August 2016                                                                                                                     ISSN 2423-0561

The Office of the Chief Nursing Officer (OCNO) is a business unit in the Ministry of Health (the Ministry). Almost every activity in the Ministry has some relationship to nurses’ work, and so our team provides advice and leadership across the organisation. For an overview of our work on nursing at the Ministry, visit: www.health.govt.nz/our-work/nursing

This newsletter is our way of sharing some of the work we are doing in the office and we hope you will find it interesting. We welcome feedback or questions about any items in the newsletter – to contact us, please email: andrea_tamahaga@moh.govt.nz

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In this issue:

• International Nurses Day 2016
• Chief Nursing Officer attends World Health Assembly
• Changes in the OCNO
• Enabling nursing scopes of practice
• FAST Stroke awareness campaign
• Welsh nurse visits the OCNO
• Family Violence Intervention Guidelines
• Focus on enrolled nurses
• Services for offenders with a mental health history
• Health of Older Persons Strategy

International Nurses Day

The early crowd, keen to sample that delicious cake

The Office of the Chief Nursing Officer celebrated International Nurses Day on 12 May by inviting all the nurses who work in the Ministry for morning coffee and cake. There are around 40 nurses working in nursing and other roles at the Ministry. Jane Bodkin (Senior Advisor in our office) spoke about the theme of International Nurses Day: Nurses: A force for change – Improving health systems’ resilience. Jane’s background in mental health provided a platform for her to describe resilience for the workforce and the contribution of nurses to enhance resilience in the people they work with, colleagues and health consumers. You can read more of Jane’s thoughts in the article she wrote for the July issue of Handover (see page 9). Handover July 2016

The cake we celebrated with was decorated in the colours of International Nurses Day. It was delicious and also caused some hilarity when we noticed the effect the intense blue icing had on people’s smiles.

Jane O'Malley welcomed guests before Jane Bodkin addressed the gathering.

New Zealand’s Chief Nurse attends World Health Assembly

Chief Nursing Officer Jane O’Malley was part of a four-person delegation from the Ministry of Health to the World Health Assembly (WHA) in Geneva in May. The WHA is a meeting of all 194 member states of the World Health Organization. The first day of the meeting is devoted to speeches from each of the member countries, highlighting health and strategic issues. For the remainder of the meeting, the WHA executive deliberates and considers submissions from countries before making recommendations to the World Health Organization.

Jane presented the country address for New Zealand (see her speech below).

Country address to the WHA for New Zealand, delivered by Chief Nursing Officer, Dr Jane O’Malley

Tēnā koutou, tēnā koutou katoa. Tēnā koe Dr Margaret Chan.
Kei te tuku mihi a Chai Chuah Director-General o te Manatu Hauora, Dr Jonathan Coleman te Miniti o Hauora, mātou katoa o Aotearoa ki a koutou o konei, ki a koutou o te ao whānui. Nō reira, tēnā koutou, tēnā koutou katoa

Greetings from New Zealand to you all and to you Dr Margaret Chan from our Director-General of Health, Chai Chuah and our Minister of Health, Dr Jonathan Coleman. Greetings from all of our New Zealand colleagues to the people of this place and to health colleagues from around the world.

New Zealand's constitutional foundation, and therefore our health and welfare system, is based on a Treaty between the British Crown and indigenous Māori signed in 1840 and ratified in 1990. The Treaty recognises indigenous rights to health in its global entirety preserved through partnership and participation in governance and protection.
While our health care system delivers high quality to the majority of our people, we unfortunately see poorer outcomes in Māori and Pacific people. In 2015, we consulted widely with New Zealanders, both consumers and service providers to develop an updated New Zealand Health Strategy and a five year action plan. Through implementation of the strategy, the government is committed to social and health reforms to deliver services that provide equality of access and outcomes for all.

