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AUGUST 2012 1
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CONTENTS age •
Editorial - Prof Jenny Carryer
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College Symposium 2012 - Baby Boomers and Beyond: Transforming aged care
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AWHC Newsletter Articles • Cancer Screening Leads To Overdiagnosis
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• Book Review - THE GOOD DOCTOR: What Patients Want
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• College of Nurses Aotearoa AGM announcement
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• Celebrating 25 years of Cultural safety in NZ
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• NPNZ Annual Conference 2012 - Future Directions: Where to from here?
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• Student nurses exposure to Primary Health Care nursing: Issues & Innovations
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• RHAANZ: A new national rural alliance
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• Kobo e-reader winners
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• Conferences and Events
30
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Editorial There is always a choice to be made about engaging or not engaging with public figures who have the opportunity to be widely reported whatever pronouncements they might make. I think nursing has let Professor Des Gorman off very lightly as he travels the country espousing his particular world-view of health workforce development and especially his opinions on the proper contribution of nursing and how nursing services might be developed and deployed. Prof Gorman has been especially vocal at times about the nurse practitioner role and more generally about primary health care development. Engaging with Professor Gorman has always seemed a little futile to me but on reflection as the years go by and the workforce predictions grow more dire, I am constantly reminded of the expression that we are “fiddling while Rome burns�. It would be hard to point out any major achievements other than ad hoc, agenda driven, experimental developments in which nursing is used to shore up a medical model of health service delivery.
Professor Jenny Carryer RN, PhD, FCNA(NZ), MNZM Executive Director
An area of workforce development: Catch 22
Let’s get that out of the way first. I think nursing can quite appropriately in some instances extend its contribution in that direction (shoring up a medical model of care), if a clear consumer/patient benefit can be seen. It would be churlish to refuse. Nursing addressed that need very directly by re-crafting the RN scope of practice statement in order to enable nurses with appropriate or relevant preparation to take up many procedures and forms of service not previously imagined. But if nursing were to confine its ambitions to such an agenda then we would not be directly addressing the problems, which confront the health sector.
As a profession nursing has increasingly attended to the obvious need to find different ways of responding to burgeoning health need in a shrinking workforce environment. Sanely the response as, articulated by many in and outside nursing, is to ensure that all clinicians are working at the top of their license and delivering to their maximum potential. Developing the nurse practitioner role based on a huge amount of evidence seemed like one of the most logical responses. In recent years this has felt increasingly like pursuing a sane agenda in an increasingly irrational milieu.
Bio-medicine has dominated our decision4
TE PUAWAI making about how we design, structure and deliver health services for over a hundred years now. As in much of the world we now find ourselves addressing high levels of degenerative disease; in New Zealand especially we have ever-increasing levels of infectious conditions and totally unacceptable levels of health disparity. Our technological competence means that more people live longer with higher levels of disability and need. Combined with the challenge of maintaining sufficient workforce in an aging population the future is not encouraging. Given that we have come to this point after many years of biomedical predominance why would we consider that shoring up the same model will improve our situation into the future.
constantly against the hegemonic capture of that vision by an assumption that NPs are simply “wannabe docs” who forgot to go to medical school. In this respect it is revealing to take a critical look at some of Professor Des Gorman’s words and tease out some of the underlying messages. The moot that nurse practitioners (NPs) provide a substantive opportunity for task substitution in primary health care in New Zealand is not borne out by experience and is potentially in conflict with a fundamental objective of most health service planning, which is that primary health care and/or general scopes of practice become the usual habitat of doctors (Gorman, 2009, p. 142). What exactly does Prof Gorman mean here. Whose moot was it and to what experience does he refer. Substitution was never our goal and we have been far more ambitious than that from the start. But if indeed it is considered valuable or useful ( as it is indeed possible) to have NPs able to replace the gaps in the rapidly disappearing GP workforce why would health sector leaders support the persistence of a situation, which directly impedes that goal? Anomalies or lack of clarity in capitation, enrolment, GMS payments, ACC payments and legislative barriers persisting years beyond their identification are clear impediments to successful use of NPs in the primary care environment. This is the epitome of a catch 22 if ever there was one. Prof Gorman must know this so what is his rationale? Perhaps the answer can be found in the second part of the statement “a fundamental objective of most health service planning, which is that primary health care and/or general scopes of practice become the usual habitat of doctors”
The thing I find most ironic is that virtually every person involved with health leadership, health policy and health politics speaks constantly about the need to do things differently. It is however apparent that the loudest voices lack any vision beyond designing so called innovations, which prop up the current model. It has proved almost impossible despite excellent intentions to institute any really serious change since the implementation of the primary health strategy over ten years ago. As I have previously noted elsewhere, the process of appeasement of medical lobbying consistently stymies any genuine revolution and will have been a source of covert resistance to NP role establishment. Internationally NPs have risen to the challenge of providing health services to rural and disadvantaged communities, where physicians have withdrawn their services, and there are many examples of NPs now successfully leading and managing comprehensive primary health care services. It is evident to me that in the New Zealand process of establishing the NP role as a transformative role we have had to struggle
I have no idea whose fundamental objective this is (or was) and it seems a rather futile and limited objective. Medicine has 5
Editorial cont. been, in effect, voting with its feet for years and becoming less and less likely to select General Practice or rural environments as their chosen practice destination and this phenomenon is not peculiar to New Zealand and is internationally noted. Continuing to expect that that will change and spending an ever-increasing fortune on locums is an extraordinarily short sighted and expensive response when alternatives are available.
prove that patients preferred to see a doctor and that the public supported doctors as the natural leaders and decision-makers in health care teams. As is taught in all basic research papers, surveys can only secure the answer the question dictates unless the question wording is carefully designed. Even so the public will always have limited appreciation for nurse practitioner services until they have actually received care directly from a NP. To this day all public pronouncements about prescribing or drug related matters issuing from the Ministry of Health conclude by advising the public to discuss the matter with their doctor. Several times I have asked key people in the MoH to please say “doctor or nurse practitioner’ as an essential strategy towards raising public awareness, but have yet to hear this happen. Catch 22 again. We don’t mention NPs because there are not many of them; there are not many of them and those who exist are rendered invisible in the public view by seemingly deliberate strategies.
