WHAKAARO: The Truth: Inconvenient or...
I would like to commend Dr Clark for his Whakaaro in The GB Weekly last week. It summed up the issues, stated the realities and rekindled the vision that has underpinned this project from its beginnings over four years ago.
All of the reasons which led the drive towards integrated services still exist. Recruitment/retention issues; nurses working in isolation from medical support; no after-hours nursing support for doctors; fragmented services for patients (hospital patients requiring X-ray needing to travel to the medical centre, often by ambulance; rest home residents who are ill/unstable having to be moved to GBCH, then back again when well; no on-site doctor at the hospital during the day, meaning the doctor must drive to GBCH if a patient suddenly deteriorates; the on-call doctor arriving at a dark cold medical centre in the night to see a patient, whilst up the road there is a warm, well-lit place with registered nursing support).
I have hesitated, until now, to join in the public debate about health care/service integration in Golden Bay. I felt because I am employed by NMDHB, I was somehow not in a position to voice my perspective. But I am also a Golden Bay resident who came to this wonderful place 20 years ago to work as a nurse. And it is from the nursing perspective that I came to support the vision for integration.
The nursing resource in Golden Bay is currently one of our strengths, but it’s a fragile thing. Many times in the past 20 years we have struggled to attract and retain nurses. The New Zealand reality is a severe shortage of registered nurses and an almost non-existent pool of enrolled nurses. Integrated services being offered on one site by a team of health professionals working together are a much more attractive proposition for new nurses coming into the area.
We are all aware that working in isolation is hard – it is not always safe, and it is challenging to maintain best practice without peer support and input. Bringing nurses together in an integrated facility is not about nurses having to carry out each other’s work or roles; it’s about collegial support and the sharing of specialist nursing skills and knowledge. This will undoubtedly have positive benefits for patients.
I agree that staff at the medical centre, the rest home, and the hospital all work hard and do a great job. But this is in spite of the difficulties and challenges. The truth is patient care suffers from having scattered services, nurses can feel isolated and unsupported, and doctors struggle with on-call/after-hours responsibilities.
There has been concern expressed by many about the cost of bringing rest home, hospital and medical centre services together under one roof. What we need to remember is that the current arrangement is extremely costly. Separate facilities with their individual overheads and running costs - maintenance, purchasing systems, HR functions, duplications of equipment – the list is long. We know the “economies of scale” issues that face our rest home. Those same issues face our hospital. It simply makes no sense to be separate.
Call it what we will - an integrated family health centre; Golden Bay Community Health – Te Hauora o Mohua - our strength for the future lies in being together.
Alexia Russell, rural nurse,
charge nurse manager,
Golden Bay Community Hospital and Allied Services
