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July 3, 2016
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CCDM from a Charge Nurse Perspective

By Caroline Dodsworth, charge nurse, Palmerston North Hospital

As an NZNO member working in a DHB, I know that getting Care Capacity Demand Management (CCDM) working in all our DHBs is a priority in our multi-employer collective agreement (PDF pg 66).

I know that it has been started in most DHBs and I think the implementation has actually been completed in only one so far. It is good work to be doing and it’s important to do it right – better to take the time to get every step correct than to rush it and not get the benefits.

We all want patients to have the best possible outcome. This is most likely to be achieved when patients have the care they need when they need it.

CCDM is the programme that has been developed by the Safe Staffing Healthy Workplaces Unit, NZNO and district health boards (DHBs) to make sure we can actually do this every day (not just on those random, lucky days…).

Working in partnership is the key to CCDM’s success; NZNO members and staff working together with DHBs to make safe staffing a reality. It’s about making sure base staffing is right every day. It’s about making sure there are workable strategies in place if the match between demand (what patients need), and capacity (our resources) is not right. And to do that there has got to be good quality data available to everyone so we can see on the day and over time if the programme is working. The whole system depends on the information we provide.

You can find out more about CCDM here: www.nzno.org.nz/carepoint

I thought I’d share my experience of CCDM at Palmerston North Hospital, so you can get an idea of what to expect when your DHB gets the programme (if it hasn’t already).

In 2012 I was charge nurse manager of an acute 32 bed medical ward. TrendCare showed that we consistently didn’t have enough staff to complete the care required; often between 20 and 30 hours short over a 24 hour period! Rosters were pretty much set in concrete and didn’t (and couldn’t) respond to the peaks and troughs in workload. We knew care rationing was happening but there was no way to “see” it or prove it.

The opportunity to become the first ward to undertake work analysis and data collection to inform the CCDM programme was floated and our application was successful.

There was excellent communication during the process; ward staff were included and actively involved. It was a great example of working in partnership with close collaboration between charge nurse, NZNO and ward staff. Ward staff were given every opportunity to express their concerns and listened to in a non-judgmental manner. Facts and figures were explained and we were given time to digest and seek clarification if we weren’t sure about anything. Unfamiliar data was explained in language that we could all understand. Charge nurse, associate charge nurses, management and NZNO delegates were professional and supportive, and assisted with propelling the process forward – staff joined in at “grass roots” level.

The data collection process was difficult and hard work, as I had anticipated; ironing out teething problems, ensuring everyone was on the same page, encouraging the negative staff and the fence-sitters, keeping the momentum going when enthusiasm flagged.

The data collection process was generally seen as “just another data gathering exercise”. But as the process developed it was an eye-opener to be able to quantify the many interruptions during each shift. It also highlighted and reinforced what nurses already know; many interruptions means less time for patient care. We also gained further insight into the peaks and troughs of ward work.

By the end of the two weeks we had become quite attached to our diaries! Finally, we were able to show care rationing – especially the missed nursing care that had become “business as usual”.

It took quite a while for the information we collected to be analysed and some wondered if their hard work had all been for nothing. During this time we implemented Releasing time to care which helped keep a sense of momentum.

As soon as the results were confirmed we swung into action and developed a new model of care. The entire nursing team got together, and with butchers paper and models, felt pens and timetables, we arranged and rearranged the FTE and the roster to meet workload over the entire 24 hour day and seven day week.

We divided up the available FTE into the most efficient and effective spread of regulated and un-regulated staff, thinking outside the square and breaking down traditional shift time barriers. Our new model of care implemented a new role of “admission and discharge nurse” who straddles the morning and afternoon shifts without a patient load, but instead focuses on timely discharges and active “pulling” of patients from MAPU and ED.

This means less pressure on the qualified staff, especially on the morning shift. Discharges happen in a more timely manner, and the discharge of complex patients requiring a lot of registered nurse time is now smoother. Patients feel more informed and new admissions are seen and assessed early without having to wait for a busy nurse.

The model of care for patients with delirium also changed – instead of being staffed by a ward RN and a bureau Health Care Assistant (HCA) we have our own ward HCA who knows the patients and provides continuity of care for them. To have our own HCA caring for these patients is amazing. The benefits to the patient outcomes, and working relationships between the team are invaluable.

The staffing numbers across all three shifts are well thought out. Patient safety has improved significantly with an extra registered nurse at night.

The difference to staff morale and motivation as a result of CCDM has been immense! While the ward remains very busy it now operates efficiently and effectively. Complaints, incidents, falls and medication errors have reduced, staff turnover is practically zero and productivity has improved.

