Your Choice. Your Voice | Grant Brookes for NZNO President

Summer will soon be officially over, and 2017 well under way. It’s time to think about what the year ahead will hold.

For NZNO members, this year is filled with possibility. In 2017, we will have a real ability to make change for the better. And don’t we all need that!

Summer is often the season which reminds us most of life outside work. But when we’re run ragged through understaffing, and leave work exhausted, everyone misses out. Our friends and families don’t see us at our best. Our patients don’t get the best from us. We miss out ourselves, too, on the good things we see others enjoying.

Funding squeezes, year on year, have created an ever-increasing pressure to “do more with less”. This pressure is now being felt across the health sector.

It has pushed resident doctors in district health boards (DHBs) to take escalating industrial action, just to get rosters and staffing levels which don’t leave them burnt out, and on the edge of unsafe practice. St John Ambulance professionals can’t get the rest and meal breaks they need so they’re fit to make decisions on the job. In many places, ambulances still aren’t fully crewed with skilled staff.

Funding squeezes also mean that more and more people are missing out on the health care they need, while new grad nurses who could provide care struggle to find work. So how can we change this for the better?

Day in and day out, nurses and midwives at all levels claim the right to take part in decision-making, based on our professional expertise and experience. But in 2017, the opportunity for all NZNO members to influence the future of health will be greater, due to the alignment of two major events.

Renegotiation of the DHB multi-employer collective agreement (MECA), which expires in July, will enable close to 30,000 of us to have a say about conditions in the public health system. The general election  in September allows every member to have a say about this country’s priorities – not just as an individual voter, but also as an influential member of their community.

Nursing’s full power

Professionalism gives us a voice. But it’s the synergy between professional authority, industrial strength and political enfranchisement – like the one developing this year – that releases the full power of nursing.

That’s not to say it’s going to be a walk in the park. The resident doctors are facing an uphill battle and attacks in the media. Ambulance professionals suffered 10 per cent pay cuts designed to weaken their resolve.

But public support for the doctors has been overwhelming. In a 1 News Facebook poll, 95 per cent of respondents supported their strike last month.

And the “ambos” have showed that when you stick together and stand firm, fairness can win. In mid-January, St John backed down on the pay cuts and talked about repaying all wages they’d deducted.

For us, if you’re in a DHB the first step in making change is exercising your right to attend the MECA meetings which start in May. Times and places will be advertised by NZNO delegates and organisers.

Then, in the election, NZNO won’t tell members who to vote for. But staff will produce resources to enable you to make an informed vote for a government which values health, and to support conversations with family, friends and workmates so they can do the same.

There are 48,000 NZNO members, and many more potential supporters. There is power in numbers. Chances like this may not come around again for a while, so this year we need to seize our opportunities and use our power for nursing and health. •

“DID YOU notice that?” I asked.
It was near the end of the first day of last month’s NZNO annual general meeting (AGM) and conference, and I was talking to NZNO vice-president Rosemary Minto. What I was asking about was something that lasted no more than five or 10 seconds, and happened during my opening speech.

When I reported to the assembled delegates that our board of directors had reviewed NZNO’s investment portfolio, and had moved to divest any direct holdings in fossil fuel companies, the room erupted into applause.

I was momentarily taken aback. I’d thought this was a fairly dry part of my speech, and didn’t expect such a reaction. So I said to Rosemary that when something unexpected like that happens, it tells us we need to update our assumptions.

The health impacts of climate change, and the need to withdraw investment from fossil fuel extraction to shift towards a low- carbon economy – as explained by environmental group 350.org – were both put on NZNO’s agenda by a vote at last year’s AGM.

And just as they were put on the agenda by NZNO members, it was ongoing activism by members which then made the divestment happen this year. Going by the spontaneous applause during my speech, this is clearly an issue which is widely and deeply felt.

At the time of the 2015 AGM vote, large organisations in New Zealand were just starting to get behind fossil fuel divestment. The Presbyterian Church, Dunedin City Council and Victoria University voted to divest in 2014. The Royal Australasian College of Physicians and the Tertiary Education Union did the same in 2015.

Since then, Otago University has voted to divest from fossil fuels, while Kiwisaver providers, the NZ Super Fund and Auckland Council, have ditched their shares in weapons manufacturers and unhealthy food brands and are reconsidering their fossil fuel investments.

Could it be that when members call the shots, NZNO is more in tune with positive shifts in public attitudes and more able to make ethical decisions?

Member-driven 

The need for organisations to be member-driven was another theme which ran through our AGM and conference.

