‘Nurses a voice to lead’ – Speech to NZNO Canterbury/West Coast Regional Convention

E ngā mana, e ngā waka, e ngā hau e wha, tēnā koutou.

Ko te kupu tuatahi ka tuku ki te Kaihanga. E te iwi kāinga, ko Ngāi Tahu, tēnā koutou. Kei te mihi anō ki ngā maunga, ngā awa me ngā wāhi tapu o tēnei rohe.

E ngā mate, haere, haere, haere. Rātou te hunga mate ki a rātou. Tātou te hunga ora e huihui mai nei, tēnā tātou.

Ko wai ahau? Ko Kapukataumahaka te maunga, ko Ōwheo te awa, ko Cornwall te waka, ko Tangata Tiriti tōku iwi, ko Grant Brookes ahau.

He tapuhi, he kaiārahi; kia piki ake te hauora – tēnei te kaupapa o te hui nei.

Nō reira, tēnā koutou, tēnā koutou, tēnā koutou katoa. 

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Greetings, to the Creator and the home people, Ngāi Tahu. I also acknowledge the mountains, rivers and sacred areas of this district.

I acknowledge too those from our nursing whānau who have passed on since we last gathered together. 

I address in particular Maureen Laws, a leader in nursing and midwifery on the national and international stage, who had a special connection to this place. Born in Christchurch in 1939, Maureen completed her nursing training here in 1960. Over the decades until her passing in Wellington last month, Maureen made an enormous contribution to NZNO and to our forerunner, the New Zealand Nurses Association. In the 1980s, she led the drafting of NZNA’s first social policy statement and championed nurses’ right to participate in health and social policy development – a cause which strikes a chord with the theme of today’s convention. 

We honour her by carrying on her work, and so I greet, too, the living gathered here. 

Who am I? I hail from Dunedin. I grew up here at the foot of Mt Cargill and by the Water of Leith. My ancestors arrived on board the ship Cornwall. My name is Grant Brookes.

Nurses as leaders, to improve health. This is the focus of our hui. So greetings, greetings, greetings to you all. 

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I’ve been asked today to break down the theme for the day, and to address one particular piece of it. But before I start, I’d like to acknowledge our midwives and all our other members, even though I’m not qualified to speak for you on professional matters. 

So, “nurses – a voice to lead”. What does this mean? 

According to the International Council of Nurses, “Becoming a voice to lead means talking to governments, community leaders, policy makers and investors”. 

It’s not just talking for the sake of it, though. Our voice is used to lead them, but towards what? 

In the first session this morning, Professional Nurse Advisor Julia Anderson helped us to identify examples of leadership at the point of care. 

Although the term didn’t come up, it seemed to me that we were talking about what the World Health Organisation now calls “a people-centred and integrated health services approach”. 

People–centred care is a return to the basics and to the evidence of putting people at the heart of health care. It is about nurses being true to what is at the heart of the nursing profession. 

Drawing on NZNO’s newly-published Strategy for Nursing 2018-2023, Julia also stressed that nurse leadership happens across a variety of levels, and does not depend on being in a formal leadership role in a health provider or policy agency. This point was reinforced by your Regional Council Chair, Cheryl Hanham, who mentioned the advocacy role of workplace delegates. 

And Kerri just now has spoken about advocacy in international forums, and towards the United Nations’ Sustainable Development Goals. 

I want to highlight one other way that nurses are a voice to lead towards these goals. 

The SDGs comprise 17 goals, such as “Good Health and Well-Being for people”, and 169 targets which governments have committed to meeting by 2030. Achieving Universal Health Coverage is one such target.

New Zealand is generally thought to have achieved this target long ago, as far back as the end of the 1930s. But is this really so? 

According to the World Health Organisation, “UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

I think it’s arguable whether this is actually true today. 

Last year, a pilot study published in the New Zealand Medical Journal found at least 25 per cent of adults were unable to get the primary health care they required while 9 per cent of people had unmet secondary health care needs.

Christchurch surgeon Dr Phil Bagshaw, who led the study, said, “There are probably hundreds of thousands of people who have an unmet need that are not recorded”. 

