In Conversation with Australian College of Nursing CEO, Dr Kathryn Zeitz

As she approaches one year in the role, Hospital + Healthcare speaks with Australian College of Nursing CEO Dr Kathryn Zeitz to learn where we’re at — and where we need to go — with nurses’ scope of practice.

Dr Kathryn Zeitz FACN is about to mark her first anniversary as CEO of the Australian College of Nursing, and if she could summarise her year in one word, it might be ‘eventful’.

With ambitions to increase the scope of nursing and midwifery practice, Zeitz — who is also an Adjunct Professor — has been tirelessly advocating for reform.

And while funding and regulatory models are still holding these sectors back, there is growing recognition that nurses and midwives are currently underutilised.

“Nurses make up more than half the healthcare workforce and have enormous untapped potential,” she said. “We are competent at supporting preventative care and the management of complex comorbidities.

“We’re also the most geographically distributed. You’ll find us in the most remote communities, where you won’t find other health service providers.

“So, nurses are a critical part of Australia’s healthcare solution.”

Relieving the burden

Zeitz says advanced nurses can deliver preventative and post-diagnostic care “readily and cost-effectively”, complementing GPs, specialists and other members of a multidisciplinary care team. She says this is an asset to an under-resourced system.

“I come from a world of hospital ramping and I don’t think there’s any jurisdiction that isn’t being touched by this. Almost everywhere you look it’s often a six week wait to see your GP; a month to access allied health.

“We have this tsunami of chronic disease coming and the cost of delivering care in acute settings is not sustainable. We’re on track to have a 70,000 shortfall in nurses by 2035.

“We need to do something different,” she said.

Reconceptualising nursing

For Zeitz, something different means a rethink in how nurses are conceptualised and a shift in policy to reflect that.

She believes discrepancies in local regulation are restricting growth in the nursing profession.

“Say I’m a remote area nurse working in Outback Australia. There is a whole lot of work that I can do. I can put in intravenous lines; I can do full comprehensive assessments; I can provide complex wound care.

“But if I were to move interstate and work in a major metropolitan setting, I might not be allowed to do that. There is a lack of consistency between jurisdictions and care settings on the type of work nurses can do.”

Overshadowing this is what Zeitz calls an outdated funding model that “severely limits nurses’ scope of practice”.

In the current system, acute hospitals receive activity-based funding from their state, while most primary care services are funded mainly by the Commonwealth’s Medicare Benefits Schedule (MBS).

“The majority of that primary care funding is going to GPs or the medical practice and there are very few opportunities for nurses who work in the primary setting to establish independent services and relieve the pressure on the system,” Zeitz said.

Lack of incentive

Kylie is a registered nurse, who works in a GP clinic — and is a case in point.

She is a credential diabetes educator and is undertaking study to become a nurse practitioner. She manages complex chronic conditions, provides wound care and supports preventative health. She is often delivering 30-minute consultations for individual patients.

Despite her expertise, Medicare pays just $14.00 for one of the few MBS items a registered nurse can access — chronic disease support.

“It doesn’t matter how long Kylie spends on those services, $14.00 will be the limit,” Zeitz said.

“For wound care, the doctor just needs to pop in, say hello to the patient and check how they are going for that encounter to be billable through the practice. Meanwhile, Kylie delivers all the actual care.

“And, yes, she’s getting a salary, but there is no financial incentive for her to undertake independent practice and do that work.

“This undervalues Kylie’s work in easing healthcare pressures; and it wastes doctors’ time.”

A push for blended funding

A blended funding model that is less heavily weighted towards MBS funding could counter this issue and enable Kylie to work at her full scope of practice.

Such models — which include capitation, bundled and performance-based payments — have already been recommended in independent reviews, and ACN is now advocating for their enactment.

“This would give nurses a funding stream to work independently, particularly in chronic disease management,” Zeitz said.

“We see this as the best way forward and a ticket to so many of the outcomes we are looking to achieve in health.

“We are deeply committed to seeing this become a reality.”

In the driving seat

While Zeitz may not have yet reached the finish line, she is pleased to now be driving a vehicle that will help her get there.

“After working many years in public health, it was frustrating not being able to turn service delivery around to benefit our community. Taking the helm of ACN and having that opportunity is a real honour,” she concluded.

*Amy Sarcevic is a freelance science and technical writer who regularly writes for Hospital + Healthcare. She has an academic background in psychology.