LRH: Understanding the Australian Health Care System 3e
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RRH: 17 Nursing in Australia
Chapter 17 Nursing in Australia Yvonne Parry and Julian Grant
Key words and abbreviations Australian Health Practitioner Regulation Agency (AHPRA) Australian Nursing and Midwifery Accreditation Council (ANMAC)
Australian Qualification Framework (AQF) Coalition of National Nursing Organisations (CoNNO) enrolled nurse (EN) National Prescribing Service (NPS) nurse practitioner (NP) Nursing and Midwifery Board of Australia (NMBA)
nursing praxis Pharmaceutical Benefits Scheme (PBS) practice nurse primary health care nurse (PHCN) registered nurse (RN) scope of practice unlicensed healthcare workers
Key learning outcomes When you finish this chapter you should be able to: •
demonstrate an understanding of the scope of practice and roles of registered nurses, enrolled nurses and nurse practitioners in Australia
•
understand some of the specialisations present in nursing in Australia
•
identify some of the key differences between nurse practitioners and practice nurses.
Introduction This chapter provides a brief description of nursing qualifications, outlines some of the numerous roles of nurses in Australia and briefly discusses the scope of these roles.
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The title ‘nurse’ is protected internationally by legislation. This aims to ensure that those practising as nurses are regulated using standards of practice, ethics and codes of conduct. The International Council of Nurses states that:
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (International Council of Nurses 2014)
The first international gathering of nurses occurred in 1893, in Chicago at the World
Fair, in an effort to transition nursing into a profession (Raile Alligood 2013). Nursing is underpinned by nursing praxis, which refers to the knowledge-guided action and action-guided theory that is at the centre of nursing practice (Kagan et al. 2009; Raile
Alligood 2013). Nursing praxis provides the meaningful processes of decision-making and activity that inform the mosaic of modern nursing practice (Crawford et al. 2002).
Nursing praxis is also founded on the ideals of social justice and the social model of health. Nursing theories and practice incorporate aspects of the social determinants of health (see Chapters 1, 5 and 6) and the social health model (see chapters 1 and 6) (Baum 2008). As a profession, nursing espouses that knowledge and actions focus on
the provision of holistic care to individuals and groups. In addition, nursing is legislated and regulated in order to protect the public from inappropriate and potentially harmful care (Kagan et al. 2009; Raile Alligood 2013; Ralph et al. 2014). In Australia, the Nursing and Midwifery Board of Australia (NMBA) provides registration standards, codes of conduct and ethical guidelines that are used to regulate nursing practice at a national level. The primary role of the NMBA is to protect the public and set standards and policies that all nurses must meet (Australian Health Practitioner Regulation Authority at www.ahpra.gov.au ). There are separate standards and codes for ethical practice for enrolled nurses (ENs), registered nurses (RNs) and nurse practitioners (NPs). Since August 2009, the Australian Health Practitioner
Regulation Agency (AHPRA) has regulated practice for all nurses, working in partnership with the NMBA. All courses leading to registration as an EN, RN or NP are accredited through the Australian Nursing and Midwifery Accreditation Council (ANMAC). This ensures that once a candidate has completed a course of study, they meet the relevant professional standards.
Enrolled nurses, registered nurses and nurse practitioners are responsible for maintaining their education and the quality of their work in accordance with their registration requirements and scope of practice. Each nurse must be registered or
enrolled with the AHPRA under the Health Practitioner Regulation National Law Act.
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This national law is enforced in all states and territories in Australia and provides a definition and regulation of who is entitled to use the term ‘nurse’. Regulation of the
nursing profession is undertaken in the public interest to ensure that all nurses have attained, and maintain, an appropriate level of education, qualification and safe practice. Each level of nursing is defined by the level of education and subsequent registration
required by NMBA and AHPRA. Registered nurses, enrolled nurses and nurse practitioners are identified as such on the AHPRA register. In Australia there are two distinct areas of nursing practice based on the level of education and mode of function:
RNs (Division 1) and ENs (Division 2). Additionally, NPs are RNs who have obtained advanced practice, skills and education in a specific area of clinical practice. Each mode is determined by its scope of practice.
