Reforming the cost of care

In her editorial to Nursing Praxis three years ago, Rhonda McKelvie reflected on the nursing strike of 2018, the first of its kind in Aotearoa New Zealand for over 30 years (McKelvie, 2018). Whilst appropriate pay was one motivator, the need for a safely staffed environment delivering quality care was a strong driver of nursing angst. Nurses claimed that the health care system had failed to live up to its promise in 2009 to deliver a Care Capacity Demand Management (CCDM) programme to respond to excessive nursing workloads, which placed patient safety at risk. The CCDM was a partnership endeavour between the union - the New Zealand Nurses Organisation (NZNO), and the employers - the district health boards (DHBs), developed on the back of a national inquiry (Safe Staffing/Healthy Workplaces Committee of Inquiry, 2006). McKelvie, herself, played a significant role in developing the CCDM infrastructure. Yet, she too had to conclude that despite the best efforts of nurses to input data on the patient care needed and the nursing capability required to deliver it, nursing workforce gaps were not fully addressed, leading to ongoing deficits.