Acting for nurses in aged care: NZNO is sometimes accused of focusing too much on the public sector to the detriment of nurses working in aged care.

I WAS recently asked: "What is NZNO doing for the registered nurses (RNs) in the aged-care sector?" The questioner, who worked in aged care, said NZNO seemed to do a lot for caregivers and there was a strong focus on the public sector. The questioner wondered why this was the case. Other questions included: "Why fair pay in the public sector and not for us as well?" "Safe staffing seems to be focused in the public sector. What about those of us who work in aged care?"

The question "What is NZNO doing for us?" is an interesting one. While NZNO employs staff, it is an organisation of its members. Members elect the board of directors and members are the ones who will win safe staffing and pay equity. Staff are able to support members' efforts but cannot do the task alone. Women had to fight for the vote--it was not handed to them on a plate--and it will be the same for nurses with their issues.

Pay equity is not a new issue--women have been fighting for pay equity for more than 40 years. We all know nurses deserve more, that nurses contribute to the health of the nation and that other sectors have forged ahead of nurses in terms of pay and conditions. NZNO's pay equity campaign was initiated in the public sector. The reason NZNO chose to start this campaign in the public sector is because that is where the density of NZNO members is and we are therefore more likely to win it there. The Government also has a policy on pay equity, so it is more likely to be won initially in the public sector. There will be flow-on effects from this into the private sector, in fact we are seeing this already. There are plans for the campaign to cover the private sector, including aged care.

The issues in aged care are two fold: staffing shortages and staff/patient ratios, and some aged-care facilities failing to comply with any staffing standards.

The new health and safety disability standards are now in place and members have lost the ability to enforce minimum staffing levels in relation to registered and enrolled nurses. While the previous legislation was not adequate, there was at least a requirement to have an RN in an aged-care hospital at all times. Under the new standards, this is no longer the case. Broadly interpreted, the new standard means that once a facility has been through the new certification process and is certified, it can employ anyone to do the work. The standard related to staffing is very vague: 4.1.1 Undertaken by suitable qualified/skilled and/or experienced providers who are competent to perform the function. (1)

What does this mean for qualified nurses? Does this mean the facility should be staffed with the number of RNs it has at present, or does it mean that untrained care staff can provide the care? I receive many queries about this and we all know what the answer should be, given the increasing acuity of many patients. But there is no legislation to enforce that.

NZNO at present has two representatives on the Standards New Zealand committee identifying what staffing effectiveness is in aged care. This is important work for our members because it is about being able to work in a safe environment that is conducive to quality care for our patients and families. These two representatives are lobbying for minimum qualified staffing ratios. Every nurse would support the safe staffing numbers if they heard the concerns I hear.

NZNO also has two vocal representatives on the Ministry of Health's Expert Advisory Panel, which has previously done work on appropriate staffing ratios in the aged-care sector. The work of this committee is the basis for the Standards New Zealand work on staffing effectiveness in the sector.

Another major concern for NZNO is that many aged-care Facilities that once provided good, safe working conditions for staff have been sold and large corporations are now involved. The management philosophy is very different to that of the previous employers. Staff are seen as a commodity and an expense, rather than an asset. Everyone is replaceable and any one can do any job just as well as anyone else. I received a complaint recently from a woman whose father was in a facility that had changed ownership. With that change had come a change in philosophy and many of the excellent staff had left, leaving the residents with fewer staff and poor care.

There are many challenges in aged care. For many members there does not seem to be active lobbying at a local level. I can assure those members NZNO has not forgotten the issues or the implications of the current environment for them.

But in saying that, members must report issues and convey concerns to management and to NZNO. These concerns contribute to NZNO's lobbying ability.

Members have to speak up. Members are not alone. NZNO knows the issues and supports our members in providing the quality care we all want for our friends, relatives and ourselves in the not too distant future.

* NZNO's Gerontology Section is holding its annual conference at the Michael Fowler Centre, Wellington on August 27-28. For all conference information contact: www.akaroa.ws/ger/index.htm.

REFERENCE

(1) New Zealand Standard (2001) Health and Disability Standards; NZS 8134:2001 Wellington: Standards New Zealand.