Nurse practitioners in New Zealand: An integrative review of clinical practice and involvement in policy

Abstract

Background: Nurse Practitioner roles have escalated internationally with the aim of improving access to healthcare and thereby enhancing health and social outcomes. In Aotearoa New Zealand, Nurse Practitioner registration began in 2001, yet questions remain about their contributions to practice and policy. Aim: To critically appraise peer-reviewed research on nurse practitioners’ contributions to clinical practice and health policy in New Zealand. Methods: This integrative review followed Whittemore and Knafl's five-stage framework. A search was conducted across six databases between January 2001 and May 2025. Inclusion criteria required studies to report primary research or audits. The Mixed Methods Appraisal Tool assessed methodological quality. Data were extracted, summarised in tabular form, and synthesised narratively across key domains. Twenty-two studies were included: 8 qualitative, 11 quantitative, and 3 mixed methods. Findings: Nurse practitioners deliver expert, culturally safe healthcare across diverse settings. They collaborate interprofessionally to deliver coordinated care, promote health, and provide clinical leadership that improves healthcare access and equity. Studies highlight the nurse practitioner role in supporting underserved communities through models responsive to Māori and Pacific populations. Policy engagement remains weak. Barriers include organisational constraints, limited early-career support, insufficient data on workforce, clinical activity, and patient outcomes, and a misalignment between nurse practitioner values and funding models. Discussion: Strong evidence shows that nurse practitioners improve care across diverse settings. However, their involvement in policy development remains limited. Data gaps and structural barriers continue to constrain their impact. Strengthening practitioner leadership, research capacity, and policy engagement is essential to advance equity and drive health reform.