Xmas looming

As I am leaving for holidays as of next Friday, this is my last blog for the year - and what a year! Highlights for me include

• APNA's first conference which epitomised the dynamic, optimistic membership we work with.
• rigorous debate about nursing roles in general practice/primary health care, including nurse practitioner roles - especially being part of a wider group of nursing colleagues developing a unified voice.
• engaging with the different stakeholders around general practice and nursing
• continuing to serve a wonderful, visionary and considered Board who are open to my ideas but willing to reject those that should be rejected
• answering calls from members most days of the working week who never fail to impress with their sensibility, passion and concern for the community
• getting to see all the Best Practice Award applications and then see the winners and runners up on the night
• seeing the development of the Primary Times publication under the very capable and dedicated hands of Val McKenzie and the rest of the Editorial Board
• moving to our new premises
• the ongoing enthusiasm and commitment of APNA staff where I know I can leave so much in their capable hands and it gets done!

I hope all of you have a wonderful Christmas and New Year, refreshing yourselves for what promises to be a huge year for nurses in general practice and in primary health care more broadly. Have one on me!

Different takes on the same thing

It has been a bit of a political few days. Last Thursday we received news that the Nurse Practitioner and Midwives Access to MBS and PBS legislation which is before the Senate, had an amendment tabled for consideration by the Senate. For those of you who have been watching the hoo-hah over the last two months about this legislation, it will come as no surpise that the Minister bowed to some pressure from the medical profession to formalise in the legislation that NPs and midwives will only be eligible if they enter into a collaborative arrangement of a kind or kind specified in the regulation with one or more medical practitioners.
The AMA hailed this as a victory but it has been interesting to see different nursing groups response. Should we be outraged? The midwives certainly are. Or is this actually a clever action by a minister under pressure to address medical practitioners concerns without being overly specific. How do we respond? Do we say nurses always work collaboratively and while we don't think it was necessary to spell this out, depending on the regulation requirements, it wouldn't make all that much difference to how nurse practitioners currently do their work. In fact the one private mental health NP reckons it will force GPs to work with him. There is also the dilemna of - 1/making a fuss about the amendment creating an impression that we don't want to work wiht medical practitioners and feeding into the hysteria in the medical media etc or 2/succumbing to the control of medical fraternity over professional nursing care/roles.
There is no right answer - I myself lean to the pragmatic. Get this legislation in on time while we have a favourable government and reap the significant benefits. It was always stipulated in the federal budget initiative back in May that it was intended that nurses would collaborate with medical practitioners -but I know I have not been fighting the NP cause for a long time and hence do not the same frustrations.
I would be really interested in comments on this one. Be brave!
Finally can I strongly encourage you all to submit proxies if you are unable to attend SGM. This is a key important strategic decision for your association. We have received some positive and negative feedback so there is no right answer. If you want your proxy to vote no - make a note on the form.

