Contact any of the following
for Further Jen Udy Judy
Harris Margaret Hearn Rachael Sullivan Merryll Frear Cherry Waldron Chris Tipa Julie Palmer
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IN THIS MONTH’S NEWSLETTER:
Page 1
Nursing Group contact details
Agenda
Quote
Page 2
Minutes of the Nurse Project Meeting held 2nd February 2005
Pages 3 - 5
Primary Focus 2— Conference Report
By Julie Palmer
Page 6
Primary Focus 2—Conference Report
By Pam Baldwin
Page 7
Draft Discussion Document—
Recruitment & Retention for Nursing in Kaipara
Page 8
Yet to be decided—look and see!
Agenda
Blessing/Welcome
Apologies
Previous Minutes
Matters Arising
ESIF Submission
Feedback on the Maternal Mental Health Meeting
Other
General Business
Presentation by Margaret Curry &
Adrienne Taylor , Northland Cancer Society
Topic – The role of the Cancer Society Nurse
KCI Nurse Rep Report – Cherry Waldron
KCI Board Meeting Feedback
Verbal report on the Primary Health Care Conference
NIL Report – Julie Palmer
Primary Health Care Conference Report
Draft proposal on recruitment of Kaipara Nurses
Regional Nurse Leadership Meeting Feedback
Care Plus Workshop – 21st May
International Midwives and Nurses Day/s
Other
Open Forum—Dept/Service News/Panui
Facilitation of next meeting—4th May 05
Minutes of March 2005 Meeting
MINUTES OF THE NURSE PROJECT MEETING HELD ON WEDNESDAY, 2nd MARCH 2005
AT 12.00, CONFERENCE ROOM, COMMUNITY HEALTH, DARGAVILLE HOSPITAL
Present: Celeste Sherman, Lin Snape, Jacci Whippy, Geoff Nickerson, Cherry Waldron, Julie Robertson, Jen Udy, Marion McCahon, Merryl Freer, Pam Baldwin, Liz Clark, June Henwood, Julie Palmer, Maureen Hendry
Karakia/Blessing of Kai: Geoffrey Nickerson Welcome/Greeting: by facilitator Geoffrey Nickerson
Apologies: Raey Stainton, Zoe Tipa, Chris Tipa, Marilyn Archibald, Glenis Turner, Kath Bowmar, Karen Franklin, Susan Harris, Deborah Ashley-Smith.
Previous Minutes:
Accepted as true and correct with the amendment that Jen Udy was omitted from the list of Apologies.
Matters Arising:
NIL Report
· Funding for Elective Services. Submissions being worked on, have extension until Friday. Commendation was given for the level of collaboration, help, commitment and enthusiasm which has been tremendous. Stats show DNA’s at Clinics have become a significant issue (approx 10%). Definitely needs some attention and worthy of putting forward.
Mental Health meeting next week addressing issues of no maternal mental health in Kaipara. Don’t need duplication of services which would cream off funds. Referrals needed through midwives. Waiting for information on funding. Recommended that a GP rep be included in the meeting.
Business:
PowerPoint presentation by Mental Health Team - Geoff Nickerson presenter:
· Full title is Kaipara Mental Health and Addiction Services. An excellent overview of the services offered in Kaipara was presented. An information sheet was also handed out.
NIL Report:
· Nurses not under the DHB will not get the increases that have been publicised. This will be discussed at the Nursing Integration Dinner with a view to writing a letter to Annette King to support the inclusion of Primary Health Care nurses. Primary Health Care nurses are to meet with Annette King to press their case.
· KCI to donate redundant computer to Public Health nurses to bring them in line electronically with other Community Health staff.
· There is a need to push for recruitment of nurses to Kaipara Health Services, perhaps drawn from a casual nurses pool. Input and ideas requested.
Dept/Service News/Panui:
· Next month (9th to 16th) is World Homeopathic Awareness Week. There will be an article in the D&D News and on the radio.
· Regional Group Meeting
· Staffing crisis on Ward 2 due to staff leaving, annual leave and sickness. This seems to be an ongoing problem. Some casual staff have been lured into maternity which leaves Ward 2 at a disadvantage.
Other
· Facilitator for the April meeting – Julie to arrange
· Venue – to remain the same.
