advocacy | NZNO's Blog

May 25, 2016
by NZNO 3 Comments

Not holding my breath for Budget

Hi, my name is Hamish Hutchinson. I’m a registered nurse, an NZNO delegate and I work at Waitakere Hospital in Auckland.

We’re coming up to the Budget, which is when the Government prioritises its spending for the next year. Will they prioritise health? I’m not holding my breath.

The Council of Trade Unions calculated we are well over a billion dollars short for the health system just to stand still. I can’t really comprehend what a billion dollars looks like, but I can tell you what underfunding looks like to me, every day.

I’ve been working as a nurse for 5 years. I chose nursing because it’s the sort of profession where you can use your own humanity to help others. This is still why I want to be a nurse.

I work in an Emergency Department (ED), so we are used to it being busy. We have a great team that responds well in a crisis. But it’s not always trauma and lights and sirens – another part of the ED is about doing screening for family violence and asking about how things are for people in the home. When it’s busy – and it’s getting more and more busy all the time – this stuff – the social stuff, the time spent listening to people gets pushed aside. That worries me.

We always say that the Emergency Department is for emergencies only. I’ve lost count of the times I have heard people saying that they couldn’t get into their GP for 3-4 days or couldn’t pay for after-hours clinics or couldn’t get into a GP because they work two jobs and have kids. Inevitably they come to ED – where else will they go?

Just as an example, I saw one man who had an infected wound. He had put off seeing the GP because of cost and because he couldn’t take a sick day from work. When he finally arrived in the ED his wound had gotten really bad. Something that probably could have been managed by a GP a few days ago ended up needing surgery and a hospital stay. It was worse for the patient and it cost so much more than it needed to as well, in equipment, bed space, and staff time. This doesn’t need to happen.

Some days the Emergency Department feels like a game of musical beds. When the hospital is full it’s just one big balancing act. I’m amazed it works and I think that’s down to the tireless work of nurses and other hospital staff. But the reality is this is not a game, this is people’s lives.

Good health is vital for a good society and if I got to make the big decisions, I would make health and wellbeing a bigger priority than it is now. Everyone needs to be able to get health care in their own communities. We need more hospital staff for sure – but keeping people out of hospital is cheaper in the long run.

What this would look like for me? It would mean having enough time to talk to people to find out what brought them to ED and how we can stop it happening again. You can’t do that when it’s too busy, when there’s people in corridors, and it’s the really important stuff like this that falls away with underfunding and understaffing.

Other things that would make a big difference, in my opinion are:

Free GP visits for everyone and clinic hours extended to suit working families. People should be able to see a GP on the same day and have flexibility if they are workers.

Improving the ‘social determinants of health’- the things that should keep people well in the first place, like housing, welfare, education and employment. We would have more time available for the unavoidably sick if preventable causes of disease were reduced or removed.

In particular, outside of the hospital, there has to be more emergency housing, and this is an issue that’s needs to have been resolved yesterday! There’s nowhere in West Auckland to go if you are homeless, only sleeping rough or paying for a motel which might not be an option for lots of people. Addressing the human right to safe shelter is an absolute must and would ultimately improve the health of people in hardship. If nothing is done on this issue, I will be worried for the future, because it’s bad enough now. On Thursday, I hope the Government prioritises health and the people in our communities. And that means housing, welfare, education and employment as well. They could do it if they had the will. They could fix this all if they wanted. That’s something we are all holding our breath for.

May 6, 2016
by NZNO Leave a comment

What we want for health

The Government’s 2016 Budget will be announced in a couple of weeks so we thought we’d set out now what NZNO wants for health. Here’s hoping that is what the Government delivers.

What we want is a health system where everybody can access the health care they need, where and when they need it.

It’s not an outrageous ask, and we’ve never met anyone who disagrees. So, let’s unpick it and see what lies beneath the words.

We want a health system that is funded to provide equitable and universal health care.
We need the right people to make it happen; nurses, doctors, kaimahi hauora, kaiāwhina, administrators, cooks, cleaners and clinical leaders.
Those people must be trained and paid appropriately and be provided with safe work environments.

Last years’ Budget does not provide enough funding to meet the health needs of New Zealanders. Nor did the Budget the year before, or the year before that… In fact economist Bill Rosenberg estimated last year that the funding allocated for health was at least $260 million short. This year will be worse. Rosenberg says that in the eight months to February 2016, District Health Boards were already $27.9 million in deficit.

Funding for the primary health services we so desperately need are being squeezed and cut and services are closing. It just doesn’t make sense – primary care is the way to make our vision for a healthy New Zealand happen. Attacking small services as they begin to make headway into our communities is completely counter-intuitive.

The Minister of Health is famous for saying “We must live within our means” – implying that health funding is a finite pool. It’s not. This Government could prioritise health if it wanted to.

