Ngaruawhia-based Thurston came to Plunket 10 years ago as a new graduate and currently works four days a week as a Plunket nurse and one day at the Teen Parent Unit at Fraser High School where she works with another NP, Janice Wotton.
Plunket chief nurse Dr Jane O’Malley said it was an exciting time for Karen and her community with the new NP able to directly affect the outcomes of those whānau most in need in her community.
Thurston said she had seen many changes in communities since becoming a nurse.
“There is an increased level of need, and the disconnect between families and their community is leading to greater feelings of isolation and social anxiety.”
She said she was grateful for all the support from her family, Plunket and the local community while completing her master’s degree, including mentoring support from a local doctor. Thurston recently received the Margaret May-Blackwell Fellowship Travel and Study Scholarship from the NZNO.
Plunket has over 498 registered nurses, 390 of whom have undertaken postgraduate study and 76 are currently completing a postgraduate certificate in primary health nursing (delivered by Plunket in partnership with Whitireia Polytechnic to develop the Well Child Tamariki Ora nursing workforce).
“The potential to develop the nurse practitioner role within Plunket is something the organisation is definitely interested in exploring,” said O’Malley.
]]>Marlborough nurse practitioner Diane Williams told Clark she would like to see a commitment from the Ministry of Health to ensure that Health Workforce New Zealand (HWNZ) saw the value of NP skills and capabilities and increased the number of funded places on the NPTP programme (see more below).
She also said that more local research was also needed to explore the difference that NPs working in general practices can make in primary health care.
“I know I’m preaching to the converted for GPs who do use our services,” said Williams. “But we really need the research to convince other places to use our skills.”
Clark said he would take on board the comments saying he had seen and heard of “plenty of examples where nurse practitioners were being used to great effect”. “I also know that Heather Simpson (chair of the Health and Disability System Review) is very interested in different models of care that are being offered.”
He said the Health Research Council has commissioned a research evaluation of primary care and the models being used but he was also aware of some of the challenges the NP workforce faced in building a workforce from a small base – particularly in DHB regions where there are few NPs practising.
“And I’m personally absolutely convinced of the value of growing our nurse practitioner workforce.”
Clark also called on NPs, GPs and other health professionals to share “early” and “often” their challenges and solutions to the Simpson-led Health Review.
There are currently 318 nurse practitioners with annual practising certificates – up on 299 in mid-March this year.
Update on NPTP
Earlier this year the Ministry of Health released a positive evaluation report of the first cohort of the Nurse Practitioner Training Programme (NPTP) and sought feedback on whether to expand beyond the current 20 places a year.
The Ministry has reported back that Health Workforce New Zealand is intending to put the NPTP out to competitive tender – probably at the end of this month – after the majority of the 29 submissions called for the programme to be expanded. There was also general agreement on the importance of sustainable funding including funding for release time, travel, accommodation, and ongoing education. Plus targeting entry into the programme for Māori and Pacific nurses. It is not known yet how many NPTP places would be funded for 2019.
The evaluation report looked at the 19 nurses who were part of the first fully-funded NPTP cohort in 2016 (18 of whom gained registration as NPs) and compared them with 49 recently registered NPs who had gained registration through other pathways – mostly through having their clinical masters degrees via the regular HWNZ postgraduate funding pool.
The NPTP programme is funded for 500 hour clinical hours of training – two clinical practicums of 250 hours each in advanced nursing practice and advanced diagnostic reasoning. Prospective NPs under standard HWNZ funding do not get full funding support for the clinical training practicum requirement of a clinical masters’ programme.
]]>Nominations for the first Tapuhi Kaitiaki Awards will close on July 10 and announced at the Indigenous Nurses Conference in Auckland on 11 August 2018.
Pharmac and Te Pōari o Te Rūnanga o Aotearoa of the New Zealand Nurse Organisation launched the awards recently with Pharmac chief executive Sarah Fitt saying the awards acknowledged the role that Māori nurses have as key influencers and role models.
“For whānau, the Māori nurse with the knowledge, expertise and understanding of tikanga, kawa, Māori health needs and practise is an important advocate and support person,” said Fitt. “These awards are a financial contribution for all Māori nurses to further their studies and clinical practise, and can be used by nurses to help support their work load and whānau commitments.”
