Nursing leadership narrative for change


In collaboration with nurse leaders, the Office of the Chief Nursing Officer has developed a nursing leadership narrative to support leadership development across the nursing sector. The narrative is to be used in conjunction with the key discussion points that follow. The narrative will remain a work in progress as we continue working with nurse leaders, the people we care for and others to refine and develop it. 

The narrative:

  • supports a shared understanding of nurse’s contribution to implementing the strategy
  • captures our current work and the future work we will need to do
  • provides nursing leaders with a narrative to draw on and share as they engage with others
  • enables an individual and collective response to health system change.

Leadership narrative

Every place is the right place for responding to the health needs of people.

The 2016 New Zealand Health Strategy (NZHS) has a strong emphasis on primary prevention and early intervention to ensure New Zealanders live well, stay well, and get well. Realising the vision of the NZHS requires a fit-for-purpose, responsive health workforce and system that makes the best use of everyone’s knowledge and skills.

While recognising the critical role of secondary and tertiary services for those that need them and that significant achievements have been made, radical change in the way we work is needed to ensure that nursing is equipped to embrace the future. This requires substantial shifts in thinking and practice from traditional places of care (hospitals) to care closer to people’s homes, and from an illness focus to a prevention focus.

Nursing is well placed to support a proactive health service that works to protect, restore and maintain wellness from birth to death. Nurses use a strengths-based approach to enable and mobilise individuals, whānau and communities. They can use this approach to work with others to co-design new models of service delivery.  To do this will require putting people’s views at the forefront of decision-making. 

Nurses can influence change through:

  • engaging in clinical leadership with colleagues
  • advocating a shift in emphasis from illness to wellness
  • emphasising primary prevention and early intervention
  • driving innovation and supporting access, quality and safety.

Leadership is required to ensure a workforce and system relevant to the needs of people. This means services that are people centred; integrated; responsive to Māori, Pacific and those with high health needs; and that support equity of access. 

Key points underpinning the narrative

  • The New Zealand Health Strategy envisages a more integrated and person centred model of care, and early intervention and prevention-focused health services.
  • An integrated model of care is one that blends health, social, education, justice and community services; is responsive to high needs populations; supports equity of access to and quality of services; and has a focus on determinants of health, particularly in early childhood, that set a pattern for later life.
  • The government is committed to investing early in people’s lives (from pre-conception through to early childhood).
  • Key drivers are persisting inequalities, a growing and ageing population, the unsustainability of a siloed and disease-focused model, and developments in technology (such as genomics, robotics and nanotechnology) that will change health care in ways not yet imagined.
  • The narrative recognises peoples’ desire to be active participants in their health care and the importance of building health literacy to enable people to better manage their health.
  • Realising the vision of the New Zealand Health Strategy will require maximal effort from a health workforce with the right skills, in the right place, at the right time to meet the needs of the population.
  • As the largest health professional workforce, nursing is well placed to contribute to new models of care. Work has been done to remove statutory barriers and enable nurses to work to the full extent of their scope of practice. A focus on workforce data has provided us with a good base for planning to meet future need.
  • To increase responsiveness to Māori, more Māori nurses are needed, with more in leadership positions. This holds true for Pacific nurses too. 
  • There are opportunities for nurses working in all settings to influence the development of services, demonstrate clinical leadership, drive innovation and collaborate with sector partners and users.
  • Nurses combine their clinical and interpersonal skills to engage, educate and work with people and their families/whānau. 
  • To improve responsiveness and assist families to self-manage their health and life goals, nurses will need well developed skills in assessment, motivational interventions and brief counselling; rapid response for management of acute care in homes; and long term conditions management.
  • Nurses and others will also need enhanced skills in system navigation and will need to be capable of working with a wider variety of community, iwi, and public service agencies to deliver more integrated interventions.
  • Key enablers to nursing’s contribution include opportunities to undertake advanced education. It is also important for experienced nurses to support the development of graduates’ skills, knowledge and expertise.
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