Professor Gorman at the same time made the following statement In contrast to a common obsession that employment models limit NP engagement, qualitatively the barriers would appear to include GP and consumer attitudes, a sense amongst nurses that the required training to become a NP is onerous and time-punitive, a strong desire among nurses to maintain part-time work that accommodates their own and their family needs, and an apparent reluctance to accept roles that result in significant clinical responsibility (Gorman, 2009, p. 142). There is a great deal embedded in this statement and the sources for such assertions were not provided. There is another transcript on line where he refers to focus groups with RNs but not NPs. Let’s deal first with consumer attitudes. I presume Prof Gorman means that consumers have expressed preferences for seeing doctors. The comment is disingenuous as consumers are not likely to request attention from a role of which they have never heard nor had experience. And countless international research has shown that where people do know and experience NP practice they express high levels of consumer satisfaction and experience safe, high quality care. I am reminded of the highly anxious, methodologically curious survey conducted by Old et al and published in the NZMJ last year. This paper purported to
GP attitudes to NPs are an interesting case to examine. Gorman implies GP resistance has limited NP employment and he may in some ways or some places be quite correct. But I know first hand that where GPs have worked directly with, in partnership with or have been able to refer patients to NPs they are highly complimentary and relieved to have such expertise available to share the stress of increasing patient demand. Smart GPs know there is more than enough work for everyone and that the quality of patient care can be greatly enhanced in the presence of an NP. That the NZMA and the RNZCGPs recently endorsed the planned move of NPs from designated to authorised prescriber is testament to a high degree of change in their camp at least. 6
TE PUAWAI I will not argue with Prof Gorman that the road to NP status is seen as onerous and time punitive. The road to any senior position in most fields is long and demanding. But I find his comments both sexist and paternalistic. He would not use similar comments to justify a failure to employ medical graduates. The many, many nurses who now hold the clinical masters degree is proof that despite the multiple demands of work and family commitments many nurses have been prepared to make that journey. Large numbers of them however have had those efforts wasted or have failed to take the final step of portfolio completion because they see no hope of employment. Again Prof Gorman has confused the chicken with the egg!
Prof Gorman reveals a number of perspectives in these two statements and many others on record. He has a quaint and old world-view of women and nurses and is apparently very out of touch with the aspirations of graduates in this century. This is concerning in someone charged with overseeing solutions to a health workforce crisis. Despite the widely acknowledged limitations of the medical model of health service he appears keen to support and maintain that structure at all costs and apparently prefers that nurses continue to work quietly and cheaply in the background servicing that model. On reflection I wonder what was achieved by letting such statements go unremarked and unchallenged. And even had we decided to challenge them what would have been different? The authority of medicine is enforced and reinforced by uncritical media sources and a bureaucracy that seems to struggle with simply reading and utilising the evidence. Professor Gorman as executive chair of Health Workforce NZ appears to hold views of women and nursing which are grounded in the mores of much earlier days. Nursing however remains strongly committed to “new ways of working”, strongly committed to person centered care, strongly committed to multidisciplinary team work and most of all dedicated to improving access to care for those who continue to miss out.
Lastly the statement contains two extraordinary observations; firstly that the failure to establish NP employment is due to “a strong desire among nurses to maintain part-time work that accommodates their own and their family needs”. This is an appalling comment in the twenty first century and flies in the face of the most basic issues of gender policy. Using the fact that women still do the majority of domestic work and child rearing as a reason to inhibit their career development is taking us back fifty years. It throws up an interesting challenge to current work commissioned by HWNZ to find out how to retain older nurses (nurses in the third age) in clinical practice in order to reduce workforce shortages. Imagine if they simply reported that older nurses needed to retire in order to care for elderly parents!
References Gorman, D. (2009). The nurse practitioner provides a substantive opportunity for task substitution in primary care: No. Journal of Primary Health Care, 1(2), 142-143.
The final comment “ and an apparent reluctance to accept roles that result in significant clinical responsibility” is intriguing. I know of no evidence for such a statement and cannot even imagine its source. Such a comment implies that NP roles have been constructed and NPs have failed to apply for them and we know this is not the case.
Old, A., Adams, B. Foley, P & White, H, (2011). Society’s expectation of the role of the doctor in New Zealand: results of a national survey NZMJ 124 (1342)
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Ageing in New Zealand in 2012 College of Nurses Aotearoa (NZ) Inc Bi-annual Symposium
Thursday 11th & Friday 12th October 2012 Commodore Hotel
Christchurch
This major nursing symposium, the first in the south island since the earth moved, is for all people working in areas contributing to the health and well-being of older people. Speakers from New Zealand and Australia will provide a range of social, health, nursing and political perspectives, and a consumer’s perspective will also be heard. The Symposium offers an excellent 2 day program considering current responses to older people’s health care and wellbeing. This is a great opportunity for nurses and other interested health care professionals to gain valuable professional development hours, network with others and contribute to a blueprint for the future of nursing in the aged care sector. Delegates will receive a certificate for 14 hours professional development.
Speakers include:
Lynn Chenoweth Diana Crossan Mary Gordon Merryn Gott Jackie Robinson
Professor of Aged and Extended Care Nursing, UTS, Sydney Retirement Commissioner Executive Director of Nursing, CDHB Professor of Health Sciences, University of Auckland. Nurse Practitioner, Palliative care
Earlybird Registration- Paid by 31 Aug - $265.00 Earlybird College of Nurses Members - $245.00 Registration from 1 Sept - $285.00 College Members - $265.00
For all online registration, speakers bio’s, accommodation options & programme go to -
www.nurse.org.nz 8
Registrations open - book now for earlybird savings
www.nurse.org.nz
TE PUAWAI
PROGRAMME Thursday 11th October 2012
Friday 12th October 2012
8.00 Registration – Main Foyer
8.30 Registration desk open
9.00 Powhiri
9.00 Active ageing in urban Christchurch: Michael Annear, PhD candidate, University of Otago
9.15 Opening – Dr Jane O’Malley, Chief Nurse, MoH 9.30 Key Note: Lynn Chenoweth, Professor of Aged & Extended Care Nursing, UTS, Sydney. 10.30 Morning Tea 11.00 Diana Crossan, Retirement Commissioner 11.45 Research from around New Zealand: What’s going on? Dr Stephen Neville, Massey University.
10.00 Impact of earthquakes on care of the elderly: Mary Gordon, Executive Director of Nursing, CDHB 10.50 Morning Tea 11.15 Ageing and ageism in a youth focused society: Professor Merryn Gott, Professor of Health Sciences, University of Auckland.
12.30 Lunch
12.00 Lunch
Community Initiatives 1.30 Advance Care Planning: What you need to know : Jackie Robinson, NP Palliative Care.
