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Care rationing a sad reality

Care rationing web headerNZNO believes every patient has the right to receive quality care, every shift, every day. Nurses, midwives and health-care assistants also have the right to work in safe, supportive environments and be enabled to provide quality care.

The Safe staffing healthy workplaces unit defines care rationing as: “Any occasion when an aspect of a patient’s required care is either missed altogether, unduly delayed, performed to a suboptimal standard or inappropriately delegated to someone not qualified to perform the activity.”

Is care rationing the “new normal” in patient care?  Are failing to take observations and administer medications on time, inability to turn bedridden patients two hourly, skipping hygiene cares, inability to mobilise patients  regularly, failing to provide comprehensive patient education, not answering call bells, all too familiar aspects of too many nurses’ shifts, too often?

Care rationing is unacceptable because it means patients do not receive all the care they require, it exposes patients to unacceptable risks, it can have serious consequences, it increases patient morbidity and mortality, and contravenes people’s rights to health services of an appropriate standard.

Drawing on national and international research, NZNO’s newly-released position statement attributes care rationing to a systems failure due to inadequate staffing or inappropriate skill mix or insufficient time or a combination of these factors.

The position statement was developed to articulate that care rationing is a systems failure, not a failure of individual nurses. We have chosen the term ‘care rationing’ because terms such as ‘missed care’ or ‘care left undone’ imply that an individual nurse is to blame.

Care rationing is not just another form of prioritisation. Prioritisation occurs at the start of a shift when nurses consider the work that has to be done over their shift and what needs to be done first. Care rationing happens in a chaotic way when there are simply not enough staff to do the work and nurses have no control over the situation.”

It doesn’t have to be this way. NZNO has a plan to eliminate care rationing. What we need is:

  • increased funding for DHBs;
  • nursing care made a priority in decision-making;
  • nursing seen as an investment, not a cost;
  • patient-centred models of care;
  • a focus on early intervention and prevention, and nurses working to the full extent of their scope;
  • full implementation of the care capacity demand management programme in all DHBs;
  • effective workforce planning;
  • transparency about staffing levels;
  • funding to address its cultural impacts;
  • immediate action when staffing requirements are not met to ensure patients get the care they need; and
  • patients who are empowered to complain when their needs are not met because of inadequate staffing.

To find out more about care rationing and what NZNO is doing to eliminate it, go to www.nzno.org.nz/carerationing

 

This blog post was developed from an article first published in Kai Taiki Nursing NZ, vol 20, no 6, July 2014.

 

 

 


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Give us a hand

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

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

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

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

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

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

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

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

 


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$180,000 pay rise? Yes please!

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

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

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

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

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

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

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

Something is very wrong with this picture.

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

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

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

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

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


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My NZNO journey

536955_10153136416250072_1618011563_nDanielle Davies is a new NZNO organiser in Wellington. She writes about her journey from NZNO member to delegate to organiser. 

I knew from a young age that healthcare was a precious taonga. My parents impressed on me that each check up with the doctor, each visit to the dentist- was a significant benefit that I was able to access because of the union which my Dad was a member.  My Dad was one of the thousands of construction workers who migrated from New York to California during the construction booms of the 1970s. As construction work is a physically demanding job which regularly places workers in vulnerable situations, my Dad’s union bargained for comprehensive benefit packages for employees and their families; benefits which, outrageously, Americans do not have as basic entitlements. The battles the union fought for ensured that his overtime was paid, that his hours of rest were protected and that his family’s medical and dental costs were covered. Growing up with this exposure, I became aware of the link between collective action and collective good.

My own union journey began shortly after commencing work as a Staff Nurse at Wellington Hospital. The previous ward delegate was planning an OE and had taken notice in my interest in all things union!  A handover and election quickly followed and, before I knew it, I was a ward delegate.

I believe that becoming a NZNO delegate made me a better nurse. Not only was I responsible for my own nursing practice with my patients, but also responsible to my fellow members to resolve workplace issues, to educate on rights and responsibilities under the MECA and to promote collective participation with NZNO campaigns. It was not long after I took up the role of delegate that I noticed an increase in my colleagues approaching me about employment matters, from sick leave conditions to roster patterns, from payroll matters to NZNO campaigns. Being able to resolve matters at the delegate level, and increase members’ knowledge of their rights and collective power was hugely rewarding.

This week I commenced my new role as NZNO Organiser for the Wellington region. My role has shifted my professional duties from caring for patients at the bedside to caring for nurses. I have a great passion for nursing and believe that together we can achieve great outcomes. As ever, I feel proud to be a part of NZNO: Freed to care, proud to nurse!


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When bad things happen in good hospitals

Film-Colour-133A serious adverse event is one which has led to significant additional treatment, is life threatening or has led to an unexpected death or major loss of function. District health board (DHB) providers are required to review these events and report them to the Health Quality and Safety Commission.

Over the past year 454 serious adverse events were reported; more than one a day.  248 (55 percent) of these events were falls that resulted in serious harm – fractures, serious wounds and serious head injuries.

We’re concerned about this for many reasons.

Each one of these ‘events’ happened to a person, a family, a community. Each event will have caused considerable pain and suffering, loss of mobility, confidence, independence and increased length of stay in hospital, along with the increased costs that go with all those outcomes.

