Nurses run out of patience

Most people agree nurses are overworked and underpaid. GEOFF CUMMING investigates why they expect to start getting their dues now


Organised chaos crackles around a nurses' station in Middlemore's emergency department. It is just after 10.30 on a Thursday morning. Staff nurse Tracey Cooper has started a 12-hour shift and is staring at a full board - indicating the 10 cubicles in the monitoring and resuscitation area to which she's posted are already taken.

They are cardiac patients mostly, needing heart monitoring - although there's a middle-aged man in resus who may not make it. When they found him this morning, he'd been trapped in a crashed car near Maramarua for 16 hours. Hypothermia had set in.

"When you come into a full board at this time of the morning, you know it's going to be a busy day," Cooper says. Four nurses and a co-ordinator are working the shift.

It's a similar story in the assessment area; a full board and patients waiting in the corridor. Out in the waiting room, a dozen people face a long wait.

Up to 200 patients a day pass through the emergency department, about 14 nurses work each shift. Cooper says it's not enough; the ideal patient-nurse ratio is four to one and the department is at present down 15 full-time staff. "You're often on your own on the floor. If you get called away ... "

Another car crash victim, a young woman, has just had x-rays and needs further observation. A pregnant woman is bleeding badly. The cardiac patients typically are short of breath and have varying degrees of chest pain and fast heart rates. At any time, one could stop breathing - and there's no cover available. "It's a typical day - things can get complicated in a matter of seconds."

Whatever comes at them is handled with crisp efficiency, leavened with black humour.

"We like to think it's organised chaos."

This is not a problem confined to Middlemore. It could just as easily be Auckland City or North Shore, Tauranga or Palmerston North - where operations were cancelled earlier this month. Nationwide, public hospitals are short of 2000 nurses. Low pay rates and tough working conditions are blamed. Experienced nurses have been lured overseas by better pay and conditions or left for easier jobs which pay better. School leavers no longer see three years of study, a student loan and a starting rate of $16 an hour as a good career choice.

The ageing workforce left in the wards has had enough. Increasingly militant industrial campaigns over the years have done little to improve their lot; now nurses are united as never before behind a new strategy.

They want not only a return to a national award (these days called a multiemployer collective agreement, or Meca) but a 21 per cent pay rise to hoist salaries closer to those of police and secondary school teachers. If the Government doesn't come to the party, nurses are promising to bring hospitals to their knees in the depths of winter.

All of this may sound like typical pre-award talks posturing (the talks begin in July). At the end of the day, employers may console themselves, nurses' commitment to patient care always outweighs what's in their wallets.

This year, however, there's good reason to heed predictions of the most serious industrial disruption since the 2002 secondary teachers' dispute. A ballot on whether to press claims for a national award this week won a stunning 98 per cent endorsement.

Nurses see this year as a once only chance to get something close to what they are worth. For a start, there's a deep well of public sympathy to draw on; everyone agrees that nurses are undervalued and should be paid more. And the Government, as this week's Budget showed, is flush with cash.

Earlier this month, the Government committed itself to introducing pay equity - equal pay for jobs of similar skills, effort and responsibility - throughout the public sector by 2008.

The decision follows a taskforce report on gender-related pay gaps in the public sector. It found the gender gap widest in health, where women earn 36 per cent less than men. Nursing is the most female-dominated profession: 90 per cent of the 27,000-strong workforce are women.

A unit in the Labour Department will be set up to usher in pay equity. Its work will include developing a tool to compare different jobs of equal value and a method for reducing pay gaps. But the process will take up to four years; nurses say the crisis is too severe to wait.

On the taskforce was Laila Harre, former Women's Affairs Minister and Alliance leader, now managing organiser for the Nurses Organisation. "Clearly this Government is in a better position to do this than has ever been the case," says Harre. "Our assessment is that with the money they have, with their commitment to pay equity, with the nurse shortage and the way nurses are organised to an extent they haven't been for a long time, then if we can't do it who can?"

There is also the spectre of Labour being thrown out of office, meaning the pay equity argument would fall on deaf ears. It's also an argument which finds little favour with employers.

The equity claim compares nurses' salaries with male-dominated police and secondary teachers. Harre says the gender gap is obvious. Even a nurse working nights and weekends struggles to match a teacher's starting salary and the gap widens with experience. Police receive a package which far exceeds that of a nurse working shifts. Yet police need only six months' paid training, whereas a nurse must complete a three-year degree - usually building a substantial student debt - before she starts work.

Simon Carlaw, the Business New Zealand chief executive, says nurses are muddying the waters with the equity claim.

"I happen to think nurses are worth a great deal more than they receive. We don't pay nurses enough or we wouldn't have the shortage we have. But pay equity is not the panacea.

"The issue is more about rationing within the health sector and how much trickles down. It's about how they value nurses compared to doctors and radiographers, not about comparing nurses with police who are male."

Carlaw says pay equity mechanisms have been tried in Canada and the USA with unhappy results. "If they are going to hold water at all - and it's a leaky boat - you need an institution which makes King Canute-like observations about what will apply. I would rather have access to state of the art medicine and drugs than have pay rates decided by some arbitrary pronouncements."

The Nurses Organisation has not, in fact, compared the jobs of nurse, policeman and teacher in any depth. "I don't think we need to spend a whole lot of time and money going through a detailed evaluation process," says Harre. "I think we have demonstrated that what we are looking for in comparison to other groups is not at all generous."

Indeed, the increases sought still leave nurses lagging behind the police and working unsociable hours to match teachers.

Tracey Cooper sees comparisons to teaching and police work as broadly valid. All three involve looking after, or looking out for, people. She says teachers are responsible for a large group of people and have their daily work plans "but they don't have the unpredictability". Police have the unpredictability and are exposed to life-and-death situations "but they are getting recognition for what they do. We can have excessive violence but are still expected to cope."

Cooper had already been to business college and reached restaurant manager level in the hospitality industry when she began nursing studies, aged 21, in 1991. She had always wanted to go nursing and joined Middlemore after graduating.

Ten years on, she has reached staff nurse proficient level with supervision and teaching responsibilities after undertaking extra studies. If she remains a staff nurse, her salary will soon plateau.

What she wants most is appreciation - and that includes better pay.

In the assessment area, she says, you can get 15 patients lined up in the corridor because no nurse is available.

"When all the beds are full and you have a corridor full of patients you are a tad busy.

"And it's not just a nursing role. You become a social worker and a counsellor. You have patients getting tired and frustrated. It happens daily."

Nurses at Middlemore are preparing a case for more staff. "Even though there is this chaos we are expected to be able to reflect on what we are doing and how we can improve.

"The hardest part is when you try to get changes made and management can't always visualise what we are talking about."

For someone working 12-hour shifts under constant pressure, she seems impossibly fresh and energetic. A healthy diet and exercise do the trick, she says.

"I enjoy it. I have a good family life; a supportive husband and a black labrador that absorbs all the pressure."

But staff burnout is huge. "Seeing your colleagues tired and frustrated, leaving their shift in tears feeling like they haven't done anything beneficial - it is disheartening."

Leaving nursing is not a consideration for her - no matter how hard the work, she still enjoys the patient interaction and the staff camaraderie.

"You know you are making a difference in people's lives. I get home and although I'm knackered it's still rewarding. The day that stops, I will stop nursing."

The phone rings. Cooper passes on the medical history of an 18-year-old diabetic with heart problems. The young woman from the car accident is wheeled off to an observation ward; another patient moves in. Someone yells for a patient alarm.