Understanding the general practice nursing workforce in New Zealand: an overview of characteristics 2015-19.

Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.

Approaches to Improving Adherence to Secondary Prophylaxis for Rheumatic Fever and Rheumatic Heart Disease: A Literature Review with a Global Perspective.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions resulting from infection with group A streptococcus. Current management of these conditions includes secondary antibiotic prevention. This comprises regular 3 to 4 weekly long-acting intramuscular benzathine penicillin injections. Secondary antibiotic prevention aims to protect individuals against reinfection with group A streptococcus, thereby preventing recurrent ARF and the risk of further damage to the heart valves. However, utilization of benzathine penicillin can be poor leaving patients at risk of avoidable and progressive heart damage. This review utilizes the Chronic Care Model as a framework to discuss initiatives to enhance the delivery of secondary antibiotic prophylaxis for ARF and RHD. Results from the search strategy utilized revealed that there is limited pertinent published evidence. The evidence that is available suggests that register/recall systems, dedicated health teams for delivery of secondary antibiotic prophylaxis, education about ARF and RHD, linkages with the community (particularly between health services and schools), and strong staff-patient relationships may be important. However, it is difficult to generalize findings from individual studies to other settings and high quality studies are lacking. Although secondary antibiotic prophylaxis is an effective treatment for those with ARF or RHD, the difficulties in implementing effective programs that reduce the burden of ARF and RHD demonstrates the importance of ongoing work in developing and evaluating research translation initiatives.

Sustaining and growing the rural nursing and midwifery workforce: understanding the issues and isolating directions for the future.

Nurses and midwives represent the largest group of health professionals in the Australian health care system. In rural environments nurses and midwives make up a greater proportion of the health workforce than in urban settings, which makes their role in service provision even more significant. The role and scope of these nurses and midwives' practice is by necessity more generalist than specialist, which results in disciplinary strengths and weaknesses. As generalist health professionals they work in diverse settings such as public hospitals, multi-purpose services, community health, aged care and in non-government and private for profit and no-profit organisations including general practices. Their scope of practice covers prevention, intervention and rehabilitation and is lifespan inclusive. Rural nurses and midwives are older than their metropolitan based counterparts, work part-time and traditionally have limited access to professional development often due to ineffective locum relief programs. Workplace inflexibility, access to acceptable housing and partner employment are factors cited as inhibitors to growing this workforces. The future of the rural nursing and midwifery workforce will only be secured if Government invests to a greater degree in both education and training and the development of a nationally agreed remuneration scale that allows for part-time work.

Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature.

In Australia, mentoring is beginning to emerge on the rural and remote nursing landscape as a strategy to improve the recruitment and retention of nurses. However, the terminology used to discuss this and other supportive relationships in nursing is often unclear and can be confusing. The main aim of this article is to locate mentoring, clinical supervision and preceptoring in the nursing literature, and thus provide a guide for Australian rural nurse clinicians, managers and policy-makers in general. It is through better understanding of the possibilities of each type of relationship that they can be factored into the development of supportive work settings, and that will encourage the retention of existing staff and possibly the recruitment of new staff. Each type of supportive relationship discussed in the literature has a different focus. Mentoring is broadly based and concentrates on developing areas such as career progression, scholarly achievements and personal development. Clinical supervision focuses on progressing clinical practice through reflection and the provision of professional guidance and support. Preceptorship focuses on clinical skill acquisition and socialisation. Each support relationship also differs in context and intensity. Mentoring relationships are based around developing reciprocity and accountability between each partner. They are normally conducted outside the work environment and in the participants' own time. Clinical supervisory relationships are similar to mentoring in that they are reliant on developing a strong sense of reciprocity and accountability, and take place over a long period of time. They differ, though, in that they are conducted during working hours, although preferably away from the work setting. They are also commonly facilitated through the use of small groups. Preceptoring relationships are short term, exist in the clinical context and concentrate on clinical skill acquisition and assessment.