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An open letter to New Zealand voters.

blog banner open letterPictured- NZNO members and Registered Nurses Phoenix and Michael.

 

This year, we are asking for your help.

This isn’t something people working in healthcare would normally do – it’s usually the other way around. We help you in your time of need – in your hospitals, your Plunket office, your home, your marae and in your community. We love our skilled work, and turning your worst day into a better day. When you are sick, injured or in need of support, you can turn to us for healing, comfort and safety. We help no matter who you are, where you come from, how much you earn or where you live. Knowing we can help is what drives us to work in health.

 
Right now it’s getting harder to do the work that we trained for. We want the best for everyone who comes into our care, but health underfunding means that sometimes we’re not able to give you the best. We are often short staffed, rushed, and need a little more time to give you care. We are sad sometimes because of what we couldn’t do for your tamariki, your grandparents or your neighbour. Many of you are feeling frustrated by delays in getting the healthcare you deserve and expect. We are frustrated too.

 
Together, we can fix this. If health was funded sustainably now and into the future we could improve that service for every New Zealander. We can have a health system where every patient knows that when they need care, they will see the right health professional, with the right skill, in the right place, at the right time. This is the proud tradition of our country.

 
It is election year. Who you vote for is your personal choice, but we are asking you to use your vote to help us give you and your loved ones the best care. Make sure you are enrolled to vote now, and that the people you know are enrolled . Check out which political parties are committed to increasing health funding. Pay close attention to what they say about resourcing us to give you quality care.

 
We are asking you to make health funding your first priority this election. Talk to your friends and family about voting for health. Without an increase to health funding we are all in serious trouble. With your vote, we can improve and save lives.

Yours sincerely,

NZNO Kaiwhakahaere Kerri Nuku, NZNO President Grant Brookes, the undersigned nurses, caregivers, midwives, healthcare assistants, kaiāwhina, and the people they care for.

You can add your name, where you’re from and message of support as a comment on the blog. Your nursing team would really appreciate it.

Authorised by Memo Musa, New Zealand Nurses Organisation,
Crowe Horwath House, 57 Willis Street, Wellington
PO Box 2128 Wellington


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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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A day in the life of a mental health nurse in New Zealand

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This blog was sent to us by a NZNO member who works in mental health. We are choosing to keep their details anonymous because of the intense scrutiny that mental health services are currently under. This blog is a personal reflection on their own experience, rather than NZNO’s view, but we are sure it resonates with many of you who work in the sector. We really appreciate them sharing their story, and hope it gives some context to the recent media coverage of our mental health services. 

It is 7am and I am off to see a patient in the emergency department. It is a young man who has self-harmed overnight. This scenario is becoming all too common in today’s mental health setting. You see, mental illness is the invisible disease. Presenting to the emergency department in emotional distress, the only visible signs are an unkempt man with a frightened look on his face.

Coming into the cubicle I see a young man in obvious distress. A feeling of hopelessness comes from him. I walk in and introduce myself. We begin to talk. Eyes downcast, feeling somewhat embarrassed as he shares his story with me. He talks to me in a quiet voice. He knows he needs help but does not know where to obtain the help he needs. His relationship with his family has become strained. They have tried to help, but are unable to provide the support he requires.

This man begins to articulate his struggle with schizophrenia. His self harm is due to despair: a belief that life holds nothing for him.  By the end of the interview I know I have several options open to me as a clinician:

  • We could send him home to his parents. But evidently his parents are unable to cope anymore with his distress.
  • We could suggest his GP follow up and maybe a visit from the already over-stretched crisis team.
  • Another option is to find a community respite bed for a few days. But we know that these are few and far between. I will have to telephone and “sell” his case to the respite coordinator if I am to make this happen.
  • Another option is to try and organise for him to be admitted into the inpatient ward. But I know they are nearly always full or over capacity. This is yet another hard sell to find this young man a place to be safe and be supported.

