Nursing Manifesto 2020 - New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa - NZNO
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New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa Nursing Manifesto 2020 Nursing matters Even more in 2020
Introduction Why have a Manifesto and
how was it prepared?
Our five Manifesto
themes: Health workforce;
Health funding models;
Achieving health equity;
Health determinants;
and Health-related
referendums
related issues they experienced 1. Nurse education and training
during the pandemic and the programmes must graduate
What will help the health sector’s recovery international evidence circulating nurses who drive progress
from the COVID-19 pandemic? about how heavily the pandemic in primary health care and
has impacted this critical workforce. universal health coverage
They can also look to the successful 2. Planners and regulators should
Why a Manifesto? • What reduces the harmful examples of community- and iwi- optimise the contributions of
consequences of inequitable based initiatives for answers to nursing practice
The purpose of this Manifesto is to those questions.
access to health care in Aotearoa 3. Collaboration is key.
provide evidence-based information
New Zealand?
to NZNO members to support Mid-pandemic the World Health
These three actions were notable
discussions about key health issues Risks to the health workforce Organization and the International
for their absence in Aotearoa New
and voting decisions in both the have been made very clear by the Council of Nurses released the
Zealand during the pandemic.
2020 general election and the two COVID-19 pandemic. The 2020 State of the World’s Nursing 2020:
referendums. In the International general election is a way for nurses, Investing in Education, Jobs and
Year of the Nurse and Midwife 2020, midwives, health care assistants, Leadership report. Among the 10
NZNO’s key questions are: kaimahi hauora and all NZNO key actions specified (pp. xix-xxi),
members to use their voice to three require particular focus in
• What supports the health sector’s
advocate for change. They can do Aotearoa New Zealand:
recovery from the COVID-19
this based on the health and work-
pandemic?
2 3
About NZNO “Nurse education and
What will reduce the harms of inequitable NZNO is the largest health training programmes must
graduate nurses who drive
access to health care in Aotearoa New Zealand? workforce voice in Aotearoa New
Zealand, with more than 52,000 progress in primary health
voting members. NZNO embraces care and universal health
te Tiriti o Waitangi and contributes coverage; Planners and
How to read this Manifesto to improving the health outcomes regulators should optimise
“We cannot expect better
of all who live here by influencing
The information in this Manifesto is outcomes by maintaining the contributions of nursing
health, employment, education and
presented using five themes: Health the status quo.” social policy development. NZNO
practice and collaboration
workforce; Health funding models; aims to represent the main issues is key.”
Achieving health equity; Health and concerns of its members as the
determinants; and Health-related 2020 election approaches.
referendums. All are interconnected
and important. We cannot expect
better outcomes by maintaining the
status quo.
4 5
Health workforce Nurses and other health
workers have concerns for
the safety of themselves,
their ‘bubble’ members
and their patients. They
also have concerns for
the wellbeing of their
profession.
“The pandemic has exposed Education
What areas need specific attention to ensure significant workforce Education, both before and after
vulnerabilities which are
the wellbeing of the health workforce and what registration, is fundamental to
particularly acute in the transforming health service delivery
could be done?
Māori and Pasifika health in Aotearoa New Zealand. It’s also
workforce.” essential to building an autonomous
and resilient workforce with the
Nurses and other health workers Safe work environment skills and values to provide the best
workforce are predicted to become
faced the COVID-19 pandemic in care for all people.
Prioritising a safe work environment further embedded given that it is
an already fatigued state. Some
and sustainable workforce an ageing workforce and highly
are now experiencing exhaustion
(particularly in aged and dementia dependent on migrant nurses
Enabling potential
as a result of their ‘essential
care, mental health and primary whose availability is being impacted Improving equal access to services
worker’ status during the pandemic
care settings) is of paramount by pandemic border restrictions. will require enabling the potential of:
response and the associated
importance. This is especially true, Health workers are further • nurse practitioners
concerns for the safety of
as the national pandemic response compromised by levels of violence
themselves, their ‘bubble’ members • registered nurse prescribers
moves to a primary care focused and aggression in their places of
and their patients. in primary health and specialty
contact tracing and management work (NZNO, 2019). teams
response. Shortages in the health
• community nurse prescribers.
6 7
This enabling will require recognition “Prioritising a safe work Workforce vulnerabilities programmes in the Institutes
and commitment of the resources environment and sustainable of Technology and Polytechnics
The pandemic has exposed and
needed to recruit, educate, employ, and wānanga risks diminishing
workforce, as the national exacerbated significant workforce
remunerate and retain health recruitment to a diverse health
pandemic response moves vulnerabilities which are particularly
professionals who have access workforce. This is especially so in
to the necessary resources for
to a primary care focused acute in the Māori and Pasifika
the regions and this risk must be
themselves and their patients. contact tracing and health workforce where an enduring
actively managed.
management response, is of commitment to sustainability and
equity is needed.
Professional development paramount importance.” Graduates
Continuing professional Investment Health graduates are more likely
development of the health implement infectious disease to remain in regions on graduation
The 2020 Budget invests $1.6
workforce must: contact tracing if their experiences as students
billion in trades training in ‘critical
• include ongoing development support their professional
• improve access to health care, industries’ to support rebuilding
of understanding of te Tiriti o resilience and aspirations, and
particularly in underserved and infrastructure. NZNO advocates
Waitangi and anti-racism and non-government organisations are
rural communities for similar funding to support the
cultural competence training funded to employ health graduates.
• retain the ‘surge’ workforce rebuild of social infrastructure. The
• realise the potential for which made itself available during Review of Vocational Education
technology to, for example, the pandemic. to health related education
8 9
Health funding models The COVID-19 pandemic has made it
abundantly clear that the way we fund
health must change to address more
than a decade of neglect. Recent high
level inquiries have also revealed this and
it is clear that current business models
are unfair and inequitable to both health
professionals and health consumers –
particularly for Māori.
Proposals from NZNO’s alternative model
of health funding appear in the Health and
Disability Review report and are achievable.
• Rejuvenation of public health An alternative model
units and the national close
What’s wrong with current funding contact service.
The NZNO Strategy for Nursing
models and what needs to change? • Stage one of the WAI 2575 Health
(2018) proposes an alternative
care model that seeks sustainable
Services and Outcomes Kaupapa
innovation and evaluation, and aligns
Inquiry.
with community need. It embraces
What’s wrong with current Implementation of findings of The current business models whānau ora concepts and better
funding models? recent inquiries are not achievable privilege acute and specialist utilises and funds the breadth of
without significant change to health care over primary care, which is nurses’ skills, including culturally-
The urgent need to change health
funding and delivery models and over-reliant on the private sector appropriate ways of working.
funding so it is more connected,
mechanisms. These inquiries to provide things like oral health. These proposals also feature in the
culturally appropriate, closely
include the: Pandemic management in the recommendations of the HDSR
co-ordinated and achieves care
• Mental Health and Addictions primary care sector has shifted (2020) including:
expectations has been highlighted
Inquiry priorities, which has further • a new health authority – Health
during the COVID-19 pandemic. In
highlighted resourcing shortfalls, New Zealand (HealthNZ)
fact the extent of the erosion of • Health and Disability System
particularly as the contact tracing
investment in population health over Review (HDSR) • a Māori Health Authority (MHA)
system is established.
the last decade was starkly revealed. • Oranga Tamariki Inquiry to sit alongside HealthNZ and
the Ministry of Health
10 11
• a reduction in the number of owned aged care sector as well “The NZNO Strategy for
district health boards (DHBs) as the big differences in incomes
Nursing (2018) proposes an
• DHB members appointed rather of DHB and non-DHB employed
alternative care model that
than elected. nurses. There are also discrepancies
in professional development
seeks sustainable innovation
Inequities opportunities and health and safety and evaluation, and aligns
Pay inequity for workers in Māori standards, and few nurse leaders with community need.”
and iwi health providers is a prime control the budgets for which they
example of how the existing funding are responsible.
models create inequitable access
to and delivery of health services.
