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FREQUENTLY ASKED QUESTIONS

 

NPs AND NP PRACTICE.

 

What is an NP?

Nurse Practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills, such as managing and prescribing medications and the ordering and interpretation of laboratory tests. NPs practise both independently and in collaboration with other health care professionals to promote health, prevent disease and to diagnose, assess and manage people’s health needs, often by working across traditional boundaries.

What qualifications does a nurse require to become an NP?

The NP scope provides a clinical career pathway for those nurses who have attained a Master's degree in nursing (usually a clinical Masters), and who are expert, advanced practice nurses. NPs are highly educated and experienced health professionals working to improve health and to reduce inequalities in health.

How does an NP actually function?

NPs provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering, conducting and interpreting diagnostic and laboratory tests and administering therapies for the management of potential or actual health needs. They work in partnership with individuals, families, whanau and communities across a range of settings. NPs may choose to prescribe medicines within their specific area of practice. NPs demonstrate leadership as consultants, educators and researchers and actively participate in professional activities and in local and national policy development
NP roles vary between case management of a specific patient population, to consultation, to leading a nursing team or being part of a MDT management approach

What is the difference between a Nurse Practitioner and a Clinical Nurse Specialist?

Aren’t they both advanced practice roles?

The discussion about advanced practice encompasses a variety of designated senior clinical nursing roles and titles.
The distinction between nurse specialist and nurse practitioner roles is not reliant on any one factor but rather based on an array of factors that together create the terms of a role/position.
The ability for Nurse Practitioners in NZ to have narrow scopes of practice and with or without prescribing has made the difference/division between CNS and NP roles less distinct than other countries, where NPs are in wider scopes and the distinction is much clearer.

 

CRITERIA

CLINICAL NURSE SPECIALIST
(Registered Nurse scope)

 NURSE PRACTITIONER
(Nurse Practitioner scope) 

FOCUS

Specific skill/intervention and/or disease type/health problem management.
Specialist area of practice, within RN scope.

{Often} Broader (NP) scope of practice related to population and speciality.
May case manage population / patient group

NURSING ROLE

Extended aspects / expanded / advanced practice role.

Extended, expanded and advanced practice role (i.e. Patient’s needs assessment, diagnosis and treatment which may include pharmacotherapy).

RESOURCE FOR

Skill or specialty care / patients/ family.

Patient / family, community health professionals
Consultant for organisations.
Local and national.

RESULT

Output – outcome focussed Health promotion

Outcome focussed.Health promotion

CONTEXT

Independent within a specialty team may extend across services.

Autonomous role in specialty domain, often across services (primary, secondary, tertiary and community.
May run nurse-led clinic, often ambulatory.
Strong and progressive leadership role

PRACTICE SCOPE

Specialist care that may include delegated medical responsibilities, diagnostics and implementation of treatment protocols/standing orders.

Comprehensive management of patients utilising specialist expertise.
Utilises advanced assessment, diagnostic and treatment skills which may include pharmacotherapy.

 

How can I support nurses who want to become NPs, where do they get support and advice?

Following a number of enquiries received recently, here are some ideas and routes to investigate in relation to NP activity;

  • If you are interested in the Nurse Practitioner career pathway, please contact the Director of Nursing for your district or the Nurse Leader for your organisation. You can use the link on the Nurse Executives website for a list Directors of Nursing http://www.nurseexecutivesnz.org.nz/
  • For information on education requirements for NPs, please approach one of the tertiary education providers for advice.
  • Auckland University of Technology - Master of Health Science in Advanced Nursing Practice
  • Eastern Institute of Technology - Master of Nursing
  • Massey University - Master of Nursing
  • The University of Auckland - Master of Nursing
  • University of Otago - Christchurch School of Medicine
    • For NP scope of practice, please access the Nursing Council of New Zealand website http://www.nursingcouncil.org.nz/
    • For advice or information on NPs generally you will find an excellent links page on the NPF website, including resources and information specific to NPs in New Zealand from the College of Nurse Aotearoa  and the New Zealand Nurses Organisation http://www.nurse.org.nz/  or http://www.nurse.org.nz/np_nw.htm http://www.nzno.org.nz/Site/Professional/Other/ANP/NPAC.aspx
    • For information on NP developments within your own DHB, check on the NPF website for your NP network champion.
    • The following organisations have trained NP Mentors to assist NP candidates to refine their application and prepare for the interview: CoNA, NZNO, NZCMHN, NCMN
    • If you have any questions specific to the work of the NPF Steering Group, you can use the NPF website discussion board or send a specific question on the webpage enquiries form.

