Emergency departments are bursting. Why don't we use the workforce who can prevent this?

The Advertiser

4 days ago

We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be.
There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities.
The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system.
The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce.
While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right.
Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both?
I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention.
They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health.
The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past.
So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability.
We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses.
Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available.
We need to look at regulations that hinder nurses from delivering safe and quality care in their communities.
This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities.
Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP.
The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure.
But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments.
We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible.
This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs."
These are areas for which nurses are educated and eager to enhance.
Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services.
Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks.
It is about giving access to care where little to no care exists and delivering care where the people live.
We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions.
At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort.
We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be.
There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities.
The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system.
The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce.
While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right.
Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both?
I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention.
They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health.
The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past.
So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability.
We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses.
Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available.
We need to look at regulations that hinder nurses from delivering safe and quality care in their communities.
This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities.
Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP.
The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure.
But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments.
We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible.
This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs."
These are areas for which nurses are educated and eager to enhance.
Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services.
Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks.
It is about giving access to care where little to no care exists and delivering care where the people live.
We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions.
At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort.
We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be.
There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities.
The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system.
The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce.
While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right.
Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both?
I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention.
They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health.
The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past.
So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability.
We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses.
Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available.
We need to look at regulations that hinder nurses from delivering safe and quality care in their communities.
This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities.
Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP.
The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure.
But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments.
We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible.
This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs."
These are areas for which nurses are educated and eager to enhance.
Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services.
Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks.
It is about giving access to care where little to no care exists and delivering care where the people live.
We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions.
At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort.
We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be.
There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities.
The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system.
The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce.
While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right.
Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both?
I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention.
They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health.
The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past.
So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability.
We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses.
Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available.
We need to look at regulations that hinder nurses from delivering safe and quality care in their communities.
This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities.
Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP.
The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure.
But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments.
We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible.
This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs."
These are areas for which nurses are educated and eager to enhance.
Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services.
Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks.
It is about giving access to care where little to no care exists and delivering care where the people live.
We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions.
At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort.