Key messages

  • Creating a flexible and sustainable workforce that releases the talents of our skilled health professionals will be crucial to improving patient care and advancing quality, safety and innovation.
  • A number of new advanced practice roles have been piloted and are underway in Victoria.
  • The next phase of work for advanced practice roles will involve integrated services, both within the health system and across health and social care sectors.

Advanced practice roles are widely established internationally and within Australia. These roles utilise the skills of health clinicians to expand the range of activities they undertake. Advanced practice roles increase scope for health service provision and enable development of additional career pathways and leadership opportunities for health professions.

Advanced practice roles involve assessment, diagnosis, initiation, and coordination of complex care needs of individuals within primary, secondary and tertiary settings.  Rules, regulations, and boundaries in which a fully qualified advanced practice professional can operate are subject to local organisational governance, culture and practice at each workplace. Decision making frameworks are available to assist individual practitioners to determine whether certain activities exist within the safe scope of practice.

  • Advanced scope of practice is a level of practice characterised by an increase in clinical skills, reasoning, critical thinking, knowledge and experience so that the health professional is an expert working within the scope of established contemporary practice.
  • Extended scope of practice is a level of practice which incorporates practice beyond the established, contemporary scope of practice.

The next phase of work for advanced practice roles will involve integrated services, both within the health system (e.g. chronic care) and across health and social care sectors (e.g. family violence and National Disability Insurance Scheme). This phase will explore the human factors associated with the take up of new and emerging technology, and investigating skill sets required for the new workforce of the future.

Advanced practice programs supported through Workforce Innovation and Reform include:

Advanced musculoskeletal physiotherapy

In 2014-15, ten Victorian health services implemented an advanced practice physiotherapy program in Post Arthroplasty Review (PAR) services: Albury Wodonga Health, Austin Health, Ballarat Health, Barwon Health, Bendigo Health, Eastern Health, Monash Health, Northern Health, South West Healthcare, and Western Health.  The program addressed long wait times for surgery and new appointments following a 77% increase in hip and knee replacement surgeries in the last decade.

The program was led by highly trained advanced practice physiotherapists to assist in review of patients following hip or knee replacement surgery.  The state-wide roll out utilised skills of our talented health professionals to provide earlier and more connected person centred care.

As a result, the capacity of orthopaedic surgeons to see new and complex patients was increased by 551 hours, and an additional 3,053 orthopaedic appointments were made available.

The cost per patient appointment was reduced by 41%, while still maintaining safe and high quality care, with no adverse events related to the advanced practice physiotherapy role.

97% of patients reported satisfaction with the model, and state wide benchmarking of patient outcome measures are now in place across all ten participating health services.

Victoria's advanced practice physiotherapy model demonstrates a replicable standardised pathway for competency. Advanced musculoskeletal physiotherapy roles have further been tested successfully in physiotherapy led orthopaedic and neurosurgery screening clinics, and primary contact physiotherapists in emergency.

For further information on implementing advanced musculoskeletal physiotherapy roles, visit the Advanced Musculoskeletal Physiotherapy Implementation Program section.

In 2016, the department celebrated success in winning the KoAwatea International Excellence in Health Improvement Award for the Victorian state-wide collaborative of advanced practice physiotherapy redesign in PAR services.

Advanced practice pharmacy

In 2013, Alfred Health piloted an advanced practice pharmacy role through a Partnered Pharmacy Medication Charting (PPMC) workforce model and credentialing program. The PPMC provides credentialed pharmacists to operate at top scope of practice in collaboration with an interdisciplinary team of doctors to undertake medication reviews and chart patient medications for administration by nursing staff. The advanced pharmacist role and care pathways were developed in collaboration with senior clinical pharmacists, general medical consultants, consultant physicians, and emergency and trauma unit.

Five Victorian health services in 2016-17 are being funded to replicate and evaluate the workforce and service model in different settings: Monash Health, Eastern Health, Echuca Regional Health, Melbourne Health, Barwon Health. An evaluation of the PPMC model will inform the department about the safety and quality, efficiency, sustainability and feasibility for mainstreaming the model state-wide.

Advanced practice continence and women's health physiotherapy services

In 2014-16, four Victorian health services: the Women's Hospital, Monash Health, Barwon Health and Western Health led the way in Victoria implementing advanced practice continence and women's health physiotherapy services to meet demand in gynaecology, urogynaecology and urology clinics. Urogynaecology clinics set up and led by advanced practice physiotherapists provided conservative management as a first line treatment for managing urinary incontinence or pelvic organ prolapse.

Advanced practice continence and women's health physiotherapy clinics for women with incontinence and other pelvic floor disorders demonstrated a streamlined, cost efficient workforce model, consistent with best practice guidelines. Management of patients through these clinics has led to an increased number of patients receiving timely access to physiotherapy management prior to invasive procedures.  A suite of competency documents have been developed to assist health services with implementation of advanced practice continence and women's health physiotherapy services.

Advanced nursing roles

The Nursing and Midwifery Board of Australia (National Board) has prepared a fact on sheet on advanced practice nursing, as well as the Guidelines on endorsement as a nurse practitioner, which define 'advanced practice nursing' as the application of advanced levels of knowledge, skill and experience by the nurse to the nurse--patient/client relationship.

The national board recognises the basis of advanced practice as the high degree of knowledge, skill and experience applied in the nurse--patient/client relationship in order to achieve optimal outcomes through critical analysis, problem solving and accurate decision making.

For more information regarding advanced nursing roles, visit the advanced nursing roles section.

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