InScope No10 Winter19 by Queensland Nurses and Midwives' Union

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

Winter 2019

Feeling sick? Don't be present

Equine assisted therapy

Keep laughing and carry on PLUS!

CPD CONTENT ON BULLYING AND HARASSMENT, SHIFT SWAPPING, PSYCHIATRIC CARE AND MORE

SE Y O UL CL J 19

QNMU Scholarships now open The QNMU’s scholarship program provides financial assistance to members to help progress their studies, professional development and research, and grow our nursing and midwifery professions.

CURRENT SCHOLARSHIPS: ■■Aboriginal and Torres Strait Islander scholarship - $3000 awarded whole or in part to an Aboriginal or Torres Strait Islander QNMU member to enhance their professional skills through appropriate study. ■■Research scholarship - $5000 awarded whole or in part to assist a member to undertake a specific project or research study that will advance the strategic, professional or organisational interest of the QNMU. ■■AIN/PC scholarship - $3000 awarded whole or in part to assist a member to attend a relevant conference or seminar, or to undertake an accredited course, relevant to their nursing work (e.g. a Certificate III, Diploma or Bachelor course). More scholarships will be offered later in the year. Keep an eye on your emails, including your monthly qnews, to find out when more scholarships open.

Apply online at www.qnmu.org.au/scholarships APPLICATIONS CLOSE 19 JULY 2019

Winter 2019

INDEPTH

Navigating prison health

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 18 20 24 28 32 34 36

Federal election 2019. Aged care: in for the long haul

38 40

Guess who's not at the table ... again?

Walking with (gentle) giants Queensland's first midwife-led birth centre celebrates 25 years Laughter is the best medicine The experience of a lifetime. Nurses in Kenya Feeling sick? Don't be present Sexual harassment. The silent truth Navigating prison health Fighting for a career. Portuguese nurses unite for a better National Health System.

Turning clinical waste into gardening goodness

43 44 46 49 50 54 55

56 Priority-setting in wound care. What are your challenges in clinical practice? Restaint in aged care Positive Practice Environments. Getting the balance right

REGULARS

Sexual harassment or bullying?

INSIGHT

The challenges of preventing in-hospital falls for older people with cognitvie impairment

TEA ROOM

WINS

JUST IN

Swapping your shift? It's a win-win for hospitals

NOTES FROM THE NORTH

Professionalism is the key to a healthy workplace

IN VIEW

INCOMING

CALENDAR

ADVERTISING

Therapeutic nursing observation in psychiatric care

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

Cover photo: Equine Assisted Therapy Australia founder Jane Faulkner and her horse Sunny.

insight

A stellar effort for aged care this election Sally-Anne Jones QNMU President

FTER weeks of tolerating endless media campaigns from various political parties, the outcome of the recent federal election was a bit of a surprise to many. In the lead up to this federal election the Australian Nursing and Midwifery Federation (ANMF) and branches, including the QNMU, reinvigorated a long-fought campaign in aged care. Our ask was clear and wellresearched – both in clinical terms (with the National Aged Care Staffing and Skills Mix Report), and in experiential terms (with telephone staff surveys, resident and carer focus groups). It was also a nationally coordinated effort. Our strategy was focused around lobbying all political parties to ensure our elderly, some of the most vulnerable people in our community, receive the level of staffing and skill mix in nursing they deserve in residential care facilities. Despite a targeted and wellplanned campaign, it was difficult to gain support from some of our federal representatives who seemed rather unwilling to commit to any part of an investment into the future of Australia’s aging population.

The QNMU and ANMF will not give up on gathering the evidence to prove that ratios in aged care can and will make a difference. We thank the politicians who signed up to support our aged care campaign and safe staffing laws. You can see who they are here: www.qnmu.org.au/pledges Shame on all those politicians who could not show courage and leadership on this issue, no matter the political party.

Our work continues Nursing Now is a three-year global campaign (2018-2020) that aims to improve health outcomes by raising the profile and status of nursing worldwide. Run in collaboration with the World Health Organisation and the International Council of Nurses, Nursing Now seeks to empower nurses to take their place at the heart of tackling 21st Century health challenges and maximise their contribution to achieving Universal Health Coverage. To my mind, this includes all points of care in the human life spectrum primary care, acute care and aged care.

Whether you work in the public, private or aged care sector, the impact of long-term under resourcing in facilities is felt every day with more emergency department presentations from residential facilities, longer lengths of stay in acute hospitals and longer time to be assessed for placement or for higher levels of care.

Due to conclude on International Nurses Day next year (2020), the campaign focuses on five core areas:

A lack of resources in one sector places immense pressure on the limited resources of another. And in the middle of that are many vulnerable older Australians who deserve better.

■■ recruiting more nurses into leadership positions

■■ ensuring that nurses and midwives have a more prominent voice in health policy-making ■■ encouraging greater investment in the nursing workforce

■■ conducting research that helps determine where nurses can have the greatest impact, and

■■ sharing of best nursing practices. Our federal election campaign served to meet each one of these principles with the single purpose of uniting nurses (and our collegiate midwives) to improve the quality of life, dignity and life experience of older Australians who need nursing support to live. Members should feel proud that our union provided incredible leadership in aspects of this campaign, including the highly publicised and awardwinning secret aged care audit that made international news and got everyone talking about aged care! It does not matter who the leading political party is in this country. The QNMU and ANMF will not give up on gathering the evidence to prove that ratios in aged care can and will make a difference to the quality of life for Australians who need the extraordinary skills of the staff in residential facilities.

QNMU COUNCIL secretary :

Beth Mohle

assistant secretary : president :

Sandra Eales

Sally-Anne Jones

vice president :

Lucynda Maskell

councillors :

Julie Burgess Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Michael Hall Raquel How Shelley Howe Christopher Johnson Damien Lawson David Lewis Dallas Meyers Fiona Monk Sue Pitman Melanie Price Karen Shepherd Katy Taggart Janelle Taylor Kym Volp Deborah Watt Charmaine Wicking

insight

Playing our part: Re-shaping health and aged care A

S HAS been the case for as long as I can remember, health was again a significant area of focus for the 2019 federal election. This should not come as a surprise given how important Australians view our health and aged care systems as a tangible symbol of our collective commitment to each other and a cornerstone of fairness. In the lead up to the polls, Health Minister Greg Hunt reiterated the Coalitions’ support for the long-term national health plan based around four pillars of health: primary care, hospitals, mental health and medical research. Now the election outcome is known we must focus on delivering policy commitments and what these will mean from quality and sustainability perspectives. Health and aged care funding are very large and growing components of government budgets at the federal and state levels. The current pressure on our health and aged care system is unrelenting, so there is an urgent need to pause, reflect and take stock of where we are. We must chart a different course to address the root causes of the demand and fundamentally shift the focus from illness to wellness. This requires new thinking. The factors contributing to the current unsustainable pressures are complex and multi-faceted, and include (but are not limited to): ■■ Federal-State health funding arrangements – including outstanding historical federal government underfunding. ■■ A funding model that is no longer fit for purpose given its predominant

Beth Mohle QNMU Secretary

focus on medically driven activity and inadequate focus on primary and preventative health care. ■■ Lack of focus on and funding for innovative services such as nurse or midwife led or multi-disciplinary community-based care teams that will decrease demand on acute care services. ■■ Entrenched cultural barriers and power imbalances in our health system. ■■ Devolved governance arrangements and the impact of organisational structures that result in inconsistent responses, decreased cooperation and those with day to day responsibility for patient safety lacking necessary authority. ■■ The way in which risk is identified and managed within our health system. ■■ Failure to adequately address the social determinants of health and broader economic factors (including record low wages growth and high levels of household indebtedness).

