From today for the first time nurse practitioners can issue the death certificate for patients in their care. Suitably qualified nurses can also write sick leave certificates.
Dr Michal Boyd, a long-standing NP, says being unable up until today to complete death certificates for patients in her care meant the risk of unnecessary delays and distress for a grieving family.
“As the primary healthcare provider I know the person’s medical conditions and have often led their care over months or even years,” said Boyd. “Now I am able to provide all the care needed for the older person and their family.”
More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made only come into effect today (January 31).
The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), and other health practitioners like pharmacists, registered nurses and physiotherapists are now qualified to carry out those roles.
Lobbying began early in the millennium by nurse leaders to identify and remove a range of legislative barriers to nurse practitioners’ practice and formal work began back in 2005 to go through legislation with a fine tooth comb to find references to “doctors” or “medical practitioners” in roles that now could be done by other suitably qualified health practitioners. The acts remove the anomaly where NPs could sign ACC forms and sickness benefit forms but could not sign an ordinary sick leave certificate for work under the Holiday’s Act.
Boyd, a former chair of Nurse Practitioners New Zealand (NPNZ), said today’s enacting of the new laws represented to her the removal of some of the last barriers to being able to practice at the top of her scope as a nurse practitioner.
The Ministry of Health’s outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.
Memo Musa, the chief executive of the New Zealand Nurses Organisation congratulated all those involved in the watershed changes particularly the Nursing Council and the Office of the Chief Nurse.
Musa said the amended Acts meant more nurses could improve public access to some medicines and also enable them to work to the full breadth and scope of their practice. “It is often easier and quicker to see a nurse than a doctor so this change means more people in the community can benefit by accessing health care sooner.”
2018 LEGISLATION CHANGES SUMMARY
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury including suitably qualified registered nurses, if their employer and the Nursing Council of New Zealand recognise that they are competent and safe to do so
Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.
Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).
Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.
Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.
Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.
Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.
Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.
]]>More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made will only come into effect on 31 January. The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), nurses and other health practitioners are now qualified to carry out those roles.
“One of the things I’m most excited about is overseeing the enactment of this legislation that is coming in at the end of the month,” said Clark.
“This means that nurses will be able to issue sick notes for work and NPs can issue death certificates,” he said.
The amended Acts also remove the current anomaly where NPs can sign ACC forms and sickness benefit forms but cannot sign a certificate for ordinary sick leave from work.
Roles changing under the new legislation (see full details at end of story) include:
Outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.
“We’ve got to make the most of particularly the nursing workforce, with its 53,000 nurses who oversee the largest unregistered workforce in the sector,” said Clark. “If we have these people active and practising at top of scope, there’s a huge opportunity for our health system to deliver more care within the fiscal restraints that we have.”
The Minister talked about the legislative changes in an interview with Nursing Review this week in which he also discussed pay expectations and briefly touched on pay relativity for nurses working in sectors such as aged care and Māori and iwi health providers.
Clark said pay relativity was something that needed to be looked as part of the primary health care review. It is understood that the terms of reference are currently being worked on for the review of the primary care funding system promised by the incoming government within its first 18 months.
“I do want to see different models of care looked at,” said Clark. “I think that is required if we’re going to have a sustainable sector that actually delivers better access to quality care for New Zealanders.
“We need to recognise that in many areas, particularly those that are rural or underserved, they have workforces – and nursing workforces – that are actually practising at the top of their scope.” Clark said he believed that was where the opportunities were – ensuring that people were supported to practise at the top of their scope.
Clark added that his job as Minister of Health was to defend the interests of the patient.
“I’m not there to represent any particular workforce but to ensure the best outcomes for the public patient, and that involves ensuring that the workforce is sustainably funded and we have healthy workforces and safe staffing levels.
“I think the only reason our health system is in the good shape that it is, is because of the good grace of the workforces that have been subject to underfunding over the last nine years,” Clark told Nursing Review.
He said the new Government was committed to putting that money back into the sector, but it would take time. It would also take time to build a sustainable health workforce and the capacity to employ more new graduate nurses, he said.
LEGISLATION CHANGES FOR 2018
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury.
Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.
Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).
Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.
Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.
Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.
Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.
Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.
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Health Minister David Clark says he understands nurses’ and other health workers’ hopes for better salaries under the new Government, but the reality is that “not everyone’s expectations will be met”.
He was responding to questions from Nursing Review and online health hub Health Central about New Zealand Nurses Organisation members rejecting the 20 district health boards’ pay offer of roughly two per cent a year, amidst expectations that the incoming Government may be more open to funding a more “respectful” offer.
