Pay push for Fiji nurses

With the backing of NZNO and an Australian nursing and midwifery union, Fiji nurses have achieved significant pay increases.

By NZNO president Grant Brookes

In April, kaiwhakahaere Kerri Nuku and I were invited as honoured guests to open the Fiji Nursing Association (FNA) annual general meeting (AGM). The invitation for the NZNO co- leaders to attend came after joint work last year between FNA, NZNO and the New South Wales Nurses and Midwives Association on a pay push for Fijian nurses.

It was the latest in a long series of collaborations between the Pacific nursing unions. In 2005, after New Zealand’s “fair pay” multi-employer collective agreement was successfully concluded, NZNO campaign leaders travelled to Fiji to support the FNA’s own fair pay campaign. In return, FNA leaders shared their victory and inspired delegates at the following NZNO AGM.

More recently, Fiji’s nurses had seen their pay fall behind the rising costs of living. But in 2017, backed by Australasian research and policy analysis, the successful FNA submission on a new civil service salary structure has resulted in pay increases of up to 75 per cent.

For the first time, the new pay grades recognise advanced nursing practice and specialty roles. However, they also impose five-year fixed term contracts in place of previous permanent employment.

The first roles to be graded under the new salary structure include nurse practitioners (NPs) and midwives. NP Vilisi Uluinaceva told me that the FNA’s evidence-based submission made a big difference.

Vikatoria & Vilisi IMG_6922
Nurse practitioners Vikitoria Makrava (left) and Vilisi Uluinaceva enjoy a break during the AGM.

Previously, she said, Fiji’s 40 NPs earned between FJ$26,000-28,000 (NZ$19,000-20,400) a year. “We’d been working for so long on that pay, we didn’t know how to bring this up.”

Now, she said, they’re on FJ$43,000.

Fellow NP Vikatoria Makrava explained: “When we talk about pay, we look at what we do. Many of us work in remote areas. There are no doctors. We prescribe – we do everything – and we might see more than 60 patients in a shift. The pay was not appropriate before.”

Aliote Galuvakadua is a midwife and maternity unit manager who first registered as a nurse in 1976. She said she was excited when she read the FNA submission. It has seen midwife pay go from FJ$18,000 to FJ$28,000.

Fiji Times photo (with Aliote Galuvakadua)
Midwife Aliote Galuvakadua explains what the new civil service salary structure means for her profession at the AGM (Photo/Fiji Times).

“The paper was really good”, she said. “It’s good we have been recognised as specialists after all these years. Talk of balloting for a strike is now gone.”

Other nursing specialties have either undergone, or are about to undergo job evaluations in order to be placed on the new salary scale. So far, the average pay increase for the nation’s 3360 nurses has been 14 per cent.

Meanwhile the Fiji Trades Union congress has lodged a dispute with the Ministry of Labour over the decision to place all civil servants on individual fixed-term contracts and says it plans to take the matter to the International Labour Organisation. •

First published in Kai Tiaki Nursing New Zealand, June 2018

Related coverage:

The President comments: ‘To strike, or not to strike? Is that the question?’

MECA meeting Kenepuru 2, 12.12.17

 

To strike, or not to strike? Is that the question?

Or as NZNO members in DHBs prepare to vote on their employer’s latest offer, is the question now vexing the troubled soul of nursing something deeper? 

There’s no doubt we’re living in a time when unrest is driving change, for our profession and for NZNO. As I said in last month’s issue of Kai Tiaki, members are rising up and making history.

“Never before have NZNO members in our public hospitals voted to reject an offer recommended by the national negotiating team, as they did in December”, I observed. 

“And the turnout at the March meetings saw a majority of members vote in a ratification ballot for the first time.”

To that, we can now add that more members took part in the online strike ballot last month than in any other vote in NZNO’s 109-year history. 

The past as we knew it – one of “doing more with less”, of increasing workloads and stress, and of NZNO membership as just “an insurance policy” and a person at the end of the phone – this is being swept away. Yet in the words of Joe Strummer, “the future is unwritten”. 

But as we write the future, we must attend to the soul of nursing. Fundamentally, it’s now a question of being true to who we are, as professionals and as trade unionists. 

