“New goals” and “time for change,” are common ideas in circulation at the start of a new year.
There are countless opportunities for change across the health system. I hope that by the end of 2019 we will at least be on the path towards achieving change that supports improved recognition and utilisation of the primary nursing workforce.
Going beyond visibility, it is about demonstrating the kind of value nursing offers towards maintaining and improving health outcomes. So the question arises: what can be done?
Throughout the country there are pockets of excellence within models of care where nursing and nurse practitioner (NP) roles are embraced by the health sector and patients. A strong need still exists though for more fundamental change to occur from within the healthcare sector itself, as well as from the public. International research has already shown the value that nurse practitioners and nurses bring to primary care and the beneficial improvement to population health outcomes and cost savings incurred1,2,3.
Sending consistent messages to the public regarding the expertise and value that nursing can offer is paramount. Such promotion makes nursing visible to the public and within the health sector and demonstrates how people can engage and partner with nursing in their journey towards accessing quality primary health care services.
Many practice websites downplay or ignore nursing
Consider how nursing is portrayed on most general practice websites. How can patients know that nursing services are available if they are not visible?
Currently if you click on many websites you will likely find the full names and qualifications for the practice’s general practitioners (GPs). For nursing you will often find first names only, no professional bios, and they are either listed together with the administrative staff, or simply not mentioned at all.
It is difficult to expect consumers to understand, appreciate and engage with the nursing profession without being able to even see us. We must seek change, and all nurses can do their part to advocate for this change, engaging nursing leads for support as required. If everyone did this—just imagine how amazing the result could be!
Within the profession, major achievements have been made to enable nursing and nurse practitioner roles to be fully maximised within the community. It is imperative that we ensure this highly valuable work is consistently visible and taken up across all levels of the sector. This is where quality data counts.
A recent project completed within the Counties Manukau District Health Board region highlighted the inaccuracies of nursing data collected as part of the primary health Clinical Performance Indicator data4.
It showed that in many instances, nursing activity was not being accurately recorded, resulting in nursing consultations appearing disproportionately low in comparison to medical consultations. It is widely known this is an issue for primary care nursing nationally.
Time for change
When collected data fails to accurately reflect—or even entirely omits—nursing work within primary care, this perpetuates the ‘stacking of the deck’ against our profession.
We can no longer afford to sit back and accept the old saying, ‘it’s too hard to change’, which the New Zealand Productivity Commission advocates is an out-of-date view. Change is imperative, but requires commitment and leadership from nurses across the sector.
With the interim report of the Government’s Health & Disability System Review interim report due this July, it is hopeful that the pendulum will now truly swing toward a situation in which there exists a clear recognition of the significant role nursing can play in providing high quality, accessible primary health care to our population.
This is not about devaluing the work of general practitioners; it is about allocating the appropriate practitioner to meet patients’ needs; it’s about fully embracing the true essence of multidisciplinary models of care and ensuring access for all patients and communities.
Enough research exists to demonstrate the benefits of primary health care nursing. Now is the time for real action; now is the time to implement changes that will have a positive impact on our population and the nursing profession.
I am up for the challenge, are you?
Erin Meads is a nursing consultant working for Counties Manukau DHB and the Northern Regional Alliance with a special interest in primary & community health services. She is also a board member of the College of Nurses Aotearoa NZ.
- Carryer, J., & Hughes, F. (2002). “Nurse Practitioners in New Zealand.” http://www.moh.govt.nz/NoteBook/nbbooks.nsf/0/DA9F59B23B35E201CC256C14008312BA/$file/NursePractitionersinNZ.pdf
- Leach, D (2017). “Status of Advanced Practice Nursing in New Zealand.” https://international.aanp.org/Content/docs/New_Zealand.pdf
- Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, AJAH. (2018). “Nurses as substitutes for doctors in primary care.” Cochrane Database of Systematic Reviews https://www.cochrane.org/CD001271
- Enhanced Primary Care Collaborative, CMDHB (2018). “General Practice Utilisation Report”.