To celebrate International Nurses Day this year, Nursing Review once again invited district health boards and organisations across the country to contribute stories on their nursing ‘heroes’. Yet again we were sent amazing stories about some of the unsung, innovative, compassionate, high-achieving and dedicated nurses who make up the New Zealand nursing workforce. Read on…
Blanket screening for family violence in primary health is the dream of family violence intervention champion Debs Higgins.
NAME | Debs Higgins
JOB TITLE | Hawke’s Bay
LOCATION | Family Violence Intervention Programme coordinator, The Hastings Health Centre
Debs Higgins is clearly embarrassed by the title “nursing hero”. When asked how she qualifies for such an honour, she immediately offers a self-deprecating response, which in turn draws an interjection from a nearby colleague: “Yes, she is [a hero]. She is”.
A nurse with 26 years’ experience, Higgins spent the first 21 years at the Tairawhiti District Health Board and the past five years with The Hastings Health Centre (HHC).
The farmer (managing a property with her husband) and mother of three children aged 10 to 17 recently added a Master of Nursing degree from EIT in Taradale to her list of accomplishments. Her thesis, predictably enough, was on family violence intervention. It drew on five years of statistics and data from the Hastings Health
Centre’s screening programme.
Higgins took over as the Family Violence Intervention Programme coordinator at the centre in 2011, with routine screening of women and children having started at HHC three years earlier. The programme was initially developed with support from the Hawke’s Bay District Health Board (HBDHB) and the Hawke’s Bay Medical
Research Foundation, and HHC was the first primary care provider in New Zealand to establish such a programme. “Screening is across the board here. It’s entrenched in daily activity – a cultural norm,” she
says.
“We have more than 40 nurses, 25 doctors and most of our receptionists involved in it, all ably supported by our champions team of 10 family violence intervention champions (nine nurses and a doctor), a clinical support nurse and myself.
“It would be my dream that every doctor and nurse is routinely screening at every opportunity, because the opportunities are great. Eighty per cent of women see their GP once a year. And it’s known that the victims of domestic violence see their GP seven times more often than non-victims.
“While our programme has been adapted to suit primary care from the VIP programme used in hospitals, in reality we have more potential to come across the victims of violence in primary care than the hospital system does.”Higgens says that a blanket screening approach is what is needed in primary care but it’s not happening yet.
Once the ‘red flag’ is raised, it is time to refer victims on to relevant agencies and experts. To celebrate International Nurses Day this year, Nursing Review once again invited district health boards and organisations across the country to contribute stories on their nursing ‘heroes’. Yet again we were sent amazing stories about some of the unsung, innovative, compassionate, high-achieving and dedicated nurses who make up the New Zealand nursing workforce. Read on…
International Nurses Day Celebrating International Nurses Day ‘heroes’ “We’ve had 13 perpetrators ask for help for their family violence problem since screening started at The Hastings Health Centre,” says Higgens.
“Our programme covers the spectrum – elder abuse and neglect, child abuse and neglect, partner screening, victims of sexual assault. It was initially an in-house programme but now, in collaboration with Health Hawke’s Bay (PHO) and with support from HBDHB, we train other doctors and nurses.”
Higgens says it’s important to recognise that family violence is not defined by religion, socioeconomic factors or ethnicity.
“I live rurally, and there are a lot of stressed rural men. So things can go wrong in that community, which is often viewed by those outside it as wealthy. There is no one stereotype. Some are just more adept at hiding it.”
Dr Faye Clark of Doctors for Sexual Abuse Care recently described The Hastings Health Centre as a “centre of excellence” for family violence intervention in primary care.
Jan Millar helps families keep their heads above water while they are being swept along by the turbulent current that is child cancer.
NAME | Jan Millar
JOB TITLE | Canterbury
LOCATION | Nurse practitioner (paediatric oncology)
Jan Millar is a hero to many of her young patients as well as their families, says Canterbury DHB. Millar herself prefers to be seen as a consistent and steady support for families of children with cancer, helping them to navigate along a sometimes very frightening path.
Millar trained as a specialist children’s nurse at Great Ormond Street in the UK. She joined Christchurch Hospital’s paediatric department in 1997 and took on the role of clinical charge nurse in 2001 to establish the Children’s Haematology and Oncology Centre (CHOC). In 2011 Millar started the journey to become a nurse practitioner,
which she completed in 2013.
