More than a decade later, the Capital & Coast DHB diabetes clinical nurse specialist has been the lead on four internationally published research papers on hypoglycaemic episodes in children and adults with diabetes.

Current international guidelines are to give children 10g of glucose and adults 15g if they are hypoglycaemic, no matter what their size. But McTavish and his research team of doctor colleagues from CCDHB and the University of Otago did trials – firstly with children attending a diabetes camp and then later with adults with type 1 and then type 2 diabetes – to determine if the dose should vary with the patient’s weight.

“We carried out four clinical trials over 10 years to try to find whether there is a faster and more effective way to treat hypoglycaemia in children and adults with diabetes,” says McTavish.

The team’s recently published results indicate there is. The findings show larger people need more glucose – so a weight-based method is the best way of managing hypoglycaemia. The Wellington team’s research – if reviewed and adopted – could lead to guideline changes worldwide in how hypoglycaemia is managed.

Starting on the clinical research path

So how did a clinical nurse specialist end up leading the world in this type of diabetes research?

“I joined what is now Capital & Coast DHB as a paediatric diabetes nurse in the diabetes service in 2000 – just a month before 9/11,” recalls McTavish. “Back then the international recommendation was to give those with diabetes 10 grams of glucose to anyone having a hypoglycaemic event, regardless of whether the child was three or 15 years old.

“I wondered about this, and asked ‘why do we do it this way when with every other medicine given to a child it is measured on how much that child weighs?’,” says McTavish.
McTavish dug deeper and found that the international research literature recommending the dosage amount for children was based on professional opinion and not on clinical evidence.

McTavish – who now has 25 years’ nursing in diabetes and a clinical master’s under his belt – at that point wasn’t sure about the next step. So he talked to paediatrician colleague Associate Professor Esko Wiltshire, whose own research specialty is diabetes, and Wiltshire recommended he go to the UK to do a short course being offered at Cambridge University by the International Society for Paediatric and Adolescent Diabetes (ISPAD). There McTavish learnt how to do both qualitative and quantitative research on diabetes in children.

“Once I’d got the ethics sorted, I was able to do our first research at a camp for children with diabetes in Otaki in 2007.”

Both the children and their families were surprisingly supportive of the research at this stage, says McTavish.

“We were looking at what types of glucose should be used when treating a hypo and looked at their weight. We tested the different groups of common carbohydrate treatments, including glucose tablets, jelly beans, fruit juice and mints, to see what was the most effective.”

Together with his team, McTavish presented their children’s camp research – which found that treatment with 0.3g/kg of carbohydrate (excluding jellybeans) effectively resolved hypoglycaemia in most children within 15 minutes – to an international meeting.

Moving to adult research

From there someone suggested doing the same study on adults with type 1 diabetes and McTavish said ‘yes let’s give it a go, let’s do it’.

This later led to a research paper on adults with type 1 diabetes, then children and adults on insulin pumps, then a research paper on what amount of glucose best helps someone with type 2 during a hypoglycaemic event.

The research all showed that treating someone with more glucose, if they were larger, and less, if they weighed very little, was more effective than the current guidelines. As a result, Capital & Coast and Hutt Valley DHBs switched 10 years ago to a weight-based approach for children and five years ago for adults.

The impact of treating hypos with glucose tied to the weight of the patient has been huge, says McTavish.

“If you give the right amount of glucose in the beginning, you can actually shorten the duration of the hypo. A hypo can last for more than 15 minutes for the symptoms of shakiness etc. to return to normal. But they can be resolved in 10 to 12 minutes if treated properly.

“If you don’t get the right amount of glucose into the patient, they will be having longer and more hypos over time.

“Cognitive gaps and signs of dementia are now being seen in long-term diabetes patients as a result of too many hypos,” says McTavish. “So you may as well do it right once rather than follow the international guidelines and give them several doses of glucose throughout one hypo.”

Minimising the shock

From the get-go, McTavish was drawn to diabetes nursing.

He sees one of the most important elements of what is a multi-faceted role is first and foremost minimising the shock of a diagnosis to the families affected by diabetes – particularly a child diagnosed with type 1 diabetes.

“Some of those families are injecting insulin two to five times a day. A lot of families and kids hate getting, or administering, injections. It is an ongoing process of matching their food with their insulin and activity to get it right.”

McTavish didn’t always plan on being a nurse; he did two years of pharmacy training before changing tack.

“I actually chose nursing after coming across a motorbike accident one day and finding I was totally useless at the scene. I later went to Sydney Children’s Hospital to start one of the last hospital-based nursing programmes – I didn’t think I was cut out for learning in a classroom.”

Prior to beginning the research, McTavish remembers reading just one line in an American Diabetes Association publication talking about studies in the 1990s suggesting tying glucose to weight.

“Otherwise it hadn’t been studied. Previously the adult patient would feel symptoms like feeling shaking and difficulty concentrating at a blood glucose of around 3.1 mmol/L then they would be told to have, say, 15 grams of glucose.

“The longer and more frequent the hypos, the higher the likelihood of brain damage of one form or another, or it could lead to poor diabetes control and bigger problems later on, like eye disease and renal failure.”

McTavish says diabetes burn-out for clients is a real thing. “You feel empathetic towards them; they’ve been doing injections and testing for many years and surviving with a chronic illness. It’s a tightrope managing both hypo and hyper events.

The juggle – of nursing and research – is also real, says McTavish. “I have to be conscious about having ringfenced time for research. Clinical time is clinical time and you think differently.”

Nurses – give research a go

“I came up with a simple algorithm for the type of research any nurse can do,” says McTavish. “You have a question you need the answer to. You just have to find the energy to answer it.

