"Curiouser and curiouser": Is it time for a fresh look at the NP role?

9 March 2015

OPINION: The perpetually curious ANDY McLACHLAN (an Auckland cardiology NP) wonders about sharks in swimming pools and whether it may be time for a fresh look at the nurse practitioner role

Children have an abundance of natural curiosity and my own kids seem to be going through this very important but slightly annoying phase in their lives.

The older one asks about practical – well, sort of practical – issues like: "Dad, why is the sky blue?"; "How do TVs work?"; and "What’s the point of Minecraft?".

My middle child asks more ethereal questions: "Where does the tooth fairy live, Dad?"; "Are there any sharks in the swimming pool?". And my personal favourite (as I wonder this sometimes too): "When will you die, Dad?"

My youngest asks things that perplex him. "Why do you have hair in your ears?" Another favourite is: "Dad, in a fight between you and Superman, who'd win?" He always laughs when I say, "Me, of course!".

But I find myself struggling to give an answer to most of these questions. "No, sharks don’t live in swimming pools." "What about Kelly Tarlton's then," is the quick response. So while I have always known I don’t know everything, I now know I don’t know much about anything. (How does a TV work? Thank goodness for Google!) Luckily, when kids ask questions, they don’t actually care if we don’t know the answer but enjoy learning as we figure things out together.

Curiosity and finding a career path

Like most people, I wandered through my teenage life without too much idea about the wider world or career planning and, to be honest, I didn’t really think at all about the future (except maybe having my own jet pack one day). I look back now and wonder why I didn't invest my pocket money in Apple or buy a 1/4-acre section in Ponsonby. 

In my early nursing career, I continued my fondness for meandering and fell into many temporary jobs in various locations and departments. I was told that I was a “good worker” but had my “head in the clouds”. I thought this was a compliment but apparently curiosity was considered a liability, not an asset. I enjoyed the variety of my early career; I liked the hustle and bustle of acute care, and the stories, funny, sad and inspirational of patients and my colleagues. I also liked being a clinical nurse and developed a lot of clinical experience, skills and knowledge.

It’s difficult to know what I would have been doing if I hadn’t come to live in New Zealand but it was here that I was encouraged (pushed) into postgraduate study. I was a reluctant student at first. Trained in the hospital apprenticeship model, I had never written an assignment in my life and my earlier curiosity had been dampened by too many years of being taught to "do what you're told". But slowly I began to learn about new and exciting ways of nursing and I began to enjoy this new studious me. (Though I still struggle to see the point of all that formatting in referencing and sadly most nursing research methodology still leaves me bewildered; hermeneutical phenomenology anyone?)

 Struggling along the vague path to NP status

Like my kids, as I learned and read more widely, my thinking changed. I began to develop a new passion for nursing and its role in delivering effective, innovative and quality health care. I read all I could about the nurse's role in supporting health and became convinced that the nurse practitioner scope was the ideal model.

My journey to become an NP myself was a struggle; the vagueness of the process overwhelmed me at times. I became very aware that a prevailing perception was still stuck on what nurses currently do, rather than what NPs could offer.

Luckily my NP peers were incredibly supportive. These 'early adopters' were passionate and driven individuals who had carved their roles out of nothing, convinced others of the value that NPs could add, and often created new bespoke models of care. I was also lucky to have a very supportive team, including the service manager, senior nurses and doctors who backed me to the hilt. However, I'm not sure if I would have received the same level of support if my choice of NP role was in a less specialised and broader area.

Barriers to NP roles still remain; fresh look on way?

In my DHB another 17 nurses have completed their clinical master's degrees since I qualified as an NP more than five years ago, but none have been able to develop an NP role. Too many barriers remain, preventing skilled and passionate nurses becoming NPs and it's clear that those in DHB leadership have not embraced the potential advantages of an NP workforce.

An NP isn’t just an expensive nurse, it is a way to expand capacity to care for an increasingly complex population. It’s interesting that primary care leaders are almost falling over themselves to open the door and fund the development of physician assistants but struggle to provide the same level of support for NP placements. If we all agree that we need more NPs in primary care, then we need to ensure the training needs of NPs are more closely aligned with patient and employer needs and less with the generic clinical masters’ process.

I'm hopeful that the Nursing Council's recently completed consultation process on broadening the NP scope – along with developing new clinical learning time and set programme outcomes – may make a difference.

I'm hopeful that it may open the door to a growing band of nurses curious and ready to learn. A band of nurses filled to bursting with experience, enthusiasm, skill and desire to be part of (or lead) a better system than the current one where each potential NP has to reinvent the wheel again and again.

It’s time for a fresh look at the role of the NP – who is with me?

P.S. Has anyone seen my ear hair trimmer?