Hold on to community nursing workforce.

New Zealand must hold on to its strong public and community health nursing workforce, according to a United States (US)-based nursing advocate Tine Hansen-Turton. In New Zealand at the invitation of Auckland University of Technology, she said the US used to have such a nursing workforce in the '60s and '70s but it was moved out of the community and this had had a major impact on health care.

On her second visit to New Zealand in as many years, Hansen-Turton is the chief executive of the national Nursing Centers Consortium (NNCC). This organisation represents 190 nurse-managed community-based health centres in the US which provide primary care, health promotion and disease management to more than 2.5 million people annually. Operated by schools of nursing and community-based, not-for-profit organisations, the centres provide care to vulnerable populations, 46 percent of whom have no health insurance.

"In the US we have 47 million people uninsured and 30 million under-insured--a terrible indictment on our system--so there is a huge population of need. The two million plus people our centres see doesn't scratch the surface of need." The nurse-managed health centres are located in such places as public housing developments, churches and homeless and domestic violence centres. More than half the staff of the centres are nurses: 20 percent are nurse practitioners (NPs); 23 percent are advanced practice nurses and nine percent are registered nurses, with the remainder including social workers, therapists, community outreach workers, collaborating physicians (just 0.5 percent), administrative staff and health educators. The centres have impressive health outcomes, with two major studies showing the care provided by NPs was comparable to that of physicians.

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Hansen-Turton said her visit to New Zealand this time was to re-energise people involved in NP development in this country. "It's a journey, there are battles to fight, strategies to develop and people can get worn down."

Funding streams for NPs at district health board and primary health organisation level and a more streamlined NP application process, particularly around prescribing, would help, she said.

"I understand you have 38 NPs, 20 with prescribing rights. It would be great if you had 200. New Zealand has a fantastic primary health care strategy but it doesn't have the volume of NPs to prove their value in the communities where they are needed. Once that happens, NPs will be more visible to funders but you have to have the volume."

But getting the volume of NPs and getting them working in a fully integrated way with doctors takes time. "NPs first started in the US in 1968 and now there are 141,000 of them, all prescribing. But it is only in the last 15 years there have been the policy and legislative shifts required and NPs have begun working more closely with the medical community, working as partners with physicians."

Hansen-Turton has noted a shift in attitudes towards NPs since her visit in 2005. "The first time I was here, one GP responded to the idea with 'not over my dead body' but now I sense the GP community is more open to NPs and there is certainly the need. In another two years I am sure there will be much more integration."

Nurse practitioner website launched

The nurse practitioner facilitation programme now has a website. The website, part of District Health Board New Zealand's website, contains an overview of the work of the programme steering group. The link is: www.dhbnz.org.nz/Site/ FutureWorkforce/Nurse-Practitioner.