Nurse practitioners flying solo in business
By Lynne Day MACN, Nurse practitioner, Geriatrics Director, Aged Health and Care Consulting Pty. Ltd.
Nurse Practitioners: Aged Care Models of Practice Program is an Australian Government funded project that is supporting nurse practitioners (NPs) to explore models of practice designed to meet the health needs of older Australians. I hope that my story of entering primary health care as a nurse practitioner and business owner will encourage others to specialise in aged care and set up as small business. It’s an innovative way to meet the health and wellbeing needs of older Australians.
Health and care needs of older adults are changing. Change has been incremental as medical advances have successfully intervened in many acute disease processes. Australia is experiencing a growing demographic of people over 85 years of age; many are entering a chronic disease trajectory that sees them living longer with increased disability.
Older people often present to the emergency department during an acute exacerbation of a chronic illness that may have been preventable if identified earlier. When admitted to hospital, I’ve often seen the presenting issue dealt with in isolation to co-existing issues. These chronic problems often find the older person assessed as not being able to manage at home, and ‘streamed’ into waiting for a nursing home bed. I think this medical viewpoint of the multifaceted array of issues facing ageing Australians uses resources inappropriately and inefficiently. Our elderly are often unsure of how to advocate for themselves and navigate the health system.
Long-term vision for primary health care involves NPs. NPs provide direct clinical care, focussed clinical service, monitoring and adoption of evidence for practice, autonomous practice (diagnosis, prescribing, referrals), and clinical leadership. The NP role can provide a clear continuum of health and care, potentially reducing unnecessary hospital admissions and improving health outcomes by enunciating a set of guidelines and functions. These functions are emergent, visionary and need to be flexibly applied to the prevailing social, political and fiscal environment.
Drafting the scaffolding for a new NP model in community aged care is a challenging process. Principles that I use to guide my practice aim to improve equity, quality, efficiency and accessibility of health and care for older adults living in their own homes. To do this I am embarking on creating an aged care NP consultation model based in a primary health setting. This has been initially possible with a grant from the Department of Health and Ageing, project management with RCNA (now Australian College of Nursing) and an amazing network of support from many health professionals who have previously gone into private practice.
To set up as an autonomous nurse clinician is relatively new. The introduction of Medicare NP item numbers (November 1, 2010) has made private practice more feasible for a nurse. For me, the Medicare item numbers meant an opportunity to give something I’d considered quietly for many years, a go. It had always struck me that nurses did not start small business, except in agency type arrangements. Setting up a business as a clinical nurse was a way for me to meet patient needs while also providing a viable business option for myself.
In the last six months, I’ve learnt how to set up an appropriate business structure, find a good accountant, set up systems for cash flow, set up systems for documentation and secure sharing of information, ensure compliance with government and regulatory bodies, minimise risk, network effectively, manage IT systems…..and much more.
Developing a new role in our current changing health system is challenging. For those who have worked in the health system for many years, the realisation of an emergent role to act as a bridge between the medical and nursing model is exciting. This role is a way to combat the challenge of working with elderly people who are living beyond their expectations due to medical technologies, yet are ageing with chronic issues that often defy acute medical intervention. Specialist community aged care NPs can work in collaboration with other health professionals to provide for unmet needs through community health outreach. This reduces unnecessary hospitalisations and aims to preserve older Australians’ quality of life. It can also be a sustainable business model for NPs, and provides a wonderful new challenge for nurses to immerse themselves in.
ACT Women’s Matters
Help contribute to an understanding of ACT women’s body satisfaction
WCHM is supporting University of Canberra psychologist Vivienne Lewis and Psychology Masters student Melissa Carters to conduct research into women’s body satisfaction in the ACT.
If you are a woman living in the ACT and aged over 17 years, we urge you to participate in this important research.
The survey will help to provide a more comprehensive understanding of the underlying processes behind body dissatisfaction and identify possible areas to focus prevention and intervention activities for body dissatisfaction within the ACT.
The online survey will take approximately 15 minutes to complete.
