Why this research matters for everyday nursing practice
In December 2026, Aotearoa New Zealand will mark 25 years of nurse practitioner (mātanga tapuhi) practice. Since 2001, nurse practitioners (NPs) have become an established part of the health workforce. Yet questions remain. What do NPs, as an advanced nursing practice role, do? Where do they add value? And how does their work contribute to patient and whānau care and health outcomes?
The findings are consistent across health-care settings. NPs provide expert clinical care in hospitals, primary care, rural services and communities.
A recently published integrative review on the first 20 years of NP practice1 draws together peer-reviewed New Zealand research published since NP registration began here. Where NP-specific data could be identified, the aim was to understand how NPs contributed to clinical practice and health policy during the formative years of the role.
The findings are consistent across health-care settings. NPs provide expert clinical care in hospitals, primary care, rural services and community contexts. They work collaboratively with other health professionals. They support access to care for populations with high need. They bring a nursing perspective to complex clinical decision-making. Over the 20 years, the volume and sophistication of NP research has increased and more recent studies are investigating patient outcomes of different models of care.
Alongside these contributions, the review identifies persistent structural constraints. These include limited opportunities and involvement in policy development, service design and system-level decision-making.
Twenty years of New Zealand research show that NPs add clear value to patient and whānau care, and that they are a well-accepted workforce. But it also shows the full contribution of advanced nursing practice is still shaped, and often constrained, by the systems in which it sits.
Across the 20-year period, there was no coordinated national evaluation of the NP role, which limits what can be concluded about changes in how NPs practise, location of practice, preparation of NPs, workforce changes, roles satisfaction, employment, long-term outcomes, equity and system impact
What is an integrative review?
An integrative review brings together evidence from different types of research to build a comprehensive understanding of a topic. It may include qualitative studies, surveys, audits and mixed-methods research.
For this review, peer-reviewed New Zealand research published between 2001 and 2021 in which NP data could be clearly identified was systematically searched, critically appraised and analysed. This approach allows patterns, strengths and gaps in the evidence to be identified 2 .
Why share this research beyond academic journals?
Many nurses cannot easily access academic journals. There are many barriers, including subscription costs, limited institutional access, and at times technical and inaccessible language.
The full contribution of advanced nursing practice is still shaped, and often constrained, by the systems in which it sits.
Sharing research through accessible nursing publications supports informed professional discussion. It strengthens understanding of nursing roles across the workforce. It also helps ensure research reaches those delivering care, leading services, and shaping how health care is organised.
What this review means for nurses
This review provides a consolidated account of how NPs have contributed to health-care delivery in New Zealand during the first 20 years of the role. It shows that advanced nursing practice supports access to care and responsive service models.
The review also highlights the importance of organisational, funding and policy alignment. When these are misaligned, opportunities to use advanced nursing skills fully are reduced. These constraints affect how nursing expertise is recognised and integrated across the health system.
As the profession approaches 25 years of NP practice, evidence from the first two decades supports informed and realistic conversations about strengthening nursing roles.
At a glance
- Nurse practitioners (NPs) improve access to care. NPs frequently work with populations experiencing health inequities, including Māori and Pacific communities — although their ability to address inequity was often constrained by funding and policy settings.
- NPs are grounded in nursing philosophy. Findings reflect nursing values they encompass, including holistic care, relational practice, and whānau-centred approaches.
- The role is shaped by system settings. Funding models, organisational structures, and role clarity influence whether NPs can work to their full scope of practice.
- Policy engagement remains limited. NPs contribute substantially to service delivery, but involvement in health policy development and governance is inconsistent in the published literature.
Deborah L Harris, NP, MSc, PhD, was New Zealand’s first registered nurse practitioner. She is now professor of nursing and midwifery research at the University of Newcastle and Hunter New England health, Australia. Her expertise includes neonatal care and NP workforce development and she hopes to build strong trans-Tasman partnerships to advance the NP role in both countries.
Eileen McKinlay, RN, MA, is director of the University of Otago’s division of health sciences Centre for Interprofessional Education and a professor in primary health care.
References
- Harris, D. L., & McKinlay, E. (2025). Nurse practitioners in New Zealand: An integrative review of clinical practice and involvement in policy. Collegian, 32, 328-40.
- Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced Nursing, 52(5), 546-53.
See also: NPs gifted new Māori title