Scope of practice
Scope of practice is legally defined and describes the procedures, actions and processes that a nurse is permitted to undertake at the distinct level of professional regulation (Australian Bureau of Statistics 2012; Ralph et al. 2014). For example, ENs usually completes an accredited 18-month course at Australian Qualification Framework (AQF) level 5 or 6. They can only administer medicines if they have completed the relevant medicine administration education units (Australian Commission for Safety and Quality in Health Care 2012). This is essential to better protect the public by making sure that only ENs who are educated in administering
medicines are able to do so. An EN must work under the direction and supervision of a RN. An RN generally completes an accredited three- or four-year Bachelor of Nursing
program (AQF level 7), after which they work as part of a team and can supervise other staff such as ENs and unregistered healthcare workers. Registered nurses are responsible for the nursing care provided by themselves and other nurses such as ENs. An RN is responsible for patient assessments and decisions regarding the delegation of
care and assessments. Unregistered health care workers, such as aged-care workers or care assistants, work under direct supervision of an EN or RN. They are usually educated to AQF level 3 or 4 and are not regulated. Each level of nursing has its scope of practice that determines the roles, activities and care provided by each nurse.
Pause for reflection Enrolled nurses practise under direct supervision of RNs. All nurses are responsible for their own actions and are accountable to the AHPRA for their practice standards and care of
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What are the implications for the public regarding the use of unlicensed health care workers?
•
Go to the AHPRA website (www.ahpra.gov.au) and review the scope of practice for ENs and RNs. Compare these with the scope of practice for an NP (or the NMBA website: Australian Nursing and Midwifery Council (2016) National competency standards for the nurse practitioner. Available: http://www.nursingmidwiferyboard.gov.au/News/2016-02-01-revised-standards.aspx
Advanced registered nurse practice Registered nursing practice comprises a variety of nursing specialisations that are generally undertaken by nurses working at an advanced level. ‘Advanced practice’
represents a continuum of professional development rather than a role (Nursing and Midwifery Board of Australia 2014). Some examples of specialist areas are mental health nursing; maternal, child and family health nursing; critical care nursing; remote area nursing; and diabetes nursing. Gardner et al. (2007 p. 383) offer a working definition of advanced nursing practice, as: nursing roles that involve higher level knowledge and skills that enable clinicians to practice with autonomy and initiate nursing actions but do not include diagnostic and treatment decision-making.
The majority of nurses working at an advanced practice level in a specialisation have qualifications at AQF level 8 or 9. This means that they have completed a graduate certificate, graduate diploma or Master’s level qualification in their area of specialisation.
Unlike qualifications that lead to registration as an EN, RN or NP, advanced nursing practice specialisations are not regulated by the AHPRA. Instead, ownership of
professional development and standards for specialist practice lies with self-regulated professional groups such as the Australian College of Mental Health Nurses (ACMHN) for mental health nurses, the Australian Primary Health Care Nurses Association (APNA) for practice nurses and the Australian Diabetes Educators Association (ADEA)
for diabetes nurse educators (Bostrom et al. 2013). The majority of professional groups have developed standards for their specialist practice. In addition, the Australian Nursing and Midwifery Federation (ANMF; 2005; Department of Health Victoria 2014) has competency standards for advanced registered nurses. These are currently under review by Gardner and Duffield through the Queensland University of Technology.
In 1991, the Coalition of National Nursing Organisations (CoNNO) was established to ‘guide the orderly development of nursing specialties in Australia’ (Coalition of National
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Nursing Organisations 2010). Formerly known as the National Nursing Organisation (NNO), CoNNO is supported with funding from the CDepartment of Health. The ANMF
provides the secretariat for CoNNO, and acts as a fund-holder for the group (Coalition of National Nursing Organisations 2010). CoNNO has a range of objectives; the two most
pertinent to the development of a national specialist group are the offers to ‘assist the development of governance and capacity of member organisations’ and to ‘contribute to professional frameworks’ (Coalition of National Nursing Organisations 2010).
