Fiji nurses prepare for their own fair pay campaign: improving nurses' pay and conditions is the key to stopping the migration of nurses from Fiji to countries abroad. NZNO is willing to do what it can to help.

Low pay and poor working conditions are driving Fiji's experienced nurses out of the country for better career prospects in Australia, New Zealand and further afield. Unless their appallingly low pay levels are addressed, nurses will continue to leave, taking with them their country's investment in their skills, training and experience.

So warned vice-president of the Fiji Nursing Association (FNA), Miriama Leweniqila, when she met NZNO organising services manager Laila Harre and communications adviser Lyndy McIntyre in February. Harre and McIntyre had been invited to spend a week with FNA leaders and members to explore ways NZNO could support the FNA's struggle to improve members' pay and conditions and stop the flow of nurses out of their home country.

Leweniqila, a nurse with 114 years' experience, is now a nursing tutor at the Fiji School of Medicine. In research in 1999, she sought to establish the key reasons for nurses leaving Fiji to work in other countries. Eighty percent of the nurses who participated in the research identified "low salary" as the most important issue facing Fiji nurses, with poor work conditions a dose second. Those leaving the country were found to be from two key groups--older, more experienced nurses and those with six to ten years of experience, the "young, enthusiastic, productive and ambitious nurses who have the potential for further studies", said Leweniqila. Her report recommended an urgent review of salaries to stem the flow of nurses from the country.

A report on the 2004 Asia Pacific Nursing Congress identified that nurses in Fiji were leaving the health system faster than they could be replaced. (1) Around 120 to 150 nurses graduate in Fiji annually, but nearly half are lost to external migration. In the last five years, the number of nurses either resigning or moving overseas has exceeded the number of graduates. This is not only devastating for the economy, it is having a detrimental affect on the remaining nurses.

Registered nurse Paulini Narawa works in the acute surgical ward at Suva's Colonial War Memorial Hospital (CWM). Narawa earns $13,900 [the Fiji dollar is similar to the New Zealand dollar] and is in her tenth year of nursing. Koila Gavidi is a registered nurse in intensive care at CWM. She graduated in 1999 and, as an Indo-Fijian, is in a minority. Around 70 percent of Fiji's nurses are indigenous Fijians. Gavidi earns $13,118 after six years in intensive care.

Both are typical of younger but experienced nurses who are leaving Fiji for better pay and conditions. Narawa says some of her workmates are waiting to go and when they do, current nursing shortages will be worse. "At the moment we've had recruiters from the Emirates coming to Fiji to do interviews," she said.

Many of her friends are leaving for New Zealand, Australia, the United Arab Emirates, the Marshall Islands and Palau for vastly higher salaries, a move that puts the health of the Fiji population at risk and strips the FNA of members. "At the moment we want to fight for fair pay. If we had better pay, nobody would be leaving," said Narawa.

Midwife Apenisa Waqanivalu agrees. A recently appointed sister in charge of nine midwives, 12 staff nurses and a range of students in a busy labour ward, Waqanivalu has 24 years' nursing experience. "With my expertise and training I am worth a better pay," he said. In 2001, Waqanivalu spent a year in Lebanon with a peacekeeping force to supplement his family's income. He is the family breadwinner and has four children. "It was too long to be away from my family and really hard on my wife," he said. In the year in war-torn Lebanon, he managed to save $8000, an amount he could never dream of on his current $15,000 salary.

Health and safety is also an issue, with staff shortages, increasing workloads and long work hours stretching Fiji's nursing workforce, he says. The number of nurses for every 100,000 people in Fiji is 19.6, compared to 81.5 in New Zealand. (2) Fiji's population is around 800,000 across over 100 inhabited islands.

Although FNA members agree the main reason for leaving is money, frustration at continual lack of equipment and resources is another factor. lack of vital supplies is a fact of daily life. "Syringes, lines, drugs--the basic things we need every day are out of stock," one member said.

The FNA represents over 80 percent of Fiji's employed nurses, medical orderlies and trainee nurses--around 1355 members. FNA's general secretary and sole industrial staff member, Kuini Lutua, has a huge job representing the interests of FNA members across Fiji's many islands and the vast range of issues facing nurses.

In her three years as general secretary, Lutua has worked tirelessly to address the pay issues and build FNA's membership. Although she has had success with the latter, fixing the pay problem is a mammoth task.

Although not a nurse, Lutua brings extensive financial acumen from her background as a bank worker and an array of negotiation skills and union principles from years of experience and training as a union delegate. She is a strong advocate for Fiji nurses.

