Rural Nurse Specialist: A Model

2. Rural Nurse Specialist: A Model Robin Williams RGON ADN Operational Manager and Clinical Advisor Community Health West Coast District Health Board

3. West Coast Rural Nurse Specialist Team • Heather Maw (Karamea) • Elizabeth Burns (Moana/Otira) • Bruce Hall (Harihari) • Sue Cleland (Whataroa/Franz Josef Glacier) • Louisa Davidson (Fox Glacier) • David Verrall (Haast)

4. This presentation will… • Provide a description of the RNS model, as developed on the West Coast (Who are they and what do they do?) • Discuss the relevance of Nurse Practitioner role in rural health care (What is the step from what we have to what is needed?) • Give a brief overview of the costs and benefits of the RNS model, including funding

7. Evolutionof roles 1996 variation in employment contract between Coast Health Care and the South Rural Nurses contract • title change from District Nurse to Rural Nurse Specialists • salary increase in recognition of current skill level and experience and isolation lack of residential GP backup [on his/her days off] on call work 2000 Public Health Nurse to Rural Nurse

8. What is it about rural nursing?

9. What is it about rural nursing? A “multiskilled rural nurse – providing 24hr cover, 7 days a week”, advised that “rural nursing is not for the faint hearted or the truly organized nurse. It is however rewarding, stimulating and a way of life, a darn good one at that”.

10. What do we mean by rural nursing? ‘Rural nursing’ is not a scope of practice, it is a context of practice. Nursing practice is shaped by the rural context. (Jones & Ross 2001)

11. What is distinctive about the rural context? • Distance • Isolation • Interdependence between team members • The nurse lives and works as a community member • Resilience and independence of rural community members

12. What do the RNSs do? Everything!

13. What do the RNSs do? It is a generalist role, but a specialised generalist

14. What do the RNSs do? • deliver personal and population health in a rural setting, under the principles and goals of NZ Health Strategy, PHC strategy and ‘Roadside to Bedside’ document • as autonomous practitioners they are the first point of contact for day to day health care needs on a continuum

15. Personal health care [80%] • Clinic and home and school based consultations • Tamariki Ora / well child / immunisation of hard-to-reach • Well adult health screening • Early intervention thru assessment, monitoring and referral • Palliative care • Antenatal and postnatal care • Follow-up care following hospital admission • Emergency response -- PRIME

16. Population health initiatives [20%]Guided by founding documents Treaty of Waitangi and Ottawa Charter National health goals & local health needs e.g. • Maori and Pacific Island Health • Screening programmes • Health promoting schools • Quit Smoking programme • Safety in the workplace

17. interplay between personal and population based health an example

18. Rural Nurse Practitioner ? ‘ PHC— rural health’ as a ‘scope’ is problematic…

19. What is the step from RNS to RNP ? • Organisational • Professional • Personal

20. Why have NPs in rural health? Changes in the economics in demography of New Zealand through the past decade or more have led to hard times and the depletion of health and other social services in rural settlements have bought the health of rural community to the attention of policy makers (Litchfield 2001).

21. Why have NPs in rural health? The difficulty in finding GPs for rural areas has gone on for along time. My father was Chairman of the Maniototo Hospital Board and I remember the difficulties – I have newspaper clippings -- they had in those days trying to find a GP for Ranfurly. It’s not something new and is not going to go away. I firmly believe that the Nurse Practitioner idea is something that needs to the developed more and more in rural areas to assist GPs so that they don’t feel so isolated and burnt out(Marg Eckhoff).

22. Advanced practice roles …in rural health? • Specialised practice • Expanded practice • Advanced practice (ANA cited in Cronenwett 1995:115)

23. specialization Specialization is concentrating or delimiting one’s focus to part of the whole field of nursing.

24. expansion Expansion refers to the acquisition of new practice knowledge and skills including the knowledge and skills that legitimize role autonomy within areas of practice that overlap the traditional boundaries of medical practice.

25. advancement Advancementinvolves both specialization and expansion and is characterised by the integration of a broad range of theoretical, research-based, and practical knowledge that occurs as a part of graduate education in nursing.

26. Are RNSs cost effective in delivering the aims of NZ health strategy, PHC strategy and roadside to bedside strategy? • Cost of a Rural Nurse Specialist is $85,614 per annum • Plus costs relating to continuing education and annual leave locum cover

28. Benefits • RNS: It's the difference of having a health service or not • Variation in GP services • An effective working relationship between Nurse and GP • Clinical placements • Accessible, appropriate service • Transferable skills

29. A vision for the future Primary Health Care contracts that provide for equal status of Medical Practitioners and Nurse Practitioners, whilst recognising each as having specialised roles with joint responsibility to improve health outcomes

30. My acknowledgements Jean Ross Wayne Marshall Shelley Jones