Nurse practitioner leaders see amended laws coming into effect today – removing barriers to NP practice – as part of building momentum for the now fast growing role.

From today for the first time nurse practitioners can issue the death certificate for patients in their care.  Suitably qualified nurses can also write sick leave certificates.

Dr Michal Boyd, a long-standing NP, says being unable up until today to complete death certificates for patients in her care meant the risk of unnecessary delays and distress for a grieving family.

“As the primary healthcare provider I know the person’s medical conditions and have often led their care over months or even years,” said Boyd. “Now I am able to provide all the care needed for the older person and their family.”

More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made only come into effect today (January 31).

The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), and other health practitioners like pharmacists, registered nurses and physiotherapists are now qualified to carry out those roles.

Lobbying began early in the millennium by nurse leaders to identify and remove a range of legislative barriers to nurse practitioners’ practice and formal work began back in 2005 to go through legislation with a fine tooth comb to find references to “doctors” or “medical practitioners” in roles that now could be done by other suitably qualified health practitioners. The acts remove the anomaly where NPs could sign ACC forms and sickness benefit forms but could not sign an ordinary sick leave certificate for work under the Holiday’s Act.

Boyd, a former chair of Nurse Practitioners New Zealand (NPNZ), said today’s enacting of the new laws represented to her the removal of some of the last barriers to being able to practice at the top of her scope as a nurse practitioner.

“Over the 17 years nurse practitioners in New Zealand  have shown that they are highly skilled clinicians that provide innovative healthcare practices and increased access to care for the population,” said Boyd. “It took 10 years to register 100 NPs, five years to register 200 and only a further two years for the registrations to climb to over 300. This growth shows that the value of nurse practitioner practice is being recognised nationally more than ever.”
NP Jane Jeffcoat, another former NPNZ chair, said as more NPs register she was hearing that both public and private organisations were now seeing the value of NPs as they see them in practice.
“In October 2017 I stood before more than 100 delegates at NPNZ Conference and asked for a show of hands of those who registered as a NP in the last 12 months,” said Jeffcoat. “It seemed like half the room put up their hands! It was overwhelming, exciting and an endorsement of all the hard work so many have contributed over the years to forward the recognition and development of NPs.”
“I believe momentum is still building and greater discussions around models of care and sustainable workforce will continue recognise the role of NPs in providing better and more innovative access to healthcare to a greater extent.”

The Ministry of Health’s outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.

Memo Musa, the chief executive of the New Zealand Nurses Organisation congratulated all those involved in the watershed changes particularly the Nursing Council and the Office of the Chief Nurse.

Musa said the amended Acts meant more nurses could improve public access to some medicines and also enable them to work to the full breadth and scope of their practice. “It is often easier and quicker to see a nurse than a doctor so this change means more people in the community can benefit by accessing health care sooner.”

2018 LEGISLATION CHANGES SUMMARY

  • Changes across eight Acts amend references to medical practitioners to include health practitioners including nurse practitioners, registered nurses and, in one instance, pharmacist prescribers.
  • Seven of the amendment Acts with their new terminology will commence on 31 January 2018 and the Transport Amendment Act will commence on 8 November 2018.
  • The amendments enable competent health practitioners (as defined under the Health Practitioners Competence Assurance Act 2003 or HPCA Act) working within their prescribed scope of practice (e.g. registered nurses) to carry out new roles as defined by the amended Acts.
  • This does not mean that all health practitioners regulated under the HPCA Act will be able to undertake all the amended statutory functions.
  • The Ministries of: Health; Transport; Business, Innovation and Employment; and Social Development are responsible for the affected legislation. Other agencies, including ACC and the New Zealand Police, will also need to implement the changes.

AMENDED ACTS

Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury including suitably qualified registered nurses, if their employer and the Nursing Council of New Zealand recognise that they are competent and safe to do so

Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.

Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).

Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.

Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.

Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.

Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.

Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.

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