Nursing Workforce Governance Group

The Nursing Workforce Programme is supported by a Governance Group and Working Group that each meet quarterly.

The Governance Group is chaired by the NNO Chair and consists of:

  • DHB Chief Executive Officers (CEOs)
  • DHB Directors of Nursing
  • CEO Primary Health Organisations
  • CEO New Zealand Aged Care Association
  • Pacific nursing representative
  • Māori representatives from Te Runanga o Toa Rangatira Inc
  • National Māori PHO Coalition representative
  • Consumer representative.

Key messages from the meetings

Key messages - 25 August 2017

At its meeting on 25 August 2017, the Group:

  • discussed the April 2017 Strategy Day and recognised that there would need to be significant change to get to ‘good’ by 2030
  • accepted a slogan to be tested – ‘Your health and wellness through new nursing’ with the following strategic pillars:
    • Nursing leadership
    • Structural change
    • Strengthen relationships with consumers, customers and communities
    • A shift to the front end of care.

Key messages  - 16 May 2017

The Nursing Workforce Governance Group (the Governance Group) met on 16 May 2017 and agreed the following key messages: 

  • The Governance Group agrees the current model of vocational training is not fit for purpose for meeting future needs. The model requires change to better suit the future needs of the community and should have greater transparency. The group is less certain contestability is an effective process for delivering the desired changes. A clear workforce strategy to guide decisions around disinvestment and reinvestment will be essential. 
  • The Governance Group continues to explore barriers to the effective utilization of primary health care nurses and to Nurse Practitioner employment. Research being conducted by Ian Axford fellow Amy Downes was instructive in coming to understand useful strategies for change.  
  • The Governance Group reviewed the findings from the 20 April 2017 Nursing Strategic planning day. The findings will give clear direction to the ongoing work of both the NNO group and the NWGG itself.  
  • The Governance Group is pleased that HWNZ is committed to putting more resource behind activating the decisions and directions of the taskforce.

Key messages  - 25 November 2016

The Nursing Workforce Governance Group (the Governance Group) met on 25 November 2016 and agreed the following key messages:

  1. Nursing workforce is a significant resource and health workforce enabler for improving population health outcomes. The government’s social investment approach is an opportunity to emphasise nursing as human capital or a source of investment, an enabler, and a catalyst for change. Nurses already work actively across key priority areas, including primary health, Well Child/Tamariki Ora, schools, and with vulnerable young people. Nursing as an enabler is part of a broader strategic change model that encompass four components – enablers, models of care, organisation, and business models – as well as the policy, regulatory, funding, and commissioning environments. The Governance Group is mindful of operational barriers that limit using nursing to its full potential. Nurses need to be supported and enabled to make increased and new contributions to the health sector.
  2. The Governance Group supports and endorses the planned 2017 Nursing Forum. The Governance Group agreed with the focus of the Forum being on nursing contribution to future health and wellbeing of New Zealanders to actualise the vision of the New Zealand Health Strategy. The upcoming Nursing Forum will be a proactive and challenging examination of the next 20 years of nurses’ role in a rapidly changing environment. It is important nursing places itself in the broader context of the strategic change model.
  3. The Governance Group continues to keep an active watching brief on the review of Health Workforce New Zealand’s funding allocation model to support medical training. The Governance Group is pleased to note the project is moving toward a whole-of-workforce approach to training needs and looks forward to being an active participant at the forthcoming 14 December 2016 stakeholder workshop held to discuss next steps.

Key messages  - 24 August 2016

The Nursing Workforce Governance Group (the Governance Group) met on 24 August 2016 and agreed the following key messages:

  1. The Governance Group is committed to a whole-of-workforce approach to aged care nursing. Existing mechanisms, including Nurse Entry to Practice (NETP) funding, the Voluntary Bonding Scheme, and the Ministry of Business and Innovations Essential Skills List, could be modulated to better support the aged care workforce. The Governance Group sees additional merit in exploring with the other Health Workforce New Zealand (HWNZ) Taskforces (Medical, Allied Health, and Kaiāwhina included) coordinated and cross-workforce approaches to aged care.
  2. Progress continues with efforts to grow the Māori nursing workforce. The Governance Group, in consultation with the National Nursing Organisation (NNO) treaty partners, has endorsed key levers to grow the Māori nursing workforce. Key efforts will centre around supporting all Māori new graduates into employment, building on current initiatives to promote nursing careers, and building Mâori faculty at universities and other providers.
  3. The Governance Group agrees that the way in which postgraduate study is funded needs to change. Opportunities exist to influence the future direction of postgraduate funding for nursing, especially in the context the New Zealand Health Strategy and possible revisions to HWNZ’s medical vocational funding. The Governance Group has a crucial role to play in ensuring nursing is well placed to contribute effectively to future health need and will remain fully engaged in all relevant discussions.
  4. New Zealand’s models of care need significant and urgent transformation. The Governance Group continues to engage with the Ministry of Health (the Ministry) around its current work programme around models of care. The Governance Group wishes to see a significant departure from the current status quo. Future models of care should be carefully aligned with the New Zealand Health Strategy and sufficiently agile to respond to population health need.

Key messages  - 18 May 2016

The Nursing Workforce Governance Group (Governance Group) met the 18 May 2016 and agreed the following key messages:

  1. The Primary Health Care and Community nursing workforce needs to be aligned to community needs. The primary health care and community health nursing workforce needs to be aligned to the needs of the community and deliver people centred care as outlined in the New Zealand Health Strategy. Current siloed funding, contracts, and some employment relationships may be limiting the best deployment of primary care nurses. Community based and primary health care nurses are pivotal to the achievement of better integrated services across the full continuum of wellness promotion to partnering with people in the management of long term conditions.
  2. Aged Care – The aged care workforce is forecast to decline at the same time as demand is increasing with growth in the older population. There is merit in supporting a stakeholder working group tasked with addressing developing a roadmap of actions to address anticipated demand.
  3. The Governance Group has reiterated its strong support for increasing the presence of Nurse Practitioners in a range of settings. Nurse Practitioners are considered essential for sustaining services at risk from workforce deficits, increasing the focus on wellness and providing boundary spanning roles across primary secondary and tertiary services.

Key messages - 19 February 2016

The Nursing Workforce Governance Group (Governance Group) met on the 19 February 2016 and agreed the following key messages:

  1. Models of Care - For many people the New Zealand health system works well however poor health outcomes continue to be a reality for some New Zealanders. The Governance Group believes that the current model of care delivery is in places reactive, lacking in leadership, funded in fragmented ways, and that the nursing profession is often impeded from delivering customer focused services in many settings. Determining how nursing can help ensure robust and patient-centred models of care that improve outcomes is a central task of the Governance Group’s forward work programme.
  2. Nursing Workforce Forecasting Model - It was noted that the nursing workforce forecast model developed by Health Workforce New Zealand and the Office of the Chief Nurse indicates that the registered nurse workforce will continue to grow in size and will almost keep pace with projected total population growth by 2025. Vulnerable areas in the nursing workforce predicted to decline in the next 10 years are Māori and Pacific nurses, enrolled nurses and registered nurses in continuing care of the elderly settings. The nursing workforce programme intends to develop strategies for each of these areas with sector stakeholders.
  3. Māori Nursing Workforce - The Governance is beginning a process to engage with employers, education providers, iwi and other stakeholders interested in forming local or regional partnerships to achieve the goal of a Māori nursing workforce that matches the percentage of Māori in their population by 2028. The collective impact of central government leadership and a community-based approach with whānau, hapu, iwi, education providers and health providers working together will be needed to achieve the goal.

Key messages - 20 November 2015

The Nursing Workforce Governance Group (Governance Group) met on the 20 November 2015 and agreed the following key messages:

  1. Major achievements of the workforce programme: Significant progress is being made towards removing barriers to nurses practising   to the full extent of their scope of practice.
    • Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill – is progressing through the Parliamentary process and proposes changes in seven Acts to allow health practitioners, including nurses, to perform activities previously restricted to medical practitioners.
    • Designated Nurse Prescribing – has been approved by Cabinet and will allow prescribing rights for registered nurses who work in collaborative teams with people with long-term and common conditions.
    • Nurse Performing Endoscopies postgraduate training progamme – has been developed starting in Semester 1, 2016.
    • New Nurse Practitioner training programme – has been developed to support 20 applicants in 2016 in a revised approach to training nurse practitioners.
    • Standing order regulations - the Minister of Health (the Ministry) has agreed to progressing an amendment to the Medicines (Standing Orders) Regulations to enable nurse practitioners to issue Standing Orders.
    • Verifying death - the Chief Coroner has approved a rule change to allow nurse practitioners, registered nurses, enrolled nurses, midwives and paramedics to verify death.
    • Electronic Special Authority - Medtech has updated software to enable nurse practitioners to apply electronically for Special Authorities on medicines.
    • Mobility parking permits – Crippled Children Society Disability Action now accepts applications for mobility parking permits completed by nurse practitioners.
    • Access to diagnostic testing - local barriers to nurse practitioner accessing diagnostics testing have been addressed through DHB Directors of Nursing and Funding and Planning teams.
    • ACC - has determined that the most applicable code for Self Employed nurse practitioners is 86390 Allied health services (which includes nursing services not elsewhere classified) resulting in a significant decrease in levy rates (from $0.84 to $0.18 per $100). 
  2. Postgraduate education supports nurses to make the greatest possible impact on health outcomes. Investment in growing a nursing workforce with postgraduate qualifications needs to be informed by understanding the purpose of postgraduate study as well as areas of priority need. The Governance Group has identified nurse practitioners, primary healthcare, aged care, new graduates, and developing faculty numbers to be five key areas for further strategic discussion at the next Governance Group meeting.
  3. The future nursing workforce has a critical part to play in new and emerging models of care. The Ministry’s updated Health Strategy underscores the importance of primary health care and community-based services in meeting current and projected health needs. An all-of-government approach that responds to the social determinants of our most vulnerable communities is needed to assure a fair and equitable health system. The Governance Group will discuss these issues as part of a comprehensive assessment of models of care and future health needs in 2016.
  4. Date set for equity in the Māori nursing workforce. The Governance Group has set a date of 2028 for the Māori nursing workforce to match the percentage of Māori in the population. Continuing with the status quo will not be sufficient to achieve the goal. A step change is required that incorporates new, renewed, and sustained efforts to grow the Māori nursing workforce. The Governance Group considers the next step to be partnership and engagement opportunities with iwi, education providers and employers.
  5. Health Workforce Taskforces. The Chairs of the Health Workforce New Zealand Taskforces (Medical, Nursing, Allied Health and Kaiawhina included) have agreed that greater dialogue across the taskforces would be beneficial in progressing an all of health approach to progressing key issues. The Governance Group will seek out collaborative opportunities in 2016. Taskforce Chairs will continue to meet on a regular basis and have agreed to share key documentation and messages in order to facilitate greater connections across work programmes.

Key messages - 28 August 2015

The Nursing Workforce Governance Group (Governance Group) met on the 28 August 2015 and agreed the following key messages:

  1. Models of care need significant change to achieve equitable health outcomes for all New Zealanders. Profound changes that focus contracts and funding on health and social outcomes are required to drive health organisations to operate in ways that promote long-term health and wellbeing. New models of care need to shift beyond health care organisations to include other community sectors. This will support collective action across the multiple factors (social, economic, environmental, behavioural, and clinical) that determine people’s health outcomes.
  2. Māori nursing workforce - The Governance Group has endorsed the importance of growing the Māori nurse workforce iwi engagement, whakapapa connections.  Māori leadership and local champions will be important approaches in the development of the Māori nursing workforce project. Partnering with willing iwi will be important to growing the Māori nursing workforce. Whakapapa connections that include nurses and other health leaders will help link a sense of identity as a nurse with whānau, land, marae and iwi that contribute to well-being. Leadership development and local champions have proven to be successful in growing both Māori and Pacific health workforces.
  3. Immigration and nursing workforce - There is merit in reducing New Zealand’s reliance on internationally qualified nurses. Nursing categories currently listed in the Ministry of Business, Innovation and Employment’s Essential Skills in Demand Lists could be tightened significantly. In aged care, the supply of New Zealand nurses (graduates and experienced) would first need to grow considerably. Nurse leaders have an important role in developing and implementing strategies to reduce reliance on internationally qualified nurses.
  4. Postgraduate nursing funding is an important means of developing the nursing workforce to meet changing population health needs. The Governance Group has a vision for postgraduate nurse education to support better quality practice, leadership development and increase patient safety and access to services.
  5. The Ministry of Health’s investment in growing Pacific nursing leadership has been crucial to supporting the development of the Pacific health workforce. Having the right Pacific people with the right skills in the right places is key to securing better health outcomes for Pacific peoples and New Zealand as a whole.
  6. Championing the importance and visibility of the nurse practitioner role. The Governance Group reviewed international nurse practitioner employment levels and is determined to discuss future New Zealand levels from the basis of interdependencies with other workforce groups and to work towards a stretch goal for nurse practitioner employment. The Governance Group is reviewing a Ministry of Health flyer to ensure the sector has greater awareness and information about nurse practitioner employment potential.

