‘Overcoming the headwinds’ – Presidential address to NZNO AGM 2017

NZNO AGM 2017 Presidential address IMG_6851


Whakarongo rā

Whakarongo ake au ki te tangi a te manu, e rere runga rawa e

Tui, tui, tui, tuia

Tuia i runga, tuia i raro, tuia i roto, tuia i waho

Tui, tui, tuia

Kia rongo te ao, kia rongo te pō

Tui, tui, tuia

Tihei mauri ora!

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

E te iwi kāinga, tēnā koutou. Koirā Taranaki Whānui ki Te Ūpoko o Te Ika te tangata whenua.

E te maunga e tū mai rā, tēnā koe Pukeauta.

Ki te Awa Kairangi, tēnā koe.

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

Ko te wā mō te hui taumata o te Tōpūtanga Taphui Kaitiaki o Aotearoa, ā, kia whakaterehia tō tātou waka te kaupapa.

He waka eke noa. Nā konei, mā te titiro ki muri, ka mārama te titiro ki mua.

Ka maumahara ahau ki te whakataukī: mā te tika o te toki o te tangere, me te tohu o te panaho, ka pai te tere o te waka i ngā momo moana katoa.

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


I listen

I listen, where up high, a bird flies

Its cry rings out

Sew, stitch, bind it together

From above, from below, from within, from outside

Sew and bind it together

During the day, and the night

Sew, stitch, bind it together

My first word was to the creator, who sowed the seed from the realm of beginnings, and endings.

I greeted the tangata whenua, Taranaki Whānui ki Te Ūpoko o Te Ika. Greetings to their sacred mountain and river.

Greetings to those who have passed on, since we last gathered here together.

We have lost great leaders from our NZNO whānau over the past year.

Shortly after our 2016 AGM I received the sad news that Stephen Pugh had passed away in Hamilton. Many of you will remember Steve and his Welsh lilt, which added music to our AGM debates up until his last appearance here in this room in 2015. Steve was a perioperative nurse. He served as chair of the Midlands Regional Council of NZNO, as the Midlands rep on the Membership Committee and as a worksite convenor, leading his fellow NZNO delegates at Waikato DHB. I will always remember Steve for the strong union values he brought to the DHB Sector National Delegates Committee.

A month later, Sharon Williams died in Christchurch. Sharon worked at Burwood Hospital, starting in 1988 as an enrolled nurse and later becoming an RN. She was worksite convenor from 2001 until 2007. During 2013 I had the privilege of working alongside Sharon on the Board of Directors, and the following year on the Membership Committee, where she was inaugural vice-chair. But for years before, Sharon had been an active member of the Canterbury Regional Council and, from 2009 to 2011, served as Regional Council Chair. My condolences to the delegates from Canterbury. Ka aroha ki a koutou.

On the same day, in Wellington, Helen Kelly died of lung cancer. Helen trained as a primary school teacher but soon stepped up to represent her colleagues as a leader of their union and professional body, the New Zealand Educational Institute Te Riu Roa. When she was elected President of the Council of Trade Unions in 2007, Helen became the first woman to lead New Zealand’s trade union movement – our movement. In the words of Industrial Services Manager Cee Payne, Helen “loved being with our members and would take every opportunity to stand with them”. Our tūpuna rangatira stands with us still.

This year, another great leader departed from us.

Mina Timutimu, of Te Atiawa and hapū Ngāti Rahiri, began her career as a surgical nurse in 1951 before completing her midwifery training ten years later at St Helen’s maternity hospital, here in Wellington. Minu was appointed kaumātua of the New Zealand College of Midwives in 1996 and became an inaugural member of the Midwifery Council in 2003. She dedicated her working life to Māori mothers and babies. She was a visionary kaitiaki, leading the profession down the bicultural pathway over 25 years.

Those who have gone before, are with us today. So now I greet those gathered here, among the living.

