Nurse practitioners are often the key contact point for rural patients.

Nurse practitioners are often the key contact point for rural patients.

In many small rural towns there are no doctors to visit when you get sick, no GP to know your history, and no friendly receptionist to stock you up with magazines while you await your turn. Instead, nurse practitioners run the show — upskilling themselves to a point where they can operate not only as practice managers, but write and give prescriptions, bill through Medicare, and refer to specialists.

Nurse Practitioners are essential in rural Queensland, and especially so in the small town of Camooweal which sits two hours from Mount Isa and only 13 kilometres from the Northern Territory border.

What is a nurse practitioner?

• A nurse practitioner is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role
• A practice nurse is an enrolled nurse or a registered nurse, including nurse practitioners, who is employed by, or whose services are otherwise retained by, a general practice

Camooweal is a town with a high Indigenous population and its director of nursing and nurse practitioner Andrew McCallum says kidney disease and diabetes are major issues in the town.

“I don’t think it matters whether you’re a doctor, nurse, or health worker. Having someone locally who knows people and their conditions, where they’re up to with the treatment … it’s really important,” he said.

“Some of them have five or six different specialists … and a lot of people out here have quite poor health literacy — meaning they maybe don’t understand a lot about the medical terminology or treatments.”

Nurse practitioners work under an individualised scope of practice which outlines the roles and responsibilities they can take on and when the primary healthcare general practitioner will take over.

In Camooweal, the primary GP service is provided by the Royal Flying Doctor Service.

For Mr McCallum, the ability to bulk bill and directly refer patients to specialists gives him the opportunity to keep people in the town longer without them having to go to Mount Isa or Townsville for treatment.

“An example may be a patient with kidney disease that has really complicated issues,” he said.

“We can manage locally and then, once you start getting beyond that scope of practice, I would consult directly with a renal physician or a kidney specialist.”

Mr McCallum has worked in Camooweal since 2015, and Rural Doctors Association of Queensland president Dr Clare Walker, who is based in the western Queensland town of Longreach, said that continuity of care was vital.

“We often have problems recruiting GPs to rural and remote areas,” Dr Walker said.

“What we’re seeing more of, and I think this is where the true and high value for our patients comes from, is [nurse practitioners] caring for patients with their chronic diseases.

“Our nurse practitioners are often in the right place to provide that ongoing continuity of care, really help these patients manage their symptoms and avoid the complications of their diseases.”

While the call is often put out to attract doctors to rural areas with financial incentives, Dr Walker said a major gap in the system leaves nurses and nurse practitioners left out.

“As doctors we receive funding to live in remote places and that rural area locality allowance increases with the rurality with which we live,” Dr Walker said.

“There isn’t anything like that for nursing staff except for a small pocket around Mount Isa, which is a historical arrangement.

“I think it’s something that this government should look at.”

The Queensland Nurses and Midwives’ Union secretary Beth Mohle said some nurse practitioners around Queensland already received financial incentives.

“Remote nurses are invaluable, hard-working, and form an integral part of remote communities,” Ms Mohle said.

“Under Queensland Health’s existing Remote Area Nursing Incentive Package (RANIP), remote nurses working in seven Queensland Hospital and Health Service (HHS) districts covering more than 55 remote locations receive a raft of financial incentives.

“The QNMU and Queensland Health are currently working to further expand these locations and incentives.”

Dr Walker said she believed the issue stemmed from old concepts and needed to be reviewed as nurse practitioners take the responsibilities approaching those of primary healthcare workers, such as GPs.

“Often the [nurse practitioners] see the patients and are completely responsible for their care, without a doctor in their town in many cases,” she said.

This article was originally published on ABC at www.abc.net.au on 24/9/19 by Kelly Butterworth.