Speaking up is “very daunting but definitely worth it”, NZNO’s college of emergency nurses NZ (CENNZ) told the annual college and section forum in Wellington this month.
With a large part of the forum focused on raising the professional voice of nurses to influence political decision-making, CENNZ member Lydia Moore said the college last year decided to speak out more in the media on the challenges faced by nurses. “It was very daunting but definitely worthwhile.”
Chair Lauren Miller had taken every opportunity to speak to media — including Kaitiaki — on the challenges of six-hour ED stay targets and unsafe staffing levels, and had also written to both health ministers, Moore said. “This did lead to a face-to-face [with Shane Reti] — although whether it did anything is hard to say.”
‘It’s amazing how a small collective change makes a big difference.’
CENNZ had also seen its Māori members increase from eight to 11 per cent; and Pasifika members from two to four per cent over the past two years, after developing a Māori health strategy led by member Natasha Hemopo. One action was to make grants more accessible to Māori members, which had a big impact.
“It’s amazing how a small collective change makes a big difference.”
College of primary health care nurses had also taken up the challenge to be the professional voice for primary health care (PHC), chair Tracey Morgan and member Rosie Katene said.
“If you’re not on the menu, you’re not at the table,” Morgan said. “So we took that challenge, and went to Paul [Goulter, NZNO CEO] and said, ‘We will be in every space, every opportunity in primary health we can — we want to be the voice’.”
College of air and surface transport nurses (COASTN) said, that after a three-year fight, they had managed to get a nurse representative across all four workstreams of a proposed restructure of air ambulance transfers. This proposal could affect flight nurses if they were replaced by paramedics, the college said, via their professional nursing advisor Annette Bradley-Ingle.
Neonatal nurses speak out on unsafe staffing
Most neonatal units have been running at “unsafe” levels of 120 to 130 per cent occupancy over the past six-12 months, neonatal nurses college Aotearoa secretary Michelle Willows told the forum.
“This impacts on whānau quality of care, breaches in confidentiality, loss of dignity, increases in errors and omissions and incidents of direct harm,” she told the forum.
One neonatal unit reported a shocking 224 adverse incidents in the past six months — a 200 per cent increase — “and, in their words, they felt very unsafe”.
Sixteen of the country’s 23 neonatal units reported staff vacancies of up to 20 per cent, hampered further by CCDM [safe staffing tool care capacity demand management] calculations not being added to budget and being told they’re not allowed to recruit, Willows said. “Despite what is being reported [by Te Whatu Ora]. . . there is a recruitment freeze.”
To cope, units are forced to do “patchwork” staffing, where nurses are redeployed from other areas without specialist neonatal knowledge and skills.
‘The most vulnerable New Zealander is 350g and currently being cared for in a neonatal unit in this country.’
“Sent for anything from an hour to eight hours of a shift, this adds increased layers of risk for everybody.”
Willows said it was “shocking” but not new — similar unsafe staffing issues had been identified in 2019 “but nothing has changed”.
The college was working with NZNO researchers to bring stories and data together and push for safely staffed units. “We really want to do something about it — we want to change this and collaborate with all of you.”
The college shared a slideshow featuring a single family over five days who endured separation from visiting whānau, a medication error, being refused help with pumping breast milk and a refusal to use the baby’s Tongan name, instead referring to him as “Jack”.
“The most vulnerable New Zealander is 350g and currently being cared for in a neonatal unit in this country. Him and his whānau and all the children we care for deserve to have the right skills to care for him properly,” Willows said.
‘If you’re not on the menu, you’re not at the table.’
Flight nurses, like all nurses, were experiencing increased workloads and many transfers were done by nurse-only teams. Hawke’s Bay Hospital region had about 2000 flights yearly, Nelson/Marlborough about 1200 and Dunedin about 800.
About half of these were nurse-only, Bradley-Ingle said. “This is the level of skills that the nurses have. When you start looking at those numbers of flights with nurses involved and [with] only about 500 nurses flying, it gives you a sense of the workload these nurses take on.”
Flight nurses numbers were “steadily climbing — we like that for our pilots as well” — at just under 500, a huge portion of whom were COASTN members.
The women’s health college, too, had increased its membership from 517 to 672 over the year, member Judith Beattie said. Some of its members were taking on roles formerly the domain of doctors, such as hysteroscopy (examining the uterus) and colposcopy (examining the cervix).
“So we’ve had these leaders in our committee really leading the way in nurse practitioner work within New Zealand.”
The college had also pushed, through submissions, for funding a wider range of medications such as contraceptive pills.