Where do I find out about current NPs in practice?

Check out the case presentations on the NPF website, which are located on the DHB map of New Zealand.
You can also find current NPs by contacting NPAC NZ http://www.nzno.org.nz/Site/Professional/Other/ANP/NPAC.aspx or you nurse leader within your organisation.

Are NPs the ‘pinnacle’ of nursing?

NPs are one career pathway within nursing, but there are many diverse and satisfying leadership roles available to nurses all across the health care continuum. Nurse Practitioners are in a predominantly clinical role, and other leadership positions may be predominantly involved in education, management and/ or professional leadership.

I want to be an NP, or am currently studying in preparation for NP status. How can I ensure I have a job to go to once I have registered? 

If you are thinking about or actively working towards NP scope, then you must complete some key steps.

  1. Talk to your nurse leader early on in your planning and talk to the Director of Nursing for the DHB covering your area (even if you don’t work for the DHB). These leaders will be able to review and discuss your area of practice in relation to future development needs of NP roles. They will be able to talk about the organisations strategic plan and whether there would be NP role development within the near future. If they see a need for the role they may also be able to support your case in the appropriate forums, as funding of NP roles can be a barrier. You may also be able to talk with the NP champion for your DHB, a list of these names is available on the NPF website.
  2. Develop some understanding of business models, ensure you know how to access business plan templates and maybe someone to support you to write one should you require.
  3. NPs work towards health gain to address and reduce inequalities and inequities in health. The role of the NP is centred on patient and population needs and improving health outcomes. Ensure you can clearly articulate how you, as an NP will address this.
  4. Think broadly when deciding your area of practice.  Defining the area too narrowly may be restrictive in the longer term as practice develops and roles change e.g. Mental illness and health rather than rehabilitation of schizophrenic patients.  Seek advice around this issue.

You can’t guarantee a job unless you have prepared the way, and you can’t do that in isolation, you must include people who can help with service delivery, funding strategies, business cases, job descriptions and team development. Becoming an NP is only one aspect of increasing the NP workforce, the workforce must also change shape to accommodate and embrace this new opportunity.


I am an NP in another country. Can I work as an NP locum in NZ? 

Yes, but be aware overseas NPs need to register with the NCNZ first as an RN and then make applications for NP registration.  The registration process must be completed in full and takes a considerable amount of time  http://www.nursingcouncil.org.nz/
Practice overseas as an NP does not guarantee NP registration in NZ. Please be aware that the NZ model differs from that in other countries.

At this stage of our NP workforce development, locum positions are not widely advertised, so at this early stage you may not find much information on this. However you can check on the jobs for nurse practitioner pages, where job ads and locum positions may be available.

 

FUNDING AND EMPLOYING NPs

I can’t see how we can fund an NP role.

The NP model is new to New Zealand.  Ideally, many NP roles will work with patient populations across sectors.  Traditional models of funding and purchasing health services may restrict the ability of a NP to deliver and practice to their full extent.  Innovative practice requires flexibility in both funding and employment models. It may take persistence to forge a new funding and employment model.

The first step is to identify the current and potential funding streams. Due to the diverse areas in which NPs can work, a number of options may be investigated. NPs are not restricted to one funding stream or one budget due to their boundary spanning roles.

