Health Times June Edition

June 2018

Regional & Remote Feature + Hospital closures leave nurses out in the cold + Complete rethink needed to address rural mental health crisis + Nursing accreditation at risk without adequate funding for locum support + More breast care nurses needed in rural communities

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HealthTimes - June 2018 | Page 03

June 2018 We hope you enjoy perusing the range of opportunities included in this issue.

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Complete rethink needed to address rural mental health crisis

N

ew analysis by the National Rural Health Alliance reveals how few mental health professionals work in the country.

There are just 2 psychiatrists for every 100,000 people in remote Australia, new analysis from the National Rural Health Alliance showed today.

Mark Diamond, CEO of the National Rural Health Alliance, is calling for Australia to overhaul the way it trains and supports mental health professionals to boost numbers in rural and remote areas.

“We need to both attract country kids to the professions and train them in rural areas to maximize the chance they’ll stay and work in the country.”

“Rural Australia is not only short of GPs. All of the mental health professions are scarce,” he said.

The new Alliance analysis compares the number of mental health workers in major cities and country areas. In major cities there are 120 psychologists/100,000 people. In very remote areas there are just 25 psychologists/100,000. For mental health nurses the split is 94/100,000 in cities, compared to 29 per 100,000 people living in very remote areas.

Very remote areas include Bourke and Cobar in NSW, Ceduna and Kangaroo Island in South Australia, Kalgoorlie in WA, and Cunnamulla and Charleville in Qld. The National Rural Health Alliance analysis also reveals that Medicare spending on mental health is $52.42 per person in cities, and just $8.26 per person in very remote areas.

“The Alliance has dug into different sets of data, and built a picture Australia hasn’t yet seen of the rural mental health crisis.”

The low number of mental health workers is forcing country people into hospital emergency departments.

“Nearly twice the number of people in remote

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areas end up in emergency for a mental health issue because there is simply no one else to help them” Mr Diamond said.

“If the emergency department of your nearest hospital is the only service available, country people are more likely to delay seeking help, especially if they have to travel long distances to a hospital.”

“It makes it much more likely their mental health illness has reached crisis point before they seek help, making it that much harder to recover.”

The Alliance welcomes recent announcements by the Federal Government to fund extra online and phone counselling services for country Australia.

“Technology is a part of the solution. But it’s only a part. We need significantly more mental health workers on the ground. They also need extra training to prepare them for the particular needs and challenges of working in a rural or remote setting.”

The analysis is part of the Alliance’s submission to a Senate Inquiry into The Accessibility and Quality of Mental Health Service in Rural and Remote Australia https://bit.ly/2IJN7W0 The submission makes seven recommendations including: • Overhaul the way mental health professionals are trained to both attract and retain them in country areas.

• Ensure they have additional generalist skills needed to address the unique needs of rural and remote Australia.

• Ensure rural and remote areas receive the same mental health funding per capita as major cities.

• Evaluate the effectiveness of current federal and state mental health programs.

• Ensure guidelines are used to decide whether or not telehealth services are appropriate.

HealthTimes - June 2018 | Page 09

Providing better health through computer games?

U

sing computer games and virtual reality technology to create low-risk environments holds ample value for healthcare.

With intense, life-or-death situations occurring regularly, medical teams can practice the latest surgery techniques, refine skills and better prepare for emergency situations.

John Hopkins Medical Institute, in conjunction with The Johns Hopkins University’s Applied Physics Laboratory and Carey School of Business, developed a large-scale hospital simulation where medical staff can prepare their response to patient safety challenges.

To ensure accuracy, they conducted in-depth interviews of key stakeholders as well as analysing processes and data. This program has now enabled other institutes around the world to provide better care.

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The forum will be covering essential topics including: • Achieving Interoperability • Digital Transformation • Patient Empowerment • Healthcare Integration • Clinician-Led Transformation These topics will equip delegates with the insights necessary to navigate a shifting landscape that is seeing old and new models of healthcare collide alongside increasing patient empowerment. The industry’s capacity to adapt will be critical to its future – and the health of the nation.

