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Unmasking the evidence

Coughs_and_Sneezes_Spread_Diseases_Art.IWMPST14133Many DHBs have been talking about forcing staff who don’t get the flu vaccination to wear masks.

It’s one of those things that on first glance might seem like a good idea, but peel back a few layers and you’re left with the bitter taste of a purely punitive measure.

NZNO acknowledges the right of every person to vaccinate or not. We encourage it, of course; to the extent that we pay for our own staff to get the flu vaccination if they choose to. Healthy workplaces are a priority. We believe education and access are key to improving uptake but we do not think mandatory vaccination is the way forward.

DHBs want safe environments for their staff and patients too and we applaud that. What we’re saying is the DHBs are grabbing onto a “solution” that’s not evidence-based and seems to be designed to shame individuals rather than keep staff and patients safe from the flu.

We do not support the use of face masks to protect patients from unimmunised nurses.

For one thing, masks don’t work. Evidence shows masks are ineffective in protecting healthcare workers from patients with flu; so why do DHBs think the opposite would be different?

For another – a nurse with the flu would only be able to pass it on to a patient or colleague if he or she was at work. Nurses should not be working, or be made to feel that they should have to be at work, when they are sick. DHBs need to make sure enough staff are available to cover the inevitable rise in sick leave during “flu season”.

And it’s not just nurses. There must be clear information for patients, staff, contractors and visitors that sick people should stay away.

DHBs should also be promoting good hand washing and the use of tissues for coughs and sneezes.

Our motto is “Freed to care, proud to nurse” and we want that for every single NZNO member. Please don’t hesitate to give us a call if you are being treated unfairly 0800 28 38 48.

Here is NZNO principal researcher, Dr Léonie Walker’s analysis of the evidence for and against masks to protect against flu.

Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use are not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%1.

The efficacy of any respiratory device depends on user compliance. Workers’ tolerance for wearing most types of respiratory protective devices is poor and often declines over the course of a work shift; in one study, no more than 30% of workers tolerated these devices consistently throughout an 8-hour workday, citing difficulties with speaking and communication, discomfort, and other physical problems2.

The Institute of Medicine committee has recommended that current Centers for Disease Control and Prevention guidelines for respiratory protection be maintained3. Until more data are available, the Institute of Medicine committee recommended the use of personally fitted, N95 respirator when confronting patients with influenza-like illnesses, particularly in enclosed spaces4.

1Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect Control (2008);36:276-282

2Radonovich LJ Jr, Cheng J, Shenal BV,Hodgson M, Bender BS. (2009) Respirator tolerance in health care workers. JAMA ;301:36-38

3www.cdc.gov/h1n1flu/guidelines_infection_control.htm.

4Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D (2009) Novel H1N1 Influenza and Respiratory Protection for Health Care Workers N Engl J Med 361:1823-1825”

 


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Patients’ rights, nurses’ rights

stress-feature01NZNO 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.

 

 

 


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MECA reflection

IMG_0313Jemma Irvine is an NZNO delegate at Wellington Hospital. She reflects on what the DHB MECA means to her.

I became an NZNO delegate last year and I attended the MECA training day in February 2015.

Can I just say, I am soooooo grateful for all the nurses who have fought hard for their rights up until now.

Some of the other nurses in the group were sharing their stories of what it has been like nursing in New Zealand over the past 20+ years. It sounds like they have had some pretty big ups and downs. Some nurses were talking about when their hospital board decided to dissolve all of their jobs and make them reapply for their positions. Some nurses weren’t rehired. Some were hired back as team leaders instead of Charge Nurse Managers and therefore on a lower wage. I couldn’t quite believe that this could happen!

Budget cuts affect everyone, but nurses often carry a higher portion of the impact. They work hard to try to do the same amount of work with less staff and fewer resources – always thinking of their patients before themselves. Over time this takes its toll. It’s not sustainable to always be working beyond your means. Something has got to give.

At one point there became the need to strike. These nurses talked about what it was like to strike. They shared the emotional impact, the feelings of guilt when standing on the picket line knowing their patients were still inside. It was not an action taken lightly. All of them said it was hard and they would not have done it if they felt that they could have kept going the way things were. I admired them so much for making a stand to improve their working conditions and fight to be able to give patient’s the care they deserve.

I know strikes are difficult for everyone, but I really appreciate being able to benefit from the hard work these brave people have put in to improve conditions for all of us; nurses, midwives, health care assistants and, most of all, patients.

Hearing some of these powerful stories made me so proud to be a nurse and I feel very privileged to start nursing in this current work environment. I am so grateful for our DHB MECA that means our conditions are able to be protected and we are treated (for the most part) fairly.

I know we are going to have to stand up to keep our working conditions in the near future as the DHB and NZNO try to come to and agreement about our MECA. I want to take this opportunity to thank the ‘oldies’ (meant in the most respectful way possible!) who have paved a lot of the way for us.

Thanks so much!

Love from a grateful, inspired young nurse.


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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.