Nurse practitioners hamstrung in efforts to close the gap

Healthcare in remote Aboriginal communities is hampered by bureaucratic barriers that prevent nurse practitioners from working to their full scope of practice.

Nurse practitioners are often the most senior clinicians working in remote communities like Doomadgee in far north-west Queensland, where doctors are rarely seen (see story page 22).

Doomadgee NP Lesley Salem AM says health care is hindered by regulations such as the rule that prevents NPs from prescribing medicine that a doctor hasn’t already prescribed.

“That makes it impossible for you to do your job when you’re working very remote like I am now at Doomadgee, (which has) the highest rate of rheumatic heart disease in the world,” Lesley said.

“There are a lot of drugs such as common diabetic drugs that I have nobody (in Doomadgee) to initiate for me.”

She was speaking on The Shift with Shaye , a regular podcast hosted by NSWNMA General Secretary Shaye Candish. (https://soundcloud. com/nsw-nurses-and-midwives/ the-shift-with-shaye_lesley-salem)

As an NP, Lesley is not allowed to order an echocardiogram to test for RH disease –and Doomadgee has no doctor to order one (at time of writing).

“I’ve just had 27 cardiology referrals refused because they hadn’t had an echo,” she told Shaye. “That is bureaucratic madness – there’s no logic to it.”

Instead, Lesley has had to find a telehealth doctor and ask them to write a referral for an echo. There’s a further delay of several weeks to get an appointment for the test in Mount Isa or elsewhere.

It costs Doomadgee’s Aboriginal community-controlled health service, Gidgee Healing, thousands of dollars to fly the patient out – plus an escort if the patient is a child –for the test (sometimes the patient refuses to make the trip).

It can take another two months to get the results back, have the patient triaged and obtain an appointment for treatment in Mt Isa or another distant location.

“The delay can be catastrophic for a young person with a leaky valve that’s causing heart failure – all because of one simple MBS item number,” Lesley said.

She said that under the current MBS, an NP cannot order a pelvic ultrasound or a dating scan.

Lesley attempts to get around this obstacle by ordering a full abdominal ultrasound and noting “ovary pain” on the referral.

Shaye told Leslie the new federal health minister seems committed to reviewing Medicare and the role of nurse practitioners in particular.

“What would you want to see come out of this (review)?” Shaye asked.

Lesley replied, “We need access to the MBS or any system that allows us to work at our full scope … for the patient’s sake.

“This would help not only Aboriginal people but all people who live in rural or remote (areas).