Rural Nurse Specialist: A Model

Robin Williams RGON ADN

Operational Manager and Clinical Advisor

Community Health

West Coast District Health Board

West Coast Rural Nurse Specialist Team

Heather Maw (Karamea)Elizabeth Burns (Moana/Otira)Bruce Hall (Harihari)Sue Cleland (Whataroa/Franz Josef Glacier)Louisa Davidson (Fox Glacier)David Verrall (Haast)

This presentation will…

Provide a description of the RNS model, as developed on the West Coast (Who are they and what do they do?)

Discuss the relevance of Nurse Practitioner role in rural health care (What is the step from what we have to what is needed?)

Give a brief overview of the costs and benefits of the RNS model, including funding

Evolution of roles1996 variation in employment contract between Coast

Health Care and the South Rural Nurses contract title change from District Nurse to Rural Nurse Specialists salary increase in recognition of current skill level and

experience and isolationlack of residential GP backup [on his/her days off] on call work

2000 Public Health Nurse to Rural Nurse

What is it about rural nursing?

What is it about rural nursing?

A “multiskilled rural nurse – providing 24hr cover, 7 days a week”, advised that “rural nursing is not for the faint hearted or the truly organized nurse. It is however rewarding, stimulating and a way of life, a darn good one at that”.

What do we mean by rural nursing?

‘Rural nursing’ is not a scope of practice, it is a context of practice. Nursing

practice is shaped by the rural context. (Jones & Ross 2001)

What is distinctive about the rural

context? Distance Isolation Interdependence between team members The nurse lives and works as a community

member Resilience and independence of rural community

members

What do the RNSs do?

Everything!

What do the RNSs do?

It is a generalist role, but a specialised generalist

What do the RNSs do?

deliver personal and population health in a rural setting, under the principles and goals of NZ Health Strategy, PHC strategy and ‘Roadside to Bedside’ document

as autonomous practitioners they are the first point of contact for day to day health care needs on a continuum

Personal health care [80%] Clinic and home and school based consultations Tamariki Ora / well child / immunisation of hard-to-reach Well adult health screening Early intervention thru assessment, monitoring and

referral Palliative care Antenatal and postnatal care Follow-up care following hospital admission Emergency response -- PRIME

Population health initiatives [20%]

Guided by founding documents Treaty of Waitangi and Ottawa

CharterNational health goals & local health needs e.g. Maori and Pacific Island Health Screening programmes Health promoting schools Quit Smoking programme Safety in the workplace

interplay between personal and population based health

an example

Rural Nurse Practitioner ?

‘ PHC— rural health’ as a ‘scope’

is problematic…

What is the step from RNS to RNP ?

OrganisationalProfessionalPersonal

Why have NPs in rural health?

Changes in the economics in demography of New Zealand through the past decade or more have led to hard times and the depletion of health and other social services in rural settlements have bought the health of rural community to the attention of policy makers

(Litchfield 2001).

Why have NPs in rural health?

The difficulty in finding GPs for rural areas has gone on for along time. My father was Chairman of the Maniototo Hospital Board and I remember the difficulties – I have newspaper clippings -- they had in those days trying to find a GP for Ranfurly. It’s not something new and is not going to go away. I firmly believe that the Nurse Practitioner idea is something that needs to the developed more and more in rural areas to assist GPs so that they don’t feel so isolated and burnt out (Marg Eckhoff).

Advanced practice roles …in rural health?

Specialised practiceExpanded practiceAdvanced practice

(ANA cited in Cronenwett 1995:115)

specialization

Specialization is concentrating or delimiting one’s focus to part of the whole field of nursing.

expansion

Expansion refers to the acquisition of new practice knowledge and skills including the knowledge and skills that legitimize role autonomy within areas of practice that overlap the traditional boundaries of medical practice.

advancement

Advancement involves both specialization and expansion and is characterised by the integration of a broad range of theoretical, research-based, and practical knowledge that occurs as a part of graduate education in nursing.

Are RNSs cost effective in delivering the aims of NZ health

strategy, PHC strategy and roadside to bedside strategy?

Cost of a Rural Nurse Specialist is $85,614 per annum

Plus costs relating to continuing education and annual leave locum cover

South Westland Karamea Moana / Otira Nursing Contracts

4 RNS

1 GP

1200 popn

(1996 census)

1 RNS

 

700 popn

(1996 census)

1 RNS

 

650 popn

(1996 census)

Tamariki Ora / Wellchild

School Health

District Nursing

Maternity (shared)

Health Promotion / Protection

ACC

PRIME

SAMO

Medical and Practice Nurse contract

1 GP - GMI

CHC contracted to provide Practice Nurse service and relief cover for GP

1 GP - Subsidised

12 km away

provides visiting weekly clinic and daytime medical advice

11: 3 roster

all participate

11 : 3 roster

both participate

currently no relief RNS

in place

11 : 3 roster

with Relief RNS

no participation by GP – after hrs

medical cover Grey Base Hospital

Benefits RNS: It's the difference of having a health service

or not Variation in GP services An effective working relationship between Nurse

and GP Clinical placements Accessible, appropriate service Transferable skills

A vision for the future

Primary Health Care contracts that provide for equal status of Medical Practitioners and Nurse Practitioners, whilst recognising each as having specialised roles with joint responsibility to improve health outcomes

My acknowledgements

Jean Ross

Wayne Marshall

Shelley Jones