Working as a Nurse Practitioner

The Nursing and Midwifery Board of Australia (NMBA) endorses Nurse Practitioners (NPs) to practice independently.  However, each State/Territory may have different authorisation processes for core (e.g. prescribing, requesting, referring) and supplemental (e.g. driver's license medical and workers' compensation authorisations) activities provided by NPs.  Your authorisations may differ if you work in the public or private health systems.  

For requirements in your State, members can contact your ACNP Chapter Lead, who can be found on the Chapters page.

There are three key sources of information on patient rebates when requested by an eligible NP through the MBS:  

1. Department of Health, Ageing and Disability: Nurse Practitioners
2. Services Australia: Nurse Practitioner Items 
3. MBS Online: Advanced Search
   • Category 8 - Miscellaneous Services; M14 - Nurse Practitioners
   • Category 8 - Miscellaneous Services; M18 - Nurse Practitioner Video Services
   • Category 8 - Miscellaneous Services; M18; Subgroup 10 - Nurse Practitioner Phone Services
   • Category 8 - Miscellaneous Services; M33; Subgroup 1 - Assistance at operations provided by a nurse practitioner
   • Category 6 - Pathology Services; P9 - Simple Basic Pathology Tests

The ACNP has developed additional resources in its members only section.

Nurse Practitioners can request any MBS-subsidised pathology test that is subsidised when requested by a general practitioner.  There are other commercially-available tests, such as genetic tests, which can only be requested by medical specialists and achieve a patient subsidy.

If there is no rebate payable, the NP can order the test privately if they have provided the patient with informed financial consent.

It depends.  The ACNP receives many inquiries about medicinal cannabis prescribing from both members and industry.

• Legal Authorisation: All states/territories authorise NPs to prescribe medicinal cannabis, as long as the condition being treated is within the NP's scope of practice and the NP has used the NMBA's Decision-Making Framework to expand their scope of practice to include cannabis prescribing.  Ahpra has developed additional guidance for cannabis prescribing.  The ACNP has developed members-only information to assist.
• Employer Restrictions: Ensure that there are no employer-based restrictions on your prescribing if you are employed.
• Patient Restrictions: It is the NP's responsibility to ensure they are following best practices in real-time prescription monitoring, and understand whether the patient has any pre-existing health conditions or are taking medicines at that are cautioned or contraindicated with cannabis therapy.
• TGA Restrictions: You will be required to seek approval from the TGA and State/Territory Health Department through an SAS-B request for your patient.  If applicable (for ‘unapproved’ products), you will be asked to sign a one-off declaration with TGA. As Medicinal Cannabis is not approved by the TGA, NPs will need to complete a one-off declaration when they submit their first application. Further details about the declaration are included below. This declaration acknowledges that you are responsible for your scope of practice, in accordance with the NMBA’s Safety and Quality Guidelines and Standards for Practice, and Ahpra's Prescribing Competencies Framework.

TGA Declaration

You will be asked to prepare a one-off declaration including the following specific points:

• I am a Nurse Practitioner endorsed by the Nursing and Midwifery Board of Australia (NMBA) and confirm the following:
• I have appropriate education, training and competence to diagnose and treat the relevant conditions for which I intend to prescribe medicinal cannabis and can supply evidence of this on request.
• I have appropriate pharmacotherapeutic education and training to safely prescribe medicinal cannabis and can supply evidence of this on request.
• I will prescribe medicinal cannabis in accordance with the relevant State and/or Territory drugs and poison legislative framework and the principles outlined in the National Prescribing Service's Prescribing Competencies Framework (2021), as well as the NMBA's Safety and Quality Guidelines for Nurse Practitioners (2016).
• I consent to any information (including personal information) I provide to the TGA in connection with my application under s 19(1)(a) of the Therapeutic Goods Act 1989 being provided to the NMBA.

The ACNP is aware the NMBA does not generally recognise cosmetic nursing as advanced practice, and advanced practice (5000 hours within 6 years of application) is required for the endorsement as an NP.  You can view their position statement by searching the NMBA Website: https://www.nursingmidwiferyboard.gov.au

Should you be working in a generalist or specialist context (outside of cosmetics), managing complex acute and/or chronic disease, and can accrue advanced practice hours there, we suggest you focus on that first.  You can also enrol in an approved NP Masters program once you have at least 2000 of those advanced practice hours and a graduate diploma in a clinical area of nursing.

ADVANCED PRACTICE IN NURSING

ACNP has developed a  Position Statement  on Advanced Practice in Nursing.
The nurse practitioner role is the most advanced of the clinical nursing roles in Australia . Advanced practice is often a poorly understood concept, even within nursing. This position statement clarifies advanced practice as it relates nursing in Australia. Terms commonly used include ‘extended' ‘expanded' and ‘advanced' practice.

The only regulated advanced practice role in Australia is the role of a nurse practitioner (NP). Nurse practitioners are advanced practice nurses whose registration is endorsed by the Nursing and Midwifery Board of Australia (NMBA) to enable practise within their scope using the title, which is protected by Law.

Nurses practicing at an advanced practice level incorporate professional leadership, education and research into their practice. Their practice includes relevant expertise, critical thinking, complex decision making, autonomous practice, and is effective and safe. They work within a generalist or specialist context and they are responsible and accountable in managing people who have complex healthcare requirements.

Advanced practice is a 'level' of practice rather than a particular role or specialist area. Nurses practising at an advanced level develop their practice and build expertise over time. Advanced practice does not directly refer to clinical or technical skills that a nurse may develop.

Advanced practice may involve generalist and/or specialist practice. Generalist practice encompasses a wider spectrum of activities, across a broad range of health care settings. Specialist practice may focus on a specific population or context. It is important to recognise that while there are many nurse specialist roles at the advanced practice level, specialisation alone does not characterise an advanced level of practice.

Advanced practice may be developed by a combination of formal education, exposure to relevant clinical experience, and continuing professional development. Development towards advanced practice is therefore likely to differ for individual nurses. Advanced practice always incorporates high-level assessment, decision making and autonomous practice. Progression to advanced practice will depend on the quality and complexity of developmental experiences, rather than merely the length of time spent in an area of service.

The ACNP supports the minimum formal educational preparation for advanced nursing practice is a relevant Master’s degree in nursing. However, advanced practice is not demonstrated by completing a postgraduate degree alone and arises from a combination of graduate education and clinical experience that results in the development of the skills and attributes required to practice at an advanced level.

Key points:

• Advanced practice is not defined by a role or title, but by the level of expertise, critical thinking, complex decision making, and autonomous practice
• Nurse practitioners are the only regulated advanced practice role in Australia
• Advanced practice may involve generalist and/or specialist practice
• Advanced practice may be developed by a combination of formal education, continuing professional development, and must include significant relevant clinical experience
• Each pathway to advanced practice may differ, however advanced practice must include the key elements of critical thinking, complex decision making, clinical reasoning, advanced assessment skills, and clinical expertise.

This position statement is endorsed by the Australian College of Nurse Practitioners Board on 2nd December 2019, and will reviewed by 2nd December 2021.

 

Download the ACNP Position Statement Advance Practicein Nursing to read about what they can do and the background.

If you have any questions or need more information please use the Contact Us online form.  
 

After 15 years of advocacy by the ACNP and 18 months of work by the Department of Health and Aged Care (DOHAC), legislatively-mandated collaborative arrangements ended on 1 November 2024. 

Prior information about collaborative arrangements can be found here:

1. Facts about the Collaborative Arrangements

2. Myths about the Collaborative Arrangements

3. Frequently Asked Questions

4. A brief history

5. Resources - including links to media articles