“You shouldn’t have to do it alone; you need a statistician and people who are willing to edit your work, as well as a librarian to help you do the literature search.
“It doesn’t have to be complicated. Research adds to the body of evidence we use every day in our clinical nursing practice.”

Hilary Graham-Smith, associate professional services manager for the
New Zealand Nurses Organisation, agrees. She says nurses are conducting research as part of their job sometimes without even realising they’re doing it.

“Nurses are doing research when they are trialling a new wound care product, for example. They bring huge experience and knowledge to research, so if they come up with a theory and put it to the test, the benefits can be fantastic for consumers.”

While there are not many positions where nurses focus solely on research, nurses can do research as part of their programme of study, including as part of their master’s study.
Nurses have insights into a patient’s experience that other health professionals do not, says Graham-Smith. “Patients can find it easier to talk to nurses about what is going on for them. Nurses are at patients’ bedsides in hospitals and that can give them a lot of insight into how patients are feeling and about their treatment.”

Graham-Smith says that while there are barriers to nurses being involved in research, such as a lack of time and a heavy workload, McTavish is an example of the power of nursing research. “Lindsay has a lot of passion, experience and knowledge and has put it to excellent use.”

Next research question in the pipeline

For McTavish’s research on adults with type 2 diabetes, the average weight of patients was 90kg. Next up, Lindsay wants to look at the effects of a higher amount of glucose for some bigger people, weighing around 140kg.

“I never get tired of research – there’s always another question to be asked and answered. All the studies set the path for the next one.”

In 2015 the Waikato District Health Board clinical nurse specialist received a Heart Foundation research grant to undertake a study alongside co-investigator Debbie Chappell on the link between health professional empathy and patient self-care.

In June she leaves the Coromandel, where she works as part of Waikato DHB’s nurse-led integrated heart failure service, to present the findings at the EuroHeartCare congress in Dublin.

The Wintec-trained nurse, who has a Master of Science and a PhD from Berlin’s Charité University Hospital, says heart failure care is about supporting people’s self-care skills.

“People need to know what to do to keep themselves well,” Inkrot says. “When a patient becomes unwell, education and support are key [to] getting well again.

“We know that in combination with medical treatment self-care can play a major role in preventing deterioration and hospitalisation for people with a chronic condition such as heart failure. What we’re not sure on is what ingredient it is that makes or breaks a person’s ability to self-care.”

Inkrot’s research examines the levels of empathy perceived during consultations between health professionals and their patients. “Is there a correlation? My hypothesis was that higher perceived empathy leads to higher self-care ability.”

Patients were asked to rank their ability to self-care, as well as whether they thought their health practitioner was empathetic towards them. She also asked practitioners to complete the survey to see if a patient’s perceived ability to self-care matched the practitioner’s thoughts.

Data on Māori patients was also analysed during the cross-sectional study. “We know that, statistically speaking, Māori patients generally have lower healthcare outcomes, so that part of the research was very important,” she says.

Inkrot believes her research has the potential to benefit many New Zealanders, not just those living with heart failure.

“Every New Zealander is likely to have encounters with healthcare providers at some point in their lives. I’m hoping to encourage clinicians to use the power of interpersonal connections in their interactions with patients.”

NZ’s only nurse-led community heart failure service

Inkrot has also recently heard that she has been nominated by European Society of Cardiology (ECS) as a finalist for the ESC Nursing and Allied Professions Investigator Award and in August will get to present some of her results at the ESC congress in Munich – one of the largest of its kind in the world.

The research that she’s sharing on the world stage was carried out while doing her day job as a CNS offering heart failure clinics across the Coromandel Peninsula.
She is one of six CNS working for the Waikato Integrated Heart Failure Service’s nurse-led service, established in 2009, which aims to increase access to heart failure services in the community.

Inkrot first worked in cardiology and internal medicine at Waikato Hospital after graduating from Wintec in 2002. The bilingual nurse grew up in Germany and in 2004 went to Germany to work as a district nurse and then on to agency nursing in London – mainly in cardiology, oncology and A&E.

She moved to Berlin in 2007 to take up a Charité University Hospital research position in cardiology as lead nurse trial coordinator, during which she completed her Master of Science in Nursing and started her PhD (which she completed when back in New Zealand). In 2012 she returned to help develop the Waikato heart failure service, including setting up the service on the Coromandel Peninsula.

Inkrot says the service is the only one of its kind in the country. “While most DHBs have heart failure services, we’re the only one out there in the community, where the people are.”

The nurse-led service’s home is Waikato Hospital’s cardiology department but offers CNS services – including expert care, support and education – in the wider Waikato community. Only the three CNS serving the Hamilton city area are based at Waikato Hospital with the other three based in Tokoroa, Te Kuiti Hospital and Inkrot at Thames Hospital.

“We want to improve outcomes for patients. GPs can refer to us, and we work with patients that have already been admitted too.”

While Inkrot is unable to prescribe medication, she says she works in collaboration with the patient’s doctors and specialists and makes suggestions to help with diagnoses and management plans.

Self-care skills important

Teaching self-care skills is an important part of the nurse specialists’ clinical monitoring and management role, as is working with families and whānau.
“We want to reduce hospitalisation and teach people how to recognise the warning signs of a bad day,” says Inkrot.

Self-care for patients includes following a healthy diet, managing their weight, getting rest as well as regular exercise and taking their medication as prescribed.

Inkrot says there is no “typical patient” that she works with. “Generally though, those that we see are in their late 60s to early 70s. Patients’ experiences of heart failure can differ vastly too.

“Heart failure isn’t just one thing. There are symptoms in common though; fatigue, breathlessness, swollen legs. It can be tricky to do everyday things.”

