Question: What can we do to reflect the role and worth of NPs in New Zealand?
The nurse practitioner (NP) role was launched in New Zealand in 2001, and described by the Ministry of Health as "a way of combining the best of nursing with some skills from medicine". Since then, NPs have been providing highly skilled care to patients , many choosing to work in primary and community care. More and more New Zealanders are now enrolled with an NP as their primary health care provider. NPs are highly skilled autonomous health practitioners who have advanced education, clinical training and demonstrated competency. They have the legal authority to practice beyond the level of a registered nurse. As we enter the third decade of the NP workforce in New Zealand, with 607 NPs now registered with NCNZ , it is time to revisit current support, education and training and ensure we are holding true to the intent of the NP project.
It takes a minimum of 9 years to train as an NP. They then have legal authority under the Health Practitioners Competence Assurance Act 2003 to do everything a GP does: diagnosis, investigations, prescribing including controlled drugs and special authorities, certification of all types. At this stage the only thing an NP can’t do is prescribe section 29 drugs. NPs can, and do, set up practices on their own and can apply for all the funding a GP can expect; capitation, ACC, immunisation, maternity and PHO programmes. They can also employ GPs to work for them.
We are not training GPs at the rate they are retiring and the costs of healthcare are escalating. The NP workforce offers stability and flexibility in working across multiple clinical settings in primary healthcare. NPs around New Zealand are working in areas from rural general practice to emergency and trauma, and community mental health. They provide the potential solution to the general practitioner workforce shortage. It is timely to facilitate the expansion of the nurse practitioner workforce in New Zealand.
Going forward, the following are critical for the establishment of NPs across the health sector: A review of the NP competencies to ensure the NP workforce can practice and promote health equity; support the NP pathway to ensure registered nurses (RNs), together with their employers and leaders are adequately prepared; nationally consistent and appropriately funded programmes accessible to all NP trainees which includes 500 hours of supervised clinical practice and experience of working alongside a NP in practice; and a national workforce plan that focuses on the development of the NP workforce to meet health needs of communities and promote health equity.
The slow growth of NPs in the first 15 years was testament to the range and complexity of challenges and hurdles faced. Are we now doing enough to create NPs as future leaders of our health services?
With the impending health reforms, it is time that the NP workforce receives the recognition and necessary action to embed NP services across the country. Every community deserves one.