1.00 Maria Scott- Dementia Educator, Older Persons Health, CDHB 1.30 Elder Abuse- Suzanne Edmonds, Clinical Social Work Specialist, OPHSS, CDHB
2.15 Strengthening Health of Older Persons nursing workforce: Emma Mold, Senior Advisor, MOH
2.00 Panel of elders: Personal experiences of aging & health.
2.45 Nurse Maude: Crest and Total Care Service: Fran Cook, GM Clinical Services
2.30 Final words: Professor Jenny Carryer, Executive Director, College of Nurses.
3.15 Afternoon Tea
3.00 Conference ends Programme is correct at time of printing but is subject to change.
3.45 Contemporary Technologies to support elders retain independence: Jonathan Sibbles: Chiptech
Online registration, Accommodation options, Speakers bio’s & Symposium updates are all available at our website or email admin@nurse.org.nz
4.15 Reflections from the day: Dr Stephen Neville
www.nurse.org.nz
5.00 College of Nurses AGM 6.00 Drinks & Nibbles for AGM attendees.
Special thanks to our sponsors -
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AWHC Newsletter Articles The following articles were originally published in the June 2012 edition of the Auckland Women’s Health Council (AWHC) newsletter. This group along with the Women’s Health Action Network does some superb work in reviewing and monitoring developments that potentially affect health care services or related matters. We share these articles in the spirit of the College’s goal to forge stronger alliances with consumer groups and their work and concerns. In addition the work done by both groups is an important resource for health professionals who frequently lack time to engage in such careful and thoughtful consideration of the many reports produced and changes being proposed. Most importantly we should acknowledge the work of Linda Williams as author of the newsletters. Website: www.womenshealthcouncil.org.nz
Cancer Screening Leads To Overdiagnosis In a press release dated 28 May Ray Moynihan, Senior Research Fellow at Bond University in Australia, warns that overdiagnosis poses a significant threat to human health by labelling healthy people as sick people and wasting resources on unnecessary care. (2) He gives a number of examples of overdiagnosis, such as how a large Canadian study found that almost a third of people diagnosed with asthma may not have the condition, how a systematic review suggested that up to one in three screening-detected breast cancers may be overdiagnosed, and how some researchers argue that osteoporosis treatments may do more harm than good for women at the very low risk of future fracture. “Many factors are driving over-diagnosis, including commercial and professional vested interests, legal incentives and cultural issues, say Moynihan and co-authors
Over recent years specialists have become increasingly concerned at screening programmes for cancer that are resulting in overdiagnosis of the disease. Cancer screening programmes in particular are leading to overdiagnosis, causing some people to live under the axe of such a diagnosis without gaining any benefit. Sometimes patients then undergo unnecessary procedures which cause further distress. Preventing overdiagnosis On 29 May 2012 a paper by Ray Moynihan, Jenny Doust and David Henry was published on the British Medical Journal (BMJ) website. (1) “Preventing overdiagnosis: how to stop harming the healthy” describes how there is mounting evidence that modern medicine is harming healthy people through ever earlier detection and ever wider definitions of disease. 10
TE PUAWAI Professor Jenny Doust and Professor David Henry. Ever-more sensitive tests are detecting tiny “abnormalities” that will never progress, while widening disease definitions and lowering treatment thresholds means people at ever lower risks receive permanent medical labels and life-long therapies that will fail to benefit many of them.”
ing, research foundations, disease awareness campaigns, and medical education. Most importantly, the members of panels that write disease definitions or treatment thresholds often have financial ties to companies that stand to gain from expanded markets. Similarly, health professionals and their associations may have an interest in maximising the patient pool within their specialty, and self-referrals by clinicians to diagnostic or therapeutic technologies in which they have a commercial interest may also drive unnecessary diagnosis.” (1)
The paper itself contains a list of some of the many conditions that are currently being overdiagnosed. They include asthma, ADHD (attention deficit hyperactivity disorder), breast cancer, chronic kidney disease, gestational diabetes, high blood pressure, lung cancer, osteoporosis, pulmonary embolism, prostate cancer, and thyroid cancer.
The feature article is timely as its publication occurs just as the hosting of an international conference on overdiagnosis by The Dartmouth Institute for Health Policy and Clinical Practice in partnership with the BMJ is announced. The conference will be held next year in the USA from 10-12 September 2013.
Incidentalomas New terms are used for the outcomes of overdiagnosis. “Pseudodisease” refers to the detection of disease in a person without symptoms, with the disease being in a form that will never cause that person symptoms or early death. “Incidentalomas” refers to the incidental findings during scanning of the abdomen, pelvis, chest, head and neck for other reasons. Some of these incidentalomas are tumours and most of them are benign.
References 1. www.bmj.com/content/344/bmj.e3783 2. www.bmj.com/press-releases/ 2012/ 05/28/ overdiagnosis-poses-significant-threat-humanhealth
Moving House or Changing Job
Drivers of overdiagnosis The paper describes the drivers of overdiagnosis in no uncertain terms: “The forces driving overdiagnosis are embedded deep within the culture of medicine and wider society, under-scoring the challenges facing any attempts to combat them…
Remember to update your details with the College office ASAP.
The industries that benefit from expanded markets for tests and treatments hold widereaching influence within the medical profession and wider society, through financial ties with professional and patient groups and funding of direct-to-consumer advertis-
Email - admin@nurse.org.nz (06) 358 6000
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AWHC newsletter articles
Book Review - THE GOOD DOCTOR: What Patients Want
The Good Doctor is surprisingly readable and entertaining – one AWHC member described it as a real page-turner – given the weighty medical and legal issues that the book deals with. The book is divided into four parts. Part 1, “The good doctor: the ideal,” describes what a good doctor is, based on the views of patients and doctors, explains what a ‘good enough’ doctor is, and contrasts this with the ‘problem doctor.’ Part 2, “Problem doctors, part of the reality,” describes in detail what constitutes a problem doctor, provides a case study from the HDC files, along with the scandals and inquiries that have brought this issue to public prominence, and examines “some of the ways in which such doctors fall short – by leaving patients in the dark; by exploiting patients; by harming patients; and by treating patients callously.”
After 10 years of listening to thousands of stories from patients and doctors in his role as Health and Disability Commissioner (HDC), and countless hours of researching and lecturing in health law and policy in the UK, the USA, Canada and Australia, Ron Paterson reckons he knows not only what makes a good doctor, but also what patients want.
Part 3, “The Roadblocks: why is change so difficult?” looks at why achieving the ideal is so difficult. This section explains the players and the system, describes undemanding patients and overburdened doctors, reluctant regulators, medical culture, and legal restraints. In Part 4, “Prescription for change: what can we improve?” Ron Paterson focuses on three main areas where he sees that improvements are needed – information for patients, recertification of doctors, and public trust in the medical profession. His prescription is evidence-based and a bit scary – for both patients and doctors.
At the beginning of June, several members of the Auckland Women’s Health Council attended the launch of The Good Doctor, the book written by Ron Paterson after further research and reflection during his time as the 2009 NZ Law Foundation International Research Fellow. (1) 12
TE PUAWAI The scary bit For patients, Part 4 is rather scary as among other things it describes the recertification process for doctors, and introduces the concept of the doctor who is not vocationally registered. Few members of the general public will have heard of vocational registration, let alone knowing what it actually means, or whether their own GP is vocationally registered.
had been her GP for many years, and she was reluctant to set about finding another one. For a couple of weeks she thought about what she would do with the information, whether she would raise the issue with her GP if she found out that he wasn’t vocationally registered, or whether she would take the easy way out and find another GP who was vocationally registered.
But as Ron Paterson explains the Medical Council and the Health and Disability Commissioner certainly do: “Non-vocationally registered doctors are more likely to be subject to complaints and competence concerns, particularly in general practice. This is hardly surprising, since one would expect the attainment of a specialist qualification and admission as a Fellow of a college to signify a higher level of skills and knowledge. Vocational registration means that a doctor is qualified and permitted to work in a specialist scope of practice.”
