Pulling the PIN

Andrew Chick | Senior Communications Advisor

Health and safety issues caused by unsustainable workloads and understaffing in our public hospitals have seen almost a dozen ‘PINs’ issued in the last 12 months. PINs can be a useful legal tool in holding employers to account. We spoke to nurses involved in some of the recent action to find out more.

A Provisional Improvement Notice (PIN) is a written notice issued by a Health and Safety Representative (HSR) to an employer asking them to address a health and safety concern in the workplace within a set amount of time. It represents a serious escalation of a health and safety issue and means management has a legal obligation to respond and come up with workable solutions. A PIN carries the same weight as an improvement notice served by a WorkSafe inspector. Ben Basevi is a nurse at Auckland DHB. As a union HSR for the Safe Staffing Team, he has assisted other reps across the hospital and has more experience than most of issuing a PIN. “Over the last year and a half, I’ve probably issued three for non-supply of staff. I’ve issued one for when they had an unsafe visitor policy, and in October I issued six to one workplace.” Those six related to formaldehyde exposure, where a 150% increase in the number of workbenches in a pathology lab and the introduction of lower government exposure standards meant the ventilation system couldn’t cope. The issue reached crisis point when air quality measuring devices kept sounding the alarm, requiring evacuation. Management’s initial response was to remove the devices.

Ben says PINs are a completely last resort and are usually issued after all efforts to get management to listen fail.

Breaking under the strain

In mid-2021, patient volumes, staffing shortages and fears patients could die waiting for treatment, led Dunedin nurse and HSR Anne Daniels to issue a PIN in the Emergency Department at Dunedin Hospital. It was a move wholeheartedly backed and applauded by SMOs in the department. “I would say Dunedin Hospital ED is a pretty tight team, and I would be more than happy to be there if my life needed saving. But I am also very much aware of how difficult it is when you have patient after patient and it’s just full on. You don’t get a break. You don’t get a chance to breathe,” Anne says.

We went through the whole process of reporting it and escalating it to different people.

On her days off, Anne was getting up to six texts a day asking her to come in to cover shifts. She also had colleagues getting in touch with her in tears, breaking under the strain.

She recognises that her immediate managers understood the problems, but it was becoming tougher and tougher. “I think issuing a PIN is a sign of the failure of the system,” says Anne.

Risk to psychological wellbeing

In July last year, Sonya Rider, a nurse and elected HSR for the elective and acute cluster at Palmerston North Hospital, also issued a PIN.

“We went through the whole process of reporting it and escalating it to different people. For six months we got staff to put into our risk management system that they were feeling burnt out, that patients were being held in ED for a long time and that it was affecting them psychologically.” She says senior managers were aware of the problems but said they could do nothing to change the situation. “I attended the hospital’s health and safety forum, and they were informed of how dire things were. We were facing a lot of staff resigning or walking off shift completely in tears.” The last straw came when one day there were 83 patients for the 24-bed unit. “We had them lining every spot of the corridor. And we only had our normal eight staff. The department had been in the red zone for three days and nothing had been done about it,” Sonya says.

The department had been in the red zone for three days and nothing had been done about it.

She issued a PIN over the risk to staff psychological wellbeing.

Health and safety representation

Ali Witton is the lead for worker engagement, participation, and representation at WorkSafe – the country’s workplace health and safety regulator. He acknowledges that health and safety representation in DHBs has a way to go. “I spoke to a forum of health and safety managers at the DHBs last year. Something I picked up was that some in the room saw PINs as a problem and wanted to try and stop them happening, rather than seeing them as a symptom of something.” Anne Daniels says the process of issuing a PIN can be quite challenging, and dealing with WorkSafe was not without its frustrations.

“I wanted to make sure I did it right. I’d never done it before in my life. I knew the legislation, I had the form in front of me, but really, through the entire process, there is no assistance from anyone but our union.”

Colleague support

Sonya agrees, saying using the Health and Safety Act can seem difficult in a hospital setting, but overall, the PIN was an important part of getting proper attention for staffing problems. She stresses that support from colleagues was invaluable.

“Some of our SMOs attended meetings along with myself and the Nurses Organisation. That was really helpful because it took the pressure off it being just a nursing problem.”

Sonya Rider

Some of our SMOs attended meetings along with myself and the Nurses Organisation. That was really helpful because it took the pressure off it being just a nursing problem.

Sonya’s PIN gave the DHB 14 days to respond to a list of things her colleagues wanted the DHB to do: increase staffing (including health care assistants to help with the workload), improve patient outflow, and provide more psychological support for staff. “We had a whole of department meeting which our managers came to. We asked that things be escalated to the Board so they were all informed of the current situation. And from that we ended up getting some extra FTE.” That included FTE for nursing as well as a dedicated ED cleaner overnight and one Health Care Assistant per shift. WorkSafe’s Ali Witton believes it is important to keep in mind what can be done in DHBs.

“What we are really talking about is worker participation and the ability for workers to influence the way work is done where they are doing it. That flow of information – up the hierarchy – is often blocked. As opposed to information down the hierarchy, which is usually free-flowing.” He says his key message to leadership is “listen with a view to be influenced rather than listening with a view to just respond.” He also thinks the role of HSRs is often misunderstood.

“Often they are seen as mini health and safety advisors, but they should be seen to be participating with other workers. As soon as they are leading something, like an audit, they are seen by their peers to be policing compliance. That creates this prevailing culture that being a rep is a thankless task – technically a voluntary position that you get voluntold to do.” Meanwhile, Auckland nurse Ben Basevi is convinced that the Health and Safety Act and PINs are powerful tools. “They have been very under-utilised in the health arena, and WorkSafe do seem much happier going to a factory and saying you haven’t got a guard on that saw, that’s why the man’s hand got cut off. But you’ve got to act in good faith, and you’ve got to believe the employer will act reasonably and will act as any other good employer would in reasonable circumstances. And you really can make things safer.”

ASMS is not aware of any SMOs who are elected health and safety reps in their workplaces and have the necessary training to issue a PIN (NZQA unit standard 29315). If you are a health and safety rep, we’d love to hear from you. Email andrew@asms.nz. If you would be interested in becoming a rep in your workplace, please contact your industrial officer for more information.

Ben Basevi Anne Daniels