Office of the Chief Nurse sector update

December 20151

Ngā mihi mō te Kirihimete tatou – Merry Christmas everyone!

This is our final update for 2015. We have been excited by the feedback received about the newsletters sharing our work with colleagues in nursing and health care this year. We hope you find this edition as helpful and informative as the first two. We would love to hear your thoughts on this issue – please email andrea.tamahaga@moh.govt.nz if you have any comments about this update.

The Office of the Chief Nurse (OCN) is a business unit in the Ministry of Health. As almost every activity in the Ministry has some relationship to the work of nurses, our team provides advice and leadership across the organisation. Our staff support the role of the Chief Nurse to advise the Minister of Health and work with colleagues in the Ministry and the wider health system. The office provides leadership to nursing and the broader health sector on policy, planning, delivery and evaluation of health and relevant social services.

For an overview of our work on nursing at the Ministry, visit www.health.govt.nz/our-work/nursing

Staff changes in the Office of the Chief NurseDr Kathy Glasgow joined the Office of the Chief Nurse as Senior Advisor Nursing in August 2015, replacing Dr Linda Chalmers who left for the warmer climate of Northland. Kathy has a MA (appl) in Social Science Research and proudly graduated this year with a PhD in Social Policy. In her doctoral thesis she explored the values, expectations and attitudes to ageing amongst the baby boomer cohort.

Kathy’s background in nursing includes critical care, oncology, occupational health nursing and graduate nurse education. Most recently she worked in the primary care sector as a practice manager and practice nurse. She has worked with health organisations as a policy advisor and health promoter, and as a research fellow with the NZ Institute for Research on Ageing at Victoria University.

December 2015 ISSN 2423-0561

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Kathy has an ongoing interest in sociocultural influences on wellbeing and how beliefs and values influence both individual and societal perspectives on what it means to be healthy. Kathy’s work in the office focuses on primary care, the health of older people and quality including falls and pressure area prevention.

Kathy has two adult children and lives in the beachside community of Paekakariki on the Kapiti Coast.

Our special projectStaff on the fourth floor of the Ministry building at 1 The Terrace have been treated to a nature lesson over the last several months. A pair of pigeons chose the balcony outside Chief Nurse Jane O’Malley’s office as their home. They laboriously constructed a nest from plastic cable ties, leaves and twigs, paper scraps and feathers. The pigeons have been showing how much they love each other on the balcony for months. Last year they produced two infertile eggs and then a further two hatched but the chicks suffered from some serious first time parent errors and did not survive.

This year we have watched the courtship again – there was much excitement when an egg appeared and finally hatched just after Labour weekend. Since then the nursery on the balcony has been closely observed, as the parents seem to have learned a lot more about chick rearing and have been attentive and careful with this precious baby. There was some panic recently as the window cleaners arrived through the only access to the outside of the building which happens to be a ladder half a metre from the nest. Much knocking on the window and signs pushed against the glass alerted the men to the infant in their midst.

Luckily, although Ms Pigeon took flight while the ropes were dangled around her home, she returned and junior was big enough and with enough downy feathers to survive a little while without her comforting warmth. The baby now seems to double in size each day and we will no doubt soon witness its first hair-raising attempts at flight.

You may be thinking why such concern over this pigeon chick, aren’t there enough pigeons in the world? Well I guess that is the nature of working in an office full of people concerned about the health and wellbeing of families – the progress of this little bird has been a welcome diversion on trips to the kitchen and has certainly provided a conversation starter. We have come to a consensus on his name – Le(d)ge (short for legislation of course).

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In this issue: Staff changes in the Office of the Chief Nurse New Zealand Health Strategy Ministry on the move Enabling nursing scopes of practice Nursing workforce New graduate employment Gerontology acceleration programme

Nurse practitioner education Quality safety and productivity Mental health and addictions Improving together Deteriorating patient programme

New Zealand Health StrategyThe consultation on the draft New Zealand Health Strategy closed on 4 December 2015. The strategy is on the Ministry’s website at: www.health.govt.nz/about-ministry/what-we-do/new-zealand-health-strategy-update.

