Wendy Walsh, mātanga tapuhi nurse practitioner.
Pinnacle’s mātanga tapuhi nurse practitioners and nurse prescribers are having an impact across the Pinnacle Midlands Health Network (Pinnacle MHN), helping to relieve pressure on GPs, providing patients with greater access to healthcare, and reducing acute calls and hospital admissions.
The practice of mātanga tapuhi nurse practitioners, designated nurse prescribers in primary health and specialty teams (PH&S team nurse prescribers) and community health nurse prescribers (RNPCH) attending to patients who were once only seen by GPs is not only improving access to healthcare for patients and whānau, but providing a rewarding career path for nurses.
Speaking to mātanga tapuhi nurse practitioners across the Pinnacle MHN network, the enjoyment they experience in their daily work is palpable.
“I am loving the role!”
“This is very exciting work. I absolutely love it.”
“I wouldn’t change my job for anything.”
Wendy Walsh, a mātanga tapuhi nurse practitioner** at Avon Medical Centre in Stratford, highlights the accessibility benefits of having more time available for patient consultations, helping ensure both the clinical and social aspects of a patient’s wellbeing are addressed.
“We look at ways patients can manage their ailment in a holistic environment at home,” Wendy explains. “For example, if a patient presents with eczema, we can involve the whānau and bring the whole family on board to manage the problem. If you have whānau buy-in and support to make changes that’s better than any medicine.”
Over in Rotorua, whānau involvement is a key part of Piripoho RNPCH Leesa King’s role too. “I have time to build up more of a rapport with patients and their whānau,” Leesa explains. “Going into patients’ homes allows me to see what else is going on in the environment. I can gain a better understanding of the social aspect and work to put other care practices in place to try and stop health problems from recurring.”
Based in Ōwhata Medical Centre, Leesa is regularly on site in primary, intermediate and high schools in Rotorua’s eastern suburbs. “Community health nurse prescribing is instrumental to prescribe quickly to patients,” she says. “I can speak with the parents and take medication directly to their home. It frees up time spent at the doctors and enables a quicker response within the community. It’s a really proactive approach and very exciting work. I love it!”
Pinnacle MHN nursing director, Jan Adams, says the roles of mātanga tapuhi nurse practitioners and nurse prescribers are integral to the future of healthcare, with ongoing health reforms and an aging workforce among the many challenges facing the sector.
“We need to look at a range of ways to provide communities and whānau, particularly in rural parts of New Zealand, with good access to quality healthcare. Having nurses who are able to offer a wider range of services for the community is fantastic, and also provides the nurses themselves with greater opportunities for career growth and professional development.”
There are currently 16 mātanga tapuhi nurse practitioners, 25 nurse prescribers in PH&S teams and 28 RNPCH working in the Pinnacle MHN network alone, and numbers across all three prescribing tiers are increasing every year.
However, Jan says there also needs to be an understanding of the significant personal investment nurses have undertaken to achieve this status.
“Embarking on postgraduate study is a significant commitment. Many of our nurses have families, work part or full-time, and undertake further study that can benefit their community. Mātanga tapuhi nurse practitioners do attract a higher pay scale, but many people are doing it for altruistic reasons, not financial. To date, registered nurse prescribers are not recognised within the primary care MECA, so not all receive fair remuneration for their work.’
Hilde Mullins, former nurse lead at Pinnacle MHN who has been instrumental in establishing nursing workforce pathways and services, says ultimately the growing number of nurses achieving postgraduate qualifications, or completing the Midland Collaborative RNPCH programme*** is enabling a better way of working.
“Mātanga tapuhi nurse practitioners are taking over some of the services that are traditionally sitting with a GP and that has significant benefits, equity of access being one,” says Hilde.
“These nurses have the ability within communities to be mobile and to connect with patients/whānau who have access issues or who are experiencing an inequitable service. They can provide a smarter, more comprehensive plan of care for patients that is tailored and culturally responsive to the patient and whānau.”
Two collaborative prescribing peer groups established five years ago, underpin the success of the model, providing connection and support across the network, incorporating Midland region DHBs and PHOs.
Six-weekly peer meetings with case study presentations and guest speakers provide resources for nurse practitioners, and nurse prescribers in PH&S teams, supporting and fostering ongoing conversations around workforce development – support that extends into general practices.
“This is a collaborative model, not a competitive one,” explains Jan. “Mātanga tapuhi nurse practitioners and nurse prescribers will always work in collaboration with general practitioners and have a medical colleague for support and oversight where indicated.
** Mātanga tapuhi nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practice beyond the level of a registered nurse.