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What does the DHB MECA mean to me?

20150310_154113Kimberley McAuley is an NZNO delegate at Waikato Hospital. She was asked to speak at the event held there yesterday celebrating 10 years of the DHB MECA. This is her speech. We think it’s fantastic!

To be truly honest with each of you present today, when I was first asked to present a small talk on what the MECA means to me, at the birthday party celebration of the 10th anniversary of the MECA, I was a little taken back because: a) public speaking is not one of my strongest points, and b) I was actually going to have to really contemplate and reflect on this question.

Firstly, before I let you in on what ‘the MECA means to me’, I will introduce myself to you all. My name is Kimberley McAuley. I am a registered nurse, I work in the main operating theatres for Waikato District Health Board and I am an NZNO delegate for my workplace and have been for the past 6 months.  I have been a registered nurse for only three years, so less time than the MECA itself has actually existed.

To be quite frank, for my first two years of practice as a registered nurse, or at least the first year anyway, I had no idea what the MECA was about, let alone what it meant it me. I’m not actually sure if I knew the MECA even existed. However, over the past year I have really come to develop a deeper understanding and appreciation surrounding the MECA and the value that the MECA has not only for nurses, but additionally for our HCA and midwife colleagues as well.

For me personally, the major underpinning of the DHB MECA is the element of unity. The MECA is what holds us all, as nurses, together. The MECA works to ensure that we, as nurses, are ALL looked after.  The MECA ensures that we have decent pay, and decent conditions of work. The MECA ensures that we, and all nurses in DHBs throughout New Zealand, work under the same terms and conditions.

Personally, I can vouch and admit that at times, I don’t feel that I get the salary that I deserve when I think about the hard work that I invest into my role as a theatre nurse; the extra hours that I do, and the heart, soul, dedication and passion that I put into my tasks and responsibilities on an everyday basis. I can additionally vouch for the fact that often, and very often of late, feel that I do not have adequate conditions in my workplace. However, without this unifying MECA that we all belong to, I believe all of our workplaces and related factors to our workplaces would be a lot worse of without our MECA. This multi-employer collective agreement, in my eyes is the glue that sticks us all together, and what unifies us all.

So, to conclude, I would just like to say a big happy birthday to our MECA and long may it prevail and be there for us!

 


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A demand to be taken seriously

dilbert-ceo-payNZNO delegate Ady Piesse is an activist for fairness at work and an advocate for collective action. This blog post has previously been published as a comment on Facebook. 

I’m a thinker….I think a lot. Sometimes I’m accused of over thinking, but generally my thinking usually provides me with ideas or helps me problem solve.

So, a couple of weeks ago, I got to thinking – what do I do in my job that is so different from my CEO’s that justifies our salaries?

At the start of every shift I check my equipment so if that cardiac arrest, acute SOB, trauma or the blue floppy baby arrives unannounced, I have the confidence that myself and my colleagues will be able to use that equipment to potentially save a life.

My CEO makes sure his lap top ‘on’ button works.

I monitor numerous pieces of equipment attached to my patients, checking for those spiralling trends so I can intervene early if I need to.

My CEO monitors computer screens that check to make sure my patients are meeting the six hour targets.

I do ‘end-of-bed-o-grammes’ all day every day, with new patients, existing patients, other nurses’ patients, to monitor change, deterioration or improvement.

My CEO looks at spread sheets to see how hard I’m working or how much harder I can be made to work.

I hold in my hand medication that has the potential to kill or to cure.

My CEO holds a pen, an iPhone.

I sit holding a patient’s hand while a doctor tells her and her family her condition is terminal. I hold a child’s hand. I hold the hand of a terrified patient who can’t breathe. I hug people I only met today and know won’t be here tomorrow.

I don’t know if my CEO has ever held a hand or given a stranger a hug.

Every day I take home people’s stories; for some it will be the worst day of their lives. These people have faces and I know some will never leave my memory.

My CEO takes home statistics.

Some days I leave wondering if I have it in me to keep doing what I’m doing – less is not more in my job – but my CEO seems to think so.

I know it’s all more complex than that.

