Do we need RNs in nursing homes? The NSW government doesn’t think so

 

It seems that every day I keep being reminded of issues facing the ‘premature death’ debate in Residential Aged Care Facilities (RACFs). An article today again raised this issue on a matter that had gone under my radar, that the New South Wales (NSW) minimum legislative ruling regarding a registered nurse to be on duty in a RACF 24 hours a day seven days a week had been abolished. I must say as a registered nurse, healthcare worker, former aged care registered nurse and aged care manager I was appalled.

A little background

The NSW Public Health Act 2010 superseded the NSW Public Health Act 1991. Section 104 of the 2010 act stated that a nursing home (their definition) MUST be staffed by a registered nurse at ALL times. This act was intended to ensure that RACF residents who were needing what was formerly known as high care would be taken care of by registered nurses. When this act was passed the Commonwealth Aged Care Act of 1997 was in-place and defined what was considered as high and low residential aged care.

Changes to federal funding legislation

In 2013 the Living Longer, Living Better initiative was passed by the Federal Government. This initiative did several things, but the key factor in this initiative was to eliminate the distinction between high and low residential aged care. Essentially, the government, for all intents and purposes, said that every elderly RACF resident only needed basic care, eliminating the complex health care component. This jeopardized the Public Health Act’s nursing home definition, and therefore potentially removed the requirement for registered nurses to be rostered in RACF homes 24 hours a day. However, in July of 2014 the NSW government publishes an amendment upholding section 104 and continuing to require a registered nurse in RACF homes. This amendment was only an interim measure which expired in Demeber 2015.

NSW government inquiry into RACF care

On the 25th of June 2015 the NSW government begins an inquiry entitled “Registered nurses in New South Wales nursing homes“. The inquiry is finished and the report released on the 29th of October 2015. In it the committee makes several very important distinctions about the role of registered nurses within RACFs:

3.2 For many inquiry participants the administration and management of medication in aged care facilities by registered nurses was considered essential to ensure residents’ health and safety.

 

3.4 Leichhardt Council expressed similar concern about unqualified or inappropriately qualified staff administering medications, particularly Schedule 8 drugs, as it could lead to adverse health outcomes for residents.67

 

3.12 The ability of registered nurses to clinically assess the health status of residents was another important role highlighted by stakeholders

 

3.15 The Combined Pensioners and Superannuants Association asserted that the assessment skills and expertise of registered nurses were particularly critical in aged care facilities, as – unlike hospitals – there is generally no immediate access to a doctor and in situations where a resident’s health deteriorates rapidly, a registered nurse can be at hand to make a clinical judgement about the appropriate course of action.

 

3.18 A number of inquiry participants highlighted the fact that registered nurses have the necessary skills training and experience to provide end-of-life care as a reason to mandate their continuous presence in nursing homes.

 

3.26 There was general consensus that aged care staff and enrolled nurses can undertake the personal care needs of residents with dementia, however, some inquiry participants pointed out that registered nurses are still required to administer certain medications (as already discussed throughout this chapter) and manage more challenging behaviours.

 

3.33 Numerous stakeholders noted that the supervision of enrolled nurses and aged care staff is a key accountability for registered nurses in residential aged care facilities.

 

3.37 Registered nurses also supervise aged care workers. NSW Health’s Employment of Assistants in Nursing (AIN) in NSW Health Acute Care dictates that ‘an AIN will work within a plan of care under the supervision and direction of a registered nurse when providing aspects of nursing care’.

A number of groups, such as the Australian College of Nursing (ACN), submitted statements of support for the committee recommending keeping registered nurses within RACF. The highlighted concerns that although the federal government had eliminated the high and low care qualifiers in funding nursing home residents were requiring more skilled care due to their chronic conditions. Additionally, the ACN response highlighted the committee’s evidence that assistants in nursing (AINs) and enrolled nurses (ENs) needed in-person supervision as per the requirements withing their scope of practice.

