Establishing the nurse practitioner workforce in rural New Zealand: barriers and facilitators
Sue Adams 1 3 , Jenny Carryer 21 School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
2 School of Nursing, College of Health, Massey University, Tennent Drive, Palmerston North 4474, New Zealand
3 Corresponding author. Email: sueadams2020@gmail.com
Journal of Primary Health Care 11(2) 152-158 https://doi.org/10.1071/HC18089
Published: 14 June 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: The health sector is facing considerable challenges to meet the health needs of rural communities. Nurse practitioners (NPs) deliver primary health care (PHC) services similar to general practitioner (GP) services, within a health equity and social justice paradigm. Despite GP workforce deficits, New Zealand has been slow to effectively utilise NPs.
AIM: From a larger study exploring the establishment of NP services, this paper reports on the barriers and facilitators to becoming a NP in rural PHC.
METHODS: Overall, 13 NPs and 4 NP candidates participated in individual or group interviews. Participants were employed in a variety of PHC settings from six district health boards across New Zealand. Using a scaffold map constructed to show the stages of the pathway from nurse to NP, data were analysed to identify experiences and events that facilitated or were barriers to progress.
RESULTS: Experiences varied considerably between participants. Commitment to the development of the NP role in their local areas, including support, advanced clinical opportunities, supervision, funding and NP job opportunities, were critical to progression and success. Existing GP shortages and the desire to improve health outcomes for communities drove nurses to become NPs.
DISCUSSION: Implementation of the NP workforce across New Zealand remains ad hoc and inconsistent. While there are pockets of great progress, overall, the health sector has failed to embrace the contribution that NPs can make to PHC service delivery. A national approach is required to develop the NP workforce as a mainstream PHC provider.
KEYwords: Rural health; primary health care; nursing roles; workforce; equity
References
[1] Nursing Council of New Zealand. Search the register. Wellington: Nursing Council of New Zealand; 2018. [cited 2018 November 10]. Available from: http://www.nursingcouncil.org.nz/nursesregister/search?RegNo=&HPI=&Surname=&FirstName=&NursePractitioner=1&SearchButton=[2] Auerbach DI, Chen PG, Friedberg MW, et al. Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage. Health Aff. 2013; 32 1933–41.
| Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage.Crossref | GoogleScholarGoogle Scholar |
[3] DiCenso A, Bourgeault I, Abelson J, et al. Utilization of nurse practitioners to increase patient access to primary healthcare in Canada: thinking outside the box. Nurs Leadershp. 2010; 23 239–59.
| Utilization of nurse practitioners to increase patient access to primary healthcare in Canada: thinking outside the box.Crossref | GoogleScholarGoogle Scholar |
[4] Institute of Medicine. The future of nursing: leading change, advancing health. Washington, DC: National Academies Press; 2011. [cited 2018 November 10]. Available from: http://nationalacademies.org/HMD/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
[5] Bodenheimer T, Bauer L. Rethinking the primary care workforce - an expanded role for nurses. N Engl J Med. 2016; 375 1015–7.
| Rethinking the primary care workforce - an expanded role for nurses.Crossref | GoogleScholarGoogle Scholar | 27626516PubMed |
[6] Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization; 2008. [cited 2018 November 10]. Available from: http://www.who.int/social_determinants/thecommission/finalreport/en/
[7] Sheridan NF, Kenealy TW, Connolly MJ, et al. Health equity in the New Zealand health care system: a national survey. Int J Equity Health. 2011; 10 45
| Health equity in the New Zealand health care system: a national survey.Crossref | GoogleScholarGoogle Scholar | 22014211PubMed |
[8] Browne AJ, Tarlier DS. Examining the potential of nurse practitioners from a critical social justice perspective. Nurs Inq. 2008; 15 83–93.
| Examining the potential of nurse practitioners from a critical social justice perspective.Crossref | GoogleScholarGoogle Scholar | 18476851PubMed |
[9] Kooienga SA, Carryer J. Globalization and advancing primary health care nurse practitioner practice. J Nurse Pract 2015; 11 804–11.
