DHBs around the country are using numerous methods to tackle waiting lists and keep up with patient demand.

Some of these solutions include outsourcing surgeries, employing locum doctors and upskilling nurses.

The benefit of utilising nurses in this way is that they are already familiar with facilities, patient history and protocols.

Sarah Piluden.jpg Nelson-Marlborough DHB clinical nurse specialist Sarah Piluden. Photo/Supplied

College of Nurses Aotearoa board co-chair and Victoria University director of the School of Nursing, Midwifery and Health Practice, Dr Kathy Holloway, said nursing provides a capable and agile workforce and she would strongly support nurses being utilised to the full extent of their education and training with appropriate resourcing.

Bay of Plenty District Health Board (BOPDHB) uses nurse specialists and nurse practitioners who are actively involved in both new patients and follow-up care to increase availability and efficiency of specialist care.

BOPDHB acting director of nursing Rosalind Jackson said the DHB continues to support the professional development of specialist nursing roles with access to Health Workforce funding for post-graduate education as well as identified opportunities for specialist nursing in service models of care.

This is relevant in acute care such as emergency departments and in long term condition management, she said.

“We have recently appointed another two nurse practitioners with specialist services to continue the valuable contributions that these specialist nurses make to patient management and clinical care.

“The benefits of specialist nursing input are two-fold in that they release specialist medical staff time to focus on care that only medical staff can provide, while demonstrating safe and effective clinical management of people seeking healthcare.

Within specialist services, nurses support patients and families to develop knowledge and skills to support them to self-manage their health issues proactively, she said.

“The ongoing commitment and increasing contribution to the establishment of specialist nursing roles supports the effectiveness of this way of working.

“Medical staff appreciate the contribution of nurse specialists to patient care and patients and families have indicated a high level of satisfaction in the care that they receive from these staff.”

Capital & Coast District Health Board is also developing its nursing workforce to improve access to health services and attain government targets, according to chief nursing officer Emma Hickson.

“We see the value of, and currently invest in, the advancement of the nursing role.”

A nurse, who works in Auckland and does not want to be named, said having more nurse practitioners would decrease waiting times for patients in emergency departments and outpatient clinics.

The nurse, who is from the United Kingdom, said in the UK there are nurses who do colonoscopies, asthma/respiratory clinics, skin biopsies and more.

“I worked as a nurse in ED for 13 years; I went on to be an emergency nurse practitioner which I meant I would see minor injury and illness patient instead of the doctors.”

Hawke’s Bay District Health Board (HBDHB) chief nursing and midwifery officer Chris McKenna said having nurses upskill to nurse practitioner level benefits patients.

“Hawke’s Bay District Health Board employs 11 nurse practitioners working across a range of specialities from renal and urology, to emergency medicine, radiology and sexual health care.

“Many more work in Primary Care, out in the community.

“Nurse practitioner is the very highest level of nursing practice.”

A master’s degree in nursing and four years of clinical experience is required for nurses to become a nurse practitioner.

This enables them to carry out an extended range of practice including making diagnoses, prescribing medications, admitting and discharging patients from hospital, and taking assessment and follow-up clinics.

“They take pressure off doctors by spreading the work load across a larger workforce which, in turn, improves access to health care for patients,” McKenna said.

“They are very skilled and their input is highly valued.”

HBDHB nurse practitioner Fiona Unac said nurse practitioner skills are being used to help reduce elective surgery waiting lists.

“When patients are referred to the outpatient department they can be assessed by a consultant doctor or a nurse practitioner.

“The initial specialist assessment is an important first step for determining whether a patient may benefit from elective surgery.

“Having both consultant doctors and nurse practitioners providing outpatient clinics means more patients can be reviewed in a timely manner.”

Nurse practitioners are also in a position to provide leadership and mentoring to other nurses, as they progress along their professional development path, she said.

“It is about training to that level to be able to give our best to our patients. It is incredibly satisfying.

“As well as clinical care, many of us are very involved in leadership and advisory roles both national and international.”

Taranaki District Health Board (TDHB) director of nursing Lyn Wardlaw said for a number of years TDHB has been looking at how nursing can assist in the patient journey to help relieve waiting lists and decrease wait times for patients.

“Upskilling our nurses is required, at times, to do this.

“Since 2018 the DHB has been evaluating the growing need for its services and has employed more permanent nursing staff with the aim to reduce the reliance on our core staff working additional hours.”

Having more specialised roles within a profession can make recruitment and career pathways more attractive as well as enabling improvements in timeliness of care, she said.

“While this is very positive, one of our biggest challenges as a medium sized, regional DHB is recruitment and retention of nurses and midwives.”

There are not enough qualified nurses or midwives in Taranaki to employ straight away and while TDHB is working on ways to recruit more, this will take time, Wardlaw said.

In 2017 Nelson-Marlborough District Health Board created a new clinical nurse specialist (CNS) role to meet the demand for ophthalmology patients.

“A CNS is a designated role within a multidisciplinary team involving applied clinical practice, education and consultancy within a particular clinical area. It requires the advanced knowledge of a postgraduate qualification.

“This is a particular example of how a CNS is helping NMH meet ophthalmology appointments for Avastin and other treatments.”



  1. What is required is specialists in GP practices. This has already been demonstrated in the eastern Bay of Plenty with the introduction of a specialist review clinic in the Kawerau Medical Centre. Putting specialists out in general practice allows the assessment of urgent cases and the prioritisation of those cases in the public system. It also helps with the early identification and potential treatment of cancers. This concept has been presented to the Minister without reply but will be presented to the New Zealand general practice disassociation national conference next year with the hope of national development specialists in general practice half a day a week across all the specialties would hugely improve the health system


Please enter your comment!
Please enter your name here