OPINION: A year on from nursing leaders writing an open letter criticising Health Workforce New Zealand’s lack of action on nursing Professor Jenny Carryer, executive director of College of Nurses, reflects on where to from here after a largely, positive HWNZ-hosted national nursing meeting in late November.
The recent nursing meeting hosted by Health Workforce NZ (HWNZ) was a tremendous opportunity to see and understand the breadth of work currently being achieved by the combined efforts of NZ Nurse leaders. The national nurse group (known as NNO) is a forum where leaders of nine national nursing organisations come together to find convergence of perspectives and to clarify points of divergence so as to work together effectively on agreed key nursing and health service issues.
The NNO:
• does not constitute another nursing organisation
• does not speak as a collective voice for nursing and there is no NNO spokesperson – members comment to media in accordance with own organisational policy understanding that where consensus has been reached at NNO on an issue, individual organisational comment will express that consensus.
• is not a decision making group
It is however excellent evidence of the enormous collegiality, collaboration and commitment to the greater good between all of the major national nursing organisations. Alongside the long overdue expansion in the size and capacity of the nursing team in the Chief Nurse’s office in the Ministry of Health we are seeing a really strong focus and combined expertise being brought to bear on strategic challenges and direction for nursing.
A major issue for the health sector at the moment is the ongoing development of a workforce that is flexible, responsive and able to respond to the escalating demand for services. For this reason it is critical that there be a respectful and active partnership between NNO and HWNZ.
The health system is facing challenges through a growing gap in demand for services and supply of workforce. This has been stated so often now that it risks losing impact but is nevertheless an important signal to all of us that workforce planning is extremely important. Nursing leaders have led considerable development of data intelligence around new graduates, workforce planning, advanced practice development, and care capacity demand management in hospitals. Nurse leaders also hold to the strategic vision for the all-important goal of closely aligning nursing services with community need.
Nursing, being a large, generalist and flexible workforce is well placed to meet the changes required but data indicates that this workforce is not growing at the pace required to meet the demand. Attention to the development of the nursing workforce is essential if we are to see both clinical and financial stability in the New Zealand health system.
Nursing has previously argued that to date HWNZ has paid insufficient attention to nursing as the largest regulated workforce, which also directly supervises the largest unregulated workforce. At the end of last year the College along with NZNO and the College of Midwives wrote to HWNZ expressing our concern about the progress HWNZ was making in developing and implementing a workforce strategy.
In that letter we noted that the changes required to build health workforce confidence in HWNZ and its mandated programme are:
➢ Open and transparent processes
➢ Positive engagement with the sector including representative organisations
➢ Sound problem identification and exploration of all options before developing and testing new models
➢ Robust evaluation designs
➢ Rigorous cost/benefit analysis of the introduction of new models and new health practitioners
➢ Engagement with New Zealand health workforce researchers
➢ Consultation with the sector on changes to models of delivery
The workforce strategy day held on November 29th could be seen as an eventual response to our concerns and NNO approached this day with enthusiasm. Approximately 50 nurses from a range of locations and positions attended the day as invited by HWNZ. HWNZ staff had expended considerable effort to arrange and host the day efficiently.
Chai Chuah (acting Director General of Health) opened the day with an excellent and inspiring address. He talked about his own journey to leadership and about his interest in disruptive innovations, which he sees as critical to allowing the health system to respond to demand in novel and sustainable ways. The published works of Clayton Christenson on this topic have been a particular source of inspiration for him.
The bulk of the day was taken up by a workshop aimed to elicit a range of goals based on what we do know about nursing workforce and identifying what is not known and will require further data sourcing. The day was characterised by a wonderful level of cohesion and shared vision between senior nurses present on the day who agreed that issues of importance for the immediate future include a number of key goals (summarised), which included:
1. The need for a professional practice model of leadership in every setting in every nurse practice setting
2. The need to align the investment in nursing education with strategic nurse workforce development -determined by consumer voice
3. The importance of policy support for expanded nurse roles and prescribing
4. Interdisciplinary models for rural health and other communities
5. The importance of a whole of integrated system approach
6. The need to develop and resource alternative approaches to clinical nurse education in the undergraduate degree
7. All the NetP funding to go on NETP nurses inclusive of a vision of 100% employment for new graduate nurses.
Professor Des Gorman closed the day by acknowledging the sterling work of Nursing Council of NZ in developing superb systems of data collection for the nursing workforce. He also conceded that HWNZ had been wrong to address medical workforce issues first and largely ignore nursing as he now realised that nursing workforce issues were of critical importance to the sustainability of the health system. He was less gracious in noting that he had heard nothing disruptive, tactical or strategic all day in terms of listening to the discussions that had occurred.
On that point we will need to differ. Nursing holds to a focus on attending to community need for services as guidance for aligning nursing development. This may not be short term or exciting or gain “easy runs on the board” but we believe it is the ethical, sustainable and long-term approach that is needed. And were we to reach the point where all legislative, policy and the many other more subtle barriers were addressed, so that the full potential of nursing was released? Well that, all by itself, would be a remarkably disruptive innovation!!
