Growing public health nursing:

Transcription

1 Growing public health nursing: Report on feedback to the Public Health Nursing Education Framework discussion document Next steps and actions for

2 Funded by: The Ministry of Health Project managed and written by the Public Health Nursing Education Framework Working Group and the Public Health Association of New Zealand Cover image from: Public health nursing: functions and activities, Department of Health, Wellington, Growing public health nursing

3 Contents Introduction Thanks Summary Key points from the feedback process Priorities for Priorities for Discussion and feedback process Analysing the feedback Key themes A public health nursing education framework is needed The distinctive role of PHNs needs to be clarified Concern about the future of the public health nursing workforce Putting population health into the nursing curriculum Addressing systemic barriers to appropriate post-graduate study for PHNs Other comments Tables Step 1: Prior to starting a Bachelor of Nursing degree Step 2: Bachelor of Nursing Step 3: Nursing Entry to Practice (NETP) Programme Step 4: Orientation new public health nurses Step 5: Advanced public health nursing roles Step 6: Nurse practitioner/nurse consultant/specialist nurse Step 7: Public health nurse academic Report on feedback March

4 Introduction Thanks We would like to thank all the individuals, groups and organisations who contributed feedback on the Growing public health nursing in Aotearoa New Zealand discussion document. The project group particularly values the many positive, practical and detailed suggestions on how issues could be addressed. Ka nui ngā mihi ki a koutou mā, huri noa. The project group would like to hear about any other ideas, suggestions or information that could help us develop the framework, or that could be included in the project s final report. You can contact project manager Jenny Hugtenburg on jenny.hugtenburg@huttvalleydhb.org.nz or Summary The Growing public health nursing in Aotearoa New Zealand discussion document was released for discussion in July We received feedback from many different sources, including written contributions from organisations, groups and individuals, and discussion through the Loomio online forum and the Public Health Nursing Aotearoa Facebook page. This report summarises the feedback on the discussion document, and outlines the next steps for the project based on that feedback. Key points from the feedback process: There was strong, often passionate, support for a national public health nursing education framework. The distinctive role of public health nurses (PHNs) needs to be clarified and to be reflected in nursing competencies. There is concern about the future of the public health nursing workforce (including the ageing of the workforce) and about the perceived undervaluing of public health nursing. Public health must be explicitly incorporated into the nursing curriculum (Step 2). There were diverse views about the Nursing Entry to Practice (NETP) programme as a key stage in the public health nursing development pathway and, overall, contributors considered other issues more immediate priorities for the project group (Step 3). A national core orientation programme for all PHNs is feasible and should be a priority (Step 4). Current barriers to post-graduate study and other professional training must be reduced urgently (Step 5). PHNs need to be able to access study and qualifications appropriate to their role (Step 5). There were diverse views about the value of focusing on the nurse practitioner role (Step 6) at the advanced level, with some suggesting an advanced public health nursing role as being a more useful option. Based on our analysis of the feedback, the project group will be working on five priorities. Priorities for developing a draft core orientation programme out for consultation late producing a draft competencies programme out for consultation late Priorities for producing a detailed education framework 2. working towards having all nursing study curricula include a population health focus 3. influencing the Nursing Council Competencies to have a population health focus and developing indicators to support this. 4 Growing public health nursing

5 The project team has mapped out how to deliver on the priorities over the next 48 months, with some indicative dates in this feedback report. The project manager is already working with a number of the key stakeholder organisations to gain their support and resources for the implementation of the priorities We will report on progress on the 2014 priorities and towards the 2015 priorities at the end of the third quarter of Discussion and feedback process The discussion document released in July 2013 was made available through the Public Health Association (PHA) website and publicised through the PHA s weekly e-bulletin, as well as through its Facebook page, and through , flyers and posters. We also piloted the Loomio online forum as a space for questions and discussion. Because some workplace IT systems bar all social media, not all contributors were able to access Loomio. One hundred and thirty people were invited into the online discussion forum, 42 accepted the invitation and around 20 people participated in a range of discussions. We received 32 written contributions from groups, organisations and individuals. Most were from groups of PHNs, or from organisations such as DHB public health units and schools of nursing, although we also received contributions from individual PHNs, public health physicians, and nurse academics. The Ministry of Health, Health Workforce New Zealand, and the New Zealand Nurses Organisation provided detailed comments. Analysing the feedback Three of the project team separately read and reviewed all the feedback received, looking for common themes and areas of divergence. The reviewers met to align their analysis, and this report was written from that work. What distinguishes public health nurses from other nurses is that their actions cover a continuum from individual family empowerment through to community development and systemic change. definition proposed by the Ministry of Health s Office of the Chief Nurse: Report on feedback March