Meeting Closed: at 1.15pm
Next Meeting: Wednesday 6nd April 05. Time: 12.30 - 1.30 pm - Lunch Provided.
For Your Diaries
International Midwives’ Day- 5th May 2005
International Nurses’ Day—12th May 2005
Primary Focus Two - Conference Report by Julie Palmer
PRIMARY FOCUS 2 - Moving in the Right Direction
March 10th -12th 2005 Michael Fowler Centre, Wellington
CONFERENCE REPORT FOR THE NURSES OF KAIPARA by Julie Palmer
Primary Focus 2 – Moving in the right direction was the second Primary Health Care conference to be held since the implementation of the Primary Health Care (PHC) Strategy in 2001.
The vision of the PHC is:
· People will be part of local primary health care services that improve their health, keep them well, are easy to get to and coordinate their ongoing care.
· Primary health care services will focus on better health for a population, and actively work to reduce health inequalities between different groups
· (MoH, 2001)
Six key directions for Primary health care will achieve this vision:
· Work with local communities and enrolled populations
· Identify and remove health inequalities
· Offer access to comprehensive services to improve, maintain and restore peoples health
· Coordinate care across service areas
· Develop the primary health care workforce
· Continuously improve quality using good information.
The most significant messages I took away from the conference were:
· The chronic disease epidemic shows no sign of reducing and is in fact on the rise.
· Increasing numbers of people have one or more chronic conditions (hypertension, renal disease, diabetes).
· Health systems globally are being impacted by these trends.
· The disparities in health between Maori and Non Maori are growing.
· Primary care needs to be a leader in reducing disparities in health.
· To achieve improved health outcomes, integration and collaboration is necessary.
· There has been an explosion in the volume of medical and health knowledge available, not just for health professionals but also for the public through the Internet.
· Dr Colin Feek, Director General, stated that in trying to reduce disparities in health, and reduce the burden of chronic disease we should be focusing 90% of our attention on the 10% who don’t access health. By doing this, we will not only be reaching the most needy, underserved, and hard to reach, but also, we will reach the rest of the population who do access health services.
The opening address by Annette King included a story about…The nurse, the lawyer and the Podiatrist……
It highlights the way that PHC Nurses are proactive, advocates and coordinators for patients in the community. Essentially the actions of the nurse resulted in a very sick, diabetic patient getting on top of his problems which included accommodation, employment, and finances. By addressing his social issues, he was then able him to get on with managing his personal health problems and feel empowered to access appropriate, PHC.
The Minister of Health was suitably impressed by the way this nurse had operated. As were many at the conference. (Of course the nurses present knew this was pretty much ‘business as usual’, but they didn’t want to ‘skite’).
Recruitment and Retention of PHCN
A Workshop on Team Work facilitated by the Dept of General Practice, Wellington School of Medicine and Health Sciences.
Role play was used to demonstrate the impact ‘Teamwork’ on an elderly, frail, diabetic / Asthmatic woman who lived alone, managing with the help of a home support worker and a kindly neighbor.
Scenario 1: Showed the home support worker busily doing her ‘work’, cleaning etc. Not perceiving any sense of duty or responsibility when the woman told her she had stopped taking her tablets, and was feeling unwell. The worker left to see to her next ‘client’.
Outcome The woman died.
Scenario 2: The support worker showed a little more concern about her situation, and did wrote a note in ‘the communication book’ back at the office before she left for home. However the message wasn’t read by her supervisor until the next day, by then it was too late.
Outcome: The woman was ‘discovered’ in a very bad way and was admitted to hospital.
The care giver received a verbal warning for not making sure the information had been passed on to someone who could take action.
Scenario 3: The caregiver ‘listened and connected’ to the patient, she noticed the unused medication bottles/ inhalers etc in the bedroom and heard the woman say she had stopped taking her pills because they made her feel worse. The caregiver knew this information needed to be shared with someone who could help the patient. She asked the patient if she could phone the surgery, the patient, who knew the nurse, agreed. The care worker spoke to the nurse and the nurse organised to visit the patient that afternoon. The Nurse took on board what the caregiver had said. There was a functional relationship there already.
