A snapshot of Maori nurses' health and safety issues: a unique research study by a doctoral student has provided a fascinating snapshot of Maori nurses, their job satisfaction, their health and safety issues and their work life balance.

Maori nurses in Maori workplaces are cuturally well supported, though clinically not as well supported. Maori nurses in mainstream organisations are clinically well supported but not so well culturally supported. This is a key finding from a research study on the nature of Maori nurses' work and the Likely impact of that work on their health, safety and well being.

The study of 100 Maori nurses revealed their top three health and safety concerns as the acute or chronic effects of stress and overwork (95 percent); a disabling back injury (27 percent); and an on-the-job assault (25 percent).

The 100 Maori nurses who participated in the study were randomly sampled from the general and Maori electoral rolls. There were 40 participants from a semi-rural area (Manawatu-Wanganui-Palmerston North) and 60 from an urban area (Waikato-Hamilton). Nurses were recruited through both face-to-face contact and telephone contact.

The pilot study, Workplace Safety for Maori Nurses, was funded by Massey Univesity. It was an extension of an earlier collaborative study between Massey University's Te Pumanawa Hauora and Otago University's National Environment and Occupational Health Research Centre. This study, The New Zealand Working Life Study, funded by the Health Research Council for 18 months, was designed to find out how work affects thehealth, safety and well-being of New Zealnd workers and also to identify which occupations had the highest exposure to workplace hazards. The study was in two parts: a 50 percent New Zealand sample, including Maori conducted by the Otago researchers; and a 50 percent Maori sample, conducted by the Nassey researchers. The New Zealand sample revealed cleaners and administrators had the worst exposure to workplace hazards, while the Maori sample revealed health professionals had the highest exposure. The researchers then decided there needed to be a post-pilot study, focusing on the specific occupational groups. My research focused on Maori nurses, as the largest occupational group in the Maori health workforce.

Of the 100 participants, 39 nurses had a bachelor of nursing (BM) qualification; 22 had a diploma of comprehensive nursing; and 16 were registered general and obstetric nurses (RGONs). In total, there were 77 registered nurses (RNs), 19 enrolled nurses (ENs) and four registered psychiatric nurses (RPNs). Interestingly, of the 39 nurses who had a BN, seven had been comprehensive nurses; eight had been ENs, four had been RGONs and one had been a RPN. Of the participants, 39 nurses had 25 years' or more nursing experience and 71 nurses had more than 10 years' nursing experience.

Workplace settings

The nurses' workplaces varied: 32 nurses worked in an acute hospital setting; 14 worked in a community/GP clinic; 14 worked in a long-term care facility; 12 worked in a psychiatric facility and seven worked in a Maori placement. The remainder worked in a range of practice settings, including district/community nursing, education, private practice, non-governmental organisations; the army and NZNO. Forty percent of the nurses were managers or supervisors and 75 nurses worked full-time hours. For managers, supervisors and those in senior positions, working hours ranged anywhere between 40 to 60 hours per week. Fifty nurses spent between 75 to 100 percent of their working hours in direct patient care. They also tended to work a 40-hour working week, though 33 nurses worked paid extra hours ranging from one to 20 hours per week. Thirty nine nurses had individual contracts, 82 nurses were members of a trade union and 75 were members of NZNO. Over 50 percent had an income of between $40,001 and $70,000, though a significant number earned less than $40,000. Overall, 50 nurses worked unpaid overtime and thus had greater exposure to workplace hazards.

Health and safety concerns

Questioned about health and safety in the workplace, 31 nurses said their workplace was very safe; 58 said it was moderately safe; and 11 nurses said their workplace was "not safe at all." When asked to identify the top three health and safety concerns, 95 nurses said the acute/chronic effects of stress and overwork; 27 said a disabling back injury; 25 an on-the-job assault; 17 a needle stick injury; 16 infection; and four said having a Latex allergy. Other hazards identified were a fatigue-related accident (10), toxic effects from exposure to chemicals, including adverse reproductive effects (6), and exposure to smoke (2).

Another dimension measured was relationships with fellow nurses, supervisors and/or superiors. These relationships appeared significant in relation to how supported nurses felt at work, and were also related to job satisfaction and job security. Eighty one nurses reported they were satisfied in their job, while 15 nurses were dissatisfied with their jobs.

Eighty two nurses had recently or were currently involved in either academic or clinically-focused studies to support their current practice. This was another feature of job satisfaction, but studying and working at the same time was an added stress.

Many nurses commented on the "work and family conflict" part of the questionnaire. This Looked at the effect of work demands on family and the effect of family demands on work. Fifty nurses said their work affected their home and family Life. Of the other 50, some had Learnt to block out what was going on at home, and the rest were working on finding a balance between the two.

Ninety three of the nurses were female and the average age was 46, with 95 percent of the nurses aged between 36 and 56 years.

Twenty five nurses smoked. Significantly, a good proportion of the non-smokers had been smokers who had given up. Sixty eight nurses were drinkers and the majority were social drinkers. In relation to exercise, 98 nurses engaged in walking or some form of exercise. In the last year, 34 nurses had taken time off work with work-related illness and 23 nurses had been injured at work. Of those 23, 19 had reported the injury and the other four said the injury wasn't significant enough to report.

