Journal of the New Zealand Medical Association, 11-October-2002, Vol 115 No 1163
The value of Nurse Practitioners
I write to you in response to the NZMA Chairman’s Editorial of 15 August, 2002.1 As the first registered Nurse Practitioner™ in New Zealand, I wish to acknowledge John Adams’ comments and largely agree with them.
I am employed in neonatal intensive care, and work as part of a collaborative healthcare team in the management of vulnerable and unwell neonates and their families. The reason that the nurse practitioner role is so successful within this intensive care environment is the collaborative practice model of healthcare delivery. It is not that nurses are better than doctors or that doctors are better than nurses. It is, in fact, that we are different, that we come from different philosophies with similar goals, and that together we are able to achieve better outcomes for the patients in our care. This is the message that is the essence of advanced clinical practice for the Nurse Practitioner™.
In New Zealand, this collaborative model began at Health Waikato in 1992; National Women’s and Middlemore Hospitals quickly followed in 1993. In Christchurch and Dunedin, nurses are now employed in newborn intensive care who practice at this level, but at present are not endorsed by the Nursing Council as Nurse Practitioners.
Massey University has developed a clinical Masters course in Neonatal Nursing, through which the nurse is able to address clinical scholarship, research, and ethics at Masters’ level, along with the medical and scientific knowledge that is necessary to practise within the healthcare team at the required level of competence. Auckland University also provides Masters programmes, which enable potential pathways to Nurse Practitioner™ registration.
As you may be aware, Neonatal Nurse Practitioners have been practising in North America since the 1970’s, where there is now a significant amount of literature attesting to their effectiveness. In New Zealand, there is no such research, although the neonatal units in New Zealand have been particularly focused on measuring and comparing the quality of their outcomes.
The question: is this a nurse? Some nurses similarly question advanced scopes of practice. Some consider that Neonatal Nurse Practitioners take on only medical tasks and leave nursing behind, thereby devaluing the profession of nursing itself. However, those healthcare professionals who work within newborn intensive care units can see every day the difference to patients, families and outcomes that Neonatal Nurse Practitioners can and do make. I suggest that it is most unlikely that adverse comments about the model will be found within the services that do utilise them. Nonetheless, an inevitability with any change process is to have concomitant protests. I believe it is vital to reduce the areas of such conflict by open but informed discussion.
Registration as Nurse Practitioner™ with the New Zealand Nursing Council means that a nurse has presented him or herself to the Nursing Council and has demonstrated specified standards and competence. As a nurse who has been practising in an advance practice role for some years, I welcome the opportunity to have my skills and knowledge endorsed and recognised by the nursing profession. I see the establishment of standards and competencies for registration as Nurse Practitioner as a way forward in healthcare delivery in New Zealand. These standards will provide a consistent interpretation and a greater understanding of the knowledge and skills that are to be expected from a Nurse Practitioner™. In my case, this process included the presence of a neonatologist on the interview panel in order to assess my clinical knowledge. The three other panel members were expert nurses, all of whom had separate and vital roles within the assessment process.
As we continue down this path, an opportunity for increasing innovation in healthcare delivery exists. One way is to provide opportunities for nurses who are prepared with the appropriate education foundations and who have been mentored by leaders within their chosen scope of practice. Nurses working within teams using collaborative practice are in a position to drive improvements in healthcare delivery to patients, and to feel very positive about the quality of their nursing training that has brought them to this achievement.
Interestingly, along with nursing mentors, my medical colleagues have been mentors in my nursing practice. These people have recognised my knowledge and skills, and provided ongoing encouragement and opportunities for growth. My medical colleagues recognise as I do that I am not a doctor and that I do not want to be a doctor. The contribution that I am able to make to the care of infants and their families is a nursing contribution. Practising within the team as Neonatal Nurse Practitioner™ means at times that one must speak the language of both medicine and nursing but not have an accent for either.
The most important focus for the individuals within the team is for them to work individually and collaboratively for health gain for patients, using the skills their training has provided.
Nurse Practitioner (Neonatal)
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