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Give nursing grads a fair go

By NZNO member leader and nursing student Phoebe Webster, as part of the Shout Out campaign.

nzno-students-30Pictured- Phoebe Webster, 3rd year nursing student.

“I am a 25 year old nursing student in my 3rd and final year of nursing study, and looking forward to starting my professional career. By the time I finish my Bachelor of Nursing (BN) I will have completed over 1100 hours of approved supervised practice. I will have spent countless more hours attending practice laboratories, clinical preparation sessions, lectures, tutorials, guest speaker sessions and workshops as compulsory components of my BN degree. After completing this I will sit my state final exam and, all going well, will become a Registered Nurse (RN).

My course is designed to make sure I am a safe, competent, innovative, and articulate nurse. It means that I can work in different parts of the health care sector and improve health outcomes for local, national and global communities. But there is still a steep learning curve going from a student nurse to confidently performing all of responsibilities of an RN.

The Nurse Entry to Practice/Specialist Practice (NEtP/NESP) 1 year programme provides new graduate nurses with an invaluable introduction into the healthcare system. It’s really crucial support for us going through this steep learning curve. It provides a safe and supportive environment for graduate nurses to slowly transition into the responsibilities of a competent registered nurse. This crucial support is sadly not available to all graduates however, and I can’t help wondering how I will fare in this competitive race for employment after my state finals. Only around half of graduates manage to get a NETP position in the first year, and the job opportunities for new graduates outside of the programme can be limited- everywhere wants ‘experience’, but how can we safely obtain it?

More funding is needed to provide these NEtP and NESP placements for new graduates. Sure, it is possible to enter the workforce without a NEtP position, but why make this transition less safe and harder for new grads?

More highly trained nurses are exactly what our complex healthcare system needs. Comorbidities, where patients have many related and often serious health problems going on at the same time are common. Nurses now deal with complicated care under widening scopes of practise. Making sure these new scopes are adequately prepared for and supported is vital for future workforce planning.

Other professions in New Zealand are supported to train and transition slowly into their jobs. When entry to training is regulated with supervised progression, people who come out the other end are better recognised as highly skilled professionals. Take the police force for example. In New Zealand new police undertake extensive entry requirements and progress through a (paid) training programme and are then placed in supported roles in different areas of the police force. Builders have apprenticeships which provide many hours of supervised, supported time on the job. Should the same on the job support and continued supervised learning not be available to all nursing graduates, not just the lucky ones?

The NEtP programme is based on many other successful and effective new graduate programmes around the world. Benefits include transferability of skills recruitment and retention of New Zealand nurses. I really, really want to be the best nurse that I possibly can. After sitting my state final exam this year in November it worries me that I may be entering the workforce without the support in place to give me a fighting chance to achieve that quickly. Building the strong, competent nurses of tomorrow is something I see as worth investing in. It’s a profession that I have invested in, in every way, and hope to continue to do so throughout my life. All I’m asking for is that my country supports me a little bit more, to help support them.”

NETP (Nursing Entry to Practice) and NETSP (Nursing Entry to Specialty Practice) key stats

  • There were 1455 applicants in total in the November end of year pool in 2016.  Of these 1303 were NETP applicants and 152 were NESP applicants.
  • There were 151 applicants indicating they were repeat applicants (128 NETP and 23 NESP) and 1304 (1175 NETP and 129 NESP) who indicated they were first time applicants. (Note: 1274 applicants said they completed their degree at the end of 2016.)
  • There were 121 second time applicants, 26 third time applicants and 4 fourth time applicants.
  • Only 52% of NETP applications were employed as at the 25th of November 2016, and 65% of NESP applicants were employed by the same date
  • Of the remaining applicants in the NETP pool, 605 were unmatched, 17 withdrew, were declined, or did not finish their degree. In the NESP pool, 53 were unmatched and 1 either withdrew, was declined or did not finish their degree.

That’s 658 New Zealand qualified nurses who wanted further on the job support but didn’t have NETP/NESP placements to go to at the end of last year. With a nursing workforce shortage hitting us right now, NZNO believes we need a placement for every new grad.


