An independent panel was called in by the Nelson-Marlborough District Health Board to review the shift of Marlborough’s district nurses, and district nursing services in general, out of the hospital and into the town centre, after opposition to the Blenheim move was voiced by patients, some district nurses and the New Zealand Nurses Organisation.

The panel, comprising Karen Sangster, Counties Manukau’s chief nurse advisor for primary and integrated care; nurse practitioner Rosemary Minto, vice president of NZNO; and consultant Mark Heslop, recommended that the vast majority of Marlborough’s district nurses should relocate to a Health Hub in Blenheim’s town centre.

An anonymous Blenheim district nurse has been reported as telling the Marlborough Express that the team was “completely gutted” by the decision, which she believed was “political and corporate” as it was only in 2009 that district nurses were given a custom-built department at Wairau Hospital (see below for more on the hub plans).

“[The board members] don’t actually know what happens at the coalface,” she told the Express. “We’ve been trying to defend what’s been running to date, because we’re located in the best place possible.”

The panel commended the Top of the South district nursing team for their “high level of care, compassion and commitment” and said it was clear from consumer group meetings that it was highly regarded. The panel said its recommendations aimed to take the services form “good to great” and one of those recommendations was for a “thorough review” of district nurse staffing levels across the Nelson, Wairau (Marlborough) and Golden Bay districts as staff were showing signs of being overworked and understaffed.

The main indicators of under-staffing included: nurses having to prioritise patient care; most nurses working through their breaks and working after hours to write up patient notes; fewer staff engaging in professional development and non-clinical activities like training practice; insufficient aged care nurses in wound care; and a reduction in those nurses taking annual leave. A particular indicator was “noticeable high levels of stress and low morale of district nurses interviewed in Nelson, Golden Bay and Wairau district locations”.

The panel reported that district nursing FTE staffing numbers had been reduced by 1.8 FTE over the past two years and a further reduction of 0.9 was budgeted for this year. It said the lower district nursing numbers had reduced district nurses’ capacities to meet their key objectives of preventing avoidable hospitalisation and enabling early discharge and providing support at home for patients with short- and long-term health conditions, let alone meeting new objectives for collaboration with other services and providing education to other nurses. It recommended that the review of district nursing staffing levels includes looking at dedicated clerical administration support across the district and allocating more district nursing resource to supporting, educating and training other community healthcare providers.

The DHB’s director of nursing and midwifery Pamela Kiesanowski said she was pleased to see the role of the district nursing team so strongly affirmed.

“We are now focused on ensuring that this remains the case as we meet the future needs of our community,” she said.

Cathy O’Malley, GM Strategy, Planning and Community, said the reviewers made it clear that the DHB provided a good and highly valued service “but it is not without its pressures and challenges”.

“This report is the roadmap by which we can navigate our services improvements,” she said.

Hub plans

Marlborough district nurse-led clinics are currently held at Wairau Hospital for Marlborough patients. The proposal endorsed by the panel is for district nurses to shift into a centre of town health hub that is a joint venture between the Marlborough PHO and the DHB. Phase 1 of the hub opened in 2015 and is home to the PHO and public health services including nurses and a range of other community-based services: sexual health, community midwives and child and adolescent mental health. For Phase 2 it was proposed that district nurses be based there along with specialty nurses in long-term conditions and family planning.

Community opposition to the move included concerns about parking and access but the panel said these concerns would be met by the addition of more dedicated car parks and ensuring easy wheelchair access. There were also concerns about access to the IV and other supplies required by district nursing services, but the panel said a pharmacy and on-site storage would resolve these concerns.

The panel responded to concerns that the district nursing service would become disconnected from the hospital by recommending that the wound specialist district nurse remains based at Wairau Hospital initially and a transition-to-care liaison role is established at the hospital.

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