From nurse education, clinical, or workforce issues through to healthy living, Nursing Review has it covered.

Once again, to celebrate International Nurses Day, Nursing Review invited district health boards across the country to contribute stories on nursing ‘heroes’ in their region. We received stories on some of the unsung, innovative, compassionate, high-achieving and dedicated nurses that make up the New Zealand nursing workforce.

NAME: Dr Alison Pirret

DHB: Counties Manukau

JOB: Nurse practitioner (adult intensive and high dependency care), Middlemore Hospital

Dr Alison Pirret is a nurse practitioner whose vision has taken critical care nursing beyond the walls of the traditional ICU and into the ward setting.

Last year, the adult intensive and high dependency care NP successfully completed her PhD comparing the diagnostic reasoning of NPs and medical registrars. She is the author of a 390-page acute care nursing textbook that is into its second edition.

“Alison is the epitome of what it means to be a hero role model,” says Counties Manukau acute care clinical nurse director, Annie Fogarty.

“Like how the media portrayed (super) heroes, on the surface, Alison appears incredibly normal and unassuming. However, this highly intelligent, passionate, professional, and empathic educator, team player, and visionary leader in her field doesn’t suddenly need to change her personality, shape, or form to bring her skills to the fore in a time of crisis.”

Pirret developed her NP role to meet an identified ICU outreach need and works in Middlemore’s critical care complex as an outreach NP and in support of the Patient At Risk team.

Fogarty says Pirret’s role is pivotal in supporting nursing and medical staff to identify and successfully manage patients at risk, within the ward setting.

“Alison would maintain this is nothing special, it’s what she does every day; we would argue that it takes a special type of hero to do this.”

 

 NAME: Anamaria Watene

DHB: Bay of Plenty

JOB: Clinical nurse manager, Kaupapa Ward, Tauranga Hospital

Anamaria Watene has turned her Kaupapa ward from one that has faced complaints to one that regularly receives compliments.

An intentional rounding pilot was introduced into the ward at Tauranga Hospital in 2011, leading to a dramatic rise in the frequency of times patients are checked every hour. The raw data collected in 2011 showed the lowest daily hourly rounding was 46 per cent, which increased to 100 per cent in 2012, and has remained at this high level through 2013 and the first two months of 2014. Watene, charge nurse manager of the ward, attributes the dramatic improvement to her staff buying into intentional rounding and all disciplines working as a team. Her major goal with intentional rounding has been to reduce harm from falls by minimising the risk of falls by patients by meeting the patient’s fundamental care needs.

The mantra of the ward is now A for aid mobility; B for bell, pain, position; C for clutter; D for drink; E for elimination (toileting), and signs reminding staff and patients are found throughout the ward.

“The systems introduced include mobilisation recommendations, rounding checks, signs in every patient’s room, all actions recorded in the Care Plan, and audited twice a month, with an intentional rounding audit once a month,”says Watene.

Additional prompts Watene has introduced include rounding checks on computer screensavers and coloured 3D rounding checks ticker-taping across computer screens.

 

NAME: Anna Reed

DHB: Wairarapa

JOB: Nurse practitioner, Masterton Medical

Anna Reed is a nurse practitioner creating wrap-around care for the high needs elderly in the community with often complex health needs.

She works for Masterton Medical Centre,

New Zealand’s largest general practice, with 23,000 patients. About half of her patients are in the community and the other half in residential aged care facilities.

After completing her clinical Masters in 2009, Anna was Wairarapa DHB’s clinical nurse specialist in aged care before moving to general practice to train as an NP.

“Once I worked with older people, I never wanted to do anything else,” she says.

“Most have had such a remarkable journey and have so many stories to tell. Many are lonely, anxious, and some are angry. Their families may have gone away, their friends are dying, and some struggle to care for themselves in their own homes.”

Their health issues can be complex and many of her referrals are for people in the early stages of memory impairment or dementia.

“Ensuring support packages are in place such as access to day activities, respite and carer-relief is essential to protecting the valued carer role.”

Anna’s role includes assessment, diagnosis, and treatment, including prescribing, of acute and chronic illness in consultation with GPs, DHB physicians, and other members of the multidisciplinary team involved in coordinating care of older people. She also does the three-monthly reviews of rest home patients, looking at their mobility, medication, and wellbeing, and talking to family members.

 

NAME: Anne Cleland

DHB: MidCentral

JOB: Gastroenterology lead clinical nurse specialist

Anne Cleland is in the forefront of helping build a endoscopy nursing skills framework, which may lead to the development of the nurse endoscopist role in New Zealand.

Cleland, who has a Master’s degree in nursing, has a background of 25 years of endoscopy nursing, mostly at MidCentral Health, but including some years in America. She has recently been appointed to a

part-time position with the National Endoscopy Quality Improvement Programme (NEQIP) as a nursing workforce development lead. In this role, her focus will initially be on the continued development of an Endoscopy Knowledge, Skills and Competency Framework for endoscopy nurses, which may include the development of a nurse endoscopist role in New Zealand. She will also be supporting the national implementation of the NZGRS (a patient-centred quality improvement tool) and other NEQIP activities.