It is time for the hui taumata, the highest meeting of NZNO. The purpose of the meeting is to steer our waka. It’s a waka we’re all in together, and we’ll hear more about this waka shortly from the Membership Committee and Te Poari. But for now, by looking back, the view ahead will become clear.

At this time I remember the ancient saying: “by designing and shaping the keel of the waka to perfection, your canoe will overcome obstacles”.

So to the many leaders, and guests from afar – greetings, greetings, greetings one and all.


When I look back over the last year, I see that our waka’s progress towards some of the goals contained in the NZNO Strategic Plan 2015-2020 has been buffeted by strong headwinds.

President's address (to be amalgamated with final slides)

Our organisation – our members, and staff – have paddled hard for Improved Health Outcomes. But headway has been slight in the “implementation of population health approaches which reduce health inequalities, address determinants of health and those things that impact on people’s ability to live well”.

We have pursued of our goal of Skilled Nurses, one where “all graduate nurses, Enrolled Nurses and Midwives… have access to a funded Entry to Specialist Practice or Nurse Entry to Practice Programme position”. But progress – in the words of Associate Professional Services Manager Hilary Graham-Smith – has been “glacial”.

And we have steered towards a Strong Workforce, but getting “employers to implement systems for safe staffing in the workplace” remains a far-off shore.

In other areas, such as advocating for pay equity to promote a fair society and healthy communities, we’ve made the most of favourable conditions and have come a long way. The Chief Executive will shortly highlight some successes in achieving our goals as an Effective Organisation.

Scanning the horizon for approaching weather systems, and developing strategies to navigate the challenges, is the responsibility of the Board of Directors. At the start of last year, the Board recognised that underfunding was emerging as a strong wind impeding our progress and voted to make health funding a campaign priority for NZNO for 2016/17.

This has been implemented by NZNO staff and by member-leaders — some of you are in the room today — as the #ShoutOutForHealth campaign. It’s been our karakia to calm the headwind, whakataka te hau. Through #ShouOut and our collaboration with the broader #YesWeCare coalition, we have helped to make health the number one issue for voters in this year’s general election. That’s according to the latest Newshub-Reid research poll.

Back in April, Kerri Nuku and I launched the #ShoutOut Open Letter on Health Funding. You’re invited to join us outside Te Papa at lunch time tomorrow for the next campaign activity, displaying the 5,000 signed letters and boxing them all up, to keep health funding in the public eye this week.

Turning our attention to 2018, there are two key events which will influence how we achieve the goals in our NZNO Strategic Plan.

Thursday of next week is the last scheduled day of bargaining for the DHB MECA. Fuelled by member participation, the MECA campaign is propelling us forward towards our strategic goals.

But before Thursday, of course, comes election day. Climatic conditions will definitely be affected by this.

NZNO has published a manifesto outlining our priorities for health in this election, titled Nursing Matters. We have evaluated the policies of eight political parties against these priorities and published the results in Kai Tiaki, to enable an informed vote for health.

President's address (to be amalgamated with final slides)2

But it is up to you, your families and your communities to turn out and cast that vote, for your chosen party.

As we were reminded yesterday, on Suffrage Day, voting matters. It mattered to Kate Sheppard, Meri Mangakāhia and the 32,000 other women who took action in 1893 to demand it.

President's address (to be amalgamated with final slides)3

The right to vote is a taonga which our foremothers and forefathers fought for, and handed down to us. It is the foundation of a democratic system, one which also includes other checks and balances on the exercise of power. Democracy brings scrutiny, accountability and protection from leaders making decisions which are unsupported by evidence, or harmful to the common good.

And just as this true for our country, so it’s also true within our own organisation.

Soon we will begin voting on remits which members have put to refine our rules and determine our strategic direction.

The AGM also reviews and ratifies the strategic policy decisions made by your Board in the last year. This happens because AGM delegates from years gone by voted to add these checks and balances into our NZNO Constitution. In 2015, a proposal by the previous Board to remove them was voted down.

