InScope No12 Summer19 by Queensland Nurses and Midwives' Union

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

Summer 2019

Do changes to super affect you? Turning the tide on occupational violence

RATIOS:

the next phase

PLUS!

CPD CONTENT ON PATIENT HEALTH RECORDS, MIDWIFERY RATIOS AND NMBA FRAMEWORK.

C MMUNITY

U M N S Q ER R MB FO E M

qnmu YOUR ISSUES

YOUR DISCUSSIONS OUR PROFESSIONS

We've launched an exciting new online community for QNMU membersâ&#x20AC;Ś Connect with thousands of nurses and midwives across Queensland no matter where you are. Ask your burning questions, hear from peers and experts, and chat about the issues that matter to you. Read industry updates, get work-related advice, and find out what other nurses and midwives are doing around the state. Share ideas, images, videos and documents in your private online community

mycommunity.qnmu.org.au

Summer 2019

INDEPTH

Healing through music therapy

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.

INDEPTH

14 16 18 22 28 32 34 36

Prep work underway for Ratios campaign phase 3

A story from the heart Healing through music therapy Turning the tide on occupational violence I need to talk to you about... Nursing with Mercy Ships Farewell to the Ensuring Integrity Bill

CPD

43 44 46 50 51 52 54

Organising the afterlife

PRINTED BY Kingswood Print Signage, 80 Parramatta Rd Underwood 4119

56 57

REGULARS Involving patients in acute pain management

INSIGHT

Facility design: setting the necessary parameters

TEA ROOM

WINS

JUST IN

NOTES FROM THE NORTH

YOUR $ HEALTH

IN VIEW

Your rights and responsibilities when accessing patients' health records

INCOMING

Making decisions? The NMBA's framework is here to help

CALENDAR

The art and science of caring

ADVERTISING

It's time to count the babies Patients and families want to learn about medications from YOU! Re-energising through Clinical Supervision Sepsis: A medical emergency

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: QNMU member Bukky Oduware

insight

Making decisions at the national level Sally-Anne Jones QNMU President

HE CRUCIAL role nurses and midwives play in enabling the community to access quality health care was the focus of the Australian Nursing and Midwifery Federation’s (ANMF) Biennial National Conference 2019, which was held from 17 - 19 October in Melbourne.

was Australia’s aged care crisis, particularly the failing of the funding model that perpetuates the inability to hire more qualified staff across the sector.

The theme of the Conference was Fairer, stronger, healthier: nurses and midwives make it happen.

They debated a range of significant resolutions, which will set the strategic policy direction of the ANMF over the coming two years.

That’s the message we’ll be sending to government decisionmakers and other stakeholders – that nurses and midwives do make it happen and that ongoing investment in a strong nursing and midwifery workforce will allow us to provide all Australians with greater access to a fairer and equitable health care system. The QNMU is a Branch of the federal body, the ANMF, and like in Queensland, the ANMF is the fastestgrowing union in Australia, with current membership standing at over 275,000. The two-day Biennial National Conference was officially opened by Victorian Premier Daniel Andrews and featured a range of guest speakers. These included Federal Opposition Leader Anthony Albanese, former nurse and ANMF Federal Secretary Ged Kearney (and current Federal Member for Cooper), Helen Haines, who is also a Registered Nurse and the Federal Member for Indi, ACTU President Michele O’Neil, and community aged care advocate Sarah Holland-Batt. They presented powerfully on a range of issues. However, the overriding theme we returned to throughout the whole three days

More than 115 delegates from all states and territories attended the conference.

Nine motions from the QNMU’s Annual Conference in July were presented and all were carried for action at the national level. Significantly, a motion from one of our aged care branches made it to the floor and passed unanimously. Other guest speakers from the nursing profession included Professor Jill White, Professor Emerita, University of Sydney and former Dean of Sydney Nursing School and Nursing Now campaign board member. She explained how nurses around the globe are becoming active in the Nursing Now campaign. We also heard from Australian nurses from across the country, who provided examples of the work they’re doing to improve health care access. And finally 22-year-old Emma Murphy (from Queensland!), who gave evidence at the Aged Care Royal Commission. With the workforce hearing in Melbourne taking place that week, it’s no surprise the crisis in aged care was at the centre of discussions. We heard from community advocate Sarah Holland-Batt, who has also given evidence to the Royal

Commission and appeared on the ABC’s Q & A program, telling of her father’s horrific experience living in a nursing home. It was a spellbinding and poignant horror story that ended with her call for more RNs in residential aged care and legislated minimum staffing ratios, which will not only assist in delivering safe, quality, care to elderly residents, but also assist in recruiting and retaining nurses to the sector. If mandated ratios aren’t introduced as a matter of urgency, nurses will continue to leave the sector and residents will continue to suffer. We can’t wait for the recommendations of the Royal Commission, it’s time to act now. We encourage members to send a message about the crisis in aged care to Prime Minister Scott Morrison and Minister for Aged Care Richard Colbeck. Head to the ANMF website at https://bit.ly/33eDaJP

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

‘Business as usual’ not an option Beth Mohle QNMU Secretary

HE END OF 2019 is fast approaching, and what a year it has been. We have seen shocking, but sadly not surprising, revelations unfold from the Royal Commission into Aged Care. The state of this sector is a national disgrace, and will continue to worsen until we have minimum staffing ratios. Disappointingly, aged care was not a prominent policy focus of this year’s federal election, with both major political parties “kicking the can down the road” until after the Royal Commission. Sadly, much needed innovation in health funding and policy was also absent from this election campaign, which highlighted yet again the disconnect that exists between the electorate and the “political class” about the things that matter to voters. There is a lot of uncertainty, fear and anger in our community, yet too few politicians are focused on listening to understand and address the root causes of societal fracturing. For example, solutions don’t seem to be in sight for our long-term record low wages growth, record high levels of household indebtedness, and existential threats such as climate change. Not to mention the seemingly unrelenting demand for health and aged care services and growth in complexity and acuity. But continuing with “business as usual” is both unsustainable and unsafe. Health funding now accounts for close to one third of the Queensland government’s budget, meaning new approaches and different ways of thinking are required to keep people well and better manage complex and chronic conditions.

Disappointingly, aged care was not a prominent policy focus of this year’s federal election, with both major political parties “kicking the can down the road” until after the Royal Commission. The focus must be on addressing the root cause of the demand for services. There are three big picture ‘drivers’ that we as a union are particularly focused on addressing: ■■ The funding model is fundamentally broken and privileges medically driven activity over outcomes, evidence and wellness. ■■ Governance structures, transparency and accountability mechanisms need a radical overhaul. ■■ Poor culture and power imbalances in health must be addressed, especially aimed at giving more power and control to “consumers”. The symptoms of failing to address these issues are seen every day in the workload concerns courageously raised by members across all sectors. We have legislated minimum nurseto-patient ratios in prescribed medical and surgical units in Queensland Health (QH), and these are soon to be expanded to acute mental health facilities. The state government has also just passed the Health Transparency Bill, which establishes minimum nurse-toresident nursing hours for state-run aged care facilities. See page 13 for more information. But much more needs to be done – we need minimum ratios everywhere.

That is what our long-term ambitious ratios campaign seeks to achieve. We are now armed with evidence from the QH evaluation, which proves conclusively that ratios do indeed save lives and money. This positions us well to escalate for areas where ratios are not yet in place. To raise member and community awareness of the importance of ratios and what the evidence tells us, we are running a state-wide advertising campaign, to commence in December and continue throughout the 2020 International Year of the Nurse and Midwife. Next year’s state election will also see us lobby for real action around the three ‘drivers’ of unrelenting demand to our health system, as outlined above. But above all, we need to grow our voice in 2020 to advance these critical policy agendas for our professions and our community. Nurses and midwives are a key part of the solution to the challenges that confront our health and aged care systems. We all have a role to play, individually and collectively, to achieve policy change, and I look forward to working with you next year to make a difference. Until then, I wish you and your loved ones a safe and relaxing festive season.

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 you have the training to perform higher duties or advanced skills? THE QNMU has received calls from members who are concerned about being asked to carry out higher duties/ advanced skills that are outside their scope of practice when they haven’t been given the appropriate training and education. An example of this might include being asked to change a dressing requiring a specific technique you’re not familiar with because you haven’t done it before and/or you haven’t received the correct training. While advancing your scope of practice is important, this should be done in a safe way. Nurses and midwives should never perform any activity that is outside their scope of practice. An activity is outside your scope if you have not been provided with the appropriate education, guidance, support and clinically-focused supervision to perform the activity. Nurses and midwives should always refer to the NMBA’s Decision Making Framework (DMF) when dealing with any task delegated to them that they feel may fall outside their scope of practice. The DMF promotes consistent, safe, person-centred and evidence-based decision-making across the nursing and midwifery professions. See page 56 for more information or visit https://bit. ly/2LDRsQx to view the DMF on the NMBA’s website. Furthermore, before performing any new task, you must complete the necessary educational requirements. You should then be closely supervised performing the procedure, and then signed off as competent to undertake that particular activity by following the relevant policy and procedure.

If you have questions about our Tea room column email mconnect@qnmu.org.au

It’s vital you feel competent to perform an activity confidently and safely – this is for the benefit of both yourself and your patients. If you are asked to carry out an activity that you do not feel confident

to perform safely or you do not have the relevant knowledge, insist that you are provided with the appropriate training first. If this does not resolve the situation, contact Member Connect on 3099 3210 or 1800 177 273 (toll free outside Brisbane).

Can I be forced to take my ADO on a weekend? THE QNMU has noticed an increase in calls from members who have reported that management are repeatedly rostering their ADOs on weekends. For public sector members, Clause 15.1(d) of the Nurses and Midwives (Queensland Health) Award – State 2015 states the following: (c) ADOs may be accumulated up to a maximum of five days, or 12 days in exceptional circumstances, and taken at a mutually acceptable time. In other words, members can refuse to have their ADO rostered on a weekend unless the employee and employer mutually agree otherwise. If your manager continues to roster your ADO on a weekend, contact the QNMU for assistance. Furthermore, with numerous public holidays coming up throughout the Christmas and New Year season, it’s important to remember that ADOs cannot ever be rostered on a public holiday. The Award states: (d) ADOs will be arranged so that they do not occur on a public holiday. An ADO will be taken on another day as agreed by the employee and employer within the same four weekly cycle where possible. Many private sector enterprise agreements also contain similar clauses, but members should check their individual agreement for details regarding rostering of ADOs on weekends and public holidays. Visit www.qnmu.org.au/ wages_conditions and search for your agreement.

wins

Buderim nurses retain 12-hour shifts AFTER HOURS Nurse Managers (AHNM) at Buderim Private Hospital have successfully retained their 12hour shifts, which were introduced more than 12 years ago. In 2018, management consulted with staff about introducing a new Patient Flow position, which after hours managers agreed was needed. Staff and management discussed a few different roster types and agreed AHNMs would work six, eight or 10-hour shifts during the week to provide after hours cover, while still maintaining their 12-hour shifts on weekends. The management team had a change of personnel during the change process. Without taking into account nurses’ availability or requests, the next roster was issued without any 12-hour shifts. Nurses were now faced with working any combination of four, six, eight and 10-hour shifts during the week instead of the 12-hour shifts they normally worked.

Nurses push back In failing to consult with staff on such a dramatic change, management were in breach of the Enterprise Agreement. To avoid a formal grievance, an urgent meeting was called with staff, management and QNMU organisers. Nurses agreed to work the rejected roster for one week while management approved a new roster that took into account staff requests. But management once again published the next roster without any 12-hour shifts. Eventually, management agreed to a three-month trial of the nurses’ preferred roster type, which concludes in December. Better still, AHNMs designed the rosters themselves for management’s approval, allowing them to consider their own availability and special requests. Congratulations to members at Buderim Private Hospital for standing together and insisting (many times!) they be consulted.

Thousands recovered for Kawana Private Hospital nurses AFTER more than 12 months of EB negotiations with Kawana Private Hospital, nurses were dismayed to learn their employer was refusing to pay the 17.5% leave loading they had just secured in their new agreement. Instead, management said they would only pay the 17.5% leave loading on annual leave accrued after 17 May 2019. In other words, any leave accrued prior to 17 May 2019, but still taken after this date, would only receive the old agreement’s annual leave loading of 8%. After members pointed out to management that this did not reflect the terms of the new agreement,

Anglicare nurses secure time for admin duties TIRED of rushing between visits and having to complete admin work, unpaid and outside their rostered hours, Anglicare community members took action recently and reaped the rewards. The action came after nurses were repeatedly scheduled client appointments that left zero time to complete administrative duties or enough travel time between appointments. With the advice and support of the QNMU, members began conducting visits only after the paperwork and communication for the previous visit was complete. In other words, members insisted later appointments be re-scheduled and only visited the number of clients their working hours allowed. Eventually, management agreed to schedule staff for 30 minutes of paid non-client contact. Well done to members for demanding a reasonable workload, refusing to do unpaid work, and improving the quality of service to their clients!

management still refused to pay, so the QNMU lodged a dispute with the Fair Work Commission. The FWC advised both parties that the employer had a hopeless case. Now, management have agreed to pay the correct 17.5% leave loading, including backpay. Through working collectively and standing up to their employer, Kawana members have secured thousands of dollars in underpaid annual leave loading. Congratulations to Kawana members!

wins

Winning through the grievance process R

ESOLVING workload grievances can be a lengthy process. Often the formal grievance process can be complicated and involve extensive negotiations with management over many months, and often years. But they do often result in significant outcomes – and in the recent cases of Robina Hospital and Redcliffe Hospital Emergency Departments, QNMU members certainly have reason to feel proud of their collective achievements.

Extra 34.33 FTE nurses to support Robina ED In a huge win for nurses at Robina Hospital ED, QNMU members have secured an additional 34.33 FTE nurses, as well as an additional two FTE doctors. While some of these positions are not permanently funded and will be subject to review in the coming months, it is still a testament to the terrific work of QNMU members and HHS nursing management, who worked together to find common ground and real solutions. For 18 months nurses submitted over 400 workload concern forms, expressing a range of problems that were occurring in the ED as a result of chronic understaffing and an influx of patients. Some of the issues included: ■■ an inability to transfer patients to other areas of the facility during the night ■■ staff missing their meal breaks ■■ safety concerns due to large numbers of patients congregating in corridors due to insufficient beds ■■ drug and alcohol affected patients housed next to paediatric patients

Nurses from Robina Hospital ED

■■ ICU patients being transferred to the ED for overnight stay due to ICU staff being deployed to the Gold Coast University Hospital. As a result, staff sick leave was increasing (with sick leave not being replaced), nurses were working double shifts, triage staff were increasingly required to take patients, and the number of presentations was also increasing. Members and management agreed to form a working party to resolve the issues.

Unfortunately, the updated Business Planning Framework (BPF) Service Profile presented to the QNMU in July 2019 did not incorporate any of the strategies from the working group’s action plan. With the BPF Service Profile still not addressing the imbalance between supply and demand, members’ issues were set to continue.

Collaboration gets results The QNMU then called a meeting of all members within the ED to discuss options.

wins The meeting was attended by 45 QNMU members, who all agreed to progress the matter to a Stage 3 Workload Grievance. After substantial collaboration with management, it was agreed that an additional 34.4 FTE nurses were required. Some of the initiatives management agreed to implement include (but are not limited to): ■■ a recurrently funded increase of 5.61 FTE in ED nursing ■■ permanent recruitment of an additional 8 FTE nurses to address maternity leave ■■ a temporary increase of 8.32 FTE nurses for Acute and Short Stay Clinical Pods, including a transfer nurse to support increasing transfers from Robina ED to GCUH ■■ a Mental Health CNC and Respiratory CNC based in ED to support these patients ■■ establishing a new seven-bed Results Pending Unit, aimed at providing capacity relief for the ED. While many of these commitments are still a work in progress and are not permanently funded, they are nevertheless extraordinary achievements for nurses working at Robina ED. The QNMU and members will continue to work constructively with management to deal with issues of patient safety, and ensure the BPF remains up to date to reflect the ED’s ever-changing demands.

Extra 13.2 FTE nurses for Redcliffe ED QNMU members at Redcliffe Hospital ED had been dealing with excessive workloads for years. In particular, there was a significant reduction in nurses on night shifts, despite a consistent flow of patient presentations leading to increased wait times. At the suggestion of the QNMU, members started submitting workload concern forms whenever there was a workload issue. The volume of forms demonstrated there was an ongoing issue, and the QNMU escalated to a Stage 3 Workload Grievance, where a working party was formed.

