InScope No6 Winter18 by Queensland Nurses and Midwives' Union

The official journal of the Queensland Nurses and Midwives’ Union

Winter 2018

QNMU’S

SECRET AGED CARE AUDIT

AMERICA'S GUN VIOLENCE EPIDEMIC PLUS! CPD CONTENT ON MEDICATION MANAGEMENT, AHPRA AUDITS & MORE

D N D N U O R

QNMU Scholarships now open

After a review and revamp, we’re pleased to announce our 2018 scholarship program.

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

SCHOLARSHIPS AVAILABLE NOW: ■■ Aboriginal and/or Torres Strait Islander nurse/midwife scholarship – $3000 awarded whole or in part to an Aboriginal and/or Torres Strait Islander QNMU member to enhance their professional skills through appropriate study. ■■ Undergraduate book bursary – 8 x $500 book bursaries to undergraduate nursing and midwifery students, with the aim of relieving some of the financial pressure for these students. ■■ Postgraduate book bursary – 1 x $500 book bursaries to Enrolled Nurses and Registered Nurses and Midwives engaged in postgraduate studies relevant to their professions. ■■ Pat Nichols Bursary – $500 to advance diabetes education and promotion by supporting a member in this field. We’ll have more scholarships on offer later in the year, so keep an eye out in future journals and qnews. All financial QNMU members are welcome to apply.

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

APPLICATIONS CLOSE WEDNESDAY 11 JULY 2018.

Winter 2018

INDEPTH

The health epidemic America is ignoring

THE OFFICIAL JOURNAL OF THE QUEENSLAND NURSES AND MIDWIVES’ UNION ISSN 2207-6018 ABN 84 382 908 052 106 Victoria Street West End Q 4101 (GPO Box 1289 Brisbane Q 4001) T 07 3840 1444 1800 177 273 (toll free) F 07 3844 9387 E inscope@qnmu.org.au W www.qnmu.org.au EDITOR Beth Mohle, Secretary, QNMU PRODUCTION QNMU Communications team: Linda Brady, Melissa Campbell, Stephanie Lim, Lou Robson, Luke Rutledge PUBLISHED BY The Queensland Nurses and Midwives’ Union AUTHORISED BY B. Mohle, Secretary, Queensland Nurses and Midwives' Union, 106 Victoria St West End 4101. PRINTED BY Kingswood Print Signage, 80 Parramatta Rd Underwood 4119

INDEPTH

CPD

13 14 16 19

Offender health – time for action

20 24 30 32 36 42 44 46

QNMU's aged care audit reveals shocking truths

49 50 51 52 56 58 59

It's time we talk about Superannuation Nurses on my doorstep Accessing quality mental health services in rural and remote Australia

The health epidemic America is ignoring In solidarity with our New Zealand friends The gift of life Food for thought Change the rules

60 64 52

REGULARS Free flu vaccinations for kids Australian team fosters nursing research Re-energising through clinical supervision Medication management: How do the sectors compare? Midwives and managing medication What to expect when audited by AHPRA

INSIGHT

TEA ROOM

IN MEMORY

WINS

JUST IN

YOUR $ HEALTH

LIBRARY

Increasing the power of the Health and Safety Representative

INCOMING

Consent and Capacity

IN VIEW

Are you 80% sure your patient needs that PIVC?

CALENDAR

ADVERTISING

Put another nail in my coffin No more nukes

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

Front cover: QNMU member Cherise Matthews and her mother Kerrie

insight

Ensuring end-of-life dignity for our elderly Sally-Anne Jones QNMU President

NTERNATIONAL Nurses Day this year, apart from being a great time to take a breath and celebrate the nursing profession world-wide, marked the launch of an unprecedented nation-wide Australian Nursing and Midwifery Federation public awareness campaign calling on federal politicians to legislate staff ratios in aged care. The ANMF stood united with members of all State and Territory Branches and community supporters at simultaneous events across the nation drawing attention to the crisis in aged care and sending a message to all federal politicians to act. Our Ratios for aged care: Make them law now! campaign highlights how fewer nurses and carers are expected to care for an increasing number of nursing home residents with complex needs. Research shows nursing home residents are receiving 2.6 hours of nursing care per resident per day. This is well below the 4.3 hours they should be getting, illustrating how in the absence of mandated ratios, inadequate staffing levels are putting the lives of our elderly at risk. For those of us who work in clinical environments that are not in residential aged care, it is difficult to imagine the stress these workers feel. Anecdotal reports shared by those in aged care speak of sadness, guilt and anger at not having enough time to complete tasks, and that poor skill mix prevents supporting training and care environments. With Australia’s ageing population, as well as increased life expectancy and longevity, there is growing demand for aged care.

Australia’s aged care sector is under pressure to meet this growing demand while at the same time facing significant recruitment and workforce challenges. For example, half the current aged care workforce will retire in the next 15 years. While there are many who advocate for increasing care of the elderly in their own homes with tailored care packages, there is no doubt that residential care facilities are the only place to go for many who are the frailest or suffer from debilitating physical or mental conditions. For these residents, aged care facilities are the only place where they can receive the 24 hour nursing required to manage the symptoms and facilitate quality of life… and some of that nursing is intensive. I don’t mean in the critical care sense. I mean that many hours of nursing are required to attend to hygiene needs, assisting with or actually feeding, administering medications and monitoring for effect, physical therapy, providing company, adding meaning to life and attending to the basic human needs of security and belonging that can only be conveyed through the touch of human hands and time spent together. It is an indictment on our society that nursing is not valued enough to ensure there are adequate staff for each resident to receive the caring support to ensure the last fragile years of someone’s life are dignified. Ratios for aged care. Make them law now!

QNMU COUNCIL secretary :

Beth Mohle

assistant secretary : president :

Sandra Eales

Sally-Anne Jones

vice president :

Lucynda Maskell

councillors :

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

insight

for a fairer society Beth Mohle QNMU Secretary

HIS MAY has been a busy month for our union.

In addition to our usual activities around International Day of the Midwife, International Nurses Day and Labour Day, we also launched our national aged care campaign for legislated minimum staffing ratios. In Queensland, we were able to showcase our aged care campaign across the state at local Labour Day celebrations. The theme for this year’s Labour Day for all unions was Change the Rules — an ACTU campaign that aligns with the themes and objectives of our own campaign to change the rules in aged care. The ACTU’s Change the Rules campaign aims to restore fairness in so many spheres of our lives and refocus us on what really matters. Whether we look at this from a societal or economic perspective, the priorities are out of whack. The growth in wealth and income inequality in Australia and around the world is so pronounced, with the top 1% of Australians owning more than the bottom 70%.

and a productive economy — are under significant stress. This is a core role for government. We give effect to our commitment to each other through the provision of high quality public services for all based on need and not capacity to pay. And, of course, there has been a concerted attack on penalty rates, the first cuts occurring in the hospitality and retail sectors. We know that if penalty rates are cut in one part of the economy it will easily flow on to other areas, including nursing and midwifery, where penalty rates make up 20 – 30% of our income. The Change the Rules campaign not only highlights these problems but also identifies solutions. It is a campaign that will hold all political parties accountable and one that will continue until our objectives are achieved. The QNMU has started this work with our International Nurses Day audit of 70 aged care facilities in each of Queensland’s 30 federal electorates (see page 20 for more details). This audit was a perfect example of the advocacy role nurses, midwives

and carers can play to advance health care for all as a basic human right. The lack of nursing in aged care — as shown through the audit results — is an assault on this human right. The audit found almost 80% of those surveyed said staffing levels at their workplace were unsafe. This is a national disgrace. How we look after our most vulnerable defines us as a society. Our elderly Australians deserve better and we will be vigorously lobbying every federal politician in Queensland to tell us how they are going to fix our broken aged care system. Advocacy for our most vulnerable requires more than words, it requires action. We need your help to make aged care a major focus for the next federal election. Join our campaign in your local community and join the movement to change the rules and make ratios in aged care a reality. For more information on the Change the Rules campaign, see page 42.

Profits are booming for big business, while wages growth in Australia is at almost record lows, and household debt is amongst the highest in the world. Job security is a thing of the past for so many, with the increasing ‘Uberisation’ of work and growth of sham contracting arrangements. Our industrial relations system is broken — the rules are skewed against working people. Quality public services in areas such as health, aged care and education — the key underpinnings of a fair society

Labour Day March Brisbane 2018. Left to right: ACTU Secretary Sally McManus, QNMU Secretary Beth Mohle and QCU General Secretary Ros McLennan.

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.

My employer wants to cut my hours. What are my rights? Employers often try to reduce staff hours or change rosters, which can create uncertainty, and affect your income and the care you provide. While employers are entitled to propose changes, there is a process to follow, and you do have rights.

Varying your hours

Generally, if you are not a casual employee any variation to an employment contract must be by mutual agreement. This means you do not have to agree to cuts to your hours. Sometimes cuts are proposed as a measure to reduce the need for redundancies or other measures, which is why proper consultation and good communication are so important.

Consultation and representation

Whether you’re under an award or an Enterprise Agreement (EA), you have the right to be consulted and to be represented by the QNMU. You have the right to receive detailed information about the proposed changes and an opportunity to give your feedback, and management has an obligation to genuinely consider your feedback before making a decision. You also have the right to be represented by the QNMU at any stage in the process. If you have a meeting scheduled with management, the QNMU can represent you either individually or as a group.

What you need to do

If cuts to your hours are proposed you need to contact your QNMU Organiser immediately so we can advocate on your behalf. Members often contact the QNMU after they have already signed new contracts authorising cuts to hours, by which stage there is very little the union can do. If you have questions for our Tea room column email memberconnect@ qnmu.org.au

Make sure you have a copy of your agreed hours, especially if you work part time. If you have not retained this from the time you started employment you can get this from HR or payroll. If you are employed full

time then you are employed at the hours specified in your EA or award. Finally, encourage your colleagues to resist signing until a proper consultation process has been conducted. By acting collectively you can achieve better outcomes for yourself, your colleagues, and your patients and residents.

Bullying and harassment – what do the new Codes of Conduct say? Members often require the QNMU to assist with bullying related matters. The new NMBA Codes of Conduct — released in March 2018 — contain the following information on bullying and harassment. We encourage members to be familiar with their professional requirements. When people repeatedly and intentionally use words or actions against someone or a group of people, it causes distress and risks their wellbeing. Nurses understand that bullying and harassment relating to their practice or workplace is not acceptable or tolerated and that where it is affecting public safety it may have implications for their registration. Nurses must: a. never engage in, ignore or excuse such behaviour b. recognise that bullying and harassment takes many forms, including behaviours such as physical and verbal abuse, racism, discrimination, violence, aggression, humiliation, pressure in decision-making, exclusion and intimidation directed towards people or colleagues c. understand social media is sometimes used as a mechanism to bully or harass, and that nurses should not engage in, ignore or excuse such behaviour d. act to eliminate bullying and harassment, in all its forms, in the workplace, and e. escalate their concerns if an appropriate response does not occur. Keep an eye out for a more in-depth article on bullying and harassment in a future edition of InScope.

in memory

QNMU mourns the loss of much loved friend Gay Hawksworth QNMU Secretary 1995-2011

HE QNMU lost a much loved and respected friend this month with the sudden passing of former Secretary Gay Hawksworth. News of her passing has shocked and saddened her QNMU family, none more than her friend and colleague, and current Secretary Beth Mohle. “Gay was an inspirational and courageous nurse unionist and leader,” Beth said. “She was a true and fierce advocate for nurses and midwives and as Secretary she positioned our union strategically so that it grew to become the largest union in Queensland. “Gay was also a magnificent comrade, friend and mentor… I often sought her wise counsel on many issues and she was always keen to hear the latest news.” “I can’t thank her enough for all she did for nursing, midwifery, the union movement and to improve the health of the wider community… I will miss her dearly.” Gay was Secretary of the (then) QNU from 1995 to 2011 but started working for our 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. And as Secretary,

she oversaw the introduction of many concepts that are now well embedded in our professional lives including the public sector EB process, 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. She also led the QNMU's charge against the Federal government’s WorkChoices legislation during the Your Rights at Work campaign, and squared up to the State Beattie Labor government during EB5 bed closures. And who could forget the Chunder Bucket Express that brought nurses and midwives down the coast from Cairns to Brisbane for a massive protest outside Parliament House. Our members closed hundreds of beds across the state because of unsafe workloads, as we languished amongst the country’s lowest paid nurses and midwives. The next agreement, EB6, ultimately saw Queensland nurses become amongst the highest paid and also saw the groundbreaking introduction of Professional Development Leave and Professional Development Allowance. 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. But it wasn’t all work no play with Gay. She loved sharing downtime with her colleagues and friends, and many QNU conference-goers will remember the joy she took tearing up the dancefloor to Abba’s Dancing Queen. Her love of a good glass of bubbly was also well known. Gay was so gregarious and she loved people. She was at home mixing with anyone from the Prime Ministers to a homeless person. Everyone was equally valued and respected. She had a particular love of QNMU activists, the lifeblood of our union, and was energised by spending time with those who shared her passion for advancing the interests of nurses and midwives and the health of our community. Since retiring in 2011 Gay’s health had not been the best but she remained a keen ally and supporter of her beloved union. She passed away in Brisbane on Friday, 1 June, 2018. Our love and thoughts are with her husband Peter, son James, her family and her wide circle of friends. She was a remarkable woman, friend and colleague and her passing has left us heartbroken.

wins

Midwives win big on the Gold Coast MIDWIVES working in the Women, Newborn and Children’s Service on the Gold Coast are celebrating a huge win for safer workloads after securing an additional 38 full-time equivalent cross the service. With ever increasing demand in birthing and newborn services, Gold Coast midwives and nurses were struggling to keep up with unmanageable workloads. Midwives, along with their nursing colleagues in the Newborn Care Unit, began submitting workload reporting forms, including detailed accounts of their shifts each time there was a workload concern. Midwives were particularly concerned about skill mix levels, especially with such a large cohort of early career midwives, and the lack of experienced staff to assist with the increased acuity of patients and unwell babies. The QNMU met frequently with hospital management and initially achieved some small wins in terms of extra staff, but it wasn’t enough to address the systemic problem of supply not keeping up with demand. The issue eventually progressed to a stage four grievance in accordance with the Queensland Health award, where each service profile covering all maternity and newborn areas was reviewed. Sure enough, each review demonstrated there were simply not enough midwives or nurses employed to deliver safe care within the Women, Newborn and Children’s Service.

What has been achieved? Thanks to excellent and open dialogue between members, management and the QNMU, each service profile has been updated to incorporate additional staffing for more balanced workloads. Significantly, management have committed to recruit an additional 38 FTE midwives and nurses across the entire service, a process that has already commenced.

Pictured, left to right: Emma Bateman, Rachel Campbell, QNMU Organiser Carol Lewis, Jenni Latter and Sue Hunt

There are also more Team Leaders on each shift, who will provide support for early career midwives, casual and agency staff, and will monitor workloads and source additional staff when required. Importantly, a reference group for the neonatal intensive care unit (NICU) has also been established to progress the growing need for more NICU cots along with additional staffing to meet the demands of this tertiary level service. This terrific outcome could not have been achieved without the full cooperation of all parties involved. Recognising that something needed to be done, management worked closely with us to reach a sensible solution — one that addressed members’ concerns and will make a real difference to providing high quality women and family centred care.

Thanks to excellent and open dialogue between members, management and the QNMU, each service profile has been updated to incorporate additional staffing for more balanced workloads.

wins

$308.2M PAID TO QUEENSLAND IN OUTSTANDING DEBT

THE FEDERAL government has finally admitted it owes Queenslanders significant funding for already budgeted health services. The admission followed months of Queensland nurses and midwives putting pressure on the federal government. The QNMU led a joint union awareness campaign (with United Voice and Together Queensland) which included a petition directed at Prime Minister Malcolm Turnbull. In April, the federal government agreed to pay Queensland $308.2 million for services delivered in the 2014-16 financial years. Thank you to the thousands who signed the petition — your voices were heard loud and clear.

Outstanding funding While this is a significant development and will ensure public health services can continue to be delivered, there is still a significant amount of money owed to Queensland. This initial $308.2 million is well short of the $1.12 billion the federal government owes. And while the government has always claimed this black hole does not exist, the commitment to pay $308.2 million is an admission that Queenslanders are being significantly ripped off.

ACORN standards enforced at Noosa Private HAVING QNMU Representatives in the workplace is one of the best ways to achieve workplace improvements … something Noosa Private Hospital learned recently. The hospital is in the process of brushing up on its ACORN standards thanks to the establishment of a new Consultative Forum. One of the criteria for establishing a consultative forum in the private sector is that there are QNMU Representatives in the workplace. After recruiting a new QNMU Rep (the first for this workplace), management established the first consultative forum meeting. It was at this meeting that the Rep, with the support of their local Organiser, alerted management to a QNMU newsletter outlining the ACORN standards expected by both the union and the nursing profession in peri-operative units. Management have since rostered an additional nurse on in the procedure room to meet ACORN standards, and

together with the QNMU have been working collaboratively to address other issues in the peri-operative unit. In a show of good faith, management also invited the QNMU Organiser on a tour of the peri-operative unit to introduce her to nurses and encourage union involvement amongst staff. Working collaboratively with management is how nurses prefer to get things done – it’s how we get the best possible outcomes for everyone involved. We hope this is a sign of more good things to come at Noosa Private.

Members paid correct Saturday penalty rates SOMETIMES all it takes is a simple email to remind management of your rights and entitlements. In the case of Sunnybank Private Hospital, management advised nurses they would not receive their penalty rates for attending education sessions, despite being directed to attend. The education sessions were held over a number of Saturdays, and totalled 15 hours for each member. Working with their QNMU Organiser, members escalated the issue to management and highlighted their correct entitlement. Fortunately, that was all it took for management to confirm staff would be paid the appropriate rate. While it’s not always that simple, sometimes that really is all it takes… especially when members act together! Additionally, the Sunnybank Private Hospital nursing consultative forum is about to reconvene, thanks to the fact that there are now numerous QNMU Reps. Well done to our members!

wins

Improving communication with management MEMBERS at an aged care facility on the Gold Coast have been working to establish better communication with management, after an inflammatory memo was circulated to staff. The memo, written by a non-nurse manager, was critical of nursing staff for their handling of various residents. Staff were rightfully offended by the memo’s unprofessional and derogatory tone, which failed to comprehend the issues at play. The QNMU helped members put their frustrations in writing and escalate the matter to management. Management listened and members have had their concerns addressed. And to ensure a situation like this doesn’t happen again, the QNMU has worked with members to begin establishing a workplace consultative committee — the most effective way to ensure proper communication between staff and management.

A message to aged care members Unfortunately, this is not an isolated example of aged care staff being wrongfully blamed for missed care. Only a few weeks ago, federal minister for aged care Ken Wyatt blamed nurses and carers for the problems in aged care. But nurses will not be blamed, shamed or intimidated into silence. Our Ratios for aged care campaign is gaining media and public attention, which is essential if we hope to convince our federal politicians to legislate ratios now. However, we understand that this level of public scrutiny can be distressing for those who are trying their best to provide quality care to residents. From the beginning, our message to the public has been clear:

none of the issues in aged care are the fault of nursing staff. The aged care system is broken. If you do witness anything you think should be reported, in the first instance report it to local management and contact the Aged Care Complaints Commissioner at www.agedcarecomplaints.gov. au, then the QNMU.

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

Unpaid meal breaks results in wage recovery IT PAYS to check you are receiving your correct entitlements when it comes to meal breaks. An RN has an extra $50,000 in her bank balance this month thanks to a successful QNMU wage recovery claim for missed meal breaks. The RN, who works in a small private facility, was often the only registered staff member rostered on during her shifts, meaning she was required to be available for duty during her meal break. Crucially, she was not allowed to leave the facility during that break. According to the Nurses Award 2010, “Where an employee is required to remain available or on duty during a meal break, the employee will be paid overtime for all time worked until the meal break is taken”. In reality, the member was never able to take a proper meal break. The QNMU argued the member was entitled to overtime rates for every hour worked until the end of her shift. The QNMU lodged an underpayment claim which the employer challenged, but after a strong fight the QNMU won the case and the member received her well-earned overtime.

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History remembered in Centaur anniversary

Fee increase TO ENSURE we continue to provide you with the best possible support and representation, QNMU Council recently determined to increase membership fees by 2.5% — in line with the average pay increase the QNMU has negotiated for members. As always, we aim to minimise any fee increase as much as possible. The increase takes into account the rising costs of operations and our capacity to deliver the services you need and expect, including expert industrial, professional and legal representation, as well as other benefits such as education and training, member publications, our expanded CPD resources, and hotline support.

