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No more politicians scoring points over people’s lives

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

Health is the ultimate political football in Aotearoa. Every party in power tries to use it to their advantage, to impose their short-term ideals onto health and – even worse – to only focus on the surface issues so they look like they’ve done something. We can’t let politicians keep doing this at the expense of people’s health and lives.

Opposition parties are willing to tear each other down over failures, even though they’ve all helped gut the system we have today. Yet when in power, rather than be accountable and effective, they tinker around the edges, failing to address the systemic issues.

Politicians go on three yearly cycles, during which time they’re mostly better at destroying than creating. But unlike them, our voice and our work is constant. We must urge for a common public health approach based on the idea that all people deserve the best health care, and all workers deserve the best conditions. If we don’t take control of the political narrative, governments will continue trying to distract people from the real health issues.

To do this we must fight the anti-Māori and anti-union rhetoric on the right. We need to stake our claim as experts of our own field and fiercely protect our profession. The current workforce crisis is going to require some immediate fixes and a long-term strategy which will require nursing to be part of the planning.

COVID has brutally exposed the nursing shortage. While the obvious course should have been to build the nursing workforce, this has not been the case. Instead, changes to the Health Act further undermined and eroded nursing by extending the scope of an unregulated workforce to bridge the shortfall.

We have a 4000+ nursing workforce shortage and the international Council of Nurses reports a 4.6 million nursing shortfall worldwide, so I repeat: if nursing is going to be the political football we need to control the narrative!

Political parties need to consider how we are going to make nursing attractive again, how are we going to make nursing a career choice for school leavers, support them through their training and graduate them into good jobs. How are we going to support and retain the nurses currently in the workforce by valuing their work, protecting their health and safety, including deconstructing the pay disparities that continue?

I have been inundated with calls of immense distress from nurses, health care assistants and kaimahi hauora upset and powerless to speak out against what they are witness to: care choices and negative outcomes driven as a direct result of nursing shortage.

If only our nursing crisis was as simple as a hospital drama tv show  – but  when a nursing shift finishes the emotional debrief plays out in your head hours after leaving the workplace, or wakes you from your sleep as you try to remember whether or not you signed that form, or what you need to do today, or whether there will be enough staff on the next shift.

Nursing is not a drama – nursing is real and it’s up to us to ensure that Government responds to the needs of the people, not us having to bend to their whims.


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Maranga Mai! – Health and Safety

Anne Daniels, President
NZNO, Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Is every nurse, everywhere sufficiently resourced to safely do their job?

What can we make of the Minister of Health saying the hospitals are coping when a raft of professionals within the health sector are saying exactly the opposite? Let’s unpack the statement: Hospitals are coping……

Health care is delivered by nurses everywhere in New Zealand, not just in hospitals. Are Primary Care, Aged Care, Māori and Pasifika nurses coping? I don’t think so. In many cases they are even less resourced. They are at the front-line providing prevention, health education, and wrap around services that include whānau and iwi, but this appears invisible in the Minister’s statement. If it was not for them, the pressures on hospitals would be so much greater.

But the situation is so dire that doctors themselves have written to the Minister demanding that change happen for nurses so they (the doctors) can do their work.

And Aged Care is definitely not coping. Facilities are closing due to nursing shortages, making for unsafe work environments. At a recent Select Committee hearing, NZNO College of Gerontology Nursing Chair Natalie Seymour clearly outlined the major challenges Aged Care nurses and facility managers are facing. The toll being taken on those who provide the care, nurses and health care assistants, in the current nursing shortage context, is beyond belief. Yet our members keep going to work, keep caring, and keep voicing their concerns about unsafe work environments ever more loudly.

Maranga Mai! – The Health and Safety umbrella.

Health and Safety is a main area of focus within our Maranga Mai! campaign. Under this umbrella we are organising opportunities to build member power to hold our employers and their masters to account.

NZNO now has a Health and Safety Representative (HSR) WhatsApp group run by NZNO educator John Howell. This is bringing HSRs together to build understanding and support to engage all members to actively participate in resolving nursing shortage issues. We are building infrastructure, capacity and action by and with our NZNO HSRs, delegates and members.