She says heart failure is complicated and there is no single trajectory. “It can be something of a rollercoaster. You can have bad days and good days.”

Inkrot’s aim is to reduce hospitalisation by teaching patients how to recognise the warning signs of a bad day. “We want to prevent and avoid hospitalisation. It’s about empowering patients to look after themselves.”

While there is no cure for heart failure, there is plenty that can be done to help. “It is true that there is no cure. But we can improve both heart function and quality of life. Early treatment and support is so important.”

Inkrot says patients using the service are generally discharged within six months, once they have the support and tools needed. “We do have a small number who need palliative care, and we support them and their families with that too.”

The prevalence of heart failure is rising. “We have an aging population so it is becoming more common. Better health care also means the numbers are increasing.”

The importance of collaborative education

Education is also an important part of Inkrot’s collaborative work with both primary and secondary health professionals and community teams.

“The service is not possible without the support of the cardiologists, the general practitioners, the nurses. They are integral to this. It’s a multi-disciplinary effort where we
work together.”

She is also excited about the future of the sector.

“Five to 10 years ago, heart failure was in the too-hard basket. It wasn’t sexy, it was super-complicated and hard.”

Having a patient with heart failure was a challenge when she first trained as a nurse. “But now, we’ve worked out how to improve things significantly for the patient. We’ve worked out how to reduce costs and how to decrease mortality.

“I’m so passionate about this work because I can make a difference.”

Kunac is a clinical nurse specialist (CNS) with the district health board’s infectious diseases team and helps manage hospital patients’ transition to having intravenous antibiotics at home, under the supervision of a district nurse through the OPIVA (outpatient intravenous antibiotic) service.

She was nominated by her charge nurse manager Liz Gunn, who said Kunac helped navigate families and patients through the “big words that exist in the world of bacteria and antibiotics” during pre-discharge meetings.

“She will explain the laboratory results in appropriate language and discuss appropriate medication therapies and how these will be managed both as an inpatient and then as an outpatient,” said Gunn. “She gives her time willingly and patients are never made to feel rushed.”

Kunac trained as a nurse in the Waikato in the late 1980s and nursed around the country before returning in the year 2000 to take on firstly a nurse specialist role in internal medicine and then a district nurse role for five years before taking up her current role in 2015.

“That [district nursing] experience and those networks really help me do my job now,” said Kunac. “Even though I am based at Waikato Hospital, I know the reality of the community –  what support and resources district nurses need from me so they can help the patient, and what Sunday afternoon in Ngāruawāhia looks like if something goes wrong and help is needed.”

Kunac said returning to study after 20 years of nursing had also helped her expand her practice and made her focus on the patient journey through the health system.

Her current CNS role was created by Dr Paul Huggan when the infectious diseases team was set up in 2015 by Dr Paul Huggan and Kunac said his vision, and smart planning, meant the CNS role could totally focus on patients.

The infectious diseases team supported Kunac’s nomination.

“Tracey takes it for granted that patients should receive care on their own terms, in an environment most suitable to their needs and in a manner which is truly respectful of their ideas, concerns and future expectations….” said their submission.

“Tracey leads by example with this approach and has elevated the practice of the ID team, as we seek to emulate and match her high standards.”

Trials of telehealth Wound Nurse Specialist clinics began earlier this year to connect wound care patients at health centres in Balclutha and Dunstan with vascular surgeons at Dunedin Hospital.

Emil Schmidt, the clinical nurse specialist who leads the monthly telehealth clinics, said the success of the clinics to date means the team hope to expand to other locations next year.

Wound care specialists like himself work with patients requiring the most complex treatment regimens  – like patients with diabetic ulcers or peripheral vascular disease – that need frequent follow-up assessments and adjustments to their therapy.

Providing care for such patients is particularly challenging when they live a distance from a secondary care hospital so the telehealth clinics, linked by video, can help specialists work with district nurses at the rural hospitals to help heal the demanding wounds.

The clinics video link with consultants via secure connections and both sites have shared access to electronic patient records, and specialist wound imaging, measurements and documentation system.

“We can directly communicate, face-to-face,” said Schmidt. “We can zoom-in on the wound and make decisions together on the best approach to caring for the patient.”

He said that patients appreciated the convenience of telehealth appointments and healthcare teams were equally pleased with the quality and efficiency of the appointments.

“In-person appointments are still a part of the patients’ care plan but by providing these clinics we are able to reduce the number of times patients have to travel long distances. It also helps to free up appointments in outpatients clinics for first specialist appointments and other treatments for other patients, so everyone benefits,” said Schmidt.

The regulation introducing RN prescribing in primary health and specialty teams came into force on September 20 last year, with the aim of improving access to medicines for vulnerable populations.

The 29 new RN prescribers authorised to prescribe from a schedule of common medicines for common and long-term conditions join 53 diabetes nurse specialists authorised to prescribe in diabetes health, making 82 RN prescribers in total.

Pam Doole, the Nursing Council’s Strategic Policy Manager, shared the updated statistics on the new second level prescribing at the Clinical Nurse Specialist Society NZ conference in Christchurch earlier this month.

There are now also 254 nurse practitioner prescribers (the top level and only autonomous nurse prescribers), and a group of nurses are currently trialling a third and more limited level of RN prescribing in community health. The first NP prescriber was authorised in 2003 and a pilot followed in 2011 of RN-designated prescribing in diabetes (applications under the diabetes regulations close in November).

Doole said to date most of the 29 RN prescribers in primary health and specialty teams have come through the alternative pathway of having first completed a clinical master’s degree. But the first graduates of the council-approved postgraduate diplomas in registered nurse prescribing were now starting to seek prescribing approval.

RN diploma prescriber

Hawke’s Bay’s Rachael Engelbrecht is one of the first RN prescribers to come through the diploma model.

