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Development of The Nurse Practitioner Standards

Table of Contents

Nurse practitioners in Australia.

NPs’ role in Australia.

Scope of NP.

Registration standards for NPs in Australia.

Ongoing requirements for the NP endorsement

Registration renewal

During the period of registration.

Practice domains for NPs in Australia.

References

Nurse Practitioners in Australia

A registered nurse who can diagnose and treat patients of all ages suffering from a range of chronic and acute health conditions is termed as a Nurse Practitioners (NP). An additional university study at master’s degree level have to be completed by the NPs. They are the senior clinical nurses in the health care system. A person who has been authorized by the Nursing and Midwifery Board of Australia can use the title of “Nurse Practitioner” only. NPs work together as team members of the healthcare and work in partnerships with other nurses and healthcare professionals that includes GPs, surgical and medical specialists, dieticians, social workers, occupational therapists, physiotherapists and several others. They work in hospitals and community settings locations (Schadewaldt, et al 2016).

The aims of this innovative role are as follows:

  1. Improving access to healthcare treatment
  2. For the patients providing cost effective care
  3. Providing guidance, mentorship and clinical expertise to other health professionals in any health settings
  4. To focus on populations that are at risk
  5. Providing outreach services for patients in remote and rural areas

Through disease prevention, health promotion and health management strategies, NPs work together with other health professionals in improving access to healthcare for Australian communities in a cost-effective manner (Jennings, et al 2015).

NPs’ Role in Australia

Since 2000, healthcare has been provided by NPs in Australia and they are practicing in all the states and territories. Initially, the main role of the NPs was to improve healthcare access to persons who were homeless, old people and to the vulnerable or marginalized populations like those residing in remote and rural areas. NPs are employed in wide range of clinical settings such as hospital, community and primary care settings. They have been eligible providers of health care since 2010. They are sponsored by the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) (Woods, & Murfet, 2015).

They play an important part in effective and safe health services. They help in improving access to healthcare, facilitating positive health outcomes for consumers and in increasing satisfaction of consumers with health care delivery. In the dynamic and evolving healthcare environment, the NPs are an effective and integral part through which they provide highly skilled clinical leadership. They do so by enhancing the autonomy of nurses within a collaborative and interdisciplinary model of care. The role of NPs also symbolizes a retention and recruitment strategy for nursing which provides a career pathway for advanced and extended nursing practice roles. Thus, it is important that this valuable nursing role is recognized by giving the necessary assistance required for role implementation inside all levels of healthcare services.

Thirty years ago, in the United States of America, United Kingdom and Canada, the role of NPs was established. In Australia, the development of the role of NPs is comparatively recent as the first endorsed NP role happened in New South Wales (NSW) in 2001. The framework and criteria for NP authorization was supported by the South Australian nursing regulatory authority in 2002. The first NP was approved in the same year (DHA, 2017).

The roles of Australian NPs have been established by the key legislative, regulatory and educational standards for the past fifteen years. They have to demonstrate latest innovations in caring and meeting the changing health needs of populations, as proved through cost, quality, feasibility, effectiveness, safety and efficacy. The key characteristic of the role of NPs in managing and improving health efficiencies in health resources and accessing health services in managing patient low.

Scope of NP

Extensive post-graduate clinical experience and mandatory prescribed education at master’s level are completed by Australian NPs. They help in providing health care by employing an advanced nursing model of care.

NPs practice have the legal authority to practice autonomously and independently while a registered nurse does not possess that kind of authority (Harvey, 2011). It is the ability of the nurse practitioner to consider and diagnose health problems. They can order and understand diagnostic investigations, in formulating and evaluating response to treatment plans. They can prescribe medicines and consult other health professionals within their specific fields of competence.

The NPs can also give admission and discharge to consumers from health services including in a hospital setting. NPs work together with other health professionals in improving access to healthcare for communities of Australia by promotion of health, prevention of disease and strategies for health management. They enhance the health outcomes for communities or specific patient populations.

NPs have the option to develop partnerships with health consumers and their families for becoming their primary health provider. However, they can also practice as a team member of a bigger healthcare team. They provide person-centered care by uniting their advanced nursing skills and knowledge with therapeutic knowledge and diagnostic reasoning. NPs are able to manage and diagnose health consumers by means of complex and common health conditions. They act as the clinical leaders and they can practice across healthcare settings to influence delivery of health service and the wider profession (Dunn, et al 2010). 

The scope of practice of a nurse practitioner evolves and expand with time, experience and education. NMBA Decision-Making-Framework (2019) guides the role expansion and extent of practice and the fine evidence like the Australian NP Metaspecialty Framework (Woods, & Murfet, 2015). In order to demonstrate competence in an expanded range of practice, the NPs have to undergo clinical training and get relevant education to fulfil the requirements of NMBA. The national practice standards for NP ensures that they are capable of rendering a higher quality of patient-centered care (PCC) (Sidani, et al 2015). The NPs are proficient in clinical research, leadership and education as it is employed in clinical care and development of health service.