Finally, having made her decision, she plucked up the courage to go to her computer, nervously googled his name and went to the Healthpoint website which provides information on whether doctors are vocationally registered – www. healthpoint.co.nz She was relieved but not that surprised to find that he was. Her brief discussions with him on health issues over the years inclined her to believe that he was likely to be vocationally registered. And if he wasn’t, then she would make an appointment to go and see him and ask him about it.
He goes on to state that “general registrants working in the community, particularly in solo practices or alongside other nonvocationally trained doctors, may perform poorly without detection. New Zealand, while at the forefront of promoting primary care, lags behind other countries by tolerating general registrants working in general practice. It is unsatisfactory that around one quarter of doctors working in general practice are not vocationally registered, nor working towards vocational registration by participating in a training pro-gramme.”
The medical profession’s response The medical profession has been reported as reacting coolly to Ron Paterson’s prescription for improve-ments, especially his claim that there was an unhealthy closeness between the Medical Council and the medical profession. Medical Association, Dr Paul Ockelford, said the doctors on the Medical Council provided high levels of professional insight. And the Medical Council’s chairperson, Dr John Adams, said its systems for requiring doctors to demonstrate ongoing competence as the basis of renewing their annual practising certificates struck the right balance between external regulation and the culture of medical professionalism. (2)
Having read and then reread Part 4, the AWHC’s co-ordinator wondered whether her own GP was vocationally registered. Her response was not what you might expect in a woman’s health advocate. She wondered what she would do if she found that he wasn’t vocationally registered. He 13
AWHC newsletter articles References 1. Ron Paterson. The Good Doctor. Auckland University Press 2012. 2.www.nzherald.co.nz/nz/news/article. cfm?c_id=1&objectid=10810212
Of course this just confirms that there is considerable truth to the claim. The book ends with Ron Paterson’s three recommendations for regulatory change which he says are consistent with patient and public expectations, are practical and achievable, and are designed to support, not undermine medical professionalism.
Reprinted from Auckland Women’s Health Council Newsletter July 2012
And he’s quite right – they are.
To purchase this book online go to www.harpercollins.co.nz NZ RRP: $ 39.99
NOTICE OF ANNUAL GENERAL MEETING for
College of Nurses Aotearoa (NZ) Inc to be held on
Thursday 11th October 2012 at 5.00pm Commodore Copthorne Airport Hotel
Christchurch
All College of Nurses members are encouraged to attend the AGM, (attending the College Symposium is not required and entry is free) Drinks and finger food will be served following AGM.
Remits: Individuals or regional groups may submit remits for consideration at the Annual General Meeting. Remits must be in writing and received at the College office at least 21 calendar days prior to the AGM. Contact admin@nurse.org.nz or www.nurse.org.nz for further information.
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Celebrating 25 years of Cultural Safety in NZ The following stories have been submitted from Nurses in NZ following a call for nurses to share their own Cultural Safety experiences. These contributions include experiences and viewpoints from individual writers and the College of Nurses does not take responsibility for the viewpoints and ideas offered. Please feel free to share your own experiences & stories with us via the College website www.nurse.org.nz
Exemplar of cultural safety in the ED When reflecting on our emergency department responds to the needs of a client’s cultural safety I consider that we perform this function in many ways on a daily basis. As the nurse educator for the emergency department I am in a position to observe nurses working with individuals and their families and recall a particular case which to me provides an example where nurses adapted their practice to accommodate a particular clients cultural needs without compromising the emergency management of his presenting complaint. On this particular afternoon shift we had received word from the paramedics that there had been a scuffle at a local swimming pool between rival gang members. The paramedics had been called and were unable to assess the individual because of his reluctance to be assessed and the combative nature of fellow gang members. We were told he was being brought by car to the hospital. On arrival in the ED he was wheeled into the department on a wheelchair slumped forward with blood all over his face and back and was only responding to voices. We quickly realised that he that he was haemodynamically compromised and 15
needed urgent intervention. We managed to get him from the wheelchair on to a bed and quickly begin oxygen. At this stage he was combative and his friends were very sketchy on what had happened. Blood was coming through the many layers of clothing on his back and it was clear to me that we needed to get his clothing off to assess where the blood was coming from. This proved difficult because his friends were insistent that we didn’t remove his clothing. Realising the significance of the vest and patch that indicated his gang affiliation I quietly talked with him and his friends about why we needed to remove the jacket and other t shirts at the same time acknowledging how important the jacket was to him and that we would be able to leave it lying underneath him when we took it off. His girlfriend and friend were very combative and appeared to be guarding his honour in this situation and were not going to allow us to remove his clothing. Whilst this was happening nurses were quietly attaching monitoring equipment and carrying out the primary survey as well as they could. It wasn’t until the arrival of another member of the gang who obviously had the respect of the girlfriend and friend that we were started to get anywhere.
Cultural Safety Stories cont... With this mans help we were all able to help take off the jacket (something in any other circumstance that would have been cut off almost immediately on arrival) without damaging it. We acknowledged the help that he gave us and from then we utilised this man to convey information to the many other gang members who had assembled at the hospital. Without asking he appeared to initiate a roster of ‘dogs’gang brothers to be at this mans bedside which met there need to be with him and also helped us by calming him down. Following removal of the clothing we found 3 stab wounds to his back, on assessment of his breathing we became aware of the potential for him to have a pnuemothorax on the right side. The doctor was called to formerly assess the patient (up until now then they had made an initial eyeball assessment and indicated what they wanted done from a medical perspective). During this time we as nurses had switched off to the conversational language of the members present and were not offended by it so when the doctor came to assess the young man and told him to settle down and not speak to the nurses like that we felt the tension in the room increase. We
all just continued the way we were and said quietly to the doctor that we were ok and were not having any difficulty managing the young man and his friends. We continued to take responsibility for the care of this young man utilising the older gang member who appeared to be in charge when going for CT and X-ray and also when the chest drain was inserted. We keep them informed at all times and described procedures and examinations to allay there concerns. Prior to admitting him to the ward we spoke with both after hours and the ward about this patient and how we had managed to care for him in ED and what we had identified as potential consideration for them on the ward. This allowed them time to arrange for a single room and a bed for a support person before we escorted him up to the ward. I think this case shows how we as ED nurses adapt our practice to both manage an emergency condition at the same time as respecting the individual cultural needs of the patient. Submitted by Karen Blair.
Cultural and Linguistic Diverse (CALD) group cultural competencies The Northern Region DHB Support Agency (NDSA) and Waitemata (WDHB), Auckland (ADHB) and Counties Manukau (CMDHB) District Health Boards are partners in the Auckland Regional Settlement Strategy Migrant Health Action Plan to improve service responsiveness to culturally and linguistically diverse (CALD) populations and to support our increasingly culturally
Since April 2010 nurses in the Auckland region have been trained in Cultural and Linguistic Diverse (CALD) group cultural competencies. The overall goal of the CALD training programme is to improve the cultural awareness, sensitivity, knowledge and skills of nurses and other health practitioners working with CALD patients and their families. 16
TE PUAWAI diverse health and disability workforce. The NDSA contracts the WDHB Asian Health Support Services (AHSS) to develop and deliver Cultural and Linguistic Diversity (CALD) Cultural Competence Training to Auckland region District Health Board’s workforces, Primary Health Organisations (general practices, psychological services, retinal screening services etc) and Primary Care Organisations (Pharmacies, Laboratories, Plunket, Family Planning etc) and Non-Government Organisations (NGOs) including Disability Information and Advisory Services (DIAS), Mental Health NGOs and Home based support services (HBSS). CALD cultural competency training courses and resources are accessible from the web portal www.caldresources.org.nz. Over 4000 health practitioners have completed one of more Cultural and Linguistic Diverse (CALD) group cultural competency training modules in the Auckland region. These courses are tailored to a range of clinical specialities and settings. The suite of CNE accredited CALD cultural competence face to face and e-learning courses includes: CALD 1 Culture and Cultural Competence (e-learning and face to face courses) CALD 2 Working with migrant (Asian) patients (e-learning and face to face courses) CALD 3 Working with refugee patients (elearning and face to face courses) CALD 4 Working with Interpreters (elearning and face to face courses) CALD 5 Working with Asian mental health clients (face to face courses only) CALD 6 Working with Refugee mental health clients (face to face courses only) CALD 7 Working with Religious Diversity (e-learning and face to face courses) CALD 9 Working in mental health context with CALD clients (e-learning and face to face courses - under development)
test evaluation of the first module CALD 1: Culture and Cultural Competence in 20111/12 were nurses. The purpose of the evaluation was to measure the effectiveness of the content and of training delivery in terms of improving practitioner cultural awareness, knowledge and skills. The findings of the evaluation demonstrate attitude and behaviour change in participating health practitioners. The following are participant responses to the question “How have you applied the information you learned from the CALD 1 module to your practice?” “I have been much more aware of my preconceptions and cultural biases when interacting with CALD patients since completing the course -it has made me a more sensitive and less judgmental nurse. I take more time to address patients’ expectations now that I am aware they may be very different from my own.” “I now start with having good conversation with CALD patients. Sometimes they come and talk about herbal medicines. I have to incorporate this in my triage so the Dr. will be alerted. I see patients that are quiet and shy and I started asking how long they been in NZ and asked how they are integrating with the new society. They just smile and start to be more open in discussing their illness.” “Probably the best one I can think of is that we have quite a few people from the Middle East and the example of the lady that they gave in one of the interviews was her religious beliefs were more important than her health beliefs. I always assumed that the health would take preference but obviously religion in some cultures is extremely more important than health.” “Recently we’ve had a person who was fasting come in and I explained to them that it’s important that the medication is
The majority of participants in a pre-post 17
Cultural Safety Stories cont... taken three times a day and they said that, no, they couldn’t take it during the day times. And it was trying to understand the whole culture that, ok, the religious part is more important than any other and how do we actually deal with this. And it was pretty easily solved where we changed the medication so that they could take it at morning and at night, so we were able to get around the situation that way, but it’s the fact you would think that health would come first and in this situation, it didn’t.”
I note that in some cultures that interactions between males and females are different from those in NZ. Would they prefer a same-sex person to be their primary nurse, for instance? Some cultures are more formal than NZ in interactions between health practitioners and clients. How should I address you? I now get more specific in my questions, rather than more general open-ended questions.” Many participants described the various ways they had applied the information learned to their practice including: knowing how to establish rapport with culturally diverse clients; improved communication with culturally different clients; increased cultural sensitivity and awareness and making allowances for cultural difference. Submitted by Dr Annette Mortensen.
“Prior to this course, I was not so bold in talking directly about culture. I would ask people where they were from, check that I was pronouncing their name correctly and ask them to talk to me about their culture, ask how they say some greetings in their language, alert me to any special cultural needs that Detox could ensure were met. However, I now spend more time, on first interaction, talking directly about culture.
An American Nurses Experience of Cultural Safety in NZ As I sit way up in the far north around the lunch table hearing from one of our 83 year old Kuia about the old days, I sit very quietly hardly breathing so I do not break the atmosphere of her sharing. She surprises me by starting to talk about sex and through her giggles I hear her tell about how there was lore in her days before the laws came. There were times for mating and certain traditions that kept the men away from the women after they had given birth. Food has been a good place for me to show my appreciation of the Maori way of eating their Kai. I have enjoyed sharing this kai and the plentiful kai moana that
the far north has to offer. Of course all of the trimmings that go along like fried bread and even kanga piro (fermented corn). The Kuia today also shared about the use of the poro and liver from the mullet. I realize I have come a long way on my journey learning about cultural safety. I know I have a lot more to learn but realize how much I have been taught since nursing in New Zealand about caring for the Maori. I am sure that the Maori would rather have a Maori nurse care for them but there are times that this is not possible. When I try to speak Te Reo I know that they are happy with this effort. 18
TE PUAWAI My first Maori cultural experience came when I was working in Middlemore Emergency Department in 1989. I was just fresh off the boat per say from America and did not realize how much I had to learn. We had a lady that came into our resuscitation room unresponsive. She had been at a marae and something had happened. No one would tell us what had happened so we had to do a lot of guessing. It seemed that it was secretive and I was annoyed that we could not take an accurate history. At this time a Maori nurse named Dianne took me under her wing and started teaching me about cultural safety. 10 years later I went to work in the Far North and continued to have many cultural experiences. At Kaitaia hospital again one of the Maori nurses Dinki took me under her wing and would go before into the room to tell the Maori whanau I was okay. This made a huge difference. One story that stands out for me was when I realized I needed to not be frightened of this culture so different than my own that I went to a tangi to show respect to a patient I had cared for. I had dreamed
the night before an unusual dream that I was being pulled into the coffin. The next day I followed the other nurses as they went to show respect and went and kissed the tupapaku since I felt I was supposed to. I believe this is what my dream was preparing me for. I learned later I did not need to do this. At another tangi I went by myself to show respect to another patient and his wife. I went and paid these respects and then went to leave the marae. One lady followed me and told me I could not leave. The man that starting speaking thanked me for the help I had given the patient but told me I was lucky that I was not run down by his car since it was very rude of me to leave before I had been acknowledged. So I stayed and spoke some words that had to be followed with a song and a cup of tea. Next time I will take someone with me. I am thankful that people have patience with me and are willing to teach me. Submitted by Joyce Jones
Disclaimer - The College of Nurses Aotearoa (NZ) provides Te Puawai as a forum for its members to express professional viewpoints, offer ideas and stimulate new ways of looking at professional practice and issues. However, the viewpoints offered are those of the contributors and the College of Nurses does not take responsibility for the viewpoints and ideas offered. Readers are encouraged to be both critical and discerning with regard to what is presented.