To complete the survey please log online to https://www.surveymonkey.com/s/ACTbodyimage
Join us for 100 Years of Canberra Women International Women’s Day Breakfast
This year marks 100 years of Canberra and in celebration of 100 years of Canberra Women the ACT Women’s Services Network warmly invite you to join us for breakfast on International Women’s Day.
Date: Friday 8 March 2013
Time: 7:30am – 9am
Venue: CIT Function Centre, Constitution Ave Reid
RSVP: Monday 4 March to Women’s Legal Centre email@example.com or 6257 4377
EFT: BSB: 112908 Account: 043989710 Ref: Your name
Cheque: Women’s Legal Centre GPO Box 1726 Canberra ACT 2601
This year’s event will be hosted by Virginia Haussegger, ABC TV News Canberra, with Welcome to Country from Auntie Agnes Shea OAM.
Guest speakers include:
Marie Coleman—Marie has played a pivotal role in many developments in the women’s movement in Australia over the last four decades. As a public servant in the Whitlam and Fraser governments Marie was instrumental in providing a positive outlook for women during times of massive social change.
Dennise Simpson—For over 30 years Dennise Simpson was an advocate on behalf of women and children in the Canberra region who have been affected by family violence. Dennise was the Manager of the Domestic Violence Crisis Service in Canberra and Dennise received a Medal of the Order of Australia in 2009, recognising her work in supporting women and children who have experienced violence.
Minister Joy Burch—Joy Burch is the minister for Women, Arts, Racing & Gaming, Multicultural Affairs, Education & Training and Disability, Children & Young People. Joy is passionate about making life better for our community and draws on a wide range of professional experiences in her work as a member of the ACT Legislative Assembly.
Australian Longitudinal Study on Women’s Health—Seeking 18-23 year olds
Hey Ladies aged 18-23! You are more than the sum of your parts. You are a complicated being.
The Australian Longitudinal Study on Women’s Health is one of the most comprehensive health studies in Australia and has helped improve health for Australian women.
The Study is now recruiting women aged 18-23 in order to determine what the health issues are for women in this age group.
You can help by taking a 15-20 minute confidential online survey and you will go in the draw to win one of 100 prizes valued at $50 each.
Provide feedback on ACT public hospitals
Just in case you’re back from holidays and have some spare time, the ACT Local Hospital Network is seeking feedback on Canberra’s public hospitals. In particular, they want to get a good idea of consumer experiences ranging from the contact, treatment and care given within the ACT public health system.
In July 2011, the ACT Minister for Health announced the establishment of the ACT Local Hospital Network Council (the Council), an independent advisory body made up of a range of Canberrans working together to support the implementation of national health reforms in the ACT and to provide high level strategic advice to the Government.
Now the Council now wants to hear from you and if you want to let the Council know what you think about Canberra’s health services, or to tell them of an experience, it’s as easy as sending an email.
What do they want?
The Council is seeking community comment on the delivery of public health services in the ACT and would like advice on the following:
- Whether you were provided with an appropriate amount of information about your treatment, which you were able to clearly understand
- Your experiences, from beginning to end, around the contact, treatment and care given within the ACT public health system
- Your overall satisfaction with the health services that are offered by the ACT’s public hospitals, including the Canberra Hospital, Calvary Public Hospital, Clare Holland House and QEII Family Centre
The Council will consider all comments received and your feedback will inform the development of recommendations to improve health services in the ACT. The Council’s recommendations, together with a generic summary of feedback received, will be included in the Council’s Annual Report which is presented to the ACT Minister for Health and tabled in the ACT Legislative Assembly.
If you would like to provide comments or feedback, please email the ACT Local Hospital Network Council at LHNCouncil@act.gov.au or you can write to:
ACT Local Hospital Network Council
c/- Council Secretariat, Executive Coordination Unit
ACT Health Directorate
GPO Box 825
CANBERRA ACT 2601
The Council will be accepting feedback from the community until close of business on Tuesday 30 April 2013.
