11 July 2022
From left: Nurse Practitioner Jane Laidlaw, Physiotherapist and UTAS Lecturer Marie-Louise Bird and RN and UTAS Lecturer Michele Dowlman.
Article from July 2022 edition of INPractice
How a nurse-led initiative is bringing hope and dignity to disadvantaged communities... And why nurses are 'awesome'.
Registered nurse and lecturer at the University of Tasmania, Michele Dowlman says working with a free of charge, drop-in, nurse-led health clinic for people experiencing homelessness is an "immense privilege".
"But it also makes me very angry," she says, "because we should not need to exist. Health care Is a human right and should not be a function of charity.
Australian health care should be meeting the needs of every single Australian regardless of their economic situation".
Established m March 2019, Mission Health opens every Thursday morning from 9am to 12.30pm and is a collaboration between Jane Laidlaw, a nurse practitioner, Ms Dowlman and the Launceston City Mission, a Tasmanian not-for profit organisation. Initially, the collaboration included Grace Bennett-Daly and Leigh Harkness, also registered nurses and University of Tasmania lecturers.
The pioneering project was the recipient of a $10,000 grant by the Rosemary Bryant Foundation (RBF). Based at the ANMF (SA Branch)'s Ridleyton offices, the Foundation aims to support the work of Australia's 360,000 nurses and midwives by raising funds to improve health outcomes through nursing and midwifery-led research.
Named after Rosemary Bryant AO, Australia first Commonwealth Chief Nurse and Midwifery Officer, Emerita Director of Nursing at the RAH and honorary life member of the ANMF (SA Branch), the Foundation seeks applications for high quality research projects which have a strong focus on being able to be translated into practice.
The RBF funding to Michele and her colleagues was to help determine the efficacy and future of a nurse-led clime like Mission Health.
Historically, Launceston's homeless population has typically presented to local emergency departments when requiring health care rather than primary care or preventative care services. They are often not registered with a general practitioner, nor can they afford to pay both the fees associated with seeking medical help and the cost of medications.
"Launceston is the regional city of Northern Tasmania. We have a population in the city area between 60,000 and 80,000, Michele says. we have large areas outside the city that increases the population to about 110,000. In our satellite towns doctors tend to bulk bill but in Launceston itself we have one consistently bulk billing practice. Only one.
"People will nag and the earliest that they can get an appointment at the bulk-billing practice is three or four weeks away, if they are lucky. Or they hear, 'No, sorry, we are not taking new patients'.
So, there's a significant need. we also have a growing homeless community in Launceston. I drove past a little camp site night in the city this morning underneath an overpass. People have got their tents set up.
"The need for healthcare for marginalised people had been recognised by City Mission for some time, but they had not been able to source clinicians.
Mission Health operates because of nurses. Michele's role Is supported by the University of Tasmania, and Jane as a Nurse Practitioner provides a bulk billed service and is able to receive some payment for the care she provides.
Jane says that "although Mission Health needs to be a bulk-billed service for this group of people, there are many related challenges. Personally, I am fortunate to be able to provide a day per week working at the clinic earning purely the bulk-billed rates per consultation (It’s regularly reported from GPs that bulk-billing is unsustainable for them and bulk bill rates for Nurse Practitioners are at least half the rates of GP bulk-billing).
"The other issue Is that in Tasmania there are only 48 nurse practitioners state-wide, all working in other areas. I am the only NP providing support to this group. Nationally there are only 2,332 endorsed Nurse Practitioners.
"I am aware that this model of care could and should be replicated Australia-wide to assist marginalised communities. But unless there is adequate funding of the Nurse Practitioner role and increased opportunity for nurses to expand their skills to the peak of clinical role, I am fearful that Mission Health will not be able to continue".
The clinic was awarded the UTas Vice Chancellor's Community Engagement Award in 2020, recognising that by being a drop-in service Mission Health is helping people to mitigate some of the chaos that homelessness has brought to their lives.
"People turn up, register and wait until seen. We give each patient as long as they need," Michele says.
"The people that we see can have very complex health needs. Homeless individuals are commonly affected by tri-morbidity; mental illness, physical illness, and substance misuse".
For 2 1/2 years the small clinical team worked in a "tiny room which had no handwashing facilities and a donated examination couch.
Last year, City Mission fitted out a new building with the help of State Government funding and generous private donors.
"In October last year we moved into a purpose-built clinic, it's amazing: Michele says. "We have two consulting rooms with handwashing facilities, we have a proper patient toilet, a proper reception and waiting area.
“And this says to the people in the Launceston community who are homeless. who are marginalised, who are vulnerable, who feel like they have nothing and also people who are really struggling financially, what this clinic says to these people is 'you are worthy, you have as much right 10 quality health care as anybody else'.
"I really commend City Mission for that approach of supporting the dignity of people who feel like they have nothing".
Michele says the team would love to see the service expanded, even nationally.
"City Mission wants to expand but it's the resourcing that is the problem".
Michele echoes Jane's thoughts about more support for the education and funding of Nurse Practitioners: "There's a lot of structural work to be done to say that this model could be duplicated around the country, if we get a Federal Labor Government, I'll be going and talking to the Health Minister about our model of care, and how it might be extended and duplicated," she says.
"I really hope that the other leg of Labor policy is to adequately fund the Medicare rebate so that more doctors can go back to bulk billing.
"In the 1990s in Launceston, my family was able to access quality bulk-billed health care when we needed it. It didn't cost us anything, and that's how it should be for ALL Australians".
Michele says the clinic has made a huge difference to the lives, health and wellbeing of the homeless and at-risk communities. She cites the case of a young person who had been suffering a long illness which went untreated for lack of a bulk-billing doctor. The person openly wept when told that care at Mission Health would be provided free of charge.
Some of the highlights of service provided by this nurse-led clinic have been treating active Hepatitis C, commencing a poorly controlled diabetic on insulin. suturing wounds, placing long-acting contraceptive implants, and excision of suspicious skin lesions.
One of the services of this clinic is to provide free essential prescription medication, pathology testing and radiology, on a case-by-case basis.
Mission Health also works closely with a Tasmanian Government service MHHOST (Mental Health Homelessness Housing Outreach and Support Team), advising patients that this service exists. and then referring when consent 1s provided.
Jane says: "In my view the best facet of this nurse-led clinic is the opportunity for people to talk about their health, their lives and to feel listened to. I believe that people attending Mission Health feel they matter". This was borne out by the research published December 2021 (Bennett-Daly et al. 2021).
"As nurses that's what we look for, that is our job satisfaction," Michele says. "That's what nurses want to be able to do, to be able to go 'the care that I provided made a difference to that person's life'. That's what we thrive on as nurses. We do that every single week in our little clinic, we make a difference. It's an incredible honour to be able to that.
"Why is it so good being nurse-led?
"Because nurses are awesome with patients," Michele says.
"Yes, a lot of GPs are as well, but nurses are different".
"We bring something to our interaction with our patients, to help our patients to feel heard, and that's what Jane, as a nurse practitioner, is so good at.
"Not just listening but hearing. then identifying what they regard as their needs, and then helping them to meet their needs. That what nurses do so, so well."
Reference:
Bennett-Daly G, Unwin M, Dihn H, Dowlman M, Harkness L, Laidlaw J, Ton K.
Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative. International Journal of Environmental Research and Public Health. 2021: 18(23):12770.
https://doi.org/10.3390/ijerph182312770
Click here to read the July 2022 edition of INPractice.