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Nurse Practitioners New Zealand
TE PUAWAI
Future Directions Conference 2012 Saturday 13th October 2012
Copthorne Commodore Airport Hotel 449 Memorial Ave
Christchurch
Speakers
For full bio’s check the website
www.nurse.org.nz
Dr Michal Boyd Chairperson NPNZ & Gerontology Nurse Practitioner, Waitemata DHB Dr Jane O’Malley Chief Nurse, Ministry of Health New Zealand
PROGRAMME
Saturday 13th October 2012 Time
Event / Speaker
8.00am
Registration desk opens
8.30am
Opening address: Dr Michal Boyd “A decade of Nurse Practitioners in New Zealand: Moving forward.”
9.00am
Key Note: Dr Jane O’Malley “Funding streams & models of practice”
10.00am
Morning tea
10.30am
Key Note: Prof Jenny Carryer “NPs Servant or Solution”
11.15am
Angela Bates & Dr Jill Wilkinson: Innovative NP model of practice in Wellington “The Nurse Practitioner will see you now”
12.00pm
Research presentation: Alison Pirret. “Nurse practitioner diagnostic reasoning - does it differ from registrars?”
Rosemary Minto Nurse Practitioner & Chair of the NZ College of Primary Health Care Nurses, NZNO
12.45pm
Lunch
1.45pm
Rosemary Minto/Chiquita Hansen: “PHC integration or Bust”
Chiquita Hansen Director of Nursing Primary Health Care, MidCentral DHB
2.45pm
Hillary Graham-Smith, Professional Advisor NZNO
3.45pm
Closing address: Dr Michal Boyd
4.15pm
Conference ends
Professor Jenny Carryer Executive Director College of Nurses Aotearoa & Professor of Nursing, Massey University Angela Bates Nurse Practitioner, Clinic Lead, Te Aro Health Centre, Wellington Dr Jill Wilkinson Senior Lecturer in Nursing, Massey University Alison Pirret Nurse Practitioner, Critical Care Complex, Middlemore Hospital
Hillary Graham-Smith Professional Advisor NZNO
Information and registration www.nurse.org.nz E: admin@nurse.org.nz P: 06 358 6000
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Student nurses exposure to Primary Health Care nursing: issues and innovations Karen Betony – Nurse Maude Association Judy Yarwood- Christchurch Polytechnic Institute of Technology Dr Chris Hendry – New Zealand Institute of Community Health Care Dr Philippa Seaton – Christchurch Polytechnic Institute of Technology
April 2012
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TE PUAWAI EXECUTIVE SUMMARY INTRODUCTION Providing quality clinical placements for health care students is acknowledged as a major challenge for tertiary institutions. However, one particular issue facing the institutions is to reflect the shift in healthcare delivery from hospital to community-based care settings, by providing clinical placements in primary health care settings (Victorian Government Department of Human Service, 2007; Pullon & Lum, 2008; Betony, 2011)1. A research project was undertaken to explore the exposure student nurses, the largest group of health professionals, have to Primary Health Care (PHC) and community nursing in New Zealand during their undergraduate Bachelor of Nursing (BN) programme. The project consisted of two components: a review of the international literature surrounding the issue of clinical placement provision for undergraduate health care professionals with a focus on both nursing and PHC and community settings; all New Zealand tertiary institutions providing BN programmes were invited to complete a short questionnaire and the subsequent data were analysed, with the findings presented here. The goals for this project were to (i)
Gather baseline information on the range of PHC and community settings used in offering clinical experience to Bachelor of Nursing students
(ii)
Identify barriers to providing quality PHC and community clinical placements
(iii)
Identify areas of innovation in providing PHC and community placements
(iv)
Make recommendations for ensuring BN students gain appropriate exposure to PHC and community based nursing.
METHODS AND RESULTS A questionnaire was developed to: identify the duration, frequency and location of PHC clinical placements; the exposure students had to staff with experience working in PHC settings while in the classroom; any innovations introduced relating to PHC placements and any issues affecting provision of placements. Responding to each question was optional as was free text entry.The questionnaire was created using the SurveyMonkey® web-based software. A hyperlink to the questionnaire imbedded in a letter explaining the project and also assuring anonymity of the respondents, was emailed to the head of schools of nursing at the seventeen tertiary institutions delivering Bachelor of Nursing programmes. Fourteen questionnaires were returned, providing an 82% response rate.
SUMMARY OF QUESTIONNAIRE RESPONSES
The majority of Bachelor of Nursing (BN) Programme providers offer two Primary Health Care (PHC) and community placements, including one in the third year. Public health nurses, district nurses, Māori health providers and practice nurses were most widely used for PHC and community placement experiences. Providers used a creative range of nursing teams for PHC and community placements. Theoretical components of the programme relating to PHC and community were largely delivered as a discrete module though some providers also embedded the PHC components throughout. PHC specific clinical skills were taught by most providers.
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References are in the full copy of the report, available, on request, from the authors.
Student nurses exposure to PHC nursing... cont.
The PHC content was generally taught by a combination of academic staff with PHC experience or background, together with current clinicians, that is, staff working in PHC clinical settings. Clinical lecturers usually also had a PHC background. Key issues arising related to placement availability for increasing student numbers; the impact on staff taking a student and ensuring the PHC placements provided were valued. The majority of respondents felt their programmes prepared students for work in PHC, with the remainder (two) undecided.
Innovations identified A revised curriculum to embed PHC concepts of health promotion and education throughout the programme and incorporating rest homes in the year three PHC placement to increase placement capacity. Only third year students who have identified an interest in PHC have a PHC placement for the Transition to Practice placement and then on to a new graduate programme. This ensures appropriate use of placements and helping the transition into a new role. A hospital admission reduction pilot project team will be approached to offer PHC placements. Establishing a Dedicated Education Unit in District nursing services has increased placement capacity, staff feel less pressured when students are on placement and students feel well supported. The advent of Whanau Ora may well lead to opportunities for integrating this programme into PHC placements enabling students to work with families. Thirty two separate points were made by respondents which related to PHC clinical placement provision.
There was a lack of placements due to student requests, increased student numbers and competition between providers. Placement in medical centres was highlighted as an issue as medical students were given preference over nursing students. Also, the issue of payment for placements was more apparent in these centres. One respondent highlighted that several non-nursing services, such as the Salvation Army could provide students with appropriate exposure to a PHC experience. However, the Nursing Council of New Zealand’s (NCNZ) (2010a) requirement for students be supervised by a Registered Nurse (RN) prevented placements with these teams. Impact on staff taking students was identified on several occasions. Reluctance of staff to take on extra responsibility was cited, along with the impact on workloads, clients and frequent staff changes making student placements challenging for staff. Perceived value of a placement was raised as a concern due to medical students taking priority in some PHC settings, nursing students not seeing the relevance of the PHC placement to their practice, students being too hospital focussed and, staff not providing suitably challenging experiences to meet the students’ learning needs.