It essentially comes down to money and power. How health is funded and by whom, and how we can make this sustainable into the future. Who has the power in the system currently and who needs to have power shifted to them. These issues go to the heart of our purpose as a union: To grow power, confidence and capacity to improve the industrial and professional interests and wellbeing of nurses and midwives and the health of our community. We must engage in and influence funding conversations and use our power to effect the change required. These are big issues and will be strongly contested. But it is vitally important work and will ensure our health system is strong, safe and responsive.

■■ Lack of access to meaningful and timely information to inform health care decision making. We must ensure we are “measuring what matters”. These are complex and interrelated matters that demand a comprehensive and collaborative response by all who are committed to supporting a high quality and sustainable public health system. But all too often the people for whom the system should be designed around are not at the table where key decisions are made (see opinion piece on page 38).

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.

Have you been offered a contract outside of your enterprise agreement? You should be very wary if your employer suggests your position falls outside of your enterprise agreement (EA) or wants to alter your existing employment contract. A QNMU member at a Brisbane private hospital was approached by HR seven months into an existing EA. HR offered the member a new contract, claiming the member’s current role no longer fell within the QNMU-negotiated EA (despite there being no change to the member’s existing role and the new EA containing nothing different from the previous EA in relation to their classification). The new contract contained many of the same conditions set in the existing EA, including the same hourly rate, the 4% qualifications allowance, and the same level of superannuation. However, unlike the member’s EA, which provided for a minimum five weeks’ annual leave, the new contract only entitled the member to four weeks, and was very vague about the member’s ordinary hours of work. The new contract also specifically omitted any rates applicable to overtime but stated the member might be required to do some “reasonable extra hours”. Unlike the EA, which contained very specific paid leave entitlements for things like long service leave and paid parental leave, the contract only referred to the Fair Work Act, which provides for substantially less. The member immediately contacted the QNMU for advice. We let them know: ■■ The employer cannot contract outside of an EA for a nursing or midwifery role that clearly falls within the EA’s classifications.

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

■■ If a role currently falls within the EA, it is unlikely that it suddenly doesn’t (even if there have been some changes to your role). ■■ An employee cannot be forced to accept a contract that provides

lesser conditions than their EA or Award. ■■ You do not have to agree to a change to your existing contract, particularly if it is to your detriment. ■■ It is unlawful to enter into a contract that is substandard to the EA or Award. If this does occur, the employee would be entitled to recover all underpayments and the employer may face penalties. Armed with this advice, the member went back to the employer, who withdrew the contract and the member’s employment continued as per their EA. Some cases are not as clear cut as this, but if your employer wants to change your existing employment contract and you even suspect you’ll be worse off, contact the QNMU immediately.

Remain covered with QNMU inactive membership Are you taking a break from your nursing or midwifery career? Or perhaps you’re retiring… Whether you are on parental leave, taking an extended break, pursuing other interests, between jobs, or retiring*, you can remain up-to-date with your profession by maintaining inactive membership of the QNMU (particularly if you are maintaining your AHPRA registration). Monthly membership fees are significantly reduced – you can stay connected for only $11.50 per month (from 1 July 2019).

What do you get with inactive membership?

■■ You're covered by the QNMU’s professional indemnity insurance (PII) policy** ■■ Access to the QNMU’s CPD Portal ■■ Access to QNMU LegalPlus ■■ Continue to receive your copy of InScope ■■ Receive return-to-work advice. *Terms and conditions apply in relation to member support and PI insurance available. **As an inactive member, you will continue to meet the NMBA’s PII standard if you wish to remain registered. You will also be covered by PII if you engage in a good Samaritan act while not working. Terms and conditions apply. Contact the QNMU Membership Team on 3840 1440.

wins

$10,000

returned to Fresenius nurses NURSES at Fresenius Medical Care have received an incremental pay rise and more than two years’ back pay after a QNMU organiser noticed a number of members were being paid incorrectly. It was during a meeting between QNMU members and Fresenius management that the organiser realised one member was being paid in a lower pay bracket. The organiser worked closely with management to identify and rectify the issue, and upon discovering other staff also hadn’t been moved to the right pay bracket as outlined in their enterprise agreement, Fresenius management volunteered to conduct a state-wide audit of all staff pay levels. As a result, eight members received a collective total of about $10,000-plus in back pay and an ongoing pay increase after being moved to the right pay brackets. “This win really highlights the importance and value of coming to speak with your QNMU organiser when we’re on site,” the organiser said.

Leave correction on its way for Woodford Correctional nurses MORE THAN 20 Woodford Correctional Centre nurses will receive up to six weeks’ extra paid leave after the QNMU intervened on leave entitlements. For some time, nurses at the facility north of Brisbane had incorrectly received five weeks’ leave a year instead of six. Following the QNMU’s involvement, nurses can retrospectively receive up to one week a year in paid leave for the last six years which equates to a maximum of up to six weeks’ additional paid leave. The Queensland government has agreed relevant nurses at the facility would now receive six weeks a year in paid annual leave rather than five. The credits are expected to appear on members' pay statements in the coming weeks.

“What began as a question from one member about an unrelated pay issue became a five-figure incremental pay rise and back pay for a number of employees who should have progressed to a higher pay grade quite some time ago.” Of course, you don’t have to wait until you see QNMU staff around your workplace to raise an issue. Our Member Connect team is just a phone call away and ready to assist. If you think you may have been underpaid, call 3099 3210 or 1800 177 273.

Are you receiving your laundry allowance? THOUSANDS of Metro North nurses and midwives are set to receive significant backpay, after it was discovered management had not paid a laundry allowance. After members at The Prince Charles Hospital noticed they weren’t receiving their laundry allowance, the QNMU took it up to management, who discovered it extended across the entire HHS. Metro North nurses and midwives must now submit an application to receive their laundry allowance, including any potential backpay. Visit https://bit.ly/312wQoF for more information.

