Abstract
Over the last two decades there has been an increasing demand on health care services. This has led to increased waiting lists and waiting times to access public hospital services. In ophthalmic practice an aging population and technological advances have been major contributors to this situation. The challenge for health care providers is how to manage waiting lists within the resources provided and targets set by Elective Services, a department of the Ministry of Health (MoH). The Ministerial Taskforce on Nursing (1998) highlighted that nurses are an underutilised resource. Subsequent to the Ministerial Taskforce, the availability of interim funding from Elective Services and a skilled speciality nursing workforce the Ophthalmology Department at a large metropolitan hospital was able to implement an advanced nursing role with respect to glaucoma management. Early diagnosis is important in reducing the risk of permanent visual impairment from primary open angle glaucoma; therefore the length of time to diagnosis can have long term implications for the patient. Patients for the ‘nurse-led' glaucoma clinic were recruited from specific categories of glaucoma patients on the waiting list. An audit of the impact on the waiting list was undertaken periodically over a two year period. The audit following the introduction of the clinical nurse specialist clinic shows a marked reduction in waiting list numbers and length of time waiting for first specialist assessment for glaucoma. The implementation of this role proved to be successful and has subsequently become a permanent nurse specialist position in the ophthalmology department.

Keywords
Glaucoma, nurse specialist, nurse led clinics, chronic care management

Introduction
The lengthy waiting times for first specialist appointments has been a concern in many speciality areas of practice particularly over the last decade, as the population ages and technology advances. Ophthalmology is an area that has seen significant increases in referral rates directly related to the aging population and advances in medical practice. Along with an increased number of referrals, is the Ministry of Health's (MoH) expectations of health service delivery which is clearly outlined by the Elective Services team in terms of access, assessment and treatment criteria and timeframes (Ministry of Health, 2001). As a consequence of increasing demand and finite resources, the deliverers of public health care have to explore alternatives to a totally medicine-led service. Literature reveals that skilled ophthalmic nurses, in the United Kingdom, are undertaking advanced nursing roles which are making an impact on waiting lists and patient outcomes in some ophthalmic subspecialties, glaucoma being one such area (Hume & Abbott, 1995; Martin, 1999; Mayer, Waterman, & Grabham, 2000).

A trial of a clinical nurse specialist role in a large New Zealand metropolitan hospital was funded via Elective Services for 12 months, with ongoing funding contingent on evidence of its success. The background of the role is considered along with ......cont.