Case study 17.1 Nursing care that meets individual and community needs Polly is an Indigenous primary health NP who works for an Aboriginal-controlled medical service in a large country town. In accordance with her role and the wishes of the local Indigenous community, she has developed health drop-in sessions in collaboration with the local community in order to service the unmet need for health assessment and intervention requirements. Since developing these drop-in clinics, Polly’s workload has increased and the number of people using the service has quadrupled. Polly organises the drop-in clinics by age group or diagnosis. For example, she provides 0–5 years, 6 - 12 years and youth drop-in clinics, along with separate diabetes and chronic pain clinics. Polly provides overall health assessments that include risk factors, physical and mental health examinations, and tests, and community capacity to meet the needs of the Indigenous population. During these assessments, Polly identifies several chronic health issues through her health assessment processes that have not been addressed in the local community. Case study questions From your knowledge of Aboriginal health issues and reading of Chapter 11, consider the questions below. 1
What issues are raised in this case study?
2
What is Polly’s scope of practice?
3
What tests can Polly order for her patients/clients? What medications can Polly prescribe?
4
What resources would assist Polly in providing health equity for her community?
5
How would cultural knowledge and awareness assist health professionals who work with Indigenous people requiring equitable health interventions?
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To provide the answers to these questions, start by exploring your community. That is, find out the community services that are available in your area. Find out how many NPs you have access to in your area.
Nurse practitioners There are significant differences between advanced nursing practice, the nurse practitioner role and the practice nurse role. An NP ‘is an advanced practice nurse
endorsed by the Nursing and Midwifery Board of Australia (National Board) to practice within their scope under the legislatively protected title “nurse practitioner” ’ (Nursing and Midwifery Board of Australia 2014). As such, the first step to becoming an NP is working at an advanced practice level. The NP is defined as:
a registered nurse who is educated and endorsed to function autonomously and collaboratively in an advanced and extended clinical role. The nurse practitioner scope of practice is built on the platform of the registered nurse scope of practice. The NP provides higher levels of clinically focused care. The role includes assessment and management using advanced nursing knowledge and skills. The role may include, but is not limited to, the direct referral of patients to other healthcare professionals, prescribing medications and ordering diagnostic investigations. As part of providing care, NPs can order and interpret investigations to facilitate diagnosis and care planning. Care may include nursing interventions that involve initiation, titration or cessation of medications. Nurse practitioners take responsibility for following-up on any components of care initiated. They are accountable for care provided and self-monitor their work. (Australian Nursing and Midwifery Council 2014).
Internationally, the NP role has been introduced to address areas of need in the
provision of health care, for example to reduce inequalities and inequities in Indigenous and at-risk population groups such as the aged, children and mental health populations (Productivity Commission 2005; Queensland Government 2011). The role is a response
to the emerging and increasing pressures on health systems to provide timely, effective
and cost-efficient health access, especially in response to improving primary health care (Toffoli & Rudge 2012). Nurse practitioner roles have expanded to include the areas of community health care, primary health care, aged care, child and family health, veterans care, palliative care, acute care and surgical and anaesthetic assistants and continue to
evolve in response to changes in societal and health care needs (Elsom & Happell 2006; Queensland Government 2011; Iglehart 2014). Nurse practitioner roles centre on individual and population needs and on improving health outcomes (Productivity Commission 2005; Foster 2010). Consequently, population health status is one of the
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drivers for the provision of NP services (Productivity Commission 2005; Nursing and Midwifery Board of Australia 2013c; Iglehart 2014). Although NPs are first rRNs, the
comprehensive and advanced levels of education, clinical practice and advanced knowledge and skills ensure that they practise at levels well beyond those of advanced clinical nurses (Queensland Government 2011).
Registered nurses wanting to enter into an NP program in Australia are required to have a minimum of three years working at an advanced practice level in their area of specialisation. In addition to their specialisation qualifications, they must complete an AQF level 9 program of study (Masters level) that has been accredited by ANMAC as leading to registration as an NP (Nursing and Midwifery Board of Australia 2013c). Once registered, NPs are only eligible to practise within their designated scope of specialist practice (Nursing and Midwifery Board of Australia 2013c).