The Health Strategy has five themes: 
First: services close to home – focusing on increasing delivery of safe and appropriate care in homes and communities

Second:  a system that is people powered – engaging the New Zealand people to actively participate in their own care and in the design and evaluation of services to make them more accessible and acceptable for all

Third: a system that focuses on value and performance – the emphasis here is on analysing data and other evidence to plan, deliver and evaluate health services better. We need to thoughtfully consider how investment in prevention, protection and promotion will reduce unnecessary expenditure. If we don't move the focus of our health system from illness to wellness, we will be faced with a growing demand for hospital services. 

Fourth: a smart system – this is about using technology to support a more integrated and responsive healthcare system.

And finally, one team – this is about integrated teams, including partnering with consumers and other government agencies in recognition of the social determinants of health. The New Zealand Government is clear that health is about more than the delivery of health services.

The five themes are interlinked. 

The objectives of the New Zealand Health Strategy reflect the expectations of the Sustainable Development Goals (SDGs). New Zealand believes it is well on track to deliver the health components of the SDGs and will be considering how to accelerate their delivery.

The New Zealand government has chosen to focus on those aged 0–24 years. Our evidence highlights if we focus on future parents, newborns and their families, we will have the best chance of providing a healthy start for children and youth now and into the future.

New Zealand is committed to concentrating on efficiency and avoiding duplication of practices and effort; we must build on the lessons learnt in implementing the SDGs.

The Government’s commitment to the new health strategy and the SDGs extends to programmes it supports in the Pacific.
The focus must now turn to how to use the SDGs and measure their effectiveness. We will work with our Pacific Island and WHO partners to develop indicators suitable for all, including small or developing countries.

In closing New Zealand would like to acknowledge and thank the Director General, Dr Margaret Chan for her hard work and leadership of the WHO.
Mā ā koutou  rourou, mā ā mātou rourou  ka ora haere ai te hauora  Tēnā tātou katoa

In closing I acknowledge that we are all here contributing in order to improve health. Greetings to you all.

This picture of Jane was tweeted from the WHA as she made an intervention about health workforce.

Staff changes

We live and work in a fast-paced world and it seems in almost every update we advise you of a change in our staff. We have temporarily lent our Principal Advisor, Dr Paul Watson, to a different team in Health Workforce New Zealand.

Paul has been seconded to work with the new Chief of People and Transformation in the role of Manager, Strategy and Relationships in Health Workforce New Zealand. So he has not left the building, and he is still working in an area with a great deal of overlap with our office. The secondment is for three months. Paul is well prepared to take up the role; he has a strong commitment to planning and developing the health workforce to respond to the health needs of New Zealanders. That means thinking about skill mix and deploying the health workforce most effectively so that people receive the care they need from the most appropriate worker.

Enabling nursing scopes of practice

The last few months have seen some major pieces of legislative work coming to fruition. This is great news for improving access to health care for New Zealanders.

Medicines (Registered Nurse Designated Prescriber) Regulations 2016

In June, the Medicines (Registered Nurse Designated Prescriber) Regulations 2016 received the Governor-General’s Seal. This means that the Regulations are now law and will be in force from 20 September. Medicines (Designated Prescriber - Registered Nurses) Regulations 2016

PHARMAC has consulted (closed 5 August) on amendments to the Pharmaceutical Schedule rules to ensure prescriptions issued by registered nurse designated prescribers (RN prescribers) will be eligible for subsidies https://www.pharmac.govt.nz/news/

At the same time, the Misuse of Drugs Regulations 1977 was also amended to allow RN and pharmacist prescribers to prescribe from a limited schedule of controlled drugs, and to allow designated RN prescribers to issue prescriptions for a seven- day supply of controlled drugs. Misuse of Drugs Amendment Regulations 2016

