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Nurse Practitioners in New Zealand

Case Studies


A potential Nurse Practitioner role in chronic (cardiac) disease management in the Wairarapa
Maureen Barnes


Image of Maureen Barnes taking blood pressureI am a cardiac specialist nurse for the Wairarapa District Health Board and have been contemplating the potential role for a Nurse Practitioner in the Wairarapa. These are my thoughts…

Background and training


I’ve been nursing for 30 years beginning with hospital-based training at Princess Margaret Hospital in Christchurch, then working mainly in coronary care/cardiothoracic intensive care in Wellington and more recently specialising in cardiac medicine in the Wairarapa. During this time I’ve also raised a family of four.

Developing a cardiac outreach service and a cardiac nurse specialist role


While working in our local coronary care unit a fellow nurse and I were given the opportunity to develop a pilot model of nursing practice for the Wairarapa. At the time our hospital had the unfortunate reputation of having the second highest re-admission rate for respiratory and cardiac conditions in New Zealand. We visited many GPs in the district to inform them of our plan and set about visiting cardiac patients at home after their discharge from hospital. This was not easy as many patients lived up to one and a half hours away, some in quite isolated areas. After 12 months we were able to demonstrate a reduced rate of re-admission for cardiac illness, and for those who were re-admitted, a reduced length of stay. This success anchored the service which became known as the cardiac outreach service and over time both GPs and hospital physicians came to support and rely on the service.

The cardiac outreach service provides cardiac education and management through classes and a clinic at the hospital as well as the home visiting service. Many patients are Māori, and enjoy attending our rural marae clinic, held at Papawai marae, where once a month a group of specialist nurses and dietitians meet to provide a multidisciplinary service for Māori and non Māori. The local GPs enthusiastically support the outreach service and refer patients to us.
Image of Marae
As elsewhere in New Zealand, our population is ageing quickly. In fact, in 2005 17% of the people are aged over 65, compared with 12% of the New Zealand population (Wairarapa District Health Board demographic data). This has meant an increase in chronic illnesses such as respiratory disorders, cardiac disease and diabetes. Many of the “frequent flyers” visiting our hospital are people with respiratory and/or cardiac illness. For this reason I have developed the cardiac nurse specialist role, using my clinical masters study to support and expand the role.

More about my role


Over the past three years the PHO has made a great difference in improving access to GP and practice nurses for previously marginalised patients. I have enjoyed teaching and upskilling practice nurses to identify and manage cardiovascular risk factors of our patients. Knowing that many cardiac or potential cardiac patients are “under their umbrella” has enabled me to concentrate on and use my studies to focus on specialist nurse management of heart failure patients in the community, which in turn is helping reduce re-admssions. I presently titrate cardiac medications using standing orders developed from one of my post graduate papers. Working from the hospital as a base aids the case management model of a continuum of care for complex cardiac patients. It also gives me a valuable interface with nursing, medical and multidisciplinary staff in the CCU and wards. I also provide in-service teaching to both primary and secondary nurses and student nurses.
Image of Maureen Barnes

Rewarding relationships and opportunities


One of the most valuable aspects of this role is the close collegial relationship I enjoy with the senior doctors at the hospital, who, with their highly specialised knowledge and skills are always available for consultation and advice, as most of my patients have co-morbidities and complicated medical histories.

The most rewarding part of the work I do is the close relationship I enjoy with both patients and families, together with the priviledge of being a welcome guest in their homes and on the marae. I have learned more from them than I could hope to from any text book and appreciate that I can help them, with my access to both the hospital and specialists, to improve their health and/or quality of life.

In contemplating the Nurse Practitioner role I believe there are opportunities for nurses to specialise in any of the chronic illnesses and develop, as I have, a model of practice across both primary and secondary health sectors providing a continuum of care to patients with highly complex health needs. All that is required is a commitment to the vision of improved care for one’s patients and a passion to make it happen.

Thank you for the opportunity to share my experience.

Image of Anne and Jim Hemi's wedding

Acknowledgements


These photos have been donated to me for presenting the Cardiac Outreach model of practice by patients and staff. I use them in teaching to demonstrate that heart failure can happen to anyone, in this case younger women. The Māori couple on the marae steps are Anne and Jim Hemi. We were priviledged to be invited to their wedding. Jim died from heart failure two weeks after this photo was taken. I consider it an honour to be able to use this photo. Written permission has been given by all participants.

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