Nurse practitioner practice in Aotearoa New Zealand: national Nurse Practitioner Workforce Survey 2025

The nurse practitioner (NP, mātanga tapuhi) role was established 25 years ago in Aotearoa New Zealand. It enabled nursing autonomy to strengthen access, continuity and quality of care in areas under sustained health system pressure.¹ NP practice now spans primary, secondary and tertiary services.² NPs contribute through advanced clinical decision-making, first-contact assessment and treatment, and continuity of care for patients, whānau and communities. They also contribute through service leadership, education and system improvement.

As the NP workforce grows, the policy question shifts; it is no longer whether NPs should exist, but rather how NP roles are being integrated, enabled and sustained in ways that support full-scope practice and improve outcomes for patients, whānau and communities. Workforce strategy must look beyond growth to understand who NPs are, where and how they practise and what enables their contribution to the health targets and the health of New Zealanders.

Comparable jurisdictions have moved from encouraging NP registration to planned workforce development supported by routine reporting. Australia’s Nurse Practitioner Workforce Plan positions NPs as part of the response to access and demand across health and aged care and sets out actions to grow and enable the workforce.³ Ireland provides a second comparator where advanced practice is visible through national reporting.⁴ These examples show that workforce strategy depends on routine data that can be monitored and tracked over time. Similar data in Aotearoa New Zealand remain scarce.

The Nurse Practitioner Workforce Survey (NPWORKS) was established to address this gap. NPWORKS is a repeatable national dataset describing NP demographics, employment contexts, practice settings, and self-reported practising conditions including scope enactment, workplace support, professional development and burnout.⁵ Importantly, NPWORKS incorporates equity-related measures for the first time in a national NP survey. It captures perceived organisational enablement for equity-oriented practice, including support to meet Healthy Futures (Pae Ora) Act 2022 obligations and to deliver culturally safe care.

Earlier national survey rounds (2014–2022) demonstrated feasibility of repeat NP data collection and reported persistent constraints on NP practice.⁶ The 2025 NPWORKS survey extends this work by establishing a contemporary national baseline that includes demographic representation, practice settings, self-reported practising conditions and equity-related indicators. The study was guided by the question: What are the characteristics and practising conditions of NPs in Aotearoa New Zealand in 2025 and what do these data indicate about equity enablement, full-scope practice and workforce sustainability?

Methods

Study design and participants

The NPWORKS is a national, cross-sectional, self-reported survey. Eligible participants were NPs registered with Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand who held a current annual practising certificate when the survey opened (January 2025) and were practising in Aotearoa New Zealand. NPs who had been retired for more than 1 year were excluded.

Data collection

An electronic survey was administered using Qualtrics and remained open for 8 weeks (January–March 2025). Recruitment was distributed via professional networks, email and social media. Invitations were distributed through the College of Nurses Aotearoa, Nurse Practitioners New Zealand, the New Zealand Nurses Organisation, Te Kaunihera o Ngā Neehi Māori, Pacific nursing networks and Health New Zealand – Te Whatu Ora. Fortnightly reminders and weekly social media updates supported participation. Consent was provided electronically at the start of the survey after participants read the information sheet.

Survey instrument

Survey items were co-developed with NP researchers and the Māori NP Advisory Rōpū. Data included demographics, employment and role characteristics, practice environment, funding and support, professional development, self-reported burnout, and cultural safety. Respondents were routed into one of three practice pathways (clinical; both clinical and non-clinical; non-clinical), with pathway-specific item sets. The survey was pilot tested with six NPs, including Māori NPs, to confirm the clarity and relevance of the questions. Pilot responses were not included in the final analysis. Ethical approval was granted by Te Herenga Waka—Victoria University of Wellington Human Ethics Committee (Ref: 2024/HE000107). The survey questions can be found in the Appendix.

The anonymised data were stored in a password-protected database at Te Herenga Waka—Victoria University of Wellington. Responses were screened for coherence and internal consistency. Potentially identifying free-text was removed to protect anonymity. Missing data were recorded as missing.

Data analysis and definitions for data cleaning

This manuscript reports quantitative findings only. Descriptive statistics (counts and percentages) are presented by practice pathway. Regions are reported using Health New Zealand – Te Whatu Ora groupings (Northern; Midland Te Manawa Taki; Central Te Ikaroa; South Island Te Waipounamu). Patient- and whānau-facing care was defined as role activity delivered in direct contact with patients and/or whānau (in person or via telehealth), excluding roles that were solely education, management, policy, research or governance without routine clinical contact. This was the total of NPs practising solely in clinical, and both clinical and non-clinical roles.

