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Growing Advanced Nursing Roles in

Aotearoa

Helen CostelloProject Manager - C&C DHB Nurse Practitioner Initiative

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International Council of NursesNurse practitioner (NP) as "a registered

nurse who has acquired the expertknowledge base, complex decision-making skills and clinical competencies for

expanded practice."

The Nursing Council of NZ has developedcompetencies for this level of practice

- NP scope

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Advanced Practice Nurse (clinical roles)

Australia / NZ

America

Nurse Practitioner

Clinical Nurse Specialist Nurse Specialist Nurse Consultant

Advanced Practice Nurse APN NP

UK*

Not Physician's Assistant

an

Nurse Practitioner* Advanced NP*

Specialist Practitioner Nurse Therapist Higher Level Practitioner

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Advanced Practice on the Agenda

International and National Drivers: Health workforce issues are a global concern

Major changes in population structure

International shortages of healthcare workforce Skill-mix - best healthcare & health professionals working to

optimal level

ea t care re orm exam n ng new mo e s o ea t caredelivery & potential to extend traditional nursing roles

1998 Ministerial Task Force Report:

Releasing the potential of nursing

Recommended advanced nursing roles

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Advanced Practice Senior Roles Education

Management Leadership

Clinical

NP, CNS, NS - Specialist)

... Expert RN with extensiveexperience in a speciality

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Workforce Development Is it accepted and or expected that nurses

provide a more specialised and quality

enhanced service as their career progresses?

, ,seen on a continuum and is the broad term

that is used in New Zealand to encompass

a range of developing practice and

employment roles underpinned by post

registration education and practice

expertise (National PDRP 2005)

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Advanced Nursing Practice (ANP)

Reflecting a range of highly developed clinicalskills and judgements acquired through a

combination of nursing experience andpostgraduate education.

,requires the application of advancednursing knowledge, with practitioners

drawing not only on their own clinicalexperience, but also on the experience andresearch of the profession as a whole.

National Professional Development & Recognition Programmes Working Party [PDRP] (2005)

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Qualification requirements Registration with the Nursing Council of New Zealand in

the registered nurse scope of practice for IQNs

A minimum of four years of experience in a specific area ofpractice

uccess u comp e on o a c n ca y ocuse as ersDegree programme approved by the Nursing Council

Successful completion of a Clinical Masters 2010

A pass in a Nursing Council assessment of NursePractitioner competencies and criteria

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The future changing context......there is a very strong likelihood that the mental health and addiction

workforce, working in the current way, will be unable to meet futuredemand for servicesContext:

Projected demographics indicate that there will be anincrease of 72% in people > 65yrs of age between2001 2021 (NZ Institute of Economic Research 2004).

Changing aging workforce ....

Consumer choice, lifestyle factors and technological

developments are changing the way services areprovided.

Shift to service-user-focused care based and DHBurgent responsibility to redress disparity

More complex health needs, including an increase inchronic illnesses, are developing as a result of theageing population

National workforce drivers recruitment & retention(DHB/Service)

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I am sure that the development of nurse practitioners, with their

population focus, will have a positive impact on the qualityand effectiveness of health care in New Zealand.

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Level of Practice (Clinical Pathway)NP is the highest level of clinical nursing - extended and expanded ANP

roles.

Role extension - inclusion of a particular skill or area ofpractice responsibility that was not previously associatedwith the nurse's role.

Role expansion - the core elements of nursing practicestill apply but that additional skills and areas of practiceare encompassed within a specialist role that involvesgreater responsibility, accountability and autonomy for

broader aspects of the management of specialised care

Daly, W.M. and R. Carnwell, Nursing roles and levels of practice: a

framework for differentiating between elementary, specialist and advancingnursing practice. Journal of Clinical Nursing, 2003. 12(2): p. 158-167.

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Health Workforce Drivers

What does this mean for

practice?

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Extended + expanded = advanced

nursing practice

extendedexpanded

MedicineNursing

nursingpractice

As with other health professions, nursing practice has become increasinglydiverse and complex in response to societal, political and technological

challenges.

Figure by Jill Wilkinson

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Extended Practice: The addition of aparticular skill or area of practice

responsibility usually in responseto increased demand orconsumer need

Expanded practice: Pushing the boundaries of

nursing role development

A professional strategy withncrease range o au onomy,accountability and responsibility.

Usually occurs within a specialistnursing practice and involvesadditional skills such as diagnosis

and prescribing. There is a formalpathway to role expansion thatentails further education and mayinclude regulation

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Nurse Practitioner Positions evolving in NZ

Confusion in the healthcare setting and literature

around how this role - need to maximise the fit

with other advanced practice roles and very

NPs have gained through a rigorousprocess, a registration enabling them to

work within a nursing framework in aninnovative non-traditional advanced nursingrole

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Strategic capacity: building the capacity of

the DHB sector to influence thedevelopment of the health workforce. This

workforce issues and new workforcedirections.

Career pathway not a great fit for the NP

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Planning... services need to find ways of working

better and more efficiently within currenthuman resource levels and DHB

...C&C DHB commitment to NP development

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Workforce Development CTA

DHB commitment tointroduce NP Candidate(training positions)

....ultimate goal is toensure better health

outcomes for serviceusers.

en y gaps po en afor enhancement

Workforce readiness

Expanded advanced

nursing practice roles

..building both thecapacity and the

capability of human

resources within the

health sector.

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Where are we going?

NP roles MUST be DHB lead and evolved.

Nursing leadership DHB commitment to a structuredcollaborative a roach for o timal NP role

development- Improved linkage with universities ...

NOT all nurses with Clinical Masters aspire to NP

BUT a mismatch exists- CTA mechanisms - practicum courses

- NPC Programme - internship

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Nurse Practitioner Pathway Right papers ...right degree NCNZ

Enhancement of existing service/nursing roledevelopment ...substitution

Service/Directorate agreement for NP role capacity

Key to scoping the Nurse Practitioner role within your

service is understanding the NP scope of practice anddetermining how this nursing role can enhance service

delivery and address population needs

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CTA levels of postgraduate programmes

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Your Nursing Workforce and

Services

What does this mean for gastroenterologyendoscopy nursing practice?

Extended RN roles endoscopy nurse

NP roles - including endoscopy

- Nurse Lead clinics screening

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4. Population health status will drive the provision

of nurse practitioner services.

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NCNZ - broad areas of practice usingpopulation groups and practice areas

A t V H lth C diti

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Acute Vs Health Condition

NP Applicants If your practice area has a significant surgical and acutecomponent, for example, you manage/are involved in clinicspreparing people for surgery, surgical interventions and

then following clients up post surgery, as opposed to a rolepredominantly involved in the chronic non-operativemanagement of clients, it might be more appropriate to

app y or e cu e are area o prac ce as oppose o especific Health Condition area of practice.

Whilst some conditions could appropriately sit under

alternative practice areas, it is up to you to decide whereyour practice best fits so that you have decided what yourarea of practice is when you submit your portfolio.

(NCNZ 2009)

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Nurse Practitioner framework for

establishing and sustaining NP rolesFive Part Nurse Practitioner Framework:

Part one: Assessing the need for a NP role in the practice setting - define

the population focus, area of practice and scope the model ofcare/NP role

Part two: Determining the best way to approach implementation

o e ro e an a e ro e or reg s ere

Part three: Establishing the NP Candidate or NP role in the practice

setting (getting started)

Part four: Implementing the NP Candidate or NP role in the

practice setting (role development, monitoring process)

Part five: Evaluate role implementation and role outcomes