Dr Jill Clendon & Dr Léonie Walker

NZNO Research Report –

NENZ 2015

(1)

Flexible working & nurses 50+

(J. Clendon & L Walker)

• Ageing nursing workforce• Ageing population• Anticipated nursing workforce shortages• Need to increase nursing numbers

– Recruitment– Retention

Flexible working defined as:

‘…practices that enable employees to exercise greater choice over how, where and when they work in order to more effectively meet their work-life balance needs…’

Examples include:• Job share• Part time hours• Casual hours • Time in lieu

Literature:Impacts of flexible working

Advantages include:• Increased job satisfaction• Improved retention• Lower incidence of work-related stress• Reduced absenteeism• Reduced turnover• Higher organisational commitment• Improved work-life balance

Method

• Ethics approval• Recruitment of District Health Boards• Individual interviews• Focus groups

Results – nurses

Scope: 44 RN, 1 NP, 1 EN

Ethnicity: 35 NZ European, 2 Māori, 6 other European

Age: 26 aged 51-60, 17 aged 60-65

Finding the balance

I thought of it from both perspectives… from the employer’s perspective to meet the needs of the service but also from the individual perspective where there might be times within your working life where you need changes to hours and that can be accommodated depending on what’s happening in your personal life.

Frustrations and barriers

I’ve been told that if I want to cut down then I have to take it as annual leave and I don't want to drip feed my annual leave.

Our charge nurse here’s really flexible about that and she can authorise annual leave or flexible hours. At this unit level it’s extremely flexible, and it’s just the dictates from above that restrain you...

Results - policy

• 11 DHBs (out of a possible 20) provided information on flexible working hours and/or career planning policies.

• Telephone interviews with regard to these policies were undertaken with either Directors of Nursing (n= 7), human resource advisors (n=7).

Recommendations• Organisations should have clear policies &

procedures around flexible working• Unit managers must be aware of these policies

& enact them with respect & acknowledgement• Organisations may wish to explore job sharing

opportunities in more depth• Enabling older nurses to take on roles in

mentorship may facilitate both retention & succession planning

(2)

Nursing skill mix in Primary Care

(L. Walker, J. Clendon, Kathy Nelson)

Understanding evolving nursing roles in primary care

Methods

•Ethical review

•Practice recruitment

•Document review – policies, Standing orders

•Interviews

•Observation

Analysis

• Integrated pictures of each case were developed;

• Data sets were combined & compared to capture specific similarities, differences & perspectives;

• A skill-mix framework was used to compare findings related to nursing skill mix across case studies.

Case study 1 Broad description of practice setting

Small, semi-rural practice, situated in a small town.Privately owned and run by a GP and a RN as equal partners

Patient roll and demographics Around 2000 enrolled patients, aged 0-90+, of all ethnicities, and all socio-economic groups. High proportion of over 65s, and high proportion of Care Plus funded patients.

Description of staffing (clinical team)

2 GPs (1.8 FTE)2 RNs (1.2 FTE) (referred to as Family Nurse Specialists)1 PCPA (0.8 FTE)All including the practice manager were interviewed.

Broad description of services Full range of general medical services; acute care, management and monitoring of long term conditions, women’s health, immunisations, smoking cessation, after hours on call, patient education, home visits, falls prevention classes, occupational health and palliative care

Unique features / model of interest

Model of care is interdisciplinary in nature; work collaboratively both within the practice and with clinicians in other organizations. RNs use of Standing Orders extensively. PCPA is used to improve patient flow and the regular measurement and recording of relevant clinical and social data to enhance continuity. Onsite dispensary with limited medicines related to Standing Orders available.

Case study 2 Broad description of practice setting

Large multidisciplinary practice in a small town.Privately owned and run by 6 GPs

Patient roll and demographics Patient roll is around 10,000, relatively affluent population, but also a much higher than average number of over 65 year olds, so many with long term conditions and complex multiple co-morbidities.

Description of staffing(clinical team)

11 GPs (5 employed, 6 partners)12 RNs (1 mobile, 1 occupational health nurse, 1 NETP nurse)2 EN (1 mobile)1 Health Care Assistant1GP, 3 RNs 1 EN, the nurse manager and the practice manager were interviewed.

Broad description of services General medical services, wound clinic, ear suction clinic, plastering, on site radiology, immunisations, patient education, warfarin management, blood pressure clinic, women’s health, podiatry, optometrist. About to launch an insulin initiation service.

