VIDEO: Globalisation – Its Impact on Nurses and our Associations. Panel debate at the 2017 Congress of the International Council of Nurses, Barcelona

Yesterday I represented NZNO​ at the ICN Congress​ in Barcelona, in a panel debate on “Globalisation: Its Impact on Nurses and our Associations”. I spoke alongside nurses from Malawi, Denmark, Rwanda and Canada.

Dealing with the impact of globalisation requires international coordination, as it’s too big for any one country to tackle on its own. Opening remarks by Howard Catton, Director of Nursing & Health Policy at ICN​, take up the first seven minutes and are also well worth a watch.

Unfortunately, the video did not capture the Canadian speaker, or the wide-ranging questions and discussion from the conference floor. My speech notes are posted below.

Globalisation: Its Impact on Nurses and our Associations

ICN Congress Panel Debate,  29 May 2017

2017-05-16 ICN Panel on Globalisation-GB changes.pptx copyKia ora, greetings. I am Grant Brookes, Co-president of the New Zealand Nurses Organisation.

I would like to thank Howard Catton and ICN for inviting to participate in this panel discussion on Globalisation. I would also like to greet my fellow panelists: Dorothy, Vibeke, Barbara and Andre.

Our organisation is a professional association and union which represents 48,000 nurses, midwives, students, kaimahi hauora and health workers on professional and employment related matters. NZNO is affiliated to ICN, the South Pacific Nurses Forum, Global Nurses United and the New Zealand Council of Trade Unions. NZNO embraces biculturalism, the partnership between the indigenous Māori peoples and the more recent settlers of European and other ancestries who have arriv2017-05-16 ICN Panel on Globalisation-GB changes2.pptx copyed in the last two centuries.
In the words of the whakataukī, or ancient Māori proverb, we all in the canoe together.

 

 

Our association believes that globalisation will be felt by nurses and NNAs in seven main areas.

  1. 2017-05-16 ICN Panel on Globalisation-GB changes3.pptx copyWorkforce mobility
  2. Immigration/migration/ recruitment practices
  3. Technology/telehealth
  4. Population displacement and climate change
  5. Workforce development and regulation
  6. Trade and investment agreements such as the Trans-Pacific Partnership Agreement
  7. Influence of ICN and member NNAs

 

2017-05-16 ICN Panel on Globalisation-GB changes4.pptx copyRegarding workforce mobility:

  • Health workforce shortages globally are predicted to continue
  • Workforce mobility is set to continue
  • Reliance in some countries on internationally qualified nurses (or IQNs) is likely to continue

 

If allowed to persist, health workforce shortages will increase inequities in access to healthcare, causing preventable illness, disability and death, and threatening public health, economic growth and development. These key points were highlighted by the High-Level Commission on Health Employment and Economic Growth in 2016.

For our association, our publication on Internationally Qualified Nurses and Immigration released this year notes that: “New Zealand has the highest dependence on migrant health professionals of any OECD country (Zurn & Dumont, 2008), and… very low retention of health professionals (Hawthorne, 2012; Ministry of Health, 2016a). [There is a] high percentage of churn among IQNs, both leaving the country and leaving the sector they were recruited for (Walker & Clendon, 2015).”

The next slide illustrates our association’s response.
2017-05-16 ICN Panel on Globalisation-GB changes5.pptx copyLong-term planning for a sustainable nursing workforce should include a commitment to employment of new nurse graduates. In 2016, only 57 per cent of new graduates from New Zealand education institutes found work through the Advanced Choice of Employment scheme, according to the Ministry of Health.

Meaningful IQN retention strategies could include:

  • Accessible and affordable competence assessment programmes
  • Security of working visas (for example, freedom from revolving renewals)
  • Supportive work environments (including safe clinical environments, equitable remuneration and freedom from xenophobia and racism)

2017-05-16 ICN Panel on Globalisation-GB changes6.pptx copyTechnology is the fastest growing enabler of health care delivery. Technology transcends borders and thus its impact on nurses, on nursing practice, and on associations is inevitable.

Technology allows for remote care (telehealth) and interdisciplinary clinical support, as well as knowledge transfer. It has been shown to enhance people’s access to health services.

The way in which consumers/patients use technology as an enabler for their own self care will also impact on nursing and influence future models of care.

Technology and telehealth will change the notion of place and presence. Consequently, nursing care may not be provided in the traditional way (face-to-face). It may be provided across national boundaries, which raises regulatory concerns.

To influence direction in New Zealand we have developed a Position statement: Nursing, Technology and Telehealth, published in 2016.

2017-05-16 ICN Panel on Globalisation-GB changes7.pptx copyAccording to the High Level Commission on Health Employment and Economic Growth, the number of political conflicts globally has doubled over the last decade. The number of people displaced due to conflict has increased from 37 million to 60 million, mainly in middle income countries. Between 2008 and 2014, natural disasters displaced 184 million people.

Within conflict zones, healthcare workers and nurses might become deliberate targets.

Nurses and our associations will need to be more prepared, educated and trained to work with displaced populations and refugees, including providing nursing care in conflicts.

2017-05-16 ICN Panel on Globalisation-GB changes8.pptx copyRegarding climate change, our association published a position statement in 2016. We have since divested our funds from fossil fuel companies. The communiqué of the 2016 South Pacific Nurses Forum, which we attended, identified population displacement as a result of climate change – along with migration, education and regulation – as key areas for attention. Our members frequently respond to disasters in the Pacific caused by extreme weather events.

The health crises caused by SARs, Ebola virus, MERS, Zika virus and yellow fever demonstrate the interconnectedness of global health and the inescapable impact on nurses and our associations.

2017-05-16 ICN Panel on Globalisation-GB changes9.pptx copyTo succeed in implementing the agenda for sustainable development through SDGs in poverty reduction, quality education, decent work inclusive economic growth and gender equality, we potentially will see a shift in workforce development away from narrow specialisation to broader and lifelong building of competencies.

Nursing workforce development, education and training will likely have a strong emphasis on early intervention, community based care, primary care, population health, public health promotion. This will be complemented by improvements in advanced nursing practice to improve access to health services.

Likewise, our associations are likely to change their focus to support a broader approach to workforce development but will continue to ensure that this results in decent jobs, working conditions and pay for health workers.

2017-05-16 ICN Panel on Globalisation-GB changes10.pptx copyGlobalisation requires NNAs to engage more in political commentary.

Some governments respond to globalisation by entering into trade and investment agreements like the Trans-Pacific Partnership Agreement (TPPA). These have a potential negative impact on economic inequality and other determinants of health and illness, on health policy, health funding and access to medicines. Nurses and our NNAs will need to promote inter-sectoral collaboration at local, regional, national, and international levels.

We have an election in New Zealand this year. Our political commentary will be based on our Election year manifesto (2017), which identifies 7 priorities for nursing and public health:

  • Sustainable nursing workforce used to its full extent
  • Investment in public health
  • Primary care approach to improving population health
  • Best start for children
  • Safe clinical environments
  • Fair employment
  • Social & health equity in Aotearoa/NZ, Asia-Pacific region & globally

2017-05-16 ICN Panel on Globalisation-GB changes11.pptx copyI will conclude by saying globalisation will require multi-level engagement to address the seven areas highlighted in this talk:

  1. Workforce mobility
  2. Immigration/migration/ recruitment practices
  3. Technology/telehealth
  4. Population displacement and climate changes
  5. Workforce development and regulation
  6. Trade and investment agreements such as the Trans-Pacific Partnership Agreement

Nurses and our associations will need to be adept at managing the impact of globalisation.

