Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Attacks on women by the current Coalition government, in recent weeks, are unprecedented. The silencing of women’s voice to push back through lack of accepted legislative process (e.g. select committee submissions) has gutted our right to be heard.

Two weeks ago, I presented at the NZNO Neonatal College of Nurses Aotearoa Conference. The main thrust of my presentation was that there is an expectation, by those who hold power over us, that ‘nurses play nice in their sandbox’. In other words, nurses, midwives, health care assistants, kaiawhina and student nurses should ‘stay in our box’ as David Seymour would have it and let others decide and speak for us. I countered this narrative and said it was up to us to change that by being the first one in the room to stand up, even when no-one else would and expect that the rage inherent in the oppression and inequities we experience, to galvinise action by rising up. Maranga Mai!

And here we are being told that we need to be civil by a government who has just ripped the pay equity legislation process out from under 33 ongoing claims, 10 of which were ours (NZNO), and told that the goal posts had shifted higher, to make it near on impossible for hundreds of thousands of undervalued, under privileged women, many of whom are our members, to achieve equity albeit pay equity, kiwisaver equity, equity of opportunity or anything else you can think of. Calls for ‘civility’ in politics are used by those in power who are engaged in systems of oppression to silence dissent, maintain hegemonic power structures, and retain patriarchal, capitalist norms.

History shows us that when women are galvinised by anger to overthrow oppression, we will never shut up until the change we need for ourselves, our families and our communities, occurs. Why are we angry? Why are we attending quickly organized protests all around the country? Why were there thousands of us standing on the parliament lawn on budget day afternoon?

$12.8 billion dollars, set aside for women’s pay equity claim processes, have been stolen from 180,000 low income, female-dominated workforces, many of them work in health care. But the changes to the legislation have also stolen the human right to be paid equally to a man for the same work, from our future generations. That’s $71,111 stolen from each of those 180,000 women today and too much to count for the future. Theres’ more. Budget day saw the promised ‘money in the back pocket’ disappear, never to be seen again. Women are paying the price. Pay Equity was a campaign win for women after decades of fighting, speaking up and protesting in this country. We will not stay silent, nor will we stay still until our right to be equally valued in all spheres of our lives are embedded in everything that matters to us.

One strategy that every member, everywhere can engage in is the ‘Peoples Select Committee’ led by past MP Marilyn Waring (put link here). We will not accept decisions being made about us, without us.

Why do we need to think about this. Poverty is a public health problem and requires a properly funded public health response. Marc Daalder (Newsroom) said this budget is a fiscal timebomb of unlimited liabilities.

The cuts made by this government will impact on the health and wellbeing of most of us. Without a fully funded infrastructure that supports education, affordable access to publicly fully funded health services and care, provided by culturally appropriate healthcare professionals and care givers, where and when its needed, healthy homes for all, jobs for all paid with at least a living wage that supports choice, the costs to the health system and this nation will be exponential downstream.

Our nation is calling out for all of us to Stand Up and Fight Back. Together we must win. We cannot wait for others to do it for us. Sisters must do it for themselves.

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

In my previous blog post I discussed the context that gave us Te Tiriti o Waitangi (Te Tiriti) and how dishonouring it has led to the marginalisation and politicisation of Māori health. Since my last blog we have seen the introduction of the HPCA Act Review, the slashing of the Pay Equity process and the Equal Pay Act, and the insidious Regulatory Standards Bill. Changes to these pieces of legislation remain relevant to our work as nurses, midwives, healthcare workers and tauira; as well as for our Pākehā, Tauiwi and non-Māori members.

It remains clear that honouring Te Tiriti will enable Māori to take control of their own decisions and futures. But how can we identify when Māori are not considered in the decisions made for us? In March the NERF Committee invited Dr Heather Came to deliver a workshop on Strengthening Engagement with Te Tiriti o Waitangi. Dr Came is an activist and anti-racist scholar and her research focuses on institutional racism within the New Zealand public health system.