Kerri Nuku, NZNO’s Kaiwhakahaere, said the awards were a great opportunity to acknowledge Māori nurses’ uniqueness.
“Undertaking further academic study and training to become nurse prescribers and nurse practitioners is a huge commitment on top of everyday mahi and whānau life,” said Nuku.
“Te Rūnanga are extremely proud of the support and investment PHARMAC is providing with the Tapuhi Kaitiaki scholarships and we believe this will help whānau, hapū and iwi to access and understand their medicines.”
“Māori nurses are great innovators, it’s a great opportunity to showcase ways in which they work day-to-day for the betterment of their people, hei oranga motuhake mo ngā whānau, me ngā hapū, me ngā iwi.”
The scholarships will be awarded in two categories:
Application forms and more information can be found here
]]>NPs expressed frustration in February at discovering that new legislation that came into effect on January 31 had removed many legal barriers to their practice but the Cremation Regulations had remain unchanged. This meant NPs were still unable to complete all the paperwork for patients’ families at a patient’s death.
Dr Jill Clendon, the acting Chief Nursing Officer, said today that the Cremation Regulations have now been amended so NPs can complete a cremation certificate.
“A nurse practitioner who provides the care for a person in their last months of life and has developed a relationship with their family can now complete both the death certificate and cremation certificate,” said Clendon.
She said about two-thirds of all people who die choose to be cremated and require an authorised health practitioner to sign a cremation certificate. “This change enables continuity of care for patients and families, timely completion of certification and ultimately less distress to a grieving family.”
On January 31, seven of eight Acts changed when the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill came into force, enabling nurse practitioners and other health professionals to do more for patients.
Roles changed under the new legislation included:
The eight bills enacted to amend the parent Acts were:
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Adams, a senior lecturer at Massey University’s School of Nursing, graduated this month with her PhD that looked at the establishment of nurse practitioner (NP) services in rural primary health care. She interviewed 20 nurse practitioners (NPs) working in a diverse range of rural settings, along with other clinicians and rural health managers, about the development of the NP roles and how the NPs practiced.
Her research identified that fragmented health services and the ongoing policy focus on doctor-led care were limiting the ability to use the NP model as a way of improving and meeting the primary health needs of rural communities.
“Much time, energy and money is wasted endeavouring to maintain the status quo of doctor-led health services, rather than embracing a nursing workforce that has the enormous potential to transform primary health care services, increasing both access and health outcomes.”
She said her findings challenge health policy makers and funders to make clear plans to develop the nurse practitioner workforce as a cost-effective solution for New Zealand. “And an obvious solution to the current crisis around rural and small town services as the GP workforce disappears.”
Late last year Adams and her supervisor Professor Jenny Carryer also published an article in the Australian nursing practice journal Collegian that focused on Adam’s research findings about how the NPs and others described the nature of NP practice – and on NPs potential to be a “solution to transformative and sustainable health services” in primary health care.
The article said that it was clear that the nurses did not become NPs in order “to be more like or substitute for medical practitioners” and being able to diagnose, prescriber and order diagnostic tests just meant they could see “more patients in more circumstances” than before they became an NP. They said the NPs drew on their nursing background and sought to deliver a person/family-centred, collaborative approach to meeting the health needs of their communities and reducing inequalities in healthcare access.
But NPs also felt constrained by the “expectations imposed by funding or employment structures” with a number employed by privately owned general practices with many of those following an old-school acute model of primary care provision with short appointments for fee paying patients. “This private business model has perpetuated the domination of biomedicine using a reductionist approach to long term conditions that is unlikely to make significant inroads into the health of populations, nor to reducing health inequalities,” said the pair.
“Based on the findings of this relatively small study we suggest there would be value in further research to more closely assess the alignment between the transformative potential of NP practice, the goals of current health strategies and the employment structures or setting in which NPs are often required to practice work,” said the pair.
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The Ministry of Health and Chief Nurses Office is seeking feedback on where next for the ‘registrar’ style Nurse Practitioner Training Programme (NPTP) which recently received a positive evaluation report.
