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LIZ MANNING and JENNY CARRYER reflect on the journey to date to establish nurse practitioners (NPs) in New Zealand, plus they report on a new project to support NP supervisors and mentors in their essential role of training future NPs.

As many know, it has been a long and arduous journey spearheaded both by the brave pioneers who achieved nurse practitioner (NP) status early on, and the back-up work of a range of nurse leaders. Reaching the tally of 200 New Zealand NPs is now in view – especially as the 23-strong cohort currently undertaking the first dedicated funding NP training programme (being delivered by Massey University and The University of Auckland) is due to complete and apply for authorisation at the end of this year.

There have been NPs in the United States for more than 60 years and in New Zealand and Australia for nearly 15 years. Numerous international studies have failed to show cause for concern. In fact, studies show that NP care is safe, cost-effective and garners high levels of patient satisfaction and improved adherence to healthy behaviours. Studies also show that NPs refer their patients in the same manner as GPs to ensure that the correct level of care is received in a timely manner and follow-up care is provided.

Debunking the myths

One of the most difficult challenges faced along the way is the persistence of myths or misinformation about the safety and legal capacity of the NP role and also the processes for funding and employing an NP.

To this day, general practitioners are reported as saying that they would like a nurse practitioner in their practice, but cannot possibly afford to pay them. This is odd given that an NP who chooses to work in general practice is able to be income-generating through the same sources of funding as a GP; using the 70 per cent government funding of general practice services and the associated fee for service.

It is to be hoped that DHBs and PHOs will soon look more closely at this relatively inexpensive fit-for-purpose role as a highly effective solution to the many challenges facing the health sector. That many more are now doing so is shown by the increasing number of advertisements for NPs being placed on the College of Nurses website.

However, there are few fully fledged, unemployed NPs waiting for such positions. So services need to look to ‘grow their own’ by providing encouragement and appropriate leave for a locally based nurse to complete a master’s degree and full endorsement by the Nursing Council as an NP. Notably, many nurses have already completed the master’s degree and are looking for active encouragement, relevant practice experience and a prospective position before seeking full authorisation.

Support on way for NP supervisors and mentors

To foster the support and development of NP candidates, the College of Nurses has been focusing on a new project that aims to provide information and resources to the often under-supported individuals who are vital to the continued development of New Zealand’s nurse practitioner workforce –  that is, the NP supervisors and mentors.

Focus and attention on NP workforce development has often been on the academic preparation, service configuration, funding and portfolio development. In late 2015, the executive members of the College of Nurses, Aotearoa (NZ) and Nurse Practitioners NZ discussed the need for resources that could quickly, concisely and effectively inform practitioners – both physicians and NPs – who are approached to be supervisors or mentors of  intern NPs.

The resulting project has been underway since mid-March and has a strong project team sponsored by the College’s executive director Professor Jenny Carryer, with Dr Mark Jones as the project lead. The project team has representatives from the Nursing Council, NPs (including NPNZ chairperson Jane Jeffcoat), postgraduate academic staff, a general practitioner and a College administrator. Alongside the project team are some key sector experts who will bring different sets of skills and knowledge to the project.

The aim is to develop a suite of online resources that will be publicly available to concisely deliver some important messages about becoming an NP intern supervisor or mentor to health professionals working in varied organisations, such as DHBs and GP practices. These will include:

• the NP intern supervisory process and how to best observe and facilitate reflective practice
• NP scope, domains and competencies: reviewing the scope and the requirements of advanced practice
• NP application process: evidential requirements
• prescribing practice: reviewing practice against prescribing competencies
• employing NP interns: contractual requirements.

The resources will be multimedia: a mix of short video clips, web links, key documents and guidelines. Tanya McQueen, director of Global Spirit Films, is filming and editing the video clips.

The project aims to have resources up and running on the College website by mid-2016.

More still to be done

Supporting mentors and supervisors of NP candidates is a very important part of building this workforce. It is, however, only part of the process. Much work remains to be done to ensure that lingering barriers to NP practice are eradicated and that no new barriers are created through ignorance or invisibility.

It is also to be hoped that our medical colleagues will put aside their expressed concerns and focus on the strong evidence showing that NPs are a cost-effective and completely safe way of ensuring that the best possible services are available to all
New Zealand individuals and communities – regardless of postcode. :

AUTHORS: Professor Jenny Carryer is the executive director of the College of Nurses and Liz Manning is a consultant and College of Nurses board member.