As the High-Level Commission on Health Employment and Economic Growth stated: “No single agency and no single sector can implement the changes required to achieve a fit for purpose health workforce in the context of persistently high unemployment and underemployment in many countries, and amid the major demographic, technological and socioeconomic changes occurring across all countries. Political will, leadership, inter-sectoral action and international partnerships will be critical to success”

Thank you

2017-05-16 ICN Panel on Globalisation-GB changes12.pptx copy

International Nurses Day 2017 – Launch of ‘Listening with my heart: Poems by Aotearoa New Zealand nurses’

NZNO celebrated International Nurses Day in Wellington today with the launch of Listening with my heart: Poems by Aotearoa New Zealand nurses. Edited by Professional Nurse Advisor Lorraine Ritchie, this fabulous new book features the work of 35 nurses, three of whom – Clare Mills, Gayle King-Tamehana and Ali Morris – read their poems aloud to us. Reverend Don Rangi blessed the books, which were then snapped up by the invited guests. Production of this poetry book is part of NZNO’s Visibility of Nursing Project. It can be ordered online here. Some photos of the launch, and my few words of welcome, are below.

collage-2017-05-12-2
The cover of ‘Listening with my heart: Poems of Aotearoa New Zealand nurses’ features panels from the Nurses Chapel at Wellington Hospital. It was my privilege to welcome guests the launch.
collage-2017-05-12-4
Lorraine Ritchie received flowers to express NZNO’s gratitude for her work in editing the book. Oncology nurse Clare Mills read us her poem, ‘Calibration’.
collage-2017-05-12-3
Gayle King-Tamehana, a nurse from the Waikato, read her poem ‘Internal assonance’. Stroke Rehab Nurse Ali Morris, from Christchurch, read ‘Nurse’.
collage-2017-05-12
Reverend Don Rangi blessed the books, which were then snapped up by the invited guests, who included (l-r) Andrea McCance (DONM, Capital & Coast DHB), Pam Doole (Manager, Strategic Policy, Nursing Council of NZ) and Kathy Holloway (Director, Graduate School of Nursing, Midwifery & Health, Victoria University).

My welcome:

“E ngā reo, e ngā mana, e ngā karangarangataha maha, tēnā koutou katoa.

To the voices, the authorities – too numerous to mention – and the many affiliations, greetings to you all. A special welcome to those who have travelled from afar, and the nurse poets who will read to us shortly.

We are gathered today to celebrate nursing, past and present. International Nurses Day is marked every year on May the 12th, the birthday of our great foremother, Florence Nightingale.

I have been re-reading the poems of William Wordsworth, which I enjoyed so much when I was younger, and recently came across his description of “the best portion of a good man’s life: the little, nameless, unremembered acts of kindness and love”.

So I think that today is about not only the nursing greats, who are rightly celebrated and who give their names to our scholarships, our buildings, and our ceremonial events. It’s also about the unremembered and unsung nurses – the Mary Seacoles as well as the Florence Nightingales; Heni Whangapirita, the second Māori Trained Nurse, as well as Grace Neill; the famed Hester MacLean of the Army Nursing Service, but also Miss Ethel Jennings of Wellington, one of the nurses who joined Ettie Rout’s Volunteer Sisterhood during World War One.

We are gathered not only to celebrate nursing, however, but literature. And it occurs to me that so many of the great literary works I’ve had the privilege of discovering over the years have been by, or about nurses. Vera Brittain’s Testament of Youth, is familiar to many, I’m sure. The main character in Nor The Years Condemn, by my favourite New Zealand author Robin Hyde, is the beautifully drawn Nurse Bede Collins. Last year, I was introduced to another nurse author at the Hui-a-Tau of Te Rūnanga o Aotearoa – Helen Waaka, who read from her short story collection, Waitapu.

And soon, we will launch another fabulous literary work by nurses, edited by Lorraine Ritchie, Listening with my heart: Poems of Aotearoa New Zealand nurses.

Without further ado, then, thank you for coming and welcome, welcome, welcome to you all.”

Step it up, #ShoutOutForHealth – Speech to NZNO Greater Wellington Regional Convention

IMG_1271

Ko Ranginui kei runga, ko Papatūānuku kei raro, ko ngā tāngata kei waenganui – tīhei mauri ora!

Kei te tū ahau ki te tautoko i ngā mihi ki te Kaihanga. Kei te mihi anō ki ngā maunga, ngā awa me ngā wāhi tapu o tēnei rohe.

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

E te tiamana, ko Jane, me ngā mangai-ā-rohe o Te Rūnanga o Aotearoa NZNO, ko Lizzy, tēnā kōrua. Ngā whakawhetai ki a kōrua mō tā kōrua pōwhiri.

E ngā rangatira – Memo, Titihui – tēnā kōrua. E ngā kaimahi, me ngā kaiārahi nēhi e huihui nei, tēnā koutou.

Ko wai ahau?

Ko Kapukataumahaka te maunga, ko Ōwheo te awa, ko Cornwall te waka

Nō Ōtepoti ahau, engari kei te noho ināianei ki Pōneke

Ko Don rāua ko Helen ōku mātua, ko Tangata Tiriti tōku iwi. Ko Grant Brookes tōku ingoa.

Ka maumahara ahau ki tēnei whakatauāki: “Ko te toki tē tangatanga i te rā”. Nā konei, tēnei te kaupapa o te rā nei: ka huihui tātou kia whakapakaritia ake te mahi tahi. Ka kōkiri ngā nēhi, ka whitiwhitia te tautiaki.

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

It’s Ranginui above, Papatūānuku below, and the people in between.

I stand to support the greetings to the Creator. I also acknowledge the mountains, rivers and sacred areas of this district.

I greet those who have passed on, and the living gathered here.

To the Chair for today, Jane, and the Rūnanga rep, Lizzy, thank you for your invitation.

To the chiefs – Memo and Titihuia – greetings. To the staff and all the nursing leaders gathered here (which is all of you), greetings.

Who am I?

Although I now live in Wellington, I hail originally from Dunedin. I grew up at the foot of Mt Cargill and by the Water of Leith.

My ancestors arrived in Dunedin on board the ship Cornwall in 1849, although I now live in Wellington. The son of Don and Helen, my name is Grant Brookes.

I recall this proverb: “We are the adze whose bindings cannot be loosened by the sun” – we will work as one, in unity. In sharing it, I acknowledge the mana whenua of Taranaki Whānui ki Te Ūpoko o Te Ika, to whom this whakatauki belongs. It also gives rise to the purpose of today: we are all gathered for the building of productive workplaces. When nurses are at the forefront, care is transformed.

So greetings, greetings, greetings to you all.

It’s good to be back in front of a home crowd. So many familiar faces.

This is the fifth Regional Convention for me in the last month. They have all shared the theme: “Nurses at the forefront, transforming care – Building Productive Workplaces”.

At the Southern Regional Convention and Canterbury/West Coast Regional Convention, I also shared a whakataukī of Kai Tahu, the iwi with mana whenua in those areas.