I use my knowledge and observation skills to think ahead and intervene early to avoid a failure to rescue situation, my CEO uses their knowledge and observations to think strategically, for example.

What I’m thinking doesn’t take away from the important role my CEO plays in the day to day running of my organisation, but thinking simply – that’s about the bones of it.

Then some more thinking. I play a damned important role in this organisation too, so how is it I only get paid maybe a quarter of what my CEO earns?

And why should I feel guilty or scared of standing up and asking for more? So I’ve decided I owe nobody an apology for feeling the way I do.

More thought. Stand up and be counted, get as many colleagues on board as I can to speak out and say enough is enough!

I’ve become quite vocal in the past couple of weeks –I’ve decided to stand up for myself. I’ve realised that complaining to colleagues is not going anywhere. We need to be the very visual faces behind our MECA.

I’m guilty like many of having not gone to meetings in the past, been so apathetic to expect Government and the Boards to realise my worth and support me accordingly – I’ve been ridiculously naive! I know there are many colleagues feeling the same way and I’m hoping my ranting will given colleagues the confidence to stand up too and speak out for change!

MECA representatives at these current negotiations can only push the “we’re serious about this…” boat so far – we need to make ourselves visible to Government and our Boards and not just ask, but demand to be taken seriously,  otherwise we have another long three years of the same and more than likely, a lot worse to come.

So, be at those MECA meetings that are coming up and come with ideas! It’s time we got tough!

 

 


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Give us a hand

washing_handsThis blog post was written by an experienced NZNO delegate at Hutt Hospital.

Just when I thought the morale at Hutt Hospital couldn’t sink any lower and staff had had enough of negative reporting, last week saw yet another damming media report.  Hutt Hospital staff do not wash their hands as much as other hospitals, earning the unenviable accolade of being the dirtiest hospital in the country.

As a registered nurse at Hutt Hospital, I felt personally affronted, not only by the report which I felt beggared belief, but also by the derogatory, insensitive and extremely hurtful social media comments that resulted. I take my personal hygiene seriously. I want to reduce risk to my patients and reduce the risk to myself. I do not want to inflict unwanted bugs on my family.

I was hoping Management would respond quickly to the article in our defence (and surely they must?), providing reasons which could have contributed to the findings and reassuring the general public and staff that processes are in place to change these worrying statistics.

I’m also disappointed there has been no public apology about the article that accused nursing staff of ‘hiding beds and manipulating Trend Care data’ – albeit we were reassured management were misquoted in this article but the public are still waiting to hear this.

I’ve worked at Hutt Hospital in varying roles for the past 13 years and am concerned about the low morale. I’ve seen colleagues having full blown anxiety attacks, staff in tears because they feel at their wits end and “just can’t do this anymore”.  Many staff have already left and the rate of resignations is climbing and picking up speed. In the meantime we’re constantly being told that we need to work harder, smarter, faster.

This all comes hot on the heels of being told last week through the media that DHB CEOs been given a huge pay rise – up to 48%! Many view these pay rises as obscene and totally immoral in today’s economic climate.

We can’t go on like this. I hope HVDHB start implementing  strategies to support staff to be able to provide the high level of care we want for our patients.

 


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$180,000 pay rise? Yes please!

money_graph_pointing_upYou’ll remember before Christmas NZNO started talks with DHBs about negotiating a new collective agreement.

Our negotiating team is well prepared with evidence of how overworked, under staffed and stressed our hospitals wards are, and how inadequate planning with too few staff has the potential for poor outcomes for patients.

None of this is news. It’s the reality of nursing in a sick health system, and the solutions are clear, available and achievable.

We’ve got evidence that shows when a hospital has the right skill mix of staff in the right place at the right time, providing the right care with the right resources, everyone wins. Patients receive better outcomes and nurses have satisfaction in providing better and more timely care.

We all know that when you’re treated respectfully at work and remunerated fairly, when you can take leave to rest and rejuvenate, when you’re able to actually take a day off when you’re sick – everyone benefits. And when I say everyone, I mean staff, patients, the hospital, the budget, the health system.

