Australian General Practice Nurses Study

Project Update

2008-07-23T15:10:00.003+10:00

The AGPNs was originally scheduled to wind up at the end of July 2008. Due to the complexity of our analysis and some unforeseen issues which have arisen for team members, we have negotiated an extension of the project timeframe. The AGPNS is now due for completion at the end of December 2008.
Meanwhile work progresses and we are currently analysing findings from Phases 1 and 2 prior to developing our final report.
The team presented a poster at the recent General Practice and Primary Health Care Research Conference in Hobart. Click here to view the poster and abstract.

Phase 2 summary and Bulletin #4

2008-05-21T13:50:00.003+10:00

These two documents outlining the second phase of the study, and summarising progress, are now available. Click here to view them. If you have difficulty accessing them please email the project team on agpns@anu.edu.au

Phase 1 findings and Bulletin #3

2007-06-19T15:29:00.001+10:00

A preliminary summary of findings from Phase 1 of the project has been released, and the third AGPNS bulletin is also now available.
Both can be viewed here as pdf files. Please contact the project team if you have any trouble accessing these documents.

Bulletin #3

2007-06-19T15:24:00.001+10:00

The third project bulletin is now available. It can be viewed here, as a pdf. Please contact the project team if you have any difficulties accessing this link.

Phase 2 Sites Underway

2006-12-11T12:18:00.000+11:00

Seven practices around Australia have been recruited to participate in Phase 2 of the study. These practices are located in New South Wales,Queensland,South Australia, Victoria & Western Australia. Individual change projects, using an action research approach, are now underway and will continue until late 2007.

Preliminary findings of Phase 1 of the AGPNS have been used to inform the development of Phase 2. These results are currently being formulated for dissemination and will be available early in 2007.

Phase 2 Begins

2006-09-28T11:41:00.000+10:00

Phase 2 of the AGPNS is about to begin.
This phase of the study offers support to practices wishing to improve the way their Practice Nurses are used and thereby the quality of service they offer to their patients. The aim is to develop a series of case studies exploring the introduction of sustainable change in the role or activities of the practice nurse over a year, in one of seven focus areas. This builds on the first phase, which mapped the activities and roles of nurses in 25 general practices.
The specific objectives of this part of the project are to:
• institute specific small, scale change management projects in seven general practices in different settings addressing the activities and roles of the practice nurse;
• assess the effectiveness of each change project in meeting the specific aims articulated by that practice team; and
• evaluate the role of the practice nurse in the change management process.

The process differs somewhat from other change projects, in that practices will be involved in designing the change management process.

We are currently recruiting practices through the Divisions network, with expressions of interest due to close on Wed 4th October.

For more information on Phase 2, please contact the project team on agpns@anu.edu.au

Second Bulletin

2006-04-10T09:28:00.001+10:00

The second bulletin has just been released. If you missed it, then you can view the bulletin HERE, as a pdf. if you have any trouble, contact the project team.

Observing Nurse Activity - Tell us what you think

2006-04-03T13:54:00.000+10:00

In Phase One the AGPNS team used a Rapid Appraisal Tool (RAT) to gather information during practice visits. One element of the RAT was structured observation of an hour of nurse activity, at two different points in the day. We now have records of fifty hours of nursing time in general practice. Our data show that:
 Practice nurses cycle through many tasks in an hour, often returning to the same task several times.
Is this the most effective way for Practice Nurses to work?
 Nurses are extremely responsive to the request of others in the practice. Having a space dedicated to practice nurse clinical activities may reduce the number of interruptions a nurse experiences in an hour.
What are the pros and cons of having a dedicated clinical nurse space?
 Practice nurses range over the entire general practice throughout their day.
What does this say about the nature of a nurse’s role in a general practice?

Practice Nurses and their role in Quality & Safety

2006-04-03T13:48:00.000+10:00

The excerpt below is a paraphrase from an interview with a practice nurse.