“It’s a very rewarding role… it’s the ultimate really. I get to be involved all the way along and see the patient’s care right through – from the time they are first admitted to the time they leave – and for some patients it can be up to three years later after all their treatment, various surgeries, to then going into remission,” Millar says.
“Seeing different faces all the time can be really daunting for a young child, not to mention parents and caregivers. I can be with them during those times, and also can talk them through it beforehand.”
Millar has extended her practice to the complete management of oncological emergencies. “I can complete the whole process from initial assessment to prescription of antibiotics and fluids. It makes the process simple, quick and very reliable.”
Millar always sees the positives when working with children with cancer and their families.
“It’s a very complex, challenging area for young doctors and nurses who are new to it. I can bring them up to speed and remind them of the positives – when I started in this field in 1981 the survival of children with leukaemia was less than 50 per cent; now, for some types, it is well over 90 per cent.” Amanda Lyver, CHOC clinical director, says Millar has played a key role in the Paediatric Oncology Department since its beginnings at Christchurch Hospital.
“Jan has been a ward nurse, charge nurse manager and is now a nurse practitioner. One of Jan’s great skills is her ability to explain things to parents in a manner that makes what their child is experiencing seem less scary and more manageable – she empowers parents when they are feeling vulnerable.”
’Tough customers’ are now turning up for appointments more and more often since Jane Dutton joined Whanganui’s Castlecliff Health nearly six months ago.
NAME | Jane Dutton
JOB TITLE | Whanganui DHB
LOCATION | Nurse practitioner (primary health care)
Jane Dutton is under no illusion about how tough life is for many of her patients living in Whanganui’s beachside suburb Castlecliff. It’s an area of high deprivation, with all the challenges that go with that. But right now,
Dutton says she wouldn’t want to be working anywhere else.
Dutton is one of the country’s 50 qualified nurse practitioners in primary health, a qualified midwife and a prescriber, and currently is the only nurse practitioner in the Whanganui region.
In the five months since she joined forces with practice owner Dr Praveen Thadigiri, Dutton knows the two of them have made a difference. The pair has earned the trust of patients, including some of their ‘toughest customers’ who in the past refused to attend doctor’s appointments and are now coming to the health centre on a regular basis. In addition, Castlecliff Health has now achieved a 100 per cent immunisation rate for children less than eight months old.
Dutton says a key focus for her is encouraging patients to take the lead in doing all they can to improve their health. This includes giving up smoking, drinking in moderation, eating well, exercising, taking their medications and caring for their teeth.
Former colleague, WDHB nurse manager surgical services, Declan Rogers says Dutton is the perfect person to guide and persuade people to live healthily.
“She’s very approachable, gentle, reliable and thoroughly committed to her work and those she serves,” Rogers says. “We’re very fortunate to have her working in primary health. I’m not surprised she’s having such a positive impact on her patients.”
Meanwhile, Dutton is feeling very positive about the direction in which the nursing profession is moving.
“We’re seeing excellent new nurses coming through, we have legislative changes happening to widen nurses’ scope of practice and the Nursing Council is improving the nurse practitioner application process,” she says.
“I’m very pleased to be actively supporting several nurses working in Whanganui’s primary health sector who are following the nurse practitioner pathway. It bodes well for the future that we have nurses wanting to take up
this opportunity.”
Melody Mitchell says being a Māori nurse in management (she is in charge of 270 surgical nursing staff) gives her a unique opportunity to articulate her community’s needs.
NAME | Melody Mitchell
JOB TITLE | Waikato Hospital nurse manager of surgery
DHB | Waikato
Māori managers with a direct connection to the community can see the impact of inequity, says Mitchell, because it affects them and their families.
“There are characteristics around populations that are seen as minorities that could be changed or better understood if they had more Māori representing these communities at a management level.”
Mitchell manages one of the largest clusters of nurses at Waikato Hospital as the nurse manager of surgery and says the role can certainly be challenging.
“Being a manager can sometimes be a double-edged sword. First and foremost I am a nurse but I am now also a manager and sometimes I have to make decisions that are not very popular.”
This year she will begin postgraduate studies, and she has chosen to do her master’s degree in nursing, rather than health management or business.
