Health & Safety 2015 by Queensland Nurses and Midwives' Union

HEALTH

& SAFETY HANDBOOK

Introduction

Welcome to the 2015 edition of the Queensland Nurses’ Union’s health and safety publication. As you may have noticed, this year’s book has a fresh new look and feel. This year’s publication has been reshaped into a practical reference tool for nurses and midwives across all sectors.

Beth Mohle

It contains an overview of workplace health and safety legislation, professional guidelines, and mechanisms which are designed to keep nurses and midwives safe at work. As a practising nurse or midwife you may have a reasonable understanding of health and safety as it relates to your work, but you might not know what to do or who to contact when you suspect a breach or identify a problem. This handbook also gives you information about what to do in those circumstances. At the front of the book you will also find a chapter which dovetails neatly with the QNU’s current Ratios save lives campaign.

Sandra Eales

While our overarching campaign is primarily associated with the delivery of safe quality care for patients, appropriate nurse/ midwife-to-patient ratios and skill mix certainly have health and safety implications for nurses and midwives. As part of our commitment to supporting you and your profession, this book also includes handy worksheets, and a CPD reflective exercise at the back of the book to help you meet your CPD obligations which are required as part of your registration. Whether you work in the public health system, private hospitals, aged care or community health, this handbook is for you. If you think you have a workplace health and safety issue that needs addressing, but are not sure how to go about it, you can start by calling QNU Connect on (07) 3099 3210 or 1800 177 273 (toll free for members outside of Brisbane). We hope you enjoy this year’s new look handbook.

Beth Mohle Sandra Eales Secretary Assistant Secretary

Contents

Health and safety in focus 2015: Nurse/midwife-to-patient ratios

What is health and safety in the workplace and why is it important?

History of OHS and the union movement

Health and safety laws: what are your rights and responsibilities?

Health and safety in the workplace

Steps to addressing a workplace health and safety issue

Resources

Further information

CPD reflective exercise

Notes

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Health and safety in focus 2015:

Nurse/midwife-to-patient ratios Improving the quality of care and the health and safety of your workplace National and international studies have consistently proven the number of nurses and midwives, their skill mix and their practice environment positively influence the safety and quality of health services.

Nurses and midwives who work in clinically supportive work environments—with the right number of appropriately skilled staff—will deliver safer, higher quality care to patients. They will also be more satisfied with their workplace and actively contribute to the productivity and sustainability of their health service. Unfortunately, the principles of safe staffing are not applied consistently in Queensland’s health services in relation to nurse/ midwife numbers, skill mix levels and work environments. This has led to disparities in patient outcomes, unsafe work environments and high levels of staff dissatisfaction. In January 2015, the QNU launched the Ratios Save Lives campaign to improve the quality of patient care and the safety of clinical environments across Queensland. The campaign focuses on the following claims: ■■ Mandate and enforce (via legislation and regulation standards) minimum nurse/ midwife-to-patient ratios1 and skill mix levels for Queensland Health facilities, to act as a care guarantee in conjunction 1 Where the term “patient” is used, it also refers to “aged care resident”.

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with the proper application of the Business Planning Framework workload management tool. ■■ Mandate and enforce (via legislation and regulation standards) minimum nurse/ midwife-to-patient ratios and skill mix levels for acute private health facilities to minimise unwarranted service variation across Queensland. ■■ Mandate and enforce (via legislation and regulation standards) the participation of public, private and aged care sectors in minimum nursing/ midwifery data sets that monitor and openly report nurse/midwife ratios, skill mix levels and quality outcomes across Queensland. ■■ Urgently review the adequacy of nurse numbers, skill mix and quality indicators in residential aged care facilities across Queensland to determine the parameters

NURSE/MIDWIFE-TO-PATIENT RATIOS

of safe staffing for the purposes of mandating minimum nurse-to-patient ratios and skill mix levels ■■ Mandate and enforce via legislation that a Registered Nurse is present on shift in residential aged care facilities at all times to improve the safety and quality of care delivery in parity with New South Wales’ Public Health Act 2010. These claims are designed to guarantee safe staffing levels and safe work environments by providing a reliable and enforceable workload management methodology for nurses and midwives across all health sectors. These would be monitored through mandatory reporting.

What are minimum ratios and skill mix levels?

Nurse/midwife-to-patient ratios describe the minimum number of nurses required to deliver direct care to a set number of patients. Skill mix levels refer to the minimum proportions of different nursing/midwifery categories rostered to meet patient demand. These categories may include Registered Nurse, Registered Midwife, Enrolled Nurse, and Assistant in Nursing. For example: The ratio and skill mix level required for an adult medical ward on a morning shift is: ■■ One nurse to every four patients (1:4) + 1 in charge nurse

How do ratios and skill mix levels work? Minimum ratios and skill mix levels provide a safety net for patients, staff and organisations by outlining the minimum staffing and skills required to meet patient demand.

Ratios and skill mix levels can be applied across a range of health services in the public, private and aged care sectors and are determined based on the type of facility, domain of nursing/midwifery and time of day. Ratios are implemented in many countries around the world, including Japan, Canada, the United States, the United Kingdom and some Australian states. Victoria and New South Wales have mandated ratios to guarantee the delivery of high quality care to patients and a safe working environment for staff.

Patient benefits

Minimum ratios and skill mix levels have improved patient satisfaction, lowered mortality, decreased readmission rates and reduced adverse events such as infections, pressure injuries and postoperative complications. Research demonstrates: ■■ Every one patient added to a nurse’s workload is associated with a 7% increase in deaths after common surgery.

■■ a minimum of 80% Registered Nurses rostered on each shift

■■ Every 10% increase in bachelor-educated nurses is associated with a 7% lower mortality.

■■ no more than one (headcount) Assistant in Nursing working on any shift.

■■ Every one patient added to a nurse’s workload increases a medically admitted 2015 HEALTH AND SAFETY Handbook 3

NURSE/MIDWIFE-TO-PATIENT RATIOS

child’s odds of readmission within 15-30 days by 11% and a surgically admitted child’s likelihood of readmission by 48%. Mandated ratios and skill mix levels mean Queenslanders are likely to spend less time in hospital and receive more personal nursing and midwifery than ever before.

Staff benefits

Poor staffing and skill mix levels can have negative impacts on nurses and midwives— both physically and psychologically—to the point they can no longer work and decide to leave the profession. Minimum ratios and skill mix levels are associated with work environments where staff are more likely to be satisfied with their workplace, are less inclined to burnout, and experience fewer occupational injuries or illnesses. Staff absence and attrition are costly and adversely impact continuity of care, which results in inefficiencies and loss in productivity for the health service. Research demonstrates: ■■ After the implementation of the California ratio legislation, Registered Nurses experienced 31.6% lower than expected rate of occupational injuries and illnesses. ■■ Every one patient added to a nurse’s workload is associated with a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. ■■ A Queensland study revealed 50% of nurses in the aged-care sector, 32% of nurses in the public sector, and 30% of 4 2015 HEALTH AND SAFETY Handbook

nurses in the private sector experienced the inability to meet patient demand due to insufficient staffing, with many planning to leave the profession. Mandated ratios and skill mix levels ensure Queensland nurses and midwives will have the time to care for patients in better work environments.

RATIOS

SAve lIveS Nursing contribution to better healthcare

Increasing Registered Nurse hours by as little as 10% resulted in the following decreased incidence of adverse events:* ■■ 45% central nervous system complications ■■ 37% GI bleeding ■■ 34% UTIs ■■ 27% failure to rescue ■■ 19% pressure ulcers ■■ 15% sepsis ■■ 11% pneumonia * D. Twigg, C. Duffield, P. Thompson, P. Rapley (2010) “The impact of nurses on patient morbidity and mortality – the need for policy change in response to the nursing shortage”, Australian Health Review, vol. 34, no. 4, pp. 312-16.

