NurseTalk NZ » healthcare

The whole shebang

Newbie NP — Tue, 20 Jul 2010 15:29:07 +0000

I have just attended an excellent conference including a presentation on performing pelvic exams on challenging patients. Which begs the question- why do “non-medical smear-takers” aka nurses NOT get taught to do bi-manual pelvic exams with their smeartaking? It is like teaching phlebotomy without teaching how to actually draw the blood.

Can anyone tell me why this is so?

Every smeartaker should be able to complete the second phase of a smear- the bi-manual exam. It is not rocket science. It is a technique like many others nurses do- invasive- yes but you are already down there anyway! But not dangerous.

Makes me wonder who designed the original smeartakers courses in the first place?

Dissected to death????

Newbie NP — Tue, 08 Jun 2010 09:24:37 +0000

What is it about nursing that makes funders/academics/anyone have to dissect every aspect of the nursing process/service/experience. We don’t see that volume of scrutiny focused on the doctoring process that I have ever noticed.

Is it because we need to justify and prove the value of nursing because the financial benefits to an organisation from nursing are so difficult to prove?

Is it because we, as women, need to describe what we do as nurses, to describe the complexities of nursing and how it relates to the patient/human experience of health and illness?

According to this article, the patient experience is so intrinsically involved in the quality of a service, that the nursing gets dissected within the evaluation of that service. So what happens when the evaluation doesn’t show a great outcome for the service? Where does that leave the nurses? Is it so intrinsically incorporated with the service outcomes that the nursing role gets thrown out with the bathwater?

Is this one reason why nursing is struggling for financial and professional respect/recognition in specialist roles, or why it is often the first service to face budget cuts? With all the research on the value of effective nursing and the positive effect it has on overall quality in an organisation (see Magnet hospital research for example), what other conclusion can we come to about poor funding decisions made for, and on behalf of, nursing?

And yes, once again, this article’s summary states that the study described “clearly demonstrated the complexity and multiplicity of components of the CNS role and its impact on patients”.

Just call me Poly Filler

Newbie NP — Wed, 19 May 2010 09:08:25 +0000

Sometimes the tug of war (almost literally it seems at times!) between NPs and MDs just gets ridiculous, and I suspect this article will only add fuel to the tuggers. The point of difference here is that the author is an economist so approaches the evidence from the fiscal angle- which will make a whole lot of sense to the funders in the current financial climate. But what I liked most was this-

“The published literature also shows that collaborative, team-based approaches to care—including teams led by nurse practitioners—should be actively promoted to reduce overall spending on health care.”

Because at the end of the day that is a big part of my role,and one that can make the most difference. I just fill the gaps where GPs can’t,not interested, dont have time to, reach. And there are plenty of gaps if you look differently at the wider picture, and at a different angle. It’s more often that the funding that should follow the need isn’t there at the same gap at the right time, so that’s where innovation and funding flexibilty must happen.

At the end of the day, there is plenty of work to go around, so why can’t we all just pack away our prejudices and patch protection blinkers and just get along.

what’s in a day?….

Newbie NP — Thu, 13 May 2010 09:16:24 +0000

I always have an uncomfortable niggle at the thought of “Nurses Day”. I get the same feeling when I consider the “special” nurses conference day that the GPCME conference offers. Its a “pat on the head and be good/silent for the rest of the year” kind of niggle. And I see that I am not alone. Head Nurse has some issues and would rather have nurses recognised adequately and respectfully for what we really do-

“We’re not just warm and fuzzy: we’re scientists, we’re social workers, we’re personal counsellors If we can give the people we talk to about nursing a complete picture of what it is we do–rather than focusing on things like nurses eating their young, or crappy doctors, or how fulfilling it is to wash a back at three a.m.–we’re likely to find many more smart, motivated people who are suddenly interested in becoming nurses..”

Health Leaders Media journalist Rebecca Hendren asks why nurses should get a day when so few others, including doctors, get the same special recognition. One of the doctors I know suggested facetiously that docs get the other 364 days to be special! Wouldn’t it be nice, they say, if we didnt need nurses week to celebrate how nurses actually contribute to the health of nations.

The nursing advocacy website suggets a T-shirt slogan : “My physician colleagues got 99% of the funding for research and residencies, and all I got was this Nurses Week T-shirt!”

