Nurse Practitioner History
Endorsed is not the same as employed: what 34 years of NP regulation actually tells us
n December 2000, two Australian nurses held nurse practitioner endorsement. By mid-2025 there were 3,194. But the share of endorsed NPs actually working in an NP role has been falling — and a new analysis in the Journal of Nursing Regulation explains why.
Endorsed is not the same as employed: what 34 years of NP regulation actually tells us Category: Policy & Regulation Suggested slug: endorsed-is-not-the-same-as-employed Author: EndorseMe Tags: nurse practitioner, AHPRA, NMBA, scope of practice, Medicare, workforce Reading time: ~7 min
Excerpt: In December 2000, two Australian nurses held nurse practitioner endorsement. By mid-2025 there were 3,194. But the share of endorsed NPs actually working in an NP role has been falling — and a new analysis in the Journal of Nursing Regulation explains why.
Meta description: A new analysis of 34 years of Australian NP regulation shows endorsement numbers rising while the proportion working in NP roles falls. Here is what it means for nurses on the endorsement pathway.
In December 2000, two nurses in Australia held endorsement as a nurse practitioner. By mid-2025 there were 3,194.
That is an extraordinary thing to have built in a working lifetime. It is also, on its own, a misleading number.
Because over the same period the proportion of endorsed NPs actually employed in an NP role has been going the other way: 67% in 2020, down to 63% in 2024. More than one in three endorsed nurse practitioners in this country are not working in an NP position — in a health system that is short of clinicians almost everywhere you look.
A new open-access analysis in the Journal of Nursing Regulation traces how we got here. Nicole Carter and colleagues at Curtin University mapped every significant piece of NP legislation, regulation and funding reform from 1991 to 2025 and asked a blunt question: if the law has expanded NP autonomy for three decades, why hasn't practice followed?
The answer is worth understanding, whether you are two years into a portfolio or twenty years into a career.
Thirty-four years in five phases The authors group the whole trajectory into five phases, and once you see them, a lot of the confusion in this space falls away.
1991–1999 — Experimental Foundation. It starts in New South Wales. Ten pilot NP models were trialled between 1992 and 1995, largely in rural and remote services, and the evidence from those pilots produced the Nurses Amendment (Nurse Practitioners) Act 1998 (NSW) — the first Australian law to let a nurse practise with expanded clinical authority, including supplying and administering scheduled medicines.
2000–2008 — State-by-State Recognition. The first two endorsements land in December 2000. Victoria, South Australia and the ACT build their own frameworks. What you get is eight jurisdictions with eight sets of definitions, criteria and authorisations — and an NP authorised in one state who could not simply practise in another. The Australian College of Nurse Practitioners (then the Australian Nurse Practitioners' Association) is founded in 2003 into exactly that fragmentation.
2009–2010 — National Coordination. Eighteen months that reshaped everything. The Health Practitioner Regulation National Law Act 2009 (Qld) — with Queensland acting as lead jurisdiction and every other state and territory mirroring it — creates Ahpra, and the NMBA takes carriage of endorsement standards. National registration commences July 2010. From 1 November 2010, NPs get MBS provider numbers and PBS prescribing.
There is a catch, and it defines the next fourteen years: both were conditional on holding a collaborative arrangement with a medical practitioner.
2011–2023 — Constrained Growth. The workforce grows anyway: roughly 123 NPs in March 2012, about 2,737 by late 2023. But growth happens despite the settings rather than because of them. State and territory poisons legislation still governed prescribing separately from national endorsement, so what you could actually prescribe depended on your postcode, not your endorsement. Most jurisdictions aligned between 2011 and 2020; Tasmania did not complete the process until 2025.
The 2018–2020 MBS Review is the clearest single illustration. The NP Reference Group put forward 14 recommendations for expanded Medicare access. The MBS Taskforce endorsed none of them.
2024–2025+ — Independent Eligibility. The Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Act 2024 passes with bipartisan support and commences 1 November 2024. NPs can access MBS and PBS-subsidised prescribing independently, within their scope. New MBS items follow: chronic disease case conferencing, point-of-care STI testing in remote settings, and the first procedural items — burns dressings, intradermal areola colouration, then in 2025 surgical assistance and long-acting reversible contraceptive insertion and removal.
This phase is still open. That matters.
The divide that explains almost everything Here is the analysis's central argument, and it is the thing to take away.
