27 September 2001 Speech Notes
New Zealand Nurses Organisation conference
I feel genuinely privileged to be speaking at this historic conference. It is great to see so many familiar
faces here as well in a year in which we commemorate the centenary of Nursing Registration in New Zealand.
Your profession can not only look back with great satisfaction on what has been achieved in the last hundred
years, but look forward to the next century in good heart. I have absolutely no doubt you will continue to build on
nursing's proud traditions.
New Zealand is envied around the world for the quality and professionalism of its nursing. Other countries want
our nurses, and look to New Zealand nursing as a benchmark.
It is all too easy to take such high standards for granted, all too easy, that is, until you look around the world.
Nursing organisations in many countries are fighting for the requirement for nurses to complete a degree as part of
their training, for example. The New Zealand profession should congratulate itself on being a leader in this and many
Nursing has often been at the forefront of change in the past century. There have been revolutionary
developments in options for medical intervention and in the philosophy of patient care.
In 1901 nurses worked in the pre-antibiotic age. Now you work in an age of silicon and biotech.
In 1901 nurses worked in a self-contained colonial society wary of illness and diversity. Today we are a proudly
diverse society committed to including all people, regardless of their physical or intellectual disability, ethnicity or
In 1901 many people were suspicious of mental illness. Today we understand the need for paths to rehabilitation.
Such changes have had an enormous impact on nursing. There has been particularly intense change in the past few
years. We have seen the introduction of nurse-led community services, the introduction and rapid growth of information
technology, and the development of new medical technologies.
Another change is imminent. We are about to see the return of enrolled nurses, a policy supported by the NZNO,
the Government and many employers. This move has not been without its critics, who have done their best to destabilise
the decision, but I am pleased that they have failed.
And, of course, we have also seen the introduction of the role of the Nurse Practitioner to allow nurses to offer
innovative ways of addressing health needs.
I am sure nurses will continue to reassess their roles and adapt to changes. I am equally confident they will
continue to show the same unwavering commitment to delivering quality health care. Nurses have a passion about what they
do. Dignity and a sense of vocation are essential. None of that will change in the future.
The 1999 NZNO manifesto
I have been asked today to talk about the Government¡¦s progress toward addressing your organisation¡¦s
suggestions and recommendations in your 1999 Health Manifesto.
As you will be aware, this document contained 15 core aims, with suggestions divided into the following broad
„Y Openness and cooperation in the health service
„Y Standards for patient care
„Y Fairness for employees in the health service
„Y Professional development
„Y Addressing poverty
„Y Access to health services
I will discuss each area, starting with openness and cooperation in the health service. Your specific aims, numbered
one to three, were to end the competitive model of health that led to privatisation and secrecy in decision-making, to
introduce elected community representation on health boards, and to ensure nurses and midwives can act as patient
advocates by speaking out about unsafe or inadequate care.
There has been significant progress on all three aims in just 20 months. The Government is committed to a
cooperative, collaborative public health system. This is well illustrated in the New Zealand Health Strategy and the
introduction of district health boards.
The NZHS provides the vision for the ongoing development of the health system and focuses on the following core
„h promoting a population health approach
„h focusing public health funding on reducing inequalities
„h improving coordination between different agencies
„h empowering local solutions to local problems, and
„h addressing wider socio-economic issues affecting health
We are honouring our pledge to reintroduce elected community representation in decision-making. This will
restore the democracy to health and disability services lost in the decade of National-led government. Postal voting is
taking place right now.
Partially-elected health boards will provide greater transparency in decision-making. It also means the very
people who are most in touch with local needs and have the best knowledge about local resources will shape local health
priorities. Local knowledge is vital in developing the preventive public health focus we need to slow down increased
demand for services and pressure on available funding.
Transparency is also promoted by the DHB structure as there is open discussion of issues like deficits and
services as part of the annual plan process. This will help give the public more understanding of the need for
prioritisation in decision-making. DHBs have to plan wisely and stick to their budgets.
As far as patient advocacy and complaints processes are concerned, the Government has overseen significant work to
provide better systems for patient advocacy and for health consumers to voice concerns and have complaints investigated.
