It took eight years for New Zealand to register its first 50 NPs but nearly 90 registered in just the last year, the biennial Nurse Practitioners New Zealand conference in Blenheim was told.

Mark Baldwin, NPNZ chair and mental health NP welcomed the 150 registrations for the conference saying it met a number of firsts including the first to have an awards ceremony, the first to be held in the regions and the first to be addressed by a minister of health.

He said membership of NPNZ had grown since the last conference in 2017 from about 150 to 264 – which was more than 70 per cent of the country’s 373 NPs.  He said back in 2017 the conference had been excited to hear that 77 new NPs had registered in the previous 12 months – a marked jump from previous years – and the trend was now continuing with nearly 90 having registered last year.

Margareth Broodkoorn, the new Chief Nursing Advisor for the Ministry of Health addressed the conference on nurse practitioners ‘20 years on’ from New Zealand first deciding to pursue the new scope of practice.

The nurse practitioner scope was launched by the Ministry of Health and the Nursing Council in May 2001.  This was in the wake of the 1998 Ministerial Taskforce of Nursing promoting the advanced nursing role (a move also supported by the Nursing Council and Nurse Executives New Zealand) and amendments in 1999 to the Medicines Act 1981 allowing nurse prescribing.

Broodkoorn told the conference that in December 2001 neonatal nurse Dr Deborah Harris became the country’s first nurse practitioner. (Harris – who wasn’t present at the conference as she was working – went on to carry out ground-breaking and award-winning neonatal care research to gain her PhD.) Two years later the late Janet Maloney-Moni became the ninth NP and first Māori NP. Broodkoorn acknowledged that Maloney-Moni was amongst four of the country’s NPs who had since passed away.

The 50th NP was registered in 2009 and Broodkoorn said the first fifty NPs were pioneers and leaders in their field.  “They are individuals doing extraordinary mahi and work.” She highlighted some examples including Dr Alison Pirret who has published a highly regarded text book on clinical assessment, Dr Helen Snell who supported the development of diabetes nurse prescribers in New Zealand, Dr Michal Boyd whose work includes being instrumental in developing the Acute Intervention Respiratory Service, and first mental health NP Bernadette Forde-Paus.

Broodkorn said growth in NP numbers had stepped up since 2016 with a 25-30 per cent increase each year over the past three years bringing the most recent total to 373.  “Also somewhat pleasing to see is an incremental increase – about an extra five each year – of the Māori NP workforce.”

She said the increase was due to a range of factors including the tenacity of NPs themselves, the support of NPNZ, legislative barriers being removed, increased education and training opportunities (including the targeted NP Training Programme funding), changed registration processes and the growing critical mass of NPs and evidence-based practice that has influenced others to follow.

But Broodkoorn said a lot more growth was needed to occur in both the general and Māori NP workforce to respond to population needs and to ensure the workforce reflects the population.

The Health Minister David Clark told the conference that the NP role was likely to expand in the future along with the size of the workforce.  “I am impressed to hear about the rapid growth – still not quite fast enough for my liking – but I think we need to be encouraged by it.”

Health workforce training

Both Broodkoorn and Clark spoke of a recent Ministry of Health workshop with NP training providers about the NPTP programme and looking at options for NP training funding.

Broodkoorn also presented to the group a presentation about the restructuring of the Ministry of Health which has seen Health Workforce New Zealand (HWNZ) disbanded and re-established as a Health Workforce Directorate under the direction of a yet to appointed deputy director general of health.

She said the new directorate was continuing with a mix of “business as usual” programmes – including implementing the Nursing Accord and voluntary bonding scheme and was working on developing three to five top health workforce strategic priorities for the next five years.

Broodkoorn said an announcement was expected “imminently” about the training development fund for the health workforce.

Professor Jenny Carryer, executive director of the College of Nurses Aotearoa is the nursing representative on the Interim Health Workforce Advisory Committee.

Carryer said working with HWNZ in the past had been a “constant struggle” to claw money for postgraduate nursing training.  She said the “enormous nursing workforce” had received about $30 million of the approximately $170-180 million in the training pot with the vast majority going to medical specialty training.

But she said she was more optimistic about the new directorate.  “I’m optimistic we will see increased attention to postgraduate nurse education with the demise of HWNZ.”

A number of NPs expressed their frustration at the ringfencing of funding for training medical officers in some hard to fill specialty services, like venereology, that NPs in the field could be trained to deliver if they could access training funding.

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