New Zealand Nurses’ Organisation

1909 –

New Zealand Nurses’ Organisation

1909 –

Theme: Health

Known as:

  • New Zealand Trained Nurses' Association
    1909 – 1971
  • New Zealand Nurses' Association
    1971 – 1993
  • New Zealand Nurses’ Organisation
    1993 –

This essay written by Patricia Sargison was first published in Women Together: a History of Women's Organisations in New Zealand in 1993. It was updated by Patricia Sargison in 2018.

New Zealand Nurses' Association 1909 – 1993

The New Zealand Nurses' Association (NZNA) represented the professional, social, economic, and industrial interests of nurses. It aimed to ensure the best standards of professional nursing practice, supported by appropriate nursing education and research. In 1991, the association had 27,325 members, 98 percent of them women, and a permanent staff of 44.

Although the Nurses Registration Act 1901 and the Midwives Act 1904 made New Zealand the first country in the world to introduce state registration for trained nurses, it was slower to form a nurses' association. In 1905 the Wellington Private Nurses' Association was founded as an employment bureau for registered private nurses; it was followed in 1907 by the Dunedin Trained Nurses' Association and in 1908 by Auckland and Christchurch associations, which also included hospital nurses. Hester Maclean, the Department of Health's Assistant Inspector of Hospitals and Deputy Registrar of Nurses, saw the need for a united body 'to shape the future of nursing'. [1] With her encouragement and assistance from doctors, the four associations became branches of the New Zealand Trained Nurses' Association in November 1909. Maclean was the first president and her assistant, Jessie Bicknell, the first honorary secretary. These early links with the Department of Health gave the fledgling association immediate access to government and considerable influence in nursing issues. The association did not proclaim its total independence from the department until 1973.

Always committed to the principle of a single organisation representing nurses, the association has reacted to both internal and external pressures in its struggle to maintain unity. Originally it was concerned only to preserve the status of registered nurses of good character; but by 1932, when it changed its name to the New Zealand Registered Nurses' Association, it had admitted masseurs, maternity nurses and psychiatric nurses as associate members. The Student Nurses' Association was formed in 1936 as a subsidiary body, with full amalgamation occurring in 1976. Hospital aids joined in the 1940s. Male nurses were for some years actively discouraged, but the Society of Registered Male Nurses finally amalgamated in 1969.

Christchurch nurses in 1913

Christchurch Hospital nurses 1913. ATL, Steffano Webb Collection (PAColl-3061). Reference: 1/1-005393-G

The name change to New Zealand Nurses' Association in 1971 reflected its now wide coverage, and associate membership was abandoned in 1974. In 1973 the association was instrumental in establishing and servicing the New Zealand Industrial Nurses' Union for private sector nurses, who enjoyed joint membership until they formed their own separate union in 1987. The formation of the National Council of Māori Nurses in 1983 stimulated an interest in bicultural issues.

The association's structure grew to meet the needs of its increasing membership. In 1922 a fifth branch, Hawke's Bay, was formed, and annual conferences were introduced. Kai Tiaki, founded by Maclean in 1908, was purchased from her in 1923; renamed the New Zealand Nursing Journal, it became the association's official journal in 1927. A Dominion executive and the first standing committees were formed in 1928, and a salaried Dominion secretary appointed in 1932.

Further challenges followed. When matrons and occupational health nurses broke away to form independent organisations in the 1960s, the association recognised the need to cater for different professional groups. In 1970 it introduced Special Interest Sections in various clinical fields, which focused on professional development and were a significant factor in increasing membership from the mid-1970s. The criticisms of another breakaway group, the Nurses' Society (formed in 1972), provoked the association to decentralise in order to improve communication with its membership. Regional officers were appointed in 1975, and in 1989 the 58 branches were restructured into eleven regions, with an emphasis on workplace representation.

The association was always concerned with the quality of nursing education, and jealously guarded its nurse majority representation on the Nursing Council, which controlled curricula, examinations and registration. The association was slow to reject the hospital apprenticeship system of nurse training, although it encouraged increased theoretical content in the courses. During the 1960s, however, attitudes changed and the system's inadequacies caused president Enyth Holdgate to declare that nursing was 'on the brink of a precipice'. [4] A severely critical WHO report the same year and the success of the Association's 'Operation Nurse Education' resulted in the introduction of pilot nursing courses at Wellington and Christchurch polytechnics in 1973. After further strenuous efforts, the changeover to the tertiary education sector was completed by 1984.

The first call for university nursing courses came in 1922. The association set up the New Zealand Postgraduate Nursing School (later the School of Advanced Nursing Studies) in Wellington in 1928. Scholarships, bursaries and study days followed, but progress was hampered by a lack of universal agreement about the place of university education in nursing. Although the 1959 NZNA conference unanimously called for a Chair of Nursing, it was 1973 before courses were finally established at Victoria and Massey Universities, and 1984 before Nancy Kinross was appointed to the first chair at Massey.

