NZNO International Nurses Day

Thank you for inviting me here again this year to celebrate International Nurses Day, which is tomorrow. 

It is always a pleasure to take time to recognise the important contribution that nurses make to the health of New Zealanders. 

State of nursing in New Zealand

Nurses are hugely valuable and respected workers in our health system.  According to the Nursing council there are just on 46,000 nurses currently practising in New Zealand.

That's an increase of around 1,000 nurses on last year.

Nurse graduate numbers are also increasing.  Last year, we had a six percent increase in the registration of new nurse graduates[2]. 

That is encouraging but we still face a workforce shortage - which is projected to worsen as baby boomer nurses retire and become consumers of the health services they used to provide.

And it's the health workforce problem we inherited that tops the government's list of priorities.  More on this later.

Chronic care and primary care

The theme that the International Council of Nurses has set for International Nurses Day this year is ‘Nurses Leading Chronic Care'. 

I'd like to firstly acknowledge Marion Guy, the former president of the NZNO, who was elected onto the board of directors of the International Council of Nurses last year. 

The Council is a federation of national nurses' associations representing nurses in more than 133 countries. 

It is an honour for New Zealand to have one of our nursing leaders hold a global leadership role such as this.

Marion's years of service to nursing were recognised in the New Year Honour's List earlier this year.

 As you know, the Council has called for a strong response from nurses to the growing burden that chronic conditions are placing on health systems worldwide.

Chronic diseases account for more than 80% of all deaths in New Zealand and, according to the National Health Committee, 70% of public sector health funds are spent on chronic disease.

These include asthma, arthritis, diabetes, chronic neck or back problems, depression, and cardiovascular disease.

Many common risk factors, such as an unhealthy diet, physical inactivity, stress, poverty, smoking, and alcohol/drug misuse can result in preventable chronic diseases. 

The human costs of preventable disease facing affected individuals and their families are substantial: 

Cancer: Cancer is the second leading cause of death in New Zealand. There are nearly 20,000 new registrations of cancer each year, with the highest rates in the middle and older age groups.

Emerging research shows that the same common risk factors of other chronic diseases (as above) are key for cancer. 

Obesity: Data suggests that one in four New Zealand adults is obese and one in three adults are overweight.

The recent "Portrait of Health" survey found no increase in obesity rates for children and Maori adults since 2002/3.

In New Zealand, obesity is defined as Body Mass Index greater than or equal to 30. Overweight is defined as BMI between 25-30.  

Diabetes: About 200,000 New Zealanders have type 2 diabetes, but only half of them have been diagnosed.

The incidence of diabetes is expected to double within the next 20 years unless effective action is taken.

In some population groups - such as Maori and Pacific People - up to 12% of people aged over 40 will currently have type 2 diabetes. 

Cardiovascular disease: CVD is a leading cause of death in New Zealand, accounting for 40% of all deaths, many preventable. 

There are other significant chronic diseases like asthma and arthritis. 
It is also important to note that prevention is a key component in a wider continuum of health service aimed at chronic diseases: prevention, early detection, self-management support, clinical treatment, and co-ordination through to end-of-life support. 

Right now, New Zealand has a piece-meal approach to the prevention and management of chronic diseases.

There's Care Plus and Diabetes Get Checked, both of which have had questions raised about their performance.

There are varying levels of success across DHBs, across and within PHOs, and even within general practices.

There's a lack of integration within primary care and between the primary and secondary sectors. 

When I visit general practices and talk to nurses there - and it is nursing that drives chronic care management - I am often told about their frustration of how the rules around Care Plus and Diabetes Get Checked and other programmes often get in the way of providing service and helping patients.

Innovative work in the management of chronic disease has been developed and implemented within various primary-care networks.

This work needs to be recognised and more effort applied to integrating it across community and hospitals.

With encouragement, the existing clinical networks of nurses and GPs in primary care have the potential to operate much more effectively than they have been allowed to in recent years. 

