As the nurses' strike goes down to the wire, a staff survey reveals key concerns

by Charlotte Graham-McLay / 29 June, 2018

Nurses at Wellington Hospital say stress and anxiety often lead to absences - and unsafe staffing levels. File photo / Getty Images

There’s been heated discussion of fair pay for nurses ahead of looming strike action that looks likely across the country next week, after nurses rejected an offer from their DHB employers. But less attention has been given to nurses’ calls for so-called “safe” staffing, which some say is more important to them than money.

At Wellington Hospital, nurses say discontent in their ranks is “the highest it’s ever been,” a year on from a staff engagement survey that said staffing levels and stress were two of the problems they most wanted their employer to tackle. Charlotte Graham-McLay took the temperature of nurses in the capital.

“I used to feel passionate about nursing - it's who I am,” wrote one respondent to a staff engagement survey distributed by Capital & Coast District Health Board just over a year ago.

“But now I feel sick in my stomach and have a feeling of dread hours before the next shift starts … Most days I dread coming to work. What new calamity will today bring?”

It’s a feeling that several nurses NOTED spoke to at Wellington Hospital found all too familiar.

“A lot of the sick calls I’m covering are due to stress and anxiety,” said a nurse who works casual shifts at the capital’s main hospital. After eight years, she personally knows most of the people she’s covering for, she said, and the uptick in nurses struggling with work-related anxiety and burnout has been “massive, in the past year alone.”

NOTED has agreed not to name the nurses we spoke to, as they are all current Wellington Hospital staff. All had stories to share of the stress their nursing peers were under.

“There are three nurses on my unit who regularly call in to check on patients after their shift has finished,” said one nurse, adding that the practice of “care rationing,” where staff were forced to prioritise which aspects of care a patient received due to time constraints, meant staff left work worried they had made a wrong decision.

While care rationing isn’t a new practice in hospitals, or unique to Wellington, nurses reported they often clocked off feeling “awful” and “guilty” about calls they had made, and it might take hours to fall asleep. That led some to miss work the next day.

“Things get forgotten or late. There are lots of near-misses,” one nurse said. “Sometimes you get home and feel like no patient got what they deserved.”

Others complained that once nurses had worked at the hospital for a certain period of time, they were rostered to supervise shifts in their units, often for no extra money, and with no special training for managing more than a dozen staff and two dozen patients - including those who were unconscious or had high needs.

“It wouldn’t happen if you worked in a cafe,” she said, of supervising colleagues for no added pay.

A revealing staff survey

It’s something their employer, Capital & Coast District Health Board, is well aware of. Between March and April last year, CCDHB - the body responsible for Wellington Hospital and healthcare providers in the region, including Kenepuru - carried out its first-ever survey that focused solely on staff engagement. A 103-page report analysing the results was released to NOTED under the Official Information Act.

While the DHB highlighted some pleasing results - just over half of all staff (nearly 3,000 people) took the survey, almost 70% of respondents felt positively engaged with their employer, and just over 80% planned to stay another year - other figures were concerning.

More than half of all nursing and midwifery staff at the DHB reported they felt under too much pressure, were emotionally drained, and had witnessed or experienced what the DHB called “unwarranted behaviour,” like bullying. More than 35% of staff said their workplace was not safe and supportive. Asked for the one thing that could be changed to make the DHB a better place to work, the most common response from workers was “more staff.”

“It is not acceptable that our staff are feeling unsafe and unsupported at work,” the DHB wrote in its report, pledging that staffing, stress, and reducing unwarranted conduct would be priorities.

A year on, how do nurses think the DHB has measured up? Some NOTED spoke to said there had been small wins; one said in the past month she had had managers recommend - for the first time in her five years working there - that she claim for the overtime she does daily.

Previously it was suggested by managers that those doing overtime “weren’t organising our time well enough.” Her comments were echoed by several other nurses.