Around September, October and November each year DHBs Planning and Funding divisions are involved in prioritisation of funding for the next years annual planning round. This means that funding proposals for that funding stream need to be prepared early. In many DHBs the DHB provider arm must also prioritise their own funding proposals that go forward for consideration. To be prioritised, proposals must demonstrate strong links with DHBs strategic priorities and articulate how they will assist with the achievement of priority outcomes.

 

Business Case Tool Kits are available:
NPAC-NZ Website: http://www.nzno.org.nz/Site/Professional/Other/ANP/NPAC.aspx
NPF website: www.dhbnz.org.nz

Aren’t NPs an expensive option?

Current salary scales according to the DHBNZ/NZNO MECA

Designated Senior Nurse and Midwife Salary Scales

There is not a significant difference between some CNS, advanced clinical roles and NP positions. 
There are several NPs who are prescribing who have filled gaps in services related to doctor shortages and therefore are not considered an expensive option, in many circumstances they have been financially preferable.

Nurse practitioners would generally fall in the grade 8 band.

How would I know if we should look at filling a service gap with an NP?

The NP registration requires a very broad and flexible range of advanced skills and knowledge therefore it is highly likely that gaps in clinical service provision could be met by an NP.  This was one of the leading principles behind developing the NP role in NZ.  If you have long waiting lists, high readmission rates or a gap in your service created by the inability to recruit other specialised health professionals, it is likely the gap could be filled by an NP.  Many NP roles have been created and successfully developed as a direct result of doctor shortages, for examples refer to the following case presentations on this site.

Questions:

  • Have you comprehensively described the population area and health needs?

  • Does the current service delivery model address the health needs of the identified population?

  • Is the current service delivery model cost effective and efficient?

  • Are the current healthcare practitioners being used to optimal effect or would another health practitioner be more appropriate?

  • Has the identified population currently got equal access to healthcare?

  • Are the patients and community receiving optimal care from the current model of service delivery?

  • How will an NP address the need you have identified?

I have nurses, who want to be NPs, but the services are not able or prepared to change work structures to employ them; how do I progress this?

Introducing a new role within an established multidisciplinary team can be challenging but support from colleagues who can see the benefits is required for the change to succeed.  The NPAC-NZ Business Case Tool Kit will assist in thinking through the issues and preparing a case to be presented to the service.  Leadership from the Director of Nursing will be important for successful change.
You will need to have created a business plan, job description and proposal.  Some NP roles in NZ have been proposed as 6-12 month pilots.  A proposal will show the cost benefits to the service. 

Whilst we could create NP roles everywhere if there was surplus money this is never the case, so NP roles will have to show the financial benefits to the service

A key to introducing the new role may be to engage a stakeholder group for the short term, with health professionals (internal and external) as well as community/ patient representation. This will address a number of issues:

  • Many health professionals (including nurses) don’t have a clear understanding the NP role.
  • There may be ‘overlapping’ areas of practice which will need to be identified and worked through. It may be helpful to look at how other NP roles are operating.
  • External relationships the NP will have to interact with, such as labs and radiology. What is the level of understanding in these areas of NP scope?
  • Do the patients and the wider community understand the role and how they will use the service?

Preparing the wider team for the introduction of a new role is vital to aiding any team and work/ role transition period, so early inclusion in the process will be beneficial.

Can I employ an NP from another country?

Yes, but be aware overseas NP’s will need to register with the NCNZ first as an RN and then make an application for NP registration.  The registration process must be completed in full.  http://www.nursingcouncil.org.nz/ . This can take some time.

A combination of the registration processing, moving countries and residency can result in a delay of some months, just as it does for other health professionals. 
An alternative option would be to scope up a position and start it as a trainee NP position and move the successful candidate into it by supporting them to complete their educational and clinical requirements.

