“E ngā iwi, e ngā mana, e ngā hau e wha, tēnā koutou.
Greetings to the people, the great ones and to those from from afar.
My name is Grant Brookes.
I am a Registered Nurse, and the president and co-leader of the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa.
And this? This is the first day of a future where trade agreements serve the needs of citizens and our natural environment. Despite the weather, it is wonderful to be here to share this day with you.
The New Zealand Nurses Organisation objects to the New Zealand government’s intention to sign the Comprehensive and Progressive Trans Pacific Partnership Agreement in Chile later today. We assert that although some improvements have been made, the CPTPP is not ready to be signed.
Trade Minister David Parker acknowledges that the deal is not perfect. He told Newshub last week that he gives it a score of “seven out of ten for New Zealand”.
Let’s just imagine, for a minute, that that score is accurate.
What does seven out of ten mean, when it comes to your health? What if you went to the Emergency Department with a serious cut, and you were told that you could have stitches to seven tenths of your wound? What if you were in severe pain, and you were given treatment that left you 30 percent sore?
Nurses work for the best possible health status for all peoples in Aotearoa New Zealand. We cannot support the CPTPP because despite improvements on the original TPPA, threats remain to population health and all that sustains it.
Intellectual property provisions which would delay access to affordable new medicines have been “suspended” for now, but they are still in the text and could be reactivated.
The same is true, despite side agreements, for the Investor State Dispute Settlement provisions which privilege multinational corporate interests above our sovereign and indigenous interests.
The Treaty of Waitangi exception in the agreement is not robust enough to ensure indigenous rights are protected and it’s not consistent with the recommendations of the Waitangi Tribunal. This means Māori-led efforts to address health disparities could be undermined.
The Labour Chapter will not protect the decent jobs, liveable incomes and fair treatment at work needed to sustain healthy communities. And the Environment Chapter does not even mention climate change, which the World Health Organisation calls “the greatest threat to global health in the 21st century”.
Defenders of the deal point elsewhere, to possible economic gains (though no-one today is claiming they’ll be huge).
But is that the right way to look at it? What are a few extra dollars really worth, if you don’t have your health? Around the world, the thinking on trade and investment agreements is shifting, away from a sole focus on narrowly-conceived economic gains.
The New Zealand Nurses Organisation has promoted this shift, from first hearing of the TPPA the better part of a decade ago, through the High Court challenge to the government’s secrecy which our other co-leader Kerri Nuku joined in 2015, to the massive protests in 2016, and up until today. We will continue to work for this healthy future.
In reality there’s no way of knowing how the CPTPP rates on a health scorecard – whether it’s seven out of ten, or one out of ten. This is because there has been no health impact assessment of the deal.
Until there is an independent health impact assessment, which the Labour Party campaigned for while in opposition, then as nurses we say please, ‘Don’t sign!’.
At last December’s biennial meeting of Global Nurses United, NZNO leaders were able to bring some unique perspectives and gain fresh insights.
By NZNO president Grant Brookes
Nursing union leaders from 18 countries, representing more than one million nurses and health-care workers, gathered in Québec, Canada, in December for the biennial meeting of the Global Nurses United (GNU) executive committee.
As a new GNU affiliate, NZNO was taking part for the first time, represented by kaiwhakahaere Kerri Nuku and myself. There we helped plan internationally-coordinated actions for 2018 and contributed a New Zealand perspective on global nursing and union debates.
We were also able to gain fresh insights into some of the issues facing NZNO, such as the need to grow advanced nursing practice in primary health and how to strengthen union democracy in an age of electronic voting (see articles, p29; listed below under “Related coverage“).
Collective bargaining discussed
The GNU meeting opened with a discussion on nurses’ rights to organise and bargain collectively. Although changes to the Employment Relations Act under our previous government have temporarily threatened multi-employer collective agreement (MECA) bargaining, some nursing unions in Asia, Africa and Latin America face bigger challenges.
The discussion in Québec laid the basis for a subsequent GNU joint approach to the government in Honduras, signed by NZNO.
Along with the Australian Nursing and Midwifery Federation, we highlighted the health impacts of climate change in the Pacific. The GNU meeting adopted a consensus statement on “Global Nurses Leadership for Climate Justice”.
Next, we received an expert briefing from the Canadian Federation of Nurses’ Unions on the current state of trade negotiations, including those for the Trans-Pacific Partnership Agreement (now known as the “TPP-11”, or “Comprehensive and Progressive TPP”).
The original TPPA was vigorously opposed by NZNO. Strong Canadian opposition to the TPP-11 has ensured some of its harmful provisions have been suspended.
Actions against violence
The two final agenda items – on workplace violence and safe staffing – included proposals for action. The GNU meeting voted for global actions against violence towards nurses to be held on International Women’s Day (March 8), and for a week of action in May in support of safe staffing.
The NZNO board of directors later approved these two campaigns in principle, subject to operational contingencies.
Coinciding with the convention of the local nurses’ union, the Fédération Interprofessionelle de la Santé du Québec (FIQ Santé), five GNU affiliates were also invited to take part in a panel discussion. NZNO was among them. Our topic was how government policies affect the care union members provide, and what struggles we face.
