In the late 80s, early in my grad year, I recall telling my mum I was puzzled that the most experienced nurses were the furthest from the bedside.
Pathways to promotion led away from clinical practice to management and education roles. The 90’s saw the introduction of Clinical Nurse Specialists and Clinical Nurse Consultants, followed in 2001 by the first Nurse Practitioner (NP).
The NP role in Australia developed slowly. Planning began in the early 90’s but advancement was hindered by legislative barriers and opposition from medical colleagues. Once established, momentum built, as advanced practice registered nurses acquired the necessary qualifications and experience for endorsement.
Now, in 2024, there are 2,860 endorsed NPs in Australia.1
Although frustrating, slowly and steadily building momentum for NPs allowed us to learn from international experiences and to develop our own robust framework. Our regulated title, master’s degree qualification, national standards, and accreditation process are highly regarded and coveted globally.
We laid the groundwork, built the framework, consistently and persistently promoted and advocated for the role, despite the negativity and criticism from other professions and sometimes even our own.
In 2009, the efforts of Federal Health Minister, Nicola Roxon were instrumental in overcoming barriers to affordable, safe, high-quality healthcare. She was interested in the role of nurses and midwives, and particularly the role of NPs. In May that year, the Labor federal government introduced historic health reform enabling access to the MBS and PBS for nurses and midwives. The resultant Health Legislation Amendment (Nurse Practitioners and Midwives) Act 2010 provided the legal framework for those receiving care from NPs and eligible midwives to access MBS and PBS funding.
The then ANF, alongside the Australian College of Nurse Practitioners, played a pivotal role in the advisory groups that shaped this legislation. Despite being outnumbered by medical colleagues, we navigated tough negotiations on MBS rebate amounts and PBS medicine access. While we gained access to more PBS medicines than we thought we would, restrictions remained, mostly under ‘shared care’ and ‘continuing therapy only’ arrangements, which continue to limit NP practice and impact the provision of care.
In the past decade we have been part of the research team that developed the NMBA Nurse Practitioner Standards for Practice; participated in the review of the NMBA Endorsement as a nurse practitioner registration standard; provided expert advice on the ANMAC Nurse Practitioner Accreditation Standards; participated in the MBS Review Taskforce consultation; provided expert advice as a member of the Taskforce’s Nurse Practitioner Reference Group; reviewed NP scholarship applications; commissioned and participated in NP research; and made hundreds of submissions to consultations on health policy and reform highlighting the importance of growing the NP workforce. Although much of our feedback was initially overlooked, in more recent times, thanks to the efforts of Assistant Minister for Health and Aged Care, Ged Kearney, we have had success with several recommendations previously made to the MBS Review Taskforce. Most significantly, the 30% increase to the MBS rebate for NP item numbers from 1 July 2024 and the removal of collaborative arrangements taking effect 1 November 2024.
Our journey has been marked by both frustrations and successes. The bonds formed through collective efforts in these battles remain strong. Our shared experiences and support for one another have been crucial in overcoming challenges.
There is still significant work ahead to ensure NPs receive the recognition and place in our healthcare system they have worked hard for and deserve. The ANMF continues to lead this work because acknowledging and supporting NPs is advancing the whole of the profession. All nurses need to get behind NPs and the work they do.
Our aim is a universal understanding of the NP role, much greater NP numbers, widespread employment in all contexts of practice, appropriate funding for NP services wherever they’re delivered, and acceptance, trust and respect from our health practitioner colleagues. For our part, we will continue our lobbying, advocacy, research and policy efforts, and promote NPs through submissions, publications, and collaboration with other nursing organisations.
We have been persistent and most recently heard. The ANMF is committed to ensuring the vital contributions of NPs are widely recognised and valued. We will continue to make sure that everyone knows about NPs, works with NPs, and wonders what we ever did without them.
Reference
1 Nursing and Midwifery Board of Australia. 2024. Registrant data: Reporting period 1 January 2024 to 31 March 2024. Available at: https://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx
