Chief executive Memo Musa addressed last week’s 2017-18 annual general meeting after a year dominated by the long and fraught negotiation process for the DHBs’ multi-employer collective agreement that saw the union face strong criticism on a number of occasions.
In his speech for the AGM, Musa said health was a human right for nurses too – with professional wellbeing part of that right. Nurses had the right, he said, to be equipped to provide excellent care, a healthy workplace with empowering policies and safe staffing levels and workplace conditions. “And, perhaps most essential to your wellbeing,” he said, “you have the right to be recognised for what you do – to be valued and fairly paid.”
He said it had been an extremely complex year, which had included an election and the initiation of DHB bargaining.
“But if you look at the submissions we wrote, the campaigns we ran, the publications we produced, the media attention we generated, and the bargaining we conducted – the work outputs and the achievements have been truly phenomenal. And we have also bucked the trend in that we are the only union in New Zealand to have grown its membership.”
He said NZNO’s total membership grew 4.7 per cent to 50,708 members (up from 48,444 last year). Financially the organisation had an income of $21.4m (more than 90 per cent from members subscriptions) and expenditure of $21.7m. But he said tax and adjustments meant that NZNO ended the year with a surplus of $182,419, which followed the organisation ending the previous financial year (2016-17) $266,697 in the red after tax after four years of health surpluses.
“Last year in my AGM report I said we do not celebrate enough of our successes, and that we are highly critical of our shortcomings, to the point that it overshadows the good things – and the progress we are making,” said Musa. “I would like to restate that it is vital that as an organisation for nurses we celebrate the successes and the work we have done together and collectively.”
Some statistics from 2017-18 annual report:
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It follows the challenging DHB NZNO negotiations that saw resolute DHB nurses unite to take the first national strike in nearly 30 years over pay and safe staffing concerns – and ended with 64% voting in favour of a fifth DHBs’ offer following the signing of the safe staffing Accord and NZNO’s recommendation that further industrial action would not lead to extra funding for the deal.
The hui is being held on August 19 in Auckland by the newly-formed NZNO Members Action Group to discuss where-to-next for the NZNO members who expressed frustration on social media about the union’s responsiveness to members during and after the DHB MECA negotiation process.
Asked what lessons he believed NZNO could learn from the 2017-18 negotiation round NZNO chief executive Memo Musa said the union would be conducting its usual evaluation and review of the MECA negotiation process to look at what worked well and what could be improved on. “Particularly in regard to the growing climate of social media dialogue that took off during the negotiations”. And he said it would be engaging with members on how they would work together on planning the next round of negotiations – including the pay equity process – taking into account the review results.
Musa added that members have a wide range of views and the negative comments on social media had to be viewed with the context of the 64 per cent who had voted in favour of the final offer.
Action group spokesperson Danni Wilkinson said the group had about 400 members and was a ‘rank and file’ member response to unite NZNO members who had spoken out about their concerns on a number of the nursing social media platforms.
Wilkinson founded the Facebook page Nightingales Fight for Fair Pay in late May as a spin-off from the ‘Nurse Florence’-founded New Zealand, please hear our voice page. The page has 2800 followers compared to Nurse Florence’s 45,000 plus, and the longer-established NZNO Members & Supporters page (8200 members) and the New Zealand Nurses Organisation page (20,200 followers).
“I think if we don’t keep the momentum that we have gathered over the last six months – if we don’t keep that going we will go back to that apathetic – ‘the union doesn’t give a (toss) so why should I’ – attitude with people refusing to vote and just not paying attention to what is going on,” said Wilkinson.
“And we will sit on that for another ten years and flare up again. And I don’t think that’s healthy. I think we’re better to create the change and maintain our healthy union along the way rather than clash and fight every ten years or so – which is exhausting.”
“I guess we are at the point where there have been a lot of people talking – and it’s time to put up or shut up – if you are just going to sit in the background and whinge, whine and complain but not actually participate in creating the change that you want, then stop your whingeing.”
Musa said alongside the negotiations review NZNO was now turning to delegate and member education and communication about what the new DHB/NZNO MECA contains. “And show we will work together on the implementation and planning for the next round of negotiations including the pay equity process, taking into account outcomes from the review.”
He said NZNO was supportive of members being able to speak openly about the deal on social media. “However, what is disappointing and unacceptable on social media are the personal attacks on the negotiating team and process based on insufficient knowledge, evidence and facts about the technical aspects of the negotiation process.”
