Looking at barriers to practice nurse development.

STRATEGIC LEADERSHIP is not a subject generally taught to nurses in clinical practice. If one wanted to learn this skill, business courses would be a more appropriate learning pathway. Or would they?

It appears that in the new health care environment, particularly in primary health care, it may be entirely appropriate for nurses to have an understanding of the basic concepts of strategy and how to apply them in practice. They would then be able to respond, as a profession, and in a strategic and timely manner to the opportunities and threats that may arise and affect their practice.

In this article I will give a brief outline of the concepts of strategic planning, the New Zealand College of Practice Nurses NZNO's [the college] strategic plan (1) and the barriers to its implementation.

Every organisation needs to have guideposts to signal future direction. These guideposts help to focus activity to ensure optimum benefit to the organisation and its members. The vision describes what the organisation really wants to be and can describe its highest aspirations. The mission statement describes the over arching purpose of the organisation and should be a clear statement of why the organisation exists. The goals and objectives should emerge out of the vision and mission. These specify the actions and tasks required to fulfill the vision and the mission.

A visionary organisation is one that not only survives, but also excels at what it does and exhibits clarity about what it is and where it is going. (2) A key component to maintaining this ideal is for the organisation to preserve the core--the vision and the mission--while continuing to stimulate the organisation's progress.

One way to stimulate that progress is to continually hold up the activities of the organisation against the vision and mission to ensure they are synergistic. If the organisation has a basic set of very clear guideposts in the vision and the mission, the members should be empowered to drive forward to fulfill them, without requiring rules and restrictions that may hinder progress. The college has a vision. It states that practice nurses "will be professional providers of practice nursing, as integral members of the primary health care team".

The mission statement includes improving health outcomes for the community through expanded practice nursing services, which offer better primary health care options. The goals and objectives are clearly stated in the strategy. The implementation of the strategy is a challenge for practice nurses nationally.

Despite the college's strong frameworks for professional practice, eg education standards, a career pathway and job description, practice nurses struggle to gain recognition of their professionalism nationally. The lack of effective marketing by practice nurses around the potential for expanded nursing roles within the GP team is one reason other stakeholders in primary care are slow to realise the potential of practice nursing.

However, the major barrier is the lack of direct funding to practice nurses from the Ministry of Health and other funders. Practice nurses provide valuable nursing services for general practice patients. This needs to be recognised through practice nurses having similar access to government subsidies, eg the general medical subsidy, ACC payments and Clinical Training Agency (CTA) funding as GPs, some nurses and some other health professionals.

If insurance companies recognised nursing services with claim payment, that would also increase patients' access to practice nursing services. Support from the government for ongoing training, similar to the vocational training support from the CTA for GP registrars, would help recruit and retain practice nurses, whose average age is now over 40. (3)

A nursing funding stream, channelled into primary health care organisations (PHOs), would allow practice nurses to be more autonomous in the services they provide and to grow professionally, both of which would benefit the communities they work in. There is, at present, no extra funding for primary health care nurses within the new PHO frameworks, despite the declaration in the Primary Health Care Strategy that nurses are an integral part of the implementation of the strategy. (4)

The college, as part of its strategic plan, will work towards national standardisation of courses for practice nurses so such courses can be audited and standards maintained, to ensure evidence-based care, ie best practice, is offered to patients.

The successful accreditation programme, introduced in 1994, will continue. This will assist with standardisation and auditing of practice nursing care. There is an opportunity for the Ministry to recognise the accreditation programme by promoting it to employers and district health boards. The Ministry could also offer funding to practice nurses to complete accreditation.

The college recognises the importance of research in clinical and professional practice. I am undertaking a research dissertation as part of my master's studies into the beliefs of practice nurses about their current role in primary health care and their perception of future professional opportunities. I plan to use focus groups to identify the main themes and then survey all practice nurses.

The Ministry has recognised the benefits of primary health care nursing but has not acknowledged or provided for the barriers that exist around implementing the primary health care strategy due to funding and other issues. Despite these barriers, the college will continue working to implement its current strategic plan, while ensuring it is clearly focused on future developments in primary health care that may affect practice nurses and their profession.

The college recognises the need to be strategically focused in primary health care. This way it can lead practice nurses in a direction that benefits our peers, patients and professional colleagues and gives increased professional satisfaction. The vision will only be achieved if practice nurses are committed to these goals.

REFERENCES

1) New Zealand College of Practice Nurses NZNO Strategic Plan (2002). Wellington: NZNO

2) Collins, J. and Porras, J. (1994) Built to last: successful habits of visionary companies. New York: Harper Collins.

3) Ministry of Health (2003) Primary health care nursing survey. Wellington: Ministry of Health.

4) King, A. (2001) The Primary Health Care Strategy. Wellington: Ministry of Health.

--Report by the chair of the New Zealand College of Practice Nurses NZNO, Rosemary Jamieson.