The President comments: 'Year of the nurse, the midwife and of coming back together'

THE YEAR of the Nurse and Midwife is now just over a month old. This international celebration is long-overdue recognition of our professions’ contribution and our worth.

But we all know our professions need and deserve more than a year of acknowledgement. Behind the celebrations is our health system under strain and our professions under pressure. Distressing health inequities persist and nurse and midwife shortages are predicted to grow.

So how can we, as NZNO members in Aotearoa, make this a year to celebrate? 2020 affords real opportunities, but success is not a certainty unless we unite.

Our work has been historically undervalued because we’re a female-dominated profession. A pathway to resolution may be close, with our first pay equity settlement due this year. Will we be able to drive this settlement to all sectors and members?

A solution to entrenched pay disparities for those in Māori-led health-care providers could also be close at last, thanks to years of campaigning and a landmark claim lodged with the Waitangi Tribunal by Te Rūnanga. But with their first deadline of 2020 already missed, can we hold the Crown to account?

The district health board multi-employer collective agreement (MECA) is up for renegotiation. Can we make the gains our professions need in our benchmark collective?

Together, we can make 2020 our year. But that will rely on us using our best source of power: unity in action. And there’s no easy way to say this – unity in NZNO has lately been in short supply.

“In our combined 50-plus years of reporting and observing the activities of NZNO and the wider profession, we have witnessed some turbulent times”, wrote two co-editors in this journal last October. “But never before have we witnessed the division now, sadly, so evident within the organisation.”

To advance the health and wellbeing of our professions, we must heal our internal divisions. Each of us – especially those in positions of leadership – must take our share of responsibility for the years of division, and commit to rebuilding NZNO unity and power. The way to do so, I think, has already been written.

Acting in good faith

“Whatever people’s personal or political understandings”, said the co-editors, “the constitution offers a clear definition of partnership: Partnership is defined as including an acknowledgement by NZNO, based upon the te Tiriti o Waitangi partnership, of the ideals of reciprocity and of mutual benefit, including an obligation to act reasonably, honourably, and in good faith. In so recognising, NZNO further acknowledges the need for, and emphasis on, recognition, respect, accountability, compromise, and a balancing of interests.”

With ideas of reciprocity, respect, recognition and mutual benefit, this partnership concept is about working collectively to advance the interest of all, not just your own immediate interests. Indeed, our definition of partnership is a well-written way of describing the fundamental union principle of looking out for everyone. In 2020, this must be our way of working.

When together we remove historic pay injustices for women, the men in NZNO will benefit too. When together we end discriminatory funding for Māori and iwi providers, gains will also be made for the many non-Māori working in that sector.

But mutual benefit is not always automatic. It takes work, and commitment from us all.

By May this year, as things stand, NZNO members covered by the primary health care MECA will be paid up to 10.6 per cent less than those in DHBs. All those benefiting from extra steps in their latest MECA should now lend their support to those who don’t yet have them.

2020 is the year of the nurse and the midwife. Let it also be our year of coming back together. Our professions and our patients are relying on it. •

First published in Kai Tiaki Nursing New Zealand, February 2020. Reposted with permission. 

Year of the Nurse and the Midwife – Reflecting back as we move forward

by NZNO Kaiwhakahaere Kerri Nuku and President Grant Brookes

The World Health Organization has designated 2020 as the Year of the Nurse and the Midwife. NZNO will be joining in to celebrate the contributions nurses and midwives make and to envision the even greater contributions we can make in the future.

As we reflect on the mahi of nurses and midwives, we take inspiration from the whakataukī: “Titiro whakamuri kōkiri whakamua – Look back and reflect so you can move forward.” In so doing we honour our ancestors and learn from past mistakes.

2020 also marks the 200th anniversary of the birth of Florence Nightingale. Florence is a hugely important figure in the development of our profession, but she left behind a mixed legacy.

Nurses, midwives and tohunga have been serving their communities and practising healing in Aotearoa for centuries; from long before when Florence was advising Colonial authorities in Aotearoa New Zealand about how to prevent the “inherent diseases” of the “savages” from leading to their extinction, as they were brought out of “barbarism” through “the inestimable blessings of Christian civilisation”.

In fact much of our nursing history has been marred by these sorts of conservative and racist views, some of which persist today.

