Following mediation in late January the New Zealand Nurses Organisation are waiting for the 20 DHBs to consider whether they can come back with a new offer by February 26.

The online petition was launched by NZNO in December after members voted to reject the DHBs’ initial multi-employer collective agreement (MECA).

NZNO Industrial Adviser Lesley Harry said nurses want to achieve pay rates and conditions that led to sustainable workforce and healthy workplaces.
She said any new offer needed to deliver improvements on the key issues – including a improved pay offer, safe staffing cand a firmer timeframe for pay equity – if it was to be accepted by members.

NZNO delegates Sarah Gilbertson and Karen Durham presented the petition to DHBs’ advocate Kevin McFadgen and said pay and conditions had to improve in order to sustain a quality health care service.

The pair said the issue was about recognising and rewarding a predominately female workforce. “The outcome of these negotiations is a reflection on our society and the value we place on health. Well supported health teams improve the health of all New Zealanders.”

NZNO has set up a series of MECA meetings between March 6-23 for its 27,000 registered nurse, enrolled nurse, midwife and health care assistant members covered by the NZNO/DHB MECA.

Prior to mediation the union indicated that it would not rule out using the March meetings to vote on industrial action, if a deal couldn’t be reached that it believed members would be ready to accept.

Late last month Health Minister David Clark told Nursing Review that he understood nurses’ and other health workers hopes for better salaries under the new Government but the was reality was that “not everyone’s expectations will be met”.

PETTION:
Dear District Health Board Chief Executives

‘Nurses, midwives and healthcare assistants are the heart of our public healthcare services. Their skills, hard work and compassion keep all New Zealanders happy, safe, and healthy. I support better pay and healthy workplaces in our public healthcare services for our precious nursing and midwifery teams. Please keep our local health services safe and sustainable by delivering our nurses a better deal.’

The link between unhappy patient and too few nurses per patient in England’s National Health Service (NHS) hospitals was found in a major quantitative study led by researcher Linda Aiken.

The study, published in the British Medical Journal earlier this year, is the first to bring together data on patient to RN staffing ratios, missed nursing care and patient satisfaction with NHS hospital care in England. Researchers say their findings refutes claims that quality of care deficits in NHS hospitals were due to uncaring nurses.

The study, led by Aiken, the professor of nursing at the University of Pennsylvania, said, highly publicised reports citing preventable deaths and deficiencies in hospital care in England, like in Mid-Staffordshire, had uniformly concluded that inadequate hospital professional nurse (RN) staffing was a contributing factor.

But she said that despite that leading to national guidance on safe staffing there was still substantial variation in staffing levels across NHS hospitals and the value of more RNs per patient was still questioned at the policy level.

Data gathered during the RN4CAST study found that nurse workloads averaged 8.6 patients per RN during the day, and ranged from 5.6 patients per RN to 11.5 patients per RN across the 46 hospitals involved in the English arm of the international research study.

“National survey data from patients experiencing a hospitalisation in an NHS hospital in England confirm that patients have a high level of trust and confidence in RNs.” The study said this evidence refuted the media reports blaming quality of care deficits in NHS hospitals on uncaring nurses.

“However, only 60% of patients indicated that there were always enough RNs to care for them, and 1 in 10 patients indicated that there were never rarely enough RNs. The importance to patients of adequate RN staffing is evident in their responses; 57% of patients who indicated that there were always or nearly always enough RNs to care for them rated care as excellent, compared with only 14% of the patients who said there were rarely or never enough.”

The researchers said additional analyses undertaken indicated that patients in hospitals with poorer RN staffing were much less likely to say there were always enough nurses to care for them.

“We estimate, from models that took account of numerous confounds, that the likelihood of patients saying there were always enough nurses to take care of them were about 40% lower in hospitals in which the average nurse took care of 10 patients than in hospitals in which the average nurse took care of 6 patients. These findings reinforce from patients’ perspectives the importance of adequate hospital RN staffing.”

The researchers concluded that the evidence showed that English patients expressed a high level of confidence and trust in nurses; and their satisfaction with hospital care was less favourable when they perceived there weren’t enough nurses available.