There are many very experienced overseas NPs and NZ RNs who have already undertaken a significant part of the study who would willingly finish the requirements if they could be guaranteed an NP position at the end.


I think an NP is a good idea, but how do I convince the service group and funding managers?

Prepare a business case to clearly articulate your reasons for NP employment and funding
Implement a sound change management process.
You must clearly identify and demonstrate strong links with DHBs strategic priorities and articulate how they will assist with the achievement of priority outcomes.

Remember to work through the following questions:


Questions:

  • Have you comprehensively described the population area and health needs?
  • Does the current service delivery model address the health needs of the identified population?
  • Is the current service delivery model cost effective and efficient?
  • Are the current healthcare practitioners being used to optimal effect or would another health practitioner be more appropriate?
  • Has the identified population currently got equal access to healthcare?
  • Are the patients and community receiving optimal care from the current model of service delivery?
  • How will an NP address the need you have identified?

This should be presented in the form of a business case or proposal.


WORKING WITH NON-NURSING COLLEAGUES

Will NPs fill gaps created by doctor shortages? Are NPs are trying to take over from doctors in some areas?

To respond appropriately and responsively to population health needs in New Zealand, the structure of our health workforce is changing. Throughout history professionals have extended their boundaries, and though the NP role is different from that of a doctor, NPs can and will fill gaps created by Doctor shortages as well as undertaking some areas of practice that are currently considered the domain of doctors.  NPs can order tests, make differential diagnosis and, if registered to do so, prescribe medicines within their scope.

Some of the core principles that drove the development of the NP qualification in NZ were:

  • NPs work towards health gain to address and reduce inequalities and inequities in health.
  • The role of the NP is centred on patient and population needs and improving health outcomes.
  • Population health status will drive the provision of NP services
  • The role of the NP will mostly complement the role of other health professionals but will inevitably overlap in some areas.  This will enable substitution between groups to occur and thus promote efficiency and flexibility in the use of valuable resources.

The NP role is driven by population health needs and the reality that many nurses have advanced clinical skills or have the ability to gain them. 

I have heard ‘physician assistant’ roles being proposed. Is this another option?

The role is one option of many which is under consideration by the medical training board.


What is the point of employing an NP who can’t prescribe?

They can practice in the expanded NP role, spanning boundaries and bridging gaps.

Would an NP order too many tests and X rays?

International research has not found this to be the case.
NPs are qualified to make efficient decisions on the ordering of appropriate tests and X rays.

Why should I allow NPs to order diagnostic tests and imaging?


NPs do require access to ordering lab and radiology tests, it would be impossible to function in an advanced way without access to diagnostic tests. They are qualified to make these decisions and to interpret results.

If you are unsure of how NPs work- contact the NP and discuss your concerns, alternatively talk to the Director of Nursing for the area.


My organisation won’t support an NP role, how do I progress my case?

Timing is everything! Using examples from other organisations where an NP has improved access, reduced admissions etc. to address your organisation’s current problems will pave the way.
You must clearly identify and demonstrate strong links with DHBs District Annual Plan, or your organisations strategic priorities for population health, and articulate how they will assist with the achievement of priority outcomes.

Remember to work through the following questions:

 

Questions:

  • Have you comprehensively described the population area and health needs?
  • Does the current service delivery model address the health needs of the identified population?
  • Is the current service delivery model cost effective and efficient?
  • Are the current healthcare practitioners being used to optimal effect or would another health practitioner be more appropriate?
  • Has the identified population currently got equal access to healthcare?
  • Are the patients and community receiving optimal care from the current model of service delivery?
  • How will an NP address the need you have identified?

This should be presented in the form of a business case or proposal.


As a doctor how do I manage the work of an NP?

You will be colleagues, both working autonomously but conferring with each other.  It will take time to build trust in the new model and a new way of working.  Give it time and talk about issues as they arise.
NPs work collaboratively with the MDT.  They do not have their work managed by other health professionals.


 

 

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