If you have any issues with your leave entitlements, please contact the QNMU on 3099 3210.

If you work in another Queensland Health HHS, it might be worth checking your payslip to check you’re receiving your correct laundry allowance… you never know!

Congratulations to our members at Woodford Correctional Centre!

If you have any issues, contact Member Connect on 3099 3210 or 1800 177 273.

wins

CHANGES AND ACTION IN QUEENSLAND PRISONS THERE’S been a lot of movement in the offender health space over the past few months, including commitments for more staff, correctional officer strikes, and the transfer of two major facilities into public hands.

Commitment for more nurses and redesign Following a campaign by members, nurses working in offender health across West Moreton HHS are finally getting their serious understaffing and safety issues addressed after years of neglect. Following a review of the Business Planning Framework (which determines required staffing levels), it was determined that an additional 55 FTE nurses were required to meet demand. In December last year, Health Minister Steven Miles met with QNMU members to hear their issues first-hand. The minister later wrote to the QNMU and committed additional funding for the extra nursing positions. The government has also committed to a redesign project for the Brisbane Correctional Centre (BCC), which will address issues relating to muchneeded infrastructure. The QNMU has already attended meetings regarding this redesign, and we’ll continue to represent our offender health members throughout this process.

And sometimes it’s the little things that make a huge difference to our nurses’ ability to provide safe care – in this case, members had long called for an ambulance ramp to be installed at the BCC. This would avoid nurses having to walk patients, who might have been suffering a cardiac arrest, down the stairs onto a trolley. Finally, the ramp has been built, and our nurses couldn’t be happier!

Public hands means better staffing In response to recommendations from a Queensland offender health review in 2018, the Queensland government also announced that two privately-run high security prisons – Arthur Gorrie Correctional Centre and Southern Queensland Correctional Centre – would be transferred to public hands. The QNMU welcomes this move and hopes moving into the public system will mean improved safety and a reduction in the number of assaults against prison staff, including nurses. The review found the number of staff assaults was higher at private facilities due to lower staffing levels. Promisingly, the government has already committed to more staffing at the prisons.

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!

Nurses support correctional officer strikes Nurses stood in solidarity with their correctional officer colleagues across Queensland Correctional Services (QCS) recently they took strike action for better wages and conditions. At the time of going to print, workers had made some positive progress with their negotiations, and had placed all rolling stop works on hold. While we supported QCS officers exercising their workplace rights, the industrial action did significantly affect our nurses. The QNMU worked closely with management throughout the stop work action and locked in state-wide security plans from each HHS to ensure there were extra nurses and more custodially trained officers on hand. These plans ensured our nurses’ safety and security were not compromised, and members were able to adequately escalate their workload concerns. Congratulations to all QCS officers who took part in the industrial action and for the progress made in the campaign so far for better wages and conditions.

wins

Traffic lights finally approved for TPCH A CAMPAIGN for traffic lights at a notorious intersection outside The Prince Charles Hospital (TPCH) has finally been approved following the death of respected TPCH Registered Nurse and QNMU member Solita Honorio. Solita was struck by a passing car while leaving the hospital late last year and tragically passed away. Devastated by the death of wellloved Solita, her family, friends, colleagues and members of the QNMU TPCH branch rallied for road safety upgrades and the installation of traffic lights on the Hamilton Road intersection outside the hospital. This effort was led by TPCH branch delegate and RN Deb Ranson, and supported by the QNMU and the Queensland Community Alliance (QCA). Deb said the dangerous intersection had been a known problem area for more than 16 years. “TPCH staff have long attempted to get something done about this intersection as there have been many near misses and accidents there over the years… you just cannot get out of that road safely,” she said. “To kick off our campaign, we initially sent out a survey across the hospital to gather information about the intersection and we had a whopping 90% response rate. So you can see

how important this issue was for everyone.”

priced and included in both council and State Government budgets.

A community assembly was organised by the QNMU TPCH branch and the QCA earlier this year to hear from Brisbane City Council and State Government representatives about the possibility of upgraded road safety at the facility.

■■ An agreement that the HHS would fix or change the infrastructure of any internal roads to help council accommodate the new set of traffic lights.

The event drew more than 200 people, yet no formal agreement was reached.

Deb said she was pleased progress had been made in getting the traffic lights installed, but the branch and the QCA would be keeping the pressure on to ensure they are delivered.

A petition for safer streets was launched, including a request for work on the upgrade to begin by the end of 2019. It gained thousands of signatures within the week. Since lodging the petition, the group met with Minister for Natural Resources, Mines and Energy Dr Anthony Lynham, former Brisbane Lord Mayor Graham Quirk, and representatives of Brisbane City Council and the Hospital and Health Service to discuss details of the upgrade. At the time of print, the following had been agreed: ■■ A commitment from Minister Lynham and Brisbane City Council for a new set of traffic lights to be installed at the intersection by December 2019 (with input from TPCH). ■■ An agreement that Brisbane City Council would create a design to be

■■ Regular meetings to continue advancing the upgrade.

“Solita passed away at the end of November last year and in the six months since then we’ve moved more mountains on this issue than anyone has managed to in the past 16 years,” she said. “Council has made the commitment so we’re pretty much on track to get those lights installed by December 2019… and we’ll be holding them to account. “This was a combined effort of union, faith and community coming together for the one cause - safety for all.” Pictured: The QNMU TPCH branch, including Solita’s family, friends and colleagues, laid a wreath in Solita’s memory at this year’s Worker’s Memorial Day service. Inset: RN and QNMU member Solita Honorio

just in

Our Strategic Plan keeps us on track THE QNMU is an organisation of many moving parts and at any given time we can be engaged in negotiations, representations, education and agitation, and a whole lot more in between.

■■ Value what matters: Demonstrate the value of nurses and midwives in achieving quality health outcomes so what matters is measured, and resources are allocated accordingly.

With such a wide scope of activity, it’s important everyone has the same organisational goals in mind, which is why every few years we take the time to draft a new Strategic Plan.

■■ Build community wellbeing: Improve community health outcomes by addressing the social determinants of health through the actions of nurses and midwives.

The 2019-2023 QNMU Strategic Plan was finalised late last year.

“Our Strategic Plan is a document that keeps us on track,” QNMU Secretary Beth Mohle said.

Used as a reference point for everything we do, the Plan is like a well-crafted roadmap that sets out our purpose, values, commitments and goals. Our goals for the next five years are: ■■ Growing our voice: Increase the number of nurses and midwives exercising greater autonomy and control over their practice and work environment. ■■ Win good jobs: Safeguard and extend good, secure jobs and safe positive working environments to nurses and midwives in Queensland.