Becoming a career nurse was not originally part of Mitchell’s life plan. She was accepted into physiotherapy but she decided it wasn’t what she wanted and her mum then convinced her to go into nursing.
“She told me it would give me career options, a job, but also I could go travelling,” she says.
On graduating from the then-Taranaki Polytechnic,she worked at Middlemore Hospital, then at Waikato Hospital, returning to Middlemore as an associate charge nurse, and then going back home to Taranaki as a charge nurse.
“I got so much exposure to procedures at a big hospital like Middlemore and then to those at a smaller hospital like Taranaki.
Mitchell questions what job other than nursing could have given her “such exposure to human life and all its challenges”.
“I got asked a few weeks ago why I am doing nursing again and not business or management – it is really simple, I am just so proud to be a nurse.”
Dunedin’s criminal courts are home turf for Patsy-Jane Tarrant, who recently gained a doctorate in her specialty field of forensic mental health.
NAME | Dr Patsy-Jane Tarrant
JOB TITLE | Clinical nurse specialist, Forensic Services – Mental Health
DHB | Southern
Southern DHB says Tarrant’s contribution as a clinical nurse specialist in forensic mental health services is significant – not only through her clinical practice but also through the new knowledge she has brought to the area and the support she gives her colleagues to practice in contemporary and evidence-based ways.
The role of the mental health nurse in New Zealand’s criminal courts is the novel topic explored in Patsy-Jane Tarrant’s doctoral thesis.
Tarrant graduated in December last year after completing a doctoral research project that for the first time looked at nursing practice in New Zealand’s criminal courts.
The court liaison nurse (CLN) is the sole health practitioner in the court setting and Tarrant says this means it is under a high level of public and media scrutiny. Her research looked at what it was like to nurse in a practice setting where two conflicting cultures – justice and health – met, and whether this generated tensions for the nurses involved. Her thesis findings provide a baseline for the court nursing role and ongoing development
for nursing practice in this area.
Tarrant – who achieved her doctorate while simultaneously working as a clinical nurse and forensic service leader and raising a family – also represents the Southern DHB on a national committee for women in secure care. This
committee promotes standards of care for women within forensic mental health settings.
She is also currently organising a Court Liaison Nurse Symposium to be held in Dunedin in May. It is the first time in more than10 years that there has been a specific forum for CLNs across New Zealand. Tarrant says the symposium will be an opportunity for both professional development and networking. There are also plans to work on developing a guideline for CLN practice that may possibly be adopted nationally.
A pre-diabetes education programme that is successfully helping to prevent diabetes in the community is one of the initiatives leading to Tracey McNeur’s hero nomination.
NAME | Tracey McNeur
DHB | MidCentral
JOB | Clinical nurse specialist, long-term conditions (and authorised diabetes prescriber)
MidCentral describes Tracey McNeur as an inspiring primary health care nurse who selflessly goes ‘above and beyond’ to ‘be the change she wants to see’.
McNeur is employed by Kauri HealthCare, an integrated family health centre in Palmerston North, as a clinical nurse specialist in long-term conditions and is a strong component of the saying, ‘teamwork makes the dream work’. She is an authorised diabetes prescriber and is currently completing her master’s degree.
Kauri HealthCare GP and partner Dr Esther Willis says the pre-diabetes education programme she initiated illustrates McNeur’s commitment to quality improvement.
“This is now an integral part of care within Kauri HealthCare.
To date, none of the people who have gone through the prediabetes education programme have progressed to developing diabetes. All care is centred around patient needs and goals – I have no doubt this is a major contributing factor to the favourable health outcomes she achieves.”
McNeur has been involved with a number of practice and district-wide quality improvement initiatives since 2008.
At a district level, she is chair of the Long-Term Conditions District Group, chair of the Pre-Diabetes Working Party, a member of the Diabetes Partnership Group, and a member of the Map of Medicine Diabetes Collaborative Clinical Pathways.
At a practice level,she is involved with IFHC Practice Development Plans, Pre-Diabetes Programming, Diabetes Annual Review, and Diabetes Standing Orders.
Chiquita Hansen, MidCentral’s primary health care director of nursing and also the Central PHO’s chief executive, says McNeur has well-recognised leadership skills in chronic care management.