The NPTP, currently offered at only Auckland and Massey universities, is now into its third annual cohort with selected NPTP students requiring employer support and an NP job awaiting them at the end of the intensive ‘registrar’ style programme which includes two fully-funded clinical practicums.
Mark Baldwin, an NP and chair of Nurse Practitioners New Zealand, said New Zealand was a long way short of the number of NPs needed to meet health care needs and doubted it would ever get to the point of over-producing NPs “even if we add an extra 10-20 NPTP places”.
Currently New Zealand has 299 practising NPs and registered a record 77 new NPs in 2016-17, including 13 NPTP graduates.
This week the New Zealand Nurses Organisation released its new Strategy for Nursing 2018-2023 which includes the ‘aspirational’ target of training an additional 200-250 new NPs a year until 2020.
Associate Professor Michal Boyd, an NP and the leader of the University of Auckland NPTP programme said the evaluation reported showed that NPTP provided a clear pathway that incorporated education, registration and employment as never before.
But she added that the report also emphasised the need for NPTP classes to have a critical mass of 10 or more students to enable students to support each other and for the provider to have the NP faculty resources to teach and supervise clinical practicums across the country. “Such resources are only available at a limited number of providers.”
At present five university nursing schools – Auckland, AUT, Massey, Victoria and Otago’s Christchurch School of Medicine – offer clinical masters’ programme that are accredited by Nursing Council as leading to NP registration plus Waikato Institute of Technology (Wintech), Eastern Institute of Technology (EIT) and Ara Institute of Canterbury (in league with EIT).
The University of Auckland this year has 13 NPTP students enrolled along with four other final year NP trainees funded through the conventional Health Workforce New Zealand (HWNZ) postgraduate funding pool.
Associate Professor and NP Karen Hoare, who is the new postgraduate director at Massey University and convenor of its NPTP programme, said Massey this year has 10 NPTP students and six other final year NP trainees.
Hoare had taken note of the Ministry seeking feedback on encouraging greater participation of Māori and Pacific nurses in NPTPs and said her intention was for half of Massey’s 2019 cohort to be Māori and Pacific nurses. She said there had been no Māori NPTP applicants to Massey for 2018 and she would be working nationally with colleague Val Williams, who was very involved in Māori workforce development, to make that change for 2019.
Associate Professor Stephen Neville, head of AUT’s nursing school and New Zealand spokesperson for the Council of Deans of Nursing and Midwifery, said the Council was currently preparing its submission on the report and request for feedback.
But he said it was the Council’s view that the NPTP should be expanded to include only existing providers of Nursing Council-approved nurse practitioner education. He said it was also clear that these providers must be able to meet a threshold of critical resourcing including sufficient NP academic mentors and having a programme lead by research active staff, preferably doctorally-qualified.
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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.
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.
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.
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?
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The positive evaluation report of the first cohort of NP graduates from the two NPTP programmes was released this week by the Ministry of Health. The Ministry, Health Workforce New Zealand (HWNZ) and the Office of the Chief Nurse is now seeking feedback from nurses, employers, training providers and other stakeholders on whether to expand beyond the current 20 places a year and to include other nursing schools beyond the University of Auckland and Massey University programmes.
Feedback is also being sought on:
Nurse practitioner training providers last year expressed frustration that the majority of the country’s nurse practitioners were trained “on a shoestring” with only the 20 nurses on the NPTP pathway getting full funding support for the resource-intense minimum 300 hour clinical training practicum. (The NPTP programme is funded for 500 hour clinical hours of training – two clinical practicums of 250 hours each in advanced nursing practice and advanced diagnostic reasoning).
The evaluation report looked at the 19 nurses who were part of the first fully-funded NPTP cohort in 2016 (18 of whom gained registration as NPs) and compared them with 49 recently registered NPs who had gained registration through other pathways – mostly through having their clinical masters degrees via the regular HWNZ postgraduate funding pool. It noted that key difference between NPTP and other NP education pathways was the requirement for employers to guarantee support throughout the programme and employment as a NP after registration.
The Evaluation of a nurse practitioner education programme report by Malatest International found:
The Ministry of Health is now leading a call for feedback on nurse practitioner training and development based on the findings of the report. Submissions can be sent to [email protected] until Friday April 27.
