Staffing and HR

The capacity of your clinic to serve its community and achieve its goals is largely dependent on gathering the right clinical and support staff. Non-clinical duties, including admin, building management and reception tasks, often fall to the first available person. Establishing clear roles and responsibilities reduces staff discontent and helps cement a more cohesive and collaborative staff culture.

These should accurately reflect all team members’ roles, responsibilities, accountabilities, continuing CPD opportunities and working relationships. PDs are essential documents, providing the basis for effective teamwork and provision of safe patient care. They are also used to facilitate discussion when conducting a performance appraisal. Remember, PDs should be created for a position, not a specific person.

Along with PDs, nurse clinics need to have a range of HR policies, within a governance framework, to ensure the equitable treatment of employees, such as:

• EEO/diversity management (including bullying and harassment)
• Training and development
• Leave
• Performance and discipline
• Remuneration and reward
• Other HR functions include obtaining insurance for building and contents and professional indemnity

For more information on governance issues in health care, review the following:

Clinic sustainability can be a challenging issue, particularly if you are the sole nurse running the clinic. Sick days, leave, and resignations can heavily impact on the viability of the clinic.

These are a few things you can implement to minimise your risk:

• Participation of other nurses in an induction program: This ensures that nurses working in the nurse clinic are introduced, welcomed and integrated into the team.
• Encouraging team innovation: Provide opportunities to generate new ideas and processes for capturing and trying out different ways of doing things. Stay connected to the outside world, learning from other organisations via external training, websites, newsletters and emails.
• Sharing the workload: Can you share the clinic with another nurse? Or can you backfill your other role so that you can better attend to the nurse clinic?
• Capacity building other nurses in the clinic: Can you develop the other nurses’ capabilities to support the clinic? For example, writing guidelines and providing training.

Governance refers to the rules and procedures that define accountability. A strong governance structure will hold your clinic in good stead to deal with any organisational issues that arise.

Depending on the size and scope of your clinic, you might establish these governance groups and roles:

Governance Committee

• Provides overall oversight for the nurse clinics.
• Sets direction and provides leadership.
• Ensures alignment with the organisation’s strategic vision and direction.

Working Group

• Responsible for planning, organising and coordinating clinic activities (e.g. resourcing, staff communications, implementation of clinical guidelines and systems, marketing).

Project Champion

• Ensure that any conflicts that impede the clinic are resolved.
• Advocates for resources and changes needed to support the clinic.
• Builds support across the organisation to make the clinic successful.

Lead nurse

• Person dedicated to implementing the nurse clinic.
• Reports to the governance committee on issues for discussion and decision.
• works with the change team to implement the clinic

An important part of governance is effective stakeholder engagement. This is essentially about communicating clearly and with appropriate regularity with people or groups who have an interest in the clinic’s operations, for example:

• Senior management
• External service providers (PHN, local hospital, allied health providers etc.)
• Internal staff (receptionists, allied health, GPs, etc.)
• Funding bodies

Create a plan for keeping your stakeholders up to date, identifying:

• who to consult
• when to consult, and
• how to consult (newsletter, briefing, workshop, etc.)

It is vital that nurses increase their knowledge and skills in nursing practice, particularly when embarking on a new initiative such as a nurse clinic. CPD activities must be relevant to the nurse clinic, and have clear aims and objectives that meet your self-assessed requirements.

Possible examples of activities include:

• postgraduate studies
• participating in journal clubs
• in-service education
• attending conferences, workshops and seminars
• authoring a book chapter, or
• having an article published in a peer-reviewed journal, and
• undertaking relevant online or distance education

As the peak professional body for nurses working in primary health care, APNA provide a range of services to support the professional development needs of both its members and the wider primary health care nurse workforce.

Given the broad range of care that can be delivered within nurse-led clinics, it is crucial that the scope of practice for the nurse/s involved in the clinic is understood.

There are two elements to a nurse’s scope of practice:

1. Professional practice: The scope of professional practice is set by legislation. This includes professional standards such as for practice, codes of ethics and codes of professional conduct.
2. Individual practice: The scope of practice of an individual nurse includes that which the individual is:
   • educated
   • authorised
   • competent, and
   • confident to perform.

A nurse can build their clinical and professional capabilities to expand their scope of practice through education and training to develop a broader skill set that remains within the legislated professional practice standards and competencies.

The Australian Nursing and Midwifery board have developed a set of tools and principles to assist all nurses in the process of making decisions about whether specific tasks are within their individual scope of practice. The Nursing practice decision flowchart (and summary) and the national framework for the development of decision-making tools for nursing and midwifery practice can assist nurses to make decisions around scope of practice.