What is news, though, is hearing that most DHB chief executives received pay rises of between $10,000 and $180,000 (in some cases, pay increases of up to 45%) in the last financial year!*

It feels pretty demoralising to know how much DHB chiefs are valued and how little value is placed on their staff. NZNO members working in DHBs are expecting a paltry pay offer of 0.6 – 0.7%.

Something is very wrong with this picture.

I expect if we asked each DHB why their chief executive received such a large pay rise, they would have an answer down pat. And I suspect, if we asked them how much they think their staff is worth, we’d receive a heartfelt statement of gratitude for the wonderful work we do and a sob story about how they wish they could pay us what we deserve but….

Belonging to NZNO is a good way to start making a difference. If we want a different ending to this story, we are going to need to write it ourselves.

Our team will be heading back into negotiations soon. There are 10 of them. There are 48,000 of us!

If we work together, take the hard decisions when required, stand strong beside each other, and let the whole country know what we need and WHY – we’ll get the outcome we, and every patient we care for, deserves.

*Pay scales for DHB chief executives are set by the State Services Commission.


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Together we can win; for ourselves and our patients

IMG_1527A message from NZNO industrial adviser for the DHB sector Lesley Harry.

“Meetings are underway at all DHBS to endorse the recommended issues for negotiations as well as the negotiating team and ratification procedure. We know achieving your key issues will not be easy because the DHB’s bargaining parameter is not enough to deliver on your key issues. Please participate in the endorsement meetings and activities and support a decent outcome for all of us.

Together we need to convince the Government to fund DHBs adequately so you are better able to provide quality care for your patients as well as receive a decent pay increase.”

Grant Brookes is an NZNO delegate at Capital and Coast DHB and member of the negotiating team for the 2015 MECA bargaining. He talks about his experience attending several endorsement meetings.

NZNO members working in the DHB Sector are now over half way through a nationwide series of meetings on our Multi-Employer Collective Agreement (MECA).

Next month, we’ll start negotiations for a new MECA. These will not only shape the working lives of more than 25,000 nurses, midwives and other health workers, the negotiations will also influence the quality of care provided by the public health system.

Last week I went to six of the MECA meetings across a couple of DHBs, and not just to vote (only once, of course!) on the issues for negotiation, on the makeup of our negotiating team and on the ratification process we’ll use to accept a settlement.

As a member of the proposed negotiating team, I also attended to get a feel for members’ issues in person, so I could better represent them.

The main issues for negotiation proposed at the meetings are:

  • Wages
  • Safe staffing and healthy workplaces: Care Capacity Demand Management (CCDM)
  • Sick leave
  • Fairness at work
  • Professional development and PDRP/QLP allowances and
  • Outstanding issues from the previous MECA negotiations

Although we will be negotiating with DHB representatives, all of these issues are ultimately influenced by Government.

Towards the end of each of the meetings I attended, the presenters read out the following statement:

Today we have set out the issues that are deeply and widely felt by members as well as highlighted the under-funding of health and nature of recent wage increases in the DHB sector. The financial parameter for 2015 bargaining is almost certainly going to be insufficient to address all of your issues. We anticipate negotiations will not be easy and delivering an acceptable outcome will require all of us working together and likely will need to involve our communities to achieve your goals”.

In other words, we will probably have to convince the Government to increase funding for the DHBs. How successful we are will depend above all on how deeply members believe that our goals are fair and reasonable, and how many people actively participate in our campaign.

Already, many thousands have taken part by filling out and returning the MECA issues survey – an impressive number, especially considering it was the very first campaign activity.

Momentum appears to be building. Signs so far suggest that the current round of MECA meetings have had high turnouts. Discussion of the DHB MECA campaign by delegates at the NZNO AGM last month revealed a strong determination.

Common themes have emerged in discussions at the half dozen meetings I’ve attended. There is a sense that nurses have fallen behind. There also seems to be a feeling that we exercised restraint in MECA bargaining in 2010 and 2012, in response to the Global Financial Crisis and the Christchurch earthquake, and that now it’s time for health to take a higher priority.

If you’re an NZNO member working in a District Health Board and you haven’t been to a meeting yet, get along to one this week. The details of upcoming meetings in your area are at http://www.nzno.org.nz/dhb.