In the early years the association gave low priority to the economic welfare of nurses. The association saw proposals for a 56-hour week (1910) and an 8- hour day (1930) as 'lowering the nurse's conception of her work'. [5] Maclean had insisted in 1909 that 'we must guard against any element of unionism. ... A nurse must be a woman working not ... for the sake of money making but for the good of her fellow creatures'. [6] The association stood firm against the first Labour government's unionisation policies, and in 1947 succeeded in embracing 'unionism without the label of a "trade union"'. [7] Then the government recognised it as the bargaining body for nurses employed in public hospitals, with the right to make representation to the new Hospital Boards Salaries Advisory Committee. The association formed a standing committee on economic welfare in 1954 to deal with these issues, but assured nurses that they were neither overworked nor underpaid; it even rejected government attempts to introduce overtime payments.

From the 1950s the association gradually discarded its anti-industrial stance, although many nurses continued to view those active in economic welfare as having lost their sense of vocation. During the 1960s the association took the initiative in two successful industrial campaigns. It was instrumental in getting the Lythgoe Committee set up in 1965, and influenced its recommendations for a 40-hour week for nurses, with two days off per week, shift allowances and penal rates. The association's work on the Council for Hospital Employee Organisations led to the formation in 1969 of the Hospital Services Tribunal, which established full negotiation, appeal and arbitration rights.

From 1972 the association, under pressure from other unions such as the PSA which already represented some groups of nurses, placed increasing emphasis on its role as an employee organisation. In 1973, president Margaret Bazley declared that 'the days of exploitation are over ... if our tradition of serving patients is to be maintained, then the welfare of nurses must be put first and foremost by this Association'. [8] By 1986, nurses' protests against conditions and wages—'the greatest distress cry of nursing in this country'—caused the association to give notice of strike action as part of its successful 'Nurses are worth more' campaign. [9] A 24- hour strike, unthinkable in earlier years, took place on 14 February 1989.

During 1992, the association faced its first award round under the shadow of impending health reforms and the Employment Contracts Act 1991. Negotiations took place on a regional basis with area health boards determined to reduce nursing budgets. Although there were strikes in four board areas, most awards were ultimately settled, but variations between the regional collective agreements meant that parity had been lost. The bitterness engendered during the negotiations did not bode well for the future.

From the 1970s, the association placed increasing emphasis on patient care and clinical nursing. Its Professional Services Committee issued several policy statements on nursing standards and practice. The association was convinced that 'Successes in the industrial field advance professional interests'; [10] but some nurses disagreed, claiming that the association was not fulfilling its professional function. A separate College of Midwives was established in 1988, followed in 1991 by a College of Nurses to 'provide a combined professional focus'. [11]

Patricia Sargison

New Zealand Nurses’ Organisation, 1993 – 2018

On 1 April 1993, the NZNA amalgamated with the private sector union, the New Zealand Nurses' Union, to form the New Zealand Nurses' Organisation (NZNO). The new organisation had a combined membership of approximately 30,000. By the end of 2017, this figure had reached nearly 49,000, although other unions declined in this period. [12] Specialist sections were constituted from 1999, when practice nurses formed a college, which was extended to include all primary health care nurses in 2006. In 2018, there were 21 colleges/sections. The organisation employed well over 100 full- and part-time staff. It became a leader in its use of social media platforms, with ‘the biggest online reach of any New Zealand union organisation’. [13]

The new organisation remained committed to Te Tiriti; Te Runanga o Aotearoa, the Maori nurses’ collective, first established in 1990 as part of the New Zealand Nurses’ Union, became the bicultural partner of the new NZNO in 1993. In 2012, a bicultural structure was formally embedded in the constitution and early in 2013, the first paid, full-time NZNO president and kaiwhakahaere took office as equal heads of the organisation. It was, however, acknowledged that genuine biculturalism remained somewhat controversial and ‘a work in progress’. [14]

The NZNO was formed to offer a concerted response to a difficult industrial climate. Constant restructuring and changes to funding saw the loss of many nursing positions, including those of nurse managers, while the destruction of national employment awards resulted in wide disparities in the pay and conditions of nurses and midwives around the country. It was not until the new century that the NZNO was again able to engage in multi-employer bargaining. A Fair Pay campaign was launched on 19 September 2003. Lengthy negotiations, including petitions and the threat of strikes, finally resulted in the ratification of a multi-employer collective agreement (MECA) in 2005, which included pay rises for hospital nurses of between 20% and 47%. [15] The agreement was updated in 2007, the same year it was expanded to include all primary health care nurses and midwives, and again in 2009 and 2015. The long battle for equal pay for care and support workers in the aged care and mental health fields, during which NZNO supported the court case taken by the E Tu Union and Kristine Bartlett, was finally settled in 2017. [16]