Minister for Women Julie Anne Genter, who is also Associate Minister of Health (but in that capacity has no responsibility for wage settlements), says she is aware that nurses’ expectations are high and meeting everybody’s expectations poses “fiscal challenges” as there is a lot of investment that the new Government needs to catch up on.
Clark said he would not comment on the negotiations, which are due to go to mediation at the end of the month – with NZNO not ruling out industrial action if a better offer was not reached – or pre-empt the mediation outcomes.
“But I can understand firstly why those nurses might have hopes of better things. This is a government that wants to see a more sustainable health sector. We don’t intend to run it down like our predecessors did. We want to ensure there are healthy workplaces and safe staffing and more sustainable funding over time.”
He said he needed to better understand why the NZNO negotiating team thought the initial pay offer would be accepted by members and why it was rejected.
“But the public also has an expectation based on the priorities outlined and the promises made that there will be more services delivered.”
“So the money that we pledged to put into healthcare won’t all go into salary raises,” said Clark. “Not everyone’s expectations will be met. I think that is the reality and I think we need to be upfront about that. But a Labour Government recognises the need to have a sustainably funded workforce and the need to make sure we have safe staffing and healthy workplaces.”
Nurses and midwives underpaid
Genter said as Minister for Women her number one priority was new pay equity legislation and working to close the gender pay gap in the public service.
“Female-dominated professions like midwives and nurses have structurally lower pay,” said Genter. “Those professions have been underpaid and undervalued because they are female-dominated.”
She said where there were MECAs (multi-employer collective agreements) for specialists or doctors the gender pay gap had disappeared, because so many more women were pursuing medicine and becoming specialists.
“But across the health workforce it is not necessarily the case and there is still more work to be done to rectify the pay gap.” She is aware of the NZNO’s pay equity claim for its DHB nurses, midwives and health care assistants. She said such pay equity claims are not her responsibility alone, but as Minister for Women she is working with other ministers on pay equity legislation to progress such claims (see below).
“Obviously this government is very supportive of closing the gender pay gap and lifting pay for the lowest paid workers, and valuing all of the professions that add so much to life in Aotearoa – we can’t do without them.”
Genter, in her role as Associate Minister of Health, spoke to Health Central about her two new delegations for health – population health (built environment) and climate change – along with women’s health, sexual health and disability services.
Next step to new pay equity legislation
This week Genter, in her role as Minister for Women, and Iain Lees-Galloway, the Minister for Workplace Relations and Safety, announced the reconvening of the Joint Working Group on Pay Equity Principles as the first step to new pay equity legislation.
The original group was set up in 2015 to develop principles to guide pay equity implementation, but Galloway said these principles had been ‘undermined’ by the pay equity bill introduced in July last year by the former government, which would have made pay equity claims tougher for women. The bill was scrapped by the incoming government in November.
The new working group has been charged with considering the issues around how to determine the merit of a pay equity claim and how to select appropriate male comparative professions/trades to compare the pay rates of women workers who lodge pay equity claims.
The group, facilitated by Traci Houpapa, meets today, January 24, and is due to make its recommendations to Ministers by the end of February. “Once we receive the recommendations, we will work to develop pay equity legislation which we expect to introduce mid-2018,” said Genter.
The tripartite partners include government representatives, unions (led by the New Zealand Council of Trade Unions) and employers (led by BusinessNZ and the Employers and Manufacturers Association).
]]>It was revealed today that a new deal – a six per cent pay rise spread over just under three years – was offered by the DHBs on November 8 after, it is understood, successfully seeking sign-off from new Health Minister David Clark for additional funding. The offer also includes an “agreement in principle” by the DHBs to the merit of NZNO’s separate pay equity claim with negotiations on pay equity due to begin in February.
The pay deal now on offer is for an initial two per cent increase, backdated to November 6, for the majority of nurses, midwives and healthcare assistants covered by the DHB/NZNO multi-employer collective agreement (MECA) and further two per cent pay rises in August 2018 and August 2019. In addition there is a lump sum payment of $350 for current NZN0 MECA members who are permanent DHB employees. Designated senior nurses and midwives are being offered a four per cent pay rise backdated from November 6 and then two per cent pay rises in August 2018 and August 2019.
The DHBs’ initial pay offer was made in mid-October, prior to the new Government being formed, and NZNO negotiators have now revealed that they recommended the 27,000 registered nurse, enrolled nurse, midwife and healthcare assistant members covered by the MECA to vote against that first offer in the series of ratification meetings due to start on November 22.