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TE PUAWAI
POINTS FOR DISCUSSION What is a PHC placement? Teams where students were placed for the PHC placement were varied. Some respondents specifically identified community mental health teams, correctional services, defence force and residential schools. Several respondents included aged care facilities yet others did not. NCNZ (2010a, p.8) stipulates students should gain experience in “primary health care and community settings”. This appears to be creating a situation where any non-hospital-based placement is considered to meet this requirement. PHC clinical practice placement length and frequency NCNZ (2010a) does not stipulate how many hours any PHC clinical placement should be. Therefore the length and frequency of placements varied among the programme providers with most offering two placements, with one always being available in the third year of the programme. In many cases one was compulsory and one was optional. One placement of either four or five weeks was offered by half the providers though some placements were a week and others - especially in the third year were for six weeks. One provider had the potential to allow students a total of fourteen weeks on placement in a PHC team over three years. Exposure to PHC principles The exposure to PHC principles and PHC specific clinical skills while students were in the tertiary institutions was generally provided by staff with PHC experience, as is recommended best practice. However, in some areas, only non-PHC experienced staff were involved and this was often the case regarding clinical lecturers who were responsible for supporting students while on placement. Free text responses highlighted that in some areas, clinical lecturers were allocated areas based more on availability than relevance. This can impact not only on the student but also the team they are with who may feel unsupported. The cost of payment for placements has the potential to reduce the range of placements that providers can make available. Preparedness for PHC on completion of the programme The final question asked respondents to consider how well they believed their programme prepared students for work in PHC on qualification. Respondents could answer ‘strongly agree’, ‘agree’, ‘undecided’, ‘disagree’, ‘strongly disagree’. After cross referencing the responses to this question and others throughout the questionnaire, the qualities of a particular programme that better prepared students could not be conclusively identified. Of the group who ‘strongly agreed’, there appeared to be the potential for students to spend more hours in PHC, over the three year programme. However, compulsory PHC placement time was, in some cases as low as two weeks, compared with the respondents who ‘agreed’ and offered a minimum compulsory placement of three weeks and over. Of the group who ‘strongly agreed’, all delivered either a discrete module or embedded PHC into their curriculum and all lecturers had a PHC background. This was virtually identical to the group who ‘agreed’, apart from one respondent who highlighted that they did not deliver PHC specific content and most, rather than all, lecturers had a PHC background. Apart from one respondent, all involved current clinical staff in teaching sessions and all the clinical lecturers had a PHC background in the majority of programmes. In each of the groups who agreed or strongly agreed, current clinicians were used for teaching clinical skills 25 in all but one provider. The two respondents who were ‘undecided’ ran programmes that were not particularly different to other programmes, offering at least a two week compulsory
the group who ‘strongly agreed’, there appeared to be the potential for students to spend more hours in PHC, over the three year programme. However, compulsory PHC placement time was, in some cases as low as two weeks, compared with the respondents who ‘agreed’ and offered a minimum compulsory placement of three weeks and over. Of the group who ‘strongly agreed’, all delivered either a discrete module or embedded PHC into their curriculum and all lecturers had a PHC background. This was virtually identical to the group Student nurses exposure to PHC nursing... cont. who ‘agreed’, apart from one respondent who highlighted that they did not deliver PHC specific content and most, rather than all, lecturers had a PHC background. Apart from one respondent, all involved current clinical staff in teaching sessions and all the clinical lecturers had a PHC background in the majority of programmes. In each of the groups who agreed or strongly agreed, current clinicians were used for teaching clinical skills in all but one provider. The two respondents who were ‘undecided’ ran programmes that were not particularly different to other programmes, offering at least a two week compulsory placement and optional placements up to twelve weeks in total. Most staff involved in teaching PHC had a PHC background and current clinicians taught on the programme. One respondent did not run a PHC specific module.
Impact on staff In PHC placements the one nurse, one patient and one student ratio can raise issues related to time and workloads. Support from team members, managers and tertiary institutions is necessary to make PHC placements successful and increase the willingness of PHC staff to support students.
RECOMMENDATIONS 1 2 3 4 5 6 7
Establish regional clinical placement allocation groups to adopt a regional, rather than institutional approach to managing clinical placements. Review funding regime for clinical placements for nursing students particularly in PHC settings. Increased inter-professional collaboration could reduce competition for placements and open up opportunities for inter professional placements, such as nurses with physiotherapists, and medical students with nurses. Take a team approach to student learning to include PHC teams such as dieticians, podiatrists and social workers provided a RN retains overall responsibility for supervising and assessing the student. Clarification from the NCNZ of the core expectations of a “primary health care and community experience”. Further research to identify an appropriate exposure to theoretical, practical and clinical experience of PHC would reduce inconsistencies across the country and ensure students are prepared for work in PHC. Ongoing collaboration between tertiary and healthcare providers is required together with further research to ensure PHC providers believe student nurses are suitably prepared for working in a PHC setting on qualifying.
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TE PUAWAI ABOUT THE AUTHORS Karen Betony, RGN, MSc in Nursing. Clinical Nurse Educator, Nurse Maude and Research Nurse, New Zealand Institute of Community Health Care (NZICHC). Karen worked in the UK as a District Nursing Sister for nearly ten years before becoming a lecturer delivering theoretical and clinical practice components relating to primary care. Karen has a long lasting passion and commitment to district nursing and home-based health care and remains a strong advocate in this area. Since moving to New Zealand in 2007, Karen has worked at Nurse Maude for over four years as a nurse educator for community nursing. She was influential in introducing the Dedicated Education Unit (DEU) model for managing student nurse placements at Nurse Maude, the first community based DEU in New Zealand. Karen also has a role working as research nurse with the NZICHC, where she worked on a MoH project, Nurses Utilisation of Evidence to Inform Practice, a key outcome of which was the development of the Nursing Evidence website. Karen now manages the Nursing Evidence website for the Canterbury District Health Board. Karen is also evaluating a new Nurse Maude service for patients receiving hospital level care in the home and is facilitating the implementation of the Liverpool Care Pathway into a District Nursing service. karenbe@nursemaude.org.nz
Judy Yarwood, RN, MA (Hons), BHSc, Dip Tchng (Tertiary), FCNA (NZ). Principal Lecturer, Christchurch Polytechnic Institute of Technology Judy has spent the last twenty years working in nursing education where her undergraduate and postgraduate teaching and research interests have focussed on Family and Community nursing. She is currently involved in research projects looking at Public Health Nurses’ use of a fifteen minute family assessment model, and the impact of sudden change caused by the recent Christchurch earthquakes on teaching and learning in a Bachelor of Nursing programme. Judy is Co-Chair of the College of Nurses Aotearoa (NZ), a national professional nursing organisation. judy.yarwood@cpit.ac.nz
ACKNOWLEDGEMENTS The authors would like to acknowledge the support they received from their project mentors: Dr Chris Hendry – New Zealand Institute of Community Health Care Dr Philippa Seaton – Christchurch Polytechnic Institute of Technology Also Mrs Frances West, data analyst, New Zealand Institute of Community Health Care We wish to acknowledge and thank Ako Aotearoa for funding this research. We thank Bridget O’Regan and Pat Roberston from Ako Aotearoa for their assistance
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RHAANZ: A new national rural alliance
Photo courtesy of Udo von Mullert - Palmerston North
Across the country an increasing number of challenges confront rural people and communities health and well-being, be it difficulty in accessing health care services, a lack of available health professionals, unemployment, family poverty, or pandemic like health concerns such as rheumatic fever. In response, a national rural health alliance has been established aiming to address these many and often complex health concerns.