Dr Came has developed a Critical Tiriti Analysis framework that enables policymakers and practitioners such as yourself to evaluate whether policies and processes are consistent with Te Tiriti, and helps develop solutions that honour Te Tiriti. The framework allows you to examine a policy through the preamble and four articles of Te Tiriti o Waitangi to determine whether Te Tiriti is upheld throughout the delivery of healthcare policies. Because the New Zealand public healthcare system has been imported from Britain, we can assume that there are many policies that do not uphold Te Tiriti. Findings from the 2019 WAI 2572 Health Services and Outcomes Inquiry found that the ongoing resistance of the Crown in honouring Te Tiriti places the burden on Māori to assert their needs, which continues to harm Māori.

Critical Tiriti Analysis teaches us to look and ask for evidence that Māori values and decision making have influenced the policy design; that the policy ensures equitable participation and leadership; that wairua is acknowledged as more than physical health, and that Te Tiriti is central to the policy design process.

Hospital visitor and carer policies are a good example for this analysis. Hospital visitor policies restrict the number, frequency and age of visitors who come to the hospital to support the patient. For Māori, ‘whānau’ goes beyond the immediate family and includes those who secure a person’s wellbeing and safety. This may include parents and siblings, aunts, uncles and cousins, and the neighbour that checks in on you. Whangai children may be raised by grandparents, great grandparents, or caregivers. All these people secure a person’s wellbeing and safety, and all may be considered whānau. In comparison, many hospitals visitor policies centre on the Pākehā ‘nuclear family’ unit that includes parents and sibling, spouses and children. The Pākehā conceptualisation of ‘family’ focuses on the immediate kinship group.

By following Dr Came’s the analysis framework we can identify that:

1. Preamble: The policy does not preserve Māori interests because it does not allow for the conceptualisation of ‘whānau’.
2. Kāwanatanga: Because Māori interests have not been preserved it is clear that Māori thought leadership did not contribute to the development of this policy – the policy embeds a Western conceptualisation of ‘family’ into our healthcare system.
3. Tino Rangatiratanga: “the right for Māori to make decisions for Māori”, is not allowed for in this policy, because it does not allow for an interpretation that recognises ‘whānau’.
4. Ōritetanga: The rights and privileges of the citizens of Aotearoa should be equal, including access to healthcare and the factors that ensure wellbeing, such as access to whānau. The policy excludes access to whānau when you are a patient. 
5. Wairuatanga: this policy diminishes the mana of the patient as they are denied access to their whānau and support network.
6. Now that we can identify where the hospital and carer visitor policy breaches Te Tiriti, it is our responsibility to suggest improvements that ensure the service we provide is meeting the needs of your patient and their community. This needs to involve consultation with Māori to ensure the policy honours the five sections of Te Tiriti and ensures the patient and their whānau are informed enough to make their own healthcare decisions. This may include expanding the number of visitors, changing the ‘requirements’ for visitors, training for healthcare professionals or the building of hospitals that centre wairuatanga in healthcare strategies.

Once you understand the Critical Tiriti Analysis framework, you may start to see other policies that can be improved, such as the ability to provide professional care for whānau, patient advocacy, bereavement leave, case management, and pathways for students and graduates.

Critical Tiriti Analysis requires long and robust efforts to improve our healthcare system, but it will create culturally informed and mana-enhancing engagement and informed by racial justice. When Te Tiriti is honoured, we will have a public healthcare system that authentically engages with the aspirations of Māori citizens and grounded in equitable healthcare outcomes. And we will all be healthier for it.

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

As I write we a day away from an opportunity for every worker, their colleagues, their friends, their families, neighbors’ and communities to STAND UP and FIGHT BACK, on May Day, 1 May. The weather forecasts are dire as are the working conditions and disrespectful, demeaning pay offers, and wage theft that we are experiencing every day. May Day will see doctors, Auckland perioperative nurses and Access health care support workers on strike. It will see unions, families, communities joining together to stand up and fight back for workers’ rights.

But history tells us that when workers are up against it, we will stand up and fight back. The decisions this Government has made has galvinised the people to stand together and demand workers justice.

What’s it all about? It’s about workers’ rights. More, it’s about the insidious decimation of workers’ rights being done to us, within and without the law. Protections for workers are being stripped away. It is up to us, every one of us to stop it.

