The president comments: Nurses’ courage and self-determination

Late last year I attended my first NZNO membership committee meeting. A pervasive theme was the trauma experienced through unsafe staffing. 1 Reflected too in the media, this growing issue affects nurses and midwives in private, tertiary and community sectors, as well as those they care for.

Nurses’ history of sacrifice is well documented and continues unrelentingly. 2

Today nurses support each other and their patients by sacrificing their days off, doing double shifts, overtime – and a whole lot more. But many shifts remain unfilled even on public holidays.

There could be many reasons for this, but I believe it reflects a burned out, exhausted and understaffed nursing workforce. 3, 4, 5

This state of play was evident well before COVID-19 arrived, with predictions of 25,000 nurses needed by 2030. 6

Our members go to work every day, wondering what care-rationing decisions they will have to make, how many patients will be put at risk through unsafe staffing and lack of resources and how patients and their families will respond to the ever-increasing wait times before being seen. Yet nurses are still expected to provide safe care, despite having little control over decisions relating to nurse recruitment and retention.

Competencies for safe practice were developed by the Nursing Council in 2003. At the time, NZNO policy analyst Eileen Brown recognised the need for the nursing profession to be in control of its own standards. She (unsuccessfully) challenged the process of nurses’ competency development by the council, suggesting NZNO colleges and sections should develop them and the council approve them.

Brown presented NZNO’s submission to the Health Select Committee, which was based on four principles: protecting patient safety; professional self-regulation (self-determination); consultation with the profession; and inclusion of the Treaty of Waitangi. 7

NZNO is still fighting for these principles today. Nursing Council competencies 1.1. and 1.48 require nurses to promote an environment that maximises health consumer safety while providing care that best meets the needs of the health consumer and the public.

NZNO members’ reports of unsafe staffing were finally heard in 2005 when the Safe Staffing/Healthy Workplaces Committee of Inquiry was set up. The committee soon identified a disconnect between those in a position to enable change to unsafe staffing, and nurses working in clinical settings. 9

This concern was reiterated by the government of the day, which recognised a potential crisis in nurse staffing by 2021. 10

Sixteen years later, New Zealand nurse job vacancies are now in the thousands, engendering increasingly high and unsafe nurse workloads which impacts on those being cared for. 11, 12 Collective agreements between nurses and nurse employers are often violated, resulting in Health and Safety in Employment PINs (Provisional Improvement Notices) being served on nurse employers. 13, 14, 15

Unsafe staffing complexities have been exacerbated and made visible through the increased work demands on nurses related to COVID-19. So, what can we do?

First, we need to follow the science and recognise that much of the expertise to engender a safe staffing work environment resides outside the Ministry of Health. 16

Across the ditch, legislation and evaluation research have demonstrated the value of mandating safe staffing to safeguard nurses’ right to a safe working environment from any successive government. 17

To achieve this, NZNO members must realise their ability to be self-determined (ie take up the right to equally participate and control our working environment to meet professional, legislative, ethical and cultural standards of practice). Long-term innovative strategies focused on recruitment AND retention are a must. 18

In a context where our health system is becoming more centralised, opportunities exist to increase the supply of nurses.

Government, the Nursing Council and employers must prioritise work in partnership with NZNO to make current nurse immigration and registration systems more efficient.

NZNO represents the majority (54,000-plus) of nurses who work in New Zealand. Recently NZNO successfully led a pay negotiation for district health board (DHB) nurses – but there are still many nurses outside DHBs who do not have pay equity and that is a continuing injustice.

Ground up, workplace organisation, solidarity and independent action will resolve continuing inequities experienced by our nurse members working in private and community settings, and ensure mandated safe staffing for all. 19

