New Zealand Nurses Organisation media release, 26 November 2019

The New Zealand Nurses Organisation (NZNO) welcomes Learning from adverse events: Te ako I ngā pāpono kōaro, released by the Health & Safety Commission last week.

However, NZNO Professional Nursing Adviser Kate Weston says the yearly report is once again evidence of an under-resourced health system that is putting the wellbeing of New Zealanders at risk.

“More than 50 percent of the 916 reported adverse events relate to clinical care and indicate under-staffing. Failure to rescue, for example, which has risen by an alarming 28 percent, happens when staff are busy and stretched. The high number of pressure injuries reported are also evidence of not having enough time to deliver proper care.”

Ms Weston says factors mentioned in the report reflect what NZNO members say across the country about too few nursing staff to meet ever-increasing patient needs.

“The report confirms the incredible stress nurses, midwives and health care assistants are under every day. How many times do we need to be reminded that the health system is not sufficiently resourced for employers to meet their obligations around safe staffing? How many adverse events will it take?”

The report suggests the increase in recorded serious events could be the result of better reporting, while acknowledging this should not be assumed. Ms Weston says, however, that the notion of better reporting has been around for too long to continue as an acceptable explanation and that the increases are more likely to relate to workloads, insufficient staffing and poor skills mix – which the report also acknowledges.

“Many of those affected by adverse events are our most vulnerable, such as the elderly. Apart from the pain and suffering caused, many will no longer be able to live independently, which is a huge cost to them on a personal and financial level, and to the health system funded by tax payers.”

Ms Weston said the report was a valuable tool and indicator of the need for increased spending on health. But she questioned the lack of security and staff safety reports.

“We are well aware there has been a significant increase in violence and aggression towards staff, and we also know this is being underreported because internal systems and policies around staff safety also tend to fail when staffing resources are stretched.”

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

The New Zealand Nurses Organisation (NZNO) says changes proposed to staffing for the CREST service proposed by Canterbury District Health Board (DHB) will reduce the quality of care available to older persons in Christchurch and surrounding areas.

The Community Rehabilitation Enablement Support Team (CREST) cares for the health of older persons when they are first discharged from hospital so they spend less time on return hospital visits and remain in their own homes longer – instead of in residential care.

NZNO Professional Nursing Adviser Marg Bigsby said NZNO members are very concerned the changes would disestablish 17FTE of experienced nurses (including two leadership roles), replacing them with just five ‘liaison staff’ and one clinical nurse specialist (CNS). Case management work would then be contracted to private community providers.

“Depending on who is appointed to  the liaison and CNS positions, this represents a loss of 11-16 experienced nurses to CREST, which would have serious impacts on the care available to older persons in the region, especially when they are leaving hospital. This is something Canterbury older persons’ health services can ill-afford,” Ms Bigsby said.

“Our members are also concerned about people being employed who were unfamiliar with the CREST service and the possible lack of case management expertise when work is given out to community providers.

“Many of these providers are already quite underfunded and short-staffed so they will struggle to provide care to the standard they would like and which currently exists. It will be a systemic problem.”

NZNO is also concerned about the failure of the DHB to collaborate with or consult CREST staff.

“Case managers learned about the proposed changes from nurses in community providers before they had heard anything about them directly, which is a completely unacceptable violation of professional confidentiality,” Ms Bigsby said.

NZNO made a submission today to Canterbury DHB opposing the changes, suggesting alternatives and calling for nursing expertise to remain in-house. Ms Bigsby said CREST nurses are invested in the service and that she hopes the DHB will listen to their voices.

At NZNO’s encouragement more than 160 health professionals around the region including doctors, nurses and allied health professionals, have sent letters to Canterbury DHB CEO David Meates opposing the changes and in support of the nurses’ call for a rethink.

Ms Bigsby said the CREST service supports elderly to regain independence and quality of life following a stay in hospital.  Without its support the focus will inevitably fall on just the basics – and there is so much more to life than merely being able to wash and dress yourself or go to the toilet.

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

More information:

The spokesperson for this media release is Professional Nursing Advisor (Canterbury) Marg Bigsby, who would be happy to be interviewed. However, NZNO can also provide media access to an NZNO delegate working in the CREST team. Please contact Rob Zorn (as above). 

