North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerIt is accepted by Waitemata DHB that the medical staff need a clinical director at service levelbut nurses do not.The nurses were clear at the review that the structure did not give authority over daily practiceor connect them up in a real time way. It did not enable meaningful partnership (presence)with Clinical Directors and managers.The service managers were not required to be nurses but those interviewed in the medical areawere.It is also worth noting at the time of the site visit in 2008 a direct question was asked of theCNMs, Service Managers and CD regarding [Clinical Nurse Specialist] involvement ininpatient care. Examples were given to these people of Respiratory and Cardiac CNS. It wasreported there were such positions but they were not medical inpatients; they were outpatientbased. The response says they do have such positions working in the inpatient services.Team NursingThe ideal team delivery model was described by me. The approach taken of working as onelarge team when supply and demand do not match (a tactic to preserve safe staffing) was alsodescribed by me. This is the safe staffing escalation process agreed in New Zealand.This does not seem clear to Waitemata DHB.It was known at the time of the review, team nursing (small teams of different levels of nursesand HCAs working with a defined group of patients within the bigger department team) wasto be used in the ECC. The overheads of the ECC training were provided to me. In thebusiness case for the shift co-ordinators and Clinical Nurse Directors, the collaborative modelwas to be put in place in the medical wards.Team nursing and the collaborative nursing models applied as described by Waitemata DHB,and me, are appropriate when nursing supply and patient demand match.In the response they do refer to implementing the safe staffing recommendations but have notapplied this to the model of care in their response.The nurses indicated in the ECC that team nursing in the model, described by WaitemataDHB in the response, did not work given their workload. This reality is not acknowledged atall in the response on Team Nursing and the response on safe staffing is one line.In asserting that team nursing is different from safe staffing team nursing, they have notaddressed the issue of how they will work when they are short staffed and not able to preservethe communication and oversight processes of team nursing, as in 2007. Their response as tohow they will work when supply of nursing time is below patient demand level needs to besought.I am really concerned that in asserting that team nursing is an appropriate model of care(failed in 2007 under the surge) they have missed the point and not address how they willwork when they are short staffed. There is one line about safe staffing recommendations, butthey did not understand/recognise the process in the review and are arguing against it in theirassertions about the robustness of their version of team nursing.…NEWS[In relation to the DHB‘s recent audit data]: Comprehensive audit, pleasing results. Great toget to trending over time. I would encourage [Waitemata DHB] to continue with regularfeedback as they are going.‖110April 2009