“The narrative that quality deficits in hospitals in England are due to ‘uncaring’ nurses is not supported by the evidence. On the contrary, our findings suggest that reducing missed nursing care by ensuring adequate numbers of RNs at the hospital bedside and improved hospital clinical care environments are promising strategies for enhancing patient satisfaction with care.”

The full study can be viewed at: http://bmjopen.bmj.com/content/bmjopen/8/1/e019189.full.pdf 

Victoria University researcher Dr Helen Rook’s recently completed PhD research found Kiwi nurses felt conflicted and anxious at being unable to deliver care true to their nursing values because of pressures on the ward to discharge patients quickly, keep-up the paper work and keep costs down.

She said the nurses’ response– sometimes conscious and sometimes not – was to focus on essential duties like documentation and nursing tasks as a coping strategy. Sometimes this also lead to nurses cutting short patient conversations, ignoring call bells and in other ways withdrawing from their patients to protect themselves emotionally.

Rook’s PhD research  – prompted in the wake of the inquiry into patient neglect in Mid-Staffordshire – involved spending 300 hours observing nurses on medical wards in three district health boards, multiple interviews, checking nurse sensitive indicator statistics (like falls and pressure injuries), and measuring burnout levels. She concluded that the conflict that the nurses felt – between their personal and professional values and how they actually were able to practice nursing because of the constraints of modern healthcare – caused anxiety, exhaustion, cynicism and burnout.

Building and supporting nursing leadership at the ward level upwards was one recommendation by Rook to help nurses speak up and act on their concerns. Another was for district health board and other healthcare providers to put in place strategies to help mitigate the organisational dysfunction and financial constraints that lead to nurses feeling unable to consistently deliver compassionate, clinically competent care.

Withdrawing from patients a coping strategy for conflicted nurses

“In all of the wards the nurses said they were practising team nursing and yet there was very little evidence of that,” said Rook.  Instead they were observed to be mostly focussed on tasks and “getting things done”.  “They are very skilful at that,’ said Rook. “In order to protect themselves they use defensive strategies to protect themselves from anxiety.”

She said the conflicted nurses also used the coping strategy of withdrawing a little bit from the patients they were caring for.  So they tried not get caught in conversations with patients by using strategies like giving a quick smile.  “Or say ‘I’ll be with you in a minute’ and then pull themselves away as they know they have all this other stuff they need to get done.”

Rook said she also observed more overt withdrawal by busy nurses. “I watched nurses walking past patients who were calling out for help, and call bells that were unanswered, not because nurses were uncaring but because they had so many other things to do, to comply with.”

When she spoke to nurses about the organisational values at their DHBs – and the DHB’s strategies for improving patients care – she said a number expressed cynicism that while DHBs talked about focusing on partnership and respect most improvement projects were actually about discharging patients quicker, balancing the budget and ensuring the required documentation was done.  She said there was also a sense that the DHB’s emphasis on economics and managerialism was becoming more prevalent not less.

But she added that for her Phd she drew on the iconic nursing research carried out in a London hospital in the late 1950s by Isabel Menzies, who wrote about how nurses de-personalised patients to protect themselves from the anxiety of their work.

“That’s a long time ago – we’re 2017 now – but a lot of things that she found in that research I also found in my research.  Not a lot has changed in healthcare in the intervening years really…”

Be consciously present not emotionally numb

“Nurses go into the profession with an assumption that they will be caring for people who are sick, taking a moment to talk with them and build caring relationships,” said Rook.

But said the current culture didn’t allow for that and DHB’s managerial imperatives to get patients out of hospital quickly, combined with financial constraints, meant that it just wasn’t possible.  So nurses often responded by focussing on doing the essential nursing tasks.

“I think there is a bit of guilt in that we focus on tasks,” said Rook.  “I don’t think it’s such a bad thing if we do. Because that is what the public expect – they expect us to be able to do things for them.”

Rook said if the reality was that nurses’ coping strategy for pressured workloads was to focus on tasks, then nurses should take ownership of this new reality.  They needed to be vocal about the type of nursing care they were able to deliver, and why, and then deliver the task excellently.

“We need to be very clear that ‘okay we are going to focus on a task but we are going to be excellent in that task and in our interactions with people….even if is only a minute or two.”

She said nurses need to aim to be fully present with their patient even if “just doing a task” as that would be much more beneficial therapeutically.

