Merry Xmas

Apologies for being so absent on the blog lately as things have been very busy in the office here at APNA.

I wanted to finish the year off with a reflection on the year, both within APNA and in the wider political context.

From an internal APNA perspective, the year has been a huge one with many highlights including

• Membership increase from 1532 in December last year to over 2650 currently.
• This time last year we were mid transition to new database and were offline for online joining and renewal.
• New website which has been a big hit with increasing traffic all year
• Creating enews only subscription for non-members with over 1000 subscribers
• CPD portal launch
• Conference 2010 was a big success and extremely well evaluated
• CPD committee commenced and very active and enthusiastic which brings a lovely injection of energy to the office
• Launch of CPD endorsement process for education providers with more and more providers seeing endorsement as of value
• Moving online learning platforms to go live in next week or so, which will enable us to develop many more courses at a more affordable cost for both participants and course developers.
• Over 1000 respondents to salary and conditions survey
• High quality Primary Times and Enews out on time all year

From a broader perspective highlights of the year have included

• May Budget Announcement of the injection of more money and a more flexible payment structure for nurses in general practice through the proposed PN Incentive Program
• Providing members with analysis of the different political parties proposals relating to nursing in the federal election process
• Invitations to sit on PNIP, Diabetes Advisory Group and Telehealth Advisory Group
• Active voice in discussions and workshops around Medicare Locals
• Working with ANF on preliminary moves towards industrial negotiations around the pay and conditions of nurses in general practice

Finally, as always, the highlight for me personally and the staff at APNA, is the interaction with members. We never fail to be inspired by the passion and commitment of our members to improving patient care and contribute to better primary care. From phone calls to emails to events, we always come away with a sense of pride in our membership and a renewed commitment to doing the best we can for our members.

Hope Christmas is a time of relaxing and catching your breath before what promises to be another big year next year. See you after the holidays!

All steam ahead

Over 2010 we have experienced a significant increase in the numbers of members from 1500 to over 2400 so far. Similarly we have had almost 1000 responses to our salary and conditions survey. Numbers of unique visitors to our website has also gone through the roof. Why?
I suspect that the focus on national registration requirements, an increased sense of professional identity and maybe better marketing on our part, has contributed to this level of engagement from nurses in our sector. At a meeting I attended the other day, other nursing organizations commented on a similar increase in membership and engagement. It really feels like we are gathering a level of professional momentum.
Launching the CPD portal this week has been a long work in progress. We hope as many of you as possible will use this new functionality and provide us with feedback on its usefulness and how we can improve it. It is a key part of APNA’s increasing focus on professional development within our specialty, supported by a fantastic CPD committee which is currently recruiting new members. The other aspects of our CPD strategy is a total revamp of our online learning college with a number of new courses coming online; careful endorsement of other providers’ education enabling nurses to know which courses or events are relevant and of high quality; development of a comprehensive event calendar and course information webpage.
The preliminary results from the salary and conditions survey indicate that pay and conditions continue to be problematic for nurses in general practice. And while this is the case we will continue to lose good nurses of this much-needed area of community care. Hence we are pleased to be able to work with the Victorian ANF to provide a workshop next week for practice nurses on industrial issues. As part of the workshop we will be working on describing the different roles and responsibilities of practice nurses at the different potential paypoints. We have gone into this collaboration to support the ANF in its industrial role while providing the benefit of our understanding of the issues of our members. The intent is to work positively with employers to develop agreements which are of advantage to both the nurse and the employer. While the APNA is not an industrial organization, we cannot get away from the impact of the highly variable and at times difficult employment conditions of our members as it directly affects their ability to work professionally and affects retention and morale. We will keep you up-to-date with where this is going.

A state of limbo

Election 2010 did not deliver the result we were expecting and certainly creates a sense of uncertainty within our particular sector with the policies from the ALP and Coalition being significantly different. I have taken heart from some of the independents comments, in particular Rob Oakeshott, that they are keen to see the work of expert committees and reviews implemented. I think for me that is the most potentially disheartening aspect of this election – to see the excellent and highly consultative work of the National Hospital and Health Reform Commission, the National Preventative Healthcare Taskforce and the National Primary Health care Strategy Expert Reference Group, be to no avail. If the independents can influence both parties to ensure that this excellent work is carried forward into policy - that will be a good outcome for all of us. Julianne Badenoch has written to the independents to express our desire for a strong, flexible and well-funded r ole for nurses in general practice and how critical this will be for the growing burden of chronic disease, meeting the needs of the ageing population particularly in areas of GP workforce shortage. If any of you are in electorates with the independents, this may be your opportunity to express what you want to see.

