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:

Changes in the OCNO
Move to Molesworth Street
Enabling nursing scopes of practice
Medicines Regulations 2016
Changes to Health Practitioners status
Nurse practitioner education programme
Enrolled nurses
Nursing Governance Group key messages
Healthy Ageing Strategy
Primary Care
ACE update
Growing the Māori nursing workforce
Innovation on the West Coast
Mental Health and Addictions

Changes in the office

Alison Hussey, Senior Advisor, left the Ministry at the end of October. Alison was with us for four years and in that time she worked hard to remove barriers to innovation. She was the nursing advisor for child health in the Ministry, and worked to improve employment and deployment of enrolled nurses and nurse practitioners. She worked with colleagues from Health Workforce New Zealand (HWNZ) and Health Legal to take the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill through the machinery of government.

Alison and Ministry colleagues worked with the Nursing Council to have the regulations for Designated Prescriber Registered Nurses enacted, and led the amendment of the Medicines (Standing Order) Regulations to enable nurse practitioners and optometrists to issue standing orders. She worked with the Chief Coroner and other stakeholders to change the rules so other health practitioners can now verify death. Alison became known for her ability to work across teams at the Ministry, and in the sector and for her tenacity and ability to keep working through the challenges to get the job done. One admiring external partner went so far as to liken her to a ‘dog with a bone’ – an anecdote she has delighted in sharing ever since.

In the short term, Alison is planning to concentrate on her daughter’s upcoming wedding and managing a long awaited move to Hawkes Bay. We have no doubt she will find a new way to contribute to nursing in the future once her short term objectives are met. We will all miss her and wish her the very best for what comes next. We held a farewell morning tea, and colleagues attended from the Ministry, Nursing Council, Plunket, Ministry of Social Development and New Zealand Nursing Organisation (NZNO).

Left: Alison with Caroline Flora (Manager of the Children’s Action Plan at the Ministry) and Erin Beatson (from the Children’s Action Plan at MSD)

Right: Alison with Suzanne Rolls, Professional Nursing Advisor at NZNO; Mary Louise Hannah from HWNZ and Jane O’Malley

We are thrilled to announce two new members of our team: Dr Jill Clendon, Chief Advisor, and Carolyn Jones, Senior Advisor, for a fixed term appointment of six months. They will both start in January 2017.

Dr Jill Clendon is a registered nurse with an extensive background in nursing policy, research, education and practice with a particular focus on primary health care. She comes from to us from NZNO where she was an advisor and researcher on nursing policy. Jill was responsible for leading the development of future-focused, evidence-based nursing related policy and strengthening the vision, policy and leadership of NZNO.

Carolyn Jones is a General and Obstetric registered nurse with many years of clinical nursing experience in New Zealand and the United Kingdom in many areas of practice including surgery, critical care, accident and emergency, district nursing, and ACC assessments in the community. Carolyn has recently been with Te Tai Tokerau PHO working on long term conditions redesign in conjunction with Manaia PHO where, amongst other things, she set up the Mobility Action Programme in Northland.

Move to Molesworth Street

The Ministry of Health has moved to 133 Molesworth Street. The OCNO is located on level 1 of the refurbished building. The new building is designed to cater for flexible working. While we are in a ‘neighbourhood’ with the Office of the Chief Medical Officer and the Māori Leadership team, we have new technology which allows us to move to work with others on common projects. We are enjoying the work environment and our refurbished building withstood the recent earthquakes very well.

Enabling nursing scopes of practice

The last few months have seen more progress on the legislative work to remove barriers and enable the health workforce to work to the full breadth of their scopes of practice.

Medicines (Registered Nurse Designated Prescriber) Regulations 2016

The Medicines (Registered Nurse Designated Prescriber) Regulations 2016 came into force on 20 September.

The Nursing Council of New Zealand has published a Gazette Notice to set out the required education and competence assessment requirements for registered nurse prescribers. The list of specified medicines designated prescriber registered nurses can prescribe from is also published as a Gazette Notice. The Nursing Council has also published comprehensive guidance for registered nurses, employers and the public on the website.

The Nursing Council has advised the Ministry and the Minister it intends to progress registered nurse prescribing in community teams in the near future. The model has been revised based on feedback received in the consultation on two proposals for registered nurse prescribing in 2013.

Dr Frances Hughes, Chief Executive Officer of the International Council of Nurses wrote to Dr Jane O’Malley in August to congratulate New Zealand on authorising registered nurses to prescribe.

