Questions & answers for members at NZNO Central Regional Convention

At the NZNO Central Regional Convention in Palmerston North on 9 April, Kaiwhakahaere Kerri Nuku, Chief Executive Memo Musa and I were invited to be part of a Q&A panel. We answered eight questions, sourced from NZNO members in the Region and provided to us the week before. 

Three of the questions were addressed to me. Here are the notes I prepared, for use in my answers. 

Question 1. Social media is a growing factor in communication and in influencing opinion. What is NZNO’s strategy and safeguards in relation to social media platforms?  

Firstly, thank you for the opportunity to participate in your Regional Convention in this way. When I received the invitation to be part of this panel from your Chairperson, Trisha Hurley, I wrote back and commended the Central Regional Council for building member responsiveness and leadership accountability into today’s programme. 

Turning now to the question, I would like to clarify what we mean when we talk about NZNO. What might pop into your head when you hear “NZNO” are the staff who work in our NZNO offices. But I’m really clear in my mind that “NZNO” means the 52,000 of us who are part of this organisation, each with with our own role to play in successfully delivering NZNO’s strategies. 

Social media is a topic I spoke on at the Southern Regional Convention in Dunedin, the week before last. The notes from that presentation are available on my blog. 

In that speech, I covered NZNO’s main safeguard for members – the new guideline, “Social media and the nursing profession: a guide to maintain professionalism online for nurses and nursing students 2019”, published in February. This guideline is available on the NZNO website. 

What about strategy? 

In my speech the week before last, I also mentioned the upcoming CTU Organising Conference, held in Auckland last week. 

As anticipated, social media strategy was a major theme running through the conference. It featured in the three keynote speeches from international guests. Carl Roper from the UK spoke about the work of the Trades Union Congress Digital Lab, which supports research, leadership and training in digital transformation. Melanie Gatt & Felicity Sowerbutts from Australia showcased recent successful social media strategies in Sydney and Melbourne. 

Much of the learning at the conference was focused on digital unionism, although NZEI Te Riu Roa (which is both a union and professional association, like us) presented on their new social media strategy for teachers in Early Childhood Education. And a values-based communication workshop run by the Post Primary Teachers Association Te Wehengarua – also a professional association – covered social media campaigns. 

A number of key points for came through all of this. Firstly, and most obviously, was the need for a strategy. The point was made repeatedly that if we don’t lead the debates about our issues on social media, then other people will. 

Secondly was the importance of using Facebook groups – either by joining large existing ones (like the 35,000-strong “NZ teachers” group), or by setting up new ones (like the “PPTA members – bringing out the best” group, created by the comms team at the secondary teachers union). 

Thirdly, it is essential to interact. The power of social media lies in its interactivity. Using social media like a noticeboard, simply posting messages and then walking away, won’t work. In fact, it may be worse than doing nothing. 

Fourthly, this social media interaction must be member-led. This is not only a practical necessity, given the 24/7 nature of interaction on these platforms, it’s also key to maintaining credibility. But equally, our volunteer digital activists need support from union staff, including training and mentoring. Private Messenger groups bringing together communications staff and member activists was highlighted as a good way to provide support, allowing debriefing and problem-solving in what can be a very challenging environment. 

If those were some of the learnings from the CTU conference, what then is NZNO’s strategy? 

The short answer is that unfortunately, we don’t yet have an overall strategy. A framework for developing an NZNO social media strategy does exist. It came out of a communications review commissioned by the Board and completed in 2017. But implementation of the review recommendations has been delayed, partly due to resource constraints. 

In the absence of an overall strategy, what we have at present are discrete social media campaigns, a range of practices by different actors within the “NZNO 52,000”, a range of views on how to approach social media, and a few decisions and actions regarding social media. These decisions tend to be reactive and ad-hoc. 

I will conclude by giving some examples from Board level. There, some decisions and a range of views are documented in the Board meeting minutes, which are available to members on the NZNO website

The minutes of the meeting held on 15 February 2017, for instance, record that: “The Board expressed concern that the President is still reporting personal blogs [and other social media activity] toward his key performance indicators (KPIs) which is not part of Presidential work. The President responded that the work plan approved by the Board contains reference to [social media] KPIs and these are what is being reported on, and that he sees this as part of member engagement.”

So there you can see clearly that there was a range of views, in this instance over whether member engagement on social media should be part of my work as President.

“Regarding social media”, the minutes continue, “a Board member has observed that there is an “NZNO” Facebook group which is not an official one. The communications review may inform the use of the unofficial and official Facebook pages.  A board member commented that on more than one occasion use of the unofficial Facebook group has caused problems.  A request is to be put in writing to the administrators of the unofficial Facebook group containing recommendations to remove the NZNO branding… 

The Vice President is to draft a letter to the administrators of the unofficial Facebook group to request removal of NZNO branding.  The letter, once approved, is to be sent on behalf of the Board to ensure the message is clearly received that this was a decision made by the Board.”

This decision reflects one approach to social media strategy, agreed by the Board.  

Incidentally, I had been an administrator of that unofficial “NZNO Members and Supporters” Facebook group at that time, supporting the team of NZNO delegates who moderated and led the debates, and part of their private Messenger group. After the meeting, I was obliged to give up that admin role. 

Decisions on social media activity were also made at the following Board meeting, on 19 April 2017.

The minutes record: “The Board observed that who makes the posts plays an important part in social media.  NZNO’s Employment Lawyer has advised that while NZNO may look to ensure that the right of freedom of expression does not override any specific legal duties and obligations by way of its formal moderation for official NZNO Facebook posts, it is not clear as to how much (if any) oversight might be extended to unofficial Facebook posts in the absence of formal NZNO moderation of same.

The Board discussed the President writing a second article for Kai Tiaki as a way to inform members.  The Board instructed the CE to request that Kai Tiaki journalists write a brief article covering the Employment Lawyer’s opinion for the next issue of Kai Tiaki.”

These two articles appeared in Kai Tiaki, as directed by the Board, as “To post or not to post? Social media and nursing” and “Notices to members: caution advised on Facebook”.

Again, on 15 August 2018, the Board minutes record: “A member of the Negotiating Team believes there needs to be moderation of sites with NZNO’s name attached. The President advised that he had looked in February and at that time there were 41 unofficial websites Facebook sites with NZNO’s name attached”. 

A resolution was passed: “That a letter from the Board be sent to unofficial NZNO Facebook site administrators requesting that they cease to use abbreviations NZNO and associated NZNO branding on the unofficial Facebook sites they administer.”

This resolution has not yet been implemented. 

Question 2. Do you believe NZNO is a membership driven organisation and how confident are you that the voice of the members is being heard? How valuable are Regional Councils in the NZNO structure and do they serve their intended purpose?

This is a two-part question. If it’s ok with you all, I will deal with the first part quickly. 

Do I believe NZNO is a membership driven organisation and is the voice of the members being heard? Yes, to an extent, but it needs to become more so. 

The second part is about Regional Councils. I’d like to take some time to look at why we have Regional Councils. What are they? Where do they come from? What is their purpose? Do they make the voice of members heard? 

Regional Councils are one of the five fundamental membership structures mandated by the NZNO Constitution. The other four structures are the workplace delegates, colleges and sections, the National Student Unit and a little-known body called Health Professionals NZ. You can find out more about these in Schedule Seven of the Constitution, on the NZNO website. 

The origin of Regional Councils is described on pages 209-10 of NZNO’s official centennial history, “Freed to Care, Proud to Nurse” by Mary Ellen O’Connor:

“By 1988, there were 54 branches of [the New Zealand Nurses Association]… In 1989 a major restructuring took place. Branches, which facilitated remits and conference voting, were abolished in favour of… individual membership of NZNA, with workplace groups being the first point of reference and the eleven regional councils being the next. All these regions would have representation on the new NZNA national council, bigger than the old national executive…

“This restructuring was seen by NZNA leadership as better representing the majority of members, who now worked across multiple workplaces. It was perceived by the membership, however, as the destruction of the organic channels that they had created. 

“In fact, the imposed structure was never to function in the comfortable, rhythmic way that the old branches had.”

So there you have it. In the opinion of the author of our official history, compared to the previous structures Regional Councils have never functioned to make the voice of members heard.   

This excerpt from our history also talks about some of the other purposes of regional councils. 

Each regional council decided on their “representation on the national council”, the governing body known today as the Board of Directors. That purpose was removed in 2012, when election of directors was transferred to an all-member ballot. 

And the regional councils “facilitated remits and conference voting”. Conference voting has also been removed, now replaced by the “one person, one vote” system

The remaining purposes of these structures are set out in the NZNO Regional Council Handbook. This document is currently under review. The new version will be out very soon. The current version is seven years old, and still refers to the functions now removed, but where it’s not outdated it says: 

“In general,  Regional Councils are critical for the information flow and promulgation of NZNO policy between the Board of Directors and general membership within the region. They also play an active role in the successful operation of Regional Conventions [and congratulations to Trisha and your council for organising today’s great event], management of any regional funds… management of consultation documents and submissions, regional activities such as International Nurses Day, projects and the operation of any sub-committees.”

