Liability and collaborative arrangements for nurse practitioner practice in Australia
Mary Chiarella A C , Jane Currie A and Tim Wand A B
+ Author Affiliations
- Author Affiliations
A The Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia. Email: jane.currie@sydney.edu.au
B Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Email: timothy.wand@sydney.edu.au
C Corresponding author. Email: mary.chiarella@sydney.edu.au
Australian Health Review 44(2) 172-177 https://doi.org/10.1071/AH19072
Submitted: 13 April 2018 Accepted: 3 April 2019 Published: 5 December 2019
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
The purpose of this paper is to clarify the relationship between medical practitioners (MPs) and nurse practitioners (NPs) in general, and privately practising NPs (PPNPs) in particular, in relation to collaboration, control and supervision in Australia, as well as to explore the difficulties reported by PPNPs in establishing mandated collaborative arrangements with MPs in Australia. In order for the PPNPs to have access to the Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) in Australia, they are required, by law, to establish a collaborative arrangement with an MP or an entity that employs MPs. This paper begins by describing the history of and requirements for collaborative arrangements, then outlines the nature of successful collaboration and the reported difficulties. It goes on to address some of the commonly held misconceptions in order to allay medical concerns and enable less restrictive access to the MBS and PBS for PPNPs. This, in turn, would improve patient access to highly specialised and expert PPNP care.
What is known about the topic? NPs have been part of the Australian health workforce since 1998, but until 2009 their patients did not receive any reimbursement for care delivered by PPNPs. In 2009, the Federal government introduced limited access for PPNPs to the MBS and PBS, but only if they entered into a collaborative arrangement with either an MP or an entity that employs MPs.
What does this paper add? The introduction of collaborative arrangements between PPNPs and MPs seems, in some instances, to have created confusion and misunderstanding about the way in which these collaborative arrangements are to operate. This paper provides clarification of the relationship between MPs and NPs in general, and PPNPs in particular, in relation to collaboration, control and supervision.
What are the implications for practitioners? A clearer understanding of these issues will hopefully enable greater collegial generosity and improve access to patient care through innovative models of service delivery using NPs and PPNPs.
Additional keywords: interprofessional relationships, private practice.
References
[1] Currie J, Chiarella M, Buckley T. Preparing a realist evaluation to investigate the impact of privately practising nurse practitioner services on patient access to care in Australia. Int J Nurs (N Y) 2015; 2 1–10.| Preparing a realist evaluation to investigate the impact of privately practising nurse practitioner services on patient access to care in Australia.Crossref | GoogleScholarGoogle Scholar |
[2] Chiarella M. The legal and professional status of nursing. Edinburgh: Churchill Livingstone; 2002.
[3] Chiarella M. Nursing issues: what’s in a name? Aust Nurs J 2000; 8 39–40.
| 11894251PubMed |
[4] Lutze M, Fry M, Mullen G, O’Connell J, Coates D. Highlighting the invisible work of emergency nurse practitioners. J Nurse Pract 2018; 14 26–32.e.
| Highlighting the invisible work of emergency nurse practitioners.Crossref | GoogleScholarGoogle Scholar |
[5] Cox K, Karikios D, Roydhouse JK, White K. Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit. Aust Health Rev 2013; 37 632–5.
| Nurse-led supportive care management: a 6-month review of the role of a nurse practitioner in a chemotherapy unit.Crossref | GoogleScholarGoogle Scholar | 24176186PubMed |
[6] Murfet G, Allen P, Hingston TJ. Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy. J Adv Nurs 2014; 70 1150–63.
| Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy.Crossref | GoogleScholarGoogle Scholar |
[7] Craswell A, Dwyer T, Rossi D, Armstrong C, Akbar D. Cost-effectiveness of nurse practitioner-led regional titration service for heart failure patients. J Nurse Pract 2018; 14 105–11.
| Cost-effectiveness of nurse practitioner-led regional titration service for heart failure patients.Crossref | GoogleScholarGoogle Scholar |
[8] Masso M, Thompson C. Nurse practitioners in NSW ‘gaining momentum’: rapid review of the nurse practitioner literature. Wollongong: Centre for Health Service Development, University of Wollongong; 2014.
[9] Nursing and Midwifery Board Australia. Nurse and midwife – registration data table – June 2018. 2018. Available at: http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx [verified 19 October 2018].
[10] Carter M, Owen-Williams E, Della P. Meeting Australia’s emerging primary care needs by nurse practitioners. J Nurse Pract 2015; 11 647–52.
| Meeting Australia’s emerging primary care needs by nurse practitioners.Crossref | GoogleScholarGoogle Scholar |
[11] Commonwealth of Australia. A healthier future for all Australians – final report of the National Health and Hospitals Reform Commission. 2009. Available at: http://www.cotasa.org.au/cms_resources/documents/news/nhhrc_report.pdf [verified 2 June 2019].