In addition to these roles, Anne has been treasurer on the New Zealand Nurses’ Organisation Gastroenterology Nurses Section and is also a member of the National Bowel Cancer Working Group. Recently she was awarded a travelling scholarship and visited England to view hospitals that have implemented the Global Rating Scale and viewed workforce development initiatives and efforts to improve the patient journey.

Gastroenterology charge nurse Lynley Morton says that Cleland’s work is helping put gastroenterology in the spotlight.

“Not only is her experience helping us develop our service here at MidCentral Health, but it’s helping nurses and patients around the country.”

 

NAME: Brenda Baird

DHB: Auckland

JOB: Staff nurse, respiratory ward, Auckland City Hospital

Brenda Baird is a staff nurse who made up to two litres of Milo a shift for a vulnerable long-term patient and is seen as a nursing hero for consistently going the extra mile.

Each month, one member of the Auckland DHB team is selected as a local hero with nominations coming in from patients, their families, and from staff alike. Earlier this year, Brenda Baird, a staff nurse of 30 years at Auckland City Hospital, was nominated by her charge nurse, Sarah Wilson. Wilson says Baird consistently goes the extra mile for patients.

“The effects of her care and attention were recently demonstrated when she was looking after a very vulnerable, long-term patient. Every shift, Brenda would make this patient up to two litres of hot Milo, one cup at a time. She led the team to manage his pressure sores, improving his health and enhancing his experience of being in hospital. This patient now smiles and communicates – he is a completely different man.”

Wilson says Baird works tirelessly for patients to ensure that they get the best out of life.

“She really listens to them, understands what they want for their life, and then she works closely with them and their families to help them achieve their goals.

“Brenda is well-known and loved by our patients who comment they feel better when she walks in the room.”

 

NAME: Delia Williams

DHB: Whanganui

JOB: Clinical nurse specialist diabetes

Becoming Whanganui’s first diabetes nurse specialist prescriber has enabled

Delia Williams to make a big difference to her patients.

Williams, who has been in nursing since 1984 and a diabetes nurse for 13 years, is one of only 27 nurses in the country employed in the prescribing diabetes role.

“Being a designated diabetes prescriber is a small but very exciting aspect of my role because it gives me the opportunity to advance my clinical practice while offering an efficient and comprehensive service for those with diabetes,” Delia says.

“Prescribing can make a significant difference for the patient by simplifying the processes involved for them and by influencing their continuity of care.

“Unfortunately, the number of patients with diabetes has almost doubled in the last 10 years, so it’s important we extend the scope and skills of our healthcare team to help us manage the increase.

Williams see patients on the hospital ward, outpatients, and also hold clinics in rural health centres. She also provides education and support to nurses working at the hospital and in general practices.

Williams supports a collaborative approach by the DHB’s diabetes service to strengthening the partnership between primary and secondary care with the aim of maximising available resources for the management of diabetes. Her vision is to bring about change by empowering nurses through their knowledge and skills, working alongside them to build confidence and foster a seamless service for people with diabetes.

 

NAME: Fiona Unaç

DHB: Hawke’s Bay

JOB: Acute care nurse practitioner (radiology and vascular services)

Fiona Unaç is the only nurse practitioner in Australasia working in the acute care specialties of radiology and vascular services.

Hawke’s Bay DHB chief nursing officer Chris McKenna says Fiona is a real nursing hero because she is “innovative, positive, and goes the extra mile to improve patient outcomes”.

“Fiona carries out technical skills traditionally performed by doctors, such as ultrasound guided paracentesis and thoracentesis, and she has a core responsibility of delivering advance nursing care across radiology and vascular services from first specialist assessment to post procedural follow-up.

“She is the only nurse practitioner in Australasia working across these specialties and has a special interest in peripheral vascular disease (PVD) management, particularly as people with PVD are a high risk but neglected disease population.”

McKenna credits Unaç with working to make sure this group of patients is better integrated into the system and not forgotten.

Unaç’s nursing achievements have also been recognised by her peers firstly as a recipient of the DHB’s Innovation in Nursing Award in 2010, and then as a recipient of a New Zealand Nurses Organisation Award for Services to Nursing and Midwifery in 2013. She is the current chair of the Perioperative Nurses College (NZNO) and is a technical expert in medical imaging nursing for International Accreditation New Zealand.

 

NAME: Helen Lloyd

DHB: Canterbury

JOB: Community clinical nurse specialist (older people’s health)

Helen Lloyd is passionate about helping older people stay well in their own homes and has been key to a number of post-quake Canterbury initiatives aiming to do just that.

“I have a huge passion for older people in terms of helping them to live the way they want to live.” Lloyd is a key member of the Community Older Persons Health Team and has been instrumental in a number of innovations in the Canterbury Health System for older people in the community including a lead role in launching the Community Rehabilitation Enablement and Support Team (CREST).

