Reed is retiring this month after 10 years as the chief executive and registrar for the regulation body of the country’s 57,500 nurses. Current Taranaki DHB director of nursing Catherine Byrne and former Council chair will step into the role in March.

Speaking to Nursing Review while reflecting on her decade in the role Reed said the Council was aware of nurses’ frustration at the ongoing competency requirements. (Nursing Review will publish the full interview next week.)

Reed first arrived at the Nursing Council to take up an education role in 2004, the year the Health Practitioners Competence Assurance (HPCA) Act 2003 came in uniting all registered health professions under one act and requiring all health professionals to ensure ongoing competency.

No longer could nurses just send off a cheque in the mail each year to renew their annual practising certificate.  From 2004 onwards nurses have had to declare they are competent and be ready to prove that not only had they completed 60 days of practice in the previous three years but also completed 60 hours of professional development and be ready – if audited – to produce proof they met the Nursing Council competencies for their scope of practice.

District health board and other nurses who are part of a professional development recognition programme (PDRP) are exempt from audit but during the industrial unrest earlier this year many stretched nurses expressed frustration at the amount of out-of-work time they had to commit to keeping up their PDRP and/or ongoing competency portfolio to show proof that they met the Nursing Council competencies.

“We are all very aware that we need to review the competence requirements.  And the Council will get to it,” said Reed. “All of the professions are thinking that.”

She said largely the Act’s public safety requirement – for the Council to ensure nurses are competent and fit to practice – was done by self-declaration that nurses had done the practice hours and professional development. But nurses are also expected to reflect and record each year how they meet the competencies – and this is the area that the Council may review.

“There’s certainly new ways of thinking about how nurses can demonstrate their competency,” said Reed.  She said the Council was watching closely a piece of research work being done in Canada on developing a different way of proving competence.  It was also looking at what the legal professions were doing.

“So we are just keeping our eye broadly out there about what will reassure the public about nurses being competent without unnecessarily burdening them (nurses).”

“I think where my thinking is at the moment is valuing the learning that happens everyday in practice,” said Reed. “You don’t have to go to a conference or do a Nursing Review professional development hour to be learning. I learn every day in my job and I guess we don’t place enough value on that.”

Byrne has stepped down from her role as Council chair in anticipation of yesterday’s announcement that she will step into the shoes of retiring CEO Carolyn Reed as both chief executive and registrar of the regulatory body for the country’s about 57,000 nurses. Her appointment follows the recent announcement of Margareth Broodkoorn’s appointment as the country’s new Chief Nursing Officer.

Jane Bodkin, acting chief nursing officer, said the Office of the Chief Nursing Officer welcomed the appointment of the former chair and current director of nursing (DoN) for Taranaki District Health Board who was widely respected by the sector for her wealth of nursing operational and governance experience. She said the office had had regular contact with Byrne in both her DoN and chair roles and was looking forward to working closely with her in her new role.

“Taranaki’s loss is the Nursing Council’s gain. Catherine’s appointment ensures the Nursing Council will be in good hands following Carolyn Reed’s decision to retire,” said Bodkin.

The College of Nurses executive director Professor Jenny Carryer also welcomed the appointment saying Byrne brings a highly appropriate breadth of experience to the role.

“I am so glad the role has been taken by a New Zealander who understands our context and will build on the stellar work led by the Carolyn Reed.”

Likewise New Zealand Nurses Organisation chief executive Memo Musa said he was delighted at Byrne’s appointment as she brought to the role her wealth of nursing practice and leadership experience and her insight and understanding as a previous chair of the Council.

“I am sure that under her guidance the NCNZ will strive for great heights in ensuring public safety, whilst advancing professional nursing standards and practice; ensuring excellence in nurse education; and in continuing good stakeholder engagement practices.”

Byrne says she sees her new role as a great opportunity to combine her leadership experience, nursing regulation knowledge and her connection to the practice reality of nursing.

She said she was very much looking forward to working with the Nursing Council team and key stakeholders across the sector and continuing the work set out in the Council’s strong strategic plan.

“I intend to build upon the  wonderful work that Carolyn and the team have achieved in regards to ensuring that our nursing regulatory practices are forward-focused, evidence-based, flexible and the right touch.

“The role of the Nursing Council is to protect the public by the regulation of nurses, however regulation also needs to be connected and relevant to the profession,” she said.

Byrne takes up the role in March and said as the Nursing Council’s business was complex she would be spending the first few months getting to understand that business better and building relationships across the sector.

