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A day in the life of a mental health nurse in New Zealand

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This blog was sent to us by a NZNO member who works in mental health. We are choosing to keep their details anonymous because of the intense scrutiny that mental health services are currently under. This blog is a personal reflection on their own experience, rather than NZNO’s view, but we are sure it resonates with many of you who work in the sector. We really appreciate them sharing their story, and hope it gives some context to the recent media coverage of our mental health services. 

It is 7am and I am off to see a patient in the emergency department. It is a young man who has self-harmed overnight. This scenario is becoming all too common in today’s mental health setting. You see, mental illness is the invisible disease. Presenting to the emergency department in emotional distress, the only visible signs are an unkempt man with a frightened look on his face.

Coming into the cubicle I see a young man in obvious distress. A feeling of hopelessness comes from him. I walk in and introduce myself. We begin to talk. Eyes downcast, feeling somewhat embarrassed as he shares his story with me. He talks to me in a quiet voice. He knows he needs help but does not know where to obtain the help he needs. His relationship with his family has become strained. They have tried to help, but are unable to provide the support he requires.

This man begins to articulate his struggle with schizophrenia. His self harm is due to despair: a belief that life holds nothing for him.  By the end of the interview I know I have several options open to me as a clinician:

  • We could send him home to his parents. But evidently his parents are unable to cope anymore with his distress.
  • We could suggest his GP follow up and maybe a visit from the already over-stretched crisis team.
  • Another option is to find a community respite bed for a few days. But we know that these are few and far between. I will have to telephone and “sell” his case to the respite coordinator if I am to make this happen.
  • Another option is to try and organise for him to be admitted into the inpatient ward. But I know they are nearly always full or over capacity. This is yet another hard sell to find this young man a place to be safe and be supported.

I go to discuss treatment options within the consult liaison team and the decision is made to admit the young man to the inpatient unit. I call the ward coordinator.  “What are his risks they ask?” Not, ‘who he is’, but, what logistical problems might he bring to the unit.

This is mental health nursing today. There is now a ‘risk adverse’ culture that always errs on the side of organisational safety: a system characterised by a lack of choices due to limited resourcing.

This is the young man’s first time in an inpatient unit. I try and reassure him, but as soon we get to the unit the door closes.  People are busy. I try and find a nurse. They are few and far between. I eventually find the nurse assigned to my client. A brief introduction is shared, but I know the nurse is trying to get the paperwork done. Admission note, risk assessment, interview with the psychiatrist, place them on the observation board and a host of other tasks. This leaves little time to begin getting to know, understand and work alongside my client to better support them.

I leave my client and return to the ED, there is another case on the board.

This time another young person in a self-harm situation – they were bullied at school and decided to end their life.

Nurses do care, but we are not being given the time or resources to provide the level of service and care that I would want or expect if it was my family member presenting to mental health services.

We do not want to restrict or deny the people we care for their freedoms. Too often the concept of least restrictive practice is sidelined by lack of resources.

The organisations we work for are worried. Worried about risk and what could be in the papers tomorrow. So much so they seem to have forgotten about the core reason we are here – we are here to help.

I as a clinician welcome the reviews and public scrutiny. The current structure needs looking at so we mental health professionals are able to provide the service, care and support that our clients deserve.

 

 


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Suffrage Day – vote for great health leaders

 

 

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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 


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It’s time to shout out for health

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I’ve spent a long time working in health, and have seen a lot of change. Governments come and they go, budgets change, policies shift. But what doesn’t change is the reason we are attracted to health careers- it comes from a deeply felt desire to make a difference, and change the lives of others for the better.

What you’ve been telling us over the last few years is that it’s becoming harder to connect to that feeling in your everyday working life.

Of course, we still do good. Nursing, like all people-centred jobs is about getting creative, working with what you’ve got and accepting what you can’t change. But the more workarounds our members have to do to give good care, the less time they actually have to provide that care. Nursing SHOULD be a job where you can go home at the end of the day with a satisfied feeling that you were able to make the difference, not frustrated about what you couldn’t do. Nursing is a job we should be able to love.

