Ncah issue 19 2013

Issue 19 23/09/13 fortnightly

Theatre & Critical Care Feature Victorian perioperative nurse volunteers at sea Australian nurses and midwives planning exodus: survey Palliative care program to employ nurses and allied health professionals Women dominate allied health workforce

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www.ncah.com.au )SSUE p 3EPTEMBER We hope you enjoy perusing the range of opportunities included in Issue 19, 2013.

If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or if you would like to receive our publication, please email us at careers@ncah.com.au

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Nursing Careers Allied Health - Issue 19 | Page 5

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Nursing Careers Allied Health - Issue 19 | Page 7

Murray Bridge nurse practitioner gains recognition

by Karen Keast The role of nurse practitioner is a new one in South Australia, giving highly qualified and talented nurses the power to work autonomously. Judy said friends and colleagues had always indicated she was smart enough to pursue a career in medicine. “I said, ‘I can be very smart and be a nurse too.’”

Nurse Practitioner Judy Bagg has qualified as a finalist for a Rural Community Health and Wellbeing Award.

Judy, who became Murray Bridge Soldiers’ Memorial Hospital’s first nurse practitioner four years ago, said the introduction of a team mentality with the establishment of Country Health SA had been a boon for healthcare provision, adding that the new approach could reassure patients with even the most challenging prognoses.

Page 8 | www.ncah.com.au

Having completed her initial studies in Adelaide, working in the country offered unique rewards.

“In the country you’ll find all the nurses and doctors are willing to put in that bit extra, and you also get that community support you wouldn’t get in Adelaide, fundraising and helping us to buy equipment,” she said.

“The good thing now with Country Health is we (at Murray Bridge) work with the Mallee we’re in clusters and look out for each other,” she said.

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Palliative care program to employ nurses and allied health professionals

by Karen Keast A pioneering community-based palliative care program will employ around 120 nurses, allied health professionals and community support workers in Tasmania next year.

The District Nurses, a not-for-profit organisation, will deliver the client-centered, multi-disciplinary Hospice at Home program, believed to be the first of its kind in Australia.

The new program will provide a mix of face-toface visits, telephone advice and support, and ehealth initiatives as part of a 24-hour service for people with life limiting illnesses or nearing the end of their lives.

The program will deliver wrap-around care to include the client, their family, carers and their Page 10 | www.ncah.com.au

local community and aims to avoid unnecessary hospital admissions.

Director of care Fiona Onslow said the organisation was now mapping out the state’s palliative care needs and had also begun its recruitment process. “We are looking at having an office in Launceston and one in Burnie and we will be looking at employing over three years at least 120 staff in that period,â€? she said. “There will be a mix of staff depending on needs‌there will be a mix of community support staff and a mix of nurses and allied health roles.â€?

For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 19 | Page 11

Australian nurses and midwives planning exodus: survey

by Karen Keast More than 40 per cent of nurses and midwives will explore other career opportunities while 23 per cent will exit the profession in the next year, according to a new national workforce survey.

The second Australian and Nursing Midwifery Federation (ANMF) survey, conducted by the Monash University Department of Management, found the number of nurses and midwives planning to leave the profession in the next 12 months was up on last year, rising from 15 to 23 per cent.

It also found 33 per cent of nurses and midwives often consider leaving the profession and 23 per cent are working double shifts.

The ANMF has blamed high workloads due to inadequate nurse to patient ratios for the rising number of disenchanted nurses and midwives.

ANMF federal secretary Lee Thomas said nurses and midwives responding to the survey, who worked across the health, mental health and aged care sectors, were experiencing high levels of stress due to poor staffing levels and skill mixes which also compromised safe patient care.

“Nurses and midwives are stressed and exhausted and are working under conditions which are putting safe patient care at risk,” she said.

“In one instance, two nurses on night duty (were) caring for 23 mentally unstable patients.”

Ms Thomas said survey respondents planning to leave the profession were registered and enrolled nurses with an average of 22 years’ experience in the profession.

“This is a dire warning that unmanageable workloads due to critical funding shortages, no nationally mandated nurse to patient ratios, attacks on working conditions and the lack of professional recognition from some Page 12 | www.ncah.com.au

employers, is taking its toll on frontline nurses and midwives,” she said.

Ms Thomas said hundreds of graduate nurses and midwives are still struggling to find employment, further exacerbating the nation’s nursing and midwifery workforce.