Why does time speed up towards the end of the year

I really want to understand the phenomena of feeling like I come to the end of every year at ever increasing speed then a dashing sideways skid into Christmas. The blood pressure has been rising steadily since before the APNA move and the 8-10 hours in a working day feel dramatically shorter, the tasks on both my work and at home to-do list is getting longer not shorter. There is something about the not-for-profit and general practice worlds which means that conferences all happen in the October/November period, governments are madly trying to sign off on things announced in May budget and everyone organises meetings to 'finish' the year off nicely.
APNA of course decides to have our Best Practice Awards and Symposium, 2 day board meeting in Sydney, Melbourne PNCE all in November and as a result of all this with the AGPN conference, some meetings in Canberra and Sydney - I will be away from home a total of 14 days this month (7 in a row), and working through 2/4 weekends. Before I know it Christmas will be staring me in the face! All of this means however that we are consistently growing, getting out there and being invited to key meetings etc.
2 weeks ago, I was at Adleaide PNCE which was lovely - the smaller PNCE conferences are always such an energising spending time chatting with members, hearing all your issues and being inspired by your enthusiasm.
Last week I attended a meeting of primary health care experts in Sydney looking at the NHHRC proposed new 'primary health care organisations' - regional organisations who may be charged with a range of responsibilities e.g. coordination of local PHC services, fundholding for services provided etc. While a bit heady and removed from the concrete world of practice nursing, these potential organisations if implemented will change how you are funded, coordinated and other areas of your work.
Last week I also presented at the Practice Managers conference here in Melbourne and manned a booth there where we got lots of questions and interest - many PMs took home bags of our material for their practice nurses. This is an important forum for us to advocate for nursing roles and encourage appropriate salary and conditions, proper management of nursing roles and showcase the great work practice nruses can do.
Finally on a personal note, I have been challenged recently by the developing social lives of my two teenage daughters, particularly regarding alcohol consumption and safe partying. Like most other parents of teenagers, I feel like the rule book has disappeared, it is each parent/s to their own and it is very energy depleting to be constantly justifying our position on drinking and safe partying which may or may not be other parents' view. I have been somewhat shocked by the very casual attitude to alcohol consumption (and we are no wowsers) and in particular binge drinking, and have real concerns about what this means for this generation of kids. The flow on effects to behaviour, risk-taking, and attitude is really confronting. While I know there has been alot of debate about this, I guess until it is your own kids or their friends, that as a public health issue, it does not hit home. I feel reasonably confident that we have got it sort of right in terms of our expectations and navigating our kids to a safe adulthood, but we are pretty informed as parents and there are plenty who are not, as I am finding out. I expect this to become a key issue in primary health care nursing as we move into more health promotion and adolescent health.

Pandemic vaccine rolls into town

We have been regular participants in weekly teleconferences conducted by the Chief Medical Officer and the Office of Health Protection, culminating in the roll out this week of the vaccine. The information about the seriousness of the pandemic is still important to understand now we have seen a decline in cases in Australia - all indications are that the northern hemisphere are starting to see a new surge in cases with some evidence that the second wave may be more serious than the first. All health professionals need to be immunised and that means you! You need to understand why, and why your patients should be immunised, particularly the priority groups.
It is going to be an interesting exercise to see how general practice delivers on a major public health initiative like this. I will be really interested in any comments on how its going, problems and good news stories. We have every confidence that practice nurses will be a key enabler in the successful roll out of this! For all the latest information go to our website www.apna.asn.au
By the time I write my next blog we will be in our new premises and hopefully it will have all gone smoothly but we ask that people be tolerant if phones/internet etc experience some disruption. Wish us luck!

A deep breath

I have had a quiet 10 days or so with my eldest daughter having a tonsillectomy. There is nothing like looking after a crotchety teenager in pain to make you take a break from thinking about work! It also proved that once a nurse always a nurse - I think I did a pretty good job looking after her, ensuring she was hydrated, in minimal pain, kept moving when able to and largely self-managing in good spirits.

However, sitting next to her for hours cuddling and just 'being there' gave me plenty of time for reflection and the opportunity to take a deep breath before launching into what promises to be an extremely busy next few months.

• Responses to salary and conditions survey are currently sitting at 311 which is fantastic but we need more.


• First meeting of 2010 conference committee is on Friday and what a motivated bunch they are - I am really looking forward to it


• Patient satisfaction data collection tool project is in its final stages beofre submitting report to the government. Thanks to all who participated- your patients love you!


• Nominations for Best Practice Awards are rolling in and the best part of my day currently and until it closes is reading the applications as they come in - inspiring. With the BPA awards this year we are having a one-day clinical symposium for practice nurses in Sydney where we are often criticised for not having much of a presence. I hope to see as many of the APNA Sydney members there as possible on the 27th November.


• Finalising the next strategic plan and consulting with you all on it - again is looking exciting but need to knuckle down and concentrate on pulling it all together


• And we are entering conference season for the general practice sector- while we can't attend all due to costs, we try to have a presence at as many as possible. Coming up are the RACGP conference, Australian Association of Practice Managers, Australian General Practice Network, Australian College of Nurse Practitioners etc.


• And moving offices.........

I hope you all saw our letter in Ausdoc this week regarding a cartoon 2 weeks ago. I would encourage any of you with sensible GPs to write in support of it or nurses generally. We were appalled by the demeaning portrayal of nurses and their clinical decision making in the cartoon.