6 Key themes A public health nursing education framework is needed As expected, those who provided feedback both individuals and organisations strongly believed that a clear, defined and agreed professional development framework was needed. Most contributors added comments on the value of a framework to public health work. A typical comment was vital in today s climate. Contributors considered that a framework could: spell out what a PHN at various levels is and does many contributors referred to the lack of clarity between the primary care and PHN roles provide national consistency for professional development show how development needs can be addressed. There was agreement that pathways need to be flexible and should provide for both clinically based nursing practice (e.g. ear health) and for community-based public health. The distinctive role of PHNs needs to be clarified What does a public health nurse do? Contributors told us there is currently no single agreed definition of public health nursing in New Zealand. Some contributors thought the discussion document did not do justice to the unique public health role, and that the final report needs to make it clear what distinguishes PHNs from other nurses, and what PHNs contribute to population health in Aotearoa New Zealand. The project team agrees this project offers opportunity to develop a working definition, and we are working with key stakeholders on this task. Some contributors also thought this project is the opportunity to create a vision for public health nursing. The project team agrees that while creating a vision is not one of the five priorities for , it is important to have a vision that captures the essence of public health nursing and that this vision underpins all the work we do. Concern about the future of the public health nursing workforce Many contributors expressed concern that the PHN workforce needs a broad skill set to meet increasingly complex population health challenges, to future proof the profession. This was linked by many contributors to the urgent need for PHNs to have access to post-graduate study and other training, which could increase their ability to understand and address the many determinants of population health in Aotearoa New Zealand. There was also concern that the PHN workforce is ageing and that there needs to be a planned process to encourage younger nurses to become PHNs. Some contributors cited this concern as a key reason for supporting the framework which could show potential PHNs that there is a career and professional development pathway for them. Putting population health into the nursing curriculum Many contributors said it is necessary to have population health in the curriculum. The feedback was mixed as to whether they should be additional or modified competencies. Elements contributors wanted to see added to the curriculum include inequalities, the Ottawa Charter, preventing illness, and population health outcomes. Many said they would like to see schools of nursing review their current curriculum so that all nursing curricula explicitly include population health. Addressing systemic barriers to appropriate post-graduate study for PHNs PHNs need opportunities to undertake postgraduate study in areas relevant to their role, both to increase public health nursing skills and to keep 6 Growing public health nursing

7 nurses in the workforce. However, many PHNs seem to face barriers to formal skills development. In particular, several contributors detailed their own experiences, or those of others with whom they worked, with criteria that limited their ability to study population health. There was also concern that PHNs in some workplaces were getting a smaller share of workforce development funding than other public health disciplines in which annual training hours are a professional requirement. Contributors identified possible solutions including: promoting scholarships allowing for more modular, online study options ring-fencing funding so that nurses have the same opportunities to study as those in other public health disciplines working with Health Workforce New Zealand so that policies and criteria for supported study meet the development needs of the PHN workforce. Other comments Some contributors were concerned the discussion document did not adequately recognise the place of the Treaty of Waitangi in public health nursing development, nor did it specifically address the role of Māori public health nursing. We will address Māori public health nursing and Māori health development in more detail in the final report. There were many positive comments about the History of Public Health Nursing (Appendix 4 in the discussion document) with some commenting that many PHNs would not be aware of the rich history behind their work. Others thought it needed to be expanded and have more detail to capture the essence of the profession s history. We are considering publishing an enhanced version of this paper as a separate resource for the project. Report on feedback March

