The Australian 'grey nomad' and aged care nurse practitioner models of practice: a case study analysis

The Nurse Practitioner - Aged Care Models of Practice Initiative supported the roll-out of a range of nurse practitioner (NP) models of practice, across Australia. One of these models was a community-based clinic-located practice, situated in a remote tourist destination where there is no resident general practitioner. Services were delivered by a NP to the local population as well as the many seasonal tourists passing through the region. These seasonal tourists included a growing number of older people, many of whom had chronic health conditions such as hypertension, diabetes and cardiac disease.

A case study approach was taken to test and develop connections between the theory of nursing models and the practice of the NP. This approach enabled the development of a detailed explanation of the community-based, clinic-located NP model, including the model's associated enablers and challenges. The case study approach also supported further theoretical development of nursing models more generally.

Enablers of the NP model were the sponsoring not-for-profit organisation, which provided pre-existing structures for clinical governance and general management, as well as funding; and the collaborative agreements negotiated at a systems level between the NP, other health professionals, and a variety of service providers. Challenges to the model included the organisation's limited capacity to back-fill the NP for leave and professional development entitlements obtaining recurrent funding to sustain the model. Also identified was the need for the organisation to more clearly explain the NP role to consumers of the services being delivered. Theoretically, analysis led to the inclusion of an additional component of the nursing model: influence of context. This component is important because it highlights the way in which nursing models of practice are affected by local conditions.

The community-based, clinic-located NP model of practice described in this article provides a rigorous exemplar for other organisations providing similar services in remote, rural or other suitable locations.