December 2017                                      

Hello everyone and welcome to the December edition of our newsletter.  

In this edition we are showcasing some of the good work of nurses in primary care. 

Nurses in schools, Well Child / Tamariki Ora, general practice, district nursing, public health nursing and occupational health make a substantial contribution to prevention, early intervention and management of health.

A strong primary health care system is central to improving the health of all New Zealanders and reducing health inequalities. We continue to support better use of the whole primary health care workforce and particularly in general practice.

We include stories on award winning nurses, primary mental health innovation and a perspective from nurse prescribers in the community. We have also included summary workforce data and links to general news and updates.

We welcome contributions, feedback or questions. To contact us, please email Debra_Begg@moh.govt.nz

In this issue:

• Changes in the OCNO
• Out and about
• Growth in primary health care nursing
• Primary health care a priority
• Young Nurse of the Year
• Primary mental health in Lakes DHB
• Registered nurse prescribing in general practice
• Nurse credentialing in primary mental health
• Innovation to increase patient wellbeing prior to surgery
• Nurse practitioner update
• Mobile apps library
• Insights from young Māori women who smoke
• 2018 Pacific health scholarships
• Annual health survey key results
• Improving the health of NZ children

Changes in the Office of the Chief Nursing Officer 

We are pleased to welcome Debra Begg to the team, as Senior Executive Assistant to the Chief Nursing Officer.

Debra comes to us from the private sector, where she worked in debt collection for 18 years. During her time there she worked in administration, recruitment, IT, in the contact centre and as a team leader. She brings experience gained through working with people from varied social and ethnic backgrounds and is skilled at diffusing difficult situations.

As most of her family is local you can often find Debra on the sideline of rugby games, hockey fields and netball courts cheering on her nephew and nieces. She also has a keen interest in motorsports and we are reliably informed that she is not to be disturbed on race weekends.

Debra Begg, Senior Executive Assistant to Jane O'Malley

We are also delighted to announce the appointment of Ramai Lord who will be joining the Office as Senior Advisor on 24 January.

Ramai is an experienced registered nurse with a unique and extensive background in Māori health and primary health care. She has a BA in Māori and Indigenous Studies and Te Reo, and a Post Graduate Diploma in Health Sciences. She is currently completing her Masters of Health Science (Nursing Clinical). Ramai is of Ngāti Kahungunu ki Wairarapa, Ngāi Tahu, Te Whānau-a-Apanui and Ngāti Porou descent.

Ramai will be on a one-year secondment from her position as Māori Health Manager at Pegasus Health in Christchurch. She will be performing the usual duties of a Senior Advisor in the Office, and will hold specific responsibility for advancing the Office’s Māori Workforce Development Plan. We look forward to welcoming Ramai to the team.

Ramai Lord, Senior Advisor, Office of the Chief Nursing Officer

Haere rā Jane O’Malley

After seven years as Chief Nursing Officer, Ministry of Health, Jane has decided to take up a new role as the Chief Nurse at Plunket, reporting to the Chief Executive, Amanda Malu.

The opportunity to work with the Plunket leadership team to support their strategy focusing on the importance of the first 1000 days of life is one she is very much looking forward to.

There is never a good time to leave a position however it would be fair to say much has been achieved in the past seven years thanks to the deliberate and collaborative manner in which nurse, sector and Ministry colleagues have worked together.

Jane will remain Chief Nursing Officer until late February so there will be plenty of time to bed-in transition arrangements and celebrate the great achievements we have gained together.

Our love and best wishes go with you Jane.  “Whaia te iti kohurangi.”

Out and about in the sector

Jane O’Malley attended the Australasian Nurse Educators Conference in September and spoke at the New Zealand Emergency Department conference in October. In her opening address, Jane acknowledged the work of those who are on the frontline of acute care services. Brief interventions, including alcohol, suicide and family violence screening, can help to build community resilience in small ways and reinforce a focus on getting well and staying well.