8 Step 1: Prior to starting a Bachelor of Nursing degree Step Feedback Discussion and action points Issue 1.1 Opportunities to grow the potential workforce pool may be lost if career opportunities are not promoted at an early age to high school students. Recommendation 1.1 PHN stakeholders actively support initiatives to encourage secondary students and second-chance learners to meet entry requirements for nursing. Overall this step was seen as a lower priority for action than other steps. To keep new PHNs entering the workforce students need both to be interested in nursing and to have the necessary NCEA qualifications. One contributor said Nurses need science qualifications [we] should be encouraging kids to think of science as pathways to nursing. There was general agreement that having determinants of health in the curriculum is essential. Put determinants [of health] into the student curriculum don t promote public health nursing. There was national variation in the initiatives being offered to promote public health nursing: some current school-based initiatives do include population health, and some schools of nursing are actively involved in promoting public health nursing. Possible new directions suggested included: using social media engaging PHNs in career expos or similar events encouraging all nursing schools to actively promote public health nursing as a career option. Recognising contributors overall view, the project team is making this step a lower priority. We note the variety of initiatives already in place. Actions which will be considered at a later stage include: talking to organisations that produce health career resources about including public health nursing in these examining ways key population health ideas, such as the social determinants of health, could be reflected in school curricula. 8 Growing public health nursing

9 Step 2: Bachelor of Nursing Students often don t know enough about public health nursing to consider it an option. There was extensive feedback about the national Registered Nurse Competencies, the education standards, and the need to include population health in the curriculum content. Contributors agreed the current situation does not meet the needs of public health nursing. Overall points were: There must be population health content in the national nursing education standards, which set the curriculum. Contributors described the current situation as an oversight that must be rectified. However, if population health is not explicitly included in the national Registered Nurse Competencies, schools of nursing are unlikely to include it in their curricula one nurse academic said If it s not in there it won t be taught. There were differing ideas about how to include public health content in nursing study. Possibilities offered were: including papers from the online Certificate of Public Health and Health Promotion (to be offered starting in 2014) reviewing current nursing papers so population health content could be included where appropriate. The limited number of public health placements for nursing students was also of concern for many contributors, who saw placements as a way of engaging potential PHNs. However, contributors recognised that: with a relatively small number of PHNs nationwide, there are fewer opportunities for placements than in other areas of nursing public health nursing services need a balance of senior and junior staff to support students. Supporting student placements is only possible if there are adequate numbers of senior PHNs who have time available to supervise placements. Step Feedback Discussion and action points Issue 2.1 The education standards guiding nursing curriculum content and clinical experience do not specifically require the inclusion of concepts of population health and community settings. All contributors agreed with the recommendation. Some commented that calling public health nursing primary care is unhelpful. Contributors called for consistency in the education standards. Contributors wanted to see students completing their training with much better population health knowledge and skills, particularly a good understanding of the social determinants of health and of how nurses can contribute to reducing inequalities. This recommendation has been agreed as a priority as it underpins other recommended changes. work with the Nursing Council of New Zealand with the aim of having nationally consistent education standards that include population health papers. Report on feedback March

10 Recommendation 2.1 Negotiate to increase the required level of knowledge and skills in population health and community settings in the Education Standards, using the GPHCs as a guide and including a reducing inequalities focus. Issue 2.2 The indicators of competence in the national Registered Nurse Competencies appear to focus on personal health and nursing care of the individual. Recommendation 2.2 Negotiate a review of the Registered Nurse Competencies using the GPHCs as a guide to include population health and community settings content. Issue 2.3 Variable population health and reducing inequalities content in schools of nursing curriculum content. Recommendation 2.3 Encourage or incentivise schools of nursing to review the levels of public health nursing knowledge and skills in the curriculum content in their nursing programmes, using the GPHCs as a guide and including a focus on reducing inequalities. This recommendation was strongly supported. Around 80 percent of contributions endorsed the Generic Public Health Competencies (GPHCs) model, with comments such as the Generic Public Health Competencies do reflect the real working environment. One team said: GPHCs would mean more relevant competencies when students undertake placements in our service as a preceptor you aren t necessarily able to show them the real PHN role you are having to change parts to the role they see so that they pass their prescribed clinical tasks. Many contributors believed schools of nursing need to develop population health skills in their teaching staff, including more staff with a population health background. influence the Ministry of Health s Office of the Chief Nurse and the Nursing Council with the aim of enhancing and strengthening the nursing competencies to include a population health focus. work with schools of nursing to identify a possible pilot for an increased focus on population health. 10 Growing public health nursing

