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Nursing and Midwifery OfficeNurse PractitionerThe Role | Patient Outcomes | NPs in Other Countries | Authorisation Process | Scope of Practice | Current NPs in NSW | Service Delivery | Evaluation | Clinical Guidelines for NSW NP's | Enquires What is a Nurse Practitioner/Midwife Practitioner?A nurse practitioner (NP) or a midwife practitioner1 (MP) is a registered nurse (RN) or a registered midwife (RM) who has satisfied the requirements of the Nurses and Midwives Board of NSW (NMB) to be authorised. Authorisation allows the NP or MP to initiate diagnostic investigations, to prescribe medications and to make limited referrals provided they are working under approved clinical guidelines. They may also use the protected title of "Nurse Practitioner" or "Midwife Practitioner." NPs work at an advanced practice level that demands: It is important to note being an expert-by-experience in a specialty is not on its own sufficient for NP or MP authorisation. Nor is accepting more delegated medical tasks or technical procedures. Once authorised, NPs or MPs are required to submit clinical practice guidelines that articulate the specific scope of practice in which the nurse or midwife will practice (see scope of practice/clinical practice guidelines). In accordance with the Nurses and Midwives Act 1991, the NMB is responsible for the authorisation of NPs or MPs. The Australian College of Midwives draft position statement about Midwife Practitioners is available at www.nswmidwives.com.au/aboutus/professionalissues/tabid/104/Default.aspx 1 The term Nurse Practitioner will also refer to Midwife Practitioner where appropriate. As a move towards consistency across NSW and nationally, NP practice has been defined in the following way: A nurse practitioner is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include but is not limited to the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations. The nurse practitioner role is grounded in the nursing profession's values, knowledge, theories and practise and provides innovative and flexible health care delivery that complements other health care providers. The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorised to practice. (ANMC, 2006) What Role Does the Nurse Practitioner Play?Due to increasing nursing specialisation and the need to address inequalities in access to healthcare, the role of the NP is centred on patient and population needs, thereby improving health outcomes. The career opportunities for nurses has changed, not only because of increased demands but because nurses have demonstrated their competence in a variety of extended practice roles. NPs value clinical nursing and provide a much-needed addition to the clinical career paths for the nursing profession. Extensive national and international studies provide evidence of clinical and financial effectiveness of NPs. The research consistently demonstrates the positive performance of NPs in relation to increasing health care access, cost effectiveness and that the NPs role is safe, effective and highly acceptable to the patient population. Patient Focused OutcomesNPs have a wide range of experience, skills and knowledge in their chosen speciality. These professional attributes and the ability to work collaboratively with other health professionals, whilst having a clearly defined expert scope of practice, assists NPs to deliver high quality, client centred care which ultimately improves client health outcomes. How Many Countries Have Nurse Practitioner Roles?The NP movement began in the United States (US) in 1965. The concept of NPs then spread to the United Kingdom (U.K.). NPs are now established in Canada, Europe, Asia Pacific, New Zealand and Australia. It has been estimated that nearly 40 countries have established or emerging NP roles in nursing. The expansion of the NP role through legislation has not been universally accepted. Whilst some countries have legitimised the NP role or are contemplating legitimising the role of NPs through legislative changes, the utilisation of the NP is very dependant upon individual country, state, location and health service, i.e. remote, rural and urban areas. How to Become a Nurse PractitionerNPs in NSW undergo a thorough authorisation process through the NMB. This enables the successful applicant to use the protected title of 'Nurse Practitioner' and to have the authority to prescribe, order pathology tests, order medical imaging investigations and make limited referrals only, whilst operating within approved guidelines. Re-authorisation for all NPs is required every five years. There are two pathways for RNs and RMs to become authorised. Pathway 1 This option is for RNs who have completed a NMB approved Master's program leading to authorisation to practice as a Nurse Practitioner. The applicant must:
Pathway 2 This option is for RNs or RMs working at advanced practice levels that have NOT completed a specific NP Master's degree approved by the NMB. The applicant must:
For further details on the process of applying for authorisation as a Nurse Practitioner including an information brochure, application guide and guidelines for the preparation of case studies, refer to the NMB website at www.nmb.nsw.gov.au/Nurse-Practitioners/default.aspx or telephone (02) 9219 0222. Scope of PracticeA scope of practice is how a NP describes his/her practice. It includes reference to the population service group in which the NP is authorised to practice. Clinical guidelines are approved by the Area Health Service Chief Executive. The approval of scope of practice/clinical guidelines is separate from becoming authorised. The scope of practice/clinical practice guidelines of individual NPs is influenced by the settings in which they practise and includes clinical, educational and academic dimensions of nursing or midwifery practice. The document contains procedures related to delivering a particular aspect of clinical care and they are based on current research and best clinical practice. The guidelines will consider the health needs of people, the level of competence and experience of the NP and the policy requirements of the health service in which they work. They are designed to assist practitioners incorporate, evaluate and implement the ever-increasing amount of evidence and opinion on current best practice. The guidelines should include the context in which the practice is delivered and is usually indicated by defining the following:
They are intended as neither a cookbook nor textbook. Guidelines can assist health care professionals in making decisions about appropriate and effective care for patients. The NP, along with a local multidisciplinary team develops and takes responsibility for the clinical content of the clinical guidelines. The Nurses and Midwives Act 1991 makes provision for the NSW Director-General of Health to approve guidelines. The approval of the NP guidelines has been delegated by the Director-General, NSW Department of Health to the Chief Executive of each Area Health Service. The scope of practice/clinical guidelines is required by law to provide a framework to guide the clinical practice of the Nurse Practitioner. An infringement of the approved guidelines may constitute "professional misconduct or unsatisfactory professional conduct" under the Nurses and Midwives Act 1991. Other Points of Interest NPs do not have access to PBS prescriber numbers or unlimited prescribing of medications. Any initiation of medication will relate to the NPs scope of practice/clinical practice guidelines. Authorised Nurse Practitioners and Midwife Practitioners in NSWTo date, 105 NPs have been authorised by the NMB in the following specialities:
The first Aboriginal NP in New South Wales, Lesley Salem was authorised in May 2003. Lesley is employed by John Hunter Hospital and works throughout the Lower Hunter New England area as a Nurse Practitioner in Nephrology. Delivery of Nurse Practitioner Services in NSWCurrent Nurse Practitioner Policy - PD2005_556 Since 1992 Australia, and more specifically NSW, has been considering the NP role. This resulted in commencing 10 pilot site projects in regional, rural and remote locations during 1995 (Nurse Practitioner Project Stage 3). Areas of practice examined in the project were competencies, accountability, diagnostic imaging, diagnostic pathology, prescription of medications, referral procedures and professional indemnity insurance. Results from the projects found that NPs were safe, effective and provided quality health services in the 10 sites. Subsequently in 1999, in what has been described as a milestone for Australian nursing, 40 nurse practitioner positions were created in rural and remote NSW. In September 2002 the Minister for Health announced the support and expansion of NPs into metropolitan areas of NSW. The establishment of a NP position in a health service is to be guided by the collaborative planning, practice, implementation and evaluation within the Area Health Service the nurse will be affiliated with. The NP authorisation process is completely separate from the Area Health Service developing and approving NP positions. The obligation is on the employer to ensure that nurses practising in NP roles have access to the resources needed to deliver services to the public that are safe and of acceptable quality. The following conditions should exist within the Area Health Service to support the NP service:
Evaluation of Nurse Practitioner ServicesEvaluation is one of the critical elements in the implementation of NP services. Effective evaluation will ensure the delivery of quality care that is responsive to the needs of the community. The evaluation of the NP service in each AHS should include ongoing monitoring and review of the service consistent with the principles of continuous quality improvement, performance management and local health service evaluation strategies. This evaluation should be based on the quality dimensions of safety, effectiveness, appropriateness, consumer participation, access and efficiency, as outlined in the NSW Department of Health's Framework for Managing the Quality of Health Services in New South Wales. This framework could also be used to determine an appropriate set of performance indicators for each NP service. Clinical Guidelines for NSW Nurse PractitionersUnder Section 78A of the amended Nurses and Midwives Act 1991, NSW Nurse/Midwife Practitioners are required to work under guidelines which relate to their functions as well as making provision for the possession, use, supply or prescription of poisons or restricted substances under Section 17A of the Poisons and Therapeutic Goods Act 1966 [Nurse/Midwife Practitioners Amendment, Nurses and Midwives Act 1991, s. 78A]. As part of these guidelines the Nurse/Midwife Practitioner will be required
to identify their The AHS is to ensure that each Nurse/Midwife Practitioner has defined their guideline/scope of practice and that this is evidence based and in accordance with AHS policy requirements (e.g. Codes of Conduct and Ethics, etc.). The approval of these NP guidelines (including the scopes of practice) has been delegated by the Director-General, NSW Department of Health to Chief Executives of each AHS. In order to ensure consistency across NSW a guidelines and formulary approval proforma is appended to the N/MP policy, NSW Health Policy Directive 2005_556. Additionally, prior to final Chief Executive signoff, the Area or hospital Drug Committee needs to approve the drugs that are identified for use by the Nurse/Midwife Practitioner in the formulary to ensure clinical appropriateness and consistency with local policy. The signed agreement must include the Area Director of Clinical Operations and the Area Director of Nursing and Midwifery Services. AHS Approved Guidelines It is requested that when a NP guideline is approved by an AHS a copy of the guideline, local signatories and the formulary be sent to the Chief Nursing Officer, NSW Department of Health. The attached paper provides and details discussion and outline of Clinical Practice Guidelines for Nurse Practitioners - click here for more information. "Nurse Practitioner Clinical Guidelines" Approved by their Area Health ServiceThe following guidelines have been approved for use by a specific NP within their AHS. If you would like to use these guidelines you will need to seek permission from the NP and their AHS. When considering using these guidelines the following factors need to be taken into consideration. This document reflects what was regarded as safe practice at the time of writing the guideline However, as in any clinical situation there may be multiple factors which cannot be covered by a single set of guidelines. This document does not replace the need for the application of clinical judgement to each individual presentation. The document is also identified as being able to meet the needs of the NP in a particular clinical environment. There may be issues specific to your clinical environment which mean that different strategies may be required, for example if working in a secure environment such as a prison or a remote location. Guidelines need to be reviewed in light of the local conditions in which the NP is required to practise. If in any doubt about the appropriateness of using a guideline in a different setting, advice should be sought from other experienced clinicians. NP Cardiac FailureSouth Eastern Sydney Illawarra AHS Nurse Practitioner: James McVeigh, Prince of Wales Hospital, Email: james.mcveigh@sesiahs.health.nsw.gov.au Nurse Practitioner Clinical Guideline - The Management of Heart Failure NP DiabetesChildren's Hospital Westmead Nurse Practitioner: Nuala Harkin, Children's Hospital Westmead, Email: nualah@chw.edu.au Sydney South West AHS Nurse Practitioner: Julie Bligh, Liverpool Hospital, Email: Julie.Bligh@swsahs.nsw.gov.au The Management of Type2 Diabetes Mellitus (DM) Nurse Practitioners: Jane Overland & Belinda Brookes, Royal Prince Alfred Hospital, Email: belinda@email.cs.nsw.gov.au Diabetes Nurse Practitioner Guidelines Role and Scope of Practice Nurse Practitioner: Jane Payne, Bankstown Hospital, Email: jane.payne@swsahs.nsw.gov.au Diabetes Nurse Practitioner Guidelines - Role and Scope of Practice NP Drug and AlcoholHunter New England AHS Nurse Practitioner: Stephen Ling, John Hunter Hospital, Email: stephen.ling@hnehealth.nsw.gov.au Nurse Practitioner Clinical Practice Guidelines for the Management of Cannabis Abuse/Dependence Nurse Practitioner Drug and Alcohol - Formulary Nurse Practitioner Clinical Practice Guidelines for the Management of Opioid/Heroin Abuse/Dependence Nurse Practitioner Clinical Practice Guidelines for the Management of Nicotine Abuse/Dependence Nurse Practitioner - Pharmocotherapy Treatment Plan NP Emergency GuidelinesGreater Southern AHS Nurse Practitioner: Margaret Dennis, Wagga Wagga Base Hospital, Email: Marg.Dennis@gsahs.health.nsw.gov.au and Wendy Waters, Yass Hospital, Email: Wendy.waters@gsahs.health.nsw.gov.au and Marienne Shanahan, Albury Base Hospital, Email: marienne.shanahan@gsahs.health.nsw.gov.au Greater Western AHS Nurse Practitioner: David Ranger, Parkes Hospital, Email: David.Ranger@gwahs.health.nsw.gov.au Emergency Nurse Practitioner - Parkes Health Service - Scope of Practice
