Implementing emergency NPs in a small rural hospital nurse-led assessment and treatment service: Exploring potential and exceeding expectations

Ms Michelle Cruse1, Ms Jodie Cameron1

1Southern NSW Local Health District, Pambula District Hospital, Australia

Across Australia, many rural health regions are facing the dilemma of providing safe high quality health services to their populations in the wake of hospital downgrades and/or the loss of medical practitioners in rural small hospitals. There is a lack of available evidence and service description supporting or describing the implementation and outcomes of Nurse Practitioner services in Australian rural small hospitals with no on-site medical staff. In addition, public health policy to close or downgrade small hospitals and concentrate services in main centres often causes community angst and hardship in rural areas where people have previously relied on their local community hospital and GP services to provide for their health needs.

This presentation describes the first 6 months of data after the successful addition of Nurse Practitioners to a nurse led Assessment and Treatment Centre at a small downgraded NSW rural hospital. With no doctor on site or available on call, and with a limited Scope of Practice for the RN-led service, the addition of NPs has improved ATC patient numbers, improved community confidence, filled a service gap between overloaded local GP services and the regional hospital ED, and has significantly reduced the load on the regional hospital by reducing transfers and presentations, particularly important in periods of high tourist activity.

To date the service has demonstrated safe, cost effective, community based care and is proving to be an excellent alternative to GP or ED presentation, including collaboration with the GPs and ED to co-manage their scheduled re-presentation patients (e.g. dressings, daily reviews, IVABs). There is potential for growth and development for the RNs to further increase their scope and work satisfaction, and provides a potential training pathway for aspiring NPs. The success of this service has positive implications for many smaller rural and remote services needing innovative solutions for provision of safe and cost effective care.


Michelle has an extensive nursing background including orthopaedics, burns, education and finally settling in emergency. Michelle has been a emergency Nurse Practitioner for the last 9 years, first in Adelaide metropolitan, then a remote small hospital in the WA Kimberley region, and now in southern NSW. Nurses making a positive difference – to their patients and families, and to each other – is central to Michelle’s personal nursing philosophy. Michelle is a long-standing CENA member holding committee positions including SA State President, National Board member and is a current CENA Fellow.