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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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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

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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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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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It’s time to shout out for health

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I’ve spent a long time working in health, and have seen a lot of change. Governments come and they go, budgets change, policies shift. But what doesn’t change is the reason we are attracted to health careers- it comes from a deeply felt desire to make a difference, and change the lives of others for the better.

What you’ve been telling us over the last few years is that it’s becoming harder to connect to that feeling in your everyday working life.

Of course, we still do good. Nursing, like all people-centred jobs is about getting creative, working with what you’ve got and accepting what you can’t change. But the more workarounds our members have to do to give good care, the less time they actually have to provide that care. Nursing SHOULD be a job where you can go home at the end of the day with a satisfied feeling that you were able to make the difference, not frustrated about what you couldn’t do. Nursing is a job we should be able to love.

You have told us you want:

  • “A health system we can be proud of, where everyone can get the healthcare they need when and where they need it.”
  • “To feel proud of the care we provide, and be confident that we have the resources to provide safe, quality care at all times.”
  • “We want satisfying careers with pay that values our work and is enough to thrive on, and ongoing professional development.”

And that’s what NZNO is also pushing for. But we need your help!

Right now, the effects of healthcare funding are all around us- on the ward, in the community, and in the news. In just the last few weeks, we’ve seen news reports about

And the list could go on. The best management and policy in the world can’t make 1+1 = 3. Healthcare underfunding affects almost every aspect of our working lives, and is starting to impact on patient care. I know we all want better. That’s why we are running a campaign programme led by YOU, our members, called Shout out for health. Shout out for health will take action on health funding to push for a health system we are all proud of. Sometimes it will be about a particular service, like our petition on funding for Smokefree services.

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And sometimes it will be about a local issue, that you let us know is happening. The important thing is we need confident, passionate members to make it a success.

If you are an NZNO delegate or NZNO champion, you should have received an email inviting you to a special Shout out leadership training programme. You need to let us know now if you are in- so check your emails please!

If you are ready to stand up and take action to make health funding a priority for all politicians, sign up to be a supporter of the campaign here.

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We are a professional association and union of 47,000 people who care deeply about others. If we use our voice to say ‘health matters’, we have the power to make it better for patients, but also for ourselves.

Memo Musa

NZNO Chief Executive

Nurse


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Not holding my breath for Budget

HamishHi, my name is Hamish Hutchinson. I’m a registered nurse, an NZNO delegate and I work at Waitakere Hospital in Auckland.

We’re coming up to the Budget, which is when the Government prioritises its spending for the next year. Will they prioritise health? I’m not holding my breath.

The Council of Trade Unions calculated we are well over a billion dollars short for the health system just to stand still. I can’t really comprehend what a billion dollars looks like, but I can tell you what underfunding looks like to me, every day.

I’ve been working as a nurse for 5 years. I chose nursing because it’s the sort of profession where you can use your own humanity to help others. This is still why I want to be a nurse.

I work in an Emergency Department (ED), so we are used to it being busy. We have a great team that responds well in a crisis. But it’s not always trauma and lights and sirens – another part of the ED is about doing screening for family violence and asking about how things are for people in the home. When it’s busy – and it’s getting more and more busy all the time – this stuff – the social stuff, the time spent listening to people gets pushed aside. That worries me.

ED nursesWe always say that the Emergency Department is for emergencies only. I’ve lost count of the times I have heard people saying that they couldn’t get into their GP for 3-4 days or couldn’t pay for after-hours clinics or couldn’t get into a GP because they work two jobs and have kids. Inevitably they come to ED – where else will they go?

Just as an example, I saw one man who had an infected wound. He had put off seeing the GP because of cost and because he couldn’t take a sick day from work. When he finally arrived in the ED his wound had gotten really bad. Something that probably could have been managed by a GP a few days ago ended up needing surgery and a hospital stay. It was worse for the patient and it cost so much more than it needed to as well, in equipment, bed space, and staff time. This doesn’t need to happen.

Some days the Emergency Department feels like a game of musical beds. When the hospital is full it’s just one big balancing act. I’m amazed it works and I think that’s down to the tireless work of nurses and other hospital staff.  But the reality is this is not a game, this is people’s lives.

Good health is vital for a good society and if I got to make the big decisions, I would make health and wellbeing a bigger priority than it is now. Everyone needs to be able to get health care in their own communities. We need more hospital staff for sure – but keeping people out of hospital is cheaper in the long run.

ED nurse talking with patientWhat this would look like for me?  It would mean having enough time to talk to people to find out what brought them to ED and how we can stop it happening again. You can’t do that when it’s too busy, when there’s people in corridors, and it’s the really important stuff like this that falls away with underfunding and understaffing.

Other things that would make a big difference, in my opinion are:

Free GP visits for everyone and clinic hours extended to suit working families. People should be able to see a GP on the same day and have flexibility if they are workers.

Improving the ‘social determinants of health’- the things that should keep people well in the first place, like housing, welfare, education and employment. We would have more time available for the unavoidably sick if preventable causes of disease were reduced or removed.

In particular, outside of the hospital, there has to be more emergency housing, and this is an issue that’s needs to have been resolved yesterday! There’s nowhere in West Auckland to go if you are homeless, only sleeping rough or paying for a motel which might not be an option for lots of people.  Addressing the human right to safe shelter is an absolute must and would ultimately improve the health of people in hardship. If nothing is done on this issue, I will be worried for the future, because it’s bad enough now. On Thursday, I hope the Government prioritises health and the people in our communities. And that means housing, welfare, education and employment as well. They could do it if they had the will. They could fix this all if they wanted. That’s something we are all holding our breath for.

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