InScope No3 Spring 2017 by Queensland Nurses and Midwives' Union

The official journal of the Queensland Nurses and Midwivesâ&#x20AC;&#x2122; Union

Spring 2017

The 88-minute difference in aged care

Healing through pet therapy

PLUS! CPD CONTENT on emancipated teens, WHS & more

Recruit and

Relax

$20in 00 trav el v ou che

Competition

Are you overdue for a getaway? Recruit a new QNMU member and go in the draw to win a $2000 travel voucher. Whether you want to escape to the mountains or spend a week lying on the beach, it’s up to you how you spend your voucher for discounted travel!* Winner announced in December 2017.

Details: Refer a non-member to join the QNMU online at www.qnmu.org.au or by completing the printed form. Make sure you ask them to put your name and workplace on the application in the ‘recruited by’ section. You’ll then be entered into the random draw to win a travel voucher valued at $2000. The more members you recruit, the more times you enter the draw!

Terms and conditions: Competition is open to all financial members of the QNMU who recruit a new member. The recruiter must be identified in the ‘recruited by’ section on the online or printed form to be entered into the random draw. Form must be completed and returned to the QNMU by close of business 11 December 2017. Winner agrees to be featured in QNMU communications materials. *Travel voucher can be used on selected deals through Queensland or internationally as offered by ubookdirect.

Star

Branch

Competition

Enter to win:

Closing dates

■■ A QNMU-sponsored event for your Local Branch (up to the value of $1000) featuring Secretary Beth Mohle and other expert staff. Your Local Branch picks the theme and topics for this event and we’ll make it happen – plus there will be plenty of freebies and cake!

Please submit your applications by the following dates:

■■ QNMU sponsoring for a local member of your choice to attend our 2018 Annual Conference as an observer in Brisbane.

Draw 1: 4 December 2017 Draw 2: 4 June 2018 b

It’s time to get your thinking caps on and come up with some creative ways of energising your Local Branch and getting visible in your workplace.

For more information visit http://bit.ly/starbranchcomp

INDEPTH

LGBTI mental health – Let’s talk about it!

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) T 07 3840 1444 1800 177 273 (toll free) F 07 3844 9387 E inscope@qnmu.org.au W www.qnmu.org.au 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

Spring 2017

INDEPTH

CPD

14 18 24 25 26 30 36 38 40 58

43 44 47 48 50 51 52 54 56

School nurses – linking health and education A pet a day: pet therapy Penalty rate cuts – more than meets the eye Cricket – One Game, One Voice The 88-minute difference LGBTI mental health – Let’s talk about it Same issues, different continents Graduates driving change Stay calm and keep nursing Annual Conference: our democratic heart

62 Keeping an eye on staffing When is a child no longer a child? Antimicrobial dressings for CLABSI prevention Good Samaritan liability

REGULARS

Prophylactic negative pressure wound therapy

INSIGHT

NMBA draft midwifery standards for practice

TEA ROOM

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JUST IN

IN VIEW

CALENDAR

INCOMING

ADVERTISING

Maintaining health and safety in the community settings Who is responsible for your safety at work? What helps nurses and midwives thrive?

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.

insight

How do you make a difference? Sally-Anne Jones QNMU President

In July we held our Annual Conference, where we debated motions that will shape the actions of the QNMU over the next 12 months and into the future. Our conference, themed ‘making a difference’, celebrated our new name and a fresh look, but reinforced the determination and commitment to making a difference for nurses, midwives, those who undertake nursing in all settings, for our communities, and for society as a whole. ‘Making a difference’ can be quite the cliché, but it is nevertheless an important message that speaks to the core of what we do. There is much we can do to increase the ways in which we make a difference. Here are some suggestions … and they’re not all about what we do in the workplace: ■■ Write a list of things you are passionate about, why these things are important to you and the personal connection you have to them. ■■ Become a critical thinker. Question everything and try to see as many viewpoints as possible. Be educated and stand up for your rights. ■■ Have both passion and a positive attitude. We all have something to give and our voice is meant to be heard. ■■ Know your values and practice them. ■■ Be educated in world events. You have more power when you know what goes on because it trickles down and will perhaps, in some way, affect you. ■■ Vote! Voting is a right women and various cultural groups fought for,

for centuries. People are still trying to achieve this great right in many countries. It is a privilege and you must treat it as such. ■■ Don’t be scared to speak up on issues you believe in. This may seem daunting, but it’s necessary if you want people to believe in your idea. ■■ Be conscious of the legacy you wish to leave. No matter who you are or where you come from you are part of the bigger picture and you matter in creating a better future for the generations to come. ■■ Know that one voice makes a difference and can be the change you wish to see in the world. Our union unites nurses and midwives to work together to achieve security and fairness in our workplaces, as well as fairness, equality and opportunity in the community. As nurses and midwives, it is our role to promote our core nursing and midwifery values of caring, professionalism, advocacy and holism. They are central to the identity and contribution of our professions. Apart from negotiating improved pay and working conditions for members, the QNMU is also committed to making the world a better place. We stand up for and believe in democracy, a decent standard of living, access to free quality public

health care and education, work-life balance, reconciliation, a sustainable environment, equality, as well as international cooperation for peace and human rights advocacy … to name just a few. The strength of your commitment to make change in this world is echoed in the values of nursing and midwifery and in our union. ‘Making a difference’ can mean so many things. And as the very fabric of the QNMU, we debated at conference this year ways in which nurses and midwives can make a difference now and for future generations to come.

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 Maddi Heathfield 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

Aged care blame game must end Beth Mohle QNMU Secretary

The current state of aged care in Australia is a source of considerable concern. Just about every day we hear new cases of staffing cuts and inadequate skill mix leading to poor outcomes for residents and their families. Of course, it impacts our dedicated nurses and carers, who are doing the best they can in a failing system. Last year the QNMU started work on a multi-faceted campaign, which our Council has endorsed. Given the responsibility for aged care funding lies with the federal government, this will be a national campaign coordinated by our federal office, the ANMF. The ANMF “Because We Care” campaign launched in 2009 so clearly highlighted the root causes of the problem: poor staffing and skill mix, inadequate accountability, substandard pay, and the failure to regulate all performing nursing in aged care. A failure by government to address these issues meant the situation continued to deteriorate. Now, the new aged care funding model has made the situation worse, leading to deeper cuts in hours and skill mix. Ignoring pleas from the ANMF to campaign together to oppose any funding cuts, aged care providers instead settled for a funding deal they claimed was “the least worst option”. We see this as a human rights issue. Our recent submission to an Australian Law Reform Commission Inquiry into Elder Abuse argued the lack of nursing in aged care

constitutes a form of elder abuse. How can government quite rightly regulate staffing in child care yet refuse to do likewise in aged care? So who is being held accountable? At the moment, the troubling reality is that the system is let off the hook while individual nurses are in the firing line for failing to meet their professional obligations, putting their individual licence to practise at risk. This is simply unfair.

So must providers. Which is why we need to be organised and ready for our on-theground campaign. We must take action in our workplaces and our local communities. We cannot give up or accept the blame shifting and lack of accountability as this only serves to reinforce the status quo. And the status quo in aged care is dangerous.

So we must act to hold the system to account. We all have (or will soon have) family or friends who are receiving community or residential aged care services. Disturbingly, the evidence shows that each resident in Australia is experiencing, on average, a one and a half hour per day deficit of nursing. Imagine what could be done for an individual resident in an hour and a half. You can read more about this on page 26. More importantly, imagine what is currently not being done. This is a national disgrace and as a community we cannot continue to look the other way. This means we need to “get political”. It is politicians who set their governments’ priorities and make funding and policy decisions accordingly. We need to lobby all political parties at both the federal and state levels about our concerns and hold them to account. We elect them after all. Both levels of government must commit to solving this crisis.

So we must act to hold the system to account.

Get Active! At our Annual Conference this year we called on delegates to “Get Active” in our campaigns — it’s important we have informed members in all electorates lobbying politicians and candidates on the issues that matter to us. You can get involved too by staying up-to-date on any latest developments. Contact Political and Community Organising Coordinator Genevieve Siddle on GSiddle@qnmu.org.au

tea room 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.

Protected industrial activity/action

They’ve got very similar names but there’s a big difference between protected industrial activity and protected industrial action. Both can be used to persuade employers to improve their offers during enterprise bargaining to ensure nurses and midwives are appropriately valued. Engaging in protected industrial activity and taking protected industrial action is our right as union members. But in order to take that leap, nurses and midwives need to know exactly what those rights are and exactly how the law protects us. So what’s the difference?

Protected Industrial Activity This includes instances when union members collectively participate in an activity organised or promoted by a union outside rostered hours (paid time). If the QNMU and your employer cannot agree on something (and this doesn’t necessarily have to occur during enterprise bargaining), members may decide to engage in protected industrial activity. Examples of such activity may include wearing QNMU shirts, asking people to sign petitions, sharing QNMU posts on social media, rallying outside the workplace, distributing flyers, or talking to co-workers, patients/ residents and other people about the campaign. All activities must occur outside paid work time.

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

What can protected industrial activity look like? Opal aged care AINs at Greenfern and Leamington recently engaged in protected industrial activity. It was a collective effort, and a decision made by the majority of QNMU members who’d been instructed to do laundry and kitchen work. AINs signed a refusal notice, which stated they would prioritise the care of their residents by not performing tasks that were outside their classification, including transporting clothes to and from the laundry, putting items away in cupboards, and scraping plates. Since then, no QNMU member has been punished in any way … because ultimately, refusing to do this work is a workplace right under these members’ enterprise agreement. Another form of activity members frequently undertake is signing and distributing petitions. You cannot be disciplined in any way for doing this, so long as any petition-related activity is encouraged by the QNMU and occurs outside paid work time. Petitions are an effective way of getting employers to listen. A petition containing lots of signatures from staff and members of the community can be difficult for employers to ignore.

Protected Industrial ActiON This involves union members doing something, or refusing to do something, which results in a ban, limitation, restriction or delay in them performing their work or the work being performed differently. Taking this form of action requires a ballot of union members where more than 50% of members vote and more than 50% of those who vote, vote yes. Examples of protected industrial action may include: ■■ communicating with patients/residents and their families during work time about what we’re fighting for ■■ bans on low priority work (ie: duties within your classification but which are considered low priority) ■■ things that create administrative strain or extra work for management ■■ safe stoppages of work ■■ bed closures (where patients/residents are directed to receive care elsewhere).

How do we ensure patients/residents stay safe? Patient and resident safety remains the priority for nurses and midwives when taking protected industrial action. Action is always taken responsibly to ensure safety is never compromised. The QNMU can insist that agency nurses care for patients/residents while QNMU members stop work.

How am I protected? Remember, it’s called ‘protected’ for a reason. Under the Fair Work Act, QNMU members cannot be dismissed or disadvantaged in any way by their employer for engaging in protected industrial activity/action or exercising their workplace rights. If this does occur, this is called adverse action, which is illegal. In the private sector an employer can be fined up to $54 000 or up to $10 800 for individual managers. In state and federal jurisdictions an individual can be fined up to $11 353.50. Visit www.qnmu.org.au/infosheets to read the QNMU’s information sheet on adverse action.

Union Training Program Some of our upcoming training courses:

OCTOBER 24-25 October Knowing your entitlements & understanding the Award!

26 October Professional Culpability – Where do I stand?

Toowoomba

26-27 October Someone should do something about that!

31 October No excuse for abuse!

ToWNSVILLE

ROCKHAMPTON

NOVEMBER 1 November Handling grievances in the workplace

14 November How to make the BPF work for nurses and midwives

ROCKHAMPTON

cairns

15 November QH Rostering – Equity & work life balance Find out how to improve the roster in your work unit

cairns 15 November No excuse for abuse!

GOLD COAST

16 November QH – BPF for NUMs & MUMs

cairns

16 November Aged Care and Private Hospitals - Everything you wanted to know about your agreement but were afraid to ask!

GOLD COAST Courses are extremely popular and book out quickly. Avoid being disappointed. Get your enrolment in early.

For all training courses available or to enrol visit www.qnmu.org.au/education or phone 3840 1431

wins

Hours reinstated for Southern Cross Care, Stretton Gardens It’s important we celebrate our wins, and a win is exactly what nurses at Southern Cross Care Stretton Gardens recently had. After being told their hours were being cut, Stretton Gardens members in Brisbane stood together and responded by: ■■ submitting workload forms highlighting the changes in resident care and increased risk to resident safety. ■■ refusing to cover shifts or work past their allocated hours. ■■ encouraging residents’ families and friends to lodge complaints with management about the staffing cuts. When confronted with a serious shortage of staff, management called a meeting and tabled all the complaints. Faced with numerous workload forms, complaints from families, and one staff member ready to resign, management ultimately apologised and reinstated the nursing hours. As one of our members said, nursing staff should not be afraid of standing up to management.

“I would encourage people to stick together and communicate with each other,” she said. “Proper communication will get you a long way. “People are scared of speaking out because they fear they’ll lose their job — but this is your livelihood. “Aged care is a hard area at times, but if you can get staff to come to the table and actually say what’s wrong in your work area and ways to make it safer, then that’s very important. “Talk to each other not just behind closed doors, but openly, and say what is wrong and what you’re worried about.” If you’re facing similar issues in your workplace and want to do something about it, talk to your colleagues first about how you can work together, then contact your Local Organiser on 3840 1444.

I would encourage people to stick together and communicate with each other. 6

Members chuffed with pay win We’re really proud to have recovered a massive $800,000 for our AIN members working in Queensland Health sterilising services, after discovering they were being incorrectly paid shift and Sunday penalty rates.

I received $6,254.51 in backpay… I’m over the moon and really happy. I’m semi retiring next year, so we’ll put it in the bank and put it towards our big overseas trip! Vickie Rowlands, AIN

More buses means better safety Ipswich Hospital nurses and midwives will now benefit from extended courtesy bus hours with Ipswich Hospital’s Park and Ride service. The free transport will now operate Monday to Friday from 6.20am to 11.15pm (previously until 6pm), and improve safety for staff leaving work late at night. The buses provide transport between a free car park and drops passengers off at the front door of the hospital, with wait times of no longer than 10 minutes in the morning and 20 minutes in the afternoon or evening. Well done to our Ipswich Hospital members who worked hard to lobby for the extended hours and will now reap the rewards!

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Nurses at Robina Hospital ICU

Robina ICU nurses set to recover more than $100,000 “Why was my friend paid for a public holiday not worked and I wasn’t?” This was the simple question a QNMU member posed to her Local Organiser that sparked an 18-month investigation which could see Gold Coast nurses and midwives reclaim hundreds of thousands of dollars. Under their award, Queensland Health nurses and midwives are entitled to a full day’s pay if they are rostered off on Labour Day, Show Day and Easter Saturday, but are normally available to be rostered on those days (Easter Sunday was recently added to this list).

However, after investigating a number of wards across the Gold Coast HHS, the QNMU discovered a significant number of members were not being paid for these days not worked. While we don’t know the exact amount to be paid, we estimate it will be in the hundreds of thousands of dollars across the entire HHS. In the Robina Hospital Intensive Care Unit alone, 35 nurses have received (on average) between $2000 and $3500, so we expect this unit to total at least $100,000 in backpay. The GCHHS has now put in place various mechanisms and training for managers to ensure staff are

correctly paid for public holidays not worked in the future. Over the 18 months of this investigation we’ve worked collaboratively with management at both Gold Coast sites and with members who produced the payslips and other documentation needed to produce this terrific outcome.

Have I been paid correctly? If you think you haven’t been paid for a public holiday not worked (and keep in mind every nurse and midwife is different depending on your regular hours of work), you should look up previous payslips from the past six years to see if this is the case, then contact your local QNMU Organiser for assistance.

Need the union’s support? QNMU members needing advice or support are encouraged to 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!

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A big win for Logan midwifery QNMU member and Midwife Michael Hall

Logan mums and bubs will now have access to better maternity services and maternity care options after the state government committed $2 million in new funding to deliver community-based maternity hubs across Logan.

This is a significant victory for our member midwives who campaigned to maintain community-based midwifery services in the area — services which were sadly cut under the LNP government in 2012.

The money will fund six midwives who will support mums and their babies at local community centres.

QNMU member and midwife Michael Hall said members and the community worked closely with the Queensland Community Alliance, Logan Together and the Maternity Project Action Group to achieve this great outcome. “I’m very passionate about midwifery in the Logan community because I live here and I’m raising my kids here,” he said. “I saw the changes after the community clinics were closed and I saw the destruction of the Newman years where services were being dismantled - changes which negatively impacted upon the Midwifery Group Practice of Logan Hospital. “I’ve been listening to patients who wanted more and this win means the community is not only getting back what it lost but improving services at the same time, and I find that very exciting. “What’s coming is bigger and better than what we initially lost.” This significant outcome is testament to the power QNMU members have when we work together and in collaboration with other likeminded organisations. The QNMU will be participating in a stakeholder group to identify potential locations for the hubs.

WIN

for Carinity members

Thanks to community support for a QNMU campaign, Carinity has withdrawn its attack on nurses’ penalty rates and other entitlements, and is dropping claims to: ■■ cut penalty rates ■■ introduce 12 hour shifts ■■ remove level 3 RNs from the Enterprise Agreement ■■ increase extreme fluctuations in weekly hours.

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Persistence leads to better safety Safety should always be the top priority when it comes to looking after not only our patients, but also ourselves. That’s what was at the front of Tracey White’s mind when she pushed the case for her employer to install safety duress alarms in the hostel facility at Wahroonga Retirement Village. Tracey, who is an AIN and a QNMU Delegate, said staff kept approaching her with safety concerns. “Staff were saying they were being left by themselves after 8pm,” Tracey said. “In the dementia unit and the nursing home, there’s always a Registered Nurse on shift and you’ve always got staff with you. But the hostel is a fair walk away.” Tracey initially approached her manager and, although it was agreed the duress alarms were a good idea, nothing changed. “The issue was also spoken about at various meetings, but again nothing happened. “So I wrote a letter about my suggestion to install duress alarms, and it got sent to head office. “Even though the facility was assessed as low risk by the police, staff kept pressing the issue with me and so management finally decided to do it.” The duress alarms were finally installed in March. Tracey said persistence was key, with staff having tried to install duress alarms in the past. “At one stage they had walkie talkies, but they stopped working. So this is a great outcome to something that’s been ongoing for a long time.”

Staff were saying they were being left by themselves after 8pm.

QNMU recovers $15,000 for member The QNMU has recovered a massive $15,000 for Clinical Nurse Kathleen Szolna from West Moreton Mental Health. For almost three years, Kathleen had been paid at an incorrect pay point and did not receive her higher education allowance. She has now pocketed over $15,000 in backpay — a big win for Kathleen! “I doubt I’d have got through it all without the support of my QNMU Organiser,” Kathleen said. “She understood what needed to be done and what paperwork was required. “The backpay has been put to good use — it’s allowed me to move into a different nursing position and assisted in furthering my studies. Of course, there is also some leftover for a holiday!”

I doubt I’d have got through it all without the support of my QNMU Organiser.