This annual meeting is where, in between the triennial elections for the NZNO Board and Officers, members exercise democratic control in this member-run organisation. It’s where we are accountable to you.

There is, however, room for improvement in our democracy. Problems with NZNO’s current voting system will be discussed after lunch, in a presentation from the Voting Strengths Working Party.

A variety of proposals will be put forward, for consideration by all members over the next year. No decisions will be made today. But I ask everyone to listen closely to the various options, and evaluate each of them against the stated goal of creating a “more democratic and equitable process”. The changes we make in 2018 will shape the democracy which we pass on to the next generation.

The 2016/17 NZNO Annual Report also contains an update on implementation of the four policy remits passed last year. Three of those remits have been fully implemented, or are in process.

The fourth, submitted by the Cancer Nurses College, was that: “Clinical Supervision be provided for nurses as per NZNO guidelines and that this should be included in the MECA”

As stated in the 2016 AGM documents: “The remit committee acknowledges the cancer nurses’ wish to have these remits go forward to the AGM although there is a mechanism for including items raised by and important to members who are covered by the DHB MECA.”

“Clinical supervision for nurses as per NZNO guidelines was not included in the claims for DHB MECA bargaining”, says the Annual Report. “This was not identified as a priority by members covered by the DHB MECA.”

I have met with the Cancer Nurses College Committee, to discuss this further.

There are also four policy remits passed at the 2015 AGM still in various stages of implementation. Two years ago, delegates to this meeting voted that: “College and Sections banking systems need to be reviewed and policy formulated to reflect modern electronic banking practices and technologies”. Implementation of this remit is progressing.

You voted: “That new policy be developed to publish the Kai Tiaki in electronic format to align with current technology”. Kai Tiaki will become available in an electronic format following a recently completed review of NZNO’s communications.

You voted: “That NZ Nurses Organisation delegates be given training and support to run MECA Endorsement and Ratification meetings”. As reported in last month’s Kai Tiaki, this was not implemented for the endorsement meetings in May, but following action by the Board it will be implemented in time for upcoming ratification meetings.

In 2015 you voted: “That NZNO continues to prioritise and support campaigns towards nurses and midwives entry to practice programmes, for Registered Nurses, Registered Midwives and Enrolled Nurses, with the campaign goal of 100 per cent employment of new graduates and improved health workforce planning in Aotearoa”.

As I reported here last year, no specific campaign was launched, although some generic campaign activities continued. After last year’s AGM, I again raised this with the Board and presented a supporting letter from NSU/TRT. Given the glacial progress towards our strategic goal, I will continue to advocate for the full implementation of this remit.

Finally, I also remain committed to delivering on pledges I made to members during the last NZNO President election and in my inaugural address:

President's address (to be amalgamated with final slides)4

• To “be accessible to members”, online and in your locality

• To ”make your issues visible… [in] the media”, including on social media

• To “strengthen NZNO’s bicultural partnership”

• To support more members “to actively participate in NZNO membership structures”  – even though, I acknowledged, this means “voluntary work, on top of long hours in paid employment or study – and often after caring for family members as well”.

President's address (to be amalgamated with final slides)5

On this last point, the two co-leaders have commissioned a project to strengthen volunteer sustainability, member engagement and leadership development, after meeting last year with Chairs of Regional Councils, Colleges and Sections, Te Rūnanga and NSU/TRT.

The first fruit of this project to strengthen our waka will be the reinstatement in November of the annual training day for new Chairs and Treasurers. Focus groups were held earlier this year to identify other measures to support participation by our volunteer member leaders. Some of you would have taken part. Over the lunch break, we will update Chairs on themes and next steps in the project.

Here today, we are designing and shaping the keel of our waka to perfection. Working together, our canoe will overcome all obstacles.

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

At this election, rise like lions!

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

There are now just a few weeks to go. The country is counting down to the general election, to be held on 23 September.

Health is political, and never more so than in 2017, when the impact of underfunding became intolerable for healthcare workers and the public we serve.