“Tracey is passionate about primary health care teams developing a proactive response to working with informed activated long-term conditions clients. She is cognisant of the value of teamwork and the benefits of offering individual and group consults to people with long-term conditions.
“Tracey has a high level of professional competence, excellent quality improvement knowledge, a real commitment to improving the patient experience, awareness of ethical and social issues inherent in health care and dedication to achieving improved health outcomes.”
Hand hygiene compliance has almost quadrupled in Middlemore’s emergency care department since Debbie Hailstone provided evidence to staff of the bugs lurking on their phones and keyboards.
NAME | Debbie Hailstone
DHB | Counties Manukau
JOB | Quality improvement facilitator, Emergency Care
It’s not easy to make hand hygiene appealing, but Debbie Hailstone has succeeded in turning the Emergency Care department’s hand hygiene compliance rates from a low 20 per cent to a very respectable 79 per cent.
Hand hygiene compliance in the department is made more complex because of the wide range of staff who come and go, including doctors, nurses, allied health, non-clinical staff, paramedics, students and visitors.
Annie Fogarty, acute care clinical nurse director, says Hailstone brings passion, enthusiasm and energy into the role.
“Her creative and innovative ideas help to reinforce the message that everyone has a part to play in keeping patients safe while [they are] under our care.This includes keeping your hands clean so you’re not spreading germs.”
Fogarty says you will often see Hailstone out on the floor swabbing people’s hands and a range of surfaces, such as phones and computer keyboards, to show them that dirty hands can grow bugs.
These bugs are then grown in Petri dishes, which are on display where staff can see them. This had a huge impact, resulting in a positive shift in attitude and behaviour, says Fogarty.
“What Debbie has helped to create is a culture shift – one where people are actively taking responsibility for ensuring their hand hygiene rates remain at a high level,” she says.
As for Hailstone, it would be fair to say that she loves her job.
“Nothing gives me more satisfaction than making a difference – it’s what motivates me to come to work each day,” she says.
Bev Gray is retiring after 50 years of nursing and says, given the chance, she would choose nursing all over again.
NAME | Bev Gray
DHB | Lakes
JOB | Public health nurse (retiring)
“I have loved my years of nursing. The bond I have had with the other nurses is just wonderful, it’s been fantastic,” says the Lakes DHB public health nurse.
Gray trained at Rotorua Hospital, beginning in 1965. She says those early years of nursing were wonderful years – “great days” where there was a lot of fun.
In those days the matron had strict control over the young nurses and standards of dress were high. She remembers having to change from her white uniform and cap in the hospital to a blue one to go back to the nurses’ home for a meal, all in half an hour.
Gray worked in the medical ward and ICU and around1969 was asked to go to Waikato Hospital to learn about the running of a coronary care unit. She worked at Waikato for three months before returning to set up the coronary care unit at Rotorua Hospital, with the support of three local physicians.
Gray had to learn and teach others about different heart rhythms, running the machines and new medications – it was new for the doctors too.
“It was a huge project, scary at first, but I got more comfortable with it and the doctors were really supportive.”
She worked in ICU/CCU for many years, with a few years off to have her three children and working part-time when her husband was home with the children. When it was time for a change, she moved to public heath 15 years ago.
“I love it. Working with people and trying to see the whole story [because] there’s always more to the picture.
It’s very challenging work and can be very rewarding.
“It’s a very different working environment from the hospital ward, working alone in the community as a visitor in people’s homes.”
Gray says once people realise she can work alongside families and help, they are more welcoming and she has built some really good relationships with families and schools. She would definitely choose nursing as a career, given her time again, but acknowledges there are so many more career options for women today.
Gray was told she would know when it was the right time to retire and she agrees – she has heaps of other things to do and is looking forward to making a start.
The mother of two children by the age of 17, Uputaua Suniula is now a nurse who is helping to turn around the health of teenagers and children in Porirua.
NAME | Uputaua Suniula
DHB | Capital & Coast
JOB | Community health and rheumatic fever prevention nurse, Porirua
Uputaua Suniula was recently recognised with the Margaret Faulkner graduate award for her compassionate care that is making a difference in Porirua – a difference she describes as “empowering”.
“The positive impact I can make within the community has been mindblowing, especially working as the first point of contact for people in need,” she says.
Suniula has worked on the front line of healthcare at both Waitangirua and Porirua’s Community Health Service.
