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.