Nurse practitioner reforms provide a career boost for nurses
The federal Labor government is making it easier for patients to use nurse practitioners – and boosting career prospects for registered nurses.
After more than a decade of lobbying by nursing unions, Australia now has a government committed to allowing nurse practitioners (NPs) to work to the full extent of their education and ability.
The federal Labor government’s May Budget allocated $50.2 million to fund 1850 postgraduate scholarships for RNs to become NPs.
The Budget also allocated $46.8 million over four years from 2023–24 to fund: a 30 per cent increase in patient rebates for a consultation with an NP enabling NPs to participate in allied health multidisciplinary case conferences by giving them access to MBS case conferencing items enabling NPs to independently prescribe PBS medicines and provide services under Medicare without the need for a legislated ‘collaborative arrangement’ with a doctor.
Until now, NPs have been required to make agreements to form “collaborative” work arrangements with doctors or be employed by services that have doctors.
Without such arrangements, patients have been denied Medicare rebates on the cost of NP services, or PBS subsidies on prescriptions written by NPs.
More changes needed
Professor Mary Chiarella of Sydney Nursing School has described the collaborative arrangements requirement as a waste of doctors’ time and “an insult to the professionalism” of an NP working well within their scope of practice.
“Not every patient needs to see a doctor every time they visit a primary healthcare setting,” Prof. Chiarella, a former NSW Health chief nurse, wrote in 2022.
“Many patients can and are managed by a nurse for chronic disease management, lifestyle and self-care support visits, immunisation, dressings, and care coordination. However, the system consistently undermines this.”
Despite the May Budget measures, the government still has a lot of work to do to allow NPs to work to their full scope of practice – as its NP workforce plan acknowledges.
Experienced NP and NSWNMA member Lesley Salem is among five NPs working at a remote Queensland Aboriginal community, who were recently terminated by their employer, an Aboriginal health service.
They have been replaced by fly-in fly-out doctors from a Sydney-based agency.
“Most of the doctors are from overseas, with little cultural understanding of Aboriginal people and some have poor English,” Lesley said.
However, the health service must generate its own income and can make a lot more money using doctors who have unimpeded access to the MBS.
NPs replaced by doctors for financial reasons
Lesley said it is the fourth health service she has worked at where NPs have been replaced by doctors for financial reasons.
“Under the MBS, NP charges are time-based rather than procedure-based – we don’t have the full range of MBS item numbers available to us,” she said.
“I could be doing a pap smear or suturing somebody and I have to use the same time-based item number.
“Medicare has no idea what I’m actually claiming for.
“NPs are incredibly underpaid for doing the same procedures a doctor does.
“A doctor might get $70 (item 30032) for doing fewer than seven sutures. The same procedure would usually take me under 20 minutes, so I would get $19.55 (item 82205).
“NPs working in remote situations do Aboriginal health assessments but can’t access the relevant MBS item number 715, which pays a benefit of $232.50 to the doctor.
“NPs play a vital role in many Aboriginal communities but still can’t access the MBS item numbers related to Close the Gap initiatives, such as obtaining equipment and accommodation for patients.”
She points out another glaring anomaly: NPs are not allowed to give COVID-19 vaccinations and advice.
“Registered nurses can do it, pharmacists can do it, but the doctors’ lobby didn’t want us NPs doing it because they would have had to give us a Medicare number, which also serves as insurance for the doctor so they don’t have to take out separate indemnity insurance.
“Medicare is an incredible scheme and the doctors think it is their monopoly. It was set up for the people of this country, not as a tool for doctors to create wealth.”
NP workforce must grow
A nurse practitioner (NP) is an experienced registered nurse (RN) who has completed an additional master’s degree and been endorsed as an NP by the Nursing and Midwifery Board of Australia (NMBA).
The NP workforce plan recognises that NPs “have the skill, knowledge, expertise and legal authority to provide preventative care, and diagnose and treat people of all ages with acute and chronic health conditions.”
In releasing the plan in May, Assistant Federal Minister for Health and Aged Care, Ged Kearney, said NPs have existed for more than 20 years but the workforce remains small.
In 2021, only 1549 NPs were working across Australia, while another 650 had completed their masters-level training but were still working as RNs, Ms Kearney said.
About 30 per cent of employed NPs work in regional, rural and remote areas.
“The NP workforce needs to grow, to help address inequities in access and outcomes so all Australians can get the care they need when they need it,” she added.
To be eligible for admission to an NP study program, an RN must have:
- current general registration as an RN with the NMBA
- a minimum two years’ full-time equivalent (FTE) as an RN in a specified clinical field and two years’ FTE of current advanced nursing practice in the same clinical field
- a postgraduate qualification at Australian Qualifications Framework Level 8 in a clinical field.