Australian Nursing & Midwifery Journal Volume 22, No. 2. August 2014
Standing up for what’s right What it means to be an ANMF rep www.anmf.org.au
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Editorial Lee Thomas, AnMf Federal Secretary The message that severe budget cuts impacting health, education and other services are unacceptable is clearly and loudly being driven to our government. Last month thousands of community members, including many nurses and midwives, across the country protested at ‘Bust the Budget’ rallies, voicing their deep concern and anger about the slash of more than $50 billion of health funding and other detrimental austerity measures planned. Standing by my fellow community members I spoke at the Canberra rally held on the lawns of Parliament house. The passion of the community sentiment against this budget made it abundantly clear that as one of the largest unions in this country we have an essential job to do, which is to fight hard against these cuts before they devastate the health of Australians. The ANMF’s ‘Lies, Cuts and Broken Promises’ online campaign is a great way nurses and midwives can participate in sending a clear and powerful message to our politicians to protect the future of our healthcare. Sharing your stories and making a pledge on the campaign website will help the government understand we are facing a healthcare emergency if these cuts in funding are continued. I commend many of you for contributing already and strongly urge the rest of you to participate at www.anmftakeaction.org.au and spread the word through social media using the hashtag #healthcareemergency. Through strength in numbers our voice will be heard.
In this month’s ANMJ, journalist Kara Douglas looks at the role of the ANMF job/ worksite rep. It is an essential grass-roots role, necessary in assisting fellow nurses and midwives on industrial and workplace matters. I myself started out as a rep on the ward at the hospital I was working at in South Australia many years ago. Not only was this a time that I look back at fondly and proudly because of what was accomplished, but it also became the backbone of where I am in the union movement today. I would encourage any of you interested in taking up the role to contact your local branch who will give you the support and training that you need. Also in this month’s journal, the Focus section examines the role of the oncology nurse and the work they are doing to improve the quality of life for their patients. An interesting read is the clinical update which looks at the effects of complementary medicines on prescribed medications and what the role of the nurse or midwife is in flagging these. I hope you enjoy this month’s journal, and don’t forget to pledge your support to the ‘Lies, Cuts and Broken Promises’ campaign at: www.anmftakeaction. org.au and tweet using the hashtag #healthcareemergency
As part of the campaign, ANMF Assistant Federal Secretary Annie Butler and I have been meeting face-to-face with Federal Minister for Health Peter Dutton, opposition leaders and Senators, about these concerns. With your support we will continue to lobby hard to ensure healthcare is protected.
PAGE 1 August 2014 Volume 22, No 2.
ANMF Directory Australian Nursing & Midwifery Federation National Office www.anmf.org.au Canberra
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Front Cover Federal Secretary Lee Thomas
Assistant Federal Secretary Annie Butler
Photography by Mark Coulson
Editorial
Editor: Kathryn Anderson Journalist: Kara Douglas Production Manager: Cathy Fasciale Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email anmj@anmf.org.au
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Australian Capital Territory
Branch Secretary Jenny Miragaya Office address Unit 3, 36 Botany Street, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au
Northern Territory
Branch Secretary Yvonne Falckh Office address 16 Caryota Court, Coconut Grove NT 0810 Postal address PO Box 42533, Casuarina NT 0810 Ph: (08) 8920 0700 Fax: (08) 8985 5930 E: info@anmfnt.org.au
South Australia
Branch Secretary Elizabeth Dabars Office address 191 Torrens Road, Ridleyton SA 5008 Postal address PO Box 861 Regency Park BC SA 5942 Ph: (08) 8334 1900 Fax: (08) 8334 1901 E: enquiry@anmfsa.org.au
Victoria
Branch Secretary Lisa Fitzpatrick Office address ANMF House, 540 Elizabeth Street, Melbourne Vic 3000 Postal address PO Box 12600 A’Beckett Street Melbourne Vic 8006 Ph: (03) 9275 9333 Fax (03) 9275 9344 Information hotline 1800 133 353 (toll free) E: records@anmfvic.asn.au
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The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrangement with the Australian Nursing & Midwifery Federation Federal Office Note: anmj is indexed in the cumulative index to nursing and allied health literature and the international nurSing index ISSN 2202-7114
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Branch Secretary Brett Holmes Office address 50 O’Dea Avenue, Waterloo NSW 2017 Ph: 1300 367 962 Fax: (02) 9662 1414 E: gensec@nswnma.asn.au
PAGE 2
Queensland
Branch Secretary Beth Mohle Office address 106 Victoria Street West End Qld 4101 Postal address GPO Box 1289 Brisbane Qld 4001 Phone (07) 3840 1444 Fax (07) 3844 9387 E: qnu@qnu.org.au
Tasmania
Branch Secretary Neroli Ellis Office address 182 Macquarie Street Hobart Tas 7000 Ph: (03) 6223 6777 Fax: (03) 6224 0229 Direct information 1800 001 241 (toll free) E: enquiries@anmftas.org.au
Western Australia
Branch Secretary Mark Olson Office address 260 Pier Street, Perth WA 6000 Postal address PO Box 8240 Perth BC WA 6849 Ph: (08) 6218 9444 Fax: (08) 9218 9455 1800 199 145 (toll free) E: anf@anfwa.asn.au
Moving state? Transfer your anMf membership If you are a financial member of the ANMF, QNU or NSWNMA, you can transfer your membership by phoning your union branch. Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.
CIRCULATION 96,450
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Contents Volume 22, No 1. News
4
World 17 Reflection 18 Industrial 19 Research 20
News:
Page 4
Nurses and midwives make a stand against lies, cuts and broken promises
World:
Page 17
UK district nurse extinction fears
Wellbeing 21 Feature 22 Ethics 27 Clinical Update
28
Focus 32 Calendar 45 Mail 46 Coral 48
Wellbeing:
Page 21
Focus: Oncology
Page 32
Is it possible to have a work-life balance?
Feature: Standing up for what’s right
Page 22
What it means to be an ANMF rep
PAGE 3 August 2014 Volume 22, No 2.
News Nurses and midwives take a stand against lies, cuts and broken promises Nurses, and midwives and the community are joining the Australian Nursing & Midwifery Federation’s (ANMF) online campaign, Healthcare Emergency - Lies, Cuts and Broken Promises, to stop the government from slashing healthcare funding and the introduction of other austerity measures in health. The systematic slashing of more than $50 billion of health funding to states and territories began last month. In addition the government will be asking the Senate to demolish Medicare by introducing a range of new costs for basic health services, including a $7 fee for GP visits, diagnostic and pathology services and an extra $5 for pharmaceutical medicines. The ANMF’s national campaign, also launched last month, is asking nurses, midwives and members of the community to take a stand against these measures by going to the ANMF website to nominate which lie, cut or broken promise they are most concerned about and then sharing their pledge on Facebook and Twitter using the hashtag #healthcareemergency ANMF Federal Secretary Lee Thomas said amplifying the nurses, midwives and com-
On Budget night, May 2014, the Abbott government launched a devastating assault on Australia’s universal health care system.
munity messages social media Msyour Thomas it wasa pledge imperative to Go tothrough www.anmftakeaction.org.au to share storiessaid and make to this would send a clear messagetotorespond Senators to #healthcareemergency continue the pressure. “As a collective reject these changes to funding. “Part of we can make a difference to ensure the campaign strategy is to target Senators the most vulnerable people in our comwho have the power to accept or reject munities are supported. That’s why I am these changes to the health budget. We encouraging all of you to participate and will be lobbying hard for them to oppose take a stand and hold the government these changes going through.” to account for the healthcare emergency they are creating.” Ms Thomas said she was pleased how nurses and midwives had embraced the To join the Healthcare Emergencycampaign so far. “Nurses and midwives Lies, Cuts and Broken Promises camunderstand the serious consequences this paign go to www.anmftakeaction.org. budget will have on our healthcare and au and share your pledge on Twitter the wellbeing of Australians. They are the and Facebook using the hashtag ones who will be left to deal with the fall #healthcareemergency out including coping with increased loads and sicker patients who delay seeking care because they could not afford it.”
Australians say bust the budget! Nurses and midwives joined thousands of community members at ‘Bust the Budget’ rallies around the country last month. People in their thousands joined rallies in Melbourne, Adelaide, Brisbane, Hobart, Darwin, Sydney, Canberra and Perth on 6 July to express their disappointment and dismay at the array of planned government cuts. Australian Nursing & Midwifery Federation (ANMF) Federal Secretary Lee Thomas, who addressed crowds at the Canberra rally, said the sheer numbers that attended the rallies in the capital cities was a clear indication that Australians were not willing to stand by and see services destroyed. “People are very angry at the government for introducing such measures that will ultimately break the backbone of social support services in Australia including healthcare, education and other social supports.” PAGE 4
Lee Thomas speaking at Bust the Budget rally, ACT
News Hear our message loud and clear Australian Nursing & Midwifery Federation (ANMF) Federal Secretary Lee Thomas and Assistant Federal Secretary Annie Butler have been lobbying senators and politicians as part of the Healthcare Emergency - Lies, Cuts and Broken Promises campaign to fight cuts to healthcare and the introduction of fees for healthcare services.
The union leaders are also lobbying against increases to higher education debts. Last month Ms Thomas and Ms Butler, met with the Shadow Minister for Health, Catherine King, Shadow Assistant Minister for Health, Stephen Jones, and Shadow Minister for Communities, Claire Moore at a media event on the front lawn of Parliament House to highlight the union’s concerns. During Parliament that day ANMF leaders and members watched from the Gallery as shadow ministers asked questions on the budget that would impact healthcare and the professions. These included questions about nurse and midwifery job losses, and the nursing workforce crisis, pressure on the public hospital system, as well as the potentially crippling debt nurses will acquire for their education. The ANMF secretaries also met with Federal Minister for Health Peter Dutton, where they affirmed ANMF’s opposition to the budget cuts. “We have informed the Minister, in no uncertain terms, that the ANMF will continue to actively campaign against budget cuts impacting healthcare and the professions.” The Minister was also told that the ANMF would continue lobbying senators to ensure these changes were rejected.
Healthcare Emergency What you can do
ANMF Federal President Coral Levett joins NSNMA members at Bust the Budget rally, NSW
• Visit the ANMF website • Nominate which lie, cut or broken promise you are most concerned about • Share your pledge on Facebook and Twitter using the hashtag #healthcareemergency • Change your Facebook profile picture to the #healthcareemergency logo and share the campaign with friends and family PAGE 5 August 2014 Volume 22, No 2.
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News Dementia funding axed causes alarm Aged care providers from across the country converged in Canberra last month to persuade the Minister for Social Services Kevin Andrews to protect quality of care for people living with severe dementia. The providers’ action came after the federal government axed the Dementia and Severe Behaviours Supplement, which came into effect on 31 July, causing great alarm within the aged care sector. Leading Age Services Australia Chairman Marcus Riley said the funding withdrawal would have a devastating impact on individuals who needed extra support. “Our
research shows that it will also damage the industry’s ability to invest in training and dementia-specific care environments. “We are desperately worried that if the government goes ahead and rips funding away from people with disturbing behavioural and psychological symptoms that this could contribute to an unsafe environment to all residents and care staff.” Australian Nursing & Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the cut would dramatically impact the funding and quality of care being delivered to elderly, vulnerable Australians. “There are currently more than 332,000 Australians living with dementia and with these
Obesity hitting crisis point
numbers set to soar to almost one million by 2050. It is therefore important that in funding residential care, the extra costs of caring for people with dementia are considered.” Ms Thomas said without any warning the Abbott government had launched yet another attack on the aged care sector. After the election the government quickly moved to rob nurses and aged care workers of $1.1 billion in agreed funding for wages, education and training, by overturning the Workforce Supplement.”
for the coming generation of elderly, their families and the government. This underscores the importance of increasing our efforts to prevent weight gain throughout life and to support those with overweight and obesity to prevent further weight gain, improve fitness and gain appropriate treatment.” According to the report’s recommendations multiple strategies, policies and programs will be required to address the issue. These include: sweeping changes to sedentary workplaces (a known risk factor for obesity) that promote more physical activity and healthier food choices throughout the working day; taxes on unhealthy junk food; restrictions on advertising junk food to children; ensure the availability and affordability of nutritious foods; and the introduction/follow of public health and wellbeing plans.
Obesity levels will reach crisis point unless a whole of community and government approach is adopted, research from Australia has found. By 2025 an estimated 16.9 million Australians - 83% of men and 75% of women will be obese or overweight. The VicHealth research summary found lower socioeconomic groups were most likely to become overweight or obese,
predicting that in 11 years, 44% of people with greatest disadvantage and least resources will be obese. Research lead Associate Professor Anna Peeters said despite best efforts Australians were ‘fighting a tide’ of environmental factors that lead to poor diet and physical inactivity. “Our research showing that overweight and obesity in middle age will compromise people’s ability to live independently in old age has implications PAGE 7 August 2014 Volume 22, No 2.
News Immunisation grants up for grabs
Nurses and community organisations can improve their immunisation programs by applying for one of four immunisation grants worth $20,000 each.
gaps in service delivery and patient contact especially in remote areas or with refugee communities. Dr Hearnden said funding would support valuable work of groups including community health teams, Medicare Locals, General Practice Networks and individuals such as practice nurses, maternal and child health nurses. “The grants help providers make a positive impact on immunisation in their local community,” he said.
Dr Neil Hearnden, a GP vaccination specialist and independent chair of GSK grants judging panel with Erin Senz, past winner and Coordinator of Primary Care Programs at Medicare Local Tasmania.
The grants, sponsored by pharmaceutical and healthcare company GSK, aim to help improve access, coverage and timely delivery of vaccination services.
Chair of the grants judging panel Dr Neil Hearnden said that nurses and doctors working in communities had great insight, drawing on their clinical experiences to uncover
Streamlining organ and tissue donation
A new clinical information system that will streamline organ and tissue processes across Australian hospital networks was launched live nationally last month. The DonateLife Electronic Donor Record (EDR) is a clinical information system used by donation specialists and replaces a manual paper-based record system. The record will provide real-time access to essential information about organ donors from the donor referral, organ offer, donor management and organ retrieval processes. According to Federal Assistant Minister for Health Fiona Nash, the EDR will make comprehensive donor referral data, medico-social history and family consent
information readily available for consideration by transplant units and donation coordination specialists in a consistent format. “The EDR replaces a 28-page based form known as the Confidential Donor Referral Form. Donor coordinators would then spend many hours making phone calls and coordinating information with transplant units to identify a suitable recipient.” Minister Nash said the roll-out of the system would ultimately benefit Australians awaiting a transplant, donor families and
457 visa program under review
The federal government is considering recommendations made from a review of the 457 visa program, the Senate was told last month. The Australian Nursing & Midwifery Federation (ANMF) and the ACTU have been raising concern about the employment of 457 visa workers over Australian employees, including graduate nurses. In the Senate, Assistant Minister for Immigration and Border Protection Senator Michaelia Cash said she was currently considering the recommendations made from an independent review panel. PAGE 8
The Senator made the claim after being questioned on the lack of graduate nursing positions available in Queensland by senate leader of the Palmer United Party, Senator Glenn Lazarus. “Can the Senator explain why the federal government continues to support the importation of overseas nurses and midwives on 457 working visas while Queensland has the highest level of graduate unemployment and underemployment in the nursing and midwifery sector,” he asked.