View our Strategic Plan at www.qnmu.org.au/ StrategicPlan

Timeless work MITMENTS

OSE, VALUES AND COM

OUR GUIDING PURP

pe is never done. The landsca The work of our union tly and we work changes constan in which we live and if our ges that confront us can only meet the challen ed. This is achieved position well and union is strong g and our focus, proper plannin through maintaining members. being accountable to with our rules, are Our strategic plan, along the documents that guide bedrock governance ful g is vital for any success QNMU. Strategic plannin

ongoing commitments domains of our work. In addition, this plan ambition to:

to members in the various

will particularly focus

on our

■ Grow our voice s ■ Value what matter ■ Win good jobs

ng ■ Build community wellbei us the the QNMU and give OUR VALUES our purpose, Our plan will anchor but to to manage challenges, ic plan sets out wherewithal not only This five-year strateg ns. In the coming and thrive. ambitio years and five next ments commit embrace the union and nursing and values, Our ng our on deliveri midwife focus ry to e values continu guide will all that we do. We know wevalues These five years, are mutually reinforc what we stand for and ing and are underpinned why. sustainable manner. by our fundamental commitment to operate in a

organisation.

Union value EMENT s: PURPOSE STAT

Collectivism – We are stronger when we work together. is to grow

purpose of the QNMU The Fairnes s – We are commitcapac to and ted to aity fair go in our ence workpla r, confid ces and powe our broader society. l trial and professiona Opport ve the unityindus impro – We seek to improv e thes quality of life of all Austral wellbeing of nurse interests andians. our of Equality – All Austral health the and ians should be treated ives and equally, bemidw free from discrimination , harassment, intimida and violenc tion unity.e and deserve equal comm

“It’s not just something we draft and then forget about, it’s a living document that ensures the work we undertake has a strategic purpose, aligns with the values we hold dear, and will help us reach the goals we’ve set ourselves as an organisation to benefit Queensland's nurses and midwives.” “It is our blueprint to thrive.”

QNMU STRATEGIC PL 2019-2023

access to quality

public services.

Nursing and and recognise that in we ifery midw values: Members are the union Caring –our must strengthen the wepeople care for to grow Wepower with their specific orderin mind and caring decisions that needs e the is central to our identity as nurses members to influenc y of capacit and midwives. life. affect our work and Professionalism – Nurses rs must membees and midwiv al activism are accoun h transfo tablermation Throug and uphold high, ethical influence ed topractic e standad, empowered and activat rds. be engage and values. advance our interests andcy Advoca change – Nurses and midwiv es keep the system safe and are the critical link between patient and system. Holism – Nurses and midwives provide continu ity of care to the whole person around the clock.

COMMITMENTS TO

OUR MEMBERS

ORGANISATIONAL

To build an organisation with the capacity, people and systems to achieve our purpose.

INDUSTRIAL

To improve, maintain and enforce the industrial rights and aspirat ions of members.

PROFESSIONAL

To advance and protect the professions and standards of safe practice of nursing and midwifery.

SOCIAL

To facilitate positive and sustainable social change through directed activities, education and policy development.

POLITICAL

To maximise the influenc e of the QNMU in political processes.

DEMOCRATIC

To promote the particip ation of members in internal and externa l democratic processes.

Timebound work: 2019

-2023

OUR AMBITION

GROW OUR VOICE

Increase the number of nurses and midwives exercising greater autonomy and control over their practice and work environment.

BUILD COMMUNITY

WELLBEING

Improve community health outcomes by addressing the social determinants of health through the actions of nurses and midwives.

VALUE WHAT MATT

ERS

Demonstrate the value of nurses and midwives in achieving quality health outcomes so what matter s is and resources are allocate measured, d accordingly.

WIN GOOD JOBS

Safeguard and extend good, secure jobs and safe positive working environments to nurses and midwives in Queensland. 12/18

Fee increase supports our vital work 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% from 1 July 2019 - 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. With over 60,000 members, you’re part of the strongest and most experienced professional organisation representing Queensland’s nurses and midwives.

12/18

just in

Tax receipts are on their way QNMU tax receipts for the 2018-2019 financial year will be available from the second week of July. Financial members are able to print their own tax statements through their new-look member profile page. See page 10 for information on this new member profile. If you are a little behind lodging your tax, the good news is you can print the past three years’ receipts this way. The QNMU will also email statements to members who pay by direct debit, please check your spam or junk folder in case it has dropped in there by mistake. Members who have not registered an email address with the QNMU will receive their tax receipts by mail. If you have not received your tax statement within a month of your

last June payment, or have problems downloading your tax statement, please call Membership on 3840 1440 or email member@qnmu.org.au.

■■ If your employer has already reimbursed you for a work-related expense, you can’t claim the expense as a deduction.

It’s tax time – know your deductions

■■ If you use your car for work travel, you will need to keep a diary or a logbook to calculate your workrelated kilometres travelled.

With tax time looming now is also the perfect time to take a look at what work-related expenses you might be able to claim when lodging your return this year. To help you identify what expenses you might be able to claim, the Australian Taxation Office (ATO) has produced a handy little poster you can read or download to assist. A few things to remember: ■■ Make sure you keep the receipts and documentation for anything you claim.

■■ 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. If you’re not sure about what you can claim you should consult an expert. The ATO can impose monetary penalties for making false or misleading statements. For more information, go to ato.gov.au/occupations

Queen’s Birthday Honours list recognises QNMU members TWO OF the QNMU’s very own have been recognised in the 2019 Queen’s Birthday Honours List as Members (AM) in the general division. Congratulations to Veronica Casey (Executive Director of Nursing and Midwifery Services for Metro South Hospital and Health Service) who is recognised for her significant service to nursing, medical education and community health, and Professor Kerry Anne Reid-Searl (Central

Veronica Casey

Queensland University Rockhampton) who is recognised for her significant service to nurse education. This year’s Queen’s Birthday Honours made history with the highest percentage of women ever included in the award list, making up 40 per cent of recipients. More than 1000 Aussies have been recognised – see the full list at http://bit.ly/2ZhEIAZ

Professor Kerry Anne Reid-Searl

just in

PSST...

Guess what's new?

YOUR NEW-LOOK MEMBER PROFILE LAUNCHED HERE AT the QNMU we’ve been doing a lot of work to ensure you, as a valued member, have access to everything you need from your union when you need it. We’re super excited to have launched your new-look member profile page, containing information personalised to your preferences, workplace and sector. Through your new personalised member profile, you can now: ■■ see all your personal, professional and membership information in one place to ensure you receive the most up-to-date information relevant to your working life ■■ view your completed and required CPD hours and access your online CPD record ■■ view your registered events and browse upcoming events in your area ■■ access key resources and information, all available at your fingertips

■■ easily update your settings and communication preferences ■■ read the latest news customised to what’s most relevant to you ■■ update your membership details. To ensure you’re getting information that’s most relevant to you and your

work, be sure to head to your new member profile to review and update your details. Visit www.qnmu.org.au to log into your member profile.

