A prescription for future care

Thank you Kathy for a very interesting article and for your comments Angela. I support the view advanced by Kathy about the need to more fully utilising the skills of nurses within the primary care sector. Traditionally in Australia the skills of nurses have tended not to be fully utilised except outside of capital cities. I have been struck by the broad scope of nurses in many other countries with similar nursing education systems to that in Australia. Since 1986 I have had the opportunity to visit health services and spend extended periods of time with clinicians and educators, nursing and medical, in the UK, Canada, USA, Sweden amongst other places it was evident that nurses in Australia have not had the opportunities available to their peers. Attending international nursing conferences and hearing what peers overseas are doing can be eye opening.
Several examples illustrate this point – nurse run clinics, with support of GPs or specialists for decades, with limited prescribing rights for common conditions where treatment is routine; nurses routinely referring to nurse specialists within mental health for an opinion on care and management that was entered into the clients file and read by ALL clinicians; Community and district RNs working closely with small teams of ENs and care staff and local GPs; nurse anaesthetists. I could go on.
Angela I agree we do not want more clinicians prescribing unnecessarily however nurses can work effectively within set guidelines. We have guidelines that all prescribers ought to follow. Many nurses, now and in the past, suggest particular medication regimes to a doctor, directly or indirectly. Well trained and supported nurses can provide advanced care. Specialist diabetic nurses transformed the community care of people with diabetes, supported by medical specialists. Womens health nurses provide a great service. You note the impact of the AMA, clearly it has had an impact on the scope of nursing practice. However medical specialists have also supported expanding nurses roles.
Do nurses have the skills to take on more independent roles, yes and no. Are RNs currently educated to take a broader role – I sometimes wonder. I recall efforts made to teach nurses basic physical assessments in early degree floundered – it was not doctors who objected, it was colleagues in the health service. Nurses can be taught the knowledge and skills they require to work to the limit of their registration and be encouraged to undertake further education. I think it is great that nurses are taking more responsibility and working in teams. An example recently my husband recently saw the Nurse Practitioner who works with his cardiologist. She did a through and very competent examination, recorded it in detail, suggested some tests, ordered some and wrote to the GP to request others be undertaken. All at half cost to us and the tax payer. My sister-in-law in the UK sees the nurse at her GPs clinic, she examines her, monitors her health, prescribes and sends her for tests. The nurse consults the doctor as necessary. I would like to see more of this occurring. And I would like to see more nurses taking greater responsibility for planning and providing care within a team context. One of the most important developments in Australian nursing, in my view, is that practicing nurses are now teaching. Nursing students have some clinical role models, nurses who like their medical peers, manage units, provide care, research and teach.