Since then we have developed a hospital-wide response to variance in collaboration with NZNO. The CCDM variance response management (VRM) tool is a visible and user-friendly process. It still cannot produce nurses out of thin air, but it raises awareness of areas under pressure to all the right people and allows an organisation-wide approach to pooling resources and to providing support where it is needed. Everyone is talking the same language and the tool triggers a response at the top of the cliff instead of the bottom.

I’ve heard a lot of feedback about CCDM over the last couple of years but the comment that has had a lasting impression, and the thing that I think CCDM stands for above all else for nurses is: “Since CCDM it feels like I’ve actually met the patients and I don’t go home with that horrible feeling that I’ve missed something”.

As the charge nurse for that ward I take pride in the fact that I was responsible for making that happen. We need senior managers to influence change at the executive table, but the charge nurse is responsible for driving change at ward level with enthusiasm and passion, leading from the front and never giving up.

If you are involved with CCDM in your ward or unit, I’d love to hear how it’s going. You can leave a comment by clicking the “leave the comment” link to the left of this article.

If you would like to know more about CCDM please talk with your local NZNO delegate or organiser, or visit www.nzno.org.nz/carepoint or centraltas.co.nz/strategic-workforce-services/safe-staffing-health-workplace

July 1, 2016
by NZNO 3 Comments

Celebrating NZNO’s Living Wage journey

By NZNO president, Grant Brookes

Today we celebrate NZNO’s accreditation as a Living Wage employer. The announcement is confirmation from the Accreditation Advisory Board that NZNO has met all the criteria to wear this badge of honour.

The impact of today’s announcement won’t be felt by anyone directly employed by NZNO. They are already paid above the current Living Wage of $19.80 an hour.

But the decision to become an accredited Living Wage employer means all our contracted staff get this rate, too. So it will be felt by people like Yong, who cleans the NZNO National Office after hours.

Yong has told me that she works two cleaning jobs – both for minimum wage. She starts at a motel at 8.45am in the morning, and finishes at NZNO at 9pm at night.

Yong has now received her first pay at her new rate, and was so happy that she could buy better food at the supermarket, instead of the cheapest food. Her dream is that now she might be able to go home to China to visit her father, who she hasn’t seen in four years.

She wanted me to write this, she said, so everyone could understand how much NZNO’s decision means.

It has been a long journey to reach this point, with plenty of debate and discussion along the way. So it’s fitting today to look back on how we got here, and pay tribute to the NZNO members who kept us moving forward.

It’s now over four years since the Living Wage was launched in Auckland, in May 2012. NZNO was one of the first organisations to sign up to the statement of principle:

“A living wage is the income necessary to provide workers and their families with the basic necessities of life. A living wage will enable workers to live with dignity and to participate as active citizens in society. We call upon the Government, employers and society as a whole to strive for a living wage for all households as a necessary and important step in the reduction of poverty in New Zealand.”

Our support was based on our understanding – as nurses, midwives and healthcare workers – that poverty and inequality are a root cause of much ill health. Some of us, especially those in aged care, and Māori and Pasifika members, knew this from personal experience of low pay.

Back in 2012, economists calculated that the Living Wage needed to live with dignity and participate as an active citizen in society was $18.40 an hour.

In the DHB elections the following year, NZNO asked candidates to support the idea that all DHB staff should get at least the Living Wage, which by 2013 had been recalculated as an hourly rate of $18.80.

At this time, we were coming to understand that it wasn’t enough to just agree with the Living Wage in principle. We should also contribute to the organisation which was working to make it a reality. In August 2014 NZNO took its place alongside other organisations as a full member of Living Wage Movement Aotearoa NZ Incorporated.

What propelled us along was growing support for the Living Wage among NZNO members.

Using the Nursing Matters manifesto, we’d been calling on voters and politicians from all parties in the 2014 general election to see a Living Wage for all as fundamental to a fair and healthy society.

Those of us who attended the DHB MECA endorsement meetings in late 2014 then showed our support by voting overwhelmingly for a set of claims which included progress towards the Living Wage (which by then meant at least $19.25 an hour) for HCAs.

When we couldn’t get agreement on this from employers, members expressed their frustration and reaffirmed their belief in the Living Wage at DHB MECA ratification meetings around the country.

By 2015, awareness was growing further. If we were asking our health sector employers to pay a Living Wage, then NZNO needed to walk the talk and do it, as well. That awareness culminated in a vote at last year’s NZNO AGM. Delegates from across New Zealand decided, by a large margin of 85 percent to 15 percent, to set a deadline of today - 1 July 2016 – for NZNO to become an accredited Living Wage employer.

There are also some NZNO members who deserve special mention, for helping our organisation to reach this goal.

They include people like Maire Christeller, a Primary Health Care nurse and workplace delegate, who has been involved in the Lower Hutt Living Wage Network since the beginning. She helped to spread the message to other NZNO delegates in the Hutt Valley, and has also lobbied for Hutt City Council to become a Living Wage employer.

