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The Budget and the MECA

scalpel12This past week has been a busy one. Thursday 21 May was Budget Day. It’s a day we are always on the edge of our seats, hoping for a plan for health that delivers for our members and all New Zealanders.

And the day after that we held our final meetings about the offer from DHBs for our multi-employer collective agreement. The results of those meetings did not surprise us but what we didn’t expect was the extent to which NZNO members working in DHBs rejected the DHBs’ offer. Over 82 per cent voted no.

This years’ Budget does not provide enough funding to meet the health needs of New Zealanders. In order to meet the costs of rising prices, an increasing population, an ageing population, an ageing health workforce, long overdue decent wage increases, new services etc etc, we estimate the funding allocated is at least $260 million short.

District Health Boards (DHBs) are short-changed by at least $121 million. And we know almost all of them are already struggling to manage massive deficits, meaningless health targets and the continuing push from government to “centralise” services at any cost.

How are DHBs going to deal with the likely flow-on impacts on safe staffing, workplaces that are healthy for staff and patients and quality care?

Nurses, midwives, caregivers and other health care workers are telling us they are already stretched to the limit. Some are having to sacrifice tea and lunch breaks and are working unpaid overtime just to keep up with the care they need to give to ensure needs of patients are met. Support for training and development is decreasing. Stress levels are rising and morale is low.

And it’s not only DHBs that are bearing the brunt of reduced spending. Efforts to reduce poverty related illness are not being tackled in a “joined-up” way.

Health workforce planning is proceeding at a snail’s pace. New graduate nurses are still looking for jobs that aren’t there. Older nurses are still being pressured to work night shifts.

Health workers need a fair deal to cope with the increasing demands that are being placed on them.

And this means we need to stand together to make progress in our bargaining with the DHBs for our multi-employer collective agreement.

NZNO members working in DHBs don’t feel valued. They instructed the negotiating team to retain what’s already in the MECA, secure a decent pay increase, improve access and support for professional development and advance safe staffing and healthy workplaces.

The DHBs’ offer clearly didn’t cut it. They need to do better for their largest group of workers.

We’re heading back into bargaining on Thursday with a clear mandate: the offer must be improved. Nurses can no longer continue to take up the slack for a sick health system.

We can’t do all the work here! DHBs need to take some responsibility for advocating for the funding that provides appropriately for every member of staff and every patient. New Zealanders won’t settle for anything less.


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Southerners won’t back down

Nurses at Dunstan hospital celebrate International Nurses Day

Nurses at Dunstan hospital celebrate International Nurses Day

Southerners are gutted to hear of a five percent funding cut to their network of rural community hospitals in Oamaru, Ranfurly, Dunstan, Balclutha and Gore.

And if that’s not bad enough, there will be reviews of health services and no increases for changing costs or population. What that means is that if the population of your town increases, there won’t be any corresponding increase to health funding.

Hospitals are still working out what impact this will have on services and each hospital will be affected differently. What we do know is health services are under threat and so are many jobs.

At the same time, Southern District Health Board (SDHB) has announced plans to contract out and privatise its food service, with frozen meals being driven down from Auckland, in a further attempt to save money that threatens local jobs. We can see no sense in that whatsoever!

So why is all this happening? Southern DHB’s financial situation is pretty grim – they are $27 million in the red this financial year and are predicted to be at a $42 million financial deficit next year. When DHBs are squeezed this tight, something has to give. This time it’s the health of our rural communities, not to mention their nutritional needs!

While we don’t know all the reasons for their financial woes, or why they are so much worse off than other DHBs, we do know that a contributing factor is the year in, year out, underfunding of health services in New Zealand [pdf].

It’s this Government’s seventh budget this week, and they’ll be announcing funding for health for the next year. If they get it wrong, we’re looking at losing local jobs and local health services. Without more money coming in, it’s hard to see how Southern DHB will be able to preserve all the health services the population needs.

It’s not fair that valued local services, through no fault of their own, have to bear the brunt of Southern DHB’s deficit. NZNO will be working constructively with the affected rural hospitals to save services and protect member’s jobs. Not only will these cuts put patients’ health at risk, but removing skilled jobs from the regional economy impacts on the region’s long term financial health.

