Clinical Services Director Report
The year ending 30 June 2022 provided some intense challenges in relation to staff management and service provision. The service was in the midst of a global pandemic, the End of Life Choice Act was ready for implementation in November 2021 and a national nursing workforce shortage affected Te Kahu Pairuri Hospice Taranaki.
Covid 19 Pandemic
Infection prevention and control practices were at the forefront for all inpatient and community staff. Covid advisory group meetings were in place with membership across the organisation. The advisory group is responsible for decisions involving PPE provision and use, promoting Covid screening prior to any patient or family interaction, overseeing inpatient bed use, accessing and supplying PPE, ensuring staff received regular updates as the pandemic situation continued. A high percentage of nursing staff became ill with Covid and it was notable that it was not work acquired. The illness amongst nursing staff created additional stresses during a fraught time. Screen team meetings occurred each morning which linked all areas of care. The meetings provided information to allow workload planning and to prioritise admissions to the inpatient unit. A shorter version of the screen meetings is now in use and adopted as normal practice. The focus on care and service provision has changed to predominantly community based rather than inpatient admissions and staffing resources were added to community care as a result.
The clinical and allied health teams recognised the implications of the Act and a plan to prepare staff was adopted. The Clinical Nurse Educators developed a comprehensive education session to explain the Act and its implementation for Te Kahu Pairuri Hospice Taranaki staff. This education was extremely useful and staff felt supported and knowledgeable about the Act and how it would be managed within our organisation. The education session was repeated in June 2022 to capture newer staff members and also acted as a refresher for those who had attended previously.
Mauri Mate Framework Implementation and Health and Disability Sector Standards
Review of the Mauri Mate Framework identified areas for development. A group of Te Kahu Pairuri Hospice Taranaki staff and community representatives met and discussed its implementation. Subsequent meetings have expanded on the original project plan and more detailed progress is now occurring monthly. Mauri Mate forms part of the Health and Disability Sector Standards which this organisation is measured against. The audit agency was complimentary on the pgoress the organisation was making towards implementing change to meet the Mauri Mate framework requirements. A successful audit was achieved in June 2022.
There have been great challenges to maintain the necessary workforce during the year. Local public health nurses have been seconded to the Covid vaccination programme, aged care facility staff are being recruited to fill hospital roles, no international nurses were being permitted entry to NZ, Covid vaccination mandates and an aging workforce were all factors that impacted on recruitment at Te Kahu Pairuri Hospice Taranaki. We managed to employ five new RNs and they have successfully orientated to the service and will be working both in the inpatient unit and community settings in the future. Staff resignations and/or retirements saw new appointments to the Hospice in-reach team and Triage roles. Both these areas are running successfully. Recruitment for an RN reliever for South and Central Taranaki nursing team has been unsuccessful so a plan to provide cover from the North Taranaki nursing team was required. A new role of Inpatient Care Co-ordinator was created and an RN appointed. Unfortunately, the staff member left after six months to explore another specialty of nursing. There has been no interest from remaining staff in this role so a nursing workforce review occurred to ensure the right roles exist and the staff skills matched the roles required. A decision to restrict bed numbers in the inpatient unit has allowed lower staffing levels on duty whilst safe care is still maintained. This action was required to address difficult nursing recruitment and staff illness. A combination of these factors has led to closer teamwork. This teamwork has been readily recognised and appreciated by managers and staff alike. the challenging work environment has provided an opportunity for all staff to recognise the value of their colleagues and how care can still be provided during very challenging times.
Heather Koch, Clinical Services Director