The Taranaki-born and trained nurse – whose roles included being a charge nurse and nursing advisor at Starship Children’s Hospital before returning to Taranaki – said she would be sad to be leaving her DoN role.

“I am proud of the nursing achievements here at Taranaki. The nursing team is a strong team, with the best care to patients and families first and foremost in their sights. I have been astounded by the nursing team’s commitment and passion to their profession and the Taranaki community. They are a strong team of nurses and I will always hold them in the highest regard.”

Her appointment as the head of the regulatory body for the country’s about 57,000 nurses follows long-time CEO Carolyn Reed signalling in mid-September that she would retire at the end of this year.

It is the second major nursing appointment announced recently following Margareth Broodkoorn’s appointment as the country’s new Chief Nursing Officer.

Byrne has been chair of the Council since 2015 and her deputy chair Safaato’a (To’a) Fereti stepped into the role as acting chair to announce the appointment of its new CEO who she said came to the role with an “impressive background of practical nursing experience and a strong interest and knowledge of the nursing regulatory environment”

“The Board is very confident that Catherine will be an excellent leader of the Nursing Council of New Zealand and are positive that with her leadership we will build on the constructive changes made to the organisation over the past few years,” said Fereti.

Byrne, who has a Master of Nursing degree, was instrumental in helping the Council develop its 2017-2022 strategic plan with its emphasis on ‘right touch regulation’.

The Taranaki born and trained nurse graduated as a registered nurse in 1984 and was working as a charge nurse at Auckland’s Starship Children’s hospital, plus representing senior nurses on the national joint DHB/NZNO Job Evaluation Review Committee, when she stood and was elected in the first Nursing Council election in 2009. She successfully stood again in the following two elections, became chair in 2015 and was re-appointed as chair earlier this year.

Byrne returned to Taranaki a few years ago to take up the role as the DHB’s director of nursing where she has been committed to “the provision of a safe, sustainable nursing workforce and professional standards reflecting quality nursing care delivered with pride”.

Married with two teenage children she has said she understands the reality of maintaining a nursing career, raising a family as well as facing the daily challenges that nursing brings.  She is a keen gardener who also enjoys kayaking, walking and swimming.

The Massey University school of nursing lecturer and public health advocate says she wants to continue her advocacy work within the Council – but this time as a patient advocate.

“With my clinical work as a nurse specialist, active health advocacy in the community and a lecturer, I hope to work hard in advocating for the safety of the underserved New Zealand public in this role,” said Hernandez.

Hernandez came to New Zealand in late 2009 after being directly recruited from the Philippines by Counties Manukau District Health Board from her job as a lecturer for her alma mater, the University of Philippines’ College of Nursing. She underwent a CAP course before starting work at Middlemore Hospital where she worked in a high-risk post-partum ward and briefly in neonatal intensive care before coming a clinical nurse specialist in infection prevention and control – a role she held until completing her MNurs (Hons) degree in 2016 and moving to her current job at Massey’s Albany campus.

Philippine-trained nurses are the fastest growing part of the Kiwi registered nurse workforce moving from six per cent of the RN workforce in 2015 to eight per cent in 2017. The Philippines has been the predominant source of internationally qualified nurses (IQNs) in recent years. About 25 per cent of  New Zealand about 50,000 practising RNs are IQNs and Philippine-trained nurses make up 30 per cent (4,018) of those followed by 29 per cent (3,825) UK-trained and 18 per cent (2,370) trained in India and Sri Lanka.

The nine member Nursing Council has three elected health practitioner positions, three minister-appointed health practitioners and three minister-appointed lay members.

The two new lay members appointed to the council were Joanne Hewlett and Iosefa P.Tiata (Anesi Sale). The Minister also re-appointed Dr Kathy Holloway as a health practitioner member.

Byrne joined other nursing leaders in paying tribute to her work saying she had been a “capable, visionary leader” for the organisation and thanked her for her years of service.

Reed first stepped into the role as acting chief executive in late 2008 and was appointed to the role in 2009.  During her time she oversaw some major changes for New Zealand nursing including changes to the registered nurse, nurse practitioner and enrolled nurse scopes of practice and the introduction of registered nurse prescribing.

In announcing her retirement Reed said it had been an incredible privilege to work with the Council, nurses and people from across the country and internationally. “There hasn’t been a day that I didn’t want to come to work,” she said. She said she had been part of an amazing team and they had achieved success they all could be proud of.

Professor Jenny Carryer, executive director of the College of Nurses said Carolyn Reed has been an outstanding CEO for the Nursing Council.