Returning to the whakataukī with which we opened, here are just some of the notable figures and events in our history we can look back on:

  • In 1901, thanks to the pioneering efforts of Grace Neill, Aotearoa New Zealand became the first country in the world to pass legislation recognising the qualifications and status of registered nurses. Recognition of registered midwives came three years later.
  • In 1902 Ellen Dougherty of Palmerston North became the world’s first registered nurse.
  • Akenehi Hei became the first Māori nurse and midwife to register under her own [Māori] name six years later in 1908. However, Māori trained nurses were providing care even before official registration began, following in the footsteps of Mereana Tangata (Mary Ann Leonard) who qualified in 1896.
  • Founded in 1908Kai Tiaki Nursing New Zealand is one of the world’s longest running nursing publications. Last year, Kai Tiaki became one of just 20 publications so far inducted into the Nursing Journal Hall of Fame at a ceremony in Reno, USA.
  • Turning 111 years old this year, the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa is proud to be one of the world’s first professional nursing associations.

Our indigenous and home-grown nurses and midwives have made an immeasurable contribution throughout the 20th and 21st centuries towards raising the health of all peoples in Aotearoa New Zealand. They’re now being joined by our internationally qualified nurses, too.

However, our health system today is under strain. Distressing health inequities persist and nurse and midwife shortages are predicted to grow. Historically our work has been undervalued because we are a female dominated profession. Thankfully an end is finally in sight, with the first Pay Equity settlements due this year. Entrenched pay disparities for those in Māori-led health care providers could also be closed at last, thanks to years of campaigning and a landmark claim lodged with the Waitangi Tribunal by Te Rūnanga o Aotearoa NZNO.

Nurses and midwives need to be properly deployed, valued and included in policy and decision-making. By the end of 2020, we hope to achieve greater investment in improving education, professional development, standards, regulation and employment conditions for nurses and midwives. Our goal is greater influence for nurses and midwives on health policy, more nurses and midwives in leadership positions, and more opportunities for development at all levels.

The needs of the 21st century also require innovative services that make better use of new technology. We need more community and marae-based services that are holistic and people-centred, as well as an increased focus on prevention and on undoing the harm caused by colonisation. These are all areas where we can play a leading role.

Finally, it is our hope that by the end of 2020, NZNO’s Strategy for Nursing 2018-2023 will be accepted across the health sector. This would signal a stronger commitment to a safer and more equitable future for all nurses and midwives in Aotearoa New Zealand.

“Me haere tahi tātou mō te hauora me te oranga o ngā iwi katoa o Aotearoa”, “Let us journey together for the health and wellbeing of the people of Aotearoa” (Rev Leo Te Kira 15 December 2005).

First published at NZNO’s blog. Reposted with permission of the authors.

Providing maternal and child care with scarce resources

Reports from the GNU meeting by NZNO president Grant Brookes

Delegates to the Global Nurses United (GNU) meeting in the Dominican Republic visited San Lorenzo De Los Mina, a hospital in a deprived suburb of the capital, Santo Domingo. There we talked with nursing and medical staff. 

Established in 1974, San Lorenzo provides advanced maternity and child health care through a range of secondary and tertiary services, with limited limited financial and human resources. 

The hospital specialises in the treatment of foetal alcohol spectrum disorder and maternal HIV transmission. Nurse-led programmes include post-discharge follow-up care for teenage mothers. 

The Dominican Republic is an indebted, middle-income country with a population of 10 million and a two tier, public/private health system. 

Last year, the government spent 2.2 percent of gross domestic product (GDP) on debt repayments and just 1.8 percent of GDP on public health services. There are only three nurses per 10,000 population, compared with more than a hundred for every 10,000 people in New Zealand. 

The Dominican nurses union, which hosted the GNU meeting, is campaigning to raise health spending to five percent of GDP. 

Despite the scarce health resources, the Republic’s public hospitals also provide healthcare to people visiting from its more impoverished neighbour, Haiti. 

First published in Kai Tiaki Nursing New Zealand, September 2019. Reposted with permission. 

Related coverage:

‘Building global ties’

‘Nurse/patient ratios under the spotlight at GNU’

Nurse/patient ratios under the spotlight at GNU

Reports from the GNU meeting by NZNO president Grant Brookes

Campaigns for minimum, mandated nurse-to-patient ratios were a key focus at July’s Global Nurses United meeting. 

Encouraging progress was reported in Canadian provinces and in central and eastern parts of the United States. 