Unique features / model of interest

EN-led wound clinicMobile RN / EN pairing Occupational health serviceNurse led phone line for prescription repeats

Case study 3 Broad description of practice setting

Busy mid-sized urban NGO-managed practice with salaried GPs and nurses (this practice is part of a more complex 3 practice organisation).

Patient roll and demographics 10,200 patient roll. High Māori population, low socioeconomic patient population with subsequently high needs.

Description of staffing(clinical team)

1 NP4 GPs9 RNs (Community RN, Disease State Management (DSM) RN & Outreach Practice nurse, 6 Practice Nurses)KaimahiPCPA (called a nursing assistant (NA) in this setting)Social worker* / Low cost dentistry*The CEO, NP, DSM, NA, clinic coordinator, practice manager and 2 RNs were interviewed.

Broad description of services General medical servicesMobile Disease State Management service

Unique features / model of interest

NP, NA, DSM RN and broader liaison with whānau ora / non health services

Evolving nursing roles

• Nurse led clinics• Outreach & proactive LTC management• Nurse Practitioners• Nurses as business partners• Nurse led discharge & community follow

up• Primary Care Practice Assistants freeing

up nurses to deliver more advanced nursing care

(3) Nursing Professionalism

(L. Walker, J. Clendon, & Jo Walton)

Exploring the attitudes & understandings of nurses in New Zealand towards nursing professionalism & its impact on patient care & safety.

Methods

• Initial consultation – key opinion leaders• Wider survey • 4 Focus groups

Awareness of Codes of Ethics and Codes of Conduct

aware not aware 0

50

100

150

200

250

Awareness of Codes of Ethics & Codes of conduct (N= 224)

NZNO Code of Ethics NCNZ Code of conduct

Perception of compliance with Nursing Council Code of conduct

Always fully compliant

Mostly fully compliant

Rarely fully compliant

0 20 40 60 80 100 120 140 160 180 200

Perception of compliance with Code of Conduct (N= 224)

Focus group dataProfessionalism themes Illustrative quotes

Adherence to the Code of Conduct Adherence to a Code of Conduct, Code of Ethics and all other documents which underpin best practice

Integrity, trust, honesty and ethical behaviour To be trustworthy and honourableThat I am scrupulously trust worthy in my dealings with my patients

Keeping focus on the patient Ensuring the safety of the patientsMaking sure patients are at the heart of everything we do

Maintaining patient confidentiality Being constantly mindful of patient confidentiality

Taking responsibility for competence Acknowledging one’s own limitations and knowing when to ask for help

Boundaries and the need to limit self-disclosure Professional boundaries.Maintaining nurse patient boundaries

Focus group dataProfessionalism themes Illustrative quotes

Commitment to cultural safety Culturally safe nursing.Able to listen, and respectful of their needs

Empathy, caring &compassion Compassion, integrity, genuine caring, and commitment to doing your best for those who need you

Good communication & interpersonal skills

Planning of care and communicating it to colleagues, patients and their families.

Self-awareness, remaining non-judgemental

Being non-judgmentalBeing resilient and self-aware

Showing knowledge & technical competence

A nurse who knows what they are doing. Has good clinical skills, practices safely

Commitment to ongoing education & updating nursing knowledge

Ensuring you keep up with current practice. Reading journals, attending conferences

Hot debates

• relative importance of knowledge and technical competence

• selection of candidates for nursing education

• Appearance and standard of dress

Paper(s) available

Other research projects

• Impact of 12 hour shifts on error rates• 2015 Employment Survey

• Intergenerational Teams• Nurses as care givers• Health of nurses

• Suggestions?

Visibility of Nursing

Problem identification

The contribution of nursing and the value that it adds continues to be largely unrecognised and when tough choices or decisions are made about health system change frequently nursing becomes the first target and the nursing voice is unheard by those in power.

Campaign purpose

• Reinforce professional pride• Promote nursing• Raise nursing’s profile and image

• Raise awareness of the professional association profile of NZNO

Campaign outcomes

• Nurses conveying pride in nursing• Nurses projecting professionalism• Members empowered to articulate the

value of nursing• Demonstration of the value of nursing to

the public, funders and providers• Nurses become known as knowledgeable,

skilled health professionals • Improved engagement at all levels

Activities so far….• Project team• Market research focus groups• Campaign slogan and branding developed• Resource development• Leader identification, development,

activation• Member awareness & involvement

And…..

• Professionalism research• YNY Awards• Nursing oral history website

Next phase…

• Media engagement• Social media involvement• Advertisements in media

What we need from you

• Support for the project

Thank you!