The Nursing Council of New Zealand has been preparing the Gazette Notice to set out the required education and competence assessment requirements for RN prescribers and working on transition arrangements and competence requirements for the RN prescribers currently prescribing under the Medicines (Designated Prescriber – Registered Nurses Practising in Diabetes Health) Regulations 2001. Read more from the Nursing Council and see guidance on becoming a registered nurse prescribers at http://www.nursingcouncil.org.nz/Nurses/Registered-Nurse-Prescribing?utm_source=Nursing%20Council%20of%20New%20Zealand%20-%20Non%20members&utm_campaign=CE%20newsletter%20Prescribing&utm_medium=Email

Medicines (Standing Order) Amendment Regulations 2016

The Medicines (Standing Order) Amendment Regulations 2016 was approved by Cabinet in July. The new Regulation amends the definition of issuer to include nurse practitioners and optometrists. This means nurse practitioners and optometrists will be able to issue standing orders under the same conditions that apply currently to medical practitioners Medicines (Standing Order) Amendment Regulations 2016.

The Ministry of Health Standing Order Guideline will be revised and published on
17 August to reflect the amendment to the Regulations. Read the Standing Order Guidelines.

Health Protection Amendment Act 2016

The Health Protection Amendment Act was passed on June 2016 and will come into force in six months. The Act amends sections in the Health Act 1956. The main change relevant to nursing is that Section 7 of the Act amends references to medical practitioner in Section 74 of the Health Act to allow health practitioners to make notifications of infectious diseases under the Act. Read the Health Protection Amendment Act

The Health Practitioners (Replacement of Statutory references to Medical Practitioners) Bill has moved up the Parliamentary Order to sit at number three. This means the Bill will be before the House for its second reading fairly soon after Parliament resumes in August. You can read the Bill and the Health Committee report to the House here Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill.

FAST Stroke awareness campaign

A national FAST awareness campaign is running from 5 June through to early August 2016. The information in this document is designed to support local initiatives to promote awareness of FAST.  

Further information about the campaign can be read on www.hpa.org.nz/stroke-fast-campaign.

The FAST mnemonic helps people recognise the key signs of stroke and prompts people to call 111 immediately if they see any of the signs.

FAST stands for:

Face – Is their face drooping on one side?

Arm – Is one arm weak?

Speech – Is their speech jumbled, slurred or lost?

Time – Time to call 111.

Welsh nurse visits us

Nicola Meredith, Diana Murfitt, Jane O’Malley, Bonnie Jones, Caitlin Leonard and Chris Millar

We recently enjoyed hosting Welsh public health nurse Nicola Meredith when she visited the Ministry as part of her visit to New Zealand as a Winston Churchill Memorial Trust fellow. Nicola was in New Zealand to look at the New Zealand health system staff immunisation programme with a view to learning from our success in achieving high rates of staff flu immunisation. Nicola met with Jane and the Ministry’s immunisation team.

Family Violence Assessment and Intervention Guideline: Child abuse and intimate partner violence

The Ministry of Health recently published the revised Family Violence Assessment and Intervention Guideline on the website www.health.govt.nz/publication/family-violence-assessment-and-intervention-guideline-child-abuse-and-intimate-partner-violence

Nurses and other health care providers are in an ideal position to assist victims of interpersonal violence and abuse. It is well known that victims of abuse have a range of health issues and may use health care services more often than others.

The Guideline is a practical tool to help health practitioners intervene safely by screening for and responding to disclosures or allegations of abuse. It has been written to support practice across health professions and so that it applies in a range of settings.

The guideline presents a six-step model for identifying and responding to family violence within health care settings. Given the co-occurrence of partner abuse and child abuse, the guidelines also outlines an integrated response to addressing both of these issues. The guidelines have been endorsed by a number of health professional and family violence intervention organisations. 

The guidelines are intended for use in conjunction with health professional training offered through the Ministry of Health Violence Intervention Programme

www.health.govt.nz/our-work/preventative-health-wellness/family-violence

Focus on enrolled nurses

Much of the work we do involves influencing and advising to ensure the three nursing scopes of practice are employed, enabled and contribute to improving health outcomes for New Zealanders. We recognise the value of a nursing skill mix that includes all three scopes of nursing practice to respond to differing levels of health need.

