Editorial

Te Puawai April 2009

This is an interesting issue of Te Puawai with much food for thought.  Firstly my appreciation to Vicki Noble and Kathy Nelson for the extended version of their article recently published in Nursing Review (on the College page) about the consequences of the recession and the increasing vulnerability of people in terms of access to health and health care.  

This raises a topic of importance to me, which is that nursing should adopt the role of becoming guardians of the essential intent of the primary health strategy.  Whilst we may all agree that the actual process of operationalising the strategy has been far from perfect, nurses are almost universally committed to the intent of the strategy recognizing that an “ambulance at the top of the cliff” was long overdue.  By guardians I mean loud and active advocates for protecting all that has been gained by the strategy and clear and strong voices of resistance for any efforts to reverse the gains thus far, small as they might have been.

Leaders get caught in difficult positions; needing to work with the current structures of power in order to achieve our goals and yet needing also to remain true to a basic concern for the needs and rights of people whose vulnerability renders them silent recipients of ( in this case)  the end results of a recession for which they hold no responsibility whatsoever.

Recently the Vice Chancellor of Massey University, Steve Maharey made an excellent speech in which he noted:

There has long been a tendency to think of social policy as either an area of cost not investment or a luxury that can be attended to after the economy is fixed.
This kind of thinking means that the lessons of the last crisis on the scale of the one we now face have not been remembered.
The depression of the 1920s and 30s in New Zealand taught us that social policy is crucial to economic recovery. Indeed sound social policy may well be the driver of recovery.

Steve Maharey also noted that:

If we do not take social policy seriously, social problems will build and they will be a cost.  Imagine what high youth unemployment will do to our gang population. My hope is that the recent history of social policy will lead to a continued emphasis on social investment and social development. And that crucially more effort will be put into supporting front-line staff to address social issues.

These comments also apply very strongly and aptly to health policy and can rapidly be translated into the importance of investing in health as a source of wealth for our country. Any moves to reduce the investment in preventing long-term conditions, or reduce the investment in the health of children and adolescents will be very costly in the longer term.  Similarly any move away from an open and up front acknowledgment of the need to own and address health disparities will result in suffering and long-term expense.  So lets take our role as guardians of primary health care and the intentions of the strategy very seriously.

I am delighted to note in this editorial that the College is working closely with NZNO in a project to address the numerous current challenges around multiplying competency documents, the Ministry’s intentions around credentialing and concerns about how to manage the inevitable addition of various tasks to the RN scope as has occurred for years but which may be currently escalating.  See page ?? for an update on this project.

I would also very much like to put the issue of provisional registration back on the professional agenda as well.   Given the availability of (under subscribed) entry to practice places now, and the demonstrated ability of such programs to detect failure to reach competency we seem ready for the next step in ensuring public safety.   Provisional registration awarded on completion of the degree could be followed by full registration conferred following satisfactory completion of the NETP program (first year of practice) and achievement of level 2 on the PDRP program. This would provide a further and essential quality and safety net no matter where a nurse chose to eventually practice.  It would also force adoption of the NETP program in areas where nurses work but where NETP programs are difficult to establish as they would have no other way of building their workforce.  What do people think about this; why not some letters to Te Puawai or a debate on the electronic discussion group?

And finally in terms of collaboration please read on page (?) a draft paper, which is a work in progress by a sub committee of the Primary Health Advisory Council to the Ministry of Health. In its current form the paper is not necessarily a reflection of the views of any constituent organisation.   As a member of that sub committee I now need your feedback on this draft paper in order to support me to represent College views as the paper progresses to its next iteration.

Jenny Carryer