Changes to Health Practitioners status

The affectionately known HPSR Bill passed through the third reading in Parliament in October. You can watch Minister Coleman's speech introducing the Bill for the third reading here. The related eight amendment acts gained royal assent on 7 November 2016. Each amendment act will be brought into force by an Order in Council, which will also name the commencement date when the act becomes law. The Ministry will work internally and with the other agencies who administer the amendment acts (MSD, ACC, Ministry of Business, Innovation and Employment) throughout the Order in Council process, to ensure the systems needed to implement the changes in the Acts. Any provisions not brought into force earlier will automatically become law two years after the royal assent is granted.

Watch out for general advisory information about changes to health practitioners’ status that will appear on the Ministry’s website early in the New Year.

Nurse practitioner education programme

Health Workforce New Zealand has funded a new way of training nurse practitioners in 2016 following advice from the National Nursing Organisations group. The training programme is specifically designed to complete the preparation of experienced registered nurses for nurse practitioner roles and ensure their employment as nurse practitioners after training. In 2016 The University of Auckland and Massey University were contracted to provide a training programme for 20 trainees. The Nurse Practitioner Education Programme will be offered again in 2017. A formal independent evaluation of the programme will be undertaken to inform decisions on the future funding and delivery of the training programme.

Enrolled nurses

A revised fact sheet describing the enrolled nurse scope of practice and potential roles for enrolled nurses in health care settings has been published on the Ministry website. The previous fact sheet was published in 2013 and the refresh has provided the opportunity to share examples of current enrolled nurse practice to offer insight into the flexibility of the scope of practice.

Alison Hussey has also worked with a group of Directors of Nursing and the Enrolled Nurses Section of NZNO to further develop the Enrolled Nurse Supported into Practice Programme (ENSIPP) proposed by the Section in 2014. A framework of components for safe, supported transition to practice for enrolled nurse graduates has been drafted, using the ENSIPP and the available orientation programmes in use around the country.

The framework is designed to offer a consistent base for employers to then add to depending on the needs of the new enrolled nurse and the practice setting. We discussed progress with the Directors of Nursing at their meeting on 8th December. Jane Bodkin picked up the enrolled nurse and nurse practitioner portfolios at the beginning of November.

Nursing Workforce Governance Group

The Nursing Workforce Governance Group (the Governance Group) met on
25 November 2016 and agreed the following key messages, which were issued on 9 December:

Nursing workforce is a significant resource and health workforce enabler for improving population health outcomes. The government’s social investment approach is an opportunity to emphasise nursing as human capital or a source of investment, an enabler, and a catalyst for change. Nurses already work actively across key priority areas, including primary health, Well Child/Tamariki Ora, schools, and with vulnerable young people. Nursing as an enabler is part of a broader strategic change model that encompass four components – enablers, models of care, organisation, and business models – as well as the policy, regulatory, funding, and commissioning environments. The Governance Group is mindful of operational barriers that limit using nursing to its full potential. Nurses need to be supported and enabled to make increased and new contributions to the health sector.
The Governance Group supports and endorses the planned 2017 Nursing Forum. The Governance Group agreed with the focus of the Forum being on nursing contribution to future health and wellbeing of New Zealanders to actualise the vision of the New Zealand Health Strategy. The upcoming Nursing Forum will be a proactive and challenging examination of the next 20 years of nurses’ role in a rapidly changing environment. It is important nursing places itself in the broader context of the strategic change model.
The Governance Group continues to keep an active watching brief on the review of Health Workforce New Zealand’s funding allocation model to support medical training. The Governance Group is pleased to note the project is moving toward a whole-of-workforce approach to training needs and looks forward to being an active participant at the forthcoming 14 December 2016 stakeholder workshop held to discuss next steps.

Launch of the Healthy Ageing Strategy

The Healthy Ageing Strategy was launched at the Beehive on 13 December 2016. Formerly titled the Health of Older People Strategy, the name change of the final document reflects feedback in submissions that healthy ageing is a life-long process, and signals government’s commitment to early intervention and investment in prevention, to support the best possible health in late life.

The next step is the development of an implementation plan with the health sector partners, setting out details on how the priority actions will be implemented.

Primary Care

A recent discussion with a senior primary care nurse has motivated us to consider further developing, with the sector, a strategic nursing narrative for use and adaptation by nurse leaders and nurses to assist in the journey of change. A strategic nursing narrative would align itself with the emphasis on primary prevention and early intervention in the New Zealand Health Strategy.