This ends up costing the Government more in the long run through health, social services, and other agencies. Southerners understand this, and we will be backing them all the way to find healthy and sustainable solutions to the District Health Board’s financial crisis.

Watch this space for NZNO’s response, and updates on the Southland and Otago rural hospital network plan for dealing with the cuts.

 


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Unmasking the evidence

Coughs_and_Sneezes_Spread_Diseases_Art.IWMPST14133Many DHBs have been talking about forcing staff who don’t get the flu vaccination to wear masks.

It’s one of those things that on first glance might seem like a good idea, but peel back a few layers and you’re left with the bitter taste of a purely punitive measure.

NZNO acknowledges the right of every person to vaccinate or not. We encourage it, of course; to the extent that we pay for our own staff to get the flu vaccination if they choose to. Healthy workplaces are a priority. We believe education and access are key to improving uptake but we do not think mandatory vaccination is the way forward.

DHBs want safe environments for their staff and patients too and we applaud that. What we’re saying is the DHBs are grabbing onto a “solution” that’s not evidence-based and seems to be designed to shame individuals rather than keep staff and patients safe from the flu.

We do not support the use of face masks to protect patients from unimmunised nurses.

For one thing, masks don’t work. Evidence shows masks are ineffective in protecting healthcare workers from patients with flu; so why do DHBs think the opposite would be different?

For another – a nurse with the flu would only be able to pass it on to a patient or colleague if he or she was at work. Nurses should not be working, or be made to feel that they should have to be at work, when they are sick. DHBs need to make sure enough staff are available to cover the inevitable rise in sick leave during “flu season”.

And it’s not just nurses. There must be clear information for patients, staff, contractors and visitors that sick people should stay away.

DHBs should also be promoting good hand washing and the use of tissues for coughs and sneezes.

Our motto is “Freed to care, proud to nurse” and we want that for every single NZNO member. Please don’t hesitate to give us a call if you are being treated unfairly 0800 28 38 48.

Here is NZNO principal researcher, Dr Léonie Walker’s analysis of the evidence for and against masks to protect against flu.

Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use are not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%1.

The efficacy of any respiratory device depends on user compliance. Workers’ tolerance for wearing most types of respiratory protective devices is poor and often declines over the course of a work shift; in one study, no more than 30% of workers tolerated these devices consistently throughout an 8-hour workday, citing difficulties with speaking and communication, discomfort, and other physical problems2.

The Institute of Medicine committee has recommended that current Centers for Disease Control and Prevention guidelines for respiratory protection be maintained3. Until more data are available, the Institute of Medicine committee recommended the use of personally fitted, N95 respirator when confronting patients with influenza-like illnesses, particularly in enclosed spaces4.

1Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control (2008);36:276-282

2Radonovich LJ Jr, Cheng J, Shenal BV,Hodgson M, Bender BS. (2009) Respirator tolerance in health care workers. JAMA ;301:36-38

3www.cdc.gov/h1n1flu/guidelines_infection_control.htm.

4Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D (2009) Novel H1N1 Influenza and Respiratory Protection for Health Care Workers N Engl J Med 361:1823-1825”

 


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Nurses – making the difference in healthcare

IND resources_Page_2International Nurses Day is my favourite day in the nursing calendar. May 12th is Florence Nightingale’s birthday, and the day on which we celebrate the importance of nurses around the world. It’s a day to celebrate our achievements, give each other a pat on the back and reflect on our proud history/herstory and look forward to our future with hope and determination.

Thank you for your work, thank you for your tenacity, thank you for your care, thank you for your grit and determination. Together we can change the world.

The theme for International Nurses Day this year is ‘Nurses: A Force for Change: Care Effective, Cost Effective’. The theme could not be more timely. The Government’s 2015 Budget is on the 21st of May and NZNO members around the country are considering whether to accept the DHBs’ collective agreement offer or not.