Most pressing, recently, is the Health Practitioners Assurance Competency Act (HPCA) review where submissions closed on the 30 April. This silenced te Tiriti o Waitangi, cultural safety competency, and patient safety, which underpins the impetus of health care profession regulation.

The history, purpose, and content of the HPCA was entirely absent from the Ministry of Health’s consultation document Putting patients first: modernising health workforce regulation. Further, there has been no rationale given for the need for change. Finally, it is clear that the consultation looks to undermine the role and independence of the regulatory authorities such as the Nursing Council, through increased government intervention and control. Regulatory decisions should never be directed by political agendas.

Workers, their families and our health and wellbeing are under attack by those same political agendas. Most, if not all, are suffering wage cuts in real terms as employers are offering pay rises that are a great deal less than inflation. Finance Minister Nicola Willis wants to remove the requirement that government contractors have to pay the living wage resulting in some getting a pay cut  from the living wage ($28.95) to the minimum wage ($23.50). This means many more will work second or third jobs, and it will reduce their ability to stay well, eat well, live in a warm, dry home, choose to be educated and it goes on. This makes access to the health system, affordable and early timely care all the more difficult. Further financial pressure is coming in the repeal of Fair Pay Agreements which will see impact on workers trying to maintain wages above the minimum wage.

Protections for workers are also threatened by extending 90-day trials – which includes nurses – giving employers the right to fire an employee for no reason creating instability and uncertainty for new staff. Redress to such situations are being removed. Even if employees win personal grievance cases, they will no longer be able to be reinstated or compensated if they have ”contributed to the issue in any way”.

It is time for our Maranga Mai! goals to be actualised as they have never been before. Every member, everywhere, must stand up and fight back at every opportunity. We need to show up and speak up when the easy thing do would be to stay home, stay silent and wait for someone else to fight for you. We all need to fight for each other. That means showing up, shouting out, speaking up. You are the answer and the solution. We need to be the ones who aren’t afraid to be heard. The ones who know that change doesn’t wait for permission. If that’s you. Speak up. WE NEED YOU – EVERYONE OF YOU. Right now. Today. Maranga Mai!

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

At recent NZNO conventions and events I’ve spoken about Te Tiriti o Waitangi (Te Tiriti) and the way in which Māori health has been politicised. I’m often asked to explain why and how Te Tiriti is relevant to our work as nurses, midwives and healthcare workers, and particularly to our Pākehā, tauiwi, and non-Māori members.

I can’t answer this question in one blog so I will explain so over time. For now, let us look at why Te Tiriti remains relevant to us as members.

Te Tiriti remains a foundational and living document that Māori Chiefs (Rangatiratanga) and representatives of the British Crown (Kāwanatanga) agreed to abide by in 1840, and which we work to honour today. Margaret Mutu, co-author of Matike Mai, views Te Tiriti as “a treaty of peace and friendship, one that promised what the rangatira had asked for: acknowledgement and respect for their absolute power and authority throughout their territories while relieving them of responsibility for lawless British immigrants” who remained ungoverned throughout the lands.

Te Tiriti gave the Crown the right to settle their British citizens in Aotearoa and to set up a government for them, while assuring Māori that they could maintain their way of life – “the unqualified exercise of their chieftainship over their lands, villages and all these treasures”. It is important to remember that treasures – taonga – is more than pounamu and gold: the health of the whānau, hapū and iwi is a taonga; the survival of te reo Māori is a taonga; enduring access to fresh water and ancestral lands are taonga.

For the Māori and Rangatira partners of Te Tiriti, their Tino Rangatiratanga is yet to be realised. The assertion of The Treaty of Waitangi, an English and interpreted replica of Te Tiriti, has enabled the Crown to enforce governance over the taonga of Māori, including themselves and their health. This process was well-practiced by European colonisers and was enacted with guns, disease, death and legislation, such as the 1907 Tohunga Suppression Act. Through force, the Crown established an entirely new way of life for Māori who were no longer allowed to heal and care for their people in the manner they had for centuries.

Māori had no choice but to rely upon the Euro-centric approach to health and medicine that we continue to uphold and enforce. The hostility and distrust many Māori have towards the Crown’s healthcare system is a result of centuries of legislative and policy-enforced oppression and racism. For us Māori health professionals and Members, our role is to advocate for the very existence of our people, through a healthcare system that is inequitable by design. Colonisation has a lot to answer for when it comes to low Māori life expectancy.

