The Role of Nurses as Alternative Providers of Medical Services in Community-Based Care
Authors: Kent Susan 
Published: January 2024

The demands on the Irish acute and community-based health services are exponential, increasing the patient flow to the GP practice and/or ED department. Many of the attendances at both are as a result of a deficit in alternative options for the population to attend or because the GP practice and ED department have no alternatives to offer patients. This is also due to the increased acuity and complexity of patients being cared for. This is further compounded by a reduction in the workforce further affecting scheduled care. The nursing workforce has experienced significant impact as a result of the pandemic with many nurses deciding to not remain in the profession and instead reskilling for other professions outside of nursing. Other nurses  travel for work abroad for experiences not acquired during the pandemic. Those nurses that have remained in the profession are now retiring and some choosing to do so earlier and returning to work through agencies and other alternatives in a flexible way to acquire a work/life balance. The health systems are increasing work pressures on nurses that lead to increased risk of patient and professional risk that many nurses are not comfortable with. Together these issues are compounded onto an existing health structure that is unable to manage the escalation in population needs, year on year.

Sláintecare is the current Irish health policy with principles including hospital avoidance and early discharge including patient satisfaction, choice and flow. Nursing policy advocates for the advanced capability and competency from graduate to advanced practice. Whilst much attention is duly associated with advanced practice, the practice of all nurses to the full scope of practice is also advocated. Whilst not funded in the same way as advanced practice, opportunities are available for the profession to develop there mode of service delivery similar to other professionals such as GPs, Dentists, Opticians  and Pharmacists. The HSE policy advocates for the contracting of all types of services to meet the healthcare demands, however nurses are normally employed within a public/private service or within agency employment.

This proposed initiative is the development of a private clinical nursing service that can be delivered in the home to meet the patients’ needs avoiding attendance at the hospital and GP clinic. It differs to the current community nursing service in that it offers universal health coverage. Currently, there is no opportunity for public funding to support reimbursement. As mentioned earlier the PCRS system does not reimburse nurses for clinical  work undertaken privately and is an issue that requires further investigation. The cost of this project already demonstrates exponential savings to the health services. It is also attractive to the workforce and offers a quality of life to the patients treated in their own homes.. What is offered is the opportunity for each nurse, who wishes to work independently, to place a plaque on the wall and ‘open for business’. This mode of service delivery is novel, innovative and is an opportunity to discover new ways of practice for nurses