New Zealand Nurses Organisation media release, 6 September 2019

The New Zealand Nurses Organisation (NZNO) is challenging proposed staffing changes at two facilities run by Presbyterian Support Southland (PSS), saying they will reduce standards of patient care and put extra strain on nursing and care staff, and that they are being justified on out-of-date guidelines.

NZNO Organiser Simone Montgomery said that across its hospital services and two rest homes (Vickery Court in Invercargill and Rest Haven in Gore), the PSS proposals would cut net staff care by around 157 hours per week – and, she said, this comes after net care hours were cut by 114 per week last year.

“The staff reductions are being justified by the claim that PSS services are currently over-staffed according to the 2005 Aged Care Staffing Guidelines, but we have been saying for some time that these standards are hopelessly out-of-date and do not account for the increased number of people in aged care, or for their increasingly complex needs.

“The clear message in all of this to current staff, who are already overstretched, is that somehow they aren’t working well or hard enough, and that’s ridiculous.”

In March this year NZNO and E tū released their joint report: In safe hands? How poor staffing levels and rationed care are harming aged care residents and staff. The research surveyed 1194 people working in aged care facilities and found that three quarters (73.45 percent) of those surveyed either disagreed or strongly disagreed that staffing levels were sufficient to provide quality care for residents.

The report called for a review of the existing standards and that new resulting standards be made compulsory. The 2005 standards currently in place are voluntary.

The rationale for the staffing reductions is that DHB funding for aged care does not cover staff that would be considered ‘extra’ when staffing levels are compared to the 2005 Guidelines, but Ms Montgomery said the proper solution should be to seek increased funding and not reduce standards of care to save money.

“We think New Zealanders care very much about the health, wellbeing and dignity of our seniors and would agree that the way we care for them reflects back on all of us,” she said.

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

New Zealand Nurses Organisation media release, 26 July 2019

The New Zealand Nurses Organisation (NZNO) says an emerging crisis at Middlemore Hospital demonstrates the serious problems district health boards (DHBs) are facing in recruiting and retaining nurses.

On Tuesday ambulances to Middlemore were diverted to Auckland and Northshore Hospitals due to a lack of capacity, including lack of beds, understaffing and the emergency department being under pressure. Counties Manukau DHB has requested nurses from Auckland DHB to provide emergency relief.

However, it has been confirmed to NZNO that Auckland Hospital is also at full capacity and has suggested that Counties Manukau DHB request emergency assistance from the New Zealand Defence Force instead.

NZNO Organiser Justine Sachs said this sort of thing happening outside of a civil emergency situation should send alarm bells to those holding the purse strings and responsible for resource and workforce planning. 

“Nurses are at breaking point; many telling us they are leaving the profession or going to work overseas because of intolerable workloads.

“Delays caused by diverting ambulances to other hospitals puts patients at serious risk and puts pressure on other hospitals also struggling to cope because they are under-staffed and under-resourced.”

Ms Sachs said increased demand on the public health system should be expected during the winter season and that contingency plans that include having options for patients to being admitted in other hospitals and sufficient nurses on staff should be in place to cope with increased demand.

“Given the enormous stress on our under-resourced health system it’s frightening to contemplate how hospitals in the Auckland region would cope should there be a significant catastrophic event.”

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

New Zealand Nurses Organisation media release, 7 June 2019

The New Zealand Nurses Organisation (NZNO) has written an urgent letter to the Hawke’s Bay District Health Board (HBDHB) saying difficult working conditions faced by nurses are seriously compromising both staff and patient safety.

NZNO Professional Nursing Adviser Anne Brinkman said that what the union and professional association is hearing from HBDHB members is alarming but that no response from management has been received to alleviate nurses’ expressions of concern.

“Nursing staff have been expressing and documenting their health and safety concerns with management repeatedly and at every shift because they pose a significant danger to both patients and staff. Despite this, no response has been received from management and nothing has happened to mitigate these systemic weaknesses.”

Ms Brinkman said there has been increasing disquiet about risks arising from high bed occupancy, inadequate staff numbers and skills mix and increasing incidents of violence and aggression by patients.