THIS YEAR marks the 75th anniversary of the sinking of the Centaur, an Australian hospital ship that was attacked by a Japanese submarine during World War II. This year, Council approved the QNMU becoming a platinum corporate sponsor of the Centaur Memorial Fund for Nurses. The QNMU will donate $2000 a year, money that will go towards the fund, an organisation dedicated to the memory of nurses who have served in the Australian armed forces.

What happened in 1943? The Centaur only completed two voyages with patients before being attacked. The attack near Moreton

Island in South East Queensland — which was a war crime — killed 268 people, including nurses, doctors, field ambulance staff and crew. It was 4am when a torpedo struck the ship’s side, igniting a massive explosion that caused the ship to burn and sink within just three minutes. Only 64 people survived. Of the 12 nurses on board, only one survived — Sister Nell Savage — who was later awarded a George Medal for her “conspicuous gallantry”. Although badly injured herself, Sister Savage helped the other survivors during the day and a half of being stranded at sea. She even organised a sing-along to help lift peoples’ spirits.

Midwife of the Year

During a time of flat wages growth across the Australian workforce, it is those industries that have a strong collective voice at the bargaining table that continue to benefit from increased wages and conditions. This is largely due to their unions negotiating enterprise agreements. With nearly 60,000 members, you’re part of the strongest and most experienced professional and industrial organisation representing Queensland’s nurses and midwives.

CONGRATULATIONS to QNMU midwife member Mary-Ellen Russelhuber, who was named the Johnson and Johnson Mum’s Midwife of the Year. The award was presented to MaryEllen on International Day of the Midwife. If you want to nominate a midwife for next year’s award, head to www.midwifeoftheyear.com.au

What’s more, using an average Queensland Health Registered Nurse (grade 5 pay point 7) as an example, the pay increase of 2.5% negotiated under EB9 was worth more than three times the value of your annual membership fees. It will be a similar result under your next enterprise agreement, and other agreements across all sectors.

Mary-Ellen (centre) with her colleagues on International Nurses Day

See page 73 for the latest rates or visit www.qnmu.org.au/ FeeSchedule

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BODY CAMERAS TO CAPTURE OCCUPATIONAL VIOLENCE WOULD the use of body cameras in the workplace make you feel safer? The Queensland government is trialling body cameras for hospital security guards in a bid to reduce the rates of occupational violence. The cameras serve a two-fold purpose — first and foremost as a deterrent to bad behaviour and secondly to provide visual evidence for assault victims. Nurses have welcomed the initiative, but believe more needs to be done in the workplace to address the problem before a situation escalates to the point of violence. A QNMU member* who currently works at a hospital where the body cameras are being trialled agreed the cameras were a “necessary piece in the puzzle” but said there were still violent incidents. “The cameras give you something to take to management and say, these staff are getting hit, look at the footage,” the RN said. “But there needs to be more physical security presence, because cameras just record, they don’t stop any violence.”

An escalating issue The body cameras are just one measure in a raft of initiatives being rolled out following the ongoing work of the Occupational Violence Taskforce. The committee, which includes QNMU representatives, has oversight of developing and implementing recommendations from a report released in 2016. Other initiatives include: ■■ enhancing CCTV technology and communication devices ■■ developing a framework for staff training ■■ enhancing communication between health services, Queensland Ambulance Services and police to improve information exchange on patients with violent histories ■■ developing peer support programs for staff who are assaulted ■■ trialing a customer-focused liaison within EDs to reduce aggression ■■ developing minimum security arrangements. As nurses are well aware, occupational violence has escalated to crisis levels in many hospitals over

the past few years. Unfortunately, there is no easy fix. “I’ve been nursing for many years and I see so much occupational violence now that it’s just part of my everyday job,” the member said. “I’ve seen staff being hit, people coming in who are drug affected, they will lash out, spit, swear, they strip off. And it’s just part of another day at work. “The people themselves who may normally be very nice people just lose all inhibitions and don’t care. “They just don’t understand what they’re doing and there’s no consequence. It’s like they’re not even connected to their mind.” While the QNMU welcomes the body camera trial, we believe more resources must be allocated to enhance security and training for staff. The QNMU will continue to work with the state government to address ongoing issues. Any instance of occupational violence should be reported, and members can contact the QNMU for professional assistance.

Nurses and midwives march for aged care on Labour Day IN A SHOW of solidarity, nurses and midwives across Queensland marched for ratios in aged care this Labour Day. It marked the official launch of our Queensland aged care campaign. Visit https://bit.ly/2IegqQl to view our Labour Day photo album on Facebook – feel free to ‘tag’ yourself! For more pics, see page 68-69.

*name withheld.

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She recruited… now she can relax!

CONGRATULATIONS to QNMU member Robyn Kildey from Redlands Hospital, who is the winner of our Recruit and Relax competition.

Yoga, berries, mindfulness… oh my!

To enter the draw to win a $2000 travel voucher (destination of own choice), members were required to successfully encourage a non-member to join the QNMU. Robyn told the QNMU the prize couldn’t have come at a better time as she is currently on a return to work program following a motorbike accident that left her with a torn hip muscle. Having never travelled overseas, Robyn and her husband are eagerly planning a trip within the next year to either Fiji or Thailand.

NURSING and midwifery may be the most trusted and respected professions, but we often put our patients and residents ahead of our own wellbeing. So this year we celebrated International Nurses Day and International Day of the Midwife with a focus on healthy ageing. Queensland's Health Minister Steven Miles joined the QNMU for a relaxing and meditative yoga class, which was a chance for members and QNMU staff to learn some techniques to stay fit and healthy. Our delicious breakfast was catered by Kiss the Berry (it really hit the spot!), and was followed by excellent guest speakers. Lauren Todorovic from Carepage (previously called Aged Care Report Card) spoke of the challenges in aged care and her passion for ensuring accountability for providers. And Belinda Sleeman – the first woman to officiate in the NRL, a Test Match and at a World Cup – discussed her personal journey to realising her dream in a male-dominated industry… an empowering story for all women.

QNMU Health and Environment Reference Group GOT SOMETHING to say about health, the environment, wellbeing and climate change? Then the QNMU’s soon-to-be established Health and Environment Reference Group might be the perfect way for you to have a say through your union. The purpose of this new reference group is to help guide the QNMU on how nurses and midwives can advance these issues and make real change. To register your interest, contact QNMU Wellbeing Officer Janet Baillie on JBaillie@qnmu.org.au

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Queensland nurses take out top HESTA Award THE KOMBI Clinic Hepatitis Queensland has taken out the Team Excellence title at this yearâ&#x20AC;&#x2122;s HESTA Australian Nursing and Midwifery Awards. The mobile clinic based in Brisbane provides life-saving treatments to people living with hepatitis C. The clinic is unique to other services because it brings medical care directly to people who are most vulnerable, enabling them to easily access treatment. Queensland finalists also included Deanne Ward from Cairns Private Hospital for Nurse or Midwife of the Year, and Glynnis Carvalho from John Flynn Private Hospital for Outstanding Graduate. Congratulations to our Queensland winners and finalists!

Mim O'Flynn receiving the Team Excellence Aw ard for The Kombi Clinic Hepa titis Queensland.

3rd from right: Glynnis Carvalho, Queensland finalist for Outstanding Graduate. 6th from right: Deanne Ward, Queensland finalist for Nurse or Midwife of the Year. Centre: Mim O'Flynn (The Kombi Clinic Hepatitis Queensland), winner of the Team Excellence Award.

Logan midwifery hubs birth first baby

LOGAN midwives are celebrating the opening of the Logan Maternity and Child Health Hubsâ&#x20AC;Ś a service the QNMU lobbied for, for a long time This is the culmination of the collective efforts of QNMU member midwives, the Maternity Project Action Group which is made up of many local community groups including Logan Together, and the Queensland Community Alliance. The hubs will deliver community-based midwifery services in the area. And it was great to welcome Isaiah as the very first baby born to the new community midwifery service!

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OFFENDER H E A LT H - time for action N

URSES working in Queensland’s prisons are struggling to manage excessive workloads as our prison population grows and staffing levels and resources fall behind. With Queensland Health reviewing offender health services across the state, now is the time for QNMU members working in prisons to make sure their voices are heard.

State of play Across the state, Queensland Health provides offender health services (including oral health and mental health) to nine publicly operated high security correctional centres and six low security correctional centres. It also provides mental health and oral health services in two privately operated high security correctional centres. Nurses and midwives providing these essential services in Queensland’s prisons are acutely aware of the difficulties in delivering those services due to the burgeoning population within our prisons.

which has placed prison resources under significant pressure.

given that many prisoners return to their former communities.

During this time, clinical staff numbers increased by only 32.9%, which in turn is placing nursing and midwifery workloads under considerable strain.

■■ Prisoners should receive the same standard of healthcare that is available to the community.

Another factor affecting workloads is the lack of physical space and resources that are required to enable comprehensive health care.

So we can properly advocate for members working in Queensland prisons, member feedback will be very important.

Queensland Health’s offender health review The first part of this review project is establishing a Steering Committee of key stakeholders to guide the development of an action plan. The second part of the project will be implementing that plan. The Offender Health Services Steering Committee Alliance (OHSSCA) has been established and the QNMU is a key stakeholder on this committee. So far the committee has established the following:

With the ever-expanding prisoner numbers, members are experiencing excessively high workloads partly because clinical staff numbers have not kept pace.

■■ Prisoners generally experience high levels of poor personal health and psychiatric illness and engage in activities that present a high risk to general health.

In the four years to June 2017, prisoner numbers increased by 40%,

■■ Improving prisoner health is an important public health measure,

Your feedback is critical

Members working in prisons are encouraged to contact QNMU Member Connect or their local Organiser to discuss current issues and share their views on how services can be improved. We understand staffing and workloads are the priority issues at present, but we would still like to hear from members about specifics and their suggestions for improvement. To this end, we are also planning to create a QNMU Correctional Health Reference Group that will meet for one hour by teleconference, once every six to eight weeks, to discuss current and impending issues. If you currently work in a prison and would like to express an interest in being part of this reference group, please contact the QNMU on 3099 3210 or 1800 177 273 (toll free outside Brisbane).

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It’s time we talk about Superannuation W

HEN IT comes to earnings, working women really do get a raw deal. It’s bad enough they must contend with unequal pay for equal work and the gender pay gap, but to have less in the kitty at retirement – well that’s the final indignity. The superannuation gap between men and women at retirement age is currently sitting at 47%. That’s a massive discrepancy! In fact, the average difference in dollar terms is about $85,000. Research suggests this is a key reason why as many as 40% of older single retired women live below the poverty line, are financially insecure, and are the fastest growing cohort of homeless people in Australia.

So how did it come to this? In addition to often being paid less money for the same or similar work than their male counterparts, women are also more likely to be in lower paid jobs and do more casual work. Not only does this mean there is less income for the super percentage to be calculated on, but those who earn very little income miss out on employer contributions altogether. At present, employers do not have to pay super to employees who earn less than $450 each month — and, you guessed it, this group of people is predominantly women. Then there is parental leave. Unlike other forms of leave, super is not paid on parental leave, which

means a woman who is out of the workforce, often for many years as the primary carer, misses out on super payments for all those years. And finally, there are tax matters. Tax concessions on super are skewed toward high income earners — the greater percentage of whom are men. It’s estimated about two-thirds of super tax concessions are paid to men. Meanwhile, low-income earners — who are mostly women — pay above marginal tax rates for any earnings they make on their super investments.

So what’s the plan for making super fair?

income bracket and until their super balance reaches $100,000.

2 Make sure there are no further

delays in increasing the Superannuation Guarantee to 12%. Over the years Liberal governments have put planned increases on hold. In 2014 the Labor government legislated to restart the annual increases from 2015 so the Super Guarantee would reach 12% by 2019, but the Abbot government intervened and pushed the start date back to 2021.

3 Remove the $450 monthly

pay threshold, which sees an estimated 220,000 women miss out on super every year.

The push to make super fairer for women and low-income earners has been in the works for some time.

4 Make sure super is paid on

But with a federal election due by May 2019, we have a real opportunity to put the issue in the spotlight.

5 Measure and publish the impact

The Women in Super (WIS) advocacy group has developed a five-point plan to make super fair and provide women with greater economic security when they retire. It’s a plan wholeheartedly supported by Australian unions — including the QNMU.

The plan in a nutshell is: 1 Provide women and other low-

income earners with an additional $1000 contribution annually into their super to boost their balance and help make up the gap. The annual boost would continue for as long as they fall within the low-

government paid parental leave, like other types of leave. that any future changes to super would have on women.

How can I help? Getting the Women in Super fivepoint plan translated into legislation will be no easy task. But you can help by spreading the word and getting the conversation started. Visit the Make Super Fair website — makesuperfair.com.au — and add your name to the list of people calling for a fairer superannuation and share the page on your social media feeds.

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Super stuff: a little history S

It was unions who first agitated for super in the 70s by bargaining for it during EB negotiations.

Currently, the Fair Work Commission nominates default funds for employers and they have traditionally chosen industry super funds because they have lower fees.

By the 1990s the union movement helped normalise the concept of superannuation and supported the Labor government establishing a compulsory superannuation framework to cover all Australian workers.

Of course, Australian workers can choose to put their super into other funds — but most (about 75%) stay with their default fund, which means the banks miss out on millions of dollars in potential fees and commissions.

Around this time we also helped set up industry super funds.

More recently the Turnbull government continued its attempt to dismantle the governance structure of industry super funds. They want to bring in third party "independents" when there is no evidence that the bipartisan (employer and union representation) system is broken.

UPERANNUATION is a product of the union movement.

They were established because we wanted to ensure the money being saved for retirement was protected from high fees and commissions that characterised retail super funds. Industry super funds have a member-first philosophy, are mostly not-for-profit, and are usually governed by a board made up equally of employers and employees within the industry. They do not have shareholders and regularly out-perform retail funds, including those run by banks. But superannuation has long been viewed by politicians — particularly those on the right — as a poorly tapped resource.

In Australia, if you are aged 18 or more, are employed and earn more than $450 (before tax) per month, your employer must pay super contributions every quarter into a super fund. This is your Superannuation Guarantee.

The current Super Guarantee rate is 9.5% of your ordinary time earnings.

Fast figures

Legislation to push through these changes has failed so far, and a good thing, too.

Superannuation 47% The gap between men

The current royal commission into the banking and finance sector has revealed just how unscrupulous that sector is.

$85,000

The last thing Australian workers need is to have their super earnings exposed to these kinds of operators who are more interested in targets and profits than looking after members.

A few years ago, the Abbott Coalition government flagged plans to give banks greater access to worker’s super.

BREAKING NEWS

What is the Superannuation Guarantee?

and women at retirement age.

The average dollar difference between men and women’s super at retirement age.

percentage of 40% The older single retired

women who live in poverty or experience economic insecurity in retirement.

After years of campaigning by the Media, Entertainment and Arts Alliance, Fairfax Media agreed in May to extend superannuation to employees on parental leave. This is the value of a union! Well done MEAA!

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Nurses ON MY

doorstep

One patient’s tale of Queensland Health’s

Acute Care@Home service

T’S 8AM on a Thursday morning. I’m nauseous, in pain and for the third night in a row, I’ve barely slept.

The calf of my right leg is swollen and aflame with an angry case of cellulitis that’s turned into one massive weeping sore about the size of a dinnerplate thanks to not one, but two antibiotic reactions and a doctor not best versed in wound care. The combines and tape the Plastics folk wrapped me in last night are soaked through, and the crepe bandage rubs almost unbearably at the allergy rash on my legs, despite the antihistamines I’m taking to tame the itchy full-body breakout. I’m bloody miserable.

I’ve already been to the ER twice, dripped plasma all over their lino waiting room floor and had egg-sized blisters deroofed. My other half is now on a first name basis with every pharmacist from the Wesley to Rocklea thanks to his almost daily searches over the past week for Mepilex Border dressings and the strongest OTC pain relief he can find. If only I’d stocked up on Nurofen Plus before codeine rescheduling kicked in! As I sit on the edge of my bed in my daggy shorts elevating my leg, feeling thoroughly sorry for myself and wondering when I might have a proper shower again, there is a knock at my front door. I don’t know it yet, but this is the moment the cavalry arrives…

Acute Care@Home's Keith Girvan. Photo: Kasun Ubayasiri

indepth Clinical Nurse Catherine Pratt, has been a nurse for 40 years and a member of the Acute Care@Home team for the past three. In her blue polo shirt and sensible shoes, she has an air of practical efficiency that is instantly reassuring. She flips open the big red vinyl bag that is the essential accoutrement of the home-visit nurse and pulls out a blood pressure cuff, securing it to my arm while asking me questions about my general state of health and how I got myself into such a pickle. I’m no fool, I know there is more to these questions. That’s the thing about nurses, they are smart, they can pick up nuances in answers that tell them so much more about a patient’s wellbeing than simply what they might say. And Catherine is certainly smart. She’s one of those old school nurses who manages to be both super experienced but not jaded, friendly but firm, authoritative and knowledgeable, but friendly enough to tell you stories about her early nursing days as she expertly wraps your limb. Which is exactly what you want in a home visiting nurse. Here within the four walls of your bedroom — your most intimate of spaces — when you are in pain, feeling vulnerable and yet still a little worried she’ll notice the dust bunnies under the bed or the dog hair on the doona — you want a nurse who makes you feel like you are in good hands. “It’s absolutely a privilege to be able to go into someone’s home,” Catherine said.

The team is nothing short of amazing. Keith Girvan

What is Acute Care@Home? Metro South Acute Care@ Home is a Queensland Health Service which delivers health care to patients in their home, clinic or other suitable location.

Catherine Pratt at work

The Acute Care@Home teams work as distinct units within the Princess Alexandria, QEII, Logan and Redlands public hospitals and, depending on the patient’s care needs, can include doctors and nurses. The nurses in this unit are Clinical Nurses with advanced clinical skills. They have a broad background in assessment and clinical management of acute and chronic illness.

“You must be respectful and courteous, because you really have been invited into their space.” She said working in a home environment and seeing first-hand the level of family support and capacity can help her understand her patient’s needs better, and allows her to recalibrate or reassess her care plans when necessary. “And it’s important to be able to have enough time to connect with my patients - it means I can holistically assess them in a way that is impossible in a hospital environment where you’ve got the continued pressure of the next patient coming in. “This job provides me with the time that, as a nurse, you so crave,” she said. “That personal connection, and the autonomy of the work, also makes you feel very responsible for your patients so you don’t want to leave any stone unturned in their care. “For me personally that’s where I get my job satisfaction from.” Catherine was one of 10 nurses who walked through my door during two-and-a-half weeks of being housebound. Each one had their own style, their own individual way of approaching

my treatment — yet the care was consistent and effective. One nurse was quiet and methodical but took a shine to my excitable dog, another gave me advice about eating pumpkin seeds to increase my Zinc intake to assist with healing. At one stage early on when my wound was at its most complex and painful, two of the visiting nurses brought in a senior colleague who was a wound specialist, and together, at the foot of my bed, they discussed the best way to manage my condition.. It was a thing of beauty! Three highly skilled nurses collaborating on the direction of my care. Smart, respectful and professional discussion that, for the first time in more than a week, made me feel like I was finally in the hands of experts. “The team is nothing short of amazing,” my day-eight nurse Keith Girvan said. “Everyone has different perspectives and that works really well. Keith is all smiles and good humour. With just three months in the service, he’s the new boy on the block, but he comes to the job with 12 years in ICU behind him.

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It’s absolutely a privilege to be able to go into someone’s home. You must be respectful and courteous, because you really have been invited in to their space. Catherine Pratt

there, you make the call’… that is pretty special. “It stretches you professionally because you really do feel a great sense of responsibility.” “I don’t regret making the change from working in ICU — it was certainly a privilege being there for those very sick people, often at the end of their lives, but I needed a change. “In this job it’s a privilege to go out and see someone at their house where they are letting you into their front door, into their house and into their life — a lot of times when they are not in a good place physically and mentally — and you know you can help them.” In my case, Keith helps by using humour and conversation to distract me from the tweezers at work on my wound. It’s a clever strategy. Keith is a natural conversationalist and the chat is comfortable and easy, and suddenly it feels like the most natural thing in the world to have a complete stranger swabbing my legs with Betadine as we talk breezily of home renos and kids. He’s there for nearly an hour and my leg feels all the better for it. “The Acute Care@Home team truly work autonomously, and the ability to make choices about what we see and do on the ground is important and really rewarding," Keith said. “A few weeks ago, I was treating a patient with a wound I really wasn't happy with, I discussed options with my colleagues and they said ‘you’re

“But that’s what’s great about it – it’s the best job ever really,” he grinned. As my wounds start to heal and the team’s visits were interspersed with days of self-care, I find myself channelling Catherine and Keith and their colleagues as I speak knowledgeably about debriding, skin elasticity and the nature of infection to friends and well-wishers.

