By NZNO President Heather Symes

NZNO has both a President and a Kaiwhakahaere as governance co-leaders. Among other things we chair the Board, and act as its public face and spokespersons when required. As Board members we have oversight of the organisation and its member groups, but we do not involve ourselves in the day-to-day running of the organisation (e.g. advocacy, the MECAs, Pay Equity etc). This work is done by staff and is managed by the Chief Executive.

So why are both a President and Kaiwhakahaere necessary?

Essentially we have these two offices working co-operatively as part of NZNO’s commitment to becoming a bi-cultural organisation and to working under te Tiriti o Waitangi.

It is important we acknowledge and work within te Tiriti so we can address appropriate cultural lenses to our organisation and its activities.  As a nation we cannot expect to move forward in unison unless each te Tiriti partner is aware of and respects the other’s worldview and approaches. We try to operate under te Tiriti in the same way as an organisation.

The Kaiwhakahaere is also the leader of Te Rūnanga (the Māori arm of the organisation) and supports Māori members by representing Te Rūnanga’s views to the Board. The Kaiwhakahaere also advises the organisation on what is culturally appropriate from an indigenous perspective.

The NZNO President has to this point never been indigenous, and brings a different (usually more western) cultural worldview. This means that together we have a rich tapestry and wealth of knowledge. But we are both equally accountable to members and work together to ensure plans going forward are good for members and therefore good for all in Aotearoa New Zealand.

Both positions are democratically elected, but there is a difference in how this is done for each. The President is elected by all paying members and can serve a maximum of two three-year terms. The Kaiwhakahaere is elected by Te Rūnanga at Hui ā tau every three years, but may serve more than two consecutive terms.

This is part and parcel of the bi-cultural approach we work towards under te Tiriti and an acknowledgement that different cultures may approach things like leadership differently.

It is entirely appropriate that the Kaiwhakahaere is elected only by Māori members but it is also important to note that his or her power is not unlimited. The Kaiwhakahaere’s performance is examined at each Hui ā Tau and they must be endorsed on a yearly basis to remain in the position. The President faces no such requirement. 

I hope that makes the co-leadership roles of the Kaiwhakahaere and President a little clearer.

by NZNO Kaiwhakahaere Kerri Nuku and President Grant Brookes

The World Health Organization has designated 2020 as the Year of the Nurse and the Midwife. NZNO will be joining in to celebrate the contributions nurses and midwives make and to envision the even greater contributions we can make in the future.

As we reflect on the mahi of nurses and midwives, we take inspiration from the whakataukī: “Titiro whakamuri kōkiri whakamua – Look back and reflect so you can move forward.” In so doing we honour our ancestors and learn from past mistakes.

2020 also marks the 200th anniversary of the birth of Florence Nightingale. Florence is a hugely important figure in the development of our profession, but she left behind a mixed legacy.

Nurses, midwives and tohunga have been serving their communities and practising healing in Aotearoa for centuries; from long before when Florence was advising Colonial authorities in Aotearoa New Zealand about how to prevent the “inherent diseases” of the “savages” from leading to their extinction, as they were brought out of “barbarism” through “the inestimable blessings of Christian civilisation”.

In fact much of our nursing history has been marred by these sorts of conservative and racist views, some of which persist today.

Returning to the whakataukī with which we opened, here are just some of the notable figures and events in our history we can look back on:

• In 1901, thanks to the pioneering efforts of Grace Neill, Aotearoa New Zealand became the first country in the world to pass legislation recognising the qualifications and status of registered nurses. Recognition of registered midwives came three years later.
• In 1902 Ellen Dougherty of Palmerston North became the world’s first registered nurse.
• Akenehi Hei became the first Māori nurse and midwife to register under her own [Māori] name six years later in 1908. However, Māori trained nurses were providing care even before official registration began, following in the footsteps of Mereana Tangata (Mary Ann Leonard) who qualified in 1896.
• Founded in 1908, Kai Tiaki Nursing New Zealand is one of the world’s longest running nursing publications. Last year, Kai Tiaki became one of just 20 publications so far inducted into the Nursing Journal Hall of Fame at a ceremony in Reno, USA.
• Turning 111 years old this year, the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa is proud to be one of the world’s first professional nursing associations.

