Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Aged care nurse practitioners in Australia: evidence for the development of their role

Shannon Clark A B , Rhian Parker A , Brenton Prosser A and Rachel Davey A
+ Author Affiliations
- Author Affiliations

A Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, ACT 2601, Australia. Email: rhian.parker@canberra.edu.au; brenton.prosser@canberra.edu.au; rachel.davey@canberra.edu.au

B Corresponding author. Email: shannon.clark@canberra.edu.au

Australian Health Review 37(5) 594-601 https://doi.org/10.1071/AH13052
Submitted: 5 March 2013  Accepted: 2 August 2013   Published: 1 November 2013

Abstract

Aim To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people.

Methods Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles.

Results This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners’ care in aged care settings.

Conclusions If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required.

What is known about the topic? Australia, like many industrialised countries, faces unprecedented challenges in the provision of health services to an ageing population. Attempts to respond to these challenges have resulted in changing models of healthcare and shifting professional boundaries, including the development of advance practice roles for nurses. One such role is that of the nurse practitioner.

What does this paper add? This paper positions a current Australian evaluation of nurse practitioners in aged care against the background of the development of the role of nurse practitioners internationally, evidence for the effectiveness of the role, and evidence for nurse practitioners in aged care. Recent legislative changes in Australia now mean that private nurse practitioner roles can be fully implemented and hence evaluated. In the face of the increasing demands of an ageing population, the paper highlights limitations in current Australian evidence for nurse practitioners in aged care and identifies the importance of a national evaluation to begin to address these limitations.

What are the implications for practitioners? The success of future healthcare planning and policy depends on implementing effective initiatives to address the needs of older Australians. Mapping the terrain of contemporary evidence for nurse practitioners highlights the need for more research into nurse practitioner roles and their effectiveness across Australia. Understanding the boundaries and limitations to current evidence is relevant for all involved with health service planning and delivery.


References

[1]  Silver HK, Ford LC, Stearly SG. A program to increase health care for children: the Pediatric Nurse Practitioner Program. Pediatrics 1967; 39 756–60.
| 1:STN:280:DyaF2s7mvVGruw%3D%3D&md5=9d59183fb1ae47d8f09e0f7dd64d0941CAS | 6026876PubMed |

[2]  Bail K, Arbon P, Eggert M, Gardner A, Hogan S, Phillips C, et al Potential scope and impact of a transboundary model of nurse practitioners in aged care. Aust J Primary Health 2009; 15 232–7.
Potential scope and impact of a transboundary model of nurse practitioners in aged care.Crossref | GoogleScholarGoogle Scholar |

[3]  Productivity Commission. Australia’s health workforce. Final research report. Canberra: Productivity Commission, Commonwealth of Australia; 2005.

[4]  Crilly J, Chaboyer W, Wallis M. A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents. J Adv Nurs 2012; 68 322–34.
A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents.Crossref | GoogleScholarGoogle Scholar | 21679228PubMed |

[5]  Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Social Res Methodol 2005; 8 19–32.
Scoping studies: towards a methodological framework.Crossref | GoogleScholarGoogle Scholar |

[6]  Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ 2002; 324 819–23.
Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.Crossref | GoogleScholarGoogle Scholar | 11934775PubMed |

[7]  Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews 2004; 2 CD001271 https://doi.org/ 10.1002/14651858.CD001271.pub2.

[8]  Flynn K. Systematic reviews for nurse-led primary care. Boston: Veterans Health Administration Office of Patient Care Services Technology Assessment Program; 2009.

[9]  Laurant M, Harmsen M, Wollersheim H, Grol R, Faber M, Sibbald B. The impact of nonphysician clinicians: do they improve the quality and cost-effectiveness of health care services? Med Care Res Rev 2009; 66 36S–89S.
The impact of nonphysician clinicians: do they improve the quality and cost-effectiveness of health care services?Crossref | GoogleScholarGoogle Scholar | 19880672PubMed |

[10]  Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al Advanced practice nurse outcomes 1990–2008: a systematic review. Nurs Econ 2011; 29 230–50.
| 22372080PubMed |

[11]  Kinnersley P, Anderson E, Parry K, Clement J, Archard L, Turton P, et al Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting ‘same day’ consultations in primary care. BMJ 2000; 320 1043–8.
Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting ‘same day’ consultations in primary care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3islKluw%3D%3D&md5=f80e708086c16c5421ccd9e669566c83CAS | 10764366PubMed |

[12]  Lenz ER, Mundinger MON, Kane RL, Hopkins SC, Lin SX. Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Medical Care Res Rev 2004; 61 332–51.
Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.Crossref | GoogleScholarGoogle Scholar |

[13]  Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai W, Cleary PD, et al Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA 2000; 283 59–68.
Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2Fps1WnsA%3D%3D&md5=e400884b8c5e9375761cbe4969188c76CAS | 10632281PubMed |