QNMU Delegate James Johnston said he and a core group of nurse activists made an effort to keep other staff updated on developments as the meetings progressed. “We met regularly and there was a core group of us that rotated through all the meetings,” James said. “We kept everyone else updated by talking on shift handovers, we ran some surveys to get feedback from nurses and ensured we were presenting everyone’s views.”

Wins along the way From the working party, and over the course of many months of progressing to a Stage 4 Workload Grievance and then back to a Stage 3, a number of positive outcomes were achieved, including: ■■ an additional 1.7 CNC and 4.4 RN on night shift

Left to right: Caryn Alner, James Johnston, Delia O’Brien and Leigh Fraser from Redcliffe Hospital ED

■■ approval for a Nurse Navigator position ■■ workplace education sessions delivered by the QNMU, with further sessions requested by the DON. Despite these wins, members continued to report major workloads concerns.

Presenting the evidence In preparation for returning to a Stage 4 Workload Grievance, members worked with the QNMU to gain a clearer understanding of how many more nurses were needed to resolve their workload concerns once and for all. In alignment with the QNMU’s Ratios Saves Lives Phase 2 claims document and CENA staffing standards, members determined an additional 13.2 FTE nurses were required. This included 8.8 NG5 and 4.4 NG7.

This proposal was accepted by the specialist panel, and management committed to work towards these improved staffing levels over the next 18 months. Nurses now report improved patient flow on night shifts, better communication between teams, and a dramatic reduction in workload forms. Most importantly, staff feel they can now provide better quality care to their patients. “It did take a long time to get here, but you’ve got to keep persisting,” James said. “We tried really hard to keep everyone informed so that we didn’t lose the momentum. “It certainly helped that we were dealing with co-operative management. “Both parties worked well together to find a solution that helped our patients.”

just in

Christmas closure arrangements THE QNMU offices in Brisbane, Toowoomba, Bundaberg, Rockhampton, Townsville, Cairns, Sunshine Coast and Gold Coast will close from 3.30pm on Tuesday 24 December 2019 and will reopen at the regular starting time of 8.30am on Thursday 2 January 2020. 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. 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 2019/20 Christmas New Year period. These arrangements do not apply to shift workers. Part-time employees are only entitled to the concessional leave day when Friday 27 December 2019 would be one of their rostered ordinary days of work.

Celebrating women through the Emma Miller awards CONGRATULATIONS to this year’s QNMU Emma Miller award recipient Julie Lentas – an inspirational activist from Cairns Hospital. Julie has been a member of the QNMU for more than 14 years and has been at the forefront of the QNMU Cairns branch for many years, including during the recent Cairns Hospital Emergency Department workplace grievance. The grievance saw nurses close beds, circulate their own petition across the hospital, and ultimately secure an additional 8.6 FTE nursing staff. “I’m humbled and proud to receive the 2019 Emma Miller Award,” Julie said.

Date

Leave

Wed 25 Dec 19

Christmas Day public holiday

Thu 26 Dec 19

Boxing Day public holiday

Fri 27 Dec 19

Concessional day (leave on full pay without debit)

Mon 30 Dec 19

Annual/recreational leave, TOIL or accrued hours

Tue 31 Dec 19

Annual/recreational leave, TOIL or accrued hours

Wed 1 Jan 20

New Year’s Day public holiday

“Through this award I feel a connection to such an amazing and strong woman. “I accept the award on behalf of all my colleagues in North Queensland and I value the support of both the local organiser Krissie Bishop and the QNMU team.” The annual awards are held in honour of Emma Miller – a strong advocate for women’s workers’ rights in Queensland in the 1800s.

GREETINGS from the

QNMU Your new 100% biodegradable journal FOR THOSE members who receive their copy of InScope in the mail, you may have noticed this edition arrived looking a little different… That’s because it’s now wrapped in 100% biodegradable plastic! It’s all part of our bid to be as environmentally friendly as possible and reduce the amount of plastic in the world. 8

Props to QNMU member Helga Sundin for suggesting this cleaner alternative – we love your thinking! And remember, if you’d rather read your journal digitally, members can change their InScope preferences any time at www.qnmu.org.au/ preferences

QNMU Emma Miller award recipient Julie Lentas (left) with QNMU Assistant Secretary Sandra Eales

Lead

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AND

make a difference GAY HAWKSWORTH LEADERSHIP SCHOLARSHIP

OMINATIONS are opening soon for the QNMU’s Gay Hawksworth Leadership Scholarship. With up to $10,000 offered to the recipient, this is the QNMU’s most prestigious prize in our yearly scholarship offering. The scholarship was created in memory of our dear friend and leader Gay Hawksworth, who served as Secretary of the (then) QNU from 1995 to 2011. QNMU Secretary Beth Mohle said the scholarship continued Gay’s vision – and the union’s vision – to nurture the future leadership voice of our nursing and midwifery professions. “As nurses and midwives, we’re all leaders – we’re the gem in our health system, the ones who are at the bedside caring for our patients and residents twenty four-seven,” said Beth. “We know nurses and midwives have the answers when it comes to some of the big challenges facing our health system, but it’s up to us to ensure our voices are heard.

“This scholarship is a step to achieving that.” To qualify for this scholarship, you might be looking to complete a leadership course in Australia, or even have your sights set on an overseas nursing conference that will empower you to grow the voices of nurses and midwives back at home. More information will be emailed to QNMU members when applications open on 13 January 2020.

2019 winner – Lisa Harrison The winner of the inaugural 2019 Gay Hawksworth scholarship was Registered Nurse and Nurse Practitioner Lisa Harrison from Rockhampton. Lisa intends to use her scholarship to undertake a six-month leadership course titled ‘Executive Leadership Coaching and Organisational Development Services for Leaders’. “I’m working towards improving my leadership abilities by developing my

2019 Gay Hawksworth Leadership Scholarship winner Lisa Harrison (left) with QNMU Secretary Beth Mohle

critical thinking, seeing opportunities differently, and stimulating new perceptions,” Lisa said. “Nurses are uniquely positioned clinicians within the health care system – we’re advocates and educators, and are ultimately involved in collaborations that can influence and achieve excellence in the care outcomes for those we care for. “By having more nursing and midwifery leaders, our professions can be more resilient, engaged, united and inspired, and be more aware of the system-wide influence we can achieve together. “For this reason, it’s so important that we consider the influence we have as health professionals – and the Gay Hawksworth scholarship is a unique opportunity to do this.”

Applications open 13 January 2020 at www.qnmu.org.au/scholarships

Gay Hawksworth (1947 - 2018) GAY HAWKSWORTH was Secretary of the (then) QNU from 1995 to 2011 but started working for the union back in 1989 when nurses were agitating for university education. For more than 22-years Gay worked tirelessly to ensure the work of nurses and midwives was properly valued and recognised. As Secretary, she oversaw the introduction of many concepts that are now well embedded in

our professional lives, including an enforceable workloads management clause for public sector nurses, a national Nurses Award (2010), and the first research into the work-life balance of Queensland nurses and midwives. In recognition of her distinguished service to industrial relations, Gay was awarded the Centenary Medal in 2001 and a Medal of the Order of Australia (OAM) in 2010.

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QNMU chalks up eco-friendly rating The QNMU head office building in West End, Brisbane has once again achieved an excellent rating of 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.

ANMF Biennial Delegates Conference QNMU Delegates recently attended the Australian Nursing and Midwifery Federation’s (ANMF) Biennial Delegates Conference in Melbourne. All nine of the motions we proposed were voted up by Delegates, including motions relating to improved access to Medicare benefit claim numbers for Nurse Practitioners, personal safety training and medication management in aged care, and changes to federal funding models. QNMU member and aged care Registered Nurse Emma Murphy also addressed Delegates and spoke about her recent experience presenting evidence to the Aged Care Royal Commission. We’re so proud of Emma, whose speech was truly inspirational.

QNMU member Emma Murphy

You can read a Q and A with Emma at https://bit.ly/33So8uc

Talking climate and refugees Thank you to everyone who joined us at our special climate and refugee forum in Brisbane. We heard from four fabulous speakers about environmental and refugee issues, and planted our veggie garden. We are now also the proud owners of a native (stingless) bee hive thanks to Bob the bee man! Special thanks to our speakers: Sue Cooke Climate and Health Alliance, Ngaire McGaw - Certified Sustainability Professional (Mater Group Brisbane), Kagi Kowa - Asylum Seeker Resource Centre (Brisbane Organiser) and Erin Kennedy - Social Justice Activist and teacher.

We’re proud to show our dedication to reducing our carbon footprint, particularly in light of the recent drought affecting Queensland.

just in

Super changes could leave members exposed

HERE have been a number of changes to superannuation matters recently, which could leave thousands of QNMU members without crucial insurance coverage.

profit-for-members funds like QSuper and HESTA, will only be able to provide life insurance to new members under the age of 25 if members decide to “opt in”.

Most superannuation funds offer life insurance and total and permanent disability (TPD) cover for members.

Previously all new members were given life and TPD coverage automatically upon sign-up.

However, changes due to come into effect on 1 April 2020 could leave people under 25 or those with superannuation of less than $6000 without protection.

Furthermore, from 1 April 2020, providers will be required to cancel automatic insurance cover from existing super funds that have not had any contributions or rollovers for 16 consecutive months.

The changes are designed to prevent small superannuation balances being whittled away by insurance premiums. There are some positive aspects – a 3% per annum cap on fees for low balance accounts and a ban on exit fees allowing people to switch funds without penalty. But on the downside the changes could also leave young workers, low income earners and people on extended maternity or sick leave without built-in insurance coverage.

Opting in and ‘ghost accounts’ The new rules are the latest in a raft of superannuation changes passed by the federal government in February 2019, known as the “Protecting Your Super” laws. Under these reforms, superannuation providers, including

“Ghost accounts” – inactive accounts that also have a balance of less than $6000 from 1 November 2019 – will be closed and have their balance transferred to the Australian Taxation Office. Where possible these funds will be rolled into an active account held by the same person, but the insurance attached to the inactive account will be cancelled.

What should I do? If you are a new employee under 25, have an inactive super account or an account balance of under $6000 and you wish to keep your insurance cover, then you need to contact your superannuation provider and follow their processes to retain it. It is important to note that once the insurance cover on a super account is cancelled it can only be reinstated

by going through the insurer’s usual application and assessment process. We strongly advise members to check their current and potentially inactive superannuation accounts from any previous employment, prior to the April 2020 automatic cancellation date.

Need advice? Please note, the QNMU cannot advise members to take any actions regarding their superannuation arrangements other than to review your current policy and understand how these changes affect you. If you have any issues or concerns about these changes and what they mean for you, please contact your superannuation fund directly.

Financial health checker As part of QNMU members’ new member profile page, you can now access a ‘financial health checker’, which takes you directly to information on your super fund’s website. The information is all about ensuring you take an active interest in your financial health and start thinking about how much you’re putting away for retirement. Simply log in to your QNMU member profile at www.qnmu.org.au and click ‘financial health checker’ (under ‘My quick links’).

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Your

C MMUNITY

E’RE THRILLED to have finally launched the QNMU’s latest membership benefit - it’s called QNMU Community.

Through this new digital platform, you can: NETWORK with thousands of nurses and midwives across Queensland no matter where you are. CHAT with fellow nurses and midwives about your current issues (day or night!), and hear from content experts. READ industry updates, get work-related advice, and find out what other nurses and midwives are doing around the state. SHARE images, videos and documents in your online community. Visit https://mycommunity.qnmu. org.au to enter your Community now! Once you’re in and have accepted the terms and conditions, simply explore and join in on peer discussions, or perhaps share an interesting article or video. Remember, this is your community to connect with other nurses and midwives.

is waiting!

Already there are thousands of QNMU members reaching out to their nursing and midwifery colleagues about all sorts of issues. It’s a friendly and supportive space designed to assist you to have conversations and share information with like-minded people… because, at the end of the day, we’re all nurses and midwives! QNMU member and Enrolled Nurse Tegan Parrish has been an active member in the Community since it launched, and said it’s allowing her to network with other nurses and midwives across the state. “The platform provides a great opportunity to connect with fellow nurses to discuss trending industry topics and share knowledge and experiences,” said Tegan. “This is really valuable for new nurses like myself, as I’ll be able to ask questions and get support from a variety of nurses working within different disciplines, who I wouldn’t have been able to connect with previously.”

Ask the expert Members in the QNMU Community also have the opportunity to participate in a regular ‘Ask the Expert’ live Q and A session. This is your chance to ask whatever burning questions you have relating to various nursing and midwifery topics.

In November we held our first Ask the Expert session with the QNMU’s very own Occupational Health and Safety Officer James Gilbert. We had some great discussions around nurses and midwives’ rights if assaulted, shift work, fatigue, and more. If you couldn’t participate, don’t worry – the feed has been archived in the Community, which you can view right now.

Having trouble logging in? If you require assistance with logging in to your Community or you have any other issues, head to https://mycommunity.qnmu.org.au/ contactus Your username will be the email address that the QNMU sends you emails to.

What’s the weekly digest? To stay up to date with what’s happening in your Community, QNMU members now receive a weekly digest email. Your digest contains a summary of all the previous week’s discussions. However, if you’d rather not receive these emails or you’d prefer to change the frequency of these emails, you can always change your subscription by visiting https://mycommunity.qnmu. org.au/help/digestemail

mycommunity.qnmu.org.au 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 work with you to secure wins like the ones you’ve read today!

just in

New standard set for aged care in Queensland QUEENSLAND is leading the way when it comes to reforming the aged care sector. In November, the Queensland Palaszczuk government passed the Health Transparency Bill 2019, which establishes minimum nurseto-resident nursing hours for Queensland’s 16 state-run Residential Aged Care Facilities (RACF), and improves transparency right across the public and private sector.

Public reporting – public and private sectors Significantly, this new legislation also provides a framework for all Queensland nursing homes – both public and private – to publicly report vital information, including their daily resident care hours and staffing skill mix. While privately run RACFs cannot be forced to report, those who fail to

Under the new legislation: ■■ Queensland’s 16 state-run RACFs will be required to provide a minimum average of 3.65 daily resident care hours. ■■ Any state-run facility currently providing less than these average hours will be required to increase its daily resident care hours, and any state-run facility that currently provides more than 3.65 hours will have their current hours maintained. Actual levels of care will continue to be calculated using the Business Planning Framework.

Private hospitals will also be required to publicly report certain information on quality and safety – something the QNMU has long called for to increase transparency across the sector. Reportable information will include data relating to the facility’s performance against the National Safety and Quality Health Service Standards, percentage of patients being treated within clinically recommended timeframes, numbers of admitted patients, information about patient outcomes and information about infection management.

What happens now? The QNMU has been working with the state government since July 2019 to make this legislation a reality, and we’re thrilled the bill has finally passed. The QNMU will work closely with the state government to ensure these new reforms are rolled out as smoothly as possible.

■■ Staffing ratios for Registered Nurses, Enrolled Nurses and Assistants in Nursing will be introduced to ensure that at least 50% of care is provided by Registered and Enrolled Nurses, with at least 30% of overall care provided by RNs. Actual staffing ratios will reflect the needs of each facility within the requirements set out in the legislation. Assistants in Nursing will remain an essential part of the workforce. ■■ The government has given a commitment that there will be no job losses as a result of this legislation.

do so will be named and shamed on a public website.

And similar to the worldfirst evaluation of legislated ratios in Queensland’s public hospitals, an independent evaluation will be conducted to establish an evidence-based minimum standard for Queensland’s state-run RACFs.

QNMU member Kristie Hobbs

This is a big step in the right direction towards improving our aged care sector. It sets a new standard for staffing in aged care, and puts us in the best possible position to champion minimum ratios across the rest of the aged care sector.

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Prep work underway for

Ratios campaign PHASE 3

QNMU member Bukky Oduware

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OU MAY have noticed that our Ratios Save Lives campaign slogan has been tweaked. It now reads Ratios Save Lives and Money.

We’ve added the additional tagline because we now have the evidence to prove ratios save money as well as lives. Furthermore, in the next phase of our campaign, we will be taking on for-profit organisations – health care providers in the private and aged care sectors for whom profits are a major (some might argue, primary) consideration. We believe it’s necessary to make it clear that introducing minimum nurse-to-patient/resident ratios is a win-win situation for everyone – good for patients, good for nurses and midwives, and good for the bottom line. As we stated in the last journal, the ratios results thus far have been outstanding. Since minimum nurse-to-patient ratios were legislated for prescribed public hospitals in July 2016 there have been 145 deaths avoided, 255 readmissions avoided, and 29,200 hospital days avoided. From a monetary perspective, the deaths and readmissions avoided saved $1.2 - $2.4 million while the hospital days avoided saved $54 $81 million. That’s no small change, and it’s one of the points we will be making as we head into Phase 3 of our Ratios campaign.

