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*Remuneration Packages for Nurse Practitioners
*Scopes of Practice for Nurse Practitioners
*Co-ordinating Masters Specialties Nationally
*Nationally Consistent Titles / a National Clinical
Career Structure for Registered Nurses
*Bedding Down Implementation of the Nurse Practitioner
Role via the DHBs
*Protecting the Vision of the Nurse Practitioner as
a Senior Clinician Recommendations
Foreword
The College is delighted to have hosted the forum to progress the development
of Nurse Practitioner roles in New Zealand. The event was characterised
by a sense of shared excitement, immense collaboration and a very productive
meeting of people who work in different parts of nursing.
The nurses present acknowledged the ongoing challenge of nursing workforce
development and clinical practice concerns. I think we also gained a sense
of the power and productivity possible when we work together and focus
on our shared goals.Currently the profession is focused on the development
of Nurse Practitioner roles. It is, however, important to note that Nurse
Practitioners will only ever be a part of the nursing workforce and in
no way should any nurse who has no interest in becoming a Nurse Practitioner
be made to feel less valuable. All nurses form a vital part of the nursing
service but the evidence also compels us to direct energy towards developing
this particular role.
The last five years have seen considerable gains for nursing. We have
begun to establish our position at the centre of primary health care delivery,
amassed compelling evidence for our centrality to patient safety in acute
hospital settings, and nurtured the growing links between education and
practice.
Thank you to all those who attended and worked hard for two days. The
recommendations from the forum provide a sense of direction as we continue
to establish the role of Nurse Practitioner in New Zealand. These recommendations
will be taken to the strategic planning meeting of the National Nursing
Organisations' leadership meeting in May 2003.
Professor Jenny Carryer
Executive SummaryIn February 2003 the College of Nurses Aotearoa brought
together, for a two day forum, the nursing leadership of New Zealand and
nurses with an interest in progressing the development of the Nurse Practitioner
role in New Zealand. The 80 forum participants came together to identify
barriers to the development of the Nurse Practitioner role, determine
processes for dealing with these, and develop strategies for protecting
and nurturing the Nurse Practitioner role as it develops in New Zealand.Early
in the forum participants identified key strengths and opportunities associated
with the emerging Nurse Practitioner role in New Zealand, such as the
opportunities this role offers for addressing current gaps in health service
provision, the robust framework and accreditation process for the role,
the enhanced clinical career path this role provides, the extensive international
evidence base for the Nurse Practitioner role, and the opportunity to
extend this body of knowledge with New Zealand based research.Participants
also identified a number of challenges which need to be worked through
for the Nurse Practitioner role to be developed optimally in New Zealand.
These included insufficient recognition of the strengths of the role within
District Health Boards, some opposition to the role of nurse prescribers,
the current lack of equity in the funding distributed by the Clinical
Training Agency, and the personal financial burden of attaining Nurse
Practitioner status.A major focus of the forum was participant generated
analysis of the following topics:
1. Remuneration packages for Nurse Practitioners
2. Scopes of practice for Nurse Practitioners
3. Co-ordinating masters specialties nationally
4. Nationally consistent titles and a national clinical career structure
for Registered Nurses
5. Bedding down implementation of the Nurse Practitioner role via the
District Health Boards
6. Protecting the vision of the Nurse Practitioner as a senior clinicianConsensus
discussions based on analysis of these topics gave rise to a set of
recommendations.
These focus on co-ordinating and refining the considerable body of work
already achieved within nursing. The recommendations are directed towards
supporting and developing the Nurse Practitioner role, enhancing communication
across the profession and to the public about nursing career structures,
addressing inequities in the funding of education/training for Nurse Practitioners,
and facilitating the development of new Nurse Practitioner positions in
emerging Primary Health Organisations.
The Forum
Goals
The forum to progress the role of the Nurse Practitioner in New Zealand
was convened with the following goals in mind:
1. To bring together nursing leaders and other nurses with an interest
in the development of the Nurse Practitioner role from throughout New
Zealand to talk together as a profession about the future of this role.
