Why nurse practitioners and dental therapists are necessary for rural and remote Australia as well as suburban practices and A&E units

Why nurse practitioners and dental therapists are necessary for rural and remote Australia as well as suburban practices and A&E units Journal Article

Australian and New Zealand Journal of Public Health

• Author(s): Radford, Anthony J.
• Published: 2008
• Publisher: Blackwell Publishing Ltd
• Volume: 32
• ISBN: 1753-6405

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Abstract: Without major policy initiatives, and rural medical student schemes not withstanding, there will be a serious shortfall in rural medical and dental resources. Currently, the shortfall estimate for rural GPs is over 1,000. In Queensland and New South Wales only eight of 643 recent graduates were working in rural/remote settings. This shortfall extends to many urban areas. Patients are waiting up to six hours in emergency departments, and hundreds are being told they can not get an appointment with their GP for over a week. The quality of care is not likely to increase with the growth in mega-practices. To graduate more doctors to move into the rural workforce will take over a decade. A number of overseas trained doctors are unsuited for rural Australian careers for a variety of social, cultural and professional reasons. Despite the rise in practice nurses who undertake some of the procedural tasks of practice, their use as clinicians is minimal. Categories of clinicians, though less trained than a doctor or dentist, have been successfully employed for decades in both industrial countries such as the US, and the less resourced world. They have worked both independently and in association with general practitioners/family physicians, and emergency physicians. Such practitioners are able to‘recognise andmanage’ common conditions competently. Midwives of course have been doing this in the field of obstetrics for centuries. While many rural practitioners work 24/7, schemes such as the state and federally funded South Australian Rural Doctors Workforce Agency (RDWFA) initiatives, provide significant relief. In South Australia, at least, training programs for hospital-based rural nurses has provided some primary clinical care skills which have enabled some nurses to assess and carry out basic primary medical care e.g. for an acute asthmatic attack. These nurses relieve the need to summon a doctor for every attendance after hours, but there are few of them, and the system needs to provide regular refresher programs. Within 10 years, one quarter of the rural towns in rural Australia supplied with, or presently without, medical or dental practitioners could/will be serviced by nurse practitioners and dental therapists. A few nurse practitioners have been trained during the past decade but remain few in number, e.g. there is only one working in rural South Australia, and she is in the private sector. Rural Australia cannot find adequate numbers of doctors who are prepared to live and work in rural and remote areas. Recently in rural New South Wales even a $500,000 start-up carrot proved insufficient to attract a doctor. There is no reason why such communities should be denied basic clinical care because a doctor or dentist cannot be found to provide it. Nurses on remote communities, with minimal additional training, and dental therapists in South Australian primary schools have been undertaking such care for decades. The fundamental axiom in care provision should be that ‘nobody is prevented from doing anything they can readily be taught to do competently with appropriate supervision’. Such supervision may be in the same room, next door, in the next town, or at the end of telephone. In evaluating patients seen in general and emergency departments for over three decades, I estimate that a nurse trained for a further 12 months in clinical diagnosis and management can undertake in excess of 50% of the medical workload. The use of such a cadre enables the general practitioners to spend more time with those patients whose problems are more complex. Such a clinically trained nurse could provide competent, and much quicker care, to those in nursing homes and hostels, and relieve pressure in emergency departments. I have trained and used nurses‘to recognise and manage competently the common and significant conditions’ in primary medical care in several countries. This includes the ability to ‘recognise’ serious conditions and‘initiate appropriate primary care and arrange referral’. If further consultation for the GP is only as far away as a telephone or an email (with or without photographs), then certainly it is no less so for a nurse or dental assistant.

• Urls: http://dx.doi.org/10.1111/j.1753-6405.2008.00314.x