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The growing demand for health care to be more efficient and accessible has led to a call to extend the scope of practice of nurses working in primary care practices to include prescribing.
In response, the Nursing Council of New Zealand has consulted with professional groups and key stakeholders on two proposals to extend nurse prescribing in New Zealand (Nursing Council of New Zealand, 2013).
Following consultation, two partner organisations – CM Health and Family Planning New Zealand – were selected to pilot a programme that enabled and supported nurses to prescribe in primary health care settings.
The Nursing Council has described the need for people in New Zealand to have greater access to nursing services, due to socioeconomic, environmental and health literacy barriers, and has cited these barriers as the main reasons for extending nurse prescribing to RNPCH (Nursing Council of New Zealand, 2013).
To prepare nurses for this new scope of practice, the Nursing Council has decided to trial a recertification programme, with a work-based learning approach using blended learning methods (Nursing Council of New Zealand, 2017).
Unlike other nurse prescribing roles, such as nurse practitioner, nurses do not study at a postgraduate level to gain the prescribing competencies for RNPCH.
The selected approach allows nurses working in a community setting, who may face financial barriers or have difficulty in accessing academic learning programmes, to develop their clinical practice. The employer approval required for nurses to enter the programme ensures that mentoring and supervision for prescribing is provided in clinical practice and that the practice supports the nurse to prescribe (Nursing Council of New Zealand, 2016).
This approach will potentially enable the largest group of nurse prescribers working in primary care practices in New Zealand to be trained, because it increases access to training programmes.
In 2017, 33 nurses employed across primary care practices, secondary schools, Mana Kidz programmes and as public health nurses participated in the CM Health trial.
The nurses are employed individually within primary care practices, most often by a general practitioner (GP) employer. The primary care practices vary in size and population demographics. The majority are in areas of high socioeconomic deprivation, with a few located in more affluent areas. The practices vary in size from a single GP and nurse, with 2000 enrolled patients, to multi GP and nurse teams, with 12,000 enrolled patients. The practices are supported by five primary health care organisations: Procare Limited, Alliance Health +, East Health, East Tamaki Health Care and National Hauora Coalition.
To enter the programme, the nurses were required to have been registered with the Nursing Council of New Zealand for more than three years, worked in primary care for the past 12 months, and have been using standing orders to provide medications to patients under delegation of their GP.
The participating nurses all undertook a six-month programme of preparation, successfully completed the learning outcomes and demonstrated safe practice in prescribing for the limited range of medicines. Each nurse has now been approved as an RNPCH by the nursing council, and is practising in a primary care practice located in the CM Health region. Restrictions placed on the nurses‘ prescribing scope means that they are only able to prescribe within a primary care practice located in Counties Manukau.
The programme evaluation confirmed that he nurses who completed the programme have transitioned to be competent prescribers in their area of practice. They are able to assess, treat and prescribe medicines for a well population with minor health concerns. This has increased access to care for a number of families in our most socioeconomically deprived communities.
The programme will be officially launched on 5 July 2019 by the Associate Minister of Health. This will allow other districts to develop their own programme, building on the success we have had at CM Health. All of the resources developed for the CM Health programme will be shared nationally.