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

Canterbury Regional Convention 10.4.18
Participants at the NZNO Canterbury Regional Convention support the #healthneedsnursing campaign.

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 – ēnei te kaupapa o te hui nei.

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


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. 


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. 

Global nurses unite in Québec

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.

GNU Executive Committee, 1.12.17
GNU Executive Committee meeting, Québec, 1 December 2017 (Photo: Linda Silas)

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.

Us two
NZNO co-leaders Kerri Nuku (left) and Grant Brookes (right) took part in an international panel at the FIQ Santé convention.

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/. •


Related coverage:

‘No fees at nurse-run service’

‘Do online votes aid union democracy?’

(First published as “NZNO brings its views to the world stage” in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permission). 

No fees at nurse-run service

Grant Brookes and Kerri Nuku were hosted by (from left) Coop SABSA coordinator Amélie Bédard, nurse practitioner Isabelle Têtu and registered nurse Maureen Guthrie.

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.” •


Related coverage:

Global nurses unite in Québec

Do online votes aid union democracy?

(First published in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permission) 

Do online votes aid union democracy?

Union Democracy and Electronic Vote

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, 11.92 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. •


Related coverage:

Global nurses unite in Québec’

No fees at nurse-run service

(First published in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permisison).

Promoting the voice of members inside NZNO

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

Membership Committee
L-R:  Committee vice-chair Joan knight, Victoria Santos represents colleges and sections, Former NSU representative Phoebe Webster.

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. 

‘Struggles we must face’ – Joint NZNO presentation on the Global Nurses United international panel, Québec City

Kaiwhakahaere Kerri Nuku and I represented NZNO at meetings in Québec from 27 November – 1 December. We attended a meeting of the Executive Committee of Global Nurses United, and spoke on an international panel hosted by the Québec nurses’ union, FIQ Santé. I spoke first, followed by Kerri, on the topic: “How do your government’s policies affect the care that your members provide and what struggles must you face? What will be your battles over the next few years?” Financial support from FIQ Santé, which enabled our attendance, is greatly appreciated. 

Us two.jpg

Kia ora, koutou.

Greetings, to you all.

It is customary in our young country, when beginning a formal speech at a meeting, to start with an introduction which acknowledges one’s connection to the natural and spiritual world of your birthplace, to a shared experience of migration and to a collective identity based on ancestry. This custom has been adopted from the indigenous culture of the Māori, the tāngata whenua or people of the land.

Nō reira, ko wai ahau?

Ko Kapukataumahaka tōku maunga

Ko Owheo tōku awa

Ko Cornwall tōku waka

Ko te Tāngata Tiriti tōku iwi

Ko Grant Brookes taku ingoa, ā, ko te perehitene ahau ō te Tōpūtanga Tapuhi Kaitaiki ō Aotearoa.

To translate: The sacred mountain overlooking my birthplace is Kapukataumahaka, and the sacred river is Ōwheo. My ancestors arrived on board the ship, Cornwall. My tribe is known as the People of the Treaty, which means I am not indigenous. I reside on the land by right of the 177-year old Treaty of Waitangi between the Māori peoples and the British Crown. My name is Grant Brookes and I am the co-president of the New Zealand Nurses Organisation.

It is then customary to pay respects to the tribe on whose land we are meeting. So I would like to acknowledge that the land on which we gather is the traditional and unceded territory of the Abenaki and Wabenaki Confederacy and the Maliseet.

This biculturalism – embracing the twin perspectives of the of the indigenous and non-indigenous peoples – is today reflected (to a greater or lesser extent) across New Zealand’s health sector. And it is embedded in the structures of our union, as reflected in the two co-presidents you see before you.

FIQ International Panel - slides2 copy.jpg

It hasn’t always been customary for non-indigenous people to start speeches this way. New Zealand is a colonial settler society. After signing the Treaty of Waitangi in 1840, the British Crown and colonists proceeded to ignore it. Māori land, cultural treasures and authority were alienated over following decades through military force and other means. Respect for Māori customs is being restored today through reconciliation for these Treaty breaches.

The initial health impacts of colonisation were devastating. A pre-contact Māori population of up to 150,000 was reduced to 42,000 in little over a century. Our other co-president, Kerri Nuku, will speak shortly about our union’s current battles to improve Māori health status and about government policies affecting the care that our Māori members provide.

Before I turn to the set questions, I would like to briefly explain the structure of the New Zealand health system.

FIQ International Panel - slides3 copy.jpg

Since 1938, the system has been organised around a core of “socialised medicine”, which resembles the UK National Health Service. The government owns and funds most inpatient and outpatient hospital services, including mental health facilities, and all emergency, intensive care and preventive health services.