[14]  Spitzer WO, Sackett DL, Sibley JC, Roberts RS, Gent M, Kergin DJ, et al The Burlington randomized trial of the nurse practitioner. N Engl J Med 1974; 290 251–6.
The Burlington randomized trial of the nurse practitioner.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE2c%2FmtFKhsA%3D%3D&md5=f9ea75d51f56c8a0628f92145ca022cbCAS | 4808929PubMed |

[15]  Dierick-van Daele ATM, Metsemakers JFM, Derckx EWC, Spreeuwenberg C, Vrijhoef HJM. Nurse practitioners substituting for general practitioners: randomized controlled trial. J Adv Nurs 2009; 65 391–401.
Nurse practitioners substituting for general practitioners: randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |

[16]  Sakr M, Angus J, Perrin J, Nixon C, Nicholl J, Wardrope J. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial. Lancet 1999; 354 1321–6.
Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FgtFChtA%3D%3D&md5=ab5aadb7561adc2c26794dc38edc4f51CAS | 10533859PubMed |

[17]  Shum C, Humphreys A, Wheeler D, Cochrane M-A, Skoda S, Clement S. Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial. BMJ 2000; 320 1038–43.
Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3islKlug%3D%3D&md5=82945ad12832f82f58e2494196ec37c0CAS | 10764365PubMed |

[18]  Venning P, Durie A, Roland M, Roberts C, Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ 2000; 320 1048–53.
Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3islKksg%3D%3D&md5=4346e839cb8a4f6737cdd4c7d04acdc5CAS | 10764367PubMed |

[19]  Running A, Kipp C, Mercer V. Prescriptive patterns of nurse practitioners and physicians. J Am Acad Nurse Pract 2006; 18 228–33.
Prescriptive patterns of nurse practitioners and physicians.Crossref | GoogleScholarGoogle Scholar | 16681710PubMed |

[20]  Brown SA, Grimes DE. Nurse practitioners and certified nurse-midwives: a meta-analysis of studies on nurses in primary care roles. Washington DC: American Nurses Association Publications 1993; NP-85 5M: i–xx, 1–105.

[21]  Seale C, Anderson E, Kinnersley P. Comparison of GP and nurse practitioner consultations. Br J Gen Pract 2005; 55 938–43.
| 16378563PubMed |

[22]  Hayes E. Nurse practitioners and managed care: patient satisfaction and intention to adhere to nurse practitioner plan of care. J Am Acad Nurse Pract 2007; 19 418–26.
Nurse practitioners and managed care: patient satisfaction and intention to adhere to nurse practitioner plan of care.Crossref | GoogleScholarGoogle Scholar | 17655571PubMed |

[23]  Haidar E. Evaluating patient satisfaction with nurse practitioners. Nurs Times 2008; 104 32–3.

[24]  Allnutt J, Allnutt N, McMaster R, O’Connell J, Middleton S, Hillege S, et al Clients’ understanding of the role of nurse practitioners. Aust Health Rev 2010; 34 59–65.
Clients’ understanding of the role of nurse practitioners.Crossref | GoogleScholarGoogle Scholar | 20334759PubMed |

[25]  Gagan MJ, Maybee P. Patient satisfaction with nurse practitioner care in primary care settings. Aust J Adv Nurs 2011; 28 12–9.

[26]  Agosta LJ. Patient satisfaction with nurse practitioner-delivered primary healthcare services. J Am Acad Nurse Pract 2009; 21 610–7.
Patient satisfaction with nurse practitioner-delivered primary healthcare services.Crossref | GoogleScholarGoogle Scholar | 19900223PubMed |

[27]  Reveley S. The role of the triage nurse practitioner in general medical practice: an analysis of the role. J Adv Nurs 1998; 28 584–91.
The role of the triage nurse practitioner in general medical practice: an analysis of the role.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1cvislKmug%3D%3D&md5=b668fbaa32dcb797f0032117759c68faCAS | 9756227PubMed |

[28]  Thrasher C, Purc-Stephenson R. Patient satisfaction with nurse practitioner care in emergency departments in Canada. J Am Acad Nurse Pract 2008; 20 231–7.
Patient satisfaction with nurse practitioner care in emergency departments in Canada.Crossref | GoogleScholarGoogle Scholar | 18460162PubMed |

[29]  Laurant MG, Hermens RPM, Braspenning JCC, Akkermans RP, Sibbald B, Grol RPT. An overview of patients’ preference for, and satisfaction with, care provided by general practitioners and nurse practitioners. J Clin Nurs 2008; 17 2690–8.
An overview of patients’ preference for, and satisfaction with, care provided by general practitioners and nurse practitioners.Crossref | GoogleScholarGoogle Scholar | 18647199PubMed |