The Government could say, for example, it’s worth spending more on health for the next 10 years until the massive benefits of focusing on primary care start showing in the system. It could say, more spending now means spending less in future.

If there was a plan, we would know how many nurses to train and we’d be able to support and mentor them after graduation appropriately.

It would be recognised that short term “savings” often don’t yield long term rewards, for people or for budgets.

Nurses, midwives, caregivers and other health care workers tell us they are stretched to the limit. Some are having to sacrifice tea and lunch breaks and working unpaid overtime just to keep up with the care they need to give to ensure needs of patients are met. Support for training and development is decreasing. Stress levels are rising and morale is low.

A healthy health system would train and employ the right number and skill mix of staff so that people aren’t burning out and/or making mistakes and/or rationing care.

So, that’s what we want in the Budget. New Zealanders deserve it and, as the largest health workforce, we expect to be heard. We are putting it out there that we will fight for it, for all New Zealanders.

A healthy health system should be a top priority for any Government. We want a health system where everybody can access the health care they need, where and when they need it.

February 3, 2016
by NZNO 1 Comment

Getting out of an unhealthy relationship

Tomorrow, the 4th of February, the Government is signing the Trans Pacific Partnership Agreement (TPPA) in Auckland, along with eleven other countries.

I’ve been travelling around for the last few weeks and talking about why it’s important we walk away, for our health and our human rights.

This ‘partnership’ agreement they are signing is not an equal or healthy one and I’m really worried.

I’m worried that Pharmac is going to have to pay more for essential medicine. If just one company holds a patent for a longer time, they can charge whatever they like – for example, up to $300,000 per patient for a cancer drug like Keytruda. This could cost us hundreds of millions of dollars in the long run and people we love could miss out on care they need.

I’m worried that foreign tobacco companies can demand they ‘help’ us write the laws on tobacco control. Even if they can’t sue us directly, they can ask their own Governments to do it for them. We need to have the right to make our own laws. I’m worried other companies, like Coca-Cola, or casinos, or oil companies, will use this agreement to go after a small country like us if we do things against their interests. Even law changes like removing the GST on fresh fruit and vegetables could be at risk. Protecting our own health should be our decision, not theirs.

I’m worried for our hospitals. If DHB services are contracted out to private companies, it could be really hard to get these services back in the future. Under the TPPA, we couldn’t do anything that ‘favours’ services owned and supplied by the people, versus for-profit companies. The American health system has been taken over by huge multi-national insurers, and we don’t want to end up in the mess they are in!

Thankfully, it’s far from over. Although the Government is signing the agreement tomorrow, they have to change a lot of law in parliament for it to begin. Every time they do this, we have the opportunity to tell them it’s not ok. We need them to know it’s a really unpopular move for any Government to sign away our rights.

Keeping our independence to decide what’s healthy for our country is keeping our strength. Nurses and health workers in America, Australia and around the Pacific Rim are sending their governments the same message.

Tomorrow I’m standing with them, against the TPPA and for partnerships which protect health and human rights, and I’m asking you to join me.

Details of the rallies against the signing can be found here.

If you want to read up on the TPPA text in more detail, check out my speech notes from the speaking tour on my blog.

November 10, 2015
by NZNO 1 Comment

A visit to MP Jackie Dean

From left: Robyn Hayes, Jackie Dean and Jo Wibrow

NZNO organiser Simone Montgomery and delegates aged care delegates Robyn Hayes and Jo Wibrow visited MP Jackie Dean at her electorate office yesterday. They knew it was the day before Equal Pay Day – the day women in New Zealand start working for free – and were hoping Jackie would sign our Equal Pay pledge. Here’s Simone’s account of the visit:

I met up with a slightly nervous Jo and Robyn for a quick fortifying shot of caffeine, before we met with Jackie Dean the National MP for Waitaki, to invite her to sign the Equal pay pledge. We visited Jackie in her very blue office, she was very personable and welcomed the delegate’s presentation.

Jo wrote a fantastic speech outlining that she has worked as a caregiver for the past ten years, how much she loves the job and works very hard caring for her residents at their end of their life. Jo outlined the sorts of duties she preformed and the emotional toll it can take on you when you constantly loose residents that you have become attached too.

Jackie listened carefully to Jo’s speech and the questions that Jo asked of her. Jo asked, ‘who will be there to look after you?’ ‘Do you agree that the Equal Pay campaign is important for low paid caregivers?’ and ‘Would you please sign the pledge as a show of support for Equal Pay?’

Jackie absolutely agrees with the equal pay principal and totally endorses the Equal Pay Campaign. She also acknowledged that she was in a privileged position where her job does enjoy pay equity.

Jackie shared with us that when she was a student in Palmerston North, she did work as a caregiver and felt very empathetic and understood the nature of the job and that she does think about the question Jo asked, who will be there for her when it’s her turn in an Aged Care Facility.