That is part of the push behind the recent Expressions of Interest for accelerating the Primary Health Care Strategy.

Primary care is full of ideas to improve chronic care yet is hampered by many of the rules around the various funding streams for a multiplicity of programmes.

We've asked the EOI participants to focus on improving chronic care services particularly for older New Zealanders.

Nurses have been very active in this work.

The Government has been considering amalgamating all these various funding streams in order to provide greater funding flexibility to chronic care for patients.

Such flexible funding would avoid unnecessary duplication and fragmented services, and remove barriers and bureaucracy.

It would also make the best of limited resources.  An announcement on these considerations will be made soon.

The NSW Chronic Care Collaborative has shown how clinical leadership, networking of services, and effective use of clinical information can lead to better decisions and better results for patients.

You will see significant advances in chronic care set out in the EOI plans. 

Many of the EOI proposals expand nurse-led service in order to provide more convenient and efficient service for patients - especially older New Zealanders.

And we shouldn't forget that patients should be at the centre of everything done to improve chronic care.

Patients with chronic conditions find themselves spending a lot of time dealing with a large number of health professionals at a large number of locations.

They are all repeating the same warnings to patients about managing their chronic conditions.

But as you know, for many patients life is a lot more complicated than that.

And having to travel to a myriad of locations to see the podiatrist, the diabetes nurse educator, the GP, the dietician, the smoking cessation people, or the renal specialist does make it hard for patients.

That's why the government is keen to encourage the co-location and integration of health services... because it makes it better for patients and better for care

Update: Enrolled Nursing

One of the greatest achievements in nursing this past year is the elevation of enrolled nursing.

After being pushed into the background and marginalised with an unwanted name change, enrolled nursing is back.

The Government is strongly supportive of restoring the role of enrolled nursing and has put considerable effort into encouraging change in this area.

In December, the Nursing Council announced that the scope of practise for Enrolled Nurses will be expanded. 

We want to see Enrolled Nurses taking on more skilled work and so make a broader contribution to health and disability services. 

Better support for Registered Nurses by second level nurses is required, and is the main rationale behind this change. 

Education standards have been agreed and the qualification will be a level 5 diploma on the New Zealand Qualifications Authority framework. 

Nurses registered in the existing Enrolled Nurse and Nurse Assistant scopes will have an option to transition into the new scope of practice, and the Council has agreed on a framework for transition.

The new scope of practice and qualifications will be gazetted by the end of this month I am advised. 

The Council is working with the education sector and providers to be able to start the new programme in the 2011 academic year. 

I appreciate the NZNO's support of the Government's drive for this change, and your engagement to help with a successful implementation. 

I am looking forward to meeting with, and talking to Enrolled Nurses at the National Enrolled Nurse and Nurse Assistant section conference in Dunedin at the end of June.

Update: Voluntary bonding

Nurses need to be supported so that you are at the frontline, doing the work you do best - and there need to be enough nurses on the job - and not on a flight to Australia.

That's why we introduced the voluntary bonding scheme which is now in its second year.

This time, intensive care, cardiothoracic and theatre or surgical nursing are designated as hard-to-staff. 

Graduates can pay off their student loans in full if they are willing to work in these areas for the full five years.

As of 3 May, 371 nurses who graduated in 2009 have registered their interest in joining the scheme - which is very encouraging.

Last year we accepted 684 nurses on the Scheme who had graduated in the four years between 2005 and 2008. 

Many of these nurses will now be almost halfway through their minimum three-year voluntary bonding period, and if they continue to work in the hard-to-staff specialties, they will be eligible for their first payment in 2012. 

Registrations of interest in the Voluntary Bonding Scheme in 2010 have just closed, and I am pleased to see how keen nurses are to be involved.

Update: Clinical leadership

Clinical leadership is one of the cornerstones of the Government's health policy. 

Last December, we announced the members of the National Health Board, with a strong representation from clinicians, including three of the ten Board members with nursing backgrounds. 

