Nursing leadership positions at a number of district health boards (DHBs) are under threat. In a major structural change across all hospital services, Waikato DHB is proposing to cut clinical nurse director positions; the chief nursing officer (CNO) and director of nursing (DoN) positions at Capital and Coast DHB and Hutt Valley DHB respectively are being combined into one CNO role; and the DoN at Taranaki DHB has recently resigned after being in the role little over a year. Canterbury DHB’s long-serving executive director of nursing Mary Gordon left the DHB last month because of its “dysfunctional and divisive governance team”.
NZNO acting associate professional services manager Kate Weston said there appeared to be an emerging trend in the sector to dismantle, diminish or degrade senior nursing leadership positions.
“It seems as though some DHBs are starting to implement the recommendations of the health and disability system review [the Simpson Report] by stealth. The review recommends cutting the number of DHBs. But there must be no reduction in strong, visible nursing leadership at a local level,” she said.
Waikato DHB’s proposal for change removes seven clinical nurse director and nurse director (ND) roles and creates three ND roles. The new roles are at a higher level of decision-making within the DHB, which, according to NZNO, is an improvement. But NZNO organiser Jenny Chapman said there was frustration that clinical leadership roles were being reduced, alongside unrealistic workloads for the new roles. NZNO’s submission said nurses in the new ND roles could not be strategically focused or innovative “due to the enormity of the roles”.
NZNO is also concerned at reporting lines for the NDs, which have no link to the current director of nursing and midwifery (DONM) structure.
As a result of the submissions on the entire proposal, Chapman said it would be revised and there would be further consultation before any final decisions. “We are pleased the DHB appears to be listening to staff’s concerns.”
The two top nursing roles at CCDHB and HVDHB had been combined into one large role, while the two chief medical officer roles had been retained, NZNO professional nursing adviser (PNA) Suzanne Rolls said. “Yet nursing is the biggest workforce and the single CNO role will be across primary care, aged care, mental health and hospital services. It is a significant role and will be inadequately resourced. In the first international Year of the Nurse and Midwife, this is a real blow to nursing visibility and respect for the profession.”
NZNO had objected to the proposal, could not understand the rationale for it and was unsure of the appointment process, Rolls said. The person appointed would struggle to provide strategic leadership because of the enormity of the role and this would ultimately impact on the development of nurses and nursing.
PNA Wendy Blair said in the six years she had been involved with Taranaki DHB, there had been no stability in the DoN role, with three DoNs in that time.
Weston said there was a gulf between the rhetoric about nursing’s contribution to health care, particularly its response to COVID-19, and the reality of nursing’s power and influence within the sector.
Ministry of Health CNO Margareth Broodkoorn said she had been made aware of proposed changes at Waikato, Capital & Coast, Hutt Valley and Taranaki DHBs.
The health and safety of patients was a priority for DHBs “and current systems and standards will remain in place, ensuring patient care remains uninterrupted during any recruitment process”.
During her remaining time as CNO – she leaves early next year – she would “continue to liaise with my DHB colleagues and be available to offer any advice when requested”.