Speaking of a stronger role for nurses within the health system, there is a very interesting article by a range of experts here http://www.sa-lives.com/entry/13/why-nurses-should-be-more-prominent

On another note we have announced this week when and where the APNA conference 2011 will be held – Sydney 7-9 April. The conference committee met for the first time on Monday and comprises a great range of nurses including ENs, RNs, and an NP candidate who come from a range of settings, including rural and urban, indigenous health, academia and sexual health. The enthusiasm in the room was very infectious and is reflected in the theme decided- Roadmap to the Future - Great Expectations. And this in the face of uncertainty about the election outcome!! As well as a very detailed program being developed with a range of fantastic topics, a theme for the dinner of' Route 66' was chosen with a lot of laughter and fun. Please out this date in your diary and hope to see you there.

I had the privilege last week of going out to the East Brunswick Medical Practice where 2 of our members Teresa Reid and Roz O'Reilly had invited me to come and talk with their GPs about the new PN incentive. It was a fabulous experience as the practice is very progressive and we had a very constructive and useful discussion about their desire for a greater role for their nurses, impact of the block grant funding models and their desire to have undergraduate nursing students etc. Teresa AND Roz had presented at the APNA conference on their innovative model on new patient registrations done by practice nurses and the improvement in GP throughput and comprehensive records.

Finally, keep the calls and emails rolling in. Calls this week have included issues around pap test provider numbers, bereavement leave entitlement under new awards, EN supervision issues and much more.

More interesting times

Just in case we all thought life was going to settle down, we have an election! Every year I do a presentation to public policy students at the University of Melbourne where I present on the policy environment within which the APNA operates. At the session this morning I was asked a lot of questions about what impact a change of government at this election would have on health, primary healthcare and specifically nursing in general practice. What struck me as I was talking was a real sense that for health this election is crucial. Most of this government's first term has been spent in developing policies to move forward and if not given a second term in government, not enough on the health reform has been embedded that cannot be undone. For those of us who have been advocating for health reform, even if we don't agree with elements, would find it very frustrating to return to the status quo.

At APNA we have set up an Election 2010 webpage so keep your eyes on this as we get through the next few weeks.

On another note, the presentations for the New Zealand primary healthcare nurse's conference are available at the following website

http://www.nzno.org.nz/groups/colleges/college_of_primary_health_care_nurses/phc_conference_presentations

I am off to New Zealand tomorrow for the World Health Care Networks conference which will be debating and holding the development of our own primary healthcare networks or "Medicare Locals". Evolving from the current Divisions of General Practice Network, we to ensure nurses play a key role in the new organizations from governance through to program management and down to the practice.

Back from the wilderness

It has been a long time since I have written in this blog. It has been a combination of ill health and being a way in New Zealand.
Firstly over 5 weeks ago now, I experienced some chest discomfort and of course immediately thought heart attack. Along with severe chest pain, came waves of anxiety and adrenaline. As those of you who know me know, I can usually manage fairly high levels of stress with equilibrium - so these feelings of anxiety were very foreign to me. After many tests, I was diagnosed with chostochondritis and instructed to take it easy for several weeks. It has been a testament to both my proactive board and my resourceful staff that APNA managed perfectly well without me for a number of weeks.
However, I am conscious that my absence coincided with a lot of e-mails from members regarding the new practice nurse funding. Whilst I tried to reply to as many as possible, I apologize to those of you who did not get a response. Needless to say I have taken on board all of your concerns especially from those of you in large practices, those of you who are enrolled nurses and in fact all of you who feel the incentive may adversely affect your role. The consultation process has not yet begun and we will be taking your concerns into those meetings.
After much debate, I decided to proceed with a long planned trip to New Zealand with our new President, Julianne Badenoch. The purpose of the trip was to attend the New Zealand primary health care nursing conference, where I was presenting a paper, and to visit some of our nursing colleagues working in primary health care. Julianne and I will be putting together a paper on what we learned but in brief we were totally inspired by both the roles of the nurses at the general practice level and the level of engagement of nurses in their primary health care organizations. Nurses are key members of their Boards, leaders of their health programs and writers of their business plans.
The conference was equally interesting in that it brought nurses from a range of primary health care settings together. It marked the beginning of their new New Zealand College of Primary Health Care Nursing and provided us with numerous examples of nurses providing innovative and best practice care, some of whom we hope to entice across to our conference.
The trip also provided Julianne and I the chance to chew the cud and establish good communication channels which will enable us to have the robust President-CEO relationship an effective organization needs.
Whilst I am still not feeling 100%, I am back at work. It has been a significant shock to realize that your body can really only take so much and I think this will be a positive in the long run. Like many of you, I am trying to balance a demanding career with raising teenage daughters and keeping all the family stuff semi-organized. Like many of you, I am passionate about what I do and frequently feel reluctant to let any opportunity to escape me or APNA. However what gets lost is time for myself and I am now looking at ways to make some lifestyle changes and get some more balance in my life. What I really need is a nurse in general pratice to provide me with some lifestyle risk factor management counselling!