Moving, NP Advisory Group, Swine Flu

It has been a big month for us since my last blog. We have decided on new premises for the APNA office in Carlton, Victoria and are looking forward to moving in on October 9th at this stage. The office will allow us to have our own meeting room/s and will look a lot less transient than the current office. The building is a Victorian terrace and is being repainted inside and out and recarpeted etc for our moving in. The location is also close to public transport, beautiful gardens and the best coffee in Melbourne which is always important! We were asked to provide a nurse practitioner/GP combination to represent APNA on the Nurse Practitioner Advisory Group, which has been set up to implement the NP and Midwife Access to MBS and PBS legislation. APNA member Cassie Holland and Dr Robert Clarke are doing this and we really appreciate their commitment. They are being supported and advised by other members of the NP special interest group within APNA. If any of you want to join this, email me and I will add you to the email group.

Scholarships and Best Practice Awards have been released and as always mean the phones are running hot in here. I always enjoy the Best Practice Awards process as we get to hear so many inspirign stories which give meaning to what we do every day. I encourage all of you to have a go at these awards even you entered before as we have had a very hard time deciding each year.

Planning for next years conference are well underway and the 2010 conference committee is meeting face to face at the end of next week to decide on the final program for release. Any great ideas, email lucy.dear@apna.asn.au so we can incorporate them.

We continue to meet with the Chief Medical Officer on a weekly basis presently around teh rollout of the swine flu vaccine program and Karen Booth and Jenny Dandeaux are doing a marvellous job representing practice nurse concerns and issues - and the department really seems to be listening and responding to all concerns. If anyone wants to contact them, email me and I will forward it on.

I am working from home next week while looking after a teenager post-tonsillectomy (joys of balancing motherhood and work) which will be a great time to finalise the draft 2010-2015 strategic plan for members to look at.

flying around

One of the joys of my job is the level of travel involved. Whilst at times there are a some mutterings of discontent at home, I relish the opportunity to get out and about amongst practice nurses from all over - as well as get away from some of the daily hustle and bustle involved in running an organisation as well as a household with 2 teenage girls.
In the last 2 weeks I have been to Perth, Gold Coast, Canberra and Sydney. I did Perth and back in a day which sounds mad but was actually quite relaxing. Reading a book, watching the movie of my choice and daydreaming is not to be sneezed at and a return trip to Perth meant 8 hours of that in one day. I was in Perth to participate in the Perth PNCE and give a presentation on the evolving roles of the practice nurse. As always the presentation turned into a discussion and there was a real vibe of optimism about the roles nurses in the room were envisaging for themselves.
The Gold Coast was to check out the venue for next years conference. Whilst it looked good on the web and on paper, I wanted to check that it met our particular needs. And it is a wonderful venue! Very professional and corporate for the conference end of it with alot of space for the exhibitors everyone loved this year, space for us to implement some innovations such as a practical skills area, great venue for dinner which is always important. As importantly for APNA members/practice nurses, it is more affordable than this years was, will be a great place to bring your family if you want to incorporate a family holiday, has inexpensive travel options (Virgin or Jetstar was flying Melb - Gold Coast for $59 one way last week). Now I am getting really excited about the conference and hope to see as many of you there as possible.
Canberra was to discuss the proposed streamlining of the scholarships programs for nurses and allied health which impacts on a program which we have been administering for a number of years now. While practice nurses access to the program won't be impacted, our involvement is likely to be less from January 1 2010.
And finally Sydney was for a Kidney Health Australia PN Subcommittee meeting discussing training they are running out to practice nurses. Apart from the serious discussions, I was able to give Clodagh Scott (our APNA PN rep) a green APNA polo shirt that we wore at the conference for her to wear as she traipses around Russia on a nursing conference cruise!!! She has promised photos of the APNA short on its travels.
Am not travelling anywhere for the next little bit and will be a bit more popular at home!

