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A year of chaos

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

As another year draws to a close I am reminded of the whakatauaki, Ka mua,ka muri – walking backwards into the future. It suggests that time is a continuum, with the past present and the future connected and where learning from the past can help inform future actions.

Having just completed the national Te Whatu Ora strike for safe staffing and fair pay, further questions being raised in the media about the health budget, I wonder what learnings we can take from 2024.

The year has been fraught with (among other issues) conflicting messages, their lack of proper communication and consultation and a legacy of destruction.

At the start of the year there was a general acceptance among nurses and Te Whatu Ora that there were approximately 4000 nurse vacancies across the sector – a fact acknowledged in the build up to the 2023 elections. By March the cracks began to surface with Budget issues announced blaming over recruitment of personnel, especially nurses as the significant contributor to budget blow out. Te Whatu Ora were instructed to collectively save $105 million by July using ‘cost containment’ methods including banning double shifts, pressure to take leave, non-replacement of sick staff and wiping unfilled roles.

All the while offering reassurance to the public that none of the cost saving methods will impact the level of care patients receive. Despite reassuring messages patients were impacted and the health professional alike all expressed serious concerns about burn out, fatigue and staffing pressures.

Then the announcement of a recruitment freeze for non-patient-facing hospital roles followed together with the hiring limited places available for the mid-year intake of new graduate nurses. We were told in the nine months from June 2023 to March 2024, 2886 nurses were recruited. There was no mention of retirements in an aging workforce, resignations and nurses migrating overseas, especially to Australia.

In June NZNO released accessed information under the Official Information Act (OIA), Te Whatu Ora data showed more than a quarter of nursing shifts were below target staffing numbers, and some wards operated below safe staffing levels nearly all of the time. NZNO did not receive responses from Te Whatu Ora, something wasn’t adding up ,how can we reassure the public of quality health care when Te Whatu Ora data identified nursing shifts were understaffed.

Then it seemed to make alittle more sense , the Commissioner is reported as saying “there are too many nurses for the budget ’’while the CEO of Te Whatu Ora acknowledges the new 3000 nurses are needed for patient safety. So what and who sets the budget -are we working for determining what quality of care looks like to meet the needs of the community and staff accordingly or are be setting a budget based on funding cuts and recruiting the nurses to fit the budget.

The burning platform is what about the other parts of the sector , the impact on rural communities where staffing and funding is impacting of the quality and accessibility of services to these communities, or how about nurses in Primary care and community how well are they supported to cope.

As we walk into 2025, I can only encourage the Minister to stop talking to the sector and talk to the nurses, health care workers and tauira we are all in healthcare to make a difference that I am sure of.

We can’t continue to walk confidently into the future without a comprehensive long term workforce plan designed by those with real knowledge of the issues.


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Our voices must be heard

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

These are interesting times we live in. At a recent convention I attended I was asked a very interesting question about the power of a voice on global health. My response was a simple but one that rings true through the mists of time. “Throughout history the power of the voice can inspire people and make them brave, or it can diminish people by the language and the tone of voice.”

The voices of many historical figures – both good and bad – have left indelible marks on humanity and its impact on nurses has been no different! Over our history, we’ve largely been silenced by the dominant forces within the system.

So, the big question is how do nurses get that voice we long for in order to tell our story when that the voice has been stripped away from us through legislation, through policies and practice in many situations? Now more than ever it’s important that our stories be heard. One such example is the OIA NZNO obtained from Te Whatu Ora. This provides a platform for us to inform the data when it comes to getting the truth out there. This can be done by our union lending support to our nurses by giving them the courage to regain that confidence and strength. We need to protect them in a quite hostile environment where it’s not okay for nurses to speak out.

Many of our legislative decision-makers only put forward only a medical view.  Pae Ora for example looks at having doctors as part of those decision-making groups. Nurses are excluded. It raises the question again about why the voices of nurses are silenced. Is it because of the more historically subservient role that nurses play? It’s the stereotypical approach and still a hangover from the old ways! It used to be that women should be seen and heard, in many ways that archaic attitude still exists. This marginalisation is only worse if you’re Māori or another minority group.

It’s taken a few brave women to really challenge the status quo and we need to support them. The way forward is to look at what leadership looks like within nursing. And those nurses that are speaking out have got to see that there’s a group of people around them, and not just a few individuals popping up. It is the responsibility of the union to support and promote the freedom of a voice, and to protect the interests of nurses that speak out.

Through our struggles we’ve always got to be optimistic for change because our purpose in life right is to make it easy for the people coming behind us. It does take some solid action and solidarity and that’s why our Ratio Justice bus tour requires more than just a few people to turn up, but we need crowds present who need to make their voices heard loudly and clearly.


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IQNs not the long-term solution

Kerri Nuku, Kaiwhakahaere
Tōpūtanga Tapuhi Kaitiaki o Aotearoa NZNO

There has been some media focus recently on Internationally Qualified Nurses (IQNs) being exploited by recruitment agencies taking advantage of monetary incentives offered by the Government.

