Nurses negotiations need cool heads

The district health boards’ decision to head to the Employment Court over life-preserving cover during nurses strikes is misguided brinkmanship not likely to advance their cause with the union or the public.

Arrangements for life-preserving cover during strikes involving healthcare workers are nothing new and if there were/are issues around them, it is in both the nurses’ and the boards’ interest to ensure they get them right.

Nobody, least of all the New Zealand Nurses Organisation (NZNO), would expect this process to need court intervention.

For the DHBs to say this move was not antagonistic beggars belief.

Health Minister and former union leader Andrew Little’s attempt to make us think the nurses rejected an offer which NZNO leaders had come up with was not convincing either.

And, even if that were the case, he knows that in the end the rank and file in unions are the ones who must have the say.

What we are hearing from nurses is not new. They want to be able to go to work and feel they can work safely, able to do the work and offer the care as they have been trained to do.

It has not, and never has been, all about money.

Who could blame nurses for being sceptical about safe staffing promises when by last month only half of the DHBs had implemented what was agreed to three years ago in the safer staffing accord involving the Care Capacity Demand Management (CCDM) programme?

This time round, the rubber bands holding the creaking hospital system together have become even more stretched and nurses are understandably digging their toes in.

This week, in the Southern DHB, we have had two distressing examples indicating the seriousness of the situation.

First, there was the report from consultant Jane Lawless reviewing the board’s implementation of CCDM which is supposed to identify nursing and midwifery staffing needs to ensure there is safe, effective and productive staffing on every shift.

Although the board’s involvement with CCDM began 10 years ago, it is still not working as it should, and at the end of last year was only 71% implemented.

The report made the point, however, that the Government required the use of CCDM without committing to providing additional funding for identified gaps.

Ms Lawless looked at one ward in Dunedin and two in Southland. (These were chosen by the board as being broadly representative of how CCDM was applied, which makes us wonder if there may be some wards where the situation might be much worse).

She found patients were being placed at risk of harm due to understaffing. In some cases, care rationing was resulting in patients unable to be showered on multiple consecutive days, patients waiting hours for wounds to be redressed, pressure injuries, meal help reliant on visiting relatives, and patients unable to be helped to mobilise.

Then there was the news yesterday that frustrated and desperate Dunedin Hospital emergency department staff have lodged a provisional improvement notice, under the Health and Safety at Work Act, which will require the DHB to take steps within eight days to address safety issues raised or face possible further action.

The notice said staff had experienced ‘‘emotional, psychological, ethical and physical harm’’ in a workplace which did not meet Australasian guidelines for triage patients.

Nobody is suggesting solutions to safe staffing will be simple or immediate, particularly when nurses are in high demand internationally and overseas recruitment, with border restrictions, is extremely difficult.

Moves for considerably better pay, which look promising, will help but pay alone without proper attention to safe staffing will not help recruitment and retention.

With the prospect of another strike looming, it is a time for cool heads and thoughtful, practical problem-solving in negotiations.

Posturing and mischief-making will do nothing to help nurses or their patients.


If anything the one thing this dispute makes clear is that our system of District Health Boards is failing us. I'm talking here about the ability, or inability, of the Boards to provide effective governance and policy leadership. It has resulted in "lucky dip" access to health care around the country.
I do not believe that entrusting the management of health boards to elected panels, most of whom are not at all known to the voters electing them or have no boardroom experience of governing what are effectively large companies, is logical or sensible.
In a small country like ours there has to be a better model of providing the management and provision of health care for our citizens.