A Short History of the Nurse Executives of New Zealand

The Department of Health initiates meetings of Chief Nurses

Back in the 1970s and early 1980s it was the practice of the Director of Nursing of the Department of Health to call an annual meeting for Chief Nurses of hospital boards to discuss topical issues, share information and act as an expert resource group. Health sector reforms in 1983 lead the then Director, Mrs Margaret Bazley, to advise that it was no longer considered appropriate that the Department of Health initiate these meetings.

The Chief Nurses of New Zealand is formed

A working party of Chief Nurses (Shona Carey of South Canterbury, Janice Neame of Otago, Barbara Shadbolt of Wellington and Janice Wenn of Taranaki) recommended to the Chief Nurses that an independent association be formed. The aims and objectives of The Chief Nurses of New Zealand were:

• To represent the views of Chief Nurses on major issues in the health services of New Zealand
• To provide forums for dialogue, discussion and dissemination of information for Chief Nurses
• To promote and initiate the preparation and education of senior nurse administrators

The first chairperson was Barbara Shadbolt, Chief Nurse of the Wellington Hospital Board and the organisation enjoyed membership from all Hospital Boards. An executive committee was formed and there was a loose network established on regional lines for between meeting communications.

The first conference and inaugural meeting of The Chief Nurses of New Zealand were held in Christchurch on 25 September 1984. The newly elected Minister of Health, Hon Dr Michael Bassett opening address to the conference was of considerable political significance as he outlined for the first time some of the new Government’s health priorities particularly in the fields of primary health care and psychiatric services.

The first annual report of the organisation records that the Chief Nurses of New Zealand and the New Zealand Nurses Association worked closely together to express deep dismay to the Director General of Health and the Minister of Health at the erosion of the role of the Director of Nursing, apparent in the job description for the advertised vacancy.

The appointment process was suspended and the job description revised by the Department of Health at the Minister’s direction. Sally Shaw, the former Deputy Director, was later appointed as the new Director of Nursing. The Chief Nurses of NZ continued to enjoy a close working relationship with the Director of Nursing.

The advent of Area Health Boards

Enabling legislation came into effect in 1985 to permit the formation of Area Health Boards through the merger of Hospital Board and District Health Office functions of the Department of Health. The 1986 report of the chairperson of The Chief Nurses of NZ records support for the area health board concept but deep concern regarding the clarity and readiness of national guidelines and policies, particularly in the personnel field, for this development. The health sector was moving from a tightly regulated structure to one of regional accountability and variation.

The Chief Nurses of NZ developed position statements at this time on the management of area health boards advocating for a head of nursing services in a triumvirate structure, provision of nursing services by a qualified workforce, and future nursing structures to provide for career opportunities and protection of nurses following on from the phasing out of hospital based nursing education.

Membership of the group was extended to the Deputy Chief Nurse of Hospital and Area Health Boards where the position had been formally established. Shona Carey of Timaru succeeded Barbara Shadbolt as chairperson of The Chief Nurses of NZ.

Taskforce to Review Hospital and Related Services

1988/89 was a year of change and uncertainty for many Chief Nurses. The taskforce headed by businessman Alan Gibbs to review the structure of the health service reported to the Labour government in 1987 and in 1988 the State Sector Act established a framework for change in the public sector, including health services.

Hospitals and Area Health Boards were restructured and general management introduced. For the first time chief nurses were not directly responsible to their respective Boards, and there was considerable loss of experienced nurses. Some Chief Nurses moved onto general management, some were appointed to joint management and nursing leadership roles, others continued in nursing positions. Many experienced job loss as their positions were restructured.

Throughout this time The Chief Nurses of NZ continued to be involved with the national Review of the Preparation and Initial Employment of Nurses (RIPEN) and the National Action Committee appointed to implement the recommendations of this report on career development for nurses.

Sally Shaw was succeeded by Sheryl Smail as Chief Nursing Officer in the Department of Health. She was instrumental in calling a workshop for chief nurses in 1989 to assist the transition to a professional advisory role at the corporate level in the general management structure.

