Turning frustration into action

1 April 2013

NICOLA RUSSELL vents some frustration that in 2013 general practice is still largely “business as usual” despite the optimistic rhetoric of the 2001 Primary Health Care Strategy. She also calls for input into an upcoming College of Nurses workshop for nurses keen to explore developing primary health care nursing services.

I have worked in primary health care for a decade – and depending which era you come from, that either makes me a novice or an expert!

I am a Generation X primary health care (PHC) nurse working in general practice, in small town  New Zealand ... and these comments are my reflections on life as I know it. They are also a call for some input from other primary health care nurses as the College of Nurses, Aotearoa considers development of a workshop focused on the development of PHC nursing services.

In 2007 with a little (actually a lot) of trepidation I duly accepted the challenge of completing two new masters’ papers offered through Massey University – Primary Health Care and Management of Long Term Conditions.

The Primary Health Care Strategy (2001) had offered so much to us in terms of future of nursing governance, not least of which the eventual release of funding streams for PHC-focussed postgraduate nursing education and the construction of nurse practitioner (NP) training programmes.

Nurses were touted as crucial to the implementation of a primary health system that was innovative, efficient, population-focused and accessible to all members of the community. There was a verbal commitment to increased possibilities for nurses to take on roles of clinical leadership and decision-making. Behaviours traditionally firmly ensconced in the medical domain, were finally going to be ours to take ownership of! The future was exciting, the possibilities endless.

I began to have conversations with colleagues that even included the (then) staggering option of nurses one day maybe buying their own practice – what if we actually employed GPs and made the rules? What if we could effortlessly design and deliver a mobile nursing service for hard-to-reach patients? Oh...yes, the future looked amazing. Nursing was going to transform the parameters of delivering primary care to the masses.

Fast forward to 2013, masters under the belt, but general practice continues largely as ‘business as usual’ and what have I learned?

Well, I have come to the realisation that, whilst I know what needs to be done – it sure is difficult to cut through all the political jargon, rules, regulations and biases that permeate our health care system. Seems like every month a new ‘focus’, a new ‘target’, a new or often pervasive ‘barrier’ stands in the way of true patient-centred care. Yes, being a primary health care nurse is often fraught with constant change and sadly, what often feels like a juggling act of epic proportions.

We are in a unique position to clearly identify what impedes ‘better, sooner and more convenient’ patient care within the mainframe of traditional general practice models of care. Issues like access due to lack of transport, restricted opening hours, after-hours access, financial difficulties, poor health literacy...and the list goes on.

I don’t know about you, but it frustrates me when I see patients constrained to a system that doesn’t meet everyone’s needs. I lament the resources wasted and the inconvenience/suffering experienced by a patient when they are hospitalised for a condition that could have been effectively managed in the community – if only the service was more easily accessible for them.

I am embarrassed when I have to explain to a frail, elderly patient that they have to make their way to the clinic for nursing care – because new rules mean that community nursing hours have become stricter to access. I worry about the lack of access to screening opportunities for those working within high risk, low pay industries – particularly within a pressurised economic environment. I’m sure you can think of many, many other examples from your own practice experience. 

I find it hard not to be cynical about what was – and continues to be - promised to us and through us to our patients . Being clinically autonomous and having access to funding is not a reality for most nurses working in primary health care, especially general practice.

This is especially so for many of those in our nursing community who have completed the arduous task of NP training and registration, only to find themselves shut off from silos of available funding that would allow them to work to their full scope of practice, determining the nature, design and structure of the services they provide and thus transforming primary health care services.

Good things take time (and all that) and certainly there are some upcoming changes to legislation and policy that will solve some of the issues, but we certainly need to start thinking about ways we can take ownership of our role as leaders in the development of a consumer friendly and sustainable primary health care service. As a rather large group of health care providers, we have enough integrity and experience to drive the process. Maybe we just need some more intensive and focussed knowledge about how to get there?

The College of Nurses is in the process of organising a workshop for primary health care nurses and NP’s who want to explore their options for nurse-led or more patient-focused service delivery. Whilst there are a few trailblazers who have already successfully taken up this challenge, how many of us continue to dream of the possibilities but get stuck on the seemingly insurmountable task of actually realising these dreams.

So, have a think about what would be useful for you to know. What frustrates you? What issues need addressing to ensure certain patient groups in your practice can have greater access to primary health care services? What would you do differently if you could?
You can send your thoughts, stories or requests to me at tn.russell@hotmail.com

About the author: Nicola Russell BN M.Phil (Nursing) works as a primary health care nurse in general practice, Invercargill. She is also a board member of the College of Nurses (Aotearoa).