Advanced Practice Nursing in New Zealand

  • Jenny CarryerEmail author
  • Sue Adams
Part of the Advanced Practice in Nursing book series (APN)


Nurse practitioners in New Zealand are regulated as advanced practitioners who are fully authorized prescribers working independently or in collaborative teams. The NP role carries no requirements for oversight, supervision, protocols, enforced or formal collaboration nor limits to prescribing. In this regard, NPs have an enviable amount of freedom and autonomy to practice their craft. However, the growth of the NP workforce has been slow to materialize, with considerable variation in the establishment of their services across New Zealand. Over the years, nursing leadership has worked consistently and proactively to lobby for and progress the necessary changes in legislation that has enabled NPs to deliver services similar to those of a primary care or family physician and to receive equivalent government funding. Yet despite the ongoing shortage of physicians in the primary health and aged care sectors, the increasing prevalence of long-term conditions, and persisting health inequalities, NPs have not been recognized in policy as a solution. Through this chapter we describe the development of the NP workforce within the context of the health system in New Zealand, identifying current and future challenges.


Nurse practitioner Primary health care Primary care Health inequalities (or inequities) Advanced nursing Nursing leadership 


  1. Adams S. Nurse practitioners in rural primary health care in New Zealand: an institutional ethnography. PhD thesis. New Zealand: Massey University; 2017. Accessed 1 July 2019.
  2. Adams S, Carryer J. Establishing the nurse practitioner workforce in rural New Zealand: barriers and facilitators. J Prim Health Care. 2019;11(2):8–14. Scholar
  3. All-Party Parliamentary Group on Global Health. Triple Impact - how developing nursing will improve health, promote gender equality and support economic growth. London: All-Party Parliamentary Group on Global Health; 2016.Google Scholar
  4. Bodenheimer T, Bauer L. Rethinking the primary care workforce-an expanded role for nurses. N Engl J Med. 2016;375(11):1015–7. Scholar
  5. Browne AJ, Tarlier DS. Examining the potential of nurse practitioners from a critical social justice perspective. Nurs Inq. 2008;15(2):83–93. Scholar
  6. Came H. Sites of institutional racism in public health policy making in New Zealand. Soc Sci Med. 2014;106:214–20. Scholar
  7. Carryer J, Adams S. Nurse practitioners as a solution to transformative and sustainable health services in primary health care: a qualitative exploratory study. Collegian. 2017;24(6):525–31. Scholar
  8. Carryer J, Yarwood J. The nurse practitioner role: solution or servant in improving primary health care service delivery. Collegian. 2015;22(2):169–74. Scholar
  9. Carryer J, Boddy J, Budge C. Rural nurse to nurse practitioner: an ad hoc process. J Prim Health Care. 2011;3(1):23–8. Scholar
  10. Christensen CM, Raynor ME, McDonald R. What is disruptive innovation? Harv Bus Rev. 2015;93(12):44–53.Google Scholar
  11. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization; 2008. Accessed 5 June 2019.
  12. Cumming J. Commissioning in New Zealand: learning from the past and present. Aus J Prim Health. 2016;22(1):34–9. Scholar
  13. Downs A. From theory to practice: the promise of primary care in New Zealand Fulbright New Zealand; 2017. Accessed 1 July 2019.
  14. Durie M. Whaiora: Māori health development. Oxford: Oxford University Press; 1998.Google Scholar
  15. Finlayson M, Sheridan N, Cumming J, Fowler S. The impact of funding changes on the implementation of primary health care policy. Prim Health Care Res Dev. 2012;13(2):120–9. Scholar
  16. Gagan MJ, Boyd M, Wysocki K, Williams DJ. The first decade of nurse practitioners in New Zealand: a survey of an evolving practice. J Am Assoc Nurse Pract. 2014;26(2014):612–9. Scholar
  17. Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. New Zealand Government; 2015. Accessed 1 July 2019.
  18. Health Practitioners Competence Assurance Act. New Zealand Government; 2003. 12 June 2019.
  19. Health Quality & Safety Commission New Zealand. Patient experience. 2019. Accessed 3 July 2019.
  20. Hughes F, Carryer J. Nurse practitioners in New Zealand. Wellington: Ministry of Health; 2002.Google Scholar
