From regulation to practice: Mapping the organisational readiness for registered nurse prescribers in a specialty outpatient clinic setting

Abstract
Registered nurse (RN) prescribing has the potential to improve equitable patient care delivery and timely access to medicines. Changes to legislation in Aotearoa New Zealand in 2016 enabled the regulation of RN prescribers. The successful utilisation of this role is largely dependent on how organisations approach and employ this new workforce. This article presents a project which critically reflected on the journey of a registered nurse to gain the educational requirements necessary to become a RN prescriber, register with the Nursing Council of New Zealand, and then implement the role delivering RN prescribing services in a sexual health clinic. Using a mapping technique, developed as an analytic tool in institutional ethnography, the RN mapped her journey, identifying her engagement with various organisations and their guidelines and documents, and recording her work and actions. Gaps in policy and a lack of organisational readiness delayed the implementation of the RN prescriber’s role in practice. The work and effort undertaken by the RN was considerable as she negotiated her way within her employing organisation, the tertiary education institute, and between other national organisations engaged with RN prescribing. Mapping the RN’s journey highlighted areas of confusion and the unpreparedness of organisational vision and national strategy around developing and implementing this role in practice. The onus on successfully implementing RN prescribing in the specialty clinic largely fell to the individual nurse, despite the need to deliver health and prescribing services to the local population. Strong nursing leadership is required to champion the contribution that RN prescribers can make to quality outcomes for patients and to create a cohesive vision of advanced practice nursing in the workplace. This includes advocating for nursing workforce development strategy and policies, the creation of peer networks, and negotiating appropriate remuneration. 

Ngā ariā matua
Mā te tuhi puka rongoā tapuhi rēhita (RN) ka āhei pea te whakapiki i te ōrite o te horanga atawhainga tūroro me te hohoro o te whiwhinga rongoā. Nā ngā huringa ki ngā ture i Aotearoa i 2016 i āhei ai te whakarite ture mō ngā kaituhi puka rongoā RN. Ko te whakamahinga whai hua o tēnei mana kei te āhua o te pai o ngā kawenga me ngā whakawhiwhinga mahi a tēnā whakahaere a tēnā whakahaere ki tēnei rāngai kaimahi hou. Tā tēnei tuhinga he tāpāe kōrero mō tētahi kaupapa i arohaehae i ngā mahi a tētahi tapuhi rēhita kia whiwhi ia i ngā tohu mātauranga tika kia whakamanaia hei kaituhi puka rongoā RN, kia rēhita ki te Kaunihera Tapuhi o Aotearoa, kia kawea tūturutia hoki ngā mahi o te tūnga ki te tuhi puka rongoā RN i tētahi whare manaakitanga hauora hōkaka. I whakamahia e ia tētahi ritenga whakamahere, he mea whakawhanake hei taputapu tātari i ngā mahi tuhi kōrero pono mō ngā iwi i roto i ngā whare nunui, ā, ka tuhia e ia ana hīkoinga, ka tautohutia āna pānga ki ngā whakahaere huhua, me ō rātou aratohu, tuhinga hoki, ka tuhia e ia āna mahi me ana kōkiri. Nā ngā āputa i ngā kaupapa here, me te korenga e rite o ngā mahi o ngā whakahaere i uaua ai te haere a te RN ki te whakatinana i tana tūnga i te ao mahi. He nui ngā mahi i kawea e te RN i a ia e kōpikopiko ana i tōna whare i mahi rā ia hei kaimahi, te whare akoranga tuatoru, me ērā atu whakahaere ā-motu e kawe ana ki te kaupapa tuhi puka rongoā RN. Nā te whakamahere i te haere a te tapuhi rēhita nei ka āta mārama ngā wāhanga taupatupatu me te pōtatutatu o te kitenga o ngā whakahaere, me te rautaki ā-motu, mō te whakawhanake me te whakatinana i tēnei tūnga i te ao mahi. I tau ngā taumahatanga o te whakatinana tika i te tuhi puka rongoā RN ki runga i te tapuhi takitahi, ahakoa ngā hiahia kia horaina ngā ratonga hauora, tuhi puka rongoā hoki ki te iwi o te rohe. E tino hiahiatia ana ngā mahi hautū pakari hei kōkiri whakamua i te āwhina nui ka taea o ngā kaituhi puka rongoā RN ki ngā putanga whai kounga mā te tūroro, hei tārei kitenga tōtika mō ngā mahi tapuhi hōhonu i te wāhi mahi. Ka uru ki tēnei āhua te kauwhau tikanga mō ngā rautaki whanaketanga kāhui kaimahi tapuhi me ōna kaupapa here, te hanga whatunga hoa mahi, me te whakarite taumata utu tōtika mō te tapuhi. 

Keywords / Ngā kupu matua
ambulatory settings / ngā horopaki hīkoi ki wāhi kē; community nursing / te mahi tapuhi i te hapori; nurse prescribing / te tuhi puka rongoā tapuhi; institutional ethnography / ngā mahi tuhi kōrero pono mō ngā iwi i roto i ngā whare nunui; mapping / te whakamahere; primary health care / te tiakitanga hauora tuatahi; sexual health services / ngā ratonga hauora hōkaka