“My focus is to work with Porirua’s young population to help develop prevention strategies that can stop acute presentations of preventable things like asthma and skin infections, reduce the strain on hospital services, as well
as lower our overall healthcare costs.
“One of the problems we face is that teenagers and children don’t come in to see a doctor till they’re really sick,” she says.
“What could’ve been addressed in the clinic instead becomes complex, at which point they become an inpatient in the hospital.”
One campaign Suniula works closely on is the rheumatic fever prevention programme in Porirua, where finding and treating strep throat can prevent the risk of a lifetime of heart issues.
“It’s all about treating the patient early, before they develop a serious problem.”
Suniula is now working towards a postgraduate certificate of nursing, with the aim of gaining a master’s qualification specialising in primary health care.
Brittany Jenkins is a West Coast hero for developing a resuscitation service for health practitioners stretching from Karamea to Haast.
NAME | Brittany Jenkins
DHB | West Coast
JOB | Resuscitation Service leader
Nurse specialist Brittany Jenkins expanded an existing resuscitation education programme into a DHB-wide Resuscitation Service to meet the isolated West Coast’s unique needs.
Jenkins began her nursing career at the West Coast DHB in 2007 after graduating from Massey University’s Bachelor of Nursing programme.
Originally from Montana, she describes herself as a “home-grown but American-accented” nurse and says she was drawn to the Coast by its small-town lifestyle and generalist career opportunities.
She eventually settled into working between critical care and general medicine and in 2009 was nominated to train as a New Zealand Resuscitation Council CORE instructor. She taught CORE for three years before successfully applying for the Resuscitation Service leader role at the end of 2013.
“I love the challenge and variety of the role. I enjoy teaching and the content – you can make it fun, but the role also involves everything from data collection and basic research to policy writing and working on local
and national initiatives.
“The role is also fairly unusual because it covers secondary and primary care, and is part of a trans-alpine collaboration with tertiary provider Canterbury DHB.”
She says the wide scope spans the care continuum from pre-hospital to specialist services, and has seen her facilitate partnerships with a range of professional groups, including rural nurse specialists and generalists from Karamea to Haast, Canterbury-based specialists from anaesthetics and paediatrics, and practitioners within the South Island Regional Training Hub (SIRTH).
The hero nomination of home dialysis nurse Sue Patience is the result of her dedicated support of patients caught by last year’s Auckland power outage and her earlier work for evacuated Christchurch earthquake dialysis patients.
NAME | Sue Patience
DHB | Auckland
JOB | Home Haemodialysis Unit staff nurse
All Sue Patience ever wanted to be was a nurse. She bought nursing books at school, cared for animals knocked over on the road, and had a potentially hazardous encounter with a candle as she pretended to be Florence Nightingale.
Patience started her nursing career in 1976 and has spent the past 15 years working in renal services, most recently at the Home Haemodialysis Unit at Greenlane Clinical Centre, where she trains and supports patients to use dialysis
equipment safely at home.
In October 2014, widespread power outages hit Auckland.
“I was on call that day and I’m sure I did what any other of my colleagues would have done in that situation,” she says.
Knowing the disruption the power outage would mean to patients using home dialysis, Patience made every
effort to find any available space to support dialysis patients who had lost power at home, as well as continuing
the training and support for patients already in the unit “Of course, we didn’t know how long the power would be out for, so I made the space available for those who needed it urgently, and it really gave them peace of mind.”
Patience had previous experience to call upon, having helped patients evacuated from Christchurch during
the earthquakes.
“I advocated hard to maintain after-hours dialysis and support for these patients. It was a traumatising
time and lots of patients needed urgent help dialysing.
“I still see some of the patients, who pop in if they’re passing through Auckland. The renal population is
very embracing, they’re a very strong group and I have much admiration for them.”
Patience was also awarded Auckland DHB’s Local Hero award last October after being nominated by a patient.
“There are so many wonderful things that I can describe about Sue,” said the patient. “She is so amazing, so caring, loving and giving of herself. She is very accurate and there are no shortcuts when doing her job.
“When I first started at the Home Haemodialysis Unit, Sue taught me the machine, helped me with the troubleshooting and I nearly always got her on the 24hr helpline we have. I love her; she has made my life worth living.”