Left-right: Maire Christeller and baby Iris, with HVDHB delegates Monica Murphy and Puawai Moore, at the Hutt Living Wage Network launch

Kathryn Fernando is a delegate at Capital & Coast DHB, who joined me on last year’s “Mop March” to Wellington City Council, aimed at extending the Living Wage to contracted council workers, like cleaners and security guards.

CCDHB delegate Kathryn Fernando (left), NZNO Organiser Danielle Davies (right) and I at the Living Wage “Mop March” for Wellington City Council contract cleaners

Litia Gibson works at Porirua Union and Community Health Service. She has led the nursing team’s support for their workplace paying the Living Wage (even if they aren’t accredited yet).

Litia Gibson works at Porirua Union and Community Health Service

Kieran Monaghan is a Primary Health Care nurse and a leader of the Living Wage Movement in Wellington. It was his tireless efforts last year – presenting on the Living Wage at the NZNO Greater Wellington Regional Convention, getting the issue into Kai Tiaki, writing for NZNOBlog, and drafting the successful remit for the NZNO AGM setting a deadline for accreditation – which helped us take the final step.

Kieran Monaghan (left) and fellow Living Wage activist Naima Abdi at the “Mop March” for Wellington City Council contract cleaners

As NZNO President, I have spoken of the need to strengthen union values within our organisation, as we continue to sharpen our professionalism – values like social justice, equity and solidarity.

By walking the talk on the Living Wage today, I believe we’re doing just that.

June 9, 2016
by NZNO 2 Comments

Diversity and inclusion in health

Hi, my name is Siȃn Munson. I am a Community Clinical Nurse for people with long term conditions. I am also an NZNO delegate, a mum, a friend, a lesbian and many other things too of course.

My journey to nursing

My Grandmother and one of my cousins are nurses, so nursing was always a possibility for me, however my journey to nursing took a while! I left school after the 6^th form, went to the UK for year and applied to take an enrolled nurse course when I got back. That didn’t end up happening. Instead I got married and had three wonderful children, one of whom has significant learning and support needs. I also did an extramural degree over 6 years at Massey University. I majored in Women’s Studies which gave me a passion for women’s health.

I got divorced and made a decision to move to Palmerston North to do my nursing training. I studied at UCOL when my children were 7, 9 and 10 and I was a solo mum. I tell you what – if you can handle being a solo mum, you can handle anything!

When I started I thought I wanted to work in Mental Health but over the course of my studies I realised I wanted to focus on Women’s Health.

After a few years of working as a civilian Army Nurse in a women’s and sexual health role, I got my current role. I’ve been here for three years now and I love it.

Starting post grad study

While I was working in sexual health I began my Masters Degree at Massey University. I started with the Women’s Health paper and it snowballed from there. During my study I realised that there was very little New Zealand literature about lesbian women’s experience of healthcare – and what I was seeing in my practice made me think something needed to be done about that. As a result my final paper was the Research Report and I graduated in 2015.

I was extremely lucky to have a wonderful supervisor, Dr Catherine Cook, who is a senior lecturer at Massey University.

Coming out at work

When I started at Central PHO my manager was really supportive of my studies and when I knew what my research topic was going to be I thought I should probably “come out” to her. So, I officially told her I identify as a lesbian.

It’s a big deal to come out to someone, especially your manager. I mean, sometimes you know people know, or it’s an open secret or whatever, but actually officially telling someone you are queer is pretty scary. If you are not queer it might be hard to understand that, but people who are lesbian or bi or gay will understand that being “out” and “coming out” is something that happens every single day. Every day we have to evaluate our personal and professional safety and comfort in every single situation we are in. And that includes with patients as well as colleagues.

In this case, it was the best decision I ever made! It’s been a really positive experience for me to be out at work with my colleagues, although with patients it’s still a case-by-case thing. I’ve heard people say things like “no one needs to know” or “I don’t know why gay people have to come out”, but believe me, it matters. Being in the closet is awful. You’re constantly second guessing everything you say. You’re editing your life. It’s tiring and it’s soul destroying. I didn’t know until I came out how important it is to come out and how life affirming it is to live an authentic life. Not to hide who you are. And most importantly to be accepted for who you are in all your rainbow glory. Life is far better since I came out. One of the great things I’ve gotten to do since I came out was to attend Wellington Pride Parade with NZNO – Out At Work. Three years ago I’d never have done that!

My research

Anyway, my research… My research topic was “Cloaked in Invisibility – Experiences of Lesbian and Bisexual Women in their Encounters with Health Professionals for Cervical Screening and Sexual Health”. For this research I interviewed six lesbian and bisexual women about their experiences receiving sexual and gynaecological healthcare in New Zealand. There is very little research on lesbian and bisexual women’s health in a New Zealand context, and this research adds to and expands that knowledge.

