21 May 2018

Rural health workforce reaching crisis point

5:33 pm on 21 May 2018

The rural health workforce is at crisis point, with more than 25 percent of country doctors due to retire in the next five years.

A doctor with a stethoscope writes up a medical record

Photo: 123RF

So could the growing number of nurse practitioners, nurses who have taken extra training to be able to prescribe medicines and make diagnoses, provide a solution?

The nurses themselves say yes, but those working in rural health say there are some professional and bureaucratic hurdles which make it more difficult.

Doctor Sue Adams, a senior lecturer in nursing at Massey University, studied the experiences of rural nurses working towards the higher qualification of nurse practitioner, as part of her PhD.

She said in medical centres where nurse practitioners were employed alongside doctors, they worked together really well.

"And it works for the community because there is someone there who is committed to [them], likely to be there for years and years and years and is interested in the health of those individuals and their families and how they're functioning in the community."

Dr Adams said the nurse practitioners were often interested in outreach work and would operate in ways which meant they could go out to people in their communities and their homes, which could make a big difference.

She said that resulted in a level of continuity of care which did not necessarily happen when overseas locums were brought in to replace retiring doctors.

"They are a very expensive workforce, they don't have the commitment to the community and they often move on in a few weeks to work in the next interesting part of New Zealand."

Royal New Zealand College of General Practitioners president, Tim Malloy, himself a rural GP in Wellsford, works alongside nurse practitioners.

Dr Malloy said staff at the medical centre he operated from included a nurse practitioner who had just completed his training at the practice and a rural nurse specialist who could prescribe.

They were about to be joined by another nurse practitioner with Emergency Department experience.

Dr Malloy said the nurse practitioners brought a more holistic approach to healthcare but there were several barriers to employing them, including that some funding streams were only allocated to doctors and exceptions had to be sought to enable that money to be used to employ nurse practitioners.

There were also professional barriers to the work of nurse practitioners.

"Sometimes we've had speciality services within the hospital not accepting [referrals] from our nurse practitioners, which is entirely profession-based, so those prejudices and barriers have to be overcome."

'If it wasn't there what would they do?'

One nurse practitioner who has spent almost 15 years in rural health is Adie Murray, who works with Te Hiku Hauora, the largest provider of primary healthcare in the Far North.

She runs a mobile health service from a caravan for isolated communities, who find it hard to reach healthcare because there is no public transport and they cannot afford taxis.

Ms Murray said the people she saw were extremely grateful for her service.

"Obviously we've had time to reflect, get information and get their feedback because it's been going since 2004."

"I'm probably seeing the third generation of families and for them it's that access, that convenience of care. If it wasn't there what would they do?"

She agreed there were barriers to working as a nurse practitioner, but she said the chief nurse at the Health Ministry was trying to push the work they do.

The whole intention of training nurse practitioners was to increase the numbers of people qualified to work in primary healthcare, who could see patients of all age groups in the community, but many people still thought 'doctor first' when it came to their health.

Ms Murray said that was partly because of a lack of advertising about what nurse practitioners could offer.

"We haven't had that spurt of information, that reassurance to the public. There [are] no big billboards, no advertising on the TV to say we are part of the team, we're not an alternative."

"I keep on selling the message that we are part of a team, we're not in competition."

The Nurses Organisation said there were now almost 300 registered nurse practitioners in New Zealand.

Training programmes attract two applications for every place available, but the NZNO's associate professional services manager, Hilary Graham-Smith said there was a real concern over whether funding for those programmes would continue.

It was just another example of the lack of investment in nursing generally, she said.

"Those nurse practitioners can add enormous value, particularly working in the community, not just in rural areas, but in the community generally in primary healthcare."

"Why wouldn't you support a growth in the number of places available in the training programme and therefore the number of nurses registering as nurse practitioners?"

A Ministry of Health evaluation of nurse practitioner training last year was positive, finding most students completed the course in the time required.

It is now seeking feedback on that report from employers and other stakeholders.

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