It’s better together
In February, I spent three weeks studying nursing leadership on a Florence Nightingale Foundation travel scholarship to New Zealand.
A clear vision and senior leadership support for integrated working is paramount to the success of the task, and travelling to the opposite side of the world helped me to understand how nurse leaders are contributing to integrated care.
Senior nurses in the region of Canterbury, where I was based, understand that it takes time to develop effective relationships after a cultural shift to an integrated system. Integrated working was role-modelled at all levels; through meetings, group decision making and trusted working relationships.
I observed that most directors of nursing had been in their role for a number of years. They worked well together, and were seen as having recognised, influential roles. A repeated message was that leaders should be authentic and accessible.
Directors of nursing stressed the need to have an identified senior nursing role in all organisations – including the independent sector – and the importance of working as part of a senior leadership team.
The team met formally every month. At the meeting I attended members discussed their vision for nurse practitioner roles, made decisions on postgraduate education and agreed a single, clinical policy source for use across all care sectors.
One said: ‘Nurses naturally know how to collaborate, and most initiatives have been based on nursing services. As a group of directors of nursing, we made a pact that it doesn’t matter who you work for as long as you do the right thing for your patients.’
The chief executive of Pegasus, the main primary care organisation in Canterbury, is a nurse, and there are nurses on the board and advisory clinical board.
Key groups, such as directors of nursing and clinical networks, acted as the framework for developing services and joint working. Many services developed through this work at senior level were nurse-led or had significant nursing input.
In Canterbury, the divide between health care and social care was less apparent than in the UK. ‘We take good care of our nursing team and the identity of the district nurse,’ one team leader told me. ‘They have a sense of belonging and like being in a team, working alongside home care staff.’
New Zealand aims to achieve more integrated care through district health boards, reintegrating hospital service provision and contracting for community services. Since the publication of a primary healthcare strategy in 2001, alliance working has developed across the Canterbury network.
Although policy and healthcare structures in Canterbury are different to those in the UK, they are relevant to the development of integrated care in that they ensure nursing leaders work well across boundaries and are engaged fully with integrated systems.
As we develop new care models in the UK (such as vanguard sites) and integrate care across all systems, senior nurses need to be able to make clear how they are developing services and approaches.
The foundations for this are robust structures and opportunities to develop relationships of trust between providers, commissioners and educators. If these are in place, the effects will be visible for patients.