Nobody expects a trainee surgeon to organise their own education. But up to now would-be nurse practitioners largely had to take a DIY approach. The Nurse Practitioners Advisory Committee wants this to change.
FIONA CASSIE finds out more about what an NP ‘registrar’ programme could offer
To become a nurse practitioner in New Zealand involves jumping through many hoops.
Until recently most NPs had to go it alone so it is not surprising a number tripped, stumbled or gave it away.
Over time informal support networks have developed and there has been increased financial support for postgraduate study. But it is still largely up to the individual to track down and organise the clinical training needed to become Nursing Council-approved NPs.
The Nurse Practitioners Advisory Committee wants this to change and has been working on guidelines for a two-year funded ‘registrar’, ‘candidate’ or ‘intern’ programme.
The proposed programme would take an NP candidate, close to completing their masters degree, and provide them with the clinical supervision, specialist expertise and work experience to challenge, develop and fine-tune their clinical and leadership skills.
The programme is being fine-tuned by committee chair, diabetes NP Helen Snell and builds on the experience of her own MidCentral District Health Board’s NP candidate programme and Waitemata DHB’s NP intern programme.
One of MidCentral’s candidates – Pauline Giles – is now one final hurdle away from becoming an NP – a Nursing Council panel interview.
The diabetes nurse had just begun her masters degree when MidCentral advertised the NP candidate position in diabetes. Deciding she might as well go as far as she could in her chosen field, Giles successfully applied and found herself on the NP path.
The difference for her was that she was not alone on that path – the position came with its own built-in mentor, Helen Snell plus endocrinologist Paul Dixon and a network of NPs within a supportive DHB.
She says being an NP candidate has given her the motivation needed to complete her masters degree and then her NP portfolio while working full-time and honing her clinical and leadership skills. “It’s developed my clinical skills immensely having the ongoing support of Helen Snell and Paul Dixon,” says Giles.
The other NPs at the DHB also met with her regularly – initially fortnightly and then weekly as they critiqued and advised her while compiling her application portfolio. With her portfolio now having passed the Nursing Council desk audit, the NP team are helping her polish up her panel presentation, including facing a mock panel interview. Having already sat in on somebody else’s mock panel she laughs that her colleagues may perhaps be even tougher than the real thing.
“It (being a candidate) made the whole goal a lot more achievable,” says Giles. “I think it would be a huge struggle to do it entirely on your own without direction.”
Snell says when Giles came on board she stepped into a clinical nurse specialist position but with the special recognition that she was an NP in training. That meant support for her to complete her masters and special release time for her to attend national meetings or conferences and take on new roles outside of the DHB. “Developing that political savvy that is an important part of meeting NP competencies.”
But the programme’s particular focus is on developing clinical practice skills particularly in assessment, diagnostic reasoning and prescribing.
Snell’s role was not only as a mentor and clinical supervisor. As nurse leader she negotiated placements to ensure Giles had clinical experience across the lifespan and across practice settings including outpatient, inpatient and people’s own homes. Not to forget working and networking with the wider multidisciplinary team and across specialities that diabetes patients can be involved with, from renal to respiratory. Which all has to be balanced with ensuring services to Giles’ and Snells’ diabetes clients continue to be delivered.
So while it might be better than going it alone, providing and being on a NP programme is still no picnic.
Or as Waitemata aged-care NP Michal Boyd puts it, NP interns or registrars still need to “work their guts out”.
Waitemata used the now-defunct NP innovation grants to offer two aged-care >> NP intern positions in 2007 – one in its Assessment, Treatment and Rehabilitation (ATR) service and one in its community service. The latter – Janet Parker – has recently gained NP status and the former is finishing her portfolio.
With the ATR intern programme came access to not only building clinical skills under supervision of a geriatrician and carrying out a prescribing practicum but also access to weekly teaching and journal clubs, a weekly advanced nursing education forum, weekly case review forums, and weekly clinical supervision under a gerontology GP.
Boyd says creating intern positions ensures everybody is on the same page about the role from top management through to the clinical team. The employer has already created an NP position for the intern to step into on registration, they support the training process and by registration the interns are already working, under supervision, at an NP level.
This means there is none of the ‘confusion’ she has seen arising for some would-be NPs expected to carry out their existing clinical workload as well as stepping up into an advanced role, without employer support or an NP job at the end. “To do it without support is asking too much,” Boyd says.
MidCentral and Waitemata’s programmes got off the ground because they had people with vision who got management and consultants on board. But having a funded national programme could open up opportunities for other keen people to foster NP roles in their workplaces.
An evaluation of the Waitemata ATR intern programme found that by working with an NP intern other members of the multidisciplinary team gained an understanding and appreciation of the role and the intern’s skills and expertise.
And more understanding means more groundswell for building the NP workforce at a faster rate than the previous decade.
NPAC hopes that a ‘registrar’ style programme could remove some of those hoops – both funding and logistical – discouraging nurses and employers from trying the NP journey for themselves.
