New obligations

• Nurses might need to provide evidence of professional indemnity insurance
• CPD requirements
• Recency of practice requirements
• English language skills
• Criminal history checks (for first time registration)

All nurses should have received a letter from NMBA confirming registration details. If you haven’t received one, contact AHPRA.

Mandatory reporting

Mandatory reporting is a key feature of the new legislation. It requires members of the regulated health professions to report notifiable conduct of another health professional to AHPRA. AHPRA will then forward the notification to the appropriate professional board for investigation.

What is notifiable conduct?

• Practicing while under the influence of alcohol or drugs
• Engaging in sexual misconduct in connection with practice
• Placing the public at risk of substantial harm because of impairment
• Placing the public at risk of harm due to practice that constitutes a significant departure from accepted professional standards

Who is required to report?

A registered health practitioner who forms a reasonable belief that another registered health practitioner has behaved in a way that constitutes notifiable conduct, is required to report this to AHPRA as soon as practicable.

A registered health practitioner is required to report unless they know or reasonably believe that AHPRA has already been notified.

Employers who form a reasonable belief that a staff member (who is a registered health practitioner) has behaved in a way that constitutes notifiable conduct are also required to report the matter to AHPRA as soon as practicable.

If it comes to AHPRA’s attention that an employer failed to report notifiable conduct that it was aware of, AHPRA will issue a written report to the responsible minister of that health service, informing the minister of the failure to notify.

How health services can prepare for mandatory reporting

• Have a clear understanding of what constitutes “accepted professional standards” in order to apply the test of a “significant departure”. This will help determine whether a notification needs to be made or not.
• Identify how the health services’ internal processes (investigations, grievances etc) will be effected by and need to accommodate the notification process.
• Communicate with staff what the changes mean and how the notification process works.
• Consider how to manage the welfare and ongoing employment duties of staff that may have a notification made against them.

Health services should also review their existing policies and procedures in order to incorporate the requirement to notify AHPRA as described above. These may include but not be limited to:

• Performance management
• Disciplinary procedures
• Whistleblower protection
• Occupational health and safety
• Investigation, root cause analysis
• Grievance procedures

Australian Health Practitioner Regulation Agency, ph 1300 088 950

A recent study by AGPN and ANU recognised the role of the PN in general practice, and identified PNs’ potential to collaborate to improve primary health care delivery. The study identified six key roles of the PN:

• patient carer
• quality controller
• organiser
• problem solver
• educator
• agent of connectivity

The role of the PN is changing in general practice with increasing emphasis placed on Chronic Disease Management.

Dr Djakic (AGPN chair) was recently quoted as saying that “business case modelling suggests that employing a PN may free up GP time to enable the GP to see an extra 10 patients per week.”

Federal funding for practice nurses is changing and becoming available to urban practices.

Interestingly, in the midst of this changing scene, the 2009 APNA Salary and conditions survey found that while most PNs were satisfied or very satisfied with their position and responsibilities, 18% of PNs were currently looking for another position.

This is an important consideration for practices given the time it takes to orientate and train a new clinical staff member. What’s the practice culture like in your work place?

Opportunities for practice nurses are stronger than ever. Career paths for PNs have improved.

Courses are now available including specialised orientation courses for nurses new to general practice through GPV, Graduate Certificate in Nursing (General Practice-Uni of Sunshine Coast) and potentially Nurse Practitioner roles with organisational collaboration, support and clinical governance (La Trobe Masters of Nursing [Nurse Practitioner]).

Contact me at jom@bddgp.org.au for more details.

1. Your practice would like to “try” a nurse before committing to employing one.
2. Your practice would like to cover holiday leave or extended sick leave periods of your existing nurse/nurses.
3. Your practice would like some additional nursing time to run Practice Nurse Clinics. (immunisation or diabetes for example)
4. Your practice would like to offer additional nursing services.
5. Your practice would like to offer Diabetes Educator services on site.
6. Your practice nurses need some support to implement new ideas.

Gail is also an accredited Nurse Immuniser. Gail has excellent information management skills and has good knowledge of Medical Director 3 and ZedMed clinical software packages.