Keith Girvan at work

My partner’s perfect herringbone patterned bandaging is the subject of much admiration, and we are now bona fide aficionados on the chemical irritants in moisturisers. The Acute Care@Home team had taught us well. Not only am I healing, I understand my care and, better still, I understand how to prevent my injury from happening again — for which I am very grateful. For as much as I value and appreciate their visits and their excellent care — I fervently hope I never have to see them in my bedroom again.

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Accessing quality mental health services in rural and remote Australia I

DENTIFYING and managing mental health conditions within rural and remote communities is a strategic challenge for many Hospital and Health Services (HHS) in Queensland. Vast distances and a decentralised population often preclude all members of the community being heard, engaging with their health needs and having the opportunity to be productive. The Australian Senate is currently conducting an inquiry into the accessibility and quality of mental health services in rural and remote areas. The QNMU has made a submission to this inquiry highlighting the important role of mental health nurses. Building and promoting accessible rural and remote mental health systems will require a concerted effort by health planners and governments at all levels. Mental health nurses, Nurse Practitioners and Nurse Navigators are well placed to provide these services, but governments need to do much more to educate, recruit, develop and accommodate these critical clinicians. Mental ill health is estimated to be the third largest health problem in Australia, next only to heart disease and cancer. The National Mental Health Commission (NMHC) (2014) predicts that nearly 50% of adults will encounter mental illness in their lives, and that each year more than 3.6

million people in the same age range will experience mental ill health. While the prevalence of mental illness in rural and remote Australia is similar to that in major cities, the impact is much greater. Mental health professionals are in short supply, with rates declining markedly with remoteness. According to the Australian Institute of Health and Welfare (2016), the incidence of suicide is 30% higher in regional/rural areas and twice as high in remote areas, while mental health hospitalisations are higher by at least 10% and intentional self-harm and drug and alcohol issues are higher by up to double when compared with major cities. The lack of available services results in many people not accessing prevention, primary health care and early intervention services. They present late, are diagnosed late, and often are at a more advanced stage of illness, with corresponding physical comorbidities. Among a number of items, the QNMU has recommended the federal government, through the Council of Australian Governments (COAG), provide targeted quarantined funding for: ■■ incentives to recruit mental health nurses, Nurse Practitioners and Nurse Navigators to assist in rural and remote nurse-led models of care in general practice and community based programs through measures such as improved access

to technology, accommodation, study, training and professional development ■■ scholarships for mental health Nurse Practitioners to work in rural and remote areas ■■ scholarships for education and professional development specifically in dementia care for all nursing staff and care workers in rural and remote aged care ■■ immediate implementation of the system improvements for suicide prevention as identified in the Fifth National Mental Health and Suicide Prevention Plan ■■ wider advertising of rural and remote mental health assistance services ■■ prioritising the NBN rollout in rural and remote areas ■■ promoting and expanding the availability of telepsychiatry consultations for people in rural and remote areas. For a copy of the QNMU's full submission contact ltodhunter@qnmu.org.au

References Australian Institute of Health and Welfare (2016) Healthy communities: Hospitalisations for mental health conditions and self-harm in 2013–14, Canberra, AIHW. National Mental Health Commission (2014) Report of the National Review of Mental Health Programmes and Services. Contributing Lives, Thriving Communities.

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QNMUâ&#x20AC;&#x2122;S AGED CARE AUDIT REVEALS SHOCKING TRUTHS

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N A COLD Saturday morning, more than 80 Queensland nurses and volunteers rose before dawn to drive to local aged care facilities. Men and women from across Queensland parked outside privately-run aged care facilities and walked inside. Volunteers and QNMU staff used QNMU-supplied aged care surveys to evaluate conditions, report rosters, and document employee responses to questions about staff ratios and the associated provision of care. In total, we audited 83 of Queensland’s 446 privately run aged care facilities between 7 am and 11 am. The results were damning. “We were shocked with the findings,” QNMU Secretary Beth Mohle said. "79% of aged care staff surveyed said their facilities were dangerously understaffed. "A further 80% of staff reported residents who called for help were forced to wait. "More than two thirds or 68% of staff surveyed, said chronic understaffing meant they were unable to properly clean residents. The audit found it had become common practice in some facilities to wash residents just once a week." While these survey findings are preliminary and analysis is ongoing, the early information is devastating. "We were not aware just how low the percentage of Registered Nurses in Australian aged care had become," Beth said. “We knew it was low, and that ratios of one RN to up to 200 residents were not uncommon, but the findings surprised even us. “One reason we held the audit was to pull back the veil on the culture of secrecy in Australian aged care.

“The lack of federal laws regarding staff numbers, and the complete lack of transparency around how many nurses and carers are rostered at each individual facility, meant we had no choice but to take matters into our own hands.” The audit was conducted on International Nurses Day.

KEY AUDIT FINDINGS:

CURRENT AVERAGE SKILL MIX (FROM AUDIT RESULTS): Enrolled Nurses, TAFE Diploma

Registered Nurses, degree qualified

16%

■■ More than 77% of aged care staff are not Registered or Enrolled Nurses

Personal Carers, no qualifications

77%

■■ 80% said understaffing forced residents to wait longer than they should for help ■■ 79% said staff levels were unsafe at their facility ■■ 68% said they did not have enough time to properly clean residents. It has become common practice for residents to be showered just once a week due to chronic understaffing ■■ 60% said residents were not being walked as often as required ■■ 57% said there was not enough time to turn residents, increasing the likelihood of bed sores and ulcers. Research shows these wounds account for large numbers of life-threatening infections and hospitalisations

REQUIRED AVERAGE SKILL MIX (ACCORDING TO RESEARCH):

Enrolled Nurses

20%

Personal Carers

50%

Registered Nurses

30%

■■ 55% said staff were not replaced when they couldn’t come to work ■■ 57% said they did not have enough time to properly feed residents ■■ 57% said dangerous understaffing led to increased falls. Research shows falls may lead to premature death ■■ 40% said poor staffing led to pressure injuries ■■ Average nursing hours provided by aged care facilities was 2.61 hours per resident per day. Research shows residents should receive on average 4.3 hours of nursing per day ■■ 11% of facilities audited were providing less than 2 hours of care a day.

The backlash has already begun. Less than 24 hours after the findings were published in the Sunday Mail, Federal Aged Care Minister Ken Wyatt turned on Queensland and Australian nurses. The attack was stunning in its oddity and ferocity. In a move that shocked nurses, midwives and journalists alike, Mr Wyatt accused Australian nurses and carers of being responsible for "elder abuse". The Courier Mail, 13 May 2018, read: "And he (Wyatt) plans to hold the directors of aged-care companies, as well as senior

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managers, accountable for elder abuse by nurses and carers. "We will fuss over a baby and give it all the attention it needs… "But when somebody becomes frail in their twilight years then the level of care given in some cases diminishes because of the staff attitude that might prevail." Beth said the comments were a direct attack on Australia’s 260,000-plus nurses. "Australia’s nurses and carers are not responsible for the systemic failures that allow chronic understaffing to occur in almost every Australian community," Beth said.

unnecessary pain, suffering and premature death in almost every community.

CAMPAIGN LAUNCH GOES NATIONAL

"We will not rest until federal laws are put in place and this elder neglect ends.”

On 12 May, our federal body the Australian Nursing and Midwifery federation (ANMF) officially launched our national campaign Ratios for aged care. Make them law now.

Response to the campaign so far has been overwhelmingly positive. There is a groundswell of support from those with loved ones in care, those who have lost loved ones in care, aged care staff, their colleagues in nursing and midwifery, and the media who have reported horrific conditions. "The one place we are not receiving support is from the federal government," Beth said.

At the time of publication more than 11,000 Australians, including nearly 4000 Queenslanders, had signed up to take part. Beth said the ANMF and the QNMU would not rest until safe staff levels were made law in Australian aged care.

“It is the federal government that allows aged care providers to legally operate without minimum staffing laws.

"Mr Wyatt has instead attempted to shame, blame and bully one of Australia’s largest workforces into silence on this issue.

"The aged care audit has revealed elderly Queenslanders are regularly being left without a Registered Nurse on staff overnight," she said.

“The lack of laws and resulting understaffing mean elderly Australians are experiencing

"I believe he has made a terrible mistake in insulting the nation’s nurses."

"We know there are much loved parents calling for help and not receiving it.

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WYATT SAID WHAT?

“We will fuss over a baby and give it all the attention it needs…

“But when somebody becomes frail in their twilight years then the level of care given in some cases diminishes because of the staff attitude that might prevail."

Federal Aged Care Minister Ken Wyatt, The Courier Mail, 13 May 2018

“We know that aged care facilities are dangerously understaffed throughout Queensland and Australia, and that elderly residents are suffering as a result. “Behind closed doors, in almost every city and town, Registered Nurses are being left to look after up to 200 residents at a time. While nurses and other staff are doing their best, they simply can’t meet the demand for care under those circumstances. “Findings from our audit have revealed unqualified staff are being allowed to administer dangerous and potentially lifethreatening medications, that residents are falling and not being checked, that residents are laying

Bed bound residents being showered once weekly because there are

with untreated injuries such as broken hips for days at a time and regularly experienced malnutrition and dehydration. “This chronic understaffing and elder neglect is occurring in so many facilities.”

WHY ARE RATIOS IN AGED CARE SO ESSENTIAL?

It’ll provide better safety for both the residents and the nurses and carers. Stacey Bevan, AIN, Caboolture Regis

Enough is enough. We won’t stand for it. Queensland and Australian nurses and midwives are taking matters into their own hands and will not rest until Australian laws are introduced to protect the elderly — and those who care for them. If you haven’t already done so, please join our national campaign at www.morestaffforagedcare. com.au

Nurse reported being off site and

You hear in the media every day that there’s a lack of staff. The less staff they have to look after residents, the worse the care will be. Marcela Cornejo, AIN, Ipswich Hospital

remotely on call via the phone for six aged care facilities.

not enough staff on the floor to assist with showering daily or even second daily. Allegations aged care management are receiving bonuses from keeping costs down. Cost cutting

Residents having to wait two hours for pain relief overnight because there was only one registered staff

reported included locking up gloves, incontinence

member on site for

pads or refusing to replace items that had run out.

140 residents.

We have ratios for general nursing in public sector, so why not aged care? We need to shift the way we think about aged care, they get far less funding. Domenico Natoli, RN, LCCH

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The health epidemic America is ignoring

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ENS OF thousands of Americans die each year from gun-related violence. For any other cause of death, such a disturbingly high mortality rate would be cause for investigation. Take car accidents as an example. Over the past few decades, the number of vehicle-related deaths has gradually decreased thanks to applied research that called for increased car safety features and improved roads. In the early 1980s, the yearly US fatality rate was more than 51,000. As of 2016, that figure has dropped to just over 37,000. Yet the rate of gun-related deaths — most of them domestic disputes and a small number from mass shootings— continues to increase every year. According to the Centers for Disease Control and Prevention (CDC), there were 33,563 deaths resulting from gun violence in America in 2012. In 2016, this figure climbed to 38,658 (Everytownresearch, 2018). And despite gun violence now being the third leading cause of injuryrelated deaths in the US (Health Affairs, 2017), there have been few attempts to treat the crisis as a health epidemic. But according to the CDC, that is exactly what US gun violence is. What’s more, the American Public Health Association has declared it a public health crisis. Comparing the rate of firearm homicides per 1 million people across various western countries paints a sobering reality for the United States.

For any other cause of death, such a disturbingly high mortality rate would be cause for investigation.

Firearm homicides per 1 million people (2012) Australia 1.4 Germany 1.9 Netherlands 3.3

Canada 5.1 United States 29.7

SOURCE: UNODC, Small Arms Survey.

Such a high per capita rate of firearm homicides has lasting effects on America’s economy. And this includes the health system. According to the American Public Health Association, gun violence cost the US economy $229 billion in 2015. A 2017 study from Johns Hopkins University estimated the cost to the health system alone was $45 billion, including $2.8 billion in emergency room and inpatient charges.

First responders to gun violence That’s the financial cost. It’s much more difficult to quantify the emotional and psychological toll of gun violence. And it’s not just the victims or their families and friends who suffer. In America, first responders working within the health system — including nurses — are exposed to victims and perpetrators of gun violence on a regular basis, from both domestic disputes and mass shootings. It’s difficult for Australian nurses to imagine what it would be like to be a first responder to a mass shooting. Security units and hospital teams did carry out response drills for mass shooting or terrorist attacks at the Gold Coast ahead of the 2018 Commonwealth Games, and health workers confessed they were both foreign and confronting.

Thankfully, the drills never became a reality. But many hospitals in the US now conduct drills simulating mass shootings as a regular part of their operations. And since the Columbine High School shooting in 1999, many hospitals prepare their staff for treating victims with high-velocity gunshot wounds. The reality is many health professionals in the US frequently see firsthand both the immediate and lasting horrors of gun violence. It’s no surprise then that nurses have a stake in the gun control debate. New York State Nurses Association (NYSNA) Executive Director Jill Furillo said nursing unions across the country had been lobbying for gun reform for decades. “As a Registered Nurse in the Emergency Room, I treated hundreds of women, men and children who fell victim to gun violence,” Jill said. “I cared for and comforted people whose bodies were broken by bullets… this wasn’t just violence I read about in the media, it was something I experienced every day. “Watching President Obama shed tears as he announced his executive orders aimed to curb this growing crisis, I thought of my former patients, of the six-year-old children massacred at Sandy Hook Elementary School […]

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Nurses in New York and Washington DC took to the streets for the ‘March For Our Lives’ rallies in March 2018.

of the public health care workers shot down in San Bernardino, and so many others.” Jill said it was no small task for frontline nurses, doctors and caregivers to care for those victims. “Our emergency and operating rooms are taxed beyond limit in many places […] meaning this fundamental condition makes gun violence central to our professions and ability to care for patients and communities. “The violence is senseless and overwhelming.”

The ‘Dickey Amendment’ Researchers and health care professionals have long called for a science-based health approach to find solutions to America’s gun violence culture. To us as health professionals in Australia, it seems difficult to fathom that gun violence would not be addressed for what it is: a leading cause of premature death.

indepth “As health care professionals, we know that the most effective treatments are developed through scientific research,” Jill said. “Yet our government institutions are blocked from conducting any research that could help us narrow down risk factors for gun violence and determine which evidence-based approaches would work best to stop this epidemic.” The ‘block’ to research came in 1996 through what is commonly referred to as the ‘Dickey Amendment’ — an amendment to a bill that stipulated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control”. This effectively prevents the CDC from conducting any research into the causes of gun violence, let alone find ways to fix the epidemic. “For example, in the immediate aftermath of the massacre in Charleston, the US House of Representatives Appropriations Committee quietly rejected an amendment that would have allowed the CDC to study the underlying causes of gun violence,” Jill said. “The National Rifle Association got its way again, using anti-science

political jockeying to put the health of our entire nation at risk. “What we need is full-scale, funded research to solve the escalating crisis of gun violence. “Like other epidemics we’ve faced, including polio and auto safety, gun violence is not insurmountable. “Imagine how many millions of people around the world would still be impacted by polio if our scientists weren’t allowed to conduct the research necessary to discover a vaccine.”

US gun violence in a nutshell On average, 38,000 Americans die each year as a result of gun violence A further 85,000 more suffer non-fatal gunrelated injuries

Under President Obama there was renewed hope for a more evidencebased approach to the crisis.

In 2017 there were 346 mass shootings, killing 437 people and injuring a further 1802

“President Obama’s executive orders aimed to make it harder for guns to end up in the wrong hands by strengthening background check requirements,” Jill said.

Gun violence cost the US economy $229 billion in 2015, including $45 billion in health

“And, critically, he also vowed to increase funding for mental health services so that those in need received treatment, preventing acts of lashing out. “As our psychiatric nurse colleagues have witnessed, too many mental health facilities have closed over the past decade. “Mental health care services rarely receive the funding necessary to ensure all patients have access to the care they need when they need it.”

I cared for and comforted people whose bodies were broken by bullets… this wasn’t just violence I read about in the media, it was something I experienced every day. Jill Furillo, New York State Nurses Association (NYSNA) Executive Director

Source: American Public Health Association, 2018

But since then America has slipped backwards, with President Trump repealing the expansion of background checks. And while his budget did allocate more funding for mental health, it is feared proposed cuts to Medicaid (Obamacare) would offset any improvements. The ongoing debate continues to become more bizarre as policy makers move further away from any evidence-based approach. Only a few months ago, President Trump suggested arming teachers with firearms in the classroom – a solution based on a twisted logic of ‘fighting fire with fire’. Fortunately, this idea has (for now) stalled. However, there is hope. If recent nation-wide protests are any indication, it looks like it will be the next generation of leaders — today’s youth who will soon be eligible to vote — who might be motivated enough to bring about real change. Until then, America is as far off as ever before from finding any sensible solutions to their gun crisis.

indepth a patient tried to pull a gun in the Emergency Department. “I was the triage nurse and a gentleman who presented to the ED went to grab a gun from his jacket,” Jared said.

You get used to dealing with the emotions at work and then once you go home you’ve got it going in the back of your mind but you just get on with life.

“I reached through the triage window and grabbed his arm, we called code black, and I kept a hold of the patient while we waited for security to arrive. “I was terrified and fearful for my life… there was no way I was letting go of his arm, and if he did break free I was going to run away from the area straight away.” It wasn’t until the next day that Jared discovered the patient had been carrying a replica gun. “Just because it was identified as a replica gun didn’t make it any less real over the next couple of weeks, and still doesn’t even today,” Jared said.

Kahli Seymour, RN

Australia’s gun reality In Australia, we are fortunate not to have the same gun culture as the US. Indeed, it is extremely difficult to obtain a gun in Australia, thanks to extensive background checks and processes. Unlike Americans, Australians do not have the ‘right’ to bear arms… and public opinion polls show we don’t want it. A 2016 Essential Research poll showed 45% of Australians thought our gun laws were “not strong enough”, while a further 40% thought they were “about right”. Only 6% said they were “too strong”. Nonetheless, gun violence is still a reality in Australia. According to the Australian Institute of Health and Welfare, there were 338 hospitalisations resulting from firearm-related injuries between 2013 and 2014, and between 2012 and 2013 there were 209 gun-related deaths. The same research showed rates of gun-related injuries and deaths were four and six times higher respectively in remote and very remote areas.

While none of these hospitalisations or deaths resulted from mass shootings, nurses still see the effect of gun violence in their jobs. Registered Nurse Kahli Seymour recalled her experience with patients who had been involved in firearm disputes. “I remember one patient was a victim of a home invasion — he got shot in the face, it was a close-range shot,” Kahli said. “The other experience I remember was a guy who was heavily involved in the bikie scene. He came in under police custody but was later found downstairs with a loaded gun in his pants. The safety was off so it could have gone off at any time. “It frightens you a bit… I’m pretty good with leaving those incidents behind, but the girls down in ED who found the gun were quite distraught for a long time. “You get used to dealing with the emotions at work and then once you go home you’ve got it going in the back of your mind but you just get on with life.” Registered Nurse at Logan Hospital Jared Lewis recalled an incident when

“It just made me aware of how unprotected we are if someone was to present with a gun to an ED… all I could do was grab him through the window. “If it had been another colleague that wasn’t as strong or as big as myself, if they did have a real gun there was no defence other than trying to duck behind the desk or run off.” Following the incident, Jared sought professional support and took time off work to spend with his family. “After that incident I wouldn’t have gone back to work if it was a job I didn’t enjoy.”

Caring for the perpetrator Another QNMU member, who wished to remain anonymous, said nurses sometimes faced moral dilemmas when required to provide quality care to a perpetrator of gun violence. The member recalled having to look after a patient who shot his wife before shooting himself in the head. “It was very hard considering we knew what he’d done, we knew he wasn’t going to survive,” the member said. “All the nurses were angry that there were armed police outside the room […] We’d had violent offenders

indepth before — people who had used guns on the public or had threatened staff — and we couldn’t get police assistance in the unit then. “But here’s a man who’s committed this act and is essentially dead, and we’re being asked to care for him. “You don’t want to look after the perpetrator, but nurses are ethically bound to look after their patients. “We just try and be professional, we don’t judge people, we don’t bring the outside world in. “However, it’s hard at times to turn off when you know someone is capable of inflicting such injury or destroying a life and you’re expected to give them the same care that you would give a child with cancer.” The member described it as a battle between “the moral and the ethical”. “I’m sure a lot of nurses have thought, I don’t want to give this person the same treatment as I’ve given this other person next door. “But at the end of the day they will. It’s just who nurses are.”