The context by which British immigrants found themselves in Aotearoa is thanks to Te Tiriti. Te Tiriti has been recognised as one of the first written immigration agreements in history – it protects the rights and interests of British, and future, immigrants by entrusting them to Kāwanatanga. Apart from the “God, Guns, and Glory” goal of colonisation, the Crown had ulterior motives to sign Te Tiriti. First, the French had landed in Aotearoa and were also hoping for access to the whenua and taonga.

Secondly, the behavior of the British who were already here – whalers, sealers and miners, was at risk of punishment by Māori. Most importantly, Britain was overcrowded and the poor and working class were growing a political and class consciousness. The Crown needed Te Tiriti to minimise the risk of revolt in Britain.

Māori assumed that Kāwanatanga would protect their people just as Rangatira would theirs, yet this continues to not be the case. The removal of Aotearoa New Zealand’s plan to be smokefree by 2025 is already harming non-Māori. The cut to bowel cancer screening is already harming non-Māori. The review of the HPCA Act will harm non-Māori. The rollback of the public health system is not in the interest of our non-Māori members, but in the interests of the Coalition Government’s donors and lobbyists. No one is safe while Te Tiriti is dishonoured.

Not one Government in the history of this country has been able to kill Te Tiriti. The Crown’s legal representatives in Aotearoa have shown publicly that Te Tiriti still applies, although both parties would agree there’s a lot of mahi to be done to honour it.

In future blogs I will address the ‘how’ part of the question – how Te Tiriti is relevant to us as NZNO members: Pākeha, tauiwi, non-Māori and Tangata Whenua. Once we accept the ‘why’, then we can look to the ‘how’. By understanding Matike Mai and the NZNO Draft Constitution we can embed Te Tiriti into our future.

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Curiosity (from Latin cūriōsitās, from cūriōsus “careful, diligent, curious”, akin to cura “care”) is a quality related to inquisitive thinking, such as exploration, investigation, and learning, But there is also a saying that ‘curiosity killed the cat’. This suggests that asking too many questions might get you into ‘hot water’. Curiosity has not always been encouraged. In fact, censorship has always been evident in our political and societal history. Censorship is used to control and restrict the choices of individuals and groups and is a hallmark of far-right politics.

Challenging such ideologies start with challenging conversations. Censorship is the antithesis of being open to having challenging or difficult conversations within our society and in our workplaces. But challenging conversations are necessary to become aware and informed of potentially conflicting opinions. When the option to have challenging conversations is taken from us, many of us, rightly, push back.

Very recently Sir Colin Tukuitonga (Professor of Public Health, Auckland University and President of the New Zealand College of Public Health Medicine) described the current Coalition governments decision to demand that Medical Officers of Health must get their employers permission to speak out about health issues, as censorship. Professor Micheal Baker (Otago University Public Health Specialist) stated that this policy would ultimately reduce the ability of our system to respond to public health issues and safety. Further it has been noted that complying with such a policy would breach collective employment agreements and if extended to other health professionals, their ability to practice to the standard required by the Health Practitioners Competency Assurance Act and consequent regulations and competency standards.

This is just part of the attack on the regulations that support patient safety. It started with the austerity policy of ‘freezing’ nurse, doctor, and support staff recruitment. It continues with the proposed deregulation of regulated health staff, which once again does not put patient safety first. In a recently published review paper by the Minister of Health entitled “Putting Patients First: Modernising health workforce regulation, patient safety is mentioned once over 13 pages, whereas cost, bloated bureaucracy, red tape and various types of ‘assistants’ were mentioned frequently. Current regulations not only put patients first, but they put patient safety as the priority. Yet this government is trying to change this priority amid a workforce and patient safety crisis.

Recently Te Whatu Ora published a Clinical quality and safety review that analysed the results of care provided over the last ten years. It found that overall access to care at both primary and hospital level has deteriorated, particularly since 2020. Death rates in patients who left an emergency department without being seen increased. The number of complaints involving Te Whatu Ora, received by the Health and Disability Commissioner, has doubled from 330 to 653.

