The role of the Nurse Practitioner has been supported by the State Government since 1998, with the first nurse practitioners endorsed in 2004.
This coincided with the development of the National Competency Standards for the Nurse Practitioner by the Australian Nursing and Midwifery Council in 2004/2005. The Victorian Nurse Practitioner project has been undertaken since this time by the Department of Health Victoria.
Monash Health’s Executive Management Team has supported the renal nurse practitioner concept in Monash Health since 2008. Becoming a nurse practitioner candidate requires existing clinical nurse consultant or clinical nurse specialist status and two years’ study with Deakin University Victoria to obtain a Masters Degree of Nursing. A twelve month internship then applies at Monash Health with physicians supervising the candidates throughout this time.
The scope of practice includes the following components:
- Address social issues
- Adequacy of dialysis
- Adjust medications
- Clinical studies
- Chronic Kidney Disease (Stage 3-5) teaching and education
- Deal with patient medical complaints
- Diagnosis screen via protein creatinine ration
- Medical declotting of venous catheters
- Pre-End stage renal failure education
- Preventive medical evaluations – blood pressure, vitamin D, anticoagulants, anaemia treatment.
- Referrals for procedures and consultations
- Rounds on dialysis patients
- Routine periodic physical examinations
- Set dialysis parameters, target weight
- Triage problems
How the Renal Nurse Practitioners are assisting renal patients
Two renal Nurse Practitioners, based at Clayton in the Department of Nephrology, work across all Monash Health sites within the dialysis units and at renal outpatient clinics. The different elements of practice are now noted.
Nurse Practitioner Clinic
Nurse Practitioners provide individualised education and decision support for people with advancing chronic kidney disease at a weekly outpatient clinic at Dandenong. Many people approaching end stage kidney disease, including the culturally and linguistically diverse (CALD), population require individualised education regarding treatment options.
People with stable, slowly progressive kidney disease, are seen at the clinic for monitoring and management of anaemia, hypertension and diabetes. This group may or may not progress to dialysis and are appropriate for the supportive care offered by Nurse Practitioners. Dandenong has been chosen as the clinic site due to its accessibility for a large number of clients.
New Dialysis Patients
Nurse Practitioners review new outpatient haemodialysis patients commencing treatment at Clayton, provide education, support and assessment, and ensure that they are linked in with all appropriate services. Care of inpatients remains with the treating medical team with Nurse Practitioners available for consultation.
Satellite Unit Dialysis Patients:
The Nurse Practitioners, with medical, nursing and allied health staff, care for approximately 240 patients at the four Monash Health haemodialysis units, managing the monthly routine review of pathology and maintenance care activities. There is sessional support from a nephrologist at each site.
Renal Outpatient Clinics
The Renal Failure and Glomerulonephritis clinic are attended by Nurse Practitioners, to conduct patient reviews, attend the post clinic team meeting and receive referrals. The Nurse Practitioners are not routinely rostered to these clinics, with attendance contingent upon room availability.