All feedback received will be treated in strict confidence and personal details will not be used in the context of developing any recommendations to the Minister.
The Annual Report will be available on www.health.act.gov.au in the second half of 2013.
New counselling service for the sex and gender diverse community
A Gender Agenda has established a counselling service in an attempt to meet the high unmet need for counselling services in the sex and gender diverse community. The sex and gender diverse community includes transsexuals, transgender people, intersex people, cross-dressers and other gender variant or gender non-conforming people, as well as their partners and other family members.
The team of professional and experienced counsellors including a registered psychologist offer a range of services:
- 50 minute sessions (one-off or ongoing)
- Individual/couple/family sessions
- Mental Health Care Plan with GP referral
- Telephone sessions are available for people outside the ACT
Currently counselling is offered between 11am and 6pm on Mondays, although special arrangements can be made if these times are not possible for you.
How to access the service:
All referrals to the service must be initiated either by a case worker, or by individuals seeking counselling.
Clients who are happy to contact the service independently can call on (02) 6162 1924 or email firstname.lastname@example.org.
For other service providers who have clients who are less confident about making contact, A Gender Agenda can arrange an initial telephone or face-to-face meeting which allows the individual and their case worker to discuss issues with the psychologist before deciding whether or not to proceed.
If you’re not sure whether it’s appropriate to make a referral to the service, please feel free to call A Gender Agenda who are always happy to discuss the issues with you and provide any additional information or support.
Fees are charged on a sliding scale ranging from $15 to $222 per session dependent on an individual’s income and referral pathway. In cases of demonstrated financial hardship, A Gender Agenda can offer further reductions to these fees.
Individual Fee Schedule for 50 minute counselling session (when paid privately by an individual):
- Less than $13,000 pa (less than $500 per fortnight)—$15.00
- Less than $20,800 pa (less than $800 per fortnight)—$30.00
- Less than $41,600 pa (less than $1,600 per fortnight)—$60.00
- Less than $67,600 pa (less than $2,600 per fortnight)—$90.00
- More than $67,600 pa (more than $2,600 per fortnight)—$120.00
- More than $104,000 pa (more than $4,000 per fortnight)—$150.00
Corporate and Organisational Rate:
Where psychological services are provided as part of a case management plan and subsidised by an organisation such as Comcare, fees charged are as set by the Australian Psychological Society which is currently $222 for a 45-60 minute consultation.
WCHM Matters, Work and Women
Another year over and a new one begins at the WCHM office, which is filled with the anticipation of what 2013 will bring. Report launches, new research projects, seminar presentations, events and campaigns are just a few of the things on the WCHM agenda.
We received good news early in the year with the Australian Taxation Office advising us on January 2nd that WCHM had successfully been endorsed as a deductible gift recipient (DGR), under the category of health promotion charity. This means that WCHM will be able to receive income tax deductible gifts and contributions and that any donors can claim income tax deductions for these. It also means that WCHM can now apply for other funding managed by philanthropic trusts that require DGR Status and that WCHM can offer slightly higher net increases in remuneration to staff through salary sacrificing at no cost to WCHM’s Salary Budget. We would like to thanks the WCHM Board members and staff who worked hard over the last two years to prepare WCHM for the successful application. In particular we’d like to thank our previous Chair, Margo Mitchell, who gave up her time to thoroughly research the requirements and to develop the approach that WCHM should take.
The office had a shake up late last year with the arrival of our new stand up desks (yes, that’s a desk you stand up at!) and through a combined effort—with an exceptional effort from Marg—we’ve created an environment that is truly a pleasure to work in. Not only are the desks of great benefit from a Work Health and Safety perspective but the office has become an even more inviting and welcoming space for all who visit.
WCHM’s Executive Director Marcia continues to work with and support a number of organisations within the ACT community sector. High on the agenda is Marcia’s membership in the ACT Women’s Services Network (WSN) who are currently working to ensure the continued support for women’s specialist services as an integral part of the ACT service system. She also represents WCHM on the Ministerial Advisory Council for Women, the ACT Women’s Health Advisory Group and a range of other committees.