[30]  Baishnab E, Karner C. Primary care based clinics for asthma. Cochrane Database System Rev 2012; CD003533
Primary care based clinics for asthma.Crossref | GoogleScholarGoogle Scholar |

[31]  Schadewaldt V, Schultz T. Nurse-led clinics as an effective service for cardiac patients: results from a systematic review. Int J Evid Based Healthc 2011; 9 199–214.
| 21884449PubMed |

[32]  Page T, Lockwood C, Conroy-Hiller T. Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease. Int J Evid Based Healthc 2005; 3 2–26.
Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease.Crossref | GoogleScholarGoogle Scholar | 21631742PubMed |

[33]  Renders CM Valk GD Griffin SJ Wagner E van Eijk JTM Assendelft WJJ Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database of System Rev 2000 (4 ):CD001481 10.1002/14651858.CD001481

[34]  Owens D, Eby K, Burson S, Green M, McGoodwin W, Isaac M. Primary palliative care clinic pilot project demonstrates benefits of a nurse practitioner-directed clinic providing primary and palliative care. J Am Acad Nurse Pract 2012; 24 52–8.
Primary palliative care clinic pilot project demonstrates benefits of a nurse practitioner-directed clinic providing primary and palliative care.Crossref | GoogleScholarGoogle Scholar | 22243681PubMed |

[35]  Offredy M, Townsend J. Nurse practitioners in primary care. Family Practice 2000; 17 564–9.
Nurse practitioners in primary care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7kslensQ%3D%3D&md5=1d86bc3f634fb593cb92cefe8360b2f7CAS | 11120732PubMed |

[36]  Laurant MG, Hermens RPM, Braspenning JCC, Sibbald B, Grol RPT. Impact of nurse practitioners on workload of general practitioners: randomised controlled trial. BMJ 2004; 328 927–30.
Impact of nurse practitioners on workload of general practitioners: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 15069024PubMed |

[37]  Wilson A, Pearson D, Hassey A. Barriers to developing the nurse practitioner role in primary care: the GP perspective. Family Practice 2002; 19 641–6.
Barriers to developing the nurse practitioner role in primary care: the GP perspective.Crossref | GoogleScholarGoogle Scholar | 12429668PubMed |

[38]  Curtis L, Netten A. The costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix. J Nurs Manag 2007; 15 449–57.
The costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix.Crossref | GoogleScholarGoogle Scholar | 17456174PubMed |

[39]  Browne G, Birch S, Thabane L. Better care: an analysis of nursing and healthcare system outcomes. Ottawa, Canada: Canadian Health Services Research Foundation; 2012.

[40]  Ford P. AMA aged care survey. Australian Medicine Vol. 24. 2012 : 16.

[41]  Catholic Health Australia. Survey of access to general practice services in residential aged care. Canberra: Catholic Health Australia; 2010.

[42]  Australian Government Department of Health and Ageing. Aged care GP panels initiative – 2006 aged care homes survey. Canberra: Department of Health and Ageing; 2006.

[43]  Dick K, Frazier SC. An exploration of nurse practitioner care to homebound frail elders. J Am Acad Nurse Pract 2006; 18 325–34.
An exploration of nurse practitioner care to homebound frail elders.Crossref | GoogleScholarGoogle Scholar | 16827838PubMed |

[44]  Fulmer TEL. Geriatric nurse practitioners: vital to the future of healthcare for elders. Generations 2001; 25 72

[45]  Ganz DA, Koretz BK, Bail JK, McCreath HE, Wenger NS, Roth CP, et al Nurse practitioner comanagement for patients in an academic geriatric practice. Am J Manag Care 2010; 16 343–55.

[46]  Ornstein K, Smith KL, Foer DH, Lopez-Cantor MT, Soriano T. To the hospital and back home again: a nurse practitioner-based transitional care program for hospitalized homebound people. J Am Geriatr Soc 2011; 59 544–51.
To the hospital and back home again: a nurse practitioner-based transitional care program for hospitalized homebound people.Crossref | GoogleScholarGoogle Scholar | 21391944PubMed |

[47]  McAiney CA, Haughton D, Jennings J, Farr D, Hillier L, Morden P. A unique practice model for nurse practitioners in long-term care homes. J Adv Nurs 2008; 62 562–71.
A unique practice model for nurse practitioners in long-term care homes.Crossref | GoogleScholarGoogle Scholar | 18489449PubMed |

[48]  Christian R, Backer K. Effectiveness of nurse practitioners in nursing homes: a systematic review. JBI Library Syst Rev 2009; 7 1333–52.

