Nursing reports

Te Rūnanga o Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) is urging Māori nurses to throw their hats into the ring for the sixth annual Pharmac Tapuhi Kaitiaki Awards.

The awards are sponsored by Pharmac and were first held in 2018. They recognise the positive impact Māori nurses have on whānau and the role they play as key influencers on health outcomes.

Kaiwhakahaere Kerri Nuku says these awards have been created to support Māori nurses to continue their studies and develop their clinical practice.

"We need a health system that supports services run by Māori for Māori to improve the health of our whānau, hapū and iwi. These awards are a crucial way to tautoko that aspiration, especially for our nurses who are studying to be nurse prescribers and nurse practitioners so they can serve their people who have limited access to health care."

Ms Nuku said some truly exceptional nurses and tauira have been recognised over the years through these awards, and she was confident this year would be no different.

"Māori nurses are not only dedicated professionals but great innovators. The Kaitiaki Awards provide a wonderful opportunity to showcase their day-to-day mahi for the betterment of their people, hei oranga motuhake mo ngā whānau, me ngā hapū, me ngā iwi katoa."

The Tapuhi Kaitiaki Awards are allocated in two categories. The first category for Nurse Practitioner/Nurse Prescriber recognises Māori nurses who are on a professional development journey to advance their clinical practice and expertise. The second category, Māori Nurse Mātauranga, supports nurses and tauira to further their study and/or develop an innovative way to help whānau, hapū and iwi to access and understand their medicines.

Te Pātaka Whaioranga Pharma’s Kaituruki Māori/director Trevor Simpson said they were honoured to be part of this initiative to celebrate and support the contributions and aspirations of Māori in the health sector.

"This is a partnership with Tōpūtanga Tapuhi Kaitiaki o Aotearoa to build in strong and enduring Māori leadership within the critically important area of nursing.

"Related to this important kaupapa, the awards are a small but important gesture for the growth and development of our Māori nurses. In many ways this is an investment in the lives of our mokopuna, both now and into the future."

Submissions close on 16 June 2023. Nominations can be made on the NZNO website here.

New Zealand Nurses Organisation media release, 23 May 2023

The New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) says the absolutely vital right of workers to strike over health and safety matters has been upheld with the Employment Court dismissing a Te Whatu Ora application to stop a one-hour health and safety strike planned by nurses working is Ward 5 at Gisborne Hospital.

However, just as important, says NZNO Chief Executive Paul Goulter, is the moral victory.

“These are exhausted nurses who have given everything they have for their patients for an extended period of time, and they have finally reached breaking point.

“Nurses right across the health system are not currently safe at work and to have denied them the right to strike over health and safety concerns would have been an intolerable injustice.

“These Gisborne nurses have been raising concerns for more than nine months, and, as the judge pointed out during the hearing, Te Whatu Ora had not managed to change anything at all to help them. This is simply not good enough from one of the country’s largest employers.”

NZNO Ward 5 delegate at Gisborne Hospital Christine Warrander said it was bewildering that Te Whatu Ora chose to expend thousands in resources and taxpayer’s money on fighting a one-hour strike, instead of putting those resources towards fixing the significant health and safety problem they have.

“Despite overwhelming evidence of physical and emotional trauma from the affidavits we gave in evidence, Te Whatu Ora still tried to argue that our workplace is safe.

“It simply isn’t safe, and it is our patients’ wellbeing that is most at risk. Things have got to change before something goes seriously goes wrong that ends a nurse’s career and has lifelong consequences for people.”

The one-hour health and safety strike will go ahead from 1.30-2.30pm tomorrow (24 May 2023). Ward 5 staff will leave the hospital, to demonstrated support by their health worker colleagues (including nurses and other health workers from other wards) to join a rally directly across the road from the Gisborne Hospital.

There will be speakers at the rally, which will also be attended by community supporters, other NZNO members and other unions.

Media and the public are welcome to attend.

