Message to NZNO members from the Mental Health Nurses Section – Constitution Remit 2

Kia ora NZNO members

The Mental Health Nurse Section Committee would like to draw your attention to Constitution Remit 2 and the potential implications for our section.

The Remit Committee has provided more information for members to consider when voting on this remit.

Our Section is particularly affected by the MoU signed between NZNO and PSA which requires that mental health nurses in Waitematā, Auckland, Counties Manukau, Marlborough/Nelson and West Coast DHB areas join the PSA for industrial coverage. Those members have no choice of their primary bargaining authority. We are concerned that our members who have no choice in their selection of the PSA may be precluded from engaging in committee membership.  This would reduce the pool of members who might wish to be involved in section participation such as holding office.

Thank you for your consideration of this matter.

Helen Garrick

Chair, MHNS Committee

• Re-posted with permission. A personal message from the MHNS Secretary is also available here. Text of the Remit is below.

NZNO Mental Health Nurses Section Newsletter – June 2022

The best way to predict the future…

Crystal balls are not part of the evidenced-based toolkit of a Mental Health Nurse. If they were, we might know for certain what the future holds for us in this time of system change. As things stand, however, past events are a fair predictor of what we can expect. 

Last month’s much-anticipated “Wellbeing Budget” sadly failed to live up to its name. As NZNO Chief Executive Paul Goulter explained, “We’re looking forward to getting some of the detail from Government that we hope will show concrete support for the health workers, but it’s pretty clear at this point that the urgent need at the frontline has gone unacknowledged.”

The lack of change in the make-up of the Interim Leadership Teams for Health New Zealand is also telling. It speaks more to continuity than to the “transformation of the health system” promised by Health Minister Andrew Little.

Meanwhile the MHNS Committee has noted with concern recent comments by Health New Zealand Interim Chief Executive Margie Apa (from 44:37 in this video) and what they might mean for nursing in the new health system: “We can have another look at the way our teams work and how jobs are done”, she said. “There are tasks that can shift from medical practitioners to nursing, nursing to allied health.” After citing the growth of non-clinical vaccinators as part of the Covid response, Margie Apa continued, “In some areas we’ve got lots of nurses delivering a service that in other areas are delivered by technicians. That can be an awkward conversation for our workforces, but we’ve kind of got to go there.” 

Our future is also shaped, however, by longer term trends. The MHNS Committee is pleased to publish in this newsletter reflections on the history of Mental Health Nursing from recently-retired Kaitiaki co-editor Teresa O’Connor. Her reflections below, originally composed for the (Covid-disrupted) 2021 MHNS Forum in Dunedin and titled “Can mental health nursing survive the zombie apocalypse?”, take the place of this month’s feature article. 

Ultimately though, as American academic Peter Drucker quipped, the best way to predict the future is to create it. This issue of the MHNS Newsletter also reports on the “Future 2030” project, a collaboration between MHNS, Te Ao Māramatanga and the Directors of Mental Health Nurses national group to set the direction for mental health, addiction, and disability nursing. We hope you find something of interest in the following pages. 

Introducing new Committee member Katie Neal

The MHNS Committee is delighted to welcome our newest member. Katie Neal, who joined us this month, qualified as a Mental Health Nurse in the UK in 2006. She has worked in acute and psychiatric inpatient intensive care, acute forensic inpatient, mixed rehab forensic inpatient and adult community mental health teams. She currently works as a Prison Liaison Nurse at Southern DHB. 

Katie says, “Whilst I do not have any committee experience, I am a passionate Mental Health Nurse and am enthusiastic about the ongoing development of Mental Health Nursing in Aotearoa.”

Katie has been co-opted onto the Committee for the period up until the next MHNS Biennial General Meeting. The Committee, which comprises in addition Helen Garrick (Chairperson), Jennie Rae (Treasurer), Brent Doncliff (Secretary) and Grant Brookes (newsletter editor), is still looking for three more members. We invite any new, emerging leaders to join us. To express your interest, please click here for a nomination form. 

Committee news 

The MHNS Committee has met twice since our last newsletter in March. At our 17 March meeting, we reluctantly farewelled Margaret Daniela. In the context of increasing staff shortages, Margaret informed us that the demands of her role had grown to the point that she could no longer continue on the Committee. 

Margaret was elected to the Committee in 2017. Among her many valuable contributions, she represented MHNS to the Chair of the 2018 Government Inquiry into Mental Health and Addiction, Ron Paterson, and filled the role of Committee Secretary. We thank Margaret for her service. 

Committee members reported back about work on external bodies on behalf of MHNS. Brent Doncliff represented colleges and sections on the NZNO Membership Committee up until recently, and currently sits on the Mental Health and Addictions Employee Retention work group, created last year under the terms of settlement for the PSA Mental and Public Health Nursing MECAs. 

Jennie Rae belongs to the NZNO DHB MECA Implementation sub-committee and the Constitutional Review Advisory Group (CRAG). CRAG signed off the member survey on the Constitution, which was sent to all NZNO members in April. MHNS is also represented on the NZNO project Address Violence and Aggression Against Nurses (AVAN), which is re-starting after an hiatus during the Covid pandemic. 

Helen Garrick has been an advisor on the “Are You Ready?” advertising campaign, recently launched by the Ministry of Health to promote Mental Health and Addictions Nursing as a career. Helen also represents MHNS on “Future 2030” (see below for more about this project). 

Lastly we revisited the idea of an online option to make it easier for NZNO members to join MHNS. This has now been actioned. We hope that current MHNS members will now encourage their colleagues to join. 

A second, shorter meeting on 16 May focused mainly on planning for the next MHNS Biennial General Meeting, on a date to be confirmed, and on succession planning for the Committee – including the welcome news of Katie Neal’s co-option. 

‘Future 2030’: A Framework for MH Nursing

It’s been 16 years since the publication of landmark report, the 2006 National Framework for Mental Health Nursing. Much has changed since that time. In recognition of this, a collaborative comprising NZNO MHNS, Te Ao Māramatanga and the Directors of Mental Health Nurses national group last year commissioned a project, Taking Mental Health, Addiction and Disability Nursing Forward to 2030. The aim of this “Future 2030” project was to prepare Mental Health, Addiction and Disability (MHAD) Nurses to make significant contributions to service delivery, their profession and in the lives of the people we serve and their whānau, over the next ten years. 

The project contractors are now reaching the stage in the project scope where they are required to consult with MHAD nurses, followed by a presentation of draft recommendations. 

As the project scope document states, “Within the scope of MHAD nursing, we demonstrate specialist skills across the variety of settings from acute, inpatient, community, and primary care to highly specialist settings such as maternal mental health and working with people with complex, traumatic life experiences. Combined with our professions ‘24/7’ approach to the nursing care of whaiora, we can lead in the specialist therapeutic skills that will be essential for the preparation of the future workforce and the challenges within the health environment.”