Winning! QNMU scooped two top spots at this year’s Queensland Labour Day Awards!

The official journal of the Queensland Nurses and Midwives’ Union

We snagged Best Union Journal for the Winter 2018 edition of InScope and Best Union Story in the Mainstream Media for our secret aged care audit conducted on International Nurses Day last year. A big thank you to all members who continue to read and support our journal, as well as engage in our ongoing campaigns and activities. It’s as much your awards as ours!

Winter 2018

QNMU’S SECRET A GED CARE AUD IT AMERICA'S GUN VIOLENCE EPIDEMIC PLUS! CPD CONTENT ON MEDICATION MANAG EMENT,

AHPRA AUDITS & MORE

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BOB

the reformer MEDICARE In 1984 he introduced an affordable, universal health insurance system called Medicare. It is his most enduring legacy.

Vale Bob Hawke, friend of the worker, father of Medicare

9 December 1929 – 16 May 2019 THE NEXT time you pull your Medicare Card out of your wallet or check your superannuation statement you might want to say a quiet word of thanks to the late Mr Robert Hawke. The passing of former Labor Prime Minister Bob Hawke last month, two days before the federal election, marked the end of an era in Australian politics – the passing of an iconic politician who lived a large public and political life without the weight of constant polling, digital scrutiny or the 24-hour news cycle. One of our most beloved prime ministers, Bob Hawke had a reputation as a larrikin, a drinker, a womaniser. But he was also a reformer who championed fairness, compassion and equality – an Oxford educated Rhodes scholar with a sharp political mind, who wasn’t ashamed to cry when his heart hurt. He joined the Australian Labor Party in 1947 when he was just 18 and in 1956 landed a job with the Australian Council of Trade Unions (ACTU) as a research officer. He was elected ACTU President in 1969 and in 1983, just three years after being elected to

INDUSTRY SUPER Though political machinations within the ALP meant he didn’t get to implement superannuation reform, it was Hawke who worked with unions to craft industry super legislation as part of the Prices and Incomes Accord, which was designed to keep a lid on inflation.

SEX DISCRIMINATION ACT parliament as the Federal MP for Wills in Victoria, led Labor to a landslide election victory. Over the next eight years successive Hawke ministries transformed our nation, introducing landmark legislation on universal health care, sex discrimination, environmental protection, and superannuation. The social reforms also included a 50% increase in funds for public housing and a boost to age pensions. These reforms were real, tangible things workers and families needed. There were sophisticated economic and foreign policy matters, too – stuff that might not resonate as much for the average voter – like floating the Australian dollar, deregulating the financial system and establishing APEC (Asia-Pacific Economic Cooperation). But for most Australians, and certainly for those of us who work in health care and understand what it means for the people we care for, Hawke will always be known as the father of our world-class Medicare system. For that we cannot thank him enough.

Thanks to Hawke introducing the SDA in 1984 women could no longer be discriminated against, particularly in the workplace, for their marital status, pregnancy or the possibility of becoming pregnant.

NATIONAL ANTHEM AND OUR NATIONAL COLOURS In 1984 he convinced the governor-general to make Advance Australia Fair the national anthem instead of God Save the Queen. He also flagged the idea that green and gold – the colours of wattle – should become Australia’s national colours.

PROTECTING OUR ENVIRONMENT He passed the World Heritage Conservation Act which effectively blocked controversial plans to dam Tasmania’s Franklin River. He also banned uranium mining at Jabiluka in the Northern Territory.

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Strengthening your privacy – changes to My Health Record THE FEDERAL Parliament recently passed new laws to strengthen My Health Record privacy protections.

Marching to Change the Rules at Labour Day

Hundreds of nurses and midwives joined unions across Queensland in solidarity at this year’s 2019 Labour Day marches, with our call to Change the Rules in health and aged care. See pics on page 56.

Solidarity for our NZ sisters and brothers

Along with the rest of the world, we were shocked and horrified when a gunman stormed mosques in Christchurch this March in what is now known as New Zealand’s worst terrorist attack. In light of this, QNMU Executive passed a resolution in solidarity with the Muslim and New Zealand community: http://bit.ly/2HDNvpE

A win for Chemist Warehouse workers

Chemist Warehouse workers have won a new agreement after standing up for fairer wages and conditions, which includes wage increases, permanent jobs for a number of labour hire workers, improvements to OHS and rostering, and more. Thank you to the nurses and midwives who showed up at rallies alongside National Union of Workers members in their fight for decent pay and secure jobs.

Midwives shine

Congratulations to QNMU members Lauren Skinner and Kelly Padro West for taking home Johnson and Johnson’s Qld Midwife of the Year Award and Consumer Choice Midwife of the Year Award respectively. Well done ladies!

Pay rise kicks in for QHealth members

From 1 April 2019, wages and allowances for Queensland Health nurses and midwives increased by another 2.5%. This increase was negotiated by the QNMU as part of EB10.

What are the changes? ■■ You can now choose to have a My Health Record or permanently delete it at any time in your life. ■■ Health information in your My Health Record cannot be released to any third party for non-health care related uses. There are increased criminal penalties for unauthorised access. ■■ Parents will be automatically removed from having access to their child’s record from the age of 14. Minors can nominate their parent or guardian to have access to their record.

If you have any concerns or questions contact My Health Record on 1800 723 471.

HESTA Award winners crowned

Nurses and midwives were recognised at the 2019 HESTA Nursing and Midwifery Awards for their outstanding performance and commitment to patient care and clinical improvement in our professions.

However, the changes that have been made to the legislation were necessary to ensure stronger protections to people’s personal information and privacy.

You can read a more detailed summary of these changes by visiting https://bit.ly/2ZezczW

Find out more at www.qnmu.org.au/EB10

See who the winners are at www.hestaawards.com.au

The QNMU supports the principle of a digital health record system. Having a centralised point for health information can benefit patients, particularly during a medical emergency, as it enables health professionals to access information in a timely manner.

Congratulations Lauren (left) and Kelly (right)!

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FEDERAL ELECTION 2019

AGED CARE: IN FOR THE LONG HAUL I

F THERE’S one thing to take away from the federal election result, it’s that one of the major issues for Queenslanders is jobs. Good jobs. Together with the wider union movement, our focus was always on jobs, including better wages and more secure employment. Many Queenslanders are doing it tough and want to be heard. This is true for thousands of nurses and midwives across the state, particularly for those working in aged care, who are among some of the lowest-paid workers in the country. But all the post-election analysis makes it easy to forget what we’ve actually achieved, including the most significant achievement of putting aged care on the national agenda.

