For the record September 2013

A round-up of national and international nursing news

Nursing at risk of losing regulatory voice by FIONA CASSIE

The Nursing Council is consulting on whether nurses want the status quo or to ‘merge’ and reduce the ‘voice’ of the largest profession to just one of 16.

The council has been open about its “concerns” at the Government’s controversial and stalled proposal to merge the administrative and regulatory roles of the 16 regulatory authorities from January next year.

In mid-July, there was a new twist to the shared services organisation (SSO) proposal, with the Director-General of Health writing in mid-July to the 16 authorities suggesting working together to combine “back room” functions as stage one of a two stage process to forming an SSO.

Council chief executive, Carolyn Reed, has said that the stumbling block for many authorities was the combining of regulatory roles and the council’s concerns about the SSO proposal were not alleviated by the proposed compromise as it still sought to ultimately create an SSO.

The council, just about to finalise its SSO consultation document, considered the last minute proposal and added it as ‘option two’. The option is only given two paragraphs as the council was unclear what the model involved, but as the option was still “intended to lead to an SSO”, the benefits and risks were similar to those outlined in the SSO option.

In the consultation document, the council says the PricewaterhouseCooper (PwC) report* that outlines the SSO proposal identifies the benefits of forming an SSO was that it would “better protect public safety” over time; increase coordination across RAs, which would lead to more efficient and consistent processes and a stronger unified voice; and it was expected to increase public confidence in the sector. Under the proposal, the RA’s governance boards and councils would remain but all staff carrying out the regulatory and administrative functions would work for the SSO limited liability company.

The transition cost to form an SSO was estimated to be $4.8m over three years funded from RA reserves and lead to an estimated overall saving of $3.5 million across all 16 RAs from 2017 onwards.

The Nursing Council commissioned a report on the SSO proposal from KPMG consulting* and says this identified no empirical evidence that the SSO would improve public safety.

The council said it was concerned that the loss of a direct governance relationship between it and its staff could see it “lose its flexibility” and become unresponsive to change.

“Additionally, there is a risk of loss of momentum on a strategic direction for the nursing profession as other profession’s strategic projects may take precedence,” says the document.

It also noted that nursing made up more than half of the regulated health workforce but the proposed model would reduce the council’s ‘voice’ to just one of 16.

The Director General had wanted authorities to get back to the Ministry of Health by August 31 but the Nursing Council is seeking submissions on its consultation document up to September 27.

*The consultation document, PwC SSO proposal, and KPMG critique are all available to download at the Nursing Council website: www.nursingcouncil.org.nz

Summary of Consultation Options

• Option 1: Maintain status quo.
• Option 2: Combine back office functions of 16 regulatory authorities (RAs) as stage one of developing a shared services organisation (SSO).
• Option 3: Combine back office and regulatory functions of the 16 RAs to form SSO.

Nurses: too many complaints and not enough plans?

A challenge was thrown to the nursing sector to be more pro-active and solutions-focused if it wants greater influence on the direction of primary health care.

Cathy O’Malley, the Ministry of Health deputy director general for sector capability and implementation, threw the challenge during her speech to last month’s College of Primary Health Care Nurses NZNO conference in Wellington.

O’Malley told the conference that when she looked back on those who had “knocked on her door” in her first year of the job, and now had regular spots in her diary, there were “very few nursing organisations”.

“I’ve had a few letters – most of those were complaining letters about what committees or not I had put nurses on.”

She said while she was aware that the Ministry’s chief nurse, Jane O’Malley, had regular interaction with nurses, she questioned nursing’s influence on the wider ministry – including her directorate, which was in charge of implementing the primary health strategy.

“So the presence of nursing leadership across the health system needs looking at – and the way you apply your influence.”

Cathy O’Malley asked the audience to consider nursing leadership’s strategy and agility to respond and influence the decision-makers in the system to advance not only the “interest of nursing” but also better outcomes for populations which were also sustainable “win-wins” for all stakeholders.

She said her “offer” to the nursing sector in response to her challenge was to help do something about it including fostering “pro-active proposals from nursing on how they can really make a difference”.

“I haven’t had a single one since I’ve been in the role. I’ve had letters; I’ve had requests for participation, but nothing in terms of what actually is the solution … so bring them on!”

Marion Guy, NZNO president, said O’Malley indicated “all she was hearing was complaint letters” and, though Guy did not believe this was the case, the organisation would certainly work to rectify that perception.

Rosemary Minto, chair of the College of Primary Health Care Nurses, said O’Malley’s speech had been a good challenge to “bring us back to the fact that we need to be solutions-focused”.

“The College has been trying to do that since our inception really … since we began we’ve been in the solutions game and not the whinging game.”