Great idea on utilising often academically well prepared nurses. However the Masters requirement has left many very experienced nurses out. They are aged in their mid forties and up, often the primary income earner in their household and were denied an opportunity to study due to family & financial committments.
I am finding the swing towards the perceived better qualified nurse is leaving many clients harmed because of their lack of experience. Nursing is one place you get NO, repeat NO RECOGNITION OF PRIOR LEARNING. I have an Intensive Care Certificate but that was hospitalised based, hard work fitting in intensive study, working fulltime, including nightshift and juggling a small child!! I cannot even get into a university to study.
I am a good foot soldier and prepared to put in the hours these flighty nurses only stay until the going gets tough or they have to start justifying their clinical practices the text book wont help them then!!
Bring in RPL and start valualing an important part of the workforce.

It is difficult to understand why so little attention is paid to the potential contribution of Nurse Practitioners to the health workforce in Australia. As the writer points out, the Canadians, faced with the same shortages of doctors as ourselves, have invested heavily in building up the role of nurse practitioners. While NPs play a key role in Canada’s innovative multi-disciplinary primary health care services, they also provide general medical care in nursing homes (the EverCare group) and in remote areas. The ability to qualify as a nurse practitioner provides registered nurses with a challenging career path – the frustrating lack of which causes many RNs to quit nursing through lack of job satisfaction. Perhaps the major hurdle to be overcome in seeing numbers of NPs increase is the opposition of the AMA, which fails (or refuses) to see how NPs complement their members’ own role.

If there is so much requirement etc why not just put them thru med school? A junior doctor with academic and clinical theoretical knowledge PLUS nursing practical, life skills is a lot safer and more cost effective than a highly qualified nursing (non-medical)staff (with Masters and non-medical doctorate degrees)doing a NP course. Not ignoring that life skills and nursing experience being important, the reason why we still need doctors to make certain decisions because when dealing with life and death it is clinical skills AND theoretical evidence based knowledge that counts!

Another thought:If a NP is acting as a pseudo doctor, what will the liability be? Right now in clinical practice the team leader (doctor) is the point man of law suits for all clinical errors, regardless if it is the nursing staff that initiates it. What will the indemity insurance be like? Will it raise the cost of ALL health practitioners in the country?

The history of modern health care evolved to the current structured approach for patient safety. Are we going backwards in allowing pseudo-doctors and sub-standard clinical care? The answers lie in training more doctors AND nurses to keep up with population growth and ageing populations (everyone in the healthcare stuture has a role and each role is important). Not band aid measures of half-baked clinical fill-ins. We will spend more time mopping up this mess in the future. History has certainly taught us many of these lessons! It is time we learn from our past mistakes!

Why with medicine are we so focussed on heaps of training and intelligence?

I find doctors, especially specialists, are so over worked ( due to lack of training of more doctors ) that they cant even take down a basic compaint.

I find myself reporting a sore knee, and find later they recorded a sore ankle. Or a persistent cough, to find they recorded my birth date but then calculated my age on what I look to be. Or that they cannot even align a clean fracture despite being surgeons.

Training and intelligence must be accompanied by a clear mind which means more doctors and less workload. Nurse practitioners would be less money-hungry and thus more suited to accomodate for this.

Why with medicine are we so focussed on heaps of training and intelligence? > Should that quetsion even warrant an answer?

Yes you will get mistakes made by individuals, whether a nurse or doctor. A GP or a specialist. That's called being human. That's why there is a role of a nurse to counter-check things.

Risk minimalisation thru reducing human error is done thru a team appraoch (doctor-nurse). Each has an important an defined role. Once you start cutting corners (reduce staff) and mixing up roles and responsibility is when potential disasters can occur. What we need is MORE doctors AND nurses to cope with MORE patients. Not pseudo-roles and reduced staffing! NP or doctors, still human. ie still human errors!

Training and intelligence must be accompanied by a clear mind which means more doctors and less workload. Nurse practitioners would be less money-hungry and thus more suited to accomodate for this.>>

Yes better work distribution between more healthcare staff (of both doctors AND nurses). It is false economics to think that having a half-trained staff is just as good as a fully trained one. You get out what you put in. We may not pay the price now,and it may even seem cheaper, but what happens in the future when things go wrong? What is the price we have to pay? How much is your life worth?

Having re-read the article in view of some of the posts, I cannot see where "half-trained" practitioners or "pseudo-doctors" are advocated?