She did however applaud the manner in which this campaign is being run with no ‘argy bargy’ and harsh actions and felt that this was getting the message out in a very constructive manner. Jackie went on to discuss the fact that there has been significant improvements to the mileage payments for home based caregivers and that all these gains push the door open for further improvements in remuneration for all caregivers.

Jo and Robyn discussed with Jackie their personal situations and that they both do not stay in the job not for the money, but for the love of the residents. They told Jackie what their hourly rates were, the responsibilities they held and that there it is essentially a ‘dead end’ job, ie it does not progress into being an EN or RN. Jo mentioned about a caregiver at Iona that had started when she left school at the age of fifteen and was still there forty years later and she is not paid fairly for her experience and skills.

Overall, Jo and Robyn gave a fantastic and heartfelt presentation to Jackie, but we failed in our goal of getting the pledge signed. However Jackie did keep the pledge and promised to find out if she could sign it and to ring Jo back next week. Here’s hoping.

Update 11 November – we’ve just heard that Jackie Dean has signed the pledge! Great work Jo and Robyn – it really does work when we tell our stories with honesty and passion.

October 20, 2015
by NZNO Leave a comment

Everyone needs work security

By NZNO president Grant Brookes

Last week I was proud to be one of a delegation of 16 NZNO members and staff who attended the Council of Trade Unions Biennial Conference. We all had responsibilities; from running workshops to researching remits and presenting reports.

It was my job to address the remit “That unions intensify our campaigning against insecure work including seeking outcomes through collective bargaining and legislative change”.

NZNO voted in favour of this remit and here’s why.

We see the health impact of insecure and precarious work every day of our professional lives. We see it affecting our patients and some of us experience it ourselves.

When we don’t know how long a job will last,
when we don’t have any control over when we work, or for how long,
when our pay is low or fluctuates,
when there’s no chance to upskill,
when there’s no union representation,
when there’s no protection against discrimination and
when things are unfair and we know we could lose our job without good reason –

That’s insecure work

The World Health Organisation says, “The global dominance of precarious work, with its associated insecurities, has contributed significantly to poor health and health inequities.”

If you were asked to imagine a person in precarious work in New Zealand today, chances are you’ll think of someone like a young McDonalds worker on a zero hours contract. Sadly, precarious and insecure work is widespread.

The aged care sector is another area where rising work insecurity is an issue.

In August, a residential aged care provider in Christchurch tried to change the roster so that no one was guaranteed more than 28 hours a week, with no fixed shifts.

Here are some of the messages NZNO members sent to the manager about what the proposal would mean for them and the residents they care for.

“I feel very stressed and extremely worried about my future, because of this roster change. This clearly means I will lose my working hours, and a rotating roster will make it difficult to catch up with friends because you don’t know one month or two months earlier what your schedule will look like. A big worry for me is I may not be able to pay all my expenses – rent, food, petrol etc. The only option is to pick up shifts, but there is no guarantee for everybody.”

“The proposal will not give me enough hours per week, which makes it really hard for me to pay off my bills. I am on a work visa at the moment. I need a full-time job to renew my visa, not a part-time job. As it is unsure when is my day off, it makes it hard for me to make plans for my family events.”

“Staff will be forced to leave if the changes occur, as management’s proposal will affect each staff member’s earnings. They can easily hire new staff, but the service which the old staff rendered to our beloved people will be affected, as new staff will need to do a lot to know more about the old people’s routine.”

“The company has a policy of ‘person-centred care’. It’s a great shame that this does not extend to its staff. I feel like a cog in the wheel of the machine, just a name on a roster to fill a slot, not a valued, 15-year experienced employee.”

Insecure work is also coming to District Health Boards.

The West Coast District Health Board is currently consulting on a proposal that will affect all nursing staff. If it goes ahead, the proposal could require any member of the nursing team to work in any service, in any role, no matter their specialty or the distance they might need to travel to get there – and don’t forget how big the West Coast is! Nurses could be travelling for hours.

Meanwhile, the three Lower North Island DHBs want to hire nursing staff to work across DHB boundaries. This could see nurses employed by one DHB directed to work in a neighbouring DHB. That’s a really insecure place of work!

The good news is that the roster changes at the Christchurch facility were withdrawn, thanks to the union member’s submissions. Proposals for staff to work across DHB boundaries in the Lower North Island are still under discussion with NZNO and the PSA, and have not been implemented. And we remain optimistic that working in partnership with West Coast DHB will see nurses retaining security around their employment there.

Where unions are present in a workplace, we can often reverse trends towards insecure work.

But the reality is that people in the most precarious employment, who experience the greatest health effects from insecure work, are outside the coverage of collective bargaining and union organising,

So if unions are to campaign against insecure work, which is contributing significantly to poor health and health inequities, the emphasis will have to be on seeking outcomes through legislative change.