Tracey White, AIN

just in

Aged care rally draws public support

What can I do? The public and the media are talking about aged care right now. Here are some simple actions you can take to help keep the momentum going: ■■ Tell us your story – complete the ANMF’s national survey and tell us whether there have been cuts in your workplace: www.surveymonkey. com/r/D95M562

Our aged care campaign is ramping up, and the community is starting to listen.

providers to maintain safe nursing staff numbers.

At a time when we need more nurses in aged care, employers are reducing nursing hours and handing their complex work to Personal Carers and AINs.

We also encouraged those with relatives in aged care to tell managers they do not give permission for PCs and AINs to distribute medications to their loved ones.

This isn’t news to those who work in aged care, of course, but following Blue Care and Southern Cross Care’s recent announcements to further slash nursing hours, the issue is heating up in a very public way.

We know all aged care nursing staff can and want to provide the best possible care. But these cuts and dangerous medication administration practices are making it increasingly difficult, and it’s putting residents and staff at risk.

Fed up with these cuts, nurses, residents and families recently rallied at a QNMU event in Bundaberg.

At one point or another we will all be affected by the quality of care provided in aged care, whether it’s our loved ones or us personally.

Our ‘rally for the elderly’ called on the public to support aged care nurses by telling their local aged care

This is an issue all Australians should be concerned about.

■■ Sign our Blue Care petition – 1500 people have now signed our petition to Blue Care management, demanding they stop cutting nursing hours and put a stop to dangerous medication administration: www.megaphone.org. au/p/bluecare ■■ Contact the federal Minister for Aged Care Ken Wyatt – the federal government has the ability to fix aged care but needs to hear from you about why we need better staffing. Call (02) 6277 7720 or email ken.wyatt. mp@aph.gov.au

Nurses around the world – ICN Congress QNMU Secretary Beth Mohle was in Barcelona for the International Council of Nurses Congress. Beth was asked to speak internationally about legislated nurseto-patient ratios and its impact on healthcare in our state. Beth said the experience gave her a stronger appreciation for our collective approach in working to advance the interests of nurses and midwives. “There are so many nurses and midwives around the world that aren’t as unionised as we are,” she said. “Even though we have problems to surmount in Queensland, we’re union — we get it, and we get that we’re better positioned and stronger as a collective.”

Left to right: Shelley Nowlan, Chief Nursing and Midwifery Officer Queensland, Beth Mohle, QNMU Secretary, Professor Linda Aiken from the University of Pennsylvania and Professor Patsy Yates from the Queensland University of Technology.

just in

Historic night for Queensland Community Alliance Premier Annastacia Palaszczuk and about 1400 QNMU and likeminded community members gathered for a historic night at the Queensland Community Alliance (QCA) Founding Assembly. The QCA is an alliance of charities, unions and community organisations working together to help Queenslanders address issues that matter to them. The event was an opportunity for members and the community to put key asks directly to decision makers in the room. We discussed some important commitments around healthcare, including aged care, disability and mental health, and employment and training.

QNMU Assistant Secretary Sandra Eales addresses the assembly

To join in, visit www.qldcommunityalliance.org.

Three cheers for the QNMU!

Statewide BPF generic review recommends improvements The primary purpose of the Business Planning Framework (BPF) is to deliver safe workloads for all nurses and midwives in the public sector, by applying a standardised methodology to help frontline staff determine the supply of nursing/ midwifery resources based on the demand for their services. For many years, the QNMU has raised concerns regarding the inconsistent application of the BPF with Hospital and Health Services (HHS) and the Department of Health (DoH). In pursuit of improvement, we successfully lobbied Queensland Health to review the BPF in every HHS.

It was decided by all parties that maternity services would not be included in the statewide generic review, as earlier in the year the Minister for Health committed to appointing an external auditor to formally review midwifery staffing levels across all HHSs. The QNMU actively participated in the local BPF reviews, with our organisers and member representatives included in every HHS team. In fact, 136 members signed up to be BPF champions. The key findings, which were recently shared during a roundtable discussion in Brisbane,

demonstrated the application, governance and promotion of the BPF was inconsistent across HHSs, and there was poor staff engagement in the workload management process. Participants in the roundtable agreed to a number of systemlevel recommendations to improve the application of the BPF across Queensland Health. Those recommendations have now been endorsed by the Nursing and Midwifery Implementation Group (NaMIG) and are currently with the Director-General of Health for final approval.

just in

Fantastic Fae wins Emma Miller Award

QH agrees LSL and ADOs cannot be deducted on public holidays Following the QNMU filing an application in the Queensland Industrial Relations Commission (QIRC), Queensland Health has formally agreed that Long Service Leave and Accrued Days Off may not be deducted on public holidays.

Fae Morgan (centre) with QNMU Assistant Secretary Sandra Eales (left) and organiser Krissie Bishop.

Congratulations to this year’s QNMU Emma Miller award recipient Fae Morgan — a keen activist for her local area and the union movement. Fae, a Registered Nurse at Gordonvale Hospital, was nominated for her grassroots activism, both in the workplace and through broader community campaigns, including penalty rates. Her engagement in union issues has helped build strong relationships with her QNMU Local Branch and management, and has encouraged her colleagues to become active both in the workplace and through union training.

“I’m very honoured to be the recipient of the 2017 Emma Miller award. She was such a strong union activist who was unafraid to stand up for the rights of others,” Fae said.

The QNMU will now work with QH to have this leave recredited to the leave accounts of QNMU members if it has been incorrectly deducted over the past six years. If you think you have had leave deducted incorrectly visit http://bit.ly/2ezUhhW to find out more.

“I feel I have a duty to fight to protect and advocate for fairer working conditions … how would past union activists feel if we stood by and allowed their hard work to be eroded? “Touch one nurse, touch all nurses. We are all united in the workers’ goal of fair pay for fair work.” The annual awards are held in honour of Emma Miller — a leading advocate for women’s and workers’ rights in Queensland in the 1800s.

Inaugural awards recognise CQHHS nurses and midwives More than 250 guests gathered at the Inaugural Central Queensland Hospital and Health Service (CQHHS) Gala Awards recently to recognise and honour the outstanding efforts and contributions of CQ nurses and midwives. A big congratulations to the following QNMU members: ■■ Nurse Educator Bree Walker (Rockhampton Hospital) who took home the Employee of the Year Award, and is well known for going above and beyond to help others. ■■ Midwife Maria Fogarty (Biloela Hospital) who won the Compassion Award – need we say more? And of course a big thumbs up to all the other winners on the night — well done!

Employee of the Year Award recipient Bree Walker (right) pictured with QNMU Organiser Grant Burton.

just in

‘Your Work, Your Time, Your Life’ – what did you tell us? Staff shortages, insufficient skill mix, and occupational violence … these were just some of the issues many of our members highlighted in the QNMU’s latest Your Work, Your Time, Your Life study. Conducted every three years, Your Work, Your Time, Your Life gives you and your colleagues a direct say on the issues you want your union to focus on. In fact, it was this very study back in 2013 that drove our Ratios Save Lives campaign which, of course, continues. Some of the key issues identified in this year’s survey were: ■■ A quarter of respondents indicated they were seldom or never able to complete their jobs to their satisfaction. Reasons for this included too many inexperienced staff, too few experienced staff, health service policy on number and skill mix of staff, lack of funding, and lack of effective communication. ■■ 40% of aged care respondents indicated there was insufficient staff to meet patient needs. ■■ Almost 50% of respondents had experienced workplace violence in the preceding three months, with aged care and acute public sector members most likely to experience it. ■■ All sectors noted a lack of sufficiently skilled staff, but it was worst in private aged care.

Midwife Navigators (left to right): Bee Schaeche, Diane Tamariki, Bethan Townsend

‘Navigating’ pregnancy in a complex health system

■■ Many respondents raised concerns about the effects the working environment was having on their physical and mental health.

Vulnerable women and their babies will benefit from better support and streamlined services, thanks to the newly created Midwife Navigators.

The 2016 research was conducted by Curtin University.

These positions, which the QNMU lobbied the state government for at the last election, are being rolled out on the Gold Coast.

To read the Your Work, Your Time, Your Life short report, visit http://bit.ly/2fENDe7 Thank you to those members who took the time to complete this important survey. Your responses will help drive our union’s priorities and ensure we remain focused on the issues that make a difference to you and your professions.

Midwife Navigators aim to increase engagement with maternity and allied health services for women with drug/alcohol dependence and/or significant mental health issues. The program is also being implemented in Townsville and Cairns, targeting rural and gestational diabetes mellitus women respectively. By keeping the woman at the centre of care and streamlining required services, the aim is to improve perinatal outcomes for these women and their babies. We’re pleased to see these vital additions to midwifery care implemented and hope the roll-out continues throughout Queensland.

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School nurses

â&#x20AC;&#x201C; link ing health and education

We all think we know what school nurses do... They look after the sickbay and deal with children when they get crook, right? They give out Panadol and BandAids, and when a kid gets really sick they ring the parents and send them home. Pretty straightforward, isnâ&#x20AC;&#x2122;t it?

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he reality, of course, is very different and far more complex.

School nurses provide a range of services for our children and for the broader community, and are integral to children’s development and education. It’s a role that encompasses many responsibilities and challenges. On the one hand you are working with children and adolescents at an individual level, as well as their families and teacher to address various day-to-day health and wellbeing issues. On the other hand you are providing schools with care plans for students with complex health needs and implementing a wide variety of care programs. And then of course there is the reality of being the only health professional in an environment of education professionals. Being a school nurse is certainly not a role you can step into without the right experience and training.

Social model of care Nurses work within a number of programs in the school setting, including the School-Based Youth Health Service, where nurses address the health and wellbeing of students in grades seven to 12. These nurses provide assessments, support, information or referrals to students on a range of issues, from healthy eating, relationships, and personal and family issues, to sexual health, smoking, alcohol and growth and development. Clinical Nurse Helen Cootes works under the School-Based Youth Health Service and said the work can vary widely on a daily basis.

“For example, if the issue is nutrition and you’re working with a family who is under the breadline in finances, their ability to go along with health suggestions is going to be a lot more difficult than doing it with somebody who’s got easy access to money.” Employing a ‘family partnership model’ — recognising that the child and their family are the experts in their lives — is also a key component to how these school nurses operate. “You don’t apply an authoritarian view where you tell the child what they need to do,” Helen said. “It’s about working in partnership and recognising what they’re capable of. “When you’re working with adolescents you have to have an understanding of their developmental capacity.” She said it was very different to having parents implement a GP’s advice. “It’s not like they sit with their mum or dad like it might be at a GP and then the parents go and implement your suggestions. “You have to ensure the young person has the competence to understand what the pros and cons are for their decisions.”

From the ward to school Helen says working as a nurse in the education sector comes with challenges you just don’t get in a more traditional clinical role. “You get more definitive results when working on a ward — like getting a diagnostic result and providing the appropriate drug or intervention — but

in this role where it’s very much on that social model of care and about health intervention, it’s very difficult to capture those outcomes,” she said. “On the flip side, as a school nurse you’ve got that amazing opportunity to develop ongoing professional relationships with students and you see them grow and mature from year seven to 12, and that’s incredibly rewarding to see.”

Compassion fatigue As carers, compassion fatigue is an issue for nurses in all sectors, and school nurses are no exception. “You can hear appalling things day after day,” Helen said. “You’re the only nurse in a school of sometimes thousands, so if you don’t have really good personal and professional boundaries and you’re getting drawn into a young person’s life and their story, of course that’s going to have a massive effect on you.” Helen said one of the most challenging aspects about the role was the lack of resources available to young people when it came to referrals. “When you work with a young person and you realise their issue is outside your level of training and scope of practice – it may be a mental health issue or they might be at risk of homelessness – then there is a real lack of available services. “Unless the family has got the money for a private psychologist, your options can be really limited. “On a lighter note, by the very nature of adolescent development, young people can come to you in tears and their world is caving in

“It can go from a student coming to you for advice about a biology assignment on the reproductive system, all the way to someone who has got significant mental health issues,” she said.

It can go from a student coming to you for

Helen said the program operated under a social model of care.

reproductive system, all the way to someone

“Rather than primarily using a medical model where you look at the complication in the person, it’s more about having a holistic view,” she said.

advice about a biology assignment on the who has got significant suicidal issues. Helen Cootes

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one second, but by next break it’s all resolved. “It’s all about understanding that brain development and what’s going on for that young person. “If you get that then the job is fine and very fulfilling, but if you don’t then I’d imagine the job would be very frustrating.”

State School Registered Nurses Operating alongside the SchoolBased Youth Health Service is the State School Registered Nurse program (SSRN), which provides nursing services to students with specialised health needs. Registered Nurse Trish Rohl said the program’s services included risk assessment, developing individual

or emergency health plans, and training teachers and teacher aides to manage students’ health needs. “For example, if a student has epilepsy we would do an individual health plan for their day to day school needs and emergency health plan for what the school needs to do when the student has a seizure,” Trish said. “We would also do a big general training session for the entire school on epilepsy management, as well as individual training for relevant school staff, such as the classroom teacher, on individual students’ needs, including emergency medication.” Working with non-medical professionals is also a unique challenge for SSRNs.

don’t necessarily have a medical background. “Giving them enough information to make it work for the student but not giving them so much so they don’t feel overwhelmed is challenging.”

Working autonomously Trish said one of the most important skills required of SSRNs was the ability to work independently and have excellent communication skills. “I think the biggest challenge our nurses face when they start working in the education

“While our teachers are all awesome, they’re teachers so they

I think the biggest challenge our nurses face when they start working in the education system is the need to be autonomous. Trish Rohl, RN

indepth system is the need to be autonomous,” Trish said. “They are generally in a base on their own, and if there are other nurses they’re lucky but it does not always happen. “They need to go from a very health focused model to an education focus. “The language is so different. We often talk about health speak and education speak — we literally translate health department speak for education staff.” Helen said it was a similar situation for nurses working in the SchoolBased Youth Health Service. “Because you’re on your own and you’ve got this massive scope of role boundaries where you can make it your own and work pretty much autonomously, that’s fantastic, but it can be a bit lonely at times,” she said. “Working on a ward you’ve always got someone there to bounce off and you know at the end of your shift someone is stepping in to carry on that care 24/7.

School nurses win big under enterprise agreement State School Registered Nurses recently had a significant win by joining their Queensland Health nursing colleagues on their enterprise agreement (EB9). The move to EB9 resulted in significant wage increases and improvements to conditions. The QNMU had long argued that SSRNs were underpaid for their work compared to Queensland Health nurses. With the election of the Palaszczuk government in 2015, we secured a commitment from the government that SSRNs would remain employed by the Department of Education and Training but would be covered by EB9.

What we secured for SSRNs ■■ Wage increases of: ◆◆ 14% (approximate) for NU6 ◆◆ 27% (approximate) for NU7 For many nurses this resulted in an individual wage increase of $10,000-$24,000 a year. ■■ Professional development leave (three days per year)

“Here you leave and if you’ve got concerns, there is no one to hand over to make sure that person is being looked after.”

■■ Professional development allowance of $1765 per year

Improving education

This win, which we argued for many years to achieve, acknowledges the important work these nurses do and brings them in line with their Queensland Health colleagues.

Ultimately, improving a young person’s health — whether it be physical, emotional or social — leads to improved learning, which is something both school nursing programs aim to achieve.

■■ The employment of an additional 10 FTE SSRNs ■■ DET committed to provide the same Information and Communication Technology resources to SSRNs as it provides to school teachers.

Congratulations to these members, and a big thank you to the Reps who helped make this possible.

“If their health conditions are managed really well at school and the staff are aware of what’s needed, they generally learn better and they’re able to attend school and participate better,” Trish said. “There are a lot of students who would attend school far less if they didn’t have school staff trained to meet their needs, especially students who are really complex or newly diagnosed with a condition. “And our aim is to get in there day one.”

School nurses celebrating their win.

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A pet a day They may not keep the doctor away, but one tail-wag at a time these furry volunteers are enriching the lives of Aussies through pet therapy.

Helen and Belle

Mater Pet Therapy Program

indepth More than man’s best friend Many of us share a special bond with our four-legged companions. They’re a constant source of comfort and joy, a non-judgemental listening ear at the end of a long day and, most importantly, they’re there for you no matter what. There’s no doubt dogs have earned their moniker of man’s best friend. And it’s this special bond between human and animal that is at the cornerstone of pet therapy, an initiative swiftly gaining popularity as a pathway to supporting patient rehabilitation outcomes. Every Thursday, Registered Nurse and QNMU member Fiona Morton volunteers her time to take her KelpieRidgeback pooch Ruby to visit patients at Mater Hospital Brisbane. The duo are part of a specialised team from Delta Therapy Dogs, a program that brings the joys of animal companionship to about 20,000 Aussies in hospitals and health care facilities.

started talking to her and telling her stories about the dogs he’d owned previously,” she said. “It was amazing the difference she made just by being there. “Over the next few weeks he developed a special bond with Ruby and he would light up every time she came into the room. I found it very special to witness their connection.” In 2013, Mater Volunteers launched a brand new pet therapy program thanks to a family’s bequest to the Mater Foundation. The program was introduced to provide patients with the benefits of one-to-one therapeutic intervention

as part of a patient’s rehabilitation journey. Mater Pet Therapy Program volunteer Helen Squibb and her Pyrenees Mountain dog Belle work closely with an allied health professional to achieve specific rehabilitation goals. Helen said for many patients they were a welcome alternative to the monotony of gym sessions. “Last year we saw a young 16 yearold girl who had a brain bleed and was recovering from surgery,” Helen recalled. “She was constrained to a wheelchair and very weak in an arm

Fiona and Ruby

Delta Therapy Dogs

And the past six years have seen them make an amazing difference to patients who are at their most vulnerable.

A helping paw Fiona said pet therapy was a welcome distraction for many patients who had already seen a number of doctors, nurses and medical teams during their stay in hospital. “It’s just something different for them and it’s nice for people to cuddle a dog and spend some time talking to somebody who just listens,” she said. “People just relax straight away, the entire mood of the room lifts and it’s very special. We see a lot of older people and many with dementia who are waiting to go into other forms of specialised care.” Fiona recalled one of her first visits with an elderly gentleman who had not spoken since his admission a few days earlier. “When we arrived at his room, Ruby went straight up to him and put her head in his lap and he immediately

indepth and a hand, so we would get her to use her weaker hand to groom Belle and balance wooden blocks on Belle’s back. This helped to reboot her fine motor skills and regain strength and mobility. “We progressed to the point where she could stand up out of the wheelchair and hold onto Belle for support, and was soon able to walk Belle around the ward and get stronger in her ability to walk again.”

