As Australia faces a multitude of challenges surrounding its ageing population and increased incidence of chronic conditions, the demands on our primary health care system are increasing, and so too is the need for nurses.
Primary Health Care (PHC) is widely understood through the World Health Organisation’s Alma Ata Declaration (1978) as combining health policies and health care systems that create conditions in which primary care can thrive.
In Australia, PHC is defined as socially acceptable, accessible to all and evidenced based, provided by a suitably qualified workforce that is multi-disciplinary and focuses on care that is integrated.
PHC is distinct from primary care which is the first point of contact with the healthcare system and can include a visit to the GP, nurse practitioner, allied health services, a community health centre, community pharmacy or via care in the home, telehealth, video consultations or use of health apps.
PHC gives priority to those in greatest need, thus addressing inequalities in health by maximizing community and personal independence. This is achieved by collaboration with sectors within and outside health to promote public health.
Additionally, PHC includes personal care with a focus on health promotion and the prevention of disease. It is underpinned by guiding principles of equity, access, empowerment, self-determinism and inter-sectoral collaboration, integrated with an understanding of the determinants of health.
Often then, working in a PHC setting refers to any workplace outside a hospital.
General practitioners (GPs), nurses, nurse practitioners, allied health professionals, midwives, pharmacists, dentists, and Aboriginal health practitioners are all considered primary health care professionals.
Many nursing students gain a basic understanding of PHC throughout their degree, but most of their clinical placements are understandably ward-based in large tertiary hospitals. This can limit their exposure to PHC and thus the wide range of career options that exist beyond hospital walls.
Nursing roles in PHC include (but are not limited to);
The University of Sydney’s Primary Health Care Nursing Course Coordinator, Dr Sue Randall, has had an impressive nursing career encompassing acute clinical settings, community and primary health care, research and education. She believes there are a number of reasons to pursue a rewarding career in PHC.
“I was surprised by the fabulous opportunities available to nurses outside the hospital. I enjoyed having more flexibility to spend time with people, as well as greater autonomy and decision-making responsibility. All of these features improved my professional skill-set and made me a better nurse,” she explains.
With a growing global emphasis on the need for health care systems that keep people well, PHC offers the most appropriate and supportive environment for the prevention and management of chronic and complex health conditions, and care that helps to avoid preventable hospitalisations.
Due to an increasing desire from patients to receive care in their homes, there is an equivalent need to increase community nurse numbers. Similarly, General Practices are seeking more practice nurses, making professional careers in PHC not only accessible but valuable for patients and their families, and for the Australian community long-term.
With a greater emphasis on the prevention of illness and the promotion of health and wellness, Dr Randall explains that working in PHC involves developing long-term therapeutic relationships and building partnerships with both patients and family members.
She also emphasises that PHC nurses must develop and exercise a greater degree of professional autonomy while working as part of a collaborative team. PHC nurses have greater exposure to the personal, environmental and social determinants of a person’s health and this broader knowledge is used to inform assessment and shared decision making, as well as appropriate referrals and coordination of care.
One of the myths about nurses who work outside hospitals is that they become deskilled. But Dr Randall contests that:
“People with higher acuity are now cared for in their own homes through Hospital in the Home services and other service delivery models. Nurses have the opportunity to use all their skills and learn new ones, many of which are transferable within all health contexts - including assessment, referral, coordination of care and communication.”
“If you really like people, enjoy building relationships with patients, families and other health care professionals, and you are able to problem-solve because you are aware of the ‘bigger picture,’ then a PHC career is likely to be hugely rewarding,” says Dr Randall.
For Mohammed Nazeem, completing his Graduate Certificate in primary health care broadened his understanding of the field while improving his clinical skills. Specialising in PHC has enabled him to feel more confident in his role within Justice Health where he performs health assessments, provides patient education, runs immunisation clinics and works alongside a multidisciplinary team.
To pursue a career in primary health care nursing, find out more about our postgraduate study options.