MARY CHIARELLA - FACULTY OF NURSING,
MIDWIFERY & HEALTH - UNIVERSITY OF
TECHNOLOGY, SYDNEY

Nurses say that it's time the AMA got with the times. Professor Mary Chiarella writes "In coming months, the World Health Organisation will launch a series of case studies showing how nurses around the world are leading primary health care projects, as well as innovation and development more broadly in health care.

The report, which I've helped prepare, also shows that in countries such as the US, Canada, the UK, South Korea and the Cook Islands, nurse practitioners are providing front-line care that is recognised to be as safe and effective as that delivered by doctors. Sometimes patients report being more satisfied with the care provided by nurses. The WHO report also shows that in many countries, midwives deliver the bulk of maternity services and do so safely, appropriately and without the excessive intervention that can occur in Australian obstetric servicing. So it's extremely heartening that Australia is finally taking steps to modernise its health care practices and to enable nurses and midwives to work to their full potential. The Federal Government's recent appointment of a Chief Nursing and Midwifery Officer is long overdue.

It's embarrassing, however, that elements of the medical profession seem to wish to take us -- not even back to the future, but forward to the past. Rosanna Capolingua's recent address to the National Press Club and subsequent press statements are more reminiscent of Dr Findlay's casebook than a modern health care service. The perfect
medical world that she paints is far from the reality for the majority of health care consumers. While Dr Capolingua stresses the importance of doctors being the gatekeepers of the health system for ensuring continuity of care, I wonder who looks after her patients on the days outside her Monday surgery? I point this out not to
denigrate Dr Capolingua's commitment to her patients, but to highlight the reality of the modern health care system, in which many doctors work part-time in the clinic, and refuse to see patients out of hours or do home visits. Don't let's imagine either that the AMA has a monopoly on safety or quality. There are plenty of other really good health professionals - nurses, midwives, physiotherapists, radiographers, pharmacists and others - who are more than capable (and quite probably more appropriate and less expensive than doctors) of working with people in the community to provide good case management AND to be able to liaise with everyone else who needs to be involved. That's what nurses in hospital do every day of their lives. The big issue for the AMA is not quality of care, not patient safety -- its turf, its money.

Don't be fooled, Australia -- other countries can demonstrate the safety and efficacy of nursing and midwifery led models. The sky won't fall in when we formalise similar models here -- in fact there will be improved access to health care and better primary health care in homes, schools and work places. While the PM and Health Minister do their best to bring Australia's health system up to date, it looks like the AMA will continue on its Luddite path. In the meantime the nurses and midwives of Australia are already working collaboratively and successfully with many visionary doctors and allied health professionals who want to be a part of a 20:20 vision for health care.

Source - Mary Chiarella Professor of Clinical Practice
Development and Policy Research in the Faculty of Nursing, Midwifery &
Health, at the University of Technology, Sydney.