The changing role of practice nurses in Australia: an action research study

Abstract

Objective: The original aim of the study was to report on the methods used to develop a new model of service delivery, namely nurse led well women’s clinics. However participants identified several key barriers to an expansion of their role that had not been accounted for in either the original policy directive or in the continuing professional development delivered as preparation for their accreditation to deliver cervical screening services from a general medical practice. How the group addressed these barriers became the objective of this action research study. Design: This paper reports the findings from an action research study with three registered nurses working in general practice credentialed to provide cervical screening services. Six reflective group meetings were held over a six‑month time frame facilitated by the lead researcher. During the meetings a variety of creative techniques were used to stimulate discussion, The meetings were audio-recorded and partially transcribed. Feedback from the concurrent data generation and analysis was provided to participants the following week. Setting: A regional division of general practice. Subjects: Three registered nurses employed by the general medical practice. Main outcome measures: The barriers identified by participants in the process of implementing change in their clinical practice to incorporate the provision of cervical screening services. Results: There were three themes identified in the findings from this study that related to the myth of interdisciplinary collaboration in general practice. These were: nurses in general practice renegotiating their roles; identifying and negotiating gendered patterns of cervical screening; and multidisciplinary collaboration and retention of practice nurses. Another important outcome of this study that relates to change management is the role of practice champions in implementing new models of primary care. Conclusion: The potential role of nurses in general medical practice in Australia has broadened considerably in recent years, mainly due to Australian Government driven initiatives which reward general practitioners for employing nurses; a recognition by the nursing profession that general practice nursing is a specialist area of nursing practice; the establishment of a national professional association for nurses working in general practice; an increase in the availability of continuing professional development for nurses working in general practice; and additional Medicare Benefit Schedule (MBS) item numbers relating to general practice nursing, which gives the general practice a rebate for the services the nurse provides independently of the general practitioner. Suggestions are made that address the barriers identified by participants in the process of implementing change in their clinical practice to incorporate the provision of cervical screening services.