Those NZNO HSRs and delegates – in combination with members – are a power to be reckoned with, particularly when the HSRs utilise the Health and Safety at Work Act (HSWA) 2015. The HWSA’s main principle is that workers are given the highest level of protection from workplace health and safety risks as possible.

All NZNO members are expected to participate and, as a result, increasing numbers of Provisional Improvement Notices (PINs) are being submitted by NZNO HSRs in regions such as Palmerston North, Auckland, Hawke’s Bay, Southern, Wellington, and I believe more will come.

A PIN is written notice legally requiring an employer or service provider to address a health and safety issue before a certain time.

Nurses are rising up to make sure that every nurse, no matter where they work in the health sector, has the power and resources to safely do their job. Maranga Mai!

This is just the beginning.


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NZNO elections and the values of our leadership

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa, NZNO

Finally, our organisation is becoming more progressive, politically active, and responsive to our member voice. This can be seen in Maranga Mai!, our overarching health and safety campaign that recognises workers across all sectors—aged care, primary and private health, community and Māori health—are all now being prioritised alongside DHB. Maranga Mai! advances Tino Rangatiratanga and Mana Motuhake as real drivers for change; achieving the best outcome for all without Māori losing mana.

With NZNO’s elections coming up (nominations have just opened) I wanted to reflect on what’s moving us in this direction and what I believe will strengthen us moving forward. For me, it comes down to values. What I see making the difference is that the leadership are taking a more values-based approach. That means we’re working in unity, making decisions based on what we’re trying to achieve together. It also means coming back to our shared values to navigate differences.

Members expect a lot of NZNO’s Board, just as we expect a lot of all leaders. We’re rightly held to account to do the best for our members, and to be guided by our shared values when making decisions. We’re all well familiar with seeing politicians and leaders start off saying one thing and then doing the opposite. And instead of owning up to their failings, or addressing them, they put the blame elsewhere. At their worst, they champion false news and repetitively articulate off the wall messages that aren’t grounded in fact, until the uninformed become believers. We have all been a witness to this over recent years from politicians and the like.

To keep building on the momentum we have right now, we need to ensure our leaders have integrity and commitment to their values and to our organisation. We need to be able to trust that those elected will stick together to do the best for all our members. Our organisation will continue to flourish if we continue to make decisions based on values.

The flipside is that we can’t buy into division amongst ourselves. Our members deserve better than that and I believe we know such rhetoric won’t serve us. My hope for these elections is that we instead shift our focus to what we’re building together, our shared vision of justice. I hope those who put their hats in the ring will model the values that have helped NZNO turn the corner in the last year.  I look forward to the outcomes of these elections and continuing to build our collective voice and action. We have so much more to do, and we can only do it together.


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Maranga Mai! – Rise up and act together

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

On 12May 2022 NZNO launched the Maranga Mai! campaign. Central to Maranga Mai! are the “Five Fixes” which form the charter of demands for the campaign:

  1. Te Tiriti o Waitangi actualised within NZNO and across the health system
  2. More nurses across the health sector
  3. Pay and conditions that meet nurses’ value and expectations
  4. More people training to be nurses (in New Zealand)
  5. More Māori and Pasifika nurses

These fixes have a number of areas of focus.

In her recent blog,, NZNO Kaiwhakahaere Kerri Nuku said our work and lives are political. She encouraged members to “get political”, and indeed, it is our professional responsibility to do so.

The third fix, more specifically the conditions needed to meet nurses’ values and work conditions, demands political critical thinking, collective power and action to meet our responsibilities to ourselves, our future selves and those we care for.

So what is the” WHY” in our Maranga Mai! campaign?

Our why is to win the necessary political and resourcing commitments needed to address the nursing, midwifery, HCA, support worker and kaimahi hauora shortage crisis permanently, across the whole health sector.

“WHAT” are we aiming to achieve?

1. Mandated minimum nurse-to-patient ratios supported by a fit for purpose tool that can increase appropriate skilled and experienced nurse resourcing when and where it is needed.

