Nurse practitioners 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.
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Nurse practitioners combine their advanced nursing knowledge and skills with diagnostic reasoning and therapeutic knowledge. They provide care for people with both common and complex conditions.
Many nurse practitioners work in primary care where, like general practitioners, they may be the lead health care provider for health consumers and their families/whānau. Some nurse practitioners own their own practice. Others work for district health boards, non-governmental organisations, or for Māori and iwi providers. Nurse practitioners are more likely to work in rural areas and in underserved communities.
There are now more than 300 of the skilled practitioners working around New Zealand.
Although numbers are growing, people don’t always understand what nurse practitioners do.
Here’s the Ministry’s acting Chief Nursing Officer Dr Jill Clendon to explain the role.
Dr Jill Clendon, Acting Chief Nursing Officer:
Nurse practitioners are highly skilled and experienced clinicians. So even before you become a nurse practitioner, you have to have at least four years of clinical experience, you have to then complete a clinical masters degree. So these guys know what they’re doing.
They can diagnose your needs, they can order tests, they can prescribe your medicines, they can treat you. But the great thing about nurse practitioners is that they bring all of those nursing skills with them as well. So they’re all registered nurses before they become nurse practitioners ... so you get that real combination of skill, experience, knowledge, all of the things that people need to see.
The other neat thing about nurse practitioners is that they’re really meeting the needs of high needs communities – in particular our rural and remote communities, people with extra particular needs, so that might be people on low incomes who have high social needs. So nurse practitioners are able to manage and deal with the issues that those population groups are presenting with, really quickly, really effectively. The evidence is unequivocal – they’re providing really, really good care.
At the moment, over 50 percent of our nurse practitioners are working in primary health care or community settings, so you’re more likely to see them, you might see one instead of seeing your general practitioner, you might see one in aged and residential care, which is where we’re seeing some fantastic outcomes for older people who are seeing nurse practitioners in the community; you might well also see them in hospitals – so some of them have very specialised areas, we have neonatal practitioners as well. But what we will see over time is a real shift to community focus, so we will see nurse practitioners in the community and chances are, when you make an appointment down at your general practice, you may well be making an appointment to see a nurse practitioner rather than a general practitioner.
1. Nurse practitioners provide a wide range of assessment and treatment interventions
Nurse practitioners make diagnoses and differential diagnoses, and order and interpret diagnostic and laboratory tests. They prescribe medicines within their area of competence with the same authority as medical practitioners.
There has been ongoing work at the Ministry of Health since 2010 to remove the legislative, funding, custom and practice barriers that prevent nurse practitioners practising to the full breadth of their scope of practice. For example:
- changes to eight acts of Parliament will enable nurse practitioners (and, in some cases, other health practitioners) to carry out activities previously done by medical practitioners, including issuing death certificates and sickness certificates
- nurse practitioners can issue Standing Orders (as permitted under the Medicines Act)
- a change to the Coroner’s rules to allow nurse practitioners (and other nurses, ambulance personnel and midwives to verify death)
- nurse practitioners can supervise registered nurses who are training to become designated registered nurse prescribers
2. Nurse practitioners work across health care settings and can influence health services and the wider profession
Nurse practitioners may admit and discharge people from hospital and other health care services. They are involved in research, have leadership roles, and supervise and mentor other senior nurses.
3. Nurse practitioners have a broad scope of practice and have the same prescribing authority as medical practitioners
The Nursing Council established the broad scope of nurse practitioners to enable them to safely and appropriately meet changing health needs.
4. Nurse practitioners are funded and subsidised for the treatment they provide
Nurse practitioners can claim General Medical Services (GMS) subsidies to help reduce patient fees for children and subsidy card holders. See Provider payments.
Nurse practitioners receive funding from the Accident Compensation Corporation (ACC) for providing treatment for a person after an injury. See Invoicing us on the ACC website.
Nurse practitioners are funded to provide primary medical treatment to residents under the Aged Residential Care (ARC) Service Agreement. See National agreements on the TAS website.
Nurse practitioners have access to flexible funding and capitation funding streams through Primary Health Organisations (PHOs).
To register in the nurse practitioner scope of practice the following qualifications are required.
- Registration with the Nursing Council in the registered nurse scope of practice.
- A minimum of four years’ experience in a specific area of practice.
- The completion of an approved clinical master’s degree which includes the demonstration of the competencies for advanced practice and prescribing applied within a defined area of practice of the nurse practitioner. The programme must include relevant theory or concurrent practice or the completion of an overseas clinically focused master’s degree qualification which meets the requirements specified above.
- Passing an assessment by an approved panel against the nurse practitioner’s competencies.
- A minimum of 300 hours’ clinical supervision.
Funding for registered nurses training to become a nurse practitioner is available through Health Workforce New Zealand. Applications can be made locally through district health boards.
- the Nursing Council website to find out more about the nurse practitioner scope of practice.
- Changes to health practitioner status for more information about the changes to eight acts of parliament that enables nurse practitioners to carry out activities previously only doctors could do
- the Nurse Practitioners New Zealand website for more on how to support registered nurses to become nurse practitioners, and for examples of nurse practitioner job descriptions and business cases
For more about nurse practitioners at work see:
- Nurse Practitioners New Zealand website
- The nurse practitioner older adult on the INsite website
- Rees Dart tramp triggers Angela's goal to become a nurse practitioner on the Matua Raki website
- Handover issue 36 on the Te Pou o te Whakaaro Nui website.