District health boards are employing more nurses than budgeted for – according to the latest statistics – but DHB budgets don’t reflect actual patient need, says the nurses’ union.
Safe staffing levels have been high on the agenda in the current pay impasse between New Zealand Nurses Organisation (NZNO) and the 20 DHBs, with the DHBs’ spokesperson Ashley Bloomfield acknowledging the pressure many nurses are currently working under on the ward floor.
The Ministry of Health released its latest DHB financial performance update to the Minister last month which was predicting worsening DHB deficits – partly due to unusually high patient volumes over summer – and that DHBs were carrying more than 400 vacancies. The breakdown of DHB staffing showed that allied health was the area with the greatest full-time equivalent (FTE) vacancies and DHBs were employing 260 more nursing FTEs then budgeted for.
Sixteen of the 20 DHBs were employing more nurses than budgeted for in their annual plans, with in total 28,297 FTE nurses, midwives and health care assistants being employed as at the end of February. This was up more than 900 FTE on the same time last year. Medical staff were also over budget by more than 100 FTEs and had 382 more FTEs than the same time last year.
Pressure has been on district health boards for the last couple of years to absorb more of the record number of new nurses graduating each year (more than 1900 in 2016-17) to ensure New Zealand’s ageing nursing workforce was being replenished – with many new graduate programmes starting in February.
DHBs were also reporting higher than expected patient volumes in recent months contributing to escalating deficits through increased personnel costs and the need to outsource staff and clinical services.
Cee Payne, NZNO industrial services manager, said nursing FTEs might be higher than DHBs budgeted for but that didn’t mean the budgets were sufficient to deliver safe, quality patient care.
“We are aware that people are sicker coming into hospital and there is increased consumer demand so the volume of people and the acuity of patients is impacting on how many nurses are actually needed,” she said.
But she said at present the number of nurses required to meet patient needs was not being accurately calculated by DHBs because of the slow implementation of the Care Capacity Demand Management (CCDM) system process that began nearly a decade ago.
“Even though they (DHBs) might be over budget, basically nurses are not being able to manage the work…and they are not making that up. And yes they may have a budget for nurses but it is not based on any evidence of what is actually happening in the hospital.”
Speeding up the implementation of CCDM has been a major platform in the NZNO collective agreement talks with the DHBs agreeing in the rejected offer for all DHBs to fully implement CCDM – including funding and filling nursing shortfalls revealed by the CCDM analysis – by 2021.
Only one district health board, Bay of Plenty, has fully implemented the safe staffing CCDM tools that use acuity software to calculate how many nurses are needed on each ward based, not on bed occupation, but on what level of nursing the ward’s patients require and the ward’s historic patient demand patterns.
“If they had implemented CCDM ten years ago they would be able to measure and tell us whether they’ve got the right number of nurses based on patient acuity…but they have never done that,” said Payne. “That’s why we are concerned because they can say ‘this is the budget’, but the budget is made to fit whatever money they have got. It’s not based on what are the actual patient and nursing needs.”
She said the fact that hospitals were strained over summer was a warning sign with the winter peak still to come which this year – if the flu season is as severe as it was in the northern hemisphere winter – could be a particularly challenging one. “I do think we are in for a bit of a crisis – and we are going to have to bring people into work ..and the budget is going to probably blow out even further. But patients deserve decent care.”