NSW government refuses to take action

However, in April of 2016 the NSW government disagreed with the committee’s findings and overturned the amendment to the Public Health Act. In an article the then health minister Jillian Skinner stated that RACF facilities were regulated by the federal government, and therefore a NSW specific requirement would constitute double regulation.

The Shooters and Fishers party, led by R.L. Brown introduced an amendment to the Public Health Act 2010 which replaced the term nursing home with a definition more appropriate to the Living Longer, Living Better initiative. This would then bring the Public Health Act of 2010 current and uphold section 104 requiring 24 hour seven day a week registered nurse coverage. The bill was passed by the upper house in May of 2017 and voted down by the lower house on the 11th of May 2017.

What does mean for RACF residents?

Within nursing homes it is often, particularly in the evening/night and weekend hours, that the registered nurse serves as the in-charge for the facility. This means they are ultimately responsible for all care and function of the facility. It is during these times that rates of pay, due to penalties, is highest for registered nurses. So it stands to reason that this is the period where a registered nurse would not be rostered on.

But who will clinically assess a resident’s need for analgesia, and would a RACF allow a non-licensed AIN to administer schedule eight medications such as Endone or Ordine? If a resident falls in a facility during these hours who is going to make the clinical assessment of whether that resident is safe to be lifted, and whether that resident should be sent to hospital? If a resident shows signs of aspiration (coughing after swallowing, difficulty breathing during meals, etc.) on a Saturday morning and no registered nurse is rostered on until Monday morning, will that resident not eat for the weekend? I know these are extreme examples, but they are common within aged care facilities.

Registered nurses within facilities also handle administrative and safety tasks. They are often required to fill sick-calls during their shifts. Registered nurses are also seen as fire wardens and trained to respond to fire alarms if needed. Who is going to undertake these jobs if the registered nurse is absent? I know these are extreme cases, but currently there is NO legislative requirement for registered nurses to be rostered within aged care facilities at ANY time. It is the discretion of the facility to decide when to roster on a registered nurse. I wonder if families of loved ones in aged care facilities would be made aware of periods when a registered nurse was not employed, and how would they feel about this?

What does this mean for the hospital and greater acute health system?

From personal experience and common sense if a registered nurse is not available in an aged care facility if a resident is requiring as needed (PRN) medication an ambulance is called. An issue with aspiration, which could be assessed by the registered nurse, would need to be undertaken by the local hospital who would be the closest access to registered nurses. Any changes in a patient’s condition would require transfer to hospital as there would be no registered nurse on premesis to assess their condition and contact the resident’s medical representative.

This means increased workload on the ambulance service and emergency departments. In a period where the number of ambulance call-outs and emergency presentations is rising do we need a further burden on our health system? And it isn’t fair for the residents themselves. Transferring a elderly person, particularly one with dementia, to hospital can lead to disorientation and further complications in their treatment leading to longer stays in hospital.

Call to action!

Jillian Skinner stated in her 2015 statement that she would encourage federal adoption of the mandatory 24 hour registered nursing requirement through the Council of Australian Governments. NSW through their own inquiry found critical evidence that registered nurses provide an invaluable link to improving a resident’s health and well-being in aged care facilities. Every clinical representative body can attest to the need for trained clinical registered nurses to be on-duty at all times in aged care facilities.

There needs to be action on this subject, not just debate and fact-finding. The evidence is overwhelming for the need for minimum clinical supervision in aged care facilities. We need lawmakers to listen to their constituents and put into place minimum standards.

