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Shouting Out because We Care!

A message for politicians and NZNO members from Richard and Annie.

A couple of weeks ago, the Yes We Care tour arrived at Wellington Hospital on the most horrible day of the year. It was cold, it was wet, and the rain was falling sideways. Richard and Annie are two Shout Out member leaders who were determined to deliver a health funding message despite the weather. Here is why they did it.

Richard

Richard McCormick Wellington Nurse 2.jpgRichard in the rain!

Quite honestly, standing outside in the cold and windy Wellington weather was minor compared to the challenges of working in an underfunded health system. Like many nurses, I believe everyone has the ‘right to health’ – that New Zealand has a fundamental duty to provide access to healthcare that people need. That’s what we try to achieve in our work.

But, the work of nurses is being undermined by living and working conditions that don’t enable good health outcomes for an increasing number of people. And when those people get sick and come to us for help, at the moment we are not able to provide every patient with the best quality care every time. Slowly, Kiwis’ ‘right to health’ has been taken away, until we have reached a point where my colleagues are experiencing moral distress in their work. They regularly tell me that they feel despair when they are faced with preventable situations they can’t fix with their clinical skills because of a lack of health resources.

That’s why it’s time to use our political skills as well as our clinical ones. As a nurse and NZNO delegate, what really mattered to me was showing up to this event to demonstrate we can overcome our despair.  We have a strategy to campaign based on hope, courage and collective action: hope for a healthier future and courage to stand up for what we aspire to achieve. We stand up for collective action, no matter how small it may seem at the time, to protect the right to health. Even in the rain!

My message to politicians is that underfunding of the health system is not about money, but is about the right thing to do for New Zealanders. Just like nurses do, each of you make choices about how much money to spend on different priorities. When you were elected, you took on responsibility for the health of the nation. We are telling you as clinicians that it’s time now to increase health funding. In fact it is overdue. When health needs aren’t met, they don’t just vanish, they get much worse, and our population is growing and ageing. Acting now is a moral imperative before the problem is even bigger.

My message to nurses is that I know what you are going through at work, because I experience it too. Sometimes it feels like you couldn’t possibly do anything more – but that’s why we need to shout out for our health now, so we can be the change we want to see.

Annie

Wellington We careWellington NZNO staff, delegates, and NZNO President Grant Brookes at the Yes We Care tour action outside Wellington hospital. Annie is wearing the pink hat to the right of the picture.

My message for politicians is very simple. My colleagues and I just want to be able to do a job that gives the very best care for the people we look after. Part of that is having the right tools, safe staffing levels, and a reasonable workload. I want to be able to take my meal breaks, go home on time and not constantly revise and ration the care I am able to provide. This doesn’t seem like too much to ask, but at the moment this is not happening in our health system. Each and every nurse I know comes to work to give 100% on the job, despite the shortages. If you fund health properly, we can go back to having good work days where we go home satisfied with a job well done, and patients’ needs being met.

To my fellow NZNO nurses: As health professionals, it comes naturally to us to speak up for our patients. Every day we are our patients’ advocates. We want the best outcome for each and every one of them. So I’m not willing to stand by in silence and allow them to be disadvantaged by an underfunded health system. And I don’t think that you are willing to be silent either. If we don’t speak up for our patients, who will? That’s all that we are doing- extending our advocacy outside of the ward. Join me, because this year we have to do it together. We will win this, for us all.

The Yes We Care tour is coming to to Pukekohe tomorrow and moving north up the country until the end of March. For a full list of events that you can go to support, see www.facebook.com/pg/yeswecare.nz/events/ . We’d love to see you there.

 


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A comfy chair

Social media shares2 10 Feb2

A Shout out for health blog by NZNO delegate and member leader Rachelle Smith.

My name is Rachelle and I work in the Bay of Plenty. I am a Health Care Assistant on a ‘high acuity’ medical ward, where we also specialise in looking after the elderly. High acuity means that patients need lots of immediate care, unlike conditions you can manage over a longer term or outside the hospital. So it can be quite full on, but I love my job.