Do Regional Councils serve these purposes? Given that they are heavily dependent on the precious time and effort of our wonderful volunteers, I think that by and large they do these things as well as they can.

But the questions remain. Is this what they were intended to do when they were created? And are they the best structure for ensuring that the voice of members is heard? 

Because Regional Councils are part of the interlocking, fundamental membership structures in Schedule Seven, if anyone ever decided they needed to change, it would probably require a full review of the Constitution. 

Question 3. Members have raised concerns about the amount of overseas travel undertaken by the leadership. Is the overseas travel justified and what benefits does it bring to the average member? 

My answer to this question will be in two parts. The first part is about something which can be measured precisely. The second thing is impossible to quantify. 

I have a handout to go with my answer. Here is an extract from a paper presented to the NZNO Board meeting on 12 February 2019 by David Woltman, our Manager, Corporate Services. 

David prepared the paper at the request of our Audit and Risk Committee, who had heard the member concerns about the amount of overseas travel undertaken by the leadership and responded. 

The figures in the table cover travel costs for all NZNO members and staff. As you can see, while costs go up and down from year to year, in 2018 the total gross amount spent on all international travel was $28,163, or roughly 0.1% of the NZNO budget. Twenty times that amount was spent on domestic airfares, supporting NZNO members to attend events like the AGM and Conference, college and section committee meetings, and so on.  

I think many would be surprised to see what a small amount goes on international travel. Some of the $28,163 gross spend was later recovered, by the way, through payments to NZNO from sponsoring organisations and individuals. 

In terms of the benefit to members from this travel, this is something that’s impossible to quantify, so I won’t even start. 

But I would like to read a couple of messages. 

“I am writing to you today on behalf of the International Council of Nurses (ICN) following the brutal and horrific attack on two mosques in Christchurch in which dozens of people were killed during Friday prayers.

“We offer our unconditional support to the New Zealand Nursing Organisation, Nurses and all healthcare workers in Christchurch and across New Zealand. The thoughts of Nurses from around the world will be with you, the victims and families of these attacks and we stand resolutely beside you in condemning all forms of violence, harassment, intimidation and discrimination against immigrants and minorities and indeed people anywhere.

“We are deeply saddened by this barbaric act, which goes against all human values and took the lives of innocent people while they were praying. We understand from news reports that 49 people have been killed and more injured including young children with gunshot wounds and that Christchurch hospital was a safe haven during the attack. We acknowledge both the compassion and bravery of the nurses, first responders and all the healthcare staff who provided care immediately after the incident and continue to do so during a time of great pain and grief. Nurses will always provide care for patients whenever and wherever it is needed.

“Our sincerest sympathy and complete solidarity is with NZNO and all the people of New Zealand at this time.

Yours sincerely,

Annette Kennedy, President & Howard Catton, Chief Executive Officer”

This letter was circulated. Its compassion is born of NZNO’s close connections to ICN. I think that members who read it in the days and weeks after the attack, felt better. And for me, that’s the benefit. 

One more:

“Nurse leaders around the world joined together in expressing shock and horror at the deadly slaughter in Christchurch, New Zealand and said it is a reminder of the deadly consequences of hate speech, Islamophobia and anti-immigrant policies that must be confronted and challenged by all.

“Global Nurses United, representing nurses and health care workers unions in 23 nations, said they stood in unity with the Muslim community targeted by the attack, and expressed support for New Zealand nurses, represented by the GNU affiliate, the New Zealand Nurses Organisation (NZNO), and other health care workers who are providing care for the victims and their families.

“No nation can be considered democratic when people must live in fear of violence because of their religion, ethnicity, immigration status, or race, said GNU. In addition to the loss of life and injury, there are also long-term consequences that can erode the mental and physical health of affected family members and entire communities and nations for years.

“New Zealand reminds us that this has become a global crisis and must be confronted as a global community.  

“It is incumbent on our world leaders to join together in not only condemning the violence, but in directly challenging the inflammatory rhetoric and policies that encourage them.”

I think this sums up why we engage internationally: “New Zealand reminds us that this has become a global crisis and must be confronted as a global community.”

The hate that caused so much grief to so many people – not least, to NZNO members at Christchurch Hospital – is international, and can only be confronted by us connecting internationally. 

And it’s not just in moments of tragedy. Global interconnections – involving governments, health authorities, health employers, nursing regulators, educators, nursing policy-makers and researchers and even our families – shape the lives of NZNO members, every minute of every day. This is why NZNO must be there on your behalf, too. 

You can read more about these reasons in the publication (produced through consultation with members), “Guideline: NZNO and its international relationships and affiliations, 2016”. 

‘The impact of social media on NZNO’s members, delegates and reputation’ – Presentation to NZNO Southern Regional Convention

Speech notes of a presentation to NZNO Southern Regional Convention at the Otago Golf Club, Balmacewan, Dunedin, 28 March 2018.

Tihei mauri ora! Te mea tuatahi, ka tū ahau ki te tautoko i ngā mihi ki te kaihanga. Firstly I stand to support the acknowledgement of the creator. 

Kei te mihi hoki ahau ki ngā uri whakaheke nā Tahu-pōtiki, te tino tipuna, me ō rātou wāhi tapu katoa. I also acknowledge the descendants of Tahu-pōtiki, the great ancestor of Ngai Tahu, and all their sacred places. 

Nō reira, e ngā mana e ngā reo, e ngā karangaranga maha, tēnā koutou. So to all the authorities, all voices and the many affiliations, greetings. 

As I speak at meetings around the country, I often talk about my connections to this place. It was here, in Ōtepoti/Dunedin, that my ancestors arrived from Scotland back in 1849, aboard the Cornwall.

Behind me I know that Mount Cargill, Kapukataumahaka, is looking down on us, as it always has. Out there beyond the trees, I see my old high school, where I returned last year for the school centenary. And over the ridge line, I know that Ōwheo, the water of Leith, winds its way to the sea. 

It’s wonderful to be back home, on my tūrangawaewae, the home where my feet belong.

The topic I’ve been asked to speak on today is, “The impact of social media on NZNO members, delegates and on NZNO’s reputation”. It’s a sensitive topic. It is also very large. 

My talk will not be a definitive, or comprehensive account of the impact of social media. 

As you may be aware, a review of the DHB MECA bargaining process and supporting campaigns is currently being conducted by former CTU President Ross Wilson. The terms of reference for the review direct him to “Enquire into and comment on NZNO’s… processes for communications (internal and external) including the use of social media”. We keenly await his findings, which are due to be delivered to the NZNO Board in June. After that, we will be in a better position to evaluate thoroughly the impact of social media on NZNO members, delegates and on NZNO’s reputation. 

Even this time next week, I would be better placed. At the CTU Organising Conference in Auckland on Wednesday, there will be an NZNO presentation on, “Lessons learned from the major state sector industrial campaigns of 2018”. No doubt this will cover the impact of social media, as well. 

In place of a definitive, or comprehensive account, what I have to offer now are just some interim personal observations, based on a few examples of social media impacts, followed by a brief introduction to NZNO’s new publication, “Social media and the nursing profession: a guide to maintain professionalism online for nurses and nursing students 2019”. 

So what are we talking about, when we speak of social media? 

Social media is defined in our Guideline as the “internet or web-based technologies that allow people to connect, communicate and interact in real time to share and exchange information. This may include using Facebook, Twitter, YouTube, Snapchat, Instagram, blogs, forums, dating “apps” and personal websites. The key element of social media… is the active nature of the dialogue, enabling user-generated content and images to be communicated instantly.” 

It’s a truism to say that social media is rapidly evolving. It’s moving so fast, in fact, that some of the content in NZNO’s new guideline, updated during 2018 and published just last month, is already starting to become dated. 

Part of this rapid evolution is a blurring of the distinction between social media and traditional news media. Online newspapers such as Stuff are increasingly integrating user-generated content, through a comments area, through reporting on social media posts, through embedding of tweets and Facebook Live videos directly in their articles and through an entire section dedicated to content submitted by readers, called “Stuff Nation”. For this reason, my talk will also touch on the impact of the news media. 

Let me start with an immediate example – one that’s current, and close to home. 

Here are a couple of photos taken earlier this month in Ōamaru. 

You may recognise some of the people, and what the photos depict. 

Last month, the Otago Daily Times obtained a copy of a confidential “proposal of change” document distributed to Ōamaru Hospital staff, which included a proposed staffing restructure. The proposed restructure would impact seriously on NZNO members. All current nursing positions would be disestablished. Those currently employed to fill the 35.3 full-time equivalent nursing roles would be forced to reapply for a reduced number of jobs, adding up to just 20.5 FTE.

