What is a Primary Health Care Nurse Practitioner?

Meet Primary Health Care Nurse Practitioner Melanie Rose!

Nurse Practitioner, NDIS verified Registered Nurse and Credentialed Wound Care Specialist Nurse. Bachelor of Nursing (RN), Post Graduate Certificate of Rural and Isolated Practice (RIPERN), Masters of Advanced Nursing Practice – Nurse Practitioner (NP), TAE and Diploma in Vocational Education.

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I am a nurse and have practised as one on and off since I was 18 (that’s a long time ago now!) I have lived on Phillip Island for about 10 years now and I love it. I originally emigrated from South Africa about 25 years ago with my parents. I have 3 children and my extra child who came for a sleepover and stayed a few years. My children have all gone to school on the Island and my girls especially love the life we have here. I have dogs, cats and a duck and I am also fortunate to live next to a small parcel of land, so my home feels “country like”.

I love the water, I surf badly, I swim in the ocean and I love to kayak.  I enjoy challenging myself regularly and am always coming up with new ideas.  In the last few years, I have climbed Kilimanjaro to raise funds in support of Dementia Australia and Kayaked the Murray River Marathon (I did both slowly and proudly brought up the rear!).

At home, I am a closet artist with a short attention span, so I have an art studio in my backyard and I spend any free time I can playing with my “stuff”. I work in many mediums, clay, metal, plastic, glass. I love the variety of making different works of art with different stuff.

My children have been a great support in enabling me to study and achieve my Masters of Advanced Nursing Practice, Nurse Practitioner. Not an easy thing living on Phillip Island and needing to attend Melbourne University for lectures and still working full time. I was very lucky as I had not only their support but the support of my colleagues and teammates at work on the Island. That is part of why I want to give back, by being able to provide support to the community that has supported me. I feel very lucky to live where I live and to be part of our Island community.

You have been a RIPERN nurse. What is that and what was your role?

RIPERN is a postgraduate certificate in Rural and Isolated practice. This qualification allows the registered nurse working in a RIPERN position to diagnose and administer and dispense medication in accordance with specific protocols as set out in the Primary Care Manual. The Primary Clinical Care Manual provides clinical guidance to standard practice. HERE 

What is a Primary Health Care Nurse Practitioner?

As a Nurse Practitioner in Victoria, all NP’s can apply for their endorsement in their area of primary advanced nursing practice. For me, I have two areas of advanced practice these include primary health and the older person/aged care.
Primary health refers to clinical care of the general community similar to what a General practitioner may do. Aged care or older person endorsement refers to NPs who are endorsed based on advanced nursing practise in aged care or those over 65 years of age.

I look after people across the age continuum based on my experience level. I do not look after emergencies. My clinic focuses on Chronic disease management, holistic and supportive health management programs, pathology and wound management.

My days vary, which is something that I love. I can start with a little 18 months old who may or may not have an ear infection and then move on to supporting someone on their weight loss program followed by an infected, necrotic ulcer that requires debriding.

What are some of the biggest gaps in primary health care in your view?

One of the biggest gap is that patients require time to talk and establish a rapport with their practitioner. They want to see the same person every time they attend a primary health care clinic and they don’t want to feel rushed. These are probably the two biggest things that upset people about the current primary health care service. As a NP our consulting time is longer than a GP and the feedback from patients is that they feel they have time to talk. Being able to provide time to talk is fundamentally what most people need.

If you were able to fix one thing with the aged care system what would it be and why?

There are a number of things that need to be addressed in aged care, far more than I could elaborate on in this interview, so I will highlight just two that come to mind. From my perspective, I would like to start by highlighting that the general consensus appears to be that aged care is where nurses go to have an easy time…… Nothing could be further from the truth.

Aged care registered nurses are in charge of looking after a high-risk group of people with many comorbidities, overseeing EEN team leaders and they usually have their own resident load as well. Hospital ratios are 1 nurse to 4-6 patients. Aged care you have 1 nurse to 25-30 residents and overseeing the work of Personal Care workers. The RN in charge may have their own 25-30 resident load, they will also be required to oversee the work of any other team leaders.

Having said this there are a number of facilities that have Enrolled Nurses in Charge, with indirect supervision by an RN. This is a financial decision made by organisations and very unfair on the EEN who is placed in this position, with the possibility of needing to work outside of their scope of practice.

Scope of practice?

The scope of practice of an NP is dictated by the area the NP has advanced nursing experience in. Advanced nursing experience for NP is generally defined as 5000 hours in an advanced nursing/management and clinical/educational position. In order to be endorsed to practice, you need to provide evidence of those 5000 hours with references. There is a huge amount of study and time that is required once you can provide evidence of that experience. You then need to continue working at that level as you get the University study component completed. The final scope of practice of an NP is ultimately dictated by their workplace.

The scope of practice of a RIPERN is dedicated by the limitations of their endorsement, their specific scope of practice as per the Nursing guidelines and the workplace and in conjunction with the Primary Health care manual.

What is CDM and why is it a primary focus of your work?