My satisfaction comes from impacting lives in a positive way, and providing quality care that meets my patients’ needs and helps them achieve their goals. We provide a holistic approach to care, where we encourage whānau to give us feedback and input. This supports both us and the well-being and safety of each patient.

I am passionate about engaging others on the effects of chronic underfunding of health care in New Zealand. I see this every day in my own work, but I’m still learning through our Shout out for health campaign how it affects every other part of our health system too. I’m part of this campaign because each of the patients and families we work with are worthy of our time, quality care, and our advocacy.

On reflection, I see our health system as a framework, a framework that supports our families and wider communities. When our framework is built on a foundation of underfunding, like building on sand, it becomes compromised and the whole long-term system that keeps our communities going starts to break down. This shows itself in big ways, like longer waiting lists, but the little ways are just as important too.  Simple things like an appropriate comfortable chair for our older patients now are a ‘luxury’ item. But a comfy chair can make all the difference for someone who is old and in pain. Facilities need to weigh up whether they can afford to purchase these things against all their other growing expenses. It’s not a simple case of providing what patients need straight away anymore. These decisions take more thought and time.

Healthcare staff and other organisations are doing their best to fix these little gaps in the framework. But if the Government dedicated more funds for health than it does at the moment we would have a stronger foundation to build on. We could provide ‘uncompromised’ care and ensure every New Zealander could achieve their own health goals. The Government needs to put a higher priority on the well-being of the whole population, especially when they are in need of a little extra help from healthcare services and staff.

I know that little things like comfy chairs for the elderly end up adding up to make a big difference to the quality of our lives. I want a strong health framework, not just for my patients, but to support the kind of country I want us to be for future generations.


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Patients deserve to get back to their homes pain free

By Registered Nurse and delegate Ben Rogers as part of the Shout Out campaign

As a Registered Nurse working in the theatre and recovery environment I frequently see patients who having long ordeals before they have had the opportunity for their surgery. I became a nurse because I get great joy from the process of healing and recovery – getting patients back to their work and their families in as good shape as possible, no matter what has happened. But often, patients will have to fight ACC just to get the need for their surgery recognized. Or, they have surgery delayed as there was simply not enough staff to run all the planned operating theatres that day. Sometimes acutely injured patients wait without food on ‘nil by mouth’ only to have their surgery cancelled and rescheduled for the next day, or are discharged too soon to make space for the next person who will go through exactly the same thing. Rinse and repeat.

One case that stuck with me was a patient who had their surgery late in the day. They had been given local anaesthetic to numb the area and reduce their pain, which normally wears off early in the morning. It was late in the day so there were no pharmacies open nearby open to collect the strong pain relief they would likely need when the local anaesthetic wore off. Ideally they would have stayed in hospital overnight, and then been discharged the next morning, however the hospital was simply too full and there was a lot of pressure to minimize incoming patients. This patient did go home that day. I slept poorly that night, worried that this patient who was in my care would now be in excruciating pain.

For me, health under-funding leads to full wards of people stuck in limbo, frustrated, hungry and suffering; and staff such as myself stressed and losing sleep, from being not able to give the quality of care the people of New Zealand deserve. This is why I feel so strongly that health should be funded to meet the health needs of New Zealand, so we can discharge people in the state that they deserve from our publicly funded health system.


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Give nursing grads a fair go

By NZNO member leader and nursing student Phoebe Webster, as part of the Shout Out campaign.

nzno-students-30Pictured- Phoebe Webster, 3rd year nursing student.

“I am a 25 year old nursing student in my 3rd and final year of nursing study, and looking forward to starting my professional career. By the time I finish my Bachelor of Nursing (BN) I will have completed over 1100 hours of approved supervised practice. I will have spent countless more hours attending practice laboratories, clinical preparation sessions, lectures, tutorials, guest speaker sessions and workshops as compulsory components of my BN degree. After completing this I will sit my state final exam and, all going well, will become a Registered Nurse (RN).

