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The founding of APNA
By the Primary Times Editorial Team
Source: APNA Primary Times Winter 2022 (Volume 22, Issue 1)
Since its grassroots beginnings in 2001, APNA has focused on providing a voice and a support network for nurses in primary health care (PHC), and on recognising their needs and achievements. To celebrate our 21st birthday, we look back at the changing face of PHC in Australia and we look forward to a bright future for all PHC nurses.
The Founding of APNA
In Australia, nurses have played an integral role in the general practice setting for more than 50 years; however, prior to the 1990s, practice nurses received little recognition and their scope of practice was limited.
‘The nurses were often the wives of the GPs,’ says former head nurse for GPNSW, Liz Meadley. ‘They would carry out administrative duties and some basic health-care procedures, like wound care, but they didn’t have much autonomy.’
During the 1990s, a shortage of GPs was starting to strain the health-care system. In 1998, the Australian Government Department of Health and Ageing implemented the Practice Incentives Program to increase vaccination rates and to encourage continuous improvements in PHC. Policymakers and health-care professionals realised that nurses could play a crucial role in general practice settings to relieve some of the pressure, especially when it came to providing immunisation.
At the time, the transition to general practice from the hospital system was quite difficult for many nurses as their education had not included training for PHC nursing.
‘I went into general practice in around the year 2000,’ former APNA President Julianne Badenoch recalls. ‘It was very different to working in hospitals. I was using every skill that I had, and it felt like everything I did was scrutinised by the doctors. There wasn’t much support.’
Some nurses experienced a kind of culture shock in moving from the public health system into a small-business environment: ‘I didn’t like the focus on making money,’ Julianne says. ‘I had to change the way I thought about it. With time, I realised that if we wanted to expand our service to provide quality care, we needed to run a successful business.’
The general practice environment could also be quite isolating compared to working as part of a large team in a busy hospital. APNA founder, Sam Moses, recalls her transition from the hospital system to general practice in the early 1990s: ‘I was loving my work in general practice. I worked with supportive doctors who pushed me to expand my scope of practice. However, I was the only nurse in the practice, and I wanted to know how other nurses worked. I wanted to know if other nurses received that kind of support. I felt like we needed to educate more doctors about the potential of nurses working in the general practice setting.’
In 2000, Sam attended a nurses’ information day hosted by the Royal College of Nursing, Australia (RCNA) in Melbourne. ‘I asked whether there was a membership organisation I could join as a practice nurse and was told that the RCNA would support that kind of initiative,’ she says. ‘I was excited to receive this encouragement and started working on plans to create a network specifically for nurses working in general practice. I felt strongly that the association should be run by practice nurses for practice nurses: nurses who worked with patients in the primary care setting and recognised the needs of PHC workers. I wrote to the Department of Health towards the end of 2000 to introduce myself and the Australian Practice Nurses Association (APNA).’
Sam received support from the Royal Australian College of General Practitioners (RACGP): ‘It was through them that I sent an email to invite nurses to the first APNA meeting.’ There was a lot of work to do and a lot to learn, including writing applications for government funding and speaking at meetings and conferences to spread the word about APNA.
‘I remember the day in August 2001 when I submitted the paperwork at Consumer Affairs Victoria to have APNA officially incorporated,’ Sam says. ‘We had invested a huge amount of time and effort to get to this point and I will never forget the feeling of achievement – it was a very special moment for me.’
APNA takes off
APNA quite quickly attracted more than 200 members. ‘When I heard about APNA, I thought, “This is exactly what I need!”,’ Julianne says. ‘It gave me hope that I’d find professional support. At the time, the Commonwealth Government wanted to change the health system through primary health care. People were realising that PHC nurses could drive that change and we nurses could see that there was more we could do. APNA became our voice. APNA drove that recognition of PHC nurses as a skilled workforce that could be utilised to achieve positive health outcomes.’
Right from the beginning, APNA provided a phone support service where nurses could ask questions or share their concerns. APNA’s first website was launched in 2002 and this would later become a platform for members’ online education and professional development. In 2004, a series of workshops were initiated around the country on clinical topics, such as wound care and immunisation, and these events offered nurses the opportunity to form meaningful connections with other nurses in their area. In late 2006, APNA was able to offer its members access to a professional indemnity insurance product specifically tailored to nurses working in general practice.
The first of APNA’s national conferences was held in Melbourne in 2009. According to APNA Patron Rosemary Bryant, this is when APNA really began to pick up momentum as a national organisation. ‘The conferences brought everyone together,’ Rosemary says. ‘APNA would invite government ministers and other high-profile people and they would really showcase what practice nurses could do. This is how APNA attracted people from outside of the organisation who could help them achieve their goals.’
As APNA grew, nurses across multiple sectors of PHC began to show interest. They too wanted representation and a sense of professional belonging. At a special general meeting in November 2009, members voted to expand APNA’s membership base to include nurses working in the broader PHC sector, not just those working in general practice.
‘I was very proud of this,’ says Julianne, who was APNA president at the time. ‘We opened APNA membership to all nurses working in PHC and gave them a professional voice. Suddenly nurses working in community health and aged care, who may have been struggling to shine, now had APNA advocating for them.’
APNA lobbied for PHC nurses to have a broader scope of practice and in 2010 the federal government announced a restructured budget that included the Practice Nurse Incentive Program. This program intended to increase the number of general practices that employed nurses. It also aimed to give practice nurses more responsibility for comprehensive patient care, rather than the limited range of tasks that had previously been funded by item numbers on the Medicare Benefits Schedule. While this was the intent of the program, more work still needs to be done in this space.