11 Issue 2.4 There are few placements available for students who wish to work in population health and community settings. Recommendation 2.4 Facilitate partnerships between schools of nursing and public health nursing employers to offer and promote PHN student placements. Responses varied about the issue and the recommendations. Some contributors believed nurses should do hospitalbased placements before population health; some that the two types of experience should be complementary; some thought hospital placements were not necessary for PHNs and could lead to medical model thinking rather than a population health approach. Several contributors told us employers taking NETP placements would or could not take students. Contributors also expressed concern that students were not always getting the attention they needed during their placements. identify barriers and look for options for improvement for registered nurses to preceptor students find the barriers for areas that are unable to have nursing students and look for solutions talk with schools of nursing and NETS around promoting the value of public health student placement look for examples of positive acknowledgement by employers for people to be preceptors (PDRP may already be this and may just need highlighting) talk to experts about how alternative placement options could be included and managed commence a dialogue with schools of nursing around a partnership between them and PHN employers, to encourage commitment and understanding on both sides consider a marketing campaign highlighting the value of students in a workplace. Report on feedback March

12 Step 3: Nursing Entry to Practice (NETP) Programme There were many comments from contributors that NETP is a good way to attract nurses to public health nursing, such as Bringing NETP nurses into the public health nurse workforce will help grow and build the future workforce. One contributor said there is an awareness of a greying workforce but that placements are limited in public health nursing. One public health unit told us they couldn t recall ever having a new nursing graduate in population health. However, quite a few identified issues that create barriers. The main issue seemed to be around recruitment and vacancy availability. While some areas around the country were different, it seems many workplaces need to have a vacancy to enable a new nurse to be appointed. A ring-fenced position seems to be the exception rather than the rule. Other issues included: many DHBs prefer to employ experienced nurses rather than take NETP placements, although this is not always the case some workplaces do not want to take NETP nurses as they are unable to provide appropriate support, particularly due to difficulties finding preceptors the NETP model of training is individual-focused NETP placements have a one-year contract with no secure future. Contributors generally agreed there were particular issues with the NETP programme as the PHN workforce is so small. There were a number of comments from contributors about a supportive environment and the need for a trained and experienced preceptor. There were a number of comments from respondents about the huge value of the preceptor role, the support required and the professional development required to allow them to be appropriately prepared. There was mixed feedback about the best way to address the issues. There were diverse views about NETP as a key stage in the PHN development pathway, and about whether it was an immediate priority. Overall, contributors saw NETP as a less immediate priority than other issues raised in the discussion document. Step Feedback and discussion Action Issue 3.1 The content of the PHN NETP programmes delivered at DHB level have variable amounts of population health knowledge and skills. Contributors generally agreed with this issue. Comments included: the personal health assessment that NETPs have to do is not relevant to the population health NETP doesn t support them to develop population health skills. carry out research to determine what the barriers are for employing NETP nurses talk with the Office of the Chief Nurse in the Ministry of Health to influence a ring fenced FTE model for PHN employers 12 Growing public health nursing

13 Recommendation 3.1 Work with DHBs to review the NETP programme and to increase the national consistency of population health knowledge and skill content, using the GPHCs as a guide. Comment Are there other existing programmes that you believe might improve NETP? What suggestions do you have to help nurses have positive NETP programme experiences? Issue 3.2 Graduate nurses seeking PHN placements on the NETP programme have difficulty securing positions. Recommendation 3.2 Encourage or provide incentives for organisations to invest in newly qualified PHNs and to offer NETP programme placements. There is no incentive to put population health in the programme, as [in this workplace] at most one registered nurse is doing a public health NETP. As discussed in the introduction to this section, respondents agreed that graduates seeking PHN placement is an issue, but also identified reasons why increasing NETP placements might be a challenge to address. talk with HWNZ and the Ministry of Health to influence NETP programmes to include population health as a generic topic for all nurses. Report on feedback March