YOU MADE A DIFFERENCE Our campaign to fix aged care has always been a long term one.

support ratios. The Australian Labor Party also announced during the election a proposed increase in staff numbers and improved skill mix, as well as support for Registered Nurses on duty 24/7. And the stories about the appalling working conditions our aged care members regularly face, told through the media, were enough to bring on a Royal Commission. The Royal Commission is ongoing and is due to report at the end of April 2020. We know this will go a long way to shining a light on the issues in aged care and continue to build community pressure on our federal government to act. But none of this progress could have been achieved without the involvement from nurses, midwives, carers, and other community activists on the ground. Across the country people passionate about ratios for aged

care marched on the streets, held market stalls, helped out on polling booths, sent 60,000 letters to politicians, and talked with family and friends about the importance of safe staffing numbers.

WHERE TO FROM HERE? Unfortunately the Morrison government did not make any commitments to our aged care campaign. However, there are opportunities for us to highlight to the government the issues that matter to every Australian, including well-funded universal health care, an aged care system that provides dignity to our elderly and properly supports nurses, and well-paid secure jobs. As always, we will hold politicians on all sides to account, and continue to be a voice for the nursing and midwifery professions. We’re in it for the long haul – are you?

But it starts with commitments from those who can make the necessary legislative changes – our politicians. On that front, we’ve achieved remarkable progress. Significantly, we got the support of 96 politicians nationwide for our campaign. Merely a year ago we only had support from Senator Derryn Hinch. Head to www.qnmu.org. au/pledges to see which Queensland politicians support our campaign. The Greens formally endorsed aged care ratios and skill mix (and more) as their official aged care policy, and Katter’s Australian Party leader Bob Katter also signed up to

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Walking with (gentle) giants

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Equine assisted therapy is quickly gaining popularity as a form of complementary therapy to help tackle mental health issues. Because let’s face it, who wouldn’t enjoy being around these gentle giants?

GENTLE nudge of the head, a small flick of the tail, a light stomp of the hoof… They may seem like the mundane everyday movements of a horse, but these near imperceptible motions provide uncanny insight into how a person is feeling and what issues they may be coping with. According to Equine Assisted Therapy Australia founder Jane Faulkner, a soft nudge of the horse’s nose may indicate someone is frequently exploited and unable to set boundaries. She said a horse turning its head or walking away could signify a person is overly invested in others and has lost touch with themselves. For Jane, these responses provide important information about issues that may be taking place in a person’s life, which she then helps them address. Jane has used equine assisted therapy as a tool to tackle a variety of mental health issues, such as: ■■ Autism and Asperger’s ■■ Anxiety and depression ■■ Eating disorders ■■ Bullying ■■ Post-Traumatic Stress Disorder (PTSD) ■■ Relationship or attachment issues ■■ Low self-esteem ■■ Stress ■■ ADHD ■■ Learning issues.

Turning the cogs Jane Faulkner’s interest in mental health was first piqued when she worked as a Registered Nurse in Logan Hospital’s adolescent and adult mental health wards. During her seven-year career as a nurse, Jane supported people through difficult transitions of illness, grief and loss, trauma and mental health issues. This led to her study of Gestalt therapy and eventually to her work in equine assisted therapy. “I found working in mental health fascinating. I was always curious about the difference between those who suffered from mental health illnesses and those who didn’t – what made some sick but not others?” Jane mulled. “Trying to find an answer to that question became a big part of my thesis when I did my Masters degree in Gestalt therapy, which is very much about working in the here and now. “It’s a very holistic therapy and matches up well with equine assisted therapy, because horses are very relational and very aware of how people are feeling in that moment.” Armed with her background in nursing, a certificate in Equine Assisted Psychotherapy and a love of horses, Jane’s aim was to create a registered training organisation that could support vulnerable members of the community who may struggle to afford therapy.

What is Gestalt Therapy? Gestalt therapy is a client-centred approach to psychotherapy that helps clients focus on the present and understand what is really happening in their lives right now, rather than what they may perceive to be happening based on past experience. Instead of simply talking about past situations, clients are encouraged to experience them, perhaps through re-enactment. Through the Gestalt process, clients learn to become more aware of how their own negative thought patterns and behaviours are blocking true self-awareness and making them unhappy. Pictured: Equine Assisted Therapy Australia founder Jane Faulkner with her beautiful boy Phoenix.

Source: Psychology Today (2019). Gestalt Therapy. https://www.psychologytoday.com/au/therapy-types/gestalt-therapy

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Pictured: Jane and partner Andrew with horses Glacier and Phoenix.

Today, with the support of a passionate team of horsemen, Jane’s organisation uses an integrative approach combining equine assisted psychotherapy, counselling, Gestalt therapy, horsemanship, yoga, mindfulness and art therapy to benefit people from all walks of life and in different stages of their journey. Jane’s clients range from people with anxiety, depression and eating disorders, to those who have difficulties setting boundaries, as well as teenagers with suicidal ideation or self-harm. “While I don’t specialise in autism I do see some adults and teens with high functioning autism,” she said. “Equine therapy is really helpful for people with autism because they can read visual cues that tell them when the horse is unhappy, something they might generally struggle to do with a person.”

issues, working with horses generally requires a person be congruent – meaning what they’re feeling, saying and doing need to match up. “In day-to-day life most of us just push through or are totally oblivious to what’s happening in our bodies,” Jane said. “A lot about working with the horses is really learning to understand your body and when it’s giving you messages, then learning to respond to those messages.” An initial session with Jane usually involves a short intake process to better understand a person’s background and what they’re hoping to achieve out of therapy. She then takes clients through a quick education session about horse safety.

Reaching out

“I’ll identify certain tell-tale signs that show if a horse is uncomfortable or unhappy – if his ears are pinned, for example – we’ll need to take a step back rather than keep approaching the horse,” she said.

While there are a variety of creative ways in which equine assisted therapy can help someone with mental health

“Horses are distinctly aware of what’s happening in our bodies so if someone is overly excited or

anxious about the session the horse will pick up on that and become uncomfortable. “So we also go through a breathing and grounding exercise – just taking a few deep breaths and feeling our feet on the ground – to help calm ourselves before approaching the horse.” For those who have experienced trauma, simply seeing the horses or being in their presence can evoke feelings of fear and anxiety. This is especially true for those who have a history of abuse or of being bullied, and feel they have little ability or power to say no to others. “I’ve had a client who experienced severe childhood abuse and neglect. For her, the world hasn’t felt safe and still doesn’t. It was extremely difficult for her to form any relationships as an adult,” Jane recalled. “We started by having her interact with my miniature horse Sunny. We worked to build a relationship between them so she could begin to feel safe with her, and be able to share what’s happened to her with the horse.