CDM refers to Chronic Disease management. In my practice, I work with patients who have chronic diseases, for example, COPD, MS, Diabetes, Obesity etc and I provide holistic care and support on an ongoing basis. These patients tend to attend the clinic regularly and not only when they are unwell. I get a lot of satisfaction in supporting those patients in achieving the best quality of life they can attain. I also think the ongoing support provides motivation for people to stay healthy, which is ultimately the purpose of primary health care.

You are a co-owner of Phillip Island Health along with a GP. How does one set up a GP clinic as a nurse practitioner? Where should NPs look for more advice?

My partner in Phillip Island Health is Dr Carol Head. We both work as independent sole practitioners but we share the clinic room and our equipment. It is an interesting setup and it really works well for us. We were friends before we set up Phillip Island Health so we wanted to make sure that going into business together didn’t impact on that friendship. The easiest way to do that was to basically each set up as sole traders and just work together.

As for setting up a primary health care practice, I’ve had a number of NPs ask me about this as there are not a lot of us out there running their own practice. It’s a minefield really as it’s an area that we are not prepared for as nurses. The easy answer is to say do your research….. BY that I mean review all the software available out there and don’t go just by what’s cheapest.

Then you need to ensure that you protect your registration and for that, you need to ensure that you don’t step out of your scope and you have sufficient indemnity insurance. (Any ANMF member automatically gets indemnity insurance cover as part of their membership) Then you need to find a venue and sort out your provider and prescriber numbers. To be honest this is a minefield and takes a long time to negotiate so you need to be patient.

What are the benefits to my approach?

A clinic that started 6 months ago with 4 patients a week…… to a clinic where I see around 40 patients in the 3 days I work. I will be presenting this process and why I think the community benefits from NP primary health care clinics at the National Australian College of Nurse Practitioner conference in March next year. The subject being around setting up my primary health Nurse Practitioner clinic in a small rural community and how this service supports the local GP clinic.

What is one thing you wish you would have known before you became a nurse practitioner?

Oh wow, there are lots of things I wish I had known, but it’s the same at any level of nursing. You never know what you need to know until you are in a position where you need to know something. I suppose in relation to NP’s specifically, I was always aware that there weren’t many of us in Australia so I had every expectation that there was going to be a lot I would need to teach myself or source a mentor in order to develop the skills I need. I believe that both aged care and primary health provide  nurses with the ability to stretch their knowledge and develop skills that can be specialised

What are the most challenging and difficult aspects of your area of work and how do you overcome them?

The most challenging aspect of my area of work currently is the lack of community knowledge in relation to what NPs can actually do. In Australia most of the NPS that are in practice work in and around hospitals. Working with the community there is the need to not only increase awareness of what an NP can do but to also prove that the care delivered is in line with the nursing model of care – holistic and proactive.

What is one myth or common misconceptions that you want to debunk about your areas? 

Aged care is easy work and boring – nothing can be further from the truth. From complex nursing skills (catheterization and wound management) to people management and family and community support.

What were the main challenges you faced when working rural?

Predominantly the biggest challenges related to access. Access to regular medical practitioners, specialists and supportive care options.

You have also taught at the Diploma and Bachelor level. Can you tell us about this?

I love teaching – I have taught on and off for the last 10 years. I like investing time and energy in the new “baby” nurses. I have been nursing on and off for the last 30 years and I still love what I do. I like to use that in my teaching. Enthusiasm is contagious.

What pathway would you like to see the future of your profession take over the next 10 years?

I would love to see the NP role being better supported by the government as being able to provide bulk billing service is a financial strain as an NP due to the poor reimbursement through the medicare system. This means that NPS in general need to charge an out of pocket fee in order to earn a living. I think if the medicare system rebates for NPs was closer to what a Medical officer receives for the same service, more advanced practice nurses may consider taking the plunge and becoming an NP.

What are some great resources that have helped you along the way? Or what have you listened to or read recently that has inspired you

To be honest my greatest resource has been my peers. I have a few NP friends and a few people I have studied or worked with during the last 15 years. These are the people who have supported and encouraged me in order to achieve this dream.

Who are the 3 people who have been most influential to you and why?

This one is an easy one for me:
1. I am a single mum with three kids. I wanted them to see that hard work equates to success and no matter how hard things are there is always a way through. I wanted them to be proud of me.
2. Two people, I met when I was teaching 10 years ago. they both always laughed at and with me, while instilling in me the confidence that I can do it. We should all be lucky enough to have people like that in our lives.

What is your leadership style?

I tend to lead by example if that makes sense. I work on supporting the people I work with and ensuring that they know they are not on their own. I like to encourage education and I will personally facilitate any education my team needs. I like to be accessible and my team needs to know that I will help whenever I am needed.

Conflict resolution in nursing?

This is a very big issue in aged care. Not just with staff but families as well. In my experience, I have developed compassion for families who place their relatives in aged care. There is a lot of guilt associated with this and this can manifest in conflict and aggression towards staff. I like to address conflict at the time it occurs with the individuals still heated. I believe that if both parties are taken to a private space and given the opportunity to speak their mind, feel validated. Once this has occurred they are then more receptive to listening and possibly coming up with a plan moving forward.

You’ve got this!!!

For other nurse practitioner articles go HERE