The former practice nurse specialising in diabetes said she finished a postgraduate diploma in health sciences in 2015 at EIT and spent 2016 waiting for the new prescribing diploma path to be finalised and approved so she could do the EIT diploma’s prescribing practicum.

Engelbrecht began her practicum at the start of this year at the general practice where she had worked for eight years and had become the lead diabetes nurse after developing an interest in diabetes. She said she had a very supportive GP mentor and they envisaged that while her main prescribing focus would be diabetes, it would be useful for her to also have the potential to prescribe for conditions like urinary tract infections and other long-term conditions apart from diabetes.

But midway through her prescribing practicum she changed roles and took up a new post as a diabetes nurse specialist for Hawke’s Bay District Health Board’s diabetes service and completed her diploma practicum under an endocrinologist.

The new RN prescriber believed the role was more clear cut in secondary services and was still evolving in primary care where some issues, like what to charge for an RN prescriber consultation, needed to be worked through.

At the DHB she is one of seven diabetes nurse specialists, with five of them now prescribers – four through the diabetes prescribing regulations and herself through the primary health and specialty team regulations. She said a sixth was currently following the diploma pathway to prescribing.

Changes afoot to regulations controlling RN prescribing

Pam Doole told the clinical nurse specialists’ conference that developing the RN prescribers’ medicines list of commonly used medicines for common conditions had not been a simple process.

Including the Council needing to respond to concerns raised by doctors and pharmacists, which led to it removing some medicines from the final list that was approved and gazetted by the Ministry of Health under the Medicines Act 1981.

Doole said she was aware that medicines used by some nursing specialties, and some new medicines, were not covered by the list. She said the medicines list, gazetted in 2016, was unlikely to be reviewed for a couple of years and in the interim nurses could develop a case for adding additional medicines that could make a difference to their patients.

Meanwhile, work was underway on a new regulatory regime to replace the Medicines Act 1981 and regulations, which could see controls on prescribing shifted to the Health Practitioners Competence Assurance Act and authorities like the Nursing Council. Doole said she was not sure yet whether that meant control of the medicines list would also come under Council’s control, but it could be simpler to make changes in the future if it did.

BACKGROUND INFORMATION

The specific common and long-term conditions that nurses authorised to prescribe in primary health and specialty teams can prescribe for include:

• diabetes and related conditions
• hypertension
• respiratory diseases including asthma and COPD
• anxiety and depression
• heart failure
• gout
• palliative care
• contraception
• vaccines
• common skin conditions and infections.

Examples of primary health and specialty team settings that RN prescribers can work in include:

• general practice
• outpatient clinics
• family planning
• sexual health
• public health
• district and home care
• rural and remote areas.

The requirements for registered nurses who wish to prescribe in primary health and specialty teams are:

• a minimum of three years full-time practice in the area they intend to prescribe in with at least one year of the total practice in New Zealand or a similar healthcare context
• the completion of a Council-approved postgraduate diploma in registered nurse prescribing for long term and common conditions or equivalent as assessed by the Nursing Council
• a practicum with an authorised prescriber, which demonstrates knowledge to safely prescribe specified prescription medicines and knowledge of the regulatory framework for prescribing
• satisfactory assessment of the competencies for nurse prescribers completed by an authorised prescriber
• RN prescribers in primary health and specialty teams must work in a collaborative team with a doctor or nurse practitioner available for consultation if the patient’s health concerns are more complex than the RN can manage.

JOB TITLE: Clinical nurse specialist, Trauma Service, Bay of Plenty District Health Board

Nursing qualifications:

• Diploma of Health Science (Nursing) 1990 (La Trobe University, Northern Campus, Bendigo, Australia)
• Bachelor of Nursing 1996 (Edith Cowan University, Perth, Australia)
• Postgraduate Diploma in Nursing 2011 (Wintec)
• Master of Nursing (Distinction) 2014 (Wintec

Briefly describe your initial five years as an RN.

Initially I worked in a regional hospital in Victoria, Australia, on medical/surgical/paediatric/emergency department (ED) wards, which was a fantastic experience. In 1993 I headed off to the Kimberley region of Western Australia to do remote area nursing for six months. On my return I did a critical care nursing course, worked in ED for a year, then left for Perth to pursue a career in intensive care for the next 10 years.

Did you have a career plan (vague or definite) on becoming an RN? And how did those first five years influence your subsequent career?

I always wanted to be a nurse, but I don’t really know why. If I had my time again, I’d consider being the costume designer for a major ballet company. That’s not to say I wouldn’t still choose to be a nurse, but reflects the opportunities now available for women.

My first five years’ nursing didn’t really shape my career. I went to the Kimberley because a friend told me it was paradise (I shouldn’t have listened!) and I only did the critical care course because all my closest friends were applying.

When I moved to New Zealand I was introduced to the postgrad study culture here, which was a surprise, but one I welcomed and relished. I’m planning on starting a PhD in the near future. Although most colleagues think this is a form of madness and torture, I see it as career planning. How long can I work full-time in nursing and still be effective? I don’t know. Therefore my PhD will fulfil my research passion, and reduce my hours – or at least allow me to put in the hours I want to put in – not what a contract tells me I have to.

What led you into your current field or specialty?

After moving to New Zealand I found I’d had enough of intensive care and was excited at the thought of returning to ED. While working in ED I was interested in the trauma patients and decided to research a few trauma-related topics through my postgraduate diploma. Then a position opened up for a clinical nurse specialist (CNS) in the Trauma Service.

What qualifications, skills or stepping-stone jobs do you think were particularly helpful and/or necessary in reaching your current role?

