As a nurse with more than 20 years’ experience in this field, of course I’m going to say that the role of the rheumatology nurse is invaluable.
As a nurse with more than 20 years’ experience in this field, of course I’m going to say that the role of the rheumatology nurse is invaluable.
In 2015, more than 3.5 million Australians were affected by arthritis (1.7 million with inflammatory arthritis) and by 2030, this figure is predicted to increase to 5.5 million. This represents a substantial burden not only to the health of our population but also to our health system budget.
It has been well-documented that care for patients with inflammatory arthritis by rheumatology nurses is not only effective but cost-effective. Patients receive better education and improved psychosocial support, there is improved care coordination and continuity of care, there are reduced health system costs and patients report improved outcomes and satisfaction with care.
Management guidelines also now include the role of the rheumatology nurse further emphasising patient care is enhanced by this role.
But rheumatology nurses are few and far between. It was reported in the recent Arthritis Australia publication, Rheumatology Nurses: adding value to arthritis care, that there are only 39 full-time equivalent rheumatology nurses in Australia.
In addition, to date, there are only three nurse practitioners credentialled and working specifically in rheumatology in Australia, a role that has been shown internationally, to be particularly effective in the patient with a chronic disease.
WHY IS THAT?
Funding is likely to be the major factor. Much of the care of the rheumatology patient is in the private sector, and funding for nurses in this setting is difficult as it requires the specialists to generate sufficient income to afford to pay a rheumatology nurse salary.
However, a rheumatology nurse could be cost effective by providing care and support, traditionally given by the specialist thereby freeing the specialist up to see more patients.
Funding in the public sector is also difficult with many departments funding positions from research funds, departmental funds or by submitting a compelling business case to justify the nurse’s employment.
Historically, rheumatology nurses were clinical trials nurses – an important aspect of the future of rheumatology. And despite the fact treatments have evolved and the role of the rheumatology nurse has developed, funding is often still centred around clinical trials with the majority of the time taken up with trial processes and not patient care.
There is a lack of standardisation of the role with many nurses still juggling clinical trial work with clinical support.
There is also a lack of formal training for rheumatology nurses in Australia. At the moment, there is a Graduate Certificate in Musculoskeletal and Rheumatology Nursing course available at a cost of $7900 – this is an online course. Unfortunately, this cost along with the time required to complete the course makes it inaccessible for many nurses.
Finally, there still exists a lack of acceptance and understanding with regard the value of the rheumatology nurse role among some clinicians. While many specialists are very supportive, there is the potential to improve awareness across the profession of the unique skill set and benefits rheumatology nurses can bring to the team.
WHAT CAN BE DONE?
Things will not change overnight and we need to work together. Organisations such as the Rheumatology Health Professionals Association, the Australian Rheumatology Association and Arthritis Australia need to collaborate on developing new models of care to incorporate the rheumatology nurse.
The rheumatology nurse role needs to be defined with clear responsibilities identified, along with the skills and competencies required for the role. Examples of role descriptions should be developed alongside business case templates.
Although the value of nurses has been demonstrated internationally, it may be necessary for individual departments with nurses already to document their value both clinically and in terms of cost savings.
As a group, we should also campaign to allow access to specific MBS item numbers for specialist nurses. As a group, we need to have our voice heard. Given our small numbers, it might be worth collaborating with specialist nurses in other disease areas so, as a group, we can work together to achieve this goal.
With regard to training and education, there are several ways to approach this. Rheumatology should be promoted as an area of specialisation in general nurse training, both within primary care as well as in the hospital setting.
We need affordable, accessible and accredited educational modules for nurses interested in rheumatology, as well as for professional development for those already working within the field. For experienced rheumatology nurses, we need to provide encouragement and support, and recognition of their value.
Importantly, we need to promote the rheumatology nurse role among the patient population. Unfortunately, if a patient does not have access to a rheumatology nurse, they may not be aware of the potential benefits.
We need to make the rheumatology nurse a household name for people with arthritis, much like the breast care nurse is for patients with breast cancer.
Finally, we should learn from our colleagues overseas. Even though health and funding systems are often different from Australia, some of the models may be adaptable.
Rather than “reinvent the wheel”, we could modify training approaches, education modules and business models to suit our needs.
Currently we are working on some of these approaches. We have access to some fantastic adaptable education modules and we have started looking at role descriptions and business models. As with everything however, this takes time, enthusiasm and volunteers, so watch this space.
Ultimately, ensuring the best outcomes in terms of patient health and safety are the most important aspects of rheumatology care.
With the shortage of specialists, the challenges of rural and remote practice, the ageing population, earlier diagnosis and and a greater variety of treatments becoming available, the rheumatology nurse role is likely to be increasingly important and hopefully invaluable in the future.
Linda Bradbury, RGN MSc MNPSt, is a Nurse Practitioner – Rheumatology, based in Queensland