| Globalization and advancing primary health care nurse practitioner practice.Crossref | GoogleScholarGoogle Scholar |
[10] Xue Y, Intrator O. Cultivating the role of nurse practitioners in providing primary care to vulnerable populations in an era of health-care reform. Policy Polit Nurs Pract. 2016; 17 24–31.
| Cultivating the role of nurse practitioners in providing primary care to vulnerable populations in an era of health-care reform.Crossref | GoogleScholarGoogle Scholar | 27166344PubMed |
[11] Laurant M, van der Biezen M, Wijers N, et al. Nurses as substitutes for doctors in primary care Cochrane Database Syst Rev. 2018; CD001271. [Review].
| Nurses as substitutes for doctors in primary careCrossref | GoogleScholarGoogle Scholar | 30011347PubMed |
[12] Martínez-González NA, Djalali S, Tandjung R, et al. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis. BMC Health Serv Res. 2014; 14 214
| Substitution of physicians by nurses in primary care: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 24884763PubMed |
[13] Swan M, Ferguson S, Chang A, et al. Quality of primary care by advanced practice nurses: a systematic review. Int J Qual Health Care. 2015; 27 396–404.
| Quality of primary care by advanced practice nurses: a systematic review.Crossref | GoogleScholarGoogle Scholar | 26239474PubMed |
[14] Carryer J, Adams S. Nurse practitioners as a solution to transformative and sustainable health services in primary health care: a qualitative exploratory study. Collegian. 2017; 24 525–31.
| Nurse practitioners as a solution to transformative and sustainable health services in primary health care: a qualitative exploratory study.Crossref | GoogleScholarGoogle Scholar |
[15] Goodyear-Smith F, Janes R. How are rural funding initiatives impacting on rural general practice? N Z Fam Physician. 2007; 34 101–7.
[16] Verma P, Ford JA, Stuart A, et al. A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv Res 2016; 16 126
| A systematic review of strategies to recruit and retain primary care doctors.Crossref | GoogleScholarGoogle Scholar | 27067255PubMed |
[17] Royal New Zealand College of General Practitioners. 2017 general practice workforce survey: part 1. City: Publisher; 2018. [cited 2018 November 10]. Available from: https://oldgp16.rnzcgp.org.nz/assets/Workforce-Survey-2017-Report-1-final.pdf
[18] Nursing Council of New Zealand. Nurse practitioner. Wellington: Nursing Council of New Zealand; [cited 2018 November 10]. Available from: http://www.nursingcouncil.org.nz/Nurses/Scopes-of-practice/Nurse-practitioner
[19] New Zealand Government. Health Practitioners. (Replacement of Statutory References to Medical Practitioners) Bill. Wellington: New Zealand Government; 2015. [cited 2018 November 10]. Available from: http://www.legislation.govt.nz/bill/government/2015/0036/32.0/DLM6514118.htm
[20] Adams S. Nurse practitioners in rural primary health care in New Zealand: an institutional ethnography. PhD dissertation, Massey University, Palmerston North, New Zealand. Available from: https://mro.massey.ac.nz/handle/10179/12816
[21] Smith DE. Institutional ethnography: a sociology for people. Lanham, Maryland: Altamira Press; 2005.
[22] DeVault M, McCoy L. Investigating ruling relations: dynamics of interviewing in institutional ethnography. In: The SAGE handbook of interview research: the complexity of the craft. 2nd edn. Gubrium JF, Holstein JA, Marvasti AB, McKinney KD, editors. Thousand Oaks, California: SAGE; 2012. pp. 381–95.
[23] Carryer J, Boddy J, Budge C. Rural nurse to nurse practitioner: an ad hoc process. J Prim Health Care. 2011; 3 23–8.
| Rural nurse to nurse practitioner: an ad hoc process.Crossref | GoogleScholarGoogle Scholar | 21359257PubMed |
[24] King A. The Primary Health Care Strategy. Wellington: Ministry of Health; 2001.
[25] Ministry of Health. New Zealand Health Strategy: future direction. Wellington: Ministry of Health; 2016.
[26] Nursing Council of New Zealand. Trends in the New Zealand Nursing Workforce: 2012–2016. Wellington: Nursing Council of New Zealand; 2017.
