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Providing primary health nursing leadership: the government's primary health care strategy is set to change the face of primary health care delivery. Nurses have to be ready for the challenges that entails. That's where NZNO's Primary Health Care Nursing Council can help.

Another round of primary health care nursing scholarships has been awarded, more money has gone to general practice to improve access to primary health care (PHC), PHC nurses are working in various ways throughout the country to gain improved outcomes for patients--but what has really changed for PHC nurses in the community?

National nursing groups continue to beaver away at issues related to PHC nursing, eg professional development programme frameworks, pay parity, employment structures and strategic plans. But what has really changed?

It is timely to remember the key directions within the Government's PHC strategy: work with local communities and enrolled populations; identify and remove health inequalities; offer comprehensive services to improve, maintain and restore people's health; co-ordinate care across services; and develop the PHC workforce.

Nurses are trained and able to assess and respond to the health needs of individuals and populations. Nurses want to contribute fully to collaborative and integrated PHC teams and work in partnership with those needing health services. Investing in Health states that nurses can "seize opportunities inherent in the implementation of the primary health care strategy and play a key role in shaping their own destiny in order to contribute to health gain for all". (1)

One of the main barriers to changing how PHC nurses practise is their historical specialties. These have developed and been perpetrated by funding and ways of working in the PHC sector over decades. It is time to break down these "specialty silos" and begin to work in innovative ways and to share the knowledge and skills each specialty has developed over the years. Another barrier are funding mechanisms that do not support nursing service integration or accountability.

NZNO has led the development of a framework for cohesive PHC nursing leadership, development and advice. Demonstrations of this leadership include NZNO's facilitation of three successful PHC conferences and the establishment of a PHC nursing advisory panel in 2003 to promote a shared purpose and common structure for PHC nurses within NZNO. Another example has been the establishment of the NZNO PHC Nurses' Council, approved by NZNO's board of directors in May 2004. The council replaced the advisory panel. The work of the council has been presented at a number of recent conferences, including last month's PHC nursing conference. A central tenet of the presentation is that, until now, PHC nurses have been "islands in the health care stream"--working in isolation but towards a common goal. The council is working to bring together these "islands " and to support nurses to meet the challenges of the PHC strategy.

One of the council's biggest challenges is creating the communication networks needed to ensure we are all working towards common goals, thus minimising fragmentation and duplication of nursing services.

Governance

An ideal in the council's strategic plan is that PHC nurses gain equality with doctors in the governance of health organisations. To make positive changes, PHC nurses need to be active in all areas of practice, including the governance of those organisations that direct and manage nursing services.

The council has undertaken to make the processes, roles and responsibilities of nurses on governance boards more visible to nurses. The council also wants to create an environment in which nurses can question the status qua, which, in turn, may lead to nurses making changes in their working environment to enable them to help shape their own destiny.

Community need

How many PHC nurses actually understand the community they work in? How many would know how to reach that understanding? How many would know how to re-direct nursing services to respond to community need? The council aims to provide PHC nurses with tools to complete community profiles.

To influence funding streams and nursing services in the communities they serve, PHC nurses need to understand how district health boards (DHBs) and primary health organisations (PHOs) manage and direct services. Community profiles are just part of what is required to develop proposals for nursing services funded through DHBs and PHOs. The council plans to develop a template for PHC nursing service specifications that nurses can use when lobbying for changes in nursing services to support integrated practice.

Professional practice environment

The first objective of a professional practice environment is to put the patient first. (2)

Traditionally, PHC nurses have not had the same professional development opportunities as their DHB colleagues. This has led to ad hoc nurse education and a lack of resources for PHC nurses to take advantage of existing opportunities. The council wants to address this urgently and to ensure consistency and a high standard of professional development opportunities nationally. Towards this goal, the council is working on a PHC nursing professional development template. This template recognises the intent of the PHC strategy, which is likely to lead to changing models of care delivery, more integrated approaches to practice, and changes to PHC nurses' traditional roles. The council hopes implementation of the programme will lead to more effective use of nursing expertise and hasten the implementation of the PHC strategy.

Conclusion

The council's work is ambitious and cannot be done without collaboration with other nursing groups and PHC nurses. It must assist PHC nurses to be innovative and to redirect nursing services to improve health outcomes for their communities. The council is working for all PHC nurses, but recognises that PHC nurses have a responsibility for their own professional practice and for working towards improving health outcomes for the individuals and the communities with which they work.

References

(1) Ministry of Health (2003) Investing in Health: Whakatohutia te Oranga Tangata: a framework for activating primary health core nursing in New Zealand. Wellington: Ministry of Health.

(2) American Association of Colleges of Nursing (AACN)(2002) Hallmarks of professional practice, http://www.aacn.nche.edu/Publications/positions/hallmarks.htm. Retrieved May 20, 2005

Chiquita Hansen, RN, BN, MPhil (Nursing), is the chair of NZNO's PHC Nurses' Council and director of nursing, primary health at MidCentral District Health Board.

Rosemary Minto, RN, PGCertHSc, is the chair of the College of Practice [Nurses.sup.NZNO]
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Title Annotation:NEWS FOCUS
Author:Hansen, Chiquita
Publication:Kai Tiaki: Nursing New Zealand
Date:Sep 1, 2005
Words:1006
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