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Media enquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617 | media@nzno.org.nz

JOINT MEDIA RELEASE: The Nursing Council of New Zealand/The New Zealand Nurses Organisation

Te Kaunihera Tapuhi o Aotearoa The Nursing Council of New Zealand today launched a new Enrolled Nurse Scope Statement, setting the scene for change in Aotearoa New Zealand.

The new statement has been developed in collaboration with the Enrolled Nurse Section of the New Zealand Nurses Organisation (NZNO).

NZNO Enrolled Nurse Section Chair Michelle Prattley says the statement will benefit both nurses and people who use health services in Aotearoa.

"Enrolled Nurses will be able to practice in a wide range of health care services with this less restrictive scope of practice and enrolled nurses have lobbied for these changes."

The new statement has been prepared by a design group including representatives of the Council, Te Poari o Te Rūnanga o Aotearoa, enrolled nurses themselves, and employers and educators of enrolled nurses.

"Enrolled nurses are skilled nursing professionals in their own right," said Catherine Byrne, Chief Executive of the Nursing Council. "They can work across a wide range of possible practice areas and settings, and this statement recognises that."

Key changes in the new statement include stronger recognition of Te Ao Māori, including Te Tiriti o Waitangi and the Kawa Whakaruruhau framework, and moving from listing specific tasks to a flexible description of practice that reflects an EN’s education and experience. The new statement also shifts the relationship between enrolled and registered nurses (RNs) from ‘direction and delegation’ by an RN to a focus on support and guidance.

The development of this new statement is part of a full Review of the Enrolled Nurse Scope of Practice. The next step in this Review will look at the competencies which describe the skills, knowledge, and behaviours needed to be a safe and competent enrolled nurse, and the education standards that govern Enrolled Nurse programmes. The new statement, competencies, and standards will come into full effect at the beginning of 2024.

"With the Pae Ora and vocational education reforms, the systems in which nurses practise and are educated are both experiencing their most dramatic transformation in decades." Said Byrne.

"How we describe Enrolled Nurse practice and learning needs to support this, enabling these nurses to contribute fully to the health and wellbeing of people, their whānau, and communities. Moving to a focus on partnership and collaboration with RNs and the wider health care team is important and should reduce confusion that might have in the past stopped health employers from realising the possible value of enrolled nurses."

Enrolled Nurses are one of three types or ‘scopes’ of nurses in Aotearoa New Zealand, alongside Registered Nurses and Nurse Practitioners. They complete an 18-month Diploma qualification rather than a Bachelors Degree, and are expected to work with the support of a Registered Nurse or other regulated health practitioner. At 31 March 2023 there were 2,409 enrolled nurses representing 3.5% of the nursing workforce.

The Nursing Council regulates nursing practice and education under the Health Practitioners Competence Assurance Act 2003, including managing complaints against nurses. A person must be registered with the Council and maintain an Annual Practising Certificate in order to work as a nurse in Aotearoa New Zealand.

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Enrolled Nurse Scope Statement

Enrolled Nursing in Aotearoa New Zealand reflects knowledge, concepts, and worldviews of both tangata whenua and tangata tiriti. Enrolled nurses uphold and enact Te Tiriti o Waitangi ngā mātāpono - principles, based within the Kawa Whakaruruhau framework for cultural safety, that promote equity, inclusion, and diversity.

Enrolled Nurses are accountable and responsible for their nursing practice, ensuring all health services they provide are consistent with their education and assessed competence, legislative requirements, and are supported by appropriate standards. This includes the right of Māori and other population groups to quality services that are culturally safe and culturally responsive.

The Enrolled Nurse works in partnership and collaboration with the health consumer, their whānau, communities, and the wider healthcare team to deliver equitable person/ whānau/ whakapapa-centred general nursing care, advocacy, and health promotion across the life span in all settings. An Enrolled Nurse’s practice is informed by their level of educational preparation and practice experience, and may include a leadership or coordination role within the healthcare team.

