LOGIC June 2018 Vol 17 Vol 2 | Page 42

For me, it is all about what I want to be doing, and what my community needs me to be doing. I don’t work in an organisation that has service barriers in access to diagnosis, investigation or prescribing activity. The community and people we work with tell us this. However, what our community does tell us is that they experience issues around the planning, coordination and provision of older persons services, advanced care planning, long term condition education and support, screening and preventative healthcare, and hands on palliative care services. For these issues, the RN is often the clinical expert in the right place at the right time and is why these activities are where my colleagues and I focus our expertise and time. To do this, I utilise Standing Orders and work within a model of care that facilitates and does not hinder or limit my practice in any way. For me right now, the personal and organisational investment in the years of further education and supervised practice that it would take to register as an NP makes neither strategic or financial sense for my community, myself or my organisation. Especially when it won’t improve the current efficiency and effectiveness of June 2018 L.O.G.I.C the way I deliver services within an integrated team to meet my community’s needs. Besides, becoming an NP is not as simple as myself or any other individual nurse making the decision to be an NP anyway. This journey requires workforce and employer structures, support, funding and system wide commitment that still is not (and has never been) adequately in place. NP candidates need employment security, a large amount of personal and financial resourcing, and at least one supportive long-term relationship with a medical or NP colleague before they even begin! Not a situation to be underestimated or embarked upon unless the benefits significantly outweigh the costs and risks. Costs and risks that are not just about individual nurses, but about what our communities, DHB’s and country require from its workforce and are prepared to resource. In your area, perhaps there are issues around access to the kinds of services an NP can provide. In which case, I fully support the development and implementation of these roles. But like any other health discipline; none of us can provide 100% of what every patient requires, including an NP. We are all, or should be, one big team. Made up of diverse professions, scopes of practice and roles, with a wide range of strengths and skills. New Zealand needs all of us and more of us. Thinking about my future as I approach the last third of my working life, I see that it is in fact a sound decision that I not pursue NP registration. After all, not being an NP hasn’t stopped me from owning a general practice, participating at a regional and national level in various groups, teaching, mentoring, leading, working overseas for many years, or anything else I have done during my nursing career. Instead of being an NP, what I would love for my future is to continue to be part of making positive change around the systems and infrastructures of health, beyond my own general practice, and through this facilitate better practice environments for my RN colleagues. What I would also like for the future is to hear the nursing profession start talking about “nursing” being an answer to the issues within the health, disability and social systems; rather than focussing on any specific nursing scope and role as the workforce solution. I think we need more than ever to minimise any intra- professional divisions and false 41