Empowered Nurses, Improved Patient Journeys

Aim

To determine whether an EPA RN Part A model could safely expand nursing scope to deliver timely minor injury and illness care, increase capacity during peak periods, and strengthen a flexible, sustainable workforce in the Ripley Minor Injuries and Illness Clinic (MIIC).

Outcomes

72 presentations met EPA RN eligibility; 71 completed full episodes of care under the nurse  led model. Service capacity improved during evening peak demand without additional staffing. Five nurses were successfully credentialed and delivered care within existing funding. Nurses reported feeling valued and empowered, with many going on to do further  post graduate studies. Strong multidisciplinary support ensured safe escalation and robust governance. EPA RN Part A has now been adopted as a part of standard practice in the Ripley MIIC, with expansion of model underway.

Background

The Ripley Satellite Health Centre Minor Injuries and Illness Clinic (MIIC) provides a high volume service with a consistent minor injury and illness case mix and unpredictable demand surges. These surges placed pressure on timeliness, patient flow, and service sustainability. Traditional staffing models alone have been insufficient to meet peak demand without additional medical resources, prompting exploration of innovative ways to better utilise existing nursing capability.

The Extended Practice Authority Registered Nurse (EPA RN) Part A provides a regulated mechanism for registered nurses to undertake specified clinical activities using approved health management protocols (HMPs) under the Medicines and Poisons Act 2019 and employer endorsed guidelines. These protocols, frequently aligned with the Primary Clinical Care Manual (PCCM), outline assessment steps, medicines management, red flags, and escalation triggers. This ensured the pilot operated within a robust, clinically governed framework. West Moreton Health participated in the statewide EPA RN Part A pilot led by the Office of the Chief Nurse Officer in partnership with Metro South Hospital and Health Service. Ripley MIIC was well suited to trial the model due to its predictable case mix, protocol driven workflow, and established escalation pathways.

The project aimed to determine whether expanding nursing scope could reduce wait times, increase service capacity during peak periods, and strengthen workforce capability and morale. The pilot was intentionally conducted without additional FTE or funding to test feasibility within existing resources.

Discussion

During the three week pilot at Ripley MIIC, five Registered and Clinical Nurses were  trained, credentialed, and authorised to deliver EPA RN Part A care. 72 consumers were deemed eligible, and 71 completed their full episode of care under the nurse led model. Consumers described care as timely, reassuring, and efficient, while staff reported  increased professional value and autonomy. Improvements were achieved within a lean workforce profile, demonstrating feasibility at current resourcing. Service modelling indicates that a modest increase in nursing labour would enable a substantially higher  proportion of minor presentations to be managed under EPA RN, with measurable gains in patient flow and responsiveness to demand. Following overwhelmingly positive results, EPA RN Part A transitioned to routine practice at Ripley MIIC.

The pilot demonstrated  that a well-designed, protocol aligned scope expansion model can sustainably improve workforce utilisation and consumer experience. Success was underpinned by strong contextual alignment, governance, and workforce engagement. The clinic’s predictable case  mix and protocol based workflow created an optimal environment for expanded nursing scope. Alignment between EPA RN requirements and PCCM based protocols ensured care remained safe, standardised, and replicable. Multidisciplinary collaboration was central  to implementation. Medical officers, nurse practitioners, pharmacists, and physiotherapists provided clear escalation pathways and reinforced medicines governance. Nursing and medical leadership maintained visible support and daily feedback loops, strengthening  accountability and clinical oversight. Nurse engagement was high. Participants reported greater autonomy, professional recognition, and job satisfaction. Several have since progressed to advanced practice pathways, including postgraduate prescribing and Nurse  Practitioner studies, reflecting longer term workforce development benefits.

Consumer feedback remained strongly positive, with reports of reduced waiting times and high confidence in nurse capability. By enabling nurses to complete full episodes of care,  medical capacity was preserved for more complex presentations, improving overall clinic flow. Limitations included the short pilot duration and reliance on a highly motivated cohort within a lean workforce model. Replication in other settings will require  comparable governance structures and appropriate case mix alignment. Despite these constraints, the model has proven sustainable within existing resources and is now embedded in standard practice. Service analysis suggests that even a modest increase in nursing  labour would allow a significantly greater proportion of minor cases to be managed under EPA RN, delivering further improvements in demand management and patient flow. Overall, this initiative represents a practical and scalable workforce innovation that enhances
access, efficiency, and professional capability while maintaining strong clinical governance.

References

1. Queensland Health. Primary Clinical Care Manual (PCCM). Available at https://www.health.qld.gov.au/orrh/clinical-manuals/primary-clinical-care-manual-pccm/view-current-edition

2. Queensland Government. Medicines and Poisons Act 2019. Available at https://www.legislation.qld.gov.au/view/whole/html/inforce/current/act-2019-026

3. Queensland Government. Extended Practice Authority ‘Registered Nurses’. Available at https://catalogue.nla.gov.au/catalog/8609983

4. Queensland Health. Legislation, standards & extended practice authorities — Medicines and Poisons Act. Available at https://www.health.qld.gov.au/system-governance/licences/medicines-poisons/medicines-poisons-act/legislation-standards