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ANMF negotiates above-agreement redundancy packages following shock hospital closures

T

he Australian Nursing and Midwifery Federation (Vic Branch) has been successful in negotiating above-agreement redundancy packages for Healthscope nurses who are losing their jobs, following the unexpected closure of the company’s Cotham Private and Geelong Private hospitals.

ANMF (Vic Branch) Secretary Lisa Fitzpatrick described the closure of Healthscope’s facilities and the accompanying loss of jobs as ‘incredibly distressing’ for the affected ANMF members and their families.

Ms Fitzpatrick said ANMF’s support for members included negotiating a redundancy package that reflected community standards, ensuring members received their entitlements and assistance with finding new positions.

“Our members’ gratitude was palpable at the meeting when Minister Hennessy made the announcement that the Andrews Government would identify 117 job opportunities within Barwon Health and other positions in some metropolitan networks,” she said.

“We are very appreciative of the Andrews Government working so hard and so quickly to assist nurses and others gain employment.”

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In May, Healthscope announced that Cotham Private Hospital in Kew and Geelong Private Hospital would close over the following four week period, due to financial inviability The closures resulted in the loss of 417 jobs across the two hospitals.

Under the severance pay deal, negotiated by ANMF, Healthscope nurses would receive at least four weeks’ pay if they’d worked for the company for onetwo years, or 20 weeks if they’d worked there for more than 25 years – eight weeks more than severance pay under the enterprise agreement.

Nurses who have been working for Healthscope for seven years or more will also receive greater long service leave payments than their entitlements under the agreement, ranging from 6.06 weeks (for seveneight years’ service) to 1.733 weeks per year of service for nurses who have spent 10 or more years with the company.

Long-term, regular casuals will receive a payment equivalent to 50 per cent of the enterprise agreement severance pay scale.

For more articles visit HealthTimes.com.au

Career Opportunities in Central Victoria

Maryborough District Health Service provides services to the Central Goldfields & Pyrenees Shire with campuses in Avoca, Dunolly and Maryborough.

MDHS is one of the largest employers in the region, providing the perfect setting to become part of our team and community.

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For more information, contact Wendy Giddings on (03) 5461 0306 or HR on (03) 5461 0303. Applications to include a cover letter, resume & written response to key selection criteria. Submit via the 'Careers - Vacancies' link on our website by selecting the 'Apply Now' button for the advertised role.

MDHS is an equal opportunity employer. Appointments are subject to a satisfactory National Police Check.

HealthTimes - June 2018 | Page 15

Nursing accreditation at risk without adequate funding for locum support

L

ocated in the Corangamite Shire, also known as the Lakes and Craters region, Camperdown has a steady population of over 3,300 residents.

It is two and a half hours west of Melbourne and just over an hour south of Ballarat with the Great Ocean Road a 30-40 min drive away.

The Camperdown community comprises primarily of farming and small businesses with a small percentage of welfare-based families and an increasing number of elderly residents, all of whom require access to quality and affordable healthcare services.

Camperdown Clinic provides cradle-to-grave healthcare across the Great Ocean Road to Mount Elephant and Lismore.

They have employed practice nurses for over 14 years and provide educational opportunities for Continuing Professional Development (CPD) and skills maintenance for their staff. The local hospital is run by General Practitioners and is supported by highly proficient nurses who care for their inpatients.

Mark Leddy, Practice Manager for Camperdown Clinic, is responsible for ensuring that appropriate staffing levels are met to provide continuity of service within the local community, especially during CPD training. Mark said, “it is always a human resource issue to rely on other team members to adjust their lifestyle in order to cover a position when training is undertaken”.

Mark first heard about the Australian Government-funded Rural Locum Assistance

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Programme (Rural LAP) in 2011 and he was glad the initial conversation took place.