14 Step 4: Orientation new public health nurses A robust flexible quality national orientation for new nurses entering the field of public health nursing is essential. There was very strong support for a national core orientation programme. Contributors thought a programme would need to be flexible to allow for different contracts and for regional and local differences. Options suggested for giving all new PHNs the opportunity for orientation included online training (such as webinars). Most contributors agreed a consistent recognition of prior learning process is needed; as one contributor said, It is important to attract nurses from other areas into public health nursing. A system or model that recognises the transferable and relevant skills they bring to the role is important and essential. There were many comments from contributors about the strength of the Plunket professional development model and national orientation programme. Some spoke favourably about the post-graduate certificate at Whitireia Polytechnic that all Plunket nurses are required to do. The certificate is funded by Plunket, and initially nurses work reduced hours to complete their study. Step Feedback and discussion Action Issue 4.1 PHN orientation programmes are variable in content, length and requirements. Recommendation 4.1 Support the development of nationally consistent standards for orientation programmes (using the GPHCs as a guide) that are suitable for: new PHNs nurses with other nursing experience nurses with a population health approach in primary health care settings. There was very strong support for a national quality core orientation programme which could: recognise local variation to meet local needs and configurations focus on how a registered nurse integrates the GPHCs with their daily practice be based on core competencies. develop a draft national orientation programme and put this out to the sector for consultation talk to organisations already providing training about innovative ways to manage and support a national orientation programme consider the possibility of building in preceptoring as a draft public health nurse competency develop a generic national job description with the ability to add in specialties, specifics and variations to accommodate differences in roles. 14 Growing public health nursing

15 Issue 4.2 Experienced nurses bring valuable knowledge and skills that are often not recognised. Recommendation 4.2 Develop some form of national recognition of prior experience process. How important is this and what do you suggest? Issue 4.3 There is no formal education pathway for public health nursing career development. Recommendation 4.3 Develop a national Public Health Nursing Education Framework that provides a pathway for structured public health nursing career development. While there was agreement with this issue, especially valuing the importance of registered nurses with other backgrounds, many contributors were unsure how recognition of prior learning could be done. There were many comments about recognising the skills that are transferable to population health, as opposed to generic nursing skills. One contributor said the project team needs to identify the specific skills/knowledge areas that add value to public health nursing practice. Some respondents commented that recognition of prior learning models could be aligned to the Professional Development Recognition Programme (PDRP) model. More than one respondent suggested using the Generic Public Health Competencies as a self-assessment tool, or as the basis for assessment. develop a recognition of prior learning model investigating the use of the Generic Public Health Competencies as a self-assessment within the model (this model will acknowledge the range of skills and experience every nurse brings to the PHN role). All who gave feedback strongly supported the value of a clear, defined and agreed professional development framework. Typical comments: vital in today s climate and we need to grow the workforce and future proof it. Contributors felt a framework could: spell out what a PHN at various levels is and does many respondents referred to the lack of clarity between the primary care and public health nurse roles provide national consistency show how development needs can be addressed. Contributions emphasised that pathways need to be flexible, to include both the clinical (e.g. ear health) and population health aspects of the PHN role. It was suggested the Plunket professional development framework could be a useful model. Other contributors suggested basing the model on the Generic Public Health Competencies. The project group is passionate about this and will: develop a clear, defined and agreed national professional development framework, considering national and international models. Report on feedback March

16 Issue 4.4 Resource and other access barriers restrict opportunities for public health nursing career development. Recommendation 4.4 Identify access issues and barriers to tertiary and non-tertiary training (including in-service) and develop recommendations to improve access. Expectation and culture there needs to be clear expectation that you will, as a PHN, develop yourself and that the system will support you to do that. Expansion of career pathways [is] necessary to ensure strong leadership. Comments on this issue are discussed in the introduction. There was a strong view that workforce development strategists and funders did not understand public health nursing, so current funded professional development options were not tailored to the needs of public health nursing. Among the many concerns contributors identified were: equity of access many contributors were concerned about that the disparity between available professional development funding for doctors and nurses the shrinking amount of money available for professional development difficulties factoring training/study into PHNs workloads, especially in workplaces where vacancies are not being filled. At the same time, contributors suggested many options to address the current situation, including: programmes with flexible study options, recognising that a significant proportion of PHNs work part-time modular training online training, which was suggested as particularly helpful for such a small workforce nationally national scholarships to support PHNs who may have difficulty getting support from their own workplace. Some contributors also noted that not all PHNs have the capacity or commitment to undertake formal study. They emphasised that the final framework should recognise this and consider how those nurses can be developed inside the workplace. talk with HWNZ about facilitating a clear pathway for professional development for public health nursing and the development of the actions for recommendation 4.3 of this paper. 16 Growing public health nursing