Reflecting on the theme of today’s convention, “Nurses A Voice to Lead – Health for All”, the proposal for change could also impact on access to healthcare for the rural population inthe Waitaki District.

“The document has caused a large amount of negative discussion around the community”, reported the ODT on 25 February, “particularly on social media platforms, which has caused public unease. As a result, the Waitaki District Council-controlled company that owns and operates the hospital will hold community meetings.”

The photo on the lower left of the slide above comes from an ODT story about one of these meetings, where strong views were expressed about the proposal to cut nursing jobs. The one on the upper right, courtesy of Oamaru Captured, shows a march to support jobs and services. So here we see how social media is influencing practice environments and job security for NZNO members. 

Then last Saturday, the ODT reported: “On Wednesday the Waitaki Community Hospital Action Group started an online petition on its Facebook page – Halt the Oamaru Hospital Proposal.”

That petition, fronted by former Ōamaru Nurse Manager Dr Janice Clayton, calls for a halt on the restructure because: 

“The Waitaki Community deserves the right to ensure ongoing service provision at the Hospital now and well into the future.

The current staff deserve the right to voice openly what matters most to them moving forward with a new Model of Care.

Our elderly and young families deserve to know exactly how community-based and home-based care structures will affect them.”

In its first week, the petition has been signed by over 400 people – or around one in 30 of Ōamaru’s resident population. 

So overall, I think the primary impact of social media on NZNO members and delegates in this instance has been to rapidly mobilise strong public support. It’s a good example of what’s known as “online-to-offline” activism, where the power of social media is harnessed to generate measurable effects in the community – in this case, to the benefit of NZNO members and delegates. 

But this is not the only prominent example from this region over the last year. Here are two photos taken in the Octagon, on International Nurses Day 2018. 

They depict one of 15 rallies held around New Zealand that day. 

As reported in the ODT these rallies, too, were organised through social media: “A social media site has transformed into a nationwide nurses movement which will stage rallies across New Zealand this weekend”, says this article, which also carries an interview with Dunedin Hospital delegate Anne Daniels (pictured, on the right).

The site in question was the the “New Zealand, please hear our voice” Facebook group, created by two anonymous nurses after the first DHB offer was rejected. Within a fortnight, it had grown to 37,000 members.

The effect of this large social media-led campaign is probably impossible to quantify, in what was a period of intense and multi-faceted activity by and for NZNO members. But two weeks after these rallies, the DHBs lifted their pay offer to members from 6% over three years to 9.3–15.9% over 26 months. I think it’s undeniable that the impact on NZNO members was significant and positive.

But to say that the impact of social media hasn’t been universally positive would be an understatement. 

I won’t dwell on this point, as I’m sure most of us who are on Facebook have plentiful first-hand experience of negative impacts, both on ourselves as members and on the reputation of our organisation. But I will refer to the end of year editorial in Kai Tiaki

Co-editor Teresa O’Connor looked back on 2018 and reflected that, “Social media, notably Facebook, was used to mobilise nurses and to provide a platform for their views on the progress and eventual outcome of the [DHB MECA] negotiations. The power and influence of social media took some by surprise, but what was more of a shock was the rancour of many who took to Facebook to air their views.”

In this, O’Connor was echoing the sentiments of an earlier editorial by acting Manager, Nursing and Professional Services Hilary Graham-Smith, who wrote: “Some members (and non-members) took to social media to rain down abuse on NZNO and on individual staff. For many of us in the profession, that behaviour was the wellspring of deep sadness. What has the profession come to, we asked ourselves and each other as, day after day, the insults, name-calling, ill-informed commentary and blatant lies spewed forth from various Facebook pages.”

The abuse that was rained down via social media fell, above all, upon NZNO representatives in the DHB MECA negotiating team and campaign leadership. And I want to acknowledge in particular the impact this had on your local delegate, Robyn Hewlett. 

In July last year, as the manifold impacts of the protracted bargaining started to mount, I called a special meeting of the Board to consider whether some organisational guidance from the governance leadership might be required. In the event, the meeting took place in August, just after the MECA offer was ratified. 

One of the issues we discussedwas the impact of social media on NZNO negotiators. Afterwards, a statement penned by Vice-President Rosemary Minto was published on the official NZNO Facebook page.

It said: “The Board would like to wholeheartedly thank the NZNO negotiating team and supporting NZNO staff for their work on the recent MECA negotiations… The Board acknowledge the part that social media played in the process, which at times directed negative and personal attacks towards NZNO members and staff… The Nursing Council of NZ Code of Conduct and the NZNO Constitution and guideline on social media and the nursing profession should be considered by all nurses including NZNO members, before and during their engagement and discourse on social media sites.”

It is hard to say why NZNO experienced such a negative impact, where other professional groups taking large scale industrial action over the last year, such as doctors and teachers, did not. 

One difference between NZNO and these other groups is that the others mounted high profile media campaigns, starting well before bargaining commenced, or set up their own officially moderated Facebook groups for union members to engage in online-to-offline activism. 

Here on the left we see the primary teachers union launching its campaign, and on the right the creation of the secondary teachers union Facebook group, in each case six or more months prior to the start of their negotiations. 

When NZNO did embark on our digital campaign on 26 March 2018, under the umbrella of #HealthNeedsNursing, it immediately generated strong positive effects for NZNO members and delegates, and for NZNO’s reputation. Although it did not utilise Facebook groups, #HealthNeedsNursing was a cross-platform, multi-media campaign, deploying text, images and video over Instagram, Facebook Pages, YouTube and Messenger. 

This two-page infographic shows just how great the impact of our social media was. I have hard copies of the “Campaign at a Glance” document here, for you to take away. 

Again showing the power of online-to-offline campaigning, note the three dozen rallies which were held around the country in April. Organised through Facebook Events as well as through workplaces, they involved thousands of NZNO members and supporters – even more than the numbers who took part in the #HearOurVoices marches. And of course there was integration with the historic DHB strike on 12 July. Overall, this social media activity certainly contributed to positive impacts on DHB members achievedthrough bargaining. 

So far, I have offered observations and examples where social media has impacted on NZNO members collectively. I will conclude by looking at individual impacts. 

Rosemary Minto’s statement abovementions the Nursing Council of NZ Code of Conduct

Historically, nurses have tended torun into trouble on social media through breaches of patient confidentiality. The 2016 Annual Report from the Nursing Council, for example, notes that, “With the millennial generation so digitally connected, there has been concern at their reduced awareness of issues related to privacy and the increasing number of disciplinary cases related to social media.” 

Patient confidentiality remains a primary focus of the new NZNO social media Guideline. But speaking with NZNO Professional Nurse Advisors in different parts of the country, new trends appear to be emerging. 

Anecdotally, referrals to Nursing Council for individuals are now less frequentfor breaches of patient confidentiality, and more frequentfor social media breaches of these two standards – “treat colleagues with respect” and “maintain high standards of behaviour in your relationship with your employer”. 

There is little in the way of hard data on this, as yet. The latest published Annual Report from the Nursing Council is now two years old. And I’m told that NZNO’s data collection systems, through the Member Support Centre, are not well set up to capture this emerging trend. Calls related to social media issues could be coded variously by MSC as an “Industrial – Disciplinary” matter, a “Professional –Media” issue, or something else. 

But there appears to be one such case, here in this post in the “hear our voice” group in January.

“I’ve just received a message from a member who’s been reported to Nursing Council… due to being overtly savage online regarding their employer”.

I hope these personal observations and examples of social media impacts have helped to stimulate your thinking. I will leave you with one piece of advice. To avoid the negative impacts of social media for yourself and NZNO, and maximise the positive impacts, the best thing you can do is refresh your knowledge of these two guidelines. 

Thank you.

* See also:
‘To post or not to post? Social media and nursing’

‘The role for migrant nurses in NZNO’ – Presentation to NZNO Migrant & Internationally Qualified Health Workers Conference

(Following some unscripted remarks on the events in Christchurch the previous day, these were the speaking notes for my presentation.)

Photo courtesy of Kai Tiaki Nursing New Zealand.

Āta mārie, tēnei te mihi ki a koutou. 

Good morning, greetings to you. 

Ko wai ahau? Ko Kapukataumahaka tōku maunga, ko Ōwheo tōku awa, ko Cornwall tōku waka. 

Ko te Tāngata Tiriti tōku iwi, ko Don rāua ko Helen ōku mātua. Ko Grant Brookes ahau. Nō reira, tēnā koutou katoa. 

Who am I? The place I come from looks up at a mountain called Kapukataumahaka, or Mount Cargill, and sits beside a river called Ōwheo, the Water of Leith. My ancestors arrived there, in Dunedin, aboard a waka, or ship called The Cornwall. I belong to the People of the Treaty, the people who reside here under the agreement first signed at Waitangi in 1840. My parents are Don and Helen, and I am Grant Brookes. 