Spreading the word

Preparations for this phase of our campaign, which kicks off in early 2020, are well underway and we are busy mapping out its timing and scope, and the specific projects within it.

Have you seen our fabulous nurses on your television screen or social media channels recently. We’ve launched a major TV and digital ad campaign to spread the word far and wide that ratios are saving lives and money in our public hospitals.

Photo: Kasun Ubayasiri

These ads will continue in various stages throughout the year, and will be altered to focus on aged care, private hospitals, maternity and more, as we continue to build pressure for ratios everywhere.

Our campaign will leverage off the gold standard evidence we’ve gathered from ratios commitments and implementation so far, to press for wider engagement with ratios. Our Count the Babies campaign also falls under the Ratios umbrella, as we call upon midwifery services and maternity units to ensure babies are counted independent of their mother in any midwife-to-patient ratio calculation. We also expect to weave the Aged Care Royal Commission findings into

our strategies to address workloads and skill mix in that sector. And with a state election due in 2020, this phase will also include developing our election “asks”, including full compliance with the BPF and developing Positive Practice Environment standards in the public sector. When we started our Ratios campaign five years ago we committed to sticking with it for the long haul. Now that the results are in and the benefits are clear, we are more resolved than ever to continue what we started.

A timeline of the campaign so far Ratios Save Lives Phase 1 Launched in January 2015. Secured legislated minimum nurse-to-patient ratios for the majority of acute medical and surgical wards in Queensland Health.

Ratios Save Lives Phase 2 Launched in October 2017. Secured a state government commitment to extend minimum legislated ratios in public acute adult mental health units, and establish minimum care hours per resident day and minimum skill mix levels in Queensland’s 16 state-run nursing homes. The bill to establish minimum care hours and skill mix levels in state-run nursing homes recently passed. See page 13.

Ratios Save Lives and Money Phase 3 To launch early 2020.

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A STORY

heart from the

INSLEY STOCK is a Clinical Nurse at Brisbane’s Hummingbird House palliative care hospice for children. She’s a mum-of-two and, we have discovered, a rather eloquent writer. Ainsley’s gentle tribute to her grandmother who passed away a few weeks ago (see following page) touched a chord for us here at the QNMU, and so she became the first member whose personal nursing story we accepted for publication in our upcoming book celebrating the International Year of the Nurse and Midwife in 2020.

opportunity to be with dad and be with gran and to thank her carers,” she said. In just a few lines, Ainsley wove together a short story that echoed across generations, even capturing the kindness of the carers who made her grandmother’s last days comfortable. “The carers just loved her so much and we just knew she was in a good place in that nursing home and I really respected the work they did for her.”

“My grandmother was 100 per cent my inspiration for becoming a nurse,” Ainsley told us.

While Ainsley’s story is deeply personal, we are keen to hear stories of all kinds from our members. They can be inspirational, aspirational, heart-warming, funny… even a little cheeky, we just want them to be told.

“She was a very compassionate and generous person – it was always in the front of her mind – ’how can I help?’”

And Ainsley has some sound advice for those considering submitting their stories.

When Ainsley saw the QNMU was seeking stories to be featured in a special commemorative book, she didn’t hesitate putting pen to paper to record a precious fragment of her gran’s final moments.

“I think it’s about connecting with a story – don’t worry about your writing skills, just connect with a moment in time that had an impact on you, something you went away and thought about or reflected on, or perhaps (prompted) a call to action… or triggered something in you,” she said.

“It was all so fresh in my mind, she’d only passed away three weeks earlier and I felt so blessed to have had the

“It’s a lovely opportunity.”

My grandmother was 100 per cent my inspiration for becoming a nurse.

COINCIDING with the 200th birthday of the founder of modern nursing, Florence Nightingale, the World Health Organisation’s Year of the Nurse and Midwife (YONM) puts us front and centre in 2020. To celebrate this milestone year, the QNMU will host a whole range of activities for members to participate in. This includes a fantastic lineup of events around our annual International Day of the Midwife and International Nurses Day celebrations including a statewide Big Brekky event and the burying of a QNMU time capsule. We’ll also be holding a quirky Count the Babies installation, where we’ll use handmade dolls as a prop to illustrate our call for babies to be included in ratios. But our biggest event for the year will be the launch of the inaugural QNMU Professional Practice Awards with a prize pool of $20,000. This is a new annual gala event that celebrates and recognises our members’ achievements in professional leadership and innovation. Yep, it’s going to be a huge year so keep your eyes peeled and your ears switched on for further details!

Want to share your story? In 200 words or less give us a summary of your story. If your yarn is identified for potential inclusion, we’ll contact you and organise a time to have a chat and take your photo for the publication! Send your story to comms@qnmu.org.au

Ainsley Stock

A sneak peek at our YONM event calendar

2020

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YEAR OF THE

NURSE & MIDWIFE 200 years

of making a difference

Ainsley’s story…

“Do you think she needs to keep being fed?” I asked just before leaving Grandma’s nursing home. I had seen the plate keep arriving and with good intentions, the puree being tipped in between tight lips. The carers were devoted, they loved Gran because she loved people. After 15 years of dementia, she still had a twinkle in her eye and a cheeky smile but language had left her. She’d been through breast cancer, the death of her husband and the loss of her memory. Gran had nursed at the local rural hospital for 20 years before resigning to help take care of us kids. She had taught me bed corners on the mattresses at home and had the determination of a country woman who had seen her fair share of suffering. Watching as Dad knelt beside her bed, I was content to stand guard at the door, later to find out she’d whispered the words “I love you” before they parted. She passed away the morning I flew home. I touch the tapestry threads that she once held and consider her work and mine woven together with wisdom in one hand and heart in the other.

Photo: Kasun Ubayasiri

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Healing THROUGH

music therapy

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Music can move us to the heights or depths of emotion. It can persuade us to buy something, or remind us of our first date. It can lift us out of depression when nothing else can. It can get us dancing to its beat. But the power of music goes much, much further. Indeed, music occupies more areas of our brain than language does – humans are a musical species. Oliver Sacks, neurologist and author

HE POWER of music is hard to define.

We’ve all experienced that moment when our favourite song comes on the radio. In an instant, it can trigger a certain feeling, or sometimes a distant memory from our past.

The therapeutic relationship One of the most common health settings where music therapy is employed is children’s health.

And with music so easily accessible now, there’s a soundtrack readily available to set the mood for virtually every occasion.

Dr Carmen Cheong-Clinch is the Senior Music Therapist at the Queensland Children’s Hospital and Logan Hospital, and she specialises in child and youth mental health.

It’s not surprising, therefore, that music has found its way into the way we as health professionals treat our patients and residents.

She said music therapy was about using music as the means to develop a therapeutic relationship between the therapist and the patient.

From dementia care to paediatrics, acquired brain injury to physical rehabilitation or addiction, music therapy has slowly emerged as its own profession, and is being used more and more within allied health teams across all health settings.

“Music therapists are trained to use and respond therapeutically to the nuances of music in this engagement,” Dr Cheong-Clinch said.

It can also be used to complement other forms of therapies, including occupational, physio and speech therapy. While many nurses will not have been exposed to music therapy techniques before, it makes sense for us to be aware of the unique role music can play in the health care journey of our patients and residents – not for all, but for many.

“Within that music-making or musiclistening interaction, the child or young person may feel heard, understood, and be able to work through and find relief and support for what they’re going through. “We have young people who might be feeling very anxious and are afraid to go to school or leave the house. “So I might use their favourite songs to sing with them, and by establishing that therapeutic relationship they may feel heard and understood, then I encourage them to learn new songs.

indepth “By working from the safety of that therapeutic relationship, the young person or child is able to build confidence and start exploring new things. “Then, hopefully, they can take that learning to, ‘I might go outside to play’, or ‘I might actually go to school today’.”

What is it about music? There is no simple answer to why music has this apparent ability to shift our behaviour or improve our wellbeing – whether that be for a child or dementia patient, or anyone in between. But according to Dr Cheong-Clinch, part of the answer lies in the role music plays in our everyday lives. “For a lot of young people their music engagement is a very significant part of their life,” Dr Cheong-Clinch said. “If you take yourself back to when you were a teenager, you might have had favourite songs to explore your thoughts and feelings, identity, romantic love... music is very much part of growing up and becoming your own person.

Music therapy – a little history MUSIC as a form of therapy has roots in Australia dating back to the early 1900s, most of which was focused on mental health. But it wasn’t until 1978 that the first undergraduate music therapy degree was established at the University of Melbourne. In 1984 the Australian Red Cross employed four qualified music therapists and provided music therapy to 14 hospitals across Victoria. In Queensland, the first official music therapy program established at the former Royal Children’s Hospital was in 1993. The program saw music students from the University of Queensland provide four hours of therapy. In contrast to this, today’s music therapy program at the now Queensland Children’s Hospital delivers more than 200 hours of music therapy each week. Today, music therapy is still a small profession – there are approximately 500 Registered Music Therapists across Australia, though this number is growing as the demand for music therapy increases across all health settings.

“Music is also a way to set up your environment. “Some people call it a wallpaper, or a soundtrack to accompany our activities – you put on your party music as you get ready to go out, you get in the car and start skipping songs because that’s not right for this drive. “So it’s something that meets us at a very deep emotional level, and when we listen to music we change it unconsciously to meet those needs.”

An emotional vocabulary The techniques employed in music therapy are diverse and varied. They can include lyric analysis, improvisation, active music listening and song writing – but all are designed, according to Dr Cheong-Clinch, to use music as an alternative means for self-expression or to open up communication. “When we play drums together, we might be copying each other with a simple rhythm pattern and then we might go free flow,” Dr Cheong-Clinch said. “Then we start to follow each other, not because there’s sheet music guiding us, but because we’re listening to each other in order to match the other and have some sort of synchronicity.

I’ve seen patients who weren’t able to express themselves find their voice through music. Dr Carmen Cheong-Clinch Senior Music Therapist

indepth “For instance, some children might be socially isolated or have a diagnosis of autism and might come across as aggressive or not listening, but it’s quite likely they don’t know what to do and won’t respond to verbal instructions. “When we’re involved in a joint activity like drumming or singing, we start to listen to each other and make a beautiful sound together. “I’ve seen patients who weren’t able to express themselves find their voice through music.”

Bringing nurses on board One of the less explored benefits of music therapy is the effect it has on nursing staff. While nursing and music therapy are separate professions, there are examples where nurses and music therapists work together within an allied health team to ensure the benefits of therapy may continue beyond the regular music therapy sessions. Queensland Children’s Hospital Registered Nurse Elisha Neal said she regularly saw the benefits of music therapy for her patients – which in turn helped her deliver nursing care. “Sometimes when your typical safety planning isn’t working for the patient, you have to come up with other strategies that are a bit more out of the box,” Elisha said.

we can relate to the patients,” Elisha said. “Particularly in adolescents, music is so important to that age group. “There was one young person who was so quiet and into himself, and then he wrote this song with the music therapist. “It was like a rap – it was so emotive and showed he did have a lot to say but he just needed to find a way of saying it.” Dr Cheong-Clinch emphasised the difference nurses can make when it comes to music therapy. “I cannot work alone, and I think that mantra of ‘it takes a village’ motivates me to collaborate,” Dr Cheong-Clinch said. “Music is a natural coping strategy for a lot of young people, and I’m not here 24/7, the nurses are.

Helping young people access music TOGETHER with the Queensland Children’s Hospital (QCH) Child and Youth Mental Health Inpatient Units, Senior Music Therapist Dr Carmen Cheong-Clinch has developed an information page on the Children's Health Queensland HHS website as an outreach to support nurses and allied health professionals to use music with their patients and clients in other services. You can check it out at https://bit.ly/2XCqoUe

“In a mental health inpatient unit, it’s important to work with the young people to find ways to safely manage their distress. “Music therapists have a unique opportunity to collaborate with nurses to support young people to do that with their music during their hospital admission, and hopefully do the same when they’re back in everyday life.”

“Music therapy definitely helps broaden our toolbox of strategies we can use for young people. “Yes, you can make a safety plan that gets the young person to write down their triggers and so on, but you know some of them are unlikely to use it once they leave the hospital. “But with music, you can be more confident that they’ll use it and find it useful.” Elisha said music also helped improve the atmosphere on the ward, as well as assisted with building rapport with patients. “It definitely has helped deescalate situations and stop incidents, and brings another way

References:

Sacks, B (2007) Musicophilia: Tales of music and the brain. Picador, www.oliversacks. com/books-by-oliver-sacks/musicophilia/ Australian Music Therapy Association (2012), viewed November 2019, https://www. austmta.org.au/content/history Children’s Health Queensland Hospital and Health Service (2019), viewed November 2019, www.childrens.health.qld.gov.au/ latest-news-childrens-health-queenslandcelebrates-25-years-of-music-therapy/

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Turning the tide on

occupational violence

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I was 30 weeks pregnant when I was punched in the stomach by an intoxicated male patient. I was trying to dress his head wound and he just snapped and jumped out of bed and punched me fair in the stomach. I’m normally in control of things, but this was the one time when I just froze… I didn’t make a sound.

HIS WAS the experience of Clinical Nurse Consultant and QNMU member Lita Olsson eight years ago. Fortunately, her baby was fine and Lita received the support she needed from her colleagues and workplace. But unfortunately, Lita’s story is not an isolated experience. Most nurses and midwives have witnessed or experienced first-hand some form of occupational violence, whether physical or psychological. Just last month a community mental health nurse was stabbed to death by a patient in Sydney. Queensland Health’s own statistics show disturbing rates of occupational violence in our health facilities. Between 1 July 2018 and 30 June 2019, 76% of all reported occupational violence related incidents were reported by nurses. And in the past year alone, 6300 Queensland Health staff reported being attacked at work, with reports nearly doubling at some hospitals.

Queensland’s response In response to the escalating crisis and QNMU lobbying, the Palaszczuk Government commissioned a review of occupational violence across Queensland Health. The taskforce report, delivered in May 2016, a few months after the tragic murder of South Australian nurse Gayle Woodford, made 20 recommendations, all of which were accepted by the Queensland government. The Statewide Occupational Violence

Implementation Committee (OVIC) was then established to implement all 20 recommendations, which led to more than 100 separate bodies of work. The Queensland Occupational Violence Strategy Unit (QOVSU) is now responsible for scoping, developing, trialling, evaluating and implementing initiatives across all 16 Hospital and Health Services (HHS). Since the beginning, the QNMU and members have been heavily involved in this process. We’ve been the voice at the table for nurses and midwives, and we’re pleased to see that many of the projects are making a real, tangible difference, both in terms of on-theground results as well as shifting attitudes towards occupational violence.

Lita Olsson

Lita Olsson is now the Clinical Lead on the QOVST. “I don’t think we will ever completely eradicate occupational violence because society is the way it is,” Lita said. “But our job now is to create sustainable, holistic and meaningful solutions to support staff through every one of the four guiding pillars – awareness, prevention, incident interaction, and post incident. “It’s about changing the conversation and making sure staff are aware that you will be supported if you choose not to go into an environment that you determine is not safe. “Fortunately, we’ve now got a lot of frameworks in place that really empower the clinician to do that.”

Between 1 July 2018 and 30 June 2019,

76% of all reported occupational violence related incidents were reported by

nurses 23

indepth A sample of the work so far The following summary provides an overview of some of the projects that have been/are being implemented by the Occupational Violence Strategy Unit across Queensland.

Ambassador program Perhaps one of the most significant developments to have resulted from the strategy unit is the Ambassador Program – an innovative model that employs a proactive rather than reactive approach to monitoring and responding to security issues. First trialled in emergency departments in Nambour and Gympie, and now established in Logan, the program embeds a security officer known as an Ambassador (who is often plain-clothed) into a typically stressful environment such as an ED. Metro North Director of Nursing of Community and Oral Health and QNMU member Andy Carter was one of the key drivers of the program.