In last year’s survey, nurses reported lower levels of job satisfaction and contentment than the broader working population, with almost half of nurses not trusting their employer to keep promises while nurses also felt they had little influence over important workplace decisions.

Only 40 per cent of nurses reported being content with their pay and conditions while 38 per cent reported high to very high levels of burnout and stress.

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Nursing Careers Allied Health - Issue 19 | Page 13

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UK research paramedic initiative heads to Canberra

by Karen Keast

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An initiative to screen patients for sepsis while en route to hospital in the United Kingdom will be showcased at the Australasian Paramedic International Conference in Canberra next month.

North East Ambulance Service (NEAS) research paramedic Paul Younger, who developed the screening approach with colleague Graham McClelland, will speak about the organisation’s work fighting one of the leading causes of death world-wide, at the October 17-19 conference.

The two paramedics created a screening system, using a checklist of symptoms, to identify patients showing signs of sepsis.

Under the system, paramedics issue a pre-alert to hospitals in the area, warning that a patient with suspected sepsis is being conveyed to emergency - enabling the hospital to prepare for urgent treatment on arrival.

Research shows early detection of sepsis and beginning antibiotic therapy is crucial to saving lives.

Sepsis, a potentially fatal inflammation caused by severe infection, kills more than 37,000 people every year in the UK – claiming more lives than lung cancer, and more than breast cancer and bowel cancer combined.

In Australia, statistics show there were 40,492 adult hospital admissions as a result of sepsis or septic shock between 2006 and 2012.

The screening system was introduced at NEAS last year and has already resulted in a dramatic increase in the number of patients ambulance crews have been able to identify as potential sepsis sufferers.

For the full article visit NCAH.com.au

Page 14 | www.ncah.com.au

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Nursing Careers Allied Health - Issue 19 | Page 15

Expansion planned for NSW neo-natal intensive care unit

by Karen Keast

The neo-natal intensive care unit (NICU) at John Hunter Children’s Hospital in New South Wales looks set for significant expansion and enhancement following confirmation of a funding injection to improve the facility.

Seven million dollars has been allocated from the Hunter Infrastructure and Investment Fund for the refurbishment of the unit.

The hospital is the primary referral facility for more than 20 per cent of the state’s children and young people.

New South Wales Minister for Health Jillian Skinner commented that the move represented a significant investment designed to enhance the high-quality, specialised care provided to newborns and babies from the Hunter, New England and north coast areas of NSW. The funding, which will complement the government’s recent commitment to a new paediatric intensive care unit, will allow stage one of the neo-natal intensive care unit refurbishment works to proceed.

Page 16 | www.ncah.com.au

With the original unit established in 1991 with 28 cots in 775 square metres of space and having expanded to 42 cots within the same physical space since then, Minister for the Hunter Mike Gallacher said the funding injection would see it significantly expanded in order to cater to current demand. ‘‘This project will provide the much needed expansion in space, taking advantage of the 1700 square metres of space adjacent to the unit recently vacated by the Hunter Medical Research Institute.’’

Newcastle MP Tim Owen reportedly the project was a high priority for families in Newcastle and the wider region. ‘‘Families in the Hunter will be reassured that their babies and children will have access to the highest standards of intensive care closer to home,’’ he said.

John Hunter Children’s Hospital NICU is one of the largest units in New South Wales and provides care to hundreds of critically ill newborn babies each year.

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Nursing Careers Allied Health - Issue 19 | Page 17

Victorian perioperative nurse volunteers at sea BY +AREN +EAST

Perioperative nurse Jennifer Adamthwaite uses much of the same equipment and instruments in the theatres on board the charity hospital ship Africa Mercy as she does in the theatres at Victoria’s Swan Hill District Health.

The only difference to the work is the actual operations.

“The operations are more extreme than anything we do at home,” Jennifer said.

“There are things that you see on board that you would not see in any western country.”

A nurse of 16 years, Jennifer has volunteered four times aboard the Africa Mercy.

In her most recent experience, a four-week trip to Guinea in March this year, she met a female patient she will never forget – a woman in her late 30s with severe facial contractures.

“When she was just three days old she was accidentally burned and had not received any medical care,” Jennifer recalled.

“The scarring from her upper chest to her lower jaw had distorted the whole area. Her lower jaw was pulled down so tightly by the resulting contractures that she has never been able to close her mouth or chew her food.”

