How Can Nursing Education and Development Strengthen Operational and Clinical Practice to Enhance Quality Outcomes Within Te Whatu Ora, Health New Zealand, Waikato District?
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Atherfold, Cheryl
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Zambas, Shelaine
Webster, Karen
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Auckland University of Technology
Abstract
Aotearoa New Zealand’s health system requires a well-equipped nursing workforce capable of delivering effective care to the population it serves. To progress this aim, the Professional Development Unit within Health New Zealand (Te Whatu Ora) Waikato District, provides a comprehensive range of post-registration education and development opportunities. An earlier project examined the integration and streamlining of education and development functions resulting in development opportunities. Building on that foundation, the present research explored how nursing education and development can more effectively support operational and clinical practice to enhance quality outcomes within Te Whatu Ora Waikato District.
A single embedded case study design, informed by bicultural approaches and critical appreciative processes, was used. The study was situated within a critical interpretive paradigm and underpinned by critical social theory. Two units of analysis guided the inquiry: strategic intentions identified through document review, and stakeholder perspectives gathered via focus groups and individual interviews. Data were analysed using Braun and Clarke’s (2022) reflexive thematic analysis.
The strategic intentions units of analysis evidenced that the Waikato DHB Strategic Plan (2016) and the Nursing at Waikato Strategy (Waikato DHB, 2017) positioned education as central to achieving effective health service delivery. However, the intent was not consistently reflected in other documents and organisational structures. The stakeholder perspectives units of analysis confirmed the presence of a learning culture in parts of the organisation, while revealing gaps between operational efficiency and aspirations for quality outcomes for patients/tāngata whaiora.
Three interconnected themes were identified. The first theme, ‘impact and influence’, highlighted the reactive nature of practice environments; the significance of nurses’ presence in care delivery; and tensions between clinical and management priorities, workforce composition, and siloed structures. The second theme, ‘safe, shared practice growth’, drew attention to the need to equip nurses with essential skills, the value of mentoring for individual and team development, and the importance of interprofessional collaboration. The final theme, ‘embedding identity, equity, and Te Tiriti o Waitangi in practice’, emphasised Kawa whakaruruhau, cultural safety, Te Ao Maori worldviews, identity, and Tuakana–Teina relationships. Together, these findings demonstrate that strengthening education within governance and leadership structures, integrated learning cultures, and bicultural practice are foundational to operational and clinical practice to enhance quality outcomes.
The study proposes several actions to strengthen education within governance and leadership structures, and facilitate learning cultures and bicultural practice. Recommendations include embedding strategic priorities across operational management, clinical practice, and education and development; integrating education and development leaders within governance at organisational and service levels; involving education and development teams early in service planning; and developing culturally grounded indicators of quality that reflect Te Ao Māori values, equity, and relational care.
This case study contributes insights into how integrated educational, clinical, and operational systems can strengthen practice and enhance quality outcomes. The findings provide a foundation for broader application across comparable health districts.