April 2020 vol 26 no 3

At the COVID-19 coalface

• Frontline nurses prepare for unknown • How will the pandemic change nursing? • NZNO fights for PPE for all • Tips for remote assessment Conference and AGM Wednesday 16 & Thursday 17 September 2020 Museum of New Zealand Te Papa Tongarewa, Wellington Call for remits: opens 16 March 2020 – closing date 16 May 2020 at 5.00 pm Call for Abstracts: now open – closing date 5 June 2020 at 5.00pm Call for award nominations: now open – closing date 12 June 2020 at 5.00 pm Full details available on the website: www.nzno.org.nz/2020conference Call for Abstracts We invite you to share your innovations and achievements, allowing others to learn from your developments as you will learn from theirs. NZNO’s annual conference is vibrant, attracting nurses, students, educators and researchers from all health sectors across the country, creating multiple opportunities for relationship building and networking. Information: www.nzno.org.nz/2020conference Closing Date: Friday 5 June 2020, at 5.00pm

National Awards Nominations for Service to NZNO and Service to Nursing/Midwifery are called from Regional Councils, National Sections and Colleges, National Student Unit and Te Ru-nanga. Criteria: Service to NZNO The nominee must be an NZNO member who has a commitment to NZNO and who has made a superior contribution to the national or regional work of NZNO. Contribution could be made in any area of NZNO activities at a national or regional level. • Promotion of NZNO to nurses or outside groups • National or regional committee work • Performed additional work for the committee • Advanced NZNO objectives or policies Criteria: Service to Nursing/Midwifery The nominee must be an NZNO member: a) Whose actions have made a difference to nursing or midwifery care in the region (may be in the area of practice, education, management of nursing/midwifery, research or support area such as QA, infection control, staff development), or b) Whose actions have improved the occupational health, welfare or practice environment of nurses or midwives in New Zealand Information: www.nzno.org.nz/2020conference Applications to: [email protected] Closing Date: Friday 12 June 2020 at 5.00pm

Conference Sponsorship The New Zealand Nurses Organisation (NZNO) invites you to become a sponsor for our 2020 Conference being held at the Museum of New Zealand Te Papa Tongarewa on Wednesday 16 September 2020, giving you an opportunity to promote your services to nurses and health professionals. A range of sponsorship options are available for your consideration. If you would like to consider other options to support our event, you are welcome to contact our Conference and AGM organisers, Paardekooper and Associates at [email protected], 04 562 8259 or view the Prospectus from our homepage at www.nzno.org.nz/2020conference April 2020 vol 26 no 3 This issue . . . At the 2 | Editorial 1-6 | IND tributes COVID-19 The chief nursing officer honours nurses’ role coalface in fighting COVID-19. 26 | History

• Frontline nurses prepare for unknown • How will the pandemic change nursing? By Margareth Broodkoorn. To celebrate Florence Nightingale’s 200th • NZNO fights for PPE for all • Tips for remote assessment birthday, we salute some nursing pioneers. 3 | Letters Compiled by Anne Manchester. ISSN 1173-2032 Tell us what you think. 31 | Literature review Vol. 26 No. 3 5 | News & events Resilience is an important factor in coping APRIL 2020 • NZNO fights for PPE for all nurses. with workplace stress. THIS ISSUE has been produced in un- • Hundreds of nurses re-register. By Jewel Baker-Armstrong. precedented times – New Zealand is in • DHB MECA preparations to continue. lockdown to contain the spread of the COVID-19 virus. Nurses – the country’s 34 | Viewpoint largest health-care workforce – are 9 | News focus Florence Nightingale had some racist in the frontline of that containment Nurses from a range of practice areas talk attitudes towards indigenous peoples. battle. This issue includes interviews about how they have prepared for COVID-19 By Grant Brookes and Kerri Nuku. with nurses from a range of special- and its potential impact and implications. ties about how they are coping in By the co-editors 36 | Profiles these testing times. To mark Inter- national Nurses Day, we salute some To mark International Nurses Day – th nursing pioneers of Aotearoa. 17 | Science short Florence Nightingales’ 200 birthday – two The latest on the range of new graduates share something of their Kai Tiaki Nursing New Zealand is the COVID-19 symptoms. nursing journeys, hopes and aspirations. official journal of the New Zealand By Samantha Teinakore and Melissa Harrington. Nurses’ Organisation, Tôpûtanga Tapuhi By Georgina Casey. Kaitiaki o Aotearoa. Views expressed are 40 | Te Rûnanga not necessarily those of NZNO. Kai Tiaki 18 | Practice Nursing New Zealand, under a variety of Nurses working for Mâori and iwi providers titles, has been published continuously Some practical tips, in these times of lock- need kindness – Nuku. since 1908. down, to help nurses assess patients using digital platforms. By Mary Longmore. Kai Tiaki Nursing New Zealand is a peer- By Michelle Honey and Bridget Meehan. reviewed journal. All clinical practice 41 | NurseWORDS articles are independently reviewed by expert nurses/researchers (see below). 20 | Viewpoint 42 | Industrial focus It is indexed in the Cumulative Index to COVID-19 raises multifarious issues for Members need to understand their rights Nursing and Allied Health Literature and nurses to consider. and responsibilities during a pandemic. International Nursing Index. By Patricia McClunie-Trust By NZNO staff. Kai Tiaki Nursing New Zealand retains copyright for material published in the 22 | News focus journal. Authors wanting to re-publish 43 | Sector reports Why is bullying so prevalent in nursing and material elsewhere are free to do so, • PHC MECA ratification delayed. what can be done to reduce it? provided prior permission is sought, the • Nurse Maude strike called off. material is used in context and Kai Tiaki By Teresa O’Connor. Nursing New Zealand is acknowledged as the first publisher. 44 | Section & college news 25 | Professional focus • COVID-19 dominates meeting. Kai Tiaki is the Mâori term for carer or Maintaining mental health in testing times. • Northland nurses share research. guardian and has always been incorpo- By Anne Brinkman. • Cancer nurses join national agency. rated in the title of the magazine. Co-editors: Need information, advice, support? Teresa O’Connor, Anne Manchester 0800-28-38-48 and Mary Longmore. Call NZNO’s Membership Support Centre: Practice article review process: Clinical practice, education and Correspondence: Advertising queries: Cover: With thanks to Southland Hospital research articles are critiqued for pub- The Co-editors Evelyn Nelson nurses Bridget Leonard (in PPE) and Sarah Halder. lication in Kai Tiaki Nursing New Zea- Kai Tiaki Nursing New Zealand Kai Tiaki Nursing New Zealand Advertising Photo: With thanks to Bernadette land by nurses/educators/researchers PO Box 2128, Wellington, 6140 PO Box 9035, Wellington, 6141 Gourley. with expertise in the subject area of ph 04 494 6386 Ph 0274 476 114 /[email protected]/ Pre-press production: TBD Design. the article, and by the co-editors. [email protected] www.kaitiakiads.co.nz Printers: Inkwise.

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 1 editorial Nursing the world to health

a more hygienic approach to caring for Mereana Tangata (1869-1929), known wounded soldiers during the Crimean and registered, in 1902, under her Euro- War in 1854, dramatically reducing pean name, Mary Ann Helena Leonard, death rates. Along with mass infections, went on to have a successful career in soldiers were dying of illnesses such as hospital and community nursing and typhus, typhoid and cholera in over- stood out for her commitment to nurs- crowded and unsanitary conditions. ing. (See also p28.) Akenehi Hei (1876-1910) was the ‘A passionate sanitarian’ first Mâori to register as a nurse in her A passionate sanitarian, Nightingale Mâori name, which she did in 1908, and promoted the benefits of cleanliness, the first Mâori nurse to qualify in both hygiene, notably handwashing, clean air general nursing and midwifery. She stood and water – all of which are as relevant out for her absolute commitment to today as then. She went on to promote improving health care for Mâori. sanitary conditions in the army, hospitals and communities after the war was over, Raising the profile of nursing saving countless lives in peace time also. My hope this year, as we deal with the She professionalised nursing and nurse fear and uncertainty of COVID-19, is that By chief nursing officer education, all the while advocating that our professional, compassionate and Margareth Broodkoorn high-quality patient care from dedicated informed care provides an opportunity nursing staff was a basic human right. to raise the profile of nursing, and that As we, along with the rest of the this continues long into the future, as he theme of this year’s International world, face a pandemic of unprecedented we work to grow a strong and resilient Nurses Day – A voice to lead, nursing and unpredictable proportions, Florence workforce. Tthe world to health – could not be Nightingale’s approach more relevant to the world right now. to the profession of In New Zealand, along with the rest of nursing is more relevant the world, nurses are either directly car- than ever. This is what ‘Nurses are in the spotlight and all around ing for COVID-19 patients or doing their we are trained for and, the planet this tragic pandemic is reveal- best to prepare for a pandemic which has as a profession, we can ing the irreplaceable work of nursing for taken more than 50,000 lives globally to and must rise to it – date. with evidence-based best all to see.’ practice, courage and Spreading with ‘devastating speed’ determination. I look forward to seeing nurses, includ- 2020 brings with it the International Just as important as her clinical care ing our Mâori nurses, develop into great Year of the Nurse and Midwife, the and public health initiatives, was her leaders, setting a pathway for others to completion of the global Nursing Now holistic approach to nursing, which come, as those who have gone before campaign and the 200th anniversary of recognised the need to draw on the have achieved for us today. the birth of Florence Nightingale. It has past habits and histories of indigenous International Council of Nurses also brought a new virus that is spread- people. In Aotearoa, she provided impor- president Annette Kennedy has said the ing with devastating speed around the tant advice in assisting and addressing eyes of the world are on our profession globe. the health and wellbeing of Mâori. in a way we could not have anticipated: Nurses are indeed nursing the world International Nurses Day (IND) on May “Nurses are in the spotlight and all right now and, together with colleagues, 12 – Florence Nightingale’s birthday – is around the planet this tragic pandemic is placing themselves in the frontline of celebrated in her honour. And this May revealing the irreplaceable work of nurs- a highly contagious virus overseas and 12 marks her 200th birthday. ing for all to see.” now here in New Zealand. Here in New This year’s IND is also an opportunity I, too, wish to express my deep ap- Zealand, we are doing everything pos- to honour and recognise our Mâori nurs- preciation and support for all that you sible to ensure our valued nurses and ing pioneers. Two early nurse leaders in are doing today, in the coming days and colleagues receive the latest information particular were Akenehi Hei and Mereana into the future, as we all work together and protective equipment they need to Tangata, who were pioneers in every way to combat this situation. stay safe. because they paved the way for other For the latest advice, please go to our Florence Nightingale led the way to Mâori nurses. website www.health.govt.nz. •

2 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 letters Tell us what you think

Health Minister praises nurses’ again, it is nurses, midwives, health-care ‘vital contribution’ to the Email your letter to: assistants and kaimahi hauora who are stepping into the breach, at increased COVID-19 response [email protected] personal risk, to care for the health TO ALL nurses in Aotearoa, including We reserve the right to edit letters needs of others. enrolled nurses, registered nurses and for sense and length. Shorter letters You are doing your duty in the most nurse practitioners: (under 400 words) are preferred. extreme of circumstances, just as you I am writing to acknowledge and Please include address, nursing have done in the past during world wars thank you for the vital contribution you qualifications and phone number. and earlier pandemics. And though I am are making in the COVID-19 response. sure the public will be grateful, I’m also Whether you are working in the com- pretty sure that few will understand the munity, aged residential care, or for full extent of your dedication. Mâori health providers or district health Midwife. The year has been endorsed to And that’s why my heart is also heavy. boards, the skills, service, commitment celebrate the role of nurses and mid- I understand the fear and uncertainty and care you are providing to our com- wives, highlight the challenging condi- members are facing – about contracting munities is invaluable at this time. tions they often face, and advocate for the virus themselves or bringing it home Nurses’ work has always been impor- increased investments in the workforce. to their families and communities. tant, but now it is more important than I know nurses are a resilient workforce. As I write, there has been the first ever. At stake is not just the health and Many of you have stepped up and are COVID-19 death and the first nurses with wellbeing of individual New Zealanders, practising to the top of your scope. confirmed cases. I can only imagine how but the health and wellbeing of entire In doing so, we want to keep you safe things may have worsened by the time communities. and well during this period, so have this is read. I can only imagine how I am heartened tasked the Ministry of Health to ensure you are feeling. I can only admire, with by the response resources are distributed as required. gratitude, your continued courage. we have seen to But in doing so, we also want to ensure You are the largest health workforce in the call for nurses those resources are used wisely and ap- the frontline against COVID-19. You are and other health propriately. crucial now more than ever, not just in professionals to This is a stressful and uncertain time hospitals, but across all sectors and in register their in- for all New Zealanders, and I acknowl- every community. That means you must terest in returning edge that this is exacerbated by your be fully supported by the Government, to work. work as an essential frontline worker, the public, your employer and by staff at The nursing which also impacts on your family, NZNO. workforce is the whânau and loved ones. Please look after We are doing as much as we can – Health Minister David Clark largest it has ever yourselves. New Zealand is known for its meeting with district health boards every been in New Zea- manaakitanga and now, more than ever, single day, and with other employers land. Among you, nurse practitioners are we need to remember the power of kind- regularly, to get the best we can for playing a vital role in the pandemic with ness and uniting together. you in terms of additional support and their advanced clinical and leadership I know all New Zealanders will want protection. While we have had some skills. Nurse practitioners are working in me to thank you all for your service and successes, we will continue this fight, the frontline of the COVID-19 response in commitment to their health and the and also our work in the media to make primary care, in emergency departments wellbeing of all of us in the face of ad- the public aware of how much nurses are and in secondary hospital care, with versity. I sincerely value your hard work doing for them. older people and others vulnerable to the and commitment. And, of course, we remain ready and COVID-19 virus. The Minister of Health, available to support members with I’d like to also acknowledge and thank David Clark employment and professional matters as the approximately 2500 nurses who work they arise. in intensive and critical care and other Pride in nurses’ work in our We are proud and grateful for what you acute settings, who have been working are doing in our country’s hour of great hard to prepare for people with COVID-19 country’s ‘hour of need’ need. Thank you – sincerely and from the who require acute care. I WRITE this letter with feelings of great bottom of our hearts. Together we will I am aware 2020 has been sanctioned pride and sadness during this uncertain get through this difficult time. by the World Health Organization as and stressful COVID-19 pandemic. I am NZNO chief executive, International Year of the Nurse and the extremely proud of our members. Once Memo Musa

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 3 nzno news

The president comments:

over night. 640,000 PPE masks were By Grant Brookes shipped to district health boards in a day. None of this made the health system OUR LIVES have changed, utterly. I write perfect. Parts of the sector were com- this column in the early days of the his- pletely overlooked. Many inequities re- toric COVID-19 lockdown. Given the daily mained. But such resourcing was almost rate of change, I can hardly imagine unthinkable just weeks earlier. what our professional and personal lives This transformation extends far beyond will look like when the April issue of Kai health. As a society, we are now embrac- Grant Brookes Tiaki Nursing New Zealand is completed. ing new values and ideas. From the Prime But I know this. We have the poten- Minister down, the message is, “Be kind”. comparing the fight against COVID-19 to tial to create lasting, transformational We’re working together so the needs of a war. And like in a war, when the battle change beyond this crisis – a different the community are prioritised above in- against COVID-19 is over, we will have to future for our profession and our society dividualism. New “caremongering” groups rebuild. is possible. are springing up in communities, to help There may be hard times ahead. But The top priority for the country right more vulnerable members. with our new priorities and values, the now is to unite against COVID-19. Collec- We have returned to more socialist world we rebuild can be better than tively and individually we’re stepping up. ways of thinking – “from each according before. As World War II was drawing to And as we step up, the Government is to their ability, to each according to their a close, the British Government con- mobilising the country’s resources behind needs”. templated a radical vision of post-war us. Health Minister David Clark said he’s The same thing’s happening inter- reconstruction. It knew the people who'd been given a blank cheque to maintain nationally, too. Countries less affected sacrificed so much for the country – New Zealanders' wellbeing. For as long as by, or recovering from the pandemic are especially the troops on the front line any of us can remember, NZNO has been helping those suffering more – because – wouldn't settle for going back to how fighting for a fully-funded health system. until there’s a vaccine, the only way any things were before. Now, at last, the focus is on the value of us will be safe from future outbreaks So, despite the war rationing and scar- of our work, not the cost. We are being is through global control. city, they drew up plans to massively ex- recognised for what we are – “essential”. As World Health Organization Director- pand workers’ rights, social housing and These first days of lockdown have seen General Tedros Adhanom Ghebreyesus the welfare safety net. Out of this came seismic shifts in practical support for our says: “The bottom line is solidarity, what was then the world's best health

essential work. solidarity, solidarity”.1 system, the National Health Service. Some cities made public transport free We’re all in this together. He waka eke I believe Prime Minister Jacinda Ardern for us. Our need to get to work became noa. As the weeks go on, we must inten- when she says, “we will get through the focus for hastily re-designed timeta- sify this focus on community, solidarity this”. And when we do, today’s frontline bles. Staff parking became free for most, and kotahitanga. This is the way to keep will be insisting on a better future. • too. Provision of free childcare began. us united against COVID-19, support es- Discretionary sick leave was suddenly sential health workers and fix the inequi- available when we needed it. Constrained ties still in our health system. Reference budgets for clinical supplies, like those But let's not shelve this approach once 1) Ghebreyesus, T. (2020, February 11). Research and innovation which regularly forced the indignity of the virus is under control. forum on novel coronavirus 2019. Retrieved from www.who.int/ dg/speeches/detail/research-and-innovation-forum-on-novel- rationed continence pads, were gone All around the world, countries are coronavirus-2019

Notice to members: NZNO’s BOARD of directors has decided to defer membership fee increases, due to come into effect on April 1, 2020, for six months to October 1, 2020. This is in recognition of the unprecedented circumstances members are facing at this time. It is also a recognition of the stress and impact on families, whânau and communities.

4 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news and events Frontline staff to get PPE Daily meetings ALL FRONTLINE nurses, midwives and she said. “PPE for nurses’ health staff in contact with patients will should be the be able to access personal protective last line of wellbeing equipment (PPE), including medical-grade defence, not the face masks, after a deal between health first.” NZNO and its sister unions are talking unions, the Ministry of Health (MoH) and The new daily with district health boards (DHBs) district health boards (DHBs) was agreed guidelines would and Ministry of Health (MoH) representa- over the weekend of April 4-5. also cover the tives in virtual meetings to try and keep NZNO associate professional services proper use of nurses safe and protected, NZNO indus- manager Kate Weston said freeing up ac- PPE. “If PPE is trial adviser David Wait says. cess to PPE for nurses and staff working not used prop- Access to protective gear, childcare, Kate Weston with patients of unknown COVID status erly, staff can accommodation, scrubs or laundry ser- was “hugely important”. put themselves, patients, colleagues and vices and extra pay were all on the table. Updated guidelines were released on whânau at risk,” Weston said. “We get to discuss these issues every April 7 on the MoH website. They include Director-General of Health Ashley day, even if we don’t have solutions to workers across community, hospital, Bloomfield has confirmed 41 million face them all immediately,” Wait said. aged-care and iwi providers, particularly masks 500,000 isolation gowns, 30,000 “DHBs are looking for ways to make in remote and rural areas. face shields and 50,000 goggles would things work. We are ensuring that mem- “NZNO has been working around the arrive within the next six weeks. The bers’ rights are protected, along with clock with other unions to get universal MoH said they would be “for our health- their safety and wellbeing. We’re keenly access for health workers dealing with care workers’ immediate use”. aware that our members want to play patients with unknown COVID status, in Weston said PPE was already more their part in getting through COVID-19.” response to the call from our members. widely available except for some “pock- Childcare availability for essential This has been the number one issue for ets” NZNO would deal with locally. workers had also been resolved. Where them,” Weston said. Health unions have been meeting it was not available, staff could apply Widening access would help staff – daily with DHB and the MoH. A sub- for special leave without affecting leave and patients – feel confident, she said. group with Weston, Deborah Powell of entitlements, he said. That appeared “It’s not only science, it’s perception – APEX medical laboratory workers’ union to mostly affect smaller regions at the people feel safer,” she said. and Caroline Conroy of midwives’ union moment. However, proven infection control MERAS have been working with chief Talks were continuing on a vast range methods, such as patient screening, nursing officer Margareth Broodkoorn on of issues thrown up by the pandemic, hand-washing (even if using gloves) PPE guidelines. The guidelines would be such as whether nurses and health work- and distancing were still the priorities, updated as the situation evolved.• ers must launder their own uniforms or could access scrubs, rostering, and whether extra payments would be made Accommodation for nurses sought for working in risky environments, Wait NZNO HAS been working with the district dren. The “panicked” nurse was poised to said. health boards (DHBs) to find urgent quit her job and leave the region but, af- The sense from members was fear but accommodation for nurses and health ter NZNO became involved, her manager determination, he said. workers shunned by house mates over sorted out some accommodation for her. “Our members put themselves in COVID-19 fears. Wait said the DHBs were also working harm’s way every day, but what is differ- “There have been nurses who have to find accommodation in apartments or ent about this is the level of publicity been evicted by their flatmates,” NZNO hotels for nurses and health staff who about what is happening. This means industrial adviser David Wait said. About had to isolate themselves after travel- people are necessarily more careful. 15 nurses were affected around New ling, or could not stay home because COVID-19 is the only thing people are Zealand, so this was an “incredibly rare” of vulnerable family members or elderly talking about. occurrence in the context of the size of parents. “It’s obviously a good thing but “The sense I have is that members just the nursing workforce, he said. also a big step for our members, who have want to get on and get going. It’s scary An NZNO organiser has told Kai Tiaki to leave their homes and live alone.” but they want to help.” Nursing New Zealand about one young The availability of accommodation APEX, the Association of Salaried Medi- nurse who was asked to leave a family “varied” around the country, Wait said. cal Specialists, Specialty Trainees of NZ she was boarding with. The family feared No numbers on how many nurses or staff (junior doctors), MERAS (midwives), E tû she would bring the virus into their still needed accommodation were avail- and the Public Service Association were household, which included young chil- able by deadline. • all involved in the daily meetings. •

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 5 news and events Hundreds of nurses re-register THE NURSING Council has issued more fore applying for [from clinical practice],” she said. “I can than 400 interim practising certificates an interim cer- help in primary care, I can help anywhere to nurses returning to practice to help tificate. Byrne I have some clinical knowledge.” out in the COVID-19 pandemic. said the council She said re-registering had been very It had also received more than 1500 had diverted ad- simple and free. email queries and 600 phone calls. ”This ditional nursing Byrne said all council staff were work- is a dynamic situation and therefore and administra- ing remotely but were responding to these numbers are changing all the tive staff to its calls and emails during normal hours. The time,” council chief executive Catherine phone lines and council had recently invested in a new Byrne (pictured right) said. emails to enable database which improved its capacity The practising certificates were interim a quick response to enquiries. and capability to work remotely and ones for the duration of the pandemic Byrne said the number of nurses who remain connected. and were being issued in response to had contacted the council about getting The council has deferred continuing a pandemic workforce request from the an interim practising certificate to help competence requirements and audit pro- Ministry of Health, she said. As well as with the COVID-19 effort demonstrated cesses for the duration of the pandemic being interim, some other conditions “amazing commitment and resolve from to enable nurses to focus on clinical care may be required on the practising certifi- nurses to provide the best care to New to the public. It had also deferred ac- cate, depending on the individual nurse. Zealanders when they are needed the creditation and monitoring visits to edu- Nurses over the age of 70 and those most”. cation providers and was now conducting whose practising certificates had lapsed Auckland public health nurse Lizzie a number of essential panel and commit- for more than 10 years, were not eligible Farrell put her hand up to re-register as tee meetings electronically, Byrne said. for the interim certificates. “another pair of hands”, after retiring in She thanked all nurses for their “com- Nurses can apply for an interim prac- late 2018 after 30 years of nursing. mitment, dedication and hard work” to tising certificate online and the council “When I heard they were looking, fight the COVID-19 pandemic. can also be contacted by email or phone, I thought I’d do it. I only retired 15 “Never before has the work of nurses as many nurses have questions to ask be- months ago, so I’m not that far away been more vital or more valued.” •

DHB MECA preparations to continue PREPARATIONS FOR the NZNO/district and claims endorsement will be by online are continuing and the focus of the health board multi-employer col- ballot. online campaigning is solidarity with lective agreement (DHB MECA) will “The claims already collected at nurses. It will return to the specific continue “in the background” during delegate-run claims meetings will form DHB MECA campaign when the situation the COVID-19 lockdown. the basis for the online claims survey,” allows.” NZNO DHB industrial adviser David Wait said. Despite the lockdown, there was Wait said the national delegates’ A broad selection of claims had been still time for preparations, as the DHB committee – made up of an elected collected at the meetings, he said, but MECA did not expire until the end of member from each DHB in the country the two most “widely and deeply felt” July, Wait said. “Continuing with the – had reached a consensus decision were pay and leave, notably sick leave. preparations means we will avoid long to continue with the preparations. Nominations for the negotiating team delays, once the situation returns to “Claims collection and delegate have been extended until the middle normal.” selection for the bargaining team will of April. The dates for online voting for The situation will be reassessed when continue in the background and allow the 12-strong team have not yet been the national COVID-19 level four alert us to prepare for bargaining when it finalised. drops or at the end of this month, does occur. This will add approximate- Wait said local campaigning had whichever occurs first. ly four weeks to the current process,” stopped during the lockdown. “Members Wait said it was crucial that, despite Wait said. are overloaded with information right COVID-19, member engagement and Members will need to participate in now and we did not want to contribute leadership of the campaigning and bar- an online survey for claims collection, to that. National campaign preparations gaining preparations were maintained. •

6 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news and events

Southern DHB hopeful its Concerned hospital not COVID-19 source members AN ABSENCE of further COVID-19 infec- The hospital re-opened on April 2, tions among Queenstown’s Lakes District after being extensively cleaned. swamp NZNO Hospital staff “builds confidence” there NZNO organiser Karyn Chalk said the NZNO MEMBERSHIP support centre has not been community transmission in SDHB had responded well. A COVID-19 (MSC) staff are being “slammed” the hospital workforce, Southern District team had been in place for “weeks” and with an average of 200 calls and Health Board (SDHB) Medical Officer of access to personal protective equipment 90 emails daily from worried mem- Health Susan Jack said. had not been an issue. “They have done bers, lead adviser Jo Stokker says. Two of the hospital’s nurses have CO- everything they can. Not one member The main concerns are over the VID-19 and are in isolation. The second has called me – and if there were con- availability of personal protective nurse was one of 15 close contacts of cerns, they’re a strong bunch of people equipment for staff, childcare, the first nurse. All those contacts were who would ring me. Their silence is a casual staff and members who are in isolation for 14 days and would be huge message.” pregnant, she said. retested if symptoms developed, Jack College of critical care nurses chair Before the lockdown, many said in a statement. Steve Kirby said, while it was not yet calls were from members over 70. Another 21 “casual” contacts who clear how the Queenstown nurses had However, since the government tested clear have returned to work. All picked up the virus, based on overseas directive for them to self-isolate, 74 staff who have worked at the hospital evidence, it was “inevitable” more those had lessened. over the past 14 days have been tested, health-care workers would get infected Organisers had stepped in to as the SDHB tries to discover the source here. “It’s inevitable, but that’s the sac- help cope with the calls, she said. of the infection. “It is noted there are a rifice we are making, and that’s what the “The team is getting slammed – number of COVID-19 cases in the wider public need to see – that we are putting we’re getting heaps and heaps of community in Queenstown,” Jack said. ourselves on the line.” • calls and emails every day.”

Support from other staff But with the support of NZNO’s Students ‘non-essential’ industrial and professional teams, NURSING STUDENTS around the country on nurse-entry-to practice/specialist staff were well-placed to advise have been pulled out of clinical place- programmes, to complete their require- members. ments as they are considered non-essen- ments, he said. “The MSC staff are managing re- tial workers. If students were called on by the ally well. They have all said to me “Currently, legally we are closed and Government “my preference would be ‘we just care about our members all students’ education is on hold,” that they would be placed in non-con- and want to give them the best Auckland University of Technology head tact places like Healthline so, when the service we can’.” of nursing Stephen Neville said. university opens, then they are ready to Members were “really stressed”, All nursing students, including post- immediately resume clinical.” Stokker said. graduate students, were removed from That was important to protect the “Members are struggling and their clinical placements on March 24, a future pipeline of nurses, he said. going through some really difficult day before AUT closed to all lectures, tu- NZNO student leaders Mikaela Hellier stuff. These issues are far more torials, clinicals and assessment activities. and RitaPearl Alexander said it was a complex than what normally comes “For as long as the country remains at very “uncertain” time around clinical through, so it takes extra time for level 4, and students and academic staff requirements. the call advisers to deal with.” are deemed non-essential workforces, we They would work with the advanced Member adviser Georgina Ara- will be closed,” Neville said. choice of employment committee, Nurs- boglos said members were fearful, ing Council and nursing schools to help but thankful for the advice and a Future pathways students navigate their next steps. sympathetic ear. “However, we are in the process of work- Many were meanwhile “gaining fabu- “There is a lot of fear, people ing out future potential pathways for lous experience” as health-care assis- are really scared. We just work students to minimise any disruption to tants (HCAs), Alexander said. through their feelings with them the future pipeline of registered nurses.” MoH agreed students could still be and break everything down, so we AUT would offer flexible ways for its employed on “essential work” such as can give them guidance.” • postgraduate students, including those Healthline or as HCAs. •

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 7 news and events

Abortion law now changed UCOL honours Wenn NZNO WAS “pleased” abortion was now a where protestors must stand 150m away FORMER NURSE Janice Wenn, Kahungun- health service rather than a crime – but from any facility. A second attempt to gu ki Wairarapa, last month received the disappointed “safe zones”, where women remove any way to enforce these zones, Universal College of Learning’s (UCOL) seeking abortions could avoid protestors, via a verbal vote led by ACT leader David highest award – an honorary fellow for were removed from the Abortion Legisla- Seymour, succeeded. her services to Mâori health. tion Bill. MPs, including Justice Minister Andrew Now in her late 80s, Wenn became Associate professional services man- Little, appeared confused by the deci- a nurse in the 1950s and has worked ager Kate Weston said NZNO’s Women’s sion, later acknowledging it was “annoy- extensively in the health sector since, Health College, along with Family Plan- ing” but said he would not attempt to focusing on Mâori health issues and ning, had strongly advocated for abortion remedy it. Green MP Jan Logie, however, improving access to care. In 1998, she to be taken out of the Crimes Act and said she was looking at options to re- helped set up Whaiora Whanui, a primary treated as a reproductive health issue. insert safe zones. health care service for Mâori in the “But we are disappointed women will Weston said MPs appeared to have Wairarapa. still have to face a barrage of protestors been “asleep at the wheel”. UCOL council chair Ben Vanderkolk said because removing their place of safety “While we at NZNO uphold freedom of Wenn’s work had “touched many lives”. somehow slipped through,” said Weston. expression, we also uphold the right for “Her contribution to Mâori health and In a late-night vote last month, MPs women to seek health care – which abor- health care in the Wairarapa has left a voted to legalise abortion by 68 to 51. tion is now – without being threatened, lasting impression.” They initially voted to keep safe zones, intimidated or harassed.” • Wenn gained a Massey University doc- torate when 84, and in 2017 published an autiobiography, Ko Mâtakitaki te New student leaders for Te Rûnanga Tauira Tuatahi – A ‘sort of life’. Drawn from her thesis, it focused on her interviews with “expensive and TWO students, 40 kaumâtua about Mâori values that time-consum- one from Na- were essential to health and wellbeing. ing” elections pier, the other She was awarded Te Rûnanga o Aote- with less than from Southland, aroa NZNO’s Te Akenehi Hei award for her have been sec- six months of services to Mâori health in 2010. • onded to lead the term re- Te Rûnanga maining, Nuku Tauira (TRT) un- said. til the 2020/21 Alexander NZNO staff changes election in said while NZNO PROFESSIONAL nursing adviser June. “Unprec- she had not Kate Weston has been appointed to edented” pres- Ritapearl Alexander from EIT Kimmel Manning from SIT actively sought fill the associate professional services sure had led to a shortage of candidates the role, she saw it as an opportunity. “I manager role for the next six months. for the 2019/20 elections, according to believe that leadership isn’t just about The role was vacated by Hilary Graham- kaiwhakahaere Kerri Nuku. Second-year leading, but providing a safe haven to Smith, who resigned after nine years. nursing student at Eastern Institute of ensure students can unload and be sup- Nursing and professional services Technology (EIT) Ritapearl Alexander, ported,” she said. manager Mairi Lucas said Weston would Ngâti Porou, Tainui and Te Arawa, has Manning said they wanted to explore bring new ideas and 12 years of working been appointed chair, and second-year how to enhance the mana of tauira, so knowledge from her time at NZNO. Southland Institute of Technology (SIT) “when they make it into the workforce Kaiâwhina (assistant) to the kaiwhaka- student Kimmel Manning, Ngâi Tahu, they will have the confidence to stand up haere, Pirihira Toroa, has also resigned vice-chair. for themselves and the people they will after four years. Chief executive Memo Students had been unwilling to put be caring for”. Musa said Toroa had encouraged staff themselves forward and take on the bur- Both wanted to focus on changing at- to learn te reo Mâori and run regular dens of leadership roles last year, Nuku titudes to bullying. Former TRT chair Tracy waiata, alongside her obligations to pro- said, due to tensions within NZNO and Black said she would be staying on to vide administrative support to te poari experiences of racism. provide tuakana (mentoring) support. and members of Te Rûnanga. In March, te poari agreed to second Alexander and Manning join National NZNO board vice president Cheryl Alexander and Manning into the roles, Student Union chair Mikaela Hellier and Hanham has also resigned, creating a as per the NZNO constitution (schedule vice-chair Trudi Kent, as co-leaders in a vacancy on the board. An election would five, clause 1.9), rather than go through bicultural model. • be held in due course, Musa said. •

8 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news focus

Interviews by Mary Longmore, Anne Manchester and Teresa O’Connor PHOTO: Clinical nurse specialist in infection prevention and control Julie White at Christchurch Hospital. Nurses at the frontline Rising to challenge of a lifetime Public health nurse Justine Paterson says the COVID-19 pandemic is nurses’ chance to ‘shine’.

(ARPHS) team responding to COVID-19 at ways it’s been a really positive experi- Auckland airport. ence,” Paterson said. She believed, for This led to a lot of rapid up-skilling as all its challenges, COVID-19 could be she and colleagues tried to stay one step “career-defining” for nurses, who were ahead of the rapidly-evolving virus. stepping up and demonstrating their While pressured – “I haven’t had a skills and leadership. “The feedback from 40-hour-week since the end of Janu- people has been really appreciative of ary” – she’s not complaining. An event the importance of our work.” She hoped the profession would gain more recognition and visibility as a Hot off the back of an intense result. “It’s really amazing to see the measles epidemic in 2019, nursing leadership at the moment – for dealing with COVID-19 was us it’s been really positive to be recog- nised as leaders. We are the experts in tough on public health staff. this – it’s our chance to shine.” The ARPHS team had been observing n late January, Auckland public like this is what she and fellow health since December the virus’ emergence in health nurse Justine Paterson was professionals had been trained for, and China, and were aware of the pneumonia- Ipulled off her regular work in com- an opportunity for nurses to “shine”. type illness some people displayed. “We municable disease control onto the “To lead a team at the border was could see quite early on we could have Auckland Regional Public Health Service uncharted territory for me, but in many some work to do around the border,” she

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 9 news focus

said. “We knew we would get COVID here, aging calls from the public, schools and protective equipment, simply by keeping it was just a matter of time.” GPs all worried about the virus. “There a physical distance, she said. Working at the airport, as well as mon- is a lot of fear and anxiety, so it’s trying Hot off the back of an intense measles itoring the World Health Organization, to give consistent, accurate advice to epidemic in 2019, dealing with CO- Ministry of Health and Customs’ fast- manage that.” VID-19 was tough on public health staff. changing advice was “quite a change and But there were – and remain – so many “Measles was long and hard work.” But quite a step up” for her professionally. unknowns. “Assisting people to make while hours had again been long, ARPHS All public health nurses had to re- that clinical decision, in an environment had been taking good care of staff by prioritise their workloads, which meant that we don’t have a lot to go on” was a providing meals and coffee and making difficult decisions. “How can you let challenge. With a background in public sure they took breaks. Paterson has been existing work go and what will the impli- health, Paterson had a good under- working 10-hour days and most week- cations be? It’s a real tension.” standing of how to approach infectious ends for the past two months. For her, it was tuberculosis patients, usu- diseases. “But COVID is so new, fast and She believed the current shut-down ally closely case-managed and supervised the science is still coming.” would slow the disease, but expected taking their medication, who now had to Health staff had to figure out quickly continuing “small peaks” over coming take it themselves. With COVID-19 acceler- whether people without symptoms were months. ating so quickly, it became the priority. infectious – still not clear – track people A parent of three teenagers, Paterson The team worked out a system of case who had left hospital without permis- made the “difficult” decision to send and contact management with each sion, visit homes of patient contacts, them to stay with their father during the notification, trying to “wrap around” while keeping safe. The team copped shutdown, allowing her to focus. “It’s the patient, their family and household, criticism for not wearing masks at the pretty challenging, but I think a good while tracing their contacts on flights. airport but, mostly, protection was decision, given the amount of time I’m At the same time, Paterson was man- manageable with a minimum of personal working. They will be better supported.” • ICU staff ready for challenge Auckland critical care nurse Steve Kirby says the intensive care workforce is ‘resilient’ from recent disasters. ritical care nurses – toughened and “high-risk” procedures like intubation whatever that resilient from dealing with earth- and ventilation. However, there was an might be.” Cquakes, eruptions and shootings – acceptance there would likely be infec- Long- say they are as prepared as they can be tion of staff. “There is a general feeling standing for the unknown effects of COVID-19. that this is extremely infectious and concerns about “The nursing workforce is ready to there is a high risk that a lot of us will inadequate meet this challenge – as much as any- get it, even with all the protections.” staffing and body can meet something which could be Auckland-based Kirby has been com- bed numbers really overwhelming,” college of critical municating with hospitals nationwide on would now be care nurses (CCCN) chair Steve Kirby said. policies and processes – trying to prepare validated, he “Recent disasters for the unknown. said. “But we have shown how hard- He acknowl- will do our absolute best with what we working, professional ‘There is a high risk that a edged it was a have.” Discussions included using operat- and adaptable the lot of us will get it, even “scary” time, but ing theatres and post-anaesthesia care critical care nursing said New Zealand’s units for overflow patients. workforce is.” with all the protections.’ nursing workforce Critical care nurses, in wards and With high health had been through higher acuity areas like high depen- worker infection rates in Europe, protect- several crises in recent years – from the dency units (HDU), across district health ing staff was “hugely top of mind” and Christchurch mosque shootings to the boards (DHBs) had been trained in using the availability of personal protective Whakaari/White Island eruption, and was PPE correctly to protect both themselves equipment (PPE) a constant topic of again preparing to put itself in harm’s and those around them. With a limited conversation among nurse and clinical way. “These staff have come through supply of the single-use items such as leaders, he said. those events admirably and have dem- face masks, Kirby said the emphasis was CCCN was working with the Australian- onstrated such professionalism and care on safe but appropriate use to avoid New Zealand Intensive Care Society for each other. I think that will stand wastage. “So the equipment is being (ANZICS) to carefully plan, especially for us in good stead for what is coming – used appropriately and not needlessly.”

10 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news focus

The college was working closely with the infection preven- ‘Comradeship is strong’ tion & control nurses’ Northland nurse practitioner Margaret Hand says nurses are ‘in it together’. college on best practice guidelines across DHBs, t Te Hau Âwhiowhio ô to them by local iwi and as well as a network of Otangarei health care kaumâtua, as well as intensive care clini- Aclinic in Whangârei, nationally.” cians. nurse practitioner Margaret Instead of patients Kirby said it was Hand has noticed a dramatic coming into clinics to col- important to have rise in patient numbers in lect their medications, the clear, accurate and recent weeks, many of them team was picking these up honest communication with long-term and chronic for them from the phar- with health staff and health conditions. She at- macies. This relieved the the public – particu- tributes this rise to other pressure on pharmacies larly around bed and practices in the area closing and provided access to ventilator numbers, their books and people return- medications for whânau. as hospitals and ing to the area from overseas “Patients can make intensive care units or other parts of New Zealand. appointments with us by prepared for the worst. Hand would normally spend an 0800 phone or engage “These disaster plan- part of each week working with us on Facebook ning preparations for at the iwi provider Te Hâ O where up-to-date informa- dealing with a high Te Oranga O Ngâti Whâtua ‘Many of our patients and tion is being posted.” number of pandemic clinic in Dargaville, but all Hand admires how iwi victims are already in community clinics have been whânau are experiencing are working together place,” he said. “We’re closed due to the national a lot of fear – fear of the across Northland to reduce looking very carefully emergency. unknown. What they might barriers and provide re- at how the units are Nursing consultations at need are messages to be sources for many patients/ staffed, managed and both clinics are now being whânau, despite marae equipped.” done by phone, with nurses given to them by local iwi being closed. “My marae, Nurses felt “reas- checking whânau, especially and kaumâtua, as well as Waikaraka, has stopped sured” by the govern- those over 60, to see how nationally.’ all bookings and, with the ment response, support they are going mentally and new tangihanga proce- and education, he said. physically. “While our doors are closed, patients dures, this is going to have a huge impact on “They are clearly, like who are unwell will still need to be seen, but whânau. Not being able to touch your loved everybody, concerned with limited stocks of PPE, we have to be cau- one or say goodbye goes against all Mâori by the speed that CO- tious. Full face masks are safer, but we don’t tikanga. However, whânau understand the VID-19 is developing, have any yet,” she said. risks and will adhere to the rules.” and the high number Ngâti Whâtua iwi was providing support to Senior staff from all the clinical practices of cases around the around 400 whânau members aged 65 or more, in Northland also met recently via video to world.” Concern was many subject to chronic diseases, pregnant discuss how they might help each other – the focused on when the mums, and large families. Welfare packs included feeling of comradeship was strong, Hand said. virus would “peak”. vouchers for GP visits, medication, transport and “The Ministry of Health has put a call out “I really hope that kai. “With the average wage in this area only for nurses and doctors willing to become these measures have around $17,000, there is not a lot of money for community testers. Like many other health come in soon enough anything beyond the basics. We need to check professionals, I want to do my part and have to prevent the catas- children and families are safe,” Hand said. registered my interest to support wherever trophes seen in other At Te Hau Âwhiwhio ô Otangarei, flu vaccina- else I’m needed.” places. The Government tions are continuing, but they are being done in While admitting to feelings of stress has stepped in fast and the open air – more than 200 flu vaccinations and sadness at times, she says the team at hard and we really sup- were done over seven days a couple of weeks Otangarei try and have a few laughs, recog- port that decision.” ago. However, a lot of kaumâtua had been fearful nising that laughter was the best medicine. He urged nurses to to leave their homes to get their flu injections. “Nurses are in this together, nationally and stay socially connected “Many of our patients and whânau are expe- internationally, and I think they should be with friends and riencing a lot of fear – fear of the unknown. congratulated for their work at every level of colleagues in closed What they might need are messages to be given the health system,” she said. • online groups. •

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 11 news focus Workload heavy for IPC Infection prevention & control leader Carolyn Clissold says other staff are turning to IPC nurses for their expertise.

areas such as dental and anaesthetics, to ment, “people are having to make deci- ensure they were keeping themselves safe sions more quickly than ideal”. from infection. “We are just going to have to face Clissold said the college was “absolutely each day as it comes and do the best we supportive” of the restrictions. Social can, given the evidence we have and the distancing and screening patients was key. resources we have available.” “Nurses need to make sure they’re asking There was sufficient PPE currently, “but patients screening questions, like if they’ve we are being mindful of not using too travelled recently or are feeling sick.” many and we are at the end of the supply She was working chain in New about two hours longer Zealand.” nfection prevention & control nursing than normal every day ‘It’s a really hard time for She said it college of nurses (IPCNC) chair Caro- at present. “Today was a tough everybody, we need to be Ilyn Clissold, who works in Wellington, I’ve gone to see two time for many said its members were busy assessing patients and talked over compassionate . . . ‘ people, having patients and advising other nurses and the phone about two to isolate them- health staff, while also trying to prepare patients in connection with people who selves at home, with limited visitors. “It’s for the pandemic. have been overseas.” a really hard time for everybody, we need “All of us are really feeling that we IPC nurses were spending a lot of time to be compassionate. People are lonely have a very heavy workload at the mo- assessing people: “Do they need swab- and sad, and fall over . . . nurses can be ment, both preparing hospitals in terms bing? Do they need to be in isolation?” creative and compassionate in this situ- of how to take protective gear (PPE) on Also ensuring that staff were screening ation”. and off, and prepare for these patients everybody coming to the hospital – IPC nurse leaders like her were involved if and when they come in . . . thinking either by phone or in person. with many more meetings and emails about the best rooms for them, the best Clissold said it was very much a team than normal, as people sought advice. procedures for them and how to do the approach, “and the team is the entire The college had set up a forum online for procedures correctly.” hospital, coming in behind us”. members to ask questions, as well as a Other staff were turning to IPC nurses Its approach was to limit visitors, use twitter account linking to best interna- for their expertise. IPC nurses were also PPE when necessary, and run education tional practice articles, at www.infection- advising health workers in outpatient sessions. But also in the current environ- control.co.nz •

“We’ve been saying ‘it’s bigger than Ben Hur’. We have to kind of keep on going, ‘Unknown territory’ but there’re a lot of anxious people, pre- sentations and staff right now.” Associate emergency charge nurse manager Tanya Meldrum Meldrum, as a designated COVID-19 says it feels like the ‘calm before the storm’. planning nurse, had been working 50-plus hour weeks, holding meetings, keeping unedin associate emergency charge unknown territory,” she said. up-to-date with developments overseas nurse manager Tanya Meldrum says it Meanwhile, camaraderie and humour was and at the Ministry of Health, liaising Dfeels like the “calm before the storm” helping keep nurses’ spirits up. “The nice with other services, such as St John’s at Southern District Health Board. thing about nurses is we do tend to pull ambulance, medical flight services, com- Staff were busy trying to prepare for together and look after each other. There munity assessment clinics and GPs, as well COVID-19, but nobody knew exactly what is a lot of talking going on. People worry as managing staff workloads. it would look like. “It’s a funny in-between but appropriately. We’re worried about our “Emergency departments [EDs] are often stage as we haven’t got definite commu- own families – are we putting them at the gateway between the community and nity-acquired illness related to COVID yet. risk? Should we be staying away from our the hospital. We have our feet in two It’s like the calm before the storm, it’s families? camps.”

12 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news focus

Staff wellbeing is a huge priority for residential aged care nurse manager Natalie Seymour.

enough staff to take care of residents, she said. “There is an underlying angst, Caring for the vulnerable because they have their own families to Seymour has been working up to 16 go home to. If it comes into the facili- hours a day since early March, from ties, how should we handle it?” 6.30am to midnight in her 75-bed rest Already several staff did not want to home and hospital facility. “I’m tired. work or were in self-isolation. “Who’s But I have got some really fantastic staff prepared to work? Who doesn’t have around me to alleviate the situation,” young families?” said the NZNO college of gerontology If COVID-19 did infect residents – as it member. “We are all doing this, we all had in Auckland and Hamilton facilities – have to work as a team.” residents would be isolated. The facility Staff wellbeing was a huge priority also had the ability to split into infected for Seymour, as she tried to maintain a and non-infected areas. sustainable Seymour workforce in hoped a clearer the face of The home had totally changed all its picture of a potentially processes for cleaning, laundry and what to expect overwhelm- would emerge ing pandemic meals, to minimise outside providers soon – and esidential aged care nurse manager situation. “I’m coming in. it would look Natalie Seymour, of Christchurch, fully engaged like Taiwan or Rhas her overnight bag packed, ready with my staff, and putting my own emo- Singapore, which had far slower infec- to stay should COVID-19 hit her residen- tions and feelings aside.” tion rates than Italy. “We just don’t know tial aged care home, run by Nurse Maude. All clinical matters had been delegated exactly what we’re working with yet.” “I’ve got my overnight bag, ready to to the clinical manager, and between Ministry information had been “over- stay if I need to, to the point where I checking for Ministry of Health updates, whelming” and not clear or concise am able to get staff comfortable and “I’m constantly walking around checking enough, making it difficult to plan and confident being here. I’m role-modelling if staff and residents are okay”. communicate with families. that we’re doing this together, we’re all Her biggest challenge if COVID-19 did “I think we are in for a really inter- in this together.” get into the facility would be finding esting time. On the positive side, this

Protecting staff was a key focus, with good pressure rooms for isolation, and poor design. hand hygiene reminders and guidance on ED nurses were screening arrivals on entry, personal protective equipment (PPE). “Looking from a barrier two metres away; categorising after all our staff is the key to our department, patients as “red”, “green” or “orange”, if their and we’ve had good support from our nurse status was unclear. leadership, coming down and talking to us Nursing staff were enjoying plenty of sup- every day.” port and messages from friends, acquaintances Human resources were looking at the spread and each other. “We are listening, talking, of staff, considering age, chronic conditions sharing, supporting each other – it’s really and family situations, while trying to plan important to feel listened to right now.” ahead, she said. “We’re working out how we After “huge” hours over several weeks, can cater for more numbers. We are planning Meldrum was now working from home due to for further escalation.” a chronic health condition which rendered her The closure of schools and childcare services vulnerable, but was still very busy coordinat- had put extra pressure on nurses, many of whom ing remotely. ‘It’s been a struggle for me, were parents. Another challenge was working knowing that I have the skills to help but in an older hospital building, with no negative cannot be in there.” •

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 13 news focus is an opportunity to really showcase our skill set, as nurses. We are charged with providing care to a really Planning for the worst vulnerable population and now is our chance to really Nelson Marlborough District Health Board associate director of nursing demonstrate that.” and operations manager of ambulatory services Jill Clendon says nurses’ Seymour said the home skills and knowledge are ‘utterly vital’ in this pandemic. had “totally” changed all its processes for cleaning, laun- have had some pretty sick people in Nelson,” dry and meals, to miminise she said. outside providers coming in. Most other public health nursing work – “Staff are now taking full apart from flu vaccinations – has been put on responsibility for these.” hold. Contact tracing, which is being man- aged nationally, is being carried out by health Virtual consults protection managers, assisted by health GP consults were now be- promoters and PHNs, if needed. ing done virtually, through Clendon said DNs, after emergency depart- Skype, and all non-essential ment and intensive care nurses, were among care cancelled. Management those most at risk. “They are going into were meeting daily instead people’s homes and not knowing what’s going of weekly, to ensure things on and that has created a level of anxiety. A would run as smoothly as lot of my role has been to support them,” she possible, including sourcing said. enough personal protective equipment (PPE). When PPE should be worn Seymour was in close Their anxiety has been focused on personal contact with the Nurse e’ve been planning for the worst protective equipment (PPE) and Clendon has Maude infection prevention ‘ case scenario but because of the developed a flow chart for DNs, and other and control nurse coordina- Wlockdown, we hope we won’t get health-care workers who go into people’s tor. There was enough PPE there. But if we do, plans are in place.” homes, to determine when PPE should be to last for a couple more That’s how Nelson Marlborough District worn, drawing on the Ministry of Health’s weeks and more on order. Health Board (DHB) associate director of latest guidelines. “It is a screening tool – a There were also really clear nursing and operations manager of ambula- home visit check list to determine whether processes on its use, which tory services Jill Clendon sums up how the PPE should be worn. If anyone has any was only when COVID-19 was DHB has prepared for COVID-19. Because symptoms at all, PPE should be worn. But 90 suspected or confirmed. planning began weeks before the lockdown, per cent of district nurse visits won’t require all those involved have had PPE, as nobody in Without visitors time to put the policies, pro- the home will be cedures and protocols in place. Other than that, for most Clendon is develop- symptomatic.” “We have had time to think residents, it was “business She believes the about the issues and what ing a model for ‘swoop as usual”, except without education provided might emerge and put plans in teams’ to provide care visitors. and the screening place,” she said. “Every DHB She predicted the level in people’s homes and tool has mostly unit had a business continuity four restrictions would be to enable them to die at allayed nurses’ plan in place.” “the new norm” for some anxiety. Among other things, Clendon home safely. time. The DHB has is responsible for public health Residents’ families had introduced a been very considerate and nurses (PHNs) and district nurses (DNs) and colour-coded triage system to decrease concerned about staff preparations have been different for each. the patient load, based on the level of “Public health nurses are case managing wellbeing, and staff were support patients need. Those identi- the COVID-19 cases. Every patient [there doing their best to reassure fied as “green” will be educated to self were 19 when Kai Tiaki Nursing New Zealand residents. “There is a true el- manage their condition at home, with spoke to Clendon] gets a phone call every ement of professionalism and regular phone contact with their DN as day and the PHN does a clinical assessment. responsibility in our work – needed. Those identified as “orange” Most of the calls are straightforward but we it’s humbling to see.” • have had their visits pushed out, with

14 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news focus

video or phone consultations Residents and staff scared as needed. “Red” patients need to be seen regularly. As with other nurse manag- Health-care assistant Marita Mobile phones and computers had be- ers, Clendon has had to deal Ansin-Johnson says rest-homes come “vital tools” for residents unable to with immuno-compromised are mostly well prepared for out- have visits from family and friends. “The lack of contact is very difficult so phones staff and those over 70. “We breaks of infectious illnesses, due are using them in different and Skype have become vital tools to keep ways,” she said. to experience with norovirus. them communicating. It is lovely to see Clendon said the DHB was their faces light up when they are talking “fine in terms of staffing”, e’ve got frightened residents and we’ve with their family on the phone or over with people lined up to help if ‘ got frightened staff. People are scared Skype,” Ansin-Johnson said. needed. W– they are afraid of the unknown.” She is “tentatively optimis- That’s how Dunedin health-care assistant Strong loyalty tic” that the Nelson/Marlbor- (HCA) Marita Ansin-Johnson describes the Most HCAs felt “a strong loyalty” to their ough region will be able to atmosphere in many rest-homes around the residents and she cited the staff at Brad- “keep the lid on” the spread country. Ansin-Johnson, the driving force ford Manor in Dunedin who had chosen to of the virus. “We have had no behind establishing an NZNO section for stay at the facility during the lockdown. community transmission so far HCAs, has contact with caregivers all over the “They have chosen to live with their – all cases have been linked to country and from a range of different care second family and leave their first family overseas travel as far as public settings. in their bubble. That demonstrates their health is aware. Most of those “I’ve heard of HCAs who can’t afford to loyalty,” she said. with COVID-19 were already take time off work and of good and bad Ansin-Johnson had heard that Rymans, self-isolating. If we can keep employment practices. But one of the country’s it at a slow rate of increase, generally speaking, most largest aged residential regionally we might be okay.” rest-homes are prepared, care providers, was pro- Looking ahead, Clendon is seem to have adequate viding “care packages” developing a model for “swoop personal protective equip- to staff. “I heard from teams” to provide care in ment, which is only to be one HCA who works for people’s homes and to enable used if the virus gets into Rymans that they are them to die at home safely. rest-homes, and are edu- getting an extra $2 an It is based on a critical care cating their staff on what hour, backdated to the decision-making flow chart. to do to prevent COVID-19 start of the lockdown, Each team will most likely getting into rest-homes,” a care package, meals consist of a nurse and a GP. she said. and that there were And she said rest-homes security guards at facil- Difficult decisions were mostly well prepared ity entrances. She said “Some really difficult deci- for outbreaks of infectious the HCAs were feeling sions about who should and illnesses, as they had had pampered.” shouldn’t have treatment may to cope with norovirus in By contrast, one HCA have to be made. The swoop the past. “We have knowl- had told her that at her team will be able to provide edge and history around facility they were short comfort and palliative care for such situations.” staffed, had to re-use people in their homes.” But HCAs were reporting HCAs were reporting that masks and that HCAs Clendon said the skills and that many residents were many residents were had been left out of all knowledge of nurses were “ut- afraid, and the lack of afraid, and the lack of COVID-19 planning. An- terly vital” in this pandemic contact with their families contact with their fami- other had reported that situation. Nurses were in- some staff were “aban- because of the lockdown lies because of the lock- volved in much of the systems was compounding their doning ship”, leading planning around COVID-19. stress. down was compounding to even greater staffing “This situation will be a cata- “I am finding I have to their stress. pressures. lyst for change in our society ease residents’ anxieties, The Otago Daily Times in a way we have never seen then do the cares. We need to have people reported that Presbyterian Support Otago before.” • settled so we can provide care safely,” Ansin- (PSO), the largest provider of rest-home Johnson said. care in Otago had asked staff over 70 or

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 15 news focus

in other high-risk categories to stay at requirements for the Government’s wage during the Covid-19 crisis.” home. subsidy, she said. “We’ll continue to sup- Ansin-Johnson said there was a marked “Not all of these staff wish to stay port all our staff in every way we can, contrast between providers with money, home, but those that do are being asked whether they are at work or at home, who could provide extras for staff, and to use sick leave, then annual leave to and that includes lobbying the Govern- those which struggled and were doing cover their time at home,” chief execu- ment for more specific wage support for the best they could. “But most HCAs are tive Jo Rowe said. charities and not-for-profit organisations doing a wonderful job under extreme As a charity, PSO did not meet the working in social services and aged care conditions.” •

Combining leadership with self-isolation has been the challenge for Waikato District Health Board chief nursing and midwifery officer Sue Hayward. Communication and compassion

happy and committed. The key to this separately, wiping down all hard surfaces was good communication and the ability and, of course, washing hands frequently. to maintain compassion – for other staff Staff shortages could become an issue members, patients and their families. in the future. “We only have so much “Our nurses continue to work within resource. We will have to deal with this aikato District Health Board their scope of practice but some are in the coming weeks. Quite how we do (DHB) chief nursing and mid- now working in other arenas to meet this, we haven’t quite nailed yet. As well Wwifery officer Sue Hayward spoke other immediate needs, eg staffing our as staffing our hospitals, nursing support to Kai Tiaki Nursing New Zealand from community-based assessment centres. will also be needed for people recovering a unique perspective – that of a nurs- There are around seven at the moment, from the virus at home or in residential ing leader nearing the end of a period covering both rural and urban areas, but care.” of self-isolation and having to continue that number will increase. We also have managing staff via e-connections. registered nurses who are adding to their Reassurance and support Hayward had returned to New Zealand skills, taking refresher courses on work- On March 26, the chief nursing officer from a meeting of the Global Centre for ing with ventilators, so they will be able Margaret Broodkoorn held a meeting, Nurse Executives in Brisbane just before to care for high-dependency patients via Zoom, with all directors of nursing the midnight deadline on March 15 for when that need arises. around the country. “This worked very people returning from overseas. The “We have other nurses going on leave well and gave us reassurance and sup- time line changed, because they port,” Hayward said. “We can now spread however, so she are immune- the messages we received to our own needed to go into ‘We only have so much re- compromised teams. These meetings might well be self-isolation. source. We will have to deal and we want to held weekly.” Hayward recognises more personal pro- “We have all with this in the coming weeks. keep them well. sorts of means of There are nurses tection equipment (PPE) will be needed connecting using e- Quite how we do this, we in self-isolation in the coming weeks and this issue was platforms but what haven’t quite nailed yet.’ because they being looked at. However, it was also I have learnt is could have been important that nurses used PPE correctly there’s nothing like face-to-face commu- exposed to the virus or they have come – ie only when nursing people who were nication. However, perhaps this will have back from overseas recently.” sick. “Nurses know how to use PPE – this to become our new normal for a while. Some nurses were anxious about the is something we all grew up with.” After the earthquakes in Christchurch, risk of bringing the virus into their Hayward fully recognises that levels people had to get used to new ways of homes and families, Hayward said. The of concern will escalate as the numbers living and working. Now it’s our turn.” DHB had been putting out guidelines on of cases increase. Communication is the Hayward said her primary focus was how to manage this risk. Advice included key, she says, and assuring staff “we to ensure the nursing workforce at her changing clothes as soon as a staff will all get through this just as well as DHB remained well-supported, healthy, member got home, washing work clothes we can”. •

16 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 science shorts

airborne transmission particles so do not remain suspended in the air for long, but a sneeze can potentially transmit drop-

lets up to six metres indoors.6 Infection occurs when the droplets land directly on another person’s mucosal surfaces (eyes, nose, mouth) or through the person touching contaminated surfaces and then touching their own mucosal surfaces. Coronaviruses may last on surfaces for anything from a few hours up to nine days, depending on temperature, humid-

ity and the type of surface.7 However, they can be inactivated with alcohol, hy-

drogen peroxide or sodium hypochlorite.7 Once transferred to a mucosal surface, the SRAS-CoV-2 virus attaches to recep- tors on the surface of cells, mainly the angiotensin converting enzyme-2 (ACE-2) receptor. The ACE-2 receptor is found all A pandemic in action over the body, particularly in the alveoli. Once attached, the virus penetrates the In some people, an over-reactive immune response to COVID-19 cell and starts replicating, releasing new brings on severe pneumonia. virus particles to infect further cells. Clinical signs of infection are caused number of countries. by the body’s immune response to the By Georgina Casey • Death rates are affected by regional presence of the virus. Inflammatory health-care capabilities and access to mediators called cytokines are released intensive care for the seriously ill. within the body to kill the virus or pre- n March 11, the World Health Orga- Globally, 3 to 4 per cent of reported vent its replication. nization declared COVID-19 – the cases of COVID-19 have died. In the over- Odisease caused by the SRAS-CoV-2 80s, the reported rate is currently around Unregulated inflammation virus – a pandemic. This means multiple 15 per cent. The true overall mortality In some people, this system over-reacts, countries, including New Zealand, are rate is likely to be less, although some and a cytokine storm leads to unregu- experiencing sustained transmission. experts put it as high as 5.7 per cent.3 lated acute inflammation in the target Most people experience mild symptoms The incubation period for COVID-19 is tissues. In COVID-19, this is mainly following infection – a sore throat and one to 14 days.1 A person may be infec- the lungs where it causes a severe viral rhinorrhoea, or perhaps fever, dry cough tious before symptoms appear, and is pneumonia due to the inflammatory exu- and fatigue. For some, symptoms can be particularly infectious in the early stages date entering the alveoli. This progresses severe, progressing from viral pneumo- of symptomatic disease. Very few cases to ARDS, with acute hypoxaemic respi- nia, acute respiratory distress syndrome 4 appear after 14 days.5 ratory failure. As yet there is no drug (ARDS) and/or cardiac injury, to multiple Transmission is exclusively via drop- therapy for the SARS-CoV-2 virus. organ failure and death. Even those 1 lets. Wet respiratory droplets are gener- After first exposure, the immune surviving this more severe form of the ated through coughing or sneezing. memory system allows a more rapid, and illness may suffer from ongoing cardiac Droplets are larger and heavier than more controlled response to the virus. • and respiratory damage.2 Risk of death increases with age or in the presence of co-morbidities such as cardiovascular or References 1) Zimmerman, P., & Curtis, N. (2020). Coronavirus infections in children including COVID-19. The Pediatric Infectious Disease Journal. respiratory disease, diabetes, cancer or https://journals.lww.com/pidj/Abstract/onlinefirst/Coronavirus_Infections_in_Children_Including.96251.aspx 2) Zheng, Y-Y., Ma, Y-T., Zhang, J-Y., & Xie, X. (2020). COVID-19 and the cardiovascular system. Nature Reviews Cardiology. https://doi. impaired immune function. org/10.1038/s41569-020-0360-5 3) Baud, D., Qi, X., Nielsen-Saines, K., Musso, D., Pomar, L., & Favre, G. (2020). Real estimates of mortality following COVID-19 infec- tion. The Lancet Infectious Diseases. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30195-X/fulltext Mortality rate unclear 4) Tapiwa, G., Cecile, K., Dongxuan, C., Andrea, T., Christel, F., Jacco, W., & Niel, H. (2020). Estimating the generation interval for Calculating the mortality rate of CO- COVID-19 based on symptom onset data. https://www.medrxiv.org/content/10.1101/2020.03.05.20031815v1.full.pdf 5) Baum, S. (2020). COVID-19 Incubation period – an update. NEJM – Journal Watch. https://www.jwatch.org/na51083/2020/03/13/ VID-19 is difficult because: covid-19-incubation-period-update 6) Xie, X., Li, Y., Chwang, A., Ho, P., & Seto, W. (2007). How far droplets can move in indoor environments – revisiting the Wells • We do not have an accurate count of evaporation-falling curve. Indoor Air, 17(3), 211-225. cases due to milder cases going unrec- 7) Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020). Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. The Journal of Hospital Infection, 104(3), 246-251. ognised and low rates of testing in a 8) World Health Organization. (2015). China country assessment report on ageing and health. Geneva: Author.

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 17 practice Hot tips to assist virtual patient assessment in uncertain times

As the COVID-19 pandemic continues, nurses are being called to work in new ways. Connecting with patients via video-conferencing, Skype or Zoom can help keep patients safe, connected and out of hospital.

