Last week NZNO held its AGM and conference. This year around 300 delegates and college and section members met at the Museum of New Zealand Te Papa Tongarewa to discuss and make decisions about our organisation, nursing and the wider health sector. We learned new skills, to celebrated our successes and took up the challenges that were laid down.

Our new elected leaders were welcomed and our our departing leaders were thanked for their mahi. One of the highlights of the AGM and conference were the wonderful speakers, from within NZNO, around the motu and throughout the world. 

Here is the address given by NZNO chief executive, Memo Musa on the morning of the first day. 

Tēnā koutou, tēnā koutou, tēnā koutou katoa

I am Memo Musa, Chief Executive of NZNO.

It gives me great pleasure to welcome you all to NZNO’s 22^nd Annual General Meeting. And to our exhibitors and sponsors who are here today and for conference tomorrow, welcome. I know that Marion and Kerri have welcomed you already but it is important that I do so too.

This is my second report to the AGM on NZNO’s performance during the past financial year.

I hope you have had the opportunity to read our Annual Report 2014/15 and reflect on our operational and financial performance as well as our achievements.

I would like to take a few minutes to take you through some of the key highlights of the year. Before I do so, I would like to comment briefly about the AGM today. You will have seen from the information you received that we have a total of seven remits and twelve policy remits. These should provide us today an opportunity to fine tune some aspects of the constitution as well as debate or discuss policy matters that are important to you and require our collective action as an organisation. I accept that it is a democratic process to amend aspects of the constitution. I would like to sound alarm bells that this can equally create a state of inertia as it makes it difficult to work within rules that are continually changing. That said, some improvement are required.

Back to key highlights from the past year:

We started the year with five priorities.

• To increase and maintain membership
• To increase the visibility of NZNO’s role as a professional association of nurses
• To promote nurses and the nursing profession
• To contribute to health sector workforce planning
• To improve organisational health

Strong operational management and transparent reporting are critical to the long term success and creation of value. This is why, with support from the Board, during the past two years we have completely revamped the Annual Report to give you more information, detailed highlights, successes and challenges. This provides us an opportunity to celebrate successes and face up to what we could have done better. Often we hear that we do not celebrate or showcase our successes enough.

Now the key highlights. I will only pick a few to illustrate key points.

Increase and maintain membership

The biggest challenge for any member organisation is maintaining membership, let alone increase it. Membership levels have a big impact on the viability and sustainability of NZNO.

The solid work you are doing, including the work by our organisers, industrial advisors, professional nurse advisors and other staff through our organising ethos, models and approaches, including our communication, has resulted in us maintaining our membership numbers at above 46,675 based on 2013/14 year with a very modest increase of 103 members to 46,778 members.

Our biggest growth was in the registered nurse members were we saw an increase of 918 members from the previous year totalling 35,275. This makes up 72 percent of practicing registered nurses. According to the Nursing Council there are 48,406 registered nurses practicing.

However we had challenges with student nurse membership which declined from 4,225 in 2011 to 2,700 by the end of March this year a drop of 36 percent. This a concern we must address.

Fellow colleagues, we cannot ‘rest on our laurels’ when it comes to membership, as during the past five years union membership in New Zealand has been in decline.

In 2010 there was a decline of 2.1 percent

2011 it fell by 1.3 percent

Then 1.4 percent in 2012

By 2013 it had fallen by 2.0 percent and at the end of March 2014 this had fallen by 1.8 percent. I am waiting for the 2015 figures to be published. My guess is that the same trend will continue.

Whilst overall we are doing better than some unions and professional associations we have room to improve.

Increasing NZNO’s role as a professional association

Promoting nurses and the nursing profession

At our AGM last year some of you may recall my report and reflections. I stated that advocacy and lobbying are at the core of what we do to advance the agenda for nursing teams both from an industrial and professional perspective. Being an election year, I observed that on one hand there is a sense that we are not visible, not adversarial or political enough, that we need to be out there and showing leadership on key issues, on the other hand some argue and lament that we are politically biased or in favour of a particular political leaning whilst others say we are negative and adversarial, whilst other say we are doing ok.

The profile of our role as a professional association, promoting nurses and the nursing profession is critical to our future existence at the same par as membership.