“He mahi kai takata, he mahi kai hōaka”. “It is work that devours people, as greenstone wears down sandstone”.

Is this true? I think many here would acknowledge that it has some validity.

The latest issue of Kai Tiaki contains the testimonies of many nurses, midwives and other healthworkers on this subject. It makes for sobering reading.

I’d like to share one, from Duty Nurse Manager Kathy Knowles. Kathy is also the National Delegates Committee rep for Cap Coast. She says:

“The constant pressure of striving to care for patients in an underfunded environment results in nurse disillusionment, fatigue and low morale. In my duty nurse manager practice, I hear these stories every day. 

“Very rarely can duty managers fill the staffing requests from our pool of bureau nurses. It’s not uncommon for some areas to request multiple nurses on a daily basis, to fill both sickness and existing roster gaps. 

“Recently, I received 13 staffing requests but only three nurses were available. How can we divide these nurses up? We are very rarely able to staff the hospital to the satisfaction of nurses or the organisation.

“Continual restructuring, too few beds, and multiple demands on nurses exacerbate the problem and can lead to nurses feeling overwhelmed. 

“Nurses have told me that sometimes patients are not showered for days because of staffing pressures. When there are so many demands on nurses, showering goes to the bottom of the priority list. Nurses go home very dissatisfied after days of constantly chasing their tails.

“Nurses shouldn’t be afraid to speak up and to campaign for ourselves and our patients. Nurses who are politically aware and who speak out tend to be heard. One ward where nurses worked together to challenge constant understaffing had their needs prioritised. 

“A simple ‘thank you’ to staff at the end of a frantic shift, while a small gesture, can have a big impact.

“We need to grow our nurse leaders and nurse managers through ongoing postgraduate education. On the whole, most managers listen but we have to learn to speak up and with more confidence.”

The testimonies in Kai Tiaki are in line with research findings contained in the NZNO Employment Survey 2017, published in February.

It was NZNO’s fifth biennial employment survey of our nurse membership, and it revealed a steady decline of overall morale with specific concern about safe staffing levels, workload and pay. In addition there is an increasing loss of confidence in health sector leadership.

The survey revealed that nurses are showing resilience and commitment to their profession in the face of continuing restructuring and resource constraints.

But workload, increasing patient acuity, stress and lack of job satisfaction are contributing to staff turnover and to lower morale. Over a third surveyed experienced significant restructuring in the past two years. Some restructures were leading to loss of clinical nursing leadership in the health workforce.

A perception of poor pay relative to other professions such as for teachers and the police, is a growing source of dissatisfaction for many.

Evidently the Care Capacity and Demand Management programme is not gaining the traction, or resulting actions, it should have in DHBs and this means safe staffing improvements and progress is stalling.

All these issues are a symptom of an underfunded health system that is under pressure.

While in Dunedin and Christchurch for their Regional Conventions, I visited our members in Dunedin Hospital, Hillmorton, Princess Margaret Hospital and Burwood Hospital. There, I heard them express these concerns in person.

“He mahi kai takata, he mahi kai hōaka”. “It is work that devours people, as greenstone wears down sandstone”.

And yet our vision for nursing is something different. We aspire, as NZNO together, to be “Freed to care, proud to nurse” – in productive workplaces.

How do we get there, from here?

Building productive workplaces requires a multi-faceted approach. This is reflected in today’s programme.

Shortly we will hear about the importance of a positive workplace culture from NZNO Professional Nurse Advisors Suzanne Rolls and Anne Brinkman.

I think that many of us will want to know more about “Dealing with bullying and harassment in the workplace”, the focus for NZNO Educator Angelique Walker.

And we will learn from each other, as NZNO members together, when Lead Organiser Lyn Olsthoorn and local delegates present on “How we are transforming the workplace”.

I will use the short time left to me now to highlight one more facet of the multi-faceted approach that’s needed.

Lifting productivity requires investment. This truth has been repeated for decades by politicians, business leaders and by unions.

And yet, it has not been heeded, at least in our workplaces. Annual increases in government health funding have failed to keep up with population growth and other cost pressures. Council of Trade Unions economist Bill Rosenberg has calculated that the cumulative shortfall means that health is now underfunded by $1.85 billion, compared with 2009 funding levels.

Kaiwhakahaere Kerri Nuku, Chief Executive Memo Musa and I meet twice a year with the Minister of Health. We have presented him with evidence of the need for greater investment. On its own, this has not been enough.

Recognition of the impact of underinvestment on workplace productivity – on our own stress and burnout, and on the people we care for – led the Board of Directors to decide last year that health funding would be a major campaign focus for NZNO in 2016/17.

Just over a month ago, the YesWeCare roadshow arrived in the capital. YesWeCare is a coalition of health unions and consumer groups.

Outside of the Wellington and Hutt Hospitals, the team assembled 200 life-sized cut-outs, representing the missing health workers who are needed to ensure safe staffing, safe care, 24 hours a day, 7 days a week.

Some of you were there. Erin Kennedy, the legendary lead delegate from Cap Coast who is unfortunately unable to be here today, spoke to the Dom Post about why she was supporting the action. NZNO supports YesWeCare because it’s in tune with our own campaign for a fully-funded health system, Shout Out For Health.

In the build-up to DHB MECA bargaining and the general election in September, we are taking our Shout Out message to all decision-makers and all political parties.

Last month, the two main opposition parties announced “Budget Responsibility Rules” which would tightly restrict government spending in any future Labour/Green government. These rules are not good enough. We support CTU president Richard Wagstaff’s call for “higher levels of government activity and investment than these rules permit.”

“There is”, said Richard, “an urgent need”.

At the same time, we’re calling on the current government to restore the $1.85 billion missing from health in this month’s Budget.

Last week Finance Minister Steven Joyce made a significant pre-Budget announcement. He signalled an $11 billion increase in government spending over the next four years, including some increased investment in health. This came after years of government Ministers insisting that health spending was adequate. Why the sudden change of heart?

We should take some credit for bumping health up the government’s priority list, through our collective action as unionists, in partnership with health consumers and the wider community.

I know that many of us today can feel powerless to effect real change. But remember what Prime Minister Bill English told Newshub, when he was asked what he thought about the YesWeCare campaign. He said, “Discussions are under way right now about the next Budget. So yeah, we do pay attention to the views of people on the front line because they’re a pretty good measure of what’s happening.” We have already made a difference.

So we know what works. Now we need to step it up.

Last month, Kerri Nuku and I launched the latest phase in the Shout Out For Health campaign – an open letter to New Zealand voters. It asks everyone to make health funding their first priority this election. The letter is in your registration pack, and online at NZNO Blog.

The main goal between now and the election is to get as many signatories to the open letter as possible, both online and on hard copy. Signed letters are now starting to arrive in Wellington from all over the country. They are being gathered up for use in a pre-election event. We will hear more about the letter this afternoon.

NZNO staff and member leaders are also starting to distribute Shout Out For Health leaflets and bumper stickers. Wrist bracelets are coming soon. We ask you to use these resources to start conversations in your community about health funding being an election issue. Primary Health Sector members in particular are being asked to investigate hosting community meetings on health funding through the next few months, as the DHB members start to be involved in their own MECA negotiations and campaigns.