As nurses, we have a unique language of kindness, understanding, perception and logic. Every day we bring that to the patients we care and advocate for. It is that language we now need to use for our own advocacy. 

The foundations of our profession are built on ethical integrity. We are evidence-based in thought and compassionate in deeds. 

We must now interact with each other and engage with our employers and the wider public ethically, using evidence and compassion. 

When the DHBs chose to talk to the media rather than give us time to digest their offer, we were angry. But we kept our integrity. We cannot let fear or anger undermine who we are or decide our vote for us. 

We are advocates. Effective advocates combine passion with good analysis, and carefully crafted communication. We must be that kind of advocate for ourselves and our profession. 

And we are carers. Each of us was drawn to the work of helping others because of this. 

Another name for care is solidarity. Our foremothers and forefathers who founded the union movement understood the meaning of this word. 

They were animated by the socialist spirit of looking out for others and standing together behind the collective decision, whatever it may be. As we seek change, let us also hold fast to that spirit. 

Whether we strike or not, the next steps for us may be difficult. But with care towards each other, they can be made easier. 

Struggle and adversity can bring out the worst, or the best in people. How we struggle and advocate for our profession defines who we are as a profession. 

My call to each and every one of you is this: be yourself, it is who we need most right now to win. •

(Written for Kai Tiaki Nursing New Zealand. Posted here in advance of publication in the June issue, with permission)

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

Kerri & Grant TPPA

by NZNO President Grant Brookes and Kaiwhakahaere Kerri Nuku

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

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

A decade of severe underfunding of our public health services has meant our health system has failed to keep pace with our growing community need, the demands of an ageing population and ageing workforce, and increased costs of providing services.

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

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

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

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

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

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

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

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

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

Evidently investing in health makes us all better off.

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

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

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

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

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

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

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

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

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

FNA speech

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

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

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

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

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

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

Ko wai ahau? 

Ko Kapukataumahaka tōku maunga

Ko Owheo tōku awa

Ko Cornwall tōku waka

Ko te Tāngata Tiriti tōku iwi

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

Who am I? The sacred mountain overlooking my birthplace is Kapukataumahaka, and the sacred river is Ōwheo. My ancestors arrived on board the ship, Cornwall. My tribe is known as the People of the Treaty, which means I am not indigenous. I reside on the land by right of Te Tiriti o Waitangi, the 177-year old treaty between the Māori peoples and the British Crown. My name is Grant Brookes and I am the Co-President of the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitaiki ō Aotearoa. 

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

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

Vakaturaga i Kubuna, Burebasaga, Tovata. 

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

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

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

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

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

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

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

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

2018-04-28 Speech to FNA AGM – slides 

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

2018-04-28 Speech to FNA AGM – slides2 

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

2018-04-28 Speech to FNA AGM – slides4

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

2018-04-28 Speech to FNA AGM – slides5

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

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

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

2018-04-28 Speech to FNA AGM – slides6 

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

2018-04-28 Speech to FNA AGM – slides7 

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

2018-04-28 Speech to FNA AGM – slides8 

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

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

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

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

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

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

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

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

And what is Universal Health Coverage? According to the World Health Organisation, “UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

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

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

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

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

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

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

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

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

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

Bagshaw said the 9 percent of people with an unmet secondary health care need in the survey had been told by a specialist they needed treatment but had not received it, generally because they didn’t meet the criteria to go on the waiting list.

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

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

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

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

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

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

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

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

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

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

2018-04-28 Speech to FNA AGM – slides9 

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

2018-04-28 Speech to FNA AGM – slides10

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

We’ve been front page news.

2018-04-28 Speech to FNA AGM – slides11 

We’ve been on TV, too. 

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

2018-04-28 Speech to FNA AGM – slides13 

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

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

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

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

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

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

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

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

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

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

2018-04-28 Speech to FNA AGM – slides14

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

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

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

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

Vinaka vakalevu 

Proud to serve for three more years – excited by our collective potential

1

This afternoon’s announcement by NZNO Chief Executive Memo Musa that I have been re-elected unopposed for a second term as President came as a great surprise. A fuller and more considered statement on the election results (see below) must wait, but I offer some initial comments.