The development of the role of the NP challenges the traditional boundaries of nursing practice (Productivity Commission 2005, 2011a). For example, the Productivity Commission (2005) acknowledged that while the role of the NP ‘mostly complemented the role of other health professionals’, it also stated that there will be ‘inevitably overlap in some areas’. One area of note for overlap is the prescribing of medications. Nurse practitioners’ scope of practice has at times been severely limited by the lack of PBS
prescriber numbers (see Chapter 8). Thus despite their advanced medication and treatment knowledge, only small numbers of NPs have been provided with PBS prescriber numbers. This restricts many NPs from prescribing, thus limiting care that involves initiation, titration or cessation of medications (Nursing and Midwifery Board of Australia 2013c; Iglehart 2014). Addressing NP prescribing rights can improve patient care, increase convenience for population groups with compromised health access, improve patient–nurse relationships, improve collaborative practices and reduce health care costs (McMillan 2007; Productivity Commission 2011a; Queensland Government 2013). International research has found NPs to be safe and effective prescribers (McMillan 2007; Duckett 2008; Iglehart 2014). An improvement in NP
prescribing rates would also assist in remedying the issue of a lack of general practitioners (GPs), especially in rural and remote areas (Productivity Commission 2011a; Guzys & Petrie 2014; Iglehart 2014). Additionally, an increase in NP prescribing could promote efficiency and flexibility in the use of health human resources by freeing up other health professionals to complete more complex or role-specific tasks (Productivity Commission 2011a; Iglehart 2014).
Shortages of doctors and GPs could be addressed by some role substitution using NPs
(Productivity Commission 2011a; Iglehart 2014). Nurse practitioners, like RNs, work independently as part of a team and like other expert health professionals do not
require supervision of their practice by other disciplines (Productivity Commission 2005; Duckett et al. 2014). Working effectively with other health professionals, NPs
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show high levels of leadership, collaboration and colleagueship and this can enhance the practice environment to provide joint decision-making that incorporates the overriding goal of better health care (Kralik et al. 2011; Productivity Commission 2011a; Nursing and Midwifery Board of Australia 2013c; Middleton et al. 2014). Providing care that
addresses health practitioner shortages without compromising health services or patient care requires health team members that are equal in the joint decision-making processes and have concern for mutual goals, access to information and service provision rather than controlling each other’s practice (Productivity Commission
2011a; Middleton et al. 2014). Nurse practitioners have continued to provide care that is often below their optimal level of care provision due to limitations imposed by other professions and by policy-makers (Middleton et al. 2014). This hinders patient care, as NPs working under unnecessary limitations are often required to wait for approval by another health provider before proceeding with health care plans, referrals, treatment and medications (Middleton et al. 2014). This under-use of NPs can potentially increase cost and treatment regimens for patients and increase the costs to the health system through inefficiencies.
Practice nurses
Practice nursing is the colloquial term given to nurses who work in clinics alongside GPs/medical officers. It is often confused with advanced practice nursing and the NP role. Practice nurses provide medical clinics and general practice clinics with enhanced interprofessional practice and multi-professional service delivery (Toffoli & Rudge 2012). A practice nurse may be defined as follows.
The Medicare Benefits Schedule (MBS) defines a practice nurse for the purposes of providing MBS services, as a registered or enrolled nurse or an Aboriginal health worker (AHW) who is employed by, or whose services are otherwise retained by, a general practice. (Rural Health West 2012)
For some, it is recognised as an area of advanced practice nursing. As a specialisation, practice nursing is now referred to as primary health care nursing (Joyce & Piterman 2011; APNA 2014).
The role of nursing in the provision of primary care has increased in recent years. The practice nurse provides primary care through general practice services (Toffoli & Rudge 2012). This has led to an increase in the role of the practice nurse (Joyce & Piterman 2011; Desborough et al. 2014). Practice nurses have expanded their roles beyond
immunisation and health assessment to include the ongoing assessment of patients with chronic health illnesses (Joyce & Piterman 2011; Desborough et al. 2014). Research
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suggests that patients are satisfied with the levels of care and collaboration provided by practice nurses (Desborough et al. 2014).