GSK Vaccines and Medical Director Dr Mark Amies said while Australia had a comprehensive childhood immunisation program that targeted adult scheme, there were still people needing assistance. “Communities and at-risk populations who have greater contact with the education programs, intervention or better access to innovative programs are more likely to have better outcomes.” Applications close 15 August. For more information go to: www.immunisationgrants. gsk.com.au
donation and transplant specialists. “Time and access to consistent information are crucial factors in facilitating the donation and transplant process.” The EDR is a clinical platform for donation specialists. It is a separate system to the Australian Organ Donor Register – the national database of people who register their intentions to be organ and tissue donors. To register your decision about becoming an organ and tissue donor go to: www.donatelife.gov.au
Senator Cash replied that the 457 visa program had slowed and where there was an Australian ready, willing and able to be employed, an employer was obliged to do just that. After Senator Lazarus continued questioning further, Senator Cash said a review of the 457 visa program had been undertaken and that she was currently considering their recommendations. “I will be making announcements in due course in relation to the 457 visa program,” she said.
When pain is gone, hugs are back on.
Nothing is more suitable
1–3
Children’s Panadol® is a first-line choice for the relief of pain and fever,* and is suitable for babies as young as one month.1,2 FIRST-LINE CHOICE FOR RELIEF OF PAIN AND FEVER*1
*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.1 References: 1. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. 2. Children’s Panadol Approved Product Information, last updated November 2009. 3. NSW Department of Health. Infants and children: Acute management of fever. Clinical Practice Guidelines, 2nd edition, 2010. Available at: http://www.ciap.health.nsw.gov.au. Accessed September 2012. Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDREN’S PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1151/UC.
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On Budget night, May 2014, the Abbott government launched a devastating assault on Australia’s universal health care system. The ANMF has launched a new national campaign to stop these changes before they have the chance to devastate the health of Australians. Stand up and be counted. Share your stories and make a pledge to respond to this #healthcareemergency
Show your support at www.anmftakeaction.org.au
News Recognition of rural and remote telehealth clinical service providers By Julianne Bryce, ANMF Senior Federal Professional Officer and Vicki Sheedy, ACRRM Strategic Programs Manager Registered nurses and midwives already providing telehealth services are being invited to establish and develop a peer network. The network will be part of the Australian College of Rural and Remote Medicine’s (ACRRM) Telehealth Provider Directory. The directory database, which is the first national non-commercial database, operational since 2012, aims to assist nurses, midwives, GPs and other patient-end clinicians in Australia to obtain relevant information regarding specialists providing telehealth services and vice versa. The directory is endorsed by the members of the ACRRM Telehealth Advisory Committee (ATHAC), which includes nursing peak bodies and medical specialist colleges across Australia.
The next exciting development to the Provider Directory is a peer mentor listing. This will be designed to enhance professional networking amongst clinicians and to support informal peer learning between experts and novices in the use of Telehealth.
ACRRM has collaborated with the Australian Nursing & Midwifery Federation (ANMF) over four years in the development of resources to assist clinicians in the establishment of telehealth services.
In addition to the directory database ACRRM has developed a Telehealth community at www.eheath.acrrm.org.au The web portal provides access to:
The use of telehealth seen by ACRRM and the ANMF is an important component of effective rural and remote practice and consider that a collaborative and interprofessional approach is essential for successful implementation.
• Telehealth toolkit for providers • Telehealth clinicians provider directory and connection services • Telehealth technology directories • Online discussion forums • Videos and case studies Registered nurses and midwives are critical to the success of telehealth in reaching the rural, remote and underserved populations, making this an invaluable resource.
If you are interested in being involved in the peer network email ehealth@acrrm. org.au or Vicki Sheedy, ACRRM Director of Strategic Development, for further information v.sheedy@acrrm.org.au If you would like to be part of the telehealth community go to: www.eheath.acrrm.org.au
Nothing is more versatile
1
Children’s Panadol® offers an extensive range to manage pain and fever in children aged one month to 12 years.1
FIRST-LINE CHOICE FOR RELIEF OF PAIN AND FEVER*2
*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.2 References: 1. Children’s Panadol Approved Product Information, last updated November 2009. 2. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. Childrens Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDRENS PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1154/UC.
GSK1154 Childrens Panadol_ANMJ Half Pg_Versatile_v2a_FA.indd 1
19/06/14 12:13 PM
PAGE 11 August 2014 Volume 22, No 2.
Trek Nepal Adventure Volunteering Volunteer • Trek • Give
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News Hearing loss detected through app
and the elderly for hearing loss, according to the International Journal of Audiology. More than 360 million of the world’s population suffers from permanent disabling hearing loss and more than 32 million of these are children, data from the World Health Organization (WHO) reveals. In developing areas, up to 80% of people with hearing loss have no prospect for early detection. In addition to using the app in developing countries, co-author of the paper, UWA’s Adjunct Professor Robert Eikelboom said he hoped the app could be used in an Australian setting, particularly in remote communities.
Professor De Wet Swanepoel testing a child with smart phone app HearScreen
A smartphone app that can screen for hearing loss will benefit those in developing countries and in rural areas, a new report reveals. The ‘HearScreen’ app, developed by researchers at the University of Pretoria (UP), South Africa, University of Western
Australia (UWA) and Ear Science Institute Australia, will make it easier and cheaper to screen people, including young children
The app screening takes one minute and the data can be uploaded via the mobile phone network to a centralised site for evaluation and recommendations. “Mobile health technologies such as this app are becoming more and more important in taking healthcare to the people who would otherwise not have screening,” said research lead UP Professor De Wet Swanepoel.
Keeping kids’ ears healthy Strait Islander peoples of ear disease, focussing on risk factors for ear disease and promoting the importance of seeking and following treatment to prevent hearing loss.
A campaign on keeping kid’s ears healthy to ensure they have good hearing has been launched by the government. The Campaign particularly aims to increase awareness among Aboriginal and Torres
The Campaign includes a range of electronic and hardcopy resources for parents and carers, healthcare workers, early childhood groups and teachers. A number of the resources have been translated to up to 22 Indigenous languages spoken across Australia. In addition a ‘talking book’ has been produced which communicates ear health promotion messages in English and in a range of Indigenous languages. The
resources compliment the information that can be found on the campaign website. Youth Hearing Health Coordinator Sandi Nelson said children’s ears should be checked every time they are in the clinic. “If they’re coming in for an immunisation, a chest infection, or even a splinter in their toe – check their ears. A quick 10 minute test can make all the difference. It’s impossible to underestimate the importance of kids’ hearing.” The Care for Kids’ Ears resources and online videos talking about the impact of ear disease on Aboriginal and Torres Strait Islander children can be found at: www.careforkidsears.health.gov.au
Women leadership in the Pacific A dialogue for Pacific women political leaders and policy makers to help address the barriers to women’s leadership and to discuss ways to improve the lives of women in the Pacific, was held in Tonga last month. The event, attended by 30 Pacific women leaders and senior women in government,
was hosted by Australia’s Ambassador for Women and Girls Natasha Stott Despoja and supported by the Australian government.
reducing poverty and promoting economic growth and democracy, an Australian government communiqué said.
Women in the Pacific are under-represented in their Parliaments, comprising of about 5% of Parliamentarians compared to the global average of 21.7%. Improving leadership and decision-making opportunities for women in the region was essential to
Following the dialogue a second Women Parliamentarian Partnerships forum will be held to focus on building women Parliamentarians’ skills in community consultation and working to influence policy changes that benefit women. PAGE 13 August 2014 Volume 22, No 2.
POSTGRADUATE DEGREES INFORMATION SESSION Deakin University School of Nursing and Midwifery invites you to an information session to hear about our innovative postgraduate degrees: • • • • •
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Melbourne Burwood Campus, 221 Burwood Highway Burwood. Building BC, Level 2. Tuesday 9 September, 5.00–6.30 pm. A short presentation will begin at 5.15 pm after light refreshments. There will be an opportunity to move to breakout rooms with course leaders to discuss specific courses and answer your questions. To register your attendance at the information session please email nursinfo@deakin.edu.au. For more information call 9244 6102, deakin.edu.au/nursing DEA0079 Deakin University CRICOS Provider Code: 00113B
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News High numbers of stroke burden found nationally The impact of stroke across the Australian landscape has been mapped out for the first time ever. The report showing that no postcode has been left untouched by the condition.
Close to 440,000 Australians are living with the impact of stroke. The disease also costs the Australian economy $5 billion a year, including $3 billion in lost productivity. “Despite successive governments recognising stroke as a national health priority, Australia does not have a federally funded strategy or the care services to address the widespread need,” Dr Lalor said. The report reviewed data including estimates of the number of strokes, survivors and the death rate. It also identified where stroke is having the biggest impact and where stroke survivor support is needed. Per head of population South Australia and Tasmania had the highest rates of stroke burden, however other states also recorded high levels of strokes.
The Stroke in Australia: No postcode untouched report, mapped out by the National Stroke Foundation, revealed just how big the stroke challenge is in each Australian electorate.
National Stroke Foundation CEO Dr Erin Lalor said every ten minutes someone in Australia will suffer a stroke, totalling in a thousand cases a week. “Close to 12,000 people will die in 2014 from stroke and twothirds of those that survive will be disabled.”
“By ranking electorates we can understand where the impact is greatest. While this ranking can help with service planning and coordination, our report demonstrates that the burden of stroke is significant in all parts of the country,” Dr Lalor said.
Workers still believe antibiotics work for colds and flu Nursing posts to be upgraded Nearly two in three Australian workers mistakenly believe that taking antibiotics will help them get over a cold or the flu and back to work sooner, according to a poll undertaken by Galaxy research.
such as pneumonia and tuberculosis harder to treat with potentially dire consequences.”
The research, taken on behalf of NPS MedicineWise, indicates the misconception could be contributing to the spread of antibiotic resistance in Australia.
• Staying at home if not well • Using a tissue when coughing or sneezing and disposing of it properly • Washing your hands with soap and running water particularly after coughing or blowing your nose, and before preparing or eating food • Avoid touching eyes, nose and mouth • Not share cups, glasses and cutlery • Keeping household surfaces clean.
NPS MedicineWise clinical advisor Dr Andrew Boyden said antibiotics only worked for bacterial infections, not viral infections like colds and flu. “To help prevent the growing problem of antibiotic resistance it’s important that all Australians recognise and address this misconception. Using antibiotics when they are not needed, like for colds and flu, is contributing to antibiotic resistance. This is making bacterial infections,
To help prevent the spread of colds and flu in the workplace, Dr Boyden encourages Australian workers to practise the basics of hygiene such as:
Nursing posts along with small hospitals in the Central Wheatbelt and Great Southern regions will be upgraded as part of a major $325.8 million healthcare infrastructure boost.
The initiative, funded by the Western Australian government’s Royalties for Regions program, will involve infrastructure upgrades and may include an upgrade to existing facilities, said State Health Minister Kim Hames. “Community consultations and planning will continue to be undertaken to determine what works will be carried out to the small hospitals and nursing posts.” The upgrades are part of the state government’s Southern Inland Health Initiative that also includes upgrades to six district hospitals and funding towards the Primary Health Care Demonstration Site program, with the first two sites in Pingelly and Cunderdin underway. PAGE 15 August 2014 Volume 22, No 2.
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Poverty and severe hardship affect more than a million Australians. Around the world more than a billion people are desperately poor. In Anti-Poverty Week help fight poverty and hardship. • Why not organise a display, stall or award? • Maybe a workshop, lecture or forum? • How about a fundraiser, fact sheet or petition?
For more information and ideas: • visit www.antipovertyweek.org.au • email apw@antipovertyweek.org.au • call 1300 797 290
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Poverty and severe hardship affect more than a million Australians. Around the world more than a billion people are desperately poor. In Anti-Poverty Week help fight poverty and hardship. • Why not organise a display, stall or award? • Maybe a workshop, lecture or forum? • How about a fundraiser, fact sheet or petition?
For more information and ideas: • visit www.antipovertyweek.org.au • email apw@antipovertyweek.org.au • call 1300 797 290
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World UK district nurse extinction fears The Royal College of Nursing (RCN) in the UK has warned district nurses are currently ‘critically endangered’ and face extinction by the end of 2025 if urgent investment is not made.
According to the RCN there has been a 47% reduction in the number of qualified district nursing staff in England, threatening the ability of the whole health and social care system to cope with soaring numbers of frail older people in the coming decade. The college is calling on the government to fulfil its commitment to increase the community workforce by 10,000 in order to plug this growing gap. Dr Peter Carter from the RCN said it is the only way to meet the growing demands of an ageing population. “The district nurse role is the foundation of a system which should be able to manage conditions and keep sick and frail people at home. Remove
those foundations and the whole edifice could come crashing down.” A RCN survey found many community staff reported being pushed to breaking point, with
Midwives could cut maternal and newborn deaths Midwives could provide the majority of essential care needed for women and newborns and potentially reduce maternal and newborn deaths by two thirds, according to a new global report. The State of the World’s Midwifery: A Universal Pathway – A Woman’s Right to Health report found midwives could provide 87% of essential care for women and newborns when trained and supported by a functional health system. Midwives make enormous contributions to the health of mothers and newborns and the wellbeing of entire communities,” said Dr Babatunde Osotimehin from the United Nations Population Fund (UNFPA).
The report presents findings on midwifery from 73 low and middle income countries. These countries are home to 96% of the global burden of maternal mortality, 91% of stillbirths and 93% of newborn mortality, yet they have only 42% of the world’s physicians, midwives and nurses. “Access to quality healthcare is a basic human right. Greater investment in midwifery is key to making this right a reality for women everywhere,” said Dr Osotimehin.
more than eight out of ten working additional hours on their last shift. Three quarters said they had left necessary activities undone due to a lack of time, and four in ten said that they would leave the job if they could.
There has been some progress in reducing the number of women and newborn deaths since the inaugural State of the World’s Midwifery report was released in 2011. Thirty-three of the 73 countries covered in the report have implemented efforts to improve workforce retention in remote areas, while 20 countries are increasing the recruitment and deployment of midwives.
The report estimates 289,000 women and 2.9 million newborns died in 2013. The vast majority were due to complications or illnesses that could have been prevented with proper antenatal care or the presence of a skilled midwife during delivery.
The latest report also makes recommendations to help countries build on this progress. Recommendations include addressing issues such as child marriage and poor nutrition during pregnancy, ensuring pregnant women have access to four prebirth care visits and improving women’s access to emergency services when needed.
Margaret Hellard from the Burnet Institute’s Centre for Population Health.
edge and evidence, prevent transmission and improve screening, care and treatment.
Professor Hellard helped draft the initiative after a meeting on hepatitis, which brought together researchers, academics, NGOs, civil society, development agencies and the WHO.
According to the WHO, the number of deaths each year from viral hepatitis is slightly less than for HIV and AIDS at 1.46 million, but much more than tuberculosis (1.2 million) and malaria (1.17 million).
Call to action on hepatitis The World Health Organization (WHO) has launched a new global campaign to raise awareness of viral hepatitis. The ‘Call to Action to Scale up Global Hepatitis Response’ highlights the global impact of viral hepatitis on human health. “There are over 1.44 million deaths from viral hepatitis every year, despite many of these infections being either preventable or curable in those infected,” said Professor
The Call to Action calls on the global community to take immediate and concerted action to increase advocacy and awareness, knowl-
More than 200,000 people live with hepatitis C in Australia. PAGE 17 August 2014 Volume 22, No 2.
