A new NSWNMA branch aims to address the historic under-recognition of primary health care nurses and midwives.
Australia’s hospitals and nursing homes were at the frontline when COVID-19 swept across the nation from early 2020.
Facilities imposed strict visitor limits and enforced mask mandates in an effort to protect patients and staff.
However, most of the 3,500 to 4,500 primary health care nurses in GP clinics and community settings in NSW had fewer resources, less protection and little visibility.
“Primary care nurses felt their needs were being overlooked,” said RN Annabel Wood, who was nursing at a Sydney GP clinic when COVID-19 hit.
“Unlike hospitals, many primary care settings remained fully accessible to the public,” she said.
“We couldn’t close our doors and we had people coming in who refused to wear masks.
“There was aggression, uncertainty and a constant need to adapt – and we were largely navigating that without a collective voice.”
Annabel sought advice from the NSWNMA on ways to protect herself and colleagues.
“The Association was able to support me as an individual member, but there was no clear way for primary care nurses to engage collectively.
Working in isolation
“We couldn’t form workplace branches due to small team sizes, and many of us were working
in isolation.”
That experience led to a sustained push for better representation – a process that began during COVID-19 and took several years to navigate through formal structures.
Annabel has been advocating for a dedicated primary health care voice within the Association since that time.
“Through ongoing collaboration with the NSWNMA, a new model emerged: a statewide Primary Health Care Branch,” she said.
“We recognised that a statewide specialist branch was the best vehicle to give a unified voice to isolated nurses in metro, regional, rural and remote areas.
The branch represents nurses in settings ranging from GP and specialist clinics to Aboriginal community-controlled health services, school nursing, correctional health, refugee health, community health, and occupational health nursing.
The NSWNMA has promoted the branch to potential members through social media groups, a Primary Health Care Nurses Day video produced by the Association, and an expression of interest form on the Association website.
Fast growth
Interest has grown rapidly and more than 100 members registered within weeks of the branch’s first meeting held online in April.
Annabel said responses to the new branch range from strong, enthusiastic support, to cautious scepticism.
“After years of feeling overlooked, it makes sense that not everyone is ready to trust that change is possible.
“And that’s exactly why this work matters.”
Annabel says the timing of the branch is critical.
“COVID exposed the gaps and also highlighted how essential primary health care nurses are.
“What we’re seeing now is a shift in expectations – nurses are being asked to manage more complexity, take on expanded roles, and deliver more care in the community.”
Emerging changes, including nurse prescribing and broader scope of practice opportunities, are increasing both responsibility and potential impact.
Complex needs
At the same time, patient needs are becoming more complex.
“We’re no longer managing single conditions in isolation,” she said.
“Many patients are living with multiple chronic diseases, which require more coordination, more clinical judgement and more time.”
Primary health care is also central to chronic disease prevention – an area under increasing pressure.
“Preventative care has never been more important, and primary care nurses are in one of the strongest positions to deliver it.
“We’re the ones championing health assessments, care planning, education, and follow-up – the work that keeps people well and out of hospital.
“However, systemic barriers are limiting that potential.
Limited support
“Workload pressures, limited support and a lack of understanding of our role within some practices make it harder for nurses to consistently deliver this level of care – if at all in some cases.”
Annabel said these pressures are reflected in the issues being raised by members of the new branch.
They include meal break and overtime violations, significant pay disparities, scope-of-practice breaches and heavy workloads contributing to burnout.
“People are not getting paid overtime for missing meal breaks and they are subject to unlawful deductions for breaks that they actually worked.
“Minimum wage rates remain significantly below the Public Health System Nurses’ and Midwives’ (State) Award and some nurses are paid even less than the minimum rate.
“Currently, a Level 1 RN (pay point 8 and thereafter) general practice nurse who is paid under the federal award will be earning around $15.80 an hour less than an RN at the same level in the public system.
“That’s a difference of about $600 per week for a full-time nurse.”
Other issues flagged by primary health care members include nurses being required to work outside their scope of practice and ENs being asked to work without direct supervision by a RN.
Some nurses report they cannot get a copy of their employment contract and are not given pay advice slips.
Know your rights
Educating primary health care nurses on entitlements is a priority.
“A fundamental problem is low awareness of entitlements due to the absence of structured orientation programs,” Annabel said.
“The branch is working on practical ways to educate members about their rights.”
Annabel says these challenges are interconnected and increasingly urgent.
“The risk is already visible. The causes are already understood. There is a clear opportunity to address this now.
“Without meaningful change, we will continue to see workforce attrition, reduced capacity in primary care and increasing pressure on the broader health system.”