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Primed for life--working for the ministry: 'some people work very hard. But they still never get it right ...'.

From time to time, the Te Henga Marxist Nursing Confederation [motto: surf today, dominate the world tomorrow] hold nursing career development evenings and report on the outcomes. This is one of those times.

Louise the Lecturer gave the presentation this evening. She put forward a very simple proposition with implications for Lifelong employment opportunities.

It's this--get involved with the Ministry of Health PRIMHD [pronounced 'primed'] at any Level you can. PRIMHD is the MoH Mental Health data collection agency [yes, our eyes grew heavy as well, when Louise told us that]. Louise could not find if PRIMHD is an acronym--although her research was not extensive. "We don't do 'deep' research anymore in the universities," she says. "Just Lots of it to keep tenure. Research lite, we call it. We have such fun with Post Modernist concepts in the staff rooms these days."

Anyway, PRIMHD is the career choice for those seeking stability of employment with Lifelong career prospects. The wonderful thing about PRIMHD, Louise said, is that with mental health, no-one knows what is being measured. Of course, there are measurement tools, and we would be negligent if we didn't use them, they being so extraordinarily expensive. But really, given that clinicians and NGOs find filling in a HoNOS more of an expression of artistic or even aspirational endeavour than any attempt at accuracy, we accept we haven't a clue what relationship the data has to reality. And this is before we know what relationship the data should have with reality. Reality is not something the PRIMHD crew is totally worried about.

The other wonderful thing, Louise said, is that we don't really know how data is collected. We seem to be a bit reliant on people filling in the forms. It seems that some of our coding structures may be a Little confusing. We do roll out various projects going forward, the SISSAL, the MHC Standing Order, the PRIMHD KPI Reporting system--whatever it takes to convince the Minister of the day we do something else other than walk up and down corridors Looking meaningfully at our Blackberries.

But really, said Louise, how data is collected, and knowing if we have the right, or the relevant, or the full, or the factual figures is more an act of faith than any assuredness.

Intelligent allocation of resources

Lastly, Louise told us that the PRIMHD people don't know why they collect information. Of course, said Louise, there is the usual party Line. Data means intelligent allocation of resources and allows sensible planning and policy development. This occasioned much Laughter amongst those of our Little group who work in areas subject to intelligent allocation of resources, sensible planning and policy development.

"Yes," said Louise ,"we share your pain. We in the PRIMHD family are as bewildered as you. However, remember that, going forward, our projected outcomes are aspirational. Remember that Treasury shared a similar bewilderment as it tried to reconcile its measurement of Solid Energy's profitability with what actually happened'" We all agreed that if it's good enough for Treasury, it's good enough for the PRIMHD whanau.

"So," said Olga the Intern, who tends to get a ride to meetings with Nic from NICU these days, "you're saying that PRIMHD doesn't know what it's doing, or how or why. So why is this such a good career option, pray tell?" She can be quite searching, if not direct in her questioning of Louise these days. She says it's something to do with her critical thinking training she got at the University, which does seem to be more enhanced since she gets her clinical supervision from Nic, rather than Louise.

Louise was so receptive to this question. "That is the point," she said. "How do we, how can we stop this suite of projects going forward? It's a rhetorical question, we can't, we must not. Measurement must occur, it means freedom, it means the Liberation [here her voice became strangely forceful and her gestures wonderfully theatrical and phlegm appeared on her bottom Lip] for the Volk! It means Leibensraum und the triumph of the Ubermensch!"

She then coughed, collected herself, explained that this was the pattern of speech most common in the MoH and at the higher Levels of certain DHBs, and returned to the question.

A career with PRIMHD, she explained, is a career that can take a motivated and committed nurse through a Lifetime of satisfying employment. It involves, of course, sacrifices. Meetings in Wellington, for example. However, there are conferences to attend (video conferencing is, really, for the Little people), expenses to be claimed, projects to be envisaged, reports to be collated, DHBs and NGOs to be excoriated for failing to provide reports or the right reports on the correct forms.

Visceral reaction

Most of all, Louise said, there is nothing Like the thrill one can get from popping into a Provider's office and saying, "Hi, I'm from the Ministry of Health" and watching the visceral reaction and waiting for the club sandwiches and Lamingtons to come out with the morning tea.

"I'm all about empowerment," Louise said, "and this job has it in spades. Beats working, don't you think?"


(1) Reed, L. (1969) Beginning to see the light. The Velvet Underground [record]. California: MGM. (1968).

Chris Cottingham, RN, BA, MEd, DipSocSci, PGDip (Hlth Sci), is a staff nurse working for a district health board that prefers not to be identified. In his spare time, he writes a bi-monthly column of alternative (sometimes amusing or irreverent but always challenging) musings on our profession.
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Title Annotation:(a) musing on nursing
Author:Cottingham, Chris
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Apr 1, 2013
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