One Turangi resident got a nice surprise when Midlands Health Network nurse practitioner Anna Mastrovich (formerly Dawson) showed up at his favourite fishing spot back in 2008 to talk about his long term conditions.
Then in his 50s, he had severe heart failure due to his alcohol abuse, was short of breath, obese, a heavy smoker and would start drinking beers from 11am.
“A hospital physician called me saying the patient needed a bit of ‘Anna-ing’, so I went to his house to meet him but his wife said he was out fishing. I drove out to a remote fishing lake to meet him, and since I had all my monitoring equipment with me I was able to conduct an initial consult and start a care plan,” says Anna.
“He was blown away that someone had bothered to come out to him, and he has been my patient ever since. He has stayed off the booze and has quit smoking. He’s also lost 40kgs and maintained it for seven years.”
Anna has been a nurse practitioner for five years and holds clinics at Pihanga Health as well as providing home visits. Her speciality is long term conditions.
Nurse practitioners have completed advanced education and have been approved by the Nursing Council of New Zealand. They have to complete a clinical master’s degree, which takes four years, as well as another year for an optional pharmacology paper.
They are considered experts that work in a specific area of practice, and often work in a community that they know well.
“We assess, diagnose and treat patients, including prescribing medication,” says Anna.
“We practice independently and can assume full responsibility for the patients. We also work with other health professionals, multidisciplinary teams, GPs, hospital physicians and nurse specialists to manage the patient.”
“I was the clinical nurse manager at Taupo Hospital for seven years. I noticed that a lot of patients were coming back to hospital because of their long term conditions and I really wanted to do something about it.”
“Lakes DHB funds my position in response to the high needs population – 63 per cent of the Turangi population are Maori. We also have many locums as it is difficult to recruit GPs.”
“A female patient who passed away last year was previously presenting to hospital four to six times a year with congestive heart failure, lung disease and diabetes. She didn’t go to hospital for four years after I started meeting her at home.”
“We had regular visits and she was responding well to treatment. I was anticipating her care needs and able to arrange support services like home help and shower support in a timely way.”
Anna uses a holistic approach to managing patients. She talks to them about their environment, and finds out what is important to them to get a sense of their goals. She takes the time to build a relationship to get an appreciation of what the realities of their situation are.
Nurse practitioners also have an extended role in nursing leadership.
“We have multi-disciplinary team meetings, which include health providers, pharmacists, mental health specialists and others, to enable the practice to be the health care home and streamline patient care.”
“Often the practice might say they haven’t seen a patient in years, so I take their blood pressure and other measurements when I visit them.”
“This is one of the reasons why Turangi has achieved 100% in our Quality targets. I also teach at Wintec in Hamilton and take part in nurse practitioner panels for the Nursing Council of New Zealand.”
Midlands Health Network