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We have done too much not to do more

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

I was fortunate enough to have caught up with a couple of nursing whānau and my kuia recently.  Dedicated to her work, the kuia has reduced her hours now, after all she is 79 years young.

As we sat down to for a chat, her concerns for the future were marked not only with the words she spoke but the tiredness in her eyes and anguish on her face. Nan has been an advocate and at the centre of many political actions in her times, including being the mediator between the whānau and hospital with our now infamous Hawke’s Bay child uplift case.

Her mokopuna who live with her are “an absolute joy” and, together with work they keep her going. But her fears for the future, especially herald a warning that poverty, social challenges and complexities are complicating health. We need to think differently to respond to the changing health demands, she cautioned.

Nan has walked through many changes to the health sector, but this time it’s different – her concerns are for the mokopuna and their future.

She is not alone in her views. The media is speculating a difficult year ahead, and there is no doubt that the unrelenting social, economic and political pressures are making it difficult to find the rainbow or look for the silver lining as the unpredictability of our economic future hangs in the balance.

This gave me more cause to reflect on my responsibilities as a mother, grandmother and worker, and our contributions as the largest female dominated union and professional organisation in Aotearoa to her story and what must be different as we approach the year ahead.

Our organisation has held the view of political neutrality and in the past, we have gone to great lengths to ensure nonpartisanism. Our history, including the New Zealand Trained Nurses Association, New Zealand Nurses Association (NZNA) and our organisation as we are known today NZNO Toputanga Tapuhi Kaitiaki o Aotearoa. Professional, social, economic and industrial interests of nurses are the common purpose across our evolution, but our history highlights our struggles between industrial and professional identity within a female dominated workforce and our strength and political awareness.

We have a rich history of active protection, but perhaps one of our most defining moments was in 1973, when Margaret Bazley (who would go on to be the first female State Services Commissioner and receive the Order of New Zealand) declared that “the days of exploitation are over… If our tradition of serving patients is to be maintained, then the welfare of our nurses must be put first and foremost by the association”. By 1986 nurses’ protests over conditions and wages – the greatest distress cry of nursing in this country – caused the association a few years later to give strike notice as part of a successful “Nurses are worth more” campaign.

However, it would take almost 30 years before the country would see further strike action of that size, but it came frustratingly after almost 10 years of government underfunding of DHBs for us to act.

This year we have had further strikes and issued more provisional improvement notices than ever before. Each one, regardless of size, builds on the collective voice of the last and sends the consistent message. While we have been successful over several areas, claims in the Waitangi Tribunal, Pay Equity although still to be resolved we have stood resolute in our challenge: Pay Parity, expansion to include fast track to residency, inclusion on the workforce taskforce and expanding role of enrolled nurses. We have not won the war for every nurse everywhere; we still have work to do.

Whatever our position is next year, there is no doubt that we must ensure health is one of the election priorities. We must be effective in raising and using our collective power, raising our political voice and making our presence felt.

“He tawhiti kē to tātou haerenga ki te kore e haere tonu, he tino nui rawa ta tātou mahi ki te kore e mahi tonu – We have come too far not to go further, we have done too much not to do more”. Sir James Henare

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Feeling the fear and doing it anyway

Anne Daniels, President
NZNO, Tōpūtanga Tapuhi Kaitiaki o Aotearoa

“Nothing is too difficult to achieve. Only (fear) and apathy can defeat us.” – Sonja Davies.

Fear and apathy are the biggest threats to the health of our nation and our (regulated and unregulated) nurses’ ability to provide safe care through eliminating nursing shortages.

History shows we cannot rely on a government of employers to do right by us. Accountability to the public and professional health and safety through nurse/patient ratio regulation is a no brainer. We are the UNION. It is up to us, every NZNO member, to make this happen.

Fear is holding us back. Gender norms have contributed to a culture of deference to authority, self-depreciation, and overt oppression – strategies that devalue us, erode our self-esteem and belief in ourselves. Many of our members are afraid of losing their jobs if they get involved in political action or speak out. However, if you saw something happening that was causing your patient to be harmed, would you stand by and let it happen? I don’t think so. But when it comes to us, and the health and wellbeing of our nation, most of us are silent and inactive.

Very recently it was noted that some Te Whatu Ora nurse job descriptions had a new addition. And I quote: “Resilience/Flexibility”.

