2015: Report card on the year that was…

December 2015 Vol 15 (6)

Nursing Review ended the year by asking a wide range of nursing and health leaders to assess and fill in a ‘report card’ on how they believed nursing and health fared in 2015. 


Report cardThe year that was 2015 began with an upswing in new graduate jobs but also up were graduate numbers, so 41 per cent of new nurses still began the new year job-hunting*.

It is the year that the first dedicated nurse practitioner training programme gained funding but training for registered nurse prescribing and nurse endoscopists was put on hold so the finer points of these innovations can be established and worked through.

It is the year that the fifth national collective agreement for district health board nurses was ratified – a decade on since the ‘fair pay’ boost was negotiated between DHBs and the New Zealand Nurses Organisation. 2015 is also the year that an ‘equal pay’ legal challenge by a rest home worker prompted the Government to agree to look at fairer pay also for the aged care and disability sectors.

Likewise, a decade in the making has been the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill, which had its long-awaited first hearing in Parliament this year after the groundwork began back in 2005 to remove legislative barriers to nurse practitioners working at the top of their scope.

And finally, 2015 is another year when headlines about budget-stretched and strained DHBs and the impact of these on health services were far from unknown.

Nursing and health leaders share their views below on how they saw 2015 and what they would like 2016 to bring for nursing.

*NB most of those job-hunting new graduates were nursing as 2015 drew to a close.


JANE O’MALLEY and OFFICE of the CHIEF NURSE TEAM Ministry of Health

Jane OMalleyFrom the point of view of the Office of the Chief Nurse (OCN), nursing and health in 2015 made great strides forward in:

This has been a year where work that has been in progress for a number of years has gathered momentum; in particular, the work with Health Workforce New Zealand to remove barriers to nurses contributing to health care to the full extent of their scopes of practice so people can access the right care, at the right time, from the right person. Some of the barriers are legislative and have progressed as below:

The Health Practitioners (Removal of Statutory References to Medical Practitioners) Bill (HPSR Bill, for short) is being considered by Select Committee.

Prescribing for registered nurses working in primary care and specialty teams.

The Minister has agreed to the Ministry progressing an amendment to the Medicines (Standing Order) Regulations to allow nurse practitioners to issue standing orders.


Registered and enrolled nurses, nurse practitioners, ambulance personnel and midwives are permitted by the Chief Coroner to verify death (assess for signs of life extinct).


What else has been working well from an OCN perspective?

One of the Office’s roles is to provide leadership in the sector. This year we have worked with other nurse leaders to achieve the following:

Increased the number of new graduate nurses employed within 12 months of graduation.

Alignment of new opportunities for enrolled nurses to contribute to the skill mix, for example in mental health services.

Evaluations of alternative models transition to employment, including, for example, new graduate nurses in VLCA practices and the Gerontology Acceleration Programme.

Working in partnership with Associate Directors of Nursing Mental Health to support DHB policies for implementing the Emergency Department Guidelines for Suicide Prevention.

Undertaken many visits, meetings, workshops and conferences with nurses and others to make links, share national level strategy, build understanding and capacity in the sector and share intelligence to influence the development of practice-based policy

Published a newsletter for frontline nurses to make the work of the office and national/central government processes more visible.

The joined-up work of nursing leaders through the National Nursing Organisations (NNO) group has contributed a great deal to the clarity of the nursing voice on strategic matters. The group functions to bring together leaders from each of nursing’s peak bodies to share information and agree strategic direction for nursing. The Office’s role is to share information from a political and government perspective.


Goals for 2016:

We look forward to 2016 and progress on:

the New Zealand Health Strategy being finalised and providing a road map to shape the delivery of health care for the future

the Mental Health Workforce and the Nursing Workforce plans

the revision of the Health of People’s Strategy

the progress toward enactment of the HPSR bill (see above), registered nurse prescribing and nurse practitioners issuing standing orders

more opportunities to work with nurses to ensure nursing is able to contribute to its full potential to improve health outcomes for New Zealanders.


JENNY CARRYER Executive director of College of Nurses Aotearoa and professor of nursing at Massey University.

Jenny CarryerNursing and health in 2015 made great strides forward in:

In 2015 one notable feature was the continuing collegial and strategic collaboration of all nursing leaders pulling together to address the strategic direction for nursing and to address the challenges arising.

Also on a positive note the funding for the new version of nurse practitioner training was a welcome bonus. Over 50 employers (mostly in primary health care) revealed their commitment to hire an NP at the conclusion of the programme next year. Let’s hope the funding is sustained and then we will see a significant change in the workforce landscape.


Passed but could do better next year:

One interesting feature of 2015 seemed to be an ever-increasing volume of Ministry strategy documents requiring consultation and input across a vast array of topics. It seemed to me from a nursing perspective that a closer attention to some of our core basics might address all of these numerous strategic documents without so much effort expended on consultation.