Cultural safety an the workplace

A unique dimension measured was cultural safety in the workplace. Culturally unsafe behaviour included physical or verbal abuse and discrimination. Seventeen nurses said they had experienced verbal abuse from workmates and some named this "horizontal violence." Physical and verbal abuse was not only related to cultural safety but also related to workplace culture. Forty seven nurses said they were more aware of client physical violence and 82 nurses said they were more aware of client verbal abuse within the workplace and discussed the impact of this awareness on their workplace practices. In some workplaces posters on the wall stated that verbal and physical abuse would not be tolerated. Seventy seven nurses were aware of intimidation in the workplace; 37 nurses were aware of sexual discrimination; and 61 nurses said they were aware of ethnic discrimination, which some named "racism" Awareness meant they had not necessarily experienced discrimination but were aware of staff who had and of practices they called discriminatory.

Nurses indicated that unsafe working conditions affected the quality of patient care and that workplace safety was a significant determinant in the kind of nursing work chosen and whether they continued in nursing practice. A preliminary report has been disseminated to all the study participants, national Maori nursing groups, other national nursing groups and and other interested parties. I have been privileged to talk with these Maori nurses about their work in order to:

* Describe the distribution of occupational exposures and hazards.

* Investigate the associations between exposure to hazards and adverse health outcomes.

No futher data is available at present. There will be some further analysis, with the intention of completing an application to the Health Research Council for funding to recruit and survey another 300 Maori nurses to ascertain a national Maori nursing picture.

A PASSION FOR NURSING AND FOR NURSING EDUCATION

Victoria Simon has always been passionate about education. Her parents were teachers and instilled in their daughter the value of education. She took the advice seriously and, after a career in nursing and education, she is now a research officer and PhD student at Massey University.

In 1987 she began her nursing education at the then Waikato Polytechnic. After finishing, she worked at Waikato Hospital on its intern programme and began some university papers. In 1991 she moved to Auckland to begin a degree in anthropology and Maori, doing agency nursing at nights. It was a gruelling schedule. "I was a student from Monday to Friday during the day; I was a registered nurse at nights; and at weekends I was an army nursing officer."

As a nursing student, she had begun her infantry training and subsequently did her officer training and was in the New Zealand Army Medical Unit. She remains in the army reserve. After completing her degree, she embarked on her "OE", visiting and working in 37 countries. When in England, the New Zealand Army sent her to Chester in England to undertake nuclear, biological and chemical training. She also met a British Army sergeant major who was to be come her husband.

After her hectic year away she returned to Hamilton and applied for a job at her former hospital She challenged a question from the interviewing panel about how she would implement the Treaty of Waitangi in her practice. "I'd completed a degree and Ranganui Walker, Pat Hohepa, Sir Hugh Kawharu and Anne Salmond, among others, were my tutors, so I asked those interviewing me how they implemented the Treaty in their practice. One of the charge nurses on the interview panel said she wouldn't have me on her ward."

Such matters notwithstanding, Simon got the job and worked in a variety of clinical settings including intensive care. In 1994 she gave birth to a son and a comment from a young nurse propelled her into nursing education. "She said she'd done cultural safety and I was a Maori and she knew how to look after me. I didn't take offence but I realised that the place to change nursing was in education."

So in 1995 Simon began her nursing education career at her alma mater, now the Waikato Institute of Technology (WINTEC). Of Ngati Hikairo, Ngati Tuwharetoa, Ngati Manawa and Ngati Porou descent, she worked primarily in the Tihei Mauri Ora programme, her last year as programme leader. She co-developed a number of post-graduate Maori nursing papers. In February 2003 she took 18 months' leave from WINTEC to join Massey University's PhD programme looking at workplace safety, and began the research which resulted in the research study on Maori nurses' health and safety concerns. In July this year, she decided to leave WINTEC and complete her doctoral studies. Since completing the pilot study of 100 Maori nurses, Simon now wants to do further research with an additional 300 Maori nurses. "For prevalence indicators you need a minimum of 400 participants to make international comparisons with other nurses. But I won't be able to make comparisons with other indigenous nurses internationally, as the research just doesn't exist. Ours is a unique research study."

Simon is applying for Health Research Council funding to complete the larger study, which will constitute the data collection for her PhD, which she hopes to have completed in 2006. She is unsure where her career will lead then but it is bound to remain in education. "Education is so fundamental. If you can instill in students a passion for nursing, they will take that with them whatever practice setting they work in."

* This report was originally written to disseminate some early descriptive information to nurses interested in the Workplace Safety for Maori Nurses Study. No reira, me mihi ki a koutou.

I would also like to acknowledge my PhD supervisors, co-directors of Massey University's Research Centre for Maori Health and Development, Professor Chris Cunningham and Dr Maureen Holdaway.

Victoria Simon RN, MSocSci, is a research officer and doctoral student at Massey University's Research Centre for Maori Health and Development, part of the university's School of Maori. Previously, she was a principal academic staff member and nursing tutor at Waikato Institute of Technology.