Realising the vision of the Strategy so that New Zealanders live well, stay well, get well will require the most effective use of the health workforce. The focus on prevention and upstream intervention makes sense to nurses. Contemporary models of care will need to better address arrangements to improve access and to reduce inequalities. Nurses are the largest workforce and provide care to people in a wide range of settings. In future nurses will need to make the most of their traditional skill set and apply new knowledge and ways of thinking to ensure every contact is viewed as an opportunity to support people’s wellbeing. They will need to activate skills in partnership working and assessment, preventative interventions and self-directed care, system navigation, and cross agency collaboration.

We imagine the call to action will result in us all recognising that every place is the right place for responding to the health needs of people. We need a substantial shift away from traditional places of care (hospitals) to care closer to people’s home and delivered in response to their needs and their personal and family resources. Corresponding shifts in nursing education and models of care are needed, alongside continuing to remove barriers to innovation. We look forward to sharing an early draft of a strategic narrative with you early in 2017.

Advanced Choice of Employment scheme update

End-of-year new graduate employment

Advanced Choice of Employment (ACE) data from the end of year new graduate recruitment round confirms the pattern of the last four years in which more than half of graduates gain employment before they know the outcome of the Nursing Council of New Zealand State exam.

This year during the end-of-year recruitment round:

1455 new graduates applied for positions on Nurse Entry to Practice (NETP) or Nurse Entry to Specialty Practice (Mental Health & Addictions) (NESP) programmes using the ACE system
779 of those (54 percent) were known to be employed as at 25 November 2016
1274 were graduates from November 2016; of those 714 (56 percent) were employed as at 25 November 2016
the other 181 applicants had applied in earlier recruitment rounds
12 months after becoming registered nurses 37 (3 percent) of the 1245 November 2015 graduates who applied through ACE are still actively seeking work through ACE. This shows that employers are continuing to recruit new graduates throughout the year as vacancies arise.

As in previous years, Māori and Pacific graduates were employed at higher proportions than non-Māori and non-Pacific. In the November 2016 recruitment approximately 66 percent of Māori applicants and 61 percent of Pacific applicants are known to be employed compared with 50 percent of non-Māori and 53 percent of non-Pacific. These rates of employment of Maori and Pacific have increased (by 12 percent and 8 percent respectively) compared to last year. Given the under-representation of Māori and Pacific in the nursing workforce, this increase is a positive step in the right direction. The Chief Nursing Officer has had recent discussions with Directors of Nursing and Nursing Educators about speeding up this progress.

The top three ‘setting preference’ choices for graduates continue to be surgery, medical, and mental health and addictions. Primary health care (including practice nursing, iwi providers, school nursing and hospice) comes in at sixth place (after paediatrics/child/youth health and perioperative care).

Early results show few graduates employed in aged care in the initial match. However, we know from past data that most of the recruitment in Aged Residential Care occurs outside of the ACE match process as DHBs work with employers to recruit off the Talent Pool. The Office of the Chief Nursing Officer continues to work with DHBs and the aged care sector on ensuring a sufficient workforce is attracted to this specialty area of practice.

Noeline Whitehead, Rishmar Balloo and Jane O’Malley at the Aged Care Association Annual Conference where Jane and Rishmar presented on NETP and Career Pathways in Aged Residential Care.

Growing the Māori nursing workforce

The Nursing Governance Group has set a stretch goal for the Māori nursing workforce to match the proportion of Māori in the population by 2028. This will require a collective approach across the nursing sector, across agencies and with communities all involved in working towards the goal.

The Office of the Chief Nursing Officer is working with HWNZ and Alison Thom, Māori Leadership on a number of actions that will contribute to growing Māori nursing workforce. These include: establishing a cross-government working group to focus on growing the Māori workforce; setting expectations in regional workforce planning; requiring organisations that receive HWNZ funding to have a Māori workforce action plan; and publishing a biennial report that shows progress toward the goal.

Sector initiatives promoting employment of Māori new graduate nurses

Counties Manukau DHB and Procare pilot: increasing Māori new graduate nurses in primary care

Procare PHO and Counties Manukau DHB are participating in a pilot designed to increase the numbers of Maori new graduate nurses working in primary care. Procare and the DHB work closely with Manukau Institute of Technology School of Nursing to identify both Māori undergraduate nurses who are interested in working in primary care and practices that are interested in employing a new graduate or having a student on placement. The pilot includes a financial incentive for practices to support a Māori new graduate and cultural support, including identifying emerging leaders and providing opportunities for new nurses to participate in wānanga based programmes that blends the leadership curriculum with tikanga and mātauranga Māori values and principles.

To be eligible to participate in the pilot, practices must demonstrate a commitment to high needs populations and offer employment.