Ron de Witt of Auckland succeeded Shona Carey as chairperson of The Chief Nurses of NZ. There was much talk about the future of the group as the health sector experienced a state of transition. Membership was fluid as a result of employment changes, not all boards in the country were represented at meetings. There was real sense of loss of nursing voice and place in the health sector. In an effort to promote nursing, the group hosted a national conference “Celebrating the Diversity of Nursing” to affirm nursing practice and conscious commitment by nurses to nursing, and to provide an opportunity for non-nurses to grasp in a practical sense what it is that nurses really do.

Rejuvenation of the Chief Nurses of New Zealand

1991/92 was a busy year for the group, which firmly established as a principal role member peer support and review of issues of national and individual concern. Members took an active part in planning and policy making on the implementation of the health reforms, nursing and midwifery education, occupational regulation, and leadership for the nursing profession.

Membership attendance was regular, although there was concern that changes in administrative arrangements at some health boards meant there was no named senior nurse executive or nurse advisor employed. An executive of regional representatives was established and Elizabeth Lee of Northland succeeded Ron de Witt as Chairperson of the group. Thinking Nursing an information booklet to assist nurses and others involved in health service management and planning to identify and think through issues of importance for nursing was published by the group.

The Nurse Executives of New Zealand

The Annual Report of Chairperson of the Chief Nurses of NZ describes 1992/93 as a year of whirlwind activity with fundamental change to the organisation of health services. Regional health authorities, crown health enterprises, the Public Health Commission, the National Committee on Core Health and Disability Support Services, and the Ministry of Health were all established. The NZ Nurses Association and the NZ Nurses Union reorganised to become the NZ Nurses Organisation.

Despite the turnover of almost all the members of the group as a consequence of the changes, the Chief Nurses of NZ were able to refocus the organisation and continue to work on current issues of importance for nursing.

A strategic plan was established for the organisation to be known as the Nurse Executives of NZ. The purpose of the group was to provide regional and national nursing leadership, to act strategically on nursing and other health matters, and to influence the development of nursing practice. Membership was open to one nurse executive from each crown health enterprise, the Departments of Justice, Defence and Labour, and the senior nurse executive from the Department (later the Ministry of Health) an ex officio member. Concerned about loss of nursing leadership expertise, the group made provision for members who lost their employment positions through restructuring to continue in the group if they wished as emeritus members.

Gillian Grew was appointed as Principal Professional Advisor Nursing with the Department of Health, succeeding Sheryl Smail.

A focus on professional standards

1993/94 saw a focus on development of professional standards for education and entry to the profession. The NZ Qualifications Authority was established with overlapping statutory authority for nursing education standards with the Nursing Council of New Zealand. There was concern about the relentless progress to establish nursing unit standards on the NZQA qualifications framework. The Nurse Executives of New Zealand (NENZ) worked tirelessly to promote the role of the Nursing Council in establishing entry and practice standards, and continuing competence of nurses and midwives. The outcome has been a joint approach with the Nursing Council responsible for practice standards and the Qualifications Authority responsible for education standards.

A joint meeting of nursing organisations called by NENZ had wide ranging discussion on a number of issues for the proposed Nurses and Midwives Bill. The group was not united in its views and was unable to influence to government to advance the Bill on the legislative programme, which gave priority to a new Health Commissioner Bill and a revised Medical Practitioners Bill.

Other issues addressed by the NENZ this year were the development of prescribing rights for nurses, the purchase of clinical training for nurses in pre and post entry programmes, workforce planning. Joanna Harper, Director of Nursing Hawkes Bay was voted as Chairperson in 1995.

In 1995, the membership of Anita Bamford, Director of Nursing from Mercy Auckland and Barbara Fox from St Georges Christchurch was agreed.

An active approach to key professional issues

NENZ established its first strategic and business plan in 1996/97 with key issues and a portfolio structure to manage the work of the organisation in the face of continual restructuring and other change occurring in the health sector. Change in membership followed change in nursing leadership roles in many crown health enterprises, and there was loss of experience and institutional knowledge as a result.