What is health and safety in the workplace and why is it important? Everyone has the right to work in a safe and healthy workplace. At its simplest level, workplace health and safety—sometimes called occupational health and safety—is about protecting all employees in the workplace from exposure to hazards and risks resulting from work activities. In Australia work related illness and injury costs the economy as much as $60 billion a year. However, the cost to the individual injured worker is incalculable. Being injured at work not only means absenteeism and a loss of income, in many cases there are long lasting effects such as a reduced quality of life—which is particularly true if there is a disability or ongoing health issue. There are also issues such as reduced future earning capacity and of course the impact on family life and relationships that might result from the stress of being injured or out of work.

According to latest Safe Work Australia data there were about 19,000 worker’s compensation claims for serious injury or illness in the health and community services industry in 2011-12. There were about 50 claims every day from employees in this sector who required one or more weeks off work because of workrelated injury or illness. There were 15 work-related deaths in our industry in 2007-8 to 2011-12, and during that time our industry accounted for about 14% of all serious workers’ compensation claims. That’s a lot of people hurt, sick or killed. Creating and maintaining a safe workplace requires vigilance and it is a responsibility that must be shared by both employers and employees. You owe it to yourself, your loved ones, your colleagues, your patients and your employer to take health and safety in the workplace seriously.

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History of OHS and the union movement

For more than 160 years, Australian unions, including the QNU and its federal branch the Australian Nursing and Midwifery Federation, have campaigned to make workplaces safer. The movement’s efforts have seen a huge reduction in the number of people killed, injured or made sick at their workplace. Many protections and rights we take for granted—like the standard working week, rest breaks, and mandatory protective clothing—were fought for, and won by unions. Below are just a few of the health and safety achievements fought for and secured by the union movement over the years.

1856

The eight hour day was introduced after stonemasons took action in Melbourne to give workers eight hours work, leisure and sleep.

1900

Following agitation by unions, and outrage over high workplace death and injury rates, governments begin establishing Australia’s first workers’ compensation systems.

1900-1916

States and territories begin introducing specific laws on workers’ compensation, for example the Workmen’s Compensation Act 1900 (SA).

1916

Queensland Workers’ Compensation Act 1916 introduced by Ryan Labor Government. Also under this Act the State Insurance office (SIO) was established to give the state a monopoly in workers’ compensation insurance to ensure fairness for workers.

1926

NSW Government makes it compulsory for employers to have insurance, providing coverage for journey injuries incurred on the way to and from work, and establishes a Workers’ Compensation Commission.

1947

The Conciliation and Arbitration Court awards a 40 hour week to all federal award employees.

1960s-1970s

Unions win a wide range of health and safety improvements at work including meal and rest breaks, accident make-up pay, improved conditions in mines, protective clothing, and weight restrictions for lifting. Unions also campaigned against industrial deafness and for improved construction safety.

1970s-1980s

Unions expose the dangers of asbestos across a range of industries. Without unions there would be no ban on asbestos importation and exportation.

1972 – 1989

All state, territory and federal governments introduce new OHS laws.

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HISTORY OF OHS AND THE UNION MOVEMENT

1985

Union campaigning to make sure OHS representatives get the power to ‘cease dangerous work’ pays off with powers enshrined under a new OHS Act in Victoria. The ‘cease work’ right and powers to order Provisional Improvement Notices (PINs) face fierce opposition from employers but are now recognised as a crucial way to improve health and safety.

1985

The National Occupational Health and Safety Commission is set up to lead and co-ordinate national health and safety improvements. Unions, employer groups and government are represented on the Commission.

1980s-1990s

Unions begin to negotiate enterprise agreements with specific OHS provisions.

1988

Federal government passes the Safety Rehabilitation and Compensation Act 1988 which establishes Comcare.

1991

Federal government introduces the OHS Act 1991 covering Commonwealth employers.

1995

Queensland introduces the Workplace Health and Safety Act 1995.

1997

QNU launched the No Lifting by 2000 campaign. Today patient handling equipment is mandatory.

1999

The Australian Nursing Federation in Victoria successfully lobbies the government for a campaign on manual lifting of patients resulting in a massive decline in injuries and savings for the health system.

2000

Workplace bullying is put on the agenda with an ACTU survey revealing 60% of workers saying bullying is affecting their home and social life.

2002

The ACTU’s Reasonable Hours Test Case highlights the dangers of overwork.

2004

Asbestos finally banned in workplaces after a long-running union campaign and work with asbestos victims to make manufacturer James Hardie pay compensation. In 2005 James Hardie and the NSW Government sign historic agreement, providing $4.5 billion for Australia’s asbestos victims.

2005-2007

Unions successfully lead Your Rights at Work campaign against Liberal government’s unfair WorkChoices laws and moves to undermine workers’ award protections and the federal workers compensation’ scheme.

2011

The Bligh government passes the Work Health and Safety Act 2011, which mirrors new federal legislation developed through a national WH&S harmonisation process and finalised by the Gillard Federal government the same year.

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Health and safety laws: what are your rights and responsibilities? Health and safety of workers is core business for unions.

Committee—to reduce workplace injuries by improving health and safety laws.

In Australia, unions including the QNU have always sought to shape laws that govern health and safety.

The committee:

Recently in Queensland, health and safety laws have undergone major revision. It is not always easy for nurses and midwives to understand what the changes are, let alone what their intended consequences are supposed to be. This article traces the creation of health and safety laws in Australia. Historical knowledge of how our laws came to be, and what their intentions are, is the best way to understand current changes. Where did Australian health and safety laws come from? In Australia, the regulatory framework is largely derived from the recommendations of a review of health safety conducted in the United Kingdom in 1972. This review was conducted by the Safety and Health at Work Committee— more commonly known as the Robens

■■ recommended moving from prescriptive legislation to a risk management approach, which allowed individual businesses and industries to better manage hazards ■■ found employers have a central role in health and safety, as well as a “duty of care” to provide workplaces that are both healthy and safe ■■ found employers must consult with their employees on health and safety matters to achieve improvements in the workplace. The arguments for such changes centred on the inflexibility of laws at the time, which did not promote innovation or consideration of changes in technology, working conditions or new industries. Health and safety legislation has changed many times since 1972, but these concepts have remained central in our regulatory regime. Our system puts great emphasis on selfregulation. Harmonisation—bringing all the laws under one umbrella In Australia, our current health and safety legislation was developed through a long consultation period commencing in 2008, and involved all states and territories and the Commonwealth. This process, known as harmonisation, sought to create consistent laws that could achieve improved health and safety outcomes by reducing costs and enabling

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HEALTH AND SAFETY LAWS

The ‘three tiers’ of health and safety laws

While the majority of Queensland workplaces are subject to the Work Health and Safety Act 2011, the entire legislation regime in Queensland and Australia can be described as a ‘three-tier system’. The three tiers are: ■■ the Work Health and Safety Act 2011 ■■ the Work Health and Safety Regulation 2011 and ■■ a number of Codes of Practice. The Work Health and Safety Act 2011 sets out what those covered by the legislation must do to meet their obligation to health and safety. The Act is mandatory and provides a framework for general duties for businesses, workers and others.

better co-ordination in all health and safety jurisdictions. The QNU made a considered submission to the harmonisation process, and so did many other unions, businesses, and government departments. The process resulted in the Work Health and Safety Act 2011 being passed in the Queensland Parliament under the Bligh Labor government.

The Work Health and Safety Regulation 2011 describes how those covered can meet their obligations to the Work Health and Safety Act 2011. This includes further details around specific duties, including minimum requirements that need to be met for some hazards. Non-compliance with the Act or Regulation can result in prosecution by the regulator.