17 Step 5: Advanced public health nursing roles For many contributors, this was their main concern. With constant changes in community health, and constant new knowledge about best practice in public health, both in Aotearoa New Zealand and internationally, contributors were very aware of the need for continuous skill enhancement. Contributors noted that this is the stage at which PHNs have to make critical choices: advanced or nurse practitioner, academic or practice, public health nurse or consultant. Many contributors pointed out that the discussion document focused on the nurse practitioner role, and suggested the project team further investigate the place of the advanced PHN role in the professional development framework. Many contributors described personal experience of struggling to find information about what study/training was available, what might meet their needs, and what could be funded. There was also concern that not all employers understood the benefits of having advanced public health nursing positions, or of supporting nurses to reach those positions. Nurses wanted to have professional development seen by their employers as being relevant, of value, and worth investing in. In Issue 5.4, the discussion document said PHNs working in primary care settings were not able to undertake the Public Health Leadership Programme. This statement was incorrect and we would like to take this opportunity to ensure all PHNs know the programme is a professional development option for them. Step Feedback and discussion Action Issue 5.1 In the absence of a targeted PHN post-graduate qualification, PHNs are studying other nursing areas such as primary care, mental health, business, Māori studies, health promotion and leadership. Recommendation 5.1 Negotiate with HWNZ and facilitate collaboration between nursing and population health educators to identify opportunities for postgraduate qualifications that more clearly incorporate public health nursing practice. Contributors agreed, and said it is critical to address this issue. However, there were varied views on the best directions for post-graduate study; for instance, some contributors supported the Master of Public Health (MPH) qualification, while others did not see them as relevant to PHNs work. continue work with key funders and policy setters about options for PHN post-graduate study, e.g. cross-crediting papers (dependent on the outcomes of the actions for recommendations 4.3 and 4.4. of this paper) continue work with education providers about the post-graduate study options public health nurses can access. Report on feedback March

18 Issue 5.2 Access to, and employer support for, advanced study for PHNs is unreliable. Recommendation 5.2 Negotiate with HWNZ and work with employers to improve access and support for advanced public health nursing education. Issue 5.3 There is little clear information about what post-graduate study is needed and what is available. Recommendation 5.3 Complete a needs assessment of what public health nursing post-graduate This was a major frustration for many respondents, both accessing HWNZ funding and getting employer support. Contributors had observed difficulties in receiving HWNZ support for public health qualifications. This was after having been told (it was not clear where this information was coming from) that HWNZ would only fund a clinical qualification such as a Master of Nursing. This excluded the Master of Public Health degree, which a number of respondents saw as a key advanced qualification. Other contributors mentioned being advised they would only be funded for one post-graduate qualification. This created a barrier for nurses wanting to do a Master of Public Health, who can be required by universities to complete a Diploma of Public Health before being accepted into a Masters programme. One contributor said, I have advocated about this to NZNO and the Nursing Council over 3-4 years and with no response, really. At the workplace level: different employers policies may mean variable recognition of nursing professional development, which can be a disincentive access to funding is variable between employers more opportunities for study leave are needed for PHNs to enable qualification progression. talk with HWNZ about facilitating a clear pathway for professional development for public health nursing and the development of the actions for recommendation 4.3 of this paper. Not all contributors commented on this issue, but those who did all agreed there is an urgent need for information on post-graduate options. There seemed to be major variation between workplaces as to whether information was available, and how helpful the advice given was. There is currently no single place (e.g. website) where PHNs can see the qualifications available to them. continue to collaborate with the Ministry of Health s Public Health Workforce Development Programme (Te Uru Kahikatea), and with other nursing education bodies, in order to keep nurses up-to-date on postgraduate study options. 18 Growing public health nursing

19 qualifications are needed, then develop a guide of what is available. Issue 5.4 The entry criteria for the Public Health Leadership Programme exclude nurses doing public health nursing working in primary health care settings. Recommendation 5.4 Formally recommend the Ministry of Health continues to offer the Public Health Leadership Programme, and expand the entry criteria to include nurses doing public health nursing work in primary health care settings. As mentioned at the beginning of this section, at the time the discussion document was released we understood that the Public Health Leadership Programme criteria excluded PHNs based in primary care. The Ministry of Health has assured us there are no such criteria and that they encourage all PHNs to apply for the programme Contributors who commented on this issue had varied views about the Programme. They ranged from an essential component of public health practice to doesn t really support the role of the PHN. It is likely that views differ according to whether particular PHNs see their pathway as becoming more advanced in their existing practice, or moving into a team leader/manager role. Report on feedback March

