Handover | Issue 42 - July 2018
In 2006, Professional Development and Recognition Programmes (PDRP) were seen as being intrinsically linked to clinical career pathways (CCP). CCP programmes were introduced in New Zealand in the late 1980s to recognise the ‘clinical expertise of nurses and to retain professional autonomy and development’ (National Professional Development and Recognition Programmes Working Party, 2004, p.4).
A CCP was seen to provide ‘... a structure for career development for nurses involved in practice, and advancement in such a structure provides recognition and reward for increasing expertise in frontline work with patients/clients’ (Jones, 1997, p.2).
The creation of CCPs with appropriate ongoing education was able to enhance nurses’ career options and foster the aspirations of new and returning nurses. Specific benefits of CCP programmes for employers were succession planning, leadership development, professional direction, informing the skill mix of registered nurses, and the value that mental health nurses bring to clinical and management practices (MOH, 2006, p.19).
PDRPs were set up to:
- ensure nursing expertise was visible, valued and understood
- enable differentiation between the different levels of practice
- value and reward clinical practice
- encourage practice development
- identify expert nurse/role models
- encourage reflection on practice
- encourage evidence-based practice
- provide a structure for ongoing education and training
- assist nurses to meet the requirements for competence based practising certificates
- assist in the retention of nurses.
(MOH, 2006, p.20).
In 2006, the framework’s situational analysis on the state of clinical career pathways (CCPs) revealed the following:
- The development of CCPs in New Zealand were ad hoc. There were a variety of models emerging and a lack of consistency. The NGO sector had not taken a position on CCPs and PDRPs.
- The 2003 review of CCPs for mental health nurses, by Te Rau Matatini, revealed that the application of CCPs was limited to mainstream institutions, and the conceptual framework underpinning CCPs was not applicable to NGOs and Māori community mental health services.
- Te Ao Māramatanga - NZCMHN Māori caucus stated that cultural competencies needed to be merged with CCP clinical competencies and noted a lack of Māori assessors for portfolios.
- Pasifika mental health nurses, reflecting what they described as their ‘holistic view on life’, identified the need for CCPs to balance academic pursuits with a high level of practice/experience.
- NGOs did not have the same level of infrastructure in place as DHBs, and their resource constraints meant that some mental health nurses may not be part of CCP programmes. NGO mental health nurses often had difficulties with accessing supervisors, mentors and interprofessional health staff.
- An example of clinical career pathways for mental health nurses was outlined, see image on page 21.
The framework made two recommendations:
- Employers should develop consistent clinical career pathways that are transferable between organisations.
- Clinical career pathways should be linked to nursing positions within organisations.
In 2004, the Nursing Council of New Zealand began approving PDRPs. Nurses who are on these programmes are exempt from the Nursing Council’s continuing competency audit process.
PDRPs are now offered by many employers, DHBs, NGOs, private hospitals, aged care and primary health care. In addition, some DHBs offer their programme to community providers. DHBs employment agreements now make provision for renumeration that rewards levels of practice.
In 2007, Te Pou o te Whakaaro Nui launched Handover - mental health and addiction nursing newsletter to profile nursing practice and nurses working in a range of roles. The 42 issues have shone a light on clinical pathways open to many nurses.
Te Rau Matatini has developed the Huarahi Whakatū PDRP, that promotes the philosophy of ‘dual competency', that is clinical and cultural competencies. Clinical competencies are drawn from the Nursing Council of New Zealand, whereas cultural competencies are informed by Te Ao Māori. This programme is now online and is a Nursing Council accredited PDRP specifically tailored by, and for, Māori registered nurses. Te Ao Māramatanga - NZCMHN Māori Caucus have had a continuous relationship with Te Rau Matatini, supporting the Huarahi Whakatū Māori nursing PDRP including supporting a successful pilot in mental health.
Stakeholders impression of the current situation, in summary were:
Professional development and recognition programmes
- Employers have undertaken steps to develop consistent PDRPs that are transferable between organisations.
- “Generic PDRPs are in place – but not always applicable to mental health nursing which should be underpinned by Standards of Practice for mental health nurses and specific practice frameworks eg addiction, intellectual disability”.
- Enrolment in a PDRP is mandatory in some services and not in others.
- Māori nurses need improved access to PDRPs and support for professional career pathways that are culturally sound and robust.
Clinical career pathways
- Yes, clinical career pathways should be linked to nursing positions within organisations.
- Issue arises if nursing positions are capped. Pathways need to be available to all nurses as long as they meet the criteria.
- Clinical career pathways should be based on standards or frameworks of practice.
- “There is still a tendency for our best nurses to get syphoned into management or education because a lack of valued clinical pathways. There remains a lot to be done in this regard”.
- Access to post graduate papers has helped.
- Māori nurses need to be able to access appropriate cultural support, mentorship and supervision, to support their professional development/career pathway.
- “Career pathways are a good thing, but for me, experience is also a vital element in mental health nursing- good leadership on the wards for the new grads and junior nurses. Having the opportunity to rotate through different clinical areas is a great learning tool”.
- New clinical career pathways are evolving as the development of the primary/community workforce grows. This means “we need to work together with secondary care personnel”.
- Need to continue to develop the primary care/NGO sector workforce in conjunction with secondary services.
- Standardisation and consistency of pathways for all senior nurse requires post graduate and PDRPs.
- We need national consistency. Is this an agenda that the DoMHNs could work on? Maybe a solution is for the resourcing of the DoHMNs to drive many aspects of the Framework and maybe work in conjunction with the College.
- Some people like the “managerial ladder” and aim to get up the steps as quickly as possible and linking career pathways with positions is something I would struggle with – being a manager is one thing, being a leader another. Some positions you can get away with a manager, others you need that leadership and understanding of the nature of mental health nursing in order to truly advocate for the profession in various forums.
Where to from here?
- The overall impression is that the professional development and recognition programmes (PDRPs), have evolved and continue to be linked to clinical career pathways. However, these programmes are generic and may not fully enable mental health, addiction and disability nurses to clearly articulate their practice.
- The Huarahi Whakatū PDRP has provided many Māori nurses with the opportunity to articulate their dual competencies. However, there appears to be no similar PDRP for the growing Pasifika nursing workforce.
- More planning and resourcing is needed to support Māori nurses to access appropriate cultural support, mentorship and supervision, to support their professional development/career pathway.
- Local solutions have resulted in new clinical career pathways (CCPs) being developed for mental health and addiction nurses. One example is in the primary care sector, another is in nurse practitioner roles. However, the absence of a national plan to develop clear clinical career pathways for mental health and addiction nurses may result in differences in roles and responsibilities.
- Although it is argued that both PDRPs and CCPs should be underpinned by the Standards for Mental Health Nursing Practice, our earlier article signals that these standards are still not yet fully embedded into the mental health and addiction services who employ nurses. Furthermore, strategies are needed to raise awareness about the standards among nurses, managers and leaders of nurses