Golden Opportunities abounding

I am back in APNA office really for the first time in 10 days. And what a ten day period it has been.
Thursday week ago, we started the APNA conference with a lovely welcome drinks and launch of the first general practice nursing textbook written by Lynne Walker, Elizabeth Patterson et al. I have just been reading the conference evaluations and overall the satisfaction was extremely high. Delegates loved the venue, the speakers and the overall program and obviously felt inspired by the whole conference. There was constructive feedback about running to time, too many choices and poor showing at the concurrent papers which we have definitely taken on board for next year. There were some comments about wanting more warning about the Health Minister coming (we would have told you if we knew!) and again many raised the cost of attending despite us reducing all registration levels by $50 this year. The cost is a real dilemma for us as we want the conference to reflect that nurses deserve a conference which is not second rate compared to medical conferences and reflects your importance in the scheme of things but our delegates are largely self funded and do not have much money. Hence we source the sponsorship levels that we do to make it as affordable as possible. The evaluation had delegates rate affordability as a concern but are less concerned re cost to APNA - unfortunately the only funds we can use to apply to the conference will come from member subscriptions and away from other member services - so it is very challenging! Feedback on how to manage this dilemma is appreciated!
The Health Minister alluded to changes in the Federal Budget on the following Tuesday night and reminded me personally as she left to be ready to go on Tuesday with media etc. I assured us that we were prepared with media releases and footage etc.
I returned home from the conference on the Sunday am (Mothers Day) to go to the opening of the new stadium for Melbourne Storm. I collapsed into bed that night and slept for 12 hours, waking on Monday am at 9am to 10 missed calls on my mobile...ABC Radio, Daily Telegraph, Ged Kearney and so on. Arggh! The PN funding news had been leaked and I then spent the next 5 hours in my PJs in our home office doing radio interviews, organising practices for journalists to visit and nurses to be interviewed. Skynews then rang wanting me to go on their PreBudget show on Tuesday am in the Canberra Studio. So I rearranged flights and accommodation to Canberra, texted my teenage girls at school to say I was disappearing again, cooked a spag bol (which nobody ate!) and headed back out to airport.
Tuesday am saw me in the Parliament House Skynews studio at 7.30am for my first ever TV experience, which went well according to the only 2 people I know who watched it - my 15yr old and hubby. Off to the National Primary Health Care Partnerships meeting and then Budget Lock-up, before retiring to hotel room to write APNA media releases.
The next morning I headed to airport at 6am for flight to Adelaide via Sydney to speak to SA Divisions Network NIGP program officers and then flight back home to Melbourne. Needless to say Thursday and some of Friday were spent in somewhat of a blur...
The Budget announcements are very exciting for nursing in general practice but have also been accompanied by anxiety. I hope you have all had a chance to look at the 'Advice to Members' document we sent out last Friday. We are very keen to have any feedback positive or negative about the changes.
Here's to a quieter couple of weeks!

Where are the nurses

In the avalanche of media releases in the last couple of weeks about health, where are the nurses? Were we mentioned in the workforce announcement -no. Were we mentioned in the aged care strategy -no. Were we mentioned in the primary health care organisations announcement-no. Maybe the emergency department announcements- again no.

