Neonatal nurse practitioners--a model for expanding the boundaries of nursing culture in New Zealand

The development and terminology of what constitutes advanced practice nursing roles in New Zealand has been the subject of recent debate within nursing. This article outlines the development of the neonatal nurse practitioner role in New Zealand as an example of one advanced practice nursing role. A model of how nursing culture changes to include roles that incorporate components that historically have been considered the domain of other health professionals is proposed. This article outlines some of the issues surrounding the neonatal nurse practitioner role, including the educational requirements for this role in New Zealand.     

The triumph and continuing struggle of nurse practitioners in New South Wales,Australia

Finally nurse practitioners in New South Wales, Australia, are legally recognized after more than a decade of struggle. In this article the authors provide an update on the nurse practitioner movement, including the continuing conflict with the medical profession as nursing strives to achieve full implementation and acceptance of the nurse practitioner role in New South Wales. Discussion includes nurse practitioner role legislation and authorization process. The issues and concerns expressed by the medical and nursing professions are outlined, and the authors make recommendations to strengthen and support the advanced professional role and status of nurse practitioners.     

Extending the prescribing framework to nurses: lessons from the past

This paper highlights the parallels between the journey to prescribing for nurse practitioners when the role was initially introduced in New Zealand and the journey now towards extending the prescribing framework to registered nurses. Nurse practitioners are the only nurses who can prescribe medicines, and their numbers are few. There are several thousand experienced registered nurses who meet the education requirements to be a nurse practitioner but who have not applied to the regulatory body for registration. Attention has begun to turn from this model, in which nurse practitioners are the only category of nurse who can prescribe, towards independent and supplementary nurse prescribing models. The New Zealand government is yet to fully commit to a specific plan for extending prescribing responsibilities to registered nurses, but feedback has been sought on two different proposals. Dependent prescribing arrangements used elsewhere appear to disregard the implications for professional autonomy. The proposed models of nurse prescribing for New Zealand impose oppressive restrictions, which nurse leaders over the last decade have fought hard to resist. Regulations are needed to allow nurses who have the appropriate education to be designated prescribers in their named area of specialisation. The difference between advanced practice nurses with prescribing rights and nurse practitioners must be clarified to minimise the impact of other prescribers on the nurse practitioner role. Lessons from the past and from the United Kingdom's experience could be drawn upon in order to better utilise the existing well-educated nursing workforce.     

Competency and capability: imperative for nurse practitioner education.

OBJECTIVE: The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. SETTING: The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand. SUBJECTS: The research was informed by multiple data sources including nurse practitioner program curricula documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners. PRIMARY ARGUMENT: Findings from this research include support for master's level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability. CONCLUSIONS: There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand.     

Mental health nursing in New Zealand primary health care

International literature and New Zealand health policy is giving increased emphasis to the role of the primary health care sector in responding to mental health issues. These issues include the need for health promotion, improved detection and treatment of mild to moderate mental illness, and provision of mental health care to some of those with severe mental illness who traditionally receive care in secondary services. These developments challenge specialist mental health nurses to develop new roles which extend their practice into primary health care. In some parts of New Zealand this process has been under way for some time in the form of shared care projects. However developments currently are ad hoc. There is room for considerable development of specialist mental health nursing roles, including roles for nurse practitioners in primary mental health care.     

Am I dying nurse?

Tensions exist with regard to truth-telling about dying. Attitudes and opinions of doctors and nurses impact upon patients and their families. While traditionally doctors have assumed the role of telling patients and/or families, the nurse practitioner often has a closer relationship with the patient and may be the most appropriate person to answer the question "Am I dying?" If nurses accept they have a moral obligation to tell the truth then it is imperative that clinicians, researchers, educators, and the consumers of health services, deliberate on what truth-telling is. Cultural implications of both-truth telling and dying are little understood in New Zealand. The multi-cultural nature of New Zealand provides an opportunity for nurse researchers to address the many issues raised by the question "Am I dying, nurse?"     

Whither nursing in the 21st century?

There is no doubt that the role of the nurse in New Zealand will continue to evolve. Developments in the US where clinical nurse specialists and advanced nurse practitioners are taking on roles and responsibilities that in New Zealand are undertaken by other health professionals, mainly medical, will ultimately permeate the New Zealand health care system. Today the nurse practitioner has a greater degree of professional independence than at any time in the history of the profession, and, if the recommendations of the taskforce are accepted and nurse prescribing eventuates, the nurse will have even greater independence and autonomy. With this increased professional independence comes a greater emphasis on the responsibilities of the nurse and professional accountability. The acceptance of greater responsibility will inevitably result in a proliferation of nurse "specialists". Postgraduate programmes must be established with carefully planned curricula to accommodate the requirements of these nurse specialists. Planning, content and design of these programmes must come from nurses in consultation with the Nursing Council, the Ministries of Health and Education, and health agencies. The functioning of the human species within their environment, in both wellness and illness, can only be adequately explained or explored with a sound knowledge of biological systems. It is for this reason that the study of biological sciences must be undertaken by nursing students to prepare them for the advanced role they are likely to play in the health care system of the 21st century.     

