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Providing a 'fast track' for nurse practitioners.

THE MARCH issue of Kai Tiaki Nursing New Zealand certainly provides food for thought about where we are going with the development of the nurse practitioner (NP) role in primary health care.

Marg Eckhoff in "Relishing the challenges of rural nursing" (p16 17), has conveyed a sense of disappointment and disillusionment with the process of applying for NP status. Reading her article, one gets a sense of a nurse who, like many others in New Zealand, has pushed the boundaries of community, practice and rural nursing over many years. They have kept the true spirit of nursing alive for patients, families and the profession, and in some cases have done and are doing extraordinary and undervalued work, including advanced levels of illness, wellness and family management. Some have undertaken all the courses and post registration training available to them, only to find it is worth little in the newer academic scheme of things, ie clinical masters education.

This is precisely why, in the first years, the Nursing Council was to consider applicants who did not have masters preparation, but who had "educational equivalence". But it seems practically impossible to attain NP status without being on track to complete a masters degree.

Given the vital importance of having NPs collaborating to provide leadership for the primary health care strategy and in the development of primary health organisations, what could be done to provide a "fast track" academic pathway for clinically proven, leading primary health care nurses who simply have not had access to university graduate nursing education? Isn't this what a "grandmothering in phase" means?

Luckily for the younger/newer generation, distance-based learning and good, accessible university education will be available, hopefully even to isolated rural health nurses. But this has not been the case until very recently. One option is a "fast track" programme, of four to six months, providing courses such as primary health care concepts, management of common conditions, prescribing, preceptorship, evidence/research-based practice and professional and ethical issues for advanced clinical practice. It would still be a commitment, but not to a four-year masters degree. It is impossible to do a full-time masters in New Zealand because such courses are not available. It would certainly have been a worthwhile investment for the Ministry of Health to initially fund a select primary health care nurses' group. The cohort might consist of 30 nurses nationwide, eg those who have set up tremendously successful practices, nurse-led teams and clinics. These nurses would undertake a rigorous programme, gain an immense amount and emerge as a strong and leading cohort with a mission, and a sense of celebration and optimism to go along with it. The NP "movement" would be launched where it is urgently needed, in primary health care, and the concept would fly.

After the initial "grandmothering in phase", until 2010; all NPs should have the advantage and pleasure of a postgraduate education. Not only does this guarantee a certain level of preparation and qualification for "advanced practice", for which the Nursing Council as our professional regulatory body needs to certify us, but also helps us be confident we have the knowledge and skills required for advanced practice. And, of course, it helps with credibility among health professionals and patients alike. We need a culture, a philosophy of practice, standardised qualifications and a role for NPs, especially within primary health care, not just a status for them. Here's hoping that by the end of 2003 we'll have 20 of the best to drive the NP role in the community, and truly begin to make a difference in expanding access to disadvantaged people and improving our shocking preventable hospitalisation and mortality rates. The challenge is for those in power to reconsider how that might he achievable.

Paula Renouf, RCpN, BA, MS, PNP

NP child and adolescent health

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Title Annotation:letters
Author:Renouf, Paula
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Letter to the Editor
Date:Apr 1, 2003
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