“The assistance, guidance and professionalism were at the highest level. The whole evolution was undertaken with clear advice and, surprisingly, minimal paperwork. The quality of candidates put forward allowed management to select the most appropriate locum to cover the position. If I had been recruiting for a full-time practice nurse, all three of the candidates would have been on my interview short-list” Mark explained.

Camperdown Clinic was eligible to receive Government-funded locum support which they used for a practice nurse who was required to attend a Pap Smear Update course that was a five-hour drive away.

This meant that the practice nurse was away from the clinic for several days to provide adequate travel time and undertake the course refreshed and focused. Mark said, “without access to locum support, we would not have been able to cover their absence and their accreditation may have lapsed.”

“The ability to allow health providers access to a staffing resource through Rural LAP certainly encourages managers to support the endeavours of their staff in maintaining currency and competency”, he concluded.

Camperdown Clinic continues to access this Government-funded service with a locum currently deployed to cover a practice nurse on leave.

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HealthTimes - June 2018 | Page 17

Hospital closures leave nurses out in the cold

M

ore than 200 nurses will be impacted by Healthscope’s decision to close Geelong Private Hospital and Cotham Private Hospital, a move which has left staff shocked and dismayed.

Registered nurse and midwife Gillian Wride has been working at Geelong Private Hospital for almost 20 years, and says the impending closure has left her feeling lost and confused.

“I’m devastated, sad, angry, shocked and disappointed,” Ms Wride says.

“I’m very emotional about it.

“You sign a piece of paper with a date to leave by. You hand in your ID badge, swipe card, and just quietly walk out the door after nearly 20 years.”

Having been a nurse for more than 37 years, Ms Wride says she’s unsure what the future will now hold.

“As I am of a certain age, finding new employment will be difficult, especially as I am seeking to continue in my vocation, and not just looking for a job.

“I feel I have few good years left in me, but now in Geelong there are many nurses that are keenly looking for nursing positions.

“These positions are limited, most nurses have family in the Geelong area so they will have to look at relocating to Melbourne or other areas for work.

“Logistically this is difficult and emotionally it is heartbreaking.”

To make matters worse, staff have been left largely in the dark with regards to timing and

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process in relation to the closure.

“I knew that the hospital could not be financially viable with very poor occupancy rates that we had been experiencing for some time, so I was expecting something to give but still shocked that the solution was closure.

“Despite the obvious planning which would have been many months in development, notice of the closure was only communicated to the employees at five minutes to midnight.

“Unfortunately this left staff in a difficult situation, especially with the end of the financial year looming.

“So, planning could have been so much better in order to benefit the loyal staff, but I guess we all understand the financial imperatives.”

Ms Wride says the way the matter has been handled may force her into an early retirement.

“I am still shocked that I am unemployed after 37 years.

“Yet I am hopeful that my experience will stand me in good stead.

“I am of a certain age that makes it challenging to be re-employed. Experience does not seem to amount to much.

“Once you are not working at the bedside directly giving patient care as a nurse, there are much less employment possibilities.”

A devastating reality for Ms Wride who loves being a nurse and working with nurses, particularly in the Geelong area.

“Our jobs have such an impact on people’s lives, from nursing critically ill patients right

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through to caring for our palliative patients.

Nurses are the patients advocates making sure that their needs are met with respect and dignity.

“The Geelong area and Bellarine peninsula provides a great family environment with an eclectic mixture of local culture and lifestyle opportunities which are second to none.”

Ms Wride says she believes the closure is the result of a broader issue, and a number of associated problems. She says Health Policy makers should be doctors and nurses, rather than bureaucrats, as a starting point, followed by a reexamination and redesign of the structure of health policy and its financial base.

“The main stakeholders, the consumers, need to be consulted,” says Ms Wride. She also says the following issues need to be addressed: Private Health Insurance, which is too expensive for most people with its restricted cover; MBS, which is unrealistic when the value of the service is grossly underestimated. “Indexing

For our latest career opportunities go to www.gvhealth.org.au

of the MBS is also unrelated to changes in the CPI and technology advances,” says Ms Wride.

