A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Development of clinical assessment criteria for postgraduate nursing students.

This paper explores the development and implementation of specific criteria to determine the level of clinical performance of postgraduate nursing students during the first year of a Master of Nursing course. The authors describe two commonly used clinical skill assessment tools and identify limitations of these tools for postgraduate nursing students. As a result of these limitations, Clinical Assessment Criteria (CAC) utilising the framework of Benner (1984) was developed. Inherent within the CAC is four levels of clinical nursing performance, which enable the nurse teacher and student to monitor the progression from novice to proficient levels of practice within a specialty area. Following a successful pilot study, the CAC was incorporated into clinical assessments in nine specialty postgraduate courses. Furthermore, the framework developed for the CAC can also be integrated into a variety of professional development domains.

Geriatric nurse practitioners in long-term care: demonstration of effectiveness in managed care.

OBJECTIVE: This study was undertaken to review the impact of utilizing geriatric nurse practitioner/physician (GNP/ MD) teams on cost and utilization for a cohort of Medicare HMO enrollees residing in long-term care facilities. The results would be used by the organization for further development of the GNP Program. DESIGN: A 1-year retrospective data analysis on revenues and cost for 1077 HMO enrollees residing in 45 long term-care facilities. SETTING: Proprietary and not-for-profit, licensed long term care facilities in the HMO's service area of central Massachusetts. Facilities in the study had both skilled (Medicare-certified) and custodial beds. MEASUREMENTS: Data were collected retrospectively on overall cost, revenues, emergency department (ED) transfers, hospital, and subacute days. RESULTS: Of 1077 residents, 414 were cared for by GNP/MD teams compared with 663 by physicians alone. Acute care and ED costs were significantly lower for the GNP/MD-covered patients. There was a gain of $72 per resident per month (PRPM) with the GNP/MD-covered patients compared with a loss of $197 PRPM for physicians alone. There were no significant differences in ancillary services or prescriptions. CONCLUSION: The use of GNPs in collaboration with physicians reduced ED and acute care utilization costs as well as overall costs for a cohort of HMO enrollees in long-term care. This encouraged the HMO to support the concept that all long-term care HMO residents should be covered by GNP/MD teams.

Demonstration of the cost-effectiveness of a nurse practitioner/physician team in long-term care facilities.

To an HMO with a Medicare risk contract, providing high-quality medical care to a nursing home resident may generate considerable costs. To address this issue, Fallon initially assigned each primary care physician to just one nursing home. The program was successful in that coverage of all Fallon patients admitted to nursing homes was assured. In a pilot project 5 years ago, a geriatric nurse practitioner (GNP) was hired to provide primary and episodic visits to nursing home residents in three area nursing homes. Research was conducted to determine the effectiveness of a GNP-MD team. Based on positive outcomes, additional GNPs were recruited. In the current follow-up study, a review of the 1992 fiscal and utilization data for nursing home patients revealed significantly lower rates of emergency room transfers, hospital lengths of stay and specialty visits for patients covered by GNP-MD teams, as compared to patients covered by physician only. Nursing home drug costs, skilled nursing days and primary care visits were higher for patients covered by the teams, but the differences were not statistically significant. Overall costs were 42% lower for the aggregate pool (skilled nursing plus intermediate care) and 26% lower for those with long-term stays.

A geriatric nurse practitioner/physician team in a long-term care setting.

A large Massachusetts group practice and affiliated HMO studied the effects of a geriatric nurse practitioner/physician team on quality and cost of health care delivery in a long-term care setting. A geriatric nurse practitioner (GNP) was recruited to work with one physician in three nursing homes. The GNP/MD team made joint routine visits; the GNP provided primary care, including episodic visits as needed. After one year, a retrospective chart review was conducted comparing the periods before and after the implementation of the GNP/MD team. There was a 26% reduction in hospital admissions, and a decrease in the total number of hospital days after the GNP/MD team was implemented. Patients, nursing staff, and physicians all expressed satisfaction with the program. This study suggests that significant cost savings and increased quality of care can result from the implementation of a GNP/MD team in a long-term care facility.