What is occupational violence? ACCORDING to Queensland Health’s agreed definition, occupational violence is: “…any incident where an employee is abused, harassed, threatened or assaulted by patients and consumers, their relatives and friends or members of the public, in circumstances arising out of, or in the course of, their employment, irrespective of the intent for harm.” The full definition and clarifying statement can be read at https://bit.ly/35vQkEy

“The Ambassador’s role is to constantly survey the environment and pick up on temperature changes within the unit,” Andy said. “The impact of these trials was pretty immediate from both community and staff feedback. “The Ambassadors de-escalated situations before staff even realised there was a problem, they acted as a conduit between the clinical staff and the people waiting to receive care, and that helped to diffuse issues and enabled staff to do their job.” Adapting the model for aged care Armed with the success of these trials, the strategy unit then suggested the model be adapted to an aged care setting, where evidence was pointing to far more frequent instances of violence and aggression.

Andy Carter

The Ambassadors received targeted education and support specific to dealing with residents with dementia and cognitive impairment, and were trained in how to distract, diffuse and de-escalate any behaviours that emerged from the residents. “Unlike EDs where patients are moving through rapidly, this was about selecting Ambassadors that could become part of the team and develop a rapport with the residents themselves,” said Andy.

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Who should I contact? Local Employee Assistance Support Programs – contact your line manager for details Queensland Health Victim Support Service – 1800 208 005 Policelink – 131 444 (for non-urgent incidents)

Metro North Cooinda House Ambassador Ash with resident Scotty. The program was trialled at Metro North’s Cooinda House, which had been dealing with significant escalations of occupational violence. The results speak for themselves. “Basically, we’ve had a dramatic decrease in violent and aggressive incidents of any description – down from 12 to 16 incidents a month (73 at its worst) to just one or two,” said Andy. “We’ve not had a single resident nor staff member transferred to an emergency department as a result of injury or assault since the Ambassador trial commenced in September 2017. “What’s more, staff and resident surveys now say how calm and safe the place feels and how peaceful the environment is.” Significantly, feedback from the initial ED Ambassador trials suggested transitioning traditional security to a more ambassador model. “They want the response to be proactive de-escalation rather than just reactive,” Andy said. “It will never replace the traditional security officer because there’s absolutely a need for them too. “But we might start to consider a more blended model in certain environments like ED, mental health and, of course, aged care.”

Maybo training Training nurses and midwives in how to deal with occupational

violence has also undergone a major overhaul. A review of the training offered by each HHS revealed significant inconsistencies and lack of governance across the state, leading to staff and patient injuries. QOVSU’s Clinical Lead Lita Olsson said there was an urgent need for training that specifically reflected the needs of patients who were particularly vulnerable, such as those presenting with mental health issues, delirium or dementia. There was an extensive procurement process to find a training provider to deliver evidencebased training that was focused on de-escalation and least restrictive practices. “Existing occupational violence prevention trainers from across the state have participated in the two-week train-the-trainer Maybo program, and we now have 36 accredited trainers working across the health services delivering training,” Lita said. But the training is not a one-sizefits-all. “We don’t expect that our theatre nurses will require the same level of training that our mental health nurses receive. “Maybo has a huge range of blended, layered training options to suit everyone.

Victim Assist Queensland – 1300 546 587

The QNMU is here to help If you experience occupational violence at work, there are numerous ways the QNMU can assist members. This includes: ■■ providing advice/ assistance around workers compensation and legal matters (such as speaking with police) ■■ assisting with returning to work (such as health and wellbeing support or negotiating return to work programs) ■■ assistance with reporting an incident ■■ offering advice on health and safety matters, including employer obligations.

Useful resource The QNMU Policy Committee has produced an informational resource for members titled Essential information for nurses and midwives who are assaulted at work. It contains useful information on how to report an incident, incident management, making a statement and more. Members can download this resource at www.qnmu.org.au/ infosheets (under ‘Industrial Series’).

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Lita Olsson (right) with QOVSU Manager Joanna Griffiths

“There are add-on packages for dementia and delirium, paediatrics, mental health, lone workers, and so on. “There’s even online training for admin officers at triage, because they are often the frontline to the most challenging environments.”

Peer support program Initially trialled in Mackay, the ‘peer support program’ was developed to achieve a truly holistic approach to support services across the state. Lita said it was built after reviewing national and international programs, and is similar to the Queensland Ambulance Service’s ‘Priority One’ program. “The Peer Support Program is very much about using your networks and your colleagues to keep an eye out for you and make sure you’re okay,” Lita said. “It comprises a team of specially trained staff volunteers from within a health service who are given psychological first-aid training and foster a ‘look, listen, link’ approach. “It cultivates help-seeking behaviour, so you can assist your colleagues in navigating all those little accumulative things. “You didn’t sleep well after night shift, then you had a fight with your husband, then your car broke down on the way to work, then you decompensate after someone either strikes out at you or swears at you and it’s the icing on the cake.” The program was well-received in Mackay and has since been implemented at the Royal Brisbane and Women’s Hospital’s anaesthetics

departments and adapted in numerous other facilities.

Incident response kit Finally, the impetus for the incident response kit came from an experience Lita herself endured during a shift. “I was a shift coordinator in emergency and had to support my colleagues in the adjoining mental health unit, all of whom had been seriously assaulted,” Lita said. “Essentially, I was left with no choice but to shut down the mental health unit and absorb all the mental health patients into an overflowing ED, all the while trying to support staff who were incredibly injured at the time. “It highlighted to me that we were all just winging it, and that nobody had ever really been given any succession training on how to support a staff member after they’ve been assaulted.”

“What that highlighted was that managers didn’t really know what was already in their power to do to better support staff. “Just little things like keeping in touch with a staff member who might be off work, or letting them leave their shift early, or offer a cab voucher – things beyond the formal procedures.” From this project came the incident response kits – designed not just for managers, but for all levels of staff who may need to support a colleague involved in an incident. “They’ve been really well received – it was about setting the tone for the whole state by standardising the approach.” The incident response kits and employee toolkits have now been rolled out across most Queensland health services.

The strategy unit undertook extensive research, including speaking with staff who had experienced all levels of occupational violence to hear their stories, and gathering 40 line managers to talk about how they’d dealt with REFLECTIVE QUESTIONS situations in the Reading and reflecting on this article may count towards past. your continuing professional development. Be sure to record the hours on your Record of CPD at www.qnmu.org.au/CPD

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Unpacking occupational violence

Q&A D

R JACQUI PICH is a nursing lecturer at the University of Technology Sydney. She has researched and written extensively on occupational violence in nursing and health. We spoke with Dr Pich about some of the broader issues around occupational violence, and what the research is telling us today.

Has occupational violence always been an issue in health care, or is it a problem unique to today? There’s always been an element of occupational violence in health care and I think it’s inherent due to the environment and the types of patients and situations that nurses find themselves in. But the evidence certainly tells us it’s becoming more of an issue and it’s significant. There’s an increase in the amount of violence as well as intensity. That’s something that’s not unique to Australia, but recognised by the International Council of Nurses.

Do we know what’s behind this increase? That’s the million-dollar question. When we look at who is violent, we know drug abuse and alcohol intoxication are precursors, as well as mental health, and often all these things are happening together. People also point to a societal influence. People

A conversation with Dr Jacqui Pich

seem to expect that instant gratification. They seem to have a lower tolerance and are more prone to acting out in a violent way. But it’s difficult to understand why this is happening. There also seems to be more of a tolerance for this kind of behaviour. In terms of the nursing profession, sometimes we don’t help ourselves because a lot of nurses regard occupational violence as just part of the job. We’ve kept that mantra even though the amount of violence has steadily increased.

Why are health workers – particularly nurses – more likely to experience occupational violence? We know health care is risky, and it’s nurses who bear the brunt and experience the most levels of violence. That’s because of our presence, as well as patients’ perception that we’re the gatekeeper as they’re moved through the system. We’re typically with our patients for the whole shift, so often we cop people’s frustrations with the health system itself.

Are there areas that have higher levels of occupational violence than others? When I did my research, I found that regardless of what area of nursing or midwifery you worked in, more

than 50% of nurses reported they’d experienced violence. This was from midwives in the birthing suite, to medical wards, paediatric, community nursing and beyond. There’s also a misconception that violence occurs more in metropolitan hospitals, but we now know that’s not the case. The only difference really is that our regional and remote counterparts are not as well supported in terms of security and the support they get before and after episodes of violence. The research is also starting to highlight an increasing prevalence of sexual harassment and sexual assault of nurses. Concerningly, these types of behaviours can extend beyond the workplace with the use of social media and the ability to stalk, so it’s a bit more of a hidden issue.

What are students’ perceptions of occupational violence entering the professions? I think students hear mixed messages because they understand the ‘zero tolerance’ policies, but then they witness episodes on placements and hear that it’s part of the job. I think there’s an opportunity to tailor education to them before they enter the profession so they come in with that attitude of, ‘No, it used to be part of the job, but now it’s not’.

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about...

I need to to you 28

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Health care is nothing if not personal, and this

can make for some pretty uncomfortable bedside conversations. So how do we equip our budding

nurses and midwives with the skills to handle them?

T THE HEART of what we do as nurses and midwives is advocate for those in our care. This means we’re there for our patients for every horrific-looking wound, awkward check-up or invasive procedure. From organ donation to bowel movements, and pretty much everything in between… these subjects are not only deeply personal, some require difficult conversations. Dr Karen Theobald is an Associate Professor and Director of Academic Programs at the Queensland University of Technology’s (QUT) School of Nursing. She said some of the difficult conversations nurses may need to initiate with patients and their families might include things like: ■■ supporting unexpected diagnoses ■■ sudden death ■■ end-of-life care

REFLECTIVE QUESTIONS Reading and reflecting on this article may count towards your continuing professional development. Be sure to record the hours on your Record of CPD at www.qnmu.org.au/CPD

■■ permanent disability ■■ organ donation. “I think one of the more challenging conversations nurses face is in the wake of a decision that nothing more can be done for someone,” Dr Theobald said. “While nurses may not deliver a diagnosis, they’re the ones who will be supporting patients and families

through it, such as aiding in the set-up of support services. “We need to work out what the patient’s end-of-life care will look like, what type of palliative care is most appropriate in this case and how the family or carer would like to be involved – approaching this sort of conversation can be really difficult and challenging, not to mention awkward.”

Communication – a safety standard Tackling such conversations may sound daunting, but Dr Theobald said patient-centred care should always be the focus. “As health professionals our duty of care is to the patient and we need to place their safety and quality of care at the forefront,” she said. “Taking a culturally safe approach to how we interact with others is vital in creating a partnership that is built on trust and equality – we need to acknowledge that everybody has different perceptions, experiences, beliefs and cultures and thus may have a different view to us. “I think the awkwardness of some health care situations can make communicating really challenging, but it’s a very big part of making appropriate clinical decisions,

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While nurses may not deliver a diagnosis, they’re the ones who will be supporting patients and families through it... Dr Karen Theobald, Associate Professor and Director of Academic Programs, QUT’s School of Nursing

and it’s core to our practice as nurses and midwives.” Indeed, Communicating for Safety is one of the eight National Safety and Quality Health Service (NSQHS) Standards, which aim to protect the public from harm and improve the quality of health service provision in Australia. The Standard identifies a requirement for organisations to “set up and maintain systems and processes to support effective communication with patients, carers and families; between multidisciplinary teams and clinicians; and across health service organisations”. Dr Theobald said it’s important nurses speak up when a person’s condition is deteriorating, if their care needs addressing or approaches need to change, and this can be quite difficult.

Safe and effective communication As health professionals, nurses and midwives play a vital role in communicating effectively to ensure the safety of those we care for. It’s why communication skills are unpacked with nursing students as a core component within the Bachelor of Nursing program at QUT. “Within the undergraduate courses and as part of what we call the

Integrated Nursing Practice Stream (units of study), students learn the theory that underpins good communication skills,” Dr Theobald explained. “This can include things like discussing the attitudes or approaches around communication in different forms and situations. “But the nurse-to-patient relationship and person-centred care are very much at the heart of our program.” Nursing students take part in lectures, tutorials, labs and simulations where they must assess, communicate and plan for a patient’s care, then evaluate and reflect on it. This approach is underpinned by a clinical reasoning framework. “This framework helps students to focus and consider the patient and the situation, including looking for and recognising verbal and non-verbal cues,” she said. “We also teach students to preplan conversations by considering what they might say or do in certain situations and how to deal with it, then evaluate and reflect on that to further develop critical inquiry and reasoning skills for future use.” Students also practice clinical handovers using an oral communication framework called ISBAR – where they introduce

themselves, evaluate the situation, provide key background information about the patient, give an assessment of the situation and provide recommendations for person-centred care.

In the real world While these approaches and tools equip students with important theoretical knowledge, QUT nursing student and QNMU member Romnick De Los Ama said clinical placement also plays a significant part in helping students gain the experience they need to tackle difficult conversations. “As a novice nurse, it can be daunting when you’ve had limited clinical experience and you’re talking about topics you’ve never talked about before... you don’t know how the patient is going to react,” Romnick said. “Providing an explanation to the patient about a procedure or a medication that they’re going to receive is part of the consent process and that’s something that is really emphasised at uni. “In one of my clinical placements, I had to insert an in-dwelling urinary catheter (IDC) and I was pretty lucky that the patient followed my explanation of the procedure well and responded positively. “For most patients, when they gain an understanding of what a procedure

indepth is, how it’s performed and how it can help them, they feel more at ease.” Romnick said regardless of the nature and topic of discussion, he uses a person-centred approach for all conversations. “I always try to familiarise myself with the patient’s background and do a bit of research beforehand,” he said. “This way if I do receive any questions, I’m well equipped with the knowledge to provide an explanation that’s specific to my patient’s needs. There’s nothing worse than trying to have a conversation with a patient and their family and not knowing what you’re talking about. “You also need to be honest and it’s okay to admit that you don’t know something. Ask someone that does know for help, whether it’s your facilitator or your buddy nurse.”

Supporting a culture for learning

“Students will generally be working within a team or with another health professional so there should be someone experienced who can support them through conversations. They should have the opportunity to role play or talk something through with a senior colleague... a good role model makes a real impact. “In the future, we’re going to see a lot more emphasis and structure in undergraduate courses around working in teams and with other health professionals.” Now in his final year of his nursing course at QUT, Romnick said he aims to apply everything he’s learned at university into communicating effectively with future patients. “I find reading journal articles really useful in gaining background knowledge and keeping up to date with the latest evidence-based nursing management of clinical problems,” he said.

Dr Karen Theobald said a workplace or placement culture that is supportive of learning, enabling and facilitating good practice with communication will help improve interprofessional learning.

“But again, I feel good communication all boils down to person-centred care – so grab a seat, acquaint yourself with your patient, and have a friendly discussion with them.

“It’s really important for students to be supported and mentored in a safe environment and in situations where they are able to undertake the role of a nurse under supervision,” Dr Theobald said.

“Lastly, ask a lot of questions when you’re on placement! No matter how stupid you think the question is, it’s not, and that same question was probably asked by a senior nurse when he or she first started.”

I feel good communication all boils down to person-centred care – so grab a seat, acquaint yourself with your patient, and have a friendly discussion with them. Romnick De Los Ama, QNMU member and student

Top tips for tackling those curly conversations QUT’s Dr Karen Theobald said the basic principles of courtesy and good communication apply to tackling any conversation. Here are some of her top do’s: Make sure your verbals and your non-verbals match. Make sure you’re in the right head space and have the time to not only have the conversation but to address concerns and clarify any questions in an unhurried way. Choose an appropriate time and place – this can be ensuring there aren’t a lot of people crowded in the room or going into a quiet room. Make direct eye contact when appropriate – keep your patient’s culture in mind. Be genuine and be in the moment for that particular person or patient – that means don’t rush through it. Use a trusted translator if necessary. Make preparations beforehand by considering confidentiality – how much can you say and is it absolute?

Reference

Australian Commission on Safety and Quality in Health Care, 2019, The NSQHS Standards, https://www.safetyandquality.gov.au/standards/nsqhs-standards

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Nursing with Mercy Ships BY QNMU MEMBER ANGELA FISCHER

Angela Fischer is a Perioperative Nurse at Logan Hospital and a QNMU member. She recently returned home from volunteering aboard the Africa Mercy Ship in Guinea, West Africa. The Africa Mercy Ship is the largest ship of its kind outside military hospital vessels, and is operated by Mercy Ships, an international not-forprofit organisation focused on providing free, safe, high quality health care to some of the poorest people in the world.

