WHEN 28,000 nurses, midwives and health-care assistants voted last month to reject the second district health board (DHB) multi-employer collective agreement (MECA) offer – knowing a strike ballot would be the next step – the “no” was powerful enough to influence the course of history.
The vote was a message to stop devaluing nurses and stop failing the patients and communities who need our care. After a decade of worsening health underfunding, the vote said, “No more!”
Only once before – in 1989 – have New Zealand nurses taken nationwide industrial action. This mobilisation reshaped nursing and led to the birth of NZNO. The winds of change now blowing will also be felt beyond the DHBs.
But for every “no”, there is a “yes”. Through their vote, our DHB members were also affirming the need to restore our public health system, to recognise and fairly reward all members of the nursing team for their skilled work and to address the staffing crisis.
This “yes” belongs to everyone – people inside and outside NZNO, health-care workers and the communities we serve. All can come together to agree that health needs nursing.
Launched on March 26, #HealthNeedsNursing is the name of NZNO’s new DHB campaign. It’s an affirmation that the nursing team is the essential core of the health system. We are dedicated, caring and always there.
#HealthNeedsNursing also says that the health system itself is ailing. In a way, the rot in the walls at Middlemore Hospital is symbolic. Those in charge at Counties Manukau DHB have known for years the hospital is sick. But to remain within their undersized budget, as demanded by the previous government, they just patched holes in the walls and carried on, until the problem couldn’t be covered up any longer.
Health system sick
It’s like that for the whole DHB sector. There’s now no denying the health system is sick. It needs to be nursed back to health.
Already, our campaign is growing. Council of Trade Unions president Richard Wagstaff came to the launch, and pledged the support of the union movement.
Prime Minister Jacinda Ardern has also given a “yes”, of sorts. The morning after NZNO said “no”, she told the AM Show on TV3, “I value our health workforce. Do I want our nurses to be satisfied? Of course I do. Do the DHBs need more money? Yes.”
At the same time, though, she talked about barriers around “timing” and “budget allocations”. If our campaign can win strong public agreement that health needs nursing, then the pressure of public opinion can help overcome barriers for the Government.
At the same time, the campaign is also setting the pattern for a renewal of NZNO as an organisation which is open and responsive to members.
Members are making the big decisions through democratic votes. Campaign planning is taking place through cooperation between NZNO staff and member leaders, from local workplace delegates to the nationally elected board. Actions are designed to maximise member participation.
As the current surge draws more members into action, the transformation of NZNO is bound to continue apace.
By the time you read this, the next stage of the #HealthNeedsNursing campaign will be well under way. Rallies for good health at each DHB, from April 9-20, will also prepare us for whatever comes next.
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?
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.
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.
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.
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.
People gathered at Parliament in Wellington on Thursday, 8 March to protest the signing of the Comprehensive and Progressive Trans Pacific Partnership Agreement. I spoke on behalf of the New Zealand Nurses Organisation.
“E ngā iwi, e ngā mana, e ngā hau e wha, tēnā koutou.
Greetings to the people, the great ones and to those from from afar.
My name is Grant Brookes.
I am a Registered Nurse, and the president and co-leader of the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa.
And this? This is the first day of a future where trade agreements serve the needs of citizens and our natural environment. Despite the weather, it is wonderful to be here to share this day with you.
The New Zealand Nurses Organisation objects to the New Zealand government’s intention to sign the Comprehensive and Progressive Trans Pacific Partnership Agreement in Chile later today. We assert that although some improvements have been made, the CPTPP is not ready to be signed.
Trade Minister David Parker acknowledges that the deal is not perfect. He told Newshub last week that he gives it a score of “seven out of ten for New Zealand”.
Let’s just imagine, for a minute, that that score is accurate.
What does seven out of ten mean, when it comes to your health? What if you went to the Emergency Department with a serious cut, and you were told that you could have stitches to seven tenths of your wound? What if you were in severe pain, and you were given treatment that left you 30 percent sore?
Nurses work for the best possible health status for all peoples in Aotearoa New Zealand. We cannot support the CPTPP because despite improvements on the original TPPA, threats remain to population health and all that sustains it.
Intellectual property provisions which would delay access to affordable new medicines have been “suspended” for now, but they are still in the text and could be reactivated.
The same is true, despite side agreements, for the Investor State Dispute Settlement provisions which privilege multinational corporate interests above our sovereign and indigenous interests.
The Treaty of Waitangi exception in the agreement is not robust enough to ensure indigenous rights are protected and it’s not consistent with the recommendations of the Waitangi Tribunal. This means Māori-led efforts to address health disparities could be undermined.
