InScope No8 Summer18 by Queensland Nurses and Midwives' Union

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

unpacking the aged care royal commission

Summer 2018

ngels IN THE HOSPITAL

Ask the question:

How many nurses are on duty?

PLUS! CPD CONTENT ON HIDDEN CAMERAS, DEALING WITH POLICE & MORE

Union Training Program

www.qnmu.org.au/ education 3840 1431

FEBRUARY – JUNE 2019 FEBRUARY Tues 26

Wed 27

Ethical decision making

Being a QNMU Contact in the workplace

BRISBANE

Wed 27

Thurs 28

No excuse for abuse!

QH Rostering – Equity & work life balance

BRISBANE

Thurs 28 Aged Care & Private Hospitals – Getting prepared for our next agreement

BRISBANE

MARCH

MAY Wed 8

Thurs 9

Handling grievances in the workplace

No excuse for abuse!

TOWNSVILLE

Fri 10

Wed 15 – Thurs 16

Ethical decision making

Knowing your entitlements & understanding the Award!

TOWNSVILLE

BRISBANE

Thurs 23

Fri 24

Creating a safe workplace (WH&S)

Being protected at work

BUNDABERG

Wed 6 – Thurs 7

Tues 12

Wed 29

Thurs 30

Knowing your entitlements & understanding the Award!

Being protected at work

QH Rostering – Equity & work life balance

Being protected at work

TOOWOOMBA

BRISBANE

MACKAY

Wed 13

Thurs 14

QH Rostering – Equity & work life balance

Ethical decision making

BRISBANE

Wed 13 – Fri 15

Wed 20

Workplace Representatives 1

QH – BPF for NUMs & MUMs

CAIRNS

SUNSHINE COAST

Thurs 21

Wed 20 – Thurs 21

QH Rostering – Equity & work life balance

Someone should do something about that!

SUNSHINE COAST

ROCKHAMPTON

Fri 22

Wed 27 – Thurs 28

Professional Culpability – Where do I stand?

QNMU Branch Development 1

ROCKHAMPTON

BRISBANE

Fri 29

JUNE Tues 4 – Wed 5

Thurs 6

Workplace Representatives 2

Professional Culpability – Where do I stand?

BRISBANE

Wed 12

QH – How to make the BPF work for nurses & midwives

Creating a safe workplace (WH&S)

BRISBANE

Thurs 13

Handling grievances in the workplace

QH Rostering – Equity & work life balance

BRISBANE

Mon 17 – Fri 21

Tues 25

Health & Safety Representatives training for nurses & midwives

QH – BPF for NUMs & MUMs

BRISBANE

QNMU Branch Development 2

Wed 26

BRISBANE

Thurs 27

Being protected at work

APRIL

BRISBANE QH Consultative Committees – How to make them work

BRISBANE

Tues 23 – Wed 24

Tues 30 – Thurs 2

Thurs 27 – Fri 28

Someone should do something about that!

Workplace Representatives 1

Someone should do something about that!

BRISBANE

GOLD COAST

Summer 2018

INDEPTH

Aged care: The mother of all inquiries

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, Lou Robson, Luke Rutledge PUBLISHED BY The Queensland Nurses and Midwives’ Union AUTHORISED BY B. Mohle, Secretary, Queensland Nurses and Midwives' Union, 106 Victoria St West End 4101. PRINTED BY Kingswood Print Signage, 80 Parramatta Rd Underwood 4119

INDEPTH

CPD

Breaking down barriers: Understanding the power of continuity of care

Hidden cameras in aged care: Are they legal?

Lost in the game: WHO declares gaming addiction a mental health disorder

46 50 51 52 54 56

Dressing and securement methods: preventing catheter failure

58 60

A focus on psychological safety helps teams thrive

18 22 24 28 34 36 40 42 43

Angels in the hospital Code green: How can we make our hospitals more sustainable? Celebrating a century of Child Health Nursing Aged care: The mother of all inquiries Where did all the nurses go? What's your emergency? Ask the question: How many nurses are on duty?

Making family-centred care happen in ICU Dealing with the police: Your rights and responsibilities Maintaining progressional boundaries with patients Your professional indemnity insurance: What you need to know

Conscientious objection

United by a common purpose Working women power this country

REGULARS

INSIGHT

TEA ROOM

WINS

JUST IN

IN MEMORY

IN VIEW

INCOMING

CALENDAR

ADVERTISING

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.

Cover photo: The Prince Charles Hospital ICU Nurse Unit Manager and QNMU member Vanessa Rainbow (left) and Charlie's Angels volunteer Margaret Van Gerrisheim.

insight

The evidence the Royal Commission must hear Sally-Anne Jones QNMU President

IN MID-SEPTEMBER 2018, the Morrison federal government announced a Royal Commission into Aged Care Quality and Safety.

This ANMF-commissioned report specifically outlines the ratio and requirements of safe skills mix for various levels of residential care.

The Royal Commission is the culmination of a fierce and determined crusade, including the years-long campaign efforts of the Australian Nursing and Midwifery Federation (ANMF) and respective state branches (including the QNMU).

So instead of just asking for more staff, we now knew exactly what kind of staff and how many.

The Australia-wide campaign this time was invigorated by the resolve of the ANMF Council on behalf of members and residents across Australia. It was ignited by the continued injustices of the current system, and inflamed by the lack of impact of previous campaigns to shift the inertia in funding for appropriate staffing levels and skills mix, providing nursing to the most vulnerable in our society. Despite years of submissions, meetings with key politicians from all parties, public lobbying, and numerous senate enquiries and productivity reports, no real change has been made to improve the working conditions and pay for aged care workers. As we know, the cornerstone of our campaign is minimum staff-toresident ratios. The ANMF commissioned several bodies of work to provide the hard evidence to underpin what we have long known — that there are not enough staff in aged care, nor enough with the right skills and qualifications. In 2016, the ANMF commissioned the National Aged Care Staffing and Skills Mix Project in response to a 2011 productivity commission report, whose recommendations were once again frustratingly limited to education and training opportunities and little else.

To further support our claims, the ANMF commissioned further bodies of work from the Tax Justice Network, Australia (TJN) and the Global Alliance for Tax Justice, organisations well placed to explain the harmful impacts of tax evasion, avoidance, competition and tax havens. The work was commissioned to analyse possible tax avoidance by for-profit aged care companies and to provide recommendations for improving transparency of federal government spending on for-profit aged care. There was an immediate response across the sector and from media and government following the release of the report. A senate enquiry was launched into tax avoidance by aged care providers, which reported in August this year. Meanwhile, the ANMF and state branches ramped up our campaign — and Ruby became the poster-woman as the public face of the urgent need for ratios. Her fate, her plight, her life became the story for each arm of the campaign to alert politicians, the public and families to the devastating reality of deficits in funding that do not allow for the right number of staff with the right skills to provide quality care. The Royal Commission’s findings and recommendations are a long way off, and their impact on the industry is yet to be seen.

But we don’t have time to waste. Our immediate opportunity to make a difference is to join the campaign and lobby on this important issue in the lead up to the imminent federal election. It is time to ask each party where they stand on legislated ratios in aged care. Ruby is depending on you!

ANMF RESEARCH National Aged Care Staffing and Skills Mix Project: https://bit.ly/2fYjpAM Tax avoidance report: https://bit.ly/2NIxMYg

QNMU COUNCIL secretary :

Beth Mohle

assistant secretary : president :

Sandra Eales

Sally-Anne Jones

vice president :

Lucynda Maskell

councillors :

Julie Burgess Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Michael Hall Raquel How Shelley Howe 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

Achieving a care guarantee step by step Beth Mohle QNMU Secretary

AS YET another busy year comes to an end, I have been reflecting on the things that really matter to Queensland’s nurses and midwives and how many of us have taken courageous actions to defend high quality nursing and midwifery for all. No matter where our members work, an enduring concern is ensuring safe workloads. This is a top priority across all sectors — public, private and aged care. Our ambitious Ratios Save Lives campaign, which launched in January 2015, places safe workloads front and centre. We have made great advances in the past three years, starting with the passing of legislation on 12 May 2016 to establish minimum nurse-to-patient ratios in prescribed Queensland Health medical and surgical units. In the lead up to the 2017 election we secured a commitment from the Palaszczuk government to extend minimum ratios in state government nursing homes and mental health units. Work has commenced to make these commitments a reality. In Queensland Health we have continued our focus on making sure the industrially mandated workload management tool, the BPF, is properly applied. Members have bravely campaigned locally to secure increased staffing numbers, largely through completing workload concern forms. Gathering the evidence is critical, and trialling an electronic workload reporting process in West Moreton HHS will greatly enhance timely reporting, response and monitoring of trends.

Our campaign for ratios in aged care is intensifying in the lead up to the federal election. We also continue to pursue safe workloads through ratios in private hospitals. Although employers have resisted our claims made via enterprise bargaining, we will not give up. Shining a light on the differences that exist in staffing and skill mix across sectors is essential. Ultimately, the community will be faced with the questions: why is this so? How is this justifiable? We firmly believe the community has a right to a care guarantee — no matter where people are being cared for they are entitled to the same highquality nursing and midwifery. Ratios are that care guarantee. At its October meeting, the QNMU Council approved an advertising campaign to highlight our concerns and build community support. Find out more on page 40. Our message is simple — ratios save lives and are needed across all sectors. We have the evidence to prove this. This ad is currently airing across television and online. It’s a reminder

that safe patient and resident care matters to us all. Use it as a conversation starting point with family and friends. Tell your own stories about your current workloads and how ratios make a difference. Most importantly, tell those you care about that they need a care guarantee for when they are at their most vulnerable. Make your voice heard at work too — always report workload concerns. When you do, you are advocating for safe professional practice. If concerns are not raised — if you are not seen or heard — there is no possibility of a remedy. Our campaign will ramp up in 2019. Please join our activities — we cannot succeed without you. Add your voice to extend minimum ratios across Queensland’s health and aged care sectors. Let’s make some noise. Whether you’re working this Christmas or lucky enough to have a break, I wish all QNMU members and their loved ones a safe and happy holiday season.

Our message is simple — ratios save lives and are needed across all sectors. We have the evidence to prove this.

But much more needs to be done.

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.

Do I have to notify my employer/the NMBA if charged by police? Yes. All health practitioners, including students, have an obligation under the Health Practitioner Regulation National Law Act 2009 (Qld) (National Law) to give written notice to the Nursing and Midwifery Board of Australia (NMBA) of certain events that may affect their registration. Many QNMU members have run into trouble for not notifying the NMBA at the right time or at all, simply because they were not aware of their requirements. If you fail to notify within the timeframe, the NMBA may take action against your registration.

What do I have to report? For RNs, ENs and RMs: You must notify the NMBA in writing within seven days after becoming aware of: ■■ being charged with an offence punishable by 12 months imprisonment or more (also applicable to students)

Need assistance? The process of notifying the NMBA is simple. Members should contact the QNMU immediately regarding advice on whether and how to make a notification.

■■ being convicted or found guilty of an offence punishable by imprisonment, including less than 12 months imprisonment (also applicable to students) ■■ not having appropriate professional indemnity insurance arrangements in place in relation to your practice ■■ your right to practice at a hospital or another facility being withdrawn or restricted because of your conduct, professional performance or health ■■ your billing privileges being withdrawn or restricted under the Medicare Australia Act 1973 because of your conduct, professional performance or health

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

■■ your authority to administer, obtain, possess, prescribe, sell, supply or use a scheduled medicine or class of scheduled medicines being cancelled or restricted ■■ your registration in another country being suspended, cancelled or subjected to a condition or restriction (also applicable to students)

■■ a complaint being made about you to any of the following entities: ◆◆ the CEO under the Medicare Australia Act 1973 ◆◆ an entity performing functions under the Health Insurance Act 1973 ◆◆ the secretary within the meaning of the National Health Act 1953 ◆◆ the secretary to the Department in which the Migration Act 1958 is administered ◆◆ another Commonwealth, State or Territory entity having functions relating to professional services provided by health practitioners or the regulation of health practitioners.

Other requirements Being issued a ‘notice to appear’ by a police officer constitutes being charged with an offence, meaning the seven-day period commences from receiving your notice. You may also be required to notify the NMBA for certain workplace disciplinary processes.

Notifying your employer For Queensland Health employees (including AINs) There are also strict requirements for Queensland Health employees to notify their supervisor or manager of charges and convictions. Under QH Policy E4, you must notify your supervisor or manager no later than 48 hours after being charged or convicted of an indictable offence. This includes being served with a ‘notice to appear’ or served with a summons to appear in court to answer an alleged offence. Members can read the E4 policy at https://bit.ly/2JFMm1t For private sector employees Members working in the private sector should check their Code of Conduct to see what their reporting obligations are, or contact QNMU Member Connect for assistance.

wins

$180,000

recovered in unpaid meal breaks NURSES at Yumba Binda Aged Care in Central Queensland will share in a whopping $180,000 pay correction, after years of not being able to take their meal breaks.

staff were required to remain at the facility in case of an emergent situation, they were entitled to overtime or TOIL.

Under the Nurses Award, all employees are entitled to a 30-minute meal break after working six hours, and must receive overtime or TOIL if they cannot take it.

In the end, management agreed the meal break payment would be paid to 19 nursing staff, with initial calculations putting the total figure at $180,000.

“The staff at the Woorabinda Hospital — which is run by the same HHS — were getting paid for not being able to take their meal break, but staff at the aged care facility weren’t,” said one QNMU member, who wished to remain anonymous. After raising their concerns, management initially refused to acknowledge the staff were entitled to compensation.

If it wasn’t for the assistance of the union, we wouldn’t have got anywhere.

HOLY SPIRIT NORTHSIDE ENs RECOVER THOUSANDS IN UNPAID WAGES

“Usually there was only one EN and AIN rostered in the afternoon and night shifts, so it wasn’t possible to leave the facility. We didn’t have any choice but to work through our meal breaks.”

“A lot of the staff simply didn’t know what the Award was or what they were entitled to,” the member said. “If it wasn’t for the assistance of the union, we wouldn’t have got anywhere.”

Ensuring you get your meal break Taking your meal break is a matter of safety. Fatigued nurses mean accidents are more likely to happen. That’s why the QNMU negotiated additional conditions and penalties around meal breaks for Queensland Health nurses and midwives in EB10, which include:

Members contacted the QNMU and began submitting workload forms.

■■ 30 minutes paid at ordinary time if you are unable to take your meal break between the fourth to sixth hours of the shift

Finally, when the QNMU sought clarification on behalf of members, the HHS concluded that because

■■ 30 minutes overtime if you cannot take your meal break at all during your shift.

ENROLLED Nurses at Holy Spirit Northside are in the process of recovering thousands of dollars in unpaid wages. Noticing their payslips did not reflect their correct hourly wage, members approached their QNMU Workplace Rep.

One member has already received about $4500 in back pay, and is expecting more after another pay error was identified. The QNMU is now in the process of recovering outstanding backpay for other members.

The QNMU checked the employer’s calculations and found members were not being progressed through the pay scale in accordance with their agreement.

If you work at Holy Spirit Northside and haven’t yet progressed a wage claim, we encourage you to contact the QNMU for assistance.

wins

$1300 in unpaid leave loading A FEW months ago, QNMU member Petrus Botha had never heard of ‘leave loading’. What’s more, he wasn’t aware his employer at the time wasn’t paying it. Petrus only became aware of his entitlement to leave loading when a new colleague started talking about it. “It occurred to me that it wasn’t something I’d ever seen on my payslips when I took leave,” Petrus said.

Queensland sweeps CRANAplus Awards Congratulations to those Queensland nurses who were honoured at this year’s CRANAplus Awards, where four out of five winners were from Queensland!

as the Torres and Cape Nursing and Midwifery Education Team (for excellence in education or research in remote health).

The CRANAplus Awards recognise remote and isolated health professionals who have made a significant contribution to their profession or to improving health outcomes in their community.

QNMU members Natalie Thaiday and Josh Stafford took out the excellence in remote health practice award and excellence in mentoring award respectively.

Among the winners was the Torres and Cape Nurse Navigator team (collaborative team award), as well

For more information on CRANAplus, including future nominations, visit https://crana.org.au/

“I questioned the boss a few times, and their response was that they didn’t have to pay my leave loading because they paid me above the minimum Award wage.” Petrus turned to the QNMU, who set the record straight. “They definitely helped me a lot — it was like a weight off my shoulders.” The employer initially refused to consider the issue, but the QNMU worked with Petrus to educate them on the entitlements set out in the Nurses Award and the Fair Work Act.

Torres and Cape Nurse Navigator team

As a result, Petrus was paid $1300 in unpaid entitlements.

Know your entitlement As a minimum, all Queensland nurses and midwives must be paid an annual leave loading of 17.5% of their ordinary pay when taking annual leave — this is the minimum entitlement set out in the Nurses Award. Members should refer to the Award and their individual enterprise agreement for details, as conditions will vary (including for shift workers).

rsing and Torres and Cape Nu team n tio uca Ed ery Midwif

Josh Stafford (centre), recipient of the excellence in mentoring award

Natalie Thaiday, rec ipient of the excellence in remote health practice award

wins

Queensland decriminalises abortion AFTER a historic vote in Parliament, abortion has at last been decriminalised in Queensland. Both Labor and LNP MPs were granted a conscience vote on the matter, and the bill ultimately passed 51 to 41. Termination of pregnancy is a complex health issue, and a difficult decision that should be made between a woman and her health practitioner. Removing abortion from the criminal code will provide dignity to women who face these situations and protect the health practitioners who assist them. The QNMU made numerous submissions to parliamentary and Queensland Law Reform

Commission inquiries in support of decriminalisation. In arriving at our official position, the QNMU Council and its policy committee (QPC) — which are all democratically elected by members — followed due process, drawing on briefing papers and empirical evidence where available.

Conscientious objection Nurses and midwives have a right to refuse to participate in procedures which they judge to be unacceptable based on strongly held religious, moral and ethical beliefs. Members can familiarise themselves with the ANMF’s policy on conscientious objection, which is outlined on page 60.

The Termination of Pregnancy Act 2018 came into effect on 3 December. Members can visit the Clinical Excellence website for information about the Act, including your rights and obligations. Visit https://bit.ly/2PaZME0

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

just in

Taking care of midwives Royal Commission into aged care

THE TERMS of Reference for the Royal Commission into Aged Care Quality and Safety have been announced. The Hon Justice Joseph McGrath and Ms Lynelle Briggs AO have been appointed Commissioners, with the Royal Commission’s final report due by April 2020. We unpack the Royal Commission on page 28.