Difficulties were experienced advancing some of the NENZ work programme because health sector restructuring discouraged collaboration between health service providers and other health sector groups. An example of this was seen in the workforce planning and benchmarking project that commenced this year. NENZ had been concerned for some time that there was no national workforce planning being done to assure the future of quality health services. The project was to establish a national nursing workforce data collection and comparison process, the intention being to agree and define appropriate nursing staff requirements to support best practice.

A scoping exercise to identify nursing titles and terminology in common was developed, but the project lost momentum when support for its implementation was not universal among the health provider participants. Ministry of Health assistance was finally established two years later after the report of the Ministerial Taskforce on Nursing found a need to develop consistent processes for measuring the work of nursing and a new project was established.

The NENZ were active in promoting regulatory change through the review of the Nurses Act, the introduction of competency based practising certificates, and the introduction of prescribing rights for nurses.

The absence of a formal forum for professional debate among the various nursing groups was a barrier to progress and reaching consensus on professional issues. NENZ initiated meetings with and made submissions to various groups and agencies on matters relating to nursing. Working with the Nurse Educators in the Tertiary Sector (NETS) and the Mental Health Managers group, NENZ promoted to the Nursing Council of NZ the need for a review of the undergraduate nursing curriculum, the aim being to ensure graduates are well prepared for the changing health environment.

Other work in relation to nursing education was the development of the Post Graduate Education Framework as a collaboration between NENZ and NETS, submissions to CAPE on their strategy for education and training for the health and disability support sector, and to the Nursing Council on their draft standards for post-registration nursing courses.

Restructuring a constant state in the health sector

Constantly changing membership of NENZ was again a feature of the 1997/98 year as restructuring within the health sector remained a constant. The Annual Plan for the organisation proved valuable in providing a sense or purpose, structure and direction. Technology such as e-mail and telephone conferencing proved invaluable in supporting the work of the group.

Maintaining a proactive approach to the key professional issues of workforce benchmarking and the legislative review programme were significant activities. The group established a compendium of position statements, the current views of nurse leaders on key issues facing the profession, as a living document to be reviewed and updated each year. The statements were circulated to relevant organisations and individuals as the group worked to influence their views and make progress on issues. The statements included:

• The role of nursing in the health service in NZ
• Nursing leadership in the health service in NZ
• Safety in nursing and midwifery practice
• Cultural safety and professional practice
• Research
• Comprehensive preparation for professional practice
• Preparation for maternity practice
• Post registration nursing and midwifery education
• Post registration programmes for advanced clinical practice
• The first year of practice
• The role of the second level nurse
• The role of registered nurse working with unlicensed assistive personnel
• The changing role and function of nursing practice
• Professional education and the New Zealand Qualifications Authority
• Information systems to support professional practice

NENZ worked in collaboration with other professional groups to publish papers on some key professional issues, including:

• Developing and Supporting advanced practice roles of Clinical Nurse Specialist and Nurse Practitioner
• Health Service Assistant and the Registered Nurse: A discussion paper, principles and guidelines
• Framework, guidelines and competencies for post registration nursing education, a publication of the Nursing Council
• Commonwealth Nursing and Midwifery Action Plan for NZ with the Chief Advisor Nursing from the Ministry of Health

A forum for collaboration with Crown Health Enterprise Chief Medical Advisors was established to take a leadership role in addressing common issues. The relationship continued with NETS to progress issues on undergraduate and postgraduate education in support of goals for nursing practice.

An historic opportunity for the profession to shape the future of nursing and health outcomes for New Zealanders was created through the Ministerial Taskforce on Nursing in 1998. NENZ was represented on that group and has subsequently taken responsibility for implementing some key recommendations.

NENZ held a successful leadership conference “Leading the Profession” in Rotorua in 1998. Response to this was so positive from the profession that the group determined to hold similar conferences each year to influence the development of a strong profession to meet changing social and health needs.

