North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerInquiry recommendations. I would specifically recommend Waitemata management provideleadership in these key short-term priorities needed to institutionalise the patient safety culturethat nurses, doctors, allied health professionals and managers desire, and patients and familiesneed:1. Determine the management of electives for safety of ECC patients in this environment of100% occupancy.2. Develop training to assist staff develop skills in giving bad news to patients and families.3. Work systematically through the barriers to the delivery of professional practice in thesetting with nurses, and address these.4. Strengthen the transfer nurse process so it is more than a transport process.5. A process needs to be developed to capture the care planning that is recorded on thewhiteboards in the ECC.6. Review the health assessment competency required as per the registration requirementsand ensure all nurses demonstrate competence and confidence in holistic healthassessment, and model this in practice for the future workforce.7. Review the care planning and progress notes format and ensure they provide a frameworkto enable nurses to demonstrate the registration competencies in their practice.8. Ensure the requisite knowledge, skills, and systematic nursing process are internalised ineach nurse, and monitor practice at individual, day, week and month level to assurequality of care.9. Revisit the amount of support requirement for the number of entry to practice, bureau andcasual staff, including orientation, particularly in the ECC.10. Extend the planned increase in surveillance through supernumerary clinical shift coordinatorpositions to all shifts (given the size of the areas and the complexity) in AMsand PMs and partially on nights, as per Safe Staffing recommendations, so that the ―TeamLeader‖ is enabled to meet their professional obligations in this clinical supervisory role.Educate and train, and recognise and reward these positions for the added clinicalmanagerial responsibility they carry.11. Re-set the nursing establishment requirements and staff to them. Establish the nursinghours per patient day required based on acuity, as per the Health Round Table and patientutilisation rates (includes daily turnover) for wards and for each area of the ECC, andcalculate the nursing FTE required. Add on all leave, the amount of orientation andcontinuing education that will be required given the skills mix and vacancy rate, andsupport positions.12. Acknowledge the patient complexity and skills mix mismatch and create Clinical NurseSpecialist positions linked to specialty medical departments to work in each ward and ineach area in the ECC. Specialty expertise needs to be built into the acute services inresponse, to respond to the acuity and case mix in order to, in a timely way,systematically consult on complex care, role model the expected quality of practice, andadvance the practice of the nurses after they complete the entry to practice programme ortheir orientation programme to the specialty. This will also provide a career structure andsuccession, improving retention of Level 3 and 4 nurses.13. Implement full-time Clinical Nurse Directors positions to lead and manage nursingservices in the specialties as soon as practicable to strengthen nursing leadership, enablemulti-professional partnerships, and to give a voice and heart to the largest key asset ofthe organisation, the nurses.106April 2009