References

Earley, M. (2020). Auckland DHB nurses say staff shortages putting patients and staff at risk. Retrieved from Auckland DHB nurses say staff shortages putting patients and staff at risk | Stuff.co.nz on 20.1.2022.
O’Connor, M. E. (2010). Freed to care, proud to nurse. 100 years of the New Zealand Nurses Organisation. Steele Roberts Publishers.
NZNO. (2021). Worried Auckland nurses say health system anything but ok. Retrieved from Nursing Shortages – New Zealand Nurses Organisation (nzno.org.nz) on 20.1.2022.
NZNO. (2021). NZNO warns Government: “You ain’t seen nothing yet!” Retrieved from Nursing Shortages – New Zealand Nurses Organisation (nzno.org.nz) on 21.1.2022.
Steyl, L. (2021). Midwife shortage an ‘extreme risk’ for Southland Hospital. Midwife shortage an ‘extreme risk’ for Southland Hospital | Stuff.co.nz on 21.1.2022.
Health Central. (2019). Overseas nurses being sought to help the nursing shortage. Overseas nurses being sought to help with nursing shortage | Health Central on 21.1.2022.
O’Connor, T. (2003). New law brings major changes. Kai Tiaki Nursing New Zealand. November 2003. P. 11.
www.nursingcouncil.org.nz/Public/Nursing/Standards_and_guidelines/NCNZ/nursing-section/Standards_and_guidelines_for_nurses.aspx
Crossan, D. (2006). Report of the Safe Staffing/Healthy Workplaces Committee of Inquiry. NZNO-Retirement inside.indd (ccdm.health.nz) on 20.1.2022.
Ministry of Health. (2006). Health workforce development. An overview. Wellington. Health Workforce Development: An Overview | Ministry of Health NZ.
North, N., Leung, W., Ashton, T., Rasmussen, E., Hughes, F., & Finlayson, M. (2013). Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes. Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes – PubMed (nih.gov) on 21.1.2022
Steyl, L. (2021). Aged residential care reaching ‘tipping point’. Aged residential care reaching ‘tipping point’, DHB boss says | Stuff.co.nz on 21.1.2022.
Houlahan, M. (2021). ‘Someone will die’: Ed staff take legal action on work conditions. ‘Someone will die’: ED staff take legal action on work conditions | Otago Daily Times Online News (odt.co.nz) on 21.1.2022.
NZNO. (2021). NZNO issues Provisional Improvement Notice to Hawkes Bay DHB. Nursing Shortages – New Zealand Nurses Organisation (nzno.org.nz) on 21.1.2022.
Trigger, S. (2021). Wellington Hospital Emergency Department: 11 nurses resigned in 10 days amid health and safety complaints. www.nzherald.co.nz/nz/wellington-hospital-emergency-department-11-nurses-resigned-in-10-days-amid-health-and-safety-complaints/TPIVMMJ3N2EXSB2SZHPFZINKUM/ on 21.1.2022.
Powell, I. (2022). Take that world! How we gave covid our best shot. Retrieved from Take that, world! How we gave covid our best shot | BusinessDesk on 21.1.2022.
McHugh, M. D., Aiken, L. H., Windsor, C., Douglas, C., & Yates, P. (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ Open, 10, e036264. doi:10.1136/ bmjopen-2019-036264
Buchan, J., Catton, H., & Shaffer, H. (2022). Sustain and Retain in 2022 and Beyond. International Centre on Nurse Migration.
NZNO Board of Directors. (2020). Policy Remit 1: Review of NZNO strategies for safe staffing. Remit information booklet. NZNO Conference.

