Nursing in New ZealandChief Nurse Newsletter, February 2008 Greetings colleagues, It really doesn’t seem a month has passed since I posted my last note, but time flies I guess. Pondering on what to include this time around the rain pounding on my roof at home led me to think I would be coming to work in my kayak this morning! The rain of course is a welcome change for our farming communities, and I am well aware of the work being done by our rural nurses in helping people address the real health challenges faced, not just as a result of drought, but due to the sheer distances involved in accessing health care, threat to employment, and sadly just general poverty. I recently had the opportunity to meet with colleagues in the South Island working in a Maori provider NGO. The organisation started as a two person operation seven years ago and now has 27 employees offering a full range of health and social services. The ‘strap line’ for the service is ‘connecting people with resources, ideas and energy’, and the nurses were certainly doing that. A stark reality though, was the impression that nurses were spending a good deal of time helping people in their community fit the health service system so as to get the care they needed. Their practice was indeed innovatory in that they were constantly inventing ways to get care to people, and to bring people into contact with a delivery system that in many cases was simply not configured to meet their needs. It would seem then, that a major challenge for us is to provide support to established and emergent health care services so they can properly assess community health care requirements and contract with the providers most able to address them. This also involves equipping service users themselves with the advocacy skills to engage in constructive debate within governance systems operating within provider organisations. Innovation in nursing practice is a great thing to see happening, but it is a shame when this is driven by a lack of ‘fit’ with ‘mainstream’ health care systems. This is an issue I am keen to work to address from our base in the Sector Capability and Innovation Directorate. Nursing innovation continues to be manifest in the ongoing development of the nurse practitioner role. The nurse practitioner facilitation project hosted by DHBNZ is going from strength to strength. Every DHB now has in place an ‘NP Champion’ and there is an increasing awareness of the potential for this role within the DHB environment (see www.dhbnz.org.nz/Site/Future_Workforce/Nurse-Practitioner for further detail). Of course it is all well and good developing new roles and refining service models, but as I previously noted in our 5 key objectives (see below for a reminder), we need to be sure that nurses are able to practise utilising their full range of skills and competencies. In order to facilitate this we are working to address a range of legislative barriers to innovative practice. This is a significant project led by colleagues in our Health and Disability Systems Strategy Directorate (HDSSD). A good deal of research and scoping of legislation aided by the input of an expert advisory group has now got us to the position where the Minister of Health has agreed to moving forward to consult with interested parties on amendments to a range of legislation which would allow for non-medical health practitioners to carry out some functions and powers that are currently unnecessarily restricted to medical doctors. This work will also involve other Government agencies responsible for legislation not under the purview of our health Ministry and will be quite time consuming. Just as pertinent, and potentially rather more immediate is the need to address potential barriers to practice arising from custom and practice or just simple myth. It is important for the delivery of quality and timely health care that appropriately qualified and competent nurses – be they working in acute or primary health care environments – are able to access services such as laboratory and diagnostic testing when making judgements in formulation of patient care plans. We will soon begin work on this important issue. Workforce issues are always a significant part of our work plan, and I am pleased to be able to report that we have almost completed the process of selecting members of the advisory committee addressing the nature and kind of the future workforce needed to support the work of registered nurses. We have appointed an independent chairperson - Candis Craven. Candis was recommended to us by the Ministry of Women's Affairs and is familiar with the prevailing legislation governing nursing practice, with experience in undertaking competency reviews for the Medical and Nursing Councils. The committee will begin its work in early March. Once the work begins we have a relatively tight timescale of 6 months to provide the Minister with advice via our Director General. Finally, I am really pleased that I have the short list of candidates for the two senior analyst posts for nursing policy sitting on my desk. We will be convening an interview panel as soon as possible and I hope to have our new colleagues up and running in the very near future. Please bear in mind that the nursing pages of the Ministry web site: www.moh.govt.nz/nursing continue to develop, and they are a place for us to describe and promote nursing innovation. Do let us know what is going on in your area. Take care, Mark Jones Chief Nurse
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