Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

As I write the turmoil and peril of the New Zealand health system is evident. Desperate multiple txts going out to nurses every day offering overtime are now the norm. Inequity is rife as evidenced by the very different additional workforce payments offered to doctors that perpetuates the gender discrimination and undervaluing of our profession.

Nursing students are being asked to do patient watches for grocery vouchers with little training to conduct a role requiring skill and experience (putting them at risk) – and often carried out by our amazing health care assistants.

The pressure on NZNO members, no matter where they work in the system, to do more with less (and less and less) is unrelenting. What does this mean for our wellbeing when working in a failing system, our mental health when we feel guilty for giving ourselves a few hours to sleep, eat, and be with our families, instead of going back to help our overwhelmed colleagues? How do we get off this downward spiral?

We are struggling to survive but NOW is the right time to take the appropriate action to correct the situation. Those who accomplish change are willing to engage in the struggle. To survive we must collectively find ways to work together to create the change that needs to happen.

Now is the time to Rise Up! Every member, everywhere must become actively engaged in the Maranga Mai! campaign for change and stand strong until the changes we need are embedded in our workplaces, our work, our contracts and in legislation. We must establish cohesive communication networks so we can work across the public/private/tertiary/primary care divides.

We must also be cognisant of the opportunities Māori models of organising and campaigning offer us all. Maranga Mai! is a national campaign conducted through local events led locally by leaders who are inclusive of NZNO members across all sectors within their local region. Every member needs to step up and act.

One example is occurring in Whangarei Hospital Emergency Department. The nurses decided to work to their contracted FTE only. The expectation that nurses will always step up to fill the roster gaps is now being challenged. These nurses understand that if you continue to do what you always have done nothing will change. They are now supporting each other to put their wellbeing first and nursing shortage issues are being made visible by their action. And their action is being supported by nurses across New Zealand.

Another example is what nurses and health care assistants in Canterbury did. They were not being paid properly or on time as legally required and a local protest was arranged after the employer refused to engage. They organised locally through their networks, social media, radio and tv, to bring the issue to the publics’ attention nationally. The DHB representatives met the NZNO members on the picket line and agreed to work together to resolve the issues.

Where there is anger born of injustice, discrimination and racism; agitation and action by each one of us working together will bring hope. The realisation of beneficial change will only come if we harness our anger and make it work for us. Maranga Mai!

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

Health is the ultimate political football in Aotearoa. Every party in power tries to use it to their advantage, to impose their short-term ideals onto health and – even worse – to only focus on the surface issues so they look like they’ve done something. We can’t let politicians keep doing this at the expense of people’s health and lives.

Opposition parties are willing to tear each other down over failures, even though they’ve all helped gut the system we have today. Yet when in power, rather than be accountable and effective, they tinker around the edges, failing to address the systemic issues.

Politicians go on three yearly cycles, during which time they’re mostly better at destroying than creating. But unlike them, our voice and our work is constant. We must urge for a common public health approach based on the idea that all people deserve the best health care, and all workers deserve the best conditions. If we don’t take control of the political narrative, governments will continue trying to distract people from the real health issues.

To do this we must fight the anti-Māori and anti-union rhetoric on the right. We need to stake our claim as experts of our own field and fiercely protect our profession. The current workforce crisis is going to require some immediate fixes and a long-term strategy which will require nursing to be part of the planning.

COVID has brutally exposed the nursing shortage. While the obvious course should have been to build the nursing workforce, this has not been the case. Instead, changes to the Health Act further undermined and eroded nursing by extending the scope of an unregulated workforce to bridge the shortfall.

We have a 4000+ nursing workforce shortage and the international Council of Nurses reports a 4.6 million nursing shortfall worldwide, so I repeat: if nursing is going to be the political football we need to control the narrative!

Political parties need to consider how we are going to make nursing attractive again, how are we going to make nursing a career choice for school leavers, support them through their training and graduate them into good jobs. How are we going to support and retain the nurses currently in the workforce by valuing their work, protecting their health and safety, including deconstructing the pay disparities that continue?

I have been inundated with calls of immense distress from nurses, health care assistants and kaimahi hauora upset and powerless to speak out against what they are witness to: care choices and negative outcomes driven as a direct result of nursing shortage.

If only our nursing crisis was as simple as a hospital drama tv show  – but  when a nursing shift finishes the emotional debrief plays out in your head hours after leaving the workplace, or wakes you from your sleep as you try to remember whether or not you signed that form, or what you need to do today, or whether there will be enough staff on the next shift.