The topic I have been given to speak about is, “Where to from here? Into the future, the path forward, what is the role for migrant nurses in NZNO?”. 

Let’s begin with definitions. What is this group, the migrant nurses in NZNO? Who are they? 

The answer may surprise you. We don’t entirely know. 

The NZNO membership database contains a field recording a member’s “country of first qualification”. In theory, therefore, the migrant nurses in NZNO should be clearly identifiable. They would be the members who ticked a box other than “New Zealand” in their membership application, in response to this question. 

However, in speaking with the NZNO Membership Department in preparation for this talk, I learnt that it’s not so simple. 

Firstly, this field was added to the database only around four years ago. For members who joined prior to that, there is no record of where they first qualified. And I was told that anecdotally, the data is not reliable, as many members who have joined since 2015 left this field blank on their membership form, or filled it out incorrectly. 

But when we speak of migrant nurses (and of internationally qualified health workers who may not be working as nurses, the other group covered by this conference), what we’re often thinking of are people who share particular cultural backgrounds – backgrounds other than New Zealand European or New Zealand Māori. Research suggests that the experiences of NZNO members in these minority groups (including experiences of racism) are similar, regardless of whether the person first qualified as a nurse in New Zealand or overseas.

In other words, what we’re talking about is ethnicity. And with your permission, I would like to focus on this concept, which thankfully is captured by NZNO in a time-series data set which is more robust. 

Do you like data? I do, as you may have guessed. So if you’re not a fan, please indulge me for a couple of minutes as I present some charts showing the changing ethnic makeup of our membership over the last ten years.

Just one final word about data quality – up until 2015, ethnicity categories in the NZNO membership database were less specific. So, for example, members belonging to one of the many Asian ethnic groups were described as either Chinese, Indian or “Other Asian”. The NZNO Board requested refinements to the reporting categories in 2016, to make the growing diversity of our membership more visible. You will see this in the later charts. Ethnicity data captured in the NZNO database is now aligned with the fields recorded by the Nursing Council, although it’s still not perfect and anecdotal reports suggest a member’s ethnicity sometimes defaults incorrectly to NZ European.

So based on what we have, this was the picture at 31 December 2008.

Our membership was largely made up of people identifying as New Zealand European, with a significant Māori group. There was also a visible group of “Other Europeans”, reflecting the traditional trickle of migrant nurses from places like the UK and Australia. 

Click to play the video below and watch how it changes, year by year. 

In 2010, the “Other Asian” group started to overtake “Other European”, as the primary source countries for IQNs started to change. The trend then accelerated. 

And this is where we are now. 

If current trends continue, New Zealand Europeans like me will be a minority of NZNO members by 2025. 

It is worth mentioning in passing that there hasn’t been any similar transformation of the NZNO staff. There are almost 130 people employed by NZNO, in a variety of roles. But aside from our Chief Executive, there are still no IQNs of non-European ethnicity among them. 

So that’s the picture from the last ten years. But if you go back further, the demographic transformation of the NZNO membership appears starker still. I became a member of NZNO in 2002. Back then, the organisation looked like this. 

As you can see, the NZNO which I joined was largely monocultural, at least as far as our membership base was concerned. 

You might also note that the opening up of this monoculturalism has come through the declining proportion of members identifying as New Zealand European. Māori membership has not declined. The proportion of members who are tāngata whenua, or people of the land, and the proportion who are tauiwi, or more recent arrivals residing here by virtue of Te Tiriti o Waitangi, is virtually unchanged through this period. 

The relationship between these two groups underpins the bicultural foundation of our organisation – in accordance with the bicultural foundation of our nursing profession, and indeed of our nation. Kerri Nuku will speak more about this next. 

If this is the story so far, what is the role for IQNs and migrant health workers in NZNO, into the future? 

Let me first flip that question. What is my role, as Co-chair of the NZNO Board, for IQNs and migrant health workers in NZNO? 

I know that as a New Zealand European, citizen and NZRN, I automatically benefit from a system of privilege, whether I like it or not. My role for IQNs and migrant health workers in NZNO is to use that privilege to make space at the top table for people without it, like you. 

Your role is quite simply to take your place in the leadership of NZNO – as increasing numbers of you are already doing. 

I would like to briefly showcase just a few of the leading roles being filled by migrant nurses today. Some of these people, you will probably recognise. 

Victoria Santos is an IQN from the Philippines. She also holds a senior leadership position in the governance of NZNO. Victoria sits on the Membership Committee, the national body which advises the NZNO Board of Directors on the views and needs of the diverse membership. The Membership Committee also helps to carry out delegated work such as drafting the constitutional changes which will this year see voting on NZNO policies and rules opened up to everyone, though an online “one member, one vote” system

Jed Montayre is also from the Philippines. Within NZNO, Jed is an elected member of the National Committees of Gerontology Section and also the Nursing Research Section. He has served on the abstracts committee which selected the papers for presentation at the NZNO Annual Conference. Here, he is pictured receiving the award as joint winner of the NZNO Young Nurse of the Year in 2016. 

One of the three abstracts chosen for last year’s NZNO Annual Conference was on “The Experience of Migrant Health Workers in New Zealand”. It was jointly presented by three Filipinos – Joey Domdom, Judith Salamat and Mayie Pagalilauan – in conjunction with Toga Katyamaenza, an IQN from Zimbabwe. Here they are pictured with IQN and former NZNO Board member Monina Hernandez, who will speak to us later this morning. 

Shamim Chagani is an IQN from Pakistan, and an elected member of the National Committee for NZNO Nurse Managers New Zealand. She is also the editor of the Nurse Managers’ newsletter, Te Wheke, a Māori title which means, “The Octopus”. 

But IQNs are not just demonstrating professional leadership within NZNO. 

This poster features Ebson Abraham, an IQN from India. The poster was produced by the NZNO Tai Tokerau Regional Council for International Nurses Day last year, to celebrate local NZNO leadership in Northland. The writing is probably too small for you to read, but it says Ebson was a workplace delegate at Cairnfield House Rest Home in Whangarei, where “he took responsibility for NZNO services, promoting the union movement from scratch and then constructed a movement that is measurable by the increase of NZNO membership density up to 80% that eventually built a strong force for change. This wave became a pillar… for NZNO bargaining in 2016/17 with an effective settlement of a collective agreement in 2017”. 

As an aside, there is a widespread assumption among New Zealanders that union membership and activism are somehow foreign to the cultural values in the primary source countries for IQNs today.

The diversity clearly displayed on marches and rallies by DHB nurses last year should help to dispel that stereotype. But so would greater knowledge of overseas nursing unions, which are growing under very difficult conditions and waging struggles on a scale and intensity which make our DHB strike look timid. 

A case in point is the United Nurses Association of India. It was formed in the southern state of Kerala in 2011, in response to the suicide of a nurse who had been bullied by her managers. It now numbers over half a million members. Months of protests and strikes in 2017 and 2018 won agreements on pay rises for around 80,000 nurses in private hospitals. At one hospital in Kerala, nurses remained on strike and picketed outside the facility daily, for over a year

The spectacular rise of the United Nurses Association is an amazing story. I hope to meet leaders of that union for the first time in July at the annual meeting of our international union federation, Global Nurses United. But it’s by no means an isolated case. Nurses in the Philippines have been organising for decades – again under very difficult conditions – through unions including the Alliance of Health Workers and more recently through Filipino Nurses United. Last year, Kerri Nuku and I attended 61st annual general meeting of the Fijian Nursing Association. FNA has been active as a Pacific nursing union since 1977, including campaigning for workers’ rights under military rule, and so on. 

Returning to the slides, the last two IQN leaders in NZNO I wish to showcase highlight the need to avoid assumptions when it comes to migrant nurses. 

Current Board member Eseta Finau occupies the highest leadership role in NZNO of any IQN. She will talk to us shortly about that role. Despite also being the most Tongan person I know, however, she actually qualified as a nurse in Australia. Gidday cobber! 

And then there are NZNO leaders who you might not pick as IQNs from their appearance.

Debbie O’Donoghue is a former NZNO Board member who now serves on the national committee of NZNO Nurse Managers New Zealand. She is also an IQN, from the UK. 

But leadership for IQNs within NZNO does not depend on holding a title, like these people. The NZNO Strategy for Nursing 2018-2023 recognises that, “Many nurses demonstrate excellent… leadership, though they may not recognise this, associating leadership only with formal roles.”

In many ways, leadership exercised by people without a formal title is the most important kind. As Bernie Sanders likes to say, “Real change does not happen from the top down. It happens from the bottom up.”

One of the ways that any member can influence NZNO’s direction from the bottom up is by responding to consultation requests. This is where staff from the NZNO policy and research team seek member input, in order to determine NZNO’s position on a wide range of issues. They do this by emailing all member groups, including Regional Councils, to ask for feedback. 

