There are four Cs that drive Aloha Sison, a clinical nurse specialist in Waikato DHB’s Older Persons and Rehabilitation service – competence, confidence, character and compassion.
“You have to know what you are doing. You need to work with other people and other specialties and be able to navigate through that. You need to do things with the right heart. Finally, every day in this journey of life we try to find our meaning and our purpose, and for nurses that is, undoubtedly, compassionate service.”
All of this was evident during the COVID-19 pandemic when Sison and other specialist nurses were called on to support and work with staff in Waikato’s aged residential care facilities, one of which experienced cases of the virus. Using videoconferencing technology, they could provide detailed education and support for rest home staff about COVID-19 and using PPE gear, as well as supporting management to meet the challenges of preventing potential clusters. It worked, with the Waikato response to COVID-19 in aged care seen by many as best practice.
Sison, who came to New Zealand from the Philippines five years ago, is the first nurse to embark on the ‘pipeline’ of professional development developed by the Older Persons and Rehabilitation service in partnership with the Office of the Chief Nurse at Waikato DHB. It will support her to achieve nurse practitioner scope of practice in another few years. A nurse practitioner is a nurse who is highly qualified to practice and prescribe independently in their area of expertise, and with skills that include being a leader, consultant, researcher and educator, as well as a clinician.
With high level support from the DHB’s nursing directorate and management, Sison is developing her clinical nurse specialist role in the Older Persons Service, familiarising herself with a range of hospital and community-based services, and working on her Masters degree as part of her journey towards nurse practitioner status.
“I’m lucky that I have great support and encouragement. If things go smoothly, I hope in two or three years I will have the knowledge, skill, confidence and competence to take up a gerontology nurse practitioner role in Older Persons and Rehabilitation.”
At that point, her current clinical nurse specialist role would be filled by a new person starting on a similar pathway along the ‘pipeline’ towards nurse practitioner status in gerontology.
This ‘pipeline’ approach is a key element in the new model of care for older people – He Korowai Oranga o Nga Kaumatua (A Cloak of Well-being for our Older People) – developed by Waikato DHB and published early this year. It’s about augmenting the primary healthcare of older people by building up a resource of nurse practitioners in multiple localities across the Waikato who will have older people with complex needs and conditions referred to them as clients, and will work closely with other primary care services and health professionals.
The focus is on proactively working with patients in the community, often in their homes, to target avoidable hospital presentations and give them appropriate and safe support. Ideally the outcome is people who can stay in their homes longer, and whose health and wellbeing is maintained longer.
Sison is excited about the approach. “Already we can use data to identify patients who have high and complex needs. As specialist nurses we can do a full assessment in their home covering not just physical/medical aspects but also social and functional ones. We look at people holistically.”
She says nurse practitioners are also aware of the full range of services and expertise available to support older people – from Memory Clinic or Strength and Balance programmes, to occupational therapy, physio or social worker input, or equipment that may be available to help.
As an overseas-trained nurse, Sison is passionate about sharing her journey with other nurses coming from countries such as the Philippines so that they can aspire to professional development.
“Sometimes they can feel a bit intimidated. English is not their first language and that can make them feel hesitant to speak up or ask questions. They might worry that someone will think they are stupid or being disrespectful, but I tell them, ‘Ask questions’. That is what people here want you to do. It shows you are interested and willing to learn.”
In Aloha Sison, they have an excellent example of what can be achieved.