Advocates for gun safety? While no conclusive surveys have been conducted on American nurses to determine how they perceive their own

responsibility as advocates for safer gun control, a small Facebook sample of 515 nurses found the majority of respondents did not agree that nurses should ask patients whether they owned firearms or should educate them on firearm safety. Writing on these findings in the Journal of Paediatric Health Care, President of the National Association of Paediatric Nurse Practitioners Mikki Meadows-Oliver said the responses made her sit up and think. “If asking about firearms in the home is not something that nurses should be doing, who will do it?” Ms Meadows-Oliver said. “Violence related to firearms is both a public health and a nursing issue and it is nursing’s business. “As nurses, our message needs to be heard by patients and their families, but we should also make our voices heard on another level by supporting legislation that targets injury and violence prevention.” Jill Furillo from the NYSNA agreed, adding nurses and their unions had a responsibility to lead the conversation around gun violence and health care. “Trust in our profession is the greatest in the nation and we must use that heralded voice to denounce gun violence in all its forms.”

References

American Public Health Association. (2018). Preventing gun violence. www.apha.org/-/media/files/pdf/ factsheets/160317_gunviolencefs.as hx?la=en&hash=AB71DE1BEDEBB2A 797F8EC378E672791904FCF87 Castellucci, M. (2017). Modern Healthcare. Hospitals lean on practice to treat mass shootings. www.modernhealthcare. com/article/20171002/ NEWS/171009990. Essential Report. (2016). Gun laws. www.essentialvision.com.au/gunlaws-2. Everytown For Gun Safety Support Fund. (2018). Gun violence by the numbers. https://everytownresearch. org/gun-violence-by-thenumbers/#DailyDeaths. Furillo, J. (2016). Ending gun violence. New York Nurse: The official publication of the New York State Nurses Association, p.4. Gani, F., Sakran, J. & Canner, J. (2017). Emergency department visits for fire-arm related injuries in the United States. Health Affairs. 36(10). Retrieved from www. healthaffairs.org/doi/abs/10.1377/ hlthaff.2017.0625. Jacobson, L. (2018). Politifact. Expand mental health programs. www.politifact.com/truth-ometer/promises/trumpometer/ promise/1361/expand-mentalhealth-programs/.

Unlike Americans, Australians do not have the ‘right’ to bear arms… and public opinion polls show we don’t want it.

Los Angeles Times. (2017). For the second straight year the rate of gun deaths has risen in the US. http://www.latimes.com/nation/ nationnow/la-na-gun-deaths-rate20171103-story.html. Meadows-Oliver, M. (2013). Violence prevention: A nursing issue. Journal of Paediatric Health Care. 27(4), 240-241. Rubin, J. (2017). Quartz. Cost of carnage. https://qz.com/1093144/ us-gun-violence-costs-an-averageof-2-8-billion-a-year-a-johnshopkins-study-reveals/. Vox. (2018). America’s unique gun violence problem explained in 17 maps and charts. www.statista. com/statistics/258913/numberof-firearm-deaths-in-the-unitedstates/.

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In solidarity with our New Zealand friends BY LINDA MYERS, QNMU MEMBER AND REGISTERED NURSE

AM A New Zealand trained Registered Nurse now living in Australia. This International Nurses Day I attended a march in Auckland with my nursing colleagues to show solidarity and support for their unprecedented action for better conditions. Thousands of New Zealand nurses, health care workers, families, friends and supporters marched in 15 cities and towns around the country. They were marching for fair pay, nurse-to-patient ratios, safe staffing, and the safety and future of all New Zealanders. Despite the rain many people marched and chanted loudly regarding fair pay and conditions. There was a strong feeling amongst nurses, health staff and their families and supporters that the situation within New Zealand hospitals is becoming dangerous and untenable and that change is needed NOW. A grass roots movement of protest was started by two anonymous nurses on social media, known as The Two Florences on a page titled â&#x20AC;&#x153;#hearourvoiceâ&#x20AC;?. The page has developed a following of more than 45,000 people and has provided a forum where nurses and supporters have been able to tell their stories. The hear our voice page has revealed disturbing levels of stress due to workloads, low pay, poor nurse-to-patient ratios and bullying that exists within the health sector in New Zealand. The nurses of New Zealand have not had a decent wage increase for at least 14 years, thanks to an austerity policy following the Global Financial Crisis. They have been offered 2% this year. Nurses are being left behind. Ultimately, this leads to poor recruitment and retention of staff and adds further stress to those who remain. Nurses are calling for a 20% pay increase and for nurse-topatient ratios. This is about ensuring good patient care for all New Zealanders, now and into the future. Kia Kaha to the nursing whanau in New Zealand.

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QNMU resolution In solidarity with our colleagues across the ditch, the QNMU council made the following formal resolution of support at its May meetingâ&#x20AC;Ś. [The QNMU] sends our support and solidarity to colleagues employed in district health boards in New Zealand. In Australia we know from firsthand experience that it is only through campaigning and the organising of nurses and midwives in their workplaces and the broader community that the worth of our professions is recognised and respected. We are dismayed by the lack of investment in public health as well as the impact the 2% per annum wages growth will have on nurses, hospital aids and core midwives in your country. The growth of inequality in New Zealand is stark and key workers such as nurses and midwives are feeling the full brunt of this through government austerity measures including a lack of investment in health. The QNMU calls upon the Ardern government to intervene in negotiations, scrap the 2% wages offer for New Zealand nurses and midwives and enter into genuine negotiations with the NZNO and other health unions. It is essential to the health of New Zealand to properly recognise the worth and contribution of nurses and midwives in the health system.

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gift The

of life

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ACH AND every day, people of all backgrounds and ages become recipients of a life-saving organ transplant and are granted a new lease on life. The procedure has saved countless lives but making them a reality isn’t easy. From identifying a suitable donor to caring for patients after transplant surgery, the process of an organ transplant is a mammoth job that never truly ends. And it’s only made possible by skilled organ transplant teams, including the dedicated nurses who coordinate the complex process from start to end.

BEGINNING AT THE END Townsville member Rhonda Farley is a Donation Specialist Nurse Coordinator who raises the matter of organ donation with families when end of life care is being discussed. It’s a difficult time for families, but it’s part of Rhonda’s job to provide important information and explain the process of organ and tissue donation. “We always try to give families the time they need — firstly to absorb the terrible news of the loss of a loved one — before discussing the opportunity for donation,” Rhonda said. “We approach the families very sensitively and support them in every way possible. “I answer all their questions and concerns and confirm the wishes of the deceased and of the family regarding donation. I also check the Australian Organ Donor Register to identify if their loved one had signed on to be a donor. “In speaking with families, many tell me that donation is the only positive thing out of this tragedy and take comfort in knowing their loved ones have helped others after their death. “It’s a humbling experience to share these intensely personal moments of grief with a family and a privilege to be able to fulfil their wishes to help save the lives of people they will never know.” Rhonda also has the job of informing the donor family the transplants have

taken place and how many lives have been transformed and saved. “That’s usually a wonderful phone call as they really look forward to knowing how the recipients are doing,” she said. “Sometimes down the track a bit, donor families receive anonymous written letters of thanks from the recipients — which are filtered through the DonateLife Queensland office — and they cherish those letters very dearly.”

A DOUBLE-EDGED SWORD Having been in the role for over four years, Rhonda said it can sometimes be a double-edged sword — to know someone will die but that his or her donation could be the gift of life for someone else. “It’s the cold, hard reality of it. The death of our young patients is without doubt the hardest and I always remember them,” Rhonda said. “Their parents always ask me ‘how do you do this job?’ but I think they are the true heroes to be thinking about others after the death of a child.”

ON THE FLIP SIDE It’s just as painful to conceive the notion of someone on an organ transplant waiting list, awaiting a donation that may never arrive. The agonising wait is usually between six months and four years but it can be even longer and tragically, people pass away while waiting for a suitable donor organ. When a suitable donor organ becomes available, it is Transplant Co-ordinator Trish Leisfield’s role to ensure the entire process goes smoothly. “I do periods of 24 hours on-call and when a donor organ becomes available I co-ordinate the transplant process starting with the organ retrieval team – a team of dedicated surgeons and nurses who are specially trained in organ retrieval. “I speak with the intended recipients and their families. It is, understandably, an emotional time

It’s the cold, hard reality of it. The death of our young patients is without doubt the hardest and I always remember them. Rhonda Farley, Donation Specialist Nurse Co-ordinator

DID YOU KNOW? ■■ Australia is a world leader for successful transplant outcomes. ■■ Around 1400 people are on Australian organ transplant waiting lists at any time. ■■ In 2017, 510 deceased organ donors and their families gave 1402 Australians a new chance in life. ■■ The majority of Australians are generally willing to become organ and tissue donors (69%). Source: DonateLife

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Recovery and post-transplant care is intensive. Lung transplant patients often require more care and surveillance... Trish Leisfield, Transplant Co-ordinator

for them and we offer them support and reassurance.

or phoning the co-ordinators when they are not well.

“I also co-ordinate all the teams required for the transplant operation such as the operating theatre, blood bank, Emergency Department, ICU, Tissue Typing labs… this process can take up to 12 hours to facilitate.”

“They see us in clinic at least twice a week initially after the transplant and when they are fully recovered we continue to see them four times a year.

ROAD TO RECOVERY Trish also works as a Clinical Nurse Consultant for the Queensland Lung Transplant Service based at The Prince Charles Hospital, where she helps care for about 280 patients who have undergone lung transplantation.

“They are never discharged from our service. Because we take our patients on for life we build strong relationships and we get to know them and their families very well.”

She said the transplant procedure is just the first step in a long journey.

Patients also have the support of a skilled multidisciplinary team of medical, nursing and allied health professionals, as well as physiotherapists, dietitians, social workers and psychologists who support them through this lifelong journey.

“Recovery and post-transplant care is intensive. Lung transplant patients often require more care and surveillance — they are more prone to respiratory infections, some of which are difficult to overcome and a patients’ health can deteriorate quickly if not treated,” Trish explained.

“It is heart-warming and very rewarding to see lung transplant patients go from being critically ill and barely able to breathe to be back to normal life — running their households, back at work, and even participating in sporting events such as marathons,” Trish said.

“We educate patients on how to monitor their health at home and they are very reliable about coming to clinic

In Australia, laws of confidentiality mean the donor and recipient families will never officially know each other.

Once a donor organ is matched to a patient, the donor’s medical information is de-identified and everyone on the transplant side of the process will only know the donor as a number. But the need for transplant patients to connect with the family of their donor is often strong. “Quite often recipients talk about meeting with their donor families, however, we cannot facilitate that in any way and do not arrange for them to meet,” Trish said.

DID YOU KNOW? MOST RELIGIONS support organ and tissue donation as an act of charity and goodwill. People from all walks of life depend on organ and tissue donations, regardless of race, origin, religion or language. Find out more at www.donatelife.gov. au/sites/default/files/ Religion_facts.pdf Source: DonateLife

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ORGAN TRANSPLANT PROCEDURES IN AUSTRALIA IN 2017 Kidneys

832

Livers

281

Hearts

Lungs

206

Pancreas Intestine Total

51 1 1469

Source: DonateLife

“We can organise the exchange of letters between donor families and recipients. Sometimes recipients like to say thank you and donor families gain comfort in knowing that the recipient is doing well, however all letters and cards are de-identified before being exchanged. “Some patients will build up quite a relationship with the donor families and they will write to each other regularly over many years with updates of how they are getting on and that is always really lovely.”

SPEAKING UP While Australia is a world leader for successful organ transplant outcomes, there is still a lot about organ donation that is misunderstood. In Australia, only 1 to 2% of people die in hospital in the specific circumstances where organ donation is possible. It makes education around organ donation all the more crucial, and it’s why Rhonda Farley is passionate about raising awareness on the issue.

IN AUSTRALIA, ONLY 1 TO 2% OF PEOPLE DIE IN HOSPITAL IN THE SPECIFIC CIRCUMSTANCES WHERE ORGAN DONATION IS POSSIBLE. “A lot of people have misconceived ideas about donation. Most people think everybody that dies can simply be a potential organ donor… they don’t realise how rare it is or that someone each week may pass away waiting for a transplant,” Rhonda said. “It’s why a big part of my role is education. I have a stall at orientation week at the local university and I try and attend most of the major events in Townsville, to make sure I’m a presence in the community to answer any questions about organ donation and encourage people to go on the register. “I speak up anywhere I can get a voice.” DonateLife Week takes place from Sunday 29 July to Sunday 5 August 2018. Find out more at www.donatelife.gov.au

REVIEW OF THE ORGAN DONATION SYSTEM THE COUNCIL of Australia Governments (COAG) has announced a review of the organ donation, retrieval and transplantation sector, to be undertaken by the Commonwealth in collaboration with states and territories. The review will examine pre- and post-transplantation services and identify barriers to equity of access to transplant waiting lists and transplantation services. It will inform the development of a long-term to build on the Government’s national reform agenda on organ and tissue donation and transplantation. More information on the review will be provided in August.

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FOOD FOR THOUGHT Improving our elderlyâ&#x20AC;&#x2122;s quality of life through food

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E ALL love a good meal. There’s so much more to breaking bread than simply consuming the food our bodies require. And for our elderly sometimes it’s all there is to look forward to in a day. But meals being served to our mums and dads in aged care facilities fail miserably at whetting anyone’s appetite — three nuggets and five chips or mushy peas swimming in a centimetre of water do not a hearty meal make. Despite aged care providers reaping in $1 billion in profits last year, they currently spend on average a measly $6.08 per resident to provide three meals a day. This would hardly buy a millennial an avocado on toast, yet nursing homes still cut the food budget by 30 cents per resident just last year! Most of us have seen the media reports, and yes, the statistics are depressing… but it’s brought the issue of food to the fore and provided an opportunity to constructively bring awareness to the matter.

Mealtime matters

It also revealed a reduction of 30 cents per resident per day in the spend on raw foods, and an increase of 50 cents on supplements. Cherie said the pressures of documentation have led aged care providers to rely on medical supplements to counter malnutrition in their residents. “Supplements are an easy road to take — when someone has lost weight it’s a strategy that shows we’ve actioned something, but really it’s a band-aid fix that isn’t helping their quality of life,” she said. “We need to look at why the problem has begun and correct that so they can resume more of a normal diet, rather than be on a medicalised nutrition supplement that hasn’t addressed the underlying problem of why weight was lost in the first place.”

More than just a meal While getting the food right is an integral part of caring for our elderly, there are also a multitude of factors that can contribute to whether a person eats; a disease might increase nutritional needs for a particular resident; they may have dementia, dental issues or problems with dexterity.

Cherie Hugo is a dietitian and founder of The Lantern Project, which aims to improve the quality of life for our elderly through food.

So there are many considerations along the way…

“Food provides more than just nutrition, it’s a social catalyst that triggers memories and engages the senses,” Cherie said.

■■ How it was prepared in the kitchen: Did staff have the appropriate cooking equipment?

“For elderly residents, up to 70% of their waking day revolves around meals or thinking about food. “If we get it wrong we can really bugger up residents’ day, but if we get it right we can not only make their day but drastically improve their quality of life.” As part of The Lantern Project, unprecedented research was conducted on nutrition and food in the aged care industry. A review of almost 65,000 residents from 817 aged care providers found that half of the residents suffered from malnutrition.

■■ How the food was delivered: Was it fresh or frozen?

■■ How it was presented: Did staff have training to present the meal appealingly?

■■ How the resident received the meal: Was it properly described to them? ■■ How the resident ate the meal: Did they require assistance or have any problems chewing? It’s a holistic experience, and what Cherie considers to be the essence of her work. “Yes, I’m a dietitian but it’s often about taking the dietitian hat off and saying ‘what are we doing just to improve their enjoyment of life through food?’” she said. “If residents aren’t enjoying or eating their meals and are malnourished, it ends up costing providers more on supplements or wound care (due to an increased risk of bed sores) or even medication for depression. “If a meal is enjoyable a resident is happy to linger and chat with other residents then they are going to eat more. And that to me is success. “In the long run there’s savings to be had and happier, better outcomes for residents, happier families, happier staff… it’s good all round.”

Capturing the dining experience Fortunately, there are aged care facilities that are getting meal times right. Registered Nurse and member Cherise Matthews’ grandfather lives in an aged care facility that has listened to its residents and adopted a new approach to meal times, having recently introduced a seasonal rotating menu with several options for variety.

A review of almost 65,000 residents from 817 aged care providers found that half of the residents suffered from malnutrition. The Lantern Project

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I think it’s a difficult transition for them to leave their life and independence behind to go into a facility, then to be told what you have to eat and feel like you don’t have a choice is even harder. Cherise Matthews, RN

“This allows residents to choose what they want to eat and ensures they’re always getting something new,” Cherise said.

“These changes make them feel more valued and respected, and just more human I guess.”

It’s in the little things

“There’s also a whiteboard that lists their meal options for the day so they know exactly what they’re getting and it gives them something to look forward to.

While it can seem daunting, it doesn’t require drastic measures to set the wheels of change in motion. In fact, it’s the little things that count.

“The dining tables are dressed with white linen tablecloths which enhances the atmosphere, making the dining room like a restaurant… and residents are loving it!”

As part of The Lantern Project, dietetics students visited a number of aged care facilities to identify small food initiatives that have had a positive impact on residents.

Residents are also offered a glass of wine or beer during Happy Hour each afternoon, and a drink with their lunch on Wednesdays. These initiatives encourage socialisation and draw residents out of their rooms.

In one aged care home, residents were encouraged to come to the dining room half an hour earlier to socialise while nursing staff served

Since the introduction of the new menu, Cherise said residents’ attitudes toward meal times have greatly improved. “My grandad is the fussiest eater that’s lived — if it’s not my grandma’s cooking it’s not good enough — but even he is liking the food which is really amazing!” she said. “He really looks forward to the social aspect of meal times even though I don’t think he realises how much he enjoys it... in fact, all the residents do. “I think it’s a difficult transition for them to leave their life and independence behind to go into a facility, then to be told what you have to eat and feel like you don’t have a choice is even harder.

hot bread rolls straight into residents’ hands. “It’s a fantastic social experience that breaks down those clinical lines between residents and nursing staff,” Cherie Hugo said. “They feel the warm bread roll in their hands and have a chat to others at the same time, and it just reminds them that this is their home — it also means they’re eating an additional serve of bread! “It’s such a small thing but it breaks the cycle and has huge social benefits. Some sites now have staff eating meals with residents — particularly residents with dementia – because they can mirror a staff member’s

Breaking it down: How can we improve nutrition for our elderly? Older adults’ nutritional requirements can vary dramatically from middle age. It’s important to keep the diet as normal as possible with food that is enjoyable. ■■ As we get older, our appetites won’t be as great as they used to be. Make the most of every bite and aim for higher nutrient density in smaller portions. ■■ Without dumping the calorie load up, older adults need more protein, calcium and Vitamin D in the diet. ■■ Boost foods with extra protein, like substituting normal flour in cakes and biscuits with Lupin flour (a legume-type flour) which increases protein and calories, and contains fibre which helps the bowel. ■■ Involve residents in menu planning. Source: Cherie Hugo

indepth ability to eat and help increase their independence at the same time. “It changes the carer-patient dynamic to have everyone on the same level and eating the same food... it’s just human and it’s bringing it back to basics.” The initiative has proven there are food-based strategies that cost very little (or even nothing!) to implement that can make a huge difference to residents’ dining experience. “We’re trying to give providers the confidence to invest in food and training and the ambience of a dining experience, and to know that they’re not going to be out of pocket because it’ll save costs in many other ways,” Cherie said.

Stepping forward Through The Lantern Project, a diverse group of aged care stakeholders are working to implement new ideas and food-first approaches in aged care. Over the past five years, the project has evolved into a not-for-profit organisation with action research at its core and a vision to improve the quality of life for aged care residents through food… and the conversations continue to be positive. “While there is a research component it is very much action-

Food provides more than just nutrition, it’s a social catalyst that triggers memories and engages the senses… If we get it wrong we can really bugger up residents’ day, but if we get it right we can not only make their day but drastically improve their quality of life. Cherie Hugo, dietitian and founder of The Lantern Project

based with learnings being rolled out as part of our Lantern Approach program later this year,” Cherie explained. “Our stakeholder group meets monthly — all aged care workers are welcome to participate — and we’re putting theories and ideas in front of aged care providers and talking about food-based strategies that instil the value and importance of the dining experience and of training for staff,” she said. “The conversation is definitely evolving… what used to seem quite far out in the past is now starting to be adopted into practice, so we’re stepping forward in that way. “At some of the workshops we present we sometimes ask the audience how often staff and management eat the meals served to our elderly. In the past we’d just get blank stares, but recently 80% of workshop participants said they do so and it happens every day. That is a great measure of success!” Cherie is also part of a reference group working with the quality agency on the new aged care standards (to be released on 1 July 2018). Find out more about The Lantern Project at www.thelanternproject.com.au

Here’s what you had to say about meals in our aged care homes... CM Can’t complain about the food where I work. All freshly cooked on site, two choices for lunch, lighter meal for dinner and breakfast is very well done. I feel for those who don’t get to enjoy their meals because for some it’s the only thing to look forward to. Like · Reply

RH I’ve worked in prison and aged care and the aged care food is way better. Cooked on site and evening meal served with a glass of wine. Like · Reply

MH I have heard many times our prisoners are treated better than our aged care [residents]. If this is true it is a political and national shame. No respect for our aged at all it seems. Australia, you must do better. Like · Reply

EB I’ve worked in both [prison and aged care] and the prison food while cost effective was delicious. Like · Reply

TJ Where I work serve great food I have already booked my room! Like · Reply

ER Do not believe the menus, they are for show only. Like · Reply

KJ The food is good where I am but [staff are] underpaid. I keep saying this… pay your staff fair wages not the minimal rate required, protect your staff and they will go above and beyond. Like · Reply

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Talking food WITH MAGGIE BEER

ELEBRITY chef and 2010 Senior Australian of the Year Maggie Beer has been at the helm of improving the quality of food in aged care facilities.

