Inscope No5 Autumn18 by Queensland Nurses and Midwives' Union

The official journal of the Queensland Nurses and Midwives’ Union

Autumn 2018

AGED CARE’S RACE TO THE BOTTOM

Your new

CPD

portal

PLUS! CPD CONTENT ON NMBA STANDARDS, CODEINE RESCHEDULING & MORE

QH - BPF for NUMs & MUMs 1 May Brisbane 22 May Townsville As a NUM or MUM preparing your service profile, calculating Nursing/Midwifery hours per patient day and getting your Service Profile and resource allocation signed off in accordance with EB9 can be a challenge.

Union Training Program APRIL – JUNE 2018 Creating a safe workplace (WH&S) 19 April Brisbane Nursing unions throughout Australia have made significant inroads into improving the health and safety of our members. This course aims to provide nurses and midwives with practical advice and tools to create a safe workplace culture.

No excuse for abuse! 18 April Sunshine Coast 31 May Mackay Occupational violence is on the increase in both frequency and severity and is the subject of a taskforce report recently published This important course will unpack the taskforce recommendations and provide some strategies to implement now in your workplace to assist in providing you and your co-workers with a safer workplace.

QH EB10 - Your work, your voice 19 April Sunshine Coast 24 May Townsville 1 June Mackay 7 June Gold Coast 7 June Cairns 21 June Rockhampton QH EB10 is about getting everyone involved in influencing the agreement negotiations and then implementation. This course will evolve in real time to reflect what is happening throughout the bargaining, voting and implementation stages to build the best possible outcome for members.

Aged Care & Private Hospitals - Guide to the QNMU and workload reporting 24 April Brisbane This day is for all nurses working in Aged Care and Private Hospitals. This course is about understanding how we can help you to have a safe voice at work. Knowing how to raise and resolve issues quickly can make a really big difference to you and those in your care

This course takes us through the detail of working up a Service Profile, the seven steps to calculating Nursing/Midwifery Hours per patient day and resource allocation.

QH Rostering Equity & work life balance 2 May Bundaberg Bad rosters have the ability to make your life miserable. Frequently poor rostering practices are the result of running a service that is too large with staffing numbers that are too small, resulting in poor patterns of rostering, difficulty with accessing all forms of leave and even noncompliance with your basic entitlements.

Professional Culpability - Where do I stand? 3 May Bundaberg In a resource stretched environment what are my responsibilities and where does my culpability lie at work? “I had too many patients on that shift, what was I supposed to do?” or “I didn’t have time to do everything and the NUM knew we were short staffed” are statements we often hear but unfortunately are not very helpful in keeping us and our patients safe.

Knowing your entitlements & understanding the Award! 10-11 May Brisbane 5-6 June Gold Coast 5-6 June Cairns 19-20 June Rockhampton What are my entitlements right now in 2018? Am I in the State or Federal Industrial Relations system? How do I find my entitlements and find answers to my questions? This 2 day course is a must for all nurses. It’s about knowing how to determine your entitlements and how to find that information quickly.

Workplace Representatives 1 15-17 May Brisbane This 3 day course aims to assist activists and potential activists to develop the skills required to organise their workplace. Members should have completed the Being a QNMU Contact in the Workplace course before they enrol on Workplace Representatives 1.

Being a QNMU Contact in the workplace

Aged Care & Private Hospitals - Getting prepared for our next agreement 24 May Brisbane A really important course for all Private Hospital & Aged Care members. The course covers the enterprise bargaining process step by step with a focus on how we can achieve the best bargaining and campaigning outcomes for members quickly. Come along and find out how to make your next agreement your best agreement.

Health and Safety Representative Training for nurses and midwives 11-15 June Brisbane Health & Safety Training for nurses and midwives is 5 day Approved Training for H&S Reps Facilitated by Safe Work College. This is employer paid training and leave for elected Health and Safety Representatives and Deputies.

KICKSTART EDUCATION Assertiveness Skills 20 April Brisbane Cost $100 The assertiveness skills course is designed for anyone who wishes to communicate their ideas more clearly and confidently in a team environment. In this program, participants will focus on skills to generate mutual understanding and co-operative outcomes in both personal and work-based relationships.

Conflict Management Skills 23 May Brisbane Cost: $100 This workshop looks at practical strategies to improve our conflict management skills and use them when it really counts. We will focus on how to navigate those crucial conversations which can be a heady mix of conflicting thoughts, high emotions and important issues and look at how to constructively influence others’ thinking and behaviour.

Think on your feet (2 day course) 5-6 June Brisbane Cost: $495 This internationally acclaimed workshop gives you strategies and techniques to organise your ideas and verbal responses FAST. Whether you’re negotiating with managers and employers, answering questions on the spot, dealing with hostile situations, or aggressive people or wanting to communicate more assertively, Think On Your Feet® provides techniques to get to the point with clarity, brevity and impact.

23 May Townsville Being a QNMU Contact is the first step to getting more involved in the QNMU. This course looks at the role of the QNMU Contact, the structure of the union, how the QNMU functions and how QNMU members make democratic decisions.

This program will benefit all aspects of your professional and personal life.

This is our foundation course and therefore should be completed before you enrol on our longer activist courses.

You will receive a CPD Certificate for 13 hours learning and development.

You will receive a 108 page licensed manual containing a synopsis of the Think On Your Feet® formats for easy study plus examples, worksheets, checklists and memory-jogging wallet cards.

To enrol visit www.qnmu.org.au/cpd or phone 3840 1431

Autumn 2018

INDEPTH

Aged care's race to the bottom

THE OFFICIAL JOURNAL OF THE QUEENSLAND NURSES AND MIDWIVES’ UNION

ISSN 2207-6018 ABN 84 382 908 052 106 Victoria Street West End Q 4101 (GPO Box 1289 Brisbane Q 4001) 07 3840 1444 1800 177 273 (toll free) F 07 3844 9387 E inscope@qnmu.org.au W www.qnmu.org.au T

EDITOR Beth Mohle, Secretary, QNMU PRODUCTION QNMU Communications team: Linda Brady, Melissa Campbell, Stephanie Lim, Luke Rutledge PUBLISHED BY The Queensland Nurses and Midwives’ Union PRINTED BY Fergies Print and Mail

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QNMU supporting your CPD Tissue adhesive for vascular access devices: who, what, where and when

06 REGULARS

43 44 45 46

Infection control during workplace renovations

48 50

How do standards in aged care compare with the acute sector?

INSIGHT

TEA ROOM

New rules for low dose codeine products

WINS

Infection control management plans for private practicing midwives

JUST IN

YOUR $ HEALTH

IN VIEW

INCOMING

IN MEMORY

The pregnancy journey and beyond. Your rights at work

CALENDAR

Up, up and away: Profits soar for health insurance providers

ADVERTISING

INDEPTH

15 16 20 22 28 34 39

CPD

A gift of heart Understanding grief in nursing and midwifery Taking nursing to the streets Lights... Camera... Stethoscope... Action! Aged care's race to the bottom

Is your hospital relocating?

Changes to NMBA professional standards – what you need to know

DISCLAIMER: Statements expressed in articles in InScope are those of the contributor and do not necessarily reflect the policy of the Queensland Nurses and Midwives’ Union unless this is so stated. Copyright of articles remains with the contributor and may not be reproduced without permission. Statements of facts are believed to be true but no responsibility for inaccuracy can be accepted. Other material may be reproduced only by written arrangement with the Union. Although all accepted advertising material is expected to conform to the QNMU’s ethical standards, such acceptance does not imply endorsement. Visit www.qnmu.org.au/privacy to read our privacy statement.

Front cover: QNMU member Nerea Urquiza, RN, from Queensland Fertility Group.

insight

Sally-Anne Jones QNMU President

IN INCREASINGLY challenging financial and complex work environments, increasing activism amongst our membership is how we strengthen the voice of nurses and midwives both in the health care system and the broader community. But what does being an activist mean to me, you might ask? Throughout history, nurses have fought for justice and been significant political contributors to contemporary health care. Such advocacy has come with some personal and professional risks for nurses and midwives, yet their courage and leadership has brought about change for many. One example is Margaret Sanger (1879 – 1966) who lobbied for birth control in America and risked her life to provide women with vital information on reproductive health. Her efforts led to what would eventually become Planned Parenthood. Dorothea Dix (1802-1887) is another example of a nurse activist, who lobbied for a health policy for the mentally ill. And then there’s Australian activist Lowitja O’Donoghue, who’s lifelong advocacy for Aboriginal rights and reconciliation made her one of the most respected and influential Aboriginal people in Australian history. When her application to pursue nursing training at the Royal Adelaide Hospital was refused because she was of Aboriginal descent, O’Donoghue’s resentment and determination to gain admission to the program led her to join the Aborigines’ Advancement League, which, in the early 1950s, made the fight to allow Aboriginal

Making change as activists – our proud history!

women to enter the nursing profession one of its main causes. In 1954 O’Donoghue became the first Aboriginal trainee nurse at the Royal Adelaide Hospital. She went on to a lifetime of work and advocacy on issues related to the health, housing, community development, and land rights of Indigenous Australians. The roots of activism and social justice are embedded in our professional practice standards, codes and guidelines. Nurses and midwives have a social contract with society that demands professional responsibilities from us. These include defending and promoting access to high quality care, equality and safety, none of which can be maintained without an adequate workforce and continuously improving working conditions. Despite our health care system rating well in the world, there remain many issues that require our activist vigour. These issues include addressing violations of human rights, homelessness, hunger, stigma of illness, and reducing occupational violence; and championing matters such as safe staffing and better education, and recruitment and retention for our professions. If we are to succeed in our endeavors, it cannot just be the responsibility of QNMU officials to be the activists for nursing and midwifery issues — every nurse and every midwife must be an activist for the causes we hold dear. We want the power to be back in our hands, to transform activism and make the voices of nurses and

Nurses and midwives have a social contract with society that demands professional responsibilities from us. midwives and our communities heard at every level. To do this, we must keep informed of issues affecting nurses, midwives and the public. Encourage colleagues to join the QNMU, get involved in your Local Branch, be a mentor to someone new, participate in public demonstrations, meet or write to your local MP and outline your concerns and solutions. Your QNMU membership brings you many things. Beyond individual benefits, being a union member allows you to be part of influencing change in the health and wellbeing of our community, strengthening and advancing our professions, and leaving a lasting legacy of social justice reform.

QNMU COUNCIL SECRETARY :

Beth Mohle

ASSISTANT SECRETARY : PRESIDENT :

Sandra Eales

Sally-Anne Jones

VICE PRESIDENT :

Lucynda Maskell

COUNCILLORS :

Janet Baillie (on leave) Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Raquel How Shelley Howe Leanne Jiggins Christopher Johnson Damien Lawson David Lewis Dallas Meyers Fiona Monk Sue Pitman Melanie Price Karen Shepherd Katy Taggart Janelle Taylor Kym Volp Deborah Watt Charmaine Wicking

insight

The federal government must pay its bill to Queensland

Beth Mohle QNMU Secretary

MOST PEOPLE’S eyes glaze over when the conversation turns to federal/state health funding arrangements. Health funding is complex and has a long history peppered with significant power imbalances and competing interests. But it is very important, so we must make the effort to understand how it works, given the direct impact it has on the working lives of nurses and midwives and the quality of health care our community receives. So please stay with me as I recount a bit of the back story to the health funding stoush that erupted at the February 2018 Council of Australian Government (COAG) meeting, the peak inter-governmental forum. A journey of health reform to end the ‘blame game’ between the federal and state/territory governments started about a decade ago, and resulted in the 2011 National Health Reform Agreement (NHRA). Two independent authorities to oversee the process for determining and allocating health funding were created. In 2011 the federal government committed to meeting 45% of the growth in efficient hospital costs for the first three years, which would then increase to 50%. However, in 2014 the Abbott government withdrew unilaterally from the 2011 agreement. They introduced a new model that ripped billions of dollars from health, which justifiably angered all State and Territory governments. But things can change quickly in politics.

The health of our community is too important to become a political football again. Tony Abbott was ousted by Malcolm Turnbull, and in 2016 Prime Minister Turnbull agreed to partially restore these cuts and has offered for the federal government to cover 45% of hospital funding with growth capped at 6.5% per annum for five years from 2020. But the damage had already been done. The amount owed to Queensland is a staggering $1.12 billion. If this funding shortfall is not addressed urgently, there could be devastating consequences. We have been advised that this estimated $1.12 billion could mean 196,839 fewer procedures in Queensland public hospitals, 2168 fewer new nurses and midwives, and 622 fewer new doctors… not to mention the increase in wait times. We are extremely concerned about the potential devastating consequences for our members and our community that this funding shortfall may have. Which is why we have started a campaign to exert pressure on Prime Minister Malcolm Turnbull to immediately pay up what is owed. The timing of all this leaves a lot to be desired. Right now we are concentrating on finalising our Enterprise Bargaining deal with Queensland Health and implementing policy commitments made to nurses and midwives by the Palaszczuk government.

But this funding shortfall places all this at risk. Such a significant failure by the federal government to deliver on a deal is also not a good sign for our 2018 campaign for ratios in aged care. However, it highlights why it is important for us to be politically active – politicians’ decisions have a direct impact on our working lives and the quality of care we are able to deliver. Health care is understandably a top priority for our community at every federal and state election given our universal health system is a symbol of fairness and equity for all Australians. This cannot be placed at risk. We must send a strong message to the federal government to pay their fair share now. The health of our community is too important to become a political football again.

PAY UP MR TURNBULL! PLEASE SIGN OUR PETITION AND SEND A MESSAGE TO MALCOLM TURNBULL www.qnmu.org.au/ payuppetition

tea room m Q A

We sometimes take it for granted that everyone knows their entitlements. However, for new entrants to the nursing and midwifery workforce it is often difficult to understand the plethora of entitlements and payslips across our profession. In fact, many nurses and midwives are uncertain about which allowances, loadings and penalties they are entitled to given the diversity of their work and working hours. The following questions are frequently asked of our Member Connect call centre.

If I am rostered to work but then not required, should I still be paid? If you work part-time, then yes. We often hear from members (particularly during holiday periods) who have agreed to work additional hours, have been rostered on, but are then told the morning of their shift they are no longer required to work. For part-time nurses and midwives, this is not acceptable — your employer should pay you for the shift regardless of whether you are required to work or not. Most agreements contain clauses similar to the effect of the following: “Unless the employee/s otherwise agree, an employer desiring to change a roster/s shall give the employee/s at least 7 days’ notice unless the change is necessary to meet unforeseen fluctuations in patient demand for services, or where another employee is absent from duty on account of illness or an emergency”. An “unforeseen fluctuation” may include a natural disaster or emergency – it does not include your employer realising they are overstaffed on the day of the shift. If you are not paid after being stood down, you should first check your agreement and raise it with your employer. If your employer still refuses to pay you, contact the QNMU. Please note this advice may also apply in limited circumstances to casual workers, depending on your agreement. Check your agreement at www.qnmu.org.au/wages_ conditions or contact the QNMU.

If you have questions for our Tea room column email memberconnect@ qnmu.org.au

What is meritorious sick leave (QH members)? Meritorious sick leave is sick leave that can be awarded to long term employees in addition to their current annual sick leave entitlement.

Public sector nurses and midwives may apply for meritorious sick leave after 26 years of full-time meritorious service. It entitles you to an additional 13 weeks on full pay and is added to your current sick leave balance. Part-time employees who have completed the required period of service through a combination of permanent full-time, part-time or temporary engagements are also eligible for meritorious sick leave on a pro-rata basis. Nurses and midwives must apply in writing for meritorious sick leave. You do not have to exhaust your existing sick leave or use up your annual leave before applying. You do not have to be sick to apply for the leave – you can apply for it once you have completed 26 years of meritorious service, and it may then be added to your already accrued sick leave. The employee may be required to provide additional information to support their claim and demonstrate they have had meritorious service, if there is not sufficient information on the employee’s personnel file. Queensland Health can refuse your application for meritorious sick leave if you have had disciplinary action taken against you resulting in a penalty, if you have been formally counselled for poor performance, or if you have a high rate of absenteeism without reasonable justification. Queensland Health can also defer your application based on a number of conditions, including a break in service or a period of demotion. However, your employer should act in a reasonable way when considering your application. The QNMU can assist members with applying for meritorious sick leave. Similarly, if you feel your employer has unfairly rejected your application, you can also contact the QNMU. For more information, visit http://bit.ly/sickleavepolicy

wins

Mater nurses win what they’re due NURSES at Mater Hospital were recently successful in accessing their Professional Development Allowance (PDA), after management initially refused. Members tried to access their PD Leave to attend courses, but management refused claiming rostering and budget limitations. As a last resort, members requested they be paid their PDA ($750 annually) so they could buy laptops in order to access online learning from home. While management approved the allowance for some staff, a second round of applications were then refused. Members contacted the QNMU, and we provided them with advice and assistance in raising a local grievance. We also wrote to Mater management, outlining our concerns that one group of staff had been refused the allowance while others were granted access to their entitlement. Mater agreed to ‘consult’ with members and as of November last year, all members who requested their PDA have now received it. Mater management have admitted to “mixed messaging” regarding the approval process, and have also committed to rebuilding the Nursing and Midwifery Consultative Forum (NaMCF) this year. With a new round of bargaining due to start in 2018, we’ll be looking to address issues around PDL and PDA to avoid this situation happening again.

Bumper wage increase for Bupa nursing staff THE QNMU has successfully secured a bumper 3.3% wage increase for nursing staff in Bupa. This is one of the highest wage increases for any nursing staff in Queensland in recent years, particularly in aged care. In 2017, a number of aged care employers tried to reduce the wages and employment conditions, but aged care staff voted down many of these substandard employer-proposed agreements. Bupa nurses and carers in Victoria even took unprecedented protected industrial action in an attempt to negotiate a fairer agreement. We’ve pushed back against employers’ increasing attacks on our members’ wages and conditions, and this wage increase is a testament to the strength of nursing staff standing together for a fair go.

This is one of the highest wage increases for any nursing staff in Queensland in recent years, particularly in aged care.