Industrial bargaining by the NZNO was also focused on work conditions and safe staffing, which became a primary concern in the MECA negotiations which began in 2017.  The issue was first raised in 2004, and in 2006 a Safe Staffing Health Workplaces Unit was established to oversee the introduction of care capacity demand management (CCDM) in DHBs. The model was one of the first of its kind in the world and attracted international attention, but according to NZNO research, implementation was ‘patchy’. [17] Sceptical nurses argued that a decade of underfunding meant DHBs saw them primarily as a budget item in constant need of pruning, so that promises of safe staffing were seldom kept. By 2018, NZNO members, suffering higher levels of depression, anxiety and illness than the general population [18] and forced into ‘care rationing’ in order to meet patient demand, had ‘had a gutsful’. [19] Accordingly, after rejecting four offers from DHBs, they voted for a nationwide 24 hour strike on 12 July 2018. On 30 July, an agreement was reached with the Minister of Health and the DHBs to fund the full implementation of the CCDM in all DHBs by 2021 [20], and on 7 August 2018, NZNO members accepted a fifth offer which included pay rises of between 12.5% and 16%. [21] Nonetheless, divisions within the organisation and some cynicism about the settlement process remained. [22]

While industrial issues often took centre stage in the 21st century, the NZNO’s professional role was not neglected. Nursing education remained an important focus, so the loss of its right to nominate four candidates to the Nursing Council in 1999 caused major consternation. [23] Nevertheless, the NZNO has continued to advocate for educational advances for nurses. Many curriculum changes were introduced in the 1990s, including an emphasis on cultural safety issues and patients’ rights principles, which arose from the 1988 Cartwright Report. The enrolled nurse training programme was restarted in July 2002 after lapsing in the 1990s, and a revised scope of practice was issued in 2009. NZNO pushed for special undergraduate training programmes for Pasifika nurses (2004) and Māori nurses (2009), designed both to improve health care for these communities and to increase the numbers of nurses with these ethnicities. In 2018, scholarships to support Māori nurse development were launched. NZNO drove the development of nurse entry to practice (NETP) and advanced choice of employment (ACE) programmes for all nursing graduates, giving new nurses a structured and supervised introduction to full-time employment. Its goal was that these programmes should be available to 100% of graduates. Supporting postgraduate education opportunities for nurses was also important. By 2018 NZNO employed two nurse researchers, who published regularly, but also offered a wide range of scholarships, research grants and travel funds to enable its members to undertake university study. This enabled nurses to pursue advanced career paths as educators, leaders and administrators, and in advanced clinical fields previously restricted to doctors, such as the nurse practitioner role (first advocated in 2000) and training for nurses performing endoscopies (2016). Finally, for many nurses unable to undertake formal postgraduate education, the NZNO’s specialist sections and colleges, with their workshops and conferences, provided excellent opportunities for professional development. [24]

The professional concerns of the NZNO were highlighted in its 2018 publication, Strategy for Nursing. This raised issues such as New Zealand’s lack of any coherent national nursing workforce strategic plan, its current dependence on internationally qualified nurses (at 27%, the highest in the OECD), the under-representation of Māori and Pasifika nurses in the workforce, lack of employment for graduate nurses (by 2018 only 63% were offered jobs on graduation), the ageing workforce, and the chronic underfunding of postgraduate education. The NZNO saw its dual role as covering both industrial and professional advocacy for nurses, making it extremely well placed to lead campaigns addressing these problems, as well as social issues such as inequality and poverty. As president Grant Brookes said in 2015, its ‘professional and industrial realities are not opposing dimensions, but inseparable parts of the whole’. [25] Professional aspirations to deliver excellent care, backed by industrial strength, meant that ‘more than ever nurses can, and should, play a lead role in shaping the future of health service delivery’. [26]

Patricia Sargison

Notes

[1] Hester Maclean, Kai Tiaki, Vol. 1 No. 3, July 1908, p. 94.

[2] Annual report, 1960.

[3] President's speech to conference, 1960.

[4] NZ Nursing Journal, Vol. 64 No. 6, June 1971, p. 4.

[5] Anderson, 1968, p. 2.

[6] Editorial, Kai Tiaki, Vol. 2 No. 3, July 1909, p. 77.

[7] Gibson Smith and Shadbolt, 1984, p. 35.

[8] NZ Nursing Journal, Vol. 66 No. 6, June 1973, p. 5.