Guest speaker Frances Hughes, who is chief executive of the International Council of Nurses, stressed the strategic direction of ICN was set by its 130 member organisations. There is no room for passive membership, she said.

President of the Canadian Federation of Nurses Unions (CFNU) Linda Silas reminded us that NZNO members pay for all NZNO activities and salaries, right up to chief executive Memo Musa. “You have to listen to your members,” she said.

It’s probably no coincidence that both speakers also talked about how their nursing organisations are now focusing on climate change as a determinant of health. This was the topic of one of the ICN interventions at this year’s World Health Assembly – the biennial meeting of health ministers, held under the auspices of the United Nations (UN).

But for NZNO members to steer this organisation, you need to know what’s going on. So another link in this chain – stretching all the way from your workplace and community to the world-shaping decisions at the UN – was provided by an AGM vote for greater transparency. From now on, the agendas and minutes of NZNO board meetings will be available to members.

Knowledge is power. And when NZNO members are empowered, then I believe we are better equipped to achieve NZNO’s strategic goals – including implementation of population health approaches which reduce health inequalities, and address determinants of health and those things that affect people’s ability to live well.

So my message to members, after our AGM and conference, is to keep on speaking up about NZNO’s direction. It’s not too much of a stretch to say that if you do, then together we can help save the world. •

Response to NZNO Consultation Request: Essential skills shortage review – Immigration New Zealand, from Grant Brookes

It is widely accepted that anti-immigrant sentiment is on the rise in developed countries. Negative attitudes towards new migrants are seen as a factor in many political developments today – from the popularity of US presidential hopeful Donald Trump, to the UK’s “Brexit” vote to leave the European Union, the growth of European Far Right parties and the implementation of harsh anti-asylum seeker policies in Australia. The powerful emotions which often accompany the immigration debate have also been used by politicians here.

NZNO is currently involved in a review of Essential Skills Shortages in nursing, being undertaken by Immigration NZ. The outcome of the review will affect how easy it is for Internationally Qualified Nurses to gain temporary work visas and possible residence in New Zealand.

NZNO members are being consulted, to inform our organisation’s input into the review. If you’re a member, you can have a say by emailing NZNO Senior Policy Analyst Marilyn Head (marilynh@nzno.org.nz) by 17 August.

In my role as President, I represent NZNO to external stakeholders. When I do this, I reflect our organisation’s agreed positions.

But I am also a member of NZNO. And in that role, since our position has not yet been decided, I would like to express my own individual views about Essential Skills Shortages in nursing. This will be considered, along with every other member’s feedback, in shaping NZNO’s input into Immigration NZ’s review.

I would like to start by stressing that in today’s world, it is especially important that NZNO’s position is based on careful, dispassionate examination of the available evidence and informed by critical social theory. Prevailing social attitudes can colour our perceptions in ways we are unaware of. This is a particular risk for those of us who benefit from prevailing social conditions, such as white privilege.

The review is considering shortages in five nursing specialties – Aged Care, Critical Care and Emergency, Medical, Mental Health and Perioperative. In each specialty, Immigration NZ has to decide three things – whether the occupation meets skill level requirements, whether it’s of sufficient scale to warrant a listing, and whether or not there is a shortage. Since all nurses are classified as skilled workers, and there are lots of us, the only real question is the third one.

To answer it, Immigration NZ has produced Preliminary Indicator of Evidence Reports (PIERS), which look at just five indicators of workforce shortage. The reports conclude that more information about these five indicators is needed to determine whether there is a shortage – from employers, government agencies, and from unions like NZNO.

As the consultation request for NZNO members points out, “there are many aspects affecting workforce supply and demand that are not reflected in the PIERS reports, and which should be considered as part of the review. Eg resourcing, recruitment and retention policies, pay and conditions, safety, quality etc.”. In addition to the ones mentioned in the NZNO consultation request, I think we also need to consider workforce projections.

As has been widely discussed, the Nursing Council of New Zealand commissioned a major report in 2012, titled The Future Nursing Workforce: Supply Projections 2010 – 2035. This report showed how factors such as ageing and increased life expectancy among the general population are expected to increase the demand for healthcare. It observed that the nursing workforce is ageing, and predicted that over 50% of our present workforce will retire by 2035. It concluded that under a “business as usual” scenario, the nursing supply will remain adequate until 2020 but then begin to diverge from health demand, resulting in a shortage of 15,000 nurses by 2035.

