October 2017 December 2013 | Page 5

Te Puawai
practice
model
used
elsewhere.
By
professional practice model I mean one
whereby nurses report to nurses and nurse
leaders oversee professional development,
discipline and decisions about position
appointments and the appropriate deployment
of nursing staff.

The lack of such a model is painfully clear to
me when various primary health care nurses
from all over the country ring the College
office looking for support with employment
crises at work. It’s hard to summarise but my
impressions over the last many years are
firstly of fear, of intimidation, or oppression
and also very cavalier approaches to correct
HR procedures. Nurses in these settings often
express an almost unbelievable sense of
vulnerability and appear to lack any sense of
their own value, let alone rights. Ridiculous
myths about professional accountabilities are
sustained and being vocal or assertive is
almost always punished in one way or
another. Such environments destroy potential
leaders and only the hardiest rise above such
settings. Very rarely do they sound like
potential fearless “tire kickers”.

Back in 2003 when writing the blueprint for
PHC nursing development Investing in Health
we recognised that PHC nurses were largely
starved of access to post graduate education.
The implementation of scholarships (initiated
by Annette King and administered by the
MoH) brought forth a flood of applications.
Those of us in leadership positions saw this
as an exciting breakthrough and in many ways
it was. However as the years have dragged
by the comparative numbers of PHC nurses
who are accessing postgraduate education
remains a trickle and they consistently report
greater challenges with accessing the time
away from work and gaining genuine support
© Te Puawai

from employers. It is hard enough to do
postgraduate study when working full time but
to do it from a climate that begrudges the
support and belittles the value is sometimes
just too much.

As I have frequently argued, postgraduate
study fulfils a dual purpose. It is an essential
source of clinical skill and knowledge. It is also
a source of personal development in which
the nurse gains a much broader and more
strategic view of health sector issues and the
challenges facing all countries as they attempt
to sustain services against increasing demand
and diminishing workforce capacity. As such
it is a critical component of leadership
development. From my perspective as
someone who teaches these nurses every
year however, I am constantly reminded that
gaining strategic vision is more often a case of
increasing frustration for these nurses rather
than engendering or empowering action.

In summary thus far nursing efforts towards
leadership development have suffered from
working in a sector that largely does not see
or embrace any need for change. Powerful
voices in General Practice particularly, remain
resistant to real nursing leadership and
continue to pay lip service through partial
forms of team-work and paternalistic models
of power sharing. In addition we know that
behind the scenes if the GP lobby group has a
tantrum everyone from the Minister down
listens and acts. In nursing we could have all
the tantrums we like and nothing would alter
except probably even greater resistance to
our supposed “self-interest”.

So this brings me to the obvious question.
When as suggested nursing leadership “steps
up” more than it already does, what should it

College of Nurses Aotearoa (NZ) Inc
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