Conference provides launching pad for new primary health care college: primary health care is facing major change and change was the theme of NZINO's primary health care conference in Auckland last month, attended by close to 400 primary health care nurses.
|Article Type:||Conference notes|
Primary health care
(Conferences, meetings and seminars)
Nurses (Conferences, meetings and seminars)
|Publication:||Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032|
|Issue:||Date: July, 2010 Source Volume: 16 Source Issue: 6|
|Product:||Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners|
|Organization:||Organization: New Zealand Nurses Organisation|
|Geographic:||Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand|
Funding streams for primary health care (PHC) nurses and nurse practitioners, cuts to frontline health services, the fate of Te Rau Kokiri (TRK), the campaign for pay equity for Maori and iwi health workers, and the need for Health Minister Tony Ryall to engage with the new PHC nurses' college, were among the concerns raised by conference delegates with National MP and member of the Health Select Committee, Jackie Blue, after her opening conference address.
Blue's speech canvassed how the government would achieve better, sooner, more convenient health services, including the expressions of interest (EoI) in PHC, the government's commitment to clinical leadership, and the establishment of the National Health Board, which had three members with nursing backgrounds, and Health Workforce New Zealand. "We need nurses' involvement more than ever in the changes that are underway," she said.
She said nurses would be the drivers of chronic care in a strong PHC system. The EoIs would be clinically led, with patient needs at the forefront and with more nurse-led clnics. "Now is the time for clinical leadership and empowering people in the front fine. Primary health care is about delivering health care that can meet demand. We are looking forward to working with your new organisation [the college of PHC nurses]", Blue said.
Former NZNO president and practice nurse Marion Guy said PHC nurses were poised to deliver better, sooner, more convenient health services but were restricted by funding structures. "We are training nurse practitioners (NPs) but can't fund them. Is the government looking at ways funding can be released to acknowledge nurses for what they do? We are restricted due to funding mechanisms. Are there any plans to change that?" she asked.
Chair of the College of Practice Nurses NZNO, Rachael Claverely, referring to the government's commitment to clinical leadership, asked if the Minister would be advocating for nursing leadership and an audible nursing voice within the Ministry of Health. "We ask that Tony Ryall strategically and positively engage with the College of PHC nurses and hear us at a strategic level." Her comments were greeted with applause.
A former chair of the college of practice nurses, Debbie Davies, asked conference delegates who were the subject of reviews and frontline service cuts to nursing staff to raise their hands and a forest of hands went up. "We were promised there would be no cuts for frontline services or frontline staff. The Minister needs to hear that there are frontline cuts and they are primarily affecting nursing."
Hamilton practice nurse Sharon Colville asked why the Ministry's chief nurse role did not report directly to the Director General of Health, as did the chief medical adviser.
Tairawhiti NP Dianne Williams reiterated that the lack of funding streams was a barrier to NPs and the Ministry of Health was well aware of that. "There is a big body of knowledge in the Ministry that knows these barriers," she said.
In response to a question about TRK, Blue said "severe fiscal restraints" was one of the issues but she urged the new college to keep on talking about the issue. "Lobbying makes the world go round."
Close to 400 delegates attended the three-day conference, the theme of which was Changing Face: Revolutionising the face of primary health care. Speaking after the conference, chair of the organising committee, former practice nurse and now a Plunket nurse, Lorraine Hogan, said she was thrilled with the numbers attending and felt the conference format worked well. "The feedback so far has been very positive."
There were five main speakers, 11 breakout sessions, and dose to 40 abstract speakers.
On the first day, one of the main speakers, Waitemata District Health Board NP in aged care, Michal Boyd, said the PHC strategy had redesigned the system "but we are still going through that paradigm shift". There had been a move from an individual care focus to a more population-based focus, from a provider focus to a more community and people focus and from providers working alone to more of a team focus. There were now more nurse-led clinics which was very exciting and Boyd said long-term condition management was what nurses were called to do. "It is about relationship and that's what we are really good at."
Autonomy, mastery and purpose
In her presentation, Creativity and a common purpose: What really motivates teams, she referred to the "inertia we struggle with" in trying to motivate teams to do things differently. Motivation depended on autonomy, mastery and purpose. The people who knew best what needed to be changed were those who were doing it every day. But it was important to evaluate the possibility of success. "Don't bloody your head on the brick wall," she warned.
Mastery was the urge to get better and better at something that matters and purpose was a yearning to do what we do in the service of something bigger than ourselves.
"Carrots and sticks don't work. Research has shown that they extinguish motivation, crush creativity, crowd out good behaviours, as well as encourage unethical behaviour and, at worst, addiction."