The refreshed strategy is based on five interconnected themes with a central goal that all New Zealanders live well, get well and stay well:1. People powered2. Close to home3. Value and high performance4. One team5. Smart system

A Roadmap of Actions proposes a direction of travel for the next five years to support the achievement of the vision.

In addition to the formal submission process, there are a number of workshops and meetings planned with a wide range of stakeholders and audiences during the six-week consultation period.

The online discussion forum is designed for people to talk about the health subjects and issues important to them. You can find the consultation documents and read the discussion on the online forum https://futuredirection.health.govt.nz/.

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Ministry on the moveThe Ministry of Health has embarked on a change programme titled Ministry on the Move. This refers to both an organisational review to improve the function of the Ministry to provide service to the people of New Zealand, and also our pending physical move to larger, newly renovated premises in Molesworth Street, scheduled for 2017.

The key elements supporting Ministry on the Move are a strategy for the Ministry of Health and an operating model to support the achievement of the organisation’s strategic goals.

The work is largely internal at this stage.

Enabling nursing scopes of practiceThe Health Practitioners (Replacement of Statutory References to Medical Practitioners) BillThe Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill (HPSR) is an important Bill and supports our work to remove the barriers to the health workforce practising to the full extent of their knowledge and skills. The Bill is now being considered by the Health Select Committee which has been considering submissions on the Bill.

You can read the Bill at http://legislation.govt.nz/bill/government/2015/0036/latest/DLM6514118.html?src=qs

There were 28 submissions from nursing, medical and allied health organisations and individuals. Oral submissions were heard early in October. You can read submissions here:www.parliament.nz/en-nz/pb/sc/documents/evidence?custom=00dbhoh_bill63296_1

Alison Hussey in our office has been working closely with Mary Louise Hannah from Health Workforce New Zealand, the team at Health Legal and the Parliamentary Counsel Office to prepare the Departmental Report for the Committee with the Ministry’s response and advice to the Committee on the submissions. Jane O’Malley, Ruth Anderson (Health Workforce NZ) and Don Mackie (Chief Medical Officer) have been fronting the presentations and discussions with the Select Committee, showing support across the Ministry and from medicine. The Committee will consider the advice before recommending any changes to the Bill before it is redrafted for its second reading in Parliament.

Registered nurse prescribingWork on registered nurse designated prescribing in primary care and specialty teams is progressing through the machinery of Government.

The proposal for regulations allowing registered nurse designated prescribing was heard by the Cabinet Social Policy Committee on 4 November. Cabinet has given approval for

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drafting instructions for new Regulations which will now be sent to the Parliamentary Counsel Office.

ACC levy for self-employed nurse practitionersAll self-employed people in New Zealand are required to pay a levy to the Accident Compensation Corporation which is assessed based on their level of risk of having an accident. This year we became aware that because there is no code specifically for nurse practitioners they were being levied at the same rate as registered nurses, a group known to have high rates of workplace injuries, mainly to their backs. ACC has recognised the work of self-employed nurse practitioners is likely to be considerably different to registered nurses and in the meantime have allocated a risk or occupational Classification Unit (CU) with a lower levy to nurse practitioners.

As an interim measure, nurse practitioners should use the code 86390 Allied Health Services (not elsewhere classified). While this may not be the best fit in the long term for nurse practitioners (dependent on further analysis), it does result in a significant decrease in levy rates from the previously applicable CU ($0.18 as opposed to $0.84 per $100).

Standing OrdersThe Minister has agreed to the Ministry progressing an amendment to the Medicines (Standing Orders) Regulations to enable nurse practitioners to issue Standing Orders ahead of the development of the new regulatory regime for therapeutic products and the associated legislation to improve access to medicines (see information below).

The Ministry has undertaken a targeted consultation (closed 24 November) with regulatory authorities and professional associations of each authorised prescriber group.

The submissions are being analysed before we progress to the next stage of the work which will be a proposal for amending the Regulation to the Cabinet Social Policy Committee in the New Year.

Review of the Therapeutic Products Regulatory RegimeThe New Zealand Government is working on a new and comprehensive legislative regime to regulate therapeutic products in New Zealand, which will replace the Medicines Act 1981 and its Regulations. This follows the cessation of the Australia New Zealand Therapeutic Products Agency (ANZTPA) project.