Have conversations about enrolling to vote and taking positive action for health funding – spreading the word through stalls, meetings, leafleting, writing letters to the editor and meeting MPs from all parties. We will have a great opportunity this afternoon, to address MPs from Labour, the Green Party, the Māori Party and NZ First.

Members wanting to take action can ask their local staff and member leaders for support.

Shout Out for Health is about empowering you, the NZNO members, to carry out your own campaign ideas.

But something else I have heard clearly while meeting with members at work over the last month is that nurses are tired. It’s hard to find the energy to participate in campaigning activities.

So Kerri and I are leading another piece of work, along with the Board, to improve volunteer sustainability, member engagement and leadership development within NZNO. To begin with, we have decided to reinstate the training day for new chairs and treasurers of Regional Councils, Colleges and Sections.

In April and May, a small number of focus groups are being held, to find out from members what else would enable you to get more involved in NZNO’s many and diverse areas of activity. Once the results are analysed, then resourcing will be allocated in the NZNO budget, to support our volunteers. Next steps will be discussed at a meeting for all chairs at the NZNO AGM in September.

Sustainability and leadership development may also extend to greater support for Board members. At present only two of NZNO’s Board members – the President and Kaiwhakahaere – receive remuneration from NZNO. AGM this year will be asked whether the other Board members should also be remunerated. So that’s something to think about between now and then, and something to talk about with your AGM delegates, in the Regional Councils, Colleges and Sections, Student Unit and Te Rūnanga.

Together – NZNO board, members and staff – we can achieve our vision. The challenge is large. But with nurses at the forefront, we will transform care.

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

Making it happen: Investment in health for productive workplaces – Speech to NZNO Midlands/Bay of Plenty/Tairāwhiti Regional Convention

IMG_1236*

Ko Ranginui kei runga, ko Papatūānuku kei raro, ko ngā tāngata kei waenganui – tīhei mauri ora!

Ko te kupu tuatahi ka tuku ki te Kaihanga. Koia rā te timatanga me te whakamutunga o ngā mea katoa.

Kei te mihi anō ki ngā maunga, ngā awa me ngā wāhi tapu o tēnei rohe.

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

E ngā tiamana, Marianne kōrua ko Nicki, me ngā mangai-ā-rohe o Te Rūnanga o Aotearoa NZNO, ko Hinemotu kōrua ko Anamaria, tēnā koutou. Ngā whakawhetai ki a koutou mō tā koutou pōwhiri.

E ngā mēma o te poari – Tituhuia, Cheryl – tēnā kōrua āku hoa. E ngā kaimahi, me ngā kaiārahi nēhi e huihui nei, tēnā koutou.

Ko wai ahau?

Ko Kapukataumahaka te maunga

Ko Ōwheo te awa

Ko Cornwall te waka

Ko Don rāua ko Helen ōku mātua

Ko Tangata Tiriti tōku iwi

Ko Grant Brookes tōku ingoa.

Ka maumahara ahau ki tēnei whakatauāki o Te Puea Herangi: “Mehemea ka moemoeā ahau, ko au anake. Mehemea ka moemoeā e tātou, ka taea e tātou”. Nā konei, tēnei te kaupapa o te rā nei: ka huihui tātou kia whakapakaritia ake te mahi tahi. Ka kōkiri ngā nēhi, ka whitiwhitia te tautiaki.

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

There is Ranginui above, Papatūānuku below, and the people in between – behold!

My first word, I sent to the Creator, the beginning and end of all things. I also acknowledge the mountains, rivers and sacred areas of this district.

I greet those who have passed on, and the living gathered here.

To the Regional Council Chairs, Marianne and Nicki, and the Rūnanga reps, Hinemotu and Anamaria, thank you for your invitation.

To my fellow board members – Titihuia and Cheryl – greetings, friends. To the staff and all the nursing leaders gathered here (which is all of you), greetings.

Who am I?

I hail from Dunedin. I grew up at the foot of Mt Cargill and by the Water of Leith.

My ancestors arrived in Dunedin on board the ship Cornwall in 1849. The son of Don and Helen, my name is Grant Brookes.

I recall this saying of Te Puea Herangi: “If I am to dream, I dream alone. If we all dream together, then we will achieve”. In sharing this whakatauāki, I acknowledge the mana of the Kingitanga. It also gives rise to the purpose of today: we are all gathered for the building of productive workplaces. When nurses are at the forefront, care is transformed.

So greetings, greetings, greetings to you all.

It’s good to be here in Kirikiroa/Hamilton. This is the fourth Regional Convention for me so far this month. In the preceding conventions, I have addressed the theme of the day. If you’ll allow, I will depart from my advertised topic in today’s programme and talk about this again: “Nurses at the forefront, transforming care – Building Productive Workplaces”.

At the Southern Regional Convention and Canterbury/West Coast Regional Convention, I also shared a whakataukī of Kai Tahu, the iwi with mana whenua in those areas.

“He mahi kai takata, he mahi kai hōaka”. “It is work that devours people, as greenstone wears down sandstone”.

Is this true? I think many here would acknowledge that it has some validity.

This month’s issue of Kai Tiaki contains the testimonies of many nurses, midwives and other healthworkers on this subject. It makes for sobering reading.

I’d like to share one, from Waikato DHB mental health nurse Gina Soanes. Gina is also the Chair of the NZNO Mental Health Nurses Section. She says:

“Nurses are still trying to do the best they can for their clients, but in a climate where resources are becoming increasingly stretched, this is difficult. 

“Clients are being admitted to hospital and discharged back into the community in greater numbers these days. The challenge is finding the right people in the community to provide the support they need. Many community-based services, eg counselling services, are being cut. This creates a chain reaction to other services like mental health. 

“The ongoing push of using unregulated staff in the community, particularly by non-government organisations, is putting even greater pressure on DHB nurses. We are responsible for supervising these unregulated staff. It’s another stress we have to cope with. 

“Older, experienced staff are not applying to work in the community in the way they once did. And for nurses at the coalface, being able to develop their leadership roles is becoming harder.”

The testimonies in Kai Tiaki are in line with research findings contained in the NZNO Employment Survey 2017, published in February.

It was NZNO’s fifth biennial employment survey of our nurse membership, and it revealed a steady decline of overall morale with specific concern about safe staffing levels, workload and pay. In addition there is an increasing loss of confidence in health sector leadership.

While the survey reveals that nurses show resilience and commitment to their profession in the face of continuing restructuring and resource constraints, there is a tipping point where nurses will just walk away from the profession.

Workload, increasing patient acuity, stress and lack of job satisfaction are contributing to staff turnover and to lower morale. Over a third surveyed experienced significant restructuring in the past two years. Some restructures were leading to loss of clinical nursing leadership in the health workforce.

A perception of poor pay relative to other professions such as for teachers and the police, is a growing source of dissatisfaction for many.

All these issues are a symptom of an underfunded health system that is under pressure.

While in Dunedin and Christchurch for those Regional Conventions, I visited our members in Dunedin Hospital, Hillmorton, Princess Margaret Hospital and Burwood Hospital. There, I heard them express these concerns in person.

“He mahi kai takata, he mahi kai hōaka”. “It is work that devours people, as greenstone wears down sandstone”.

