They provide a wide range of assessment and treatment interventions, including
This has all been possible through a change in nursing education which allowed access to education that was previously the domain of medicine. It has enabled them to provide healthcare that is not only complementary and supportive to their medical colleagues but able to offer an alternative to a medical practitioner.
In the Waikato, several nurse practitioners are employed by Waikato District Health Board both in hospital-based and community-based roles, and others are employed by primary healthcare organisations. Nationally, the number of nurse practitioners now exceeds 130 and is increasing all the time.
Nurse practitioners are not new, having been registered in NZ for over a decade. Internationally they have been meeting the healthcare needs of communities in Canada and USA for over 30 years and in Australia and UK for a similar time to NZ. Nurse practitioners (NPs) are Masters prepared advanced clinical nurses who work within broad areas of practice incorporating advanced diagnostic knowledge and skills into their practice.
Previous legislative changes and amendments have enabled Nurse practitioners to work in an advanced Scope of Practice that is unique and separate from registered nurses.
The Medicines Amendment Act 2013 and Misuse of Drugs Amendment Regulations 2014 which took effect from 1 July 2014, makes nurse practitioners authorised prescribers.
After a long consultation process the changes to the Act will allow nurse practitioners to work to a fuller extent of their Scope of Practice. This means they can now prescribe medicines under the same conditions as their colleagues in medicine. Prior to these amendments nurse practitioners were designated prescribers working to a list of medications which over time became outdated.
The support for the changes came after robust consultation where submissions on the proposed amendment to nurse practitioners’ prescribing noted the autonomy and specialised experience of this professional group, and the training and skill required for registration. Most submitters acknowledged that amending nurse practitioners’ prescribing of controlled drugs will improve access, timeliness and quality of care, and be more cost effective.
The 1 July 2014 changes will further enable nurse practitioners to meet the needs of their patients.
NPs work in many different areas of practice across hospital and community settings. A NPNZ 2012 study of nurse practitioner practice in NZ highlighted that initially NPs were concentrated within the hospital setting with few in primary health care. Over the last few years we have seen a shift from secondary services to primary health care and aged care/older adult in response to meeting government and DHB health targets. Some of the influencing factors are fewer doctors especially in general practice and rural, an aging health workforce and aging population living longer.
Nurse practitioners have proven their value added not only in their ability to manage patient care but also provide leadership and mentorship to the nurses around them, lifting the capacity of those nurses to provided better healthcare to their patients. In addition NP’s are involved in research, scholarship and management being represented on many national working groups and advisory boards. They offer a lot of bang for the buck being able to contribute both as nurses as well as having the perspective of independent healthcare practitioners.
Jane Jeffcoat Nurse Practitioner
Chair Nurse Practitioners New Zealand (NPNZ)
The nurse practitioner is the most senior clinical role with its own defined scope of practice. Their ability to diagnose and then set treatment plans for that diagnosis has been demonstrated through research to be accurate and highly effective. The nurse practitioner provides highly skilled and knowledgeable nursing services to patients that makes a difference to their experience and outcomes.
In the Waikato we have slowly grown the number of nurse practitioners and now they are found in areas of health disparity as identified in the Waikato DHB Annual Plan. The nurse practitioner spans the boundary of the populations they provide care for across primary and secondary health sectors.
- Sue Hayward, Director of Nursing and Midwifery, Waikato District Health Board