The scope of practice of the NPs is established on the registered nurses’ scope of practice. Therefore, they are required to meet the professional and regulatory requirements for the Australia including the nursing code of conduct and the registered nurses practice standards. While the standards of the NPs described above are expanded and built upon the standards that are required from a registered nurse. When the scope of practice and the title has to be assumed for a NP, the NP must understand the changes in the practice scope from that of the registered nurse. The NP must also understand the various ways in which these are impacting the accountabilities and responsibilities. Thereby, a NP renders a nursing care within their regulated practice scope (Lowe, Plummer, & Boyd, 2013).

The attributes for the NPs are built upon the formal learning which are inclusive of the work-based component. The educational requirement for the NPs endorsement in this country is that of a Master’s degree. The NPs possess high degree of literacy of the systems and are able to manage the care across the diverse healthy systems for maximising the health care outcomes. The NPs with their higher level of education, skills and knowledge are able to work in critical and complex care. They are capable for critical thinking and integrating information and evidence for healthcare decision-making. They also judiciously use clinical investigations and are able to communicate empathetically and skilfully with all the people who are involved in the healthcare services including the people who are receiving healthcare, their families, communities and the healthcare professionals in the healthcare teams.

Registration Standards for NPs in Australia

The registration of the NPs is the responsibility of the NMBA. The Australian Health Practitioners Regulation Agency (AHPRA) maintains a national register which is accessible by the public (Department of Health, n.d.). This register has the details of the nurses who have been registered with the NMBA including any restrictions or conditions on professional practice. This register identifies if the healthcare practitioner has an endorsement for practicing as a NPs. This register is available at the AHPRA website (NMBA, June 01, 2016).

The standards for registration are set out the NMBA’s requirements for the endorsement as a NP under the section 95 of the National law or the Health Practitioner Regulation National Law for each territory and state in this country (Department of Health, n.d.). As per this standard when a nurse wants to apply for the NP, she or he must be able to demonstrate the following:

  • There should be a general registration as a registered nurse of this country with no undertakings or conditions related to any unprofessional conduct or the unsatisfactory professional performance.
  • There should be equivalent to three years of full-time experience which should be 5000 hours at the clinical advanced level of nursing practice. This must be attained within the past six years from the date when the completed application for endorsement as a NP is being received by the NMBA.
  • There should be successful completion of the NMBA approved study program leading to endorsement as a NP or a program which is substantially equivalent to the approved programs of NMBA which leads to the endorsement as the NP. This has to be determined by the NMBA.
  • The nurses wanting to endorse NMBA must have compliance with the standards of practice that has been prescribed by the NMBA for the role of NP in the Australian healthcare settings (NMBA, June 01, 2016).

Ongoing Requirements for the NP Endorsement

The ongoing endorsement by the NMBA is conditional for the NP who are complying with the following conditions:

  • NMBA approved registration standard for the continuing professional development, recency of practice standard for registration, professional indemnity insurance, standard for arrangement registrations and standard for criminal history registration.
  • Safety and quality guidelines for the NPs and the other applicable guidelines and codes that have been approved by the NMBA in this country (NMBA, June 01, 2016).

Registration Renewal

The registration must be renewed by the NPs. This is necessary as they must demonstrate their recency of nursing practice at the level of advanced nursing practice for retaining their endorsement (NMBA, June 01, 2016). When the NPs apply for renewal of registration, it is important for them to declare that they are complying with the ongoing eligibility requirements for the endorsement as given in the registration standard of NMBA.

During the Period of Registration

The NMBA conducts the audit on a regular basis for the compliance of the NPs with the registration standard. This can also be checked if any notification is given by the NPs to the NMBA. Therefore, it is imperative for the NPs to retain their records of nursing practice and learning as the evidence. This is used for demonstration that a NP has met the requirements of the registration standard when there is audit (NMBA, June 01, 2016).

The NPs when fail in meeting the registration standard are then not made eligible for the endorsement as a NP. According to the National Law, there are consequence when a nurse does meet the ongoing requirements for the registration standard. In such a case, the NMBA can impose conditions on the registration or endorsement of the NPs or it may refuse the renewal of the NPs’ endorsement or registration as per the sections 82 and 112 of National law. Further, the guidelines, codes or the registration standards may be used in the disciplinary proceedings against a NP. This can be used as evidence of what is constituting as appropriate conduct or practice for the professions of the midwifery and nursing as per the section 41 of the National law (NMBA, June 01, 2016).

Practice Domains for NPs in Australia

There are four practice domains for the NPs in this country and these are mainly the clinical, education, research and leadership (Cashin, et al 2015). This is shown in the following framework for the NP standards. The research, leadership and education domains are embedded in the clinically focussed standards. The skills and knowledge are contained within the three domains of the leadership, research and education. These are integrated in the expression of the clinical work or role of the NPs. These attributes in a collective sense are expressed in the skills, knowledge of the NPs and are applied in the domain of education by educating the patients, the peers and colleagues. The use of knowledge in the domain of research is through the judicious application of the research evidence in taking decisions related to nursing practice. It is also used in the self-regulation and the development of newer systems of care. The leadership domain is evident initially in the clinical work and this increases the capacity for including the political and community engagement.