Big Steps Walk-off

NURSES and midwives were proud to stand in solidarity with early childhood educators and teachers at the Big Steps Walk-off recently, in support of their bid to convince the government to fund equal pay. www.bigsteps.org.au

There’s been a lot of activity among our midwifery members over the past few months, including a focus on psychological safety in maternity services.

Maternity Care Summit In October, Central Queensland HHS held its first Maternity Care Summit. Multidisciplinary teams came together from all corners of the district to discuss safety for mothers and babies. Topics included progress on streamlining the GP antenatal referral process, Queensland’s maternal and perinatal outcomes, and psychological safety in maternity care. It was also an opportunity to celebrate some significant achievements made in Central Queensland maternity services over the past two years, including reducing postpartum haemorrhage rates, creating pregnancy loss pathways, and developing a huband-spoke model incorporating a safe birthing/referral matrix for rural sites, and developing more timely

Green thumbs up for QNMU

THE QNMU head office building in West End has once again achieved five stars for energy efficiency and 5.5 stars for water saving under the National Australian Built Environment Rating System (NABERS), with six stars being the maximum. We always aim to be enviro-smart as part of our ongoing commitment to the environment!

Central Queensland Maternity Care Summit

A century of supporting children’s health

A CENTURY ago Queensland’s first child health clinics opened in Fortitude Valley, Woolloongabba, West End and Spring Hill. This vital service has grown ever since, contributing to a dramatic decrease in infant and maternal mortality rates. Read about Child Health Nurses on page 24.

Metro North Midwifery Matters

data collection analysis for maternity outcomes.

Midwifery Matters In Brisbane, midwives from across Metro North gathered to workshop and problem solve identifed workplace issues. This practical training day, organised by the QNMU, supported members through discussions around the Safe Workloads in Midwifery (SWiM) standards, the BPF, the importance of engaging with your local politicians to create change, and managing the media. There was also discussion and practical strategies for improving mental health and wellbeing. In the face of intense media scrutiny, this was a great opportunity for midwives to come together, share common experiences, and support one another.

just in

AGED CARE NURSES RALLY FOR RATIOS WELL DONE to nurses and carers at Cooinda Aged Care in Gympie, who recently rallied for minimum staffing, fair pay and fair conditions. Cooinda nursing staff have been offered a shocking enterprise agreement (including a dismal 1% pay rise), and management have refused to introduce nurse-to-resident ratios despite severe understaffing making it near impossible to deliver safe quality care.

What has Cooinda management proposed in the new agreement? ■■ 1% pay increase for first year of agreement ■■ discriminatory pay rises in subsequent years ■■ no nurse-to-resident ratios ■■ no paid domestic violence leave

■■ no commitment to stop AINs and carers administering medications ■■ conditions below the Award QNMU members at Cooinda decided enough was enough, and worked with QNMU staff to organise a local rally. At least 80 nurses, carers and Gympie locals turned up to grab a sign, put on a t-shirt, and let their voices be heard. We got plenty of media coverage too, including online and television. It just goes to show that when nurses stand up and speak, people listen! Once again, well done to all those brave nurses for rallying. The community is well and truly on our side — people understand our aged care system is broken and needs to be fixed!

A BOOST FOR OUR KIDS CONGRATULATIONS to this year’s QNMU Maurice Blackburn student bursary winners — Isobel Brown, Jeanne Antonio, Jayla-Beth Marsh, Jessie Wilson and Twisha Bokhoree. They’ve won $1,000 each to assist with their studies and help them on their way to promising careers. A nursing student at the University of Queensland, Isobel said the bursary would help support her passion for emergency nursing. “Emergency nursing is a very competitive area so anything that helps you stand out makes all the difference toward achieving that career goal,” Isobel said. “The bursary will go toward the cost of a venepuncture and advanced life support course that I’ve recently enrolled in, to help advance my career in emergency nursing.” The bursaries are offered to the children of QNMU financial members undertaking tertiary studies at university or TAFE in any field. It’s all part of our commitment to supporting our next generation!

Thank you Maurice Blackburn for sponsoring these important bursaries. Keep an eye out for our range of scholarships available in 2019 at www.qnmu.org.au/scholarships

QNMU Christmas closure arrangements

just in

THE QNMU offices in Brisbane, Toowoomba, Bundaberg, Rockhampton, Townsville, Cairns, Sunshine Coast and Gold Coast will close from 3pm on Monday 24 December 2018 and will reopen at the regular starting time of 8.30am on Wednesday 2 January 2019.

women through the Emma Miller Awards CONGRATULATIONS to this year’s QNMU Emma Miller award recipient Gaye Kazakoff-Corr — a keen activist for her local area and the union movement.

nurses and carers, and is always willing to be the support person in meetings with management. For this, she has earned the respect of her colleagues.

Gaye, an AIN at Proserpine Nursing Home in North Queensland, was nominated for her grass-roots activism, both in the workplace and through broader community campaigns.

“It’s a big honour to be the recipient for the Emma Miller award… there are so many hardworking women in the union movement,” Gaye said.

Gaye is very active in her QNMU Local Branch and holds the positions of Delegate, Workplace Contact, and Resident Safety Advocate. Gaye is also heavily involved in the QNMU’s Ratios for Aged Care campaign, and contributes significantly to recruitment in aged care. She regularly displays posters and stickers around her local community and has signed up local businesses in Proserpine to support the campaign.

Officials will be on call to deal with emergencies such as dismissals, and they will contact you. We wish all our members a safe and enjoyable festive season!

Queensland Health Queensland Health has released compulsory closure and leave arrangements for the 2018/19 Christmas New Year period. Please note part-time employees are only entitled to the concessional leave day when Wednesday 27 December would be one of their regular, ordinary days of work.

“It’s so important to have strong female workers, particularly in the union movement and as leaders.

DATE

LEAVE

Tuesday 25 Dec 2018

Christmas Day public holiday

“We deserve just as much to have a say as the men, because we’re equal.”

Wednesday 26 Dec 2018

Boxing Day public holiday

Thursday 27 Dec 2018

Concessional day (leave on full pay without debit)

The annual awards are held in honour of Emma Miller — a strong advocate for women’s and workers’ rights in Queensland in the 1800s. This year marked 101 years since the death of Emma Miller.

Friday 28 Dec 2018

Annual/recreational leave, TOIL or accrued hours

Monday 31 Dec 2018

Annual/recreational leave, TOIL or accrued hours

Tuesday 1 Jan 2019

New Year’s Day public holiday

Pictured above: Gaye (middle) with QNMU Assistant Secretary Sandra Eales (left) and QNMU Secretary Beth Mohle (right).

Gaye is also passionate about supporting her fellow aged care

LLENG INSTA-CHA WINNERS 10

During this time members who require emergency advice or assistance should ring the Brisbane office on (07) 3840 1444 or 1800 177 273 (toll free outside Brisbane) and leave a message.

CONGRATULATIONS to QNMU members Nicole Meyer, Elise Adair and Rosheen Laurence. You’ve each won a brand new pair of Frankie4 shoes! Thanks for taking part in our InScope Insta-challenge*, we hope your new pair of shoes provide some much-needed TLC for your feet! *As featured on page 23 of the InScope Spring 2018 edition.

indepth

Breaking down barriers: Understanding the power of continuity of care QNMU MEMBER Jude Cooze is a midwife working for Jajumbora Midwives, a unique partnership between Metro South Health and Brisbane’s Aboriginal and Torres Strait Island Community Health Service (ATSICHS). The service provides continuity of care in pregnancy and childbirth for the Aboriginal and Torres Strait Islander women and their families who live in Logan. In this article Jude shares her challenges and experience as a Midwifery Group Practice (MGP) midwife. Since beginning in January this year, the Midwifery Group Practice’s journey in Logan has not been without its challenges. None more so than for the women and families accessing our service. Historically, Indigenous people across the country do not fare well within the health care system. Figures show they have some of the poorest health outcomes in comparison to that of their non-Indigenous counterparts. When we asked to be placed in the healthcare hub that would serve the Indigenous community it was with the hope that we could be instrumental in changing the journey for Indigenous families. We hoped to create a better relationship between the service provider and the recipient of service. Often the expectations between both are quite different and inadvertently, as we stand behind our

evidence base, we unknowingly create a harmful environment to women and their families. Our systems often create barriers at the very first encounter and little by little tear away at the strength these women have to navigate what the health care system deems to be a “reasonable service”. It is not until I have walked side by side with our most vulnerable that I have realised why they don’t turn up to appointments, why they have not had blood tests, ultrasounds and the like. These are things the service provider expects you to undergo should you plan to birth in Logan Hospital. If you don’t do them, you may be labelled as non-compliant which might just result in a report being made to Child Protection Services. But the women who fail to meet these expectations often have bigger concerns. Where will I sleep tonight as I am homeless? How will I get to the hospital when I don’t have a car? Will this new baby I’m feeding be taken from me? The list goes on... As a midwife, when you become aware of what they go through daily it is truly humbling when they still consistently turn up for their midwife visits. It speaks to the trust they have slowly developed. They begin to open up and share their deepest concerns and in some instances are begging for help and understanding to change a situation that has become too painful for them to carry alone. I will share with you the journey of Jane (not her real name).

Pictured above: Jajumbora Midwifes (left to right) Peggy Keyte, Chris Coombs, Nicky Taylor-Edwards and Jude Cooze.

Recently released from incarceration and with none of her children in her care, Jane asked me, “What can I do differently? I don’t want them to take my baby”. She accepted responsibility for her past actions but did not want them to continually define her future. We had many frank conversations and referrals to the services around parenting programs and what ATSICHS can offer to support her in terms of managing herself and managing the health and well being of her new baby. After numerous phone calls and emails between Child Protection Services, Family Well Being Services and Midwifery Services, at 37 weeks into Jane’s pregnancy we are now at no uplift order* status. Jane’s words as she hangs her head, “I don’t want to get my hopes up”. My words to her were, “keep walking across the floor, you can only ask to be met somewhere in the middle”. We wish her the best and will continue to advocate for her. Continuity of care for women changes lives. Jane’s story is one of many stories Jajumbora Midwives are a part of. We are blessed and honoured to be caretakers of the future elders of our Indigenous community. * An order is in place, agreed by all parties, that as things stand, the baby will not be uplifted/ removed from her care.

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Lost in the game WHO declares gaming addiction a mental health disorder

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t’s 2.15am and Kyle is battling it out in the Blind Well in the hope of securing his second Seed of Light. It’s taken hours of gameplay to get to this point, and he’s still waiting for the seed to drop, so this is clearly no time to sleep... By mid-morning Kyle is struggling to concentrate on his statistics lecture. He’s tired, he’s bored and his mind keeps floating back to the early hours of the morning, reliving the thrill of unlocking his new Gunslinger subclass. Kyle knows there’s no way he’s going to make it through the next two lectures… so he does what he always does – skips them and promises himself he’ll make it up on the weekend. By the time night falls, Kyle is back in front of his computer. He was meant to catch up with his old school friends this evening but he lied and said he had to study. It’s true, he should be studying, he’s on his last academic warning, but now he has the new supers, he can’t not play. He tries to ignore the stomach-churning guilt he feels, and the pangs of shame as he imagines telling his mum he’s failed uni again this semester. But he’ll feel better when he’s back in the game – all he needs now is that third seed.

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A person has had continued overuse of internet games even with the knowledge of how much they impact a person’s life.

in Brisbane, said while a little bit of escapism is harmless, there is a real risk to mental and physical health when that ‘escapism’ becomes allconsuming.

Among the new listings this year was ‘gaming disorder’.

The person lied to others about his or her internet game usage.

The person uses internet games to relieve anxiety or guilt — it’s a way to escape.

The person has lost or put at risk an opportunity or relationship because of internet games.

“A lot of people will come to us with other mental health problems or emotional problems but often once you lift the lid there is an addiction at the bottom of that.” Suzanne said there are warning signs, including low esteem and social isolation.

N JUNE this year the World Health Organisation unveiled its proposed 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11).

The classification describes gaming disorder as a mental health condition where a player’s gaming habits dominate everyday life and take precedence over their health, other interests and social interactions. Gaming disorder is listed as an addictive disorder in ICD-11 — the same category as drug abuse. It will sit alongside gambling disorder as one of only two behavioural disorders in the classification — disorders whereby behaviour and activity are at the core of the addiction, rather than a substance or consumable.

So what are the symptoms? Identifying genuine gaming addiction means distinguishing between an avid fan who may occasionally spend ridiculous hours on the weekend fighting online goblins for a bit of fun, and someone who’s gaming behaviour is excessive, uncontrollable and having a negative effect on their health and wellbeing. The gaming disorder entry in ICD-11 includes a set of criteria drafted by a panel of international experts which they say can be used to diagnose genuine gaming addiction.

The nine criteria are:

Preoccupation or obsession with internet games.

Withdrawal symptoms when not playing internet games.

A build-up of tolerance — more time needs to be spent playing the games.

The person has tried to stop or curb playing internet games but has failed to do so.

The person has had a loss of interest in other life activities, such as hobbies.

The panel concluded that if four or more of these criteria are met within a one-year period, then gaming may be at addiction levels. Even so, identifying the problems around a person’s online gaming addiction can be a bit of a chickenand-egg exercise. Did they become addicted to the online world because it was an escape from difficulties in their real life like isolation, bullying, poor health or grief? Or is their social isolation, fatigue, ill health or loneliness a result of spending too much time in a virtual world? It’s no surprise that one of the concerns some psychologists have about the ICD-11 classification is that health practitioners may overdiagnose the condition and miss other health problems such as the anxiety, bullying and depression that may have led a gamer into the virtual world in the first place. Clinical Nurse specialist in Mental Health Suzanne Thew said from her experience, gaming addiction follows similar patterns to other addictions like gambling or alcohol abuse. “It usually starts out as an escape from whatever hand life is dealing,” she said. “I have had men and women use gaming as a way of avoiding uncomfortable feelings, particularly depression and anxiety — they just disappear into it.” Suzanne, who works with adult patients at Cooinda Mental Health

“Another signature symptom would definitely be the deception and dishonesty — that goes across the board for any age whether you are a 15-year-old or whether you are 55… lying about playing, about money spent on subscriptions, it’s a biggie.” She said people who develop an addiction can also be prone to aggression and violence if their games are removed or blocked. “This is a response to craving,” she said.

Games and the brain Make no mistake, computer games are specifically designed to keep players hooked. Gaming companies use cutting edge technology, spectacular graphics, and engage behavioural psychologists to ensure their games tick exactly the right boxes for their target demographic and keep players coming back for more. One of the primary hooks is the concept of reward. Most games keep players hooked by giving them the opportunity for little victories during play — like levelling up, unlocking hidden features or securing special items or extra powers. When a player succeeds their brain rewards them by releasing the neurotransmitter dopamine, flooding them with a pleasurable sense of achievement. For some people, that rush becomes addictive and they crave it more and more. And as Suzanne notes, if that craving isn’t satisfied, it can lead

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It usually starts out as an escape from whatever hand life is dealing.

to irritability, angry outbursts, restlessness, and scheming to find ways to use again. Online gamer Barry from the Whitsundays told InScope he completely understands the lure of games, particularly massive multiplayer role-play games (MMPORGs) in which players can turn themselves into idealised characters that are more impressive and fantastic than they are in real life. The 48-year-old audio technician was once a self-confessed “fanboy” of Red Dead Redemption 2. “When I started playing I was a bit ‘meh’ about the trophies and rewards, but the next thing I know I’m telling my brother how I’ve gone platinum or won some such thing — it was a real kick, we’d compare notes, and brag, you felt great!” he said.

“So I can absolutely see how kids can get sucked in — particularly young people who may not have achievements in their offline lives to celebrate.”

were less likely to be able to control their behaviour.

In an interview with ABC last year, addiction neuroscientist at the Florey Institute of Neuroscience and Mental Health Dr Heather Madsen said recent research indicated that gaming addicts begin to lose the dopamine receptors in their brain which means they need more game play and more rewards to feel the same dopamine rush.

School nurse and QNMU member Jay (not member's real name) has worked with a number of children who are keen gamers and believes there is definitely a difference between an enthusiast, a ‘problem’ gamer and an addict.

Identifying a problem early

This biochemical response of fewer receptors and diminishing reward is also commonly found in drug addicts.

“I think it can be quite easy to be a bit alarmist about kids gaming particularly for those of us who aren’t gamers,” Jay said.

Dr Madsen said gaming addicts were also shown to have an impaired prefrontal cortex, which is the part of the brain that controls behaviour and decision-making — meaning addicts

“It really is no big deal if a welladjusted kid spends 12 hours over the weekend playing Fortnite if they also still hang with their friends, go to the movies, spend time doing family stuff.

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The physiological impact

These kids are playing up to 10 hours a day, staying up past midnight on a school day.

“It’s when gaming starts to affect their schooling or their health or their social interaction with real life peers then alarm bells should start to ring. “These kids are playing up to 10 hours a day, staying up past midnight on a school day,” she said. “Then they come in to school and they are chronically tired, irritable, they don’t want to eat or they feel nauseous because they are exhausted. “These days so much of a young person’s life is spent online and they are never far from a device, so if you are attracted to gaming, the lure is always there, literally in the palm of your hand.”

Effect on mental wellbeing It isn’t hard to find evidence of the health implications of gaming addiction in medical journals and other academic research. One of the afflictions that crops up repeatedly in studies is depression. Former Canadian game addict Cam Adair, who founded Game Quitters — an international support community for video game addiction – believes depression is one of the biggest health risks to game addicts. At the height of his addiction Adair had dropped out of high school, was lying to his family about being

employed and was playing video games up to 16 hours a day. He said eventually the gaming was no longer enjoyable, but the compulsion to play was out of control. The turning point came when, deeply depressed, he found himself writing a suicide note. He estimates about 84% of gaming addicts recognise they have a problem but it takes them more than a year to act on it. Suzanne Thew is not surprised. She said it takes more than just acknowledging a problem for an addict to want to change their behaviour. “It’s about weighing up the costs and benefits. Only once the costs become great enough that they outweigh the benefits, that you find folk are ready to give it a go,” she said “Even then people will lapse and relapse a few times before they pull clear of it.” Suzanne who uses Cognitive Behaviour Therapy to treat her patients, said it can then take another year or so before therapy sticks. “Maintaining the gains you’ve made takes at least a year — it needs to be practiced. You can do all the courses and get your skills, but then it is up to you to practise those skills and move yourself through and past those urges and cravings.”

