Nursing reports

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Earlier this week, we heard about the cost of not exercising bravery or courage when it is most needed.

The British nurse, Lucy Letby, convicted of murdering seven babies over two years was shocking news to hear. But what’s even worse, was that senior leadership at the hospital where she worked, appear to have turned a blind eye to her behaviour. If they hadn't done that, those babies may still be alive today.

While this is an extreme case thousands of kilometres away from Aotearoa New Zealand, there are some lessons for us.

Too many nurses, midwives and healthcare workers are scared to speak out about concerning occurrences in their workplace.

Yes, there are delegates who will be a voice for them but many of them have told me they are finding it harder to get their colleagues to open up to them, especially in the current political environment. I hear they are mainly scared they'll lose their jobs or be labelled a “troublemaker”.

Many of them are also falling into the trap of believing the hierarchies, who in the quiet corners of the office, are saying things to deter them from talking to their delegates and other advocates.

I know that tactic all too well.

When we became nurses and midwives, we signed up to not just a job but a responsibility or code to protect, care and serve our patients.

And that’s the point we must keep at the forefront of our thinking when we see things that aren’t right, that will hurt our patients and us.

If we look at some of our Māori matriarchs, they always put their people and culture at the centre of their decisions.

As the first Māori nurse to register using her Māori name in the early 1900s, Ākenehi Hei showed bravery and courage everyday she went to work in a health system that was openly and bluntly racist.

She stood up for her whakapapa, her cultural identity, not ashamed to just be Māori when other Māori nurses hid their names in exchange for more English sounding names.
Te Puea Hērangi was another wahine who exercised bravery and courage everyday, challenging the system so she could protect, care and serve her people.

Overall, I am so proud of all our nurses and midwives. Most of us are brave and courageous when we need to be, but there are some in positions of influence within the system who aren’t and who appear to be encouraging nurses who work under them, to follow their way.

Be like Ākenehi and Te Puea. Be the troublemakers when you need to be – we here at NZNO will have your back.

Kia maia!

More than 36,000 Te Whatu Ora nurses, midwives, health care assistants and kaimahi hauora have voted to strike for 24-hours after Health NZ failed to address their safe staffing concerns.

New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) Chief Executive Paul Goulter says there was strong support from members to take strike action after a new offer from Te Whatu Ora last week was worse than a previous one in May.

"This latest offer from Te Whatu Ora fails to address concerns about safe staffing despite them being raised continually throughout the collective agreement bargaining process.

"Patients are at risk because of short staffing. Nurses, midwives and health care assistants are stretched too thin and can’t give patients the care they need. This is heartbreaking for our exhausted members who became health care workers because they want to help people.

"Te Whatu Ora data obtained by NZNO under the Official Information Act shows between January and November last year, 50% of all days shifts were understaffed across hospital wards in 16 health districts," Paul Goulter says. (see table in editor’s notes)

To "add insult to injury" members have again been offered a wage increase which doesn’t meet cost of living increases and will see them and their whānau go backwards financially, he says.

"There were 30,000 New Zealanders who moved to Australia in the past year. We know some of them are burnt out nurses moving for better conditions and wages.

"Te Whatu Ora needs to do more to retain our nursing workforce, employ graduate nurses and ensure patients get the care they need. This is about the health and wellbeing of real people and their whānau, not the need to meet some arbitrary budget set by the Government.

"It looks like this Government has lost control of health," Paul Goulter says.

Editor notes:

-The nationwide strike will be held from 9am on Wednesday 30 July until 9am on Thursday 31 July.

-The strike will be a complete withdrawal of labour at every place in New Zealand where Te Whatu Ora provides health care or hospital care services.

-Life preserving services will continue to be provided.

The Coalition Government must provide urgent funding to Tōtara Hospice to stop it having to cut its services by a quarter from next week, NZNO says.

Tōtara Hospice provides end-of-life care at no direct cost to patients from a diverse and growing community of around 520,000 South Aucklanders and is the subject of a new documentary series called Hospice Heroes.

New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) delegate and hospice nurse Ed Boswell-Correa said staff were yesterday told the hospice had to reduce the number of people they actively care for in a month from 420 to 320 because of a lack of Government funding.

"This decision is devastating for the local community. It will mean only the sickest people will be able to access our services.

"It will force elderly people to remain in aged care facilities when they need specialist palliative care. Other people will be forced to go to Middlemore Hospital for care or worse still, not receive the care they need at all.

"These people deserve the dignity they are provided by hospice when they are dying."

Ed Boswell-Correa says yesterday’s "bombshell announcement" follows a hiring freeze Tōtara was forced to put in place last month.

"Fewer nurses and health care assistants mean less care for our patients. We want to be able to provide our patients and their whānau with the health care they need at this traumatic time in their lives," he says.

Sadly, Tōtara Hospice isn’t alone. NZNO is aware of at least four other hospices having to reduce their services. The Coalition Government must provide Te Whatu Ora with the funding it needs to save these services now.