Areas that failed or struggled to deliver in 2015:

As ever for nursing, the challenges come thick and fast in a health sector under increasing pressure with cash-strapped hospitals and ever-increasing demand for good primary health care. The need to employ and retain our precious new graduates has never been greater and right now, as I meet the about-to-be graduate nurses around the country, I feel for their anxiety as they begin the job hunt.


Goals for 2016:

Investing in nursing employment, postgraduate nursing education and freeing nurses to work in a truly person-centred manner – rather than in an employment or contract-focused or rationed manner – would address many of our challenges.


KATHY HOLLOWAY National chair of NETS (Nursing Education in the Tertiary Sector Aotearoa NZ) 

Kathy HollowayNursing and health in 2015 made great strides forward in:

The normalising of the ACE process for new graduate nurse employment for nursing schools and students. ACE is providing a rich data source. Also progressing legislative changes to remove barriers preventing nurses utilising the full extent of their education and training. And a greater awareness of the contribution that nurse practitioners can make.

Passed but could do better next year:

Employment of new graduates is improving but early indications are concerning for 2016.


Areas showing initial promise but failing to deliver in 2015:

The ‘refresh’ of the New Zealand Health Strategy raised the profile of the need for consumer engagement and funding redesign for the delivery of health services. The implementation of these will be closely watched in 2016.


Goals for 2016:

One hundred per cent employment for new graduate nurses within the first year of practice.

Māori nursing workforce development strategy developed and implemented.


GRANT BROOKES President of the New Zealand Nurses Organisation

Grant BrookesNursing and health in 2015 made great strides forward in:

Great strides have been made this year in removing regulatory barriers that prevent nurses from making the best use of their knowledge and skills.

The movement of the Health Practitioners (Removal of Statutory References to Medical Practitioners) Bill through Parliament raises hopes that we’ll soon achieve this, enabling a more efficient and effective health system. NZNO supports this Bill. We also hope our suggested improvements are taken on board by the Select Committee when it reports back to Parliament in February.


Passed but could do better next year:

The progress made in implementing Care Capacity Demand Management (CCDM) across the district health board (DHB) sector deserves a pass mark.

This year, Bay of Plenty achieved the distinction of being the first DHB “over the line”, meaning the core components of CCDM have been implemented for all their acute medical/surgical areas.

Hawke’s Bay and Taranaki DHBs joined the CCDM programme, and Auckland DHB began the enormous task of rolling it out across its many inpatient areas.

But from NZNO’s perspective, there are still five DHBs not currently active in the programme, with two more “pending”. Progress elsewhere remains painfully slow. There are even backwards steps at some DHBs.

Given the critical importance of safe staffing, both for NZNO members and for quality of care in our public hospitals, more definitely needs to be done in 2016.


Areas showing initial promise but failing to deliver in 2015:

For new graduate nurses, the year began with movement towards NZNO’s goal of 100 per cent graduate employment by 2018 at the latest. NZNO’s 2014 petition campaign, alongside a report from the National Nursing Organisations, had secured funding to cover Health Workforce New Zealand’s contribution towards another 200 NETP (nursing entry to practice) places.

Raising the cap from 1100 to 1300 places this year still wouldn’t provide full employment. And the actual number of places was always dependent on the ability of employers to offer jobs.

Sadly, cash-strapped DHBs and insufficient participation from other sectors has meant the promise of 1300 NETP places was not fulfilled.

In September, therefore, delegates to the NZNO AGM voted for a motion: “That NZNO continues to prioritise and support campaigns towards nurses and midwives entry to practice programmes, for registered nurses, registered midwives and enrolled nurses, with the campaign goal of 100 per cent employment of new graduates and improved health workforce planning in Aotearoa”.


Areas that failed abjectly:

Budget 2015 failed abjectly, once again, to provide sufficient funding for health.

According to Council of Trade Unions economist Bill Rosenberg, Vote Health was $245 million behind what is needed to cover announced new services, increasing costs, population growth and the effects of an ageing population.

The accumulated funding shortfall in government health expenditure for 2015/16 compared with 2009/10 is more than $1 billion.
This is what underlies the painfully slow adoption of CCDM, the failure of new grad employment opportunities to live up to their promise, and the growth of serious, related problems like care rationing. This has to change next year.


SHARON HANSEN Rural nurse practitioner and chair of the Rural General Practice Network (RGPN)

Sharon HansenNursing and health in 2015 made great strides forward in:

Registered nurse prescribing – which is still being worked on and is still not ready for the sector. This is not a fault as all good things take time, and it is too important to rush. It is my hope that employers, the public, and nurses themselves are ready for it. All credit to the work being done by Pam Doole and the team at Nursing Council, plus the people who have contributed to that work.