Countries around the world are facing similarly constrained health budgets following the global financial crisis, at the same time as rising healthcare needs with aging and increasingly sick populations. This has resulted in both a global shortage of nurses, and at the same time, higher nurse unemployment.

While it is nice to know that some of the problems seen in New Zealand are not unique, International Council of Nurses (ICN) research shows that when nurses are supported to work creatively, innovatively and to their limits of their scope – there are economic benefits.

The ICN says “Evidence shows that nursing is a cost effective yet often undervalued and underutilised health care resource”.

We know you work incredibly hard every day, and the advice from ICN is that the general public and policy makers need to see the impact of nursing work so that it is in the forefront of their minds. This year they call for nurses’ engagement in policy setting and transforming healthcare systems to be safer, more efficient and more effective in ways that only nurses can see.

We’re taking up their advice too, which is why we are very excited to announce the launch of our new website sharing nurses and their patient’s own stories about how nursing makes the difference in healthcare. You can add your story to the collection right now at nurses.org.nz.

I hope you enjoy reading each other’s inspiring stories, as we make a difference in healthcare together.

Yours in nursing solidarity

Memo Musa
Chief executive
New Zealand Nurses Organisation


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International Day of the Midwife

Film-Colour-1Midwife and NZNO delegate Joanna Ramsay talks about her career as a midwife.

I feel so blessed to be a midwife in our primary unit, within our local community, where I work with kind and competent colleagues, awesomely brave and knowledgeable lead maternity carers, and the treasured women, babies and families of Kāpiti.

We are a small unit that packs a lot of punch! A bastion of midwifery and woman-centered care!

I feel honoured to work in a profession and workplace that enables me to participate in that most miraculous of times; birth. To share in that most intimate and beautiful occasion, to witness the opening up, the joy and pain, and the process of recovery.

I understand what it is to be with women; midwives and clients alike. To give my love in that work, assisting as I can; a kind word, a helpful insight, an experienced pair of hands, a pot of tea, kindness and encouragement.

I am proud out unit has a 98 percent breastfeeding rate for many years, and proudly, our fourth Baby-Friendly Hospital Initiative recertification in 2014. Being involved in supporting breastfeeding, which I consider to be the most important health measure in the world, is a gift.

To women I say; “You are giving your baby the gift of health, having given them the gift of life! Your milk is liquid love! And generational health!”

It is my gift to see the women feeding competently, staring lovingly at their newborn; those amazing little creatures at the cutting edge of energy.

There have been many midwives who have helped to grow our unit into the positive and well-functioning place that it is. A generative, inclusive and growing entity that seeks to develop and improve its processes and effectiveness in an on-going way. One of the beauties of our unit is our communications with each other and our relationships, with each other and with our clients and their whānau.

What a place – midwife, women and family friendly! I am so proud to belong here. It is joyous and satisfying. It is challenging and heartbreaking. But always, it is overwhelmingly wonderful work. I am honoured to be of this womanly line.

Joanna Ramsay RCN RM

 


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An ordeal with the flu

Kate and Sam Pohe

Sam Pohe (on the right) with her sister, Kate.

Community clinic nurse Sam Pohe’s job was to endorse the flu vaccine to her high-risk patients but, as she lay in a coma at death’s door, her body riddled with complications deriving from influenza, it became obvious she’d forgotten to get one herself. She shares her ordeal with Jodi Fraser.

The Whangarei 45-year-old was usually one to practise what she preached but, last year, got so busy vaccinating her patients, she forgot to get immunised herself.

Sam recalls leaving work early one day in August, thinking she had a cold.

“I was just feeling rather poorly. I left work early and went home to bed. I think I slept for three days. On the third day I woke for some reason, went to the bathroom, as I knew something wasn’t right, and I was blue.

“I text my friend to say ‘Why am I a blue colour?’ I called the ambulance and was taken to hospital ED. My oxygen sats (oxygen-saturated) were about 70 per cent and dropping.”

She was admitted to ICU soon after and placed on a bipap machine to help her breathe.

“I was struggling to breathe for six or seven days – it was terrifying. I never want to experience that again.”

A day later Sam’s doctor told her ‘We have to talk’.

