September - APNA

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PRESIDENT AND CEO MESSAGES Reflections from the President It’s been a very busy few months for APNA and for me as the new President. Within hours of being elected as APNA President I was off to New Zealand with Belinda Caldwell, our dynamic CEO, to visit general practices and Primary Health Organisations (PHOs); which have a similar role to our Divisions in Australia. We met several amazing nurses working in many varied roles. Nurse practitioners in NZ are a growing primary healthcare workforce, further progressed and entrenched in the primary healthcare system than the Australian sector and much respected by their colleagues in general practice. I was equally impressed by the nurses that work on the frontline of general practice. Much of their basic day-to-day work is similar to the PN role in Australia, in that they run acute clinics daily, triage unbooked clients, organise and manage chronic disease self management clinics, and plan and run preventive health programs. What stood out was that the PNs in the PHOs we visited are well respected by their clients and colleagues and are reasonably renumerated for their contribution to the health of the population they serve. They also have a well structured career path that allows for growth and development in areas of interest. The PHOs, in line with the national registration boards, run graduate nursing entry to practice programs in general practice, based on competencies that are well structured and allow for individualised learning plans Looking to the future and the development of portfolios against knowledge, skills and scope of practice. These nurses each have an enthusiastic preceptor who is constantly challenged, educated and supported to provide a balanced educative experience with learning objectives and demonstrated outcomes. There is a prevalence of PNs at every level in the NZ health system. Since the establishment of the NZ Primary Health Care Strategy in 2001, there has been a business case for the development of a Primary Health Care nursing strategic plan in 2010, which has nurses on the advisory group. District Health Boards (DHB) have Directors of Nursing, nurses are on the boards of DHBs and PHOs, and several of the PHOs have nursing development teams with nurses employed as Nurse Leaders. PHOs encourage nurse leaders to run dynamic preventive health decision support programs and the data from these feed back from the general practice to the PHOs — the evidence ensuring funding of future projects. At the end of our tour we attended the 2010 NZ Primary Health Care Nurses Conference in Auckland. It provided a wonderful opportunity to hear more about the inspiring work of nurses in primary healthcare in NZ. The culmination of the conference was the official launch of the NZ College of Primary Health Care Nurses. The College is a merger of three colleges and sections, and is made up of members from the former New Zealand Nurses Organisation (NZNO) District Nurses Section, Public Health Nurses Section (NZNO) and NZ College of Practice Nurses (NZNO). We are delighted to hear that our NZ colleague Rosemary Minto was recently elected as the chair of the NZNO’s 2000-strong College of Primary Health Care Nurses. Debbie Davies and Rachel Calverley are also on the executive committee of the College. These three amazing primary healthcare nurses attended the APNA 2010 conference and shared their stories of hard work, growth and development of nursing. They have been instrumental in the development of nursing into a respected and well structured career path for primary healthcare nurses. We look forward to continuing our friendship with our NZ colleagues and extending our international links to further value add to APNA’s growth and development. Finally, I would like to thank our immediate past president Anne Matyear who has led us so well and continues to support and mentor me on my journey as APNA President for 2010. Thanks so much Anne. Julianne Badenoch President Australian Practice Nurses Association We finally know what the future holds, or have a better idea of its general direction, now that the Australian government has been formed. delayed writing this message until the announcement, I as the policy differences between a Coalition and Labor government has significant ramifications for primary care nurses and for APNA. It was a busy period while we attempted to have a voice in the election campaign and provide members with an overview of the different policies proposed in general practice and health. It has been great to see members engaged in the process, putting their tuppence worth in and at times holding us to account. Member engagement is a key achievement for which we aim and encourage. Now we know what lies ahead, we can get down to the task of advocating for nurses on primary healthcare reform, including the practice nurse funding incentive, formation of primary healthcare organisations (Medicare Locals), after hours telephone triage, telehealth consultations and patient controlled electronic health records. It will be a busy time and I look forward to engaging with members over their experiences and views of the challenges and opportunities for nursing in each of the proposed reforms. The conference committee 2011 has met and developed a very exciting and robust program for next year’s conference, to be held in Sydney (see ad on page 5). Members of the committee range from ENs, RNs and a NP candidate, and also have an academic and public health nurse in the mix. Rural and city locations are also well represented. I cannot speak more highly of the value of grass roots members taking full ownership of the conference program. Finally, in response to the APNA member survey, you may have noticed we have ramped up the member rewards program. The intention is to provide value to members and, in some cases, revenue to the association, so that we can limit the need for membership subscription increases. However, we are monitoring for impact and suitability and welcome any feedback as to level of benefit of such programs. We also welcome suggestions of other companies we could approach. Belinda Caldwell, MPH Chief Executive Officer Australian Practice Nurses Association belinda.caldwell@apna.asn.au 2 Primary Times September 2010
