‘It is gaslighting’ — nurses refute Levy’s claims hospitals are fully staffed

Patients might go for a week without a shower or hair-washing. Or someone with spinal injuries can’t get help to operate the technology they need to communicate. Or a nurse doesn’t have the time to sit with someone and do a full assessment.

These are some of the effects of care rationing in an understaffed hospital — but not the worst, warns Christchurch enrolled nurse Debbie Handisides.

“What’s it going to take? That’s what we’re worried about — is it going to take a death? Is it going to take somebody’s practising certificate being taken off them?”

‘That equates to intentional unsafe staffing by Health New Zealand.’

And someone has died — in August, a woman collapsed and died at Rotorua Hospital after waiting three hours in its emergency department (ED), which nurses say had been chronically understaffed.

Handisides is on the NZNO-Te Whatu Ora bargaining team currently embroiled in contentious negotiations for the 2024/25 collective agreement.

The differences led to a nationwide eight-hour strike this month– with rolling regional strikes also underway in the lead up to Christmas.

Not only is Te Whatu Ora talking about a mere one per cent pay rise — which won’t kick in till halfway through next year — but it has paused its safe staffing calculations till February, saying it needs to fix regional inconsistencies in how it gathers figures.

But NZNO safe staffing coordinator Maree Jones describes it as “intentional short-staffing” by Te Whatu Ora on top of an eight-month hiring freeze.

“Since May, they haven’t been releasing budget for any new FTE [full-time-equivalent staff] as a result of the CCDM calculations,” she says.

“That equates to intentional unsafe staffing by Health New Zealand.”

CCDM — care capacity demand management — is a safe staffing programme which matches patient need to staff numbers and skill. Despite 15 torturous years of trying by NZNO, it is not yet fully up and running in any of Te Whatu Ora’s regions.

“None of them have fully implemented it after all these years,” Jones says.

Handisides fears that pausing its calculations is part of a plan to ditch it altogether. And while it’s not perfect, CCDM is “all we have” to hold Te Whatu Ora accountable for staffing hospitals safely, she says.

“They don’t want to know – and it’s a tool that we don’t want to lose, that’s why we have it in our bargaining. We have our safe staffing claim, because we know where it’s worked it’s worked well — it’s proven.”

After identifying it was short 4800 nurses in 2023, Te Whatu Ora has since claimed it blew its budget recruiting 2900 — many from overseas — over the following 12 months and was staffed up. So when New Zealand’s graduates hit the job market this year, hundreds were turned away from entry-level hospital jobs.

‘We’ve just had four staff resign and none of them have been replaced — they haven’t even been advertised.’

Reports of a hiring freeze on graduates first emerged in June — but Te Whatu Ora repeatedly denied this, chief nurse Nadine Gray stating in July “there is no pause on the recruitment of graduate nurses”.

Freeze or no freeze?

But Handisides says there is “definitely” a recruitment freeze.

“We’ve just had four staff resign and none of them have been replaced — they haven’t even been advertised.”

As well as failing to recruit to the unsafe gaps identified by CCDM — they are not even replacing current nursing staff on maternity, sick or annual leave, says Handisides, who regularly talks to delegates around the country.

“The reality on the floor is that the majority of shifts are under [staffed]. If they do replace somebody who is sick, they’ll replace them with the wrong skill mix  — so they’ll send an HCA [health-care assistant] who can’t do the work of an RN.”

Handisides suspects the true nursing shortfall runs into the “thousands” — and that’s just in her region, Canterbury.

Te Whatu Ora has so far refused to release its 2024 safe staffing figures. This is despite promising in the 2023/24 collective agreement that it would work with NZNO to ensure it was safely staffed.

But in 2023 — when NZNO forced Te Whatu Ora to release its figures under the Official Information Act — they showed a quarter of nursing shifts were understaffed. Some — such as mental health wards — were understaffed nearly all the time.

‘It’s gaslighting. What do you do with a Government which is basically telling itself a story? When someone denies your reality?’

The impact on nurses and patients is profound, says Handisides. “People are worried about their practising certificate, because really unwell people are arriving, then not getting their full care on time and becoming more unwell. It’s so difficult for nurses, especially when we care so much.”