“She has balanced the rigour and attention to detail needed to maintain public safety with a wonderfully warm  and humane approach to everything she does,” said Carryer. “Under her leadership the Council has supported significant developments in the scope of registered nurse practice and the ongoing development of the Nurse Practitioner role. She is visionary and focused in the role and will be very sadly missed and very hard to replace.”

The Ministry of Health’s Office of the Chief Nursing Officer congratulated Carolyn Reed on her retirement and acknowledged the outstanding contribution she had made to nursing throughout her career.

Dr Jill Clendon said as acting Chief Nursing Officer she had personally enjoyed working with Carolyn and would miss her dedication and contribution to nursing and the sheer passion she has for the sector. She said Reed had worked tirelessly to strengthen the nursing profession in areas like nurse prescribing and enhancing the scope of practice for nurse practitioners which enabled nursing to contribute more holistically to the wellbeing of all New Zealanders.

“Carolyn leaves the Nursing Council in as strong a position as ever to advocate for the safety and competency of the workforce.

Byrne said Reed had worked with the profession to ensure right touch regulation and is widely respected for her nursing leadership in the sector. “She has been instrumental in the forging of national and international links between regulatory authorities. Byrne said Reed had also worked hard to transform the organisation’s operations to improve efficiency.

Former Ministry of Health chief nurse and now Plunket chief nurse Dr Jane O’Malley said Carolyn Reed had probably been the finest registrar the country had ever had.

“She’s always been at the forefront of regulatory change for nursing – not just here in New Zealand or Australasia but internationally,” said O’Malley. She said during Reed’s time she had overseen tremendous changes in nursing scope of practices, prescribing, the new Code of Conduct and much more. “She’s been marvellous, has a great way with people and is a smart woman,” said O’Malley.

The Council has begun recruitment for a new Chief Executive/Registrar and expects to recruit a suitable candidate in due course.

David Savage, 43, has had his registration as a nurse cancelled and ordered to pay $4400 in costs to the tribunal and the Professional Conduct Committee appointed by the Nursing Council of New Zealand for the hearing.

The tribunal decision was released today following the hearing in February.

In 2017 Savage was convicted in the District Court on two counts of indecent assault against a colleague.

The court sentenced Savage to six months’ community detention and 150 hours of community work.

Sentencing notes from the court hearing said Savage and a colleague were working a night shift together when he made inappropriate comments of a sexual nature.

Then when in the hospital pharmacy he “grabbed his colleague’s left breast
over her clothing and squeezed while placing his left hand on her back, asking
her for a ‘quickie’, and made other inappropriate sexual suggestions to her”.

Later in the evening, Savage saw the same colleague in another part of the hospital.

“Mr Savage grabbed the colleague on the bottom, rubbed the inside of her thigh and then between her legs at the genital area; and made inappropriate comments to her as he was doing so.”

The sentencing notes also said, “It was clear from the evidence heard at trial that black humour, sexual innuendo and comment were part of the working environment, often used to relieve stress and lighten the load in a difficult and stressful working environment.”

Referring to the two assaults, the tribunal said it found that “the convictions entered against Mr Savage on which the charge is based are qualifying convictions that reflect adversely on his fitness to practise as a nurse”.

It also said “Savage’s conduct fell well below that expected of a nurse”.

Savage was also noted to be absent at the tribunal hearing.

The appointment of new members – Maria Armstrong and Joanna Hart – has just been confirmed by the Minister of Health after the results of last year’s Nursing Council election were delayed by the change of Government. The Minister has also re-appointed current chair Catherine Byrne to the Council.

The two new members were amongst 16 nurses who put themselves forward for the three elected health practitioner positions on the nine member council – including sitting council members Catherine Byrne, Jo Ann Walton (who was deputy chair at the time) and Joanne Hopson.  Walton later withdrew from the election process and from her place on the council as she is now a council employee having taken up the post of Director, Registrant Quality.

Joanna (Jo) Hart, a Bay of Plenty registered nurse with 20 years’ experience, stood for the Council on the platform of the Council not only protecting the public but also protecting nurses from the “overwhelming expectations” for further study. “I’ve seen my colleagues despair at overwhelming expectations to further their education, along with annual increases in PDRP (professional development and recognition programme) requirements and I’ve experienced them too,” she wrote in her election candidate’s bio.

The second new Council member is Maria Armstrong, who is a charge nurse at the Auckland District Health Board and a director on the board of the New Zealand Nurses Organisation.