These agencies are bringing IQNs into the country without first securing them employment  which leads me to reiterate what I’ve been saying in the media. We uphold the importance of ethical recruitment. We have serious concerns about the recruitment agencies that are incentivised to flood Aotearoa with nurses, particularly from India. These nurses are often unable to be employed despite completing New Zealand’s competency assessment programme and holding NZ practising certificates (APCs).

That many recent IQNs are not being employed is through no fault of their own. IQNs are not always professionally or culturally suitable for employment in positions where local experience is required. It puts a strain on the system with training, culturalisation and finding effective support for them once they’re in jobs. The levels of support required to upskill them costs too much, so often they’re left to drown in the deep end.

It has been revealed to me recently that these agencies are also exploiting loopholes in the system to bring nurses into Aotearoa via the UK’s National Health Service. If not already illegal this kind of activity should surely be shut off as it is in my opinion tantamount to fraud.

This cannot continue and Te Whatu Ora has recently assured us that the $10,000 incentive to agencies has been closed But will the funding now be diverted to growing our own workforce where it should have been in the first place?

It’s time we realised IQNs are not the solution to the nursing shortage in Aotearoa even in the short term. Our focus should be on strategies to attract New Zealanders rather than IQNs to take up nursing study with the aim of building a strong workforce that is culturally competent and responsive.

We are aware of the harmful effects of international nurse recruitment which according to the International Council of Nurses some associations in poorer and developing countries equated with a form of neo-colonialism. IQNs are needed in their home countries as much as they are here, and this is another reason why more effort and resources need to be put into growing our own workforce.

The Government now needs to consolidate the situation with the existing number of IQNs in the country to ensure they get jobs along with appropriate training and support and this means we need to freeze the recruitment of IQNs and discourage recruitment agencies from bringing them out.
It needs to divert any possible funding into broadening the number of nursing students and then training them, keeping them, and giving them good jobs afterwards. That would be the long-term solution to this nursing crisis.


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Get up, stand up. Don’t give up the fight!

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Late in 2023 NZNO CE Paul Goulter outlined NZNO’s priorities for 2024. First and foremost is achieving Pay Parity for nurses working outside of Te Whatu Ora. Consequently, on 8 December NZNO raised a Pay Equity claim for Primary Health Care members involving more than 500 employers. We are standing up and fighting the roadblocks in our way.

Heading into 2024, the NZNO Board has prioritised member health and safety. Paul Goulter recently said, “We need to ensure that nurses and health care workers work in safe workplaces and that they are unafraid to press for their rights.” Specifically, we will be standing up and fighting for our right to safe staffing through legislated nurse-to-patient ratios underpinned by CCDM.

Health and safety is everyone’s business, including Government, employer and employee. The Government’s job is to provide legislation and policy. A guiding principle of the Health and Safety at Work Act 2015 is that workers and others need to be given the highest level of protection possible from workplace risks.

Employers and employees need to uphold legislation and standards in practice. The employer must engage with the workers and enable them to identify and manage risks (physical or mental) in the workplace. Employers must “ensure there are sufficient health care and support workers on duty at all times to provide culturally and clinically safe services” (Health and Disability services (safety) standard 2.3.1). But we all know that is not happening.

Research tells us that appropriate levels of nurse staffing is critical to patient safety. The CCDM system matches staff resources to patient care need supporting a better working environment but is yet to be fully funded or implemented after 20 years of asking.

The lack of Government or employer commitment is telling – every time a nurse writes an unsafe staffing incident report. My request to Te Whatu Ora and the Ministry of Health to provide numbers around reports of unsafe staffing over the last five years was declined because “it would take too long and too much resource” to provide me with an answer.

Te Whatu Ora is required to “follow the National Adverse Event Reporting Policy for internal and external reporting… to reduce preventable harm (HDSS 2.2.4). Therefore, Te Whatu Ora and the government are legally required to resource data collection and reporting. We will not let this go.

Health and safety representatives (HSRs) around the country have consistently reported unsafe staffing, met with managers and escalated their concerns. HSRs have submitted increasing numbers of Provisional Notices of Improvement to WorkSafe over the last three years but an external review found there are “some instances of known harm where WorkSafe appears to be taking little or no intervention” (Pennington, 2023). This is why we need nurse patient ratio legislation to fund and implement safe staffing (and CCDM) across the whole health sector.

Meanwhile HSRs are making a difference. In December 2023 alone, the Waikato District Nursing Service used health and safety process to gain an increase of eight RN FTE. The HSR said that after asking for years “the Executive now knows we mean business”.

Wellington ED HSRs working with the CCDM facilitator, identified a gap of 67 FTE through Trendcare data. Health and safety caught the attention of media repeatedly through actions taken by member HSRs, e.g. Auckland (Nico Woodward), Gisborne (Christine Warrender), Waikato (Janferie Dewar) where there are chronic failures to safely staff workplaces.

2024 will see us all “Get up, stand up. Stand up for our rights!” (Bob Marley and the Wailers).