2. To identify barriers to the development of the Nurse Practitioner role
and determine processes for dealing with these.
3. To develop strategies for protecting and nurturing the Nurse Practitioner
role as it develops in New Zealand.
Process
Leading up to the forum the College of Nurses Aotearoa worked with the
nursing leadership throughout New Zealand to canvas opinions on issues
that should be covered at the forum, and to determine the best processes
and format for covering these issues. Initial input was welcomed from
all nurses, and in particular assistance was sought from the New Zealand
Nurses' Organisation (NZNO), the Nursing Council of New Zealand, The Nurse
Practitioner Advisory Committee of New Zealand (NPAC-NZ), the Australian
and New Zealand College of Mental Health Nurses, Nurse Executives of New
Zealand (NENZ), Nurse Educators in the Tertiary Sector (NETS) and the
Council of Maori Nurses. A set of useful pre reading material was posted
to workshop participants just prior to the forum.
The two day forum was opened with a greeting and Karakia by College of
Nurses Aotearoa Board member, Taima Campbell. The first activity for the
80 participants was a SWOT (Strengths, Weaknesses, Opportunities, and
Threats) analysis of the Nurse Practitioner role in New Zealand. This
analysis was done in small discussion groups. The group as a whole then
reconvened to share the findings of the SWOT discussion groups and to
hear presentations from the three guest speakers. A major focus of the
forum was participant generated analysis of six major topics which had
been selected and advertised as part of the programme prior to the start
of the forum. The six discussion topics are listed below:1. Remuneration
packages for Nurse Practitioners
2. Scopes of practice for Nurse Practitioners
3. Co-ordinating masters specialities nationally
4. Nationally consistent titles/a national clinical career structure for
Registered Nurses
5. Bedding down implementation of the Nurse Practitioner role via the
District Health Boards (DHBs)
6. Protecting the vision of the Nurse Practitioner as a senior clinicianDiscussion
groups were held concurrently for three of these topics at a time. Forum
attendees selected one from each of the three topics on offer at each
of the workshop times, and had opportunities to contribute to the facilitated
feedback session and combined group discussion held for each of the six
topics. At the conclusion of day one Deborah Harris, Nurse Practitioner
from Hamilton, facilitated an impromptu workshop on the application process
and NPAC-NZ plans for supporting future applicants.At the conclusion of
day two, in a final consensus discussion, the group as a whole agreed
the recommendations to be put forward from the forum, and nominated a
group of 14 people to review the draft proceedings. These people were:Jill
Clendon Pamela Lee
Jackie Cooper Barbara Middleton
Deborah Harris Chris Millar
Frances Hughes Christine Payne
Rosemary Jamieson Jane Pope
Shelley Jones Thelma Puckey
Judy Kilpatrick Sue Wood
Presentations
Three guest speakers gave presentations on the first day of the forum.The
Honourable Annette King, Minister of Health, spoke about the Government's
commitment to implementing the role of the Nurse Practitioner in New Zealand
and expressed her expectation that District Health Boards would implement
Nurse Practitioner roles. The Minister took the opportunity to announce
11 successful applicants for the Nursing Innovations funds for primary
health care nursing projects.Laila Harré, Organising Services Manager
for the New Zealand Nurses' Organisation, presented on the topic of remuneration
and other conditions of employment for Nurse Practitioners. Adam Lewis,
a senior solicitor at Chapman Tripp, gave a presentation and entered into
discussions with forum attendees on the topic of professional accountability
vis à vis employer accountabilities.
SWOT AnalysisA SWOT (Strengths, Weaknesses, Opportunities, and Threats)
analysis by forum participants on day one identified the following:
Strengths
1. The role of Nurse Practitioner is based on an international review
and therefore benchmarked from an educational point of view.
2. There is a robust framework and accreditation process for the role.
3. The role offers an advanced clinical role and consequently an enhanced
clinical career path.
4 There is strong agreement amongst the nursing professional bodies
regarding the role and its future direction.
5 Implementation of the role will increase access and choices for health
care which in turn will address current gaps in service provision.