“Staff are fearful and say their ability to care for patients has been seriously diminished. Managers at HBDHB must recognise their responsibility to staff under the Health and Safety at Work Act and promptly produce an action plan to resolve these concerns.”

She says nurses are leaving their shifts in tears and many are actively seeking alternative employment.

“This is a really serious concern as recruiting to nursing vacancies and retention of nursing staff has already been identified as an ongoing problem at the DHB.”

She also says the impact of the resident doctors’ strikes has been significantly underestimated and that the strikes could not have gone ahead without the tangible support of nurses at an already difficult time.

NZNO has asked HBDHB to account for how it will address the health and safety concerns raised by nurses in the short- and medium-term, and has requested a response within one week.

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

New Zealand Nurses Organisation media release, 30 May 2019

The New Zealand Nurses Organisation (NZNO) commends the Government for a good start towards a Wellbeing Budget for people living in New Zealand. In particular it commends the significant increase in Vote Health, and meaningful allocations in key areas such as: mental health and addictions; child wellbeing; family violence; and Māori and Pasifika wellbeing.

NZNO Kaiwhakahaere Kerri Nuku said that more specifically, significant investments have been promised in areas such as school-based health, homelessness, early learning to improve wellbeing; infrastructure support; and kaupapa Māori services. She said there is still more to be done.

“Nurses and nursing services will be key to each and every one of these extended services, but we agree with the Government’s observation that currently the required workforce needed for them is not in place.”

NZNO President Grant Brookes said NZNO was therefore pleased to see the Government identifying specific workforce targets such as the primary mental health services workforce (which must include nurses) and pathways to employment for the Māori and Pasifika health workforce.

“We are particularly pleased that the importance of supporting students to enter into nursing and midwifery practice has been recognised.”

However, Kerri Nuku said the glaring disparity in earnings between the DHB nursing workforce and those working in Māori and Pasifika, Aged Care and Community services should have been more clearly identified as a target in the Budget.

“NZNO looks forward to continuing to work with Government to develop the required nursing workforce and helping to ensure that working conditions and remuneration levels continue to improve so nursing remains an attractive option for young people seeking a professional career in health. Investing in the wellbeing of the workforce remains a priority.”

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

New Zealand Nurses Organisation media release, 29 May 2019

The New Zealand Nurses Organisation (NZNO) says it’s heartened by the Government’s promise to accept or consider 38 out of the 40 recommendations from the mental health report. However, it urged the Government to make sure nursing issues and kaupapa Māori approaches are central to the work it does in mental health and addiction.

“We appreciate that Government’s willingness to listen to the experts in the main and to consider new and evidence-based ways of looking at this complex, persistent and tragic problem,” NZNO President Grant Brookes said.

However, he said Government must ensure nursing issues such as adequate staffing levels and safe working environments – which were almost entirely omitted by the report – feature prominently in the actions it takes in implementing the recommendations it comes to accept.

“Nurses, whether in the community or in hospitals, are at the forefront in treating mental health and addiction, and are probably the professionals people experiencing mental health and addiction problems interact with most.

“They’re essential to any health care we provide, but the mental health and addiction nursing workforce is becoming more tired, fearful and burnt out. That makes it a difficult branch of nursing to recruit to. Failing to work towards a nursing workforce that is robustly resourced, safe in the workplace and fully staffed will put the success of any of the Government’s planned initiatives in jeopardy.”

NZNO Kaiwhakahaere Kerri Nuku said she welcomes the Government’s agreement to broaden the types of services available, and said NGO and kaupapa Māori services will play a vital role in providing culturally appropriate responses and supporting whānau in the community.

“Removing barriers and short-term contracting costs, and streamlining funding would make these services more sustainable and ensure that the workforce in this sector is well supported. Māori bear the mental health and addiction burden disproportionately so developing services that are ‘by Māori for Māori’ is just common sense.”

Ms Nuku said NGOs and kaupapa Māori services form a key part of the ‘whole of government’ approach to wellbeing and says Government must support their development.  She also said the focus on Māori health must continue to be strengthened within the Ministry of Health and other Government agencies.

NZNO looks forward to continuing to work with the Government and other stakeholders to help bring about the changes resulting from the recommendations that come to be accepted.

