As you know the Council has been reviewing the nurse practitioner scope of practice and associated qualifications over the past two years. I am writing to thank you for your interest and input into this review and to update you on the decisions the Council has made as a result of your feedback.
In April 2017, a new scope of practice will come into effect after the publication of a new statement in the New Zealand Gazette. The key change is the removal of the restriction to a specific area of practice. As advanced clinicians new nurse practitioners will be expected to self-regulate and practise within their areas of competence and experience.
The change to the scope will be accompanied by changes to education programme standards for Masters degrees leading to registration as a nurse practitioner. This will be followed by a review of the Council’s accrediting and monitoring policies for tertiary education institutions delivering these qualifications.
We are excited by these changes as we believe the new scope of practice and programme standards look to the future and will improve the flexibility and capacity of nurse practitioners to meet the health needs of increasingly diverse populations, under-served and vulnerable groups, and those in remote and rural settings. The changes will also clarify the role of the nurse practitioner and differentiate it from advanced registered nurse roles.
Education programme standards
In addition to supporting a broadened scope, our initial consultation in 2014 showed strong support (75%) for a more specific, streamlined nurse practitioner programme with greater clinical content and more emphasis on mentor support and clinical learning time. To fine tune proposals, we embarked on a second round of consultation in November 2015. Fifty four submissions were received from a wide range of organisations and individuals. I am pleased to now release the detailed analysis of submissions.
In summary, 78% of submitters supported the proposed education standards for the broader scope of practice and requiring students to develop advanced skills in more than one setting. The draft standards were seen as providing greater structure to nurse practitioner preparation, improving alignment between education and practice and increasing consistency between education programmes.
These changes will also be gazetted in March 2017.
Assessment of nurse practitioners for registration
The Council has decided to retain a refined portfolio and panel assessment system during the implementation of these changes.
In our consultation we proposed two options for changes to the registration process. The first, like the model used in Australia delegating assessment of clinical competence to education providers, was not supported.
The second option, proposing the Council maintain a role in assessment in addition to that undertaken by education providers was supported by 74% of submitters. Concerns remained about the ability of multiple education providers to assess clinical competence to a consistent standard. There was also comment that there is a potential conflict of interest for education providers to ensure students achieve educational qualifications and meet professional standards.
The Council has listened and carefully considered all the feedback. We appreciate that you do support our goal of improving the registration process and we will review it again when all the changes - to education standards, programme outcomes, competencies, assessment requirements, clinical learning hours and practicum requirements - have settled in. We expect over time to see increased confidence that a consistent standard of education and clinical training is being achieved.
In the meantime we will continue to explore options for national assessment. Trends in nursing regulatory assessment internationally indicate an increasing shift to outcomes based assessment methods that are independent of education providers, less reliant on subjective methods such as peer or mentor assessment, and that are underpinned by validity, reliability and defensibility.
Review of accrediting and monitoring processes
The consultation raised issues of inconsistencies between education programmes. The Council has decided to review its processes for accrediting and monitoring programmes to ensure they are in line with best practice and is planning to consult with key stakeholders in 2017.
Decision about Council’s role in accrediting programmes that don’t lead to a scope of practice
Clinical master’s programmes have become increasingly diverse to meet the needs of newly graduated nurses, nurses in specialties and nurses who wish to become educators, mangers and researchers. Some of the content of these programmes is outside the Council’s statutory role to accredit and monitor programmes that are prescribed qualifications for scope of practice.
In Australia, postgraduate nursing education that does not lead to registration in a scope of practice is accredited only by education quality assurance agencies. In New Zealand, we have precedence in the field of psychology with the separation of clinical masters from other postgraduate education. The Council works with the New Zealand Qualifications Authority and the Committee on University Academic Programmes (CUAP) that have responsibility for the quality assurance of tertiary education programmes but we also have the distinctive mandate of assuring public safety which is our primary focus.
The Council has discussed this issue with Health Workforce New Zealand and is working towards only accrediting education programmes that lead to registration as a nurse practitioner or registered nurse prescribing. We will continue to accredit and monitor Clinical Masters’ programmes until the review of accreditation and monitoring processes is completed. The Council realises that education providers and other agencies will need time to adjust to this change.
While new nurse practitioners will no longer be restricted to specific areas of practice, they will be expected to self-define their own area of competence and expertise. Those already registered will be able to continue to practice with a condition placed in their scope of practice indicating that they work in a particular area or do not prescribe.
If you have any questions or comments, please feel free to contact my staff or me.
Finally I would like to wish you season’s greetings and I hope you have a relaxing and rejuvenating break.
With best wishes