A nurse practitioner (NP) is a registered nurse (RN) who has satisfied the requirements of the Nursing and Midwifery Board of Australia (NMBA) to be endorsed in accordance with the Health Practitioner Regulation National Law Act. Endorsement allows the NP to initiate diagnostic investigations, prescribe medications and make referrals. NPs work at an advanced practice level that demands:
- expert clinical knowledge
- advanced specialised education
- complex decision making skills
- clinical reasoning and diagnostic skills
- ability to initiate and evaluate therapeutic management plans
Importantly, being an expert-by-experience in a specialty is not on its own sufficient for NP endorsement. Nor is accepting more delegated medical tasks or technical procedures.
The Australian Nursing and Midwifery Accreditation Council (ANMAC) defines NP practice as:
'A NP is a RN educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The NP 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 NP role is grounded in the nursing profession's values, knowledge, theories and practise and provides innovative and flexible health care delivery that compliments other health care providers. The scope of practice of the NP is determined by the context of practice.'
What is the role of a 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 NPs role is safe, effective and highly acceptable to the patient population.
Endorsement as a NP
The National Registration and Accreditation Scheme for health professionals in Australia commenced on 1 July 2010 under the Health Practitioner Regulation National Law Act (the National Law).
The NMBA has established State and Territory boards to support the work of the National Board in the national scheme. The National Board will set policy and professional standards, and the State and Territory boards will continue to make individual notification and registration decisions affecting individual nurses and midwives including decisions regarding NP endorsements.
Endorsement of RNs as NPs is against the national NMBA Endorsement as a nurse practitioner registration standard, developed under section 38 of the National Law. This registration standard describes the requisite qualification and experience required for endorsement as a NP. The NMBA have also published Guidelines for endorsement as a nurse practitioner including the Safety & Quality Framework (S&QF) which exists to support safety and quality in practice. Compliance with the S&QF is mandatory for NPs.including the Safety & Quality Framework (S&QF) which exists to support safety and quality in practice. Compliance with the S&QF is mandatory for NPs.
RNs may apply for endorsement through the NMBA and once endorsed, will be entitled to use the protected title of ‘Nurse Practitioner’. NP endorsement authorises practice at entry level within an advanced practice context.
To be eligible for endorsement as a NP, the RN must be able to provide evidence to demonstrate all the following:
- current general registration as a RN with no conditions on registration relating to unsatisfactory professional performance or unprofessional conduct,
- the equivalent of three (3) years’ full-time experience in an advanced practice nursing role, within the past six (6) years from the date when the complete application seeking endorsement as a NP is received by the Board,
- successful completion of a Board-approved NP qualification at Master’s level or education equivalence as determined by the Board,
- compliance with the Board’s National Competency Standards for the Nurse Practitioner AND
- compliance with the Board’s registration standard on continuing professional development.
The National Competency Standards for the Nurse Practitioner can be accessed from the Board’s website at Nursing and Midwifery Board of Australia.
Two pathways have been established for endorsement as a NP.
Applicants must demonstrate evidence of successful completion of an ANMAC accredited and NMBA approved NP program of study at Master’s level.
Board-approved programs of study are listed on the NMBA’s website at Nursing and Midwifery Board of Australia - Accreditation.
Applicants must demonstrate evidence of the successful completion of:
- a program of study at Master’s level that is clinically relevant to the applicant’s context of advanced practice nursing for which they are seeking endorsement as a NP; and
- supplementary education that will demonstrate equivalence and meet the National Competency Standards for the Nurse Practitioner.
A portfolio of evidence is required to support applications for endorsement via either pathway (including supplementary education demonstrating equivalence). Portfolio requirements are available on the NMBA website Endorsement and Notations.
The UK Department of Health has published Advanced Practice Nursing: A Statement based on international definitions and competencies related to advanced practice, including the National Competency Standards for the NP.
The statement outlines fundamental requirements in defining advanced practice which can be applied to clinical practice accepted as advanced in Australia.
Ongoing endorsement as a NP is contingent upon the NP meeting the Board’s
Requirements for ongoing endorsement as a Nurse Practitioner. NPs are required to make an annual statutory declaration that they have met requirements under section 109 of the National Law, including completion of the required continuing professional development and meeting the recency of practice requirements.
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 local health district should include ongoing monitoring and review of the service consistent with the principles of continuous quality improvement, performance management and local health district evaluation strategies.
This evaluation should be based on the quality dimensions of safety, effectiveness, appropriateness, consumer participation, access and efficiency.