“We had this girl come in. She just appeared in the surgery in tears and I took her into the treatment room. Anyway she was suicidal and at that stage we didn’t have our other practice nurse as well, but you just have to prioritise. She needed me until I could get a doctor to her. So I just put everything into looking after her and that’s where the team works so well, because the girls out the front just said “We’ve got a medical emergency. The nurse will ring you back.” They just kept taking phone numbers and saying, “She’ll ring you back,” because I couldn’t be disturbed. This girl had come in and she was in a crisis. So anyway in the end I got the doctor to take over and that was it. As it turned out then I had to, sort of, do a lot of following up and ringing for them while they were with her.”

We are interested in what other practice nurses think about this situation. In particular:
 How did the nurse's actions contribute to quality and safety?
 What is the nurse's role in the team?
 What role does the doctor play? Is it appropriate?
 What does this say about access to services?

BULLETIN

2005-12-12T16:40:00.001+11:00

The project team recently distributed it's first information bulletin. If you missed it, and want an update - then you can view the bulletin HERE, or alternatively download a pdf copy from HERE.

Nurse Workspace

2005-11-24T14:39:00.000+11:00

An early focus of our analysis is to look at the workspaces of nurses. Practice nurses often seem to work in shared spaces and in a public way. The common setting is that the nurse is “stationed” in the treatment room, a room that has multiple functions and is used by multiple people. In part this stems from the early model where the nurses’ role was almost exclusively to assist the doctor. Having occupied this space, nurses are now adapting it to expanded roles.
While spaces allotted to nurses suggest that they are placed in public rather than enclosed places (e.g. thoroughfares and treatment rooms), their micro-workspace (e.g. the desk and shelving) indicate highly specific, non-public activities, with a cluttering of medical equipment, papers and computer. Reception desks, for example, are not piled high with this kind of work-related business. Receptionists' work occurs in public, while the ways in which nurses working spaces are constructed suggest that nurses occupy an intermediate space, not quite public (receptionist space), not quite private (doctors' space). They occupy a transitional space that seems to be an expression of their role in the practice. We value your comments on this.

How many nurses should we observe and interview?

2005-11-09T11:52:00.000+11:00

Some interested parties have questioned the number of nurses we will be interviewing and observing in each practice. For instance, nurses in a multi-nurse practice may feel “jilted” if one or more of their colleagues are observed and interviewed and they are not. The research team considered the options of observing more than two nurses at any one practice, and of observing two nurses while interviewing a different two. Ultimately we decided that we will conduct only two observations and two interviews with the same nurses in each practice, as originally planned. There are many reasons for this:
1) We wish to gain an overview of what practice nurses do, and by visiting 24 practices and observing up to 48 nurses, we believe this will be achieved. We do not need to know what every nurse in every practice is doing.
2) Our pilot and completed practice visits indicate that the roles of other nurses in the practice are often mentioned in the interviews.
3) We do not have the budget to complete anymore observations and interviews than those scheduled.
4) We wish to minimize the time we spend in any one practice.
5) Rapport develops between the researcher and the nurse during the observation period. Interviewing nurses other than those observed would require that rapport establishing process to repeated.

Project Team Complete

2005-10-27T10:07:00.000+10:00

We now have our full staff complement on board at the AGPNS. Monika Thompson has joined the team this week as the Administrative Support Officer. Monika brings a range of experience in health administration support and some international expertise, having worked in general practice in Switzerland. Monika is a welcome addition to the team and can be contacted at the Academic Unit of General Practice & Community Health at the ANU on 02 6252 4511.

Participating Practices Finalised

2005-10-24T13:57:00.000+10:00

The 24 practices who will participate in Phase 1 of the project have now been finalised. Eight of these are in NSW, and the remaining 16 in Victoria.
Many thanks to all those practices who expressed an interest in participating. The project attracted lots of interest and was oversubscribed with practices wanting to be involved - unfortunately we were unable to include everybody - but the level of enthusiasm is really encouraging.
A big thank you also to those Divisions who assisted so willingly with the recruitment process.
The group of study practices includes a mix of rural, urban, remote, large and small, with a wide range of nursing models. Rapid appraisal visits to these practices have already commenced and will continue over the next couple of months.