My course is designed to make sure I am a safe, competent, innovative, and articulate nurse. It means that I can work in different parts of the health care sector and improve health outcomes for local, national and global communities. But there is still a steep learning curve going from a student nurse to confidently performing all of responsibilities of an RN.

The Nurse Entry to Practice/Specialist Practice (NEtP/NESP) 1 year programme provides new graduate nurses with an invaluable introduction into the healthcare system. It’s really crucial support for us going through this steep learning curve. It provides a safe and supportive environment for graduate nurses to slowly transition into the responsibilities of a competent registered nurse. This crucial support is sadly not available to all graduates however, and I can’t help wondering how I will fare in this competitive race for employment after my state finals. Only around half of graduates manage to get a NETP position in the first year, and the job opportunities for new graduates outside of the programme can be limited- everywhere wants ‘experience’, but how can we safely obtain it?

More funding is needed to provide these NEtP and NESP placements for new graduates. Sure, it is possible to enter the workforce without a NEtP position, but why make this transition less safe and harder for new grads?

More highly trained nurses are exactly what our complex healthcare system needs. Comorbidities, where patients have many related and often serious health problems going on at the same time are common. Nurses now deal with complicated care under widening scopes of practise. Making sure these new scopes are adequately prepared for and supported is vital for future workforce planning.

Other professions in New Zealand are supported to train and transition slowly into their jobs. When entry to training is regulated with supervised progression, people who come out the other end are better recognised as highly skilled professionals. Take the police force for example. In New Zealand new police undertake extensive entry requirements and progress through a (paid) training programme and are then placed in supported roles in different areas of the police force. Builders have apprenticeships which provide many hours of supervised, supported time on the job. Should the same on the job support and continued supervised learning not be available to all nursing graduates, not just the lucky ones?

The NEtP programme is based on many other successful and effective new graduate programmes around the world. Benefits include transferability of skills recruitment and retention of New Zealand nurses. I really, really want to be the best nurse that I possibly can. After sitting my state final exam this year in November it worries me that I may be entering the workforce without the support in place to give me a fighting chance to achieve that quickly. Building the strong, competent nurses of tomorrow is something I see as worth investing in. It’s a profession that I have invested in, in every way, and hope to continue to do so throughout my life. All I’m asking for is that my country supports me a little bit more, to help support them.”

NETP (Nursing Entry to Practice) and NETSP (Nursing Entry to Specialty Practice) key stats

  • There were 1455 applicants in total in the November end of year pool in 2016.  Of these 1303 were NETP applicants and 152 were NESP applicants.
  • There were 151 applicants indicating they were repeat applicants (128 NETP and 23 NESP) and 1304 (1175 NETP and 129 NESP) who indicated they were first time applicants. (Note: 1274 applicants said they completed their degree at the end of 2016.)
  • There were 121 second time applicants, 26 third time applicants and 4 fourth time applicants.
  • Only 52% of NETP applications were employed as at the 25th of November 2016, and 65% of NESP applicants were employed by the same date
  • Of the remaining applicants in the NETP pool, 605 were unmatched, 17 withdrew, were declined, or did not finish their degree. In the NESP pool, 53 were unmatched and 1 either withdrew, was declined or did not finish their degree.

That’s 658 New Zealand qualified nurses who wanted further on the job support but didn’t have NETP/NESP placements to go to at the end of last year. With a nursing workforce shortage hitting us right now, NZNO believes we need a placement for every new grad.


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We have the science, now we need the staff to keep patients safe

colour-206

NZNO champions the use of Care Capacity Demand Management (CCDM) in our hospitals. CCDM tools and processes uses patient acuity data to determine how many staff hours are needed for each shift. CCDM is the first of its kind and is available in some, but not all DHBs, and in certain wards and units of these DHBs. CCDM results in safer patient care and a better working environment for staff. CCDM enables staffing levels (capacity) to meet incoming need (demand).