Musa said some of the comments had been unpleasant and unprofessional and directed at people “doing their utmost to deliver the absolute best for members” and who had to “personally dig deep” to continue in an environment where they suffered continual criticism from some members. He said the relationship between senior staff and many grassroots members remained strong. “NZNO gained the best possible MECA offer and we are now receiving many, many emails of thanks to the senior staff which had been heartening.”
Wilkinson said the action group was particularly keen to see change in how the upcoming pay equity negotiations were carried out and to have assurance that the negotiations would be backed by quality research. “The other concern that we have is that NZNO said repeatedly that the members are the union but there is definitely a strong feeling that that is not the case.” Wilkinson said she was aware of many members who felt that NZNO had prioritised the union’s partnership with DHBs over representing many members’ wish to push for a better offer or consider further industrial action.
But she said if members are wanting change from the union in return they also had to be ready to participate themselves. “They don’t have to be the workplace delegate – they can just be the person who helps the workplace delegate, collects signatures on petitions or offers other support so they are active participants. We are hoping if we can encourage 30,000 members to take a bit more interest then things will change from within for sure.”
Wilkinson said talking on social media had been great – while acknowledging there had also been some misinformation and confusion – but more action than social media posts and comments were needed to create the change that members had talked about.
“If our group finds that we don’t have enough support – and actually members are happy to just go back to work and tick along – then we (Action Group leaders) will keep looking at doing things through official channels – because we do believe there is a strong need for change and we will help guide that.” The group is also inviting people from other centres to join the Auckland meeting via teleconference.
]]>A number of nurses disappointed at the announcement on Tuesday at the fifth offer being accepted had posted on social media sites calling for NZNO to be transparent and release the ballot results.
Memo Musa, the chief executive of the New Zealand Nurses Organisation, said the decision to release the voting details came in the wake of “the large amount of social media comment suggesting NZNO had misrepresented the facts of the vote result” and following consultation with key NZNO staff.
“The percentage of votes in favour of the fifth DHB MECA offer as returned by Electionz.com is 64.1 percent to accept the offer and 35.9 percent to reject the offer,” said Musa in a statement released this evening.
“The previous offer result was 49.4% to accept the offer and 50.6% to reject the offer.
“As said last time the vote result was very close and this time there was a significant majority accepting the offer.
Musa said the union was now focused on implementation. “The organisation is strong and growing and I am proud of the hard work of my colleagues, the delegates and members that have undertaken to achieve a MECA which lays down the foundations for a safer and rewarding career in nursing,” Memo Musa said.
| DHB NZNO MECA Offer | ACCEPT | REJECT |
| 1st offer Nov 2017 | 43.4% | 56.6% |
| 2nd offer Mar 2018 | 27.0% | 73.0% |
| 3rd offer Jun 2018 (post-Independent Panel) | 30.7% | 69.4% |
| 4th offer Jul 2018 (pre-strike) | 49.4% | 50.6% |
| 5th offer Aug 2018 (post-Accord and strike) | 64.1% | 35.9% |
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Dr David Clark, the Minister of Health in announcing the accord today said it was clear that “we’ve been asking too much of our nurses and their workloads are not sustainable”.
Concerns about unsafe staffing and the DHBs’ slow implementation to date of the Care Capacity Demand Management (CCDM) tools – that were created to calculate and resolve understaffing – was one of the major reasons many DHB nurses gave for rejecting the 4th offer and going out on strike on July 12. The 5th offer, that online voting is due to start on Tuesday, was endorsed by the NZNO negotiating team saying it would strengthen the implementation mechanisms and monitoring of safe staffing as the 20 DHBs worked toward implementing CCDM by 2021.
Memo Musa, NZNO chief executive, said the announcement of today’s accord was supplementary to the offer and meant he was finally confident that the top level of Government would address the unsafe staffing levels experienced for over a decade in the public sector.
Clark said under the terms of the Accord, DHBs and the Ministry will work with NZNO to monitor the implementation of the CCDM safe staffing tools. “There will be clear accountability mechanisms in place to ensure the required staffing is delivered,” said Clark.
In a letter to the parties to the Accord he said he would be asking the State Services Commissioner to consider re-wording the Director-General’s performance expectations to reflect the Accord. Also asking the chairs of the 20 DHBs to consider similar wording in the performance expectations of their DHB chief executives.
Jim Green, the DHBs spokesperson and Tairawhiti DHB CEO, said DHBs knew that implementation of CCDM had been inconsistent across the 20 DHBs and the Accord would give nurses and others the confidence that DHBs would provide staffing where a need was identified.
He says any additional staff identified through CCDM will be on top of the $38 million already earmarked for recruiting about an additional 500 nurses in the latest offer.
In a press conference Clark said the Accord creates a formal process where DHBs now have to report regularly on their CCDM progress to the Director-General who would report quarterly to him as Minister.