Mandated means legislation, which means political and collective power and action is needed. This is an outcome of the remit passed by the membership at the 2020 AGM.

Going forward, nurses must have appropriate levels of experienced and skilled resource available, built on data driven information to ensure patients and nurses are not put at risk. Nurses must not have to struggle to do the best they can, fearful of what may meet them when they go to work. This must be worked through across all sectors of the health system, not just the DHBs – and the Māori and iwi sector is the most urgently in need of attention.

2. All nurses, regardless of their sector must receive pay equity/parity and work conditions that: reflect the true value of nurses everywhere; attract people to the profession; and support nurses’ work choices.

While the Minister of Health has already signalled this will happen, the questions are when and which sector first? Māori and Pasifika nurses in primary care have, for a long time, been marginalised, more so than many other nurses in different sectors.

Making our commitment to te Tiriti o Waitangi a reality is a real opportunity for us all. Raising up our Māori and Pasifika colleagues will drive parity of pay and conditions for all.

“HOW” are we going to do this?

Our national Maranga Mai! campaign strategy is being developed by our great team and it will be up to us, the nurses at the coal face, to make it real for ourselves locally. Our expectation that the recent Budget would deliver on some of our goals has not been realised. Therefore, we have to to take the lead.

The Care & Support Worker rallies we held across the country (together with the PSA and E tū) on 23 May were our first ‘on the ground’ and publicly visible Maranga Mai! action, and I was proud to lead and speak at the one held in Dunedin. We will do many more of these sorts of activities.

The power to create change is in our hands. Every nurse everywhere must Maranga Mai! – Rise up and act together.


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Time to get politically proactive

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Nurses have long been marginalised in the politics of health and unfortunately, NZNO hasn’t been a strong enough advocate to challenge that. For years the organisation has made compromises and concessions because it didn’t have the political will or the belief in our collective strength to challenge power.

But we need to get past the idea that we’re non-partisan. Our work is political, our lives are political, and the powerful will exploit our apathy to their advantage. As health workers we’re advocates for our patients and as a union and professional organisation, we advocate for a better health system. To do that we must engage in politics. And by that I don’t mean endorsing a political party. I mean building and pushing our own vision of health and holding all decision-makers to account to get there.      

After all, unions have always fought on broader political causes because workers’ lives don’t just begin and end when they clock in. Unions have been part of the fight for Indigenous liberation, women’s rights, racial justice, climate justice and the peace movement across the world. As the union saying goes, “an injury to one is an injury to all.” We are part of a long history of collective struggle for all people.

I also want to point out that it’s not only our unionist roots that demand political courage, but our professional responsibilities too. When standards of practice are watered down or public health measures are eased against our better judgement, those are the result of political decisions that we must challenge. 

So now, with the general election on the horizon, we start seeing National and the Act Party rolling out racist rhetoric, including calls to extinguish the Māori Health Authority. They’re also advocating the same economic policies that gutted our health system. At the same time Labour will continue to make promises they won’t deliver on. We need to watch all this and be ready to push back on it.  

From this point on, NZNO must change the way it operates if we want to go from conservative to progressive, from reactionary to proactive. If we want what’s best for ourselves and our communities, we need to go hard and front foot on political issues.

We must start to empower people to do their own thinking and not be afraid to front divisive issues on race, gender, sexuality, class, and power. We can’t sit and wait for change to happen for us. We’ve got to be courageous and realise we have the power to make change. Not only do we have the power, we have the right and the responsibility to stand up, be heard and fight for a better future.


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Fighting the good fight – are we there yet?

Leadership blog, by Anne Daniels

Kerri Nuku ended her recent Leadership blog on pay equity with an important whakataukī, Ki te kotahi te kākaho ka whati, ki te kāpuia, e kore e whati – When we stand alone we are vulnerable, but together we are unbreakable.

We have some loud voices standing strong, but only from some of the many members we have. We need to all raise our voice because this fight isn’t just for DHB Nurses, or even all nurses. This fight is for all women everywhere in New Zealand and throughout the world. History tells us why.