Nursing is not a drama – nursing is real and it’s up to us to ensure that Government responds to the needs of the people, not us having to bend to their whims.

Anne Daniels, President
NZNO, Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Is every nurse, everywhere sufficiently resourced to safely do their job?

What can we make of the Minister of Health saying the hospitals are coping when a raft of professionals within the health sector are saying exactly the opposite? Let’s unpack the statement: Hospitals are coping……

Health care is delivered by nurses everywhere in New Zealand, not just in hospitals. Are Primary Care, Aged Care, Māori and Pasifika nurses coping? I don’t think so. In many cases they are even less resourced. They are at the front-line providing prevention, health education, and wrap around services that include whānau and iwi, but this appears invisible in the Minister’s statement. If it was not for them, the pressures on hospitals would be so much greater.

But the situation is so dire that doctors themselves have written to the Minister demanding that change happen for nurses so they (the doctors) can do their work.

And Aged Care is definitely not coping. Facilities are closing due to nursing shortages, making for unsafe work environments. At a recent Select Committee hearing, NZNO College of Gerontology Nursing Chair Natalie Seymour clearly outlined the major challenges Aged Care nurses and facility managers are facing. The toll being taken on those who provide the care, nurses and health care assistants, in the current nursing shortage context, is beyond belief. Yet our members keep going to work, keep caring, and keep voicing their concerns about unsafe work environments ever more loudly.

Maranga Mai! – The Health and Safety umbrella.

Health and Safety is a main area of focus within our Maranga Mai! campaign. Under this umbrella we are organising opportunities to build member power to hold our employers and their masters to account.

NZNO now has a Health and Safety Representative (HSR) WhatsApp group run by NZNO educator John Howell. This is bringing HSRs together to build understanding and support to engage all members to actively participate in resolving nursing shortage issues. We are building infrastructure, capacity and action by and with our NZNO HSRs, delegates and members.

Those NZNO HSRs and delegates – in combination with members – are a power to be reckoned with, particularly when the HSRs utilise the Health and Safety at Work Act (HSWA) 2015. The HWSA’s main principle is that workers are given the highest level of protection from workplace health and safety risks as possible.

All NZNO members are expected to participate and, as a result, increasing numbers of Provisional Improvement Notices (PINs) are being submitted by NZNO HSRs in regions such as Palmerston North, Auckland, Hawke’s Bay, Southern, Wellington, and I believe more will come.

A PIN is written notice legally requiring an employer or service provider to address a health and safety issue before a certain time.

Nurses are rising up to make sure that every nurse, no matter where they work in the health sector, has the power and resources to safely do their job. Maranga Mai!

This is just the beginning.

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa, NZNO

Finally, our organisation is becoming more progressive, politically active, and responsive to our member voice. This can be seen in Maranga Mai!, our overarching health and safety campaign that recognises workers across all sectors—aged care, primary and private health, community and Māori health—are all now being prioritised alongside DHB. Maranga Mai! advances Tino Rangatiratanga and Mana Motuhake as real drivers for change; achieving the best outcome for all without Māori losing mana.

With NZNO’s elections coming up (nominations have just opened) I wanted to reflect on what’s moving us in this direction and what I believe will strengthen us moving forward. For me, it comes down to values. What I see making the difference is that the leadership are taking a more values-based approach. That means we’re working in unity, making decisions based on what we’re trying to achieve together. It also means coming back to our shared values to navigate differences.

Members expect a lot of NZNO’s Board, just as we expect a lot of all leaders. We’re rightly held to account to do the best for our members, and to be guided by our shared values when making decisions. We’re all well familiar with seeing politicians and leaders start off saying one thing and then doing the opposite. And instead of owning up to their failings, or addressing them, they put the blame elsewhere. At their worst, they champion false news and repetitively articulate off the wall messages that aren’t grounded in fact, until the uninformed become believers. We have all been a witness to this over recent years from politicians and the like.

To keep building on the momentum we have right now, we need to ensure our leaders have integrity and commitment to their values and to our organisation. We need to be able to trust that those elected will stick together to do the best for all our members. Our organisation will continue to flourish if we continue to make decisions based on values.

The flipside is that we can’t buy into division amongst ourselves. Our members deserve better than that and I believe we know such rhetoric won’t serve us. My hope for these elections is that we instead shift our focus to what we’re building together, our shared vision of justice. I hope those who put their hats in the ring will model the values that have helped NZNO turn the corner in the last year.  I look forward to the outcomes of these elections and continuing to build our collective voice and action. We have so much more to do, and we can only do it together.

