Hawke’s Bay’s Rachael Walker was thrilled to hear she’d become New Zealand’s first renal Nurse Practitioner.
It’s a significant achievement in a region with a high prevalence of diabetes. The disorder leads to nearly half the cases of kidney failure in New Zealand.
At 32, Rachael is also the youngest to have gained Nurse Practitioner status since the Nursing Council of New Zealand established the expanded nursing role nine years ago.
Nurse Practitioners are expert nurses who work within a specific area and practice incorporating advanced knowledge and skills. Rachael’s achievement means she can assess, diagnose and prescribe to patients who have renal dysfunction.
Rachael’s interest in caring for people with impaired kidney function and kidney disease started six years ago when she transferred from the Hawke’s Bay Hospital’s acute medical unit to the Hawke’s Bay District Health Board’s renal service.
It was another step in a steep career path. Originally from Wairoa, she graduated with a Bachelor of Nursing from EIT Hawke’s Bay and went on to work in the hospital’s medical wards.
After a working holiday overseas with husband-to-be Shayne, she returned to nursing in Hawke’s Bay and to further study at EIT, doing a paper a year to complete her Master of Nursing last year.
As if this wasn’t enough to keep her fully occupied, Rachael and Shayne chose this time to start a family.
It helped that EIT was so baby-friendly, Rachael says. Four-year-old Ariana once accompanied her to a class and son Kahu, born 14 months ago, was just two weeks old when he attended his first lecture.
“I knew what my goal was and EIT supported me in achieving that with a new baby. They worked the practicum around maternity leave as well. I couldn’t have done that clinical paper if they hadn’t been so good about supporting me.”
A star student, Rachael was awarded the Hawke’s Bay District Health Board Associate Directors of Nursing Award for Excellence in Postgraduate Nursing Studies at EIT’s graduation ceremony earlier this year.
Dean of Health and Sport Science, Dr Susan Jacobs, says Rachael is one of six EIT Master of Nursing graduates to have become Nurse Practitioners. Others based in Hawke’s Bay are Maureen Bent (Adult Cardiology), Sharon Payne (Emergency Care), Trish White (Adult Urology) and Pip Rutherford (Wound Care), while Diane Williams works in primary care for the Tairāwhiti District Health Board.
Rachael chose to specialise in renal care because she wanted to work with patients who had long-term conditions. She particularly wanted to work with people to prevent end-stage kidney failure.
She started working in the haemodialysis and peritoneal dialysis units before moving into the role of Pre-dialysis – Clinical Nurse Specialist.
The appointment of Drew Henderson as the renal service’s clinical director was the catalyst for her decision to seek Nurse Practitioner status.
“He’s a good teacher,” she says of the Scottish-trained nephrologist. “We developed a 10-year plan for the renal service and saw the need and value of having a Nurse Practitioner working in a preventative role. Drew and the Director of Nursing guided me through the journey, and I’ve also had excellent support from my managers in doing this and in continuing with my postgraduate papers.”
Drew confidently predicts Rachael will add value to the community with the depth of knowledge she has acquired – “I would not have encouraged her to train otherwise.” Head of a team of 28 nurses, technologists and caregivers, he says the service does much of its work out in the community, making home visits to monitor patients who manage their own dialysis.
“So we have a nurse role model for chronic disease management,” he proudly says of Rachael, whose patients range in age from 18 to 87. More than half of these have diabetes, which is more prevalent in populations with a large proportion of Māori and Pacific Islanders.
Rachael educates patients on kidney disease and how to manage their health to prevent deterioration in kidney function.
Kidney disease is a ‘silent killer’, she says – most people don’t develop symptoms until their disease is very advanced.
Rachael educates patients on the importance of maintaining good blood pressure, controlling their diabetes, keeping to a healthy diet and weight and stopping smoking. Not adopting these measures can lead to further kidney damage.
Because prevention is always preferable, the message from Rachael, Drew and the rest of the renal service team is to look after yourself, see your primary care team for regular check-ups and manage your health. Kidney disease isn’t inevitable, they say.