October 2017 December 2013 | Page 17

Te Puawai
In addition, they (DHB Providers) will need
to use their knowledge and capability to
support primary care providers and the
wider health workforce to identify and
address mental health and addiction
issues.
Rising to the Challenge, MoH 2012 p 6

Nurse practitioners such as myself,
working in secondary services, are ideally
positioned to work across traditional
boundaries and integrate with primary
health services. By remaining in the
secondary service I am (at least
potentially) able to support both worlds in
my practice. For example with secondary
services I have good administrative and
clinical
back-up,
along
with
supervision/support from my multidisciplinary colleagues. I am also able to
access clinical pathways more efficiently
and effectively. This ability to improve
timeliness and accessibility has direct
benefit for the clinical needs of patients
and the educational and attitudinal needs
of primary health care staff.
Working in close liaison with primary care
GP’s, NPs and other clinical staff would
help shift the ambulance closer to the top
of the cliff not towards the bottom where I
consistently see clients now. I could more
effectively provide clinical input for the
mild to moderate mental health and
addictions problems with which people
present. This reduces the pressure on
primary health by providing a much
needed resource for primary health care
staff, significantly mitigates against stigma
by not referring onto secondary mental
health & addictions services and limits the
overall demand on secondary mental
health & addictions services.

© Te Puawai

It seems to make sense for the Ministry to
actually walk the talk and influence if not
direct funders, planners and providers of
health services to change for the better.
By “the better” I suggest as just one
example,
incorporating
Nurse
Practitioners into key roles within the
health system rather than either not using
them at all or using them to do what does
not interest medical staff. I am sure the
bean counters out there can see the
benefit as systems and processes can be
recharged to achieve productive outcomes
and quality improvement.
Nurse practitioners still face fundamental
barriers in working to their full extent.
There are a number of regulatory
restrictions to NP practice to still work
through with government departments,
i.e., signing authority of benefits
applications
and
ACC,
authorised
prescribing of medications, and in mental
health not being able to do certain
sections of the Mental Health Act which
are reserved for medical officers. These
regulatory restrictions are being worked
on with dogged determination by nursing
representatives around the country but the
progress is as one NP described recently
“glacial”.
Some of the bigger restrictions to practice
can come from within the health service
itself. I have talked about the glass
ceilings before (see Editorial Kia Tiaki
Sept 2013) and how these are formed
essentially from the attitudes of our
colleagues influencing national, regional
and local