Jennifer said the patient’s contractures were removed and skin grafts were applied.

“Surprisingly she was able to move her jaw once the contractures were released and for the first time she could close her mouth.

Page 18 | www.ncah.com.au

“Something so simple can mean so much to these patients.”

Jennifer first decided to volunteer for Mercy Ships, which uses hospital ships to deliver free world-class health care services, in the lead up to her long service leave.

She wanted to use her long service time to help others while also gaining invaluable experience overseas.

“All roads seemed to lead to Mercy Ships. I could use my theatre skills and knowledge in a first world environment to help third world people,” she said.

“You get the opportunity to work with health workers from around the globe with minimal risk to your personal safety, while experiencing very different countries.”

Since then, Jennifer has spent time in the Max Fax specialty, which ranges from correcting cleft lips and palates to removing facial tumours.

“If you enjoy travel, challenging yourself, learning about different cultures and want to help people who desperately need it, then this is the job for you,” she said.

The Africa Mercy is seeking theatre nurses for its current field service in the Republic of Congo, Central Africa, where it plans to provide more than 3,300 surgeries for adult and child

patients and to treat more than 20,000 people at land-based dental and eye clinics as part of its 10-month stay.

The theatre nurse periods available are from December 8-21, December 29-January 11 and March 2-May 24.

Applicants must have a current Nurse Practitioner licence, be able to both scrub and circulate, be fluent in English, have knowledge of theatre procedures, standards and equipment, and have a minimum of two yearsâ&#x20AC;&#x2122; experience as a theatre nurse.

The Africa Mercy is also seeking PACU/ recovery room nurses from December 8-21, March 9-April 12 and April 20-May 24.

To find out how to volunteer visit www. mercyships.org.au/volunteer.

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Nursing Careers Allied Health - Issue 19 | Page 19

Pay rise for aged care nurses in doubt

by Karen Keast More than $1 billion in pay rises for Australia’s 350,000 aged care nurses and care workers is in doubt after the new Coalition Federal Government revealed the funds will be redirected into the general aged care budget.

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Australian Nursing and Midwifery Federation (ANMF) federal secretary Lee Thomas said it was disappointing the government was abandoning the first ever pay rise set to directly flow into the pockets of underpaid nurses and care workers.

Government to make changes to the workforce

“The $1.2 billion earmarked for the workforce supplement has now, as we understand, been put into general revenue, so there is no accountability or transparency that it will ever reach employees,” she said.

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agreements, and nurses had started to see wages increase as a result,” she said.

“Sadly many employers expected the Coalition supplement and therefore would not bargain or were on a go slow until after the election.”

A Federal Government spokesperson told media the Coalition will work with providers to ensure the funds are distributed in a way better targeted to “genuinely improving” pay and conditions for aged care nurses and care workers.

“Labor’s Workforce Compact adds to red tape

The Coalition plans to forge ahead with its pre-election proposal to redirect the $1.2 billion in funds, abandoning the previous Labor government’s plan to allocate the funds to the Workforce Compact.

without guaranteeing improved conditions for all

Under the Labor plan, aged care employers were required to vary the current enterprise agreement or negotiate a new agreement through unions as part of the Workforce Compact.

Ms Thomas said an industrial agreement was

Legislation was passed in Federal Parliament on June 26 delivering pay rises of about $46 a week or $2390 a year for registered nurses, $35 a week or $1820 a year for enrolled nurses and $29 a week or $1510 a year for assistants in nursing (AINs) by 2016 under the Living Longer, Living Better aged care reforms.

“Since 2002 there has been a range of

Ms Thomas said some nurses had already started to see an increase in their pay as a result of the reforms.

“The numbers were small but some providers, who had been bargaining and who commenced Page 20 | www.ncah.com.au

workers,” the spokesperson said.

“It appears to be more about boosting union membership than improving aged care.”

the most transparent and accountable way to ensure the funds actually reach the workforce.

government

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enhancing the capacity of aged care employers to offer competitive wages, including $211 million over four years in the 2002-03 budget and a further $877.8 million over years from 2004,” she said.

“Unfortunately, these additional amounts were not tied to bargaining and consequently hardly any nurses or assistants in nursing saw any benefit.”

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Nursing Careers Allied Health - Issue 19 | Page 21

Women dominate allied health workforce

by Karen Keast and osteopaths, and reveals almost two thirds of all registered allied health practitioners are psychologists, pharmacists or physiotherapists.

