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Playing politics with safety statistics

IMG_4303Over the last few days there has been a roaring debate over changes to health and safety law. The law was revised after the Pike River disaster claimed 29 lives. The Independent Taskforce on Workplace Health and Safety said “The number of people harmed at work is about enough to fill Eden Park four times. This is simply not good enough.”

The changes were supposed to reduce the unacceptably high rate of preventable workplace injuries and deaths (our rates are six times that of the U.K.) but instead, the Government is actually reducing the requirement for Health and Safety Representatives at workplaces, instead of fixing the law. They are removing this vital safety check from all businesses with under 20 staff, even if the employees request one, except for ‘high-risk’ industries.

Some of the industries the Government has classified as ‘high-risk’;

  • Rabbit breeding
  • Lavender farming
  • ‘Amusement’ like mini-golf and video-game parlours
  • Dog racing
  • Fur dressing.

Some of the industries that the Government has not included as ‘high- risk’

  • Beef, dairy, deer and poultry farming
  • Tree-pruning
  • Work in mental health, addictions, prisons or dementia units

How can this be?! The Government has categorised industries according to figures for workplace deaths and accidents since 2008. But the way industries are grouped seems suspicious – ‘cattle farming’ is separate from ‘other livestock farming’ for example. We know that farmers are just one of the groups who lobbied the Government to water down the bill. And it is not clear at all how the industry categories and statistics have been put together.

The only health industry listed is ‘Pharmaceutical and Medicinal Product Manufacturing’ under ‘Potential for Catastrophic Risk’ (!).

It is absurd that the Government has missed all other kinds of health work when, for example, there is an average of one physical assault on staff every day at Capital and Coast District Health Board. It’s not dissimilar in other DHBs; Waikato DHB reported 85 physical assaults on staff and 132 total assaults in the first four months of this year.

Nursing in challenging environments like prisons requires a very high level of skill and a high degree of personal risk. Any clinical health work can be physically challenging, with intense lifting, turning, and physicality, as outlined in our last blog on nurses’ health and safety.

Finally, not all workplace harm gets accurately recorded as an ‘injury’. High stress and workloads are recognised as common workplace hazards that cause physical and mental harm if not managed properly. Environments like hospices, oncology units and crammed emergency departments all have the potential to pose high risks to staff well-being.

It’s never going to be possible to eliminate every risk to health and safety. Health and safety depends on many different elements that are unique to each workplace. That’s why Health and Safety Representatives are so important for all workplaces.

Bending to the will of powerful lobbying interests will always result in wacky outcomes, but there is a simple answer that makes sense: one health and safety law for all.

 

 


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Working to stay safe

Fb picYou’ve probably heard a lot in the news recently about the Government’s back-track on improving health and safety laws. After the Pike River tragedy the Government promised to improve health and safety legislation – so that no family would ever need to have the police turn up and tell them that their loved one was killed on the job – but instead they’re doing the opposite.

We speak to a nurse about what health and safety means to her.

Why does Health and Safety mean so much to you as a nurse?

Firstly, for us in hospitals, I know lots of colleagues that have had accidents at work, twisted knees and backs from lifting. There’s an immediate loss of earnings for that person, they’re down to 80 percent of their earnings on ACC, because our DHB doesn’t top them up, unless we use our sick leave allowance. And then someone on ACC isn’t usually replaced with another staff member, so we get short on the wards.

What happens then?

The first thing to go is meal and tea breaks. Nurses are terrible about working through without taking a break and just running between patients. Then, they’re likely to have more accidents because they are rushing, or even make medication errors or errors of judgement. So it starts having an impact on patient care too. And care rationing definitely happens when you have a staff member off injured. That’s when you decide what is going to keep people alive versus the best care you could give someone.

Can you give us an example?

Like, if you have someone who needs a shower, an elderly patient who hasn’t showered, giving that gentleman a shower might take 40 minutes, but you just can’t afford the time. Basic care like that could get missed. It’s so much easier to prevent accidents from happening than dealing with the flow-on effects of when they’ve happened. That’s why having effective Health and Safety strategies is so critical for everyone. Not just in big workplaces too but in all healthcare settings.

You deal with workplace accidents when people come in as patients too, right?