Paul and Belle

Forming a bond For some, coming face to face with a 45 kilogram Belle can be intimidating. But Paul Sheppard is a patient who has benefited firsthand from Belle’s kind nature, and said he formed a special bond with the gentle giant. “I’m used to dogs like retrievers but Belle was huge and I was a little apprehensive but she won me over,” Paul said. “I worked with a number of dogs while in hospital, but I miss Belle the most and she’s the one that made the biggest impact for me.” Paul was admitted to Mater Hospital last year with a brain injury. When he woke, Paul had limited speech or movement and was unable to walk for the first three months of his stay. “I was in a bit of a panic when I woke not being able to speak or move properly,” he said. “I couldn’t even feed myself and it was frustrating. So when the occupational therapist suggested pet therapy I jumped on it straight away. “My movement and speech all seemed to come along in leaps and bounds once I began therapy, and every session I would get a little better.”

Getting into shape But it’s not all fun and games for these dedicated dogs, who are handpicked to undergo strict behaviour training. While Fiona described Ruby as a naturally mild-tempered dog, Ruby was also trained to be exceptionally calm in overwhelming situations such as large groups or crowds. “Dogs with the Delta program undergo basic training and temperament testing, so if they hear a loud noise or someone pets them a bit too roughly they won’t react at all. Basically nothing fazes them,” she said. “They even have to undergo what’s called ‘The Muffin Test’... They have to walk past a muffin at nose height and ignore it. A pretty big ask for a dog!” As a Mater Pet Therapy dog, Belle underwent eight weeks of tailored training by Brisbane-based Positive Response Dog Training, to ensure she exhibited the right behaviours to provide the best rehabilitation outcomes for patients. This included Belle being trained in a variety of mock situations, and ensuring she wouldn’t be distracted by the myriad of sights, smells and sounds of a hospital. Her handler Helen even taught her to wave goodbye to patients, something that has now become Belle’s signature move.

My rehabilitation included gym, physiotherapy and a number of other programs. But of all of them, pet therapy was the one that made the biggest difference to me. Paul Sheppard, patient

indepth And if Belle could speak, she’d tell you she takes her job very seriously. “She knows when she’s on the job. As soon as she sees me getting all her paraphernalia like her bags and treats and her little vest goes on she knows she’s off to work!” Helen said. “Sometimes we have to conduct sessions in confined spaces when there’s a lot going on so a lot of work goes into teaching Belle to keep focused on the session. “We constantly reinforce her training by getting her to obey certain commands every evening, so we know she’ll exhibit those behaviours no matter the setting she’s in.”

Does pet therapy actually work?

Dogs making a difference The inspiring tales of Ruby and other Delta Therapy dogs as they bring hope, help and healing to people’s lives are featured in a book ‘Dogs that make a difference’ by Saskia Adams. The book is available from all good bookstores as well as Target, Kmart and Big W and online from Bookworld: http://bit.ly/2wnm3W2 All book proceeds go toward the Delta Therapy Dog program.

Recent research into the physiological effects of animals on humans have showed measurable benefits of pet therapy.

According to pet therapy beneficiary Paul, the proof is in the pudding.

and after four months was able to be discharged.

It was found animals have a profound effect on the physical and emotional responses of patients, including reduced blood pressure, decreased anxiety and pain, and improvements in mood.

“It worked for me and I would recommend pet therapy for anyone in hospital who needed it,” he said. “I went into the therapy hoping for a good result and I’ve got one.”

“My rehabilitation included gym, physiotherapy and a number of other programs. But of all of them, pet therapy was the one that made the biggest difference to me,” he said.

As an animal lover, Paul looked forward to Belle’s visits each week

“I’m now on the path to getting my driver’s license and once I do I’ll

indepth be able to go back to work which is something I’m really looking forward to.”

People just relax straight away, the entire mood of the room lifts and it’s very special.

Fiona said she was conscious of concerns about animals on a ward being considered an infection control risk, but patients were protected by stringent infection control protocols. “All the dogs that go into a hospital facility are washed prior to entering and pathology tested every three months,” she explained.

Fiona Morton, Delta Therapy Dogs volunteer

“They are very, very clean but we still encourage anyone who pats them to wash their hands afterwards to reduce cross infection. The dogs aren’t allowed on beds without a protective blanket to minimise infection risk. “We’re very strict with this because it would only take one little mishap for the whole program to cease and we’ve worked so hard to get the program to where it is today. We don’t want to put it in jeopardy.”

Sharing the love While furry participants clearly take centre stage, programs such as Delta Therapy Dogs and Mater Pet Therapy also rely on the hard work and support of two-legged volunteers like Helen and Fiona, who generously donate their time to the cause. As a Registered Nurse, Fiona’s innate need to help others was at the heart of her decision to volunteer for the role, and there is no shortage of people who might benefit from her and Ruby’s help. “The program has come such a long way and we’ve expanded to include a number of other programs like Classroom Canines, where dogs go to schools and help children overcome their reading difficulties; and Paws the Pressure, which is where workplaces can request for dogs to visit their workplaces or universities to help people de-stress or just have a bit of down time with the dogs,” Fiona said. “It makes such a difference even to staff at the hospital, who really appreciate seeing the dogs when they’re having busy days at work.” For Mater Volunteers Helen and Fiona, giving their valuable time to pet

therapy was a way to share the joys of their pets with the world and give back to the community.

It’s a dog’s life

“It’s a really rewarding thing to see patients rehabilitate and gain that benefit from pet therapy,” said Helen. “I’m really fortunate to also be employed by the Mater Young Adult Health Centre Brisbane so I get to pair up with occupational therapists within the centre as well, and help support our younger generation there. “It’s kind of a dream come true to be able to give back.” Find out more about Delta Therapy Dogs at www.deltasociety.com.au and the Mater Pet Therapy Program at www.mater.org.au

Follow Belle’s adventures on Instagram as she helps change the lives of patients at Mater Hospital! www.instagram.com/ babybelleoz

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Did

you

know?

■■ Pets have been proven to reduce high blood pressure, relieve anxiety and promote longer lives. ■■ Research shows pet owners have a reduced risk of developing heart disease due to lower blood pressure and triglyceride and cholesterol levels. ■■ A study found elderly residents in nursing homes who were exposed

to pets consistently smiled more and became measurably more alert than those who did not encounter animals. ■■ A large and growing arsenal of scientific evidence shows pets are of vital importance to the health and happiness of the aged. Source: The Pets for the Elderly Foundation

‘Hensioners’ and the power of chooks Therapy dogs might be a common sight but a new initiative in New South Wales’ nursing homes is raising a few eyebrows and eliciting a few ‘chook’-les. HenPower is an Australian-first trial by The Whiddon Group which aims to promote the wellbeing of aged care residents through the practical aspects of hen-keeping. Aptly dubbed ‘Hensioners’, the residents there form bonds with chickens which gives them a sense of purpose and helps combat loneliness and depression. The trial has been successful in a number of Whiddon’s residential care homes across NSW, with residents showing health and wellbeing benefits from looking after the hens and participating in creative activities. HenPower won a Better Practice Award in 2016 and the initiative has now been implemented across Whiddon’s residential services. Find out more at www.whiddon.com.au Photos: The

Whiddon Gr oup

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Penalty rate cuts – more than meets the eye

UTS TO penalty rates for thousands of retail and hospitality workers began on 1 July, the very day federal politicians received a pay rise and a tax cut.

To add insult to injury, Clubs Australia applied to put club workers on to the hospitality award where penalty rates had already been cut. Nurses and midwives stood in solidarity with club workers, and together with other unions we were successful in securing commitments from a number of clubs to protect their workers’ penalty rates. However, despite strong campaigning and overwhelming public outrage, more companies are lining up to slash penalty rates. And nurses and midwives’ penalty rates aren’t safe. Our penalty rates recently fell prey to a number of employers, particularly in the vulnerable aged care sector where nurses are already underpaid, overworked and job cuts are rampant. We saw the slippery slope become a reality when Sonic HealthPlus proposed a 25% cut to nurses’ Sunday penalty rates in their new enterprise agreement. PresCare followed suit with a proposal to abolish penalty rates for community care staff working afternoon shifts (which would have cost nursing staff up to $7.15 an hour). Thanks to staunch community support and our members standing united, Sonic HealthPlus and PresCare both withdrew their attacks on nurses’ penalty rates. This was a great outcome and an example of what can be achieved when we work together. Employers have learned we won’t stand idly by while our hard-earned penalty rates are snatched from us…

But now they’re finding creative ways to cut our penalty rates. In a proposed enterprise agreement, Carinity aged care launched a sneak attack on nurses’ penalty rates by redefining afternoon and night shifts. Essentially this would have abolished penalty rates on shifts starting between 12pm and 2pm and reduced night shift penalty rates. While this would not be an obvious attack on penalty rates, management would have had both the incentive and ability to change nurses’ start or finish times just enough to avoid paying penalties. But we exposed Carinity’s tactics, and once again the community rallied behind our nurses and Carinity dropped its attack. While we’ve been fortunate to have defeated a number of attacks on nurses’ penalty rates, the question on everyone’s lips is “who’s next?” The QNMU and other unions will continue to stand up to protect our penalty rates. We believe the sacrifice of Australians in working these shifts deserves proper compensation. You can get involved by asking your friends and colleagues to join our fight against penalty rate cuts. We’re stronger when we stand together.

Backing our workers Some businesses have committed to protecting penalty rates for their workers despite the Fair Work Commission’s ruling. By supporting these businesses, you’re making sure your money goes to fair wages. Find your local supportive business at www.businesses4penaltyrates. com.au

Clubs worker and United Voice member Selina Young.

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Cricket –

One Game, One Voice Opinion by Dr Liz Todhunter, QNMU RESEARCH AND POLICY OFFICER

e may not all particularly identify with high-profile cricketers and their earning capacity, but the recently resolved pay dispute between the game’s national governing body Cricket Australia (CA), and the collective and representative voice of male and female elite cricketers, the Australian Cricketers Association (ACA), has demonstrated how the first principles of unionism will inevitably bring results. In the game’s very early stages, cricketers not only played the sport, but selected national teams, promoted it and ultimately benefited from it. Around 100 years ago, the Australian Board of Control for International Cricket was formed to control the game’s management on the basis that rewards were too focused on the elite players. Later it renamed itself the Australian Cricket Board and in 2003 became Cricket Australia. Tension between cricket administrators and players is not new. In 1997, the players founded the ACA to claim a share of some of the revenue flowing to the game, improve the welfare of members,

safeguard their rights, provide advice and promote the sport. Sounds like a union, however, the ACA is not formally registered as a trade union. Rather, it is an Incorporated Association. Hitherto, CA has also been able to control the game and the players through lucrative media rights and individual contracts. However, over the past 10 months, the players have sought a more equitable distribution of the profits that they, through their cricketing performance, generate. For CA, like most employers, this represents an incursion not only into the game’s affluence but also its control. Perhaps CA has become too corporate, bureaucratic and unaccountable. At its core, this player’s dispute is one of contested power and brinkmanship. At some point, the realisation corporate wealth is growing while wages stagnate will also hit other Australian workers. They too may return to trade unions to pursue better wages and conditions. Australian elite cricketers may earn much more than the average worker,

but for ACA, the player’s unwavering commitment to each other and their principles have been the hallmark of their success. It takes courage to put your livelihood on the line to pursue a collective goal, particularly the young, lesser earning women players who stood alongside their higher paid male colleagues. Ultimately, these women have made tremendous gains for themselves and the sport itself. As is often the case in dispute resolution, both sides claimed victory and indeed there were some great mutual outcomes. However, the winner in all this is the union tradition of solidarity. There may be many other industrial tactics that come into play during a dispute, but none of them will bring results without unity of purpose, belief and action. Unfortunately, relationships can suffer and ongoing ‘good faith’ may be again tested in future discussions. What is uncontested though is the right of workers or players to band together for a greater good that leaves its legacy in improved conditions for those who are yet to come.

...the winner in all this is the union tradition of solidarity.

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The 88-minute difference

One hour and 28 minutes. Itâ&#x20AC;&#x2122;s enough time to watch Toy Story with the kids, bathroom break included. Itâ&#x20AC;&#x2122;s also enough time to cook a roast chicken or drive from Brisbane to Nambour. One hour and 28 minutes is also how much nurse-to-resident time our aged care residents are missing out on each and every day.

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issed care in aged care has been a hot topic in the media in the past few months. Horror stories of serious cases of missed care from Bundaberg to Oakden have created plenty of fodder for news headlines and sadly, again, the only ones being held accountable for gaps in care are the overworked, underpaid nurses and carers on the frontline. We know the problems in aged care do not lie with nurses and carers — we know it’s systemic and we know that at its core it comes down to not having enough nurses on shift and not having the skill mix needed to keep residents safe.

An extra 88 mins per day per nurse equals...

4-5

1 shower = 15-20 minutes

— OR —

10-12

In June the Australian Law Reform Commission’s report, Elder Abuse – A National Legal Response, revealed some fairly damning evidence about declining numbers of qualified staff in aged care and the rise of untrained carers. It found about 70% of direct care workers in residential care in Australia are now AINs or Personal Carers (PCs), some of whom have no minimum training qualifications. The Commission’s report is an excellent companion piece to the ANMF’s National Aged Care Staffing and Skills Mix Project Report released earlier this year. The ANMF report cited evidence stating residents should receive an average minimum of four hours and 18 minutes of nursing per day compared with the two hours and 50 minutes currently being provided. Put simply, poor staffing numbers meant aged care residents on average were missing out on about one hour and 28 minutes of care each and every day.

more residents having their teeth cleaned

1 cleaning = 5-8 minutes

Those who should be carrying the burden of blame are the private aged care providers favouring shareholder profits over patient safety and the federal politicians who have refused time and again to address the systemic issues. And it’s not as if there isn’t evidence drawing the link between staffing and resident care.

more residents being showered before breakfast

— OR — residents who require feeding eating lunch at their own pace 1 dinner = 20 minutes

— OR —

more residents being turned in bed to prevent pressure sores

1 resident (2 staff) = 10-15 minutes

— OR —

5-6

residents having their fingernails clipped

both hands = 10-15 minutes

— OR —

8-9

residents enjoying a 10 minute bedside chat and check with a nurse

Surely the fact that residents simply aren’t getting the care they need or deserve should be evidence enough.

on basic but critical nursing, including showering, feeding, hydration and oral hygiene.

Or perhaps we need to break down just what missed care really means.

It also means residents are at greater risk of falls if they attempt movement without nursing staff, weight loss and dehydration because they aren’t fed or hydrated adequately, and pressure injuries

What is missed care? The gap in care of 88 minutes means many residents are missing out

indepth because there’s a decreased opportunity to turn them over in bed. In fact, acording to a recent Monash University study, the number of aged care residents dying prematurely from potentially preventable injuries has quadrupled in a decade and it’s hard not to conclude that the reason, at least in part, lies with inadequate staff levels and poor skill mix. This isn’t just a problem — it’s a national disgrace.

So what does 88 minutes of care look like? QNMU aged care member Pam said 88 minutes means dignity. “A lot of people like to be up, showered and dressed for the day before they go to breakfast, but because we don’t have enough staff, I don’t get a chance to do that for everyone who wants it,” she said. “I have to modify the care I give because I just don’t have time, I at least try and give everyone a sponge if I can’t do a shower, but if we are particularly short staffed I might only have time for a top-and-tail.” She said an extra 88 minutes would be a ‘godsend’. “Eighty-eight minutes per resident is the difference between doing the best you can and doing everything they need,” she said. “I could get more people showered and I could spend time with them, trimming their nails — even spending a few minutes talking with them rather than rushing through the tasks and dashing off to the next resident. “It’s about that personal contact — that’s when you notice things, you are more attuned to their condition and you can identify changes a lot earlier and pass that on to the RN.” Another member identified only as Mau said short staffing meant residents were at the mercy of unreasonable schedules. “It’s terrible when you have to keep apologising to someone who is dying to go to the toilet that you just can’t get to them at the moment because there is nobody available to help you get them into the hoist.

“You try to do what you can, but when there are four of us AINs for more than 70 residents it’s difficult. “In my facility we have a set timeframe to get people up for a shower in the morning but I refuse to wake people up at 5am for a shower – nobody wants to get up that hour for a shower, but then I get into trouble – it’s a fine line we walk really.” Mau, an AIN, said 88 minutes would make a huge difference to the quality of life for her residents. “I could keep on top of nail trimming and brushing teeth which would be great. I often don’t get a chance to do more than a couple at a time.” She said she’d also take more time with residents who need help eating. “Some of these people take half an hour to eat a meal and if I’d like to let them eat at their own pace. “I mean, think about it, I wouldn’t like someone shoving food at my face every few seconds because they were hurrying to get on to the next person. “But sometimes you don’t get a choice, it’s like an assembly line and it’s awful.”

“That’s a recipe for disaster — it’s bad for the residents and for the new carer, and the chances of something being overlooked, something serious, is real.” Both Pam and Mau said they loved their work but felt they were letting the residents down. “You come home feeling guilty and heartbroken because you can’t do any more for these lovely people and you think ‘am I in the right job?’,” Mau said.

We need action These sort of stories, told by frontline nurses and carers, paint a devastating picture. But all too often members working in aged care are scared to speak out for fear of losing their jobs, particularly in regional areas where options for work are limited. The current aged care system issues are a failure of regulation and we know if there were similar problems in public hospitals there would be demands for political intervention.

Mau said there would also be more time to train newcomers on the job.

It is the responsibility of government to ensure aged care providers do the right thing by older Australians and their hard-working staff who keep the system going.

“At the moment, because we are so short staffed, sometimes they get only one buddy shift before they have to strike out on their own,” she said.

Yet consecutive federal governments, which have known about the problems in aged care for a very long time, have repeatedly failed to act.

“It’s nowhere near enough and one shift doesn’t cover off on all the different areas of the facility and the differing needs of the residents… so you can get someone who has never worked in dementia going in cold.

So it’s up to all of us to make the public and the government stand up and take note, and we will be doing this through the national ANMF Aged Care campaign.

“You’d never think it happens that way but it does.

Check out the What Can I Do? box on the next page to see how you can join us.

Eighty-eight minutes per resident is the difference between doing the best you can and doing everything they need. Pam, QNMU aged care member

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How do we fix it? We have a very clear idea on how to fix the problems in aged care, but it requires the federal government to stop pandering to the profitmaking aged care providers and make a genuine commitment to older Australians. ■■ The federal government must legislate minimum staffing and skill mix levels for the safety of residents and to ensure enough time for proper care. ■■ There must be a Registered Nurse on site at each aged care facility 24/7. ■■ The federal government and Aged Care Minister need to act now to bring aged care providers into line to protect the safety of residents. ■■ Wages in aged care need to be in line with the public sector to attract and retain skilled staff. ■■ Comprehensive standards for aged care, like those in the hospital sector, need to be developed and implemented. ■■ Aged care accreditation processes need to be made more effective. ■■ Unlicensed carers must be subject to a registration scheme with minimum standards of training for the safety of residents and staff. ■■ The federal government must implement an aged care funding process that covers the real cost of ensuring safety and dignity in aged care. ■■ Aged care providers must be required to report on: ◆◆ how public funding is spent ◆◆ staffing levels and skill mix ◆◆ resident harm and care outcomes.

