| Topic and Section/s |
Submitters comments |
Page 1 Lines 10 – 14
Page 1 Line 12 |
The preamble should include that the primary reason to advance a nurse's practice is to improve patient/ community outcomes. This could either be through a clinical specialty focus e.g. chronic condition management – CVD, or COPD etc or through a more generalist approach e.g. rural health, family health, primary health care where life span health and wellness are the focus. The latter lack visibility and are key areas of health improvement nurses will impact on.
The primary objective of further education and training is to prepare a nursing workforce, which is responsive to local, regional and national health needs – the appended workforce model illustrates the processes. Using a model such as this would provide some assurance that consistent approach is taken to developing implementing and evaluating to outcomes of education and training. It may also serve to clarify just how limited the available funding is. |
1.0: Preamble
Page 1 Lines 16 - 22 |
A formula is needed to accurately establish a nurse to population ratio as already exists in other countries and in other professions. Nursing workforce development is characterised by a lack of any scientific rigour at any level in national policy work. |
1.0: Preamble
Page 1 Line 30
Page 1 Lines 34-37 |
Rural primary health care needs are not visible
There is an inherent assumption in this work that already very meagre resources can be spread across the full publicly funded sector. There is a potential impact on acute providers as well as lack of scale for education providers that may lead to lack of viability of some key programmes in the country.
Because historically the CTA nursing funding has been used only to fund DHB provider arm training there needs to be an explicit statement in the preamble (rather than a footnote) so that it is transparent that this funding applies to both funder and provider arms of DHBs. Doing this will help to ensure measures are put in place to make certain the voices of both arms are heard and their needs considered when decisions are made regarding training programme support each year. |
1.0: Preamble
Page 1 Lines 49-56 |
Observation time is a program component that is missing. Students benefit from time spent observing an expert in practice.
It should also be made explicit that the co-ordinator for the programmes at DHBs has an understanding/knowledge of the whole DHB sector (provider & funder arms) so that CTA training programmes are not limited to a hospital focus. |
2.0: Programme Selection
Page 2, Lines 61 - 67 |
While prioritisation is noted as being identified by the DHBs workforce needs (line 63)- a point should be added to this to include the non DHB - provider arm. These organisations have their own strategic plans/ annual plans and workforce needs which may be different to the DHB provider arm. A large percentage of the Non-provider arm will most likely be in Primary health care services – whereas the DHB provider arm will be largely secondary services– there is a potential for creating an imbalance between the two sectors. Nurse Leaders should consult with the workforce as part of the prioritisation process. |
2.1: Programme Description
Page 2, Lines 72 - 101 |
Lines 72 – 74: Nurses undergraduate preparation is of necessity general and does not provide depth in many aspects of practice. The level of the programme depends on the building blocks required to get the nurse ready to access more advance knowledge. A blanket statement about the level of the programme is limiting when scaffolding competence. However it is generally agreed that Level 8 on the academic framework is correct given that nurses have already completed an undergraduate degree and natural progression is to the next level. Inclusion of attitudes on Line 73 as this is often an outcome of continuing education
Line 77: Why not include PhD degrees? To enhance capacity to competently undertake clinical research and win contestable research grants, nurses must be actively supported to PhD level. Consideration could be given to professional doctorates if research doctorates are considered outside the remit of CTA. Literature relevant to professional doctorates in nursing can be found at the following website:
http://www.medscape.com/viewarticle/514545_References . Examples of testimonials from nurses undertaking professional doctorates at the University of Bath, UK, can been viewed at: http://www.bath.ac.uk/health/programmes/testimonials/pd.html .
Line 78: The goal may not always be to integrate theory and clinical practice, but for example to integrate theory and leadership or theory and resource allocation; neither may the goal be to always align to a clinical area. As a consequence there are other studies, which may be highly relevant and essential to workforce capability (eg ethics, health policy, research, quality management). We recommend that the specification clarifies what is meant by ‘clinical practice', how this is distinguished from ‘theory', and what constitutes ‘integration of theory and clinical practice'. Furthermore by altering Line 79 to read knowledge, skills, competence and confidence to respond to the population – provides a more encompassing description. Also add cultural competence to Line 80.
Line 89:
The current Nursing Council (NC) approval process steers nurses towards study in uni-disciplinary contexts. There is an unfounded belief that only NC approved courses contribute to the professional development component of Registered Nurses practicing certificates. However nurses currently undertaking study in a variety of non-NC approved courses find these meet their need for advanced education in subjects such as rehabilitation, primary health care, public health, psychological medicine, ethics, research.
