Our community is our purpose
Nurses in Aotearoa New Zealand have a proud tradition of caring for individuals, families or whānau, and communities. Since the mid-19th century - through good times and bad - nurses have provided services to communities by horseback and bicycle, through to four-wheel drive and flight transfer. Nurses are integral to the health, social and psychological care of New Zealanders and will continue to touch and transform lives.
Nurses appreciate the respect afforded to them by the community which has endured over many decades. Nursing has changed throughout this time, and people are often unaware of the knowledge and skill of contemporary nursing. The community perception of contemporary nursing needs to expand beyond traditional virtues, to be seen as compassionate, knowledgeable, qualified, clinically-skilled and professional in service delivery.
2.1 Our community is changing
- Our overall population is ageing – with an increasing proportion of people over the age of 85 years
- In contrast, our populations of Māori and Pacific peoples are younger - service provision will need to reflect the requirements of these groups and be culturally appropriate
- Our population is becoming more diverse – care and support will need to be adapted to meet the needs of migrants from around the world
- There is a growing understanding of lesbian, gay, bisexual, transgender, intersex and queer people (LGBTIQ). However, there is discrimination, a scarcity of data about LGBTIQ people, and lack of access to transgender healthcare in New Zealand
- There is a change in where people are living – more people are choosing to live in the cities rather than regional areas. There are more people living in multigenerational households
- Many people are employed beyond the age of 65, and people of all ages are working longer hours. It is becoming harder to find volunteers for health and social-related charities and service groups
- The gap between rich and poor is increasing and this affects our whole society (the inverse care law)
- People’s requirements and expectations of health care and support are increasing.
2.2 NZNO: advocating for the community and for government investment in health
'Shout out for health' is the NZNO member-led campaign for a fully funded public health system. Member-leaders around the country are ready to talk about how health underfunding is affecting their work, their patients, and their communities. Through this campaign, NZNO now has trained member leaders throughout Aotearoa New Zealand who are better able to continue to advocate on behalf of the profession and the community in which they live and work.
The consumer experience of health-care provision in Aotearoa New Zealand is a crucial consideration in policy and decision making. Consumer representation can be an important source of information regarding the realities of using specific health services, quality issues and priorities from a community's perspective.
The voice of consumers in co-design of health services is essential.
- Amend documentation and policy to require consumer involvement wherever direct care to the consumer is an outcome of that work, eg models of care, standards of care, service design
- Consider options to improve consumer input and representation on its governance board by 2023.
2.3 Health needs in the community are changing
Health care is increasingly being moved out of hospitals and into the home and community.
Community care aims to reduce hospital length of stay, increase patient choice and satisfaction, improve health outcomes, reduce unscheduled health care use, embed prevention and health promotion models, and deliver care closer to home.
Home and community-based services can improve outcomes by supporting active recovery and rehabilitation by preventing unnecessary loss of independence.
In particular, research has found that care in the community can be an effective alternative to hospital treatment for older people and those with long-term conditions.
2.4 Patterns of health and ill-health are changing in our communities
Nursing is part of the continuum of care from prevention through to palliative care. This section focuses on the major health issues facing Aotearoa New Zealand, due to their impact on nursing and the health system.
Aotearoa New Zealand has an ageing population that is living longer. Over 60 per cent of people in acute settings are over the age of 65.
NZNO supports the care and support of seniors in their own home. NZNO welcomes the current strategic direction of: a comprehensive, evidence-based assessment for people aged over 65 (interRAI NZ), guaranteed hours, and a wage that is stepped to educational achievement for home and community support workers. However, the ratio of registered nurses (RNs) to home and community support workers in this sector is unacceptable, and RNs do not have pay parity with their DHB counterparts.
Nursing services for older people aim to:
- increase ability to remain living well in one’s home, to remain connected with friends and family, and to remain meaningfully engaged within their community
- reduce long-term reliance on formal supports
- reduce avoidable hospital admissions
- avoid, or delay, premature entry into aged residential care service.