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We have the science, now we need the staff to keep patients safe

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NZNO champions the use of Care Capacity Demand Management (CCDM) in our hospitals. CCDM tools and processes uses patient acuity data to determine how many staff hours are needed for each shift. CCDM is the first of its kind and is available in some, but not all DHBs, and in certain wards and units of these DHBs. CCDM results in safer patient care and a better working environment for staff. CCDM enables staffing levels (capacity) to meet incoming need (demand).

To find out more about CCDM, see: http://www.nzno.org.nz/get_involved/campaigns/care_point/what_is_ccdm

 This blog is by Lisa Taylor, Registered Nurse and NZNO Delegate

‘It’s the challenge that gets me out of bed in the mornings, I love my job caring for patients and there’s always so much to learn.

I am a nurse working in an acute surgical ward with a high acuity. Many patients every day go to and from surgery, ED, ICU, other hospitals and home. We have a big turnover of patients.

Regardless of patient numbers, in the last two years we have gone from having a Care Assistant and a Health Care Assistant on each morning shift, to having one or the other but not both. Having only one out of the two assistants has resulted in delays in patient care.

As an example, the more specialised Registered Nurse tasks such as clinical assessments and complex wound dressings are often delayed so we can attend to patients more ‘immediate’ needs, such as toileting and mobilising. This can result in ‘care rationing’ for this really important patient care.

If we were to have a Care Capacity Demand Management (CCDM) Work Analysis completed on our ward, which calculates in detailed the work that is completed by our nursing team, we would be able to show who was doing what work and when that work was being done. Work analysis is really specific and gives us the opportunity to analyse the information.

We use CCDM Response Management tools within our hospital and in our ward. This is a programme telling us when we should increase or decrease each type of nursing team staff rostered on as patient demand goes up and down outside of what we have planned. However, when we do go into yellow – which means we need assistance as the patient care requirements outweigh the staff resource on the ward – we are often told there is no more help. This is a difficult situation, as the Clinical Nurse Managers and the Duty Nurse Managers do want to help, but when there is no one to help, there is nothing they can do.

If health funding was appropriate, it’s more likely there would be better help available for our patients. Having confidence that the resources were available to provide the right care at the right time would make for a safer workplace for patients and staff.

TrendCare, the patient acuity system that shows how much nursing care each patient will probably need, has made a difference to us on our ward. We understand that we often have a ‘negative variance’. This means patient care requirements outweigh the staff resource on the ward. We are working to further improve our data. I feel optimistic that once the data is absolute correct we will be able to do the calculations for how many full time equivalent staff we need, and it will be accurate.

TrendCare data is really powerful in getting the right staffing, but the staff also actually need to be available. If health funding was increased we would always be able to have the right staff, at the right time, delivering the right care, all the time.’


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To hold their hand

This beautiful blog was put together by one of our delegates and Shout Out member leaders, Angela Stratton, a Registered Nurse working in aged care. We’re publishing it as part of what will be a series on the impact of health underfunding in different care settings around New Zealand. 

colour-72-cropNZNO stock photo image, copyright 2014

One of the special privileges of my work is to be with people when they’re dying. It’s a time when if I do my job well and the doctor has charted any necessary medication, someone can take their last breath relaxed, with less pain or fear.

What I find difficult, is when someone is dying and they are scared and want a hand to hold but I have to go and answer another call bell. Or when a grieving family member breaks down and needs to talk, but I can’t give them as much time as I’d like to, because I need to go and look after others.

Nurses working in aged care all want to do the best for their patients. But with people living longer and their carers growing older too, we simply need more staff. For that, we need more funding from the Government. The Government funds care for older people just like other parts of our public health system.  In aged care our role is special because we also help ease the very last days of a long life. This all part of the health journey for patients and their families which deserves proper funding, dignity and respect.

In Whanganui we have an aging population. Some say we are living longer but death will come to all of us, and I feel it’s a human right not to die alone. When a person has nobody else to hold their hand at the end, I hope there’s a nurse beside them.

 


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We can’t afford to ignore nurses’ cries for help

colour-103This blog was originally published by New Zealand Doctor, and is kindly reblogged here with their permission. Thanks New Zealand Doctor for continuing to highlight nursing issues both here and overseas!

By Barbara Docherty

It’s not really in my nature but I feel a bit like the doomsday merchant at present.