The 2018 leadership elections came at a time of adversity both in the health sector and in our organisation. Over the next three years, I aim to ensure that the momentum driven by members and harnessed above all by the #HealthNeedsNursing campaign also flows into the renewal of NZNO as an organisation which is open and responsive to members.

With courage we can journey past adversity to secure renewal and change. This goal is expressed in the statement (no longer needed, but available here) which I submitted for Kai Tiaki Nursing New Zealand and the candidate profile booklet.

It is regrettable that the lack of an election has deprived future NZNO leaders of the opportunity to campaign and make themselves known to the wider membership. However, it is my great hope that many will consider putting themselves forward in the next elections for the NZNO Board of Directors.

First and foremost I thank every member who over my first term has shared their aspirations for our organisation with me. Let us work on those now together.

I also wish to thank my campaign team who generously gave me their belief and support.

I thank outgoing Vice-President Rosemary Minto, who did not stand for re-election, for her contribution to NZNO over these three years. Rosemary’s broad experience in governance roles has enriched Board discussion and strengthened our decision-making.

I greatly look forward to working more closely with Cheryl Hanham, who will take office at the NZNO AGM in September. NZNO has a Vice-President Elect of unsurpassed dedication to members and to the nursing profession.

I relish the opportunity to continue working with Kaiwhakahaere Kerri Nuku, Tumu Whakarae Titihuia Pakeho and Te Rūnanga o Aotearoa NZNO to strengthen bicultural relationships right across our organisation.

And for myself, I am proud to serve for three more years.

 

2018-04-20 NZNO nominations and elected unopposed Further Notice of Election 2018

The President comments: ‘The winds of change now blowing’

Kai Tiaki cover, 4.18
First published (slightly abridged) in Kai Tiaki Nursing New Zealand, April 2018. Reposted with permission.

WHEN 28,000 nurses, midwives and health-care assistants voted last month to reject the second district health board (DHB) multi-employer collective agreement (MECA) offer – knowing a strike ballot would be the next step – the “no” was powerful enough to influence the course of history.

The vote was a message to stop devaluing nurses and stop failing the patients and communities who need our care. After a decade of worsening health underfunding, the vote said, “No more!”

Only once before – in 1989 – have New Zealand nurses taken nationwide industrial action. This mobilisation reshaped nursing and led to the birth of NZNO. The winds of change now blowing will also be felt beyond the DHBs.

But for every “no”, there is a “yes”. Through their vote, our DHB members were also affirming the need to restore our public health system, to recognise and fairly reward all members of the nursing team for their skilled work and to address the staffing crisis.

This “yes” belongs to everyone – people inside and outside NZNO, health-care workers and the communities we serve. All can come together to agree that health needs nursing.

Launched on March 26, #HealthNeedsNursing is the name of NZNO’s new DHB campaign. It’s an affirmation that the nursing team is the essential core of the health system. We are dedicated, caring and always there.

#HealthNeedsNursing also says that the health system itself is ailing. In a way, the rot in the walls at Middlemore Hospital is symbolic. Those in charge at Counties Manukau DHB have known for years the hospital is sick. But to remain within their undersized budget, as demanded by the previous government, they just patched holes in the walls and carried on, until the problem couldn’t be covered up any longer.

Health system sick

It’s like that for the whole DHB sector. There’s now no denying the health system is sick. It needs to be nursed back to health.

Already, our campaign is growing. Council of Trade Unions president Richard Wagstaff came to the launch, and pledged the support of the union movement.

Prime Minister Jacinda Ardern has also given a “yes”, of sorts. The morning after NZNO said “no”, she told the AM Show on TV3, “I value our health workforce. Do I want our nurses to be satisfied? Of course I do. Do the DHBs need more money? Yes.”

Public opinion

At the same time, though, she talked about barriers around “timing” and “budget allocations”. If our campaign can win strong public agreement that health needs nursing, then the pressure of public opinion can help overcome barriers for the Government.

#HealthNeedsNursing - Weeks of Action launch 2
The #HealthNeedsNursing Weeks of Action were launched on 9 April, taking the message to commuters at Wellington Railway Station.