Procare and Counties Manukau DHB work on the principle that employment of Māori nurses is an investment approach because they can effectively engage with Māori whānau and influence positive lifestyle changes. The pilot increases numbers of undergraduate clinical placements in primary care and numbers of primary care NETP positions. There will be two intakes of five Māori new graduates in September 2016 and a further five in January 2017.

Strengthening Māori New Graduate Recruitment Strategy –
Lakes DHB

Lakes DHB has changed the recruitment process for new graduate nurses based on evidence that the previous interview process disadvantaged Māori applicants. The new recruitment strategy requires applicants to participate in a team activity and then an individual written assessment to respond to a Māori case study.

Lakes DHB have modified the assessment process by incorporating a cultural component in recognition of the DHB’s population. 33 percent of the population in Lakes identifies as Māori.

The data has validated the new approach. In November 2014 Lakes DHB employed 35 percent (n=7) of the Māori new graduate registered nurses who stated a preference to work in Lakes DHB. In November 2015 Lakes employed 73 percent (n=24) of the Māori new graduate nurses who stated a preference to work in Lakes DHB.

Innovation on the West Coast

West Coast Buller integration pilot – improving the physical health of people with long term mental health conditions.

The Equally Well initiative shocked New Zealanders by highlighting that people with mental health and addictions have a life expectancy reduced by up to 25 years – the most common causes of death being cancer and cardiovascular diseases.

www.tepou.co.nz/initiatives/equally-well-physical-health/37

The Buller pilot is a collaboration between the West Coast PHO, the West Coast DHB Buller Community Mental Health Team (CMHT) and Buller Medical Service to integrate care for people with long term mental health conditions and physical health needs, into the PHO long term conditions programme. A clinic tailored for service users who have been with CMHT for more than two years is being trialled.

The pilot aims to improve physical health of West Coasters with mental health and addictions in Buller CMHTs. The pilot also seeks to improve communication, links and integration between the CMHT and the general practice. Objectives of the initiative include improving the timeliness of and access to physical health care and improving service user trust by co-designing a service that better addresses their needs.

The pilot includes an initial free extended consultation to general practice, quarterly visits and an annual review. As part of the pilot a GP Liaison role (CMHT) was re-established in the practice with subsequent benefits of increased ability to assess/triage, champion integration and to facilitate the integration between the CMHT and general practice. While funding is ‘one off’ once established, on-going funding will be sought.

Jane O’Malley’s recent West Coast DHB visit with some of the team from Buller Health.
Left to right: Back row: Linda Brace, Kathleen Gavigan, Marla Hill, Tim Fletcher, Karyn Bousfield
Front row: Jane O’Malley, Diane Brockbank, Sue Fox, Dianna McLean, Dawn Ross

Mental Health and Addictions

The Associate Directors of Mental Health Nursing and Te Pou are collaborating on a Safe Practice Effective Communication (SPEC) Programme. This involves a nationally consistent approach to de-escalation and restraint minimisation training that is based on best practice evidence. See Te Pou’s website for the evidence that underpins this programme.

www.tepou.co.nz/initiatives/seclusion-prevention-and-reduction/177
www.tepou.co.nz/initiatives/reducing-seclusion-and-restraint/102
www.tepou.co.nz/initiatives/the-six-core-strategies-checklist/105

This initiative is a good example of clinical nursing leadership and collaboration across DHB. The forum in November brought together leaders, trainers, consumers, Māori, families, the Ministry of Health and Te Pou, from across the country to work together to set up a governance group and a way forward. Governance will ensure all DHBs will have ongoing access to contemporary best practice training, with appropriate validation and modification processes and structures.

Many people made a valuable contribution to the forum with Cathy King being awarded ‘most valuable person’ for her organisational skill. Jason Edkins (Lead Trainer, Southern Mental Health Service (SMHS)), Kathy Moore (Lead Trainer Counties Manukau Health ) and Dean Rangihuna (Consumer Trainer SMHS ) and Michelle Atkinson (CMH) presented the trainer perspective and were instrumental in the success of the forum. Other speakers included Dr Peri Renison (on behalf of National CD/GM), Tony Farrow and Stu Bigwood (SMHS), Lois Boyd from Te Pou, Anne Brebner from CMH and Jeff Hammond from Whanganui DHB. Henare and the team from Te Korowai welcomed the guests, supported all presenters, and set the scene for a very successful and productive couple of days. Jane Bodkin attended and is supporting this work on behalf of the Ministry.

Kathy Moore (Lead SPEC Trainer Counties Manukau Health) cuts the cake with Dean Rangihuna (Consumer Trainer) and Dr John Crawshaw (Director of Mental Health) [right to left].