This law mirrored model federal legislation.

Codes of Practice are more practical in nature and are developed to provide further detail on how an employer may meet their legislative obligations. They often deal with a specific hazard.

The legislation took effect on 1 January 2012 and is current today—although it was significantly weakened by the Newman LNP government in 2014.

Although they are not enforceable, an employer needs to demonstrate equivalent compliance for something covered by a specific code. 2015 HEALTH AND SAFETY Handbook 9

HEALTH AND SAFETY LAWS

Other materials include guidance and fact sheets, as well as Australian Standards to provide information on specific health and safety issues. These materials are not part of the legislative regime.

What to do when the inspector calls Many nursing managers are unaware of their obligations when a Workplace Health and Safety Queensland inspector enters the workplace.

Who is Workplace Health and Safety Queensland?

Inspectors have significant power at their disposal, including the ability to conduct a workplace investigation.

In Queensland, the responsibility for ensuring compliance with the Act and the Regulation falls to Workplace Health and Safety Queensland (WHSQ). WHSQ inspectors have the power to enter workplaces and undertake enforcement activities. WHSQ is also responsible for investigations of workplace incidents. WHSQ inspectors who believe there has been a breach of the Act may issue: ■■ a formal written notice, which could include anything from an improvement notice on issues that don’t pose a serious risk through to a prohibition notice for more serious issues that must be acted on immediately ■■ on-the-spot fines ■■ prosecutions in either the Magistrates’ court or the District court, depending on the nature of the offence ■■ enforceable undertakings, which are used for some offences that could have been subject to sanctions through the courts where there is agreement to undertake activities that enhance health and safety. WHSQ is also a source of information on health and safety and can provide advice to duty holders on how they can meet their legislative obligations. 10 2015 HEALTH AND SAFETY Handbook

These powers give them the right to interview people in the workplace, take measurements and photos, request documents, take affidavits, remove samples, require a person to answer questions, and more. A full list of the inspector’s powers can be found at www.worksafe.qld.gov.au/ laws-and-compliance/compliance-andenforcement/workplace-inspections Nurses and midwives in management positions should be aware inspectors are required to notify the employer or the “most senior management person onsite” when they arrive. This will often be a senior nurse. You must give reasonable help to the inspector when exercising their powers, unless you have a reasonable excuse— this requirement also extends to your colleagues. Individuals who do not assist the inspector could face fines as well as possible sanctions from their employer. So when can you refuse to assist an inspector? An example of a reasonable excuse as to why you are unable to immediately assist the inspector could be an emergent clinical issue requiring your attention.

HEALTH AND SAFETY LAWS

You should make this known to the inspector if you are the “most senior management person onsite” at the time, and negotiate a suitable compromise. The QNU is aware nurses and midwives at various workplaces have not always been given adequate information by their employer. Therefore, be sure to make yourself aware of your obligations, including to staff. If a WHSQ inspector arrives and you are unsure how to proceed, notify your employer in the first instance, and always remember you can call the QNU if you still have concerns.

What’s in the Act?

The Act seeks to ensure workers and others are afforded the highest level of protection for their health and safety by eliminating or minimising risks associated with work. These risks include those posed by a substance (e.g. chemotherapy) or plant (e.g. hospital beds). Other objects of the Act include: ■■ providing for fair and effective workplace representation, consultation, co-operation and issue resolution in relation to work health and safety ■■ encouraging unions and employer organisations to take a constructive role in promoting improvements in work health and safety practices, and assisting persons conducting businesses or undertakings and workers to achieve a healthier and safer working environment ■■ promoting the provision of advice, information, education and training in relation to work health and safety

■■ securing compliance with this Act through effective and appropriate compliance and enforcement measures ■■ ensuring appropriate scrutiny and review of actions by people exercising powers and performing functions under this Act ■■ providing a framework for continuous improvement and progressively higher standards of work health and safety ■■ maintaining and strengthening the national harmonisation of laws relating to work health and safety, and to facilitate a consistent national approach to work health and safety in Queensland. The role of unions and the emphasis on an employer engaging with its employees are central beliefs to ensuring optimal health and safety outcomes.

Key concepts

What does PCBU mean? A Person Conducting a Business or Undertaking (PCBU) is a central concept in the Act and Regulation. Under the Act, the primary duties of care are placed upon the PCBU. The PCBU is a broad term and can be an individual (e.g. a nurse in a private position) or an organisation (e.g. a government department or a residential aged care provider). For most nurses and midwives, the PCBU is their employer. However, in recognition of modern employment arrangements, it also includes labour hire agencies and similar businesses. While a PCBU may not directly employ staff such as agency nurses, they still have an obligation to ensure their health and safety. 2015 HEALTH AND SAFETY Handbook 11

HEALTH AND SAFETY LAWS

As the agency is a PCBU, they also owe a duty of care to the nurse while that person is working for the other PCBU. The PCBU has a health and safety duty to others who could be affected by the work carried out by the PCBU. This means that people such as patients and relatives must not be put at risk. The Act also extends the concept of PCBU to: ■■ those with management or control of a workplace ■■ those with management or control of fixtures, fittings or plant in a workplace ■■ those who design, manufacture, import or supply plant, structures or substance ■■ those who install, construct or commission plant or structures. So even companies that design health equipment and drugs must consider how these may impact the health and safety of users and eliminate or minimise these risks.

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Who is a worker? The Act defines a person as a worker “if the person carries out work in any capacity for a person conducting a business or undertaking”. This includes: ■■ an employee ■■ a contractor or subcontractor ■■ an employee of a contractor or subcontractor ■■ an employee of a labour hire company assigned to work in the person’s business or undertaking ■■ an outworker ■■ an apprentice or trainee ■■ a student gaining work experience ■■ a volunteer. In the hospital environment, university nursing students on placement and hospital auxiliary volunteers are defined as workers.

HEALTH AND SAFETY LAWS

What constitutes a workplace? A workplace is a place where work is carried out for a PCBU and includes any place where a worker goes or is likely to be while at work. Therefore, not only are conventional workplaces, such as hospitals and medical centres considered workplaces and included in the coverage of the Act, but also people’s homes if they are receiving care or treatments. Even the vehicle the nurse or midwife uses for travel while working is considered a workplace. What does the term “reasonably practicable” mean? The term “reasonably practicable” sets the standard that a PCBU must meet to satisfy their health and safety obligations. Under legislation prior to 2012, there was an absolute obligation to ensure health and safety.

ii. ways of eliminating or minimising the risk d. the availability and suitability of ways to eliminate or minimise the risk e. after assessing the extent of the risk and the available ways of eliminating or minimising the risk, the cost associated with available ways of eliminating or minimising the risk, including whether the cost is grossly disproportionate to the risk. A PCBU cannot simply say they are unable to make changes within a workplace to eliminate or minimise a risk because it is too costly.

Health and safety duties

PCBU The primary duty of care for a PCBU is to ensure the health and safety of workers and others, so far as reasonably practicable. They are also required to comply with a number of general duties, including:

However, with the introduction of “reasonably practicable”, the standard for a duty holder is what a reasonable person could be expected to do in that circumstance.

■■ providing and maintaining safe working environments

To assist in determining what “reasonably practicable” is, the Act requires a PCBU to consider the following:

■■ ensuring the safe use, handling, storage and transport of plant structures and substances (e.g. provision and administration of pre-prepared single use cytotoxic drugs)

a. the likelihood of the hazard or the risk concerned occurring b. the degree of harm that might result from the hazard or the risk c. what the person concerned knows, or ought reasonably to know, about: i. the hazard or the risk, and

■■ providing and maintaining safe plant and structures, including the commissioning of plant or structures (e.g. ceiling hoists)

■■ ensuring and maintaining safe systems of work (e.g. adequate number of appropriate skilled nurses or midwives) ■■ providing adequate facilities for the welfare of workers (e.g. proper accommodation for remote area nurses, 2015 HEALTH AND SAFETY Handbook 13

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facilities such as toilets and drinking water)

■■ workers can have their representative involved in consultation.