While much of the focus on problem gaming revolves around mental health and the breakdown of relationships, there are also physiological concerns — especially in relation to long term addicts. The leading concern here is musculoskeletal complaints, with many studies pointing to the long-term effects of sedentary game play while seated in the same position performing the same repeated movements over extended periods of time. In 2010, Norway’s University of Bergen conducted a survey of game players focusing on seven areas of health including back pain and neck pain. In every one of the seven health areas surveyed, gaming addicts were significantly more likely to have suffered the affliction than nonaddicts. For example, more than 25% of nonaddicts said they’d never experienced back, or neck pain compared with about 16% of addicts. Similarly, about 71% of non-addicts had never suffered palpitations but only 53% of addicts could say the same. A Finnish study two year ago found musculoskeletal symptoms (and, interestingly, depression), were more likely in people who played for more than five hours a day on weekdays and whose game play was motivated by the need to escape — both behaviours more common to problem gamers. The probability of ill health decreased when gaming was for fun or had social motives. There is also evidence of increased likelihood of weight gain, high blood pressure, carpal-tunnel syndrome, migraines, eye strain….. the list goes on. At its very worst — and it must be said, very rarest — gaming addiction has also been linked to physical conditions leading to death. Heart failure, deep vein thrombosis and pulmonary embolisms, exhaustion, dehydration and malnutrition have been medically

indepth reported as the cause of death for a small number of gaming addicts — all directly linked to marathon gaming sessions over consecutive days with little or no physical movement, sleep or nutritional intake.

of Mental Disorders, claiming there was “insufficient evidence” to include it as an official mental disorder.

In 2005, ten South Korean gamers died while gaming — most of them from complications around deep-vein thrombosis caused by sitting in a single, cramped position for too long. Similar cases have been recorded in Japan, the UK and Taiwan.

Other critics maintain that this new classification will scare well-meaning parents into thinking their keen gamer son or daughter is an addict.

Not everyone is convinced For many health professionals the inclusion of gaming addiction in the new WHO list is a positive step as it opens the door to better diagnosis and medical care – largely because the ICD codes are often used internationally as medical or insurance codes, increasing the likelihood of a patient securing insurance coverage and treatment. But others are uncomfortable with the addiction label. In May 2013, the American Psychiatric Association (APA) declined to include video game addiction in the 5th edition of the Diagnostic and Statistical Manual

The Association did however earmark ‘Internet Gaming Disorder’ as a condition worthy of further study.

WHO has made it clear in the classification that gaming itself is not harmful, nor is it an intrinsically risky or addictive activity like drug use. But some argue gaming’s inclusion is a knee jerk reaction to generalised popular panic about young people spending time online, and claim any activity taken to extreme — for example exercise, Tweeting or online shopping — could just as easily be classified a behavioural disorder. They may have a point, but Suzanne Thew believes the ICD -11 listing serves a purpose. “I don’t have concerns about it (its inclusion) because it does need to be treated,” she said. “I think DSM5 calls addiction a sickness, but it’s not a sickness — you treat a wound but that’s not a sickness either.”

References

Burkhardt Freeman, C (2008) ‘Internet Gaming Addiction Treatments’, The Journal for Nurse Practitioners, vol. 4, no.1, pp. 42–47. Festl, R, Scharkow, M, & Quandt, T (2013). ‘Problematic computer game use among adolescents, younger and older adults’, Addiction, vol. 108, no. 3, pp. 592–599. Hellström, C, et al (2015) ‘Effects of adolescent online gaming time and motives on depressive, musculoskeletal, and psychosomatic symptoms’, Upsala Journal of Medical Sciences, vol. 120, no.4, pp. 263-27. Adair, Cam (2018) ‘Reclaim your loved one from Gaming’, Gamequitters website, Canada, viewed 15 November 2018, <https://gamequitters.com/ reclaim/>. Li, B, et al (2014) ‘Impaired frontalbasal ganglia connectivity in adolescents with internet addiction’ Scientific Reports, vol 4 article no. 5027, viewed 16 November 2018, <https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4030253/>. Männikkö, N, Billieux, J, & Kääriäinen, M (2015) ‘Problematic digital gaming behavior and its relation to the psychological, social and physical health of Finnish adolescents and young adults’, Journal of behavioral addictions, vol. 4 no. 4, pp.281-8. Pallesen, S, et al (2014) ‘Scope of Problems Related with Gambling and Computer Games in Norway (English Abstract)’, University of Bergen, viewed 12 November 2018, < Scope of Problems Related With Gambling and Computer Games in Norway 2013"/"Omfang av pengeog dataspillproblemer i Norge 2013”>. Turel, O, Romashkin, A, & Morrison KM, (2016) ‘Health Outcomes of Information System Use Lifestyles among Adolescents: Videogame Addiction, Sleep Curtailment and Cardio-Metabolic Deficiencies’ PLoS ONE, vol 11, no. 5, viewed 18 November 2018

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The Prince Charles Hospital ICU Nurse Unit Manager and QNMU member Vanessa Rainbow (left) and Charlie's Angels volunteer Margaret Van Gerrisheim. Photo: Kasun Ubayasiri

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ngels IN THE HOSPITAL

For well over two decades

Margaret Van Gerrisheim has been a Charlie’s Angel.

Don’t be mistaken — she isn’t part of the American crime-fighting trio that kept us glued to tv screens in the 70s (oh that Farrah Fawcett hair!), but Margaret is one of 120 dedicated volunteers at The Prince Charles Hospital (TPCH) who freely give their time to support patients, families and staff in almost all areas of the busy hospital. In their brilliant yellow t-shirts the Angels are a familiar sight to locals, warmly welcoming those who step through the hospital’s front doors. Margaret is one of the longest serving Charlie’s Angels, having volunteered in almost every department of the hospital for the past 23 years.

DID YOU KNOW

“I was a bit of a spoiled wife and was very fortunate not to have to work. So instead I volunteered my time at schools and different organisations over the years,” Margaret said. “I wanted to become a Charlie’s Angels volunteer because I’m a heart patient myself, and I just thought it was time for me to give back in this way… I’m going to need them in the end!” Margaret has spent more than a decade of her volunteer life with TPCH’s Intensive Care Unit, greeting and supporting families of patients and acting as a liaison between them and nursing staff.

In 1984, Universal Studios — who held the international copyright for the Charlie’s Angels name — issued a letter to the Charlie’s Angels service for being in breach of the copyright. The Angels wrote directly to the head of

Universal Studies to tell their story and request permission for continued use of the name. Universal Studios granted this right for 99 years and for as long as they were identified as the rightful copyright holder.

indepth She works with the bedside nurse or team leader to determine if a patient is up for visitors and the best time for family to visit, then escorts visitors into the ICU. “Instead of relatives having to buzz in on the intercom we greet them face-to-face and sit down with them in the waiting room prior to them coming into the unit,” Margaret explained. “Sometimes it’s nice for them to talk to somebody who doesn’t have a medical background and is just there as a sympathetic ear. “It can be a bit tough in the ICU at times because you get to know some

families better than others and share in their experiences firsthand.” Volunteers like Margaret provide a vital service to the hospital and its staff. They help ease the load for nurses and act as gatekeepers for a busy area like the ICU. And according to the ICU’s Nurse Unit Manager and QNMU member Vanessa Rainbow, they’re worth their weight in gold. “Having the volunteers there means nurses don’t have to come off the floor,” Vanessa explained. “They direct the traffic of the ICU and make sure it’s safe for visitors to come into the unit, especially if there are emergencies coming through.

I wanted to become a Charlie’s Angels volunteer because I’m a heart patient myself, and I just thought it was time for me to give back in this way… I’m going to need them in the end! Photos: Kasun Ubayasiri

indepth “Often when you’ve got a grieving relative out in the waiting room on their own its nice to have somebody there with them even if it’s just to provide a cup of tea and a quiet place to sit and chat… it’s a relief for some people. “Without the Angels the unit wouldn’t run as efficiently as it does and we’re very grateful to them.” After the recent tragic passing of both her mother and brother within the space of a few short weeks, Margaret felt it was time to take her volunteer work away from the hustle and bustle of the ICU.

She now enjoys a different challenge on the front desk of the hospital’s main reception area. “We help put people’s appointments through when they come in and direct them to the area of the hospital they need to go,” Margaret said. “Front desk can be rather challenging – sometimes even more so than the ICU – because people do get frustrated and impatient if they are made to wait. “But I love being a Charlie’s Angel because I get to help people out – I’ve always put others before myself and I love what I do.”

years of

ngels

HE CHARLIE’S ANGELS program was first conceived in 1978 by retiring Sister Eileen (Bindi) Walker and retired matron Joyce Clarke to assist patients in the Jacaranda Nursing Home (which at the time was attached to TPCH). It would be a good two years before the first Charlie’s Angels volunteers would begin working in the wards of the main hospital. At the time, the volunteers were a combination of a local Red Cross group and residents from the local area. And they not only assisted with the care and feeding of the elderly, they even helped bath residents and make the beds! The volunteers also focused efforts around fundraising to purchase equipment and minor auxiliary items for the hospital – which there was no budget for at the time. As staff within the main hospital became aware of the volunteers’ existence, demand for their services increased. In 1982, restrictions on using volunteers in some of the more specialised departments was lifted and Charlie’s Angels volunteers began to receive training. Fast forward to 2018 and the Charlie’s Angels recently celebrated four decades of service to TPCH and the surrounding community.

Want to become a Charlie's Angel? If you’re interested in becoming a Charlie’s Angel, please send an expression of interest to info@thecommongood.org.au or call The Prince Charles Hospital Foundation on (07) 3139 4636 to request an application pack.

Today more than 120 volunteers freely give their time to the cause, with many having provided continuous service for about 20 years. In recognition of the group’s wonderful contributions to the hospital and local community, the Charlie’s Angels were presented with a special pin to commemorate the group’s 40th year of service.

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CODE GREEN:

How can we make our hospitals more sustainable? The surgery is finished. As the patient is transferred to ICU to recover, all that’s left in the theatre is the weary surgical team and the mess — the bloodstained drapes, soiled masks and discarded latex gloves, the spent IV bags and metres of plastic tubing, dirty swabs and sponges, and trays with smeared stainless-steel scissors, scalpels, forceps, clamps, retractors, surgical needles and mesh. Most of the debris is made up of single use, disposable items which will either be treated and dumped as clinical waste or disposed of directly in general waste. And for good reason of course. Single use items are safe, convenient, usually cheap and an excellent way to prevent contamination and infection. But they do come at a price. Research published in The Lancet Planetary Health journal earlier this year estimated that health care generates about 7% of Australia’s carbon emissions and hospitals alone are responsible for about half of that — which includes the tens of thousands of tonnes of waste they produce each year. Of course, it’s not just the waste that contributes to greenhouse gasses. Hospitals are complicated facilities with all manner of services contained within — from radiology, sterilizing units, laboratories and general wards to catering departments and public restrooms.

So it’s no wonder their carbon footprint is hefty. But over the past few years, as our knowledge of carbon emissions and climate change has grown and we’ve learned more about the potential health implications of climate change, there has been a good deal of movement in health circles about the need to look at ways of reducing the health system’s impact. So over the next few editions of InScope we will look at how we can improve the green credentials of our hospitals and clinics and why it is important. In this edition we start by identifying why we need to make changes, and throughout 2019 we will look at some of the programs and practices currently in place, some of the innovations being trialed and researched, and how you might be able to do your bit.

Why worry? As evidence-based health professionals the QNMU organisationally acknowledges the scientific evidence of climate change and its links to man-made global warming. As nurses and midwives we also know how human health can be affected by the environment. A few months ago the Australian Bureau of Meteorology released its summer 2018-19 heat-map, which predicts we are in for another of those “hottest summers on record”.

Yes, BOM predicted there would be an 80% chance that great swathes of Australia would record higher than average temperatures between November and January this year, making for a sweaty summer indeed! And so far they’ve been right on the money. Heatwave conditions in the last week of November sparked more than 140 bushfires around Queensland. The blazes around Capricornia and Central Queensland, whipped up by hot, dry conditions and gusty winds were so fast and dangerous they were declared “a catastrophic risk” — the very highest level the Fire Services use. Meanwhile in Cairns temperature records tumbled. The city had never recorded a day over 400c during November, but had three in a row during the heatwave, including one at 43.60c — the hottest day ever on record, for any month. But perhaps we should be getting used to this by now. Since 2001 only two calendar years (2005 and 2013) have been cooler than average. The hottest summer so far was in 2012-13. It was dubbed the Angry Summer after 123 weather records were smashed. BOM even had to add a new colour to its forecasting chart so it could illustrate temperatures over 52 degrees.

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Single use items are safe, convenient, usually cheap and an excellent way to prevent contamination and infection. But they do come at a price.

And then, as summer drew to a close, Queensland and Northern NSW were hit by monsoon rain and flooding thanks to Tropical Cyclone Oswald. And that’s another thing — we’ve also seen record rainfall and flooding over the past few years. But we aren’t alone with our hotter summers and other out-ofkilter weather patterns. Australia’s unusually warm temperatures were actually in line with global ones. The great majority of scientists attribute the rise in global temperatures to an increase in greenhouse gas emissions which rose about 2% last year.

The cost of doing nothing In Australia, climate change is already increasing heat-related illnesses and deaths. Health research shows we are also seeing a rise in infectious disease outbreaks, mental illness and stress associated with extreme weather events, and respiratory and cardiovascular diseases. The Lancet Countdown 2030 Australian policy brief released two years ago painted a troubling picture of the human cost of ignoring climate change: ■■ About 117,260 additional vulnerable people in Australia alone (aged over 65) already exposed to heatwaves between 2000 and 2016.

■■ Australian population already facing increased exposure to harmful air pollution from coal production, dust storms and bushfires (health implications include respiratory problems — especially in children, eye and skin irritations). ■■ Coastal areas vulnerable to rising sea levels, storm and tidal surges and costal erosion face potential loss of life and displacement. ■■ Increased storm and flood activity with potential loss of life, population displacement, food spoilage, contaminated drinking water, spread of disease and trauma. Transmission of mosquito borne dengue has already increased by at least 9.4% due to climate trends since the 1950s. ■■ Crop production affected by longer or more frequent dry seasons, unseasonal rains, in turn affecting food availability. ■■ Livelihoods lost, famine, farmer suicide risk/mental health issues.

What do we need to look at? While many of us have already adopted enviro-friendly practices at home, there are opportunities to make changes to our work environment too. For example, we can review our use of single use items that are resourceheavy and clog up landfills.

We can also rethink the power and water use and look at more energy efficient facility design. In its comprehensive Healthy Hospitals, Healthy Planet, Healthy People report in 2009 the World Health Organisation identified seven elements for a climate friendly hospital — including energy efficiency, green building design, alternative energy production, transportation, food, waste and water. In the coming editions we will look at some of these elements. We are keen to hear from you about any eco-friendly initiatives in your workplace. If you have a story to share or can point us in the right direction, please email cjobs@qnmu.org.au

References:

Climate and Health Alliance (2013) Lives increasingly at risk from ‘angry climate’, viewed 20 November 2018, <http://www.caha.org.au/ lives_increasingly_at_risk_from_angry_climate_ 7gedixfittwyvowdd6_68q>. Malik, A, Lenzen, M McAlister, S & McGain, F (2018) ‘The carbon footprint of Australian health care’, The Lancet Planetary Health, vol. 2, issue 1, viewed 23 November 2018, <www. thelancet.com/journals/lanplh/article/PIIS25425196(17)30180-8/fulltext>. Russell, L, Anstey, M & Wells, S (2015) ‘Hospitals should be exemplars of healthy workplaces’, MJA, vol. 202, no. 8, viewed 20 November 2018, <www.mja.com.au/system/files/issues/202_08/ rus01437.pdf>. Ting, J (2016) ‘Whole-of-hospital approach to waste’, MJA inSight, issue 24, viewed 23 November 2018, <www.doctorportal.com.au/ mjainsight/2016/24/whole-hospital-approachwaste/>.

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I:\GRAPHICS\2018 images\Child Health Nurse 100 celebration

Celebrating a century of Child Health Nursing

NE HUNDRED years ago, having a baby was a much riskier business.

The risk of death for both child and mother was a very real and alarming possibility. In 1903, the infant mortality rate was more than 10 per cent, and in 1918, 5.31 of every 100 pregnancies resulted in the woman dying. Flash forward to today and things are very different. We now live in an era where we are much better placed to identify health and developmental concerns in those first crucial years of a child’s life. Sure, we have the internet and a plethora of literature available at our fingertips, but nothing compares to the face-to-face support and expertise provided by someone trained in this very area. Which is exactly the purpose of the Child Health Nurse. It’s a role that was originally created in the early 1900s to reduce infant and maternal mortality rates. This year marks a century since the establishment of Child Health Services in Queensland. In 1918, Queensland’s first Child Health clinics were opened in four locations across Brisbane in Fortitude Valley, Woolloongabba, West End and Spring Hill.

Pictured: Child Health Nurses Cassie Weir (left) and Erica Gwynne (right).

Looking back over the past 100 years (see graphic on next page), it’s easy to see the effect these Child Health Nurses have had on Queensland’s population.

indepth But Child Health Nursing isn’t just about reducing mortality statistics. It’s also about education, health promotion, and strengthening parenting capacity and family relationships. What’s more, the role sits within a broader multi-disciplinary familycentred model of care, which is provided in community clinics, schools and the home. Child Health Nurse Cassie Weir said the role operates on a primary health care model and takes a holistic approach. “We all know the saying that it takes a village to raise a child,” Cassie said. “But in this day and age, we don’t all live in villages with an extended family to help us. “A lot of families these days are quite isolated from their immediate relatives, so they’re not getting that support and help from matriarchs of previous generations. “Child Health Nurses pick up some of that role, where we deliver information and education on how to look after a new-born baby.” Child Health Nurses work across the spectrum of childhood — from zero to 18 years — but generally focus on the ages of zero to five. “In the early stages, we’re there to support the families — particularly new families — who are having their first babies,” Cassie said. “Midwives support the family in the postnatal period and then the Child Health role takes over.” The responsibilities of Child Health Nurses range from assessing growth and developmental milestones to offering advice on issues such as breast feeding, formula feeding quotas, and immunisations. The role has always been specialised but has consistently evolved in terms of how it links to other health specialties and support services. Child Health Nurse Erica Gwynne said while the development of the child had always been a focus, an increasing number of mental health support services have been incorporated into the role since the 90s.

INFANT

MATERNAL MORTALITY RATE:

MORTALITY RATE:

1903

1918

per 1000 births

per 100 pregnancies

119.9

5.31

2018

per 1000 births (non-Indigenous)

per 100 pregnancies

3.3

0.06

Source: Australian College of Children and Young People’s Nurses

“We have very close links with our early intervention parenting specialists, who also do our postnatal depression groups; and work with mums who have high needs for support, be it mental health issues or intensive parenting support,” Erica said. “We also work with the Circle of Security program, which helps with the attachment process between the mother and child, and also the Positive Parenting Program, Triple P.”

