NZNO's Blog


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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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Unmasking the evidence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 


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Patients’ rights, nurses’ rights

stress-feature01NZNO delegate, Erin Kennedy asks an important question: “Is unsafe staffing a breach of the Code of Health and Disability Services Consumers’ Rights?”

Like most nurses, I am not easily shockable, but I found myself almost speechless last week on learning that three nurses had been forced into the position of caring for 40 patients overnight on a heavy orthopaedic ward. (A pool nurse also came to help for part of the shift.)

NZNO organisers and delegates have argued strongly for safe staffing for years now, but unfortunately, the level of permanent and pool staffing means that staffing levels including skill mix are often unsafe, with sick staff unable to be replaced. The constant push to avoid financial penalty when the 6-hour Emergency Department rule is breached also leads to patients being moved from the Emergency Department to areas where there are simply not enough nurses to care for all the patients safely.

Under the Code of Health and Disability Services Consumers’ Rights, patients have a number of rights, including the right to co-operation amongst providers to ensure quality and continuity of services, and the right to informed consent. The right to be fully informed means information must be conveyed to the patient in a way that enables the patient to understand the treatment or advice. Right 6 of the code states that every consumer has ‘the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive’. Specifically, it states that patients are entitled to an explanation of his or her condition and an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option.

Given the unsafe staffing levels at some of our DHBs, it is high time that explanations around surgery, for example, go further than simply outlining the procedure and its risks and benefits. Patients should ask, and should be told, whether their post operative care will be safe. A “reasonable consumer” clearly has the right to know whether their recovery might be hampered because of unsafe staffing. Certainly, if I have surgery any time soon, I will be asking whether there are enough nurses rostered on to provide all of the care I and other patients require. Will there be enough staff to ensure that I can obtain analgesia or other medications on time? Will the nurses be able to check my vital signs often enough to notice if I am bleeding, or have arrested or need medical intervention? If I need help mobilising to the toilet, will there be someone to help me or will I risk a fall and further injury? Will there be someone to answer my call bell if I need help?

Nurses do not like being forced to ration care, but until all DHBs accept that in many instances staffing levels are unsafe (for both patients and nurses), it is a fact of life and one which can seriously impact patients’ wellbeing and recovery. Not warning patients that their post-operative care may not be optimal, and could be downright dangerous, is, in my opinion a breach of the code.

 

 

 


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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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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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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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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.