Nurse Practitioners in New Zealand

Case Studies

Working life as a Nurse Practitioner in Urology
Trish White

Background

I work for Hawke’s Bay DHB as a Urology Nurse Practitioner. I started nursing in 1980 as a green 17 year-old in the last hospital-trained class based at Napier Hospital. Following graduation I worked in a variety of settings before setting forth on the big OE in 1988. I was away seven years working first in London and then in Sydney, as a Clinical Nurse Specialist in a Surgical Ward, and gained great experience. When I returned home to Hawke’s Bay in the mid ‘90s the health reforms were well underway and I arrived in the midst of a “restructure”. I was lucky to be employed as a Clinical Nurse Advisor for General and Specialist Surgery, but then a couple of years later these positions were also disestablished! My next job as a Urology and Gynaecology Case Manager lasted seven years up until my appointment as a Nurse Practitioner. During this time I finished my Bachelor of Nursing then completed my Masters Degree in 2004 at the Eastern Institute of Technology, application to Nursing Council with my Nurse Practitioner portfolio followed and I was successful in July 2005.

Setting up the role

I applied for funding from the Ministry of Health Elective Services Initiative, which was supportive of the introduction of the Nurse Practitioner role. One of my goals was to reduce the number of patients waiting for First Specialist Assessment (FSA) in Urology Outpatient Clinics. I had to show a reduction in the number of patients waiting longer than six months for their appointments to be assured of continued funding for the Urology Nurse Practitioner role from my DHB, happily I was successful in this pilot.

Clinical Responsibilities

Outpatient Clinics:
I have two clinics per week and patients are referred, following triage, by the Urologist.

• New Patients:
  30% of men over the age of 60 have significant urinary problems (Nacey, J.N., Morum, P., & Delahunt, B. 1995). This statistic is only going to get worse with our aging population. In my clinics I see patients with a variety of urology diagnoses including lower urinary tract symptoms (LUTS), recurrent UTI, voiding disorders and continence issues. These patients often have low priority and long wait times for clinic appointments with a Urologist. I’m concentrating on this group initially so we can provide a more equitable service. I assess, diagnose and put treatment plans into place and I’ve developed evidence-based protocols based on best practice. I’ve also recently gained prescribing rights which is great for my patients as I’m now able to write a prescription there and then and provide more timely access to appropriate treatment and medication.
  
  Outcomes:
  I keep a database of patients seen in this clinic and I’ve shown I can manage 45% of the population independently, by establishing a diagnosis and developing a treatment plan. I either follow this group myself or they’re discharged back to their GP. The remaining 55% require Urologist review – the majority of them going on to require surgery of some description. By weeding out the patients who do not require Urologist review he can focus his time on higher acuity patients requiring his expert skills and our waiting lists don’t continue to grow.

• Follow-up patients:
  Oncology surveillance clinic – in this clinic I review patients following surgery for prostate, bladder or kidney cancer. I order blood tests, ultrasound scans or other
  tests as appropriate then review the results with the patient. They see the Urologist for the first year postop then I see them until the five-year mark is reached, when
  they are hopefully still cancer free. I also follow-up Prostate Cancer patients following radiotherapy and see some uncomplicated follow-up patients discharged from
  the Urology ward.

Community/Primary Health Care:
I’m involved in the case management of Urology patients in the community. I follow-up our complex cases and see approximately 80 – 100 patients in their own homes each month. For this service I’m referred patients by GPs, District Nurses and Rest Homes as well as the usual hospital referrals from the Urologists. Part of this service is preventing admission to hospital and managing the patient in the most appropriate environment. I consult with other health professionals as required.

Hospital:
I’m utilised as a Urology resource person for the hospital and am often called to provide advice on complicated patients in the wards. I organise urology training programmes in the hospital and also give lectures to both Bachelor of Nursing and post-graduate classes at the Eastern Institute of Technology.

Complementary and collaborative

My role is complementary and collaborative with the Urologists I work with and I appreciate their support of the role. They continue to provide me with clinical supervision. I’m able to bring a nursing focus to the care of patients I see. I aim to empower the patient by including their personal goals while working with them to develop treatment plans. I also work at maintaining patient independence by utilising health promotion strategies during the consultation.

Research

Research is an important part of the role and I hope to be able to set aside dedicated time to work on projects. Initially I want to focus on evaluating the outcomes of my practice. Another project I am working on with the Urology Registrar is the burden of care for patients awaiting surgery for urinary retention. I’m also involved nationally with the NZ Urology Nurses Society having been past chairperson now serving on the committee and also past President of the Australasian Urology Nurses Society.

Meeting challenges head-on

My role is in its infancy and I’m sure there will be many challenges, but with a great team around me we’ll meet them head-on and continue to work together to provide the best care we can for our patients. I would like to encourage Registered Nurses working in Urology to consider applying for Nurse Practitioner endorsement. It’s wonderful we now have this career option available to us and I’m happy to provide assistance if anyone is interested.

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