Rural and Remote Advanced Primary Health Care Certificate

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Background

During 2007-08, the Rural Collaborative Practice Model (RCM) was piloted at five rural hospitals, includingone bush nursing centre.  This Pilot engaged clinicians, health managers and government in a collaborative, action research approach to developing and implementing strategies to strengthen the sustainability of rural emergency services. Key strategies implemented involved advancing nursing practice, adopting evidence-based clinical guidelines and building collaborative clinical teams. Key outcomes of this pilot included a reduction in the times the doctor was needed to attend the hospital, improved confidence and capacity of nurses in managing the range of patient presentation and improved relations and communications within the clinical team.  As part of the RCPM project, a modified version of the Queensland Health Rural and Isolated Practice Registered Nursing Certificate was piloted with 23 nurses. 

In 2008 a survey of rural Directors of Nursing and Clinical Services was undertaken to obtain their views on what should be considered in the development of a curriculum to enable nurses working in rural and remote settings to manage at a more advanced level in dealing with the people that present at their emergency service. The following questions were asked:

1. Considering what your nurses do in their every day practice (focusing on the unplanned presentations for now), what is the essential core content for an advanced rural/remote nursing curriculum?
2. What methods of education delivery will meet the needs of rural/remote nurses?
3. What teaching/learning strategies would be effective?
4. What other matters should we consider in designing this program?

As a result of the survey and the evaluation of the Queensland RIPRN course the Rural and Remote Advanced Primary Care Certificate (RRAPCC) is being developed.  The RRAPCC will give registered nurses (Division 1) the knowledge and skills to manage more autonomously the wide range of patients who present to rural hospitals and bush nursing centres.  The curriculum focuses on nursing at an advanced level, performing comprehensive patient assessment and care, and working in a collaborative practice model. 

Curriculum

The development of the RRAPCC is funded by Rural Health Branch, Department of Human Services.  A working group was established and lead by Elise Sullivan (Senior Nursing Advisor) and consisted of members from Department of Human Services (Rural Health Branch, Gippsland Region, Nurse Policy Branch and Service & Workforce Planning Branch), Nurses Board Victoria, Monash University, and Ambulance Victoria.  Sue Crocker has been engaged to develop and deliver the curriculum to the first cohort of students.  Sue has delivered and reviewed the Queensland Health RIPRN program to nurses across Queensland for over 10 years and was involved in the Victorian pilot of the RIPRN. 

The course is made up of 4 modules:
Module 1 – Context of practice                                                     
Module 2 – Pharmacology            
Module 3 – Health assessment and pathophysiology             
Module 4 – Enhanced clinical practice                                      

The curriculum has been developed to enable nurses to assess and respond to the range of less urgent patients that present to emergency services which represent the vast majority of cases.  Nurses will use the Primary Clinical Care Manual (PCCM) to guide their practice, and assuming the health services have the appropriate policies and permits in place, would be competent to administer medicine according to the health management protocols contained in the PCCM.  Each nurse will be given course resources and a PCCM.  There will be no mandatory requirement to purchase texts as a part of this course however if the nurse wishes to purchase texts to assist with their study a list of recommended texts will be provided with each module.

Admission Requirements

• Current Division One nursing registration with the Nurses Board of Victoria
• Minimum of 12 months post graduate experience
• Concurrent employment in a rural or remote practice setting
• Demonstrated Advanced Life Support competencies’

Course Objectives

1. Function effectively as a primary health care practitioner in rural and remote settings
2. Apply principles of collaborative practice to achieve optimal, culturally relevant client outcomes
3. Conduct comprehensive health assessments and plan and articulate primary health care requirements for groups and individuals across the lifespan
4. Use evidence based practice and research to inform primary healthcare of the client in the rural and remote setting   
5. Demonstrate contemporary knowledge and skills pertaining to medicines administered and supplied under their care.   
6. Demonstrate comprehensive advanced clinical skills in a variety of complex primary care/emergency situations in rural and remote settings.

Pilot implementation

The RRAPCC is a year long course.  Originally the course was to be piloted with 25 nurses selected from Victorian rural health services in 2009-2010, however the response to the expressions of interest was overwhelming and we have increased the number to 52 nurses.  The two way workshop to commence the course was held the 1st and 2nd June 2009 in Melbourne. 

Download

Web references module 1 (139kb, pdf)

Web references module 2 (22kb, pdf)

Rural and remote advanced primary care certificate (57kb, pdf)

Rural and remote advanced primary care certificate change management (187kb, pdf)

Drug calculations

Practice drug calculations (21kb, pdf)

Practice drug calculations - answer sheet (21kb, pdf)

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