What can I do? Tell us your story. Complete the ANMF national survey at www. surveymonkey.com/r/D95M562. Talk to your family and friends. Educate them, get them involved. Contact federal Aged Care Minister Ken Wyatt. Call (02) 6277 7720 or email ken.wyatt. mp@aph.gov.au. Become a QMNU Resident Safety Advocate. Contact your Organiser or nearest QNMU Office.

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LGBTI

mental health –

Let’s ta lk about it

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he journey to equality for the gay community has been marked by significant milestones over the past few decades. From violent police action during the first Sydney Mardi Gras march in 1978 to the eventual decriminalisation of homosexual sex in all Australian states in the early nineties, the gay movement has made steady progress to shift society’s perceptions and challenge homophobia. In March this year the Queensland government finally scrapped the ‘gay panic’ defence, an outdated and homophobic law that allowed murder charges to be downgraded to manslaughter if the killing was triggered by so-called unwanted homosexual advances. In November last year it became legal for same-sex couples in Queensland to adopt. And in May this year, Queensland Premier Annastacia Palaszczuk delivered an historic apology for the harm caused by laws that criminalised homosexuality. But there is still much to be done. The community, which is now generally referred to under the more inclusive banner of LGBTI (lesbian, gay, bisexual, transgender and intersex), still faces a daily battle against discrimination. And it’s costing lives. For all the progress towards acceptance, LGBTI people are still five times more likely than their heterosexual peers to attempt suicide (National LGBTI Health Alliance, 2016). And this includes schoolkids. Funding for the Safe Schools program — which was designed to educate school students about sexuality and gender diversity – dried up in June this year. Former Liberal Prime Minister Tony Abbott dismissed the program as a “social engineering program dressed up as anti-bullying”. But the program’s defunding is a real concern for LGBTI students and their families who hoped the program would create kinder, fairer schoolyards.

Even as the political debate over Safe Schools raged, the need for the program was tragically brought home in November last year, when 13-yearold Queensland student Tyrone Unsworth took his own life after years of being bullied because of his sexuality. Tyrone’s story resonates loudly with thousands of LGBTI people and their loved ones. Many LGBTI children and adults alike struggle with depression, self-harm and other mental health issues because of how society perceives their sexuality or gender. But the mental health of the LGBTI community is an issue that affects all Australians. At least 11% of our population identifies as LGBTI (Australian Human Rights Commission, 2011) — these are our family, friends and colleagues. As nurses and midwives this 11% are also patients and residents in our care, and we have a role to play.

Focusing on mental health Christopher Johnson is a Clinical Nurse working in mental health on the Gold Coast. He said while the stigma of mental health is common to almost all patients, there were often additional issues at play for people struggling with their sexuality or gender identity. “We see patients when they’re at their worst mental state, whether they’re suicidal or psychotic or on drugs, but because of their sexuality, sometimes they feel quite abandoned and alone and without resources,” Christopher said. He said one of the bigger issues for LGBTI patients is homelessness, as many have been thrown out of home or rejected by loved ones. “We rely a lot on family members being involved in the follow-up care and treatment, and unfortunately a lot of people in the LGBTI community don’t have that. “Acceptance is still a big thing.” The result, of course, is that the health outcomes for these patients are poorer than they could and should be. While there have been many legislative changes made to progress

Mental health in the LGBTI community Compared to the Australian heterosexual population… ■■ LGBTI young people aged 16 to 27 are five time more likely to attempt suicide ■■ Transgender people aged 18 and over are nearly 11 times more likely to attempt suicide ■■ LGBTI people are twice as likely to be diagnosed and treated for mental health disorders ■■ LGBTI people aged 16 and over are nearly three times more likely to be diagnosed with depression ■■ LGB people aged 16 and over are three and a half times more likely to be diagnosed with anxiety, while transgender people aged 18 and over are nearly three times more likely to be diagnosed with an anxiety disorder. National LGBTI Health Alliance, 2016

the rights of LGBTI people, it’s still very easy for them to be overlooked or forgotten if they don’t already have their own support network in place. “Because LGBTI people are so supposedly accepted these days, it’s like it’s all good,” Christopher said. “But quite often that’s not the case, and some of our patients tell a very different story. “Particularly in regional areas, there aren’t those strong links to community supports that we as nurses can refer patients on to. “In the south east corner — particularly Brisbane — you’ve got the Queensland AIDS Council, you’ve got a lot of community services, and even where I work on the Gold Coast there are links to where we can refer LGBTI people on to. “But if you go out further into rural communities, they’re less likely to have that.

indepth “The internet has broken down a lot of those barriers for young people growing up and is helping them feel less isolated, but there’s still not that connection to community or support groups. “Most often these people will be referred on to the nearest city. Queensland is a huge state, so that can obviously be a barrier for people.” As Christopher notes, many of the LGBTI patients he cares for in Mental Health have drug or alcohol issues. It’s an experience backed up by statistics indicating that rates of alcohol and drug abuse are higher amongst the LGBTI population than they are in the straight population. The 2010 Writing Themselves In study concluded, “Many of these young people are… self medicating to ease the pain of the rejection and hostility in their families, schools and communities”, a conclusion the study claims challenges “the tendency in literature to think of the higher rates of drug use in LGBTI adults as connected with sociability and the gay lifestyle”. Executive Director of Operations at Mind Australia and Mental Health nurse Bronwyn Lawman said stigma, prejudice, discrimination and abuse all contributed to these significantly higher statistics for LGBTI people across a wide range of health issues. “While it’s tempting to think the broader community accepts samesex attraction — and most people do — the actual levels of violence and discrimination tell a very different

story and we’ve got a long way to go,” Bronwyn said. “And there are other problems associated with being part of a marginalised group: if you find you’re being discriminated against in terms of employment, housing, access to appropriate health care and welfare, it all leads to disadvantage and poverty for a lot of people, and that further adds to stress and high rates of mental illness. “It attacks your sense of self-worth and safety and belonging, and I think we all need those things to feel safe in the communities we live in and to have good mental health.”

Our opportunity to make a difference for patients According to the Queensland AIDS Council, “LGBT people often underuse and are reluctant to access mental health services due to their expectations of prejudice and discrimination, especially when they are vulnerable or because they feel services will not understand their specific issues and needs”. Nurses and midwives are therefore powerfully placed to make a real difference to the care LGBTI people receive in our health system. “I think nurses and midwives in general can make or break the milieu for patients in the sense that if they have an attitude about it, it can render their treatment in a negative way,” Christopher said. “So they do have a big role to play in the mental health of LGBTI people.

Really it goes to our core values as nurses and midwives to not be judgemental.” Bronwyn agreed, noting that being aware of the diversity of our patients can impact their experience in the health system. “I think nurses and midwives should absolutely care about this stuff,” she said. “A better understanding of the experience of, for example, what it would feel like to transition from one gender to another is important to the care we deliver.”

An evolving language We’re now living in a world where binary social constructs of gender and sexuality are being challenged. No longer is it just male or female, straight or gay. New terms have entered the vocabulary, such as intersex, genderqueer and Mx. Keeping up with the latest terms to describe the ever-evolving scale of sexuality or gender can be complex — there’s suddenly a whole new language for people to wrap their heads around. “It can be hard for people to understand it,” Bronwyn said. “Just being aware of the range of pronouns that people might want to call themselves is really new territory.” As illustrated by the ‘genderbread person’ diagram (right), no one size fits all. But engaging our patients and residents in a way they want to be engaged is vital to that person’s health care.

Where to get help - there is support available Lifeline – 13 11 14 Queensland AIDS Council – 07 3017 1777 QLife – 1800 184 527 Australian Transgender Support Association of Queensland – 07 3843 5024

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The Genderbread Person v3.3 Identity Woman-ness

○{ Attraction

Man-ness

Gender Expression

Expression

Feminine Masculine

Sex

○{ Sexually Attracted to

○{

(Women/Females/Femininity) (Men/Males/Masculinity)

“Sexuality, how we present ourselves, how we appear physically, who we’re attracted to, it’s really complex stuff,” Bronwyn said. “Even for the straight community, how they appear, who they fall in love with, it’s different for everyone.”

More than the right to marry And then there’s marriage equality. While on the surface the fight for marriage equality may seem like a straightforward civil rights issue, there are also mental health implications. Evidence from countries that have achieved marriage equality suggests “significant improvements in wellbeing are gained by LGBT people when their relationships are socially and legally accepted” (ACON, 2016). Significantly, a recent study in the US suggests marriage equality may be associated with a drop in mental health issues amongst LBGTI people. The report, published in The Journal of the American Medical Association

Female-ness Male-ness

Romantically Attracted to

○{

(JAMA) Pediatrics journal, collated data from 47 American states and found that “same-sex marriage policies were associated with a 7% reduction in the proportion of all high school students reporting a suicide attempt within the past year. The effect was concentrated among adolescents who were sexual minorities” (Raifman et al, 2017). While every eligible Australian will now get the chance to vote on marriage equality, there are concerns the debate and the tone of some of the campaigns could have a damaging impact on the mental health and wellbeing of many vulnerable LGBTI Australians. It’s for this reason the state government recently announced an additional $338,000 to help nongovernment support organisations cope with an expected increase in demand for their services during the voting period.

(Women/Females/Femininity) (Men/Males/Masculinity)

Source: Sam Killermann, www.itspronouncedmetrosexual.com

○{

QNMU’s position The QNMU supports marriage equality and recognises that embracing diversity and opposing discrimination against LGBTI people are important and necessary steps towards equality and health for all members of society. The QNMU’s policy was developed by the QNMU Policy Committee (QPC) following the endorsement of a federal policy by ANMF biennial delegates. The policy was voted up by QNMU delegates at our 2014 Annual Conference, and was then endorsed by QNMU Council. All Delegates, QPC and Council positions are democratically elected by QNMU members. Visit http://bit.ly/2qPWfQt to read the full policy..

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Life as a transman: A member’s story For QNMU member and Registered Nurse Jack*, the road to understanding his own gender and sexuality began when he was 12. The member asked to remain anonymous but will be referred to as Jack in this article. *Not member’s actual name

“I first came out as a lesbian when I was 12, and I put that down to simply lacking any language around gender identity,” Jack said. “I think it was year 12 when I first met a trans person. “There was a super lack of visibility back then. So when I met that person my reaction was, ‘Oh yeah, this potentially fits. This is super scary and I’m not going to talk or think about it for a while’.” The term ‘gender dysphoria’ is often used by trans people to describe (as Jack puts it) the “lack of matching between how you appear and how society views you”.

they were interfering with everyday life.

“That feeling is really crushing and obviously causes a lot of anxiety.

“My family did not take me coming out as gay terribly well, so I was pretty stressed that they wouldn’t like the concept of me being trans even more.”

“For trans people you’ve got this total disconnect between mind and body and there’s no real way to fix it without taking drastic measures in terms of physically transitioning.”

It was during Jack’s university placement at a mental health ward that he finally decided to take action.

The unfortunate reality for many LGBTI people struggling with their identity is the double stigma of how society views the LGBTI community, and the mental health issues that often result from that.

“I was on a mental health ward and I suddenly thought, ‘Wow, half these people are less ill than I think I am, but they’re all seeking help’. Straight after my placement I got connected with a few services.”

A double stigma

“One newspaper recently published an article that said generation Y has no hope without being healthy, and right in the centre of it was the figure of 16% of individuals identify as LGBTI,” Jack said.

“People can have gender dysphoria about their voice, their chest, anything that is particularly binary-gendered,” Jack said.

For Jack, the process of coming out — first as gay and then as trans — caused a lot of depression and anxiety.

“So these things can lead to depression and suicide, and that kind of thing.

“I would explain it by looking into a mirror and seeing absolutely everything you don’t want to see,” Jack said.

“The only reason why your sexuality or gender identity makes you depressed is when other people in the community don’t accept you.

“It’s looking at yourself and being so uncomfortable with the person staring back that you don’t recognise them.

“It’s such a roundabout doublewhammy and it really sets a lot of LGBTI individuals up for failure.”

“I didn’t do anything about — or even start thinking about — me being trans until those feelings of gender dysphoria got to the point where

“It’s 2017, no one needs to be told their sexuality or gender identity is the reason they’re potentially depressed.

indepth Passing privilege Fortunately, Jack has had a positive experience as a transman in his workplace. For the most part he experiences ‘passing privilege’ — a term used by the trans community to describe blending in with society. “It’s the idea that you’re able to walk down the street and nobody thinks, that guy is trans,” Jack said. He said any disrespect from colleagues has “come from lack of education, not lack of empathy or acceptance”. “It’s been very interesting because we’ve started doing more trans-specific surgery at my workplace. “There’s a surgeon who does top surgery, so double mastectomy with plastics like nipple grafting and that sort of thing, and another surgeon who does hysterectomies on trans guys. “I sometimes hear the struggles some of those nurses go through, not with their personal beliefs, but things like if their trans patient has female on their UR band, what pronoun do they use? “That’s the sort of thing that’s not covered particularly well in any curriculum or ethics.” And, of course, there are the barriers resulting from the health system itself. “My AHPRA registration is still female, which is ridiculous. “The last time I looked at changing my gender on my AHPRA registration, you had to change your university certificate, your tax file, your birth certificate. “My birth certificate has my current name on it, but it still says female because in Queensland you need to have sex realignment surgery or have a doctor who is willing to sign off to something of that effect.”

Growing visibility in our health system Coming to terms with Jack’s gender and using the correct pronouns is something his father still struggles with. It’s a difficult situation that many LGBTI people face with their loved ones, and is a reminder of why our health system must operate as a safe refuge free of judgement. “You can’t underestimate how powerful it is to have someone who doesn’t know you respect your gender,” Jack said.

The only reason why your sexuality makes you depressed is when other people in the community don’t accept you. “When you’re spending all your energy and time trying to encourage people around you who love you to respect your pronouns, the last thing you want when you’re most vulnerable as a patient is to have that conversation with a nurse.” So how far has the nursing and midwifery workforce come? Jack believes it depends where you work. “I think we’re leaps and bounds ahead of where we were just five years ago, but I don’t feel like nursing has come far enough where I would feel safe to be an ‘out’ trans person within the private sector,” Jack said. “I think in the private sector in particular there is still some expectation of being a bit more conformative, I think it’s a bit of a stricter environment compared to my experience in the public system. “Because the public system is so big it feels like it is a younger workforce with more diversity. I think that’s what it comes down to – there’s a larger visibility within the public system.” And if it ultimately comes down to visibility, then we all have a role to play. “That’s something I struggle with — do I be visible and be an advocate for my community, or do I be selfish and protect myself by not being ‘out’?” Jack said. “Where it’s safe to be ‘out’ and it’s safe to have those conversations — and you’ve got to pick your audience — I think it’s really important to be an advocate for your own community.”

References:

National LGBTI Health Alliance. (2016). Snapshot of mental health and suicide prevention statistics for LGBTI people. NSW. Australian Human Rights Commission. (2011).Face the facts: Lesbian, gay, bisexual, trans and intersex people. https://www.humanrights.gov.au/ face-facts-lesbian-gay-bisexualtrans-and-intersex-people Nursing and Midwifery Board of Australia. (2008). Code of ethics for nurses in Australia. Melbourne: Nursing and Midwifery Board of Australia. Blackman, J., Gahan, L., Hillier, L., Jones, T., Mitchell, A., Monagle, M. & Overton, N. (2010). Writing themselves in 3. Australian Research Centre in Sex, Health and Society, La Trobe University. Melbourne, p.54. The Queensland AIDS Council. Mental health and well being in lesbian gay bisexual transgender (LGBT) communities. http://www. qahc.org.au/mindoutresources Killerman, S. (2017). The genderbread person V3. [online]. It’s pronounced metrosexual. Available at http:// itspronouncedmetrosexual. com/2015/03/the-genderbreadperson-v3/#sthash.xY1zuUsZ.dpbs Kolstee, J. & Hopwood, M. (2016). Health impacts of marriage equality & marriage denial on the health of lesbian, gay and bisexual people. ACON. Sydney, p.5. Raifman, J., Moscoe, E., Austin, B. et al. (2017). Differencein-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts. JAMA Pediatrics. 171(4), 350-356.

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Same issues, different continents Opinion by TERRI BUCKLEY

Nurse and Member Connect Supervisor Terri Buckley recently returned from a trip overseas that included visits to our sister unions in the US, England and Ireland. Her journey reminds us we must never get complacent about the working conditions and wages we have secured over the years, and we need to protect and preserve them.

After 35 years of nursing I have just taken long service leave for the first time.

have access to the union and therefore have no professional or industrial representation.

When planning my overseas holiday I wanted to take time out to visit the nurses’ and midwives’ unions in some of the countries I was travelling through to see what their working conditions, experiences and concerns were.

In stark contrast to this, some hospitals have clauses in their enterprise agreements that require all nurses employed at the facility to join the union within 30 days of commencing work.

The big apple So I set out on my adventure in April with my first stop being New York City. The New York State Nurses Association has 40,000 members — mostly Registered Nurses — working within the NYC area. Unfortunately a lot of nurses working in smaller or private facilities across the state do not

The NYSNA has been working very hard to raise awareness of the health system issues and does have good support from some community groups, but it struggles to achieve engagement from the wider community. Members recently participated in a successful campaign where they wrote postcards outlining their workplace concerns like skipped meal breaks, unmanageable workloads, feeling pressured to work outside of

their scope of practice and patient safety. Interestingly, there has been an increase in membership growth and activism since the election of Donald Trump. The United States trade union movement experiences many of the same challenges that we do here in Australia like low wage rates, dealing with hostile employers and negotiating in a climate where profits are placed before standards of care, safety and good outcomes for patients and residents.

OLD BLIGHTY London was my next destination so I headed off to the Royal College of Nursing. The RCN has 452,000 members within the four countries that make up the UK, 58,000 members working in London alone. The majority of members are Registered Nurses, Health Practitioners (equivalent to our AINs) and some Mental Health nurses. Midwives are part of another union. To say that England is desperately short of nurses at present would be an understatement.

Visiting the New York State Nurses Association in the big apple.

They have lost 30% of their EU nurses since Brexit due to the uncertainty of ongoing employment and the UK’s economic outlook. The reality is, the money nurses earn in

indepth pounds is now worth less euros for them to send home. There are more than 12,000 vacant nursing positions in London alone that cannot be filled. Furthermore, cuts to student nurse and midwife bursaries will leave students with £50 000 and £60 000 ($80 000 and $95 000 AUD) in debt respectively by the completion of their course, which is a huge disincentive for young people to enter the professions. The situation is pretty dire. In April this year 270,000 nurses voted to take industrial action and recently held their second rally in their ‘Scrap the Cap’ campaign, after receiving a non-consolidated pay rise of just one per cent for the last seven years. In real terms that is a 14% pay cut since 2010. At our annual conference in July, QNMU members passed a resolution in support of the RCN campaign.

While in London I visited the Emmeline Pankhurst Memorial at the entrance to Victoria Tower Gardens.

EMERALD ISLE The last union I visited was the Irish Nurses and Midwives Organisation in Dublin.

Showing off some of our QNMU campaign materials at the Irish Nurses and Midwives Organisation in Dublin.