Nurses who felt empowered had challenging work which utilised their skills. Those who were unempowered had a tendency towards oppressive behaviour which led to horizontal violence.
The more ability a group had to determine their autonomy, the more productive they actually were, Boyd said.
The New Zealand College of Primary Health Care Nurses NZNO has been born. After a gestation period of some years, some complications during labour and with the Primary Health Care Nurses' Advisory Council, which guided the development of the college, as midwife, the birth was witnessed by around 350 delegates attending the first day of the PHC nurses' conference in Auckland last month.
The inaugural annual general meeting (AGM) was co-chaired by NZNO president Nano Tunnicliff and Te Runanga o Aotearoa NZNO tumu whakarae Paulette Taylor.
Chair of the advisory council, Karyn Sangster, said one of the catalysts for the college was the need for a strong, united PHC nursing voice, particularly in dealing with the Ministry of Health. A hui in January last year, attended by 38 section and college representatives, was a significant step, as was NZNO's board of directors mandating the council to develop a model for the college. This had been a whole team effort and Sangster paid tribute to the chairs of the college of practice nurses and the district nurses and public health nurses' sections for their "hugely important roles" in bringing the college to fruition. She referred to the fact 81 nurses had been nominated for the 37 positions in the new college structure and that 25 percent of PHC members had voted. "This is a higher rate of engagement and activism than in other parts of the organisation," she said.
She read an email from the chair of the inaugural advisory council Chiquita Hansen, who was overseas, which said the launch of the college was a "fantastic occasion" and a vision shared by many nurses over the years.
Each member of the advisory council spoke briefly on the challenges of helping establish the college. Sangster said, as a district nurse, a key challenge was to keep the district nursing role visible, but the vision of establishing the new college had kept everybody going.
Each advisory council member placed a symbolic gift in a kete to the incoming college executive committee.
A former chair of the college of practice nurses Debbie Davies spoke of the significant work of the council and placed a stone in the kete to represent "trust in the kaupapa as we move forward together."
Erin Beatson of the Children and Young Persons of Aotearoa Section said the advisory council had achieved a shared vision of PHC nursing practice. "It is PHC that ensures the best start for every child and our gift is of new beginnings for children and for the college."
Public health nurses' (PHN) representative Rosemary Edlin said a significant challenge for PHNs was to ensure their voice was not lost in the new college and to maintain links with child family and youth health in schools. The college enabled a strong voice and increased representation for PHNs. Their gift was that the new college would continue to hear people's stories.
Rural nurse Leonie Howie said rural nurses were pleased to be part of the college as they didn't fit smoothly into existing sections and colleges. Rural nurses gifted wisdom to the kete, symbolised by three stone-fired pebbles representing memory, inspiration and growth, or the past, present and future.
Te Runanga o Aotearoa NZNO representative Brenda Close said she had been the Te Runanga representative on the advisory council since its inception. The challenge had been to have a collective voice for Maori. "This partnership with college and section members has been important in the creation of kotahitangi, of unity."
Iwi representative Marie Noa presented a whakaatauki for the kete--Ko tae rangatira mai matou, No reira kona e koutou e hoki muri. We have arrived this for with honour, therefore don't go backwards.
Davies presented the financial report. Expected income for the 2010/2011 year was $217,494, from the financial reserves of the district nurses' and PHN sections and the college of practice nurses and from Levies to be collected. The estimated expenditure for the year was $172,311, leaving a surplus of $45,183. A full set of financial accounts would be available at the 2011 annual general meeting. The delegates approved the financial report, along with the official name of the college and its logo. The logo was blessed and sanctioned by Nga Puhi and Ngati Whatua kaumatua Dennis Hansen, who praised the coming together of different groups to work in unity.
After some debate, delegates also voted in favour of a $25 annual levy, $15 of which would support the production of the college journal and $10 to support regional college forums.
NZNO professional nursing adviser Angela Clark, who has played a pivotal role in the college development, said it was the culmination of a lot of hard work. The college represented 1917 nurses who had "risen to the challenge from the Ministry of Health to have one professional body representing all nurses within PHC."
Clark paid tribute to the advisory council Davies presented a high-level annual plan modelled on NZNO's leadership, membership, organisational and social strategic goals.
The college has a nine-strong executive committee and four other committees: clinical practice; education; policy and communication; and research. The college covers practice, district, public health, iwi and Maori health provider, rural, sexual health, Family Planning and children and young people's nurses.
Wrapping up the inaugural AGM, Tunnicliff said PHC nurses now had one very loud voice. "And with one loud voice nurses can direct policy and change the health system."
|Gale Copyright:||Copyright 2010 Gale, Cengage Learning. All rights reserved.|