Twelve separate discussion papers are due to be released this month, on topics such as supervision, leadership and wellbeing. Consultation periods for these documents will be condensed, requiring a quick turnaround for any feedback. The MHNS Committee will distribute these discussion papers to MHNS members as soon as they are available. 

IJMHN, Vol. 31 No. 3, June 2022

The MHNS Newsletter showcases the International Journal of Mental Health Nursing. Full access to the journal is a benefit of MHNS membership. To obtain an article, please email library@nzno.org.nz with the citation of the full text article you would like. 

Issue Information

Issue Information

Pages: 445-446 First Published: 11 May 2022

Editorial

Supporting the emergent nursing workforce in the wake of the COVID-19 pandemic

Debra Jackson AO RN PhD FRCSI SFHEA FCNA, Kim Usher AM, RN, PhD, FACMHN

Pages: 447-449 First Published: 04 May 2022

Review Articles

Prevalence, associated factors and adverse outcomes of workplace violence towards nurses in psychiatric settings: A systematic review

Sun Joo Jang PhD, RN, Youn-Jung Son PhD, RN, CCAPN, Haeyoung Lee PhD, RN

Pages: 450-468 First Published: 13 November 2021

The effect of long-acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta-analysis

Chizimuzo T.C. Okoli PhD MPH MSN APRN PMHNP-BC, Amani Kappi MSN RN, Tianyi Wang MS, Andrew Makowski DNP APRN PMHNP-BC, Andrew T. Cooley MD

Pages: 469-535 First Published: 20 December 2021

Original Articles

Exploring mental health clinicians’ perceptions of the Zero Suicide Prevention Initiative

Joanne E. Porter PhD, MN Grad Dip CC, Grad Cert Ed, Grad Dip HSM, BN, RN, Elissa Dabkowski PhD candidate, BN (Hons), RN, BPhysio, Owen Connolly MN, NP, GradDipBus, DipAOD, BN, RN, Valerie Prokopiv BA, Research Fellow

Pages: 536-543 First Published: 29 December 2021

Wait times in an Australian emergency department: A comparison of mental health and non-mental health patients in a regional emergency department

Sharene E. Pascoe BSocSc, MSc, Christina Aggar RN, BN(Hons), Grad Cert HE, PhD, Olivia Penman BPsychSci (Hons)

Pages: 544-552 First Published: 14 January 2022

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients

Suzanne Dawson BAppSc (OT), PhD, Candice Oster BA (Hons), PhD, Justin Scanlan BOccThy, PhD, Jocelyn Kernot BAppSc (OT), PhD, Barry Ayling DipNg, GradDipMHNg, Katarzyna Pelichowski MBBS, Amelia Beamish BAppSc (OT)

Pages: 553-566 First Published: 07 January 2022

Contemporary perceptions and meanings of ‘the medical model’ amongst NHS mental health inpatient clinicians

Georgina L. Barnes BSc, MSc, DClinPsy, Maryam Z. Haghiran BSc, MSc, Derek K. Tracy MB BCh BAO, MSc, FRCPsych

Pages: 567-575 First Published: 07 January 2022

Sexual dysfunction in people treated with long-acting injectable antipsychotics in monotherapy or polypharmacy: a naturalistic study

Gema Martínez-Giner MD, Elisa Giménez-De Llano MD, Dolores Romero-Rubio RN, María José Abad-Pérez MHN, RN, Vanessa Sánchez-Martínez PhD, MHN, RN

Pages: 576-590 First Published: 01 January 2022

Experiences and challenges faced by community mental health workers when providing care to people with mental health conditions: A qualitative descriptive study

Yong-Shian Goh RN, RMN, MN, PhD, Qing Yun Jenna Ow Yong BSc (Hons), Shuenn-Chiang Soo MBBS, MMed (Psych), Po Ching Jennie Wan MSc, MSSc, Vincent Chee Keong Ng MSocSci, PhD

Pages: 591-600 First Published: 24 January 2022

Older residents’ perceptions of loneliness in long-term care facilities: A qualitative study

Pi-Hua Huang RN, MSN, Shou-Yu Wang RN, PhD, Sophia H. Hu RN, PhD, Yeu-Hui Chuang RN, PhD

Pages: 601-610 First Published: 03 February 2022

Rules and ward climate in acute psychiatric setting: Comparison of staff and patient perceptions

Marta Corbetta RN, BSC Nursing, Barbara Corso PhD, Carlo Alberto Camuccio RN, Msc, Msc Nursing

Pages: 611-624 First Published: 06 February 2022

An exploration of New Zealand mental health nurses’ personal physical activities

Glen Philbrick Master of Nursing (MN), New Zealand Diploma in Business, Nicolette Fay Sheridan PhD, Master of Public Health, Diploma in Occupational Health Practice, Kay McCauley PhD

Pages: 625-638 First Published: 14 February 2022

Prevalence and influencing factors of posttraumatic growth among nurses suffering from workplace violence: A cross-sectional study

Li Zeng BS, RN, Master Student, Xiangeng Zhang PhD, MD, Fang Wang RN, Jie Yun RN, Li Lai PhD, Man Jin BS, RN, Master Student, Guiling Liu BS, RN, Master Student, Yinong Qiu BS, RN, Master Student, Jialin Wang MSN, RN

Pages: 639-649 First Published: 12 March 2022

Measuring mental health recovery: Cross-cultural adaptation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP)

Jessica Marian Goodman-Casanova Master’s, Daniel Cuesta-Lozano PhD, Marta Garcia-Gallardo Master´s, Francisco Javier Duran-Jimenez, Fermin Mayoral-Cleries PhD, Jose Guzman-Parra PhD

Pages: 650-664 First Published: 11 March 2022

Mental health nurses’ experience of challenging workplace situations: A qualitative descriptive study

Kylie Cranage RN, MMentalHealth(Nurs), Kim Foster RN, PhD

Pages: 665-676 First Published: 28 March 2022

An evaluation of professional development for staff working with nursing students in distress

Colleen Ryan, Jennifer Mulvogue

Pages: 677-686 First Published: 04 March 2022

Protocol for a mixed methods process evaluation of the Promoting Resilience in Nurses (PRiN) trial

Minh Viet Bui RN, Elizabeth McInnes BA(Hons), Grad Dip App Sci, MPH, PhD, Gary Ennis RN, PhD, Kim Foster RN, PhD

Pages: 687-696 First Published: 13 March 2022

Mental health nurses perceptions of missed nursing care in acute inpatient units: A multi-method approach

Bindu Joseph PhD, RN, MSN, PG, Higher Ed, PBNN, Virginia Plummer PhD, RN, RM, FACN, FCHSM, CHE, Wendy Cross PhD, M Ed, B App Sc, RN