You would be forgiven for thinking nurses are a minority player in the health system - not 55% of the total health workforce. Even in our space of primary health care, there are over 10,000 more nurses than GPs if you look at the nurses in domiciliary care, maternal child health, school nurses, sexual health, family planning etc, as well as the 9000 practice nurses.

Why are nurses so invisible? Is it something in the type of people attracted to nursing that we don't like conflict, are more interested in caring and being part of a team than agitating. Obviously nurses by and large do not hold the vested business interests in health care that other groups such as medicos and phamarcists and even allied health professionals do?

More importantly, why does the medical profession hold such sway? The current federal labour government has been far more even-handed in its approach to health professional groups than the previous government (every time we raised a practice nursing issue under the previous government the stock response was to go and ask the AMA what they thought - and adopt that as the policy) but the recent announcements have reverted to form. Do medical groups have so much sway over state premiers that they need to be appeased to get these reforms across the line?? We are fully supportive of the measures to increase GP workforce which are long overdue but the nursing workforce is ageing faster than the medical workforce and the attrition rate is higher, often because of working conditions. Where is the nursing workforce of the future going to come from?

We have been commenting on announcements and entering the debate, despite not being recognised as key players in primary health care. We look forward to mroe announcements which will reassure us that the health reform proposals place nursing at the forefront of a genuine attempt to deliver better quality primary health care to more people in need using taxpayer dollars most efficiently.

KRudds reform proposal - do we care?

I was lucky (on unlucky) enough to be working from home last Wednesday when the PM hit the National Press Club to launch the National Health And Hospital Network. Mum and Dad were down from NSW for the week and, with mum out working everyday, I took pity on Dad and spent the day at home. Dad, as some of you may remember, is quite debiitated with COPD, diabetes and atrial fibrillation and is very confined to the house. Dad has always been very politically active and is a passionate watcher of Questions Time and the National Press Club.

So we sat down to watch the address, not quite knowing what to expect. And it was a big, bold and some say provocative announcement. Does it have anything to do with us??

The hospital network part does not particularly have mcuh to do wiht general practice but it will allow nurses at the hospital level input into determining local priorities.

Not so prominent in the speech but in the document was the fact that the Commonwealth intends to fund 100% of primary health care. They already fund general practice but this would now include services such as Maternal and Child Health, drug and alcohol, home health services, mental health services, palliative care etc. Currently about 4.2billion is spent annually through general practice by the Commonwealth and 4.2billion through the state governments for the other services.

For nursing there are several possible ways this could play out. we could see merging of like services e.g. MCH nurses into general practice/superclinic models, greater collaboration between general practice and domiciliary nurses. Where services are duplicated e.g. 4 year Healthy Kids Check and local MCH 3yr old checks, we could see a logical rationalisation. Potential advantages for nurses are greater collaboration and interraction with our nursing colleagues in other settings, and sharing of clinical knowledge and expertise. I am sure many of you will see positives in this scenario and think of examples where services for patients can be improved

While we are yet to see what is proposed more specifically in primary health care, this is a promising start.

On a personal note it was fun to point out to Dad who was who in the Press Club audience. For the first time in ages, it gave me pause to think how far APNA has come in interracting with the relevant players in that I was able to identify who many of the people were, that we had met with them etc. But we look forward to the day that we are invited to be in the audience for such a launch....

What is primary health care nursing?

What is primary health care nursing? With our recent change to our constitution, it is critical that we get a clear and concise definition and at our recent board meeting last weekend, there was considerable time devoted to thrashing this out.

Our change to our constitution was driven by pragmatic considerations arising out of interest from other nurses within primary health care, movement of nurses across the different settings, and addressing a long-term thorny issue for APNA of the slightly demeaning and non-descript term 'practice nurse'. Also other similar health care systems were moving in a similar direction e.g. New Zealand and Canada.

What d0 primary health care nurses do?

Firstly we need to define primary health care. Of key interest to nurses would be the document Primary Health Care: A Nursing consensus view - to which APNA among other nursing groups were key drivers and contributors http://www.anf.org.au/pdf/PHC_Australia.pdf. I encourage you all to read this veryr eadable document which not only defines primary health care but provides many readable case studies fo nursing work in primary health care. There is also an excellent summary on the PHCRIS website with links to other useful resources http://www.phcris.org.au/infobytes/about_phc.php
For an international perpective, the World Health Organisation released a paper recently which can be found at http://www.who.int/whr/2008/08_overview_en.pdf.