By Brigette Meehan and Michelle Honey

uring these uncertain times of managing COVID-19 in New Zealand, Dnurses have already been, and are increasingly likely to be, called to work in new ways. This is both to protect our patients and also to limit our own expo- sure to COVID-19. One option is to use technology to me- diate interaction with patients. We share some ideas that have been developed when undertaking interRAI assessments, as these provide some useful hints for any setting where you need to assess a patient without being with them – so us- ing a phone or video-conference, such as Skype or Zoom to connect with a patient. These hints have been developed and In times of a pandemic, an tested for using interRAI (www.inter- interRAI home care assess- ment – either face-to-face rai.co.nz). interRAI is a collection of or virtually – can provide comprehensive clinical assessment tools indicators of clinical issues developed by an international collab- needing to be addressed. It can also provide good orative to improve the quality of life of social support at times of vulnerable people. InterRAI is already uncertainty. used throughout New Zealand by health professionals in district health boards at times of uncertainty. For example, the can both see and hear the patient. We and aged residential care facilities. Stan- assessment can identify who needs an present these, bearing in mind an older dardised interRAI assessment tools help advance care plan or who is at risk of person who might need support to use determine which level of support clients depression. technology and who might have varied and residents need. The hints offered here can be divided needs. You could adjust these hints to An interRAI home care assessment, into three sections: pre-assesment; suit the client you need to assess. either face-to-face or virtually, can during the assessment; and general keep people out of hospital. This is not comments. Firstly, a virtual assessment Pre-virtual video-assessment only because it can identify the need is likely to take longer because all the preparation for home-based supports (by a regular usual cues you might pick up when face- u Contact the person or their family home-care provider) that can help a to-face are not available. More prepara- member/carer to prepare for the assess- person stay out of hospital but also, in tion will also be needed. Both of these ment: times of a pandemic, it provides indi- can be offset, however, by considering u Check whether a mobile device cators of clinical issues that may be the travel time saved. capable of sharing live video between reversed or maintained through interven- The following hints are proposed the person and the assessor is avail- tion. It also provides good social support based on using video and audio so you able. Preferably this will be a tablet or

18 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 practice

portable laptop. GP) in the same way as a face-to-face for a different occasion. u Check whether the person is com- assessment. u At the beginning of the telephone Hot tips to assist virtual patient fortable with this technology and how u Use the mobile device to enable call, you advise the person of the pur- much support they may need. observations that are fundamental to the pose of the call, outline what they can u Practise with the person to see if assessment. expect will happen during the call, and assessment in uncertain times the device can be positioned to allow u During the assessment explore: inform them they can seek a review of both close ups and views of the whole a) cognitive or functional losses that the assessment findings if they wish. person, to see the person in motion, and might occur due to isolation or adverse u If you are interviewing an older per- to observe the environment. consequences of isolation; u Practise sending photos of the envi- b) psychosocial issues that might be af- ronment if the device is not mobile. fected by isolation; A virtual assessment is likely u Identify a third person who can c) any issues related to medication and to take longer because all the attend the assessment to hold the device food, which may be problematic if the usual cues you might pick and liaise with the assessor if the person person doesn’t have support to access cannot manipulate the device adequately them, prepare medications or make up when face-to-face are not themselves. Ideally this is the family meals; available. member/carer accompanying the person d) pay particular attention to any physi- being assessed and who is alert to ap- cal COVID-19 health symptoms related son, it may be helpful to ask the person propriate precautions against infection. to the outbreak – fever, dyspnoea or for the name and contact details of a u Ask the person to collect all their shortness of breath, history of chronic family or whânau member you could also medications together. obstructive pulmonary disease, history of contact to discuss the assessment, if re- u Have the person’s current height heart failure; quired or if desired by the older person. and weight information available, where e) Ask about new, continuing cough or u The assessment phone call should possible. sore throat. You should ask whether the be conducted like a conversation and be u Ask the person to have available person has had these symptoms in the finished within 20-30 minutes. other documentation that is routinely last three days and record this. u Older people with significant hearing collected for the assessment, such as u Ask the family member/carer for difficulties, visual, speech, language or health-care identification number or input to provide any supplementary cognitive difficulties such as dementia, names of other health providers. information that is not demonstrated or who have English as a second lan- u Review the person’s previous assess- readily through the device. guage, should be assessed face-to-face. ment (if this is not their first assess- u Because COVID-19 can lead to rapid, If you think these apply, then you should ment) to highlight any issues that may severe changes in the health of vulner- stop the call and make arrangements for require specific clinical observation or able people, it is important that your a face-to-face assessment. discussion. assessment is sensitive to changes in Nurses are the frontline health pro- u Arrange the opportunity for family/ physical or mental health, cognition, fessionals who are on the scene and carer involvement in the assessment. If function, and other clinical signs. involved in providing care. In these the family member/carer is in the home, u If you notice substantial changes in uncertain times, this includes those who check they will be available to partici- the person’s health and wellbeing based may be infected and in isolation due to pate while the person is assessed. If the on the new assessment (eg change in COVID-19. Using technology to support family member/carer will not be in the cognitive function), ensure other health- assessment at a distance is another home at the time of the assessment, care partners are aware of the change. means to ensure we can maintain care try to include them via conference call, u Depending on your workplace policy, and keep in touch with our patients. We either by linking them to the video con- this may be an opportunity to check hope these hints may assist this or give nection or via a conference call. If that is whether the family member/carer who is you ideas on how to better prepare and not possible, arrange for a follow-up call also present at the assessment has the undertake virtual assessments. • with the family/carer at another time. COVID-19 symptoms listed earlier. u A family member/carer must be present if the person has any known Extra points to think about for a Brigette Meehan, PhD, is a speech and lan- cognitive or communication problems. guage therapist by background and now principal phone interview assessment adviser for interRAI national services at TAS, an u Good practice, as well as expecta- agency that undertakes work on behalf of the Completing the assessment and tions of the Health and Disability Com- Ministry of Health and district health boards in being mindful of COVID-19 missioner’s code of rights, requires that New Zealand. u Assess the person through struc- people must be clearly advised that an Michelle Honey, RN, PhD, is a long-time tured conversation, in the same way as a assessment or reassessment is planned. advocate of nursing informatics. She is a senior face-to-face assessment. lecturer and MNSc programme director with the Ideally this is arranged with the person School of Nursing at the University of Auckland u Obtain information from family by letter or, alternatively, by a phone and she serves on the interRAI NZ governance member/carer and others (such as the call to confirm an appointment time board.

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 19 viewpoint

ficient to sustain our nursing workforce into the future. Greater investment is Potential impacts of needed in public health and other ser- vices where nurses are key to population health. The World Health Organization COVID-19 pandemic (WHO) maintains that health workers are an investment in the infrastructure of a

country, rather than a fiscal burden.5 Un- What will happen to nursing after the pandemic? It is likely to leashing the power of health workers is involve new technologies and new ways of working. an opportunity we cannot afford to miss. A well-educated and skilled nursing work force is part of a country’s wealth. By Patricia McClunie-Trust Nursing’s professional values he COVID-19 pandemic has chal- Over the last week of March, some nurses lenged health systems world-wide, have spoken to me about how public putting nurses at the forefront of safety is currently foremost in their T practice, forcing to the background the efforts to slow the spread of the virus, and care for those with serious complica- patient-centred and culturally respon- tions. The challenge for the future will be sive values central to their professional to manage the changes the experience of beliefs. For these nurses, social distanc- nursing during this pandemic will bring for ing and triaging patients via a phone both individual nurses and the profession. comes at a cost, which is the loss of their relational practices in the midst of Kiri Hunter While the impact of COVID-19 is still unfolding in New Zealand, the talk the pandemic. They also understand that among nurses already indicates concern people who are already compromised in terms of their health and access to for themselves, their families, and their Patricia McClunie-Trust relationships with the patients and health services may be those who are most at risk in a pandemic. communities they serve. At the same shape our profession in the future? 6 time, significant numbers of nurses have American infection control physician Balancing potentially conflicting chosen to return to practice in response Kent Sepkowitz argues that countries rights, interests and values between to a call to action from the Ministry of with higher rates of nurses per capita individuals and communities is central to Health, just as they did during the 1918 seem to have lower death rates in this pandemic planning. Human liberties and 1 individual rights are likely to be limited flu epidemic.2 pandemic.3 This suggests nurses may be While the current pandemic may be the critical element in health services for periods of time to serve broader unprecedented in living memory, histori- that enable effective patient manage- public interests, including public safety cal accounts of the 1918 flu epidemic ment and survival. Nurses have demon- and the wellbeing of health-care work- 2 ers. However, public health measures provide insight into the experience of strated a particular kind of social gener- 7 nurses at that time. Reports suggest that osity in their response to emergencies in must also inform, educate and com- “the need for nurses was acutely felt”, our country, by returning to the work- municate with the public to ensure they meaning the health services and nurs- force in times of need, and sustaining understand the nature, scope and threat ing workforce were stretched beyond care delivery through personal sacrifice. of a pandemic. The concern these nurses capacity, with much of the care given in expressed to me, in wanting to uphold the community by volunteers and family. Social generosity these values of patient-centred and The reports from 1918 communicate core Social generosity is a kind of altruism culturally responsive care, indicates they values of nursing at that time, including that goes beyond contractual obligations will need professional support to come to terms with their experiences of practis- duty, service and a social generosity that one person may have to another.4 It characterised the profession’s relation- forms the core of social cohesion in any ing during this pandemic. The profession ship with the New Zealand people. The community or society, and the generos- will also need to research these experi- reports also convey a sense of the entire ity of nurses at this time needs to be ences and disseminate information about population being all one family that noticed and respected by New Zealanders how our core professional values can be needed to pull together. However, they and the Government. It means that this nurtured and sustained into the future. are also a stark reminder that nurses “gift of self” should not be interpreted The “gift of self” inherent in the idea lost their lives in the service of their as a commodity. of social generosity has potential costs profession and their country during the Knowledge of the demands this pan- to individual nurses. The National Ethics demic will make on our health service Advisory Committee (NEAC) states that 1918 epidemic.2 How will the COVID-19 pandemic affect New Zealand nursing and shows that social generosity is not suf- “health professionals have obligations

20 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 viewpoint

to provide care if a pandemic occurs, that might take, would also enable ear- current crisis. United States physicians including when there is increased risk to lier mapping of cases and clusters, and Judd Hollander and Brendan Carr argue themselves and their families”.8 potentially ease the demand on laborato- that telehealth is “virtually perfect” Nurses clearly have obligations as es- ry services. Artificial intelligence allows as a first-line approach to prioritising sential health-care workers, but commu- mapping of outbreaks and forecasting convenient and inexpensive care.13 While nity expectations of nurses should also the nature and scope of their spread.11 telehealth has the potential to benefit be reasonable and not create unneces- Knowledge of the means of transmis- greater numbers of health consumers, sary risks for individual nurses. NEAC ac- sion also allows governments to educate there are also some people for whom it knowledges that kotahitanga, or working their populations about the reasons may not be a perfect fit. People who are together in unity and solidarity, is more for public health strategies and how to already compromised in terms of their likely to occur if health professionals feel maintain their own personal safety. The health and access to health services may valued and supported by their organisa- developments and discoveries arising be those who are most at risk of remain- tions and communities. Nurses’ right to from the pandemic have the potential to ing disenfranchised in our new world. refuse to perform work that is likely to change how nurses work in the future, These health-care technologies, and the cause serious harm is identified in the particularly in being able to diagnose people who use them, will need to be Health and Safety at Work (HSWA) Act and treat people with infectious diseases clever in managing the factors that dis- 2015. However, as NZNO suggests, where with much greater efficacy. tance people from health services, par- there are sometimes competing obliga- Learning to do things differently has ticularly in maintaining person-centred tions between personal and professional been another aspect of our early expe- and culturally-safe nursing practice. responsibilities, each nurse needs to rience with this pandemic. There has How we live and work may have decide where to set limits.9 been a sudden upscaling of virtual-care changed forever in the face of this The NZNO capacity, with pandemic. It is likely I will do far more guideline on phone triage teaching and research using online and obligations in or self-triage videoconference approaches from the a pandemic or Nurses clearly have obligations as es- tools being “bubble” of my home office. Nurses will disaster also sential health-care workers, but com- the first con- use telehealth, perhaps as their first line includes the munity expectations of nurses should tact people of contact with clients and colleagues. importance of also be reasonable and not create un- have with The ethics of using health-care technolo- nurses being health-care gies, and concerns with who is enabled necessary risks for individual nurses. aware of the providers.12 or not with new our ways of working, NEAC ethical In the United will be something we need to carefully guidelines for a pandemic and any specific States, telehealth has enabled social consider in our future world. • contractual obligations to their employer. distancing, reducing the risk of infection Nurses working on the frontline of health transmission through face-to-face consul- services will need ongoing support from tations. However, there have been lengthy their professional organisations and other waiting times due to overloaded systems Patricia McClunie-Trust, RN, PhD, is a principal nurses to manage the impact of the extra- and a lack of suitably trained clinicians. academic staff member at the Centre for Health 12 and Social Practice, Te Tari Hauora me Te Tari ordinary responsibilities they will have Some commentators see telehealth as Tikanga-â-Hapori, Waikato Institute of while working in pandemic conditions. the new opportunity arising out of the Technology, Hamilton. Those of us who are trained as profes- sional supervisors or counsellors might want to consider how we could contribute References 1) Ministry of Health. (2020, March 27). Ministry seeks expressions of interest from health and care professionals for COVID-19 response. to this support on a voluntary basis. https://www.health.govt.nz/news-media/media-releases/ministry-seeks-expressions-interest-health-and-care-professionals-covid-19-re- sponse 2) Kai Tiaki. (1919). Influenza epidemic. Kai Tiaki: The journal of the nurses of New Zealand, 12(1), 13-14. ‘Virtually perfect’ technology 3) Sepkowitz, K. (2020, March 25). Why is Covid-19 death rate so low in Germany? CNN. https://edition.cnn.com/2020/03/24/opinions/ger- many-low-death-rate-for-coronavirus-sepkowitz/index.html?fbclid=IwAR3U6P_g7nlpKr14s5rMlIro20WlV9VCQxjtN_TrsLBe6DVR6Qj5WB4c9Rc Technology and knowledge are two key 4) Frow, J. (1997). Time and commodity culture. Oxford: Oxford University Press. enabling factors in our ability to respond 5) World Health Organization. (2016). Working for health and growth – investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. http://apps.who.int/iris/bitstream/10665/250047/1/9789241511308-eng.pdf to the threats COVID-19 presents, that 6) World Health Organization. (2015). Ethics in epidemics, emergencies and disasters: research, surveillance and patient care. https://apps. who.int/iris/bitstream/handle/10665/196326/9789241549349_eng.pdf;jsessionid=6D51B73A5C15D1E05F4D5ABE8BCFE5FA?sequence=1 our predecessors did not have in 1918. 7) World Health Organization. (2007). Ethical considerations in developing a public health response to pandemic influenza. https://apps.who. Technology has given us the ability to int/iris/bitstream/handle/10665/70006/WHO_CDS_EPR_GIP_2007.2_eng.pdf?sequence=1 8) National Ethics Advisory Committee – Kâhui Matatika o te Motu. (2007). Getting through together. Ethical values for a pandemic. (p.55) understand the virus’s microbiology and http://www.neac.health.govt.nz 9) New Zealand Nurses Organisation. (2020). Guideline: obligations in a pandemic or disaster. https://www.nzno.org.nz/LinkClick.aspx?filetic patterns of transmission. Work is under- ket=vlDcH9XdIDg%3D&portalid=0 way on rapid-detection methods using 10) Nguyen, T., Bang, D., & Wolff, A. (2020). 2019 Novel Coronavirus Disease (COVID-19): Paving the Road for Rapid Detection and Point- of-Care Diagnostics. Micromachines, 11, 306. doi: 10.3390/mi11030306 portable devices to screen suspected 11) Moore, B. (2020, March 02). The tech on the frontline of the fight against COVID-19. IT Brief. https://itbrief.co.nz/story/the-tech-on- the-frontlines-of-the-fight-against-covid-19 cases, which will enable early detection, 12) Padmanabhan, P. (2020, March 28). Opinion: How the COVID-19 pandemic is reshaping healthcare with technology. CIO. https://www.cio. isolation and treatment. A point-of- com/article/3534499/how-the-covid-19-pandemic-is-reshaping-healthcare-with-technology.html 10 13) Hollander, J. E., & Carr, B. G. (2020, March 11). Virtually perfect? Telemedicine for covid-19. New England Journal of Medicine. https:// care diagnostic device, whatever form www.nejm.org/doi/pdf/10.1056/NEJMp2003539?articleTools=true

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 21 news focus What causes bullying and how can it be reduced? Bullying is a widespread problem in nursing. What causes it and how can it be reduced?

managers which brings pressure right on their career,” Blackwood said. By co-editor Teresa O’Connor down to the frontline,” she said. Another factor in the mix is that man- And often those managers in closest agers often tolerate bullies. “It may be contact with nurses do not have the that those who bully are perceived to be ullying is not a new problem in leadership skills needed for their roles. those who get things done when things nursing; rather there is an embed- “People are often promoted to man- need to be done in a hurry, so their Bded culture of bullying in nursing, agement roles on the basis of their behaviour is tolerated. But the long-term according to a leading researcher in the clinical skills but some of the so-called impacts of such behaviour – patient er- field. ‘soft skills’ – effective communication, rors, plummeting staff morale – are not “Bullying has been a problem for a empathy, being available, demonstrating considered.” long time – we are just talking about trustworthiness – are missing. The majority of bullying is senior it more now,” says Massey University “Performance pressures on everyone nurses bullying nurses more junior to researcher Kate Blackwood, whose PhD can also lead to mistakes/errors and them, often new graduates. thesis explored bullying in nursing. these are often not dealt with in an ef- The impact of bullying on new gradu- The prevalence of bullying in nursing fective or develop- arises from a combination of factors. mental way, rather Kiri Hunter “My thesis and other research confirms in a punitive way,” three factors – stress, frustration and Blackwood said. There is a real conflict, and the culture of the organisa- Another factor lack of aware- tion – all contribute to creating an envi- is that a lot of ness and ronment in which bullying can flourish,” bullying behaviour understanding Blackwood said. “And nursing is exposed has long been to all three factors.” tolerated, even of what bullying expected. Black- is. Often bully- ‘Huge stressors’ in nursing wood says this ing is a subtle Blackwood acknowledges the “huge may be a reflection build-up of stressors” in nursing – heavy workloads, of oppressed group staff shortages, patient acuity, double behaviour. “Re- behaviours over shifts, working through meal breaks, search shows one time, rather sometimes having to work in unfamiliar of the lingering than an overt, areas or departments and the emotional impacts of oppres- isolated drain of nursing itself. sion is that those “All these factors can lead to frustra- who were suppos- incident. tions and strains which manifest in bully- edly oppressed Kate Blackwood ing behaviours. And nurses now come to indulge in harmful work with more outside responsibilities behaviour to those less powerful than ates can be devastating. “New grads like children, ageing parents, grandchil- themselves. Many senior nurses are very often feel they are responsible for the dren, community obligations and societal supportive, but others display such be- bullying behaviour – that the fault pressures.” haviours and undergraduate nurses are at was with them. They don’t have skills, Because of greater patient acuity, risk because they are less powerful and confidence or experience to identify bul- nurses now must have more and more di- lack the skills and confidence to confront lying behaviours, particularly when those verse skills and they bear more responsi- the behaviour,” she said. behaviours are common place.” bility. This leads to increased stress and Blackwood said new graduates went Bullying within nursing is longstand- pressure in their workplace, Blackwood through a socialisation “to harden them ing, embedded and its impacts severe. believes. up. From what I understand, this is a very So, are there ways it can be ameliorated? Performance pressure from managers is real culture that exists within nursing. Just as the causes of bullying are multi- also a major factor. Blackwood refers to “The struggle new grads face to factorial so, too, must be the responses the cascading effect of pressure. “Pres- determine whether they are at fault [for to it, Blackwood believed. sure from government means pressure on the bullying behaviour] can lead to huge “Early, low-level intervention is crucial, senior managers means pressure on line insecurity and have an ongoing impact along with addressing the contextual fac-

22 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 news focus What causes bullying and how can it be reduced? Bullying behaviours as listed in the Negative Acts Questionnaire – Revised1 tors which give rise to it.” Staffing is also crucial. “If there were Work- • Someone withholding information which affects enough staff to cover every shift, that related your performance would likely overcome some of the con- • Being ordered to do work below your level of textual factors and prevent some bullying bullying behaviours.” competence Awareness of bullying behaviours and • Having your opinions ignored how to confront them should “absolute- • Being given tasks with unreasonable deadlines ly” be a part of undergraduate education • Excessive monitoring of your work “but that is only a small part of the solution”. • Pressure not to claim something to which you are entitled More education needed • Being given an unmanageable workload More education on what constitutes bullying (see table at right) is essential. “There is a real lack of awareness and Person- • Being humiliated or ridiculed in connection understanding of what bullying is. Often related with your work bullying is a subtle build-up of behav- bullying • Having key areas of responsibility removed or iours over time rather than an overt, replaced with more trivial or unpleasant tasks isolated incident,” she explained. And that means reporting it can be • Spreading of gossip and rumours about you fraught. “Normal channels of reporting, • Being ignored or excluded such as incident forms, don’t capture • Having insulting or offensive remarks made the subtle behaviour that has built up about your person, attitudes or your private life over time. Three or four months of small often covert incidents, for example being • Hints or signals from others that you should ignored in the corridor, or information quit your job being withheld, or being excluded from • Repeated reminders of your errors or mistakes group conversation, each in isolation • Being ignored or facing a hostile reaction when don’t seem particularly serious. But the accumulated effect can amount to bul- you approach lying and is what causes harm. How do • Persistent criticism of your errors or mistakes you report that?” • Practical jokes carried out by people you don’t Blackwood said often victims of bul- get along with lying didn’t have evidence to support their claim. ”The traditional ways of • Having allegations made against you dealing with conflict often don’t work • Being the subject of excessive teasing and for bullying.” sarcasm • Being shouted at or being the target of sponta- HR processes ‘too difficult’ Complaining to the human resources neous anger (HR) department often wasn’t helpful. “Lots of nurses I have spoken to have Physically • Intimidating behaviours such as finger-point- said that HR had told them they couldn’t’ intimidating ing, invasion of personal space, shoving, block- do anything, for example start an in- ing your way vestigation, unless they got a formal a bullying written complaint. Often it is managers • Threats of violence or physical abuse or actual doing the bullying, so who else can an abuse individual report to? There are many rea- sons why victims won’t put a complaint Souce: Einarsen et al., 2009, p. 32 in writing. They just want it to go away and to go through HR processes is too There are different ways of measuring bullying and different ways of applying this questionnaire, but the most common is that an individual is said to be a target of bullying if they are exposed to at least difficult for them,” Blackwood said. two of these behaviours, at least weekly, for a period of at least six months.1

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 23 news focus

But HR could provide support to line steps to address bullying and all had of the health workforce doesn’t seem to managers to deal with interpersonal some sort of “zero tolerance” bullying be highly prioritised. To bring about a issues in their team, such as training in policies in place, she said. culture shift, organisational leaders must coaching and mediation. Line manag- One DHB she knew of had adapted her recognise that looking after the health ers were in an ideal position to provide research on the management competen- workforce is beneficial in the long term. early, low-level interventions but needed cies needed to handle bullying as part of The focus can’t always be totally on the support to do so because the work took their training for managers. patient – prioritising patients at the ex- an emotional toll, she said. Bullying behaviours should be named pense of the health workforce will have Research showed that once there was and not tolerated and reporting should a long-term impact on the wellbeing of an escalated case of workplace bullying, be encouraged. “Excuses such as ‘that’s health workers,” she said. it became almost impossible to solve. my style’ or ‘I have a blunt communica- Nor does Blackwood think building the “Who is going to admit they are a bully? tion style, get over it’ should not be resilience of the workforce is the way to If bullying isn’t effectively addressed accepted. And there has to be a focus tackle bullying. ”Enhancing the resilience first time round, subsequent bullying is on developing healthy relationships and of your workforce is not addressing the much less likely to be reported and in strong leadership in line manager roles.” cause of the problem.” many cases the victim will eventually But new ways of reporting had to be leave. It is very rare that an individual developed – ways that captured the Organisational culture crucial will have the confidence to approach subtlety of so much bullying and which She’s clear about what needs to be ad- the bully and address the issue. Unfor- did not worsen the situation for the dressed, if bullying is to be genuinely tunately, it is also rare for organisations victim. “How to report bullying can be confronted. “While there are personali- to intervene effectively to resolve the problematic. DHBs need to look at dif- ties with blunt communication styles in bullying,” she said. ferent ways from the traditional methods every workplace, we need to acknowl- One key factor in reducing bullying of reporting problems. There needs to be edge that bullying behaviour is the result was to try and bring about a culture shift an unbiased communications channel, an of the workplace/organisational culture within the organisation. Elements of this independent network for those who have and not only attributable to individual included very strong messaging from se- been bullied. Participants in my research personalities. nior leadership – “they must be strongly said they found it healing to talk about “As long as the contextual factors in on board and committed to addressing their experiences, to be listened to and the work environment which contrib- the issue”. taken seriously.” ute to bullying remain and there is no Attempting to reduce some of the Blackwood believes the prioritisation concerted effort to focus on them, and risk factors associated with a stressed, of patient care above and beyond look- the focus remains more on interpersonal burnt out workforce was another ele- ing after fellow nurses may be another issues, then we are never going to be ment. “Getting those contextual factors contributing factor to bullying. She cites able to address bullying.” • to be more conducive to healthy work the Nursing Council’s code of conduct as will mean we have a greater chance of a document in which patient/client needs Reference tackling the issue.” are elevated well beyond those of nurses. 1) Pitama, S., Robertson, P., Cram, F., Gillies, M., Huria, T., & Dallas-Katoa, W. (2007). Meihana Model: A Clinical Assessment- “Some DHBs were taking really good “Promoting the health and wellbeing Framework. New Zealand Journal of Psychology, 36(3), 118-125.

