Time for a new way of thinking

With four in five Australians having at least one chronic disease, such as diabetes or kidney disease, and an increasingly ageing population, Australia’s traditional approach to health care needs to change.

Recognising the limitations of our current system, there has been an increased emphasis from governments on primary and community care. The Health Care Home model, for example, which the government is currently piloting, aims to keep people with multiple chronic diseases out of the hospital system by better coordinating their care in the community.

These shifts underline the increasing need for, and value of, primary health care nurses. But as we know, Australia faces a projected shortfall of about 27,000 primary care nurses by 2025. For many, primary care nursing isn’t seen as a career of choice. From talking to nurses like you, we know there are several barriers to people viewing primary care nursing as a viable career choice—and that there is need to increase the optimisation and perceived value of primary health care nursing—things that we are working hard to change.

From an educational perspective, many academic courses have traditionally focused on preparing nurses for a career in hospitals, with limited opportunities for undergraduate nurses to experience primary health care. From a career development perspective, while the hospital setting offers obvious career progression opportunities, many primary health care nurses are finding it hard to navigate and advance their career in a primary care setting. This lack of career structure can be a significant impediment to the development of primary health care roles in general practice and community nursing settings. 

This state of affairs has made it hard for general practices to recruit and retain nurses—and this is where APNA’s Career and Education Framework comes in. 

Better retention and recruitment means more career options 

While there isn’t a silver bullet to address the challenges that come with a nursing career in a primary health care setting, experts are recognising that the development of career pathways for practice nurses is part of the development of new ways of delivering care.

The development of a career and education framework has been on the policy agenda for several years. In 2015, the Career and Education Framework was developed under APNA’s Nursing in Primary Health Care Program (NiPHC), which was funded by the Department of Health to support the current and future nursing workforce in primary health care, by addressing recruitment and retention issues in the nursing profession.

APNA was engaged to develop the framework, with the project commencing in early 2016, involving extensive engagement across many consultation phases, to ensure the framework would provide the right answers and be a true reflection of primary health care challenges.

We applied an evidence-based consultation methodology, which involved a range of face-to-face and online workshops, focus groups, key stakeholder interviews, publications and conference presentations, which resulted in the successful initial engagement with over 700 nurses and other health professionals.

A vast amount of data was collected, collated and analysed by the APNA project team, forming the evidence base for the project and underpinning the development phase. The key themes that emerged from the consultation phase centred on the important role of the Career and Education Framework as a workforce initiative to improve the perceived value and professionalism of primary health care nursing roles.

This research helped us ground the framework’s purpose: to re-engineer primary health care as a first choice for nurses considering their next career step, by improving the perceived value of these roles while promoting and highlighting the rewarding employment opportunities and dynamic career progression options available in the field.

Consultation continued in the first six months of 2017, further growing the community of nurses and health professionals engaged in the project. This second phase of consultation involved a human-centred design approach, where primary health care nurses led the design, structure and functionality of the framework.

A prototype was developed and refined through nearly 40 one-on-one prototype testing interviews, which gained insights into how the nursing workforce seeks and retrieves career information. This process was designed to ensure that the final product would be accessible, readable and relatable to those it is designed for.

In total, more than 1,000 frontline nurses, representatives from peak nursing and health organisations, and academics and researchers from the nursing and public health fields were involved in this development phase and we are extremely grateful for the support and excitement shown for the project. It has been crucial in conducting such a comprehensive and extensive consultation process to inform the framework. We’d like to express our sincere gratitude to those who took part in our consultation. Thank you for giving us your time and expertise and sometimes even flying across the country to participate in the consultation process. We simply could not have done it without you.

APNA’s frameworks and My Nursing Future

The Career and Education Framework was designed to be a practical and useful tool. To give nurses a framework that was easy-to-use and that fitted their lifestyle, we developed an online tool that can be accessed from any device, anywhere, whether computer or laptop, tablet or mobile.

As a result of all this work, at the end of 2017, we launched My Nursing Future (mynursingfuture.com.au), a website with a series of easy-to-use tools to help people—whether they currently work in primary health care or not—better understand primary health care and guide them on their career development path.

The site contains three sections.

Firstly, a career quiz aimed at tertiary nurses, nursing students, newly graduated registered and enrolled nurses and other professionals allows them to be matched with primary health career options that best suits their preferences. Fifteen questions help determine an individual’s personal and professional attributes such as the importance of work/life balance, willingness to travel and work from a variety of environments and physical stress. As a result, the quiz matches the user with the primary health care sectors that are best suited, such as mental health, school health or refugee health for example.

Secondly, the self-assessment tool allows registered nurses assess their level of practice across five domains specific to primary health care nursing—clinical care, education, research, optimising health systems and leadership—to articulate where their strengths lie. Taking approximately an hour to complete, the process takes an in-depth look at your career to assess your level of practice in each domain. A separate version of the tool is available for enrolled nurses, which assesses your level of practice across three domains: provision of care; reflective and analytical practice; and professional and collaborative practice.

At the end of the self-assessment, the tool produces a tailored report along with a record for your continuing professional development, which can be saved in the system for future reference. The report recaps your level of practice in each domain and recommends actions to take to grow to the next stage, identifying the additional skills, knowledge and education needed to further your career in primary health care—such as activities or online modules you can take to further your practice.

In addition to supporting nurses to understand how their existing skills, knowledge and qualifications can contribute to primary health care nursing roles, the self-assessment tool is a great exercise for practice managers to complete with nurses as part of performance reviews, and will become a key tool for career planning, as well as, campaigning for further training in a particular area.

Finally the website also provides career advice, articles and tips around nursing employment including CV drafting, building skills, and finding a mentor in a primary health care setting.

My Nursing Future is a great tool to help current and future nurses understand the potential roles and opportunities in primary health care and articulate the range of skills that can be used across the various primary health care sectors.

More broadly, the framework on which My Nursing Future is based is now a great national reference point against which managers and employers can benchmark their nursing staff and assess their level of expertise in primary health care nursing.


My Nursing Future doesn’t only help you. It will also help APNA to better understand challenges faced by the workforce as a whole, better plan resources and professional development activities, and better advocate on your behalf.

My Nursing Future and the associated frameworks demonstrate the professionalism and value of nursing in primary health care, including the impact of nurses on improving the health and wellbeing of individuals and the community.

With chronic disease management needs on the rise and an ageing population, we need a new approach to delivering care. The government is acknowledging that the answer to these healthcare challenges is not ‘more hospital beds, more doctors’. It is clear that primary health care nursing is more important now than ever. The delivery of strong integrated primary health care contributes to improved population health outcomes, increased efficiencies and reduced rates of hospitalisations. It’s time the profession stops seeing primary health care nursing as the poor cousins to other nursing careers.

Do you want to progress your nursing career but aren’t sure where your strengths lie? Take our self-assessment to understand your value and plan your CPD. Visit MyNursingFuture.com.au

Source: Primary Times Winter 2018 (Volume 18, Issue 2)

The Australian Primary Health Care Association acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respects to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

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