Enrolled Nurses partner with health and disability support consumers to initiate care, monitor, and enhance health status through nursing assessments, care planning, implementation, and evaluation of care. Enrolled Nurses work with access to and seek, when appropriate, guidance from a Registered Nurse or other registered health practitioner.-

- A health practitioner is a person who is registered under the Health Practitioners Competence Assurance Act 2003 - for example a midwife, medical practitioner or occupational therapist.:

ENDS

For more information contact:

Rob Zorn | Communications and Media Advisor, New Zealand Nurses Organisation

Email: rob.zorn@nzno.org.nz, Tel: +64 (0)4 494 8242, Mobile: +64 (0)27 431 2617

New Zealand Nurses Organisation media release, 21 May 2023

The New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) says Te Whatu Ora has applied for an interim injunction to stop a one-hour health and safety strike by its desperate Ward 5 (Acute Medical) nurses at Gisborne Hospital.

The 24 staff planned to strike from 1.30pm-2.30pm on Wednesday 24 May and on 12 May had already negotiated an agreement, signed off by Te Whatu Ora, over provision of life preserving services, including a protocol for management of emergencies.

NZNO says it will oppose the interim injunction and the hearing will take place on Monday 22 May at 10am in Wellington.

NZNO delegate at Ward 5 Christine Warrander said this was a small-scale strike, by a small number of exhausted staff for a short period of time – and that it was motivated by genuine fears for their own and patient wellbeing.

“We took this action as a last-ditch effort to be heard after repeated pleas for help had fallen on deaf ears.”

A provisional improvement notice (PIN) was issued back in December 2022 for Ward 5 in response to health and safety concerns including acute staff shortages, untenable workloads, staff stress, increased sick leave, burn out and resignations.

But the situation has only become worse since the PIN was issued, Ms Warrander said.

“Our asks are simple, such as reducing beds from 25 down to 20 to make workloads more manageable, but instead of acknowledging they have a serious problem and addressing it, we feel like we’re being strong-armed and silenced.

“Staff morale is at an all time low and my colleagues and I are genuinely anxious about coming into work every day.”

NZNO Chief Executive Paul Goulter said this “at best heavy-handed” response in the middle of a crisis, where the wellbeing of both patients and nurses is seriously at risk, does not reflect well on Te Whatu Ora as an employer.

“Our members right across the motu are experiencing the same dismissive response to their concerns and calls for help, and they’re just asked to do more and more until that becomes the norm. This just cannot carry on because people’s wellbeing is at risk, and our members have the right to strike in a situation like this.”

He said there had been an outpouring of support from nurses around the country for the courage and determination of the Ward 5 staff.

“Nurses across the health system feel like their situation is very similar and they’re angry and disappointed that Te Whatu Ora has tried to prevent a very legitimate and justified strike.

“These nurses just want to get this dangerous situation in their ward fixed because they care about their patients. This response from Te Whatu Ora will only ensure things continue to worsen.”

He said NZNO would always be happy to sit down with Te Whatu Ora to discuss this situation further.

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Media enquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617 | media@nzno.org.nz

The New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) says while the Governments Budget offers some staffing relief and pay adjustments it fails to respond to the frontline crisis in health.

NZNO President Anne Daniels says while the $1 billion investment is welcome, most of it was already committed in the 2022 budget and significantly more new spending was required to meet the need in the health care system.

Ms Daniels said Budget 2023 provides no significant additional core funding for health which will continue the crisis of acute workforce shortages and unmet health need.

"There was an opportunity in this Budget to commit additional funding beyond the $1.3 billion uplift announced in Budget 2022 that could have meaningfully addressed the workforce shortages and need for improved pay and conditions across the entire health system."

She said 500 new nurses is a step in the right direction, but 4000 new nurses are required urgently just to plug the most urgent gaps alone.

"This is a drop in the ocean of what’s required. An additional 500 new nurses will not resolve burnout and fatigue that chronic staffing shortages brings to the workplace for nurses."