CCDHB starts programmes to support staff

The Capital and Coast District Health Board said, in an emailed statement, that it had launched a three-year Supporting Safety Culture programme to address the concerns staff raised in the 2017 engagement survey.

The first plank of that, an initiative called Speaking Up For Safety, encourages staff to make safety concerns known, and aims to create a culture where they’re supported for doing so. It was launched last month, and will be followed later this year by a wellbeing initiative, and another programme to thank and appreciate staff.

The DHB is also using modelling to predict future staffing needs.

Nurses welcomed the DHB’s attempts to change the culture, although they worried it would be too little, too late, and if the safety programmes didn’t result in a bottom line of “more nurses” and soon, most weren’t interested.

“I know two nurses who have resigned recently to go and work in Australia, where they will get slightly more money,” one Wellington nurse told NOTED.

“Someone else I know went to work for a drug company; she makes twice as much as me.”

The nurse said she loved her job and was proud of her ability to perform under pressure. Her concerns weren’t primarily about money.

“I would forgo a pay rise if we could just get more nurses,” she said.

“Nurses are people-pleasers,” said another. “All they want is a little bit of recognition, and they will work so long and so hard.”

Last-ditch effort to avoid strike action

The country’s District Health Boards and nurses’ representatives spent yesterday in last-minute talks with the Employment Relations Authority to try to avert strike action planned across the country for next week. More talks are scheduled for today.

If the nurses and their employers cannot reach agreement on pay and working conditions, two 24-hour strikes will go ahead; one on July 5 and the other on July 12.

Nurses spoken to by NOTED were anguished about the possibility of leaving patients stranded, but all said they had voted to reject the latest pay offer, as they felt it was their only chance to make a change to their conditions.

“When all of this first started, it felt like there was a groundswell of support for nurses,” said one. “But now we’re further on, it feels like people are saying, ‘We know you’re worth more, but no one’s got any money to give you, so shut up.”

The last offer put to the nurses’ union by DHBs, and which members voted to reject, was for pay increases of between nine and 15 per cent to be rolled out over 18 months, and a one-off payment for nurses of $2000.

It also included funding for a 2 per cent increase in staff numbers, which David Clark, the Health Minister, said would equate to about 500 more nurses. One spoken to by NOTED pointed out that spread across 20 District Health Boards, that boost equated to about 25 nurses per DHB. Some in Wellington said they worked in units that were down three or four nurses already.

With individual nurses demoralised about a resolution for staffing shortages any time soon, NOTED asked the nurses’ union, the New Zealand Nurses’ Organisation, to comment on working conditions at Wellington Hospital.

It said it would not be interviewed about the workings of one DHB so close to a national strike, but in an emailed statement said it was “working with its members and raising issues formally with DHB management” relating to the issues raised in the staff engagement survey.

Nurses said they had some sympathy for Capital and Coast District Health Board’s predicament; the DHB - thought to hold debt levels second in the country only to those of quake-stricken Canterbury - could only do so much to boost staffing with the resources they had. A number pointed out that helping nurses avoid burnout would take more than upping the numbers; a mix of skills was important too, and nurses complained that it was almost impossible to take time out for the training, education and study they needed to be better at their jobs.

One said it came down to how employers spoke to staff. A casual nurse who works across the region’s public hospitals, as well as at Southern Cross’ private facility, said it was clear morale was low at Wellington Hospital because the overall tone of communication was negative.

“When you step into Hutt Hospital, you see posters for ridesharing, biking to work, eating healthy,” she said. “Wellington Hospital is trying, but the focus is negative rather than positive.”

At Southern Cross, she said, employees were offered a $55 refund for treating themselves to an act of self-care, like a movie, a massage, or new gym shoes. Despite her belief in the public health system, she said she had been taken aback by the private hospital’s culture.

“Why would I work my arse off in public, when I could go to private, where they’d value me and I’d have fewer sick patients and a work-life balance?” she said.

“But I’m still really torn because I want to believe that the public system can work.”

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