6 Nurse Practitioners will contribute to nurse led research and evidence
based practice.
7 Collaborative practice will be enhanced.
8 The role legitimises current roles in practice.
9 Our New Zealand Nurse Practitioner is unique being based on a careful
review of international expressions of the role.
Weaknesses1. Lack of developed support and mentorship networks.
2. Lack of business planning.
3. Lack of understanding of the role on the part of many DHBs, consumers,
and other health professionals.
4. Too few work environments have a pathway for Nurse Practitioner development.
5. Possible lack of positions for Nurse Practitioners in the near future.
6. Insufficient recognition of the role and its strengths within DHBs.
7. The personal financial burden of attaining Nurse Practitioner status.
8. Accessibility to post graduate masters programmes and lack of support
for advanced education.
Opportunities1. Could radically alter the way health care is
provided in New Zealand.
2. Offers opportunities for creativity.
3. Provides a platform to develop different models of care.
4. Primary Health Organisations (PHOs) can be used to demonstrate the
potential contribution of Nurse Practitioners.
5. Promotes interdisciplinary practice.
6. We can lay the foundation for formal evaluative research in the New
Zealand context.
7. The Nurse Practitioner role showcases what we can contribute as nurses,
and should therefore lead to an increased profile for nurses.
8. We need to take hold of opportunities to provide a strong media campaign
to promote nurse practitioners.
9. There is an opportunity to add New Zealand research to the large
body of international evidence supporting the Nurse Practitioner role.
Threats/Challenges1. Opposition to the role of nurse prescribers.
2. The risk of other professions attempting to define the role.
3. Current structures limit the number of Nurse Practitioners and how
they might work.
4. Structural barriers within DHBs.
5. Challenges for rural practitioners re defining their scope of practice.
6. The current lack of equity in the funding distributed by the Clinical
Training Agency (CTA).
7. Lack of funding for research.
Discussion Topics
Remuneration Packages for Nurse Practitioners
This discussion was a follow up to the presentation on remuneration and
other conditions of employment for Nurse Practitioners given by Laila
Harré, Organising Services Manager, NZNO. The key points from Laila
Harré's presentation are as follows:1. New Zealand nurses are lower
paid than other comparative professional groups, and in particular, male
dominated professions.
2. Fragmentation, public sector wage restraint and the squeezing of middle
incomes have impacted negatively on nurse pay.
3. Interventions based on job evaluation and gender pay equity have improved
nurse pay elsewhere and teachers' pay in New Zealand.
4. Nurse Practitioner credentialing should result in relative pay improvements
for non Nurse Practitioner specialist nurses.
5. A range beginning at $70,000 is estimated by NZNO to be reasonable
with higher rates assuming pay equity intervention.
6. Other elements of the package and job description must ensure that
Nurse Practitioners are able to perform at a high level.Subsequent discussion
focused on the following topics.As the Nurse Practitioner role is a developing
one, it is unlikely that it will fall within the Multi Employer Collective
Agreement (MECA) in the short term. Many present at the workshop felt
there would never be a place for a MECA for Nurse Practitioners. NZNO's
long term view, however, is that Nurse Practitioner packages should be
part of agreements. Some concern was expressed that collective agreements
can be inflexible, and that Nurse Practitioners who are used to negotiating
their own contracts could lose flexibility in a MECA arrangement. It was
suggested that the term "collective" comes with a number of
connotations and that alternative terms such as "a benchmark agreement"
could be more acceptable. Some advocated the use of a generic agreement
for Nurse Practitioners with some flexible components which could be tailored
to individual scopes of practice.There was agreement that employment packages
for Nurse Practitioners must include more than remuneration elements,
i.e. they should include provisions for research and continuing nursing
education and professional development. The package should ensure that
Nurse Practitioners are able to achieve Nursing Council of New Zealand
revalidation. It is important that there is equivalence between Nurse
Practitioners working in secondary settings and those working in primary
health care. One approach would be for the DHB to take responsibility
for ensuring a consistent approach to remuneration in both the secondary
and primary health care sectors in relation to its roles as employer and
funder. This would involve the Board and the funding and planning team.