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

On 12May 2022 NZNO launched the Maranga Mai! campaign. Central to Maranga Mai! are the “Five Fixes” which form the charter of demands for the campaign:

1. Te Tiriti o Waitangi actualised within NZNO and across the health system
2. More nurses across the health sector
3. Pay and conditions that meet nurses’ value and expectations
4. More people training to be nurses (in New Zealand)
5. More Māori and Pasifika nurses

These fixes have a number of areas of focus.

In her recent blog,, NZNO Kaiwhakahaere Kerri Nuku said our work and lives are political. She encouraged members to “get political”, and indeed, it is our professional responsibility to do so.

The third fix, more specifically the conditions needed to meet nurses’ values and work conditions, demands political critical thinking, collective power and action to meet our responsibilities to ourselves, our future selves and those we care for.

So what is the” WHY” in our Maranga Mai! campaign?

Our why is to win the necessary political and resourcing commitments needed to address the nursing, midwifery, HCA, support worker and kaimahi hauora shortage crisis permanently, across the whole health sector.

“WHAT” are we aiming to achieve?

1. Mandated minimum nurse-to-patient ratios supported by a fit for purpose tool that can increase appropriate skilled and experienced nurse resourcing when and where it is needed.

Mandated means legislation, which means political and collective power and action is needed. This is an outcome of the remit passed by the membership at the 2020 AGM.

Going forward, nurses must have appropriate levels of experienced and skilled resource available, built on data driven information to ensure patients and nurses are not put at risk. Nurses must not have to struggle to do the best they can, fearful of what may meet them when they go to work. This must be worked through across all sectors of the health system, not just the DHBs – and the Māori and iwi sector is the most urgently in need of attention.

2. All nurses, regardless of their sector must receive pay equity/parity and work conditions that: reflect the true value of nurses everywhere; attract people to the profession; and support nurses’ work choices.

While the Minister of Health has already signalled this will happen, the questions are when and which sector first? Māori and Pasifika nurses in primary care have, for a long time, been marginalised, more so than many other nurses in different sectors.

Making our commitment to te Tiriti o Waitangi a reality is a real opportunity for us all. Raising up our Māori and Pasifika colleagues will drive parity of pay and conditions for all.

“HOW” are we going to do this?

Our national Maranga Mai! campaign strategy is being developed by our great team and it will be up to us, the nurses at the coal face, to make it real for ourselves locally. Our expectation that the recent Budget would deliver on some of our goals has not been realised. Therefore, we have to to take the lead.

The Care & Support Worker rallies we held across the country (together with the PSA and E tū) on 23 May were our first ‘on the ground’ and publicly visible Maranga Mai! action, and I was proud to lead and speak at the one held in Dunedin. We will do many more of these sorts of activities.

The power to create change is in our hands. Every nurse everywhere must Maranga Mai! – Rise up and act together.

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Nurses have long been marginalised in the politics of health and unfortunately, NZNO hasn’t been a strong enough advocate to challenge that. For years the organisation has made compromises and concessions because it didn’t have the political will or the belief in our collective strength to challenge power.

But we need to get past the idea that we’re non-partisan. Our work is political, our lives are political, and the powerful will exploit our apathy to their advantage. As health workers we’re advocates for our patients and as a union and professional organisation, we advocate for a better health system. To do that we must engage in politics. And by that I don’t mean endorsing a political party. I mean building and pushing our own vision of health and holding all decision-makers to account to get there.      

After all, unions have always fought on broader political causes because workers’ lives don’t just begin and end when they clock in. Unions have been part of the fight for Indigenous liberation, women’s rights, racial justice, climate justice and the peace movement across the world. As the union saying goes, “an injury to one is an injury to all.” We are part of a long history of collective struggle for all people.

I also want to point out that it’s not only our unionist roots that demand political courage, but our professional responsibilities too. When standards of practice are watered down or public health measures are eased against our better judgement, those are the result of political decisions that we must challenge. 

So now, with the general election on the horizon, we start seeing National and the Act Party rolling out racist rhetoric, including calls to extinguish the Māori Health Authority. They’re also advocating the same economic policies that gutted our health system. At the same time Labour will continue to make promises they won’t deliver on. We need to watch all this and be ready to push back on it.  

From this point on, NZNO must change the way it operates if we want to go from conservative to progressive, from reactionary to proactive. If we want what’s best for ourselves and our communities, we need to go hard and front foot on political issues.

We must start to empower people to do their own thinking and not be afraid to front divisive issues on race, gender, sexuality, class, and power. We can’t sit and wait for change to happen for us. We’ve got to be courageous and realise we have the power to make change. Not only do we have the power, we have the right and the responsibility to stand up, be heard and fight for a better future.