Our indigenous and home-grown nurses and midwives have made an immeasurable contribution throughout the 20^th and 21^st centuries towards raising the health of all peoples in Aotearoa New Zealand. They’re now being joined by our internationally qualified nurses, too.

However, our health system today is under strain. Distressing health inequities persist and nurse and midwife shortages are predicted to grow. Historically our work has been undervalued because we are a female dominated profession. Thankfully an end is finally in sight, with the first Pay Equity settlements due this year. Entrenched pay disparities for those in Māori-led health care providers could also be closed at last, thanks to years of campaigning and a landmark claim lodged with the Waitangi Tribunal by Te Rūnanga o Aotearoa NZNO.

Nurses and midwives need to be properly deployed, valued and included in policy and decision-making. By the end of 2020, we hope to achieve greater investment in improving education, professional development, standards, regulation and employment conditions for nurses and midwives. Our goal is greater influence for nurses and midwives on health policy, more nurses and midwives in leadership positions, and more opportunities for development at all levels.

The needs of the 21st century also require innovative services that make better use of new technology. We need more community and marae-based services that are holistic and people-centred, as well as an increased focus on prevention and on undoing the harm caused by colonisation. These are all areas where we can play a leading role.

Finally, it is our hope that by the end of 2020, NZNO’s Strategy for Nursing 2018-2023 will be accepted across the health sector. This would signal a stronger commitment to a safer and more equitable future for all nurses and midwives in Aotearoa New Zealand.

“Me haere tahi tātou mō te hauora me te oranga o ngā iwi katoa o Aotearoa”, “Let us journey together for the health and wellbeing of the people of Aotearoa” (Rev Leo Te Kira 15 December 2005).

17 September 2019

Tēnā koutou, Tēnā koutou, Tēnā koutou katoa.
It is my pleasure to welcome you all here to NZNO’s 26th AGM and to the Conference tomorrow.

I would like to acknowledge the outgoing Board, the incoming Board, Te Poari and the Membership Committee. I would like to thank our exhibitors and sponsors for both the AGM today and Conference tomorrow, and especially our sponsors Summerset and Pharmac.

The theme of tomorrow’s Conference is “Leaving No One Behind – Health For All” and I want to talk about the past financial year in light of that theme which captures the very reason we exist as an organisation.

We are here to support nurses, midwives, student nurses and health care workers as they work daily to ensure “no one is left behind”.

Nurses are there for us from the day we are born to the day we die, and on many occasions in between. They provide expert but compassionate care, often under trying circumstances. They are trained, knowledgeable and skilled, and they positively affect the health and wellbeing of us all.

The theme of our AGM and Conference is an appropriate one as it relates to the first pillar of our Strategic Plan which is improved health outcomes.  We want a sustainable, strong and skilled nursing workforce (the second and third pillars) so all people living in New Zealand can be healthier, and no one is left behind.

On top of what we achieve for members by supporting them in their nursing professional practice and negotiating collective agreements, there is the collaboration we engage in with the Ministry of Health, employers and other partners to improve working conditions and achieve pay equity.

As well as the industrial and professional support we give members daily, there is the research and advocacy work we do to improve policy around nursing both here and internationally in collaboration with other organisations.

A lot of what we do is highlighted in the Annual Report for the year 2018/19 and in my CE report within it. In what has been a challenging year, it is timely to focus on the positive. Alongside our members, we are doing many good things for the health and wellbeing of New Zealanders so no one is left behind.

I would be remiss not to mention our membership growth and finances. At the end of March this year our membership numbers reached 52,093 – an increase of 2.7 percent from the previous year; and we are currently at 51,339 members.

We ended the year with a net financial surplus of $153,288.  The gains from the investment portfolio increased that to $996,164.

I would like to conclude by reminding us, as I have done before, that 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 have a massive influence. Together we make an effective team.

I would like to place on record my sincere appreciation the work our staff have done on your behalf.  I also thank you as delegates for the many volunteer hours you have put into NZNO’s work.

No reira, Tēnā koutou, Tēnā koutou, Tēnā koutou katoa.