As a staunch advocate for the cause, Maggie has travelled across the nation to run workshops with aged care chefs and cooks. She shares her food journey with us… What set you on the path to forming the Maggie Beer Foundation? After being awarded Senior Australian of the Year in 2010, I was asked to speak to a thousand aged care CEOs. It was then that I realised just how many passionate people there are involved in this industry, all of them doing what they can with limited resources to create change in aged care. It was my hope to pull science, research, nutrition and management under the one umbrella to support the ever-growing aged care industry in providing wholesome, flavoursome food to everyone. The Maggie Beer Foundation was established to be part of the journey to transform the food experience of the elderly; bringing life-altering change to their wellbeing through good food that is full of nutrition and flavour.

What’s been your impression of the food being served to our elderly? The quality of food is so very different and I have had great, good and terrible. The cooks and chefs I find really want to do well; they need the support, the ideas and the skills to make it possible.

Tell us about the food workshops you’ve been running with chefs and cooks in aged care facilities. Our very first step in bringing the Maggie Beer Foundation to life was to conceive a program that influences and

inspires chefs and cooks. You can’t be a chef or a cook without caring for the people who will enjoy your meals. But not all chefs are given the training they need. We also wanted to understand what they saw as their limitations. The Creating an Appetite for Life Masterclass is all about reinforcing the love of fresh food, creativity and resourcefulness, and finding ways that this can translate into food every day that is full of nutrition and pleasure, which in turn will create positive emotional and physical wellbeing for our elders. This is a ‘hands-on’ program for me. I work alongside expert guest speakers with a broad knowledge of the benefits of wholesome food, and we focus on the importance of enjoying the food experience and economically sustainable menus.

What are some of the challenges to improving food in aged care? There are many stumbling blocks in relation to cooking in aged care homes, but my purpose with the Foundation is not to focus on the negatives, but rather to put some fresh thinking around what is possible … and how we can improve the emotional wellbeing of elders through food. This was never going to be an easy road and so there will most certainly be challenges along the way, but the common denominator is that everyone involved can agree that change needs to happen, so we start from there. It’s not always just about the nutrition; it’s also the pleasure, the smells of home cooking to encourage appetite. It doesn’t matter how

This was never going to be an easy road and so there will most certainly be challenges along the way, but the common denominator is that everyone involved can agree that change needs to happen, so we start from there. Maggie Beer

nutritious a meal is if it’s not being eaten.

Aged care staff work very hard but there often aren’t enough of them to provide the care that is required. What would you say to them? I know those of you working in aged care work so hard and are in the industry because you care and because you want those you look after to thrive. So always have the confidence to talk to management about your ideas — you can do so much to make a difference! Find out more about the Maggie Beer Foundation at www.maggiebeerfoundation. org.au

Maggie Beer’s chicken soup with leek and barley Maggie shares her fave wholesome chicken soup recipe that she thinks should be a staple in every aged care facility!

indepth MAGGIE BEER'S

Chicken soup with leek and barley Chicken soup has always been a favourite comfort food in my family. As a child it’s what I asked Mum for when I was not feeling well or down about something, and my own children have the same feeling for it so it really is worth making it from scratch with the best ingredients. I like to cook the barley separately and add it in the final stages to stop it becoming gluelike from long cooking. But that’s a personal preference. Someone very close to me loves it like that: so thick with barley you could cut it into pieces!

Maggie

¾ cup (150 g) raw organic pearl barley, rinsed 2 tablespoons extra virgin olive oil 1 large brown onion, finely diced 2 carrots, cut into 1 em dice 1 leek, halved lengthways, washed well and cut into 5 cm thick slices 10 sprigs thyme 25 g unsalted butter Sea salt flakes and freshly ground black pepper 3 tablespoons verjuice 2 sticks celery, cut into 1 cm dice ½ cup chopped flat-leaf parsley Crusty bread, to serve Chicken stock 1 x 2 kg free range or other well brought-up chook, cut into quarters and left on the bone 1 brown onion, quartered 1 carrot, quartered 2 sticks celery, cut into 5 cm pieces 1 leek, green and white parts, washed well and cut into 5 cm pieces 2 cloves garlic, thinly sliced 2 bay leaves, crushed 1 teaspoon black peppercorns ½ teaspoon sea salt flakes

SERVES 6-8

To make the stock, place all the ingredients in a large heavy-based saucepan with 4 litres water. Bring to the boil over high heat, then reduce the heat to low and simmer very gently for 1-1½ hours. Remove from the heat and set aside to cool completely, then refrigerate overnight. The following day, place the rinsed barley in a large saucepan with 4 times the amount of water. Bring to the boil over high heat, then reduce the heat to low and simmer for 30-40 minutes or until tender. Drain, then cover with a cloth so it doesn’t dry out and set aside. Skim off any fat that has risen to the surface of the chicken stock. Remove the chicken pieces and discard the skin and bones. Shred the meat into bitesized pieces. Place the cold stock in a large saucepan and heat until just warm, then strain and discard the solids. Return the stock to the pan and bring to the boil, skimming off any impurities, fat and foam that rises to the surface. Reduce the heat to low and simmer gently. Meanwhile, heat the olive oil in a large saucepan over medium heat. Saute the onion for 10 minutes or until translucent. Add the carrot, leek, thyme and butter, then season with salt and pepper. Simmer for another 5 minutes or until the vegetables are tender. Remove the thyme sprigs. Add the verjuice and simmer until nearly evaporated, then add the hot stock. Bring to the boil, then reduce to a simmer. Stir in the shredded chicken meat, cooked barley and celery and simmer for 5 minutes or until heated through. Check the seasoning. To serve, ladle the soup into warmed bowls, scatter with the chopped parsley and serve with crusty bread.

NUTRITION The goodness in chicken soup has been proclaimed for centuries in so many cultures around the world. This soup will be no exception, with garlic, onion and leek to provide anti-inflammatory, antioxidant and anti-microbial components.

GIVEAWAY For a chance to WIN a copy of Maggie’s Recipe for Life, tell us in 50 words or less what your comfort food is, and why. Email your answers to comms@qnmu.org.au

indepth

N A BLONDE brick home north of Brisbane, a woman in her forties prepares for work. The aged care Enrolled Nurse, who doesn’t want to be named for fear of losing her part-time position, has risen at dawn to make school lunches and prepare for dinner. She puts a casserole in the slow cooker then empties and loads the washing machine. While she works, the Enrolled Nurse thinks about the day ahead… About getting the kids to school early so she can get to work on time, about traffic, which could eat into the fiveminute travel buffer she factors into her daily commute, about the car rego due in June, the rates bill which has jumped again, and about where she’ll find the $220 required to pay for soccer registrations and uniforms in a fortnight’s time. When every cent counts, these things require thought. In fact, the woman, and hundreds of thousands of other Australian part-time and casual employees like her, spend much of their time contemplating how they will make ends meet. Life as a part-time or casual employee is tenuous, her work hours defined as anywhere between 16 and 72 per fortnight. She says those hours depend on whether she can find a lastminute sitter in order to take on a sudden extra shift, on working uncomplainingly through lunch to meet the massive workload demands and on silently making do with the ever-dwindling resources available to the elderly in her care. “There’s absolutely zero security,“ the woman told the QNMU. “Those days are history. Management where I work are deliberately getting rid of the nurses or anyone else who might be in a union because they want to break down that power. “Day by day and week by week they’ve lowered the bar on how

indepth much they have to pay staff and how experienced those staff are. Now the place is full of people who have no idea what they’re doing and the residents are suffering. “Managers come and go but every single one of them comes up with new ways to cut down the budget or reduce staff. I swear management who do the rosters are getting bonuses for cutting costs. “And anyone who speaks up against them in relation to the conditions for staff or residents will have their hours dry up until they simply don’t exist. It feels third world and it should be illegal.“ This woman is not alone. In fact, around four million Australians are currently in insecure work. They say job instability, deteriorating working conditions, financial uncertainty, rising costs and a sense of isolation and lack of hope are ruining their quality of life. That while the bills continue to mount, their entitlements and rights are being constantly eroded. However, a growing number of Australians are pushing back. On March 21, Australian Council of Trade Unions (ACTU) Secretary Sally McManus called for workers to know and campaign for their rights. Sally outlined how, under the Turnbull government, the rights of Australians had deteriorated while big business boomed.

“We in the union movement still believe in the fair go — and we are prepared to fight for it." Sally said it was “now up to this generation of working people” to do the same. The speech launched the ACTU’s Change the Rules campaign — a combined union push to highlight and address the erosion of worker’s rights. The Change the Rules campaign identifies: ■■ One third of big business didn’t pay any tax ■■ Conditions for Australian workers are slipping below those outlined by the International Labour Organisation (ILO) ■■ Wage inequality is at a 70-year high ■■ The Fair Work Commission is no longer independent ■■ Penalty rates continue to be eroded ■■ A recent Australia Report linked the end of wage growth to the lack of stop work action ■■ Workers are being prevented from being active within their unions ■■ Workers are suffering silently within their own industries ■■ Since the 1970s, Australian stop work action or strikes have decreased by 97% ■■ The decline in strike activity has been caused by Australian industrial laws, which are some of the most restrictive in the developed world.

QNMU Secretary Beth Mohle said Queensland and Australian workers need to hear and be part of the Change the Rules campaign. “This disintegration of the Australian way of life and quality of life does not have to continue,“ Beth said. “But there does need to be change. Queensland and Australian workers need to be willing to join the campaign to protect our rights and the way we want to live. Or the way in which we want to be able to care for others, as part of a society that is not purely dollar-driven. “By joining a union, by joining the Change the Rules campaign, Australians can use their experience and numbers to push back and reinstall the independence of institutions such as the Fair Work Commission to protect Australian workers. “The ongoing reduction of workers’ rights, penalty rates and the tax paid by big business will not only erode job security, the dignity workers deserve and our quality of life, they will erode Australian institutions that are the envy of the world such as our public health system. “There is a very real need for change and the union movement is asking all Australian workers to take part.“ Find out more or join the Change the Rules campaign at www.changetherules.org.au

She said people from many industries were disillusioned and suffering — and it was time for change. “Once the promise of living in Australia was that each generation would pass on something better to the next. Better healthcare. Better education. Fairer pay,“ Sally told the Press Club during her widely-reported Change the Rules speech. “The cornerstone to all this was a belief that working people should get a fair go, and that we would all share the wealth we helped create. “But the Turnbull Government and big business have no interest in this promise. Instead, they’re actively dismantling our job security, or are standing idle while it disappears.

We in the union movement still believe in the fair go — and we are prepared to fight for it. Sally McManus, ACTU Secretary

indepth

Put another nail in my coffin O

N ANY GIVEN THURSDAY, the Community Shed in the Tasmanian Central Coast town of Ulverstone is filled with a symphony of power tools. There’s Gina on the planer, Ed on the dropsaw, and former carpenter Russell is showing a newcomer how to wield a belt sander. But there’s not a turned table leg, stool or birdhouse in sight. There are however, coffins. “Mine’s coming along nicely,” Ed said. “I’ve tried it on and I fit fine.” Ed King, 54, and his timberworking friends are all members of Australia’s first Coffin Club — a unique, if somewhat unorthodox social club in which people can build their own coffins. It began in September 2016 and is an initiative of Care Beyond Cure, an organisation that delivers what it describes as “grassroots psychosocial” care for people with diagnosed progressive life limiting illness, and their families and carers. But just because its designed for people with terminal illnesses, don’t for a second think that makes it gloomy.

Coffin Club members (left to right): David Smith, David Wardle, Russell Game, Gina McKinlay, Ed King and David Boddy.

Just ask Ed. A former high school art teacher Ed has been diagnosed with end stage Dementia (Alzheimer’s). He can no longer work or drive, but thanks to some good medication he can still swing a hammer — and he’s making the most of it. “I’m going to have a bit of fun with my coffin,” Ed chuckled. “I’m turning it into a sort of faux Viking (boat) up the front…. And adding a little rudder, possibly, because you’ve got to know where you are going don’t you? “I don’t want to slip the wrong way up to heaven — I’ve got to make sure I go to hell where all my friends are!” Ed’s good-humoured approach to his own mortality is pretty much par for the proverbial course at the Coffin Club, where conversation about death and dying are treated in a refreshing matter-of-fact fashion. Care Beyond Cure Secretary Lynne Jarvis said giving people an opportunity to open up about illness and death, embrace humour and be creative are all part of the organisation’s philosophy which takes a holistic approach to palliative care.

I don’t want to slip the wrong way up to heaven — I’ve got to make sure I go to hell where all my friends are! Ed King

“End of life can become very focussed on the medical…on tests and hospitals and the next treatment,” she said. “But palliative care should also about looking after our psychological, social and spiritual wellbeing. “Palliative care treatment should really be there for symptom and pain management, so you can get on with All photos by Scott Gelston/Fairfax Photos

indepth the business of living...and living well until you do die.” In the past year club members have made about 10 coffins, some out of pine or plywood, but many out of old wooden pallets which cost a pittance to make. Lynne said it’s not uncommon for families and carers to get involved with the build, and says working together on a loved one’s casket can help families bond at a time when they feel they are being pulled apart by circumstances beyond their control. “It’s a gift of love that people share,” she said. “We had a wonderful situation where we had 11 members of one family including grandchildren come along and help and it was just absolutely beautiful. “I think that sort of bonding is healthy and has the potential to foster a healthier bereavement.” While some people are drawn to the club for the affordable coffins, Ed said for most of his club colleagues it’s about the social interaction and the chance to shoot the breeze with people in a similar situation.

“It’s really great, you can sit down, have a coffee and there is lots of banter — and banter is good!” “And I can’t drive anymore so this is also an outing for me.” As someone who has always loved building things, Ed said making his own coffin is also an opportunity to forget about his illness for a while and enjoy the physical process of working with his hands. “I’ve got some nice Oregon timber in my shed I’m using. It’s from a building they knocked down,” he said. “They used to use if for roofing in the 30s and 40s, but it’s really beautiful looking timber, it has a nice orange colour. “Then I’ve got some really nice old things I want to put on it, I’m a sculptor see.” But when his time comes he admits he’s not keen to have his work go up in flames, instead he’s going to pass on his casket and depart this world in a shroud. “You have to have a coffin to go from the car to the crematorium, but after that the idea is that they just pick me up and burn me and my family can scatter me anywhere they want.”

“I first came here with my support worker David and it was really nice… as soon as we came in, all the people here were really friendly,” Ed said.

“I’m going to give the ‘boat’ to my nephew — he’s 7ft something and he’s a bikie … and he’s a bit of a collector like me.”

“And now I’m pleased to be part of this community.

“So yep, it’s going to be just a short ride in the boat.”

Carpenter and Coffin Club mentor Russell checking the size.

All-of-community approach to palliative care Care Beyond Cure is based on the philosophy of Australian sociologist Prof Allan Kellhear and his groundbreaking research on the human experience of dying and the idea of a more holistic, community approach to end of life care. Care Beyond Cure provides a range of activities for people with life limiting illnesses including gentle yoga, oncology massage, art therapy, mindfulness sessions and bereavement support. The Coffin Club is part of that suite of activities.

Check this out! Coffin Clubs have been part of the New Zealand community landscape for many years now and some have a great deal of fun taking the sting out of death. Check out this fun 3-minute video about the colourful Kiwi Coffin Club.

www.youtube.com/ watch?v=YKxkLKggTlo

For more information visit: www.facebook.com.au/CommunityCoffinClub www.facebook.com.au/CareBeyondCure

Coffin Club member Gina is quite the pro on the nail gun. 45

indepth

NO MORE NUKES It’s time to act on nuclear weapons

This year I’ll retire from nursing after 50 years! How I’ve learned and loved being part of this caring, rewarding profession.

binding international agreement to prohibit nuclear weapons and aim towards their total elimination.

I started my training at the PA hospital during the worldwide political combustion of 1968. Australia had joined the US to fight in Vietnam even without a security threat, and Aboriginal people struggled for their rights after recognition as Australian citizens the year before; French students rioted; US police shot and killed students protesting the Vietnam war, and Martin Luther King was assassinated in the struggle against racism.

The treaty grew from a decade of advocacy by the International Campaign Against Nuclear Weapons (ICAN) and its partners. ICAN is the brainchild of the Medical Association for the Prevention of War in Australia and was awarded the 2017 Nobel Peace Prize.

Alongside many thousands of Australians I joined the peace movement. I still work actively for peace, justice and nonviolent resolution of conflict — locally through Just Peace Queensland and nationally in the Independent and Peaceful Australia Network (IPAN). There’s much to be done.

S PRESIDENT Donald Trump’s recent decision to pull out of the 2015 Iran nuclear agreement has raised fears the world could be heading toward nuclear conflict. Breaking the agreement, making threats and reinstating economic sanctions against Iran, raises the very real risk of Iran itself abandoning the agreement and, fuelled by antiAmerican sentiment, re-building its nuclear capabilities. This worrying development in global affairs struck a chord with long-time peace activist and QNMU member ANNETTE BROWNLIE, who penned the following article to encourage her nursing and midwifery colleagues to join the movement for nuclear disarmament.

Seventy years ago America bombed Hiroshima and Nagasaki in Japan, immediately killing 80,000 people and leaving tens of thousands to die of radiation exposure. America’s shocking ‘world first’ motivates many of us to ensure such a disaster is never repeated. The use of nuclear weapons — intentionally or otherwise — clearly means catastrophe. So what can we do? After nuclear bombing it’s too late. Ionizing radiation kills or sickens those exposed, contaminates the environment, and has longterm health consequences. The medical profession could not work in radioactively contaminated areas. So our efforts must be directed toward preventing a nuclear attack. Last July the United Nations passed the Treaty on the Prohibition of Nuclear Weapons, the first legally

To come into effect, the treaty needs to be not just signed but also ratified by at least 50 countries. For countries already nuclear armed, the treaty provides a framework for negotiations leading to elimination of their nuclear weapons programs. As of May 2018, 58 states had signed the Treaty and eight had ratified it. And here’s the tragic irony. Although ICAN and the treaty have strong roots in Australia, the current Australian government refused to sign the treaty — and it ignored the Nobel prize achievement by Australians. Yet there’s hope. Contrary to the federal government’s position, recent opinion polls in Australia have shown strong public support for negotiating an international ban on nuclear weapons. Furthermore 72% of federal Labor MPs and all Greens joined a pledge to sign the treaty when in government. For the future of all life on earth, I pledge to use my time in retirement to work through IPAN for an independent Australia that promotes peace and works internationally to have nuclear weapons banned and destroyed. I encourage my union, nursing and midwifery colleagues to join me. ICAN: www.icanw.org/au IPAN: https://ipan.org.au

your $ health

GET THE MOST OUT OF YOUR TAX RETURN W

ITH TAX time looming it’s time to start thinking about the deductions you can claim to help boost your refund. As nurses and midwives, it’s likely that throughout the year you’ve purchased work-related items out of your own pocket. Many common nursing or midwifery expenses are valid tax deductions that you can claim back on your tax return. To help boost your tax refund this year, we asked the nurse and midwife accounting experts at Etax.com.au for this handy list of common deductions, plus do’s and don’ts to ensure you claim your fair share this year.

Common tax deductions for nurses and midwives There are many work-related expenses you may be able to claim. The key is ensuring you’ve got the receipts and documentation for anything you claim. Here’s a list of common nurse- and midwife-related items you may be able to claim on your 2018 tax return: ■■ Memberships and union fees Fees paid to industry bodies or unions (like QNMU!). ■■ Work related car expenses - Travel between hospitals or transporting patients etc. (remember home to work travel is generally not claimable). ■■ Work uniform expenses - Specific or protective clothing required for your job/uniforms. ■■ Laundry costs - Cost of washing, drying and ironing work clothes (specific, protective or has a logo).