They also post the requests on the NZNO website, under the menu “Get Involved > Consultation”. If migrant nurses are not getting the consultation requests by email, from a member group, you can sign up on the website to be notified each time a new one comes out. 

Here is a recent request, asking for input to shape NZNO’s view about the changes to temporary work visas for migrants currently being proposed by the government. Unfortunately, the deadline has passed for people to respond to this request, although if anyone is interested in making an individual submission to the government, you can do it via the MBIE website until Monday, at the address on screen. 

So these are some of the ways that migrant nurses can take up your role as leaders of NZNO and use your power to make a difference.

But as the title of Monina Hernandez’s presentation on today’s programme reminds us, the role for migrant nurses in NZNO is not just about “making a difference”. It’s also about “being yourself”. I will end on this point. 

Coming up before morning tea is Abel Smith’s presentation, “An introduction to the Pacific Nursing Section”. The PNS is one of NZNO’s 20 colleges and sections. I am really looking forward to it because for me, this group epitomises what it means for ethnic minority members to be themselves while also making a difference. 

NZNO sections and colleges are groups of members with a focus on a specific field of nursing. The colleges are groups relating to a specific clinical specialty, while the sections are groups representing a role or membership classification, such as those sharing a specific culture or cultures. Formed in 2008, the Pacific Nursing Section was the last NZNO section to be established before a moratorium was placed on the formation of new sections in 2011. 

The NZNO Constitution was amended last year, through a remit submitted to the NZNO AGM by the Greater Auckland Regional Council, to lift the moratorium and allow the creation of new colleges and sections. 

The rationale provided in support of the remit noted that: “NZNO structures need to be flexible enough to respond to the changing reality”. And we’ve seen in the pie charts the changing reality of NZNO membership. The remit rationale added: “Various membership and role classification groups exist without a corresponding NZNO structure to date. Examples include… internationally qualified nurses”. 

I will now hand over to Kerri Nuku. Because we will be back as part of the discussion panel after lunch, and because I have used up all of my available time, I would ask that you save any questions until then. 

Thank you. 


• See also:
‘Too many immigrants’?

The President comments: ‘A new strategic direction for NZNO?’

Titiro ki muri kia whakatika ā mua. Look to the past to proceed with the future.

I CAME across this proverb last month at Te Matatini, the national kapa haka championships in Wellington. It summed up for me our task as we prepare to update and replace NZNO’s five-year strategic plan, which expires next year. The process approved by the board will involve input from external stakeholders, NZNO staff and members.

Looking back, and thinking about the future, gives us all a chance to re-focus on the big questions for NZNO. Who are we here for? What are we hoping to achieve? How will we get there? What’s going on in our environment – political, economic, social/cultural, technological, legal and environmental – that we will need to respond to?

Much has changed since delegates at the 2015 NZNO annual general meeting voted to approve the current strategic plan. Back then, as chief executive Memo Musa reminded us, union membership was declining. Law changes had made it harder for unions to operate, and union influence was dwindling. An NZNO strategy stressing nursing professionalism fitted with the times.

Fast forward to 2019 – anti-union laws have been reversed, and the trend of declining union membership has also turned around. Union engagement with employers and government is stronger. Health funding is no longer falling. There’s also much to learn from last year’s unprecedented DHB MECA campaign.

The board has also agreed in principle on a review of our operational structures, to make sure they’re suitable for implementing the new strategy. And while no decision has been made, we have discussed whether the NZNO constitution – which spells out who has the power to do what in NZNO, and members’ rights and responsibilities – might need to be reviewed, as well.

Who are we here for?

In my view, the answer to the first big question, “Who are we here for?”, is that NZNO is here, above all, for the members, and we must keep members at the centre of our planning. If we focus on supporting and empowering members, then our strategic goals and the ways to achieve them will become clear.

Members see the impacts of health and social policies, and belong to communities who experience impacts, too. Supporting members means our strategic goals should include political changes.

All of us are unionised workers and health professionals. Focusing on members solves the conundrum of whether to stress “industrial or professional” strategies. At all times, we are both.

And nurses and midwives are required to practise in a culturally safe manner, under the Treaty of Waitangi/Te Tiriti o Waitangi. Supporting members means strengthening biculturalism.

Such a member-centric strategic plan might suit an NZNO structure where more authority and resources are devolved to our volunteer member-leaders.

It could drive full implementation of NZNO’s organising model, an approach which empowers members in the workplace to act as a team in their own interest, rather than just looking to an NZNO staff member to “fix” things for them. •

First published in Kai Tiaki Nursing New Zealand, March 2019

The President comments: ‘Here Comes The Sun’

HERE COMES The Sun – the classic Beatles track off the 1969 Abbey Road album – was one of the first songs that our son, aged two and a half, learned to sing. Memories of walking to feed the ducks in the summer of 2007/8, accompanied by strains of, “Sun, sun, sun, here it comes!” still warm my heart.

This George Harrison composition could have been a glib, throwaway ditty. I think its longevity and power stem partly from its invocation of a “long, cold, lonely winter” which has lasted for what “feels like years”.

Shortly after its release at the end of the 1960s – that decade of struggle – brilliant cover versions appeared, by feminist civil-rights singer Nina Simone and rebel reggae artist Peter Tosh.

Ice is melting

They enriched the meaning of lines like, “I feel that ice is slowly melting”. Patterns of injustice long frozen were starting to shift.

And so, as summer 2018/19 arrives in Aotearoa, there are signs the long, cold winter – for nursing and for the people we care for – is also coming to an end. The ice has been cracked by passion, courage and the collective action of NZNO members.

Nine years of underfunding ended in May with this year’s Budget. It was our campaigning, together with others, which made health the number one issue for voters and a top priority for the incoming government.

Our escalating protests and strikes this year were unprecedented. Our demand to bring back the warmth into health has been game-changing.

We didn’t win everything we need to rebuild our health system, but I can see rays of sunlight. Over the last couple of months, I’ve helped assess and approve each DHB’s plans for their share of the 500 new nursing positions created by our campaign. And I’ve felt the warmth returning to our profession.

Meanwhile, the health minister will be looking at options for providing employment and training for all nursing and midwifery graduates – delivered under the new Safe Staffing Accord.

I see new buildings, new services, new initiatives for our peoples, and I have hope.

It will take more struggle to clear away all the dark clouds over our public health system – and the deeper chill still lying across the rest of the sector. But as our courage and passion spreads, so, too, do the cracks in the ice.

In November, the first-ever collective action by NZNO members at Ngāti Porou Hauora confronted historic injustices facing Māori and iwi health providers. Trying to survive on meagre government funding, these providers pay nurses around 25 per cent less than those working for DHBs; some are also having to cut services to survive. 

And December saw members at Family Planning vote to strike for the first time.

But before we take up the struggle again, it’s time to celebrate. Summer is here. Let’s make it a good one.

Whether you’re working through, or have leave approved, I hope you are all able to enjoy some time in the sun with your loved ones. I will be.

Our son is older now, and has a younger sister. From our whānau to yours, I wish you a happy festive season. •

(First published in the December/January issue of Kai Tiaki Nursing New Zealand. Reposted with permission).

The President comments: ‘NZNO’s bold new experiment in democracy’

NZNO HAS embarked on a bold new experiment in democracy. That, for me, was the big news to come out of our annual general meeting (AGM) and conference, held in Wellington last month.

The two-day event, which was preceded by colleges and sections day and the National Student Unit AGM, attracted around 230 members, staff and guests (see coverage, p11-19).

Around 230 people attended the NZNO AGM and conference last month

We celebrated the outstanding achievement and service of members at our NZNO awards dinner. And presentations by an amazing group of cross-sector leaders on the second day helped us all raise our sights and embrace the conference theme, Health is a human right – optimising nursing to make it happen.

But it was on day one that the major decisions were made. As I noted in my opening address, we had come together on Suffrage Day, and at the end of a turbulent year for our union and our profession.

Overshadowing all else in the last 12 months has been the bargaining in the district health board sector. The effects of nine years of underfunding, which we highlighted and campaigned against in 2017, finally compelled us to take unprecedented industrial action.

The MECA bargaining sparked a campaign of extraordinary drive and determination, on the part of NZNO members and staff alike. Together, we achieved momentous things.

But there were also problems. As we faced difficult decisions, differences emerged between members, and between members and their representatives. Some felt the voice of members was not being heard.

Unity out of division

These differences were seen again in the debates on the conference floor. But the democracy that the Suffragists fought for, back in 1893, has the power to forge unity out of division. A democratic vote can resolve many individual differences into one collective union decision.

So the decision by AGM delegates to deepen and strengthen democracy within NZNO could be the most important thing to happen to our organisation in a long time.

Up until now, voting on proposed changes to NZNO policies and our constitution has been done at the AGM. Only those who attended got to vote.