Memo Musa, NZNO Chief Executive

Memo Musa, Chief Executive, NZNO

As many will know, the Government announced a review of the New Zealand Health and Disability System in September 2018. The purpose of the review was to identify opportunities to improve the performance, structure, and sustainability of our current Health and Disability System. Its goals are achieving equity of outcomes, and contributing to wellness for all – particularly Māori and Pasifika.

The first interim report by the Expert Review Panel (led by Heather Simpson, a special advisor in the Prime Minister’s Office) was released in early September 2019. In response NZNO met with Heather Simpson, Sarah Prentice and Margaret Southwick (a Panel member) in early October 2019 to present our work and suggestions around the report’s three key themes of Leadership, System Complexity and Equity. The presentation was prepared by Eldred Gilbert (Visibility of Nursing Project Lead), Hilary Graham-Smith (Associate Professional Services Manager) and myself, with input from Kaiwhakahaere Kerri Nuku and President Grant Brookes. The presentation was led by Hilary.

We agreed that the current Health and Disability System is not serving people living in Aotearoa New Zealand well. We discussed the utility of nursing as key to making a difference to the issues of equity and access for under-served individuals, families and communities. After all, nurses are well-versed and experienced in population health. They understand: wellness, health promotion and illness prevention; their framework for care is holistic; and they are experts in system and boundary navigation. Nurses also have a common agenda – to work in partnership in an integrated system that best serves the needs of people.

Unfortunately, the current system makes it impossible for nursing leadership to be freed up and maximised in policy and services design/delivery at a Tier 1/Primary Care level. Funding, contractual and employment arrangements constrict the way nurses practise, and impede them from working in the way they could to reduce system complexity.

It is important the Panel considers establishing a ‘peak body’ of nurses to help in co-design processes for nursing that allow for integration of services, and to develop a model of care whereby nurses can fully contribute to the health and social care needs of the population by utilising all of their skills – and this is what we have recommended. With abundant knowledge, skill and adaptability, nurses have the opportunity to offer alternative and innovative approaches to delivering health services that can make the real difference required.

Such a nursing renaissance falls well within the scope of the NZNO Strategic Plan 2015-2020. The first pillar of our Strategic Plan is to improve health outcomes by promoting excellence in patient care. The third is having a strong workforce by strengthening nursing and workforce planning, sustainability and leadership.

There remains much work to do in further developing our thinking and we will keep you updated on progress. We are pleased that members of the Review Panel are listening and that the Panel has the skills and knowledge to appreciate our suggestions.

I would like finish by thanking Eldred Gilbert and Hilary Graham-Smith for their ongoing work on this project, and Kerri and Grant for their input and support.

On Thursday 3rd May midwives from Aotearoa took to the streets in a National Day of Action. Why? Like nurses, midwives are fed up with the chronic under-funding of the maternity system. Despite having launched a Pay Equity claim with the high court in 2015 midwives have largely been ignored. In the spirit of good faith the claim was taken out of court and into mediation where a new funding model (co-designed by the College of Midwives and the MoH) was agreed on. But it is waiting to be given the green light because it will involve a significant increase in funding.

Thursday saw the culmination of a two-month long campaign to raise awareness of the issues for midwives, particularly the Lead Maternity Carers (LMCs). Charlie Ferris, an LMC from Southland started the “Dear David” campaign after being told by her accountant that her business was just not sustainable. A breakdown of costs revealed that despite working up to 80hrs a week, Charlie was earning just $7.45/hr. And she isn’t alone. One analysis of LMC work has put the average hourly rate for an urban midwife at $12.80 and $7.23 for rural practice – that’s less that half the minimum wage!

After marching through the streets of Wellington we arrived at Parliament grounds where a petition with over 13,000 signatures was presented to the Minister of Health, David Clark. We heard from a line-up of speakers including Associate Minister of Health and Minister for Women, Julie-Ann Genter. A bound book of Facebook posts was also presented, and we were assured that our impassioned pleas had “been heard”.