These efforts focus on follow-up from the Cull report that recommended a one-stop shop for dealing with patient
complaints and amendments to the Health and Disability Commissioner Act 1994 and ACC legislation.
The existing complaints process can be intimidating. We will continue to oversee changes to make it more
user-friendly. Health consumers should know where and how to complain, and expect realistically a speedy and thorough
investigation. Health professionals also need speedy and clear resolution of complaints.
The second broad area of your manifesto concerned standards for patient care. Your specific aims, four and five, were to
develop and implement standards for safe staffing levels and employment practices, and to ensure that clinical
practitioners lead the process of standard setting.
The Government has introduced a number of initiatives and projects to improve patient safety, adequate staffing
levels and high quality clinical practice. In particular we are developing a Health Sector Quality Improvement Strategy
setting out the components of the high-quality public health system we all want.
The Ministry is also working on developing registered nurse staffing levels. As many of you will know, an Expert
Advisory Panel, convened last year, worked on a registered nurse staffing formula for use in aged care services.
In August another Expert Panel (with NZNO representatives) recommended some changes to the original nurse
Officials are working on these changes, and will brief me on the panel¡¦s recommendations.
Your manifesto was also naturally concerned with issues of fairness for health employees. Your four aims, numbered six
to nine, were to repeal the Employment Contracts Act, to protect employees from unfair legal processes, to introduce
paid parental leave, and to ensure realistic compensation for workplace injury within a workable ACC scheme.
The repeal of the Employment Contracts Act is one of the Government¡¦s major achievements. I am proud at its
We have introduced a more balanced and fairer legal framework in its place. The Employment Relations Act
encourages collective agreements and recognises workers have an inalienable right to organise to represent their
The NZNO will be well aware of the Court of Appeal ruling on union registration made prior to 2 October last
year. My colleague, Labour Minister Margaret Wilson, will be taking recommendations to Cabinet next week to ensure that
unions and employers who acted in good faith will be legally protected by amending legislation.
Margaret has made it quite clear that it would be wrong for arrangements made in good faith to be affected by a
technicality of registration date.
I must also mention today that preliminary work has begun on developing the first tripartite approach, involving
unions, employers and the Government, to nursing workforce issues. Other senior Cabinet ministers support me in backing
this initiative. Such a longer-term and strategic approach has the potential to provide greater consistency and fairness
across a whole range of workforce issues, and to allow better and surer planning by employers as well.
The Government has also reversed the decision to allow competition in the accident insurance market that was leading to
private firms creaming off profitable parts of the market and leaving the rest to the state. And we have reintroduced
lump sum payments.
Parental leave decisions are close to being made and will no doubt be announced in due course by the Minister of
In terms of professional development, your manifesto detailed four aims, numbered 10 to 13. Your organisation wished:
„h to improve career structures and access to clinically oriented education
„h to develop systems for the governance of nursing and midwifery based on wide participation by practitioners and
credible professional leadership
„h to address the development of nursing as a key element in all health strategies
„h and to update the Nurses Act in line with NZNO policy.
The area of professional development of nurses is also dear to my heart, and this Government recognises that the
many challenges facing the health workforce include professional development. The Health Workforce Advisory Committee
(HWAC) is considering strategic aspects of this problem.
This committee was recently set up to provide me with an independent assessment on current health workforce
issues and now has a permanent secretariat. It will be looking at the health workforce needed in the future to meet
objectives of the New Zealand Health Strategy and the Disability Strategy.
Many of you may be aware of reports about some of the committee¡¦s initial work and options it has generated, such as
considering loyalty payments, matching schemes and promotion of nurse training.
Loyalty payments are used as a recruitment tool for several overseas health systems. Ultimately they are only a
short-term fix, but they are something that will have to be considered in New Zealand.
Matching schemes may, for example, simplify the current situation that requires graduate doctors to make
multiple applications to hospitals. Matching hospitals with doctors¡¦ preferences offers real opportunities.
This suggestion also illustrates the need for DHBs to coordinate activities. The suggestion has a real chance of
success if DHBs work together.