To find out more about CCDM, see: http://www.nzno.org.nz/get_involved/campaigns/care_point/what_is_ccdm

 This blog is by Lisa Taylor, Registered Nurse and NZNO Delegate

‘It’s the challenge that gets me out of bed in the mornings, I love my job caring for patients and there’s always so much to learn.

I am a nurse working in an acute surgical ward with a high acuity. Many patients every day go to and from surgery, ED, ICU, other hospitals and home. We have a big turnover of patients.

Regardless of patient numbers, in the last two years we have gone from having a Care Assistant and a Health Care Assistant on each morning shift, to having one or the other but not both. Having only one out of the two assistants has resulted in delays in patient care.

As an example, the more specialised Registered Nurse tasks such as clinical assessments and complex wound dressings are often delayed so we can attend to patients more ‘immediate’ needs, such as toileting and mobilising. This can result in ‘care rationing’ for this really important patient care.

If we were to have a Care Capacity Demand Management (CCDM) Work Analysis completed on our ward, which calculates in detailed the work that is completed by our nursing team, we would be able to show who was doing what work and when that work was being done. Work analysis is really specific and gives us the opportunity to analyse the information.

We use CCDM Response Management tools within our hospital and in our ward. This is a programme telling us when we should increase or decrease each type of nursing team staff rostered on as patient demand goes up and down outside of what we have planned. However, when we do go into yellow – which means we need assistance as the patient care requirements outweigh the staff resource on the ward – we are often told there is no more help. This is a difficult situation, as the Clinical Nurse Managers and the Duty Nurse Managers do want to help, but when there is no one to help, there is nothing they can do.

If health funding was appropriate, it’s more likely there would be better help available for our patients. Having confidence that the resources were available to provide the right care at the right time would make for a safer workplace for patients and staff.

TrendCare, the patient acuity system that shows how much nursing care each patient will probably need, has made a difference to us on our ward. We understand that we often have a ‘negative variance’. This means patient care requirements outweigh the staff resource on the ward. We are working to further improve our data. I feel optimistic that once the data is absolute correct we will be able to do the calculations for how many full time equivalent staff we need, and it will be accurate.

TrendCare data is really powerful in getting the right staffing, but the staff also actually need to be available. If health funding was increased we would always be able to have the right staff, at the right time, delivering the right care, all the time.’


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To hold their hand

This beautiful blog was put together by one of our delegates and Shout Out member leaders, Angela Stratton, a Registered Nurse working in aged care. We’re publishing it as part of what will be a series on the impact of health underfunding in different care settings around New Zealand. 

colour-72-cropNZNO stock photo image, copyright 2014

One of the special privileges of my work is to be with people when they’re dying. It’s a time when if I do my job well and the doctor has charted any necessary medication, someone can take their last breath relaxed, with less pain or fear.

What I find difficult, is when someone is dying and they are scared and want a hand to hold but I have to go and answer another call bell. Or when a grieving family member breaks down and needs to talk, but I can’t give them as much time as I’d like to, because I need to go and look after others.

Nurses working in aged care all want to do the best for their patients. But with people living longer and their carers growing older too, we simply need more staff. For that, we need more funding from the Government. The Government funds care for older people just like other parts of our public health system.  In aged care our role is special because we also help ease the very last days of a long life. This all part of the health journey for patients and their families which deserves proper funding, dignity and respect.

In Whanganui we have an aging population. Some say we are living longer but death will come to all of us, and I feel it’s a human right not to die alone. When a person has nobody else to hold their hand at the end, I hope there’s a nurse beside them.

 


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We can’t afford to ignore nurses’ cries for help

colour-103This blog was originally published by New Zealand Doctor, and is kindly reblogged here with their permission. Thanks New Zealand Doctor for continuing to highlight nursing issues both here and overseas!

By Barbara Docherty

It’s not really in my nature but I feel a bit like the doomsday merchant at present.