[12] Considine J, Kropman M, Stergiou HE. Effect of clinical designation on emergency department fast track performance. Emerg Med J 2010; 27 838–42.
| 20581389PubMed |
[13] Considine J, Martin R, Smit D, Winter C, Jenkins J. Emergency nurse practitioner care and emergency department patient flow: case-control study. Emerg Med Australas 2006; 18 385–90.
| Emergency nurse practitioner care and emergency department patient flow: case-control study.Crossref | GoogleScholarGoogle Scholar | 16842309PubMed |
[14] Jennings N, McKeown E, O’Reilly G, Gardner G. Evaluating patient presentations for care delivered by emergency nurse practitioners: a retrospective analysis of 12 months. Australas Emerg Nurs J 2013; 16 89–95.
| Evaluating patient presentations for care delivered by emergency nurse practitioners: a retrospective analysis of 12 months.Crossref | GoogleScholarGoogle Scholar | 23953091PubMed |
[15] Jennings N, O’Reilly G, Lee G, Cameron P, Free B, Bailey M. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne Australia. J Clin Nurs 2008; 17 1044–50.
| Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne Australia.Crossref | GoogleScholarGoogle Scholar | 18321270PubMed |
[16] Wand T, White K, Patching J, Dixon J, Green T. Outcomes from the evaluation of an emergency department based mental health nurse practitioner outpatient service. J Am Acad Nurse Pract 2012; 24 149–59.
| Outcomes from the evaluation of an emergency department based mental health nurse practitioner outpatient service.Crossref | GoogleScholarGoogle Scholar | 22404793PubMed |
[17] Jennings N, Lee G, Chao K, Keating S. A survey of patient satisfaction in a metropolitan emergency department: Comparing nurse practitioners and emergency physicians. Int J Nurs Pract 2009; 15 213–8.
| A survey of patient satisfaction in a metropolitan emergency department: Comparing nurse practitioners and emergency physicians.Crossref | GoogleScholarGoogle Scholar | 19531080PubMed |
[18] Wilson A, Shifaza F. An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department. Int J Nurs Pract 2008; 14 149–56.
| An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department.Crossref | GoogleScholarGoogle Scholar | 18315828PubMed |
[19] Wand T, White K, Patching J. Realistic evaluation of an emergency department based mental health nurse practitioner outpatient service in Australia. Nurs Health Sci 2011; 13 199–206.
| Realistic evaluation of an emergency department based mental health nurse practitioner outpatient service in Australia.Crossref | GoogleScholarGoogle Scholar | 21595814PubMed |
[20] Dinh MM, Enright N, Walker A, Parameswaran A, Chu M. Determinants of patient satisfaction in an Australian emergency department fast-track setting. Emerg Med J 2013; 30 824–7.
| Determinants of patient satisfaction in an Australian emergency department fast-track setting.Crossref | GoogleScholarGoogle Scholar | 23139091PubMed |
[21] Dinh M, Walker A, Parameswaran A, Enright N. Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors. Australas Emerg Nurs J 2012; 15 188–94.
| Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors.Crossref | GoogleScholarGoogle Scholar | 23217651PubMed |
[22] Lee GA, Chou K, Jennings N, O’Reilly G, McKeown E, Bystrzycki A, Varma D. The accuracy of adult limb radiograph interpretation by emergency nurse practitioners: a prospective comparative study. Int J Nurs Stud 2014; 51 549–54.
| The accuracy of adult limb radiograph interpretation by emergency nurse practitioners: a prospective comparative study.Crossref | GoogleScholarGoogle Scholar | 24016599PubMed |
[23] Stanik-Hutt J, Newhouse R, White M, Johantgen M, Bass E, Zangaro G, Weiner JP. The quality and effectiveness of care provided by nurse practitioners. J Nurse Pract 2013; 9 492–500.e13.
| The quality and effectiveness of care provided by nurse practitioners.Crossref | GoogleScholarGoogle Scholar |
[24] Weiland SA. Reflections on independence in nurse practitioner practice. J Am Acad Nurse Pract 2008; 20 345–52.
| Reflections on independence in nurse practitioner practice.Crossref | GoogleScholarGoogle Scholar | 18638173PubMed |
[25] Carrigan C. Collaborative arrangements: are expanded roles for nurses and midwives being stifled? Aust Nurs J 2011; 18 24–7.
| 21667695PubMed |
[26] Harvey C. Legislative hegemony and nurse practitioner practice in rural and remote Australia. Health Sociol Rev 2011; 20 269–80.
| Legislative hegemony and nurse practitioner practice in rural and remote Australia.Crossref | GoogleScholarGoogle Scholar |
[27] Cashin A. Collaborative arrangements for Australian nurse practitioners: a policy analysis. J Am Assoc Nurse Pract 2014; 26 550–4.
| 25132682PubMed |
[28] Currie J, Chiarella M, Buckley T. Privately practising nurse practitioners provision of care subsidised through the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. Aust Health Rev 2017; 43 55–61.
| Privately practising nurse practitioners provision of care subsidised through the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme.Crossref | GoogleScholarGoogle Scholar |
[29] NSW Health. Nurse practitioners in New South Wales: discussion paper. Sydney: NSW Health; 1992.