The Labour Chapter will not protect the decent jobs, liveable incomes and fair treatment at work needed to sustain healthy communities. And the Environment Chapter does not even mention climate change, which the World Health Organisation calls “the greatest threat to global health in the 21st century”.
Defenders of the deal point elsewhere, to possible economic gains (though no-one today is claiming they’ll be huge).
But is that the right way to look at it? What are a few extra dollars really worth, if you don’t have your health? Around the world, the thinking on trade and investment agreements is shifting, away from a sole focus on narrowly-conceived economic gains.
The New Zealand Nurses Organisation has promoted this shift, from first hearing of the TPPA the better part of a decade ago, through the High Court challenge to the government’s secrecy which our other co-leader Kerri Nuku joined in 2015, to the massive protests in 2016, and up until today. We will continue to work for this healthy future.
In reality there’s no way of knowing how the CPTPP rates on a health scorecard – whether it’s seven out of ten, or one out of ten. This is because there has been no health impact assessment of the deal.
At last December’s biennial meeting of Global Nurses United, NZNO leaders were able to bring some unique perspectives and gain fresh insights.
By NZNO president Grant Brookes
Nursing union leaders from 18 countries, representing more than one million nurses and health-care workers, gathered in Québec, Canada, in December for the biennial meeting of the Global Nurses United (GNU) executive committee.
As a new GNU affiliate, NZNO was taking part for the first time, represented by kaiwhakahaere Kerri Nuku and myself. There we helped plan internationally-coordinated actions for 2018 and contributed a New Zealand perspective on global nursing and union debates.
We were also able to gain fresh insights into some of the issues facing NZNO, such as the need to grow advanced nursing practice in primary health and how to strengthen union democracy in an age of electronic voting (see articles, p29; listed below under “Related coverage“).
Collective bargaining discussed
The GNU meeting opened with a discussion on nurses’ rights to organise and bargain collectively. Although changes to the Employment Relations Act under our previous government have temporarily threatened multi-employer collective agreement (MECA) bargaining, some nursing unions in Asia, Africa and Latin America face bigger challenges.
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.
I explained to the 1000 convention delegates that all NZNO struggles are framed by bicultural relationships – highlighting struggles for the restoration of health funding, for safe staffing, new graduate employment, fair employment laws and for a health workforce that is culturally, ethnically and gender-representative, and that enacts Treaty of Waitangi articles.
On the TPP, Nuku said: “We will ensure no international agreements compromise New Zealand’s ability to control and lower the prices of pharmaceuticals and other medical supplies: to carry out public health programmes or maintain and expand the public funding and public provision of health on a non-commercial basis.”
Her description of NZNO’s 10-year battle for pay parity for nurses working in Māori and iwi health providers touched a nerve. Canada has embarked on its own truth and reconciliation process to address historic injustices suffered by indigenous people. After the panel discussion, nurses came up to Nuku to share stories about inequities experienced by indigenous health services on First Nations reserves.
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.” •
One of the FIQ Santé convention workshops Nuku and I attended was on a topical issue for NZNO members – Union democracy in the age of electronic voting.
NZNO has limited experience with online voting. It’s been used to elect board members since 2011. Turnout in these elections hasn’t topped 14 per cent. In 2012, 6.52 per cent of members voted in the online referendum on adopting the NZNO constitution.
A one-off, localised trial during multi-employer collective agreement bargaining in 2011 saw just 6.64 per cent of members at Capital & Coast DHB vote electronically to endorse the negotiating team and the claims – well below the national average.
Such limited experience meant the FIQ Santé workshop was valuable.
The facilitator defined union democracy as: “The opportunity for any member of a trade union to develop informed opinions on the objectives of their organisation and on the means to achieve them, on the one hand, and the opportunity to express these opinions in such a way that the union is governed by the majority of these opinions expressed, on the other hand.”
This requires a formal framework of power for the union’s administration, the ability for members to influence decisions, cohesion among members and transparency and responsiveness from administrators.
FIQ Santé research has found electronic voting can lift turnout in elections, as long as members know the candidates and the voting process.
In bargaining, meanwhile, the research found the participation rate was only slightly higher for the electronic vote.
Potential disadvantages with electronic voting were also identified – possible weakening of collectivity, confidentiality issues, increased cost and difficulties maintaining up-to-date email addresses.
The workshop concluded that while electronic voting can be considered a democratic tool, it does not replace the democratic process.
Opportunities will be sought to present the full findings to NZNO staff, to help inform future planning. •