Protecting the public through excellent nursing practice

An Overview of the Nurse Practitioner Project in Tasmania Protecting the public through excellent nursing practice M Laverty – 27 June 2006

Patient –focussed care  What does the patient need?  Who is available to deliver those needs?  Are they appropriately skilled and educated?  Will they be supported in their work?  Are there available resources to enable them to give the quality of care required? Protecting the public through excellent nursing practice

What is a Nurse Practitioner ANMC Definition  A registered nurse educated & authorised to function autonomously & collaboratively in an advanced and extended clinical role.  The role includes assessment and management of clients using nursing knowledge and skills and may include, but is not limited to;  Direct referral of patients to other healthcare professionals, prescribing medications and ordering diagnostic investigations.  The role is grounded in the nursing profession’s values, knowledge, theories and practise  Provides flexible health care delivery that compliments other health care providers.  The scope of practice is determined by the context in which the nurse practitioner is authorised to practice. Protecting the public through excellent nursing practice

The Regulatory Background The Nursing Board of Tasmania acknowledges the contribution of Nurse Practitioners to the health care of the public by defining and endorsing the title and professional standards for Nurse Practitioners The Board has enacted its functions and powers under the Nursing Act 1995 –To administer the scheme of registration and enrolment Protecting the public through excellent nursing practice

The Regulatory Background (continued) –To monitor the standard and provision of nursing services in Tasmania –To determine the activities that constitute or are included in the scope of nursing practice –To monitor standards of nursing education. Protecting the public through excellent nursing practice

Authorisation under the Nursing Act 1995 The Nursing Act 1995 refers to restricted areas of practice the Board has the power to require authorisation in. The following areas are restricted practice areas: –Midwifery; –Psychiatric nursing; –Such other areas of nursing practice as may be prescribed Protecting the public through excellent nursing practice

Authorisation under the Nursing Act 1995 (cont.) Protecting the public through excellent nursing practice On 28 November 2005 the following amendments were made to the Nursing Regulations 2005 The area of practice of nurse practitioner to be a restricted practice area; and the area of nursing practice performed by a nurse practitioner is prescribed as a restricted practice area.

Protection of the Title “Nurse Practitioner” Prescription of nurse practitioner as title. The title of nurse practitioner is prescribed as a title under which a person, other than a registered nurse or an enrolled nurse, must not practise a profession or trade. Protecting the public through excellent nursing practice

Underlying Principles The Nursing Board of Tasmania has the role and function to regulate the practice of nursing in the public interest The nature of advanced and extended practice is accepted, nationally and internationally as evident in the role of the nurse practitioner Clear authority for the advanced scope of practice in an extended nursing role is facilitated by the regulation of the practice of nursing in the public interest Protecting the public through excellent nursing practice

Developing Nationally Consistent Standards for the Nurse Practitioner Role  The Australian Nursing and Midwifery Council (ANMC) commissioned a research project to develop a consistent national approach to national competency standards for nurse practitioners, which have been adopted by all States and Territories Protecting the public through excellent nursing practice

An Overview of the Nurse Practitioner Role  The NP movement began in the United States (US) in 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 have emerging NP roles.  In % or 196,279 of the USA nurse workforce were advanced practitioners and of that number 88,186 were NP’s. Protecting the public through excellent nursing practice

Range of Practice for Authorised NPs  Mental Health; Diabetes; emergency care; Women’s Health; Palliative Care  Neuro surgery; cardiology; continence; oncology; rural and remote care; respiratory; Aged care; wound management  Paediatric/Neonatal; Genetics; Alcohol and Other Drugs; Sexual Health; renal Protecting the public through excellent nursing practice

What’s Happening Nationally: New South Wales  69 authorised NPs in positions  2 “Midwife Practitioner” positions  1 Aboriginal Nurse Practitioner Australian Capital Territory  3 registered nurse practitioners  Completed trial of NP in Aged Care - report available on the ACT website. Protecting the public through excellent nursing practice

Northern Territory  In principle endorsement of the scope of the Nurse Practitioner role  Nursing and Midwifery Board completed the Authorisation process  Palliative care; alcohol; special care nursery, rural remote, school health and Renal. Queensland  Legislative and policy changes being progressed  20 government scholarships for Masters in Nurse Practitioner Scholarships Protecting the public through excellent nursing practice

South Australia  11 registered nurse practitioners  Currently working in acute care and community settings within the metropolitan area.  Keen to support the development of rural and remote nurse practitioner Protecting the public through excellent nursing practice

Victoria  4 nurse practitioners endorsed  4 NP Candidates, 3 in women’s health & 1 Emergency commenced their applications  4 further in palliative care approaching final approval  Further 13 candidates in emergency Protecting the public through excellent nursing practice

Western Australia  23 Registered NPs  Areas have to follow a business case route for approval to site a NP  4 NP courses leading to registration as an NP in WA Protecting the public through excellent nursing practice

What’s Happening in Tas Goals  To develop a framework for the nurse practitioner role in Tasmania  Recognition of the role  Defined scope of practice  Regulation  To develop and pilot nurse practitioner models in collaboration with professional and regulatory bodies. Protecting the public through excellent nursing practice

What’s Happening in Tas Outcomes  Better access to specialist nursing services that are responsive to the needs of the population  Strengthen multidisciplinary care  Improved utilisation of nurses with advanced and extended clinical skills Protecting the public through excellent nursing practice

Phase 1 Phase 2-looking at  Rural HealthSexual Health  Mental HealthForensic nursing Protecting the public through excellent nursing practice

Completed or under development  Business case Template  Nurse Practitioner Pilot Guide  Guidelines for Mentors  Criteria for scope of practice  Legislative changes Protecting the public through excellent nursing practice

 Agency Policy for endorsement of clinical guidelines  Guidelines for clinical privileges and clinical reviews  Authorisation process  Statement of Duties Protecting the public through excellent nursing practice

Nurse holding Master of Nursing (Nurse Practitioner) qualification, supported by a portfolio demonstrating clinical experience and expertise Submission of completed Nurse Practitioner Application Package Interim authorisation by Board Undertake and complete required academic education as determined and accredited by Board Authorisation by Board Interview Pathway 3Pathway 2 Pathway 1 Submission of completed Nurse Practitioner Application Package Interview If not approved Appeal Process Section 72 of the Nursing Act 1995 If approved Nurse possessing knowledge, skills and experience applicable to the nurse practitioner role but without formal academic preparation for the role Nurse holding Clinical Masters (Nursing) qualification (or equivalent) Pathways Leading to Authorisation as a Nurse Practitioner Protecting the public through excellent nursing practice