And yet our vision for nursing is something different. We aspire, as NZNO together, to be “Freed to care, proud to nurse” – in productive workplaces.

How do we get there, from here?

Building productive workplaces requires a multi-faceted approach. This is reflected in today’s programme.

At the start of the day you were given a cultural perspective on workplace transformation, from Te Rūnanga.

You have heard also about the skills and knowledge needed in a productive workplace, from Sonya Saunders, Associate Director, Student Success, at Waikato University. Organisational Development Specialist Dr Maureen Marra explained the importance of workplace relationships in times of stress and pressure.

We will learn more about navigating workplace relationships shortly, from NZNO Professional Nurse Advisor Annette Bradley-Ingle. I think that many of us will want to know more about “Dealing with bullying and harassment in the workplace”, the focus when NZNO Educator Bethea Weir and organiser Paul Mathews join her at the front. And finally we will learn from each other, in the closing presentation on “How we are transforming the workplace”.

I will use the short time left to me now to highlight one more facet of the multi-faceted approach that’s needed.

Lifting productivity requires investment. This truth has been repeated for decades by politicians, business leaders and by unions.

And yet, it has not been heeded, at least in our workplaces. Annual increases in government health funding have failed to keep up with population growth and other cost pressures. Council of Trade Unions economist Bill Rosenberg has calculated that the cumulative shortfall means that health is now underfunded by $1.85 billion, compared with 2009 funding levels.

NZNO Kaiwhakahaere Kerri Nuku, Chief Executive Memo Musa and I meet twice a year with the Minister of Health. We have presented him with evidence of the need for greater investment. On its own, this has not been enough.

Recognition of the impact of underinvestment on workplace productivity – on our own stress and burnout, and on the people we care for – led the Board of Directors to decide last year that health funding would be a major campaign focus for NZNO in 2016/17.

On 23 March, the YesWeCare roadshow arrived in Hamilton, after visiting Gisborne and Wairoa, Whakatāne and Taupō, Rotorua, Tauranga and Thames. YesWeCare is a coalition of health unions and consumer groups.

Outside Waikato Hospital, the team assembled 200 life-sized cut-outs, representing the missing health workers who are needed to ensure safe staffing, safe care, 24 hours a day, 7 days a week. Some of you were there. A senior nurse, named only as Jan, spoke to the Waikato Times about why she was supporting the action. NZNO supports YesWeCare because it’s in tune with our own campaign for a fully-funded health system, Shout Out For Health.

In the build-up to DHB MECA bargaining and the general election in September, we are taking our Shout Out message to all decision-makers and all political parties.

Last month, the two main opposition parties announced “Budget Responsibility Rules” which would tightly restrict government spending in any future Labour/Green government. These rules are not good enough. We support CTU president Richard Wagstaff’s call for “higher levels of government activity and investment than these rules permit.”

“There is”, said Richard, “an urgent need”.

At the same time, we’re calling on the current government to restore the $1.85 billion missing from health in next month’s Budget.

But before then, Finance Minister Steven Joyce is expected to make a significant pre-Budget announcement. Later today, he is likely to signal increases in government spending, including some increased investment in health. (edit: Steven Joyce’s subsequent announcement here: ‘Government to allocate $11b in new capital‘)

It is natural for politicians to take credit for popular announcements. But as we listen to Minister Joyce talking about increased investment in health, we need to remember that we helped to make this happen too, through our own collective action as unionists, in partnership with health consumers and the wider community.

I know that many of us today can feel powerless to effect real change. But we need to remember what Prime Minister Bill English told Newshub, when he was asked what he thought about the YesWeCare campaign. He said, “Discussions are under way right now about the next Budget. So yeah, we do pay attention to the views of people on the front line because they’re a pretty good measure of what’s happening.” We have already made a difference.

So we know what works. Now we need to step it up.

Earlier this month, Kerri Nuku and I launched the latest phase in the Shout Out For Health campaign – an open letter to New Zealand voters. It asks everyone to make health funding their first priority this election. The letter is in your registration pack, and online at NZNO Blog.

The main goal between now and the election is to get as many signatories to the open letter as possible, both online and on hard copy. Signed letters are now starting to arrive in Wellington from all over the country. They are being gathered up for use in a pre-election event. We will hear more about the letter this afternoon.

NZNO staff and member leaders are also starting to distribute Shout Out For Health leaflets and bumper stickers. Wrist bracelets are coming soon. We ask you to use these resources to start conversations in your community about health funding being an election issue. Primary Health Sector members in particular are being asked to investigate hosting community meetings on health funding through the next few months, as the DHB members start to be involved in their own MECA negotiations and campaigns.

Have conversations about enrolling to vote and taking positive action for health funding – spreading the word through stalls, meetings, leafleting, writing letters to the editor and meeting MPs from all parties – including a group of MPs who we’re meeting at this venue, once the formal part of the Convention is over.

Members wanting to take action can ask their local staff and member leaders for support.

Shout Out for Health is about empowering you, the NZNO members, to carry out your own campaign ideas.

But something else I have heard clearly while meeting with members at work this month is that nurses are tired. It’s hard to find the energy to participate in campaigning activities.

So Kerri and I are leading another piece of work, along with the Board, to improve volunteer sustainability, member engagement and leadership development within NZNO. To begin with, we have decided to reinstate the training day for new chairs and treasurers of Regional Councils, Colleges and Sections.

This month and next, a small number of focus groups will be held, to find out from members what else would enable you to get more involved in NZNO’s many and diverse areas of activity. Some of you took part in a focus group over lunch. Once the results are analysed, then resourcing will be allocated in the NZNO budget, to support our volunteers. Next steps will be discussed at a meeting for all chairs at the NZNO AGM in September.

Sustainability and leadership development may also extend to greater support for Board members. At present only two of NZNO’s Board members – the President and Kaiwhakahaere – receive remuneration from NZNO. AGM this year will be asked whether the other Board members should also be remunerated. So that’s something to think about between now and then, and something to talk about with your AGM delegates, in the Regional Councils, Colleges and Sections, Student Unit and Te Rūnanga.

Together – NZNO board, members and staff – we can achieve our vision. The challenge is large. But with nurses at the forefront, we will transform care.

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

#YesWeCare, so we Shout Out For Health

When NZNO’s board of directors agreed to make health funding a major campaign focus in the 2016/17 year, I had visions of members taking all sorts of individual and collective action.

I never imagined us assembling 200 life-size cut-outs of health workers, made of white plastic.

Yes We Care nzno-group-shot (1 of 1)
In tbe rain, outside Wellington Hospital, from left: NZNO organiser Georgia Choveaux, delegates Kieran Monaghan, Richard McCormick, Erin Kennedy, Annie McCabe, Ann Simmons and Jane Shaw and president Grant Brookes. 

One rainy day last month, however, that’s exactly what we did, when the YesWeCare roadshow rolled into Wellington. NZNO supports YesWeCare because it’s in tune with our own member-led campaign for a fully-funded health system, Shout Out For Health.

Both campaigns start with the same idea. Politicians and union leaders have been saying health is underfunded by $1.8 billion this year, relative to 2009 funding levels.

But it’s human stories about what underfunding means for an individual staff member or patient that motivate action.

By the time the YesWeCare roadshow got underway, almost 6000 people had responded to their survey. Half were NZNO members. Many shared heart-breaking stories from the front line.