Horizontal violence ‘alive and well’ in nursing HORIZONTAL VIOLENCE between nurses The findings were “disheartening”, Wilmott was surprised to find that and towards new graduates is “alive according to Wilmott. “I was surprised to many nurses who exhibited bully- and well” in the clinical environment, discover that many new graduate nurses ing types of behaviours were often regardless of practice setting, according report first encountering horizontally unaware they were doing so, as to a study by Otago Polytechnic School violent behaviours from nurses while on they, too, had been “socialised into of Nursing academic lecturer Chelsea clinical placement and also in academic professional norms”. Wilmott. institutions. It seems to happen early Transformational leadership and The research study, part of Wilmott’s while student nurses are being socialised a commitment from managers and 2019 masters dissertation, looked at 1516 into the profession and is magnified in senior nurses had been effective in new graduate nurses’ experiences. It used the first few years of nursing practice. generating culture change. Working an integrative review methodology, which The oppression cycle between medicine with managers, existing staff and captured an international perspective and and nursing remains the strongest expla- new graduate and student nurses had was across all areas of nursing practice. nation for the prevalence.” also proved effective, she said. •

24 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 professional focus Coping with the COVID-19 virus The level-four alert restrictions now in place nationally will have a major impact on the mental health of our community. Nurses have a crucial role to play in helping reduce their impact.

now all living under? China has reported increase your stress through perfection- By professional nursing adviser an increase in domestic violence since ism, rescuing or victim behaviours. There Anne Brinkman COVID-19 isolation measures were intro- is a plethora of information on the web duced. Our own rates of domestic vio- that can help you improve your coping ental health – our own as nurses lence are frightening in “everyday life”; mechanisms and prevent yourself from and that of the community in these will doubtless increase significantly tipping over. We particularly recommend Mgeneral – is a very real issue with under added unfamiliar and threatening the Mental Health Foundation’s website: the country now in level-four lockdown pressures. How can we work to prevent www.mentalhealth.org.nz/get-help/co- to prevent the spread of COVID-19. and reduce these looming issues? There vid-19/ Last month, I was in Dunedin with the is even a term for the reaction to major Being aware of the mental health

mental health nurses section national fatal epidemics – epidemic psychology.1 needs of others is an integral part of committee. Those working in district It is a recognised and serious issue. effective nursing care. Think about health boards (DHBs) were lamenting What are the measures we can all bear the questions you can ask and discuss what might lie ahead for already under- in mind, as we set out to role model bal- in establishing how another person is staffed areas. There simply aren’t enough anced mental health approaches staff or the right skill mix in mental in containing COVID-19-generat- health wards and community settings ed anxieties and fears, let alone There is even a term for the reaction now, nevermind in an unfolding crisis. the virus itself? One of the best frameworks to keep in mind for to major fatal epidemics – epidemic Role modelling needed mental health is that of aware- psychology. COVID-19, added to this already taxed ness, acknowledgement and ac- and vulnerable mental health situation, tion. Our role modelling can make a huge thinking and feeling. Listening is vital to becomes an incendiary device we all difference, as people watch for our lead ensure a person feels heard. hope won’t blow up. Anxiety is already in these uncertain times. Taking action demonstrates your rife in our communities, so if ever calm To increase your awareness, assessing understanding and awareness of how to and reason were needed to be role mod- your strengths and weaknesses in coping manage anxieties and fears. There will be elled by health professionals, then the with difficult situations is essential. How a need to be selective in what you take time is now. are you currently placed and how do you on board. What can nurses do to contain their achieve balance in the four pillars of Professionally, you have obligations own anxiety? How balanced are their your own health – mental, emotional, to be informed about COVID-19 and lives already, and how effective are their the many implications of the national physical and social?2 What are your own coping mechanisms? What do nurses reliable coping mechanisms? How will containment strategy. It is changing our need to reflect on to assess their own the COVID-19 virus restrictions affect lives daily. Personally, you have to be mental health strengths and weaknesses what you and your family/whânau can selective about the amount and intensity so they can effectively prepare for these or can’t do, let alone afford? Family/ of the information you absorb through new and uncertain health demands? whânau interactions – face-to-face or by social media and other platforms. These are questions we all must pon- social media – will increase in intensity Wisdom comes from both knowledge der. Certainly, gathering quality and as people work out how they settle into and experience. Pursue both in your quest evidence-based information on COVID-19 new, enforced patterns of behaviour. for making wise, informed decisions that is essential. The old adage “knowledge is will help promote the mental health of power” is relevant here. Knowing others ‘Early warning signs’ the nation. and knowing yourself and how you re- Being aware of your own “early warn- Do ring NZNO’s Member Support Centre spond to life’s challenges are necessary, ing signs”, eg feeling unbalanced and for further advice and support. Even if so you can maintain perspective. stressed, is necessary to survival – you NZNO staff are working remotely, we are Nurses are crucial in transferring useful can choose to pause and determine the still on the end of a phone. Kia kaha in information and skills to patients and best way forward. This is a time not to these turbulent times. • their family/whânau to help promote health and prevent illness. What are some of the likely mental References 1) Strong, P. (1990). Epidemic psychology: a model. Sociology of Health and Illness, 12(3). doi.org/10.1111/1467-9566.ep11347150 health impacts of the restrictions we are 2) Durie, M. (1994). Whaiora: Mâori Health Development. Auckland: Oxford University Press.

9 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2019 25 International Nurses’ Day May 12 “Nursing the world to health”, with a focus on the “true value of nurses to the people of the world” is the theme for International Nurses Day 2020, celebrated on May 12. Themes are set by the International Council of Nurses, with 2020 intended to be “extra special” because 2020 has been designated the Year of the Nurse and Midwife, coinciding with the 200th anniversary of Florence Nightingale’s birth. With the World Health Organization declaring Covid-19 to be a pandemic on March 11, as Covid-19 has spread to more than 114 countries, the true value of nurses becomes starkly obvious. May 12 can hardly be considered a celebration, but let us International Midwives’ Day May 5 stand in solidarity with nurses throughout New Zealand and around the world – our lives depend on them and their skills and commitment, along with those of their health professional colleagues, as never before. NZNO chief executive Memo Musa

In the International Year of the Nurse, nothing shines a light on how important nurses are in our communities quite like the current COVID-19 pandemic. ProCare stands alongside our talented practice nurses who are facing this crisis head-on as true professionals. We thank all nurses across the network for placing themselves at the forefront of primary care, along with their GP colleagues, for the good of our communities. We are proud to be on your team.

1 Kai Tiaki Nursing New Zealand * International Nurses’ Day Supplement * April 2020 THANK YOU Capital & Coast DHB leaders acknowledge and thank all nursing and midwifery teams working across hospital services, mental health, addictions and intellectual disability, primary, community and aged residential care settings during the International Year of the Nurse and Midwife. Your contribution to the care, health and wellbeing of the people of your community during New Zealand Blood Service would like to sincerely thank these unprecedented times of challenge make our Enrolled and Registered Nurses for their significant an enormous difference. We appreciate your contribution to the health and wellbeing of all our donors commitment, kindness and generosity towards the and patients. people you care for and one other. He aha te mea nui o te ao, he tangata, The care and compassion you demonstrate to your patients and donors and your ongoing dedication and he tangata, he tangata commitment to quality, ensures we continue to collect What is the most important thing in the world? and provide safe blood products to New Zealand It is the people, it is the people, it is the people 9068-0320

THANK YOU! • Northland DHB acknowledge and thank all the amazing nurses and midwifery teams working across the sector during the COVID-19 response and throughout the year, who are committed to the well being of the people of Te Tai Tokerau

•#LOVENURSING#LOVENURSING •#LOVEMIDWIFERY#LOVEMIDWIFERY

Kai Tiaki Nursing New Zealand * International Nurses’ Day Supplement * April 2020 2 To our Nurses, Midwives Have you ever worked with or received and your wha-nau – care from an exceptional Nurse or Midwife? Nominate them today. we are so very proud of you; • For selflessly serving something that is greater The award winner will receive an than us, which is our care and duty to others Air New Zealand Deluxe Mystery Break • For your courage in facing an unprecedented for two* event in both our personal and professional lives Nominations are open from • And for supporting each other in ways unseen 1 April to 5 pm, 12 May 2020 to ensure we sustain our energy

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3 Kai Tiaki Nursing New Zealand * International Nurses’ Day Supplement * April 2020 Thank you practice nurses To all nurses in general practice, We cannot thank you enough for the strength and dedication you have shown, and sacrifices you have Waitemata- District Health Board made to support our community through these trying thanks all nurses and midwives times. Please know that your work is highly valued. working across North Shore, We are here to support you in any way that we can. Waitakere and Rodney district for From the team at Comprehensive Care their contribution to the health of our community. Now more than ever, it’s great to see our team continue working together to deliver quality patient outcomes and best care for everyone. Thank You for all that you do.

To all our nurses and midwives who work in our hospitals and communities across Auckland DHB - every day you make a difference to someone’s life through kind, respectful and compassionate health care

Kai Tiaki Nursing New Zealand * International Nurses’ Day Supplement * April 2020 4 Rewarding Career, Fantastic Locations! YOU BELONG HERE . . .

Nursing the World to Health In these unparalled times Bay of Plenty District Health Board applauds all nurses for their contribution to International providing the health and care needs Nurses and Midwives Day of the people in our communities. A chance to celebrate with nurses and midwives the care and compassion they show each day. This is our turn to thank and acknowledge them for the work www.bopdhb.co.nz they do in Hawke’s Bay everyday.

5 Kai Tiaki Nursing New Zealand * International Nurses’ Day Supplement * April 2020 NZNO Young Nurse of the Year 2020 Nominations now open! Purpose of award: • To recognise and celebrate the often exemplary work of nurses in the younger age group who may still be in the early stages of their careers • To encourage younger nurses to demonstrate their commitment to and aspirations for the nursing profession in Aotearoa New Zealand • To provide an incentive for them to remain nursing in Aotearoa New Zealand. Nomination criteria: The public, colleagues or managers may nominate a young nurse for this award. Nominators are requested to specify how the nurse they are nominating demonstrates commitment and passion to nursing beyond the every day. This may include how the nurse: • Shows compassion or courage beyond what is expected in their role as a nurse; • Has improved care or health outcomes for their patients through their commitment to care, leadership, research or quality; • Works to deliver care that honours the articles of Te Tiriti o Waitangi: Tina Rangatiratanga; Partnership; Active protection; Options and Equity. • Has overcome major challenges to deliver exceptional care. Nominees may be registered or enrolled nurses, may be new graduates, do not have to be in paid nursing work, must be under the age of 31 as at December 31st 2020, be resident in New Zealand, and a current financial member of NZNO. There is a two phase nomination assessment process: • Firstly, shortlisting of up to 6 nominations by a subcommittee of the YNYA assessment panel convened for that purpose and comprising NZNO staff, Te Ru-nanga representation, and a previous recipient of the YNYA and using the criteria above. • Then an opportunity for nominators and nominees on that shortlist to ‘meet’ the full YNYA assessment panel, by Zoom or similar, to respond verbally to set questions made available in advance. Pre-recording (filming) of nominators and nominees responses to these questions may also be an option. Assessors will be looking for strong, detailed nominations that clearly evidence the strengths, achievements and aspirations of the nominee. In addition to giving evidence of how the nominee meets the criteria listed above, further aspects that the assessment panel will be considering are as follows: • Is there a particular project that the nurse has been involved in or is it a general, all round nomination? • In what way are any outcomes demonstrable e.g. has the nurse been accepted onto a programme by merit or have patient outcomes demonstrably improved? • Has the nominee contributed in a special way to a community or culture that stands out? The winner will receive a trophy and a cash prize (of which 50% must go toward further education / professional development). Two runners up will receive a runner-up certificate and a book voucher to the value of $200. All nominees will receive a certificate recognising their nomination. This is an exciting opportunity for young nurses in Aotearoa New Zealand and we encourage you to submit a nomination in recognition of the work of young nurses throughout the country. Closing date for nominations: 5.00pm, June 30, 2020 Nominations to be sent to: Heather Sander [email protected] For Nomination Form and further information/criteria go to: www.nzno.org.nz or www.nznursesstation.org

Kai Tiaki Nursing New Zealand * International Nurses’ Day Supplement * April 2020 6 history Honouring our pioneer nurses and midwives To mark International Nurses Day, co-editor Anne Manchester offers a brief insight into the lives and achievements of some of our professions’ trailblazers. The first are Mere Harper and Ria Tikini – the Ngâi Tahu midwives who helped found Plunket.

ere Harper (Ngâi Tahu, Ngâti Huirapa) was a midwife, porter Mand wahine toa. Also known as Big Mary or Mere Hapa, she was the main informant for ethnographer Wil- liam Anderson Taylor’s work on Kâi Tahu history. She is credited as one of the midwives who paved the way for the creation of the Plunket Society of New Zealand in 1907. Mere lived her whole life around the shore-whaling station established at Waikouaiti in the 1840s, situated just north of the settlement of Karitane. She was the daughter of Mata (Caroline) Pu- nahere, of Ngâi Tahu, and William Elisha Apes, a Native American Pequot from Massachusetts. Mere Apes (Hipi), born in 1842, was the first of their six children who Mere Harper (left) and Ria Tikini. From photos by William Anderson Taylor. survived to adulthood. With the excep- tion of one son, Thomas, all of the ships that came in at Waikouaiti. There was her neighbour on Huriawa. Mere Apes children lived their entire lives at are numerous accounts of her physi- Harper and Truby King would sit together Waikouaiti. cal feats. One described her winning a and peel potatoes from Dr King’s garden, Mere was born two years after the wager that she could carry three diggers, then bake them on the hot embers in his signing of the Treaty of Waitangi and swags and all, from the surf boat to the kitchen. They’d discuss families in the was still an infant when the first sales beach. Aged about 21, she took one Karitâne area who were concerned about of Ngâi Tahu land to the British Crown under each arm while the third man was the health of their tamariki or other ill- took place, beginning with the Otago perched on her back. The account in the nesses within their whânau. Deed of Purchase in 1844. Mere probably Southern Cross in 1898 says she depos- In 1906, Mere and Ria delivered baby attended the mission school that had ited her load on the shore “as easy as if Thomas Rangiwahia Mutu Ellison (Tommy been established by Reverend Watkin in she had been carrying bags of chaff”. Mutu). His older brother had died in 1844, and was later run by his successor, By the early 20th century, Mere and infancy, and Tommy Mutu became ill Reverend Creed. her brother Thomas were among the too. Mere took the sick child to Dr King, In 1863, Mere married an English- oldest residents living at Waikouaiti. Her where he stayed for some months, thriv- man, William Harper, a former skipper of knowledge of wâhi tapu, place names ing under the care of Mere, Ria, and Dr the Alice and the Result. They had one and traditions made her a highly valued King, and becoming the first Plunket child, William (jr). In 1872, Harper was cultural informant for a number of baby. The Karitane Home for Babies appointed the deputy harbourmaster of Pâkehâ ethnographers. opened within a year. Thanks to the sup- the port and later the light-keeper on In later years, she worked as a mid- port and traditional knowledge held by Huriawa. wife among Mâori and Pâkehâ in the Mere and Ria, this home soon developed Mere, like her father, was extraor- district. Like her friend Ria Tikini (“Mrs into the Plunket Society. dinarily tall and strong. As a young Chicken”), 30 years her senior, she also In 2016, an interpretative panel over- woman, she earned money by carrying worked closely with Frederic Truby King, looking the Waikouaiti River was updated passengers ashore on her back from the the founder of the Plunket Society, who to recognise the work of Mere and Ria

26 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 history

and, in 2020, Plunket rebranded its latching, others were allergic to breast- In the later years of her life, Ria logo to acknowledge its founding Mâori milk, some mothers weren’t able to pro- watched as the men she had cared for midwives. • duce enough milk for their babies. They as infants left her whenua for war in a turned to Ria and Mere Harper, who were foreign land. At the age of 108, she was ot only was Ria Tikini (Kâi Tahu, the first ports of call for these and other still working and caring for her commu- Kâti Mamoe, Kâti Huirapa) an influ- health issues in the community. nity, helping with food and entertain- Nential tôhuka, healer and midwife Ria and Mere encouraged healthy ment at an outing for wounded soldiers in the Karitâne community, she was also mothers to share milk and other supplies arranged by her whângai son Henry a clever businesswoman who sold poultry with mothers who were struggling. They Parata. Ria Tikini was considered the – hence her nickname “Mrs Chicken”. established a network of people who “oldest person in the dominion” when By the time she met Frederic Truby both received and gave support to pêpi she died in 1919, aged 109. Her memo- King, Ria had been working to improve and whânau. ries are held by the uri (descendents) of the health of people in her community Ria was 95 years old when she and those she served, and those she loved. • for many years. Mere helped deliver Thomas Rangiwahia Ria was born around 1810 at Rua- Mutu Ellison (Tommy Mutu) at Puket- puke Island. She was tattooed in the eraki. When Tommy Mutu became ill, Ria • Information for these profiles has been tuhi style, “each side of her face being and Mere took him to the home of Mere’s taken from Tângata Ngâi Tahu: People adorned with two straight lines and from friend and neighbour Dr Truby King, of Ngâi Tahu, edited by Helen Brown mouth to ear”. where he stayed for several months. and Takerei Norton and published by In the early 1900s, just as today, some Truby used the networks Ria and Mere Te Rûnanga o Ngâi Tahu with Bridget mothers had problems with breastfeed- had established, as he worked alongside Williams Books, 2017. Additional infor- ing. There were local Kâi Tahu mothers them to improve the health of the com- mation from the Plunket Society and struggling with pêpi – some had trouble munity. Wikipedia. Shadbolt named ‘dangerously political’ NEW ZEALAND HISTORY ONLINE ené Shadbolt led the only New Zealand contingent to the Span- Rish Civil War. She and fellow nurse Isobel Dodds cared for wounded soldiers, particularly those from the International Brigades, from July 1937 to November 1938. René Mary Shadbolt was born in Akaroa in 1903. She began her nursing training at St Helens maternity hospital in Auckland in 1927 and graduated in 1932. By 1936 she was head sister of Auckland Hospital’s casualty ward. Shadbolt had been “nudged leftward by the urban misery of the Depression years”, though she was not a member of René Shadbolt (centre), leader of the nursing contingent to Spain during the Spanish Civil any particular political party. She was War, with Isobel Dodds (left) and Millicent Sharples (right). horrified that some doctors and nurses were reluctant to treat patients wounded Sharples, aged 46, who worked at a arrived in Spain in mid-July. by police batons during street marches private hospital in Levin. Shadbolt told Their first posting was to a large and riots. an Auckland newspaper that she believed makeshift International Brigade hospital At the outbreak of the Spanish Civil the group could “be of some service to in Huete, central Spain. Shadbolt and War, she was among the first to volun- people in need”. Dodds stayed there until mid-1938, when teer for a contingent of New Zealand Prior to their departure in May the hospital was evacuated to Barcelona. nurses being put together by the Span- 1937, the group was detained by police They continued to care for wounded ish Medical Aid Committee (SMAC). She for a number of hours, with Shadbolt soldiers until November 1938. was appointed to lead the group, made accused of being the secretary of a com- On their return to New Zealand in Jan- up of Dodds, a 22-year-old staff nurse munist cell. Eventually the group was uary 1939, Shadbolt and Dodds worked from Wellington Hospital, and Millicent released in time to meet their ship. They for SMAC. In February, they embarked on

Kai TiakiKai Nursing Tiaki Nursing New Zealand New Zealand * vol 25 * novol 1026 * no November 3 * April 2019 2020 2719 history

a six-week speaking tour to raise aware- two never met again. In 1949, she became matron of Hoki- ness of, and money for, the hundreds Like others who had served in the anga Hospital, where she remained until of thousands of Republican refugees in Spanish Civil War, Shadbolt was marked 1967. Following representations of the France. Unbeknownst to SMAC, Shad- as “dangerously political” and initially people of Hokianga, she was made an bolt had married one of her patients, found it difficult to find work. Eventually MBE in 1969. She was widely mourned on Willi Remmel, a German member of the she was employed at a private hospital her death in 1977. • International Brigade, during her time in in Martinborough. During World War II Spain. Despite her numerous appeals on she worked at an Auckland convalescent • Adapted by Imelda Bargas (and his behalf to the New Zealand govern- home for returned soldiers and again abridged by Anne Manchester) from the ment and other agencies, Remmel was at Auckland Hospital. She remarried in Dictionary of New Zealand Biography by denied entry into New Zealand and the 1944, but was divorced 11 years later. Maurice Shadbolt. Mereana - the first Mâori registered nurse

or many years, nurse Alenehi Hei, “During the influenza epidemic of who trained at Napier Hospital and 1918, Mereana was the matron of the Te Fregistered in 1908, was regarded as Kuiti Temporary Native Hospital situated the first Mâori to gain registration. at the Mâori pa, where a total of 50 However, in 2001, research by former patients were treated.”1 Auckland Hospital nurse educator Diana She and her children later returned to Stuart Masters showed she was predated Peria, where Hattaway continued nursing by Auckland Hospital nurse Mereana Tan- and encouraging girls from the district to gata, who registered under her European become nurses. name, Mary Ann Leonard, in 1902. When she was 60, she developed bowel Tangata came from Peria, near Kaitaia. cancer. Her surgery was unsuccessful After completing her secondary school- and she died at Mangonui Hospital in ing at Hukarere School in Napier, she Northland in 1929. She was described by moved to Auckland, becoming a nurse the matron as being “brave and bright to probationer in 1893. After certification the end”. in 1896, she became a charge nurse – Mereana Tangata, known as Mary Ann 1 Helena Leonard, photographed at An obituary in Kai Tiaki in 1930 equivalent to a ward sister. Auckland Hospital c1899. describes her as “a well-known nurse She married Vincent Hattaway in 1904 who used her nursing knowledge for the and the couple had six children. They nursing in the community, and tearing up benefit of her neighbours, both Pâkehâ moved to the King Country and, in 1908, her best sheets when she needed ban- and Mâori” in Te Kuiti and later in the nurse Hattaway helped establish a nurs- dages. . . . northern district. • ing home in Te Kuiti called Wharemana. 2 According to Masters’ article in Kai Tiaki References Nursing New Zealand in September 2001, 1) Masters, D. S. (2001). Mereana Tangata – the first Maori registered nurse. Kai Tiaki Nursing New Zealand, 7(8), 14-15. “Family stories recount her continuing 2) The editor. (1930). Obituary, The New Zealand Nursing Journal, Kai Tiaki, 23(1),36. Wellington: Author. Te Puea brought health to her people e Puea Hêrangi was not a nurse or health problems from both a Mâori and Puea nursed many of the sick, building

trained health professional, but she a Pâkehâ point of view”,1 retaining her open-air shelters at Mangatawhiri, where Tspent much of her life (1883-1952) belief in traditional healing practices she was then living, to isolate the sick. committed to improving the health of while promoting Pâkehâ medicine and She also cared for around 100 orphans Waikato Mâori. treatment for Pâkehâ diseases. who became the founding members of Te Puea was a granddaughter of These convictions arose from her ex- her new settlement of Turangawaewae at Tâwhiao Te Wherowhero, the second periences during the smallpox epidemic Ngâruawâhia. Mâori king. In later life, she was often of 1913-14 and the influenza epidemic During World War I, Te Puea led an referred to as Princess Te Puea, though in 1918. She herself was afflicted by tu- anti-conscription campaign in the it was a title she did not use herself. berculosis (Tb) most of her adult life and Waikato. This highlighted Mâori griev- According to writer and historian Patricia fully accepted she could not cure herself. ances against the Government over land Sargison, she was “able to look at Mâori During the 1918 flu epidemic, Te confiscations.