In New Zealand there are two arms of the midwifery workforce, the LMCs and the DHB employed ‘core’ midwives. We have a symbiotic relationship and when one arm is under stress the other arm is called upon to carry the extra load. LMCs are on-call 24/7, have no sick pay or annual leave and their travel is not billable. Effectively it’s like being a contractor but without any ability to adjust your fees. Core midwives are paid under the DHB MECA and are represented by either NZNO or MERAS. It is my opinion that the lack of industrial voice for LMCs has resulted in the situation we have now where pay and conditions have become untenable. LMCs are leaving the profession in droves and our world-class maternity system is in crisis.

There is important mahi to be done in the DHB space as well. Midwives are specialists in maternity care and undertake a four-year degree programme. Despite functioning as autonomous practitioners who have the legal authority to prescribe, diagnose and discharge we are not remunerated as such and so feel very under-valued! I am hopeful that the pay equity process which forms a key component of our NZNO MECA claim will address these disparities.

As for funding the new co-design model, well that depends on how much gets dished out in what feels like the very long-awaited budget.

This International Midwives Day will go down in history as the year we midwives stood together, LMC and core, united and impassioned in our love for our work and our belief in delivering a quality service for the people of Aotearoa.

In solidarity
Sarah Gilbertson (Midwife, NZNO delegate)

Lyn Shirley is a Registered Nurse who works in aged care. She is also a Shout Out member leader and delegate for NZNO. Lyn’s involvement in Shout Out for Health led her to speak to M.P.s about how health under-funding is affecting the aged care sector. A public meeting in Nelson held by two political parties was the perfect opportunity for her share her nursing experience.

“I feel very strongly that the issues nurses and other staff face in aged care need to be better understood by politicians and the public. Both staff and residents are impacted by under-funding and short-staffing, as is the whole of the health sector. With an aging population, more families will have to experience these problems soon if we don’t better plan and fund services now.

Elderly people who have just entered an aged care setting are vulnerable. They are more often high needs or even in end of life care. Nurses and other staff need to spend time with them to reassure them about the journey they are going through, moving out of their own homes and away from their communities and the people they know. Sometimes they can be confused about what is happening with their health. This is why it’s really important there are enough staff who can explain to them clearly and calmly what we are doing for them. For this to happen in aged care we need more government funding. All MPs need to be aware of our situation. After all, they may well be in an aged care home one day too!

Way back in 2011 I was involved in the Caring Counts report on the aged care sector, and I didn’t know what had happened to the recommendations of that report. I suspected not a lot, given my experiences working in the sector.

When there was a public meeting in Nelson on aged care earlier this year, I was keen to go. Labour Deputy Leader at the time, Annette King and Green Party Co-leader Metiria Turei were speaking and answering questions from people at the meeting, as well as Rachel Boyack, the new Labour candidate for Nelson. The public comments at the meeting matched my own experiences as a nurse working in aged care – it really validates our clinical expertise on the need for safe staffing for our elderly. There were a couple of student nurses there too who spoke with passion and confidence about the issues facing our sector.

After the meeting I managed to speak directly to an MP about some of these continuing issues; the inadequate staffing levels, the increasing workload due to the residents being more unwell, and problems with the way people entering care are assessed.

I spoke about needing more time to carry out the social and clinical assessments and interventions that we have trained for, and that it was so important in our jobs not to be rushed. This is how to treat the patients with the dignity they deserve. I also described how as nurses we need to not be so overburdened with work that we barely have time to think. The paperwork required of registered nurse has become more demanding. On some days I could be on the computer for hours, taking valuable time away from caring for the residents. I became a nurse to deliver care, not just reports!

We need more nurses to work in aged care. I know a lot of nurses in aged care experience moral distress and burnout when they can’t act in their patient’s best interests because they are short on staff, equipment, and time. We are experts in our own jobs. Part of being the best advocates for our patients is making sure their issues, and ours, get through to decision makers.

I felt really good being able to share just a little of my experiences and hearing others do the same at this meeting. I encourage our other members to make an appointment with their MP too. It’s a simple way you can get your voice heard, and your local NZNO staff will support you.”

To take action on health funding, contact your local NZNO office to be put in touch with a member leader like Lyn, or plan your own MP visit with the help of your local staff. You can also sign the open letter on health funding by leaving a comment at the bottom of this blog post.