EDITORIAL
Vol. 21 No. 3 November 2005
The end of the year is a time for report cards and prize givings. A time to review progress to date and to acknowledge achievements. This year, 2005, has been a year of significant milestones, most of which are the culmination of previous hard work and sustained effort. Media coverage of nursing has highlighted that not every grade has been an “A”, and continued endeavour will be required in many areas. However it is timely to acknowledge how far nursing has come and our successes to date.
The implementation of Nurse Practitioner prescribing has been a long and hard fought battle. The first consultation paper on nurse prescribing was in 1997, and the Medicines Act (1985) was amended in 1999. Yet it has taken until this year for implementation.
Professional boundaries have been a major barrier to nurses making progress with this issue. As this is being written the New Zealand Medical Journal has published an editorial (Moller & Begg, 2005) challenging the safety of nurse prescribing and calling for “dependent” rather than independent prescribing. What the public received from the media were headlines and bulletins that questioned the safety of nurse prescribing.
Neither the editorial nor the media reporting commented on the transparent and rigorous process required to become a designated prescriber. These conditions include passing an approved programme and being assessed against specific prescribing competencies, after having achieved nurse practitioner status. While the fears of both the public and our medical colleagues will need to be considered by the pioneers in this area, the international research evidence is clear about the benefits of nurse prescribing and that greater, not lesser, teamwork is an outcome.
With the first year anniversary of the implementation of the Health Practitioners Competence Assurance (HPCA) Act (2003) it is clear that the processes around nursing are robust and above or equal to those of other health professions. Many nurses will be surprised to learn that some other professions listed under the Act have yet to identify their criteria for measuring competence. Most are aware that it is nursing language (i.e. scopes of practice) that dominates the Act and I note it is nursing definitions and previous rulings that are being used by the Health Practitioners Disciplinary Tribunal.
Nursing continues to be hard on itself, with people over assessing and, if anything, asking for much greater amounts of evidence than are usually required. It is pleasing to see that research has surrounded the changes related to the introduction of the HPCA (2003), and that Nursing Council of New Zealand (NCNZ) is reporting these findings to the profession.
For many, a major highlight on the report card has been the progressive salary adjustments within the District Health Boards (DHBs) and the negotiations to translate these to the private sector. Appropriate financial remuneration is very important, not least to address the crisis of recruitment and retention. To this end it was pleasing to see the long overdue publicity campaign being implemented to attract new people into nursing and to encourage nurses back into the workforce. People today have many options for employment and nursing does not “sell” itself well. We now have clear career pathways, excellence and expertise recognised in the form of nurse practitioner status and better remuneration, yet the people who should be selling nursing as a career choice, are often the people putting it down. National Radio did an interview on the launch of the campaign and nurses who sent follow up comment were overwhelmingly complaining, highlighting workload, stress, poor financial remuneration and powerlessness. While I acknowledge that it is tough out here and that we still have a lot of work to do, publicly denigrating nursing is both unprofessional and the worst way to win the much needed future nurses who will help alleviate some of the stress.
New graduate programmes, a constructive step towards fostering and supporting the future members of the profession, have to date had no national consistency between programmes and the extension to the primary care setting has been slow. National consistency has now been developed for programmes such as professional development recognition programmes (PDRP), with NCNZ developing a framework to accredit such programmes. So it is positive that the previous Labour government pledged $800, 000 to establish a national new graduate programme under Clinical Training Agency (CTA) funding. A framework for consistency is being developed and equal funding will be given to approved programmes, with some money spent on establishment costs and national monitoring. This is an encouraging development but unfortunately the money is neither guaranteed to continue, nor is it enough. Only 800 of the approximate 1,350 graduates will have funded places. That means less than two thirds of our graduating nurses will be encouraged to stay and work in New Zealand. Political support for nursing is imperative if the profession is to achieve its potential. Annette King came to recognise the benefits of a high performing nursing profession and she was a good ally to nursing. During the previous government Primary Health Nursing made significant advances with the funding of 11 practice innovations and approximately 120 scholarships that allowed those in primary care to undertake postgraduate study. This investment into nursing needs to continue and broaden. While significant numbers of nurses are now accessing post graduate study, the personal cost of this on an already burdened workforce is high. The profession must continue to seek political backing to ‘release the potential of nursing’ (Ministerial Taskforce on Nursing, 1998). Nursing has proved how essential it is for initiatives such as the meningococcal immunisation campaign, airport screening of SARS suspects and, should a ‘bird flu’ epidemic eventuate, we would be the front line workers.
Nursing as a profession in New Zealand is progressing well. We are developing the upper levels of the profession with nurse practitioners and prescribing, we have established robust processes that we continue to evaluate and nursing is beginning to get the financial recognition it deserves. National frameworks for new graduate and PDRP programmes make sense in a small country and allow for the continuing professional development of nurses. These measures coupled with political support and increasing postgraduate qualifications mean the profession is at its greatest capability to date. The efforts must continue, but we should congratulate ourselves on having come a long way in the last few years. The hard work by many has paid off and we deserve to be proud of where the profession is at today.
Tina Smith
RN, BA, PGCert, MCNA(NZ)
References
Health Practitioners Competence Assurance Act (2003).
Medicines Act (1985).
Ministerial Taskforce on Nursing. (1998). Ministerial Taskforce report on nursing: Releasing the potential of nurses. Wellington: Ministry of Health.
Moller, P., & Begg, E. (2005). Independent nurse prescribing in New Zealand. The New Zealand Medical Journal, 118 (1225). Retrieved November 8 2005, from http://www.nzma.org.nz/ journal/118-1225/1724.