28 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 history

ALEXANDER TURNBULL LIBRARY After the war, Te Puea established example of Sir Aprirana Ngata’s “back-to- a new settlement at Ngâruawâhia and the-land” movement on the East Coast. campaigned hard to include proper She finally did manage to establish medical facilities to improve health stan- a clinic at Mâhina-a-rangi, but never dards. She did get government support achieved her dream of a full-scale hos- to build a meeting house – Mâhina-a- pital. Nevertheless, “mortality from both Rangi opened in 1929 – but the Health typhoid and Tb dropped to European Department refused to allow it to run as Te Puea levels” as Mâori adopted better medical Herangi, a private hospital, shattering one of her c1938, treatment for these diseases.1 dreams. wearing But her greatest achievement was her In 1936, Doctor Harold Turbott Com- restoring the mana of her Tainui people became medical officer of health in Ham- mander and that of Kingitanga, bringing con- of the ilton. Together he, Te Puea and district British fidence and hope back to people beset nurses worked to improve sanitation and Empire by poverty and despair. She helped reduce disease, getting piped and tanked medal. negotiate a compensation deal with the water supplies for Waikato communities. touring the country with a concert party Government in 1946, thus paving the She also went to Waikato Hospital for Tb made up of her kâhuipani, her flock of way for a future Deed of Settlement with checks and x-rays, setting an example orphans. She continued purchasing or Waikato-Tainui in 1995 that has restored for others. acquiring other plots of land, using the economic viability to the iwi. • She improved her people’s economic base when she bought a farm near Reference 1) Sargison, P. (1993). Notable Women in New Zealand Health. Te Hauora Ki Aotearoa: Ôna Wâhine Rongonui. Auckland: Longman Paul Ngâruawâhia, raising money through Ltd. Additional information from Wikipedia https://en.wikipedia.org/wiki/Te_Puea_Herangi Bazley gives credit to nursing for success

ighly respected public servant Sunnyside Hospital (1965-73), when she PHOTO: RADIO NEW ZEALAND Margaret Bazley has never forgot- was in her 20s, as one of its pinnacles. Hten her nursing roots. She credits She had earlier been charge nurse at them, in fact, with giving her the skills Tokanui Hospital and assistant matron to achieve so much and the ability to at the Seacliff group of hospitals in manage teams of people so successfully. Dunedin. A nurse with 27 years’ experience, “While at Sunnyside, I was part of a Bazley held a number of senior roles in team that led the move away from the mental health, her career culminating in custodial care model to one based on the role of Health Department director of therapy. This change was made possible the division of nursing. She was a public by the development of psychiatric drugs. servant for more than 60 years, filling This was a huge change to the role of roles as diverse as State Services Com- nurses too – they became therapeutic missioner, Secretary of Transport, chair practitioners. Sunnyside led New Zealand of the New Zealand Fire Service and chair and the world in this change to how Margaret Bazley at a press conference in 2018, of Environment Canterbury. mental health institutions operated. after releasing her report into sexual miscon- Now 82, she is still full of energy and “We developed a system of collabora- duct at the Russell McVeagh law firm. has a very sharp intellect. Being chair tion, having meetings with patients of the economic development imple- to give them a say in how they wished “The Public Service Association had mentation strategy for the Wairarapa, to be cared for. We worked with our made a bid to represent all nurses, not where she lives part of each week, and patients so they could manage to live just psychiatric nurses. I was approached serving on the Waitangi Tribunal are outside the institution. Over the eight to stand for president, as I understood privileged and satisfying roles, she says. years, we reduced our bed number from these industrial issues. 1972 was also She also remains patron of a number of 1000 to just over 600.” an election year, so this gave NZNA the organisations – the Nursing Education It was while she was at Sunnyside, in chance to get members involved in po- and Research Foundation, Mental Health 1972, that Bazley was elected president litical action, though not all nurses were Nurses College, Volunteer Firemen and of the nurses association (NZNA). Psy- comfortable with that idea.” the Nurses Memorial Fund. chiatric hospitals had just moved from In 1971, the Carpenter Report had Looking back on her nursing career, being run by the health department to recommended the transfer of nursing she regards her eight years as matron of hospital board administration. education from hospitals to educational

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 29 history

institutes. This gave nurses the ammuni- be left looking after patients coming “As a psychiatric nurse I learnt the tion they needed. back from theatre on my own. The one powers of observation – skills I still use “NZNA had been trying for 50 years nursing supervisor on duty could be any- every day. I know how to read the signs to change the way nursing was taught. where in the hospital. It took about 15 and how to prevent problems. This is the Finally it had the evidence to back its years to get all the decisions around the lens I work from.” campaigns,” Bazley said. transfer of nursing education in place.” By the time Bazley had completed her “The first nursing schools approved Bazley also firmly believed that six years as director of the Department and established within general educa- psychiatric, psychopaedic and general of Health’s division of nursing (1978- tion were in Wellington and Christchurch nurse training should be integrated into 1984), she felt some in the department in 1972 – while I was still president. A a comprehensive nursing curriculum, as feared the nurse’s voice had become too third and fourth school was established every nurse needed to have both general powerful. Later, the position was down- in Auckland and Nelson while I was and mental health nursing skills. graded, with future incumbents strug- deputy matron-in-chief for the Auckland As NZNA president, Bazley was part gling to have any real influence. Hospital Board. I then moved to the of a board of health committee charged Bazley has sometimes been criticised Waikato Hospital Board as matron-in- with reporting on the shape of nursing for working too quickly and decisively in chief and was there when the transfer services for the future as hospital nurs- her later government appointments. She was approved for this region too.” ing schools were closed. disagrees. There was much opposition to these Without the skills she gained from “When you work for government changes from hospital board administra- nursing, Bazley believes she could never organisations like Social Welfare or the tors, the medical profession and older have achieved so much. “Nursing taught Ministry of Transport, you are limited by nurses, Bazley said. But she believed me how to manage hundreds of patients, the three-year election cycle. You have staffing hospitals with student labour to make sure everyone was bathed and to be hard-nosed and able to bulldoze was not a safe model. fed on time. I learnt leadership and ahead to get things done. No one likes “I looked back on when I was a stu- communication skills as a teenager, how change but when change is needed, it dent nurse at Thames Hospital and how, to educate patients about illness pre- just has to be done. This is one of the on an afternoon or night shift, I could vention, and how to manage people. cores of nursing.” • Bee Salmon – at the centre of change

velyn Beatrice (Bee) Salmon is ously for comprehensive nursing educa- remembered as a scholar, mentor, tion in an academic setting. Enursing leader, speaker and writer. She achieved this in 1973, when she Thanks to her influence during the 1960s became senior lecturer in nursing at Vic- and ‘70s, education for nurses broadened toria University. At the same time, Nan to include the humanities, as well as Kinross developed programmes in nursing physical sciences. No longer based on as part of a bachelor of arts degree at a set of circumscribed rules and tasks, Massey University in Palmerston North. nursing began to base itself instead Salmon struggled with enrolments on social understandings, reason and and funding while working at Victoria. analysis. When she resigned in 1981, the course Salmon graduated in 1945 from New was suspended, though the University Plymouth Hospital, later gaining mid- Beatrice Council had accepted a plan to establish wifery and Plunket qualifications. After Salmon, a bachelor of nursing degree. a stint in 1960 as nursing inspector of c1980 Salmon was active with NZNA, serving hospitals in the Department of Health, sity. She gained her master of science, on various national committees. She was she won the British Commonwealth applied, from McGill University in 1967. also a consultant for the International Nurses’ War Memorial Scholarship which That same year, she was appointed Council of Nurses. She received the enabled her to study at McGill Univer- principal of the postgraduate school in NZNA Award of Honour in 1984 and an sity in Montreal. She was the first New Wellington, where she promoted a more MBE (Member of the Order of the British Zealander to gain a bachelor of nursing holistic model of health education. At Empire) in the New Year Honours in degree. the same time, she campaigned vigor- 1982. • Her next move was to Ghana where she

worked with the World Health Organi- Sources zation, setting up a two-year diploma 1) O’Connor, M. E. (2010). Freed to Care. Proud to Nurse. 100 years of the New Zealand Nurses Organisation. Wellington: NZNO. 2) Carroll, P., Fieldhouse, A., & Shaw, S. (eds). (1982). A Profession in Transition. A Selection from the Writings of E. Beatrice Salmon. course for graduates within the univer- Wellington: The C. L. Bailey Nursing Education Trust.

30 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 literature review Building nurses’ resilience Nurses are facing increasing pressure in their workplaces. Resilience is an important factor in coping with such stress but there’s no single path to building it.

strategies, enabling them to think criti- A 2007 literature review found that By Jewel Baker-Armstrong cally and reflexively about their future empowering nurses and nursing students practice. enabled them to challenge their posi- urses face a growing number of These ideas build on the earlier work tion within the nursing profession.7 The pressures. These pressures originate of internationally renowned nursing three researchers suggested building Nfrom many sources, including the theorist Rosemarie Parse, who suggested resilience through personal growth and patients nurses care for and the organ- building resilience could enable nurses to self-development, a key aspect of which isation in which nurses are employed. better deal with workplace adversity.4 In involves developing skills to allow inter- And these pressures can lead to in- 1992, she developed the “human becom- personal problems to be identified and creased stress levels, increased sick leave ing” theory of nursing, which highlighted resolved.7 Their research identified that and poor staff retention. It is, there- the significance of focusing on quality many nurses faced workplace adversity fore, essential nurses develop and use of life and making healthy life choices. during their career, such as bullying. personal resilience strategies to continue When nurses are guided by quality of life They suggested equipping nurses and caring for the populations with which as a goal for practice, they can achieve nursing students with the skills to de-

they work.1 a deeper connection with their patients, velop positive and nurturing professional In this article, several strategies are empowering them to respect each other’s relationships, allowed them to function explored under four main themes identi- perspective.4 By teaching nursing stu- with increased optimism and emotional fied during a search of the literature: dents to create meaningful connections, insight.7 This positivity may lead nurses nursing education and development; they will be supported to develop and to achieve a greater feeling of work/ coaching and mentoring; experiential sustain their own professional resilience, life balance and increase their sense of learning; and emotional attributes. empowering them to challenge adversity professional accomplishment.7

as nurses in the future.4 ulEducation and development One author noted self-care was ulCoaching and mentoring The significance of the role nurse educa- an essential component of personal The important role that coaching and tors play in the development of resilience mentoring plays in the development resilience.5 Her work uncovered a in nursing students cannot be underesti- distinct lack of self-care demonstrated of personal resilience cannot be un- mated. One group of researchers suggests by nurses. She highlighted the benefit derestimated.8,9,10 One research study nurse educators are crucial in preparing of a self-care approach to building identified having a resilient mind-set nursing students for sustained profes- personal resilience. And she suggested as a key aspect of personal resilience.8 sional resilience.2 They believe resilient that through self-care, nurses could Resilient individuals were better able to nurses are more likely to be retained in develop and sustain their own personal reframe setbacks in a positive light and the profession had effective self-care habits.8 In this during times of study, researchers worked with coachees adversity, due The significance of the role nurse educators play to promote and develop individual to their abil- resilience. To achieve this, coachees ity to challenge in the development of resilience in nursing were supported through three key and improve students cannot be underestimated. areas: facilitation of learning, personal their current growth and reflection on personal goals. roles, rather than potentially abandon- resilience, enabling them to face the Providing structured coaching sessions ing their career when the complexities complex challenges of professional assisted the coachee to build resilience

seem overwhelming.2 Teaching nursing practice.5 and enhanced their ability to deal with students strategies of reflective learning This view is supported by nurse author uncertainty and change. There was also and reflexive practice enables them to Eileen McGee, who states that “it is not an increase in levels of optimism and sustain their equilibrium during periods possible to give patients what nurses do hope, and a decrease in turnover and

of adversity.2 Through reflective learning not themselves possess”.6 Through not absenteeism.8 nursing students can consider aspects caring for oneself, nurses are left feeling This is supported by a later study, of their practice, using models such burned out and emotionally exhausted, where coachees were encouraged to

as Gibbs reflective cycle3 Students are therefore increasing their likelihood of reflect and explore personal learning thereby able to evaluate and develop leaving the profession.6 goals, with the aim of increasing self-

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 31 reflection literature review

reflection and insight.9 share many similarities and may assist communication, assertiveness and self- Other researchers explored the ben- in developing and sustaining resilient confidence. Participants commented on efit of implementing a strengths-based individuals.12 their increased knowledge of resilience resilience building programme.10 They strategies, which they felt had enabled developed the promoting adult resilience ulExperiential learning them to develop and sustain resilience Several authors have identified that programme, which supported coachees in in themselves and their colleagues.15,16 developing and sustaining personal resil- experiential learning is an impor- They highlighted the significant role tant strategy in the development of ience.10 A key aspect of the programme that experiential learning plays in the involved teaching coachees the value of resilience.13,14Three Swedish nursing development of resilience. Through the positive self-talk. Participants reported researchers noted student nurses’ self- establishment of trusting relationships experiencing increased levels of coping, confidence improved when clinical skills between group members, enhanced com- self-efficacy and personal resilience due and competencies were tested through munication and rapport could be devel- to their increased use of positive self- practice simulation.13 The student nurses oped, allowing participants to experience reported decreased levels of uncertainty talk.10 each other’s differing perspectives. In Finally, several authors have identified and worry when their clinical skills were this study, participants worked collab- the importance of enhancing leadership reinforced and supported during simula- oratively to discuss simulated workplace tion. This improved self-confidence through resilience.11,12 One researcher 13 scenarios, resulting in an increased sought to enhance leadership resilience could be linked to increased resilience in confidence to share their options with these students. through guiding and supporting coachee 13 each other.15,16 A pilot study used simulation and personal growth.11 She highlighted the significant role resilience plays and sug- debriefing as a component of “resilience ulEmotional attributes gested the benefit of using resilience as intervention” with nursing students.14 A number of authors allude to the role a preventative strategy to support those Alongside simulation and debriefing, that emotional attributes play in devel- working in challenging contexts. To there were three additional modules oping and sustaining resilience.5,17 Two achieve this, five key aspects of resil- aimed at supporting the students to social psychology researchers suggested ience coaching were identified: develop personal resilience through everybody was capable of resilience.17 • reclaiming self-belief; professional empowerment strategies, However, the level to which personal • learning; teamwork building, and conflict man- resilience could be achieved was deter-

• supportive relationships; agement techniques.14 The researchers mined by four factors: previous experi- • seeing wider perspectives; and were unable to demonstrate a significant ences; personal attributes and qualities; • thinking space. change in students’ resilience levels, they environment; and existing protective

In working with coachees to address hypothesised that this was related to factors.17 They used the metaphor of each of the complex elasticity and malleability when describ- these five nature of re- ing resilience, comparing the properties of malleable metals to the psychological aspects,11 A number of authors allude to the role silience, and qualities possessed by resilient individu- both person- that emotional attributes play in devel- that working al resilience to enhance als.17 These qualities allowed resilient and leader- oping and sustaining resilience. individual re- individuals to withstand adversity, ship resil- silience levels compared to those individuals who pos- ience were enhanced, and this contrib- might benefit from a more personalised sessed more “brittle” characteristics. The importance of acknowledging these fac- uted to a wider culture of organisational approach.14 tors when supporting nurses to develop resilience.11 This study acknowledges A group of Australian researchers and sustain resilience is stressed. earlier research,12 which identified the aimed to support participants in build- 17 importance of developing specific core ing their personal resilience by imparting This notion is supported by three strengths to enhance personal resilience. a greater understanding of workplace nursing researchers from Texas, who identified the attribute of “hardiness” as The use of cognitive behavioural (CB) adversity.15,16 They implemented a series techniques enabled individuals to learn of six resilience workshops aimed at being important in resilient individuals.18 to better cope during periods of adver- improving participant knowledge of They suggested ‘hardiness’ consisted of three main beliefs: life has a meaningful sity.12 Three core strengths that resilient workplace adversity and resilience strate- individuals often demonstrated were an gies, in a positive and non-threatening purpose; individuals are able to influence ability to tolerate high levels of frustra- environment. Using techniques such their environment and the outcome of tion; self-acceptance; and an ability as self-reflection, critical thinking and events; and that positive and negative life experiences allowed for personal to keep things in perspective.12 This collaborative learning, participants were research highlighted the benefit of using able to develop and practise the skills growth.18 a CB methodology when using coaching being presented. The research findings When ‘hardiness’ is present in a resil- as a technique to enhance personal resil- noted that participants demonstrated ient individual they become less ‘brittle’ ience, suggesting that the two methods an increase in their levels of supportive and more able to be responsive to the

32 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 literature review

pattern, attributes present in resilient individuals were identified. Resiliency could be attributed to a number of characteristics such as: a positive Building resilience in outlook; a sense of self-confidence; positive self-esteem; and a belief in

self-efficacy.24 When these personal these testing times characteristics were combined with ad- ditional attributes, such as being able DURING THESE unprecedented times feelings of hurt, frustration or an- to identify positive role models, de- of a nationwide lockdown to contain ger. When responding to a negative velop close relationships and interact the spread of COVID-19, building and event, first, acknowledge the event, positively in a broader social network, maintaining resilience can be extremely then pause to “breathe” and con- the level of an individual’s resiliency challenging. However, these are the sider your response. Doing this will increased. Resiliency came from an times when being resilient is critically help you respond instead of react. individual’s ability to assess and react important. Taking small steps, such as ulAsking for help benefits not positively to stressors or situations of being kind to each other, appreciat- only the person asking, but also adversity. Personal values and beliefs the person being asked. The person 24 ing the small things, having a positive also play an important role in the asking for help feels safe to seek mindset and asking for help are a great development of resilience. She found place to start. assistance and reassurance; while 24 the person being asked, feels ac- that resilient individuals displayed Following is a list of small ways to knowledged, appreciated and that determination and persistence, while build your own resilience and that of their opinions are valued. maintaining a balanced perspective of others. Finally it’s important to remem- life.24 ulBy showing kindness to each other, ber you are not alone. If you would we can create an environment that dem- like support during these chal- Conclusion onstrates “we are all in this together”, lenging times, accessing services Developing strategies to enhance allowing us to be more accepting of such as the employee assistance resilience is an essential element of others. programme, calling 1737 or speak- nursing practice and education, leading ing to a workplace support person, ulAppreciate the small things, particu- can all help. to improved job satisfaction, greater larly those that seem insignificant, such Quoting two of the Waikato DHB retention of nursing staff, and enhanced patient care. as the smell of freshly cut grass on your core values seems an appropriate 25 way to work. These small moments can way to close. As we face these un- The literature has revealed that resilience help increase our resilience when facing precedented times, ensure you keep is a complex subject and it is not possi- daily challenges. people at heart – te iwi ngâkaunui ble to identify one simple approach that will be effective for everyone. The use ulEmbracing a positive mindset can – and remember that we are stron- of a combination of strategies tailored help to lower stress levels and decrease ger together – kotahitanga. • to the individual may be a more effec- tive approach for building resilience in nurses, empowering and enabling them to successfully navigate the challenges of workplace adversity. •

situations and events around them.17,18 sustained, deliberate practice and consci- Maintaining a positive outlook by entiousness, combined with perseverance * References for this article are on the seeing the possibilities that situations and a sense of competency, was associ- NZNO website or available on request. and events possess is also significant, ated with fewer absences, decreased as is the value that both positive and risk of turnover and increased ability to This article has been reviewed by Auckland negative experiences have on building manage the complexities of the profes- University of Technology senior nursing resilience. Other researchers identified sion. 5 19, 20, 21,22,23, lecturer Jacquie Kidd, associate profes- the importance of being able to associ- sor at the University of Waikato Anthony ate positive emotion with periods of Holistic perspective O’Brien and the co-editors. Nurse researcher Laura Polk considered adversity.17 They highlighted the power of laughter, which they found decreased resilience from a more holistic per-

levels of burnout and reduced negative spective.24 She examined 26 published emotions. papers and identified four patterns of Jewel Barlow-Armstrong, RN, BN, MEd (hons), 17 is a nurse coordinator, practice development, The importance of grit has also been personal attributes that define resil- in the professional development unit at Waikato highlighted as a key characteristic of ience: dispositional; relational; situ- Hospital. This literature review was undertaken resilient individuals. Demonstrating ational; and philosophical. Within each as the final paper in her master of education.

