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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
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