Policy Analyses and Reports

Policy Analyses and Reports

Service to Nursing Award 2020 goes to patient rights advocate

New Zealand Nurses Organisation media release, 18 September 2020

Each year the New Zealand Nurses Organisation (NZNO) presents Service to Nursing and Midwifery Awards as a way of recognising nurses or midwives who are NZNO members and who have made a positive difference to nursing or midwifery practice or practice environment.

The Award was presented on 17 September at NZNO’s online AGM to Waitematā-based registered nurse Bronwyn Kavalinovich. A longstanding member and delegate for NZNO’s Greater Auckland Region, her nominators say Bronwyn has been a strong advocate for patient rights and women’s rights around informed consent.

“Bronwyn advocated for both patient and staff adherence to the informed consent process for operations where others were present as observers,” say nominators Esther Linklater and Geraldine Kirkwood.

“This process took several years, and Bronwyn faced some stiff opposition regarding the concerns she had raised and continued to raise at every opportunity while advocating for patients.”  

Bronwyn says she was surprised to receive the Award and that she feels incredibly humbled and honoured.

“I am so grateful and really want to thank my nominators and the wonderful staff at NZNO, such as Professional Nursing Advisor Kate Weston. It was so good to be working with NZNO to advocate for patients and to instigate a much needed change.”

Bronwyn says that, while she enjoys her current work, she is looking to the future and possible work more directly involved with patient advocacy.

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


De-valuing of nursing deeply worrying

New Zealand Nurses Organisation media release, 27 August 2020

The New Zealand Nurses Organisation’s (NZNO’s) College of Emergency Nurses (CENNZ) says the de-valuing of the nursing role evident in recent moves by the Canterbury DHB (CDHB) are deeply worrying, and that all New Zealanders should be concerned.

College Chair Dr Sandy Richardson says the loss of key personnel from the DHB such as Director of Nursing Mary Gordon, and the DHB Board’s decision to prioritise deficit management will have significant health effects.

“We’re looking at an anticipated $13 million cut in nursing staff costs. The willingness to target nursing whenever money needs saving is long-standing and shows a lack of awareness that patient safety is reduced when the number of nurses and skill mix is lower than required to meet patient need.

“It’s a failure to comprehend what nurses actually do and how vital their role is.”  

Dr Richardson said CDHB is unique in that Canterbury, the West Coast, Kaikoura and Marlborough have experienced ongoing and cumulative crises and disasters over the past decades, which have had a significant impact on the health system, the health workforce and community. 

“The ongoing effects of these remain in terms of physical, emotional and psychological reminders for people in these areas, and the health system has suffered financial, structural and institutional wounds – and now we have COVID-19. 

“Throughout this, nurses have continued to work effectively and efficiently, and to maximise savings.  There is no fat left to cut.  A nursing shortage already looms due to its ageing workforce, but the Board plans to reduce the number of new graduates being employed.”

Dr Richardson said the loss of important clinical voices and institutional knowledge resulting from the mass resignations is reminiscent of the 1998 Stent report which made 112 recommendations related to Canterbury Health. The investigation came after multiple warnings from clinical staff and professional organisations.

“Then Health and Disability Commissioner Robyn Stent recognised the damage done by cost cutting and loss of clinical expertise. Her report validated the warning letter sent by concerned staff ‘Patients are dying’. 

“This was centred on Christchurch Hospital and should be a reminder of the worst that can occur; but this seems to have slipped from the Board’s collective memory.”

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


Serious lessons from Waitakere Hospital COVID-19 report

New Zealand Nurses Organisation media release, 13 May 2020

The New Zealand Nurses Organisation (NZNO) says it welcomes the incident review report released today by Waitematā District Health Board (DHB) into COVID-19 Staff infections at Waitakere Hospital during April.

Seven nurses contracted the virus at the hospital during April, one of whom was admitted to hospital.

NZNO Associate Professional Services Manager Kate Weston thanked the DHB for acknowledging the exemplary care provided by the nurses and for their apology to those nurses and their whānau.

“This will go some way to rebuilding their relationship with their employer,” she said.

However, Ms Weston said the report’s recommendations highlight a number of serious concerns and some valuable lessons about practice going forward.

“Health and safety concerns continue with a real lack of clarity around patient flow and rostering to properly eliminate exposure risk, case definitions and ongoing PPE access issues.

“The DHB has put these nurses and their whānau at an unacceptable risk and we’re concerned lessons weren’t learned from the larger clusters in Waitemata and Rosewood/Burwood.”

Ms Weston also said a major concern arising from the report is that workplace exposure to COVID-19 is not recognised as a reportable event to Worksafe.

“NZNO and other unions are very concerned that health workers aren’t afforded that level of investigation from this external body and regulator when things related to safety go wrong in workplace and someone is hospitalised.”

She said, however, that NZNO is pleased the DHB has been in contact with affected staff to check on their wellbeing.  NZNO has also supporting the nurses who had been in contact.

“Our thoughts are with the nurse who was hospitalised with hopes for a full recovery. They are also with those other staff unwell and at home, especially where other members of their household were exposed.”

An NZNO delegate was part of the review panel that produced the report and Ms Weston said NZNO is keen to provide part of the oversight as the report’s recommendations are implemented.

“There is an urgent need to implement the recommendations immediately to provide clarity, and build confidence for staff and the public as we move from Level 3 to Level 2, which involves a real ‘unknown’ in terms of another COVID-19 spike.”

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


Employer and employee rights and obligations during a pandemic

New Zealand Nurses Organisation media release, 7 February 2020

The New Zealand Nurses Organisation (NZNO) is reminding both employers and employees that they have rights and obligations regarding their own safety and the wellbeing of others during a pandemic situation.

