Nursing Integration

Nursing Integration Leader

Mary Carthew

The challenges of achieving integration – a discussion posted 23/09/10

The vision of the Primary Health Care Strategy (2001) states that primary care services will focus on better health for populations and will actively work to reduce health inequalities between different groups, particularly vulnerable groups who are over-represented with poor health. The Minister of Health, Tony Ryall, whilst in opposition, stated that the intent of the Primary Health Care Strategy – to enhance the role of nurses - has failed to deliver a strong and expanded involvement of nurses in patient management (Ryall, 2007). There remain many barriers to the development of new or expanded roles within primary health care nursing, particularly practice nursing. Although there has been substantial growth in some roles in the management of chronic care management and working with people in underserved and vulnerable groups, there are still several impediments to the expanded role of the practice nurse. Nurses have an important part to play in educating clients about their life choices and many are providing great care through many nurse-specific programmes such as CarePlus, Diabetes Get Checked, immunization and women’s health - programmes which are funded and delivered in general practice. However, general practice funding models tied to GPs, particularly the ‘fee for service’ model, and the employee / employer relationship are cited as two main barriers to further expanding the role making it challenging for nurses to advocate and argue for change (MOH, 2009). Debate about the cost-effectiveness of nurses working within general practice has recently been supported by evidence found in a robust cost benefit analysis of practice nursing which concluded that the expansion of the role of nurses in general practice is a cost effective option (Hefford et al, 2010). Having different employers, individual and narrow service contracts as well as different pay and conditions can be a barrier to integration leading to suspicion over motives which limits the potential to enhance integrated teamwork. Transparency and an open consultation and communication process, although challenging when working with inter-disciplinary teams, is identified as a key to successful integration (Imison, 2009).

Successful prevention and management of chronic conditions requires action both within the integrated health team and beyond the health sector including local territorial authorities, inter-sectorial government agencies, community leaders and private businesses. Achieving true integration will need to involve and include the wider community to address the issues affecting the whole community. This may involve such joint initiatives as reducing access fees to the local swimming pool for people with chronic disease or supporting the development of designated cycling lanes to enhance physical activity. These initiatives will require strong alliances with local authorities if the health of local populations is to improve (International Council of Nurses, 2009).

There are many examples of great work being done in teams across Manaia Health, but the true potential of our nursing work-force is still to be realized. With the burgeoning growth of chronic un-wellness and the known future shortage of medical practitioners, the ability for every patient who comes through the general practice door to be seen by a GP is neither sustainable or cost-effective, and, in many cases, not appropriate. The old model / ratio of one practice nurse to one GP is no longer working and has to change if the reported deluge of patients accessing primary care is to be stemmed. It is timely now to work together as an integrated team to find the solutions where everybody benefits – better and timely service to patients; reduction in stress and burnout for staff; improved working relationships and, ultimately, a healthier population who will have easy access to high quality care provided by happy, integrated health teams who do what they know and do best.

Discussion posted 23/09/2010 by Mary Carthew, Masters candidate, AUT