Western Bay NPs join GPs in providing community healthcare

When you next visit your doctor or GP in the Western Bay of Plenty, you may be provided with care from a nurse practitioner, or NP.

Nurse practitioners are expert nurses who practice both independently and with other healthcare professionals to manage people’s health needs.

They consult in a similar way to a doctor, and in many cases have their own patients. NPs can assess, order tests and diagnose, as well as providing health advice and education. Unlike other nurses, they are also able to prescribe medicines. Often NPs support patients with long-term conditions and can provide longer appointments.

The role has been established in New Zealand since 2002 but the number of nurses gaining NP status has almost doubled in the past few years to more than 350 nationwide.

The Western Bay of Plenty Primary Health Organisation (WBOP PHO) has nine NPs within its ranks, the most of any PHO in the country. Three are employed directly by the PHO in Tauranga and another six work in PHO-affiliated medical centres throughout the region.

WBOP PHO services leader Philippa Jones supported Caroline Vanstone and Ruth Haynes from the PHO’s Health and Wellness Services to become NPs, and they, in turn, have supported others to become NPs.

Caroline says with people living longer and with more complex health problems, there is a real need to support people to assist them in their understanding of their condition. NPs work in the community, including in patients’ own homes, helping people to keep well.

“We support people to recognise changes in their condition early and to take the appropriate intervention.”

For example, she recently visited a patient with chronic obstructive pulmonary disease (COPD) at home following her discharge from hospital.

Caroline arranged home oxygen as well as some home-based supports such as mobility aids and home help. These interventions helped to keep the woman well and out of hospital.

“Having a holistic view, and thereby ensuring you are meeting all the needs of the patient, means you’re not just focussed on one thing, but are considering the whole person.

“Because of these interventions, the woman was no longer as fatigued and her quality of life improved.”

Ruth works in two medical centres where she consults with patients as well as their GP. It results in a powerful consultation, she says.

“It really benefits that person because they have all their issues addressed and they benefit from different knowledge streams.”

Ruth also visits ‘vulnerable’ patients in places such as Women’s Refuge, the Salvation Army, emergency housing provider Te Tuinga Whanau, and a weekly clinic in a Tauranga pharmacy.

Caroline and Ruth support other WBOP PHO nurses, as well as supporting the PHO’s walk-in clinic in First Avenue West, various community clinics, hauora, Workplace Wellness programme, and working in collaboration with WBOP PHO general practices. Several WBOP PHO general practices now employ NPs.

Megan Brebner is a nurse practitioner at The Doctors Tauranga, one of 31 general practices in the WBOP PHO.

After more than 25 years in nursing, including gaining a post-graduate diploma in chronic care management and working as a special diabetes nurse, she was shoulder-tapped by her employer to train as a nurse practitioner.

“A lot of my job is motivating people to self-manage their health. This qualification allows me to give people a good overview of their illnesses and assess and prescribe on the day.”

Megan runs a NP clinic four days a week, offering longer appointment times to her patients – 20 minutes rather than the standard 15-minute appointment with a GP – and up to an hour for patients with long-term conditions who need more time.

GPs often refer patients to Megan who need more education about their condition, or new medication, and she also contracts to other medical centres.

Megan’s clinic has been welcomed by patients, with one nominating her as a ‘Community Champion’, and her employer, Green Cross Health, awarding her and colleague Catherine Robertson a ‘Do the Right Thing’ award for their establishment of a heart failure management programme to help people keep well at home and stay out of hospital.

In order to qualify, nurse practitioners must obtain a Master’s degree, gain practical experience, and present a portfolio of work to the Nursing Council proving evidence of their competency in leadership and education roles, and projects and research they have been involved in.

Caroline and Ruth studied part-time around their jobs over several years, while Megan completed a full-time one-year programme in 2016 where she worked with a GP mentor two days a week in general practice, and completed her Masters degree.

“There is funding and good support for nurses to do that. My boss often says she wishes she could multiply me and there is awareness that, with the shortage of GPs, it will be beneficial to the health workforce and the community to have more NPs.”

Megan says with more and more NPs completing their training, patients can expect to see more of them working in primary healthcare, both in the community and within general practice.