APNA VP interviewed on radio

APNA Vice President Karen Booth interviewed on ABC Radio National http://www.abc.net.au/am/content/2009/s2623127.htm

In front of a camera

Last week, Anne Matyear, Karen Booth and I were invited to attend media training in Sydney run by Sheryl Taylor, previously the health reporter for Channel 9 for 20 years. It was very practical with lots of time in front of the camera and on the end of a phone.
For most of us this is a very foreign experience and very intimidating! While I am pretty confident in front of an audience now, trying to explain my message in 10 sec 'grabs' for the average punter (not a health professional) was really hard! My two topics were access for NPs to the MBS and PBS (try saying those quickly with no acronyms) and the role of the practice nurse in prevention. As nurses we all spent way too long over explaining everything to make sure we had covered all bases! But by the end of the day we had gotten the hang of a lot of it. Karen got the chance to practice yesterday with a radio interview on ABC which unfortunately got edged out at the last minute by some swine flu announcements!

On Tuesday I was invited on a panel at a Teamwork symposium in Sydney showcasing research undertaken by the UNSW Centre for Primary Health Care and Equity. The research showed you can facilitate teamwork in general practice and that this can benefit chronic disease management. Practice nurses were featured as key enablers of teamwork.

Today we are releasing our annual membership satisfaction survey. Please assist us to tailor APNA to support members as best we can by filling in the survey. The end of the survey also asks you to provide input into the next 5 years for APNA which is vital!

Under fire....

I have had an interesting week on the web. In response to an article on the website www.6minutes.com.au entitled "Should Nurses be Doctors?" I responded with a clarication about the role and qualifications of nurse practitioners. Well! I have never been in receipt of such vitriol in my life! Assumptions about who I was, supposed claims of being "hardworking and smart", 'massaging my ego" and so on and so forth from GPs and others.
Anyway I then enlisted the support of the nurse practitioners and NP candidates who are APNA members to add their contributions to the debate, which they did very ratioanlly and calmly (in comparison to some of the other contributions). The whole discussion became a much broader discussion about nursing as a profession and then towards the end about best management of exercise induced asthma.
Despite acknowledging that GPs who contribute to web forums such as this may not be your typical GP, the expereince highlighted some things for me of concern. there were alot of assumptions made about who I was and what I was saying which were not in writing. Do they do this with patients? Likewise there was very selective use of evidence. Finally ideology was expressed as fact - and that for me is the essential difficulty for all of us in this debate.
Should we engage in such silly debate? I suspect yes - we need to keep calmly and rationally stating the evidence and the facts. As more and more on the ground GPs enjoy the experience of working alongside nurses of all level and skill bases and in a collegiate and respectful manner, debates such as these will become obsolete as they are becoming in other countries such as the UK.

Medical and nursing groups together

On Tuesday I attended a Roundtable meeting in Canberra again which had medical and nursing groups together. It was a follow on from the same roundtable last year which we organised alongside the ANF and the College of Nurse Practitioners. Last year we placed the advanced nursing roles in primary health care evidence on the table for consideration by all present. This year we launched the Position Statement on Primary Health Care- a nursing view.
It was an incredibly productive and rational discussion. All the areas we agree on and disagree on were debated and a commitment was expressed by all present to continue talking in a more formalised way with each other.
From APNA's perspective, we would like to see a productive approach taken to discussion of the 'for and on behalf 'of issues, how the access of NPs to the MBS and PBS is going to play out to the best advantage of patients and practices, how we can get greater clarity of roles and accountability between members of the general practice team.

Swine flu after all

After finishing off the previous blog, the GP called and let us know that Lucy does in fact have swine flu. Since we were informed that we were clear on Sunday, I am not sure we have done much for the government's containment strategy! I fortunately stayed home to work as I was concerned about our accountant Dinusha catching even the normal flu as she is 12 weeks pregnant.
Obviously a key message for my general practice- a positive test for influenza A is a reason to keep a level of quarantine up whilst waiting for swine flu results, not a dismissal of swine flu; removing of masks etc when my other daughter visited the practice with tonsillitis may have also been somewhat premature; and getting some concrete information on the quarantine required for all of us while we wait for communication from DHS. As hubby has been going to work Monday and Tuesday, is quarantine for Wednesday and Thursday going to mean anything.

