Staff perceptions of the potential for nurses to address service gaps within a homeless health service in Sydney, Australia: Results of a cross-sectional survey

Background

People experiencing homelessness face significant health disparities and higher rates of morbidity and premature mortality, resulting in increased demands on the acute health system. Nurses have a key role in supporting vulnerable populations to access appropriate care.

Aim

To determine if increased service demand might be addressed through expanding nurse-led services and further developing the roles of nurses within the Homeless Health Service.

Methods

A 14-item cross-sectional survey was designed to obtain the views of staff employed by a Homeless Health Service (n = 50) in nursing and non-nursing roles. Quantitative data were analysed using descriptive statistics and nonparametric tests. Qualitative data were analysed thematically.

Findings

Seven of the 20 respondents were from nursing roles, and the remainder were from non-nursing staff including physicians, allied health personnel, and peer workers. Respondents identified service gaps in the Homeless Health Service that nurses could potentially address by optimising the scope of practice in physical and mental health assessments and referral pathways. Most (95%) pledged in-principle support for enhancing the nursing role within the Service. Qualitative themes were falling through the gaps, resourcing and workforce, and collaborating with other care providers. Solutions to improve access to care included outreach clinics, mental health and chronic disease management, advanced nursing roles, crisis teams, and specialised care for older clients.

Discussion

Awareness of service gaps and ways of improving access to care is critical and may facilitate the implementation of other strategies to better meet client needs. However, issues including funding and eligibility for health care are beyond the influence of nursing scope of practice.

Conclusion

Study findings indicate strong support for optimising the scope of nursing roles through improving client access to assessment, treatment, education, support, and referral. More specifically, outreach health support, mental health assessment, and enhanced provision of after-hours care were noted as key areas that could be enhanced through optimisation of nursing scope.