History of New Zealand Chief Nursing Officers

Grace Neill, 1895 – 1906

Grace Neill was appointed Assistant Inspector of Hospitals from 1895, and is credited with beginning the work of organising nursing. Despite her title not changing throughout her tenure, she is considered the first Chief Nursing Officer in the world.

Born in Scotland, Mrs Neill trained in London and spent time in Australia before moving to New Zealand. After being left a widow with a son to support, she found work as a factory inspector.

She spent her early years visiting various health services and isolated communities around the country. She advocated for standardisation of nursing training, despite facing considerable opposition from matrons and schools wishing to maintain their independence. She was a key contributor to the drafting and passing of the Nurse Registration Act in 1901, making New Zealand the first country to have state registration of nurses. This included a standard three-year curriculum, a state examination and the creation of a register.

Mrs Neill then pushed for similar legislation for midwives, and in 1904 State Maternity Hospitals and training schools were established. This legislation included supervision of obstetric nurses and registration of midwives.

Hestor Maclean, 1906 – 1923

Hester Maclean replaced Grace Neill as the Assistant Inspector of Hospitals in 1906. An Australian of Scotch parentage, she had wide experience in hospitals, obstetrics and district nursing. She is described as a woman of strong character, interested in people and well liked by those she came in contact with.

Miss Maclean led throughout a period of significant developments for nursing in New Zealand. The period saw the beginning of Māori nurse training programmes, increased emphasis on child welfare (including the passing of the Child Welfare Act in 1907) and the prioritisation of district nursing in order to increase access to services in rural areas.

The Private Hospitals Act was passed in 1906 and brought the supervision of private hospitals under the Health Department and identified the proportion of registered nurses or midwives to the number of beds.

This period also saw the beginnings of the NZ Army Nursing service, with a contingent of nurses sent abroad during the First World War, and the influenza epidemic that followed. This led to the new Health Act in 1920 which reorganised the Health Department.

The 1920 Health Act created seven divisions within the Department of Health, one of which was nursing. Miss Maclean was appointed Director, Division of Nursing, making her New Zealand’s first official “chief nurse” in the Department of Health, although the change in title to Director of Nursing was said to be one of title rather than function.   

Miss Maclean founded the New Zealand Trained Nurses’ Association. She was also the founder of Kai Tiaki Nursing New Zealand in 1908, and editor until 1923.

Jessie Bicknell, 1923 – 1931

Jessie Bicknell was the first New Zealand-born Director of Nursing, and is remembered in particular for her work to establish postgraduate and specialist nursing training. She was a trained nurse and midwife who had served in the New Zealand Army Service during the First World War, and was made an Associate of the Royal Red Cross in recognition of her work. Upon her return from the war she worked under Hester Maclean as an assistant inspector in the Department of Hospital and Charitable Aid, before becoming Director, Division of Nursing upon Miss Maclean’s retirement.

One of Miss Bicknell’s key projects was to set up a Nursing School associated with Otago University with undergraduate training and post graduate education for nurses. Without sufficient funds to pay salaries for nursing educators this was terminated shortly after it was established, however a postgraduate course was established in Wellington to prepare nurses as teachers and public health nurses.

In 1925 a new Nurses and Midwives Registration Act was passed and included the establishment of the Nurses and Midwives Registration Board. The first action of the Board was to revise the system of obstetric nurse training, which was finalised in 1930 and included separate training courses for maternity nurses and midwives. The Board was also able to establish reciprocal registration agreements with other countries, making it possible for New Zealand nurses to practise in other countries without additional training or exams. A Superannuation Act was passed in 1926 which included Superannuation Schemes for nurses, something that the New Zealand Nurses Association (NZNA) had been advocating for for some time.

Another testament to Miss Bicknell’s strong commitment to the nursing profession was her work to establish a close relationship between the New Zealand Trained Nurses’ Association and the Department of Health.

In this period the Plunket Society expanded, as did the staff of the Department of Health in regard to district nursing for the Māori population and for school nurses, as well as nurses within TB clinics and industry, and in the Pacific region. The earthquakes of 1929 in Murchison and 1931 in Napier also had an impact on services and nurses, with ten nurses killed in Napier when the nurses’ home collapsed.

Mary Lambie, 1931 – 1950

Mary Lambie was appointed Director, Division of Nursing in 1931, and oversaw significant reforms in nursing and New Zealand’s health system.

