A message for politicians and NZNO members from Richard and Annie.

A couple of weeks ago, the Yes We Care tour arrived at Wellington Hospital on the most horrible day of the year. It was cold, it was wet, and the rain was falling sideways. Richard and Annie are two Shout Out member leaders who were determined to deliver a health funding message despite the weather. Here is why they did it.

Richard

Richard in the rain!

Quite honestly, standing outside in the cold and windy Wellington weather was minor compared to the challenges of working in an underfunded health system. Like many nurses, I believe everyone has the ‘right to health’ – that New Zealand has a fundamental duty to provide access to healthcare that people need. That’s what we try to achieve in our work.

But, the work of nurses is being undermined by living and working conditions that don’t enable good health outcomes for an increasing number of people. And when those people get sick and come to us for help, at the moment we are not able to provide every patient with the best quality care every time. Slowly, Kiwis’ ‘right to health’ has been taken away, until we have reached a point where my colleagues are experiencing moral distress in their work. They regularly tell me that they feel despair when they are faced with preventable situations they can’t fix with their clinical skills because of a lack of health resources.

That’s why it’s time to use our political skills as well as our clinical ones. As a nurse and NZNO delegate, what really mattered to me was showing up to this event to demonstrate we can overcome our despair.  We have a strategy to campaign based on hope, courage and collective action: hope for a healthier future and courage to stand up for what we aspire to achieve. We stand up for collective action, no matter how small it may seem at the time, to protect the right to health. Even in the rain!

My message to politicians is that underfunding of the health system is not about money, but is about the right thing to do for New Zealanders. Just like nurses do, each of you make choices about how much money to spend on different priorities. When you were elected, you took on responsibility for the health of the nation. We are telling you as clinicians that it’s time now to increase health funding. In fact it is overdue. When health needs aren’t met, they don’t just vanish, they get much worse, and our population is growing and ageing. Acting now is a moral imperative before the problem is even bigger.

My message to nurses is that I know what you are going through at work, because I experience it too. Sometimes it feels like you couldn’t possibly do anything more – but that’s why we need to shout out for our health now, so we can be the change we want to see.

Annie

Wellington NZNO staff, delegates, and NZNO President Grant Brookes at the Yes We Care tour action outside Wellington hospital. Annie is wearing the pink hat to the right of the picture.

My message for politicians is very simple. My colleagues and I just want to be able to do a job that gives the very best care for the people we look after. Part of that is having the right tools, safe staffing levels, and a reasonable workload. I want to be able to take my meal breaks, go home on time and not constantly revise and ration the care I am able to provide. This doesn’t seem like too much to ask, but at the moment this is not happening in our health system. Each and every nurse I know comes to work to give 100% on the job, despite the shortages. If you fund health properly, we can go back to having good work days where we go home satisfied with a job well done, and patients’ needs being met.

To my fellow NZNO nurses: As health professionals, it comes naturally to us to speak up for our patients. Every day we are our patients’ advocates. We want the best outcome for each and every one of them. So I’m not willing to stand by in silence and allow them to be disadvantaged by an underfunded health system. And I don’t think that you are willing to be silent either. If we don’t speak up for our patients, who will? That’s all that we are doing- extending our advocacy outside of the ward. Join me, because this year we have to do it together. We will win this, for us all.

The Yes We Care tour is coming to to Pukekohe tomorrow and moving north up the country until the end of March. For a full list of events that you can go to support, see www.facebook.com/pg/yeswecare.nz/events/ . We’d love to see you there.

A Shout out for health blog by NZNO delegate and member leader Rachelle Smith.

My name is Rachelle and I work in the Bay of Plenty. I am a Health Care Assistant on a ‘high acuity’ medical ward, where we also specialise in looking after the elderly. High acuity means that patients need lots of immediate care, unlike conditions you can manage over a longer term or outside the hospital. So it can be quite full on, but I love my job.

My satisfaction comes from impacting lives in a positive way, and providing quality care that meets my patients’ needs and helps them achieve their goals. We provide a holistic approach to care, where we encourage whānau to give us feedback and input. This supports both us and the well-being and safety of each patient.

I am passionate about engaging others on the effects of chronic underfunding of health care in New Zealand. I see this every day in my own work, but I’m still learning through our Shout out for health campaign how it affects every other part of our health system too. I’m part of this campaign because each of the patients and families we work with are worthy of our time, quality care, and our advocacy.

On reflection, I see our health system as a framework, a framework that supports our families and wider communities. When our framework is built on a foundation of underfunding, like building on sand, it becomes compromised and the whole long-term system that keeps our communities going starts to break down. This shows itself in big ways, like longer waiting lists, but the little ways are just as important too.  Simple things like an appropriate comfortable chair for our older patients now are a ‘luxury’ item. But a comfy chair can make all the difference for someone who is old and in pain. Facilities need to weigh up whether they can afford to purchase these things against all their other growing expenses. It’s not a simple case of providing what patients need straight away anymore. These decisions take more thought and time.