Outcome:
The patient was seen in her home, cared for by her Primary Care Practitioners, and her condition improved rather than deteriorated.
This was an excellent workshop which included small group discussion with a range of different health folk at the end of the scenarios to look at the pros and cons of the different kinds of ‘teams’ demonstrated in each scenario.
The workshop showed me that someone who may not seem to be ‘in the team’ may be crucial to the patient, and that communication and valuing each other is vital.
There was also discussion about the benefits of interprofessional (or interdisciplinary) education.
The case for interprofessional education:
INTERPROFESIONAL OR INTERDISCIPLINARY EDUCATION
“A group of students (or workers) from different health related occupations with different educational backgrounds, learning together with interaction as an important goal, to collaborate in providing promotive, preventive, curative, rehabilitative and other health related services.” (WHO 1988)
Students reported that
· Their interdisciplinary PG study has specifically encouraged them to stay in the PHC sector.
· Interdisciplinary PG study has improved their professional practice, and improved their workplace practice.
· Not only has their understanding of their own role increased but also greatly increased their understanding of the role of other health disciplines in the PHCT
· Interdisciplinary PG study directly increased collaboration in their workplace for 45%of respondents.
· Interprofessional learning in sustained professional development programmes has the potential to promote quality not only for individual health professionals but also best practice for the primary care workforce as a whole.
· If supported by the wider workplace, it can help not only retain the current workforce, but help recruit newly qualified health professionals into a PHC career.
I also attended a session on Primary Health Care Nursing. At Waikato Institute of Technology (WINTEC) the undergraduate Comprehensive Nursing program is being developed with an education pathway in PHC for student nurses. The pathway will assist students to learn about PHC.
Key issues for recruitment of students into PHC as graduates include:
· A supportive undergrad experience
· Preceptor ship program so that students have a good experience.
NURSE PRACTITIONERS (NP)
A presentation was also made by Paula Renouf the first, and Janet Maloney Mony, the first Maori NP in New Zealand. It is clear that NP is still in its infancy in terms of its introduction and journey onto the healthcare landscape in NZ. However, given the number of nurses who are now studying fulltime to complete their Masters and those who are in the final year, it is highly likely that there will be more like 50 by the end of next year.
In no time at all they will have a presence in a wide range of health care settings demonstrating a new level of autonomy and accountability which will have positive health outcomes for the population being served. Although there is probably no limit to the contexts in which NP can function, in terms of PHC, I could see how the role of DN would be an excellent platform on which to develop this role. (Adrienne Murray in Kaitaia is the latest nurse to be awarded NP status, our first in Northland!).
MENTAL HEALTH WORKSHOP
90% of all people with a mental health problem are managed in primary care
30% of people with a severe and enduring mental illness are managed entirely in primary care.
Several models and perspectives of mental health were presented.
1. In Counties Manukau they are preparing a structured program which fits in to their chronic care management model. It comprises a continuous, coordinated and structured approach away from episodic care including a wide range of professionals which links primary and secondary care.
2. The Tidal Model; primarily a personal care tool for Mental Health, based on the strengths based model that is used in Northland.
NORTHLAND NURSING INTEGRATION LEADERS PRESENTATION
A copy of our presentation is available on request. We were allocated 2 hours for our workshop. 47 people registered, approximately 30 attended.
PHO NURSING LEADERS NETWORKING BREAKFAST
A forum was held with PHO Nurse Leaders. This was structured to enable people to introduce themselves, their role and where they worked.
Outcomes:
An email network will be established to enable sharing of information and resources.
Common Issues included:
· Nurses in Governance roles
· Establishment of PHC Nurse Leadership positions
· The range of PHO PHCN ‘leadership’ positions
· Resources available from the Ministry of Social Development (MSD) to help support good parenting.
· Pay parity for PHCN
· The need to raise awareness about what PHO’s are all about.
· The need for unity between PHC and Secondary care
· Nurses in Governance roles being paid less than their board colleagues.
· New nursing positions being created within PHO’s.