From next year, however, all members will be able to vote online on these matters, with the results announced at AGM. Agreement to move to the “one member, one vote” system means the voice of members will be heard more clearly.

Jennie Rae, a mental health nurse from Taranaki, introduces the proposal to move to the “one member, one vote” system.

For me, as your president, the 2018 AGM and conference marked the start of my second term in office. I pledged to delegates that over the next three years I will work for NZNO’s renewal, in partnership with the kaiwhakahaere and in conjunction with the board and chief executive.

In every organisation, there are always a few who want to keep things as they are. But I never underestimate our collective power as NZNO members to deliver renewal.

AGM delegates have placed their trust in their fellow members. Now the obligation is on us to live up to this trust, to participate wisely in the new democratic process to make sure NZNO is the open and responsive organisation we need. •

First published in the October 2018 issue of Kai Tiaki Nursing New Zealand. Reposted with permission.

’Your Place in the NZNO World’ – Speech to NZNO Colleges & Sections Day 2018

Grant - Colleges & Sections DayKia ora, koutou. Thank you for inviting Kaiwhakahaere Kerri Nuku and I to present at your Colleges and Sections Day. With only ten minutes allocated for both of us, please forgive me if I skip the introductions and get straight down to the topic at hand: “Colleges and Sections – Your Place in the NZNO World”. 

As I was preparing for this talk, I thought I’d better check what it says about the topic in your own documentation. In the Colleges and Sections Handbook, I found this statement: “Colleges and sections are part of NZNO: they do not have a separate legal status.”

So it seemed to me that the topic is essentially about the relationship of this part – your part – to NZNO as a whole. And much like the relationship of an organ to a biological system, we can describe the relationship of part to whole in terms of structure, or function. 

In other words, your place in the NZNO world can be described in terms of the “anatomy” of NZNO, or in terms of our “physiology”. 

In terms of physiology or function, the purpose of NZNO activity is to pursue the goals in our Strategic Plan 2015-20.

Draft NZNO Strategic Plan 2015-20 Part A for AGM

These are:

• Improved health outcomes – by promoting excellence in patient care 

• Skilled nurses – by contributing to, and advocating for the development of nursing education programmes and the ongoing professional development of members 

• Strong workforce – by strengthening nursing workforce planning, sustainability and leadership 

• Effective organisation – by ensuring NZNO is a healthy and sustainable organisation 

You will all be very familiar with the Strategic Plan above. This year, as Acting Manager of Nursing and Professional Services Hilary Graham-Smith has just mentioned, the Strategic Plan 2015-20 has been supplemented by the NZNO Strategy for Nursing 2018-2023, which you will discuss in more detail after lunch.

Your role in this functioning of NZNO is vital. The Colleges and Sections Handbook says, “Colleges/sections are integral in realising the goals of the NZNO Strategic Plan 2015-20 and its professional vision for nurses.”

You do this by performing functions such as: 

• Hosting educational conferences and publishing journals or newsletters. These contribute to the ongoing professional development of members and achievement of skilled nurses. 

• Making formal submissions or providing input into NZNO’s national submissions, sometimes through responding to NZNO Consultation Requests. These can promote the excellence in patient care needed to achieve improved health outcomes. 

• Representing NZNO on external committees or in the media (including specialty media such as Kai Tiaki, Nursing Review, NZ Doctor etc.). 

• Building strategic relationships, scanning the environment and communicating emerging strategic issues to NZNO leadership. This helps achieve NZNO’s goal of being an effective organisation. 

Your capacity to perform all these functions, as volunteers, has been the focus of the Board’s Volunteer Sustainability Project.

Switching now to the “anatomical” view, your place in the structure of NZNO is shown in the Structural Diagram: “Our Waka, Our Way”. 

I will race through this presentation, which was given at last year’s AGM and at this year’s Regional Conventions, highlighting just a few points. The full powerpoint will be on the Membership Committee page of the NZNO website. 

In the side view, the hull or riu of the waka is the membership. 


In the top view, the staff are seated towards the stern and the various membership groups sit towards the bow. Your place is marked number six. Those sitting nearest to you indicate your direct relationships: these are Te Rūnanga (number seven), Regional Councils (number eight), and the Membership Committee (at number nine). 


“The college and section link with the Board of Directors is through their representation on the membership committee”, says the Colleges and Sections Handbook. 

Your next speaker is Victoria Santos, the current Colleges and Sections rep on the Membership Committee. 

And then at the front of the waka are the National Hui and the AGM (at number 17), which takes place tomorrow. 

Because Colleges and Sections do not have a separate legal status, you must comply with NZNO rules and policies. These are set and amended through remits to the NZNO AGM. 

Colleges and Sections can have input into these rules and policies, and often do. A recent example is the 2017 remit from NZNO Nurse Managers New Zealand: “That the NZNO membership has the option to belong to up to three colleges or sections”, up from two. This remit was passed, and as at 31 March 2018 there were 109 members who had joined three Colleges or Sections. 

It followed an earlier attempt in 2016, by the Cancer Nurses College, to allow members to join as many colleges or sections as they needed, to allow them to be professionally supported in their chosen fields or interests. This earlier attempt was unsuccessful, as the voting system is not based on “one member, one vote”, and multiple College or Section memberships would increasingly distort representation at AGM. 

A number of other remits from Colleges and Sections have been unsuccessful in recent years, including another one from the Cancer Nurses College in 2016, that “Clinical Supervision be provided for nurses as per NZNO guidelines and that this should be included in the MECA”. DHB MECA negotiations are now complete, and an entitlement to clinical supervision has not been included. 

I understand that further discussion of these topics is planned today. As time is short, I won’t take questions now, but I will be available throughout the day to assist. 

Statement on my remuneration as NZNO President


Statement on my remuneration as NZNO President

In standing for election in 2015, as many NZNO members know, I pledged publicly that, “As your next President, I will accept only my current Staff Nurse pay rate”.

As I approach the end of my first three-year term in office, I make this brief statement on my remuneration to verify that the pledge has been fulfilled.

The mechanism for delivering on my campaign commitment was reported in the September 2015 issue of Kai Tiaki Nursing New Zealand:

“[Brookes] says he will be standing by his pledge to only accept a staff nurse pay rate by donating the difference back to NZNO. 

‘My preference, so I don’t give any suggestion the role is worth less than the previous president has received, would be to accept the full salary and donate back the difference between my current staff nurse pay rate and the presidential pay rate’.

And since 2015, with the support of my family who were directly affected, this is what I have done.

Keeping my take-home pay the same as it was before I became President, and adjusting it only in line with changes in the DHB MECA, meant that I started on a net (after tax) annual salary of $60,246.94. This went to $61,451.88 on 4 July 2016, when base rates in the MECA rose by two percent. There it remained, up until the ratification of the new MECA last month.

Over the course of the last three years, I have reported in regular letters to the NZNO Board of Directors, through its Governance Committee, on the amounts donated back to NZNO. I now publish these letters, in the interests of full transparency.

Although it wasn’t part of my pledge, I also wanted to save money on work-related expenses. This was achieved by doing things like staying with local NZNO members while away on work trips, rather than in hotels, and by choosing the cheapest fares.

For the two full financial years I’ve been in the role so far (1 April 2016 to 31 March 2018), spending on travel and accommodation averaged just 53% of the money budgeted per annum in the NZNO President cost centre.

For their part, the Board wanted to make it clear that they did not endorse my decision to accept only Staff Nurse pay and to donate the rest back to NZNO – a position they expressed, for example, at the Board meeting held on 18 October 2017 (see page 5 of the minutes, available at this link).

My last letter to the Board and Governance Committee, dated 10 September 2018, notes that when I stood for re-election this year, my candidate profile statement did not repeat the 2015 pledge to accept only the pay of a Staff Nurse. This decision was made after consultation with my family.

Therefore, while I will continue to decline the full salary during my second term as NZNO President starting on 19 September 2018, this statement constitutes my final public comment on my remuneration for the role.

Grant Brookes, NZNO President

If health is a winner on Budget Day, we’re all better off

Kerri & Grant TPPA

by NZNO President Grant Brookes and Kaiwhakahaere Kerri Nuku

It’s Budget week. All eyes are on Finance Minister Grant Robertson, and what the government’s first budget has shaped up like. Our eyes of course are primarily on what it means for health.

Kiwis see the need: A third of people think that health should be the top priority on Thursday, according to the last 1 News Colmar Brunton poll. The reasons aren’t hard to find. DHB deficits, crumbling hospital infrastructure and the mental health crisis and health workforce dissatisfaction have made the headlines for months.

A decade of 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 health system itself is now sick, and needs to be nursed back to health. This is the number one message to the Government from the New Zealand Nurses Organisation on Budget Day. It’s why we’re rallying around the country.

But “health needs nursing” in more ways than one. The nursing team is the largest workforce in health. We are the dedicated, skilled professionals who are with you from the moment you’re born until your last breath.

