ࡱ> uwt \bjbj c,3* * mm111tmDlrM63333%Z#&?&LLLLLLL$OJRJL91*$^M%|**Lmm33 ,M---*pm83R3L-*L--*G"aL3gFTBS+JnLBM0rM[KR+ RaLaLR1uLDO&m'-9((O&O&O&LL, O&O&O&rM****RO&O&O&O&O&O&O&O&O&* 3:  Jessica Wood Professional Standards Section Nursing Council of New Zealand PO Box 9644 Wellington 6141 New Zealand This submission was completed by: Name: Elaine McCall, Rosemary Marks Address: PO Box 22 234, Wellington Email:  HYPERLINK "mailto:psnz@paradise.netnz" psnz@paradise.netnz Organisation: Paediatric Society of New Zealand Position Treasurer, President You are making this submission: ( as an individual ( on behalf of a group or organisation ( other (please specify) Please indicate which part of the sector your submission represents: ( Individual nurse ( Individual other ( Consumer group ( Regulatory authority ( Primary health organisation ( Mori health provider ( Pacific health provider ( Government agency ( Education provider ( Professional organisation ( Private Hospital Provider ( Aged care provider ( Non-government organisation ( District Health Board ( Other (please specify) In the interests of a full and transparent consultation process under section 14 of the Health Practitioner Competence Assurance Act the Nursing Council intends publishing submissions received on this consultation document on its website. However, if you as an individual or as an organisation object to this publication or to the publication of your name tick one or both of the following boxes:  I do not give permission for my submission to be published on the Nursing Council website. I do not give permission for my name to be listed in the published summary of submissions. General consultation questions Do you think the issues for the enrolled nurse and nurse assistant scopes of practice are clearly outlined in this consultation document? ( Yes ( No If no, what other issues should the Council consider related to scope of practice? Consultation questions on the revised scope of practice (Pages 32- 35) Do you support a generic scope of practice which would allow second level nurses to work in all health settings? ( Yes ( No If no, please explain which settings second level nurses should be excluded from and your reasons The Paediatric Society of New Zealand does not support the use of a second level nurse to provide patient care within acute paediatric services. We do not feel that a second level nurse role is appropriate in acute paediatric clinical settings due to the high acuity, complexity of care requirements and significant co-morbidities of the children in these services. We consider that the educational preparation of a second level nurse will not promote the adequate critical analysis required to care for acutely unwell children. Childrens conditions and situations can change rapidly thus requiring a broader scope of knowledge and skill to manage these situations. Childrens illness trajectories are often unpredictable and require a high level of critical analysis and nursing judgement thus it is inappropriate for the registered nurse to delegate care to a second level nurse (Nursing Council of New Zealand, 2008). The use of a second level nurse to provide direct patient care may limit the ability of the registered nurse to access and synthesise all the required information to provide effective patient care. An important part of nursing unwell children is building trust and confidence between the child/family and the healthcare team and it is not appropriate to fragment the care delivery into a series of tasks delivered by lots of different people to children on a daily basis. There is already a differentiated model of care and RN skill mix with the Professional Development and Recognition of Practice framework within acute paediatric services. Adding a second level nurse may be potentially detrimental to patient outcomes through fragmentation of care, increased stress on registered nurses who would need to supervise another persons work in addition to own workload and junior registered nurses work and ultimately lower the job satisfaction of registered nurses. The paediatric Society supports the use of a second level nurse to provide patient care in non acute paediatric services and recommends that a review of the disability service workforce is required. Do you think that that the revised scope of practice should include allowing second level nurses to lead teams of unregulated workers under the direction and delegation of a registered nurse in some settings? ( Yes ( No Please explain your reasons. If yes please indicate which settings. This would not be appropriate within acute paediatric clinical settings but may be appropriate in non-acute settings provided there was clarity of and agreement on responsibility and accountability. Do you think that that the revised scope of practice should allow second level nurses to work under the direction and delegation of other registered health professionals in some settings (e.g. doctors, physiotherapists, occupational therapists)? ( Yes ( No Please explain your reasons. If yes please indicate which health professionals in which settings. Within the discussion document it is identified that the second level nurse role is to support the registered nurses role and to provide delegated nursing care under supervision of a registered nurse. It would thus be inappropriate for other health care professionals to delegate care and to supervise this position. Do you think the Councils guidance on direction and delegation is sufficient for a revised scope of practice? ( Yes ( No If no, what would you include: It would be useful to have some acknowledgement of the involvement, responsibility and accountability required from employers alongside RNs if they choose to employ second level nurses as part of the skill