NZNO's Blog

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

This week NZNO Te Whatu Ora delegates and members have been attending paid union meetings (previously known as ‘stop works’) around the country. What is our why?

We have fought and won Pay Equity for Te Whatu Ora members, but we need to maintain that equity in the context of continued high cost of living, high rents, interest rates and more. Fair pay is a strong incentive for successful recruitment and retention. And we all know we need more nurses/midwives/health care assistants so we can deliver safe and excellent care to those who need it, where and when they need it.

The research is unequivocal. Fewer nurses result in avoidable harm for our patients because we are the safety net of the health system. We are there, 24/7, but these days we are not there when we should be. Filling budgeted vacancies does not meet patient need.

It is our right to work in a safe environment with enough skilled, knowledgeable, and experienced nurses to provide care the way it should be done. It is the employer’s responsibility under the Health and Safety in Employment Act to provide a safe work environment and that means more nurses/midwives/healthcare assistants.

In May this year, two thirds of surveyed Te Whatu Ora staff reported they don’t have the time, people, budget, or facilities to do their job well. This state-of-affairs has been going on for far too long.

More than 20 years have passed since NZNO started campaigning for nurse patient ratios. On the back of members calls for safe staffing, an NZNO remit proposed by myself and co-written with Grant Brookes to explore how we could get legislated nurse patient ratios over the line starting 2020, is now seeing fruition through our Maranga Mai! campaign.

It is envisaged that a fit for purpose CCDM (Care Capacity Demand Management), designed to match the demand safely and consistently for services and care required by patients with the resources required to provide that care, will be the tool that is enforced under the legislation. This is necessary as DHBs and now Te Whatu Ora have failed to act on their legislated and employer responsibilities to keep us safe at work.

As we speak, the right to strike under the Health and Safety in Employments Act is being contested in court. And our patients suffer. We need to make Te Whatu Ora, and every nurse/midwife/health care assistant/kaiāwhina employer, live up to their own set of rules and policies. This campaign will make that happen.

But it is not just about us. These issues affect Te Whatu Ora members, Primary Health Care, Aged Care and the funded sectors. These areas still have not achieved full equity in pay or conditions.

Maranga Mai! asks us all to rise up together. A show of strength and numbers is pivotal to making this happen. Successful campaigns use the power of the people to keep the pressure on until we win.

Every NZNO member, everywhere must achieve Pay Equity and equitable conditions of work. We need to demonstrate that we are prepared, willing, and able to take action to advocate and influence the Government and employers to achieve these goals. That means action by us all, backing each other up by turning up and doing the mahi. Every NZNO member has a responsibility to stand up and act in solidarity wherever the action is taking place.

As Tom Petty and the Heartbreakers sang…

Well, I know what’s right, I got just one life
In a world that keeps on pushin’ me around
But I stand my ground and I won’t back down.

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

At a recent conference speakers talked about the waves of pandemics not isolated to viruses, communicable or non-communicable diseases. They also talked about the pandemics of economic disadvantage, declining social and labour markets; pandemics of hate and war for control and resources. All of these are underlined by power and greed, with the highly calculated weaponisation of racism, xenophobia and bigotry to divide people and concentrate more power and wealth in the hands of the few.

We see this on full display in Palestine where one of the largest military powers in the world, backed by the US, is committing alleged ethnic cleansing and displacing millions of indigenous people living in what the UN has described as the world’s largest open-air prison. And why is Israel doing this? If the ‘war’ is really about driving out Hamas, then why displace hundreds of thousands of Palestinian civilians? This is and always was about claiming more land and resources.

As the genocide in Palestine continues to escalate, my thoughts are with the thousands who have been slaughtered, and the hundreds of thousands displaced in the last month. It would be difficult for many of us to appreciate the indescribably harrowing and traumatic experience of those people, and especially of the Palestinian health workers dealing with mass death and injury under siege.

It’s sickening to see the violent invasion of al-Shifa Hospital where more than 3000 doctors, nurses and civilians have been sheltering. Seeing these images, it’s clear to me that there’s no symmetry of power, and it reminds me of the events of our own history in Aotearoa.

