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 led 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 or 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 or Health, Hon Dr Michael Bassett's 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 the Area Health Boards
Enabling legislation came into effect in 1985 to permit the formation or Area Health Boards through the merger or Hospital Board and District Health Office functions or the Department or 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 tighly 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 suceeded Ron de Witt as Chairperson or 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 nursrng practice. Membership was open to one nurse executive from each crown health enterprise, the Departments of Justice, Defence and Labour, and the senior nurse executlve 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 SheryI 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 NZ (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 the purchase of clinical training for nurses 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 lncluded:
- 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
- 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 successfulI 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 Bethe 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' profited 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)
Past Office Bearers
Chief Nurses of New Zealand
Up to 1993 Chairperson Elizabeth Lee
Secretary/Treasurer Patricia Ryan
Nurse Executives of New Zealand
1993 - 1996 Chairperson Elizabeth Lee
1996 - 1999 Chairperson Joanna Harper
1999 - 2001 Chairperson Beth Cooper-Liversedge
2001 - 2003 Chairperson Christine Payne
2003 - 2005 Chairperson Anita Bamford
1993 Secretary/Treasurer Patricia Ryan
1993 - 1994 Secretary/Treasurer Sheilah O'Sullivan
1994 - 1995 Secretary/Treasurer Lois McKee
1995 - 1999 Secretary/Treasurer Jocelyn Peach
1999 - 2000 Secretary/Treasurer Debbie Penlington
2000 - 2001 Secretary Debbie Penlington
2001 - 2003 Secretary Rhondda Knox
2003 - 2005 Secretary Kerry-Ann Adlam
2000 - 2003 Treasurer Mary Gordon
2003 - 2005 Treasurer Helen Pocknall