How do we define nursing role within primary health care? The New Zealand definition at present is

'Primary health care nurses are registered nurses with knowledge and expertise in primary
health care practice. Primary health care nurses work autonomously and collaboratively to promote, improve and restore health. Primary health care nursing encompasses population health, health promotion, disease prevention, wellness care, first point of contact care and disease management across the lifespan. The setting and the ethnic and cultural grouping of the people determine models of practice. Partnership with people – individuals, wha¯nau (a maori community), communities and populations – to achieve the shared goal of health for all, is central to primary health care nursing (Ministry of Health 2003:9).' http://www.moh.govt.nz/moh.nsf/0/7B8611D77164266ECC25705B001BB6BA/$File/EvolvNurse.pdf

In it discussions, the board was keen to also include concepts of improving quality of life where an improvement in health care is not feasible which is in line with broad definitions of nursing. They also discussed where research and advocacy or shaping health policy fitted in to a definition. The concept of teams was felt to be important in any definition, along with leadership, partnership with the community and patients/consumers, and management systems. Overall it was felt critical to clearly define the 'nursing perpective', the concept of a holistic approach to care.

The Board has directed me to start the development of an organisational definition, with a view to submitting to membership for feedback. I welcome any comments or thoughts at this time via this blog or via email to belinda.caldwell@apna.asn.au

On a lighter note, if any of you want to be part of these exciting Board discussions, consider nominating for the APNA Board. The closing date is 2nd April 2010. Go to website for further information or again email me.

Finally, if any of you have been wondering why the APNA website has been looking particularly tired and less up to date than usual - we are about to go to a new improved website. This process, as with all IT processes, is taking a bit longer than we anticipated but I am positive you will enjoy it when it gets there!

Welcome 2010

Here we are in 2010, ready for another huge year. I hope all of you reading had a great break over Xmas. I had a lovely holiday for 4 weeks, 2 weeks up at my parents hobby farm in Robertson NSW and 2 weeks by the beach in Inverloch, Vic. As well as celebrating Xmas at Mum and Dad's, we celebrated my Dad's 70th birthday - which a couple of years ago I would have sworn he was not going to see due to his COPD, AF and diabetes. Whilst his early days as a person with COPD were less than desirable and the care he received patently inadequate (treated for asthma for 5 years despite a 45 year smoking history of 2 packs a day), for the last three years he has recevied unbelievable general practice care, psychologist visits via the MH Plans, a care plan at the practice, access to pulmonary rehab, diabetes education, INR testing with his beloved practice nurse etc. So it was quite emotional to see Dad amongst 40 of his best friends, some from childhood, drinking champagne looking out on what has to be one of the most beautiful views in the world - from his back paddock.

APNA has been extremely busy since my return. Internally we are transitioning across to a new member management system which like all things IT has been beset with challenges. We are hoping to have this running smoothly ASAP but if for any reason you receive two letters, are not getting communications or anything - please call us so we can correct any issues. The next step is to turn on the new website - but we need to catch our breath first...

The call for board nominations are being mailed out next week and I encourage you all to have a think about this.

The conference is getting bigger and better all the time. Most recently we have secured Faye Jackson, who is a fantastic speaker on mental health, in particular mental health first aid and working in teams (www.visioninmind.com.au). The MC this time is a fabulous guy called Michael Pope who is one of Australia's best MC's (www.michaelpope.com.au), let alone TV/Radio host, warm-up guy for most of the live and comedy shows on TV, including the Logies. He is hilarious energetic and warm and will keep you all awake and on your toes.

The master classes are looking fantastic and those of you intending to come need to know that it is a first in first served approach to allocation to master classes and spaces are limited. We have tried to create a challenging and inspiring program for you all, as well as a huge range of relevant exhibitors.

I really hope as many of you can come as possible - I love catching up with members but much more importantly it was inspiring to see the networking and sharing of such a dynamic group of women (and a few good blokes) that occurred at last years conference.

Have a great 2010- keep the phone calls coming and have fun!