Need some support? QNMU members needing advice or support can contact Member Connect on (07) 3099 3210 or 1800 177 273 (toll-free). We’ll do our best to help you secure wins like the ones you’ve read today!

wins

In for the long haul… Prince Charles ED Specialist Panel gets results NURSES at The Prince Charles Hospital Emergency Department have achieved a huge win after escalating their workload issues to a specialist panel. All up it was a two-year process. At the heart of the problem, patients were being sent to the ED overflow area, which became increasingly unmanageable and unsafe. Not only were there up to 20 patients being treated in the corridor at any given time, there were not enough nurses rostered on to provide quality care. To highlight the ongoing issue, QNMU members submitted workload reporting forms consistently over many months. Despite attempts to resolve this at the local level, the issue eventually escalated to a stage 4 workload grievance (a Specialist Panel). The panel, which met several times over 12 months, consisted of QNMU member reps and organisers, QNMU professional and industrial officials, EDONs and BPF experts. It’s not often matters are escalated to a Specialist Panel, but the following outcomes show why having this process to follow is so important, and what can be achieved by staying for the long haul. The following outcomes were achieved either directly or indirectly through the Specialist Panel: ■ a ratio of 1 nurse to 3 patients in the overflow area ■ an additional 24 FTE nurses, including RNs, CNs and Associate NUM positions, plus an increase to Clinical Nurse Teachers and Nurse Educators ■ three additional acute treatment spaces ■ four additional chairs in the short stay unit ■ a leadership program for CNs. While not directly related to the Specialist Panel, an introduction of an Older Persons Assessment and Liaison Service (OPALS) unit has also been implemented. Patients are now fast tracked through the department to a quieter and more controlled area to ensure decreased time in the emergency waiting room. Management worked closely with nurses (including regularly surveying staff) to implement all changes.

When you stand back and reflect on what we’ve achieved for our patients and staff, you realise it’s well worth the fight. As a result, there has been a significant cultural shift in the ED, supported by extra training and working groups. Members report their workloads have significantly improved, and all issues originally raised at the Specialist Panel have been addressed. TPCH Registered Nurse Laurel Castleton, who was one of the leading QNMU reps on the Specialist Panel, said making her workplace safer was what kept her and her colleagues committed to the two-year process. “If I make my workplace a safer place for not only my patients but also a more secure work area for my colleagues, then I’ve done my job,” Laurel said. “Yes, it’s been a lengthy process and it can be stressful, and there’s a lot of to-ing and fro-ing and there are always issues with funding, but I did feel that management listened to us and the union supported us all the way through. “When you stand back and reflect on what we’ve achieved for our patients and staff, you realise it’s well worth the fight.” This is a great win, and a testament to members and the QNMU working collaboratively with management to ensure patient and staff safety is always the top priority.

wins

Cooinda backs down on reducing leave WE RECENTLY helped members at Cooinda Aged Care win back six weeks' annual leave after their employer suddenly decided to slash their annual leave to five weeks. Nursing staff at Cooinda who regularly work weekends in addition to other days of the week are entitled to six weeks’ annual leave and have received that entitlement for many years. But management had some financial trouble and, without warning or any consultation, decided to change their interpretation of the term ‘regularly’ to mean ‘34 per year’. That is, if you didn’t work each day of the week (including weekends) on at least 34 occasions per year, your annual leave was slashed to five weeks. Management said not a single one of their employees was entitled to six weeks’ leave under their reinterpretation of ‘regular’. That’s because it is impossible to work on each day of the week on 34 occasions in a year (under a regular roster) without breaching the entitlement of staff having at least four days off work per fortnight. After receiving complaints from members, the QNMU challenged management’s decision and dismantled their reinterpretation. Management quickly agreed to reinstate six weeks’ annual leave to all nursing staff who had previously received that amount, and to backdate that leave to October 2017 when it was first slashed.

Our campaign for domestic and family violence leave THE QNMU has been working hard to secure domestic and family violence leave in all enterprise agreements.

Johnson Stenner, Estia, and Medibank Telehealth, with more currently being negotiated.

Following all public sector members achieving 10 days per year paid domestic and family violence leave, we have also secured similar entitlements from other employers, including Arcare and Lutheran Services (5 days).

Private Hospital employers have so far been reluctant to include any paid domestic and family violence leave entitlements. However, with this issue firmly on the national agenda and more employers now offering entitlements, we are hopeful many private hospital employers will come on board this round of bargaining.

Many more employers have also introduced supporting clauses around evidence and confidentiality, as well as provided nurses and carers with access to personal or carer’s leave for family and domestic violence related issues. Employers so far include Beauaraba Living, Star Aged Living, Feros Care,

Paid domestic and family violence leave continues to be on all log of claims, and we will continue to negotiate this entitlement for all QNMU members.

Arcare nurses secure higher penalties and domestic violence leave AGED CARE nurses and carers at Arcare have secured some great improvements to their working conditions through a new enterprise agreement. The agreement is now going through the Fair Work Commission approval process. After members initially voted down a sub-standard offer, management improved their position on a number of entitlements. An updated definition of ‘shift worker’ means more nurses and Personal Care Workers will be able to access six weeks annual leave. And at a time when many employers are trying to cut penalty rates, Arcare agreed to increase penalty rates for PCWs from 150% to 175% on Sundays, as well as increase casual loading to 125%. Nurses and carers also now have access to paid domestic and family violence leave. Specifically, members have an additional five days’ leave per year when their personal leave balance is 10 days or below. This is fantastic news, and sets a great example for other aged care employers to follow. There are still some entitlements that need to be improved and we hope we can build on the success of this campaign in the next round of bargaining. Well done to those nurses and carers who got involved in the EB process!

#WIN 7

wins

Changing culture at Maryborough Hospital’s Ward 3 NEW APPROACHES to caring for dementia patients have been trialled and implemented on Ward 3 at Maryborough Hospital — and the results are impressive. In fact, so successful have the changes been that the Ward 3 team received an Australia Day Award, and the Nurse Unit Manager who led the change received an individual Award for her outstanding leadership. The 20-bed ward was experiencing alarming rates of aggression and violence towards staff from dementia patients. NUM Kym Pointon, whose background is in aged care and clinical governance, said she and the nursing staff, along with the allied health team, decided to change the model of care. “We had a very high rate of staff injury. We do still have the odd incident, but nowhere near as many and nothing like it was,” Kym said.

Education and training Recognising the need for more staff education, management engaged Dementia Training Australia (DTA) to assist with training and to conduct audits of the ward. As a result, nurses now have specialist knowledge of dementia patients, and the training is now a prerequisite for those working on the ward.

“Staff now have a much deeper understanding of what’s happening to the brain and the body, and are more skilled in de-escalating behavioural components before they become a problem,” Kym said.

Staff also have regular debriefs, and a counsellor visits the ward on a regular basis to provide professional support.

“The staff are also more empowered with a deeper understanding of appropriate medication management.

The nursing staff have also worked closely with the allied health team and created a more integrated approach to caring for patients.

“We’ve seen a dramatic decrease in the use of chemical restraint, which is much better for our patients.”

Reducing stimuli Changing the environment of the ward has also been pivotal to better patient management. “We’ve gone from a very chaotic, fast-paced ward to a calm one,” Kym said. “As soon as you walk through the door you slow down out of respect for the patients. “At 2pm we dim the lights to reduce stimuli, because at that time we’ve got afternoon staff coming on, we’ve got the tea ladies and their trollies, we’ve got doctors doing rounds… the stimuli gets very high and that’s when we have that escalation in behaviour. “We also keep the noise to a minimum level, we keep the corridors free, and we’ve redeveloped our program so that allied health come in the morning rather than the afternoon.”

Integrated approach

“We find out the details of the patient’s history, about their preferences, their family members, what they’ve done in their past work life,” Kym said. “All information sits above their bed so anyone coming in has some reference to initiate conversation and build a rapport with the patient. “So there’s been a massive culture shift in how the staff see our patient cohort and how they interact.” In fact, so successful has the change been that other staff have asked to work on the ward. “Everyone has been so open to change and I’ve had no resistance,” Kym said. This terrific outcome shows what can be achieved with strong leadership and cooperation from all involved. Pictured (L-R): NUM Kym Pointon, Christie-Lee Krause, Danielle Pascoe, Carol Campbell, Margaret Nippress-Smith and Delia Wyatt.

just in

Abortion law reform submission The QNMU recently made a submission to the Queensland Law Reform Commission’s review of Termination of Pregnancy Laws in Queensland.

in the public interest to reduce harm to the individual, those who perform or assist with the procedure and the public. ■ Women should have access to:

The QNMU Council and its policy committee — which are all democratically elected by members — has given extensive consideration to this matter. The QNMU developed its position through due process, drawing on briefing papers and empirical evidence where available.

◆ legal and safe abortion

The QNMU recognises the need to modernise and clarify the law to reflect current community attitudes and expectations.

◆ appropriate sexual and reproductive health and information.

We maintain that the interests of the woman and those who assist her are best served where abortion is not a criminal offence. Females need safe, quality care for all their reproductive and health needs and this should be reflected in legislation. The QNMU recommended: ■ Sections 224, 225 and 226 of the Criminal Code 1899 (Qld) (the Code) be removed. ■ Any further legislation or regulation should be drafted

◆ reliable, safe and affordable contraception ◆ counselling services before and following a termination ◆ information and services to support adoption or maintaining a pregnancy

■ The Queensland government, in conjunction with the federal Department of Health, develop and implement a broad female sexual and reproductive health strategy that includes comprehensive access to education, services, counselling and information. The submission also noted that nurses and midwives have a right to refuse to participate in procedures which they judge on strongly held religious, moral and ethical beliefs to be unacceptable.

March for aged care this Labour Day THIS YEAR’S Labour Day is a special one, because we’ll be marching for real change in aged care… change we desperately need. The march will mark the official launch of our national aged care campaign. Among other things, we’re asking for legislated ratios in the sector. The situation in aged care is dire. Sweeping cuts to nursing staff across the state and the transfer of medication management to carers and support staff is creating a dangerous situation for our elderly and our aged care workers. You can read more about the situation on page 28. It’s time for us to make a stand. We need as many people as possible to join us, whether you work in the aged care, public or private sectors. We want to send a clear message to our federal politicians… it’s time to fix aged care! So come along and bring your friends and family — you’ll also receive a free t-shirt!

Event details In Brisbane, the Labour Day march will begin as usual from the corner of Wharf and Turbot streets at 10am on Monday 7 May, and end with a family fun day at the RNA Showgrounds. For dates, times and details of Labor Day marches and events elsewhere around the state visit www.queenslandunions.org/ labour-day-2018

just in

Supporting our next generation CONGRATULATIONS to our five QNMU/Maurice Blackburn student bursary winners – Joshua Prior, Kelric Mullan, Lauren Fernandes, Nicola Barnes and Laura Sinclair! They’ve won $1000 each to assist them in undertaking studies in any field at a university or TAFE. Having just finished his first year of a nursing degree, Joshua Prior said the bursary would go a long way toward supporting his university education. “I’ll put the money towards a laptop, which will take the pressure off from having to borrow other people’s stuff,” Josh said.

Similarly, Laura planned on cutting down hours at work to focus on study. “Currently we’re going through unpaid internships — which is the expectation of the degree— so this money can compensate for the time I’m putting in there, and will go a long way with textbooks that cost hundreds of dollars each semester,” Laura said. The student bursaries are awarded to the children of QNMU financial members and is part of our commitment to supporting the next generation. Stay tuned for more information on our upcoming scholarships and bursaries.

New Health Ombudsman THE OFFICE of the Health Ombudsman has a new head honcho, and she’s an experienced leader in the Queensland public service. Rachel Hunter took up the Health Ombudsman role in early March, after resigning from the Children’s Health Queensland Hospital and Health Board to take on her new duties. Ms Hunter has a solid knowledge of the health sector. Her career in the Queensland Government has spanned more than three decades, with previous roles as Public Service Commissioner and the DirectorGeneral of both the Justice and Attorney-General’s Department, and the Education, Training and Arts Department. The Health Ombudsman is an independent watchdog for the Queensland’s health sector, with the role being responsible for both the public and private health sectors relating to both registered and unregistered practitioners.

(L-R): Joshua Prior, QNMU Secretary Beth Mohle, Laura Sinclair and Maurice Blackburn Lawyers’ Giri Sivaraman

(L-R): Maurice Blackburn Lawyers’ Tanya Straguszi, Kelric Mullan, Nicola Barnes and QNMU Organiser Krissie Bishop

Image: Children’s Health Queensland Hospital and Health Service

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‘Age healthy’ with this year’s International Nurses and Midwives Days IT’S NEARLY that time of year again… the time to celebrate our awesomeness as nurses and midwives!

crisis in aged care and the role we must all play to fix it.

International Day of the Midwife (5 May) and International Nurses Day (12 May) are always a good opportunity to pause, take a breath, and reflect on how much we contribute to our community every day.

■ Where: 106 Victoria Street, West End

In keeping with the May launch of our national aged care campaign (see Labour Day article on page 9), this year the QNMU will focus on the theme of ‘healthy ageing’. We’ll be hosting a yoga class at the QNMU Brisbane office. It’ll be a fun chance to learn some techniques to stay fit and healthy and improve your wellbeing. Plus there will be a meet and greet brekkie to get your day started, catered by Kiss the Berry. Guest speakers will include Lauren Todorovic from the Aged Care Report Card, who will talk about the current

■ Cost: $30 (includes breakfast and a QNMU goodie bag)

Local Branches can host their own events, too — whether it’s a yoga class or a breakfast. Talk to your local organiser or branch about what's happening in your area. Email eschulz@qnmu.org.au for details.

#IND18 #IDM18 We love sharing photos of nurses and midwives celebrating, so send us your happy snaps and cake pics to comms@qnmu.org.au. We’ll add them to an album on our Facebook page, so keep an eye out!

Get set to run (or walk) for breast cancer awareness IT’S TIME to don those pink outfits and gear up for the annual Mother’s Day Classic fun run! The annual fundraiser will be held around the nation on Sunday, 13 May to raise vital funds and awareness for breast cancer research. Since the run began in 1998, close to 1.3 million runners and walkers have helped raise more than $33 million, making a real difference to those diagnosed with breast cancer. This year’s Mother’s Day Classic Event in Brisbane will be held at South Bank Promenade near the Brisbane River.

REMEMBER – you don’t have to live in Brisbane to get involved in this nationwide community event. Why not rustle up some pals and set up your own event in your town? All you’ll need are some enthusiastic folk, a local park or circuit and some decent walking shoes, and you’re ready to start raising money for a great cause! For more information or to register, visit www.mothersdayclassic.com.au

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PAY UP MR TURNBULL! THE TURNBULL federal government currently owes Queensland $1.12 billion in health funding, but is refusing to pay up. That could mean 2168 fewer new nurses and midwives, 196,839 fewer procedures, and longer waiting times for patients. With public sector EB10 negotiations in their final stages, a shortfall of $1.12 billion could also affect the wages and conditions we have negotiated so far with Queensland Health. It could also affect the Queensland Palaszczuk government’s ability to implement some of its election commitments, including jobs for nurse graduates.

HOW CAN THERE BE A $1.12 BILLION ‘BLACK HOLE’? In 2014, Tony Abbott’s federal government abandoned an agreement that secured federal and state health funding for years to come. By walking away from this agreement, billions of dollars were ripped out of already budgeted stated health services.

WHAT CAN I DO? We need our federal politicians, including Prime Minister Malcolm Turnbull, to hear our message loud and clear – it’s time to stand up for Queensland. It’s time for Canberra to pay up! Sign our petition and send a message on to Malcolm Turnbull – www.qnmu.org.au/payuppetition Contact your local federal MP and tell them to pay their bill. Visit electorate.aec.gov.au to find your local member.

SHORTFALL OF ALMOST

3000 NEW HEALTH PROFESSIONALS IN OUR PUBLIC HEALTH SYSTEM

When Malcolm Turnbull became Prime Minister he agreed to partially restore funding. But the damage was already done, with Queensland owed an estimated $1.12 billion.

196,839

HOW CAN THE FEDERAL GOVERNMENT SIMPLY NOT PAY UP?

FEWER PROCEDURES

Exactly! If ordinary Queenslanders can’t get away with refusing to pay their bills, why should the federal government be allowed to do it? The federal government claims the $1.12 billion owed to Queensland was money that was never there. The fact is, the original agreement (from 2011) guaranteed health funding for years to come. Individual states – including Queensland – budgeted and provided services based on this agreement.

Nurses and midwives across Queensland have been telling their local MPs to stand up for Queensland and pay up! If you want to get involved and visit your local MP, email gsiddle@qnmu.org.au

PLEASE SIGN OUR PETITION AND SEND A MESSAGE TO MALCOLM TURNBULL www.qnmu.org.au/ payup

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THE TALE OF THE FEDERAL GOVERNMENT’S FUNDING FIDDLE 2

QUEENSLAND GOVT

55%

FEDERAL GOVT

45% IN THE BEGINNING THERE WAS AN AGREEMENT – THE FEDERAL GOVERNMENT PAID 45% OF STATE HOSPITAL GROWTH COSTS, QUEENSLAND PAID 55%... THE FUTURE OF OUR HEALTH FUNDING WAS SECURE THANKS TO FUNDING LEVELS SET BY AN INDEPENDENT UMPIRE.

STATE GOVERNMENTS — LIBERAL AND LABOR — PROTESTED!

PAY QLD WHAT YOU! PROMISED

SHOW US THE MONE Y!

THEN CAME PM TONY ABBOTT WHO ABANDONED THE AGREEMENT WITHOUT CONSULTATION. HIS NEW FUNDING MODEL RIPPED BILLIONS OF DOLLARS FROM ALREADY BUDGETED STATE HEALTH SERVICES.

UMM, WE’RE NOT PPAYING THE MONEY MO WE OWE YOU...

3 WITH CANBERRA REFUSING TO PAY ITS DEBT OF $1.12 BILLION, QUEENSLANDERS FACE: ■ ■ ■ ■

NO NURSING, MIDWIFERY OR HEALTH WORKER GROWTH ALMOST 200,000 FEWER PROCEDURES INCREASED WAIT TIMES CUTS TO HOSPITAL UPGRADES AND EXPANSIONS

IT’S NOT GOOD ENOUGH! WHEN MALCOLM TURNBULL BECAME PRIME MINISTER HE AGREED TO PARTIALLY RESTORE FUNDING. BUT THE DAMAGE WAS DONE — QUEENSLAND IS OWED AN ESTIMATED $1.12 BILLION.

