Abstract: This paper describes the Kidz First paediatric community homecare nursing team in South Auckland. While the service was not initially planned as an integrated approach to child health, its evolution reflects the move to more community based care delivery and the expansion of nurse-led initiatives in New Zealand. The components of a community paediatric home nursing team as described by Eaton (2000) are used to provide the framework with which to describe the service. A focus group held with the Kidz First paediatric community homecare nurses has enabled definition of the key nursing components provided to children and their families living in South Auckland.

Abstract: This article describes two interprofessional learning modules offered by the Faculty of Medical and Health Sciences at the University of Auckland to undergraduate medicine, nursing and pharmacy students. The modules, 'Maori Health“ and ”Patient Safety", have a focus on quality improvement in healthcare and are used to bring together students for a shared learning programme.The specific dimensions of healthcare quality covered in the programme are: patient safety, equity, access, effectiveness, efficacy and patient-centeredness.

Abstract: The aim was to report on implementation of a nursing initiative of cardiovascular disease (CVD) screening risk assessment at the Mornington Health Centre, Dunedin, with initial outcomes after six months. The practice aim was 80% of their eligible population assessed within three to four years, particularly targeting high-risk groups. The audit indicates that in their first six months, Mornington Health Centre had screened 42% of their eligible patients. This is described as very successful progress towards their goal of 80%. A number of key organisational factors are identified that are likely to have contributed to the development and success of the nurse CVD risk assessment programme at Mornington Health Centre. The authors suggest that this case study demonstrates how organisational change, where the practice nurse role in the multidisciplinary team is clear, can facilitate a practice to meet a population-based goal.

Abstract: An ethnographic study which attempts to understand what initial employment means to graduates from a comprehensive nursing course. The researcher participated in the first 3-4 months of the nurses' employment in general hospital settings. Five major themes emerge from the study indicating that the rhetoric practice of the school of nursing is different from the rhetoric and practice within general hospital settings. The reality of initial employment for the new graduated conflicts with the values and ideals of nursing promulgated by the comprehensive nursing course. The educational program stressed patient centred nursing, where nurses accepted responsibility for the continuing care of individuals. In contrast the hospital settings stress nursing as management of tasks across different patients. This conflict was a major source of frustration for the 'beginning' nurses. Ultimately they accept the reality of nursing as the management of tasks, but not without some personal cost. Orientation programs and the early employment period focus on 'fitting in to the system'. A significant determinant of the practice of new graduates are context effects such the time of their shift and the availability of experienced nurses. A number of management practices foster and maintain a beginning level of practice and new graduates have no opportunity to practice as autonomous nurses within a multi disciplinary health care team. Beginning practice is identified in new graduates through their difficulties in coping with unplanned or unexpected events. The initial employment period is dominated by shift work, resulting tiredness and adjustment to social activities.It is argued that management practices which support the ideals of comprehensive nursing courses and totally qualified nursing workforce have yet to occur. There are implications in this study for nursing education and nursing practice

Abstract: This paper looks broadly at issues to do with quality monitoring in higher education and considers the role and focus of the Nursing Council of New Zealand in the approval of and ongoing monitoring of undergraduate nursing degree programmes. It is suggested that the approach taken by the Nursing Council is accountability led where minimal attention is given to teaching and learning and actual graduate outcomes. This may lead to a mistaken belief that Nursing Council's monitoring focuses on quality or that the outcomes of their monitoring might contribute to programme enhancement. A shift to emphasise learning processes, students and continual improvement in order to enhance programme quality is proposed.

Abstract: On call emergency health services are becoming routinely provided by some rural nurses, predominantly within the South Island. Rural nurses have been advancing their practice to accommodate the limited availability of general practitioners in rural communities. Although this is becoming routine practice, the author has been providing a service such as this for the past 12 years. This dissertation describes this practice in relationship to the present social-political context, advancing nurse competencies and her experience of rural nursing in a rural town within the South Island. Particular significance for the rural nurse is the required independent practice and overall responsibility when remote from traditional medical oversight. Providing on call emergency care with the possibility of a broad spectrum of emergency situations while maintaining competence for the unpredictable frequency (or lack of frequency) of the rural emergency is the focus of this dissertation. The professional and personal risks are high for rural nurses when placed in situations they are not prepared for or unable to remain competent to manage. Implications resulting from the critique of the health service literature on this subject are identified. Firstly, rural nurses need to be insightful of their own emergency on call expertise and limitations. Secondly, rural nurses require ongoing education and thirdly that appropriate education is available and accessible to rural nurses. Lastly, rural nurses require maintenance of competency so these emergency skills are not lost. This dissertation and the resulting recommendations embrace Nursing Council of New Zealand Nurse Practitioner Competencies. The resulting outcomes fulfilling the rural nurse's need for maintenance of competency for emergency on call care, the community's need for safe appropriate emergency care and national legislation requirements.

Abstract: The author notes that it is widely accepted that there is a global shortage of nurses, and there are many studies in the health workforce literature about the negative aspects of nurse work environments, nursing workloads, decreased job satisfaction of nurses and the impact these have on patient health outcomes. In the past five years there has also been international and New Zealand-specific research into the effects of health restructuring on nursing leadership, retention of nurses, and on patient care. Much of this research has shown that countries with very different health care systems have similar problems, not only with retention of qualified nursing staff due to high levels of job dissatisfaction, but also with work design and the provision of good quality patient care in hospitals. This dissertation explores the many detrimental effects on nurses and nursing leadership, of extensive, and continuing, public health restructuring in New Zealand. The context of this dissertation is New Zealand public hospitals, with references pertaining to medical and surgical areas of nursing practice. Health reforms have negatively impacted on patient care delivery systems, patient health outcomes, and retention of educated nurses in the workforce. In order to resolve these issues, coordinated efforts are required in New Zealand district health boards to develop and sustain effective nursing leaders, who will promote and assist in the development of strong, healthy organisational cultures to retain and support professional nurses and the ways in which they wish to practise.