This week started with 31 shift gaps between Monday and Sunday in the roster for the Whangārei Hospital emergency department nursing staff.

If the hospital could fill these gaps with nurses from other wards or
with ED nurses who have been working overtime for months and are now on the brink of exhaustion is uncertain.

Renal and oncology are also facing acute staffing issues this week along with other wards meanwhile ED nurses have been refusing to pick up extra hours for the past two weeks because staff and patients are not safe anymore, they say.

An ED nurse, who cannot be identified, says it has been a struggle since the pandemic started but their roster has become unmanageable in the last three months.

“We have been patching shifts for a while. But now, with winter sickness, we’re starting every week with 30-40 shift gaps.

“We manage in a very chaotic way to cover those gaps. It’s just really messy.”

They said it’s been done on goodwill and to keep patients safe but the morale among the nurses was low.

Their staff manager has been trying to recruit but instead of hiring new people, the team have been losing four nurses “in the last little while” to Australia – because of better pay or more welcoming immigration regulations for their families.

“Last year, we were six full-time positions down. Now, it’s 11.”

That equates to about 15 nurses. Most nurses work 80 per cent of a full-time equivalent (FTE) position – often because of the changing shift with draining night hours.

Management knew the winter surge was coming but it wasn’t dealt with, the nurse said.

“Nurses are being texted and called to come in on their rest days and pick up an extra shift.”

They said rest days were important for those working night shifts to catch up on sleep or rest ahead of an upcoming shift, and not to forget other private commitments including children, family occasions and friends.

Still, it was hard to say no to extra shifts because you know the patients’ wellbeing is on the line. If you don’t do it, another colleague will have to, the ED nurse explained.

The ED nurses collectively agreed to no longer work shifts in addition to their contracted hours for the last couple of weeks to visually show management how dire their staffing situation was.

Tracey Schiebli, interim district director for the newly formed Te Whatu Ora Te Tai Tokerau says the organisation coordinates to ensure staffing and resources are deployed and shared to support people’s access to healthcare wherever it is needed.

“We do our best to fill all staffing gaps but acknowledge that this is not always achievable.

“We understand the pressure this puts on the whole team in ED and are continuing to look for ways to resolve this in the short and longer term.

“Nurses continue to do an incredible job for patients and we certainly appreciate and thank them for this,” Schiebli said.

To fill the staffing gaps in the ED, Te Whatu Ora Te Tai Tokerau has been drawing on registered nurses – including from their bureau, other wards, public health and other services – and reassigning them to pick up ED shifts.

What further fuels the ED nurses’ upset is a “pathetic” offer from Te Whatu Ora Health New Zealand for winter incentive payments as well as the fact that most nurses don’t get paid penal rates when picking up extra shifts.

Effective this week, health staff nationwide are receiving winter incentive payments for certain shifts, however, Te Whatu Ora Health NZ chief executive Margie Apa admits that “there has been variation in existing incentive arrangements between districts”.

“This is a legacy of the former fragmented DHB system.”

Apa stressed, however, that nurses were “critical to the continued delivery of healthcare services for our community”.

Health NZ was also continuing with their “comprehensive recruitment campaigns to bolster the nursing workforce”.

The winter incentive payment offer Whangārei’s doctors received is eight times higher – depending on the timing of the extra shifts – than what has been set aside for the nurses.

“The winter payment as an incentive is not very exciting,” the ED nurse said.

“The doctors’ offer is eight times better. That is not equitable.”

They said the ED nurses and doctors worked closely together in a team and the doctors were “horrified” about the nurses’ winter payment offer.

The New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) last week met with Te Whatu Ora Te Tai Tokerau, including interim district director Schiebli, to demand a better offer and discuss the ED staffing situation.

An NZNO delegate said the employer met with doctors’ unions and negotiated much better winter support packages, including agreements to ensure the wellbeing of doctors working additional shifts, but did not negotiate with nurses or NZNO.

Penal rates for extra shifts were also discussed in the meeting.

As per their union agreement, the Multi-Employer Collective Agreement (MECA) with NZNO, ED nurses only receive penal rates if they work more than 80 hours a fortnight.

Because most of the staff only work 0.8 FTE, they don’t get overtime rates if they pick up an extra shift or two.

Other regions, including Wellington and Waikato, pay their nurses penal rates for any extra hours outside of their contract.

The ED nurse the Advocate spoke to said working extra shifts had to be worth leaving your kids or missing out on a family dinner.

“But for some reason, we are always treated as an expendable commodity.”

NZNO has said they would lodge a claim with Health NZ this week for consistent penal rates across the country as well as “significant improvement on the winter Incentive payments”.

Meanwhile, Schiebli said they expected sustained pressure on health services to continue throughout winter and it would help if everyone does their bit to help them get through the cooler months in good shape.

“Our best protection this winter is to be up to date with influenza and Covid-19 vaccinations, which can help reduce the need for hospitalisation, along with the other precautions of staying home when sick; getting tested when you have flu-like symptoms; wearing masks as directed; and regularly washing hands.”