Nursing reports

New Zealand Nurses Organisation media release, 22 January 2020

The New Zealand Nurses Organisation (NZNO) says a crisis is looming in the Primary Health Care Sector (general practices and accident and medical centres) if funding is not increased to allow practice and registered nurse salaries to match those of district health board (DHB) nurses.

NZNO has been negotiating the Primary Health Care Multi Collective Agreement (PHC MECA), which covers more than 3400 nurses, medical receptionists and administrators in more than 500 New Zealand general practices and accident and medical centres. But NZNO Industrial Advisor Chris Wilson says an acceptable offer for members has not been possible so far because of the funding shortfall.

Early in 2020 NZNO surveyed its members working in these workplaces and 70 percent of respondents said they were considering leaving the sector because of higher pay elsewhere – such as at services run by DHBs. Many nurse leaders who responded said they are struggling to recruit new nurses or keep the ones they already have.

Ms Wilson says a serious drop in practice and registered nurses is inevitable unless things change, and this will make health care much harder to access for people in Aotearoa New Zealand.

“Nurses at these workplaces provide services such as vaccinations, patient care programmes and triage at point of entry. They also give medical or health advice, which often reduces hospital admissions. Fewer nurses will mean these services become less available or more expensive, and this will have consequences for health and put extra demands on the health budget.”

Sector funding comes through the Vote Health Budget and is allocated to general practices and other services via the DHBs and primary health organisations (PHOs). 

Ms Wilson says that while DHBs are paying their own nurses at the higher rates negotiated in the DHB/NZNO MECA, they are not passing on enough funding to ensure these primary health care nurses are paid the same. She says primary health nursing is just as complex as nursing in DHBs, yet it is being significantly undervalued by this obvious pay parity issue.

“As of May this year an experienced nurse covered by the PHC MECA will be paid 10 percent less than an experienced nurse in a DHB. That’s a huge difference and our survey respondents say this has significant impacts for their lives, including working extra shifts to make ends meet, foregoing holidays and family time, and not being able to afford a house.”

She said NZNO members are concerned about what this means for their communities and they want them to know of the impending issue. They will be asking funding decision makers to recognise the value of these primary health care nurses by addressing the salary issue. They are hopeful funders will acknowledge the value of this investment in community health when NZNO returns to bargaining next week.

“The Government and the DHBs need to understand that underfunding the Primary Health Care Sector is just robbing Peter to pay Paul. Not funding services that keep people well just costs everybody more in the long run, and increases suffering and inequities,” Ms Wilson said.

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

Quotes from the survey (anonymised but used with permission)

There is an impending crisis in Primary Health unless funding is improved

“It means we are finding it increasingly more difficult to recruit and keep nurses in primary care.”

 “I am tempted to leave PHC to be in a better remunerated job but then my passion is PHC … it’s very frustrating.”

“This is my community and I care about it.”

Underfunding sends the wrong message to a crucial health sector

“The message is clear: prevention /keeping people out of hospitals isn’t as important or valued as looking after them in hospital.”

“I feel undervalued and unseen.”

The community needs a well-funded Primary Health Care sector 

“Our skill reduced the number of hospital admissions.”

“The health care and education we provide not only improves health outcomes for individuals, but also for communities.”

“We are the glue that holds the health system together. We connect many different services together.”

“We look after not just the individual – it extends to the whānau.”

“My direct nursing care has kept patients in their own homes rather than be admitted to hospital. Our continued hard work in times of disease outbreaks such as the Measles has a very direct impact on our communities.”

“We worked very hard through the recent measles epidemic ensuring all those that were vulnerable were vaccinated, that those who needed the vaccines the most were prioritised, and fielded hundreds of calls from concerned parents.”

“I know the work I do as a nurse in primary care everyday supports people to look after their health and their families so they can keep working and be active in our local community.”

“Community and Primary Health is essential in keeping people out of hospital and keeping well in the community. This in turn will save money in the long run. I work closely with type 2 diabetes and we work together to improve their overall health and to keep them well.” 

The work is varied and complex

“I am an emergency nurse, educator, vaccinator, mental health nurse, paediatric nurse, palliative care nurse, surgical nurse, older persons nurse and much more each and every day for my community. I am the contact for the community and I am trusted and respected.”

“We are the advocates, the life jackets and the bridge builders for our patients. We are the rapport makers, the listeners and the understanders, the encouragers and the teachers. See us, respect us and value us.....or ultimately, you will lose us.”

“We see and manage patients that should or would have been in hospital earlier...”

“All up it ‘just doesn’t compute’ when there is a greater emphasis being put on keeping people well in their community.”

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.

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.

22 November 2012:

The New Zealand Nurses Organisation (NZNO) welcomes the 2011/12 Serious and Sentinel events report “Making our hospitals safer”.

The report contains the serious adverse events that have happened in hospitals over the past year. This year’s report shows that the largest categories of harm have occurred either as a result of a fall (47 percent) or from delays to treatment due to what is described as “breakdowns in hospital systems”.

NZNO professional nursing adviser, Kate Weston says, “Patient falls are an indicator of inadequate staffing levels. The pattern and frequency of harm from patient’s falling and “systems breakdowns” is attributable to a system that is not properly resourced to provide patients with the right care at the right time and in the right place.”

“NZNO believes the increase in inpatient suicides and patients “going missing’ from inpatient mental health units is likely a staffing issue as well. We support the commission’s intention to investigate this tragic issue further.”

“Inadequate staffing can also result in late monitoring of a patient’s vital signs. The results of this show in the report in cases where appropriate and timely treatment has not been provided and harm has occurred,” Weston says. 

“NZNO is currently working in partnership with DHBS to solve that problem and make sure patients don’t come to harm. The safe staffing initiative, care capacity demand management (CCDM) ensures that the right number of skilled and appropriately qualified staff are available to provide care to meet patient demand and minimise the risk of harm.”

“We believe CCDM provides the health system with the right tools to provide the right care to patients. We are confident that future reports will show a marked decrease in falls, medication and treatment errors and “systems breakdowns” when all DHBs come on board with CCDM.”

3 June 2012:

A New Zealand Nurses Organisation (NZNO) survey of members working at Auckland DHB has shown shortages of over 120 registered nurse positions, 48 alone at Starship Children’s Hospital.

NZNO organiser Craig Muir says, “These shortages are shocking. NZNO members have been telling us how overworked they are but we had no idea how bad it was. Running a DHB 120 nurses short is dangerous! It’s dangerous for overworked, stressed staff and the flow on effect of that is concern for patient care.”

“Nurses pride themselves on the professional and technical work they do under trying circumstances. To hear that our members are willing to take their concerns to the media means the situation is very serious.”

“NZNO works closely with the DHB to resolve issues such as these. We are not always able to secure a safe result for patients and staff. We know the DHB is trying to save $4million. We also know that leaving 120 positions unfilled is not the way to do it,” Muir says.

“All New Zealanders ought to be able to rely on the best possible care when they are in hospital. It’s hard to see how that can happen when wards are so short staffed. Overwork and burn out inevitably lead to lower standards of care. It is only a matter of time before a serious incident occurs.”

Muir says that the situation could easily be resolved if the DHB prioritised staffing levels and patient care, “DHBs and unions need to draw a line in the sand – cost cutting should not impact on staffing and quality patient care.”