What did you think of the Nurse Practitioner Training Report (NPTP) evaluation report findings?
It is certainly heartening to see that there were very high completion rates and high pass rates. It is a tough course and anyone who has done the prescribing papers will tell you that.
I think the report has pretty much hit the nail on the head. The tying of entry onto the course with a job at the end, has no doubt inspired those on the course and got employers to think about the business case before the person graduates.
I completed the pathway far faster than my DHB thought and I had to wait 13 months between becoming an NP and starting in the role.
It should also be noted that the NPTP had students from across New Zealand – from Dunedin to Kaitaia, and that about 50% of all students were from primary care settings, which mirrors the distribution of NPs in the work place. The funding following the student (rather than the usual bulk funding to DHBs for prescribing practicums) promoted more primary care NP Interns and those from rural areas, which is where the demand will be.
One thing that needs to be considered is the evaluation report noting the disparity between employers noting changes in confidence and competence in the NPTP graduates despite the graduates own self-assessment being tougher on themselves.
For me, as Chair of NPNZ, I am always struck by the humility of NPs and by their awareness of the enormity of the responsibility on their shoulders, so that finding did not surprise me. NPs are good at knowing where their boundaries are and knowing what they don’t know.
Do you think the NPTP scheme should expand both in numbers and providers i.e. beyond the current two providers (The University of Auckland and Massey University) and 20 funded places.
We are a long way short of the numbers of NPs estimated to be needed to cover the delivery of healthcare.
For example Nelson/Marlborough District Health Board has gone from ‘half’ an NP (0.5 fulltime equivalent) to nine NP FTE in two years, and still needs to grow more to meet the needs of the community.
We also have to factor in that we are 17 years in from registering the first NP so now those experienced RN’s who became NPs will be starting to retire, and the issue of succession planning needs to be considered.
I would be keen to know if the subsequent courses were over-subscribed. The aged care and primary health sectors will continue to grow and place heavy demand on health services.
We are still in the situation of that if you want an NP then you must grow your own. I am not sure we will ever get to the point of over-producing NPs – even if we add an extra 10-20 NPTP places. Alongside the NPTP cohort are students on the usual Health Workforce New Zealand (HWNZ) pathway but they don’t have to have an employer agreement for a job at the end of their clinical masters’ degree.
In terms of providers I did my clinical papers in Christchurch so think it would be good to see a South Island provider. We are a very rural and remote populace on the whole and there are opportunities for NPs out there.
What did you think of the evaluation’s comment that an ongoing barrier to the NP workforce is “lack of awareness, understanding and acceptance of the NP role”?
It always takes a new role time to bed in.
We are looking at a health system that has been around for a while and the role boundaries have been very fixed for a long time; so the media, the general population and even the health system will be challenged in how to best manage, support and utilise this new resource.
Within Southern DHB (where I am based) we have a development group, this initially was for NP role development and has now expanded to look at the opportunities for RN prescribing.
Workforce development and funding has been a little too much based on historic service delivery and also on the personalities, personal preferences and effectiveness of those in the senior nursing roles. I would like to see a more analytic approach to that.
The Ministry of Health are doing great work, their release of the factsheet, Nurse Practitioners In New Zealand in October 2017 helped clarify what we do.
The work of the Nursing Council on the NP competencies and broadening the scope can also not be under-rated. That work, along with the work on registered nurse (RN) prescribing, has opened clear paths for those nurses who want either a narrow, often disease-specific focus, or those who want a broader focus with the authorised prescribing responsibilities of the Nurse Practitioner.
The work Nursing Council did on streamlining portfolios was of immense benefit for those coming through, it was seen by many as one hurdle too many and often the size of the task was over-estimated as there wasn’t much guidance.
The Nurse Practitioners New Zealand (NPNZ) group are constantly working on those issues and barriers. Often with those institutions outside of health they do not know what NPs are or what we do. When we talk to them they usually get it and the barrier – to our practice and also to the patient getting an equitable service – disappears.
Within the last year we have seen national meetings held for the mental mealth NPs, the emergency department NPs and soon the haematology/oncology NPs are having their first national meeting too. We have also been working on getting the regional NP support groups going (this remains a work in progress) in order that support and mentoring is available not only for NP graduates but also those on the pathway.
Another issue raised in the report of interest was that providing clinical supervision for GP registrars’ pays more and – when we look at the disparity in HWNZ funding between medicine and the other health professions – it is not hard to see why that is.
This is the same issue with continuing education for nurse practitioners there are no real postgraduate courses aimed at qualified NPs.
NPNZ has been having discussions with organisations that provide medical postgraduate education around accessing resources, as NPs need to know pretty much the same things. Those discussions have been very productive, but like any paradigm shift it takes time.
It was disappointing, but not unexpected, that the recent New Zealand Nurses Organisation/DHBs MECA negotiations didn’t make progress on continuing education money. Because the NPTP evaluation report accurately stated there is a disparity between access to continuing education between DHB and non-DHB employees, between DHBs, and also between NPs and our medical colleagues.
NPs are expected by Nursing Council to keep up to date, but with no resources and no funding this is difficult.
Another avenue through which this issue can be addressed is via the Health Practitioners Competence Assurance Amendment Bill, as Clause 27 of the bill currently before parliament “requires an authority to promote and facilitate interdisciplinary collaboration and co-operation in the delivery of Health services..” This would include the Nursing Council and Medical Council, amongst others, promoting interdisciplinary collaboration.
Any other comments on the report or the Ministry of Health’s request for feedback on how to develop the role of NPs?
In terms of the mentoring, the College of Nurses have produced some great resources. Also as we have just short 300 nurse practitioners with a current annual practising certificate (APC) we will have more NPs available for mentoring nurses on the NP pathway.
The issue of back-filling is an interesting one, not only do people struggle while on the NP pathway, but also once they are an NP.
In primary care NPs, on the whole, are employed to help make money for the business, so time off for peer groups, supervision or training is an issue. Again that would require funding to deal with that issue.
This is also an issue in secondary care- there aren’t the NPs to take over from you if you want a sabbatical or are sick.
This may improve as the numbers build.
One colleague stated that there was also no evidence of the mentioned honorarium for NPTP clinical supervisors being paid? There is also a time impact on the clinical supervisors involved in training NPs which I wonder whether is fully acknowledged?