There is no specific qualification for becoming a CNS for trauma. The critical factor in my gaining this position was my experience in critical care areas, including collecting data in Perth for the state’s trauma registry. As a result of my role I now belong to several trauma professional groups, including the Major Trauma National Clinical Network, the National Trauma Nurse Network and the Australasian Trauma Network.

What personal characteristics do you believe are particularly important for nurses working in your role?

You need to be able to work autonomously and utilise your time well. Since I started my CNS role has expanded exponentially and so it is critical to have good time management skills.

Being humble is also important. I care for people who have faced adversity and survived. They are often left with the impacts of their traumatic event (be they physical or emotional scars) and recognising this, and what they have gone through, is incredibly important. Humility is also important when communicating with my peers as this isn’t a job I can do alone.

Good patient advocacy is an important skill, not just for the patient currently in my care, but for future patients, which means having difficult conversations with peers in order to make changes and keep up with international guidelines.

What career advice would you give to nurses seeking a similar role to yours?

I believe the single most important advice is to undertake a Master of Nursing. This enables you to reflect on who you are as a nurse and what you need to change in order to improve. I had been nursing for many years when I started my master’s and I didn’t realise the personal growth it would bring.

An interest in research is also essential. I collect data on 1,500 patients per year and can use the information gained from this data to contribute towards some exceptional research papers in injury prevention.

Communication is absolutely critical to the success of my role and is essential for patient care delivery.

Describe your current responsibilities.

My CNS role is multi-faceted. One of the key areas is case management of the severely injured. My case management involves, but is not limited to, a needs assessment, a review of radiological studies (to pick up on injuries missed because of distracting injuries), liaison with the patient and their family, ensuring appropriate referrals are made and early discharge planning.

Data collection is a large component and is undertaken on most trauma patients admitted to hospital. This data contributes to research, including my own, published in national and international journals.

I contribute to community-based injury prevention initiatives through outreach programme presentations and I develop trauma-specific protocols and policies for the DHB to ensure care is based on current evidence-based practices.

I participate in local and regional trauma initiatives and in national trauma strategies as I am currently part of a national trauma committee.

Another part of my role is education, mostly at a patient’s bedside or through informal dialogue with my colleagues, but several times a year I present at local study days, regional meetings and at conferences across Australasia.

Sandilands has a clinical master’s degree and has been a diabetes nurse specialist for the past 15 years – training at Nelson Hospital before the keen skier shifted five years ago to take up her current position based at Dunstan Hospital in Central Otago.

She supports the more than 300 people with type 1 and type 2 diabetes across an area stretching from Queenstown and Wanaka in the west to Ranfurly in the east and down to Roxburgh in the south. In 2012 – despite of and because of the isolation – she became the first prescribing diabetes nurse specialist in the South Island, which has reduced the barrier of travel for people.

She is employed as part of the Southern District Health Board diabetes specialist team and works in collaboration with her supervisor, Dunedin-based endocrinologist and associate professor Dr Patrick Manning, with whom she holds regular case reviews both in person and by email.

She offers clinics in Queenstown and Wanaka and most of the general practices across Central so she gets to mentor practice nurses in diabetes care. This means that most of the 18 practices she works with now have a nurse competent to start and titrate patients on insulin – though she is always only a phone call away – compared with  only two or three when she arrived in 2011.

Since last year she has been involved in offering up to monthly paediatric diabetes telemedicine clinics.

A big screen has been set up in Dunstan Hospital so Central Otago families can skip the six-hour-plus return trip to Dunedin and instead join Sandilands and the local dietitian at Dunstan for a video link consultation with paediatrician Dr Ben Wheeler in Dunedin. The children arrive with their downloaded insulin pump information to see “TV Dr Ben” who is larger than life on the big screen and she can do the physical examination and HbA1c tests while Wheeler from Dunedin can discuss test results, ongoing management and any other issues. And Sandilands can write any prescription needed there and then.

Amongst her rural diabetes patients are those keen on smartphone apps with quite a few using an app to download results from their blood glucose meter to share with her and others using apps recommended by the dietitian as being good for carb-counting. While she is concerned about the lack of validation of the many apps on the market she says with so many patients really keen the key was to work alongside the patients who want to use them.

New blood glucose sensor technology to avoid finger pricking (yet to be released in New Zealand) is also appealing to some of her younger clients who are bringing it in from overseas.

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.

One took a side trip to caregiving, another started their journey as an enrolled nurse, one literally grew up on hospital grounds, and others had career paths that took unexpected u-turns. They each have a good tale to tell and tips to share on career planning, the skills and qualifications helpful in their roles, the value of ongoing education, and how important a good mentor can be.

From caregiver to aged care nursing director

Name:

Kate Gibb

Job title:

Nursing Director, Older People – Population Health, Canterbury District Health Board

Nursing qualifications:

• Caregiver*
• BN 2004
• Christchurch Polytechnic Institute of Technology
• PGDip in Health Sciences (Gerontology Nursing) 2008
• University of Otago, Christchurch
• PGDip in Health Management (in progress) University of Otago, Christchurch

*I first started my nursing degree in 1997 but soon realised I needed some time out to ‘grow up’ a little bit more. I had been working part-time as a caregiver while studying, so I decided to go full-time as a caregiver, which I loved. I later re-started my studies and focused on gaining clinical experiences that would support me in a nursing career for older people.

Briefly describe your initial five years as an RN?

Immediately after qualifying, I worked as an RN in the residential care facility I’d already been working in as a caregiver. I then gained a place on the new graduate programme with the Canterbury District Health Board, at Older Persons Health’s Assessment, Treatment, and Rehabilitation service at The Princess Margaret Hospital. After some time as a staff nurse, I returned to the aged care sector in various senior clinical roles, eventually becoming manager of a rest home, hospital, and retirement village.