This is where NZNO can – and will – join together with our sisters and brothers in the wider union movement to make positive change for all.

October 1, 2015
by NZNO 32 Comments

To the awesome nurse with the pink hair

Louisa Davies is a registered nurses, NZNO member and mum. She is proud to stand up for her colleagues.

Louisa says she wrote this because she had a bit much time on her hands and was feeling really worked up about the situation. Personally, I doubt whether people who are mums, RNs and advocates for fairness ever have “a bit much time on their hands” but I’m thankful Louisa found the time to pen this lovely note to the “awesome nurse with the pink hair”!

To the awesome nurse with the pink hair! You don’t know me, and I don’t know you, but I would just like to take the time to say, “I’m sorry”.

I’m sorry that you have been judged and bullied, I’m sorry that one of the proudest moments of your nursing career, a cover page of our national nursing magazine, has been stripped down by your peers. I’m sorry that your peers have covered their bullying, by focusing their tirade against NZNO, for putting you on their cover, as though this reduces their bullying on you. I sincerely hope that you have broad enough shoulders to brush off these people who feel the need so strongly to comment about you, and realise that they are probably suffering from tall poppy syndrome.

We used to call each other “sister”, (sorry male fraternity) we are predominantly a female workforce, we should not be shooting each other down, but we should be lifting each other up, and celebrating each other’s achievements.

I imagine this nurse probably works pretty hard, probably has been covered in human excrement, just like the rest of us. Probably has spent overtime filling in her documentation, just like the rest of us.

She could probably teach many of us a thing or a thousand about critical care nursing, and she still wouldn’t have taught us all that she knows. The way she has been treated is horrible. She deserves much better than that, and all of those who have been opinionated enough to comment about it should be ashamed. Would you say this to her face?? If not, it is trolling. If you would say it to her face, then you truly are a bully.

Hair colour, piercing, tattoos… None of these make us less than amazing nurses, they do not affect our abilities to care for our patients, their families and our colleagues. They make us real humans, with life outside of the hospital, and our own creative spirits shining through just a little bit.

Be proud nurse Pinky!!! You look beautiful, you look capable and skilled as the wonderful nurse that you are. Frame that cover, and remind yourself every day that you are way better than the people who are pulling you down. Keep up the hard work Sister.

September 21, 2015
by NZNO Leave a comment

Memo Musa – conference address

Last week NZNO held its AGM and conference. This year around 300 delegates and college and section members met at the Museum of New Zealand Te Papa Tongarewa to discuss and make decisions about our organisation, nursing and the wider health sector. We learned new skills, to celebrated our successes and took up the challenges that were laid down.

Our new elected leaders were welcomed and our our departing leaders were thanked for their mahi. One of the highlights of the AGM and conference were the wonderful speakers, from within NZNO, around the motu and throughout the world.

Here is the address given by NZNO chief executive, Memo Musa on the morning of the first day.

Tēnā koutou, tēnā koutou, tēnā koutou katoa

I am Memo Musa, Chief Executive of NZNO.

It gives me great pleasure to welcome you all to NZNO’s 22^nd Annual General Meeting. And to our exhibitors and sponsors who are here today and for conference tomorrow, welcome. I know that Marion and Kerri have welcomed you already but it is important that I do so too.

This is my second report to the AGM on NZNO’s performance during the past financial year.

I hope you have had the opportunity to read our Annual Report 2014/15 and reflect on our operational and financial performance as well as our achievements.

I would like to take a few minutes to take you through some of the key highlights of the year. Before I do so, I would like to comment briefly about the AGM today. You will have seen from the information you received that we have a total of seven remits and twelve policy remits. These should provide us today an opportunity to fine tune some aspects of the constitution as well as debate or discuss policy matters that are important to you and require our collective action as an organisation. I accept that it is a democratic process to amend aspects of the constitution. I would like to sound alarm bells that this can equally create a state of inertia as it makes it difficult to work within rules that are continually changing. That said, some improvement are required.

Back to key highlights from the past year:

We started the year with five priorities.

To increase and maintain membership
To increase the visibility of NZNO’s role as a professional association of nurses
To promote nurses and the nursing profession
To contribute to health sector workforce planning
To improve organisational health

Strong operational management and transparent reporting are critical to the long term success and creation of value. This is why, with support from the Board, during the past two years we have completely revamped the Annual Report to give you more information, detailed highlights, successes and challenges. This provides us an opportunity to celebrate successes and face up to what we could have done better. Often we hear that we do not celebrate or showcase our successes enough.

Now the key highlights. I will only pick a few to illustrate key points.

Increase and maintain membership

The biggest challenge for any member organisation is maintaining membership, let alone increase it. Membership levels have a big impact on the viability and sustainability of NZNO.