Pages: 697-707 First Published: 16 March 2022

How we say what we do and why it is important: An idiosyncratic analysis of mental health nursing identity on social media

Stephen McKenna Lawson RMN, MA, PgDip, BA

Pages: 708-721 First Published: 18 March 2022

Shared trauma during the COVID-19 pandemic: Psychological effects on Israeli mental health nurses

Sagit Dahan MA, RN, Galit Levi MA, RN, Ronen Segev PhD, RN

Pages: 722-730 First Published: 28 March 2022

Staff experiences related to implementation of a recovery-oriented nursing programme in psychiatric inpatient care

Johanna Salberg RN, MSc, Lisa Ekselius MD, PhD, Timo Hursti Psyc., PhD, Caisa Öster RN, PhD

Pages: 731-742 First Published: 21 March 2022

Perspectives

Defensive practices in mental health nursing: Professionalism and poignant tensions

Oladayo Bifarin RN(MH), MSc, Anne Felton RN (MH) PhD, Zoe Prince RN(MH), MSc

Pages: 743-751 First Published: 26 September 2021

The use of recovery model in forensic psychiatric settings: A Foucauldian critique

Jim A. Johansson RN, PhD(c), Dave Holmes RN, PhD, FAAN, FCAN

Pages: 752-760 First Published: 17 April 2022

Letter to the Editor

Fear of vaccines is an understatement: A story of breaking the bondage of fear

Bindhu George BSc, MBA, Mini George BSc (Hons) N, MN, MPhil N, PhD

Pages: 761-764 First Published: 30 December 2021

Feature article: Can mental health nursing survive the zombie apocalypse?

Click on the image to read the talk at the (Covid-disrupted) 2021 MHNS Forum, by Teresa O’Connor.

• This newsletter is re-posted from https://www.nzno.org.nz/groups/colleges_sections/sections/mental_health_nurses/newsletter

NZNO Constitutional Review – Speak up now for rules to empower union members

The revolt over broken promises to back-date Pay Equity for DHB nurses to 31 December 2019 is showing, once again, that union members are powerful when we organise and speak up. 

For many DHB nurses, the broken back pay promises briefly brought back bad memories of 2018, when our MECA negotiators told us to accept substandard offers, refused to let us vote unless we sat through hour-long meetings, cancelled a strike that we had voted for and then, when we did strike, they let DHBs make a mockery of the Life Preserving Services agreements.

On 11 April, three days after releasing the proposed Pay Equity settlement, NZNO backtracked and announced a full legal review of the settlement agreement and the process leading up to it. The review validated what members had been saying. This was fantastic. It really was!

But why does it have to be so hard to get NZNO to act on our behalf, when We Are The Union? 

We Are the Union. The Union is US.

This kind of thing mustn’t happen again. We need to rewrite the rules, so that NZNO is driven by its members. And between now and 30 April, with the Constitutional Review, we have a golden opportunity to do just that.

What is the Constitution, and why does it matter?

Weighing in at a hefty 49 pages and written in dense legalese, the NZNO Constitution is a document that most people have never read. Who can blame them? 

And yet the Constitution is a matter of importance for every fee-paying member of NZNO. This is because it: 

  • Defines the purpose and objectives of NZNO (what it’s for, and what it will do)
  • Sets out the rights of union members (along with our responsibilities)
  • Determines who has the power to do what, inside NZNO 

Since NZNO is an incorporated society and a union, its Constitution is a legally binding document. Any member is actually able to go to court or to the Employment Relations Authority if they believe the Constitution has been breached. And now this document is up for review. 

All NZNO members were emailed a link on 1 April to a Member Survey about the Constitution, open until 30 April. The survey is 40 pages long! I know, because I printed it to PDF using A4 paper size. Who’s got time for a 40-page survey? 

The good news, as explained at on page one, is that, “You do not need to answer all questions in order to provide valuable feedback. There may be specific issues of concern to you that you would like to focus on.” 

So if you read no further in this article, please at least click on that link in your email and go to Section 4 of the survey, to speak up for the “Objects of the NZNO” that you want to see prioritised. 

Along with the Board election later this year (more on that below), the survey is our biggest chance to exercise our rights as as members and speak up for a membership-driven union. If you’d like to see how I answered all the survey questions, click here. If you want to understand my perspective on problems in the Constitution and the rule changes needed to empower members, please read on. I am proposing ideas which you might like to put in your survey responses, in the following areas: 

Openness and honesty  

When Board members Anne Daniels, Katrina Hopkinson and Sela Ikavuka resigned in April 2020, just eight months after being elected, many NZNO members were shocked to learn that they were bound by a “gagging order”. “Right from the start”, the trio wrote, “we were required to sign a confidentiality agreement before our first meeting.” 

That’s right – the elected leaders NZNO are barred, under threat of legal action, from sharing information with the membership who vote them into office. It hasn’t always been this way. Up until a decade ago, all NZNO Board members used to produce regular reports for the members they represented. 

But NZNO today has a problem with openness and honesty, and the problem starts at the top. Last year, the Board refused to release an external review of its performance. Hundreds of members signed a petition calling for its release. “As a transparent, member-led organisation”, said petition organiser and NZNO delegate Al Dietschin, “we believe every member who wants to see this review, which was paid for by NZNO members’ fees, should be able to access it on the website.” The Board dismissed their call. 

Agendas and minutes of Board meetings are supposed to be made available to the membership and staff, after a binding motion was passed in 2016 by NZNO delegates unhappy at the Board’s lack of accountability and transparency. But last year, the Board simply ignored that vote and went back to operating in secrecy. Their secrecy has included a serious lack of detail about how all our member fees are spent. 

Perhaps the most significant report for NZNO in recent years, the Independent Review of the 2017/18 DHB MECA campaign which led to major changes in NZNO’s approach to bargaining, was also initially withheld. NZNO chief executive Memo Musa said the report would “remain confidential and not be shared with others without the express permission of the chief executive and industrial services manager.” It was only published, in a redacted form, thanks to the organising efforts of hundreds of members who forced its release. 

This culture of secrecy filters down from the top and affects other parts of NZNO, in ways big and small. The secretaries and chairs of NZNO Colleges and Sections, for instance, aren’t even allowed to know the names of the people on their own membership list. Delegates in the same workplace are prevented from talking with each other (and they members they represent) because they can’t get names or contact details. 

The withholding of information is a way of actively disempowering NZNO members. In place of open and honest communication, we have even been fed self-serving misinformation. In 2019, a very strange email to all member groups from the Board said, “The Board wishes to clearly state that it is united. Contrary to some suggestions that have been made, the Board is neither dysfunctional nor divided.” Meanwhile the external review, which later leaked despite the Board’s attempts to suppress it, said that during this time the Board was in “a governance crisis”, crippled by internal conflicts and unethical conduct, to the point where it couldn’t say what value (if any) it was adding to the organisation. 

