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Development of the Nurse Practitioner – A New Zealand Perspective. Michael Geraghty, Nurse Practitioner. Auckland City Hospital, NZ. Michael Geraghty 2018
Development of the Nurse Practitioner – A New Zealand Perspective <<<>>><<<>>><<<>>> National Development - 2001 Personal Journey
A little about NZ… NZ Population: 4. 7 million (Singapore 5. 7 million ) NZ Land mass: 270, 000 sq km ( Singapore 700 sq km) What the world thinks about NZ Lesser known facts Clean, green, outdoor life Youth suicide high Tourism Smoking amongst indigenous Maori high Nuclear free Obesity high Sheep - yes, there are more sheep than people here Diabetes / renal disease high All Blacks - rugby Access to primary health care expensive Lord of the Rings Cancer screening (adults) poor Child abuse - To name a few !
Why NP’s ? Ministry of Health 2000’s - Current medical model not sustainable - Increased need for HEALTH care, not necessarily medical care - Predicted clinical shortages requires us to change the way we structure our health workforce & consider alternative models of health delivery “. . . the demand for GPs will outstrip supply in the not too distant future, unless services are delivered in a different way. . ” Nursing retention / Career development Increased need for healthcare in remote, rural NZ The need for healthcare delivery specifically targeting high users : Maori, elderly.
Nurse Practitioners Scope of Practice: • Have advanced education, clinical training and the demonstrated competence and legal authority to practise beyond the level of a registered nurse. • Work autonomously and in collaborative teams with other health professionals to promote health, prevent disease, and improve access and population • • health outcomes for a specific patient group or community. Manage episodes of care as the lead healthcare provider in partnership with health consumers and their families. Combine advanced nursing knowledge and skills with diagnostic reasoning and therapeutic knowledge to provide patient-centred healthcare services including the diagnosis and management of health consumers with common and complex health conditions. They provide a wide range of assessment and treatment interventions, ordering and interpreting diagnostic and laboratory tests, prescribing medicines within their area of competence and admitting and discharging from hospital and other healthcare services/settings. As clinical leaders they work across healthcare settings and influence health service delivery and the wider profession.
Dream of being a NP The old process to become an NP Invited for interview if portfolio accepted Get help (nursing / medical ) Submit a portfolio to Nursing Council Secure a role where you can get gain experience in the role Attain an approved Masters degree (pharmacology) Nursing Council Panel Interview – 4 -6 hours Endorsement as an NP ( if successful) Find a job !!!
Total Nurses Registered 55289 - 2018 Registered Nurses Enrolled Nurses NP's 300
October 2015 • “Nurse practitioners are a valuable resource. They are highly educated and experienced, and are a key part of our health workforce, ” Dr J Coleman Min of Health. New model of training for Nurse Practitioners: • 20 places across two Universities • 12 months • Balance of academic and clinical time • Funded by central government • Ring fenced clinical support. • Clinical mentor • Guaranteed employment
Legislative changes 1. NZ Health Practitioners Statutory Reference Bill (2016 …. . ) removes medical practitioner title and substitute with health practitioner • Death certificate • Cremation • ACC / Med cert’s 2. Designated to authorized prescribing – open access to prescribe limited only by professional judgment with access to special authority
NP Registrations per annum – New Zealand NP Registration 60 50 40 30 NP Registration 20 10 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 0
New NP Candidate Model Nursing council panel assessment – No medical / academics / indigenous Be endorsed as an NP Dream of being a NP Submit portfolio (electronic) Be accepted under the Min of Health NP scheme Complete Masters degree (with prescribing) Undergo 12 month clinical mentorship Guaranteed clinical position
Auckland City Hospital Emergency Dept. 2018: 90% of all ED’s in NZ employ CNS /NP • 5 NP’s, • 6 CNS – under clinical supervision of NP’s • See approx 20 -25% of all ED visits
NP Scope of practice – ED perspective High Acuity / High Complexity / Low Acuity High Acuity / Low Complexity Low Acuity / Low Complexity