The solid work you are doing, including the work by our organisers, industrial advisors, professional nurse advisors and other staff through our organising ethos, models and approaches, including our communication, has resulted in us maintaining our membership numbers at above 46,675 based on 2013/14 year with a very modest increase of 103 members to 46,778 members.

Our biggest growth was in the registered nurse members were we saw an increase of 918 members from the previous year totalling 35,275. This makes up 72 percent of practicing registered nurses. According to the Nursing Council there are 48,406 registered nurses practicing.

However we had challenges with student nurse membership which declined from 4,225 in 2011 to 2,700 by the end of March this year a drop of 36 percent. This a concern we must address.

Fellow colleagues, we cannot ‘rest on our laurels’ when it comes to membership, as during the past five years union membership in New Zealand has been in decline.

In 2010 there was a decline of 2.1 percent

2011 it fell by 1.3 percent

Then 1.4 percent in 2012

By 2013 it had fallen by 2.0 percent and at the end of March 2014 this had fallen by 1.8 percent. I am waiting for the 2015 figures to be published. My guess is that the same trend will continue.

Whilst overall we are doing better than some unions and professional associations we have room to improve.

Increasing NZNO’s role as a professional association

Promoting nurses and the nursing profession

At our AGM last year some of you may recall my report and reflections. I stated that advocacy and lobbying are at the core of what we do to advance the agenda for nursing teams both from an industrial and professional perspective. Being an election year, I observed that on one hand there is a sense that we are not visible, not adversarial or political enough, that we need to be out there and showing leadership on key issues, on the other hand some argue and lament that we are politically biased or in favour of a particular political leaning whilst others say we are negative and adversarial, whilst other say we are doing ok.

The profile of our role as a professional association, promoting nurses and the nursing profession is critical to our future existence at the same par as membership.

Demonstrating relevance and value add to patient outcomes, healthy families and communities should be the cornerstone or platform upon which we build our profile as an association and by promoting nurses and the nursing profession.

I am pleased to report that during the last year we continued to push forward our agenda to promote NZNO, nurses and the nursing profession by increasing our clarity of relevance and value add.

On Wednesday 28 August 2013 the main headlines in the Dominion Post read “Nurses ration patient care” “Families pitch in as staff stretched”. This article reported nursing shortages at Wairarapa and Hutt Valley hospitals stating that nurses are ‘rationing’ their care to patients. It referred to essential care being prioritised over patient ‘comfort’ or ‘non-essential’ tasks.

The following day Thursday 29 August 2013 the main headline read ”Rationed care cuts deep says patients” reporting that ‘care rationing in understaffed hospitals is affecting basic medical needs as well as comfort, patients say.”

There was the usual follow up discussion and debate in the media and between nurse leaders with attention being on nurses’ decisions and actions about patient care when faced with nursing shortages or the wrong skill mix.

What was missing in all the dialogue was the fact that in reality it was not nurses rationing care, it the public health system; the way it is funded resulting in not having enough nurses, inadequate time, and the right skill mix to provide complete care.

Our policy and research teams, with member input and consultation, developed a position statement on Care Rationing which was presented to all District Health Boards, the Ministry of Health and the Minister of Health. This helped change the dialogue and inform the debate on this very complex area which often is very emotive.

You will hear about this more this afternoon.

We also embarked on a project to increase the visibility of nurses of which the first phase establish a theme which is “Nurses – Making the Difference in Healthcare”. A website has been set up where nurses can share stories. You can access this through our website under the campaigns banner. The second phase involves identifying and training nurse champions. A third phase to promote and increase the visibility of nursing is yet to commence.

You will hear more about this in more detail this afternoon.

Another highlight is our work is with the Service and Food Workers Union Ngā Ringa Tota on the campaign for equal pay “All the way for equal pay”. The sterling legal defence work which saw the Court decline Terranova’s leave to appeal on and directing the Employment Court to establish equal pay principles to resolve the equal pay claim.

Again we will hear about this in more detail this afternoon.

One last key highlight under this section is the work we do to represent members, whether it be through Health and Disability Commissioner investigations, employment related matters, Professional Conduct Committee and Health Practitioner’s Tribunal hearings. Approximately 237 ‘events’ were taken up involving more than about 3000 members. We noticed an upward trend in the request for representation and the number of complaint against nurses which are being made to the Health and Disability Commissioner. We have also noticed an increase in the number of nurses that the Health and Disability Commissioner finds in breach of the Code of Health and Disability Services Consumer Rights. Last year we challenged the Commissioner by asserting that some of the breaches could be at the system level not the individual nurses’, and primarily caused by inadequate funding which leads to poor staffing levels impacting on patient care. We asked him what approach he intended to take to address some the breaches we considered to be at a system level. His response was that his concern was “primarily to assess the quality of health and disability services” and the system issues I had raised were better addressed by District Health and and/or the Ministry of Health’. This I found astounding.