Passed but could do better next year:

A realistic approach to the public health issue of obesity. It seems to me that we still have a focus on the individual and their families without true examination of the place of big business and food supply.


Areas showing initial promise but failing to deliver in 2015:

The new money that the Minister announced supporting the training places for 20 new nurse practitioners (NPs). NP candidates in the new supported NP training scheme are required to have employer backing. In the rural sector we have nurses who are self-employed and want to be supported into NP registration. These nurses are already working in locum positions and both the nurses and the communities they serve would benefit from their change of scope.


Areas that failed abjectly:

I believe the failure of the Government to recognise the need for ongoing, sustainably supported and focused further education for NPs and other advanced clinical roles.


JONATHAN COLEMAN Minister of Health

Jonathan ColemanNursing and health in 2015 made great strides forward in:

New Zealand is moving towards a more integrated and better-connected healthcare service with patients at the centre. Nurses are playing a vital role in this shift. 

There continues to be an increased focus on moving services into the community and a focus on early prevention and intervention. 
I’m committed to making the best use of nurses’ skills and experience, and good progress has been made this year. 
The Health Practitioners (HPSR) Bill is before Parliament. It will enable health practitioners to carry out many functions that traditionally have been restricted to medical practitioners. 
 Health officials are progressing an application to allow appropriately skilled and educated nurses in primary and specialty teams to practise as designated prescribers. 


Goals for 2016:

The New Zealand Health Strategy will be implemented from 2016. It will set a clear direction for the sector on prevention, more integrated services, support for innovation, better collaboration, and ensuring services are more accessible. 
I want to see continued progress in the battle against NCDs (non-communicable diseases), particularly diabetes and childhood obesity. 
We want to continue to harness the full potential of our workforce. I expect progress to be made on the HPSR Bill, and enabling skilled nurses to practise as designated prescribers. There will also be enhanced training for nurse specialists and nurse practitioners in 2016.


HEMAIMA HUGHES President of National Council of Māori Nurses/Te Kaunihera Neehi Māori o Aotearoa

Hemaima Hughes

Nursing and health in 2015 made great strides forward in:

Relaunch of the Bachelor of Health Sciences Māori Nursing at Te Whare Wānanga o Awanuiārangi in Whakatane. Māori students are doing well and being well received in the clinical placement arena. Positive contribution towards increasing the Māori nursing workforce. Also 246 attendees at the annual National Māori Students Nurses Hui held at the Manukau Institute of Technology this year.


Passed but could do better next year:

We can always have our dreams and work towards making these a reality in terms of improving healthcare delivery through the nursing workforce, however this does require increased funding to be able to have the appropriate human, practical and physical resources to deliver the care.


Areas showing initial promise but failing to deliver in 2015:

It’s not always about us as the professional nursing workforce. So often we deliver care mechanically because of time constraints imposed on us in our places of practice. A redirection of our focus is that it is about the client/patient and not us.


Areas that failed abjectly:

Healthcare delivery and nursing practice in care of the older person requires serious consideration. The care of a loved one in our whānau this year was appalling. His death was accelerated because he acquired a very large sacral pressure sore that became infected. Basic nursing care is being compromised because of so-called ‘busyness’ created by understaffing.

Also participation by nurses in the nomination and appointment process to the Nursing Council of New Zealand was encouraged by Nursing Council, however, the final process was not made transparent to participants. But rather they/we were informed that appointments had been made. This transparency has also been missing in previous election processes.


Goals for 2016:

Prescribing rights for RNs – so long as the practice is monitored correctly and not abused.

The Nursing Council of New Zealand needs to seriously consider the inclusion of Māori representation in council to ensure the indigenous voice in decision-making is transparent, evident and fair.

Transparency in election processes to NCNZ.

Improved monitoring of unregulated caregivers in residential aged care facilities.


ANNETTE KING Health spokesperson for Labour and deputy leader of the Labour Party

Annette KingShort message to end 2015

Without a dedicated and committed health workforce working in our hospitals, communities, and homes, New Zealand could not provide the level of care expected, and needed. But we should never take them (nurses) for granted or expect them to shoulder decisions that make their jobs unsafe or compromise quality care.

We can be proud of our nursing workforce who, 114 years after the introduction of nurse registration, have led as the health carers in New Zealand.




DENISE KIVELL Chair of NENZ (Nurse Executives of New Zealand)

Denise KivellNursing and health in 2015 made great strides forward in:

Reclaiming and profiling the value nursing makes when working with, designing and utilising technology. Plunket now has an electronic health record. HINZ (Health Informatics New Zealand) partnered with nurse executives to raise awareness and also run multiple health informatics workshops.

New Zealand is the first country to use the interRAI assessment tool in home, community and residential care facilities nationwide.

Secured the longevity of the Safe Staffing Healthy Workplace unit and the value of the unit’s CCDM (care capacity demand management) systems are more evident.