California Nurses Association president Malinda Markowitz, who also conveyed a message on behalf of the Queensland Nurses and Midwives Union, explained that California is currently the only American state with legislated staffing ratios in its hospitals. 

“These vary by unit from 1:2 in ICU to 1:5 in med/surg wards. Violations are subject to civil penalties. 

“The ratio is the minimum. There must be improved staffing based on patient acuity. 

“The road to victory wasn’t easy”, she said. “Nurses organised rallies, protests and flexed their political muscle. One of the largest studies on nurse:patient ratios found that if the California law was implemented nationally, it would literally save tens of thousands of lives.”

In 2016 Queensland became the second Australian state after Victoria to implement ratios. “An exciting study by researchers at Queensland University of Technology confirms what nurses know to be true – more nurses save lives, save money and improve the work life of nurses. 

“These victories add fuel to the fire in the global fight for safe staffing. Nurses united will never be defeated,” Markowitz said. 

First published in Kai Tiaki Nursing New Zealand, September 2019. Reposted with permission. 

Related coverage:

‘Building global ties’

‘Providing maternal and child care with scarce resources’


Building global ties

Reports from the GNU meeting by NZNO president Grant Brookes

Nursing union leaders from around the world came together in the Caribbean in July for the annual meeting of Global Nurses United (GNU)

Founded in 2013 by representatives of 14 nursing unions, GNU now spans 27 countries. This year’s meeting meeting, attended by representatives from 19 countries, was hosted by the Dominican National Union of Nursing Workers, with the assistance from the United States’ (US) largest union for RNs, National Nurses United (NNU). 

Hosting this year’s GNU meeting was the Dominican National Union of Nursing Workers, known by its Spanish acronym SINATRAE.

Attending on behalf of NZNO were kaiwhakahaere Kerri Nuku and I, with Te Poari member Tina Konia also attending as a self-funded observer. 

Addressing the opening ceremony, NNU executive director Bonnie Castillo said that when nurses stand together in one hospital, they could hold their bosses accountable. 

‘Guardians of humanity’

National Nurses United executive director Bonnie Castillo addressed the opening ceremony, alongside SINATRAE general secretary Julio Cesar Garcia Cruceta.

“When we stand together in one city, one province or state, or one country, we can advocate for patient and nurse safety on a larger scale and with greater power. So it is incredible that nurses are building our solidarity to the highest level and strengthening our ties globally. I look around today, and I see advocates for the health and safety of everyday people. I see the guardians of humanity.”

The struggle for union rights in an age of authoritarian Right Wing government topped the meeting agenda. A spokesman for Guatemala’s National Union of Health Workers, Luis Alpirez Guzmán spoke about the international campaign to secure his release, supported by NZNO, after eleven of the union’s leaders were arrested in January. 

Filipino Nurses United general secretary Jocelyn Andamo reported that police agents had come to her offices and interrogated staff. A letter calling for an end to the attacks and signed by GNU affiliates, including NZNO, was later sent to Philippines president Rodrigo Duterte. 

But there were also success stories. Formed in 2011, India’s United Nurses Association (UNA) has now has 550,000 members. 

It has members in 23 overseas countries, including New Zealand, where they would be encouraged to join NZNO, UNA president Rince Joseph said. 

Speakers from NNU and the Canadian Federation of Nurses Unions shared their successful campaigns for stronger legal protections from workplace violence. We were all encouraged to lobby our governments to ratify and abide by the new Convention Concerning the Elimination of Violence and Harassment in the World of Work adopted by the International Labour Organisation this year. 

Other items on the agenda concerned safe staffing, universal health coverage, public health and the environment, disaster relief and retirement security. 

The environmental discussion focused on union campaigns for people’s access to clean water and to prevent and mitigate the effects of climate change. 

Underscoring our common cause, Maria Estela of Costa Rica’s National Association of Nursing Professionals spoke of the “creeping control” of water sources and the erosion of indigenous rights by multinational companies. “They’re bottling our water to sell it back to us”, she said. 

Kerri Nuku spoke on NZNO’s campaigns for health equity for Māori communities and pay equity for Māori nurses working for Māori and iwi health providers. 

NNU co-president Cathy Kennedy showed that disaster relief didn’t always happen overseas. This year, NNU members had provided humanitarian assistance to children and migrant families detained at the US-Mexico border. 

