Sep 2016

Meet the…nurse practitioner
There are 175 nurse practitioners (NPs) in New Zealand, but Carol
Slight is the only one working in ophthalmology. Jai Breitnauer
finds out more
I
meet Carol Slight on one
without having to involve
of her non-clinical days
anyone else, however, there
at Greenlane Clinical
are certain sub-specialities I
Centre where she is based
and, over a hot chocolate
at Muffin Break on campus,
discover just how busy
Carol’s life is. She runs
glaucoma clinics, uveitis
clinics, works alongside
several ophthalmologists
and also goes off-site to
assist at satellite clinics in
other parts of Auckland,
including Waitakere Hospital.
She has her own patients,
works largely autonomously,
and is required to participate
in 40 hours of continued,
professional development
education each year, and
is audited by the Nursing
Council every three years.
“It’s quite hard to become
a nurse practitioner,” Carol
admits, “It was a seven-year
process for me. Perhaps
Carol Slight is New Zealand’s only nurse practitioner in ophthalmology
feel more comfortable in, and
certain things I don’t do by
choice. For example, I don’t
give Avastin injections for
AMD patients although that
could always be a possibility if
I underwent the training and
audit process.”
Anything related to
narrow-angle glaucoma, laser
treatment or patients with
a complicated condition, or
who perhaps need surgery,
are also referred quickly to a
consultant if they end up in
one of her clinics, she adds.
“I have consultants I can
call on, and I have a lot of
support. It’s about buy-in, and
getting that comes through
cultivating trust. They know I
won’t push my boundaries.”
One of the biggest
challenges for Carol is her
that’s why there are so few of us.”
The role of nurse practitioner is relatively new. It was
introduced in 2001 to help ease patient waiting times and
manage an ever-increasing workload in our health care
system. Nurse practitioners are registered nurses who have
completed a masters in nursing, worked in an area at an
advanced level for at least four years and are registered
with the Nursing Council after an intensive portfolio
assessment and oral interview. Nurse practitioners are
registered in a specialist area, but still have a holistic
approach to the care of patients. They bridge a care-gap for
groups of patients who need expert assessment, but who
do not require a consultant.
“I’m a hospital-trained nurse who qualified in 1980 and,
apart from a few years out when I had my three children,
I’ve always worked within an ophthalmology setting,” Carol
says. “I wanted to further my skills, so I took a Masters of
Nursing, and part of my dissertation was looking at the role
an NP can play in relieving the pressure on waiting times for
glaucoma referrals within a defined scope.”
Carol qualified as an NP in 2007 and began practicing
in 2008.
The role of an NP is quite a lot more advanced than a
registered nurse, even for those working in specialist areas,
and Carol has made the job her own. But she stresses the
collaborative nature of the work she does and the unique
role she has.
“As an NP, I can assess, diagnose and prescribe within
my scope of practice. I see, and treat, a lot of patients – in
fact I probably see more uveitis patients through my clinic
than many junior doctors. But I also work very closely with
ophthalmologists and I learn a lot from them.”
Carol also says as a nurse practitioner you have to be both
confident in your skills and know where the boundaries of
your role end. This is important, not just for the safety of
patients, but also to maintain a good working relationship
with other healthcare professionals – some of whom may
not fully understand the scope and skills an NP has.
“I get referred the lower-risk patients, or patients who
are transferring from private to the public system. I do
initiate treatment under some circumstances, and it is
possible for me to see a whole patient episode-of-care
requirement for continuing education. As the only
ophthalmology NP in New Zealand, she finds her needs
aren’t necessarily catered for by current educational
programmes.
“At the RANZCO conference, I spent more time in the
doctors’ conference than in the nurses’ room,” admits
Carol, who was a speaker at the nurses’ meeting this year.
“I do get some additional funding to attend overseas
meetings and events, as I don’t always get what I need
from local programmes. I’ve previously been to the World
Glaucoma Congress in Hong Kong and Canada, and I’m
hoping to go to the International Ocular Inflammation
Society conference in Switzerland next year.”
Another issue Carol has to face is making sure other
professionals understand the full scope of her role,
although this is a journey all NP’s have to face, she says,
particularly when undertaking roles that traditionally have
been the domain of medics.
“As trailblazers we’ve all had to pave the way, but I
think we’ve all found it has run smoothest when we work
alongside someone more senior as a mentor.”
Carol says she’s grateful for the support she has had
within ophthalmology circles in Auckland. “The scope of
my role is increasing now, and also the understanding
of what I do is getting wider. I have recently worked
with ophthalmologists in other parts of New Zealand on
working groups looking at elective surgery prioritisation.”
Ultimately, the part of the job Carol most enjoys is its
personal nature; seeing patients regularly, helping them
and making connections.
“I had patients who were with me through the birth of
my first grandchild. These patients always ask how many
grandchildren I have now. My patients share things with
me as well. You make friends, build personal relationships,
and live through the highs and lows of their lives.” ▀
An apology: In our July 2016 issue we wrongly
described Carol Slight as a clinical nurse specialist in our
post-RANZCO coverage, instead of nurse practitioner:
ophthalmology. However, we are actually grateful for
this mistake that led us to meet Carol in person and learn
about her interesting and very individual role. Thanks for
your time, Carol.
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