As soon as I write about nursing in any form, a little flurry of emails arrives in my inbox often indicating unhappy nurses. This latest alert from the UK worryingly has shades of what nurses are articulating in different forms here in New Zealand, and about which I have written on previous occasions.

‘Skint, shaken and yet still caring’

This recent major survey in the UK with the intriguing title “Skint, shaken and yet still caring”, followed more than 2200 responses from nurses, midwives and healthcare assistants about financial hardship and deprivation, domestic abuse, health, illness, wellbeing and employment uncovering what has been referred to as “worrying facts”.

It identified that nurses are twice as unlikely as the general public to be unable to afford basic necessities such as beds, decent shoes, washing machines, keeping their homes warm or eating two meals a day.

They are three times more likely to suffer domestic abuse than the general public, 14 per cent of them victims of domestic abuse in the last year. This compares with a national average of 4.4 per cent.

Physical and mental illness

The report also found that two in five nurses, midwives and healthcare assistants have a long-term physical or mental illness that limits their day-to-day activity and is expected to last longer than a year.

The survey questions on domestic abuse matched those used in the 2012-13 crime survey for England and Wales carried out by that government’s official statistics body. They came out a week after a Sunday paper revealed 14 per cent of nurses have applied for payday loans, laying bare the hardship faced by NHS staff.

The United Kingdom’s Royal College of Nursing responded by saying it “painted a shocking picture of the hardships” faced by some nurses and midwives. The nursing support charity Cavell Nurses’ Trust which commissioned the research, has branded the findings as “appalling”.

Foolish to dismiss survey results

There are no suitable words to describe the significance of these findings. Some might say it is a relatively small sample in a country the size of the UK.

It will likely be dismissed by others in New Zealand as nothing much to do with us. But closing our minds to the strong possibility that this likely mirrors what some nurses are experiencing in New Zealand is tantamount to foolishness.

I find it disturbing. It’s another reminder that, when I blogged some months ago in New Zealand Doctor about nurses here admitting to taking anti-anxiety or antidepressant medication, some attempting suicide or experiencing suicidal thoughts, it hit a strong chord because nurses were speaking their realities.

One dissenter

Yet a week after that blog was published, I received an email (from whom I still don’t know) asking me to back off, to stop raising the issue because it was stirring fear when only a handful of nurses would be affected anyway.

The United Kingdom study has not been replicated here to my knowledge so we don’t have specific NZ data. But nurses throughout the world are coping with strained health services and this report highlights the reality of a nurse’s working life and the impact on home life or vice versa.

It once again shows that nurses keep going in spite of often physical and mental health issues that can be damaging in the short or long term to both themselves and their patients. Canada and the United States have also identified many similar issues with their nurses and we ignore all these findings at our peril.

I have been receiving a constant trickle of emails over many weeks since writing that blog and as I write this one, another email has just arrived from a nurse now considering the role of nurse practitioner but needing to know if he is “doing the right thing”.

Scared to join general practice

He says, “My brother is a GP and feels it is time to leave his profession as it is all getting too much for him. For me I don’t want to accept that nurses don’t support nurses but I have yet to be entirely convinced and I don’t want to embark on a NP journey if I am anxious about the lack of support mechanisms if I end up with physical and mental health problems.”

And unfortunately, we don’t have the equivalent in New Zealand of the UK Cavell Nurses’ Trust which has supported nurses, midwives and health assistants in many different ways since being founded in 1917 after British nurse Edith Cavell was executed in 1915 for helping to evacuate 200 Allied soldiers in Belgium.

Speaking on behalf of nurses

If I am sounding as if I am stirring the pot of negativity, tell that to the nurses who email me simply because they do not know where else to turn to vent or get assistance.

While DHBs provide access to confidential counselling by independent professionals as part of their Employee Assistance Programme to help nurses work through stress, anxiety and depression, as well as personal and financial issues, what is evident is that many nurses don’t reach out and take this important step believing little will change for them post-counselling anyway.

Skint and shaken? That’s probably only the half of it.