It is concerning however that this year the rhetoric has been about the “competing demands” on the government, and about expectations that are not likely to be met in a year of spending.

Prime Minister Jacinda Ardern has said: “It is as important for us to make sure we meet the competing needs that we have around strong services for health and education as it is to also make sure that we keep the books in good shape, that we are ready for any economic shocks”

While the threat of another earthquake or two is making the government cautious, is it really a case of balancing health against the economy?

World Health Organisation Director General Dr Tedros Adhanom stated recently that, “Governments see health as a cost to be contained…This is wrong. Health is an investment to be nurtured.”

In 2016, we took part in a meeting in Geneva to advise the United Nations High-Level Commission on Health, Employment and Economic Growth and here is an extract from its statement:

“The returns on investment in health are estimated to be 9 to 1. One extra year of life expectancy has been shown to raise GDP per capita by about 4 percent.

“Investments in the health system also have multiplier effects that enhance inclusive economic growth, including via the creation of decent jobs. Targeted investment in health systems, including in the health workforce, promotes economic growth.”

Evidently investing in health makes us all better off.

Rebuilding a quality public health system includes investment in the health workforce. To enhance the health and wellbeing of all peoples in Aotearoa/New Zealand and to lift our economy, adequate and safe staffing levels in our health services, healthy shift rostering, access to study leave for professional development and full employment of new graduate nurses are vital ingredients.

This will attract students to the profession and retain those already in it. It also leads to a happier, healthier workplace that will also relieve some of the bullying that can occur.

Fair pay, which appropriately recognises our skills and qualifications, naturally also attracts and retains nurses, midwives and healthcare assistants.

The health and wellbeing of New Zealanders also depends on other factors surrounding the healthcare system, like having liveable incomes, warm and affordable housing, equitable access to education, nutritious food, and a healthy environment. Therefore NZNO is also assessing Budget 2018 for policies in the social sector and environment that support health and wellbeing.

Tomorrow we will see whether the government has decided to make a sufficient investment in health. We hope for the sake of the health and wellbeing of the population and the nursing workforce especially that it does, if not in one go then we want to see a clear roadmap to recovery of the public health system and workforce itself. As shown in the placards at rallies around the country: The healthcare team needs to be well to keep others well.

Finance Minister Grant Robertson has hinted that come Thursday, “Health and Education will get long overdue boosts to their capital and operating funding to deal with cost pressures.”

For all our sakes, the boost must be big enough, and soon.

‘Walking together in solidarity & Pacific friendship’ – Speech to Fijian Nursing Association AGM

NZNO Kaiwhakahaere Kerri Nuku and I were honoured and deeply humbled to be the Chief Guests at the 61st AGM of the Fiji Nursing Association (FNA), held in Suva on 28 April 2018. It was the first time that elected NZNO leaders had been formally invited to Fiji. Our invitation reflected decades of work with the FNA by many people in our organisation. I spoke second, after the Kaiwhakahaere, and delivered this speech.

FNA speech

Ni sa bula vinaka, kia ora koutou, warm Pacific greetings to you all. 

It is customary in our country, when beginning a formal speech at a meeting, to start by acknowledging the Creator, and those who have gone before as well as those present. This custom has been adopted from the indigenous culture of Aotearoa New Zealand. Over the last two days I have been learning of the many similarities between this Māori culture and the cultures of Fiji. 

Nō reira, Ko te kupu tuatahi, ki to tātou kaihanga, nāna nei te kākano i ruia mai i Rangiātea. 

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

To translate: my first word was to the Creator, who sowed the seed from the realm of beginnings, and endings. I greet those who have passed on, and the living assembled here.

To introduce oneself, we speak of the place and the people we belong to. We refer to our connection to the natural and spiritual world of our birthplace, to a shared experience of migration and to a collective identity based on ancestry – as Kerri also did, a few moments ago. 

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. 

Who am I? 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 Te Tiriti o Waitangi, the 177-year old treaty 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 Tōpūtanga Tapuhi Kaitaiki ō Aotearoa. 

Our bicultural leadership model, reflecting Te Tiriti, consists of indigenous and non-indigenous Co-Presidents. Kerri, who has just spoken, is the other Co-President of NZNO. Her Māori title is Kaiwhakahaere. 

In a formal speech it is then customary to pay respects to the land on which we are meeting and to its traditional guardians. So, as a vulagi, I acknowledge the vanua, the people of the Burebasaga confederacy and the ancestor Ro Melasiga, or Ro Koratu. 

Vakaturaga i Kubuna, Burebasaga, Tovata. 

I acknowledge also ngā rau rangatira mā, the many great nursing leaders from Fiji and around the Pacific I see before me, and I thank Dr Adi Alisi Vudiniabola and the Fiji Nursing Association for the invitation to speak today. 

I am here with you at an historic time for nurses, midwives and health care assistants in Aotearoa New Zealand. 

Six days ago, on Monday, the 28,000 members of NZNO who work in the public health system, for our District Health Boards (DHBs), began voting to strike. 

It is just the fifth time in the 109-year history of our organisation that such a vote has been held. 

The last time that NZNO members in the public health system voted to strike was part of a famous episode in our history – an episode which also marked the beginning of stronger bonds between our organisation and yours. 

The year was 2004, and our claim was for a single, multi-employer collective agreement (MECA) to unite all of our members in the DHBs, for safe staffing levels, and for pay equity with teachers and police. This would mean pay increases of between 20 and 47 percent – the biggest ever seen in New Zealand’s public health system until that time. 

We called it our “Fair Pay campaign”, and it was successful. 

In February 2005, as our celebrations were about to get under way, we were privileged to receive a two-week long visit from Pacific nursing unionists, including Miriama Vakaloloma and your current Vice-President, Miliakere Nasorovakawalu. The story is told in the pages of our NZNO journal, Kai Tiaki Nursing New Zealand.

2018-04-28 Speech to FNA AGM – slides 

Afterwards, the leaders of our NZNO Fair Pay campaign, Laila Harré and Lyndy McIntyre, came to Fiji to meet with FNA members.

2018-04-28 Speech to FNA AGM – slides2 

When on International Women’s Day, 8 March 2005, the FNA launched your own Fair Pay campaign, it was a great honour for us. We were pleased to be able to share the fruits of our work, sending Fair Pay stickers and t-shirts, and to see how you were able to improve on our campaign tactics. To win support for your campaign, you produced postcards for people to send to the politicians – like ours, but with the addition of a prayer on the back.

2018-04-28 Speech to FNA AGM – slides4

Laila Harré also gave evidence at the arbitration hearing here in Fiji against performance pay for nurses. After your successful five-day strike in August, your general secretary Kuini Kutua and Nurse of the Year Mereani Yaranamua were guests of honour at our 2005 NZNO AGM and Conference. The inspiration they brought to New Zealand was immeasurable. 

2018-04-28 Speech to FNA AGM – slides5

Two years later, our NZNO chief executive Geoff Annals was able to reciprocate, attending your 2007 FNA AGM. 

Later in 2007, we watched avidly as nurses and midwives in Fiji again took industrial action – this time, for 17 days – to stop a five percent pay cut. The NZNO Board of Directors was able to return Kuini’s and Mereani’s gift and make a small contribution to support FNA members facing hardship. When you won, we also celebrated your victory for nurses and patients. 

In 2008 we were again here with you in Fiji, when the FNA hosted the 14th South Pacific Nurses Forum.

2018-04-28 Speech to FNA AGM – slides6 

Kuini and 30 FNA members came to Auckland for the next Forum in to 2010.

2018-04-28 Speech to FNA AGM – slides7 

More recently, NZNO members volunteered to join the New Zealand Medical Assistance Team which was deployed to Fiji in the aftermath of Cyclone Winston.

2018-04-28 Speech to FNA AGM – slides8 

My friend and colleague from Wellington Hospital, Emma Brooks (second from right in the photo), sent back amazing stories of extraordinary and outstanding service by Fijian nurses to their communities, some of which had been almost devastated by the cyclone. Seeing the humanitarian need, the NZNO Board had to respond with support for the FNA.  

And last year, we welcomed the chance to work with our sister union, the New South Wales Nurses and Midwives Association, on your FNA submission about the new pay structure for nurses and midwives. 

Our stories, as Fijian and New Zealand nurses and midwives, as Pacific trade unionists, are intertwined. Our bonds of friendship and solidarity are many and strong. 

And so it continues, as we now embark on fresh campaigns for health as a human right. 

“Nurses: a voice to lead – health is a human right” is the theme for this FNA Symposium and AGM. It is also the theme set by the International Council of Nurses for International Nurses’ Day (IND) this year. As Dr Adi Alisi has just mentioned, the idea of health as a human right is not a new one. It is an idea which guides our work as NZNO – including the ballot on strike action in the DHBs which started last Monday. 