Every day we speak out about being short-staffed, about the sheer volume of admissions, referrals and presentations, about the lack of resources or risks to patient safety.

More often than not, it seems, our voices are ignored. We’re even told that there is no underfunding or resource shortages, so we’re either imagining things or it’s our fault our workload is unmanageable.

But at election time, at least, the politicians have to listen to us.

For the last couple of years, people around the world have been using the ballot box to express their rejection of ruling elites and establishment politicians. This populist wave has brought down the mighty, catapulted political outsiders to centre stage.

NZNO does not advise members who to vote for. But since kaiwhakahaere Kerri Nuku and I launched NZNO’s Open letter to New Zealand voters in April, we have been encouraging every member to “shout out for health”, to help make health funding the top priority this election.

NZNO is publishing a manifesto containing other policies, too, because health outcomes are fundamentally determined by access to social and economic opportunities: a liveable income, safe and decent work, affordable housing, education, adequate and nutritious food, and clean, healthy and sustainable environments.

Regardless of who wins the election, we’ll be urging the next government to prioritise:

• A sustainable, fully utilised nursing workforce

• Investment in public health

• A primary health care approach to improving population health

• Oranga Tamariki – the health and well-being of children and young persons

• Safe clinical environments

• Fair employment

• Social and health equity, within Aotearoa, the Asia-Pacific Region and globally

Voting once every three years will not be enough, on its own, to achieve our ultimate goal — a health system where every patient knows that when they need care, they will see the right health professional, with the right skill, in the right place, at the right time.

Other kinds of activity are needed, too, like writing letters, making submissions, getting to meetings and joining protests. But as the populist wave overseas has shown, for better or worse voting does make a difference.

One of the most unlikely scenes it has produced was this year at Glastonbury, the United Kingdom’s famous annual rock music festival. A youthful crowd of around 120,000 cheered as a 68 year-old, grey-haired politician read from a 200 year-old poem.

The poem Jeremy Corbyn chose to read is also my all-time favourite. So my message to NZNO members, from now until the election, is the same:

Rise, like lions after slumber

In unvanquishable number!

Shake your chains to earth like dew

Which in sleep had fallen on you:

Ye are many—they are few!”

Facing up to global challenges

1. IMG_1398
NZNO’s official congress delegation, from left, chief executive Memo Musa, kaiwhakahaere Kerri Nuku and president Grant Brookes.

Globalisation, patient safety, nursing leadership and climate change were among the myriad topics debated at the congress.

By NZNO president Grant Brookes

“I just want to say up front, we absolutely have deliberately put this topic on the agenda. For some, it’s a very controversial subject. There are people who may have extreme and differing views.

“It’s an issue which has become political over recent months as well, but there’s no doubt it is impacting on nurses, nursing practice and the work of our associations.”

With these words, ICN nursing and health policy director Howard Catton introduced the panel debate, Globalisation: Its impact on nurses and their associations, at the congress.

When I met Catton before speaking on the panel, he explained that under the leadership of president Judith Shamian and new chief executive Frances Hughes, ICN had been pushing for greater relevance by engaging with the major global challenges of today.

Alongside presentations on nursing leadership, nursing education and specific areas of practice, the congress elevated climate change, gender equality and sustainable development to headline this year’s agenda.

‘Care, compassion and advocacy’

The congress was opened by the former United States (US) deputy secretary of health in the Obama administration, Mary Wakefield, a nurse.

She called on nurses to lead the implementation of the United Nations’ sustainable development goals. Quoting former World Health Organization director-general Margaret Chan, she said we must tackle the root cause of ill health – inequality – and respond to the refugee crisis. “The core of our profession is care, compassion and advocacy for strangers,” Wakefield said.

World-leading researcher into clinical outcomes and nursing workloads Linda Aiken presented the latest evidence that safe staffing saves lives. Welsh chief nursing officer Jean White followed with a presentation on the Nurse Staffing Levels (Wales) Act 2016.