“I want to see improved transparency”, said NZNO Vice President Nano Tunnicliff in her election profile statement last year. The Constitutional Review provides an opportunity to achieve this. The Constitution should set out clearly the rights of NZNO members to information about our own union. NZNO’s culture of secrecy is out of step with other similar organisations, current understanding about good governance and recent law changes.

This month, the Incorporated Societies Act 2022 came into force. This Act updates the legislation governing entities like NZNO, and expresses the expectations of New Zealanders around open and transparent governance. Section 80 of the Act sets out for the first time a legal right to information held by incorporated societies (including unions) for members of that society. If the officers of a union refuse an information request, members can now get a court order for its release. There are only a few limited grounds for refusing a request to release information to a member. One of them is if it says that information can be withheld in an organisation’s constitution. 

After learning from the Independent Review of the 2017/18 DHB MECA campaign, last year’s MECA bargaining was refreshingly different. DHB Sector members were given frequent updates, containing all the information they needed to make informed decisions for themselves. Information previously marked “confidential”, such as the detailed results of member votes, was now made available. NZNO negotiators were accessible for the first time on social media, and answered questions. 

It’s time to make this the norm, for all of NZNO. We can do that by speaking up for rules to empower NZNO members in section 7 of the survey. I suggest that the Constitution should explicitly state, under “Rights and Responsibilities of Membership”, that union members have a right to information held by NZNO, subject only to the grounds for refusing information requests provided in the Incorporated Societies Act 2022. 

Genuine democracy

NZNO today is stuck, part way through a transformation into a genuinely democratic organisation. The Constitution currently says that all members have the right to vote on some matters, but decision-making on other matters remains secretive and undemocratic. Section 6 of the Member Survey is our chance to speak up for changes to strengthen our union democracy and member voice. 

Enabling all members to vote is a relatively recent development for NZNO. It was not until 2018 that the system of “One Member, One Vote” was introduced, finally empowering every member to vote online for NZNO policy and rule changes. That same year, online voting was introduced in MECA bargaining. When online voting was first raised, it met with strong opposition from NZNO leaders. Now we have to wonder what all the fuss was about. It seems strange to think that prior to 2018, the only members allowed to vote on these things were those able to attend long meetings, in person. 

But for other decisions which affect NZNO members, voting by people able to attend long meetings is still in place. This is the case for Annual General Meetings and for two Special General Meetings of the union held in 2019. Whether I like it or not, this part Constitutional Review is bound up with my own story as NZNO President, as these SGMs were both about me. But as someone who has campaigned long and hard against undemocratic features of the Constitution for over a decade – in print, on line and at meetings, even drafting a remit for a constitutional review (later superseded) in December 2019 – my ideas now are not simply a reaction to my own recent experiences. 

The problems with the current system of voting at meetings “on a representational basis” are that: 

  • Under Section 30 of the Constitution, just 33 people (out of the 55,000 members in NZNO) are allowed to vote. They are the representatives of the 11 Regional Councils, 20 Colleges and Sections, the National Student Unit and Te Rūnanga 
  • These 33 representatives (generally the Chairpersons) get the number of votes equal to the number of members in the group they’re representing. This means you can have one rep casting the vote for up to 15,000 members 
  • The largest five membership groups comprise over half of the membership, meaning just five representatives could make a “majority” decision for all of NZNO
  • Yet, there is no requirement for the “representatives” to consult the membership they’re voting on behalf of – and many have been quite open about the fact they don’t consult – or to vote in accordance with the wishes of their members, if these are known 
  • There’s no way for members to know how their representatives even voted, because it’s “secret”
  • And the kicker? The eleven Regional Council Chairs, who wield two thirds of the total vote at AGMs and SGMs, aren’t even elected by the membership of their Region 

Members can see that an unelected handful casting thousands of secret votes is an open invitation to corruption, and this has contributed to a breakdown of trust in NZNO. It’s also a pretty rotten system that so few can make a decision that’s paraded around as a democratic decision of the membership. 

If this wasn’t reason enough, the system of voting “on a representational basis” is now broken completely in a time when meetings are being held virtually by Zoom. The NZNO Annual Report 2020/21 and the audited financial statements, for instance, were accepted through an AGM ballot where only a minority of the eligible reps voted on behalf of their members at all. 

Given this, I have two strong suggestions for responses in Section 6 of the survey. Firstly, people should clearly state that we must keep the “One Member, One Vote” system. Because believe it or not, there is a push at the top of NZNO to remove this from the Constitution and go back to making decisions about remits on a “representational basis” at meetings. Those driving the move backwards say that democracy is inherently “racist”, against Māori. 

Their argument rests on the assumption that all Māori think and vote the same way, and that Pākehā and other tauiwi always vote against them. Because Māori are a minority, the argument goes, they will always be outvoted and always lose out. 

This argument, however, stereotypes Māori and is not supported by the evidence. Voting for NZNO Board members, for instance, is an area where the “One Member, One Vote” system has applied since 2011. At the last election in 2019, democracy produced wins for Māori candidates. The following year, in an all-member ballot using the “One Member, One Vote” system, a remit giving Māori NZNO members the power to veto anything in future which affects Te Rūnanga or is inconsistent with their rules (Ngā Ture) attracted overwhelming democratic support. This remit to empower Māori NZNO members, which I wrote before stepping down as NZNO President, passed with 73 percent of the vote. 

It can sometimes happen that democratic, majority rule systems fail to adequately respect minority rights. This is why protections underpinned by Te Tiriti o Waitangi – like giving Māori members veto power over things which affect them – are needed. 

But democracy is not inherently racist. Dressing up opposition to democracy in the garb of anti-racism is just disingenuous. As the world looks on in horror at attempts to suppress democracy in Ukraine, we need to be very clear that democracy is the best system of governance we have. Since the introduction of online democratic voting in 2018, it has strengthened our union, massively increased participation, delivered better outcomes and improved member satisfaction. It is certainly superior to the secretive, unaccountable decision-making that goes on at meetings. 

The Kaitiaki headline testifies to the multifaceted success of the “One Member, One Vote” system of online democracy introduced in 2018. Full story: https://kaitiaki.org.nz/article/record-turnout-as-dhb-members-accept-offer/

So in addition to stating clearly in Section 6 of the survey that we must keep the current “One Member, One Vote” system, members should also tick “yes” to support “One Member, One Vote” on AGM matters and also tick the box to say that “Voting at a special general meeting should be… By one member, one vote to be carried out electronically or by post.”