Fuimaono Karl Pulotu-Endemann and Rosalie Waghorn (West Coast DHB) at the Australasian Nurse Educators Conference in Christchurch.

She also spoke at the Perioperative Nurses Conference in October. Jane talked about rapid changes in health and how new technology will render many things we currently do, when we look back on them, as primitive, inexact and maybe even dangerous. The question for perioperative nurses is not so different from that of all nurses: what will the need for nursing be in 2030 and what will you do?

From left to right: Jane O’Malley, Catherine Freebairn from Hawkes Bay DHB, and Jennifer Sexton and Shona Matthews, from The Dissector Journal at the conference.

One of Jane Bodkin’s ‘getting out and about’ highlights from the last couple of months was attending the Te Ao Maramatanga (College of Mental Health Nurses) Conference in Hamilton.

The conference generated a lot of interest with more than 200 nurses attending. Jane spoke about the mental health nurses important role in implementing the vision of the New Zealand Health Strategy. Jane co-presented a workshop with Bay of Plenty Nurse Practitioner Jeff Symonds on what RN prescribing in mental health might look like in the future. She also attended the inaugural ED NP conference and spoke as part of a panel debate on ‘the NZ NP in 2025’.

Jane Bodkin presenting at the Te Ao Maramatanga conference.

Kathy Glasgow has been meeting with nurse leaders in aged residential care and home care support. Both Kathy and Jill Clendon were pleased to be involved in Healthcare New Zealand’s Leadership Seminar on 19 October.

The day was attended by registered and enrolled nurses and occupational therapists from HCNZ Community Health, Healthcare Rehabilitation and NZCare. Participants explored qualities of leadership and came with pre-prepared improvement initiatives for group discussion.

Christine Maxwell, Director of Nursing at HCNZ said feedback on the day was very positive, that improvement projects are progressing with support from managers, and attendees are continuing their discussions online.

Jill Clendon and Kathy Glasgow co-presenting on leadership and change at HCNZ’s leadership seminar.

Jill has also attended and presented at a number of sector forums, including the Procare Nurses Development day, the College of Child and Youth Nurses Symposium, and the Health Sector Relationships Agreement biannual health forum.

The first two presentations focused on the New Zealand Health Strategy and the role of nurses in implementing it. Jill challenged nurses to think about the role they play in addressing the social determinants of health and how they can integrate approaches into their practice individually, within their organisation and across sectors.

The third presentation drew on research she completed in her previous role at NZNO on late career nurses with a focus on how we can support nurses to age well at work. The photo below is of nurses attending the College of Child and Youth Nurses Symposium. If you look carefully, you’ll see Jill in the middle of the front row.

Group photo from the College of Child and Youth Nurses Symposium.

 Growth in primary health care nursing

We are continuing to collect data on the primary health care nursing workforce to help inform planning.

Analysis of Nursing Council annual practising certificate data shows that in the last five years there has been growth in the proportion of nurses in primary health care settings compared to the general population. This rose from 192 nurses per 100,000 people in 2011 to 219 per 100,000 in 2016.

By comparison, the ratio of primary health care Pharmacists and Physiotherapists per population has increased only slightly, and the ratio of Optometrists and Midwives per population has remained the same.

Nurse Practitioners increased from 2 to 3 per 100,000 between 2011 and 2016 and Registered Nurses in general practice or practice nursing rose from 131 to 152 per 100,000 population. There has been small growth in the ratio of Public Health/School Nurses, from 20 to 23 per 100,000, and slight growth in District Nursing, from 30 to 31. The ratio of Child Health nurses (those indicating they practice in child health and are employed by a Maori or Pacific or primary health care provider) compared to the 0-19 population age group has not changed.

HWNZ's Nursing Workforce Forecasting Model projects that the Primary Care & Practice Nursing workforce will increase over the next ten years and keep pace with population growth.  However, any future growth in this workforce may not translate directly to increases in service delivery as most primary health care nurses work part time.

Primary health care a priority for new government

Primary health care is a priority area for the new government and we are working hard to provide advice to the new Minister on our work to date.