Did you have a career plan (vague or definite) on becoming an RN? How did those first five years influence your subsequent career?

I had the fortune of working with an amazing mentor who encouraged me early on to consider a leadership role within aged care, and who spent time and energy supporting my development through my few years as a RN. I continued to love working with older people, so I knew that this was the area of nursing I wanted to pursue. The nursing experience and skills gained from working with older people are significant – the level of autonomy, assessment skills needed in caring for people with such complex needs, and leadership skills gained in working in residential care are often undervalued.

What qualifications, skills, or stepping stone jobs do you think were particularly helpful and/or necessary in reaching your current role?

I initially completed a postgraduate diploma in gerontology nursing and have begun another postgraduate diploma in health management, which I should finish in a few months. I’ve also been fortunate to be a member of the New Zealand Palliative Care Council since 2008, and this has been a fantastic opportunity to better understand our health system and strategic planning to improve outcomes for our older people.

What personal characteristics do you believe are particularly important for nurses working in your role?

A passion for nursing first and foremost! While I don’t work directly with older people currently, the ability to listen and form relationships is as important in my role now as it was when I was in previous more ‘hands on’ roles.

What career advice would you give to nurses seeking a similar role to yours?

I think ongoing education is so important for exposing nurses to a breadth of knowledge outside their workplace. I’m a firm believer too in the impact mentorship can make. I would highly recommend nurses finding someone whose career pathway you admire and asking for their support.

Describe your current role and responsibilities?

My role is to provide professional leadership, knowledge, and strategic advice to nurses and organisations working with older people throughout Canterbury and the West Coast, and to work with primary and community providers to promote and support collaborative nursing initiatives and developments. This means I get the opportunity every day to meet and work with passionate people working within our health system to make a difference to older people in the communities where they live – I’m very fortunate.

Guided by making a difference for Māori & Pacific

Name:

Amio Ikihele

Job title:

Senior Lecturer at Manukau Institute of Technology’s Faculty of Nursing and Health Studies

Nursing qualifications:

• BN 2004 Manukau Institute of Technology
• PGCert in Health Science 2009
• University of Auckland
• Cert in Tertiary Teaching 2010
• Auckland University of Technology (AUT)
• PGDip in Health Sciences 2012
• University of Auckland
• MHSc (First Class Honours) 2012
• University of Auckland

Why nursing?

My interest in nursing was brought about by my grandparents’ health; both suffered from long-term conditions (LTC), with my grandmother having serious complications from type 2 diabetes. My mother was caring for them, and I wanted to understand more so I had the knowledge to help my family and others.

Briefly describe your initial five years as an RN?

I worked for four years as a primary health care nurse in South Auckland with Mangere Health Centre and one other clinic. I then became a GP liaison for Breast Screening with Counties Manukau District Health Board for one year before returning to Manukau Institute of Technology (MIT) in 2009 to work as a lecturer at the nursing faculty.

How did those first years of nursing influence your subsequent career?

As a student, I realised working in PHC was the area where the biggest impact could be made on improving the health of people with LTC. I worked with a lot of Māori and Pacific people in my first jobs and felt this was where I was needed most.

Māori and Pacific health has always been a passion for me because of the health disparities faced by these two groups and I want to help to improve this situation

Being Niuean and Māori, I was able to relate to both Māori and Pacific people and their families and understand their needs.

In my breast screening role, I worked to raise awareness of the need for breast screening amongst Māori and Pacific women, where there are a lot of disparities in screening rates and a higher incidence of breast cancer. Because the age for breast screening is 45 to 69, there were definite barriers with me being young. The role was all about building relationships and trust to enable them to feel safe when using the service.

What led you into your current field or specialty?

Lecturing was always a job that I wanted to do. A position came up and I thought I would go for it.

When I was training to be a nurse, there were only ten Māori and Pacific nursing students in a class of around 80. I also have a big interest in workforce development, so I wanted to see more Pacific and Māori people training to become nurses, and I love teaching so I felt this was a way I could encourage others into the field.

By teaching the student nurses about the health disparities faced by Māori and Pacific, I hope to enable them to be both clinically and culturally competent when working with Māori and Pacific individuals and their families.

What qualifications, skills, or stepping stone jobs do you think were particularly helpful and/or necessary in reaching your current role?

When I first started at MIT, I was completing my postgraduate diploma. To be a lecturer, I needed to show my career plan and that I was working towards my Master’s degree. I started my Master’s in 2010 and wrote a thesis about the sexual health behaviours and sources of information amongst New Zealand-born Niuean adolescent girls. During the writing of my thesis, I had my two children and completed my Master’s in 2012. I loved writing my thesis and am contemplating doing my PhD in 2014.

What personal characteristics do you believe are particularly important for nurses working in your role?

A passion for nursing and a love of teaching, plus good time management, a sense of humour, and an ability to relate well with others from diverse cultural backgrounds.

What career advice would you give to nurses seeking a similar role to yours?

Go for it! If you feel that teaching is something you want to do, then apply because there’s always a lot of support that will be provided in order to help you transition from being a clinical practitioner to a lecturer to help you succeed in this role.

Describe your current role and responsibilities?

I work as a senior lecturer and teach on MIT’s new Bachelor of Nursing Pacific programme that started in 2011, which will see its first graduates at the end of 2013. I love teaching on this programme because it incorporates the importance of being both clinically and culturally competent when working with Pacific and non-Pacific people. Our students learn to work within two worlds, a skill which is strengthened by the experiences they bring with them from home and through their personal development within the course.