Kaitiakitanga & servant leadership

The dissatisfaction over the Board’s lack of transparency and the damning assessment of its ethics in the recent external review has fuelled a widespread suspicion that in recent years, the NZNO Board has been driven by personal agendas – not by the needs of the membership. In my experience, this suspicion is well founded. Spending a quarter of a million dollars of members’ money on the Board’s own legal battles in 2018-19 must rank as a scandal, all on its own. We need a board who hold fast instead to values like kaitiakitanga, acting as custodians serving on behalf the membership for a time, rather than as owners of the organisation who would use its resources for their own ends. 

The culture and values of a Board, whether that’s a culture of service or an inflated sense of superiority and entitlement, is shaped by many factors. But in the case of the NZNO Board, they include aspects of the Constitution. 

Section 5 of the Member Survey focuses on the Board. The second question in this section begins, “The current term for board members, with the exception of the Kaiwhakahaere and the Tumu whakarae is three years, with a right of re-election for a further consecutive three years in any one position. A director may serve up to two terms in any one position. The maximum consecutive terms on the board in any combination of positions is four. Following two terms in any one position or four terms in a combination of positions, a director may be eligible to stand for office again after a break of two years.”

So as the survey explains, the Constitution currently limits how long the President, Vice-President and the non-officer directors can remain in their positions. 

What the survey does not mention is the very next clause in the Constitution: “… The term of the Kaiwhakahaere and Tumu whakarae Directors shall be three years, with a right of re-election for a further consecutive three years, and may be eligible to stand for office again every three years thereafter.” In other words, there are no limits on how long the Kaiwhakahaere and Tumu Whakarae can hold hold office. Nor does the survey mention the six figure salaries paid to the elected officers.

And the survey does not mention how the Kaiwhakahaere and Tumu Whakarae are elected, either. As stated in Schedule Three of the Constitution, these positions are elected at the Hui ā-Tau – which is run each year under the rules of Te Rūnanga (Ngā Ture). In accordance with the principle of tino rangatiratanga, Ngā Ture are determined by solely by Māori members of NZNO. They are not up for wider input as part of the Constitutional Review. However, Ngā Ture are referenced in the NZNO Constitution and need to be read alongside it, as these rules of Te Rūnanga provide relevant additional context. 

Ngā Ture state that to be eligible to stand in elections for the position of Kaiwhakahaere or Tumu Whakarae, candidates must have held a position at Te Poari within two years of applying. In other words, while a call for nominations for these positions goes out every three years to all 4,000 members of Te Rūnanga, the only people eligible to stand (apart from the two incumbents) are two nursing students from Te Rūnanga Tauira, or (realistically) the eleven regional representatives who make up the rest of Te Poari. 

This tiny pool of potential candidates (numbering just eleven, or perhaps a couple more given turnover in these positions in a two year period) are all people who have served loyally under the incumbent office-holders – who also happen to control the budget for travel and accommodation for the delegates to Hui ā-Tau, and control who may speak at Hui-ā-Tau, where the couple of hundred voters who’ve been funded to attend elect the Kaiwhakahaere and Tumu Whakarae. 

These rules go some way to explaining why, in the last 13 years, the position of Kaiwhakahaere has never been the subject of a contested democratic election – and probably won’t be in the future, either. 

The term limits which specified how long the Kaiwhakahaere and Tumu Whakarae can hold hold office were removed from the Constitution in 2017. The rationale for this was something I went along with at the time, and I lent my support to the change. But with the benefit of hindsight, the key argument – that the pool of Māori RN members with the level of skill and knowledge required is so small, that two individuals must be allowed to hold office indefinitely – does a gross disservice to the amazing strength and leadership abilities of Māori nurses as a whole. 

In combination with the strict limitations on eligibility for office in Ngā Ture and the introduction of six figure salaries for NZNO officers, the consequence of this Constitutional change – perhaps unintended – has been to effectively turn what should be kaitiaki roles into careers and “jobs for life”. This is having a negative impact on the development and emergence of new Māori nursing leaders, and creating psychological and cultural shifts on the Board which divert its focus away from serving the membership. 

Servant leadership is a leadership philosophy in which the goal of the leader is to serve. A servant leader shares power, puts the needs of members and staff first and helps people develop and perform as highly as possible. Instead of the people working to serve the leader, the leader exists to serve the people. This culture is what we need to restore to the NZNO Board, and Constitutional change can be a part of that. 

The last question in Section 5 of the Member Survey asks, “If I could propose one process involving the Board that would benefit me as a member, that process would be…”. I suggest that an answer could be, “To apply equal term limits for all Board members so they each understand their stewardship role, as custodians serving on behalf the membership for a limited time only.”

Engagement and Belonging 

Section 3 of the Member Survey will strike virtually all NZNO members as odd. Under a heading of “Connection to the NZNO”, it begins by asking whether you belong to a Regional Council. Faced with this question, most NZNO members will wonder, “What’s a Regional Council?”. 

In this way, the survey unintentionally highlights what is a fundamental disconnect between NZNO members and the structures of our union. This disconnect is based on flaws in the Constitution. We now have the opportunity to fix these flaws and build other member structures which support engagement and belonging. 

The eleven NZNO Regional Councils were created in 1989. They replaced the 54 “branches” in the old New Zealand Nurses Association (NZNA), shortly before it transformed into the NZNO we have today. Under the NZNO Constitution, Regional Councils have a lot of power. Not only do the Council Chairs wield thousands of votes each in NZNO meetings (see above), they also control the submission of remits for the “One Member, One Vote” process and approve candidates wishing to stand for the NZNO Board. 

The flaws in the system have been well understood for many years. Back in 1998, the NZNO Conference requested that the effectiveness of Regional Councils be reviewed. The review concluded that Regional Councils were not effective, but the resulting changes were minor. 

In 2003, delegates to the NZNO AGM went further. They debated a paper proposing significant change to the structure of NZNO. The discussion paper said:

  • “Regional Councils have not been effective in representing members and have been reviewed in the past. 
  • At present there are 11 Regional Councils. The Committee reviewed the attendance over the past 12 months of six of those Regional Councils; Central, Bay of Plenty, Auckland, Midlands, Wellington and Southern. All met two- monthly. The lowest attendance was three persons, the maximum attendance was 23 (Southern). No other Regional Council meeting had an attendance of 20 or more persons. The average attendance of the Regional Councils over the 12 month period ranged between under 10 to a little over 14 (Auckland). These are extremely low numbers and cannot give any confidence that decision making structures based around Regional Council are inclusive, democratic and participatory.” 

The problem has only gotten worse since 2003. In 2010 the official centennial history of NZNO, Freed to Care, Proud to Nurse, described the replacement of union branches by Regional Councils: 

“This restructuring was seen by NZNA leadership as better representing the majority of members, who now worked across multiple workplaces. It was perceived by the membership, however, as the destruction of the organic channels that they had created. In fact, the imposed structure was never to function in the comfortable, rhythmic way that the old branches had.”