The fight for fair pay for women started in the 1890’s for New Zealand women principally by the newly formed National Council of Women. In 1957 the Council for Equal Pay and Opportunities (CEPOP) was formed by a coalition of women and men’s organisations and unions and later in 1986, the Coalition for Equal Value, Equal Pay (CEVEP) was set up by women’s groups and unions with the Nurses Association prominent among them. After decades of organising, the Labour Government introduced the Employment Equity Act in 1990 to “redress past and present discrimination experienced by women in the labour market.” But this historic legislation was quickly repealed by the new National Government the same year.

This is the political context when, as a young nurse dissatisfied with pay and conditions, I became one of the few NZNO delegates in 1990. Since then, I’ve been in many campaigns for the same thing, fair pay and conditions. Each time we’ve failed because we were too trusting. In 2010, we received a small pay jump but within a few years the buying power of this rise had fallen away. Successive governments continue to fail women, reflecting the ingrained patriarchal attitudes of both men and women in power.

And here we are one hundred and twenty-two years later still fighting for justice. Ironically, our current Labour Health Minister has a union background and our female Prime Minister stands on the shoulders of women who fought for equality. We expect them to stand with us, not against us to right the wrong of the perpetual injustice of women being underpaid, while also enduring substantially poorer work conditions than men receive.

We can’t wait for others to do right for women. We must take our fight to the streets and join with all women, everywhere in New Zealand, as our fight is their fight. We put this government and any successive government on notice. We will fight without ceasing until we win, as together, we are unbreakable.

References:

Equal pay in New Zealand from 1988 to present (cevep.org.nz)


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Kotahitanga and the opportunities presented by Pay Equity

Kerri Nuku, Kaiwhakahaere
New Zealand Nurses Organisation, Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO)

This is a truly significant time. Despite the difficulties we’re currently facing, the rates offered to DHB nursing staff under the recent proposed Nursing Pay Equity settlement should be something to celebrate because it’s a formal recognition that we have been undervalued. Of course, it doesn’t come close to really addressing the power imbalance we face in a sexist society, but material compensation would be better than just words.

It’s taken an incredibly long time even to get to this point, and I think we owe it to ourselves and each other to be staunch and see this process through. It’s crucial for us to challenge with curiosity and hold fast to what we know our value to be. We can’t settle for anything that will undermine the future of nursing.

The fact that members are not satisfied with what’s been put in front of them is a positive thing because it has opened a conversation and presented us with possibilities. We’ve come across an obstacle, and now we’re given an opportunity to reflect, regather and renew our direction.

For me, the critical part of this, and the opportunity that we’re now afforded, is to put a line in the sand and say that all workers across all sectors need to be recognised. What we do today is important for our colleagues across the sectors.

We can truly enact kotahitanga and solidarity. We can be forward thinking, and above all, we can embrace a broader sense of justice than what the Government and employers want us to have. They want us to fight amongst each other for funding, to think it’s either DHB or Māori providers or Aged Caregivers. They also benefit if we think that Te Tiriti and equity are at odds with union principles. That kind of thinking creates division. It’s not the kind of thinking that wins the fight for justice.

We can and must fight for all, and in doing so we have to acknowledge that non-DHB campaigns haven’t had the same support at NZNO.

Just as nurses are trained to triage patients based on their acuity, everybody should get the care they need and deserve. Why shouldn’t we apply the same to our own organisation? Why can’t we also focus our resources on those who most deeply experience inequity?

Again, we don’t have to choose between, but our NZNO’s relative silence for those outside DHBs has to be addressed and together with the strength of 55,000 we can expand Pay Equity to all sectors. 

Ki te kotahi te kākaho ka whati, ki te kāpuia, e kore e whati – When we stand alone we are vulnerable, but together we are unbreakable.


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Nursing shortages – beyond crisis. Is there an upside?

Anne Daniels, President
New Zealand Nurses Organisation, Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO)

NZNO Kaiwhakahaere Kerri Nuku and I have repeatedly stated that DHBs and communities in Aotearoa New Zealand are beyond crisis when it comes to having enough appropriately trained and experienced nurses to do the job well. A crisis can be defined as a “time of intense difficulty or danger”. It’s also when important decisions must be made, and we are at that time.