Emotional support The clinical aspect of the role is also balanced by the emotional support provided to new mothers and families, according to Cassie. “Sometimes it might just be about lending an ear to a family member, because that mum might be so tired and exhausted with her new baby that she’s not thinking straight,” Cassie said. “She might want to just vent to us, and we’ll give them the tools required to support their family.” But as any nurse or midwife knows, ensuring that relationship does not cross the line of dependence is an ongoing challenge. “We’re trying to create an interdependence, not a dependence,” Cassie said. “But we see some families for up to three months, and when we close at the end some families are really reluctant to let us go. “They really look at you as a support person.”

Mandatory reporters Most Child Health Nurses will be quick to describe how rewarding their job can be. But like most jobs, there is a darker side that can be emotionally draining. “The role isn’t for everybody and it’s certainly not about the cute little babies that you think you might get to cuddle all day,” Cassie said. “As nurses, we’re mandatory reporters and we’re going into people’s homes, so if we see things that are reportable, we’re bound by law to report it. “You get good at reading people and you have to get very honest with your clients […] so the DoCS (Department of Child Safety) side of things can be very challenging.”

A voluntary service Families are not required to seek the assistance of Child Health Nurses, and the unfortunate reality is, those who most require that extra support are less likely to engage. “We mostly see the vested and interested families, but sadly a lot of the lower socio-economic families that really need our support don’t engage with health care services.” To counter this, the service’s home visiting program targets clients with complex needs, such as drug and alcohol issues and domestic violence. Erica said the key to encouraging those families to engage was to build a rapport and sense of trust.

indepth “It can be hard, especially with families that have been involved with the Department of Child Safety who might be reluctant to engage with us because they’re scared of losing their children,” Erica said. “But we try to let them know that we’re there to help them keep their children and work with them and get things going.” And, Erica notes, the success stories far outweigh the challenges. “One of my clients was a single mum who had a child with learning difficulties and an intellectual disability,” she said. “Her relationship with her daughter was really falling apart. “Because we were able to build that relationship, she trusted the service and she did really well. “I did some Positive Parenting with her, and she came back to me and said, ‘If it wasn’t for you, I don’t know where I’d be’. “Over time she’d built up her own confidence as a mum, and her daughter’s whole behaviour started changing. “She said to me one day, ‘I didn’t know that something as simple as making a cake with her could make us so happy’.”

Child Health Nursing in Queensland – a little history

1923

1938

First country clinic was opened in Rockhampton.

Opening of Brisbane Women’s Hospital followed by in-house provision of antenatal clinics.

1924 Infant training centre for nurses was established in Fortitude Valley, signalling the start of a specialty nursing role. First home visits commenced in Brisbane, Townsville and Rockhampton.

1915

1929

Social pressure led the Labor Queensland government to support the establishment of Maternal and Child Health Clinics.

Child Welfare railway clinic launched — this mobile clinic travelled to 150 remote locations each year. The service was terminated in 1982.

1918

1932

Four clinics were opened in underprivileged areas in Brisbane (in Fortitude Valley, Woolloongabba, West End and Spring Hill).

Notification of Birth Act — legislation mandating the registration of every new baby’s birth within 72 hours of delivery.

1940 Over half of Queensland babies attending baby clinics, with infant mortality rate falling to 3%.

1961 Queensland Maternal Mortality Committee established to reduce rate of preventable maternal deaths.

1944 Sandgate Maternal and Child Welfare Home opened – government convalescent/emergency home for children.

1984 Scope of Child Health Nursing broadened to include older children, no longer just first years of life. Source: Australian College of Children and Young People’s Nurses

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100 years on, and much to celebrate Sue Lewis and Wendy Engler devoted a combined 64 years to child health nursing. Completing their midwifery together in 1977, Sue and Wendy attended the 100-year celebrations of Child Health Queensland at Ipswich Health Plaza in October. Although the service has grown over the decades, Sue said one thing has always remained the same. “The dedication and the end goal of improving the health of babies and their families has never changed – it’s always been about providing the care,” Sue said. “We’d often get people come in and say, ‘This would be a lovely job for my granddaughter, she’d like to weigh babies’, and they’d think you’d just need an hours’ training or something. “The clinics were very busy – on Wharf Street we could get up to 100 babies a day, so you’d see up to 30 a day on your own.” Wendy, who spent many years working with women in prisons, described the satisfaction of seeing women turn their lives around once

they had their babies and started receiving support from the nurse. “Working in the community, you felt you were making a difference,” Wendy said.

Pictured: Retired Child Health Nurses Wendy Engler (left) and Sue Lewis (right)

“It made you more humble, it’s so important to not be judgemental. “It made you appreciate the good things in life, because you see a lot of hardship that others have to go through that most wouldn’t see.” Although she is now retired, Wendy’s life is still connected to her work as a Child Health Nurse through some lasting bonds. “There was one mother who I visited for six years over the course of three babies,” Wendy said. “Sadly, she passed away a little while ago, but I still see the children and they still call me Aunty Wendy, which is lovely.”

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the mother of all inquiries

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royal commissions are perhaps the most public and open process for conducting an investigation in Australia. In the words of the Australian Law Reform Commission, they are the “highest form of inquiry on matters of public importance”. So the announcement recently of a Royal Commission into the care of our elderly is good news for those who have long attempted to shine a light on the systematic failures of the aged care sector. The bad news, however, is that Royal Commissions are also lengthy, expensive (often costing tens of millions of dollars), and have no legal enforceability. So after countless inquiries into aged care over the past decade, how have we arrived at this point? And what will actually be achieved by having a Royal Commission?

the final tipping point In September 2018, the Morrison federal government announced a Royal Commission into Aged Care Quality and Safety. It came on the eve of a two-part ABC Four Corners investigation into issues the QNMU has been campaigning on for many years, including poor staffing levels, a lack of Registered Nurses in the sector, dangerous medication management practices, and a lack of transparency around how providers report their spending.

It also came after QNMU members conducted an audit of 83 Queensland aged care facilities on International Nurses Day this year, which provided a snapshot of just how understaffed our facilities are. But the QNMU has never called for a Royal Commission. We don’t need a Royal Commission to tell us that when you slash nursing hours from the sector, the quality of care suffers. We don’t need a Royal Commission to tell us that providers are putting profits above quality care because they are not required to report how they spend $17 billion in taxpayers’ money. And we don’t need a Royal Commission to tell us that legislating minimum nurse-to-

resident ratios is the only way to ensure there are enough nursing staff to provide the best care. All the evidence already points to this. Those who work in the sector already know what needs to change.

so why are we having a royal commission? The federal government’s decision to hold a Royal Commission is, of course, political. Senior Research Associate of the University of Queensland’s Centre for Policy Futures Roger Scott said there are three broad reasons why governments call Royal Commissions. “One is that there is a lot of discontent in the community and

we don’t need a royal commission to tell us that providers are putting profits above quality care...

The Four Corners program was the tipping point — a blistering investigation that followed years of intense media coverage in newspapers and news programs across the country, revealing repeated failures in the sector, including nursing hours cuts, poor food quality, and elder neglect.

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the media are running with a particular issue, so it’s a response to public pressure,” Professor Scott said. “The second reason is that the government of the day wants to stop things happening and delay action and get things off the agenda, so it’s a way of avoiding responsibility.

“But what the Royal Commission will do is keep refocussing media attention on what’s going on and keep it on the agenda.

“The third reason is to make a party-political election commitment.”

“Just look at the banking Royal Commission — we’ve all been glued to it.”

It’s no coincidence that the timing of the federal government’s announcement came just before the damaging Four Corners investigation… and perhaps more telling, just before the crucial Wentworth by-election in the leadup to the next federal election.

Another benefit of Royal Commissions is that they are given the autonomy and impartiality of the judiciary.

But it’s a clear sign the government has finally realised that Australians do care about this issue. More to the point, aged care has become a voting issue for the community. “The general view about the aged care sector initially was that specific horror stories from various aged care facilities were just bad apples and that the barrel was okay,” Professor Scott said. “But the issue is now seen to be more systemic. “The general public is now much more interested in this issue than even just a few years ago.”

visibility, autonomy, power Although expensive and lengthy, there are many benefits to having a Royal Commission. In terms of educating the community on the issues in aged care (and keeping it on the political agenda), a Royal Commission will be very powerful. Professor Scott said one of the benefits of having a Royal Commission is the visibility they bring purely because they are Royal Commissions.

“The aged care industry is generally well organised and well funded, and they’ve put a great deal of effort into keeping these things off the political agenda,” he said.

“Other government inquiries tend to be more openly partisan, they’re often more of a sounding board for a political activity.” Over the past 10 years, there have been 36 inquiries into aged care (both federal government inquiries and productivity commissions). The QNMU has made submissions to all of them. While some of those inquiries have resulted in minor changes to the sector, none have come remotely close to the reforms we need. Furthermore, Royal Commissions are very different to police investigations and have unique powers. Royal Commissions have the power to summon witnesses and provide evidence under oath, or provide material evidence. If summoned, there are very few grounds on which a person can refuse to give evidence to a Royal Commission. “Police investigations are conducted if there’s an alleged crime and remain confidential until matters come to court and penalties can be applied,” Professor Scott said. “But a Royal Commission is a very public exercise. “Most things are published on the website, [they] can have open

or closed hearings, and they can demand papers that organisations may not want to produce. “That’s been evident in the banking Royal Commission – the banks kept saying they couldn’t find certain documents, but the Royal Commission eventually weeded them out.”

the reality of recommendations Unlike police investigations, however, Royal Commissions do not place criminal charges (although they can refer matters to the police to pursue). Instead, they make recommendations to government and/or other institutions. But while there is no limit to the number of recommendations they can make, the reality is they are just that — recommendations. Governments of the day can choose whether to implement recommendations through legislative changes or throw them in the ‘too hard’ basket and ignore them. Take the Royal Commission into Aboriginal Deaths in Custody as an example. After a four-year investigation (concluding in 1991), the Royal Commission made 338 recommendations. But the majority of these have still not been fully implemented and since the Commission wrapped up, more than 400 Aboriginal and Torres Strait Islander people have died in custody. To make matters worse, the government is currently undertaking yet another review, this one looking at the implementation of the Royal Commission itself, whose original recommendations are now 27 years old. Similarly, the Royal Commission into Institutional Responses to Child Sexual Abuse made 409 recommendations and referred 309 matters to the police.

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Twenty-seven prosecutions have begun, and 75 cases are currently being investigated. However, the Catholic Church took nine months to formally reply to the recommendations. Furthermore, the Church has refused to adopt the recommendation to lift the seal of confession, and Archbishop Coleridge said that while voluntary celibacy would be examined, he “doubted” the change would happen soon.

Professor Scott said the Royal Commission into child abuse, while failing to get the Catholic Church to move on certain issues, has nevertheless brought positive change. “That Royal Commission has clearly affected the way organisations have to do their reporting, including having to be much more systematic in their controls over staff,” Professor Scott said.

changing societal attitudes

“As the Royal Commission was ongoing, it was changing people’s behaviours and attitudes towards the Church and other religious organisations.”

It’s not all doom and gloom, however.

power rests with us

Royal Commissions, when established correctly and given the proper autonomy, can make a difference and achieve substantial reform.

But ultimately, it is public pressure that forces governments to act, not Royal Commissions. “I think the Royal Commission into aged care is going to highlight a

whole lot of information that people don’t want to think about, but which they’ll be forced to think about,” Professor Scott said. “But I anticipate the outcome of the Royal Commission will be shaped in part by issues of cost and how much we can afford to improve the situation.” Just how much we are prepared to pay to fix our broken system will be determined by what kind of society we want, including what sort of care we want our elderly to receive. And as voting citizens, it’s our responsibility to send a clear message to our federal politicians that we value a well-funded and properly regulated sector. Because at the end of the day, ensuring our elderly are protected and receive a dignified end of life is something that affects us all.

a history of royal commissions Federal governments have been calling Royal Commissions into various issues since 1902. They have investigated issues ranging from our taxation system right through to human relationships and responsible parenting. Some of Australia’s Royal Commissions have included:

1911-1912

1914

1920-1923

Royal Commission on the sugar industry

Royal Commission on meat export trade

Royal Commission on taxation

1927-1929

1974-1978

1979-1981

Royal Commission on the Constitution

Royal Commission on human relationships

Commission of inquiry into the efficiency and administration of hospitals

1983-1985

1987-1991

2013-2017

Royal Commission into Aboriginal Deaths in Custody

Royal Commission into Institutional Responses to Child Sexual Abuse

Royal Commission on Australia’s security and intelligence agencies

2016-2017

2017-present

Royal Commission into the Child Protection and Youth Detention Systems of the Government of the Northern Territory

Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry

Visit https://bit.ly/2JbhIwE for a complete list of prior Royal Commissions.

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supporting our colleagues in aged care OKAY, so we’re having this Royal Commission, and it is due to report in April 2020. Which means the aged care sector — including those who care for our elderly — will be under the microscope. While media attention is the most powerful way to highlight the issues in aged care, we understand that this level of public scrutiny can be distressing for those who are trying their best to provide quality care to residents. Aged care AIN and QNMU member Kathryn Heggarty said it made a huge difference knowing nurses and carers in all sectors were standing together and supporting each other. “It takes a lot of internal strength to work in the aged care industry,” Kathryn said.

“So it’s important to have a support system to help you through this troubling time and to ensure your own wellbeing isn’t suffering. “I think self-care strategies are very important, and just looking out for one another and asking your colleagues if they’re okay every so often.” The QNMU will take every opportunity throughout the Royal Commission (and beyond) to speak up for aged care nursing staff and make our message heard: THIS CRISIS IS NOT THE FAULT OF NURSES AND OTHER STAFF. THE AGED CARE SYSTEM IS BROKEN. Through the QNMU, aged care members have the largest collective voice of Queensland’s nurses and midwives behind them.

And every nurse, carer and midwife (regardless of sector) has a role to play. Remember, when nurses and midwives speak, people listen. Whether it’s having conversations with your family and friends or posting messages of support on social media, it’s up to all of us to support our colleagues in aged care. Members who have concerns or need help during the course of the Royal Commission can call Member Connect on 3099 3210 or 1800 177 273 (toll free outside Brisbane) for expert assistance.

At the iconic Charles Kingsford Smith statue in Bundaberg

Rockhampton Shopping Centre

QNMU Weipa Branch stall

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royal commission

we asked nurses and midwives what they want the royal commission to investigate. here’s what you said…

What will the Royal Commission into Aged Care investigate? The Royal Commission into Aged Care Quality and Safety will focus on residential aged care and home care, as well as the care provided to young people with disabilities who live in residential aged care facilities. Visit https://agedcare. royalcommission.gov.au/ Pages/default.aspx to read the full terms of reference.

Who may be asked to provide evidence/appear before a hearing? Any person the Royal Commission considers necessary to the investigation can be required to provide evidence or appear before an open or closed hearing. This may include aged care providers and management, government officials, nurses and carers, family members and other key stakeholders (such as union officials). Any QNMU members required to appear before the Royal Commission or provide evidence should contact the QNMU immediately so we can provide expert assistance.

How long will the Royal Commission last? The Royal Commission will provide an interim report by 31 October 2019, with its final report and recommendations due by 30 April 2020. The Royal Commissioner can also request more time to continue their investigations.

What happens once the Royal Commission concludes? The Royal Commission’s final report will contain a number of

recommendations to address the various issues identified throughout the investigation. However, the federal government is under no obligation to enact these recommendations through legislation.

Do we need to wait for the Royal Commission to conclude to take action? No! Nurses and carers already know why the aged care system is broken. A Royal Commission will highlight what we already know — that we need more staff for aged care and legislated staffing ratios now. Visit www.qnmu.org.au/ ratiosforagedcare to find out more about our campaign for ratios in aged care.

References:

The Guardian Australia (2018) Deaths inside: Indigenous Australian deaths in custody, viewed November 2018, <www. theguardian.com/australia-news/ ng-interactive/2018/aug/28/deathsinside-indigenous-australian-deaths-incustody>. Hynes Legal (2018) Royal Commission into aged care quality and safety: What you need to know, viewed November 2018, <http://hyneslegal.com.au/news/ aged-care-royal-commission-updateproviders-urged-to-start-preparationsnar-510>. Parliament of Australia (2018) Royal Commissions and Commissions of Inquiry, viewed November 2018, <www.aph.gov. au/About_Parliament/Parliamentary_ Departments/Parliamentary_Library/ Browse_by_Topic/law/royalcommissions>. Royal Commission into Institutional Responses to Child Sexual Abuse. (2018). Final report recommendations. viewed November 2018, <www. childabuseroyalcommission.gov.au/ recommendations>.

KH How having a set ratio will benefit our residents, including taking into account the skill mix of RNs, ENs and AINs. Like · Reply

EF Transparency in the sector, particularly around how the money being paid by the resident and the federal government is being spent, and then compare this to the profits that each organisation is making. Like · Reply

KB Definitely staff to resident ratios and meal quality. Staff need to feel valued and this translates into great care. Like · Reply

VP Carers being forced to give medications when they don’t want to. Like · Reply

DP Financial transparency and accountability from aged care facilities. Like · Reply

TRF Only having one RN or EN for an entire facility overnight. Staff to resident ratios, it is crazy leaving one person to medicate 30 or more residents! Like · Reply

KJ ACFI funding model, person centred care (less task orientation), and mandatory dementia training. Like · Reply

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T WAS 3AM on the second evening of our holiday in Cambodia. I found my partner, Darrin, collapsed on the floor, unconscious and very blue. He was clearly struggling to breathe with all the foam blocking his airway. After an anxious exchange with the hotel staff, the ambulance arrived and took us to Phnom Penh Hospital. Upon arrival, the ambulance driver put his hand out to me to pay him $30 USD. I didn’t care, I was just so relieved to get Darrin some help. Darrin was wheeled into the ED. It was one long room with beds squeezed so close together as far as the eye could see. Lots of family members were standing around providing care for the patients. There were only a few nurses that I could see to at least 60 patients. There was no privacy, no buzzers, and no curtains that could be pulled for dignity. There were people using bedpans. I couldn’t help but notice how primitive the equipment was — the ECG machine had suction caps on it. The blood tests established that Darrin had had a heart attack and was in kidney failure. He had a CK level of 28,000, he had Rhabdomyolysis, his potassium was extremely elevated, and his BGL was 128 mmol/L. Ultimately, the medical team concluded that Darrin had reacted to the anti-malarial medication he was taking, the long flight and dehydration.

THE BARE BONES What was supposed to be the holiday of a lifetime quickly turned into a nightmare for QNMU Servicing Organiser and Registered Nurse Susan Lines. While holidaying in Cambodia, Susan got a taste of a health system in stark contrast to our own. The medical care was excellent… but there was something missing: nurses. As Susan writes, when you take nurses out of health care, you are left with a very different, almost unrecognisable, health system.