PROFESSIONAL ISSUES Member questions It’s been a busy year, with many industry changes. As expected, lots of questions have been raised. Do you have a list of the mandatory indemnity requirements/competencies for practice nurses To remain registered, you are required to undertake 20 hours (not points) of learning a year. National registration does not require you to do anything other than that which will ensure you remain competent to continue to work in your role — this is up to you to decide as a professional. You will need to prepare a learning plan looking at your role and determine what you need to undertake over the year. APNA has developed an online CPD portal that allows nurses to develop learning plans and record CPD activity. APNA is also endorsing learning activities, so that learning providers display how many hours certain activities are worth. (Check out the APNA website: www.apna.asn.au) As for professional indemnity, there are new standards in national registration around indemnity. You will be required to either present evidence of your employer’s cover or have your own (see article on page 6). The Mediprotect policy covers you for full scope of practice and does not have specific requirements. So, again it is up to you to determine your own scope of practice and ensure you are appropriately qualified and trained, competent and confident. Colleagues who attended the PNCE legal issues session in Sydney have said we need to have our own professional indemnity insurance even if covered by our employer’s insurance. However, I have received information from GP NSW and the NSW Nurses Association that there is no need to have your own insurance policy if you are covered by your employer’s insurance. You do not need to have your own professional indemnity insurance. However, if you are relying on your employer’s indemnity insurance, you need to make sure that your employer has practice indemnity insurance and that you have sighted it. The new national board can require you to submit evidence of your employer’s insurance. You need to also make sure the practice has practice indemnity insurance, not GP professional indemnity insurance only. If you are relying on your practice indemnity insurance, you need to look at it and check what nursing care is covered. Some policies cover specific nursing activities and others cover scope of practice. We still recommend having your own professional indemnity insurance even though it is not a requirement under national registration. Relying on your practice indemnity insurance will not cover you for the three years after you have left the practice, during which a patient is entitled to make a claim. Having your own insurance means that you know what you are covered for and it will travel with you to a new employer. I am keen to find out more about the removal of MBS item numbers. How does the Government find out what nurses are being used for The ‘for and on behalf of’ nurse item numbers had significant issues in terms of being focused on a task, paying insufficiently, and implying a medicolegal liability that did not exist. The proposed new funding changes are intended to expand the scope of practice of nurses in general practice, as well as increase the funding going to general practice for nurses. The new funding is a significant increase on the funding provided by the PIP incentive and the nurse item numbers. The intent is to not change what you do, only how it is funded. This is a big change, however, and we expect there to be a lot of work and consultation to get the business rules correct. This funding provides a greater acknowledgment of the autonomous nurse role than the current item numbers, which imply nurses only work at the direction or under the supervision of the GP. How will we know what nurses are doing We suspect we will see more sophisticated use of medical software being uploaded to two local networks. The GP analogy is that we only have evidence of what they are doing through the BEACH study — their item numbers do not indicate the clinical care provided. We will certainly be arguing that a similar annual study is undertaken for the nursing role. Nurse practitioners will be funded differently from November with access to generic attendance item numbers in a similar way to the GP. We will keep members up-to-date with the changes, and will be seeking input as the consultation progresses. We have conflicting ideas with some of our GPs at the moment regarding nurses undertaking cryotherapy treatment, mainly for warts. Are there standards for this or education we can undertake Cryotherapy needs to be considered in the same way as any extension to scope of practice — are you authorised (probably no restriction here), are you educated to do it (is there training available) and are you competent/confident And, finally, does the practice/organisation have a suitable clinical policy and procedure If no training exists in this area, you can do research, reading, etc. If you are confident that GPs are undertaking current best practice, they can teach you. Or, you can organise a deemed expert to teach you, such as a dermatologist. Would you please clarify the hourly rate for a Registered Nurse NO2 as a practice nurse From what I understand, practice nurses are now under the same award as nurses working in the hospitals. When I checked out the hourly rate, it was significantly less per hour. I have thought this would be a great career move, but I can’t justify the loss of income. Do you think wages will increase in the near future It is true that from January all nurses were placed under the same award. However, what nurses in the hospital get paid will continue to vary, as the hourly rate they are paid is part of an enterprise bargaining agreement negotiated by the union. The average hourly rate for nurses in general practice is around $30.50, but can vary depending on your negotiations with your employer. Every practice is different. We hope you continue to consider general practice nursing as a great career move, as nurses in general practice a very satisfied group with their role and the pay and conditions will continue to improve. I understand the 20% casual loading will increase 1% each year, as part of the Modern Awards that commenced from 1 July. Can you confirm if this should be paid to casual practice nurses from the first full pay after 1 July The casual loading applies on and from 1 July and is adjusted by 1% each year until it reaches 25%: • 01/07/2010: 21% • 01/07/2011: 22% September 2010 Primary Times 3
Page 1 and 2: Supporting nurses in PRIMARY HEALTH
Page 3: CONTENTS EDITORIAL BOARD APNA NEWS
Page 7 and 8: APNA NATIONAL CONFERENCE 2011 Great
Page 9 and 10: PROFESSIONAL ISSUES All practice nu
Page 11 and 12: Secure your FLUVAX ® 2011 season o
Page 13 and 14: PRACTICE MATTERS standards or guide
Page 16 and 17: CLINICAL CARE Helping patients thro
Page 18 and 19: PRACTICE NURSE PROFILE Practice nur
Page 20 and 21: CLINICAL CARE Gastroenteritis in ch
Page 22 and 23: CLINICAL CARE Identifying common nu
Page 24 and 25: SPECIALIST INTERVENTION Practice nu
Page 26 and 27: FEATURE Nutrition and chronic disea
Page 28 and 29: FEATURE without the nutrients. Pati
Page 30 and 31: NEWS Role of codeine questioned The
Page 32: CoaguChek ® XS systems - the smart

September - APNA

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