There you can show your support, like the Wellington Hospital members in the photo, for this solidarity statement:

“Together we can win more pay in our pockets, decent professional development opportunities and safe staffing to ensure quality care for our patients”.

 

 


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8,000 signatures! Petition goes to Parliament.

Today we took our 8,000 strong petition calling for a nurse entry to practice position for every new graduate nurse to Parliament. Ryan Boswell from TV1 and his cameraman were waiting to find out what was going on.

You can see the ONE news piece here: Desperate nurses call for jobs action

NZNO president Marion Guy talked about the nursing shortage New Zealand is facing – we will be short more than 15,000 nurses by 2035!

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Kaiwakahaere Kerri Nuku explained how important it is to have a homegrown nursing workforce. We need nurses who are representative of our population; that means we need to train and retain way more Maori and Pacific nurses and rely less on internationally qualified nurses.

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We had a quick photo with the petition before Marion, Kerri and our CE Memo Musa went into the Beehive to meet with Minister of Health Tony Ryall. An entire class of school kids spontaneously joined us!

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Marion, Kerri and Memo head into the meeting.

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The rest of us, enrolled nurses, registered nurses, student nurses, new grads, delegates and NZNO staff, unfurl the petition. It’s massive! 8,000 signatures takes a lot of paper to print.

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While a few members roll the petition back up, the reporter talks to new grad, Kim Lane. Kim talks about what it’s like to spend years getting a nursing degree and have no job to go to at the end of it. Madness! We’re going to need every nurse we can get in a year or two…

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Here’s hoping the Minister sees the sense in what we’re asking for. The nursing workforce must be a priority.


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Referrals from ED to primary care

B7_emergencyIn a bid to reduce patient numbers Southern DHB announced this week that it would implement a new system in its Emergency department, where patients not deemed in need of urgent medical attention would be asked to see their GP instead.

Those unable to afford to see their GP would be issued with a voucher. Southern PHO would be the partnering community provider of GP services.

Southern PHO head, Ian Macara wasn’t keen to publicise the vouchers though:

”We don’t want to set up a free service – that all you’ve got to do is trot down to your local ED and get a voucher and away you go.” 

The new Southern DHB system proposes that a triage nurse (if comfortable to do so) would have a conversation with a patient and ‘encourage’ them to see a GP instead. If cost was a barrier a voucher could be issued.

Southern DHB says they are not turning patients away, merely “offering the patient the choice of an alternative treatment provider.”

NZNO was asked our view of the new system. Our answer is – it must comply with Ministry of Health guidelines on the interface with primary care.

Making sure every single New Zealander has access to Emergency Departments is a fundamental part of our public health system.

The decision to treat someone in ED or redirect them is a clinical decision with clinical and professional accountabilities for the health practitioner.  We all know what happens when something goes wrong!

According to the plan, the burden of this work will fall on registered nurses.  Our members were not part of the design of this local system and we fear they may be pressured to reach targets, either of acuity or numbers of patients seen in ED.

Not only that, but the system is counter to the Ministry of Health NZ guidelines on the interface with primary care, which includes the important proviso that ‘encouragement’ to leave ED and make an appointment with a GP instead should not occur at the triage stage of the process. Triage does not accurately determine the appropriateness of a patient’s condition for presentation at either the ED or primary health care.

The Ministry of Health guidelines also state that the NZ public will not be declined care in emergency departments.

If the system does not change at Southern DHB, patients will not receive the assessment/diagnosis that must happen before a decision is made, triage nurses will be at risk and their workload will increase greatly.  This is not good for patient safety.

Nurses should have been part of the planning for this process and now need to have education on the redirection process, including the understanding of professional accountabilities.

NZNO will be working with Southern and other DHBs to ensure patients and staff receive high quality care, where and when they need it. The College of Emergency Nurses NZ -NZNO is drafting a position paper to detail responsibilities. We’ll link to that when it is finalised.

Below are the relevant sections of Ministry of Health’s 2011 guidelines on the Interface with primary health care.