NZNO Associate Professional Services Manager Hilary Graham-Smith said that much of the information coming from authorities such as the Ministry of Health was comprehensive and helpful, but that the rights of nurses and others working in health to be fully informed and fully protected must also be very clear.

“Good infection control practices by clinicians will be essential in reducing the likelihood of disease spread should we find ourselves in a pandemic situation and coronavirus cases start turning up in Aotearoa New Zealand.

"Nurses and health care assistants will be central in this work and employers must ensure these employees are given guidance around best practice in a pandemic and about how to remain safe while providing clinical care.”

NZNO recommends all health facilities have up-to-date disaster and pandemic guidelines for employee health and safety and Ms Graham-Smith said employees should notify management via their health and safety representative if they are not satisfied their wellbeing is being sufficiently cared for.

“Under the Health and Safety Act employees have the right to refuse to perform work likely to cause them harm if steps to mitigate risks to wellbeing are not taken in conjunction with employers to resolve the situation.

“We recommend nursing staff contact NZNO and that other employees contact their unions immediately if they have remaining doubts about their safety at work.

“It is often nurses, midwives and health care assistants who play an important and leading role in ensuring readiness for an emergency such as a pandemic, and they should be supported in this task by management – and their leadership, expertise and mana acknowledged.”

The World Health Organization has declared a public health emergency of international concern over the coronavirus and Ms Graham-Smith said that should send a clear signal to both employers and employees around preparedness and full disclosure of information, including information about employee rights to safety and how staff will be protected at work.

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


Adverse events report reveals heavily under-resourced health system

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.


Middlemore so understaffed it may need to call on army

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.


NZNO demands DHB response on systemic weaknesses compromising health and safety

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.


Summit calls for aged care staffing review after ‘shocking’ research report

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.”


Resident doctors deserve much better says NZNO

New Zealand Nurses Organisation media release, 14 January 2019

The New Zealand Nurses Organisation (NZNO) supports the New Zealand Resident Doctors Association (NZRDA) in its industrial dispute with District Health Boards (DHBs) and warns that unsafe working conditions imposed on resident medical officers (RMOs) would impact on the quality of health care in New Zealand.

NZNO Industrial Advisor Lesley Harry says DHBs are now insisting on reducing the terms and conditions agreed with RMOs in the 2016/17 multi-employer collective agreement (MECA). These reductions include less safe rostering, reductions to callout pay and RMOs being redeployed without their agreement.

“This is completely unacceptable when we are currently facing a serious shortage of RMOs and medical specialists across the board resulting in inadequate and unsafe staffing levels.

“Demand on hospital services continues to increase, which means we need to be forward thinking. We should be attracting and retaining trainee doctors and treating them with respect because better staffing levels are vital in sustaining health services.”

Lesley Harry said nurses can testify that what doctors are saying about short staffing and burnout is a fact, and that NZNO members in hospitals increasingly report situations where staffing levels and working hours mean patients are not receiving the standards of care they should expect.

“As health care professionals, doctors' and nurses’ first priority is meeting the needs of every patient coming through the hospital door. We don’t want to see our best and brightest unable to provide the quality of care they are trained for because they are exhausted or do not feel respected.” 

She said it was imperative these issues were sorted quickly before the existing MECA expires in February.

“RMOs move around between employers as part of their work and if an acceptable agreement isn’t negotiated in time they could be vulnerable to any number of unreasonable conditions imposed upon them by employers.

“This will just continue to exacerbate the problem and lead to poorer relationships, working conditions and poorer health care for New Zealanders. The longer this dispute goes on, the more likely DHB doctors will look to greener pastures.

“We urge the DHBs to listen to the concerns of RMOs and to settle this dispute in an acceptable manner. This is ultimately about the wellbeing of everyone in New Zealand so we support the NZRDA in putting patient safety first.”


Nurses unfairly blamed for systemic failures

1 August 2013:

The New Zealand Nurses Organisation (NZNO) is extremely disappointed and disturbed that Rymans is publically blaming nurses for failure of care in their Malvina Major facility in Wellington.

NZNO industrial advisor for the aged care sector, David Wait says “All NZNO members will be appalled by the treatment of the elderly woman at the centre of this case and we support the family in their call for change and improvements to the sector.”

“However this must not be considered an isolated incident. Residential aged care in New Zealand is in crisis as the Human Rights Commission Caring counts report identified independently last year.”

“The lack of mandatory staffing levels, inadequate registered nursing hours, training requirements and pay rates for carers on, or near the minimum wage, clearly show how undervalued this work is.”

“Nurses and carers simply cannot provide the care which they want to provide if the facility is understaffed and under resourced.  Residents have complex health and personal care needs. Evidence demonstrates that patient outcomes are negatively impacted when there are insufficient regulated nurses. We have heard from a former Ryman’s staffer that on night shifts there is only one registered nurse rostered on for the entire facility – that’s one nurse responsible for over 200 residents and patients, ” says Lorraine Ritchie, NZNO professional nursing adviser.

“There is something seriously wrong with the sector when taxpayers provided $800 million to Rymans last year to provide care for our most vulnerable elderly citizens and at the same time they post profits of $100 million. And that massive profit is up 19 percent on the previous year, and Ryman’s eleventh year of profit increases.”

“NZNO members have been lobbying for Government intervention to address this situation through better transparency in funding (including targeted funding for pay increases), the development of enforceable staffing levels, and the requirement of all workers to be trained. The Government must step up and make the changes needed to improve things for our elderly.”
 


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