Uncut – news briefs

20 Dec	Health NZ introduces public reporting of key primary healthcare measures and PHO performance Health New Zealand \| Te Whatu Ora (Health NZ) has introduced public reporting of key primary healthcare measures and Primary Health Organisation (PHO) performance.
19 Dec	Quarter 1 performance report released Health New Zealand \| Te Whatu Ora has today published its Quarterly Performance Report for Quarter 1, covering the period 1 July to 30 September 2024.
18 Dec	Recent uptick in Boostrix immunisations amid whooping cough epidemic, but work still to do As the healthcare sector continues to respond to a whooping cough (pertussis) epidemic across the motu, it’s promising to see a recent uptick in the number of Boostrix immunisations among the 15- to 44-year-old age group, with a recent doubling of doses administered from about 1,000 per week to over 2,000 per week.
18 Dec	Extra security to again keep EDs safe this summer Health Minister Dr Shane Reti is again reminding New Zealanders that violence against patients, visitors and health workers won’t be tolerated, with additional security for hospital emergency departments across the country this summer.
13 Dec	Mental health and addiction targets implementation plans released Health New Zealand \| Te Whatu Ora has today published its first quarterly results for four of the five mental health and addiction targets, covering the period 1 July – 30 September 2024.
12 Dec	Health targets encouraging – work continues New data shows that the Government’s focus on health targets is putting the brakes on the steep decline in delivery seen over the past five years.
12 Dec	Gisborne receives mental health beds boost Minister for Mental Health Matt Doocey today opened Gisborne Hospital’s new acute mental health unit, Te Whare Awhi Ora, and says the region will be better served by a bigger, more therapeutic acute mental health unit.
9 Dec	Afghan women ‘banned from nursing and midwife training’ in latest blow to rights BBC News has reported that female nursing and midwifery students in Afghanistan have been told not to return to their studies, effectively ending women’s only access to further education, and putting women and children’s lives at risk.
9 Dec	How student and early career nurses can influence policymaking The International Council of Nurses (ICN) held a webinar which highlighted the vital importance of primary and preventative health care in meeting the World Health Organization’s (WHO) challenging goal of achieving Universal Health Coverage (UHC) by 2030
3 Dec	Health NZ end-of-year deficit confirmed In publishing its annual report, Health NZ has confirmed it ended the financial year with a deficit of $722 million, against a target surplus of $54 million.
2 Dec	ICN says COP29 climate finance shortfall threatens the planet’s health The International Council of Nurses (ICN) has expressed profound disappointment with the outcomes of COP29, held in Baku, particularly the New Collective Quantified Goal (NCQG) on climate finance that was passed despite significant objections from developing countries.
29 Nov	Minister reminds public health officials of priorities Minister of Health Dr Shane Reti says the National Public Health Service should concentrate its focus on prioritising serious public health issues facing New Zealanders.
29 Nov	Community providers rally to protect hapū māma and pēpi as national whooping cough case numbers surpass 1,000 for 2024 Hapū māmā are being urged to get immunised, and parents and caregivers are encouraged to get their babies immunised on time, as whooping cough case numbers continue to climb across Aotearoa New Zealand.
28 Nov	Govt ignores health crisis, plans to axe 1500 public health roles The health of New Zealanders will suffer because of the Government’s plan to axe nearly 1500 roles at Te Whatu Ora, coming at a time when the public health system is already under severe pressure.
27 Nov	Health New Zealand Establishes Technical Advisory Group to Lead Transformation in Maternity Care This team of experts and community representatives will play a key role in the development of the Maternity Commissioning Framework, a core element of the wider Kahu Taurima programme, which aims to make maternity and early years services more equitable, accessible, and whānau-centered.
22 Nov	Whooping Cough epidemic declared across Aotearoa New Zealand Health agencies have confirmed today that Aotearoa New Zealand is now in the early stages of a Whooping Cough epidemic, with a nationally coordinated response now in place.
20 Nov	A Global Map of Winter Depression Healthnews has released an extensive study that ranks 194 countries based on their winter-pattern Seasonal Depression Disorder (SAD) risk.
18 Nov	Potential travel disruption expected with Tuesday’s national Hīkoi Health New Zealand \| Te Whatu Ora urges those with an appointment scheduled at Wellington Regional Hospital on Tuesday morning or early afternoon, to please allow extra time to get to appointments.
15 Nov	ICN’s calls on G20 leaders to address international health worker migration crisis Ahead of the G20 Leaders Summit in Rio de Janeiro next week, the International Council of Nurses (ICN) welcomes the Declarations recently adopted by the G20 Health Working Group and health ministers.
13 Nov	Measles case confirmed in Tāmaki Makaurau Health New Zealand \| Te Whatu Ora has confirmed today that a new case of measles has been identified on Waiheke Island in Auckland. The case and their household are being supported by the National Public Health Service (NPHS), with those most at risk now in quarantine to help reduce the chance of further spread.