APNA continued to evolve and by 2014 membership had grown to more than 4000. With this growth, APNA was able to offer members an expanded range of benefits and opportunities. The first 2 APNA nursing networks were set up in 2014. These face-to-face peer-led local networks aimed to connect nurses to reduce professional isolation, generate discussion, engage nurses, share information and provide leadership opportunities. By 2017, there were 35 nurse networks across the country.
In 2015, APNA’s ‘Salary and Conditions Survey’ (which had been run annually since 2004) received a makeover and was re-named the ‘APNA Workforce Survey.’ The new survey was designed to improve the continuity of data collection so that the work done by PHC nurses and the challenges that they face could be given maximum visibility. The survey collates data that are not captured by any other national data sets and is used to support APNA’s advocacy and to assist with data-driven policy solutions.
During 2015-2017, a series of APNA’s flagship programs were rolled out, including the Career and Education Framework, the Transition to Practice Pilot Program and the Enhanced Nurse Clinics Program.
APNA’s representation and advocacy work also expanded steadily each year, including consultations and collaboration with other professional health-care associations, liaising with federal and state governments and participation in various committees and working parties. In 2020, APNA submitted its first pre-budget submission to Treasury. The submission was titled ‘A Strong Nurse Workforce for a Healthy Australia, 2020-2021' and provided details on several key solutions for a stronger and more robust PHC nursing workforce.
The World Health Organisation declared 2020 as the International Year of the Nurse and Midwife, and the APNA team had ambitious plans to celebrate with a year-long calendar of special events for APNA members. By April, though, most of those plans had been scrapped as the team pivoted in response to the COVID-19 pandemic. In a time of unprecedented adversity, the APNA team rose to the challenge, keeping nurses up to date with the latest COVID information, providing support through the nurse support line and moving APNA programs to an online format. APNA’s COVID-19 ‘PulseCheck’ Surveys helped inform the government about job losses for PHC nurses and the impact of lockdowns on the workforce.
APNA’s Nursing Australia podcast was launched in XXXX 2020. This news and education podcast was exclusively directed to PHC nurses and was promptly awarded best nursing podcast in the country.
While the APNA conferences had to be put on hold during 2020 and 2021 due to lockdowns and travel bans, they’ve been re-configured in 2022 as a travelling Conference Roadshow that visits APNA members in every state and territory. This is another example of APNA’s progressive approach and its determination to support its members in innovative ways.
Despite the challenges of the pandemic, APNA has continued to grow, with increasing membership numbers each year. Current APNA President Karen Booth reflects on this growth: ‘Membership growth has been strong, even through the difficulties of the COVID-19 pandemic. This shows that nurses recognise the strength of a united voice and that they’re demanding recognition for the contribution they make to the primary health care space. We are also seeing a growing number of corporate memberships as large employer groups recognise the value of professional support and the education that APNA offers nurses.’
APNA comes of age
The development of PHC over the last 21 years has benefitted Australia’s health-care system by taking responsibility for preventative health and chronic disease management, which relieves pressure on the tertiary system. Governments and other medical organisations are recognising that the PHC nursing workforce is willing to do more and that it makes sense to maximise nurses’ skills. APNA has played a key role in this change and the organisation is now seen as a leader in the sector and one that can continue to advance the profession of PHC nursing.
‘APNA has seen a dynamic shift in how PHC nursing is viewed by policymakers,’ says Karen. ‘We have provided representation on all the major PHC reform committees for more than a decade. We are now seen as the go-to organisation for all things PHC nursing.’
In 2022, APNA was commissioned by the Department of Health to develop and present on an issues paper to inform the PHC nurse and midwife consultation for the federal government’s Primary Health Care 10-year Plan. Also in 2022, School Nurses Australia merged with APNA, demonstrating APNA’s reputation as a leader from the perspective of other nursing organisations, and giving greater strength to the collective PHC nursing voice.
The future looks bright for PHC nurses
PHC nursing will continue to evolve as the population’s health-care needs grow and today’s PHC nurses have multiple career paths available to them. The role of the nurse practitioner has expanded in recent years, and this is great career path for PHC nurses.
‘I’d like to see the funding structure changed to give registered nurses more autonomy,’ says Julianne. ‘As long as they are appropriately skilled and endorsed, they could be given much more responsibility.’
‘With perseverance and some lateral thinking, the hierarchical structure of the PHC system will change and we’ll be left with a level playing field,’ says Sam. ‘I already know of a few general practices that are owned by nurses, and the general practitioners are their employees. This is a significant shift and something we’d like to see more of.’
APNA is working hard to ensure that nursing education has a greater emphasis on PHC nursing, including consistent PHC nursing curriculum in nursing courses and funded placements in PHC for undergraduate and postgraduate nursing students. It’s important that student nurses understand the potential of PHC nursing as a career path and APNA will continue to advocate for this.
‘The role of the nurse within primary health care has grown so much!’ exclaims Liz. ‘Today’s nurses are so multiskilled and knowledgeable, and they understandably want recognition for this. Nurses are the pivot that makes primary health care work.’
Primary Times would like to thank Julianne Badenoch, Karen Booth, Rosemary Bryant, Liz Meadley and Sam Moses for sharing their memories and perspectives on APNA’s history.
Happy 21st birthday APNA!
Help us celebrate our 21st birthday! You’re invited to the biggest nursing conference in 2022, the APNA Conference Roadshow! Join other nurses at one of our in-person events across the country. We're bringing an APNA Conference to every state and territory. For details and to register, visit www.APNA.asn.au/education/roadshow.