By Phil Pennington for RNZ
Bullying of highly trained nurses has been going on for years at one of the country's busiest neonatal units for premature babies, newly released documents show.
Staff have called into question the safety of care in a toxic environment at the unit at South Auckland's Middlemore Hospital.
RNZ has learned of investigations that found a small handful of managers at fault for bullying or mismanaging the nurses caring for the babies and mothers in the neonatal unit.
There was even pressuring behaviour going on during emergencies, sources said.
The bullying goes back at least seven years, but little was done until the middle of last year. The Nurses Organisation union backs that up.
None of this has been made public before, and the health board still will not say what it did to make sure babies and mothers were safe, and the environment was safe for staff, during the almost 18 months of investigations that have been going on.
"The concerns and the reports include a substantial amount of personal information, and about a significant number of people, including individuals no longer employed by us," the health board said in an Official Information Act response to RNZ.
Problems revolved around unreasonable rostering going back years that only got worse if nurses spoke up, sources said.
There have been previous reports of rosters at other hospitals being used to punish staff who speak up.
At Middlemore neonatal, there was a lack of support for staff after babies died, a lack of training, namecalling, and nurses concerns - even around safety - being dismissed.
"Intimidating behaviour, at times of high acuity or an emergency, walking around the ward with a rubbish bag emptying bedside drawers criticizing staff for untidiness or overstocking, instead of providing support," the report said.
"Many of those interviewed expressed genuine distress at the environment they have experienced for many years."
This piled on the stress and led to nurses resigning, sources said, in a highly stressful area of medical care, and one where Middlemore is called on often to give intensive care and special care to babies from other centres.
A big chunk of the country's specialised neonatal nurses - there are maybe 40 or 50 of them nationwide - work in the Middlemore unit, but they're incredibly stretched as many of the other nurses there are fairly junior.
Counties Manukau Health was alerted to the breakdown in management in its neonatal unit years before the investigations began and more than once, sources said.
Two closed-door investigations have been done, and a third is still going on.
First, in early 2018, a group of union members approached the union which took their concerns to management, "but little was done", the Nurses Organisation said in a statement.
In July 2018, the union raised a complaint and the board brought in an independent investigator.
The complaints were about the management of the neonatal unit, but remained confidential, the board said.
The union said that investigation ran to a "three-volume report ... with extensive recommendations".
A second internal investigation was done in recent months.
The board refused to release either report on several grounds, including privacy.
"To disclose the concerns or the reports would be likely to prejudice the regulator's investigation, which is ongoing, and the right of any person under investigation by the regulator to a fair trial," the board said.
The regulator, the Nursing Council, but will not comment on any individual case. It receives complaints about nurses' conduct and refers those to professional conduct committees to investigate..
Disclosing more information might put people off coming forward in future, the DHB said.
"Everything possible should be done to preserve the sanctity and integrity of these types of disclosure."
As for stopping the bullying, the board said it was "confident that the primary cause(s) of the concerns have now been addressed, and that a new governance structure will prevent any recurrence of similar situations in this unit".
The union confirmed some staff had left since the investigations - but not how many - and said recommendations had been acted on.
The board has not answered RNZ's questions about:
• if its changes to governance have been vetted by any independent party
• if it has assessed if the care of babies or mothers was impacted or potentially impacted by the neonatal bullying
what measures it took during months of investigations to ensure a safe environment in the neonatal unit
• whether it has added extra nurses to ease the pressure in the unit
"There are no current complaints we are aware of in [the unit], but we do know Counties are working on a number of culture-changing initiatives still," the union said.
Counties Manukau has had some of the highest rates of disciplinary action cases for staff bullying and harassment in the last five years.
Formal complaints have doubled since 2016, to more than 20 a year (across a staff of 8500, up from 7200 in 2016).
The board referred RNZ to 35 pages of guidelines on bullying it had for staff and managers but declined to say how this was working out on the ground.
It is not alone. Last year, allegations arose of widespread staff bullying at Tauranga hospital.
Bullying has been described by the Emergency Medicine Australasia journal as the most "destructive phenomenon plaguing medical culture".
Surgeons have reported bullying being "pervasive" and "endemic".
Workplace safety regulator WorkSafe has recorded 228 bullying cases from 2014 till April 2019. No one has been prosecuted.
"We investigated 20 of the 228, and 84 were either referred to a more appropriate agency (ERA [Employment Relations Authority], Police, other) or referred to the business to self-manage," Worksafe said on its website.