More recently, these projections have been questioned by the Office of the Chief Nurse and Health Workforce NZ (HWNZ), who this year published some results from their own workforce modelling (see coverage in Nursing Review, “Nursing Shortage Forecast Cautiously More Optimistic In Short Term“). Their updated forecast notes a sharp rise in the number of registered nurses being educated in New Zealand since 2010. It predicts that the growth in the nursing workforce as a whole is on track to match population growth by 2025. But it is still predicting steep declines in the proportion of aged care, Māori, Pacific and enrolled nurses required to meet projected demand.

And crucially, this (slightly) more optimistic overall picture is based on the assumption of internationally qualified nurses (IQNs) continuing to make up 26 per cent of the RN workforce, including 50 per cent of the RNs in residential aged care and all continuing care (elderly) settings by 2025.

While they’re outside the narrow scope of Immigration NZ’s review, these workforce projections would not provide evidence for removing the five nursing specialties from Essential Skills Shortage lists.

There are two other arguments which have been raised for removing nursing from the lists, which also lie outside the current scope. The first is the impact of immigration on new graduate employment opportunities.

New grad employment is an issue which is very dear to me. It breaks my heart that only 54% (677) of the 1285 Registered Nurses who graduated last November got jobs through the December intake of the Nurse Entry to Practice (NETP) Programme. The disappointment and hardship suffered by each of the 568 unsuccessful new grads, after years of sweat and rising debt, is only compounded by the stress of all the RNs I know who are working short-staffed and needing more help, and the waste of taxpayer’s money spent on three years of underutilised higher education. I would support removing nursing from Essential Skills Shortage lists, if it reduced this misery and waste.

NZNO has committed to ensuring that there’s a NETP place for every new graduate nurse, by 2018 at the latest. And to be eligible for a NETP place, a new grad nurse must be a New Zealand citizen or permanent resident. IQNs cannot apply, so immigration has no direct impact on new grad employment.

It has been said that ongoing migration of IQNs undermines efforts to make Aged Care a priority area for voluntary bonding, since almost half of the IQNs currently working in New Zealand are employed in this sector. Adding Aged Care to the list of “hard-to-staff” specialties would provide financial incentives for New Zealand Registered Nurses (NZRNs) to work in this area, and would be valuable for new grads and workforce planners alike.

But whether or not they’re eligible for the voluntary bonding scheme, according to NZNO new grads in Aged Care still deserve to be employed under the NETP Programme. And as mentioned, these positions are only open to New Zealanders.

This means, essentially, that in NZNO’s view there should be no direct competition for jobs between IQNs and new grads – in Aged Care, or any sector of the health system.

In fact, depending on the specialty, IQNs must have three to five years post-registration experience in order to apply for a work visa under an Essential Skills Shortage category. So while there is some competition for jobs with more experienced NZRNs, the positions which IQNs are taking are not positions which a new grad could fill.

Therefore, reducing the IQN intakes under current Essential Skills Shortage categories would not improve new grad employment prospects in any significant way. What’s worse, continuing to focus on immigration distracts us from real solutions to new grad unemployment.

Last year, delegates to NZNO’s AGM voted for a resolution: “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”. To address new grad unemployment woes, attention could turn instead to this positive alternative, and to NZNO’s new “Shout Out For Health” campaign for a health system fully funded to employ the nurses needed.

The other argument for making it harder for IQNs to obtain work visas, which is outside the scope of the current review, relates to concerns around the “cultural awareness” of IQNs. Some within the profession openly doubt the ability of IQNs to care for patients in New Zealand in a culturally safe way.

In response I say simply this: according to the 2013 Census, nearly 40 percent of the population of Auckland was born outside of New Zealand. That’s well over half a million people. The most common overseas birthplaces reported were in Asia.

It is my view that cultural competency must be seen at a workforce level, as well as at the level of the individual practitioner. Viewed from this perspective, IQNs do not detract from cultural safety, they add to the ability of our profession to care for our culturally diverse population.

NZNO has long advocated for Māori and Pacific nursing workforce strategies which will see the proportion of these nurses matching the ethnic composition the population. So there is some precedent for this approach. And just as in Māori and Pacific workforce development, the proportion of nursing students from other ethnic minority backgrounds currently being trained in New Zealand is also too low to meet population needs. Our input into the Immigration NZ review should therefore recognise the valuable cultural skills which IQNs bring.