A specific Key Performance Indicator (KPI) here with reporting requirements
linked to health goals would be useful.We should bear in mind that Nurse
Practitioners could gain income from a range of avenues including co-payments
and ACC payments. There is work for the profession to do around assisting
new Nurse Practitioners to access these streams of income.
Scopes of Practice for Nurse Practitioners
Individual and organisational definitions of what a scope of practice
entails may be different. A parallel process occurs whereby both employers
and Nurse Practitioners develop the description of a scope of practice.Scopes
of practice for Nurse Practitioners should be broadly defined and can
be tailored to encompass an individual's area of practice. The task of
defining and describing an area of practice is one which should be owned
by Nurse Practitioners themselves. Specialty groups may assist with this
process. The process can also be assisted through discussion groups for
nurses working in a common area (e.g. primary health care nurses). DHBs
have a role to play in supporting inter DHB communication forums of this
kind. It was suggested that the scope should reflect the range of skills/knowledge
as applied to the specific population being served. There is agreement
that the matrix framework for broad scopes of practice for Nurse Practitioners
(as described in Nursing Council Nurse Practitioner publications) was
a useful starting point. This matrix should now be reviewed and replaced
with a broad statement encouraging individuals to define their own scope
of practice.
There is a need for further debate and clarification about the boundaries
between Clinical Nurse Specialists and Nurse Practitioners. We need to
clarify what is meant by the title Clinical Nurse Specialist and the ways
in which this could be structured to lead into a Nurse Practitioner role.
In addition it needs to be clear how this differs from a nurse consultant
where that title is used.
Action points for the profession:
1. Provide clarity re the difference in roles between Clinical Nurse
Specialists and Nurse Practitioners.
2. Nursing Council to review the matrix framework for nurse practitioner
scopes of practice.
3. Monitor the Medsafe website (www.medsafe.govt.nz).
Monitoring is needed to review the meeting agendas of the Medical Classifications
Committee and attend to subjects coming up which have relevance to nurse
prescribers. It has since been agreed that this will be done by the Nurse
Practitioner Network in the College of Nurses.The forum acknowledged the
interprofessional debate about potential medicalisation of nursing inherent
in Nurse Practitioner roles. Dr Merian Litchfield provided the diagram
on the following page. This usefully clarified the manner in which Nurse
Practitioners may take on tasks which have traditionally been medical,
where this can be seen to benefit patients. As the diagram shows, however,
the approach of the Nurse Practitioner is always derived from nursing.
THE DIFFERENCE AND COMPLEMENTARITY OF THE DISCIPLINES OF NURSING AND
MEDICINE
Skills & activities shared by professional practitioners - Where
practitioners are able to explain the meaning of these skills & activities
in relation to the health of NZ patients/clients.
They can do this because they have a distinct perspective of health developed
through their scholarly endeavours within each discipline.
