MECA enables nurses to begin rebuilding their profession.

No one can miss the importance of the district health boards' (DHBs) multi-employer collective agreement (MECA) settlement. It is a groundbreaking achievement. (See coverage on p12-17 of this issue.) As well as the substantial pay gains it achieves for nurses and midwives employed by DHBs, it has also changed the basis of pay negotiations from those based on percentage increases and maintenance of relativites, which often perpetuated the gender pay gap, to negotiations based on the worth of an occupation. But probably its greatest significance is in the way it forms a basis on which nurses can begin to rebuild their profession. This may seem an inflated expectation of an industrial settlement but a brief analysis reveals the DHB MECA to be nursing's greatest professional opportunity in a generation.

As nurses, we assume the ability to act as professionals. We accept the duty of care and the responsibility to undertake that duty safely, on the basis that we have the authority to arrange nursing services and provide care according to the principles and standards established by our profession.

However, most nurses find the reality of their daily practice, more often than not, departs markedly from this. Too often the real authority for making fundamental decisions about how nursing care is delivered does not rest with nurses.

Resource efficiency over-riding concern

Resource efficiency became the over-riding concern of Government and public sector managers in the 90s. Cost cutting displaced professional standards and patient care as the preeminent service imperative. Nurses were replaced as managers of nursing services with generic, general managers.

These changes were not only detrimental to nursing but, more significantly, were detrimental to patient safety. One consequence was a reduction in the relative number of nurses employed, so often too few nurses were employed to keep patients safe. Less obvious but just as damaging is the way more and more of the important decisions nurses need to make to ensure standards of care are maintained have been taken out of nurses' hands. At the same time, many senior nursing and professional support positions have been downgraded or cut --considered to be unnecessary overheads.

Erosion of professional authority

Such damaging changes are not easily reversed. A vicious cycle ensues in which the erosion of professional authority and practice standards has co-existed with and is exacerbated by a widespread and chronic nursing shortage. With demand for nurses cut without regard for practice standards, and the supply of nurses choked off by low pay and poor conditions, it has become almost impossible for the nursing profession to respond pro-actively to ongoing decisions to reduce standards of professional practice. Instead of actively managing nursing care to ensure standards are maintained, nurses have become caught up in the need to make the best of limited resources, even when this exposes them and the public to unreasonable risk. The DHB MECA settlement changes all this. It gives nurses the opportunity to turn back the torrent that has eroded our professional foundations, and to take up the authority necessary to ensure nursing care is effective and safe. It does so in three main ways;

1) It attacks the root cause of supply failure, ie artificially low pay.

Pay that reflects nurses' worth is essential to make nursing attractive to school leavers. Without a healthy supply of nurses we will always be a compromising profession. In fact, unless school leavers see nursing as an attractive career option, nursing is a profession without a future.

2) It commits DHBs and the Government to an independent inquiry into staffing.

Nurses believe that staffing arrangements and staffing Levels often do not allow professional standards to be maintained and that patient safety suffers as a result. Now we have the opportunity to present the evidence and make the changes necessary for safe care. Establishment of the conditions for all nurses to give safe and effective care will be the single most important factor to reverse the exodus of experienced nurses from practice.

3) It re-establishes a single employment agreement for DHB nurses and midwives.

A single employment agreement is fundamental to the sense of collectivity and unity of nurses that is one of NZNO's core values. Furthermore, having all DHB nurses on one agreement removes the multiplicity of employment arrangements that have obstructed the mobility of nurses between DHBs. Such mobility is often essential for nurses' professional development.

This settlement has been achieved with very careful planning and sustained and determined action by thousands of NZNO members throughout all DHBs. It will restore real confidence in the ability of nurses to set the agenda for nursing and patient care, instead of reacting to the agendas set by others.

NZNO strategy is now to build on the potential this settlement gives the profession to establish Legitimate authority for all nursing decisions in the DHB sector, and to roll out the basic elements of the settlement to nurses in the primary health care, aged care and private health sectors. This roll out will be campaign-based and carefully planned, engaging our members and the public in ways that respond to the unique natures of each of these sectors. Planning is already underway.

I have no doubt we will be successful in reestablishing nursing as a profession that determines its own future--because the 37,000 nurses, midwives and caregivers who are the members of NZNO have decided that it is how it should be.

Geoff Annals-- ... a brief analysis reveals the DHB MECA to be nursing's greatest professional opportunity in a generation.'