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THE GLOBAL ECONOMIC CRISIS |
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As we enter this period many may recall previous economic and political shifts, with the new policies that came with them and the impact these policies had on peoples’ lives and on the work of nurses and nursing (Pollitt & Reese, 1997; White, 2004). The current economic crisis will have a comparable effect on policy, and on many people’s health and wellbeing. The new National Government has already signalled the need for a change in priorities. It is not yet known what this will mean with regard to the current population health strategy and its focus on reducing health inequalities. There is every indication, however, that we will see fundamental change. Such change will inevitably impact again on nursing and the way nurses work. So this is a very good time for to reflect and take stock of their contribution to health so as to ensure, as New Zealand moves forward, that the health system retains what works well, while embracing the opportunities that change offers. At the heart of whatever changes occur there must be a continued commitment to maintaining and improving people’s health and wellbeing. In our view three issues are of critical importance, now and in the future: recognising changing health needs; strengthening those models of health care that are already successful while continuing to support innovation; and extending and expanding the nursing workforce potential. On one level health needs are unlikely to change dramatically in the months to come. People will go on requiring nursing input and support for needs arising from normal life processes – growing up and growing old, managing a long-term condition, or experiencing a health event such as an accident or a newly diagnosed illness. And the health care needs of people presenting within the primary and community care sectors will continue to grow more complex as the management of long-term conditions and care for the aged becomes increasingly intertwined. But at another level we will gradually see significant changes as a result of tougher economic times. There will be more and more reliance on a range of health professions and social agencies. In some cases, this development may be in response to the fact that many families will find it harder than before to support and care for ageing parents or relatives with long term conditions. Tougher economic times will also have an impact on the wider determinants of health, among them income, housing, and education, and lead to increased numbers of people in poor health in both the short and the long term (Keefe et al., 2002). The economic crisis is already so severe that many more people than before are finding it difficult to buy fresh produce, pay their mortgages and power bills, and meet the co-payment costs of general practice visits, pharmaceuticals and dental care. This is impacting on health and access to health care, and will continue to do so more and more seriously both during and beyond the economic recession. Nurses need to be aware that under these stressful circumstances many people will grow less resilient and less able to manage themselves, thereby exposing themselves to increased risks such as infection, stress, family violence, and a general deterioration in health. Those with long term conditions will be most vulnerable. Meeting the health needs of youth will also remain a major issue. In difficult economic circumstances it will be harder for young people to find employment and handle student debt. This will place pressure on both them and their families, and may result in an increase in their mental health problems. Faced with such issues nurses will need to keep on developing new ways of making a difference to the lives of individuals, families and communities and to addressing inequalities (Smith, 2007).
Many will recall the health care reforms and restructuring of the 1990s in terms of the disruption and fragmentation they caused. Others will hail the period for the opportunities it created. During this period we started to see the emergence of alternative and innovative models of health care such as the increase in the number of Māori and iwi providers, and expansion of the non-government organisation (NGO) sector. In addition the 2000 NZ Public Health and Disability Act resulted in many people seriously examining how health and disability outcomes could be improved, and more importantly how disparities could be reduced by focusing on improving the health of Maori and other population groups. Those that adopted population health methodologies to plan health care services with their local communities have since seen significant improvements in the overall health and wellbeing of the people, and have had some success in reducing health inequalities. Success stories of innovation are regularly showcased on the Ministry of Health (MOH) website. Many nursing initiatives and innovations have contributed to improving access to health and to health and social services (MOH, 2005). Given the successes achieved in building and strengthening primary health care (PHC) infrastructure, we believe a period of consolidation rather than change is now in order. In many district health board regions the primary, community and NGO/iwi provider models are robust, and opportunities exist now more than ever for further development of new service delivery models. Of course there are still concerns. One of these is about the general shortage of GPs and nurses and the ageing character of the workforce. Another is about the increasingly urgent need to provide for a skilled, competent workforce at every level. This second concern relates to the increasing complexity of people’s health care needs, and to the ongoing pressure to treat and discharge people from secondary services as quickly as possible. The good news is that we are starting to see more ‘specialist generalist” nurses who are multi-skilled across a wide range of specialties providing nursing services to people in their homes. One way the capacity and abilities of this work force can be improved is through the support provided by secondary services, with regard not only to general health needs but also to mental health needs. The roles of nurses are also being extended both outside and within the Nurse Practitioner path. Extending and expanding the nursing workforce potential Finally let us turn our minds briefly to how in the current political environment we can help extend and expand the potential of the nursing workforce. A number of recent evaluations (Primary Health Care Nurse Innovation Evaluation Team, 2007) highlight the contribution that nursing can make in improving the health and wellbeing of local populations and also in reducing the disparities affecting disadvantaged groups. Moving forward, we as a profession must have the courage to continue to champion new roles for nurses outside mainstream health care delivery systems. Some of these roles may be under threat from those looking prematurely for tangible evidence of the impact on health outcomes or return on investment. Further attention must be given to establishing outcomes in community settings (Kendall, 1997; Mackereth & Appleton, 2008) that are directly related to nursing services – as with out these there is a risk that valuable services may be lost for lack of evidence. It is unfortunate to note from recent political history that New Zealand has a tendency to embark on new reforms (with “new” ideology) just as soon as current ones begin to bear fruit. Given the current strained economic environment it is all the more important for us to make the argument in favour of persisting with current reforms rather than embarking on another round of new ones. To extend and expand the nursing workforce we need to be aware of the need to equip a culturally diverse workforce. We must work towards the establishment of a full nursing workforce and towards a nursing profession that is exciting – nursing needs to be continually open to change and engaged in politics and fully receptive to opportunities. By doing so we will ensure that nursing remains an appealing, creative profession that attracts those with talent, energy and commitment. In doing so we will have to be both responsive and nimble, and stay focused on and intent upon, making a difference where we can. Conclusion To build on the current strengths of the partnerships that have grown up between health care professionals and local communities, and to maintain recent population health gains, nurses must continue to be proactive, and avoid being too distracted by political change or economic upheaval. We believe that as nurses and members of the nursing profession we should celebrate the value of our contribution to date, and embrace change when it improves health outcomes and benefits the health and wellbeing of people and communities. We should also go on looking for ways to provide better health care systems for the future. These include gathering and using best available evidence in our decisions; engaging with each other and with other stakeholders, especially the community; and uniting in our understanding that people are central to our purpose.
Vicky Noble RN BA (Hons); MA (Applied) Nursing. Vicky is Director of Nursing, Primary Health Care and Integrated Care for Capital and Coast DHB, Wellington. She is also currently a College of Nurses (Aotearoa) Board Member. Katherine Nelson RN PhD. Katherine is Senior Lecturer at the Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington. References |
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