Merian Litchfield 1995 / 2003
Litchfield Healthcare Associates
Co-ordinating Masters Specialties Nationally
This topic was raised in order to address three issues:1) The need for
masters programmes for Nurse Practitioners to contain a specialty focus;
2) The difficulty in making specialty papers available in an accessible
manner in a small, spread out country;
3) The need for transparent information about the location of specialty
topics and the possibilities for cross crediting, nationally and internationally.A
key consideration of this discussion group was where and how students
access information on clinical specialties for Masters programmes. Current
Nurse Practitioner programmes are broadly similar, but specialty papers
are available sometimes in only one location. There are a number of constraints
to offering specialty programmes, including: the size of New Zealand's
population, resourcing constraints, regional differences in the programmes
offered and a degree of confusion over graduate/postgraduate status. Sometimes
there is confusion over the difference between level seven and level eight
papers. There is also the difficulty of retaining clinical specialty staff
who are also research active in line with the requirements of the performance
based research funding model soon to be implemented. Most people feel
that the existing model of masters with a clinical focus with broad streams
is a useful model with enough flexibility to incorporate more specialised
fields of knowledge. "Special topic" research papers in existing
programmes enable some degree of specialty focus, and learning contracts
are effective for managing a specialty focus for students outside of major
centres. This may be working while the student group is relatively and
often extensively clinically experienced but as the students coming through
are less experienced the need for high quality solid clinical content
will become even more paramount.Students wishing to cross-credit papers
across masters degrees are constrained by the lack of a consistent mechanism
for communicating these and the limitations on cross-crediting set in
place by educational institutions. However, there are some successful
existing models of collaboration between educational institutions for
the delivery of courses to prepare nurses for Nurse Practitioner endorsement.There
is a need for Nurse Practitioners (or those who are close to applying)
to provide relevant clinical teaching into specialty courses, although
the low number of current Nurse Practitioners limits our ability to achieve
this in the short term. DHBs could support the development of this approach
through various joint appointment models.Major concern exists about inequitable
funding for clinical nursing programmes through the Clinical Training
Agency (and indeed for any postgraduate education). The CTA provides an
extremely limited and highly constrained fund. The Ministry of Education
funds tertiary providers. Some employers have become more realistic about
providing professional development support but a significant amount of
this money remains as personal investment from nurses themselves.
Action points for the profession:1. NETS will finalise the database of
postgraduate offerings and specialty courses. There is an urgent need
for this work in progress to be completed, posted onto a website and made
widely available through links to other nursing and health sector sites.
(When the website becomes available the address will be www.nurseeducation.org.nz.)
2. In addition to the postgraduate education provision database, NETS
will develop a companion information kit for potential students, covering
questions to consider when enrolling in masters programmes - costs, relevance,
quality, duplication, portability, cross-crediting and whether cross-credited
courses meet the Nursing Council requirements for an approved Nurse Practitioner
programme.
3. Clinical areas should establish formal links with education providers
to ensure quality benchmarking and to enhance the portability of clinical
qualifications.
Nationally Consistent Titles / a National Clinical Career Structure for
Registered Nurses
The Nurse Practitioner role is endorsed as a senior clinical role, thereby
implying that there is a supporting career structure. The current range
of roles and titles complicate career development planning for nurses.
Nurse role titles have often been employer or contractually defined. There
is confusion around the co-existence of Clinical Nurse Specialist roles
and Nurse Practitioner roles. It has been suggested that the Clinical
Nurse Specialist role can be a preparation for the Nurse Practitioner
role; however, this has not been widely debated.
Points of agreement:There is strong agreement that national titles and
roles should be professionally determined and nationally consistent within
reason. At least the titles Nurse Practitioner, clinical nurse specialist,
clinical nurse educator, nurse consultant, charge nurse, primary health
care nurse etc should be nationally consistent.There is also a need for
national clarity around a Levels of Practice (LOP) or Clinical Career
Pathway (CCP) framework.
Action points for the profession:
1. Co-ordinate a national project to define and clarify national titles.2.
National co-ordination is needed between the work being undertaken by
the Nursing Council, NZNO and Directors of Nursing on the competency framework,
levels of practice framework and clinical career pathways.3. The existing
work requires a short term taskforce to oversee the development of a national
framework and standards for LOP/CCP programmes which references and integrates
work undertaken by Nursing Council and implements the intent of earlier
work led by a small group arising out of the 2001 NZNO CCP Forum.4. The
same or similar taskforce could determine appropriate "levels of
practice" such as those defined by Benner for entry to titles as
defined in the work already undertaken by Nurse Executives of New Zealand,
e.g. practice level of proficient or expert recommended for Clinical Nurse
Specialist position.5. Once we have agreement amongst the profession regarding
titles and levels of practice, there must be follow up work with the DHB
management, including DHBNZ (District Health Boards New Zealand). It would
be useful for DHBs to have a specific KPI to report on proportions at
different levels in LOP/CCP programmes and number of positions held at
various titles.
