in in either the original policy directive or in the continuing the availability of continuing professional development professional development delivered as preparation for nurses working in general practice; and additional for their accreditation to deliver cervical screening Medicare Benefit Schedule (MBS) item numbers relating services from a general medical practice. How the group to general practice nursing, which gives the general addressed these barriers became the objective of this practice a rebate for the services the nurse provides action research study. independently of the general practitioner. Suggestions are made that address the barriers identified by Design participants in the process of implementing change This paper reports the findings from an action research in their clinical practice to incorporate the provision of study with three registered nurses working in general cervical screening services. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 26 Number 1 16 RESEARCH PAPER Introduction preparation for their accreditation to deliver cervical screening services from general practices. How the In recent times, there has been a rapid development group addressed these barriers ultimately formed of the role of nurses working in general medical the body of this action research study which was practice in Australia. Between 2004 and 2006 the limited by a six‑month timeframe. Despite the short number of nurses working in general practice grew time frame, some interesting issues were identified by 23% (Australian General Practice Network 2006), by the group which exposed the cultural underbelly closely tied to a number of funding initiatives by the of general practice and which can be used to inform Australian Government (Keleher et al 2007; Porrit the ongoing process of reform in general practice 2007); a recognition by the nursing profession of in Australia. general practice as a specialist area of nursing practice; the establishment of a professional nursing Research METHOD association for practice nurses; and the availability of continuing professional development opportunities Action research is a research methodology that for nurses working in general practice (practice typically begins with a concrete problem in practice nurses). Extended roles for nurses with concomitant (Carr and Kemmis 1986). Cycles of observation, allocation of Medicare Benefit Schedule (MBS) item critical reflection, action and evaluation lead to a numbers have promoted greater autonomy in clinical modification of actions in the form of action plans, practice for nurses and an opportunity to contribute which are subject to ongoing cycles of modification to an increasingly multi‑professional team approach until the original problem is addressed (McNiff and to general practice services in Australia. Medicare Whitehead 2006). In this study, the authors acted as is Australia’s publicly funded universal health facilitators for a reflective group of co‑researchers. insurance scheme however rebates for services A series of questions, adapted from Winter and provided are generally only available to medical Munn‑Giddings (2001), were used to stimulate practitioners. Additional item numbers have recently reflection on issues of concern agreed to by the been introduced which attract rebates for services group: provided for and on behalf of general practitioners • What else is having an impact on this issue in by nurses and other allied health practitioners. The the practice? provision of MBS item numbers for practice nurses • How else may this problem be viewed? means that the general practice receives a rebate for the services provided by the practice nurse. • Why do others behave the way they do? This assists in offsetting the cost of employing the • How do I feel about this and what do these practice nurse. feelings tell me about what is going on? One of these initiatives has enabled nurses in general • What else do I need to find out before making a practice to undertake cervical screening. This paper judgement? reports on the findings from an action research study In 2005 the Division of General Practice where undertaken with nurses in general practice who had the study was undertaken recruited six nurses to been recently credentialed as cervical screeners. The undertake a continuing professional development original aim of the study was to report on the methods program that led to credentialing to undertake used to develop this new model of service delivery, cervical screening. These nurses were invited to join namely nurse led well women’s clinics. However an action research group which was convened in participants identified several key barriers to an 2006. The attrition rate was 50%, resulting in three expansion of their role that had not been accounted participants attending the majority of reflective group for in either the original policy directive or in the meetings. Ethics approval was granted by the James continuing professional development delivered as AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 26 Number 1 17 RESEARCH PAPER Cook University Ethics Committee. Each participant practitioner employers to become credentialed signed a consent form prior to participating in the cervical screeners, that support did not necessarily study and was free to leave the study at any time. lead to a smooth transition to incorporate cervical screening into their clinical practice. Six reflective group meetings were held over a six‑month time frame facilitated by the lead The group was challenged to ask what else might be researcher who is an experienced mentor. Each having an impact on the business of general practice meeting lasted between two to three hours, with that would discourage the initiation of nurse led well participants and the research team sharing a meal at women’s clinics. Participants immediately responded the beginning of the meeting. During the meetings a that time equals money. The MBS item number rebate variety of creative techniques were used to stimulate at the time was inadequate to compensate for the discussion, review participant’s activities and plan amount of time they wanted to spend with clients actions as an outcome of the meeting. Some of undertaking a well women’s health check as opposed the creative techniques used were: scrapbooking; to undertaking the task of cervical screening as a poster making; sharing of journal entries; postcard stand alone activity. prompts to express feelings; and brainstorming using From this, the group decided they needed to raise ‘butchers’ paper and coloured pens. The meetings awareness of the value of nurse led well women’s were audio recorded and partially transcribed. clinics beyond the MBS item number rebate, while Feedback from the concurrent data generation and accounting for the power
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