More than two months on from settling the nurses’ pay deal most DHBs are still finalising plans to get their share of $38m for relieving immediate DHB nursing workloads.

The DHB multi-employer collective agreement (MECA) ratified by NZNO members in early August included a $38m Government fund towards the immediate, short-term relief of nursing and midwifery workload pressures.

As of late last week seven of the 20 DHBs had submitted the required ‘brief plans’ to the Ministry of Health’s Chief Nursing Officer on ‘why, where, who and how’ workforce capacity would be increased at their DHB.

For DHBs to receive their share of the $38m funding pool their plans need to first be approved by the joint DHB-NZNO Safe Staffing Healthy Workplace (SSHW) governance group. To date three out of the seven submitted DHB plans have been approved or partially approved.

Hilary Graham Smith, NZNO associate professional services manager, when asked whether she was concerned at the DHBs progress said she would much prefer DHBs to take their time to work through their plans thoroughly.  She said it was ‘all good positive work’ between DHBs, NZNO staff and NZNO members at the bedside to determine the ‘hot spots’ with major staffing needs or gaps. “Some of these gaps are pretty substantial,” says Graham-Smith. She said the $38m was agreed to not be enough but it was a “launch pad” to start filling those gaps while the safe staffing Care Capacity Demand Management (CCDM) system* was being fully implemented.

The $38m is the funding equivalent of employing 500 extra nurses across the country – which is acknowledged as just providing some short-term relief to areas under the most pressure while DHBs meet their MECA commitment to roll-out and implement the CCDM system to ensure they have evidence-based safe staffing levels for each ward and unit.

The fund can be used for whatever nursing staff skill mix is agreed to by each DHB’s joint union-DHB CCDM Council or equivalent; so it can be used to employ additional registered nurses, health care assistants, enrolled nurses or midwives but it can’t be used to fill existing vacancies or to staff planned new services.

The latest workforce statistics for the 20 DHBs show that nursing numbers increased by 1096 nurses or 981 full-time equivalent (FTE) positions between June 30 2017 and June 30 2018 – about a 4.5% increase. Most of these positions would be to meet demand for new services and population growth as well as absorbing more new graduates. The 20 DHBs financial reports to the Ministry of Education indicate that the growth in nursing numbers was higher than budgeted for with the DHBs taking on 549 more nursing and midwifery personnel than planned for in the year to June 30 2018.

Graham-Smith, who is on the SSHW governance group, said mostly the DHB plans she had seen to date to relieve the pressure staffing points were good – as they were required to be signed off by nurses at the ‘coalface’ before being submitted – but some required a “little tweaking”.  “It’s been a good process and in the end you get the right result”.  She says all DHBs are using different methodology to work out their pressure points and submitting different plans with some using the opportunity to resolve some longstanding issues.

Dr Jill Clendon, the Ministry of Health’s acting Chief Nursing Officer said the work between the Ministry, NZNO and DHBs was progressing well.  She said most DHBs were distributing the new positions fairly evenly across the workplace and no particular trends had been identified yet about what skill mix was being employed.

*CCDM three core components

  1. Mix and Match Staffing (i.e. using patient acuity data analysis to calculate the safe FTE base staffing required for a ward or unit to meet patient demand patterns)
  2. Variance Response Management (i.e. capacity at a glance screen (CAG) and ‘traffic light’ system to alert when ward is in immediate need and systems of how to respond)
  3. Core data set (Using high-quality data to review and respond to safe staffing needs)


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