No. 1 May 2015
ISSN 2423-0561 (online)
Kia ora. The Office of the Chief Nurse (OCN) is a business unit in the Ministry of Health. We
are often asked for updates on our work so we have developed this newsletter to provide easy
access to information on nursing initiatives and other relevant Ministry of Health activities.
Almost every activity in the Ministry of Health has some relationship to the work of nurses and
our team provides advice and leadership across the Ministry. Our staff support the role of the
Chief Nurse to advise the Minister of Health and work with colleagues in the Ministry and the
wider health system. We also provide leadership to nursing and the broader health sector on
policy, planning, delivery and evaluation of health and relevant social services.
For more about work on nursing at the Ministry, visit health.govt.nz/our-work/nursing
Introducing the Chief Nurse and her team
We are all experienced nurses from a range of nursing backgrounds; recently we calculated we
have cumulative experience in the health sector of more than 160 years!
Dr Jane O’Malley is the Chief Nurse. She is supported by an Executive Assistant, Lesley Holder;
Principal Advisor, Dr Paul Watson; and Senior Advisors, Alison Hussey, Dr Linda Chalmers and
Jane Bodkin.
Jane Bodkin, OCN Senior Advisor
Jane Bodkin, our newest member joined the Ministry in August 2014. Jane is a registered nurse
with a Masters of Nursing (Clinical) and Masters in Public Policy. Nursing wasn’t her original
career choice: she first got a BA in the late 1980s, but finding a job related to her degree wasn’t
easy. She got a job at Mary Potter Hospice washing dishes and soon switched to a nurse aide
position. Jane loved her work at the hospice: she found it a privilege to be with people during
their last days and it was during that time that she decided to become a nurse.
After training at Wellington Polytechnic, Jane worked in various clinical roles in mental health
and completed her two Masters degrees. She came to the OCN from her most recent position as
senior nurse in consult liaison. Jane trained in Cognitive Behaviour Therapy and Dialectical
Behaviour Therapy (DBT) and practised DBT individual therapy and group skills therapy while
working in the community. In the consult liaison role, Jane was progressing towards becoming a
nurse practitioner. However, when she saw the advertisement for a senior advisor role in the
Office of the Chief Nurse, she recognised it as a productive way to combine her clinical
knowledge and her public policy qualification.
Office of the Chief Nurse Sector Update – No.1 May 2015 1
Jane’s activities in the team relate to her portfolios of mental health and health of older people.
In addition, like all of us in the OCN, she is involved in a range of other activities across the
Ministry. For example, Jane is the OCN representative on the Ministry’s Ebola readiness team.
A very active Office of the Chief Nurse
Our team is very active! Recently we enthusiastically participated in the 10,000 steps challenge.
With team members who cycle, run and attend boot camp regularly alongside the keen walkers,
we put on a pretty strong showing for one of the smallest teams participating at the Ministry of
Health. Team pacemakers proudly clocked up 3,911,467 steps in total throughout the six-week
challenge, placing us in 26th place out of 95 competing teams at the Ministry.
We saw a lot of the Ministry’s stairwells during the challenge. The major health outcomes for
our hips and thighs have encouraged us to make the climb to level four part of our everyday
practice.
Working for the nursing workforce
In our day jobs, we are also busy working on priorities for nursing. A good deal of our work
relates to recruiting and retaining the nursing workforce, and to enabling nurses in all three
scopes – enrolled nurses, registered nurses, and nurse practitioners – to practise to the full
extent of their knowledge and skills.
Through our work we advise on policy and work on projects designed to maintain a nursing
workforce that is responsive to current health needs and can adapt to needs predicted for the
future.
Nursing workforce programme
One of our major activities of the last 18 months has been to develop a nursing workforce
programme for the future. In 2013 our office and Health Workforce New Zealand partnered
with the National Nursing Organisations to map out a nursing workforce programme. Members
of the National Nursing Organisations include representatives from the NZ Nursing Council, the
NZ Nurses Organisation, Nursing Education in the Tertiary Sector, Nurse Executives NZ,
district health board Directors of Nursing, the College of Nurses Aotearoa, the Council of Deans,
the College of Mental Health Nurses and the National Council of Māori Nurses.
The nursing workforce programme has an external governance group, which meets quarterly.
Improving nursing workforce data, recruitment and retention is the priority. We’re working
with the Tertiary Education Commission to understand its data about attrition rates in schools
of nursing, especially for Māori and Pasifika nursing students. Other work focuses on
occupational classification, nursing leadership and preparedness for prescribing.
New graduate employment
Together with HWNZ, we’ve developed a workforce planning model to show the cost, turnover
rate and nursing skill mix within DHBs and to help DHBs to more confidently employ new
graduates in greater numbers without blowing full-time equivalent budgets. The model was
updated this year to accommodate the specific roles of enrolled nurses and nurses working in
mental health and community.
In 2012 we worked with the DHB Directors of Nursing to introduce a national new graduate
employment database, the Advanced Choice of Employment (ACE) system (for more about ACE,
Office of the Chief Nurse Sector Update – No.1 May 2015 2
visit www.kiwihealthjobs.com/ace/graduate-nurses. The sector has worked hard to
continually improve the ACE system and is employing more new graduate nurses each year.
Since the ACE database was introduced:

in 2015 197 more new graduates have been employed compared with the same time last year

almost all graduates are employed within 12 months of qualifying

40 to 50 percent of graduates have got a job before they knew the outcome of their Nursing
Council State Exam and 60–70 percent within five months of getting their results

of the 1078 graduates in November 2013 who applied for work through ACE in that year, just
19 (1.7 percent) remain in the nursing ACE talent pool.
With the ACE data, we’ve gained useful information. For example, in November 2014, 59
percent of Māori applicants were matched to positions compared with 49 percent of non-Maori
applicants.
We also know that students who wanted to work in mental health and addictions in November
2014 had the best chance of getting a position in their preferred area.
We know there is a lot more work to do, particularly in increasing employment of new graduates
in aged care. Only 18 applicants identified aged residential care (ARC) as their first-choice
practice setting.
Aged care
We know we need to have a sustainable nursing workforce in aged care to respond to predicted
growth in the older population. This means we are keen to attract nurses to work in aged care
and keep them in that sector. Earlier in April we called a workshop with sector and Ministry
people on the aged care workforce. Some of issues discussed were the needs of new graduate
nurses, roles for enrolled nurses, models of care and skill mix. Another meeting later in the year
will invite a wider group of people from the aged care sector to help us decide what is needed
and how we should phase future work.
Other recent contributions to the development of a workforce for aged care are the:
nurse entry to practice programme in aged care health.govt.nz/publication/agedresidential-care-nurse-entry-practice-arc-netp-programme-evaluation-report
gerontology acceleration programme to improve health of older people knowledge and skills for
mid-career nurses www.cdhb.health.nz/Hospitals-Services/HealthProfessionals/Postgraduate-Nursing-Education/Pages/default.aspx
Kaiāwhina Workforce Action Plan for non-regulated health and
disability workers
The Health and Disability Kaiāwhina Workforce Action Plan is also closely linked to the care of
our older people. Its aim is to develop an infrastructure to support the non-regulated health
workforce. Careerforce and HWNZ have developed and are progressing the plan. Senior
advisors Alison Hussey and Jane Bodkin are also participating in the working group.
The plan contains seven workstreams: Consumer; Quality and Safety; Workforce Intelligence;
Sustainability; Access; Career Development; and Workforce Recognition. Through this work,
the partners will produce a set of actions to guide the development of this workforce over next
20 years.
For more about the Kaiāwhina Workforce Action Plan, visit www.workforceinaction.org.nz
Office of the Chief Nurse Sector Update – No.1 May 2015 3
Enabling nursing scopes of practice
Nurses and nurse practitioners face various barriers that get in the way of delivering care within
their scope of practice and capability – barriers ranging from legislative and contractual issues
to custom and practice. Senior advisor Alison Hussey dedicates considerable time to addressing
these barriers, working across the Ministry and other government departments. Here’s a
summary of her current work in this area.
Verifying death

The Chief Coroner is considering changing a rule to allow nurse practitioners, registered
nurses, midwives and ambulance personnel to verify death. The Chief Coroner is likely to
confirm the rule change later this year (slightly delayed because a new Chief Coroner took
office in 2015).