That initial offer had a six-month delay before the first pay increase and a 43-month term, rather than the 33-month term now being offered.
“But on November 8 NZNO was informed that the DHB CEOs were meeting with the Minister for approval to go beyond the financial parameter so that they could increase the offer and that the CEOs would manage/address the additional costs within their budgets,” said NZNO in a MECA bulletin update to its members, that was revised on November 17 to clarify what lead to the new offer.*
Lesley Harry, the NZNO’s industrial advisory, said it believed having a new Minister of Health had “provided the opportunity to push the parameters a little further” leading to the latest offer.
NZNO negotiators are telling members that they believe the latest offer is “a fair settlement that delivers on most key issues and providers processes with set timeframes to address others”. It also noted that the overall cost of the offer was greater than other recent MECA settlements in the DHB sector.
When the MECA negotiations began in June the union also tabled an historic pay equity claim for nurses.
The negotiating team said the DHBs had now agreed in principle that the work of nurses, HCA and midwives is predominantly performed by women, and had been “historically undervalued and subject to systemic undervaluation”.
The union said it had also reached agreement on the process and timeframes for resolving pay equity issues with negotiations due to begin in February “with the goal of achieving an outcome later in 2018”.
A major plank of the negotiations was also safe staffing and the current slow implementation by DHBs of the Care Capacity Demand Management (CCDM) tools that use evidence-based data to calculate how many nurses need to be employed on a ward to deliver safe, quality patient care. (See recent Nursing Review story on DHB announcing nursing staff boost due to CCDM.)
The negotiators said the DHBs had now agreed to a package of changes that it believed would strengthen the DHBs obligations to deliver CCDM.
*Article updated at 12.45 on November 17 to reflect correction to NZNO MECA bulletin.
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Clark made the comments during an interview with the New Zealand Herald as part of its Break The Silence campaign on youth suicide.
The interview charted the new Government’s hopes for greater suicide preventions and a pledge that more would be done to save the lives of those contemplating taking their own.
Our teen suicide statistics are the worst in the developed world and we have the second greatest number of self-inflicted deaths among those aged 25 and under.
The latest suicide statistics had the highest number of suicides ever – 606 people took their lives. And the figures were little better measured against an increasing population showing little movement in the last decade.
Clark was critical of Coleman and the previous government during the interview, saying officials were “frustrated” over the failure to develop a new Suicide Prevention Strategy after the previous one expired a year ago.
He also criticised Coleman for failing to match an increase in people seeking mental health support with funding.
Asked if that cost lives, Clark initially said it was “very hard on an individual level to say that somebody died because of a lack of funding”.
He then said: “The proposition you’ve put is one that seems reasonable to me, that if you don’t support people, more people are going to take their own lives. I don’t think we can deny that.”
Asked how he felt about there being no current suicide prevention policy, Clark said: “I have expressed publicly frustration with the previous minister. I don’t think there’s much point dwelling on that now. I feel the burden of office that I have picked up. I want to make sure we are in a position as government to find solutions.”
Labour campaigned on mental health and pledged the return of the mental health commissioner and an inquiry into mental health.
Terms of reference and other details around the inquiry were yet to be settled, Clark said, but forecast it as wide ranging, considering issues of colonisation and poverty.
He spoke of “hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories”.
Past practices of shutting down debate on suicide did not deal with an issue that was persistent, Clark said.
“I think we need a public conversation about this. We can’t avoid it as a country. We have a problem and we need to talk about it.”
But he also challenged media to tell stories of survival and recovery, and not to dwell only of those who had taken their lives.
He had personal experiences of suicide in his family, Clark said, and among those he knew, or had encountered through his work as a Presbyterian minister or Youthline counsellor.
But he said those experiences would not be unusual for any New Zealander, with everyone likely able to relate their own personal story of suicide affecting those in their lives.
Coleman would not be interviewed on the comments. Through a spokeswoman, he said: “Dr Clark has made it clear for some months that he believes the Minister of Health is accountable for New Zealand’s suicide rate. It’s now up to him to set targets and to meet them.”
He also said officials would not be pleased to have the new minister speaking publicly about those in the previous government.
Asked if he would contribute to the upcoming inquiry into mental health, Coleman’s email said: “It is very hard to comment on a mental health inquiry as absolutely no details have been provided by the new Government.”
WHERE TO GET HELP:
If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757