Supporting Indian nurses migrating to New Zealand: a literature review

WOODBRIDGE M. & BLAND M. (2010) Supporting Indian nurses migrating to New Zealand: a literature review. International Nursing Review 57 , 40–48 Background: New Zealand, like many other Western countries, is struggling to cope with increasing demands for nursing services. Registered nurses are being actively recruited internationally and New Zealand has become a popular destination for nurses who wish to emigrate, including those from India. These nurses have unique cultural, professional and educational needs yet it is unclear how to best support them as they move to their destination countries. Aims: The issues around nursing migration and its effects have been discussed in many forums, but there is evidence of a gap in understanding the issues around acculturation and socialization. This selected literature review sought to identify the significant factors that impact on migrating nurses becoming competent and confident registered nurses in the New Zealand practice environment. Methods: A bibliographical database search was undertaken (Web of Knowledge, Web of Science, CINAHL, Medline, Academic Search Elite, and Ebscohost EJS) along with national and international nursing websites for the period 2002–2009. Search terms included Indian nurse, international nurse, migration, experience, cultural safety, globalization, nurse migration, nurse recruitment, New Zealand and research. The search was limited to texts published in English, with preference given to peer‐reviewed research‐based articles. Results: A significant volume of literature was located. The key themes that arose were migration, education, language, nursing skills, competence, cultural safety and reflection on practice. Literature considered to best reflect these main themes, and of most relevance to New Zealand, was selected for this review, with preference given to research reports and official nursing publications. Conclusion: Strategies such as providing ongoing professional education, ensuring cultural safety and offering mentoring in practice environments will contribute to a safe passage for migrating nurses. Further research is required into the acculturation and socialization of Indian nurses, especially those moving to New Zealand.     

From competence to capability: a study of nurse practitioners in clinical practice

Aims and objectives. This research aimed to understand the level and scope of practice of the nurse practitioner in Australia and New Zealand further using a capability framework. Background. The original study, from which the present paper was developed, sought to identify competency standards for the extended role of the nurse practitioner in Australia and New Zealand. In doing so the researchers became aware that while competencies described many of the characteristics of the nurse practitioner they did not manage to tell the whole story. In a search of the literature, the concept of capability appeared to provide a potentially useful construct to describe the attributes of the nurse practitioner that went beyond competence. Design. A secondary analysis of data obtained from interviews with nurse practitioners working in Australia and New Zealand was undertaken. These data had previously been obtained in a study to identify nurse practitioner competencies. The analysis described in this paper investigated whether or not the components of capability would adequately explain the characteristics of the nurse practitioner. Methods. Fifteen nurse practitioners were interviewed from Australia and New Zealand. A secondary (deductive) analysis of interview data using capability as a theoretical framework was conducted. Results. The analysis showed that capability and its dimensions is a useful model for describing the advanced level attributes of nurse practitioners. Thus, nurse practitioners described elements of their practice that involved: using their competences in novel and complex situations as well as the familiar; being creative and innovative; knowing how to learn; having a high level of self‐efficacy; and working well in teams. Conclusions. This study suggests that both competence and capability need to be considered in understanding the complex role of the nurse practitioner. Relevance to clinical practice. The dimensions of capability need to be considered in the education and evaluation of nurse practitioners.     

Nurse Practitioner competency standards: findings from collaborative Australian and New Zealand research

BACKGROUND: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards. OBJECTIVES: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. DESIGN: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand. SETTINGS: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. PARTICIPANTS: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities. RESULTS: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators. CONCLUSIONS: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.     

Delineating advanced practice nursing in New Zealand: a national survey

Background

A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning.

Aims

To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles.

Method

Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one‐way ANOVA and post hoc between group comparisons.

Results

Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain‐specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership.

Conclusions

Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles.

Implications for nursing policy

By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence‐based nursing workforce planning and policy development.     

Advanced nursing practice--evolution or revolution?

This article has been written to challenge the seemingly unquestioning acceptance of changing roles in New Zealand nursing. It is evident in nursing history that a number of issues, such as community versus hospital services and generalist versus specialist practice, tend to resurface in a cyclic manner. Characteristics that are currently associated with 'advanced' nursing roles can be recognised when the origins and development of nursing in New Zealand are traced. This gives rise to speculation that changes to nursing scope of practice are not so much revolutionary as evolutionary, and can perhaps be viewed as a reclaiming rather than a redefining of nursing roles.     