Aotearoa college of diabetes nurses chair Amanda de Hoop said members had made several submissions over the year to improve access to medications for patients. It had also successfully lobbied the Nursing Council to add the medication Victoza to the nurse prescribing list which would benefit whānau with type 2 diabetes.
In growing its reach and diversity, the college also now had a representative on the Mahitahi Matehuka diabetes national clinical network and was considering a bicultural leadership model. While this prospect was exciting, de Hoop said she was mindful that Māori membership was low and she did not want to burden the few Māori members in the college.
‘Insanity is when you do the same things over and over and expect different results.’
The college of respiratory nurses had also made several submissions over 2024, including on proposed downgrades to insulation requirements in homes; and on the return of prescription charges including for inhalers, chair Jacqueline Westenra said.
Pacific nursing section (PNS) member Abel Smith said the section — which was 17 years old this year — wanted to take a different approach to expanding and empowering the Pasifika nursing workforce including nurse practitioners.
“Insanity is when you do the same things over and over and expect different results,” Smith said. “This year we’re determined to do things differently.”
Despite seven Pacific nurses graduating with a PhD last year, only one had become an NP, he said. And after 25 years of the NP role’s existence in New Zealand, there were only 12 of Pacific descent. “There’s something wrong and we need to do something about it.”
PNS planned to become more involved with the nurse practitioners’ training programme (NPTP) governance, Smith said.
‘My view after 30 years is that mental health is the Cinderella of health services.’
Nursing research section members, in a recording, said they had grown to 370 members in the past year and were enjoying high levels of social media engagement through Facebook and LinkedIn.
A research hui last year had been a great chance for emerging nurse researchers to practise their presenting skills and now the section was keen to explore hosting online workshops and grow its mentoring support.
Mental health nurses section member Bruce Tomlinson shared the challenges facing mental health nursing, particularly lack of staff. Māori mental health fared the worst, he said.
“My view after 30 years is that mental health is the Cinderella of health services – and unfortunately Māori mental health has been the Cinderella service of a Cinderella service.”
This had a significant impact on Māori, as well as Pasifika, communities, whose whānau were often left to deal with mental health issues unsupported.
The withdrawal of police from all but the most severe mental health callouts was one of the biggest pressures facing mental health nursing, Tomlinson said.
College of gerontology nursing chair Bridget Richards put a call out for more registered nurses (RNs) working with older people — whether in hospitals, communities or aged residential care — to share their experiences for NZNO’s age safe campaign. Contact: [email protected].
“It’s really important to get the RN voice out there . . . we want a proper 360 view of what’s going on.”
‘If you don’t have ENs in your workplace, can you advocate for us? We are a very important workforce.’
Particularly high numbers of internationally-qualified nurses (IQNs) in aged care currently, meant there were not many vacancies for new graduates — also struggling to find work in hospitals.
The college was open to all nurses who worked with older adults, even outside of aged residential care, she said.
“Nearly everybody in here will be looking after older adults but don’t see themselves as specialist in that area. Actually you are – that’s what we do, day in day out. Eighty per cent of people in Te Whatu Ora hospital beds are over 70 so please use our resources,” Williams said.
The infection prevention and control (IPC) nurses college was pushing to become the leading voice in its field, by connecting with Te Whatu Ora and chief nurse Nadine Gray, member Angie Foster said.
Membership had grown from 866 to 944 over the past year, much of which was driven by its Facebook page. However, it was still not representative of the number of IPC practitioners.
Nursing leadership section representatives said membership had grown to 800 and it hoped to take its coaching and mentoring workshops beyond the provinces into mainstream centres this year.
College of critical care nurses’ Rachel Atkin and Alicia Osland said social media use was also driving higher engagement, particularly through events such as webinars. The college was also partnering with its Australian equivalent to access professional development workshops, webinars and conferences.
With 1234 members currently, the college wanted to reach out and recruit nurses who worked in high dependency and coronary care as well as in intensive care units.
Enrolled nurses section representative Debbie Handisides called on colleagues to advocate for ENs in their workplace, now an expanded EN scope of practice allowed them to work “everywhere”.
“If you don’t have ENs in your workplace, can you advocate for us? We are a very important workforce and . . . we’ve extended our scope so we can work everywhere. Thank you for being a voice for ENs where and whenever you can.”
The section would also be celebrating 60 years of enrolled nursing in Aotearoa this year.
The gastroenterology nurses college said it was developing guidance on safe care for transgender patients as well as lobbying the Government and Te Whatu Ora to reverse its decision to remove priority bowel cancer screening for Māori and Pasifika. It also planned to work more closely with Pharmac on its drug consultation process to try and get better medication options for gastroenterology patients.