Clinical leadership also means supporting health professionals to have more say in the leadership and regulation of their profession. 

With this in mind, last year the Government announced a new process for nurses on the Nursing Register to elect members of the Nursing Council.

The vote turnout was heartening, particularly since it was larger than the usual voting response for, say, NZNO elections

Barriers to Innovation Project

Health workforce New Zealand is working to consolidate workforce planning and activity across the health sector.

It includes nurses Helen Pocknell from Wairarapa and Karen Roach the CEO of Northland DHB.  Under Professor Des Gorman, HWFNZ is planning to trial a number of workforce innovations.

The great bulk of their works-in-progress with respect to innovations involve nurses ... diabetes specialist, nurse colonoscopy, nurse colposcopy, nurse pre-admit clinics, nurse first assistants.  

Nursing is at the forefront of their work because of our recognition that the aging nursing workforce is one of our most pressing challenges.

As I said the baby boomers will go from providers to consumers.

Given the real shortage of nurses and the key role that you have, HWFNZ's view is that extended roles for nurses should be sensible extensions of what are core nursing skills, knowledge and experience. 

It is trite to say all future health workforce shortages can be met by nurses moving away from nursing, as nursing is valuable and essential work in itself.

Your organisation is being kept informed of these developments. They demonstrate action rather than surveying and strategising.

We want you involved and engaged in this work. That will mean your organisation should continue to demonstrate a willingness to engage and contribute.

We don't want you sitting on the sideline as a passive spectator or protector of the status quo.

Quality Improvement

Quality improvement is also a priority for the Government.  And this is a key focus for many hospital nurses.

The 'Releasing Time to Care' programme focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiency. 

It has been available to DHBs since January 2009 and involves training of staff along with on-going support from the Ministry of Health. 

To date 2106 DHB staff, have been trained in the Programme's methodology, tools and techniques. 

I visited Hutt Hospital recently and spent a couple of hours walking around talking to staff and patients.

From the emergency department to the medical wards, frontline staff shared with me their enthusiasm for improving the quality of service for patients.  And what they were doing to make theirs a safer and happier workplace.

And one ward stood out to me. We all know that many of our nursing staff had been leaving the public health service frustrated with the level of paperwork and their inability to spend more time with patients and do what they were educated to do. High staff turnover undermines quality care for patients.

Yet in the Hutt Valley, in one of the busiest wards in the hospital ... in 10 months only one nurse had left. That speaks volumes of the culture and service of that hospital and for efforts across the sector to improve quality for everyone.

At Rotorua Public Hospital nurses used Lean Thinking to improve productivity and service - with real success.

The time it took to transfer a patient from the Emergency Department to a bed in the wards reduced by one-third. Instead of three or four staff making four or so phone calls, a bed can now generally be found in one call.

That means theatre nurses now spend half the time they used to looking for and retrieving surgical equipment, meaning faster set-up and turnaround times for operations. Translated that means more patients being seen, sooner.  They are now doing more elective surgery than at any other time in Rotorua's history.

On a recent visit to Tauranga Public Hospital - I saw first hand what nurses are doing to improve patient care by improving the time they spend with patients.  

The average hospital nurse spends less than a third of his or her time working directly with patients.  The rest is spent running up and down the corridor and massaging keyboards.

But one ward tem at Tauranga Hospital had increased their patient-contact time from 32% to 57%. Needless to say the nurses seemed happier and so did the patients.

Congratulations to nurses who have and will continue to lead such productivity improvements in the health service.

Close

There is a reason why nurses are among the most trusted professionals in New Zealand. 

You are there when we need you, and our population forecasts show that we will need even more of you even more. 

This requires clinical leadership and smart thinking so that we recognise and are able to harness the best that nurses can offer.

Thank you, nurses, for all the work that you do.  Thank you also for sharing your ideas and your energy to make our health system best able to respond to the challenges, both now and into the future, that we face.

As at 31 March 2009. Nursing Council of New Zealand. Annual Report 2009.