“Pay inequity...
Specifically, it shows the racist
shows the racist
marginalistion of kaupapa Māori
services despite these services
marginalistion of
looking after those with the kaupapa Māori services
greatest needs. Other examples despite these services
of inequity include the health care looking after those with
workers in the largely privately the greatest needs.”
12 13
Achieving health equity Inequities are everywhere
within our current health
system, particularly
but not exclusively for
Māori. Redesigning the
primary health care
system and adopting an
equity focus will improve
health services and
make providers more
accountable.
tangata whenua with the articles “The Waitangi Tribunal
of te Tiriti o Waitangi: Tino Hauora Inquiry report
What sorts of health inequities exist in Rangatiratanga; Partnership; Active
presents compelling
Aotearoa New Zealand and what could be Protection; Options; and Equity.
evidence of funding
done?
NZNO supports this report inequities, institutional
and asserts that reinstating racism and structural
tino rangatiratanga and mana barriers that negatively
‘Equity recognises different people inequities, institutional racism and Māori motuhake is fundamental
with different levels of advantage structural barriers that negatively
impact the ability of
for addressing the systemic
require different approaches and impact the ability of whānau, whānau, hapū and iwi
dispossession that hinders tangata
resources to get equitable health hapū and iwi to access health and whenua from looking after
to access health and
outcomes.’ (MOH, 2019) wellbeing services in Aotearoa themselves on their own terms. wellbeing services...”
New Zealand.
The Waitangi Tribunal
The report’s recommendations
Hauora Inquiry report
include replacing the principles of
The Waitangi Tribunal Hauora the Treaty of Waitangi – Partnership,
Inquiry report (2019) presents Protection and Participation – as
compelling evidence of funding the basis for engagement with
14 15
The primary health care as mental health and rheumatic
system completely redefined fever which burden Māori and
Pasifika communities at a much
The Waitangi Tribunal
greater rate.
recommendation, which is
acknowledged by the HDSR Other groups needing advocacy to
(2020), will completely redesign achieve equity of access to health
Aotearoa New Zealand’s primary care include: those living with
health care system to better serve dementia; those living with disability;
Māori. Adopting an equity focus will the LGBTQI (Rainbow) community;
improve health services and make and those living in rural and remote
providers accountable with funding areas.
based on Māori health outcomes.
Doing this will make a difference to
screening rates and treatment
outcomes for non-communicable
diseases such as cancers,
cardiovascular disease and diabetes,
and diseases of disadvantage such
16 17
Determinants of health There is a strong
correlation between
health and things like
housing and profit-driven
diseases. These problems
disproportionately
affect low income
communities and it
makes no sense to try to
improve health outcomes
without addressing the
determinants of health.
Provisions in the 2020 Budget for Profit-driven disease triggered
affordable housing and insulation of by obesity, addiction and poor
How can determinants of health be addressed existing houses will amount to an oral health disproportionately
to improve health outcomes? increased health budget because of affects low-income communities.
the health benefits better housing Children’s oral health is an indicator
achieves. of community health and wellbeing
Housing Contributors to poor housing along with housing affordability
Profit-driven disease and income and benefit levels – all
We’ve known for decades that there Social researchers working in of which complicate the national
is a strong correlation between the the National Science Challenge: Researchers and public health
challenge to address the number of
quality, availability and affordability Building Better Homes Towns and advocates are calling for the
children in Aotearoa New Zealand
of housing and health outcomes. Cities have done a retrospective determinants of health to include
living in poverty.