What people have to understand is that Health and Safety matters to nurses not just for our own workplace but because after a workplace death or accident, we have to come in to fix up the mess. It’s incredibly stressful dealing with a workplace death. When you clock off at the end of the day, it goes home with you. Every accident or death like that has ripples that go far afield and affect many people. And they come back to us too.

What you mean by ‘coming back to you?’

Oh, nurses treat the aftermath of those things with grieving friends and family too, in areas like addiction or depression. Or even poverty, some whole families have to deal with the grief and being thrown into sudden poverty. And then they’re back in the health service with stress and diseases that wouldn’t have happened if their family member wasn’t killed or injured. It’s never just one person affected, and it’s health staff as well.

It’s not just deaths, it’s accidents. Not everyone is covered by ACC so sometimes it’s a choice between their health and their income. When you see a bad employer that thinks workers lives don’t matter a lot it’s really disgusting and you know they think it’s going to cost less in dollar terms to just replace a killed or harmed worker than to invest in health. It costs the rest of us though, we pick up the tab.

There was a case recently, a woman who worked for a really well known New Zealand company, one that’s won awards, that you’d think could do better. She’d hurt herself at work. The operation was the only chance to avoid a permanent disability, but it entailed time off.  She told me that she couldn’t take time off because her boss wouldn’t keep the job open, and she wouldn’t get another one.  She had a family to support and felt she had no choice.  I’m pretty sure she would have gone straight back to work, and as a result of that will have an avoidable and permanent disability.

Do you have a message for the Government about the Health and Safety Reform Bill?

‘Yeah but you can’t print it! No, seriously, good health and safety reps can prevent these kinds of accidents when the attitude to them is positive and constructive and management takes them seriously. The Government has to give the message that they’re important and can’t be removed if they’re a ‘nuisance’ to bad management. We have to look at workplaces where they have health and safety committees that work and where there is a good record of improvement. What works is when unions and workers and employers are doing it right and engaging together. We didn’t have to lose all those lives and Pike River and we shouldn’t be losing any more in other industries now. Everyone has a responsibility.


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The Budget and the MECA

scalpel12This 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.


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Southerners won’t back down

Nurses at Dunstan hospital celebrate International Nurses Day

Nurses at Dunstan hospital celebrate International Nurses Day

Southerners are gutted to hear of a five percent funding cut to their network of rural community hospitals in Oamaru, Ranfurly, Dunstan, Balclutha and Gore.

And if that’s not bad enough, there will be reviews of health services and no increases for changing costs or population. What that means is that if the population of your town increases, there won’t be any corresponding increase to health funding.

Hospitals are still working out what impact this will have on services and each hospital will be affected differently. What we do know is health services are under threat and so are many jobs.

At the same time, Southern District Health Board (SDHB) has announced plans to contract out and privatise its food service, with frozen meals being driven down from Auckland, in a further attempt to save money that threatens local jobs. We can see no sense in that whatsoever!

So why is all this happening? Southern DHB’s financial situation is pretty grim – they are $27 million in the red this financial year and are predicted to be at a $42 million financial deficit next year. When DHBs are squeezed this tight, something has to give. This time it’s the health of our rural communities, not to mention their nutritional needs!

While we don’t know all the reasons for their financial woes, or why they are so much worse off than other DHBs, we do know that a contributing factor is the year in, year out, underfunding of health services in New Zealand [pdf].

It’s this Government’s seventh budget this week, and they’ll be announcing funding for health for the next year. If they get it wrong, we’re looking at losing local jobs and local health services. Without more money coming in, it’s hard to see how Southern DHB will be able to preserve all the health services the population needs.

It’s not fair that valued local services, through no fault of their own, have to bear the brunt of Southern DHB’s deficit. NZNO will be working constructively with the affected rural hospitals to save services and protect member’s jobs. Not only will these cuts put patients’ health at risk, but removing skilled jobs from the regional economy impacts on the region’s long term financial health.

This ends up costing the Government more in the long run through health, social services, and other agencies. Southerners understand this, and we will be backing them all the way to find healthy and sustainable solutions to the District Health Board’s financial crisis.

Watch this space for NZNO’s response, and updates on the Southland and Otago rural hospital network plan for dealing with the cuts.

 


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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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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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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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Our health, our taonga

233_Hui_a_Tau233

Inspired attendees at the Indigenous Nurses Aotearoa conference 2014

Kerri Nuku is NZNO’s kaiwhakahaere and is of Ngāti Kahungunu descent. As a leader for Māori within NZNO she sees it as her responsibility to ensure that equity is achieved for all Te Rūnanga members.