HEN I became a nurse, I was inspired by the notion of helping people heal. I think this is true of many nurses. We are often helpers, givers and caretakers, motivated by a desire to make a positive difference in peoples’ lives. We start with such passion and energy, ready to change the world. But somewhere along the way, many of us lose that. The excitement fades and we become burned out. I’m guilty of this — becoming complacent in a culture of complaining. I didn’t realise how much I needed a change in my perspective until I arrived on the Mercy Ship. Nursing as I knew it was completely turned upside down. Working and living on the Mercy Ship is a saturated experience unlike any other: extreme heat, close quarters and unfamiliar languages being spoken all around you, being away from family and friends… Life moves at a different pace on the floating hospital. But the truth is, healing a person is about more than treating their physical symptoms. It’s about meeting a person in their place of need and vulnerability. We don’t always have the chance to do that when we are caught up in tasks and clinical medicine. We

get so focused on the body that we forget the person within it. But the beauty of volunteering with Mercy Ships is the ability to restore hope to people’s lives. This begins with the first steps the patients take onto the ship where they are looked directly in the eye and met with a warm smile. From beginning to end there is a purposeful intent to see and affirm their unique worth and importance.

A different kind of nursing As a theatre nurse in Australia, our care finishes when the patient goes to recovery. But on the Mercy Ship we are encouraged to visit the patients on the ward and spend time with them. I spent lots of my free time on the ward playing with the children and sitting with the patients holding their hands and playing games. Over the course of my time there, I got to know a 21-year-old girl, Mahawa, very well. The day I met Mahawa was my first day on the ward. It was a strange sight. Most patients were out of bed and interacting with each other, the children were playing together, the men were watching football on the TV, and a group of patients and nurses were singing and dancing.

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But there was Mahawa in bed 18 under the blankets, trying to hide from everything going on. Mahawa had travelled for weeks on foot to receive hope and healing from the Mercy Ships. She was to receive reconstructive facial surgery for a condition called Noma – an infectious disease not seen in the Western world since the concentration camps, which destroys oral facial tissue. Though treatable, most of those afflicted with Noma have no access to basic health care, and thousands die from the condition each year. Those who survive are not only disfigured, but also have difficulty eating, breathing and swallowing.

life-giving, and we have the incredible opportunity to be a part of that.

It was hard to hear people upset about their first-world problems.

Another life-changing experience came from my time in the eye theatre.

I’d just visited a country where people died outside the hospital gates because they couldn’t prove they had money, or where it was normal to go hungry some days from lack of food.

This was a very busy theatre – we performed 18 to 20 cataract surgeries each day. I was privileged to attend a celebration of sight that was held off ship at the eye clinic. It was an emotional day as it was filled with stories from the patients about what their lives were like living in the darkness before Mercy Ships. Now they can see, and their life has completely changed, thanks to a ship that they have never seen.

Sharing the human experience

Over the next few days, I interacted with Mahawa by playing games and she even sang with the other patients. The more I visited her, the happier she became.

Now that I’ve returned to my job in Australia, I’m challenging myself to do more of this, and I challenge you to do the same.

Much to everyone’s delight, Mahawa had surgery to review the skin graft and after a few days was discharged to the Hope centre where she stayed for a week before going home to her village.

But returning home, I initially had a hard time adjusting back into life. The contrast is stark – people here feel they have a right to their health, which of course we do, but many take it for granted.

Being exposed to this provided me with invaluable perspective. It helped me appreciate the profundity of our profession. Medicine is life-saving and

People here think nurses and doctors have all the answers and should be able to cure and control whatever issue a patient is experiencing.

It was a place where suffering went deep yet somehow joy was overflowing. I got to be so intimately involved in so many people’s lives on board the Africa Mercy Ship. I got to hear patient stories and witness a pivotal point of change in their life. From cradle to grave, nurses witness the full spectrum of life. This is a beautiful and staggering gift, one that shouldn’t be taken for granted. I ask you to consider this as you go into your next shift. Reflect for a moment on how you will touch a life that day. Consider whether you will leave a patient better or worse for knowing you. Remember that our work is more than clinical tasks. We offer hope, restore dignity and alleviate fear. We share in the human experience. I will forever be grateful to Mercy Ships and the people of Guinea for reminding me of this.

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Farewell to the Ensuring Integrity Bill... at least for now

OPINION BY DR LIZ TODHUNTER, QNMU RESEARCH AND POLICY OFFICER

Nation and Jacquie Lambie along with the Greens and Labor senators voted against the Bill in the Senate.

We must also thank Pauline Hanson and Jacquie Lambie for voting against the Bill.

This came as some surprise to the government who had assumed Pauline Hanson’s One Nation and Jacquie Lambie would vote in favour of the Bill despite strong opposition from unions, academics, lawyers and other parties.

There are many reasons why this Bill was an unprecedented attack on unions and Australian workers.

ORPORATE collapses, a damning royal commission into the financial sector and the largescale unethical conduct by Westpac bank do not appear to have deterred this early term federal government from pursuing the predictable coalition ritual of curtailing union activities. Most recently, the federal government has attempted to do this through the introduction of the Fair Work Registered Organisations Amendment Ensuring Integrity Bill (the Bill). At its core, the Bill seeks to undermine the essential democratic nature and functioning of unions by introducing a range of punitive provisions including deregistration or the expulsion of officials for certain types of industrial action. But in a move that blindsided the government, Pauline Hanson’s One

This is a temporary victory for workers given the Attorney-General has indicated the government will reintroduce the Bill into the parliament. Yet despite these ongoing moves to destabilise and punish unions, this was a win for collective action and a belief in fairness. The QNMU and other unions worked tirelessly behind the scenes and publicly through campaigning to convince the cross benchers this Bill is unnecessary. So thank you to the members who contacted the politicians to speak up about the unfairness of this Bill.

This time, the target was the Construction, Forestry, Maritime, Mining and Energy Union (CFMMEU) – a traditional male-dominant union representing workers in very high risk industries. However, this was a catch-all bill that would have affected every worker whose union is covered by the Fair Work Registered Organisations Act 2009, and that includes nurses and midwives. There is nothing subversive about unions taking industrial action. The whole point of these activities is to challenge the overwhelming and disproportionately high level of employer power and resources through collective action. This is the essential nature of the labour/capital contest.

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Over recent weeks we have seen rampant white-collar crime exposed, involving tens of millions of breaches by Westpac, with no effort from the bank or this government to deal with their illegal actions. This week we also saw the Registered Organisations Commission called into question by the Federal There are already severe pecuniary and other penalties at law for unprotected industrial action – i.e. action taken outside enterprise bargaining negotiations. The supposed concern for ‘the public interest’ on which this bill appears to be founded seems to be missing when we consider a couple of other confronting areas of industrial relations policy the federal government has chosen to overlook. According to SafeWork Australia there have been 121 workplace fatalities so far this year. One death is too many. Why doesn’t the federal government put greater effort and resources into punishing employers who enable this to happen? This is the national disgrace, not union industrial activity. Wage theft is another prevalent scourge that has long been poorly addressed by federal authorities. It is an insidious but often unrecognised crime that too often

goes unnoticed and unpunished, but it undermines the basis of Australians’ sense of fairness, to say nothing of their incomes.

Court over what appears to be an illegal raid on the Australian Workers

Australian employers owe workers billions of dollars in unpaid wages including unpaid superannuation.

Union.

The federal government has finally announced an inquiry into wage theft, but why is this not a major government priority?

unions to act in

Judging by the federal government’s lacklustre response to the number of workplace deaths and injuries and endemic wage theft, it seems to prefer putting its resources and energy into pursuing and punishing unions. The public interest is fundamental to the purpose and the democratic nature of unions. Unions have withstood numerous attacks and overcome many obstacles in their long history and will continue to do so because they operate on a set of unshakeable principles of fairness and the common good.

When you’re asking accordance with the law, you need Government departments to lead by example. Pauline Hanson (Media Statement, 28 November 2019)

These are indeed strange times when we look to Pauline Hanson for insight into unions but let’s leave the last words (above) for her and her accurate summation of this whole situation. We hope these sentiments prevail if the bill is returned next year for yet another attack on workers.

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Organising afterlife THE

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Saying goodbye to a loved one is never easy. But for many families, it can be hard to grieve a loss when there are a myriad of decisions and arrangements to be made quickly. Enter the Last Wishes app.

ounded by QNMU member and Registered Nurse Felicity Wegemund, the Last Wishes app helps create a positive end-of-life journey for families during their most vulnerable moments. With the passing of a loved one, families are suddenly confronted with decisions they may have never given thought to…

Users can upload their favourite photos, store favourite music, house a contact list of family and friends, or drop a pin anywhere in the world where they’d like to be laid to rest. At a small additional cost, users can also upload “wishes” in the form of copies of their will, bank account information and even personalised letters or bequeaths.

Would their loved one prefer a burial or cremation? Who would they want to invite to the funeral? What music would they like played at their funeral?

Ten per cent of the proceeds from the app will be donated to charity.

It was in debating this question that Felicity conceived the idea for an app.

Should the worst happen, a nominated family member has the authority to mark their loved one as “passed away” within the app.

“One of my friends threw out a song she wanted played at her funeral that was really obscure and I thought ‘I’m never going to remember that!’” Felicity said. “It got me thinking about how overwhelming and stressful it can be for families to try and find information about their loved one’s wishes if it wasn’t something they’ve talked about in the past, especially if it were a sudden passing. “I thought to myself ‘you’d need an app for that!’ and that’s how Last Wishes began.”

Getting organised

The one-of-a-kind app was launched just last year and as its name suggests, provides a central space for a person’s last wishes to be stored. Dubbed by Felicity as an “online afterlife organiser”, the free app helps people take charge of how they want to be remembered and gives families confidence in making decisions without having to sift through paperwork.

All information is locked within the app with a secure, two-step authentication process.

This then unlocks all pre-populated information for a family member to action on your behalf. Felicity said the app was an easyto-use option for people who wanted to keep building on information throughout their life and no matter where they are. “It’s a lot easier to record something down in our phones straight away when it comes to mind,” she said. “I use the app myself which I’ve loaded with my preferred photos – I know if it were up to my daughter, she would only pick the photos where she looked good herself! “I’ve also got my friends list in there because my daughter wouldn’t know half of my friends, and I’ve also left little anecdotes and stories to be shared after I’ve passed. “Hopefully no one will need to access the information in the app any time soon though!”

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Easing the process

A nurse of 25 years, Felicity said she often sees the stress families go through in the mad scramble for information after a loved one has passed. “There’s a short amount of time between when someone passes away to when the burial takes place,” she said. “It’s hard to make decisions when you’re at your most vulnerable and it can cause fights within the family. “The app helps take away the need to make decisions on behalf of your loved one, because they’ve already made it.” Felicity said she also hoped the app would help patients nearing the end of their life feel more at ease. “I’ve seen patients become very restless and unsettled and feel they can’t pass on with unfinished business,” she said.

“I hope the app will help relieve that stress for them, so they can feel they’ve got things organised and not have to worry.”

A passion for palliative care

The Last Wishes app is a culmination of Felicity’s passion for palliative and end-of-life care, which she developed at an early age while working at Sacred Heart Hospice in Sydney in 1993 when she was just 23 years old. “Helping people live before they die is what I remember from working there,” she recalled. “Some days could be really sad but it was also rewarding being able to help people die well and support their families through the process. “That part of my life is really etched in my mind and has always stayed with me. I personally feel it’s the real caring part of nursing… not the rush and the routine, but working with

the mind, body and soul, and the full holistic care that comes with working in palliative care.” Felicity said she also created Last Wishes as a light-hearted approach to opening up conversations around death. “Our culture doesn’t like talking about death because we think if we talk about it it’s going to happen,” she explained. “But we all know that someday it’s going to happen anyway! So why does it need to be an uncomfortable topic? “It’s important to have those conversations and I hope the app helps facilitate that in a light-hearted way.” Last Wishes has already received international attention, with downloads from not only Australia and New Zealand, but as far away as America, the UK and even China. Felicity said she plans to continue expanding on the app in the future.

The app helps take away the need to make decisions on behalf of your loved one, because they’ve already made it.

Find out more at http://lastwishesapp.com 38

Providing timely access in isolated areas T

IMELY access is one of the cornerstones of primary health care. Years ago, Queensland recognised this by legislating an extended scope of practice for suitably qualified Rural and Isolated Registered Nurses. The endorsement was established as Rural and Isolated Practice Endorsed Registered Nurse (RIPERN). With national registration, the name was later changed to Scheduled Medicines Endorsement (Rural and Isolated Practice), though is still colloquially known as RIPERN. This extended scope of practice meant people seeking care in legislatively listed isolated and rural areas could be treated by the RIPERN for conditions outlined in the Primary Clinical Care Manual (PCCM), according to the Health Management Protocol (HMP) and, where relevant, the Drug Therapy Protocol (DTP). It also allowed for vaccines to be administered according to the Immunisation Schedule, all without the need to involve a medical officer. But the Nursing and Midwifery Board of Australia (NMBA) intends to discontinue this endorsement, which also exists in rural Victoria. Acknowledging that discontinuing the endorsement without necessary changes to state legislation would cause barriers to timely access to health care, the NMBA has agreed to maintain the Scheduled Medicines Endorsement while work is undertaken to ensure a seamless transition for all states and territories. Work has been progressing and the QNMU has been meeting regularly with the Office of the Chief Nursing and Midwifery Officer (OCNMO), with the aim of a seamless transition.

Ntohtees

from

North

Lucynda Maskell QNMU Vice President

Recently, QNMU Councillors attended the Biennial Australian Nursing and Midwifery Federation (ANMF) Conference. Excitingly, Queensland’s motion to improve Nurse Practitioner (NP) access to Medicare benefit claim numbers was passed. In the future, while the qualification will not be specified on an individual’s registration, the practice will still be supported in Queensland for those suitably qualified. Further efforts continue to be made to improve timely access, which is vitally important in regional areas. Health outcomes for people living in rural and remote areas are, on average, poorer than metropolitan counterparts. Moreover, health and life expectancy for Australian Aboriginal and Torres Strait Islander people continue at an unacceptable divide. Recently, QNMU Councillors attended the Biennial Australian Nursing and Midwifery Federation (ANMF) Conference. Excitingly, Queensland’s motion to improve Nurse Practitioner (NP) access to Medicare benefit claim numbers was passed! While this resolution specifically cited Advanced Health Directives, the need to expand access for NPs is obvious. For example, an NP specialising in diabetes currently has no access to Medicare funding for working with clients on their health management care plans and team care arrangements. These are multi-disciplinary plans to help clients identify health and care

needs, set actions, goals and also provide a health calendar. In areas where medical services are limited and deal not only with primary health, but also acute and sub-acute presentations, allowing NPs access to items such as these would enable many more patients to receive best practice plans. Services employing NPs in this capacity could then seek fairer Medicare reimbursement for their work. The Queensland government has committed to providing health care closer to home. This includes vital services such as oncology, chemotherapy and dialysis, which often require medical expertise, as well as specialised nursing. While this changes lives, we cannot lose focus on primary care, which we know results in health prevention and promotion, and include strategies to keep people well, out of hospital, and cost less. The outer island nurses in the Torres Strait recently secured funding through the Queensland Health EB10 Innovation Fund. This funding will assist those very isolated nurses to allow NP candidacy with supervised practice by other NPs on the Islands where they work. Let’s hope we can progress access to more federal Medicare funding for their work in this space.

your $ health

Tax implications when receiving a back-paid allowance T

HE FOLLOWING tax advice has been provided for QNMU members by Etax Accountants, following recent inquiries about tax implications when receiving back-paid allowances, particularly in relation to Queensland Health’s laundry allowance. The article also clarifies the difference between a reimbursement and an allowance for the purposes of what counts as taxable income and what can and cannot be claimed as a tax deduction. The QNMU cannot provide members with tax advice – we therefore encourage you to speak with an accountant or your tax advisor about your individual circumstances.

Case study Sophia works as a nurse full-time and she did not receive a laundry allowance for six years. She is required to wear a uniform and she launders that uniform herself (it’s not laundered by her employer). Sophia claimed the cost of uniforms and laundry on her tax returns for those six previous years. That gave a little boost to her tax refunds in each of those years. This year, the QNMU was successful in getting Sophia and her colleagues back-paid for the laundry allowance they were entitled to all that time. This is paid in a lump sum amount equivalent to what they should have received over the six years. Sophia wonders if there are any adverse tax implications, and whether she should declare this lump sum as income. She also wonders if it will be taxed, or whether it will be paid tax free.