As soon as I write about nursing in any form, a little flurry of emails arrives in my inbox often indicating unhappy nurses. This latest alert from the UK worryingly has shades of what nurses are articulating in different forms here in New Zealand, and about which I have written on previous occasions.

‘Skint, shaken and yet still caring’

This recent major survey in the UK with the intriguing title “Skint, shaken and yet still caring”, followed more than 2200 responses from nurses, midwives and healthcare assistants about financial hardship and deprivation, domestic abuse, health, illness, wellbeing and employment uncovering what has been referred to as “worrying facts”.

It identified that nurses are twice as unlikely as the general public to be unable to afford basic necessities such as beds, decent shoes, washing machines, keeping their homes warm or eating two meals a day.

They are three times more likely to suffer domestic abuse than the general public, 14 per cent of them victims of domestic abuse in the last year. This compares with a national average of 4.4 per cent.

Physical and mental illness

The report also found that two in five nurses, midwives and healthcare assistants have a long-term physical or mental illness that limits their day-to-day activity and is expected to last longer than a year.

The survey questions on domestic abuse matched those used in the 2012-13 crime survey for England and Wales carried out by that government’s official statistics body. They came out a week after a Sunday paper revealed 14 per cent of nurses have applied for payday loans, laying bare the hardship faced by NHS staff.

The United Kingdom’s Royal College of Nursing responded by saying it “painted a shocking picture of the hardships” faced by some nurses and midwives. The nursing support charity Cavell Nurses’ Trust which commissioned the research, has branded the findings as “appalling”.

Foolish to dismiss survey results

There are no suitable words to describe the significance of these findings. Some might say it is a relatively small sample in a country the size of the UK.

It will likely be dismissed by others in New Zealand as nothing much to do with us. But closing our minds to the strong possibility that this likely mirrors what some nurses are experiencing in New Zealand is tantamount to foolishness.

I find it disturbing. It’s another reminder that, when I blogged some months ago in New Zealand Doctor about nurses here admitting to taking anti-anxiety or antidepressant medication, some attempting suicide or experiencing suicidal thoughts, it hit a strong chord because nurses were speaking their realities.

One dissenter

Yet a week after that blog was published, I received an email (from whom I still don’t know) asking me to back off, to stop raising the issue because it was stirring fear when only a handful of nurses would be affected anyway.

The United Kingdom study has not been replicated here to my knowledge so we don’t have specific NZ data. But nurses throughout the world are coping with strained health services and this report highlights the reality of a nurse’s working life and the impact on home life or vice versa.

It once again shows that nurses keep going in spite of often physical and mental health issues that can be damaging in the short or long term to both themselves and their patients. Canada and the United States have also identified many similar issues with their nurses and we ignore all these findings at our peril.

I have been receiving a constant trickle of emails over many weeks since writing that blog and as I write this one, another email has just arrived from a nurse now considering the role of nurse practitioner but needing to know if he is “doing the right thing”.

Scared to join general practice

He says, “My brother is a GP and feels it is time to leave his profession as it is all getting too much for him. For me I don’t want to accept that nurses don’t support nurses but I have yet to be entirely convinced and I don’t want to embark on a NP journey if I am anxious about the lack of support mechanisms if I end up with physical and mental health problems.”

And unfortunately, we don’t have the equivalent in New Zealand of the UK Cavell Nurses’ Trust which has supported nurses, midwives and health assistants in many different ways since being founded in 1917 after British nurse Edith Cavell was executed in 1915 for helping to evacuate 200 Allied soldiers in Belgium.

Speaking on behalf of nurses

If I am sounding as if I am stirring the pot of negativity, tell that to the nurses who email me simply because they do not know where else to turn to vent or get assistance.

While DHBs provide access to confidential counselling by independent professionals as part of their Employee Assistance Programme to help nurses work through stress, anxiety and depression, as well as personal and financial issues, what is evident is that many nurses don’t reach out and take this important step believing little will change for them post-counselling anyway.

Skint and shaken? That’s probably only the half of it.


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Getting the shift pattern right for nurses

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DHB junior doctors are lobbying hard for shifts with fewer days in a row and fewer night shifts in a row. This is because they know fatigue leads to greater risk of mistakes. They also know that patient care and engagement is not as good when they are sleep deprived or not rejuvenated sufficiently between rosters.