■■ Stationery expenses - This includes diaries, planners, log books, workbooks. ■■ Computer/Laptop - Depreciation costs using a percentage of legitimate work-related use. ■■ Mobile phone - Percentage of your mobile phone bill used for workrelated phone calls. ■■ Subscriptions - Subscriptions to nursing or midwifery magazines, books and journals (digital or hardcopy). ■■ Home office expenses - Claimable if you’re genuinely required to work from home. You can claim a percentage of costs such as internet for the time you work from home. You may also be able to claim ■■ Travel expenses ■■ Personal car usage ■■ Self-education expenses ■■ Charitable donations ■■ Tax agent fees

Top tax tips for nurses and midwives If you’ve been reimbursed, don’t claim it If your employer has already reimbursed you for a work-related expense, you can’t claim the expense as a deduction. The Australian Taxation Office (ATO) is very good at detecting this and you could be penalised later.

Keep good records and save your receipts The key to paying less tax (and a bigger refund) is good record keeping

and saving your receipts. Even if you’re not sure whether you can claim it, save it. Your tax agent can advise you if it’s an allowable claim.

Track your personal car use trips If you use your car for work travel (e.g. transporting patients, transport between hospitals during shift etc.) keep a diary or a logbook to calculate your work-related kilometres travelled. This does not include trips to and from work.

Improve yourself and your refund with self-education If you’re required to up-skill or study further for your current role, these expenses can be claimed. This includes short courses (e.g. first aid, OH&S) as well as some qualifications or certificates. But remember, selfeducation expenses must be related to your current job and cannot be claimed if the study helped you get a new job or start a business.

NUMBER 1 TIP: If you’re not sure, always ask an expert. Tax agents generally cost less than $100 which is tax deductible, and it’s their job to ensure you get the best possible refund without running into ATO trouble.

Learn more at www.etax.com.au/ tax-deductions-for-nursesand-midwives/

FR EE

New CPD portalâ&#x20AC;¦

FREE for QNMU members! www.qnmu.org.au/CPD QNMU member Nerea Urquiza, RN, from Queensland Fertility Group

CPD

Free flu vaccinations for kids BY QUEENSLAND DEPARTMENT OF HEALTH, IMMUNISATION PROGRAM

FTER 2017 being the worst flu season in recent years, the Queensland Department of Health is implementing the Childhood Influenza Program this year. The program provides free influenza vaccines to all Queensland children aged from six months up to five years through general practices and other childhood immunisation providers. Children under five years of age have some of the highest rates of influenza and associated complications, and the highest number of flurelated hospital admissions. Senior Medical Officer for Queensland Health, Dr Stephen Lambert, said the risk is not just for children with medical conditions, but also healthy children. “Experience from Australia and overseas shows the majority of influenzarelated paediatric hospitalisations and deaths actually occur among children without any underlying medical conditions,” Dr Lambert said. “We also know that children contribute greatly to the spread of influenza in the community, and serious complications from influenza can be devastating for children and their families.” Annual immunisation is therefore important for all children and continues to be the best way to prevent the flu from spreading. “Providing vaccine to very young children will greatly enhance their protection against influenza — the most common vaccine — preventable disease whose severity is unfortunately often underestimated even among healthcare professionals,” Dr Lambert said. The influenza vaccine is a safe vaccine for children and should be offered annually to everyone older than six months of age. Research demonstrates that children are three times more likely to receive an influenza vaccination if a healthcare provider recommends it to their parents or carers. Healthcare professionals are therefore in a unique position to have this discussion with parents and encourage them to vaccinate their children against the flu each season. Midwives also play a critical role in recommending the free influenza and whooping cough vaccinations to women during their pregnancy. Vaccination during pregnancy is the most effective way to protect both the mother and her baby from these serious and potentially life-threatening diseases. Remember, immunisation is not a replacement for basic hygiene of handwashing and mask-wearing.

RESOURCES To see a short video on why health professionals should recommend the flu vaccine annually, visit www.health.qld.gov.au/clinicalpractice/guidelines-procedures/ diseases-infection/immunisation/freeinfluenza-vaccine-for-children Resources for immunisation providers to promote the childhood flu vaccine are available for download at www.health.qld.gov.au/clinicalpractice/guidelines-procedures/ diseases-infection/immunisation/freeinfluenza-vaccine-for-children More information on vaccinations during pregnancy is available at https://vaccinate.initiatives.qld.gov.au/ pregnancy/

REFLECTIVE QUESTIONS 1. What other strategies could be implemented to prevent spread of infectious disease in day care centres and preschools? 2. Has promotion of and reliance on vaccination as a panacea for public health strategy overshadowed universal precautions and basic health strategies like good diet and hygiene? What are the drivers of health spending and strategy? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Australian team fosters global nursing research N

URSES increasingly play a greater role in global health activities, strengthening interdisciplinary and interprofessional collaboration and partnerships, to reduce health and health care disparities based on wealth, education, gender and place.

benchmark results with other hospitals worldwide.

Despite the prevalence of peripheral intravenous catheters (PIVC) in clinical practice, little is known about day-to-day insertion and management practices of these devices on a global scale.

With networks now established, this has opened the doors to further collaborative research studies.

The AVATAR Group in the School of Nursing and Midwifery has been playing a significant role in global nursing with its involvement in the One Million Global (OMG) Peripheral Intravenous Catheters (PIVC) worldwide prevalence study. Following a pilot study of 14 hospitals in 13 countries, the OMG study team recruited a whopping 416 hospitals in 51 counties for an international audit of PIVC use and management to provide data on current practices on insertion and care of over 40,000 PIVCs — information that was previously unknown. Interest in the study was spread by word of mouth, conferences, newsletters, industry partners, social media (Twitter, Facebook, LinkedIn), and global research networks in multiple languages. On a given day, decided by each organisation, consenting hospital patients permitted the details of their PIVC(s) to be collected for the study. Feedback from participating clinicians was overwhelmingly positive, with many taking the chance to celebrate their involvement in a global nursing study. The far-reaching response to this study confirmed that clinicians are keen to become involved in simple research projects with defined clinical benefits for patients. Investigators from participating hospitals reported the benefits of this study included the opportunity to audit practice and

The enthusiasm for the project far exceeded expectations and has led to the creation of extensive global nursing and medical research partnerships.

The AVATAR Group is now working with nursing colleagues in Latin American Countries (Argentina, Brazil, Colombia and Mexico). The Vascular Access Catheter Use in Latin America (VASCULAR) study is a multinational study designed to assess and compare the prevalence of PIVC in Latin American hospitals and complications leading to PIVC failure. Results of this project will enable clinicians, researchers, policy-makers and the community to compare vascular access device outcomes and prioritise issues for education and international research collaborations to tackle the problems of device failure. Monitoring and benchmarking of PIVC insertion and management practices will raise awareness of evidence-based guidelines and enable the development of planned strategies to improve patient outcomes.

BY DR RACHEL WALKER RN, BN, BA, MA (RESEARCH), PHD RESEARCH FELLOW, SCHOOL OF NURSING AND MIDWIFERY GRIFFITH UNIVERSITY AND DIVISION OF SURGERY PRINCESS ALEXANDRA HOSPITAL DR GILLIAN RAY-BARRUEL, RN, BSN, BA(HONS), GRADCERTICUNURS, PHD POSTDOCTORAL RESEARCH FELLOW, AVATAR GROUP, MENZIES HEALTH INSTITUTE QUEENSLAND, GRIFFITH UNIVERSITY

References

Alexandrou E, Ray-Barruel G, Carr PJ, Frost S, Inwood S, Higgins N, et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015;10(8):530-3. Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public to planetary health: a manifesto. Lancet. 2014;383(9920):847. Wilson L, Mendes IA, Klopper H, Catrambone C, Al-Maaitah R, Norton ME, et al. ‘Global health’ and ‘global nursing’: proposed definitions from The Global Advisory Panel on the Future of Nursing. J Adv Nurs. 2016;72(7):1529-40.

REFLECTIVE QUESTIONS 1. How have you contributed to global health, both personally and professionally? This may include contribution to international clinical guidelines, donations and/or service to charitable organisations, post-graduate education, or membership of nursing organisations. 2. If given the opportunity how could you, both individually and collectively, make a difference to health care services in your local context? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Re-energising through clinical supervision D

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

Clinical supervision might be just what you need to re-energise, gain insight into your work, and support your provision of quality care. Clinical Supervision Consultancy (CSC) will be offering the eight-day foundational training program Clinical Supervision for Role Development, at the QNMU in Brisbane later this year. CSC founder and principal Paul Spurr says the 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 and CSC cofacilitator Tamzin Mondy described clinical supervision as dedicated time for reflection on all aspects of your professional practice. At the heart of clinical supervision is a trusting relationship between the supervisor and supervisee, which allows personal and professional development through regular reflection. 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. She said clinical supervision has kept her committed to her work and her clients, and has helped her manage challenging situations and relationships with positivity and innovative thinking. Many in the health sector, particularly those engaged in mental health services, have experienced the benefits of regular clinical supervision for many years.

Mental Health Nurse and CSC co-facilitator Julie Sharrock said nursing and midwifery is emotional and relational work and says clinical supervision can help nurses and midwives perform at their best.

Tamzin Mondy

“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. Are you interested in learning about the supervisor role?

TRAINING DETAILS: 68 CPD hours WHEN: 10-12 July, 25-27 September and 27-28 November 2018 (participants must attend all eight days) WHERE: QNMU Brisbane office COST: $2800 To register your attendance or for more information, email paul@spurrcsc.com or phone 0410 033 342

Paul Spurr

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

CPD

MEDICATION

MANAGEMENT: How do the sectors compare?

CPD

URSES play a key role in medication management across a diverse range of

practice settings. We undertake an essential surveillance role across prescribing, dispensing and storage, as well as administration and monitoring. Nurses are also the primary reporters of adverse events and errors, including medication errors. Currently, there is significant attention on the aged care sector particularly around issues such as staffing levels and skill mix, resident safety, quality of care, and overall governance and regulation.

to provide a point of comparison for the aged care sector. At a national level, the Mediation Safety Standard of the National Safety and Quality Health Service Standards provide the minimum acceptable standards for medication safety for health services.

Medication management practices are also receiving much-needed scrutiny.

They are supported by a range of medication safety resources including a standard national hospital medication chart.

While aged care facilities are not hospitals, both environments are characterised by significant levels of clinical care, and specifically nursing care, for vulnerable people.

At a facility level, medication safety is a key focus of accreditation processes and clinical governance, as well as patient safety practice and processes.

Over recent years there have been attempts by some aged care providers to de-emphasise the clinical aspects of aged care in favour of a ‘social’ model of care.

Yet, despite the involvement of highly trained medical practitioners, nurses and pharmacists, ongoing medication error rates flag this as a critical area of clinical practice requiring constant vigilance. The risks involved are sobering:

However, the current Senate inquiry into aged care quality, accreditation and care standards recommended that a significant component of aged care must be classified as health care and therefore regulated by the appropriate health quality standards and accreditation processes. Unfortunately media reports, the experience of QNMU members, and the findings of many aged care inquiries indicates there is a significant difference in the level of care provided by the acute and aged care sectors. Emblematic of this difference is the area of medication management.

■■ 2-3% of hospital admissions relate to medications ■■ There are two errors at admission for every three patients admitted ■■ Prescribing errors may be as high as one per patient ■■ Administration errors are at a rate of one per 10 administrations ■■ There can be up to two discharge errors per patient.

Medication management in aged care

Hospitals as a medication management benchmark

Given the critical risks associated with medication management in the acute sector, how does the aged care sector compare?

While there is always room for improvement in our hospitals, it is still worthwhile reviewing how medication management takes place in this sector

Older Australians, particularly those receiving residential aged care services, are characterised by significant care needs, multiple

CPD diagnoses, comorbidities and polypharmacy. It is estimated that on average they have 3.4 – 4.5 separate diagnoses, six comorbidities, and are taking 8.1 medications. Research undertaken by Macquarie University indicates that 85% of aged care residents were prescribed five or more medications, 45% were on 10 or more medications, and 4% were on 20 or more medications. Medication management is also one of the top five complaint areas reported to the Aged Care Complaints Commissioner.

In the aged care sector: ■■ Nurses are the primary managers of medication therapy but generally don’t have the onsite critical support and resources, such as medical practitioners and on-site pharmacists and pharmacies. ■■ There is an increasing number of unregulated care workers (often with little training in medication related roles), thanks to cuts to registered staff.

These figures highlight that medication management is a critical clinical process in aged care, just as it is in the acute sector.

■■ The aged care quality standards are far less comprehensive. While there is a whole standard related to medication safety for the hospital sector, there is currently no reference to medication management or medication safety in the Draft Aged Care Quality Standards.

However, this is where the hospital and aged care sectors diverge.

■■ The use of prepacked mediations is common practice. However,

It is estimated that, on average, older Australians have 3.4 – 4.5 separate diagnoses, six comorbidities, and are taking 8.1 medications.

evidence suggests that the error rate for this approach is higher than administration from original packaging (error rates of up to 10% have been reported). ■■ Approximately 75% of residents require total help with medication administration. ■■ Uptake has been limited on a national residential aged care medication chart, unlike the standardised medication chart used in the acute sector.

The problem with aged care If medication related errors and adverse risk remain an acknowledged and a high risk in the acute sector despite the availability of highly trained staff, comprehensive standards, and wide-ranging

CPD medication safety processes, it is hard to believe that transferring medication administration tasks to AINs and PCs will maintain safety. This practice would simply be unacceptable in the hospital sector. Feedback from QNMU member AINs and PCs indicates they are often given little choice in undertaking this role, are concerned for their job security if they refuse, and worry about the safety of undertaking this role, often with little training. The significant theoretical and competency based training in pharmacology undertaken by nurses reflects the minimum standard of knowledge and practice deemed necessary by the Nursing and Midwifery Board of Australia. The idea that this role can be undertaken by unregulated aged care workers — many having received only a few hours’ training — is concerning, to say the least. Unregulated aged care workers are an essential part of the aged care workforce and do have a role to play in assisting those competent aged care residents who ask for help to take their prescribed medications. The professional standard for Registered Nurses — the Nursing Guidelines for the Management of Medicines in Aged Care — also states that carers should assist with medication management only when the resident is competent to selfmedicate.

This standard is also referenced on page 60 of the Commonwealth Department of Health’s Guiding Principles for medication management in residential aged care. However, aged care providers choose to take a much broader, and inherently unsafe, interpretation of these carer provisions, and the professional standard, than the QNMU. As a result, the safety of medication management in residential aged care is significantly inferior to the hospital sector. The QNMU will continue to advocate for the governance frameworks, standards and practices of medication management in the acute sector to be applied to aged care.

RESOURCES ACSQHC health service standards: https://bit.ly/2xgMoJ3 Information on the current aged care accreditation standards: https://bit.ly/2rXhU8L The new draft aged care standards: https://bit.ly/2FBZX6S

REFLECTIVE QUESTIONS 1. How do you implement the ACSQHC Standards if you work in the hospital sector and the Aged Care Accreditation Standards if you work in aged care in relation to medication management? 2. Review both sets of standards and compare and contrast how applicable each set of standards would be for medication management in your area of practice. Analyse why you think there is a difference. 3. Do you think residential aged care needs the same level of standards for medication safety as the hospital sector? Why or why not? 4. Reflect on and document the medication safety issues relevant to your area of practice and identify a strategy for risk reduction for each issue you have recognised. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References Aged Care Complaints Commissioner (2017) retrieved from https://www. agedcarecomplaints.gov.au/wp-content/ uploads/2018/01/National-QuarterlyBulletin-September-2017-Quarter-excel.xlsx Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017. Australian Department of Health (2012), Guiding principles for medication management in residential aged care facilities, retrieved from http://www.health. gov.au/internet/main/publishing.nsf/content/ guide-med-mgmt-aged-care Australian Department of Health (2018), Draft Aged Care Quality Standards and Draft Application of Draft Aged Care Quality Standards by service type, retrieved from https://agedcare.health.gov.au/quality/ single-set-of-aged-care-quality-standards/ draft-aged-care-quality-standards-anddraft-application-of-draft-aged-carequality-standards-by-service-type Australian Nursing and Midwifery Federation (2013), Nursing Guidelines for the Management of Medicines in Aged Care, retrieved from http://anmf.org.au/pages/ nursing-guidelines-for-the-management-ofmedicines-in-aged-care Canadian Patient Safety Institute, (2016), retrieved from http://www. patientsafetyinstitute.ca/en/Topic/Pages/ Medication-Management.aspx Community Affairs References Committee (2018), Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practiced – Interim Report, retrieved from https://www.aph.gov.au/Parliamentary_ Business/Committees/Senate/Community_ Affairs/AgedCareQuality Hussainy, S.; Marriott, J.; van Koeverden, P., Gilmartin, J., 2012, How accurate are manually prepared dose administration aids in residential aged care facilities? Australian Pharmacist, Vol. 31, No. 4,: 320-324. Jackson, J and Welsh, E. (2017), Medication charts in residential aged-care facilities, Australian Prescriber, Vol. 40, No. 1, 20-22 NSW Nurses and Midwives’ Association (2017), The state of medication in NSW residential aged care, NSW Nurses and Midwives’ Association, Waterloo NSW Phillips, J., Currow, D., Parker, D. & Ries, N. (2017), Australia’s aged care residents are very sick, yet the government doesn’t prioritise medical care, The Conversation, retrieved from https://theconversation.com/ australias-aged-care-residents-are-verysick-yet-the-government-doesnt-prioritisemedical-care-88690 Westbrook, J., 2017, Johanna Westbrook from Macquarie University [video], retrieved on September 6 2017 from Willis, E., Price, K., Bonner, R., Henderson, J., Gibson, T., Hurley, J., Blackman, I., Toffoli, L. & Currie, T. (2016) Meeting residents’ care needs: A study of the requirement for nursing and personal care staff, Australian Nursing and Midwifery Federation.

CPD

re you up to speed with the regulations around midwives and medication?

Obtain, possess and administer The current regulations state Queensland registered midwives may obtain, possess and administer specific medications based on oral or written instructions by an authorised health care provider, or under a Drug Therapy Protocol (DTP). The Health (Drugs and Poisons) Regulation 1996, DTP â&#x20AC;&#x201C; Midwives, is the DTP for midwives and lists the medications midwives may use within their scope of practice. Local procedures determine when a midwife has met the criteria and knowledge required to work under the DTP-Midwives (DTP-M). Working under a DTP-M removes barriers and allows midwives to provide comprehensive antenatal, labour and birth, and postnatal care to women and babies.

Prescribing

Midwives and managing medication

Midwives who have completed a postgraduate prescribing course, and have an endorsement on their registration, can prescribe medications and can secure Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) provider numbers. Most midwives with an endorsement who prescribe do so in their private practice role. However, the Queensland Health minister has just signed off on a consultation paper seeking feedback on proposed changes to the Health, Drugs and Poisons regulation to permit employed midwives, Nurse Practitioners and allied health practitioners with national endorsements to prescribe relevant to their role and scope of practice. This is a positive step for midwives, and the QNMU will be making a submission to this consultation. Midwives managing medication within the appropriate context, and using their essential skills and knowledge, provides greater autonomy for midwives and helps them provide quality care that is timely and appropriate.

CPD

NMBA terms set to change From 1 January 2017, a one-step process of applying for NMBA endorsement replaced the two-step process of applying for notation, then endorsement. The transition period is expected to finish on 30 June 2018. When all midwives have transitioned to the endorsement, the term ‘eligible midwife’ and ‘notation’ will no longer be used by the NMBA. Eligible midwife will be replaced by ‘midwife with endorsement’.

Key regulatory extracts for your information Section 167 of the Health Act 1937. Health (Drugs and Poisons) Regulation 1996 (Current as at October 2017)

Appendix 1 of the Health (Drugs and Poisons) Regulation 1996 : Drug Therapy Protocol – Midwives

Midwives

(Current as at December 2016)

1. To the extent necessary to practise midwifery, a midwife is authorised to—

Appendix 1 is the list of medications midwives working under the DTP-M can obtain, possess and administer.

a. obtain a restricted drug; and b. possess a restricted drug at the place where the person practises midwifery; and c. administer a restricted drug to the person for whom it has been dispensed under the instructions stated by the dispenser; and d. administer or supply a restricted drug— i. on the oral or written instruction of a doctor, nurse practitioner or physician’s assistant; or ii. under the midwives DTP.

