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| January 2009 | Vol. 7, No. 1 | ||||
Portland Associate Professor Linda Felver, PhD, RN, gives a |
Visiting Teacher Sees Contrasts between New Zealand and American Health Care Systems Program Spotlight: Nursing Education Graduate Program A Day in the Life: Four OHSU Faculty Members Share Snippets of Their Jobs |
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Visiting Teacher Sees Contrasts between New Zealand and American Health Care Systems By Lee Lewis Husk New Zealanders don’t say they have chronic illness. They have “lifelong conditions” according to Sarah Kooienga, PhD, FNP, assistant professor, who spent four months last year in the island nation and says chronic illness is a stigmatizing label. And instead of teaching a course, she gave a “paper” on the management of lifelong conditions at Massey University in Palmerston North, a north-island city of 80,000 people. Despite the semantic differences, the 47-year-old McMinnville resident quickly adjusted and says the New Zealand academic culture readily opens itself to nurse educators from the United States and other countries. Kooienga (pronounced koy-ING-ga), teaches half time in the OHSU advanced practice Family Nurse Practitioner program and works part time in a family practice clinic in West Linn. This past June through October, she took unpaid leave to teach graduate-level courses in Palmerston North, as well as Auckland on the north end of the North Island and Invercargill on the south end of the South Island. Her salary came from tuition paid by the Ministry of Health (the government channel for funding health services), some district health boards and the students themselves. “I was recruited because New Zealand has few advanced practice nurses or nurse practitioners in the primary care sector,” she says. Instead, nurse practitioners tend to be specialty focused and based in the hospital or specialty clinics. Outside the hospital system, most primary care nurses are employees of general practice physicians, who traditionally have resisted the practice nurses’ efforts to gain greater autonomy. “Nursing is in a different place in New Zealand,” Kooienga explains. “The employee/employer relationship in general practice hasn’t utilized nurses to their fullest potential, nor has it been particularly empowering.” Besides teaching the intensive, three-day block course to practice nurses, she also spent time mentoring them. “There’s a desire in New Zealand for practice nurses – those who work in general practice – to care for people across the lifespan in rural settings and to improve their knowledge of chronic illness,” she says. As part of the national primary health care strategy, there is a movement for practice nurses to obtain postgraduate education and potentially become primary care nurse practitioners or family nurse practitioners as known in the U.S. She visited several general practice groups and saw first-hand the strength of New Zealand’s primary health care system. “The country actually has a primary care system and a population-focused primary health care strategy – something we don’t have in the United States,” she states. Although health care is mostly government funded, primary care is a mixed pay model with a 60 percent of fees coming from the Ministry of Health and 40 percent from patients. Some services for people with one or more lifelong conditions, such as diabetes, are fully covered, she reports. And in contrast with the United States where many primary care settings rely heavily on medical assistants and non-nurses, New Zealand physicians typically have three or four RNs in their practices – many with a defined physician/RN team. Another difference she noted was the relaxed atmosphere of the work culture. She says it’s a slower pace there, and people who work together often play together. She also observed the islanders’ devotion to keeping the environment clean and green. “Coffee is served in a glass cup,” she says with admiration. “And they talk a lot about finding the proper balance between work and life.” As with many people who spend time abroad and return home, Kooienga achieved new insight on her own culture. She appreciates the collegiality and respect American nurses have earned among their medical colleagues. “We can have autonomy in many settings, whereas our New Zealand counterparts are struggling to achieve that standing,” she says. Another bonus of the American health care system is its consumer-driven or patient-centered care. “In primary care, we develop therapeutic partnerships with our patients. In New Zealand, the relationship is physician-driven, and GP practice is structured around a firm 10-minute appointment.” So what conclusions did this American nurse draw? Global exchanges are beneficial. Blend the two health systems together, drawing on the strength of New Zealand’s established primary care system with America’s integration of nurse practitioners in primary care and the provision of patient-centered care. And for nurse education Kooienga believes that chronic disease case management models could be taught at both undergraduate and graduate levels. |
"There’s a desire in New Zealand for practice nurses – those who work in general practice – to care for people across the lifespan in rural settings and to improve their knowledge of chronic illness.” – Sarah Kooienga, PhD, FNP, assistant professor |
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A Day in the Life:
Four OHSU Faculty Members Share Snippets of Their Jobs What is a day like for faculty members at OHSU’s School of Nursing? How do they approach education? What’s the first week of school like? What do they hope to accomplish? Read the Nursing Progress article to explore snippets of the lives and approaches to teaching of four faculty members with diverse backgrounds, expertise and daily routines. Featured faculty:
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February 6-7, 2009: Northwest Environmental Health Conference at OHSU February 12, 2009: Annual Career Fair May 7, 2009: Meet the Dean Reception in Klamath Falls May 12, 2009: 1919 Society Dinnner June 4, 2009: Reunion Brunch No More Dues OHSU School of Nursing Alumni are on Facebook
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