As well as replacing and modernising the regulatory arrangements for medicines, the new regime will provide regulation of all therapeutic products. This includes medical devices and cell and tissue therapies which are currently not adequately regulated in New Zealand.

Therapeutic product is an umbrella term for products intended to be used in or on human beings for a therapeutic purpose. Therapeutic purpose is defined in Section 4 of the Medicines Act 1981. Examples of therapeutic purpose include bringing about a physiological response to prevent, diagnose, monitor, alleviate, treat, or cure a disease, ailment, defect, or injury.

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The new regime will be flexible enough to ensure effective control over the quickly evolving technology used in therapeutic products, while also being as efficient and cost-effective as possible.

The new regulatory regime will also look to align with international standards where appropriate, and uphold the quality of regulation currently carried out by the Ministry of Health. This will help to: assure the safety of products used in health care delivery in New Zealand, and secure New Zealand producers a positive position in the global marketplace.

Timeframes and processThere will be a range of opportunities and methods for the public and sector to inform this process. As part of this work, a paper that outlines some options for changes to the prescribing, supply and administration of medicines in New Zealand will be released to the sector for early feedback during November 2015.

Additional initial consultation on prescribing will occur through December and January.

An exposure draft of a Therapeutics Products Bill will be released for public consultation in mid-2016. This process enables an early draft of the Bill to be improved, based on public and stakeholder feedback, ahead of the Bill’s introduction to Parliament.

The Bill is expected to be introduced to Parliament at the end of 2016, and will then pass through the parliamentary process, becoming the Therapeutic Products Act in 2017. Development of the regulatory detail to support a new Therapeutics Act will be ongoing throughout 2016 and we will continue to engage with stakeholders during this time.

Keep an eye on the Ministry website, for updates on the project.

Please feel free to share this information with colleagues or members of your organisation.

If you would like to know more about this project, please contact the policy team working on the therapeutic products review on: therapeuticproducts@moh.govt.nz.

Nursing workforceThe Nursing Workforce Taskforce, established by Health Workforce New Zealand (Health Workforce NZ), met for the fourth time on 29 August 2015. Dr Jane O’Malley and Dr Ruth Anderson are co-sponsors for this work and Dr Jenny Carryer chairs the group. Dr Paul Watson reports that the group agreed the following key messages: Models of care need significant change to achieve equitable health outcomes for all New

Zealanders. Iwi engagement, whakapapa connections, Māori leadership and local champions will be

important approaches in the development of the Māori nursing workforce project. There is merit in reducing New Zealand’s reliance on internationally qualified nurses. Postgraduate nursing funding is an important means of developing the nursing workforce

to meet changing population health needs.

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The Ministry of Health’s investment in growing Pacific nursing leadership has been crucial to supporting the development of the Pacific health workforce.

Championing the importance and visibility of the nurse practitioner role.

Māori nursing workforceThe nursing workforce programme has begun work on developing a high-level project brief related to the Māori nursing workforce. Once developed, the Taskforce will give further reconsideration to priorities for action and those key stakeholders that need to contribute to achieving the agreed objectives.

Over the past two decades, significant efforts have been made to grow the Māori nursing workforce. The table below shows the gains made in Māori participation in the nursing workforce since nursing ethnicity was first recorded in 1994. Over the last 21 years the annual rate of growth in Māori nurses was 16 percent compared with 4 percent for all nurses. This equates to an average increase of 127 Māori nurses per annum.

Growth of the Māori nursing workforce 1994–20151

1994 1998 2010 2013 2015

Māori nurses 780 955 2,858 3,279 3,448

Total nurses 28,122 31,869 45,526 47,751 52,729

% of Māori nurses 1.1% 1.9% 6.3% 6.9% 6.5%

However there is still a significant gap between the proportion of Māori in the nursing workforce and the proportion of Māori in the population (see table below).

1 In 1994 nurses were asked to identify which ethnicity they most closely identified with. This may have had the effect of underestimating the number of Māori nurses. In 1996 the question was revised in line with census data collection were able to identify up to three ethnicities they identify with.

