Employing a Nurse Practitioner

Question
I am an employer, or future employer of Nurse Practitioners. What are the supervision requirements for Transitional NPs, or NP Candidates/Students?

Answer
Transitional, Student and Candidate NPs are those who have not yet received NMBA endorsement to practice independently as a Nurse Practitioner.  When working as a Registered Nurse, and not actively expanding their scope of practice to meet advanced practice requirements for their education programs, they are individually accountable for their autonomous practice as a Registered Nurse.  Supervision requirements (direct or indirect) will depend upon:

• Whether they are enroled in a Master of Nurse Practitioner education program and are undertaking supervised advanced practcie hours to fulfil the requirements of that program; 
• The clinical governance arrangements of the employer and/or supervisor
• The governance arrangements between the University and the employer/supervisor.

Nurse Practitioners are independent practitioners under the Health Practitioner National Law (as enacted in each state/territory) and do not require medical supervision to practice within their clinical scope of practice, once endorsed by the NMBA. However, as with all health practitioners, if expanding their clinical scope of practice they will require additional education and training, which may include a period of supervision by a suitably qualified practitioner.  

This support does not need to come from a medical practitioner; it can be provided by an experienced NP or another suitably qualified senior clinician, depending on the clinical setting and individual developmental needs and service needs. As with all prescribing practitioners, it's recommended NPs have a prescribing mentor/collaborator when new to practice or working to expand their clinical scope of practice in a different area.

In each State or Territory, there are public sector enterprise bargaining rates for Nurse Practitioners.  We recommend consulting local information to ensure you are able to provide a competitive rate.  The ACNP does not endorse the Fair Work Commission's Nurses Award 2020 as a means to inform pay rates, as it is inappropriate and unfair in its recommendations.

If you are contracting a NP, you will need to consider hourly contract rates and negotiate.  The Public Sector rate can be used as a base, and should be adjusted in line with private contract considerations.

If negotiating an employment rate, you must factor in sick leave, annual leave, superannuation, continuing education, administrative support, office space, and payroll management.  

We highly recommend considering incentives for after hours and weekend/public holiday work to mirror public sector arrangements.

Employers are expected to:

• Provide appropriate orientation and support in the clinical workplace;
• Ensure the role is aligned with the NP's existing clinical scope of practice and, if not, work collaboratively with the NP to expand their scope using the NMBA's Decision-Making Framework;
• Support ongoing professional development and learning requirements;
• Provide appropriate remuneration;
• Ensure the NP is registered and endorsed with the NMBA by checking Ahpra's national register annually; and
• Ensure the NP has appropriate private or employer indemnity insurance.

The Transition to Practice at an Advanced Level refers to the developmental phase where a Registered Nurse (RN), already practising at a high level, begins formally preparing for the Nurse Practitioner role. This often involves:

• Working in a supported clinical candidacy or TNP program across a single or multiple settings to build a broad understanding of expert care delivery
• Refining clinical decision-making, research and leadership skills within their area of expertise
• Gaining exposure to complex case management, diagnostics, and therapeutic interventions

In some organisations, rotating through different departments (e.g., chronic disease, emergency, aged care, urgent care) is used to develop a well-rounded, system-wide understanding of care delivery. However, this should be tailored to the nurse’s clinical background and intended scope of practice.