The INMO membership is made up of 40,000 nurses and midwives. Like England, Irish Nurses and Midwives have not had a pay rise for seven years since austerity measures were put in place by the government in 2010. This has effectively been a 15% reduction in wages. This wage freeze is the number one issue the INMO is faced with today. A recent national ballot seeking a mandate to take industrial action saw a five per cent increase in INMO membership growth as nurses and midwives joined up in the hope of progressing their wage claims. Many nurses and midwives are choosing to leave Ireland to work in countries that offer more attractive wages and conditions. In an effort to stem this exodus every new graduate nurse and midwife is given a permanent contract of employment with an agreed 12 month leave of absence after their first year of service. INMO also has a spot on the daily news called Trolley Watch, which reports on the number of patients waiting “on trolleys” for admission in each hospital due to a shortage of beds. For example the March 2016-2017 figures show there were 9459 more patients than there were beds across the country. Unmanageable workloads, overcrowding in hospitals and patient safety are the big issues for Ireland and are of significant interest to the public.

REFLECTION Now I am back home in Australia and have had time to reflect on my travels and the experiences of nurses and midwives in other countries, one thing is strikingly clear and that is we can take nothing for granted.

We have seen how things can radically change overnight as happened under the Newman government, with services and nursing and midwifery positions being cut and graduates not able to secure employment. This is not a place we want to revisit. We have recently seen attacks on penalty rates in the hospitality industry and rest assured it will not end there. Now is not a time to be complacent and think that what overseas Nurses and Midwives are experiencing could not happen to us here too. While in London I visited the statue of Emmeline Pankhurst who was an activist and leader of the British suffragette movement who fought for women to achieve the right to vote and have a say over their own lives, this was driven by the appalling treatment of women and the horrendous conditions that they worked under. As in Emmeline’s day so must we get involved through our QNMU workplace branches. Collective action is the only way to progress our issues and protect the entitlements we currently enjoy.

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Graduates driving change

Pictured: Gift Mutero

raduating from university and making the transition to the nursing or midwifery workforce can be daunting. Every year thousands of nursing and midwifery graduates enter their professions armed with the knowledge and practical experience gained from their studies. But inevitably, there are realities of working as a nurse or midwife that are only learned on the job. Which is why the QNMU established a new graduate reference group (formally called the Newly Qualified and Early Career Nurses and Midwives Reference Group). Officially formed back in late February 2017, this reference group assists QNMU members with their transition to the workforce, and guides the union to better represent and advocate for new grad members.

The Newly Qualified and Early Career Nurses and Midwives Reference Group provides insight and advice on the real experiences of nurses and midwives transitioning to practice. The group pays particular attention to: ■■ adequacy of preparation for practice in undergraduate courses ■■ availability of employment and recruitment opportunities ■■ accessibility to formal orientation, induction and transition programs, including identifying their benefits and constraints

“University gives you a very good base in clinical knowledge, but it doesn’t prepare you for the realities of what you’re going to hit when you enter the workplace,” Donna said. “When you first become a nurse, you’re just learning how to be a nurse for the first year on the floor. “If there are supports in place at university before you become registered, it’ll make a world of difference to the way nurses develop and grow and perhaps also help with retention.”

■■ determining the enablers to increase the likelihood of successful transition to practice.

Donna worked in a nursing role for 10 years before graduating as a Registered Nurse in 2015, but still found the shift in her scope of practice challenging.

One of the original members of the reference group is Donna Searles, who works as a Clinical Nurse in a complex primary healthcare service.

“Learning in this unique environment to work autonomously was an enormous learning curve and if I’d had a mentor at each of

indepth having to learn all those things has been a big experience.”

In my country, unions were there before the collapse of the economy.

Gift Mutero

the facilities I rotated through, my experience would have been a little easier because I would have had someone to go to for support,” she said.

“The reference group acts like a sounding board because a lot of the issues we face as early career nurses already have solutions, but we just don’t know what they are,” Gift said.

“The perception of some of the other staff members was that this was not an environment for graduate nurses, but it absolutely is.

“So the reference group allows us to come together, sound it out, get direction on where to go and what instrument to look at, that sort of thing.”

“How do you form the next generation of primary health nurses if you don’t start with the grads?” Fortunately, much has changed to improve the workplace culture and attitudes towards graduates. “At the time I did it, the graduate program was in its infancy, but graduates are receiving better support now,” Donna said. “As a member of the reference group I have an opportunity to be part of making changes for those behind me.”

A sounding board Like Donna, many members of the reference group come from diverse backgrounds and careers — they have not all entered university straight out of high school. Registered Nurse Gift Mutero had a career in the finance and not-forprofit sectors in Zimbabwe before making the move not only to nursing, but also to Australia. Gift joined the reference group to make a difference for new graduates, particularly around support programs and better access to education.

Like Donna, Gift cited adequate support and better mentoring as key to assisting graduates with their transition. “Some new grads are only given two days of hand holding and then they’re thrown in the deep end,” Gift said. “Some are given roles in highly technicalised wards, where you have to learn complex procedures two weeks into your career, which is a challenge because you haven’t mastered the basics yet.”

But one of the most significant differences Gift noticed between Australia and his home country was the role of unions — and his assessment of how fortunate Australians are to have such a strong advocate for workers should be a lesson to us all. “In my country, unions were there before the collapse of the economy. “But with the high unemployment rates, there’s barely anybody who is going to stand up with their union when you don’t even have the basics to live by yourself. “If you’re going to join a union, you might just be one of 200 people in the whole country who is in a union and you’re not a big voice. “That’s a huge difference when you come to a country like Australia and every industry has a union, and they’re all set up to achieve the same thing. “I think a lot of Australians take that for granted.” Gift hopes he can help spread the word to other students, particularly through the international student community, about the role of unions. He sees the reference group as an opportunity to do this.

Join a QNMU reference group The QNMU has established many other reference groups, including:

Cultural challenges and observations

■■ Aged Care

For Gift, the challenges of university and transitioning to the nursing workforce were accompanied by cultural differences.

■■ Midwifery

“In my culture if you’re talking to somebody in a respectful way and maybe you’re apologising or being humble you look down, you don’t look them in the eye, whereas it’s the opposite here in Western society, you have to look them in the eye,” Gift said.

■■ Aboriginal and Torres Strait Islander Members

“So there are many small nonverbal cues that get in the way, so

■■ Mental Health ■■ Practice Nurses ■■ Rural and Remote Nurses

■■ NUM/MUM To express your interest in joining a reference group, contact cgraham@qnmu.org.au

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Stay calm and

keep nursing Everyone has their bad days. Maybe you slept poorly, maybe you’re stressed, or maybe you can’t seem to do anything right lately. There could be any number of reasons for feeling frustrated or angry at work, but one thing is for certain: if you let that anger get the better of you, you’re likely to find yourself in a world of trouble.

rom time to time the QNMU receives calls from members who are facing disciplinary action or worse because they’ve lost their cool at work. We are not talking about lively disagreements, but rather explosive outbursts that leave everyone a little shell-shocked. It’s certainly not a common occurrence, and while most have been incidents of yelling or screaming at a colleague within earshot of patients, there have been a handful of cases over the years where members have been accused of slapping a workmate, hitting someone with a folder or book, throwing water at a colleague and getting into fisticuffs over a car park. There is no question this sort of behaviour is completely unacceptable in the workplace. Most employers have a code of conduct which outlines expected staff behaviour and flying into a rage is most definitely filed under ‘inappropriate’. The state’s biggest employer of nurses and midwives, the Queensland government, states quite clearly in its Department of Health Human Resources Policy on workplace conduct and ethics that “employees have a responsibility to always conduct and present themselves in a professional manner and to ensure personal conduct displays integrity and maintains public confidence in the Queensland Public Sector”. This, it states, is part of the DOH’s commitment to “creating and maintaining an environment for patients, clients, visitors and employees which is professional, client responsive, safe and free of any form of unlawful or inappropriate behaviour.” Similarly, the NMBA’s Codes of Professional Conduct for Nurses and Midwives both outline a set of minimum national standards of conduct nurses and midwives are expected to uphold. These are contained within a number of provisions requiring nurses and midwives to behave in a manner which “maintains and builds on the

indepth community’s trust and confidence in their profession”.

drained and miles away from the person she was a few minutes earlier.

because you feel something essential has been threatened.

Breaching these codes of conduct can put not only your current employment at risk but could also see you stripped of your registration.

“It took more than half an hour to calm her down. She couldn’t really believe she’d gone that far.

In the simplest of scientific terms, the amygdala in your brain reads the threat and triggers the brain into releasing hormones that essentially tell your body to prepare for flight or fight action.

Trouble in civvies It’s also important to remember that it’s not just bad behaviour at work which can put your livelihood at risk. Yelling or screaming at someone in a supermarket is unlikely to get you sacked, but nurses and midwives who are charged with criminal offences may be required by law to notify their employer and AHPRA.. This means angry outbursts that lead to violence in your personal life could open the door to disciplinary action, termination or reporting in your professional life if charges are laid. This includes domestic violence, road rage, a public brawl or a punch up at a backyard barbecue.

Losing it QNMU member and South-East Queensland Mental Health nurse Tanya* says she’s experienced workplace rage twice in the past seven years and said it can be frightening to observe. “I’ve not been on the receiving end thankfully, just there when it happened, and it sort of came out of nowhere,” she said.

“She resigned the same day, but I have no doubt she’d have been fired had she stayed. “She’d never got that angry before, never.” *Not member’s actual name

The science behind the anger So why do we lose it? Angry outbursts are linked to the ’flight or fight’ response we have when we sense a threat. Of course ‘fight or flight’ — also known as the acute stress response — is easy enough to understand if we imagine ourselves threatened by an Eastern Brown snake on a hot summer day — but how does it relate to losing a car park or facing criticism? Psychologists and neuro experts across the world have some creative ways to explain the link, but one of the most compelling explanations comes from US neuroscientist R. Douglas Fields. He argues there are nine threat triggers that provoke a rage response in humans. life and limb - as in your physical safety

“This is proper rage, not just someone getting angry… it’s like an explosion, and in both cases seemed to be really out of proportion to the issue they were actually angry about.

insult - meaning a verbal threat

family

environment

“In my friend’s case, it started as just back-answering, a snippy response to criticism... but then the RN pulled her up on it and layered on a few other criticisms, and before you know it my friend was up in the RNs face screaming and swearing at her, we really thought she was going to take a swing. Luckily she didn’t but as she stormed off she kicked a trolley.

mate

order in society

resources

tribe

stopped – feeling of restraint or being trapped.

“By the time I found her she was bawling her eyes out in the carpark and shaking all over, she looked really

Things you’d fight for if you felt they were in danger

He says that for each of these triggers, (which he remembers with the acronym LIFEMORTS) your body prepares you for a potential fight,

So you start to feel your heart pounding faster as it pumps blood to your major muscle groups, your mouth dries out as the digestive system is slowed and you may start to sweat as your body changes your autonomic functions to prepare you for a big burst of strength or energy. This is all well and good if you need to save your child from a vicious dog, but in the workplace if you are unable to recognise these symptoms and change the trajectory of what you are feeling, you can eventually become aggressive and even violent. Aware that a violent outburst is not appropriate at work, many people will rechannel their anger and lash out verbally instead, whereby their yelling and screaming acts as a sort of release valve. But of course verbal aggression is still wildly inappropriate, and in professions such as nursing and midwifery, where we rely heavily on the public’s trust in us and we are well respected for being rational, compassionate and cool under pressure, angry explosions either on the ward or in the tearoom need reining in.

Keeping your cool There are a plethora of self-help books and webpages crammed with techniques for managing anger, but one of the recurring concepts used by neuroscientists, with specific focus on the flight or fight aspect, is identifying and labelling the anger feelings and/ or their trigger.

Identify the symptoms When you start to feel those signs of stress building up — the shortness of breath, the pounding in your ears, the flush of adrenaline — recognise the symptoms and acknowledge you are getting worked up and may need to work to keep your anger in check.

indepth Label the trigger or the reason for your anger If the anger continues to build, identify which one of the triggers you are reacting to. If you can’t remember Field’s acronym, simply label the reason for your anger. ■■ Is your order in society (workplace) threatened? Then that’s the O trigger. ■■ Are you getting angry by someone else’s sloppy work or poor performance? At the core, this is frustration. ■■ Are you about to rage because you’ve been cut off by a bad driver? You are responding to fear/being afraid for your life. ■■ Are you about to fly off because of criticism? Possibly the I trigger (insult) or maybe you are feeling stressed? ■■ About to lash out at a slow computer? Frustration or the S trigger (your activity is being stopped or limited). This process of thinking about your anger and labelling it is believed to help divert the brain away from it’s rising trajectory. It’s not something that comes naturally, it’s learned behaviour and it takes practice.

Focus on your body Now that your brain is rethinking the flight or fight response you need to work on normalising the body. It’s a well-worn technique, but breathing slowly and deeply, and counting 1 to 10 on the inhale and 1-10 on the exhale remains a staple. These deep breaths bring more oxygen into your lungs and your bloodstream, which is the opposite effect of the fight or flight reaction. It helps to cancel out the physical symptoms of your rising anger. At the heart of it, anger is a normal human response to stress or threat, it’s just the environment we live and work in is fundamentally more complex and nuanced today than it was when our brain and its flight or fight mechanism were developed. Today we sense threats at many different levels, including threats to our character and our pecking order at work, and it sometimes takes determination and practice not to let the primal urges take over. But if your livelihood or career is at stake, learning how to rein rage in may be well worth the effort.

Angry outbursts are a health hazard Frequent angry outbursts can put you at greater risk of heart attack or stroke. ■■ Heart rate can jump from 80 beats/minute to 180 ■■ Blood pressure from 120/80 up to 220/130 ■■ Body releases chemicals that clot the blood

Anger may cause tension headaches and migraines ■■ Muscles tense up in readiness for ‘fight or flight’

References: Fields, R Douglas, Why We Snap, Dutton, 2015 England http://nymag.com/scienceofus/2016/01/neuroscience-behind-i-just-snapped.html http://www.nationalforum.com/Electronic%20Journal%20Volumes/Hendricks,%20LaVelle%20 The%20Effects%20of%20Anger%20on%20the%20Brain%20and%20Body%20NFJCA%20 V2%20N1%202013.pdf http://www.youngdiggers.com.au/fight-or-flight https://www.nottingham.ac.uk/counselling/documents/podacst-fight-or-flight-response.pdf

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Keeping an eye on staffing It is the responsibility of all nurses and midwives to recognize whether there are enough staff on the floor during shift to care for the needs of all patients and provide adequate monitoring.

Of particular concern to the Committee was that she left the floor to deliver handover to the oncoming afternoon shift nurses, without first checking that there was sufficient staff remaining on the floor to cover.

This is particularly important during times when staff numbers are lower, for example during meals breaks, but especially during handover periods when nurses and midwives are engrossed in communicating to the oncoming shift.

The nurse had assumed that three other nurses were on the floor, when in fact two were attending to admissions and one was in and out of the unit on medication matters.

A recent NSW Nursing and Midwifery Professional Standards Committee decision should alert all nurses and midwives to the fact that they are responsible not only for their own conduct, but also for ensuring their unit is adequately staffed at any given time during the shift, whether they are in charge of that unit or not.

The case before the Committee: This matter revolves around a nurse who became caught up in a disciplinary matter involving a colleague who was on an overtime shift and had left the unit earlier than permitted to go to his regular shift in another unit. The Committee’s investigation into the colleague however, also uncovered a number of issues in relation to the nurse’s own professional conduct on the unit at the time.

Staffing levels within the unit had recently been raised as a problem, and while efforts were being made to find more staff, the matter had not been resolved. Ultimately the situation was that of a busy ward with competing demands and poor staffing. Legal counsel for the nurse drew attention to the employer’s noncompliance with the industrial provisions on staffing on the unit and particularly on that shift. Nevertheless, the Committee found that the nurse had failed in her professional obligations and that she had engaged in unsatisfactory professional conduct by not checking that the unit was adequately covered by nursing staff during handover. The Committee issued the nurse with a formal caution. This case serves as a timely reminder to all nurses and midwives that it is not only the team leader or the NUM who is required to consider

staffing issues relevant to clinical care and patient monitoring. We all have a duty to lift our gaze from the bedside and monitor what’s happening on the unit. Only then can we engage our professional judgment and challenge staffing practices that lead to adverse outcomes for both the patients and those who care for them.

Reflective questionS 1. How conscious are you of staff numbers on the floor at times such as handover and breaks? Is the staffing and skill mix sufficient? 2. How can you practically fulfil your professional obligations regarding staff levels during these times? 3. The QNMU website has workload reporting forms for all sectors of healthcare. Review the form for your sector and consider how it can empower you to ensure safe, quality care for your patients. Remember to record your reflections for registration purposes using the template on page 65 or by using the QNMU Record of CPD available at www.qnmu.org.au/cpdrecord

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When is a child no longer a child?

he challenges providing nursing and midwifery care/services to adolescents who are separated from families or guardians. Nurses and midwives provide care to young people in a range of healthcare settings including primary health care, emergency care, GP practices, schoolbased health care, antenatal services and acute inpatient care. It is clearly acknowledged that the needs of adolescents differ from those of adults and children. Nurses and midwives may encounter teenagers where ‘parents or guardians are not present, active, or supportive of them’ (Lane et al, 2012) who are functioning with autonomy but without the legal rights and protections provided an adult. It is accepted world-wide that a child is considered to be a person under the age of 18 and in this country the national frameworks, policies and plans that guide nursing and midwifery practice follow this definition. Child protection legislation in Queensland recognises this definition with an exception with regard to the age of consent for (all lawful) sexual activity — which is 16 years . That said, it is commonplace for children between the ages of 13 - 18 years to be described as adolescents or teenagers. In the United States many states permit emancipation allowing adolescents to legally ‘attain the

legal age of adulthood before reaching the age at which they would normally be considered adults’. In Australia, generally parents have legal responsibility over their children until the date of their 18th birthday. Child protection legislation may apply, where the parents are found to be unfit. This would generally ensure the child is taken care of by another adult, such as a family member or an adoptive parent. At present in Australia, there is no legal process, at either state or national level, to allow a child to become emancipated and cases using other legal avenues are rare. The legislation designed for the protection of children in Queensland defines a child as any person under the age of 18 years. So where does this leave nurses and midwives who are providing services to adolescents who are living largely or entirely unsupported by an adult or guardian? The law in Australia is ambiguous when it comes to adolescents and decision-making so whilst it is important, the law cannot be solely relied upon by nurses and midwives to guide their practice when providing health services to adolescents.

Nurses and midwives have an obligation to support the safety and well being of children and adolescents. These obligations to adolescent patients are derived from legislation; public policy that drives national and state frameworks; and international conventions designed to defend and preserve the rights of children and youth. Responsibilities also stem from professional associations that outline the philosophy and particular competencies required to provide care to children and youth, and from participation in peak nursing and midwifery bodies such as the ANMF and QNMU that reflect the global expectations for the care of children and young people. Underpinning all of this is the professional practice framework set by the national regulator – the Nursing and Midwifery Board of Australia (NMBA). It is the body that establishes the codes and guidelines for the professions with specific requirements for nurses and midwives when making decisions in their day to day practice. We must comply with legislation, regulations, policies, guidelines and other standards (such as safety and quality standards) including the delivery of evidence based practice.