But seeing as how we still have it for now- lets use it for the greater good and blow our own trumpet positively, respectfully and intelligently!

NP’s miss the cut-again?

Newbie NP — Tue, 04 May 2010 09:21:10 +0000

I don’t know, maybe I am partisan, but I would kind of expect to see some explicit mention of NPs in any national health workforce plan- especially because they are a new animal in the NZ health landscape and there is so much international evidence to say how well they improve health outcomes. But no, the latest inaugural NZ health workforce annual plan from the newly appointed Health Workforce NZ Board has absolutely no mention of them. They are quite explicit about RMO & SMOs (docs) and mention allied health and other professionals, which I guess covers NPs! There is even a section:

3.3.1 DEMONSTRATION SITES ESTABLISHED AND EVALUATED ACTIVITY
Demonstration sites established for:
• physician assistant
• nurse endoscopy
• surgical assistant (RN).
Public/private partnership demonstration site(s) agreed.
Demonstration site proposals approved for:
• Diabetes nurse specialist prescribing extended practice
• Extended pharmacist practice.

So does this mean NPs are so accepted and entrenched by the health sector that they do not rate a mention?(Make a good Tui ad, that one!) . The report seems a bit doc heavy in terms of focus. Having a look at the Board members I see 5 docs and 2 nurses, so maybe the nursing voice was just not loud enough (again). Wonder what national response from nursing we will see?

Retreating under fire?

Newbie NP — Thu, 15 Apr 2010 06:34:43 +0000

Well, it seems that the USA medical profession may be retreating under fire with the Obama health reforms. This article suggests that need and healthcare reform may be assisting the nurses to edge ahead on the age old doctor vs nurse practitioner power struggle.Going by the comments the public is divided re the benefits/risk analysis. Interesting to see the race evening out with legislation change though…….

Not sure I like the quote that NP’s are “just like doctors without the pay”. I kinda like the idea that I work differently and add value rather than the competitive model that this quote represents…..but it would be great to reduce what Peter Pronovost calls the toxic heirachy. Suzanne Gordon, on her blog, has a great expose on this concept

Reform across the ditch…

Newbie NP — Mon, 05 Apr 2010 08:23:45 +0000

Looks like the Aussies are in for some changes to the primary health care landscape, although it can’t be as radical as what our Labour Govt tried during their tenure (2001..)i.e., mucking around with the GPs’ incomes, because I didn’t hear any screams last month when the news hit the airwaves. Apparently Rudd’s crowd is planning to fund PHC 100%…well, maybe they should talk to the NZ National party before they go down that track, so they don’t have to yank the rug out from under the older population and repark the ambulances at the bottom of the cliff when they run out of money..or is it just their means of messing with the next Government’s budget?

Still on the PHC subject- practice nurses overthere have got the marketingthing going on..check out this website for information on Practice Nursing

P.S….Note to self- don’t leave it so long between blogs- you will get out of practice and lose what edge you have….

Much ado about iFHC n’ all

Newbie NP — Thu, 18 Feb 2010 10:17:22 +0000

I admit to being rather bemused and bewildered at the conclusionof the recent RNZCGP Quality Symposium last week- mainly because there did not seem to be much about Quality and more about intergrated Family Health Centres. It seems that the meeting had been hijacked to pass the word down the line about the latest MOH buzzword for the PHC sector and funders. There was comparisons made and discussions about the UK models- particularly GP superclinics. The Kings Fund researchers invited to speak had lots to say about those. Checkout their website- also the Darzi review. Some of the ideas sound veerrryy familiar…. ” identified a range of hospital services that could be delivered closer to the patient’s home, including minor surgery and many outpatient consultations”.Hmmmmm. So more apparent opportunities for nurses to strut their stuff as Barbara Docherty suggests? Or another round of rhetoric without the legislative and funding change to back it up- which generally leaves nurses hanging in the breeze as they watch the status quo and current power monopolies cruise on through.

Quote of the Week

admin — Mon, 01 Feb 2010 08:21:25 +0000

“Labour increased health services and the National Government is busy dismantling them,” Ruth Dyson said.

Is our healthcare system heading for the rocks?