MBS rebates thus lag behind the real cost of providing services.”

Public hospitals holding onto the private patients, as they can have greater remuneration by charging these patients health funds. “These private patients block access to public beds and the waiting list for surgery for public patients continues to increase,” she says.

“These are but but a few areas that need addressing,” says Ms Wride.

“Overall we appear to have lost focus on best outcomes for patients, the government and health providers are always looking for a cheaper alternative for delivering Healthcare at the cost of patient safety.

“If we do not make some significant changes I feel our health system will become unaffordable and unsafe.”

HealthTimes - June 2018 | Page 19

More breast care nurses needed in rural communities to help those who need it most

A

s breast cancer diagnosis continues to rise, so too does the need for specialised breast care nurses.

Current research suggests there is a gap of around 80 nurses already, which is only set to increase along with Australia’s ageing population, advances in treatments and greater exposure to breast cancer risk factors.

Since 2005, McGrath Breast Care Nurses have been travelling to remote and regional communities, to assist women with breast cancer, their families and their carers.

“A McGrath Breast Care Nurse is a specialised, registered nurse who acts as a patient advocate,” says Jane Mahony, McGrath Foundation Nursing Program Director “Their unique role sees them provide timely care and referral services to people experiencing breast cancer, their families and carers.”

Inspired by the Jane McGrath’s experience with a dedicated breast care nurse, the foundation is dedicated to to raising enough money to place breast care nurses in the communities that need them the most, for free.

“Specifically, when it comes to our breast care nurse programme we’re focussed on growing the network of McGrath Breast Care Nurses we have across Australia,” says Ms Mahony.

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“While we’re extremely proud of the work we’ve done, we’re still a long way from meeting the growing need.”

Support from a McGrath Breast Care Nurse is free and people don’t require a doctor’s referral to get access.

“In a nutshell McGrath Breast Care Nurses help individuals and their families affected by breast cancer by providing invaluable physical, psychological and emotional support, from the time of diagnosis and throughout treatment,” says Ms Mahony.

Duties vary, and depend on whether the patient has early, advanced or metastatic breast cancer.

“The key stages a breast care nurse provides support for includes screening, diagnosis, treatment, survivorship, relapse and treatment and metastatic.

“The types of support an early breast cancer patient receives starts right from diagnosis including counselling, post diagnosis support, referral and access to psychosocial supports, help with treatment options and making informed decisions.

“On the treatment side this can include help with managing side effects, reconstructive surgery, lymphedema, wound care and overall care coordination.

“To put it more informally our McGrath Breast Care Nurses form relationships with their

patients that are meaningful and important.

“They provide calm and consistency in times of great stress.”

There are currently 119 McGrath Breast Care Nurses in communities across Australia, and about 70 per cent of these are stationed in regional and rural areas.

“These breast care nurses have supported over 60,000 individuals and their families since 2005.

“The McGrath Foundation’s vision is for every person in Australia experiencing breast cancer to have access to a breast care nurse no matter where they live or their financial situation.

“In the beginning much of the focus was on ensuring access in regional areas.

“While currently just over 70 per cent of our McGrath Breast Care Nurses are in regional and rural areas, there is a growing need for nurses in urban areas.”

Many of the foundation’s regional breast care nurses support patients over large geographic areas.

“For example, we recently placed our second McGrath Breast Care Nurse in Cairns to support people in Far North Queensland who have breast cancer.

“Our McGrath Breast Care Nurse in this role travels to visit patients from Cairns right up to Cape York and all of the areas in between.

“Together with our other Cairns based McGrath Breast Care Nurse, they support an area spanning over 380,000 km2 including Cardwell, Normanton and Torres Strait Islands.”

There is also one dedicated ‘flying McGrath Breast Care Nurse’ with the Royal Flying

Doctors (RFDS).