Care rationing and waiting lists for non-urgent procedures have become a feature in recent decades, leading to a small private health insurance market. During the period of neoliberal ascendancy in the 1980s and 90s, parts of the public health system – such as elder care and some disability support services – were privatised.

General Practice was excluded from the state-owned system at the outset, and it has largely remained a private business ever since – along with dentistry. Government subsidies, however, fully fund free access for children and part-fund GP visits for adults. Prescription drugs are also subsidised.

Total health spending is 9 percent of GDP. Public spending, generated through general taxes, accounts for 80 percent of this total (Mossialos et. al., 2017).

From this overview it can be seen that government is the ultimate employer of the majority our members and that government policies greatly affect the care that all our members provide.

Two months ago, the New Zealand general election delivered a change of government. Many of the policies of the former conservative government are being reversed. In some cases, where the new Labour-led coalition government has pledged to adopt our policy priorities, we may face struggles to ensure they deliver on their promises in a timely fashion.

Current rapid change means it is difficult to see what our battles may be over the next few years. So I will briefly mention five of the immediate priorities we have raised with the new government.

FIQ International Panel - slides4 copy.jpg

1. Reinstate health funding to levels able to provide the same quality and quantity of health services for our population as at 2009/2010.

Under the previous conservative administration which took office at the end of 2008, government health funding failed to keep pace with population growth and inflation, leading to a cumulative funding shortfall of $1.4 billion. Effectively a 9% cut in operational funding over 8 years, this has meant that our members have been providing care to more people with no corresponding increase in workforce size. The new government has pledged to restore funding. We will battle to make this happen sooner, rather than later.

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2. Ensure safe staffing levels and workloads throughout… all health care services

Nurses comprise half of New Zealand’s health workforce. As the largest single group, our members have borne the brunt of the funding cuts of the last 8 years. Unsafe staffing levels, unmanageable workloads and long hours have become the norm in the care our members provide.

We have collaborated in developing a unique local model to ensure safe staffing levels, called Care Capacity Demand Management, as an alternative to legislated ratios used overseas. CCDM relies on a tripartite approach to calculate and adjust staffing levels in the public health system based on patient acuity. Our big battle now is to get this model implemented.

In privatised sectors such as aged care, where a tripartite approach cannot be guaranteed, we will push for mandatory standards for minimum safe staffing levels and skill mix in residential facilities.

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3. Full employment for all new nursing graduates

Research shows that employment experience in the first few years post-graduation is a critical factor in retaining nurses in the profession long-term. The New Zealand health system offers a supported Nurse Entry to Practice programmes (NEtP), with enhanced mentoring and educational opportunities. Last year, however, only 62 percent of nursing graduates secured NEtP positions. Many of the others were reduced to voluntary, part time or casual jobs ie. precarious work. We will battle for a NEtP place for every new grad.

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4. Fair employment laws

The previous government amended New Zealand’s industrial relations law seven times in 9 years – each time reducing union rights and workers’ rights.

These changes have reinforced structural barriers to fair and balanced employment relationships that, in the rapidly changing labour market, have led to increased job insecurity and persistent low growth in wages, despite growing productivity.

The struggle we will wage, along with the other affiliates of the New Zealand Council of Trade Unions, is not only to roll back these changes – which the new government has agreed to – but to strengthen the pre-existing framework.

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5. Health workforce planning

It is projected that half of all nurses will retire over the next 10 to 15 years. An improvement to long term workforce planning is urgently needed to meet projected shortages and to ensure that the workforce is culturally, ethnically and gender representative, enacts Treaty of Waitangi articles, and meets international obligations for ethical recruitment and self-sustainability.

I will now hand over to Kerri to speak more about our struggle for workforce planning – especially to ensure that it is culturally representative of the population.


There are many workforce issues due to funding constraints and I want to focus on one specific area, identify the impact funding constraints has on community and our responsibility as advocates and finally trade agreements

1. Pay inequities

Significant pay disparities of up to approximately 25% exist for nurses working with Primary Health Organisations, especially with Indigenous Health Care services. These disparities occur even in cases where staff have professional qualifications and affect the workforce predominately working within Indigenous service providers who are predominately female.

Pay disparities seem to be the unintended consequence of how the government funds healthcare, which fails to address the differences in infrastructure and investment required specifically within indigenous healthcare service providers versus other larger health providers. This issue affects an indigenous workforce.