Each day the nurses would bring me the hospital bill which was written in Khmer, so I had no idea how much I was expected to pay until I got to the cashier. There was no bathroom for showering, only a toilet for visitors that had no toilet paper. Each day I assisted Darrin to have a cold shower. I had to ask daily for toilet rolls as supplies were very limited. The hospital also did not provide food or hot water for patients, so I had to buy meals every breakfast, lunch and dinner from the hospital cafe.

indepth profession back home. And, of course, there are barely any nurses to begin with. Family members are expected to provide most of the care. In the mornings, the nurses took observations and bloods and gave me the AM and PM medications in small zip-locked bags to administer myself.

Susan Lines and her

partner Darrin

FAMILY NURSING I don’t say all this to criticise the hospital staff. The medical care Darrin received was wonderful. They saved his life. But there was very little ‘nursing’ during our time there. The role of nurses themselves is remarkably different – not hands-on like our

There are no call bells to request help if you need it. Family members have to go up to the nurse’s station and knock on the door, otherwise you don’t really see them. I even had to measure Darrin’s inputs and outputs. After a few days, we were fortunate to be able to arrange a VIP room which was $85 USD per night excluding tests, medications and other care. The room included a private bathroom and couch for me to sleep on. It was a small price to pay for a little comfort, but well out of reach for most in Phnom Penh where the average salary is less than about $300 a month.

WORTH HOLDING ON TO The total bill for the hospital stay was approximately $3000. It would have cost $184,000 for medevac retrieval, but we didn’t have traveller’s insurance. Luckily, the day we were due to fly home, Darrin was mobile enough to shuffle down the hallway (despite his swollen legs), and we got a tuk tuk back to our hotel. We weren’t given any pain relief medication. As soon as we arrived back in Brisbane, we headed straight to the Gold Coast University Hospital ED. From this experience, I now have a new appreciation for our amazing health system. We are so fortunate to be treated in such state-of-the-art facilities and equipment, to have access to free health care, and have such highly skilled nurses looking after us. While our system is by no means perfect, we are miles ahead, and what we have is worth holding on to.

HEALTH FEELS THE PINCH AS COUNTRY STRUGGLES TO REBUILD Cambodia is one of the world’s poorest countries and, like many still recovering socially and economically from the ravages of colonial occupation and war, it faces the huge task of rebuilding the nation’s infrastructure and public services. Most of the population is still employed in subsistence farming and as many as one third earn as little as a dollar a day. Poorly maintained, damaged and outdated infrastructure means power outages, water shortages, impassable roads and unreliable telephone services. These things are part of everyday life – particularly in rural areas outside Phnom Pehn. Health and hospital services also feel the pinch. The influx of people moving to Phnom Pehn over the past few decades means hospitals struggle with overcrowding — not least because poor living conditions and the lack of basics like sanitation and clean water mean there are many presentations of illnesses such as diarrhoea, mosquito-borne diseases and tropical infections. There is income from garment manufacturing, tourism, and natural resources like oil, and recent foreign investment from China and Vietnam, but widespread corruption means it doesn’t always trickle down to the average citizen or into the infrastructure the country desperately needs.

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WHAT’S YOUR EMERGENCY? She’s the voice of calm on the other end of the line during your most harrowing moments. Enrolled Nurse Sharon O’Connor hung up her scrubs to follow her calling as a triple zero (000) Emergency Medical Dispatcher… and it’s a job not for the faint of heart. Photo: Tanya Giles

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He said to me, ‘I feel so much better, I’d just like to thank you very much for your help’ and then he shot himself… I remember the deafening sound of the gunshot over the phone and for a long time I asked myself ‘why did he do that?’ Emergency Medical Dispatcher (EMD) Sharon O’Connor was manning the triple zero line one evening when a caller on the verge of suicide dialled in.

And she’s got an impressive arsenal of skills under her belt.

Emergency services were dispatched immediately but the caller was a fair way out of town and it would take longer than usual to get there.

Seven years ago Sharon kicked off her career as an operational paramedic with the QAS before transitioning into the communications environment as an EMD in the early 2000s.

Sharon stayed on the line to the caller and just as emergency services pulled up, he expressed his gratitude for Sharon’s help and counsel, and took his own life with a gun.

This work inspired her to gain her qualification as an Enrolled Nurse, and she was offered the opportunity to work at Townsville Hospital while continuing her role as an EMD.

“When he thanked me I thought to myself ‘Oh I’ve helped this gentleman out’. I thought he was going to be ok. But that was not it…” Sharon recounted.

Sharon is now based at the Townsville Operations Centre, where she works with up to 12 other EMDs in the Communications Centre on a rotating roster of 12 hour shifts.

“It took me a long time and a lot of counselling to realise all he’d wanted was someone to unload to. He hadn’t wanted to burden his family with his pain and I was just a voice on the phone, someone he’d never met, someone he’d felt comfortable enough with to express his feelings to.

The work is divvied up into two main roles – call takers man the triple zero line and dispatchers send out the emergency vehicles.

“It’s cases like this that make you realise how important you are in the entire process of an emergency. Even if we follow all the correct procedures people will still make their own choices, but we can provide care and support so they feel comfortable while help is on its way.”

“We all listen out for one another so if an urgent call comes through – say a person is drowning in a pool – those around you will jump in to help out and the dispatcher will have already begun planning what cars are going to be dispatched.

ON THE LINE It’s just one of the many calls that has stayed with Sharon during her decades-long career as an EMD with the Queensland Ambulance Service (QAS). Each shift Sharon taps into the experience and training she’s gained as a nurse over the past 25 years to methodically triage incoming calls to the triple zero line and dispatch emergency vehicles.

“Most of the call-takers sit next to each other and the dispatchers sit at the back, but we’re all in close proximity,” Sharon explained.

“It all happens very quickly.” With time often of the essence, the team has perfected their technique – emergency services are usually on the scene within five minutes of a triple zero call coming in. “By the time I get the details from the caller and the job is prioritised and sent to the dispatchers, the vehicle is already rolling out the door,” Sharon said. “I’ll then stay on the line to the caller to get more information or help deliver

instructions on first aid. Most of the time before I’ve even finished the ambulance is already pulling up to the caller’s house – they’re pretty quick!” Sharon follows set policies and scripts closely to ensure she covers all her bases and calls are appropriately managed. A caller is first asked for an address which Sharon reads back to them for verification. She checks if the phone number of the call is registered to that address, then further cross checks with a Telstra data mapping system to pinpoint the caller’s exact location. “Once we’ve verified a location I ask for the nature of the emergency, and step through some set questions with them to gain a better understanding of the situation,” she said. “If an ambulance is needed it is dispatched while I stay on the line to the caller. If it isn’t an emergency but an ambulance is still required it gets coded a different way (there’s a code for everything!) and we might dispatch a low acuity car instead to take them to the hospital.”

KEEPING IT COOL The first few minutes of an emergency are critical and with lives on the line, every second counts. Despite the adrenaline rush that comes hand in hand with the job it’s critical Sharon keep the caller calm and focussed. “There can be some hairy situations. Sometimes you can feel a bit heightened but you’ve got to remind yourself not to let that come across to the caller,” she explained. “I try and get them to focus through repetition. While they’re following my instructions they tend to be in less

indepth “What I learned in nursing is vital to what I do today. When doctors or nurses ring up with patients for transfer and provide their clinical condition I understand what they’re talking about and how urgent a case is, which allows me to prioritise appropriately,” she explained.

The calls you answer could be someone's one and only call to triple zero that they'll ever make in their lives so you've got to make it count.

“It really helps to know the lingo as well. I can go ‘oh yep if you’re not gunna bung that IV off we’ve gotta have an escort in the back of that ambo’ and it’s great in building rapport with them. “I’m a bit of translator sometimes – when we get faxes of paperwork for transfers I’m the one everyone comes to ask what it means!”

Photo: Tanya Giles

of a panic because they’ve been given something to do.

chuckled over some rather strange requests.

“In situations like a major car accident, I’ll try and get a caller to be my eyes and describe what they see in detail (how many people and what the situation is), then let them know they’ve done a great job.”

She’s also had the odd hoax call (claims of a crocodile having bitten off someone’s finger) and unfortunately some repeat prank call offenders, but said sometimes you just have to laugh it off.

The work is intense and emotionally draining, and understandably it can be hard to let go of a call even after it’s ended.

“We’ve had the odd one ring us up at 2am in the morning (because we’re the only ones awake) wanting to know what’s on TV,” Sharon said.

But Sharon said she’s fortunate to have a very supportive and loving family, and it helps that both her husband and eldest son also work in the pre-hospital environment.

“Someone who called for an ambulance once asked if we could pick up his pizza on the way… I had to tell him we don’t do pizza delivery!”

“Paramedics will also often pop upstairs after a job and give us an update so we have a bit of closure, otherwise sometimes you just sit there and think ‘my goodness what ever happened to that person?’ “QAS is also very aware of the pressures and demands their staff face on a daily basis and have incorporated a peer support and counselling network which extends to our immediate family. I’m proud to be an active Peer Support Officer in this program and use my training and experience to assist others when required.” But there’s also frivolity to be had on the job. While prank calls to the triple zero line are frowned upon, she’s

DRAWING FROM THE WARD Calls to emergency services are many and varied, and they aren’t all nail-biting and panic-inducing. Sharon also takes non-emergent calls for ambulance services like inter-hospital transfers and booking doctor’s appointments. It’s where Sharon draws on her knowledge as a former EN in Townsville Hospital, having experience in geriatrics (in the dementia unit) as well as a rotation of shifts in surgical theatre and the medical centre. She now inadvertently swaps into “nurse mode” when liaising with health professionals.

Sharon said nursing was rewarding and satisfying as it allowed her to get back into hands-on work. But eventually the thrill of the call centre beckoned and she returned to EMD work in 2016. “I just really enjoy the fast pace of being an EMD and never knowing what you’re going to get next on the line – it’s always go, go, go!” she said. “My heart was also in teaching and training our next generation, which I do a lot of now, and passing on knowledge to all the new EMDs that are coming through.” New recruits undergo intensive training in Brisbane to learn the computer systems and protocols before being sent into regional training centres for practical experience. They are assigned to a buddy system and have a mentor or trainer for at least 16 to 20 shifts when answering triple zero calls. In addition, recruits go on the road with paramedics to gain a better perspective of the process from the time a call comes in, to paramedics treating a patient on the scene then transporting him or her to hospital for triaging. “It’s also very much about supporting our newbies through their training as they won’t be used to how traumatic the job can be,” Sharon said. “We teach them how to be calm (amidst screaming from callers

indepth sometimes) and afterwards we talk about the cases with them so we can nurture them through it.” Once recruits have gained confidence as a triple zero call taker for a few months, they are sent to the dispatch unit for additional shifts with a dispatch mentor. Again, it’s fast-paced. And dispatchers learn to prioritise cases and dispatch not only ambulance, but the police and fire crew as well. Like nursing, it’s hard work that requires true passion, and Sharon said she wouldn’t give it up for the world. “The calls you answer could be someone’s one and only call to triple zero that they’ll ever make in their lives so you’ve got to make it count,” she said. “People ring us when they are at their worst or at their most anxious, and to be able to help them out in some way is really rewarding.” If this article has rised any issues for you, please cal Lifeline on 13 11 14.

WHO YOU GUNNA CALL? It’s the number that saves lives, yet we hope never to have to dial those three zeroes. EMD Sharon O’Connor sheds light on what people commonly call the emergency line for… ■■ Chest pains and shortness of breath (or asthmas) top the list for most frequent calls, as well as callers contemplating suicide. ■■ Asthmatics are frequent callers around flu season. ■■ During school holidays falls and fractures abound… “cause all the kids think they’re Evil Knievel!” ■■ In the summer, it’s common to get calls from people having been stung by Irukandji jellyfish on the beach. ■■ Callers suffering anxiety attacks dial in frequently during cyclone season. ■■ And while pranksters don’t top the list, inappropriate or hoax calls are still often made to triple zero.

IN 2016 TO 2017:

Of the 14% of people who called triple zero between January and June 2017:

Over

8.5 million

calls were made to emergency services.

called for an ambluance

called for the police

called for the fire services

Most understood it was appropriate to call triple zero to: report a fatal car accident

70%

of calls were made from mobile phones

30%

of calls were made from fixed-line phones

98%

report possible self-harm

call about domestic violence

90%

85%

Source: ACMA Commissioned Research, July 2017, conducted by Galaxy Research; ACMA Communications report 2016-17, https://www.acma.gov.au/theACMA/Library/researchacma/Research-reports/triple-zero-by-the-numbers

indepth

Ask the question:

How many nurses are on duty? 40

indepth

EEP AN eye and ear out on TV, radio and online in the lead up to Christmas… because we’ve got a simple message for all Queenslanders about ratios. As part of our ongoing campaign in the aged care and private hospital sectors, we’re calling on the community to ask the question: how many nurses are on duty? A lot of people simply don’t realise that while legislated minimum nurse-topatient ratios apply to Queensland public hospitals, there is no requirement for minimum staffing in any private hospital or aged care facility. As nurses and midwives, it’s our job to provide quality care to our patients and residents. But it’s the hospital and aged care providers’ jobs to make sure we can. Our ads will be running on television and radio, as well as various social media platforms and ‘SMART’ television channels… so they’re sure to get people talking. And if you want to watch our ad now or share with a friend, visit www.qnmu.org.au/RatiosSaveLives

Our campaign: A little recap Thanks to the QNMU, Queensland is now the fourth jurisdiction in the world to have minimum legislated ratios. We campaigned hard and provided the evidence, and on 12 May 2016, the Palaszczuk government enshrined minimum ratios in law for prescribed medical and surgical units in Queensland Health acute facilities. These units account for around 80% of activity in 27 public hospitals. What’s more, all public hospitals are covered by a notional ratio — calculated using the Business Planning Framework (BPF) — which is equal to or better than the legislated ratio. The notional ratio can be

used to improve the legislated ratio where supply does not meet demand. Then in October 2017, we launched Phase 2 of our long-term ratios campaign. Our attention turned to getting ratios rolled out in the rest of the public sector, as well as aged care facilities and private hospitals. Our asks include: ■■ refine and expand the legislated minimum ratios in the public sector ■■ legislate minimum ratios in the private and aged care sectors ■■ legislate for at least one Registered Nurse to be present at all times, on all shifts, in all Queensland residential aged care facilities ■■ improve application and compliance with the BPF (Business Planning Framework - a nursing and midwifery workload management tool) in the public sector ■■ legislate public reporting of safety and quality performance indicators in all sectors. And we’re making progress… Already the Palaszczuk government has committed to introducing minimum ratios for public aged care facilities, which would set the benchmark for the rest of the private sector. There’s a lot of work happening behind the scenes, but nurses and midwives have a role to play in educating all Queenslanders on why we need ratios. Talk to your family, your friends, and your colleagues. Head to www.qnmu.org.au/RatiosSaveLives for more information. Here you will also find a link to our Ratios Save Lives Phase 2 document – a detailed analysis of the evidence that underpins ratios, what we are seeking for private hospitals and aged care facilities, and what the ratios should look like for individual units and wards.

Whether it’s a hospital or an aged care facility, as nurse-to-patient ratios drop, the risk of death increases.

indepth

United by a common purpose T

here is a movement happening across Australia’s workforce. Thirty years of experimenting with trickle-down economics has failed to provide secure jobs or fair pay rises. And even though profits are booming, a third of big business still don’t pay any tax. The laws that were once designed to give Australian workers a fair go are now broken. It’s time to Change the Rules. The ACTU’s Change the Rules campaign unites all workers — no matter what industry we work in, we all need to change the rules in some way to restore and protect our rights. But at the local level, each industry faces its own unique challenges. The issues facing nurses and midwives, for example, are vastly different to the challenges facing transport workers. Which is why Queensland unions across all sectors are campaigning to Change the Rules to meet the needs of the workers they represent.

One goal, many campaigns Nursing and midwifery The QNMU is campaigning to Change the Rules so nurses and midwives have a stronger voice in determining their pay and conditions. We need to ensure there is adequate

funding to support our world-class universal health care. We need to protect our penalty rates in the face of many employers’ attempts to scale them back. And we need to Change the Rules to fix our broken aged care system.

Education Similar to ensuring health care is properly funded, teachers are uniting to demand fair funding for our schools – a funding model based on the needs of students, so every child receives a world-class education. The Independent Education Union has battled for nearly 18 months with an employer trying to use the current broken rules to push through cuts. The employer’s lack of care and respect for their teachers has been bolstered by the current industrial laws that allow them to treat their employees in such a shameful way.

Manufacturing and trade Manufacturing and trade workers are focusing their efforts on Changing the Rules so employers cannot exploit workers through dodgy labour hire laws and temporary work visas. The Australian Manufacturing Workers’ Union is campaigning to ensure improved job security for casual and labour hire employees by demanding automatic permanency after six months. The Electrical Trades Union is fighting against the Trans Pacific Partnership trade agreement, which would allow employers to hire workers on temporary visas without first seeking local workers. The Australasian Meat Industry Employees Union is tackling unfair labour hire and outdated “zombie” enterprise agreements that are leaving workers further behind. And workers in the transport industry are fighting against big business, including airlines and airports, who continue to make record profits but still expect workers to accept sub-par agreements. The Transport Workers Union is also campaigning to introduce sectorwide agreements, which would give workers a bigger say in determining their own wages and conditions.

Join the movement for change These are just a few examples of how workers and their unions are campaigning to Change the Rules. To join the movement, head to www.changetherules.org.au

indepth

Working women power this country Australian women juggle many roles.

other, employee, partner, care giver, cook, cleaner, emergency responder.

For the most part Australia’s working mothers do it with grace, accepting, as millions of employed mothers do world-wide, that they are largely responsible for providing the majority of child care — as well as contributing to the family finances and taking care of domestic duties. Working multiple jobs and performing multiple roles has become the norm for working women – but the lifestyle takes a toll. Australia’s working mothers are burning out emotionally, physically and financially. Juggling work hours, school drop off and pick up, responding when a child is unwell, meeting financial demands and performing domestic duties leaves little time for rest or relaxation. Working mothers are stressed, overworked and often struggling to appease workplaces that frown on them or their partner arriving late or leaving early to meet family obligations or respond to an unforeseen family emergency. They are also paid less than their male counterparts in the same situation and receive far less superannuation. As reported in the Sydney Morning Herald: “Women, who make up 70% of all part-time employees, take on multiple jobs at once for lower wages and are more likely to have their super trimmed from the outset by a 30-yearold rule that stops any earnings under $450 from an employer in a month from attracting superannuation.’’