I still do shifts on the ward. But working full time at NZNO, I didn’t feel I had enough recent experience of the health system to complete the survey. So I’d like to share a personal story now about what health underfunding means to me.

I believe that the health needs of the peoples of Aotearoa/New Zealand are the basis for nursing and a core reason for our campaigns.

But what has touched me personally over the last two years has been the thousands of NZNO members I’ve met and talked with. I’ve heard your stories.

I know that many of you don’t go home on time. Sometimes you’re there for hours after the end of your shift or working day, still writing your notes. If you’re lucky, you won’t have problems getting paid for it. I know that nagging feeling when you go home, that you’ve let someone down again – a workmate or a patient or resident – because you didn’t have enough time.

There’s no cover when you’re sick, so either you go in, or your colleagues carry the extra load. When someone resigns, it takes a long time before they’re replaced – if at all. Amidst all the pressure, you witness (or suffer) someone taking it out on more junior colleagues.

I know medications aren’t always given when they should be, and personal cares get skipped. You spend ages looking for equipment, or trying to make old equipment work.

In the community, you’re picking up work that should have been done before discharge. In mental health, some days you’re just waiting for violence to happen to self or others.

The frustration and the hurt are sometimes unbearable. And what makes it worse, you can see how the system could work better, with just a little extra funding.

Sometimes NZNO members write to me, asking what they should do. Most of the time, after I’ve clicked reply, I feel I haven’t done enough to help. As the president of NZNO, there ought to be something more I can do. This is what underfunding means to me.

Those of us with more ability to make a difference do have more responsibility to act. But the problem is too big for any one person to solve. So I am motivated by your stories to join and support collective action, and to help lead NZNO, as a whole, to do the same.

In the lead-up to DHB MECA bargaining and the general election, we’re taking our messages to all decision-makers and political parties.

Labour and the Greens have announced “Budget responsibility rules”, for tightly restricting government spending. These aren’t good enough. We support CTU president Richard Wagstaff’s call for “higher levels of government activity and investment than these rules permit. There is an urgent need”.

At the same time, we want the current government to restore the missing $1.8 billion in next month’s Budget.

Our campaign is having an impact. Prime minister Bill English has responded to YesWeCare, saying: “Discussions are under way right now about the next Budget. So yeah, we do pay attention to the views of people on the front line because they’re a pretty good measure of what’s happening”

And we’ve only just begun.

(An abridged version of this blog was published in the April 2017 issue of Kai Tiaki Nursing New Zealand)

‘An urgent need: Investing in productive workplaces’ – Speech to NZNO Canterbury/West Coast Regional Convention

Ka tangi te tītī, Ka tangi te kākā, Ka tangi hoki au – Tīhei mauri ora!

Kei te tū ahau ki te tautoko i ngā mihi ki te Kaihanga.

Kei te mihi anō ki ngā maunga, ngā awa me ngā wāhi tapu o tēnei rohe.

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

E te tiamana, ko Cheryl, me te mangai-ā-rohe o Te Rūnanga o Aotearoa NZNO, ko Ruth, tēnā kōrua. Ngā whakawhetai ki a kōrua mō tā kōrua pōwhiri.

E te rangatira, Kerri, e ngā kaimahi, me ngā kaiārahi nēhi e huihui nei, tēnā koutou.

Ko wai ahau?

Ko Kapukataumahaka te maunga

Ko Ōwheo te awa

Ko Cornwall te waka

Ko Don rāua ko Helen ōku mātua

Ko Tangata Tiriti tōku iwi

Ko Grant Brookes tōku ingoa.

Ka maumahara ahau ki tēnei whakataukī o Kai Tahu: “He mahi kai takata, he mahi kai hōaka”. Nā konei, tēnei te kaupapa o te rā nei: ka huihui tātou kia whakapakaritia ake te mahi tahi. Ka kōkiri ngā nēhi, ka whitiwhitia te tautiaki.

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

As the muttonbird calls, as the kaka calls, so will I speak.

I have just explained that I stand to support the acknowledgements to the Creator. I also acknowledge the mountains, rivers and sacred areas of this district.

I acknowledge those who have passed on since we last gathered together. At this time I remember Sharon Williams, former Chair of the Canterbury Regional Council. I worked alongside Sharon on the Board of Directors in 2012-13. Only later did I learn of her long service to health – as a volunteer, hospital aide, Enrolled Nurse and Registered Nurse. Sharon was a great believer in fairness at work for all. She became an NZNO delegate at Burwood Hospital in 2001 and that same year, took on the role of worksite convenor, continuing in this role for the next six years. I also want to acknowledge Daryl Godsiff, who passed away shortly after. Daryl received the Service to NZNO Award in 2002. He is remembered as an Enrolled Nurse, a delegate and a leader at Burwood Hospital.

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

To the Regional Council Chair, Cheryl, and the Rūnanga rep, Ruth, thank you for your invitation.

To the chief, Kerri, to the staff and all the nursing leaders gathered here (which is all of you), greetings.

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, in 1849. The son of Don and Helen, my name is Grant Brookes.

I recall this saying of Kai Tahu: “It is work that devours people, as greenstone wears down sandstone”. In sharing this whakataukī, I acknowledge the mana whenua of the local iwi. It also gives rise to the purpose of today: we are all gathered for the building of productive workplaces. When nurses are at the forefront, care is transformed.

So greetings, greetings, greetings to you all.

It’s always good to be back on the Mainland, in Te Waipounamu. I called this city home for a time, when I moved north from Dunedin and took my first job after leaving school. The city is so changed now. The loss of old familiarity and solid grounding must be a stressor for those born and raised here, to be overcome by strength of community and shared experience.

“It is work that devours people, as greenstone wears down sandstone”. True?

I think many here would acknowledge it. I spent yesterday afternoon with some of you, talking with members of the nursing and midwifery team around the city. I spoke with nurses at all levels, from new grads on the floor to senior managers.

IMG_5387

Canterbury DHB is a large organisation. I was only able to glimpse a small snapshot yesterday, at Hillmorton, Princess Margaret and Burwood Hospitals, and to speak with some West Coast DHB delegates last night.

I heard some staff say, “we’re okay”. But they would add, “we’re not as badly off as some other wards”. They saw themselves as an exception to the rule.

More common were comments like these:

  • “We’re getting an extra 200 admissions per month, across mental health, compared to pre-earthquake levels”
  • “We’re five nurses short on this ward and four nurses short on that ward.”
  • “The problem is just short staffing. It’s global, all over the hospital.”
  • “We’re recruiting all the time. We just can’t find enough staff. The problem is that our supply of UK nurses has dried up.”
  • “Our nurses are doing a great job, but they’re tired.”
  • “The managers are stuck in the middle. They’ve got all these demands coming down from government, and staff who can’t meet the demands.”
  • “Nurses are working a lot of extra hours to cover the gaps in the roster. We’re all tired.”
  • “People don’t like ‘getting sold’ to other wards. Sometimes they’ll say, ‘I went last time, it’s someone else’s turn’. We’re a tight team, but it’s making people snap at each other.” (I heard this word, “sold”, in a few wards here. In other DHBs, they talk instead about “being redeployed” when acuity is higher elsewhere).