[49]  Aigner MJ, Drew S, Phipps J. A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. J Am Med Dir Assoc 2004; 5 16–23.
A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only.Crossref | GoogleScholarGoogle Scholar | 14706124PubMed |

[50]  Gardner G, Carryer J, Gardner A, Dunn S. Nurse practitioner competency standards: findings from collaborative Australian and New Zealand research. Int J Nurs Stud 2006; 43 601–10.
Nurse practitioner competency standards: findings from collaborative Australian and New Zealand research.Crossref | GoogleScholarGoogle Scholar | 16257407PubMed |

[51]  Adrian A, Chiarella M. Review of the implementation of the role of NPs in South Australia. Adelaide: Nursing and Midwifery Office, SA Health; 2008.

[52]  Della PR, Zhou H. Report on the evaluation of the nurse practitioner role in NSW. Perth: School of Nursing and Midwifery, Curtain University of Technology; 2009.

[53]  Department of Human Services. The Victorian Nurse Practitioner Project: final report of the taskforce. Melbourne: Policy Development and Planning Division, Victorian Government, Department of Human Services; 1999.

[54]  Queensland Health. Nurse practitioner project report. Brisbane: Queensland Health; 2003.

[55]  WA Health NaMO. Nurse practitioner business models and arrangements. Perth: Nursing and Midwifery Office, Department of Health, Government of Western Australia; 2011.

[56]  ACT Health. The aged care nurse practitioner pilot project: final report to the Australian Government (Rescinded). Canberra: Australian Capital Territory Government; 2005.

[57]  ACT Health. Implementing the nurse practitioner role in aged care: final report to the Australia Government. Canberra: ACT Health; 2007.

[58]  Joanna Briggs Institute. National evaluation of nurse practitioner-like services in residential aged care services. Canberra: Department of Health and Ageing, Commonwealth of Australia; 2007.

[59]  Arbon P, Bail K, Eggert M, Gardner A, Hogan S, Phillips C, et al Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital Territory. J Clin Nurs 2009; 18 255–62.
Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital Territory.Crossref | GoogleScholarGoogle Scholar | 18800993PubMed |

[60]  Allen J, Fabri AM. An evaluation of a community aged care nurse practitioner service. J Clin Nurs 2005; 14 1202–9.
An evaluation of a community aged care nurse practitioner service.Crossref | GoogleScholarGoogle Scholar | 16238766PubMed |

[61]  Borbasi S, Emmanuel E, Farrelly B, Ashcroft J. A nurse practitioner initiated model of service delivery in caring for people with dementia. Contemp Nurse 2010; 36 49–60.
A nurse practitioner initiated model of service delivery in caring for people with dementia.Crossref | GoogleScholarGoogle Scholar | 21254822PubMed |

[62]  Borbasi S, Emmanuel E, Farrelly B, Ashcroft J. Report of an evaluation of a nurse-led dementia outreach service for people with the behavioural and psychological symptoms of dementia living in residential aged care facilities. Perspect Public Health 2011; 131 124–30.
Report of an evaluation of a nurse-led dementia outreach service for people with the behavioural and psychological symptoms of dementia living in residential aged care facilities.Crossref | GoogleScholarGoogle Scholar | 21692400PubMed |

[63]  Denniss R, Fear J. Measuring what matters: do Australians have good access to primary health care? Policy Brief No. 13. Canberra: The Australia Institute; 2010.

[64]  Parker R, Forrest L, Ward N, Scanlon C, McCracken J, Cox D, et al. Health care consumers’ knowledge and opinions of the role and use of nurse practitioners in Australian primary health care. Canberra: Australian Primary Health Care Research Institute, Australian National University; 2011.

[65]  Gardner A, Gardner GE, Middleton S, Della PR. The status of Australian nurse practitioners: the first national census. Aust Health Rev 2009; 33 679–89.
The status of Australian nurse practitioners: the first national census.Crossref | GoogleScholarGoogle Scholar | 20166918PubMed |

[66]  Council of Australian Governments. Intergovernmental agreement for a national registration and accreditation scheme for the health professions. 2008. Available at http://www.ahwo.gov.au/documents/National%20Registration%20and%20Accreditation/NATREG%20-%20Intergovernmental%20Agreement.pdf.

[67]  Australian Government Department of Health and Ageing. MBS arrangements for midwives and nurse practitioners. 28 October 2011. Available at http://www.health.gov.au/midwives-nurse-practitioners [verified 23 October 2012].

[68]  Pawson R, Tilley N. Realist evaluation. 2004. Available at http://www.communitymatters.com.au/RE_chapter.pdf [verified 11 October 2011].

[69]  Prosser B, Clark S, Davey R, Parker R. Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care. Eval Program Plann 2013; 40 55–63.
Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care.Crossref | GoogleScholarGoogle Scholar | 23807117PubMed |

[70]  Productivity Commission. Caring for older Australians. Final inquiry report No. 53. Canberra: Productivity Commission; 2011. Available at: http://www.pc.gov.au/projects/inquiry/aged-care/report [verified 21 February 2012]