Undervaluing migrants’ nurses,exacerbates minority health disparities

A new working environment, communication barriers and new culture are key challenges for overseas-trained nurses working in the New Zealand health system. An increased demand for healthcare particularly for Pacific people due to poor health outcome is increasing pressure on an already strained nursing workforce.My research focuses on the criteria surrounding the use of English language proficiency assessment using the IELTS (International English Language Testing System) to qualify an overseas trained nurse to sit the Competency Assessment Program to attain a New Zealand nurse registration. Revising this qualifications system may help alleviate the current, and growing, nursing workforce shortage.     

Teaching student nurses to be culturally safe: can it be done?

From the perspective of a third-year student nurse about to graduate in New Zealand, this article discusses the complexities of teaching and learning the concept of cultural safety for educators and student nurses. The background of the implementation of cultural safety content into New Zealand nursing curriculum is briefly discussed, and the evolution of cultural safety and its diverse meanings that has led to some confusion among student nurses. How is cultural safety taught and what are the surrounding barriers? Also, where does the student nurse fit into this process? Recommendations are then made to improve the teaching of cultural safety in the New Zealand nursing curriculum.     

Nurse practitioner research: issues in practice and theory

Since the inception of the nurse practitioner role, numerous studies have focused on the characteristics of NPs, including their educational preparation, their practice settings, demographic characteristics of clients, cost analysis, and the quality of services within a medical context. The two major conclusions of the majority of these studies have been that the delivery of health care by nurse practitioners has been fully accepted by patients, and that nurse practitioners are competent in the delivery of quality care. A brief historical overview of nurse practitioners is presented; the major methodological and conceptual issues of nurse practitioner research are reviewed. Views on practice issues and nursing theory development are shared, and directions for future nurse practitioner research are explored.     

Participant [correction of Patient] observation in nursing home research: who was that masked woman?

Undertaking fieldwork in nursing home environments can present researchers with many challenges, particularly when the researcher also happens to be a registered nurse. This article discusses the issues that one nurse researcher faced during participant observation in three New Zealand nursing homes. These include the complexity of the nurse researcher role, the blurring of role boundaries, and various ethical concerns that arose, including the difficulties of ensuring that all those who were involved in the study were kept informed as to the researcher's role and purpose. Strategies used to maintain ethical and role integrity are outlined, with further debate and discussion around fieldwork issues and experiences for nurse researchers called for.     

Advanced nursing practice: an idea whose time has come

Aims and objectives. This paper aims to analyse the concept of advanced nursing practice critically and to demonstrate an appreciation of the development of the role of the advanced nurse practitioner in the Irish context. Background. The concept of advanced nursing practice has existed in the US since the 1960s and in the UK since the early 1980s. The first signs of the advanced nurse practitioner began to emerge in Ireland in the late 1990s as a result of increasing demands and changes occurring within nursing and health care. Currently, there are 31 advanced nurse practitioners in the country, many of whom practice in the general setting. Strategies are in place to introduce advanced nursing practice into other nursing disciplines in the future. Methods. A literature review was conducted to address the various issues inherent within this concept. Results. There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes. In light of this, the advanced nurse practitioner has a valuable role to play in providing a beneficial contribution and filling a gap in healthcare services. Conclusion. This paper has demonstrated that nursing continues to be a dynamic and ever‐changing phenomenon where the onus is firmly on the advanced nurse practitioner as expert, leader and collaborator, to capture the hearts and minds of nurses and healthcare workers, so as to challenge traditional values and transform clinical practice. Failure to do so may allow medicine or other interested parties to shape the future of nursing or even absorb it. Relevance to clinical practice. Nurses working at an advanced level are striving to develop their expertise, initiate nurse‐led services and practice, in collaboration with other professionals in an effort to provide the highest quality care to the patient. Although the idea of the advanced nurse practitioner is relatively new to nursing in Ireland, it is the result of an idea whose time has come and there is nothing more powerful than an idea whose time has come.     

The future for nursing education: UKCC review has relevance for New Zealand

The strategic review of undergraduate nursing education recently commissioned by the Nursing Council of New Zealand (NCNZ) will provide a focus for nursing education in Aotearoa/New Zealand in the immediate future. Recently the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) completed its own review of undergraduate nursing education. The published report 'Fitness for Practice', has many areas of relevance for New Zealand educators in outlining possible strategies for nursing education. Issues such as recruitment and access to education; retention; clinical assessment and placements; clinical skill acquisition and partnership are valid concerns for educators here also. Internationally the commonalties in issues of concern are remarkable and lend validity to the concept of the global village and the necessity for a global perspective in health care workforce planning, including educational preparation. Discussion of some of the recommendations informs nursing education of the possibilities for forward progress in these times of continual change in health care delivery systems.