Reflection Steve Brown
A conversation about the registered nurse’s role government, over twenty years show (Crisp 2008). No wonder so much delay as beneficiaries in the hospital system who represented the interests of status quo, bureaucracy and the state were threatened. An exploitive system riddled with sexism, elitism, hierarchical, autocratic and bullying it successfully inculcated young working class nurses with exploitative narratives justifying selfless giving, no matter the personal cost, of minimal training, low pay, payment in kind, and long unsociable hours to be suffered without protest. A closed world, controlling almost every aspect of student nurses lives in order to socialise them. The eventual move to universities in 1975 opened whole new vistas of critical thought and opportunity to young working class nurses and smashed the old narratives.
A response to the feature, ‘The responsibility of care’ ANMJ June 2014 “Conversations”, the new political speak for narratives, and like the old narrative an essential tool for influencing, developing and justifying policy (Mumby 1987). The conversation we have to have around the role of nurses should not be inwardly looking, smacking of self-deprecation and self-blame. The only conversations that matters to working class nurses are about our approach to power politics and quality education - power to get what we need as professionals and power to sustain a broad university education reflective of our holistic roles as registered nurses. There is no doubt the use of nursing power results in funding, and a failure to exercise our power results in nothing. Inadequate funding leads to responses by junior nurse managers and administrators to reduce labour costs and shift workload onto frontline nurses. Registered nurses’ work is being substituted and devalued by lesser qualified health workers and volunteers. Then there are shorter shifts and contracts, increasing and ever evolving allocated work, and unpaid overtime at the shifts end. For nurses the results are unsociable rostering, heavy workloads, short cuts, errors and bullying amongst other issues. PAGE 18
At all levels nurses have been co-opted into narratives and language that supports the status quo and organisational oppression undermining the situation of nurses and the profession. Take for example the word “prioritisation”, it implies some work can be left till later, but effectively keeps dedicated nurses back to finish their non-priority jobs after shifts end. There are numerous others including, “can’t you manage”, and the big one “we have no overtime for that”. It’s no wonder the general public hold nurses in such high regard, it’s our dying dedication. Trying to do so much with so little and expected to do more with less. This aspect of nurses’ work is strangely ignored by the conservative press. They would rather manufacture a link between the nurse’s role, a university education and bad nurse behaviour. According to Shields and Watson (2007), studies have shown university trained nurses are responsible for superior health outcomes not worse. The link for nurses between political/bureaucratic powerlessness, inadequate education and poor health outcomes is well proven. There are only two narratives that matter in nursing, and they are well illustrated by the adoption of university education in 1975, and nurse power in Victoria’s great nursing strike of 1986. The first, university education was long debated and resisted, by the established bureaucracies as fifteen reports to the
The second and related issue was Irene Bolger and the great Victorian nursing strike of 1986. It was a watershed, awakening of nurse power. A grassroots discontent drove the strike which was resisted by entrenched forces. Under Bolger’s leadership it resulted in large pay increases for junior nurses and a new respect for nurse power (Ross 1987). Now those gains are being threatened by privatisation. The same conservative, forces are attacking registered nurses work, with the same elitist and oppressive narratives including the “nurse’s role”. Co-opting nursing thought to justify Taylorist work practices, fragmentation of holistic care ideals, and nursing education. Following the UK’s example, will see further fragmentation of RN’s work, and, for working class nurses, reduced education opportunities, conditions and wages.
References
Crisp,J. et.al. (2008) Potter and Perry’s Fundamentals of Nursing p.5 www.inkling.com/...nursing...1/the-history-ofmodern-nursing 30/6/2014 Mumby, D.K. (1987) The political function of narrative in organizations Communications Monographs, PP. 113-114 Ross, L. (1987) Dedication doesn’t pay the rent! 1987 The 1986 Victorian nurses’ strike. Socialist Action vol XIII (1) Shields, L. and Watson, R. (2007) The demise of nursing in the United Kingdom: a warning for medicine, J R Soc Med. Feb 2007; 100(2): 70–74.
Steve Brown, Clinical Nurse Specialist, B.Health Sc. Nursing, Cert. Renal Nursing.
Industrial Andrew McCarthy, Federal Industrial Officer
Dealing with bullying As from the beginning of the year, the Fair Work Commission has been receiving and dealing with employee applications to end bullying in the workplace. The legislation for the Commission’s jurisdiction was introduced by the former federal Labor government and passed by Parliament last year. While the jurisdiction does not apply to as many people as desirable, for those affected workers who are covered it provides a cheap and efficient option to take action, especially where an employer fails to take sufficient action to stop bullying in the workplace. Under the jurisdiction, workers who reasonably believe that they are being bullied at work can apply to the Commission for an order to stop the bullying. Bullying is defined as repeated unreasonable behaviour that creates a risk to health and safety. The Commission is required to start dealing with any applications within 14 days. The Commission is not able to award monetary compensation but, if it determines that bullying has occurred and there is a risk that it will continue, is able to make orders directed at the relevant individuals (eg. work colleagues or managers) to cease bullying conduct. Despite alarmist claims from some employer groups and conservative commentators that the jurisdiction would lead to a flood of claims, the number of applications so far has been less than predicted. In the first quarter of 2014, the Commission received 151 applications; the Commission had been preparing itself for about 3,500 applications annually. Few published decisions have so far been made, mainly on the basis that most applications are able to be resolved between the relevant parties, so the details remain private. In one of the few matters so far where the Commission has made an order, the Commission ordered that an employee found to be bullying should have no contact with the applicant, make no comment on the latter’s clothes or appearance, not send any emails or texts to the applicant except in emergency circumstances, and ordered that both parties not come to work and leave work by a particular time. One unfortunate hole in the jurisdiction is that it generally does not apply to those working in the public sector, except for
the Commonwealth and territory public sectors. The bullying laws therefore are mainly restricted to those employers who can be considered to be ‘corporations’. Unfortunately this is not an easy question to resolve, however many state public sector entities and local councils are not corporations. For example, the Commission has decided that a not-for-profit service in Victoria which received government funding to provide support services to people with psychiatric disabilities was not a trading corporation, therefore the applicant employee could not proceed with her claim. This means that many public sector nurses (outside the federal or territory public services) will not be able to access the jurisdiction, however given the uncertainties you should ask your branch for advice. A recent NSW Parliamentary inquiry into the state’s workplace health and safety regulator WorkCover NSW, which was (ironically) found to be rife with bullying, noted the legislative gap and has recommended that the NSW Parliament pass similar anti-bullying laws to remedy the deficiency. The need for laws regarding bullying is demonstrated by a recent statement released by Safe Work Australia, the national health and safety body. It found that the rate of workers’ compensation claims made on the basis of bullying has increased over the last ten years. It also noted that the health and community services industry had the third highest frequency of claims. Another area where the Commission has made recent decisions is in relation to whether an employer’s action was ‘reasonable management action carried out in a reasonable manner’. If particular conduct is considered as such, then it is defined not to be bullying. This issue will frequently arise where allegations of inadequate performance are made by the employer. In one decision, the Commission found that the employer’s conduct in handling bullying complaints made against the applicant herself was reasonable including by referring the complaints to an investigation and the way the investigation was carried out.
bullying occurring in the first place. As a health and safety issue, bullying should be dealt with in the same way as any other workplace hazard: by the employer assessing the likelihood of health and safety problems arising, devising and applying suitable measures to prevent bullying occurring and then monitoring and reviewing measures to ensure their effectiveness. If bullying is reported, employers should act to address the problem and put in place measures to ensure it does not continue or recur in the future. If you believe you are a victim of bullying or have had bullying allegations made against you, you should speak to your relevant ANMF branch for further advice.
Aside from bullying laws that allow affected individuals to take action, employers are also legally obliged to ensure a healthy and safe workplace by preventing PAGE 19 August 2014 Volume 22, No 2.
Research Cholesterol drug could slow osteoarthritis
Drugs used to lower cholesterol are being trialled to stop the advancement of osteoarthritis.
Study shows Indigenous health gap widening Researchers at the University of Western Sydney have found Indigenous children from Mount Isa in Queensland are more than five times as likely to be admitted to hospital for certain chest infections than non-Indigenous children. The study published in the Medical Journal of Australia looked at children under the age of 15 years who were admitted to hospital for conditions such as pneumonia and bronchial infections between 2007 and 2011. The findings show the annual admission rates for Indigenous children with infections were similar to those reported for the Northern Territory, where rates of pneumonia in children under a year old are among the highest in the world. “Our study provides evidence that acute lower respiratory infection (ALRI) is a major, increasing health burden in north-west Queensland, especially among Indigenous children,” said the report authors.
Monash University’s Professor Flavia Cicuttini said osteoarthritis was the most common cause of knee pain and disability in people aged over 50. “Knee pain is a common and debilitating problem for many people, whether it is from simply getting up out of bed in the morning, walking the dog, driving the car or sitting for too long.”
which may delay or negate joint replacement surgery altogether.”
“Current treatments usually don’t stop pain completely, leaving people the only option of getting joint replacement surgery.
Researchers are looking for people aged over 40 who suffer knee pain to take part in the trial. For more information contact: (03) 9903 0553 or email jointstudy@monash.edu
“This trial will look at whether low cholesterol drugs stop osteoarthritis worsening,
As part of the trial, magnetic resonance imaging (MRI) will be used, which Professor Cicuttini said will enable the team to look closely at the knee joint and assess how the disease is progressing.
The report found average annual hospitalisation rates by age group were five to eight times higher for Indigenous children compared to non-Indigenous children. The report authors said it was not yet certain why Indigenous children are predisposed to these infections. “Possibilities include prematurity and intrauterine growth restriction, under-nutrition, poor hygiene and exposure to cigarette smoke.” The study said more attention needed to be paid to the region and that the rise of ALRI showed the Indigenous health gap is widening despite national aspirations to close it.
Researchers unlock key to triggering labour in pregnancy Australian researchers have identified an electrical switch in the muscle of the uterus that can control labour and may help explain why overweight pregnant women have difficulty giving birth. After studying uterine muscle biopsies from 70 pregnant women, researchers found a uterine muscle ion channel that sends electrical signals that control uterine contractions. This channel does not function properly in overweight mothers, resulting in higher rates of Caesarean delivery. Monash University’s researcher lead Professor Helena Parkington, said the switch needed to be turned off to allow labour contracPAGE 20
tions to occur, but remained turned on in overweight women.“The reason it stays on is that the ‘molecular hand’ that should turn the switch off fails to appear in sufficient quantities in the uterine muscle of overweight women when labour should be occurring. These women also respond poorly to our current methods of induction.” University of Melbourne and Royal Women’s Hospital researcher Professor Shaun Brennecke said the finding significantly advances understanding of how labour progresses, with implications for all women who have complicated labours. “The clinical significance of this discovery is that, having identified the problem responsible for dysfunctional labour in overweight women, we are now able to look at developing
a safe, effective and specific treatment to correct the problem. For example a drug to turn off the switch to allow normal labour to start and progress.” Pregnant women who are overweight often continue pregnancy past their due date or progress slowly when labour begins. Recent findings show 52% of Australian women are overweight, including 35% of women aged 25-35 years of age. As a result, the proportion of overweight women in pregnancy is also rising. Overweight women have higher rates of medical interventions around labour and birth, including higher rates of induction for prolonged pregnancy and higher rates of Caesarean section as a result of failure to progress in labour.
Wellbeing Bron Watson
Is it possible to have a work-life balance? As nurses we have all at some time experienced shift work where you were at work and everyone else wasn’t! To sign up for nursing, means signing up for working strange hours and shifts. Our profession is a 24/7 day job, something you all know too well, especially if you have been working for a while, however, it does not mean you have to love it. In fact there are times when many of you wish you could just give it all away! Is there such a thing as work-life balance (WLB)? Great question! The truth of it is, balance alone will not solve this issue, it does not mean an equal life, it is more about having a fulfilling life and enjoying what you do. There are times when you need to work, there are times when you need to rest, and these vary from day to day, person-to-person; different priorities, different lives. In the ever-changing environment of nursing today, Simmons (2012), states that although this is a challenging task, it is necessary for your health and ongoing wellbeing. In fact, your future depends on it. I have been asked…‘How do I achieve a work-life balance, how to make it work and enjoy both working as a nurse and having a ‘balanced’ life?’. Research is numerous, blogs and experts aplenty, however, a common theme emerges, and is based on two core concepts; achievement and enjoyment. Achievement is something I am sure you are familiar with, let’s take a look at enjoyment and why this is important to have BOTH these in living the life you want. As part of a relevant WLB definition, enjoyment does not just mean ‘laugh until you drop’ style happiness. It can mean anything from love, a sense of empowerment, pride, joy, and a satisfaction of a job well done…both at work and in your down time. Not only are the core concepts relevant, you need to be aware of the mind traps… the ‘as soon as I’, or ‘I will wait until…. type traps that happen throughout your week. For example; ‘As soon as I have finished that course’; ‘As soon as I have enough money’ or ‘As soon as I go parttime’…waiting until the right time, means you may be waiting for a very long time.
Where to start The best way to start your WLB program – is today!
Imagine I have come to work on a morning shift, before my caffeine fix and one bright patient asks me a question way out of the norm. ‘Bron…what is your life purpose?’ Oh my, it is a bit early for a loaded question like that! The way I could answer this question is something like this. ‘I choose to enjoy one thing and achieve one thing today. If that happens I am in for a good day. If I do this every day for the next year, I am sure the year is going to be amazing’. Take a moment to think about this, one small achievement and one small enjoyment and the day can work out your way. We all work, sometimes the choice is not there, why not make it a good day, give it your best and really focus on WHY you became a nurse in the first place. Connecting back to you, and why you are here is so important to maintaining a WLB.
and include the small steps to celebrate along the way.
Ask yourself the following questions:
Let’s recap
1. When was the last time you enjoyed and achieved something at work? 2. When was the last time you enjoyed and achieved something at home, or in your down time? 3. What about something just for YOU? 4. Look at what you can control each day, there are times when the stress and fatigue make this a challenging experience, which means taking a ‘stock take’ on the controllables is essential. Your energy must be on what is in your control and not on what is not. Write your answers down and let’s look at what you can do next to get your WLB program going for you.
Next…
Visualise the goal, add a date and reverse engineer, and start with the end in mind. Take action!
WLB is about enjoyment and achievement every day, it is NOT about equal balance, it is a choice on what you want to achieve each and every day. To make this real, set a goal on what you would like to achieve and enjoy every day, every week, every month and year….as you know, when you have something to work for, and a commitment to making it a reality…your reality…your WLB program is up and away! Wishing you a fantastic week, and as Dolly Parton says, ‘don’t get so busy making a living, that you forget to make a life. Cheers, Bron
The reality of what you do NOW does not have to dictate how you would like your reality to be in your future. This means aligning your WLB with your goals and intentions in the next 12 months and beyond. Before you can actually set your goals, it is as important to work out what your intention is. Intention is your WHY, the big reason why something is important to you, being clear on how this will be each day is more important than the goal. It carries energy and is empowering for YOU. Once you have this clear intention, create goals that will help you make it a reality. Make them real, make them manageable
References
Simmons, Susan, 2012, ‘Striving for worklife balance’, American Journal of Nursing, vol, 112, no.1, pp. 25-26. doi:10.1097/01. NAJ.0000410173.98529.f6
Bron Watson is a registered nurse, educator, mentor and founder of Nurse Power. Email: bron@nursepower.com.au PAGE 21 August 2014 Volume 22, No 2.
Standing up
right
for what’s What it means to be an ANMF rep
Being an ANMF workplace/job rep can be a rewarding experience personally and professionally. ANMJ journalist Kara Douglas explores what being a rep actually means and what is involved.
ED nurse & ANMF (VIC Branch) job rep Ross Donaldson PAGE 22
Feature
PAGE 23 August 2014 Volume 22, No 2.