I think of the violent displacement of our people by the British so that settlers could have more land and resources. I think of Parihaka, where 1600 British soldiers arrested hundreds of peaceful protesters trying to protect their own whenua from unlawful occupation. I think of the purposeful erosion of our legal, political, cultural and economic institutions over the past 250 years, and the violence that our resistance is met with. I see the similarities between our fight for tino rangatiratanga and mana Motuhake, and the struggle for Palestinian liberation.

There’s a growing call globally for a ceasefire and an enduring solution that recognises the Palestinian state. There are also calls for Israel to be held accountable for war crimes. Among those countries calling for justice, it should be noted, is South Africa who intimately understands the injustice from their own history of apartheid.

Palestinians often say: “justice is the seed, peace is the flower”. We know that those in power will play on our fears and make us believe that justice is impossible and peace unreachable. But as unionists and health workers, we know that those in power rarely have the people’s best interests at heart. So, we must critically analyse their motives and interests, and listen to the dreams of the Palestinian people. When we do, it is clear to see that with global solidarity, justice is possible, and so too is peace.

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

National Nurses United Executive Director Bonnie Castello’s opening address to the almost 3000 strong members attending the National Nurses United convention in San Francisco this month acknowledged that “now is an extremely important time in our era”. For many of the same reasons our health workforce will be facing many of the same issues, political changes, failures to invest in health and errors of our nation’s past.

In the US, nurses are coping with the changes and increasing development of new technology and the upsurge of biotechnology and artificial intelligence (AI).

With the increasing shortages of nurses, compounding issues and challenging pay and working conditions, the role of the nurse becomes increasingly important. There is ongoing work in this area to ensure that the role of the nurse, the art of caring and the unique responsibilities and relationships nurses have with patients is not lost in the advancing world where artificial intelligence seems to be leading the way in other areas.

While I acknowledge AI has the potential to make nurses lives easier, especially with technical data and by reducing human error, according to many studies around the world, these projects often encounter hurdles such as data security, patient privacy and ethical breaches.

I fail to see how technology can replace observing a patient the way a human can. Is a machine capable of empathy towards a gravely ill or dying patient? I don’t think so. How does a machine determine how a patient with dilated pupils is haemorrhaging? These are life and death situations we face every day as nurses which come from watching and checking on our patients.

Nurses must continue to lead human interaction with communities valuing the art of nursing and relationships. They must also ensure that new technologies are used to enhance their health and not to dehumanise and alienate those who need the human touch in their recovery.

However, if it cannot be avoided, I think that when implementing AI in our processes, the nursing workforce must be closely involved. Applying AI into the education of nurses, midwives, kaimahi hauora, health care assistants and tauira should happen as soon as possible and should not be forced upon us in the workplace. Nurses need to be active in the selection process, collaborate with IT teams, and advise on solutions that prioritise patient safety. Nurses can also help ensure this technology is as accurate as possible.

At the end of the day, we’re only human, but I read somewhere recently that humans have the ability to imagine, anticipate, feel, and judge – that’s something I believe machines can never achieve – not in my lifetime anyway.

Maranga Mai!

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

In a recent television debate between the “two Chrises”, promises were made regarding nurses. It was reported by RNZ (Newshub leaders’ debate: The new commitments and refusals to rule out | RNZ News) as follows:
Nurses’ pay: Both said they would make pay equal for nurses working at hospitals and GP clinics.

“And we put $200 million in just this year to achieve that but Christopher again is making a whole lot of promises with no money to pay for that,” Hipkins said.
Hipkins also committed to increasing nurses’ pay “when they next go into bargaining, yes of course”.

What concerned me about this debate was what was not said. Firstly, there were mixed messages. The usual line “that there is no money to pay for that” came out. Yes, $200 million was committed, but there was no acknowledgement that Primary Health Care nurse pay has not achieved parity with nurses working in public hospitals. There is a widening gap and no equitable parity for any nurse working outside of Te Whatu Ora, nor any timeline to deliver on the promises made.

New Zealand’s health funding is one of the lowest when compared to similar countries. There is money, just an unwillingness to spend it on the largest female-dominated health workforce that constantly delivers health care in an environment that is severely challenged in terms of safe staffing and high patient acuity.

