iwi – Nursing Review…

Editor’s letter: A fair go needed

Fri, 30 Nov 2018 22:40:43 +0000

Back in 1908 one of the country’s first Māori registered nurses and midwives, Akenehi Hei, struggled for a year to get the Government to fund its own plan to employ Māori district nurses to work with Māori.

Now 110 years on nurses working for Government-funded Māori and iwi health providers get paid – but have been struggling for over a decade for extra funding to close the near 25 per cent pay gap with their District Health Board nursing colleagues.

And that gap is now growing wider after a pay settlement that fell short of many stretched and stressed DHB nurses’ expectations but is looked at admiringly by many nurses working for Māori and iwi health providers, as well as their colleagues working at residential aged care facilities. Māori nurses have said ‘enough is enough’ and taken their longstanding pay and related grievances to the Waitangi Tribunal.

The aged care sector is also sounding alarm bells that the pay gap is quickening the exodus of nurses to the DHB sector and an already fragile workforce is fast heading to crisis mode.

It is acknowledged that some of the highest-needs patients in the New Zealand health system are Māori – the health statistics bear stark witness to unmet needs taking their toll – and the elderly, particularly the frail elderly requiring hospital or dementia level care.

So why the pay gap when nobody can argue that the nursing is no less clinically challenging or the workload less than their DHB nursing counterparts? Particularly as the three sectors are largely funded from the same pot – the Government?

Both Māori and iwi health providers and residential aged care facilities will tell you they are keen to pay their nurses more – but the different funding formulas for their sectors makes this financially unfeasible without an injection of extra government funds.

It seems simply fair that nurses should be valued equally wherever they work and whoever they care for. And it also just seems fiscally sensible to have a well-paid, clinically skilled and stable nursing workforce supporting some of the country’s highest need patients so they stay well in the community and don’t require expensive secondary care.

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Leader takes Māori nursing case to the UN for third time

Tue, 01 May 2018 04:16:26 +0000

Setting an “aspirational” goal to boost Māori nursing numbers by 2028 without any funding or workforce strategy is “unacceptable”, says NZNO Kaiwhakahaere Kerri Nuku.

The New Zealand Nurses Organisation leader is just back from addressing the United Nations Permanent Forum on Indigenous Rights in New York for the third year running to support the case of Māori nurses.

Nuku requested a UN interventionto ensure Māori women’s voices were included in health policy decision-making and for the health system to support having a nursing workforce that matched the Māori population. And on her return to New Zealand has called for the Government’s ‘full commitment” to developing and planning a growing Māori nursing workforce.

“An aspirational Māori nursing workforce goal with no further commitment, funding or implementation strategy is unacceptable,” said Nuku.

In November 2015 the Health Workforce New Zealand’s (HWNZ) Nursing Governance Taskforce for Nursing set a date of 2028 to meet a goal of “significantly increasing” the number of Māori nurses (currently 7%) to better match the proportion of Māori in the population (15.6%), with the aim of improving access to care and the quality of care for Māori.

Nuku said recruitment and recruitment of Māori nurses was vital for the future health and wellbeing of whānau, hapū and iwi and a Maori Nursing Strategy was “urgently needed to address this”.

“Whilst commitment has been made to form some regional partnerships to achieve the goal of a Māori nursing workforce that matches the percentage of Māori in their population by 2028, there is no supporting operational strategy to make this happen.

Health Minister Dr David Clark was unavailable for comment but the Ministry of Health’s acting chief nursing officer Dr Jill Clendon said theNational Nursing Organisations group’s (NNOg)MāoriCaucus – which included Nuku – was providing leadership on developing a strategy to meet the goal, with the support of the Ministry’s Office of the Chief Nursing Officer (OCNO).

“We currently fund a number of operational initiatives to grow and support the widerMāorihealth workforce, including scholarships, cultural support and leadership programmes, and initiatives in secondary schools, undergraduate and post graduate education,” said Clendon. “There are also two Bachelor of Nursing (Māori) programmes based on kaupapa Māori perspectives supporting Māori nurses to work in their communities”.

Nuku also drew attention to the ongoing pay parity issue for nurses working for Māori and iwi health care providers who were paid up to 25 per cent less than their counterparts in district health boards.

An 11,000-plus petition was presented to Parliament back in July 2008, pointing out the inequity and calling for the Government to work with NZNO and Māori and iwi PHC employers so that pay equity could be funded and delivered to their nurses and other health professionals.

“This situation, although complex could be remedied by different contractual arrangements, if there was the political will to do so,” she said. The Ministry said it could not comment, saying DHBs funded Māori and iwi providers to provide primary health care services and that nurses pay was dependent on negotiations between the nurses and their employers.

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Māori nurse pay parity – enough is enough

Mon, 15 Feb 2016 21:56:19 +0000

Back in 1908, one of the country’s first Māori registered nurses and midwives, Akenehi Hei*, struggled to get the government to pay for her work. (See her story below.)

More than a century later, nurses working for Māori and iwi health providers are still struggling with pay equity issues, says Kerri Nuku, kaiwhakahaere of Te Rūnanga o Aotearoa NZNO. Nuku says the pay gap between iwi nurses and their district health board counterparts has now got to the point that she knows of iwi nurses taking on extra jobs or contracts to make up for the low wages and to ensure a reasonable standard of living for their families.