NZNO’s bicultural framework
I explained to the 1000 convention delegates that all NZNO struggles are framed by bicultural relationships – highlighting struggles for the restoration of health funding, for safe staffing, new graduate employment, fair employment laws and for a health workforce that is culturally, ethnically and gender-representative, and that enacts Treaty of Waitangi articles.
On the TPP, Nuku said: “We will ensure no international agreements compromise New Zealand’s ability to control and lower the prices of pharmaceuticals and other medical supplies: to carry out public health programmes or maintain and expand the public funding and public provision of health on a non-commercial basis.”
Her description of NZNO’s 10-year battle for pay parity for nurses working in Māori and iwi health providers touched a nerve. Canada has embarked on its own truth and reconciliation process to address historic injustices suffered by indigenous people. After the panel discussion, nurses came up to Nuku to share stories about inequities experienced by indigenous health services on First Nations reserves.
The full text of our joint presentation is at https://nznogrant.org/2017/12/13/struggles-we-must-face-joint-nzno-presentation-on-the-global-nurses-united-international-panel-quebec-city/. •
(First published as “NZNO brings its views to the world stage” in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permission).
By NZNO president Grant Brookes
Québec City, the venue for the GNU meeting (see Related coverage, below), is also home to Coopérative de Solidarité SABSA, a small, innovative primary health care (PHC) service with a growing reputation. When the nurses at Coop SABSA offered to give up their weekly staff meeting to show us around, Nuku and I eagerly accepted.
Established initially as a voluntary organisation in 2011, Coop SABSA is unique. Unlike other PHC services in Québec, the cooperative is a nurse-run, not-for-profit organisation that doesn’t charge consultation fees.
Canada is usually thought of as a country with universal health coverage. Canadian citizens, permanent residents and some temporary migrants are eligible for free health care (with certain exceptions) by presenting their health card.
For GP consultations, most doctors charge a fee for service. The card, however, ensures reimbursement under a public Medicare insurance scheme.
But among vulnerable populations, some do not have a health card. SABSA nurse Maureen Guthrie estimated the proportion of the population denied access to PHC as a result could be as high as 10 per cent. It’s this group, living in downtown Québec, who are cared for by her team.
The service has six staff and sees around 300 patients a month – either by appointment, at a walk-in clinic or through home visits.
Much of the care involves long-term conditions management of non-communicable diseases or HIV-related conditions. There are regular clinics provided by a visiting psychiatrist and other specialists.
Two GPs are available on-call, but most of the prescribing is done by nurse practitioner Isabelle Têtu. Less than five per cent of consultations result in an onward referral to a doctor.
“If we did a survey of emergency rooms around here,” said Guthrie, “they would tell us there’s been a drop in presentations since we opened.”
Initial support to establish Coop SABSA came from the nurses’ union, FIQ Santé, which contributed C$300,000 in seed funding over two years. Today, one salary is paid by the government and the team receives small grants from pharmaceutical companies and donations from local GPs, but fundraising is an ongoing issue.
“Nurses need to take their place professionally,” said Guthrie. “It wasn’t easy at the beginning, but we just ignored what people said, because we knew we were doing it for the patients. Nurses have to trust themselves that they can do it.” •
(First published in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permission)
One of the FIQ Santé convention workshops Nuku and I attended was on a topical issue for NZNO members – Union democracy in the age of electronic voting.
NZNO has limited experience with online voting. It’s been used to elect board members since 2011. Turnout in these elections hasn’t topped 14 per cent. In 2012, 6.52 per cent of members voted in the online referendum on adopting the NZNO constitution.
A one-off, localised trial during multi-employer collective agreement bargaining in 2011 saw just 6.64 per cent of members at Capital & Coast DHB vote electronically to endorse the negotiating team and the claims – well below the national average.
Such limited experience meant the FIQ Santé workshop was valuable.
The facilitator defined union democracy as: “The opportunity for any member of a trade union to develop informed opinions on the objectives of their organisation and on the means to achieve them, on the one hand, and the opportunity to express these opinions in such a way that the union is governed by the majority of these opinions expressed, on the other hand.”
This requires a formal framework of power for the union’s administration, the ability for members to influence decisions, cohesion among members and transparency and responsiveness from administrators.
FIQ Santé research has found electronic voting can lift turnout in elections, as long as members know the candidates and the voting process.
In bargaining, meanwhile, the research found the participation rate was only slightly higher for the electronic vote.
Potential disadvantages with electronic voting were also identified – possible weakening of collectivity, confidentiality issues, increased cost and difficulties maintaining up-to-date email addresses.
The workshop concluded that while electronic voting can be considered a democratic tool, it does not replace the democratic process.
Opportunities will be sought to present the full findings to NZNO staff, to help inform future planning. •
(First published in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permisison).
It was a fortnight before Christmas, and the final day of voting at the DHB MECA ratification meetings. Kaiwhakahaere Kerri Nuku, chief executive Memo Musa and I were meeting new health minister David Clark for the first time.
In the chit-chat before getting down to the business on our agenda, Clark mentioned the MECA and expressed the hope it would be settled soon.