References

NSW Public Health Act 2010- http://www.legislation.nsw.gov.au/inforce/e20f1d11-6a0d-ec9a-fe79-d31ae57c52c3/2010-127.pdf

Workingcarers.org.au: Living Longer Living Better changes that might affect working carers-  http://www.workingcarers.org.au/index.php/work-n-care/reports/1467-living-longer-living-better-changes-that-might-affect-working-carers

NSWNMA: Timeline of events – registered nurses in NSW nursing homes-  http://www.nswnma.asn.au/wp-content/uploads/2013/09/Timeline-of-events-registered-nurses-in-NSW-nursing-homes.pdf

Legislative Council: Registered nurses in New South Wales nursing homes- https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryReport/ReportAcrobat/5821/Report%2032%20-%20Registered%20nurses%20in%20New%20South%20Wales%20n.pdf

Australian College of Nursing: ACN submission inquiry into RNs in NSW nursing homes-  http://ACN_submission_inquiry_into_RNs_in_NSW_nursing_homes.pdf

Sydney Morning Herald: NSW Government abandons 24/7 nursing in aged care homes-  http://www.smh.com.au/nsw/nsw-government-abandons-247-nursing-in-aged-care-homes-20160430-goium1.html

Talking Aged Care: NSW registered aged care nurses on duty 24/7- https://www.agedcareguide.com.au/talking-aged-care/nsw-registered-aged-care-nurses-on-duty-24-7

NSW Legislature:  Public Health Amendment (Registered Nurses in Nursing Homes) Bill 2016-  http://www.legislation.nsw.gov.au/bills/84bb3a65-4581-4187-a2b8-90a8d6e7c659

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Are we taking care of our new nurses?

As I sit at my computer I ponder what to write. Then I think to the new graduate nurses who I work with every day. In a previous life I was a university lecturer, and the same statements I hear each day from my new graduate nurses I heard from those students: “I can’t find a new graduate position”. So I wonder, what is the current state of new graduate registered nursing uptake in 2017?

This question should be an easy one to answer. The Australian Health Practitioner Association (AHPRA) agency is requiring all student nurses to be registered with them in order to fulfill clinical placements. So finding out the number of students enrolled in accredited nursing programs in Australia should be easy, right? Not so fast. I search of the AHPRA website revealed NO data on the number of student nursing registrations. Despite this AHPRA quite easily detailed a report about the number of nurses registered in Australia all the way back to 2012, along with pertinent demographic data which I used in an earlier post. So why has AHPRA not bothered to reveal student nursing numbers?

So why does this matter?

Because nursing is a profession which cannot be automated and is increasing in demand! You cannot simply create a machine to do what a nurse does, despite some attempts otherwise. In our most vulnerable state nurses provide the personal care we need. And nurses need the complexity of thought needed to provide intricate assessment of a patient’s needs and identify problems before they cause serious life-and-death situations such as those of Vanessa Anderson.

And let’s face it, the Australian public is becoming older and needing more healthcare. Modern healthcare is allowing for longer life expectancy, and with that older adults will utilize more healthcare. Additionally, the baby boomer generation will expect greater results in terms of customer care which will require adequate numbers of appropriately trained and attentive nurses. So where will these registered nurses come from?

Will there be a nursing ‘shortage’?

Last year Monash business school did a study on on the climate of the nursing and midwifery workforce. The Monash report determined that an occupation which is demanding, such as nursing, should likely see between three to six percent of its workforce intending to leave. However, this study showed that 32% were considering leaving the profession, with 25% determined to do so. Even the Department of Health in a report filed in 2013 stated their figures indicated Australia had adequate numbers of nursing staff only up to 2016. Another poll found that 100% of nurses surveyed stated that the government undervalued their role.

Ah, but overseas nurses can fill the void? It is true that a significant number of nurses are overseas-trained? The Australian Bureau of Statistics reported in 2013 that one-third of nurses (33%) were overseas-trained, up from 25% in 2001. This fact has been highlighted as a reason why Australian new graduate nurses cannot find post-registration employment. But with 33% of the 342,221 nurses registered in Australia overseas-trained in 2016 is the overseas nurse a threat to our domestic nursing cohort? Some may think so. The Australian Nursing and Midwifery Federation feels that the 457 visa program for overseas nurses is “… being taken as a shortcut and that employers see it as a quick fix.”

