More time for patients proves to be the best medicine

Pinnacle’s growing mātanga tapuhi nurse practitioner and nurse prescriber workforce is having a significant impact across the network, relieving 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 RNPCH and 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.”

More time and scope

“I have the time to spend with patients,” says Donna Radich, RNPCH* in Stratford, Taranaki. “That makes all the difference. I’m not just looking at the problem, I have time to look at the patient and the family as a whole.”

Donna says her role enables her to “see the low level stuff” so GPs and nurse practitioners can focus on the more complex health problems.

“I see patients with skin and throat infections, ear problems, those needing contraception and sexual health consults, or patients requiring respiratory assessments. I can educate and prescribe skin products, contraception, pain relief, or antibiotics.”

“It’s an extension of what nurses already do, but as an RNPCH, I have a lot more scope and empowerment to see things right through for a patient, rather than requiring them to go to a GP.”

Making healthcare accessible

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 Owhata 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!”

The future of care

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.”

Supervision and support

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.

For Donna Radich in Taranaki, that support has been invaluable to the success and enjoyment of her role. “I have very good support here from Wendy Walsh and my colleagues. They’re very encouraging and they have confidence in me,” she says.

“I’d encourage all practice nurses to embark on this study. They all have the knowledge and the experience anyway. It’s about empowering them to take that next step. To be able to treat their patients with what they already know. Our roles are vital in this environment where we have a GP shortage, and it’s very rewarding.”

*A Midland region RNPCH can support healthy patients /whānau who are experiencing minor health ailments. They have completed a programme of training through the Nursing Council of New Zealand (NCNZ) approved Midland Collaborative RNPCH recertification programme with online theory and work based clinical supervision a key. Each nurse has a year to complete requirements and apply for prescribing rights.

**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.

*** The Midland Collaborative RNPCH programme has completed three virtual programmes since November 2020, with an average of 55 nurses enrolled per intake, the majority of these being Pinnacle nurses from all community settings (school based, general practice, outreach teams).