SUGGESTIONS ARISING FROM THE CONFERENCE
· Plan a PHCN / Rural Nurses Education day:
· Proposed Agenda could include
· Chronic Care management
· Wound Care
· Mental Health
· Case Management
· Rural Nurses attending Conference
Approach the KCI PHO Board with a view to them allocating funds for Kaipara Health site Nurses from each organisation to attend the NZNO and MOH Primary Health Care Conferences. The outcome would be enhanced knowledge about the opportunities and issues related to PHC. Secondly, enhanced integration, collaboration and team building will happen because of the enormous value of the experience attending a conference of this caliber provides. By having nurses from each provider attend such a conference, the potential for collectively initiating interdisciplinary projects is also enhanced.
Summary
This was a world class conference and is held every 2 years. The presentations from the conference will be available on the MOH website. I have a copy of the program available for anyone interested in perusing it.
PHC is being recognised as the sector which is pivotal in improving and maintaining, the health of our communities. In Kaipara, it’s not just PHC, but all of the health providers working together which will make a difference.
On Thursday 24th March, ‘Our future together; Community Expo’ is being held which includes all of the groups who have a role in the wellbeing of this community are coming together. This is another example of how local solutions can work for local communities.
Julie Palmer
Nursing Integration Leader, Kaipara Care Inc. PHO
March 2005
Primary Focus Conference Report by Pam Baldwin of Health Options
An Overview: Primary Health Care: Focus Conference. Wellington, March 2005 — by Pam Baldwin
Attending this national event as representatives of KCI/PHO, Cherry and Pam
collaborated with Julie (who was presenting) to gain a wide range of
perspectives, by selecting different workshops in addition to the main speakers.
International, national and regional visions, models initiatives and outcomes were provided by a variety of people from other countries, World Health Organisation, Ministry of Health, governance, research and groups of small and large PHC providers. The attendance was primarily doctors, nurses and administrators, and we linked up with old friends-- Rhonda Zeilinski, Diane Lawson, Rob Cook and Chris Farrelly, in addition to other colleagues making a difference in communities similar to our own. The networking and knowledge sharing was valuable.
A number of familiar buzz words were touted like population outcomes,
community representation and participation, integration and collaboration.
The latter concept was posed as a challenge for DHB/PHO’s to consider,
advocating the need for workshops to fully understand and actively practice
collaboration, with horizontal relationships and power sharing. As tokenism
was commonly reported with structures tending to maintain the status quo,
gatekeeping and the old hierarchical tradition. Ironically research shows the
smaller PHC organizations (like ours) were more representative, less
professionally dominated and tended to show much greater compliance, than
larger organisations with formal experienced administration and management.
The Ottawa Charter vision of interdisciplinary and intersectoral collaboration
was highlighted, valuing interprofessional relationships and inclusion of the
many social institutions and agencies that may impact on people’s realities and
benefit health outcomes e.g. income, housing, legal etc. Nurse-led clinics were
acknowledged as good as GP-led teams, with shared technology/client database access and team collaboration, to provide effective Chronic Care management, promotive, preventive, curative, rehabilitative and palliative services.
DHB/PHO’s are charged to value the whole community as resource, and to
focus 90% of attention to the 10% of the population most needy, underserved
and hard to reach people not accessing PHC services. Strong recommendations
were to target and consult with Maori/our Treaty partners when planning
initiatives and service changes, to improve access and health outcomes for this
population group, whose mortality and morbidity rates remain very high.
While it was acknowledged that as a nation we are still in the process of change to
PHC (with some regions just developing the infrastructure and foundations to integrate services that are patient/client focused), current statistics and research findings demonstrate no major improvement in inequities or disparities in health outcomes in NZ. The Ministry apologised for problems with funding and administration hitches, reporting an overwhelming but pleasing move to PHC (with a 90% practice participation in capitation).
Draft Discussion Document on Recruitement & Retention of Nurses in Kaipara
DRAFT DISCUSSION DOCUMENT FOR KAIPARA NURSES ON
RECRUITMENT AND RETENTION FOR NURSING IN KAIPARA
21ST MARCH 2005
Introduction
Kaipara currently has 3 main providers of nursing services. They are: Northland Health Ltd, Dargaville Medical Centre, and Te Ha O Te Oranga O Ngati Whatua. All three employers recruit, and employ their own staff. All three are either actively recruiting, have just, or are about to recruit nurses into their organisations.