Nurses are also on shifts, do overtime, work nights and need to have recovery time to be on form. A New Zealand research project about nurses shift work was launched earlier this month.

Studies in Australia and the United States of America show nurses get less sleep on work days than non-work days and how much less depends on the shift pattern they are on.

Massey University’s Sleep/Wake Research Centre and School of Nursing, in collaboration with the New Zealand Nurses Organisation, is running the project designed to take an evidence-based approach towards managing shift work and fatigue for hospital nurses.

The Safer Nursing 24/7 project, led by Professor Philippa Gander, aims to improve health service delivery by improving both patient safety and the safety, health, quality of life and retention of nurses.

Project manager Dr Karyn O’Keeffe says, “Less sleep is directly related to increased risk of clinical errors, struggling to stay awake at work, and drowsy-driving on the way home.

“The hours of sleep someone gets in the 24-hour period before their shift significantly affects their ability to remain awake at work, and is a significant predictor of errors and, near errors. Sleep-deprived nurses report a higher number of patient-care errors, and an American study found nurses struggled to stay awake on 20 per cent of their shifts,” Dr O’Keeffe says.

NZNO has worked collaboratively with the team from Massey University from the project’s inception, both sitting on the advisory board, and in helping with seed funding to support the Health Research Council funding bid. NZNO principal researcher Leonie Walker is a member of the study team and helped develop the study protocol and survey.

“There is a huge variety of shift patterns worked in New Zealand. We have different lengths of shift and different patterns of day and night rosters operating. We need to discover the pros and cons and practicalities of these to develop some evidence-based guidelines for safe and appropriate shift rostering,” Walker explains.

“It’s a bigger problem for some than others, depends on physiology, other life issues, age and also the nature of the work.”

Walker says a shift in an operating theatre for example might be more or less fatiguing than a shift in an outpatient clinic or a special care baby unit but we just don’t know at this stage.

The literature is clear about the risks of error increasing with fatigue. A recent systematic review by NZNO policy adviser Jill Clendon and Veronique Gibbons showed the errors for 12 hour shifts were higher, other things being equal, than for 8-10 hour shifts.

“Equally important to us is the risk to nurses of chronic fatigue – to their health, and for example driving home drowsy,” Walker said.

Walker suggests we need to research our hunch that there are factors other than shift length alone, particularly the pattern of the shift changes that will be just as important.

Safer Nursing 24/7 is a collaboration between the researchers and the nursing community, and is supported by an advisory group of key nursing representatives, as well as an expert in epidemiology and biostatistics.  Nurses and District Health Boards are being invited to participate in three main activities:

  1. Completing an online survey of the work patterns of nurses nationwide in six practice areas.
  2. Development of new education and training materials on how shift work affects fatigue and how to improve sleep, particularly when working shifts.
  3. Consultation on a new Code of Practice for shift work in hospital-based nursing.

Research funders: The project has received major funding from the Health Research Council, with additional funding from the New Zealand Lottery Grants Board, McCutchan Trust and Massey University.

Click here to watch a short video about the project.


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A day in the life of a mental health nurse in New Zealand

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This blog was sent to us by a NZNO member who works in mental health. We are choosing to keep their details anonymous because of the intense scrutiny that mental health services are currently under. This blog is a personal reflection on their own experience, rather than NZNO’s view, but we are sure it resonates with many of you who work in the sector. We really appreciate them sharing their story, and hope it gives some context to the recent media coverage of our mental health services. 

It is 7am and I am off to see a patient in the emergency department. It is a young man who has self-harmed overnight. This scenario is becoming all too common in today’s mental health setting. You see, mental illness is the invisible disease. Presenting to the emergency department in emotional distress, the only visible signs are an unkempt man with a frightened look on his face.

Coming into the cubicle I see a young man in obvious distress. A feeling of hopelessness comes from him. I walk in and introduce myself. We begin to talk. Eyes downcast, feeling somewhat embarrassed as he shares his story with me. He talks to me in a quiet voice. He knows he needs help but does not know where to obtain the help he needs. His relationship with his family has become strained. They have tried to help, but are unable to provide the support he requires.