In Australia, the power to authorise NP practice and the power to fund it sit in different places. Professional regulation was harmonised nationally in 2009–2010. Medicare and the PBS remain Commonwealth instruments. Scheduled medicines remain state and territory law.
So when regulation expands and funding does not, you get exactly what the workforce data shows: rising endorsement, flat or falling utilisation. The authors describe it as a persistent divide between regulatory authorisation and funding eligibility — and they argue it is the primary constraint on the NP workforce, not scope, not education, and not safety.
The paper reads the whole timeline through three policy lenses. Reform advanced in careful sequenced steps, each pilot buying the credibility for the next (logical incrementalism). Collaborative arrangements survived for roughly a decade after the evidence against them was clear (strategic drift). And eight jurisdictions solved the same prescribing problem eight different ways (disjointed incrementalism). Those are academic terms for things every NP has experienced as friction.
Collaborative arrangements: a compromise that outlived its rationale Collaborative arrangements were introduced in 2010 as the price of Medicare access. They were framed as a clinical safeguard. The literature from the mid-2010s onward increasingly described them as a structural barrier — most acutely in rural and remote settings where the required medical practitioner may simply not exist.
The authors make a sharper point than "it took too long." They argue the dependency was designed in, not implemented badly. That is a lesson worth holding onto: a compromise accepted to get a reform across the line can be far harder to remove later than it was to introduce.
Their other observation is about how reform actually happens. Evidence did not drive change on its own. Change came when good evidence met a political window and an organised profession ready with a worked-up proposal — 2010, and again in 2023–24 after the Nurse Practitioner Workforce Plan set out 25 actions with timeframes and accountability. Collaborative arrangements were gone within 18 months of that plan's publication.
What is still in the way The 2024 repeal was real and significant. It was not the end of the story. The analysis identifies constraints that are now operational rather than regulatory:
The Bulk Billing Practice Incentive Program does not extend to NP-led clinics. MyMedicare ties enrolment and blended-funding incentives to an accredited general practice with a nominated preferred GP — recreating gatekeeping through funding design rather than through a formal collaboration requirement. Allied health referrals. An NP managing a musculoskeletal injury or a mental health presentation still cannot generate the referral that attracts an MBS rebate for physiotherapy, podiatry or psychology. The patient needs a separate GP consultation for care the NP is already providing. PBS restrictions. Around 40 medicines still require shared-care arrangements for NP initiation; "Continuing Therapy Only" and Section 100 Highly Specialised Drug rules persist. Telehealth eligibility rules, including established-relationship criteria, which the ACNP has argued put services to marginalised patients at risk. Public-sector NPs are not exempt. Salaried positions buffer the billing problem, but service design, credentialing pathways and workforce planning models built around fee-for-service assumptions produce the same drag by another route.
What this means if you are on the pathway Three things.
First: endorsement is necessary and it is not sufficient. That is not a reason to slow down — the whole shift of the last two years has been in your favour. But the moment endorsement lands, the questions change from regulatory to operational: what does this service fund, what will it let me refer, how does this model of care actually pay for itself. Plan for both, not just the first.
Second: build your portfolio to describe a role, not just to clear a threshold. The endorsement–employment gap in that data is partly a story about roles that were never designed. Evidence that shows what you can safely and independently manage is the same evidence that makes the business case for a position later.
Third: this is a live phase, not a settled one. MBS items, PBS listings and program eligibility have all moved in the last 24 months and will keep moving. Anything you were told about NP funding before November 2024 needs re-checking before you rely on it.
The regulatory argument in Australia has largely been won. The funding and service-design argument is the one still open — and it is the one that decides whether a nurse practitioner endorsement becomes a nurse practitioner job.
Source Carter, N. W., Helms, C., Gower, S., & Brown, J. A. (2026). Evolution of clinical autonomy: A critical analysis of nurse practitioner regulation in Australia, 1991 to 2025. Journal of Nursing Regulation, 17, 161–172. https://doi.org/10.1016/j.jnr.2026.04.002 (Open access, CC BY.)
All workforce figures, dates and policy milestones in this article are as reported in that study, which draws on NMBA registration statistics and the Department of Health and Aged Care's national health workforce data set. Nothing here is regulatory, legal or financial advice — check current requirements with Ahpra, the NMBA and Services Australia before acting on them.