Feature
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Understanding how to talk to employers about issues, documentation and communication would probably be the biggest thing for me. – Ross Donaldson
”
As an emergency department (ED) nurse in one of Melbourne’s bigger public hospitals, Ross Donaldson is right in the thick of it. So when the Victorian government tried to scrap mandated nurse-patient ratios and introduce split shifts during the last EBA negotiations, it pushed Ross to act.
During her three years as a rep, Robin’s skills have been tested as the hospital she works at in rural South Australia faced closure after the state government cut its funding. “Our stability has been very up and down and with that has come a lot of emotion and a lot of stress to the nurses and the members here,” says Robin.
“It was going to dramatically change the dynamic of nursing so I started going to a lot of protest marches and rallies,” says Ross. “The treatment of nurses was really starting to slide downwards and it was something I was really worried about.”
“It’s been a trying time so as a worksite rep I have had a lot of experience dealing with these different issues over the past three years.”
This led to Ross becoming an Australian Nursing & Midwifery Federation (ANMF Victorian Branch) job representative, where he quickly discovered there was much more to the role than industrial action. “I’m very lucky at our workplace. We’ve got a fantastic manager and the staff really do get along quite well, so for me it’s about making sure the staff understand their rights, their roles, it can be from basic things like payroll to what is a WorkCover claim or questions about maternity leave.” Monitoring staffing levels is also a big concern and one of the more challenging issues Ross deals with working in an emergency department. “The new four hour target has put a lot of pressure on emergency nurses to keep up with those processes and it really does push us in a new dynamic in caring for patients because the roles and responsibilities have changed quite a lot because of the fact that we’re continually moving patients around,” says Ross. ED’s are dynamic working environments where nurses need to change to accommodate a situation, but Ross says his role is to make sure that this does not become the norm. “The one thing I always try to make sure of with the staff is that it’s not a reoccurring thing and more importantly that the hospital doesn’t see it that since we’ve been over numbers we can constantly stay over numbers because no one is really caring about it.” That means keeping the information flowing between management and the nurses on the ground, he says. “It’s not a matter of arguing or anything like that, but making sure the hospital does keep informed about the issue because the top level might not even know the problem exists because as nurses we do everything, we will cover to make sure things keep moving.” Talking to the staff, keeping up with issues and maintaining an open dialogue with management makes a huge difference to everyday working conditions, says Ross. “The issues don’t tend to get blown out of proportion because we talk about it and try to resolve problems very quickly where we can.” Ross says his leadership and negotiation skills have improved significantly since becoming a rep. “Understanding how to talk to employers about issues, documentation and communication would probably be the biggest thing for me.” South Australian registered nurse and worksite rep Robin Redden agrees that becoming a rep contributes to professional development. “Your leadership skills develop with more knowledge and having background information on things, why we actually do them and what it means to the professions,” she says. PAGE 24
Being a small community, Robin says the closure of the Keith District Hospital would have impacted the whole town not just the 20 or so nurses working there. “Ninety per cent of the nurses are local and have been in the area for many years, we have a vested interest in the community as well as the hospital. “We knew we could get jobs elsewhere if the hospital closed but the impact was that it would mean so much to our town, so that’s why we really fought hard to get funding reinstated.” The hospital has remained open with funding guaranteed for the next two years but Robin and her nursing colleagues have had to deal with the uncertainty that comes with different leadership and consultancy teams coming in to manage the hospital. The experience has taught Robin how important it is to have an active worksite rep prepared to take on the challenges of the role. “There are always challenges. You have challenges getting people to meetings, getting support from everyone because everyone is so busy, and just getting people to be passionate about things as well. “Usually when you’ve got an enterprise agreement or something like that going on that affects everybody, people get quite involved, but when something like that is not happening it’s quite hard to keep the level of enthusiasm up. It takes a lot of work behind the scenes.” Robin says there is also a false perception that a worksite rep is a trouble maker. “That’s the sort of reputation we’ve got but I don’t think that’s the case at all.” Since doing her worksite rep training, Robin says she has spoken with her hospital’s CEO and DoN to discuss the role and how it can benefit the hospital. “If we’ve got an issue and the worksite rep can become involved we can often settle that issue before it goes any further. It doesn’t always have to elevate.” Rather than being seen by management as a troublemaker, reps are often promoted because of the leadership skills they demonstrate at work. “A person who volunteers to do something over and above their ordinary working life, they do start to show good leadership skills and some, not all, get promoted. Management starts to see they’ve got these skills,” says Melva Austin, job representative trainer at the ANMF Victorian Branch. Melva says some new reps tell her they were warned not to take on the role because it would hurt their careers, when more often than not, the opposite is true. “Our experience is that an effective job rep is seen as a plus and will often get promoted based on their people skills and ability to deal with difficult situations.” Workplace representative trainer at the ANMF Tasmanian Branch, Jude Mullane agrees. “Training as a rep gives nurses and midwives
Feature
“
They provide a really good conduit between the ANMF office and the actual workplace. If we have a workplace rep there it’s gold because it enables us to get a really good idea of what’s really happening in the workplace – Jude Mullane
”
ANMF Tasmanian workplace rep trainer Jude Mullane
different skills to what they get in nursing. A lot of it is around leadership and empowerment and when reps really understand their role as a leader in their workplace, I think that’s probably the most empowering thing that we give our members.” Jude says often workers do not realise how much power they actually have in the workplace. “And when we empower them they see less of a divide between them and management and then as workplace reps they can seek a change in their workplace and enact change in a positive way, it doesn’t have to be negative relationships and they begin to see themselves differently and see that they can change things by being an ANMF rep.” Training as a rep covers a number of areas including how the ANMF works, unionism on a broader scale and the role, rights and responsibilities of an ANMF job rep. Reps also learn about industrial relations, how Enterprise Bargaining Agreements (EBAs) are created and the rights of reps and members. A lot of time is also spent problem solving by practising assessing and analysing an issue, then going to management. Victorian trainer Melva Austin says they teach the reps how to approach issues in a methodical way rather than just running to management. “We give them a problem solving framework where they have to go through all these steps before they approach management so that they go to management with all of the information, all of the facts and all of the rights that might apply to that particular issue. “It might be that they’re not getting paid overtime so they’ll look up the EBA to see what the EBA says about it and what they should be getting.” Part of the training is also about how to behave professionally in meetings with management as well as how to support members with issues that the rep may not be directly involved with, says Melva. “With allegations of sexual harassment or bullying we don’t want our job reps to deal with those directly but they are there as a support base for the members, so it can be emotional support or it can be more tangible support.”
Melva says reps are taught the steps in a disciplinary procedure and that the person involved is entitled to natural justice, so they can use that insight to help calm the member down. Workplace organising is another key element of the training, Melva says. “We take them through tangible things they can do and why it’s important for them to be organised at the workplace in terms of networking with other job reps, communicating with the members and having a union profile at the workplace and it can be something as simple as having posters up or stickers.” Both trainers say the feedback from reps that complete the training is overwhelmingly positive. “They say they feel more confident, they know what their rights are, they know what to do when members come to them,” says Melva. “The other benefit is all the training we provide is free,” says Tasmanian trainer Jude Mullane. “It contributes to the CPD hours for registration and not only that, they get a whole heap of skills that they wouldn’t actually get at the bedside, so they’re high-end negotiation skills that our reps go on to develop over years, so that is a very positive thing for them and it can actually assist their career.” The trainers agree that reps are the backbone of the ANMF. “They’re an essential part of the union, the union can’t operate without them,” says Melva. “Sometime reps can feel a bit afraid of that as they think they have to stand up there and negotiate the town clock every five minutes but they don’t,” she says. “They provide a really good conduit between the ANMF office and the actual workplace. If we have a workplace rep there it’s gold because it enables us to get a really good idea of what’s really happening in the workplace,” says Jude. “They also participate in consultations and certainly the reps that I’ve worked with over the years have been very involved in working with management to improve working conditions within their workplaces.” PAGE 25 August 2014 Volume 22, No 2.
Feature Knowing they’ve made a difference to conditions at work for their colleagues, and ultimately their patients, is one of the most satisfying things about being a rep, say reps Ross Donaldson and Robin Redden. “It’s about doing the best for the nurses at the time. Sometimes the issue may not go the way they want it to go but it’s about always looking out for our nursing staff,” Ross says. “It’s very rewarding,” Robin agrees.
I always find that very satisfying because I feel I’ve done it for my members,” she says. “I think that having this extra knowledge does give you extra leadership skills and it gives you knowledge as well. It’s just a great experience to have.” If you are interested in becoming an ANMF rep contact your local state/territory branch.
“After we’ve done an enterprise agreement or resolved an issue,
Taking a stand Aged care nurses Lisa Williamson, Heather Furness and Leanne Mooney-Ricketson (pictured with ANMF Federal Secretary Lee Thomas) know just how difficult but rewarding it is to stand up for their fellow nurses and the residents they care for. The three Victorian job reps and their colleague Tamar Climpson (not pictured) have been fighting for over a year to stop the public aged care facilities they work for from cutting its nursing hours by 324 hours per week. “We started off by talking to families and residents that could advocate for themselves about the concerns we had and how it could possibly affect them and just empowering them and giving them contacts of who to speak to raise concerns,” says Lisa Williamson (pictured right). The nurses handed out information about the impact of the cuts, talked to the public on their days off, encouraged residents to speak up about the cuts and be interviewed by media as well as writing to management, members of Parliament and newspapers. They also withstood significant pressure from management to silence them and remove information they were distributing to families and residents. “There was a relatives meeting where the CEO came out and apologised for the campaign of fear by the union, scaring residents and families – which was not what was actually happening - and there’s just a feeling of being watched,” says Lisa. PAGE 26
But Lisa and the other nurses stood firm. “My view is you either stand up and do something about it, or if things changed and it got privatised then I wouldn’t want to be working there anyway because it wouldn’t have been a safe place to work and not good patient care. So it was either stand up for it or just leave,” she says. That need to stand up for what is right encouraged Heather Furness (pictured centre) to become a job rep during the dispute. “The position they were taking needed to be fought. All of the nurses I was working with were all very worried, not so much about their workload, the main concern was the impact on the residents,” Heather says. With the support of the ANMF, the reps organised meetings with politicians, got petitions signed, encouraged other members to join the campaign and appeared before the Fair Work Commission. The dispute is still underway and Leanne Mooney-Ricketson (pictured left) says it can be challenging at times but also rewarding to know they are making a difference. “You hope that every time we do something there’s a little better outcome, that’s what we aim for. Hopefully there’s a better outcome for everyone and usually it results in a better outcome for the people we take care of.” The women were awarded the 2014 Hannah Sellers Job Rep of the Year Award for their work at the ANMF Victorian Branch delegate’s conference last month.
Ethics Megan-Jane Johnstone
Bigotry and racial discrimination
In March 2014, the Australian federal government proposed amendments to the Racial Discrimination Act, which included removal of the key words ‘offend’, ‘insult’ and ‘humiliate’ from relevant sections of the Act.
Provisions requiring the need to act ‘reasonably and good faith’ in public discussions on political, social, cultural, academic, scientific and other matters were also earmarked for removal. These amendments were proposed ostensibly on the grounds that the Act, which currently prohibits ‘insulting’ and ‘offending’ people on racial grounds, was ‘too broad’ and unnecessarily restricted freedom of speech. Defending the proposed changes, Attorney-General George Brandis argued, ‘people do have a right to be bigots, you know’ (Alcorn 2014, p.30). Since the proposed amendments have been made public, influential members of the community have openly criticised them on grounds that they would see broad exemptions applied to what would otherwise count as acts of ‘racial vilification’, thereby leaving offenders free to maliciously disparage and abuse others on racial or ethnic grounds without censure. As Tim Soutphommasane, the Race Discrimination Commissioner, reportedly argued:
of Australia’s (2008) Code of Professional Conduct, which states:
Nurses promote and protect the interests of people receiving treatment and care. This includes taking appropriate action to ensure the safety and quality of their care is not compromised because of harmful prejudicial attitudes about race, culture, ethnicity, gender, sexuality, age, religion, spirituality, political, social or health status, lifestyle or other human factors (NMBA 2012, Standard 4.2).
Human rights and bigotry Human rights have been developed over time as a critical response to the need to recognise, prevent the reoccurrence of, and protect people against ‘terrible injustices’ and ‘most grievous wrongs’ (Dershowitz 2004). A key aim of a human rights response (as indicated in the Universal Declaration of Human Rights) is to provide a foundation for freedom, justice and peace in the world (www.un.org/en/documents/udhr/#atop).
Bigotry and the nursing profession In its 2011 position statement on Nurses and human rights, the International Council of Nurses recognises that ‘all human rights are interdependent and indivisible and that individuals’ health and wellbeing can be harmed when their human rights in any category are violated.’ The ICN further holds that all nurses ‘have an obligation to safeguard, respect and actively promote people’s health rights at all times and in all places’.
A question of nursing ethics
A bigot is someone who is intolerant and prejudiced against others (usually on the basis of their ethnicity, race, religion, sexuality, age, etc.) and who, because of their prejudices, treat ‘othered’ people with fear, hatred, and contempt. Disregarding the norms of social decency and fairness, bigots make statements, exhibit mannerisms and behave in ways that are not merely offensive or hurtful to the entities they target but which, ultimately, create a ‘we-they’ divide in the minds of onlookers. This divide is morally problematic on two accounts: first, it provides a foundation for those who are vilified to be dehumanised; and second, once dehumanised, the vilified are portrayed as being outside of the category of ‘human’ and all the protections that being human would normally entail.
Bigotry is a violation of human rights and, given its capacity to affect prejudicially the health and wellbeing of ‘othered’ people, stands to also violate people’s health rights. Accordingly bigotry and the hatred it incites have no place in the nursing profession. Even so, the profession is not immune to its incidence or impact. Bigotry therefore warrants careful attention as an ethical issue by nurses. In order to be able to deal with bigotry and to ‘take appropriate’ action, however, intolerant and prejudicial behaviours first need to be recognised and uncovered; once uncovered these behaviours then need to be challenged and countered in ways that are morally purposeful. This obligation exists not only in the workplace but other social milieus where nurses might find themselves since being a morally passive bystander to offences committed against the humanity of others is morally intolerable.
The ethical issues raised by the proposed amendments to Australia’s Racial Discrimination Act might seem far removed from the concerns of everyday nursing ethics. However, there are at least two considerations that make this issue relevant to nurses: first, is the relationship that exists between racism and poor health outcomes in non-dominant racial populations (Paradies 2006); second, is the nursing profession’s codified obligation to take ‘appropriate action’ in cases where the health, safety and care of people is placed at risk by the prejudicial and discriminatory behaviours of others. In healthcare contexts, this requirement has been made explicit in the Nursing and Midwifery Board
Bigotry, by its very nature, is a violation of human rights. When perpetrated, acts of bigotry rupture the peaceable bonds that might otherwise be developed between people and which would enable them to live safe lives free from the unwanted and hateful intrusions of others. Acts of bigotry also impose an unfair burden of suffering onto those who have been vilified by virtue of the fear, psychological distress and emotional trauma that they cause. Given this, to claim that people have a ‘right to be a bigot’ is not only nonsensical (human rights claims fundamentally entail respecting human beings, not maliciously denigrating them), but a culpable perversion of moral reasoning.
References
This [proposal] would involve a very dramatic change to the law… it severely weakens the protections that exist against racial vilification and may have the effect of encouraging a minority of the population that they can racially abuse and harass someone with impunity (quoted by Alcorn 2014, p.31).