Meet the herd!

Equine assistance horses don’t require special training however they have to be emotionally well-balanced, have a calm, even temperament and be comfortable with people who may have big emotions. Jane’s horses come from a variety of backgrounds but they all have one thing in common… they’re adorable!

P hoe

Glacier is the youngest in the herd at five years old. He’s calm but with a cheeky personality! He loves working with people and will often stop what he is doing to check out what people in the paddock are up to.

a cie r

Phoenix is my chestnut and I’ve had him the longest. He came from a family with an autistic child who used to ride him so he already had experience as a therapy horse. He’s calm and quiet and very sensitive to what’s happening with people. I feel very blessed to have him and secretly he’s my favourite!

nn “Over time it has made an incredible difference in her life. She’s now able to set boundaries with people who used to push her around or bully her, and she’s learned to regulate herself in certain situations rather than spiral into depression. “It’s also helped her understand what a healthy relationship feels like.”

Into the paddock Every therapy session can be different, and how it goes depends on the way a horse reacts to someone. “I never know how the horses are going to respond as they can pick up on a person’s emotions much better than you or I can,” Jane said. “We’ll generally go and meet each member of the herd and see what they have to say. Often the horses will all react the same way and we’ll work on that theme with the client.” For some, simply being among the horses and working with them can make a big difference. But for others with low self-esteem or who want to build their confidence, Jane recommends mounting up.

I don’t know a lot about Java’s background but he’s a little more complex. But just like my other horses he’s very calm and not much fazes him. Anything can happen around him and he won’t be easily flustered or spooked and that’s really important.

Sunny is my little girl in the herd – she’s a miniature. She used to be a brood mare before she was rescued, and very sweet with people… perfect for equine assisted therapy work!

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“Riding horses is really effective for some of the teenagers I work with who need to build self-belief and confidence,” she said. “The horse can tell if you’re doubting yourself and won’t feel safe or comfortable, so you’ve got to take charge. You have to learn to communicate with the horse without being dominating or aggressive, and to trust the horse underneath you. “The movement of the horse can also be very calming and almost meditative, yet very empowering at the same time."

“I think we get into nursing because we care and love helping people, but it’s easy to tip into that imbalance of losing touch with what you need and placing equal value upon your needs. “I’m so grateful for my career in nursing because we see people at their most vulnerable and I think that gives us the capacity to be humble and authentic. “My experiences as a nurse certainly influences the work I do now in equine assisted therapy.”

While Jane helps people from all walks of life and different professional backgrounds, nurses are frequent flyers at her therapy sessions. She said most nurses seek selfempowerment and the capacity to stand up for themselves, as well as clarity about who they are in life. “Us nurses have that pattern where we’re awesome at meeting everyone else’s needs but we’re totally out of touch with our own needs – everyone else comes first!” Jane laughed.

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Queensland’s first midwife-led birth centre celebrates F

OR 25 years mums have stood on the shady veranda of the Mackay Base Hospital’s Birth Centre clutching their precious newborn babies. Over 3100 Mackay families have utilised this service, whose existence is owed to the determination of the local community who fought hard to provide greater birthing options for women. The Birth Centre will celebrate its 25th anniversary in June, a significant achievement for a service that was the first of its kind in Queensland. Working out of a little cottage about 10 metres away from the main hospital, the service is staffed by Clinical Nurse/Registered Midwife Marion Fazakerley; Clinical Nurse/ Midwife with endorsement Julie Pratt; Clinical Nurse/Midwife with endorsement Allison Davis and Clinical Nurse/Registered Midwife Donna Towers. These midwives work to a low risk, early discharge model, where a midwife provides one-on-one care and support to the mum-tobe right throughout her pregnancy including birth. QNMU member Julie Pratt said while the homely, calm atmosphere of the cottage is a drawcard for many

women, it’s the holistic model of care women really benefit from.

25 YEARS

“The rapport we build with women over the pregnancy journey allows for a relationship of trust and respect. Women appreciate the reassurance and accessibility of a known midwife whereby the woman knows who she's going to get on the end of the phone when her time comes,” Julie said. “And you can see in the outcomes, our statistics show less medical

Mackay Birth Centre midwives (left to right) Julie Pratt, Marion Fazakerley, Donna Towers and Allison Davis

interventions and pain relief needed compared to other models of maternity care.”

There are also proven long-term health benefits for both mother and child, including breastfeeding for longer, and less postnatal depression. Searching through the Birth Centre's archives QNMU member midwife Marion Fazakerley said the centre had achieved most of its initial goals which included increasing the birth numbers to 200 a year, and ensuring

There’s that rapport with women and friendships made over that journey, and the woman knows who she’s going to get on the end of the phone when her time comes or she gets to the birth centre. Julie Pratt, QNMU member

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[Being a birth centre midwife] is a situation where your home life and your work life are one. Marion Fazakerley, QNMU member

the centre’s clients included 10% Aboriginal and South Sea Islander families. “It’s amazing sometimes, in the room, you’ll have aunty who I assisted during pregnancy, and mum that I was with, then all the young female cousins, and then the woman birthing, who is the next generation - it’s so lovely to be able to accommodate that,” Marion said. The centre also hit its targets for midwife education with two of the centre midwives recently securing their Prescribe Scheduled Medicines endorsement. Marion, who has been with the centre for 20 years, said the success of the Mackay service, and others like it at the Royal Brisbane, Townsville and Gold Coast, prove midwife-led centres are safe and should be more widely established. Although, she conceded, this would require midwives who could manage the rigours of the jobs. “It’s a situation where your home life and your work life are one, whereas a lot of midwives want a total separation of that,” she said. Julie Pratt agrees, but said the irregular hours and unpredictability were well worth it. “You go that extra mile because they’re just lovely women… it really is a great job, I wouldn’t do anything else.”

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r e t h g u La t s e b e is th e n i c i d e m T

HERE’S something to be said for nurses and midwives’ sense of humour. It can be pretty dark. Often only our colleagues get it and taken out of context people may think we’re being insensitive or crude. But when we spend our working lives caring for thousands of patients and residents (not to mention working with hundreds of other nurses and midwives), the inspiration for what may be described as raw and honest humour is endless. And let’s face it – some days if we didn’t laugh, we’d probably cry. For South Australian nurse turned comedian Georgie Carroll, coming to work with a sense of humour was always an essential part of how she approached her job. “I used to cry every time somebody died, but you can’t do that forever,” Georgie said. “I’m not blasé about it now – I don’t talk about Home and Away over the body – but I definitely now think, that’s in that room and now I’m going into the next room and I’m going to be happy again. “It’s a bit twisted.”