Section 167A of the Health Act 1937. Health (Drugs and Poisons) Regulation 1996 (Current as at October 2017) Eligible midwives* 1. To the extent necessary to practise midwifery, an endorsed eligible midwife* is authorised to prescribe a restricted drug. 2. In this section— endorsed eligible midwife* means a midwife whose registration is endorsed under the Health Practitioner Regulation National Law (Queensland), section 94 as being qualified to prescribe scheduled medicines required for midwifery practice. * This will be changed to the new terminology in the Award

References

https://www.health.qld.gov.au/system-governance/licences/medicines-poisons/legislation-standards/ acts-regulation http://www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/Endorsements-Notations. aspx#eligible

REFLECTIVE QUESTIONS 1. ‘Eligible midwife’ will no longer be used, what is the term for a midwife who has met the criteria to prescribe? 2. What is the key difference between being authorised under the Health (Drugs and Poisons) Regulation to obtain, possess and administer specific medications and being endorsed by the NMBA? 3. Find the relevant regulation and reflect on how working under a DTP-M or being able to prescribe may affect how you currently work. 4. Reflect on what you need to do to update or maintain medication management skills and knowledge. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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What to expect when audited by AHPRA A

HPRA and the National Boards have developed a nationally consistent approach to auditing health practitioners’ compliance with our mandatory registration standards.

Random audits are conducted by AHPRA throughout the year, not just after renewal of registration. Nurses and midwives can be audited at any time with respect to any registration period over the preceding five years. If you declare on your registration renewal form that you have met the standard and you are audited, AHPRA will request you provide evidence of compliance with the audited standards within 28 days. You should expect to be audited at least once during your career. When you are audited, you will receive a letter from AHPRA advising that you are being audited for compliance with one or more of the registration standards. You will also receive a checklist outlining the supporting documentation you must supply. AHPRA commonly audits four registration standards: continuing professional development (CPD), professional indemnity insurance (PII), recency of practice (ROP), and criminal history.

CPD Evidence of CPD compliance can include your completed CPD booklet and certificates of attendance at training courses that contributed to CPD. In your booklet, you need to articulate the necessary information in each column of the template, especially your learning needs, outcomes and reflection. Course certificates alone may not be sufficient evidence of meeting the standard. Keep in mind that CPD may also include annual mandatory training, as you are refreshing your knowledge and determining if there have been any new protocols or procedures that require you to change your practice or conduct.

PII Evidence of PII compliance can be obtained from the QNMU website by downloading one or more certificates of currency to cover the period being audited. This certificate of currency of PII is sufficient evidence to meet the standard.

ROP Meeting the ROP registration standard can be done by obtaining a statement of service from your employer, or providing sufficient pay slips to demonstrate at least 450 hours of practice in the past five years.

Criminal history

Being audited by AHPRA can be a stressful experience if you haven’t kept up-to-date records.

AHPRA will initiate a criminal history check on you while you are compiling your evidence of meeting the other three registration standards.

If you are unsure about the process or what evidence to provide, contact Member Connect as soon as possible for professional advice.

References:

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

REFLECTIVE QUESTIONS 1. Why is it important to maintain contemporary professional knowledge through continuing professional development? 2. Review the CPD Fact Sheet on the NMBA website. a. How does the NMBA define “practice” and what do they say about CPD activities for nurses who are also registered as midwives? b. For how many years do you need to keep your CPD record? 3. Review the Recency of Practice Fact Sheet on the NMBA website. How does the NMBA differentiate between clinical and non-clinical practice? 4. Review your CPD record (downloadable on the QNMU website). Is it complete with all the necessary information? Don’t wait until you are audited. Get it up to date today. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Increasing the power of the Health and Safety Representative I

N RESPONSE to the tragic fatalities at Dreamworld and an Eagle Farm worksite in 2016, a review of work health and safety laws was undertaken. In 2017, the Best Practice Review of Workplace Health and Safety Queensland Final Report (BPR) was released, and made recommendations to strengthen workplace health and safety in Queensland. The Queensland parliament passed legislative amendments, including a new industrial manslaughter provision, on 12 October 2017. These are significant changes which can and should benefit nurses, midwives and carers, but as we know with ratios legislation, implementation is the key to success. Work Health and Safety Queensland (WHSQ) is working to implement all 58 BPR recommendations and the QNMU is supporting the implementation to provide the best outcomes for our members.

Health care a priority WHSQ has now listed the Health Care and Social Assistance industry sector as a priority industry. A QNMU representative is chair of a committee to help develop an explicit strategy to meet the challenges facing this growing sector. The committee recognises that there are already more serious injury workers compensation claims from health and social assistance workplaces than any other industry, as well as the highest incidence of mental health disorders. In the health system the duty of care to our patients is sometimes in competition or direct conflict with an employer’s duty of care to the worker.

Sandra Eales QNMU Assistant Secretary

While nurses, midwives and carers may be self-sacrificing in their roles, they should be able to expect to go to work and return home safe. This issue was reported during the 2016 taskforce review of occupational violence in Queensland Health. Despite previous policies and campaigns across QH promoting ‘zero tolerance’ towards occupational violence, there is in fact an unacceptably high level of tolerance of workplace violence. While nurses, midwives and carers may be self-sacrificing in their roles, they should be able to expect to go to work and return home safe. The Work Health and Safety Act 2011 and 2017 changes out of the BPR are designed to “[protect] workers and others against harm to their health safety and welfare through elimination or minimisation of risks”. Some significant changes from October 2017 include: ■■ a new offence of industrial manslaughter for negligence causing death ■■ a requirement for persons conducting business or undertakings (PCBUs) to provide the regulator with a list of Health and Safety Representatives (HSR) and deputy HSRs and a copy of all provisional improvement notices issued by HSRs. Changes to commence on 1 July 2018 include: ■■ mandatory HSR training required within six months of being elected to the role and refresher training every three years ■■ a WHSQ strategy to provide HSRs with support and encouragement, including comprehensive online HSR

resource materials, a case study of a PCBU working effectively with HSRs, and a pilot of training and support for inspectors to better liaise with HSRs onsite. As part of our efforts to ensure the proper implementation of the legislation, the QNMU and SafeWork will conduct a five-day HSR course on 11-15 Jun 2018 and will increase the courses available in the second semester of 2018 including training in regional centres.

References

Lyons, T. (2017). Best Practice Review of Workplace Health and Safety Queensland Final Report Queensland Health. (2016). Occupational Violence Prevention in Queensland Health’s Hospital and Health Services Taskforce Report, State of Queensland (Queensland Health). Workplace Health and Safety Act 2011 s 3(1)(a)

REFLECTIVE QUESTIONS 1. Can you identify the HSRs in your workplace? 2. Have there been any barriers to HSRs being elected in your workplace or accessing training? 3. Why might it be beneficial to be able to call on an external inspector from outside the health department to review workplace health and safety issues identified by a nurse or midwife? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Consent and

Capacity

BY KALINA PYRA AND JULIANA VIRINE, HALL PAYNE LAWYERS

CPD

ONSENT is one of the touchstones of modern health care. In the distant past, patients were treated in a paternalistic way, with not much thought given to their input regarding treatment. Modern health care and consent is all about appropriate engagement with the patient, so they can partner in their healthcare with treating practitioners. Consent for major procedures is the responsibility of the whole treating team. For nurses and midwives, much of the health care they provide on a day-to-day basis will rely on implied consent. However, failure to obtain appropriate consent can lead to complaints to the regulator (AHPRA or the Office of the Health Ombudsman) or in rare cases, allegations of assault due to absence of consent. To be able to consent to treatment, the patient must have capacity to do so. This article looks at what constitutes valid consent, how to assess capacity and what to do if you believe your patient does not have it.

What constitutes valid consent? For there to be valid consent, the following requirements must be met: ■■ the consent must be voluntary ■■ it must cover the procedure in question ■■ the patient must be informed about the care provided to allow them to make a decision, and ■■ the patient must have capacity.

Voluntary decision A voluntary decision is a decision freely made by the patient, having been informed of all treatment options. The patient should be advised in simple terms of the expected benefits and side effects of the health care, the risks and complications associated with it, and things like the long term expected outcomes. A patient needs sufficient time to make a decision regarding the health care and health professionals should not try to impose their own views or judgement on the necessity of the health care offered to a patient.

Remember, a patient with capacity is able to refuse health care offered to them, even if it is lifesaving health care.

Consent must cover the procedure in question This might seem self-explanatory, however health practitioners have still fallen foul of this important requirement. An extreme example is a 1949 case where a patient consented to a caesarean section and during the caesarean the obstetrician took it upon himself to perform a sterilisation of the patient. The court found for the patient, as it considered that whilst the sterilisation was “convenient” to perform at the time of the caesarean section, it was an unnecessary procedure.1 Even though consent must cover the procedure performed, consent can be extended to unforeseen treatment, such as an emergency occurring during the original procedure which requires additional treatment, for which consent has not been earlier obtained.

Informed consent It is important to provide the patient with sufficient information regarding the procedure, to allow them consent to it. Nurses and midwives should use simple language when communicating with a patient and avoid medical jargon. When an invasive procedure is being undertaken, and one with a more significant risk of harm to the patient, the types of information the patient should receive to allow them to properly consent are: ■■ the diagnosis and treatment recommended ■■ any material risks ■■ alternative treatment options, and ■■ any risks significant to the particular patient.

In nursing context, these issues are most likely to have already been discussed with the patient by other treating practitioners in the treating team. However, when there has been a change to a medication regime, for example, it is important for nurses and midwives to have the above factors in mind when giving the patient the new medication for the first time, to ensure they are consenting to the change in treatment. The test as to what a patient might want to know in terms of risk, is a subjective one. You need to put yourself in the place of a patient and consider what might be important to them. Information regarding what any particular patient might need to know could be found in the patient’s notes and can include things like their previous expressed needs, wishes or priorities, their medical history, their family, social or work circumstances, and their level of understanding about a procedure. In certain cases patients may not want information regarding the health procedure. Even if the patient expresses that they do not want the information, as a health practitioner you should encourage the patient to engage, as it is important for them to understand their health care options. The Nursing and Midwifery Board Codes of Conduct for Nurses and Midwives outlines what constitutes “informed” consent. To view the codes go to www.nursingmidwiferyboard. gov.au/Codes-GuidelinesStatements/Professionalstandards.aspx As indicated earlier, failure to comply with the relevant Codes of Conduct can leave a health practitioner open to disciplinary proceedings.

Modern health care and consent is all about appropriate engagement with the patient, so they can partner in their healthcare with treating practitioners. 61

CPD Express vs Implied Consent Consent can be express (verbal/ written) or implied. In nursing and midwifery, much of what you will do relies on implied consent, such as a patient holding out their arm for blood to be taken, or accepting regular medication handed to them. In the case of a procedure where there is little risk to the patient, it is usually acceptable to rely on the patient’s actions (such as those set out above) to imply consent. However, particular care needs to be taken when consent is implied, to ensure that the patient is truly consenting to the procedure and not merely complying with what is being done to them. Healthcare without significant risk to the patient can be undertaken without obtaining written consent and this could include things such as: ■■ normal health checks ■■ insertion of an IV ■■ blood tests ■■ ultrasounds ■■ dressings. However, there is a risk in certain cases (for example, catheterisation) where a nurse or midwife might believe they have a patient’s implied consent, where in reality all they

had was the patient’s compliance with the procedure. This could lead to the patient feeling they have not consented to the procedure, and making a complaint to your employer or to the Health Ombudsman or AHPRA claiming absence of consent. To avoid this difficulty, nurses and midwives should provide sufficient information about the procedure to the patient, to allow them to consent, and obtain verbal consent for the procedure. Where the treatment can be considered invasive, or the health care has significant risks, then written consent should be obtained. Your employer will have policies regarding consent, and the processes to be undertaken in relation to it.

Capacity A patient must have capacity to give consent. In a nursing setting, there are a variety of reasons why patients may not have capacity. It should be presumed that an adult patient has capacity unless it can be shown otherwise. Persons under the age of 18 on the other hand are presumed to not have capacity to give consent unless there is evidence they do have the capacity required. Usually, a child’s parents can provide consent on behalf of the child to health care however

there are occasions where young people and their parents may both be able to give consent at the same time. There are also special considerations for certain mental health patients giving consent.2 An assessment of capacity requires consideration of a number of matters prescribed by legislation. The patient must be able to: ■■ understand the nature and effect of decisions about the matter where consent is sought; and ■■ freely and voluntarily make decisions about the matter; and ■■ communicate the decisions in some way.3 It is important to remember when conducting assessments that just because a patient has made a decision you disagree with or has a condition or disability that appears to affect their ability to communicate, they do not necessarily lack capacity. Health Practitioners should also be mindful that over the course of treating a patient the patient’s capacity may fluctuate depending on the person’s health condition. If a nurse or midwife suspects their patient lacks capacity to provide consent, they should make a notation in the patient’s clinical chart and then take steps according to their employer’s polices or procedures to escalate the matter to an appropriate decision maker to conduct an assessment of capacity. This will usually be a medical officer. If it is determined that the patient does not have capacity to give consent, health care can still be delivered either through a substituted decision maker or without a decision maker in certain restricted circumstances.

EPAs and Advanced Health Directives An enduring power of attorney (EPA) is a legal document in which the patient authorises one or more other people (known as the attorney/s) to make particular decisions and do particular things on their behalf when they have impaired capacity to make decisions themselves. A patient’s

CPD EPA may authorise the attorney to make decisions about health care, except for certain types of health care including removal of tissue for donation, sterilisation, termination of pregnancy, participation in medical research or electroconvulsive therapy. The decisions the attorney is allowed to make depend on the extent of the powers given to the attorney by the patient. In exercising their powers, the attorney stands in the shoes of the patient in decision making. An Advanced Health Directive provides specific directions about health matters for future health care and gives information about those directions.4 The direction in an Advanced Health Care Directive is effective as if the patient gave the direction when decisions about the matter needed to be made and had capacity to give5 so therefore can override the wishes of the family. A patient can also appoint an attorney through an Advanced Health Care Directive.6 A direction in an Advanced Health Directive has priority over any general or specific power for health matters given to any attorney.7 There are special rules for when lifesustaining measures can be withheld or withdrawn under an Advanced Health Directive.

Where there is no EPA or Advanced Health Directive If a patient does not have an EPA or Advanced Health Directive, certain close family members and friends, known as statutory health attorneys, can give consent for health matters in the following order of priority: ■■ a spouse of the adult if the relationship between the adult and the spouse is close and continuing ■■ a person who is 18 years or more and who has the care of the adult and is not a paid carer for the adult ■■ a person who is 18 years or more and who is a close friend or relation of the adult and is not a paid carer for the adult. The public guardian becomes the patient’s statutory health attorney

for the matter if there is no one in the above list who is readily available and culturally appropriate to exercise power for the adult. For patients where there are no statutory health attorney, and in certain other circumstances, the Queensland Civil and Administrative Tribunal may appoint a guardian.10

When no substitute decision maker is required There is no need to obtain consent from a substitute decision maker in two certain urgent situations. The first is where the health care provider considers health care should be carried out urgently to meet imminent risk to the patient’s life or health11 in circumstances where the patient does not object to the health care in an Advanced Health Directive.12 Secondly, where the health care should be carried out urgently to prevent significant pain or distress to the patient and it is not reasonably practicable to get consent from a person who may give it under this Act or the Powers of Attorney Act 1998 (Qld), the health care can be provided unless the health care provider knows the patient objects to the health care.13 Any such objection may be disregarded where the patient has minimal or no understanding of what the health care involves or why it is required and the health care is likely to cause the adult no distress or the temporary distress is outweighed by the benefit to the adult.14 There are other circumstances where health care may be provided without consent including the provision of first aid, and nonintrusive examinations, withholding or withdrawing of life sustaining measures in emergencies and minor and uncontroversial health care.15

Professional consequences A failure to obtain consent from a client may result in disciplinary action. This can be seen in the inquiry conducted by the Nursing and

Midwifery Professional Standards Committee of NSW into certain nurses at the Castellorizian Aged Care Service in Kensington, New South Wales.16 In their decision, the Committee found that the Care Manager had engaged in unsatisfactory professional conduct because of her failure to obtain the consent of a family member or guardian before administering a new treatment to a resident.

Endnotes 1

Murray v McMurchy [1949] 2 DLR 442

2 This article only deals with adult consent and capacity and does not address capacity in mental health patients. 3 Schedule 3 Powers of Attorney Act 1998 (Qld) and Schedule 4 of the Guardianship and Administration Act 2000 (Qld) 4 Section 35(1)(a) and (b) Powers of Attorney Act 1998 (Qld) 5 Section 36(1) Powers of Attorney Act 1998 (Qld) 6 Section 35(1)(c) Powers of Attorney Act 1998 (Qld) 7

Section 35(3) Powers of Attorney Act 1998 (Qld)

8 Section 63(1) of the Powers of Attorney Act 1998 (Qld) 9 Section 63(2) Powers of Attorney Act 1998 (Qld) 10 Section 12 of the Guardianship and Administration Act 2000 (Qld) 11 Section 63(1)(b)(i) of the Guardianship and Administration Act 2000 (Qld) 12 Section 63(2) of the Guardianship and Administration Act 2000 (Qld) 13 Section 63(1)(b)(ii) of the Guardianship and Administration Act 2000 (Qld) 14 Section 63(3) of the Guardianship and Administration Act 2000 (Qld) 15 Refer to 2.1.3 – 2.1.5 in the Queensland Health Guide to Informed Decision-making in Health Care 2nd Edition 16 http://www.hccc.nsw.gov.au/Publications/Mediareleases/2016/RN-Bennett---Unsatisfactoryprofessional-conduct---Reprimanded

REFLECTIVE QUESTIONS 1. How well do you understand the nuances of consent? Explain. 2. Consider your everyday practice across a cross-section of patients and take a moment to critically assess your processes for obtaining informed consent. Are there practices you might improve on? 3. Do you understand ‘capacity? Explain. 4. How does consent work when there is an EPA or Advanced Health Directive in place?? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Are you 80% sure your patient needs that PIVC? TRACEY HAWKINS RN BNURS GRAD CERT EMERG NURSE KAYE ROLLS RN ACC BAPPSC DNURS

NSERTION of a peripheral intravenous cannulation (PIVC) is one of the most commonly performed invasive procedures in the emergency department (ED). Of significant concern is that up to 50% of PIVC are not used, unnecessarily exposing patients to pain and the risk of infection. Moreover, this procedure consumes limited ED resources, including staff time and money. A before and after study was undertaken in a metropolitan tertiary ED. A multi-modal intervention — CREDIT (Cannulation Rates in Emergency Department Intervention Trial) – which targeted all ED staff, was delivered over a 10-week period. The following strategies were employed: Education Key message: and training Do you believe it is 80% likely that this haemodynamically stable patient would require a PIVC in the next 24 hours for medications, fluids, contrast or blood production administration Change champions and advertising

Posters and stickers with 80% logo and ‘PIVC are you sure’ Change champions wore T-shirts with 80% logo when on shift Handover conversations/ five-minute education sessions in the clinical area

Surveillance Documentation audits and Social media updates feedback and links to Champions

Results ■■ There was a 9.8% (95% CI: -12.7 to -6.8%) reduction in PIVC insertions [pre-42.1% (869/2 063); post-32.4% (682/2110] ■■ There was a 12.86% (95% CI: 8.717.0%) increase in PIVC utilisation within 24 hours [pre-70.4% (612); post 83.4%(568)]

Take home messages ■■ Reducing unnecessary PIVC insertions can be achieved using comprehensive knowledge translation strategies. ■■ Using a facilitator model to disseminate the “Are you 80% sure?” message ensured clinicians who insert PIVC were aware of the risks and costs of PIVC insertion. ■■ Multimodal intervention empowered staff to critically appraise the requirement for PIVC and to reject the notion of the “just in case” cannula.

References

Abbas, S.Z., Klass de Vries, T.K., Shaw, S., Abbas, S.Q., Use and complications of peripheral vascular catheters: a prospective study. Br J Nurs, 2007. 16(11): p. 648. Goransson, K.E. and E. Johansson, Indication and usage of peripheral venous catheters inserted in adult patients during emergency care. J Vasc Access, 2011. 12(3): p. 193-9. Hawkins, T., et al., Peripheral intravenous cannula insertion and use in the Emergency Department: an intervention study. Acad Emerg Med, 2017. 25 (1) p 26-32. Henderson, R.A., et al., Unnecessary intravenous access in the emergency setting. Prehosp Emerg Care, 1998. 2(4): p. 312-6. Kelly, A.M. and D. Egerton-Warburton, When is peripheral intravenous catheter insertion indicated in the emergency department? Emerg Med Australas, 2014. 26(5): p. 515. Limm, E.I., et al., Half of all peripheral intravenous lines in an Australian tertiary emergency department are unused: pain with no gain? Ann Emerg Med, 2013. 62(5): p. 521-5. Velasco Diaz, L., et al., [The evaluation of unnecessary venous access ports in an emergency service]. Med Clin (Barc), 2000. 114(3): p. 89-90.