Advice from Etax On your next tax return, you should include the back-paid allowance as income in the current year. It’s not to be claimed as an amendment to the previous year’s return, because you only now received the money. To get the correct amount of tax paid on that income, your tax agent could declare the income and tell the Australian Taxation Office (ATO) that the lump sum was back pay from a prior year. That way the ATO can calculate that portion of the income at a different, correct rate of taxation. But that may be getting a bit more complicated than the difference is worth. In fact, you might end up with less money in your pocket. For a lot of people, the difference mightn’t be worth the effort, and there could be tax agent fees, not to mention the time and fuss involved. Therefore, Etax recommends the following: ■■ Declare the lump sum as income for this year, because that’s when you received it. Don’t worry about amending old returns for this income – it’s income for this year. ■■ Remember that if you claimed tax deductions for your uniform expenses in previous years, you would have got a bit back at that time when the allowance went unpaid by your employer and your taxable income looked lower. ■■ If you didn’t claim deductions for any actual uniform expenses in previous years, you could lodge an amended return via your tax agent. They should add your deductions. However, they should not add the back-paid allowance, because you received that money later. If the deduction is small, you could end up out of pocket because there will

be fees to lodge an amendment. If your unclaimed deductions are around $350 or greater, then it is probably worth your while to lodge an amendment through your agent. ■■ This year, your tax refund might be slightly less because of the back-paid allowance. Remember, this balances out against the extra money you received in previous years. ■■ One way you might boost your refund in the coming year would be to take the back-paid allowance lump sum and spend that money on a uniform upgrade, if you want or need that. Then you’ll have receipts for a deduction that will boost your refund next year. The recommendations above are general and are not tailored to any one person’s situation. It’s a good idea to get personal advice tailored to your own circumstances regarding how best to deal with any backpay of allowances.

Reimbursement vs allowance For tax purposes, it’s important to understand the difference between a reimbursement and an allowance. A reimbursement is when your employer pays you back in full for a work-related expense that you had paid for out of pocket. Because the employer paid for all of it, you can’t claim the expense as a tax deduction. But also, the reimbursement does not count as income, so you don’t pay tax on that. However, if you get a regular allowance (often as part of your Award or workplace agreement) then the allowance is considered taxable income. You do pay tax on that, but you can claim the related expenses as tax deductions.

your $ health

Etax.com.au is an online tax return service. Etax has been specialising in online taxes since 1998 and enables most individuals to complete their tax returns in under 15 minutes. Each tax return is checked by qualified accountants for accuracy and extra deductions prior to lodgment, offering a high level of support and expertise plus the time-saving convenience of a 100% online service.

ADVERTORIAL

Life events that can affect your super Some events have a positive impact on your super, others negative, and some are a timely warning to revisit your savings plan. Here’s a rundown of key events that should trigger action.

Starting a new job

It’s easy to end up accumulating various super funds as you change jobs, so whenever you start a new job, make sure you tell your new employer which super fund you want your contributions paid to.

Getting married

Getting married is a timely reminder to check the beneficiaries you have listed on your super account. If you want greater certainty about where your super goes, consider a binding death benefit nomination.

Expanding your family

When you welcome a new member to your family, it can be important to check the level of life insurance cover you have so your children are protected if the worst was to happen to you or your partner. Try our Insurance Needs calculator to help estimate the level of cover you might need.

Time off work

If it’s for travel, maternity leave, study or a sabbatical, taking an extended and unpaid period away from work is likely to impact your super savings. If your income drops drastically, you may benefit from the Australian Government’s super co-contribution scheme.

Separation

When couples separate, super can form part of the asset pool to be divided. The Australian Taxation Office (ATO) offers some useful information to make you aware of what can happen to your super entitlements if your relationship breaks down.

Get advice to suit your life

When your life changes, it’s often a good idea to get some professional financial advice. Visit our website for more information.

qsuper.qld.gov.au/advice

All QSuper products are issued by the QSuper Board as trustee for QSuper. This is general information only, so it does not take into account your personal objectives, financial situation, or needs. Consider whether the product is right for you by reading the product disclosure statement (PDS) available from our website or by calling us on 1300 360 750. © QSuper Board 2019. CNC-3212. 10/19.

EXQS0189_CNC-3212_Article campaign - October 2019 V01.indd 1

23/10/19 11:31 am

FR EE

CPD portalâ&#x20AC;¦

FREE for QNMU members!

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

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Involving patients in acute pain management BY DEEPA ANTONY BN, CLINICAL NURSE, LOGAN HOSPITAL AND DR SHARON LATIMER PHD, RN, GRIFFITH UNIVERSITY AND GOLD COAST UNIVERSITY HOSPITAL

CUTE pain is a subjective physiological and/or psychological patient experience which may be a precursor for adverse events such as deep vein thrombosis and infection1. Promptly assessing and managing acute pain can help to avoid complications, decrease hospital length of stay and improve patients’ quality of care and satisfaction1. Many patients under-report their acute pain symptoms because they perceive pain as a normal part of their hospital care experience, fear becoming addicted to narcotic medications or are unaware of their pain management options1. For nurses, managing the patient’s acute pain is complex and involves pharmacological and non-pharmacological approaches to care1. Partnering with consumers is one of the national safety and quality health service standards2 and is known to improve patients’ health outcomes and overall safety3. Involving patients in any aspect of their care requires collaboration between clinicians and patients, information sharing, mutual respect and shared decision-making4. Yet despite the benefits, only a handful of studies have examined hospital patients’ involvement in their acute pain management. Most patients want to be involved in the entire process of their pain management, yet for many this is restricted to pain assessment1. Increasing patients’ understanding of the physiology of acute pain and the importance of prompt reporting is the first step in involving them in their pain management1, 4.

REFLECTIVE QUESTIONS 1. What are the benefits of involving patients in their pain management?

Outlining the patient’s pharmacological and nonpharmacological analgesic choices can improve their pain control, hasten their recovery and increase their preparedness to manage their pain at home1.

2. Reflecting on your clinical practice area, how might you increase patients’ participation in their pain management?

Information sharing is an important strategy for clinicians to implement because it allows patients to understand the benefits of good pain management and make informed decisions1, 4.

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

Patients who are supported and encouraged by nurses to be actively involved in their pain management receive more effective pain relief, experience better health outcomes and analgesic compliance post-discharge1. Hence, increasing patient’s involvement in managing their acute pain is mutually beneficial for patients and nurses, and contributes to improving quality of care and safety.

References

1. Gregory, J. and L. McGowan, An examination of the prevalence of acute pain for hospitalised adult patients: A systematic review. Journal of Clinical Nursing, 2016. 25(5-6): p. 583-598. 2. Australian Commission on Safety and Quality in Health Care, National safety and quality health service standards. 2017, ACSQHC: Sydney. p. 1-86. 3. World Health Organization, Medication without harm-Global patient safety challenge on medication safety. 2017: Geneva. p. 1-16. 4. Larsson, I.E., et al., Patient participation in nursing care from a patient perspective: A Grounded Theory study. Scandinavian Journal of Caring Sciences, 2007. 21(3): p. 313-320.

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FACILITY DESIGN: setting the necessary parameters

Eâ&#x20AC;&#x2122;VE all heard the story from nurses about a health facility having just completed a major renovation, only to discover the new beds wonâ&#x20AC;&#x2122;t fit through the doors (true story). Clearly this type of event represents a failure to plan and assess potential issues. We acknowledge it is not uncommon for new buildings to have teething problems. However, some proper foresight and emphasis during the planning phase should alleviate most health and safety concerns. One of the common elements identified by QNMU members is the need for nurses and midwives to be consulted when new health facilities are under development or undergoing changes to existing structures. The Workplace Health and Safety Regulation 2011 provides for those responsible for the physical work environment to meet the following requirements. 40 Duty in relation to general workplace facilities A person conducting a business or undertaking at a workplace must ensure, so far as is reasonably practicable, the following: a. the layout of the workplace allows, and the workplace is maintained so as to allow, for persons to enter and exit and to move about without risk to health and safety, both under normal working conditions and in an emergency; b. work areas have space for work to be carried out without risk to health and safety; c. floors and other surfaces are designed, installed and maintained to allow work to be carried out without risk to health and safety; d. lighting enablesi. each worker to carry out work without risk to health and safety; and ii. persons to move within the workplace without risk to health and safety; and

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e. ventilation enables workers to carry out work without risk to health and safety;

The QNMU has often had to intervene when there are competing interests around maximising floorspace and the health and safety of staff.

f. workers carrying out work in extremes of heat or cold are able to carry out work without risk to health and safety;

Another common issue identified by members is the flooring in a health facility and its impact on slips, trips and falls in a workplace.

g. work in relation to or near essential services does not give rise to a risk to the health and safety of persons in the workplace.

The legislation requires an employer to not simply consider aesthetic issues when making decisions around flooring material, but also the effect on staff and others affected.

iii. safe evacuation in an emergency;

This means your employer must look at correcting these physical elements prior to writing a policy or procedure when a problem with the work environment is identified. For instance, if a nurse or midwife is required to perform a manual handling task, such as taking a patient to a shower or a commode, the physical dimension of the cubicle should be such that it is ergonomically suitable to perform this task with adequate space to move around.

There is considerable information and guidance available to employers around facility design for health facilities via the Australian Health Facility Guidelines. Members can view the guidelines at www.healthfacilityguidelines. com.au This guidance material covers most work areas, such as mental health operating theatres. We encourage members to access this information should they be advised there are to be changes to the physical dimensions of their workplace.

CASE STUDY

Nurses fight proposed changes to facility and win A RECENT DECISION in the New South Wales Industrial Relations Commission confirmed the physical layout and design of a health facility cannot be changed when it affects the safety of staff. The decision related to a proposal by the employer to renovate the mental health units, which would have seen the removal of a 1.3 metre counter surrounding the nurses’ station.

Key points: ■■ The majority of staff in the workplace opposed this proposal due to concerns it would increase their exposure to aggression. ■■ Management disagreed, believing the change was in line with therapeutic consideration and was consistent with requirements under the Mental Health Act. ■■ After intervention by SafeWork NSW, the employer was prohibited from removing the barrier as the inspector believed this would place nurses at serious risk from a hazard, namely, aggression.

REFLECTIVE QUESTIONS 1. What are some of the specific physical elements in a health facility that impact on patient and resident safety? 2. Are clear lines of sight important in a health facility work area and why? 3. Are nurses and midwives obligated under the NMBA code to identify elements of facility design that affect the care they provide? Why? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

■■ The employer appealed this decision, but the Commission agreed with SafeWork NSW that WHS legislation should be given paramountcy over the Mental Health Act. This decision is important because it reinforces the fact that proposals around clinical care should not be to the detriment of workplace health and safety.

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ITâ&#x20AC;&#x2122;S TIME TO

Count

BAB ES

the T

HERE is a growing body of evidence demonstrating the impact of midwifery workloads on outcomes for women and their babies1, 2. Nurse-to-patient ratios are already rolling out across Queensland Health prescribed facilities thanks to the QNMUâ&#x20AC;&#x2122;s Ratios Save Lives campaign, which draws directly from world-class evidence that demonstrates improved outcomes related to staffing and work environments in nursing and midwifery3, 4, 5, 6. National and international studies provide evidence that the number, skill mix and practice environment

of nurses and midwives directly impact the safety and quality of care provided within the health system. Minimum nurse-to-patient and midwife-to-patient ratios are an economically sound methodology, which save lives and improve patient outcomes. For example, health services with a higher percentage of Registered Nurses and increased nursing hours per patient have lower patient mortality rates, reduced lengths of stay, improved quality of life and fewer adverse events such as failure to rescue, pressure injuries and infections.

CPD The midwifery model For midwives, various contexts of practice and models of care exist. Evidence demonstrates that midwifery continuity of care (referred to as ‘caseload’) is not only safe for mother and baby, but also has improved outcomes and decreased intervention rates1,2,7,8. Currently, the most prevalent model of maternity care in Australia is a shift-work medical model where midwives staff maternity units across the 24-hour cycle. But acuity in maternity care is increasing. The increase in acuity, combined with increased screening and treatment for conditions such as gestational diabetes and risk of infection is creating additional workloads in the care of both woman and baby. The ‘qualified baby’ is defined under Health Insurance Act 1973 regulations, which states that a baby qualifies as a funded patient when they: ■■ are nine days old ■■ occupy a bed of an accredited neonatal intensive care facility ■■ are a second or subsequent child of the same mother, or ■■ are admitted without their mother. So newborn babies that do not meet these criteria – which is the majority of babies – are considered ‘unqualified’. In other words, they are unfunded and uncounted babies, and are therefore not included in workload design, allocation, skill mix or ratios.

Reconsidering the status quo Funding models that include care of the newborn need to be considered. The newborn is considered a separate entity in the Coroner’s court and therefore it is important to consider the workload the newborn creates. The Business Planning Framework (BPF)9 is the industrially mandated tool for managing midwifery and nursing resources and workloads in Queensland’s public sector. This is the tool that determines what staffing numbers and skill mix are needed to run a service. The BPF takes into account all services such

as non-clinical hours, as well as all multipliers, such as sick leave, holiday leave and professional development.

■■ Principle 7: Workload management includes all elements of the practice environment.

For midwives working in hospitals and health services, articulating midwifery work, including direct, indirect, productive and nonproductive, can be quite a challenge.

■■ Principle 8: Workload management must be transparent, consistently applied and requires accountability.

A survey conducted by the QNMU in 2016 and repeated in 2019 indicated that very low numbers of midwives thought they provided adequate care nearly all the time. More than half of respondents thought there was seldom or never enough midwives to provide safe quality care. Twenty per cent of those surveyed were considering leaving midwifery within the next 12 months, with excess workloads cited as the major contributing factor.

Introducing the SWiM standards With the safety of women and their babies being paramount, the QNMU and midwifery members developed the following key principles for minimum safe staffing in midwifery services. In developing these principles, the QNMU and members engaged key stakeholders and reviewed the best available evidence. ■■ Principle 1: Care must be safe for mother and baby. ■■ Principle 2: Care must be safe for midwives. ■■ Principle 3: Safe workloads in midwifery are professionally determined in accordance with evidence based minimum standards (this includes ratios of one midwife to four or six mothers and/or babies, or as the SWiM standard states a range of 1:4-1:6 [counting both mother and baby]. The key point being babies are counted as separate people).

These evidence-based principles now underpin the QNMU’s Safe Workloads in Maternity (SWiM) standards document. The QNMU has plans to establish these SWiM standards in the service articulation and BPF development in all maternity services across Queensland.

Count the babies Key to this will be a Count the Babies campaign, which will strive to enforce all Hospital and Health Services to count babies in midwifery workloads. To achieve this, we will be campaigning for an overhaul of the current federal funding models so that the care of newborn babies is appropriately funded. Already, we have achieved some great progress. In 2018 a Maternity Addendum to the BPF was published10 by Queensland Health after extensive consultation with the QNMU. This addendum, while not specifically incorporating the SWiM standards, articulates what a safe workload should look like. This is important for all midwives to be aware of. If a service is to be appropriately staffed, then workloads must be captured and articulated properly. The Maternity Addendum, the mandated Queensland Health workloads tool, specifically states: When reviewing client or service complexity, in the BPF Service Profile, there are a number of unique considerations for maternity services, these include:

■■ Principle 4: Women need one to one care from a registered midwife during established labour.

■■ holistic care of the woman incorporates social, emotional, spiritual and psychological care

■■ Principle 5: The newborn must count in staffing calculations in postnatal wards.

■■ care is not limited to the care of the woman only, the neonate also requires midwifery or nursing hours

■■ Principle 6: Skill mix is an important consideration to achieve a safe practice environment.

■■ recognition should be given to increased acuity and activity associated with care of the newborn.

Count

BAB ES

the

Example activity measures identified for maternity services:

The QNMU will be commencing a Count the Babies campaign in the year ahead. The campaign will aim to have unqualified babies funded by the federal government funding model, as well as ensure the Queensland government promotes safe workloads in midwifery by incorporating the standards into service profiles and workload management as core business in all HHSs. But midwives and managers don’t need to wait for a campaign to act. We have the tools and the evidence to back up the way we must articulate and demand safe workloads. This is for our own safety as midwives, and for the safety and wellbeing of our mothers and babies.