Data were cleaned according to the following definitions. Primary care is defined as first-contact healthcare for individuals, whānau and communities. It includes health promotion and prevention, early diagnosis, treatment of common conditions and ongoing management of long-term conditions. Primary care services include general practice, community nursing, pharmacy, allied health and Kaupapa Māori and Pacific health services.⁷ Secondary care is defined as specialist care, most commonly delivered following referral from a primary care provider.⁸ Rurality was classified using the University of Otago Rural Health Research Network Geographical Classification for Health.⁹ This classification defines urban areas by population size and rural areas by drive time to the nearest urban area. Respondents used the survey map to self-identify their primary practice location as rural or urban.

Ethnicity was collected by self-identification using a “select all that apply” item (NZ European, Māori, Pacific people, Asian, Middle Eastern/Latin American/African, and Other) with free text.¹⁰ Multiple ethnicities could be selected and were retained as multiple responses for reporting.

To reduce instability from small cell sizes and improve interpretability, results for practice area and employer are limited to the 10 most frequently reported practice areas and five most common employer categories. For reporting, response categories were collapsed to improve clarity and reduce small cell sizes. For example, support to meet Pae Ora obligations was collapsed into minimal, moderate and complete support. Collapsing rules were applied consistently across descriptive analyses.

Results

Respondents accessed the survey link 667 times. Of these, 119 respondents did not provide usable responses (viewing the information material only) and three provided limited demographic data and were excluded. The analytic sample comprised 545 responses for analyses, representing 61% of the 897 registered NPs with Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand at the time of the survey.¹¹ The Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand quarterly report did not provide ethnicity-specific counts for Māori and Pacific ethnicity. Therefore these data are presented as characteristics of the NPWORKS sample rather than as proportions of the national registered NP workforce. Seventy percent (381/545) of surveys were ≥95% complete, with only one missing item.

Nearly all respondents (537/545, 99%) were engaged with patient- and whānau-facing care. Across all groups, respondents were predominantly NZ European, urban-based and employed in patient- and whānau-facing roles, particularly within Health New Zealand – Te Whatu Ora and primary healthcare/community services (Table 1).

Demographics

View Table 1–5, Figure 1.

The distribution shows that clinical NP practice was most commonly reported in primary healthcare, with smaller but consistent representations in acute care and specialist services (Figure 1). Full results available in Appendix Table 1.

Among respondents practising in both clinical and non-clinical roles (n=96), the 10 most frequently reported areas reflected a mix of clinical, education and leadership work. Primary healthcare was most commonly reported (43, 45%). Education (42, 44%) and academic roles (31, 32%) were frequently selected; overall, 52 respondents (54%) reported either education or academic work. Leadership was reported by 41 respondents (43%), and policy and professional advisory roles were each reported by 14 (15%). Other commonly reported clinical areas included medical practice (20, 21%), emergency and trauma (19, 20%), community nursing (13, 14%) and care of older adults (13, 14%).

Of the eight respondents practising in non-clinical roles, academic practice was most frequently reported (n=5), followed by educational and leadership roles (each n=3). Policy roles were reported by one respondent.

Reported NP contributions to equity

Responses to equity-related indicators differed by ethnicity (Table 2). Māori respondents reported mixed organisational support but strong clarity about the equity contribution of the NP role. Pacific responses were broadly similar, but should be interpreted cautiously because of small numbers. Asian respondents reported the least clarity in meeting equity measures. Among all other ethnicities, support for culturally safe care was stronger than support for Pae Ora obligations or equity-focussed role clarity (Table 2).

Reported enablers and barriers to practice

Among 441 respondents practising clinically, workplace support levels were similar by rurality. Approximately 25% of respondents reported being well to fully supported in both rural and urban practice (22/92, 24% rural; 85/346, 25% urban), 32% reported being somewhat supported (29/92, 32% rural; 111/346, 32% urban) and nearly 30% reported not being supported to minimally supported (27/92, 29% rural; 87/346, 25% urban). Missing responses were comparable between rural (15%) and urban (18%) respondents. Further stratification of perceived equity contribution by reported organisational support is presented in Appendix Table 3.

NPs reported across practice area that workplace support to practise safely was consistently high (75–87%). Reported practising to top of scope ranged from 58% to 86% and was more common in rural than urban respondents (83% vs 71%).

Respondents reported on two types of barriers: NP scope-of-practice constraints (prescribing and access to investigations) and broader patient access barriers to care. Across the 10 most common areas of practice, barriers to prescribing were reported by more than half of respondents (50–74%), with the highest proportions in primary healthcare, mental health, care of older adults and palliative care. Barriers to laboratory investigations were uncommon overall, but were reported more frequently in mental health. Reported barriers to radiology investigations varied by practice area and were most frequently reported in primary healthcare, youth health and nursing education. Reported barriers were similar in rural and urban settings. Detailed results by practice area, employer and rurality are provided in Appendix Table 2. These data were collected before the Section 29 (of Medicines Act 1981) legislative amendments which removed barriers to NP prescribing.¹² Therefore, these data may not reflect current practice.

