New Zealand’s two renal care Nurse Practitioners both trained and are based in Hawke’s Bay.
Janine Palmer has followed the pathway opened up by her colleague Rachael Walker. Supported by the Hawke’s Bay District Health Board, both women completed advanced study courses at EIT to meet New Zealand Nursing Council standards for the country’s top clinical nursing role.
That’s significant in a region with a comparatively high incidence of diabetes, an often undiagnosed but increasingly common disease that can lead to kidney failure.
At least half those receiving dialysis through the DHB are diabetic. Patients in Hawke’s Bay needing treatment for diabetes are also much younger than the New Zealand average.
Janine says advancing to a Nurse Practitioner role puts her at the top of her game.
The former Hastings Girls’ High School student started nurse training at what was then Hawke’s Bay Polytechnic and subsequently took on additional courses at the renamed Eastern Institute of Technology to gain a Bachelor of Nursing and then, in 2011, a Master of Nursing.
Based in Ballentyne House, a recently upgraded building on the Hawke’s Bay Hospital site, Janine points out that there are varying degrees of renal failure.
“My clientele are at end-stage renal failure and face a complex set of problems. It’s very challenging and that’s what’s satisfying about it, helping them achieve a quality of life and to live in the best way they can.”
Rachael’s role focuses on those at the early stages of the chronic disease and preparing people for renal replacement therapy.
“Our job is to keep them well,” says Janine, who wears civvies to work with 70 patients who undergo dialysis treatment for five hours three to four times a week on the renal care unit’s 20 machines.
A further four machines are used for home training and 15 patients are treated on machines in their own homes. Eighty Hawke’s Bay patients have had the gold standard treatment, receiving a donated kidney in transplant surgery undertaken in Wellington.
Janine has nursed in Hawke’s Bay for 25 years, 15 of them in renal care services. Formerly a clinical nurse manager in the unit, she returned to a more “hands-on” clinical role in 2011.
“I like working with people, making a difference. I missed the close contact with patients and now I’m definitely where I should be.”
Making the “big leap” from registered nurse to Nurse Practitioner requires a clinical master’s and a portfolio demonstrating high-level competencies, a process that takes about four years. Well-supported and prepared by EIT, Janine feels confident in her ability to practise at an advanced level.
Her “wider reach” includes being able to prescribe drugs for patients.
“I don’t have to refer patients on to doctors, so I can achieve more for somebody at the time I see them. That makes access to health care more efficient. I see that as a real asset to the unit.”
Working as a Nurse Practitioner since last September, Janine says, has opened another world to her.
“There’s a huge pool of expertise and skills to aspire to. Nurse Practitioners are New Zealand’s ground-breakers, leading lights in their field. Rachael was first in the renal care field. I’m very lucky to have had these people to learn from.
“It’s a very cohesive group which, in Hawke’s Bay, includes Nurse Practitioners in urology, emergency care, vascular and interventional radiology and primary care.”