Director of safe staffing unit can't solve all issues: the inaugural director of the safe staffing/healthy workplaces unit knows there's a great deal riding on the work of the new unit.

Vicky Brewer plays golf off a 24 handicap. To get to that Level requires a good deal of commitment, patience, determination, tenacity, skill and judgement. She'll need all those attributes in her new role as the inaugural director of the safe staffing/healthy workplaces unit within District Health Boards New Zealand (DHBNZ).

The unit was the central recommendation of the report of the Committee of Inquiry (CoI) into Safe Staffing and Healthy Workplaces, released in May last year. The CoI had evolved from negotiations for the inaugural NZNO/DHB multi-employer collective agreement as a way of dealing with nurses' growing frustration over staffing issues. The CoI wanted the unit established within six months of the release of its report. That timeframe was not achieved but, earlier this year, Health Minister Pete Hodgson agreed to fund the establishment of the unit to the tune of $400,000, with future annual costs to be part of DHBNZ's annual funding for at Least three years.

Now Brewer, former director of nursing (DON), older person's health at Christchurch's Princess Margaret Hospital (PMH), is the person charged with making the unit a working reality: of balancing nurses' expectations and DHBs' financial considerations in the quest to enhance patient safety, through safe staffing and healthy workplaces. It's a big ask. Brewer is aware of nurses' high expectations of the unit but knows Rome wasn't built in a day.

Paediatrics a primary focus

Her nursing career, which began at PMH in 1976 and has been entirely within Christchurch, has been characterised by many changes, as she sought new challenges. Hospital, practice and Plunket nursing have all featured in her career, with paediatrics her primary focus.

After a stint as a Plunket nurse in the mid '90s, she retuned to hospital nursing as a charge nurse in paediatrics when Canterbury Health, as it was then, was in turmoil The Stent Report had been published and nurses and nursing had endured some very hard times. But Brewer enjoyed being back as part of a great team, completed her bachelor of nursing through Charles Sturt University, became involved in clinical tutoring in paediatrics and gained her certificate in adult teaching.

A six-month secondment to Christchurch Hospital's then education unit extended to a number of years, during which Brewer continued studying, completing a postgraduate certificate in professional nursing practice and papers in health economics and health services organisation and management. She applied for the PMH DoN role, encouraged by a mentor at the unit Nanette Ainge. "I felt a bit of a fraud, as I'd mostly worked in paediatrics. But I did know about how to work with families/whanau. I did know how to work within an interdisciplinary team and I did know that people coming into hospital, at whatever age, are coming on a journey." Her community experience was also useful as she understood the environment people went home to and the challenges facing nurses working on their own.

She began the DoN role in 2002 and has faced plenty of challenges but short staffing has not been one of them. "We've had a comparatively luxurious time, with very little turnover in our enrolled nurse (EN) workforce of 65. There has been more turnover in the registered nurse (RN) workforce [240 RNs] but we haven't had major vacancies."

But there have been other challenges. One has been the re-introduction of second-level nursing training. Brewer chaired the advisory group at Christchurch Polytechnic Institute of Technology (CPIT) and along with Burwood Hospital DoN Diana Gunn, took the students in the first year of the new training. Other challenges have followed: infectious disease outbreaks; the changing nature of the workforce and its impact on patient care, particularly how to sustain primary care with many older nurses wanting to work part-time; the disestablishment of management roles at PMH; and the changing role of charge nurses.

But there have been rewards, including seeing staff doing well. "We have a number of RNs doing the postgraduate certificate in gerontology and some have completed their masters. I enjoy seeing new graduates complete the entry to practice programme and remain within Canterbury DHB."

But after five years Brewer was ready for a new challenge. As part of the nurse executives group, she had had input to the CoI report and had discussed the report and its recommendations with colleagues. The unit director job emerged as a new challenge--"I Love a challenge"--and one in which she could continue her passion for nursing. "It has a blank slate; it has a national focus; it involves working collaboratively; and it provides an opportunity for me to develop a new set of skills."

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'Small steps in the right direction'

She believes her understanding of the complexity of the health environment, her experience of the clinical environment, her pragmatism, her ability to see both sides of a story and her communication skills will be vital in her new role. Taking "small steps in the right direction" is her goat at first. The data from the stocktake of DHB staffing--from both staff and management perspectives--once collated, will inform further action. "We will frame up that action against the principles outlined in the report and decide the priority actions."

As she ponders her role in an initiative that is "revolutionary", she is encouraged by the commitment of the governance group to work collaboratively with her. "We are all here for the same reasons. Improving patient outcomes will always be the bottom line. Everything the unit does has to be linked back to patient outcomes." She is anxious the unit does not become mired in bureaucracy but knows there has to be some accountability "but I want to keep bureaucracy to a minimum".

While acutely aware of nurses' expectations of the unit, Brewer says she can't single handedly "change the world. We all have to work collaboratively and I just hope nurses can be mindful that I won't be able to solve all their issues tomorrow."

By co-editor Teresa O'Connor