NZNO Kaiwhakahaere Kerri Nuku said there is no clear pathway to remedy poor health outcomes for Māori in this Budget. Nor is there anything to specifically address the urgent need for Māori and Pasifika nurses.

"We need an increased percentage of Māori and Pasifika nurses to ensure people receive health care that that is culturally sensitive and appropriate for them. Nurses need adequately resourced and staffed workplaces to deliver the safe, timely, accessible care that New Zealanders deserve."

Ms Daniels said nurses and other health workers are in the frontline every day working under tremendous pressure, but the seriousness of this situation seems to be eluding our government.

"There is a growing exodus of nurses from the New Zealand health system who need to be retained. While there are inevitable delays to growing a skilled and regulated workforce to the degree needed in the short-term, there are steps that can be taken to recruit, attract and train nurses. Nothing in this budget addresses the need for increased funding for training for example."

While some wraparound initiatives are expected to alleviate pressure in the health system such as scrapping prescription fees and an emphasis on primary care there is inadequate provisions to fund the frontline to ensure accessible, safe and timely care is delivered.

In the context of the limited spending, some important initiatives will address the cost-of-living issues that can restrict patient access to primary and community care.

"Increased funding for pay parity in primary healthcare will be welcomed to address disparities.

"However, there are many other nurses who have not been valued in this Budget, with no mention of cost of living pay increases for them." 

Nurses and kaimahi working for Māori and Iwi health providers are hoping tomorrow’s Budget helps ease the daily struggle they face to deliver services to their communities.

Te Runanga o Aotearoa New Zealand Nurses Organisation representative Kathryn Chapman says those planning the Budget need to significantly understand the shortfalls nurses in the Māori and Iwi sector face in terms of equity.

Ms Chapman said Māori and Iwi nurses are culturally ingrained to focus on their communities, which is why it is vital additional money is set aside to recognise the value Māori and Iwi nurses bring to the health setting.

" Everything we do in health is for our people. We are never off duty ."

The greatest challenge is the lack of resources which mean nurses have to be innovative to treat patients, she said.

"Sometimes we have to make a dressing out of a piece of cloth because we can’t afford to supply these. It takes a longer time for wounds to heal because we don’t have right dressing.

"It’s wrong if Government cannot offer money to fund proper wages so services to the most vulnerable in our communities can be maintained. And this funding has to be significant and long-term. We can’t do that with a 50 cent offer."

Ms Chapman said she would love to see money specifically ringfenced for Pay Parity for Māori and Iwi provider nurses and this should go directly to these nurses without getting caught up in red tape and funding issues.

"The skill base we have, given the environment in which we grew up, is unique.

"There is still mistrust of the system among our people so we have to go the extra mile. Whether we have pulled out our last $5 for whānau who cannot afford medication or $10 for fuel to travel to the hospital, we are always helping out in some way."

She called for specific funding to support professional development opportunities within the provider groups, and community-led services where it was difficult to fill vacant positions.

"I’d also like to see funding for mental health to help communities cope with the impact that extreme weather events like the Hawke’s Bay flooding have created.

"I’d like to make sure there’s adequate funding set aside that supports programmes of counselling, mentoring and support. Also, there’s a huge need in suicide prevention.

"We’ve got to help, especially the rural communities. It affects everyone not just Māori and Iwi.

"When you choose to live in rural communities, you’re aware that it does isolate you - but the right to culturally appropriate health services provided by fairly paid staff remains."

It’s no secret that the Aged Care sector in Aotearoa New Zealand is struggling but the Budget can help to significantly rectify this, a veteran nurse says.

The sector is in a constant fight for funding, recruiting and retaining staff, paying them a salary on par with colleagues in other sectors, and in some cases face liquidation.

Christchurch-based Aged Care nurse Liz Croton is tired of the daily battle on all fronts.

Ms Croton, who has been a nurse for 44 years, says as a result of staffing shortages, hundreds of care home beds have been forced to close.