We are especially interested in reinforcing the important place of enrolled nurses in providing quality nursing care. Enrolled nurses have academic preparation, a nursing foundation and knowledge and skills that is essential to improving health outcomes. Working in teams with registered nurses, enrolled nurses can direct care that is delivered by the unregulated workforce and can also be part of the solution to current and future health need demands on the workforce.

A new scope of practice for enrolled nurses was implemented in 2010. Since the new scope was established, almost all previously trained enrolled nurses now meet the 2010 scope competencies.

There are around 2700 enrolled nurses in the workforce. Around 64 percent of all enrolled nurses are aged over 50 years. For this reason the nursing workforce governance group has identified enrolled nurses, along with the Māori and Pacific and aged care nursing workforces as priorities.

Southern and Canterbury DHBs are leaders in employing enrolled nurses – around 30 percent of all enrolled nurses work in the South Island. Both DHBs have refined their models of care, clinical governance systems and tailored the nursing skill mix to include enrolled nurses in a range of acute, mental health, medical and continuing care settings. In some areas enrolled nurses work to the full breadth of their scope of practice.

In June, Alison Hussey (Senior Advisor) attended the NZNO Enrolled Nurse Section Conference in Blenheim. The theme of the conference was ‘Enrolled nursing ENriching and unique’. Alison was part of a panel discussion on the application of the enrolled nurse scope of practice in the New Zealand health workforce.

You can read more about the NZNO Enrolled Nurse Section conference and access presentations at Enrolled Nurse section conferences

The panel L-R: Rose Mitchell (ARA enrolled nurse programme; Pam Kiesanowski, Director of Nursing Nelson Marlborough DHB; Alison Hussey; Angela Crespin, enrolled nurse, Kapiti PHO; Beth Tester, Chief Executive Marlborough PHO.

Showcasing enrolled nurses in diverse roles

The following examples show how enrolled nurses provide safe and cost effective care.

In the Southern DHB six enrolled nurses working out of the renal dialysis unit at Dunedin hospital provide all the care and support for people in the home haemodialysis programme. These enrolled nurses are supported by a clinical governance system that includes a rigorous training programme, ongoing professional development, peer mentoring and a well described direction and delegation process. Kristy Booth recently presented at the Enrolled Nurses Section conference and described the professional and personal benefits of working in the programme, including the opportunities for growth and ability to have a work/life balance. The service provided by this team of nurses means people receive the care they need, from the most appropriate person using advanced technology and as close to home as possible – a really practical demonstration of the themes underpinning the New Zealand Health Strategy.

At Waikanae Health in the Capital and Coast DHB area two enrolled nurses work to the full extent of their scope of practice. Angela Crespin works as a wound care nurse, both in general practice and the community. Angela works with a registered nurse but is acknowledged as an expert by others in the team, to the extent she provides advice to less experienced registered nurses and, on occasion, to the doctors. Angela provides wound care, dressings, advice and education for staff in clinics and in rest homes around Kāpiti. You can read more about Angela’s work here http://www.nurses.org.nz/stories/artmid/3539/articleid/12/a-passion-for-wound-care

In the same team, enrolled nurse Sue Goodwin works as a mobile practice nurse in a service that began as a day-and-a-half a week and now employs a fulltime registered nurse, with Sue working part time. This team visits older people who have deteriorating mental and physical health to support them to live well in their homes. The role involves working independently but in touch with the general practice team, other wellbeing and social services in the community and with families. The range of nursing and relationship skills needed is impressive as the nurses balance family demands and respect for older people’s wishes and capabilities.

In the Waikato DHB area Debbie Palmer is employed as a senior enrolled nurse at Atawhai Assisi Home and Hospital at Matangi, Hamilton. Debbie wears several hats in her role and says she is able to work to the full breadth of her scope of practice because her workplace understands and values the versatility and flexibility of the enrolled nurse role.

