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Regional training hubs − what are they, and what role will they play in new graduate and postgraduate nurse education?

Current funding barriers limiting what postgraduate leadership and management courses are available to nurses may be removed by an upcoming review of postgraduate funding.

Nurses leaders have expressed frustration for some time at limitations placed on the way Health Workforce New Zealand (HWNZ) postgraduate nursing funding can be used.

Last year, Sue Hayward, as head of the Nursing Education Advisory Team (NEAT), suggested that funding be opened up to multidisciplinary qualifications in areas like health management, public health, or population health.

Brenda Wraight, director of the HWNZ business unit, says the unit is looking at “exactly that issue at the moment” and next year it will be reviewing the current funding rules as part of a full review of postgraduate nurse funding.

This has come as a surprise to Sue Hayward and Kathy Holloway, chair of nurse educator group, NETS, as both were aware the Nursing Council has indicated a review of the council-approved postgraduate framework but were unaware that HWNZ was also considering a funding review.

At present, only courses that can lead to a Nursing Council approved, clinically-focused postgraduate nursing qualification are eligible for HWNZ funding.

“That’s not necessarily helpful to us if we’re looking at multidisciplinary teams,” said Wraight.

The rules, developed under the former Clinical Training Agency, excluded a number of training programmes in other clinical areas, like epidemiology or courses offered by other schools like allied health and medical schools, she says.

She is also aware that nursing leaders are wanting funded postgraduate courses to help develop clinical leadership roles.

“We’re really keen to look at that and to make sure our rules don’t create barriers where there shouldn’t be barriers.”

HWNZ has already carried out a review of medical discipline funding to look at priorities including medical health workforce “vulnerability and criticality” areas. Wraight says the directors of nursing have “really warmed to the notion” of a similar review and consultation process for nursing funding, which would include looking at funding priorities and mechanisms. “So the nursing sector helps us to determine what’s the best way of applying the funding we have, to best meet the needs of nursing into the future.”

This would include looking at the current funding rules – an issue Wraight and HWNZ chair,

Des Gorman, would be discussing in their next meeting with the Nursing Council.

“It’s an anomaly, really, and it goes against our own premise that there should be opportunities for generic training for workforces that can work across settings.”

Holloway says she hopes the review will result in more long-term strategic priorities for the nursing funding pool as there was a danger in being too specific and narrow as needs change. However, along with meeting national priorities, the funding also needs to be responsive to regional needs.

She believes the current funding specifications allow for management and leadership courses as long as they can be counted towards a Nursing Council approved qualification. With the council due to review postgraduate nursing education, she also hoped there was an opportunity for the two reviews to be linked.

Hayward said that if there was a HWNZ review, then NEAT had asked in the past and would support a removal of restrictions that require DHBs to only use funding for specific areas, whether or not they fit the DHB’s workforce or service requirements.

HWNZ postgraduate funding

HWNZ postgraduate nurse training (units)

2010 1753 units

2011 1526 (projected),1428.77 (actual)

2012 1161.78 (as at September)

• HWNZ postgraduate funding pool – approximately $12 million but still to be finalised for 2013

• Same priority areas of aged care, mental health and addiction, and rehabilitation, but due to be reviewed in 2013

• Te Pou also continues to offer up to 43 places in postgraduate Clinical Leadership in Nursing Practice programmes for mental health and addiction nurses

New role in managed or co-ordinated care called for by HWNZ report

Developing a skilled workforce in managed or co-ordinated care for health consumers should be an urgent priority, recommends a report to Health Workforce New Zealand.

The recommendation is made in a review commissioned from nurse researcher Vicki Currie to look at the current education options for health professionals and others working in the field of healthcare co-ordination or case management.

Brenda Wraight says the review arose from nearly all of the recent workforce service reviews recommending better care co-ordination for the particular health services they focused on.

“So care co-ordination as a skill set and a practice is something we want to encourage and Vicki Currie’s work will lead to that.”

Wraight says the first iteration of that care co-ordination approach will be the cancer co-ordination nurse positions, funded in this year’s Budget, with HWNZ supporting their development.

But HWNZ was also looking at the idea of the development of a core set of common competencies or skills that would be expected of someone offering care co-ordination in other areas like rehabilitation, mental health, and primary health.

Wraight says the term “care coordinator” or “managed care” have been chosen over the terms “case management” or “case manager”, as these were associated with ACC or WINZ.

Currie’s report says research both locally and internationally provides evidence that implementing a managed, integrated, and thereby, coordinated approach to health care – particularly amongst the frequent users of health services – enhances quality and cost effectiveness.

She says encouraging the existing workforce, such as registered nurses (and/or allied health professionals like physiotherapists and occupational therapists), to be upskilled and trained in care co-ordination is a “sensible course of action” as they have existing skills and knowledge and “credibility” with health consumers.

“There are many models and terms used to describe the functions (and titles) of those co-ordinating care: integrated care, care co-ordination, guided care, managed care, case management, collaborative care, and seamless care, to name a few,” says Currie’s report. Adding to the confusion was debate about the models or systems of care.

“Irrespective of the models, systems, and terms used, there is evidence to support that well-designed and implemented care co-ordination can help persons with disabilities live independently longer with added years of quality life, and that care co-ordination/care management may be even more vital for certain populations, such as individuals with multiple chronic conditions and those with higher levels of disability.”

The full report, including examination of models here and overseas and the current gap in education programmes available, is available under reports at the HWNZ website: www.healthworkforce.govt.nz