■■ providing workers with information, instruction, training and supervision (e.g. aggressive behaviour management training)

When is consultation required? Consultation with workers must occur:

■■ monitoring the health of workers and the condition of the workplace ■■ ensuring notifications to the regulator WHSQ of certain incidents (e.g. an amputation injury). In addition to a PCBU’s primary and general duties, a significant proportion of the Act is devoted to the PCBU’s duty to consult with its workers, including the mechanisms to facilitate this duty and when consultation is to occur. These requirements are as follows: 1) Duty to consult A PCBU, so far as reasonably practicable, must consult with workers about issues that directly affect them (e.g. the introduction of new rostering arrangements, as they have impacts on fatigue.) 2) Nature of consultation Proper consultation requires the PCBU to ensure: ■■ relevant information is shared with workers ■■ workers are given reasonable opportunity to: ◆◆ express their views and concerns ◆◆ contribute to the decision making process ■■ workers’ views are taken into account ■■ workers are advised of any outcome in a timely manner 14 2015 HEALTH AND SAFETY Handbook

■■ when identifying and assessing risks to health and safety (e.g. health and safety audits) ■■ when making decisions about ways to eliminate or minimise risks (e.g. purchasing patient manual handling equipment) ■■ when making decisions about adequacy of facilities for the welfare of workers (e.g. the provision of workplace lockers) ■■ when proposing changes that may affect the health and safety of workers (e.g. changes to clinical practices such as the introduction of chemotherapy agents) ■■ when making decisions about procedures around: ◆◆ consultation processes ◆◆ resolving H&S issues ◆◆ monitoring of workers’ health and workplace conditions ◆◆ providing information and training.

Who is an officer and what are their duties?

An ‘officer’ is someone within a PCBU who influences decision-making that affects the whole or a substantial part of an organisation. The Commonwealth Corporations Act 2001 is used to determine who an officer is. Within Queensland Health, the term ‘officer’ would apply to the various Hospital and Health Service CEOs and the Director General of Health.

HEALTH AND SAFETY LAWS

Officers are required by the Workplace Health and Safety Act 2011 to exercise “due diligence” to ensure the PCBU complies with its duties and obligations. This means an officer must take reasonable steps to be across current work health and safety matters, particularly those that exist within the industry the PCBU is associated with. They must ensure proper process and management systems exist for health and safety, including resources to eliminate or minimise risks.

Duty of workers

Workers are required to take reasonable care for their own health and safety as well as for those who may be affected by their acts or omissions. They are also required to comply with any reasonable instructions and co-operate with any policy or procedure introduced to enhance health and safety. For example, if a superior piece of plant, such as a new mobile hoist, is introduced into the workplace, the PCBU must consult with those workers required to use the equipment. Once they have been given proper training, it is then a reasonable expectation for them to use this equipment unless they recognise and advise their PCBU of a reason not to.

Duty of others

A person at a workplace, such as a patient or relative in a hospital, has a duty to take reasonable care for their own health and safety and that of others. For instance, if a patient requires nurses or midwives to perform patient manual handling activities, they cannot unreasonably refuse the use of lifting aids to assist in such actions—even if they’re in their own home—as this is likely to put those performing the activity at greater risk of injury.

Right of workers to cease unsafe work

Common law has always allowed workers to refuse or cease unsafe work, but the WHS Act contains specific details about how and when workers can exercise this right. 2015 HEALTH AND SAFETY Handbook 15

HEALTH AND SAFETY LAWS

This right can be exercised when a worker has reasonable concern that, should they continue working, they may be exposed to a serious health and safety risk due to immediate or imminent exposure to a hazard. Remember, your responsibilities as a nurse or midwife do not override your right to safety. If you exercise this right, you must advise your manager of your decision and be available to work in an alternative area until it is safe to resume the previous activity.

Protections for workers

The Act prohibits discriminatory, coercive or misleading conduct against workers who exercise a duty or right, or choose not to exercise a power or function within Work Health and Safety laws. Put simply, if you are terminated or disadvantaged for either raising a health and safety issue, being nominated as a Health and Safety Representative, exercising a power as a HSR, or taking part in action to resolve a health and safety issue, those responsible can be subject to criminal or civil sanctions.

Risk management

A key change with the introduction of the harmonised legislation in Queensland in 2012 was the inclusion of “risk management” in the Work Health and Safety Regulation 2011. The regulation provides PCBUs with a framework for risk management, which includes: 1. Identifying hazards that are reasonably foreseeable that could cause a risk to health and safety (a hazard is something with the potential to cause illness or injury). 2. Assessing the risk (risk is determined by the likelihood of an incident occurring and the consequences of the incident as they relate to a hazard). 3. Eliminating the risk, if reasonably practicable, or otherwise controlling the risk. In order to control risk, PCBUs must use the hierarchy of control, which is as follows: ■■ Elimination (removing the hazard) ■■ Substitution (e.g. changing from one cleaning chemical to a less hazardous one) ■■ Isolation (e.g. seclusion rooms in mental health) ■■ Engineering controls (e.g. retractable syringes) ■■ Administration controls (e.g. policies regarding manual handling) ■■ Personal protection equipment (PPE) (e.g. lead gowns in angiography suite). Remember: the most effective control is elimination and the least effective is using PPE.

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4. Maintaining control measures, which requires the duty holder to ensure the control measures in place are effective and their effectiveness is maintained and is: ◆◆ fit for purpose ◆◆ suitable for the nature and duration of work ◆◆ installed, set up and used correctly. 5. Review control measures, which require a duty holder to review and, where necessary, make changes to control measures so both work and the work environment are without risks to health and safety. This review must take place in the following circumstances: ■■ When the control measure does not control the risk insofar as is reasonably practicable ■■ A change at the workplace ■■ A new hazard or risk identified ■■ When consultation with workers or others indicates a review should occur ■■ When requested by a HSR.

Work environment and facilities General workplace facilities A PCBU must ensure so far as reasonably practicable that: ■■ entry and exits to the workplace are without risk to health and safety ■■ there is adequate space for work to be performed safely ■■ there is safe flooring and other surfaces ■■ there is adequate lighting and ventilation ■■ work in extremes of heat and cold is managed effectively.

Accessible Facility The PCBU must ensure ready accessibility to toilets, drinking water, washing facilities and eating facilities that are clean and safe and in good working order. There is no specific regulation setting out the exact number of toilets, or the temperatures where work should cease.

Remote or isolated work The legislation is particularly important to members who work in an isolated location and require an off-site PCBU to manage risks associated with such work. In addition to the obligations outlined above, the PCBU must also provide effective communication systems for when emergent situations arise.

Codes of practice A number of codes of practices have been developed to provide more comprehensive support to the Act and Regulation. The following codes of practice are particularly relevant to processes and hazards that are raised by QNU members: ■■ Hazardous Manual Tasks Code of Practice 2011 ■■ How to Manage Work Health and Safety Risks Code of Practice 2011 ■■ Managing Risks of Plant in the Workplace Code of Practice 2013 ■■ Managing the Work Environment and Facilities Code of Practice 2011 These codes of practice can be found on the Safework Australia website at www.safeworkaustralia.gov.au 2015 HEALTH AND SAFETY Handbook 17

Health and safety in the workplace This chapter outlines the Health and Safety Representative role and two important mechanisms for the HSR, the Workplace Health Safety Committee, and the Provisional Improvement Notice. This chapter also details two of the major WHS obligations for workers and employers: ■■ When and how to report a workplace hazard using the Incident Report Form ■■ How to deal with discrimination in the workplace.