Today, although NZNO membership has grown to the point that the Regional Councils are supposed to represent thousands or even tens of thousands of members each, most still struggle to get meeting participation numbering in double digits. 

I need to stress that the fault in this system does not lie with the member volunteers who keep the Regional Councils running. Regional Council members are among the most dedicated NZNO members, who work incredibly hard to try and make them work. The problem is, they’re working in a structure that’s never worked since it was first created, 33 years ago, and is now broken beyond repair. 

“The main drivers behind our present structure were legislative requirements in the Labour Relations Act 1987 and the Employment Contracts Act 1991”, observed the 2003 NZNO AGM discussion paper. These laws were repealed decades ago. NZNO Regional Councils are relics of a bygone age. Divorced from the conditions which led to their creation, they no longer made sense in 2003, and they make even less sense now. 

Other problems with NZNO structures flow on from this. The Membership Committee, which is first mentioned in Section 2 of the Member Survey, was created in 2012 “to advise the board”, due to member concerns that the Board would become remote and unaccountable. 

It hasn’t worked. The Board did become remote and unaccountable. The Membership Committee was never to fulfil the key functions in its original Charter of:

  • “Providing further insight into the views and needs of the diverse membership of NZNO and provide a link to the local level
  • Ensuring the NZNO is responsive to the needs and issues of members
  • Receiving and considering the summary of Board meetings and providing feedback”

There are two reasons for this. Firstly, because the Board would simply refuse requests to meet, or to provide a summary of their meetings. But also because the Membership Committee is based largely upon the unrepresentative, disconnected Regional Councils. 

Despite my best efforts during six years on the Membership Committee, in various roles, I watched it get captured by the agendas of the Board, succumb to the culture of secrecy at the top and finally adopt a new Charter in 2020 which deleted its original purpose. Today almost half the positions on the Membership Committee sit vacant, partly as a result of its irrelevance. Even with the added inducement of fully funded travel, meals and accommodation, paid leave and reimbursement of meeting expenses, the vacancies cannot be filled. 

Under “General Understanding of Constitution”, Section 2 of the survey asks about “the most important functions of the Membership Committee”. I suggest that an answer could be: “Representing the views and needs of the diverse membership of NZNO and providing a link to the local level, and ensuring the NZNO is responsive to the needs and issues of members, which it cannot possibly do under current Constitutional arrangements.” 

But outside of the Regional Councils and Membership Committee, there are functioning structures where NZNO members do engage and feel a sense of belonging, such as the Colleges and Sections. The functioning structures also include the Worksite Organising Committees (aka WOCs, or the “monthly delegates meeting”), led by an elected Convenor (aka “Lead Delegate”), and the National Delegates Committees (NDCs). The WOCs and NDCs provide crucial input into on NZNO’s industrial strategies at all levels and guide our negotiating teams. You may be surprised to learn that this democratic structure, where members are highly engaged doing vital NZNO work, is described in the NZNO Delegates Handbook but has no formal powers under the Constitution. 

The Colleges and Sections are a place where members feel a sense of belonging and engage in the work of NZNO.

The delegates to the NZNO AGM back in 2003 decided to commission a full structural review. The 2004 Report of the Structural Review Committee proposed solutions which still make sense today. It said: 

“The Issue

  • The Committee recognises that much of the activity and work of NZNO carried out by members occurs at workplaces, Colleges and Sections and it seems appropriate to locate decision making where membership activity occurs…”

“Proposed Changes

  • It is proposed that as far as possible NZNO should devolve its decision making and relate to, consult with, and organise its membership through Workplaces, Colleges and Sections.
  • The Committee proposes that Workplace Committees be formalised in the governance structure of NZNO. Under the proposed model general membership participation and decision making would be devolved to Workplaces, Colleges and Sections. The primary flow of communication would be directly from workplaces and Colleges and Sections to national structures and vice versa.
  • It is proposed that existing Regional Councils… be retained for a period of two years and then reviewed.”

Section 3 of the Member Survey asks, “The benefits that I obtain from a Regional Council are as follows”. Be honest. If the answer is nothing, say “nothing”. Then in Section 7 of the survey, which asks you to, “Indicate below if you have any comment in respect of a specific structure”. You might like to write something along these lines under “Regional Councils”: 

“Back in 2004, at the time of the last NZNO structural review, Regional Councils selected the members of the NZNO Board and did all the voting on remits. Both of these democratic functions have now been transferred to the “One Member, One Vote” system. As mentioned in responses under Section 6 of this survey, voting at AGMs and SGMs also needs to be done according to “One Member, One Vote”. The Regional Councils did have a (relatively small) role in organising Regional Conventions, but these have now been cancelled.

The functions remaining – which largely consist of proposing remits, endorsing candidates wishing to stand for Board, assisting with implementation of NZNO policies and strategies, electing Membership Committee reps and working in partnership with Te Rūnanga – should be devolved to Colleges, Sections and constitutionally defined Worksite Organising Committees, in accordance with the recommendations of the 2004 Structural Review Committee. Regional Councils can then be wound up.” 

What’s next? 

This article has suggested a few ideas for members to include in their responses to the current Member Survey on the NZNO Constitution. But it’s far from an exhaustive list. For anyone interested, my complete Member Survey responses are available (for a cheeky copy/paste) here.

Section 8 of the Member Survey asks if there are, “any other comments you would like to make in respect of the Constitution of the Organisation.” You might like to comment that NZNO is the only professional association and registered union in Australasia (and possibly the world, apart from the Royal College of Nursing in the UK) which has a Chief Executive Officer. There appears to be no valid reason for this, although it does lead to a much higher salary for NZNO’s most senior manager, funded of course by our membership fees. In fact, it looks like a bit like a colonial hangover. The CEO role prescribed in Section 20 of the Constitution should be re-scoped, possibly as National Secretary, which was the title held by our current CEO as head of his previous registered union and professional association from 2008-2022. 

Some of the things mentioned in the Member Survey – like the questions about Partnership under Te Tiriti o Waitangi in Section 6 – relate largely to personalities and practices, however, which won’t be fixed by changing the Constitution. And any Constitution is only as good as the people who operationalise it. The people who have been dominating the NZNO Board for years have trampled on our union’s system of rules and the values which underpin it – much like what President Donald Trump did with the US Constitution (even to the point of seeking to overturn a democratically-elected NZNO President). 

So as well as participating in the current Member Survey before 30 April, and considering the suggestions for survey responses in this article, I hope that union members will also participate in the upcoming election for the NZNO Board. Come August, seven of the eleven Board seats will be up for grabs. For the reasons already stated, this year we need to elect people who support the ongoing transformation of NZNO. We need bicultural servant leaders committed to openness and honesty, genuine democracy and engagement and belonging for NZNO members. 