Healthcare staff and other organisations are doing their best to fix these little gaps in the framework. But if the Government dedicated more funds for health than it does at the moment we would have a stronger foundation to build on. We could provide ‘uncompromised’ care and ensure every New Zealander could achieve their own health goals. The Government needs to put a higher priority on the well-being of the whole population, especially when they are in need of a little extra help from healthcare services and staff.

I know that little things like comfy chairs for the elderly end up adding up to make a big difference to the quality of our lives. I want a strong health framework, not just for my patients, but to support the kind of country I want us to be for future generations.

This blog was originally published by New Zealand Doctor, and is kindly reblogged here with their permission. Thanks New Zealand Doctor for continuing to highlight nursing issues both here and overseas!

By Barbara Docherty

It’s not really in my nature but I feel a bit like the doomsday merchant at present.

As soon as I write about nursing in any form, a little flurry of emails arrives in my inbox often indicating unhappy nurses. This latest alert from the UK worryingly has shades of what nurses are articulating in different forms here in New Zealand, and about which I have written on previous occasions.

‘Skint, shaken and yet still caring’

This recent major survey in the UK with the intriguing title “Skint, shaken and yet still caring”, followed more than 2200 responses from nurses, midwives and healthcare assistants about financial hardship and deprivation, domestic abuse, health, illness, wellbeing and employment uncovering what has been referred to as “worrying facts”.

It identified that nurses are twice as unlikely as the general public to be unable to afford basic necessities such as beds, decent shoes, washing machines, keeping their homes warm or eating two meals a day.

They are three times more likely to suffer domestic abuse than the general public, 14 per cent of them victims of domestic abuse in the last year. This compares with a national average of 4.4 per cent.

Physical and mental illness

The report also found that two in five nurses, midwives and healthcare assistants have a long-term physical or mental illness that limits their day-to-day activity and is expected to last longer than a year.

The survey questions on domestic abuse matched those used in the 2012-13 crime survey for England and Wales carried out by that government’s official statistics body. They came out a week after a Sunday paper revealed 14 per cent of nurses have applied for payday loans, laying bare the hardship faced by NHS staff.

The United Kingdom’s Royal College of Nursing responded by saying it “painted a shocking picture of the hardships” faced by some nurses and midwives. The nursing support charity Cavell Nurses’ Trust which commissioned the research, has branded the findings as “appalling”.

Foolish to dismiss survey results

There are no suitable words to describe the significance of these findings. Some might say it is a relatively small sample in a country the size of the UK.

It will likely be dismissed by others in New Zealand as nothing much to do with us. But closing our minds to the strong possibility that this likely mirrors what some nurses are experiencing in New Zealand is tantamount to foolishness.

I find it disturbing. It’s another reminder that, when I blogged some months ago in New Zealand Doctor about nurses here admitting to taking anti-anxiety or antidepressant medication, some attempting suicide or experiencing suicidal thoughts, it hit a strong chord because nurses were speaking their realities.

One dissenter

Yet a week after that blog was published, I received an email (from whom I still don’t know) asking me to back off, to stop raising the issue because it was stirring fear when only a handful of nurses would be affected anyway.

The United Kingdom study has not been replicated here to my knowledge so we don’t have specific NZ data. But nurses throughout the world are coping with strained health services and this report highlights the reality of a nurse’s working life and the impact on home life or vice versa.

It once again shows that nurses keep going in spite of often physical and mental health issues that can be damaging in the short or long term to both themselves and their patients. Canada and the United States have also identified many similar issues with their nurses and we ignore all these findings at our peril.

I have been receiving a constant trickle of emails over many weeks since writing that blog and as I write this one, another email has just arrived from a nurse now considering the role of nurse practitioner but needing to know if he is “doing the right thing”.

Scared to join general practice

He says, “My brother is a GP and feels it is time to leave his profession as it is all getting too much for him. For me I don’t want to accept that nurses don’t support nurses but I have yet to be entirely convinced and I don’t want to embark on a NP journey if I am anxious about the lack of support mechanisms if I end up with physical and mental health problems.”

And unfortunately, we don’t have the equivalent in New Zealand of the UK Cavell Nurses’ Trust which has supported nurses, midwives and health assistants in many different ways since being founded in 1917 after British nurse Edith Cavell was executed in 1915 for helping to evacuate 200 Allied soldiers in Belgium.

Speaking on behalf of nurses

If I am sounding as if I am stirring the pot of negativity, tell that to the nurses who email me simply because they do not know where else to turn to vent or get assistance.

While DHBs provide access to confidential counselling by independent professionals as part of their Employee Assistance Programme to help nurses work through stress, anxiety and depression, as well as personal and financial issues, what is evident is that many nurses don’t reach out and take this important step believing little will change for them post-counselling anyway.

Skint and shaken? That’s probably only the half of it.

DHB junior doctors are lobbying hard for shifts with fewer days in a row and fewer night shifts in a row. This is because they know fatigue leads to greater risk of mistakes. They also know that patient care and engagement is not as good when they are sleep deprived or not rejuvenated sufficiently between rosters.

Nurses are also on shifts, do overtime, work nights and need to have recovery time to be on form. A New Zealand research project about nurses shift work was launched earlier this month.