Why (do we have to make a decision)?

Older nurses are retiring in droves; others are changing careers; too few are entering nursing study; and internationally qualified nurses (IQNs) are facing immigration barriers. This all makes the work pile higher on those left in the profession.

Nurses are working overtime and are repeatedly asked to give up valuable days off. As research affirms, exhausted nurses make mistakes and patients suffer as a result. So, despite this pressure, we’re hearing more and more that nurses are starting to say no. They’re saying, “I don’t know how much more we I can take. If things keep going the way they are, we’re going to lose patients and, as a nurse, that’s just too much to bear.”

National and international research shows nurses are feeling increasingly embattled. It’s not just the workloads or pay; it’s facing the “challenge of knowing what care patients need but being unable to provide it due to constraints beyond the nurses control.”[1]

On top of this are inequities across the health sector experienced by Māori and others in Aotearoa New Zealand. Nurses are leaving or reducing their hours of work, not responding to texts asking them to work on their time off, and in some countries, despite covid, they are striking.

What (are we going to decide) and when?

Our calls for action have been ignored for decades and we can’t wait for Government or employers any longer. Even though it will take years to overcome the complex issues we face, we must start now. It will take collaboration from the community, academia, all levels of health care and Government to work in real partnership with NZNO (as the largest representative of health workers) to develop creative solutions.

NZNO’s leadership and Board of Directors are working on an overarching campaign to ensure all nurses everywhere, work together to win the political and resourcing commitments needed to address the nursing shortage crisis permanently.

Last word…

There is an upside. We always need to know what we’re trying to achieve when we decide to stand up and fight the good fight. Power is generated from the bottom up. At 55,000 strong, we have the power in our hands to shape the future of nursing. We are all in this together and we will win.


[1]     Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: Moral injury not burnout. Federal Practitioner, 36(9): 400–402. Reframing Clinician Distress: Moral Injury Not Burnout – PMC (nih.gov)


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Why does NZNO have a President and Kaiwhakahaere as co-leaders?

NZNO Kaiwhakahaere Kerri Nuku (left) and President Heather Symes

By NZNO President Heather Symes

NZNO has both a President and a Kaiwhakahaere as governance co-leaders. Among other things we chair the Board, and act as its public face and spokespersons when required. As Board members we have oversight of the organisation and its member groups, but we do not involve ourselves in the day-to-day running of the organisation (e.g. advocacy, the MECAs, Pay Equity etc). This work is done by staff and is managed by the Chief Executive.

So why are both a President and Kaiwhakahaere necessary?

Essentially we have these two offices working co-operatively as part of NZNO’s commitment to becoming a bi-cultural organisation and to working under te Tiriti o Waitangi.

It is important we acknowledge and work within te Tiriti so we can address appropriate cultural lenses to our organisation and its activities.  As a nation we cannot expect to move forward in unison unless each te Tiriti partner is aware of and respects the other’s worldview and approaches. We try to operate under te Tiriti in the same way as an organisation.

The Kaiwhakahaere is also the leader of Te Rūnanga (the Māori arm of the organisation) and supports Māori members by representing Te Rūnanga’s views to the Board. The Kaiwhakahaere also advises the organisation on what is culturally appropriate from an indigenous perspective.

The NZNO President has to this point never been indigenous, and brings a different (usually more western) cultural worldview. This means that together we have a rich tapestry and wealth of knowledge. But we are both equally accountable to members and work together to ensure plans going forward are good for members and therefore good for all in Aotearoa New Zealand.

Both positions are democratically elected, but there is a difference in how this is done for each. The President is elected by all paying members and can serve a maximum of two three-year terms. The Kaiwhakahaere is elected by Te Rūnanga at Hui ā tau every three years, but may serve more than two consecutive terms.

This is part and parcel of the bi-cultural approach we work towards under te Tiriti and an acknowledgement that different cultures may approach things like leadership differently.