You have told us you want:

  • “A health system we can be proud of, where everyone can get the healthcare they need when and where they need it.”
  • “To feel proud of the care we provide, and be confident that we have the resources to provide safe, quality care at all times.”
  • “We want satisfying careers with pay that values our work and is enough to thrive on, and ongoing professional development.”

And that’s what NZNO is also pushing for. But we need your help!

Right now, the effects of healthcare funding are all around us- on the ward, in the community, and in the news. In just the last few weeks, we’ve seen news reports about

And the list could go on. The best management and policy in the world can’t make 1+1 = 3. Healthcare underfunding affects almost every aspect of our working lives, and is starting to impact on patient care. I know we all want better. That’s why we are running a campaign programme led by YOU, our members, called Shout out for health. Shout out for health will take action on health funding to push for a health system we are all proud of. Sometimes it will be about a particular service, like our petition on funding for Smokefree services.

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And sometimes it will be about a local issue, that you let us know is happening. The important thing is we need confident, passionate members to make it a success.

If you are an NZNO delegate or NZNO champion, you should have received an email inviting you to a special Shout out leadership training programme. You need to let us know now if you are in- so check your emails please!

If you are ready to stand up and take action to make health funding a priority for all politicians, sign up to be a supporter of the campaign here.

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We are a professional association and union of 47,000 people who care deeply about others. If we use our voice to say ‘health matters’, we have the power to make it better for patients, but also for ourselves.

Memo Musa

NZNO Chief Executive

Nurse


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Don’t block good health

By NZNO President, Grant Brookes.

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NZNO President Grant Brookes at ‘The Block’ housing protest in Auckland.

This might be a strange way to begin a nursing blog, but Season Five of The Block NZ is drawing to a close.

The top-rating programme has gripped viewers for the last two months. As eight young New Zealanders in their twenties and thirties competed for a chance at home ownership, we shared their yearning.

But this season has also attracted controversy, screening at a time of heightened awareness about the growing housing crisis.

In hindsight, it’s odd that it took five seasons. The appeal of the programme has been so strong all along because the goal of home ownership – or even a secure, affordable tenancy – is increasingly unattainable.

Last weekend I joined a protest at The Block NZ Open Home in the upmarket suburb of Meadowbank. I went along to support a group from NZNO.

It might sound shocking, but rising house prices mean that NZNO members are now starting to join the ranks of the “working poor” – people who don’t have enough left over, after accommodation costs, to pay the bills and feed the kids.

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NZNO delegate and RN Hamish Hutchinson at ‘The Block’ housing protest.

If the average Staff Nurse, working full time was somehow able to save a 20% deposit, then to buy an average-priced house in Meadowbank they’d need to spend about 90% of their income on mortgage repayments. So buying one of The Block NZ houses is clearly not an option.

But sadly, things are heading the same way across other parts of the country. A mortgage on an average-priced house anywhere in New Zealand would consume over half of a Staff Nurse’s income. And as house prices rise, so of course do rents.

But I also went along to the protest because adequate housing is essential for health.

Skyrocketing house prices (and rents to match) have recently put the issue of homelessness into the spotlight. But they also cause the less visible problem of household overcrowding.

Researchers at He Kainga Oranga, the Health and Housing Research Programme at Wellington’s Medical School, have been looking at the health impact.

In one study, they found that one in 10 hospital admissions to treat infectious diseases are the direct result of household crowding. For Māori and Pacific peoples, the figure jumps to one in five.

The researchers examined nine major categories of infectious disease — gastroenteritis, hepatitis A, Helicobacter pylori infection, pneumonia and lower respiratory infections, upper respiratory infections, Haemophilus influenzae disease, bronchiolitis, meningococcal disease and tuberculosis. They estimated that household crowding causes more than 1,300 hospital admissions a year, and even some deaths.

“Most of the diseases in the study have especially high rates in children”, said lead investigator Professor Michael Baker. “Children are more susceptible to meningococcal disease, gastroenteritis, pneumonia and most other infectious diseases, and our analysis shows that their risk is strongly associated with exposure to household crowding”.