Miss Lambie’s early career included working in the school medical service and training as a Plunket nurse before becoming involved in setting up New Zealand’s postgraduate nursing education. She travelled to Toronto to complete the postgraduate training course for public health nurses, to prepare for appointment as a lecturer in the University of Otago’s newly established diploma in nursing. This course was terminated before she could begin work, so she instead trained as a midwife.

She then took up a senior position in the Department of Health, where she started refresher courses for district and school nurses, leading to the establishment of New Zealand’s first Postgraduate School for Nurses in Wellington in 1928 where she was one of the first two tutors. Weeks before being appointed Director of the Division of Nursing, Miss Lambie was called in to lead the nursing efforts following the 1931 Napier earthquake. Upon her appointment the Department of Health focused on consolidating and standardising the work of district nurses.

During the early years of Lambie’s directorship health districts were broken up into smaller health units, with district nurses in each, and she took an active part in inspecting nurses in their workplaces in both district and hospital settings.

The period was impacted by the economic depression and the election of a Labour government in 1935 with an expansion of decentralisation programmes and establishment of social security and health related benefits and free hospital services. This saw demand for increasing nursing staff, instigating active recruitment campaigns. The syllabus was reviewed, a preventative focus was included, public health nursing expanded and the age of registration was lowered. Standards for the care of nurses’ health were developed and hours of work reduced. Nurse aids received training, obstetric nursing training was reviewed and a psychiatric nursing curriculum drawn up.

In 1947 a compulsory salary scale was established for nurses and other public hospital workers to standardise salaries across hospitals.

Lambie was also the patroness of the Women’s Health League. She retired from the Department of Health in 1950 and was appointed as a nurse consultant to the World Health Organisation (WHO), where she made a direct contribution to the WHO nursing training programmes. She continued to be actively involved in the International Council of Nurses and remained a member of the New Zealand Registered Nurses’ Association.

Elizabeth Bridges, 1950 – 1950

Elizabeth Bridges was one of the original graduates of the postgraduate School of Nursing in 1928. Sadly, within months of becoming Director in 1950 she was forced to retire due to ill health, and she died in October that year.

Flora Cameron, 1950 – 1962

Flora Cameron was a trained nurse and midwife and, like Mary Lambie, had also completed postgraduate training in Toronto. She worked as a nurse instructor at the postgraduate school for nurses in Wellington, teaching public health and social work to registered nurses. In 1949 she became Deputy Director of Nursing in the Department of Health, before becoming Director in 1950 following Elizabeth Bridges’ retirement.

Miss Cameron laid the groundwork for significant change in nursing education in New Zealand and was also involved in nursing at an international level, particularly in the Pacific.

Miss Cameron successfully introduced a community nursing course despite opposition from some groups. She was also the registrar of the Nurses and Midwives Board.

During her time there was some hostility between certain employees of the Department of Health and the Parents Centre movement, which was officially launched in 1952. The Parents Centre’s views on natural childbirth did not align with those of many in the medical and nursing professions. While sympathetic to some of their ideals, including in a paper to International Council of Nursing Congress where she stressed the mother’s role in hospital, it is said that Cameron openly disapproved of the movement.

Audrey Orbell, 1962 – 1966

Audrey Orbell was a trained nurse who had worked in Western Samoa as Matron of Apia hospital from 1945 to 1948.

During the period that Miss Orbell was Director, Division of Nursing, the public health nursing service of the Department of Health was centralised within the Division of Nursing, as was the New Zealand Postgraduate Nurses School. As well as the Director of the Division of Nursing being the Registrar of the Nurses and Midwives Board they had historically also held roles in the New Zealand Registered Nurses Association, however in 1966 the roles became clearly defined and separated.

In the 1960s nurse leaders began to express the view that nursing education programmes needed to focus on meeting the specific health needs of New Zealanders, rather than focusing on aligning with international courses to allow for reciprocal arrangements. In 1965 Miss Orbell travelled overseas to negotiate such an arrangement with nurses in the United Kingdom. Miss Orbell also continued Miss Cameron’s work to establish a university level nursing programme, however little progress was made.

Shirley Bohm, 1966 – 1978

By the time Shirley Bohm (Shirley Lowe until her marriage in 1967) was appointed Director of Nursing in 1966 she had already become a respected nurse, awarded the Fraser Medal in 1949 by the Otago Hospital Board for special proficiency in nursing. In 1962 she helped establish an operational research unit in the Department of Health, providing basic data for planning and policy, which became the Health Services Research Unit in 1970.

Significant changes to nursing governance changed during her leadership. The Division of Nursing was reorganised, with the creation of three assistant Nursing Director positions (community health nursing, hospital nursing service and nursing education) and Nurse Advisors. The New Zealand Nurses and Midwives Board was replaced by the New Zealand Council, and principal nurses of district health boards assumed more responsibility for public health nursing services.