Hawke’s Bay nurse Noreen McCallan, also on the bargaining team, is blunt.

“It’s gaslighting. What do you do with a Government which is basically telling itself a story? When someone denies your reality? That’s totally what it is,” she told Kaitiaki.

Even though Te Whatu Ora kept saying there’s no recruitment pause, there were long delays of up to several months.

“What I’m told by fellow delegates on a regular basis is there aren’t enough people on the relief team, on the medical ward . . .  sick leave isn’t being replaced — and they’re just moving patient numbers around if they can get away with it,” McCallan said.

“Any delay in replacing a long-established position, which there is currently, is effectively a cut — even if it’s only temporary.”

The latest freeze on upgrading the health sector’s ageing data systems would also increase the workload for nurses, she said.

“Everybody laughed when Lester Levy said he’s not making cuts,” said McCallan, referring to last week’s six-hour health select committee grilling of the Te Whatu Ora’s commissioner. Lester stated: “There are no cuts — I think there’s a line being drawn between reducing staff and a cut.”

“Tell the nurses that, tell the communities that, tell the national public service that,” Labour MP Ingrid Leary replied, as Te Pāti Māori Debbie Ngārewa-Packer face-palmed and Labour’s health spokesperson Ayesha Verrall said “keep digging”,  The Post reported.

Levy said Te Whatu Ora was not cutting but “right-sizing” after over-recruiting mainly in management and administration which had grown “by the thousands”.

McCallan believed the health system was heading into steep decline “like I’ve never seen before”.

Pausing CCDM calculations — on top of a hiring freeze — would only speed an overseas exodus of nurses and impact the health system for years to come, she warned.

“If we don’t get the CCDM FTE calculations that are contractually obliged to happen — that are in our contract — then people will keep resigning because they’ll go to Australia.”

‘We are going to see our youngest and brightest go — and we’ve got an ageing workforce.’

Lower Hutt nurse and delegate Nathan Clark said staff were deeply worried about the long-term impact of the current recruitment lag and CCDM pause.

“We are going to see our youngest and brightest go — and we’ve got an ageing workforce,” he said from the Hutt Hospital picket line this month.

Maree Jones said it was hugely disappointing that CCDM was not fully implemented in any hospital or region after so many years.

And now, even these painfully slow gains are being ripped away.

“Some were just about there, but now there’s little priority for the programme and hardly any resource.”

Even where CCDM is working, there aren’t enough nurses to fill the gaps it identifies, striking Lower Hutt nurses and kaiāwhina told Kaitiaki. Medical wards especially were often below the target FTE, they said.

‘We value you’ — Te Whatu Ora

Te Whatu Ora deputy chief executive northern region Mark Shepherd says the pause is simply to review how it does CCDM staffing calculations after regional inconsistencies — but acknowledges they will be limited by budget.

“FTE [full-time equivalent] calculations will resume in the new year and be aligned to ongoing budget and planning cycles,” he said in a statement.

And while Te Whatu Ora greatly valued nurses’ contribution, any settlement needed to reflect the “ongoing reset of Health NZ as we work to get back to budget”.

The pressure on Te Whatu Ora to save $2 billion in this financial year is no secret — yet Levy has (begrudgingly) staked his job on not cutting frontline health workers.

That his comment was swiftly followed  by a proposal to cut four directors of nursing, means Te Whatu Ora nurses may feel increasingly confused and gaslit.

Shepherd also said nurses’ salaries had risen higher than most in recent years, growing 45 per cent for those on the top RN step, with another 25 per cent from last year’s pay equity settlement.

But NZNO chief executive Paul Goulter said it was “misleading” and “insulting” to include a long-overdue pay equity settlement over gender inequities in wage bargaining.

He said nurses and kaiāwhina were “fiercely committed” to caring for their patients.

“They don’t want to see patients’ safety at risk because there are not enough nurses on duty to give them the care they need.”

Details of NZNO’s claims for 2024 NZNO/Te Whatu Ora bargaining can be found here.

• Te Whatu Ora — NZNO mediation is scheduled for this week.