Other comments I encountered:

  • “I’m acting up today, because our Charge Nurse rang in sick. I’m also covering for our social worker and for our cultural support worker, who also rang in sick, and I’ve got a full patient load.”
  • “We’re finding that our new graduates are not staying on after their first year. Some are heading off to Australia.”
  • “We’re losing resources all the time. Today we lost our van. If our patients can’t go on outings, it affects their mood and their rehabilitation.”
  • “I think it’s a 50-50 chance that we’ll lose another senior nurse position in the next 12 months.”
  • “We’re losing four medical beds, and half of our consulting rooms”.
  • “When they closed the beds they said they’d create a new service to provide care in the community. That was three years ago. The new service still hasn’t been established. What’s happened to the people we moved out? They’ve just become invisible.”

These comments are very similar to the things I heard at Southern DHB last week. Some are almost word for word.

They’re also in line with research findings for DHBs nationwide contained in the NZNO Employment Survey 2017, published last month. That research shows some similarities in Aged Care, Private Hospitals and Primary Health Care workplaces, and some differences.

And yet our vision for nursing is something different. We aspire, as NZNO together, to be “Freed to care, proud to nurse” – in productive workplaces.

How do we get there, from here?

Building productive workplaces requires a multi-faceted approach.

So far today, we’ve heard about the importance of workplace relationships and positive workplace culture from NZNO Professional Nurse Advisor Julia Anderson. Lisa Hurrell of Rolleston Medical Centre has encouraged us to step up to the challenge. And NZNO organiser Christin Watson – with the assistance of my former colleagues in NZNO’s DHB Sector leadership, Trisha Leith and Karen Marshall – have engaged us in dealing with bullying and harassment in the workplace.

After lunch, we’ll learn more about “The skills and knowledge needed in a productive workplace” from Tina Murphy of Greymouth ED and from Dr Paul Watson of Health Workforce New Zealand.

And we will learn from each other, as NZNO members together, in the presentation on “How we are transforming the workplace”.

I will use the short time left to me now to highlight one more facet of the multi-faceted approach.

Lifting productivity requires investment. This truth has been repeated for decades by politicians, business leaders and by the Council of Trade Unions.

And yet, it has not been heeded, at least in our workplaces. Annual increases in government health funding have failed to keep up with population growth and other cost pressures. Using Treasury figures, CTU economist Bill Rosenberg has calculated that the cumulative shortfall means that health is now underfunded by $1.85 billion, compared with 2009 funding levels.

Kerri, Memo Musa and I meet twice a year with the Minister of Health. We have presented him with evidence of the need for greater investment. On its own, this has not been enough.

Recognition of the impact of underinvestment on workplace productivity – on our own stress and burnout, and on the people we care for – led the Board of Directors to decide last year that health funding would be a major campaign focus for NZNO in 2016/17.

Two weeks ago, the YesWeCare roadshow arrived in Christchurch, assembling life-size cut-outs at Princess Margaret Hospital, representing the missing health workers who are needed to ensure safe staffing, safe care, 24 hours a day, 7 days a week. YesWeCare is a coalition of health unions and consumer groups. Its next local event will be a public meeting on May 9 in the Transitional Cathedral. NZNO supports YesWeCare because it’s in tune with our own campaign for a fully-funded health system, Shout Out For Health.

In the build-up to DHB MECA bargaining and the general election in September, we are taking our Shout Out message to all decision-makers and all political parties.

Last month, the two main opposition parties announced “Budget Responsibility Rules” which would tightly restrict government spending in any future Labour/Green government. These rules are not good enough. We support CTU president Richard Wagstaff’s call for “higher levels of government activity and investment than these rules permit.”

“There is”, said Richard, “an urgent need”.

At the same time, we’re calling on the current government to restore the $1.85 billion missing from health in next month’s Budget.

Our campaign is already having an impact. In a Newshub story about YesWeCare on 3 March, prime minister Bill English was asked what he thought of the campaign. He said, “Discussions are under way right now about the next Budget. So yeah, we do pay attention to the views of people on the front line because they’re a pretty good measure of what’s happening.”

So we know what works. Now we need to step it up.

Last week, Kerri and I launched the latest phase in this campaign – an open letter to New Zealand voters. It asks everyone to make health funding their first priority this election. The letter is in your registration pack. We will hear more about it this afternoon.

Shout Out for Health is different to other NZNO campaigns. It aims to empower you, the NZNO members, to carry out your own campaign ideas, with support. But something else I heard clearly at CDHB yesterday is that nurses are tired. It’s hard for them to find the energy to participate in campaigning activities.

So Kerri and I are leading another piece of work, along with the Board, to improve volunteer sustainability, member engagement and leadership development within NZNO. To begin with, we have decided to reinstate the training day for new chairs and treasurers of Regional Councils, Colleges and Sections.

This month and next, a small number of focus groups will be held, to find out from members what else would enable you to get more involved in NZNO’s many and diverse areas of activity. Then resourcing will be allocated in the NZNO budget, to support our volunteers. Next steps will be discussed at a meeting for all chairs at the NZNO AGM in September.

Sustainability and leadership development may also extend to greater support for Board members. And let me announce our new Board members, elected last Friday, for those who have not heard. Maria Anderson is a Charge Nurse at Auckland City Hospital, and Monina Gesmundo is a lecturer at Massey University. They join current Board members – Cheryl Hanham, your Regional Council Chair, Cheryl Hammond from Whakatāne Hospital, Rosemary Minto, Nurse Practitioner from Tauranga, Jacob Panikkmannil from Starship Theatres, Tumu Whakarae Titihuia Pakeho, Pacific Nurses Section Chair Eseta Finau, Kerri and I.

Together – NZNO board, members and staff – we can achieve our vision. The challenge is large. But with nurses at the forefront, we will transform care.

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

‘Freed to care & proud to nurse, in productive workplaces’ – Speech to NZNO Southern Regional Convention

Ka tangi te tītī, ka tangi te kākā, ka tangi hoki au – Tīhei mauri ora!

Kei te tū ahau ki te tautoko i ngā mihi ki te Kaihanga. Kei te mihi anō ki ngā maunga, ngā awa me ngā wāhi tapu o tēnei rohe.

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

E te tiamana, ko Barbara, me te mangai-ā-rohe o Te Rūnanga o Aotearoa NZNO, ko Lara, tēnā kōrua. Ngā whakawhetai ki a kōrua mō tā kōrua pōwhiri.

E ngā rangatira, Kerri, Memo, e ngā kaimahi, me ngā kaiārahi nēhi e huihui nei, tēnā koutou.

Ko wai ahau?

Ko Kapukataumahaka te maunga

Ko Ōwheo te awa

Ko Cornwall te waka

Ko Stuart me Sanderson ōku hapū

Ko Don rāua ko Helen ōku mātua

Ko Tangata Tiriti tōku iwi

Ko Grant Brookes tōku ingoa.

Ka maumahara ahau ki tēnei whakataukī o Kai Tahu: “He mahi kai takata, he mahi kai hōaka”. Nā konei, tēnei te kaupapa o te rā nei: ka huihui tātou kia whakapakaritia ake te mahi tahi. Ka kōkiri ngā nēhi, ka whitiwhitia te tautiaki.