Psychologists form the largest group of allied health professions, at 23 per cent, with 29,387 registered psychologists including 18,275 clinicians and 4,129 non-clinicians, while 216 were looking for work in psychology.

Last year, the average age of employed psychologists was 45.6 and psychologists worked 32.6 hours a week on average.

Pharmacists were the second largest group, at 21 per cent, with 17,097 clinicians and 4,234 non-clinicians, and 272 were seeking work in pharmacy.

Most Australian allied health professionals are women, with the highest proportion of women working as occupational therapists, psychologists and as Aboriginal and Torres Strait Islander health practitioners.

The Australian Institute of Health and Welfare (AIHW) report, Allied Health Workforce 2012, reveals more women than men are employed in nine allied health professions with the exceptions being chiropractors and optometrists.

More than 91 per cent of occupational therapists are women, with women making up 76 per cent of psychologists, almost 72 per cent of Aboriginal and Torres Strait Islander health practitioners, about 70 per cent of physiotherapists and medical radiation practitioners, about 60 per cent of pharmacists and 48 per cent of optometrists.

The report outlines the workforce characteristics of the 11 allied health professions including Chinese medicine practitioners, podiatrists Page 22 | www.ncah.com.au

In 2012, the average age of employed pharmacists was 39.7 and pharmacists worked 35.9 hours a week.

Physiotherapy was the third largest group, at 19 per cent, with physiotherapists working 34.2 hours a week and the average age of employed physiotherapists was 38.6.

Almost 210 registered physiotherapists were looking for work in the field, while 17,980 worked in clinician roles and 2,101 worked as nonclinicians.

Occupational therapy made up the fourth largest group at 11 per cent, with 6,310 clinicians and 921 non-clinicians while 87 were searching for work in occupational therapy.

The report shows the full-time equivalent (FTE) rate of employed allied health practitioners increased slightly between 2011 and 2012 for all professions except optometrists, where the FTE rate was steady.

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Nursing Careers Allied Health - Issue 19 | Page 23

Former palliative care nurse ponders death

by Karen Keast A former palliative care nurse has traced her relationship with death, from her childhood pet burials, through her nursing career to the death of her own father.

“It was difficult. It was very, very sad – like anybody

In Field Notes on Death, an essay published in Now We Are Ten, the latest edition of Griffith Review, Melbourne writer and facilitator Lea McInerney delves into her experiences with people in the final moments of their lives.

the sort of conversations that we had… there

“There was no obvious fear in the room, nor prayer or ritual,” she writes about the moment an elderly female patient died.

“I sat there, aged twenty-four, spellbound. Her peaceful death was one thing; the vision she let me glimpse through her eyes something else.

“Of course I couldn’t know what had happened within her or what it might mean. In the quiet with her, with no disturbances or distractions, I experienced it as something both serious and light. A last glance at life, and she was off.”

Originally from South Australia, Lea moved into nursing at the age of 17 and travelled to England to specialise in palliative care, where she studied oncology and palliative care nursing at the Royal Marsden Hospital and worked in hospices for several years.

Lea later returned to Australia to continue working in palliative care, mostly in the community setting, before venturing into work as a social policy researcher and writer.

In her essay, Lea discusses how her father, who died at home 11 months after his cancer diagnosis, approached death and how she spent time with him in those final months – as his nurse and as his daughter.

Page 24 | www.ncah.com.au

going through that, it was heart-breaking a lot of the time,” Lea told NCAH. “To be able to spend time with him and to have was a lot of honesty, there was a lot of love in those conversations.

“He was very open about it and said to all of his kids to be as much a part of it as you want to but don’t put your life on hold, which was an incredible gift to all of us - not to feel like we had to help out but all of us wanted to. It made it easy to talk.”

Lea said it was important for nurses working with people who are dying to let each person guide them in the care and support they need.

“A doctor I worked with years ago said he saw himself as a ‘naive listener’,” she said.

“What he meant was that he would leave all his assumptions at the door, and let himself encounter each person as unique, not as his idea of who they might be or what they might want.

“And an occupational therapist I know has a similar approach. She says to try and carve out some quiet time with the patient and family and find out what they want.

“Before you go into their room, gather yourself together and let go of all your preconceptions and busy-ness, so you can listen to what they understand about what’s happening, to what they want to know, and to what they want to happen.”