Key messages  - 29 May 2015

The Nursing Workforce Governance Group (Governance Group) met on the 29 May 2015 and agreed the following key messages:

  1. Strong leadership in the health sector requires a team; of which nurse leaders are a vital part. Strong leadership teams are essential to achieving best value for public health system resources; where value includes quality, safety, people’s experience of care, and equity of outcomes. Nursing leadership is an essential component of a leadership team that also includes managers, doctors and allied health professionals working as one team. A model of leadership developed by clinical leaders in the Ministry of Health (the Ministry) is being refined so that leadership teams can evaluate themselves against this.
  2. The number of Māori nurses needs to significantly increase to match the proportion of Māori in the population. The Governance Group commissioned the development of a Māori nursing workforce strategy with a goal of a Māori nursing workforce that matches the demography of Māori in the population by 2030. This strategy will be underpinned by Treaty of Waitangi and equity principles. Improving the match between the nursing workforce and the demography of the population has been shown to improve access to and quality of care.
  3. The balance between the numbers of domestically and internationally qualified nurses should be informed by principles that ensure a sustainable supply of nurses that match the demography of the population. The Governance Group endorses the Ministry of Business, Innovation and Employment’s criteria for determining which occupations are added to its Essential Skills in Demand Lists. The Governance Group considers this criterion as principles that should inform advice on how workforce supply needs are balanced between internationally and domestically qualified nurses to ensure a responsive and sustainable supply of nurses is available to meet the population’s health needs.
  4. Improved employment opportunities for nurse practitioners will enhance the capacity to contribute to effective quality healthcare. The Governance Group supports the development of a stretch goal for the employment of nurse practitioners. To improve the employment of nurse practitioners the Governance Group reinforced its support for a sector developed proposal for a revised model of nurse practitioner education that links closely with employers. Ways of increasing the visibility and value of nurse practitioners will be explored, particularly with employers and within the Ministry.

Key Messages - 27 February 2015

The Nursing Workforce Governance Group (Governance Group) met on 27 February 2015 and agreed the following key messages.

  1. Defining a set of principles that will guide their decision-making. The principles will be based on those in the National Nursing Organisations group’s report to Health Workforce New Zealand. The principles will have a strong focus on enabling people and their families to determine the type of care and support they need and enabling nurses and the systems they work in to meet the needs of the population.
  2. Nursing leadership models based on evidence were seen as critical to the nursing workforce programme. There is evidence that professional nursing leadership models add value to patients through achievement of lower mortality and improved patient safety. They also add value to organisations through improved productivity, intra-professional communication and staff satisfaction. The nursing workforce programme will work to integrate evidence-based models of nursing leadership with leadership activities in the health sector.
  3. Registered nurse designated prescribing was considered desirable for appropriately educated registered nurses. The Governance Group considers this should improve access to appropriate treatment to respond to the rising incidence of chronic disease. The nursing workforce programme will work to ensure nurses are prepared to undertake additional functions and respond to new models of care to support improved access and best practice.
  4. Access to better data is a key objective in order to have timely and comprehensive intelligence on the nursing workforce. The way nursing data is collected in regards to where nurses work and the type of work tends to focus on hospital services. The systems for collecting the data needs to be updated to ensure the contribution of nurses to individual, family and population health outcomes can be more accurately monitored in all settings. The nursing workforce programme will determine a minimum nursing workforce data set that will help to better describe the nursing workforce.

 

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