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New graduate employmentOver the last four years, since the introduction of the national ACE system for recruiting new graduate registered nurses, we have seen reasonably consistent patterns of employment. Approximately 50 percent of graduates gain employment before they know the outcome of the Nursing Council State Exam. Twelve months after graduating 2–3 percent are still actively seeking work through the ACE system. This shows that employers are continuing to recruit new graduates throughout the year as vacancies arise. This year during the end-of-year recruitment round: 1451 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

of those 735 (51 percent) were known to be employed as at 13 November 2015 1245 were graduates from November 2015; of those 677 (54 percent) were employed as at

13 November 2015 the other 206 applicants had applied in earlier recruitment rounds 12 months after becoming registered nurses 42 (3 percent) of the 1286 November 2014

graduates who applied through ACE are still actively seeking work through ACE.

More often than not Māori and Pacific graduates are employed at slightly higher proportions than non-Māori and non-Pacific. In the November 2015 recruitment approximately 54 percent of Māori applicants and 53 percent of Pacific applicants are known to be employed compared with 50 percent of non-Māori and non-Pacific respectively.

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Given that Māori and Pacific nurses are significantly under-represented in the nursing workforce, the employment rates for new graduate nurses who are Māori or Pacific should help a little in having a nursing workforce that better reflects the ethnic make-up of the New Zealand population.

For the last four years surgery, medical, and mental health and addictions, in that order, have been the top three choices for graduates’ preferred practice settings. For the last two years primary health care has been the fourth most preferred practice setting. Graduates who prefer to work in mental health and addiction have the highest chance of gaining employment. As the nursing workforce in New Zealand and most of the world is ageing, it is important that we replace as much as possible of our existing turnover with New Zealand educated new graduates. This will help ensure a sustainable workforce in the future that better reflects the New Zealand population.

Out and about with the Chief Nurse

One of the things our office is responsible for is meeting and working with our nursing colleagues in the sector. We learn so much that helps with our work from nurse leaders and nurses working in various practice areas, who help us understand the issues and implications for policy development. We all get out and about, but Jane O’Malley is the most frequently photographed on her visits. Here is a selection of shots from Jane’s travels in November.

Jane attended a celebration to mark the end of the Gerontology Acceleration Programme (GAP) in Canterbury in early November. The final evaluation of the programme is now available on the Ministry of Health website at www.health.govt.nz/publication/gerontology-acceleration-programme-gap-evaluation-report. The Evaluation concluded the GAP programme added significant value to the sector and nurses working within it, and has the potential to be replicated within other areas of nursing and across the country in other DHBs.

Graduates at the GAP ceremony in Christchurch, November 2015, with Dr Jane O’Malley.

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Jane also visited the Midlands Health Network in November, pictured with Jane are Maoitel LowenKoratika Tuban, Valentine Ronolea, Rachel Fata, Savaira Vuidreketi.

Jane was in Tairawhiti recently and visited the satellite dialysis unit. Gilbert Go in the unit has designed and lead audits to improve the quality of care provided in the unit. On the day Jane visited, Gilbert was able to explain the audits he has been working on for Knowing How We are Doing (KHWD) and show

Jane the results and information board.

Jane is pictured with Gilbert Go, Tracy Low from the Satellite Dialysis Unit and Director of Nursing at Tairawhiti DHB, Sonia Gamblen

Sonia Gamblen, Sue Cranston and Jane pictured at Planet Sunshine, the paediatric ward Tairawhiti DHB.

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Nurse practitioner educationIn 2016 Health Workforce New Zealand will fund an initial cohort of 20 nurse practitioner candidates to enter a revised nurse practitioner education programme. Delivered by the University of Auckland and Massey University, the revised programme offers more targeted clinical supervision hours with paid backfill in the candidate’s usual role on two days each week for the year of the programme for each candidate. There are requirements for employer sponsorship and graduate job security. The potential to align and streamline the registration process for nurse practitioners will be looked at as part of the programme.

Applications for places on the programme have now closed. The 53 applications received demonstrated good support from employers interested in developing nurse practitioner roles.