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

New Zealand Nurses Organisation: 26 March 2019

What:

Nurses, midwives and healthcare assistants (and their supporters) will rally in protest at the lack of care Manukau Counties District Health Board has shown for their personal safety.

When: Thursday 28 March, 2-3:30pm

Where: Middlemore Hospital main entrance, 100 Hospital Rd, Otahuhu

Spokesperson: Anna Majavu, Organiser, New Zealand Nurses Organisation

Protesters’ demands:

• Security cameras at locations of danger that will record footage for police playback
• Fencing around the entire car park – (currently anyone can just walk in)
• Floodlights on every level of the car park for the hundreds of nurses who park there
• Security guards at the carpark entrance/exit from 6pm-9am every day (this car park is a popular hangout for drug users and criminal elements)
• Security guards to escort staff to certain location after their late shifts.

Supporting comments:

People quoted intend to be there on the day.

"It has taken way too many incidents for CMDHB management to do something. I am rallying because this is no longer acceptable. I am done with broken promises and deserve to be able to feel safe. In my career I give my all to make Kiwis feel safe, why can’t this DHB do that for us?"

Sela Ikavuka, Registered Nurse, Middlemore Hospital

"I support this rally to stand for the health and safety of my colleagues which has been neglected by CMDHB Board and corporate management for so long and after so many requests have fallen on deaf ears. Staff cars being vandalised and stolen from the staff car park, there are not enough carparks for staff coming for their late shifts. Now nursing staff are being brutalised by cowards and opportunists leaving my colleagues in ICU. None of this should have ever happened and no one should ever go through such things."

Karnel Singh, Health Care Assistant, Middlemore Hospital, and NZNO delegate

"I support the rally because I am angry that it has taken a serious assault on members of staff for our employer to take our complaints seriously. I support the rally so that our staff can feel safe when going to and from their cars. I should feel safe going to and from my place of work at all times."

Judith Couch, Midwife, Counties Manukau DHB

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

New Zealand Nurses Organisation media release, 12 March 2019

EMBARGOED UNTIL 1PM, 13 MARCH 2019

The New Zealand Nurses Organisation and E tū are holding a summit in Wellington today (13 March) calling for a review of staffing standards for residential aged care – and for new and better standards to be made mandatory. The organisations are also launching a report on their joint research which reveals that standard care is missed or delayed in almost every shift, and that aged care staff frequently face distress and exhaustion in their work.

NZNO Industrial Advisor Aged Care David Wait says the public would be shocked at the findings of the research which was conducted in late 2018.

“We think New Zealanders care very much about the health, wellbeing and dignity of our seniors and would agree that the way we care for them reflects back on all of us.

“Our research shows aged care residents’ immediate emotional and physical needs often go unmet because staff are forced to ration the way they care, and if you’re not a priority you miss out.

“Right now aged care under-staffing is hurting everybody, and we’re confident the public will back our call for the government to review existing standards.”

David Wait said the current standards were published in 2005 and were inadequate even then.

“Things have changed dramatically since 2005. We have more people in aged care, they’re entering facilities later in life with much greater care needs and they’re living longer.

“What’s worse is that our current standards are completely voluntary and recent evidence shows, for example, that more than half of aged care providers deliver less registered nurse time than is recommended for hospital and dementia level patients.”

He also said medical conditions associated with care rationing, such as pressure ulcers and injuries from falls, would occur less frequently if we had better staffing, saving New Zealand money while we provide better care.

NZNO delegate and registered nurse Sacha Young says if there were enough staff to meet residents’ needs, people in aged care would have much better physical and emotional wellbeing.

“We don’t have time to do simple things like help residents take short walks, or sit with them for a few minutes when they are distressed.

“Not being able to do this puts a lot of stress on staff who would love to be able to provide better quality care. They often feel guilty or unfulfilled in their work and that’s a very unpleasant situation for everyone.”

She said a simple solution, however, would be to review the Staffing Standards and set mandatory minimum staffing numbers.

“It’s time to set staffing levels high enough to ensure our residents are always in safe hands.”

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Media inquiries

Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.