It is entirely appropriate that the Kaiwhakahaere is elected only by Māori members but it is also important to note that his or her power is not unlimited. The Kaiwhakahaere’s performance is examined at each Hui ā Tau and they must be endorsed on a yearly basis to remain in the position. The President faces no such requirement. 

I hope that makes the co-leadership roles of the Kaiwhakahaere and President a little clearer.


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Year of the Nurse and the Midwife – Reflecting back as we move forward

by NZNO Kaiwhakahaere Kerri Nuku and President Grant Brookes

The World Health Organization has designated 2020 as the Year of the Nurse and the Midwife. NZNO will be joining in to celebrate the contributions nurses and midwives make and to envision the even greater contributions we can make in the future.

As we reflect on the mahi of nurses and midwives, we take inspiration from the whakataukī: “Titiro whakamuri kōkiri whakamua – Look back and reflect so you can move forward.” In so doing we honour our ancestors and learn from past mistakes.

2020 also marks the 200th anniversary of the birth of Florence Nightingale. Florence is a hugely important figure in the development of our profession, but she left behind a mixed legacy.

Nurses, midwives and tohunga have been serving their communities and practising healing in Aotearoa for centuries; from long before when Florence was advising Colonial authorities in Aotearoa New Zealand about how to prevent the “inherent diseases” of the “savages” from leading to their extinction, as they were brought out of “barbarism” through “the inestimable blessings of Christian civilisation”.

In fact much of our nursing history has been marred by these sorts of conservative and racist views, some of which persist today.

Returning to the whakataukī with which we opened, here are just some of the notable figures and events in our history we can look back on:

  • In 1901, thanks to the pioneering efforts of Grace Neill, Aotearoa New Zealand became the first country in the world to pass legislation recognising the qualifications and status of registered nurses. Recognition of registered midwives came three years later.
  • In 1902 Ellen Dougherty of Palmerston North became the world’s first registered nurse.
  • Akenehi Hei became the first Māori nurse and midwife to register under her own [Māori] name six years later in 1908. However, Māori trained nurses were providing care even before official registration began, following in the footsteps of Mereana Tangata (Mary Ann Leonard) who qualified in 1896.
  • Founded in 1908, Kai Tiaki Nursing New Zealand is one of the world’s longest running nursing publications. Last year, Kai Tiaki became one of just 20 publications so far inducted into the Nursing Journal Hall of Fame at a ceremony in Reno, USA.
  • Turning 111 years old this year, the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa is proud to be one of the world’s first professional nursing associations.

Our indigenous and home-grown nurses and midwives have made an immeasurable contribution throughout the 20th and 21st centuries towards raising the health of all peoples in Aotearoa New Zealand. They’re now being joined by our internationally qualified nurses, too.

However, our health system today is under strain. Distressing health inequities persist and nurse and midwife shortages are predicted to grow. Historically our work has been undervalued because we are a female dominated profession. Thankfully an end is finally in sight, with the first Pay Equity settlements due this year. Entrenched pay disparities for those in Māori-led health care providers could also be closed at last, thanks to years of campaigning and a landmark claim lodged with the Waitangi Tribunal by Te Rūnanga o Aotearoa NZNO.

Nurses and midwives need to be properly deployed, valued and included in policy and decision-making. By the end of 2020, we hope to achieve greater investment in improving education, professional development, standards, regulation and employment conditions for nurses and midwives. Our goal is greater influence for nurses and midwives on health policy, more nurses and midwives in leadership positions, and more opportunities for development at all levels.

The needs of the 21st century also require innovative services that make better use of new technology. We need more community and marae-based services that are holistic and people-centred, as well as an increased focus on prevention and on undoing the harm caused by colonisation. These are all areas where we can play a leading role.

Finally, it is our hope that by the end of 2020, NZNO’s Strategy for Nursing 2018-2023 will be accepted across the health sector. This would signal a stronger commitment to a safer and more equitable future for all nurses and midwives in Aotearoa New Zealand.

“Me haere tahi tātou mō te hauora me te oranga o ngā iwi katoa o Aotearoa”, “Let us journey together for the health and wellbeing of the people of Aotearoa” (Rev Leo Te Kira 15 December 2005).