Workplace Health and Safety Representatives

A Health and Safety Representative (HSR) is a worker elected by co-workers to represent their views on health and safety matters in the workplace. Employers cannot choose the HSR—the person must be elected by workers. Why do you need HSRs? By electing a co-worker to be their representative, workers can have a say in decisions about their own health and safety. Can anyone be a HSR? Workers can elect anyone who is a worker at the workplace to be their HSR. A worker does not need any special qualifications or experience to be elected. Once they are elected, HSRs must undertake employer-paid training to help perform their role. Information about training courses is available from the QNU. A deputy HSR may also be elected to provide representation when the HSR is unavailable. 18 2015 HEALTH AND SAFETY Handbook

How are HSRs elected?

Forming a work group

Any worker or group of workers can ask the PCBU to set up a work group for the purpose of electing a HSR. A work group is a group of workers who share a similar work situation (for example, workers performing similar work, in the same section, or on the same shift). If agreed, workers from multiple areas can be part of the same work group. If workers request the election of a HSR, a PCBU must start negotiations with workers within 14 days. The negotiations will determine: ■■ the number and composition of the work groups ■■ the number of HSRs and deputy HSRs ■■ the workplace to which the work group applies.

HEALTH AND SAFETY IN THE WORKPLACE

It is the PCBU’s responsibility to notify workers of the outcome of the negotiations, and they must do so as soon as practicable. At any time, the parties to a work group agreement may negotiate a variation. If negotiations fail to establish a work group or to agree about varying an agreement, any person who is a party to the negotiations can ask an inspector to help in deciding the matter. Work groups for nurses and midwives

The elements that must be considered when forming a work group align very closely with the individual wards in each facility. These are: ■■ the number of workers ■■ the views of workers in relation to the determination and variation of work groups ■■ the nature of each type of work carried out by the workers ■■ the number and grouping of workers who carry out the same or similar types of work ■■ the areas or places where each type of work is carried out ■■ the extent to which any worker must move from place to place while at work ■■ the diversity of workers and their work ■■ the nature of any hazards at the workplace or workplaces ■■ the nature of any risks to health and safety at the workplace or workplaces ■■ the nature of the engagement of each worker (for example, as an employee or as a contractor) ■■ the pattern of work carried out by workers (for example, whether the work is full-time, part-time, casual or short-term)

■■ the times at which work is carried out ■■ any arrangements at the workplace or workplaces relating to overtime or shift work. Each ward has a dedicated nursing workforce with particular skills and clinical specialty, a distinct roster, and a designated physical location. The QNU strongly encourages nurses and midwives to raise these issues when in negotiation, particularly the need for more than one HSR for each ward due to the 24/7 nature of our professions. These principles equally apply in aged care facilities and community centres. Organising an election

Workers can organise the election themselves, but the election must, at a minimum, meet the following requirements: ■■ The PCBU must take all reasonable steps to ensure all workers in the work group are given an opportunity to nominate for the position of HSR and vote in the election. ■■ All workers of the work group are advised of the outcome. Employers must help organise an election if workers ask them to do so. Workers can also ask their union to hold the elections. If the union does this, the election must be for all workers and not just those workers who are members of the union. Remember, there is no election if the number of nominees is the same as the number of vacancies (ie. one nomination to fill one HSR position).

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HEALTH AND SAFETY IN THE WORKPLACE

How long does the role last? Workers elect HSRs for a three year period. At the end of that period, the HSR may be re-elected. A worker stops being a HSR if they stop working at the workplace or if they resign from the position of HSR. What does a HSR do? A HSR is entitled to: ■■ inspect the workplace or any area where work is carried out ■■ accompany an inspector during an inspection ■■ be present at an interview with a worker that the HSR represents (with their consent) and the PCBU or an inspector ■■ request that a health and safety committee be established ■■ monitor compliance measures by the PCBU ■■ represent the work group in WHS matters ■■ investigate complaints ■■ inquire into any risk to the WHS of workers in the work group ■■ issue provisional improvement notices (PINs)—see page 21. Are HSRs personally liable? A HSR carrying out their role is not personally liable for action or inaction, so long as the HSR acted in good faith. Training If requested, a PCBU must allow HSRs and deputy HSRs to attend a training course approved by Workplace Health and Safety Queensland. 20 2015 HEALTH AND SAFETY Handbook

The training must begin within three months of the request and the HSR given paid time off to attend the course. The PCBU is also required to pay the course costs and reasonable expenses. QNU members can enrol in Safe Work accredited HSR and deputy HSR training through the QNU website’s training page.

Workplace health and safety committees

It is essential employers and and workers talk about health and safety. Under the Work Health and Safety Act 2011, PCBUs have an obligation to consult with workers and their representatives. One of the best ways to have constructive conversations about health and safety is to form a Workplace Health and Safety Committee. What is a Workplace Health and Safety Committee? The main purpose of the committee is to help employers and workers work together to make the workplace healthy and safe. It does this by: ■■ assisting PCBUs and workers to carry out measures which ensure health and safety at work ■■ assisting in developing standards, rules and procedures relating to health and safety ■■ highlighting any functions prescribed by regulations, or any agreements between the PCBU and the committee. The committee is entitled to review information on workplace injuries,

HEALTH AND SAFETY IN THE WORKPLACE

illnesses, dangerous events, hazards and risk assessments, although consent is required for information that identifies someone’s personal or medical information. Who sets up a committee? A committee is set up by the PCBU at the request of a HSR, or by five or more workers. The committee must be set up within two months of the request being made. Who is on the committee? The PCBU and workers should negotiate about who is on the committee. If an agreement cannot be reached, a WHSQ inspector can decide.

the needs of shift workers should be considered. A committee must meet at any reasonable time at the request of at least half its members. What does the committee consider? The committee will consider a wide range of health and safety issues, including: ■■ the type of hazards and the seriousness of the risks ■■ changes in the workplace or work processes which may introduce hazards ■■ new equipment or new work systems ■■ how current health and safety standards are maintained

At least half the committee must be workers who are not nominated by the employer.

■■ whether new health and safety standards should be introduced.

A HSR can be on the committee if they wish, and cannot be refused a position.

Further information on commitees is available via the Safe Work Australia Worker Representation and Participation Guide, or contact QNU Connect on 07 3099 3210.

Workers must choose the people who they want to represent them. Workers should make sure that people from all sections of the workplace are included, and keep in mind the diversity of workers in respect of gender, linguistic and cultural differences, age and occupation. There should be a management representative on the committee who has the power to act on the committee’s recommendations. How often does the committee meet? Committees must meet at least once every three months but may decide to meet more often. Meetings should take place during ordinary working hours at the workplace, although

Provisional Improvement Notices

The Work Health and Safety Act 2011 entitles HSRs to issue a Provisional Improvement Notice (PIN) if they suspect there has been a breach of the Act. HSRs must undergo training before they can issue a PIN. Consultation prior to the issue of a PIN A PCBU must be consulted regarding an infringement before the HSR issues a PIN. Consultation is still considered to have occurred even if the PCBU does not respond to the HSR in a reasonable time, or at all. 2015 HEALTH AND SAFETY Handbook 21