Questions it wants feedback on include to what extent the NPTP should be expanded and what would be the benefits? Plus how to encouragage wider participation of Māori and Pacific nurses in NPTPs.
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Dr Michal Boyd, an aged care NP and nurse leader who last week was celebrating at last being able to issue death certificates for her patients’ families said it was a “terrible blow” to discover that NPs were still blocked from signing cremation certificates.
More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made only come into effect on January 31.
The complex Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), and other health practitioners like pharmacists, registered nurses and physiotherapists are now qualified to carry out those roles – but did not amend the related Cremation Regulations. This means cremation certificates still have to be signed by a medical practitioner, which is a particular frustration for NPs working in aged care.
Ministry of Health chief nursing officer Jane O’Malley said the Ministry was aware of the oversight of not amending the Cremation Regulations to allow NPs to complete cremation certificates and was “working as quickly as possible to remedy this”. She said the Ministry was currently in the process of informing stakeholders of its plan and timeline.
“In essence, not being able to do cremation certificates basically keeps in place the barrier to completing death certificates for over 80% of those I serve,” Michal Boyd said in a Facebook post to fellow Nurse Practitioners of New Zealand (NPNZ) members. “This development is so disappointing and frustrating. To feel that one of the last barriers to my practice in aged care was gone and to see it back again is very disheartening.”
She said apparently the cremation referee, who overseas cremation certificates, had let the Ministry of Health know of his concerns late last year about the regulations around cremation certificates being missed out.
NPNZ members shared Boyd’s frustration about the ongoing major barrier to NP practice, with one reporting that it cost her practice $90 every time it had to ask an outside GP to sign a death or cremation certificate for her patients. There was a call for action on the issue and concerns were expressed whether NPs would again to have wait years for this barrier to be removed.
Nursing Review sought comment on the NPs concerns from the Health Minister Dr David Clark and Ministry of Health. A spokesperson for the minister’s office said the Minister was aware of the issue and had asked the Ministry for a solution to the problem “which was inherited from the previous government”.
NB this article was updated on February 12 to include additional comment supplied in a revised response from the Ministry of Health and to clarify that it was the cremation regulations needed to be amended not the related legislation.
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From today for the first time nurse practitioners can issue the death certificate for patients in their care. Suitably qualified nurses can also write sick leave certificates.
Dr Michal Boyd, a long-standing NP, says being unable up until today to complete death certificates for patients in her care meant the risk of unnecessary delays and distress for a grieving family.
“As the primary healthcare provider I know the person’s medical conditions and have often led their care over months or even years,” said Boyd. “Now I am able to provide all the care needed for the older person and their family.”
More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made only come into effect today (January 31).
The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), and other health practitioners like pharmacists, registered nurses and physiotherapists are now qualified to carry out those roles.
Lobbying began early in the millennium by nurse leaders to identify and remove a range of legislative barriers to nurse practitioners’ practice and formal work began back in 2005 to go through legislation with a fine tooth comb to find references to “doctors” or “medical practitioners” in roles that now could be done by other suitably qualified health practitioners. The acts remove the anomaly where NPs could sign ACC forms and sickness benefit forms but could not sign an ordinary sick leave certificate for work under the Holiday’s Act.
Boyd, a former chair of Nurse Practitioners New Zealand (NPNZ), said today’s enacting of the new laws represented to her the removal of some of the last barriers to being able to practice at the top of her scope as a nurse practitioner.
The Ministry of Health’s outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.
Memo Musa, the chief executive of the New Zealand Nurses Organisation congratulated all those involved in the watershed changes particularly the Nursing Council and the Office of the Chief Nurse.
Musa said the amended Acts meant more nurses could improve public access to some medicines and also enable them to work to the full breadth and scope of their practice. “It is often easier and quicker to see a nurse than a doctor so this change means more people in the community can benefit by accessing health care sooner.”
2018 LEGISLATION CHANGES SUMMARY
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury including suitably qualified registered nurses, if their employer and the Nursing Council of New Zealand recognise that they are competent and safe to do so
Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.
Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).
Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.
Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.
Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.
Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.
Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.
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