Not only are Fiji's nurses poorly paid, she says, but the union has to deal with a raft of associated pay problems. The FNA is pursuing years of arrears of unpaid "merit payments", affecting hundreds of members. There is currently no process in place for progressing through the "pay scale", and new graduates are stuck on the entry level of $11,000. This compares to starting salaries of around $13,000 for similar professions such as teaching, paramedics and graduates employed by the Fiji Ministry of Health. There are no extra payments for weekend, night shifts and work on public holidays. In recent years, FNA members have relied on regular, negotiated cost of living increases. The FNA negotiates members' salaries with the Fiji Public Service Commission. However, partly due to Fiji's volatile political situation, recent cost of living increases have been small or non existent. The Fiji Government has stated that the cost of living adjustment payment will now be replaced by a performance management system (PMS) payout, which, Lutua says, would totally depend on how much the government was willing to set aside for this process.

Last year, the commission ordered an external review of salary levels. This found nursing pay rates were up to 8.6 percent lower than other state sector professions. This scenario is not dissimilar to the situation for nurses in New Zealand, which lead to our successful Fair Pay Campaign in district health boards.

In negotiations last year, the FNA claimed a fair cost of living increase and a job evaluation adjustment for its members. Despite the job evaluation recommendation and the lack of pay increases over the past three years, the commission rejected the FNA's pay claim. The FNA will now take the commission to an arbitration hearing in May, seeking a fair cost of living increase, the delivery of the job evaluation recommendations and a transparent pay scale.

Despite all the evidence supporting the need for fair pay, including the migration issues and the myriad of issues around nurses' pay, the commission is determined to abandon cost of living increases in favour of the PMS as the sole determinant of pay increases in the public sector. The FNA has consistently opposed performance pay, which, it says, goes against the Fijian culture, which is collective by nature. "Not only is it wrong to pit our members against each other, it is not consistent with our culture to oppose authority," said Lutua.

Leweniqila agrees: "Culturally, the people of Fiji are not those who will blow their own trumpets. If a manager argues a point, they will not want to disagree."

Waqanivalu also regards a performance management system as a threat to workers. "One of the main reasons for introducing performance pay is to undermine the role of unions," he said.

Lutua has no doubt that pay is the single major issue facing FNA members. She rejects the government position that there is not enough money. She says it's time the government realised that nurses need to be treated fairly. She points out that the government has plenty of money for highly paid civil servants. "The government should look for the money and pay nurses because they are the ones doing the hard work and not the bosses."

Fiji's director of nursing services in the Ministry of Health, Rigieta Nadakuitavuki, agrees that it is vitally important to retain nurses after they complete their training by ensuring they have fair wages and conditions. Nadakuitavuki graduated in 1968, and brings many years of experience in theatre, intensive care and cardiac thoracic care in London. She has also been principal of the Fiji Nursing School. "Nurses must be recognised as a vital component of the health of this country', she said. "To train nurses and to retain their skills is very important."

Nadakuitavuki acknowledges the importance of paying nurses "their due as professionals" and says the solution to migration lies in recognising nurses' worth through pay and working conditions, including an acknowledgment of hours of work such as weekend and public holiday work.

During their week in Fiji from February 28 to March 4, Harre and McIntyre met FNA members and leaders, and discussed organising effective industrial campaigns. Harre also provided advice on interpreting recent Fiji industrial taw, including analysis of the new Industrial Relations Bill. The key meeting saw 50 FNA members braving torrential rain to cram into the FNA meeting room to discuss pay equity and the NZNO Fair Pay Campaign. "The stories members told reconfirmed over and over again that Fiji nurses have waited long enough for fair pay and are ready for action," said Harre. "They want to contribute to their country but they also want acknowledgement for the work they do. They know they must raise the visibility of the issues and seek support from the wider population."

Nurses agreed a legal bid to achieve a fair pay settlement with the Public Service Commission must be backed up with a membership campaign demonstrating strong public support. FNA members are confident of public backing. On International Women's Day, March 8, members launched a fair pay campaign at a market day in Suva. To highlight their pay issues, they wore the distinctive fair pay T-shirts used in NZNO's campaign and distributed fair pay stickers to the public. "People were happy to wear the stickers and many came for more for their friends," said Lutua. Later that night, FNA members were visible again in fair pay T-shirts at a Women Reclaim the Night march organised by the Fiji Women's Crisis Centre.

Following the launch, the Suva branch of FNA formed a pay equity campaign committee. For the under-resourced FNA, winning fair pay for members is an enormous goal, requiring huge commitment from members to achieve success. "Our union leaders need to be committed. We need strong branches and strong delegates and leaders, and we need to empower them to be active in the campaign," said Lutua. "We just need to stick together."

Lutua says FNA has a proactive role to play in keeping nurses in Fiji by urgently addressing salary issues. She believes if New Zealand nurses can achieve a fair pay settlement, then so can Fiji nurses. The future of nursing in Fiji depends on it.

NZNO will continue to support the FNA in whatever way the association chooses. This may include analysing documents, offering ongoing campaign advice and assistance with the upcoming arbitration court case with the Public Service Commission.

References

(1) Armstrong, F. (2004) Walking away: leaving home and leaving nursing. Australian Nursing Journal; 12:6, 18-19.

(2) World Health Organisation (2004) Western Pacific Health Report on Manpower, Geneva: WHO.