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Federal government wants to ban union materials THE TURNBULL government – with the support of One Nation – has introduced a new building code that bans all union slogans and materials like stickers, flags and symbols on clothing from construction sites wishing to receive government contracts. The new code bans “images generally attributed to, or associated with an organisation, such as the iconic symbol of the five white stars on the Eureka Stockade Flag”. It also bans “mottos” and union names, symbols, “signs, markings or indications”. Banning union materials is simply unAustralian and further erodes unions and workers’ rights on construction sites. To show your support for our fellow union members, please sign the Queensland Council of Unions petition – we’ve now got nearly 13,000 signatures. Visit www.megaphone.org.au/ petitions/reverse-the-lnp-ban-onthe-eureka-flag

EB 10

Ending HIV through PReP

YOUR WORK YOUR VOICE

THE QNMU and Queensland Health have been busy negotiating a new EB10 agreement for public sector nurses and midwives. Some of the big ticket issues we’ve been working to improve include on-call/recall, industrial entitlements for higher duties and after-hours managers, and access to administrative support for NUMs and MUMs. We are also addressing PDL/PDA for temporary employees, inequities arising within multi-disciplinary teams, and improving the remuneration of rural and remote DONs. Public sector members should keep checking their emails for the latest updates, or visit www.qnmu.org.au/EB10 to stay up-to-date with everything EB10.

THE HIV prevention drug pre-exposure prophylaxis (known as PReP) will soon be listed on the Pharmaceutical Benefits Scheme. The drug is up to 99% effective for stopping the transmission of HIV, but up until now has cost up to $10,000 a year for individuals to access. Putting the drug on the PBS could slash that cost to just $40 a month. This is a significant step forward to eradicate the transmission of HIV in Australia and will also help reduce stigma around people living with HIV.

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A gift of

heart QNMU Member Emma Thomas recently returned from her first ever volunteer philanthropic trip with Open Heart International, and shared her experience with us!

Volunteering was a humbling experience and one that I very much look forward to again. Being exposed to the clinical systems in a third world country certainly made me proud of the high level standard of care that nurses across Australia deliver on a daily basis. I went over to Tanzania as a mentor to the local nurses of Dar Es Salaam working in the Jakaya Kikwete Cardiac Institute (JKCI) at the Muhimbili National Hospital (MNH). I was prepared to impart knowledge and guidance pertaining to surgical skills and instrument handling in the field of open heart surgery. On assessment, I found surgical skills were, in fact, not the priority for education amongst the nurses but rather (it was) the fundamentals of patient safety and encouraging the use of PPE (especially in a country with high rates of blood borne infections). The nurses I mentored for my week at JKCI have now become lifelong friends whom I remain in contact with each week. If you are ever granted the opportunity to participate in such an experience I highly recommend it. It takes you out of your comfort zone but at the same time, potentially makes you a better clinician as you have to learn to adapt and work with what you have. Emma Thomas, Registered Nurse

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in nursing and midwifery

S NURSES and midwives, people trust us to be there for them at some of their most vulnerable moments. We care and we do everything we can to make our patients and residents comfortable and healthy.

But working on the frontline we often see or experience things that most people would not be exposed to in their everyday lives, such as death, trauma and horrific injuries. Yes, we expect these things and are trained in how to deal with them from a clinical approach. It is, after all, part of the job. But at what point do these experiences start to become normalised and take their toll? And how much do we really acknowledge grief as an inevitable outcome of nursing and midwifery?

indepth Cumulative grief A recent survey by Karuna – a Brisbane charity providing in-home palliative care — found nearly 70% of nurses surveyed were affected by grief and loss in the workplace. Palliative care Nurse Practitioner and Karuna CEO Lea-anne Tuaoi said nurses were good at compartmentalising their grief. “When nurses go into a really stressful situation we automatically go into nurse mode, which says, ‘right, what do I have to do to make this better and settle things down’,” Leaanne said. “We set aside how we feel about it while we’re doing it. “If you don’t get a chance to reflect on that later, it builds up and is what we call cumulative grief. “Over a period of weeks or months or years that can come back and catch you, and I think that’s what happens when nurses hit the wall — they just think, I cannot bear to see another person die.” The idea of ‘cumulative grief’ suggests we deal with grief over a long period of time… and yet perhaps don’t actually deal with or address it in a meaningful, psychological way. Lea-anne said nurses developed a different worldview compared to other people because of the environment we work in. “You go to the pub with friends and they ask you how your week was, you go, ‘Yeah, it was okay’, even though

you’ve just seen someone bleed to death,” Lea-anne said.

is the job so how am I going to find some healthy ways of dealing with it?’

“You can’t talk to them about those things because they have an innocence that you no longer have.”

“Every nurse gets to that point where they have to make a choice whether they’re in or out, and how they’ll cope with it if they stay in.”

A first for everyone Lea-anne recalled the first time she felt grief over a patient dying. It took a while for her to register exactly what the emotion was. “I was working in an oncology ward and one of the mothers had been with us for a very long time and she passed away. “I’d been rostered off the day she died, and I remember going into work the next day and her room was empty. “I felt quite shocked that there was someone else coming into that room, and that just felt all too rude to me. “Then at home that night I lay on the floor in the dark and listened to some music this young woman had listened to and felt very sad. “I thought, ‘what is this?’, and suddenly realised, ‘oh my God, this is grief’.” Dealing with grief is not something we can really prepare for – they don’t teach us that at university. But we can choose how we manage it. “New people who come into this space will experience that sensation, and then it’s about what you do with it. “You either go, ‘I can’t do this countless times a year’, or you go, ‘this

‘Normalising’ death In some areas of nursing, such as palliative care or aged care, death is an expected and very natural outcome. “When I was a young nursing student, I was the only one running in the direction of the palliative care unit, everyone else was running in the opposite direction to do things that saved people’s lives,” Lea-anne said. “There’s a particular mindset that comes with nurses working in palliative care: they accept that dying is a normal part of human life, it’s not a shock. “So their goalposts are completely different – they’re about making someone comfortable and pain-free, looking after the family and ensuring that person has a good death.” The result of this, however, is that death can become normalised. Lea-anne estimated the staff at Karuna witnessed stet 400 deaths each year. “Then you have the situation where a new person comes in who hasn’t worked in that space before and you see them crying and you stop and think, oh that’s right, this is the first time they’ve ever seen that. We’re so used to it we take it for granted.” But what about when death becomes so normalised that we forget to even ask the question, ‘are you ok?’.

We try hard to remain

“The churn of staff is really rapid in aged care,” Lea-anne said.

present and in the

“Some of that is around grief and burnout because they’re repeatedly losing people.

moment with a patient or resident and to remain caring and sensitive, but that puts you at some risk and vulnerability. Lea-anne Tuaoi

“They might have a relationship with someone for 10 years which is longer than you’ve been married to your partner. “If that person died, everyone would say that was terrible and sad, but when a resident dies no one really asks how you’re feeling or how can we honour that person’s life and give you an avenue to express your grief.”

indepth The other side of midwifery While death may be an expected outcome for palliative care or aged care nurses, it is the exact opposite for midwives… though it is something every midwife will be exposed to one way or another throughout their career. In Australia, six babies are stillborn every day according to Stillbirth Foundation Australia, and one in four confirmed pregnancies end in miscarriage before 20 weeks according to Sands. Our understanding and approach to grief over the loss of a newborn has changed over time. Decades ago it was expected that women and families would forget about their stillborn child and simply try for another. Often the family would not see or hold the deceased child. We now understand that “memory creation” – which may include seeing the baby or creating a memory book – can help the grieving process. Gold Coast Clinical Midwife Joanne Everingham said midwives played a unique role in providing for the woman’s emotional and physical needs during this time. “From a midwife’s perspective, it’s devastating if you’re involved in a case where a baby is born and doesn’t survive, and they’re the cases that are the hardest to deal with,” Joanne said. “Psychologically, they’re in a world of grief as well – they’re grieving for

the woman, it’s just a different form of grief. “They have to make sense of everything that happens as well, and it can be difficult for them to see the light at the end of the tunnel.” With our understanding of grief changing over time, the midwife’s role has also expanded to incorporate a more specialised focus on assisting women with their grief. “What has changed since I’ve been a midwife is we’ve seen things like perinatal loss positions become available where hospitals have acknowledged the need to have midwives in these roles to look after women who have lost their babies,” Joanne said. For new midwifery graduates, it’s an aspect of the job they may not have seriously considered. Arguably, it’s something no midwife can prepare for without experiencing it first-hand. “I think a lot of young people applying for a bachelor of midwifery don’t think about all this, they’re thinking about the babies,” Joanne said. “But it’s not really about the babies, it’s about the women and looking after them. “They’re focused on getting their academic requirements and how many births they have to do, and as they come out as new grads you want them to consolidate their learning

before putting the extra burden on them of looking after someone who’s lost a baby. “There’s all sorts of stuff you have to prepare them for, like what a baby actually looks like that has been deceased for a few days.” Registered Nurse and Midwife Helen Pentecost said she was often called upon to deliver the stillbirths, which ultimately drove her to learn how and when to say ‘no’. “I had one shift where I had five babies die, including triplets,” Helen said. “There was also a Christmas Day where I had a woman give birth to a baby that had already died, and I had another lady who gave birth to a living child, and I had to swap between my happy face and sad face. “I started to lose sleep and I was taking the incidents home with me. “You do start to overthink the critical incidents you’ve been involved with. “So it’s important to be able to recognise when to say no or when you need a break.”

Managing the relationship Perhaps unique to midwifery is the relationship that can develop between the woman and midwife. Whether it happens in just a few short hours or over several months in a continuity of care model, the pregnancy journey and birth is a special moment that both the woman and midwife share. Joanne Everingham said in the event of an adverse outcome, this bond could add an extra layer of complexity to the grieving process. “There’s that real emotional trust between the midwife and the woman, and sometimes when the woman loses her baby it can be about wanting to blame someone, and that’s part of the grief,” Joanne said. “It’s not always the case, but I have seen it before, and that can be really hard, including for the midwife who has to manage that as well as their own grief.”

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Tips for managing grief ■ Regularly check in with your colleagues and ask the question ‘are you okay?’.

Helen Pentecost works as a phone counsellor at Nurse and Midwife Support

Staying true to yourself Helen Pentecost worked as an oncology nurse prior to becoming a midwife, a role that exposed her to so much death that she did not realise how ‘normalised’ it had become until the stillbirth of her own nephew. “The thing that made me leave oncology was sitting through my stillborn nephew’s funeral and not shedding a tear,” Helen said. “I got to the end of the funeral and thought, wow, you’ve gone a little bit hard... You need to take a step back and feel your feelings because it’s not healthy to sit through a funeral and not shed a tear. “I became so good at turning it off that it really wasn’t healthy.” Helen said there was a stigma around nurses showing their emotions, particularly in front of patients. “I think nurses still have that belief that they have to be tough and it’s not right to cry in front of the patient or show human emotion. “Nurses are particularly bad at looking after themselves, and there is that view of ‘take it to the tearoom, people don’t need to see that’. “When you’re looking after seven patients and one of them dies, you still have to look after everyone else. You still have to keep that pace. “But you also have to find that line between looking after yourself and

your patients and still being true to yourself.”

Support is available Helen now works as a phone counsellor at Nurse and Midwife Support, a 24/7 national support service for nurses and midwives seeking confidential advice and referrals.

■ Try to keep a robust social life, find a balance between quiet and social environments, and connect with the world outside the one you work in. ■ Exercise regularly and have good sleeping patterns. ■ Eat a healthy diet. ■ Consider writing a journal, meditate or find a hobby that works for you. ■ Always seek professional help if you think you need it.

The service, which launched in March 2017, found 22% of midwives and 18% of nurses who phoned were seeking support for mental health concerns. All staff at Nurse and Midwife Support are either nurses or midwives with counsellor training. “Other people don’t really understand the nurse or midwife mentality – it isn’t just a career, it’s a totally different way of thinking,” Helen said. “People will talk to us about whether they could’ve done something better, or they talk through the sadness they feel and how it felt to do whatever it was.” While those calling will often just want someone to listen, Helen said she often tells people to “just take time”. “Everyone grieves and feels differently, just take the time you need to look after yourself. “If you don’t look after yourself first, you can’t look after anyone else.”

Where to get help ■ Nurse and Midwife Support 1800 667 877 www.nmsupport.org.au ■ Lifeline 13 11 14 www.lifeline.org.au ■ Beyond Blue 1300 22 4636 www.beyondblue.org.au ■ More information on where to go for help can be found on the Queensland government website: www.qld.gov.au/ health/support/loss/coping

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G N I S R U N G

N I K A T

TO THE

S T E E R T S 20

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CLINICAL NURSE XAVIERA FARRELL RECKONS NURSING BELONGS IN THE GUTTER. HE SAYS it’s there – among the homeless, the battlers and the poor - that nurses do their best work.

Xaviera is a Mater Community Health Nurse embedded in the Micah Street to Home homeless outreach program and spends her working days with the most vulnerable and isolated people in our community. “My outreach goes to places not many other nurses go,” she said. “I will go under bridges and I will go to walkways and under bike paths and go down on my hands and knees under building sites to find people and treat them in their space.” And she’s not exaggerating. On any given day, Xaviera can treat anywhere up to 15 people, most of them homeless and with lives shaped by abuse, neglect, mental health issues and family trauma. And she will literally dress wounds under trees and check blood sugars in squats. On paper her job is a case management and chronic disease management role with a caseload of about 13 regular patients and a number of ad hoc referrals each day. But she provides much more than just clinical care. There are also elements of social work and nurse navigation to Xaviera’s role, helping people who struggle with life, get access to the care and resources they need. “You don’t need to bring out the stethoscope on everybody,” she said. “My work has a holistic approach, you’re not treating a wound, you’re treating a whole person who has a whole life behind them. “These are people who find it hard to articulate their feelings and articulate their symptoms. “So I’ll also go and sit in on a GP or outpatient department appointment with them, I will sit in on Biala drug screenings, parole hearings, bring them to the magistrate, advocate for them at QCAT. “And it’s when you start advocating for these people that you see how they’ve fallen through the cracks.”

BUILDING TRUST BY LISTENING She said her patients’ histories and current circumstances often make them distrustful of institutions and officials, and many are afraid of being judged or incarcerated, which means they shy away from health care services and hospitals. “You don’t end up on the streets without a story,” Xaviera said. “And I love sitting in the dirt, listening to their stories. “People gravitate toward nurses because they are good listeners, and so I become that real intimate face they can trust, where I can say, ’Hey, I know a doctor who’s going to see you and they don’t care if your pants are soiled, they don’t care if you’ve got no shoes, they don’t care if you’ve got track marks - they don’t care because I don’t care and we’re going to actually get health care for you.” She knows her particular brand of nursing is not for everyone, but says it feels like a natural fit for her. “Even as a student nurse my passion was definitely in service,” she said. “I believe you add value to your own life by serving others, and I find this service incredibly rewarding.” And her service is unwavering. “I say to my patients, ‘I am a bridge you cannot burn, sister. I don’t care if you use again, I couldn’t care less. You could put drugs through your eyeballs… but just know I’ll be here tomorrow. I’ll be here again and again and again’.”

HEALING THE SOUL AND HEART The end goal for the Street to Home project is to get people off the streets, into secure housing, and put them on the path to rebuilding their lives. Xaviera says reunifying families is one of the most rewarding aspects of her job. “One of the most healing things you can give somebody has nothing to do with band aids – it’s the healing of the person, of the soul and of the heart,” she said. “And for these people, reunifying them with family is the absolute

priority for me because if their heart is healed, the sky is the limit.” She recalls the story of a woman she found who was pregnant and living rough. Within a few months of Xaviera finding her the support and networks she needed, the mum was in secure housing, was well enough to breast feed her baby and was maintaining her life and house so well Child Services allowed her elder daughter to stay on weekends. “I looked at her and I thought, ‘I know where you came from and you are amazing’,” Xaviera said. “And I don’t think I even got the blood pressure cuff out for that one.”

DRAWING STRENGTH FROM PATIENTS With a background in trauma and Remote Area Nursing before joining Mater, Xavier has learned to be resilient, but she concedes there are still times when the suffering hits home and it can be hard to stay strong. “I do get teary at times… I also get frustrated with people who’ve not shown love and affection to a child who’s now an adult and is suffering,” she said. “But I also draw strength from my patients. I draw strength from their courage and their stories. “And I feel like they give me just as much as I give them. “Having this job… it’s a gift.” “I sometimes leave work and can’t believe this is my job, I can’t believe I get paid to do this. I really do feel truly blessed.”

Micah’s Street to Home outreach project supports people over 25 years of age who are sleeping rough or experiencing chronic homelessness. It provides integrated support and healthcare services as part of a pathway designed to break the cycle of homelessness.

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T’S SATURDAY EVENING AND YOU’VE JUST PULLED A DOUBLE SHIFT AT WORK.

You come home and are so exhausted all you can do is flop on the couch and reach for the remote. Flicking through the tv channels you come across a medical drama, because let’s face it – there’s one on every time. Ok, you think, I’ll give it a try. It might not be that bad. You watch as Dr McDreamy checks his patient’s pulse in recovery – he’s just performed miraculous life-saving neurosurgery on Joe Blow – and all without putting a hair out of place! He sits patiently by Joe’s bedside, waiting for him to wake, diligently checking obs every few minutes… You roll your eyes. That would never happen in real life – it would be a nurse sitting by the bedside, and even that’s a long shot because there’s rarely time to sit! I’m never watching one of these again! Sound familiar?

A PATRICK DEMPSEY AK MC DREAMY FROM GREY'S ANATOMY

indepth Sadly, it’s no different on the big screen. The film franchise Meet the Parents brings forth gender bias in nursing with the character of Greg Focker. In the movie, Greg’s would-be father-in-law repeatedly introduces him to visitors as “the male nurse” and, clearly unimpressed, delivers the disparaging line, “Could you at least try, maybe, to consider another profession?”

E, COULD YOU AT LEAST TR Y, MAYB N? TO CONSIDER ANOTHER PROFESSIO

As bad as it already sounds, these negative portrayals of nurses have passed beyond your average stereotype of the profession and into the realm of downright demeaning. Controversial tv show Nurse Jackie introduced us to an ER Nurse as a substance abuser who trades sex with a pharmacist for prescription drugs, and is shown to repeatedly violate the Nursing Code of Ethics.

04)

Meet the Fockers (20

Medical shows like Grey’s Anatomy and House may be hugely popular among the broader tv watching population, but those of us who work in health care know that art rarely imitates real life – and there’s research to prove it. A study of popular tv series Chicago Hope analysed the show’s dialogue and found nurses only had 10 per cent of spoken lines, whereas in reality it was based in a hospital where 90 per cent of the staff were nurses.