None of this, of course, replaces the Nursing Council’s specific cultural safety requirements for every IQN to understand the health and socio-economic status of Māori, and to practise in accordance with the Treaty of Waitangi. As for all tauiwi, education will be required for an IQN to meet this competency. And this may take time. But despite the lack of previous knowledge of the Treaty, there are reasons to believe that IQNs from major source countries may be well predisposed to learning – including shared historical experience of being colonised by European powers, and a common experience of discrimination on ethnic grounds.

In conclusion, it worth noting what is at stake in this review. As at 30 June 2016, there were 8,371 NZNO members who identify as Indian, Chinese or other Asian ethnicities. These are our fastest-growing membership categories. Many of them will be IQNs on temporary work visas, which last a maximum of 30 months. If the nursing specialties are removed from the Essential Skills Shortage lists, then our fellow union members who’ve been in work for less than two years could lose their jobs, and be forced to leave the country. 

It is my view that evidence does not support the removal of nursing specialties in Aged Care, Critical Care and Emergency, Medical, Mental Health or the Perioperative environment from Essential Skills Shortage lists, and that arguments in favour of doing this are contradictory or flawed.

Above all, at a time of rising hostility and public debates over whether there are “too many immigrants”, it is important to recognise and value the special contribution that IQNs make to nursing in New Zealand.

If any other NZNO member would like their feedback considered as part of NZNO’s submission to Immigration NZ, as noted above they should email NZNO Senior Policy Analyst Marilyn Head (marilynh@nzno.org.nz) by 17 August.

You can still have a say up until 24 August though, as an individual, by emailing the Ministry of Business, Innovation and Employment on shortages.review@mbie.govt.nz. There’s more information about the review on the MBIE website: https://www.immigration.govt.nz/about-us/policy-and-law/how-the-immigration-system-operates/skill-shortage-lists

For many of us, world affairs aren’t something we think about much as we get on with everything that needs to be done at work, and at home. But lately, for better or worse, global events seem to be impacting more than usual on our daily lives. Some of us woke up after the United Kingdom’s “Brexit” vote to find our KiwiSaver balances were suddenly lower than expected.

Meanwhile, amidst all the hub-bub and noise of the United States presidential elections, it seems the Trans-Pacific Partnership Agreement (TPPA) has been defeated, in its current form. The TPPA would have undermined health here in Aotearoa. But thanks to a people’s movement, with America’s largest nursing union, National Nurses United (NNU), at its core, it looks likely our professional aspirations to deliver the best possible care will be protected for now.

Even the biggest issue we face as health-care workers – safe staffing – has been the subject of international connections. As reported in the July issue of Kai Tiaki Nursing New Zealand, NZNO last month hosted the leaders of the Canadian Federation of Nurses Unions (CFNU).

The main purpose of their visit was to study how our care capacity demand management (CCDM) programme works, as a mechanism to deliver safe staffing in district health boards (DHBs). But they also talked with me about Global Nurses United (GNU). GNU is a new international network of nursing unions from 19 countries. CFNU and NNU helped establish it in 2013.

It was founded to “step up the fight against the harmful effects of austerity measures, privatisation and cuts in healthcare services” and to “work collectively to guarantee safe staffing and the highest standards of universal healthcare as a human right”.

The leaders of GNU were also opposed to the adverse effects of income inequality, poverty, maldistribution of wealth and resources, and the ravages of climate change.

The “austerity” mentioned refers to the way governments have responded to the global financial crisis. Austerity involves cutting government spending, including health spending, in the belief this will boost economic growth.

In this country, the erosion of core government health expenditure means there is now a shortfall of $1.2 billion, compared to the 2009/10 year. This is one reason why attempts to implement CCDM in a timely way have struck so many road blocks.

To address this, NZNO is launching a major new campaign, Shout Out For Health. We’re aiming high – the goal is a fully-funded health system, where we’re properly resourced to provide care we’re proud of. Shout Out For Health will strengthen our DHB MECA campaign next year and put a strong case for health during the 2017 general election. It’s something that all NZNO members can take part in.

But as we push against austerity and for safe staffing, we can also look to joining with others around the world doing the same. As they say, “act locally, think globally”.

Last September, delegates at NZNO’s annual general meeting (AGM) voted to “review our international affiliations before AGM 2016, in order to expand our global connectedness with nursing unions and professional associations in a cost-effective manner.”

That review, completed in June, talks of the potential for NZNO to become part of GNU. I believe we share many of the same nursing and union values as other GNU members. We’re already working on many of the same issues. It would be more effective if we did it collectively. And joining GNU is free.

I think it might be time we signed up.

