GUEST BLOG: Ian Powell – It’s ‘a song and a prayer’: hidden cost of 1,300 unfilled nursing jobs

‘A song and a prayer’ is an interesting phrase. It combines a song (words set to music) and a prayer (a petition or address to God).

Biblically, by combining emotional expression with spiritual devotion, it refers to the idea that music can serve as a form of prayer.

‘A song and a prayer’ has been adaptable since early biblical years

But, like many phrases with long historical origins, it has been prone to adaptation over the years; more metaphoric than strictly biblical. For example, it was sometimes used by airforce pilots and their crews during World War 11 (my father was such a pilot).

Adapting ‘a song and a prayer’ to public hospital nurses

It is also appropriately adaptable to Aotearoa New Zealand’s public hospital nurses. Think about this in the context of the quoted paragraph immediately below:

More than 1300 nursing positions are vacant across the public health system, with frontline nurses warning the delays filling those roles are leaving hospitals increasingly reliant on exhausted staff working extra shifts to keep wards running.

This was the opening paragraph of a penetrating paywalled article by The Post’sNational Affairs Editor Andrea Vance published on 25 July: A song and a prayer for nurses.

The strength of Andrea Vance’s article is going directly to frontline nurses for real working life experiences

Vance goes directly to those at the nursing clinical frontline for their views on what this means for them at their workplace. She notes that:

…nurses say shortages mean missed breaks, cancelled training and days off spent waiting for a text message asking them to come back in. They say replacing staff who leave can take months – and sometimes years.

Nathan Clark, who has worked as a nurse for 30 years and is a New Zealand Nurses Organisation (NZNO) delegate at Hutt Hospital, cuts to the chase:

It’s basically if you think of the Titanic, when the band played and we were shifting the deck chairs every day.

They have to basically accept the resignation, then they have to go up the food chain, have to do an authorisation to recruit, authorisation to advertise, and it’s months and months and months long.

We’ve got really awesome people trying to do the best they can within the constraints of a very broken system.

Dr Ayesha Verrall, Labour health spokesperson and former health minister: The Government “broke a promise not to cut frontline jobs and found a way to save millions by not filling vacancies.” (Stuff)

Another NZNO delegate Nickie Moore, who works in Wellington Hospital’s neonatal unit and has 39 years nursing experience, reports that nurses are now routinely relying on their colleagues to pick up extra shifts to cover gaps.

However, in neonatal care specialist skills cannot simply be replaced by moving another nurse into the ward.

In her own words:

Pretty much every shift we have, we send out our texts asking for help.

The babies that we look after are very fragile, very vulnerable. The premature, or the surgical babies, or the complex babies, and babies that have had a tricky delivery.

Commenting on the pressures under-staffing creates for risks beyond the immediate pressure on nurses, she says:

When we are short-staffed, we have to close off a nursery. A nursery is a room that might have six cots, but we need to close it off because we haven’t got staff for that room.

Risk of infection increases the length of stay. It can affect the long-term outcome.

When the unit’s very busy, they cancel the education study days. Technology is changing all the time. We’ve got to keep up to date.

A song and a prayer some days

On safety risks due to these ongoing shortages,  Nickie Moore said:

It’s a song and a prayer some days. When you send a text out asking for six nurses, that means six nurses. Some babies would be one-on-one, and they’re very complex, vulnerable babies with breathing support and blood pressure support and medication support.

Another NZNO nurse delegate, this time Mel Anderson at Wellington Children’s Hospital, told Vance that staff shortages mean nurses are increasingly forced to focus only on the most urgent tasks.

In her own words:

You end up doing task, task, task. And not doing things that are actually going to make that patient feel better, which actually makes you feel better as a nurse.

Things like a patient washing and bed change – that’s really important for a patient when they’re really sick. But those tasks, if you’re not tasked urgent, they get pushed away.

These tasks, she advises can include teaching families how to manage complex care at home, including treatments such as intravenous antibiotics, adding that:

If you don’t have time to teach that, they then need to stay in hospital longer.

Anderson also notes that  getting positions approved is slow-going, giving the example of two healthcare assistant positions on her ward that became vacant nearly two years ago.

Business cases were submitted in December 2024 but approval to advertise only occurred in mid-July this year.

Unconvincing Health New Zealand response

Health New Zealand’s response to the Vance story was unconvincing. It claimed that nursing vacancies did not represented a hiring freeze. This is playing with words. Delaying approval, intentionally or inadvertently, to advertise vacancies amounts to the same thing.

Health NZ Executive National Director of People and Culture Robyn Shearer drew the short straw to defend the implausible

It claimed that the official vacancy rate had dropped from 19.9% to 10.9% since 2023. But this omits the fact that these vacancy rates significantly understate the level of shortages. Official vacancies are restricted to what Te Whatu Ora chooses to advertise.

Shortages are the number of positions actually needed. Surveys of senior doctor shortages suggest that they are greater than official vacancies by a factor between two and three to one.

Another claim was that nursing numbers were increasing. However, in a subsequent paywalled article in The Press (28 July): Nursing workforce growth stalled, drawing upon an analysis of Health New Zealand data by health economists Drs Bill Rosenberg and Jacqueline Cumming, Andrea Vance noted that the number of nurses

…has barely changed in two years, despite the Government pointing to falling vacancy rates and an active recruitment drive to address workforce shortages.

What’s also missing in Health New Zealand’s analysis

What Te Whatu Ora also fails to acknowledge is not just the severe reality of nursing shortages but also the increasing clinical demand on public hospital nurses; a tap that can’t be turned off. In particular, the significant and dangerous increase in acute admissions (unlike planned/elective cases, acute admissions can’t be deferred).

Consequences of acute hospital charges increasing at greater rate than population growth

I discussed this issue in an earlier Otaihanga Second Opinion post (8 December). Specifically I said that:

Since around 2014 the rate of acute hospital discharges has increased at a greater rate than population growth. This is a turning point for hospital occupancy by creating ‘bed-blocking’.

Too many acutely ill patients have to stay in hospital beds longer thereby restricting access for non-acute patients requiring inpatient treatment. Longer wait times and overcrowded emergency departments are the most visible consequences.

This situation is not just due to population growth and aging. Impoverishment is increasing and becoming entrenched. More sick people are now sicker people.

This goes to the heart of what is wrong with Health New Zealand. Its leadership is not on the same page as its experienced and committed health professional workforce (in this case nurses).

If Te Whatu Ora is to turn around the ‘a song and a prayer’ state of its nurses, it needs to start singing from the same song sheet as them (and in tune). Where is a good conductor when you need one!