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

As the tītī (muttonbird) calls, as the kaka calls, so will I speak.

I have just explained that I stand to support the acknowledgements to the Creator. I also acknowledge the mountains, rivers and sacred areas of this district.

I greet those who have passed on, and the living gathered here.

To the Regional Council Chair, Barbara, and the Rūnanga rep, Lara, thank you for your invitation.

To the chiefs, Kerri and Memo, to the staff and all the nursing leaders gathered here (which is all of you), greetings.

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 belonging to Clan Stewart and Clan Sanderson. They arrived here on board the ship Cornwall in 1849. The son of Don and Helen, my name is Grant Brookes.

I recall this saying of Kai Tahu: “It is work that devours people, as greenstone wears down sandstone”. In sharing this whakataukī, I acknowledge the mana whenua of the local iwi. It also gives rise to the purpose of today: we are all gathered for the building of productive workplaces. When nurses are at the forefront, care is transformed.

So greetings, greetings, greetings to you all.

=====

It’s great to be back home. Whenever I set foot here, I feel more connected. I can visit the frail elderly, dear members of my extended family. The 2018 centenary of my old high school, visible outside there through the trees, seems that much closer. I am able to go back to the wards where I spent my clinical placements as a young nursing student.

“It is work that devours people, as greenstone wears down sandstone”. True?

I think many here would acknowledge it. I spent yesterday afternoon with three of you – Barbara Findlay, Linda Smillie and Robyn Hewlett – talking with members of the nursing and midwifery team across Dunedin Hospital.

IMG_1213.JPG

We heard some of them say, “we’re okay”.

But without exception, they would add, “we’re lucky”. They believed that their shift, or their workplace, was an exception.

More common were comments like:

  • “I didn’t get a break today, or yesterday”
  • “We spend so long looking for equipment that works”
  • “Our patients are ‘going commando’ today. They’re naked under the sheets, because we don’t have enough linen”
  • “Trendcare shows us 20 hours short, and nothing happens”
  • “We did the time and motion studies, for Care Capacity Demand Management. They showed we were short staffed. That was three years ago. We’re still waiting for the extra staff”
  • “When someone rings in sick, they aren’t replaced”
  • “There just aren’t enough nurses in the Resource Team to fill the gaps in the roster”
  • “Our new grads don’t want to work here. They’re going to Australia”
  • “If someone leaves, it can take months before a new person starts”
  • “It’s like a factory in here. It’s not about the patient, it’s all about clearing the beds”
  • “Three years ago we had a big stop work meeting. The managers took notice and things got better, for a while. I feel like we’re back where we started”
  • “Nobody smiles here any more”
  • “I’m just holding on for retirement”

These comments are in line with research findings for DHBs nationwide contained in the NZNO Employment Survey 2017, published last month. The research shows some similarities and some differences in Aged Care, Private Hospitals and Primary Health Care workplaces.

And yet our vision for nursing is something different. We aspire, as NZNO together, to be “Freed to care, proud to nurse” – in productive workplaces.

How do we get there, from here?

Building productive workplaces requires a multi-faceted approach.

Over the course of today, we will hear about “workplace culture and engagement for improvement” from Jane Wilson of the Southern DHB Commissioner’s Office. We’ll learn more about “The importance of workplace relationships in times of stress and pressure” from Shireen Tresslor of Otago Community Hospice. NZNO professional nursing adviser Lorraine Ritchie will talk about “Promoting positive workplace culture”.

Many of us will want to know more about “Dealing with bullying and harassment in the workplace”, the focus of NZNO educator Jenny Crighton. And we will learn from each other, as NZNO members together, when NZNO industrial advisor Mike Yeats presents on “How we are transforming the workplace”.

I will use the short time available to me now to highlight one more facet of the multi-faceted approach.

Lifting productivity requires investment. This truth has been repeated for decades by politicians, business leaders and by the Council of Trade Unions.

And yet, it has not been heeded, at least in our workplaces. Annual increases in government health funding have failed to keep up with population growth and other cost pressures. Using Treasury figures, CTU economist Bill Rosenberg has calculated that the cumulative shortfall means that health is now underfunded by $1.85 billion, compared with 2009 funding levels.

Kerri, Memo and I meet twice a year with the Minister of Health. We have presented him with evidence for the need for greater investment. On its own, this has not been enough.

Recognition of the impact of underinvestment on workplace productivity – on our own stress and burnout, and on the people we care for – led the Board of Directors to decide last year that health funding would be a major campaign focus for NZNO in 2016/17.

It fits with focus areas in the NZNO Strategic Plan 2015-2020, including:

  • “Actively campaign for safe staffing and healthy workplaces to ensure patient safety and workforce wellbeing”
  • “Actively campaign, lobby employers and the Government to allocate sufficient funding in a consistent and transparent manner to enable and optimise ongoing professional development for all members of the nursing team”
  • “Campaign for employers to implement systems for safe staffing in the workplace”

Two weeks ago, the YesWeCare roadshow arrived in Dunedin. Some of you helped to assemble life-size cut-outs at the Railway Station, representing the missing health workers who are needed to ensure safe staffing, safe care, 24 hours a day, 7 days a week. YesWeCare is a coalition of health unions and consumer groups, which has grown as the roadshow moved north up the country. NZNO supports YesWeCare because it’s in tune with our own campaign for a fully-funded health system, Shout Out For Health.

In the build-up to DHB MECA bargaining and the general election in September, we are taking our Shout Out message to all decision-makers and all political parties.

Last month, the two main opposition parties announced “Budget Responsibility Rules” which would tightly restrict government spending in any future Labour/Green government. These rules are not good enough. We support CTU president Richard Wagstaff’s call for “higher levels of government activity and investment than these rules permit.”

“There is”, said Richard, “an urgent need”.

At the same time, we’re calling on the current government to restore the $1.85 billion missing from health in next month’s Budget.

Our campaign is already having an impact. In a Newshub story about the YesWeCare campaign on 3 March, prime minister Bill English said, “Discussions are under way right now about the next Budget. So yeah, we do pay attention to the views of people on the front line because they’re a pretty good measure of what’s happening.”

So we know what works. Now we need to step it up.

Today, Kerri and I are launching the latest phase in this campaign – an open letter to New Zealand voters. It asks everyone to make health funding their first priority this election.

Shout Out for Health is different to other NZNO campaigns. It aims to empower you, the NZNO members, to carry out your own campaign ideas, with support. But something else that Barbara, Linda, Robyn found at Dunedin Hospital yesterday is that nurses are tired. It’s hard for them to find the energy to participate in campaigning activities.

So Kerri and I are leading another piece of work, along with the Board, to improve volunteer sustainability, member engagement and leadership development within NZNO. To begin with, we have decided to reinstate the training day for new chairs and treasurers of Regional Councils, Colleges and Sections.

This month and next, a small number of focus groups will be held, to find out from members what else would enable you to get more involved in NZNO’s many and diverse areas of activity. Then resourcing will be allocated, to support our volunteers. Next steps will be discussed at a meeting for all chairs at the NZNO AGM in September.

Sustainability and leadership development may also extend to greater support for Board members. And let me give a big plug right now for all of you to vote online in the Board elections, by noon this Friday.

Together, we can achieve our vision. The challenge is large. But with nurses at the forefront, we will transform care.

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