On behalf of NZNO, I thanked NNU for demonstrating the moral heart of nursing. This was also demonstrated by New Zealand nurses, along with other workers, who rallied outside the US embassy in Wellington in July, calling for an end to the inhumane treatment of children. 

The meeting concluded by passing a resolution supporting climate and immigrant justice

First published in Kai Tiaki Nursing New Zealand, September 2019. Reposted with permission.

Related coverage:

‘Nurse/patient ratios under the spotlight at GNU’

‘Providing maternal and child care with scarce resources’

‘Strength in unity, defeat in anger and division’ – Speech to NZNO AGM 2019

Korihi te manu, tākiri mai i te ata

Ka ao, ka ao, ka awatea – tīhei mauri ora! 

Ko te kupu tuatahi ka tuku ki te Kaihanga. Ko te tika kia mihi anō ki te iwi kāinga me o rātou wāhi tapu. 

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

Ko te wā mō te hui taumata o te Tōpūtanga Taphui Kaitiaki o Aotearoa, ā, ka maumahara ahau ki te whakataukī: He ora te whakapiri, he mate te whakatakariri. 

Nō reira, e rau rangatira mā, e nga manuhiri tūārangi, tēnā koutou, tēnā koutou, tēnā tātou katoa. 

======

And in English: The bird sings, the morning has dawned, the day has broken. Behold, there is life! 

The first word is to the Creator. It is right also to greeting the iwi of this place and their sacred places. Greetings to those who have passed on, since we last gathered here together. 

We have mourned the passing of more great leaders from our NZNO whānau, this past year.

Two years ago, on this stage, Joy Millar accepted the NZNO Award for Services to Nursing & Midwifery.

In memoriam – Joy Millar, RN, winner of the 2016 NZNO Award for Services to Nursing/Midwifery.

It was richly deserved. Joy had trained in Auckland, where she lived most of her life, graduating from nursing school in 1968. Her dedication to nursing and her Christian faith took her to Cambodia in 1975, where she worked with refugees fleeing the war and there began her life long passion for humanitarian work. Over the next 50 plus years, she would work as a nursing volunteer in many low and middle income countries. 

Joy was last with us all, here in this room, as part of the Greater Auckland Region delegation in 2017. My condolences to GAR for your loss. 

Joy missed the 2018 AGM due to illness, but recovered in time to return one last time to her beloved Pacific. I last had the pleasure and privilege of Joy’s company at the South Pacific Nurses Forum in the Cook Islands last October. 

All those who have gone before, are with us. 

So I greet those gathered here, among the living. And as I do, I recall the whakataukī: “He ora te whakapiri, he mate te whakatakariri”. “There is strength in unity, defeat in anger and division”. 

To the leaders too many to name, and to guests from afar – greetings, greetings, greetings one and all. 

=========

We meet today under some extraordinary circumstances. 

Searching for words to say in this speech, at 5am this morning, my mind went back to my AGM speech last year

When I stood before you here, twelve months ago, memories of the DHB MECA bargaining were very fresh in our minds. I spoke from this lectern about the difficult decisions we had faced, and the differences which had emerged between members, and between members and their representatives. At times, I said, there were signs of the “anger and division” our whakataukī warns about. 

Little did I know back then that the divisions would continue, in the way that they have. 

But I also spoke of what I called the “precious treasure” of democracy. 

“It’s this democracy” I said, “that has the power to forge unity, out of division. A democratic vote can resolve many individual differences into one collective union decision. As we continue the democratic process of overcoming differences, strength will grow; “he ora te whakapiri”.”

And through testing times over the last 12 months we have now relied upon this precious treasure to elect a new Board, decide on remits and confirm the presidency of NZNO. Shortly, we will vote also on the Board’s strategy and policy decisions from 2018/19 and on next year’s NZNO membership fee.

But as I also pointed out last year, healthy democracy is more than simply majority rule. 

Last month, a hard-hitting report was released on the 2017/18 DHB MECA bargaining and campaign. I believe it affirms the experiences and concerns of thousands of NZNO members. 

The report contains fifteen recommendations – number one being, “That the NZNO invest in an internal reconciliation and dialogue process”. That recommendation is limited to the “paid workforce”, which of the Board members would only include the Kaiwhakahaere and myself. An immediate priority for me will be speaking with the new Board about an internal reconciliation process for all eleven of us. 