It was such a privilege to hear their stories.

My findings show that lesbian and bisexual women suffered quite major barriers to receiving timely and culturally-appropriate healthcare.

The healthcare system is heteronormative – healthcare professionals make (probably unconscious) assumptions that everybody is heterosexual. For example, if your GP asks about your husband, that’s heteronormative and it means that the patient is instantly having to make a heap of decisions instead of being able to focus on the appointment: “O, should I say I’m a lesbian? Is it not worth it? Shall I just leave it? Maybe I should say? Why is he/she making assumptions? Etc “

There is both implied and overt homophobia in health care. While being gay is becoming more socially acceptable, not all of society is accepting. Some of the participants had experienced horrific homophobia from health care professionals which had seriously impacted their lives. Experiencing homophobia makes it difficult to return for further health care.

There is a conundrum of safer sex – What does safer sex look like for women who have women sexual partners? Many lesbian and bisexual women assume they are having safer sex because they are not having sex with men. Some believe they can’t contract sexually transmissible infections. There are no specific barrier protection methods for use by women having sex with women, and the current choices such as latex gloves, dental dams and condoms are not very user friendly for safer sex between two women.

Engagement with health promotion – it’s hard to engage with public health promotions when you are invisible in them. There is very little sexual health information available for lesbian and bisexual women. There are no posters on the walls at surgeries that depict lesbian families. Women found ways of finding the health information they needed when they didn’t feel ok about seeking advice from health professionals.

Resilence – the amazing thing I found was that, despite the barriers, lesbian and bisexual women do find ways of navigating the health system, through friends and the queer community.

I find this fascinating! I can see so many ways that we can change our thinking and practice to become inclusive and start providing care in a more appropriate and equitable way to our patients. Even understanding that there ARE queer patients on your books, even if they are not out to you, is a good start. My research found that when a woman has a positive experience coming out to a health professional it makes it more likely that she will come out to another health professional.

And I want to get these learnings out as widely as I can. I want to change practice. The thought of my work gathering dust in a library somewhere gives me the shivers. That’s why I have written a journal article with my supervisor. That’s why I am speaking out about it. My research report has been published this month in the Journal of Clinical Nursing. It’s exciting to be adding to the body of knowledge in this under-researched area. If you have ideas about how we can create inclusive environments for our patients and clients I’d love to hear them. Please add your thoughts in the comments.

Munson, S. and Cook, C. (2016), Lesbian and bisexual women’s sexual healthcare experiences. Journal of Clinical Nursing. doi: 10.1111/jocn.13364

http://onlinelibrary.wiley.com/doi/10.1111/jocn.13364/abstract

June 8, 2016
by NZNO 8 Comments

Caregivers, we’re worth it!

Tammie Bunt is a caregiver who wants all her colleagues to know they are worth $26 an hour. She says it’s about time we know our worth and get it.

Here in Aotearoa New Zealand, our population is aging, and that means a greater need for caregivers, health care assistants and nurses in both the residential and home-based aged care sector.

The women (and it mostly is women) who look after our elders in the aged care sector are devalued and underpaid, and it’s been that way forever. Because they are women, and “women’s work” has traditionally been seen by society as somehow worth less than men’s. Ridiculous, right!?

Talking to many caregivers and health care assistants and they will tell you they don’t come in to the industry for money. People get into it because they are caring and compassionate people who want to make a difference in people’s lives. It doesn’t mean they should be paid less!

Today it appears the average qualification in caregiving is only worth about 10 cents depending on who you’re working for. Most caregivers are earning the minimum wage or just above it, even after they have done their aged care qualifications.

In 2012 Kristine Bartlett stepped up in a way no one else had in the industry. She’s a caregiver with over 20 years’ experience and she’s still only earning just above the minimum wage. Kristine and her union, the Service and Food Workers Union (now E tū) took on the big guns to do something about valuing caregivers and the role they play in the community. She believes we should be recognised financially, that the thanks we get is lovely but not enough.

NZNO joined the case too and one of the discussions they had was about how much caregivers should get paid. Comparisons have been made to other male dominated professions and how the Equal Pay Act isn’t working the way it was intended. There were articles stating caregivers were worth $26 an hour. I think that’s fair but many of my colleagues cannot believe they are worth $26 – it seems like so much money!