mix. Do you support the removal or modification of the phrase: to implement nursing care for people who have stable and predictable health outcomes in situations that do not call for complex nursing judgment? ( Yes ( No Please explain your reasons. If yes, please suggest how the scope of practice statement could be modified to ensure second level nurses are not responsible for clients with complex health needs. Do you think that the revised scope of practice should include that second level nurses contribute to nursing assessments? ( Yes ( No Please explain your reasons. Nursing assessment is not just about collecting information, it is about interpreting and synthesising a wide variety of information. The use of a second level nurse to contribute to nursing assessment of an acutely unwell child will result in fragmented information and limit the ability of the registered to adequately synthesise all the required information. There is a large range of normal for age vital signs which registered nurses do not know coming out of a three year degree course thus it is unlikely that this would be achieved in a generic second level nurse training course. Second level nurses depending on education and subsequent experience may be able to contribute to nursing assessment of stable children in non acute settings particularly around the care that they are responsible for providing. Are there any specific areas of skill that should be included in an education programme? Proposed scope of practice statement (Pages 36-37) Do you think this scope of practice statement adequately addresses the issues identified with the current scopes of practice? ( Yes ( No Please explain your reasons or suggest changes or alternative wording. We believe the use of enrolled nurses are registered health professionals ... to deliver nursing care ... combining nursing knowledge, skill and judgement to contribute to nursing assessments, care planning, implementation and evaluation of care for clients and or families will lead to public and potentially inter-professional confusion between the registered nurse and second level nurse roles. Do you support an endorsed second level nurse scope of practice through employer credentialing (and application of conditions (authorisation) by Nursing Council)? ( Yes ( No Do you support endorsement by application of conditions (authorisation) by Nursing Council)? ( Yes ( No Please explain your reasons. There is currently a process for recognition of skill and knowledge development within the Professional Development and Recognition Programme for second level nurses. Title (Page 37) What title do you support for the revised scope of practice? Preferably a title without Nurse, but of the two previously used titles then Nurse Assistant more clearly reflects the stated aim of the role to assist RNs to provide and enhance quality care and improve outcomes of care. Please explain your reasons. Any healthcare worker with the title Nurse is generally perceived by the public as a registered nurse and there maybe confusion created by having another nurse role. Proposed education programme (Pages 37- 41) Option 1: Develop the present programmes into a generic programme. Do you support developing the present level 4 programme into a generic programme? ( Yes ( No Please explain your reasons. Do you support the programme being extended by a 12 week clinical placement? ( Yes ( No Please explain your reasons. Do you support a nurse entry to practice programme for the revised scope? ( Yes ( No Please explain your reasons. Option 2: Develop a work based programme that requires a partnership between an education provider and an employer Do you support developing a work based programme that requires a partnership between an education provider and an employer? ( Yes ( No Please explain your reasons. Do you support the programme being extended by a 12 week clinical placement for option 2? ( Yes ( No Please explain your reasons. Do you support a nurse entry to practice programme for option 2? ( Yes ( No Please explain your reasons. Option 3: Develop a seamless programme which allows students to exit at either the certificate or diploma level Do you support developing a seamless programme which allows students to exit at either the certificate or diploma level? ( Yes ( No Please explain your reasons. Option 4: Cease providing nurse assistant programmes Do you support ceasing nurse assistant education programmes? ( Yes ( No Please explain your reasons. The use of second level nurses in non acute paediatric clinical practice is significant and education programmes which focus on developing the specific skills and knowledge related to the clinical practice area is required. Do you support development of national requirements for an unregulated role that assist registered nurses? ( Yes ( No Please explain your reasons. If yes, which organisation(s) should be responsible for developing these requirements? For all the reasons discussed previously, The Paediatric Society of New Zealand does not support a second level nurse role within acute paediatric clinical settings. It would be useful to consider further the alternative options for supporting Registered Nurses in acute clinical practice rather than providing the second level nurse as the preferred option. The Paediatric Society of New Zealand supports the role of the unregulated healthcare worker in providing non nursing support in acute clinical practice, such as answering telephones, retrieving stock and equipment, cleaning equipment and assisting the registered nurse under direct supervision with patient transfer.     yz{} ( ) < = ? 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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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