Armstrong, who has a clinical masters degree in nursing, also talked in her candidate bio about balancing the public good with the challenges facing nursing as a profession from changing practice roles and expectations in a changing healthcare environment.

“These changes are increasing both the professional and the personal demands of nurses,” said Armstrong in her bio. “I have a good understanding of the challenges we face moving forward and will promote measures to facilitate achievement of the inter-linked objectives of optimal nursing care for the public good and the lived experience of nursing for members of the profession.”

The Nursing Council in a statement said they sincerely thanked the outgoing members of Council for their dedicated service to the Council and the nursing profession.  The council has appointed To’a Fereti as the new deputy chair.

Just over 10 per cent of eligible nurses voted in the 2017 election – the same turnout as the elections held in 2011 and 2014.  The online Council election closed on September 1 and were then caught up with the government elections and change of government as the Nursing Council was unable to announce the elected council members until the Minister of Health had approved the nominated candidates and the nominations had gone through the government’s Appointments Committee.

The owner of the Cornwall Park Hospital, Bupa, has apologised for the unacceptable care provided to the patient and said it now had better policies and processes in place.

The New Zealand Health Practitioners Disciplinary Tribunal found Rekha Devi, the facility manager at Cornwall Park Hospital, guilty of seven charges laid by the Nursing Council’s Professional Conduct Committee relating to misconduct and malpractice.

The charges included leading a group of nurses to rewrite a patient’s notes with false dates and some made-up content, falsifying a temperature chart, instructed a nurse to destroy the original patients notes and other documentation, falsifying a standing order, instructing another nurse to prepare a short-term care plan after the patient’s death and failing to report the falsification in order to cover up the care given to the woman.

In May 2014 the patient, referred to as Mrs S, developed a rash on her right forearm and was initially treated with hydrocortisone.

She developed septicaemia, quickly deteriorated and was admitted to hospital before dying later that day.

Mrs S’s daughter was upset about what happened and Devi told Bupa’s dementia care adviser Beth McDougall and the care home manager for a dementia service in Nelson, Jackie MacKenzie-Howe, who happened to be on site, that her documentation was “not good”.

Ms McDougall told the professional conduct committee she advised her to photocopy documentation and start a timeline, but rejected Devi’s claim they had told her to edit the notes.

Devi then met the nurses involved in Mrs S’s care who claimed they were instructed to rewrite the notes so that they were comprehensive “for the safety of Cornwall Park”.

One nurse, Ms Hansen, was told to delete the notes in the original document that she had made referring to cellulitis and her concern for infection.

Another claimed he was told to make up a short-term care plan after Mrs S died and backdate it, while another said Devi instructed him to destroy the original patient notes and other documentation.

The nurses claimed they were also told to make sure the notes were consistent with Bupa’s policy on infection control and to specifically related to a standing order regarding the use of hydrocortisone cream, which was also fabricated after Mrs S died.

The faking of the documents only came to light months later, after a nurse, Ms Hansen, disclosed Devi’s actions to a Bupa operations manager while at a national care home and clinical manager forum.

In its decision, the tribunal said the charges were “of a serious nature” and involved dishonesty and deception and that a message needed to be sent to Devi and her profession that that type of behaviour would not be tolerated.

Devi was ordered to pay $9,300 in costs and her nursing registration was cancelled. She no longer works at Bupa.

Bupa New Zealand managing director Jan Adams apologised to the family for the “unacceptable” and “well below our standards” care that Mrs S received and the distress caused.

As a result, Bupa reviewed and improved its practices and policies, particularly in the area of wound management.

“We realise that these improvements to practice in no way make up for the standard of care delivered, but we are taking all possible steps to eliminate the factors that contributed to the unacceptable level of care,” Adams said.

The family laid a complaint to the Health and Disability Commissioner, but no further action was taken. The notes considered in the investigation were the altered ones.

Nici Gardner was one of them in the late 1980s, along with about 10 of her Christchurch Hospital nursing school classmates. Most had done a year or two staff nursing post-registration and she conservatively estimates that about a third of her graduating class of 80 ended up in the UK at some stage.

Roll on 30 years and 25-year-old Christine Stanley thinks she is one of the very few of her University of Auckland classmates to have left New Zealand three years after graduating.

Student loan debt and more mature cohorts of graduates are probably influencing the timing and numbers doing the great Kiwi nursing OE. At the same time a much more time-consuming and expensive registration process has virtually killed the UK as a base for a nursing working holiday. (It now costs £1,415 for non-EU nurses to register in the UK – including clinical competence tests.)