We are worth that! Why are we saying to ourselves that we aren’t? Think about it…

We gently listen to everything a person wants to say as their last hours take hold. We hold the hand of a person whose last breath is only seconds away.
We help our residents find some purpose to get through today… whether it’s via an activity or simply just getting out of bed to face the day.
We make sure each person has clean clothing on and that they are appropriately dressed. We assist them with their continence needs.
We are warriors for their safety by making sure they are safe in their surroundings.
We’re highly qualified.
And also, we give up many of our weekends for our residents. We miss our kids’ sporting events, family birthdays and other social events because our clients’ needs are not 4 hours a day. They need us 24 hours a day, 7 days a week, 365 days a year.

I am relatively new in the industry and was somewhat dumped into the job due to personal circumstances two years ago. I came from a market research background and was paid well better there, sitting in front of a computer using a virtual program with only buttons to click. I then went into the cleaning business and ended up on far more for that than I am in my current position. My shock at how undervalued people who work in the aged care sector is was flabbergasting!

We have heard all the excuses, from the Government and the big names in the aged care industry, “We don’t get enough funding”, “We don’t get a lot of return from aged care”, “We can’t afford it” and on and on… It’s time for the excuses to stop and the action to happen.

I think the Government needs to get on with it!

And the other thing that needs to happen starts with us.

We do an important job, we have qualifications, we love and care for our clients and we are worth $26 an hour! Believe it sisters.

June 7, 2016
by NZNO Leave a comment

Nurses go to Fiji

When Cyclone Winston hit Fiji earlier this year, emergency services were on high alert all across the pacific. Those services included a number of NZNO nurses who also volunteered for the New Zealand Medical Assistance Team (NZMAT). Emma Brooks who normally works at the Kenepuru Operating Theatre and Megann Deveraux from the Wellington Regional Hospital Operating Theatre both deployed to Suva with the NZMAT on 1 March. We had a chat to Emma about what happened on the deployment and what it means to be part of NZMAT.

What is NZMAT and who is involved with it?

It’s basically a team of medical professionals that are trained to deploy to disaster areas to support the local health service. There are doctors, nurses, paramedics, allied health staff and even some non-medical members that work in areas like logistics. We all go through training to be able to be deployed. It’s a civilian based group so we aren’t part of the defence forces in any way but we do help with their disaster relief efforts.

What happened while you were deployed?

We left New Zealand on 1 March and flew directly into Suva with the help of the NZ Air force. We were a part of four teams, two of which were surgical, one general, and one orthopaedic and two were primary health. Because I’m a theatre nurse, I was in one of the surgical teams which was based at the Colonial War Memorial Hospital. We were there as support. We had to be flexible in what we did and had to take on the extra work that had been created due to the Cyclone. Our arrival was almost perfect timing as one of the Fijian Orthopaedic surgeons ended up in ICU the day before we arrived.

Over the two weeks we were there, we did 102 surgical cases over 12 days of surgery. These were cyclone and non-cyclone trauma cases and elective surgeries. The othropaedic team even did an emergency inter-island trip to Labasa Hospital on the northern island of Fiji. We were flown there by the French Airforce, however, they didn’t serve croissants or coffee on the flight.

What was most memorable about the deployment?

Working on the victims was by far the hardest thing we did. We did lose a couple people due to the trauma they had endured. Because of the cyclone, the Fijian health services were stretched, any countries would be, and we tried our best to help where we could. The cyclone had caused such destruction, we had to work with very limited supplies. Having said that, it was a privilege to be there. The people we helped, they all were all incredible

There are various requirements to be able to join NZMAT. Go to the Ministry of Health website to find more information.

May 12, 2016
by NZNO Leave a comment

Nurses, a force for change

We offer a warm thank you to talented NZNO member, Judy Hitchcock, for sending us this International Nurses Day poem.

Nurses: a force for change, improving health systems’ resilience

With Mother’s day remembered and now “Nurses week” ahead

There’s material citing ‘resilience’ that really should be read.

The ICN has nailed it, no more elephant in the room,

We need to look at what we do, how and why and we must do it soon.

Changing trends demands resilience but now here comes the spin:

Embracing less as being more, it’s the accountants who really win

With wages and employment frozen and hours cut to six

The expectation is still to find that perfect skill based mix

Dollars saved on paper, it’s easy to count the cost

Harder to quantify as ‘savings’ the quality that’s been lost.

Resilient in facing change with less; of course we will do more,

We give the best we can with what we have; only the minimum is poor,

There’s making it the ‘buzz-word’ endorsing our ability to cope,

But nurses are more than just resilient, for nurses provide the hope,

Whilst in the darkest hours, filled with misery and despair,

It’s nurses who provide the light, using evidence based care,

As Florence did in days gone by, “The lady with the lamp” as she was known,

Nurses care for those in desperate need and where that Red Cross is flown,

Targeted for their commitment, it’s not just resilient they must be.

But commended for their unwavering courage and acts of bravery,

Florence showed indomitable resilience, tending those injured in the war.