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Nursing Careers Allied Health - Issue 19 | Page 25

Restructuring leads to low nursing morale

by Karen Keast More than 40 per cent of New Zealand nurses who have experienced a restructure in their workplace are questioning their future in nursing, a new survey has revealed.

The New Zealand Nurses Organisation’s third biennial employment survey shows almost a quarter of nurses have experienced significant restructuring in their main employment, particularly at DHBs, impacting on morale - with 43 per cent reconsidering their nursing careers.

Twenty-seven per cent of those have highlighted concerns over reductions of senior nursing leadership positions and changes to skill mix while others reported concerns over regionalisation and privatisation of specialist services along with mergers of general practices.

“Once again nurses demonstrated resilience and commitment to their profession in the face of significant and continuing restructuring and fiscal restraint,” the report’s authors Dr Leonie Walker and Dr Jill Clendon stated.

“The profession is in good heart, if vulnerable to badly handled and on-going structural change, long-term staffing issues, and growing disenchantment with workload and pay.”

Three nurses reported injuries as a result of patient assaults while four nurses reported needle-stick injuries and only 41.5 per cent of respondents believed their employer was fully compliant with occupational health and safety standards.

The NZNO has recommended a raft of measures

The web-based survey, which received 1448 responses during February this year, showed the Aotearoa nursing workforce was working more extra shifts and changing employment less frequently due to uncertainty in general employment.

to ensure recruitment and retention of nurses,

It also found 11 per cent of nurses required time off work in the previous two years due to workplace-acquired infections and injury – with flu or norovirus infections the most common causes alongside back, knee, wrist and shoulder injuries relating to slips and lifting.

development support and leave.

Page 26 | www.ncah.com.au

including comparative pay, especially relative to pay in Australia and to other professions, and ensuring safe levels of staffing, better shift rostering, appropriate continuing professional

The organisation also expressed concern at the disruption and uncertainty in senior roles, which was impacting at all levels, and the long term effect of the loss of clinical nursing leadership.

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Nursing Careers Allied Health - Issue 19 | Page 27

How nurses and pharmacists can manage polypharmacy in older patients Statistics show around one in three unplanned hospital admissions for older Australians are related to issues with their medicines – and half are preventable. A new educational program targeting health professionals, particularly nurses and pharmacists, aims to reduce the rate of adverse medicine events in patients aged 75 and over, writes Karen Keast.

Research shows more than 40 per cent of Australians aged over 50 are taking five or more medicines a day while twice as many people aged 75 years and over are taking multiple medicines.

The figures reflect a growing number and complexity of comorbidities occurring with age but a reliance on more medicines is also placing the nation’s older population at greater risk of adverse medicine events.

To combat the issue, not-for-profit organisation NPS MedicineWise recently launched an educational program and publication, titled Older and Wiser: Promoting Safe Use of Medicines in Older People, aimed at equipping GPs, nurses and pharmacists with a series of strategies to manage polypharmacy and prevent medicine-related problems in patients aged over 75.

NPS MedicineWise clinical adviser Dr Philippa Binns says a large proportion of adverse medicine events in older people can be prevented through addressing prescribing and monitoring issues and by increasing awareness of the signs and symptoms associated with a medicine-related problem.

“NPS MedicineWise is encouraging all health professionals, including pharmacists and nurses, to adopt a coordinated approach to medicines management as an important aspect of a care plan for an older person, and Page 28 | www.ncah.com.au

to engage older people, their family and carers as active partners in health decisions,” she says.

“We’re encouraging health professionals to consider current medicines as the cause of new symptoms before attributing them to a medical condition - don’t assume symptoms relate to old age.”

Inappropriate prescribing is a common problem in aged care facilities.

A recent survey of 2465 Sydney nursing home residents revealed about half were prescribed psychotropic medicines including antipsychotics, hypnotics, anxiolytics and antidepressants.

Dr Binns says evidence suggests there is extensive off label use of antipsychotics for dementia patients in residential aged care.

“While they can occasionally be effective for short term aggression and psychotic symptoms – we see them being used too often, for too long at high doses and in dangerous combinations,” she says.

“Incorrect use of antipsychotics can have serious consequences including an increased risk of falls, hip fractures and even death.”

For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 19 | Page 29

Page 30 | www.ncah.com.au

Nursing Careers Allied Health - Issue 19

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