I guess it is a lesson in going with your gut feeling and the silent spread of this virus- Lucy had no known contact with a confirmed case but my gut still said get her tested as it was such a sudden onset and obviously highly infectious amongst her friends (only one of whom have been tested to my knowledge- one GP said it wasn't required as like us there was no confirmed case contact). Waiting 4 days for the test result has probably not helped the spread of the virus! Having to pay for the test (need to have contact with a known confirmed case to not pay) and the Tamiflu (similar) made me very conscious of the fact that I could and felt it was warranted - despite being made to feel every inch the paranoid mum! As I said in the previous post- I was not worried for Lucy but the spread of the virus.
My feeling is that we must be approaching the sustain phase of the virus any moment now in Victoria. Despite the measures in place, the virus is circulating widely. Many families are not testing and I can only imagine the pressure some of the practices must be feeling to manage the requests for tests etc.
My hope is that our voluntary quarantine avoided someone vulnerable getting this virus before a vaccine is available, hope that our few days of thinking we were not affected has not harmed anyone and we will rejoice in getting our contact wiht teh swine flu over nice and early!

Reflections on swine flu

As most of you know, APNA is based in Melbourne, Victoria and in recent times we have been somewhat in the grip of a swine flu outbreak!
Last Wednesday night, my 14 year old daughter Lucy woke us up in the wee hours with a high temperature and sore throat. Over Thursday she remained unwell and developed a cough. Being the usual offhand Mum that I am, I just let her sleep it off. I stayed home however just to keep an eye on her but I was not overly concerned as the swine flu was in the northwestern suburbs and we live in the east of Melbourne.
I had been asked earlier in the week to attend a teleconference on the Thursday evening at 6pm with the Chief Medical Officer Dr Jim Bishop along with other Presidents or CEOS of the different GP related groups - RACGP, AMA, RDAA, AGPN etc. It was with a slight sense of irony that I had to ask to have the call made to my home as I was home looking after my daughter with "flu-like' symptoms.
The teleconference was very interesting and there was alot of talk about the impact on practices, what practices should do to minimise risk to patients and staff, supplies of protective equipment and how to identify a swine flu positive patient who is 'going bad'. As most of you know, we have had a mild version of the swine flu in Australia but for those overseas who have died, they went downhill very quickly, as in 48hrs. there was much discussion about the communication with the community and it was at this point that I raised my confusion. As a relatively well-educated health professional, even I was confused as to what I was supposed to do with Lucy. I was not concerned about her clinically, but she fit the criteria of flu-like symptoms. She had no known contact at that stage but it was not unfeasible (is this a word?) that she may have come into contact with some of the girls at another girls highs school which did have confirmed cases- there had been a Yr 9 social at the local boys high school which most of Lucy's friends all attended. I had rung my general practice in the morning but the message was that if I felt comfortable looking after her, don't bring her in.
After the teleconference, I was more uncertain. 6 of Lucy's friends had all now experienced the same symptoms. I called Nurses-on-call who were trying to reassure me about her condition, but as I kept explaining I was not 'worried' about her or that she might have swine flu, I was concerned about the notion of spreading it around.
On Friday, I ended up taking her to the GP. She refused to sit in the special waiting room section with a mask, so we had to sit in the car until the receptionist rang us. we then put on masks and rushed through to a designated consulting room. She was tested and swabbed and we were ushered out the back door - nothing like feeling somewhat undesirable!
Over Friday, we heard that 2 more local schools had had confirmed cases. As the rest of us were starting to feel unwell, we basically took it easy and stayed at home. On Saturday, daughter number 1 woke up with swollen tonsils and feeling very unwell. Took her to the GPs, same procedure except the practice nurses saw us first to establish our story - all of us and nurse wearing masks etc. The GP looked at Elly, established that she had tonsillitis and this meant that swine flu was unlikely for some reason so all masks and gowns etc removed. We were allowed to exit through the front door this time!
Saturday - not test results. One of Lucy's friends confirmed as swine flu but Lucy had not had direct contact with her since a couple of days before she got sick. GP rang at lunchtime to say we would not get the results till late Monday or Tuesday. the advice was that as we had not had direct contact with a confirmed case, we were not required to be quarantined and I went out to supermarket to get some food. It still frustrated me though that if she turned out to be positive, we would have been roaming around the local shopping centre etc.
Tests results came through Sunday morning- Influenza A not swine flu. Doctors advice that likely that we all had it.
Thankfully we could all come out of our voluntary quarantine but it made me think - the kids were sicker with this influenza than some of their cohorts have been with swine flu. Did we prevent some other innocent patient from getting influenza A in the waiting room? I hope so! Even though I have a public health background, I have not really given that much thought to the practicalities of worrying about my family or I being a source of some infection for others. I hope this whole episode makes practices rethink their protocols for all infectious conditions not just pandemic flus. And for the kids to think it is normal and not embarrassing to wear a mask in the surgery if you are potentially contagious. Maybe they can make Scanlan and Theodore masks.
Alls' well that ends well- back to work and APNA.