Practice nurses assist in the provision of services to individual and population groups
that address areas of need. For example, practice nurses can assist in developing care plans for people with diabetes attending GP clinics. However, of concern is the lack of
established or consistent national education frameworks for practice nurses (Parker et al. 2009). Postgraduate education is often provided and developed through nursing organisations rather than the NMBA, unless the RN is an advanced practice nurse. Practice nurses are employed by some GPs and community-based health services
under a national incentive scheme. The Practice Nurse Incentive Program (PNIP) was established to employ practice nurses in an effort to address GP shortages (Department of Human Services 2014). The incentive payments provide a one-off $5 000 to enable
accreditation of the GP clinic or Aboriginal Community Controlled Health Service involved; once accredited, the clinic or health service can receive ongoing incentive payments for employing practice nurses (Department of Human Services 2014). GP and community-based health services may also receive an additional 50% if the service is
located in a rural or remote area (Department of Human Services 2014). Practice nurses can therefore be used by GP clinics to generate extra income; for example, a practice
nurse conducting four health assessments could earn an extra $732 for the clinic (Rural Health West 2012). These funds amply offset the cost of employing a practice nurse. A GP clinic may employ ENs, RNs and NPs to provide services in this expanded and enhanced nursing role (Department of Human Services 2014). Enrolled nurses receive lower wages commensurate with their scope of practice (Parker et al. 2009; Toffoli & Rudge 2012). This provides cost savings for employers. It is also important to note that the practice nurse may be an EN rather than a RN. The use of ENs is a concern given their limited scope of practice. Additionally, ENs require supervision of their practice due to the limitations of their role and the health service may not be aware of the
management of the scope of practice limitations. Delegation of tasks requires those who delegate to have a greater degree of accountability for the standards of task completion than those completing the task (Nursing and Midwifery Board of Australia 2013c; Blackman et al. 2015). The use of EN practice nurses may place the public at risk, for example, if they are asked to complete tasks beyond their scope of practice and thus
have not been educated to do the task. The general public attending a GP clinic is often unaware of the scope of practice of the nurse providing health services.
Differences in the scope of practice
Nurses use the Nursing Practice Decisions Summary Guide as a tool to reflect on
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practice decisions (Nursing and Midwifery Board of Australia 2010). Table 17.1
provides a brief, general guide to the differences between each area of nursing practice, using NPs and practice nurses as examples of different nursing roles.
Table 17.1 Comparison across nursing roles Registered nurse Legislation
Advanced practice nurse
Nurse practitioner
Title protected
Title not protected
Title protected
General nurse registration
No specialist registration for nursing
Endorsement under s.95 of the national law
Wide variety of nomenclature, e.g.
Nurse practitioner
Nomenclature Registered nurse
Clinical nurse specialist Clinical nurse consultant Advanced practice nurse Practice nurse Education
Clinical experience
Bachelor of Nursing
Career usually commenced in a graduate nurse program
Bachelor of Nursing
Bachelor of Nursing
While not essential, a postgraduate qualification in a clinical nursing specialty is recommended
Postgraduate qualification in a clinical nursing specialty
2–4 years postregistration
10–12 years postregistration
Set by the ANF Competency standards for the advanced registered nurse
Set by the NMBA Nurse practitioner standards for practice
Approved Master’s degree in Nurse Practitioner Studies
General or specialist experience Scope of practice
Set by the NMBA National competency standards for the registered nurse
General and specialist clinical activities in direct patient care Administration of medications
Advanced clinical activities in area of clinical nursing specialty Limited initiation and supply of medications under protocol
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Advanced nursing practice in area of clinical nursing specialty plus expanded clinical activities that include: Advanced patient assessment
Ordering and interpretation of diagnostic investigations and pathology Adapted from www.conno.org.au/images/PDF/Competency_Standards_Advanced_Registered_Nurse.pdf .
If you require more in-depth information on the roles, responsibilities and qualifications, please review the EN, RN and NP standards of practice guidelines available from the NMBA (see Online resources).
Pause for reflection More than one Productivity Commission report has highlighted the need for expanding the role of the nurse. Table 17.1 provides an easy-to-read comparison of the differences between the RN, NP and practice nurse. •
What differences are identified as key between RNs, NPs and practice nurses?
•
What are the competencies for each level of nursing practice?
•
What are the implications for using ENs in GP services? (look up the NMBA website to compare: Australian Nursing and Midwifery Council (2016) National competency standards for the nurse practitioner. Available: http://www.nursingmidwiferyboard.gov.au/News/2016-02-01-revisedstandards.aspx
•
What enhanced skills do NPs bring to patient care?