Alcorn, G. 2014. Free speech or hate speech? The Age, 29 March, pp. 30-31. Dershowitz A. 2004. Rights from wrongs: a secular theory of the origins of rights. Basic Books, New York. Paradies, Y. 2006. A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35 (4): 888-901.
Megan-Jane Johnstone is professor of nursing in the school of nursing and midwifery at Deakin University in Victoria. Professor Johnstone has extensive interest and expertise in the area of professional ethics in nursing. PAGE 27 August 2014 Volume 22, No 2.
Natasha Old
Natural but not necessarily safe: Nursing ethical and legal considerations when administering herbal and dietary supplements in clinical practice Safety is the paramount consideration of any nursing activity, that is, the safety of the patient and safety of the nurse. As the patient’s advocate it is indeed a nurse’s professional responsibility to identify and act towards any potential risk toward that individual. Although there is much dispute about the validity of herbal medicines amongst the medical community, nurses face specialised issues when administering herbal supplements to patients. The underlying theme of this article spawns from a number of international and local studies that show an increase in people using herbal supplements for chronic conditions such as arthritis, cardiovascular disease and mental illness (Australian Bureau of Statistics 2013; Dickinson et al, 2014; Armstrong et al, 2011). As such increasingly nurses are faced with making clinical decisions when administering these in conjunction with pharmaceuticals. Initially there was no division around what was herbal and what was considered ‘medicinal’. However as time progressed the division has become more profound. Certainly many modern pharmaceuticals were originally discovered and derived from herbal sources. Atropine used for the treatment of bradycardia was first synthesised from Atropa belladonna (Deadly nightshade) in 1901. (New World Encyclopedia, 2008) Digoxin used to slow and steady the heart rate is a derivative of Digitalis lanata. Amongst other commonly occurring naturally derived pharmaceuticals include Colchicine, Theophylline, Etoposide, Paclitaxel and Morphine. Despite this, modern medicine’s acceptance of herbal medicines is indeed contentious. In part the attitude is based on minimal scientific validity in support of herbal supplement usage. Traditionally research in this area has received poor funding and unfortunately many trials that have been performed are poorly designed. Of the credible research that has been conducted very little has been brought into the limelight. PAGE 28
In spite of this, there is no denying that the percentage of people using herbal supplements is increasing each year and that poses new challenges for nurses who administer medications in hospitals every day. Although the herbal supplements may be safe themselves, if taken unadvised and incorrectly they have the potential to cause undesired effects. Despite studies indicating a high number of nurses who personally use herbal and dietary supplements, research points towards the nursing professions relatively low level of knowledge about herbal supplements (Dickinson et al. 2009). Even on the Australian governments TGA website it is recommended to seek advice from ‘a health professional’ prior to purchasing herbal supplements. (TGA, 2014). However western health professionals themselves are not comprehensively educated on the use of herbal supplements. Research points out that a lack of knowledge and education about herbal supplements leads to low confidence and in turn a low level of nurses who actually communicate to patients about herbal supplements (Tasaki et al. 2002; Cockayne 2005). Nurses and nursing students alike have verbalised a need for increasing education about herbal and dietary supplements (Kemper et al. 2006; Kreitzer et al. 2002). In data pulled from the 2009 Healthcare Professionals Impact Study, 85% of nurse practitioners agreed that one of the roles of healthcare professionals is to provide their patients with information about dietary supplements (Council for responsible Nutrition, 2007).
Clinical Update Why do nurses have to be so vigilant when administering herbal medications? Herbal medicines can also cause undesirable effects in patients if unmonitored or used carelessly. In 2012 Tsai et al. conducted a review of the major drug interactions between herbal/dietary supplements and medicines that occurred from 2000-2010. The data identified 1,491 different interactions involving 213 supplements and 509 medications. Of herbal supplements St John’s Wort, magnesium, calcium, iron and gingko displayed the greatest number of reactions. Of the pharmaceuticals warfarin, insulin, aspirin, digoxin and ticlopidine reported the largest number of interactions with supplements. Of the interactions 42.3% were due to ‘altered pharmacokinetics’ (Tsai et al. 2012). In a reported 2003 case a woman presented to her local emergency department with nausea, fatigue and increased jaundice secondary to severe liver disease. Although transplanted under three weeks, she later died of complications, most likely cause through nephrotoxicity secondary to usage of a herbal supplement containing Kava. (Gow et al. 2003). St John’s Wort, indicated as a natural antidepressant/ anxiolytic, has been shown to interfere with numerous pharmaceutical drugs metabolised by the cytochrome P-450 liver enzyme system, including protease inhibitors, chemotherapeutic agents, and oral contraceptives (Hammerness et al. 2003). Herbal remedies are infrequently recorded but may be important causes of morbidity. Ginkgo Biloba, Ginseng, Feverfew and Garlic have also been shown to have associated anticoagulation effects and should be used cautiously with and without other medication. (Bent et al. 2005; Rose, et al. 1990; Groenewegen & Heptinstall, 1990; Constable, 2006). Warfarin, a commonly utilised anticoagulation medication, has been shown to interact with at least 105 reported supplements (Tsai 2012). A specific case study involved a patient taking Warfarin concurrently for six months who started taking fish oil. After two weeks the routine blood test showed an INR of 8.06.
In another case a 65 year old woman taking Warfarin for TIAs maintained her INR for 18 months. When she added a double dose of fish oil after one month her INR increased from 2.8 to 4.3 (Buckley et al. 2004). These examples outline a great concern in lack of the education given to people receiving pharmaceuticals that potentially could interact with herbal medicines. As herbal supplements are widely available in the market and non-prescription there is much scope for potential complications to arise. Of most concern is the widespread belief that most herbal medications are safe and harmless. Secondly more alarmingly is the lack of education around herbal medications by health professionals, the very people that the public turn to for expertise and advice on medications. As a profession based on holistic values, nurses are encouraged to be open minded to the choices made by consumers. With the advent of the internet consumers spend much time sourcing information on various options relating to their health. Living in the shadow of the powerful pharmaceutical and medical industry, nursing is often highly influenced by the attitudes and beliefs of western medicine. It is no secret that the majority of western medicine practitioners do not advocate for the use of herbal supplements in healthcare. Indeed often herbal medicine only comes to the limelight in western medicine when a major interaction with a pharmaceutical has resulted in a serious adverse reaction. With this in mind it is important that nurses are aware of their own personal biases and beliefs about herbal supplements when managing patient issues related to complementary and alternative medicines (CAM). A nurse cannot at any one time assume which is best for a particular patient’s care. The issue here is not whether nurses ethically agree with a patient’s choice of medication but rather respecting a patient‘s choice and practising professionally to ensure that the patients choice is upheld. Often consumers will start taking a herbal medication and only after an incident happens will the herb pharmaceutical interaction become evident. One of
the greatest difficulties that nurses face is what information they can provide to their patients. Although medical professionals often do not advocate the validity of herbal supplements, naturopaths are trained and dispense herbal products. Trained naturopaths study for four years specialising in herbalism and pharmacology related to it. Nurses are within their scope of practice to refer a consumer to a naturopath if that patient wishes to continue taking herbal medications. This article again reiterates that it is an individual consumers right to choose the medical or alternative treatment that they wish for themselves.
Who is responsible for ensuring that herbal supplement administration and prescribing is regulated in hospitals? In order to safely administer a herbal product in a hospital setting it is within a nurse’s duty of care to be aware if that product could potentially interact with another pharmaceutical or cause an adverse effect to the patient. Even under the guidance of a medical practitioner nurses can be held accountable for the administration of medicinal products. Nurses have gotten by so far with relatively few reported cases of herbal-pharmaceutical related malpractice cases however it doesn’t mean the potential does not exist. Therefore it is conceivable that broadening one’s knowledge base would underpin safe nursing practice through additional training in the administration of herbal medicine. This article does not suggest nurses taking additional naturopathic study, however a basic outline of the most commonly occurring drug-herbal interactions could indeed allow a nurse to then safely take the required action. The value of non-malfeasance perturbs that nurses have a professional obligation to consumers to do no harm, in this case the harm is administering a herbal medication that they have no knowledge or education around. This article argues that currently nurses are not equipped to safely give herbal supplements in conjunction with pharmaceuticals without further education. It is imperative that nurses are aware of potential complications when administering herbal medications that they could be held accountable for. PAGE 29 August 2014 Volume 22, No 2.
This article finally suggests that the addition of lectures in nursing schools and in house training focusing on administering pharmaceuticals and herbs would unpin a nurse being able to safely administer herbal supplements. In order for any training program to be created there first needs to exist a need in a particular niche or population of people. Nurses administer medications both chemical and natural to patients every day in every country around the world. Inducing any substance whether chemical or natural always holds the risk for potential adverse outcomes. Herbal medicines by rights hold the same risk as do pharmaceuticals when they are administered to consumers. Education in herbal medicines is one way that health care professionals can protect themselves against potential dangerous practice. Sarah selecting herbal remedies in her clinic Balanced Health based in Kirra on the Gold Coast Queensland.
Sarah Franklin, a registered nurse and naturopathic practitioner based on the Gold Coast states: “As a registered nurse and naturopath I see the complexity of the interactions between natural medicine and pharmaceutical one’s on a daily basis. Nurses need to be more informed of the risks associated when combining the two and the need to be educated on how to use tools like Mims to check the interactions between the two. And if in doubt they should be advising the patients to cease their natural substances until they are reviewed by a practitioner who is trained in natural supplements as many patients simply buy from a store without any consultation process which adds to the element of risk.”
Cuellar (2003) suggests that the major objectives of herbal medicine educational program for nurses should include assessment skills, legal and ethical issues and an opportunity for nurses to reflect on their own beliefs about CAM (Cueller, 2003). Parkman (2002) suggests the focus of complementary medicine education should be on nurses identifying patient and family understandings of complementary medicines and the appropriate teaching related to such. A suggested program for such would cover the history of herbal supplements, taking a detailed patient history, assessment of patients’ current knowledge of supplement and pharmaceutical concurrent use, legal and ethical issues, and the referral process for naturopathic practitioner or a suitably qualified practitioner of herbal medicine. Included further in the curriculum would be commonly occurring herbal interactions and contraindications, patient and family education around use/ misuse of supplements and the evaluation of patient care. Nursing stands independent as a profession proactive in the protection of health consumers. Nursing education has an opportunity to be proactive in an area that requires more education in order to safeguard nurses and future nurses in training. Such a leap forward would see nursing move with the needs of a population and answering a call from the public
PAGE 30
that is needed. It would also build alliances between health professionals and certified naturopathic practitioners who are educated and specialise in herbal medicines. These practitioners study both herbal medicines and pharmacology and therefore are able to prescribe and dispense herbal products safely with prescribed pharmaceuticals. Integrative healthcare involves practitioners working together to provide the best possible care for a consumer. As holistic practitioners, nurses need to both safeguard themselves and their patients in all clinical situations.
Clinical Update References
Armstrong, A. R.,Thiébaut, S. P., Brown, L. J., Nepal B.,2011. Australian adults use complementary and alternative medicine in the treatment of chronic illness: a national study. Australian and New Zealand Journal of Public Health 35(4) 384–390. Australasian Kidney Trials Network. 2014. http:// www.aktn.org.au/trials/recruiting.php Australian Bureau of Statistics., 2013. AHS Australian Health Survey: Health Service Usage and Health Related Actions 2011-12 Australian government., 2014. http://www.tga. gov.au/consumers/information-online-internet.htm Bent, S., Goldberg, H.,Padula, A., Avins, A. L., 2005. Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature: a case report and systematic review of the literature. Journal of General Internal Medicine 20:657–61. Buckley, M. S., Goff, A. D., Knapp, W. E., 2004. Fish oil and warfarin. The Annals of Pharmacotherapy Jan;38(1):50-2.
Groenewegen, W. A., Heptinstall, S., 1990. A comparison of the effects of an extract of feverfew and parthenolide, a component of feverfew, on human platelet activity in-vitro. Journal of Pharmacy and Pharmacology. 42:553-7. Kemper, K., Gardiner, P,. Gobble, J., Woods, C., 2006. Expertise about herbs and dietary supplements among diverse health professionals. BMC Complementary and Alternative Medicine 2006 6: 15 Kemper, K., Amata-Kynvi, A., Dvorkin, L., Whelan, J. S., Woolf, A., Samuels, R. C., Hibberd, P., 2003 Herbs and Other Dietary Supplements: Health Care Professionals’ Knowledge, Attitudes and Practices. Altern Ther Health Med 2003, 9(3):42-49 Kreitzer, M. J., Mitten, D., Harris, I.,Shandeling, J., 2002 Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: A comparative analysis. Alternative Therapies in Health and Medicine. 8(6) 44–47. 50–53. New World Encyclopedia. 2008. Atropine. https://www.newworldencyclopedia.org/entry/ Atropine
Cockayne, N. L., Duguid, M., Shenfield, G. M., 2005. Health professionals rarely record history of complementary and alternative medicines. British Journal of Clinical Pharmacology. 59 254–8.
Parkman, C. A., 2002. Complementary and alternative therapies and nursing competency.” Journal of Nurses Staff Development. 18(2):61–65.
Constable, S., Ham., Pirmohamed, M., 2006. Herbal medicines and acute medical emergency admissions to hospital. British Journal of Clinical Pharmacology. 63 247–8.
Rose, K. D., Croissant, P. D., Parliament, C. F., Levin, M. B., 1990 Spontaneous spinal epidural hematoma with associated platelet dysfunction from excessive garlic ingestion: a case report. Neurosurgery.; 26:880-2.
Council for responsible nutrition., 2007. Nurse Practitioners: Can we talk? http://www.crnusa. org/lifesupplemented/articles/news/nurse_practitioners_to_patients_can_we_talk.htm Cuellar, N. G., Cahill, B., Ford, J., Aycock, T., 2003 The development of an educational workshop on complementary and alternative medicine: What every nurse should know. Journal of Continuous Education in Nursing. 2003;34(3):128–135. Dickinson, A., Blatman, J., El-Dash, N., Franco, J. C., 2014. Consumer usage and reasons for using dietary supplements: report of a series of surveys. Journal of the American College of Nutrition. 33(2):176-82. Dickinson, A., Boyon, N., Shao, A., 2009. Physicians and nurses use and recommend dietary supplements: report of a survey. Nutrition Journal. 8:29
Tasaki, K., Maskarinec, G., Shumay, D.M., Tatsumura, Y., Kakai, H., 2002. Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients’ perspectives. Psychooncology 11(3) 212-220 Tsai, H. H., Lin, H.W., Pickard, A.S., Tsai, H. Y., Mahady, G.B., 2012. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. International Journal of Clinical Practice 66(11) 1056-1078
Natasha Old, CPCP, Ad Dip Mind/Body Medicine, Cert IV Kinesiology, is a registered nurse at Tweed Hospital
Gow, P. J., Connelly, N. J., Crowley, P., Angus, P. W., Hill, R. L., 2003. Fatal fulminant hepatic failure induced by a natural therapy containing kava. The Medical Journal of Australia. 178 (9) 442-443
PAGE 31 August 2014 Volume 22, No 2.