HEALTH AND SAFETY IN THE WORKPLACE

What must the HSR include in the PIN? A PIN must be in writing and must specify the provision of the Act or Regulation that has been breached. This PIN must also include advice on how the section was or is being breached. A HSR may also provide directions in the PIN about fixing the WHS issue, but is not required to do so. HSRs should keep a copy of any PIN issued by them. Can more than one contravention be put in a PIN? No. A separate PIN should be completed for each breach of the Act. What must the person who is issued with the PIN do after receiving it? The person issued with the PIN should ensure it is promptly passed on to managers and supervisory staff. All other people whose work is affected by the notice should be informed, and the notice must be displayed prominently in that work area. If the person who receives the PIN does not fix the breach within the required timeframe (a minimum period of eight days), the HSR can then contact a WHSQ inspector to investigate. The inspector will investigate as soon as possible. If the person who receives the PIN disagrees with it, they can contact a WHSQ inspector within seven days to investigate. If this occurs, the PIN is stayed until the inspector makes a decision. 22 2015 HEALTH AND SAFETY Handbook

What will the inspector do? ■■ confirm the PIN ■■ confirm the PIN with modifications or ■■ cancel the PIN. The recipient of a PIN must then comply with it once it is confirmed by the inspector. The inspector’s decision to either confirm or cancel the PIN can be reviewed. How must a PIN or an inspector’s PIN enquiry outcome notice be served? ■■ by delivering it personally or sending it by post or fax ■■ by leaving it at the person’s usual or last known home or business address or ■■ by leaving it with a person who is apparently the occupier of the workplace. Action to be taken against a HSR for inappropriate use of PINs If a HSR improperly issues a PIN, the chief executive or the relevant person may apply to the Queensland Industrial Relations Commission to suspend or revoke the HSR’s ability to issue PINs. If this happens, HSR members should contact the QNU. Will a mistake in a PIN make it invalid? This depends on the type of mistake. The PIN must contain: ■■ the HSR’s belief that there is a breach and the reason for that belief ■■ the legislative provision the HSR believes is being breached and ■■ the date when it must be fixed.

HEALTH AND SAFETY IN THE WORKPLACE

Incident reporting

As a worker, you have a duty under the Work Health and Safety Act 2011 to co-operate and comply with any reasonable instruction by your PCBU. This includes properly reporting incidents, hazards and potential risks to your PCBU. This is because one of the duties of an officer of a PCBU is to ensure a reporting system exists that allows the PCBU to review and consider information about incidents, hazards and risks—and to respond in a timely manner. The PCBU is not only required to have such a system, but the Work Health and Safety Regulation 2011 requires the PCBU to provide training and instruction in the use of such systems. Your employer may use a different title to describe this system. If your workplace does not have a reporting system, or the reporting system you have is unsatisfactory, you should persist in bringing this to your employer’s attention until you are satisfied an appropriate reporting system exists. The reporting system must reliably notify a PCBU of incidents that have occurred in the workplace that have the potential to, or have resulted in, injury or illness.

Unfortunately, the pain worsens and they become aware they have sustained a more serious injury than they first believed. By not reporting, they potentially jeopardise any subsequent workers’ compensation claim. This failure to report also means potential hazards continue to place others at risk.

This means you should report both injuries and near-misses—no matter how insignificant they appear.

Keep a copy Always keep a copy of your incident report.

The QNU is only too aware that many nurses and midwives suffer an injury they consider minor, do not report the injury and continue to work, believing any pain or discomfort to be transient.

Many members have advised the QNU that, despite reporting, their matter has “gone missing” and no action has been taken by the employer in relation to the incident report. 2015 HEALTH AND SAFETY Handbook 23

HEALTH AND SAFETY IN THE WORKPLACE

Investigation Once in receipt of an incident report, a PCBU is obliged to investigate the incident and the circumstance surrounding the event.

Under the Act, people who engage in discriminatory, coercive, or misleading conduct against such workers may be subject to penalties.

Members should insist on being advised of the outcome of the investigation.

Such conduct could include dismissing a worker, ceasing a worker’s contract, or treating the workers in a way that disadvantages them (e.g. changing their roster).

Logically the PCBU is then required to take action to eliminate the risk or minimise the risk. Notifiable events The WHS Act 2011 also places obligation on PCBUs to report certain incidents to Workplace Health and Safety Queensland. These incidents are referred to as “notifiable events”. Such incidents include: ■■ workplace fatalities ■■ serious injuries or illness and ■■ dangerous incidents e.g. patient hoist failure. With respect to nurses, a serious injury or illness would include a spinal injury or an infection resulting from an exposure to blood or body substances. PCBUs who do not notify as required can be subject to sanctions by the regulator.

Your protection against discrimination

It is unlawful for an employer to punish a worker for taking action on health and safety issues. A number of sections in the Act provide protections for workers when they take action to ensure a safe workplace for themselves, their colleagues, or patients and relatives. 24 2015 HEALTH AND SAFETY Handbook

Health and Safety Representatives are strongly protected by the Act. Even if you are not a HSR you cannot be discriminated against for raising legitimate concerns about health and safety, taking part in action to resolve a health and safety matter, or contacting Workplace Health and Safety Queensland or the QNU to discuss an issue. The QNU is available to assist members if they hold concerns when seeking to make their workplace safer. Contact your QNU Organiser or QNU Connect on 07 3099 3210 if you believe you have been subject to discrimination.

Steps to addressing a workplace health and safety issue How you can deal with them and how the QNU can assist

If you identify an issue affecting you or your colleagues’ health or wellbeing, there is a process you can follow to ensure the right people are aware of it, and the problem is fixed. In the first instance, you should aim to progress the matter yourself by following these steps.

Tell your manager what the issue is.

You need to identify exactly what the issue is before bringing it to the attention of your manager. For example, is a lack of lifting equipment affecting work practices, staff morale, stress levels or general wellbeing? Once you have determined exactly what the issue is, notify your HSR (if you have one) and your manager, with a request to have the issue resolved. If you don’t have a HSR, the QNU can give you advice on how to establish this role.

Fill out an incident report.

If the problem remains after this request, submit an internal workplace incident report form. Your employer is obliged to provide this form. If they do not, notify your QNU Organiser or QNU Connect, and make a written report of the problem. Remember to include as much detail as possible and keep a copy for your own records. Be sure to include any evidence you have collected over time and any relevant details

from your initial attempts to have the problem resolved.

Take note of your manager’s response.

Any response from your manager should be recorded and kept for your personal records. If it is a verbal response, be sure to write down what is said so you can refer to it later if necessary.

Inform the QNU of your manager’s response.

You should always provide a copy of your manager’s response to your QNU Organiser or your QNU Local Branch. That way, if the issue is ongoing—despite your manager saying they would address it—the QNU will have a record of their response, and the matter can be escalated.

Seek the QNU’s help by submitting a Member Request for Representation.

If your manager’s response does not fix the issue, submit a Member Request for Representation form to the QNU. This form can be found at www.qnu.org.au/mrfr This form will be passed on to the QNU official best suited to deal with the situation, in consultation with you and your colleagues.

In emergent circumstances, call the QNU.

If you feel you are at imminent risk, do not hesitate to contact your QNU Organiser or QNU Connect on 07 3099 3210 or toll free on 1800 177 273 (outside of Brisbane) to seek advice. Depending on the matter, QNU officials who are WHS entry permit holders can enter the workplace to carry out an inspection and assist members. 2015 HEALTH AND SAFETY Handbook 25

Resources On the following pages you will find some useful resources which can help you make your workplace safe, these include worksheets and checklists, and suggestions on where you can go for help and further information.

WORKSHEET: BODY MAPPING Body mapping is a way of identifying common patterns of health problems amongst workers in a particular workplace who do the same or similar job.

If you are not a HSR rep but would like to see body mapping conducted in your ward or unit, why not ask your rep to run it, or ask them if you could do it yourself?

It means that when all these employees pool their information about health problems (past or current) patterns can quickly emerge.

What you will need: ■■ A body map: Two large outlines of the body, labelled ‘front’ and ‘back’, on large sheets of paper. (Photocopy and enlarge the template on page 28.)