The next Te Whatu Ora bargaining is set to occur in 2024. While there is a commitment to increase nurses’ pay at this time, once again there is no detail on whether it will be a pay rise over and above inflation and the cost of living. It can be done. Queensland nurses recently succeeded in such a campaign.

Lastly, pay increases are needed to improve recruitment and retention of nurses so safe health care can be delivered by experienced, knowledgeable, skilled and culturally safe nurses, where and when it is needed. This detail was absent. The fact that the lack of nurses, midwives, health care assistants and kaiāwhina is having a detrimental effect on our patients and their families, while adding huge costs in nurse turnover (estimated at over a billion dollars a year) and adverse patient outcomes (more billions), was not mentioned.

Other political parties have made different promises. Some have considered these recruitment and retention issues. Some haven’t. Comparisons of each political party’s promises have been captured by NZNO’s comms and campaigns team in a recently published political party policy scorecard and an NZNO Webinar involving Labour, National, the Greens and Te Pati Māori party health spokespeople, including Minister of Health Ayesha Verrall.

Every member, everywhere, all 60,000 of us, have a collective responsibility to vote. Our NZNO staff are supporting this vote with information that can be used to understand the difference between political parties’ positions regarding the health and wellbeing of our members.

Not voting is the loss of a real opportunity to influence the outcome of the health and wellbeing of our nation. And our power to influence is very real as we represent, at a minimum, one person for every 90 people in New Zealand, and that is not counting the influence we have with our whānau, friends and colleagues.

Nurses are respected and valued by those we care for. Vote for those who support out Maranga Mai! five fixes. Our voice counts more than it ever has and is being noted in the halls of power.

Use your voice. Vote.

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

This has been an exhausting yet rewarding week for me. Our conference and AGM were very successful with some impressive guests.

On Wednesday we welcomed Minister of Health Ayesha Verrall, and after bringing Pay Equity over the line this year among other achievements, she was warmly received by our members, who acknowledged her mahi.

Our theme at the conference was Challenging the Health System. There is no doubt that patient health outcomes are influenced by what happens when a patient encounters or engages in any part of the health care system and influenced by the level of social needs of the individual. This is not a new phenomenon, COVID didn’t create the crisis, COVID exposed the fragility of the system, but COVID didn’t create the crisis, the crisis is that the system was never designed to serve the interests of the individual and communities.

Any health system that fails to address the social determinants of health or public health approach to address the health disparities will fail to address or respond to the needs of the community who will become reliant on health services. Our own definition of what failure looks like identified that more than 10 percent of people did not receive cancer treatment within 62 days from a diagnosis the in the lowest performing DHB’s nearly a third of people were still waiting for cancer treatment after 62 days. That persistent and marked inequities still exist and access and outcomes for Māori and Pasifika and low-income populations.

That the lack of progress and investment in sustainable Māori workforce despite various initiatives that to date have not delivered. That the system has failed to plan and respond to the shifting demands and failed to protect the safety of workers while they’re at work.
So, what is our role and how can we make some practical change? Firstly, we must learn to understand the system that we all work in. We must understand who and what drives change and who are the leaders in those positions of power and what is informing the desire for change. Financial funding and power are the designers of the system and not one based on the needs of community.

What is obvious is that there is much work to do to ensure that the role of nurses, kai mahi healthcare workers, midwives and students are equally recognised for the contributions that they make, and as an organisation we must take responsibility in leading that change for ourselves. We acknowledge that our own language and constant single us of the word “Nurse” discriminates and disregards other groups of healthcare workers for whom our organisation represents. Leadership and change are needed.

Maranga Mai!

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

On Tuesday 5 September, I stood with an NZNO colleague in Dunedin giving support to our ASMS medical colleagues who had gone on strike for the first time, and was reminded of Marvin Gaye’s amazing song “What’s going on”

Picket lines (sister), picket lines (brother)
Don’t punish me (sister), with brutality (brother)
Come on, talk to me (sister), so you can see (brother)
Oh, what’s going on (What’s going on)……

I remarked to a medical colleague who had just been interviewed, why do we have to fight for what is right and just all the time? He responded that to save money, we have to invest money.