"Due to the inability to safely staff facilities, beds are being blocked preventing admission and placing additional pressure and burden back onto other healthcare sectors, the community, whānau and wider community networks.

"We need help, and we need it now! The ageing population of New Zealand is rapidly growing, placing additional burden of caring for residents.

"The complexity of care requirements within our sector that our nurses need to manage has increased significantly over the past few years, but the current staffing allocations being funded do not always match the acuity of the resident or what is occurring within the facility at the time."

She said the situation has evolved into a crisis, but the solutions are also obvious.

"I would like the Government to get cracking and pay all nurses equally no matter where we work in New Zealand certainly bringing ARC nurses up to Te Whatu Ora wages would be an amazing start so that those nurses who apply for aged care work don't run as soon as they see the pay rates."

"Why stay in a job and get paid less and struggle with living costs when down the road they could be better off. If we lose these staff aged care cannot survive.

"I have a work mate who has just been informed her rental is being sold. She now not only has to manage the increasing cost of living but will be looking for a new rental at probably a much higher cost. This is making her think seriously about moving to a hospital for better pay so she can survive."

Ms Croton said more funding is needed to make nursing more attractive and bring new students into the profession.

"We need to pull out all the stops to grow our own culturally competent nursing workforce. Make the training free as we've done for the trades we need.

"Pay students for their placements where they can work full-time for weeks away from their homes for no pay; and this is the point where many nursing students give up their training because it is too hard. Forgive student loans in exchange for a certain number of years of service.

"Why aren't these options being explored? How else are we going to grow a workforce rapidly?"

On a day when they are being acknowledged and celebrated through Nurse Appreciation Day, one group of New Zealand nurses have had to make the very difficult decision to take strike action.

NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) members at Gisborne Hospital’s Ward 5 will embark on industrial action for one hour on 24 May after a series of appeals for staff and patient safety have been ignored by the employer.

Tairāwhiti delegate Christine Warrander said the decision was made because they are incredibly concerned about patient safety and the existing situation continues to compromise patient care

Warrander said a provisional improvement notice (PIN) was issued on 20 December for Ward 5 in response to health and safety concerns arising from unsafe staffing levels.

"Acute and persistent staff shortages had resulted in untenable workloads, staff stress, increased sick leave, burn out and resignations."

But the situation has become worse since the PIN was issued, Warrander said.

"The system is falling apart, and no one is listening!"

Patient care nurses are calling on Te Whatu Ora to immediately focus on three key areas.

- Reduce beds from 25 to a maximum of 20.

- until such time as staff on Ward 5 in their professional judgement agree safe staffing levels are met.

- Increase staff to provide safe patient care.

Warrander said every time there was an acute staffing shortage, it meant a patient was at risk of not getting the correct care they needed.

"We used to be stretched taking five patients each, now it is not uncommon to have eight patients each which is completely unsafe and exhausting.

"If the fact that staff are working under immense stress and fatigue with unsafe workloads is raised to management, we are often told there is nothing they can do as the whole hospital is short.

Officially there is a Variance Response Management (VRM) programme, which provides tools to help decision makers provide the right staff numbers, mix and skills every shift, every day but often there is no staff for it due to chronic shortages.

"An example of how unsafe it is, I recently worked a shift where there were only three nurses on, we had only a few beds left on the ward and we were getting admissions, so we were having to overflow patients to other wards. That alone is time consuming in itself. It was raised with the duty nurse manager (DNM) that we were drowning, and it was unsafe. We had started the shift approximately nine hours in the negative, meaning we needed help.

"The DNM informed me that it had been escalated to management, but they had gone home for the weekend & there was nothing that could be done. A casual nurse from ED was able to come and help for a little bit. We ended the shift with having taken nine admissions and approximately 12 hours in the negative.

"Staff have nothing left to give and they are exhausted, and this is when the risk for mistakes is high."

The strike will take place from 1.30pm-2.30pm on Wednesday 24 May at the Gisborne Hospital.