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 33 viewpoint Why we aren’t celebrating Florence’s birthday Many nurses find Nightingale’s statements on colonisation and the fate of indigenous people a dangerous legacy. For this rea- son, NZNO’s board of directors will celebrate other nurses and models of health on International Nurses Day 2020.

ence Nightingale that she was a close By NZNO president Grant Brookes and adviser to the Governor of New Zealand, kaiwhakahaere Kerri Nuku Sir George Grey, during his second term President Grant Brookes and kaiwhakahaere Kerri Nuku in office from 1861-68. She also advised colonial authorities in Australia and t’s surely testament to the huge elsewhere. letter to the Colonial Office in London. significance of Florence Nightingale The collected letters and reports she “But, after all, is it a fact? Iin the development of our profes- sent to Grey and others, published in “Diseases and eclipses used to stand sion that 200 years after her birth, she 2004, reveal a long-hidden side of her as effects to causes, in semi-scientific continues to stimulate debate. legacy. observations of the Middle Ages. It is the On the one hand, her contributions to usual error of quarantine reasoning,” she Kiri Hunter It is now known that Nightingale raising the status of nursing, establishing supported the alienation of Mâori land, concluded.5 formal training and applying statistical in order to force migration to European Nightingale advised that efforts to methods in sanitary reform are celebrated settlements and to bring contact with support the health of indigenous people to this day. what she termed, “the inestimable bless- should focus elsewhere. But the historical figures we choose to ings of Christian civilisation”. Her 1863 report on Sanitary Statistics venerate say a lot about who we are. And “The object should be to draw them of Native Colonial Schools and Hospi- the legacy Florence Nightingale left for gradually into better habits and gradu- tals,6 produced at the suggestion of us is a mixed one – especially here in the ally to civilise them,” she said, in her Governor Grey, explained the high rates South Pacific. It’s right that her legacy Note on the New Zealand Depopulation of child mortality using the then-dis- should be open to scrutiny. credited “miasma theory”. Question.3 For decades, feminist nurses in New To those who objected, and said that “Within or near the tropics the mias- Zealand have been uneasy about Night- “provision of land should be made for matic class of diseases occasions most ingale’s insistence that “to be a good the exclusive use of the existing tribes” of the mortality at the earlier periods of life.” Nurse one must be a good woman”.1 Her in the colonies, she replied: “this by instructions to nurses (dutifully reprinted itself would be simply preserving their In her Note on the New Zealand in Kai Tiaki, 63 years later) told us to barbarism for the sake of preserving their Depopulation Question, Nightingale always display the “higher or holier” attributed the prevalence of “chest dis- lives”.4 womanly virtues of forbearance and endurance, and that we must “above all” Nightingale supported the alienation of Mâori land, in obey the male doctors. Nurse leaders in Aotearoa have long order to force migration to European settlements and understood how Nightingale’s opposition to bring contact with what she termed, ‘the inestimable to registration and higher education for blessings of Christian civilisation’. nurses undermined our professional au- tonomy and fostered the eventual domi- Perhaps her most disturbing advice, eases” among Mâori to “the introduction 33 nance of the medical model of health.2 in the present circumstances, was her of pigs, as an article of food”. In the end, however, it was Night- dismissal of reports about outbreaks of Running through all of her colonial ingale’s troubling role in colonisation infectious diseases among indigenous writings is the idea that population which led the NZNO board of directors to communities, following contact with decline was due to inherent defects of decide that on International Nurses Day Europeans. indigenous people themselves, when 2020, we’ll be celebrating our indigenous “People assert that they always have compared to superior Europeans. and home-grown nurses instead. influenza after a boat comes to them Excessive consumption of pork was It’s a little-known fact about Flor- from the mainland,” she wrote, in a responsible for the “bad habits, filth,

34 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 viewpoint

laziness, skin diseases and a tendency to premacist views were inculcated in many Now in early 2019. We explained that, worms and scrofula” which, she believed, (though not all) of our early nurses. “Florence Nightingale wrote about our were characteristic of the Mâori people These attitudes were then carried Indigenous peoples in the South Pacific

(and also of the Irish).3 across the South Pacific, as the New in a racist, paternalistic and patronising “Incivilisation, with its inherent dis- Zealand Department of Health assumed way. eases, when brought into contact with responsibility for nursing services firstly “The continued veneration of Flor- civilisation, without adopting specific in the Cook Islands in 1903, then in ence Nightingale in the Nursing Now precautions for preserving health, will Western Samoa and Niue in 1920, and campaign is therefore disrespectful and always carry with it a large increase in later in Fiji and Tonga. painful. It continues to highlight for our mortality,” she said. Nightingale’s colonial legacy in the Indigenous nurses that their traditional “The decaying races are chiefly in Aus- region re-surfaced in 2018, in a debate knowledge and ways of being and doing tralia, New Zealand, Canada and perhaps at the South Pacific Nurses Forum (SPNF) are not being respected. Raising her as in certain parts of South Africa. They in Rarotonga. Indigenous nurses ex- the beacon for nursing globally causes appear to consist chiefly of tribes which pressed their pain that the global Nursing trauma and re-ignites the history and have never been civilised enough or had Now campaign planned to celebrate the pain of colonisation. force of character enough to form fixed bicentenary of her birth. “It was in order to address these settlements or to build towns.” A resolution, moved by NZNO and issues of Eurocentrism that we had lob- “These aboriginal populations . . . seconded by the Fiji Nursing Association, bied to gain two seats on the Nursing appear to be far more susceptible to the Now board.” operations of causes of disease arising Our request was declined – coinci- out of imperfect civilisation than are ci- dentally, around the same time as the vilised men (meaning by “civilised” men Waitangi Tribunal released its landmark who can live in a city or village without report on the WAI 2575 claim. cutting each other’s throat).”6 “The severity and persistence of health “As for the Australians, in their present inequity Mâori continue to experience state, very few of the human race are indicates the health system is institu- lower in the scale of civilisation than tionally racist,” said the tribunal, “and these poor people.”7 that this, including the personal rac- Faced with such frank expressions of ism and stereotyping that occurs in the racism, Nightingale’s defenders argue primary care sector, particularly impacts that she was a product of her time and on Mâori.”8 that whatever her faults, her priority was As nursing leaders in 2020, we see the health of indigenous people. Aotearoa’s most pressing health issue Yet other public figures of the time to be health equity. The persistent and were able to see more clearly. A select systemic health inequities have been committee report from the Legislative 200 years in the making. Our health Council of Victoria in 1858-59 found inequities will continue if we insist on that, “The great and almost unprec- Florence Nightingale, London, c1860 being wilfully blind to their existence, or edented reduction in the number of the fail to acknowledge their origins. aborigines is to be attributed to the was passed unanimously, “To recommend For these reasons, the decision for us general occupation of the country by the and request that two representatives and for the NZNO board was obvious. from SPNF representing indigenous nurses white population.”3 Celebrating Florence doesn’t fit with our Nightingale rejected this conclusion, be appointed on to the Board of Nursing vision. Instead, in the Year of the Nurse arguing that decline is “not a universal Now Global Campaign”. and the Midwife, we are choosing to law when savages come into contact On behalf of the SPNF steering com- celebrate those who move us forward to with civilisation.” mittee, we wrote to the board of Nursing a bicultural future of equity for all. • Her criticism of the report suggests where her priorities really lay: “I hope References the time is not far off when such a 1) ‘A Letter From Florence Nightingale’. (1924). Kai Tiaki: The Journal of the Nurses of New Zealand, 17(3), 123. https://paperspast. natlib.govt.nz/periodicals/KT19240701.2.35 stigma as it affixes to the empire might 2) Rodgers, J. A. (1985). Nursing Education in New Zealand, 1883 to 1930: The Persistence of the Nightingale Ethos. MA thesis, Massey be wiped away.” University, Palmerston North. https://mro.massey.ac.nz/handle/10179/6274 6 3) McDonald, L. (Ed.). (2004). Florence Nightingale on Public Health Care – Collected Works of Florence Nightingale, Volume 6. Waterloo, Or as she put it elsewhere, “This ques- Canada: Wilfrid Laurier University Press, 183-5. 4. Ibid., p 180. tion of the fate of aboriginal populations 5. Ibid., p 196. is one closely concerning our national 6. Ibid., p 168-183. 7) Nightingale, F., & National Association for the Promotion of Social Science. (1865). Note on the aboriginal races of Australia: a paper honour.”7 read at the annual meeting of the National Association for the Promotion of Social Science, held at York, September, 1864. Retrieved from Here in Aotearoa, Nightingale’s upper http://hdl.handle.net/2027/uc2.ark:/13960/t07w6pn5d 8) Waitangi Tribunal. (2019). Hauora – Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry. Lower Hutt: Legisla- class paternalism and her white su- tion Direct. Retrieved from https://forms.justice.govt.nz/search/Documents/WT/wt_DOC_152801817/Hauora%20W.pdf

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 35 profile Working for better health care for tangata whaiora To mark International Nurses Day on May 12 – Florence Nightingale’s 200th birthday – we asked two new graduates to share some of their nursing journey, their aspirations for their nursing future and whether Florence Nightingale still had any relevance to nursing in the 21st century.

specialty I am working towards By Samantha Teinakore is adolescent community men- tal health. Furthermore, I hope to develop in leadership and Ko Taupiri te maunga strength, hopefully getting a Ko Waikato te awa manager role some time in the Ko Tainui te iwi future, with my ultimate goal to Ko Ngatihaua te hapu join the Ministry of Health where Ko Rukumoana te marae I can influence future policies Ko Samantha Teinakore toku ingoa and procedures. However, I also Tênâ koutou have a passion for teaching Tênâ loutou and would love the privilege of Tênâ koutou katoa giving back to future students by becoming a lecturer. While y name is Samantha Teinakore and uncertain about what the future I am a proud descendant of Mâori, holds, I remain positive and look MCook Island, Irish and Welsh an- forward to the possibilities and cestors, and a 2019 new graduate. opportunities that emerge. I started my degree passionate about helping people and being able to provide Supporting whânau positive health-care experiences for I hope to look after my whânau people in the community. Throughout and friends, supporting them to my life I have had my fair share of achieve their best health. Fur- health difficulties, feeling and seeing thermore, as the oldest cousin on the impact it had on me and my whânau. both sides of my whânau, I hope This ignited my determination to make to be a good role model to them a difference and, with the support of all and show them you can do ‘I strive to be a nurse working in partnership with all my parents and whânau, I knew it was people ‘ – Samantha Teinakore anything you put your mind too. possible. Within nursing, I have come Throughout my study at the University for always supporting me and helping across challenges, both as a student and of Auckland, I was well supported by the me get where I am today. Reflecting on as a registered nurse, which I continue nursing staff and other organisations, my degree, it created a great foundation, to try and overcome. These challenges both within the university and outside. allowing me to grow and go on a self- include understanding different cultural This support helped me grow as a nurse discovery journey. I strive to be a nurse perspectives, staffing and the difficulties and a leader. I was able to co-facilitate working in partnership with all people, of upholding person-centred care. a rural nursing trip, tutor and participate no matter their status or background, as A common misunderstanding in Aote- in activities that helped recruit the next all people are valuable. aroa is that we are a bicultural country generation of nurses. I would like to when in reality we are multicultural. Our acknowledge the Mâori and Pacific Ad- Gaining more qualifications country is blessed with many beauti- mission Scheme (MAPAS), Kiaora Hauora, My plan for my nursing future is to gain ful cultures with different values and Whakapiki Ake and Te Kaunihera, all of further education and work my way up beliefs, which can affect the way we which are aiming to increase and support to completing my PhD, funnily enough need to deliver care. Mason Durie’s Te the Mâori workforce, with MAPAS also to be a doctor of nursing. With this Whare Tapa Whâ model is based on a supporting Pacific people. I appreciate educational growth, I hope to increase Mâori cultural perspective, which looks these organisations and the nursing staff my knowledge of mental health. The at four key pou (elements). These can

36 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 profile

affect the patient’s health, but might not be directly linked to how the patient is presenting to you. Being open-minded to In a critical time other cultures allows us to deliver cultur- like the COVID-19 ally appropriate care. We cannot under- pandemic, nurses stand the complexities of all cultures all around the – that would be impossible – but we can always ask our patients for guidance. It world are could be something as simple as greeting displaying the them in their native tongue, or getting characteristics in touch with cultural support to help us and courage as health professionals understand. As health professionals, we must continu- Florence ously challenge ourselves to understand Nightingale the different ways of life and values of displayed. our patients.

The challenge of short staffing Short staffing is a long-standing chal- lenge within nursing, affecting nurses and, most importantly, patients. It differences, all leaders are working to Florence Nightingale, often described affects nurses’ ability to provide effec- achieve a goal. Certain situations require as the founder of modern nursing, was tive care to patients and whânau, but different leadership styles to maximise a clear example of a nursing leader. She unfortunately most of the factors that the outcome, and being able to recog- was someone who came from a wealthy influence staffing levels are out of our nise that is essential. I define leadership background but always put others’ needs control. As nurses, the best thing we can as the ability to bring a group together, above her own, staying humble and do is demonstrate sound time manage- using people’s different strengths to well-grounded throughout her life. Over ment in our work and ensure we give the achieve a common goal. her years of work, she was someone who best care we can, because our patients I have seen the benefits of having pushed boundaries, defied stereotypes and whânau deserve the best. a good leader – how it can affect the and made positive changes to how Short staffing is also linked to the next dynamics of a group and the ability to nursing care was delivered. To achieve challenge. Although person-centred care work as a unit. A good leader is some- such accomplishments takes confidence, is the gold standard of care we strive one who is empathetic, open-minded, determination and passion. for as nurses, sometimes the pressures respectful, honest, trustworthy, deter- In a critical time like the COVID-19 we face make it hard. Time pressures mined, passionate and a good listener. pandemic, nurses all around the world can make it very easy to become task- Positions/titles, eg charge nurse, help a are displaying the characteristics and focused, trying to get everything com- team identify its leader, but anyone can courage Florence Nightingale displayed. I pleted before the end of shift. display leadership, no matter what posi- would like to acknowledge the hard work We all strive to focus our care around tion or title they hold. of all health professionals at this time, the person and their whânau, but the in particular nurses who remain on the reality is that sometimes it can be hard Every nurse can lead front line for the good of the people they to do that, because of the high volume Although a charge nurse manager has serve. We pray for your safety as you of tasks and the lack of time to complete been appointed into an identified leader- continue to work for the good of others. them. This situation can create an inter- ship role, their staff can display leader- Personally, I strive to uphold the nal moral challenge for nurses – we want ship qualities. Some common examples characteristics Florence Nightingale to spend more time with patients, but of such leadership are when student upheld during her career, particularly sometimes it’s really hard. We try really nurses voice concerns about being asked her determination for better health-care hard to build rapport and trust within a to do something outside their scope; a standards and to create better environ- short period of time, but sometimes it’s fellow nurse helping a colleague who is ments for the people she cared for. As more complex than that. As nurses, we struggling; or when a nurse advocates a young nurse passionate about mental all find our own ways to get the tasks for their patient. Leadership is displayed health, I hope to emulate that determi- done while also putting time aside for every day, more than some people nation throughout my career so I can patients, but it’s a skill that comes with realise. While in nursing we do have improve the environment for tangata experience. identified leadership roles, we need to whaiora (service users) and staff. I Everyone defines leadership differ- appreciate that every nurse, at all levels, consider it a privilege to be part of the ently and there are different leadership can display leadership qualities within nursing profession and look forward to styles and techniques. But despite these the workplace. my future in it. •

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 37 profile

By Melissa Harrington A nursing future hen I started to write this article COVID-19 was an emerg- Wing threat. As I completed it, dedicated New Zealand was facing unprecedented measures to contain further spread of infection. This article will have minimal to diabetes care focus on COVID-19, although I acknowl- edge the dire impact the virus is having globally and nationally in all sectors, but A new graduate nurse considers her future and draws inspiration particularity in health care and nursing. from the past. It is timely that my first year as a new graduate registered nurse (RN) coincides starting work as an RN and with the International Year of the Nurse had realistic expectations and Midwife. My mum is a primary care of what working there nurse; I have long admired her dedica- would involve. tion and the contribution she has made The setting allows time to her community, spanning more than to establish and nurture 45 years. I had wanted to be a nurse for enduring and meaning- over a decade before I started my bach- ful connections with our elor of nursing. For me, nursing is about patients. I firmly believe belonging to a widely respected profes- this is a fundamental sion, nurturing the vulnerable members component of facilitating of our societies and providing education engagement. It empow- to enhance health literacy. The ultimate ers people and acts as goal is to create better outcomes for a catalyst for behaviour individuals, families and populations. change. I feel well sup- ported, welcomed and safe Empowering patients in my role; my preceptor I completed my degree at Ara in Christ- and the wider team have church and am now working for the Can- embraced having a new terbury District Health Board as part of graduate nurse. It can the nurse-entry-to-practice programme. be daunting and anxiety My current role is split between two jobs: provoking taking a patient I work 2.5 days/week at the Diabetes load and being responsible Centre in the newly-created Christchurch for outcomes and lives, so Hospital outpatients facility. I work with it is paramount that wrap- Melissa Harrington in the endocrine test centre. patients who are having difficulty man- around support, including aging their diabetes in the community. mentoring and preceptorship, is available provide me with a robust foundation in I provide education and support to help for new grads. nursing. It has been a privilege to have those patients achieve realistic, collab- The other 2.5 days/week I work in the opportunity to learn more advanced oratively-created solutions. The aim is to the Endocrine Test Centre, also located clinical skills alongside my endocrine assist and empower patients to be able in the outpatients building. I have colleagues. to achieve good glycaemic control and quickly become part of this small team I first learnt about health theories help prevent the many serious complica- of highly-skilled nurses who perform spe- 10 years ago while I completing health tions associated with diabetes mellitus. cific endocrinology tests, often for the promotion papers at Ara. At the time, I The centre has a large multidisciplinary diagnosis of rare and complex illnesses. was working as a diploma-qualified sports team – I work closely with the diabetes My preceptor has endless patience and massage therapist, which I did for more physicians, dietitcians, clinical nurse has shadowed my every move for nearly than a decade. The theory that resonated specialists, RNs, a psychologist and a eight weeks to ensure the procedures I with me then, and still does now I am an social worker. As part of my final semes- am learning are being done with preci- RN, is Mason Durie’s Te Whare Tapa Whâ ter at Ara, I completed an eight-week sion and care. It has been a challenge to model of health. It is a renowned health transition placement at the centre. So I learn two jobs simultaneously, however model developed in 1984 as a frame- was familiar with the environment before I believe the combination of skills will work for approaching health care. It was

38 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 profile

originally orientated toward providing really got me interested in diabetes. I their families in their darkest moments. Mâori with culturally appropriate care to remain curious about how we, as nurses, It is important to acknowledge the improve their health outcomes.1 help patients cultivate an intrinsic sense impressive and substantial contribu- The framework consists of four dimen- of self care and wellness and support tion nurses make to societies, and to sions of wellbeing and describes health as patients to take on more responsibility for individuals’ lives, no more so than on a wharenui, or meeting house, with four their own health. the frontline of the fight to contain walls. These walls represent taha wairua COVID-19. Those contributions are (spirituality), taha hinengaro (mental A platform for leadership often overlooked and undervalued. health), taha tinana (physical health) and Nursing provides a platform for leadership The International Year of the Nurse and taha whânau (social relationships). Con- in health, and to change the narrative Midwife is also the 200th anniversary of nection with the whenua (land) forms the from sickness to health. In their every- Florence Nightingale’s birth. Florence was day interactions, nurses can promote foundation.1 a pioneer of nursing. Despite her father’s I think the framework and philosophy preventative health strategies and seize objection, as a young woman, she was Durie developed can be successfully opportunities to promote and implement compelled to attend the sick, injured and translated to all cultures to shift from health interventions. Ideas that come to dying. She was called to action in the a disease-centred approach to a more mind are using the skills of motivational Crimean War and effectively implemented person-centred, holistic approach. interviewing, brief interventions, referral practices that still guide nursing practice Acknowledging that health is a multi- pathways, culturally appropriate practices and philosphy today. dimensional concept helps nurses for- and timely education tailored to patients’ Florence did what no one else had mulate effective strategies of care that existing knowledge and capacity to learn. done up until that time, which was to can be moulded to individuals’, families’, Nurses in Aotearoa face many chal- consider how the nursing environment communities’ and societies’ ways of be- lenges. Issues of inequity and disparity affected a patient’s recovery and health ing. This is how nursing is unique. Our are ongoing. The link between poverty outcomes. One of the most profound profession has its own sound body of and disadvantage and poorer health out- ways she was able to reduce patient mor- knowledge and approach that is separate comes is undeniable and our most at-risk tality was to improve sanitation, which from medicine but which still greatly people are of Mâori or Pacific descent. significantly reduced infection rates. contributes to health. These populations require individualised She was also aware of the importance of care and ongoing support to overcome nutritious food and adequate rest. These My nursing future health challenges. The diabetes centre ideas are the foundation of the holis- Ultimately, my passion lies in the has Mâori and Pacific nurses who can tic approach to health we continue to treatment and management of diabetes connect with their communities and endorse today. mellitus – this is the direction in which provide the unique care I wish to steer my future career. My required. professional goal is to develop further Another topical issue As the COVID-19 pandemic engulfs knowledge, and transition into more is the endemic and toxic specialised and advanced roles. Complet- culture of bullying. I humanity around the world, at no other ing postgraduate studies, specifically have experienced first- time in my life has the need for nursing achieving a master’s qualification with hand how bullying can and all it represents been greater. nurse prescribing, is the pathway I wish affect opportunities for to take to enable me to fulfil my goal. learning and one’s self-esteem and I believe Florence Nightingale is still The World Health Organization states confidence. We must unite to eradi- relevant – many nurses are called into that type 2 diabetes mellitus (T2DM) can cate bullying and other behaviours the profession in the same way as Flor- be successfully treated and its conse- that sabotage our workforce. And as a ence, with a desire to provide comfort quences delayed with timely interven- newly-graduated RN, I was surprised and care. However, nursing has evolved tions, such as physical activity, appropri- to discover nurses are poorly paid. over the last 200 years to become an ate diet, hypoglycaemic medications, Nurses are significantly undervalued evidence-based, tertiary-educated profes- effective screening and early treatment and under-resourced within health sion, with nurses working in a vast range care. Nursing is a humanitarian profes- of practice and academic disciplines. of complications.2 Despite this, national and global rates of T2DM continue to sion – collectively we are a cohort who As the COVID-19 pandemic engulfs hu- soar and the complications of diabetes want to provide nurturing, compas- manity around the world, at no other time are costly to governments and seriously sion, advocacy, kindness and so much in my life has the need for nursing and all affect an individual’s quality of life. In more. We get to be with people and it represents been greater. Kia kaha. • my final semester, I conducted a com- prehensive literature review, examining the barriers to achieving good glycaemic control. There are many reasons patients References 1) Durie, M. (1984). Whaiora: Mâori Development. Auckland: Oxford University Press. are not able to do this and this is what 2) World Health Organization. (2018). Fact sheets: Diabetes. Retrieved from www.who.int/news-room/fact-sheets/detail/diabetes

