In October 2023, the federal government launched Unleashing the Potential of our Health Workforce – scope of practice review.
The independent review will examine the barriers and incentives faced by health practitioners working to their scope of practice (SoP) in primary healthcare (PHC). The review aims to deliver better health outcomes for people as well as greater job satisfaction, recruitment and retention of health practitioners including nurses.
According to the International Council of Nurses, PHC is the cornerstone of health systems across the planet with equity and access essential to the health and wellbeing of all people.1 In Australia, access to PHC has become more difficult, especially in rural and remote communities. Support for nurses to work to their SoP is key to improving people’s access to PHC, but this requires funding and legislative reform. Nurses must remain engaged, professionally, and politically to identify and address the barriers that prevent and the enablers that allow them to work to their SoP in PHC.
Nurses already lead in PHC settings, working with communities, identifying needs, and implementing services. However, nurses’ SoP is often restricted by approaches to healthcare funding, policies, service provision, and the requirement for collaborative arrangements between nurse practitioners (NP) and general practitioners (GP). People in Australian communities are feeling the result of this constraint due to a shortage of independent PHC providers. Nurses working as independent practitioners, under block funding (or similar) models, will increase the number of primary healthcare providers, giving the public a choice of practitioner and improving access to affordable and appropriate services, driven by a human right to healthcare, not profits.
So, what is SoP? The scope of a profession is established by the professional standards, codes and guidelines that establish the requirements for professional and safe practice. For nurses, these are set by the Nursing and Midwifery Board of Australia (NMBA) who advise that the foundational education of registered nurses (RN), enrolled nurses (EN), and NPs in Australia captures the full breadth of the scope of the profession at the graduate entry level. For individual nurses, SoP refers to what the individual is educated, authorised, competent and confident to perform in their role as a nurse. An individual nurse’s SoP will vary and change, influenced by the setting in which they work, the health needs of people, the level of competence and confidence of the nurse and the policy requirements of the service provider.2 In some instances, nurses have been unable to work to their SoP, and this has reduced their ability to undertake the work for which they were educated, leading to deskilling and reduced job fulfilment. It is also a lost opportunity to improve access to PHC.
Access to PHC has become increasingly difficult as medical practitioners choose to work in areas other than general practice and out-of-pocket costs to visit a GP spiral. Central to this deficit has been the establishment of GPs as the gatekeepers of primary healthcare and access to associated funding, with other disciplines locked out of providing the full scope of PHC services as autonomous practitioners and members of multidisciplinary teams. For example, nurses working in GP practices must work to a restricted scope of practice comprising activities related to specific Medical Benefits Scheme (MBS) items that the GP can claim. Changes to legislation, as well as jurisdictional and organisational policy reforms, are required, together with the need to raise public awareness about how nurses can offer a safe and affordable choice of PHC practitioner.
The delivery of PHC is not solely the domain of medical practitioners. Nurses offer innovative PHC programs in a variety of settings, including community nursing, palliative care, women’s and sexual health, mental health, child and maternal services and so on. In many cases they would be better able to deliver holistic and comprehensive care if supported and funded to work to and expand their scope of practice, operating autonomously and with other practitioners. Nurses do not seek to be pseudo-medical practitioners but rather to apply their education, skills, and experience to deliver evidence-based, person-centred PHC based on the needs of the communities in which they work.
The SoP review is welcomed, and I commend nurses everywhere to become informed and involved. Visit the Federal Government’s website to learn more and follow the articles in the ANMJ.
References
1 “Primary Healthcare.” ICN, accessed 4 November, 2023, https://www.icn.ch/membership/specialist-affiliates/nursing-policy/icn-strategic-priorities/primary-healthcare.
2 NMBA (2022). “Fact sheet: Scope of practice and capabilities of nurses and midwives.” Retrieved 27 September, 2023, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/Fact-sheet-scope-of-practice-and-capabilities-of-nurses-and-midwives.aspx.