The Issue
Recruiting and retaining a sustainable professional workforce in Kaipara has some challenges. The DHB has extra strength because of its economies of scale, and the new pay rates which have been negotiated for DHB Nurses. NZNO is currently working on a campaign to bring about pay parity for non DHB Nurses.
An approach worth considering has been suggested, in that, all three employers COLLECTIVELY recruit nurses to Kaipara Health Services. This would reduce duplication of resources, and missedopportunities by having a sustainable professional workforce to promote wellbeing, health and the effective delivery of services for the community. Although there will always be a solid pool of rural nurses, this number is dwindling as nurses move to meet family requirements, or changing needs. With housing markets rising, traffic congestion, and a desire to have more work life balance, there is an opportunity to recruit nurses from afar to a more relaxed, family friendly, safe community such as the Kaipara. Other attractions include Kaipara’s proximity to Northland Beaches, native bush, Whangarei and Auckland city.
Proposal
A number of initiatives could be undertaken to recruit and retain nurses in Kaipara.
· The 3 employers collaboratively recruit nurses for Kaipara health services.
· A casual ‘pool’ of nurses be established where nurses can be used across agencies.
· The PHO contributes towards the development of Primary Health Care (PHC) services in Kaipara by supporting a sustainable and professional workforce.
· Allocation of Rural Retention funds for health professionals in Kaipara could be used towards recruitment costs and to compliment professional development programs held by the 3 employers. - Specifically, - attendance at conferences, courses and workshops related to rural or Primary Health Care topics.
· Additionally it could be used for attendance at courses, conferences and workshops which address local priorities.
· Nurses and health care workers should be encouraged to attend courses that ensure maintenance of knowledge and skills that promote a multidisciplinary rural workforce which works in a collaborative manner.
· An advertising campaign (including a website) could be undertaken to promotes Kaipara’s strengths and attractions for people coming to live and work here.
· Incentives and creative ‘packages’ could be produced to make Kaipara an attractive work/life choice. E.g. Flexible rostering. Professional magazine subscriptions.
· Nursing Institutions could be targeted for new nurse graduates
· Advertisements in the Northern Advocate for nurses offering choice of work opportunities, flexibility, proactive nursing opportunities.
Next Steps
· Kaipara nurse workforce input/feedback required.
· Circulate to Nurse Leaders for comment, feedback and further input.
· Develop proposal in response to their feedback.
· Put proposal to KCI Board for funding to be made available to support professional development for rural health professionals.
· Discuss, and explore how a Casual Nursing pool could work in Kaipara.
· Take forward depending on agreements made.
Julie Palmer
Nursing Integration Leader, Kaipara Care Inc. PHO
22nd March 2005
Last Page Funny Fillers
Subject: Just for Fun
You know you're living in 2005 when…
1. You accidentally enter your password on the microwave.
2. You haven't played solitaire with real cards in years.
3. You have a list of 15 phone numbers/ email addresses etc to reach your family of 3.
4. You e-mail the person who works at the desk next to you.
5. Your reason for not staying in touch with friends and family is that they don't have e-mail addresses.
6. You go home after a long day at work and you answer the phone in a business manner.
7. You make phone calls from home and accidentally dial "9" to get an outside line.
8. You've sat at the same desk for six years and worked for three different companies.
10. You learn about your redundancy on the 11 o'clock news.
11. Your boss doesn't have the ability to do your job.
12. You pull up in your own driveway and use your cell phone to see if anyone is home.
13. Every commercial on television has a website at the bottom of the screen.
14. Leaving the house without your cell phone, which you didn't have the first 20 or 30
(or 60) years of your life, is now a cause for panic and you turn around to go and get it.
15. You get up in the morning and go online before getting your coffee.
16. You start tilting your head sideways to smile. :)
17. You're reading this and nodding and laughing.
18. Even worse, you know exactly to whom you are going to forward this message.
19. You are too busy to notice there was no #9 on this list.
20. You actually scrolled back up to check that there wasn't any #9 on this list.
AND NOW YOU'RE LAUGHING at yourself. Go on, forward this to your friends ...you know you want to!
Quotation
DID YOU KNOW—”Maternal education level is the strongest predictor of child health?'