Kerri Nuku, Kaiwhakahaere
New Zealand Nurses Organisation, Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO)

This is a truly significant time. Despite the difficulties we’re currently facing, the rates offered to DHB nursing staff under the recent proposed Nursing Pay Equity settlement should be something to celebrate because it’s a formal recognition that we have been undervalued. Of course, it doesn’t come close to really addressing the power imbalance we face in a sexist society, but material compensation would be better than just words.

It’s taken an incredibly long time even to get to this point, and I think we owe it to ourselves and each other to be staunch and see this process through. It’s crucial for us to challenge with curiosity and hold fast to what we know our value to be. We can’t settle for anything that will undermine the future of nursing.

The fact that members are not satisfied with what’s been put in front of them is a positive thing because it has opened a conversation and presented us with possibilities. We’ve come across an obstacle, and now we’re given an opportunity to reflect, regather and renew our direction.

For me, the critical part of this, and the opportunity that we’re now afforded, is to put a line in the sand and say that all workers across all sectors need to be recognised. What we do today is important for our colleagues across the sectors.

We can truly enact kotahitanga and solidarity. We can be forward thinking, and above all, we can embrace a broader sense of justice than what the Government and employers want us to have. They want us to fight amongst each other for funding, to think it’s either DHB or Māori providers or Aged Caregivers. They also benefit if we think that Te Tiriti and equity are at odds with union principles. That kind of thinking creates division. It’s not the kind of thinking that wins the fight for justice.

We can and must fight for all, and in doing so we have to acknowledge that non-DHB campaigns haven’t had the same support at NZNO.

Just as nurses are trained to triage patients based on their acuity, everybody should get the care they need and deserve. Why shouldn’t we apply the same to our own organisation? Why can’t we also focus our resources on those who most deeply experience inequity?

Again, we don’t have to choose between, but our NZNO’s relative silence for those outside DHBs has to be addressed and together with the strength of 55,000 we can expand Pay Equity to all sectors. 

Ki te kotahi te kākaho ka whati, ki te kāpuia, e kore e whati – When we stand alone we are vulnerable, but together we are unbreakable.

Anne Daniels, President
New Zealand Nurses Organisation, Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO)

NZNO Kaiwhakahaere Kerri Nuku and I have repeatedly stated that DHBs and communities in Aotearoa New Zealand are beyond crisis when it comes to having enough appropriately trained and experienced nurses to do the job well. A crisis can be defined as a “time of intense difficulty or danger”. It’s also when important decisions must be made, and we are at that time.

Why (do we have to make a decision)?

Older nurses are retiring in droves; others are changing careers; too few are entering nursing study; and internationally qualified nurses (IQNs) are facing immigration barriers. This all makes the work pile higher on those left in the profession.

Nurses are working overtime and are repeatedly asked to give up valuable days off. As research affirms, exhausted nurses make mistakes and patients suffer as a result. So, despite this pressure, we’re hearing more and more that nurses are starting to say no. They’re saying, “I don’t know how much more we I can take. If things keep going the way they are, we’re going to lose patients and, as a nurse, that’s just too much to bear.”

National and international research shows nurses are feeling increasingly embattled. It’s not just the workloads or pay; it’s facing the “challenge of knowing what care patients need but being unable to provide it due to constraints beyond the nurses control.”[1]

On top of this are inequities across the health sector experienced by Māori and others in Aotearoa New Zealand. Nurses are leaving or reducing their hours of work, not responding to texts asking them to work on their time off, and in some countries, despite covid, they are striking.

What (are we going to decide) and when?

Our calls for action have been ignored for decades and we can’t wait for Government or employers any longer. Even though it will take years to overcome the complex issues we face, we must start now. It will take collaboration from the community, academia, all levels of health care and Government to work in real partnership with NZNO (as the largest representative of health workers) to develop creative solutions.

NZNO’s leadership and Board of Directors are working on an overarching campaign to ensure all nurses everywhere, work together to win the political and resourcing commitments needed to address the nursing shortage crisis permanently.

Last word…

There is an upside. We always need to know what we’re trying to achieve when we decide to stand up and fight the good fight. Power is generated from the bottom up. At 55,000 strong, we have the power in our hands to shape the future of nursing. We are all in this together and we will win.

[1]     Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: Moral injury not burnout. Federal Practitioner, 36(9): 400–402. Reframing Clinician Distress: Moral Injury Not Burnout – PMC (nih.gov)