The Block NZ is about houses as money-making opportunities, rather than homes for people to live in. Even as it appeals to us, it glamorises the competitive race which is shutting more and more people out of a warm, dry and affordable home.

But the show is not responsible for the housing crisis, or the toll it is taking on health. That responsibility lies with the Government.

The protest at their Open Home was a chance to again send the message that everyone – whether they can afford a $1m house or not – needs somewhere dry and safe to live.


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Not so ACE

Yesterday, about 600 new graduate nurses had their hopes raised and then dashed when the ACE system malfunctioned badly.

Graduate nurses were mistakenly sent an email congratulating them on gaining a Nurse entry to practice (NETP) position at Auckland DHB.

If you were one of those nurses, we feel for you, it must have been a tough day.

ACE assures us this is a one-off and that’s good to hear because NZNO believes the system is a really good way of matching new grads with jobs.

We can’t help noting that this mistake wouldn’t have happened if the Government funded a NETP position for every new grad nurse. We believe this is the only answer for a fair, well-supported and sustainable nursing workforce that can take us into the future, and you can count on us to keep pushing for that.

 

You can find out more about our campaign for 100% NETP here: http://www.nzno.org.nz/get_involved/campaigns/newgrads


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CCDM from a Charge Nurse Perspective

By Caroline Dodsworth, charge nurse, Palmerston North Hospital

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As an NZNO member working in a DHB, I know that getting Care Capacity Demand Management (CCDM) working in all our DHBs is a priority in our multi-employer collective agreement (PDF pg 66).

I know that it has been started in most DHBs and I think the implementation has actually been completed in only one so far. It is good work to be doing and it’s important to do it right – better to take the time to get every step correct than to rush it and not get the benefits.

We all want patients to have the best possible outcome. This is most likely to be achieved when patients have the care they need when they need it.

CCDM is the programme that has been developed by the Safe Staffing Healthy Workplaces Unit, NZNO and district health boards (DHBs) to make sure we can actually do this every day (not just on those random, lucky days…).

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Working in partnership is the key to CCDM’s success; NZNO members and staff working together with DHBs to make safe staffing a reality. It’s about making sure base staffing is right every day. It’s about making sure there are workable strategies in place if the match between demand (what patients need), and capacity (our resources) is not right. And to do that there has got to be good quality data available to everyone so we can see on the day and over time if the programme is working. The whole system depends on the information we provide.

You can find out more about CCDM here: www.nzno.org.nz/carepoint

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I thought I’d share my experience of CCDM at Palmerston North Hospital, so you can get an idea of what to expect when your DHB gets the programme (if it hasn’t already).

In 2012 I was charge nurse manager of an acute 32 bed medical ward. TrendCare showed that we consistently didn’t have enough staff to complete the care required; often between 20 and 30 hours short over a 24 hour period! Rosters were pretty much set in concrete and didn’t (and couldn’t) respond to the peaks and troughs in workload. We knew care rationing was happening but there was no way to “see” it or prove it.

The opportunity to become the first ward to undertake work analysis and data collection to inform the CCDM programme was floated and our application was successful.

There was excellent communication during the process; ward staff were included and actively involved. It was a great example of working in partnership with close collaboration between charge nurse, NZNO and ward staff. Ward staff were given every opportunity to express their concerns and listened to in a non-judgmental manner. Facts and figures were explained and we were given time to digest and seek clarification if we weren’t sure about anything. Unfamiliar data was explained in language that we could all understand. Charge nurse, associate charge nurses, management and NZNO delegates were professional and supportive, and assisted with propelling the process forward – staff joined in at “grass roots” level.

The data collection process was difficult and hard work, as I had anticipated; ironing out teething problems, ensuring everyone was on the same page, encouraging the negative staff and the fence-sitters, keeping the momentum going when enthusiasm flagged.

