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Losing teeth sucks

By guest blogger Hilary Graham-Smith.
Hilary is NZNO’s associate professional services manager. She has had a long career as a registered nurse working in primary health care and as a Director of Nursing in primary health care.

OLYMPUS DIGITAL CAMERAThe debate around whether to fluoridate or not fluoridate community water supplies seems to have lost sight of why fluoridation was instigated in the first place. Instead the various factions have been caught up in battles based on pseudo-science, scare mongering and downright histrionics.

NZNO has long been a proponent of fluoridation, after careful assessment of all the research.

There is overwhelming evidence, nationally and internationally that fluoridation of community water supplies works. The NZ Oral Health Survey 2009 shows that on average New Zealand children have 40 percent less decay in areas with fluoridation compared to areas without it. Surely, that should be evidence enough.

Adding fluoride to our community water supplies is about health equity –it is about closing the gap in the oral health status of our most vulnerable children and young people.

The World Health Organisation has found that “The prevalence of oral diseases is increasing in low- and middle-income countries, and in all countries, the oral disease burden is significantly higher among poor and disadvantaged population groups”.

As a nurse, I was largely unaware of the poor oral health experienced by the children in our community. Then I got the opportunity to work on a number of oral health projects where the DHB and the PHO partnered up to fund extra services so that issues like access were addressed.

I was horrified to learn that many of our tamariki have total dental clearances – yes that is all of their teeth out – before the age of five years. In fact at that time, dental clearance was the main reason for children under five having a general anaesthetic in our region.  Imagine what it must be like as a child to have difficulty eating, to feel embarrassed about your smile, to be so ashamed of your teeth that you never laugh out loud. Imagine too what the impact is on overall health and wellbeing, on self esteem and confidence and on development  – so much more than a few fillings.

The PHO/DHB initiatives meant we could extend our reach and focus on vulnerable high need communities, teach kids and parents about cleaning their teeth and keeping the sugar to a minimum; we enrolled them with the school dental service so that they would continue to get their teeth checked regularly and we lobbied hard for the community water supply to be fluoridated – and we won.

I can’t believe that we are having this debate all over again when we have such good evidence that fluoridation really does make a difference to whether or not kids experience pain, infection and tooth decay.

The data is very clear; inequalities in oral health status are consistent between children in fluoridated and non-fluoridated areas.

The evidence that fluoride is a safe and effective starting point to address these inequalities is also very clear.

As nurses we are all about evidence based practice – let’s put the evidence into practice and push for universal fluoridation  of our community water supplies.


New grads – we’ve got your back!

ImageThere has been a lot of media lately about the situation new graduate nurses are finding themselves in after graduation. Many struggle to get nurse entry to practice (NETP) places, a scheme whereby newly graduated nurses are supported and mentored for their first months in the workforce, and those who are not successful in getting a place on such a programme also struggle to find a nursing role because employers want experience.

There is commentary from various quarters that we should train fewer nurses but we have a looming nursing workforce crisis as many of the current workforce move toward retirement. We need to educate and prepare the replacement workforce now, and we also need to plan for how we will employ and support them so that they are ready to replace today’s experienced and skilled workforce.

It is Health Workforce New Zealand’s (HWNZ) job to make sure supply meets demand in the health sector. So, what are they doing about preparing such a plan? Precious little to date.

The result is that newly graduated nurses are paying the price, with massive student loans and limited chances of employment. We estimate that around 500 nurses each year are not able to find NETP places.  Some will find employment in various parts of the sector but many find employment outside the sector; in retail for example, just to pay the bills. A number will inevitably take their talents overseas. The numbers are terrible, and the impacts on families and communities will be felt across the country (and economy).

Students and new graduates are contacting us daily with sad stories of how their dreams of a nursing career are fading. And like Michelle Duff’s article says, these nurses should be in “hot demand”!

It’s a disaster for individuals and the health system too. We want to see some change.

NZNO wants to see 100 percent employment for every single nurse graduate who wants a position in the New Zealand health sector.

We want our new graduates to be well supported in practice and to have sound preceptorship / mentorship. New Zealand is going to be around 15 000 nurses short by 2035, so we’re going to need them.

We want them to have NETP placements that are meaningful and that provide an opportunity to grow their clinical experience and clinical practice in a supportive environment.

We want a confident, experienced, highly skilled nursing workforce. New Zealand deserves it.

Fortunately, NZNO is a large organisation; 46 000 members have a lot of clout, and we are using it to get a great result for our student members, now and in the future.

We have raised the issue along with the National Nursing Organisation group at the Health Workforce NZ meeting on November 28th last year and it was prioritised by that group as an issue for urgent attention.

We are raising the issue in the media whenever we can. Public pressure, alongside private pressure on Health Workforce NZ is surprisingly effective. The Minster of Health will not want the issue to remain unresolved during an election year.

We raised it with the Minister late last year in a meeting and agreed that a solution needed to be found.

NZNO has a clear ask of HWNZ – step up and work with the DHBs and the rest of the health sector to develop a robust and sustainable workforce plan for nursing.


An ounce of prevention…

prevention-vs-cureThere are some really disturbing things being said (here and here) about health and safety in New Zealand at the moment. ACC Minister, Judith Collins describes a joint programme between Business NZ and the CTU that provides employee training about health and safety as having “all the hallmarks of a rort.”

The training scheme has been going since 2003 and 30 000 NZ workers have been trained about health and safety in the workplace in that time. Surveys of those who have completed the 2-day course report feeling more confident and knowledgeable to perform their health and safety role at work, and more aware of how important health and safety at work is. Once trained the health and safety reps are able to work towards a culture of safety in their workplace, understand the Health and Safety Act, use Hazard notices and properly investigate incidents.

ACC itself said that these measures need to be part of a wider injury prevention culture to be fully effective.

The cost of workplace injuries is $3.5 billion per year. It’s hard to say how many injuries or deaths those 30 000 people have prevented over the years – but even if it’s only one per year, that makes the total expenditure of 19 million over 10 years seem like an excellent use of taxpayer money.

No matter which way you look at those figures, I don’t see how you can come to the conclusion that it’s a rort or a scam.

From an NZNO perspective, it seems like just another attack on the health and well-being of New Zealanders. Our members know how important it is to have a safety barrier at the top of the cliff rather than an ambulance at the bottom. We support many taxpayer funded campaigns to prevent harm and death – immunisation, smoking cessation, diabetes prevention. Unfortunately we’ve seen too many long term preventative strategies discontinued over the last 5 years too; healthy eating, healthy action for one, and now the funding for the ACC health and safety training.

New Zealand has one of the worst health and safety records in the OECD. It seems inexplicable that the ACC Minister is cutting funding for health and safety training when it is obvious to us that she should be increasing it, and strengthening and extending the reach of training and education.

A long term, evidence-based view of health is needed, along with a framework that prevents harm and creates a culture of safety in all our workplaces.