Mythbusting: NZNO expert tackles Te Whatu Ora’s safe staffing denials

“I am sorry they feel that way.” – Richard Sullivan on RNZ, September 2.

Te Whatu Ora does not routinely survey nurses for job satisfaction, burnout, wellbeing and intent to leave the profession. Yet safe staffing tool CCDM (care capacity demand management) requires that the nursing staff are surveyed every three months.

It is international best practice to do this every three to six months, share results transparently and act on them — staff lose trust when feedback disappears into a void.

“Using this data in isolation to claim that wards are understaffed and unsafe is misleading.” — TE Whatu Ora national clinical director Richard Sullivan. (Media release, September 1)

Yet there is a flood of information available on nurse understaffing from the clinical floor every shift via the CCDM system. Its variance response management (VRM) flags when there is a mismatch between patient demand and staff capacity.

Te Whatu Ora does not collect, report nor analyse this information in a standard way across New Zealand.

If it invested in a national data system, it could collect this.

It could also collect data showing how many valid requests for staff for every ward are made every shift.

Without this national data, there is a gap in Te Whatu Ora’s ability to respond.

Nurses have become increasingly sceptical of the effectiveness of the VRM system due to lack of response by their employer when they indicate staffing pressure.

Research clearly tells us insufficient staff puts patients at risk.

Shifts-below-target should always be measured in real-time. But this requires clinical nursing staff and shift leaders to update the data tool, TrendCare, not only at both ends of the shift but also during the shift when patient acuity, numbers and/or staffing numbers change. TrendCare can then automatically calculate staffing shortfalls using this live data.

This ideal practice would provide:

1. Accuracy
   • Real-time data reflecting exactly what happened during the shift (such as unexpected sick leave, high patient acuity).
2. A culture of safety.
   • Supports patient safety.
   • Promotes accountability and transparency.
   • Staff feel heard and supported when shortages are documented promptly.
3. Timely decisions
   • If issues are identified immediately, managers can quickly respond by:
     • Calling in backup staff,
     • Adjusting workload,
     • Escalating safety concerns.
4. Better insights
   • Real-time trends help identify persistent gaps or staffing pressure points (such as on particular days/times).

Why it matters

• Patient risks increase when shifts are consistently below target—especially in high-dependency areas like oncology, paediatrics, and mental health.
• Nurse burnout becomes more likely when staff are stretched thin, leading to higher turnover and even more understaffing.
• Studies show that patient outcomes worsen—including higher mortality rates—when wards frequently operate below safe staffing levels.

Reports of preventable harm diminish patient and public trust and cause emotional harm to clinical nurses.

CCDM has a built-in early warning system — VRM is designed to trigger action before patients suffer harm.

Why is VRM better at keeping patient safe?

Proactive: It allows the calling in of reinforcements, reallocation of staff or escalation to leadership before the situation becomes unsafe and/or causes patient harm.

Standardised decision-making: Everyone follows the same playbook, reducing confusion and delays.

Staff wellbeing: Prevents burnout by avoiding chronic overload.

Patient safety: Ensures care quality doesn’t drop when things get busy.

Relying solely on falls, pressure injuries, hospital-acquired infections and death can be problematic for the following reasons:

Retrospective, not preventative

• They only show harm which has already occurred.
• They don’t identify risks before an incident happens, limiting proactive safety interventions.

Hard to determine the cause of the harm

• Makes it difficult to target improvements effectively.

Under-reporting and data quality

• Staff may under-report incidents due to fear of blame or workload pressures.
• Inconsistent documentation across wards or hospitals skews data reliability.

Doesn’t reflect near misses or unsafe conditions

• These measures ignore situations where harm almost occurred—and understanding of the clinical conditions that contributed.
• Unsafe staffing levels, poor communication, or environmental hazards may go unnoticed until harm occurs.

Delay in feedback

• Indicators often emerge in audits or quarterly reports, far removed from the moment of care.
• That lag reduces their usefulness for real-time improvement.

It is only logical that hospital nurse staffing needs to keep pace. However, this does not mean nurse staffing matches patient demand.

Only the data from an accurate safe staffing system can show that.

“We don’t believe the current tool . . .  is fit-for-purpose.” — Richard Sullivan,  media release, September 1.

Acuity tools turn the complex, often invisible work of nursing into quantifiable, visible, actionable data that reflects what is actually happening on the ward.

Having acuity data is vital now that nurses are no longer is in charge of the nursing budget. The nursing budget is now overseen by accountants who often do not understand nursing.

TrendCare and CCDM are absolutely fit-for-purpose. The tools provide data from nurses which informs the organisation how many nursing hours are necessary to keep patients safe and well. Only nurses are qualified to do this.

The goal of CCDM is to move away from making rosters fit budgets, and instead build budgets around actual care demand. Together TrendCare and CCDM deliver:

• Safe staffing levels based on real patient needs.
• Responsive rostering that adapts to daily fluctuations.
• Evidence-based budgeting for nurse workforce planning.
• Healthier workplaces and better patient outcomes.

Australia – Where TrendCare originated and is widely adopted across public and private hospitals.

Southeast Asia – TrendCare has been trialled and validated in various health-care facilities across the region.

TrendCare is considered a gold standard in acuity-based staffing in the southern hemisphere.

Countries using similar patient acuity systems to CCDM for staffing and budgeting:

• United States: Many hospitals use acuity-based staffing, especially in intensive care units. Some states like Massachusetts have legislation requiring acuity-adjusted staffing in certain units.
• South Korea: Has developed hospital-specific patient classification systems to measure acuity and guide staffing decisions.

 Pilots or partial adoption:

• Canada, the United Kingdom, Singapore, and Ireland have explored or implemented acuity tools in some hospitals or regions.

Te Whatu Ora previously committed to explore employing all new graduates in the 2018 safe staffing accord with NZNO.

Recently, it has also:

• Cut minimum employment hours from four days (0.8) to three days a week (0.6). This shift toward part-time roles is intended to create more “flexible” job options—but many see it as a cost-cutting move.
• Dropped on-the-job training from 240 to just 80 hours.
• Dropped study hours, including mandatory training, from 96 to 80 hours.