Future changes to the nurse practitioner scope of practice

08 March 2013

The Nursing Council will be making changes to the nurse practitioner scope of practice and qualifications when the Medicines Amendment Bill is passed. 

At present nurse practitioners can be registered without prescribing rights. Under the proposed changes to the Medicines Act 1981 nurse practitioners with prescribing rights will become authorised prescribers. The Council completed a consultation in October/November 2012 proposing that nurse practitioner becomes a prescribing scope of practice once the legislation changes. There was strong support for the Council’s proposals and from June 2014, the Council will cease registering nurse practitioners without prescribing rights.

When the Medicines Amendment Bill is passed the Council will make changes to the nurse practitioner scope of practice and qualifications to indicate that it is a prescribing scope of practice. Nurse practitioners who are already registered without prescribing rights will have a condition included in their scope of practice indicating that they may not prescribe. 

There was strong support from submitters for all nurse practitioners to have prescribing rights. More information is contained in the analysis of submissions. 

Analysis of submissions NP scope of practice February 2013 (PDF, 360 KB)

It is not known exactly when changes will be made to the Medicines Act but it is expected to occur in 2013. 

New nurse practitioner scope of practice

When the legislation changes the wording of the scope of practice will change to indicate it is a prescribing scope. The qualification will also change to indicate that all applicants must complete a programme leading to prescribing. The areas in bold below are the changes to the scope and qualifications.

Nurse practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills.They practise both independently and in collaboration with other health care professionals to promote health, prevent disease and to diagnose, assess and manage people’s health needs. They provide a wide range of assessment and treatment interventions, including differential diagnoses, ordering, conducting and interpreting diagnostic and laboratory tests, and administering therapies for the management of potential or actual health needs. They work in partnership with individuals, families, whanau and communities across a range of settings. Nurse Practitioners may choose to prescribe medicines within their specific area of practice. Nurse Practitioners also demonstrate leadership as consultants, educators, managers and researchers, and actively participate in professional activities, and in local and national policy development.

Prescribed qualification

a) registration with the Nursing Council of New Zealand in the Registered Nurse Scope of Practice;  and

b) a minimum of four years of experience in a specific area of practice; and

c) the completion of an approved clinical Master’s degree programme which includes demonstration of the competencies, for advanced practice and prescribing applied within a defined area of practice of the nurse practitioner. The programme must include relevant theory and concurrent practice; or

d) the completion of an equivalent overseas clinically focussed Master’s degree qualification which meets the requirement specified in c) above; and

e) passing an assessment against the nurse practitioner competencies by an approved panel.

Non prescribing nurse practitioners

Non prescribing nurse practitioners will have a condition placed in their scope of practice to indicate that they may not prescribe once the legislation changes.  Non prescribing nurse practitioners can achieve prescribing competency and have this condition removed by either of these pathways:

a) those nurse practitioners with qualifications that include pharmacology and a prescribing practicum will be required to complete 100 hours of supervised prescribing practice and a competence assessment by a medical mentor and a nurse practitioner;and

b) those nurse practitioners who do not have the appropriate qualification must complete a Nursing Council approved pharmacology paper and a prescribing practicum that includes 100 hours of supervised prescribing practice and a competence assessment by a medical practitioner and a nurse practitioner or supply a portfolio that demonstrates they have the equivalent knowledge and skills and complete a panel review.

The Council will be writing to individual nurse practitioners who are not prescribing to inform them of the changes and advising them of the process to follow to gain prescribing rights. Employers and medical mentors are asked to support this transition.

Continuing competence requirements for prescribing nurse practitioners

When nurse practitioners become authorised prescribers the Council will make a slight change to their continuing competence requirements to bring them into line with the three yearly requirements for registered and enrolled nurses. Nurse practitioners, authorised to prescribe, must provide evidence every three years, that they have maintained their competence with their application for a practising certificate. This includes evidence of on-going peer review of their prescribing practice by an authorised prescriber and

a) a minimum of 40 hours per year of professional development aggregated over a three-year period;and

b) a minimum of 40 days per year ongoing nursing practice aggregated over a three-year period within their defined area of practice.

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