Another large area of change during this time was nursing education, in particular the transfer of nurse training from hospital schools of nursing to technical institutes. This followed a commissioned report by Helen Carpenter, Director of Toronto’s University School of Nursing and WHO consultant. The Director-General of Health fully supported nursing education reform. Bohm was moved up to the Director-General’s suite on seventh floor – “a clear indication of his desire for close collaboration”.

Dame Margaret Bazley, 1978 – 1985

Upon her appointment as Director, Division of Nursing, Dame Margaret was a registered psychiatric, general and obstetric nurse and had held multiple hospital-based matron and nurse leadership positions. She had also been president of the New Zealand Nurses Association from 1972-74.

Dame Margaret left the role in 1985 when she was appointed as the first woman commissioner of the State Services Commissioner. “Her (nursing) appointment was advertised in the NZNJ. But when the (NZNA) got a copy of the terms of the new appointment there was great consternation. The job was downgraded in significant ways and instead of a job description there was a ‘duty list’!”. There was a groundswell of opposition, including at one point “a plan for a special train to travel throughout the country to enable nurses to join a march in Parliament”. As a consequence, the responsibility and authority of the position was reinstated.

Dame Margaret went on to hold a number of high-profile public service leadership positions including Chief Executive of the Ministry of Social Policy, Director-General of Social Welfare and Secretary for Transport. In 1999, in recognition of her significant contribution of the New Zealand public service, Dame Margaret received a Dame Companion of New Zealand Order of Merit.

Sally Shaw, 1985 – 1987

Photo of Sally ShawSally Shaw was appointed to the Ministry of Health Chief Nurse role in 1985. She was one of the earlier New Zealand nurses to undertake a university degree in nursing, graduating from McGill University in Montreal in 1967. Subsequent experience in New Zealand included public health nursing, tutoring at the NZ School of Advanced Nursing Studies (successor to the NZ Post Graduate School for Nurses), and Assistant Director (Public Health Nursing) in the Division of Nursing where she worked under two previous Directors: Shirley Bohm and Margaret Bazley.

Sally Shaw began her term as Chief Nurse the year of the ‘Nurses are worth more’ campaign of 1985. This was the first opportunity for some time for a major review of nurses salaries, but nurses in Government had to stand apart from this time of challenge.

During her time in the Chief Nurse role, Shaw took part in international meetings that reinforced the need to prepare for challenges and changes ahead in the health sector. She organised a residential workshop in the Marlborough Sounds that Chief Nurses of regional health boards attended, to consider the potential impacts of health sector changes and the introduction of general management.

Shaw left the role to become Acting Assistant Secretary, Workforce Development before leaving the Ministry in 1989. The following year she was appointed District Health Manager for the Eastern Bay of Plenty under what became the Bay of Plenty Area Health Board. She was thus involved at a regional level, between 1990 and 1995, in the health sector changes that had been foreseen.

In 1996 she became the coordinator of the new International Council of Nurses’ (ICN) Leadership for Change project, launched to strengthen leadership and management skills among nurses and broaden the positive impact of nursing on health systems and the wider societies they are responsible for. In this role she spent time with programme participants in a number of countries in East, Central and Southern Africa, Asia, the Caribbean and South America. The experiences of nurses from many diverse countries, cultures and health systems were used to illustrate her book Nursing Leadership, published in 2007.

Photo of Sheryl Smail. Sheryl Smail, 1988 – 1992

Sheryl Smail succeeded Shaw as Chief Nursing Officer in the Department of Health during a time of change in the management structure of hospitals and area health boards, particularly with the introduction of a general management level which resulted in Chief Nurses no longer reporting directly to their board.

In response to this, Smail called a Chief Nurses workshop in 1989 to assist the transition of the role to that of professional advisory at the corporate level in the new general management structure. In a speech at the NZNA conference in 1988 she called for nurses to be actively involved in these management changes in order to ensure that nurses were represented.

Smail left the role to work for the National Interim Provider Board, Department of Prime Minister and Cabinet to contribute to planning the provider component of the health reforms that separated health funders from health providers. In 1993, she moved back to the provider arm herself, initially as General Manager, National Women’s Hospital then, in 1995, as Chief Executive for a Crown Health Enterprise, Tairāwhiti Healthcare. Smail still participates in the health and disability sector, including her appointment, in 2013, as Chair, Beetham HealthCare and in 2020 as an Alzheimers NZ board member. Through her own business, she also provides executive coaching and independent facilitation of group decision processes to support entities in health and other sectors.

