Paving the Way for DNPs in Australia

Andrew Scanlon, the first nurse practitioner in neurosurgery in Victoria, Australia maintains a clinical practice at Austin Health Neurosurgery, an inpatient hospital facility that cares for acute and post-operative neurosurgery patients. He also teaches undergraduate and graduate nursing students at La Trobe University School of Nursing near Melbourne. Scanlon has more than two decades of experience as a nurse working in neurosurgery, neurology, cardiology, dialysis, ophthalmology, and respiratory medicine. He has been published in academic journals on such topics as scope of practice, international APRN development, and end-of-life issues. Scanlon serves as co-chair of the International Council of Nurses.  He received his DNP at Columbia Nursing and two master’s degree from La Trobe University. 

Q: Why did you travel 17,000 miles from your native Australia to obtain a DNP at Columbia Nursing?

A: I worked as a nurse for 15 years in Australia in a variety of roles and had branched out to teaching. I wanted to become the best clinician and educator I could be. The only way to further my clinical qualifications was to pursue a DNP, but unfortunately there are no DNP programs in Australia. I wanted to study in the United States because I knew that I would work with many outstanding NPs during my clinical rotations. In Australia, we only have about 1,100 NPs in the entire country, and you might only encounter one while working in a hospital. I looked at several DNP programs and Columbia Nursing’s was the most rigorous and it was best aligned with my career goals as it was heavily practice focused

Q: What needs to be done to increase the number of nurse practitioners in Australia? What about importing DNP programs to the continent?

A: The nurse practitioner profession was first recognized in Australia in 2001 and represents the highest level of the Australian nursing hierarchy. The vast majority of Australian nurse practitioners work their way up to NP by progressing through the ranks, from registered nurse. This process can often take decades and requires nurses to stay in the same specialty, and in some cases, the same ward, for many years. The system needs to change in dramatic and fundamental ways.

I believe a DNP program with a clinical focus like Columbia Nursing’s  would be ideal for Australian NPs. Although this may not be available to Australian NPs in the near future, I’m confident that we can make it happen through persistence and it would flourish in  the Australian healthcare system.

Q: What were some of the differences between the US and Australian health care systems that stood out to you during your clinical rotations at Columbia Nursing?
 

A: In Australia, we’ve had a universal health system since the 1970s.  We also have an option to pay for private insurance, but it’s still federally subsidized and costs between $500-about $3,000 a year for a family’s care, much less than in the US. The biggest difference I saw was regarding access to care. In Australia, anyone who needs acute care gets it right away, but patients might have to wait two years for procedure which may be deemed “not urgent”  like a hip replacement. In the US, patients might go bankrupt finance care for acute care following a heart attack, for example,  but patients with insurance such as Medicare may only wait two weeks for a hip replacement. There are positives and negatives for both systems, but that being said, Australia’s GDP contributes less to health care than that of the US, yet Australia has better health outcomes.

Another big difference I saw was in how American NPs are certified in specialties such as family nurse practitioner or nurse anesthetist. In Australia, we don’t have these classifications. The vast majority of Australian NPs work in public health. Similar to the US, nurses’ scope of practice in Australia is determined by the federal and state governments, education, and competency. Australian NPs require 5,000 hours experience at an advanced nursing practice role and completion of an approved nurse practitioner program of study at master’s level.

Q:Australia is a high income country and life expectancy is among the highest in the world. Why do you think health outcomes in Australia are so good?

A: We can attribute our long lifespan to the health care our patients receive. Our system doesn’t produce vast disparities in care between the rich and poor. But there is one exception: indigenous Aboriginal Australians are less healthy than the rest of the country and have a much higher infant mortality rate.

We have health care providers who work directly with Aboriginal communities, but these federally funded programs haven’t yet made a strong impact. Some disparities can be attributed to Aborigines’ remote locations, but there are social determinants at play as well. This community has essentially moved from a hunter gatherer lifestyle to eating fast foods and that has negatively impacted their health.

Q: How did you benefit from the DNP degree?
I went from treating 500 outpatients a year to more than 1,200, who range in age from 16 to over 100. I manage three clinics including an upper limb nerve entrapment facility that I created. I felt passionate that patients shouldn’t have to wait six-12 months before being seen in an outpatient setting, so I’ve worked to decrease the time from treatment  to surgery for patients in my clinics from about two months to a couple of weeks, which is unheard of in a public hospital system in Australia .

 I’ve been inducted as a fellow into the Australian College of Nursing as well as a fellow in the Australian College of Nurse Practitioners, presented at international conferences, and have been published in influential journals.  Columbia Nursing enabled me to become a leader and steer the conversation in health care.