These entrenched pay inequities are now affecting the retention and recruitment of nurses in these areas. We will continue to lobby within Aotearoa New Zealand government and raise a complaint to the interventions to the Human Rights Commission and United Nations in New York and challenged the application of our government to ILO Conventions 169 and 149.

2. Community impact

Health funding is imperative to ensure that the we are responsive to the changes in population health needs. Our population (like others) is constantly in a time of change demographics, health demand. However what we have seen is the opposite that is systemic barriers to access health services, escalating social, economic and health disparities has seen an increase in poverty, homelessness and over the years we have seen the emergence of diseases of poverty.

As a union we must ensure that health is central to all government policies and that these policies are integrated to address the global challenges of climate changes antimicrobial resistance and unfair work, trade and immigration patterns.

3. Trade agreements

Achieving the UN Sustainable Development Goals, including reducing inequality within and between countries, requires international trade and economic integration agreements to be free of provisions that have the potential to erode government’s rights to act in the best interest of the population and environmental health.

In Aotearoa we promote a coherent system of global health law to further multilateral cooperation in advancing global health equity, by developing and implementing strategies to achieve the sustainability development goals.

We will ensure that 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 programme or maintain and expand the public funding and public provision of health on a non-commercial basis.

To conclude, we cannot estimate that nursing is in a crisis, nurses are overworked and under respected and appreciated. Health is a human right and not a privilege and we have an important role to play in advocacy for our populations. Our challenge as a union is to progress policies, while bringing along the public, to keep alert to the changes in the environment, remain relevant and ensure as a union we continue to engage and grow members in solidarity. Be brave and courageous to take action.


Global nurses unite

Kai Tiaki Oct 2017 cover
First published in Kai Tiaki Nursing New Zealand, October 2017. Re-posted with permission.

A NEW chapter is about to be written in the story of NZNO. Next month, we will take our seat at the annual meeting of Global Nurses United (GNU) for the first time. NZNO will be represented at the meeting – in late November in Quebec, Canada – by kaiwhakahaere Kerri Nuku and me.

GNU was formed in 2013. Its founding meeting was hosted by National Nurses United (NNU), the largest union and professional organisation for nurses in the United States (US).

Nursing leaders from 14 countries in the Americas, Africa, Asia-Pacific and Europe came together around a four-point declaration, expressing shared commitment to safe staffing and universal health care, and opposition to the harmful effects of climate change, inequality, health cuts, privatisation and other neoliberal policies.

Since 2013, GNU has expanded to encompass nursing unions from 20 countries. NZNO joined this global network last year. Belonging to GNU complements our relationships with the world’s professional nursing associations, maintained through the International Council of Nurses.

This year’s GNU meeting is hosted by the Fédération Interprofessionnelle de la Santé du Québec (FIQ), a union grouping covering 66,000 nurses, respiratory therapists and clinical perfusionists across Canada’s French-speaking province.

Even flying economy class, international meetings can use up a lot of NZNO members’ money. But for this trip, the FIQ has signalled NZNO’s valued role within GNU, by offering to cover all our accommodation costs.

The benefits to NZNO members of participation in GNU were highlighted at our annual conference last month by guest speaker and NNU co-president Jean Ross.

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NNU Co-President Jean Ross was a guest speaker at the NZNO Conference last month.

The world is more interconnected than ever, Ross said. Problems and solutions for nurses are now global. Protecting health-care workers and patients from new epidemics like Ebola takes international cooperation, she pointed out (see also, ‘Advocating for patients and communities’, p11).

Emerging health problems related to climate change must also be tackled globally. Multinational corporations are increasingly influencing our health system – including through the expanding telehealth and e-health sectors. Public-private partnerships, with global giants like Serco running our hospitals, could be the next frontier. These challenges, too, call for a coordinated global response.

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A message of international nursing cooperation was delivered by NNU Co-President Jean Ross.

The Trans-Pacific Partnership Agreement (TPPA) is a case in point. It was US pharmaceutical companies who pushed the intellectual property provisions which would protect profits, but limit access to life-saving treatments for New Zealanders. And long before President Donald Trump finally pulled the US out of the deal, it was campaigning by NNU which helped to undermine congressional support and delay negotiations.

Kerri Nuku and I head to Canada to strengthen such international efforts, and to lay the groundwork for ongoing working relationships between GNU and NZNO staff. In doing so, we are responding to Ross’s vision.

“Our imperative”, she told conference delegates, “is to build the kind of global solidarity that can go toe-to-toe with the global financiers and the corporations that want to profit off people’s illnesses and, instead, create a different kind of globalisation.

“The collective power of nurses can create a new kind of world – a world of compassion and community and caring.” •