Demonstrating relevance and value add to patient outcomes, healthy families and communities should be the cornerstone or platform upon which we build our profile as an association and by promoting nurses and the nursing profession.

I am pleased to report that during the last year we continued to push forward our agenda to promote NZNO, nurses and the nursing profession by increasing our clarity of relevance and value add.

On Wednesday 28 August 2013 the main headlines in the Dominion Post read “Nurses ration patient care” “Families pitch in as staff stretched”. This article reported nursing shortages at Wairarapa and Hutt Valley hospitals stating that nurses are ‘rationing’ their care to patients. It referred to essential care being prioritised over patient ‘comfort’ or ‘non-essential’ tasks.

The following day Thursday 29 August 2013 the main headline read ”Rationed care cuts deep says patients” reporting that ‘care rationing in understaffed hospitals is affecting basic medical needs as well as comfort, patients say.”

There was the usual follow up discussion and debate in the media and between nurse leaders with attention being on nurses’ decisions and actions about patient care when faced with nursing shortages or the wrong skill mix.

What was missing in all the dialogue was the fact that in reality it was not nurses rationing care, it the public health system; the way it is funded resulting in not having enough nurses, inadequate time, and the right skill mix to provide complete care.

Our policy and research teams, with member input and consultation, developed a position statement on Care Rationing which was presented to all District Health Boards, the Ministry of Health and the Minister of Health. This helped change the dialogue and inform the debate on this very complex area which often is very emotive.

You will hear about this more this afternoon.

We also embarked on a project to increase the visibility of nurses of which the first phase establish a theme which is “Nurses – Making the Difference in Healthcare”. A website has been set up where nurses can share stories. You can access this through our website under the campaigns banner. The second phase involves identifying and training nurse champions. A third phase to promote and increase the visibility of nursing is yet to commence.

You will hear more about this in more detail this afternoon.

Another highlight is our work is with the Service and Food Workers Union Ngā Ringa Tota on the campaign for equal pay “All the way for equal pay”. The sterling legal defence work which saw the Court decline Terranova’s leave to appeal on and directing the Employment Court to establish equal pay principles to resolve the equal pay claim.

Again we will hear about this in more detail this afternoon.

One last key highlight under this section is the work we do to represent members, whether it be through Health and Disability Commissioner investigations, employment related matters, Professional Conduct Committee and Health Practitioner’s Tribunal hearings. Approximately 237 ‘events’ were taken up involving more than about 3000 members. We noticed an upward trend in the request for representation and the number of complaint against nurses which are being made to the Health and Disability Commissioner. We have also noticed an increase in the number of nurses that the Health and Disability Commissioner finds in breach of the Code of Health and Disability Services Consumer Rights. Last year we challenged the Commissioner by asserting that some of the breaches could be at the system level not the individual nurses’, and primarily caused by inadequate funding which leads to poor staffing levels impacting on patient care. We asked him what approach he intended to take to address some the breaches we considered to be at a system level. His response was that his concern was “primarily to assess the quality of health and disability services” and the system issues I had raised were better addressed by District Health and and/or the Ministry of Health’. This I found astounding.

Fellow colleagues, I will make no apologies for saying that if we fail to show relevance and to add value it will be to our detriment. Some antagonists might think what we do is ‘all about us’. Clearly that is not true. Promoting the profession of nursing and nursing standards is a key foundation to strive for recognising the mutual interdependency with our industrial focus and that getting the balance right is very critical.

Contribute to health sector workforce planning

I am going to tell you something you already know.

Nursing is the biggest workforce in the New Zealand public health and disability system. According to a report on health workforce released by the Ministry of Health and Health Workforce New Zealand in November last year, nursing makes up about 54 percent of the regulated health workforce in New Zealand, based on annual practicing data of all regulated professions. Internationally there are between 16 and 19 million nurses according to estimates by the International Council of Nurses.

We are the backbone of the public health and disability system. We nurses are everywhere, in patient’s homes, general practice, clinics, hospitals, prisons, community homes, residential care, education, research units, management and leadership, policy development and regulation.