Career u-turn leads to rural specialist role

Name:

Cathy Sampson

Job title:

Rural Nurse Specialist,

West Coast District Health Board

Nursing qualifications:

• RN 1987 Nelson Polytechnic
• BN 1994 Otago Polytechnic
• PGDip in Occupational Health 1996
• University of Otago
• PGCert (Child and Family Health Nursing) 2003 Otago Polytechnic
• Prof. Cert. in Allergy Nursing 2007
• University of South Australia
• MN 2007 Otago Polytechnic
• PGCert (Advanced Clinical Nursing) 2010 University of Otago

Briefly describe your initial five years as an RN?

I held several staff nursing roles in Dunedin Public Hospital (gynaecology, mental health, and casualty) for two years after graduating. I then joined colleagues in the United Kingdom as an agency RN working in private hospital medical wards, home-based care for the disabled, and a community unit for people with AIDS. I returned to Dunedin’s ED on night shift while studying for my postgraduate diploma in occupational health.

Did you have a career plan on becoming an RN?

No, I didn’t have a clear plan. However, my time overseas did help to shape my path into primary care.My years as a hospital-based nurse were valuable in consolidating basic skills but I became aware that acute care and the constraints of secondary care were not a natural fit for me. My experience in the AIDS unit in London highlighted the value of prevention in primary care. Hence, my move to occupational health, then public health, and onto my clinical Master’s dissertation in paediatric allergy nursing.

What led you into your current field or specialty?

The move to rural nursing was completely by chance. I had been working hard at developing an allergy nurse specialist role in Dunedin. However, a series of family and chance events caused me to take a bit of a u-turn. As it turned out though, rural nursing is a very good fit for me. It utilises all the skills and experience gained over the previous 20 odd years and still enables me to put energy into prevention and primary care. As a mother, wife, and daughter, it has also allowed me to work part-time, enjoy a rural lifestyle, and be near extended family in my hometown.

What qualifications, skills, or stepping stone jobs do you think were particularly helpful and/or necessary in reaching your current role?

My rural nurse specialist (RNS) role encompasses seven separate nursing contracts including well child, mental health, and PRIME (Primary Response in Medical Emergency). Contracts and hours do vary but RNS usually work alone and are on call afterhours. You need to have experience, and ideally qualifications, in a variety of nursing specialties, as well as the ability to work independently and flexibly. Fortunately, most of my varied primary care roles were autonomous; however, it would be fair to say my learning curve in the first year was near vertical as I gained role specific skills and qualifications. My Master’s degree was not specific to rural nursing, but it did provide the discipline to up-skill quickly. Gaining a PGCert in advanced clinical assessment and applied pharmacology was especially useful.

Regular clinical supervision has been equally vital to maintain safety when working and living in a small isolated community where your neighbours and friends are also your patients. There are no specific rural nurse organisations but monthly meetings with the region’s other rural nurses is important to keep up-to-date, debrief, and prevent professional isolation or burnout.

What personal characteristics do you believe are particularly important for nurses working in your role?

An ability to maintain professional and personal boundaries, while at the same time remaining approachable and credible within the community is important. Being the main health provider in a small remote community can be likened to living in a fish bowl, your every move is watched. A thick skin, broad shoulders, and a sense of humour are vital!

What career advice would you give to nurses seeking a similar role to yours?

Gain as much experience in a variety of nursing roles and then start applying and give it a go. Rural nursing is immensely rewarding. It is one of the few nursing roles where you get to provide wrap-around care to the whole age spectrum and be flexible to meet their needs in a meaningful way. You just need to be careful not to try to be everything, to everyone, all of the time.

Describe your current role and responsibilities?

I work in a remote rural community of approximately 650 people on the West Coast. The rural nurse role is shared between two RNs working seven days on and seven off, including after-hours on-call cover. We operate a nurse-led service filling those seven contracts. Clinical support is provided by a weekly GP clinic and regular video or teleconference contact with our GP for routine issues, and ED doctors and specialists for acute concerns.

Childhood dream to wear the red cape

Name:

Annemarie Pickering

Job title:

Nurse Manager, Adult Emergency Department (ED) & Admission and Planning Unit (APU), Auckland District Health Board

Nursing qualifications:

• RN 1989 Auckland Technical Institute (now AUT)
• BN 1995 AUT
• PGCert in Nursing Management 2004 University of Auckland
• Critical Incident Management training 2010 Auckland Region CD Emergency Management Group
• Lean Six Sigma Greenbelt training 2011 Auckland DHB

Why nursing?

Ever since I can remember, I have always wanted to be a nurse. I particularly wanted to wear the nursing uniform, which back then was a red cape and hat. This was my dream and my impetus to become a nurse.

Also, my father was an ambulance officer and we lived in a station house within the grounds of North Shore Hospital, so I spent my childhood years in the ambulance station where I loved hearing all the stories of life in the ambulance services. Living in the grounds of hospital meant I was always around patients. My friends and I would often walk with the patients down to the lake.

Briefly describe your initial five years as an RN?

I started my career at Auckland Hospital in 1990 in a general medical/infectious diseases ward, which gave me a strong foundation in basic nursing care and helped me to consolidate my practice as a new staff nurse.

Two years later, I transferred to the emergency department (ED) as a staff nurse.

In 1995 I was appointed as a clinical charge nurse in ED working on rostered shifts. I had to maintain overall responsibility for the emergency department when I was on shift. I managed a group of 15 staff nurses and was responsible for their appraisals and regular ‘one-to-ones’.

What led you into your current field or specialty?

I enjoyed my clinical placement in ED as a student and always thought I would like to specialise in that area. But felt I needed to work in a general ward initially to build my skill base.

What qualifications, skills, or stepping stone jobs do you think were particularly helpful in reaching your current role?