CYF modernisationThe Expert Advisory Panel (EAP) appointed to review the operation of Child Youth and Family has released its preliminary report.

You can access the report at www.msd.govt.nz/documents/about-msd-and-our-work/work-programmes/cyf-modernisation/interim-report-expert-panel.pdf

Alison Hussey was the nursing/health member of the Practice Reference Group appointed to advise the EAP. The Practice Reference Group provided advice on matters relating to the practice model for referral, intake and for children in care.

The Practice Reference Group met four times and the EAP is progressing towards delivery of a final report to Minister Tolley by the end of the year.

Quality, safety and productivityPressure injuryThe Ministry, ACC and the Health Quality and Safety Commission (HQSC) have agreed in principle on the need for a national pressure injury reduction programme. The three agencies plan to work with provider groups in order to develop an implementation plan.

The three agencies are working with the New Zealand Wound Care Society to provide pressure injury resources to the sector for Stop Pressure Injury Day on 19 November.

FallsDr Paul Watson has been contributing to the HQSC reducing harm from falls expert advisory group. The outcome marker in hospital falls with a fractured neck of femur has seen, for the first time in five years, a ‘shift’ down in incidents in the seven months following December 2014.

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Mental health and addictions Developing a Mental Health and Addictions Workforce Plan is an action from Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012–2017 (published by the Ministry of Health in 2012). Allen + Clarke have been commissioned to undertake this work. A draft Plan will be out for sector consultation shortly. Once complete, the Plan will inform Health Workforce New Zealand’s investment in the mental health workforce in the future. Jane Bodkin is on the Ministry reference group working with Allen + Clarke to produce the draft Plan and the ongoing development of the document.

The Commissioning Framework for Mental Health and Addiction describes the key components of the commissioning process and provides a national approach to support better outcomes for mental health and addiction. A draft is currently out for consultation and there are many opportunities for feedback through national, regional and local consultation, workshops and forums as well as by written submission. See: www.health.govt.nz/about-ministry/consultation

Check out Jane Bodkin’s column in Handover, the mental health and addiction nursing newsletter on the Te Pou website www.tepou.co.nz/uploads/files/resource-assets/Handover-Oct2015-WEB.pdf

Health data available onlineThe Ministry of Health website www.health.govt.nz offers lots of information about health and wellbeing in New Zealand from data and analysis, reports and publications, health information to the various teams and activities at the Ministry.

You might be interested to learn more about health status and health outcomes for New Zealanders. You could visit www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/surveys/current-recent-surveys/new-zealand-health-survey#2014-15 to access data and analysis from the National Health Survey.

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Or find out more about Māori health status by DHB: www.health.govt.nz/publication/dhb-maori-health-profiles

Or go to www.health.govt.nz/publication/tatau-kahukura-maori-health-chart-book-2015-3rd-edition to read Tatau Kahukura: Māori Health Chart Book 2015 (3rd edition) which presents a snapshot of the health of Māori compared with non-Māori. The chart book presents key indicators relating to the socioeconomic determinants of health, risk and protective factors for health, health status, health service use and the health system.

Improving togetherImproving Together is a new cross-agency initiative to support quality improvement in service delivery across the social sector. The Improving Together website http://improvementmethodology.govt.nz/ is an online introduction to quality improvement, including e-learning modules, case studies and other tools and resources that can be used to find simple solutions to work problems faced every day.

Being part of Improving Together means you are part of a national approach to making social services in New Zealand better. Social sector agencies, including the Ministries of Health, Education, Social Development and Health Quality & Safety Commission of New Zealand have worked together to develop Improving Together. Improving Together is part of the wider approach across government services to improve the way they work.

The e-learning modules and tools are a good addition to district health boards’ existing improvement methodology resources. The tools and resources support alignment of national and local quality improvement programmes and initiatives.

A panel of suppliers is available to provide advice on improvement methodology, formal training and project support. Information on how to access these services is available from the Ministries of Health, Education, Social Development and Health Quality & Safety Commission procurement teams.

And finallyOur very best wishes for the festive season.

We look forward to working with you in 2016.

Paul Watson Kathy Glasgow Andrea Tamahaga

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Jane Bodkin Alison Hussey Jane O’Malley