Broader NP scope out for consultation

10 December 2014

Nurse practitioners could better evolve their practice to meet community needs if a proposed generic scope of practice goes ahead, says Nurse Practitioners New Zealand chair Jane Jeffcoat.

She was responding to a consultation document released by the Nursing Council this month proposing not only new scope of practice for NPs but also a dedicated qualification for the training of NPs (see summary points below).

The Nursing Council in the consultation document acknowledges that the number of NPs registered was slow to start since the role's introduction in 2001 but it was now registering about 17 NPs a year with 136 NPs actively practising in August 2014.  It also acknowledged NPs were still facing some "systemic" barriers, which the Council could not address, but the Council could review the scope of practice and qualifications to ensure they were still relevant. 

The Council was proposing a new generic scope that could be flexible to meet health needs and also differentiate the NP role from advanced registered nurse (RN) roles. (See existing and proposed scope below.)  It added that "considerable support" had been expressed during the "pre-consultation" process for a "more generic, streamlined nurse practitioner programme with greater clinical content, mentor support and clinical learning time".

Jeffcoat said NPNZ had been consulted by the Nursing Council, along with other stakeholders like employers and education providers, in the lead-up to the release of the consultation document.  NPNZ and other nursing organisations would now be consulting their members to put together submissions on the council's proposals to meet the end of February deadline.

But Jeffcoat said proposing a broader generic scope of practice would allow NPs  - in the same way registered nurses do now – to consolidate and build their knowledge and skills and develop their practice further to meet patient needs. It was also understood by NPs that if they were to widen their original area of practice then they needed further training and mentoring to ensure their practice was underpinned by the appropriate expertise and depth of knowledge. She added that too narrower a scope of practice could decrease NPs ability to meet the changing needs of their client population.

Sharon Hansen, a rural NP and deputy chair of the Rural General Practice Network (NZRGPN), said the consultation document's proposals were significant for rural health providers and the communities they served.

She said the direction taken by the Council had potential to be positive for the rural sector "however care must be taken that the workforce is fit for (rural) purpose."

 "The rural sector has, by way of isolation and distance from support services, it's own challenges," said Hansen. "Any broadening of the scope requires rural specific clinical skills, and support and mentorship for nurses working in advanced prescribing roles." 

"The changes in education have been a long time coming and are absolutely needed," said Jeffcoat.  "One of the reasons why I think NPs have struggled for recognition is because the way we become a nurse practitioner has been a little bit ad hoc and different to how other health professionals train or even as a registered nurse trains."

Jeffcoat believed the training process needed to be specific and clear so NPs weren't regarded as an "RN with additional experience and does some postgraduate papers".

"We need to actually clearly articulate that what makes an NP different really is that we meld medical and nursing practice. And we shouldn't be afraid to say that," says Jeffcoat.  "Because in the past we've tried to 'nursify' so much of what we say we do; whereas the reality is that there is knowledge now that we have that was previously the sole domain of medicine."

She added this not did not mean that NPs were in competition with doctors; instead the NP workforce was helping meet unmet community needs.  "Nobody is sitting around twiddling their thumbs – everybody is busy enough."

“The healthcare workforce is getting busier, older and more pushed to provide services to an increasingly more complex population," said Jeffcoat. "NPs are doing that and the proposed changes will further support us to better articulate that.”

Hansen said there was much to be recommended in having a dedicated NP masters programme with specific learning time. "The devil will be in the detail as to how this might work for rural nurses."

Changes proposed to the leadership requirements for nurse practitioners were also welcomed as Jeffcoat said it was "very, very hard" for all NPs to tick leadership in all the areas at a local and national level.  "Some of us are more involved in education than others and some are more involved in management than others. We probably all do it (leadership in all areas) in a small way but it's just not the bee-all and end-all of our practice because being a NP really is about providing that expert clinical care."

Hansen agreed saying that the nurse practitioner role was by its very nature a clinical role so it made sense to focus the leadership requirement on clinical. "However the nurse practitioner voice is needed as the role develops in a New Zealand context, in many areas," added Hansen.

Main changes proposed to NP scope:

  • Shift from restricted, specific area of practice to broad generic scope of practice (like registered nurse)
  • The inclusion of "advanced nursing skills and knowledge" in the NP scope to help differentiate from the RN scope, which now also can include prescribing and assessing
  • New NP scope to require narrower focus on leadership within clinical practice rather than current broad leadership requirements on local and national level
  • Introduction of dedicated Masters degree programme for NPs with specific clinical learning time requirements and set programme outcomes
  • Suggestion that new Postgraduate diploma in RN prescribing for long term and common conditions should be prerequisite for NP Masters programme.

Submissions on the consultation document close on February 27.  The full document can be downloaded here

NEW PROPOSED SCOPE of PRACTICE for NPs

Nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practice beyond the level of a registered nurse. Nurse practitioners provide a wide range of healthcare services to people and communities, including the diagnosis and management of common and complex medical conditions. Nurse practitioners may work autonomously and in collaboration and consultation with patients and with other health professionals, including medical practitioners to provide and improve access to coordinated, comprehensive, quality health care. Nurse practitioners may manage episodes of care and may be the primary care provider or work as part of a team.

Nurse practitioners blend diagnostic inquiry and therapeutic knowledge and skills with nursing values, knowledge and practice to provide holistic, patient centred, innovative and flexible care. They provide a wide range of assessment and treatment interventions, ordering and interpreting diagnostic/laboratory tests, prescribing medicines, administering treatments/therapies, admitting and discharging from hospital and other healthcare services/settings. They work in partnership with individuals, families, whānau and communities across a range of settings. Nurse practitioners may work with a specific patient group or community and may work across health settings and teams. They promote health, prevent disease and manage people's health needs.

CURRENT SCOPE of PRACTICE for NPS

Nurse practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills. They practise both independently and in collaboration with other health care professionals to promote health, prevent disease and to diagnose, assess and manage people’s health needs. They provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering, conducting and interpreting diagnostic and laboratory tests, and administering therapies for the management of potential or actual health needs. They work in partnership with individuals, families, whānau and communities across a range of settings. Nurse practitioners prescribe medicines within their specific area of practice. Nurse practitioners also demonstrate leadership as consultants, educators, managers and researchers, and actively participate in professional activities, and in local and national policy development.