The cap means casually employed women receive far less super than Australian men. A parliamentary inquiry on the financial security of Australian women, called “a husband is not a retirement plan,” last year recommended getting rid of the cap. The inquiry heard 23% of men have balances over $500,000 — while a quarter of all women have balances less than $50,000. Australians want change. As part of the Change the Rules campaign, the Australian Council of Trade Unions (ACTU) recognised the hard work of women and stated “workplace rules and structures let women down.’’ They said “women face an unfair, uphill battle at every turn.’’ So Australian unions are calling for workplace reform that includes: ■■ The abolition of “primary” and “secondary” parental leave, to be replaced by 26 weeks’ leave that a family can use however they want ■■ The payment of superannuation on every dollar that women earn, including on paid parental leave ■■ The establishment of an expert Pay Equity Panel within the Fair Work Commission ■■ The right for all employees to receive — not merely request — family friendly working hours ■■ The provision of ten days paid family and domestic violence leave ■■ The restoration and protection of penalty rates ■■ A proper definition of casual work. It’s time to change the rules for working women in Australia.

Will you join us? For more information visit www.australianunions.org. au/change_the_rules_for_ working_women

FR EE

CPD portalâ&#x20AC;¦

FREE for QNMU members!

www.qnmu.org.au/CPD QNMU member Vanessa Kirunda

CPD

Your

CPD

WORKBOOK

CPD

WORKBOOK is on its way…. K

EEP AN EYE on your emails, folks, because the QNMU’s 2018 CPD Workbook is almost ready to drop.

This fabulous eBook, free to all members, offers a collection of interesting educational articles relevant to your working life to help grow your professional development and meet the CPD requirements you need for registration. Articles range from legal and clinical pieces to articles on wellbeing and workplace culture — some are in the style of magazine reads while others are sourced from peerreviewed research journals. Each article includes a reflective exercise at the end to help you reflect on and record what you’ve learned.

WE’VE GOT YOUR CPD COVERED The 2018 CPD Workbook is just one of a whole range of CPD resources we provide free to members as part of your membership. We also produce: ■■ Four editions of InScope every year with heaps of CPD articles and reflective exercises. ■■ Nurses and the Law – a guide to how Australian laws and regulations affect you as a working nurse or midwife. ■■ The Health and Safety Handbook – a guide on workplace health and safety rules, regulations, grievance processes and best practice for nurses and midwives. All these resources can be found on our fantastic CPD Portal at www.qnmu.org.au/CPD

2018 Our CPD Portal is your one stop online shop for all your CPD needs, including: ■■ Easy online registration for the QNMU’s courses: Our dedicated education unit provides members with training on a wide range of industrial and skill-based issues. ■■ Our webinar series: Online CPD webinar sessions featuring some great expert speakers and topics. ■■ Your CPD Record: Our Record of CPD allows members to save all their professional development and education activities in a single reference document, ready for auditing. ■■ Free access to the Australian Nursing and Midwifery Federation’s (ANMF) clinical CPE portal: Giving you access to loads more CPD at your fingertips ($30 per course for non members). ■■ Special resources for new grads: A helping hand with resumes and registration for those just starting out. ■■ Scholarships and bursaries: Every year we award $55,000 in financial support packages for members to assist with further education. As the professional and industrial organisation for Queensland’s nurses and midwives, we’ve got all your CPD requirements covered.

WHAT IS CPD? Continuing professional development (CPD) requires nurses and midwives to complete a minimum number of CPD hours directly relevant to a nurse of midwife’s contact of practice (NMBA, 2016).

CPD

Hidden cameras in aged care: ARE THEY LEGAL?

CPD

It is the QNMU's position that surveillance cameras are not the solution to addressing concerns about care. We maintain that increasing the number of licenced professional nurses in aged care facilities is the most appropriate way to protect and monitor vulnerable residents. We need more nurses not more hidden cameras. The following article addresses the legal issues around hidden cameras, not their validity as a solution to issues around quality care.

With concerns about staffing and skill levels in our aged care facilities making headlines of late, it is not inconceivable that a family of a resident could be motivated to install a camera in their loved oneâ&#x20AC;&#x2122;s room in an aged care facility because of concerns about the quality of care.

The footage might therefore be used in any complaint about perceived neglect or ill-treatment. In the event of an incident, the footage could be provided to police or the aged care provider. In the event of an unexpected death, the footage could be obtained by the Coroner. Footage could, in some instances, assist staff members in corroborating their version of events. On the other hand, if there are complaints of neglect, the CCTV in one residentâ&#x20AC;&#x2122;s room will not capture the activities of staff undertaken in other residentâ&#x20AC;&#x2122;s rooms which may have prevented them from attending the resident under surveillance more frequently. In those cases, there is clearly the potential for footage to be unfairly used to discipline staff. This article explores the current law in Queensland in relation to privacy and the use of CCTV cameras. The starting point is that privacy is recognised in international law as a fundamental human right.

However, privacy protections in Australian law are contained in a patchwork of provisions, and the legality of the use of CCTV in aged care is not clear-cut, partly due to the lack of law reform in Queensland with respect to the issue of workplace surveillance and invasion of privacy.

What powers does an employer have with respect to surveillance of employees carrying out their duties? Employers have almost unfettered power to observe and supervise employees in the course of carrying out their duties, particularly at the premises of employment. The question is: to what extent are any real constraints upon an employer in Queensland utilising surveillance? Other than the application of privacy laws contained in the Aged Care Act 1997 (Cth) and the Privacy Act 1988 (Cth), workplace surveillance is not the subject of Commonwealth regulation.

CPD The Fair Work Act 2009 expressly allows for the operation of state laws dealing with workplace surveillance in relation to national system employers. Unlike some other states, Queensland does not have specific workplace surveillance laws. Laws in Victoria, New South Wales and the Australian Capital Territory require cameras to be clearly signed and visible with restrictions on the placement of cameras and the purposes for which resulting recordings may be used. The protection of privacy in Australia has been referred to as “an uneven patchwork”. In Queensland, some pieces of that patchwork which operate to constrain employers from conducting unchecked workplace surveillance are: ■■ Invasion of Privacy Act 1971 (Qld) ■■ Security Providers Act 1993 (Qld) ■■ Criminal Code section 227A ■■ Aged Care Act 1997(Cth) ■■ Privacy Act 1988 (Cth) ■■ the Common Law. As many CCTV cameras capture both visual footage and sound, the Invasion of Privacy Act 1971 may apply. The Invasion of Privacy Act 1971 prohibits the use of listening devices to overhear or record a “private conversation” — except by a person who is a party to the conversation. The Privacy Act 1988 and the Aged Care Act 1997 provide some safeguards against misuse of surveillance footage.

Provision of footage to news media or social media would be contrary to both regimes, and an employee who disclosed the footage may be guilty of an offence against section 86-2 of the Aged Care Act 1997.

d. which causes physiological or emotional harm and distress or which prevents or hinders the plaintiff from doing an act which she is entitled to do.

Furthermore, employers who choose to take surveillance footage will be required to comply with the Australian Privacy Principles.

What are the rights of employees in respect to surveillance in the workplace?

Common law has not developed to provide any meaningful relevant protection for personal privacy. The tort of trespass is available to restrain the broadcast of footage taken while trespassing on the plaintiff’s land, but trespass is only available to an occupier with the right of exclusive possession of the land. In one case the occupant of a hospital bed has, on that basis, been held not to have the right to restrain publication of photographs taken of his injuries in a hospital. (Kaye v Robertson [1990] EWCA Civ 21). No general tort of interference with privacy has been recognised by superior or appellate courts in Australia. In Queensland, Judge Skoien of the District Court recognised a tort of invasion of privacy in Grosse v Purvis (2003) Aust Torts Reports 81-706. The court held the elements were:

Privacy is recognised as a basic human right in international law. Despite this, the domestic legal rights of staff members in respect to workplace surveillance are limited. Employees have the right not to be visually monitored or recorded in staff bathrooms. And they have the right not to have their conversations recorded by persons who are not participants to the conversation only where it would be reasonable for them to expect that the conversation may not be overheard. Employees have the right to request a clear, up-to-date privacy policy which complies with Australian Privacy Principle 1.4. Surveillance footage of workers who can be identified must be kept in accordance with the Australian Privacy Principles and the Aged Care Act.

b. which intrudes upon the privacy or seclusion of the plaintiff

This would prevent, for example, the provision of surveillance footage to the news media, or the posting of footage on social media.

c. in a manner which would be considered highly offensive to a reasonable person of ordinary sensibilities, and

However, it would not prevent the use of footage to discipline a worker or to justify termination of employment or for use in court proceedings.

a. a willed act

...employers who choose to take surveillance footage will be required to comply with the Australian Privacy Principles. 48

CPD

Surveillance footage of workers who can be identified must be kept in accordance with the Australian Privacy Principles and the Aged Care Act. Employees may also have the right to pursue a complaints process under the Australian Privacy Principles if they believe surveillance is being undertaken which is not reasonably necessary, and may make a complaint to the Australian Information Commissioner pursuant to section 36 of the Privacy Act 1988. However, the extent that it can be successfully argued will depend on whether the surveillance is directly related to an employment relationship and whether the employer’s activity is exempt under the Privacy Act. The law with respect to workplace surveillance has been reformed in Victoria, New South Wales and the Australian Capital Territory to provide a fairer balance between protecting the human right of privacy and giving employers sufficient freedom to protect legitimate interests. Queensland has not yet considered such reforms.

What are the rights of the residents in respect to surveillance in their private rooms? The QNMU has serious reservations about the idea of surveillance of a resident's private room We are concerned about the potential loss of human dignity particularly if monitoring is maintained on a 24/7 basis. Our view is that a resident has the right to privacy in their own space and should not fear their private behaviour might be captured on tape. Under the Invasion of Privacy Act 1971 residents would have the right to engage in private conversations without the conversation being recorded by someone who is not a party to the conversation.

By virtue of section 227A of the Criminal Code section 227A the use of CCTV to monitor or record a resident while they are in their room or en suite is likely to amount to a criminal offence in the absence of consent being obtained from or on behalf of the resident, if the resident is not aware of the surveillance. But residents cannot consent to an audio recording being made of their private conversations under the Invasion of Privacy Act 1971, although they may themselves use a “listening device” to record a conversation to which they are a party. If a resident does not have cognitive capacity consent could be given by the holder of an Enduring Power of Attorney, but as such a recording is not a health matter, consent could not be given by a statutory health attorney. A guardian or administrator appointed by QCAT would have to have regard to the general principles under the Guardianship and Administration Act 2000 (Qld). It is unlikely that the general principles under that Act would favour a decision to consent to recording by CCTV without there being exceptional circumstances. Residents also have the right to have any personal information held by the aged care facility (which would include any CCTV footage obtained or kept by the facility) to be protected by security safeguards against loss

or misuse, and that the footage not be used for purposes alien to the purpose for which it was taken or the provision of aged care to them.

As the aged care facility is a “healthcare service” under Qld law and a “workplace” under Commonwealth law, can management maintain the view that this is a private matter, as it is the resident’s home? In short, no. But the fact that a homely environment is sought to be created for a resident has implications for the application of the objective tests contained in the Invasion of Privacy Act 1971 and the Criminal Code concerning whether there is a reasonable expectation of privacy.

Conclusion The legality of the use of CCTV in the aged care setting depends upon the circumstances. Where consent of the resident is validly obtained, however, there may be no legal impediment to the use of CCTV to observe or record staff members – although there is the risk of inadvertently recording private conversations in contravention of the Invasion of Privacy Act 1971 (Qld). Privacy principles contained in the Aged Care Act 1997 (Cth) and Privacy Act 1988 (Cth) limits the use to which recordings can be put and requirements for their secure storage, however, those principles are unlikely to prevent the use of recordings against staff members in the disciplinary context. Law reform is required in Queensland to provide adequate privacy safeguards for employees in the workplace.

REFLECTIVE QUESTION What recourse do you have if you find an unauthorised CCTV camera being used in your patient/resident’s room? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Making familycentred care happen in ICU BY CHRISTINE LYALL, CLINICAL NURSE RESEARCH, GOLD COAST UNIVERSITY HOSPITAL

THERE are international calls for families to be involved in their loved ones’ care in ICU. For critically ill patients (many who cannot speak for themselves), the family is well positioned to advocate on behalf of the patient. Inclusion of families in the patient care and decision-making process can reduce their distress and uncertainty in the ‘high tech’ ICU environment. But how do we best engage families in their loved ones’ ICU care?

What is IMPACT? Co-leads Andrea Marshall and Daren Heyland have led extensive work answering this question. Currently, they lead a trial called Improving Partnerships with Family members of ICU patients (IMPACT). In the IMPACT trial ICU family members are randomised to one of two interventions designed to enhance their participation in either nutrition care or end-of-life decision-making. IMPACT is being conducted at eight sites, including at Australian, Canadian and American hospitals. To date we have enrolled 48 families in the trial.

Reflections As an ICU nurse now engaged as a research co-ordinator for the trial, I have become aware of the challenges families face when participating in ICU care. As health care professionals we often use words or phrases that family members are unfamiliar with and this can make it challenging to fully inform families about the patient’s care and clinical progress. The uncertainty experienced by families is well described by one family member who commented, “One day she was at death’s door, and the next day I found out from the nurse that the breathing tube was out and she was doing fine”. The lack of clarity about how a patient is progressing sometimes can be attributed to the difficulties some families have in asking health care professionals for more information or clarification of concepts that have already been explained. These experiences highlight the value of the novel-family-centred interventions used in the trial. In particular, when providing education to families, health care professionals may use medical

REFLECTIVE QUESTIONS 1. How could teach-back methods enhance your practice? 2. What questions could you encourage families to ask? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

jargon that can cause confusion and uncertainty. The IMPACT trial checks families’ understanding of the intervention by using the ‘teach-back’ method, which encourages the family member to tell us in their own words what they believe they have heard. This is effective for determining the level of understanding when communicating important information, and could easily be incorporated into routine clinical practice. The interventions in the IMPACT study are supplemented with videos and booklets to demonstrate the types of questions they could ask health care professionals, and the best way to go about this. Family members may lack the knowledge and confidence to engage health care professionals, and giving them the tools to ask questions can have benefits. Contrary to a common misconception, having well-informed family members can save health care professionals time in the long run by facilitating better communication and indirectly effecting better outcomes for critically ill patients.

References

American Medical Association and American Medical Association Foundation (2018) ‘Using the Teach-back Toolkit’, viewed 25 May 2018, <http:// www.teachbacktraining.org/using-the-teachback-toolkit>. Frampton, S, et al (2008) Patient-centred care improvement guide, Planetree Inc., Picker Institute, p. 241.

CPD

Dealing with the police: Your rights and responsibilities D

URING the course of your professional or personal life, there may be a time when you are asked to speak with a police officer. You may have simply witnessed an event of police interest, or in some cases you may be directly involved in or privy to important information regarding a possible criminal offence. So, what are your rights if the police want to speak with you? In Queensland, you do not have any obligation to provide information to the police, with the exception of your ‘identifying particulars’. Identifying particulars generally include your name, address, and date of birth. It is recommended you immediately provide police with this information when it is requested. Failing to provide this information may result in the police charging you with an offence, such as contravening a direction or requirement by a police officer. This offence alone carries a maximum penalty of $7,833. In other cases, the police may issue you with a formal notice, such as an ‘identifying particulars notice’. This notice requires you to attend a police station within seven days. When you attend a police station, a police officer may take your photograph and fingerprints. If you are served with a notice requiring you to attend a police station, you should seek immediate legal advice.

...any information you voluntarily provide to police is admissible in evidence and can be relied upon by the police in court. Your right to remain silent With the exception of providing ‘identifying particulars’ to police, you otherwise have a right to remain silent. If police request that you participate in a formal interview, whether at a police station or in another public or private place, you have the right to refuse that interview. It is worth noting that these interviews are often recorded. Police now carry field recorders and body worn cameras, and often produce these recordings as evidence in criminal proceedings. Keep in mind any information you voluntarily provide to police is admissible in evidence and can be relied upon by the police in court. While there are some exceptions, the evidence may be admissible even if the police did not provide you with appropriate cautions or the recording was obtained improperly. If you do decide to take part in a police interview, you have the right to obtain independent legal advice before doing so. You also have the right to request a legal representative to be present during the interview process. It is never too early to contact a solicitor for the purpose of obtaining legal advice.

If you are charged with a criminal offence and have already participated in an interview, it is often too late to successfully defend a criminal charge. The QNMU cannot provide you with legal advice, but we can refer members to a lawyer with expertise in criminal matters. These lawyers will be able to guide you through the process of dealing with police and represent you in court if you are charged with a criminal offence. For assistance, phone Member Connect on (07) 3099 3210, or 1800 177 273 (toll free outside of Brisbane).

REFLECTIVE QUESTIONS 1. Why is it important to identify yourself to police even if you decide to remain silent? 2. In what circumstances would you seek immediate legal assistance? 3. What mechanisms can police now use to provide admissible evidence in court? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Maintaining

professional

URSING and midwifery are some of the most trusted and respected professions in the community. Patients expect a nurse or midwife to act in their best interests and to respect their dignity. The nurse-patient relationship isn’t a friendship — it’s a therapeutic relationship directed by the patient’s health needs. The community entrusts practitioners to act in the best interest of those in their care and that the nurse or midwife will base that care on an assessment of the individual’s specific needs. Boundary violations occur when the practitioner behaves in an unprofessional manner by misusing their power in the nursepatient or midwife-patient relationship. This is because there is an inherent power imbalance between vulnerable patients and the practitioner providing care. That is, there is an inherent power imbalance in therapeutic and care relationships. A breach of professional boundaries will lead to a violation of the practitioner’s professional responsibility (see Codes of Professional Conduct and Codes of Ethics). It doesn’t matter if the boundary violation was inadvertent, thoughtless, altruistic, or even purposeful. It’s still a boundary violation. If there is a breach, each circumstance would need to be assessed on the gravity of the departure from the professional standard within context (type of service or health facility, the physical setting, characteristics of the consumer, and the complexity of care required by the patient).

THE BASIC QUESTION IS: Is the behaviour or activity within the scope of practice of the nurse, and in keeping with contemporary competency and practice standards? It is instructive to consider some examples of boundary violations. Improper boundary-crossing behaviour (nontherapeutic behaviour) by the practitioner can be in the form of: ■■ having sex with a patient (consent is not a defence) ■■ breaches of patient confidentiality or privacy ■■ use of social media - blurring the lines between professional and personal lives ■■ accepting gifts or benefits from patients and/or their families ■■ developing a personal or intimate relationship with a patient (going out together on weekends or exchanging personal telephone numbers) ■■ financial exchanges (lending or giving money) ■■ favouritism of any kind ■■ excessive personal/self-disclosure or secrecy ■■ seductive, sexually demeaning or harassing conduct, and ■■ flirtatious communication, employing sexual innuendo, offcolour jokes or offensive language.

