Clinicians highlight aspects of their work.

Emergency department nursing, the transition from union activist to manager, infection control, international student networking and clinical governance were highlighted in five presentations to conference by members--a first for conference.

'The good, the bad and the ugly'

College of Emergency Nurses' members Justin Moore and Judi van't Wout told delegates emergency nursing was about "the good, the bad and the ugly". Moore urged the media "to look behind the symptoms" when reporting on issues concerning emergency departments (EDs). Moore said the "stay away" message was not working, as those who acting on the message were those who should be coming to EDs. "By the time they do come, they are very sick and require more resources than if they'd come earlier." They then presented a photo essay detailing equipment, signs and ED buildings. Moore explained that the essay did not feature people, as there were ethical difficulties in obtaining consent from patients in ED situations.

Triumphs and pitfalls

Waikato Hospital and NZNO stalwart Diane Penney (below right) gave a fascinating account of the "triumphs and pitfalls" of her transition from union activist to manager. Penney dedicated her presentation to a young woman in her department who stood up to an entrenched culture of bullying. Penney remained on the collective agreement. She received no guidance or support into her new role and one of the first things she learnt was she was no longer part of the team. "I had to realise and accept that it was the role, not me personally that was the issue, but it was difficult no longer being invited to pot-luck dinners." Tools she found useful included advice not to surround herself with fools; effective time management, learning how to say "no" and realising she could not be all things to all people. Penney also took on the entrenched culture of bullying, a very difficult process but one in which she documented every step.

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In her management role she encourages union involvement, insists on the use of management of change clauses and union input, and ensures staff do not have to battle for payments they are entitled to.

She admitted to "falling off the perch twice", feeling "clawed at" by those around her and dumped on from those above.

Penney implored NZNO activists to support colleagues in management. "Because they don't support you all the time does not mean they are out to get you."

When she "lost the plot" and took sick leave, she received no support from staff and found that very difficult. But she sought and got support from those NZNO delegates she had worked alongside for so long.

Infection control issues

Infection control clinical nurse specialist at Capital and Coast District Health Board Viv McEnnis (right) linked what is happening in New Zealand hospitals now with what Florence Nightingale faced with poor hospital hygiene, lack of sanitation, overcrowding and her quest to use health statistics to drive reform. Nine percent of those admitted to hospital get a hospital-acquired infection, with urinary tract and lower respiratory tract infections topping the list. It is estimated that 15 to 30 percent of all hospital-acquired infections, which cost New Zealand $137 million a year, are avoidable. The infections are linked to a failure in health systems and processes and to behavioural practices.

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The World Health Organisation has recognised heavy workloads, insufficient infection control nurses and shortages of supplies as among the barriers to compliance with infection control procedures, McEnnis said. The WHO has introduced five initiatives in its "global dean care is safe care" challenge: blood safety, injection and immunisation safety, safe clinical procedures, safe water and sanitation and hand hygiene. In the United States, five innovations around central venous Line (CVL) care--hand hygiene, maximum barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selections with subclavian preferred for non-tunnelled catheters, and a daily review of lines" necessity and prompt removal if unnecessary--have had a huge impact on reducing infection in participating intensive care units. One had not had a CVL infection in nine months, McEnnis said.

Referring to New Zealand, she said the annual survey on the prevalence of methicillin-resistant staphylcococcus aureus (MRSA) revealed up to 7000 MRSA isolates a month but ecoli and klebsiella infections were causing more problems than MRSA.

Infections top the Accident Compensation Corporation's list of accepted treatment injuries, ie injuries caused as a result of seeking or receiving treatment from a registered health professional McEnnis said the situation now was "no different" from the problems facing Florence Nightingale. "Hand hygiene is implicated in 30 to 50 percent of hospital-acquired infections. It's time to start telling people to wash their hands."

Commenting on the presentation, Midlands delegate Janet Black said the rise in hospital-acquired infections in New Zealand mirrored the re-engineering of New Zealand hospitals and reflected the fact there were not enough nurses.

International student network

Outgoing national student unit chair Daniel Jackson and outgoing Tauira Aronui chair Tracy Witehira shared their experiences, frustrations, learnings and reflections on the launch of the International Council of Nurses' (ICN) student nurse network at the biennial ICN congress, held in Yokohama in May. (See Kai Tiaki Nursing New Zealand, July 2007, p28.)

Clinical governance in primary care

In her presentation, college of practice nurses delegate Rosemary Minto (below right) advocated clinical governance as a possible solution for quality management processes in primary health care, notably for advanced nursing practice roles. It provided an overarching framework for all quality tools and would promote a "no blame no shame" environment, if used correctly. "Individuals would have to ask "what do I need to do differently?'" she said. Clinical governance could help start changing PHC systems to ensure there was a genuine patient/ professional partnership. It addressed teamwork and the importance of team development, Leadership--"always a challenge in a health organisation"--and communication, all vital elements of that partnership. She ended her presentation with the aphorism that health care's best patient safety device was a nurse.

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