Fellow colleagues, I will make no apologies for saying that if we fail to show relevance and to add value it will be to our detriment. Some antagonists might think what we do is ‘all about us’. Clearly that is not true. Promoting the profession of nursing and nursing standards is a key foundation to strive for recognising the mutual interdependency with our industrial focus and that getting the balance right is very critical.

Contribute to health sector workforce planning

I am going to tell you something you already know.

Nursing is the biggest workforce in the New Zealand public health and disability system. According to a report on health workforce released by the Ministry of Health and Health Workforce New Zealand in November last year, nursing makes up about 54 percent of the regulated health workforce in New Zealand, based on annual practicing data of all regulated professions. Internationally there are between 16 and 19 million nurses according to estimates by the International Council of Nurses.

We are the backbone of the public health and disability system. We nurses are everywhere, in patient’s homes, general practice, clinics, hospitals, prisons, community homes, residential care, education, research units, management and leadership, policy development and regulation.

After many years of advocating and lobbying for a national workforce plan for nursing, last year we were successful, together with other nurse leaders, in convincing Health Workforce New Zealand to set up a national nurse workforce programme. Whilst progress continues to be slow, a joint governance group and working group have been put into place. The areas agreed to be given priority attention are:

Improving the integrity of nursing workforce information and data
Graduate nurse employment
Nurse retention
Nursing workforce plan

This is a major step forward. However results are yet to be evident.

On the New Graduate Employment front the online petition urging the Minister of Health to fund a one year Nurse to Entry Practice Programme for every graduate nurse drew more than 8000 signatures in a week. Thank you to all who contributed to this petition. This resulted in two key achievements as steps in the right direction:

Additional funding of $2.8m per annum from this year was granted by the Minister of Health to fund an additional 200 places.

The eligibility period was increased from one year to two years.

This firmly remains on our horizon with a goal of 100 percent funded places by 2018.

We got behind, supported and were involved in the proposal by Auckland University for a funded nurse practitioner education programme linked to employment. It took a long time for this to work its way through the bureaucracy of Ministry of Health and Health Workforce New Zealand. Eventually funding was granted for a programme to commence in March 2016. Auckland and Massey universities will run this programme.

We supported the Nursing Council’s application for nurse prescribing. This is important as an enabler for us to work at the top of our scopes of practice; which in time will result in an increase to access to nurse-led services for vulnerable populations and those with long-term health conditions.

Working with the Fiona Unac, Chair of the Perioperative Nurses College we saw Auckland University endorse a new Certificate of Proficiency for Registered Nurse Assistant to the Anaesthetist.

The work by the Enrolled Nurses Section to develop a dedicated Supported Entry to Practice Programme was completed. Now the challenge that lies ahead is to advocate and lobby for this to be funded.

Lastly we successfully got onto the Governance Group for the Kaiāwhina Workforce Action Plan. This was in response to concerns raised by the Enrolled Nurses Section. We argued that the Kaiāwhina workforce is a continuum of the nursing team, and that it is important that the action plan be developed within that context. This will remain a challenge but we will continue to influence, advocate and lobby.

Workforce development is complex with multiple strands to which we need to be tuned into all the time. There is no ‘one size fits all’ and our messages on these areas going forward need to be targeted at getting results for you.

Improve organisational health

Improving organisational health is controversial and a challenging philosophical concept.

From a financial perspective we are making in-roads into recovering financial losses from the past. We ended the year with a positive financial result which David will present to you later. The Board has worked hard with me and the Management Team to tackle a few areas to manage costs.

We should always be mindful and keep an eye on our financial reserve and not to use them to support organisational operational structures. Alarm bells should ring if we head in that direction.

Our staff are key to the achievements and the highlights I have reported on and those in the annual report. I applaud their commitment and relentless effort, their willingness to go the extra mile to do what is right for members. In response to key pressures we supported our staff by putting more resources into the following areas;

Professional Nurse Advisors, an increase from 7.7 FTEs to 9.1 FTEs with a focus on Hamilton and Christchurch.
Industrial Advisor increase of 0.5 FTE
Finance Office 1.0 FTE

These organisational growth areas are in response to our commitment to get to member issues quickly.

Fellow colleagues from time to time you will hear all sorts from people about what is happening within the organisation.

I will stress to you that you need context and background to know what is going on and sometimes what you hear may not be correct and other times it may be. It pays to contact me directly on operational matters.

In conclusion,

My assessment is that NZNO has done well during the past year. Some of you may say not enough in some areas, and I acknowledge that.

We can never do enough!

Acknowledgements

I would like to place on record my sincere appreciation of the work you have done in the past year and will continue to do this year, the work done on your behalf by our staff and the support of the Board and Management Team.