Gillian Grew, 1992 – 1997

Gillian Grew was appointed Principal Professional Advisor (Nursing) with the Department of Health in 1992, with one of her major work programmes being establishing the cervical screening programme. In an interview in December 1992 she stated that she wanted to “ensure that the nursing profession has some input into all major appropriate health policy decisions” and expressed concern that nursing had been dispersed in the department which had lessened the impact of their professional advice.

Dr Frances Hughes, 1998 – 2004

Dr Frances Hughes succeeded Gillian Grew as Chief Advisor (Nursing) at the Ministry of Health in February 1998. Dr Hughes initiated the 1998 Ministerial Taskforce on Nursing and worked with the New Zealand Nurses Organisation (NZNO) on the extension of prescribing rights to nurses. Under her leadership the nurse practitioner scope of practice was introduced in May 2001, followed by the first prescribing nurse practitioners.

In 2001 Dr Hughes was the first nurse to be awarded the Harkness Fellowship in Health Care Policy, and in 2005 she was made an Officer of the New Zealand Order of Merit for services to mental health.

Since this role, Dr Hughes has held senior management and nursing positions on a global level. These include as the first facilitator of the World Health Organisation’s Pacific Island Mental Health Network, Chief Nursing and Midwifery Officer at Queensland Health, Chief Executive Officer of the International Council of Nurses and the University of Auckland’s first Professor of Nursing. 

Dr Hughes currently works as the General Manager Nursing and Clinical Strategy at Oceania Healthcare.

Dr Mark Jones, 2005 – 2009

Dr Mark Jones became Chief Nurse of the Ministry of Health in 2005, moving from the United Kingdom to take up the position. He had spent 13 years as primary care policy and practice advisor to the Royal College of Nursing before becoming the director of the Community Practitioners and Health Visitors Association in 2002. He was instrumental in introducing the nurse practitioner role in the United Kingdom and spent six months on a Public Health Service fellowship in the United States, working with political advisor Ira Magaziner on proposals to reform the United States health service.

Under Dr Jones’ leadership, the single nursing advisory role grew to become an established team of senior advisors under the chief nurse. He made strong steps in building connections with Directors of Nursing across the country.

Whilst working as Chief Nurse, Dr Jones concluded his doctoral research considering how people assess, process and use information to make choices about their health.

Following his time in the role he went on to lead the Global Health Alliance of Western Australia. He was also Professor for Transcultural Health Improvement at Curtin University Perth and led teams educating nurses and midwives in East Africa. He returned to New Zealand and was Head of the School of Nursing at Massey University. He now works as an independent consultant, along with being Chair of the College of Nurses Aotearoa and President and Chair of the Nurses Christian Fellowship New Zealand.

Dr Jane O’Malley,  2010 – 2018

Dr Jane O’Malley was appointed to the Ministry of Health Chief Nurse role in 2010. Prior to this she was Director of Nursing and Midwifery for the West Coast District Health Board. She was president of the New Zealand Nurses Organisation from 2001 to 2005 and had worked as a clinical nurse manager and nursing academic. From 2010 to 2012 she was Chair of the South Pacific Chief Nursing and Midwifery Alliance.

Highlights of Dr O’Malley’s time as Chief Nurse included the coming into effect of the long-awaited Health Practitioners (Replacement of Statutory References to Medical Practitioners) Act, which removed legal barriers to nurses and nurse practitioners working to the full breadth of their scope; working with the Nursing Council and national nursing organisations (NNO) Group to develop three levels of nurse prescribing; and the creation of the Nursing ACE new graduate recruitment system.

Dr O’Malley also oversaw an increase in resources at the Ministry in order to strengthen the nursing profession’s advice and input into health policy.

On leaving the role O’Malley became Plunket’s first Chief Nurse, a role which she said reflected her belief in New Zealand’s health strategy, “in particular that we can make better inroads into improving people’s health by paying attention to the early years”.

Margareth Broodkoorn, 2019 – present

Margareth is of Ngāpuhi and Dutch whakapapa, and is New Zealand’s first Māori Chief Nursing Officer. She has over 30 years experience in the health sector working in a range of clinical practice, leadership, management and education roles.

She is committed to improving access to health services for all consumers, and developing an enabled, responsive and culturally safe workforce. She is passionate that nursing can make a significant difference in achieving equity in health outcomes across Aotearoa with a sustainable future focused nursing workforce that leads change and innovation in partnership with the wider health team.

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