Last year, Wales became the first country in Europe to pass legislation requiring the use of safe staffing tools in hospital inpatient wards.

The tools, now under development, have similarities to the care capacity demand management methodology, currently stalled in the implementation phase in many New Zealand district health boards. From 2018, the Welsh law says staffing levels must reflect patient acuity and the professional judgement of the nurse in charge.

Professor Barbara Sattler of the University of San Francisco began her presentation on climate by quoting from The Lancet: “Climate change is the biggest global health threat of the 21st century. The impacts will be felt all around the world – and not just in some distant future but in our lifetimes and those of our children.”

“We cannot have healthy people on a sick planet”, Sattler said. As well as encouraging activism for transition to low-carbon economies, she gave examples of nurse leadership in creating “climate-smart health care”.

These included ending the use of coal-fired hospital boilers in South Africa, solar-powered cold chains, “meatless Monday” food services and procurement policies for medicines and clinical supplies which favour low-carbon production.

In addition to my presentation on the impact of globalisation, the other NZNO speakers were kaiwhakahaere Kerri Nuku and professional nursing adviser Anne Brinkman.

Nuku spoke on NZNO’s role in the recent gains for advanced nursing practice in this country, including medicines management and nurse prescribing, while Brinkman’s presentation was titled Nurses leading in tomorrow’s globalised world.

Also from New Zealand, Otago University senior lecturer Daryle Deering and Heather Casey of the College of Mental Health Nurses Te Ao Mâramatanga spoke in a plenary session, on mental health and primary care.

Past president of the World Medical Association Michael Marmot, who is a global expert on the social determinants of health and author of The Health Gap, closed the congress.

He quoted Martin Luther King, that “unarmed truth and unconditional love will have the final word”, in support of his two key messages for a world of “post-truth politics”– evidence-based policy, in a spirit of social justice.

With 8200 registrations, 88 sessions in a range of languages, 1900 posters and an unknown number of side meetings, any congress participant would have seen just a subjective snapshot. This was mine. •

Related coverage:

‘Boosting Pacific representation at ICN’

‘In the footsteps of nursing heroines’

First published in Kai Tiaki Nursing New Zealand, July 2017. Reposted with permission.


In the footsteps of nursing heroines

SMAC nurses - Spain 1937
The three nurses shortly after their arrival in Spain, from left: René Shadbolt, Isobel Dodds and Millicent Sharples.
EIGHTY YEARS ago this month, another group of New Zealand nurses was arriving in Barcelona – part of New Zealand’s Spanish Medical Aid Committee.

The group was led by René Shadbolt, head sister of Auckland Hospital’s casualty ward (and the aunt of Invercargill Mayor Tim Shadbolt and author Maurice Shadbolt, and later the Matron of Rawene Hospital), accompanied by Isobel Dodds, a staff nurse from Wellington Hospital and Millicent Sharples a nurse aide from Levin (see photo above).

Shadbolt, Dodds and Sharples were among 40,000 international volunteers who travelled to Spain between 1936 and 1939. They were responding to a humanitarian crisis and a threat to democracy. In mid-1936, a Fascist army backed by Adolf Hitler had risen up to overthrow Spain’s elected socialist government.

Joining others in Spain The trio joined other New Zealanders already working there. There was surgeon Doug Jolly, who had worked as a resident doctor in Dunedin and Wellington Hospital, and Auckland nurse Una Wilson. Dorothy Morris, a Christchurch nurse, had deployed to Spain with the British Universities Ambulance Unit at the start of 1937 and was based in a Quaker-run children’s hospital south of Barcelona.

Their stories are told in two recent books, Kiwi Compañeros – New Zealand and the Spanish Civil War and Petals and Bullets – Dorothy Morris, New Zealand Nurse in the Spanish Civil War, which was reviewed in the August 2015 issue of Kai Tiaki Nursing New Zealand.