[30] Staunton P, Chiarella M. Law for nurses and midwives. 8th edn. Sydney: Elsevier; 2016.
[31] Barrett E. Chronic kidney disease in an Aboriginal population: a nurse practitioner-led approach to management of chronic kidney disease management. Aust J Rural Health 2015; 23 318–21.
| Chronic kidney disease in an Aboriginal population: a nurse practitioner-led approach to management of chronic kidney disease management.Crossref | GoogleScholarGoogle Scholar | 26683713PubMed |
[32] Raeburn T, Hungerford C, Sayers J, Escott P, Lopez V, Cleary M. Leading a recovery-oriented social enterprise. Issues Ment Health Nurs 2015; 36 362–9.
| Leading a recovery-oriented social enterprise.Crossref | GoogleScholarGoogle Scholar | 26090553PubMed |
[33] Currie J, Chiarella M, Buckley T. Realist evaluation of privately practising nurse practitioners in Australia: development and refinement of theories. Collegian 2019; 26 8–15.
| Realist evaluation of privately practising nurse practitioners in Australia: development and refinement of theories.Crossref | GoogleScholarGoogle Scholar |
[34] Currie J, Chiarella M, Buckley T. Workforce characteristics of privately practising nurse practitioners in Australia: results from a national survey. J Am Assoc Nurse Pract 2016; 28 546–53.
| Workforce characteristics of privately practising nurse practitioners in Australia: results from a national survey.Crossref | GoogleScholarGoogle Scholar | 27215578PubMed |
[35] Currie J, Chiarella M, Buckley T. Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey. Australian Health Review 2017; 41 533–40.
| 27607542PubMed |
[36] McCaffrey RG, Hayes R, Stuart W, Cassell A, Farell C, Miller-Reyes C. Program to improve communication and collaboration between nurses and medical residents. J Contin Educ Nurs 2010; 41 172–8.
| Program to improve communication and collaboration between nurses and medical residents.Crossref | GoogleScholarGoogle Scholar | 20411889PubMed |
[37] Zwarenstein M, Goldman J, Reeves S, Interprofessional collaboration Effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2009; 3 CD000072
| Effects of practice-based interventions on professional practice and healthcare outcomes.Crossref | GoogleScholarGoogle Scholar |
[38] Cowan M, Shapiro M, Hays R, Abdelmonem A, Vazirani S, Ward C, Ettner S. The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. J Nurs Adm 2006; 36 79–85.
| The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs.Crossref | GoogleScholarGoogle Scholar | 16528149PubMed |
[39] Department of Health. Medicare Benefits Schedule Review Taskforce: report from the Nurse Practitioner Reference Group. 2018. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-pcrg-consult [verified 2 June 2019].
[40] Nursing and Midwifery Board Australia. Nurse practitioner standards for practice – effective from 1 January 2014. 2014. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/nurse-practitioner-standards-of-practice.aspx [verified 7 December 2018].
[41] Australian Nursing and Midwifery Accreditation Council. Nurse practitioner accreditation standards 2015. 2015. Available at: https://www.anmac.org.au/standards-and-review/nurse-practitioner [verified 7 December 2018].
[42] Australian Council for Safety and Quality in Health Care. Australian open disclosure framework. 2013. Available at: https://www.safetyandquality.gov.au/publications/australian-open-disclosure-framework/ [verified 7 December 2018].
[43] Business Directory. Professional liability definition. 2019. Available at: http://www.businessdictionary.com/definition/professional-liability.html [verified 7 December 2018].
[44] Carney T, Walton M, Chiarella M, Kelly P. Health complaints and practitioner regulation: justice, protection or prevention? Griffith Law Rev 2017; 26 65–88.
| Health complaints and practitioner regulation: justice, protection or prevention?Crossref | GoogleScholarGoogle Scholar |
[45] Nursing and Midwifery Board Australia. Professional indemnity insurance arrangements. 2016. Available at: http://www.nursingmidwiferyboard.gov.au/Registration-Standards/Professional-indemnity-insurance-arrangements.aspx [verified 7 December 2018].
[46] Medical Board of Australia. Registration standards: professional indemnity insurance arrangements. 2016. Available at: http://www.medicalboard.gov.au/Registration-Standards.aspx [verified 7 December 2018].
[47] Vernon R, Chiarella M, Papps E. Can confidence be assured? Research report. Adelaide: School of Nursing and Midwifery, University of South Australia; 2017.
[48] Australian Health Practitioner Regulation Agency (AHPRA). AHPRA annual report 2015/2016. 2017. Available at: https://www.ahpra.gov.au/annualreport/2016/ [verified 7 December 2018].
[49] Nursing & Midwifery Board Australia. Nursing and midwifery regulation at work in Australia 2015/16. 2016. Available at: https://www.nursingmidwiferyboard.gov.au/News/2016-04-08-nursing-midwifery-regulation [verified 7 December 2018].