Following completion of my BN, I was promoted to clinical charge nurse in ED. After five years in that role, I was asked to take on various senior nursing roles within the change management programme and the rollout of the electronic rostering programme, during which I gained valuable experience in health management and project work.

The time away from clinical practice gave me a broader perspective of how the hospital functioned as an entity. It also reinforced for me that emergency medicine was my real passion. I was appointed as the nurse manager of ED and the assessment ward at the end of 2001.

Part of my role then was to plan the new adult emergency department and the admission and planning unit (APU), in Auckland City Hospital. APU was unique at the time, not only to New Zealand but also across Australasia, and I am very proud of my involvement in developing the APU model.

What personal characteristics do you believe are particularly important for nurses working in your role?

Managing more than 200 nursing staff can be tricky at the best of times. Therefore, a sense of humor and a good memory for names is essential. I maintain an open door policy enabling staff to approach me at any time.

I believe that developing a strong and collaborative senior nursing management team is the key element of the role. Also working closely with the clinical director, other hospital senior nurses, and managers enables us to achieve our goals. I have found that having a supportive family and network of friends is essential to survive in this type of role.

What career advice would you give to nurses seeking a similar role to yours?

I believe it is essential to have postgraduate education within the area you are interested in. You also need a passion for the area you choose and to pay attention to the detail of nursing practice to ensure that all of your patients receive excellent care.

Describe your current role and responsibilities?

I currently manage the equivalent of 220 people across the two acute areas of ED and APU.

The roles range from managing hospital volunteers (friends of ED), health care assistants, and senior nurses, including nurse practitioners. I am responsible for the day-to-day management of both departments and for the future planning of these two areas.

I work in partnership with the Adult ED/APU management team, as well as the wider hospital staff in streamlining processes, standards, and policies. Managing the flow of patients throughout the hospital in order to meet the MOH six-hour targets is a key challenge. I ensure that the nurses in the departments are trained and prepared for their roles; and that encouragement is given to grow professionally and achieve a sustainable work-life balance.

Planned pathway and chance direct career

Name:

Virginia Dyall-Kalidas

Job title:

Facility Manager, Enliven Presbyterian Support Central

Nursing qualifications:

• EN 1986
• BN 1998 UCOL
• MN 2004 Massey University

Briefly describe your initial five years as an RN?

I spent one year working in oncology and one year in surgical services at MidCentral District Health Board. I then moved into Māori health and worked as a tamariki ora nurse before moving to another Māori health provider as their clinical team manager. Since then I have held various roles: OR clinical coordinator at MercyAscot Private Hospital; health centre manager at Auckland Women’s Prison; and community health operations manager for ProCare PHO (primary health organisation).

Did you have a career plan on becoming an RN?

Once I became registered, I gave a lot of thought to where I wanted to be and planned out a pathway. I stuck to that plan and achieved what I wanted within the five-year time frame. During that time, I realised I did not want to work within a secondary care environment as I found it too constricting.

I was also very lucky during this period to work with some very experienced nurses and to belong to a peer review group. The performance appraisals in those early years identified my personal strengths and the areas of self-development I needed to work on. I was lucky that I worked in a supportive environment.

What led you into your current field or specialty?

It was by chance that I ended up in my current field. I was living in Auckland and shifted towns because of my husband. After considerable thought, I decided that I would apply for a position in aged care. This seemed a very logical move for me as aged care is a fast growing field. I also felt I had something to offer and my skills were transferable to this health area. After applying to Presbyterian Support Central, I was appointed as facility manager of one of their Enliven Homes in Palmerston North.

The experience of moving into this health field has been a positive one, and I have a feeling of being valued for the skills and strengths that I bring, as well as having opportunities for further professional development. I have been encouraged and supported to build and share my knowledge, to take up professional development opportunities, and to be an ambassador for the aged.

What qualifications, skills, or stepping stone jobs do you think were particularly helpful in reaching your current role?

I think that every step of my career has helped prepare me for this position. When working in Māori health, I was lucky enough to attend Institute of Management courses as well as other management training.

Completing my Master’s degree also assisted me in the way I critically analysed information in my work environment prior to implementing new practice. It gave me an understanding of the value of research in planning and facilitating change.

I have had vast experience in community groups, both volunteer and professional, as well as health-related appointments. This has ranged from being chair of a national organisation for 12 years as well as holding numerous national board positions.

Being open and ready to grasp all opportunities – whether paid or voluntary – and being open to change, along with perseverance, allowed me to develop a range of qualifications and skills.

What personal characteristics do you believe are particularly important for nurses working in your role?

• Resilience
• Good sense of humour
• Communication skills
• Maintaining work/life balance
• Effective listening
• Visionary
• Belief in yourself
• Forward thinking
• Positivity
• Intuitive processes
• Seen as a role model
• To facilitate others growth.

What career advice would you give to nurses seeking a similar role to yours?

• Make a plan
• Gain a broad experience in a range of nursing fields
• Develop strong and supportive networks
• Forge community links – i.e. community groups
• Grasp opportunities as they arise
• Believe in yourself
• Identify and utilise a mentor
• Attend clinical supervision
• Speak to people in the role
• Complete Master of Nursing or business qualification.

Describe your current role and responsibilities?

Currently, I am a facility manager of two residential aged care facilities. One is a 63-bed facility with 33 hospital beds, 24 dementia beds, and 6 rest home beds and the other is a 44-bed rest home.

Responsibilities include:

• • Implementing/embedding the Eden philosophy
• • Business and occupancy management
• • Risk minimisation and quality improvement
• • Financial management
• • Staff management
• • Accountability/professional responsibility
• • Management of nursing care
• • Accountability and interpersonal skills
• • Interprofessional health care and quality improvement
• • Health and safety management.