I spent the afternoon before the opening of the ICN’s CNR contemplating these nurses’ time in Catalonia, the semi-autonomous province around Barcelona.

At the Museum of Catalan History, I met an historian and we talked over Kiwi Compañeros. He knew of some of the people mentioned in the book, but could shed no more light on our nurses.

In the museum’s exhibition hall, I watched the newsreel footage of Hitler’s air force perfecting its aerial bombardment of civilian areas – the same techniques which, three years later, would be used on London during the Blitz. I thought of the injured and traumatised children who were evacuated from Barcelona and into Dorothy Morris’ care.

History tells us that in 1939 Hitler triumphed, as other countries (apart from Mexico and the Soviet Union) refused the appeals for help from the Spanish government.

As the danger of far-right extremism grows once more, our Kiwi nurses deserve to be remembered.

While walking the same Barcelona streets they described in their letters home, I reflected on their courage and commitment. If allied governments had shown the same spirit during 1936-39 as our nursing heroines, they might have checked the rise of fascism in Europe, and its incomparable horror could have been prevented. •

Report by NZNO president Grant Brookes

Related coverage:

‘Facing up to global challenges’

‘Boosting Pacific representation at ICN’

First published in Kai Tiaki Nursing New Zealand, July 2017. Reposted with permission. 

Boosting Pacific representation at ICN

KT photo July 2017
Some of the New Zealand nurses who attended the ICN congress in Barcelona flank ICN chief executive Frances Hughes (centre right, in white) and NZ’s chief nursing officer Jane O’Malley (centre left). NZNO president Grant Brookes is on the far left and chief executive Memo Musa is third from left.

NZNO successfully promoted better representation for Pacific nations at ICN.

By NZNO president Grant Brookes

Last month, NZNO chief executive Memo Musa, kaiwhakahaere Kerri Nuku and I travelled to Barcelona for a series of meetings held under the auspices of the International Council of Nurses (ICN).

From May 27–June 1 we took part in the 2017 ICN Congress, along with close to 20 other New Zealand nurses. For the three days prior, we represented New Zealand nursing at the ICN Council of National Representatives (CNR).

Founded in 1899, ICN articulates the voice of nursing to the World Health Organization and other global institutions. NZNO has been a member since 1912.

CNR is ICN’s biennial decision-making forum. There, the 135 member organisations from 133 countries are able to debate and vote on the way forward.

Unlike previous meetings, there were no other national nursing associations (NNAs) from the South Pacific attending. So it was up to NZNO, along with the Australian College of Nursing and the Australian Nursing and Midwifery Federation, to bring a Pacific nursing voice to the world stage.

Among the votes at CNR was an election to fill four vacancies on ICN’s 14-member governing board.

ICN elections are conducted regionally. New Zealand is part of area seven, which covers the Asia-Pacific region. Nuku was standing for election to the single vacant seat on the board for this area.

But the smaller countries of the Pacific have long struggled to get our nursing voice heard at the top table. Area seven board members are usually elected from the large NNAs of North Asia. In Barcelona, the seat was won by Wu Ying, the candidate from China.

So, when a separate vote on redrawing the boundaries of the voting areas to match those of the World Health Organization, placing New Zealand in a new Western Pacific Region, NZNO moved an amendment to create a South Pacific sub-region within that.

“There is a large group of NNAs from the South Pacific who share commonalities of language, culture, nursing education, regulatory and legal frameworks and health system organisation. And yet this large group of NNAs has been largely excluded from representation,” I said, when introducing the motion. It was seconded by the Australian College of Nursing.

In 2016, the ICN board and president had considered the possibility of establishing sub-regions, but decided against. With support from Australia, CNR voted by a margin of three to one to overturn that decision and support NZNO’s amendment.

CNR also heard an update from ICN chief executive Frances Hughes about her transformation agenda, aimed at modernising the 118 -year-old organisation.

Plans include decentralising ICN away from its Geneva headquarters to provide a greater regional presence, revamping ICN’s communications and digital services (including a new international platform for online professional development) and stronger governance and financial management.