BEYOND THE STEREOTYPE Most medical shows reinforce the stereotype of nurses as nothing more than hand holders and pillow fluffers. It’s enough to make any health professional cringe, and is one of the many reasons Redlands Registered Nurse Yolanda Bogert isn’t a fan. “It’s hard to watch them when they get so many things wrong,” Yolanda said. “A patient flatlines in a show and you see all the nurses running out of the way so the doctors can step in and do everything. “I remember a scene from House where two doctors were with a patient who needed to use the bathroom, and they both stood him

up and walked him there. That would never happen in a million years!” It’s a bitter pill for nurses to swallow when doctors take centre stage in medical shows and are often portrayed as the heroes of health care, yet back in the real world it’s nurses who are constantly at the bedside of patients. “Most of the case-breaking symptoms discussed in shows aren’t picked up by doctors, they’re picked up by nurses who are the ones with our patients for an entire 12-hour shift,” Yolanda said. “Even when there’s contact time between both professionals the nurse is just standing there behind the doctor like a prop.” Adjunct Fellow at Western Sydney University Dr Roslyn Weaver has conducted research on the image of nursing on medical shows and says the results are not encouraging. “Traditionally popular culture has portrayed nurses as a helper standing on the sidelines, ready to obey the doctor,” Dr Weaver said. “All of them ignore the very real skills and knowledge that nurses must have to do their jobs. It essentially reduces nurses to helpful objects rather than skilled professionals.”

The character of M*A*S*H’s Margaret ‘Hotlips’ Houlihan (inspired by a real life Korean War head nurse, no less!) is simply derogatory to women, with the nurse seen exploiting her looks and romantic relationships to further her career. In the Spanish film Talk to her, the male nurse character (for all his care and attention) ultimately rapes his patient and ends up committing suicide. It’s enough to make a grown nurse cry. University of New England Nursing Professor David Stanley RN has researched the topic, and said the entertainment industry just doesn’t showcase nursing as a profession to aspire to. “It might be because nursing in itself isn’t a glamorous job,” Prof Stanley said. “Nurses deal with the everyday issues of people and that doesn’t always translate into exciting television drama. “It’s contrived drama and a very unrealistic portrayal of the medical world. It often doesn’t represent reality and as a consequence, can really warp people’s perceptions by diminishing what nurses bring to the health profession.”

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Nurses deal with the everyday issues of people and that doesn’t always translate into exciting television drama. Professor David Stanley RN, University of New England Nursing

THE REAL-WORLD EFFECT Aside from its less-than-glowing depiction of nurses, medical shows have also come under fire by academics for conveying misleading information and unrealistic portrayals of the medical world. Researchers at St Joseph’s Hospital and Medical Centre in the United States (Arizona) examined the care and outcomes of fictional trauma patients in Grey’s Anatomy compared to real patients with serious injuries. It was found that not only were people three times more likely to die in Grey’s Anatomy than in real life, fictional patients who survived recovered more quickly and were discharged early. They argued such portrayals could cause unrealistic expectations of trauma care and recovery in hospitals. It gives one pause to wonder if medical shows can also influence how we, as a society, view and value a profession. “It may not happen consciously but… people do learn implicitly while they’re watching tv,” Dr Weaver said. “We obtain information from a variety of sources but if we don’t have the knowledge ourselves then to some extent we go by what we’ve watched on tv.” She said there is a risk that perceptions developed through watching tv can affect everything from patient’s expectations about nursing roles, to the ability to attract new recruits.

“Students involved in our research felt there were some unhelpful images that contributed to a negative perception of nursing in society,” Dr Weaver said. “But there are also many aspects of nursing that don’t get a lot of air time. We don’t see a lot of men in nursing on tv or any specialised nursing fields, or even midwifery. “Usually it’s just a nurse, and they just nurse. That’s typically as much information as you get.” Prof Stanley’s research into how male nurses are portrayed in film showed stereotypical and predominantly negative images persist and can take a real toll on the profession. “The biggest influence of this negative representation of male nurses is in diminishing recruitment. A lot of young men don’t see anything positive or attractive about the profession in films and it can really keep them from considering nursing as a viable career option,” Prof Stanley said. RN Yolanda agrees and said the perception in tv-land that nurses are simply doctor’s handmaidens detracts from the trust people have in nurses’ competence to make care decisions and look after patients properly. “It’s really destructive I think. Lots of people do trust nurses because they consider them to be caring, but it would be really nice to be recognised as a competent professional as well,” she said. “I think it affects the way patients interact with nurses in a big way.

S E V E E P V T T E P Reddit users chimed in on some of the most unrealistic things they’ve watched on hospital shows and movies. Here’s what really gets under their skin. See if you agree! ■ I think seeing doctors drawing blood or sitting at the bedside monitoring a patient bothers me more than the terrible depiction of codes. ■ My favourite House moment was when a patient was seizing, one of the doctors yells out “get me 20mg of Benzodiazepine stat!!”... Which one?? ■ House used to bug me when doctors would be personally wheeling patients down to have their MRI scans. Riiiight. ■ Scrubs is definitely the most realistic that I’ve seen but one time I did see them do an appendectomy on the wrong side!! ■ My absolute favourite has to be in John Q when Denzel’s son is intubated, but speaking to his father. Someone might want to check the placement of that tube. ■ ALL OF THE FREE TIME. I’m binge watching Nurse Jackie and there seems to be ample time to leave the hospital – whether it be for lunch or to hang out in the chapel. ■ In the ER, no doctor EVER has met an ambulance at the back door with gloves on, getting a pressured report while running to the room. Source: Reddit https://www.reddit.com/r/ nursing/comments/29rvni/what_are_the_most_ annoyingly_unrealistic_things/

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W O H S R A L L E T S A – T S IR F S E W H AT C O M OR GOOD OL' A CCUR A C Y? AT WHAT point does the line between fiction and reality begin to blur? Do scriptwriters have a responsibility to portray professions accurately? According to Head of Griffith Film School and veteran scriptwriter Professor Herman van Eyken, there’s an ethical dimension to the work. Yet it’s a delicate balance to deliver a good script that is both engaging and authentic… and it all boils down to doing your homework. “I think both are very important. Authenticity in your storytelling is a means to convince and to make sure your message gets across convincingly,” Prof van Eyken said. “Yet no one is interested in overly predictable characters. As scriptwriters we aim to have multilayered characters that feed the story to make for an intriguing and interesting show.” He said modern-day scriptwriters have to be very careful if they decide to trade accuracy for entertainment. “People have become very good observers - they watch tv every day and see films all the time. You have a very severe audience nowadays who can be very critical so scriptwriters and directors need to do it very carefully and very well. “It comes down to the homework and research a screenwriter does. People can see through something that’s fake and unrealistic, which causes the message to break down and the film or show won’t work anymore.” In order to ensure a realistic storyline, many scriptwriters consult closely with seasoned professionals. Grey’s Anatomy employs a former ER doctor as one of the scriptwriters for the show, and even goes so far as to film the hands of actual surgeons depicting surgeries.

You’ll often hear somebody receiving education from a nurse and then they wait to ask the doctor as well. It’s demoralising for nurses. “It’s so important to have positive and accurate portrayals of people in different roles. It can really alter public perception and in turn affects the way nurses get treated and the experiences we have.” But there can be an upside to medical dramas. The shows have proven to be a positive force in building a sense of professional identity, particularly among nursing students.

Professor Herman van Eyken, Head of Griffith Film School and veteran scriptwriter

“In watching these shows students actually start to feel more like an insider and develop a connection to the profession through learning – hopefully not in a negative way!” Dr Weaver said.

Prof van Eyken said consultancy is something that happens on a regular basis, and those who take their jobs seriously as producers and writers always consult with relevant professionals.

“People have also started to use medical shows in university curriculum as teaching tools. So even if the shows are terrible, they’re being used as case studies for students to learn what not to do.

“We also see it with writers of books, the more they know the better. If you write for something that is situated or placed in the medical world then you’d definitely have a consultant within your team to guide you,” he said.

“There’s a lot to be learned from them about ethics and patient care so I think there’s definitely that positive element.”

That’s not to say it will be 100 per cent accurate — it is fiction after all. “It’s important to remember medical shows are not made for a niche audience of nurses or doctors. But if it’s riddled with inaccuracies it should be checked thoroughly so they aren’t to the detriment of the story and turning viewers away. “Credibility is at the heart of everything and I advise my students to consult at all levels to ensure an authentic and realistic story.” Professor Herman van Eyken is the Head of Griffith Film School. He has a background in scriptwriting, producing and directing, and has directed more than 190 films. His research interests include film policies, cross cultural collaboration and film training needs for professionals.

IS THERE REALLY CAUSE FOR CONCERN? A review of several studies about the effects of medical shows on people’s perceptions returned mixed results – an indication that audiences don’t passively believe what they watch and can very much draw the line between what’s real and what’s not. “Overall I don’t think anybody should worry about it too much. There’s a possibility that they can contribute to negative or inaccurate ideas about nursing in society, but once somebody is in the healthcare system I don’t think these ideas would persist for long,” Dr Weaver said. While nursing stereotypes can really grind our gears, there are things we can do to counter any negative perceptions, including simply having conversations to raise awareness.

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HERE'S WHAT YOU HAD TO S AY ABOUT THE MEDICAL SHOWS ON OUR SMALL SCREENS TODAY... GM In these shows any interaction that doctors are supposed to have with patients is actually what nurses do. Pretty hard to make five minutes at the end of the bed meaningful drama!

ER (1994 - 2009)

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Nurse Jackie (2009 - 2015)

TS I don’t watch medical dramas because of the way they depict nurses. The way we are portrayed is how people get the idea that we have all the time in the world to make that midnight coffee, that we’re just there to do the patients bidding, marry a doctor and never question anything the doctor says because they are the professional... Like · Reply

NS It is a TV show. Give people credit. Thinking that our clients don’t know the difference between their own experience and something on the idiot box is selling our clients short. Like · Reply

Yolanda said she was grateful to the QNMU for putting the topic up for discussion on social media. “I think having those conversations and making people aware what’s on tv isn’t actually real is important,” she said. “The QNMU is already putting forth accurate and positive portrayals of nurses and showcasing what nursing is really about.” Prof Stanley encouraged nurses to turn to social media as a platform to deliver positive messages about nursing. “We can’t control what’s shown in a film or on tv but we can control

to some extent what we put on the internet or on social media, what we watch, and what we get our colleagues to watch,” he said. “The social media world is a platform for everyday nurses to make a difference. And there are already lots of nurses posting positive messages and trying to shape a more positive perception of their profession.” At the end of the day – and if Grey’s Anatomy is any indication – it doesn’t look like these shows or movies are going anywhere, so we may be better off just taking them for what they are… works of fiction.

TI Every medico-drama ever under values and under plays the role of nurses and midwives in the modern environment. As an RN friend said - doctors might “create the plan” but it’s the nurses carrying out, evaluating the plan and adjusting the plan as the patient requires. Like · Reply

VV We nurses do what doctors are portrayed to do on TV. We are the ones that care and monitor patients and have to call the doctor when something needs review. Their patient time is fleeting! Like · Reply

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AGED CAREâ&#x20AC;&#x2122;S RACE TO THE BOTTOM

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PLEASE NOTE: THE QNMU has received an influx of information regarding Blue Care facilities in the wake of unprecedented staffing cuts. However, Australian aged care residents are experiencing unnecessary pain and premature deaths in a range of aged care facilities throughout Queensland and nation-wide. This article is a case study largely based on the experiences of aged care nurses and residents in Queensland Blue Care facilities. There is no doubt similar circumstances are occurring in aged care facilities run by a range of providers. But the extreme lack of transparency makes it near impossible to gather this detail unless residents and staff come forward. The QNMU has received numerous calls regarding Blue Care facilities in direct response to corporate cuts made since August last year.

HE EXTERIOR of the building at 192 Ann Street in the CBD is a wall of granite and glass. Those entering do so via an external escalator that glides two storeys from the footpath to the marble desk of a corporate concierge.

Inside, UnitingCare and Blue Care share a floor with aeronautical giant Boeing. Their offices are rumoured to have toilets with heated seats and in 2014 The Australian newspaper reported the not-for-profit had taken on 6000sqm of floor space at $600 per metre – or pre-renovation gross face rent of $3.6 million a year. Journalists invited to a QNMU press conference on UnitingCare’s attempt to remove penalty rates from aged care nurses were gobsmacked. “This is where they’re based?“ one TV journalist hissed outside the building.

t a k c a b s t i h Blue Care aims l c t u c g n fi f a st Blue Care denies claims off breaches at QLD aged caree facility The Weekly SOURCE, 16 January 2018

“Why the hell did Blue Care move here when they could have used that money to help old people?“ a male journalist asked. “This is bulls**t.“ The media were shocked. They thought Blue Care was synonymous with quality aged care. There was a time when it was. But in 2016 something changed. In that year, on February 9, then

Blue Care’s attack on staff ‘offensive’ Bundaberg News Mail, 26 January 2018

Concerns over Blue Care cuts

South Burnett Times, 30 January 201 8

Blue Care announces job redundancies in Toowoomba Toowoomba Chronicle, 26 October 2017

“And they reckon they can’t afford to keep their nurses?“ Other journalists felt the same way. Ushered outside, and watched over by the building’s suited security guards, they whispered among themselves.

ber 2017

ail, 29 Decem

ourier M TThe Co

UnitingCare CEO Anne Cross announced “a new UnitingCare“ was coming.

customers to deliver the care and support they need will be critical in the future…

In a media release distributed on that date, Ms Cross stated: “The new UnitingCare will be characterised by business streams organised to respond to the highly competitive aged care and disability sectors in south east Queensland…“

“The proposed new structure allows us to be on the front foot; to truly be a customer-led organisation.”

She continued: “UnitingCare Queensland knows there will be a transformed world of health, aged and community care and that working even more closely with our

Since then, UnitingCare and Blue Care have stripped aged care nurses from around seven Queensland aged care facilities. As Blue Care management rolled into town to

But the reality seems quite different.

indepth make the cuts, management placed advertisements on Seek and other job websites for largely untrained people to apply for positions as Personal Carers (PCs) — at the exact facilities where the nurse cuts occurred. It happened first in Bundaberg in August 2017, with an estimated 11 of around 17 Enrolled Nurses (ENs) axed across three Blue Care facilities. The sites included Blue Care’s Pioneer Lodge where the QNMU was recently advised an elderly woman was left with a broken hip for 24 hours due to chronic under staffing. The cuts continued under a veil of secrecy, with UnitingCare Queensland now believed to have rolled out cuts in Bundaberg, Townsville, Toowoomba, Maleny, Mareeba, Kingaroy, Rothwell and Bli Bli. It’s feared they will continue at Blue Care’s 126 aged care facilities state-wide. In addition, Blue Care announced they would transfer the administration of complex medications to PCs — many of them newly hired in the regions where the cuts occurred. “It’s shocking, absolutely shocking,“ said a former Blue Care staff member. “Not only have Blue Care made the cuts, but they’ve blamed any resulting problems on the staff that remain. In some places that’s less than half the Enrolled Nurses that used to be on the roster. “But we wouldn’t know exactly because Blue Care are pretty tight with the facts. “The nurses who survived are working hard to try and provide residents with the care they need but there’s no time for proper washing or feeding, let alone time to have a chat or call a family member if there’s a problem or issue. “The nurses are just trying to keep everyone alive and they’re burning out.“ The QNMU has received numerous calls and emails from Blue Care staff, both past and present, saddened and shocked by the changes.

Staff from a range of aged care facilities throughout Queensland and Australia have contacted the QNMU to discuss chronic understaffing at the hands of various providers nation-wide. There is no doubt the issue occurs at many of Australia’s 2400-plus privately-run aged care facilities. Aged care staff are deeply worried for their residents. They are also over worked, tired, depressed, stressed and angered by their inability to publicly speak out against conditions at work and Australian aged care providers. They would like to see Federal aged care legislation changed so providers are unable to reduce staff to dangerously unsafe levels. At the moment, there is little or no regulation of aged care staff numbers in any aged care facilities Blue Care or otherwise. Aged care staff said they often felt blamed for the poor level of care now available in some Blue Care and other aged care facilities. “Some people, including Blue Care management, are blaming staff left in the wake of these cuts for the problems that are occurring,“ a staff member said. “They feel guilty, but they aren’t to blame because it is the system that is deeply flawed and failing our elderly. “It’s very important to aged care nurses that the public are aware they care, that people know they love their elderly residents as opposed to being the ones neglecting them. Blue Care and UnitingCare management, among other providers, have made cuts and they should be held accountable for the situation they have created.“

DAMNING REPORT Momentum is gathering for change in aged care. Aged care nurses, family members, the QNMU and the media have repeatedly called attention to the issue of chronic understaffing and poor regulation in aged care. This scrutiny has forced regulatory bodies to take some real action.

In February, the Australian Aged Care Quality Agency’s (AACQA) released damning findings related to chronic staffing and poor treatment of residents at Blue Care’s Pioneer Lodge facility in Bundaberg. Similar findings were also released for facilities run by other providers elsewhere in Queensland. The AACQA’s report found Blue Care’s Pioneer Lodge failed 13 of 44 quality standards including clinical care, medication, pain management and nutrition. “The home does not ensure all care recipients are as free as possible from pain,“ the report stated. “Management is not able to demonstrate care recipients receive adequate nutrition and hydration. Staff practices do not support the safe and correct administration of medication.“ The list continued and media published Blue Care’s failings nationwide. But there are issues within Blue Care and other Queensland aged care facilities that remain unaddressed. This includes a “culture of fear“ within facilities state-wide. Staff and relatives have repeatedly stated they felt they could lose their jobs, references or beds if they spoke out against their aged care provider. “I get calls from nurses and relatives who desperately want to tell their stories but fear they will either lose their job or their Mum will get kicked out if they expose the facility to scrutiny,“ one QNMU organiser said. “People live near these facilities, they have lives and families and they can’t just up and leave if they lose a job or their spot. “Aged care providers know they have the power and that’s why the culture of fear and intimidation works to keep people quiet.“ But people are talking. The QNMU has heard numerous stories about how cuts and chronic systemic understaffing right across the aged care system are affecting residents.

