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IN AUGUST 1995 when Canterbury Heath Limited (CHL) announced its extensive restructuring proposal, it was as much a surprise to me, then a senior clinical adviser in nursing, as it was to most nurses.

The proposal--about how to address the problems that CHL was undoubtedly experiencing--was developed by the then director of nursing and a service manager who had once been a nurse, Prior to the model being made public, nurses had barely been consulted. The restructure saw the removal of many senior nurse positions, including that of the ward charge nurses and the introduction of patient care managers across three units. The upshot was the loss of 39 senior nurses.

The appeals that followed eventually involved the Ministry of Health's chief nursing adviser and chief medical advisers, all members of the Canterbury health board and the Minister of Health. In spite of a sustained effort, the restructuring began and a significant number of senior nurses left. The initial proposal changed when it became patently obvious the model was unsafe. A nurse to coordinate every ward was re-instated but the title clinical nurse specialist was given to this role with little acknowledgment of the role's management component.

With the introduction of a whole hospital full of relatively inexperienced nurses (not a commentary on their now proven adaptability and potential) into a climate that lacked infrastructure, a situation of high risk had been created. The Health Jane O'Malley and Disability Commissioner's Report bears testimony to the tragic events that followed. (1)

In 1998 I participated in an NZNO delegation to the Taskforce on Nursing that identified lack of nursing control over nursing matters as a major barrier to the sale and consistent delivery of nursing care. (2) NZNO argued that, until this was restored, nursing continued to be vulnerable to the vagaries of resource decisions made by those who viewed it as a cost to be controlled rather than as an essential resource.

Recently the Ministry of Health has endorsed the magnet hospital principles, principles which NZNO also supports and many of which are reflected in our safe staffing document. However, magnet principles will require a major paradigm shift not yet evident in our hospitals. The central tenets involve: first, a nurse executive with a strong position in the organisational hierarchy; secondly, nurse control over the practice environment; thirdly, organisation of nurses' clinical responsibility at unit level to promote accountability and continuity of care; fourthly, adequate staffing and a balance between new and experienced nurses; and finally an established culture signifying nursing's importance in the hospital. (3)

The news over the past few weeks heralds a new wave of restructuring around our country's hospitals. I feel deeply frustrated that those who fund and manage our health care system continue to re-play history without learning from it. NZNO's current agenda for nursing will go a significant way to mitigate these developments. The test will be up to those who keep quoting the importance of the magnet principles while standing by and allowing continued and sustained attacks on these very principles from restructuring.


(1) Stent, R. (1998) The Report by the Health and Disability Commissioner on Canterbury Health (The Stent Report). Wellington: Office of the Health and Disability Commissioner.

(2) Ministerial Taskforce on Nursing. (1998) Report of the Ministerial Taskforce on Nursing: Releasing the Potential of Nursing, Wellington: Ministry of Health.

(3) McClure, M. L., Poulin. M. A., Sovie, M. D. & Wandelt, M. A. (1983) Magnet hospitals: Attracting and retention of professional nurses. Kansas City, MO: American Academy of Nursing.
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Title Annotation:letters
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Jul 1, 2004
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