“We need to be consciously present rather than emotionally numb in our patient interactions.”

But in the long-term she said it was imperative that nurses on the frontline were supported to build leadership skills and find their voice so the culture was changed and they could provide the nursing care that matched their personal and professional values. Also organisations had to introduce strategies that removed the constraints currently preventing nurses from delivering that care.

Rook, who is currently the Programme Director at the Graduate School of Nursing, Midwifery and Health at Victoria University of Wellington, graduates next week with her PhD in nursing.

She has a background in critical care nursing in the United Kingdom, Ireland and New Zealand, and has worked as a nursing academic in New Zealand and Ireland delivering undergraduate and post-graduate education.

He was responding to the Association of Salaried Medical Specialists (ASMS) survey published today which found a third of senior doctors and dentists had been bullied at work, and two-thirds had witnessed others being bullied – mostly by fellow doctors.  The survey findings were presented to the ASMS Annual Conference in Wellington today and showed that much of the bullying was between medical colleagues with the most common bullying perpetrators being fellow senior doctors (52.5%), followed by non-clinical managers (31.8%) and clinical leaders (24.9%). (See full survey story at Health Central)

Musa said the NZNO Employment Survey and the NZNO journal Kai Taiki had repeatedly found that bullying had a huge effect on the nurse involved, and their colleagues, and could get to the point nurses leave for other jobs, go overseas or leave the profession altogether. He said he backed the Association of Salaried Medical Specialists’ call to bring the matter to the attention of district health board leaders and boards.

The report, Bullying in the New Zealand senior medical workforce: prevalence, correlates and consequences, is based on a survey of ASMS members in June 2017 with a nearly 41 per cent response rate.

“NZNO leadership will talk with Ian Powell (ASMS executive director) shortly as nurses have this issue too and we know that nurses are leaving the workforce for a different career because of it. This is the opposite of what this country needs, let alone our patients,” Memo Musa said.

“We know that in an underfunded health system the internal stress and pressure takes its toll. When nurses and doctors and other professionals are thin on the ground and working double shifts, the working environment  is not good, healthy or staff do not feel safe to speak up against bullying.

He said its report into short staffing at Counties Manukau DHB clearly showed that when there is understaffing that discomfort levels go up in the workplace with one nurse being yelled at if the requested help.  Musa said an article in the June edition of Kai Tiaki about a nurse who walked away from her job  –after management failed to stop the bullying that went  for two years by a charge nurse gained a ‘huge amount’ of Facebook comment from nurses sharing similar stories. “This is outrageous considering nurses are highly regarded by society yet too often treated badly in their employment situation.”

“We know that Lakes DHB, Auckland DHB and Capital and Coast DHB for example are proactively tackling this problem and it is commendable,” said Musa. “But there is a long way to go for the entire staff management system to operate in a way that protects all staff and has the right management and skill mix to avoid bullying and to indeed address it.”

Behaviour described in the ASMS report ranged from violence, threats and intimidation through to humiliation, persistent criticism, allegations, gossip, exclusion and excessive monitoring of work.

Key ASMS findings included:

• Workplace bullying occurs more often, and in different forms, for certain groups of senior doctors, eg overseas-trained doctors working in New Zealand, women, doctors aged 40 to 59, and in some specialties (emergency medicine, general surgery and specialist surgery).
• Only a third of doctors who said they had been bullied reported what had happened, with the main reasons for not reporting being fear of not being supported, and concern that reporting would make the situation worse.

ASMS Executive Director Ian Powell said the survey findings were very concerning and the union would be discussing them further with DHB chief executives and senior managers. Copies of the report had been sent to all DHB Chief Executives, as well as new Minister of Health, Dr David Clark.

Bullying Resources

• Netsafe website has a page dedicated to advice on online bullying and harassment netsafe.org.nzor you can email them directly for advice at: [email protected] or phone them on 0508 638 723
• New Zealand Nurses Organisation workplace bullying information and guidance: nzno.org.nz/bullyfree
• WorkSafe New Zealand bullying prevention tools:
• Lifeline – 0800 543 354 or 09 5222 999 within Auckland.