CPD There has been recent press reports which highlight that Australian teenagers, in an attempt to escape abuse, neglect or family violence, fall victim to poverty and homelessness, with devastating impact on their safety, health and social functioning (SBS, 2017). These teenagers are vulnerable — at risk of a range of health issues including mental illness, unplanned pregnancy, malnutrition and drug and alcohol misuse (Beharry, 2012). There is no doubt there are challenges for nurses and midwives responding to vulnerable adolescents who are living without the support of a caring family or adult. As health care professionals, committed to the values and ethics of the professions, nurses and midwives advocate for individuals, their families

and the wider community and conduct their practice based on the best available evidence to ensure patient safety and deliver positive health outcomes. So in the case of vulnerable adolescents, whether it is the empathic non-judgemental response to a teenager engaged in self harming behaviour, or professional peers advocating for organisational policy that addresses ambiguity in health care decision making for teenagers, or as members of the most trusted professions15 seeking to influence public policy and legislation in order to end youth homelessness, we must meet the challenge to ‘promote and safeguard the right of [adolescents] to the highest attainable standard of health, as a fundamental human right’ .

Caring: Caring is central to our identity as nurses and midwives and maintaining focus on the person at the centre of care is crucial to our partnership approach to health... For example: Consider how the uncertainty about adolescent rights and capacity for healthcare decision making may influence your response to homeless adolescents seeking health care or teenage girls seeking contraception? – partnership vs. paternalism.

Advocacy: We help to keep our health system safe at the individual and system level… For example: At the system level – Considering the importance of the social determinants of health such as secure housing and income for the promotion

Lane, Susan H. et al. (2012) Emancipated Minors: Health Policy and Implications for Nursing Journal of Pediatric Nursing: Nursing Care of Children and Families, Volume 27, Issue 5 , 533 – 548. Volp,K (2006), Lets Talk Nursing http://www.qnmu. org.au/DocumentsFolder/ QNMU%20DOCUMENTS/ Publications/QNU%20values%20 manifesto%20Jul14%20WEB.pdf www.ohchr.org/EN/ ProfessionalInterest/Pages/CRC. aspx www.dss.gov.au/sites/default/ files/documents/child_protection_ framework.pdf www.legislation.qld.gov.au/ LEGISLTN/CURRENT/C/ ChildProtectA99.pdf www.legislation.qld.gov.au/ LEGISLTN/ACTS/2016/16AC050. pdf; https://aifs.gov.au/cfca/ publications/age-consent-laws

Reflective EXERCISE Using the professional values identified by the Queensland Nurses and Midwives’ Union — caring, advocacy, holism and professionalism (Volp, 2006) as a framework for reflective practice consider the professional issues that may arise when working with this group of teenagers. It is important to note these values are not discreet and overlap in the practice of nurses and midwives.

References

and maintenance of health and well being, what is the role of nurses and midwives in affecting changes in social policy to abolish youth homelessness and poverty? How do nurses and midwives use their professional bodies and associations to influence health policy to tailor sexual health initiatives for vulnerable youth?

Holism: We help keep the system human by caring for the whole person in all settings. For example: When a homeless adolescent presents in crisis how do nurses and midwives create the space to make key connections and referrals, when patient flow and national waiting time targets are a primary consideration?

Professionalism: We are accountable to the community. For example: What are the principle concerns for nurses and midwives with regard to protecting vulnerable adolescents? Consider legal, ethical, professional issues, importance of evidence-basis for initiatives, social and public policy and the international conventions that place the child’s ‘best interests’ as paramount.

Remember to record your reflections for registration purposes using the template on page 65 or by using the QNMU Record of CPD available at www.qnmu.org.au/cpdrecord

Net Industries. (2011). Legal ages laws. Retrieved from http://www.law. jrank.org/ pages/11848/Legal-Ages.html. cited in Lane, Susan H. et al. (2012) Emancipated Minors: Health Policy and Implications for Nursing Journal of Pediatric Nursing: Nursing Care of Children and Families , Volume 27 , Issue 5, 533 – 548. www.freedmangopalanlegal.com. au/emancipation-divorce/ www.moirarayner.com.au/ articles/04humanr/youngpeo.pdf www.ohchr.org/EN/ ProfessionalInterest/Pages/CRC. aspx www.accypn.org.au/ www.qnmu.org.au & www.anmf. org.au www.nursingmidwiferyboard. gov.au www.sbs.com.au/news/ article/2017/08/04/youthhomelessness-linked-mentalhealth-problems-report; & http:// www.abc.net.au/news/201706-09/youth-homelessnessmatters/8602814 Beharry, Meera S. Health Issues in the Homeless Youth Population, Pediatric Annals April 2012 - Volume 41 · Issue 4: 154-156 www.roymorgan.com/ findings/7244-roy-morganimage-of-professionsmay-2017-201706051543 www.nursingmidwiferyboard. gov.au/Codes-GuidelinesStatements/Professionalstandards.aspx

d r d n U o r

Applications now open for QNMU Scholarships We’re pleased to announce the next opportunities in our 2017 scholarship program.

QNMU members have an opportunity to receive financial support packages to assist them with their studies or professional development.

scholArships cUrrently AvAilABle: ■ Assistant in Nursing or Personal Carer Scholarship – Up to $3000 awarded in whole or in part for QNMU members to undertake study of a healthcare course, or to attend a relevant conference or seminar. ■ Postgraduate Enrolled Nurse Scholarship – 2 x $1500 awarded in whole or in part for QNMU members to undertake an accredited course in nursing or midwifery, or to attend a relevant conference or seminar. ■ Postgraduate Registered Nurse or Registered Midwife Scholarship – 4 x $1500 awarded in whole or in part for QNMU members to undertake an accredited course in nursing or midwifery, or to attend a relevant conference or seminar. ■ Leadership Development Scholarship – Up to $5000 awarded in whole or in part for QNMU members to undertake an accredited or postgraduate course in leadership. All financial QNMU members are welcome to apply for the scholarships.

For more information on current scholarships and to download applications forms, visit www.qnmu.org.au/scholarships.

ApplicAtions close FridAy 13 octoBer 2017.

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Antimicrobial dressings for CLABSI prevention BY JOAN WEBSTER RN, BA: PROFESSOR AND NURSING DIRECTOR (RESEARCH), EMILY LARSEN RN, BN, GDIP HLTH RES: PROJECT MANAGER, NICOLE MARSH RN M ADV PRAC (HLTH RES), PHD (CAND): NURSE RESEARCHER. THE ALLIANCE FOR VASCULAR ACCESS TEACHING AND RESEARCH GROUP, NATIONAL CENTRE OF RESEARCH EXCELLENCE IN NURSING, GRIFFITH UNIVERSITY AND ROYAL BRISBANE AND WOMEN’S HOSPITAL.

NURSES and midwives play a central role in the care and maintenance of central lines. But despite all efforts, sometimes central-line associated blood stream infections (CLABSI) do occur. These infections may be devastating for patients in terms of morbidity and mortality. For example, in the United States, CLABSIs result in thousands of deaths each year and cost health care systems billions of dollars (CDC, 2016). Similar data is unavailable in Australia but, even so, an effort to reduce the incidents of CLABSI is a priority of the Australian Commission on Safety and Quality (ANZICS, 2014). One approach to the problem has been to place an antimicrobial dressing around the insertion site of central lines. This intervention was based on a systematic review that demonstrated a 40% reduction in CLABSI when a chlorhexidine impregnated disc (CHD) is applied to the catheter entry site. Although use of the disc has become commonplace, most of the studies included in the review were conducted in intensive care units where the catheter dwell time is comparatively short. Fewer trials have been done in other populations — such as those receiving long term antibiotics or chemotherapy. In addition, reactions to chlorhexidine are not uncommon and resistant genes to chlorhexidine have been demonstrated. A cheaper disc, impregnated with polyhexamethylene biguanide (PHMB) is now marketed for the same purpose. PHMB has never been tested to prevent CLABSI nor has the effectiveness of the CHD disc been compared to another antimicrobial disc for CLABSI prevention.

The study The aim of this study was two-fold. Firstly, we wanted to make sure the PHMB disc was safe for use to prevent CLABSI. Secondly, we wanted to test our study processes to ensure a larger trial would be feasible. To do this we randomised patients to have their PICC site covered with either a CHD or a PHMB disc. All other catheter-related treatment remained the same. Depending on the group allocation, a new CHD or PHMB disc was applied every seven days, unless there was an indication to change the dressing earlier.

Reflective question Use of an antimicrobial disc is just one intervention that can reduce the risk of CLABSI. Consider what other interventions can be utilised to reduce the risk, both before and after the antimicrobial disc is in situ. Remember to record your reflections for registration purposes using the template on page 65 or by using the QNMU Record of CPD available at www.qnmu.org. au/cpdrecord

Any complications were recorded when the insertion site was inspected. This occurred 24 hours after insertion and then every second day until hospital discharge or until the device was removed, whichever was sooner.

Results Among the 101 participants, three (3%) blood stream infections occurred. Two (2%) were confirmed CLABSIs (one in each group) and one was a mucosal barrier injury-related BSI. 1217 device days were studied, resulting in 1.64 CLABSI/1000 catheter days. One (1%) disc-related adverse event occurred in the CHD group.

Implications for practice: Disc dressings containing PHMB are safe to use for infection prevention at catheter insertion sites.

Implications for research: An adequately powered trial is needed to compare the clinical and cost effectiveness of the two products. The current trial indicates that it is feasible to do so.

References ANZICS, Central Line Associated Blood Stream Infection (CLABSI) Prevention, http://www.anzics.com.au/Pages/CLABSI. aspx, 2014. Centres for Disease Control and Prevention (CDC), Central Line-associated Bloodstream Infection (CLABSI), https:// www.cdc.gov/hai/bsi/bsi.html, March 2016. Safdar N, O’Horo JC, Ghufran A, et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med 2014;42:1703-13. Webster J, Larsen E, Marsh N, Choudhury A, Harris P, Rickard CM. Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of Central-Line-Associated Blood Stream Infection: a feasibility randomized controlled trial (the CLABSI trial) Journal of Hospital Infection 2017;96:223-228.

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Good Samaritan liability By Alison Barrett, Principal, Maurice Blackburn LAWYERS

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edical practitioners and nurses have the experience and expertise to jump in when they see a medical emergency unfolding. But it’s important to be aware there can be legal implications of providing allegedly negligent treatment in such a situation.

The standard of care currently imposed by legislation is whether the person acted in ‘good faith’, taking into account the circumstances of the emergency. ‘Good faith’ has been described as acting with a genuine desire to help and without malice or ulterior purpose.

Medical practitioners and nurses are often concerned about whether they could be sued for providing allegedly negligent treatment when assisting in an emergency.

A nurse may be liable if, during their assistance, they commit an act of ‘gross negligence’. Whilst negligence is described as care or skill falling below the reasonable standard, gross negligence has been described as a ‘grave departure’ from that standard. Common law suggests that gross negligence will occur where a person acts with ‘serious disregard of or indifference to an obvious risk’ or provides treatment which is ‘inexcusably bad’.It is a high threshold and there have been no cases in Australia to date where a nurse has been sued in a “Good Samaritan” situation. The QNMU professional indemnity insurance policy provisions cover “Good Samaritan acts”.

Legislation provides that “a medical practitioner, nurse or other person prescribed under a regulation will not be liable for any act or omission done whilst providing medical care, aid or assistance to an injured person in an emergency, if the act or omission is made in good faith and without gross negligence, and the services are performed without fee, reward or expectation of such.” This general protection is offered where the assistance is provided at or near the scene of the emergency, or whilst the injured person is being transported from the scene of the incident to a hospital or other place where medical care is available. It’s important to be aware that students are not covered by this provision. Under the legislation, ‘nurse’ is defined as a person registered under the Health Practitioner Regulation National Law to practise in the nursing and midwifery profession as a nurse, other than as a student Strict application suggests AINs/ PCs would also not be afforded protection, however it might possibly be arguable in some circumstances. If a nurse offers assistance in an emergency, common law requires that they act as a reasonable person with the same skills and training would act .They don’t need to guarantee a good outcome, and they will not be liable if the injured person does not fully recover. However they have a duty to not make the situation worse. On this basis, it’s important to ask yourself ‘how would a reasonable nurse act’ and ‘would the injured person be better off if I do not offer any assistance at all?’

Interestingly, in Lowns v Woods, a doctor was successfully sued for not offering assistance to a boy suffering an epileptic fit because he was asked in his professional capacity as a doctor, was in close proximity to the boy, was not attending to any patients and knew the seriousness of the boy’s condition. There have been calls to protect laypersons under legislation after Delmae Barton, an Indigenous Elder, lay more than five hours in her own vomit at a bus stop after suffering a suspected stroke or diabetes related episode. It was suggested there is a general hesitance by community members to help someone in need for fear of being sued. Queensland is the only state which does not afford protection to laypersons who provide assistance or aid in emergencies. However to date there have been no cases suggesting a layperson would be sued for assisting in an emergency. Additionally, nurses and medical practitioners often query whether they have any rights to compensation in situations where they suffer an injury whilst providing assistance in a “Good Samaritan” situation. If you have suffered a psychological or physical

injury as the result of assisting an injured driver or passenger you may be entitled to compensation under the Compulsory Third Party scheme. A claim can be lodged against an “at fault” driver allowing compensation for medical, medication and rehabilitation expenses, income and superannuation loss, pain and suffering and home modifications, home help and personal care assistance. If you were on a break when you provided the assistance you may also have a right to workers’ compensation, and in some situations if you were travelling to or from work.

Reflective question Outline and reflect on what you have learned about the laws that protect nurses and midwives rendering assistance in an emergency. Would they affect, one way or another, your decision to assist? Why or why not? Remember to record your reflections for registration purposes using the template on page 65 or by using the QNMU Record of CPD available at www.qnmu.org.au/cpdrecord

References Camatra Property Inc v Credit Suisse Securities (Europe) Ltd [2011] EWHC 479 (Comm). Capital and Counties Plc v Hampshire County Council [1997] 2 All ER 865; Michael Eburn, ‘Nurses as ‘Good Samaritans’’ (2015) 15 Primary Times: Supporting nurses in primary health care 3. Law Reform Act 1995 (Qld) s 16. Lowns v Woods (1996) Aust Torts Reports 81-376 (NSW Court of Appeal, Kirby P and Cole JA; Mahoney JA dissenting). Lowry v Mayo Newhall Hospital 64 ALR 4th 1191 (Cal 1986), 1196; Vaughan v Webb (1902) 2 SR(NSW) 293; Michael Eburn, ‘Nurses as ‘Good Samaritans’’ (2015) 15 Primary Times: Supporting nurses in primary health care 3. Mid Density Developments Pty Ltd v Rockdale Municipal Council (1993) 44 FCR 290; Lamont v Wyong Shire Council (unreported, 13 December 1991); Michael Eburn, ‘Nurses as ‘Good Samaritans’’ (2015) 15 Primary Times: Supporting nurses in primary health care 3. South Australian Stevedoring Company Ltd v Holbertson [1939] SASR 257, 263.

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Prophylactic negative pressure wound therapy Evelyn Kang RN MScHlth MHealthPrac PhD Candidate (Griffith University) & Clinical Trial Coordinator, NCREN

Caesarean section (CS) rates are growing exponentially worldwide and the incidence of surgical site infection following CS is a common cause of morbidity, with reported rates of 3-15% (Wloch et al 2012). Negative pressure wound therapy (NPWT) has been widely used for over two decades to promote healing of acute and chronic wounds. Prophylactic application of NPWT to surgical wounds has gained popularity in Australia and internationally for high risk surgical wounds as a way of reducing potential wound complications such as surgical site infection. Though NPWT is widely used prophylactically to dress surgical wounds, there is a lack of evidence to support its clinical effectiveness (Webster et al 2012). Can clinicians and nurses justify the cost of using prophylactic NPWT for their patients during surgery? Are NPWT superior and more cost effective than the standard dressing used during surgery?

Large Australian Clinical Trial Researchers at National Centre of Research Excellence in Nursing (NCREN) at Griffith University are conducting a clinical trial called aDding negative pRESSure to improve healING (the DRESSING trial) to address these questions. The research team was awarded a $2.28 million project grant by the National Health Medical Research Council to determine the clinical and cost effectiveness of NPWT on wounds healing in women with a BMI of 30 or above, undergoing caesarean section. This nurse-led trial includes collaborators from obstetrics, midwifery, international wound experts, health economics and a biostatistician (Gillespie et al 2016). This trial is currently underway.

A total of 2,090 women with a BMI of 30 or greater undergoing either elective or semi urgent caesarean sections are being recruited from four acute hospitals in the Gold Coast and Brisbane areas. This five-year long trial is expected to be completed in 2020. To date, 1015 women have been recruited to this study since 2015. Participants recruited are randomised to receive either NPWT or the standard dressing during their caesarean section and are followed for four weeks after their surgery. Research nurses or midwives ring participants weekly for four weeks to ask them questions about their surgical wounds, such as the number of dressings used, antibiotics use and their quality of life after surgery. A chart audit is also being conducted to identify any wound related complications that have led to participants being hospitalised over the four-week period following discharge. With this being the largest trial of its kind in this area, we anticipate the results of this study will provide definitive evidence of the effectiveness of prophylactic NPWT for caesarean section women. Watch this space!

Reflective question What are the risk factors for postsurgical wound breakdown in women with a BMI over 30 and what can you do to minimise these risks? Remember to record your reflections for registration purposes using the template on page 65 or by using the QNMU Record of CPD available at www.qnmu.org.au/cpdrecord

References

Gillespie BM, Webster J, Ellwood D, Stapleton H, Whitty JA, Thalib L, Cullum N, Mahomed K, Chaboyer W. (2016). ADding negative pRESSure to improve healING (the DRESSING trial): a RCT protocol. BMJ Open, 6(2), e010287. Webster J, Scuffham P, Sherriff KL, Stankiewicz M, Chaboyer WP. (2012). Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database of Systematic Review, 18(4), CD009261 DOI: 10.1002/14651858.CD009261. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett, Sheridan E. (2012). Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 119:1324–33. doi:10.1111/j.14710528.2012.03452.x

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NMBA drafts new midwifery standards for practice Consultation is underway to review the National Competency Standards for the Midwife (2006) and develop midwife standards for practice (Standards). The NMBA has been consulting widely on the rearticulation of professional midwifery standards. The new draft standards are aimed at a general view of midwifery within a framework of women-centred care, accountability, cultural respect and scope of practice. Professional standards define the practice and behaviour of midwives and include: ■■ codes of conduct ■■ codes of ethics ■■ guides to professional boundaries and ■■ standards for practice/competency standards. The draft paper has a diagram in which the interconnectedness of Standards 1-7 are clearly presented. The draft midwife standards for practice are: ■■ Standard 1: Promotes evidencebased maternal health and wellbeing

skills and knowledge are used, including management, education and research.

pathways to facilitate midwives’ utilisation of the MBS/PBS schemes.