“She holds clinics in an aircraft hangar at the RFDS base next door to Broken Hill airport and uses the plane regularly to help isolated outback women (and men) at clinics at eighteen remote locations across far west NSW, northern Adelaide and South-West Queensland.”

Research shows that people with breast cancer in remote areas have poorer outcomes than their metro counterparts, due to later diagnosis and limited access to cancer screening and treatment services.

“It’s not uncommon to hear stories of women on the land doing 1600 km round trips every three weeks for months for treatment in larger centres, while also trying to run their families, businesses or properties.

“This adds enormous logistical and financial pressure on top of what is already a very stressful time.

“Essentially those in the rural and regional areas often have less access to the services that are available in larger cancer treatment centres.”

It costs around $140,000 to fund one McGrath Breast Care Nurse full time for a year.

“The McGrath Foundation relies on the support we receive from all over Australia – including individuals, communities, corporate partners and government.

“They help by donating, hosting or attending events, or purchasing McGrath Foundation products, which helps us continue Jane’s legacy and achieve our mission.”

HealthTimes - June 2018 | Page 21

Mandatory councelling recommended for frontline officers

S

erving frontline officers, such as paramedics, ambulance and police officers should receive routine counselling and access to a known mental health expert, according to phycologist Dr Karen Phillip.

“We currently have a reactive process rather than proactive,” says Dr Phillip.

“These workplaces do not seem to have the appropriate amount of support for members.

“They offer outside psychology which is viewed by many as a weakness if you need to attend. It can make the officer feel something is wrong with them, they are weak and they can’t cope while colleagues can.”

Dr Phillip believes a better approach is to provide ongoing debriefing from a qualified Counsellor or Therapist who develops a relationship with officers.

“The officers can then feel comfortable speaking with the therapist about any issues including work, family or personal.

“All officers and responders are people with their own issues and life experiences yet many of us see them as these strong individuals capable of anything.

“Yet, they do not get that solace and break many do at work when they can focus on a job or computer screen; they are in life, often at its worst or most traumatic.

“Our serving officers face immense pressures. They deal with death, emotional

Page 22 | HealthTimes.com.au

and distressed members of the community, hardship and trauma, accidents, and those acting violently, as this is what they face each day of their working life.

“They often have no idea what they are about to face with each callout.”

According to Dr Phillip, the past decade has seen an escalation of trauma experienced by officers and responders.

“Possibly due to more personality changing drugs such as ICE, perhaps it is the increase demands on all officers or maybe it is the additional pressures of life that infringes on their work.”

Dr Phillip says officers should be debriefed on a regular basis, such as fortnightly or monthly, as a group, enabling them to feel more connected with the team, and speak more freely.

“They could openly discuss, under therapeutic supervision, how they felt, the what, why, how aspects of their daily experiences.

“If it can become a mandatory part of their job to speak with a counsellor or therapist each month to just talk - about them, their life, family, issues, trauma and so on, it would lighten and ease so many of those caring for the community can receive the care they need as well.”

Dr Phillip says the enormous impact of these jobs on the mental and emotional health of individuals is underestimated.

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“When the officer has experienced trauma within their work, they can take this into their private lives.

“They may look for challenges when they are not present, they anticipate an issue fearing an event, they can become defensive, aggressive and always ready to respond.

“Many have difficulty sleeping, start viewing people with disdain and struggle to balance their work and life.

“They are always on duty, even when off duty, they are the first to step up or step in.”

Of course, the impact doesn’t stop with the individual officer, often extending to their families, and the broader community.

“When a family member is suffering trauma or overwhelming anxiety it detrimentally affects every family member.

“Research has told us when trauma manifests in one family member, all are affected.

“Officers can then feel an escalation of trauma due to guilt as they are not able to manage their emotions, behaviour or responses appropriately.

“Then the trauma may be accumulating each week to compound their issues. Everyone connected is affected.”