Troubles post-study for nurses

Publicity around newly registered nurse employment seemed to peak in 2014-2015. ABC news reported that ” thousands of nursing graduates are unable to find work in Australian hospitals.” Even in 2016 the rumbling of underemployment of nursing graduates continued. In West Australia a WA Today article reported that only 500 of about 1500 (33%) newly graduated nursing students secured a nursing role. The Health Times reported that of the new graduate nurses in 2007 97.4% were able to secure full-time employment; however, in 2014 that figure dropped to 80.5%.

So where do we go from here?

Firstly, we need to have clear evidence as to the extent of the problem. I would call on AHPRA as the registration body to release statistical figures about the number of student registrations, just as they have done for registered and enrolled nurses. With that information we can clearly see how many students we have in nursing programs in Australia. Additionally, I would call on AHPRA to include a statistical figure on the number of overseas-trained nurses registered in Australia. As they are the governing body and provide the certification that overseas nurses are able to work in this country they would be able to provide figures as-such.

Secondly I would suggest the Department of Health re-visit their strategy paper on nursing retention and recruitment. This report is from 2013 and stated the nursing workforce was only adequate until 2016. If the government does care about the potential nursing workforce into the future reviewing their strategies and making a future policy framework would be necessary. It would also be helpful for the Council of Australian Governments to convene on this issue as they are the primary employer of a large number of nurses through the public health hospital system.

Without adequate statistical data there can be no informative discussion regarding the debate over new graduate nurses in Australia. One thing is certain, without adequate places for these energetic and qualified nurses to go the profession will continue to struggle in providing adequate healthcare to the increasing ageing population of Australia. Policy makers and statisticians need to act now in preventing a healthcare crisis in the future.

References

AHPRA: Student registration-  https://www.ahpra.gov.au/Registration/Student-Registrations.aspx

Advantech: Industry 4.0: It’s happening – Nurses are replaced by Robots- http://www.advantech.com/machine-automation/industry%20focus/206d0919-7a6f-4c80-9caa-cdfd662bd712/

The Australian: Coroner blames hospital for death- http://www.theaustralian.com.au/archive/news/coroner-blames-hospital-for-death/news-story/3d9318ea30f206211774e7931bd6526e

Sydney Morning Herald: Healthcare is a booming industry and Australia is in the box seat-  http://www.smh.com.au/comment/the-care-boom-20160928-grqqzv.html

Sydney Morning Herald: With an ageing population is healthcare sustainable?-  http://www.smh.com.au/comment/with-an-ageing-population-is-healthcare-sustainable-20160319-gnm98t.html

Monash University: What Nurses & Midwives Want: Findings from the National

Survey on Workplace Climate and Well-being-  https://business.monash.edu/__data/assets/pdf_file/0004/624127/What-Nurses-And-Midwives-Want-Findings-from-the-National-Survey-on-Workplace-Climate-and-Well-being-2016.pdf

Department of Health: 7.2 Nursing and midwifery retention-  http://www.health.gov.au/internet/publications/publishing.nsf/Content/work-review-australian-government-health-workforce-programs-toc~chapter-7-nursing-midwifery-workforce%E2%80%93education-retention-sustainability~chapter-7-nursing-midwifery-retention

Australian Bureau of Statistics: 4102.0 – Australian Social Trends, April 2013-  http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20April+2013

Sydney Morning Herald: Nurse graduates ‘locked out’ of workforce as migrants get jobs-  http://www.smh.com.au/business/workplace-relations/nurse-graduates-locked-out-of-workforce-as-migrants-get-jobs-20150606-ghi9c8.html

Health Times: Generation Next – Helping Graduate Nurses and Midwives Find Jobs-  https://healthtimes.com.au/hub/nursing-careers/6/news/nc1/generation-next-helping-graduate-nurses-and-midwives-find-jobs/1422/

