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Sharon Hansen, NP and deputy chair of the Rural General Practice Network (NZRGPN) responds to nurse leaders concerns about barriers to NP practice in rural areas being created by new definition of general practice team

The contracts being negotiated as part of the PSAAP process rightly recognise that a general practice team requires patients to have access to both medical and nursing care. Nursing organisations have long argued that Nurse Practitioners are not doctor substitutes; they are expert nurses who bring their own body of knowledge into the patient interaction. (see also NP barrier story)

NPs use some skills that were previously the preserve of the medical profession, to enable positive outcomes or resolutions for patients, and their families, to their health issues.

There are many different models of care in rural New Zealand. These have evolved in response to available resourcing in consideration to the needs of the communities. Often the first port of call is a nurse, who may or may not complete that episode of care themselves. Nurses have a long history of collaboration that has enabled evolution of systems, which furthermore enable care. The frustrations have been the current law and the existing funding contracts, which have historically been the barriers.

In rural areas nurses and doctors have struggled with the burden of professional isolation and lack of collegial contact. In response to this isolation is the example of interdependent practice, which transcends the doctor/nurse divide, where both parties use and respect each other's expertise in providing patient care.

The impending contract ensures that patients will have access to the expertise that both nurses and doctors bring to general practice. There are no constraints on the business ownership model.

While it is the feeling of rural nurses and nurse practitioners that we wish to maintain "ownership" of our knowledge and expertise, and maintain our professional autonomy of providing care, we want patients to have access to the most skilled health professional for their circumstance. Clinical autonomy should not be confused with clinical isolation and collaboration should not be confused with clinical control.

May 15 2014