  21. Jacobs S. Advanced nursing practice and the nurse practitioner: New Zealand nursing’s professional project in the late 20th century. PhD thesis. New Zealand: Massey University; 2005. Accessed 1 July 2019.
  22. Jacobs S, Boddy J. The genesis of advanced nursing practice in New Zealand: policy, politics and education. Nurs Prax NZ. 2008;24(1):11–22.Google Scholar
  23. Kooienga SA, Carryer J. Globalization and advancing primary health care nurse practitioner practice. J Nurse Pract. 2015;11(8):804–11. Scholar
  24. Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught A. Nurses as substitutes for doctors in primary care (review). Cochrane Database Syst Rev. 2018; Accessed 3 July 2019.
  25. Marriott L, Sim D. Indicators of inequality for Māori and Pacific People. Working Paper 09/2014. Wellington: Victoria University of Wellington; 2014. Accessed 5 June 2019.
  26. Martínez-González NA, Djalali S, Tandjung R, Huber-Geismann F, Markun S, Wensing M, et al. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis. BMC Health Serv Res. 2014;14:214. Scholar
  27. Medicines Amendment Act. Wellington: New Zealand Government; 2013. Accessed 25 June 2019.
  28. Ministerial Taskforce on Nursing. Report of the Ministerial Taskforce on Nursing: releasing the potential of nursing. Wellington: Ministry of Health; 1998.Google Scholar
  29. Ministry of Health. The primary health care strategy. Wellington: Ministry of Health; 2001.Google Scholar
  30. Ministry of Health. Tatau kahukura: Māori health chart book 2015. 3rd ed. Wellington: Ministry of Health; 2015.Google Scholar
  31. Ministry of Health. New Zealand Health Strategy: future direction. Wellington: Ministry of Health; 2016.Google Scholar
  32. Ministry of Health. Publications. [n.d.]. Accessed 3 July 2019.
  33. Ministry of Health, Nursing Council of New Zealand, DHBNZ, NPAC-NZ. Nurse Practitioners: a healthy future for New Zealand. Wellington: Ministry of Health; 2009. Accessed 12 June 2019.
  34. Nursing Council of New Zealand. Nurse practitioner scope of practice: guidelines for applicants. Wellington: Nursing Council of New Zealand; 2019.Google Scholar
  35. Nursing Council of New Zealand. Reports and worforce statistics. [n.d.-a]. Accessed 3 July 2019.
  36. Nursing Council of New Zealand. Nurse practitioner. [n.d.-b]. Accessed 12 June 2019.
  37. Nursing Council of New Zealand. Competencies for the nurse practitioner scope of practice. Wellington: Nursing Council of New Zealand; [n.d.-c]. Accessed 3 July 2019.
  38. Pirret AM. Nurse practitioner diagnostic reasoning. PhD thesis. New Zealand: Massey University; 2013. Accessed 1 July 2019.
  39. Pirret AM. Nurse practitioners’ versus physicians’ diagnostic reasoning style and use of maxims: a comparative study. J Nurse Pract. 2016;12(6):381–9. Scholar
  40. Pirret AM, Neville SJ, La Grow SJ. Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study. Int J Nurs Stud. 2015;52(3):716–26. Scholar
  41. Pittman P. Activating nursing to address unmet needs in the 21st century. Princeton: Robert Wood Johnson Foundation; 2019.Google Scholar
  42. Ramsden I. Towards cultural safety. In: Wepa D, editor. Cultural safety in Aotearoa New Zealand. 2nd ed. Port Melbourne: Cambridge University Press; 2015.Google Scholar
  43. Robertson H, Carryer J, Neville S. Diffusion of the Primary Health Care Strategy in a small district health board in New Zealand. Nurs Prax NZ. 2015;31(3):17–26.Google Scholar
  44. Royal New Zealand College of General Practitioners. 2018 general practice workforce survey: part 1. Wellington: Royal New Zealand College of General Practitioners; 2019.Google Scholar
  45. Sheridan N, Kenealy T, Connolly M, Mahony F, Barber P, Boyd MA, et al. Health equity in the New Zealand health care system: a national survey. Int J Equity Health. 2011;10(45):1–14. Scholar
  46. Swan M, Ferguson S, Chang A, Larson E, Smaldone A. Quality of primary care by advanced practice nurses: a systematic review. International J Qual Health Care. 2015;27(5):396–404. Scholar
  47. Wilkinson J. The New Zealand nurse practitioner polemic: a discourse analysis. PhD thesis. New Zealand: Massey University; 2007. Accessed 1 July 2019.
  48. World Health Organization. Declaration of Astana: global conference on primary health care 2018. Accessed 3 July 2019.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.School of Nursing, College of HealthMassey UniversityPalmerston NorthNew Zealand
  2. 2.Faculty of Medical and Health Sciences, School of Population HealthUniversity of AucklandAucklandNew Zealand

Personalised recommendations