The data collection process was generally seen as “just another data gathering exercise”. But as the process developed it was an eye-opener to be able to quantify the many interruptions during each shift. It also highlighted and reinforced what nurses already know; many interruptions means less time for patient care. We also gained further insight into the peaks and troughs of ward work.

By the end of the two weeks we had become quite attached to our diaries! Finally, we were able to show care rationing – especially the missed nursing care that had become “business as usual”.

It took quite a while for the information we collected to be analysed and some wondered if their hard work had all been for nothing. During this time we implemented Releasing time to care which helped keep a sense of momentum.

As soon as the results were confirmed we swung into action and developed a new model of care. The entire nursing team got together, and with butchers paper and models, felt pens and timetables, we arranged and rearranged the FTE and the roster to meet workload over the entire 24 hour day and seven day week.

We divided up the available FTE into the most efficient and effective spread of regulated and un-regulated staff, thinking outside the square and breaking down traditional shift time barriers. Our new model of care implemented a new role of “admission and discharge nurse” who straddles the morning and afternoon shifts without a patient load, but instead focuses on timely discharges and active “pulling” of patients from MAPU and ED.

This means less pressure on the qualified staff, especially on the morning shift. Discharges happen in a more timely manner, and the discharge of complex patients requiring a lot of registered nurse time is now smoother. Patients feel more informed and new admissions are seen and assessed early without having to wait for a busy nurse.

The model of care for patients with delirium also changed – instead of being staffed by a ward RN and a bureau Health Care Assistant (HCA) we have our own ward HCA who knows the patients and provides continuity of care for them. To have our own HCA caring for these patients is amazing. The benefits to the patient outcomes, and working relationships between the team are invaluable.

The staffing numbers across all three shifts are well thought out. Patient safety has improved significantly with an extra registered nurse at night.

The difference to staff morale and motivation as a result of CCDM has been immense! While the ward remains very busy it now operates efficiently and effectively.  Complaints, incidents, falls and medication errors have reduced, staff turnover is practically zero and productivity has improved.

Since then we have developed a hospital-wide response to variance in collaboration with NZNO. The CCDM variance response management (VRM) tool is a visible and user-friendly process. It still cannot produce nurses out of thin air, but it raises awareness of areas under pressure to all the right people and allows an organisation-wide approach to pooling resources and to providing support where it is needed. Everyone is talking the same language and the tool triggers a response at the top of the cliff instead of the bottom.

I’ve heard a lot of feedback about CCDM over the last couple of years but the comment that has had a lasting impression, and the thing that I think CCDM stands for above all else for nurses is: “Since CCDM it feels like I’ve actually met the patients and I don’t go home with that horrible feeling that I’ve missed something”.

As the charge nurse for that ward I take pride in the fact that I was responsible for making that happen. We need senior managers to influence change at the executive table, but the charge nurse is responsible for driving change at ward level with enthusiasm and passion, leading from the front and never giving up.

If you are involved with CCDM in your ward or unit, I’d love to hear how it’s going. You can leave a comment by clicking the “leave the comment” link to the left of this article.

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If you would like to know more about CCDM please talk with your local NZNO delegate or organiser, or visit www.nzno.org.nz/carepoint or centraltas.co.nz/strategic-workforce-services/safe-staffing-health-workplace

 


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Celebrating NZNO’s Living Wage journey

By NZNO president, Grant Brookes

Today we celebrate NZNO’s accreditation as a Living Wage employer. The announcement is confirmation from the Accreditation Advisory Board that NZNO has met all the criteria to wear this badge of honour.

The impact of today’s announcement won’t be felt by anyone directly employed by NZNO. They are already paid above the current Living Wage of $19.80 an hour.

But the decision to become an accredited Living Wage employer means all our contracted staff get this rate, too. So it will be felt by people like Yong, who cleans the NZNO National Office after hours.

Yong has told me that she works two cleaning jobs – both for minimum wage. She starts at a motel at 8.45am in the morning, and finishes at NZNO at 9pm at night.

Yong has now received her first pay at her new rate, and was so happy that she could buy better food at the supermarket, instead of the cheapest food. Her dream is that now she might be able to go home to China to visit her father, who she hasn’t seen in four years.