Debbie is the team leader on afternoon shifts at Assisi working under the direction of a registered nurse to supervise caregivers providing care to residents. Debbie also manages the assessment and education in the Aged Care Education (ACE) programmes for caregivers. She contributes to the initial assessments and information gathering during admission of new residents and residents transferring from other facilities. This includes using assessment tools such as Katz, Braden scale pressure injury risk assessment and falls risk assessment. Debbie works with the registered nurses to individualise care plans to meet residents’ needs, including injury prevention, wound management and nutrition and mobility. Debbie plans orientation for new staff and is the infection control co-ordinator responsible for staff education, audits and monthly reporting to the Opportunity for Improvement Committee and leads development and review of infection control policies and procedures. Debbie contributes to quality improvement at a national level as a member of the Accident Compensation Corporation, Health Quality and Safety Commission and Ministry of Health pressure injury expert advisory group.

At Whangarei Hospital (Northland DHB) Maree Tugaga is an enrolled nurse working in the talipes clinic. The clinic cares for babies from across the Northland district born with congenital talipes equino varus (CTEV). Maree works in a team of orthopaedic surgeons and nurses to care for infants and their families through the 6 to 8 week Ponsetti process of corrective plaster casting, tenotomy (surgical release of the archilles tendon) and finally, fitting corrective boots.

The role includes a lot of parent education and support, and compliance monitoring. Maree understands the importance of establishing a trusting relationship with families to achieve the best result for the child. Families also need help to understand the process for correcting the CTEV and managing when their baby has full length plaster casts for several weeks. All Maree’s enrolled nursing and interpersonal skills are needed to respond to each family and her technical knowledge of casting and skin care contribute to safe care.

Our office is working with Directors of Nursing to improve understanding of the potential of enrolled nurses and to increase employment of new graduate enrolled nurses. On the Ministry website you can view the Enrolled Nurse Fact Sheet to learn more about the enrolled nurse role and see examples of the roles enrolled nurses take in health care.

Enrolled nurses, assessment, care planning and documentation
HealthCERT recently issued guidance for facilities, practitioners and auditors to clarify the role of enrolled nurses in assessment, care planning and documentation. HealthCert is the part of the Ministry of Health that oversees the Health and Disability Services (Safety) Act 2001 and is responsible for the certification of health and disability providers. Health and disability providers undergo certification audits against the Health Disability Services Standards (HDSS).

The content of the guidance is below. You can access quarterly bulletins from HealthCERT by visiting www.health.govt.nz/our-work/regulation-health-and-disability-system/certification-health-care-services/healthcert-bulletin

The guidance describes the role and scope of practice of enrolled nurses in relation to assessment, care planning and documentation and provides the following advice.  

Guidance for health and disability providers

1.  Health care assistants and/or caregivers cannot be made responsible for undertaking or documenting consumer assessments, care plans and evaluations.
    
2. Each provider of health and disability services (DHB/aged care/private hospital, hospice) is responsible to have a policy that details:

• the registered nurse responsibility for direction and delegation of care to enrolled nurses and healthcare assistants in their service
   
• how enrolled nurses co-ordinate a team of health care assistants/care givers under the direction and delegation of a registered nurse
   
• the process for recording registered nurse oversight of assessments undertaken by enrolled nurses
   
• the process for recording registered nurse oversight of care plans documented by enrolled nurses.

In recognition of the scope of practice and capability of enrolled nurses, HealthCERT has provided the following examples of acceptable practice to providers, employers and auditors.

