Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Abstract

Rural Australians have poorer access to health services than Australians living in metropolitan areas primarily because of shortages in the health professional workforce. Nurses taking on advanced skills could help this situation by relieving doctors but our understanding of the factors that enhance or inhibit uptake is poorly understood in rural areas of Australia.

The aim of this study is to identify the barriers and enablers associated with the implementation of advanced nursing roles in rural general practice specifically although an urban general practice was included to ensure that the diversity of practices were represented. The selection of general practices was based on (1). a standardised classification system that uses geographic location and population base as the key criterion and (2). ease of access for the research team. The general practices were all located within 3 hours drive of the researchers’ home base. Using case study design four rural and one metropolitan located general practices were included. The researchers compared recorded nursing activities with job descriptions, educational opportunities and advanced competency standards. Interviews with practice principals, practice managers and nurses were undertaken. Findings are categorised as: personal which includes motivation, knowledge and time; workplace which includes status, guidelines and practice conventions and routines; and policy which includes national payment systems, and scope of practice. The potential for nurses to advance their practice and meet the needs of patients, particularly in the specialist areas of chronic care and health promotion, is still under developed in the rural practices. The findings have led to the development of a framework for the introduction of advancing practice roles for nurses that will meet the needs of a currently, under-served community.