Frances Hughes succeeded Gill Grew as Chief Advisor (Nursing) in the Ministry of Health in late 1997 and the valuable relationship with NENZ was maintained. The first Associate Chair positions were established by NENZ with the appointments of Debbie Penlington of South Auckland and Beth Cooper Liversedge of Wanganui.

Significant and exciting developments

Barriers to releasing the potential of nursing and strategies to address these which were identified and published in the Report of the Ministerial Taskforce on Nursing in 1998 were a key focus for NENZ in 1998/99, as preliminary project plans were developed in the priority areas of:

• Including nursing leadership in management structures and decision making
• Strengthening collaborative nursing input to policy making
• Developing consistent processes for measuring the work of nursing and for resourcing nursing services
• Preparation of nurses for top level management and leadership in clinical practice
• Profiling nursing/nurse led initiatives and encouraging a wider range of provider organisations
• Clinical career planning for nurses
• Better links between education and health service providers

At the same time work continued to influence changes to the Medicines Act to allow prescribing rights for nurses, the ACC Act for greater nursing practice opportunities, and the Health Occupational Regulation Bill which had superseded the review of the Nurses Act.

NENZ continued to seek opportunities to collaborate with other key groups in the health, education and regulatory sectors on matters of mutual interest. A position paper on Preceptorship, Mentorship and Clinical Supervision was published in the form of a booklet and poster.

A second leadership conference was hosted by NENZ this year. “Nurses leading health care initiatives” profiled a range of inspiring new health initiatives where nurses have shown the lead. A number of media opportunities arose from this conference which helped to ensure a wider group of public had access to information about the potential of nursing.

The group welcomed Jenny Carryer, Professor of Nursing Practice from Massey University to membership following her joint appointment with the crown health enterprise Mid Central Health, the first such appointment in the country.

Again there was considerable turnover of members, with loss of experience and wisdom but injection of fresh opinions, ideas and enthusiasm.

A formal system of mentoring and coaching for new members was introduced, communication improved through the technology of computers and e-mail and there was a valuable flow of information and informal debate.

The Nurse Executives web site was established in 2000 to raise the profile of the group nationally, and the annual plan and portfolios continued to provide a framework and focus for the work of the organisation. An Executive Group of the portfolio leaders was formed to assist the flow of information and monitor progress on projects. Limited resources, both financially and in time were issues as each of the members faced the challenge of their work with the group and in their employment organisation.

Julia Hennessey Nurse Advisor from the Ministry of Health joined the organisation as an ex officio member. Joanna Harper stood down after three years as Chairperson of the group and was succeeded by Beth Cooper Liversedge at the Annual General meeting in 1999.

Compiled by Elizabeth Lee (2000).

Part Two Post Millennium

Rejuvenation of NENZ

Early 2000 saw a number of new members to NENZ which heralded another shift in institutional memory, a need for revisiting the role and purpose of NENZ and an opportunity for refreshment of the values and strategic intent. Tall Poppies was engaged to lead a workshop in November 2000, which resulted in new vision, purpose and values statements:

This became known as NENZ “MAGICC” and the values reinforce the NENZ focus on Relationships, Change and Task Orientation.

Change in Structure of NENZ

At the workshop it was also agreed to disband the portfolio groups and establish a national and regional focus.

Three regions were agreed:

Upper (North Island) – Taranaki North

Middle Nelson North

Lower (South Island) Invercargill North.

An Executive of 6 was established which included:

Three National roles: Chairperson, Secretary and Treasurer

Three regional roles: 1 Chairperson for each regional group.

This created the opportunity to achieve more outputs by working within the regional areas on agreed projects, further enhanced by increasing the focus and frequency of regional meetings between the three national meetings per year.

NENZ Inc.

At the AGM it was also agreed to register NENZ as an Incorporated Society, which would formalise the organisation as a legal entity and enable NENZ to seek funding for and lead, independently significant projects and research into nursing and health related issues.

Contributions to Health policy and nursing developments

National Nursing workload Measurement project.