ABC News: Thousands of nursing graduates unable to find work in Australian hospitals: union-  http://www.abc.net.au/news/2014-05-24/thousands-of-nursing-graduates-unable-to-find-work/5475320

NSW Nursing and Midwifery Association: Nurse graduates unemployed or underemployed-  http://www.nswnma.asn.au/nurse-graduates-unemployed-or-underemployed/

Health Times: Nursing shortage expected to worsen-  https://healthtimes.com.au/hub/workplace-conditions/60/news/nc1/nursing-shortage-expected-to-worsen/490/

WA Today: All trained up with nowhere to go: WA’s hundreds of unemployed graduate nurses-  http://www.watoday.com.au/wa-news/all-trained-up-with-nowhere-to-go-was-hundreds-of-unemployed-graduate-nurses-20161211-gt8qkz.html

Better behaved- new study finds lower rates of smoking, drinking and drug use

The day after World No Tobacco day the Australian Institute for Health and Welfare published statistics from the 2016 National Drug Strategy Household Survey. The results of that survey are encouraging:

  • Young people (under 30) are smoking less with rates dropping significantly from the 2001 survey. However, the decline is much less when compared to the 2013 survey.
  • Rates of smoking for those in their 40s, 50s and 60s have not lessened.
  • Young adults are showing a decrease in weekly alcohol consumption compared with 2013, however binge drinking is still excessively high. Youths under the legal age are also reporting less alcohol consumption and there are less reports of alcohol-viewed violence.
  • Illicit drug use has declined since the 2001 survey, however there is a slight increase since the 2013 survey.
  • Methamphetamine use is seen as the biggest concern regarding illicit drugs with crystal meth the most used variant.

What does this mean for those of us in healthcare?

There is a vast amount of evidence that smoking over a long period of time leads to higher rates of chronic health problems and increases the individual’s need for healthcare services. The lower rates of smoking of young people, although not immediately beneficial, will lessen the future health burden.

Every week our emergency department, along with many others around the country, see patients who have been the victims of over-intoxication and alcohol-fueled violence. While the binge drinking continues the lower violence numbers mean again less use of acute hospital beds, particularly on the key Friday-Sunday nights when parties typically occur.

I can say from my experience that Ice (Methamphetamine) is the most common illicit drug we see in our department. While not as problematic according to reports as drugs such as the Zombie drug it still causes a considerable amount of time and resources on the hospital system to treat.

The Future?

I am a realist. We will never completely eliminate behavioral health problems such as teenage drinking or smoking. Drug use will continue indefinitely. But at least we can see that improvements on a public health scale are being made. This will lead to more healthcare services being available for other unwell patients and can prevent young people from having poor future outcomes due to bad choices being made today.

References

AIHW: National Drug Strategy Household Survey (NDSHS) 2016 key findings

 

Telehealth to combat Australia’s growing demand for healthcare?

An article in IT Brief tackles the topic of how Australia is going to tackle the increased need for healthcare moving forward. According to a report in the Newcastle Herald Australian men are ranked in the top three countries worldwide in life expectancy, while women are in the top fourth. This is great news for Australians, and can cause sleepless nights for policy makers. The World Health Organization reports that currently Australia as of 2014 spends 9.4% of Gross Domestic Product on healthcare, that equates to approximately $4,357 per person. With the baby boomers expected to reach their senior age this figure is surely going to rise.

The IT Brief discussed several

items relating to IT and healthcare. One such discussion was over the My Health Record program by the federal government. I have previously discussed the My Health Record in another post. I believe it is a vital and important forward step in advancing the Australian healthcare system.

Another item discussed was the use of smartphone apps and other personal IT devices to aid in chronic disease management. This is a field that is sure to improve as our tech-savy population ages.

But the item discussed that interested me was that of individuals being able to visit with a doctor via an online medium. This was described in the article as a potential way for people to access medical care without needing to wait in a doctor’s office and would allow access in rural areas. In Australia we have a similar system in place in rural areas. However, looking to rely on this as a measure to markedly decrease the reliance on in-person healthcare is suspect.

