Shaun Staunton (Tascahrd) reports on a Qld study of HIV nurses and recommends that HIV nurses could play a greater role in HIV health promotion and prevention. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.

1. Who is a HIV Nurse?
The picture now and into the
future
Shaun Staunton
Chief Executive Officer
Tasmanian Council on AIDS, Hepatitis & Related
Diseases
Adjunct Associate Lecturer, University of Queensland

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Workload

10. 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

11. Workforce Skills
0 – 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
70
60
50
40
age
HIV knowledge
30
HIV skill
20
10
0
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

12. 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.”

13. 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.)

14. 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

15. Current Pressures in the HIV sector
Coded 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

16. 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.

17. 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

18. 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, anciliary
health issues (mental health etc.)

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