Speech to College of Emergency Nurses annual conference, Wellington

Introduction

Thank you for inviting me here today to open the annual College of Emergency Nurses Conference.

I’d like to acknowledge Libby Haskell, nurse practitioner and College chair, and Professor Michael Buist, Intensive Care Unit Director at Tasmania’s North West Regional Hospital who is the guest speaker today.

It’s great to be part of your conference. You have chosen a highly relevant and important theme in ‘Craft Care’ - exploring quality and safety in delivering emergency nursing care.

Nursing contribution

As the largest and often the most visible workforce, nurses are the cornerstone of our health system.

Emergency nurses have a vital and unique role in delivering acute healthcare. You are on the frontline of our health services, often seeing patients and families at their most vulnerable.

Your role in triaging people’s acuity is a skilled and crucial aspect to emergency care. In addition, as practitioners meeting many people with preventable illnesses you also have opportunities for promoting health and wellbeing.

Strong clinical leadership is important. Nurses make a significant contribution to clinical leadership as part of the healthcare team. I want to see more clinical leadership across the system.

We all know that the work of ED teams and their role at the front door of the hospital can lead the culture of the wider hospital. We know that EDs only work well when the rest of the hospital is working well too.

I’d like to take this opportunity to thank you for your contribution to improving health outcomes for New Zealanders. I know it has been a very busy and demanding winter season with high presentation rates in ED.

Overview

I’d like to start with an update on the sector. I believe our health sector is in good shape. The feedback I’ve been getting on my travels around the country is that although there are still challenges, we’re heading in the right direction.

My first year overseeing health has required swift, clear decisions to deal with some long standing issues – such as HBL and Southern DHB.

Delivering better health services is a top priority for this Government. In the tightest of budgets we obtained $400 million extra to grow health services this year. Health received the largest share of new funding in Budget 2015 - $15.9 billion.

We’re investing around $1.7 billion over the next four years for new initiatives and to meet cost pressures and population growth. This includes more funding for elective surgery, palliative care, and free doctors’ visits for children aged under 13.

Priorities

In terms of key priorities, I want to see a greater focus on prevention and earlier intervention. This includes early access for people who need healthcare.

We extended free GP visits and prescriptions to children under 13, benefiting over 750,000 children and their families. Uptake has exceeded expectations with 98 per cent of general practices across the country now opted into the scheme.

I’ve made it clear to DHBs that I expect more services to be delivered in the community. We need to continue to change the way healthcare is delivered, with more people getting the care they need away from hospitals.

I want to see continued progress on NCDs. Our largest health burden stems from people suffering from chronic conditions. Tackling obesity, particularly childhood obesity, is another key area I’m focused on.

We need to make the best use of technology. E-health offers better, safer, more efficient healthcare.

We need to make the best use of the skills and knowledge of our workforce. This includes enabling nurses to work to the full breadth of their scope in all three scopes - enrolled nurses, registered nurses and nurse practitioners.

The refresh of the New Zealand Health Strategy is underway. This will set the vision and road map for the next three to five years for the sector. We need a clear, unified direction based on a shared set of values.

Health targets

Health targets continue to be a focus. They are not just about numbers – they are about delivering better, faster access to services.

We have record performance on our targets. Since 2008 we have delivered 50,000 more elective surgeries, and 93 per cent of children are immunised, up from 67 per cent.

ED target

Thank you all for the effort you and your colleagues have put into the shorter stays in ED health target.

When the target was introduced in 2009, 80 per cent of patients were admitted, discharged or transferred from the ED within six hours. Today, 95 per cent of patients are being admitted, discharged or transferred within six hours.

This has been achieved despite increasing numbers of ED presentations. It is a considerable achievement and is due to the commitment and hard work of emergency nurses and doctors.

Family violence, alcohol & smoking screening

I know that EDs are busy places and you need to balance your responsibilities to manage acute presentations with promoting wellbeing.

Your patients are some of the most vulnerable people in our community. Brief interventions, including alcohol and family violence screening at times when people interact with the health system, can help enable people to get the support they need.

Protecting vulnerable children is a Government priority. ED is a place where vigilance and understanding the signs of abuse could mean improving outcomes for children.

I know that you also take the time to identify smokers and give them support. This is important as smoking prevalence has been shown to be higher among patients accessing the ED than in the general population.

Suicide Prevention

EDs also play an important role in identifying people at risk of suicide. ED staff see some people who are presenting to health services for the first time with a mental health problem.

Suicide is a serious issue for our communities. Around 500 people take their own lives each year. While there is some evidence that suicide rates have declined over time, rates remain too high, particularly for youth, Maori and Pacific communities.

Reducing suicide requires a coordinated range of actions such as enhancing community resilience, promoting mental health and improving the care for those most at risk.

The Ministry is about to publish updated guidance for EDs on preventing suicide. I know that emergency nurses have been involved in developing this guidance and that it will provide up to date information on caring for people at risk.

Quality Framework

Quality and safety are fundamentals in our health system.

Nurses have a responsibility to advocate for patients and report safety and quality concerns. You are also well placed to take a leadership role in activities to assure safety and improve quality.

I know that tomorrow you will be discussing Quality Framework and Suite of Quality Measures for the ED Phase of Acute Patient Care. All of you will be involved in implementing this framework.  This framework will help you to understand and improve the quality of the care you and your colleagues provide.

Nursing workforce

It was great to see the MECA settlement ratified. I think it’s a responsible and constructive outcome - it is affordable, and it is at a time of low inflation. The deal will benefit around 30,000 nurses, midwives and health care assistants across 20 DHBs.

I want to acknowledge how it’s been a positive agreement which reflects the constructive approach to bargaining from both sides.

Growing the workforce

We are continuing to grow the nursing workforce.

There were 52,729 nurses with annual practising certificates registered with the Nursing Council of New Zealand as of 31 March 2015. This represents an increase of 6,764 since 2009

Approximately 1,800 registered nurses are graduating each year, that’s around 600 more than prior to 2010.

New graduate nurses are helping to replace our ageing nursing workforce, keep up with the demand of our growing and ageing population, and reduce our dependence on internationally qualified nurses.

The Ministry is working with Directors of Nursing and nurse leaders in aged care, community and primary care to support the employment of new graduate nurses in these priority settings.

The Advanced Choice of Employment (ACE) system has made it easier for employers to recruit new graduates and provides us with valuable data about employment patterns.

Working to the full extent of scope of practice

Part of providing care closer to home includes harnessing the full potential of our workforce. We are committed to making the best use of nurses’ skills and experience across all three scopes of practice.

I know there are highly skilled and experienced nurses working in our EDs. It is important to ensure there are no barriers to these practitioners working to the full extent of their knowledge and skills.

I have agreed to officials progressing an application to allow appropriately skilled and educated nurses in primary care and specialty teams to practice as designated prescribers.

It is also important to support nurse practitioners and to grow this workforce. Models of care where nurse practitioners provide very advanced nursing care have been shown to have many advantages.

Next year Health Workforce New Zealand will be funding an initial cohort of 20 nurse practitioner candidates in a trial of a revised education programme run by the University of Auckland and Massey University.

Closing Remarks

I want to assure you that the Government is committed to providing high quality health services for New Zealanders.

I am confident that together we can meet the challenges we face by working as a team and making the most of the skills and knowledge of the workforce.

Enjoy your conference. I hope you will return to your work places with new knowledge to enhance your practice.