Nurse Prescribers for Palliative Care – New Zealand
The WHO CC UTS acknowledges use of key language from The WHO Global Strategic Directions for Nursing and Midwifery (2021–2025).
Having nurses and midwives who can prescribe medicine in community health care settings has been a radical innovation across the globe. It means that patients are able to access treatment faster, there is improved safety, improved communication with patients, as well as greater efficiency and cost effectiveness [1]. For nurses, it has brought a number of benefits including increased job satisfaction, as well as more credibility with patients and healthcare professionals and nurses also improve their knowledge through prescribing [1].
In New Zealand, highly qualified Clinical Nurse Practitioners have been able to prescribe medicine since 2001 [2]. These Nurse Practitioners, who work autonomously in continuity of care models, are often better positioned to be more responsive to patient needs than many GPs, who only see patients infrequently. It also means that terminally ill patients do not have to leave their homes to visit the GP [3].
Michelle Rodda has been a nurse prescriber for about two-and-a-half years. “It’s really new,” she says of the role. She was able to prescribe a number of drugs, including morphine and methadone, which are important for some dying patients. Now she is a nurse practitioner she can prescribe any medications a patient may need the same as a medical practitioner would. There are only 238 nurse practitioners in New Zealand and there are only 20 of those who work in palliative care. She is one of the few who work in palliative care in the North Island’s Hawke’s Bay area [2].
Rodda recently saw a young patient with a terminal disease who had had issues with nausea for months. As a nurse practitioner, she was able to change his medications. He managed to have a curry a bit later with his family.
It was really lovely,” she says. “Now he’s realised that hospice care is not about my helping him to die tomorrow — it’s that I’m there to make his life better while he’s living. And we will support him and his family when he is dying.
From surgical settings in Scotland, the UK and New Zealand to aged care work in South Africa, Rodda has had a global career in nursing for 23 years. Now in her mid-40s, she is back home in New Zealand where she works in Hawkes Bay, a region on the east coast of the North Island. She works as a Nurse Practitioner and Community Team Leader at Cranford Hospice, where she helps dying people manage their symptoms and have a better quality of life.
I never thought I’d be a hospice nurse, I always thought I’d work in acute care because I loved it. But this is the best place,” she says. “I get to use all my nursing skills all the time so it’s amazing.
Rodda’s role moves well beyond the hospice. As a Nurse Practitioner, she covers two large rural areas — Central Hawkes Bay and Wairoa. Her work touches on a number of areas — aging, mental health and non-communicable disease such as diabetes. She visits people in their homes as it can be hard for them to get out. “I’m one of the health professionals that they see that has the luxury to spend more time with them … Sometimes I have an hour or two to spend with that person,” she says.
Maori make up about 45 percent of the Wairoa population, some of them patients ill with chronic illnesses. [4]. Recently, she has started working with the renal services at local regional hospital to provide Renal Supportive Care Clinics. These look at quality of life and well as introducing palliative care for renal patients with increasingly complex needs. “We have quite a high incidence of diabetes,” she says. “Our Maori and Pacific Island population are predisposed to diabetes so a lot of our renal patients in palliative care are there due to diabetes complications.”
Rodda finds her work rewarding, particularly when she can help patients with a life-limiting illness to improve their quality of life and plan for their dying. “It’s about that quality of life and having someone in front of them that they can talk to and realise that this isn’t so scary and they are not alone,” she says.
- Stenner K, Courtenay M. Benefits of nurse prescribing for patients in pain: nurses' views. J Adv Nurs. 2008;63(1):27‐35. doi:10.1111/j.1365-2648.2008.04644.x
- Nursing Council of New Zealand, Registered nurse prescribing in primary health and specialty teams.
- Ladd, E.S., Marian, Nurse Prescribing From the Global Vantage Point: The Intersection Between Role and Policy. Policy, Politics and Nursing Practice, 2018. 19.
- Cameron VA, F.A., Gillies MW, A cohort study comparing cardiovascular risk factors in rural Māori, urban Māori and non-Māori communities in New Zealand. 2012.