Recent measures of child poverty analysis of contributing causes the commercial determinants of
identify affordability of housing as of the continuing housing crisis. health because these ‘strategies
and approaches are used by the
“Children’s oral health is
the biggest factor contributing to They conclude the single biggest
private sector to promote products an indicator of community
the poverty of households in which contributor has been progressively
children live (Stats NZ, 2020). diminishing government capital and choices that are detrimental to health and wellbeing
assistance since 1960. health’ (Kickbusch, Allen & Franz, along with housing
2016, p. e895). affordability and income
and benefit levels.”
18 19Health related referendums At this election there
will be two referendums
on matters that have
implications for both our
nursing practice and our
personal lives. NZNO does
not endorse voting either
way on either topic, but
encourages members to
be informed and make
evidence-based voting
decisions.
than six months to live, to request • an age restriction of 20 years and
an assisted death cannabis limited to recreational
What might happen if I vote yes or no, and how • allow medications to achieve an use in private homes and licensed
can I make well-informed choices? assisted death to be administered premises
orally or intravenously and by the • a ban on promotion, marketing
patient themselves, or by a nurse and advertising, and commercial
At this election there will be a ‘Yes’ informed decisions. or doctor, and in a place and at a growers could not also be
or ‘No’ vote on both the End of Life time of the patient’s choosing suppliers or retailers
Choice Act (2019) and the Cannabis End of Life Choice Act • allow nurses and doctors to opt • state control and licensing of
Legislation and Control Bill. It is out of any part of the assisted growing, product form and
If there is a majority ‘Yes’ vote and
notable that this double referendum death process without penalty. potency, and state supply at all
the End of Life Choice Act comes in
involves polarising moral issues points with no online sales or
force in October 2021 it would: Cannabis Legislation and
that have significant professional importing
implications for nursing. Accurate • prohibit nurses and doctors Control Bill
• an overall aim to reduce use and
and unbiased information is critical from starting conversations with
The Cannabis Legislation and harm and the significant inequity
so members can understand the patients about assisted dying
Control Bill will also have a ‘Yes’ or that sees young Māori with
impact of the new legislation on • establish a process for patients
‘No’ vote. It will introduce controls criminal offences rather than
their practice and on their choices who have been diagnosed with
such as: addiction treatment options that
as individuals so they can make a terminal illness, and with less
20 21will become available if cannabis www.referendums.govt.nz/ “It is notable that this
use becomes a health rather than double referendum involves
The website Legalising cannabis
criminal justice issue.
in Aotearoa New Zealand: What polarising moral issues that
As it is still a Bill, the control does the evidence say?, by the have significant professional
measures proposed may change Office of the Prime Minister’s Chief implications for nursing.”
depending on the referendum Science Advisor, also seeks to
outcome. If there is a majority ‘Yes’ provide unbiased information about
vote the Bill will start the select cannabis law reform and what might
committee process. happen if you vote yes or no.
Finding out more www.pmcsa.ac.nz/topics/
cannabis/
The website below will give more
information as the September 19
vote approaches and explains what
a ‘Yes’ and ‘No’ vote may mean in
terms of the End of Life Choice Act
and the Cannabis Legislation and
Control Bill.
22 23Recommended actions
NZNO calls on the next Government workforce that reflects
to do the following. the Aotearoa New Zealand
1. Resource the health sector communities being served
sufficiently to: • to address the significant
• settle all pay equity claims vulnerabilities and inequities
by the health workforce exposed by COVID-19
including for those working • of an ageing population
in Māori and working in whose needs include use
iwi health-based services of new health technologies,
and those in the aged and isolation, co-morbidities
primary care sectors and poverty; and whose
• achieve equitable access vulnerabilities have been
for Māori and Pasifika to all conspicuous during the
health and disability services pandemic and not well-
served by the prevailing
• achieve safe staffing and
business model innovation in primary care communities need.
appropriate skill mix in
the aged residential care • of an ageing health care and presents opportunities
The ability of the health care
sector which was under- workforce for flexibility to address institutional and
professions to respond to the
prepared for the impact of and upskilling structural barriers to care, such
demands of this and similarly
the pandemic on an ageing • for homes, communities and as technology, in this critical
impactful global events, such as
population workplaces to be free from sector.
climate change, will depend on the
• upgrade and maintain violence and abuse and to
4. Fund new, low-cost, age- and willingness of the next Government
equipment stocks including recognise the impact on the
disability-friendly housing at to initiate the recommendations of
PPE, buildings and workforce of fatigue, shift
the levels required to achieve the Health and Disability System
technology solutions. work and unsafe vacancy
housing affordability for families Review by committing resources,
rates.
of those children living in funding, policy and regulation.
