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Not so ACE

Yesterday, about 600 new graduate nurses had their hopes raised and then dashed when the ACE system malfunctioned badly.

Graduate nurses were mistakenly sent an email congratulating them on gaining a Nurse entry to practice (NETP) position at Auckland DHB.

If you were one of those nurses, we feel for you, it must have been a tough day.

ACE assures us this is a one-off and that’s good to hear because NZNO believes the system is a really good way of matching new grads with jobs.

We can’t help noting that this mistake wouldn’t have happened if the Government funded a NETP position for every new grad nurse. We believe this is the only answer for a fair, well-supported and sustainable nursing workforce that can take us into the future, and you can count on us to keep pushing for that.

 

You can find out more about our campaign for 100% NETP here: http://www.nzno.org.nz/get_involved/campaigns/newgrads


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CCDM from a Charge Nurse Perspective

By Caroline Dodsworth, charge nurse, Palmerston North Hospital

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As an NZNO member working in a DHB, I know that getting Care Capacity Demand Management (CCDM) working in all our DHBs is a priority in our multi-employer collective agreement (PDF pg 66).

I know that it has been started in most DHBs and I think the implementation has actually been completed in only one so far. It is good work to be doing and it’s important to do it right – better to take the time to get every step correct than to rush it and not get the benefits.

We all want patients to have the best possible outcome. This is most likely to be achieved when patients have the care they need when they need it.

CCDM is the programme that has been developed by the Safe Staffing Healthy Workplaces Unit, NZNO and district health boards (DHBs) to make sure we can actually do this every day (not just on those random, lucky days…).

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Working in partnership is the key to CCDM’s success; NZNO members and staff working together with DHBs to make safe staffing a reality. It’s about making sure base staffing is right every day. It’s about making sure there are workable strategies in place if the match between demand (what patients need), and capacity (our resources) is not right. And to do that there has got to be good quality data available to everyone so we can see on the day and over time if the programme is working. The whole system depends on the information we provide.

You can find out more about CCDM here: www.nzno.org.nz/carepoint

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I thought I’d share my experience of CCDM at Palmerston North Hospital, so you can get an idea of what to expect when your DHB gets the programme (if it hasn’t already).

In 2012 I was charge nurse manager of an acute 32 bed medical ward. TrendCare showed that we consistently didn’t have enough staff to complete the care required; often between 20 and 30 hours short over a 24 hour period! Rosters were pretty much set in concrete and didn’t (and couldn’t) respond to the peaks and troughs in workload. We knew care rationing was happening but there was no way to “see” it or prove it.

The opportunity to become the first ward to undertake work analysis and data collection to inform the CCDM programme was floated and our application was successful.

There was excellent communication during the process; ward staff were included and actively involved. It was a great example of working in partnership with close collaboration between charge nurse, NZNO and ward staff. Ward staff were given every opportunity to express their concerns and listened to in a non-judgmental manner. Facts and figures were explained and we were given time to digest and seek clarification if we weren’t sure about anything. Unfamiliar data was explained in language that we could all understand. Charge nurse, associate charge nurses, management and NZNO delegates were professional and supportive, and assisted with propelling the process forward – staff joined in at “grass roots” level.

The data collection process was difficult and hard work, as I had anticipated; ironing out teething problems, ensuring everyone was on the same page, encouraging the negative staff and the fence-sitters, keeping the momentum going when enthusiasm flagged.

The data collection process was generally seen as “just another data gathering exercise”. But as the process developed it was an eye-opener to be able to quantify the many interruptions during each shift. It also highlighted and reinforced what nurses already know; many interruptions means less time for patient care. We also gained further insight into the peaks and troughs of ward work.

By the end of the two weeks we had become quite attached to our diaries! Finally, we were able to show care rationing – especially the missed nursing care that had become “business as usual”.

It took quite a while for the information we collected to be analysed and some wondered if their hard work had all been for nothing. During this time we implemented Releasing time to care which helped keep a sense of momentum.

