Since the establishment of the Bridges-Webb Medal in 2008, an annual award presented by the Australasian Association for Academic Primary Care that recognises members who have made an outstanding contribution to primary care teaching and/or research, GPs have dominated honours.
That was up until earlier this year, when Professor Liz Halcomb, the inaugural Professor of Primary Health Care Nursing at the University of Wollongong’s School of Nursing, became the first nurse to take out the award.
The breakthrough represents a tipping point for the recognition of nurse-led primary care research and its value to multidisciplinary teams.
“I was very humbled to be the first nurse to receive this award,” Professor Halcomb says.
“I am very grateful for the opportunities that I have received in my career journey so far. I have been fortunate to have been supported by a number of wonderful multidisciplinary mentors who have been so giving of their time. Receiving this award was a special achievement as it acknowledged the hard work over many years to develop my research program and strengthen our current team.”
Professor Halcomb hails from a family of nurses and was destined to enter the profession.
“I sought to enter nursing to work in a dynamic job that supported people to maintain their health and mange health events,” she recalls.
“Despite having family members in the nursing profession, I really didn’t have a good idea about the scope of nursing and the variety of roles before I made the career choice.”
After graduating, she worked in a major tertiary referral hospital and spent a decade working in the Intensive Care Unit (ICU).
Whilst at Liverpool NSW Hospital, she undertook secondments at the Centre for Applied Nursing Research and the Trauma Department, working on various projects where she was able to expand her research skills.
“I found that I enjoyed this work and so enrolled in a PhD program at the University of Western Sydney,” she explains.
“After having to change my PhD topic, I serendipitously fell into primary care as my supervisor had a grant working in general practice and had noted the increasing number of nurses working in this space. I then went on to complete a PhD around the role of the general practice nurse in heart failure management. Working in primary care was dynamic as many workforce changes were happening and so I continued to build my research around this focus.”
Since beginning work in the primary healthcare space in 2003, Professor Halcomb says the number of nurses employed in general practice has grown considerably in line with expanding nurse roles and scope of practice.
“Nurses in primary care have developed strong networks to provide mutual support and foster role development. In terms of primary health care research, nurses are starting to move from passive involvement in data collection to undertaking small projects and being team members in multidisciplinary research teams.
“At the University of Wollongong, we have grown a research team, including early career researchers and PhD candidates, investigating a range of issues around primary care nursing workforce and chronic disease management. This is a significant step to be building a core group of nurse researchers who are leading primary care nursing research.”
Professor Halcomb says the biggest challenges facing primary healthcare relate to funding of nursing services and recognition and understanding of the nursing role.
“While dedicated item numbers for primary care nursing services resulted in nurses being constrained to specific tasks within their role, the current system of block payments has not successfully addressed these issues,” Professor Halcomb says.
“Working in the context of the small business environment of general practices, nurse funding is inextricably linked to practice income. This continues to constrain the role of the nurse within activities that bring income. Additionally, the relatively low rebates provided for nursing activities and low wages paid in many practices devalue the skill, knowledge and education of nurses in primary care.”
“Despite nursing in general practice being increasingly visible, there is still a lack of understanding of the role and limited recognition of the complexity of care or autonomy of practice,” Professor Halcomb adds.
“Other nurses, general practitioners, practice managers and the community devalue the role when they don’t understand the scope of practice or recognise the knowledge, skills and competence. A major challenge moving forward is raising the visibility of primary care nurses and recognition of their role and experience.”
Professor Halcomb says she remains proud of the cohort of PhD candidates and early career researchers emerging within the Primary Health Care Nursing Research Group (PHCNRG) who are helping build research capacity in primary care in Australia and globally.
Inducted into the Nurse Researcher Hall of Fame last year, Professor Halcomb believes the work she is doing, which includes generating new knowledge and understanding in primary care and supporting primary care nurses and managers to improve clinical practice, is having a major impact.
Current projects include a randomised controlled trial of a practice nurse-led intervention for hypertension in general practice, a study of the attitudes and preparedness of third-year nursing students to pursue a career in primary care, and projects looking at the delivery of lifestyle risk modification by nurses in general practice.
“It is important for any professional to work to the full extent of their scope of practice in order to be satisfied in their job and make the optimum contribution to the workplace. Nurses in PHC are no different,” Professor Halcomb says.
“Providing opportunities to work in role that encourage them to work to their full scope allows them to stretch themselves and engage in challenging work that is satisfying. Additionally, nurses can make the optimal contribution to healthcare when they are working to the extent of their scope.”
Professor Halcomb is optimistic about the profession’s future and nurses having an impact across clinical areas but says nurses must take opportunities to showcase their value and contribution to healthcare.
“This creates a need to change the language that we use about our roles and the way in which we present ourselves. It is time to stop lamenting the poor treatment that we receive from others and time to be loud and proud about being a nurse.”