“I remember looking at him and saying: ‘This is it? I’m going to die? … I need to make a few calls.’

That was Sam’s last lucid memory for the next three and a half weeks as she sank into a coma with multi organ failure.

While her beloved dogs pined for their mistress at home, her family and friends rallied round her bedside where she had been flown to Auckland, with her best friend flying over from Australia.

Sister Kate says she was shocked when she saw the state of her close sibling.

“There were tubes and wires everywhere. Just seeing Sam like that – it was awful. It was the worst experience of my life but Sam is stubborn and strong-minded and I never had any doubt that we would lose her.

“We had a family meeting and, despite being told we shouldn’t get our hopes up, looked into all the options.

“A lot of research doctors came in and I just signed her up for everything.”

While doctors considered placing Sam on the ECMO (heart and lung) machine, Kate spent the long tough days giving her sister foot and head massages, singing and reading to her.

“We all handled it differently – our nephew, who is usually really tough, just sat in the corner sobbing his little heart out. I’d wake in the middle of the night and hear dad crying which would set me off.”

While her family fretted and grieved, Sam was off in India having crazy exploits which still give her nightmares today.

“I remember having many vivid dreams while in the coma. I think I was in India with random people and we were at this place praying for forgiveness. I was paying penance I think, but I’m not sure what for. Another time I was in a bus and the oxygen was running out – I kept reaching for the handle to get out but I couldn’t move my arms. It was horrific. Other things happened but I won’t talk about them – they are too freaky.

“After I came out of the coma, a spiritual friend of mine asked me who Renee was. That is my aunt who’s passed so I believe I met with her.”

As Sam came out of her coma she remembers everyone peering down at her.

“I don’t remember what my thoughts were but my nephew told me the first thing I said was **** off to the nurses. I was shocked. I was terrified, frustrated, hallucinating. I could not walk or talk. I had a tracheostomy in situ. I was literally a dead weight. I couldn’t even lift my arms they felt so heavy. My hair was a mess, I hated being turned and my bottom wiped, I was on dialysis, I had double pneumonia, H1N1, influenza A – you name it, I had it all. I was one sick puppy.

“My emotions were all over the place and I heard I was a bit of a struggle for the nurses but I felt hopeless, useless and trapped against my own will. I just wanted to get out of bed and walk home. I said to my brother, ‘Just back the car up and I’ll pull all these lines out’ and I was trying to do just that.”

Despite the odds, Sam made a miraculous recovery and, cited a ‘medical mystery’, was finally told she could go home seven weeks later.

“I would have run if I could. “My dogs were so happy to see me, they were doing somersaults.”

Since then, she has pushed her limits every day, despite a damaged lung capacity which causes shortness of breath – the only long-lasting physical effect.

After four month’s rehabilitation, Sam has returned to work, albeit in a different less stressful job and says she absolutely advises her patients to get the flu vaccine.

“Sometimes they say to me, ‘But it’s just a little chest infection’ and I say, ‘Yeah? I had a little chest infection and it nearly killed me’.”

And there is no way Sam will get too busy to have the vaccine herself.

“Life is different now. I live like never before. I don’t feel as stressed anymore and I’m happy to be alive.”

Nine months later Sam still gets emotional while recalling her experience.

“When I was in hospital and I’d see the helicopter come in, I’d just cry because they are awesome, just awesome,” she says, tearing up. “I’m into raising money for the helicopter now – they are so good.”

A pioneer in setting up rural health clinics for vaccination, Sam is a strong advocate for making sure that health services are accessible for Northlanders.

“We used to find out which children hadn’t been vaccinated and go out and search for them.  It would be like, down this dirt road, hang a right, down a gully to find the brown house.

“I knew the people from a whanau perspective and they trusted me. Very often they didn’t have a car so they welcomed us to go to them and vaccinate their children. I will never forget sitting in a paddock with sea views, surrounded by babies playing in the dirt, while we watched them for 20 minutes after they had had their vaccinations.”

Her advice to others, having come so close to death?

“Make sure you get your flu vaccination because life is for living – oh and don’t sweat the small stuff.”