Time to empower nurses to take on positions of power and influence

I’m proud to be a nurse. But I’m worried about my profession.

We’re often characterised as the backbone of the health system and the caring profession. But our characterisation as labourers, heroes or angels is harming our profession. We are health professionals using our brains as well as our backs, hands and hearts. When we go to work, we’re applying years of nursing skills, knowledge and experience.

Sometimes, our work involves low-prestige caring labour such as changing beds and assisting with toileting. When you, or someone you care about, need such care, you quickly realise the value of a timely, skilled and compassionate approach. But what if you need care, and there are no nurses to provide it? What if there is only one nurse responsible for the wellbeing of dozens of aged care residents? What if the surgical ward is staffed exclusively by newly graduated nurses who lack the experience and confidence to advocate for a medical review when concerned about a deteriorating patient?

This is already the reality in New Zealand healthcare. According to a recent Nursing Safe Staffing Review, nurses working in our hospitals report care rationing on most shifts. This means patient care is rushed, missed or left incomplete. Patients may not be assisted with eating, drinking, toileting, bathing and symptom relief. Family concerns and patient fears go unheard. Deterioration goes undetected, and interventions are delayed.

Working above capacity day after day has a major adverse impact on workplace wellbeing, and places nurses at risk of errors and possible disciplinary action. Nurses committed to quality care - to the reassurance, comfort and dignity of others - are forced to distance themselves from the moral distress resulting from incomplete care. Some are leaving nursing altogether. We need a capable, resilient, compassionate and sustainable nursing workforce with time to care. Robots are not the future of nursing.

Workforce researchers have been predicting this global nursing shortage for some years, but underfunding combined with Covid and border closures have made things much worse here, much faster. New Zealand already has hundreds of unfilled nursing vacancies. With Covid widespread, health services are continuing to care for thousands of Covid patients each week and dealing with increases in mental and social issues, delayed care, and Long Covid. Claims that the health system has surge capacity and we’re managing well are particularly difficult for health workers who already felt overwhelmed by pre-Covid workloads.

It is the nature of nursing that we sometimes have to deprioritise our need for rest, water, food and comfort to attend to the needs of others. We work in the middle of the night with full bladders and empty stomachs. We witness suffering and sometimes experience threats and violence in our workplace. But nursing also brings powerful connection and the inherent rewards of saving lives, assisting recovery, optimising independence and comforting the suffering. There is never any doubt that our work is needed, meaningful and makes a difference. Our humanity and compassion are important assets, but nurses are now working unsustainably. Every New Zealander should be concerned because our working conditions are your healthcare conditions.

With growing populations living longer and managing more complex chronic illnesses, nursing shortages are a global problem. New Zealand needs to continue to recruit internationally trained nurses, but we’re already struggling to do so because of high workloads and paltry remuneration. Although migrant workers will continue to be important, the Covid pandemic has highlighted how vital it is to grow a health workforce that represents our population. At present, most of the registered nurses in New Zealand have European heritage. Few gains have been made in recruitment and retention of Māori or Pacific nurses, in spite of years of campaigning and reports highlighting the importance of increasing this workforce.

Although nursing has evolved considerably, and advanced nurses are taking on new, much-needed leadership roles, there is relatively little support for professional development. More than $110 million of Health Workforce New Zealand funding is dedicated to postgraduate medical education, more than $7000 per doctor per year.

Qualified nurses receive less than $350 each per year. Many nurses undertake all professional development in their own time and self-fund fees. Employers won’t release nurses from clinical duties because of staffing shortages. When professional development and quality improvement projects are deprioritised, nurses feel undervalued. Enthusiastic, experienced nurses looking for new challenges or leadership roles are leaving the profession in droves.

Seeing the great work that nurses do, I am dismayed the nursing profession is still given so little funding, power and mana. My colleagues are some of the brightest, most hard-working and compassionate people I have met. We are the largest cohort of workers delivering healthcare services but are less often involved in resource allocation decisions, healthcare leadership, policy development and change management. Medical education socialises doctors to be researchers, change-makers and health leaders. It is time nurses are also empowered to take on positions of power and influence. A greater investment in nursing is an investment in the wellbeing of all New Zealanders.