The NC approval is currently geared towards approving uni-disciplinary nursing courses. It is challenging for courses based on an interdisciplinary educational paradigm to consider undertaking the process, with no guarantee of success. No model yet exists for an interdisciplinary programme of study achieving endorsement by the NCNZ. The draft states the programme ‘be approved by the NCNZ or recognised as contributing to the development of NP. If the NCNZ looks at how the language is used here then interdisciplinary courses should be recognised – these are considered as contributing to NP body of knowledge e.g. from Public health papers (e.g. epidemiology, bio-stats, research into public health care etc). There is a place for nurses to think and study in a broader field if they can articulate how this will contribute to their advanced practice. Interdisciplinary education philosophically aligns with a number of different work streams particularly for those in primary health care (as it align with the Primary Health Care Strategy) and rehabilitation, as it is fundamental to clinical practice in this area. In addition interdisciplinary programmes can be viewed as meeting the government's strategic ideas about working collaboratively.
Overall the strength of opinion is that interdisciplinary education and training should be included and is a key method of increasing capacity within the health workforce. |
2.2: Programme Levels Page 3, Lines 106 - 110 |
It is not clear if this is clinical training and nursing training Rationale for future/ further funding should be contingent on the trainee's success in completing a PG Cert and where the study they are undertaking fits with the workforce plan and trainee's ability to complete the higher qualification i.e. through to completion of a Master's. Consideration should also be given to supporting and funding nurses undertaking a PhD. The last sentence (Lines 108 -110) could be clarified by indicating that the trainee may elect to continue studying towards a PGDip or Masters rather than taking up a PGCert or PGDip. |
2.3: Programme Categories
Pages 3 - 4, Lines 115 - 160 |
The DHB non provider arm range is too narrow looking at strata in the strata rather than health needs. Primary healthcare nursing in some areas still has a medical focus. Expanding primary health care to include innovative models of PHC and community engagement is a key to the success of primary health care and can be achieved through effective leadership.
We agree that separating Rural Health and PHC explicitly identifies both of these as specialty areas of nursing. Moreover direct funding of Rural Health Nursing programmes may be more appropriate to ensure Rural Health nursing programmes continuance. |
3.0: Access to Resources
Page 4, Lines 165 - 166 |
Funds will need to be provided to ensure consistent and equitable access to library and literature resources particularly for nurses in the primary and rural sectors work settings. It is acknowledged that through academic institutions trainees do have good distance access to resources with electronic access viewed as critical for evidence based practice. It is recommended that DHB non provider arm students be able to access the DHB libraries as part of the specification. For small Non Provider arm Organisations there needs to be some strategy for then to enable their PG students have online access at their workplace level but it should remain in the part the responsibility of the student.
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4.0: Programme Co-ordination
Pages 4 - 5, Lines 171 - 206 |
Line 170: There is a lack of clarity/understanding regarding where the ‘designated DHB co-ordinator' is located – in the DHB or in and education institution – it would help if this was explicitly stated.
Who funds this position? A statement indicating how the Programme Co-ordinator is funded is needed for consistency and perhaps the collaborative relationship the co-ordinator has with tertiary education providers could be explicit.
Lines 175 – 179: To ensure CTA funds are protected for provider arm and non-provider arm nursing education, an explicit statement of how this will be audited is critically important.
Line 187 – there is concern that a risk could arise for nurses in the rural programme particularly where there is an unsustainable cohort in DHB and regional areas unless an agreed nation-wide DHB approach can be reached – until such time this programme should continue as a national programme.
Line 189, 192 – DHB wide advisory group- this wording should include 'DHB non provider arm' so the group is inclusive not exclusive. It is recommended that terms of references are agreed for the functioning of the advisory group to ensure a consistent approach. It is not clear what role the Advisory Group would have for example in the selection process of trainees?
Ensure each DBH has a strategy for provider and non-provider arm nursing workforce development/education. How will this be equitable between provider and non-provider arm?