NZNO Mental Health Nurses Section Newsletter – March 2022

Message from the MHNS Committee

Two years of world-leading public health responses kept Aotearoa safe from the worst effects of the global Covid-19 pandemic. Now the Omicron wave is here. MHNS members are in our thoughts at this time, whether managing suspected or confirmed Covid cases among our tāngata whai ora or isolating at home yourselves.

A newly-published open-access paper in the NZ Medical Journal [Every-Palmer et al., 2022] highlights how the wellbeing of New Zealanders with mental health and addiction issues has been disproportionately affected by Covid-19. Structural discrimination experienced by our client group in the vaccine roll-out has worsened this inequity, with just 80 percent of mental health consumers and 78 percent of AOD service users being fully vaccinated as at 14 February 2022. For tāngata whai ora Māori, the data on vaccinations are even more concerning, being 74 percent and 72 percent respectively.

In brighter news, however, anecdotal evidence suggests that infection prevention and control measures in workplaces are proving effective. A message sent on 2 March 2022 to all staff at Capital and Coast DHB and Hutt Valley DHB from CEO Fionnagh Dougan, for instance, said that despite the rising number of staff isolating at home, “There has been no spread that we are aware of in our clinical areas where staff have been excellent at wearing the appropriate PPE and following infection control processes.”

As we wish our members a safe and healthy emergence from the Omicron wave, we also look forward to the longer-term restructuring of the mental health, addictions and intellectual disability sector. Although the last issue of the MHNS Newsletter promised that we would showcase the International Journal of Mental Health Nursing, the Committee has chosen to include in this issue a pay-walled feature article which the NZ Medical Journal has kindly allowed us to re-publish, ‘New Zealand’s mental health crisis, He Ara Oranga and the future’. We found this article particularly thought-provoking. We hope that you do, too.

Committee news

The MHNS Committee met by Zoom for an additional unscheduled meeting on 1 February. The main item on the agenda was the 2022 Mental Health Nurses Forum. After postponing the Forum until March 2022 due to the Delta outbreak last year, we were forced to cancel the in-person event altogether on account of the Omicron outbreak. The Committee is working with our presenters on rescheduling Forum sessions, to be held by Zoom later in the year.

We also reviewed our process for producing the MHNS submission on Transforming Our Mental Health Law. The submission closing date of 28 January made it difficult to consult with members over the holiday season. The Wellington Anniversary Day closure of the NZNO National Office, along with the half-day closure on the preceding Friday, also shortened our consultation period by four days, while NZNO staffing issues prevented us from obtaining support from the NZNO policy team. We apologise to members for the curtailed consultation, we commit to giving greater opportunity to input in future submissions and we thank those who managed to get their thoughts to us in time. The final version of the MHNS submission is available here.

Lastly we discussed the review of the NZNO Constitution. As one of the movers of the 2020 remit for a full and independent review, the MHNS Committee is represented on the Constitutional Review Advisory Group. We are committed to a democratic, membership- driven Constitution for NZNO in accordance with the NZNO Strategic Plan 2021-25.

Committee vacancies – call for nominations

The MHNS Committee – currently made up of Helen Garrick (Chairperson), Margaret Daniela (Minute Secretary), Jennie Rae (Treasurer), Brent Doncliff (Committee member/Facebook group administrator) and Grant Brookes (Committee member/Newsletter editor) – is still looking to co-opt two additional members. This is an opportunity to get a taste of Section leadership, for a shortened term up until the Biennial General Meeting in August 2022. We invite any new, emerging leaders to join us. To express you interest, please click here for the nomination form.

References

Structural discrimination in the COVID-19 vaccination programme for people with mental health and addiction issues: now is the time to be equally well
Susanna Every-Palmer, Ashley Koning, Linda Smith, Ruth Cunningham, Cameron Lacey, Deborah Peterson, Angela Jury, Kate M Scott, Tony Dowell, Alison Masters, Helen Lockett NZMJ135(1550), pages 133-139. 25 February 2022

IJMHN, Vol. 31 No. 2, April 2022 

Issue Information. Pages: 241-242 First Published: 01 March 2022

Editorial
Free Access
Combating loneliness and isolation and promoting good mental health – One ukulele at a time
Philip Darbyshire RNMH RSCN DipN(Lond) RNT MN PHD, Cheryl Green RN, RMN, BSc, MPH, Grad Cert Health Services Management. Pages: 243-246 First Published: 24 November 2021

Review Articles
Vicarious trauma and nursing: An integrative review
Sophie Isobel PhD, RN(BN), grad cert CFHN, CAMH, Res Meth, Margaret Thomas RN(BN), MMHN, BSc
Pages: 247-259 First Published: 19 November 2021

Open Access
What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services
Keiran Wilson MSc, Jessica Eaton MSc, Una Foye PhD, Madeleine Ellis MA, Ellen Thomas, Alan Simpson PhD
Pages: 260-277 First Published: 08 December 2021

Suicide by hanging: A scoping review
Rachael Sabrinskas BAppSci, Psych, BN, M.Mental Health Nursing, PhD Candidate, Bridget Hamilton BPsychN, BN(Hons), PhD, Catherine Daniel BPsychNurs, PGDipN(MtlHlth) MN, PhD, John Oliffe PhD, MEd, RN
Pages: 278-294 First Published: 25 November 2021

Original Articles
Concept analysis of shame in nursing
Michael A. Jaeb BSN, RN
Pages: 295-304 First Published: 09 November 2021

The influence of a self-determination theory grounded clinical placement on nursing student’s therapeutic relationship skills: A pre-test/post-test study
Dana Perlman PhD, M.S. (Educational Leadership), Bachelor of Education (Physical Education), Lorna Moxham RN, MHN, PhD, MEd, BHSc, DASc, Cert OH&S, Cert Qual Mngmt, Cert IV Training & Assessment, FACMHN, FACN, MAICD, Christopher Patterson PhD, M.Nurs (Mental Health) and BN (Hons), Amy Tapsell Master of Public Health and Bachelor if Arts (Psychology), Emily Keough Bachelor of Psychology (Honours), PhD candidate (Psychology). Pages: 305-312 First Published: 24 November 2021

Factors associated with Health of the Nation Outcomes Scales (HoNOS) in an acute young adult psychiatric unit
Grace Branjerdporn Cert III(TESOL), BOccThy(Hons I), CHIA, PhD, Julia Robertson BPsychSc, Alex Dymond BSocWork, BPsych, Grad.Cert.Trauma, Grad.Cert.AcadHP, MForMH. Pages: 313-325 First Published: 24 November 2021

A qualitative study exploring adolescents’ perspective about Mental Health First Aid Training Programmes promoted by nurses in upper secondary schools
Tiago Filipe Oliveira Costa RMN, MSc, Francisco Miguel Correia Sampaio RMN, MSc, PhD, Carlos Alberto da Cruz Sequeira RMN, MSc, PhD, María Teresa Lluch Canut RMN, MSc, PhD, Antonio Rafael Moreno Poyato RN, MHN, MSc, PhD. Pages: 326-338 First Published: 25 November 2021