A focus on child and youth health is also evident with the new government indicating an extension to school based health services. Work is under way to determine how this can be achieved including a realistic timeframe. We will keep you informed of developments in this area.

Similarly, our work programme with children that previously focused on vulnerable children will now extend to include a broader focus on all children. Work that continues in this space includes the Well Child/Tamariki Ora review, SUDI prevention and family violence prevention.

The new government has also signalled that mental health is a priority. Establishing an inquiry into mental health is part of these priorities. The Minister has indicated via the media that he wants an independent inquiry with a broad scope and significant consultation.

Showcasing primary health care

Primary health care NP receives Young Nurse of the Year Award

This year’s Young Nurse of the Year award went to Jess Tiplady, who is a Nurse Practitioner working at the Greenstone Family Clinic in Auckland.

Jess Tiplady is of Māori descent and is currently the youngest Māori nurse to have achieved nurse practitioner status in New Zealand. Her work providing free eczema and asthma clinics to children under 13 years of age has contributed to improved child health outcomes and reduced hospital admissions in South Auckland for children with respiratory and skin infections.

The Young Nurse of the Year Award recognises and celebrates the exemplary work of nurses in the younger age group and their commitment to the nursing profession. Those receiving the award have shown compassion or courage beyond what is expected in their role as a nurse and have improved care or health outcomes through their care, leadership, research or quality.

View the media release on the New Zealand Nurses Organisation website: Young Nurse of the Year 2017

Primary Mental Health in Lakes DHB

An interdisciplinary primary mental health intervention service in Lakes DHB is achieving above average outcomes for their clients over significantly less contacts. The Primary Mental Health Intervention Service (PRIMHIS) is a small team (3.2FTE) of clinicians (nursing, psychology and occupational therapy) employed by secondary care services who provide brief therapy-based interventions in general practices to mainly GP referred clients. Clinics are held across 16 primary health care facilities.

The service focuses on clients with high prevalent disorders such as depression and anxiety. Outcome data is captured using the MyOutcomes software application which stores and summarizes treatment outcomes, and the results are regularly reported in clinical notes and correspondence to other health professionals. Thirty months of data has been captured with 4500 individual sessions evaluated. 3.4 sessions of intervention were delivered on average for each client who completed treatment.

Clients’ wellbeing scores at discharge were above the average, with 84% of the individuals who received treatment better off than a similar group who did not receive treatment. Improvement was shown over all aspects of personal wellbeing measured, with the most notable improvement in social functioning.

Outcomes achieved for Māori and Pākehā were nearly identical. Clients identified as experiencing significant socio-economic and/or housing difficulty are also shown to benefit from this service.  They however tend to report more distress and achieve less improvement than the average client seen by this service.

Michael O’Connell, Clinical Nurse Director, believes the success of this team is its continued focus on the clients' needs through feedback informed treatment, its positioning within the primary health care hub, and the shared care dynamic between the Therapist and the General Practitioner. Clinicians on average maintain excellent working alliances with their clients, with clients reporting a high level of satisfaction with all aspects measured.

(Thanks to Michael O’Connell, Clinical Nurse Director, Mental Health and Addiction Service, Lakes DHB, for contributing this story.)

From left to right: Members of the PRIMHIS team Jenny Collier (Registered Nurse), Wilma Foster (Clinical Nurse Manager for PRIMHIS) and Lorraine Ward (Registered Nurse).

Absent are Lindy van der Merwe (Occupational Therapist), Joanna Price (Registered Nurse & Clinical Nurse Specialist for PRIMHIS) and Bronwyn Milsum (Clinical Psychologist). The team also has input as necessary from Dr Louise Armstrong (Psychiatrist).

Registered Nurse Prescribing in the community (Counties Manukau DHB Pilot)

Thirty-three nurses from Counties Manukau DHB have completed the credentialing process and are now in the process of applying to the NCNZ for prescribing rights in community health.