“If it was not for the amazing team of people I work with, then this job would be impossible. We have the best clinical leaders and multidisciplinary teams I have worked with anywhere in the world; that includes the 20 years I spent in England,” Lloyd says.

Kate Gibb, the DHB’s nursing director for older people’s health, says Lloyd continues to work closely with CREST along with filling gaps across a multitude of other roles including managing clinical teams and supporting gerontology nursing colleagues in Canterbury and the West Coast.

“Helen manages to fit an enormous amount into her working week … amidst all of this she still manages to support and regularly visit her own clients.”

Post-quake, Lloyd was part of the team supporting vulnerable aged residential care facilities, providing practical support to facilities, which had lost vital services and infrastructure such as power and water. She was also part of the team that led to the development of a Motor Neurone Disease facilitator role within the Canterbury Initiative.

Helen is an assessor and advocate for the Professional Development Recognition Programme (PDRP) and has also led the introduction of nursing students and Nurse Entry To Practice (NETP) into the community team, which is now a Dedicated Education Unit (DEU). She also established a team to develop Older Person’s Health Specialist Service education days, which are attended widely by nurses across the DHB, community, and residential care sectors.

 

NAME: Nikita Fleming

DHB: Nelson-Marlborough

JOB: Mental health nurse (second year)

Nikita Fleming’s career has moved from beauty therapy to building therapeutic relationships with her mental health clients.

The 24-year-old came to nursing via a roundabout route, as after leaving school at 16, she worked in her father’s factory and completed a beauty therapy diploma before deciding she wanted a career with more substance. As a nursing student, Fleming did a placement at Nelson Hospital’s mental health acute unit and was hooked.

“Building a therapeutic relationship with mental health consumers is both critical to develop, as well as a challenge, but that is what I enjoy about mental health nursing,” says Fleming.

“Developing rapport and trust with a person to allow you to provide care is the most important part of my job.”

Last year, while working full-time during her Nursing Entry to Practice (NETP) new graduate programme, she completed a Postgraduate Certificate in Nursing (Mental Health) through Whitirea Community Polytechnic. She says she really enjoyed study at this level and will continue to study to keep her practice current and to create a body of knowledge that reinforces “why we do what we do”. She is nominated by NMDHB as a young nursing hero who has embraced both the academic and therapeutic aspects of nursing.

 

NAME: Sara Best

DHB: Capital & Coast

JOB: District nurse (wound care management)

District nurse Sara Best’s enthusiasm and humour has helped introduce 60 of her colleagues to using a high tech, handheld laser camera to measure and monitor wounds.

Best has been named Capital & Coast’s nursing hero for her pivotal role in training the DHB’s district nursing workface in the use of the innovative wound care technology across the board’s Kāpiti, Kenepuru, and Wellington bases.

The Silhouette system comprises a 3D laser camera that captures dimensions of length, area, depth, height, and volume of a patient’s wound at home or in a clinic. That information is then logged on a secure database, from which reports can be generated to assist district nurses in the management of surgical wounds, pressure sores, and leg ulcers.

“It’s motivating for staff and patients – the graphs that we can produce make it clear for people to understand if their wound is progressing or not, and provides objective, robust data when we’re liaising with clinicians.”

Now just one paper shy of her Master’s in Nursing, Best has educated district nurses of all ages, backgrounds, and computer skill levels with humour and enthusiasm, on top of her regular role providing lower limb Doppler assessment and complex wound care management. She’s been a district nurse for around 15 years and has tried other roles but always gone back to district nursing, specialising in her passion of wound care management.

“Now we can track an ulcer. If it’s not improving, we can assess the aetiology of an ulcer and intervene proactively with best practice treatment to ensure a faster healing rate.”

Her colleagues praise Best’s compassionate and inspiring manner and speak highly of the way she challenges their thinking to encourage evidence-based best practice.

 

NAME: Kirstin Unahi

DHB: Southern

JOB: Oncology nurse educator and nurse-led oncology assessment clinic.

Kirstin Unahi is helping cancer patients by identifying early potential side effects of their chemotherapy and offering timely intervention.

Southern DHB says Unahi is a dedicated oncology nurse educator for the Southern Blood and Cancer Service in Dunedin. She is also on the nurse practitioner pathway and is working on expanding her clinical skills and knowledge by running nurse-led oncology clinics for the board’s oncology assessment unit.

This unit provides a proactive service to patients having chemotherapy treatment by phoning patients post-treatment with the aim of promptly identifying potential side effects and providing early intervention. Patients can also come into the unit for a nursing assessment, after which nurses liaise with the medical teams in developing treatment plans. The DHB says the unit’s service is reducing the number of patients requiring admission to the oncology in-patient ward, enabling patients to stay in their own homes.

Unahi’s motivation and positivity is admired by her colleagues and nursing leaders and is seen as a role model to younger members of the nursing team of what can be achieved through hard work and a ‘can do’ attitude.