It was revealed today that a new deal – a six per cent pay rise spread over just under three years – was offered by the DHBs on November 8 after, it is understood, successfully seeking sign-off from new Health Minister David Clark for additional funding.  The offer also includes an “agreement in principle” by the DHBs to the merit of NZNO’s separate pay equity claim with negotiations on pay equity due to begin in February.

The pay deal now on offer is for an initial two per cent increase, backdated to November 6, for the majority of nurses, midwives and healthcare assistants covered by the DHB/NZNO multi-employer collective agreement (MECA) and further two per cent pay rises in August 2018 and August 2019. In addition there is a lump sum payment of $350 for current NZN0 MECA members who are permanent DHB employees. Designated senior nurses and midwives are being offered a four per cent pay rise backdated from November 6 and then two per cent pay rises in August 2018 and August 2019.

The DHBs’ initial pay offer was made in mid-October, prior to the new Government being formed, and NZNO negotiators have now revealed that they recommended the 27,000 registered nurse, enrolled nurse, midwife and healthcare assistant members covered by the MECA to vote against that first offer in the series of ratification meetings due to start on November 22.

That initial offer had a six-month delay before the first pay increase and a 43-month term, rather than the 33-month term now being offered.

“But on November 8 NZNO was informed that the DHB CEOs were meeting with the Minister for approval to go beyond the financial parameter so that they could increase the offer and that the CEOs would manage/address the additional costs within their budgets,” said NZNO in a MECA bulletin update to its members, that was revised on November 17 to clarify what lead to the new offer.*

Lesley Harry, the NZNO’s industrial advisory, said it believed having a new Minister of Health had “provided the opportunity to push the parameters a little further” leading to the latest offer.

NZNO negotiators are telling members that they believe the latest offer is “a fair settlement that delivers on most key issues and providers processes with set timeframes to address others”.  It also noted that the overall cost of the offer was greater than other recent MECA settlements in the DHB sector.

Pay equity and safe staffing progress

When the MECA negotiations began in June the union also tabled an historic pay equity claim for nurses.

The negotiating team said the DHBs had now agreed in principle that the work of nurses, HCA and midwives is predominantly performed by women, and had been “historically undervalued and subject to systemic undervaluation”.

The union said it had also reached agreement on the process and timeframes for resolving pay equity issues with negotiations due to begin in February “with the goal of achieving an outcome later in 2018”.

A major plank of the negotiations was also safe staffing and the current slow implementation by DHBs of the Care Capacity Demand Management (CCDM) tools that use evidence-based data to calculate how many nurses need to be employed on a ward to deliver safe, quality patient care. (See recent Nursing Review story on DHB announcing nursing staff boost due to CCDM.)

The negotiators said the DHBs had now agreed to a package of changes that it believed would strengthen the DHBs obligations to deliver CCDM.

*Article updated at 12.45 on November 17 to reflect correction to NZNO MECA bulletin.

Safe staffing and other aspects of the proposed MECA offer:

• Full implementation of CCDM in all DHBs by 30 June 2021
• CCDM implementation plans will be agreed for each DHB within six months of ratification of the MECA (including DHBs that currently don’t have in place an evidence-based acuity tool required to implement the CCDM tools).
• CCDM implementation plans are to be part of DHB’s annual plans and accountability documents and will be included in the Ministry of Health operation policy framework.
• A re-evaluation of an agreed number of nurse practitioner role’s will be undertaken and completed by December 15 to help inform the pay equity process.
• A new Leadership Progression Pathway salary scale will be available for RNs and RMs who have been approved to be part of a DHB’s leadership programme.
• Designated RN prescribers who have been supported by the DHB will be placed on the Leadership Progression Pathway salary scale.
• PDRP allowances for ENs will increase from November 6 from $4000 to $4500 per year for EN Accomplished and from $2500 to $3000 per year for EN Proficient.
• The on-call rate will increase from $4.06 to $8 an hour from November 6 2017 and the public holiday on-call rate will increase to $10 an hour
• The escalation process for unsafe staffing has been revised to make it clearer and more user-friendly.
• Support for victims of domestic violence and an alternative dispute resolution process (consistent with NZNO’s commitment to Te Tiriti o Waitangi) will be explored jointly with other unions and DHBs during the term of the MECA.