In the first cohort are four public health nurses, seven nurses working in primary schools as Mana Kidz nurses, 16 nurses working in general practices, six secondary school nurses and one nurse working as a cervical screening coordinator. Eight nurses have completed the Family Planning certificate in contraception and sexual health and are able to prescribe in this area as well.

Within their case studies the nurses have demonstrated health literacy, antimicrobial stewardship, and have acted on social determinants of health, such as utilising Kids Can for shoes and the Auckland Wide Housing Initiative for housing assessments.

They have found the course very practical and have valued using their clinical skills. The nurses are reviewing laboratory results and applying them to the patient context and the first prescriptions have been written. They speak of feeling more engaged with their GP or NP mentors and able to discuss cases more freely, contributing to increased job satisfaction. They all speak about feeling more confident in their clinical care and excited about their new skills and the impact they can have making care more accessible for vulnerable groups.

(Thanks to Karyn Sangster, Chief Nurse Advisor Primary & Integrated Care, Counties Manukau for this contribution.)

A perspective from nurse prescribers in general practice

Nicola Elder and Caerlie Picken, Registered Nurse Prescribers, Rotorua

"In November 2016 I completed the paperwork for Registered Nurse (RN) prescribing in primary health and specialty teams with a fellow nurse colleague. We were amongst the first of six other RN prescribers within New Zealand to become registered in December 2016. We had both completed our clinical Masters of Nursing some years prior, and are both currently employed working as Registered Nurse Prescribers in primary health care in a large suburban general practice in Rotorua.

The impact of our ability to prescribe was felt immediately within the practice. Many patients have commented on this new option and appreciate that they are able to be seen more quickly, and at a lower cost than for a doctor visit. There is an acute clinic that runs each morning, and many of the patients are able to see a RN prescriber, or Nurse Practitioner (NP) to meet their health needs.

Having RN prescribers gives reception staff more options for booking patients. Reception books patients preferentially with an RN prescriber knowing they may be able to provide the required care.

Dr Harry Pert has found the experience of having nurse prescribers ‘nothing but 100 percent positive,’ and in the ideal world would like to see prescribing as a routine part of a practice nurse’s professional development.

For me, RN prescribing is a logical step to making an application for NP, and the more autonomous prescribing practice provided by a NP. My clinical practice has expanded since starting to prescribe from the comprehensive list of medications. I collaborate regularly with the NP, doctors, and pharmacists, and I have had regular supervision and mentoring from a very supportive general practitioner and NP which has enhanced my learning. I feel much more prepared and ready to make an application for NP which for me was the overall aim of RN prescribing.

I recommend Nurse Prescribing for better job satisfaction and because it is clear from research that patients benefit.”
(Thanks to Nicola Elder, Registered Nurse Prescriber, for this article.)

Primary Mental Health and Addictions Nurse Credentialing

The number of mental health and addictions credentialed nurses is steadily growing.

Te Ao Maramatanga New Zealand College of Mental Health Nurses, in collaboration with Health Workforce New Zealand and Manaia Health Primary Healthcare Organisation (PHO) developed and evaluated a pilot credentialing programme in 2011-2013. Manaia Health PHO have continued to lead and develop their programme every year since. They have also worked with the College to mentor and support further programme development.

In 2015 a collaboration of the Auckland Metro DHBs and PHOs delivered their first programme. The Auckland collaborative also commissioned an external evaluation which detailed very positive results, both in terms of outcomes for consumers and significant professional development of the nurses involved.

“I have really enjoyed the course and I think it is great for practice nurses to have the skills we have gained from this.” Cylina Sherwood, (Primary Health Care Nurse, Napier).

Since late 2015, with the publication of both evaluations and the generous sharing of information by these established regions, more locally based programmes are being offered. Programmes are developed and delivered to College specifications, which have some room for local variation. The College supports local programme development, approves the programme and provides an eportfolio for nurses to collect evidence of their learning.

At the completion of the local programme, nurses submit an online portfolio that includes a reflective piece of writing that demonstrates the translation of new knowledge into practice. These portfolios are assessed by College members against credential criteria and a mental health and addiction credential is awarded for 3 years.

