December 2016 ISSN 2423-0561

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:

1. 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.

2. 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.

3. 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].

We hope you have a relaxing and enjoyable summer. Don't

forget to stay SunSmart. Use the Health Promotion Agency’s

Sun Protection Alert to check the recommended time in your

area to be SunSmart. In 2017 the Health Promotion Agency’s

plans to release a free on-line Skin Cancer Prevention and Early

Detection module for nurses.

It has been a busy and fruitful year. We have really enjoyed

working with you all. Thank you for your continued hard work

and enthusiasm - you are inspiring.

We wish you a safe and joyful Christmas,

Jane and the nursing team.

We are always keen to hear from you. Contact andrea_tamahaga@moh.govt.nz to get in touch

with Jane or any of the team. We’d love to know if:

you would like more information about anything discussed in this newsletter

there is something particular you would like us to include in our next newsletter

you have any feedback about the newsletter.

Ministry of Health

133 Molesworth Street, Thorndon

Wellington, 6140

New Zealand

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