Not all the common problems identified during this exercise may be work-related, but they may at least merit further investigation. This is a great exercise for a Workplace Health and Safety Representative to present.

■■ Blue Tac (or sticky tape) to stick the body map on a wall or whiteboard. ■■ Coloured self-sticking dots—or coloured marking pens (red, blue, green, black).

Running a Body Mapping Session: Getting started

It is best to do this exercise when staff are all together in the same place at the same time. You could do this at a branch meeting, during an afternoon tea, at a special session in the tearoom or as part of a broader training course. The group of workers doing the body mapping should be staff who do the same or similar work.

Explain what body mapping is and why you are doing it Explain that body mapping is:

■■ a tool that can help identify and document problems in a way

26 2015 HEALTH AND SAFETY Handbook

that directly involves every single member of the group. ■■ is easy to do and done in a way that maintains individual members’ privacy. That is why no names are used—just coloured dots or marks. The outcome never identifies individuals and no personal information ever gets discussed outside of the Body Mapping session. ■■ helps build a case for action. It helps paint a real overview of health and safety conditions in the workplace. If you are a HSR you could start the session by discussing your role as the rep with your members.

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The mapping

■■ Explain that you are using the body map to record health problems. ■■ Hand out the coloured dot stickers (or markers) to each participant. ■■ Explain to them that each colour represents a different problem. For example:

■■ ■■ ■■ ■■

red - aches and pains blue - cuts and bruises green - illnesses black - anything else (eg stress, fatigue etc)

■■ Tell the participants to come up to the map and put the sticky dots (or mark) on any areas of the body they believe are affected by their work. These can be for health problems they are experiencing now, or have experienced since they have been working. ■■ If they can’t show their problems with dots (eg a generalised pain or a skin rash over a large part of the body) you/they can write the ailment to the side of the figure, allowing them and others with the same ailment to mark beside the words. ■■ Problems such as stress, sleeping difficulties, anxiety or fatigue can be put in a cloud above the head.

■■ Make sure you tell the participants they can use as many dots as they want or need.

Discuss the findings

Once everyone has finished putting all the dots they want to on the body map, stand back and take a look at it. Discuss what you can all see—are there any common patterns? Questions you might ask: ■■ Do you see any clusters or patterns of dots? Identify and label what the clusters are. ■■ What might be causing these problems? It could be long hours on your feet, poor lighting, patient handling etc. The more that members report the same problems, the more likely it is that the work they are doing is to blame.

Drawing conclusions and taking action

Collectively draw some initial conclusions and action points from the body mapping activity. Make note of the group’s comments and conclusions. The results of all the mapping sessions should then be used to prioritise and plan further action.

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Photocopy and enlarge this template

Mark in coloured dots on bodies above:

red - aches and pains ■ blue - cuts and bruises ■ green - illnesses ■ black - anything else ■■ If the problem can’t be shown with dots (eg a generalised pain or a skin rash over a large part of the body) write the ailment to the side of the figure. ■■ Write problems such as stress, sleeping difficulties, anxiety or fatigue in a cloud above the head.

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CHECKLIST: RISKS IN YOUR WORKPLACE This checklist can be used to help identify health and safety risks that may be present in your workplace. To use the checklist, answer each question with a ‘yes’ or ‘no’. If the box with your response is shaded, investigate further to see if it is necessary to implement a control. Specific control options to address the questions in each of the checklists are provided in Chapter 7 of Manual tasks involving the handling of people – Code of Practice 2001 produced by Workplace Health and Safety Queensland.

Direct risk factors

Note: “forceful exertions” is an integral part of the following risk factors, working postures (awkward, static), characteristics of the person being handled, the handling procedure, the work area design, and work organisation. A checklist to identify forceful exertions is not provided here, but is covered under these risk factors. Working posture

YES

1. Back – does the people handling action require repetitive movement or prolonged static positions with the back: a. b. c. d.

bent forward? twisted? bent side-ways? bent forward or sideways and twisted?

2. Neck - does the people handling action require repetitive movement or prolonged static positions with the neck: a. b. c. d.

bent backwards? twisted? bent forward? a combination of the above positions?

3. Arms and shoulders - does the people handling action require repetitive movement or prolonged static positions with: a. extended reach in front? b. reaching above the shoulders?

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4. Hand and wrist – does the people handling action require repetitive and/ or prolonged forceful exertions while gripping equipment? 5. Legs – is repetitive or sustained squatting or kneeling performed? 6. Other postures – is a standing posture without walking sustained for long periods? Repetition and duration 1. Do people handling activities undertaken through the shift require frequent or prolonged actions involving the transfer, holding, supporting or restraining of the person? 2. Does the worker perform the same or similar people handling actions throughout the shift? 3. Is a physically demanding people handling task/action performed frequently during a shift? 4. Is one posture required to be maintained for long periods?

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YES

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Contributing and modifying risk factors Work area design

YES

1. Are items of furniture, fittings and equipment on which people are positioned: a. of a height, or adjustable to a height, so that workers do not have to bend in handling people? b. of a width that allows easy access without reaching? 2. Are items of furniture and fittings: a. positioned to allow easy access to people and give workers sufficient space for leg and feet movements and to turn their body when necessary? b. easy to move if necessary to allow space? c. designed so that workers can get their feet underneath? d. too wide for easy access to a person (a large bed or armchair)? 3. Have all items and fittings, which allow people to assist themselves, been provided? 4. Facilities â&#x20AC;&#x201C; with regard to the design of areas where people are handled: a. is there adequate space in areas where handling aids or wheelchairs are used for easy movement? b. is the space around the toilets large enough for two workers to assist a person? c. are all doors (bedroom, bathroom, toilet, communal rooms and lift), corridors and corners wide enough for the movement of beds and handling equipment? d. is there sufficient room so that equipment can be used as intended? e. do all floor levels allow for the easy manoeuvring of mobile furniture and equipment? 5. Is handling equipment: a. designed for safe use (trolleys, beds and wheelchairs with locking mechanisms etc)? b. easy to manoeuvre? c. stored close to where they are used and in an area with good access? d. able to fit into/through all necessary spaces? 6. Does the vehicle design allow workers assisting people in vehicles: a. access from both sides? b. internal headroom? c. easy access for wheelchairs?

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Workplace environment

YES

1. Do people have to be handled over surfaces which are: a. uneven underfoot? b. slippery or wet? c. protected from the weather? 2. Does flooring on routes over which wheeled equipment and furniture will be pushed/pulled allow easy movement? 3. Is the area in which a people handling task/action to be performed cluttered or untidy? 4. Is the workplace outdoors and requiring people to be carried over difficult terrain? 5. Are there extremes of heat, cold, wind or humidity? 6. Do workers have to walk long distances or search for appropriate mechanical aids/equipment? 7. Does noise interfere with communication? 8. Is lighting adequate to perform handling actions or tasks? The handling procedure 1. Is manual lifting or carrying a person required during a transfer procedure? 2. Can the person be held close to the workerâ&#x20AC;&#x2122;s body? 3. Is a worker required to support all/most of the body weight of a person unaided? 4. Is the person located: a. on the floor or below knuckle height? b. above the workerâ&#x20AC;&#x2122;s shoulder?

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5. Does the worker need to bend over to one side to assist a person? 6. Is the person supported by one hand only? 7. Is the person located where access or movements are restricted? 8. Is the person pushed, pulled or slid across the front of the workerâ&#x20AC;&#x2122;s body? 9. Are there excess transfers in a task? 10. Are situations possible where people can fall or collapse to the floor?

Characteristics of the person being handled

YES

1. Is the person: a. awkward to handle? b. bulky or blocking the view of handlers? c. difficult to grip (slippery or wet)? 2. Is the person limited physically, for example: a. b. c. d.

unconscious? conscious but unable to assist? unable to bear weight? has reduced postural control/balance?

