Home' Australian Ageing Agenda : AAA Jan-Feb 2013 Contents LIFE AS A NURSE
But, given that NP is a relatively new and
emerging role, O'Brien was open to new
prospects and is now working part-time
within a small business model as a private
practitioner. This opportunity came from
an innovative model in which he could
operate as an independent contractor
with his own professional indemnity,
providing primary care services in
collaboration with a General Practitioner
(GP) to residents in aged care facilities.
He also works part-time for Silver Chain
delivering primary care to clients in a
rural region north-west of Perth.
In his private practitioner role,
O'Brien works in collaboration with
another nurse practitioner and several
GPs to provide services to residents
in a number of facilities. He is able to
claim certain items from Medicare, and
share other items with the GPs under a
commercial agreement. Mostly, O'Brien
says that he visits his residents on a
planned basis, but is also available for
unplanned episodes of care.
"In my work as a nurse practitioner
my focus is on taking a preventative
approach in managing residents with
chronic diseases. I monitor medications,
and with the GP, devise treatment plans.
Every three months, with the GP and the
facility staff, we conduct a review of each
resident, as well as, an annual review,
which provides a template for the coming
twelve months. Our aim is to optimise the
RESISTANCE TO THE ROLE
O'Brien says that from his experience,
setting up a private practice is best done
in collaboration with a GP because, in
effect, you are competing with his income
stream. To avoid potential conflict, he
says, it is best to have a commercial
contract in place from the outset.
Strangely enough, he adds, the greatest
resistance he has experienced has not
come from doctors, but from nurses.
"My experience is consistent with
what others have reported, which is that
initially nurses are concerned that you are
going to be taking over their role. But, it
usually becomes apparent quite quickly
that you are not there to take over their
role, but to support it."
He says that resolving the
misunderstanding takes a different
approach in each facility, as each has its
own particular culture.
O'Brien also reports that the facility
managers are also often resistant to the
role of the NP as they initially struggle
with the fact that they are working with a
nurse who is not under their control.
"It is a steep learning curve for them
as well, and sometimes facility managers
over-step the mark by trying to control
our clinical practice," he says. "But
things usually settle down reasonably
quickly when they see that our work is
not involved with ACFI or care plans,
but rather, focused on primary health
care, and especially chronic disease
Nurse practitioner Keith O'Brien
AAA: WHAT DO YOU SEE ARE THE OPPORTUNITIES
FOR NURSE PRACTITIONERS IN AGED CARE?
K.O'B: While most nurse practitioners are currently employed within the hospital system, I
see great potential for NPs working in aged care under a small business model. Given that
access to primary health services in aged care is often limited, I can see that collaborative
models like the one I am working under have the potential to improve timely access to
primary care and reduce unnecessary admissions to hospital.
AAA: WHAT ADVICE WOULD YOU GIVE
TO RNs WHO MAY BE CONTEMPLATING
BECOMING A NURSE PRACTITIONER?
K.O'B: I would encourage any nurse who has a desire to work at an advanced practice
level to consider the role. The person must be prepared to work autonomously, while at
the same time taking a collaborative approach. I believe that primary care in an aged care
setting is particularly complex and requires the collective wisdom of a specialist nurse,
and a GP with a specialty interest in the care of the elderly, in order to offer the sort of
comprehensive health care which is required.
AAA: WHAT SKILLS DOES A NURSE PRACTITIONER
NEED TO WORK IN AGED CARE?
K.O'B: To successfully work in aged care a nurse practitioner must have highly-developed
assessment and clinical examination skills. You also need well-developed diagnostic
skills and a good understanding of pharmacology, practical wound care and continence.
Experience with palliative care is important, as is experience in acute care management.
AAA: WHAT ARE THE REWARDS AND
CHALLENGES OF THE JOB?
K.O'B: The best reward is being able to maximise the residents' enjoyment of life, given the
limitations of their health. The challenges are definitely working with bureaucracy -- both,
Medicare and the aged care regulators. Medicare gives scant recognition to the skills of
nurse practitioners and we don't have access to items on the MBS for tasks, which we can
competently provide. Making a living as a private practitioner is difficult. While I understand
that regulation in aged care is necessary, it is frustrating to work in a system which seems
more focused on the regulations than the resident.
AAA: WHAT DO YOU ENJOY ABOUT
WORKING WITH OLDER PEOPLE?
K.O'B: At that late stage of their life, I find that people are more authentic and really
know what they want. It is one of the great privileges of this type of nursing to be able
to help each resident and their family on their journey towards death. We work towards
empowering the resident as our model is focused on the resident's wishes and not
necessarily on best practice indicators. Without stepping over the boundaries of
inappropriate practice, we make the person the focus of our care.
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