5 Nov	Safety fears ahead of changes to mental health 111 calls Mental Health Nurses have serious concerns about the safety of their patients, the public, their colleagues and themselves when police changes to emergency 111 calls come into effect on Monday, New Zealand Nurses Organisation (NZNO) Tōpūtanga Tapuhi Kaitiaki o Aotearoa says.
31 Oct	General practices welcome fast-track approvals process A new fast-track approval process is a good start, but more is needed to fix New Zealand’s chronic GP shortage, says the General Practice Owners Association (GenPro)
24 Oct	International Council of Nurses Bucharest Declaration priorities for the future of nursing The International Council of Nurses (ICN) marked the 125 years since its founding in 1899 with an anniversary conference held in Bucharest, Romania and hosted by the Order of Nurses, Midwives, and Medical Assistants of Romania.
10 Oct	Call to immunise now as New Zealand at high risk of whooping cough outbreak Pregnant people, babies, children and others at high risk from whooping cough are urged to get vaccinated as soon as possible, as Aotearoa New Zealand stands at high risk of an outbreak.
9 Oct	New pilot with Plunket to deliver childhood immunisations To increase access and boost immunisation rates, Health New Zealand \| Te Whatu Ora and Whānau Āwhina Plunket will pilot the delivery of childhood immunisations at a select number of sites across the country.
8 Oct	Health NZ Begins Development of National Perinatal Bereavement Care Pathway As Baby Loss Awareness Week shines a light on the heartbreak faced by many, Health NZ is taking a compassionate and hopeful step forward in transforming the support available for whānau who experience the loss of a baby.
7 Oct	Govt takes the scalpel to regional health budgets At Labour’s insistence, Te Whatu Ora financial documents have been released by the Health Select Committee today showing more cuts are on the way for our health system.
2 Oct	Orion Health and Streamliners form strategic partnership Orion Health, a global leader in digital health solutions, has announced a strategic partnership with Streamliners, creators of HealthPathways which provides an online manual used to assist with clinical assessments.
1 Oct	Rollout of new medicines across New Zealand begins Today marks the first day a range of new medicines, including cancer medicines, will start to become available in hospitals and health centres across the country.
27 Sept	New Dunedin hospital: Southerners deserve better The Government’s announcement today that it will scale back the new Dunedin hospital will negatively impact patient care, the New Zealand Nurses Organisation (NZNO) Tōpūtanga Tapuhi Kaitiaki O Aotearoa says.
26 Sept	Govt not addressing health workforce crisis The National Government is hiding the gaps in the health workforce from New Zealanders, by not producing a full workforce plan nearly a year into their tenure.
25 Sept	New programme offers step up for jobseekers seeking a career in health and wellbeing Local jobseekers have an exciting new opportunity to begin a career in Health following the launch of a new community-based kaiāwhina programme in the Hutt Valley.
23 Sept	Ministers oblivious to cuts’ effect on families The National Government is oblivious to the impact cuts to services will have on New Zealanders who are doing the hard yards caring for mentally ill family members.
19 Sept	Wānaka community to benefit from new overnight health service Health Minister Dr Shane Reti says an Overnight Acute Care Service opening in October will provide people in Wānaka and the surrounding area with the assurance of quality overnight care closer to home.
17 Sept	Dr Le Heron takes title of 2024 Alzheimers NZ Fellow Distinguished neurologist and cognitive neuroscientist, Dr Campbell Le Heron, has been made the 2024 Alzheimers NZ Fellow for his work researching and managing cognitive disorders.
11 Sept	Aged care will be worse off if redesign rushed New Zealanders needing aged care support and the people who care for them will be worse off if the Government pushes through a flawed and rushed redesign of dementia and aged care.
11 Sept	Govt takes action on mpox response, widens access to vaccine The Government is taking immediate action on a number of steps around New Zealand’s response to mpox, including improving access to vaccine availability so people who need it can do so more easily, Health Minister Dr Shane Reti and Associate Health Minister David Seymour announced today.
10 Sept	ICN launches new position statement and discussion paper setting out a revolution in the delivery of Primary Health Care The International Council of Nurses (ICN) is launching its new position statement and a discussion paper on Primary Health Care (PHC) at its Nurse Practitioner/Advanced Practice Nursing Network (NP/APN Network) Conference in Aberdeen, Scotland.
9 Sept	First cancer medicine decision following Pharmac funding boost Pharmac has decided to widen access to two medicines for several types of cancer. Pembrolizumab (branded as Keytruda) will be funded from 1 October 2024 for eligible people with advanced triple-negative breast cancer, head and neck cancer, colorectal cancer, bladder cancer, and Hodgkin lymphoma. Nivolumab (branded as Opdivo) will be funded from 1 November for eligible people with kidney cancer.
6 Sept	Health agencies working with Police on rebalancing roles for mental health responses Health New Zealand \| Te Whatu Ora and the Ministry of Health - Manatū Hauora are working with Police to change some of the ways agencies respond to mental health. The change will see an increased health-led response, supporting Police to focus on core Policing.
4 Sept	Nurses’ bargaining starts with action for safe staffing Nurses are kicking off their collective bargaining with Te Whatu Ora by taking action for safe staffing on Friday, New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) says.