Editorial

Te Puawai November 2008

There seem to be two burning issues in mind right now and both are addressed in this final edition of Te Puawai for 2008.   The year has resonated with media stories of residential care settings clearly struggling and often failing to provide an acceptable level of care to the frail and vulnerable elderly. I have personally met or been contacted by a number of highly committed and extremely dedicated senior nurses from many parts of the country who are holding the front line in residential care environments.  They have the highest levels of professional concern for elder care but are often at their wits end to work out how to maintain standards with the resources available.  Caregiver pay is a crucial concern, inability to determine appropriate hiring of caregivers, inappropriate deployment and use of enrolled nurses and an immense scarcity of registered nurses feature as the predominant concerns.  All of these concerns put the sole charge RN (in many instances) or the small team of RNs, under considerable pressure to meet or maintain their own professional standards of care.  As all nurses in all settings know, one of the most stressful things possible is to go home at the end of a day knowing that a great deal has been left undone and that patients clients or residents are suffering unnecessarily or at risk.

In this edition of Te Puawai we have shared the story of one clearly exhausted RN who no longer works in the setting for health reasons.  Her story could clearly be replicated  by many others.  One glaring feature of many of the residential care industries is that their profits are significant. Choices are clearly made to economise on staff and to repeat the age-old process of considering the input of a largely female workforce as somehow disposable and irrelevant to their core business.  Even in some of the most glamorous establishments I have seen, the attention to paintings, art work and fresh flowers far exceeds the investment in staff remuneration a situation which is both thought provoking and sad.

Research I have been involved in clearly affirms the need for gerontological nurse practitioners to address the safe clinical care of people in elder care establishments.  I have now seen a number of proposals around the country for such roles and met a number of highly dedicated nurses aiming for these roles but with huge uncertainty as to whether they will ever eventuate.  It always makes me wonder why individual nurses in different locations are busily having to “reinvent the wheel” to make individual cases to prove the blindingly obvious.  Current services to the frail elderly are under huge stress, the general practice workforce is under huge stress and diminishing and the nursing workforce in residential care lacks a visible career path and in many places, the stimulus of clinical leadership.  Hospital admissions from residential care are frequently preventable had intervention been more timely.   Why do we need multiple business cases in multiple locations to prove the need for gerontological nurse practitioners as a useful solution to at least some of the problems, which beset this sector?

This leads into another feature of this edition of Te Puawai and that is the ongoing development of the nurse practitioner role in New Zealand.   I took the opportunity to ask some questions and have a written dialogue with Dr Sarah Kooienga, a US family nurse practitioner with some twenty years of experience.  Our goal was to increase the potential for understanding why we seem to be struggling to respond effectively to the many enquiries from US NPs who would like to work in NZ.  Anecdotally we know that their enquiries may be rebuffed and that those who do come have struggled to gain authorisation here despite prolonged experience in their own country.  It seems to me that we are slow to develop the role in primary health care and rural settings and perhaps having some role models in general practice (i.e family nurse practitioners) especially might break down some more barriers through visibly testing the funding models.   Our dialogue offers no easy answers but perhaps provides some food for thought.

Another year draws to a close with no further developments on nurse prescribing.  I recall sitting in Health Minister Peter Hodgson’s office (quite a long time ago) with other nurse leaders debating the way forward for nurse prescribing.  We were assured by Ministry officials that regardless of the outcome of the Therapeutics Products and Medicines Bill, the Ministry would turn its close attention to expediting both the move of nurse practitioners to authorized prescribers and to considering other levels of prescribing for all RNs.  And many many months on we continue to wait.  As far as I can tell the Ministry officials present are no longer in the Ministry and somewhere along the track in the distant future we will probably start the process all over again.

Frustrations aside please enjoy this edition of Te Puawai.  On behalf of the Board can I wish you all the safest, happiest and most peaceful Christmas and New Year; very best wishes to you all.

Jenny Carryer