And still the founder of our profession inspires us to do much more:

“Unless we are making progress in our nursing every year, every month, every week,
Take my word for it, we are going back”

You can almost hear her speak.

Thoughts become our actions and speak louder than the spoken word.

Resilience and determination will ensure our voices will be heard.

Nurses are a force for change, of that there is no doubt,

Resilient and yet still caring: it’s what nursing is all about.

May 10, 2016
by NZNO Leave a comment

International Nurses Day 2016

An International Nurses Day message from NZNO chief executive, Memo Musa.

On Thursday we celebrate International Nurses Day, Florence Nightingale’s birthday, a very special day for our profession. It seems to come around quickly, which I think is an indication of the busy lives and careers nurses’ juggle. Nice that it does, too – because nurses are worth celebrating often!

After listening to presentations about some of you work at regional conventions around the country recently, I concluded that every day we should celebrate international nurses day, as nurses are involved every hour of the day in caring for someone in our health system.

Nurses are the largest profession in the health system, and without you the health outcomes for people receiving care and treatment in the health system would not be improving as they are.

Nurses, we couldn’t do what we do, without you. Thank you.

I often reflect that nurses hold the world together. We are in every community, culture and society the world over. Nurses are the woman and men who see health holistically and are able to innovate and advocate for whole person, whole whānau and whole population health.

The theme for this year’s International Nurses Day is Nurses: A Force for Change: Improving health systems’ resilience and here at NZNO we are certainly taking that challenge on board.

NZNO members are at every level advocating for a resilient New Zealand health system where everyone can access the healthcare they need, where and when they need it.

Our policy advisers and researchers are providing government and other decision makers with the evidence needed to make good and sustainable decisions.

NZNO members like you are making the difference to healthcare in your workplaces and communities and beyond.

Along with the World Health Organisation and the International Council of Nurses, NZNO believes that action on the social determinants of health should be a core part of nurses’ business. Not only does it improve clinical outcomes, and saves money but taking action to reduce health inequalities is a matter of equity and social justice.

“Every health professional has the potential to act as a powerful advocate for individuals, communities, the health workforce and the general population, since many of the factors that affect health lie outside the health sector, in early years’ experience, education, working life, income and living and environmental conditions health professional may need to use their positions both as experts in health and as trusted respected professional to encourage or instigate change in other areas.” Institute of Health Equity (2013), p.5

Nurses, people in the health system can’t reach their goals without you, and we can’t reach our goals without you too.

Tēnā koutou, tēnā koutou, tēnā koutou katoa.

Yours in nursing solidarity
Memo Musa
Chief executive
New Zealand Nurses Organisation

May 4, 2016
by NZNO Leave a comment

A midwife’s story

Hi, my name is Lyndal Honeyman and I’ve been a midwife for 5 years now. I started studying midwifery because I was fascinated with the physical process of pregnancy and birth. It seemed mysterious and I wanted to know more.

What sustains me now is more than the processes of pregnancy and birth, it’s the whole journey of meeting women and families, walking with them as they grow and develop, give birth and begin their new life with a new baby.

There is one woman’s story that has stayed with me for years. It’s not a complicated story or a bad or sad story. For me, it’s a story that reminds me why I became a midwife.

They were a young couple and the woman was pregnant with their first baby. When I first met them, early in her pregnancy, she was feeling really unsure about the pregnancy and becoming a parent.

Sadly, she had been told by a medical professional that because her body mass index (BMI) was relatively high she would have a difficult pregnancy and definitely need a caesarean section birth. What better way to make a woman feel like she’s not good enough!

The poor woman was feeling ashamed, like she wasn’t good enough to be pregnant, let alone be a mother. She felt like she would fail at everything – birthing, feeding, mothering.

Fortunately we had plenty of time to build a relationship and I was able to reassure her and help her begin to delight in her pregnancy.

She went into labour pretty much right on her due date, which was great, and she had quite a long early labour. I saw her at home several times before we made the decision together to go to the birthing unit at the hospital.

Because the early stage of her labour was so long she was tired and began to get anxious and self-doubting again.

We discussed the next steps. She decided to have an epidural to assist her body to rest, as she had tried other physiological and pharmacological methods and found that they were not working for her at the time. We were able to help her create a calm and relaxing environment, which was very important to her to have, and she progressed very quickly and gave birth – on her hands and knees – to a handsome baby! She ended up having the birth she never thought she could have and I have never seen anyone so over the moon.

I could see on her face the sudden awareness that she was a strong and awesome woman, capable of anything! Suddenly it all came together for her – she knew she’d be able to feed her baby, she knew she’d be a great mother.

They went home the next morning feeling really, really confident.