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Complaints recently received from Blue Care staff and residents in the wake of recent cuts, include: ■ claims an elderly Blue Care resident fell and was left to lie with a broken bone for 24 hours ■ claims of residents with “terrifying“ weight loss due to the poor quality of Blue Care food ■ claims residents have suffered unnecessary pain due to poor medication administration ■ claims family members have been forced to clean faeces and urine from residents left for long periods in their own waste ■ claims residents with bed sores and other wounds placed at much greater risk of infection or falls because their rooms go uncleaned as cleaners’ hours have been cut ■ claims Blue Care cleaners no longer work weekends ■ claims residents are regularly left without water or assistance despite calling and buzzing for help

■ claims some hallways are constantly cluttered with wheel chairs and other equipment because remaining staff simply don’t have time to return frequently used equipment to a safe position ■ claims residents unable to move independently are regularly forced to sit for hours with nothing to do ■ claims residents’ verbal and electronic calls for help or assistance regularly go unanswered ■ claims up to 60% of Enrolled Nursing staff has been cut in some areas ■ claims Blue Care staff who remain simply cannot meet residents’ demands or basic needs such as feeding, toileting and showering ■ claims resident numbers have increased as staff numbers were cut ■ claims resident fees have not been reduced despite reduced levels of care. The list continues.

IT’S VERY IMPORTANT TO AGED CARE NURSES THAT THE PUBLIC ARE AWARE THEY CARE, THAT PEOPLE KNOW THEY LOVE THEIR ELDERLY RESIDENTS AS OPPOSED TO BEING THE ONES NEGLECTING THEM.

indepth POOR NUTRITION AN ONGOING ISSUE FOR RESIDENTS Staff have stated Blue Care meals, made at state headquarters and shipped and defrosted, contain meat so cheap and tough it can’t be chewed. It’s also been reported residents consist on a diet of packet potatoes and tinned food and rarely receive fresh fruit or vegetables. “It’s got to the point that when we take Mum out, she orders a full bowl of mashed potato and basically licks the bowl,“ the daughter of a Blue Care resident told the QNMU. “We know it’s not going to be fivestar care, but surely they could use chicken bones and some veg to make a nice healthy soup and serve it with a bread roll. Or occasionally give them a potato that hasn’t come out of a packet or soup that’s not from a can. “When Mum went to hospital she wanted to stay because the food was so good. Now that’s saying something.“ A Blue Care nurse, who didn’t want to be identified, said staff were devastated. The woman, who has worked with the provider for a long period of time, said there was a time when Blue Care meant quality.

UNITINGCARE AND BLUE CARE HAVE STRIPPED AGED CARE NURSES FROM AROUND SEVEN QUEENSLAND AGED CARE FACILITIES.

“Those days are gone,’’ the woman said. “We love our residents and we love what we do. But there aren’t enough of us here to do even the simple things like have a chat. “There are kitchens on site but they certainly never get used to actually cook, it’s all shipped in frozen then defrosted and reheated and often it’s swimming in water and basically inedible. “That might not sound like much but if you’ve ever spent a week in hospital and been served some ordinary food you can imagine that stretching ahead literally until the day you die. It’s unkind and it’s depressing.“ At some facilities, relatives are banned from taking food for residents. A recent conversation with an aged care nurse involved tears and frustration. The woman desperately wanted to speak out, but simply couldn’t risk losing her job. “I would love to walk into the nearest newspaper and tell everyone just how badly Blue Care and UnitingCare Queensland are treating their residents,“ the woman said. “But I’ve got family here and bills and a mortgage and there aren’t a lot of options for work. Besides my residents need me because I can

tell you the halls are empty since Blue Care took a torch to the roster and got rid of anyone with any real experience.“

ONGOING CAMPAIGN The QNMU continues to work closely with aged care staff, residents, relatives and the media to ensure the public know where aged care cuts are occurring and how those cuts are affecting both residents and staff. The media continue to investigate and run stories regarding levels of care in aged care. They regularly call the QNMU for updates and are deeply concerned for the elderly and aged care staff in their communities. We ask the many aged care nurses, staff, residents and relatives who have reported elder neglect from a range of aged care providers to please stay in touch. The QNMU is committed to protecting those who share their stories and ensuring the media and community are aware of issues in aged care. Queensland Premier Annastacia Palaszczuk has committed to introducing nurse-to-resident ratios in public aged care facilities. And the QNMU will continue to campaign at a federal level for similar laws in the private sector.

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OUR NATIONAL CAMPAIGN TO #FIXAGEDCARE IS RAMPING UP T

HE SITUATION IN AGED CARE AFFECTS US ALL.

They are our parents and grandparents, people who looked after us and loved us, but now many of them — especially those in need of high care — are left unfed, unwashed and even in soiled nappies for hours... all because there aren’t enough aged care staff. Over the past 13 years, chronic understaffing has seen a 400% increase in preventable deaths of elderly Australians in aged care, with hundreds dying from falls, choking and suicide. Overworked nurses and care staff do the best they can in impossible circumstances, but they are run off their feet and can’t provide the care they know they can deliver. Meanwhile, aged care providers racked up over $1 billion in profits last year while cutting staff.

OUR CALL FOR RATIOS IN AGED CARE Currently, residents are receiving about 2 hours 50 minutes of care per day from nurses and carers, which is nowhere near enough time to shower, toilet, medicate, dress, feed, roll over, and move, let alone talk to an aged care resident.

IT’S TIME FOR ACTION The upcoming May budget and federal election is our chance to get the federal government to take action. Our campaign will officially launch in May on Labour Day, but in the meantime you can sign up to the campaign and join thousands of supporters across Australia. Visit www.MoreStaffForAgedCare.com.au and join the campaign Join the aged care conversation on Facebook — www.facebook.com/ MoreStaffForAgedCare This is a campaign for all QNMU members, regardless of what sector you work in. So get ready to stand up and speak out in support of our aged care nursing colleagues.

The evidence shows residents should receive a minimum of 4 hours 18 minutes of care per day — one and a half hours more than they are getting now. Australia has strict staff ratios for childcare, which is as it should be. But there are no ratios for aged care and no laws to ensure our elderly get the care they need. It’s a crisis that shames us as a nation. Our aged care system has been ignored by federal governments for far too long.

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The pregnancy journey and beyond Your rights at work

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ANAGING a demanding career and having a baby are two of the most significant challenges in our lives – and when the two collide, the term ‘work/life balance’ takes on a whole new meaning.

For decades Australian unions have campaigned for more family friendly working conditions, with a particular focus on provisions that support parents during the early years of a child’s life and encourage continued engagement in the workforce. Our society no longer accepts that women, who are still overwhelmingly the primary carers, must choose between a career or raising children, and being a working mum is now the norm rather than the exception. But for all the progress we’ve made, there remain gaps in law, employer attitudes and business models that suggest we’ve still got a long way to go.

Working in female-dominated health professions, nurses and midwives are in many ways, ahead of other workers when it comes to securing parent friendly working conditions, simply because the issues were on our radar much earlier. Even so, the QNMU assists hundreds of members every year who face problems with their employer over maternity-related issues, whether it’s during their pregnancy or returning to work following leave.

The right to a safe workplace Both the Industrial Relations Act and the Fair Work Act require pregnant employees to be transferred to a safe working environment. For nurses, this may be necessary if you normally work in radiation or x-ray, for example. This is one area where we often see resistance from employers, who argue it is too expensive or too inconvenient to transfer a nurse or midwife to another area. The reality, however, is that you are entitled to be paid your normal salary until you start maternity leave if a safe job is not made available.

Attending appointments Both state and federal legislation also provide for prenatal leave, which allows pregnant women to take unpaid time off work to attend health appointments or if they are suffering from a pregnancy-related illness. Under the Queensland Employment Standards and the National Employment Standards, eligible employees are entitled to ‘special maternity leave’ for this purpose. Employees may either use their personal leave for this purpose or take (protected) unpaid leave.

Maternity leave Then there is the maternity leave itself. Unpaid maternity leave was first introduced to Australia in 1973 and six years later female employees in the Commonwealth public sector were awarded paid maternity leave. It was not until 1990 that the thennamed Australian Industrial Relations Commission ruled that 51 of the 52 weeks of unpaid parental leave could be taken by either parent. In 2011 the federal government introduced Australia’s first universal paid parental leave scheme, which entitles parents who are the primary caregiver of a newborn or newly adopted child to be paid the minimum wage for 18 weeks following the birth or adoption of their child. Your employer may also offer their own paid maternity leave scheme, in which case you are entitled to take this in addition to the allowance under the government scheme. Even though the government scheme is relatively new, unions and other groups have had to fight to protect it over the past few years as the Liberal government tried to wind it back. They claimed parents who accessed both the national and employer schemes were ‘double dipping’.

While most entitlements are straight forward, others are open to interpretation giving some employers an opportunity to try exploiting loopholes in the system. And even with all the rights we now have, there are still some significant gaps in our legal system you might be surprised to learn.

What are your rights? The following information provides a brief overview of various workplace maternity entitlements. We strongly encourage members requiring advice and further information to contact the QNMU.

indepth Meanwhile paid paternity leave (or paid spousal leave) still does not exist as a basic entitlement. This means secondary caregivers — who are largely fathers — are unable to take paid time off work to care for their newborn baby, an inherently sexist gap in the system that disadvantages both men and women by creating an imbalance in parenting from the outset.

you cannot perform the same duties part-time is deeply flawed. Not only can this result in significant pay cuts, but it also means the nurse or midwife loses their seniority – and there is no obligation for the employer to reinstate the employee in their original position once their flexible working arrangement ends.

Breastfeeding, lactation breaks

Returning to work – flexible working arrangements

Employees are also entitled to breastfeeding and lactation breaks during work hours.

But it’s what happens when a parent returns to work after parental leave that poses the most problems – and it’s something the QNMU frequently assists members with.

Employers must provide a safe and clean space for breastfeeding and lactation breaks. Failing to do so can leave them open to a discrimination suit.

Both the state and federal Acts provide employees with the right to request flexible working arrangements. This may involve parttime work, right to work flexible start and finish times, or a particular shift pattern (to name a few).

Employers may also be breaching anti-discrimination laws if they fail to allocate consistent shifts for certain periods of time that allow childcare to be provided.

The employer does have the right to refuse your request for a flexible work arrangement based on reasonable grounds, such as business grounds, cost considerations, and the impact on other employees.

At a broader level, there’s still a lot of work to be done to shift how Australians – in particular employers – approach things like flexible working arrangements.

But unlike the state system where an employee can challenge this refusal in the Queensland Industrial Relations Commission, private sector employees cannot challenge their employer’s refusal in the industrial tribunal – it’s simply a dead end.

Returning to work – classification and pay When returning to work, you should return at the same classification level and pay rate you worked prior to taking maternity leave. A common problem QNMU members face is managers stating an employee must relinquish their higher classification level if they want to return part-time. This is not the case. Higher classification levels have been achieved through a merit process and an employer suggesting

That’s everything, right? Well, no.

Comments from employers such as “you should just put them in day care” or “flexible working arrangements… that’s just union stuff” may seem extreme, but believe it or not these are some of the comments managers have said to QNMU members in the past. Executive Director of family campaigning organisation The Parenthood, Jo Briskey, said such comments were indicative of Australia’s workplace culture which still undervalued the importance of getting the first few years right for kids. “The idea that you can’t make it work is a complete fallacy,” Ms Briskey said. “You obviously can’t make it work if the expectation is that work and life are separate. “(It) worked when there was always a parent staying at home, but that’s not the case anymore and in many instances it can’t be the case because the family needs both parents working.”

And if your employer has ever said to you, “I never had family friendly rostering in my day so why should you get it?” then you’re not alone. Ms Briskey said her response to this kind of comment is always, “No you didn’t, but don’t you wish you had?” “Why would we deny any new parent the opportunity to get it right?” she said. “That kind of attitude just reinforces the idea that the only way to have a child is if you have a stay-at-home parent, usually the mother, and that’s just not how it should be.” As recently as 2013 a Kronos study of 500 Australian employers found 38% preferred male workers, and 40% preferred workers without children. But attitudes are gradually shifting. Ms Briskey said more and more larger employers were starting to recognise the need to embrace more family friendly workplace policies. “Employees are demanding it, and businesses are slowly realising they’re missing out on a huge chunk of talent in terms of not being able to attract and retain women,” Ms Briskey said. “Younger men who are becoming parents are also wanting to shift that culture that they are the ones who work full time and don’t take any time to be with their kids. “They want to change that and are demanding it of their employers.”

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MAKING CHANGES in a maledominated industry

HEN LOOKING at the nursing and midwifery professions in isolation, it is easy to focus on the work that still needs to be done to address gaps in parental leave laws.

But it is also interesting to look at other professions to see just how far we have come, particularly compared to industries only now seeing a rise in female workers. Take the rail industry as an example. In Queensland Rail, female guards make up 20.5% of the workforce. For Locomotive Drivers (Class 2), just 5.3% are female. While these percentages are only small, they are gradually increasing. Industrial Officer Carla Jones from the Rail, Tram and Bus Union (RTBU) said rail organisations previously never had to deal with issues around maternity leave because they had historically employed only men. Now the RTBU receives at least one member request for representation a month for return-to-work issues.

“The rail industry has got this drive on to recruit more women,” Carla said. “It’s great to see that kind of thing happening, but what we’ve since found is that the way it’s been implemented is awful. “Men have always traditionally negotiated these agreements, so why would they think about things like lactation breaks or returning from maternity leave or flexible working arrangements?” Carla recalled one woman who worked as a train driver at Aurizon who faced losing up to 40% of her salary when she returned from maternity leave. “Aurizon have some really good maternity leave provisions — they’ll pay you 16 weeks then you can get the government entitlement on top of that. “But this woman came back to work and there was no provision in the EA for what would happen when she couldn’t work the full shifts.

“So she asked for specific days and hours. Management said that was fine but she wouldn’t be entitled to any aggregate pay, which would have been a 40% reduction in her salary. “So we ran that case in the Commission and she won.”

Employing women? Accommodate them For one rail traffic guard, returning to work meant having to stop breastfeeding four months prematurely. “When I was off on maternity leave I knew I had to come back when my daughter was about six and a half months old purely because I didn’t have the leave to stay off for 12 months,” said the RTBU member, who wished to remain anonymous. “I originally wanted to breast feed for 12 months. “The issue was that although I was able to pump and still work at the same time, the job cards that we

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work didn’t accommodate for our pumping breaks, so I was told I would have to do administrative work in the office. “When I came back to work they didn’t have any work specifically for me — if they had some filing at any particular time, they’d get me to do it, but nothing was set in stone.

...it was about sending a broader message to women aspiring to work in roles that may be typically held by men. RTBU Industrial Officer Carla Jones

“It was a bit demeaning… you’re travelling on trains and you’ve got all this responsibility, and now because you’re feeding your child you’re doing admin work that’s left over because no one else wants to do it.”

“So what happens when a train gets delayed? We don’t get paid for pump breaks, so it was a choice between working back late or using my lunch break, so I chose to do it in my lunch break.”

The member tried negotiating with management, suggesting she work half a job card then have a half hour pumping break before doing office duties in the afternoon.

The member said while she understood accommodating pump breaks for women in roles like train guards and drivers was difficult, it was something that needed to be worked through if employers wanted to increase their female workforce.

“The response from management was that they couldn’t incorporate job cards while I was pumping.” And while the member took up the admin role, there were still other hurdles to overcome.

“I know it’s a massive deal, but once you knuckle down and get it all sorted the first time, you could make it work,” she said.

“The room that was available to me for pumping was a few train stations away from the office,” the member said.

“They’re pushing for more female guards and drivers, so I’m not going to be the last to have to deal with this.”

Sending a message to women Eliminating the obstacles many women face when returning from maternity leave goes to the heart of the kind of workforce we want for all women. Carla Jones said overcoming the hurdles was bigger than the short term – it was about sending a broader message to women aspiring to work in roles that may be typically held by men. “You’re going to have kids who think the world is a better place and they can go out and do that job,” Carla said. “As a female child, you can see your mum driving a train and think, I can do that and still be a parent as well.”

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UP, UP AND AWAY: Profits soar for health insurance providers OPINION BY DR LIZ TODHUNTER, QNMU RESEARCH AND POLICY OFFICER

HILE both health insurance premium costs and out-of-pocket expenses have continued to rise so too have the profits of private health insurance providers.

In the year to 1 April 2017, health insurers made post-tax profits of $1.3 billion, an annual increase of 18 per cent. According to the industry regulators, these profit levels are ‘appropriate’ because the regulators have greater insight into data and reporting. This level of profit may be ‘appropriate’ for shareholders, but even if the health insurance industry needs to be in a strong prudential position to meet its obligation to policy holders, it is hard to reconcile the continuing increase in premiums. Each year, the Minister for Health approves applications from health insurers to increase premiums unless doing so is contrary to the public’s interest – a threshold the relevant legislation does not define and remains untested. It seems private health insurers win on all fronts. Not only do they post significant profits, the federal government also subsidises the scheme through $6 billion of rebates each year to private health insurance policy holders. No other insurance scheme receives such preferential treatment. Despite the initial promise that privatisation of Medibank would put downward pressure on insurance premiums through

increased competition, this has not been the case. There is a legitimate role for private health insurers and providers but at the moment consumers are faced with such an array of choices and large-scale advertising that companies such as Compare The Market exist to steer them through the complexities of these products. The market is setting a fast pace that may become unsustainable in light of the preference to reward shareholders at the expense of policy holders. Like any form of insurance, private health insurance is centred on risk management. Consumers decide whether the costs of insurance are worth mitigating the expense of potential illness or injury and the choice in care.

This may be more meaningful if Australia did not have a world class public health system funded by taxpayers. These same taxpayers are now caught up in the private health insurance world of high premiums in addition to the Medicare levy. To address affordability, the federal government must decide whether approving annual premium increases that are currently above inflation is in the public interest or to increase the rebate. If it does not act on either front then inevitably private health insurance holders will start to change their cover or exit the market. A significant enough proportion of these people would leave the remaining members to carry the risk of the entire pool, and thereby increase premiums for all. Given the amount of profit private health insurers are posting, it would make sense to freeze current premiums. No doubt the insurers would have a strong response to such a move! It is past time for the federal government to review the private health care rebate and the annual price adjustment of premiums with a view to resourcing a fairer public health system that provides services to all Australians based on clinical need and not our ability to pay.

