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

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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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Give me the tools to do a good job

Female mechanic

A fast red car or nursing degree in my middle age? I decided on my long held dream of the nursing degree. So now, I’m part of a team of extraordinary professionals who remind me every day that flagging the fast car was the right decision. I love my job, I love and respect the people I work with and I care passionately about those I am charged to care for.

But, every day it’s getting harder. Harder to care the way I want to, the way I know I should and to care to the standard that my job description and Nursing Council expect of me.

This sounds emotive – it’s meant to be! Last time I looked I’d signed up for the ‘caring profession’, I’m paid to care – not to short change my patients. I didn’t for one moment, while studying, consider that I would have to factor ‘care rationing’ into my day. Care and rationing don’t even belong in the same sentence – It messes with a nurse’s head, it shouldn’t even be a concept!!

Most people have no idea how much these constant budget cuts impact on my ability to do my job. A few get a snapshot, when they are unwell and require medical help. If I’m lucky they are empathetic and understanding of the difficulties nurses face every day, they appreciate what we do and how hard we work.”

If the Minister of Health, Dr Coleman is going to name and shame hospitals who fail to meet the ‘ED Six Hour Target’, then he should be obliged to give the public the full story – the reasons why this is happening in the first place! Perhaps explaining that some EDs have increasing, unprecedented presentations – some patients very unwell, needing massive resource input, so others sit for hours waiting to be seen because there aren’t enough nurses or medical staff to keep the patient flow going. Or maybe that the hospital is in ‘bed lock’ – not a single bed, until hurried discharges are made – a short term solution, because some of those patients will be back in ED, sicker- requiring a higher level of care and  another admission. Or maybe that some days ED waiting rooms are full of patients who could have gone to their GP, but have left it too late, or couldn’t get an appointment, or didn’t have the money.

Nurses were voted the ‘most respected profession’ survey this year. I don’t feel respected by our government. If the government respected us and our work, they would make sure that nurses had the tools to do their job, and to do it well.  Our health service is being stripped so bare, many nurses are walking away or planning to. They’re done with the stress, the shifts that end in tears, not wanting to go back tomorrow.

I just want to be able to do my job properly, safely and go home knowing I’ve done a good job. Our health system should be given a realistic budget that allows it to function properly.

If we want things to change then it’s up to nurses to say so – nobody else is going to! So do we wait until the next pay round?  Do we wait for a nurse to make that error we all dread? Do we keep waiting… for what? It’s time to use the strength of our union to give the public the full story of what is happening to our health system and why that system is letting them down. To say nothing is negligent!

By NZNO member Ady Piesse

Photo credit under Creative Commons licence.


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The demise of democracy

RIP democracyNZNO industrial adviser for the DHB sector, Lesley Harry talks about democracy, privatisation and Southern district health board.

Last week the Minister of Health announced that Kathy Grant will stay on as commissioner of Southern district health board until 2019. Democracy is at a premium in the south these days.

Grant was appointed by the Minister in June and is paid more in a day than most nurses get in a week. Apparently her $1400 a day pay rate is due to the “personal risk to her reputation” of having to improve the DHBs finances in such a short period of time. To us, that’s a clear signal that Minister Coleman is aware that the cost-cutting and service-cutting that will ensue will be hugely unpopular.

Only time will tell as to the true cost of “savings initiatives” now that Grant and her team have an extra three years to deliver the required savings.

Grant has promised a “whole of system change with more care in the community, reducing waste and working in more efficient ways.”  Integration of primary and secondary services is on the agenda and this will likely lead to more hospital-based services being directed to primary services with PHO and other private providers having more say on the way health services are governed, managed and delivered.

We will have to wait and see what will be proposed, but I am concerned that this current Government will exploit the sacking of the Board and appointment of a commissioner to move towards more privatisation of public health services in the southern region as a model for the future.

The commissioner has delivered on her commitment for improved communication with DHB staff and stakeholders, with meetings and regular updates. Long may that continue.

Although, the commissioner’s goals appear laudable; it’s the how? and at what cost? we need to keep a careful watch on.

