From the Australian College of Nursing (ACN) and the Advanced Practice Faculty: Happy Nurse Practitioner (NP) week.
This week, as NPs, we reflect on how our pioneers overcame the various hurdles to deliver the high-quality care our patients deserve. We honour their contribution through ongoing efforts to advocate for the removal of barriers to safe, high-quality care provided by highly trained advanced practice nursing professionals, including NPs.
To date, healthcare funding continues to pose challenges for the delivery of holistic care in Australia. However, newer methods of delivering health services and extensive educational options have created opportunities for advanced practice roles, such as NPs, that integrate care and improve access for patients.
I had the opportunity to lead an innovative, life-saving Extracorporeal Membrane Oxygenation (ECMO) program in a non-cardiothoracic centre. This experience was not without its challenges. I often felt frustrated by my inability to work to my fullest capability since I could offer various skill sets, including advanced ECMO management, critical care nursing, and echocardiography. The opportunity of a transdisciplinary role that combines such skills in clinical practice was unprecedented.
Fortunately, there was a way to integrate these skills into clinical practice. I was offered NP training, which provided me with the opportunity to redesign the Model of Care (MOC) and develop a Scope of Practice (SOP) that encompasses all the skills I possess. In this novel NP role, I can provide echocardiography assessments repeatedly, allowing for real-time evaluations of cardiac function in the critically ill. Interpreting this information helps guide the selection and dosing of inotropic medications, as well as the mechanical blood flow required by the patients. This holistic model of care reduces the unintended effects of unnecessary inotropic medications and the cost for repeated echocardiograms.
I hope my experience has spurred you to reflect on your practice and the benefits of advanced practices such as those offered by an NP. If this is what you are keen to do, what’s next?
Unfortunately, there is a lack of resources that outline how to prepare for the next step and navigate the systemic challenges of becoming an NP. I was fortunate to receive guidance from many wise professionals who helped shape and nurture my development into the person I am today. Now, I would like to share this knowledge with you, hoping this will assist you in your journey to becoming an NP in your specialty area.
There are three main themes you should focus on when developing a new Advanced Practice Nurse (APN) or NP role:
- Clinical argument – the rationale for the service and unmet patient need
- Operational challenges
- Professional issue(s)
1. Clinical argument: Identify gaps in the delivery of care within your speciality area
- Identifying and explaining the gaps within your speciality area is a crucial first step.
- Conduct a literature review to search for information on whether these gaps exist in other health service delivery and explore the solutions suggested in the literature.
- These gaps form the basis of your clinical argument, with the proposed solution outlining the path forward.
- Support your arguments and proposed solutions with evidence and statistics gathered from the literature review.
- In new, innovative, advanced practice roles, there may be limited literature. Consult with your Clinical Director/Director of Nursing to determine whether existing information will adequately support your clinical argument for the need for an NP role.
- Next, focus on addressing both professional and operational challenges, such as SOP, MOC, and the funding and ongoing sustainability of the role.
- In specialty areas lacking current or established service delivery models, it is essential to advocate for the creation of new funding through a document known as a “business case.”
Tips and tricks
After outlining the problem and its potential solution, it’s important to assess and ‘suss out’ organisational support for this endeavour. This support will have to come from your Divisional Manager or Director, Clinical Director, and Chief Nursing Officer.
2. Operational challenge(s): Obtaining organisational support for NP candidature (NPC) is ESSENTIAL
- Organisational support is required for entry into many Master of Nurse Practitioner programs in Australia (Pathway 1).
- Securing this support ensures that your organisation is aware of your candidacy and can provide the necessary assistance for developing advanced practice roles.
- The benefits of obtaining organisational support include approval for study and exam leave, guidance on navigating the development of MOC, SOPs, and establishing the governance structure required for such roles.
- Being in an NPC position allows for the development and consolidation of advanced practice within your specialty area, which also contributes to the 5,000 hours required for NP endorsement.
- Organisational commitment to your progress to an NP role is vital if your future practice and employment are to be supported.
The MOC
The MOC is a document that outlines your interactions with the patient throughout their entire journey within the healthcare setting. This journey may not be limited to a single specialty area or department. This may also be called a clinical service model or equivalent.
In the MOC, consider re-highlighting the proposed solution to address any gaps identified during the initial review. A flowchart-like diagram can help illustrate the patient’s journey and how your service interacts with it. This diagram helps explain how the service is delivered in the clinical setting, the scale of the service, and its potential impact on both the operational workflow and the patient’s journey.
The SOP
The SOP is a document that details your own individual practice, competence, capability, skills, and services in greater depth.
In the SOP, you should clearly outline the key elements of the practice, skills, or services you are offering, such as ordering and interpreting diagnostic tests (e.g., x-rays). This is where you will highlight and showcase the aspects of advanced practice incorporated into the MOC. These aspects include descriptions of relevant expertise, skills, and knowledge that will be utilised in clinical settings. This reflects the critical thinking and autonomous practice that characterise advanced nursing practice.
Remember the NMBA Decision-making Framework (Nursing and Midwifery Board-AHPRA 2023) to guide the development of your advanced practice matrix or position description. The Domains of Professional Practice (Nursing and Midwifery Board 2025) provide a structure to articulate your capability across the areas of Clinical Competency, Research, Education, Support of Systems (evidence-based practice), and Leadership.