As soon as the results were confirmed we swung into action and developed a new model of care. The entire nursing team got together, and with butchers paper and models, felt pens and timetables, we arranged and rearranged the FTE and the roster to meet workload over the entire 24 hour day and seven day week.

We divided up the available FTE into the most efficient and effective spread of regulated and un-regulated staff, thinking outside the square and breaking down traditional shift time barriers. Our new model of care implemented a new role of “admission and discharge nurse” who straddles the morning and afternoon shifts without a patient load, but instead focuses on timely discharges and active “pulling” of patients from MAPU and ED.

This means less pressure on the qualified staff, especially on the morning shift. Discharges happen in a more timely manner, and the discharge of complex patients requiring a lot of registered nurse time is now smoother. Patients feel more informed and new admissions are seen and assessed early without having to wait for a busy nurse.

The model of care for patients with delirium also changed – instead of being staffed by a ward RN and a bureau Health Care Assistant (HCA) we have our own ward HCA who knows the patients and provides continuity of care for them. To have our own HCA caring for these patients is amazing. The benefits to the patient outcomes, and working relationships between the team are invaluable.

The staffing numbers across all three shifts are well thought out. Patient safety has improved significantly with an extra registered nurse at night.

The difference to staff morale and motivation as a result of CCDM has been immense! While the ward remains very busy it now operates efficiently and effectively.  Complaints, incidents, falls and medication errors have reduced, staff turnover is practically zero and productivity has improved.

Since then we have developed a hospital-wide response to variance in collaboration with NZNO. The CCDM variance response management (VRM) tool is a visible and user-friendly process. It still cannot produce nurses out of thin air, but it raises awareness of areas under pressure to all the right people and allows an organisation-wide approach to pooling resources and to providing support where it is needed. Everyone is talking the same language and the tool triggers a response at the top of the cliff instead of the bottom.

I’ve heard a lot of feedback about CCDM over the last couple of years but the comment that has had a lasting impression, and the thing that I think CCDM stands for above all else for nurses is: “Since CCDM it feels like I’ve actually met the patients and I don’t go home with that horrible feeling that I’ve missed something”.

As the charge nurse for that ward I take pride in the fact that I was responsible for making that happen. We need senior managers to influence change at the executive table, but the charge nurse is responsible for driving change at ward level with enthusiasm and passion, leading from the front and never giving up.

If you are involved with CCDM in your ward or unit, I’d love to hear how it’s going. You can leave a comment by clicking the “leave the comment” link to the left of this article.

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If you would like to know more about CCDM please talk with your local NZNO delegate or organiser, or visit www.nzno.org.nz/carepoint or centraltas.co.nz/strategic-workforce-services/safe-staffing-health-workplace

 


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Celebrating NZNO’s Living Wage journey

By NZNO president, Grant Brookes

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, 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.

Left-right: Maire Christeller and baby Iris, with HVDHB delegates Monica Murphy and Puawai Moore, at the Hutt Living Wage Network launch

Left-right: Maire Christeller and baby Iris, with HVDHB delegates Monica Murphy and Puawai Moore, at the Hutt Living Wage Network launch

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.

CCDHB delegate Kathryn Fernando (left), NZNO Organiser Danielle Davies (right) and I at the Living Wage “Mop March” for Wellington City Council contract cleaners

CCDHB delegate Kathryn Fernando (left), NZNO Organiser Danielle Davies (right) and I at the Living Wage “Mop March” for Wellington City Council contract cleaners

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).

Litia Gibson works at Porirua Union and Community Health Service

Litia Gibson works at Porirua Union and Community Health Service

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.

Kieran Monaghan (left) and fellow Living Wage activist Naima Abdi at the “Mop March” for Wellington City Council contract cleaners

Kieran Monaghan (left) and fellow Living Wage activist Naima Abdi at the “Mop March” for Wellington City Council contract cleaners

 

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.