A message to the Government from the College of Nurses, Aotearoa, NZ Inc.

The health sector and many families and individuals in New Zealand continue to face significant health challenges well known to all politicians.

The potential human suffering, if these challenges are not addressed, can be avoided by taking the actions New Zealand’s nurses have identified in this manifesto for nursing.

The situation

Numerous reports now attest to

• Increasing demand for health services especially for people with chronic illnesses, cancer diagnoses, increasing age, poverty and ethnic differences.
• The challenge of recruiting and retaining an adequate health workforce

Consumer need
To address the improved health and well being of this country there are some core needs, which must be met.  These are:

• The need to continue to address disparities in health and health service delivery
• The need to provide better prevention and management of long term conditions
• The need for improved collaboration across sectors to address more effectively the wider determinants of health
• The need to focus on reducing barriers and improving integration between primary and secondary health services
• The need to deliver effective care and services to children and young people
• The need to ensure that during a hospital admission people  are provided with safe and appropriate care of the best possible quality and are not harmed
• The need to provide safe and dignified care to increasing numbers of frail older people

Background to consumer need

1) Addressing disparities
People, whose ethnicity, sexuality, income and mental health status make accessing health services potentially more difficult, need:

• Culturally safe care which is regardful of their particular challenges
•  Services which are taken to where people are and delivered by people who have insight as to those challenges
• Services which provide partnership in negotiating the barriers of formal service delivery
• Services which assure them of equitable outcomes

2) Improving prevention and management of long term conditions
In order to reduce the burden of chronic disease people need:

• Equal and realistic access to healthy lifestyle choices
• Knowledge
• Equal access to early detection
• Carefully co-ordinated care and support when they do have a chronic illness
• Effective palliative care at the end of their lives

3) Providing services to children and young people
Children and young people need:

• Parents or caregivers who are supported and empowered to provide safe and appropriate care.
• Preventative services, which provide developmental monitoring, screening and immunisation.
• To be assisted to gain the skills to make healthy and safe choices in order to reduce risk taking and prevent the development of chronic conditions.
• Access to youth friendly sexual health and mental health services.

4) Maintaining patient safety in hospital

When people are hospitalized they need to know that:

• they will not suffer an adverse or sentinel event
• that they will  not experience avoidable pain or suffering
• they will not be left with complications unrelated to the reason for their admission
• Services provided will be safe, appropriate and of the best possible quality

5) Frail older people in residential care

People in residential care are entitled to:

• The dignity and safety which comes with high quality care from an appropriately supported registered nurse workforce
• The security associated with having their needs reliably met and the avoidance of unnecessary hospital admissions
• Nurse Practitioners to sustain their care in the face of the diminishing GP workforce

Nurse’s contribution to addressing the above needs:  Evidence now conclusively demonstrates that: Registered nurses are the largest group of health professionals and work effectively at the front line in numerous settings.  Nurses are present in almost every community and health care setting in New Zealand.  Recent figures show increasing numbers of enrolment in the Bachelor of Nursing degree across NZ.

• The 24-hour presence of registered nurses in acute settings makes a critical difference to patient safety and this is increased or reduced by numbers, education and appropriate leadership of nursing by nurses.
• Improved health outcomes are contingent on the availability of strong primary health care services delivered in partnership with individuals and communities and where primary and secondary services are well integrated.

• Nurses can (and in some instances already do) deliver many first contact medical services safely and effectively.

• Nurse practitioners are a vital workforce development. They can provide the full episode of care to people across conventional service boundaries

Problems

• Unmanageable workloads and limited job satisfaction through inability to maintain professional standards of care deter people from remaining in the nursing profession. Most nurses graduate with high levels of debt and emigration is seen as a sensible option for many who face many years of debt repayment in New Zealand.  Currently 23% of the NZ nursing workforce is imported, often from countries which can ill afford to lose nurses.

• The many innovations and initiatives that nursing has striven for (such as establishment of the Nurse Practitioner role and increased nursing services in PHOs) are consistently slowed, impeded or blocked at health policy level.

• The magnet hospital movement is a strongly evidence based solution to patient safety and nurse workforce recruitment and retention. It remains largely ignored in NZ despite vigorous efforts by nursing to see it promoted.

• A larger Maori nursing workforce is needed to provide services to Maori

Solutions:  

• Greater nursing representation and participation in health management and policy development.

• Development of a Maori nursing workforce that can adequately and appropriately respond to the needs of Maori. 

• Adequate and appropriate nursing resources in all sectors in order to support a balanced health care strategy across the population, across the lifespan.

• An employment infrastructure that supports professional practice and pay and conditions for nurses practicing in primary health care and NGO settings and values them equitably with acute sector nurses.

• Continued development of the Nurse Practitioner role and the continued development and broadening of the PHO environment that includes employment of nurses and nurse practitioners on salaries.

• Urgent and rigorous examination the under-funding of nursing education at under and post graduate level, which is directly impacting on the quality of programs and runs directly counter to workforce need. See College position paper for clarification (www.nurse.org.nz/submissions/subm_funding_master.html).

• The urgent need for a national primary health nursing leadership infrastructure appropriately configured within each DHB region.
• Examination of the potential for a move to a 4 year degree in nursing in which the fourth year is a fully supported entry to practice year (accompanied by provisional registration) with full time clinical practice in a chosen field of practice be it primary health care, acute services or mental health.

• The Ministry of Health and DHBNZ to urgently adopt and implement the recommendations of Investing in Health( 2003) : Updated recommendations (2007)

• District Health Boards to establish their nursing services under the leadership of nurses according to the evidence based principles of safe and effective health care environments as per magnet hospitals.

• Implementation of the recommendations of the DHBNZ NZNO independent staffing review of the DHB sector which will establish clear standards of nurse staffing.

• Specific and focused development of nursing leadership to provide planning, delivery, oversight and evaluation of nursing services.

• A national training scheme for nurse practitioners in exactly the same manner that the medical registrar training scheme is managed. 

The incoming Government will need to:

Ensure that strategies are in place to ensure New Zealand is self sufficient in development and maintenance of its nursing workforce. Key elements in that strategy are:

Student debt
Nurses’ remuneration in primary health care and NGO settings
Removing the barriers to professional practice
Increasing access to post-registration education
Reducing the dangerous workloads carried by nurses in some settings

Conclusion

The current Government has committed to a number of important and much needed strategies to achieve safe and effective in-patient care and an accessible and affordable system of primary health care. New Zealanders need the successful achievement and maintenance of these strategies.

Underlying the success of both of these goals is a stable and well-educated nursing workforce.