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5.0: Use of Funds
Page 5, Lines 211 - 218 |
The draft specification refers to other documents however it seems clear in the draft spec that use of the funds is set out elsewhere. |
5.1.1: Tuition Fees
Page 5, Lines 222 -225 |
Clear |
5.1.2: Travel
Page 5, Lines 229 - 231 |
Because travel in remote rural area can take longer in time than distance than on straight road perhaps the subsidy could take the approach of time or mileage. |
5.1.3: Accommodation
Page 5, Lines 235 – 236. |
Generally fine. Perhaps the footnote could be included in the section as this has particular relevance for rural nurses who may have to travel long distances e.g. from the Chatham Islands |
5.1.4: Clinical Release
Page 6, Lines 239 - 241 |
Needs to include cover for observation time
Consideration for the use of this funding as paid study leave where the nurse is in a remote location and can not be replaced. Ensuring the level of funding is sufficient if the nurse is replaced by a locum GP. |
5.1.5: Clinical Access
Page 6, Line 245. |
Essential |
| 5.1.4:Clinical Supervision/Associate
Page 6, Lines 249 - 260 |
The time this role takes leads to ‘clinical slowdown' thus within the funding formula must be recognised – funding should be used to ensure the level of service provision remains steady. Alternatively would the supervisor be paid directly? What are the skills and capabilities expected of the person in this role – a required qualification seems vague. How will the effectiveness of the person in this role be evaluated? Previous evaluation in the past has suggested a lack of support from both the educational institution and the supervisors own organisation. |
6.0: Expected Outcomes
6.1.1: Trainee Outcomes
Pages 6 - 7, Lines 267 - 283 |
Include in this section an outcome of responsiveness to population need.
Line 267 – add research
Line 270 – add after treatment/care model or other skills |
6.1.1: Client/Service Outcomes
Page 7, Lines 286 - 294 |
The addition of relational practice to this section so that there is acknowledgement of the importance of professional relationships with clients, families/whanau, communities and interdisciplinary teams
Line 288 – add after accessible, acceptable effective
Line 290 – alter to read Intersectorial, interdisciplinary team based approaches to care utilising the complementary skill sets of other health professionals to establish appropriate joint care plans and on-going interdisciplinary management.
Line 292 – change culturally safe to culturally competent
Line 293 – add after research based nursing knowledge evidence based knowledge and decisions |
7.0: Eligibility
Page 7, Lines 299 - 313 |
An agreed national set of principles to ensure consistency between DHB would ensure fairness and equity e.g. where the number of hours worked per week, length of service etc are eligibility criteria. However an agreed minimum hours worked should be nationally agreed.
Line 307 – this criteria could exclude some rural providers where nurses work and need development |
8.0: Associated Linkages
Pages 7 - 8, Lines 318 - 329 |
Include links to non-provider arm services in this section. |
1) The CTA is to be commended for working towards ensuring transparency and accountability in funding processes at a time when the financial imperative under which all DHBs function could influence the prioritisation process in regard to postgraduate nursing education funding.
2) The pool of money available is too small to provide education and training to the number of nurses needed in order to create the skilled workforce so critically needed. To this end we believe every effort should continue to be made to secure such funding.
3) The sector has a track record of under delivering in nursing workforce development, post registration; policy to date has not backed up by appropriate levers for change or with appropriate funding i.e. Nurse Practitioners, primary health care. The opening statement around funding levels and planned distribution perpetuates and legitimises historic and current behaviours. The lack of any robust funding methodology or appropriate funding allocation must be acknowledged and the group working with the CTA have a responsibility to ensure that occurs.
4) What explicit mechanisms does the CTA intend to put in place to protect nursing education funding in areas where there is limited or no nursing leadership or nursing leadership which does not have appropriate access to funding decisions.
5) There is a very real possibility of anti-competitive behaviour between a single DHB and single education provider (or groups of DHBs and education provider(s)) that could jeopardise some postgraduate programmes. The specification and contract must contain a clause preventing such agreements being reached.
6) The implementation of a DHB-wide Advisory Group composed of members from associated linkages with DHB representation should provide a more equitable distribution of funds and the transparency CTA is seeking.
7) Because of the uniqueness of rural nursing and the availability only one programme it is prudent to continue to locate the money for this centrally at least in the medium term. This way national equity can be managed for rural nurse development across New Zealand .
8) It is clear that the linkages between the Government health strategies, DHB DAP's the non-provider arm strategic plans and the education programmes being provided are essential. It is however unclear in the document what process will be put in place to re-evaluate the pool of money against the health strategy goals to measure the effectiveness and reconsider the level of funding available for nursing programmes.