It appears to me that what is proposed here is a new strand to our health-care. The creation of an entirely different structure to the existing one and one which, it would appear, will provide care to those who are missing out on medical care in our over-extended system.

Yes, admitted, we need more doctors and nurses. But we are not getting them. Many factors contribute to this: it's a situation which has been devolving for decades with no steps taken until we have reached our current impasse. It will taken time, money, re-structuring, research, reform...there's no overnight fix. In the meantime the population's health problems are not going to go away and the aged population is increasing.

From what I can see no-one is talking about "life and death" situations. A large part of a GP's practice deals with innoculations, colds, coughs, impacted toe-nails, pre and post-natal care etc., and, in rural aboriginal communicaties, basic hygiene, birth control, nutrition and health education. Nurse-practitioners could alleviate a lot of this work-load thus freeing up harrassed GPs for those visits which do, indeed, involve "life and death", surely?

Reading between the lines, a NP is not really a doctor, but then not really a nurse either. The NP does some of the role of the doctor, but yet not a doctor. So to me reading the article, a NP is a pseudo doctor. And since the NP doesn't actually go through the full med school syllabus but a modified, cut down version, then to me that sounds "half-trained" as a doctor.

I do not have the answer to a problem that is faced world wide. In countries whereby healthcare is still working, the formula seems to be the established system of defined roles. And the success due to health care staff: patient ratio. Also a lot of public education of sharing of a limited resource of healthcare.

While admittedly most "medical work" in the community is non life and death, there are enough case examples of patients slipping between the cracks of the system because staff are not trained to recognise it or how to refer it on appropriately.While a statistician may say 1 in a few thousand is a reasonable risk, to me a life is still a life. One lost life due to incompetance is one life too many. If you don't have resource and a life is lost, you couldn't have prevented it. But if you want to staff it and spread your catchment area, then do a good job and not a half-hearted, band-aid attempt. Get it done right or don't do it at all! Don't create false expectations. It is not like we have an endless resource for trial and error. Fix it using a formula that has worked before

We are in this current health care impasse because no one has the guts to make the hard decision for a long term prospective. It's a "as long it doesn't happen on my watch" attitude and passing the buck. It is like the whole global warming debate. Do the hard thing now and do it right, or have band aid approaches and suffer the consequence later.

Australia had one of the best healthcare in the world before. A huge reason was the current set up but with better staff:patient ratios. If that formula worked, stick to it and catch up with what has changed.

As for non "life and death" situations,this is already part of existing nursing training. How does NP degrees add anything else? Besides, unless medically trained, innoculations have risks of anaphlactic reactions requiring intubation. Of which require medical (not NP) training. Pre-/post-natal care, infectious diseases etc also require management plan for life-threatening complications.If not medically trained, would that have been noted?

Goes back to point that if nurse's role as is currently defined, there are no false expectations. No added benefit of taking on medical roles of a doctor if not trained in management of the whole gamut of complications. Far better to just have more nurses in isolated communities to do nursing duties, have good ambulance support for resuscitation/stabilisation, and have good staffing in hospitals to refer as required. Wasting money and time to train existing nurses to be NP adds nothing and risks many.

Yes nurses can alleviate a lot of work-load and freeing up GPs. But we need more nurses and doctors! Not changing and amalgamating an already small pool of staff into more complicated permutations. We have limited financial/ human resources. Like the global-warming race, we have no time. Stick to something that has worked. Fix the ratios that tipped the balance. Creating new job description of NP adds nothing to the end equation.

Having read all the comments, I can only voice my personal opinion that reading the article, the idea of more N.P'S IN THE Health System was a positive, until I found that the qualification was to be a nurse with a MASTERS DEGREE! Here was I, thinking we were talking about a kind of PARA-MEDICAL LIKE AN AMBULANCE PARA-MEDIC who I have found to be great practical help even more capable than many Doctors:- Interns or Registrars, because of their practical experience in emergencies. Sure, Doctors tired and overworked can make mistakes,but are the best qualified to diagnose.But we all know hypochondriacs and others really only needing someone to talk to; who take up Doctor's time.If I were a Doctor who had an assistant who made no final decisions but saw my patients first to assess the most needy, that would help my work-load.

When I have come down with a minor ailment, or need medication advice.

I ask our local Pharmacist, done well by me so far and saved the GPs time.

