New Zealand's first prescribing pain nurse practitioner

A Waikato Hospital nurse who says she is passionate about pain management is now New Zealand’s first pain nurse practitioner able to prescribe medication herself.

Sue King, 54, a nurse for 33 years, describes her journey to becoming a nurse practitioner as a natural one given the work she’s been doing at Waikato Hospital since 1995, when the acute pain service was established.

Nurse practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills.
They practice both independently, in collaboration with other health care professionals to promote health, prevent disease, and to diagnose, assess and manage people’s health needs.

Not all nurse practitioners have prescribing rights – New Zealand’s only other nurse practitioner in pain management Judy Leader of Mid Central has elected not to attain prescribing rights.

Having the ability to prescribe for patients who have pain problems is central to Ms King’s work at Waikato Hospital.

“I’m often the senior nurse on the pain round and we do clinical rounds every day. The doctors look to me for advice, I’m always suggesting or recommending and now I can prescribe things myself. I don’t have to rely on junior doctors,” she said. There are some limitations though. King can only prescribe anti-emetics, laxatives and analgesics - drugs used to relieve pain - and even within that, there are some limitations.

King’s journey to becoming a nurse practitioner began in Timaru at high school when there were few career options for women. While never considered a candidate for university, her two brothers were. Funnily enough of the three of them now, she is the one with the highest tertiary qualifications.

“Nursing was one of the options. I read the Sue Barton books, and I had this romantic notion I’d get married to a med student.”

She trained in Christchurch staying the first year at the Hagley Nurses Home and then the next two years in a flat with two other girls from high school. Even before she knew whether she had passed her state finals, King and her flatmate Helen Bennett had their tickets booked for their OE in England. King worked as a barmaid, in a department store and did a bit of private nursing while Helen, who had intended to make use of her Fine Arts degree to research New Zealand artists living in the UK, also did a series of casual jobs.

When King decided she wanted to go back nursing several months later she applied for English registration, which required three months work. She worked at Kingston Hospital and because her interest had always been as a surgical nurse King’s first post-registration job was as a night nurse on a 27-bed mixed surgical ward.

After five years in the UK, and shortly after she’d broken up with a long term boyfriend who fortuitously worked for British Telecom which allowed King to regularly call home at a time when international calls were expensive, King was homesick for New Zealand.

She went home for a holiday but back in London, she was miserable, sick and working aimlessly at a nursing agency.

Then the opportunity, which resulted in her nurse practitioner status today, presented itself. She got a job at Royal Marsden in Sutton as a nurse and it was here she did a nine-month cancer course.

In 1982, she came home for good and it was her mother who was instrumental in getting King a job at Waikato Hospital through the coincidental meeting with another nurse called Sue Hurst.

“I came to work in the cancer care department. I bought a home in Hamilton and settled roots here. I’ve had a great career here and the people here that I’ve worked with over the years are great. I’ve been very well supported.”

King has had a number of positions within Waikato Hospital, culminating in her present role as clinical nurse specialist for the inpatient pain service. When the pain service was established, King was a novice pain management nurse but was desperate to learn.

“As I got more knowledgeable about pain, my interests grew and there was this natural progression into being a nurse specialist. And then I got involved at a national level with other nurses in similar roles. It was great and we formed a national group that’s grown from those early beginnings.”

King has completed a lot of writing, teaching and research. “I’ve got to a point where I can’t do anything further with the nurse specialist role. I wanted to be able to do more, especially with regard to being able to prescribe.”

She had a crack at becoming a nurse practitioner a year ago but missed out, and during this past year has completed her qualifications to being a prescriber.

So with her second sit she reflected on the sorts of things she was unable to demonstrate and articulate well the first time. She also had a huge amount of support and encouragement from Deborah Harris, who has been King’s mentor throughout this process.

To become a nurse practitioner, candidates must submit a portfolio of evidence. King’s was 272 pages long and involved six competencies.
The presentation was in Wellington before the Nursing Council. Sitting on the panel was a doctor and nurse in the pain field, a nurse educator, nurse manager and a representative from the council.

The panel normally starts at 10.30am but King and her supporter Waikato Hospital anaesthetist Dr Chris Jephcott were stuck in fog bound Hamilton.
Eventually they got to Wellington. Usually the panel makes the decision on the day and lets the candidate know immediately.

However, because of the fog delay, King had to wait until early the following week. When the call came, she was teaching at Wintec and missed it. She rang back from the solitary comfort of her car.

“I was so excited. I told the tech lecturer, rang my partner, told him, and then rang Bronnie (Pester) our other pain nurse. I came back to work, left messages for everyone including (Health Waikato chief operating officer Jan Adams who was the director of nursing when King started as a pain nurse). “Jan has always been very supportive and very encouraging of me for a long time, as indeed have many in the hospital, including the anaesthetists who work with me directly in the pain service and other nurses,” said King.

“There are some important projects I want to work on now. One is screening for risk.”

King hopes that all patients coming into Waikato Hospital for elective surgical procedures and possibly those admitted with trauma, will eventually be screened. Specific factors are known to place individuals at higher risk of severe postoperative pain with the potential if it isn’t managed well to go onto developing chronic post surgical pain. A pilot tool developed by King is about to be trialled at Waikato Hospital.

“What I hope this tool will do is flag people at risk which will alert the anaesthetists so we can then think about their pain management in a more timely and comprehensive way in order to minimise the impact of post surgical pain.”

Discharge communication from the hospital to the patient and GPs also needs to improve.

That’s another project King wants to nail. “We need to have better communication with the primary healthcare sector, especially regarding the patient’s pain management plan.”

So there are work projects but King’s not all about work. Outside the hospital she has a number of interests including travelling, reading, scrapbooking and gardening. She and her partner Robin Stewart are busy landscaping their new Rototuna home, with Robin doing the majority of the work.

It’s been quite a journey for King from novice to nurse practitioner.

You get the feeling the journey is just beginning to something else.