The times they are a changing...

What a couple of weeks! Life at APNA is never boring but I can say the last few weeks have been pretty amazing.

The conference was a very humbling experience to be surrounded by the enthusiasm and vibrancy of the practice nurses and others who attended. It is impossible to get down for too long about the level of work or stress in managing the APNA office, when you see the inspiring group of nurses we do this work for. And that goes for all in the office from the admin officer and accountant up. And do those nurses know how to party! The dinner was a huge buzz with everyone on the dance floor - photos are up on the website to prove to those unable to make it.

Then I had to change gears quite quickly to get a couple of urgent projects moving along as well as back to normal APNA business....

This week however saw me in Canberra for a range of meetings with AGPN, RCNA and others before attending the Federal Budget health lock-up. And while there had been a 'leak' a couple of weeks ago about nurse practitioners being given access to the MBS and PBS, it was still with a sense of disbelief that most of the nursing bodies present in the room listened to the almost afterthought in the presentations - nurse practitioners and eligible midwives will be given access to MBS and PBS from November 2010. For some in the room who had been advocating for this for up to 22 years there were even tears.

November 2010 is a long way off and alot can happen in between, including rejection in the senate, a double dissolution election, a normal election and alot of lobbying by medical groups. What we need though is to make this absolutely inevitable whatever happens - any of you who have any connections with any politicians on either side of politics, need to use those connections to lobby for this. While the majority of practice nurses will not aspire to become a nurse practitioner, we expect that raising their profile and role will have strong effect on raising the respect and clarity around nursing roles more broadly. For those of you who do want to explore the role, you will be able to mount a much stonger business case for the role and support for it.

And we hope this is only the first downpayment on a raft of new health reform that will place nurses firmly and squarely in the centre or primary health care.

toxic practices

Twice in the last fortnight I have had conversations with members who were anticipating being asked to leave or actually being sacked. Over the last 2 years we have had about a dozen members sacked on the spot, some with their entitlements and others without. The apparent trigger is often one particular cited problem but what becomes rapidly apparent is that there are usually a series of events/disputes/nurses feeling something was a bit off in the lead up. The reality is that a small number of practices are for whatever reason toxic practices for practice nurses.

Practices are hugely diverse. Frequently nurses are being introduced into long established teams of admin staff and GPs and the admin staff get threatened. Sometimes a new practice manager is introduced and flexes his/her muscle. Sometimes the GPs are a loose group who each have very different expectations of the nurse and when conflict arises, principal GPs are frequently uncomfortable with confronting colleagues or long established practice staff. Sometimes the practice is plain kooky and inappropriate. But these practices are in the minority and what i say to nurses is, if it doesn't feel right, generally there are plenty of other positions out there in great respectful and high functioning practices.

At PNCE last November a nurse came up to me and asked me if I remembered her call earlier last year - she had been sacked on the spot after working for 6 years for the practice with no entitlements and was distraught. Fortunately she was a member of the ANF who were able to support her with approaching the employer for her entitlements which was successful. My role at APNA was to listen, point her in the right direction and encourage her not to give up on practice nursing. ON meeting her at PNCE, she was really sweet and made my day by saying how helpful it was to have someone to talk it through and how happy she was in a new practice. She now realised that the practice she had been working in had not been a happy environment for a long time. This is a common story amongst these nurses.