Studies in Australia and the United States of America show nurses get less sleep on work days than non-work days and how much less depends on the shift pattern they are on.

Massey University’s Sleep/Wake Research Centre and School of Nursing, in collaboration with the New Zealand Nurses Organisation, is running the project designed to take an evidence-based approach towards managing shift work and fatigue for hospital nurses.

The Safer Nursing 24/7 project, led by Professor Philippa Gander, aims to improve health service delivery by improving both patient safety and the safety, health, quality of life and retention of nurses.

Project manager Dr Karyn O’Keeffe says, “Less sleep is directly related to increased risk of clinical errors, struggling to stay awake at work, and drowsy-driving on the way home.

“The hours of sleep someone gets in the 24-hour period before their shift significantly affects their ability to remain awake at work, and is a significant predictor of errors and, near errors. Sleep-deprived nurses report a higher number of patient-care errors, and an American study found nurses struggled to stay awake on 20 per cent of their shifts,” Dr O’Keeffe says.

NZNO has worked collaboratively with the team from Massey University from the project’s inception, both sitting on the advisory board, and in helping with seed funding to support the Health Research Council funding bid. NZNO principal researcher Leonie Walker is a member of the study team and helped develop the study protocol and survey.

“There is a huge variety of shift patterns worked in New Zealand. We have different lengths of shift and different patterns of day and night rosters operating. We need to discover the pros and cons and practicalities of these to develop some evidence-based guidelines for safe and appropriate shift rostering,” Walker explains.

“It’s a bigger problem for some than others, depends on physiology, other life issues, age and also the nature of the work.”

Walker says a shift in an operating theatre for example might be more or less fatiguing than a shift in an outpatient clinic or a special care baby unit but we just don’t know at this stage.

The literature is clear about the risks of error increasing with fatigue. A recent systematic review by NZNO policy adviser Jill Clendon and Veronique Gibbons showed the errors for 12 hour shifts were higher, other things being equal, than for 8-10 hour shifts.

“Equally important to us is the risk to nurses of chronic fatigue – to their health, and for example driving home drowsy,” Walker said.

Walker suggests we need to research our hunch that there are factors other than shift length alone, particularly the pattern of the shift changes that will be just as important.

Safer Nursing 24/7 is a collaboration between the researchers and the nursing community, and is supported by an advisory group of key nursing representatives, as well as an expert in epidemiology and biostatistics.  Nurses and District Health Boards are being invited to participate in three main activities:

1. Completing an online survey of the work patterns of nurses nationwide in six practice areas.
2. Development of new education and training materials on how shift work affects fatigue and how to improve sleep, particularly when working shifts.
3. Consultation on a new Code of Practice for shift work in hospital-based nursing.

Research funders: The project has received major funding from the Health Research Council, with additional funding from the New Zealand Lottery Grants Board, McCutchan Trust and Massey University.

Click here to watch a short video about the project.

Pictured- NZNO Senior Policy Analyst, Marilyn Head with CTU Equal Pay campaigner Camilla Belich, outside parliament today.

By NZNO Chief Executive, Memo Musa

Today, NZ Suffrage Day, provides an opportunity to celebrate New Zealand’s suffrage achievements and look for ways to make further progress on gender equality issues in the health sector.

With the local government elections open for voting, now is a good time to think about how to use the hard-fought right to vote wisely.

The election of new District Health Boards (DHB) is a very important arm of our democracy. The New Zealand Nurses Organisation (NZNO) has provided its members with an election issues guide sheet with key questions for DHB candidates.

Nurses, caregivers, healthcare assistants, kaiāwhina and midwives need to be supported in their work with great leadership and governance.

A living wage, safe workplaces, good faith collective bargaining and collective agreements, and equal pay for work of equal value are fundamental aspects of a fair and healthy society. We do not have access to all of these things yet for all workers in the health sector in New Zealand.

The nursing team’s first priority is improving health outcomes and patient safety. Nurses need the right tools and enough staff to deliver best care. Nurses have developed Care Capacity Demand Management (CCDM) for safe staffing in public hospitals, but not all hospitals are making full use of this tool yet. Aged care does not have mandatory minimum safe staffing levels. Safe workplaces are not nationally consistent for all health staff.

This morning we supported the ongoing call for the government to support the Equal Pay Principles. At parliament steps the Council of Trade Unions delivered white roses for women MPs to encourage them to endorse the principles.

The people making governance decisions for DHBs hugely affect the health and wellbeing of families, workers and communities. In New Zealand although women have had the vote for over a hundred years, not enough women are standing for election or being elected into governance roles. There is a gender imbalance in the board room. Local body and DHB elections are therefore also an opportunity to bring more capable women onto the board as well as more board members with the requirements of our great nurses in mind. Seizing the right to vote leads to a healthier New Zealand.

Ends.

Any DHB candidates who want to answer all the questions we have asked on the guide and have it published online can email their full names as on the ballot, contact details and answers to nurses@nzno.org.nz

Voting in DHB elections and more information on the voting process is available online here: www.localcouncils.govt.nz