What is on the horizon in nursing? There has been considerable research over the past two decades on the impact of new public management (NPM) on nursing, particularly in the acute hospital sector (Willis,
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2005; Blackman et al. 2015). Work by Kalisch and colleagues (2006; 2009), and Schubert et al. (2007) from the RN4Cast group in Europe, along with Australian-based studies, is alerting governments, funders and nurses to the impact of financial cuts on patient quality of care. These researchers have demonstrated that the impact of NPM strategies aimed at increasing productivity and efficiency in the acute care hospital sector have left nurses working with inadequate skill-mix, and fewer resources that
force them to prioritise and rationalise care (Blackman et al. 2015). One of the most interesting findings of this body of nursing research has been the identification of
presenteeims: nurses going to work when sick simply because they know that if they do not then their colleagues will be short-staffed and patient care will be compromised (Harvey et al. 2013).
The impacts of an ageing population, an ageing nursing workforce and the costs of
health care have provided an impetus for the shifting of health care from the hospital to the community. This has in part been driven by an increasing number of areas of
specialisation for RNs and NPs (Schofield et al. 2011), which can be seen as responses to the demands of the health care system. The AHPRA and NMBA are actively involved in
ensuring that the increased scopes of practice are commensurate to an appropriate level of education and standard of practice. This in turn provides guides for areas of nursing specialisation. One of the areas where the scope of practice for nurses could expand is in aged care. The emerging focus on restorative and rehabilitation care for the frail elderly integrates well with the International Council of Nurses definition provided at the beginning of this chapter.
The profession of nursing is in part driven by the needs of the population. With an increasing ageing population, including an ageing nursing workforce (see Chapter 7), [Please check; I don’t recall Chapter 7 discussing the ageing of the workforce] governments and health care providers have turned to meeting workforce numbers
through employing overseas-trained nurses. While this strategy has enriched nursing, broadening the professions’ understanding of care, it has also created tensions around quality, adequate nurse–patient communication and interpersonal communications within health care teams (Xiao et al. 2014).
Nursing has traditionally responded to the lack of provision of health services by
providing services and specialisations that meet client needs. The increasing specialisation of nursing and the expansions of the role of the nurse, such as the increasing numbers of NPs, is a response to a gap in current health service delivery.
Nurses need to ensure that their ability to meet the needs of the population is matched
by the appropriate qualifications and AQF education. The future of ENs, RNs, NPs and
Commented [YP1]: I am unsure here Eileen do you know? Thank you kind regards Yvonne
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nurse specialisation in part rests with the consolidation of nursing specialisations and nursing practice.
Conclusion
This chapter has provided some insight into the roles, skills and education required to be a nurse. Further exploration of nursing practice is available on the websites and the
references provided throughout the chapter. Further, by critiquing the various levels of nursing practice and who may use the term ‘nurse’, you should be able to understand
the use of the concepts of practice standards in order to guide professional reflective practice.
Summary
In this chapter we provide background on nursing through: •
discussion of the international use of the term ‘nurse’ and the different levels of nursing practice
•
key theoretical ideas, such as the social determinants of health and the social model of health, which are incorporated into nursing practice
•
briefly explaining the underpinning of nursing theory and practice through the concept of nursing praxis
•
the use of scope of practice to define the roles and responsibilities of different types of nurse, such as ENs and RNs. The discussion on the scope of practice also explains the levels of education required to obtain registration with the AHPRA
•
the differences between practice nurses and nurse practitioners, which provides an opportunity to explore the concept of the scope of practice and its application in the workplace.
Review questions 1
Why is it considered important to protect the term ‘nurse’?
2
What may be the possible impact of an ageing population on future nursing practice and numbers?
3
What skills and knowledge do NPs provide in caring for individuals and groups that goes beyond RNs?
4
What challenges do NPs bring to the traditional boundaries of nursing practice?
5
What are the differences between the EN, RN and NP roles, and why is it important to know?
6
What do you think are the negative outcomes of nurse presenteeism on patient care?