A report in March found hospices provide taxpayers with at least $1.59 in health benefits for every dollar of government funding. 

Te Whatu Ora's decision to pull the plug on a trial to take beds away from Wellington Hospital's maternity and gynaecology wards is the right decision, NZNO says.

It was revealed yesterday that Wellington Hospital was cutting  beds from its maternity and gynaecology wards in a trial designed to make more room for patients from its overcrowded Emergency Department.

The New Zealand Nurses Organisation Tōputanga Tapuhi Kaitiaki o Aotearoa (NZNO) raised concerns it would put the health care of women and their newborn babies at risk.

NZNO Chief Executive Paul Goutler says Te Whatu Ora's backdown is welcome.

"This is the right thing to do. Mums and their new babies will be provided with better health care and it will improve the wellbeing of their whānau.

"It's good that Te Whatu Ora listened to health care workers on matters such as this. However, it still doesn't address staffing issues for midwives and nurses," Paul Goulter says.

Health New Zealand Te Whatu Ora’s removal of both clauses involving Māori from their offer in collective bargaining shows not only disrespect but a spurning of their legal obligations, NZNO Kaiwhakahaere Kerri Nuku says.

New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) has been involved in protracted talks with Te Whatu Ora for months. The new offer from Te Whatu Ora to NZNO members on 30 June failed to include Tikanga Allowance and Kaupapa Māori dispute resolution process clauses.

"These clauses were included in the previous offer in May but have been removed without explanation in the latest offer," Kerri Nuku says.

"With massive Māori health needs and a huge shortage of Māori nurses this move devalues them and would further motivate them to move on to overseas countries like Australia. With cultural obligations to their community, the big picture is that this would further perpetuate gaps in health care, including Māori continue to die at a faster rate."

Te Whatu Ora has an obligation to Māori, starting from Te Tiriti o Waitangi and the Pae Ora (Healthy Futures) Act 2022, she says.

These obligations require Te Whatu Ora to actively protect Māori interests, ensure equitable health outcomes, and support Māori self-determination in health matters.

"But moves such as these seem to be strategic in the systemic eradication of Māori rights by the coalition Government."

Kerri Nuku says two weeks before the offer from Te Whatu Ora, the Health Minister promised changes to the Healthy Futures Act ‘would also strengthen the Hauora Māori Advisory Committee (HMAC)’.

"I strongly doubt this is what the HMAC would advise. It seems that they’re either speaking with forked tongues, or one hand does not know what the other is up to.

"We call on the Minister to encourage Te Whatu Ora to reinstate the clauses back into the offer."

The Wellington Hospital gynaecology ward that is losing beds to its Emergency Department in a trial, was already short-staffed more than a quarter of all shifts, figures obtained by NZNO show.

It has been revealed that Wellington Hospital is cutting beds from its maternity and gynaecology wards in a trial designed to make more room for patients from its overcrowded Emergency Department (ED).

The New Zealand Nurses Organisation Tōputanga Tapuhi Kaitiaki o Aotearoa (NZNO) has obtained figures under the Official Information Act showing safe staffing levels identified by the Care Capacity Demand Management (CCDM) programme from January to October last year.

NZNO delegate Michelle Cotton says the figures show the gynaecology ward was already short staffed 27% of all shifts.

"That means there are not enough nurses already for more than a quarter of all shifts.

"NZNO is concerned this trail is aimed at meeting the Coalition Government’s arbitrary and unfunded six-hour wait time target for EDs," she says.

"This trial is starting after the only gynaecological oncologist at Wellington Hospital retired and wasn’t replaced. This is partly the cause of empty beds because those women are being treated in Christchurch.

"The trial requires the ante and postnatal services to be reduced from three pods to two. There will be less options for partners to stay and more women will be required to share rooms.

"This trail is putting the health care of women and their newborn babies at risk. They deserve better at this crucial time in their lives," Michelle Cotton says. 

Te Whatu Ora is refusing to address calls to prioritise patient safety by adequately resourcing safe staffing levels, the New Zealand Nurses Organisation Tōputanga Tapuhi Kaitiaki o Aotearoa (NZNO) says.

A new offer from Te Whatu Ora to NZNO members has failed to include measures to address staffing concerns despite it being raised continually throughout the bargaining process.

NZNO Chief Executive Paul Goulter says an earlier offer from Te Whatu Ora committed to acting on safe staffing research the two organisations had agreed to do together.

"Te Whatu Ora has removed that from their latest offer without explanation. This demonstrates their focus is on cost cutting, not patient safety.

"A survey of our members shows nurses have grave concerns that continued understaffing is putting their patients at risk. Overworked staff are unable to give patients the care they need and leads to staff burnout," Paul Goulter says.

Despite claiming there is no nursing shortage, Te Whatu Ora continues to understaff shifts. NZNO has received staffing figures under the Official Information Act for 631 wards using the safe staffing Care Capacity Demand Management programme (CCDM).