Relationship between nurses’ use of verbal de-escalation and mechanical restraint in acute inpatient mental health care: a retrospective study
Alonso Pérez-Toribio RN, MSc, Antonio R. Moreno-Poyato RN, MSc, MHN, PhD, Teresa Lluch-Canut RN, MHN, PhD, Laura Molina-Martínez RN, MHN, Anna Bastidas-Salvadó RN, MHN, Montserrat Puig-Llobet RN, MHN, PhD, Juan F. Roldán-Merino RN, MSc, MHN, PhD
Pages: 339-347 First Published: 26 November 2021

‘Are they really allowed to treat me like that?’ – A qualitative study to explore the nature of formal patient complaints about mental healthcare services in Sweden
Annelie J. Sundler PhD, RN, Anna Råberus MScN, RN, Gunilla Carlsson PhD, RN, Christina Nilsson PhD, RN, RM, Laura Darcy PhD, RN. Pages: 348-357 First Published: 11 December 2021

Exploration of the utility of the Nursing Process and the Clinical Reasoning Cycle as a framework for forensic mental health nurses: A qualitative study
Tessa Maguire RN, GD FBS, GD FMHN, MMentHlthSc, PhD, Loretta Garvey RN, PhD, Jo Ryan RN, Bed, GC VRAM, Georgina Willetts RN, BN, PhD, Michael Olasoji RN, PhD Pages: 358-368 First Published: 17 December 2021

Learning your limits: Nurses’ experiences of caring for young unaccompanied refugees in acute psychiatric care
Sebastian Gabrielsson RN, PhD, Hannan Karim RN, MSc, Git-Marie Ejneborn Looi RN, PhD. Pages: 369-378 First Published: 15 December 2021

Women’s experiences of restrictive interventions within inpatient mental health services: A qualitative investigation
Amy Scholes ClinPsyD, MSc, BSc, Owen Price PhD, MSc, BSc, Katherine Berry PhD, ClinPsyD, MSc, BSc. Pages: 379-389 First Published: 24 December 2021

Psychological experiences of caregivers of adolescents diagnosed with substance use disorder attending a youth centre in a low-resource setting
Lydia Nyaga Njoki RN, BScN, MSc, Irene G. Mageto RN, BScN, MSc, PhD, Lucy W. Kivuti-Bitok RN, BScN, Msc, PhD. Pages: 390-399 First Published: 21 December 2021

Review Articles
What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review
Maya Sacre RGN, RMN, MSc, Rikke Albert RMN, MSc, Juanita Hoe RMN, PhD Pages: 400-423 First Published: 23 December 2021

Open Access
Valued attributes of professional support for people who repeatedly self-harm: A systematic review and meta-synthesis of first-hand accounts
Cara Sass PhD, Cathy Brennan PhD, Kate Farley PhD, Helen Crosby PhD, Rocio Rodriguez Lopez MPH, Daniel Romeu MB BChir MA (Cantab) PGCert, Elizabeth Mitchell BSc, Allan House BSc, MBBS, MRCPsych(UK), MRCPsych DM, Else Guthrie MB, ChB, MSc, MD, FRCPsych
Pages: 424-441 First Published: 15 January 2022

Letter to the Editor
There must be a better way: The implementation of a nurse-led mental health service to support people living with a mental health condition
Lesley J. Douglas PhD, CMHN, MFMH, Grad. Dip. Midwifery, BH (MH), Eilish P. O’Shea Pages: 442-444 First Published: 01 February 2022

Feature article

New Zealand’s mental health crisis, He Ara Oranga and the future Roger T Mulder, Tarun Bastiampillai, Anthony Jorm, Stephen Allison. NZMJ135(1548) 21 January 2022, pages 89-95.

Click on the image below to read the article.

• This newsletter is re-posted from https://www.nzno.org.nz/groups/colleges_sections/sections/mental_health_nurses/newsletter

‘Safe staffing for all’ – Parliamentary submission on behalf of the DHB Sector Committee of the PSA

Presenting to the Pae Ora Legislation Committee, 28 January 2022

Kia ora, my name is Grant Brookes. I work as a Registered Nurse in a District Health Board. I am speaking to you in the Pae Ora Legislation Committee on behalf of the DHB Sector Committee of the PSA, about safe staffing and workplace health and safety.

Our committee represents people who interact with patients every day based on skill, knowledge and experience. I am here today in my lunch break, from the hospital where I’m currently on duty. Your submissions won’t come much more “frontline” than this. 

This week, the Association of Salaried Medical Specialists stated, “We have an undeclared health workforce emergency.” New Zealand needs an 1,500 more hospital specialists, they said, and an extra 1,400 GPs and 12,000 nurses. 

“These”, observed ASMS, “are serious numbers.”

I’m here to add that the number of extra DHB administrators required, and the additional numbers of Allied, Public Health, Scientific and Technical staff needed by New Zealand are equally serious. 

Our daily reality in DHBs now involves covering roster gaps and unfilled vacancies. We are trying – I’m trying – to do the jobs of one and half people, or more. We’re pulling double shifts, day after day. We’re working from early morning until long after dark. 

DHB staffing levels are unsafe, and it’s no secret that industrial peace and patient care are suffering as a result. All of this is before the Omicron wave even hits. 

Unsafe staffing is not a temporary problem. It is a long-term, structural feature of our health system. 

The main mechanism for addressing unsafe staffing, DHB by DHB, is Care Capacity Demand Management (CCDM). 

My DHB has completed implementation of CCDM for its inpatient nursing workforce. It began reporting results in 2017. By its own measure of “shifts below target”, nurse understaffing has grown successively worse each year since 2017. Last year, 55 percent of all day shifts across the DHB were understaffed. For my ward, the figure was 87 percent. 

As a former member of the governance group monitoring the nationwide roll-out of this system from 2015-2020, I saw the same trend in other DHBs. In my expert opinion, CCDM on its own cannot ensure safe staffing for inpatient nurses – to say nothing of the many other DHB services and occupational groups not even covered by this programme. 

In a sad reflection of CCDM’s weaknesses, WorkSafe NZ has been called upon repeatedly over the last year to investigate unsafe staffing levels in hospital wards and departments. 

I submit that it makes little sense to address our health workforce emergency like this in a reactive way, ward by ward – nor to address it piecemeal, one DHB and one occupation at a time. 

As reflected in our written submission, the creation of a national health service will finally enable nationally consistent, effective staffing models.

The specifications for publicly funded services, to be set under Section 14 of the Pae Ora (Healthy Futures) Bill, should include mandatory minimum staffing levels for all. 

Thank you again for your kind attention. I believe we have left a minute or two for questions.