FAQs for employers who may be thinking about employing a NP

This section answers the following questions for employers who may be thinking about employing an NP:

1. What can an NP offer?
2. How many NPs are already registered in New Zealand?
3. What qualifications does a nurse require to become an NP?
4. What does an NP actually do?
5. How can NPs help to fill gaps in service provision?
6. How would I know if it would help us to employ an NP?
7. How do I go about getting an NP?
8. How can I prepare my services for the changes that will come with an NP role?
9. Can I employ an NP from another country?

1. What can an NP offer?

Nurse Practitioners (NPs) are expert nurses who practise both independently and in collaboration with other health care professionals. Their roles are to promote health, to prevent disease and to diagnose, assess and manage people’s health needs, often by working across traditional boundaries.

The area of practice of an NP may be either:

• broad, providing a broad range of services – eg, general practice, acute care, mental health, chronic disease management, older people’s health, or
• specialised, providing consultative services and direct clinical care to more complex patients – eg, diabetes, cardiac care, neonatal care, urology, ophthalmology, palliative care.

NPs can therefore make a difference to practice in a wide range of contexts. See profiles of NPs who have made a difference in:

• older people’s mental health
• adult urology
• rural primary health care
• primary health care / whānau ora
• adult emergency care
• cardiology
• mental health and intellectual disability
• ophthalmology
• services for older adults
• palliative care
• intensive care and high dependency.

2. How many NPs are already registered in New Zealand?

The number of NPs has grown since the first one was registered in 2001. As of 2011 there were 100 NPs registered in New Zealand (see graph).

3. 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 clinical Masters degree in nursing and who are expert, advanced practice nurses in their area of practice (minimum of four years in specialty practice).

The following are some of the core principles that drove the development of the NP qualification in New Zealand:

• 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. It opens up the opportunity to substitute between groups and thus to promote efficiency and flexibility in the use of valuable resources.

4. What does an NP actually do?

NPs provide a wide range of assessment and treatment interventions in a practice that expands on the traditional nursing role. They incorporate some of the skills that traditionally sat within the domain of medicine such as:

• making differential diagnoses
• prescribing medications
• admitting and discharging from hospital
• ordering, conducting and interpreting diagnostic and laboratory tests.

They work in partnership with individuals, families, whānau and communities across a range of settings.

5. How can NPs help to fill gaps in service provision?

NPs can fill gaps created by shortages of other health professionals because they:

• practise both independently and in collaboration with other health care professionals to promote health, prevent disease and manage people’s health needs
• can take full clinical responsibility for patients
• provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering and interpreting diagnostic and laboratory tests, administering therapies for the management of potential or actual health needs, admitting and discharging from hospital, and carrying out specific procedures (eg, colposcopy).

6. How would I know if it would help us to employ an NP?

Before a nurse can register as an NP, they must attain a broad and flexible range of advanced skills and knowledge. Therefore it is highly likely that an NP could meet gaps in clinical service provision. This potential was one of the leading principles behind the development of the NP role in New Zealand. Many NP roles have been developed as a direct result of doctor shortages.

To identify the potential for NP roles within your service:

• analyse any gaps in service provision and your organisation’s health needs
• analyse whether an NP position might meet specific gaps by analysing the gaps against the NP competencies
• read the profiles of successful and cost-effective NP roles, where outcomes have included bed closures through reduced need and slashed waiting lists.

The following questions may also help you decide if an NP role would work.

• 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 health care practitioners being used to optimal effect or would another health practitioner be more appropriate?
• Does the identified population currently have equal access to health care?
• 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?

7. How do I go about getting an NP?

If you can see the potential for one or more NP roles but don’t yet have any NPs there are two general ways in which you can develop an NP role.

1. Identify an NP position (based on a service gap) and grow an NP into it over several years.
2. Develop a training programme around a nurse who is already well on the way to becoming an NP.

See more information on:

• core components of the Nurse Practitioner Trainee Programme (NPTP)
• the learning environment the trainee needs
• the graded responsibilities involved in the NPTP
• the practice environment the trainee needs
• requirements for supervision.

For further details, see:

• NP trainee programme
• mentoring guidelines and Professional Development and Recognition Programmes

8. How can I prepare my services for the changes that will come with an NP role?

Making changes is never easy. Consider how you will prepare the service for change in terms of:

• changes to traditional boundaries and the related sensitivities that need to be managed
• change to the structure of teams; change management
• promoting the NP role with a focus on what it can do to improve population health.

9. Can I employ an NP from another country?

Yes, but be aware overseas NPs (other than Australian NPs) will need to first register with the Nursing Council of New Zealand as a registered nurse (RN) and then make an application for NP registration. The registration process must be completed in full, which can take some time. When this process is combined with the procedures involved in moving countries and gaining residency, there can be a delay of some months, just as for other health professionals.

There is a Trans-Tasman agreement for Australian NPs, which is a registration process opposed to an NP application process.

An alternative option would be to scope up a trainee NP position and move the successful candidate into it by supporting them to complete their educational and clinical requirements.

There are already experienced overseas NPs in New Zealand, as well as New Zealand RNs who have undertaken a significant part of the study required and would willingly finish it if they could be guaranteed an NP position at the end.