Emergency Nurse Practitioner - Parkes Health Service -
Appendix 2 - Section 1A - Emergency Emergency Nurse Practitioner - Parkes Health Service -
Appendix 2 - Section 1B - Emergency Emergency Nurse Practitioner - Parkes Health Service -
Appendix 2 - Section 2 - General Northern Sydney/Central Coast AHS Nurse Practitioner: Jane O'Connell, Hornsby Hospital, Email: joconnel@nsccahs.health.nsw.gov.au 1. Limb Injuries & Musculoskeletal Injuries South Eastern Sydney Illawarra AHS Nurse Practitioner: Philip Dolan, Shoalhaven Memorial District Hospital, Email: philip.dolan@sesiahs.health.nsw.gov.au Nurse Practitioner Clinical Practice Guidelines for the Management of Ear Pain Nurse Practitioner Clinical Practice Guidelines for the Management of Ocular Conditions Nurse Practitioner Clinical Practice Guidelines for the Management of Musculoskeletal Injuries Nurse Practitioner Clinical Practice Guidelines for the Management of Wounds Sydney West AHS Nurse Practitioner: Arlene Bannon, Nepean Hospital, Email: bannona@wahs.nsw.gov.au and Cate Salter, Nepean Hospital, Email: SalterCL@wsahs.nsw.gov.au 1. Respiratory Assessment of Children South Eastern Sydney Illawarra AHS Nurse Practitioner: Kariene Dwyer, Shellharbour Hospital, Email: dwyerK@iahs.nsw.gov.au 1. Management of Asthma in Adults NP Intensive Care UnitNurse Practitioner: Brad Ceely, Paediatric Intensive Care Unit, Email: bradlec3@chw.edu.au NP Mental HealthGreater Western AHS Nurse Practitioner: John Lyons, Baradine, Email: John.Lyons@gwahs.health.nsw.gov.au Clinical Guidelines - Nurse Practitioner Mental Health - Baradine Northern Sydney Central Coast AHS Nurse Practitioner: Mark Joyce, Central Coast Mental Health Service, Email: mjoyce@doh.health.nsw.gov.au Nurse Practitioner Mental Health - Emergency Department Service Background - Volume One Nurse Practitioner Mental Health - Emergency Department Role Description - Volume Two Nurse Practitioner Mental Health - Emergency Department Drug Formulary - Volume Three Clinical Practice Guidelines - Nurse Practitioner Mental Health Emergency Department - Volume Four Sydney South West AHS Nurse Practitioner: Tim Wand, Royal Prince Alfred Hospital, Email: twand@email.cs.nsw.gov.au Sydney West AHS Nurse Practitioner: Elaine Ford, Westmead Hospital Email: elaine_ford@wsahs.nsw.gov.au Nurse Practitioner: Joanne Seymour, Nepean Hospital, Email: seymouj@wahs.nsw.gov.au Clinical Practice Guidelines - Nurse Practitioner Mental Health NP NeurosurgeryNorthern Sydney Central Coast AHS Nurse Practitioner: Rochelle Firth, Royal North Shore Hopspital, Email: rfirth@nsccahs.health.nsw.gov.au and Katherine Becker, Royal North Shore Hospital, Email: kbecker@nsccahs.health.nsw.gov.au Department of Neurosurgery - Fomulary NP OncologyNorth Coast AHS Nurse Practitioner: Kristopher Liebke, Lismore Hospital, Email: krisL@nrahs.nsw.gov.au Oncology/Haematology Nurse Practitioner Clinical Guidelines Sydney South West AHS Nurse Practitioner: Keith Cox, Royal Prince Alfred Hospital, Email: keith.cox@email.cs.nsw.gov.au NP Pain ManagementChildren's Hospital Westmead Nurse Practitioner: Lynette Lane, Children's Hospital Westmead, Email: lynettel@chw.edu.au Nurse Practitioner Clinical Practice Guidelines - The Treatment of Acute Pain in Children Sydney South West AHS Nurse Practitioner: Amal Helou, Royal Prince Alfred Hospital, Email: amalh@email.cs.nsw.gov.au Nurse Practitioner Guidelines Role and Scope of Practice: Pain Management NP PsychogeriatricsNorth Coast AHS Nurse Practitioner: Anne Moehead, Lismore, Email: Anne.Moehead@ncahs.health.nsw.gov.au NP RenalChildren's Hospital Westmead Nurse Practitioner: Jill Farquhar, Children's Hospital Westmead, Email: JillF3@chw.edu.au Hunter New England AHS Nurse Practitioner: Lesley Salem, Newcastle and Lower Hunter, Email: lesley.salem@hnehealth.nsw.gov.au Nephrology Nurse Practitioner - Guidelines for Clinical Practice NP Women's HealthHunter New England Area Health Service Nurse Practitioner: Lorna Scott, Lower Hunter Area Health Service, Email: lorna.scott@hnehealth.nsw.gov.au and Carolyn Enks, Muswellbrook. Women's Health Nurse Practitioner Clinical Practice Guidelines, incorporating:- 1. Well Women's Check NP Wound ManagementHunter New England Area Health Service Nurse Practitioner: Margo Asimus, Lower Hunter, Email: margo.asimus@hnehealth.nsw.gov.au Wound Management - Nurse Practitioner Clinical Practice Guidelines NSW Health Paediatric Clinical Guidelines
Useful Guidelines Websites International Clinical Practice Guidelines for Emergency Medicine
Australian & New Zealand Based Clinical Practice Guidelines
List of Guidelines General Collections
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