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Further reading Desborough J, Phillips C, Banfield M, Bagheri N, Mills J. Impact of nursing care in Australian general practice on the quality of care: a pilot of the Patient Enablement and Satisfaction Survey (PESS). Collegian 14(3):1322–1328, 2014. Middleton S, Gardner A, Della P, Lam L, Allnutt N, Gardner G. How has the profile of Australian nurse practitioners changed over time? Collegian 14(3):1322–1328.
Online resources Keep up with the standards of practice and codes of conduct for ENs, RNs and NPs: www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards.aspx Keep up with the latest digital health innovations: www.pulseitmagazine.com.au Learn what is happening in your profession at the Australian Health Practitioner Regulation Agency home page: www.ahpra.gov.au Learn about the RN4Cast Study group on nursing work: http://www.nursing.upenn.edu/chopr/Pages/RN4Cast.aspx
References Australian Bureau of Statistics (ABS), (2012) The History of Home Nursing in Australia. http://www.abs.gov.au/ausstats/
[email protected]/featurearticlesbytitle/911B5AF72F8187 95CA2569DE0024ED5A?OpenDocument (Assessed January 2015). Australian Commission for Safety and Quality in Health Care (2012) http://www.safetyandquality.gov.au/our-work/national-standards-andaccreditation/ (Accessed September 2014). Australian Health Practitioner Regulation Authority website http://www.ahpra.gov.au/Publications/AHPRA-newsletter/November2012.aspx (Accessed November 2012). Australian Nursing and Midwifery Council (2014) National competency standards for the nurse practitioner. Available: http://www.nursingmidwiferyboard.gov.au/CodesGuidelines-Statements/Professional-standards.aspx
Australian Nursing and Midwifery Council (2016) National competency standards for the nurse practitioner. Available: http://www.nursingmidwiferyboard.gov.au/News/2016-02-01-revisedstandards.aspx Australian Nursing and Midwifery Federation (2005) Professional practice competency standards for nursing and midwifery. Competency standards for the advanced registered nurse. ANF policy. APNA (2014) Australian Primary Nurses Assocaition: Salary and Conditions Survey, Primary Times, 14 (4) page 8-14.
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Baum F. (2008). Public Health in Australia, 3rd ed. OUP, Melbourne. Blackman I, Henderson J, Willis E et al (2015) Factors influencing why nursing care is missed, Journal of Clinical Nursing, 24(1-2) page 47-56. Bostrom E, Hornsten A, Persson C, Rising I & Fischer R (2013) Clinical challenges and ongoing role changes for primary health-care nurses, British Journal of Community Nursing 17(2) 68-82 Coalition of National Nursing Organisations (2011) Coalition of National Nursing Organisations' National Nurse Credentialling Framework, Coalition of National Nursing Organisations publication.
Crawford, P., Brown, B., Anthony, P. & Hicks, C. 2002. Reluctant empiricists: community mental health nurses and the art of evidence-based praxis. Health and Social Care in the Community, 10, 287–298 Department of Human Services (2014) Practice Nurse Incentive Program: Medicare Australia (Accessed January 2015) http://www.medicareaustralia.gov.au/provider/incentives/pnip.jsp Department of Health Victoria (2014) Primary and Community Health http://www.health.vic.gov.au/pch/commhealth/index.htm (Accessed January 2015). Desborough J, Phillips C, Banfield M, Bagheri N & Mills J (2014) Impact of nursing care in Australian general practice on the quality of care: A pilot of the Patient Enablement and Satisfaction Survey (PESS), Collegian, 14(3)1322-1328 Duckett S (2008) The Australian health care systems: reform, repair or replace? Australian health Review, 32(2): 322-329 Duckett, S.J., Breadon, P., Weidmann, B. and Nicola, I., (2014), Controlling costly care: a billion- dollar hospital opportunity, Grattan Institute, Melbourne Elsom S & Happell B (2006) The Clinical Nurse Specialist and Nurse Practitioner Roles: Room for Both or Take Your Pick? Australian Journal of Advanced Nursing 24(2) 5659. Foster J (2010) A History of the Early Development of the Nurse Practitioner Role in New South Wales thesis University of Technology Sydney. Gardner, G, Chang, A & Duffield, C 2207, ‘Making nursing work: breaking through the role confusion of advanced practice nursing’, Journal of Advanced Nursing, vol. 57, no. 4, pp. 382-391.
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