Nurse Practitioners began evolving in Australia in 2000 with Health Practitioners continuing to prescribe treatments for clients.

With advanced nursing roles, the NP needed to evolve and develop novel innovative care.

In Primary Care, NP model  to be successful needed: Organisational support, Funding, develop a plan for the model in collaboration and present a business plan.

A supportive navigator needed to drive the plan, was key to success

MBS item numbers then developed (82200,82205, 82210 and 82215 which made the model financially sustainable.

Nurse Practitioner's Scope of Practice needed to be updated and approved through APRAH. It looked at inclusion/exclusion criteria, autonomous and collaborative practices, updating the scope of practice.

Presenter – Joanne Leamy

Joanne led an enthusiastic presentation about the implementation of a large scale screening program in Far North QLD which adopted a peer education model to encourage STI and BBV screening among young people.

The scale of the project appeared somewhat daunting at the start. Fortunately, with much energy, and a strategy which put local communities at the centre, a significant improvement in testing rates has been achieved.  Aspects of the project included:

• Screening in 10 remote communities and 2 towns in Far North QLD, targeted at young people.
• Traditional owner groups were included in consultations.
• Adequate staffing and ongoing staff training gave the project a real chance of success.
• Peers were recruited with the help of local employment agencies and given basic STI training. They received wages for their work. All peers were residents in the communities.
• Focus on workplace culture. It was acknowledged that working as a peer was not always easy. Support for peers was built in.
• An understanding of attrition. Young people may change priorities, and new peers may need to be recruited.
• Appropriate ‘branding’ of the screening drive in order to have cultural integrity.
• Incentives, e.g. daily prizes such as footy jumpers.
• Well planned outreach with adequate equipment.
• Continuous quality improvement was included. While the reaction to feedback by clinilinic staff was not always initially enthusiastic, it has been an important factor in developing the program.

The program led to a clear increase in screening rates across the area, rising from 24% in 2013 to 53% in 2017. Interestingly, syphilis rates were not found to be as high as expected (10%). As an example of resources required, at one of the sites which had a target population of 130 to 170 15-29 year olds, 7 staff members were present for 4 days of testing.

Joanne acknowledged that without the peer workers providing targeted messages, hope, and support, the project was unlikely to have been as successful. An example of their contribution included being able to bring local language to the testing setting. The presentation demonstrated that improved access can be achieved with a lot of energy and the right mix of resources.

Presenter - Ms Danielle Collins, Nurse Practitioner Candidate, Alfred Health

Danielle walked the audience through some of the important considerations and challenges involved in establishing nurse led models of care. Her presentation highlighted the need for rigorous step by step planning, which requires organizational commitment and solid partnerships.

Danielle used two Victorian practice examples to draw attention to these key messages, one being a nurse led rural clinic focused on HIV prevention and the other a combined medical/nursing model aimed at increasing client participation in HIV care in a metropolitan hospital.

A brief summary of the ongoing evolution of nursing roles was given, with an acknowledgement that with planning, nurses are well placed to provide various aspects of care which can improve HIV prevention and treatment, particularly with the slow but steady breakdown of barriers to advancing scope of practice.

The rural example involved the roll out of PREP to a regional area via the establishment of a monthly nurse led clinic within an existing health service in Bendigo. The visiting Nurse Practitioner Candidate is supported in her role by access to an ‘on call’ physician, and the sexual health nursing staff at the clinic.

The metropolitan project began from an understanding that many people living with HIV were presenting to tertiary hospitals with issues that were not directly HIV related. Management of these issues could have been potentially coordinated through an advanced nursing role. A specialist HIV nurse role was established, where the practitioner offers a health assessment and follow up for patients who have multiday admissions.

 Danielle noted a number of important points in relation to the planning and set up of these services.

• Organizational support was key to achieving a workable model.
• Funding can be difficult. Projects need a solid business case behind them. In a bulk billing setting financial modeling which takes into account slow clinic times must be factored in. Projects need to be viable if they are to be sustained.
• Scope of practice also needs to be carefully thought out, with planning for all contingencies. Ask ‘what if?. Recognise the limits of practice as well as opportunities for autonomy. 
• Collaboration is vital, particularly when moving into community settings. Projects need to be wanted by the client group and supported by the community. Find local leaders.

Danielle’s presentation demonstrated that the journey to innovation requires the enthusiasm of many players, sustained effort, and business acumen. It was also an optimistic take on the future contribution of nursing in the area of HIV related chronic illness management.

Innovative Models of Nursing Care and the Role of Advance Nursing Practice

Congratuations to all presenters on these inspiring sessions. The diversity demonstrated in these different models of care showed the adaption of nursing into various work settings.  

Leah showed us how being innovative in the way things are done can not only continue to achieve positive outcomes for clients living with HIV but also achieved the desired activity performance markers required by health departments.

Elizabeth reminded us that nurses are the linchpin in the treatment cascade encouraging us to act with a focus on justice, politics and collaborative leadership.

Danielle encouraged us to use creative thinking in our clinical delivery, to analyse the gaps, engage local partners and the local community and have a well defined scope of practice with appropriate governance.  

Joanne showed us how peer educators and community screens have achieved some substantial outcomes in the management of STI's in the Cape York.

Penny works across several jurisdictions to provided comprehensive SRH care to diverse communities in North Queensland. 

Bridget demonstrated the diverse role that nurses play in models of care to individuals with Hepatitis C from community settings, nurse led clinics to community care.

Karen has shown that even with a successful model of care for HIV positive pregnant women, consideration to adaptions in service delivery needs to be factored.  This has been successfully achieved by providing education to rural areas with supporting materials, sharing of CPG'S and shared cared models.

At the close of the 2nd Asia Pacific AIDS & Co-infections Conference (APACC) that took place from 1 to 3 June 2017 in Hong Kong, faculty members Dr. Charles Boucher and Dr. Patrick Chung-Ki Li quickly presented a few slides showing the breakdown of who attended the conference.

An interesting point (I think) is that as a nurse, many presenters stated that to instigate new ways of working, reaching vulnerable populations and rolling out PrEP, nurses would be the backbone of the work force. Yet, only 5% of the attendees were nurses. To get nurses onboard and understand why they are expected to step up and lead these innovations, more need to attend conferences like #APACC2017.