NZNO claims not progressed:

• Improvements to professional development provisions
• Reductions to the numbers of hours staff can be required to work on-call
• An agreed interpretation on what ‘two full consecutive days off work each week’ consists of

For a number of years the DHB has posted to Twitter and Facebook a series of “Motivational Monday” messages and the board said these had been well received by followers.

But in an apology posted on Facebook and the DHB’s website yesterday it said Monday’s “Don’t stop when you’re tired. Stop when you are done” message was one of a set of messages that had “unfortunately” not gone through its usual vetting process.

“MidCentral DHB sincerely apologises to all of our staff for posting the message,” said the apology.

“Its content is not aligned to the values, culture and working environment that we all strive for in our DHB. We do not condone people working when tired or past their limit and apologise to anybody who was offended.”

The Hawke’s Bay District Health Board has announced it will spend more than $1 million over the next two years to create around 17 new full-time equivalent (FTE) registered nurse (RN) roles and about 10 FTE care associates (health care assistant) positions.

The announcement by DHB chief executive Kevin Snee is thought to be the first time that a DHB has announced a major boost to nursing staffing as a result of using the Care Capacity Demand Management safe staffing tools (see more about CCDM and the Safe Staffing Health Workplace Unit that created CCDM below).

Snee said hard work by all the DHB staff mean it was in the “enviable” financial position to be able to respond to the CCDM findings that were designed to establish the right nursing resource to meet patient demand.

Speeding up implementing the CCDM safe staffing system across all District Health Boards was a major component of the recent DHBs and New Zealand Nurses Organisation collective agreement negotiations.

Chris McKenna, the DHB’s chief nursing officer, said it had been almost two years of hard work to do the CCDM methodology groundwork to be able to analyse the FTE staffing needs of its medical and surgical directorates based on patient acuity data.

McKenna said the CCDM staffing analysis did confirm the nursing team’s “intuitive” judgment that some wards and units were understaffed.

“We knew we were challenged with RNs in intensive care (ICU) and we knew were challenged with RNs in our acute assessment area – and the analysis confirmed that those two areas were quite short.”

The analysis also found that coronary care and the cardiac ward were short and a surgical area. She said some work had been done several years ago in the medical wards and staffing had been increased in the medical directorates at that time.

Lisa Skeet, director of the Safe Staffing Healthy Workplaces (SSHW) Unit, said the DHB and its health union partners were to be congratulated and should be proud of their achievements.

“It is also excellent to see the DHB chief executive really backing having the staffing workforce right, which is one of the key things to ensuring positive patient outcomes.”

Skeet said Hawke’s Bay DHB was a pilot site for new web-based software developed by the unit which had made the process of calculating the safe staffing FTEs a lot more easy, accessible and straightforward than the previous spreadsheet-based system. “So DHBs can speed up their [safe] staffing calculations.”

McKenna said the additional nursing FTES would be equivalent to about 30 posts, because of nurses working part-time, with the majority of those posts to be filled in February next year and the remainder in the second half of the year.

At the same time the DHB, which has a primary nurse model of care, was also looking at increasing and upskilling its Care Associates (CAs).

McKenna said its current CA staff were either employed with a level 3 qualification (or trained on the job to that level) and it would now be introducing a new training programme to upskill its CAs, on top of the level 3 qualification, so they could take on extra low-level tasks to support RNs on the ward. These included basic patient mobility so CAs could take patients to the toilet and transfer patients to a chair.

“We are increasing their scope so we can release RN time to do the more complex, higher end-of-scope activities.”

Skeet said a further nine DHBs now had access to the FTE calculation software used by Hawke’s Bay and were looking to running their CCDM staffing analysis via that software. She said Hawke’s Bay had joined CCDM a little later in the piece but the DHB had really driven the process and as the pilot site for the new FTE calculation software had lead the way.

“This [Hawke’s Bay announcement] is an excellent example of true partnership in action and will certainly support quality patient outcomes, a positive work environment for staff and the best use of health resources,” said Skeet.

Hilary Graham-Smith, associate professional services manager of New Zealand Nurses Organisation (NZNO) also said the DHB  was to be congratulated on the “outstanding progress” it had made. “NZNO is delighted to see the positive outcomes that will benefit patients, staff and the DHB as a whole.”