“I am absolutely hopeful that nurses will see that this is different to the processes that have been in place before,” said Clark. He said his brokering of the Accord was a sign of his and the Government’s commitment to implementing safe staffing. Clark said the Accord was separate from the current MECA negotiations and would be signed prior to nurses starting voting, so would go ahead whether or not the DHB NZNO nurses’ ratify or reject the DHBs’ 5th offer.
“I accept that nurses don’t feel that DHBs have always delivered on previous commitments. As Minister of Health I will be requiring DHBs to make good on all staffing commitments.”
He said in addition a strategy would be developed to help retain existing nurses and midwives in the public health service, and attract others back into the workforce.
The Accord also includes a commitment to looking at providing employment and training for all New Zealand nursing and midwifery graduates considering the model currently used by DHBs to employ medical graduates.
“Issues of safe staffing and workloads have developed over many years of underfunding and everyone acknowledges they will take time to fix,” said Clark.
“We’ve always said we couldn’t fix everything in one go. This Accord establishes a forum to deal with these issues on an ongoing basis,” he said.
Musa said nurses have said a reason they leave the profession is because of having to compromise their practice standards due to unsafe staffing. “Also because they are dissatisfied by not being able to take time to advance their own skills or to train others.” He said the Accord’s commitment to safe staffing could encourage nurses back into the workforce and NZNO also welcomed the commitment to exploring options for employing all Kiwi nursing and midwifery graduates.
The Accord’s three main commitments are:
“International nurses day comes at a time when many nurses are saying ‘enough is enough’,” said Professor Jenny Carryer, the executive director of the College of Nurses Aotearoa. “This is happening at a time when the entire system is under considerable pressure and no obvious solutions are apparent.”
Memo Musa, NZNO’s chief executive, said with just six days to go until the Budget it has asked both the Ministers of Finance and Health to boost health funding “significantly”. “With a particular mind on the struggling nursing workforce that is calling out for greater workforce support so they can work to the top of their practice.”
15 nationwide marches and rallies are to be held on Saturday May 12 – Florence Nightingale’s birthday, which is celebrated worldwide as International Nurses Day – as nurses and their supporters make sure New Zealand ‘hears their voice’ prior to the health budget being announced on May 17.
District Health Board nurse members of the New Zealand Nurses Organisation (NZNO) are also voting on whether to take two 24-hour strikes in July over their stalled pay talks with the 20 DHBs, while an independent panel tries to find a solution to prevent a winter strike.
Carryer said that a simple solution to the current pressure on the health system was for nurses’ services to be valued as they deserve and not to be considered as a cost to be “pruned and constrained at every opportunity”.
“We could switch to regarding nursing as the resource that – with thoughtful evidence-based investment and attention – could transform multiple areas of service delivery to being better for patients and more cost-effective in the long term,” said Carryer. “This will take courage and vision and acceptance that it is a long-term solution. But the longer it is left, the harder it will be.”
The theme set by the International Council of Nurses for this year’s International Nurses Day is Nurses: A voice to lead – health is a human right and for nurses to lobby for healthcare to be accessible to all, regardless of their locations or settings.
Grant Brookes, NZNO president, said the human right to healthcare has been compromised after nine years of underinvestment in health in New Zealand and as a result some people’s healthcare access was restricted. “Nurses at all levels are using their voice to uphold the human right to health, from the nurse executives to the thousands taking action through NZNO’s #HealthNeedsNursing campaign, calling for the investment to rebuild a quality public health system.”
Musa added that nurses are the backbone of healthcare systems internationally and the World Health Organization (WHO) estimates that half the world lacks access to essential health services.
“Nurses have a unique and intimate view of a person’s life more than any other health profession,” he said. “[They have] a unique position to provide care that is enshrined in human rights, that is person-centred.”
]]>From today for the first time nurse practitioners can issue the death certificate for patients in their care. Suitably qualified nurses can also write sick leave certificates.
Dr Michal Boyd, a long-standing NP, says being unable up until today to complete death certificates for patients in her care meant the risk of unnecessary delays and distress for a grieving family.
“As the primary healthcare provider I know the person’s medical conditions and have often led their care over months or even years,” said Boyd. “Now I am able to provide all the care needed for the older person and their family.”
More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made only come into effect today (January 31).
The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), and other health practitioners like pharmacists, registered nurses and physiotherapists are now qualified to carry out those roles.