The citizens of Southland and Otago no longer have democratically elected representatives governing their health services. The Minister and his appointed commissioner have enormous power to implement change.  Whose interests will be served will remain unclear for longer, now that voters will have to wait until 2019 for democracy to be reinstated in the southern region.


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Everyone needs work security

DSC_0111By NZNO president Grant Brookes

Last week I was proud to be one of a delegation of 16 NZNO members and staff who attended the Council of Trade Unions Biennial Conference. We all had responsibilities; from running workshops to researching remits and presenting reports.

It was my job to address the remit “That unions intensify our campaigning against insecure work including seeking outcomes through collective bargaining and legislative change”.

NZNO voted in favour of this remit and here’s why.

We see the health impact of insecure and precarious work every day of our professional lives. We see it affecting our patients and some of us experience it ourselves.

  • When we don’t know how long a job will last,
  • when we don’t have any control over when we work, or for how long,
  • when our pay is low or fluctuates,
  • when there’s no chance to upskill,
  • when there’s no union representation,
  • when there’s no protection against discrimination and
  • when things are unfair and we know we could lose our job without good reason –

That’s insecure work

The World Health Organisation says, “The global dominance of precarious work, with its associated insecurities, has contributed significantly to poor health and health inequities.”

If you were asked to imagine a person in precarious work in New Zealand today, chances are you’ll think of someone like a young McDonalds worker on a zero hours contract. Sadly, precarious and insecure work is widespread.

The aged care sector is another area where rising work insecurity is an issue.

In August, a residential aged care provider in Christchurch tried to change the roster so that no one was guaranteed more than 28 hours a week, with no fixed shifts.

Here are some of the messages NZNO members sent to the manager about what the proposal would mean for them and the residents they care for.

“I feel very stressed and extremely worried about my future, because of this roster change. This clearly means I will lose my working hours, and a rotating roster will make it difficult to catch up with friends because you don’t know one month or two months earlier what your schedule will look like. A big worry for me is I may not be able to pay all my expenses – rent, food, petrol etc. The only option is to pick up shifts, but there is no guarantee for everybody.”

“The proposal will not give me enough hours per week, which makes it really hard for me to pay off my bills. I am on a work visa at the moment. I need a full-time job to renew my visa, not a part-time job. As it is unsure when is my day off, it makes it hard for me to make plans for my family events.”

“Staff will be forced to leave if the changes occur, as management’s proposal will affect each staff member’s earnings. They can easily hire new staff, but the service which the old staff rendered to our beloved people will be affected, as new staff will need to do a lot to know more about the old people’s routine.”

“The company has a policy of ‘person-centred care’. It’s a great shame that this does not extend to its staff. I feel like a cog in the wheel of the machine, just a name on a roster to fill a slot, not a valued, 15-year experienced employee.”

Insecure work is also coming to District Health Boards.

The West Coast District Health Board is currently consulting on a proposal that will affect all nursing staff. If it goes ahead, the proposal could require any member of the nursing team to work in any service, in any role, no matter their specialty or the distance they might need to travel to get there – and don’t forget how big the West Coast is! Nurses could be travelling for hours.

Meanwhile, the three Lower North Island DHBs want to hire nursing staff to work across DHB boundaries. This could see nurses employed by one DHB directed to work in a neighbouring DHB. That’s a really insecure place of work!

The good news is that the roster changes at the Christchurch facility were withdrawn, thanks to the union member’s submissions. Proposals for staff to work across DHB boundaries in the Lower North Island are still under discussion with NZNO and the PSA, and have not been implemented. And we remain optimistic that working in partnership with West Coast DHB will see nurses retaining security around their employment there.

Where unions are present in a workplace, we can often reverse trends towards insecure work.

But the reality is that people in the most precarious employment, who experience the greatest health effects from insecure work, are outside the coverage of collective bargaining and union organising,

So if unions are to campaign against insecure work, which is contributing significantly to poor health and health inequities, the emphasis will have to be on seeking outcomes through legislative change.

This is where NZNO can – and will – join together with our sisters and brothers in the wider union movement to make positive change for all.

