We're not looking after our nurses

Comment: Minister of Health Simeon Brown has said: “Nurses are at the heart of our health system. They make a real difference for patients and families every day, often in complex and challenging environments.” The minister’s and the Government’s actions speak louder than words.

Let’s run a reality check. Nursing was excluded from the ministerial groups advising Brown on primary care, aged care, and workforce development. (After concerted action by nurse leaders, this may be rectified.) Nursing research is among those social sciences excluded from the Marsden fund as overseen by another minister, Judith Collins.

The Government has said that the previous government had hired too many nurses, and in effect instituted a hiring freeze in early 2024, even if it was never formally acknowledged by Te Whatu Ora. That same year, Te Whatu Ora’s own data showed 37 percent of all nursing shifts in public hospitals were understaffed. Understaffing was highest for day shifts (51 percent), which causes serious flow-on problems throughout the weekend.

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Within a public hospital, there are really two hospitals: one that operates within normal business hours; and another that operates after hours. The normal business hours hospital is where the planned decisions are made: clinical rounds take place; patients are reviewed; diagnostic and treatment decisions are made; most of the surgery takes place; most of the discharge decisions are made; and most of the scheduled outpatients are seen. Weekday day shifts are frequently the busiest shifts of any hospital’s day and require the most staff.

If a hospital is understaffed in normal business hours, treatments and surgeries will be cancelled, so more patients stay in hospital which makes it difficult to find beds for new patients. This in turn results in long waiting hours in emergency departments. From recent data only 68 percent of ED patients across the country were seen within the Government’s target of six hours. It was worse for most of the busy metro departments, where only 40-50 percent of patients were seen within six hours.

Missed, or rationed, care is becoming common in our hospitals. When a hospital is short staffed, it is not possible to provide all required care. The result is that medications are not given on time or at all, time cannot be spent in conversations that inform assessments, patient call bells go unanswered, and observations are not obtained or not recorded, potentially leading to nurses failing to respond to a patient’s deterioration. The consequences are serious. A 10 percent increase in missed care is associated with a 16 percent increase in the chances of a patient dying within 30 days of admission.

Conversely, for each added registered nurse, hospital-acquired pneumonia decreases by 30 percent, respiratory failure by 60 percent, and failure to rescue deteriorating patients by 16 percent. Patient mortality is reduced by 8 percent in ICU, 6 percent in medical wards, and 16 percent in surgical wards. Patients also spend less time in hospital. These efficiency gains support the financial value of increasing the registered staff on each nursing shift.

As if all this isn’t too much already, a litany of legislative changes add pressure and complexity to an already over-burdened workforce. We have seen the Government introduce move-on orders for the unhoused, without any planning as to how wraparound services for those people will be coordinated by the police. The police are under their own pressures, and have already made clear they can no longer participate in mental health callouts and will restrict responses to partner violence callouts. It is likely move-on orders will result in police drop-offs at emergency departments.

Nursing concern and care for humanity goes well beyond the walls of hospitals and general practice clinics. The Government tried to ban puberty-blockers for transgender youth, overriding Ministry of Health advice. That ban is now subject to an interim injunction, but the attempted ban had, and still has, a direct impact on the nurses providing gender-affirming care. We also know that the number of children living in poverty has increased since 2022, with one in seven children now living in material hardship, which will increase the burden on general practice and emergency departments.

The Government cancelled some nurses’ pay equity claims by changing the pay equity legislation, which the People’s Select Committee has described as a gross abuse of parliamentary process. Finally, the Government introduced the Employment Leave Bill, which will cut nurses pay when they take annual leave because the bill will change the way annual leave pay is calculated.

When the policy and practice environments that governments create are inconsistent with nursing’s moral values, we would argue that they may experience moral injury as a result, which leads to poor job satisfaction and burnout.

Not being able to provide optimal care because systems are under-resourced causes harm. Not being equitably remunerated for work causes harm. Nobody can flourish in such systems, neither health workers nor patients. Failure to build conducive environments puts patients and nurses at risk.

Nurses enter our profession to be of service to our communities, to provide care, compassion, and kindness to people when they are at their most vulnerable. But when nurses cannot deliver that care, we too suffer.