In the short time she has been in the role, Jenkins has multiplied the number of advanced and basic resuscitation training sessions offered on the West Coast.
She has also established and chaired a multidisciplinary Resuscitation Committee, is supporting a growing team of instructors developing the DHB’s first CPR policy and associated procedures, and is conducting the first DHB-wide audit of emergency equipment and checking practices.
Another initiative she is involved in is creating a system for reviewing clinical emergencies, and she is also working to tailor any initiatives to evolving models of care.
Last year, Jenkins successfully completed her Master of Nursing with distinction, during which she explored the experiences of internationally qualified nurses who had transitioned into New Zealand and were working as registered nurses in aged care. While studying, Jenkins spent some
time working in the Office of the Chief Nurse on workforce issues associated with international nurses.
Anne Sisam is a public health nurse hero working with vulnerable families in a caravan park in West Auckland to empower them to keep healthy.
NAME | Anne Sisam
DHB | Waitemata
JOB | Public health nurse
After registering as a nurse 40 years ago, Anne Sisam has spent half of those years working in the West Auckland community, taking a particular interest in the needs of vulnerable children experiencing disparities in care.
Her current role involves working with people living in a caravan park in very challenging circumstances and who often present with illnesses typical of lower socio-economic communities. “Within this role, my focus is on prevention and intervention.
What I see as being most important is empowering and enabling people to take control of their own health,” she says.
“That’s what I love about this job, as opposed to working in hospitals when people have already got conditions.
“It’s been such a good opportunity to change health outcomes for the better.”
Sisam has invested time getting to know the caravan park community so she is able to make a difference to the families living in a transient environment where poverty and ill health require careful assessment, negotiation and partnership.
“A lot of it is about building relationships and really looking after those relationships with that community.
“These people have limited resources and limited knowledge so it’s about supporting them with any health issues they may have, but also working with them to help them gain knowledge about their health and find realistic solutions.”
Jocelyn Peach, Waitemata DHB director of nursing says Sisam also demonstrates cultural awareness.
“She uses the Māori health model Te Whare Tapa Whā, working in partnership, encouraging participation of the community and different agencies as well as protecting the most vulnerable and their culture.
“We consider Anne a hero, meeting the needs of a vulnerable group in a challenging environment,” says Peach.
“The people we’re working with are an amazing bunch of resilient people and I do believe we’re making progress,” adds Sisam.
“When people open their doors to you and they respect what you’re trying to do for them, you form really good relationships that help them see the whole healthcare system in a better light.”
More clients than ever before can consult with a nurse by phone following a new initiative that Rose Stewart helped develop.
NAME | Rose Stewart
EMPLOYER | Family Planning
JOB | National nurse advisor
Rose Stewart’s position description “Responsible for nursing staff clinical practice and professional development” sums up her role in just a few words, but it doesn’t describe her passion for making Family Planning clinic services as easy as possible for clients to access. For some clients, this now means they don’t need to come into a clinic at all.
Stewart, alongside National Medical Director Dr Christine Roke, has driven the clinical aspects of a new phone consultation service, which allows an increasing number of clients to “be seen” by phone.
Phone consultation services require a balance between ease of access and appropriate clinical management.
“Phone consultation development was underpinned by our strategic focus to make it as easy as possible for young people, particularly rangatahi Māori, to use our services,” says Stewart.
Consulting by phone was originally only offered to clients wanting the emergency contraceptive pill or a contraceptive pill repeat. This service has now expanded by stages to include contraceptive pill repeats, emergency contraception, condoms, consultations prior to contraceptive implants or IUDs, and discussions of contraceptive options.
And there is more to come. These services are free for New Zealand residents 21 years or under and are paid for by debit or credit card for those aged 22 years or over.
Stewart is very focused on improving women’s choice and autonomy in sexual and reproductive health.
“Women have a lot to manage in their lives in terms of their fertility and they need all the help we can give them,” she says.
“For women who live remotely; women who cannot afford childcare or transport; women who cannot get time away from work to attend appointments – being able to have a phone consultation might make all the difference in the world.
“It could be the difference between rapid repeat pregnancies or a pregnancy gap chosen by the woman; heavy periods better managed that allow her to have fewer sick days away from work – there are all sorts of scenarios where providing that help can make a real difference in women’s lives.”
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