At the same time, the campaign is also setting the pattern for a renewal of NZNO as an organisation which is open and responsive to members.

Members are making the big decisions through democratic votes. Campaign planning is taking place through cooperation between NZNO staff and member leaders, from local workplace delegates to the nationally elected board. Actions are designed to maximise member participation.

As the current surge draws more members into action, the transformation of NZNO is bound to continue apace. 

Wellington rally for good health2, 13.4.18
Wellington Hospital Rally For Good Health, 13 April.

By the time you read this, the next stage of the #HealthNeedsNursing campaign will be well under way. Rallies for good health at each DHB, from April 9-20, will also prepare us for whatever comes next.

Let’s make them big, loud and proud. •

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

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

E ngā mana, e ngā waka, e ngā hau e wha, tēnā koutou.

Ko te kupu tuatahi ka tuku ki te Kaihanga. E te iwi kāinga, ko Ngāi Tahu, tēnā koutou. Kei te mihi anō ki ngā maunga, ngā awa me ngā wāhi tapu o tēnei rohe.

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

Ko wai ahau? Ko Kapukataumahaka te maunga, ko Ōwheo te awa, ko Cornwall te waka, ko Tangata Tiriti tōku iwi, ko Grant Brookes ahau.

He tapuhi, he kaiārahi; kia piki ake te hauora – ēnei te kaupapa o te hui nei.

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

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Greetings, to the Creator and the home people, Ngāi Tahu. I also acknowledge the mountains, rivers and sacred areas of this district.

I acknowledge too those from our nursing whānau who have passed on since we last gathered together. 

I address in particular Maureen Laws, a leader in nursing and midwifery on the national and international stage, who had a special connection to this place. Born in Christchurch in 1939, Maureen completed her nursing training here in 1960. Over the decades until her passing in Wellington last month, Maureen made an enormous contribution to NZNO and to our forerunner, the New Zealand Nurses Association. In the 1980s, she led the drafting of NZNA’s first social policy statement and championed nurses’ right to participate in health and social policy development – a cause which strikes a chord with the theme of today’s convention. 

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

Who am I? I hail from Dunedin. I grew up here at the foot of Mt Cargill and by the Water of Leith. My ancestors arrived on board the ship Cornwall. My name is Grant Brookes.

Nurses as leaders, to improve health. This is the focus of our hui. So greetings, greetings, greetings to you all. 

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I’ve been asked today to break down the theme for the day, and to address one particular piece of it. But before I start, I’d like to acknowledge our midwives and all our other members, even though I’m not qualified to speak for you on professional matters. 

So, “nurses – a voice to lead”. What does this mean? 

According to the International Council of Nurses, “Becoming a voice to lead means talking to governments, community leaders, policy makers and investors”. 

It’s not just talking for the sake of it, though. Our voice is used to lead them, but towards what? 

In the first session this morning, Professional Nurse Advisor Julia Anderson helped us to identify examples of leadership at the point of care. 

Although the term didn’t come up, it seemed to me that we were talking about what the World Health Organisation now calls “a people-centred and integrated health services approach”. 

People–centred care is a return to the basics and to the evidence of putting people at the heart of health care. It is about nurses being true to what is at the heart of the nursing profession. 

Drawing on NZNO’s newly-published Strategy for Nursing 2018-2023, Julia also stressed that nurse leadership happens across a variety of levels, and does not depend on being in a formal leadership role in a health provider or policy agency. This point was reinforced by your Regional Council Chair, Cheryl Hanham, who mentioned the advocacy role of workplace delegates. 

And Kerri just now has spoken about advocacy in international forums, and towards the United Nations’ Sustainable Development Goals. 

I want to highlight one other way that nurses are a voice to lead towards these goals. 

The SDGs comprise 17 goals, such as “Good Health and Well-Being for people”, and 169 targets which governments have committed to meeting by 2030. Achieving Universal Health Coverage is one such target.

New Zealand is generally thought to have achieved this target long ago, as far back as the end of the 1930s. But is this really so? 

According to the World Health Organisation, “UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

I think it’s arguable whether this is actually true today. 

Last year, a pilot study published in the New Zealand Medical Journal found at least 25 per cent of adults were unable to get the primary health care they required while 9 per cent of people had unmet secondary health care needs.