"These figures show from January to October last year almost half (or 47.1%) of all wards were understaffed 20% of the time. That means nurses and health care assistants are working in understaffed wards at least one shift a week," Paul Goulter says.

"We are also continuing to see acute levels of understaffing in emergency departments, mental health, women's health and children's wards."

Paul Goulter says Te Whatu Ora Acting Chief Executive Robyn Shearer claimed this morning that clinical need "isn’t an easy thing" to resolve through collective bargaining.

"It is concerning that Robyn Shearer isn’t aware CCDM has been in the Te Whatu Ora/NZNO collective agreement since 2010," he says.

Concerning interim findings of the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) 2025 Student Survey has found most students will go overseas if they can’t get jobs in New Zealand.

This comes as Te Whatu Ora refused to address NZNO claims around its obligation to employ new graduates in collective agreement negotiations.

The survey was completed by 1246 nursing students, and NZNO National Student Unit Co-chair Bianca Grimmer said the results were crystal clear - "hire us or we will leave".

"The survey shows 61.86% of students were considering seeking a nursing job overseas if they were unable to get a new graduate job in Aotearoa New Zealand. This increased to 73% of Māori respondents.

"This is a significant potential loss of our domestic nursing workforce."

Finances remained a significant issue for all students and was linked to high levels of stress by 80.39% of respondents, Bianca Grimmer said.

"An increased fear of not getting work is exacerbated by most students’ money concerns issues, many of whom depend on funding from student loans for their survival.

"We have a health system in crisis. At a time when we desperately need more homegrown nurses, the Government and nursing schools really need to do more to encourage students to stay in their studies and come out well and ready to nurse."

At least 35.61% of respondents said they did not work in paid employment and 61.58% of respondents had to significantly reduce their paid work hours during placement, she said.

"Paying all students the minimum or living wage while on clinical placements would make a massive difference to graduate numbers. Nursing students need assistance while they study."

NZNO Te Rūnanga Tauira chair Davis Ferguson said Māori and Pacific students are essential, and better cultural support in nurse training would result in a health system that better meets the needs of Māori and Pacific peoples.

"The lack of appropriate cultural support in nursing studies is an issue the Government and training providers need to urgently address."

The full findings of the survey will be made available on the NZNO website later this year.

A new report by the Auditor-General shows the Government must do more to build capacity in the public health system instead of outsourcing to the private sector, NZNO says.

The report titled Providing equitable access to planned care treatment found that despite reforms in recent years designed to end the postcode lottery in the health care system, inequities for Māori, Pacific peoples, those living rurally and disabled people continue.

New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) chief executive Paul Goulter says the report confirms what the public already knows - that elective services in the public system are neither equitable nor timely.

"The Auditor-General found the Coalition Government’s targets are having a perverse effect whereby some districts are not accepting referrals because they don’t have the resources they need to meet the required timeframes for assessing or treating people.

"This shows the targets for the political stunts they are. Targets won’t work without additional funding to create the capacity which will enable them to be met. 

"This confirms what our nurses across the health sector are saying and echoes concerns NZNO has been raising for some time."

Paul Goulter says the same vulnerable populations missing out on planned care are the same people who are struggling to get in to see their doctors in the first place to be referred.

"The Auditor-General is warning the Government that it’s push for even greater outsourcing to the private sector could lead to greater inequities. Outsourcing just strips capacity from the under-staffed primary health care sector and the under-funded hospital sector.

"There is only one way the Government can fix the health crisis and that’s by properly funding and staffing a quality public health system for all," Paul Goulter says.

Increases in primary care funding announced today must be passed onto nurses to fix chronic staff shortages so New Zealanders can get in to see health care professionals faster, the Nurses Organisation Tōputanga Tapuhi Kaitiaki o Aotearoa (NZNO) says.

The Government funds GP clinics based on the number of enrolled patients they have, regardless of the services they receive, through what’s called the capitation system.

Health Minister Simeon Brown today announced capitation funding for this year is set to increase to 13.89%.

NZNO College of Primary Care Nurses chair Tracey Morgan says nurses are urging primary care employers to pass this funding increase onto them via their wages, Tracey Morgan says.

"This will help stem the flow of nurses out of primary care and into hospitals.

"A skilled nursing workforce is desperately needed to keep care in the community, ensure vaccination targets are met, ease pressure on hospital emergency departments and prevent long term conditions worsening.

"During collective agreement bargaining last year, primary care nurses were 16-18% behind their hospital-based colleagues in pay. The employers told the union that if the money was available, they would willingly pass it on to nurses."

Primary care nurses will receive a 3% increase in July through their collective agreement which also gave them a further 5% on ratification earlier this year, Tracey Morgan says.

"However, this will still have them 10% behind hospital nurses with the same qualifications.

"Simeon Brown says this funding boost is help patients see their doctor and nurse earlier. The ability to recruit and retain primary health nurses is vital to achieving this," Tracey Morgan says.