(Thanks to Lois Boyd, Programme Director, for this story. For further programme information please follow the links in this story and/or contact Lois: lois@loisboydconsulting.co.nz )

Other news and updates

Innovation to increase patient wellbeing prior to surgery

Gill Fewster and Kim Snoep who won an innovation award for their “Get Fit for Surgery” proposal. (Source: Southland Times)

Southland Hospital nurses Gill Fewster and Kim Snoep see great potential for achieving better outcomes for patients who are better prepared for surgery.

Colorectal nurse Snoep and enhanced recovery after-surgery nurse Fewster, recently received a Patient Priority award for their "Get Fit for Surgery" proposal that focuses on helping patients presenting for colorectal surgery.

"We want to get their mind and body ready for surgery, and start working with them as soon as they receive their diagnosis," Snoep said.

This includes helping patients with their nutrition if they are undernourished and their mental preparation for surgery and recovery, and also making sure that their whānau know how to assist them.
"We want the patient to be the driver. Ownership is very important," Fewster said.

The award was presented as part of Southern District Health Board's Southern Innovation Challenge.
For more details view the news article: Southland nurses win innovation award

Nurse practitioners

The Nurse Practitioners in New Zealand information sheet is now available on the Ministry’s website. The information sheet is designed specifically for employers and includes sources of funding available, links to further information, and stories of nurse practitioners at work. The information sheet was written with the support of the Health Workforce New Zealand (HWNZ) Nursing Workforce Advisory Group.

HWNZ have received the final Evaluation report from Malatest International of the Nurse Practitioner Training Programme (NPTP). The NPTP programme provides a focused education pathway for registered nurses seeking registration as NPs.

The programme evaluation focused on the first cohort of nurses enrolled in the NPTP and was completed between early July 2017 and the end of August 2017. HWNZ intend to publish the report on their website by the end of 2017.

In the meantime the Ministry will be discussing the findings and implications for nurse practitioner training with the Nursing Council of New Zealand and the nursing sector.

This will include an  opportunity for the sector to comment. The evaluation findings and discussions will inform decisions about future nurse practitioner training.

Mobile apps Library supporting self-management of health

Did you know you can access a library of mobile health apps?

Mobile health apps are made to support lifestyle, disease management, mental wellbeing and behaviour change, but how do you know if they work, or if they are safe to use?

The Health Navigator NZ library includes apps that have been reviewed by a range of experts, so you can decide which ones are right for you. The purpose of the library is not to recommend apps or approve them but to provide clinicians and consumers with a selection of apps and enough information to decide which ones will meet their needs. Examples include a sleep app, medication management app, breastfeeding app, smoking cessation app, blood pressure app, and alcohol tracking apps.

For more information view the Health Navigator website.

Young Māori women who smoke

The Ministry of Health recently took a 'client insights' approach to the problem of high Māori smoking rates. This approach sought a deeper understanding through engaging with some of the people at the centre of this issue, young Māori women.

Through the project ‘Addressing the challenge of young Māori women who smoke’ the Ministry used data, evidence and insights to find out about the barriers affecting young Māori women’s ability to quit smoking. This included:

• Taking a look at the evidence of what works in smoking cessation
• Using data from Statistics New Zealand’s Integrated Data Infrastructure (IDI) about the lives of young Māori women who smoke and making sense of that data through analytics
• Engaging with over 50 young Māori women, listening to the stories of their lives and their relationship with smoking.

From this project the Ministry has learnt a lot about the complexity of the lives of young Māori women, the things that challenge them and the strengths that uphold them and provide opportunities for change. Jill Clendon was part of the team undertaking the project, all of whom developed new skills in combining client insights with data to inform policy and service planning.
Read the reports and datasheet on the Ministry of Health's website.
 

From top to bottom: Jill Clendon and Cheree Shortland-Nuku analysing data; Alison Thom (Māori leadership) sharing findings; working with young Māori women to obtain their insights.