She wanted me to write this, she said, so everyone could understand how much NZNO’s decision  means.

It has been a long journey to reach this point, with plenty of debate and discussion along the way. So it’s fitting today to look back on how we got here, and pay tribute to the NZNO members who kept us moving forward.

It’s now over four years since the Living Wage was launched in Auckland, in May 2012. NZNO was one of the first organisations to sign up to the statement of principle:

“A living wage is the income necessary to provide workers and their families with the basic necessities of life. A living wage will enable workers to live with dignity and to participate as active citizens in society. We call upon the Government, employers and society as a whole to strive for a living wage for all households as a necessary and important step in the reduction of poverty in New Zealand.”

Our support was based on our understanding – as nurses, midwives and healthcare workers – that poverty and inequality are a root cause of much ill health. Some of us, especially those in aged care, and Māori and Pasifika members, knew this from personal experience of low pay.

Back in 2012, economists calculated that the Living Wage needed to live with dignity and participate as an active citizen in society was $18.40 an hour.

In the DHB elections the following year, NZNO asked candidates to support the idea that all DHB staff should get at least the Living Wage, which by 2013 had been recalculated as an hourly rate of $18.80.

At this time, we were coming to understand that it wasn’t enough to just agree with the Living Wage in principle. We should also contribute to the organisation which was working to make it a reality. In August 2014 NZNO took its place alongside other organisations as a full member of Living Wage Movement Aotearoa NZ Incorporated.

What propelled us along was growing support for the Living Wage among NZNO members.

Using the Nursing Matters manifesto, we’d been calling on voters and politicians from all parties in the 2014 general election to see a Living Wage for all as fundamental to a fair and healthy society.

Those of us who attended the DHB MECA endorsement meetings in late 2014 then showed our support by voting overwhelmingly for a set of claims which included progress towards the Living Wage (which by then meant at least $19.25 an hour) for HCAs.

When we couldn’t get agreement on this from employers, members expressed their frustration and reaffirmed their belief in the Living Wage at DHB MECA ratification meetings around the country.

By 2015, awareness was growing further. If we were asking our health sector employers to pay a Living Wage, then NZNO needed to walk the talk and do it, as well. That awareness culminated in a vote at last year’s NZNO AGM. Delegates from across New Zealand decided, by a large margin of 85 percent to 15 percent, to set a deadline of today ­­- 1 July 2016 – for NZNO to become an accredited Living Wage employer.

There are also some NZNO members who deserve special mention, for helping our organisation to reach this goal.

They include people like Maire Christeller, a Primary Health Care nurse and workplace delegate, who has been involved in the Lower Hutt Living Wage Network since the beginning. She helped to spread the message to other NZNO delegates in the Hutt Valley, and has also lobbied for Hutt City Council to become a Living Wage employer.

Left-right: Maire Christeller and baby Iris, with HVDHB delegates Monica Murphy and Puawai Moore, at the Hutt Living Wage Network launch

Left-right: Maire Christeller and baby Iris, with HVDHB delegates Monica Murphy and Puawai Moore, at the Hutt Living Wage Network launch

Kathryn Fernando is a delegate at Capital & Coast DHB, who joined me on last year’s “Mop March” to Wellington City Council, aimed at extending the Living Wage to contracted council workers, like cleaners and security guards.

CCDHB delegate Kathryn Fernando (left), NZNO Organiser Danielle Davies (right) and I at the Living Wage “Mop March” for Wellington City Council contract cleaners

CCDHB delegate Kathryn Fernando (left), NZNO Organiser Danielle Davies (right) and I at the Living Wage “Mop March” for Wellington City Council contract cleaners

Litia Gibson works at Porirua Union and Community Health Service. She has led the nursing team’s support for their workplace paying the Living Wage (even if they aren’t accredited yet).