Bedding Down Implementation of the Nurse Practitioner Role via the DHBsNurses
need to be part of the planning process at a high level to make implementation
of the Nurse Practitioner role via the DHBs viable. This begins with a
nursing voice in the funding and planning overview across multiple DHBs.
Key alliances are important here. The profession needs to establish a
working group to put together the contracts and set up requirements for
implementing the Nurse Practitioner role within Primary Health Organisations.
This group would also devise the accompanying audit tool and have input
into DHB and Ministry of Health monitoring of PHO performance. Nurses
need to be working at the governance level of PHOs as they become established
to ensure that adequate opportunities are provided for Nurse Practitioners.
PHOs are a key focus for successful implementation of the Nurse Practitioner
role in New Zealand.It is not widely known amongst all stakeholders that
the DHB service frameworks acknowledge Nurse Practitioners in the same
way as medical specialists and allow for revenue generation in the same
manner.Nurse Practitioners need to be equipped with negotiating skills
and specific knowledge about the political and policy context. This could
be achieved through mentoring and providing a toolkit for those about
to attain endorsement. This would include training in the preparation
of successful business cases and negotiation skills. It was widely agreed
that leadership training needs to be an inherent part of Nurse Practitioner
education.
Action points for the profession:
1. Create a national workforce development plan for Nurse Practitioners
with models specific to local settings, and a Nurse Practitioner position
description that is appropriate and realistic. Quality systems need to
be in place for aspects such as clinical supervision.
2. Create links between academics and the DHBs with a view to establishing
an evaluative process for the Nurse Practitioner role.
3. Devise a strategic plan to ensure Nurse Practitioner prescribing is
protected and endorsed within the DHB environment.
4. Undertake an education and marketing campaign to explain the Nurse
Practitioner role to DHB boards, the public, consumer groups, and medical
and allied health colleagues.
Protecting the Vision of the Nurse Practitioner as a Senior ClinicianThis
session began with agreement that while there are many individuals / organisations
who wish to influence the development of the Nurse Practitioner role in
New Zealand, the commitment to a national approach must be maintained.Protecting
the vision of the Nurse Practitioner begins with recruitment into undergraduate
nursing programmes. There are existing difficulties attracting school
leavers and high calibre students to nursing programmes. Without people
entering the profession and seeing nursing as a viable career option a
situation could arise where the demand for Nurse Practitioners is not
able to be met within the profession. There is an urgent need to establish
a nationally co-ordinated plan to enhance the image and profile of nursing
with the public and more importantly with school Guidance Counsellors
who assist school students with their career decision making. It was noted
that many Guidance Counsellors have limited and often inaccurate information
on nursing as a career and are not up to date with recent developments
in the profession. The need for comprehensive profiling of nursing using
print and website materials was agreed. A project to address these issues
involving Johnson and Johnson is currently being scoped and will shortly
be launched in New Zealand. Johnson and Johnson have undertaken very successful
projects on this in the US and have recently commenced work in Australia.
Opportunities to showcase nursing and nursing developments, such as the
recent Nursing Innovation awards, were also highlighted as strategies
that raise both the public's and the profession's insight into nursing.
Ensuring potential Nurse Practitioners have access to relevant course
information, practice development, career counselling, mentoring and support
were identified as being essential to protecting the vision of the Nurse
Practitioner. It was agreed that a broad approach to which relevant organisations
contributed (NPAC-NZ, NETS, NENZ, etc) may be more appropriate than having
one group take ownership of the initiative. Concern was expressed that
the possible establishment of a separate Nurse Practitioner organisation/profession
could be divisive for the profession and result in unnecessary costs for
individuals.In the interim NPAC-NZ is establishing a mentoring programme
and collating frequently asked questions. Resource materials are available
internationally e.g. the Hitchhikers guide to becoming a Nurse Practitioner
is a US publication and it was suggested that details of this and other
materials be collated and made available in New Zealand for potential
Nurse Practitioners.It needs to be reaffirmed that New Zealand does not
support direct entry of new graduates from disciplines other than nursing
into Nurse Practitioner programmes as the role builds upon nursing experience.