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Oncology A quality and safety framework for a statewide cancer network By Penelope Slater
The Queensland Paediatric Haematology Oncology Network (QPHON) was established in 2006 to oversee, support and enhance services that provide care to children with cancer and blood disorders throughout Queensland and Northern NSW. One of the aims of QPHON has been to support regional service development in identified shared care units, so children with cancer who live outside of Brisbane can receive more care in their regional hospital and spend less time away from home. QPHON supports the statewide service through funding of regional case managers and allied health staff in regional hospitals, education, exchange of information, guidelines for care and statewide network management. The following quality and safety framework is integral to the provision of the best quality services throughout the state. Impacting on the service are the vision and strategic direction related to Queensland Health, the Statewide Cancer Clinical Network and the Hospital and Health Service, and the existing risks and issues that are being addressed
through redesign of services and adherence to standards. Tangible inputs include staffing, funding and other resources. Support is provided through appropriate governance processes, communication, education and professional development, facilitation of innovation and development of standards for team culture. With these inputs in mind, the annual operational plan is developed, which addresses various aspects of the service, including people, network and service, safety and quality, value and research. Finally the outputs and outcomes of the service are monitored to ensure appropriate achievement of key performance indicators through evaluation, shared care unit reviews, benchmarking off other services, auditing standards and achievement of planned outcomes. Known challenges are also kept at the forefront of the planning processes. This framework has been used within QPHON for the past six years. All the components are essential to ensure a continually improving statewide service that meets the needs of the families concerned. Penelope Slater is the Program Manager, Queensland Paediatric Haematology Oncology Network at the Royal Children’s Hospital in Queensland
Enhanced recovery after surgery: promoting excellence in surgical oncology nursing care By Yvette Console, Alexander Heriot, Bernard Riedel and Georgina Christelis Enhanced recovery after surgery (ERAS) is a perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. Established in 2001 by international surgical groups, the pathway was developed to embed a coordinated, evidence-based approach to pre and post-operative care of patients (www.erassociety.org). Use of the ERAS pathway has been shown to reduce care time by more than 30% and postoperative complications by up to 50% (Varadhan, Neal, Dejong, et al 2010). In 2012, the Peter MacCallum Cancer Centre (PeterMac) in Melbourne implemented the ERAS program for colorectal, hepatobiliary and upper gastrointestinal patients. The aim was to improve patient safety, patient experience, and improve healthcare efficiency by reducing hospital length of stay. A multidisciplinary ERAS Committee was formed and a phased implementation plan developed. A nurse with surgical oncology expertise was appointed to the ERAS coordinator role. Prior to implementation of ERAS, an audit of targeted perioperative practices and development of ERAS protocols were undertaken. Comprehensive nursing clinical pathways were developed and a 10-week education program delivered to multidisciplinary clinical staff. An implementation audit was undertaken to assess the ERAS program efficacy. Data from 30 patients pre and post ERAS implementation were analysed. Time to key clinical indicators such as first drink or first solids were significantly (p= <0.0001) improved in the ERAS phase. Reductions PAGE 33 August 2014 Volume 22, No 2.
Focus Specialist nurse role in gynaecological-oncology in the number of preoperative admissions prior to the day of surgery (56% vs 33%), and a reduction in the number of postoperative hospital bed days (median length of HDU/ICU and hospital stay was 2.5 and 10 days [Pre-ERAS] vs 2 days and 8.1 days [ERAS], respectively) were achieved. These changes equated to an approximate cost savings of $1,600 per patient. A program of ongoing audit will ensure sustainability of the program and inform plans to expand the program across PeterMac. The commitment of our skilled surgical oncology nurses and allied health teams have been key to the effective delivery of this pathway.
References
www.erassociety.org accessed June 2014 Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN., 2010. The enhanced recover after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized trials. Clinical Journal of Nutrition, 29(4): 434-40. Acknowledgement: The ERAS implementation project was funded by a grant from the Western and Central Melbourne Integrated Cancer Service.
Yvette Console is Perioperative Liaison Nurse and Professor Alexander Heriot is the Director of Cancer Surgery, Consultant Colorectal Surgeon, both located in the Department of Surgical Oncology at Peter MacCallum Cancer Centre, Victoria Associate Professor Bernard Riedel is the Director of Cancer Anaesthesia and Pain Management in the Department of Surgical Oncology, Peter MacCallum Cancer Centre, Victoria and University of Melbourne Georgina Christelis is the Consultant Anaesthetist in the Department of Surgical Oncology, Peter MacCallum Cancer Centre, Victoria, the Department of Colorectal Surgery at St Vincentâ&#x20AC;&#x2122;s Hospital, Victoria, The Alfred Hospital, Victoria and University of Melbourne
PAGE 34
By Olivia Cook, Meredith McIntyre and Katrina Recoche The National Gynaecological Cancer Service Delivery and Resource Framework objective is that all women in Australia with gynaecological cancer be managed by a multidisciplinary team that includes specialist nurses (Cancer Australia & The Royal Australian College of Obstetricians & Gynaecologists 2011). Yet, little is written about the specific role and function of the specialist nurse in the gynaecological-oncology setting, or how nurses in this role are guided and governed in their practice. This is in contrast to the development and formalisation of the Specialist Breast Nurse (SBN) role in Australia in recent years and release of the Competency Standards and Educational Requirements for Specialist Breast Nurses in Australia (Yates et al 2007). There is no known literature evaluating the overall role of the specialist nurse in the gynaecological-oncology setting, however fragmented evidence does exist evaluating the more patient-centred aspects of the role. A systematic review was thus conducted to critically review all randomised controlled trials and non-randomised studies testing interventions by specialist nurses in their care of women with gynaecological cancer. The review was broad in its scope, considering various intervention types and three main outcomes being quality of life, satisfaction with care and psychological outcomes. Several positive results were reported among the reviewed studies however the studies were assessed to be of variable methodological quality. The review indicated that the most successful interventions either provided comprehensive care, involved telephone contact or were executed between diagnosis and the completion of treatment. It could be speculated that quality of life may not be the most appropriate or sensitive measurement of the effectiveness of specialist nurses in their role of caring for women with gynaecological cancer and future research may consider utilising alter-
Olivia Cook
native outcome measures. Measurement tools that relate to the symptoms of disease and side-effects of treatment may be more sensitive in detecting the effect of symptom management strategies provided by the specialist nurse. Likewise, a tool that measures perceived level of knowledge might better capture the effects of the educational efforts of the specialist nurse. Adding to this, future research aimed at evaluating other aspects of the specialist nurse role such as that of coordinator and collaborator within the multidisciplinary team, clinical expert and staff educator, researcher and strategic planner would be valuable.
References
Cancer Australia, & The Royal Australian College of Obstetricians & Gynaecologists., 2011. National Gynaecological Cancer Service Delivery and Resource Framework. Canberra, Cancer Australia. Yates, P., Evans, A., Moore, A., Heartfield, M., Gibson, T., & Luxford, K., 2007. Competency standards and educational requirements for specialist breast nurses in Australia. Collegian: Journal of the Royal College of Nursing, Australia, 14(1), 11-15.
Olivia Cook, B.Nurs (Hons), RN; Meredith McIntyre, PhD, M.Ed.St, B.App.Sc, RN, RM and Katrina Recoche, MN,GradDip BusMgt, BA/SocSci, RN, all are located in the School of Nursing & Midwifery, Monash University, Australia
Oncology A nurse practitioner-led sexual health and erectile dysfunction clinic By Kathryn Schubach
The impact of a diagnosis of cancer and of treatments used to cure or control the disease on sexual function and expression is under diagnosed and poorly addressed in the cancer population (Krebs 2008). Although patients expect information about sexual health will be delivered by a healthcare professional, evidence indicates that clinicians are often reluctant to discuss sexual issues with their patients (Hordern and Street 2007). Analysis of unmet supportive care needs data of patients attending the Peter MacCallum Cancer Centre (PeterMac) in 2009 identified considerable unmet sexual health needs among our patients. In response to this, a
nurse practitioner (NP)-led sexual health and erectile dysfunction (SHED) clinic was developed to provide men (in the first instance) and their partners with timely access to evidence-based information and consultation regarding erectile dysfunction and concerns about sexual health. From 2009-2013, nurse practitioner candidacy was completed and scope of practice domains defined ahead of endorsement of the uro-oncology NP. During this time, evidence based interventions were developed by the NP candidate in consultation with key multidisciplinary cancer specialists, particularly psychology, in preparation for the implementation of the SHED clinic. Since the SHED clinic was implemented in July 2013, approximately 150 patients have attended. Patients self-refer or are referred to the clinic and may be on active treatment or have completed their cancer therapy. Interventions delivered by the NP include psy-
chosocial education, coping skills coaching and development of a tailored plan of care to help men and their partners manage erectile dysfunction. Ongoing audit of the clinic will inform refinement and expansion of the NP scope of practice ensuring the clinic and role deliver a valuable and responsive service for patients at PeterMac.
References
Hordern, A.J. Street, A.F., 2007. Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs. Medical Journal of Australia. 186 (5): 224-7. Krebs, L., 2008 Sexual Assessment in Cancer Care: Concepts, Methods & Strategies for Success. Seminars in Oncology Nursing. 24 (2): 80-90.
Kathryn Schubach is a Nurse Practitioner - Uro-Oncology Service in the Department of Cancer Experiences Research at Peter MacCallum Cancer Centre, Victoria
Understanding care complexity in ambulatory patients with cancer to inform workforce utilisation and optimise patient outcomes By Mei Krishnasamy and Donna Milne A review of international literature indicates lack of a reliable instrument to measure nursing care complexity amongst ambulatory cancer patients. With the global projected growth in numbers of cancer patients, the ability to identify patients most in need of access to expert cancer nurses becomes an imperative for efficient workforce utilisation and optimal patient outcomes. As part of a collaborative research initiative, undertaken under the auspices of the Cancer Nurses Society of Australia, nurses at the Victorian Peter MacCallum Cancer Centre (PeterMac) set out to develop a reliable and valid care index that can be used in acute ambulatory care settings to identify those patients presenting with complex care needs. A comprehensive literature review was undertaken and results presented to senior cancer nurses at a half-
day workshop. Criteria to indicate and score complexity were then identified. The criteria were pilot tested through a series of hypothetical case studies and finally, were used to score the care complexity of current patients across 10 different tumour streams. Phase 1 involved 19 nurses from PeterMac who reached agreement on the identification of 20 complexity criteria grouped into four domains (domestic, diagnostic, comorbidity, symptomatology). Pilot testing of the criteria against hypothetical case studies by 12 nurses resulted in the addition of 10 criteria across the same four domains (n=30 criteria). Twelve nurses then utilised the complexity criteria and scoring system to assess five new patients resulting in the completion of 60 assessments across 10 tumour streams. The 30 items within the four core domains appear to reflect care complexity, but the scoring system requires further development as it consistently under represented patient complexity as identified by the nurse during clinical consultation. An Australian wide study* drawing on collaborations across the
Cancer Nurses Society of Australia is now underway, to establish the reliability and validity of the complexity index. * Acknowledgement: The Australia wide study is supported by a grant from the Cancer Nurses Society of Australia. Co-Investigators of the Australia wide grant include, Professor Leanne Monterosso (WA); Violet Platt (WA); Alexandra McCarthy (QLD).
Associate Professor Mei Krishnasamy is the Executive Director of Cancer Nursing and Allied Health in the Department of Cancer Experiences Research at Peter MacCallum Cancer Centre, Victoria, Department of Nursing, University of Melbourne Dr Donna Milne is the Senior Clinician Researcher, Advanced Practice Nurse, Skin and Melanoma Service, Department of Cancer Experiences Research at Peter MacCallum Cancer Centre, Victoria, Department of Nursing, University of Melbourne PAGE 35 August 2014 Volume 22, No 2.
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Focus
Oncology
Innovative cancer survivorship professional development By Kylie Ash All nurses, regardless of practice setting are required to work collaboratively with the person affected by cancer to address their health needs throughout the cancer journey (Aranda and Yates 2009). The prevalence of cancer in our society is increasing. Survival rates in Australia have improved to 66% (five year relative survival for all cancers combined in 2006â&#x20AC;&#x201C;2010) (AIHW 2012). At the end of 2007 more than 339,000 people were alive who had been diagnosed with cancer within the previous five years, representing 1.6% of the Australian population (AIHW and AACR 2012). As a consequence, nurses need to be increasingly responsive to the needs of cancer survivors. Being a survivor means different things to different people. While some survivors report positive psychosocial effects, they are also at risk of experiencing distress associated with the range of physical, psychological, social or practical changes associated with survivorship. Psychosocial issues include anxiety, depression, isolation and negative impacts on self-identity or self-image (Department of Health 2010). Physical effects experienced by survivors include pain, musculoskeletal issues, fatigue, breathlessness, urinary/bowel problems, lymphoedema, premature menopause, cognitive deficits, infertility and sexual dysfunction (NCCN 2013; Department of Health 2010). Second cancers are more common in cancer survivors due to genetic susceptibilities, shared etiologic exposures, and mutagenic effects of cancer treatments (NCCN 2013). Fear of recurrence or second cancers is normal and very common amongst cancer survivors, especially during the first several years after completing treatment. Feelings generated by uncertainty include anxiety, fear, anger, wonder, frustration, helplessness, curiosity, hope, and depression (NCCN 2013).
A new cancer survivorship website has been developed. Within an introductory package of learning modules, fact sheets and videos, equivalent to four hours of learning, the learner can explore the context of cancer survivorship in Australia and develop an awareness of services and interventions available for cancer survivors. The resource is free to access. The website was developed and funded by the Australian Cancer Survivorship Centre, a Richard Pratt legacy, in collaboration with Workforce Education Development Group, Sydney Medical School, the Queensland University of Technology and Cancer Australia. It is the first in a suite of packages to be uploaded to the new cancer learning website. Other packages being uploaded to the site over the coming months include the topic areas lung cancer, breast cancer, psychosexual care, cancer nursing, oncology basics, and supportive care. The resource can be accessed at www.cancerlearning.gov.au/survivorship
Australian Institute of Health and Welfare (AIHW) and Australasian Association of Cancer Registries (AACR)., 2012. Cancer in Australia: an overview 2012. Canberra: AIHW Aranda, S., and Yates, P., 2009. A national professional development framework for cancer nursing. Canberra: Cancer Australia, The National Cancer Nursing Education Project. Department of Health., 2010. The National Cancer Survivorship Initiative Vision. London: DH, and Macmillan Cancer Support & NHS Improvement. National Comprehensive Network (NCCN)., 2013. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Survivorship. Version 1. www.nccn.org
Kylie Ash is the Project Coordinator, EdCaN & PSGC Projects at the Queensland University of Technology
References
Australian Institute of Health and Welfare (AIHW)., 2012. Australiaâ&#x20AC;&#x2122;s Health 2012. Canberra: AIHW PAGE 37 August 2014 Volume 22, No 2.
Body Systems
Emergency Nursing Austin Health in conjunction with La Trobe University offers postgraduate studies in a Graduate Certificate in Emergency Nursing. We are a 50 bed Emergency department that services approx 77,000 patients annually. Currently the busiest Emergency Department in Victoria • The course runs over a 52-week period with participants working 8 days per fortnight in the clinical areas • Rotations through ICU, Cardiac Care, Mobile Intensive Care Ambulance, Cath Lab, Paediatric ward and Community psychiatric team. • The course includes supported rotations, with Educators, through all areas in the Emergency Department. • Clinical skills gained include: IV cannulation, plastering, suturing, ABG sampling& analysis, Adult & Paediatric Advanced life support, Ventilation & ECG skills.
