Who is a HIV Nurse? The picture now and into the

futureShaun Staunton

Chief Executive Officer

Tasmanian Council on AIDS, Hepatitis & Related Diseases

Adjunct Associate Lecturer, University of Queensland

Researchers• Education and Project Management Specialist• HIV & HCV Education Projects; University of

Queensland School of Medicine

Research performed in partnership with;Steve Lambert; Manager, Queensland Rural Medical

Education/Research Coordinator, HIV & HCV Education Projects

Judith Dean; Sexual Health Program Convener, Griffith University/State Nurse Educator, Queensland Health

Joanne Leamy; Contact Tracing Support Officer, Cairns Sexual Health Service

Other members of the UQ HIV Nursing Subcommittee

Original Research• In 1999 Dobson and Loewenthal had 94 Australia and NZ HIV

nurses complete a survey about workforce and education issues

• Dobson, P., Loewenthal, M. (2001). The Status of HIV/AIDS Nursing in Australia: A Speciality in Decline?. Journal of the Association of Nurses in AIDS Care, 12(1). 52-60

• Since the introduction of HAART the survey found;

– 72% of respondents reported losing some or many clinical HIV/AIDS skills

– 37% reported losing confidence in their knowledge of management of opportunistic infections and cancers

– 27% reported large numbers of nurses leaving the speciality

Research was repeated in 2011

• 79 QLD HIV nurses or nurses who provide regular care to PLHIV

• Asked about; education needs, professional memberships, training, workload, duties descriptions, professional barriers, future needs

• Recruited from appropriate services, HIV education courses, and through UQ networks

Entering HIV Nursing• Range of pathways identified. Response

coding shows;

– Contact with HIV education

– Backfilling roles via an agency/secondment/locum

– Coming into contact with patients in non-HIV oriented settings

– Infection control/reproductive health

Responses show few people are directly recruited into/interested in HIV work. The majority enter the sector unplanned

HIV Nursing Profile• Average nurse age was 45.83 (of the 42,

3 were under 30) (on par with national avg)

• Transgender (3%), male (15%), female (81%)

• Avg. PLHIV caseload of respondents was 27 patients

• Average time working with PLHIV patients was 5.5 yrs

HIV Nursing Profile• HIV comm. clinic (3%), inpatient hosp

(8%), outpatient hosp (7%), QH comm. org (19%), SH clinic (14), other community organisations (49%)

• Avg 5.5 yrs with the current organisation

HIV Nursing workforce is an older but relatively stable population with strong ties to community

Workload

Workload• Avg amount of workload devoted to HIV – 57%

• Avg amount of time sample reported they were funded to work with patients – 75%

• Avg amount of time spent in direct patient contact –52%

• Avg amount of time sample reported they were funded to be involved with research – 20%

• Avg amount of time spent involved in research – 25%

Nurse population has a low to medium HIV workload, spend less time with patients than they are funded to (but aren’t spending that time on admin), and believe research is a part of their role

Workforce Skills0 – Novice 1- Not very good 2- Average 3- Above Average 4- Excellent

• Self-rated level of HIV knowledge – 2.1

• Self rated skill in HIV nursing – 1.7

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30

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60

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1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57

age

HIV knowledge

HIV skill

Changes to PLHIV patient needs in the last 10 years

• 85% of sample indicated patient needs had changed over time

• Move to a chronic disease status and resulting less reliance on health system

• Increased complexity and co-morbidities

• Clients getting older

• Broader diversity of clients

• Mental health

“It is now a discipline about dealing with the individual as they are experiencing HIV uniquely.

This is different than previous times.”

Has your specific role in HIV nursing changed in

the last 10 years?

Yes – 71% No – 29%

• Seeing more clients (increases in rates and employment position)

• More patient interaction (including role change)• Increased complexity in needs (including co-

morbidities and ageing)• Increased public health/community health work• Workplace is more proactive in HIV/SH work

(testing etc.)

Current Pressures in broader nursing that impact on HIV role

Coded themes by frequency;

• Staff shortages and funding issues (including lack of time)

• Lack of knowledge by others I work with (e.g. other staff inappropriately disclosing patient status)

• Keeping myself abreast of changes in knowledge (including lack of patients to maintain skills)

• Increase in HIV rates

• Increased complexity of the disease

• Increases in STI rates

• Lack of leadership and support

• HIV complacency

Current Pressures in the HIV sectorCoded themes by frequency;• Lack of funding• Ageing and chronic care issues (incl. blurred

boundaries of care)• HIV increases in new populations

(CALD, heterosexual)• Clients won’t access GPs for care/not enough

S100 GPs• Fear and ignorance in the community about

HIV• Access to treatments issue (costs/ineligible)• Shortage in workforce of trained HIV nurses

Have the needs of PLHIV patients changed in the last 10 years?

Yes – 84% No – 16%• No = not in field long enough to see change

• Yes (by frequency);• Living longer and negative impacts (MH, ageing)

• Patients have more say and power (educate care provider)• Living longer as a positive outcome (no longer “death

sentence”)• More “maintenance” focus – stable clients• More CALD patients and medication access issues• Fewer resources in regional areas• Increased transmission risk with online sites etc.

How has the scope of practice changed to meet changing needs?

• Very little change in actual practice noted, a strong focus on education

Have your HIV related educational needs changed in the past 10 years?

• Majority noted in relation to co-morbidities knowledge and similar

Implications in the current HIV sector

• The QLD HIV nursing sector has adapted to changes in the area and PLHIV needs over time. There is some question as to wether adapting actual practice (alongside adapting to the new issues by increasing knowledge) is an issue

• With a potential range of new HIV care issues on the horizon (community testing, rapid testing, PrEP, treatment as prevention), the relationship between community and nurses will be even more vital

• Their is scope for HIV nurses and the HIV prevention community sector to engage together even further, with nurses recognising the need for and demonstrating openness to research, involvement in public health work, anciliaryhealth issues (mental health etc.)

Questions?Shaun Staunton – sstaunton@tascahrd.org.au