2. Use a multi-disciplinary and
3. Fund the immediate expansion poverty.
collaborative planning and
decision-making model led of targeted primary health
COVID-19’s challenges to the health
by nurses to develop and care that delivers ‘place-
sector demonstrate that the status
implement a national plan for based’ (HDSR 2020 p. 100) or
quo can no longer provide what
meeting the urgent need(s): Tier 1 services to high needs
the critically important health
communities. The pandemic
• for a sustainable and more workforce requires to deliver what
has necessitated significant
culturally diverse health
24 25References
Health and Disability System Review. (2020). Health and Disability System Review –
Final Report – Pūrongo Whakamutunga. Wellington: HDSR.
Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health.
Lancet vol:4 e895-6.
Ministry of Health. (2019). Achieving Equity. Retrieved from www.health.govt.nz/
about-ministry/what-we-do/work-programme-2019-20/achieving-equity
New Zealand Nurses Organisation. (2018). Strategy for Nursing. Advancing the health
of the nation. Hei oranga motuhake mō ngā whānau hapū iwi 2018-2023. NZNO:
Wellington.
New Zealand Nurses Organisation. (2019). Position Statement: Violence and
Aggression Towards Nurses. NZNO: Wellington. Website: www.nzno.org.nz/LinkClick.
aspx?fileticket=JpI7UyOnRCw%3d&tabid=109&portalid=0&mid=4918
Paterson, R., Durie, M., Disley, B., Rangihuna, D., Tiatia-Seath, J., & Tualamali’I, J.
(2018). He ara oranga. Report of the Government Inquiry into Mental Health and
Addiction. Retrieved from www.mentalhealth.inquiry.govt.nz/inquiry-report/
Stats NZ (2020). Child poverty statistics: Year ended June 2019.
Retrieved from www.stats.govt.nz/information-releases/child-poverty-statistics-
year-ended-june-2019)
The Salvation Army. (2020). State of the Nation Report. Retrieved from
www.salvationarmy.org.nz/socialpolicy
Waitangi Tribunal Report. (2019). HAUORA Report on stage one of the health services
and outcomes kaupapa inquiry. Retrieved from waitangitribunal.govt.nz/news/
report-on-stage-one-of-health-services-and-outcomes-released/
World Health Organization. (2020). State of the world’s nursing 2020: investing in
education jobs and leadership. World Health Organization: Geneva. Website:
www.who.int/publications-detail/nursing-report-2020
26 27Acknowledgements
In preparing this Manifesto we have consulted NZNO members, and colleges
and sections. Feedback has been provided by many members and the
Enrolled Nurses Section, College of Gerontology Nursing, College of Critical
Care Nurses, Nursing Research Section; the NZNO Board; Te Poari o Te
Rūnanga; the Addressing Violence and Aggression Against Nurses Working
Group; and professional and industrial staff.
We are grateful to all contributors and to members of the NZNO Policy and
Research Team whose work was invaluable in preparing this document.
© 2020 This material is copyright to the New Zealand Nurses Organisation.
ISBN 978-1-98-856016-8
Apart from any fair dealing for the purpose of private study, research,
criticism or review, as permitted under the Copyright Act, no part of this
publication may be reproduced by any process, stored in a retrieval system
or transmitted in any form without the written permission of the Chief
Executive of the New Zealand Nurses Organisation (NZNO), PO Box 2128,
Wellington 6140.
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