When describing the advanced practice roles in the SOP, a structured format is recommended. This provides clarity for all readers. Utilising the Nurse Practitioner (NP) Standards of Practice (Nursing and Midwifery Board 2025) can offer a universally accepted structure to accurately describe your practice.
The four standards:
Standard 1: Assesses using diagnostic capability.
Standard 2: Plans care and engages others.
Standard 3: Prescribes and implements therapeutic interventions.
Standard 4: Supports the health systems.
Tips and tricks
- Look for templates from your organisation, thishelps to understand what information is needed
- The NP standards include statements that provide insights into the principles and elements of advanced practice. Incorporating these elements into your statement of purpose (SOP) will clarify your practice and serve as evidence for NP endorsement.
The ‘business case’ is one of the most challenging aspects to address when seeking funding for new nursing positions or services. It is comprised of several key elements, which can be further broken down into sub-themes:
- Problem: Define the issue and evidence of the problem.
- Benefits: Describe benefits that will be delivered and their significance
- Option analysis: Analyse alignment with the organisation’s strategic plan, outline other recommended options.
- Solutions: Present potential solutions, assess financial impact, manage stakeholder engagement, change impact statements, and address risk and governance management.
Since these components can vary between organisations, it’s advisable to obtain the business case template provided by your organisation. This will help clarify what needs to be included. Some sections may initially seem overwhelming, so don’t hesitate to seek assistance and guidance from your Divisional Manager, Clinical Director, or Director of Nursing.
To assess the financial impact and sustainability, you typically need to enumerate all costs and benefits associated with the new role or service, which will lead to a cost-benefit analysis.
To navigate this effectively, it’s essential to have a basic understanding of how your service is funded through Activity-Based Funding (ABF). Information on how ABF (National Health Funding Body) operates is available to help you understand the elements of costs and benefits, which you will use to inform the ‘cost’ of your service in the business case.
3. Professional Issue(s): Creating your own SOP
- This document serves to inform your organisation about your practices, abilities, and capabilities.
- Use this opportunity to highlight the advanced skills you seek to incorporate into your clinical practice.
- Utilising the four NP Standards of Practice is an effective way to structure this document (further details below):
Example: I have outlined the additional use of echocardiography (specific to my own capability and credentialing) in NP Standard 1: Assesses using diagnostic capability – the use of echocardiography and interpreting them for hemodynamic assessment and differential diagnosis, and in Standard 3: Prescribes and implements therapeutic interventions- prescribe the appropriate inotropic medication and its titration using echocardiography.
This approach will help clarify your advanced practice and its integration into clinical care.
- Pathway 1: Successful completion of an NMBA-approved program of study leading to endorsement as an NP and other evidence.
- Pathway 2: A program that is substantially equivalent to an NMBA-approved program of study leading to endorsement as an NP, as determined by the NMBA and other evidence.
- Understanding the requirements for NP endorsement via pathway 1 or pathway 2 will assist in progressing to the next step. Link can be found here.
- If you satisfy the requirements for Endorsement via pathway 2, lodge your application here.
- Research and understand the requirements for entry into each program.
- Consider the program’s duration, units of study, and whether the subjects are taught in person, online, or in a hybrid format. Evaluating these factors against your personal and work circumstances is crucial, especially for those working part-time or balancing work and life commitments while accumulating the necessary 5,000 hours of advanced practice required for endorsement.
- Information on the NMBA-approved program of study can be found at AHPRA and ACNP.
Become a member with the Australian College of Nursing (ACN) and the Advanced Practice Faculty
Becoming a member of ACN offers you opportunities to connect with senior health leaders, providing access to their insights that can help you navigate the complexities of establishing new health services and roles. Membership in the Advanced Practice Faculty also allows you to contribute to shaping policies that will influence the future of advanced nursing practice in Australia.
Final tips
- Assess the level of support from clinical, operational, and nursing teams for this initiative.
- Always conduct thorough research. This showcases high-level problem-solving skills, leadership, and the commitment of a senior nursing leader.
- Familiarise yourself with various templates available within your organisation, such as Standard Operating Procedures (SOPs) and business cases. Identify the key items that need to be addressed and tackle them systematically.
- Remember the words of Seneca: “Luck is what happens when preparation meets opportunity.”
- This is hard work, so keep chipping away at it!
With thanks to the ACN Advanced Practice Faculty
This article was authored by Chee Liew MACN, Deputy Chair, with editorial support from the faculty leadership team – Jo Mapes FACN, Chair; Megan Korpok MACN, Leadership Support; and Dr Stephen Yu, Leadership Support.
Joining a Faculty is an exclusive benefit of ACN membership, offering access to a dynamic community of nurses shaping the future of the profession.
Not an ACN member yet? Become part of Australia’s peak professional nursing association to access this benefit and many more. Join today by completing the online membership form.
References
Nursing and Midwifery Board- AHPRA. (2023). Decision-Making Framework (DMF). https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/frameworks.aspx
Nursing and Midwifery Board- AHPRA. (2025). Nurse Practitioner Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/nurse-practitioner-standards-of-practice.aspx
National Health Funding Body. Activity-Based Funding (ABF). https://www.publichospitalfunding.gov.au/public-hospital-funding/funding-types