Lobbying began early in the millennium by nurse leaders to identify and remove a range of legislative barriers to nurse practitioners’ practice and formal work began back in 2005 to go through legislation with a fine tooth comb to find references to “doctors” or “medical practitioners” in roles that now could be done by other suitably qualified health practitioners. The acts remove the anomaly where NPs could sign ACC forms and sickness benefit forms but could not sign an ordinary sick leave certificate for work under the Holiday’s Act.
Boyd, a former chair of Nurse Practitioners New Zealand (NPNZ), said today’s enacting of the new laws represented to her the removal of some of the last barriers to being able to practice at the top of her scope as a nurse practitioner.
The Ministry of Health’s outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.
Memo Musa, the chief executive of the New Zealand Nurses Organisation congratulated all those involved in the watershed changes particularly the Nursing Council and the Office of the Chief Nurse.
Musa said the amended Acts meant more nurses could improve public access to some medicines and also enable them to work to the full breadth and scope of their practice. “It is often easier and quicker to see a nurse than a doctor so this change means more people in the community can benefit by accessing health care sooner.”
2018 LEGISLATION CHANGES SUMMARY
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury including suitably qualified registered nurses, if their employer and the Nursing Council of New Zealand recognise that they are competent and safe to do so
Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.
Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).
Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.
Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.
Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.
Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.
Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.
]]>O’Malley, who has been Chief Nursing Officer for seven years, is to become Plunket’s first Chief Nurse in March, in a role reporting to Plunket chief executive Amanda Malu.
O’Malley said it was a coincidence and “unfortunate timing” that her announcement followed shortly after Director General Chai Chuah’s resignation. She added that she had a “great deal of respect for Chai and his vision for the future” and was not leaving because he was leaving. “Sometimes great opportunities come up and you need to grab them with both hands.”
O’Malley said she was very much looking forward to working with the Plunket leadership team on their strategic vision as it was a “perfect fit” with her own health philosophy.
“My belief in the New Zealand Health Strategy – and in particular that we can make better inroads into improving people’s health by paying attention to the early years – is reflected in Plunket’s vision for the first 1000 days of life,” said O’Malley. That it was also a nurse and consumer-led organisation also fitted well. She said she would bring with her to Plunket a wealth of knowledge about how the machinery of Government worked and how policy was developed.
O’Malley said she had mixed feelings about leaving her current role as she had loved her time at the Ministry. Some of the highlights were the coming into effect in January of the long-awaited Health Practitioners (Replacement of Statutory References to Medical Practitioners) Act – which removes legal barriers to nurses and nurse practitioners working at the top of their scope – plus the development with the Nursing Council and NNO (national nursing organisations) Group of the now three levels of nurse prescribing. Also the creation of the ACE new graduate job system which meant there was now a database of new graduate job hunters which had helped employ more new graduates as vacancies arose.
“There are lots of good things to celebrate and time really for me to move on to something new,” said O’Malley.
She said once it was known in the New Year about the appointment of an acting Director General she would be keen to ensure that the Chief Nursing Office position remained at the executive level of the Ministry and reported to the Director General.
“Because nursing is the largest workforce and it is, I believe, the workforce that if better utilised will take us into the mid-Century. So we need a strong leader at the top,” said O’Malley.
Plunket chief executive Amanda Malu said the appointment to O’Malley to the new role recognised the importance of the nursing profession to Plunket.
New Zealand Nurses Organisation Chief Executive Memo Musa acknowledged the hard work Chief Nursing Officer Jane O’Malley had done to increase nursing input into Ministry of Health policy and congratulated her on her new appointment.
Musa said that during Jane’s seven years of service she had overseen an increase of resources at the Ministry to ensure the advice from the nursing profession is effective and timely.
“We want to see more nurses at the top table of policy discussion and development, and there is still more to do to make sure nursing is fully utilised to its full scope in order to care for people, whānau and communities and improve health outcomes,” Musa said.
“We look forward to working with Jane in her role at Plunket as she works to advance and promote the hard work nurses do in their delivery of world class nursing services to mums, whanau and babies.”
Professor Jenny Carryer, executive director of the College of Nurses said O’Malley had been instrumental in ensuring nursing’s contribution to health policy was stronger than it had been “for a long time”.
“The size and positioning of the Office of the Chief Nursing Officer under her leadership has finally been positioned in a way that enables appropriately significant input,” said Carryer. “Jane has worked so hard across so many fronts and her contribution has been huge. Her passion for child health will be well matched in her new position and the College of Nurses wishes her well.”
O’Malley was the director of nursing for the West Coast District Health Board when she was appointed to the Ministry of Health role – then called Chief Nurse – in 2010. She had also been a president of the New Zealand Nurses Organisation (from 2001-2005) and is a former clinical nurse manager and nursing academic.
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