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QNMU supporting your

CPD Roll up, roll up, there is a new show in town! YES, it’s the QNMU’s hot new CPD portal – exclusively for members. Launched in early February, our new portal is packed with fantastic resources to help you meet the CPD requirements for your registration. There’s webinars with reflective questions, heaps of publications and articles, a full program of free and heavily subsidised courses, a range of scholarship opportunities… and we have lots more planned. You can also keep tabs on your CPD hours with our counter and online record of CPD, plus, (and this is a real money saver!) you get FREE access to the Australian Nursing and Midwifery Federation’s clinical CPE site and courses. We believe offering an unrivalled suite of CPD content and activities goes well beyond simply meeting the NMBA registration criteria, it’s about helping nurses and midwives reach their professional potential and developing depth in the nursing and midwifery workforce in Queensland. “Having a nursing and midwifery workforce of lifelong learners, who are routinely picking up new skills and new knowledge is really healthy not just for a nurse or midwife’s own professional growth, but for the good of the community they look after,” QNMU Secretary Beth Mohle said. “And the great thing about our CPD offerings — particularly now with our new portal and free member access to the ANMF Clinical CPE — is that it is tailor made by people who know nurses and midwives best, who are keenly aware of their local work environments and local practices and standards.” So what are you waiting for?

Share your thoughts! Tell us what you think about our new CPD Portal by joining the conversation on Facebook!

Know your CPD requirements If you are an Enrolled Nurse, Registered Nurse or Midwife you are required by law to complete a minimum of 20 hours of CPD per registration period in order to meet the registration standard required for you to practice. If you are registered both as a nurse and a midwife, you must complete the required amount of CPD for both nursing and midwifery. Some nursing and midwifery roles also require extra hours of specific CPD. ■ Nurse practitioner endorsement: 10 additional hours relating to prescribing and administration of medicines, diagnostic investigations, consultation and referral ■ RN with scheduled medicines endorsement: 10 additional hours relating to obtaining, supplying and administration of scheduled medicines ■ Midwife with endorsement or notation: 10 additional hours relating to context of practice, prescribing and administration of medicines, diagnostic investigations, consultation and referral. For more information visit the NMBA website.

Logging into the QNMU CPD Portal If you are not already logged in to your member account, you will be asked to enter your username and password. Your username is the email address you have registered with the QNMU. If you’re having trouble logging in, contact Member Connect on (07) 3099 3210 or 1800 177 273.

Visit www.qnmu.org.au/cpd and have a look around.

FR EE

New CPD portalâ&#x20AC;¦ FREE for QNMU members! www.qnmu.org.au/CPD QNMU member Nerea Urquiza, RN, from Queensland Fertility Group

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TISSUE ADHESIVE FOR VASCULAR ACCESS DEVICES: who, what, where and when BY AMANDA CORLEY AND KAYE ROLLS, SCHOOL OF NURSING AND MIDWIFERY, GRIFFITH UNIVERSITY; THE ALLIANCE FOR VASCULAR ACCESS TEACHING AND RESEARCH (AVATAR) GROUP, MENZIES HEALTH INSTITUTE QUEENSLAND; FACULTY OF NURSING AND MIDWIFERY, SYDNEY NURSING SCHOOL, THE UNIVERSITY OF SYDNEY.

This article presents the results of a review into clinical trials which looked at the effectiveness of tissue adhesives (TA). ASCULAR access devices (VADs) are required by most patients, however too many devices fail before therapy is complete.

STUDY/SETTING

FAILURE RATE

PIVC Marsh et al 85 Adults; general wards

TA - 14% (3/21) SPU - 38% (8/21) BPU – 25% (5/20) SSD – 22% (5/23)

2. reducing micro-motion and pistoning within the vessel

Bugden et al 360 Adults; emergency department

TA + BPU – 31/176 BPU – 52/184 95% CI -18% to -2%; p=0.02

3. maintaining the VAD within the vein

Peripheral arterial catheter

4. minimising skin irritation.

Edwards et al 224 Adults; intensive care

TA + SPU – 11% (6/56) SPU – 21% (10/47) BPU + SPU – 5% (2/43) SSD + SPU – 16% (8/49)

Reynolds et al 123 Adults; intensive care

TA + SPU – 6.3% (2/32) BPU – 13.3% (4/30) SPU - 20% (6/30) SSD + SPU – 16.1% (5/31)

Effective dressing and securement techniques reduce device failure by: 1. preventing site contamination

Tissue adhesives (TA) could potentially fulfil these requirements due to their purported ability to ‘seal’ the insertion site, to prevent ooze and entry of micro-organisms, bacteriostatic properties and high tensile strength. This review aims to summarise the existing evidence to inform clinical practice. Only eight randomised controlled trials (RCT) evaluating the effectiveness of TA as an adjunct to other dressing and securement methods to prevent device failure were identified (please refer to table).

Review summary: ■ For peripheral VADs in adults, TA appears to be useful but there were a small number of skin irritations related to TA use in all trials. ■ TA appears to reduce failure in CVADs in adults and children when used as an adjunct to suturing. ■ No infections were noted across any trials Take home messages: ■ The evidence base is still relatively small, and large RCTs are lacking for both peripheral and central VADs. ■ The complexities of TA use and skin complications imply that where facilities are considering trialling TA they should implement a tailored plan that incorporates a trans-disciplinary approach to education and practice. References Corley, A., et al. Br J Nurs, 2017. 26(19): p. S4-S17. Marsh, N., et al. J Vasc Access, 2015. 16(3): p. 237-44. Bugden, S., et al., Ann Emerg Med, 2016. 68(2): p. 196-201. Edwards, M., et al. Crit Care Resusc, 2014. 16(3): p. 175-83. Reynolds, H., et al. Aust Crit Care, 2015. 28(3): p. 140-8. Rickard, C.M., et al. Journal of Critical Care, 2016. 36: p. 35-42. Chan, R., et al. Trials, 2017. 18:458 Kleidon, T.M., et al., Journal of Vascular and Interventional Radiology, 2017. 28(11): p. 1548-1556, e1. Ullman, A.J., et al. BMC Cancer, 2017.

CVADs Rickard et al 221 Adults; non-tunnelled jugular lines; intensive care

TA + BPU no suture – 17% (4/23) TA + BPU + suture – 0% (0/30) BPU + suture – 4% (2/55) AD + Suture – 2% (1/56) SSD + SPU – 7% (4/55)

Chan et al 121 Adults; PICC; medicals, surgical and oncology

TA + SPU – 9% (3/35) SSD+ SPU + CHG patch – 10% (4/39) AD + CHG patch – 20% (1/5, arm stopped prematurely) ISD + CHG patch – 7% (3/42)

Kleidon et al 95 paediatric; PICC; medicalsurgical

TA + BPU + suture – 3% (1/32) SSD + BPU – 6% (2/32) ISD – 6% (2/31)

Ullman et al 48 paediatric; tunnelled cuffed CVAD; oncology and medical

TA + BPU + suture -0% (0/12) SSD + BPU + suture – 8% (1/13) ISD + suture – 17% (2/12) BPU + suture – 0% (0/11)

AD, absorbent dressing; BPU, bordered polyurethane dressing; CHG, chlorhexidine gluconate; ISD, integrated securement dressing; PICC, peripherally inserted central catheter; SPU, standard polyurethane dressing; SSD, sutureless securement device

REFLECTIVE QUESTIONS 1. How would TA fit into your current dressing and securement practice? 2. What factors would you consider before using TA, particularly as skin complications have been noted? 3. Is there sufficient evidence to support TA use for VADs in your clinical area? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

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Infection control during workplace renovations EMBERS have approached the QNMU seeking advice around potential health and safety issues during building renovations.

Many of these requests for advice have coincided with the rollout of integrated electronic Medical Records (ieMR) in various public hospitals. The need to continue providing clinical services while buildings undergo renovations raises several issues about the responsibility employers and management have when contemplating building work and the impact it might have on staff and patients or residents. Firstly, members should be aware of their right to be involved in the planning of any building activity that has the potential to affect their health and safety, or that of their patients. The Work Health and Safety Act 2011 provides requirements for staff to be involved in consultation around how and when building activities should occur, if it is likely staff will be directly affected. Members can find these obligations at Section 46 – 49 of the Act. An employer can be prosecuted and fined if consultation does not occur. Practical guidance on how an employer can meet their obligations are contained in the Work Health and Safety Consultation and Coordination Code of Practice, 2011. Other Codes of Practice relating to building activities, including abrasive blasting, demolition work, electrical work, and asbestos removal and noise, can be accessed by members,

particularly those who have taken on the role of Health and Safety Representative (HSR).

and Control provides a framework that members can refer to when raising any concerns with their employer.

These Codes provide a framework on how these types of work should be carried out.

However, if you remain concerned you should contact your QNMU Organiser or Member Connect.

Infection in a clinical area One of the most common issues members face during these times relates to how building work might compromise infection control in a clinical area. Construction and renovation work has the potential to disturb contaminants in the work environment, such as ceiling dust or animal excretions. Significant concerns have been raised within infection control literature warning of potential risks posed by Aspergillus infection linked to building work. This is particularly concerning for a health care environment where immune suppressed patients are present — quite simply, an infection could prove deadly. This was one of the key concerns our members have raised with us. They observed dust on work surfaces while infrastructure for the ieMR was being installed in their workplace. After further discussion with the health service, a suitable process for further renovation work was developed to stop future problems. Clearly, significant planning and risk management should occur prior to the start of any building work. The Australian Health Faculty Guidelines Part D – Infection Prevention

REFLECTIVE QUESTIONS 1. As a Registered Nurse or Midwife, which NMBA standards of practise support an obligation to report Work Health and Safety issues to your employer? 2. Have there been any building or renovation works conducted in your workplace that could have impacted the care of your patients? Reflect on it: How was it conducted? What health and safety protocols were put in place? Were they satisfactory? 3. What infection control interventions do you believe would be available to reduce the risk of fungal or bacterial contaminants present during renovation work? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

References: www.legislation.qld.gov.au/view/html/inforce/ current/act-2011-018 www.worksafe.qld.gov.au/laws-and-compliance/ codes-of-practice https://aushfg-prod-com-au.s3.amazonaws. com/download/Part%20D%2005%20 Construction%20and%20Rennovation_7.pdf

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Is your hospital relocating? Learn from our experience: a study on relocating an intensive care unit from a shared room setting to a single room setting

ANY OLD health care facilities are being refurbished or relocated worldwide to accommodate the changing needs of health care services (Ecoff & Thomason, 2009; Romano, 2005).

in close partnership with the ICU staff, including:

Hospital relocation may affect patient safety and contribute to staff emotional stress (Munich, 2011).

■ adopting a communication strategy

In addition, more hospitals, especially intensive care units (ICU), are adopting the single room design instead of the traditional shared rooms (Stichler, 2012).

■ supporting nurses in the single rooms

The result is that work processes may need to be changed due to the structural change of the working environment. However, there is limited research available on just what this means for staff and the way an ICU functions. In 2013, the ICU of a tertiary Australian hospital was relocated from a shared room to a single room setting in a new hospital site. To ensure patients were safe and staff were supported during the relocation, we conducted a threephase interventional study. In phase 1, we conducted group and individual interviews with staff working in the ICU, including nurses, medical staff, allied health staff, and other support staff to identify issues that may have an impact on patient safety and staff transition (see publication: Lin, Foster, Chaboyer, & Marshall, 2016). In phase 2, based on findings from phase 1, we developed and implemented a complex intervention

■ introducing a change champion ■ establishing a single room working party

■ conducting pre-move simulations

■ monitoring post move issues after the relocation (see published paper: Lin et al., 2017 - In Press). Six months after the relocation, we conducted group and individual interviews to gain insight on the effectiveness of the intervention and the implementation strategies. The results were positive. Our participants perceived the intervention was effective in improving communication about the relocation, encouraging staff engagement with new work process development process, and helping to build capacity in future change management work in the unit. A research paper on this subject is currently under review. Changes that occur in health care systems are often complex. A systematic approach to plan for the change, change management expertise, dedicated leadership and resources, clear communication, involving all staff, and monitoring the impact and outcome of the change are important strategies that can be used to manage the change.

BY DR FRANCES LIN, MENZIES HEALTH INSTITUTE QUEENSLAND, SCHOOL OF NURSING AND MIDWIFERY, GRIFFITH UNIVERSITY

REFLECTIVE QUESTIONS 1. Have you had any experience in a hospital relocation? What was your experience like? 2. What are the strategies you would consider using if you are making a change at your workplace? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

References Ecoff, L., & Thomason, T. 2009. Moving into a new hospital. Jounal of Nursing Administration, 39(12), 499-503. Lin, F., Marshall, A., Hervey, L., Foster, M., Hancock, J., & Chaboyer, W. 2018 - Published ahead of print. Using a theory driven approach to manage the relocation of an intensive care unit: An exemplar. Journal of Nursing Care Quality doi: 10.1097/ncq.0000000000000299.. Lin, F., Foster, M., Chaboyer, W., & Marshall, A. 2016. Relocating an intensive care unit: An exploratory qualitative study. Australian Critical Care, 29(2), 55-60. doi: http://dx.doi. org/10.1016/j.aucc.2015.09.001 Munich, R. L. 2011. Transplanting an organization: how does culture matter. Bulletin of the Menninger Clinic, 75(1), 126-144. Romano, M. 2005. Moving day. Modern Healthcare, 35(44), 28-28,30. Stichler, J. F. 2012. The new standard single family room design. Journal Of Nursing Administration, 42(10), 447-450.

CPD

New rules for low dose codeine products

N 1 FEBRUARY 2018, low dose codeine products that were available over the counter (OTC) from pharmacists became Schedule 4 prescription-only medicines.

Common low-dose codeine products that were available OTC were branded as Panadeine, Nurofen Plus, Prodeine or Mersyndol. Members of the public who previously bought these medicines from pharmacies will now have to present to a nurse practitioner, GP or emergency department to obtain a prescription for that product. With more people seeking a prescription for medication they previously had easy access to, it is likely to increase the workload of nurse practitioners, practice nurses and emergency department nurses. People seeking codeine will need your advice regarding whether codeine is the best way to manage their pain. Be aware that low dose codeine is indicated for acute mild to moderate pain. It is not indicated for the treatment of chronic or severe pain. However, given many people have been using low dose OTC codeine for self-treatment of chronic pain, they may attempt to continue to do so. QNMU members should familiarise themselves with the evidence on the Therapeutic Good Administration (TGA) website that clearly outlines why codeine (less than 30mg per dose) does not provide any more symptomatic relief from pain than OTC products without codeine, such as paracetamol, ibuprofen or a combination of both.

There is also the potential for more patients to require chronic pain management plans as a result of patients not being able to selfmedicate for their pain. It is also likely that some people who have been using OTC codeine products without scripts will need to be referred to specialist drug and alcohol services to treat dependence.

REFLECTIVE EXERCISE

Members should be aware that, due to the clinical evidence of poor efficacy, the Royal Australian College of General Practitioners says it does not support doctors writing prescriptions for low dose codeine products.

This is an opportune time for nurses to refresh their knowledge on:

This could create further issues for members when patients are refused a prescription, which may cause them to become agitated and aggressive.

■ current best practice in the management of chronic pain.

There is an even greater risk of agitation if the patient is already suffering from withdrawal symptoms. QNMU members should contact Member Connect if they notice any increase in presentations for codeine products or any increase in instances of aggression due to the change. By telling the QNMU your experiences, we can raise any ongoing trends with health departments and primary health networks. For further information on the rescheduling of low dose codeine, please refer to the TGA website at www.tga.gov. au/codeine-information-hubeducation-resources-healthprofessionals

■ the signs, symptoms and treatment of opioid dependence

This can be done through self-directed learning or by encouraging your nurse educator to provide training. If the changes outlined in this article affect you, you should discuss them with your managers and get involved in developing clear policies and protocols to deal with people presenting for codeine products. Assisting with the development of such policies and brushing up on your knowledge of opioid dependence and chronic pain management can also contribute to your CPD. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

CPD

Infection control management plans for private practicing midwives 17, important ROM 1 September 20 to the Public changes were made ) (the Act) that affect Health Act 2005 (Qld rvice providers. some health care se cessary to help These changes are ne ection control prevent potential inf breaches. dments provide In summary, the amen of compliance and for a broader range . enforcement actions actice are Midwives in private pr by the new changes potentially impacted rol. Act â&#x20AC;&#x201C; infectious cont to the Public Health

Whatâ&#x20AC;&#x2122;s in the Act? The following information is taken from the Queensland Health website at: www.health.qld.gov.au/clinical-practice/guidelinesprocedures/diseases-infection/infection-prevention/ management-plans-guidance/icmp Chapter 4 of the Act requires people who perform declared health services to take reasonable precautions and care to minimise the risk of infection to other persons. A declared health service is a service intended to maintain, improve or restore a personâ&#x20AC;&#x2122;s health that involves an invasive procedure (the insertion of an instrument, appliance or other object into human tissue, organs, body cavities or body orifices) or activity that exposes the person or another person to blood or another bodily fluid.

CPD The Act places a further onus on the owners/operators of health care facilities to have an Infection Control Management Plan (ICMP) for the facility. An ICMP is a documented plan to prevent or minimise the risk of infection in relation to declared health services. The ICMP must identify the infection risks at the facility and detail the measures to be taken to prevent or minimise the risks.

Further sources of information: Contact the QNMU Professional team at cgraham@qnmu.org.au Visit Queensland Health online at: www.health.qld.gov.au/clinical-practice/guidelines-procedures/ diseases-infection/infection-prevention Contact the CDIM-Infection Management, Communicable Diseases Branch, Queensland Department of Health on 3328 9755.

What’s in an ICMP? An ICMP for a health care facility must state: ■ the infection risks associated with the provision of declared health services ■ the measures to be taken to prevent or minimise the infection risks ■ how the operator is to monitor and review the implementation and effectiveness of the measures ■ details about the provision of training in relation to the ICMP for persons employed or otherwise engaged at the facility ■ how often the ICMP is to be reviewed (the effectiveness and implementation of an ICMP must be reviewed every year) ■ the name of any person who is responsible for providing advice about and monitoring the effectiveness of the ICMP.

How does this apply to midwives in private practice? The changes to the Act do have implications for midwives in private practice. Arguably, anywhere a midwife provides a health service, including the woman’s home, the midwife’s home or a designated clinical space, is a declared health service.