Sue Wood, in previous roles in Australia, had undertaken considerable work in relation to nursing workload and costs of nursing, and this became of interest to the Ministry of Health. A national project was agreed, to be led by NENZ in conjunction with the newly formed DHBNZ office.

6 hospitals participated in the project including:
2 metropolitan/tertiary centres
2 mid sized urban/secondary
2 small semi rural secondary

The six month study used the Trendcare, patient acuity tool, developed and used in approximately 80 Australian hospitals, and at this time only used in Palmerston North by Sue Wood.

Subsequent to the pilot study, several hospitals including three of those in the study implemented Trendcare to augment their nursing data on workload and support more efficient monitoring of demand on the nursing resource.

Nursing input to District Health Boards: This was the period where the review of health services management was underway, with the plans for cessation of CHEs and introduction of DHBs with devolved funding, planning as well as service delivery responsibilities. A document outlining the potential and value of the Director of Nursing role at the executive level was developed.

NENZ Leadership

2001 saw the resignation of National Chair, Beth Cooper Liversedge who moved to a general manager role. Wayne Marshall, Secretary at the time was appointed Acting Chair until the next AGM with Rhondda Knox taking over as Secretary and Mary Gordon remained Treasurer.

At the AGM, Rhondda Knox and Mary Gordon were re-appointed and Christine Payne was appointed as Chair.

With the changes in the health sector and the introduction of DHBs it was decided to rescind the agreement for “ex nurse leaders” to remain ex officio members of NENZ, and that in future membership should be confined to the most senior nurse in an active leadership role within a health organisation.

‘The introduction of DHBs also lead to significant role changes for many existing “CHE/provider” DONS who overnight found themselves with an expanded role to encompass the wider DHB responsibility not just the provider arm services.

National Nursing Organisation

2001 heralded the inception of a forum for the key nursing organisations in New Zealand on the initiative of Frances Hughes, Chief Advisor Nursing at the MOH. Frances vision was to establish a joint forum, where the nursing organisations could work collaboratively and in partnership with her role to promote nursing from a united front at the national level, thus strengthening the nursing voice and influence on policy decisions.

Clinical Leadership and Quality in District Health Boards in New Zealand

NENZ members from participating DHBs contributed to the report which had been commissioned by the Clinical Leaders Association of New Zealand and the Ministry of Health. (November 2001) This revealed that although positions of Director of Nursing/Chief Nurse Advisor roles existed and reported to the CEO with a mandate for clinical quality and clinical leadership, nursing services had been devolved to service level under the control of clinical service groupings and not managed by the Director of Nursing.

2002

The regional structure was re-inforced and each region undertook responsibility for an agreed portfolio to advance key strategic intentions:

These were:

• North: Nursing Skills and skills mix
• Central: Workload and website
• South: Quality and risk

Nursing Manifesto for Parliamentary Election

An early initiative from NNO was the development of a common nursing manifesto to inform the political parties of the key messages for health from a nursing perspective. NENZ with the College of Nursing, NZNO and NETS led the writing and publication of the manifesto. (find key messages) which was then delivered to each of the political parties health spokesperson. It was considered a significant milestone for individual nursing organisations to identify and commit to consistent messages rather than the usual disparate views often portrayed in the media.

Magnet Organisations

In April 2002 Frances Hughes returned from her Harkness Fellowship study tour in the USA and stimulated NENZ interest in and commitment to promoting magnet principles in New Zealand. The American Nurses Credentialling Center offers an accreditation programme, known as the Magnet Recognition Programme for Nursing Excellence, to hospitals meeting the accreditation standards. The outcomes for those “magnet” organisations includes: positive recruitment, retention, job satisfaction and improved patient outcomes. The compelling research evidence of positive outcomes from Magnet hospitals sets the programme apart from other accreditation systems which tend to focus on structure and processes.

In October 2002 Jeanne Floyd, CEO of ANCC visited and was hosted by MOH and NENZ. The opportunity was used to present Magnet to key stakeholders in the Ministry of Health, Treasury, Quality and Standards and Clinical Directorates, plus DHBNZ, Nursing Leaders and the public through radio interview with Rae Lamb. Following this visit a New Zealand Magnet Advisory Group was established under the leadership of NENZ, with representatives from NZNO, CNA(NZ) and the Chief Advisor Nursing of the MOH.