In her introduction to the IND information kit, ICN President Annette Kennedy says individuals and communities all over the world are suffering from illness due to a lack of accessible and affordable health care. But nurses also need to remember that the right to health applies to us as well.

“We know that improved quality and safety for patients depends on positive working environments for staff”, she says. “That means the right to a safe working environment, adequate remuneration, and access to resources, and education. We must add to this the right to be heard and have a voice in decision-making and policy development implementation.”

The right to health is underpinned by national and international legal instruments and conventions, such as Section 38 of the Fiji Constitution or the third of the United Nations Sustainable Development Goals (SDGs). SDG3 sets the target of achieving Universal Health Coverage by the year 2030. 

And what is Universal Health Coverage? 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.”

At the pre-AGM Symposium held on Thursday and Friday, there was a focus on how far there is to go for Fiji to reach this goal. My country, on the other hand, is generally thought to have achieved this target long ago, as far back as the end of the 1930s. But is this really so? Do we have Universal Health Coverage in New Zealand today? 

Surprisingly perhaps, the New Zealand government does not collect and publish comprehensive data showing whether individuals and communities receive the full spectrum of health services they need without suffering financial hardship. Without this data, you might ask, how can we report on our achievement of Universal Health Coverage? How can we identify priority areas for attention? 

But a few measures of access and barriers to health services are contained in the New Zealand Health Survey, conducted annually by the Ministry of Health. The results for the 2016/17 year, published in December, include some disturbing findings, such as:

  • 28 percent of New Zealand adults reported trouble getting seen in primary care 
  • 1 in 7 adults (14 percent) reported not visiting a GP due to cost in the past year. 
  • Less than half of adults with natural teeth (47 percent) visited a dental health care worker in the past year
  • 268,000 adults (seven percent) reported not collecting a prescription due to cost in the past year.

The International Health Policy Survey, conducted by the US-based Commonwealth Fund, is another source containing some measures of access to health services for individuals and communities. 

In the latest survey, New Zealand ranks poorly against similar countries for access-related performance measures, in particular access to diagnostic tests, long waits for treatment after diagnosis, long waits to see a specialist and long waits for elective surgery. 

Of the New Zealand doctors surveyed, 59 percent reported difficulty in gaining access to diagnostic tests for their patients, and 34 percent said patients “often experience long waits to receive treatment after diagnosis”. Twenty-one percent of New Zealanders surveyed reported cost-related barriers to accessing health care. 

The lack of comprehensive New Zealand government data on unmet health need last year led a group of medical researchers to conduct a pilot study. Their research, published in the New Zealand Medical Journal, found at least 25 percent of adults were unable to get the primary health care they required while 9 percent of people had unmet secondary health care needs.

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

Bagshaw said the 9 percent 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, generally because they didn’t meet the criteria to go on the waiting list.

The major reason for this emerging picture that human rights to health and Universal Health Coverage are under serious threat in New Zealand is nine years of cumulative health underfunding. Government spending on health has failed to keep pace with population and cost increases each year since 2009/10. It has also fallen as a percentage of GDP. Each year, health spending has slipped further and further behind. In the current financial year, the shortfall compared to 2010 reached $1.4 billion. 

The impact is being felt not only by the individuals and communities who are unable to receive the full spectrum of health services they need without suffering financial hardship. It is also being felt by nurses, midwives and health care assistants working in the public health system. 

Over the last decade, the underfunding of our public health services has meant that NZNO members have reported ever-increasing workloads, increasing patient acuity (patients are sicker coming into hospital), stress, fatigue, and lack of job satisfaction. This is contributing to high staff turnover and to lower morale. Our members are also impacted by inadequate levels of staffing, unhealthy shift rostering, the undervaluation of nurses work and a lack of appropriate access to continuing professional development and study leave.

Which brings us back to my starting point. I am here with you at an historic time for nurses, midwives and health care assistants in Aotearoa New Zealand. For the first time since 2004, the 28,000 members of NZNO who work in the public health system, for our DHBs, are voting on strike action. 

The vote is the latest step in our new campaign. This one is called #HealthNeedsNursing. 

Health Needs Nursing has a dual message. On the one hand, it is an affirmation that the nursing team is the essential core of the health system. We are dedicated, caring and always there. 

Health Needs Nursing also says that the health system itself is sick. It too needs to be nursed back to health. 

The goal of our campaign is to rebuild our public health system back to good health. The immediate staffing crisis has to be addressed. Full employment of new graduate nurses and employment of additional nurses to achieve the right skill mix matched to the needs of patients is required for New Zealand to truly claim Universal Health Coverage. Our goal is to enable nurses to maintain a standard of care that equates to our professional standards – a standard patients deserve. 

Equally, our members salary structure does not adequately recognise experienced staff nor does it incentivise nurses to remain in the profession. Inadequate pay is contributing to a vicious cycle of high nursing staff turnover. Investment in fair pay for our DHB MECA nursing and midwifery teams is urgently required.

Over the last three weeks, thousands and thousands of NZNO members and supporters have taken action, from one end of the country to the other, in the big cities and in the small towns, too.

2018-04-28 Speech to FNA AGM – slides9 

There have been at least 34 rallies for good health held so far – the latest one at Burwood Hospital in Christchurch just yesterday.

2018-04-28 Speech to FNA AGM – slides10

You may recognise some of these faces. In the photo on the top right is Christchurch nurse Simione Tagicakibau, who presented at the FNA Symposium yesterday on Pacific health models in New Zealand. 

We’ve been front page news.

2018-04-28 Speech to FNA AGM – slides11 

We’ve been on TV, too. 

We are not just protesting, though. We are also engaging with members of the public at markets and public transport hubs, talking with them about the need to rebuild our health system. These photos were taken at Wellington Railway Station.

2018-04-28 Speech to FNA AGM – slides13 

We are sending thousands of electronic postcards to government ministers. We are collecting stories from our members to submit to an independent panel which is considering ideas for resolving the dispute. 

And we are winning. On Tuesday, Prime Minister Jacinda Ardern said that the government is factoring our claims into the way it is working up its Budget, due to be released on 17 May. 

We are hopeful that our goals can be achieved without resorting to industrial action. If strikes do go ahead, they are scheduled for early July.  

But to ensure health as a human right in Aotearoa New Zealand, it will take more than a win for our #healthneedsnursing campaign. 

Discussion at the FNA Symposium over the last two days has highlighted the lack of health equity between countries, such as Fiji on the one hand and Australia and New Zealand on the other. Achieving the UN Sustainable Development Goals means reducing this health inequity. NZNO is committed to multilateral cooperation in advancing global health equity and addressing global health crises and risks. 

At the same time, it is important to address health disparities within countries, including within New Zealand, which undermine any claims of Universal Health Coverage. 

Earlier this year, New Zealand reported on progress against another UN framework, the International Covenant on Economic, Social and Cultural Rights. The UN committee responsible for overseeing the convention looked at outcomes in a range of areas such as health, housing, education and employment. According to Janet Anderson-Bidois, chief legal adviser/tumuaki kaitohu ture at the New ZeaLand Human Rights Commission/Te Kahui Tika Tangata, the committee expressed surprise and concern about the information it received from the government, and in separate reports provided by the Human Rights Commission (HRC), NGOs and community groups.

“The reports revealed significant disparities in key health areas for groups such as Māori, Pacific people, disabled people and the LGBTI community”, said Janet Anderson-Bidois. “Māori and Pasifika are more likely to be affected by preventable conditions, and to die prematurely. They have a greater chance of experiencing mental illness, dying at work or committing suicide.”

In order to reduce these disparities and ensure health as a human right for all, it is necessary to strengthen culturally appropriate services and workforce. For this reason, alongside our #HealthNeedsNursing campaign in the DHBs, NZNO is also campaigning for equitable funding for Māori and Iwi (or tribal) health providers, for a pay parity for nurses working in these providers with their DHB colleagues and for a doubling of the proportion of Māori nurses, to match the population. This NZNO campaign is being led by Kerri Nuku and our Māori governance group, Te Poari o Te Rūnanga o Aotearoa NZNO. 

Following in the footsteps of Whina Cooper who we have just heard about, Kerri led a Hīkoi (or peaceful march) in 2016 from the Te Puea Memorial Marae in Auckland to the Indigenous Nurses Aotearoa Conference.

2018-04-28 Speech to FNA AGM – slides14

The hīkoi was a show of collectivism, solidarity, enabling members of Te Rūnanga to kōrero, to waiata, to celebrate and to advocate for pay parity for Māori and Iwi Provider nurses. 

In conclusion, I hope that these stories from NZNO stimulate your discussions today, and in times to come. I believe they show how FNA and NZNO have worked together over the years, in bonds of solidarity and Pacific friendship, and how we can continue to walk our paths together in future. 

Finally, to conclude a formal speech in the custom of the indigenous people of Aotearoa, we greet three times the people gathered at the meeting. 

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

Vinaka vakalevu