The ICMP now needs to articulate how the infection control management practices are taken into account. Arguably, current guidelines, standards and practices already fulfil much of the content required. Relevant components of these guidelines are important to consider for professional understanding and respecting the value of infectious control for midwives and for the women and families they care for. These can easily be incorporated into an ICMP as well as specific considerations. For example, if a woman chooses to ingest her placenta, the ICMP should state the management

process around this. It is essential the placenta be cleaned and refrigerated in a timely process to prevent contamination and cross infection, and that the midwife considers and discusses with the woman risk factors including the woman’s infectious status. Developing an ICMP may seem like just another bureaucratic hassle for midwives already overburdened with legislative and regulatory requirements as well as professional administration demands. However, there are reasonable infection risks in midwifery practice that need to be considered and mitigation strategies identified.

REFLECTIVE QUESTIONS 1. Thinking of your own practice, how do you think it relates to the declared health service criterion?

Midwives certainly deal with bodily fluids, large bodies of water with bodily fluids in them (birth pools), blood and placenta.

2. What are the key infection risks in your practice?

Midwives do invasive procedures including blood taking, injections, vaginal examinations and suturing.

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

3. How do you address these risks in your own practice and practice setting/s? 4. How would you develop your own ICMP?

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How do standards in aged care compare with the acute sector? A

S NURSES we advocate for the highest standards of care, no matter what the practice setting.

For the acute sector, the ACSQHC (an independent statutory authority), is the standards setting body.

Unfortunately, there is a disturbing trend where the increasing clinical care needs of those in residential aged care is not acknowledged.

A range of clinical standards have also been developed by the ACSQHC.

As a result there is a discrepancy between expected standards of care in the aged and acute care sectors. In both the acute and aged care sectors, standards are about protecting those receiving care from harm, improving safety and quality, and providing a benchmark against which service providers can be assessed to evaluate if care is being provided at the expected level. According to the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2017) a standard is “agreed attributes and processes designed to ensure that a product, service or method will perform consistently at a designated level”.

For hospitals, the latest second edition Health Service Standards encompasses: ■ Clinical governance ■ Partnering with consumers ■ Preventing and controlling health care-associated infection ■ Medication safety ■ Comprehensive care (including falls, pressure injuries, nutrition, cognitive impairment, unpredictable behaviours and restrictive practices) ■ Communicating for safety ■ Blood management ■ Recognising and responding to acute deterioration. In aged care, current accreditation standards for safety and quality flow from the Quality of Care Principles implemented through the Aged Care Act (1997). These principles support accreditation standards for residential aged care, home care and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. A major difference between the acute and aged care sectors is that there is no comparable independent standards-making body for aged care. Currently, for residential aged care there are four standards and a total of 44 outcome statements against which aged care facilities are accredited by the Australian Aged

Care Quality Agency (AACQA). These standards are: ■ Management systems, staffing and organisational development (nine outcome statements) ■ Health and personal care (17 outcome statements) ■ Care recipient lifestyle (10 outcome statements) ■ Physical environment and safe systems (eight outcome statements). A single aged care quality framework is currently being developed to replace the existing accreditation standards. This new framework will consist of eight outcome-focused standards: ■ Consumer dignity, autonomy and choice ■ Ongoing assessment and planning with consumers ■ Delivering personal care and/or clinical care ■ Delivering lifestyle services and supports ■ Service environment ■ Feedback and complaints ■ Human resources ■ Organisational governance.

What’s the problem? While the standards proposed under the new aged care quality framework are an improvement on the existing accreditation standards, the QNMU remains concerned for a number of reasons about the safety and quality of aged care and the capacity of these standards to drive much needed change. Firstly, while those receiving aged care are increasingly frail with

CPD multiple diagnoses, co-morbidities, polypharmacy and complex care needs, standards in aged care emphasise a social model of care, which places emphasis on social, environmental and cognitive needs at the expense of ever increasing health care needs of older Australians, particularly those in residential aged care. Secondly, while there are approximately 90,000 hospital beds in Australia, there are over 250,000 residential aged care places for an increasingly frail, chronically unwell and dependent population. These people are essentially cared for outside the mainstream health care system but have significant health care needs. Essentially, their care is not subject to the robust clinical standards of the hospital sector. Examples of where the aged care standards fall far short of the acute sector standards include falls, medication management, pressure injuries and handover of clinical information. While comprehensive standards for these critical care areas are included in the ACSQHC Health Service Standards, there are no comparable aged care standards for these core issues. There is plenty of evidence to suggest these issues are problematic in aged care, including: ■ Medication management and administration is the leading area of complaint reported to the Aged Care Complaints Commissioner (ACCC) – unlicensed staff administering medications would be unthinkable in the hospital sector under ACSQHC Health Service Standards.

■ Falls are identified by Ibrahim (2017) as the leading (and increasing) cause of preventable deaths in residential aged care and the second leading complaint area reported to the ACCC. ■ There are less hours of care per day per resident than research based minimum requirements, leading to missed care and reduced resident safety. ■ In some residential facilities, Registered Nurses are expected to communicate the care of more than 160 residents in the space of a 15 minute handover — that’s five seconds per resident.

Where to from here? One thing is obvious: the published standards of care for the acute and aged care sectors must be comparable, in particular those standards relating to clinical care… but they are not. The many inquiries, media reports and concerns of those receiving aged care, and their families, point to many issues that must be fixed. The difference in standards between the acute and aged care sectors highlighted in this article can’t be allowed to continue. Our elderly deserve better, and our aged care nursing staff deserve better.

REFLECTIVE QUESTIONS 1. How do you implement the ACSQHC Health Service Standards if you work in the hospital sector and the Aged Care Accreditation Standards if you work in aged care? 2. Review both sets of standards and compare and contrast how applicable each set of standards would be for your area of practice. Analyse why you think there is a difference. 3. Do you think residential aged care, where most residents have high care needs and complex co-morbidities, needs the same level of clinical standards as the hospital sector? Why or why not? 4. The new NMBA Code of Conduct for nurses, which commenced 1 March 2018, requires all nurses to comply with the ACSQHC Standards in their professional practice (regardless of clinical setting). If you work in aged care, consider how you will comply with that requirement. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

2018 will be a year of action for the QNMU and Australian Nursing and Midwifery Federation, as we engage the broader community to start demanding better through our national campaign. Read more about our campaign to fix aged care on page 33.

Further resources: For a copy of the ACSQHC health service standards can be found visit www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhsstandards/nsqhs-standards-second-edition/ For information on the current aged care accreditation standards visit www.aacqa.gov.au/providers/residential-aged-care/resources/brocah00 11accreditationstandardsfactsheetenglishv14.1.pdf For the new draft aged care standards visit https://agedcare.health.gov. au/quality/single-set-of-aged-care-quality-standards/draft-aged-carequality-standards-and-draft-application-of-draft-aged-care-qualitystandards-by-service-type

References Australian Commission on Safety and Quality in Health Care (2017). National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC Australian Government Australian Department of Health (2017), Draft Aged Care Quality Standards, retrieved from https://agedcare. health.gov.au/sites/g/files/net1426/f/ documents/01_2018/draft_aged_care_quality_ standards_-_word_version.pdf Aged Care Complaints Commissioner (2017) retrieved from https://www.agedcarecomplaints. gov.au/wp-content/uploads/2018/01/NationalQuarterly-Bulletin-September-2017-Quarterexcel.xlsx Ibrahim, J., Bugeja, L., Willoughby, M., Bevan, M., Kipsaina, C., Young, C., Pham, T. & Ranson, D. (2017) ‘Premature deaths of nursing home residents: An epidemiological analysis, Medical Journal of Australia, 206, pp. 442-447.

CPD

Changes to NMBA professional standards – what you need to know HE NURSING and Midwifery Board of Australia (NMBA) recently reviewed six professional standards:

■ Code of professional conduct for nurses ■ Code of professional conduct for midwives ■ Professional boundaries for nurses ■ Professional boundaries for midwives ■ Code of ethics for nurses ■ Code of ethics for midwives. This review clarifies that the NMBA professional codes and standards apply to all types of nursing and midwifery practice and in all contexts of practice. The new codes took effect from 1 March 2018, and reflect current nursing and midwifery practice. They are up-to-date, relevant and useful. Things to note: ■ The Code of conduct for nurses (2017) and Code of conduct for midwives (2017) both include professional boundaries matters, and therefore remove the need for separate professional boundary documents for nurses and midwives. ■ The International Council of Nurses Code of Ethics (ICN Ethics) for nurses will replace the NMBA Code of Ethics for nurses. ■ The International Confederation of Midwives Code of Ethics (ICM Ethics) for midwives will replace the NMBA Code of Ethics for midwives. The two Codes of Conduct do not replace any other Code of Conduct that employers require their

employees to comply with during the term of employment.

■ provide the foundation of evidencebased practice

If you hold dual registration as a nurse and a midwife, both codes apply to you.

■ be read in conjunction with NMBA standards, codes and guidelines.

Code of conduct for nurses and Code of conduct for midwives – what’s new The Codes are structured into four domains and framed around seven principles of conduct as listed: 1. legal compliance 2. person-centred practice 3. cultural practice and respectful relationships 4. professional behaviour 5. teaching, supervision and assessing 6. research in health 7. promote health and wellbeing A specific focus on advocating for culturally safe and respectful practice also requires nurses and midwives to: ■ frame the seven principles, each with a supporting values statement ■ categorise principles into four domains:

Further points to guide your practice: ■ Health advocacy: Understanding and application of primary and public health principles including vaccination and reporting of notifiable diseases. ■ Advertising and professional representation: Honest and transparent when describing their education, qualifications, previous occupations and registration status. ■ Confidentiality and Privacy: Abide by the NMBA social media policy and relevant standards for practice. ■ End of Life Care: Providing culturally appropriate end of life care. The NMBA expectation is that all nurses and midwives will exercise their professional judgement to deliver the best possible outcomes in practice.

◆ Practise legally ◆ Practise safely, effectively and collaboratively ◆ Cultural practice, and ◆ Promote health and wellbeing. ■ ensure ‘person’ is used to refer to the those in a professional relationship with a nurse ■ ensure ‘woman’ is used to refer to those in a professional relationship with a midwife ■ apply to all nurses and midwives across all areas of practice

For more information on the new Codes of Conduct, visit www.nursingmidwiferyboard. gov.au/Codes-GuidelinesStatements/Professionalstandards.aspx

CPD

Getting the

facts right IN THE PAST couple of weeks there has been misinformation circulating in the mainstream media designed to scare nurses and midwives into thinking their jobs are at risk because of new provisions around ‘cultural safety’. The grossly exaggerated claims are simply not true. And the NMBA itself has made this clear. The Code — written by nurses and midwives for nurses and midwives — simply states that nurses and midwives “engage with people as individuals in a culturally safe and respectful way, foster open and honest professional relationships, and adhere to their obligations about privacy and confidentiality.” Most nurses and midwives do this automatically as part of good practice. It’s nothing new, it’s simply now articulated as part of our codes for better practice. There’s no doubt cultural factors, including how a patient feels while within the health system, can affect their wellbeing. For example, culture and background often determine how a patient would prefer to give birth or pass away. Considering a patient’s background and culture can help nurses and midwives deliver care in a way that makes a patient feel more at ease, helps them understand their treatment better and respond to it more positively.

REFLECTIVE QUESTIONS Outline and reflect on what you have learned about the new NMBA Standards. How do they affect you? Why are they important? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/cpd

It is important to remember that these codes were the subject of lengthy consultations with the nursing and midwifery professions and other stakeholders including community representatives. This review was comprehensive and evidencedbased, and the resulting codes are consistent with codes of practice supported by the International Council of Nurses. Being conscious of our patients’ backgrounds and cultures is not political correctness gone mad, it’s plain old fashioned good practice.

your $ health

E KNOW women are retiring with less super than men. But did you know just how much less?

The average Australian woman retires with about $138,150 in super — that’s 53% less than the average man who retires with around $292,500.1 There are several reasons for this, including broken work patterns and lower-paid employment. Ultimately, it means around 80 per cent of women don’t currently meet the Association of Superannuation Funds of Australia’s (ASFA) ‘comfortable’ retirement income standard of $44,011 per year for a single person.2

1 Know what you’ve got Take an active interest in your super! This includes knowing your super balance, the details of your insurance cover and the investment options you have chosen. Also track down any lost or unclaimed super. Just head to my.gov.au, create a myGov account and link it to the ATO. This way you will be able to see upfront all the details of any of your super accounts. While you’re there you can also consider consolidating your super. After all, having fewer super accounts means less fees eating into your super savings!3

2 Work out how much you need Use an online Retirement Income calculator to estimate how much money you might need for a comfortable retirement. www.industrysuper.com/retirement-info/ retirement-calculators

Know your Super needs

3 If there’s a gap – take action! From topping up your super to learning about spouse contributions and potentially checking whether you’re eligible to access the Australian Government’s Super Co-contribution, your super fund can help you explore plenty of actions that may help you get one step closer to ensuring you achieve your lifestyle goals for your post-work years. Even just a small amount may make a big difference to your retirement savings.

Secure a better future today Spend a few minutes talking with your Super fund about your options and work towards setting yourself up for the lifestyle you want in the years ahead.

References and notes: 1 ASFA via SuperGuru http://www.superguru.com.au/about-super/ women-and-super/, accessed 16 February 2018 2 ASFA Retirement Standard; https://www.superannuation.asn.au/ resources/ retirement-standard; accessed 16 February 2018 3 Before rolling your super over, though, you should check what fees your other super fund charges and if you’ll lose any benefits such as insurance or pension options.

CO LU M N S U P P L I E D BY Q S U P E R

This information is a guide only and is intended to provide general advice. QNMU members are advised to seek independent advice before taking any course of action.

in view

Midwives gathering: Creating community, sharing experiences BY QNMU ASSISTANT SECRETARY SANDRA EALES I HAVE BEEN inspired recently by midwives in north Queensland who are building community by extending the hand of friendship and helping each other through some challenging times. The idea germinated when a couple of midwives met at a clinician summit held at the QNMU in October 2016. They determined they should continue to meet for peer support in their local areas. Their meetings, which include a mix of social gatherings, support groups, and professional education sessions, are hosted by midwives and rotated across the district including Cairns, Mareeba, Atherton and Innisfail. Steph Bethel, who first organised the group, told me, “It was such a pleasant evening on the esplanade watching the sun go down. While there was only eight of us, we did manage to plan some future meetings”.

Mareeba Our second ’midwives gathering’ for the year was a screening of the film Microbirth at Mareeba Maternity in April 2017, with midwives from Cairns, Mossman and Mareeba. The film generated a good deal of discussion and was followed by supper where we sampled probiotic and prebiotic food prepared by several midwives themselves.

Cairns We also gathered in May at the birthing centre at Cairns Base Hospital where we took part in a mini meditation session, and learned about aromatherapy for pregnancy, birth and beyond. Each midwife was also treated to a mini massage! Then for those of us who hadn’t seen it before, we had a little tour of the new Birthing centre.

Atherton Atherton midwives hosted a gathering in June that included a weaving class and discussion about developing a MGP in the area. Midwives were asked to bring a piece of old material and they all contributed to weaving a beautiful hanging for the Atherton unit while discussing caseloads and continuity of care. There was also plenty of discussion around models of care, local agreements and governance processes. The collective hope was that women and their families get the care they are seeking and it is implemented with good governance so that midwives can work in a way that lets them thrive.

These kind of nurse and midwife-led activities combining creative activities, good conversation and a professional focus are very beneficial for building networks and communication among nurses and midwives across Queensland. They give birth to professional strength and personal resilience.

Standing with our sisters We were proud to stand in solidarity with hundreds of men and women for gender equality at this yearâ&#x20AC;&#x2122;s Womenâ&#x20AC;&#x2122;s March in Brisbane! QNMU Secretary Beth Mohle addressed a passionate crowd as we took to the streets.

in view

All things shift work Calling all fellow shift workers! Looking to make some positive changes to your crazy lifestyle? The Nourished Shift Worker website was started by an Intensive Care RN, and is designed to be a source of motivation for all shift workers. It offers ideas, tips, recipes and more to help the modern shift worker find a more positive and healthy path. Find them on Instagram @nourishedshiftworker or online at www.thenourishedshiftworker.com

SEND US YOUR PICS AND WIN!

Got a great pic of nurses and midwives? Send it to us at inscope@qnmu.org.au for a chance to win a book prize. See page 57 for details.

Christmas f u n!

in view

Nurses and midwives sure know how to usher in the Christmas cheer. Thanks for sharing your wonderful Chrissy snaps with us!

The elves got busy over Christmas at Gladstone Hospital.

BOOK PRIZE ER WINN

Bed pans have never looked so appealing at Tara Hospital in the Darling Downs! Townsville Hospital Branch conducted a Christmas walk-around with cake for all.

Charleville Hospital brought forth their Christmas spirit with a door decorating competition.

incoming On QNMU securing a 3.3% wage increase for Bupa members GA This is fantastic for Bupa staff! Well earned. Great example for other aged care providers I hope. Like · Reply

SC Well overdue for our hardworking colleagues. Like · Reply

SE It’s a good victory but I wonder how they will compensate for their stakeholders? More staff cut backs? Decrease care recipient to registered staff ratios? Like · Reply

TS Great news for Bupa nurses. Now if one employer can do it… what about the others?

QNMU SECURES sizeable 3.3% wage increase FOR BUPA NURSIN

G STAFF

Like · Reply

On the federal government freezing university funding GM I’d like to know how the system will function once the last of us old hospital trained nurses retire in the next few years. Seriously the population is aging, the workloads are only going to get bigger. The replacement of aging nurses is a joke. Like · Reply

TI How can they freeze funding when the cost for students will undoubtedly continue to increase? Are they going to justify where the fees for students are going because clearly it’s not going back into the universities as it should be? Like · Reply

SC Maybe this might give the current students a chance to complete current practical assessments. As a midwife in a busy tertiary hospital I am seeing many student midwives fighting for shifts with final year students under great stress to get the required births to complete! And these are dual degree students so it doesn’t just affect maternity if they don’t finish their degrees! Like · Reply

On nursing homes to be audited without warning SBT This can only bring about a much-needed higher standard of care! Since when has the provision of elder care been a massive profit mill? Like · Reply

GA Cannot shout FINALLY loud enough on this! Perhaps our residents might be granted a level of TRAINED STAFF and company standards that haven’t fallen waaay below the acceptable line! Bring it on! Like · Reply

JS Where is the woohoo! button on Facebook? Cheering for random audits in every healthcare facility of any type – about time! Like · Reply

PF Now to fix all the other problems in aged care. Small steps yet a great step forward. Would be great to have unannounced visits to public hospitals as well for accreditation.