Faculty and Midland Health Network , the steering group set about over the ensuing months to develop a draft constitution. Albeit a somewhat medically focussed group, the aim, to promote and enhance the rural health and wellbeing through the delivery of equitable health care services, points to a broader understanding of the complexity of health and well-being. Providing the highest quality, efficient, acceptable and culturally appropriate co-ordinated heath and disability service for all rural people and their families, irrespective of age, race, gender and sexual orientation expands that understanding.
Initial ideas for an alliance were mooted late last year when a steering group of interested organisations, determined to address the health needs of rural communities met. Consisting of New Zealand (NZ) Institute for Rural Health; Rural Canterbury PHO; Mobile Surgical Services; NZ Rural General Practice Network and the NZ Rural Hospital network, The College of Nurses Aotearoa, (the College) Rural Women NZ, (RWNZ); Rural mayors, College of Midwives, Royal NZ College of GPs Rural
Accepting the constitution, the Rural health Alliance Aotearoa New Zealand (RHAANZ) came into being with five founding members; The NZ Institute for Rural Health; Rural Canterbury PHO; Mobile Surgical Services; the NZ Rural General Practice Network and the NZ Rural Hospital network. Developing a rural health 28
TE PUAWAI strategy along the lines of the NZ Health strategy, the PHC strategy and the Maori health strategy is one of the first tasks of the new alliance. A rural strategy, together with an alliance of organisations committed to, and with years of experience in rural health and well-being, will provide a strong platform with which to direct advisory and policy development. Critical concerns such as the rural workforce, and a need for a rural research base will also be high on the RHAANZ agenda.
development with community need, Influencing policy/health leadership, and Developing a sustainable future can also be achieved. A salient example is the role of Nurses Practitioners (NPs) in alleviating work force issues in rural and remote locations. Already a number of expert rural nurse specialists provide health services to rural communities who would otherwise miss out. Membership of the RHAANZ offers the College, amongst other things, the opportunity to draw attention to the value, significance and potential of NPs work, with a group of like minded professionals committed and determined to improve rural health outcomes.
Each member organisation of RHAANZ will need to demonstrate their commitment to rural health, an assurance the College can make through our consumer alliance with Rural Women New Zealand. Being involved with RHAANZ since its inception, the College is about to become a full member. This forum enables the College’s vision of 100% access and zero disparities to be progressed. Our three strategic directions, Aligning nursing workforce
Over the next year or two as the RHAANZ ‘s work progresses, and a rural health strategy emerges, the inequitable health outcomes many rural people, families and communities currently suffer can be addressed. We will keep you informed of progress.
WINNERS of the
kobo vox E-reader
We would like to take this opportunity to welcome all the new College members who have joined us during the past few months. All the new members who joined the College of Nurses in March, April & May 2012 (together with College members who referred a new member during this time) were eligible to go in the draw for a Kobo Vox e-reader. The winners were March - Shona Walford April - Brittany Jenkins May - Sarah Banfield
Recommend College membership to your Colleagues now! 29
Conferences & Events College of Nurses Symposium 2012 ‘Baby boomers and beyond: Transforming aged care’ Copthorne Commodore Airport Hotel Christchurch 11&12th October 2012 Programme and further details see page 8.
Nurse Practitioner Conference 2012 Copthorne Commodore Airport Hotel Christchurch 13th October 2012 Programme and details see page 16.
Workshops for 2012 Professional Boundaries Workshop with Dr Patricia McClunie-Trust This workshop is designed to help nurses to define and explore professional relationships within the clinical, cultural and social communities in which they work and live. Being involved in caring and advocating for other people can involve complex and challenging personal and professional situations. This workshop will assist participants to define and manage their professional boundaries in a practical and effective ways. College members $170, Non College members $190. Earlybird discount of $20. Information & Registration online www.nurse.org.nz under ‘workshops’ tab
Location
Date/Time
Earlybird discount of $20 if paid by
Auckland (Nth Shore)
16th Aug 2012
20th July
Auckland (Manukau)
17th Aug 2012
20th July
Invercargill
20th Sept 2012
24th Aug
Dunedin
21st Sept 2012
24th Aug
Wellington
22nd Nov 2012
26th Oct
Professional Portfolio Workshops with Dr Stephen Neville
Scheduled throughout the year, these workshops are open to all registered nurses (not in a PDRP programme) and make the task of preparing and maintaining your Professional Portfolio easier than you think. Check the website under workshops for details www.nurse.org.nz 30
TE PUAWAI
Conferences & Events Workshops for 2012 - continued
Nurse Practitioner Development Day with Dr Michal Boyd & Bernadette Paus Wanting to become a Nurse Practitioner or develop a Nurse Practitioner role in your service? Are you unsure of where you are in the process? Or just unsure of the process and what is expected altogether? Or thought about it but been put off by the process? Or are you just totally confused??? Join us, dispel the myths and gain a clear understanding of the Nurse Practitioner Role. College members $170, Non College members $190. Earlybird discount of $20. Date Time Location Venue Information & Registration online www.nurse.org.nz under ‘workshops’ tab 1st May 2012
9.00am–4.00pm
Wellington
Date
Time
Location
1stthMay 10 Oct 2012 2012
9.00am–4.00pm 9.00am4.00pm
Wellington Christchurch
Massey University CPIT Block 5, Floor D, Rm 17 Christchurch Entry via Tasman Street, Wellington
10th Oct 2012
9.00am- 4.00pm
Christchurch
CPIT Christchurch
Massey University Block 5, Floor D, Rm 17 Venuevia Tasman Street, Wellington Entry
www.nurse.org.nz
To aid us in scheduling workshops around the country, if you are unable to make it to the workshops listed here, email admin@nurse.org.nz with the workshop name & your location in the subject line, we will let you know as soon as we have a scheuled workshop close to you. If you know of an event that you would like to see in this section of our next issue, please send details to admin@nurse.org.nz
Disclaimer The College of Nurses Aotearoa (NZ) provides Te Puawai as a forum for its members to express professional viewpoints, offer ideas and stimulate new ways of looking at professional practice and issues. However, the viewpoints offered are those of the contributors and the College of Nurses does not take responsibility for the viewpoints and ideas offered. Readers are encouraged to be both critical and discerning with regard to what is presented.
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