• Admission assessment: The enrolled nurse is delegated a consumer assessment by a registered nurse.  The enrolled nurse completes the appropriate admission documentation.  The enrolled nurse consults with the registered nurse and documents a care plan as directed and in line with policy. The registered nurse is not required to countersign these entries.  
• Consumer reassessment: Changes in the consumer’s care, condition or treatment are recorded in the appropriate clinical documentation (e.g. admission-discharge planner) by the enrolled nurse. The enrolled nurse consults with the registered nurse responsible for the consumer’s care plan and records any changes to the care plan in the consumer’s health record.  The registered nurse is not required to countersign these entries.
• Progress Reporting: The registered nurse responsible for the care plan and who has delegated care to the enrolled nurse is named in the consumer’s health record. The enrolled nurse is responsible to document the consumer’s day to day progress, care delivered and outcomes in the consumer’s health record. The registered nurse is not required to countersign these entries.

Nursing Council of New Zealand links

Competencies for enrolled nurses April 2012

Guideline Delegation of care by a registered nurse to a health care assistant (PDF, 730 KB)

Guideline Responsibilities for direction and delegation of care to enrolled nurses (PDF, 641 KB)

Services for offenders with mental health issues

Corrections recently received $14 million from the Justice Sector Fund to purchase mental health services over the next two years for offenders in prison and in the community. More information is available www.beehive.govt.nz/release/14m-help-offenders-mental-health-issues
 

Corrections will be working on the development of these initiatives over the next few months. Jane Bodkin is one of a number of Ministry of Health officials supporting Corrections with planning for the services.

Health of Older People Strategy

The Ministry of Health’s consultation on a draft Health of Older People Strategy is now well underway. Kathy Glasgow from our office has been involved with the Ministry’s Health of Older People team developing the strategy.

This document sets out a draft strategy for the health and wellbeing of older people for the next 10 years. Its vision is that older people live well, age well, and have a respectful end of life in age-friendly communities.

You can see the  strategy here at Health of Older People Strategy Consultation Draft.

Public feedback is now sought on the proposed future direction for each outcome area in the Draft Strategy, actions being considered, or any other general feedback. The latest consultation follows completion of the first stage of public engagement which involved meetings and workshops around the country, analysis and integration of feedback into the draft Strategy.

There are plenty of ways to give feedback

People can provide feedback through a written submission (hard copy, email or online through Survey Monkey) at LINK (SAME AS ABOVE?) or through discussion at a workshop or sector meeting.

And you can also join the discussion on the online forum at https://discuss.health.govt.nz/health-older-people-strategy

Your views there will be fed into the submission process, so every comment counts before the consultation closes on 7 September. 

TŪ KAHA 2016 – Register today!

Wednesday, 21 September 2016 12.00 pm – 
Friday, 23 September 2016
1.30 pm (New Zealand Time)

Silverstream Retreat
3 Reynolds Bach Drive
Lower Hutt
Wellington, Wellington 5014

https://www.regonline.com/builder/site/Default.aspx?EventID=1836530
Tū Kaha is a conference series that started in 2008 to promote and celebrate success in the Māori health industry. The conference for 2016 is jointly hosted by Capital Coast and Hutt Valley District Health Boards.

The overarching theme for the conference is “Mō Tātou - just as it takes a village to raise a child, it takes us all to raise the status of Māori Health.” The conference will weave together kaupapa provided by renowned weaver Veranoa Hetet. These kaupapa or themes include:

• Tukutuku - innovation
• Tāniko - service and performance improvement
• Raranga - workforce development and collaborative initiatives

We have an exciting array of speakers with more details to come. Register for Tū Kaha 2016 today!

Registration Costs
Early bird full registration (closes Friday 15 July 2016) at $391.00
Early bird one day registration (closes Friday 15 July 2016) at $175.00
Full conference registration at $440
One day registration at $222
Conference dinner only (Thursday 22 September) at $77
 

We are always keen to hear from you. Contact andrea_tamahaga@moh.govt.nz to get in touch with Jane or any of the team. We’d love to know if:

•  you would like more information about anything discussed in this newsletter
   
• there is something particular you would like us to include in our next newsletter
   
•  you have any feedback about the newsletter.