NZNO supports the Ministry of Health’s Healthy Ageing Strategy of which ageing in place is a fundamental concept. It is important to keep ageing New Zealanders well and functioning at their best, in the home of their choice. However, NZNO notes the strategy must be accompanied by the investment required for successful implementation. The strategy understates the significance of frailty and advanced frailty for older people living in the community.
- Advocate for increased service funding and particularly for greater RN and enrolled nurse (EN) numbers and pay parity with DHB-funded older persons home-based care and support services
- Work with Health Workforce New Zealand and Careerforce to ensure that RN clinical leadership, direction and delegation is integrated into planning and implementation of the Kaiawhina Workforce Action Plan Framework.
Frailty is a common syndrome, characterised by age-associated decline in physiologic reserve and function, leading to increased vulnerability to adverse health outcomes. Frailty is increasingly prevalent with age and is largely irreversible. Caring for frail, older people is challenging because they have an increased burden of medically complex symptoms and often have uncertain recovery potential and longer recovery time.
Many clients are living in their own home in severely frail states. This has implications for delivery of home-based support services, RN input (including oversight of community support workers) and specialist gerontology nursing.
- Use its gerontology and EN sections to support the emerging science of frailty, in particular nurse-sensitive indicators.
- Advocate strongly for the updating of the New Zealand sector standards for aged care, in particular for safe staffing levels.
Health literacy is the ability to obtain, process, and understand basic health information and services to make appropriate health decisions. It helps people to build their knowledge, skills and potential to make positive behaviour changes.
Patients with low health literacy have higher morbidity and mortality rates for most major health conditions. Lower health literacy has negative impacts on patient knowledge and understanding of their condition, appointment attendance, and adherence to medication regimens and health behaviour advice.
Health literacy is fast becoming an online activity. This can be a positive step, however basic health information accessed on the internet needs to be evidence based and reliable. Many consumers looking online lack the skills to appraise the value of the information they have sourced. Nurses can help to interpret and assess the validity of information found online.
The joint NZNO/College of Nurses Aotearoa Call to Action on Health Literacy outlines simple strategies that nurses can use to address the health literacy needs of New Zealanders.
Long-term conditions are ongoing, chronic or recurring conditions that can impact significantly on peoples’ lives. Nurses play a role in the prevention of long term conditions as well as promoting self management.
Long-term conditions such as cancer, diabetes, cardiovascular, respiratory illness and depression are increasingly important issues in health care - they have high prevalence and extensive personal and social effects, requiring an approach to health care that emphasises integration, continuity, self-care and access to advanced care planning. Nurses are in an ideal position to respond to the rapid increase of long-term conditions, as they work across the lifespan and across the continuum of care.
Aotearoa New Zealand needs a critical mass of nurses who have expertise to assess and prescribe in the area of long-term conditions, a model of care that supports long-term condition management in diverse settings, and access to health care for those at most risk. Action is required NOW to halt the spread of this non-communicable disease epidemic, it has severe consequences for the individual or whānau and the population of Aotearoa New Zealand.
While technology has, and will have, an increasing part to play in long-term conditions, it is the interaction of nurse with patient regarding positive lifestyles, navigating complex health systems, and walking alongside the patient to achieve their goals that will make the difference.
Promoting respiratory health
Prevention of many respiratory illnesses is achievable. There is potential for significant respiratory health gains by improving health services across the continuum of care.
Respiratory illness occurs across all ages and is highly influenced by the determinants of health.
Research by the Asthma and Respiratory Foundation identifies health inequality across socio-economic and ethnic groups as the most relentless and disturbing pattern seen in respiratory health.
Respiratory conditions are a major burden on the Aotearoa New Zealand health budget and health outcomes. Aotearoa New Zealand has the fourth highest hospital admission rates for asthma in OECD countries and respiratory diagnoses made up 10 per cent of all overnight hospitalisations in 2015.
NZNO’s College of Respiratory Nurses supports a “call to action” to prioritise the promotion, prevention and intervention in respiratory health in government health targets.
Nurses are the solution in a model of care that supports universal coverage, access and affordability, and utilises nursing knowledge and skill to the fullest extent.