I will mention again the point I made at last year’s AGM

“What we do comes with its own challenges and tensions but let us remember and work together as united we stand, divided we fall. We are one profession with many roles and voices, we are a collective and together we can continue to make a massive influence. Together we make an effective team.” Together we can be effective in shaping healthcare in New Zealand.

Lastly but not least I would to thank all our exhibitors and sponsors at this AGM and conference tomorrow.

I hope you enjoy the AGM and conference and that you get the best networking opportunities, so you can take away important ideas to innovate and to champion for changes in whatever health setting you work within.

No reira tēnā koutou, tēnā koutou, tēnā koutou, tēnā koutou katoa.

May 26, 2015
by NZNO 5 Comments

The Budget and the MECA

This past week has been a busy one. Thursday 21 May was Budget Day. It’s a day we are always on the edge of our seats, hoping for a plan for health that delivers for our members and all New Zealanders.

And the day after that we held our final meetings about the offer from DHBs for our multi-employer collective agreement. The results of those meetings did not surprise us but what we didn’t expect was the extent to which NZNO members working in DHBs rejected the DHBs’ offer. Over 82 per cent voted no.

This years’ Budget does not provide enough funding to meet the health needs of New Zealanders. In order to meet the costs of rising prices, an increasing population, an ageing population, an ageing health workforce, long overdue decent wage increases, new services etc etc, we estimate the funding allocated is at least $260 million short.

District Health Boards (DHBs) are short-changed by at least $121 million. And we know almost all of them are already struggling to manage massive deficits, meaningless health targets and the continuing push from government to “centralise” services at any cost.

How are DHBs going to deal with the likely flow-on impacts on safe staffing, workplaces that are healthy for staff and patients and quality care?

Nurses, midwives, caregivers and other health care workers are telling us they are already stretched to the limit. Some are having to sacrifice tea and lunch breaks and are working unpaid overtime just to keep up with the care they need to give to ensure needs of patients are met. Support for training and development is decreasing. Stress levels are rising and morale is low.

And it’s not only DHBs that are bearing the brunt of reduced spending. Efforts to reduce poverty related illness are not being tackled in a “joined-up” way.

Health workforce planning is proceeding at a snail’s pace. New graduate nurses are still looking for jobs that aren’t there. Older nurses are still being pressured to work night shifts.

Health workers need a fair deal to cope with the increasing demands that are being placed on them.

And this means we need to stand together to make progress in our bargaining with the DHBs for our multi-employer collective agreement.

NZNO members working in DHBs don’t feel valued. They instructed the negotiating team to retain what’s already in the MECA, secure a decent pay increase, improve access and support for professional development and advance safe staffing and healthy workplaces.

The DHBs’ offer clearly didn’t cut it. They need to do better for their largest group of workers.

We’re heading back into bargaining on Thursday with a clear mandate: the offer must be improved. Nurses can no longer continue to take up the slack for a sick health system.

We can’t do all the work here! DHBs need to take some responsibility for advocating for the funding that provides appropriately for every member of staff and every patient. New Zealanders won’t settle for anything less.

March 30, 2015
by NZNO 6 Comments

Patients’ rights, nurses’ rights

NZNO delegate, Erin Kennedy asks an important question: “Is unsafe staffing a breach of the Code of Health and Disability Services Consumers’ Rights?”

Like most nurses, I am not easily shockable, but I found myself almost speechless last week on learning that three nurses had been forced into the position of caring for 40 patients overnight on a heavy orthopaedic ward. (A pool nurse also came to help for part of the shift.)

NZNO organisers and delegates have argued strongly for safe staffing for years now, but unfortunately, the level of permanent and pool staffing means that staffing levels including skill mix are often unsafe, with sick staff unable to be replaced. The constant push to avoid financial penalty when the 6-hour Emergency Department rule is breached also leads to patients being moved from the Emergency Department to areas where there are simply not enough nurses to care for all the patients safely.

Under the Code of Health and Disability Services Consumers’ Rights, patients have a number of rights, including the right to co-operation amongst providers to ensure quality and continuity of services, and the right to informed consent. The right to be fully informed means information must be conveyed to the patient in a way that enables the patient to understand the treatment or advice. Right 6 of the code states that every consumer has ‘the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive’. Specifically, it states that patients are entitled to an explanation of his or her condition and an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option.

Given the unsafe staffing levels at some of our DHBs, it is high time that explanations around surgery, for example, go further than simply outlining the procedure and its risks and benefits. Patients should ask, and should be told, whether their post operative care will be safe. A “reasonable consumer” clearly has the right to know whether their recovery might be hampered because of unsafe staffing. Certainly, if I have surgery any time soon, I will be asking whether there are enough nurses rostered on to provide all of the care I and other patients require. Will there be enough staff to ensure that I can obtain analgesia or other medications on time? Will the nurses be able to check my vital signs often enough to notice if I am bleeding, or have arrested or need medical intervention? If I need help mobilising to the toilet, will there be someone to help me or will I risk a fall and further injury? Will there be someone to answer my call bell if I need help?