Every member of the nursing team caught up in a serious event will also have found the experience very distressing. Nobody ever goes to work expecting that a serious event is going to occur on their shift, and nurses only ever want the best outcome for their patients.

NZNO is also concerned about the overall increase of events since the last report – especially in those events that are considered nurse sensitive outcome indicators – pressure areas, infections and falls.

The number of falls reported has gone from 56 in the 2008 report to 248 in 2014; a staggering increase that cannot be attributed to improved reporting alone. The fact of the matter is that for all of those falls which caused serious harm, there will be numerous others that don’t meet the severity threshold, so do not appear in the report. There will be even more that are not reported at all.

So what might be contributing to this alarming trend?

We are aware of changes to DHB policies in regard to specials and watches – these are expensive and need special approval. Are they not being approved when they should be?

We know that older adults are coming to us more unwell and with complex needs. Is it increased acuity that is contributing to the increase in serious adverse events?

Nurses are telling us that they are stressed at work – finding it challenging to meet patients’ needs. Sometimes bells don’t get answered in time…  serious accidents can result. Are staffing numbers and skill mix not adequate to meet patient demand?

And if that’s the case, we have to ask, why not?

We believe that health services must be funded appropriately, so every patient receives the care they need, when they need it. And so every member of the healthcare team can go to work knowing all the supports and resources are in place to provide excellent care to every patient.

More needs to be done to investigate why and how serious adverse events occur and steps put in place so they no longer happen. If that means extra funding and a different number and skill mix of staff, so be it.


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Equal pay is here to stay

This is me (listening hard!) at an NZNO delegate training day a couple of weeks ago.

My name is Dilani Perera. I am an NZNO delegate and a caregiver at a resthome in Wellington. I have been following Kristine Bartlett’s equal pay case with interest.

When I heard yesterday about the Equal Pay case decision I couldn’t say anything for a moment. It took a while to sink in. It is such a wonderful decision and I will celebrate with my family at home and my other family at work. This decision means a lot to me and to every woman who works as a caregiver in aged care.

My life has not been easy but I love my job. Most days I get up before dawn to go to work and care for my old people at work. They are my second family. I look after them and care for them the way I would want my mother to be looked after.

I feel it is a privilege and a joy to care for our elders even though it is tiring and hard work. I’m always tired when I get home and I often feel bad that my family misses out.

Yesterday the Court of Appeal has told me that this country cares about me and the work I do and that the money I get is not enough.

I have worked here for 10 years and I have passed all the qualifications and still only get one dollar more than the minimum wage.

I am a solo mother and I have brought up my three children myself, and I never have enough for them. Our house is always cold. When my children ask me for something I have to think whether it is possible this week, or next week.

If I had equal pay I would have a better home and better food and better clothes. Better everything!

I would also spend more time with my family. It took me seven years to save enough money to visit my mother back home. If I had equal pay I could visit more.

Lots of my friends at work have two jobs and are so, so tired. I want them to be happy and well and enjoying their families.

I thank my sister Kristine Bartlett and my union for giving me a better life ahead. On behalf of all caregivers and their families too, thank you.

Thank you also to the Court of Appeal who finally made me feel like the work I do is valued.

This is a short clip we filmed late last year about equal pay.


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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

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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.

 


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My journey, my patient’s journey

emotional-intelligenceHere’s another blog by West Coast mental health nurse Teniah Howell. This blog is cross-posted with permission  from the Nurses Station blog “The Tea Room”. You can read Teniah’s previous post here.

The topic of emotional intelligence has come up multiple times in my journey through nursing school and into the “real world” of nursing. When the topic was first mentioned to me, I had never heard of such a thing before, and really never considered the need to become competent in this area.

Emotional intelligence, essentially, is the ability to recognise your own feelings, emotions, and responses, as well as those of others. Now, we recognise these emotions in different ways – some people journal, some people simply contemplate, and others discuss with trusted mentors/supervision/work place support etc. The importance in understanding where we are at in our own lives allows us to more easily interpret the emotions and responses of the patients we work alongside. It is easier to help our patients find strategies for coping that work for them, if we have first acknowledged and recognised our own strengths and abilities to cope. Nurses cannot relate to patients and help them if they are themselves in an emotionally unstable place.

One thing that I have noticed in my own practice, is that in order to truly develop a therapeutic relationship with a patient, I must be able to differentiate between my own thoughts/emotions and the situation. I have to be able to know what I think and believe about myself and yet not push my own thoughts and beliefs onto my patient. I have to be able to recognise that my patient’s strengths and ways of coping will be different than my own. In my experience this ties into the idea that we all possess a “shared humanness”. While we share a lot of the same emotions, experiences, desires etc.; each one of us is unique and individual. While we all have different strengths and ways of coping with the challenges of life, we all still share the experience of being human. Therefore, we can offer each other grace, knowing that we are in many ways the same.

A patient’s journey can be made easier by having a nurse who will walk alongside them, who understands that human experience; a nurse who has her/himself faced challenges and experienced a range of emotions; a nurse who can relate to them, and also recognise their uniqueness. It takes an emotionally intelligent, competent nurse to do this. It takes someone who has explored their own thoughts and beliefs; someone who is not only able to recognise their own strengths, but can also recognise the individual strength of their patient.