Optimising the Role of Nurse Practitioners in New Zealand

Date
2023
Authors
Wright, Isabella Joanna
Supervisor
Merrick, Eamon
Vorster, Anja
Item type
Thesis
Degree name
Doctor of Health Science
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Publisher
Auckland University of Technology
Abstract

Background Nurse Practitioners in New Zealand are highly skilled Registered Nurses with the qualifications to work independently, make autonomous decisions, and are authorised prescribers. However, despite the existence of the role for over 20 years, it has not fully realised its potential. Consequently, Nurse Practitioners have faced challenges in receiving organisational support, hindering their ability to achieve their maximum economic and clinical impact. Key challenges facing New Zealand’s health system include establishing sustainable models of care for individuals with long-term and complex health needs, addressing workforce shortages, and managing the repercussions of the COVID-19 pandemic. Therefore, it is time to develop new models of care and integrated inter-disciplinary primary healthcare teams, including Nurse Practitioners, to improve the coordination and provision of healthcare to the public. The development of new models of care will require an in-depth understanding of how Nurse Practitioners perform their role.

Aim
This research aims to identify the organisational opportunities for Nurse Practitioners to make decisions about the means and methods of performing their role.

Methods A cross-sectional study was conducted. The study investigated the decision-making opportunities available to Nurse Practitioners, examining the potential influence of geographical location on their practice. The measurement tool utilised was the validated Job Content Questionnaire, and the Nurse Practitioners were requested to complete a 68-item self-administered online questionnaire. A convenience sample (n=169) represented 49% of the Nurse Practitioner workforce. The Job Content Questionnaire was assessed for reliability and construct validity using the co-efficient α and confirmatory factor analysis, respectively. Linear regression analyses were performed to determine the strength of the relationships between constructs measured by the Job Content Questionnaire.

Results The study findings revealed that Nurse Practitioners perceive themselves as having more control over their decision-making when supported by their colleagues rather than supervisors. Nurse Practitioners perceive improved relationships with healthcare consumers if they feel an increase in support from their colleagues, which is mediated through the increased freedom they perceive themselves to have to make decisions about their practice. The study also found that when rural Nurse Practitioners had an increased perception of being valued and appreciated at work, they felt more secure in their jobs.

Discussion and Conclusions These findings have implications for New Zealand’s healthcare policies, emphasising the importance of supporting Nurse Practitioners so that they can practice to the fullest extent of their capabilities and contribute to reducing healthcare access disparities within the population. Explicit inclusion of the Nurse Practitioner role in the workforce policies is necessary. The study recommends implementing a funded vocational training programme for novice Nurse Practitioners, potentially enhancing Nurse Practitioner-led practice growth in New Zealand.

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