“This articulates differing perspectives on a problem and will see the merit of alternative points of view. It will change or modify own opinions and will utilise alternative strategies when necessary. This adjusts behaviour to the demands of the work environment to remain productive through periods of transition, ambiguity, uncertainty and stress.”

This requirement for new employees risks being in conflict with our human rights, the Health Practitioners Assurance Act, the Health and Safety at Work Act and the Nursing Council competency standards of practice. We are required to speak out and act when unsafe practice environments put our patients and ourselves at risk. Every one of us must get involved in our strategic Maranga Mai! campaign to eliminate this kind of overt oppression.

What must WE do about it.

  1. Turn our fears into value-based opportunities. What do you care about enough to stand up and act?
  2. Problem solve – we do that all day long at work. Name and reframe the problem. Work with your colleagues to find and implement a solution. Evaluate and engage in a continuous cycle of improvement to increase effectiveness. Be open to change. Think MARANGA MAI! strategy. Act collectively/inclusively, in different ways, starting with te Tiriti o Waitangi.
  3. How? Empowerment through education to prepare ourselves, and our future nurses, with the skills they need to make change happen: leadership, political, advocacy, activism. NZNO staff can and will support our members to become activists through our delegate, regional council, health and safety, college and section infrastructure, etc.

Get involved. Be part of the solution not the problem. The time is NOW!

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Power, politics, and money

Kerri Nuku, Kaiwhakahaere,
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

It’s difficult to know where to start when writing this blog because there is just so much happening keeping us on the edge of our seats. Internationally we have held our breath as we have watched political tensions escalate over land, power and possessions amid the backdrop of the increasing humanitarian crises and increasing numbers of refugees and displaced communities due to war, famine, natural disasters and climate change.

Back home, the increasing cost of living, exorbitant rent prices, increasing rates and mortgage inflationary costs for those lucky enough to afford the deposit for a house, adds to our burden of economic hardship. The problem with this hardship is that these features are increasingly common among us working class folk. For many of my friends and whanau, what once may have been left over from their salary or wages once all the bills are paid is no longer there. “It’s hard to stretch the purse strings any more …that broke long ago.”

As the political tensions start to warm up towards the next elections, power, politics, and money and their order of arrangement will be what makes the difference for many of us. There are already clear signs that Māori will again become political fodder, through divisive action intent on winning votes at the cost of commitment to Te Tiriti o Waitangi. 

Without even trying to address the obvious issues in the health sector let alone the issues for nurses and all health care workers and all working-class people, I can’t help but wonder what the future for the nursing profession will look like. 

Over the years and as early as the 1889 women have been calling for better pay and working conditions. We have well documented evidence of the ignorance and inaction of governments over the centuries to take affirmative action to do anything meaningful and sustainable to ensure working conditions and pay for nurses and health care workers.

Our Pay Equity celebrations earlier this year have been short-lived as we find ourselves in Employment Court seeking a determination and direction. Again, we are reminded that we don’t hold power. While Pay Equity may have been an attempt to address gender discrimination, it has not gone far enough to change attitudes, behaviour and practice. As a predominantly female workforce we still have some way to go to make sustained change. Mindful of course that these rates are not available to nurses outside of Te Whatu Ora services.

COVID-19 exposed an already fragile health system, eroded by successive governments lack of investment in terms of facility appropriateness, models of care, human resources for health, working conditions and responsiveness to the community in which we serve. These cracks were laid bare due to the sheer size, scale and speed of the pandemic on our system health system which could not withstand the sustained impact. 

We continue to raise the relenting issues of working conditions and pay, especially in response to the “impact of COVID”, however now given the nursing workforce shortage nationally and internationally we will need to consider the development of our workforce. At the latest Manatu Hauora Hui, the gathering of health care workers, was an initial discuss to collectively look at work a future workforce may look like, an opportunity to start for redesigning considering newly established Te Whatu Ora and Te Aka Whai Ora and stand up of the Iwi Māori Partnership Boards. It looks to advance opportunities for healthcare workers, Kaimahi and Kai awhina workforce, potential changes to learning opportunities and credentialing, nursing council is currently working on changes to the Enrolled Nurses Scope and design, but until these groups are involved in any consultation of about them – we will continue to be done too.

I hear constantly our workforce is tired, burnt-out, frustrated and angry, but what we do together will determine what happens tomorrow.