Nurse and midwife practitioners
What is the role of an NP? | NP services in NSW | International trends | Evaluation of NP services- expert clinical knowledge
- advanced specialised education
- complex decision making skills.
Importantly, being an expert-by-experience in a specialty is not on its own sufficient for NP/MP authorisation. Nor is accepting more delegated medical tasks or technical procedures. Once authorised, NPs/MPs are required to submit clinical practice guidelines that articulate the specific scope of practice in which they will practice.
'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.'
What is the role of an NP?
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. Career opportunities for nurses have changed, due to increased demands and 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 NP's role is safe, effective and highly acceptable to the patient population.
NP services in NSW
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 guided by the collaborative planning, practice, implementation and evaluation within the Area Health Service (AHS) the nurse will be affiliated with. The authorisation process is completely separate from the AHS 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 NP will operate within a collaborative framework with the support of a multidisciplinary team
- adequate funding exists to support the position
- infrastructure support is available to ensure the NP service is able to function as planned.
International trends
The NP movement began in the United States (US) in 1965. The concept of NPs spread to the United Kingdom (UK) and is 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.
Evaluation of NP services
Evaluation is one of the critical elements in the implementation of NP services. Effective evaluation ensures 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 Health Framework for Managing the Quality of Health Services. The Framework could also be used to determine an appropriate set of performance indicators for each NP service.