References

1. Midwife-led continuity models versus other models of care for childbearing women. Sandall, J, et al. Issue 4, 2016, Cochrane Database of Systematic Reviews, Vol. Art. No. CD004667. DOI:10.1002/14651858. CD004667.pub5. 2. Continuous support for women during childbirth. Hodnett, ED, et al. 7, 2013, Cochrane Database of Systematic Review, Vol. Art. No.:CD003766. 3. Australian Nursing and Midwifery Federation. Staffing of Nursing and Midwifery Services. [Online] February 2015. [Cited: November 1, 2016.] http://anmf.org.au/documents/ policies/P_Staffing_of_ Nursing_Midwifery_Services. pdf.

Direct care activity ■■ Number of post discharge occasions of service (OOS) for breastfeeding support ■■ Proportion of women and babies with skin to skin contact - Baby friendly hospital initiative (BFHI) ■■ Number of women where breastfeeding initiated in birth suite ■■ Number of complex care (e.g. Gestational Diabetes Mellitus [GDM]) ■■ Number of healthy hearing tests ■■ Number of examination of newborns completed ■■ Number of episodes of parent education ■■ Number of babies requiring paediatrics review in ward setting ■■ Number of unqualified babies ■■ Number of unborn child high risk alerts ■■ Number of episodes for monitoring baby after GDM. Indirect care activity ■■ Case conference ■■ Clinical supervision.

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4. Hospitals with higher nurse staffing had lower odds of readmission penalties that hospitals with lower staffing. McHugh, M, Berez, J and and Small, D. 10, 2013, Health Affairs, Vol. 32, pp. 1740 - 1747. 5. The economic benefits of increased levels of nursing care in the hospital setting. Twigg, D, et al. 10, 2013, Journal of Advanced Nursing, Vol. 69, pp. 2253-2261. 6. Hospital nursing, care quality, and patient satisfaction:crosssectional surveys of nurses and patients in hospitals in China and Europe. You, L, et al. 2013, International Journal of Nursing Studies, Vol. 50, pp. 154-161.

REFLECTIVE QUESTIONS 1. How could you incorporate the SWiM standards into your unit? 2. How could you start to articulate the workloads of babies in your workplace? 3. How might you articulate in workload forms instances where skill mix, staffing or newborn workloads impact on the safety of your day to day work? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

7. Caroline S E Homer, Ingrid K Friberg, Marcos Augusto Bastos Dias, Petra ten Hoope-Bender, Jane Sandall, Anna Maria Speciale, Linda A Bartlett. Lancet Series on Midwifery: Midwifery 2 The projected eff ect of scaling up midwifery. s.l. : http://dx.doi.org/10.1016/ S0140-6736(14)60790-X, 2014. 8. Mary J Renfrew, Alison McFadden, Maria Helena Bastos, James Campbell, Andrew Amos Channon, Ngai Fen Cheung,. The Lancet Series on Midwifery: Midwifery 1Midwifery and quality care: findings from a new evidence informed. s.l. : http:// dx.doi.org/10.1016/S01406736(14)60789-3, 2014. 9. Health, Queensland. Buisness Planning Framework: a tool for nursing and midwifery workload management: 5th Edition. [Online] 2016. 10. Business Planning Framework: a tool for nursing and midwifery workload management. 5th Edition. Maternity Services Addendum 2018. Health, Queensland. 2018.

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Patients and families want to learn about medications from YOU! BY DR GEORGIA TOBIANO, IN COLLABORATION WITH PROFESSOR WENDY CHABOYER, TRUDY TEASDALE, RACHAEL RALEIGH, JULIE BARKER, AND PROFESSOR ELIZABETH MANIAS. AFFILIATIONS: GOLD COAST HEALTH, GRIFFITH UNIVERSITY AND DEAKIN UNIVERSITY.

ATIENT and family engagement in communication is advocated internationally as a strategy to enhance medication safety.

Medication communication with patients and families frequently occurs predischarge, such as medication counselling with pharmacists. We undertook a mixed-methods study across two medical wards at one hospital to investigate how patients and families participate in discharge medication communication. Patient and family participation in communication occurs along a continuum, as outlined in the following diagram: Silent

Informationseeking

Informationsharing

Interviews Seven patients and three family members were interviewed after hospital discharge. We found that participants were constantly learning about medication throughout hospitalisation. They recognised routine activities (e.g. medical rounds, medication administration, discharge medication counselling) as opportunities to learn. At home, most participants continued learning about medications from the internet and community pharmacist. Participants emphasised the importance of patient-centred communication from health care professionals, such as being approachable, inviting, and not appearing ‘too busy’. Patients spoke highly of nurses – they built relationships with them and sought medication information from them. Receiving written information (i.e. a discharge mediation list) was highly valued. We asked participants about their level of participation (as per the above continuum). Most participants thought ‘information-seeking’ was their role,

Shared decision-making

Autonomous decision-making

but this was challenging (i.e. not sure if they could ask questions, forgot to ask questions). Participants saw no role in ‘information-sharing’ or ‘decisionmaking’ because they assumed health care professionals already had up-to-date information about their medications, and health care professionals made all decisions. Yet, with more questioning, participants shared experiences of voicing medication concerns to health care professionals (i.e. previous side-effects, adherence issues) that influenced health care professionals’ decisions. Families viewed their role as advocates but reported barriers to being present for conversations.

Observations Thirty patients were observed on discharge day. Sixty per cent of patients reached ‘shared decisionmaking’ on the continuum. Most decisions related to accessing medications (i.e. their preferred pharmacy to fill script). Four patients were ‘silent’ in every conversation. These patients

may have had lower health literacy and family member support with managing their medications. However, a larger sample size is needed to support these claims. Seventy-one medication conversations were witnessed. Conversations most frequently had were ‘information-seeking’ and ‘information-sharing’ by patients. Content related to usual medications and medication concerns. Families were present for seven patients/12 conversations. Family members were on loud-speaker on the phone for four conversations.

Key messages Patients and families want to learn about medications from nurses during routine conversations (i.e. medication administration). Families play an important role in managing medications, but it is tricky for them to be present in hospital. Patients and families hold valuable safety information including side effects, adherence issues and discrepancies in medications charted.

REFLECTIVE QUESTIONS 1. How can we better engage families in medication conversations? 2. How can we get patients to share their medication concerns and questions confidently? 3. How do we facilitate learning during routine conversations? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD Funding: This work was funded by Sigma Theta Tau International Virginia Henderson Clinical Research Grant.

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RE-ENERGISING through

Clinical Supervision

O YOU FEEL emotionally drained from your nursing or midwifery practice? Do you have dedicated time to reflect on your practice?

Many in the health sector, particularly those engaged in mental health services, have been experiencing the benefits of regular clinical supervision for many years.

Clinical supervision might be just what you need to re-energise, gain insight into your work, and support the provision of quality care.

Experienced Mental Health Nurse and CSC co-facilitator Julie Sharrock said nursing and midwifery is emotional and relational work.

Clinical Supervision Consultancy (CSC) will be offering ‘Clinical Supervision for Role Development Training’, to be held at the QNMU Brisbane office across a number of days in 2020. The eight-day foundational program equips potential clinical supervisors with a variety of techniques and approaches to conduct quality individual and group clinical supervision.

What is clinical supervision? Endorsed Midwife/Registered Nurse and CSC co-facilitator Tamzin Mondy described clinical supervision as a regular dedicated time for reflection on all aspects of your professional practice. It is not about debriefing or being ‘supervised’ by a senior clinician. “It’s an opportunity to take care of yourself, to consider those aspects of your professional role that are challenging you, to find new ways of ‘being’ and to remind yourself of your reasons for entering the caring professions,” Ms Mondy said. At the heart of clinical supervision is a trusting relationship between the supervisor and supervisee, which allows personal and professional development through regular reflection. The course provides participants with a range of techniques to assist this reflection process.

“For me, in order to do that work as well as possible, I need to keep one of my therapeutic instruments in tip top shape - that’s myself,” Ms Sharrock said. “I need to be able to sit with a patient and not come undone. “Bearing witness to human suffering and human resilience is a privilege but it is not without its dangers. “I have no doubt that a key component to not only surviving but thriving in clinical practice has been good clinical supervision.” Clinical supervision enables clinicians to remain physically and emotionally healthy and committed to their professional work.

Training details: 68 CPD hours Participants must attend all eight days: ◆◆ Session 1: 24, 25, 26 March 2020 ◆◆ Session 2: 7, 8, 9 July 2020 ◆◆ Session 3: 6, 7 October 2020 QNMU Brisbane office $3,300 (including GST) with ‘pay as you go’ option To register your attendance or for more information, email paul@spurrcsc.com or tmondy@outlook.com

REFLECTIVE QUESTIONS 1. The term clinical supervision means different things to different people. What is your understanding? 2. What has been your experience of clinical supervision as a regular protected time for in-depth reflection with a facilitator/supervisor? 3. What support do you need to sustain and develop your professional practice? How might you explore clinical supervision as an option? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Sepsis: A medical emergency

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EPSIS is a life-threatening illness that can result in death unless treated immediately. Every year at least 18,000 Australians are diagnosed with sepsis, 5,000 of whom die1. For those who survive, half are left with long-term permanent disability, including limb amputation and brain injury. The cost of sepsis to Australia is not currently known but is estimated to exceed $1.5 billion1. Nurses and midwives are well placed to detect sepsis early and initiate the necessary treatment required, so it is important that you understand:

■■ people with a wound or who have just had surgery

■■ Rash that doesn’t fade when pressed

■■ people of Aboriginal and Torres Strait Island, Pacific Island and Maori descent.

■■ Drowsy or difficult to rouse

The first priority when considering sepsis is trying to avoid it altogether by avoiding infections. There are a number of considerations here. Nurses and midwives should: ■■ practice good hygiene and hand washing ■■ keep wounds or cuts clean until fully healed ■■ provide advice to patients regarding care of any infections

■■ who is at risk of developing sepsis

■■ get vaccinated.

■■ how to avoid the onset of sepsis

The next step is identifying the symptoms of sepsis which differ between adults and children.

■■ how to recognise the signs and symptoms of sepsis ■■ what to do when you recognise that someone is septic and requires immediate intervention. Sepsis occurs when the body’s response to fighting infection triggers an abnormal response, which can damage multiple organ systems. Many types of germs can cause sepsis including bacteria, fungi and viruses. However, sepsis occurs most often in response to bacterial infections of the lungs, urinary tract, abdominal organs or skin and soft tissues2. Although sepsis can affect anyone at any time, those at higher risk include: ■■ pregnant women ■■ the very old and very young ■■ people with a weakened immune system ■■ people undergoing treatment for cancer or with other chronic conditions such as diabetes, kidney or lung disease

As Australia’s first Paediatric Sepsis Clinical Nurse Consultant, QNMU member Amanda Harley knows all too well the complexity of paediatric sepsis. “In children, symptoms of sepsis can initially be difficult to recognise as they mimic that of other, less serious illnesses such as gastro or flu,” Amanda said.

■■ Floppy ■■ Convulsions ■■ Poor urine output ■■ Parental or carer concern. For adults, symptoms can include one or more of the following: ■■ Extreme pain ■■ Rapid breathing ■■ Tachycardia ■■ Skin rash or clammy/sweaty skin ■■ Feeling hot or cold, chills or shivering ■■ New onset confusion, disorientation or slurred speech ■■ Diminished urine output or anuria ■■ Weakness or aching muscles. If nurses and midwives suspect sepsis, escalate these concerns immediately to a Senior Medical Doctor and ask, “could this be sepsis?” When sepsis has been confirmed, early commencement of antibiotics is key. Other interventions may be required depending on the presence of and level of organ damage.

“But children and babies will deteriorate much faster than adults, so it is vital to put the puzzle pieces together quickly and always listen to parental and carer concern as they know their child best.

Clinical Excellence Queensland is working with a number of key partners to develop best practice models for the early recognition and treatment of sepsis in children and adults.

“Early recognition and treatment of sepsis saves lives.”

A range of resources are available to assist clinicians to recognise sepsis and raise awareness of sepsis in their workplace.

Amanda said the signs and symptoms of paediatric sepsis can include one or more of the following: ■■ Unexplained pain or restlessness ■■ Rapid breathing or heart rate ■■ Pale or discoloured skin ■■ Feels abnormally cold to touch

References

1. The George Institute for Global Health. 2017. Stopping Sepsis: A National Action Plan. https://www.georgeinstitute.org.au/sites/default/files/ documents/stopping-sepsis-national-action-plan.pdf 2. Queensland Health Sepsis factsheet for adult patients and families

For further information contact sepsis@health.qld.gov.au or visit www.clinicalexcellence.qld. gov.au and search ‘sepsis’.

REFLECTIVE QUESTIONS Reading and reflecting on this article may count towards your continuing professional development. Be sure to record the hours on your Record of CPD at www.qnmu.org.au/CPD

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Your rights and responsibilities when accessing patientsâ&#x20AC;&#x2122; health records

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ITH THE steady introduction of electronic systems across many Queensland hospitals — including Queensland Health’s integrated electronic Medical Records (ieMR) — there is a renewed focus on nurses and midwives’ rights and obligations with respect to accessing patient records. These electronic systems allow relatively quick and simple access to a large body of clinical information. But with this access comes the potential for staff to unintentionally or inadvertently access records of patients they do not have a legitimate clinical reason for viewing.

Your professional obligations Nurses and midwives have certain professional obligations regarding access to clinical records of patients or residents while performing their duties at work. The general rule is: nurses and midwives should not access, view, read or share a patient’s medical records unless there is a legitimate clinical reason to do so, (i.e., you are involved in the care of the patient) or you have been directed to do so by management in order to perform your duties. In the course of your work, you will often have access to sensitive personal and medical information. The professional therapeutic relationship between nurse/midwife and patient/resident requires that this information only be used for the purpose of providing nursing or midwifery care to that patient or for another legitimate clinical reason. The QNMU regularly receives enquiries from members regarding allegations of unauthorised access to the clinical records of partners, family or friends who are receiving care at their workplace.

Audits To identify instances of unlawful or unauthorised access to the medical records of relatives, your employer may perform routine audits of employee access to patient records. Audits may be performed to crossmatch access by those with the same family name as patients. While it is human nature to want to ensure your loved ones are receiving the best care while in a health care facility, curiosity or concern are not legitimate clinical reasons for

accessing their clinical records in the course of your duties. Employers may also perform audits of access to the electronic clinical records of high-profile patients (such as media personalities or patients who have committed criminal offences), current or former employees. These audits are designed to ensure that the records of these patients are only accessed by those employees who have a genuine clinical reason to do so.

Remember to log out! If your employer’s electronic record system requires you to log in before using it, it is important to remember to log out each time you finish using it, even if you are simply walking away from the workstation to perform another task. It is also important to only ever use your own log in details to use the system. If others use your log in details to access ieMR or other electronic record systems, you may be held responsible for any improper actions they perform. If you have any concerns about using the ieMR system, including the practicalities of logging in and logging out in your work environment, raise them directly with your manager. You may also wish to discuss issues with your QNMU Workplace Representative.

Other obligations In addition to your professional obligations, nurses and midwives are also required to comply with their employer’s policies and procedures or legislation regarding access to patient records. These policies will normally detail the circumstances under which a nurse, midwife or other health professional can read or otherwise access a patient record. There are numerous sources of information detailing your rights and responsibilities regarding access to patient records (including electronic records). For QH employees, the following documents provide important guidance: ■■ Queensland Health Discipline Policy E10 ■■ Code of Conduct for the Queensland Public Service ■■ Public Sector Ethics Act ■■ Department of Health Use of ICT Services Policy (check QHEPS regularly for the most up to date policy details) ■■ Hospital and Health Boards Act (Qld) (2011) ■■ National Privacy Principles

REFLECTIVE QUESTIONS 1. What is the process you undertake at work when logging in and logging out of your employer’s electronic record system? What could you do to ensure nobody else accesses your account? 2. Why is it necessary for nurses and midwives to not access the medical records of a loved one who is receiving care from another nurse or midwife? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Making decisions?

THE NMBA’S FRAMEWORK IS HERE TO HELP

AVE YOU read the Decision-Making Framework (DMF) for nursing and midwifery lately? It may not make for the most riveting reading, but it is very important for nurses and midwives to be across it.

The DMF provides guidance specifically on delegations for health workers and students.

The Nursing and Midwifery Board of Australia (NMBA) has released an advance copy of the new framework.

A significant increase in nursing and midwifery students (which is crucial for our professions to grow) means that it is very uncommon for there not to be one on placement and on our shift. This framework gives excellent guidance for Registered Nurses and Midwives when supervising and supporting students safely. QNMU members are encouraged to read page 10 of the framework.