20 Step 6: Nurse practitioner/nurse consultant/specialist nurse High cost what s the bang for the buck? Not sure about the potential of the NP needs to be explored. Would like to see PHNs/NPs in all PHN units. As these comment show, contributors had very varied views about this issue. Many thought there needed to be more high-level positions because of the potential value to population health and as a way to keep highly skilled PHNs in the workforce. As noted in the previous section, many contributors believed the project should focus on a broader range of advanced nursing roles, rather than on the nurse practitioner, particularly on the scope for more advanced nursing positions. Contributors said there are already advanced PHNs working under standing orders. We have nurses out there doing very high level autonomous work. [They] should have qualifications and skills to work at that scope of practice. Several contributors also asked that the final report make clear what a public health nurse practitioner would do. Some noted that many employers are not clear what benefit their workplace might get from having nurses with an advanced or nurse practitioner qualification, and that the report could help explain this. Step Feedback Discussion and action points Issue 6.1 There is insufficient promotion and resourcing to encourage nurses to progress to PHN NP level. Recommendation 6.1 Identify the key access issues to becoming a PHN NP and develop recommendations. Contributors who commented on this agreed there were both financial barriers and significant time costs. Additionally, as there are currently few PHN-NPs in Aotearoa New Zealand, employers may not promote such qualifications. investigate the most appropriate model for advanced practice for PHNs find the best title for this role e.g. public health nurse consultant, specialist nurse work with the Ministry of Health, the Office of the Chief Nurse and Nursing Council to investigate other models from overseas that might be applied in New Zealand (e.g. nurse consultant) engage early with NZNO for support to develop this process and HWNZ for funding options. Issue 6.2 There are a limited number of positions in New Zealand for this level of practice. Those who commented on this issue agreed, with some suggesting that there may be few opportunities to create such positions outside large workplaces (e.g. PHUs in larger cities). Contributors suggested there could be more advanced PHN roles. 20 Growing public health nursing

21 Recommendation 6.2a Ascertain organisations interest in developing PHN NP roles and concurrently promote PHN NP opportunities. Recommendation 6.2b Negotiate with the Ministry of Health and HWNZ to establish a PHN NP pilot (similar to the Diabetes NP pilot) to grow the PHN NP workforce and increase the impact PHNs have on population health outcomes. There was some support for this recommendation, but not from all contributors. Several contributors said there is an urgent need to support more PHNs into a prescribing role. Report on feedback March

22 Step 7: Public health nurse academic Step Feedback Discussion and action points Issue 7.1 There is a lack of appropriately prepared academics to drive PHN workforce development at the highest academic and political levels in New Zealand. Recommendation 7.1 Provide national scholarships for PHNs to access education opportunities that lead to advanced education levels. Several contributors were unclear about what a nurse academic is (are they a teacher, a researcher, a professional mentor or all of these?) and what they do. The project team was also asked to find out how many there are nationally, and the scope of their role. One contributor was concerned that the lack of PHN academics meant a lack of visibility and advocacy for public health nursing in the academic sector. Several contributors, including some in the academic sector, said currently there is no career path for nurse academics here. There was concern that PHNs might study to this level, only to find they needed to leave Aotearoa New Zealand for career opportunities Issue 7.2 There is a lack of ongoing education pathways to lead people to the nurse academic stage. Recommendation 7.2 Promote pathways to PHN academic level and the benefits of more people attaining this level. Much of the discussion under Step 5 also applies to this issue. Contributors agreed that a richer education system for students is needed. Several contributors commented on the broader issue of how to support PHNs to do advanced study. They said that many PHNs have limited opportunities to study, and have problems with work/study balance. There was strong support for national scholarships. research the role of the public health nurse academic, including their benefits to the development of public health nursing (e.g. teaching, supervision, research on practice, innovations in practice) investigate how many public health nurse academics may be needed to support future development research study options available for PHNs to advance to this level. 22 Growing public health nursing

23 Report on feedback March

24 Funded by: The Ministry of Health Project managed and written by the Public Health Nursing Education Framework Working Group and the Public Health Association of New Zealand 24 Growing public health nursing