Making comments

2005-09-29T10:50:00.000+10:00

We welcome questions, comments and feedack from interested nurses, doctors and other members of the primary health care team, or from anyone who is interested in the progress of the study.
To make sure the comments posted here are relevant we've added a simple word verification step. This means you'll be asked to enter a randomly generated password when you want to make a comment, and rules out automatically generated spam.

Conference Presentation

2005-09-26T16:16:00.000+10:00

Julie Porritt and Chris Pearce from ADGP recently presented an outline of the project to the RCNA practice nurse conference. A copy of the presentation can be found here on the ADGP website. We welcome any comments or questions.

Second Research Assistant

2005-09-23T10:26:00.000+10:00

Dan Sybaczynskyj has also joined the project, and is our second Research Assistant. He will be based in Canberra, and visiting the NSW nominated sites for the project. This is Dan’s first go at hands-on-grass-roots research. He is currently employed with the South East NSW PHCRED Program as Admin Officer and also provides admin support for the Academic Unit of General Practice and Community Health at ANU. His background is with the HIV/AIDS sector in the ACT and Queensland. Dan can be contacted on 02 6252 4501.

Research Manager

2005-09-12T16:06:00.000+10:00

AGPNS is pleased to welcome Ms Sally Hall to the team. Sally is the Research Manager, and will be with us for the life of the project. Sally has worked as a practice nurse, and more recently in a managererial position in a division. She will be looking after the day-to-day running of the project and will be the first point of contact for AGPNS.

Sally can be contacted on 02 6252 4507, at the Academic Department of General Practice & Community Health at the Australian National University

Practice Recruitment

2005-08-26T10:55:00.000+10:00

We are now well onthe way to developing alist of practices. We are being assisted by 14 divisions of general practice across Victoria and NSW, and with each division supplyng about 3 practices, we will have sufficient to choose our 24 practices. The variety is exciting, with a good mix of practice sizes, and models. We have solo GPS with full-time nurses, larger practices using nurses in traditional and enhanced roles, and some really innovative ideas.

The team will be meeting in Canberra on the 2nd/3rd of September to refine the observation tool and finalise the practice list.

Article in the Australian

2005-07-16T20:19:00.000+10:00

Dr Pearce was recently interviewed for an article on the increasing numbers and utilisation of nurses in general practice .

you can access the link here - Australian News Nurse Story

Division recruitment commenced

2005-07-15T17:29:00.000+10:00

the important first step in the project is to identify divisions willing to assist in recruitment. All divisions in Victoria and New South Wales have been sent letters of invitation, with several already expressing interest. For more information contact the project team, or your local division.

First Reference Group Meeting

2005-06-28T16:41:00.000+10:00

The first meeting of the reference group has been set for the 25th of
August, at 8.00pm EST.

Research assistant

2005-06-28T10:19:00.000+10:00

We are pleased to announce that the first staff member of the project has been appointed. Hannah Walker will take on the post of research assistant, based at Melbourne University. Hannah has a Sociology degree, and has worked on a number of projects, most recently with asbestos victims in the latrobe valley, and has worked with divisions and GPs on a project examining how doctors, patients and computers interact in the consultation. Hannah will be involved in the observation visits to practices in Victoria.

Update

2005-06-24T08:37:00.000+10:00

Although not officially started yet, activity on the AGPNS is proceeding apace. Protocols for recruitment of practices and divisions have been developed, and a research assistant has been appointed in Melbourne. We are looking for the full time research manager, and a research assistant based in Canberra. The position description for the Research manager position can be found at :
Research manager - Australian Capital Territory

Most of the reference group have been recruited, and we will be writing to divisions shortly to commence recruitment.

We hope in the fullness of time to use this blog as a way of allowing you to comment on the activities of the project, so keep the website bookmarked.

Welcome

2005-06-10T10:59:00.000+10:00

Welcome to the blog of the Australian general Practice Nurses Study. you will find a link to the website on this page, with details about the project. The purpose of this blog is to provide regular updates on the progress of the projecct, and iinvite feedback on specific issues. We look forward to receiving any comments.