Litia Gibson works at Porirua Union and Community Health Service

Litia Gibson works at Porirua Union and Community Health Service

Kieran Monaghan is a Primary Health Care nurse and a leader of the Living Wage Movement in Wellington. It was his tireless efforts last year – presenting on the Living Wage at the NZNO Greater Wellington Regional Convention, getting the issue into Kai Tiaki, writing for NZNOBlog, and drafting the successful remit for the NZNO AGM setting a deadline for accreditation – which helped us take the final step.

Kieran Monaghan (left) and fellow Living Wage activist Naima Abdi at the “Mop March” for Wellington City Council contract cleaners

Kieran Monaghan (left) and fellow Living Wage activist Naima Abdi at the “Mop March” for Wellington City Council contract cleaners

 

As NZNO President, I have spoken of the need to strengthen union values within our organisation, as we continue to sharpen our professionalism – values like social justice, equity and solidarity.

By walking the talk on the Living Wage today, I believe we’re doing just that.


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Diversity and inclusion in health

Hi, my name is Siȃn Munson. I am a Community Clinical Nurse for people with long term conditions. I am also an NZNO delegate, a mum, a friend, a lesbian and many other things too of course.

My journey to nursing

My Grandmother and one of my cousins are nurses, so nursing was always a possibility for me, however my journey to nursing took a while! I left school after the 6th form, went to the UK for year and applied to take an enrolled nurse course when I got back. That didn’t end up happening. Instead I got married and had three wonderful children, one of whom has significant learning and support needs. I also did an extramural degree over 6 years at Massey University. I majored in Women’s Studies which gave me a passion for women’s health.

I got divorced and made a decision to move to Palmerston North to do my nursing training. I studied at UCOL when my children were 7, 9 and 10 and I was a solo mum. I tell you what – if you can handle being a solo mum, you can handle anything!

When I started I thought I wanted to work in Mental Health but over the course of my studies I realised I wanted to focus on Women’s Health.

After a few years of working as a civilian Army Nurse in a women’s and sexual health role, I got my current role. I’ve been here for three years now and I love it.

Starting post grad study

While I was working in sexual health I began my Masters Degree at Massey University. I started with the Women’s Health paper and it snowballed from there. During my study I realised that there was very little New Zealand literature about lesbian women’s experience of healthcare – and what I was seeing in my practice made me think something needed to be done about that. As a result my final paper was the Research Report and I graduated in 2015.

I was extremely lucky to have a wonderful supervisor, Dr Catherine Cook, who is a senior lecturer at Massey University.

Coming out at work

When I started at Central PHO my manager was really supportive of my studies and when I knew what my research topic was going to be I thought I should probably “come out” to her. So, I officially told her I identify as a lesbian.

It’s a big deal to come out to someone, especially your manager. I mean, sometimes you know people know, or it’s an open secret or whatever, but actually officially telling someone you are queer is pretty scary. If you are not queer it might be hard to understand that, but people who are lesbian or bi or gay will understand that being “out” and “coming out” is something that happens every single day. Every day we have to evaluate our personal and professional safety and comfort in every single situation we are in. And that includes with patients as well as colleagues.

In this case, it was the best decision I ever made! It’s been a really positive experience for me to be out at work with my colleagues, although with patients it’s still a case-by-case thing. I’ve heard people say things like “no one needs to know” or “I don’t know why gay people have to come out”, but believe me, it matters. Being in the closet is awful. You’re constantly second guessing everything you say. You’re editing your life. It’s tiring and it’s soul destroying. I didn’t know until I came out how important it is to come out and how life affirming it is to live an authentic life. Not to hide who you are. And most importantly to be accepted for who you are in all your rainbow glory. Life is far better since I came out. One of the great things I’ve gotten to do since I came out was to attend Wellington Pride Parade with NZNO – Out At Work.  Three years ago I’d never have done that!

My research

Anyway, my research… My research topic was “Cloaked in Invisibility – Experiences of Lesbian and Bisexual Women in their Encounters with Health Professionals for Cervical Screening and Sexual Health”. For this research I interviewed six lesbian and bisexual women about their experiences receiving sexual and gynaecological healthcare in New Zealand. There is very little research on lesbian and bisexual women’s health in a New Zealand context, and this research adds to and expands that knowledge.

