Submission made by the College of Nurses Aotearoa (NZ) Inc.

30 March 2005

Helena Strange
Justice and Electoral Committee Secretariat
Parliament House
WELLINGTON

Nurse Practitioners

The development and implementation of the Nurse Practitioner role in New Zealand follows a key recommendation in the report of the Ministerial Taskforce on Nursing (1998). The Nurse Practitioner role has been established in other countries for decades and New Zealand nurses have had the benefit of learning from these other countries. The research evidence into the effectiveness of the Nurse Practitioner role strengthened the Government’s resolve to establish the role in the New Zealand health sector. New Zealand now has 13 Nurse Practitioners in a variety of specialty practice areas.

Nursing is person centred, focusing on the health needs of the individual, groups and populations, in order to improve quality of life. The Nurse Practitioner is the most advanced nursing clinical practice role and is regulated by the Nursing Council of New Zealand. The title is protected and cannot be used by any nurse; the title nurse is protected under the Nurses Act 1978.

Nurse Practitioners are competent to:

• Obtain health histories and perform physical examinations
• Diagnose and treat acute health problems related to their scope of practice
• Case manage clients with highly complex chronic conditions, assisting them to access services to keep them in their homes and family environment
• Diagnose, treat and monitor chronic diseases such as diabetes and hypertension
• Undertake clinical management and monitoring of treatment regimes
• Order, perform and interpret diagnostic studies such as laboratory tests results and X-rays
• Prescribe medications and other treatment within their scope of practice
• Provide family planning and women’s health services
• Provide well-child care, including screening and immunisations
• Provide health maintenance care for adults, including annual physical checks
• Promote positive health behaviours and self care skills through education and counselling
• Refer to other health care professionals as needed
• Accept referrals from other health professionals.

Signing of Death certificates

Current legislation does not allow the signing of a death certificate by a Nurse Practitioner. However, in many specialty practice areas (especially, but not confined to, Neonatology and Gerontology) the ability to sign death certificates would assist in improving care with an appropriate balance between the emotional, cultural and spiritual needs of families. At present, in many clinical scenarios, delays in the signing of death do occur (specifically in the neonatal speciality) while a medical practitioner is either called in from home or from elsewhere in the hospital to certify death. By virtue of the nature of nursing practice, and the length of time Nurse Practitioners may be involved with the care of a person and their family, families often build up a therapeutic relationship with the Nurse Practitioner caring for their family member. Having to wait for a medical practitioner, who may have barely met the family, can be distressing for them.

In the community setting, for example rest homes, private hospitals and hospices, a Nurse Practitioner may have had the lead role in managing care and a medical practitioner may not have been recently involved. In the event of a person dying in this setting the need for an unnecessary coroner’s inquest is then raised, potentially distressing the family needlessly.

The signing of death certificate is a function that provides the ability for Nurse Practitioners to provide complete and holistic nursing care to patients and families and is well within the realms of the scope of practice of a Nurse Practitioner. The signing of death certificates is currently within the scope of midwifery practice, therefore there is a precedent for non-medical practitioners being able to do this.

Recommendation

The College of Nurses Aotearoa (NZ) Inc. recommends that in the course of the review of the Coroners Bill, Nurse Practitioners be granted the ability to sign death certificates.

Helen Snell
Nurse Practitioner - Diabetes
M.N. MPhil (Nursing), FCNA(NZ)