Getting the image of nursing right: how far has the government's primary health (PHC) strategy progressed over the past two years, what have nurses achieved and what challenges still remain? NZNO's fourth PHC nurses' conference in Auckland last month addressed some of these questions.

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'Give me the bullets and I will fire them," challenged Ministry of Health chief nursing adviser Mark Jones in his opening address at NZNO's primary health care (PHC) nurses' conference last month.

Speaking on the theme of "positive professional practice", Jones called on the 180 nurses present to provide him with clearly articulated arguments for their education needs and service delivery opportunities. He cited the example of CarePlus, which is now providing a new education stream and opportunities for practice nurses to extend their skills in managing long-term conditions like diabetes, heart disease and mental health conditions. "I took the case for CarePlus to the Minister [of Health Pete Hodgson] who supported the argument that practice nurses were in the ideal position to deliver CarePlus. I want to see practice nurses knocking the walls down to deliver this programme, which, I hope, will be available nationally this year."

Nurses needed to develop common goals and objectives so their roles in PHC became incontestable. Nurses, he said, understood the totality of the health experience. To be effective, they needed robust leadership, recognition for their expertise, good professional development opportunities and robust organisational systems. Jones hoped more PHC directors of nursing positions within district health boards (DHBs) would be created.

"We must get the image of nursing right. We must be upbeat about nursing as a career and find ways to support new graduate nurses and students in PHC settings. We have to be able to show why nursing is effective in delivering services and to be clear about our vision. The way we present ourselves is very important--people wilt follow us if they believe in what we are doing.

"We need more nurses that reflect the population mix in our country and we need to keep our nurses in practice once they have graduated. The nurse-entry-to-practice (NETP) programme is very important. However, it is mostly operating in acute care settings and must be extended into PHC. I am hoping more money will be rolled out into the NETP programmes, with nurses getting a fairer share of funding from the Clinical Training Agency."

Jones paid tribute to NZNO for achieving pay equity for PHC nurses. But he urged nurses to consider taking up Leadership opportunities on DHB and primary health organisation (PHO) governance boards; to exploit the opportunities for new provider models. "I have a lot of hope for PHOs, though some are still operating in an older mind set. They are the kernel of health care delivery and we must make sure they do what was intended. It is up to nurses to work with other health professionals on the boards. We have a very permissive funding system--funding can be used to deliver nurse-led initiatives if nurses put a robust case forward for them."

Conference coverage and photos by Anne Manchester