A small working group of Nursing Council NZ, Midwifery Council, Ambulance and OCN has
drafted guidelines for practice. We are asking for feedback on the new guideline in May, so
look out for it through your networks.
Health Practitioners (Statutory References to Medical
Practitioners) Bill

The Ministry of Health has now finished its work on this omnibus Bill, which covers seven
Acts. The Bill will amend legislation so that a range of practitioners can perform some
statutory functions that are currently limited to doctors. Examples include conducting
examinations under the Children, Young Persons, and Their Families Act 1989, prescribing
controlled medicines for addiction under the Misuse of Drugs Act 1975, and sharing
information and developing rehabilitation plans under the Accident Compensation Act
2001.

The Bill is now with the Minister of Health to introduce to Cabinet. It is expected to progress
to Select Committee later this year. For more information, visit: health.govt.nz/aboutministry/legislation-and-regulation/regulatory-impact-statements/healthpractitioners-replacement-statutory-references-medical-practitioners
Progress on other barriers
CCS Disability Services has recently changed both the rules and its technology so that nurse
practitioners can now authorise applications for Mobility Parking cards.

With Medtech32’s updated practice management software, nurse prescribers can apply
electronically (rather than by fax or through a cloud-based work around) for Special
Authorities on medicines. To find out how to access the upgrade, visit
http://ithealthboard.health.nz/our-programmes/medicines/eprescribing-andadministration/nurse-practitioners-can-do-special

Work is progressing slowly but steadily on the Nurses Performing Endoscopies project with
decisions made on curriculum, provider preparation and credentialing. For more
information, visit health.govt.nz/our-work/health-workforce/new-roles-andinitiatives/current-projects/nurses-performing-endoscopies

Nurse practitioners, as authorised prescribers, can access diagnostics (radiology and labs).
Some local DHB contracts are still limiting nurse practitioners’ access to diagnostics. We
work on a case-by-case basis with Directors of Nursing to iron out issues.
Office of the Chief Nurse Sector Update – No.1 May 2015 4
Registered nurse prescribing
The Nursing Council NZ has applied for prescribing rights for registered nurses (practising in
primary health care and specialty teams). Now that HWNZ has received the application, the
next steps are under way as the Ministry conducts internal consultation and analyses the
application in developing its advice to the Minister.
To read the application, visit www.nursingcouncil.org.nz/News/Application-forprescribing-rights-for-registered-nurses
Enrolled nurses
Some areas and DHBs are achieving great results from employing new graduate enrolled
nurses). Alison Hussey is working with nursing sector leaders to understand which success
factors can be applied across the country to improve national recruitment of enrolled nurses.
InterRAI assessments and enrolled nurses
Enrolled nurses contribute to assessments and to the development of care plans. Practitioners in
aged care use the InterRAI assessment tool to:

assess and build a picture of an older person’s health and wellbeing needs

develop a care plan to provide the level of support the person needs, in their home or in
residential care.
A pilot study is training enrolled nurses to administer the InterRAI assessment tool and
evaluating the outcomes. Three groups are participating: a mixed group of registered nurses and
enrolled nurses in Timaru; a group of enrolled nurses trained before 2010 in Invercargill; and a
group of enrolled nurses trained after 2011 in Auckland. The aim is to assess the InterRAI
training needs for enrolled nurses and to understand the way enrolled nurses’ knowledge and
skills can contribute to the assessment and care planning for older people.
Reducing treatment-related injuries
The Ministry of Health, Accident Compensation Corporation and the Health Quality and Safety
Commission are working together to reduce treatment-related injuries in three priority areas:
neonatal encephalopathy, pressure injuries and wound infections. Paul Watson is our
representative on the group that works across agencies on these priorities.
KPMG is preparing a value proposition for investing in pressure injury prevention. Sector
stakeholders, including DHBs, have taken part in workshops in Auckland, Wellington and
Christchurch.
The Health Quality and Safety Commission is making progress in its work on reducing harm
from falls, with the focus shifting to the community. For more on its work, visit
www.hqsc.govt.nz/our-programmes/reducing-harm-from-falls
The Integrated Performance and Incentive
Framework
Dr Linda Chalmers is making good use of her research experience in evaluating policy
implementation to co-lead the work stream on evaluating the implementation of the Integrated
Performance and Incentive Framework (IPIF).
Office of the Chief Nurse Sector Update – No.1 May 2015 5
The (IPIF) aims to:

support the health system in addressing equity, safety, quality, access and cost of services

foster improved performance and integration in the health system.
It sets high level directions for improved effectiveness and productivity of health care for the
whole population, while using measures to monitor progress towards better services and
creating an environment that supports constructive, collaborative, professionally driven quality
improvement in front line services.
The framework seeks balance between the local responsibility and discretion that is needed for
innovation and quality improvement, and accountability for performance in meeting sector wide
national health goals. The initial focus of the IPIF will be primary care services, with patients,
practitioners, general practice teams, Primary Health Organisations (PHOs) and District Health
Boards (DHBs), working together to plan and provide primary health care within a whole of
system context.
The IPIF is in a transition year, as it takes over from the PHO Performance Programme (PPP).
In 1 July 2015 it will begin its first full financial year as the IPIF.
In 2015/16, the IPIF will implement new performance measures related to a healthy start to life
and healthy ageing:

Healthy Start measures include – how many pregnant women register with a lead maternity
carer within 12 weeks of gestation, and how many parents enrol their newborns with a
primary health organisation within four weeks of birth

The Healthy Ageing measure focus on polypharmacy: - patients aged over 64 receiving 11 or
more long-term medications.
Primary care nursing leaders (including nurse practitioners) are contributing to the design of
the IPIF in the measures workstreams and are on the programme governance groups. Dr Karen
Hoare and Rosemary Minto will be actively engaged in the ongoing development of measures.
For more on the IPIF, visit www.hiirc.org.nz/section/35484/integrated-performanceand-incentive-framework/?tab=7380
Mental health service improvement
Since joining the Office of the Chief Nurse, Jane Bodkin has made the most of her background in
mental health. As well as working with the Office of the Director of Mental Health at the
Ministry and meeting regularly with the Directors of Mental Health Nursing, she has visited
mental health services in different areas. Here are a few of the projects in mental health that
have been keeping Jane busy.
Commissioning Framework for Mental Health and Addiction
Services
A Commissioning Framework for Mental Health and Addiction Services is being developed.
With this national framework, the mental health and addictions sector can take a more
outcomes-focused and integrated approach. It includes publicly funded services, health
promotion, primary, specialist, DHB and NGO services.
Office of the Chief Nurse Sector Update – No.1 May 2015 6
Review of the Guideline for Assessment and Management of
People at Risk of Suicide
This 2003 guideline to support practitioners in assessing suicide risk is under review. The
revised version will apply specifically for emergency departments (in response to action 6.2 of
the New Zealand Suicide Prevention Action Plan 2013–2016:
health.govt.nz/publication/new-zealand-suicide-prevention-action-plan-20132016). Look out for the draft document, which will be out for consultation shortly.
Primary health care integration for mental health
The Ministry of Health has contracted Te Pou in a project to support mental health training for
primary care practitioners. The project aims to improve access to and uptake of existing training
programmes and resources, coaching and mentoring, as well as to develop a tool to identify
practice nurses’ training needs.
Feedback and contact
We’d love to hear what you think of our first newsletter. If you have feedback about the
newsletter or would like to contact one of us about anything you have read, please email
lesley_holder@moh.govt.nz
Office of the Chief Nurse Sector Update – No.1 May 2015 7