Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Many of us feel we are caught between a rock and a hard place right now for different reasons. While the saying has different shades of meaning, I am aware of the frustrations of many of our members who want to act in the right way but are being forced, by circumstances created by others, to decide between two negative scenarios that potentially can prevent them from acting in accordance with their principles and values. The phrase is used as a heartfelt expression of real concern and frustration.  Bailey Zimmerman sang….

Between a rock and a hard place.
Is this where it mends or it breaks?
How much more can we take?”

A recent leaked communication from Te Whatu Ora regarding managing its 2023/34 budget put Clinical Nurse Managers (CNMs) and Associate CNMs between a rock and hard place. They were directed to “address personnel related costs…given that they have room to do this given the significant progress made on workforce shortages, such as filling nurse vacancies”.

The missive directed to have more nurses off the floor on annual leave, a ban on double shifts, not sick leave cover (except night shift and subject to CCDM). No context was provided in the letter i.e. how many nurses had left, how many work areas were still understaffed, how many areas still (after 20 years) don’t have CCDM, how many shifts under target there are, and how many vacancies could be removed if unfilled. Do CNMs decide to comply or push back? How do our senior nurses do that in a way that keeps their patients and staff, let alone themselves, safe? The pressures are huge, and relatively thankless when the senior nurses are still struggling to get pay equity relativity.

Just as recently, a historic rally of internationally qualified nurses (IQNs) was held in Palmerston North where nurse representatives asked for help to get jobs for the many nurses who have come from their homelands to work in Aotearoa, on the understanding that there are thousands of job vacancies. The issues are multiple from coming in on visitor visas instead of work visas, CAP courses that may not uphold the Nursing Council standards required for registration, not being able to get a job once registered, and having to live hand to mouth with little income and relying on the support of their communities. They cannot return home as they don’t have the funds to do so. The Government, Nursing Council, and employers must work together to help these nurses and do right by them.

RNs going to work in every sector are being forced to decide who gets care and who doesn’t. This is an everyday ethical dilemma. Those who make workforce decisions based on budget rather than quality and safety are responsible if harm comes to a patient when there are not enough nurses to do the job in a timely manner that meets the professional, ethical, legislative, and cultural standards of practice that guides their practice.

NZNO members have a choice. We can decide between a rock and hard place to try and make things work, or we can say no! Decisions made by others about us, without us are not ours to own. The responsibility of decisions that impact on quality and safety in health care lands back on their doorstep.

We don’t have to accept being between a rock and hard place. Our wins in court over contract breaches and the right to strike when all else has failed to address unsafe staffing and work conditions demonstrate our recourse options. We can also mindfully commit to stand up and join our colleagues on the picket lines, join the campaign for nurse-to-patient ratios in every sector throughout the health system, and report staff and safety concerns consistently until our voice is heard. It was great to see so many of you unite at rallies across the country at yesterday’s Day of Action. Be part of the change we want to see. Get involved. Kia kaha.

Maranga mai!