Developments of advanced nursing practice in Australia
Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong
The development of advanced nursing practice in Australia, like in most countries, was influenced by several factors including, political, economic, environmental and sociocultural factors. In addition, such development was also influenced by the changing expectations of the Australian community, increasing consumer awareness, advances in medical knowledge, changes in the health care delivery system and the nursing profession's vision to be in line with other trends that are happening around the world.
Advanced nursing practice, through study at the graduate level and clinical experiences for specialized practice are experts in a defined area of practice in nursing. They are able to work with individuals, families, groups and communities to provide expert care, advocate for health promotion and contribute to the advancement of the nursing profession (Fleschler & Luguire, 2002).
In Australia, advanced nursing practice is being provided by the nurse specialists, nurse consultants and nurse practitioners. Nurse practitioner is the latest development in Australia with each state pursuing changing the Nurses' Act to legislate the title "nurse practitioner". Nurse practitioners (NP) are registered nurses who practice at an advanced level and who is authorized to use the title (Dunn, 2003). The scope of practice will be determined by the context in which the NP is authorized to practice. As an advanced nurse practitioner, there is an expectation that the NP will be able to conduct sophisticated clinical judgments and decisions for the most appropriate therapeutic interventions required of the patients. The defining features of the NP includes roles of educator, mentor, clinician, manager and researcher within the context of need, setting, education and autonomy (Appel & Malcolm, 2003).
Autonomous practice is expected of an NP. Therefore, several legislations have to be revised to incorporate the NP practice. For example, the Nurses Amendment (Nurse Practitioner) Bill 1998 makes provision for the NSW Director-General of Health to approve guidelines, which allow for the possession, use, supply or prescription by NPs of any poison or restricted substance in accordance with Section 17A of the Poisons and Therapeutic Goods Act 1966. The Act also allows NPs to use the title and any unauthorized use of the title by the Board could lead to a penalty of 12 months' imprisonment (NRB, 2003).
There are two pathways to be authorized as a nurse practitioner. The first pathway requires a completion of a master degree approved by the Nurses Registration Board. The second pathway requires applicants who have not completed the approved program to provide evidence of 5,000 hours over the six-year of their experiences practicing at an advanced level (NRB, 2003).
Strengthening the visibility of the NP role is critical to its survival. Several strategies have been recommended including continuing development of tertiary-level education programmes for the NPs, creation of NP positions across the country, discussions with the medical profession highlighting their complementary by largely independent roles, conducting collaborative research or projects, publishing in medical and allied health journals, advertisements to the public to create awareness of the NP roles and services, and even involving NPs in television dramas (Appel & Malcolm, 2003).
The development of the nurse practitioner across Australia is still continuing and could be accessed through the following websites:
Appel, A. & Malcolm, P. (2003). The triumph and continuing struggle of nurse practitioners in New South Wales, Australia. Clinical Nurse Specialist, 16(4), 203-210.
Dunn, S. (2003). Nurse practitioner NNN. Connections, 6(2), 34-40.
Fleschler, R. & Luguire, R. (2002). Advanced practice role of the outcome manager. Outcome Management for Nursing Practice, 2(2), 54-57.
NRB (2003). Nurse practitioners. Board Works, 12, 8-10.