And I went home that day feeling excited and humbled. I was honoured to have helped this woman to realise confidence in herself and her body, and was privileged to be part of her journey into motherhood.

I still feel relatively new in my career as a midwife. I am inspired by my colleagues who are so skilled, insightful and confident, whose years of practice have made them so wise. One day I will be like them.

April 11, 2016
by NZNO 3 Comments

Shining a light on depression

By Grant Brookes, NZNO president

A light was shone into a dark corner last month, when NZ Doctor magazine published a blog on depression among nurses.

It generated a strong reaction. When I shared the blog on social media, a lot of nurses responded.

Some of the responses were public comments. But other nurses shared stories of depression with me privately – including traumatic events which aren’t talked about.

I have learned of several suicides of some people in our profession in recent months.

But the overwhelming response was relief at being able to speak about this taboo subject, and a desire to get it out in the open. The nurses I spoke with also talked about why the problem is so big, and what might help.

And the problem is big – much bigger than it appears. For reasons I’ll get to, nurses are not disclosing their depression.

As one nurse put it, “I’m seeing more depressed nurses trying to hide it under a smile these days”. Another said that according to her GP, over 60 percent of the health professionals enrolled at that practice were on anti-depressants.

With almost two decades of experience working in adult mental health, I have an understanding of depression, from a nursing perspective.

I’ve practised long enough to remember old concepts like “reactive depression” (occurring in response to stressful events) and “endogenous depression” (with no previous stressor). These days, all depression is seen as linked to stress in some way.

Some of the nurses who spoke with me talked about stressors specific to their group. For the Internationally Qualified Nurses, who make up over a quarter of our workforce, there is separation from family support networks, and often cultural dislocation as well.

One mental health nurse talked about the emotional impact of “dealing with out of control behaviour”. “It’s a thankless job”, he said.

A former prison nurse told me, “During my year working as an RN in prisons I witnessed violence and experienced cases involving sexual violence, self-harm/suicide, physical assault and death. That there was no support available from my employer is still shocking to me”.

But there were also common themes. The reality for all of us in the acute care setting is that we relate to people in distress. As one nurse put it, we have “constant experiences of vicarious trauma”.

Another common theme was expressed by a rural nurse. She told me that her team all love nursing. “We do it because we like caring. But it compromises your personal values when you can’t give that care, when you know it’s not ideal. It creates a conflict within yourself”.

A younger nurse described the same thing. She said she had done postgrad last year and learned to name the problem. “It’s moral distress”, she said. Many others talked about how their mental health was affected by this stressor, too.

The increasing demands on nurses, including more and more time being spent at work, were also widely reported. “I have colleagues who work many extra unpaid hours and are constantly exhausted”, a Senior Nurse told me. “It is commonplace to hear colleagues tell of how they cannot sleep at night. Some are gaining weight, others losing it, and tears are not uncommon. The relentlessness of the work is demoralizing and there is the constant fear of making a mistake”.

More hours at work also means less time for the family. This leads to feelings of guilt. These are strongly associated with depression.

Sometimes these feelings of guilt are deliberately created by managers. One nurse said, “I have been told that ‘it is an expectation of nurses to work beyond your scheduled hours’, ‘you are reluctant to change’, ‘what if it was your mother?’, to list a few”.

This is related to the problem of workplace bullying, another stressor linked to depression which was mentioned by many.

Some who shared their stories spoke of colleagues who expressed negative attitudes towards nurses with depression. But on the other hand, all mentioned others in the nursing team who had supported them.

The range of attitudes among managers appears narrower, however. I was told that nurses with depression are not supported by their managers in the way that, say, staff with health conditions like asthma or diabetes are.

“There needs to be a general acceptance that you can work with depression”, a ward nurse told me. Others named what it means when nurses with depression are treated differently by employers: “stigma”. A number of people said they think this is why depression is not disclosed by nurses.

Based on this, the things which might help address this hidden epidemic start to become clear. Firstly, campaigns to destigmatise mental illness in society at large are part of the solution, to enable safe disclosure and help-seeking. The experiences of the former prison nurse also point to the need for debriefing after traumatic incidents.

Professional and clinical supervision were also raised by some of those I spoke with – and not just by mental health nurses, who use it much more often than anyone else. As one nurse said, “Supervision is not individual therapy, but it can help with problems before they get that big, and it can signal the need for extra mental health support”.

But the helping strategy which was mentioned most often was EAP (Employee Assistance Programme). For employers who opt into it, EAP provides short-term counselling for staff, for free. This appears to be reasonably accessible in DHBs, but Primary Health Care Nurses told me that it’s sometimes harder for them to get.

While many appreciated EAP, there was this also this comment from an Enrolled Nurse: “A service like EAP is needed to help staff acknowledge and alleviate some of the pressures, but I also understand they’re not a cure and that the Ministry of Health and the government need to own some accountability for why there’s added stress of late in the workplace”.