After many years of advocating and lobbying for a national workforce plan for nursing, last year we were successful, together with other nurse leaders, in convincing Health Workforce New Zealand to set up a national nurse workforce programme. Whilst progress continues to be slow, a joint governance group and working group have been put into place. The areas agreed to be given priority attention are:

1. Improving the integrity of nursing workforce information and data
2. Graduate nurse employment
3. Nurse retention
4. Nursing workforce plan

This is a major step forward. However results are yet to be evident.

On the New Graduate Employment front the online petition urging the Minister of Health to fund a one year Nurse to Entry Practice Programme for every graduate nurse drew more than 8000 signatures in a week. Thank you to all who contributed to this petition. This resulted in two key achievements as steps in the right direction:

1. Additional funding of $2.8m per annum from this year was granted by the Minister of Health to fund an additional 200 places.

2. The eligibility period was increased from one year to two years.

This firmly remains on our horizon with a goal of 100 percent funded places by 2018.

We got behind, supported and were involved in the proposal by Auckland University for a funded nurse practitioner education programme linked to employment. It took a long time for this to work its way through the bureaucracy of Ministry of Health and Health Workforce New Zealand. Eventually funding was granted for a programme to commence in March 2016. Auckland and Massey universities will run this programme.

We supported the Nursing Council’s application for nurse prescribing. This is important as an enabler for us to work at the top of our scopes of practice; which in time will result in an increase to access to nurse-led services for vulnerable populations and those with long-term health conditions.

Working with the Fiona Unac, Chair of the Perioperative Nurses College we saw Auckland University endorse a new Certificate of Proficiency for Registered Nurse Assistant to the Anaesthetist.

The work by the Enrolled Nurses Section to develop a dedicated Supported Entry to Practice Programme was completed. Now the challenge that lies ahead is to advocate and lobby for this to be funded.

Lastly we successfully got onto the Governance Group for the Kaiāwhina Workforce Action Plan. This was in response to concerns raised by the Enrolled Nurses Section. We argued that the Kaiāwhina workforce is a continuum of the nursing team, and that it is important that the action plan be developed within that context. This will remain a challenge but we will continue to influence, advocate and lobby.

Workforce development is complex with multiple strands to which we need to be tuned into all the time. There is no ‘one size fits all’ and our messages on these areas going forward need to be targeted at getting results for you.

Improve organisational health

Improving organisational health is controversial and a challenging philosophical concept.

From a financial perspective we are making in-roads into recovering financial losses from the past. We ended the year with a positive financial result which David will present to you later. The Board has worked hard with me and the Management Team to tackle a few areas to manage costs.

We should always be mindful and keep an eye on our financial reserve and not to use them to support organisational operational structures. Alarm bells should ring if we head in that direction.

Our staff are key to the achievements and the highlights I have reported on and those in the annual report. I applaud their commitment and relentless effort, their willingness to go the extra mile to do what is right for members. In response to key pressures we supported our staff by putting more resources into the following areas;

1. Professional Nurse Advisors, an increase from 7.7 FTEs to 9.1 FTEs with a focus on Hamilton and Christchurch.
2. Industrial Advisor increase of 0.5 FTE
3. Finance Office 1.0 FTE

These organisational growth areas are in response to our commitment to get to member issues quickly.

Fellow colleagues from time to time you will hear all sorts from people about what is happening within the organisation.

I will stress to you that you need context and background to know what is going on and sometimes what you hear may not be correct and other times it may be. It pays to contact me directly on operational matters.

In conclusion,

My assessment is that NZNO has done well during the past year. Some of you may say not enough in some areas, and I acknowledge that.

We can never do enough!

Acknowledgements

I would like to place on record my sincere appreciation of the work you have done in the past year and will continue to do this year, the work done on your behalf by our staff and the support of the Board and Management Team.

I will mention again the point I made at last year’s AGM

“What we do comes with its own challenges and tensions but let us remember and work together as united we stand, divided we fall. We are one profession with many roles and voices, we are a collective and together we can continue to make a massive influence. Together we make an effective team.” Together we can be effective in shaping healthcare in New Zealand.

Lastly but not least I would to thank all our exhibitors and sponsors at this AGM and conference tomorrow.

I hope you enjoy the AGM and conference and that you get the best networking opportunities, so you can take away important ideas to innovate and to champion for changes in whatever health setting you work within.

No reira tēnā koutou, tēnā koutou, tēnā koutou, tēnā koutou katoa.