Until December the HWAC is taking stock of current workforce capacity and issues and challenges. It will seek
input from a wide range of organisations and groups, and produce a vision statement early next year.
In another recent initiative I established an informal advisory group, consisting of people who have a real appreciation
of workforce and health issues in general, to meet with me on a regular basis. I appreciate this group's contributions.
The Ministry¡¦s Funding Agreement 2001/02 with the DHBs acknowledges nurses are the largest professional group
in the health system and have a critical role to play in quality care. It is important to ensure DHBs, for example,
support clinical career pathways, professional development, on-going education and allow nursing input into decision
making at all levels. DHBs must report quarterly to the Ministry of Health on:
„h how input from nurses is received into its decision making
„h acuity systems and how nursing workload and staffing levels are benchmarked
„h strategies to deal with both high and low staff turnover, and recruitment and retention strategies
„h indicators to demonstrate achievement or remedy any nursing issues.
Early next year the Ministry will pilot two-year programmes for the first year of nursing clinical practice in
three or four sites. The programmes will involve some 140 new graduate nurses. I strongly believe that a
nationally-consistent process for supporting new graduate nurses in their first year of clinical practice will help
significantly in retaining our graduate nurses.
The Ministry is also working with an expert group to develop a national framework for purchasing and
prioritising post-entry clinical nurse training programmes. The Ministry will release a discussion document for public
consultation later this year.
I recently participated in a conference introducing the role of the Nurse Practitioner. The Nurse Practitioner
will be the highest clinical nursing expert in New Zealand, will contribute significantly to improving health outcomes,
and will deliver nurse prescribing in New Zealand.
The role of the Nurse Practitioner offers a significant new career pathway for nurses. In the past, nurses were
promoted into management, but the Nurse Practitioner role offers a clinical career path.
Early this month the Cabinet approved the first set of nurse prescribing regulations. They will allow advanced
nurses practising in aged care and child family health, who meet the Nursing Council¡¦s competency requirements, to
prescribe a specified list of medicines. Work is also under way on proposals for nurse prescribing in sexual and
reproductive health, palliative care, occupational health, and mental health.
Nurse prescribing will not only advance the nursing role, but has potential to improve access to services and
patient education, and reduce secondary illnesses and hospital admissions.
It appears the first course for enrolled nurses will start next year at Northland Polytechnic. I thank NZNO for
help in getting the course established, as I had much resistance from institutes to establish the courses. I have had
strong representations from nurses that the term enrolled nurse should be used, and I have made it clear I have no
difficulty with that if that is what nurses want.
Many professional sections of NZNO, along with other national nursing organisations, signed a Memorandum of
Understanding with the Ministry of Health earlier this year.
This provides you with the opportunity to contribute pro-actively to developing, implementing and evaluating government
health initiatives and policies. The Memorandum of Understanding has received recognition from the international nursing
In terms of addressing poverty, your manifesto said you wanted to ensure that all New Zealanders can participate fully
in their community and are not prevented from doing so by reason of poverty, or the ill health which stems from poverty
The Government has also put in place a raft of policies to address poverty and associated health problems. We
have reintroduced wage-linked state house rentals, increased benefit levels and overseen an economic recovery. All this
provides more New Zealanders with opportunities to improve their lives.
And, finally, on the issue of access to health services, you wished to improve access to both community and hospital
based health services.
The Primary Health Care Strategy aims to develop a national approach to primary health care nursing. An expert
advisory group has been established to advise on a national framework that will address capabilities, responsibilities,
areas of professional practice, and suitable employment arrangements for nurses working in primary health care.
I believe there are great opportunities for nurses under this new approach.
Thank you again for asking me to talk to you today. You should be proud of all nurses achieved in the past 100 years.
Nurses have maintained high professional standards and a personal commitment to their work despite wide-ranging and
rapid changes that have directly impacted on the work they do.
I haven't tried to suggest today that the Government has achieved all you want. We haven't achieved all we want
either. I am proud, however, of much of what we have achieved in terms of nursing in a short time, and proud of the fact
we have done by working together with you and other health professionals.
Thank you for your ongoing commitment and dedication to both nursing and the health of New Zealanders. Your past
has been important. Your future will be even more so.