Skeet pointed out that the CCDM safe staffing FTE analysis would show up different trends in different DHBs. “In some wards gaps [in staffing] are identified but there are some areas where there are too many staff, there are also some areas where they’ve got the right number of staff but they are just at the wrong place at the wrong time,” said Skeet.

“So from the SSHW unit’s point of view the staffing methodology just provides a transparent reality of what is actually happening and what is actually required on the ward to provide the service they need for the patient demand and acuity coming through the ward door.

McKenna said the process had been very much team work between the DHB, the Safe Staffing Healthy Workplace (SSHW) Unit and the New Zealand Nurses Organisation. The DHB was now going on to carry out the analysis for other areas including paediatric, maternity and renal.

*CCDM AT A GLANCE

• At the end of last year 14 of the 20 DHBs were in different stages of implementing the CCDM system tools.
• The tools are built on a validated patient acuity tool (to date all are using TrendCare) and include calculating the safe staffing level required in a ward or unit based on historic and current patient acuity demand and turnover.
• The CCDM system has been developed by the Safe Staff Healthy Workplaces (SSHW) Unit.
• The joint DHB-NZNO unit was created in 2007 following the joint SSHW Committee of Inquiry held in 2005-2006.
• The inquiry was held after NZNO agreed to drop pursuing mandated nurse-to-patient ratios during the negotiations leading to the historic ‘pay jolt’ in 2005.

A letter from Counties Manukau DHB acting chief executive Gloria Johnson was sent to senior managers on Monday suggesting voluntary redundancy be offered to a number of staff on individual employment agreements and those at the top of their pay band, including all clinicians.

Counties Manukau DHB runs Auckland’s Middlemore Hospital.

NZNO DHB industrial adviser Lesley Harry said it was “mind-boggling” to see how the proposed scheme would ensure safe staffing levels and ensure the right skill mix for patient care. “This DHB is short of senior experienced nursing staff as it is.”

Association of Salaried Medical Specialists executive director Ian Powell said it was “absurd” and “bonkers” to be encouraging staff to leave when the existing workforce was overworked.

In July, the hospital warned they were seeing record demand for services and advised people to see their family doctor first unless it was an emergency.

In August, under-pressure staff at Middlemore Hospital told accident and emergency patients to go elsewhere or face a wait of up to eight hours. They made a sign and put it up at the front of the Accident and Emergency Department warning people off because of extensive delays.

A Counties Manukau DHB spokeswoman confirmed a letter was drafted for senior managers for consultation around the “possibility that some senior staff may wish for family or other reasons to cease their employment voluntarily”.

She said it was intended as “a good thing to offer staff”.

The intent of the scheme was to enable more resources to be directed into frontline services, rather than reduce clinical staffing levels, she said. Any clinical staff approved for a cessation package would be matched by increased numbers of other clinical staff more closely involved in frontline services.

Johnson said the scheme was in the discussion stage only.

Jean Ross was a keynote speaker at yesterday’s New Zealand Nurses Organisation annual conference in Wellington. She told New Zealand nurses that it didn’t seem to matter which country nurses were in as they were all battling the same issues, including understaffing and harassment and violence in the workplace.

Ross is co-president of the National Nurses United (NNU), which was formed in 2009 by bringing together the Californian Nurses Association (which successfully lobbied for safe staffing ratios to be introduced in California in 2004), the Massachusetts Nurses Association and United American Nurses to form the largest union and professional association of registered nurses in the US, with 150,000 members. NNU also helped to initiate Global Nurses United, an organisation of around 25 nursing unions from around the world, including NZNO, that work together to fight healthcare service cuts, bring in safe nurse staffing ratios and improve patient care.

“We [the nursing unions] want safe staffing, respect for nurses and safety for nurses,” Ross told Nursing Review. “We work outside the walls of our hospitals and outside of our union contracts for social justice and a system that lets us have the kind of health care that we know patients deserve. And it doesn’t matter what country you are in – the issues are all the same. Even in a country where you do have a good nationalised health system.”

Safe staffing ratios

Ross said safe staffing ratios was one of the tenets of Global Nurses United, but it was up to each member country to decide what that safe staffing ratio should be.

California is still the only state in the US to have a safe patient ratio law where it has had set RN-to-patient ratios since 2004, including 1:2 in intensive care units, 1:5 in medical/surgical wards, 1:4 in emergency departments and 1:6 in mental health. These are the maximum number of patients are nurse can be assigned and the Californian law also requires additional RNs to be assigned based on patient acuity.

