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A recently released survey of 1500 Kiwi patients found them to be largely satisfied with the nurse at their practice. Co-researcher Deborah Davies talks to FIONA CASSIE about the research and how it links to a new knowledge and skills framework that could see both patient satisfaction and expectations of their nurse rise.

Kiwi patients are pretty happy with the nurse they see in general practice, according to a major patient satisfaction survey.

Deborah Davies, a co-author of the article on the Australian-led research project* and lead clinical nurse specialist for primary health care at MidCentral District Health Board, is keen to extend both patient satisfaction and expectations of the role that practice nurses can play in their health care – particularly long-term conditions.

The vast majority of the 1505 patients surveyed in the research had booked an appointment with their nurse and 60 per cent of them saw a nurse only during that visit.

The most likely to be highly satisfied with their nurse’s care (that is, scoring higher than the median score of 90) were regular nurse clients or people in paid employment. The least likely to be highly satisfied were those patients aged over 60 and those of European descent.

As a practice nurse herself for 15 years, up until 2005, it doesn’t surprise Davies that the over-60s were the least satisfied with seeing a practice nurse, as she says they are the generation most used to a traditional and hierarchical GP role.

“We were marginally disappointed (though) that there is still some confusion out there around the role of practice nurses, but you have to acknowledge there is variability (in practice nurse roles) across the country.”

The confusion emerged in the related qualitative research (published in 2013) involving in-depth telephone interviews with 18 of the survey respondents. A couple were unclear who was or wasn’t a practice nurse in their practice and what they did. Others were unclear about the potential scope of practice: “… I don’t think it’s ever been made clear all the things that you could use the nurse for. So my usual port of call is the GP.”

This was also enforced by the satisfaction survey, which indicated that most patients were seeing their nurse for a procedural task like vaccination (39 per cent of them), though 246 had come in for a “general check-up”.

“It was definitely not top of scope,” says Davies, adding that the nature of patient appointments reflected the variability of practice nurse services offered across the country.

“Which is why we’re driven to our next step” says Davies, who chairs the College of Primary Health Care Nurses NZNO’s standing committee on professional practice.

The next step is increasing the profile of primary health care nurses in general practice and cementing in place the knowledge and skills framework for primary health care nurses that can showcase what they potentially can offer. The first framework phase, focusing on district nursing, is close to sign-off, and the next phase – aimed at nurses in general practice – is gaining momentum.

Davies says the College is working on a business case to develop the evidence-based framework so it provides a career pathway for nurses in general practice that is linked to postgraduate education and the likely requirements for community and specialist nurse prescribing.

Discussions are underway with key stakeholders and the College hopes to successfully apply for funding from Health Workforce New Zealand for the project and to get endorsement from the National Nursing Consortium that primary health care nursing is a specialty area of practice.

Davies says with MidCentral’s track record behind it – MidCentral nurses led the development of the national diabetes nurse and the respiratory nurse knowledge and skills frameworks – the College was working in partnership with MidCentral’s Health Care Development team to develop the framework.

“We kind of have it all sitting there. We just want to pull it together into a cohesive framework, so as a nurse I can go in and say, ‘okay, that’s what I need to know for my area of practice, and this is how I can work at the top of my scope, and this is how I can demonstrate my knowledge and skills’,” says Davies.

She says the aim is to have all nurses in general practice “tipping their toes” into further study with proficient nurses working at postgraduate certificate level and experts at postgraduate diploma and master’s degree level. The focus was also not on tasks and technical skills but on being able to offer well-rounded nursing services.

The new levels of nurse prescribing being developed by the Nursing Council – with priority being given first to “specialist” prescribing followed by lower level “community” prescribing – will require postgraduate study with “specialist” prescribers likely to require a postgraduate diploma level qualification.

“We’re thinking how can we prepare the (nurses in general practice) workforce to be flexible over the next two to five years so when these opportunities come, (nurses) can keep removing the barriers to people getting effective care at the right time. It’s quite exciting.

“We’ve got huge untapped potential of nurses in the community.”

This aligns well with the ‘better, sooner, and more convenient’ push to have more healthcare in the community, with increased roles for general practices and initiatives like integrated family health centres.

“It’s really important that nursing gets its act together and knows exactly where [practice nurses] fit – it is particularly critical in long-term conditions.”