Nurse Practitioners in New Zealand

Case Studies

Working life as a Nurse Practitioner in Child and Youth Health
Paula Renouf

Background

Kia ora koutou katoa. I have been working as a Nurse Practitioner (NP), with prescribing, in the primary health care of children and youth since 1992. I graduated from the University of California San Francisco’s Master of Science program, which prepared me for the roles of Clinical Nurse Specialist in Paediatric Oncology and Paediatric Nurse Practitioner. Exams for Board certification and six months practice requirement for prescribing followed. My heart took me more and more away from the hospital setting and into the community. I worked for almost ten years full-time in a buzzing community health centre for Latin-American immigrants in San Francisco. There I carried a case load of 1800 children from 0-18 years old, provided comprehensive preventive well child and teen care, and independently managed all the common acute and chronic conditions.

Working in New Zealand

Since gaining endorsement in New Zealand in 2002, with prescribing rights since 2003, I have been lecturing in post-graduate child health courses at the University of Auckland and have had three clinical NP roles. The first two were pioneering roles in the Paediatric Registrar team of Middlemore KidzFirst Emergency Care and in a bustling General Practice (GP) faculty primary care practice in South Auckland. They were made possible with financial support at District Health Board (DHB) level. In these roles I was able to work, as I had in San Francisco, for the child and youth population however sadly, there is no mandate for primary care clinicians to ensure comprehensive preventive care, or early detection and prompt management of child or youth health problems.

As a NP breaking new ground in the primary care setting in 2004-2006, my philosophy of collaborative practice ensured acceptance by doctors, as well as the very best care for my patients. I enjoyed ‘bi-directional’ consultation with GPs and was actively involved in weekly peer education /review sessions, teaching nurses and medical students from New Zealand and abroad at our clinic, DHB and nationwide initiatives, and expert working groups in youth health, school-based health, and women’s sexual and reproductive health initiatives.

The funding barrier

Currently the greatest barrier for child and youth NPs, who wish to work in primary care settings as expert clinicians with their own case load of patients, is funding. This is because NPs cannot claim General Medical Services (GMS) funding, Section 88 or adequate Accident Compensation Corporation (ACC) reimbursement. NPs also compete with many other projects and needs for Services to Improve Access (SIA) funding, hence, despite the obvious benefits to clients, NPs tend to be perceived as a ‘cost’ rather than being financially viable. This is a marked contrast to the USA where it is perfectly easy to ‘prove one’s worth’ as a clinician as each patient encounter has inherent value (earning power) based on diagnosis, acuity, complexity and length of visit. Capitated primary care funding is DEPENDENT upon provision of regular preventive care, screening, physical examinations and health maintenance for children 0-18 and adults on a less frequent periodicity schedule. New Zealand is not yet ready to accept NPs as advanced clinicians in primary care. ‘Funders and planners’ and the Nursing Council itself want so much of us that it will be difficult for us to develop, maintain and showcase high-level broad-spectrum ‘primary care provider’ practice.

My current role at Tamaki Healthcare PHO

In 2007 I accepted an innovative NP position with the Tamaki Healthcare Primary Health Organisation (PHO), the first in New Zealand to implement a child health strategy ‘Tamaki Toi Tu Kids Service’. This role has clinical, education and research components as well as challenging demands in strategic leadership and policy making. I hope to work with PHO providers (GP practices) to strategically improve quality care for high risk kids ( Maori, Pacific and fifth quintile by the New Zealand Deprivation score) by:

1. reducing fragmentation between antenatal, well child care and primary care and ensuring children receive all the services they should, so fewer high risk kids and families ‘slip through the cracks’
2. strategically reviewing enrolled children who attend hospital Emergency Departments and after hours care
3. improving care coordination for children with complex or chronic health needs (this will be in collaboration with Auckland DHB Paediatricians who will come out into high need communities to improve access to timely specialist care and consultation).

Tamaki HealthCare PHO is driving to improve access and quality of care in mainstream primary care settings backed with allied health specialist support and is the first to acknowledge that kids standing strong is the key to healthy adulthood and reducing health inequalities overall.

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Page last updated: 7 March 2007