While visual clues and interviews are important in assessing health concerns palpation, auscultation and the ability to have the patient in front of you make up much of both doctors’ and nurses’ assessments. Additionally, many presentations we see in hospital that have come from GPs requires further acute assessment not available in a doctor’s surgery: ultrasounds, CT scans, and urgent blood tests. These items would not be available to a patient sitting in their lounge room speaking with a doctor over the internet.

If there are chronic and stable conditions which only call for simple follow-up then online medical consultation would be fine. However, I wonder if that is not being done already? My concern is that moving forward the need for acute in-person healthcare will only increase. And with that increase will be the need for more acute beds in hospitals and more healthcare facilities to deal with demand.

Your thoughts?

References

IT Brief: Digital tech – the answer to Aussie healthcare’s biggest ailments?

Newcastle Herald: Australia about to lose top spot in this world health ranking

WHO: Australia

Australia, better healthcare than America- absolutely!

stethoscope-840125_1280

 

I came across this article and had to write about it. Marie Shieh, a doctor trained in America and now practices in Australia, has written a piece for the The Telegraph. In it she states emphatically that Australia’s health care is better than Americas. Full stop, no qualifiers. And as a former consumer and provider of America’s healthcare system I can agree.

Confession: my road to becoming a registered nurse started because of poor quality healthcare that my father received before his death. We were poor, not living on the streets poor, but we did not have a lot of money. My parents owned a printing business, and we did not have health insurance. When I was young my father was diagnosed with diabetes, then cancer and finally a heart condition. Because we did not have health insurance all of these medical conditions were treated very conservatively and without extensive examination. I believe, as a consequence of that, he suffered a major heart attack and died prematurely.

Now I know that he contributed to his condition with smoking and being overweight. But a lack of medical care significantly contributed to his death. From that moment on I was destined to be in healthcare, despite my attempts to move away from it. I have worked in palliative (hospice in America) care in the U.S. and now work in the Australian hospital system.

We have an amazing healthcare system. Yes, it is over-budget. Yes, there is over-crowding and never enough beds in our hospitals. Yes, people do (at times) come into emergency departments for things that could just as well be handled at their own doctors. But our system allows for every Australian the chance to have optimal health and to be free of medical issues, or at least have them treated to the best that our medical and nursing care can offer without fear of being unable to pay for such treatment.

I have always said that the Australian healthcare system would not work in America. The current push to repeal ‘Obamacare’ as it is called exemplifies this. Americans feel that they should be self-sufficient. And that is not necessarily a bad thing. Health insurance plans are out there to assist with costs. However, the American attitude of “if you can’t afford it we won’t pay for it” still leads to a class-based healthcare system. If you have money then you have health. As a nurse and believer in healthcare that is not right. Health is part of Maslow’s basic needs, and I feel it should be offered as a right just as security in the form of police and safety with firefighters.

maslow-pyramid

Maslow’s heirachy of needs- image source

Alas I do not feel that America will change their ways. The core beliefs of self-sufficiency go all the way back to revolutionary times. I am proud to say I am an Australian registered nurse. I am proud to say that the healthcare I and the thousands of other dedicated workers allows everyday Australians peace of mind and can allow us to continue to prosper.

 

The Telegraph: Trump is right about Australian health care, an American doctor in Australia says

Is it still NEAT? The four hour rule, does it have a place in ED?

The National Emergency Access Target (NEAT) was implemented in 2011 to assist with combating the perceived increase in Emergency Department (ED) presentations along with increased wait times within those EDs. The NEAT was based on a similar measure in the UK which implemented a strict four hour rule which stipulated that patients within four hours from the time of triage were to either be admitted to a ward or discharge after completion of their treatment. The NEAT provided financial incentives for meeting the goals of presentations admitted or discharged within four hours, with the eventual goal to be a 90% success rate by 2015.