NZNO has expressed concerns over recent years about ICN governance and financial sustainability. In Barcelona, Musa was unexpectedly invited to present a training session on good governance to the incoming ICN board, under newly-elected president Annette Kennedy.

As part of its push to decentralise, ICN wants expressions of interest in hosting a series of regional forums from 2018. At last year’s NZNO annual general meeting, delegates, by a show of hands, expressed support for hosting such a forum in New Zealand. NZNO is now in the early stages of planning a possible ICN forum. •

Related coverage:

‘Facing up to global challenges’

‘In the footsteps of nursing heroines’

First published in Kai Tiaki Nursing New Zealand, July 2017. Reposted with permission.


Speaking for NZ nursing at a time of global change


First published in Kai Tiaki Nursing New Zealand, June 2017. Reposted with permission.

I’M WRITING these words during a break from packing. Tomorrow, I board a plane for Barcelona, Spain, where I will join kaiwhakahaere Kerri Nuku and chief executive Memo Musa, as part of NZNO’s delegation to the International Council of Nurses’ (ICN) biennial conference.

For the next 10 days, our job is to speak up for New Zealand nursing at a time of global change. ICN represents millions of nurses in 130 countries and brings the nursing voice to the world stage.

The first three days in Barcelona are taken up with the Council of National Representatives (CNR), where National Nursing Associations (NNAs) including NZNO will vote on proposals to reshape ICN.

ICN is governed by a board of representatives elected from seven areas. In our area, the Asia-Pacific region, the smaller countries of the Pacific have struggled to get our Pacific nursing voice heard at the top table.

In Barcelona, we’re voting on a proposal to redraw the boundaries so ICN areas match those of the World Health Organization. This would place New Zealand in a new Western Pacific region and strengthen the Pacific nursing voice.

We are also proud to support our kaiwhakahaere’s bid to bring a Pacific voice to the table. At CNR, Kerri is standing for election to the ICN board.

After CNR comes the ICN Congress – the largest international event for nurses. There we’ll be joined by other NZNO members and staff, as we take New Zealand perspectives on nursing to the world.

Kerri is presenting examples of how we have contributed to policy and legislative change to improve advanced nursing practice, eg medicines management and nurse prescribing.

I am taking part in a panel discussion on how globalisation is impacting on nursing internationally, and how NNAs and ICN should respond.

Globalisation’s impact is being felt in seven main areas: workforce mobility, immigration and recruitment practices, technology and telehealth, population displacement and climate change, workforce development and regulation, trade and investment agreements and in the influence of ICN and member NNAs.

Grow local workforce

New Zealand has the highest dependence on migrant health professionals of any OECD country. NZNO supports the right to freedom of movement, and supports IQNs having secure work visas and supportive work environments. At the same time, we must reduce our dependence on migrant nurses by growing our locally educated nursing workforce, with a supported entry-to-practice place for every new graduate.

Technology and telehealth transcend borders and are increasingly impacting on nurses and models of care. Our position statement contains pointers on how NNAs might respond.

NZNO recognises that climate change and population displacement due to conflict and natural disasters are putting pressure on health systems in many parts of the world, including the South Pacific. Nurses should lead the global transition away from carbon-based economies and contribute to plans to mitigate the impact of climate change on health.

The influence of NNAs and other health sector organisations has been key to halting harmful trade and investment agreements like the Trans-Pacific Partnership Agreement (TPPA). Recent attempts to revive the TPPA and other challenges of globalisation show why international collaboration by nurses at forums like ICN is so important. •


1) New Zealand Nurses Organisation (NZNO). (2017). Internationally Qualified Nurses: immigration and other issues (discussion document). Wellington: Author.
2) NZNO. (2016). Position Statement: Nursing, technology and telehealth. Wellington: Author.
3) NZNO. (2016) Position Statement: Climate Change. Wellington: Author.

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