Secondly the Nurse Practitioner role in New Zealand is a clinical role
and requires the nurse to be actively involved in clinical practice and
holding an active caseload.The vision for Nurse Practitioners in New Zealand
includes working collaboratively with other health professions. It was
noted that debates in the media, such as the recent one on nurse anaesthetists,
make this difficult and also have the potential to slow other Nurse Practitioner
developments. Finally the group discussed the importance of working effectively
with the media to profile the Nurse Practitioner role. It was noted that
this can be difficult as many employers have media policies that govern
who can speak to the media and the media is interested in the more controversial
aspects of the role (e.g. competition with the medical colleagues). One
way around this that was recommended was Nurse Practitioners finding opportunities
to speak out on health issues related to their scope of practice and becoming
recognised by the media as experts in their fields. Media training was
seen as a priority for all nurses developing their expertise in managing
the media.It is also acknowledged that there could be confusion as to
when and how the Nurse Practitioner title is used. Will it be limited
to a Nurse Practitioner in current active practice, or will it also be
used by someone who has held the role and now teaches or provides a leadership
role in a relevant context?
Action points for the profession:
1. Nursing needs to actively identify media spokespeople within
the profession and support them. Nursing organisations need to develop
productive relationships with key media sources in order to progress
the visibility of nursing.
2. NPAC-NZ to progress the development of the mentoring programme for
would be Nurse Practitioners.
3. Resource material to be collated and made available in New Zealand
for potential Nurse Practitioners.
Recommendations
The following recommendations were agreed to by participants at the conclusion
of the two day forum:
1. That the existing projects on the Clinical Career Pathway / Levels
of Practice and Nursing Council's competency framework projects be co-ordinated.
That a time frame for the completion of this work be agreed to by the
various parties concerned.
2. That Masters degree programmes which prepare nurses for endorsement
as a Nurse Practitioner be referred to consistently in the literature
as "clinically focused Masters degree programmes" rather than
as "clinical Masters".
3. That New Zealand nursing organisations vigorously examine better
mechanisms for communicating across the profession, including use of
channels such as Kai Tiaki, Nursing Review, Te Puawai and the Nursing
Council newsletter. There is a particular need for consistent information
about nursing career structures and appropriate academic counselling,
as well as a need for more in-depth factual content underpinning the
reportage of political debates.
4. That a working group is formed to update the work already begun by
NETS on listing available postgraduate nursing qualification choices
and their portability or compatibility with other programmes. The resulting
career/academic planning tool to be maintained on the NETS website and
linked to other nursing organisation and health sector websites.
5. That a working group is formed to monitor national developments regarding
the implementation of the Primary Health Care Strategy. The brief of
this group includes the development of a nursing audit tool for Primary
Health Organisations to ensure that the primary health care nursing
framework is able to be operationalised. This group will be linked to
the national group of Directors of Nursing and will include some Directors
of Nursing in its membership.
6. That a means of providing greater clarity to the profession is found
regarding the delineation of nursing scopes of practice at Nurse Practitioner
level, particularly in relation to personal career planning.
7. That a career planning resource is developed, to be available as
a handbook and on a website, which presents general career development
concepts useful to nurses. This would include an overview of broad career
tracks and options within nursing in New Zealand (e.g. practice, education,
research, management/ leadership) and information about the sort of
clinical/work experience and further education useful to progress within
(and across) broad tracks. This needs to enable nurses to map out next
steps on the basis of a clear picture of where they might go and how
they might get there.
8. That the profession urgently address a national strategy for funding
the education/training of Nurse Practitioners. This involves challenging
the performance based research funding formulae for tertiary institutions,
and endorsing the recommendations of the PECT (post entry clinical training
agency) advisory group to the Ministry of Health.
9. That a strategy for influencing DHBs is developed for use by Directors
of Nursing and other professional groups. This should include presentation
packs, and promotional material for DHBs, which articulate the potential
for Nurse Practitioner roles, citing examples across the health care
sector (including provider units and PHOs), and include the profiles
of the existing Nurse Practitioners.
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