Annette King, Minister of Health at the time demonstrated her support by seed funding Magnet NZ Advisory Group to promote Magnet principles across the sector and to develop a ”toolkit” to assist organisations wishing to pursue the implementation of magnet principles.

Dr Linda Aiken, Professor of Research from Pennsylvania University USA visited in November as the key note speaker at a patient Safety conference hosted by the MOH and NZNO. Mary Gordon DON of Counties Manukau, Jocelyn Peach, DON Waitemata and Sue Wood, DON Midcentral presented at the conference.

The official launch of the New Zealand Nursing Council competencies and process for recognition of a new advanced practice role “Nurse Practitioner was held in Wellington in May 2002. Annette King, Minister of Health gave her support and commitment to the role in her keynote speech, indicating a desire to see 300 Nurse Practitioners in New Zealand, and recognising the role as a critical component of the changing face of health delivery in New Zealand. Mia Carroll, the DONM for Auckland DHB had been one of the working party who developed the competencies with Nursing Council, and Directors of Nursing are core members on the assessment panels of Nurse Practitioner applicants.

Deborah Harris, a Neonatal Nurse specialist at Waikato Hospital, was the first nurse to be endorsed as a Nurse Practitioner.

The consultation process for this significant piece of legislation which incorporated a number of individual professional regulatory authorities under one umbrella was a crucial opportunity for NENZ to provide feedback from the service provider and professional perspective through written and verbal submissions to the Parliamentary Select committee.

NENZ was one of only two nursing organisations invited to present in person to the committee.

Education initiatives

NENZ in conjunction with the Nurse Educators in Tertiary Sector (NETS) developed a guide for “Joint Appointments” between Education Institutes and Service providers. This was an initiative in line with recommendations from the earlier Ministerial Taskforce on Nursing.

NENZ and NETS also agreed to hold periodic joint meetings both at national and regional level. The first national meeting was held in Wellington at Capital and Coast DHB and provide valuable opportunity for sharing ideas, exploring shared issues and individual networking.

RGON in Mental health - pathway to RCompN

NENZ took an active role in influencing the Nursing Council of New Zealand to create flexible and readily achievable pathway options for a number of Nurses who had been working in mental health settings for a number of years without formal preparation in the specialty.

NENZ link with Medical Advisors group

The opportunity to re-instate active links with the Medical Advisors group was taken through attendance by the Chair at their national meeting, which included a presentation to the Medical Advisors of the work of NENZ and the key issues and priorities facing nursing. Following this a commitment was made to hold periodic joint meetings of the groups given the level of common interests and challenges. Clinical leadership and governance and Quality were highest on the agenda.

2003 Leadership Development

With the unending turnover of DONs and changing membership of NENZ, the varying level of skill and confidence amongst the DONs in their leadership roles, and ability to influence at the executive level, led to an invitation to Ken Parry Lecturer in Management of Victoria University, to conduct a 2 day “ Negotiating and Influencing at the strategic level” workshop for NENZ members.

Post-Graduate Education Training (PECT)

The Ministry of Health Clinical Training Agency responded to concerns about the provision of post graduate nursing education by establishing a working party to review the existing situation and make recommendations for future provision. NENZ was invited to participate and provided three representatives from the sector.

Health Workforce Advisory Committee (HWAC)

The Minister of Health commissioned a multidisciplinary working party to advise on future workforce needs and challenges in New Zealand, given a growing body of evidence about global shortages in recruiting and retaining health professional staff and the projected increase in population requiring up to 50% increase on 2003 numbers by 2021.Whilst NENZ had no representative on the committee at the outset, the organisation was invited to present a submission to the committee during various consultation phases. Subsequently Taima Campbell, DONM of Auckland DHB was invited to join HWAC.

1998 Group photo: Chairperson Joanna Harper, Secretary Jocelyn Peach.

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