JOIN THE CONVERSATION Follow our social media pages and be a part of the conversation on hot topics and what’s important to nurses and midwives.

Like · Reply

TLD It’s about bloody time. Our most vulnerable deserve to be cared for. #fixagedcare Like · Reply

/qnmuofficial

incoming On the need for ratios in aged care

Letter to the Editor From my observations it is not only the shortage of staff, but also inadequate training and support resources provided to staff, that has created the dire situation in aged care. PCA/AIN is entry level employment and, due to the shortage and equal opportunity movements, facilities are employing virtually anyone with a Cert III or IV regardless of their suitability for such a role. Caring for some of society’s most vulnerable should be a role considered by potential candidates who actually care, not those who choose that path because it is ‘easy’ to gain employment. On the other hand, I’ve also worked with dedicated carers committed to upholding residents’ rights yet are subject to retribution and workplace bullying. They become afraid to advocate for their residents in fear of employment termination, or the facilities’ failure to act on previously reported breaches. It really hits home when you have a frail 96 yearold patient looking into your eyes with sadness as she holds your hand, saying “you’re leaving soon aren’t you, all the good nurses leave here”. To everyone who has a loved one in aged care... visit them regularly, speak up and be the voice they have lost. Anna, Student RN

WIN

LMR 1 RN per facility, 1 EN per ward (if you’re lucky), the remainder AINs and PCs. Hardly fits the description of a “nursing home”. We need mandatory nurse ratios - personal carers are NOT nurses. There needs to be more qualified staff providing and overseeing care. Like · Reply

PM Not happy with aged care providers but love that QNMU is speaking out so much about the terrible situation in aged care. Like · Reply

JS There has long been a shortage in RAC ratios in all shifts. The demand on aged care workers is extremely high and it’s good that aged care is being given the attention it needs - not only for the residents but for the staff who bust their backsides looking after a floor of 40+ residents and yes 200 overnight… I’ve been there! Like · Reply

PC Jobs, Jobs, Jobs is the rhetoric, we need action to fill these roles and raise the standard of aged care. Like · Reply

LCD Yeah 1 RN for 32 residents! To do meds, wounds, deal with doctors’ rounds, family meetings, staff issues. That’s just on a day shift. Then they are cutting hours so your shift is shorter and still expected to do everything in 6hrs. Like · Reply

ONE OF THESE GREAT BOOKS FOR YOUR FAB PHOTO

Outback Midwife by Beth McRae The story of Beth McRae’s 40 years as a midwife, from her ‘terrifying’ first day witnessing birth as a naïve student nurse to the outback. Beth’s career takes her from the city to the bush, bonding with people from all walks of life at one of the most important moments in their lives. Then, at a time when most people are thinking about slowing down, Beth moved to a remote Aboriginal community in Arnhem Land to embark on a whole other adventure.

A treasury of Cartoons, by First Dog on the Moon

Lion (aka A Long Way Home) by Saroo Brierley

A glorious collection of cartoons by The Guardian’s First Dog on the Moon, the nation’s only marsupial-based Walkley award-winning cartoonist, and brilliant mind behind creations like the ABC Interpretive Dance Bandicoot and Ian the Climate Denialist Potato.

Saroo Brierley becomes lost on a train in India at the age of five. Not knowing the name of his family or where he was from, he survived for weeks on the streets of Kolkata, before being taken into an orphanage and adopted by a couple in Australia.

This glorious collection showcases more than 200 of Mr Onthemoon’s greatest hits - the adorable, hilarious, poignant and occasionally whimsical drawings that have made First Dog an international treasure.

Despite being happy in his new family, Saroo always wondered about his origins. He pored over Google Earth satellite images for landmarks he recognised. After years of searching, he found what he was looking for and set off on a journey to find his mother.

Email full-size pics and image details to inscope@qnmu.org.au for your chance to win

in memory

Nurse colleagues

remembered Joyce “Joy” Lorraine Vickerstaff, AM 3 February 1944 26 December 2017 At a memorial service held in her honour in Brisbane last month, Joy Vickerstaff was remembered as a visionary nursing and midwifery leader who was instrumental in helping Princess Alexandra Hospital achieve its first Magnet designation. Joy’s illustrious career started at the Balmain Hospital in NSW where she topped the State Registration Exams for both nursing and midwifery and won the prestigious AM Kellet Prize. She would return to Balmain a few years later to set up the first District Hospital Intensive Care Unit – the start of a legacy that would span two states. After a stint as a Nurse Educator and later as an infection control nurse in the inner city, Joy became the Director of Nursing at Marrickville Hospital and then EDON at the King George V Memorial Hospital. Joy moved to Queensland in 1992, leaving behind her job as Area Director of Nursing for Central Sydney Health to take up the role of Executive DON at The Prince Charles Hospital in Brisbane. She remained there until 1998 then spent the next two years as EDON at the Mater Adult Hospital, before taking on what was possibly one of her most significant posts: EDON at Princess Alexandra Hospital and Senior Nurse Leader for the Southern Zone. It was during her time at the PA that she and her staff worked rigorously to secure Magnet status for the hospital – a prestigious achievement and an acknowledgment of excellence within the American Nurse Credentialing Centre Framework. Joy served the final years of her career in Canberra, retiring as the Chief nurse of ACT health in 2009.

Alison Moss, OAM 16 August 1925 28 December 2017 Alison Moss (nee Goodwin) was born in Charleville, Queensland on 16 August 1925. She went to school at the local convent and in 1943 started her nurse training at Charleville Base Hospital. After completing her nurse training at the Brisbane General Hospital in 1947, she moved to NSW for midwifery training at the King George V Memorial Hospital. In 1949 she was appointed Matron at Warialda Hospital and married a local farmer two years later. She took on the role of Matron at Barraba in 1958 and for the next few years moved around a number of rural NSW posts including Bingara, Bangalow and Kyogle, before returning to Charleville to be closer to her father. For the next two years Alison worked as a nurse in a local doctor’s surgery, but she returned to hospital work at Mitchell in Queensland in 1968 after her daughter left school. A few months later she was offered the position of Matron at the Roma Hospital – and it was here she really left her mark. Alison would remain at Roma for the next 20 years, becoming a much-loved part of the local community. In 1981 she was awarded a Medal of the Order of Australian (OAM) for her services to Nursing and in 1988 she retired and moved to the Gold Coast to be closer to family, spending her time volunteering with Southport branch of Red Cross, visiting cancer patients on the Coast and tending her beautiful garden.

CALENDAR

March Lung Health Promotion Centre at The Alfred Spirometry Principles & Practice 1 - 2 March 2018 Asthma Educator’s Course 7 – 9 March 2018 Smoking Cessation Course 15 – 16 March 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

Nurse Practitioners Pharmacology and Prescribing Conference

47th Global Nursing & Healthcare Conference Exploring latest innovations in nursing and healthcare 1–3 March 2018, London, UK http://global.nursingconference.com/ europe/

5th International Conference Global Network of Public Health Nurses

22-23 March 2018, Brisbane. Earn 11 Hours and 15 Mins of CPD (certificate awarded) www.ausmed.com.au/course/nursepractitioners-pharmacology-andprescribing

April

International Nurses Day 12 May

23rd Commonwealth Nurses and Midwives Federation Biennial Meeting 9 March 2018, London UK www.commonwealthnurses.org/

18 April, No excuse for abuse! Sunshine Coast 19 April, Creating a safe workplace (WH&S), Brisbane 19 April, QH EB10 - Your work, your voice, Sunshine Coast 20 April, Kickstart Education Assertiveness Skills, Brisbane 24 April, Aged Care & Private Hospitals - Guide to the QNMU and workload reporting, Brisbane www.qnmu.org.au/cpd

Lung Health Promotion Centre at The Alfred Managing COPD – Acute/Chronic 19 – 20 April 2018 Respiratory Course (Modules A & B) 30 April – 3 May 2018 Respiratory Course (Module A) 30 April – 1 May 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

4th Commonwealth Nurses and Midwives Conference 10-11 March 2018, London UK www.commonwealthnurses.org/

Skin Health Education Day Saturday 17 March 2018 What you always wanted to know about skin but were afraid to ask! Leading dermatologists and skin care experts will provide training and education on how to diagnose and how to treat and manage common skin complaints. Following the success of the 2017 Skin Health Education Day, this special one-day event will again run in 2018.

May

Australian College of Perioperative Nurses (ACORN) and joint Asian Perioperative Nurses Association (ASIORNA) Conference 23-26 May 2018 Adelaide Convention Centre, South Australia www.acorn.org.au/conference2018/

Care of the Older Person into the 21st Century – Alaska What does the future look like as the population ages into the 21st Century and what are the implications for health care delivery? 27 May - 3 June 2018, Alaska https://goo.gl/XgJkmG

19th South Pacific Nurses Forum 15–19 October 2018, Cook Islands www.spnf.org.au

June QNMU training

QNMU training 1 May, QH - BPF for NUMs & MUMs, Brisbane 2 May, QH Rostering - Equity & work life balance, Bundaberg 3 May, Professional Culpability Where do I stand? Bundaberg

5-6 June, Knowing your entitlements & understanding the Award! Cairns 7 June, QH EB10 - Your work, your voice, Cairns 11-15 June, Health and Safety Representative Training for nurses and midwives, Brisbane 19-20 June, Knowing your entitlements & understanding the Award! Rockhampton 21 June, QH EB10 - Your work, your voice, Rockhampton www.qnmu.org.au/cpd

QNMU Annual Conference 25-27 June, Brisbane

November 2018 Nursing Summit - Eastern Caribbean

7 May

QNMU training

6 March, Brisbane 8 March, Gold Coast 12 March, Bundaberg 13 March, Maryborough 20 March, Sunshine Coast 22 March, Toowoomba 27 March, Rockhampton 28 March, Mackay

International Day of the Midwife Labour Day

11 April, Townsville 12 April, Cairns

QNMU Meeting of Delegates

10-11 May, Knowing your entitlements & understanding the Award! Brisbane 15-17 May, Workplace Representatives 1, Brisbane 22 May, QH - BPF for NUMs & MUMs, Townsville 23 May, Conflict Management Skills, Brisbane 23 May, Being a QNMU Contact in the workplace, Townsville 24 May, Aged Care & Private Hospitals - Getting prepared for our next agreement, Brisbane 24 May, QH EB10 - Your work, your voice, Townsville 31 May, No excuse for abuse! Mackay www.qnmu.org.au/cpd 5 May

QNMU Meeting of Delegates

5 – 7 March 2018, Safari Park Hotel and Casino, Nairobi www.ion.ch/

CONTINUING PROFESSIONAL DEVELOPMENT

The program will cover a range of questions commonly encountered by healthcare professionals, beauticians and the general public. This one-day education program will be led by Assoc. Professor Rosemary Nixon. www.skincancer.asn.au/shed2018

1 June, QH EB10 - Your work, your voice, Mackay 5-6 June, Think on your feet, Brisbane 5-6 June, Knowing your entitlements & understanding the Award! Gold Coast 7 June, QH EB10 - Your work, your voice, Gold Coast

The Latest Advances in Health Care Delivery and their Implication for Nursing Practice. 10 November-18 November 2018. The content will be both relevant and of interest to nurses working in the acute hospital setting, community health, public health, aged care, and doctor surgeries. As well as those nurses working in the area of policy development, health education, and nursing research. We will explore a number of different ports and you will spend time with fellow nurses in an exclusive setting, on one of the most exceptional ships sailing in the Caribbean - the Harmony of the Seas. www.nursesfornurses.com.au/events

December World Congress of Cardiology & Cardiovascular Health 5-8 December Dubai, United Arab Emirates www.world-heart-federation.org/ wcc-2018/

If you would like to see your conference or event on this page, let us know by emailing the details to inscope@qnmu.org.au

The Nursing and Midwifery Board of Australia requires all nurses and midwives to complete a minimum of 20 hours CPD per registration year for each profession for which they hold current registration. Time spent reading and reflecting on the CPD articles in this journal can contribute to your hours. However in order to satisfy NMBA that your learning has been effective you need to keep a record of your activity. The following table is an example of how you might record your CPD hours. The following is an example only of a record of CPD hours (based on the ANMF continuing education packages): Date

Source or provider details

Identified learning needs

Action Plan Type of activity

01-092017

InScope Journal

Increase knowledge re Delegation & Supervision

Read article and answer reflective questions

Description of topic/s covered during activity and outcome

SelfCriteria and resources directed relevant to delegation and required levels of supervision. Increased knowledge re delegation and supervision of EN/ AIN.

Reflection on activity and specification to practice

No./Title/ Description of evidence provided

CPD hours

Answered reflective exercise questions. Read relevant NMBA codes & guidelines. Translated knowledge into practice and discussed with colleagues.

Journal article with reflective exercise questions.

2.5 hrs

Please refer to www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx for full details of CPD requirements.

VOX POP

Why is it important for nurses and midwives on the ground to participate in enterprise bargaining?

Sarah Herrmann

Barbara Lowe

Kerri Roosen

RN (Buderim Private Hospital)

CN (Queensland Health)

RN (TPCH)

It’s important to be active as a nurse as enterprise bargaining affects me directly with my pay and conditions. I want to stand up for myself and everyone else in the profession.

To maintain our conditions and our rights in the workplace. The more employees that participate, the more the employer will realise that this is what the workers want – it’s not just the union speaking.

If more nurses participate in the EB process, they can get across what they want out of their employment. It’s about taking ownership of the process.

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Summer 2017

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55,000 nurses and midwives throughout Queensland! ADVERTISING ENQUIRIES: Denielle Smith (07) 3840 1444 inscope@qnmu.org.au

With great deals on now, it’s time to talk about that new car. Plus with a RemServ novated lease you could also Li iwÌ vÀ Ì>Ý Ã>Û }Ã° Call 1300 73 14 29 remserv.com.au/offers Things you need to know: This general information doesn’t take your personal circumstances into account. Please consider whether this information is right for you Liv Ài > } > ìV Ã > ` Ãii «À viÃÃ > ì«i ì Ì Ì>Ý À w > V > >`Û Vi° Conditions and fees apply, along with credit assessment criteria for lease and loan «À `ÕVÌÃ° / i >Û> >L ÌÞ v Li iwÌÃ Ã ÃÕL iVÌ Ì Þ ÕÀ i « ÞiÀ½Ã >««À Û> ° ,i -iÀÛ >Þ ÀiVi Ûi V ÃÃ Ã V iVÌ Ü Ì ÌÃ ÃiÀÛ ViÃ° ,i -iÀÛ ` iÃ Ì >VÌ >Ã Þ ÕÀ >}i Ì À Ài«ÀiÃi Ì>Ì Ûi ÀiÃ«iVÌ v Ì i «ÕÀV >Ãi v > Þ Ûi V i° ,i -iÀÛ ` iÃ Ì «À Û ì > Þ >`Û Vi À ÀiV i `>Ì Ã Ài >Ì Ì Ì i «ÕÀV >Ãi v > Þ Ûi V i° ,i Õ iÀ>Ì -iÀÛ ViÃ + `® *ÌÞ Ì` N Ƃ {È ä Î £ÇÎ än °

A bank built for you. Did you know that ME is a bank built to help Australians get ahead? And as a member of QNMU you’re able to access exclusive beneﬁts and special offers via our Member Beneﬁts Program.

More for QNMU members. In the past, members have enjoyed:

discounts on home loans

lower rate on credit cards

bonuses on term deposits

What are you waiting for? Take a look at what’s available to you right now at

mebank.com.au/beneﬁtsqnmu Arrange a time to speak to our ME Relationship Manager Kym Chisholm kym.chisholm@mebank.com.au | 0417 296 796

This information is about products and services available to you as a union member. Your union and ME are not agents or representatives of one another. Your union does not accept responsibility or liability for any loss or damage caused by the products or services provided by ME. Your union does not receive any commissions as a result of members using ME products and services. Members Equity Bank Ltd ABN 56 070 887 679 (ME) holds Australian Credit Licence 229500.

sometimes you just want more Based on a starting income of $50,000 and a starting account balance of $50,000 HESTA has delivered $17,837 more to members than the average retail super fund over the past 10 years*. This was because of both lower fees and higher investment earnings.

hesta.com.au/betteroﬀ

*Comparisons modelled by SuperRatings, commissioned by HESTA. Modelled outcome shows 10 year average diﬀerence in net benefit of the main balanced options of HESTA and 77 retail funds tracked by SuperRatings, with a 10 year performance history, taking into account historical earnings and fees – excluding contribution, entry, exit and additional adviser fees – of main balanced options. Outcomes vary between individual funds. Modelling as at 30 June 2017. This information is of a general nature. It does not take into account your objectives, financial situation or specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk). Past performance is not a reliable indicator of future performance and should never be the sole factor considered when selecting a fund. See hesta.com.au/superraterassumptions for more details about modelling calculations and assumptions.

Moving from Medibank? Bumping Bupa? Try TUH Health Fund today! We’ve been caring for the education community and their families for over 45 years. It’s no wonder that in the 2017 Ipsos Healthcare & Insurance Australia survey, TUH came ﬁrst or joint ﬁrst in three categories: customer satisfaction, member advocacy, and fund trustworthiness.

To learn more, visit tuh.com.au/qnmu or call 1300 360 701.

With Queenslanders every step of the way. Official Supporter of the Queen’s Baton Relay and Queensland for over 100 years

Welcome to the QSuper feeling.

This information and all products are issued by the QSuper Board (ABN 32 125 059 006 AFSL 489650) as trustee for QSuper (ABN 60 905 115 063). You should consider whether QSuper is right for you, by reading the PDS available from our website at qsuper.qld.gov.au or call us on 1300 360 750. © 2018 QSuper Board

IT’S GOOD TO KNOW YOU’RE IN SAFE HANDS QNMU members benefit from FREE hotline support with Member Connect when you need assistance. Our Member Connect team are all nurses or midwives with extensive experience and backgrounds in midwifery, mental health, aged care, education, paediatrics, surgical and cardiac nursing.

MEET SOME OF THE TEAM!

Karyn

Daniel

Nelda

Maree Terri

Dianne

Danielle

In the past three years, we’ve assisted more than 53,500 members through our Member Connect call centre on professional and industrial issues such as medication management, workload concerns, wages, leave allowances, bullying and more.

(07) 3099 3210 or 1800 177 273 (toll-free outside Brisbane)

Each and every day we’re making a difference for nurses and midwives. Be part of the strongest and most experienced voice around.

BE PART JOIN OF IT! NOW www.qnmu.org.au