It was such a privilege to hear their stories.

My findings show that lesbian and bisexual women suffered quite major barriers to receiving timely and culturally-appropriate healthcare.

The healthcare system is heteronormative – healthcare professionals make (probably unconscious) assumptions that everybody is heterosexual. For example, if your GP asks about your husband, that’s heteronormative and it means that the patient is instantly having to make a heap of decisions instead of being able to focus on the appointment: “O, should I say I’m a lesbian? Is it not worth it? Shall I just leave it? Maybe I should say? Why is he/she making assumptions? Etc “

There is both implied and overt homophobia in health care. While being gay is becoming more socially acceptable, not all of society is accepting. Some of the participants had experienced horrific homophobia from health care professionals which had seriously impacted their lives.  Experiencing homophobia makes it difficult to return for further health care.

There is a conundrum of safer sex – What does safer sex look like for women who have women sexual partners? Many lesbian and bisexual women assume they are having safer sex because they are not having sex with men. Some believe they can’t contract sexually transmissible infections. There are no specific barrier protection methods for use by women having sex with women, and the current choices such as latex gloves, dental dams and condoms are not very user friendly for safer sex between two women.

Engagement with health promotion – it’s hard to engage with public health promotions when you are invisible in them. There is very little sexual health information available for lesbian and bisexual women. There are no posters on the walls at surgeries that depict lesbian families. Women found ways of finding the health information they needed when they didn’t feel ok about seeking advice from health professionals.

Resilence – the amazing thing I found was that, despite the barriers, lesbian and bisexual women do find ways of navigating the health system, through friends and the queer community.

I find this fascinating! I can see so many ways that we can change our thinking and practice to become inclusive and start providing care in a more appropriate and equitable way to our patients. Even understanding that there ARE queer patients on your books, even if they are not out to you, is a good start. My research found that when a woman has a positive experience coming out to a health professional it makes it more likely that she will come out to another health professional.

And I want to get these learnings out as widely as I can. I want to change practice. The thought of my work gathering dust in a library somewhere gives me the shivers. That’s why I have written a journal article with my supervisor.  That’s why I am speaking out about it. My research report has been published this month in the Journal of Clinical Nursing. It’s exciting to be adding to the body of knowledge in this under-researched area. If you have ideas about how we can create inclusive environments for our patients and clients I’d love to hear them. Please add your thoughts in the comments.

Munson, S. and Cook, C. (2016), Lesbian and bisexual women’s sexual healthcare experiences. Journal of Clinical Nursing. doi: 10.1111/jocn.13364

http://onlinelibrary.wiley.com/doi/10.1111/jocn.13364/abstract

 


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Caregivers, we’re worth it!

Tammie Bunt is a caregiver who wants all her colleagues to know they are worth $26 an hour. She says it’s about time we know our worth and get it.

Film-Colour-162Here in Aotearoa New Zealand, our population is aging, and that means a greater need for caregivers, health care assistants and nurses in both the residential and home-based aged care sector.

The women (and it mostly is women) who look after our elders in the aged care sector are devalued and underpaid, and it’s been that way forever. Because they are women, and “women’s work” has traditionally been seen by society as somehow worth less than men’s. Ridiculous, right!?

Talking to many caregivers and health care assistants and they will tell you they don’t come in to the industry for money. People get into it because they are caring and compassionate people who want to make a difference in people’s lives. It doesn’t mean they should be paid less!

Today it appears the average qualification in caregiving is only worth about 10 cents depending on who you’re working for. Most caregivers are earning the minimum wage or just above it, even after they have done their aged care qualifications.

In 2012 Kristine Bartlett stepped up in a way no one else had in the industry. She’s a caregiver with over 20 years’ experience and she’s still only earning just above the minimum wage. Kristine and her union, the Service and Food Workers Union (now E tū) took on the big guns to do something about valuing caregivers and the role they play in the community. She believes we should be recognised financially, that the thanks we get is lovely but not enough.