The draft standards (at this time) will not address, for example, ongoing inter-professional issues with collaboration, scope of practice or role, autonomous practice and forward planning for the midwifery profession. Unfortunately this can be frustrating for the profession.

Midwives are often unable to work to or maintain competence in their full scope of practice because they are often unable to fully employ their skills and knowledge in current available systems of maternity care and are hampered by the dominance of the medical model. These are important to consider as evidence clearly shows when women have access to a known midwife who is supported to work to the full scope of practice, maternal and neonatal outcomes are improved.

It is important to understand that standards are limited in that they are aimed at identifying midwifery practice that is generally practised across Australia rather than aspirational or modelled on best practice models of care and evidence. What is generally practiced across Australia indicates a limitation to the elements that support midwives to work to their full scope of practice as clearly defined, in the introduction to the standards, as sitting within the International Confederation of Midwives’ (ICM) definition of a midwife. Elements that enable midwives to work to their full scope of practice include, for example, access to midwifery models of care, career classification and opportunities, visiting access arrangements and

When one in three women in Australia currently experience a caesarean section and we see a burgeoning increase in the number of women experiencing PTSD after birth, it is imperative that health reform measures include more options for midwives to practice in ways that fully utilise their scope of practice. It is heartening to see the consultation process has been wide reaching and well informed and that women centred care, primary health care principles and cultural safety are the key drivers in crafting these draft standards.

■■ Standard 2: Engages in respectful partnerships and professional relationships ■■ Standard 3: Demonstrates the capability and accountability for midwifery practice ■■ Standard 4: Undertakes comprehensive assessments ■■ Standard 5: Develops plans for midwifery practice ■■ Standard 6: Provides safe and quality midwifery practice ■■ Standard 7: Evaluates outcomes to improve midwifery practice. These are the baseline standards from which any midwife practice may be assessed. Midwifery practice includes any area in which midwifery

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Maintaining health and safety in the community setting 52

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ecently employers have been seeking to link the introduction of the National Disability Insurance Scheme (NDIS) with the need to reduce industrial entitlements for workers. They argue that as NDIS clients try to find the most cost-efficient service provider, there is pressure to cut costs in order to remain competitive — and they believe they can do this by pulling back workers’ entitlements. But another pressing concern is when employers start looking for cost savings within Work Health and Safety Systems. The cost pressures may well be genuine, but they should not be resolved at the expense of an employee’s health or safety. The simple fact is the law makes clear that workers employed in the community sector are owed a duty of care to ensure their health and safety so far as reasonably practicable. And while the basis of funding for some care will change under the NDIS, the Work Health and Safety Act 2011 remains the same. Therefore, a workplace is still defined as “a place where work is carried out for business or undertaking and includes any place where a worker goes or is likely to be, while at work”. This includes nurses, midwives and carers visiting and providing services in a client’s home as well as other civilian settings. This means your employer must ensure that prior to providing a service they have undertaken a risk assessment of the residence to identity hazards and then implement proper controls to reduce the risk for both workers and clients. If this assessment identifies significant risk, an employer may be obliged to withdraw the service or offer the service in an alternative environment that is safer until such time adequate safeguards are implemented. As an example, if a client requires manual handling due to being bedridden, but refuses to be moved via a hoist or other assistive device identified to reduce the risk of injury,

neither the employer nor the client can expect a worker to comply with the client’s objection. This is because no matter where the work is carried out the employer must ensure so far as reasonably practicable the following: ■■ the provision and maintenance of a work environment without risks to health and safety; and ■■ the provision and maintenance of safe plant and structures; and ■■ the provision and maintenance of safe systems of work; and ■■ the safe use, handling and storage of plant, structures and substances; and ■■ the provision of adequate facilities for welfare at work of workers in carrying out work for the business or undertaking, including ensuring access to those facilities; and ■■ the provision of any information, training, instruction or supervision that is necessary to protect all persons from risks to their health and safety arising from work carried out as part of the conduct of the business or undertaking; and ■■ that the health of workers and the conditions at the workplace are monitored for the purpose of preventing illness or injury of workers arising from the conduct of the business or undertaking. Separate to the employer’s responsibilities, clients and carers being provided a service must also take responsibility for maintaining a safe work environment if it is their home, and co-operate with the service provider and workers in following safety protocols and work procedures. Some of the typical hazards in the community sector include: ■■ manual handling including people handling ■■ aggressive behaviour ■■ biological hazards ■■ hazardous substances ■■ electrical hazards (the QNMU is aware that some employers provide staff with portable residual current devices to manage this hazard)

Members may be interested in Workplace Health and Safety Queensland’s Guide to Working Safely in People’s Homes: www.worksafe.qld.gov. au/__data/assets/pdf_ file/0018/82503/communityworking-safely-in-peopleshomes.pdf Members should also be aware of their right to cease or refuse to carry out work if they have a reasonable concern an imminent or immediate hazard would expose them to a serious risk to their health and safety. It should be noted that the QNMU has also on occasion been contacted by members who have entered a person’s home where criminal activity has been observed. Our advice is that this constitutes an unsafe workplace environment, and we have advised members to contact their employer, describe the activity and refuse to re-enter the house until such time as the member is satisfied the employer can ensure this will not occur again and the environment is safe. Members can contact the QNMU should they have concerns.

Reflective questionS 1. How might you manage a situation in which a client or employer refuses or fails to address a health and safety risk or hazard in a community setting? 2. What role might a client’s carer have with respect to providing a safe work environment in a private residence? 3. What steps would you take if you observed potentially criminal activity in your community work environment? Remember to record your reflections for registration purposes using the template on page 65 or by using the QNMU Record of CPD available at www.qnmu.org.au/cpdrecord

■■ slips, trips and falls.

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Who is responsible for your safety at work? By Alison Barrett, Maurice Blackburn Lawyers

here is no doubt that nursing is a rewarding, but tough job. With high exposure to aggression and violence in the workplace, difficult manual handling tasks, resourcing and fatigue issues, injuries do unfortunately happen, often through no fault of the nurse or midwife. Workplace injuries can have a devastating and long term effect on someone’s life, career, family and financial situation. Workplace safety is crucial in preventing injuries and should always be priority, for both nurses and employers. So, what obligations does your employer have to ensure you are kept safe at work, and who is responsible for enforcing this?

Overview The Work Health and Safety Act 2011 is the legal framework in Queensland aimed at protecting the health and safety of all workers. The protections under the law are not limited to just employed nurses, they cover contractors, subcontractors, volunteers, trainees and those doing work experience. Businesses have an obligation to provide a safe and healthy place of work for workers while they are on their premises. For employees, the obligation on an employer extends beyond the usual place of work — or premises owned and controlled by the employer — and into the premises of third parties the employee is required to attend. In a nursing context this may include the private residences of patients being treated or cared for, or the premises an agency nurse is working in.

What does a safe workplace look like? The laws are designed to require employers to ensure: 1. The work environment doesn’t pose a risk to health and safety. 2. Appropriate equipment and facilities are available and maintained to a safe standard. For example, in a manual handling context, mechanical aides are used for patient transfers; the height of a trolley is appropriate, a patient’s bed has working brakes or can have the height adjusted to reduce the need to bend. 3. The system of work is safe; this might include ensuring the suitable rotation of duties to ensure a worker is not in a fixed posture for a prolonged period of time; adequate breaks; any lifting required is of a safe weight; appropriate security procedures are in place. 4. The equipment and facilities are used safely. Again equipment should be in good repair and maintained, and used in a manner consistent with manufacturer recommendations. 5. The workers have adequate access to facilities for their welfare. Break rooms are particularly relevant for nurses doing long or split shifts to minimise fatigue. 6. Workers are provided with adequate training, information, instructions and supervision to protect them from risks to their health and safety. Training should generally be a combination of theoretical training as well as ‘on the job’ and done by appropriately qualified and experienced employees.

Regular refresher training should also occur as well as training on any new procedures or equipment in a timely way. 7. The workplace has a system whereby the health of workers and the conditions at work are monitored to ensure illness or injury is prevented. This also includes providing support for the mental wellbeing of nurses and midwives, particularly after exposure to violent or traumatic events.

What are your obligations regarding your own safety? You also have an obligation to take reasonable care for your own safety and ensure your conduct in the workplace does not expose any coworkers to a risk of injury. You should also comply with all reasonable health and safety instructions, policies and procedures you have been trained in.

What to do when things aren’t safe? ■■ Raise the issue, risk or hazard in the appropriate arena – most workplaces will have safety meetings or a designated safety officer or health and safety representative ■■ Make suggestions about changes that can be made to improve the safety issue ■■ Report the issue in writing and keep a record of your complaint ■■ Escalate the issue to your NUM, DDON, supervisor or manager ■■ If you continue to be concerned about your safety refuse to do the task ■■ Contact the QNMU to discuss your concerns.

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What will Workplace Health and Safety (WHS) do? WHS has the power to investigate complaints and enter workplaces in certain situations. A breach of the law occurs when a workplace places a person at a risk of injury, illness or death; this may be through certain behaviour or failing to do something to avoid a risky situation. Workplaces have mandatory reporting obligations if a worker dies, suffers a serious injury or illness or there is a dangerous incident. A serious injury or illness is one that requires a worker to be admitted to hospital for treatment. Following an investigation WHS will decide whether to charge a workplace or its directors with an offence. There are three categories of offences based on the degree of seriousness with financial penalties and imprisonment for individuals prosecuted through the court system. WHS also have the ability to require the workplace to change its practices or some aspect of their business (by issuing an improvement notice) and issue an on the spot fine (infringement notice).

Summary You have the right to work in an environment that does not pose a threat to your safety or expose you to the risk of an injury. Donâ&#x20AC;&#x2122;t hesitate to speak out and report your concerns. Workplace safety should be a priority for your employer and you have the right to be safe. Visit http://bit.ly/2iYuVzk to download QNMUâ&#x20AC;&#x2122;s 2017 Health & Safety Handbook.

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What helps nurses and midwives thrive?

he cost of burnout in nurses and midwives is high â&#x20AC;&#x201D; not just to the individual, but to organisations and to patient safety (Aiken et al; Dyrbrye et al, McHugh et al). There have been decades of research on identifying the problem of burnout, yet little progress seems to have been made in addressing it. So letâ&#x20AC;&#x2122;s focus on solutions and direct our efforts to what we know works well in combating burnout.

Sandra Eales QNMU Assistant Secretary

What are the positive steps individuals and the collective can make to ensure a thriving, energetic and engaged workforce?

CPD Connection is crucial and the strength of relationships determine wellbeing The Harvard Study of Adult Development followed several hundred men for 75 years and found the biggest predictor of happiness and fulfilment in life is quality of connection. The study has some limitations. Firstly, it didn’t include women. However the conclusions may be universal. The study demonstrates having someone to rely on helps your nervous system relax, your brain stay healthier for longer, and reduces both emotional and physical pain. It also clearly revealed those who feel lonely are more likely to see their physical health decline earlier and die younger. This shows it is not the number of friends you have or whether you’re in a committed relationship that matters. It’s the quality of your close relationships that makes the difference. The quality of relationships is measured by how much vulnerability and depth there is, how safe you feel sharing with one another, the extent to which you can relax and be yourself, and also truly see one another.

Community in the workplace The quality of relationships within the work team may be just as important for determining the safety and wellbeing of nurses and midwives. Many organisational and leadership theories identify relatedness and social connection as key to success or failure. For example, in their 2009 book, Heifetz, Grashow and Linsky noted that to be able to collaborate constructively there must be lateral bands of affection, trust and camaraderie and vertical bonds of trust in authority and the hierarchical structure Professor Mary Chiarella’s (2007) models of care research found that innovation and teamwork requires a practice zone based on mutual trust and collaboration, and the most successful models had an “ethos of collegial generosity”. Even the NMBA’s Registered nurse practice standards (NMBA 2016) touch upon trusting and respectful relationships stating nurses should be “purposefully engaging in effective therapeutic and professional relationships. This includes collegial generosity in the context of

Nurses and midwives need to feel comfortable to ask questions or to assert their opinion and professional judgement without fear of humiliation or punishment... mutual trust and respect in professional relationships.” The registered nurse is required to “actively foster a culture of safety and learning that includes engaging with health professionals and others, to share knowledge and practice that supports person-centred care” (NMBA Standard 2.7). A climate of psychological safety (i.e. a practice environment which allows dissent and keeps the discussion about risk alive) is necessary to protect patient safety, and vulnerability-based trust is essential for functional teams and an adaptive learning culture (Dekker 2017; Lencioni 2002). Nurses and midwives need to feel comfortable to ask questions or to assert their opinion and professional judgement without fear of humiliation or punishment, whether in questioning medication orders or other prescribed treatment or when reviewing a sentinel event. They must be able to report mistakes and near misses and know that they will not be blamed or sacrificed to protect the organisation. A healthy learning environment is where anyone in any position within a hierarchy is able to trust the rest of the team to be open and vulnerable about what they do or don’t know. This is critical for patient safety. As Oleander-Russo (2009) states, a “culture of regard” improves bedside communication and reduces adverse outcomes for patients. Relational leadership and practice of civility are fundamental to building the sustaining professional relationships nurses and midwives need to survive and thrive, and it is everyone’s responsibility to promote healthy, trusting workplace teams. We all need to “weigh in and buy in” to the culture in our own team through daily practice of collegiality, mentoring care and kindness to each other.

References Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002;288:1987- 93. 11. Chiarella EM (2007) Redesigning models of patient care delivery and organisation: building collegial generosity in response to workplace challenges. Australian Health Review. Apr;31 Suppl 1:S109-15 Dekker, S (2017). Just culture : restoring trust and accountability in your organization (Third edition). Boca Raton, FL CRC Press Dyrbye, L.N., T.D. Shanafelt, C.A. Sinsky, P.F. Cipriano, J. Bhatt, A. Ommaya, C.P. West, and D. Meyers. 2017. Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington Harvard Study of Adult Development. (2015). http:// www.adultdevelopmentstudy. org/ Heifetz, RA, Grashow, A, Linsky, M. (2009) The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Harvard Business Press Lencioni, PM (2002) The five dysfunctions of a team : A leadership fable. Jossey BassWiley McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. (2011) Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff.,30:202-10 NMBA (2016) RN Standards for Practice NMBA: Melbourne Oleander- Russo, L (2009) Creating a culture of regard: an antidote for workplace bullying. Creative Nursing, 15(2), 75-81 QNMU CPD Webinar. (2017). Collegial Generosity. www. youtube.com/watch?v=_ a13SyQtNqk Superfriend. (2017). Promoting positive mental health in the workplace. https://www. superfriend.com.au/resources/ promoting-positive-mentalhealth-in-the-workplace/

indepth

Annual Conference: sn a pshot

230

Delegates/Alternate Delegates

observers at Professional Day

At no other time is this more evident than our Annual Conference. It is – and always has been – the democratic heart of our union. You work with your Local Branch to draft and put forward motions. You elect who will represent your branch as Delegates at conference. And it is Delegates from every branch across the state who debate and vote on the issues that ultimately set our union’s agenda and priorities. It’s our way of ensuring we remain focused on issues that impact you, both individually and for our professions. And it’s an opportunity for us to come together and talk anything (and everything) nursing and midwifery.

resolutions made

urgency motions passed

“Nurses and midwives are the union”.

It enables every member to have their say and be heard.

scholarship winners

You may have heard your colleagues say,

“When you first come to conference you’re so green and there are all these new people you don’t know, and you’re in awe of how much knowledge these people have,” said Katy Taggart, a Registered Nurse from Townsville who has attended conference since 1994. “But you come away feeling empowered. It builds you up. That’s the best thing about conference – you get empowered and go back to your workplace feeling recharged.” The way we run our conference is constantly evolving, as Nurse Unit Manager Carol Jeffers observes.

indepth

our democratic heart “It’s not just about the voting now, it’s also about professional education,” Carol said. “There’s the Professional Day for people to come and see what’s being offered in terms of professional and up-to-date information about things like ratios around the world, and talks on wellbeing.” Carol said it’s also about having your say and speaking up for your colleagues. “I want passionately for nurses to be on par with our other health colleagues to have access to more professional development leave,” she said. “I did pursue it for a number of years at conference and now it’s on the log of claims, so I’m really happy about that.” Conference is also a chance to introduce newer nurses and midwives to our union, and educate our next generation on how they can exercise their voice to make a difference. “This year for me was all about learning the process and getting an understanding so I can take that knowledge back to my branch for next year,” new midwife Hannah McBryde said. “It’s nice to know that the issues you have in your workplace are happening elsewhere, and you feel less isolated. “If ...you think you never get to be part of the decisionmaking, it’s nice in this environment to know that we actually have a voice, and what happens on the floor here actually impacts us in our day-to-day work.”

indepth

Who did we hear from? Political scientist and keynote speaker Hahrie Han Hahrie delivered a rousing speech on building power for social change — and if we organise and mobilise ourselves and those around us, we can grow movements. “What makes movements different from a company is that they’re not trying to sell people something, they’re transforming what is possible […] We don’t become transformed when we’re alone, we become transformed when we’re with others, because we’re human beings.”

Michelle Black from Elegrow Michelle spoke about compassion fatigue. Research suggests younger nurses and midwives experience higher levels of stress and fatigue, and we need to support each other to foster resilience and reduce risks.

ACTU Secretary Sally McManus Sally spoke about Australia’s rising inequality, the union movement’s role in advocating for a fairer society, and our responsibility to change broken laws.

Paul Spurr and Sue Harvey from Clinical Supervision Consultancy Paul and Sue spoke about the impact of reflective models of clinical supervision on nurses and midwives.

A panel of nurses We also heard from a panel of nurses, including Kim Rayner from MICAH Projects, Ali Drummond from QUT’s School of Nursing, and Kuranda midwife Gabrielle Williams. Whether it’s assisting with homelessness and community services, preparing the next generation of nurses, or helping women be the hero of their own birth, this discussion demonstrated the broad scope nurses and midwives have to make a difference. This year’s Professional Day was open to all QNMU members, and counted towards members’ CPD hours. We’ll be doing the same next year, so start thinking about whether you’d like to attend!

Key highlights from the floor Here are the top three themes from resolutions put forward by delegates on the floor during this year’s conference.

Workloads and maintaining safe, quality patient care Workloads were a key topic this conference and delegates unpacked the changing nature of our work — such as the impact of digital hospitals and new processes — in contributing to workload issues. While adequate staffing levels and appropriate skills mix continues to be a key focus for us (and goes to the heart of our ratios campaign), we also identified the need to have a better understanding of the underlying causes of workload pressures for nurses and midwives across all sectors. We’ll be working to address workload issues at the root cause to ensure patient safety and safe, quality care continue to be at the forefront.

indepth Relationships within and outside nursing

NEW GRAD SCHOLARSHIP WINNERS

Delegates discussed the importance of collegial generosity, and how nurses and midwives can support each other and create positive practice work environments. Important relationships extended to working with others within and outside the health system to advocate for our shared interest of delivering the best patient care. We continue to support nurses and midwives to develop the skills and confidence to effectively navigate difficult conversations or stand your ground when necessary.

