Advanced nursing skills 

Palliative care as with many other specialties has nurses working in advanced practice roles. The Nurse Practitioner (NP) role in palliative care has gained significant momentum over the last 10 years. To work as a NP the nurse must demonstrate qualifications including three years full-time experience at the clinical advanced nursing practice level within the past six years, completion of a Masters level qualification and be registered with the Australian Health Practitioners Regulation Agency (AHPRA). [1] The Australian College for Nurse Practitioners has developed a position statement on the nurse practitioner scope of practice.

As for all nurses practicing in Australia, registration with the Nursing and Midwifery Board of Australia (NMBA) is mandatory for NPs and they must meet the NMBA professional standards for:

  • codes of conduct
  • standards for practice
  • codes of ethics.

Nurse Practitioner Standards for practice reflect the broadened scope of practice.

NP role in palliative care

Nurse Practitioners provide a unique and highly advance nursing skill set, their roles within palliative care are commonly aimed at working with primary care providers to facilitate timely, equitable access to care for those living with a life limiting illness. They are trained and skilled to perform advanced duties including: [2]

  • examinations
  • diagnose illness
  • prescribe medications
  • offer referrals, and
  • follow-up care as appropriate.

The extended clinical role of NPs within palliative care is growing in Australia, with reports from individuals and single organisations suggesting improved continuity of care, likelihood of dying in a person’s place of choice, and reduced hospitalisation costs. [2-4]

The NP may be based in the acute care sector, residential aged care or the community. The role and activities of NPs across these settings of care will vary according to need and available resources. Furthermore, NPs may work as sole practitioners or as part of a wider palliative care team. [5] However, collaborative practice in multi-professional environments is a key part of the NMBA definition of NPs within the Nurse practitioner standards.

Nurse Practitioners: Their role in the Palliative Care Team

Video from St Vincent's Private Hospital Brisbane

A word on prescribing 

Endorsement as a NP by the NMBA does not give automatic access to the Medicare Benefits Scheme (MBS) or Pharmaceutical Benefits Scheme (PBS). Only Medicare Australia has the authority to provide access.

Authority to prescribe is governed by state and territory governments and the conditions and scope of permissions may vary between jurisdictions. More information on this is provided in the Nursing and Midwifery Board’s Registration standard: Endorsement as a nurse practitioner.

MBS items for nurse practitioners

Nurse practitioners can obtain remuneration for palliative care services for patients within the primary health care setting through the Medical Benefits Scheme (MBS).

MBS items supporting nurse practitioner palliative care provision (138kb pdf)

  1. Bennett K. The palliative care nurse practitioner. Aust Nurs J. 2012 Nov;20(5):34. (No abstract available)
  2. Edwards J, Hooper D, Rothwell G, Kneen K, Watson J, Saurman E. A nurse practitioner-led community palliative care service in Australia. Int J Palliat Nurs. 2019 May 2;25(5):245-253. doi: 10.12968/ijpn.2019.25.5.245.
  3. O'Connor M, Palfreyman S, Borghmans F. Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia. Int J Palliat Nurs. 2018 Sep 2;24(9):436-442. doi: 10.12968/ijpn.2018.24.9.436.
  4. Moreton SG, Saurman E, Salkeld G, Edwards J, Hooper D, Kneen K, et al. Economic and clinical outcomes of the nurse practitioner-led Sydney Adventist Hospital Community Palliative Care Service. Aust Health Rev. 2020 Sep;44(5):791-798. doi: 10.1071/AH19247.
  5. Quaglietti S, Blum L, Ellis V. The Role of the Adult Nurse Practitioner in Palliative Care. J Hosp Palliat Nurs. 2004 Oct-Nov-Dec;6(4):209-14.

Last updated 16 January 2024