NURSING SCOPE OF PRACTICE UNDER THE HEALTH PRACTITIONERS' COMPETENCE ASSURANCE ACT

Jenny Carryer, RN, PhD, FCNA(NZ)

Under the Health Practitioners Competence Assurance Act 2003 the term 'scope of practice' takes on a specific and new meaning. Instead of describing areas of specialty nursing (e.g. child health) it will now describe the content of what a professional group does.

Under the public safety responsibility of the Nursing Council of New Zealand the scopes of practice must describe the profession for the public so that they have a clearer understanding of the skills and qualifications of nurses and of the health services provided by nurses.

Council have already carried out a review of international and national definitions of nursing and engaged in consultation with national nursing organisation.

A consultation document is now posted on the Council's website (www.nursingcouncil.org.nz) and College members should review the document for a clearer outline and explanation of what is proposed.

The College will be required to take a position on this issue and we will accept and collate responses on the College website and encourage discussion on the electronic discussion group. In the meantime a brief outline is provided here.

Currently Council proposes that three scopes of practice be regulated under the Act. These are:

1. Nurse Practitioner

Nurse practitioners are expert clinicians who work within a specific area of practice incorporating advanced knowledge and skills. They practise both autonomously and in collaboration with other health care professionals to assess, treat and manage people's health problems. They provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering, conducting and interpreting diagnostic and laboratory tests and administering therapies for the management of potential or actual health needs. They work in partnership with individuals, families, whanau and communities across a range of settings. Nurse Practitioners may choose to prescribe medicines within their specific area of practice. Nurse Practitioners also demonstrate leadership as consultants, educators, nurse managers and researchers and actively participate in professional activities, and local and national policy development.

2. Nurse

Nurses utilise nursing knowledge and complex nursing judgement to assess and provide care, and to advise and support people to manage their health problems. They provide comprehensive nursing assessments, practice collaboratively with other health professionals to develop, implement and evaluate an integrated plan of health care, delegate to and direct "second level nurses" and health care assistants, and plan and provide nursing interventions that require substantial scientific and professional knowledge and skills. This occurs in a range of settings in partnership with individuals, families, whanau and communities. Nurses may practice psychiatric, psychopaedic, general and obstetric nursing. Nurses may also use this expertise to manage, teach, evaluate and research nursing practice.

Within this scope a number of conditions would limit the area of practice for certain previous registrations, e.g. registered psychiatric nurses may only practise mental health nursing.

3. "Second level nurse" - this scope is not yet named.

"Second level nurses" practise under the direction of a nurse or midwife to implement nursing care for people who have relatively stable and predictable health outcomes in situations that do not call for complex nursing judgement. "Second level nurses" assist nurses to deliver nursing care in a range of settings. The responsibilities of "second level nurses" include assisting clients with the activities of daily living, observing and reporting changes in individual/group conditions and behaviours and performing delegated interventions from the nursing care plan.

Points of interest which should inform discussion

• The Nurse Practitioner scope is straightforward - no obvious issues arise for discussion.
  
• Nurse. Here the debate lies with the decision to use the title "Nurse" or "Registered Nurse". Using 'nurse' without registered would make the word nurse a protected title and preclude its use by other groups.

However the profession may not wish to lose the designation "registered" even though it only has meaning when used to make a distinction between non-registered nurses who should no longer exist anyway - depending on how the third scope is named. Clearly the decision about naming this scope should be evaluated in conjunction with the third scope.

The third scope identified in the document as "second level nurse" is clearly an area of interest. Under the Act there will no longer be a roll for the enrolment of nurses. Council is consulting on using a legal title for the third scope that is different from enrolled nurse. Council is seeking a title that will have more meaning in the future (when there will be no roll) and that will reflect the scope of the second level nurse. The Council is seeking feedback on the title for the third scope of practice, referred to in this paper as the "second level nurse".

In keeping with the existing position of the College we could not support the third scope being named as a category of nurse. This position is well explained in our position paper on the reinstatement of enrolled nurse training located on our website.

We would however prefer to see some distinction made between the senior or long standing New Zealand enrolled nurses and the new classes of enrolled nurses currently training in Northland and Christchurch. This however is not a simple distinction as enrolled nurses also come from Australia and elsewhere to practise in New Zealand.

Titles already suggested for the third scope include "nursing assistant" and "associate nurse".

A facility has been established on our website to register statements of support or disagreement with existing suggestions in the Council document. Alternatively members may like to make other suggestions.

A College position will be formed from this consultation process and taken to a meeting of national nurse leaders at the end of May.