Today we talk to Deborah about her journey to becoming a nurse practitioner.
A little bit about me. I started nursing (State Enrolled Nurse) in 1986 as a hospital trained nurse when I was 16. Decided that it wasn’t for me (saw my first death 6 weeks into my training and left 6 months later), then jumped into dental nursing, eventually running practices both here and overseas (including working in a Harley St Practice). Re-entered nursing in 2000 as a Cert IV EN, then completed my RN in 2006. I have worked over various positions such as aged/palliative care, acute, community, blood transfusion trainer, immunisation, wounds, and education. But my real passion is emergency. Completed a post grad in 2012 then went on to complete my master's degree in 2021. Have been endorsed now for 18 months and I class myself as a Rural Generalist NP as I work across various fields in my current workplace, including urgent care and 3 aged care facilities.
Hi Deborah! Thanks for reaching out 
Can I start off by asking what your current nursing role is?
Can I start off by asking what your current nursing role is?I am a rural generalist nurse practitioner at a regional public health service.
Amazing! Can you tell me a bit more about how you find yourself in this role and the training required to become a nurse practitioner?
Ok - to be eligible to apply for a nurse practitioner endorsement from APHRA, you have to complete a master's degree in advanced nursing practice and 300hrs of clinical hours working in an advanced (NP) level. But prior to undertaking the masters you have to prove 5000 hours practice in an advanced role in the area that you are applying for endorsement in. So you usually have to have a post graduate qualification prior to undertaking the masters as well. All in all, I have spent about 8 years at university (which doesn’t include my TAFE training as I was an EN before I became a RN), nor other training courses such as immunisation, TAE, etc. My role as an NP at my workplace is new. I am the first of my kind here lol, therefore the role continues to evolve to meet the needs of the community. The beauty of this is that it enables me to help fill gaps of care and takes the pressure off the local GPs who are stretched. My background is emergency and aged/palliative care, and I was a nurse educator/wound care nurse for about 10 years as well. I am also the blood transfusion trainer, but as pressure builds on my role, some of these portfolios have needed to be handed over to others. I also currently help with mentoring a nurse practitioner candidate who works in a separate healthcare service. I provide a listening ear and someone to bounce ideas off so to speak. There are only about 2500 NPs out of over 500’000 nurses registered.
Did you have a mentor whilst you were going through the process? And who initiated it? You or your workplace?
Yes I had two - a GP mentor (my main support) and the CMO at the time. I was the one who approached my workplace but they got behind it 100% which is pretty rare and I am grateful for their support. I have found that the local GPs are very supportive, especially when it comes to aged care.
What made you decide that nurse practitioner was a role you wanted to do? Did you know anyone who had done it?
None of my friends were NPs but I knew of some at other health services in Victoria that were really making a huge difference in their communities. What made me undertake it was frustration. Seeing minor issues becoming logistical nightmares and this was prior to Covid. I started my training in 2019 when Telehealth services were basic and not utilised for many acute issues. When Covid hit, keeping residents out of emergency departments and hospitals became an even bigger priority. This also included getting people out of hospitals and into residential care beds when required, freeing up these beds for more acute patients. The health service doesn’t have hospital doctors 24/7 and the NP role also helps fill these gaps (say for example re-writing medication charts that have run out of space, pharmacology reviews to reduce polypharmacy, and prompt pain management whilst waiting for a doctor to arrive).
You mentioned before that your workplace was very supportive. Have you come up against anyone who hasn't been supportive of your increased scope?
Plenty. And I am ashamed to admit it, but from some of my fellow nurses. Unfortunately professional jealousy is alive and well and are somehow threatened by the new role. My vision is to eventually coerce them to undertake the masters and encourage them to become NP candidates. I have also experienced a reluctance from some in management to allow me to work at my entire scope of practice, but this is more based in them not really understanding what an NP can actually do. I am slowly working on breaking down these barriers, but I am also mindful that we are actually carving out a new nursing pathway. No two healthcare services will have the same needs and challenges so it’s not like I can take a job description from say another service and apply it 100% to here. It’s very much a learning curve for all stakeholders.
Can I ask how do nurse practitioners know what are the boundaries of their scope? Being such a new role who makes those decisions? Is there strong governance around it?
Scope of practice is defined by the individual’s advanced care knowledge/training and experience. It is up to the individual to decide what they will incorporate into their practice and what they won’t. It’s quite an autonomous role. Governance is in multiple forms such as state and federal prescribing legislation (inc PBS), APHRA NP standards frameworks, Medicare NP guidelines (billing rights), to credentialing at the workplace. Plus, there is shared care collaboration, which is currently being reviewed and legislative changes are being made. So that area is a watch this space 
Wow sounds like there is a lot of exciting stuff happening there. Do you get involved a lot in the policy and governance side of things?
Yes I do. As it’s a new role I work closely with stakeholders.
If a junior nurse came to you and said "one day I want to be an NP" what would be your advice to them on their journey?
Go for it. But have an idea what you want to specialise in, then works steadily towards it. Because it’s not just undertaking a masters degree, it’s about gaining the experience to underpin it. And having the confidence to make the hard decisions when the need arises. Leadership is a very important part of the role, which is almost impossible to learn out of a book. Personally, I would love to see more younger nurses becoming NPs because if you look at the statistics most of the cohort are older (eg 40+).
What is your favourite part of your role?
Probably the autonomy of the role and the ability to mould it to help fill healthcare gaps within the heath service.
It sounds very rewarding. Is there anything else you would like to share with any readers who might not know much about the nurse practitioner role?
Many people don’t understand the NP role. Out of approximately 500,000 nurses only about 2500 hold the NP endorsement. Australian College of Nurse Practitioners (ACNP) is probably the first place to start for those wanting to know more.
That's awesome, thank you!