By offering ongoing support, Dr Phillip says we can greatly reduce the stress and sick leave officers and responders need to take.

“Once emotions are reduced more logic returns and the officers and responders can do their jobs better prepared and better able to manage the continuing demands of their jobs.

“Schools offer counselling to children needing support however, we are not offering this same degree of support to our most valuable and needed group of first responders, our officers.”

HealthTimes - June 2018 | Page 23

Little things making a big impact new tool aides personalised care for non-communicative patients

G

raduate nurse Veronique Murphy has been recognised for developing an innovative tool, designed to help nurses provide more personalised care to patients experiencing delirium or dementia.

Ms Murphy, who was named Outstanding Graduate in the HESTA Australian Nursing and Midwifery Awards, designed the tool as part of her graduate project at Alfred Health.

“I first got the idea when I was looking after a patient who had recently been diagnosed with brain cancer which was affecting his ability to communicate as well as his mood,” says Ms Murphy.

“He was often visibly upset and frustrated. When his family visited, they showed the nurses photos of the patient at the gym – he had been a personal trainer and loved the gym.

“If spoken to about the gym while the patient was being assisted with medication or other cares, he was calmer, seemed to be in a better mood, and smiled more.

“I’d only been a nurse for 2 weeks and it just moved me how significant knowing some small details about a person’s life can be to their experience of hospitalisation.”

Called, ‘my preferences’, the tool is basically a patient preferences prompt sheet, which includes four areas where information can be added about the patient, for example likes,

Page 24 | HealthTimes.com.au

dislikes, food preferences, important people in their life, and important things about their past, present and future.

“Ideally, the sheet can be placed in the bedside folder of any patient who may have difficulty communicating their preferences to staff, and so can be added to whenever new information is learned about the patient through patient or family interactions,” says Ms Murphy.

“The aim was to try to facilitate improvements to patient centred care and emphasise the importance of non-clinical information to promoting a patients’ comfort and sense of personhood.”

Working in acute care, nurses are often timepoor and patients move around quickly, leaving nurses with little time to focus on the person, but rather the patient’s condition.

“The idea was that instead of having to go through the progress notes for details, the sheet could be handy and available to all clinical staff for quick notes or relevant information.”

Before becoming a reality, ‘my preferences’ began as a list of journal entries Ms Murphy had recorded, outlining positive and negative experiences at work.

“I felt like I could provide better care when I knew the ‘little things’ about patients which I had learned because I had met their families the day before, or because I’d looked after them a few

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“And I noticed that other nurses could help me with my patients when they also knew small details – the names of sons and daughters, their favourite hobby, how they spent their days – which helped to redirect or support a patient who might be confused or distressed.”

With the effects of delirium and dementia quite fluid, the ability to quickly note down preferences can have a big impact.

“Hospital is so overwhelming.

“You’ve got people who are essentially strangers asking you to swallow tablets and in many ways restricting your freedom to do what you want to do, people wheeling you into machines and asking you to eat or drink things you may not usually eat.

“Delirium is such a common hospital complication, at least when we know some of the person’s preferences, we can work with the resources that we do have to provide an environment that feels safer and more familiar, or

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perhaps guide them a little away from the fear, distress or confusion they may be experiencing.”

The idea is that the prompt sheet can be placed in the bedside chart of any patient who might not be able to consistently communicate their preferences.

It’s designed so that staff can quickly note down information that might help make the patient feel safer in an unfamiliar environment or in a time of distress, as well as a quick reference for the acute care environment, that doesn’t add too much extra paperwork.

“Simple examples might include that the person likes hot milk with breakfast and so providing this will encourage them to eat.

“Or that they worked as a shoe maker and so tend to stress if they can’t see their own shoes, or that their cat is being looked after by their granddaughter so the patient can be reassured if they forget and start to worry about their cat.”

For the full article visit HealthTimes.com.au

HealthTimes - June 2018 | Page 25

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Page 26 | HealthTimes.com.au

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