Our current system of caring for the ill has developed much like the “qwerty” keyboard. That is, from a past age to suit past technologies and systems. There are those who still perceive nurses as doctor’s handmaidens and others who believe that registrars should be worked till they drop merely because that is the way the system has always worked.
We are faced with a world that has changed it’s treatment, technology and even our perception of health care since the lady with the lamp. In other pursuits, the need is what drives the delivery….we need to re think the whole system, or sets of systems. We need to eliminate the elitism and traditionalism of a system whose rewards and perception pits one set of professionals against another. I think nomenclature in this situation is hindering what is a well overdue overhaul.
I believe in ancient china you paid your practitioner only while you stayed well, they receive nothing if you grew ill and were therefore driven to prevent illness and if you still got crook, they worked very hard to make you well!

I was looking for the agenda, I note the author credentials “Amanda Sherratt was a UK nurse practitioner for five years and moved to Perth to co-ordinate the Master of Nursing (Nurse Practitioner) program at Curtin University of Technology.”

Well if you need a doctor, you better see a doctor because this sounds like a plan to dumb-down the patient services whilst improving the income of nurses at the expense of professional doctor services.

Some folk might go to an accountant for tax advise, others are happy with the “technicians” of H&R Block. We are all at liberty to take the cheap option with your tax returns but doing the same with your health is a far more dangerous game.

Bernie2

My question " Why are we so FOCUSSED on heaps of training "...

Focus implies that other issues/objects/considerations are filtered out.

Anyway I believe the introduction of the UMAT in some medical schools entry criterion was to actually dilute such focus a little.

As for mistakes, I rarely go to doctor yet have encountered many mistakes or obvious malpractice. The rest of us with less market dominance cannot even forget to smile at the boss.

Yes, I also get the feeling that some posters are slightly out of touch with exactly what nurses do these day: the Lady of The Lamp image still persisting.

One great difference since the Crimean war is, of course, that nursing is no longer simply "women's work": the ratio of men is increasing. One poster asked why not send them to med. school to study and become doctors? Well, where on earth do you think they do study now?

Fledgling doctors and nurses attend the same classes in the beginning of their training as it is. Nurses graduate after 3 years - or 4 if they go for Honours. The criteria of attaining a Masters would increase their med. school training by another 2 years: bringing their total time to 5-6 years. A doctor of medicine must undergo another two years of practical work before qualifying but an NP, as I understand it, would be freed up to start practicing earlier than that.

As the term "Doctor" is only an honourary one in the case of medical practitioners who do not, like others with the title Doctor, actually write a Doctoral Thesis, theoretically I guess it would be possible for qualified nurse to continue studying beyond Masters and thus become a Nurse whose actual title was Doctor!

So, yeah, I agree with the poster who stated that we shouldn't get hung up on nomenclature. Rather think about ways to get qualified people into jobs quickly. As you said, Sociologist: "We have limited financial/ human resources. Like the global-warming race, we have no time".

However we part company when you continued: "Stick to something that has worked. " I would see the whole point of this discussion being that the system is no longer working.

Romany:
As a medical doctor practicing for the last 15 years and having taught both medical students and nursing students both in Australia and several countries overseas, I assure you that the knowledge base of the 2 groups are very very different.

I also hold 2 Masters degrees and a doctorate dgree, I would say that if I were sick, I rather be treated by a medical doctor who knows what he is doing and have no bedside manners that be treated by a Nursing doctorate with great bedside manner and without appropriate clinical knowledge. A doctorate historically stems from philosophy (hence PhD). The nature of the degree requires great emphasis and narrow focus (using the correct application of the word). By virtue of this fact it means there is loss of lateral perspective which is vital in clinical medicine. Word limitations here do not permit greater elaboration. In addition, many clinical specialty fellowship exams have knowledge requirements far greater than a doctorate degree. Having done both I can surely attest to that!

On systems that work, quantitative and qualitative studies have not been able to provide answers to what will work because of thenature of the rapidly evolving flied. Safe to say, most analysis points towards proven formulas.