More information

About the summit

The summit will be held at St John’s Presbyterian Church, 170 Willis St, Te Aro, Wellington 6011. The start time is 1pm, but media are welcome from 12.30pm.

The report will be launched at the summit. In attendance will be NZNO and E tū leadership in aged care, Grey Power, politicians including Jan Logie, and a range of delegates and aged care workers from around the country. All will be happy to speak to the media.

About the report

In safe hands? How poor staffing levels and rationed care are harming aged care residents and staff

• This report is based on research by the New Zealand Nurses Organisation (NZNO) and E tū which was undertaken in 2018 to examine the current state of aged care in New Zealand. What it reveals is a broken system, which endangers residents and takes a heavy toll on nurses and caregivers.
• The research records the results of a survey by NZNO and E tū of 1194 people working in aged care facilities (rest homes, dementia units and hospitals) including registered nurses, enrolled nurses, caregivers and managers.
• Care rationing – 'the withholding or failure to carry out necessary nursing tasks due to inadequate time, staffing level, and/or skill mix'.
• Three quarters (73.45%) of those surveyed either disagreed or strongly disagreed that staffing levels were sufficient to provide quality care for residents.
• 81% of staff say the care needs of residents have increased significantly over the last few years. Most report they are not able to get more staff when residents need more care.

Many more facts and statistics are available in the report which can be viewed online at https://www.flexmediagroup.co.nz/in-safe-hands/index.html.

PDF copies of the report can be requested from Rob Zorn: rob.zorn@nzno.org.nz | 027 431 2617.

Quotes from respondents to the survey (included in the report)

“I love my job, I love the residents I work with and I love the feeling of being able to make a difference. But that can only take you so far. We need help and we need it now!”

“It is clear to staff that we do not have enough time to see to residents’ most basic physical needs let alone emotional and psychological needs. For example we have no time to sit with distressed, unhappy residents and simply talk with them.”

“Staff feel like they are providing a below par service. We work extra time for free and go home exhausted and some days crying as we didn’t manage to do everything people wanted.”

“I dread to go back to work at times.”

“Residents don't report injuries to us because they think we are too busy. In one case this has meant an assisted living resident had infected wounds no-one knew about, which he later died from."

"Residents worry they are a burden and won't ring the bell because they know we are busy, so lie in pain rather than ‘making a fuss’."

“The effect on residents is that they don’t get all of the 'little' things they want and need, a cup of tea, the toilet when they really need it, their teeth brushed, lipstick put on, regular turns to keep bed-ridden residents comfortable or even just a hug, a laugh or conversation.”

“Sometimes in the rush residents are processed like products in a factory in order to get through the workload.”

“I leave the rest home, sit in my car and cry, I'm so exhausted and depressed, and angry… our residents are not getting quality care, actually some are getting no care, or very little care."

“I feel relief to have survived a shift without an incident and immense dismay and dissatisfaction about a job not able to be well done.”

New Zealand Nurses Organisation media release, 7 December 2018

The New Zealand Nurses Association (NZNO) supports the Association of Senior Medical Specialists’ (ASMS’s) call for safer staffing conditions for senior doctors and dentists working in public hospitals. It also agrees that district health boards (DHBs) and the Ministry of Health must become more actively involved to help make this happen – supported by the Government.

“Specialists in public hospitals often work long hours under stressful conditions because there aren’t enough staff to meet patient needs,” said NZNO Chief Executive Memo Musa.

“They are frequently over-tired or unwell themselves, but continue to work because of their dedication and good will. The levels of job dissatisfaction and rates of burnout reported by the ASMS are concerning. These conditions are not optimal for providing care and treatment to people needing hospital-based care.”

Memo Musa also agreed that high specialist workloads have been caused by the previous Government’s under-funding of the public health system.

“The previous Government’s years of neglect have been the main contributor to the sad and dangerous situation we find ourselves in. Therefore action must be taken to improve staffing levels for public health specialists who have the same right to safe and productive working environments as anybody else.”

Memo Musa urged the DHBs, Ministry of Health and the ASMS to start working together supported by Government to find a way forward, because what is happening now is unsustainable and will only contribute to poor health for New Zealanders.

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Media inquiries: Rob Zorn, NZNO Media and Communications Advisor: 027 431 2617.