Spotlight on barriers to NP practice

Local and international nurse practitioners discussed the professional milestones and ongoing challenges facing the profession at a RDNS masterclass held in Melbourne last week.

Visiting professor from the University of Calgary Dr James Rankin said despite initial resistance from GPs and specialists, nurse practitioners were now an accepted role within the Canadian healthcare system.

First introduced in 1967, there are now over 3,200 nurse practitioners employed in Canadian hospitals and community settings.

Professor Rankin said moves to standardise their educational preparation and national recognition of the role through the introduction of the Canadian Nurse Practitioner Exam were two important milestones for NPs in Canada.

He said the national exam has facilitated the portability of the qualification across the country and assisted Canadian NPs to move between provinces. However, there are exceptions to uniform recognition of the role, with different requirements in place in Quebec and British Colombia.

Professor Rankin said ageing populations in Australia and Canada would create further opportunities for NPs to move into aged care in greater numbers.

“One of the advantages I see in having nurse practitioners in a nursing home or an aged care centre is the consistency they provide. They are not just dropping in once a week but are actually onsite all of the time to provide an advanced level of care on a consistent basis to residents,” he told Australian Ageing Agenda.

He said as professional and public understanding of the role has increased, so too has trust and confidence in the value NPs can make to the healthcare system.

Underutilisation in Australia

Dr Susan Koch, RDNS Institute director, said in Australia restricted access to the Medicare Benefits Schedule for public sector nurse practitioners continues to be a significant barrier to their practice in community settings.

Unlike privately practicing NPs, public sector salaried NPs do not have access to MBS provider numbers, which means they are unable to order MBS-rebateable diagnostic tests or make rebateable referrals to other health professionals for their patients in the community.

She said this contributes to delays in patient care and service inefficiencies as NPs then have to direct patients to a  GP to access those MBS-subsidised tests and referrals, despite these services being part of the NP’s advanced scope of practice.

Dr Koch said these limitations on their practice need to be addressed, as well as other barriers including negative professional attitudes to NPs both from within nursing and other health professions.

There are currently 1,000 endorsed nurse practitioners in Australia, most commonly working in emergency, chronic and acute care.