Practice nurses ‘a conduit between patient and health system’

‘It’s been a really challenging year for everybody, the doctors and the nurses they work with. This generation of nurses, we haven’t really had to face anything like this before.’
 
That is Samantha Moses, founder of the Australian Primary Health Care Nurses Association (APNA) and nurse ambassador. 
 
As general practices went into crisis mode to navigate the coronavirus pandemic, calls to APNA’s Nurse Support Line spiked with queries on everything from regulations and personal protective equipment (PPE), to telehealth.
 
‘Nurses are very good at pivoting and adapting very quickly because that’s just part of the role,’ Ms Moses told newsGP.
 
While some practices managed to adapt with their nurses in tow, for others, the health crisis raised questions over job security – the most recent COVID-19 APNA PulseCheck survey, conducted last month, found more than 15% of the 671 respondents had had their hours cut as a direct result of the pandemic.
 
‘We’ve had some sad calls from nurses who have, unfortunately, had hours reduced and who have been made redundant or lost their jobs during this time as well, which was an unexpected consequence of COVID,’ Ms Moses said.
 
While the basis for the decision was often financial, she believes it could have been somewhat mitigated had there been more understanding around the role of practice nurses and what they are capable of doing.
 
‘Perhaps [GPs and practice managers] would have been able to use them to work in a different way during COVID,’ she said. 
 
‘So using the telehealth item numbers, and also using the time where there’s perhaps less foot traffic through the practice doors to do the things that they sometimes don’t have time to do, such as policy and procedure documents, and mining their data; making sure that the data that’s in the system is good and accurate data.
 
‘Also future planning for recommencing things in a new COVID normal environment. That’s work that’s really valuable.’
 
The contribution of nurses is being recognised this week with Nursing in the Community Week, focused on raising awareness about the role they play in supporting people to stay safe at home.
 
APNA President and practice nurse, Karen Booth says telehealth has added another dimension to the work practice nurses do, proving critical in managing patients with chronic disease.
 
‘Giving nurses in particular access to the telehealth items for seeing people at home, it’s made a huge difference to continuity of care,’ she told newsGP.
 
‘It’s meant that the GPs can rely on the nurses to follow up the patients at home, to keep in touch with them, to do welfare checks, make sure people are okay and that they’re still taking their medication, and if the patient needs it, they can then escalate any problems to the GP – that’s how you imagine team care to work.’
 
That impact on community health is what has kept Ms Booth enthralled with general practice, since transitioning from the hospital emergency department.
 
‘I was used to high flying blood and guts everywhere, all of that stuff. So I was sure I would get bored in general practice, but it’s interesting; it’s exciting,’ she said.
 
‘Usually in hospital people are in there because they’re already sick, but it’s the fact that you can intervene and treat someone early or pick something up early.
 
‘Nurses in general practice do a lot of the population health data mining, so they identify the people who need screening or need follow up so that they can come back and see the GP and stay out of crisis.
 
‘That’s a really important role.’


Versatility and collaboration is what led APNA founder Samantha Moses to general practice.

Associate Professor Carl De Wet, GP and Deputy Chair of the RACGP Expert Committee for Standards for General Practices, agrees. He says practice nurses are ‘invaluable members’ of general practice teams.
 
‘They deliver high-quality, patient-centred care and provide crucial support to clinical and practice management systems,’ he said.
 
‘Their role and responsibilities continue to evolve in line with patient need, and their consummate professionalism and dedication is inspirational.’
 
For Ms Moses, that versatility and collaboration is what led her to general practice.  
 
She says the additional time nurses often have with patients is critical, and something both GPs and patients appreciate.
 
‘I think nurses are seen as having more time for the patients. Often you’ll hear a patient say “I don’t want to waste the doctor’s time, but I was wondering about this”,’ Ms Moses said.
 
‘[It helps cultivate] trust and long lasting relationships with patients who will often tell you things that the doctor doesn’t get to hear in a short consultation time with them.
 
‘Those relationships often last for generations and start with mums bringing in their babies for their first vaccinations. I can’t really think of another role where you get to have that privilege of being involved with families in good and bad times.
 
‘We are the conduit between the patient and the health system.’
 
As the 30 September telehealth deadline looms, Ms Booth is hopeful that the Federal Government will respond to calls to extend it.
 
While not a replacement for face-to-face consultations, she believes the use of technology have proven to help practices maintain greater contact with patients to better manage their health.
 
‘If practices can schedule time for the nurse to do say a phone clinic for the patients who we know have chronic disease and are on a managed care plan, it can be a really useful adjunct to face-to-face visits,’ Ms Booth said.
 
‘It changes the relationship in that it can probably deepen it, and helps to keep that connection.’
 
Ms Moses agrees. She says by working together, collaboration between GPs and nurses can positively impact patient health, now more than ever.
 
‘Community health is really important, and prevention is definitely better than cure,’ she said.
 
‘The longer that we can keep people healthy and happy in their homes in a safe environment the better.’
 
A resource on how to make the best use of practice nurses during COVID is available on the RACGP website.
 
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