The other day someone asked me what the highlight of my year has been so far. Usually that kind of question causes me to ponder for a while, but not this year. The absolute highlight of my year is the very first Indigenous Nurses Aotearoa conference, held in Tāmaki Makaurau in August.

The theme for the conference was “Our health, our taonga”, which really resonated with me – as I sense it did with every other attendee. We were stimulated and challenged in our collective responsibility to protect our fundamental right to good health and wellbeing.

It was so energising to be with over 250 indigenous nursing leaders, including nurses, midwives, nursing students, kaimahi hauora and health care assistants. Our combined enthusiasm and commitment to make sure health is a taonga was infectious. It is a privilege of our te ao Māori (Māori worldview) that we see health/hauora as a part of our whakapapa, our whanau, our environment and our culture.

As indigenous nursing professionals, we are committed to reaffirming our rights under the United Nations Declaration of Indigenous people’s article 3, to self determine, and this must underpin any future Māori nursing strategy. We must have faith in ourselves and be courageous in our aspirations for the health of our whānau, hapū and iwi. We must look towards the imagination place to see what could be.

We honour our early Māori nursing pioneers, like Te Akenehi Hei, who halted the death of Māori from introduced diseases. We have nothing to fear as we move into the future – our tipuna made sacrifices and we will too, so that our mokopuna, whānau, hapū and iwi receive the best health care available in Aotearoa.

As indigenous health professionals, we must have the freedom to determine what is best for us.

We will continue to advocate for Māori nursing and workforce issues. We will lobby for change and challenge the barriers that are placed in the way of Māori nursing and workforce success.

Kaimahi hauora:  be brave, take action when you can! Ko te kai ā te rangatira he kōrero!

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

 

Click here for more information about Te Rūnanga o Aotearoa, NZNO.

 


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Value our elders by valuing us

2014-10-01 Day of the older person FB picToday is International Day of the Older Person; a day to celebrate the achievements and contributions that older people make to our society and tackle the barriers faced by older people.

American politician Hubert H. Humphrey was paraphrasing Ghandi when he said “…the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.

He’s right. And there’s plenty that NZNO members might want to say about that (check out NZNO’s priorities for health here), but let’s have a look at how we value our older citizens today.

The government approach to care of older people in Aotearoa is ageist. By under-funding this sector, the government is signaling that older people don’t matter. And by extension, neither do the workers who care for them. Staff in residential aged care facilities are some of the lowest paid workers in New Zealand, and successive governments, for over 20 years, have allowed that to continue.

In one of our many submissions to government we put it this way:

The high cost of providing substandard aged care is unsustainable and unjust: public health resources are unaccounted for; where there is a failure of care it is public health which ‘picks up the tag’ for care it has already paid for; services are being contracted out for care of our parents and grandparents with even less protection for their physical and mental wellbeing than for their financial wellbeing; public safety and our professional health workforce are being undermined: and an underclass of undervalued and underpaid workers is being embedded in our workforce while highly educated workers are leaving.”

That’s not valuing our elders or the people who care for them. We are failing to provide sufficient protection for the health, welfare and financial stability of either older people or those who work with them.

So, how do we change things? How can we show older people the respect and dignity they deserve?

Well, one way of doing that would be to value the people who care for them, and there’s a few ways of getting there…

Increase government funding to residential aged care providers; it’s just plain unfair that health care assistants and caregivers who work in aged care facilities get nowhere near as much as their colleagues who work in DHBs. The Government also needs to make sure that funding is passed on to workers, not retained as private sector profits.

A quality, nationwide training and education programme would achieve two things: consistently provided quality care for residents and a career pathway that would attract and retain great staff.

Regulate for safe staffing! Our members want to provide quality care, but at the same time as residents care needs increase, our members face continuous cuts to care hours. How can workers enjoy their work when they are stressed, overworkerd and worried about missing something and making a mistake? There must be enough staff to provide quality care for every resident.

None of this is rocket science, and none of it is news to the sector or the government. All that’s needed now is action! Action to value older New Zealanders and the people who care for them.

Our elders should be valued and celebrated. The workers who are carrying out the responsible and skilled work of caring for our elders should be valued, celebrated, admired and supported for their important work too.