But Kiwis still have itchy feet and last year 1,800 applied to the Nursing Council of New Zealand for proof of registration so they could nurse overseas – the vast majority (1,555) applying to nurse in Australia.

How many of last year’s 1,555 applicants were planning to permanently cross the Tasman and how many were popping across for some Oz-based OE – including short-term, lucrative, rural and remote contracts – is unknown.

What is known from Nursing Council annual practising certificate (APC) stats is that in 2016 there were 1,347 overseas-based nurses with valid New Zealand APCs, which indicates that many were at least keeping the option open of returning to nurse in New Zealand at some stage (some, of course, will also be doing humanitarian aid or volunteer work overseas).

Anecdotal evidence is that young nurses are still heading to the UK, but opting to work, like Stanley, as live-in carers. Nursing Council statistics for nurses seeking verification indicate that while the majority are seeking to register in Australia (1,555), some are aiming to nurse in the UK/Ireland (99), others in North America (100 seeking verification in USA or Canada where, like the UK, overseas nurses must first pass an exam or competency test process) or the Middle East (31).

The Trans-Tasman Mutual Recognition scheme for nursing registration means crossing the ditch to work as a nurse is by far the simplest option. (See Crossing the Tasman profile.)

The availability of well-paid, three-month contracts to work in the Outback or other remote locations is also a drawcard.

One Australian agency’s website, Healthcare Australia, features profiles of two Kiwi nurses taking up short-term rural and remote contracts that highlight another trend – the mid-life nursing OE.
One profile is of an Australian-based young Kiwi doing the traditional OE of nursing for 6–8 months and then travelling – last year it was to SouthEast Asia and the year before to Paris.

The other profile is of a Queenstown-based nurse with grown-up children (one based in Australia) who has been crossing the Tasman regularly for around a decade, initially taking short-term contracts to explore Australia but now returning to her favourite remote outposts.

Contracts with hospitals in Saudi Arabia or the less restrictive neighbouring United Arab Emirates states like Dubai or Abu Dhabi is another option chosen by some Kiwis for their working holidays. While choosing to nurse in restrictive Saudi is not for everyone, the opportunity to work for a tax-free salary, with free rent and frequent leave does appeal to some.

Nurses seeking jobs in countries with more complex registration requirements most commonly use agencies to help them. The NZNO recommends nurses ask around for word of mouth references or personal experiences as the best way to check out an agency. It also advises nurses to have all overseas contracts checked out by a lawyer and to be suspicious of any agency that doesn’t allow them to do so.

The other advice, of course, is to enjoy – being a registered nurse has long been seen as a ticket to travel and the Kiwi nurses who return from their OEs bring back with them rich experiences of different cultures and health systems.

The nub, as always, is how many choose to return.

The latest Nursing Council statistics for nurses seeking verification of their registration so they can practice in Australia show 1555 nurses applied in the year to March 31 2017 – more than double the rate of two years ago.

Since about 2006 the number of Kiwi nurses applying to nurse across the ditch had been steady at around 1200 to 1500 but had slumped to just 750 in the 2014-15 year and rose only slightly to 819 in 2015-16.

The 2017 statistics showed a steep increase in nurses seeking to nurses overseas in all destinations (up from 1272 in 2015-16 to 1804 in 2016-17) but has still not reached the peak years of 2001-02 and 2011-12 when more than 2200 nurses sort verification of their registration to work overseas.

How many of last year’s 1555 applicants were planning to permanently move to Australia in is unknown as a number of Kiwi nurses are known to cross backwards and forwards across the Tasman to take on lucrative short-term – mostly rural and remote – nursing contracts.

What is known from Nursing Council annual practising certificate (APC) stats is that in 2016 there were 1347 overseas-based nurses with valid New Zealand APCs.  Which indicates that many nurses keep the option open of returning to nurse in New Zealand.

Outgoing Chief Nurse Dr Jane O’Malley said Kiwis would continue to go to Australia but what was most important was ensuring that new graduate nurses start their careers in New Zealand.  “So when they finish in Australia they are more likely to come back and practice in New Zealand then if they had never practised here.”

She was particularly encouraged by the latest Ministry of Health and ACE analysis which indicated that 86 per cent (806) of the 2012 nurse graduates who gained a place in a government-subsidised NETP (Nurse Entry to Practice) programmes were still in nursing five years on – and only about a dozen of those were not practising in New Zealand.  Overall more than 80 per cent of the 1514 new graduates registered in 2012 were still nursing in New Zealand five years after graduating.