If any of you are in a practice and it involves a lot of unresolved conflict, you feel sabotaged by practice staff, you feel unsupported and undervalued - you may want to consider moving before the situation gets worse. Ideally before taking such drastic action, you talk to the principal GPs, a team meeting is called, rules for respectful treatment of all staff is implemented, toxic staff are disciplined and a happy team results. Unfortunately some practices can't or won't get to this space and you are better off without them. You are in demand currently once you have any practice nursing experience so use this lever while you have it.

What style shirt?

Board nominations are due next week and I really want to encourage all of you to think about nominating. Practice Nurse Board members are a crucial strength for APNA in that we are the only organisation devoted to representing practice nurses needs. And the board will be stronger for diversity in views and fresh perspectives. The organisation will be stronger when members have the opportunity to elect its board members- for that we need more nominees than positions. Board members generally find the experience very rewarding, not intimidating and at times inspiring. So get those nominations in!

On a more fun note - we have been looking at colours and styles of shirts for an APNA shirt that APNA nurses can wear at work which will have the logo and "practice nurse' on it. This is in response to a debate that occurred last year around uniforms and the fact that we want to increase exposure to APNA, recognition for practice nurses within the practice as being a professional clinician not a receptionist but at the same time, many of you saying that you like to have a bit of a uniform - not have to think about what you are wearing. We will have samples at the conference and PNCEs. At the moment we will be offering a pale blue and pale green elbow length shirt in a stretchy cotton with logo and wording on left pocket area. We will have the ability to add colours where there is a demand and different sleeve lengths as we go along. Would love any feedback!

All I seem to be doing at the moment is writing and meeting. Since finishing the Primary Health Care discussion paper submission, I have

1. rewritten a submission to the Department for funding for a patient satisfaction instrument for nursing services in general practice (which looks like being accepted and funded and needs to be completed by end of June!),
2. am trying to finish a submission (due tomorrow) for government funding for an online course in lifestyle risk factor management under the Australian Better Health Care Initiative funding,
3. did a submission to a Victorian Government IT Innovation funding pool for development of a clinical policies and procedures wiki tool - in layman's terms, an Internet site where nurses can contribute policies and procedures they have developed and others (nurses and experts) can correct/amend/download for their own use.
4. providing comments and input into the development of a position paper on nurses roles in primary health care being undertaken by the ANF in collaboration with a number of nursing groups including us. Funding for this project resulted from the Roundtable event we (APNA, ANF and ANPA) organised last year in Canberra for medical and nursing groups, bureaucrats, Ms Roxon etc.
5. attended National Primary Health Care Partnerships meeting which a peak group of primary health care providers - where we did some strategic planning around key issues the group needs to address. Members of this group include AGPN, allied health members organisations such as dietitians, physios, podiatrists etc, dentists, pharmacists, RCNA etc. It is an interesting mix of people.
6. met with various providers of membership type benefits in an effort by new staff member Matt Hall to reintroduce our member benefits program with a range of interesting benefits.

submission in

At 11.57pm on Friday night, APNA's submission to the National Primary Health Care Strategy Discussion Paper went in. A critical piece of work for determining the future work environment and roles of practice nurse, we felt we needed to be a loud voice in this process. Many of you got writing and gave me lots of ammunition and ideas for the submission and I want to thank all of you. if you read the submission I tried to get as many actual quotes and examples as possible in there.
What was really lovely was to receive not just the detailed emails but even the short ones just saying thank you for providing that voice. We are trying to provide that voice for nurses in a policy making space where others such as the GP/doctor groups are far better resourced than we are for staff and money and it often feels like we are not doing enough or doing it well enough. So it makes my day when someone reminds me of the reason we do it- to advocate for members and improve your lot in life.
Earlier this week I attended the Australian Health Care Alliance Health Reform conference which was extremely interesting. There was a very interesting session on teh tuesday afternoon on Primary Health Care- so got my bit in there.....
My father in the Southern Highlands of NSW has been very unwell recently having developed severe Type 2 Diabetes (almost comatose on admission to hospital) and I was reflecting on his situation. He has COPD requiring 24 hr O2 and atrial fibrillation as a result of the damage to his heart from undertreatment of his COPD. The cortisone for the COPD has resulted in the diabetes and he is feeling very sorry for himself. He has had depression previously as well. He is only 69 and an otherwise extremely intelligent, engaged, not 'elderly' person. Well, he is very attached to what he calls 'his' practice nurse. His practice has 2 practice nurses and whilst he likes them both, for some reason he has developed an attachment to Elizabeth (huge thanks Elizabeth if you are reading). Embarassingly he is very proud of me and my role and is very interested in the issues facing practice nurses - he is my very own media monitor ringing immediately there is anything in the papers. He has been trying to get 'his' practice nurses to attend the APNA conference and wants me to make sure 'his' practice nurses get VIP treatment at the conference if they come!! I am not sure that this entails! But all this serves to remind me of the very valuable role you all play particularly for those with complicated comorbid conditions, even if the role is primarily INR testing or whatever. You are someone they can talk to, can provide advice for him when GP is not contactable, make him feel like he is part of a caring health system not a nuisance etc. Dad is lucky to have access to fantastic care delivered through general practice.