- Advocate for an inter-sectoral approach to long-term conditions and their management and prevention across the lifespan Advocate for increased investment to achieve a critical mass of RNs able to assess, prescribe and promote respiratory health and other long-term conditions through better prevention, detection, treatment and education
- Advocate for the reduction of poverty and sub-standard housing, as these are often a high-risk factor for acute and ongoing respiratory illness.
NZNO supports the notion of “good lives” for people with disability and the Disability Strategy of New Zealand’s whole-of-life and long-term approach to disability - providing the right support and services for the disabled person and their family. There is an increasing number of disabled people requiring assistance with supported self-management as they age, especially in relation to long-term conditions. Increased investment in nursing care and support services will be required for this population.
Pacific people do not access disability services as readily as other populations in Aotearoa New Zealand. There is a role for improved advocacy by health professionals to ensure Pacific peoples and other under-represented groups are able to access disability services.
- NZNO acknowledges and supports the New Zealand Disability Strategy 2016
- NZNO is cognisant of the obligation contained within the United Nations Convention on the Rights of Persons with Disability and the responsibility New Zealand has as a signatory to this convention
NZNO will use a partnership approach to advocate for population groups who do not access disability services as readily as others.
2.5 Technology is dynamic and evolving
Technological change is occurring rapidly in the health sector and in society. Technology brings many positive benefits to patients and health staff – however it is a complex area.
Technological change is inevitable and NZNO will embrace the safe, secure and effective use of health technologies. More information on NZNO’s strategy regarding technological change can be found in the (NZNO Position Statement: Nursing, Technology and Telehealth. link to http://www.nzno.org.nz/Portals/0/publications/Position Statement - Nursing technology and telehealth, 2016.pdf)
Nursing expects the following critical core principles to apply to information and communication technologies in health services:
- Ease of use and minimal set up
- Access anywhere, anytime
- Support, enable, empower
- Along the continuum of care, a range of content (health information), equipment, smart devices, and applications will be available, based on patient need and choice.
- A connected community of care - the system supports the concept of a connected community of care, whether it is patients connecting with their family members, health centres to hospitals, or specialists to other professionals.
NZNO will remain wholly committed to nursing as the human face of health. Nurses journey with the patient in the most appropriate way, in health, rehabilitation or towards a peaceful death. Information technology will facilitate care and support and empower the patient and the nurse. However, the compassionate and relational dimensions of care and support are a foundation that is irreplaceable and will remain crucial now and into the future.
- NZNO provides policy and guidance to NZNO members relating to the use of new technologies
- Complete an NZNO e-nursing strategy as stated in the NZNO Position statement on nursing technology and telehealth (2016), to integrate the physical/practical, educational and regulatory changes required to realise the potential benefits of telehealth and technology outlined in the New Zealand Health Strategy 2016
- Support a socio-technological health model
- Advocate for NZNO as a major stakeholder in the development and implementation of the New Zealand Digital Health Strategy
- Develop increased capability and agility in the area of emerging technologies including robotics, artificial intelligence and seek involvement in projects and their evaluation
- Continue to encourage nurses to join HINZ to be at the forefront of information communication and technology as it impacts on health and people in our community.
2.6 Third-sector organisations
“Third-sector organisations” are neither public sector nor private sector and include voluntary and community organisations, social enterprises and co-operatives. Their close community links are invaluable in providing flexible, responsive and innovative service delivery.
The number of volunteers available to third-sector organisations is diminishing. This will have a severe impact on service users and providers. The third sector is also being affected by less individual philanthropic funding and no increase in contract funding.
Nurses provide knowledge and skills to many third-sector organisations. They are subject experts in their field, often work autonomously or in a very small team and over a wide geographical area. Nurses working in third-sector organisations are very close to their communities and can identify patient or whānau issues/gaps in services very quickly.
NZNO is cognisant that nurses working in third-sector organisations are often isolated, their work largely invisible, subject to variable terms and conditions of employment, and with scarce resourcing. The outcomes they achieve for their patient group are remarkable and often understated.
- Increase the visibility of, and support for, third-sector nurses through its publications, case studies and other fora.