Nurses' review the year that was: 2012

1 December 2012

Nursing Review asks senior nurses in fields from health promotion to family planning and education to aged care to give a report card on how health and nursing fared in 2012 and what they want for 2013.

It’s been a year when the new graduate job market remained tough, funding squeezes started to take a toll, and a new generation of enrolled nurses graduated. A year where registered nurse prescribing inched closer, the milestone of more than 100 nurse practitioners was met, non-nursing roles like physician assistants and practice assistants were pushed, and there was continuing high interest in nursing school enrolments. A year when new innovative nursing roles and practice developed but also when barriers – real and artificial – still frustrated nurse-led services. It has been a year when Indian nurses went on a hunger strike over registration, some aged care nurses took industrial action, and district health board (DHB) nurses voted for a 4.5 per cent pay increase spread over three years, while still seeking safe staffing.

In the wider health arena, more government health targets were met, DHB budgets constrained, pushes for alcohol and tobacco control had mixed success, residential aged care kept making headlines for the wrong reasons, a new mental health blueprint was released, Whānau Ora models evolved, the White Paper for Vulnerable Children was released and much, much more.

Nursing Review asked a number of nurses to give us their report card on how nursing and health scored in 2012.

TAIMA CAMPBELL

Consultant & senior teaching fellow

University of Auckland (former director of nursing at Auckland District Health Board), Auckland

Nursing and health in 2012 made great strides forward in: Contributing to patient safety initiatives and improved hospital patient experiences. Participating in new and innovative models of care such as the registered nurse first surgical assistant and diabetes nurse prescribing. Taking the lead on providing better care for the elderly, particularly in residential care. Being entrepreneurs and starting their own primary health care businesses rather than being the employed practice nurse.

Passed but could do better: Speaking up for the most vulnerable people in our population, particularly our children. Nurses gave feedback on the Government’s policy on vulnerable children, but there needs to be more action and advocacy if there is to be any change. Supporting Hone Harawira’s bill for lunch in schools and better housing would be a good place to start. 

<Areas showing initial promise but failing to deliver in 2012: Primary health care. The Government and various ministers have talked about how nurses can contribute to better primary healthcare but – as a nurse and consumer – I just don’t see it (with the exception of communities where disruption has resulted in innovation). Good on the nurses who have used their own initiative and become partners in their own general practice and community. We need more pioneers like this. 

Failed abjectly: To reduce the district health board bureaucracy. It’s simple – we don’t need three DHBs in Auckland. The process of ‘regionalisation’ is a long, protracted way of ‘nibbling’ at the problem. The ‘agenda’ isn’t that well hidden – just get on with it. 

Reducing inequalities in health care for Māori and Pacific. Again another area where the rhetoric doesn’t match the reality. Actions speak louder. 

Goals for 2013: Improvements in health care will come from Māori leadership and involvement in the way our system is designed, on the ways services are best delivered and by practitioners who are better able to engage with the people who need our care. So Māori clinical leadership and workforce development are still high on my list. 

Health public policy has a role to play in improving health care. Changes to alcohol law reforms were a bit of a failure, tighter tobacco legislation is going to help with quitting and prevent people starting, and there is more work to do to ensure practitioners are not hamstrung by legislation making it harder to do their job. So getting nurses fired up about policy is on my list for next year.

VAL WHATLEY

Clinical manager

Parkwood Rest Home and Hospital, Christchurch

Areas showing initial promise but failing to deliver in 2012: Highlighting areas for improvement within aged care.

Failed abjectly: Promoting any positive aspect of aged care nursing as relevant, vibrant, hardworking workforce under very trying difficult circumstances. Continued denigration of aged care nurses and trial by press.

Goals for 2013: Recognition of role of aged care registered nurse as career pathway instead of denigration. Promotion and recognition of partnership between acute sector/primary health and aged care – not ‘us’ and ‘them’ – so we can get the best possible outcomes for residents/patients. The acute sector areas cannot handle our residents and their multiple co-morbidities (and/or their behaviours), and we need their help and expertise for crisis management and prevention.

ROSEMARY MINTO

Nurse practitioner

Chair of the College of Primary Health Care Nurses NZNO, Tauranga

Nursing and health in 2012 made great strides forward in: Providing excellent quality nursing services to New Zealand population. Improving the performance management target results (most of this work is completed and often managed by nurses being willing and able to provide innovative models of care, for example, Horowhenua Clinic in MidCentral DHB, Waves in New Plymouth, Evolve in Wellington, and Victory Community Health Centre in Nelson).

Areas showing initial promise but failing to deliver in 2012: Nurse practitioner numbers are growing but visibility is not – the Medicines Bill has failed to help NPs deliver better sooner more convenient care.

Failed abjectly: To advocate for nursing to be included in all levels of governance and funding and planning management teams consistently across DHBs and PHOs.

To gain any additional funding for NPs or indeed recognition from/by Health Workforce New Zealand. HWNZ fund the clinical master’s degree programmes and then ignore the need for an internship programme to imbed clinical practice and support into workplaces. Also engaging consumers in the debate around using nursing to solve health service delivery issues.

Goals for 2013: To have all legislative barriers for NPs removed or solved. To have nurses involved at every level of service planning for innovation and delivery moving forward on the Government’s drive for integrated health services. To have consumers engaged in the discussion around what they want to see in their local health service including the nursing contribution.

DR JILL CLENDON

NZNO nursing policy advisor/researcher

Nelson

Nursing and health in 2012 made great strides forward in: Developing systems to measure new graduate jobs and availability of jobs (although this identified a range of issues, at least there is now a system in place). Nurses in schools – increased funding to see nurses in all decile 1 to 3 secondary schools. Cancer nurses – increased funding to roll out a case management approach to cancer care.