CPD

boundaries

with patients

To avoid a breach, abstain from the behaviour. Nurses and midwives need to practice in a manner consistent with professional standards which allows for a safe, therapeutic connection between the practitioner and the patient.

What can happen if you breach professional boundaries? In serious cases, nurses or midwives may be liable for disciplinary action brought by the Nursing and Midwifery Board of Australia (NMBA) or the Office of the Health Ombudsman (OHO) for unprofessional conduct or professional misconduct. Disciplinary matters are brought in the Queensland Civil and Administrative Tribunal (QCAT). QCAT has the power to suspend or cancel a practitioner’s registration. Nurses or midwives brought before QCAT in disciplinary matters may also be required to personally pay the legal costs incurred by the NMBA, which are usually in excess of $10,000. The OHO can also take action, including issuing a prohibition order that can prevent a person from providing any form of health service – including nursing, midwifery, assisting with nursing, or personal care work. The NMBA has incorporated their guidance on professional boundaries into the new code of conduct for nurses and midwives.

The nurse-patient relationship isn’t a friendship — it’s a therapeutic relationship directed by the patient’s health needs.

REFLECTIVE QUESTIONS

Visit www.nursingmidwiferyboard. gov.au/Codes-GuidelinesStatements/Professional-standards. aspx and review copies of the code and any associated documents relevant to your field of work. 1. Why might accepting an expensive gift from a patient be considered a breach of professional boundaries? How might you handle a situation if you are offered such a gift? 2. Why is it a professional boundary breach to disclose too much personal information about yourself to a patient? Explain the potential ramifications. 3. What would you do if you believed a colleague was breaching professional boundaries with a patient? Why would you take this action? How would you do it? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Your Professional Indemnity Insurance: What you need to know

O MATTER how diligent you are at your job, mistakes can and do happen and a third party may accuse you of negligence or a breach of a professional duty. Professional Indemnity Insurance (PII) is how professionals guard against the legal costs which can arise from such claims. For nurses and midwives having PII is compulsory by law.

PI insurance and NMBA requirements: what you need to know Nurses and midwives are accountable for their professional practice and are required to have PII to meet the PII Standard and to comply with the Health Practitioner Regulation National Law Act 2009 (National Law). Nurses and midwives must not practise unless they are covered by appropriate PII arrangements, which cover the full scope of their practice (s.129 National Law). The PII must include: ■■ civil liability cover – i.e. cover for a claim that is made as a result of a negligent act, error or omission resulting from your practice. ■■ unlimited retroactive cover – i.e. a policy that covers against claims that arise from a time before the policy commences but only where the notifier was unaware of the claim when the insurance cover commenced. ■■ automatic reinstatement – allows for the amount insured to be reinstated for new, unrelated claims, after one or more claims have been paid to the limit of the amount insured. ■■ run-off cover - is cover for claims that arise while you were covered by PII, but where the claim is made after you stop practising and have ceased being covered by the PII policy. AHPRA can check your compliance with this Standard at any time. If you fail to be truthful on your renewal form, you may be liable for disciplinary action by the NMBA or face criminal charges. Similarly, if you practise without appropriate PII, you may be liable for disciplinary action by the NMBA. This may result in the NMBA denying your registration. The NMBA must be informed in writing within seven days, if at any point when you are registered, you no longer have appropriate PII arrangements in place for your professional practice. Failing to notify the NMBA within seven days is considered behaviour for which health, conduct or performance action may be taken under the National Law. However, you do not need to inform the NMBA about routine changes, such as a change of insurance provider or if you do not have PII arrangements in place because you are no longer practising.

CPD PII coverage – one of the many benefits of QNMU membership The QNMU has long recognised that employer insurance policies vary widely with regard to the extent of cover they provide to nursing or midwifery employees. We have actively put the interest of members first by providing PII as a benefit of QNMU membership. The NMBA puts the onus upon the individual nurse or midwife relying upon employment PII to ensure an employer’s PII policy meets the NMBA registration standard. If a nurse or midwife is audited and their employer’s cover does not meet the standard, AHPRA can take disciplinary action against the individual for non-compliance with a registration standard. Some employer insurance policies require the employee to have practised ‘conscientiously and diligently’ in order to be covered. Such policies are not consistent with the mandatory need to have cover for acts that result in a negligence claim. “Vicarious” cover is unlikely to meet the PII registration standard. Joining the QNMU and remaining a financial member of the QNMU is the easiest way to ensure they meet the PII registration standard. The QNMU’s PII coverage is the market leader. In addition to PII, the QNMU’s insurance covers members for both public liability and product liability… and there is no excess to be paid by QNMU members.

Eligibility for cover under the QNMU PII policy To be eligible for cover, you must be a financial member of the QNMU and maintain your financial status and be providing nursing service and/or midwifery services (excluding midwives in independent practice, self-employed or not working under a contract of employment) or a student member undertaking a clinical placement as a nurse or midwife. If you are providing nursing services as an independent contractor, please contact the QNMU to check if you

are covered as there are conditions under the policy around independent contractors.

What exactly is the QNMU policy, and what does it cover? The QNMU policy covers members for PII for $10 million for each claim and $70 million in the aggregate claims. The QNMU’s PII policy also includes public liability insurance and product liability cover and the limit of liability is $10 million for each claim $70 million in the aggregate. The policy indemnifies eligible members for claims against negligence and other civil claims that may arise from a breach of duty as a nurse or midwife. The policy also provides retroactive cover, automatic reinstatement and run-off cover, meeting all NMBA requirements.

QNMU members are also covered when: ■■ acting as a nurse for the Sports Injury Nursing Association ■■ working or volunteering as a nurse anywhere in the world except North America (i.e. USA and Canada and their territories and protectorates) ■■ providing some ancillary or related services such as podiatry and/ or pedicure services, cosmetic injections, aromatherapy, naturopathy, massage and reflexology as recognised by the QNMU^. ^ If you provide these services. please check with the QNMU to see if you are covered by PII.

Some of the common types of claims covered by the policy: ■■ negligence claims ■■ where you are summoned to give evidence before a coronial inquest ■■ defamation claims ■■ 'Good Samaritan acts' – for example, where a nurse provides nursing, life-saving or life extending services rendered unnecessarily at the scene of a medical emergency or during voluntary community service.

PII does not cover members for criminal offences or from claims arising out of molestation/harassment in respect of: (a) actual or alleged abuse; (b) any redress scheme or other arrangement established for victims of abuse; or (c) any failure to detect, act upon or prevent abuse.

Member obligations The policy is written on a “claims made” basis. Members must immediately inform the QNMU of any incident that may lead to a claim so that the insurer can be notified during the policy period. Types of claims to immediately report to the QNMU are: ■■ an unexpected death of a patient/ resident ■■ an adverse outcome of a patient/ resident in your care ■■ a complaint against you alleging negligence regarding the care you provided to a patient/resident ■■ an allegation that you have defamed someone in the course of your employment ■■ a request by the police/employer/ Coroner to provide a statement in respect of a patient/resident. For assistance, contact Member Connect on (07) 3099 3210 or 1800 177 273 (toll free outside Brisbane).

REFLECTIVE QUESTIONS 1. Why is it important to have PII that is not held by your employer? 2. What are some of the risks of not having appropriate PII? 3. If you are a financial QNMU member and are audited by AHPRA how might you prove you have appropriate PII? 4. What are some of the claims covered by the QNMU’s PII? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Dressing and securement methods: preventing catheter failure

BY EMILY LARSEN BN, GDIPHLTHRES, SENIOR RESEARCH ASSISTANT, AND NICOLE MARSH RN, BN, MADVPRAC(NRS), PHD(CAND), RESEARCH FELLOW (VASCULAR ACCESS) THE ALLIANCE FOR VASCULAR ACCESS TEACH AND RESEARCH GROUP, GRIFFITH UNIVERSITY AND THE ROYAL BRISBANE AND WOMEN’S HOSPITAL

OST HOSPITAL patients require a Peripheral Venous Catheter (PVC) for intravenous fluids and medications.

The PVC were B. Braun Introcan Safety 3 (at the PAH) and BD Insyte Autoguard Blood Control (at the RBWH).

Regrettably, PVC failure (from dislodgement, occlusion, infiltration, extravasation, phlebitis and/or infection) affects up to two-thirds of PVCs. Insufficient dressing and securement has been highlighted as a key factor.

All groups had paper tape (Micropore) applied to secure the tubing. The primary outcome was any type of device failure.

New products are available but need to be tested in randomised controlled trials (RCTs).

The study The aim of this large nursing-led RCT was to identify the best method to dress and secure PVC, comparing both traditional and novel products. Four methods of dressing and securement were tested at two Queensland adult hospitals - The Royal Brisbane and Women’s Hospital and The Princess Alexandra Hospital - in 2013-2014. These methods included: 1. simple polyurethane (clear film) dressing (control group) 2. bordered polyurethane (clear film with adhesive gauze border) dressing 3. sutureless securement device (StatLock/Grip-Lok) with a simple polyurethane dressing 4. tissue adhesive (glue) (Histoacryl) with a simple polyurethane dressing (Figure 1).

Results In total, 1709 patients with a PVC inserted received one of the four allocations. Clinical and device details were comparable for risk between groups. The use of additional dressings and securements such as non-sterile tape/s and tubular bandaging was common (67%), applied by bedside nurses based on their assessment, usually as the dressings were coming loose, even though dwell time was short (average 54 hours). Overall PVC failure was 41%. The main analysis found no significant benefit in any intervention group, compared to the control (p=0.21, Table 1). However, in other analyses, there was an 8% overall reduction of failure with tissue adhesive, compared with the simple polyurethane alone (p=0.02). Skin adverse events (such as itching, rash, skin tearing) were typically mild but slightly higher (p=0.04) in the tissue adhesive group (4%) compared with controls (2%).

Mean costs associated with the three intervention groups were each significantly higher compared to the control group ($6.11 - $17.78 versus $2.25, p<0.01).

Implications for practice The findings of this large study were that no approach tested will reliably prevent PVC failure. Tissue adhesive may have a place, when applied by those familiar with its use, in difficult venous access patients where a replacement PVC would be challenging. Considering the frequent use of additional products (such as tapes and bandaging), and other recent evidence suggesting these have a positive impact in reducing PVC failure, we recommend dressing and securement ‘bundles’ rather than reliance on any one or two of these products alone, to secure the PVC and attached infusion tubing.

References

Marsh, N, et al (2018) ‘Observational study of peripheral intravenous catheter outcomes in adult hospitalized patients: A multivariable analysis of peripheral intravenous catheter failure’, Journal of Hospital Medicine, vol. 13, no. 2, pp. 83-89. Marsh, N, et al (2017) ‘Devices and dressings to secure peripheral venous catheters: A Cochrane systematic review and meta-analysis’, International Journal of Nursing Studies, vol. 67, pp. 12-19. Rickard, CM, et al (2018) ‘Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial’, The Lancet, vol. 392, no. 10145, pp. 419-430.

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FIGURE 1: Dressing and Securement Allocations (Top - Royal Brisbane and Women’s Hospital, Bottom - Princess Alexandra Hospital) Tissue adhesive with polyurethane

Sutureless device with polyurethane

Bordered polyurethane

Polyurethane (controls)

TABLE 1: Study findings Tissue adhesive with polyurethane (n=427)

Bordered polyurethane (n=423)

Securement device with polyurethane (n=425)

Polyurethane (n=422)

PVC failure, n (%) (Main analysis)

163 (38%) (p = 0.21)

169 (40%)

176 (41%)

180 (43%)

PVC failure, n (%) (Per protocol)

74/281 (26%) (HR 0.88, p = 0.02)

96/273 (35%)

100/296 (34%)

86/250 (34%)

Skin adverse events, n (%)

17 (4%) (p = 0.04)

2 (<1%)

8 (2%)

7 (2%)

Costs associated with initial and replacement PVC

$17∙78 (p = <0∙01)

$6∙11 (p = <0∙01)

$9∙76 (p = <0∙01)

$2∙25

HR=Hazard Ratio

REFLECTIVE QUESTIONS 1. Reflect upon your own facility’s standard PVC dressing policy — how could the findings of this study influence your practice in the future? 2. If you were to implement a dressing and securement ‘bundle’ in your clinical area, what would it include and why? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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A focus on psychological safety helps teams thrive BY SANDRA EALES, QNMU ASSISTANT SECRETARY

HE HEALTH care and social assistance sector was identified as a priority industry in the Best Practice Review of Workplace Health and Safety Queensland Final Report (BPR) released in August 2017 – marking it as an industry with troublingly high levels of workplace injury. The QNMU recognise there are more serious injury workers compensation claims and a higher incidence of mental health disorders in our industry than any other and we are working to meet the challenges. Review of Queensland workers compensation claims data (2009 — 2014) showed mental stress claims (4.6%) were the most expensive with an average of 110 lost workdays and an average statutory payment of $30,7000, compared with 29 days lost for other reasons at an average of $8072. OHS legislation in every Australian jurisdiction imposes a duty upon employers to ensure, so far as is reasonably practicable, a safe working environment that is without risks to health. Providing a psychologically safe work environment improves health and wellbeing, commitment to the job, job satisfaction, and also improves organisational and client outcomes.

There is also significant evidence that workplace bullying increases the likelihood of cardiovascular disease, chronic disease, headaches, depression, drug abuse and sleep disruption as well as negative effects on individuals and organisations, including absenteeism, high staff turnover, lost productivity and decreased levels of organisational commitment.

Social brain theory

■■ System managers - The Australian House of Representatives Standing Committee estimated the cost to the national economy of bullying is more than $6 billion every year. Cultural and structural elements of the system that contribute to a hostile work environment need to be recognised, monitored and reported to drive ongoing accountability. At the moment much of the cost is hidden as it is not borne by the employer. Our focus is on the clinician’s perspective – health workers are four times more likely to suicide than other professions (MJA 2016).

Hostile environment There is a distressingly deep catalogue of research within the nursing and midwifery literature that explores the elements associated with hostile work environment — moral distress, failure of advocacy, bullying and burnout. Moral distress is experienced when we are prevented or unable to do our job adequately, when there are ethical conflicts and we are ’forced’ into actions we know are wrong.

When we talk about psychological safety we need to consider it from various perspectives:

That increasingly regular experience is reflected in QNMU surveys, which record up to 80% of members in some areas are dissatisfied with the care they deliver.

■■ Patients need to ‘feel’ safe and be part of decision making. There is a strong link between autonomy and health outcomes.

Bullying has devastating effects on victims, both professionally and personally. It undermines self-esteem, productivity and morale, and for some

it can result in a permanent departure from the workforce and, in extreme instances, suicide.

The brain’s physiological and neurological reactions are directly and profoundly shaped by social interaction. Unconscious emotional responses to workplace stimuli as well as deepseated psychological drivers affect wellbeing and function at work. Social psychologist at North Carolina University Barbara Fredrickson developed the theory that positive emotions (enjoyment, happiness, joy and interest) broaden one’s awareness and encourage creativity, curiosity and exploration, which, over time build skills and resources. Studies show positive emotions play a role in developing long-term resources such as psychological resilience and flourishing. This is in contrast to negative emotions, which prompt narrow, immediate, survival-oriented behaviours. For example, the negative emotion of anxiety leads to the specific fightor-flight response for immediate survival. Any perceived threat rings the amygdala alarm bell and triggers the rapid response, which in the short term also reduces analytic reasoning and perspective. And the threat doesn’t have to be a sabre-toothed tiger. Rudeness has also been shown to draw cognitive resources away from individuals, causing them to perform worse and make more mistakes. “There’s no team without trust,” the Harvard Business Review concluded

CPD when it reported on a two-year team performance study by Google. The study revealed that the highestperforming teams have one thing in common: psychological safety — put simply, the belief you won’t be punished when you make a mistake.

Psychological hazards injury Psychosocial hazards are anything in the design or management of work that increase the risk of work-related stress. A stress response is the physical, mental and emotional reactions that occur when we perceive the demands of our work exceed our ability or resources to cope. Prolonged or severe work-related stress can cause injury. Stress itself does not constitute an injury — we are likely to be exposed to a combination of psychosocial hazards. Some may always be present while others only occasionally. Hazards include: ■■ High job demand – sustained high physical, mental or emotional effort e.g. high workloads, too much to do, responding to distressed or aggressive clients, exposure to traumatic events, shift work and fatigue, long periods of vigilance looking for infrequent events. ■■ Low job control – where work is highly protocolised or scripted, where workers have little say in the way they do their work, were they are not involved in decisions that affect them or their clients or where workers are unable to refuse dealing with aggressive or difficult clients. ■■ Poor support – jobs where there is workplace bullying, aggression, harassment, poor relationships between workers, managers and co-workers or conflict, and a lack of fairness and equity in dealing with organisational issues. ■■ Poor workplace relationships.

Reflective practice may be the best medicine Reflective practice is recognised as a strategy of empowerment which we need to build into our way of being nurses and midwives. It may indeed be the best medicine we have to

grow a psychologically safe practice environment. Learning through reflection in practice occurs through many experiences and may be “provoked by disillusionment with our situation or a loss of confidence or it might be prompted by unexpected achievement or success”. Reflection is a method of learning and teaching professional maturity through the critical analysis of experience. It can be done as an individual or in groups as part of a peer review process. Undertaking the process increases communication skills; and insight development is part of learning to reason fairly and ethically. We need to embed peer review processes like interdisciplinary case reviews, facilitated group clinical supervision for nurses and midwives and mentoring programs as a priority strategy for strong clinical governance as well as maintaining a positive practice environment. These processes: ■■ can improve workplace relationships and build trust essential for teamwork ■■ can promote professional accountability through clinical audit and critical analysis ■■ can maintain a safe learning environment through skill development and knowledge transfer ■■ are protective and build resilience in individuals through social support and stress relief. Reflection is an essential element in professional practice and personal development but increasingly the pressure to act – not to stop and think – is very real. Nurses and midwives need to ensure they regularly take time out for this important aspect of the professional role. Managers need to recognise that this must be built into any consideration of ‘workload management’. The time to sit and think and reflect and plan is as important as the hands-on physical tasks completed as part of daily work. Some aspects of your high demand job may not be able to be changed but known risks can be mitigated or

Sandra Eales QNMU Assistant Secretary

managed and every individual has a role in creating and maintaining positive practice environment. If you or someone you know is in need of crisis or suicide prevention support, please call Lifeline on 13 11 14 or visit www.lifeline.org.au

REFLECTIVE QUESTIONS 1. Name two factors in the design or management of work that increase the risk of workrelated stress. 2. How can reflective practice mitigate psychosocial hazards and contribute to positive practice environments? 3. How do you contribute to maintaining a positive and psychologically safe workplace for yourself and others? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References or further information Heads Up, Strategies for healthy workplaces, <https://www.headsup.org.au/healthyworkplaces/strategies-for-healthy-workplaces>. Office of Industrial Relations (2017) Health care and social assistance. Statistical updates 2009-10 to 2013-14, <https://www.worksafe.qld. gov.au/__data/assets/pdf_file/0003/138513/ health-care-social-assitance-statisticalupate-2009-14.pdf>. Safe Work Australia (2011) Work-related psychological health and safety: A systematic approach to meeting your duties. National guidance material, <https://www. safeworkaustralia.gov.au/doc/work-relatedpsychological-health-and-safety-systematicapproach-meeting-your-duties>. Workplace Health and Safety (2018) <https:// www.worksafe.qld.gov.au/injury-preventionsafety/mentally-healthy-workplaces/events>.