Nurses do not like being forced to ration care, but until all DHBs accept that in many instances staffing levels are unsafe (for both patients and nurses), it is a fact of life and one which can seriously impact patients’ wellbeing and recovery. Not warning patients that their post-operative care may not be optimal, and could be downright dangerous, is, in my opinion a breach of the code.

March 10, 2015
by NZNO 1 Comment

Employment law changes – the long answer

A couple of days ago, on Facebook, a member asked what NZNO were actually going to do about the changes to employment law, apart from posting stuff on Facebook.

Well, good question. The short answer is lots! The long answer is… longer – I’ll make a start here and see how far I get today.

The first thing I want to stress is that NZNO is its members. We are a member-run organisation. That means staff are essentially employed by members, through their membership fees. The strength of our organisation comes entirely from how many members there are, and how willing those members are to get involved in the work of the organisation.

Thousands of NZNO members are workplace delegates, thousands belong to Colleges and Sections. Thousands are active sharing information and having discussion about our issues on social media. Many inform themselves and their colleagues by reading our monthly publication Kai Tiaki Nursing NZ. We have a Board of Directors and a Rūnanga elected by NZNO members. You can be as involved as you want to be.

NZNO is as strong as its membership.

So – the next bit of the answer is about the changes to employment law. They are wide ranging changes that have been touted by the Government as fair, reasonable and just “tweaking” things. If only!

These changes have the potential to drive wages down, increase poverty and tip the balance of power between workers and employers firmly into employers’ hands.

We have been fighting these changes for a long time. In 2013 over a thousand NZNO members wrote submissions against the Employment Relations Amendment Bill to the Transport and Industrial Relations Select Committee. Over 10,000 submissions were received by the committee. I can’t remember the exact numbers but something like 98% of the submissions received were against the changes being proposed.

The Government didn’t have the numbers to pass the legislation last year, but it was first on their agenda after the Election.

We have been working hard along with the Council of Trade Unions and other health unions over the last 18 months to mitigate some of the worst changes of this new employment legislation.

Our risk assessment when the changes were first signaled showed us that our vulnerabilities were most focused around three key areas of the Act:

The 30 day rule is repealed

This means that new employees who are not union members will not be covered by the collective agreement even if their job comes within the coverage clause. Until last week, new employees were covered by the collective agreement in their workplace for the first 30 days. This protection is now stripped away so a new employee can be they can be paid less than the collective agreement right from the start. Over time this will reduce everyone’s pay and conditions.

Employers opting out of MECA bargaining

Employers will be able to opt out of multi-employer collective agreement (MECA) bargaining. An employer who seeks to opt out of MECA bargaining must give written notice to all intended parties to the bargaining within ten days of receiving the initiation notice. This could dismantle MECAs that have brought steady improvements in pay and conditions for NZNO members over the years.

Removing the duty to conclude bargaining

It is no longer a breach of the duty of good faith to fail to enter into a collective agreement.

Employers are now able to apply to the Employment Relations Authority to declare bargaining is over. Once that happens:

employers will be able to put pressure on individuals to agree to lesser pay and conditions
industrial action will be unlawful for two months

Here are a few examples of what we have been doing and will continue to do to address these attacks on workers fundamental employment rights.

We have been implementing our strategy to address both the 30 days and the conclusion of bargaining issues with new clauses in our collective agreement bargaining over the last 12 months and this work is ongoing as collective agreements reach the end of their terms.

We have been including in bargaining clauses to address the issues around conclusion of bargaining.

We will be back around the computer making sure initiation of bargaining for collective agreements is undertaken at the soonest opportunity and that conversations happen with employers around this matter to ensure coverage of collective agreements remains as it is currently.

Our sector groups (DHB, Aged care, Primary health and Private hospitals and hospices) have been identifying strategies for each particular sector.

We have developed resources for organisers to discuss with delegate the process for new employees.

We have been able to initiate all our MECA bargaining prior to the Act coming into force and maintaining collaborative relationships with as many employers as possible to secure our future MECAs and national collective agreements.

We have been participating in conversations with the CTU around the Code of Good Faith.

We have been educating our delegates and members through the Bad Medicine Campaign, delegate training and other processes.

We are strong, growing and ready for the future. We need to maintain the upmost vigilance with our employers who we have collective agreements with – we have learnt from the 1990s that our aged care employers pose the greatest risk in this type of industrial relations environment. We have been here before and thrived.

Kia kaha. We will build power through our unity.

Talk to your NZNO delegate or organiser if you’d like to become more involved.