Proposed new RN prescriber and NP competencies open for consultation as both roles bloom

Departed Nursing Council chief executive Catherine Byrne — speaking to Kaitiaki before she resigned — said both roles were “fundamental” for improving equity and access to health care.

‘There’s been so much growth in the number of NPs and therefore the influence.’

There were now more than 1000 NPs registered to practise in Aotearoa, and their work had changed significantly since the scope was last reviewed in 2016, she said.

And with a clear message from Government that continued NP growth was a priority, Byrne said it was up to the Council to ensure its regulatory framework supported this growth — as well as public safety.

RN prescriber practice, too, had changed, Byrne said, requiring a separate “future-focused” scope to reflect expanding prescribing rights.

Last year, the number of medications RN prescribers could prescribe doubled to 450 for common and long-term conditions such as high blood pressure, diabetes and menopause symptoms.

Yet RN prescribers have not had competency standards until now.

Their first scope was established in December 2025, adding prescribing skills like pathophysiology and pharmacotherapeutics to the existing RN scope.

At the same time, the 2016 NP scope was updated to bring it into line with the EN and RN scopes which were updated in 2025 — including their commitment to Te Tiriti o Waitangi, equity and culturally-safe care.

New competencies were now needed to reflect the new/updated scopes, the Council states in its consultation.

One more ‘pou’ for prescribers — four for NPs

The proposed changes would integrate NP and RN prescriber standards into the system of pou, recently introduced for RNs and ENs.

For RN prescribers, who mainly work in the community or specialist care like diabetes, the proposed new competencies simply add an extra pou (standard) to the six already within the RN scope.  The seventh pou, rongoā haumaru, sets out the requirements for safe prescribing practice, such as diagnostic reasoning, shared decision-making and ongoing evaluation, as well as guidance from experienced prescribers in the wider team.

For NPs, there are four extra pou they must meet, alongside the six RN pou. Those four new pou reflect their requirement to:

• Provide clinically and culturally-safe advanced care.
• Apply scientific evidence and mātauranga Māori.
• Provide rangatiratanga, or leadership, both clinically and in wider health system design to improve health outcomes.
• Provide person and whānau-centred care that considers (Tiriti-led cultural safety model) kawa whakaruruhau and health equity.

Qualification changes

The proposals also include changes to qualifications for each role.

RN prescribers would need just two years’ experience rather than three — but one must be in New Zealand.

‘You look at the competencies as they develop across the scopes, you can see quite clearly the difference between the EN role right through to advanced standards of an NP.’

NPs would still need four years’ experience and a clinical Master’s degree — but at least one year of experience would need to be in New Zealand.

Nurse prescriber and practitioner numbers have grown rapidly in recently years and there are now 1014 NPs and 805 RN prescribers (primary health and specialty teams) plus another 42 RN prescriber diabetes and 20 RN prescribers Hepatitis C, according to Nursing Council data.

There were also another 841 community nurse prescribers. However, updates to their authorisations would be considered separately, likely over the next year or so, according to the Council.

A ‘clear’ path to advanced nursing

The changes follow updates to the enrolled and RN scopes  in 2025/26 to reflect modern nursing practice. For RNs, there was more emphasis on preliminary diagnosis and cultural competency as well as digital health care. For ENs, it allowed them to practice more independently rather than under the direction of RNs.

RN prescriber clinical project co-lead Jill Clendon said the new scopes and competencies would provide a clear pathway for people to advance their nursing practice while maintaining safety and supporting leadership.

“You look at the competencies as they develop across the scopes, you can see quite clearly the difference between the EN role right through to advanced standards of an NP and how they develop right across that spectrum,” she told Kaitiaki

NP project co-lead Rachael Walker said the proposed changes made it very clear that NPs were autonomous practitioners, with increased emphasis on scientific knowledge and leadership.

“There’s been so much growth in the number of NPs and therefore the influence,” she said. “They are advocating for better outcomes and equity, wherever they are — a clinical environment or across policy change and population health.”

Consultation closes on September 7.

More detail on the proposed competencies can be found here.

Consultation feedback can be made here.

Key changes – NP standards of competence

Element	Current	Proposed
Competency Framework	Competencies for the mātonga rapuhi nurse practitioner scope of practice Domains (6) Competencies (47)	Nurse practitioner standards of competence Pou (4) Descriptors (29)
Competencies versus standards and descriptors	Competencies Detailed Specific areas of knowledge and skills.	Standards of competence Broad expectations and able to be contextualised to all areas of practice. The descriptors provide guidance of what’s required for each standard. Greater emphasis on the Pou statement. Less descriptors than previous competencies. Must be read in conjunction with the principles for safe prescribing practice.
Pou	Duplication between pou has been removed. Streamlined descriptors with greater emphasis on the pou.	Pou one – Safe and accountable advanced nursing practice Pou two· PGkengatanga and evidence-informed nurse practitioner practice Pou three – Rangatiratanga and leadership Pou four: Manaakitanga and people-centred care
Demonstrating continuing competence requirements	Demonstrated against each competency aligned to the pou	Demonstrated against each standard with descriptors used to inform practice expectations

Key changes – RN prescriber standards of competence

Element	Current	Proposed
Competency Framework	Competencies for nurse prescribers Competencies (5) Elements (53)	Standards of competence for RN prescriber (including standards of competence for RNs) Pou (7) Descriptors (39+12)
Competencies versus standards and descriptors	Competencies Detailed with some duplication. Specific areas of knowledge and skills.	Standards of nursing competence Broad expectations and able to be contextualised to all areas of practice. The descriptors provide specific examples of expectations required for each standard. Greater emphasis on the Pou. Less descriptors than previous competencies. Must be read in conjunction with the principles for safe prescribing practice.
Pou	Competencies for nurse prescribers – 5 competency areas.	Builds on the standards of competence for RNs. There is an additional pou (pou 7) – Rongoā haumaru – safe prescribing practice for RNs who have met the requirements for the Council approved RN prescriber scope.
Demonstrating continuing competence requirements	Demonstrated against each competency aligned to each domain and indicators.	Demonstrated against each standard with descriptors used to inform practice expectations.

— Source: Nursing Council