Bagshaw said the 9 per cent of people with an unmet secondary health care need in the survey had been told by a specialist they needed treatment but had not received it, usually because they did not meet the criteria to be put on the waiting list.

Which brings me to the 200 nurses, midwives and HCAs who rallied outside Middlemore Hospital in the rain from 6.30am this morning. As NZNO Educator John Howell mentioned in the previous session, they were taking action as part of NZNO’s #healthneedsnursing campaign, standing up for their human rights. 

Each one of them was also a voice to lead for health. 

Our #healthneedsnursing campaign website explains: “Over the last decade severe underfunding of our public health services has meant our health system has failed to keep pace with our growing community need, the demands of an ageing population and ageing workforce, and increased costs of providing services.” 

The messages on the placards at Middlemore included, “Patients deserve better”, “Good health needs valued nurses” – as well as slogans like, “Reward our work” and “2%? No way!”. 

Those NZNO members were, in the words of ICN, “talking to governments, community leaders, policy makers and investors”. They were using their voice to lead in the service of Universal Health Coverage, ensuring global goals are met. 

Being a voice to lead is often assumed to be part of our professional role, as nurses, and rallies are something we do as unionists. But professional issues can never be completely separated from industrial realities. They are inseparable parts of a whole. They can’t be divided, any more than you or I can be split into two different identities. 

The campaign website goes on: “Every day the nursing team advocates for the health and wellbeing of patients, families, whānau and the community. But right now they are advocating for the wellbeing of nurses and the whole public health system.” 

So I salute all of you who are becoming a voice to lead through the #HealthNeedsNursing campaign, and urge everyone who can to join the rally outside Christchurch Hospital from 11.30am to 1pm on Friday. 

At the same time, I believe we need to see this campaign just one expression of our nursing voice to lead in the achievement of health a human right. 

We need to be “at the table” in the earliest stage of problem identification and solution framing, whenever and wherever policy is being made – from local workplace to national and international forums. Nurses must get more deeply engaged in understanding influence in all policy making. 

If doing this, we have to do our homework and understand how the evidence is related to the issue we are trying to influence. We need also to look at how we express the groups affected and the degree to which this will engage others. 

Next, we have to look at the politics of the environment. To prompt our thinking, we should ask ourselves – are we in tune with the cycle of organisational or government budget preparation? Have we done our stakeholder analysis? Are we a group that others will take notice of in relation to this issue or will it be seen as self–interest? Have we framed our interest, our input and our contribution in a way that will be heard by others as relevant and important? Who else is interested in the issue and has a compatible position and value system and are they potential collation partners? 

Who, within nursing is most advantageously positioned to take the issue forward to the outside world – is it NZNO, or is it the regulator, senior service leaders, or researchers? Do we have a unified professional message that will be committed to by all and not result in a divided voice? In other words, have we done our homework of working on a consensus position behind closed doors, before advancing it?

If we do this, we will truly fulfil our role as nurses. 

I want to conclude by talking briefly about an example of where it’s NOT our voice to lead – not for nurses like me, anyway. 

Julia Anderson this morning sounded a note of caution that the nursing voice does not replace the voice of the health consumer. Circling back to where I started this talk, with a mihi, it’s equally true that it’s not our place as tauiwi to lead Māori, but to acknowledge and walk alongside. 

We know that application of Te Tiriti o Waitangi to practice is a required competency for nurses. We know that Te Tiriti guaranteed Māori “tino rangatiratanga” or unqualified exercise of authority over their taonga. 

The Nursing Council Guidelines for Cultural Safety confirm that, “The nursing workforce recognises that health is a taonga”. 

They continue: “Tino rangatiratanga enables Maori self-determination over health, recognises the right to manage Maori interests, and affirms the right to development by enabling Maori autonomy and authority over health”.

The Guidelines also place an obligation on nurses to work in partnership, by “ensuring that the integrity and wellbeing of both partners is preserved”. 

So as we mobilise, as we exercise our voice to lead as nurses in Aotearoa New Zealand and change our world, we must at the same time remember to apply Te Tiriti and respect its promise of te tino rangatiratanga. 

Nō reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.