And that is so right. When nurses are not with the patients 24/7 because of nurse shortages due to shortsighted funding decisions, avoidable harm and adverse events occur. In the past six years, ACC has fielded 6000 complaints regarding pressure areas at an estimated cost of $19 million a year. And that does not include the suffering of those who experienced pressure area wounds, the loss of choices, the pain, and the wider impact on their families and care givers.

New Zealand has a strong history of striking when talking and listening have failed in negotiations. Some strikes have been successful, and some haven’t. New Zealand’s longest, the 1951 New Zealand waterfront lockout which lasted 151 days and involved 22,000 workers from multiple unions, failed. The National Government of the day stated that New Zealand was at war.

Thirty years later the Kinleith strike followed hot on the heels of a national strike involving 100,000 workers, protesting against a wage freeze imposed by Muldoon’s Renumeration Act 1979, and they won. It was described as the “Greatest Workers Victory” and the Kinleith workers elected their delegates and self-organised, not only themselves but engaged the whole community to work together in solidarity. And it is starting to feel like that now.

While we might stand on the picket lines with our medical colleagues, the firefighters and ambulance crews were there too. So was the local Council of Trade Unions. We are all protesting against the same injustices, but we are doing it in silos. As someone wise said we need to “demand more than a new fitting for the current underfunded straightjacket”.

We need innovative bold solutions that we will only be able to gain by having every nurse (midwife, health care assistant, kaiāwhina)/doctor/firefighter/ambulance crew member/teacher/support worker etc stand up together in solidarity for fair pay (not pay cuts), safe staffing (not doing more with less), and quality outcomes for those we care for. There’s an election coming.

Maranga Mai! every nurse, everywhere.

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

As the world faces a major nursing shortage it’s timely that the International Council of Nurses is included in the revision of the ILO 149 – Nursing Personnel convention 1977, standards framed in co-operation with the World Health Organization promoting and securing the applications of these standards.

At the time these standards were being developed many countries were short of qualified persons and existing staff were not always best used.. This was considered an obstacle to the development of effective health services with general concerns around employment and conditions of work, such as: discrimination; on freedom of association; the right to bargain collectively; on voluntary conciliation and arbitration; on hours of work; holidays with pay and paid educational leave; on social security and welfare facilities; and on maternity protection; and the protection of workers health.

While the world is a much different place the definition of “nurse” has remained suspended in time, while our practice may have evolved – the unique role of nurses has not been realised.
There is no doubt that from the 1900s to now the role of the nursing personnel as agreed in the ILO standards are recognised as “being vital, together with other workers in the field of health, in the protection and improvement of the health and welfare of the population”.

However, its these words that make it difficult for nurses, how are nurses vital in the health field? What is it about nurses that makes us different from other workers in the field of health? What is unique about nurses, what is it that we do that no one else can do?

We can often describe the technical roles, or tasks that we undertake – we know these are important and make a difference to people’s lives but, but with the advantaging roles of the unregulated workforce, introduction of physician assistants etc, as more and more roles take on jobs that are “repeatable and trainable “these are narrowing the scope and role of the nurse.

During the outbreak COVID-19 we witnessed some significant changes the Health Act 1956, namely in provision that provided options to allow nurses who had test positive but had no or minimal COVID symptoms to work in COVID settings with restrictions only applying to work, outside of the workplace normal COVID restrictions applied. But also important for nursing is that impact that extending the scope of an unregulated workforce to undertake tasks that were “repeatable and trainable “such as the task of vaccination.

It is understandable that in a “state of emergency” decisions must be made, especially where lives and endanger, we would expect changes to be effect, quick acting and temporary for as long as the crisis exists, or the emergency has subsided or managed. I am not intending to debate the merits of this, but the changes have not been temporary, and the politicians have taken an opportunity to refine what was once a highly specialised role into a task orientation process.

The concerns of 1977 are echoed years later with the emergency we currently have with nurses nationally and internationally, the answer is not to replace a qualified workforce but for nurses to continue to define what makes the profession distinct from any other profession and the fight to maintain and grow.

Maranga Mai!