 


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Together we are stronger

DHB header for blog

 

Together we are stronger: some reflections on DHB MECA bargaining.

Lesley Harry is the industrial adviser for the DHB sector and has been leading the NZNO negotiation team in bargaining with the DHBs. Lesley is a longtime activist who works tirelessly for a better working life for NZNO members.

Since the end of last year, NZNO has been in a time of incredible busyness and energy, because of the collective agreement negotiations between 26,000 members and DHBs.

Collective bargaining can be the best of times and (sometimes) the worst of times for unions and union members. It can be disappointing when the employer doesn’t recognise the worth of their workers, or when the discussions get stuck, and it can be hard waiting for news when we don’t know what will happen or when.

On the other hand, it has been totally exciting to see the outpouring of collective creative energy of our members on action days and at worksite meetings. NZNO members are skilled bakers and costumists, artists, photographers, organisers, decorators, activists and speakers, and are also hilarious!

We see the best of you all in your collective actions and displays of strength and solidarity – and it’s slightly overwhelming when we see letters flooding back in to realise just how many of you there are!

This incredible energy has had a solid impact so far. When the first offer was taken out for DHB members to vote on, there was a resounding ‘no’, followed up by direct action.

The DHBs and NZNO were coming from very different positions, standing far apart. Since then our negotiating team has made progress in mediation, buoyed by your support. You can be absolutely sure the DHBs take note of our action. The progress we made would not have happened without it.

It’s also interesting to note that the further through bargaining we have gone the more conversations have opened up about the bigger picture.

Government funding of DHBs affects what services can be provided, and the wellbeing of both staff and patients.

In essence, NZNO and DHBs want the same thing: to protect our precious health services and create sustainable work environments that are safe for everyone.

NZNO members are a very powerful resource in the fight against health sector cuts. DHBs might just be starting to see that they are stronger standing together with us too. This is what the power of our solidarity can achieve.

We are looking forward to hearing more news from the DHBs next week and gathering together again in huge numbers- hopefully at ratification meetings!

 


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Southerners won’t back down

Nurses at Dunstan hospital celebrate International Nurses Day

Nurses at Dunstan hospital celebrate International Nurses Day

Southerners are gutted to hear of a five percent funding cut to their network of rural community hospitals in Oamaru, Ranfurly, Dunstan, Balclutha and Gore.

And if that’s not bad enough, there will be reviews of health services and no increases for changing costs or population. What that means is that if the population of your town increases, there won’t be any corresponding increase to health funding.

Hospitals are still working out what impact this will have on services and each hospital will be affected differently. What we do know is health services are under threat and so are many jobs.

At the same time, Southern District Health Board (SDHB) has announced plans to contract out and privatise its food service, with frozen meals being driven down from Auckland, in a further attempt to save money that threatens local jobs. We can see no sense in that whatsoever!

So why is all this happening? Southern DHB’s financial situation is pretty grim – they are $27 million in the red this financial year and are predicted to be at a $42 million financial deficit next year. When DHBs are squeezed this tight, something has to give. This time it’s the health of our rural communities, not to mention their nutritional needs!

While we don’t know all the reasons for their financial woes, or why they are so much worse off than other DHBs, we do know that a contributing factor is the year in, year out, underfunding of health services in New Zealand [pdf].

It’s this Government’s seventh budget this week, and they’ll be announcing funding for health for the next year. If they get it wrong, we’re looking at losing local jobs and local health services. Without more money coming in, it’s hard to see how Southern DHB will be able to preserve all the health services the population needs.

It’s not fair that valued local services, through no fault of their own, have to bear the brunt of Southern DHB’s deficit. NZNO will be working constructively with the affected rural hospitals to save services and protect member’s jobs. Not only will these cuts put patients’ health at risk, but removing skilled jobs from the regional economy impacts on the region’s long term financial health.

This ends up costing the Government more in the long run through health, social services, and other agencies. Southerners understand this, and we will be backing them all the way to find healthy and sustainable solutions to the District Health Board’s financial crisis.

Watch this space for NZNO’s response, and updates on the Southland and Otago rural hospital network plan for dealing with the cuts.