[9] Editorial, NZ Nursing Journal, Vol. 79 No. 1, January 1986, p. 2.

[10] NZ Nursing Journal, Vol. 84 No. 7, August 1991, p. 2.

[11] Proposal for a College of Nurses, August 1991, file held at NZNA library.

[12] NZ Nursing Journal, Vol. 24 No. 1, February 2018, p. 42

[13] NZ Nursing Journal, Vol. 21 No.7, August 2015, p. 34. Chief executive, Memo Musa, noted in 2017 that some Facebook postings were getting around 20,000 views (Vol. 23 No. 9, October 2017, p. 17).

[14] NZ Nursing Journal, Vol. 19 No. 1, February 2013, p. 5; Vol. 19 No. 9, October 2013, p. 2.

[15] O’Connor, 2010, p. 253. 

[16] NZ Nursing Journal, Vol. 23 No. 3, April 2017, pp. 7, 11.

[17] NZ Nursing Journal, Vol. 21 No. 5, June 2015, p. 16; Memo Musa, NZ Nursing Journal  Vol. 22 No. 9, October 2016, p. 17.

[18] ‘The nursing blues: are we caring enough for the carers?’, Nursing Review, February/March 2017, pp. 4-6.

[19] Kennedy, Erin, ‘Why nurses are going on strike’, Sutff, 11 July 2018. Retrieved 12 July 2018 from https://www.stuff.co.nz/national/health/105413975/why-were-going-on-strike-a-wellington-nurses-viewpoint

[20] ‘Accord over nurses’ staffing signed: “It is the end of this vicious cycle of severe under-funding”’, RNZ, 30 July 2018. Retrieved 30 July 2018: from https://www.radionz.co.nz/news/political/362951/accord-over-nurses-staffing-signed-it-is-the-end-of-this-vicious-cycle-of-severe-under-funding

[21] ‘Nurses accept pay offer, ending months of negotiation’, RNZ, 7 August 2018. Retrieved 7 August 2018 from https://www.radionz.co.nz/news/national/363515/nurses-accept-pay-offer-ending-months-of-negotiation

[22] Broughton, C., ‘Will the new pay deal deliver more nurses?’, Christchurch Press, 9 August 2018, pp. 16-17; Williams, K. and T. Manch, ‘Nurse union members fractured after pay deal, with many doubting it had “majority” support’, Stuff 8 August 2018. Retrieved 9 August 2018 from https://www.stuff.co.nz/national/health/106097286/nurse-union-members-fractured-after-pay-deal-with-many-doubting-it-had-majority-support

[23] O’Connor, 2010, p. 227.

[24] O’Connor, 2010, p. 242.

[25] NZ Nursing Journal, Vol. 21 No. 10, November 2015, p. 5.

[26] Gorman, Des and Ruth Anderson, HWNZ, ‘Nurses still play a pivotal role in healthcare’, Nursing Review, February/March 2016, p. 28.

Unpublished sources

Buick-Constable, Byron, 'New Zealand Professional Associations: A Case Study: The New Zealand Registered Nurses' Association Inc.', BA (Hons) research essay, Victoria University of Wellington, 1967

New Zealand Nurses' Association records, 1909- 1991, ATL

New Zealand Nurses Association website: https://www.nzno.org.nz/

Published sources

Anderson, Ruth, New Zealand Registered Nurses Association: Auckland Branch, 1908-1968, Registered Nurses' Association, Auckland, 1968

Bicknell, Jessie, The New Zealand Registered Nurses’ Association and its Contribution to Nursing in New Zealand, Tolan Printing, Wellington, 1940

Burgess, Marie, Nursing in New Zealand Society, Longman Paul, Auckland, 1984

Gibson Smith, Margaret and Yvonne Shadbolt (eds), Objects and Outcomes: New Zealand Nurse’s Association, 1909-1983: Commemorative Essays, NZNA, Wellington, 1984

Kai Tiaki, 1908-1927; New Zealand Nursing Journal, 1927-2018

Lambie, Mary, The New Zealand Registered Nurses’ Association: Wellington Branch: Golden Jubilee, 1905-1955: Souvenir Booklet, Registered Nurses' Association, Wellington, 1955

Maclean, Hester, Nursing in New Zealand: History and Reminiscences, Tolan Printing, Wellington, 1932

New Zealand Nurses' Association, Annual Report, 1958-1991/2

New Zealand Nurses’ Organisation, Strategy for Nursing: advancing the health of the nation, 2018-2023, NZNO, Wellington, 2018

Nursing Review, 2015-2018

O’Connor, M.E., Freed to care, Proud to Nurse: 100 Years of the New Zealand Nurses’ Organisation. Steele Roberts, Wellington, 2010

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