For you AGM and Conference delegates, meanwhile, this gathering is opportunity to listen to each other, to debate and resolve those differences and to come together again around new shared perspectives. 

Our gathering also provides opportunities to reaffirm our Mission, under which NZNO embraces te Tiriti o Waitangi and works to improve the health status of all peoples of Aotearoa New Zealand. 

And tomorrow, Conference presentations will help us raise our sights and embrace the vision: ‘Leaving No One Behind – Health For All’.

Lastly our gathering will enable us to share food and celebrate the achievements of our nursing leaders who have given outstanding service.

I hope you will leave this event re-energised to embrace the challenges of the year ahead. I look forward to meeting and mixing with as many of you as possible over our two days together.

In conclusion, it occurs to me that NZNO turns 110 this year. Throughout this past 110 years, our organisation has undergone much dynamic change. We’ve transformed from a small group vehemently opposed to advocacy on pay, to over 50,000 members prepared to take to the streets to secure an environment where good health can thrive. 

The journey has not always been easy. The past year has been a tough one for our 110-year old organisation. 

But we have worked through our differences before. We have innovated, adapted, and made significant changes to be where we are today. 

The next chapter is ours to write together. 

Nō reira e te whānau, tēnā koutou, tēnā koutou, tēnā tātou katoa.

The President comments: ‘We will overcome’

According to my research, the upcoming 2019 Annual General Meeting in Wellington should mark the longest period of continuous service by an NZNO president in our 110-year history. I will have served four years and a day. 

Past presidents have won an equal, or greater number of elections. But through the quirks of history, either they weren’t consecutive, or they were at a time when presidential terms were two years, rather than three years as they are today. 

Throughout this past 110 years, NZNO has undergone much dynamic change. We’ve transformed from a small group vehemently opposed to advocacy on pay, to over 50,000 members prepared to take to the streets to secure an environment where good health can thrive. 

NZNO has embraced change throughout its history. Members voted to strike in 1985, only to have it called off. Four years later, Auckland nurses Jenny Landsbergen, Lucien Cronin and Gordon Love took to the streets in our first ever nationwide industrial action.

The four years of my presidency has been a story of working together towards positive, member-led change. We have gained momentum in collectively shifting the ethos of our organisation. We are insisting that our organisation is led by us, the members. 

The changes started small. In 2015, delegates at the NZNO AGM directed NZNO to act in accordance with member values. They voted that we should divest from fossil fuels, become a Living Wage employer and expand our global connectedness with other nursing unions

Within a year, the last of these three was complete. We had joined with our sister unions in Global Nurses United, who are now leading the worldwide fight for safe nurse:patient ratios

The changes grew through members’ growing insistence that we would lead our organisation’s direction. As 2017 rolled into 2018, members in the DHBs stood up and took unprecedented actions for themselves, for communities reliant on our over-stretched health system and for a union that represents us all. 

As I wrote in this column a year ago, about the DHB strike of July 2018, “For me personally, the hours I spent picketing and marching with my fellow NZNO members that day will stand as the proudest moments of my nursing career”. 

And finally, now nearly every important NZNO decision belongs to all members with one member one vote

The four-year journey has not been easy. At times, there has been rancour and bitter division. 

But we have worked through our differences before. We have innovated, adapted, and made significant changes to be where we are today. Had our organisation not been prepared to embrace change we would still be campaigning against penal rates, and standing against the 40-hour working week! 

Last month, a hard-hitting report was released on the 2017/18 DHB MECA bargaining and campaign. I believe it affirms the experiences and concerns of thousands of NZNO members. The very existence of this report, I ascribe to member pressure, in particular to the proposals put forward at last year’s AGM by the NZNO Greater Auckland Regional Council

Today, there is a last stand of resistance to member-led change in NZNO. But we will overcome because over the four years we have organised ourselves to insist our member voice will be heard and acted upon. 

This year’s AGM will see a new Board take office, elected by the entire NZNO membership. The new Board will have to ensure that all recommendations of the MECA review are implemented, that a new NZNO Strategic Plan for 2020-25 is put in place and that our structures are up to the challenges the future will throw at us. I look forward to working with your newly elected Board to ensure this happens. 

The last four years have been important ones for our 110-year old organisation. The next chapter is ours to write together.

First published in Kai Tiaki Nursing New Zealand, September 2019