Health Research Council funding for a Māori nurse smoking project.

Recognition by the Human Rights Commission that pay and conditions for those working in the aged care sector are discriminatory.

Passed but could do better: Nurse-led clinics – mixed success with the closure of Waves, but the proven impact of Horowhenua nurses providing safe and effective care to local people due to a lack of GPs.

Areas showing initial promise but failing to deliver in 2012: The White Paper for Vulnerable Children – initial promise but failed to recognise the work of nurses with vulnerable children or provide specific direction for nurses’ roles working with children in the future.

Failed abjectly: Few jobs for NPs. Health Workforce New Zealand and physician’s assistants – why is HWNZ prioritising this workforce at the cost of NPs? HWNZ generally – mandated to do workforce planning but absolutely no evidence of this.

Goals for 2013: Get the changes to the Medicines Act implemented. Keep pushing HWNZ to recognise the essential work that must be done regarding nursing workforce projections and get them to do it. Keep pushing for improved accessibility to funding for nurse-led clinics. Make more visible the value of nursing to improved health outcomes (evidence for investment in nursing campaign). Get nurses engaged in the district health board elections – make safe staffing an election issue.

 

ROSE STEWART

National Nursing Advisor

Family Planning, Wellington

Nursing and health in 2012 made great strides forward in: Nurse prescribing – the Nursing Council have taken on board the directive from Ministry of Health to set up prescribing for RNs. There are many nurses routinely supplying medication under standing orders that means access for patients is much better. They already need to make the clinical decision and so are well prepared in many cases. Nurses with appropriate training can take on the responsibility for prescribing

Passed but could do better: Nursing organisations are working very well together after years of silo activity.

Areas showing initial promise but failing to deliver in 2012: Because there are approximately 45,000 nurses, it is critical that nursing continues to develop mechanisms to coherently contribute to health policy and strategy at a national level.

Failed abjectly: Getting authorised prescribing for nurse practitioners – a no brainer – taking too long.

Goals for 2013: RN prescribing and authorised prescribing for NPs.

JUDY YARWOOD

Research leader, CPIT nursing school

Co-chair of College of Nurses Aotearoa, Christchurch

Nursing and health in 2012 made great strides forward in: Authorised prescribing for nurse practitioners (well nearly).

Passed but could do better: Understanding significance of NPs role in PHC, particularly in rural and remote locations.

Areas showing initial promise but failing to deliver in 2012: Primary health care’ in nursing missed the boat as the ‘primary care’ reign continued unabated with its focus of treatment of disease. Meanwhile, social determinants of health such as education, employment, housing and poverty mostly remained in the too-hard basket.

Failed abjectly: Addressing inequalities, rheumatic fever and diabetes.

Goals for 2013: Make PHC a priority, that is, make it accessible, affordable, and acceptable for all.

SHELLEY FROST

<Pegasus Health director of nursing

General Practice New Zealand deputy chair, Christchurch

Nursing and health in 2012 made great strides forward in: With my Pegasus Health director of nursing hat on, I am delighted to report that nurses are now full members of Pegasus, strengthening their voice and influence within the primary care network and the Canterbury health system as a whole.

Nationally, I believe nurses have continued to make a significant contribution to leadership in primary care. There is increasing acknowledgment of the value nurses add within the primary care team and this is well evidenced in groups such as the General Practice Leaders Forum and national network organisations.

Passed but could do better: The opportunities inherent in the “better sooner more convenient” context are yet to be fully realised. There are pockets of significant success with boundaries between disciplines and agencies becoming blurred, changes from traditional practice, and a new ethos of collaborative partnerships breaking across old barriers. Consequently, the nursing role is becoming more dynamic and more complex. Learnings from such developments need to be shared and further built upon. 

Areas showing initial promise but failing to deliver in 2012: Certainly in primary care we have not maximised the potential of either the enrolled nurse or NP workforce. It has been disappointing to see the introduction of new roles when we are not utilising our existing workforce to full potential.

Failed abjectly: Giving up is the only sure way to fail, and I don’t believe nurses will ever give up!

Goals for 2013: Strengthen the professional development and support of nurses to maximise their contribution to the delivery of quality patient care in the community, alongside other members of the primary care team. Build leadership capacity and capability within the primary care nursing workforce. Maximise opportunities for nursing contribution and influence at a national level.

ANNETTE MILLIGAN

Director of workplace health and safety provider

Nelson

Nursing and health in 2012 made great strides forward in: Seemed like a steady year – and in my area, hard to see where gains were made … steady year …

Areas showing initial promise but failing to deliver in 2012: White Paper – while nurses have led many initiatives in protecting children, we have been left out again in the White Paper. Nurses barely get a mention, and overseas models in which nurses make a significant contribution seem to have been passed over.

Goals for 2013: Keep nurses right at the forefront of health – nursing has yet to reach anything like its potential in the contribution to health and well-being. We need to work together to keep nursing in the minds of policy and decision makers.

GRACE WONG

Smokefree Nurses Aotearoa/New Zealand director

Auckland

Nursing and health in 2012 made great strides forward in: Smoking cessation training to achieve a smokefree New Zealand by 2025.

About a quarter of all New Zealand nurses (n=12,758) have completed the free Ministry of Health online ABC education. This is a fantastic tribute to the readiness of nurses to enhance their practice.

Goals for 2013: More nurses ABC trained. All nurses who have trained delivering brief smoking cessation interventions to patients who smoke. Together nurses can tip the balance for a smokefree New Zealand.