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 39 te rûnanga Mâori nurses need more kindness – Nuku

urses working in iwi and Mâo- ri providers need “kindness” Nthrough being recognised with equal pay, NZNO kaiwhaka- haere Kerri Nuku told anti-racism event, Te Tiriti-based Futures 2020, in March. Te Tiriti-based Futures 2020 was a 10-day online “Tiriti-based, anti- racism and decolonisation” event with nearly 60 speakers, run by the Stop Institutional Racism network. In a session on racism and pay disparity, Nuku said she was Annette Sykes Kerri Nuku Saunoamaali’i Karanina Sumeo “heartened” by Prime Minister Jacinda Ardern’s call for kindness during the COVID-19 pandemic – Mâori nurses sleep in cars ‘loaded with clothes, because they don’t but wanted to see such an attitude know where they will be sleeping that night. How is that kind?’ – Nuku shown to Mâori/iwi provider nurses seeking equal pay. know where they will be sleeping that shared the session on pay disparities, “This should be a consistent value night. How is that kind?” calling for people to help others. “If we we apply every day, not just in times of As a primarily female workforce, there have positions of privilege, it is our duty crisis. was a gender gap also. “We are asking to lift people up.” Human rights and constitutional Same skills for kindness and recognition.” In an online discussion afterwards, lawyer and activist Annette Sykes spoke “It’s so concerning to me that an essen- Nuku said another challenge for Mâori about the experience of representing Te tial group of health workforce – nurses nurses was seeing how Mâori patients Rûnanga nurses at a Waitangi Tribunal working in iwi services – get paid dif- were treated differently within the hearing on inequalities in the primary ferently,” she said. “They have the same health system. Te Rûnanga wanted them health system late last year. skills, they have to be clinically compe- supported to be able to speak up for tent, whether working in communities, vulnerable patients if they were being Fundamentally unjust district health boards or prisons. discriminated against. She said a funding model which paid “Now that’s not fair, that’s not eq- Nuku’s vision for New Zealand was that nurses at iwi/Mâori providers less than uitable, that’s not kind, and it’s been her kids would be able to grow up with- others was fundamentally unjust. happening for many years.” out discrimination – “that my kids will be Institutional racism against Mâori The issue of the pay gap between allowed to grow up without the prejudice nurses had continued, with nurses today nurses working for Maori/iwi providers they currently face today, to be seen as even being stopped from using te reo and those working for other employers individuals because of their character Mâori in their workplace, as well as fac- was raised 10 years ago by Mâori nurse they bring, not the colour they wear. ing more barriers to professional devel- Ngaitia Nagel, in a petition to the Gov- opment opportunities. ernment to change the funding model. Te ‘Empowering my kids’ Yet a range of evidence presented to Rûnanga o NZNO had also raised the is- “My vision is to empower my kids to be the Waitangi Tribunal suggested care sue with the Human Rights Commission, proud of who they are, the whakapapa by Mâori nurses led to more success- the United Nations Permanent Forum that got them here and runs through ful outcomes for Mâori. This should be for Indigenous Issues and the Waitangi their bones.” recognised and acted on, she said. Tribunal. However there had been no Her vision for health was that it would At NZNO, Te Runanga wanted to co- change – in fact the gap was widening, recognise wellbeing – hauora – which design a funding model with the Govern- Nuku said. “We battle on to make sure involves the whole person, “not just the ment, as well as lobby Mâori organisa- the voice of nurses is heard.” broken bone”, and a society which didn’t tions for equitable funding across the As a consequence, many Mâori nurses assert the superiority of one culture over board. had to supplement their income with another. Mâori nurses were generally “quiet a second job and some slept in cars, Equal Employment Opportunities Com- activists” and needed support, Sykes “loaded with clothes, because they don’t missioner Saunoamaali’i Karanina Sumeo said. •

40 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 nurseWORDS

crossWORD Completing this will be easier if you have read our March issue. Answers in May. it’s cool to 1 2 3 4 5 6 korero

7 8

9 HAERE MAI – welcome to the April kôrero column. The natural world can be a place 10 11 12 to ground ourselves in times of peril, anxiety or distress. Taking a bush walk may not be possible right now, but the sounds of our native birds can often be 13 14 heard, even in urban areas.

15 Pîwakawaka (fantail) is a small friendly insect-eating bird with a fan-shaped tail. 16 17 Ruru (morepork) is Aotearoa’s native owl, whose plaintive two-note call can be 18 ê heard at night. Both its Mâori and English names reflect the sound of its call. 19 20 21 Both birds have strong associations with the spirit world in Mâori mythology. Ngâ kupu hou 22 New words 23 • pîwakawaka – pronounced “pee-wah- kah-wah-kah”

ACROSS DOWN • ruru – pronounced “rrroo-rrroo” 1) Birth control. 2) Man-made fibre which replaced silk stockings. 7) Bend object to make smaller. 3) Deliberate pregnancy termination. Rerenga kôrero 8) Worth less than they earn. 4) Curved line of hair on upper face. 10) Sovereignty, personal automony 5) Pointy end. Phrases (Mâori). 6) Bulb vegetable. Two simple messages about COVID-19: 13) Bright-glowing sign. 7) Branch of nursing which involves collecting 14) Wood-chopping tool. evidence. • Horoi ô ringa. Mahia te hopi. 16) Furious. 9) Most basic and important infection control Wash your hands. Use soap and water. 17) Powerful household cleaner, and body method. waste product. 11) External sex organs. • He waka eke noa. 19) Unconscious. 12) Worried. We are all in this together. 20) Breathe out, in martyred fashion. 15) Put in danger. 22) Cancer therapy using high-energy 18) An equal, in terms of profession or status. Karakia waves. 19) Skin break-out. 23) Sandy shore. 21) Coloured part of eye. Prayer Tûtawa mai i runga, Tûtawa mai i raro March answers. ACROSS: 1. Millennial. 6. Cat. 8. Sunburn. 9. Omit. 10. Culture. 12. Flour. Tûtawa mai i roto, Tûtawa mai i waho 13. Lagoon. 14. Taupiri. 18. Scapula. 20. Recipe. 22. Equal. 24. Bullying. 25. Preceptor. 26. Fade. DOWN: 1. Mask. 2. Language. 3. Eruption. 4. Nun. 5. Atom. 6. Cotton. 7. Tamariki. Kia tau ai, Te mauri tû, te mauri ora 11. Exit. 12. Future. 15. Ripened. 16. Asleep. 17. Rabbit. 19. Acute. 20. Ruler. 21. Coy. 23. Lie. Ki te katoa Hâumi e, hui e, tâiki e Come forth from above, below, within wiseWORDS and from the environment Vitality and wellbeing for all . . . The COVID-19 epidemic is a dramatic reminder that we humans Strengthened in unity are both so fragile and so resilient. Be kind to one another. Avoid the “ pandemic panic; proceed with caution. Don’t touch your face, cover your (karakia by Scotty Morrison) cough and please — wash your hands. E mihi ana ki a Titihuia Pakeho, Keelan Ransfield and – Tiffany Swedeen, a critical” care nurse and clinical instructor Leanne Manson. To learn more about pîwakawaka and ruru, go to www. working in the first United States hospital to treat a COVID-19 patient doc.govt.nz/nature/native-animals/birds/

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 41 industrial focus Your rights and responsibilities Nurses must be aware of their rights and responsibilites in these unprecedented times.

into people’s homes. NZNO is advising a Where staff are off work due to public By NZNO staff precautionary approach be taken, as this health advice, DHBs will waive the re- is an entirely new situation with many quirement for a medical certificate after ith New Zealand now in lock- questions still unanswered. three days, but may require a signed down until at least late April in NZNO members must be part of all declaration from the staff member. Wan attempt to halt the spread the planning regarding COVID-19 and to According to NZNO, if an employer of the COVID-19 virus, the health-care know their obligations in a pandemic. requires a member to stand down, who is workforce, of which nurses are the most Under the Health and Safety at Work symptom-free and willing to work, that numerous, is under immense pressure. Act (HSWA), an employer must ensure, person will be entitled to paid special District health boards (DHBs) have so far as is reasonably practicable, the leave or some other leave. been preparing for an onslaught of health and safety (H&S) of workers. patients and the Government has The primary duties of workers under Paid special leave pumped an extra $500 million into the the HSWA are: they must take reason- If a member is required to self-isolate or health service. Despite these efforts, able care of their own H&S; they must contracts the disease, they will get paid NZNO has has had to lobby for more take reasonable care that their acts and special leave. NZNO believes all health- personal protective equipment (PPE) omissions do not adversely affect the care workers in all health-care settings for nurses and others. And it has heard H&S of others; and they must comply should be entitled to the same provi- of some private-sector employers try- with reasonable instructions and cooper- sions, protections and conditions that ing to force staff to take sick or annual ate with reasonable policies, eg follow- apply to those working in DHBs. DHBs leave during the lockdown. Nurses and ing safe work practices, effective use of are, ultimately, the funders of these all health-care workers need protection equipment, wearing protective clothing other health-care providers and there and professional and practical advice and participating in training. should be a consistent approach across at this time. The employee is responsible for high- all sectors. NZNO has prepared a raft of resources lighting to their employer any conditions It is likely members will be asked to and information for members on how to or circumstances that place the worker’s work more than usual. NZNO believes cope in a range of different scenarios H&S at risk. an open conversation with employers they may face in their work. These are NZNO recommends in the case of CO- about what will be expected of health being updated regularly and can be VID-19, that members monitor their own professionals, should demand become found at www.nzno.org.nz. This industri- H&S and that of their colleagues, and overwhelming, is crucial for workforce al focus outlines some of the key issues report any concerns to their employers. planning. nurses and other members face, and their NZNO members will have to care for Redeployment was emerging as a big rights and responsibilities during the people with COVID-19. Careful planning issue as Kai Tiaki Nursing New Zealand pandemic. can help reduce the impact of the pan- went to press, including redeployment demic, but all nurses and other members to other providers. NZNO believes DHB Supporting members must be mindful of their rights and employees redeployed outside DHBs NZNO’s role in a pandemic is to support responsibilities. must remain as DHB employees, with members’ access to the latest pandemic In their information to staff, DHBs say the same conditions and protections, information; support members as they health workers are employed to use their including PPE, as they would if remain- prepare for and practise during the professional skills “to care for whomever ing in DHB employment. pandemic and throughout the recovery presents for care”. They are provided with Employers must meet all leave and phase; and support them should employ- knowledge, safe procedures and PPE to consultation provisions under the terms ment issues arise. protect them from risk as much as pos- of any collective agreement they have PPE has emerged as a major concern. sible. Those with concerns about their with NZNO. The Ministry of Health has DHBs and the Ministry of Health have immediate safety should contact their information specifically for health profes- issued guidelines in line with those of line manager. sionals on its website. the World Health Organization. However, In their information to staff, DHBs say, NZNO is in constant communication members remain concerned, particularly where possible, flexible working arrange- with DHBs to ensure all members are about cases which may be asymptom- ments should be explored for staff who supported and protected in this rapidly atic or where it not known whether a need to be away from work for either self evolving situation. NZNO thanks its person has COVID-19, eg where district isolation or other matters, such as look- members standing at the frontline in the nurses or other health-care workers go ing after dependants. battle against COVID-19. Kia kaha. •

42 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 sector reports Primary health care: MECA ratification process delayed THE NZNO team negotiating the primary ratification is an obligation to meet the relevant health care multi-employer collective and suggest employee/s and the NZNO organiser/del- agreement (PHC MECA) has indicated they email egate; there is the development of a plan that the member ratification online bal- their employ- from that point; there is a reasonable lot should be delayed until April 23. ers expressing and specified timeframe for feedback; NZNO lead advocate Chris Wilson their disap- and then a final decision is made. (right) said this was to give the 25 pointment. “These are meaningful and agreed employers who had not yet ratified the NZNO is also contractual provisions and cannot be MECA time to do so and to enable NZNO suggesting overruled in a pandemic,” Wilson said. to hold serious negotiations with seven members ask The proposed MECA includes a 2.5 per employers (to date) – via Zoom or phone their employ- cent pay increase for nurses and medical – who had declined the MECA. The delay ers to recon- receptionists, backdated to September 1, would also help ensure as many NZNO sider before 2019, and a further two per cent increase members as possible participated in the serious negotiations start. on September 1 this year, effectively a ballot, given the COVID-19 situation. Wilson said NZNO had done this in two-year term. Some 350 NZNO members work for these previous MECA ratifications and believed Before the lockdown, NZNO and the two groups of employers. it should be done this time to ensure as NZMA had been lobbying extensively for NZNO will also include advice to mem- many NZNO members as possible have more funding for the PHC sector to en- bers who have been asked to reduce their the opportunity to be balloted. Only able pay parity. This offer was based on hours during the lockdown. members in workplaces where employers what employers could afford without any Well over 67 per cent of employers – have ratified the MECA can be balloted. extra funding, and did not address pay their threshold for ratification – have NZNO is advising members who have parity with nurses in the district health ratified the MECA. been asked to reduce hours that employ- board sector, Wilson said. As at May 4, NZNO will inform members working ers needed to abide by the manage- 2020, an eight per cent pay gap between in general practices and accident and ment of change provisions in the MECA. experienced PHC and DHB nurses would medical centres that have voted against Essentially, these make clear that: there remain. •

Online ratification for new Nurse ‘ Maude offer MEMBERS AT Nurse Maude in Christchurch collective agreement (CA) – it will expire full review of nursing costs and also have withdrawn their strike notice and on August 31, 2020 – the NZNO negoti- include the two other district nursing this month are considering a changed ating team agreed to withdraw the strike providers in Canterbury, Healthcare NZ offer from their employer. Online ratifica- notices and take the proposed CA out to and Access. The DHB has proposed a tion takes place this month. members for ratification. timeline to achieve this by Septem- After a partial strike involving district The key points are: ber, which is when NZNO would next nurses in Canterbury had begun, and no- • A 2.3 per cent increase across all be in bargaining, should members tice of a full 24-hour strike in early April current paid and printed rates (exclud- ratify the proposed CA. had been issued, the employer requested ing those roles covered by the care and Wilson said this would not have to meet with NZNO on March 26. During support workers’ settlement), backdated been achieved were it not for the the negotiations, the Government an- to September 1, 2019. organiser Helen Kissell, and delegates’ nounced the escalation to lockdown. • The term will be from September 1, and members’ determination through- Nurse Maude presented a changed po- 2019 – August 31, 2020. out the campaign for pay parity. sition but with no improvements, which In addition, the Canterbury District “Collective activity has increased NZNO primary health care industrial Health Board (DHB) has agreed to a 10-fold on this site and will hold us adviser Chris Wilson said was disappoint- review of funding for community nurs- in good stead for future bargaining in ing. But given the circumstances of the ing services to create a new sustain- a few months, should members accept lockdown and the term of the proposed able funding model. It will include a the proposed CA,” Wilson said. •

Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 43 college & section news COVID-19 dominates intensivists’ meeting CONCERN ABOUT COVID-19 dominated Li Bassi talked the Australian and New Zealand Intensive about its origins Care Society (ANZICS) regional annual – a live animal scientific meeting held in Napier in market in China March. The theme was “A 2020 vision – and earlier for our environment: The spectrum of corona viruses intensive care.” which could It focused on what part we health- jump species, care workers can do to sustain the such as severe intensive-care environment and respond acute respira- to climate-related challenges affecting tory syndrome health, health equity and welfare. (SARS) which Critical/intensive care nurses were was transmitted among about 200 attendees at the three- to humans from day conference, which featured dozens of bats. However, speakers from New Zealand and around the number of Gianluigi Li Bassi Rachel Yong the world. COVID-19 cases Inspiring nursing leaders such as has grown far more rapidly than SARS, spread of diseases is facilitated as tem- Massey University lecturer Alison Pir- with more than 70,000 cases in four peratures increase. To slow the effects, ret, Counties Manukau clinical director months, compared to 7000 SARS cases in we need good governance and health of improvement and innovation Lynne eight months. care connected with the environment. Maher and Dunedin clinical nurse special- He suggested the virus would not only Discussions about recent disasters such ist Linda Grady shared their experiences. have health effects, but also psychologi- as the Australian bush fires, the mass Common themes included wanting to cal and social effects. shooting in Christchurch, the Whakaari- make a difference, having a passion, Climate change speakers, such as the White Island disaster – and now CO- challenging the system, empowering University of Colorado’s Jay Lemery and VID-19 – makes you think about how we other nurses and having courage by “do- Victoria University’s James Renwick, look after ourselves, or sustain ourselves, ing one thing that scares you”. made us think about the bigger picture, to give better care to patients. With COVID-19 spreading so quickly, and how climate change affects human The reality is, our ICUs are not the most compelling talk came from health. What are our intensive care units resourced to cope with the reality of Italian-trained, United Kingdom-based (ICUs) doing that is increasing our carbon COVID-19. • intensive care specialist Gianluigi Li footprint and how can we reduce this? Bassi on the need for global collabora- Climate change affects our sense of Report by college of critical care tion on COVID-19. identity, culture and environment. The nurses committee member Rachel Yong Northland nurses gather to share research ABOUT 50 nurses from mental health, nurses through evidence-based practice. taken in Northland, within a safe and community, education and acute care “We are celebrating the research nurs- supportive environment. attended Northland’s recent nursing re- es undertake to improve the quality of Topics ranged from early intervention search showcase, and discussed research care in our communities and the network in psychosis, barriers and enhancers for initiatives for the future of nursing in and support between nursing groups in the recruitment and retention of Mâori Te Tai Tokerau. Hosted by NorthTec/Tai Northland,” she said. The International nurse educators working in undergraduate Tokerau Wânanga, the showcase was Year of the Nurse and Midwife was a nursing programmes, to the experiences of coordinated by NorthTec nursing depart- chance to acknowledge the leadership of older adults transitioning into long-term ment staff. nurses in improving health services. residential care. NorthTec’s nursing pathway manager, There were speakers from around The symposium was also an opportunity Bev MacKay, who instigated the an- Northland, including many first-timers. for third-year nursing students to pres- nual event four years ago, said it was The symposium was a unique chance ent a range of projects they are expected a chance to demonstrate the work of to share the research and mahi under- to complete as part of an evidence for

44 Kai Tiaki Nursing New Zealand * vol 26 no 3 *April 2020 college & section news Cancer nurses ‘pleased’ to join national cancer agency advisory group THE CANCER nurses college (CNC) is the cancer patient.” were more likely to “pleased” committee member and Waika- Hamilton’s ability die – and sooner – to nurse, Mary-Ann Hamilton, has been to articulate issues of than non-Mâori with appointed to the Cancer Control Agency equity and the nurs- cancer, emphasising board’s newly-formed clinical assembly. ing perspective won the need for a well- “It is heartening to see the Ministry her a place, Wagte- resourced and focused of Health (MoH) and the Cancer Control veld said. approach to eliminat- Agency recognising the need for nurs- The first meeting ing inequity. ing representation,” CNC chair Kirstin of the assembly was Kirstin Wagteveld Mary-Ann Hamilton After lobbying, Wagteveld said. held in Wellington in the college has also After cancer nurses were excluded from late January, hosted by assembly chair succeeded in getting nursing representa- the agency’s interim board, the college Christopher Jackson and agency chief tion on the systemic anti-cancer therapy lobbied to be included, meeting MoH executive Diana Sarfati. (SACT) working group, with nursing rep- and the cancer agency, as well as writing Key points included how to develop resentation in each of the current tumour letters and asking medical colleagues for an understanding of current cancer-care streams. The SACT project is focused on support, she structures, national data collection and standardisa- said. capacity, work tion of anti-cancer treatments, including While ‘It is heartening to see the Ministry programmes chemotherapy via electronic prescribing. “disappointed” of Health and the Cancer Control and priorities The college has ongoing representation not to attain a for the agency, on the following MoH working groups: board pres- Agency recognising the need for as it prepares medical-oncology, radiation-oncology ence, she said nursing representation.’ to implement and haematology. the college the National Wagteveld said the college welcomed was pleased to have a member on the Cancer Plan. communication from members, whether agency’s clinical assembly, which is an The assembly also considered how to concerns or ideas. advisory group of clinicians. identify population-based cancer survival “We are here to represent cancer nurs- “As a committee, we are dedicated to estimates, to benchmark how New Zealand ing so please feel free to contact us on continue lobbying for nursing represen- compares on the world stage. [email protected].” • tation at ministry level and recognition Mâori epidemiologist Jason Gurney of the experience, skills and knowledge also highlighted the uncomfortable Report by cancer nurses’ college chair nursing and nurses bring to the care of truth that Mâori diagnosed with cancer Kirstin Wagteveld

edge about rongoâ heal- health care. “It’s almost Northland nurses gather to share research like its hidden and needs to be brought to the forefront. I want to draw attention to it and plant a seed in nurses’ minds to be more aware of it in their practice.” The event was worth- Participants at the nursing research showcase in Northland. while, showcasing nursing initiatives and practice course. These presentations are the importance of rongoâ Mâori. Both said providing a platform for networking always highly regarded. they valued the chance to share their find- and collaboration. • Fern Astill presented on intra-muscular ings with nurses working in the field. Report by NorthTec senior nursing injection practice and Hanibrez Sipu on Hani said there was not enough knowl- lecturer Linda Christian

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46 Kai Tiaki Nursing New Zealand * vol 26 no 3 * April 2020 Happy International Nurses Day!

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