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

Bagshaw said the 9 per cent of people with an unmet secondary health care need in the survey had been told by a specialist they needed treatment but had not received it, usually because they did not meet the criteria to be put on the waiting list.

Which brings me to the 200 nurses, midwives and HCAs who rallied outside Middlemore Hospital in the rain from 6.30am this morning. As NZNO Educator John Howell mentioned in the previous session, they were taking action as part of NZNO’s #healthneedsnursing campaign, standing up for their human rights. 

Each one of them was also a voice to lead for health. 

Our #healthneedsnursing campaign website explains: “Over the last decade severe underfunding of our public health services has meant our health system has failed to keep pace with our growing community need, the demands of an ageing population and ageing workforce, and increased costs of providing services.” 

The messages on the placards at Middlemore included, “Patients deserve better”, “Good health needs valued nurses” – as well as slogans like, “Reward our work” and “2%? No way!”. 

Those NZNO members were, in the words of ICN, “talking to governments, community leaders, policy makers and investors”. They were using their voice to lead in the service of Universal Health Coverage, ensuring global goals are met. 

Being a voice to lead is often assumed to be part of our professional role, as nurses, and rallies are something we do as unionists. But professional issues can never be completely separated from industrial realities. They are inseparable parts of a whole. They can’t be divided, any more than you or I can be split into two different identities. 

The campaign website goes on: “Every day the nursing team advocates for the health and wellbeing of patients, families, whānau and the community. But right now they are advocating for the wellbeing of nurses and the whole public health system.” 

So I salute all of you who are becoming a voice to lead through the #HealthNeedsNursing campaign, and urge everyone who can to join the rally outside Christchurch Hospital from 11.30am to 1pm on Friday. 

At the same time, I believe we need to see this campaign just one expression of our nursing voice to lead in the achievement of health a human right. 

We need to be “at the table” in the earliest stage of problem identification and solution framing, whenever and wherever policy is being made – from local workplace to national and international forums. Nurses must get more deeply engaged in understanding influence in all policy making. 

If doing this, we have to do our homework and understand how the evidence is related to the issue we are trying to influence. We need also to look at how we express the groups affected and the degree to which this will engage others. 

Next, we have to look at the politics of the environment. To prompt our thinking, we should ask ourselves – are we in tune with the cycle of organisational or government budget preparation? Have we done our stakeholder analysis? Are we a group that others will take notice of in relation to this issue or will it be seen as self–interest? Have we framed our interest, our input and our contribution in a way that will be heard by others as relevant and important? Who else is interested in the issue and has a compatible position and value system and are they potential collation partners? 

Who, within nursing is most advantageously positioned to take the issue forward to the outside world – is it NZNO, or is it the regulator, senior service leaders, or researchers? Do we have a unified professional message that will be committed to by all and not result in a divided voice? In other words, have we done our homework of working on a consensus position behind closed doors, before advancing it?

If we do this, we will truly fulfil our role as nurses. 

I want to conclude by talking briefly about an example of where it’s NOT our voice to lead – not for nurses like me, anyway. 

Julia Anderson this morning sounded a note of caution that the nursing voice does not replace the voice of the health consumer. Circling back to where I started this talk, with a mihi, it’s equally true that it’s not our place as tauiwi to lead Māori, but to acknowledge and walk alongside. 

We know that application of Te Tiriti o Waitangi to practice is a required competency for nurses. We know that Te Tiriti guaranteed Māori “tino rangatiratanga” or unqualified exercise of authority over their taonga. 

The Nursing Council Guidelines for Cultural Safety confirm that, “The nursing workforce recognises that health is a taonga”. 

They continue: “Tino rangatiratanga enables Maori self-determination over health, recognises the right to manage Maori interests, and affirms the right to development by enabling Maori autonomy and authority over health”.

The Guidelines also place an obligation on nurses to work in partnership, by “ensuring that the integrity and wellbeing of both partners is preserved”. 

So as we mobilise, as we exercise our voice to lead as nurses in Aotearoa New Zealand and change our world, we must at the same time remember to apply Te Tiriti and respect its promise of te tino rangatiratanga. 

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