This man begins to articulate his struggle with schizophrenia. His self harm is due to despair: a belief that life holds nothing for him.  By the end of the interview I know I have several options open to me as a clinician:

  • We could send him home to his parents. But evidently his parents are unable to cope anymore with his distress.
  • We could suggest his GP follow up and maybe a visit from the already over-stretched crisis team.
  • Another option is to find a community respite bed for a few days. But we know that these are few and far between. I will have to telephone and “sell” his case to the respite coordinator if I am to make this happen.
  • Another option is to try and organise for him to be admitted into the inpatient ward. But I know they are nearly always full or over capacity. This is yet another hard sell to find this young man a place to be safe and be supported.

I go to discuss treatment options within the consult liaison team and the decision is made to admit the young man to the inpatient unit. I call the ward coordinator.  “What are his risks they ask?” Not, ‘who he is’, but, what logistical problems might he bring to the unit.

This is mental health nursing today. There is now a ‘risk adverse’ culture that always errs on the side of organisational safety: a system characterised by a lack of choices due to limited resourcing.

This is the young man’s first time in an inpatient unit. I try and reassure him, but as soon we get to the unit the door closes.  People are busy. I try and find a nurse. They are few and far between. I eventually find the nurse assigned to my client. A brief introduction is shared, but I know the nurse is trying to get the paperwork done. Admission note, risk assessment, interview with the psychiatrist, place them on the observation board and a host of other tasks. This leaves little time to begin getting to know, understand and work alongside my client to better support them.

I leave my client and return to the ED, there is another case on the board.

This time another young person in a self-harm situation – they were bullied at school and decided to end their life.

Nurses do care, but we are not being given the time or resources to provide the level of service and care that I would want or expect if it was my family member presenting to mental health services.

We do not want to restrict or deny the people we care for their freedoms. Too often the concept of least restrictive practice is sidelined by lack of resources.

The organisations we work for are worried. Worried about risk and what could be in the papers tomorrow. So much so they seem to have forgotten about the core reason we are here – we are here to help.

I as a clinician welcome the reviews and public scrutiny. The current structure needs looking at so we mental health professionals are able to provide the service, care and support that our clients deserve.

 

 


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Suffrage Day – vote for great health leaders

 

 

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Pictured- NZNO Senior Policy Analyst, Marilyn Head with CTU Equal Pay campaigner Camilla Belich, outside parliament today.

By NZNO Chief Executive, Memo Musa

Today, NZ Suffrage Day, provides an opportunity to celebrate New Zealand’s suffrage achievements and look for ways to make further progress on gender equality issues in the health sector.

With the local government elections open for voting, now is a good time to think about how to use the hard-fought right to vote wisely.

The election of new District Health Boards (DHB) is a very important arm of our democracy. The New Zealand Nurses Organisation (NZNO) has provided its members with an election issues guide sheet with key questions for DHB candidates.

Nurses, caregivers, healthcare assistants, kaiāwhina and midwives need to be supported in their work with great leadership and governance.

A living wage, safe workplaces, good faith collective bargaining and collective agreements, and equal pay for work of equal value are fundamental aspects of a fair and healthy society. We do not have access to all of these things yet for all workers in the health sector in New Zealand.

The nursing team’s first priority is improving health outcomes and patient safety. Nurses need the right tools and enough staff to deliver best care. Nurses have developed Care Capacity Demand Management (CCDM) for safe staffing in public hospitals, but not all hospitals are making full use of this tool yet. Aged care does not have mandatory minimum safe staffing levels. Safe workplaces are not nationally consistent for all health staff.

This morning we supported the ongoing call for the government to support the Equal Pay Principles. At parliament steps the Council of Trade Unions delivered white roses for women MPs to encourage them to endorse the principles.

The people making governance decisions for DHBs hugely affect the health and wellbeing of families, workers and communities. In New Zealand although women have had the vote for over a hundred years, not enough women are standing for election or being elected into governance roles. There is a gender imbalance in the board room. Local body and DHB elections are therefore also an opportunity to bring more capable women onto the board as well as more board members with the requirements of our great nurses in mind. Seizing the right to vote leads to a healthier New Zealand.

Ends.

Any DHB candidates who want to answer all the questions we have asked on the guide and have it published online can email their full names as on the ballot, contact details and answers to nurses@nzno.org.nz

Voting in DHB elections and more information on the voting process is available online here: www.localcouncils.govt.nz