This leads onto a final point, made by a Primary Health Care Nurse. Depression, and the stressors which cause it, are not just individual and workplace issues. They are social problems, too.

“There is this view among nurses that things are getting tough and that we can’t do much about it. Depression can be related to the feeling that we have no control. Until nurses collectively realise this and use our influence, then I would anticipate that depression and burnout will only increase”.

We all feel down from time to time, but symptoms of depression should be taken seriously if they last for more than two weeks. You might be showing a number of the warning signs, or none in particular – everyone is different. If you are in any doubt, talk to your doctor or try the Self-Test on the depression.org.nz site.

You can also

call the Depression Helpline to talk to a trained counsellor. They’re available 24 hours a day, every day. Freephone 0800 111 757
visit depression.org.nz
find out about other services that can help

December 15, 2015
by NZNO 4 Comments

Its tough out there for new grads

NZNO associate professional services manager Hilary Graham-Smith talks about the realities of too few Nurse Entry to Practice (NEtP)places and too many new grad nurses not getting the support they should have.

It’s a busy time of year for everyone, especially for the hundreds of newly graduated nurses out there who have just got the results of their state finals and are now looking for jobs.

It’s tough out there. We know it. And that’s why we’re feeling pretty disappointed that the Minister of Health is putting out press statements painting a rosy picture of the nursing landscape.

NZNO, and the other national nursing organisations have a goal of 100% Nurse Entry to Practice places for all new grad nurses by 2018. We’re pushing hard to make it happen and pursuing every avenue for change.

The issues are complex:

There just aren’t enough NEtP places
The Government has not allocated enough funding to the NEtP programme
Employers want ‘experienced’ registered nurses
No NEtP programme for new graduate enrolled nurses
New graduates in their first year of practice working outside of the NEtP programme have inadequate support

The results of the latest Advanced Choice of Employment (ACE) round for graduating nurses makes for depressing reading. Of the 1451 applicants including first time and repeat applicants, 51% (735) gained employment in a Nurse Entry to Practice programme. November 2015 graduate numbers were 1245 and of those 568 did not gain employment through the ACE round. We can endlessly slice and dice the numbers every which way but the point is that we still have large numbers of graduating nurses who do not gain employment on a NEtP programme. Just hold that thought in your head as you read on.

The Minister’s press release celebrating this will have been of no comfort to unsuccessful applicants and makes those of us who know the real story shake our heads in dismay. For the Minister to say “This result is in line with the pattern seen in the first four years of ACE” suggests that the status quo is OK? Really?

In November 2013 the National Nursing Organisations convened a workshop with Health Workforce New Zealand (HWNZ). The purpose of that meeting was to inform HWNZ’s and the Office of the Chief Nurse’s direction for education, workforce development programmes and innovations. It was agreed that one of the key action points from that meeting should be “a balanced approach to the nursing pipeline, including full utilisation of Nurse Entry to Practice funding to support a goal of 100 per cent employment of new graduates”*. The timeframe for achieving this was 2018 at the latest.

One could reasonably expect that two years on we would see some improvement in the numbers of new registered nurses being employed through the ACE programme.

In the same press release the Minister goes on to say “The data also shows from past ACE rounds that the vast majority of graduate nurses find employment over the next year”. The salient truth about this statement is that the new graduates may well find employment outside the NEtP programme but this is likely to be in environments where they will be given too much responsibility and will not have the support and oversight of more experienced nurses. Our experience is that these new graduates end up in competency reviews, disciplinary proceedings, in front of the coroner’s court or being reported to the Health and Disability Commission. NZNO lawyer, Margaret Barnett-Davidson had this to say, “In rest home/hospitals where nurses faced allegations relating to their practice, there were a number of common issues that increased the nurse’s vulnerability….. unsupportive managers and caregivers, time pressures too challenging for the skill set, busy environments and accepting responsibilities beyond manageability or competence level.” (Kai Tiaki Nursing New Zealand, November 2013)

Remove the gloss and spin from the rhetoric and the fact is that the registered nurse workforce is being disadvantaged by systemic unfair funding models that do not recognise it as the largest health workforce in New Zealand and one that is pivotal to providing safe and effective care for our populations and communities.

Yes the issues are multi layered as are the solutions, yes there needs to be collaboration between the education providers and employers and yes we need a strategic plan that takes account of the nursing workforce shortage predicted for 2035. But first of all we need an equity lens passed over the funding that is made available to nursing, in particular our new graduate nurses.

* (Summary of selected themes and some agreed actions that emerged from discussions at the Health Workforce New Zealand (HWNZ) Nursing workshop held on 29th November 2013).