But reading between the lines and looking at what is not there is even more important. The actual rate of adverse events is unknown. With the exception of severe harm events, this information is not collected. Nor is there any mention of the relationship between workforce decimation and patient harm. However, quality and safety indicators that require nurse resource and time to prevent patient harm have deteriorated significantly, particularly since 2020 when Covid arrived on our shores and workforce pressures exacerbated. These include healthcare-associated Staphylocccus aureus bacteraemia, pressure area injuries, and DVT/PE injuries.

The relationship between high nursing workloads, lack of experienced, knowledgeable and skilled staff and deteriorating patient outcomes is well researched. Te Whatu Ora chose not to include workforce resourcing as part of its review. The question is why not? Censorship is not just about restricting free speech, it is also about restricting information, changing the messaging, and ‘putting the muppets back in their box.’

These sentiments are growing in Aotearoa and leading to a fractured cohesions where younger disaffected New Zealand men, under the age of 48, believe that having a strong leader in charge of the country, without the checks and balances of a democratic government is preferrable, another hallmark of far-right politics. We need to ask why and where this is heading. We need to have more challenging conversations not less and use facts not fiction in our kõrero. As a nation, we need, more than ever, to all be politically aware so we can stand up together and fight to keep our rights to freedom, democracy and a safe quality public health system. Only then will we be able to turn the tide of the deteriorating health and wellbeing of our nation.

Maranga Mai!

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

The fear of lending our voices to important matters for nurses is becoming more widespread in Aotearoa.

If we let that fear continue, it will be to the detriment of our profession and the health of this country which we all know is already in crisis.

The role of a nurse isn’t just to action the instructions of doctors. The role of the nurse is to use our skills and knowledge and the relationships we develop to be proactive advocates for patients, their whānau and communities. A vital element in nursing is to speak up for health justice, to be the advocate and to remember who we are here to serve, especially those who can’t voice their concerns to the decision-makers in charge.

The question that I am contemplating is how we continue to empower our nurses at this critical time. 

Following the widespread media over the last few days, public health doctors are faced with similar challenges following the latest rules from Te Whatu Ora Health NZ, telling public health doctors that any public comments need a “national Level” approval. Many are calling it a gag, others raising concerns that they won’t be able to effectively serve their communities and calling raising alarms of the government overreach.

Over the past few years many colleagues have said to me they have stopped being advocates, it’s easier to go to work and do their job and go home, don’t rock the boat. They are telling me that they fear losing their jobs and being taken away from their passion to care for people, if they ask questions.

Like the public health doctors, I believe nurses have reason to be concerned, the power control in nursing is unleased. Nursing has always had a terrible reputation for the systems that embedded hierarchy, which has always been a curious thing for me because I am sure I am not alone in my reason for nursing was to serve and care for people and the community.

While over the years there has been shifting within these hierarchies of power over the recent months they are being rebuilt at an increasing rate and the architects of these power proposition are at hands of nurses.

This power and control are playing out in many different forms, from the withholding of critical data that could information workforce issues, recruitment freezes, restricted education and training support to minimal or no consultation around service change.

Silence is our enemy we can’t repeat the challenges of our past where our silence submissive actions were frowned upon.

We must continue to question challenges and advocate. The day we start doing that will be the day we stop being nurses.

Every week I also talk with other nurses who go to work every day to make a difference to stand up and fight the brave fight.

We must form groups or support groups that check in and make sure we are all ok and create the debrief opportunities, help each other up. Seek mentorship or cultural supervision, share our stories and grow our strength and follow what is right.

We must fight back and not allow our voices to be gag or our untold stories to gather dust.

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

On Tuesday, I had the privilege of attending the first day of the annual College and Sections hui. Powerful stories of the challenges in practice that are being experienced were shared. It was an emotional roller coaster that has to be acknowledged and celebrated. Our members talked about going to work every day and providing care in an understaffed, unsafe work environment that results in preventable harm. The prevailing political disinformation that attempts to refute the ongoing decimation of our nursing workforce, in the public, primary health and aged care sectors, was put in the spotlight and strongly rebutted.