NZNO joined the case too and one of the discussions they had was about how much caregivers should get paid. Comparisons have been made to other male dominated professions and how the Equal Pay Act isn’t working the way it was intended. There were articles stating caregivers were worth $26 an hour. I think that’s fair but many of my colleagues cannot believe they are worth $26 – it seems like so much money!

74464_494373352974_569252974_6879867_8118614_nWe are worth that! Why are we saying to ourselves that we aren’t? Think about it…

  • We gently listen to everything a person wants to say as their last hours take hold. We hold the hand of a person whose last breath is only seconds away.
  • We help our residents find some purpose to get through today… whether it’s via an activity or simply just getting out of bed to face the day.
  • We make sure each person has clean clothing on and that they are appropriately dressed. We assist them with their continence needs.
  • We are warriors for their safety by making sure they are safe in their surroundings.
  • We’re highly qualified.
  • And also, we give up many of our weekends for our residents. We miss our kids’ sporting events, family birthdays and other social events because our clients’ needs are not 4 hours a day. They need us 24 hours a day, 7 days a week, 365 days a year.

I am relatively new in the industry and was somewhat dumped into the job due to personal circumstances two years ago. I came from a market research background and was paid well better there, sitting in front of a computer using a virtual program with only buttons to click. I then went into the cleaning business and ended up on far more for that than I am in my current position. My shock at how undervalued people who work in the aged care sector is was flabbergasting!

We have heard all the excuses, from the Government and the big names in the aged care industry, “We don’t get enough funding”, “We don’t get a lot of return from aged care”, “We can’t afford it” and on and on… It’s time for the excuses to stop and the action to happen.

I think the Government needs to get on with it!

And the other thing that needs to happen starts with us.

We do an important job, we have qualifications, we love and care for our clients and we are worth $26 an hour! Believe it sisters.


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Nurses go to Fiji

When Cyclone Winston hit Fiji earlier this year, emergency services were on high alert all across the pacific. Those services included a number of NZNO nurses who also volunteered for the New Zealand Medical Assistance Team (NZMAT). Emma Brooks who normally works at the Kenepuru Operating Theatre and Megann Deveraux from the Wellington Regional Hospital Operating Theatre both deployed to Suva with the NZMAT on 1 March. We had a chat to Emma about what happened on the deployment and what it means to be part of NZMAT.

What is NZMAT and who is involved with it?

It’s basically a team of medical professionals that are trained to deploy to disaster areas to support the local health service. There are doctors, nurses, paramedics, allied health staff and even some non-medical members that work in areas like logistics. We all go through training to be able to be deployed. It’s a civilian based group so we aren’t part of the defence forces in any way but we do help with their disaster relief efforts.

What happened while you were deployed?

We left New Zealand on 1 March and flew directly into Suva with the help of the NZ Air force. We were a part of four teams, two of which were surgical, one general, and one orthopaedic and two were primary health. Because I’m a theatre nurse, I was in one of the surgical teams which was based at the Colonial War Memorial Hospital. We were there as support. We had to be flexible in what we did and had to take on the extra work that had been created due to the Cyclone. Our arrival was almost perfect timing as one of the Fijian Orthopaedic surgeons ended up in ICU the day before we arrived.

Over the two weeks we were there, we did 102 surgical cases over 12 days of surgery. These were cyclone and non-cyclone trauma cases and elective surgeries. The othropaedic team even did an emergency inter-island trip to Labasa Hospital on the northern island of Fiji. We were flown there by the French Airforce, however, they didn’t serve croissants or coffee on the flight.

What was most memorable about the deployment?

Working on the victims was by far the hardest thing we did. We did lose a couple people due to the trauma they had endured.  Because of the cyclone, the Fijian health services were stretched, any countries would be, and we tried our best to help where we could. The cyclone had caused such destruction, we had to work with very limited supplies. Having said that, it was a privilege to be there. The people we helped, they all were all incredible

There are various requirements to be able to join NZMAT. Go to the Ministry of Health website to find more information.