Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Introduction and Environment
“To develop a professional nursing structure that supports the service
development initiatives being planned in a single floor unit including:
Support best practice in nursing
Redesign nursing leadership
Reinforce the clinical career pathway for nursing
Facilitate the development of multi-disciplinary teams.”
The nursing professional structure redesign was scheduled to be completed by
23 December 1998.
3.12 The Clinical Nurse Specialist (CNS) was to perform a crucial role. The
positions were planned to provide front line nursing clinical leadership, with
responsibility for patient assessment, care planning and evaluation, discharge
planning, patient and staff education, maintenance of clinical standards,
orientation, preceptorship and development of junior staff.
3.13 There was debate over how many CNS positions THL should have. The
former Director of Nursing reported that the project group’s preferred option
was to identify staff with clinical nurse specialist abilities through the Clinical
Career Pathway (CCP) process. CNSs were to be people already employed at
THL who had the necessary expertise, training and qualifications. Potentially
THL could have any number of CNS positions in each team.
3.14 The former Group Manager (Hospital) advised that the CNSs were intended to
co-ordinate the nursing interventions from the nursing workstations in the
reconfigured wards. It is significant to the eventual outcome of the nursing
changes that no appointments to the CNS positions were made at this time,
since there were no applicants. To date no CNSs have been appointed.
Clinical Career Pathway
3.15 An essential building block for the successful restructuring of the wards was
the introduction of a nursing Clinical Career Pathway (CCP) process. A
clinical career pathway would ensure that a pool of nurses with the appropriate
skills would be identified and ready to deliver the type of care appropriate to
the reconfigured wards.
3.16 As the success of the CCP process depended on identification of staff with
clinical nurse specialist skills, the fact that no one came forward and there was
no leader promoting the CCP process doomed it to failure.
3.17 THL made the following comments about the attempt to introduce a Clinical
Career Pathway:
“The CCP initiatives that were attempted to be introduced at THL have
been run successfully elsewhere in the country. Why did this fail in
Tairawhiti? … A clinical career pathway is a well recognised and
accepted process for developing nursing. However, in Tairawhiti, the
staff associated implementation of a CCP process with the restructuring.
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