Increase in new graduates employment. Data from ACE new graduate employment system now able to challenge workforce practices.

Change in language from ‘primary’ and ‘secondary’ care toward talking about one health system with more awareness of the need for an integrated approach.


Passed but could do better next year:

Reducing patient harm at all levels of care. Nurses are juggling multiple initiatives and the gains are evident. (For example the latest Hand Hygiene NZ audit showed 84 per cent of nurses and midwives are meeting the ‘5 moments for hand hygiene’). However nursing leadership and accountability needs to be relentless and take up the challenge to improve sustainable systems.

New Zealand Māori nurses make up 6.5 per cent of our nursing population. This is up by 127 on last year.

The value of co-design and working with consumers to help transform health systems; and more awareness of the importance of person/patient/client & family/ whānau-centred care. (We haven’t nailed the terminology though!)


Areas showing initial promise but failing to deliver in 2015:

Prescribing… a slow journey.

High percentage of enrolled nursing graduates not employed.


Goals for 2016

Seize the opportunity to work with the refresh of the New Zealand Health Strategy.

Utilise the Nursing Workforce Programme recommendations being developed by the HWNZ and National Nurses Organisations (a work in progress in 2015).

Profile the value of nurses at all levels of governance.


KERRI NUKU Kaiwhakahaere of Te Rūnanga o Aotearoa, New Zealand Nurses Organisation

Kerri NukuComment on nursing progress in 2015

It is disappointing to think that the total Māori health and disability regulated workforce has remained static since the mid-1990s; we need to look at new solutions and strategies to grow, keep and sustain our own Māori nurses and why there has been little movement or investment in this area.

The Māori health and disability workforce development is a key enabler of health outcomes. However, the supply of the future Māori health workforce remains critical, with a Health Workforce New Zealand report indicating that the workforce would need to triple in size to meet the needs of the communities they serve. As health professionals we need to take a deep breath of courage, to be bold and disruptive.

There is a need for the Government to engage with key Māori and Pacific nursing leaders and have a frank discussion about what Māori nursing and midwifery aspirations are.

Our moemoeā is to build a capable Māori nursing and midwifery workforce, to grow and nurture so that we can lead our whānau, hapū and iwi towards positive health outcomes.


Goals for 2016

We need to see:

100 per cent employment for new graduates

review of the transition to practice for NETP (nursing entry to practice) graduates

review that recruitment process for district health boards (DHBs) and primary health care are equitable

that NETP and NESP (new entry to specialist practice, mental health and addictions) are effective and evaluated

review return to practice programmes to ensure that cultural competency is given as much weighting as clinical competencies

that enrolled nurses are utilised and employed across all sectors

the CCDM (care capacity demand management) being effectively implemented across all DHBs and primary health care settings

collective support and advocacy for pay parity across all sectors of the workforce, specifically in Māori, iwi and aged care providers

the New Zealand Health Strategy review and the HPCA Act are opportune vehicles for nurses to have their voices heard to advance the professional role of nursing

a healthy population approach to primary health care. We look forward, along with our Pacific colleagues, to be invited to the table to be part of the solutions.


ANNE BREBNER President of Te Ao Māramatanga/New Zealand College of Mental Health Nurses (NZCMHN)

Anne BrebnerNursing and health in 2015 made great strides forward in:

I had a sense from our NZCMHN conference attendees and presenters that we are doing above average in areas such as the Equally Well work. Equally Well seeks to improve access to physical health care for people with long-term mental health conditions and the programme appears to be strengthened nationally.


Areas showing promise

I would be remiss if I didn’t add into a report card like this, that our emerging, newly prepared nurses are showing incredible promise and innovation. The postgraduate certificate that NESP (new entry to specialty practice – mental health and addiction nursing) graduates complete appears to be ‘across-the-board’ an excellent method to support nurses develop their critical thinking skills.


Passed but could do better next year

We have passed but could always do more of suicide prevention. This area of work is vital, requires clear leadership, and concerted and focused, team-based approaches. Suicide prevention remains on everyone’s radar as ‘could and should do better always’. Likewise the work done on seclusion reduction, we must not take our foot off the pedal at any time. Huge gains have been made and we have more confidence in building on what works well.

Working with non-governmental organisations that are partners in our work continues to show promise. People who receive support for mental health and addictions require more than ‘nursing’ and this cannot be achieved without the dedicated team effort that is provided by NGO partners.


Areas that struggled to deliver in 2015:

We have yet to ‘nail’ the smaller sub-specialty areas of mental health nursing such as people with intellectual disability and mental health problems. Also the ‘where’ and ‘how to’ best support the needs of people with older age-related memory/delirium/ dementia issues and the needs of their family carers. Plus working with people with serious alcohol-related and other drug difficulties who need long-term support.

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