The advance release, accessible on the NMBA website, is something nurses and midwives are obligated to familiarise themselves with and practice accordingly. The decision-making flowchart, which should be used when making decisions regarding delegation and scope of practice, on first glance appears to have had some cosmetic rebranding and a “nip and tuck”. But on further examination, you will find some significant and important changes within the framework specifically. Important additional inclusions within the framework include language and concepts such as: ■■ cultural safety ■■ person-centred/woman-centred care ■■ health care workers ■■ person receiving care. As professionals, nurses and midwives juggle the enormity of their obligations, accountabilities and responsibilities in adhering to and practicing within the standards, codes, guidelines and professional practice frameworks. (This is why we are all so exhausted!) Practicing in a professional and safe way with the guidance of the DMF becomes increasingly challenging, when insufficient staffing and inadequate skill mix is on the rise. But ultimately, we are accountable, so we need the support of the framework to make the right decisions. The revised DMF document calls out the responsibilities for employers of nurses and midwives and states in bold, “The substitution of health workers for nurses or midwives must not occur when the knowledge and skills of nurses or midwives are needed”. This substitution, which unfortunately can be the lived experience of many nurses and midwives, can often cause great moral and ethical distress when trying to delegate safely.

This is important recognition of the current nursing and midwifery workforce.

Principles of decision-making There are also a number of new additions to the principles of the DMF. These principles “support the provision of safe, personcentred/woman-centred and evidence-based care and, in partnership with the person/woman, promote shared decision-making and care delivery in a culturally safe and respectful way” (page 4 of the DMF). The need for feedback from those receiving nursing and midwifery care is one of those changes, and aims to promote culturally safe health services. Gaining consent from the person or woman receiving care is also a new principle outlined in the framework. To assist in feeling informed and empowered in your ability to practice safely and professionally, the QNMU encourages all members to read the DMF at https://bit.ly/34uG2mI/

REFLECTIVE QUESTIONS 1. What does it mean to you when asked to practice in a culturally safe and respectful way? 2. When do you find it is most useful to use the DMF and why? 3. As nurses and midwives, why do we need to use the DMF when we practice? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

caring

The art and

HE QNMU identifies four core professional values that underpin nursing and midwifery. They are advocacy, holism, professionalism and caring. What distinguishes the professional caring of nurses and midwives is that it brings together art and science. Empathy and connectedness involve a relational exchange between the nurse or midwife and the patient*. The value of human care involves a sense of self identity and spirit of the person1. Nursing and midwifery are indispensable, knowledgeable human caring2. In her 1996 paper, Falk Rafael said, “Recognising nursing expertise requires making visible nurses’ contribution to healing that are often invisible to themselves and others and resisting the temptation to look outside nursing for answers to nursing questions”3. Surveillance by a nurse or midwife engages and utilises emotional and spiritual power along with technical knowledge to benefit the patient. A recent US study5 may be a demonstration of this where a ‘nurse’s worry’ score has been shown to be more predictive of physiological deterioration than early warning tools, which are based on technical assessments of vital signs. Nurses and midwives seamlessly use multiple forms of knowledge and self – it is our presence and proximity as well as what we know that has impact. Care involves ethics, knowledge and technical skill, but it’s also about holding space so individuals can heal themselves safely. Sometimes caring requires us to fiercely push back on the system or decisions that might cause neglect or actively cause harm to the person.

science of

Caring is about knowing when to intervene and when to sit on one’s hands, watch and listen. Rafael’s examination of the concepts of power and caring suggests a nurse or midwife cannot care properly without exercising power. Importantly, this is not “power over” - it is power that enables others, based on respect for and connection to others. Midwife means “with woman” and similarly for nurses, “being with” the patient involves being emotionally connected4. The empathy and emotional connection derived from being an authentic presence with our patients is what enables healing. Nursing or midwifery expertise is a power that frequently has a transformative influence on patients’ lives and we should all recognise, value and exercise the power of our practice. *Use of patient to include women in maternity care and residents in aged care.

Sandra Eales QNMU Assistant Secretary

References

1. Watson J (1988) Nursing: Human science and human care. New York, NY: National League for Nursing. 2. Volp, K 2007 ‘Defending nursing in your workplace: Quality Workplaces = Quality Patient Care’ The Queensland Nurse. Vol. 26, no. 3, pp 8 – 9 3. Falk Rafael, Adeline 1996, Power and Caring: A dialectic in Nursing’ Advances in Nursing Science 19(1): 3-17) 4. Swanson K (1991). Empirical development of a middle range theory of caring, Nursing Research, May/June 40: 161-165. 5. Santiago Romero-Brufau, Kim Gaines, Clara T Nicolas, Matthew G Johnson, Joel Hickman, Jeanne M Huddleston, The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours, JAMIA Open, , ooz033, https://doi.org/10.1093/ jamiaopen/ooz033

REFLECTIVE QUESTIONS 1. Provide an example of when it might be appropriate for nurses and midwives to “push back” on decisions regarding a patient’s safety. How might you go about doing this? 2. Explain what you believe to be the difference between “power over” (as quoted in the article) and power that enables others. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

Standing up for mental health

in view

Well done to our members in Townsville, who are now Guinness Book of World Record holders! A whopping 2,499 people in Townsville (including QNMU members) donned high-vis vests to raise awareness on World Mental Health Day (10 October 2019) and to send a strong message - that sometimes itâ&#x20AC;&#x2122;s OK not to be OK.

BOOK PRIZE WINN ER

Theyâ&#x20AC;&#x2122;ve successfully broken a world record for â&#x20AC;&#x2DC;most people wearing high-visibility vests at a single venueâ&#x20AC;&#x2122;. Great job! Photos: Jo Konings.

Supporting our ratios campaign Thank you to Queensland Deputy Premier Jackie Trad for supporting our vital Ratios Save Lives and Money campaign. Our PA Hospital members were proud to show Jackie the results of a world-first evaluation of ratios, proving that ratios have already saved precious lives, saved health care dollars, and helped us deliver high quality nursing.

Caring better Congrats to Brisbane Womenâ&#x20AC;&#x2122;s Correctional Centre Nursing Team (pictured with QNMU Secretary Beth Mohle). They took home the â&#x20AC;&#x153;Caring better for consumersâ&#x20AC;? Award at West Moreton Healthâ&#x20AC;&#x2122;s recent Excellence Awards, in recognition of their outstanding commitment to making West Moreton Health a safe place for consumers and members of the local community. Well done team! đ&#x;?˝

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It’s an alpaca-lypse!

in view

We were so lucky to get in some cuddles with the now-famous alpacas Ed Shearan and Dame Edna from Mountview Alpaca Farm when they visited Logan Hospital recently! QNMU members and staff alike took the opportunity for some always-welcome pet therapy.

Lorraine Stevenson

Nicola Hall

Students rock! QNMU student member Isabella Holledge (and pup!) were pleased to show off the new James Cook University Student Society t-shirts, co-branded with the QNMU! We’re proud to have sponsored the student society this year and look forward to continuing to collaborate with our wonderful student members.

Star branch – Bundaberg Hospital As winners of the QNMU’s Star Branch Award, the QNMU sponsored our Bundaberg Hospital Branch in hosting its first ever Health Expo! It was a great turn out with plenty of stall holders with healthy tips and tricks, and fabulous guest speakers who provided well-received advice on how we can all take better care of ourselves amid our busy work schedules. A stellar example of what can be achieved by our fantastic branches.

CQHHS nursing staff recognised Thumbs up to Rockhampton Hospital nursing staff on their Service Awards, presented by Chief Nursing and Midwifery Officer Shelley Nowlan. Well deserved... there’s a whopping 135 years of service between the seven recipients of the awards. Well done all!

incoming On Aged Care Minister Richard Colbeck saying he does not support ratios for aged care (ABC Q&A) MG Studies show that nursing ratios work in hospitals and other health care settings and that increased RN ratios reduce the amount of errors and accidents. Why donâ&#x20AC;&#x2122;t our aged care clients deserve the same care? Like Âˇ Reply

TT Iâ&#x20AC;&#x2122;m not even surprised. Weâ&#x20AC;&#x2122;ve been waiting for this for years. How much more evidence is needed? Like Âˇ Reply

KAJ A registered nurse on site should be mandatory too. Like Âˇ Reply

JC How can high quality care be provided if the staff donâ&#x20AC;&#x2122;t have the time due to a lack of appropriate staffing numbers? Like Âˇ Reply

On Blue Care slashing nursing hours JB The care went out of Blue Care a long time ago. Great staff, poor managers. Like Âˇ Reply

DE This is so disgraceful, why are they continually dropping hours for staff but ratios increase per staff to patient. Like Âˇ Reply

KW Shame on you yet again Blue Care, your staff are your most important assets. Eventually, it will come back to bite you. Blue Donâ&#x20AC;&#x2122;t Care

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Like Âˇ Reply Aged Care Minister Richard Colbeck

BH Says people who have never worked a minute in the industry... ratios would make a vast difference! Like Âˇ Reply

MM When the Minister says â&#x20AC;&#x2DC;the evidence we haveâ&#x20AC;&#x2122;, what he actually means is what the aged care provider lobbyists have told him. If he bothered to speak to a medical professional who actually knows a thing or two about the clinical care of our elderly, he would arrive at a totally different view.

SS Are we really even surprised? Even with the royal commission, most managers still do not agree with ratios. Workloads are just shifted around and staff become even more task oriented and less resident focused. Like Âˇ Reply

Blue Care Toowoomba management wants to SLASH nursing hours and make nursing staff redundantâ&#x20AC;Ś

SHARE to say

Like Âˇ Reply

ST P CUTS THE

On the QNMU calling for an urgent review of EDs JO I would wholeheartedly support this. Like Âˇ Reply

PO Not to mention the poor understaffed nurses, doctors and administration and operational staff in these departments and all areas of hospitals. Like Âˇ Reply

JN Itâ&#x20AC;&#x2122;s a flow on. EDs are pushing patients into wards beyond their ability to cope [and] pushing workloads to be unsafe. Like Âˇ Reply

LD Not just the Emergency Departments. The flow on effect to the rest of the hospital is huge! Like Âˇ Reply

ALB EDs donâ&#x20AC;&#x2122;t have any ward beds to put patients because there are too many patients waiting for community supports and aged care beds. Also, patients are becoming more and more reluctant to go into aged care because of the cost, so they bounce in and out of hospital. Like Âˇ Reply

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JOIN THE CONVERSATION Follow our social media pages and be a part of the conversation on hot topics and whatâ&#x20AC;&#x2122;s important to nurses and midwives.

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incoming ONTH COMMENT OF THE M Ratios is a start… It ensures a minimum standard or benchmark to work from. If ratios don’t work why are they implemented in childcare, schools or public hospitals [that] have the same complex needs? The real victory we had with the new legislation in QLD was not set ratios but the transparency of ratios. RC

On higher penalty rates in the Nurses Award thanks to QNMU’s FWC appeal PQ Congratulations QNMU team and members. Interstate officials have been passing comment on this awesome win that will boost rates for a whole swathe of well deserving workers. Like · Reply

GKC Once again QNMU wins a battle. Why wouldn’t you be a member? Like · Reply

DB Fantastic news. Well done to everyone involved.

Letter to the Editor I’ve been that girl, who had to shovel tablespoons of food into people’s mouths because they have five minutes to eat a meal. Doesn’t matter if it’s breakfast, lunch or dinner... open, shove, open, shove... or get into trouble and have your job threatened. I’ve been that AIN or PC (however titled) who has had unrealistic time restrictions, because God forbid you don’t get everything done. I’ve had beds stripped after they’ve already been made because the CNC didn’t like my caring attitude. I was the girl who breached time management because I had to wake up somebody’s grandmother, undress them, shower them, dry them, dress them, make their bed, tidy their room AND have them at the breakfast table… in just six minutes. I was the girl who was told at lunch time that I had to reverse the morning pad so we could catch more urine “on the other side” to make the pads last. I saw that CNC get a $5000 bonus for coming under budget with pad use. I also saw more excoriation, more products needed, had to almost sign my name in blood for using an “interim pad” because the morning pad was soiled, and I couldn’t turn it around. I’m the girl that got in a load of trouble for going against orders and using the midday pad… at midday. I’ve been threatened so many times it doesn’t scare me anymore. I am also an RN now and thankfully, no longer work in aged care because the pay is so bad I can’t afford to work in an area I love. I can’t make a difference. I’ve been there. I worked the floor. It broke my heart. Aged care is a business. When the business gets in the way of caring that’s where it all goes so very, very wrong. It is a broken system from the get-go. Change that and our older people will get some dignity and support. Anonymous QNMU member

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CALENDAR 56th World Advanced Nursing and Nursing Practice Congress

February Australian Primary Health Care Nurses Chronic Disease Management and Healthy Ageing workshop 6 February, Brisbane www.apna.asn.au/events

Queensland Children’s Hospital

Emerging Management Therapies for Childhoood Neurodevelopmental Disorders 6-7 February, South Brisbane www.eventbrite.com.au/e/ emerging-management-therapiesfor-childhood-neurodevelopmentaldisorders-registration70094980975?aff=ebdssbdestse arch

24-25 February - Tokyo, Japan https://nursing.nursingmeetings.com/

March

12-13 February, Sydney https://midwifery.nursingconference. com/

The Well Shift

Brisbane Graduate Nursing and Midwifery Graduate Application workshop 22 February, Brisbane 23 February, Brisbane www.eventbrite.com.au/e/brisbanegraduate-nursing-and-midwiferygraduate-application-workshoptickets-83121058323?aff=ebdssbd estsearch

Australian Primary Health Care Nurses 2020 APNA National Conference 21-23 May, Sydney www.apna.asn.au/conference

QNMU Meeting of Delegates

3 March - Brisbane 5 March - Sunshine Coast 10 March - Gold Coast 17 March - Bundaberg 18 March - Maryborough 24 March - Townsville 25 March - Cairns 30 March - Rockhampton 31 March - Mackay www.qnmu.org.au/mod

Australian College of Perioperative Nurses

1 April - Toowoomba www.qnmu.org.au/mod

ACORN 2020 International Conference 28-30 May, Sydney www.acorn.org.au/conference-2020

Australian College of Nursing

Nursing & Health Expo 4 April, Melbourne www.acn.edu.au/events/nursinghealth-expo

International Council of Nurses (ICN) Workforce Forum

International Women’s Day 5th Commonwealth Nurses and Midwives Conference 6-7 March, London UK www.commonwealthnurses.org/ conference2020

Australasian Institute of Clinical Governance (AICG)

AICG Inaugural Patient safety & quality care symposium 26 March, Melbourne https://anmj.org.au/event-directory/

PharmaceuCare - Australasian Conference on Pharmacy Practice 2020 28 March, Melbourne

13-15 May, Lovedale, NSW https://criticalcarevineyards.com.au/

April

QNMU Meeting of Delegates

6 March - Nationwide

9th Midwifery Nursing Conference

15th Annual Critical Care Conference in the Vineyards

http://pharmaceucare.com/ australasian_conference_on_ pharmacy_practice_2020/ australasian_conference_on_ pharmacy_practice

State of the World’s Nursing and Year of the Nurse 21-22 April, Stockholm www.icn.ch/events/workforceforum-april-2020

July QNMU Annual Conference 15-17 July, Brisbane

May Labour Day (QLD) 4 May - Queensland

International Day of the Midwife 5 May - Nationwide

World Nursing Congress 2020

Integrating the Milestones in Nuirsing and Healthcare 13-14 May, Tokyo, Japan https://nursingcongress. nursingconference.com/

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

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

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This information is about products and services available to you as a Queensland Nurses and Midwifery Union member. QNMU and ME are not agents or representatives of one another. QNMU does not accept responsibility or liability for any loss or damage caused by the products or services provided by ME. QNMU does not receive any commissions as a result of members using ME products and services. Terms, conditions, fees and charges apply. Applications for credit are subject to approval. This is general information only and you should consider if these products are right for you. Members Equity Bank Ltd ABN 56 070 887 679 Australian Credit Licence 229500.

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Our record speaks for itself IN 2018/19, THE QNMU: Assisted 45,000 members through our Member Connect call centre Provided expert representation for 3442 members Recovered $2.05 million for members Assisted 185 members with WorkCover claims Provided legal representation for a further 252 members including representation for coronial investigations and coronial inquests Provided legal representation for 260 members responding to OHO or AHPRA notifications or investigations QNMU member Julia Suarez