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Loss of NP title causes demoralization: a group of neonatal nurse practitioners, once regarded as NP models, feel their titles have been unjustly removed.

I HAVE been a neonatal nurse practitioner (NNP) in the United States (US) since 1991. I completed a bachelor of science in nursing (BSN) in 1977 and my NNP certificate in 1990. The US National Certification Corporation has certified me for gynaecologic, obstetric and neonatal nursing specialities up until 2006.

I moved to New Zealand in 1997 and have worked at Middlemore, National Women's and Dunedin Hospitals, returning to the US each year to update my clinical practice and maintain my US registration.

Following the evolution of NP registration in New Zealand has been interesting. New Zealand was ripe for this development. As part of my NNP role, I have conducted teaching sessions in Southland and Otago on neonatal resuscitation and stabilisation of the neonate for transport. I saw first-hand the health care void in vast regions of the country, where there was little or no GP access.

In 2000, the then Nursing Council chairperson Judy Kirkpatrick conducted working groups on NP registration. She spoke with NNP groups in Auckland and Waikato and praised their practice model. They met the profile the Council was looking for--expert nurses who had completed postgraduate education in their nursing speciality, operating in an advanced practice role. The impression given was that their registration was merely a formality. The NNP was actually used as an example in the Ministry of Health resource guide published in late 2001. (1)

When the Council made the first call for NP applicants in March 2001, I was excited for the profession. As time has passed, I have begun to understand those who were more cynical about this development. I witnessed the first NNP's tumultuous application process. Here was someone who epitomised advanced nursing practice. No other NNP had published, presented and demonstrated greater expertise than this person, yet other NNPs are aware that she was reduced to tears during her interview with the Council.

When Roxburgh rural health nurse Marg Eckhoff was declined NP registration, I was very disappointed. If anyone fitted the description, she did. I have worked with Eckhoff on several occasions. She attended one of my neonatal resuscitation training sessions and asked me to come to Roxburgh to review the equipment and setup at the medical centre there. She showed initiative in seeking advanced education in rural nursing and accepted the responsibility of establishing a rural health network for her community, yet the Council didn't see fit to register her.

I believe Council took the 1998 ministry Document (2) and moulded it to its liking. Gone is the description of the clinically-based, advanced practice nurse providing health care in rural areas. Gone is the goal to retain the nation's best and brightest. So far, only nine nurses have been registered as NPs, none in rural health.

It's all well and good recommending nurses undertake their clinical masters, but you need the programmes in place and the funding to access them. New Zealand is only just coming to grips with training its workforce to bachelors' level, let alone focusing on clinical masters' programmes.

When I attended university in the US to train to become an NNP, there were only two master's level programmes, with the majority being certificate degree programmes. By the end of the 1990s, any NNP applying for registration had to be masters prepared by 2004. The aim was to "grandparent" all NNPs without mas ters' degrees prior to that time. This is the approach Nursing Council should have taken here. Instead, the NNPs who were the pioneers of advanced nursing practice have had their rifles stripped from them, leaving them feeling devalued and demoralised.

Many recent articles about NPs address the clinical role required (eg "Nurse practitioners must retain clinical focus" by NPs Deborah Harris, Mark Smith and Julie Betts in the September issue of Kai Tiaki Nursing New Zealand, p26-27), but individuals with large research and teaching portolios have been endorsed while those in primarily clinical roles have not. At a recent NP workshop, 1 spoke to an academic who stated that those completing the new clinical masters' programmes would automatically qualify for NP registration. Having experienced a sin]liar situation in the US, 1 can attest that a degree does not necessarily connote competence. When I was an NNP co-ordinator in the US, certificate programmes dealing primarily with clinical components had been replaced by masters' programmes concentrating on theory. Four out of six NNP applicants I encountered with masters degrees were unable to pass the national certification examination and unable to function competently at the clinical level.

A hierarchical nursing model has been developed here, creating a crisis in confidence and conflict among co-workers. The Auckland District Health Board (ADHB) has at present no funded NP positions. A limited number may be funded next year. There are currently two registered NPs in the neonatal group, with two others applying for registration and another five undecided. What will happen when one NP is funded and the other NPs are not? What about the others in the NNP group, all with the same job description, all doing the same jobs? When it comes down to it--attending high-risk deliveries, transporting critically ill neonates or resuscitating at the bedside--there is no difference between them.

I applied for NP registration in July 2001. I did not apply for the financial benefit or the status. I applied because I wanted to retain my professional title. My application was declined earlier this year. What does this mean to me? Aside from $10 $20,000 per annum, very little. I am an NNP and will always be an NNP from the country where the concept of advanced nursing practice originated. Besides, I get to work alongside a group of advanced practice nurses who, no matter what their title, make a difference to nursing and the patients they treat.


(1) Ministry of Health. (2001) Resource Guide: Effective Utilisation of Nurse Practitioners in the New Zealand fIealth and Disability Sector. (p 36-37). Wellington: Ministry of Health.

(2) Ministerial Taskforce on Nursing. (1998) Report of the Ministerial Taskforce on Nursing: Releasing the Potential of Nursing. Wellington: Ministry of Health.

--Tom Pantano, RCpN, RNC, BSN, NNP (US), is neonatal nurse practitioner coordinator at Middlemore Hospital.
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Title Annotation:viewpoint
Author:Pantano, Tom
Publication:Kai Tiaki: Nursing New Zealand
Date:Dec 1, 2003
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