Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Quality Assurance Systems
Specialist was established to ensure that patients received appropriate care.
This was a clinical leadership position. Currently no Clinical Nurse
Specialists are in place in any areas, resulting in a lack of clinical leadership.
5.5 Moving through the CCP is voluntary so it is possible that no staff will choose
to progress to the position of Clinical Nurse Specialist. During the
introduction of the CCP, the possibility of difficulty in filling the Clinical
Nurse Specialist position was not discussed. Nursing staff perceived there was
no job description for Clinical Nurse Specialists and no extra money attached
to the role. THL responded as follows:
“The job description for CNSs was the same as for standard registered
nurses, but the performance criteria were more rigorously applied. The
selection criteria for CNSs was agreed with the NZNO, as was a
remuneration package. There has always been an additional salary step
available for nurses achieving level 4 of the CCP and this has been
available ever since implementation.”
5.6 The main concern of the nurses interviewed was the lack of nursing structure.
There was no positive nursing structure or leadership and no professional
guidance a year after the restructuring. Nurses felt they were not listened to
and felt undermined. Their morale dwindled and this impacted on the quality
of their care.
5.7 Another key leadership change was the disestablishment of the ICU Clinical
Nurse Leader position in 1999, without transferring responsibilities elsewhere.
5.8 In an external review of Gisborne Hospital’s intensive care services
commissioned by THL in June 2000, Dr Jack Havill (Clinical Director,
Waikato Hospital Critical Care Unit) and Ms Hayley McConnell (Operations
Manager, Waikato Hospital Critical Care Unit) noted:
“Despite the seniority and experience of the nursing team they can best
be described as ‘rudderless’. Without the day to day support of one
nursing leader the team covers only the day to day patient care and
housekeeping duties required of them. There is a clearly identified lack
of quality plans and assurance taking place. This has resulted in the poor
maintenance of patient management guidelines, clinical audits, education
programmes, in-service training, regular meetings, forums, research
programmes and other QA activities.”
In response, THL noted that many attempts have been made to fill the nurse
leader position but it is “not an easy task” to get a suitable person.
Medical
5.9 The Medical Director position was occupied by Dr Danny Stewart, Clinical
Director (Paediatrics), from April 1997 until April 1999. There is concern that
no one has occupied the position of Medical Director at the hospital since Dr
Stewart resigned. One Clinical Director stated “nobody has wanted to fulfil
this position (Medical Director) because it is an absolutely powerless
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