However, when clinically practising NP respondents were asked what the barriers to overall healthcare for their patient population were, financial constraint (315/441, 71%) was the most common barrier. This is closely followed by limited access to primary care services (275/441, 62%), limited access to specialist services (277/441, 63%) and poor health literacy (283/441, 64%). NPs reported that they considered patients were less likely to be constrained by transportation (216/441, 49%) and language or cultural barriers (187/441, 42%).

Self-reported burnout

Across practice settings, patterns in reported burnout were most evident for factors related to job design and rurality. Higher levels of high to severe burnout were reported by NPs who indicated expected work outside professional development time, reported by approximately one in five respondents. Higher burnout was also reported among those without allocated funded time for staff education.

Burnout levels varied by length of registration and contracted hours. Moderate to severe burnout was most prevalent among NPs in the lowest full-time equivalent (FTE) category, with approximately one-third of those practising <0.6 FTE reporting high to severe burnout. Reduced contracted hours were not uniformly associated with lower burnout.

Across the 10 most common clinical areas of practice, no single area consistently reported the highest levels of moderate to high-to-severe burnout. This pattern indicates that differences in burnout are not related to clinical specialty alone.

Burnout also differed by rurality. Rural NPs reported higher levels of high to severe burnout than their urban counterparts, with approximately one-quarter of rural respondents reporting high to severe burnout compared with around one in eight urban respondents (Table 4).

Patterns of reported burnout varied by future work plans among clinically practising NP respondents. Those planning to retire within the next 5 years reported substantially higher levels of high to severe burnout than those not planning retirement. Differences by succession planning status were more modest, with higher levels of high-to-severe and moderate burnout reported by respondents working in settings without succession planning (Table 5). Among respondents (n=96) practising in both clinical and non-clinical roles, burnout levels varied. No single practice area demonstrated a distinct concentration of high to severe burnout. Across academic, educational, policy and leadership roles, 15–21% of respondents reported high to severe burnout. Across non-clinical roles, most respondents reported none-to-slight or moderate burnout. High to severe burnout was reported by 19% in academic roles (6/31), 17% in educational roles (7/42), 21% in policy roles (3/14) and 15% in leadership roles (6/41).

Discussion

Nearly 25 years after NP registration in Aotearoa New Zealand, NPWORKS 2025 provides the first nationally co-ordinated, survey-based profile of contemporary NP practice. Co-designed and co-led with Māori nurse leaders and NPs, the survey captured responses from 61% of the registered workforce at the time of data collection, establishing a national baseline for longitudinal monitoring. Most respondents reported patient- and whānau-facing roles, indicating a predominantly clinical workforce embedded in direct service delivery. NPs were commonly reported in primary healthcare and emergency and trauma, consistent with deployment in first-contact services under sustained access and flow pressure.¹³ Roles were reported across urban, regional and rural settings, indicating NP contribution in locations where continuity, access and workforce stability remain ongoing challenges.

NPWORKS strengthens visibility of equity-oriented advanced practice. Equity indicators were selected a priori by the NPWORKS Steering Group to capture perceived organisational enablement for equity-oriented NP practice, including support to meet Pae Ora obligations and workplace support to deliver culturally safe care. Māori NPs reported high clarity about their role in reducing health inequities. This aligns with Māori nursing scholarship that positions advanced practice as grounded in Kaupapa Māori principles, which enhances the delivery of safe and equitable healthcare.^14,15 Komene and colleagues concluded that Māori NPs felt supported in fostering relationships with patients and whānau (whānaungatanga) when their employer placed a strong focus on cultural principles.¹³ NPWORKS demonstrated that support to meet legislative obligations varied. This indicates a gap between Māori NPs’ capability, equity intent and organisational enablement to meet the obligations. This gap is difficult to reconcile given Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand expectations for Te Tiriti o Waitangi–aligned, culturally safe NP practice that seeks to eliminate health inequities.¹⁶ In order to support practice and improve patient and whānau outcomes, equity intent must be matched with resourcing, along with Māori NP–governance voice, and routine equity measurement.

Pacific NPs were few in NPWORKS. This is not a sample limitation. It reflects a continued urgent workforce signal. There were only 12 Pacific NPs recorded in 2022/2023.¹⁷ This matters because Pacific people continue to experience substantial health inequities. Te Mana Ola: The Pacific Health Strategy identifies growth of the Pacific health workforce and leadership as central to improving Pacific health and wellbeing.¹⁸ Half of Pacific respondents reported high clarity that the NP role contributes to reducing health inequities. However, small numbers limit interpretation. Pacific advanced practice nursing remains poorly visible in national workforce reporting. NPWORKS can help address this gap by monitoring Pacific NP participation and experience over time.

