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DHB launches strategy to empower nurses
By Kai Tiaki co-editor Mary Longmore
Hutt Valley District Health Board is hiring more Mâori and Pacific nurses and local residents to make sure its workforce represents its community.
When Chris Kerr took up the director of nursing (DoN) role at Hutt Valley District Health Board (HVDHB) in August 2017, nurse morale was running low after much restructuring, a late ‘flu season and frequent, lengthy vacancies. Hoping to “empower staff to be more positive”, Kerr decided to run a year-long consultation for a new nursing strategy.
HVDHB director of nursing Chris Kerr
After much kôrero with nursing staff, the strategy – Nursing at its best: Tepanikiri pai o ngaa neehi – has just been released, with a focus on four key areas – clinical leadership, nursing workforce, education and professional practice, and patient safety.
The result, says Kerr, is a strategy the nursing staff feel involved with. “The document has been developed with the nurses on the ground – they can see themselves in here, all the conversations have been captured.”
Growing populations
One finding is a strong desire to have a nursing workforce better representing its community. Against Hutt Valley’s Mâori population of about 17 per cent, just 6.5 per cent of HVDHB’s workforce and nearly six per cent of nurses are Mâori. Pacific people are seven per cent of the population but just five per cent of the nursing and overall workforce – and both populations are projected to grow in the Hutt Valley.
“We want to support our local workforce, we want to grow our own,” Kerr said. “And because of the ethnic make-up of our patients, it means we’re looking after our own in the best way possible. The best people to be able to do that are from familiar areas, with shared languages and cultures.”
HVDHB began prioritising Mâori, Pacific and Hutt Valley-based applicants last year. As a result, half its 14 new graduate recruits, who began working in January, were Mâori or Pacific, “which is a huge shift”, Kerr says.
Other problems identified included high nurse turnover – up to 30 per cent on medical, paediatric and the older person rehabilitation wards – and unsafe staffing, which was causing “lots of staffing events”.
Nurse turnover
It took, on average, three months to replace a nurse. “But now we can do that in five or six weeks, which is much better,” Kerr says. Overall, nurse turnover dropped from just over 13 per cent in 2015/16 to 11 per cent in 2017/18.
There was a high reliance on temporary agency nurses too, “who fill a gap but are not great for consistency of care. When you have regular staff on the ward, you have better quality of care”.
A “concerted effort” had led to a drop in the use of agency registered nurses and the DHB hoped to achieve a similar result with its health-care assistants, Kerr said.
As part of the DHB multi-employer collective agreement, the Ministry of Health committed to achieve safe staffing at all DHBs with an extra $38 million to boost the nursing workforce. It also allocated $10 million to ensure the care capacity demand management (CCDM) programme will be in place at all DHBs by 2021.
Kerr says HVDHB was the first to submit its plan for safe staffing, receiving approval for an extra 17 full-time equivalent nurses across a range of departments.
In the future, Kerr wants to see the Mâori and Pacific nursing workforce match the patient population – currently around 20 per cent Mâori and nine per cent Pacific (excluding outpatient clinic patients).
“I’m certainly aiming to get there . . . In an ideal world, that’s where we would be heading.”
To achieve that, support in the workplace for Mâori and Pacific nurses was “crucial” and her nursing teams would be working closely with the Mâori and Pacific health teams to provide a supportive environment.
Providing culturally safe care
HVDHB director of Mâori health Kerry Dougall said attracting Mâori into nursing created “culturally safe and appropriate care for Mâori patients and whânau within our community.
“The nursing strategy paves the way forward for our DHB to push boundaries and try new and innovative ways of prioritising and attracting Mâori nurses.” Director of Pacific people’s health Tofa Suafole-Gush said increasing the numbers of Pacific nurses will “complement how the sector provides culturally-appropriate care when Pacific patients are in the hospital”, including language support.
“We’re already making progress, and it’s only been six months,” Kerr said. “It’s exciting.”
The strategy was officially launched on February 1 and is available here.
