Training of most NPs still being done 'on a shoestring'

18 May 2017

Nurse practitioner training shouldn't still need to rely on goodwill and keep facing funding uncertainty, say NP training providers.

Dr Jill Wilkinson, a spokesperson for one provider, expressed frustration that more than 15 years on since the first NP was registered the majority of the country's highly qualified nurse practitioners were being trained "on a shoestring" compared to the funding given to train a GP.  "And on the back of a whole lot of goodwill from our medical colleagues and our nurse practitioner colleagues – who are just kind of making it (NP training) happen."

Last year's pilot of a fully funded and structured training and employment programme for NPs (see other story) was extended this year for a further 20 NP trainees.  But whether the Nurse Practitioner Training Programme (NPTP) will be continued in 2018 – and eventually widened and rolled out to all eligible NP trainees and NP training providers – remains unknown at this point. 

Dr Michal Boyd and Dr Jill Wilkinson – spokespeople respectively for the NPTP pilots at the University of Auckland and Massey University – expressed frustration that they had no indication yet whether they could plan ahead for NPTP in 2018 with a decision dependent on an evaluation due to be completed on August 31 2017.

The Health Workforce New Zealand funded the initial $846,000 pilot of the 10-month programme last year and the follow-up cohort this year with the pilot including dedicated funding to reimburse employers for the two days a week supervised clinical practice time required under NPTP (in return for offering a guaranteed NP position on registration). The majority of NPs registered last year were not part of the NPTP scheme but most were eligible for standard training subsidies from the HWNZ postgraduate nursing funding pool that is administered by their local district health board. 

Paul Watson, HWNZ workforce strategy and policy manager said HWNZ had now invested $1.6 million in funding two cohorts of the NPTP with the aim of training more NPs, supported by their employers, to become registered and working NPs.

He said it was important that HWNZ evaluate the impact of the investment to make sure it was achieving the desired outcomes.

HWNZ was in process of selecting an evaluator to: determine the overall effectiveness of the revised programme and identifying implementation issues and challenges and possible improvements.  At the same time the evaluation would carry out a 'comprehensive comparision' with the alternative pathway to the NP qualification that was partly funded through the HWNZ postgraduate nursing fund pool.

Watson said the evaluation was expected to be completed by August 31 and it would then be in a position to make a decision about the future of NPTP funding.

Wilkinson also said meeting the new Nursing Council NP education programme standards made offering the clinical masters programme much more expensive as – unlike the NPTP pilot - the normal university funding did not cover the cost of the clinical practicum hours required and the amount of HWNZ training subsidy passed on to employers differed from DHB to DHB. "It is going to be difficult to offer the programme to non-NPTP students," said Wilkinson.  She said students required site visits and NP academic supervision which could be expensive and time-consuming – particularly in isolated rural areas.  "Obviously we want more NPs in rural areas but that comes at a cost – and the current funding doesn't cover it."

Pam Doole, strategic policy manager for the Nursing Council, said it had set a minimum of 300 clinical hours as part of the new NP education standards in response to NP feedback over a number of years that they wanted to see more clinical education as part of the clinical masters' programmes.  She said the 300 hour minimum clinical practicum was less than the 500 clinical practice hours required by the pilot Nurse Practitioner Training Programme (NPTP).  (The pilot requires two clinical practicums – 250 hours in prescribing in advanced nursing practice and 250 hours in advanced diagnostic reasoning and treatment planning.)

"We did get a lot of feedback from our submittors who were concerned about the funding of those (300) hours," said Doole.  Also questions about the provision of supervision and release time for the staff involved.

She said the Council had to be aware of potential barriers when it sets education standards and it had passed on the feedback to Health Workforce New Zealand, which provides funding subsidies through its postgraduate funding pools

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