Sir Lancelot Spratt (in the "Doctor" film series) would doubtless agree with Sociologist in maintaining the status quo, but knowledge, people and techniques have changed since Sir Lancelot taught at St. Swithin's.
Sometimes it is hard to accept that change is necessary. Marshall and Warren's Nobel Prize winning discoveries were scoffed at, yet this Australian pair went against ‘proven formulas’ for the betterment of us all. We would all likewise benefit if their kind of innovative approach was adopted to get rid of the dogma and elitism that pervades our health system. Doctors (honorary or otherwise) would be revered should they assist in the passage from an antiquated system more akin to monarchy to a system that addresses the reality of healthcare needs today (and tomorrow). There is a big risk that history will look back in shocked disbelief at a system that had the potential to change, yet did not in order to maintain the status quo.

I agree with Kiama kid that the only consistency in life is change. I also agree that no single group should have a monopoly or elite status for the sake of tradition.
However Foucault have shown that interactions in health is about an interaction of power. Unless humans turn into robots this will remain for quite some time to come. Incidentally, Barry J. Marshall and Robin Warren's contributions is in microbiology and pathophysiology. Not human social/healthcare systems.

The point of this current discussion is about having NP as an answer to the healthcare woes. As I see it, based on the proposals submitted thus far, it offers nothing extra to the end-user (ie the patient) for society's time and financial investment. It creates an increase in status for the special group of nurses for the sake of status itself. The same amount of time and money invested by society could be better off training to produce more nurses and doctors in absolute numbers, rather than increasing skill set of existing nurses to match that of a doctor but not really hitting the mark. Remember the end-goal is patient quality care in totality (ie whole of society). At the planning level we should see the big picture and recognise the interst groups and their unspoken agendas versus the means that will assist in producing desired outcome.

Status? Power? Elitism? Perhaps I am naive, but I had not for a moment considered that anyone would be arguing within these paradigms.

So is this what is boils down to for some, then? I had thought that the "nomenclature" that was proving problematic was simply that: a dichotomy concerning the title of NPs vs. RNs etc. Surely the days of people "revering" doctors ended - if they existed at all - with the demise of Spratt and his ilk?

If there is indeed concern that one particular group's star might wax as another's wanes then there is indeed little hope for reform. Adherence to the status quo would only imperil an already dangerously marginalised system.

Sociologist: I was simply being mischievous with regard to the Nurse-with-a-doctorate scenario. As a University Lecturer I am quite au fait with the scholastic hierarchy.

I am, however, bitterly disappointed that such considerations as status could be allowed to impact on such a serious issue as the nation's health.

Romany I'll leave this discussion in your capable hands, I've posted the idea of practising nurses taking a greater role in health for so long it tires me.
Sociologist, your conservative ideas, for the role of doctors and nurses
is myopic, and reflects the "doctors union" well. It may well have served us in the past, but it no longer does so.
fluff4

Nurse practitioners are not "dumbing down" any systems. How can they when they are advancing their training and skills to higher levels? They are individually registered professionals who are seeking to advance the profession of nursing. They would balk at the prospect of attaining "pseudomedical status". If they wanted to be medics, then they would train as medics, rather than a 4 year nursing degree, followed by years of clinical experience, a masters degree qualification and the seperate registration and credentialling required to become a nurse practitioner. They wish to continue within the deontological nursing ethic, to provide holistic care to their patients IN PARTNERSHIP with the patient, the medical staff and other healthcare workers. They are able to overlook these TURF wars and strive for the overall good of the patent. Lets face it, thats why anyone works in healthcare isn't it?

Nurse practitioners, appropriately qualified, are able to provide a level of individual care that is independent of medical practitioners and not medically orientated. However, this paper laced with platitudes of 'quality of care' in unconvincing. It is naive to suggest, for example, that nurse pratitioners in rural and remote areas could of itself positively influence the health if indigenous people. Where proper systems of service and standards are lacking, it is hardly possible to practice safely and effectively for any nurse. Do not undermine the many experienced registered nurses who are highly skilled and knowledgable in their area of practice. Without these nurses we will not have 'quality' in health care.

AIMEE “Nurse practitioners are not "dumbing down" any systems. How can they when they are advancing their training and skills to higher levels?”

The “dumbing-down” is achieved by “diluting” the accepted qualifications and thus standard and “quality of those who we, the consumer / patients, rely on, at face value, to provide medical diagnosis and to prescribe remedies.

It can be reasonably expected that the less competently tested provider of diagnosis and remedies, on any scale of probability, is more likely to make errors than the better qualified.

Since those errors might be of a life threatening nature, such “dumbing-down” could predictably result in fatal outcomes.

“Death” is an expensive price to pay for the issue of nurse-practitioner licenses, especially if you happen to be the patient.