Services

Gail comes to us with 3½ years of practice nursing experience in addition to her 15 years of acute nursing. Gail has helped GPs provide the following services in general practice in the past and can provide these services in your practice;

1. 75 + Health Assessment (item 700, $179.15 and 702, $253.30)
2. 45-49 Year Old Health Check (item 717, $106.95)
3. Comprehensive Medical Assessment (item 712, $200.70)
4. GP Management Plans (item 721, $133.65)
5. Team Care Arrangements (item 723, $105.90)
6. GP Management Plan reviews (item 725, $66.80)
7. Team Care Arrangement review (item 727, $66.80)
8. Practice nurse items for wound care, immunisation and chronic disease management
9. General nursing duties (triage, spirometry, infection control, assistance with minor procedures)

Details

Availability: Monday, Thursday and Fridays

Cost: $55 per hour + GST (minimum 3.5 hour booking required) & additional travel time for practices outside of Greater Ballarat.

For more information contact me on 5331 6303 or michellem@bddgp.org.au.

Ballarat Mind-Body Medicine participated in a small pilot project with Ballarat District Nursing and Healthcare. BDNH provided contract nursing services to complete over 75 health assessments in the home.

Dr Millar is happy with the outcome: “The program is a great success. The district nurses are a great help for my patient management, and assessments are conducted with an outstanding professional attitude.”

He went on to say that having the nurses complete the assessment “encouraged me to see things with fresh eyes”, and that he appreciated the links with a wider variety of community services.

Dr Chris Millar and the Div 1 nurses from the BDNH assessment team; from left, Dianne Brayshaw, Jan Jones & Marietta Hannah

Soni Stecker, practice manager at Ballarat Mind–Body Medicine, commented; “From an administrative perspective everything is running smoothly. Overall one of our best projects this year!”

Director of Nursing at BDNH Jane Morehen said that they “were very happy to have developed a transferrable model for other practices to take advantage of”, and that “the project has improved collaboration and communication with general practice”.

Want to know more? This flowchart outlines the process.

To talk to someone about this opportunity for your practice, contact me at michellem@bddgp.org.au, or  Jane Morehen (Ballarat District Nursing and Healthcare) on 5334 1500.

Now, looking back, Jill feels that the hospital system is more of a sickness model and that primary care and preventative health are rewarding, and are growing in value and recognition in the health care system.

Jill commenced Practice Nursing in 2003, at what was then known as Daylesford General Practice. The two Daylesford practices have since merged as Springs Medical Centre, and will soon move to their new premises.

Jill was the first PN employed at the practice, and it was a learning experience for all. Jill says that “working as a PN made me appreciate what working in a team means”.

Jill became a PN Pap test provider about 4 years ago, encouraged by the GPs who believed it would help free up their time if the practice provided this service. Jill says the GPs were very supportive.

Jill enjoys the autonomy that being a Pap test provider brings, along with the rapport she develops with the patients. She feels that she has understanding of the various life stages of the women she sees and the issues which accompany these stages. Jill says that the bottom line is PNs need the support of the GPs in the practice to make PN Pap test providing work.

Some facts

• Rates for cervical screening in Ballarat & District Division of General Practice are poor- 56.8%
• The biggest risk factor in cervical cancer is not being screened every 2 years
• “Nurses play a key role in providing cervical screening, particularly in rural Victoria and with older unscreened or under screened women.” PapScreen Final Report 2000-2005 P:17
• Nurse endocervical component rates are higher than for other providers

Scholarships

Australian Practice Nurse Association (APNA) scholarships are available from the end of August.

Courses

• Clinical Sexual and Reproductive Health for Nurses (credentialling and HIV & Hep C pre and post test counselling accreditation), 18/19 March 2010 at Melbourne Sexual Health Centre, cost $1100.
• The Pap Test and Introduction to Sexual Health, 19-22 Oct at Family Planning Victoria, cost $1210.
• Taking Pap tests: Theory and Practice Mar/Jun 2010 at Melbourne University Dept of General Practice, cost $1680, applications close end of Nov 2009.

For more information contact me at jom@bddgp.org.au.

Training subsidy reimbursement

Practice Nurses are encouraged to claim the 50% subsidy for attending the Medicare Healthy Kids Check and the Orientation Program for Nurses New to General Practice by May 31^st 2009. Please contact me at jom@bddgp.org.au with any enquiries.

Tetanus case in January

According to the latest DHS immunisation newsletter, they were notified of a 62 year old female with tetanus in January this year. An overseas trained doctor experienced with tetanus diagnosis identified her symptoms.

Hotline number applies to NSW only

The National Needle stick Injury Hotline (1800 804 823) number you may see on websites is only available to residents in NSW (not national). Their advice for other states is to contact their local hospital emergency department or GP.

ACIR Online changes

Practices will be receiving information about changes to the ACIR main page and login. ACIR brochures for parents/carers to access history statements have also been updated.