2. Referring patients from ED to primary health care for ongoing care

2.4  The extent of ED care prior to referral to primary health care will vary, but the guiding principles should be that sufficient assessment/care is undertaken so that ED staff are satisfied that the patient is clinically:

  • safe (a need for alternative or more urgent care does not appear to be needed);
  • comfortable (distressing symptoms are addressed); and
  • appropriate (sufficient diagnostic work-up has been done so that there is reasonable certainty that primary health care is best suited to continue the patient’s management).

4. Identifying and referring patients for whom primary health care is better suited to meet their needs

4.4  However, referral to primary health care may occur if further clinical assessment determines that primary health care is better suited to meet the patient’s needs. This clinical assessment must be over and above the usual triage process and should ensure that the criteria in paragraph 2.4 are met. In addition, referral to primary health care in this context must:

  • be facilitatory and not against the patient’s wishes (ED care should not be denied);
  • be based on a high level of comfort from the assessing clinician that referral is best for the patient (the assessing clinician must not feel any institutional pressure to ‘refer’ patients to primary health care and must be protected from any undue risk associated with the referral of patients); and
  • occur in the context of a responsive primary health care service (the patient must be able to be seen in primary health care in an appropriate timeframe for their condition).

 


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Apology needed, stat!

Apology - Street ArtLast week an odd article appeared online and in the Dominion Post praising Hutt Hospital for taking on the lessons of Unilever soap factory.

Along with description of the hospital’s new “nerve centre”, with its centrepiece of four huge screens displaying brightly coloured speedometers, bar graphs and traffic lights, there were some other, more depressing, comments as well.

Hospital manger Peng Voon implied that staff were regularly dishonest; “hiding beds”, lying about the time scheduled to change dressings and saying that a culture change was needed.

While there is no doubt that the new system means things are working more smoothly, it is absolutely no fault of the nursing team that they weren’t previously!

At NZNO we hear about stressed and overworked nurses with not enough resource to consistently provide the quality of care they wish to. At the DHB, overtime has been stopped (unless pre-approved), so nursing staff are absolutely at breaking point.

I have heard that the awful comments made about them have brought some nurses to tears, and others to anger. What a shame that what could have been a positive article for the hospital and staff should have been ruined by the undermining comments of someone who seems to have lost her faith in nursing.

Nurses at Hutt Hospital want an apology and we at NZNO certainly think they deserve one.

Apparently the Chief Operating Officer, Peter Chandler has apologised for the comments on the hospital intranet but that’s not enough. The comments were made publicly, to a readership in the tens, if not hundreds, of thousands – his apology must be made publicly too.

Hutt DHB, your staff deserve an apology, stat!

 

Photo credit: Phil King via Flickr


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A message to nurse managers

A message to nurse managers from NZNO acting professional services manager, Hilary Graham-Smith. Hilary has had a long career as a registered nurse working in primary health care and as a Director of Nursing in primary health care.take a chance on a new grad

“A sustainable, fully utilised nursing workforce is NZNO’s number one priority.

We also want a sufficiently funded nurse entry to practice (NEtP) programme so that 100 percent of our new graduate RN and ENs are employed and appropriately mentored and supported during their first year of practice.

The current nursing workforce has a vital role to play in that. Sadly, we still have a significant number of new graduates who do not get into NEtP programmes who are looking for work – they need our help.

We know that many of your work environments are stretched by less than adequate staffing and we hear many of you say, “We haven’t got time to preceptor new graduates”. However we all have a role to play as experienced nurses to make sure that our new grads are welcomed into the workforce; our collective experience and expertise will help to grow the nursing workforce of the future.

I encourage those of you who are in decision-making roles and involved in recruitment to stop and think for a moment before deciding NOT to offer a job to a new grad; so many of the responses to Keren MacSween’s story were from new grads who had been turned down because of a lack of experience.

I ask, isn’t that our role? – to make sure they get experience in an environment where they can not only learn from others but share their new knowledge. New grads don’t come without skills they just need time to grow their self-assurance and confidence in clinical practice.

Remember how that felt – being the newbie RN or EN? This is about nurses doing it for nurses and the wellbeing of the whole profession.

So think about it next time a new grad applies for a job in your ward/unit/ department – give them a go. Go on you know you want to!”