Planning for an influenza pandemic: NZNO has started planning for an influenza pandemic. It is a huge task.

Nurses will face particular challenges during any influenza pandemic. One of NZNO's major tasks is to ensure its members are informed of their legal, ethical, professional and industrial rights and responsibilities in a pandemic and thus able to meet the challenges a pandemic will present. To achieve this, NZNO has established a pandemic project team, which has been working on pandemic planning activities since last October.

"NZNO is taking pandemic planning seriously. It is a major project within the organisation with a considerable workload," pandemic planning project leader, professional nursing adviser Suzanne Rolls said.

She points out that during the 1918 influenza pandemic in New Zealand, more nurses died than any other professional group because of their close proximity to infected patients and the increased exposure to the virus.

There are three streams of pandemic planning. The first is with the Government through the Ministry of Health's pandemic influenza reference committee (PIRC), of which Rolls is a member. The role of PIRC is to monitor and advise, and ensure national consistency in pandemic planning across the district health board, nongovernmental and primary health sectors.

Protecting heath workers

The second stream of NZNO pandemic planning is planning within the organisation, and the third is responding to governmental initiatives such as the Law Reform Bill for Epidemic Preparedness. NZNO has presented an oral submission on the Bill. Chief executive Geoff Annals told the Select Committee considering the Bill that proposals it contained aimed at preparing for an epidemic may expose health professionals to even greater risk. Protecting health workers was critical and NZNO said the best way to protect the health workforce was to include a clause in the proposed Legislation stating that nothing in the Act would override the Health and Safety in Employment Act.

Annals told the Select Committee that there were already significant shortages of registered nurses (RNs) and questioned whether there were enough health workers to respond during an epidemic and whether infection control procedures were nationally consistent.

NZNO has also developed a submission on the Ministry's New Zealand Influenza Pandemic Action Plan, Version 15. It asked for more specific guidance on ethical issues in pandemic planning, based on scenarios and specific ethical dilemmas health professionals will face. NZNO offered to assist the Ministry to develop guidelines and an education package for RNs to enable them to sign death certificates in a pandemic.

Continuing operation

The major focus of the pandemic planning work now is NZNO's internal planning. "We are planning how NZNO will continue to operate during a pandemic," Rolls said. "Geoff Annals has said that staff will not be put at risk, so we have to work out ways to continue operating without doing that."

In formulating its draft plan, NZNO is using the Ministry's planning codes, ie the white phase is the planning stage; the yellow phase is when the pandemic is developing; the red phase is when the pandemic is at its peak; and the green phase is the post-pandemic recovery phase. "We will be busiest in the white, yellow and green phases," Rolls said. She hopes NZNO's draft plan will be completed within the next two months. Planning had to consider personal, professional and community angles, she said.

NZNO would try to maintain services to members for as long as possible, with virtual offices as the primary way of doing so. "We had to determine our core business during a pandemic. A lot of our work will be handled by phone and one of the significant ways of doing this will be through 'calling kits' which will be developed for staff. These will contain answers to questions members will be asking, as well as information and education on members' rights and responsibilities," Rolls said. "We are also asking members to tell us the questions they have and the issues they are talking about."

Issues emerging for members during this planning phase include whether there will be enough personal protective equipment available; continuation of pay during a pandemic; the expectations on health professionals; nurses' duty of care; and the fact that nurses are predominantly female and are also the primary caregivers of children and/or parents.

"Nurses will be the main working resource in a pandemic. Their ability to continue to work will depend on multiple factors--their own, their families' and their communities' health or illness," she said.

One of the most significant documents NZNO will develop will be a position statement on nurses' duty of care during a pandemic. This document will have input from NZNO's professional, industrial and legal staff and Rolls hopes a draft will be ready within the next two months. The pandemic recovery phase would also be a hectic time for NZNO, as the organisation would have to undertake a membership and financial stocktake and consider staffing and staff rotes in the aftermath of the pandemic, Rolls said. NZNO has developed a website page which contains its pandemic planning resources, national planning documents and has links to the Ministry of Health, Department of Labour and Ministry of Social Development. It will be updated as new information comes to hand. The site is: http://www.nzno.org.nz/Site/Resources/Pandemic_Preparedness.aspx.

NZNO members involved in national pandemic planning include infection control division members Viv McKennis, who is on PIRC; and Julianne Toop, who is on the Ministry' pandemic influenza technical advisory group; chair of the college of practice nurses Rosemary Minto, who is on the Ministry's primary health planning committee; and Wellington practice nurse Cathy Mitchell, who is working with the Ministry on community-based assessment centres.

NZNO is encouraging members to Look at the plans in their workplaces and be part of the discussions and ongoing testing of those plans. Pandemic consulation is continuing and members are encouraged to give feedback on documents, which will be posted on NZNO's website. NZNO is currently working with the Ministry on ethics in pandemic planning and post-pandemic recovery for health care workers.