In addition, Marcia has been working closely with the manager of the Throughcare Unit at ACT Corrective Services to scope, design and implement a model of post-release support aimed at reducing reoffending for women leaving the Alexander Maconochie Centre (AMC). A series of workshops have been held with the Women and Prisons (WAP) group, the ACT Women’s Services Network and other service providers working with a gendered approach. The aim of the workshops has been to develop a model of post-release support that incorporates health, housing, skill development, employment, finances and social support, and which highlights the need for gender sensitivity is service development, including specialist women-only support in some cases.
Ashley and Angela are busy working on the Summer of Respect campaign, which continues to make headway in 2013. We started the year with a stall at the Summernats Festival where we spoke with over 304 men about respect and consent. The event exceeded the expectations of all the women who worked there—coming from WCHM, the Canberra Rape Crisis Centre and the YWCA—because not only were the participants responsive and positive to the message, but the cars were quite an enjoyable spectacle too! The campaign will continue until International Women’s Day on March 8, and there are plenty of activities planned between now and then including a stall at the Canberra Multicultural Festival, an info-drop during the university o-weeks and participation in the V-Day event being hosted by the ANU Women’s Collective.
If you want to know what’s happening throughout the campaign please follow us on facebook at http://www.facebook.com/summerofrespect.
At the end of 2012 Angela also completed a joint Women With Disabilities ACT and WCHM research project into women with disabilities in the ACT. The research was conducted via a survey which covered health and wellbeing, participation in social life and participation in economic life and was undertaken with two aims in mind: to complement existing disability data and to highlight areas of need where ACT specific data does not currently exist. Thanks to the interest in the community we had close to 200 women participate in the research, each contributing to the richness of the data we collected.
The research summary report Strong Women, Great City is now ready to be launched and we would be delighted if you could join us:
When: Wednesday February 6, 3pm
Where: Reception Room, Legislative Assembly
RSVP: email@example.com or 62902166
We’re thrilled to have Rhonda Galbally AO, Chair of the National People with Disabilities and Carer Council, travelling to Canberra to launch the report and to have the opportunity to hear from ACT Minister for Women Joy Burch MLA.
The report highlights the absence of ACT specific disaggregated data and the ways in which this limits a meaningful understanding of different population groups in the ACT and impacts local policy and service delivery. As a result, WCHM will be focussing on disaggregated ACT data over the coming year.
At the completion of the Summer of Respect campaign and report launch Angela will be turning her attention to preparing a paper with Annelise for the 7th National Women’s Health Conference, to be held in Sydney from May 7-10. The paper will examine ways to update conversations about gender and its relationship to health and wellbeing, in the context of policy-making or service delivery. We hope to provide a more comprehensive synopsis—if not the paper itself—at the time of the next e-bulletin, so stay tuned!
Annelise is also continuing her work with the Women And Prisons (WAP) Group. In particular she is working with Chrissie on the development of awareness training about the specific issue for women in prison system which is aimed at ACT health professionals, service providers and other interested individuals. An evaluative pilot of the awareness training will be run toward the end of the financial year.
The newest member of the WCHM team is Bess Harrison who has joined us to document a professional peer-support and advocacy framework with the WAP group. Bess will be working with WAP members over the coming months to develop the peer-support manual, which will include policies and procedures for delivering peer-support as well as the training and support requirements for WAP members.
Silvia has recently wrapped-up a longer-term research project into women who are mental health carers in the ACT, which will be published on the WCHM website in the coming month. She has also begun work on a new research project in collaboration with the Women and Mental Health Working Group (WMHWG) on motherhood and mental illness. We will provide a more comprehensive update on this project in the next e-bulletin.
And just in case we haven’t made this clear in the past, the office simply wouldn’t function without Marg, whose incredible organisation, attention to detail, optimism and lovely nature not only keep the office running smoothly but make it an even-more-fabulous-than-ever workplace. Thanks Marg!