New Zealand's health system is grappling with a severe workforce shortage. Media reports frequently highlight individuals and families being unable to access timely healthcare, exacerbated by a shortage of general practitioners (GPs) and overflowing emergency departments.
Authors
Deborah L Harris
Associate Professor Nursing, Te Herenga Waka — Victoria University of Wellington
Kathy Holloway
Associate Professor, Director of the School of Nursing, Midwifery, and Health Practice, Te Herenga Waka — Victoria University of Wellington
But one potential solution to the ongoing crisis - the greater use of nurse practitioners (NPs) - is conspicuously absent from the government's 2024 health policy statement.
Nurse practitioners are highly skilled nurses with advanced education (a minimum of a masters degree), clinical training and experience. They have the legal authority to practice beyond the level of a registered nurse.
NPs can write prescriptions and help people with screening and vaccinations. They can also help manage chronic conditions such as diabetes, high cholesterol and high blood pressure.
New Zealand's 800 NPs practice in primary health services, hospitals and speciality clinics. They work on their own and in teams with other health professionals.
But despite having delivered healthcare for nearly 25 years, and playing a critical role in closing gaps in access to health services, there remains a disconnect between policy support, education funding and practical implementation of the nurse practitioner workforce.
The role of nurse practitioners
The role of nurse practitioner was first established in New Zealand in 2001.
Globally, the ability of NPs to diagnose, treat and manage patients has been shown to enhance the efficiency of hospital services, reduce wait times, and improve both patient outcomes and experiences.
Nurse practitioners are not a substitute for medical doctors. However, overseas research has shown collaboration between doctors and NPs can lead to improved delivery of healthcare and patient satisfaction. Where NPs were available, there was a statistically significant decrease in emergency room use and admissions to hospital.
While there is ongoing debate over whether NPs can or should replace doctors, this is ultimately unhelpful. They are different roles. And it distracts from the very real concern of decreased access to healthcare for many New Zealanders.
A more useful approach is to identify where each can contribute expertise to delivering healthcare and improving the patient outcomes.
A health workforce solution
Supporting nurse practitioners is essential to address New Zealand's healthcare workforce crisis. However, to sustain and grow this workforce, the government must address a number of critical issues.
After two decades, many New Zealanders are unaware of the role of registered NPs. The lack of a comprehensive plan following the development of the role has led to uneven integration into the health services. This failure in planning has continued to this day.
Despite research highlighting the capabilities of NPs to diagnose and treat patients effectively, there is a noticeable lack of strategic planning for the role.
Decisions about the nurse practitioner workforce are commonly made by people who do not understand their role - there are no NPs at decision-making tables, including the Nursing Council of New Zealand.
Another critical issue is the uncertain funding for nurse practitioner training programmes. These are offered in partnership with employers and educational organisations such as universities and polytechnics.
Earlier this year, the government announced funding for 121 places on the nurse practitioner training programme (NPTP). But the funding is largely unstable and fragmented, creating uncertainty and anxiety for aspiring nurse practitioners, education providers and the wider workforce.
Implementing supportive policies that maximise the nurse practitioner contribution is essential. This includes removing legislative barriers, and ensuring stable funding for training programmes. Additionally, fostering a culture of collaboration between nurse practitioners and doctors will further enhance patient care, as each profession brings unique strengths to the healthcare team.
Bridging the gap
Supporting nurse practitioners through policies and collaborative practices is an essential and logical pathway to address New Zealand's healthcare workforce crisis.
By recognising and utilising the full potential of nurse practitioners, we can bridge the gap in healthcare delivery and support access for everyone.
With nearly 800 registered nurse practitioners, and another 100 expected to register between December and February 2025, we have an evidence-based, capable, caring and flexible workforce ready to meet growing healthcare demand.
It is imperative policymakers, nursing and healthcare leaders, as well as the wider public, recognise the vital role nurse practitioners play in our health system. By championing policy changes that support their proper integration, we can create a more resilient, dependable and accessible health system for those we serve.
Kathy Holloway is affiliated with National Nursing Leadership group as co-chair
Deborah L Harris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
