Ramping up NP work.

The Nurse Practitioners Advisory Committee (NPAC-NZ) is expected to be dissolved, with the work of supporting and increasing the NP workforce to be handled, from now on, by individual and national nursing organisations (NNOs) working together.

According to NZNO chief executive Geoff Annals, who recommended the change at the NZNO board meeting last month, NPAC-NZ has fulfilled its function and it is now time for the work of advancing the NP agenda to be picked up by NNOs as a whole. "We are well past the stage of conceptualising what NPs could and should be doing: it's time to ramp up the work, to change tack on this issue in order to be more effective. We want far more NPs in the workforce and we want them to reach their full potential."

Annals believes the whole nursing political landscape has changed since NPAC-NZ was first established in 2000, with nursing groups now working together much more openly. Also, 12 years ago, there was not the same trust in the Nursing Council there was now, he said. "The Council is much clearer about its role, and engagement between the Council and other nursing groups is now more open and transparent."

Annals is also recommending NZNO establish its own NP network and that it uses whatever channels at its disposal--eg submission writing, lobbying the Minister of Health and chief nurse--to advance the NP agenda.

Strength in a broad base

NPAC-NZ committee chair Helen Snell joined the group in 2004, the year after she became the 10th NP to be registered. She was appointed chair in 2009, following on from inaugural chairs Susanne Trim and Deborah Harris. There are now 105 NPs, 89 of them authorised to prescribe. The strength of NPAC, she says, has been its broad base, comprising NZNO, the College of Nurses Aotearoa, the National Council of Maori Nurses and the College of Mental Health Nurses, all working together to see barriers to the NP role removed. She is pleased to see the nurse leaders wanting to pick up the work, with a commitment to having NPs as a regular agenda item at their NNO meetings. She remains cautiously optimistic about the future.

"NPAC-NZ has achieved a lot over the last 12 years and I just hope the momentum continues, as this has been building noticeably over the last five years. It's great the Nursing Council has improved its processes around NP registration and renewal of practising certificates for prescribing NPs. In the early days, NPs had to resubmit evidence every year against all the competencies. Now the process involves a three-yearly peer review."

NPAC-NZ's achievements

Major achievements driven by the committee include getting NP authorised prescribing included in the Medicines Amendment Bill, supporting registered nurses as designated prescribers and working with the Ministry of Health and other groups to achieve other legislative changes. "There are about 65 pieces of legislation that need changing to remove ongoing barriers to NPs' scope of practice," Snell said. "We expect a number of regulatory changes to be covered in an Omnibus Bill going through Parliament sometime this year.

"Over the years, the committee has worked hard to raise awareness of the contribution NPs can make to the health system and the health of New Zealanders. We were part of the collaborative effort to produce a DVD about the NP scope in 2009, along with a booklet about the first 50 NPs, which was published that same year. And we developed the concept paper to inform the education and training of NPs, work that supports the Nursing Council's review of postgraduate nursing education standards. We supported the concept of NP mentorship training, developed guidelines and ran a number of mentor training days, working with the four major nursing organisations to set this up.

"We have supported a number of directors of nursing who have struggled to support NPs to gain employment, especially in primary health care. NPAC-NZ led the campaign for NPs to make specialised authority applications for particular medications. Since last October, they have been able to make these applications online, a much quicker process than previously," Snell said.

Executive director of the College of Nurses Aotearoa, Jenny Carryer, recognises the achievements and great dedication shown by NPAC. However, she believes it is now time to own the work at the highest level. "Given all the reports and handwringing about the workforce crisis, it's incredible it took NPAC seven years of lobbying to see NPs gain the right to make specialised authority drug orders. Seven years to achieve the blindingly obvious! It's just a joke."

Like Annals, Carryer believes there have been significant environment changes in the relationships between the Nursing Council and the NNOs. These changes need to be taken advantage of. "We should have 500 NPs by now, not 101. The community's need for NPs is huge and all the evidence is there to show how effective a strong NP workforce can be. But the number of positions established over the past 12 years is minute. So far the journey has been disheartening. And for those nurses who have slogged through their master's degrees, had years of experience and still have no NP position to go to, it must be even more disheartening. We are refocusing our efforts but the fear is the external drivers will stay the same, with a lack of political will and blocks from other professional groups hampering progress on this issue."

A teleconference between NPAC-NZ members this month will shape the committee's recommendations to the NNO gorup and is likely to be its last.

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