Campaigning for our shared goals We’re stronger when we work together and delegates talked about the many ways we take collective action to advance our interests and values. We were also buoyed by inspiring speeches from Sally McManus and Hahrie Hahn on working together to effect change with politicians and key decision makers. Though we may have problems to overcome, we’re in a better position to create positive change when we work collectively.

For a second year in a row, our new grad scholarship winners attended Conference as observers. This scholarship is part of the QNMU’s strategy to support and foster new networks for our next generation of nurses and midwives.

Check out more Conference photos on page 70



How does Annual Conference give your workplace a voice?

Katy Taggart RN (Townsville)

It’s really good to find out that some of the issues I find in my workplace are similarly shared in other workplaces so we can come together and get great ideas to take back to our workplaces and get a great outcome.

Masimba Dune RN (Townsville)

It’s been really helpful in explaining our roles and even challenging certain things we feel aren’t to the satisfaction of nurses. It’s really helped me to be empowered to support my colleagues a lot better.

Annaleese Brennan CN (Brisbane)

I’m here to make sure our opinions and motions from our local branch are put forward to try and bring our branch’s wages up to parity with the Health Practitioners who are working within our team.

in view

2017 QNMU Annual Conference Thank you to the hundreds of nurses and midwives who joined us for a busy three days of key debate, discussion, guest speakers and networking at the 2017 QNMU Annual Conference. We hope to see you next year!

in view

Congratulations Deb Ranson! Deb is the winner of our 2017 QNMU Conference social media competition! She has generously donated her $100 prize to not-for-profit community group Making a Difference - Brisbane, which assists families in crisis. Well done Deb!

QNMU and NAMRAS member Tony Speare (left) joined fellow refugee campaigners in Brisbane’s King George Square recently as part of a Nationwide Vigil calling for Australia to vacate Manus and Naru Islands. Great to see you flying our flag Tony.

in view

Tony is the winner of our Spring Book Prize. He wins a copy of Under the Same Sky by Mojgan Shamsalipoor. Congratulations!

BOOK PRIZE WINN ER

We had a great time chatting with our student members at a Queensland University of Technology Open Day, hosted by QUT’s Society of Undergraduate Nurses.

QNMU bid a fond adieu to staff member Jenny Gett. After more than four decades with the union, Jenny is now looking forward to a well-earned retirement. We wish her all the best — you’ll be sorely missed Jenny!

Then… and now! Long time QNMU member and Enrolled Nurse Kyle Penhaligon has spent decades campaigning to advance the interests of nurses and midwives. He’s featured in our Branch Handbook in a 1988 campaign, and a recent edition of InScope at the Sunshine Coast University Hospital’s official opening. Go Kyle!

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 75 for details.

calendar World Mental Health Day

September National Blue September Month www.blueseptember.org.au

National Prostate Cancer Awareness Month

Enrolled Nurse Professional Association (ENPA NSW) Conference ANMF Vic Branch Australian Nurses and Midwives Conference 21-22 September, Melbourne http://bit.ly/ANMFevents

Launceston Nurses’ Conference

2 Day Conference for Nurses - Learn Locally with Ausmed 21-22 September 2017, Launceston www.ausmed.com.au/course/ launceston-nurses-conference

18th Australasian Nurse Educators Conference Transition, Technology, Transformation 28-30 September 2017 Christchurch, New Zealand http://anec.ac.nz/

11 October, Wrest Point, Tasmania www.nena.org.au

Lung Health Promotion Centre at The Alfred Managing COPD 12-13 October 2017 Spirometry Principles & Practice 23-24 October 2017 P: (03) 9076 2382 E: lunghealth@alfred.org.au

Australasian Rehabilitation Nurses’ Association 27th Annual Conference

National Anti Poverty Week

29 September www.afp.gov.au/about-us/ourorganisation/ceremonial-eventsand-functions/ceremonial-events/ national-police

15-21 October www.antipovertyweek.org.au/about/ about-anti-poverty-week

World Self Medication Industry (WSMI) General Assembly

October Global Alcohol Policy Conference 2017

Mobilising for Change – Alcohol policy and the evidence for action 4-6 October 2017, Melbourne http://www.gapc2017.org.au/

25-27 October, Woolongong, NSW www.anaa.asn.au/

Australian and New Zealand Orthopaedic Nurses Association (ANZONA) Conference

43rd Annual International Mental Health Nursing Conference

Nursing and Legal Concepts South Pacific

Menopause: Exploring the evidence 13-15 October, Sydney www.ams2017.org/

International Police Remembrance Day

35th Audiometry Nurses Association of Australia Annual Conference & AGM

25-27 October, Tasmania www.acmhn.org/news-events/ conference-news/acmhn2017

21st Australasian Menopause Society Congress

29 September www.world-heart-federation.org/ what-we-do/world-heart-day/

We’re in it together 25-27 October, Broome, WA E: event@peppermint.com.au

Let’s Articulate, Align and Unite: ANZONA 2017 25–27 October 2017, Perth www.ona.asn.au/conference2017

The changing landscape for rehabilitation nursing: Transitions, transformation, future visions 12-13 October, Adelaide www.arna.com.au/

World Heart Day

Continuing Professional Development

Rural and Remote Mental Health Conference

13th Biennial National Enrolled Nurse Association of Australia (ANMF SIG) Conference

21-22 September, Sydney http://www.enpansw.org/

8-14 October www.mentalhealthvic.org.au/

The future of remote health and the influence of technology 18-20 October, Broome WA www.cranaconference.com/

Congress of Aboriginal & Torres Strait Islander Nurses & Midwives (CATSINaM) Conference Claiming our future 10-12 October, Gold Coast http://catsinam.org.au/

www.prostate.org.au/articleLive/

National Mental Health Week

35th Annual CRANAplus Conference

10 October www.1010.org.au/

The Health Economic Value of Self Care 18–19 October, Sydney http://wsmiga2017.com/

Keeping you and your patients safe 28 October - 5 November 2017 https://goo.gl/vf45dT

Australian College of Midwives 20th National Conference

Calling all Midwives: The truth is out there! 30 October- 2 November, Adelaide www.acm2017.org/

November Movember Month

Australian College of Neonatal Nurses 25th National Conference Shaping neonatal care: From past to future 18-20 October, King Fisher Bay Resort, Fraser Island, Qld www.acnn.org.au/events/acnnnational-conference/

Is an annual, month-long celebration of the moustache, highlighting men’s health issues, specifically prostate cancer and depression in men. www.movember.com.au

AQNL Nursing & Midwifery Leaders Conference

1 November 2017 Sunshine Coast University Hospital Site Visit

2 - 3 November 2017 Brisbane Convention & Exhibition Centre Inspiring and Engaging current and future Nursing & Midwifery Leaders www.aqnl.org.au

Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 1-3 November 2017 Smoking Cessation Facilitator’s Course 16–17 November 2017 P: (03) 9076 2382 E: lunghealth@alfred.org.au

Australasian HIV & AIDS Conference 6-8 November, Canberra www.ashm.org.au

Australasian Sexual Health Conference 7-9 November, Canberra www.ashm.org.au

Eureka Climb

12 November. The race to the top of Melbourne’s tallest building. Raise funds for Interplast volunteer reconstructive surgeons and Whitelion charity for at risk youth. www.eurekaclimb.com.au

World Diabetes Day

14 November www.idf.org/worlddiabetesday

2018 Reunion: Prince Henry, Prince of Wales and Eastern Suburbs hospitals NEC of UNSW Reunion planned for the February 1973 intake of PTS 17 February 2018, 6pm Malabar (Randwick) Golf Club Expressions of interest to: Roslyn Kerr phone: 0447472968 email: gert2@optusnet.com.au or Patricia Marshall (Purdy) email tapric135@bigpond.com

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.

incoming On OUR 2017 ANNUAL CONFERENCE KC It was an awesome conference with awesome nurses. Like · Reply

JLM Well done QNMU! I’m a 35 year long member and have seen so many gains, won through collective action and held by perseverance. Like · Reply

TC Thank you QNMU. There is no other organisation that will do this for us. No other organisation that determinedly pushes on like a dog at a bone. No other organisation that fully understands nurses and midwives and helps us with innumerable issues and doesn’t ask for a cent more. THANK YOU! Like · Reply

MO Another wonderful conference. I’m a bit teary but great speakers. Love my union! ❤ Like · Reply

Letter to the Editor After a lengthy spell in my ‘to-do’ pile, I rescued the Autumn 2017 InScope magazine and flicked through it tonight. Imagine my surprise when I saw an article about Margaret Fontana, a colleague I worked with 20 years ago! It is inspiring to hear how Margaret and her husband focus their energy on fundraising after enduring such tragedy. And to read Margaret’s words “only an EN” - let me tell you, those ENs at Innisfail Hospital taught me so much when I worked there as an almost-brand new RN. Don’t undersell yourself! Take care in your retirement, Margaret. I’m sure you’ll be missed! Alison Campbell URE indepth FEAT

At the heart of nursing On reporting of patient safety measures in hospitals LMR Private hospitals will fight this tooth and nail. The horrifying negligence I have seen over many years as an agency nurse in private hospitals that gets ignored because of specialists who generate high income is a disgrace. Like · Reply

LR Well I hope in the private sectors patient safety also refers to the nurse-to-patient ratio. In some private hospitals they are creating a perfect environment for something to go wrong. #overworkednurses Like · Reply

On mature age nursing students KM I’m 60 this year and a second year RN with no previous health work history except as an AIN while I studied. I love it! My only regret is not realising earlier that I wanted to/could be a nurse. To anyone else thinking about it - do it! A so-tough but so-rewarding journey x Like · Reply

JS I started mine at 32. Yesterday I interviewed a 60-something year old who had done hers eight years ago. I believe common sense and worldly experience are valuable tools in our role.

and Margaret Fontana

her husband

Gid

NURSE ENROLLED MEMBER AND QNMU FONTANA MARGARET HAS CARRIED OF RT THE HEA INTO SING NUR ENT, HER RETIREM HER TIME DEDICATING MUCHTO RAISING DS FOR NEEDED FUN CHARITIES.

Photos: Anne

Wilkinson

constantly doing the dishes and is always coming food out of the kitchen !” In honour of her daughter’s memory, Marga ret also genero usly funds two bursar ies to help studen at Rachel’s alma ts mater, the University of Southern Queen sland. They are the Rachael Fontan a Memorial Bursar ies for the Arts for financial and hardship. “Rachael derived joy from affordi pleasure to others ng and the bursar reflect her passion ies for art and her compassion toward others, ” she said. “I’m glad that these bursar ies are now helping others in their time of need, and in a lot of ways that is at the very heart of nursing.” Margaret’s passion for helping others comes as no surpris e. As an Enrolled Nurse of more than four decades, she threw herself into caring for people when her nursing career began in 1975 at the age of 20. With her mother expand and been able to and both we’vesisters years already Registe charities. r63-yea red Nursesto more and more five years donate , Marga knew there ret OR THE past had 120 her husband could be no other and first year, we ret very career path our “In old Marga forand iser her. attend the fundra up their home to 150 people Gid have opened “Theyannual past year, d to host an certainly had a big $3,000. This influen and raised on my decisio d 0 with ce gardens in Silkwoo n to pursue nursing proceeds donate ed to raise $14,00 with manag iser, we It . ance.” very fundra l, the runs Appeamuch in the family,” people in attend DroughtMarga around 400 s. to Lifeline, the ret said. an elegant other charitie guests and Animal Refuge Aside from offering Having High fundraiser also d the annualworked in a smalltea experience, the hospita high Margaret initiate inafter Innisfa l selling bric-ashe il, Margaret reflecte of stalls Midwives’ Union shortly boastsdaitmyriad often the ers was and Tea Fundraiser e, plants, andwas the one consta daught little things that made that helped fresh produc nt both her her through. brac, books, difference to a tragically lost on. her patients. hild. “I was strugg even an art exhibiti unborn grandc ling both emotio “Over 38years you community rallied l wasthe nally Rachae often ret said herand financially after see the Marga same people Her daughter an the death of iser, lending she died inand fundra they just suppor daught the my when t nt ers andthe QNMU to love to see a face they know. weeks pregna stallsand prenatal supported staffing methe throughbe her way to a their time to l. to these dark times. accident on “I items Hospita was il g usly donatin “I think it’s at the Innisfaonly an EN but I have genero loved appointment took the human touch money. really important help raise for sister Tania sadly of nursing people to join raffled il union. like ato Rachel’s older rub, hot pack their back Innisfa You never and a cup of small town in two years later. tea. “We live in a know when you get her own life is “The day to see peoplemay need help and iser it’s the I retired the fundra security of knowin , was wonderful I cried as soIithave For Margaret, loved being from donate clothes g there is andand help a nurse.” that has come suppor behind the cause t there if you ing really!” something positiveMarga ers’ passing. — everyth ever it.” k, plants need her daughtret thinks fondly on artwor the tragedy of as an her time ease to EN, saying the social she said. Despite recentl something aspect of “We had to do her work is what way asked local y stepping into retirem she will miss “We have never ent, Marga is just my small have ret has no intentio most. the pain. This “Wheth them donations and of n and showin er it’sgwith your businesses for slowing down. of helping others ort with for them,” colleagueshelped by friends and family. patient out there “Now that I’m s, nursing is been there is suppor all about retired I can human interac more people andute contrib tion and I love even “We get more Margaret said. that,” said. she so we’remore time toward my to yearfundra annual fundraiser was attending each iser,” she said. “Initially, the “Howev but in recent er, “The work is for Lifeline the one thing I constant — when won’t miss raise moneyis compu ters! I know we one fundraiser ends need we them begin plannin but they are the next right g for a struggle some away. days.” Through the “I intend to continu difficult times, Margaret e hosting the said the Queen fundraiser every sland Nurses year until I’m and too exhausted to continue!”

SZ I started my degree at 39 and graduated at 44... Have been doing paediatric nursing ever since and love it more than I could have imagined..

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Margaret (right) and her friend Pam Burns from Cairns at Margar High Tea Fundra et’s iser.

The day I retired I crie d as I have loved being a nurse. Annual High Tea Fundraiser Margaret’s annual High Tea Fundraiser will be held in the ﬁrst week of Septem ber in Silkwoo d, Innisfail. Tickets cost $10 for adults and $5 for children. Margaret welcom es donations for sale at the fundraiser and can be contacted on mgfontana81@ gmail.com

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.

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VV About time! I wonder if this will finally assist nursing ratios in high care areas! One nurse to ten patients at night is ridiculous.

FEATURE indep th

/qnmuofficial

incoming On Blue Care cutting nurses and transferring medication management to PCs

Letter to the Editor

RT This is what happens when healthcare ends up in the private sector. It is less about quality of care, and more about money for the shareholders. Like · Reply

JW Blue Care should be ashamed of themselves and held to account. Aged care residents and the nurses and carers must be put first and staff cuts and understaffing levels must be addressed by aged care authorities. Our elderly and the staff who care for them deserve better than this. Like · Reply

DS As an AIN personally it’s not my scope of practice to give out medication… That’s the job that ENs and RNs do. Like · Reply

I recently attended one of the QNMU’s Domestic Violence Work Aware information sessions. Initially I found the content confronting as I am currently dealing with these issues on a personal level. But from a counselling point of view I strongly encourage as many health professionals as possible to attend a session to raise awareness of the needs of your colleagues and fellow workers, and how you may be able to help or support them within the work environment. Even if it’s as simple as walking them to their car at the end of the shift, or just taking the time to listen. I am very fortunate to have a fantastic support network at work of nurses, doctors and administration staff. You just need to speak up. There have now been some areas identified in our work environment that could be improved on. The leave support that has already been established over a year ago has helped me to reduce some of the stress of taking extra time away from work, to move from the home and re-establish myself, attend legal appointments and court hearings. Thanks to all involved in this process, and my work colleagues for always being there, listening to me and wanting to help to improve my family life. Every little bit helps to make you feel you aren’t alone. Sadly, this will not stop domestic violence, but together having a better understanding may help make the impact and outcome a bit easier to work through. CB

Win

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An Outback Nurse by Thea Hayes

Atmosphere of hope by Tim Flannery

The charming story of a young city nurse who found love in the outback.

Acclaimed scientist and author Tim Flannery argues that Earth’s climate system is approaching a crisis. Catastrophe is not inevitable, but time is fast running out

Thea Hayes trained as a Nurse in Sydney in 1959. A year later she was catapulted out of the safety of her city life into the unknown world of the Outback. Thea knew nothing of the place she was soon to call home, Wave Hill Station in the Northern Territory, the second largest property in the world under one management. It covered four million acres! This is a story of growing up, falling in love and finding your home.

This book provides both a snapshot of the trouble we are in and an upto-the-minute analysis of some of the possibilities for mitigating climate change. From atmospheric carbon capture through seaweed farming, and CO2 snow production in Antarctica to reflecting the sun’s rays by releasing sulphur into the atmosphere Flannery, outlines new technologies that give cause for hope.

Traditional Healers of the Central Desert by the Ngangkari Womens’ Council Aboriginal Corporation Traditional healing is still very much a part of today’s Aboriginal society. The ngangkari employed at NPY Women’s Council are senior Aboriginal people authorised to speak publicly about Anangu culture and practices. They deliver treatment to people in more than 25 communities in SA, WA and NT. Acknowledged and respected, these ngangkari work in collaboration with hospitals and health professionals. This beautiful book details their work in their own words.

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

Enjoy right now, knowing you’ll be right later.

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Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. 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). 2016

More home. 0.35 less loan. 1

As a QNMU member you could get a discount off the variable rate with a new ME Basic Home Loan. Arrange a time to speak to our ME Relationship Manager Kym Chisholm

Kym.Chisholm@mebank.com.au | 0417 296 796 mebank.com.au/benefitsqnmu Apply through a ME mobile banking manager before 31 October 2017 and settle your loan by 31 December 2017. This offer is not available for investor or interest-only loans.

Things you should know. (1) Home loan discount offer terms and conditions. A 0.35% p.a. discount off the applicable standard variable interest rate for Basic Home Loans where the primary loan purpose at application is owner occupied. The discount is available to you as a QNMU member on new home loan applications received between 20-Jul-17 and 31-Oct-17 and settled by 31-Dec-17. The discount applies for so long as you have a Basic Home Loan and you remain an owner occupier. It is not available for interest-only loans, investment loans, internal refinances, top-ups or variations of existing ME home loans. This offer is only available on loans originated via a ME mobile banking manager. It is not available on applications made through an independent mortgage broker. 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.Terms, conditions, fees and charges apply. Applications are subject to credit approval. Members Equity Bank Limited (ME) ABN 56 070 887 679 holds an Australian Credit Licence 229500 and is the provider of the Basic Home Loan.