There was a pause. None of us across the table knew what the result of the vote was going to be. The response I came out with was simply: “Minister, there’s a lot of hurt out there”.
When it was announced the following day that the DHB offer had been rejected, I understood.
I understood because of all the DHB nurses, midwives and HCAs who have taken the time to tell me their stories. Some of those stories stand out.
“I’ve held onto the belief that things will get better”, one nurse said recently. “I’ve done the hard yards of ‘more with less’ in good faith that eventually the rewards would come – a fair salary reflective of the skills, knowledge and responsibility of my profession, sufficient support and resources to do my job safely every day.
“None of this has happened. I am tired and disillusioned that we as nurses should have to continue to fight so damned hard for such fundamental basic rights.”
“We don’t feel valued”, said another, “The effort required to work within the DHB feels so immense that we feel despondent about the longevity of our career choice.
“The sustainability of our profession weighs deeply on DHB nurses. The levels of fatigue and job dissatisfaction due to the ever increasing acuity of our patients are higher than ever. We are in DHB nursing because we love the acute health arena, but are constantly considering whether we can survive it, or how long we can sustain our efforts.”
A third told me, “DHB nurses are hurting personally and professionally. We are no longer able to keep giving extra hours to poorly staffed workplaces, as it increases our own stress and health needs and those of our families – for which we, too, have to join waiting lists for treatment.
“We must ensure there are enough staff to do the work, and fund both the wages of these staff and other health service costs, or else nurses will continue to hurt and leave this great profession.”
Three nurses, three different DHBs. The story’s the same, all over.
As I write, mediation between NZNO and DHB representatives is about to get under way. By the time you read this, the mediation process will be complete.
The outcome of mediation will be presented at NZNO member meetings between March 6 and 23.
The situation can’t be blamed on current DHB leaders or on the government of the day. It’s the result of actions by their predecessors, going back many years.
But I dearly hope that the minister and the DHBs have understood that it’s time for them to do what we do for others, every day. It’s time for them to soothe the hurt. •
(Written January 2018. First published as “The president comments” in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permission)
A recent survey has shown that members have little awareness of the work being done by NZNO’s membership committee, despite the fact it has been around for five years. By NZNO president Grant Brookes
NZNO’s membership committee was established in 2012 to provide the board of directors with further insight into the views and needs of NZNO’s diverse members. Five years later, the committee’s role is still not well understood by those it seeks to represent.
That’s according to a survey conducted at the NZNO annual general meeting (AGM) in September. Over 86 per cent of respondents – who included college and section, regional council, Te Rūnanga and National Student Unit (NSU) representatives – did not think other members knew anything about the committee.
Committee vice-chair Joan Knight believes this is symptomatic of a wider problem – one the membership committee is determined to address.
Many members are unaware of the structures through which members govern NZNO, and how the different parts of the organisation work together to achieve our common aims.
“When I first became a workplace delegate, my rationale was ‘paying back’,” Knight said. “I was grateful for the assistance of our previous delegate and the organiser during workplace change.
“But involvement in the workplace, our local regional council, and subsequently on the board opened my eyes to the depth and breadth of the organisation and introduced me to governance.”
Knight is now serving her second term on the committee, representing the Top of the South Regional Council.
The committee comprises representatives from all regional councils, plus two representatives elected by the NSU and two elected by colleges and sections.
The current chair is Sandra Corbett from Hawkes Bay/Te Matau a Māui Regional Council.
The president and vice-president also sit on the committee, but to help ensure the views and needs of members flow upwards to the board (rather than vice-versa), we are not entitled to vote.
Newly graduated nurse Phoebe Webster has recently stepped down as one of the NSU reps. “In my first year of studying, I decided to become involved with NZNO so I could help represent the students within my school,” she said. “This evolved into a wish to help represent and contribute to the views and concerns of student nurses nationwide within NZNO on a national level. For me, this was part of a larger objective to pay ‘forwards’, giving back to a wonderfully rich, diverse profession which I am excited to soon become part of.”
Victoria Santos is an internationally qualified nurse (IQN) from the Philippines. She works as a prison nurse and belongs to the New Zealand College of Primary Health Care Nurses NZNO.
“I am a voice for colleges and sections – a voice of advocacy,” said Santos. “Being an IQN on the committee means I can discuss issues about migrant nurses and their concerns. And since Department of Corrections nurses feel so isolated, I am their voice on the committee too.”
The membership committee has been working in partnership with Te Poari on a new system of direct democracy within NZNO. This would allow “one member, one vote” on matters relating to NZNO policy and rules. These decisions have, up until now, been made by various delegate groupings at our AGM. Knight and kaiwhakahaere Kerri Nuku co-lead the voting strength working group.
The committee and Te Poari have also jointly produced a new structure diagram, showing how the various parts of NZNO fit together and how members can get involved.
The committee will be seeking member feedback on both these projects next year, including at the 2018 regional conventions.
Once these two projects are completed, the committee hopes members will be more aware of how they can all participate in NZNO structures (including through the committee itself), and how we can achieve our goals together. •
First published in Kai Tiaki Nursing New Zealand, December 2017. Reposted with permission.