NPWORKS also separates perceived safety from scope enactment. Most respondents reported supportive environments to practise safely, however, fewer reported practising to their full scope. This pattern was observed across areas of practice, employer groups and rurality. This suggests that general support does not reliably translate into conditions for full-scope enactment. Both within Aotearoa New Zealand and internationally, NPs report an implementation gap or “invisible ceiling”, whereby local job design, governance arrangements and service expectations constrain advanced nursing practice, despite regulatory authorisation, and prevent full-scope practice.^19–22 NPWORKS enables these conditions to be tracked over time. It also provides a basis to examine whether policy and organisational changes reduce constraints on scope enactment. For example, prescribing barriers relating to Section 29 of the Medicines Act 1981 were prominent at the time of the survey; this restriction was removed when the Medicines Amendment Act 2025 received royal assent on 18 November 2025¹² and commenced immediately, enabling the next NPWORKS wave to assess whether reported constraints on full-scope practice reduced following this reform.

Burnout of NPs affects access, continuity and patient outcomes.^23,24 It also signals risk to NP role sustainability. Recent Aotearoa New Zealand evidence from the NP transition programme identifies burnout as part of the experience of newly registered NPs, reinforcing the importance of role support.²⁵ NPWORKS’ findings related to self-reported burnout show that high to severe burnout is clustered with job design and support factors. A greater proportion of rural respondents reported high to severe burnout than urban respondents. A greater proportion of those planning retirement within 5 years reported high to severe burnout than those not planning retirement. These patterns identify pressure points for workforce planning and service resilience. In NPWORKS, burnout is not simply a wellbeing issue: it is an early warning sign for workforce loss. Employers, services and policymakers cannot rely on goodwill to sustain NP practice. This means burnout should be treated as a workforce and service-delivery indicator, as failure to act will compromise the stability, reach and future contribution of the NP role.

NPWORKS shows that constraints on NP practice sit alongside structural barriers to care for patients and whānau. Scope-of-practice barriers (prescribing and investigations) reflect legislation that can limit full-scope practice. In contrast, respondents identified financial constraint and limited access to primary and specialist services as the main barriers to healthcare for their patient population. NPs are well educated to assess, manage and co-ordinate care in complex situations, including when social and system barriers shape what is possible for patients, whānau and communities. This aligns with nursing’s social justice mandate and includes using clinical and professional voice to advocate for patient, whānau and community needs.¹⁶ The workforce implication is that enabling full-scope NP practice in high-need, first-contact services protects clinical capacity where barriers are greatest.

NPWORKS 2025 provides the infrastructure to move from description to evaluation. Distribution and self-reported conditions are necessary but are insufficient on their own to demonstrate value. The next phase in Aotearoa New Zealand is outcomes-focussed evaluation. It must link NP models of care to access, timeliness, continuity, safety, equity indicators and cost. NPWORKS supports this work by tracking where NPs practise and which practice conditions enable expert patient and whānau care that meets community need.

This national, self-reported, cross-sectional survey reflects perceptions rather than objective measures. Recruitment via electronic distribution and professional networks may have introduced selection and non-response bias. Small sub-group sizes, particularly for Pacific NPs, limit precision and prevent detailed sub-group analysis. The cross-sectional design prevents causal inference between workplace conditions, scope enactment and wellbeing. Measures were not uniformly validated. Burnout was measured using a single-item question to minimise respondent burden in a national workforce survey as this provides a pragmatic screening indicator rather than a diagnostic or fully validated burnout measure.²⁶ However, future NPWORKS cycles focussed on domains such as burnout should incorporate validated instruments. We use “top of scope” in the questionnaire to describe perceived ability to practise at NP education and authorisation level. We recognise variable interpretation of “top of scope” across employers and contexts.

Conclusion

NPWORKS 2025 shows that NPs are a patient- and whānau-facing workforce embedded in direct service delivery across primary, community and hospital settings. The distribution of NP practice across first-contact services and specialist areas suggests a flexible clinical workforce contributing to service capacity and continuity of care in a system under sustained access and flow pressure. The reach of NP roles across urban and rural practice further indicates contribution to local service coverage where workforce stability is often challenging. NPs are not peripheral; they are the frontline clinical capacity for patients, whānau and communities. NPWORKS shows where that capacity sits and what must change to protect it, including full-scope enablement, equity support and retention.

View Appendix.