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All the skills necessary for a critical care clinician. Applications close 26th September 2014 For further information contact Emergency Coordinators: Carolyn Cochrane or Lynne Keith: Clinical Course Co-ordinator - Emergency E-mail: Carolyn.cochrane@austin.org.au OR lynne.keith@austin.org.au Phone: (03) 9496 4729
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Focus
Oncology
Research nurses changing the face of melanoma treatments By Jill Davison, Rosetta Hart, Carol Russell and Sharon Temby Metastatic melanoma has traditionally been associated with poor treatment efficacy and short life expectancy. However over the past five years with the advent of new treatments such as the BRAF and MEK inhibitors, outcomes for patients diagnosed with malignant melanoma have improved significantly with a response rate of over 50% for some patients (Ascierto, Kirkwood, Grob, et al 2012). At the Peter MacCallum Cancer Centre (PeterMac) in Melbourne, specialist melanoma research nurses (MRNs) have been central to these developments, leading coordination of early (phase 1) trials through to large randomised controlled (Phase 3) trials of these remarkable new agents. Many of these agents are oral drugs and on the whole are well tolerated but careful monitoring is required to quickly identify side
effects of these agents, such as, diarrhoea, rash, fatigue and photosensitivity. As part of their role the MRN’s take trial-specific blood samples, carry out ECGs, monitor routine bloods and vital signs, whilst at the same time play a vital role in educating patients and family members to support adherence to and capacity to remain on life saving trials. For new treatments such as the recently high profile monoclonal antibody, anti PD1 (programmed death 1) (Hamid, Robert, Daud, et al 2013) the MRNs require subspecialist knowledge of the uncharacteristic side effect profile of these agents which differ from those of standard chemotherapy. These include serious immune related side effects such as sudden onset of pneumonitis, colitis or renal toxicity. In addition to educating patients and family members, the MRNs also play a crucial role in educating other nurses across the organisation to ensure the safety of trial patients. At PeterMac, the MRNs are at the forefront of anticancer science. Their skill lies in assimilation of world-leading science with exemplary patient centred care.
References
Ascierto, P.A., Kirkwood, J.M., Grob, J.J. Simeone, E., Grimaldi, A.M., Maio, M., Palmieri, G., Testori, A., Marincola, F.M. and Mozzillo, N., 2012. The role of BRAF V600 mutation in melanoma. Journal of Translational Medicine. 10:(85). Hamid, O., Robert, C., Daud, A., Hodi, F.S., Hwu, W.J., Kefford, R., Wolchok, J.D., Hersey, P., Joseph, R.W., Weber, J.S., Dronca, R., Gangadhar, T.C., Patnaik, A., Zarour, H., Joshua, A.M., Gergich, K., Elassaiss-Schaap, J., Algazi, A., Mateus, C., Boasberg, P., Tumeh, P.C., Chmielowski, B., Ebbinghaus, S.W., Li, X.N., Kang, S.P. and Ribas, A., 2013. Safety and tumor responses with Iambrolizumab (anti-PD-1) in melanoma. New England Journal of Medicine. 369(2):134-44.
Jill Davison, Rosetta Hart and Carol Russell are Research Nurse Consultants and Sharon Temby is Study Coordinator, all located in the Clinical Trials Unit, at Peter MacCallum Cancer Centre, Victoria
A day in radiotherapy nursing By Kathryn Watty, Julie Wills and Emily Ludescher
Access to radiation oncology services remains problematic for many Australian patients (Royal Australian and New Zealand College of Radiologists 2012). In 2012 it was estimated that approximately 18,000 patients did not receive potentially beneficial radiotherapy treatment (RANZCR 2012). Reasons for this are complex but one reason may be lack of understanding of the central role radiotherapy plays in curative cancer treatment, long-term palliation and symptom management. Members of the Victorian Eastern Health (EH) nursing education team and Peter MacCallum Cancer Centre (PeterMac) Box Hill Radiotherapy Campus recognised a gap in knowledge regarding radiation therapy as a cancer treatment modality for nurses working in medical oncology in an acute hospital setting (EH). Project funds were secured*
to develop, deliver and evaluate a one day program called ‘A Day in Radiotherapy Nursing’ to enhance knowledge of how radiation therapy works and disseminate essential nursing information needed to optimise patient care and outcomes. A one-hour basic radiobiology lecture was presented to EH nurses who provide medical oncology care to patients referred to their hospital for cancer care. Many of these patients receive concurrent radiation therapy at the PeterMac facility, adjacent to EH. The lecture was delivered on four occasions over a 12-month period. In addition, a seven hour program delivered by members of the PeterMac Box Hill team involved EH nurses shadowing PeterMac nursing and radiation therapy staff to gain practical and evidence based knowledge of radiation therapy. The initiative was evaluated through completion of a project specific questionnaire. Fourteen EH nurses took part in the program. Thirteen nurses reported their knowledge of radiotherapy as absent or low prior to the day spent at PeterMac. Feedback from all nurse participants was overwhelmingly positive, with 100% of participants
scoring moderate to high on knowledge of radiotherapy after the one day program. Participants, EH nursing education staff and the PeterMac radiotherapy staff all reported with strong support for the initiative to continue. In order to ensure sustainability of the initiative and as demonstration of its success, the program has been incorporated into EH’s nurse oncology education course.
References
The Royal Australian and New Zealand College of Radiologists., 2012 Planning For The Best: Tripartite National Strategic Plan for Radiation Oncology 2012–2022, Version 1 June 2012. * Acknowledgement: Project funds were secured from the Nurses Board of Victoria Legacy Limited Grants.
Kathryn Watty is Nurse Unit Manager Radiotherapy Nursing and Julie Wills is Radiation Therapist, Site Manager both located at Peter MacCallum Cancer Centre Campus, Box Hill, Victoria Emily Ludescher is a Clinical Nurse Educator at Box Hill Hospital, Eastern Health, Victoria PAGE 39 August 2014 Volume 22, No 2.
Focus Improving patient experience of robotic prostatectomy By Emma Birch, Kathryn Schubach and Declan Murphy For men with curative prostate cancer, robotic prostatectomy (RP) offers an efficient alternative to traditional open prostatectomy (OP) (Davison, Matthew, Gardner 2014). However international evidence is equivocal about the patient-reported benefits of RP over OP (O’Shaughnessy, Laws, Pinnock, Moul et al 2013). Data from an international survey of 86 men who had received either OP or RP demonstrated statistically significant (p=0.027) higher recent distress in the RP group over the OP group 12 months after surgery (O’Shaughnessey et al 2013). Authors concluded that men who opt for RP need tailored Information to ensure they have realistic expectations of RP.
At the Peter MacCallum Cancer Centre (PeterMac) in Melbourne, a clinic has been implemented to prepare men and their partners for the potential impact RP may have on their physical and emotional wellbeing. The clinic is led by a specialist RP nurse and involves urologists, a uro-oncology nurse practitioner, physiotherapist and psychologist. On the day after his RP every man receives a telephone follow up consultation by the RP nurse. Between May 2012 and August 2013, 74 patients attended the clinic and completed a pre and post clinic questionnaire. The questionnaire assessed satisfaction with information provided pre RP and anxiety levels pre and post the clinic consultation. At presentation to the clinic, 39 (53%) men indicated that they had a high level of generalised anxiety. Following the clinic, 52 (70%) men reported reduced feelings of generalised anxiety. Sixty six (89% men felt
well supported by the nurse-led telephone consultation the day after the RP with sixty men (81%) reporting that the clinic was a positive component of their care. At PeterMac, the clinic has become an exemplar of the contribution of specialist cancer nurses within a multidisciplinary team, to the outcomes of people affected by cancer. Further research is planned to evaluate expansion of the RP nursing role to the outcomes and experiences of men undergoing robotic prostatectomy.
References
Davison BJ, Matthew A, Gardner AM., 2014. Prospective comparison of the impact of roboticassisted laparoscopic radical prostatectomy versus open radical prostatectomy on health-related quality of life and decision regret. Canadian Urological Association Journal. 8(1-2):E68-72. O’Shaughnessy PK, Laws TA, Pinnock C, Moul JW, Esterman A., 2013. Differences in self-
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PAGE 40
Oncology Cancer survivorship reported outcomes of open prostatectomy patients and robotic prostatectomy patients in an international web-based survey. European Journal of Oncology Nursing. 17(6):775-80.
Emma Birch is Robotic Surgery Nurse Coordinator in the Uro-Oncology Service and Kathryn Schubach is a Uro-Oncology Nurse Practitioner, both located at Peter MacCallum Cancer Centre, Victoria Associate Professor Declan Murphy is a Consultant Urological Surgeon at the Peter MacCallum Cancer Centre, Victoria, The Royal Melbourne Hospital, Victoria and Director of Outcomes Research at The Australian Prostate Cancer Research Centre, Victoria
By Melinda Richardson
‘Survivorship care’, which recognises the ongoing needs of people who have undergone treatment for cancer, is becoming an emerging area of research and clinical focus. Cancer treatments have long lasting consequences for survivors that can touch many aspects of their lives. This can include physical, psychosocial, relationship and financial concerns. The Flinders Medical Centre (FMC) Survivorship Program based in South Australia commenced in 2009 and is supported by clinical research relevant to survivorship care. The program is conducted within the Department of Medical Oncology located in the Flinders Centre for Innovation in Cancer. The program includes an end of treatment assessment and development of a survivorship care plan for
Flinders Medical Centre Nursing Director (Cancer Services) Melinda Richardson and Clinical Practice Consultant (Survivorship) Michael Fitzgerald at the Flinders Centre for Innovation in Cancer
each cancer survivor. The survivorship team has contributed to two survivorship conferences in 2011 (local) and 2013 (national). In May 2014 a diverse group of 30 stakeholders including clinicians, survivors, carers and community representatives were invited to inform discussion and provide feedback
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Focus to further the strategic development on the survivorship program. Participants included consumer representation from the Fleurieu Cancer Network, representatives and survivors from Cancer Voices (SA), a Marion Council representative to talk about community programs, and a representative from the Cancer Council (SA). Broad aims of the meeting were to discuss current needs and ways to address them, build capacity within the program and engage with other key providers. From this discussion, a strategic plan will be developed with a number of key initiatives to progress the program. It was also hoped that we could identify and engage a range of collaborators who could work with us in progressing the priority areas identified. A group discussion identified many areas that we are good at and should maintain
Oncology in the program, however, it was the gaps in our program that we were keen to find out more about. Our consumers gave us a valuable understanding and insight. They described the anxiety of having to let go of the trusting relationships developed with doctors and nurses and navigating support options to address their specific needs. They described the need for information that was easy to find and would help them gain independence in self management. Programs offered needed flexibility in scheduling to increase accessibility. Information given to their general practitioners should be timely and comprehensive to enable a seamless transition from acute care to community. The care focus needs to shift from illness to wellness and incorporate physical activity. Other issues
such as depression and anxiety, changes in relationships and financial hardship that can follow an extended absence from work need careful consideration. The group decided upon several initiatives including development of an information hub, progress the ‘living well after cancer’ concept in collaboration with community groups, and refocus on the Survivorship Charter developed at the inaugural Survivorship Conference (2013). The numerous outcomes from this meeting will inform the strategic plan, survivorship program, at the Flinders Centre for Innovation in Cancer for 2014 onwards. Melinda Richardson is the Nursing Director, Cancer Services at Flinders Medical Centre in South Australia
Safe handling of cytotoxic medications and related waste – practice evolution By Leisa Brown
A key project undertaken by CIRCS Nurse Educator is to conduct cytotoxic environmental audits in response to facilities reviewing processes for handling cytotoxic medications or facilities wishing to initiate a chemotherapy service. Most cytotoxic medications and related waste are classified as hazardous according to the Globally Harmonised System of Classification and Labelling of Chemicals (GHS) (United Nations 2009). Working with these medications may pose a risk of exposure to hazardous substances and/or metabolites during manufacture, transport, preparation, administration and handling cytotoxic contaminated waste, including body fluids. Although these medications are primarily used in cancer treatment, the number of patients receiving them for non-cancer indications (rheumatoid arthritis, Crohn’s disease) has increased. Therefore, all nurses regardless of clinical context may be exposed to these hazardous substances. A multiplicity of documents has identified the potential risk for occupational exposure to hazardous substances which has led to a plethora of regulatory standards and guidance documents. There is limited information regarding the long-term adverse effects of exposure; however there is suf-
ficient evidence indicating that workers may experience health issues if adequate control measures have not been implemented (Department of Health and Human Services 2004). Historically, hazard protection in this context has focused on Personal Protective Equipment (PPE) for risk reduction. State and territory regulations outline a hierarchy of control measures that are to be implemented in order of rank from most effective to least effective to manage risk. Identified risks to health and safety must be eliminated so far as is reasonably practicable, if it is not reasonably practicable to eliminate, the risk must be minimised so far as is reasonably practicable (State of Queensland 2011). In most cases, it is not possible to eliminate cytotoxic medications; therefore other controls are to be implemented in rank order. The project assists facilities to identify appropriate controls such as: • Substitution – Closed System Transfer Devices eg. Equashield© and PhaSeal©, only devices to have FDA ONB clearance • Isolation – Separating the workers from the hazard eg. appropriate packaging • Engineering controls – Use of Cytotoxic Drug Safety Cabinet to prepare cytotoxic medications • Administrative Controls – Standard Operating Procedures, education and training and cytotoxic signs and labels • PPE – What to wear and when. Conducting cytotoxic environmental
Hierachy of control measures - Cytotoxic Medications and related waste
audits formally documents how a facility is meeting legislative requirements and best practice standards. It provides practical assistance on how to protect all workers and the environment from undue exposure to cytotoxic substances and related waste.
References
Department of Health and Human Services (DHHS) - Centers for Disease Control and Prevention and National Institute for Occupational Health and Safety (NIOSH)., 2004. NIOSH Alert: Preventing occupational exposures to antineoplastic and other hazardous drugs in healthcare settings. Publication Number 2004-165. State of Queensland., 2011. Work Health and Safety Regulation. United Nations., 2009. Globally Harmonized System of Classification and Labelling of Chemicals (GHS). 3rd edition. Electronic version www.unece.org/trans/danger/publi/ghs/ghs_ rev03/03files_e.html, accessed 02/06/14.
Leisa Brown is the Nurse Educator – Central Integrated Regional Cancer Service (CIRCS) at the Department of Health, Queensland Government PAGE 43 August 2014 Volume 22, No 2.