Today we celebrate NZNO’s accreditation as a Living Wage employer. The announcement is confirmation from the Accreditation Advisory Board that NZNO has met all the criteria to wear this badge of honour.

The impact of today’s announcement won’t be felt by anyone directly employed by NZNO. They are already paid above the current Living Wage of $19.80 an hour.

But the decision to become an accredited Living Wage employer means all our contracted staff get this rate, too. So it will be felt by people like Yong, who cleans the NZNO National Office after hours.

Yong has told me that she works two cleaning jobs – both for minimum wage. She starts at a motel at 8.45am in the morning, and finishes at NZNO at 9pm at night.

Yong has now received her first pay at her new rate, and was so happy that she could buy better food at the supermarket, instead of the cheapest food. Her dream is that now she might be able to go home to China to visit her father, who she hasn’t seen in four years.

She wanted me to write this, she said, so everyone could understand how much NZNO’s decision  means.

It has been a long journey to reach this point, with plenty of debate and discussion along the way. So it’s fitting today to look back on how we got here, and pay tribute to the NZNO members who kept us moving forward.

It’s now over four years since the Living Wage was launched in Auckland, in May 2012. NZNO was one of the first organisations to sign up to the statement of principle:

“A living wage is the income necessary to provide workers and their families with the basic necessities of life. A living wage will enable workers to live with dignity and to participate as active citizens in society. We call upon the Government, employers and society as a whole to strive for a living wage for all households as a necessary and important step in the reduction of poverty in New Zealand.”

Our support was based on our understanding – as nurses, midwives and healthcare workers – that poverty and inequality are a root cause of much ill health. Some of us, especially those in aged care, and Māori and Pasifika members, knew this from personal experience of low pay.

Back in 2012, economists calculated that the Living Wage needed to live with dignity and participate as an active citizen in society was $18.40 an hour.

In the DHB elections the following year, NZNO asked candidates to support the idea that all DHB staff should get at least the Living Wage, which by 2013 had been recalculated as an hourly rate of $18.80.

At this time, we were coming to understand that it wasn’t enough to just agree with the Living Wage in principle. We should also contribute to the organisation which was working to make it a reality. In August 2014 NZNO took its place alongside other organisations as a full member of Living Wage Movement Aotearoa NZ Incorporated.

What propelled us along was growing support for the Living Wage among NZNO members.

Using the Nursing Matters manifesto, we’d been calling on voters and politicians from all parties in the 2014 general election to see a Living Wage for all as fundamental to a fair and healthy society.

Those of us who attended the DHB MECA endorsement meetings in late 2014 then showed our support by voting overwhelmingly for a set of claims which included progress towards the Living Wage (which by then meant at least $19.25 an hour) for HCAs.

When we couldn’t get agreement on this from employers, members expressed their frustration and reaffirmed their belief in the Living Wage at DHB MECA ratification meetings around the country.

By 2015, awareness was growing further. If we were asking our health sector employers to pay a Living Wage, then NZNO needed to walk the talk and do it, as well. That awareness culminated in a vote at last year’s NZNO AGM. Delegates from across New Zealand decided, by a large margin of 85 percent to 15 percent, to set a deadline of today ­­- 1 July 2016 – for NZNO to become an accredited Living Wage employer.

There are also some NZNO members who deserve special mention, for helping our organisation to reach this goal.

They include people like Maire Christeller (left), a Primary Health Care nurse and workplace delegate, who has been involved in the Lower Hutt Living Wage Network since the beginning. She helped to spread the message to other NZNO delegates in the Hutt Valley, and has also lobbied for Hutt City Council to become a Living Wage employer.

Kathryn Fernando is a delegate at Capital & Coast DHB, who joined me on last year’s “Mop March” to Wellington City Council, aimed at extending the Living Wage to contracted council workers, like cleaners and security guards.

Litia Gibson works at Porirua Union and Community Health Service. She has led the nursing team’s support for their workplace paying the Living Wage (even if they aren’t accredited yet).

Kieran Monaghan is a Primary Health Care nurse and a leader of the Living Wage Movement in Wellington. It was his tireless efforts last year – presenting on the Living Wage at the NZNO Greater Wellington Regional Convention, getting the issue into Kai Tiaki, writing for NZNOBlog, and drafting the successful remit for the NZNO AGM setting a deadline for accreditation – which helped us take the final step.

As NZNO President, I have spoken of the need to strengthen union values within our organisation, as we continue to sharpen our professionalism – values like social justice, equity and solidarity.

By walking the talk on the Living Wage today, I believe we’re doing just that.