The Council of Australian Governments (COAGs) recognized that the inability of EDs to move patients within a reasonable time was a whole-hospital process. Bed block (the lack of available in-patient beds within the hospital) and delays in assessment and treatment contribute heavily to the increased time spent in ED. The hope was financial ‘carrots’ would encourage the hospital executives to drive efficiency within the entire hospital and lead to better outcomes for all patients wherever they were in the treatment continuum.

Funding for the NEAT program was ended in the 2014-2015 budget by the Abbot government. The goal of 90% of patients being treated and moved out of ED within four hours was not achieved. However, despite the criticism of the intervention there have been some benefits of its implementation. In 2016 Adrian Rollins from the Australian Medical Association indicated that statistics like mortality of patients were improving with the NEAT in place, and that the added funding was allowing for improvements in the hospital system. With NEAT removed that funding had stalled. The Medical Journal of Australia also published a study which stated that patient mortality decreased when NEAT was applied to a certain percentage, however there was a plateau to that relationship. A systematic review undertaken by Queensland Health over the NEAT targets also showed some mixed positive results with initiation of treatment benefited by the four hour rule.

The landscape of EDs has seen a positive change as a result of NEAT. ED short-stay wards have been developed to allow for patients who are not admitted to the ward stay overnight for continuing assessment and treatment while freeing up acute beds. Nurse initiated treatments have become more relevant post- NEAT. Hospital administrators and ward managers along with specialist medical teams have become used to the need for assessment within a set time-frame, leading to overall faster admissions.

Yes, the NEAT target was a very blunt instrument which used a very narrow gauge to serve as an incentive for a change in the way acute healthcare was delivered in Australia. However, as those reporting its history have noted it was a measure which was universal across all acute services and would allow for some rough gauge of efficiency across the hospital system. Is it by any means the best measure, no. But it gave EDs something to strive for, and on the back end it allowed for improvements in the hospital and emergency system which have benefited patients. As the Medical Journal of Australia has commented since the NEAT funding has ceased expenditure within the hospital system has somewhat stalled.

What do you think about NEAT?

References used

Medical Journal of Australia: The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target

Australian Medical Association: Nothing NEAT about putting lives at risk

Deeble Institute Issues Brief: The National Emergency Access Target: aiming for the target but what about the goal?

College of Emergency Nursing Australia: Position Statement, National Emergency Access Target

Privacy concern or valuable tool: all Aussies can have an e-health record, would you?


The ABC network has written that with a new surge in federal funding the My Health Record project looks to provide all Australians with the ability to have an electronic health summary. This is a follow-on from other E-health projects trying to establish similar results. While I can understand the apprehension noted by some with regards to privacy and sharing of health information from a healthcare worker’s perspective it is a great leap forward.



In my history as a registered nurse I remember the days before electronic health records. The nature of our health system in Australia means that an individual can present at numerous public and private health institutions without any ability of those institutions knowing prior medical treatment. This is a safety concern for the patient at worst and could potentially prolong the time for effective treatment in the least.


With the implementation of the local electronic health record if I am looking after a patient who has visited another health facility within the same area, state, or even nationally connected the doctor and I can see previous treatments and tests, allowing for more accurate diagnosis and treatment. Expanding this nationally would allow those visiting or recently moved to the area to have better quality care by allowing information sharing.


It is also better for the GP. Now general practitioners must rely on discharge summaries for information about hospital treatment. However, with the electronic record the GP could access more complete information from hospital visits, aiding in their continuation of care at home. A GP could also review and place information for patients on the record in case they travel or are too sick to speak for themselves, vital information which could save their life.


There is always a potential for abuse of the system. However, I would trust that the powers-at-be would design safeguards to prevent unauthorized information sharing of electronic health records. I, for one, will be happy to welcome this advancement in Australian healthcare. According to the ABC report individuals would be allowed to ‘opt out’ of the program.

ABC news: Everyone to have a digital health record