Scope of practice for nurse practitioners
Nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practise beyond the level of a registered nurse. Nurse practitioners work autonomously and in collaborative teams with other health professionals to promote health, prevent disease, and improve access and population health outcomes for a specific patient group or community. Nurse practitioners manage episodes of care as the lead healthcare provider in partnership with health consumers and their families/whānau. Nurse practitioners combine advanced nursing knowledge and skills with diagnostic reasoning and therapeutic knowledge to provide patient-centred healthcare services including the diagnosis and management of health consumers with common and complex health conditions. They provide a wide range of assessment and treatment interventions, ordering and interpreting diagnostic and laboratory tests, prescribing medicines within their area of competence and admitting and discharging from hospital and other healthcare services/settings. As clinical leaders they work across healthcare settings and influence health service delivery and the wider profession.
This scope of practice, with its definition of what of nurse practitioners can do, was effective from 6 April 2017. It was the first major change to the scope since the nurse practitioner role was established in 2001 and followed a comprehensive review, including two rounds of consultation. Its aim is to ensure the scope provides sufficient flexibility to enable nurse practitioners to safely and appropriately meet changing health needs, with demand for care is growing from aging, diverse, remote and underserved population groups and more people are living with chronic conditions.
In pursuit of flexibility, newly registered nurse practitioners will no longer be restricted to a specific area of practice. As advanced clinicians, they are trusted to practise within their areas of competence and experience.
What does this mean for nurses applying for registration as nurse practitioners?
An 18-month transition period has been established. Until September 2018, registered nurses undertaking nurse practitioner programmes can register with a condition to practise in a specific area of practice. Refer to the
What does this mean for existing nurse practitioners?
Existing nurse practitioners are not directly affected by these changes and will continue to practice with a condition placed in their scope of practice indicating the limits of their practice - for example, that they work in a particular area or do not prescribe.
Those who wish to expand their practice and have a condition/s removed, may apply to the Council for a change of condition. Details on how to do this are contained in the
Nurse Practitioner Prescribing
Nurse practitioners are authorised prescribers (along with doctors, optometrists and midwives) under the Medicines Act.
The Misuse of Drugs Regulations 1977 permits nurse practitioners to prescribe controlled drugs within their scope of practice for:
- Not exceeding one month’s supply for Class A and B controlled drugs
- Not exceeding three months’ supply for Class C controlled drugs.
Guidelines for nurses wishing to apply for registration in the nurse practitioner scope of practice are available from the resource documents box in the right hand corner of this page.
The Medicines (Standing Order) Amendment Regulations 2016, extended the definition of who are permitted to issue standing orders to include optometrists and nurse practitioners. This means from 17 August 2016, nurse practitioners can issue standing orders and must comply with the regulatory requirements for monitoring and audit of the standing orders they issue ( Standing Order Guidelines 2016, Ministry of Health).
Nurse practitioners having the ability to issue standing orders will improve access to medicines and effective treatment and allows nurse practitioners to work to the full extent of their scope.
More information on Nurse Practitioner qualifications and competencies can be found on here
Continuing competence requirements
Continuing competence requirements
Every 3 years prescribing nurse practitioners will be required to provide evidence that they have maintained competence, when they apply for their practising certificate. This evidence includes:
- Ongoing peer review of their prescribing practice by an authorised prescriber; and
- A minimum of 40 hours per year of professional development over a 3 year period; and
- A minimum of 40 days per year of ongoing nursing practice over a 3 year period.