Wellington, New Zealand – In the 25 years Lisa* has been a healthcare assistant, short-staffing has only got worse.
Her typical day involves changing a patient’s dirty linen, clearing their rubbish, escorting them to and from the bathroom, helping them with their exercises, and feeding, walking, and washing them.
“You can’t complete the patient care because there’s just not enough of you,” Lisa told Al Jazeera. “It means you feel like you’re failing people, and it’s not fair to them or us.”
Weary from years of trying to fit 10 hours of work into an eight-hour shift, Lisa is one of more than 30,000 nurses, midwives, and healthcare assistants working in New Zealand’s District Health Boards (DHBs) who have been negotiating with the government for the last year to improve pay and working conditions.
“It’s the workload we’re not happy with and it has to change,” she said. “The number of patients is so big that it’s impossible to plan or to keep up with demand.”
The last collective agreement – covering nurses, midwives, and health care assistants working for DHBs – expired on July 31 last year. New Zealand’s 20 DHBs fund and provide health services in the country.
In June, healthcare workers went on strike when employment talks between the New Zealand Nurses Organisation (NZNO) and DHBs broke down.
The union wants an increase of 17 percent to the total amount of money paid on salaries, as well as for nurses to have sick leave when they need it, and for consideration to be made for what they describe as an unsafe working environment.
A subsequent offer was tabled and rejected in July, which led to a vote for strike action on July 29, as well as in August, and September. The government then revised the offer and the union has suspended its strike plan while nurses consider the new proposal.
Health Minister Andrew Little says the union’s decision is a positive move.
“[The offer] has been approved by a group of 120 nurse delegates for circulation for ratification and it has led to the [union] withdrawing their strike notices. That’s encouraging, but in the end, the decision is in the hands of the nurse membership.”
Overwhelmed by work
Jessica* is a registered nurse living in Hawke’s Bay.
She loves nursing – a job she says she would even do “for free” – but is rushed off her feet every day by work she says is physically, emotionally, and mentally taxing.
“You have to hit the ground running when you start a shift,” she told Al Jazeera. “You’ll be stressed, you often don’t get time to finish tasks and, in some cases, it means medication distribution may be late. You’ll miss call-bells asking for help. Sometimes you mightn’t be able to go to the toilet all day and you only realise when you’re bursting to go when you get into your car.
“I understand that budgets are tight but healthcare is important for a nation. It’s important that we look after our people. I don’t understand why healthcare isn’t a priority. COVID-19 was especially hard on us as we literally had to risk our lives to go to work whereas everyone else stayed at home. And now we’re doing the vaccine rollout – where is the consideration?”
Judith*, a midwife and registered nurse based in Auckland, has been part of discussions around nursing retention and staffing for 20 years and says it is disheartening to see little has changed.
“It’s sad because I really like what I do,” she said. “I love the fact that I get to work with women in what can be some of the happiest times of their lives. It’s a privilege to be part of that process.”
Judith’s own reckoning came when her daughter told her that for the third year in a row she had had to cook her own birthday dinner.
“It really hit home,” she said, noting that now she makes sure to avoid getting overwhelmed by the job.
“I am now very active in asserting myself so that I take time off and that I take breaks. It’s not necessarily easy to get the leave I need but it’s necessary to keep myself safe.”
Industrial services manager Glenda Alexander says much of the problem stems from gender discrimination.
“It’s a female-dominated job and like most caring professions – women are expected to care for free. Traditionally roles such as teaching or nursing have been undervalued because soft-skills weren’t seen as ‘work’,” she said.
Separate from pay negotiations, Alexander has been working alongside DHBs and unions to present a pay equity claim to the government under the Equal Pay Act. The claim is expected to come to a close by the end of the year.
As part of the pay equity claim, the NZNO has interviewed more than 200 nurses to establish whether there are any male-dominated equivalent roles in other jobs.
“It’s been an incredibly interesting exercise,” said Alexander. “Compare police work, for example, which is male-dominated and better paid. They might have to attend horrible events and see horrible things, but there’s a level of distance and the frequency of that happening is arguably less than what nurses have to directly deal with on a daily basis.”
If the question of discrimination is established, compensation will follow.
“We’ll hopefully see results in terms of pay equity by the end of the year, but the strikes are a means to rectify the problems the health profession and public are facing right now.”
The government has not revealed details of its latest offer to healthcare workers, saying the NZNO membership is entitled to see and assess it first. It includes two components – a cost-of-living adjustment, and the pay equity claim, which Little, the health minister, acknowledged had failed to make sufficient progress.
“What I can say is it is an improved pay offer to the nurses,” he said.
The government has also promised a ministerial review of agreements around staffing safety and demand for critical care, which has been “patchy” at times, he admitted.
‘It takes a strike’
DHB spokesperson Dale Oliff says the DHBs “were disappointed pay talks were not able to reach an agreement and prevent the [June] strike.”
Oliff insists DHBs understand the pressure on health professionals and have resumed formal negotiations to get a better understanding of what the nurses want.
Pay for healthcare assistants currently start at 40,382 New Zealand dollars ($28,071) a year, with annual salaries for enrolled nurses from 48,632 New Zealand dollars ($33,819) and registered nurses, who bear overall responsibility for patient care, getting from 54,034 New Zealand dollars ($37,575).
Oliff says narrowing the gap between the lowest-paid and those at the top of the scales are a key part of the discussion and that the pay equity claim will be backdated by almost two years.
The DHBs declined to discuss details of their fourth offer, but Oliff says it is a significant improvement and includes a range of wellbeing and staffing measures.
A Ministry of Health spokesperson says the government has also been working to hire more nurses, and the number holding annual practising certificates has risen by about 10 percent since 2017 to reach 61,039 last year. Based on current numbers, the number of nurses is projected to grow to more than 63,400 this year and to more than 64,600 in 2022.
On the front line, Lisa says the number of staff cannot adequately meet the needs of patients, especially as New Zealand’s population ages.
“Our population is getting older; they’re living longer and their needs are greater,” she said.
She has felt increasingly stressed by her work as she tries to do her best for the people she cares for.
“Some days I think, ‘Oh God, why am I here?’ and then I go home and I’ve absolutely had enough,” she said. “I have a family to look after and the workload is making everything else feel impossible.”
Lisa has been angry with management that she describes as “completely out of touch”, but is optimistic that negotiations may now be coming to an end. The decision to strike was a last resort but she thinks it has fulfilled its purpose.
“Unfortunately I think it takes a strike for them to listen. They need to come down and see for themselves, rather than making decisions while sitting behind a desk.”
*Names have been changed to protect the identity of the nursing professionals who spoke to Al Jazeera.