I go to discuss treatment options within the consult liaison team and the decision is made to admit the young man to the inpatient unit. I call the ward coordinator.  “What are his risks they ask?” Not, ‘who he is’, but, what logistical problems might he bring to the unit.

This is mental health nursing today. There is now a ‘risk adverse’ culture that always errs on the side of organisational safety: a system characterised by a lack of choices due to limited resourcing.

This is the young man’s first time in an inpatient unit. I try and reassure him, but as soon we get to the unit the door closes.  People are busy. I try and find a nurse. They are few and far between. I eventually find the nurse assigned to my client. A brief introduction is shared, but I know the nurse is trying to get the paperwork done. Admission note, risk assessment, interview with the psychiatrist, place them on the observation board and a host of other tasks. This leaves little time to begin getting to know, understand and work alongside my client to better support them.

I leave my client and return to the ED, there is another case on the board.

This time another young person in a self-harm situation – they were bullied at school and decided to end their life.

Nurses do care, but we are not being given the time or resources to provide the level of service and care that I would want or expect if it was my family member presenting to mental health services.

We do not want to restrict or deny the people we care for their freedoms. Too often the concept of least restrictive practice is sidelined by lack of resources.

The organisations we work for are worried. Worried about risk and what could be in the papers tomorrow. So much so they seem to have forgotten about the core reason we are here – we are here to help.

I as a clinician welcome the reviews and public scrutiny. The current structure needs looking at so we mental health professionals are able to provide the service, care and support that our clients deserve.

 

 


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Care rationing a sad reality

Care rationing web headerNZNO believes every patient has the right to receive quality care, every shift, every day. Nurses, midwives and health-care assistants also have the right to work in safe, supportive environments and be enabled to provide quality care.

The Safe staffing healthy workplaces unit defines care rationing as: “Any occasion when an aspect of a patient’s required care is either missed altogether, unduly delayed, performed to a suboptimal standard or inappropriately delegated to someone not qualified to perform the activity.”

Is care rationing the “new normal” in patient care?  Are failing to take observations and administer medications on time, inability to turn bedridden patients two hourly, skipping hygiene cares, inability to mobilise patients  regularly, failing to provide comprehensive patient education, not answering call bells, all too familiar aspects of too many nurses’ shifts, too often?

Care rationing is unacceptable because it means patients do not receive all the care they require, it exposes patients to unacceptable risks, it can have serious consequences, it increases patient morbidity and mortality, and contravenes people’s rights to health services of an appropriate standard.

Drawing on national and international research, NZNO’s newly-released position statement attributes care rationing to a systems failure due to inadequate staffing or inappropriate skill mix or insufficient time or a combination of these factors.

The position statement was developed to articulate that care rationing is a systems failure, not a failure of individual nurses. We have chosen the term ‘care rationing’ because terms such as ‘missed care’ or ‘care left undone’ imply that an individual nurse is to blame.

Care rationing is not just another form of prioritisation. Prioritisation occurs at the start of a shift when nurses consider the work that has to be done over their shift and what needs to be done first. Care rationing happens in a chaotic way when there are simply not enough staff to do the work and nurses have no control over the situation.”

It doesn’t have to be this way. NZNO has a plan to eliminate care rationing. What we need is:

  • increased funding for DHBs;
  • nursing care made a priority in decision-making;
  • nursing seen as an investment, not a cost;
  • patient-centred models of care;
  • a focus on early intervention and prevention, and nurses working to the full extent of their scope;
  • full implementation of the care capacity demand management programme in all DHBs;
  • effective workforce planning;
  • transparency about staffing levels;
  • funding to address its cultural impacts;
  • immediate action when staffing requirements are not met to ensure patients get the care they need; and
  • patients who are empowered to complain when their needs are not met because of inadequate staffing.

To find out more about care rationing and what NZNO is doing to eliminate it, go to www.nzno.org.nz/carerationing

 

This blog post was developed from an article first published in Kai Taiki Nursing NZ, vol 20, no 6, July 2014.