3. Does the person have conditions which require special handling, for example, fractures, skin conditions, impaired motor control? 4. Is the person: a. uncooperative through cognitive or behavioural problems or drugs (including alcohol) and likely to move around or go rigid? b. unable to communicate and understand when told what is to happen? c. unpredictable, likely to make sudden movements or lose their balance?

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5. Is the person: a. attached to medical equipment? b. positioned on handling equipment (such as a stretcher or wheelchair) which needs to be moved with them?

Individual characteristics of the worker 1. Does the worker/s have the necessary competency to: a. perform heavy people handling tasks/actions? b. make decisions about how to handle people with specific problems, for example, people unable to help or who are unpredictable? c. set up and use mechanical devices? d. assist with team handling in the tasks/actions within their work unit where this might be required? 2. Do the workers have any ongoing or temporary physical characteristics that indicate a limited capacity to perform the task/action? 3. While performing people handling tasks, are workers wearing: a. clothing which restricts the worker in using the best working postures? b. footwear offering inadequate stability, support and traction with the walking surface? 4. Does the required PPE increase the demands of the action e.g: a. gloves interfering with type of grip used? b. foot-covers affecting traction with floor? c. heavy or cumbersome protective clothing, restricting movement?

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YES

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Work organisation

YES

1. Is the work load affected by: a. unexpected work load increases? b. people handling tasks occurring frequently in one part of a shift? c. insufficient workers to assist with activities of daily living e.g. toileting, bathing when peak workloads occur, or to assist other staff with handling people? 2. Is organised team handling available where no alternative is possible? 3. Are people handling tasks performed without planned rest breaks or the worker being able to take a short break when necessary? 4. Are long shifts (over 8 hours) or overtime undertaken where work involves frequent people handling? 5. Are handling aids: a. sufficient in number for the volume of people handling tasks/actions done in the work unit? b. available for all the different tasks/actions done in the work unit? c. used on all occasions they should be? d. which need to be shared, accompanied by a procedure on their location and movement which suits all workers concerned? e. accompanied by adequate procedures on their safe use and introduced with training and supervision for casual as well as regular staff? f. not working well, or out of action due to needing maintenance? g. purchased only after consideration of their health and safety effect on workers during use? 6. Are there adequate policies and procedures for: a. workers to report or fix unsafe equipment or environmental conditions? b. handling people as safely as possible during emergency evacuation?

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CHECKLIST: SECURITY AUDIT The purpose of this checklist is to assist users in identifying security risk factors in their workplace. Under the Workplace Health & Safety Act 1995 when a hazard or risk is identified control measures must be implemented to eliminate / reduce the risk. Please remember your workplace may have additional hazards due to the nature of your work.

Please tick yes or no if risk factors present Buildings

Does building have functioning door locks? Does building have functioning window locks? Does building have blind spots? Does the building have adequate lighting? Does the building have a duress/alarm system? Is there access to the underneath of the building? Are plant rooms etc secure at all times? Does the building entrance have good visibility? Is there a system for key security? Are fire doors externally secured? Is there a regular building maintenance plan?

Building surrounds

Is there a perimeter fence? Is there adequate external lighting? Are external passage ways well lit? Are gardens maintained and trees and bushes trimmed? Are the grounds free from rubbish and debris?

Car parks

Are car parks within close proximity of the workplace? Is the car park lighting adequate? Are there escorts for after hourâ&#x20AC;&#x2122;s staff available?

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YES

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Please tick yes or no if risk factors present Systems of work

YES

Are staff required to work alone? Are staff required to work outside of buildings - particularly at night? Are staff orientated to the work environment and facility policies and procedures? Do staff work in high risk areas ie emergency, mental health etc? Are staffing numbers adequate? Does your facility use security personnel?

Supervisor: Name

Signature

Date H&S Representative: Name

Signature

Date Actions to be completed: 1. 2. 3. 4. Time frame for action

Date

Review date

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CHECKLIST: WORKPLACE BULLYING AND HARASSMENT The purpose of this checklist is to identify bullying and harassment behaviour occurring at your workplace, and to determine how to implement strategies for dealing with it. Workplace bullying and harassment is any unwanted or unsolicited repeated behaviour by a person (such as oneâ&#x20AC;&#x2122;s employer or co-worker) that the victim finds offensive, intimidating, humiliating, or threatening. All employers of nurses and midwives should take appropriate measures to prevent bullying from occurring in the workplace. Likewise, anybody who witnesses bullying behaviour is encouraged to report it.

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Identifying workplace bullying and harassment

YES

1. Does the behaviour include: a. Verbal or physical abuse? b. spreading rumours or disclosing confidential information about an employee? c. constant name calling, belittling or intimidation? d. making false statements? 2. Are there more subtle behaviours occurring, including: a. b. c. d. e.

inappropriate rostering? constant unjustified criticism or complaints? setting unreasonable timelines? excessive scrutiny of work performance? deliberately excluding a person from normal workplace activities?

3. As a result of this continued behaviour, have you been experiencing: a. b. c. d. e. f.

distress? an impaired ability to make decisions or carry out my work? a loss of self-confidence? social isolation at work? panic attacks, anxiety disorders, or depression? lack of sleep?

Dealing with workplace bullying and harassment 1. In taking steps to deal with the bullying and harassment, have you: g. h. i. j. k.

kept a record? approached the bully? (Note: only do this if you feel comfortable.) reported the issue? sought counselling? taken formal action?

2. If you believe youâ&#x20AC;&#x2122;re experiencing workplace bullying or harassment, you can speak to: a. b. c. d. e.

your supervisor or manager your Health and Safety Representative your human resources department your workplaceâ&#x20AC;&#x2122;s employee assistance service the QNU.

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CHECKLIST: FATIGUE MANAGEMENT There are number of factors which expose nurses and midwives to a greater risk of fatigue. This includes the requirement to perform work over a 24 hour, seven-day-a-week period, the demands of shift work, and the physical nature of the work performed. It is therefore important to consider the full range of factors that can increase the risk of fatigue. Use this simple checklist to evaluate how your employer is managing fatigue.

Overtime

YES

1. Does your employer limit overtime to 4 hours for 8 hour shifts? 2. Does your employer limit overtime to 2 hours for shifts longer than 10 hours? 3 Does your employer ensure there is no overtime performed for shifts of 12 hours? 4. Does your employer limit hours, including overtime, to 55 hours per week? 5. Does your employer have a policy on second jobs? Industrial entitlements / Restoring 1. Does your employer ensure people are able to access their breaks provided in the nurse and midwife industrial instrument? 2. Do you exercise your industrial rights around breaks between shifts ie. 10 hour break requirement? 3. Does your employer have a best practice â&#x20AC;&#x153;rostering guidelinesâ&#x20AC;? document however named and is it used?

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Consultation

YES

Does your employer consult with you and your colleagues: 1. When proposing changes to work schedules including on call arrangements? 2. When developing fatigue management arrangements? 3. If you have a Health and Safety representative for your work area are they advised of incidents when fatigue could be a factor? Incident management 1. Are staffing levels and workloads considered by your employer when workers report fatigue? 2. Is fatigue ever considered by the employer when investigating workplace incidents?

If you have answered no to any of these questions, you should immediately raise these with your manager and seek resolution. In circumstances when the responses are unsatisfactory you should contact the QNU for advice. Members should also consider the following factors that may impact on the risk of fatigue ■■ Are you getting quality sleep ■■ Are you eating a balanced diet ■■ Do you have a second job? Does this impact on your fatigue level? ■■ Do you have excessive travel time while commuting? Adapted from: www.worksafe.qld.gov.au/injury-prevention-safety/workplace-hazards/fatigue/ managing-fatigue (29 April, 2015)

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Further information