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CONSCIENTIOUS OBJECTION T

HERE may be times during their career that a nurse or midwife is asked to undertake a task that does not sit comfortably with their individual beliefs and values. We acknowledge these situations can be challenging. To this end the QNMU has adopted the Australian Nursinig and Midwifery Federation’s (ANMF) policy on conscientious objection to outline where our union stands on balancing your right to refuse to undertake tasks on the basis of personal belief, and your duty of care to your patients and residents.

It is the policy of the ANMF that: 1. Nurses, midwives and assistants in nursing (however titled) have a right to refuse to participate in procedures which they judge, on strongly held religious, moral and ethical beliefs, to be unacceptable (conscientious objection)1. Fear, personal convenience or preference, are not sufficient basis for conscientious objection. 2. In exercising their conscientious objection, nurses, midwives and assistants in nursing must take all reasonable steps to ensure that the persons preference, quality of care, safety, and advance care directives are not compromised. 3. Subject to their scope of practice, nurses and midwives in the course of their employment, must not refuse to carry out urgent lifesaving measures or procedures. 4. In situations of conscientious objection, the nurse, midwife or assistants in nursing should

express a desire not to participate in that procedure, in advance if possible. In these circumstances the employer must allow the nurse, midwife or assistants in nursing to leave the area and/or not participate in the procedure as soon as practicable without any discriminatory or adverse action being taken. 5. Nurses, midwives and assistants in nursing should give serious consideration to avoiding employment positions where they can foresee that a situation of conscientious objection may arise with relative frequency. 6. Nurses, midwives and assistants in nursing accepting employment positions where they know they may be called on to be involved in situations at variance with their beliefs, have a responsibility to inform their employer. 7. Nurses, midwives and assistants in nursing should support colleagues who exercise their right to conscientious objection, and endeavour to prevent them being placed in situations that may compromise their religious, moral and ethical beliefs. 8. No discriminatory or adverse action should be taken against any nurse, midwife or assistant in nursing voicing a conscientious objection either in an application for, or during employment. 9. In health and aged care facilities nurses and midwives should have access to counselling and support services to meet their needs in their workplaces. Reviewed and re-endorsed November 2017

REFLECTIVE QUESTIONS 1. How would you describe or define a deeply held belief, as opposed to a preference or dislike? 2. Why is it important to have some guidelines around conscientious objection? 3. Consider your professional practice – are there situations where your deeply held religious or moral beliefs may clash with your nursing or midwifery work? ◆◆ If yes, how might you manage this? Do you need to manage this? Or can you work around it? ◆◆ If no, what would you do if a colleague refused to undertake work on religious or moral grounds? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

Reference:

Nursing and Midwifery Board of Australia (NMBA) (2018) Code of conduct for nurses and Code of conduct for midwives, viewed 1 March 2018, <http://www.nursingmidwiferyboard.gov. au/Codes-Guidelines-Statements/Professionalstandards.aspx>.

in memory

Vale Norma West (1933-2018) Central Queensland's first lady of nursing

HE CENTRAL Queensland community bade farewell to one of the true icons of nursing recently with the passing of former Rockhampton Hospital DON and long standing QNMU member Norma West. A nurse for more than 50 years, Norma’s career spanned everything from rural and remote clinical work to nurse training, management and lobbying for expanded hospital facilities.

Described by colleagues and friends as a strict, dignified nurse with gentle hands and a keen eye for detail and beauty, Norma played an integral role in developing the nursing profession and expanding health services in the district, including oncology, renal, coronary and intensive care facilities.

Beginning her nursing career at the Bundaberg Hospital in 1951, Norma completed her General Certificate of Nursing and later her Midwifery and Maternal and Child Welfare Certificates in Brisbane.

She was a driving force behind the shift to nursing degree qualifications and worked enthusiastically to secure degree courses at the Central Queensland University.

At the age of just 26, Norma was appointed to the position of Matron at the Monto Hospital, becoming the youngest nurse ever to hold a Matron’s post in Queensland.

Throughout her distinguished career, Norma remained a member of our union.

After Monto, Norma spent six years as Matron of the Longreach Hospital. A thirst for knowledge and a fervent belief in the professional capacity of nurses saw Norma develop a wide range of skills in the outback — from learning how to operate x-ray equipment to administering anaesthetics and medication. She also relished outreach work in remote Queensland communities like Mount Isa, where she was warmly welcomed into the community to conduct health checks and baby clinics. In 1971 she took on the senior role of head of nursing at the Rockhampton Base Hospital. It’s a role she would hold for a record 30 years.

Her membership started in 1952 when she joined the Student Nurses Association, a special interest group of the then Royal Australian Nursing Federation. She was an active member of the CQ Directors of Nursing Branch and attended many then-QNU Annual Conferences as a delegate. She was also regularly called as an expert witness in cases taken by the QNU on behalf of members, and when wearing her manager’s hat always ensured her relationship with the union was productive and professional. Even when she retired her passion for nursing was as strong as ever. Working with the Australian Country Hospital Heritage Association she

helped establish a medical museum in Rockhampton. In 1983 Norma was awarded an Order of the British Empire (OBE) for her ‘outstanding contribution to nursing in Queensland’. She once said receiving the OBE was one of the highlights of her life alongside sharing lunch with Queen Elizabeth and Prince Phillip in Longreach in 1970, graduating from five different areas of study, and being awarded the prestigious Companion of CQ University title for her role in nursing education. We were privileged to have a nurse of Norma’s calibre and dedication in the QNMU ranks for so many decades. She will be missed. Photos: Rockhampton Morning Bulletin

Changing the rules for nurses and midwives

in view

Queensland nurses and midwives have been calling for change! As part of the ACTUâ&#x20AC;&#x2122;s Change the Rules campaign, we stood with our union colleagues to take our message to the streets with rallies across the regions and in Brisbane. The rules that once determined Australian workers got a fair go are broken. And itâ&#x20AC;&#x2122;s time to fix them.

CAIRNS

TOWNSVILLE

ROCKHAMPTON

CAIRNS

in view

BRISBANE

Greenies rejoice!

in view

The QNMU Health and the Environment Reference Group was officially launched at a special event at our head office in West End. Thank you everyone who joined us for the planting of our raised garden bed to kick off the QNMU Community Garden. We had a blast and hope all you green thumbs did too!

Welcome new grads It was great meeting all the graduate nurses at Logan Hospitalâ&#x20AC;&#x2122;s Open Day recently. Congrats and welcome to the nursing workforce!

BOOK PRIZE WINN ER

Remembering our heroic nurses This Remembrance Day (which also marked the World War I Armistice Centenary), Innisfail Hospital nurses and QNMU members came together to honour the brave nurses and war veterans who gave their lives to help keep us safe. Their lovely outfits brought back many memories for all of us!

in view

Unionists for life Vintage Reds is an activist group in Brisbane of retired trade union members keeping the union spirit alive! The group aims to support the interests of trade unionism and retired unionists. Sixty retired union members recently attended the launch of Vintage Reds at the Queensland Council of Unions (QCU). Retired unionists interested in joining Vintage Reds can send an email to rgwyther@optusnet.com.au

Aged care goes multicultural Did you catch our aged care campaign team at Festuri recently? We loved being part of the multicultural music and dance festival, and while we thoroughly enjoyed the brilliant performances, dances and stalls, it was also a great opportunity to get our message of ratios for aged care out there! Keep an eye out for our aged care stalls and meet and greets on our Facebook page www.facebook.com/qnmuofficial

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 67 for details.

incoming On the Four Corners investigation into aged care RH I worked in aged care years ago and it is heartbreaking to not be able to provide the care the elderly need and deserve due to understaffing and underfunding. Like · Reply

SA It was very distressing seeing the footage and hearing the stories of abuse. But it needs to be shown for the Australian public to see and hear what can happen. I feel a Royal Commission will do nothing. It is the Aged Care Complaints System that obviously needs to be looked into, after watching tonight! Like · Reply

CF Nurses do an incredible job in the most challenging of circumstances. Aged care nurses and our elderly deserve so much more and need many voices to bring about positive change. Like · Reply

SJ I just spent 40 mins crying my eyes out for these people. As an EN in aged care (specialty in secure dementia) I am disgusted that this is allowed to happen! Glad of the spotlight on aged care (or rather lack of it). We are not given enough time to be with our residents/clients!. Like · Reply

TB Hoping the CEOs of the major companies are watching and taking notes. I quit as I just could not endure the frustrations of working in aged care anymore. It’s all about the money and person-centred care is no longer important. Like · Reply

LW Depressing and disgraceful. Action is long overdue. So pleased those at the coal face are speaking out. Like · Reply

On hidden surveillance cameras in aged care facilities GM Sadly while private companies are allowed to make more money by exploitation of staff there are fewer eyes with time to see the predators. Poor ratios of both RNs and AINs to the elderly or the disabled and reduced education standards of carers make safe care a joke. Regulation done properly in all areas is the step after increasing staffing levels. Like · Reply

DD Sure there are problems with care but this isn’t the solution. Staff selection needs to improve and conditions. If they’re underpaid and overworked that will create poor quality work and good staff won’t stay. Like · Reply

CC Camera surveillance raises many privacy issues. Decent staff numbers with trained and registered nursing staff is a better solution. Like · Reply

GG I worry that installing cameras will be seen as the solution to stopping abuse, but not addressing staffing shortages. Like · Reply

PR Yes, but obviously necessary for some to catch those that are doing the wrong thing and abusing the vulnerable elderly people. Like · Reply

JM If one of my parents ended up in a facility I’d be installing a cam. Like · Reply

ONTH COMMENT OF THE M I suspect it is hard to love a care worker. We get up early, we come home late and are too tired to cook. We miss weekend events, holidays, birthdays. We don’t get too excited over a minor cough or cold, we have seen far worse. We don’t always want to talk when we come home, we have talked all day. We don’t always want to move when we come home, we have moved all day. It may seem that we have left all of our caring, our heart, and our love at work, and have come home to you empty, we probably have. I guess it is hard to love a care worker. But know this: we still need your love. We need your understanding. We need to know that you “get it”. We need to be the one taken care of every once in a while. We need someone else to take charge of the details because constantly doing everything ourselves is exhausting. Sometimes we need our feet rubbed. We need a shoulder to cry on when we can’t even tell you why we’re grieving. We need you to do the hardest work you may ever take on, which is... to love a care worker. I would like to thank those of you out there who love them and let us do this work, this calling, this life: care work.

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incoming On improved wages and conditions in EB10

Letter to the Editor indepth

I was distressed to see an article in the Spring Issue of your journal InScope on Sri Lanka, which contained incorrect information on the country’s history and appeared to promote the concept of mythical Tamil Eelam. This was the root cause of the deadly civil war in Sri Lanka carried out by the terrorist group Liberation Tigers of Tamil Eelam (LTTE), a proscribed terrorist organisation in many countries.

A life in limbo

indepth

In April this year the QNMU Council voted to donate $10,000 to the Logan Asylum Seeker Support group. The funds will be used to support a Tamil family who’ve been living and working in the communi ty for almost six years but are now at risk of being sent to indefinite detention on Manus Island. Meet Srik, Sisha and Srisha… .

OUR-and-a-half-yearold Srisha is a livewire.

Their parents do not have to live anymore in constant fear of their children being taken away by the LTTE. People in Sri Lanka belonging to all ethnic communities do not want a return to those dark days.

WIN

Like · Reply

AO Thanks for all your hard work everyone! Here’s to another positive step forward in the right direction for Qld nurses!

Her deep brown eyes twinkle through a mop of dark curly hair like her dad’s as she squeals with delight at the smooth stones and pretty succulents in the glass terrarium on the table behind us. “Piggy!” she cries excitedly, “it’s a piggy!” You can see where she’s coming from. The oval shaped terrarium resting on four little glass feet does indeed look pig-like — clearly the kid’s got imagination. She’s also got a good grasp of language, two languages actually — her home language of Tamil and the English she’s learning at playgroup and picking up from her friends and the Hairy MacLary books she loves. As we chat with her mum and dad at the Kingston Neighbourh ood Centre in Logan, Srisha plays on the chairs, snuggles up to her dad, wriggles, giggles and natters away to anyone who’ll listen. She’s quite simply, adorable.

She’s also not wanted. The Australian governmen t wants Srisha and her parents to go away. They don’t care where they go — they just want them gone. Srisha’s dad Srikaran (Srik) Thevarasa, and mum Sishanthini (Sisha) Sivanayagam are Tamil refugees who fled Sri Lanka in the years just after the end of the civil war.

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The LTTE massacred thousands of civilians simply because they didn’t belong to their Tamil ethnic group. They used child soldiers. Often the children were forcibly taken from their families and recruited to their brutal outfit. After the end of the war and defeat of the LTTE, these children who previously carried AK47 and T56 weapons could finally go back to schools and study.

TO Thank you for all involved at the QNMU with our EB10 agreement.

P Photo: Kasun Ubayasiri

The map of so-called Tamil Eelam shown in your magazine is the mythical Tamil State the LTTE fought to create, and we find that very offensive. I feel that, as a responsible organisation, QNMU should encourage the ethnic harmony in Sri Lanka and not encourage separatism. I feel the QNMU journal should not carry propaganda of the Tamil separatists who still dream of carving out a mono-ethnic Tamil State in Sri Lanka.

AC Thank you for your hard work in making it happen.... every little bit helps especially to us who are casual and don’t get enough hours. Like · Reply

DS Thanks for the work you do for our profession QNMU. Like · Reply

Sarath Amarasinghe

Editor's note: Srik and Sisha, the Tamil couple being assisted by the QNMU (pictured), were NOT members of the LTTE.

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February QNMU education

Ethical decision making 26 February, Brisbane Being a QNMU Contact in the workplace 27 February, Brisbane No excuse for abuse! 27 February, Brisbane QH Rostering – Equity & work life balance 28 February, Brisbane Aged Care & Private Hospitals – Getting prepared for our next agreement 28 February, Brisbane www.qnmu.org.au/education

March QNMU education

Kickstart Education - Emotional Intelligence ($100) 1 March, Brisbane Knowing your entitlements & understanding the Award! 6-7 March, Toowoomba Kickstart Education - Emotional Intelligence ($100) 8 March, Toowoomba Being protected at work 12 March, Brisbane QH Rostering – Equity & work life balance 13 March, Brisbane Ethical decision making 14 March, Brisbane

Workplace Representatives 1 13-15 March, Cairns QH – BPF for NUMs and MUMs 20 March, Sunshine Coast QH Rostering – Equity & work life balance 21 March, Sunshine Coast Someone should do something about that! 20-21 March, Rockhampton Professional Culpability – Where do I stand? 22 March, Rockhampton Kickstart Education - Assertiveness Skills ($100) 22 March, Brisbane QNMU Branch Development 1 27-28 March, Brisbane QNMU Branch Development 2 29 March, Brisbane www.qnmu.org.au/education

QNMU Meeting of Delegates 5 March - Brisbane 7 March - Gold Coast 11 March - Sunshine Coast 13 March - Townsville 14 March - Cairns 19 March - Toowoomba 20 March - Bundaberg 21 March - Maryborough 25 March - Rockhampton 26 March - Mackay www.qnmu.org.au/mod

42nd Australian Association of Stomal Therapy Nurses Conference

Power of connections – coming together 17-19 March 2019, Sydney www.stomaltherapyconference.com/

15th National Rural Health Conference

24-27 March 2019, Hobart www.ruralhealth.org.au/15nrhc/

April QNMU education

Kickstart Education – Work Matters – How to play to your strengths & manage your weaknesses ($100) 2 April, Brisbane Someone should do something about that! 23-24 April, Brisbane Workplace Representatives 1 30 April – 2 May, Brisbane www.qnmu.org.au/education

International Society of Nephrology’s Biennial World Congress of Nephrology 12-15 April 2019, Melbourne www.isnwcn2019.org/

May Council of International Neonatal Nurses Conference Enriched family - enhanced care 5-8 May 2019, Auckland, New Zealand www.coinn2019.com/

QNMU education

Handling grievances in the workplace 8 May, Townsville No excuse for abuse! 9 May, Townsville

Ethical decision making 10 May, Townsville Knowing your entitlements & understanding the Award! 15-16 May, Brisbane Kickstart Education - Think On Your Feet ($495) 22-23 May, Brisbane Creating a safe workplace (WH&S) 23 May, Bundaberg Being protected at work 24 May, Bundaberg Kickstart Education - Conflict Management Skills ($100) 29 May, Brisbane QH Rostering – Equity & work life balance 29 May, Mackay Being protected at work 30 May, Mackay www.qnmu.org.au/education

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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

Transform your career alongside Australasia’s current and future expert healthcare leaders. Early bird registration from $750. (booking fees may apply)

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YOU’RE IN SAFE HANDS WITH THE QNMU MEMBER BENEFITS INCLUDE: The best professional indemnity insurance on the market – AHPRA compliant and no excess fees

Access to a team of professional, industrial and legal experts for all work-related matters

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Extensive training program with courses across Qld

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Member-only publications including our quarterly professional magazine, InScope, delivered to your door or inbox AND MUCH MORE...

IN 2017/18, THE QNMU: Assisted 27,000 members through our Member Connect call centre

Provided expert representation for 3100 members

Recovered $2.24 million for members

Assisted 158 members with WorkCover claims

Provided legal representation for a further 239 members including representation for coronial investigations and coronial inquests

Provided legal representation for 285 members responding to OHO or AHPRA notifications or investigations

As a nurse or midwife, you get best bang for your buck with the QNMU. No other organisation offers the same benefits or value for money.

(07) 3840 1444 or 1800 177 273 (toll free for outside Brisbane)