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Calendar AUGUST
Nursing Informatics Australia Conference E-health is changing healthcare: Nurses meeting the challenge. Smart phones, smart tablets, smart nurses. 11 August 2014, Melbourne Convention & Exhibition Centre. http://www.hisa.org.au/page/ hic2014nia APNA Continuing Education for Nurses in General Practice 15–16 August, Novotel Canberra, ACT For more information and to register go to www.apna.asn.au/nigp Lung Health Promotion Centre at The Alfred 18-19 August, Spirometry Principles & Practice Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 E: lunghealth@alfred.org.au 8th International Council of Nurses, International Nurse Practitioner/Advanced Practice Nursing Network Conference Advanced nursing practice: Expanding access and improving health care outcomes 18-20 August, Helsinki, Finland. http://www. nurses.fi/8th-icn-international-nurse-prac/ National Forum on Long Term Unemployment Building Capability 18-19 August, QT Hotel, Gold Coast Qld. This conference will address the causes of long term unemployment and what can be done for these at risk groups of disability, mature age, youth, indigenous and the regional unemployed. It will focus on Building Capability to successfully tackle long term unemployment and how to create employment for the future. http://longtermunemployment.org.au Community Health Nurses Western Australian Conference No man is an Island 22-24 August 2014, Rottnest Island, WA. http://chnwa2014.iceaustralia.com/ 15th International Mental Health Conference Mental Health: Innovation | Integration | Early Intervention 25-26 August with optional workshops on 27 August, QT Hotel, Surfers Paradise. www.anzmh.asn.au/conference/ The MHS Conference 2014 What We Share Makes Us Strong 26-29 August 2014, Perth Convention & Exhibition Centre www.themhs.org 15th Asia-Pacific Prostate Cancer Conference Together in discovery and care 31 August–2 September, Melbourne. http://prostatecancerconference.org.au/
Network
Royal Melbourne Hospital PTS School of 16 June 1964, 50-year reunion Contact Jenny Cunningham Email: jennifermonaghan@ bigpond.com.au
Northern District School of Nursing School 103 1984 – 198, 30-year reunion 23 August, Bendigo. Contact julesbarbetti@ live.com.au or facebook
SEPTEMBER
International Tracheostomy Symposium 2014 and combined Australasian kickoff of the Global Tracheostomy Collaborative 8 October. An exciting multidisciplinary event including international speakers presenting on excellence in Tracheostomy care. Register via: www.tracheostomyteam.org
Lung Health Promotion Centre at The Alfred 3–5 September / 15 – 16 October, Respiratory Course 3–5 September, Respiratory Course (Module A) Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au
National Indigenous Mens Conference 13-15 October, Pullman Cairns International Hotel, Cairns, Qld. www.indigenousconferences.com
9th National Conference of the Australian College of Nurse Practitioners New Frontiers – Building future generation 2-4 September 2014, The Masonic Conference Centre, Sydney. http://acnp.org.au/events/15
18th International Conference on Cancer Nursing 7-11 September, Hilton Panama, Panama City. http://www.isncc.org/?page=18th_ICCN 3rd World Congress of Clinical Safety (3WCCS) Clinical Risk Management 10-12 September, Ayre Gran Hotel Colon, Madrid, Spain. http://www.iarmm.org/3WCCS/ New Zealand Nurses Organisation (NZNO) Conference Nurses – champions for change 18 September 2014, Michel Fowler Centre, Wellington, New Zealand. www.nzno.org.nz/2014conference Nurses for Nurses Network 2014 Annual Conference Practice Innovation in a Contemporary Nursing Landscape 20-27 September, Norwegian Jade, Departing Venice, Italy CPD Educational Cruises and Nurses for Nurses Network are proud to host the Nurses For Nurses Network 2014 Annual Conference onboard the luxurious Norwegian Jade cruising the Greek Islands. Join nursing colleges from around Australia participating in some of the most innovative clinically focused nursing education available. Earn up to 25 hours continued professional development towards your CPD portfolio. http://cpdcruises.com.au/conferences/Nurses-forNurses-2014-Annual-Conference/ CATSINaM 16th National Conference & AGM Embrace the difference within our people 23 September, Student Day, Registrations and AGM 24-25 September, Conference Rendezvous Hotel, Scarborough Beach, Perth WA. www.catsinam.org.au
OCTOBER
Lung Health Promotion Centre at The Alfred 15–16 October, Respiratory Course (Module B) 23–24 October, Managing COPD 27-28 October, Spirometry Principles & Practice Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 E: lunghealth@alfred.org.au
NOVEMBER Australian College of Nursing - National Nursing Forum 2-4 November, Adelaide. http://www.acn.edu. au/forum The National Primary Health Care (NPHC) Conference 5-7 November, National Convention Centre Canberra. http://amlalliance.com.au/events/nationalprimary-health-care-conference-2014 Lung Health Promotion Centre at The Alfred 11 November, Educating & Presenting With Confidence 12-14 November, Asthma Educator’s Course 20-21 November , Smoking Cessation Facilitator’s Course Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 E: lunghealth@alfred.org.au 6th Australian Rural and Remote Mental Health Symposium The Practitioner’s Voice 12-14 November, Commercial Club, Albury, NSW. http://anzmh.asn.au/rrmh/ 2nd International Conference on Nursing & Healthcare Exploring the Possibilities towards Better Healthcare 17-19 November, Chicago, USA. http://nursing2014.conferenceseries.net/
Australasian Association of Bioethics and Health Law Conference How should we decide 2-4 October, University of Western Australia, Perth WA. http://www.conferencedesign.com. au/aabhl2014/
17th South Pacific Nurses Forum Nurses collaboratively rowing (leading) the way Showcasing innovative ways for promoting Pasifika healthy lifestyles 18-21 November, Tonga. http://www.spnf.org.au/
John Fawkner Private Hospital/Sacred Heart Hospital celebrates its 75th anniversary October. We are seeking memorabilia, old photographs, uniforms, books, instruments, stories etc. from past staff,
Alfred Hospital Nurses League 96th AGM and Lunch 25 October at 12md, Mt.Erica Hotel, Prahran. For further information and bookings, contact Hon Sec Dorothy Owen Email: dorothy@e-owen.com
doctors and students. An open day and other activities are planned for this milestone event. Contact Chris Papas, Executive Secretary at chris.papas@ healthscope.com.au or Ph: (03) 9385 2501
Royal Adelaide Hospital Nurses Training, Group 895, 25-year reunion 29 November, Adelaide. Contact Julia Curley Email: juliacurley@hotmail.com
PAGE 45 August 2014 Volume 22, No 2.
Recuperating – Reflections of a nurse as a patient
Australian Nursing & Midwifery Journal Volume 22, No. 1. July 2014
As I lie here listening to the hospital ward coming to life I can’t help but reflect on my 35 years of nursing and the changes in nursing and healthcare. When I started nursing it was a young nurse’s job to empty the patient ashtrays that sat overflowing on bedside tables, and doctors did their rounds with cigarettes in hand. Thank goodness health ideas have changed!
Social media The pitfalls and the potential www.anmf.org.au
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Correction: The story Cervical Screening presentations to Well Women’s Clinic, July Focus section page 43, should have read that ethics approval was given from South West Sydney Local Health District Research and Ethics committee, not South Eastern
But some health ideas I worry about. We seem to have lost the use of the term ‘recuperate’. The world is faster and faster and now there seems to be only two states - sick and healthy. It seems there is no time allowed to recover, to move from feeling awful to feeling normal. If you are discharged from hospital you must be well. Take the maternity ward for example. When I was born, a while ago now, my mother was barely allowed to put a foot to the ground for ten days. She was allowed to rest and recover and learn how to care for her new baby. Today’s midwives are far more educated and knowledgeable than back then but today’s midwives have only a day or two to share this knowledge with modern new mothers. Now mothers go home before their milk starts to flow and you just have to hope they have a supportive mum, sister or friend who can help them survive that chaos of early breast feeding and childcare. And where in amongst that chaos does the new mum get to sleep and heal herself. It seems to me the human body has not changed an iota in 50 years but healthcare definitely has. It’s all about money. The money put into healthcare is so tight. It’s all about throughput. Like a sausage factory we must move them through and spit them out the end. There is no time to rest in hospital. Rest has no value. If they’re not ‘doing’ something for you in hospital then there is no point you being there. So you are sent home to ‘take it easy’ but you can’t really because no one at home understands what that means either. So you get up and get going, but what I think is that inside it takes its toll. We have increasing depression, obesity, heart disease and diabetes. We have better knowledge, better technology, and better health research. We have more but we have less. I don’t know the answers. All I know is that I will tread slowly on my path to good health. Life is too precious and I still have much to see and do. But it’s good to know some things never change in hospital - the toast is always cold, the pillows are always uncomfortable and the nurses always manage to make me laugh and are truly amazing. Just saying.... Bronwyn Pulis, RN Victoria
The winner of the ANMJ best letter receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf.org.au Letters may be edited for clarity and space
Shocked at behaviour
I feel compelled to respond to the social media article in the July issue of ANMJ. I am bewildered, disheartened and disgusted to think any conscientious nurse would ever even think of photographing a patient without that person’s informed consent. This is an absolute breach of confidentiality and privacy and a breach of patient/ significant other’s trust. Who, in their right mind, could ever consider photographing themselves with a dead patient? As a registered nurse of 27 PAGE 46
years experience, this act deeply disturbs me. The dead person should be treated with as much respect and dignity as the person still alive in the bed; comatose or conscious. What an absolute degradation of trust must the relatives/significant others have felt; especially if any of them were to see such an image on the internet? The documentation of the child’s resuscitation was also a terrible breach of trust and dignity; and then to post the poor child’s face upon the internet!!! What a sick and unspeakable act. What are these nurses thinking? Are they thinking at all? Do they understand the
full extent of confidentiality, privacy and informed consent? There obviously needs to be a full unit taught upon this subject in nurses’ university training. I also think such breaches should be taken very seriously and registration suspended for a period of time. This, to me seems criminal and an ethical violation. I seriously hope the nurses mentioned in this article were held fully accountable for their terrible, thoughtless breaches of privacy, confidentiality and patient trust. Sandra Jennings, RN Victoria
Mail Time restraints impacts care I find it interesting that the article, ‘The Responsibility of Care’ (ANMJ June 2014) sought the opinion of mostly academics, rather than those working on the frontline themselves. As a result, the opinions didn’t reflect what many of the nurses in practice know and experience every day. Compromises to basic care needn’t refresh the debate of university versus hospital training. It’s the result of one thing - time restraints. For every form we filled in for a patient fifteen years ago, there are now about nine forms. The rising occurrence of litigation and incidences where nursing staff encounter professional disciplining result in nursing notes needing to be much more comprehensive (if it wasn’t documented, it didn’t happen). Our scope of practice has increased; we do things once done by a doctor, such as cannulation. Handover, now done at the bedside with patient input, takes twice as long as
ever before. We now manage patients with greater clinical complexities in a less acute environment; where a patient with epidurals, arterial lines, CVP monitoring was once looked after with a nurse with lower patient numbers, we now have the skills to manage these in a more ward-like environment. Where once there were ward clerks in the evenings outside business hours, nurses are answering phones. Where AINs, and care assistants once assisted RNs and ENs with their patient load, in many places these have been phased out completely. Where once there might have been a ‘float nurse’ or a transport nurse, the need to meet KPI’s mean these have been considered unnecessary. All the aforementioned ‘advances’ have occurred for a variety of reasons - professional advancement, budgetary, and legal reasons and some have undoubtedly created benefit to patients and nurses. But what every one of these means is an increase on the demands of the nurse working on the ward,
and a decrease in the time they have. Everything, from the admission to the discharge process of a patient takes much longer than it did ten or twenty years ago. Singularly, the demands on time these changes have made are small, but in the bigger picture across the timeframe of a whole shift, it is not small. Very few, if any, of these changes have come with an acknowledgement of time pressure. Interestingly, the only response that gave the issue of time adequate acknowledgement in the article was Laura Irving, one of the only authors that works on a ward. I, and most nurses practising in healthcare I’m sure, took umbrage at some of the academics, sitting outside the coal face suggesting nurses today do not value the essentials of care or there is a culture of nurses sitting in the nurses station having to be ‘coaxed into the patient care area by relatives or, largely ignored, call bells’. Perhaps this gaping chasm between those educating our nurses and working in nursing research and those carrying out the job in the real-time setting is more part of the problem than the location of this education? Anonymous, RN Tasmania
An attitude of discrimination While I totally agree with the writer (ANMJ mail July 2014) on the need to place more priority on the recruitment of nationally trained Australian nursing graduates rather than employing international foreign nurses on 457 visas, I am not exactly certain what his/her definition of “Australian nurse” is.
that there is an element of discrimination going on. The comment was clearly stated and wasn’t read out of context. I want to believe this is not what a notable organisation, as ANMF is, stands for. Attitudes like these should not be condoned.
If one should go by the explanation provided by the writer, it is outrightly obvious
The writer states it’s hard to find an Australian nurse to relate to while at the same time
Every nurse should be treated equally irrespective of their migration status or whether English is their second language or not.
accusing foreign nurses for relating amongst themselves. This does not show a spirit of acceptance but rather a covert attitude of discrimination and bullying of some sort. It’s high time we kick discrimination and bullying out of nursing profession and lead by example as our upcoming young nurses are looking up to us. Looking forward to seeing this letter published for everyone to comment. Elisha Aigbokhan Registered Mental Health Nurse, Darwin.
Editorial note The opinion of letters contributed to ANMJ mail are those of the contributor and not necessarily the view of the ANMF. In relation to foreign nurses working in Australia, the ANMF supports migration and has always acknowledged nursing and midwifery as international professions that move around the globe to gain further education and different clinical experiences. We also note there is clear merit in international exchange and diversity, as well as economic benefits for many nurses and their families. The ANMF also supports temporary migration schemes as important to allow employers to meet unforeseen and unplanned labour needs. However our support is subject to the employer firstly giving preference for those jobs to local nurses and midwives before seeking to recruit from other countries. Additionally, the ANMF supports equality in wages and employment conditions for all nurses and midwives be they local or from overseas. PAGE 47 August 2014 Volume 22, No 2.
Coral Coral Levett, Federal President
Scaremongering not helpful! He claimed in a speech to the right-wing anti-worker think tank, The Sydney Institute, that if ‘weak kneed employers’ continued to cave in to ‘unreasonable union demands’, we risked another wages explosion similar to that of the pre-accord era when unsustainable wage growth pushed thousands of Australians out of work.
does this widening gap mean I hear you ask? It equates to a massive redistribution of national income to profits for the employer, including our governments. This means money that should be in your pocket for all your hard work is actually going into business and service sector profits. What’s worse is the gap is still widening.
My question to Minister Abetz is this: Where is the evidence for your claim? Such scaremongering is not helpful to anyone. The reality is that over the last three years, real wages growth has lagged behind productivity growth. Bill Mitchell, a leading Australian economist and expert in modern monetary theory weighed into the argument following the Minister’s claim with a very different view and with the real facts about wages growth. I’ll attempt to bring you Bill’s more factual take on the situation.
When the Federal Minister for Employment Eric Abetz recently warned the public about the impending ‘wages breakout’ if union power was not curbed, he made a deliberate attempt to mislead the general public into thinking that we were in trouble, again!
The graphs below are sourced from Australian Bureau of Statistics data, (2014). The first one shows productivity growth (the green line) is booming at present. This means for each extra dollar of real output created by the workforce, less workers are needed to achieve the same results. If the workers achieve a constant output, then productivity growth rises. The usual payoff for this outcome is shared out to workers in the form of improvements to living standards, thus enabling them to higher rates of spending and activity. The trouble is, that we are not seeing this payoff, with real wages (the blue bars) clearly moving in the opposite direction.
Although the average national wage is not keeping pace with labour productivity improvements, there are some exceptions. I refer to those massive executive salaries and bonuses that we hear about in the media regularly. For the rest of us though, we rely on wages growth to keep the economy ticking over. It allows us to spend more and keep the economy healthy. Without it, we tend to borrow more and place the economy at higher risk. We’ve all seen the result of this in our not so distant past with the global financial crisis (GFC) of 2008, brought on by irresponsible financial institution all too happy to loan us money. The reality is that this current Australian government looks for and will use any excuse to fulfill their union-busting ideology. The unions, including ours, are not out of control, and neither is our reasonable claim for wages. There has been measured restraint with wage claims over the last few years and more of a focus on achieving acceptable staffing arrangements, such as nurse to patient ratios that offer safer care. Acknowledgment: Bill Mitchell: http:// bilbo.economicoutlook.net/blog/
This next graph shows growth over time in hourly real wages and its relationship to labour productivity since 1997. In this time, real wages have grown by only 10% (an average of just over 0.6% per year), whereas hourly labour productivity has grown by a whopping 28%. So, what PAGE 48
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