inspired by 2 fantastic practice nurses

This week started off with the release of the Interim Report from the National Hospital and Health Reform Commission on Monday. We were contacted by the Health Ministers office before the release to remind us that this was an interim report not the final report - obviously there was going to be something in it we did not like. There was much we did like but yes - nurse practitioner access to PBS and MBS for referral for pathology etc was going to be restricted to remote and some rural areas. And they were recommending that the 'for and on behalf of' the GP remain in the funding models. we have a number of members doing their nurse practitioner training and they are more than likely not in the proposed areas although many have been encouraged by their Gps to undertake this training due to high local need for their services. In addition we remain convinced that nurses do not do 'tasks' for and on behalf of any other health professional and will continue to argue this.

I had the pleasure of attending an event in Ryde, Sydney yesterday organised primarily by one of our board members, John Douglas, and a very committed APNA member, Karen Booth. It was to promote the role of practice nurses and in particular the role they can play in the healthy Kids Check. Maxine McKew (local federal MP), Ryde Mayor Victor Tagg, local division representatives, local practice nurses, media and others all watched Karen Booth present verbally on the Healthy Kids Check whilst Christine Brelsford did a fantastic job demonstrating the check on 2 gorgeous 4 year olds, Nick andIsabella. Karen typified the professional, articulate and knowledgeable practice nurse while Christine showed the flexible, caring and approachable face of teh profession. Events like this remind me of why I do what I do and provide me with the passion to continue to ensure that practice nurses are respected and valued members of the health sector.

Calls from members

I sit here in my very neat office (not!) unable to remember what that 'just back from holidays' feeling felt like. In particular currently, I am surrounded by post it notes with messages to ring members about various issues. This is over and above the calls I actually take as they come in. many of you may not know that we are really quite small and all issues relating to nursing come to myself as the only staff member with a nursing background.

What are these issues? Well, this week I have answered

1. 2 calls from nurses new to general practice wanting information on immunisation policies and procedures/recording requirements;
2. one call from a newly medication-endorsed EN on what she can now do in immunisation;
3. one call from a member wanting to know what support we can provide if she sets up an informal local network
4. one call re accreditation
5. one call from a nurse wanting to understand what level she should be paid at on the Qld Drs Rooms award and how that might impact on her continuing to do some shifts in the hospital.
6. one call from a practice manager wanting to negotiate with the practice nurse around weekend shift penalty rates

These calls, while they can be time consuming, are very informative for us as an association - keep them coming. It ensures that we are in touch with the grass roots issues out there and gives us a lot of ideas for resources, articles etc. Then we get depressed when we don't have the resources to develop them! However rest assured we are constantly seeking funding/resourcing opportunities wherever we can.

I am extremely excited by your enthusiastic response to the conference judging by the early bird registrations. I am conscious that those of you who self-fund for these events, do so at enormous cost and we never underestimate that. Those of you who have received funding from your practices, congratulate your practices on being forward thinking and confident enough to fund their nurses to attend a conference designed to empower nurses.

Nominations for board positions have gone out this week and you should receive in the mail tomorrow. Please seriously consider nominating. Any healthy professional association should have competitive elections for board positions as it demonstrates a high level of engagement and passion of members. In an election, potential members need to articulate to the membership their credentials and views which enables you to influence board directions. So fill in that nomination form and put your hat in the ring!