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Primary healthcare
Metropolitan Melbourne

I worked as the head of nursing for a large primary healthcare organisation during the pandemic. While we obviously faced many challenges, we were also provided with some opportunities to build our capacity.

As a leader, ensuring all involved in change have clear, consistent and current information on that change is key for success, and as a nurse leader, I pride myself on making evidence-based decisions. During the COVID-19 pandemic, this was difficult. The information was fast-moving, and often contradictory across various jurisdictions and organisations, and access to appropriate equipment and supplies was limited.

In the early days of 2020, I had many conversations with my clinical and non-clinical counterparts about the scenarios we faced and whether we should change or cease certain activities to protect our workforce, patients and other community members. These were difficult decisions to make from both clinical and commercial viewpoints. Often, on implementation, we were challenged by others because the information they had was different from the information that had guided our decisions. This was particularly challenging for me, and I spent a lot of personal time reflecting on my decision making and communication.

Access to appropriate PPE in the primary healthcare sector was a challenge from March 2020. Unlike the government sector, primary healthcare does not benefit from a coordinated supply chain. It engages with vendors directly to procure the items it needs to operate. Our existing vendors were fabulous in working with us in the early days to shore up supply, but it quickly became apparent that their suppliers were unable to meet demand as our needs grew and PPE became part of the everyday uniform for all.

One of my jobs became reviewing proposals from vendors to determine the appropriateness of alternative supplies of PPE. Many memorable proposals came from entrepreneurial individuals who had made quick pivots from supplying non-medical services such as gin, giftware and clothing to offering alcohol hand rub, masks and gowns. I spent much time reviewing infection control guidelines and qualifying products, only for the official advice on PPE requirements to change the next day.

Our senior nurse leaders became responsible for daily PPE stock level checks and supplying our individual medical centres, spending a lot of time updating spreadsheets and driving, instead of providing clinical support. When primary health networks were finally able to procure and supply primary healthcare services with PPE from the government’s national pandemic stockpile, this was welcomed.

Our in-centre nurses were faced with reduced patient presentations as the public grew wary about entering medical facilities, and then as restrictions were placed on face-to-face consultations. For casual nursing staff, this often resulted in reduced hours. For permanent nursing staff, their role pivoted to providing education to our non-clinical staff and even patients on the appropriate use of PPE and infection control.

Primary healthcare services pride themselves on being a great place to work, with a warm friendly atmosphere and close-knit teams. With some staff now working from home and decreased patient numbers attending for in-person consultations, the medical centres often felt quiet and even eerie. Restrictions on the number of people permitted in the physical spaces such as kitchens and tearooms quickly put an end to the social morning, lunch and afternoon breaks that bring colleagues together to share their days.

Vaccination for children and adults is a core service provided by primary healthcare nurses, but when it came to the COVID-19 vaccination, existing medical practices were initially not included in the rollout. With state hubs and health services receiving the initial stock and needing a workforce of immunisation nurses, many of our nursing staff offered to work in those services. However, once the rollout progressed and medical practices were supplied with the vaccine, our experience in this space allowed us to provide this service quickly and efficiently.

A positive result of the pandemic was the changes that were made quickly within the Medicare Benefits Schedule to give primary healthcare professionals access to digital solutions such as telehealth for the first time. The nursing component of our chronic disease management program was swiftly updated to ensure our nurses could connect with patients over the telephone. We recognised that engaging with patients over a phone call was a new skill for our nursing workforce, and our team of nurse leaders was able to provide education and guidance on the technology and communication skills required.

Engaging with patients in this way ensured that their chronic conditions were still being managed. It also meant they had the correct information about the virus and the pandemic and access to support. Nurses reported that they were often confronted with patients proffering various theories and misinformation, particularly in relation to the vaccination. For some patients during the lockdown periods, the phone call with the nurse was the only human contact they had that day.

I would like to think that the pandemic has provided an opportunity to rethink the models and funding of primary healthcare in Australia and to recognise—and make full use of—the value nurses bring to evidence-based, patient-focused solutions.