Chief Executive Paul Goulter kicked off the day outlining the political challenges all members are facing particularly the regulation and Health Practitioners Assurance Competency Act reviews being conducted by the current Coalition Government. He reminded participants that our power is in joining up the political, professional and industrial perspectives of our practice and work environment. We need to do this to be the leading voice in health, not just for ourselves but our patients, families/whanau and communities.

Kaiwhakahaere Kerri Nuku spoke to the need to understand colonialism in the context of the history of te Tiriti o Waitangi/Treaty of Waitangi. She outlined how colonialism impacted the health and well-being of Māori and how it continues unabated today. Connections made between our history, politics, the Waitangi Tribunal findings on successive governments’ te Tiriti o Waitangi breaches and health were powerful and heart-rending. Maranga Mai! prioritises actualising te Tiriti o Waitangi through authentic power sharing, decision-making and understanding the relationship between the socio-economic and political context of Māori and health outcomes.

Feedback from the College and Section leaders demonstrated how Kerri’s work is to integrate te Tiriti o Waitangi, tikanga and te reo into who we are as a union and a profession is being embraced. Te Tiriti o Waitangi is being embedded in committee structures and ways of working, in new scholarships, and into specialty standards of practice. For volunteers, this takes a lot of time and is reflective of the commitment to walking the talk of Maranga Mai!

My presentation focused on the need to have a safe work environment free of violence and abuse and how this issue is linked to unsafe staffing and wait times. A lack of reporting enables silencing of the issue by government, employers, legislation and ourselves. Opportunities to change this part of our work world were explored through a Maranga Mai! lens including the current call for members’ stories on what unsafe staffing means to them.

Our College and Sections leaders shared their stories too, about their challenges and wins. Membership is growing in all Colleges and Sections. IT membership barriers were outlined, and consequently the new CRM programme which appears user focused and friendly, was welcomed. Members’ challenges were discussed in terms of the need to be innovative, brave, and resourceful.

The potential impact of College and Sections spokespeople on the public via the media can be huge. They are particularly well placed in countering the misinformation and partial truths in what is said and not said by politicians. The second Covid Inquiry, outlined by Tim Rochford, was an example of the untold truths experienced by our members.

The commitment of College and Sections’ members to our Maranga Mai! campaign to change such korero was palpable, reflecting the shifts we are seeing within NZNO to grow our power to stand up and fight back, while realising the ambitions of the Pae Ora Act. The Colleges and Sections member led mahi in the industrial, professional and political triangle is gathering momentum. NZNO is us.

Kia kaha!

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Hate has been dominating the headlines over the past week both here in Aotearoa and across Te Tai-o-Rēhua.

In Australia, two pro-Palestine nurses lost the plot by threatening to kill Israeli patients. In Aotearoa, followers of Destiny Church lost the plot by pushing members of the rainbow community.

Let’s also not forget that our country’s health system is not hate-free. Many nurses, midwives and healthcare workers have shared with me their experiences of racism and hate in the health system.  We don’t know about a lot of them because they were not caught on video, but they experience them first hand.
There are lessons from these incidents that all healthcare workers in Aotearoa can learn from.

And that is, that no matter how much we disagree with someone else’s views or lifestyles, we must not fall into the hate that the political environment across the globe is triggering.

We’ve sworn to care for all the sick the vulnerable and the ill regardless of their race, creed, religion and culture.

The antisemitic incident in Australia does not change our position to oppose the horrific loss of life in Gaza, including the killing of on health workers and the bombing of hospitals, which even the United Nations has have described as crimes against humanity.

The behaviour of Destiny Church followers does not change our position to give LGBTQI+ the same opportunities and care that everyone deserves.

An important reminder of the late Irihapeti Ramsden’s work around cultural safety, as she addressed the notions of power and relationships, she also redressed the important of the tradition and contemporary powerful interchange of words.

I will leave you with these words from Irihapeti Ramsden to suitably change the old nursing philosophy to become appropriate for the end of the 20th century and onward to the 21st.

By changing words from “irrespective of difference” to “respective (respect) of difference” in healthcare the objective of nurses to give appropriate service delivery can be achieved (Ramsden, 1990a, p. 35).

Nursing continues to hold a privileged position in the lives of people who access health services.