The first standard is related to the assessment by using diagnostic capability. As per the standard 1 of clinical domain the NPs must conduct relevant, holistic and comprehensive assessment of health. There should be demonstration of timely use of the diagnostic investigation for informing the clinical decision-making (Masso, & Thompson, 2014). The NPs must apply the diagnostic reasoning in formulating the diagnoses. They must develop care plan and engage with others as per the standard 2. NPs must be able to integrate and translate evidence into planning care. NPs must support and educate others for enabling their active participation in the care. NPs must consider the quality use of therapeutic and medical interventions in care planning. NPs must consult and refer to the care decisions for obtaining optimal results for the individuals receiving care.

The third standard is for prescribing and implementing the therapeutic interventions (NMBA, March, 2018). NPs must prescribe indicated pharmacological and non-pharmacological interventions (Fong, et al 2017). NPs must maintain relationships with the people at the care center. NPs must practice in accordance with the territorial, state and the federal legislation and the professional regulations which are governing the practice of NPs. The standard 4 of the NPs requires them to evaluate the outcomes and improves own practice. Within this standard, the NPs are required to advocate, participates or leads the systems for supporting safe care, professional growth and partnership (NMBA, March, 2018). The NPs have therefore, a capability to render higher levels of clinically focused nursing health care in a variety of healthcare settings in Australia. They have the capability to render care for the communities and people having complex problems.

Therefore, it is concluded that the NPs have important care in providing quality care to the patients. They have the required knowledge, skills and education for dealing with complex healthcare conditions. The endorsement of the NPs is the responsibility of NMBA. There are number of standards for registration which have to be followed by the nurses so as to remain professionally recognized in the country. Their practice domains and scope of practice are higher than that of the registered nurses and they are responsible for providing quality care to the patients. Hence, the introduction of NP’s role in the country has allowed the country to provide better care to the public in a variety of healthcare settings.

References for Role of Nurse Practitioners in Australia

Cashin, A., Buckley, T., Donoghue, J., Heartfield, M., Bryce, J., Cox, D., ... & Dunn, S. V. (2015). Development of the nurse practitioner standards for practice Australia. Policy, Politics, & Nursing Practice16(1-2), 27-37.

Department for Health & Ageing, (DHA) South Australia. (2017). Nurse Practitioners in South Australia. A toolkit for the Implementation of the Role. Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/c9998680452470f59b9edb005ba75f87/NP+ImplementationToolkit+20170321.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-c9998680452470f59b9edb005ba75f87-niQsiV7

Department of Health. (n.d.). Nurse Practitioners. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/work-nurse-prac

Dunn, S. V., Cashin, A., Buckley, T., & Newman, C. (2010). Nurse practitioner prescribing practice in Australia. Journal of the American Academy of Nurse Practitioners22(3), 150-155.

Fong, J., Buckley, T., Cashin, A., & Pont, L. (2017). Nurse practitioner prescribing in Australia: A comprehensive literature review. Australian critical care30(5), 252-259.

Harvey, C. (2011). Legislative hegemony and nurse practitioner practice in rural and remote Australia. Health Sociology Review20(3), 269-280.

Jennings, N., Clifford, S., Fox, A. R., O’Connell, J., & Gardner, G. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review. International journal of nursing studies52(1), 421-435.

Lowe, G., Plummer, V., & Boyd, L. (2013). Nurse practitioner roles in Australian healthcare settings. Nursing Management20(2).

Masso, M., & Thompson, C. (2014). Rapid review of the nurse practitioner literature: Nurse practitioners in NSW'Gaining Momentum'. NSW Ministry of Health.

NMBA. (March, 2018). Nurse practitioner standards for practice. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjT94iJ4I7sAhXSTX0KHaLKC8AQFjAAegQICxAB&url=https%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2FCodes-Guidelines-Statements%2FProfessional-standards%2Fnurse-practitioner-standards-of-practice.aspx&usg=AOvVaw3vLkSNgZ64lbMOcZ6z9yQp

Nursing and Midwifery Board of Australia. (June 01, 2016). Registration Standard: Endorsement as a Nurse Practitioner. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjrgsmm347sAhWUbX0KHV5bDWEQFjAAegQIBBAB&url=https%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fregistration-standards%2Fendorsement-as-a-nurse-practitioner.aspx&usg=AOvVaw2vq6EBTObMZruEUYZi3aOJ

Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2016). Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia–a multiple case study using mixed methods. BMC family practice17(1), 99.

Sidani, S., Collins, L., Harbman, P., Hurlock-Chorostecki, C., MacMillan, K., Reeves, S., ... & Staples, P. (2015). A description of nurse practitioners' self-report implementation of patient-centered care. European Journal for Person Centered Healthcare3(1), 11-18.

Woods, M., & Murfet, G. (2015). Australian nurse practitioner practice: Value adding through clinical reflexivity. Nursing research and practice2015.

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