The Rūnanga’s Te Rau Kōkiri campaign journey for pay equity for these nurses began back in 2006. It followed the ‘pay jolt’ ratified in 2005 for district health board nurses, which initially saw the pay gap widen between all non-DHB nurses and their DHB colleagues. A further pay gap subsequently emerged between nurses employed by Māori-led healthcare organisations and their counterparts employed by primary health organisation (PHO) funded general practices. At the crux of the issue is a government funding model for Māori and iwi health providers that differs from that of a typical neighbourhood general practice.

In 2009, in response to the petition and other evidence presented, the Health Select Committee recommended to Parliament that a working group look further into the petition issues – including recruitment and retention issues for the providers that deliver targeted services to Māori communities – and report back in six months. But Nuku says the Committee’s recommendation was vetoed by the Government and the working group never formed.

She says there is also increasing frustration that health workforce projects keep setting Māori health workforce targets to meet health needs but as yet New Zealand still doesn’t have a single data repository showing what the current Māori workforce looks like, let alone addressing pay equity issues impacting on retention and recruitment of that workforce.

Nuku says after a decade of unsuccessfully petitioning, lobbying and negotiating for more data and improved funding so Māori and iwi health providers can close the ever-widening pay gap, the rūnanga have said “enough is enough”.

“How do we shine the spotlight on this discriminatory practice that has been going on for way too long?”

There are documents such as 2012’s Thriving as Māori 2030, which says health services need to “at least triple” the Māori workforce by 2030 to reflect the communities they serve, and the tripartite Nursing Workforce Programme, which late last year set 2028 as the date that the percentage of Māori nurses needs to match the percentage of Māori in the population. But Nuku says that initiatives to date have done little to grow the Māori proportion of the nursing workforce, which has been basically static since the 1990s.

“So we have been feeling quite aggrieved for a wee while,” she says. But after years of being wary of speaking out, she says rūnanga members are readying themselves for a ‘big year’ in 2016 and to start challenging the status quo. She says they are now viewing pay parity for Māori and iwi providers, and the lack of information on Māori health workforce data, as human rights issues. To this end, NZNO has written to the Universal Periodic Review (the United Nation’s Human Rights Council process that reviews the human rights situations of all 193 UN member states) to express its concerns about the issues and has also raised its concerns with New Zealand’s Equal Employment Opportunities (EEO) Commissioner, Dr Jackie Blue.

Stats

Māori

As at 31 March last year, 3,510 practising nurses – comprising 15 nurse practitioners, 3,245 registered nurses and 250 enrolled nurses – identified as Māori. This represents seven per cent of the total nursing workforce.

In the 2013 census, Māori comprised 15.6 per cent of the total New Zealand population and were younger overall than the non-Māori population (a third were aged under 15).

Barriers to retention of Māori in the health and disability sector*
In mainstream roles, expected to be expert in and deal with Māori matters	65%
Māori cultural competencies are not valued	64%
Dual responsibilities to employer and Māori communities	58%
Lack of or low levels of Māori cultural competence of colleagues	58%
Limited or no access to Māori cultural competency training	51%
Limited or no access to Māori cultural support/supervision	48%
Racism and/or discrimination in the workplace	39%
Isolation from other Māori colleagues	33%

Retention enhancers for Māori in the health and disability sector
Making a difference to Māori health	92%
Making a difference for my iwi/hapū	89%
Being a role model for Māori	80%
Ability to network with other Māori in the profession	83%
Strengthening Māori presence in the health sector	92%
Being able to work with Māori people	89%
Māori practice models and approaches valued	81%
Opportunities to work in Māori settings	80%

Source: Participants’ ratings of importance of barriers as either ‘quite a lot’ or ‘major importance’ in research carried out for RATIMA et al. (2007), Rauringa Raupa, Ministry of Health. (Republished in Lisa Stewart’s ‘Māori Occupational Stress’ thesis.)

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Pioneering nurse Akenehi Hei

In 1901 Akenehi Hei began a basic nursing skills programme intended to make her an “efficient preacher of the gospel of health” when she returned to her village as a “good, useful wife and mother”. In 1905 the scheme was extended to offer full nurse training and the still-unmarried Hei qualified as a registered nurse in mid-1908. She quickly completed her midwifery training in the same year in readiness to be part of a 1907 Public Health Department scheme to employ Māori district nurses (working in public hospitals was not envisaged or encouraged for the first Māori nurses.)

But by 1908 there were still no government funds allocated to pay for Māori district nurses and it wasn’t until June 1909 that she was offered a two-month post nursing in a Northland typhoid epidemic. After that it took several more months until she was finally offered another post in New Plymouth. Tragically, she succumbed to typhoid herself in late 1910 after returning to Gisborne to nurse family members ill with typhoid.

Her biography in Te Ara – The Encyclopedia of New Zealand states she not only had to deal with institutional racism – her postings were seen as a test case “to see how these Māori nurses act” – but also with little support from a department which was concerned with minimising costs and was not fully committed to Māori health work.

THIS CONTENT WAS ORIGINALLY PUBLISHED AS PART OF FEATURE:

Māori and Pacific nurses: is burnout inevitable?

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