2018 Pacific Health Scholarships now open

The 2018 Ministry of Health Pacific Health Scholarships are now open and will close on 6 February 2018. The scholarships provide financial assistance to Pacific students who are committed to improving Pacific health.

Students must be undertaking a course in health or disability-related studies that is accredited by the New Zealand Qualifications Authority (NZQA) or the New Zealand Vice Chancellors Committee.

More information on how to apply for a scholarship is available on the Ministry of Health website.

Annual Health Survey’s Key Results published

The Ministry of Health recently published key statistics from the New Zealand Health Survey 2016/17. These Tier 1 statistics give a picture of New Zealanders’ self-rated health, smoking, drinking, obesity and mental health status, as well as information on cost barriers to people accessing GP care and prescriptions. Some comparisons are available now over 10 years.

Highlights include:

• 98.1% of parents rate their children as being in good health, 88.2% of adults rate their own health as good
• The current smoking rate has decreased from 20.1% in 2006/07 to 15.7% in 2016/17 and the rate for 15-17 year-olds has reduced from 15.7% in 2006/07 to 3.9%
• 79.3% of adults consumed alcohol in the last year, down from 83.6% in 2006/07.

Challenges remain:

• Obesity levels are on the increase – 1.2 million adults or 32.2% of the adult population are obese – up from 26.5% in 2006/07
• About 290,000 adults, or 7.6% of New Zealand’s population, experienced high levels of mental distress in the four weeks before they were interviewed
• The cost of visiting a GP was a barrier for 14.3% of adults
• About 7% of adults and 3.9% of children could not afford to collect a prescription
• One in five adults (19.5%) have a hazardous drinking pattern.

More information is available on the Ministry of Health's website.

Improving the health of NZ children

Children’s access to doctors has greatly improved with free GP visits for those aged 6 to 12. The latest NZ Health Survey found only 2.7% of children aged 6–12 years were not able to visit a GP due to cost in the past year. The new government has agreed to extend free doctors’ visits further, to all under-14 year olds.

While much progress has been achieved with immunisation and access to GPs, childhood obesity remains a critical health challenge for New Zealand – 12% of children are obese, one of the highest rates in the OECD. These rates are higher for Māori and Pacific children.

New Zealand has a 22-initiative Childhood Obesity Plan launched in 2015 to help improve nutrition, increase physical activity, and create supportive environments for children and their families/whānau. Actions are under way across government, the private sector, communities, schools and families.

At the centre of this plan is the Raising Healthy Kids health target, which came into effect in July 2016. The target aims to have 95% of children who are identified in a B4 School Check as obese, offered a referral for a clinical assessment and family-based nutrition, activity and lifestyle interventions. In the last quarter results, 90.9% of children identified had been offered a referral.

For more information, view: Improving the health of New Zealand children

Last words

Don't forget to stay SunSmart this summer. On this topic, a short horror film has recently been released on the perils of sunburn as part of a New Zealand webseries ‘Ao terror oa’. The film has a particularly important message about the importance of being sun safe. Set in 1985, Burn Time depicts a nightmarish vision of the worst sunburn imaginable. The film can be viewed on YouTube.

The filmmakers note that:
“In horror films, if you ignore the danger signs and scoff at warnings you will very possibly be the first to die amongst your friends. It’s a sad but vitally important lesson that the exact same thing is true when it comes to sun protection and the risks of sun exposure, namely melanoma and other forms of skin cancer.”

Don’t be like the victim in this horror film: heed the SLIP, SLOP SLAP advice and use the Health Promotion Agency’s Sun Protection Alert to check the recommended time in your area to be SunSmart.

We hope you have a relaxing, enjoyable and safe summer and wish you a joyful season.

Jane, Jill, Kathy, Jane B and Debra.

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We are always keen to hear from you and about the work you are doing. Contact Debra_Begg@moh.govt.nz to get in touch with Jane or any of the team. We’d love to hear from you.
For an overview of our work on nursing at the Ministry, visit: www.health.govt.nz/our-work/nursing

ISSN 2423-0561