Nurses’ union can’t get an answer about Health NZ’s safe staffing redesign
Monday, 12 May 2025
The New Zealand Nurses Organisation says it has been “steadily sidelined” on decisions about safe staffing.
Health New Zealand Te Whatu Ora is redesigning how it calculates the number of nurses needed on a shift, but NZNO chief executive Paul Goulter said the decision to do so was made unilaterally.
In October, Health NZ said it was redesigning the Care Capacity Demand Management (CCDM) tool, which is used to work out how many nurses are needed for a specific shift based on patient numbers as well as the acuity of the patients they’ll be caring for.
The agency now says unions have agreed the redesign was needed after the health sector reforms.
Goulter disagreed: “That’s not correct. We are still at the point of arguing: ‘You need to show us why it needs to change.’ What problem are we trying to solve?”
CCDM was born in 2005 after an inquiry into safe staffing, and it evolved as other unions such as the PSA and the Midwifery Employee Representation and Advisory Service joined.
However, the “notion of a partnership” had never gone away, Goulter said.
The Ministry of Health began rolling out the CCDM programme in 2018.
A review commissioned by Health Minister Andrew Little and published in February 2022 was critical: the Nursing Advisory Group said the programme could not be successful without employing more nurses.
“The failure is one of implementation, not of the original principles and architecture [of the tool],” Goulter said.
Health NZ national chief nursing officer Nadine Gray said the programme was now “well embedded in hospitals throughout New Zealand”, but Goulter said his members would remove the word “well”.
It could not be well embedded because nurses did not have the time to input the data required for calculations, he said, but even if they did, “they’re short of staff anyway”.
They feared a new calculation would be driven by budget rather than patient need, he said. Members were increasingly frustrated with what they saw as Health NZ putting “opaque” budget processes ahead of patient safety.
In December, Health NZ deputy chief Mark Shepherd, who has since resigned, said in a statement: “We are undertaking a rapid improvement programme to assure the accuracy and quality of data, and the methodology used for CCDM FTE calculations.”
The Southland Times asked Health NZ why there was concern about the accuracy, how far along the rapid review was and how the agency was engaging with unions.
In response, Gray said the agency continued to “work with the relevant union partners to continually improve the programme” but did not say how.
She also didn’t say why the review was needed or how far along it was.
“The ongoing transformation of our health system presents an opportunity to enhance the way we embed, monitor, and continue to improve the CCDM programme, ensuring that our workforce is supported and that patients receive the highest quality care,” Gray said.
Hospitals were using the staffing methodology standard, calculating the FTE (full-time-equivalent) requirements for the year ahead, and ensuring that staffing levels met patient care demands, she said.
In the meantime, Health NZ was using tools and processes known as Variance Response Management to reallocate resources to areas in which the care required exceeded nursing resource available “to ensure staff and patient safety”, Gray said.