Friday marks Nurse Appreciation Day which honours and recognises the invaluable contributions of nurses throughout Aotearoa New Zealand.

There are more than 65,500 nurses in Aotearoa including 4000 student nurses, but the country is still short of more than 4000 nurses.

New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) Kaiwhakahaere Kerri Nuku says the overarching message remains: "We need more nurses".

Nuku said while traditionally the focus on celebrating the essential role nurses play in providing care and support to our communities falls on 12 May, given their contribution every day is Nurses Day.

Nurses ensure that patients receive the best possible care and support, and they play a crucial role in promoting health and well-being across Aotearoa New Zealand, she said.

"Almost all nurses go the extra mile to work extra hours if required to ensure their patients get the best possible care.

"At the height of the Covid-19 pandemic, it was nurses at the forefront administering vaccines, treating patients and helping to save thousands of lives."

There is a wide range of nursing sectors in New Zealand including Primary Health Care, Aged Care, Hospice, Private, Māori and Iwi, Pasifika and Te Whatu Ora.

"In all of these sectors nurses cope with enormous workloads and pressure during their daily routines. They represent uncompromising professionalism and are the backbone of our health system," Nuku said.

She said Aotearoa is experiencing a nursing shortage crisis that affects everyone in the country. To solve the crisis the country needs 4000 more nurses trained and, on the job pay that values the nursing workforce right across the health sector and attracts more nurses and te Tiriti o Waitangi being upheld across our health services to remove inequities.

"We need nurses and as such, it is important to show our appreciation for the dedication and commitment of every nurse everywhere.

"The best thing we can do for our nurses is sign their petition on https://weneednurses.nz/ and encourage friends and whānau to do the same."

Auckland rural practice nurse and NZNO member Ros Gallagher is worried about the future of nursing in Aotearoa New Zealand but has made three wishes for Budget 2023 on 18 May.

Ms Gallagher has been a rural nurse for 29 years. She is concerned at the way nurses who work in Primary Health Care and in particular general practice continue to be treated.

Despite the best efforts of herself an others in the union, general and rural practice nurses have again been excluded from the Government’s payments to address Pay Parity and Gallagher said this has felt like another kick in the guts.

She feels angry, sad, disappointed, and personally very devalued, but says proper funding through the Budget would be a good start to appeasing nurses’ woes.

"My three wishes from Budget funding would be, firstly, pay our employers more so that in turn their nursing staff would be paid better and don’t have to look elsewhere to earn a better living.

"They would also need more money in the system for recruiting and retaining staff to address chronic understaffing.

"And thirdly, fund free study for nurses and pay students during their placements. This will help stop nurses dropping out, especially for third year students who often stop their studies out of frustration and financial desperation."

She said that the rising cost of living, higher interest rates for mortgages and the high cost of fuel, mean all practice nurses would be struggling at the moment, especially those only paid current Multi-Employer Collective Agreement rates.

"I drive some distance to work as I live in a rural area, so petrol is costing me a lot more these days.

"I also am aware of the predicted measles and whooping cough epidemics due to low immunisation rates. This is likely to increase. as it is practice nurses who deliver childhood immunisations.

"The more that leave for greener pastures the lower the rates will be, as appointments to receive immunisations will be less available."

She questioned whether the Government was really committed to Pay Parity among nurses.

"If they are committed then why have they not yet addressed GP practice nurses’ wages?"

Ms Gallagher said, with the change to immigration rules, she expects many more nurses will take the opportunity to go to Australia as "younger practice nurses would be silly not to consider it".

"If I wasn’t nearing retirement age, I would probably consider it too! I am really concerned as I near retirement. Who are the nurses who will take my place?

"I am cutting my days down to three per week come August 2023. Even this will have quite an impact on my colleagues."

"Many GP employers would like to pay their nurses more and some do. The reality is this: unless Government funding for general practice is significantly increased many will remain unable to afford to remunerate their staff adequately.