REFLECTIVE QUESTIONS 1. What is your facility’s policy on PIVC insertion? 2. If you assess that your patient is unlikely to need a PIVC, who would you consult with and how would you communicate your decision? 3. If you assess that your patient is within the 80% likely to require a PIVC, how would you explain the haemodynamic risks to the patient or next of kin prior to gaining consent? It might be a simple process but what factors do you need to consider regarding consent? 4. What steps would you need to take to initiate research on the non-use of practice resources in your ward or unit? Further reading to answer the above questions can also contribute to CPD hours. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

library

New ebooks at QNMU Library The QNMU Library continues to expand its ebook collection with three new titles added to the collection recently, Clinical Reasoning, Gerontological Nursing and Tabners Nursing Care. To access the ebooks visit www.qnmu.org.au/library If you are having difficulty accessing the ebooks, please phone the QNMU library on 3840 1443 or 3840 1480.

e b o o ks Clinical Reasoning by Tracy Levett-Jones 2nd edition, 2017 An Australian text designed to address the key area of clinical reasoning in nursing practice. Using a series of authentic scenarios, Clinical Reasoning guides students through the clinical reasoning process while challenging them to think critically about the nursing care they provide. With scenarios adapted from real clinical situations that occurred in healthcare and community settings, this edition continues to address the core principles for the provision of quality care and the prevention of adverse patient outcomes.

Gerontological Nursing by Charlotte Eliopoulos 9th edition, 2017 Focusing on the content that students need to know for effective practice, this text offers engaging, evidencebased coverage of the aging

process, factors contributing to healthy aging, and unique aspects of disease presentation and management in older adults. Updated to help students meet the challenges of this increasingly diverse population, the ninth edition retains its acclaimed holistic approach through insightful coverage of the psychosocial, legal, ethical, and spiritual elements of patient care.

— Opening times — The QNMU Library is open 10am-3pm on Monday, Tuesday and Thursday.

h ardcopy The QNMU also has a number of hard copy texts members can borrow, including Nursing Care Plans which was added last month.

Tabners Nursing Care 7th edition, 2016 The only text in the market written specifically for Diploma of Nursing students in Australia and New Zealand. Written by Gabrielle Koutoukidis, Kate Stainton and Jodie Hughson, Tabbner’s Nursing Care: Theory and Practice provides a solid foundation of theoretical knowledge and skills for nursing students embarking on an Enrolled Nurse career. Reflecting the current issues and scope of practice for Enrolled Nurses in Australia, this new edition focuses on the delivery of person-centred care, emphasises critical thinking throughout and demonstrates the application of the decisionmaking framework across multiple scenarios.

Nursing Care Plans by Meg Gulanick, Judith Myers 9th Edition, 2016 Covering the most common medicalsurgical nursing diagnoses and clinical problems seen in adults, Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 9th Edition contains 217 care plans, each reflecting the latest best practice guidelines. This new edition specifically features three new care plans, two expanded care plans, updated content and language reflecting the most current clinical practice and professional standards, enhanced QSEN integration, a new emphasis on interprofessional collaborative practice, an improved page design, and more. It’s everything you need to create and customize effective nursing care plans.

incoming

YOUR SAY ON AGED CARE

On federal Aged Care Minister Ken Wyatt blaming nurses for the aged care crisis “We will fuss over a baby and give it all the attention it needs,” Mr Wyatt told The Courier-Mail yesterday. “But when somebody becomes frail in their twilight years then the level of care given in some cases diminishes because of the staff attitude that might prevail.” MM Talk about blaming the victim! Like · Reply

JF Goodness me, nurses who work in aged care are underpaid and run off their feet due to chronic understaffing. They deserve accolades not to be accused of elder abuse. Like · Reply

HH What a load of dribble Aged Care Minister Ken Wyatt. You and your government are to blame for [the lack of] aged care skilled appropriate staff ratios. STOP pandering to providers, and allot the appropriate staff for decent care. Like · Reply

LR How better to make yourself look big by blaming those who work in aged care for the ongoing crisis. Aged care nurses go above and beyond with their duty of care, as they often work short staffed. They ensure that the residents do get the best care they can give at that time. Shame on the government… maybe they should come and work a week in our shoes to see what we are all trying to say.

On the Queensland launch of our national aged care campaign MC Thank you Beth and the QNMU. We must stand united to gain ratios for all our aged care facilities. This can only improve the care that is already being given and support the AINs and PCs who are generally worked off their feet and often work longer hours (not paid) and do extra things for their residents. Together we can improve a system that is struggling. Like · Reply

Like · Reply

PG I loved the interview with Steve Austin on radio 612. I am so happy that at last there is real leadership in the matter of aged care. Thank you Beth, and all behind you.

TS Nurses are not to blame for the conditions they are forced to work in! We are proud of our roles and caring for everyone!

LN We all need to get behind this for our families. One day, we might be in this position ourselves. It’s a disgrace, how our aged care are treated.

Like · Reply

IM Everywhere across Queensland the aged care community suffers from a shortage of staff members. It’s shocking how much burden there is for staff members in nursing homes. Like · Reply

MW About time the elderly got treated with respect and looked after properly. Like · Reply

On our secret audit of aged care facilities LW Wonderful to see progress. Our frail and aged need so much love and care. They deserve it. It’s a basic human right. We need to step up to the plate for them. Well done Like · Reply

CW Thank you QNMU for pushing this issue to the forefront of Queenslanders’ vision and thoughts. We need a complete review of aged care facilities and the legislation of nurse-to-resident ratios NOW! Like · Reply

MR About time this has been bought to light. I left the aged care sector because of under staffing and the stress I was under. I truly hope ratios get sorted out for the elderly. Like · Reply

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

/qnmuofficial

incoming ONTH COMMENT OF THE M We are all union, because we are in it for each other as much as our own skin. Solidarity means we all stand up to #ChangeTheRules to make workplaces and employment fair for all members of our society now and into the future.

On the extension of flu vaccinations to aged care BR I think it’s a good idea but do you think it’ll actually be policed… Like · Reply

AC Not really fair to those who don’t get sick... I have known people who get the flu shot yet still got the flu. So either it didn’t work or their immune system was down. Like · Reply

VV The flu shot is for what strain was around last year. If it has mutated or a totally different strain arrives you are not protected. Like · Reply

JS I’m all for it - had mine yesterday! Like · Reply

WIN

Letter to the Editor I would like to extend my heartfelt thanks to QNMU Secretary Beth Mohle for making one Kiwi nurse exceptionally proud, emotional (in a good way) and so glad that Beth leads our union. Last week as I was driving home from work, I listened to a discussion on the radio about cultural safety in the Code of Conduct for Nurses and claims that nurses and midwives now had to declare their ‘white privilege’ before treating patients. As a New Zealand trained nurse, I was totally unimpressed by the lack of understanding of cultural safety in relation to the Code of Conduct for Nurses, and the way in which it had been twisted. As the QNMU and other leading health organisations have clarified, nurses and midwives do NOT have to declare ‘white privilege’. Fortunately, on my drive home the very next evening, Beth was a guest on the same radio program and was able to properly explain that what was in the Code was not a new way of practicing for nurses.

Beth’s explanation of cultural safety was well articulated and matched my understanding of the situation — that nurses and midwives, during the course of their work, simply need to be mindful that some patients may have different care needs based on their cultural backgrounds and beliefs. I felt immensely proud that Beth was representing my union, the QNMU. Beth’s polite yet determined manner totally stopped the furore that the media were attempting to instigate around the issue. Beth was able to redirect the conversation to important matters like aged care concerns, levels of care and the lack of legislated regulation within the industry. How extremely lucky we are to have a leader of Beth’s calibre! Respect to you Beth. ētahi atu wahine ārahi Angie Hill Proud QNMU Member

ONE OF THESE GREAT BOOKS FOR YOUR FAB PHOTO

What Happened by Hillary Rodham Clinton

A letter to my Daughter by Maya Angelou

Hillary Clinton reveals what she was thinking and feeling during one of the most controversial and unpredictable US presidential elections in history. She takes readers inside what it was like to run against Donald Trump, the mistakes she made, how she coped with the devastating loss and how she picked herself back up.

Maya Angelou writes from the heart to millions of women. Letter to my daughter reveals Maya Angelou’s path to living well and living a life with meaning, told in her own inimitable style. It’s part guidebook, part memoir, part poetry — and pure delight.

Atmosphere of hope by Tim Flannery Acclaimed scientist and author Tim Flannery argues that Earth’s climate system is approaching a crisis and time is fast running out to avoid it. Atmosphere of Hope provides both a snapshot of the trouble we are in and an up-to-the-minute analysis of some of the new possibilities and innovative technologies that give cause for hope.

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

Marching for aged care this Labour Day

in view

A big thank you to the hundreds of nurses and midwives who joined us at Labour Day celebrations across Queensland! It was a fantastic show of solidarity as we launched our national aged care campaign, and called for ratios to be made law in aged care.

in view

Celebrating us!

in view

We celebrated the hard work and contributions of nurses and midwives across the world on International Day of the Midwife (5 May) and International Nurses Day (12 May). Thanks to everyone who sent in a pic of their celebrations â&#x20AC;&#x201D; we loved seeing the happy faces!

We support ratios in aged care! Across the state, community members have rallied behind our call for ratios in aged care. Thank you to everyone for taking pictures to show your support for our national aged care campaignâ&#x20AC;Ś Together, our voices are strong!

in view

Puppy power Pet therapy can bring benefits to not just patients, but staff too! Delta dog Nanook (pictured here with QNMU member Robyn Drinnan) regularly visits children at Lady Cilento Children’s Hospital as part of the pet therapy program. Unsurprisingly, the kids adore him!

Nursing the Commonwealth Games QNMU member and RN Ollie Adams was a medical volunteer at the recent 2018 Commonwealth Games on the Gold Coast.

Nurses Memorial Candlelight Vigil Left: On behalf of all QNMU members we laid a wreath at the Nurses Memorial Candlelight Vigil at Anzac Square, in remembrance and honour of our Anzac nurses and countless others who volunteered their services during times of conflict.

“On average the Polyclinic saw 280 patients a day. Many were from countries where access to medical care is limited. They didn’t mind waiting and were thankful to be seen. It felt humbled to be treating athletes and team officials. Overall it was an invaluable and terrific experience and I learned a lot about myself.”

Right: QNMU Organiser Trudie Stables dons a traditional wartime uniform at the vigil, lovingly hand sewn by member Julie McGee!

BOOK PRIZE ER WINN

CALENDAR Brisbane State High School Reunion

Graduating classes 1970 - 1974 There will be a gathering early next year of Brisbane State High School past students who attended our school between 1970 and 1974. Our committee is chasing up email addresses for these past students so that we can organise this gathering. If you are interested in attending please send your current email to bshs1974gathering@gmail.com

QNMU training

19-20 June, Knowing your entitlements & understanding the Award! Rockhampton 21 June, QH EB10 - Your work, your voice, Rockhampton www.qnmu.org.au/CPD

Lighting the path to success 21-23 June, Adelaide http://www.renalsociety.org/ education/2018-annual-conference/

21st Cancer Nurses Society of Australia 21st Annual Congress

25-27 June, Brisbane

Reconciling the Recent Trends and Innovations in Nursing 25-27 June, Dubai, UAE http://globalhealth.org/event/24thworld-nurse-practitionershealthcare-congress/

CONTINUING PROFESSIONAL DEVELOPMENT

28-29 June, Melbourne www.anmfvic.asn.au/events-andconferences/2018/06/28/annualdelegates-conference-2018

NAIDOC Week

Because of her, we can! 8-15 July

Heritage Trail & Devonshire Tea

A conference for Nurses who have a passion for wound care 16-24 July, The South Pacific Departing Sydney cruising on-board the Carnival Spirit https://goo.gl/sN3wao

Enrolled Nurse Student Study Day (EN SSD)

20 July https://www.anmfvic.asn.au/eventsand-conferences/2018/07/20/ anmf-enrolled-nurse-student-studyday-2018

Therapeutic approaches for diabetes management and endocrine complications 9-10 July, Sydney www.diabetesexpo.com/asiapacific/

5th Annual Congress on Emergency Nursing & Critical Care

Lung Health Promotion Centre at The Alfred Smoking Cessation Course 26–27 July 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

HIC Digital Health Conference

50th World Congress on Men in Nursing

QNMU Annual Conference

ANMF Victorian Branch Annual Delegates Conference

The Fabulous World of Wounds

Exploring the innovations in emergency nursing and critical care 16-17 July, London, UK http://emergency.nursingmeetings. com

Science, Symptoms and Service Delivery 21 – 23 June, Brisbane www.cnsacongress.com.au

27-29 June, Sunshine Coast www.simghosts.org/sim/ Australia_2018.asp

2 July, Canberra www.auswhn.org.au/awhnconference/

20th Asia Pacific Diabetes Conference

Renal Society of Australasia Annual Conference

SimGHOSTS 2018 Australia

Technology innovations in nursing education 16-18 July, Melbourne, Victoria http://nursingeducation. nursingconference.com/asia-pacific/

Australian Women’s History Network Symposium

8 July, 1pm - 3.30pm Cost: $10 including Devonshire Tea The Museum of Nursing History, building 19, Central Drive, Royal Brisbane and Women's Hopsital Phone: 3636 8702 Email: rbhnursesassn@gmail.com

June

24th World Nurse Practitioners & Healthcare Congress

21st World Nursing Education Conference

July

Exploring the role of men in advancing global health 16-17 July, Rome, Italy http://men.nursingmeetings.com/

5th World Congress on Hospice and Palliative Care

Refinement and renovation of medicate with hospice palliative care 16-17 July, Melbourne http://hospice-palliativecare. conferenceseries.com/

49th International Congress on Nursing Care Plan & Health

Nursing care plan- A practical guide to medicine 16-18 July, Rome, Italy http://nursingcareplan. nursingmeetings.com/

29 July-1 August www.hisa.org.au/hic/

22–23 August 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

National Aboriginal & Torres Strait Islander Children’s Day 4 August

A5M Anti-Ageing and Aesthetics Conference Connecting inner and outer health 4-5 August, Melbourne www.a5m.net/conferenceinformation/a5m-annual-conference

Heritage Trail & Devonshire Tea 5 August, 1pm - 3.30pm Cost: $10 including Devonshire Tea The Museum of Nursing History, building 19, Central Drive, Royal Brisbane and Women's Hopsital Phone: 3636 8702 Email: rbhnursesassn@gmail.com

19th International Mental Health Conference

Our treatment. Our environment. Our strategies 8-10 August, Gold Coast https://anzmh.asn.au/conference/

International Day of the World’s Indigenous Peoples 9 August

The proven, the practical and the personal Conference (OHS)

August Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 1–3 August 2018 Managing COPD – Acute/Chronic 9–10 August 2018 Spirometry Principles & Practice 13–14 August 2018 A Practical Management Approach of Non Invasive Ventilation & Sleep Disorders 16–17 August 2018 Sleep: the how, why & the what – skills for your toolkit 16 August 2018 The Pressure to Breathe – the skills for success with NIV 17 August 2018 Respiratory Course (Modules A & B) 20–23 August 2018 Respiratory Course (Module A) 20–21 August 2018 Respiratory Course (Module B)

10 August, Melbourne Contact events@anmfvic.asn.au or call 03 9275 9333

17th International Congress of Circumpolar Health

12-15 August, Copenhagen, Denmark www.icch2018.com/ Hyperbaric Technicians and Nurses Association and Australia New Zealand Hyperbaric Medicine Group 26th Annual Scientific Meeting 16–18 August, Bali www.htna.com.au/index.php

Vietnam Veterans’ Day 18 August

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

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

Source or provider details

Identified learning needs

Action Plan Type of activity

01-092017

InScope Journal

Increase knowledge re Delegation & Supervision

Read article and answer reflective questions

Description of topic/s covered during activity and outcome

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

Reflection on activity and specification to practice

No./Title/ Description of evidence provided

CPD hours

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

Journal article with reflective exercise questions.

2.5 hrs

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

2018–2019 FEE SCHEDULE CLASSIFICATION Registered Nurse/Midwife: over 24 hours per week Registered Nurse/Midwife: up to 24 hours per week

Monthly* Fortnightly+ Yearly ($) Direct Debit Direct Debit ($) ($) 696.00

58.00

26.75

522.00

43.50

20.10

567.00

47.25

21.80

424.80

35.40

16.35

494.40

41.20

19.00

371.40

30.95

14.30

Nurses covered industrially by other unions

190.80

15.90

7.35

Unpaid supervised practice/ refresher courses

190.80

15.90

7.35

Tertiary student: working up to 16 hours per week as an AIN or PC

190.80

15.90

7.35

Fulltime University/TAFE: student: no paid nursing work and no nursing qualifications

67.80

5.65

N/A

135.00

11.25

N/A

Enrolled Nurse: over 24 hours per week Enrolled Nurse: up to 24 hours per week Assistant in Nursing: over 24 hours per week Assistant in Nursing: up to 24 hours per week

Inactive member: (non-practising nurses only)

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* Monthly is based on 12 calendar months per financial year. + Fortnightly is based on 26 fortnights per financial year. Correct fee: Paying an incorrect fee can affect your industrial and professional coverage. Please ensure you are paying the correct membership fee.

Things you need to know: This general information doesn’t take your personal circumstances into account. Please consider whether this information is right for you before making a decision and seek professional independent tax or financial advice. Conditions and fees apply, along with credit assessment criteria for lease and loan products. The availability of benefits is subject to your employer’s approval. RemServ may receive commissions in connection with its services. Remuneration Services (Qld) Pty Ltd | ABN 46 093 173 089.

Ups and downs are for your working week, not your super. When your shift starts you never know what’s coming next. That’s why it’s good to know while you get on with your job, we’re striving to deliver strong returns with less risk.

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

It’s gOOd tO knOw yOu’re In safe hands QNMU members benefit from FREE hotline support with Member Connect when you need assistance. Our Member Connect team are all nurses or midwives with extensive experience and backgrounds in midwifery, mental health, aged care, education, paediatrics, surgical and cardiac nursing.

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

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

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

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Every unionist has a different story to tell... As unionists, we all know what a real union thug looks like. They are giving up their time to help with weekend football games; they are

THOUSANDS OF DOLLARS IN PRIZES UP FOR GRABS! The entrant with the best photo of the year will be presented a $1500 Gift Certificate to use towards any sort of holiday they like — courtesy of our

hiking for charity; spending time with their kids; caring for their parents; at the P&C or in the men’s shed; diving out of a plane or reading to their grandkids; travelling around Australia and the world. Unionists everywhere are making the world a better place to live. That is why we at the Queensland Council of Unions are running an online promotion called: This is Union.

Sponsor The New Daily. *^ We are also giving away $250 to the best photo every month!! To find out more visit www.thisisunion.org or follow on instagram @thisisunion

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Right now, ME is giving QNMU members discounted 1 Flexible Home Loans â&#x20AC;&#x201C; and we're throwing in our Member Package add-on for free for the first year2, saving you at least $395 in fees right off the bat. Interested? Arrange a time to speak to our ME Relationship Manager Kym Chisholm Kym.Chisholm@mebank.com.au | 0417 296 796 or visit mebank.com.au/benefitsqnmu before 30 June 2018.

Things you should know. (1) A 0.05% p.a. discount off the applicable variable reference rate for a Flexible Home Loan with a Member Package where the primary loan purpose at application is owner occupied paying principal and interest. The discount is available to you as a QNMU member on new home loan applications received between 19-Mar-18 and 30-Jun-18 and settled by 30-Aug-18. The discount applies for so long as you have a Flexible Home Loan with a Member Package and you remain an owner occupier. It is not available for, interest-only loans, investment loans, internal refinances, top-ups or variations of existing ME home loans. (2)The 1 year Member Package annual fee waiver offer, valued at $395 is available to you as a QNMU member on new home loan applications received between 19-Mar-18 and 30-Jun-18 and settled before 30-Aug-18. It is not available for top ups or refinances of existing ME Bank home loans. An applicant can only receive one Member package fee waiver and cannot be used in conjunction with any other home loan offer. Existing Member Package customer are eligible for this offer if they take out a new loan. If you do not have a Member Package, $395 will be taken at settlement, but later refunded. All eligible customers will be refunded $395 within 30 days of settlement into the account nominated for the first home loan repayment. This offer is only available on loans originated via a ME mobile banking manager. It is not available on applications made through an independent mortgage broker. This information is about products and services available to you as a QNMU 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 are subject to credit approval. Members Equity Bank Ltd ABN 56 070 887 679 (ME) holds Australian Credit Licence 229500 and is the provider of the credit product referred to above.

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Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information is of a general nature. It does not take into account your objectives, financial situation or specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Before making a decision about HESTA products you should read the relevant product disclosure statement (call 1800 813 327 or visit hesta.com.au/pds for a copy), and consider any relevant risks (hesta.com.au/understandingrisk).