There are currently two bills in front of the Senate and Congress calling for federal RN-to-patient ratios across the whole of the US and at a state-by-state level nurses are also campaigning for legislated safe staffing ratios.

“They [ratios] have been very successful in California,” said Ross. “Hospitals continue to fight them tooth and nail but they have worked very well.” She said arguments put up against introducing ratios included nurses being in short supply, but “surprise, surprise – nurses that had left the profession because the conditions were so bad came back into the fold and began working again”.

“Nurses are happy again,” said Ross. “They can do what they like at the bedside.” She said nurses used to worry about taking a break as it would foist all their patients onto a colleague’s patient load but now wards had circulating nurses so ratios stayed in place even when nurses were on a break.

She claimed at least one hospital system in California actually made more money after ratios were introduced, as they didn’t have to employ so many agency relief staff or pay overtime.

Universal healthcare, Bernie Sanders and Trump

Ross said one area in which nursing in New Zealand did differ from the US was in having a universal or ‘single payer’ healthcare system. She said nurses in the US had been fighting to have something similar to the New Zealand or UK health system “for years and years and years” because they believed health care was a basic human right.

“The US doesn’t really have a healthcare system – it’s a medical industrial complex – the only way to make money in the [US] healthcare system is to deny patient care.”

The NNU and Ross were active supporters of Senator Bernie Sanders for the Democrat’s presidential nomination and are also backing his ‘Medicare for All Act that was introduced to the Senate on September 13 with the backing of 16 Democrat senators. (At the same time this year, Republican politicians have been trying, unsuccessfully to date, to repeal and replace the Affordable Care Act i.e. Obamacare, the controversial bill expanding health insurance to millions more Americans that was passed during President Barack Obama’s presidency.)

Ross said that Obamacare saw more people than ever before gain access to health insurance, but what the NNU wanted was a system that assured all people had access to healthcare. “And the only way to do that is through a national healthcare programme,” said Ross. She said the aim of Sanders’ bill was to extend the current Medicare healthcare programme to cover more than just the current over-65-year-olds.

While the current political climate under President Donald Trump was not supportive of increasing government involvement in healthcare, NNU believed the ‘void’ created by the Republican’s failure to repeal Obamacare made it a good time to put forward an alternative model.

When asked for her view of the current president, Ross replied, “Oh my word, that man-child!” and chuckled. “You know, the nurse in me says, ‘Be kind, the man is ill’… no, none of us are fond of Donald Trump. Although, sad to say, we must admit some of our nurses must have voted for him.”

But nonetheless, Ross said, Trump’s campaign had given people something to fight and hope for – much like the mushrooming of support she experienced first-hand during the Bernie Sanders’ campaign, which the NNU had actively supported by travelling alongside Sanders on the “Bernie Bus”.

“Honestly, when we first started [on the Bernie Bus] we did not know Sanders’ campaign would take off the way it did – we [nursing unionists] were hungry for a person like this – with the kind of values we shared. And we believed the people across the country felt the same way, but it wasn’t until we actively travelled with our ‘Bernie Bus’ and talked to people along the way that we found out we were right, and look how well he did [almost winning the Democrat nomination off Hilary Clinton].”

Ross believes the absence of a positive candidate like Sanders led to Trump’s success.

“People need a hopeful campaign – and what nurses stand for is what people want … and we found that out.”

She pointed out that year after year nurses come up tops in the US, and in many other countries around the world, as the most trusted profession. “There is a reason that people trust us – and we need to use that and talk to people. And they will very often listen because they trust us.”

The last ‘Shout Out’ for better funding, and for voters to make health their top priority, is to be held as New Zealand Nurse Organisation members from across the country gather for NZNO’s annual conference, just days out from the General Election.

The organisation said that nurse, midwife, caregiver and kaiāwhina members from across the country have told NZNO that in almost every health service from public hospitals to family doctors, that health underfunding was affecting the quality and safety of patient services.

The signed letters collected from all over New Zealand will be boxed up as a presentation for New Zealand’s next Prime Minister and delivered shortly after the election as a “reminder that better health funding is priority for their first 100 days in office”.