Nursing: a life of comedy Comedy was not always part of the plan for Georgie, who only recently retired from nursing to pursue a career as a full-time comedian. “Gran told me to be a nurse because I wanted to be a pop star, and she said, ‘Okay, while you’re trying to be Britney Spears, how about you do a bit of nursing as well’. And I loved it,” Georgie said. “But my sense of humour was always there. “I’ve always been able to defuse anger pretty easily with humour, and have always been good at supporting a family through a dark time with a little bit of gentle humour, or finding out what was funny about the person who passed away.” Following her colleagues’ advice to give stand-up a go, Georgie took to the stage one night in front of an audience packed full of nurses from her workplace. “I just told nursing stories, just the kind of stuff you talk about on night shift, more to do with the characters of nursing more than the patients,” Georgie said. “Nurses are way funnier than patients – I didn’t realise what I was focusing on at the time, but most of my shows have been written about compassion fatigue. “New nurses start off a bit Beyonce and end up a bit Judge Judy. “A new nurse might come in and say, ‘How’s Mr Brian in bed three? Is he still hanging on?’ But the older nurse would come in and say, ‘Is Brian dead yet?’.“

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Gr a an n to l d sh d m es et ho o ai w be d, ab ‘ a O ou t y kay nur se ou ,w be hi do l ca e a yo us bi u’ eI to f n re t w an ry ur in te sin g d g t t o as be o b w Br e a el l’. po i An tne y S p st d ar I lo p , ve ear s, d it. It’s a bluntness that some of us who have been in the profession for a long time can relate to (orcas, as Georgie likes to call them), and which strikes a chord of realisation for the young, bright-eyed nurses fresh out of university (or dolphins, as Georgie calls them). Georgie’s 20 years of nursing have given her plenty of material to work with. But her humour isn’t just confined to laughing at ourselves. “There’s just something funny about the people you meet in hospitals that you don’t meet anywhere else,” Georgie said. “To be in a lift with a guy who’s sniffing the buttons while saying, ‘I can’t find my toes’, there’s just something real and grounded about that that keeps you in check.” And then there are the hospitals themselves, along with all the bureaucratic structures that could be source material for any comedy script.

Georgie Carroll 21

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Twenty minutes of hearty belly laughing makes for a good cardio workout. Heather Joy Campbell, Laughter Yoga International

“A new hospital that has been built has paid $4 million for robots that deliver food to patients – this is what management thinks we need, and how they can save money on kitchen staff,” Georgie said. “But somebody recently stole two of the robots, so now the robots have to have security guards. “That same hospital built glass staffrooms. We are so screwed if anyone can lipread.”

Laugh more, feel better It’s not something that students are taught in their nursing or midwifery studies, but Georgie said the importance of laughter and using humour in the workplace should not be underestimated. “Now that I’ve come out of nursing and am looking back, I’m thinking, that 20 years was insane,” Georgie said. “A lot of the things you see in nursing are so dark that if you didn’t laugh, you’d break. “I’ve seen some of the ones that don’t laugh. They’re not doing it properly. “Laughing just makes it all a bit better.” Of course, there’s a bit of truth to the phrase ‘laughter is the best

medicine’. Nothing quite beats that feeling of relaxation and euphoria during and after a good belly laugh. But as we get older and deal with life’s stresses, we’re in danger of forgetting to laugh as often as we should. That’s according to Queenslandbased Laughter Yoga International trainer Heather Joy Campbell. “There are some studies that show kids laugh about 300 times a day, and by middle-age, you’re lucky if it’s 10 to 12 times a day, and that’s not sustained,” Heather Joy said. It’s a reality that has seen the popularity of Laughter Yoga classes spread to 110 countries, including in various towns across Queensland. Developed by Indian doctor Madan Kataria in 1995, Laughter Yoga is a concept that combines playful laughter exercises with deep yoga breathing. “The really interesting thing about Laughter Yoga is that we don’t work with humour,” Heather Joy said. “We take the intellectualisation of laughter out of the equation so that we laugh as an exercise. “The brain doesn’t know the difference between intentional laughter and humorous laughter and when we willingly laugh as an exercise,

it’s sustained beyond those short social snickers. “Twenty minutes of hearty belly laughing makes for a good cardio workout.” The exercise may feel strange at first, but the benefits speak for themselves. “Laughter Yoga increases oxygen levels, we’ve got some light cardio happening, generally it reduces blood pressure, and it’s good for your heart system,” Heather Joy said. “It’s also great for your mood, because after a few minutes of sustained laughter we have the beautiful cocktail of feel-good hormones released in our body: dopamine, oxytocin, serotonin and endorphins. “I liken it to an instant vacation, because it has that stress-reducing impact.”

Bringing laughter to nursing Nurse Educator at Lismore Hospital Louise Merkel recently completed two days of Laughter Yoga training. She recommends it to any health professional as a coping mechanism for stress, and plans to introduce

indepth similar techniques to nurses in her workplace.

From a place of truth

“My idea going into it was to use Laughter Yoga as a team-building exercise to relieve some stress,” Louise said.

It’s this ‘off-the-cuff’ quality that captures the human aspect to what we joke about with our colleagues in the tearoom.

“It was beneficial even for me just from those two days – I woke up the next morning with a sore chest from laughing so much […] I hadn’t laughed for a long time, it was contagious.

Georgie Carroll characterises our humour as brutal and sentimental.

“It’s good to have a laugh sometimes but it’s hard to find the time to do it when your job is stressful.” She agreed humour often brought nurses and midwives together. “It’s the connectedness we have with each other,” Louise said. “Nursing humour is an instinctual thing, we tend to joke about things that are funny to us but not to anyone else. “A mental health nurse and I were discussing the codes we have for emergencies. He said, ‘Isn’t it ironic that some idiot has labelled one a code brown?’ Because, of course, we know code brown as something quite different. “It was just an off-the-cuff remark, but only a nurse would get that reference.”

“Gallows humour is definitely a thing in nursing humour,” Georgie said. “There’s this underpinning sentiment that we’re definitely judging people but we’ll still care for them and do something wonderful for them.“ It’s this compassion we show for our patients and residents that brings real truth to our humour … and as any comedy expert will tell you, the funniest jokes are often the ones that come from a place of truth.

d more Want to rea lth a about the he benefits of ?

laughter

Head to www.thehappydemic. com.au/7-amazing-healthbenefits-of-laughter and find out why you should laugh every day! Find a local Laughter Yoga class near you at www.laughterclubsqld.com.au

laugh

“There’s a real truth to what we do, and we’re dealing with universal truths,” Georgie said.

Want a

“Underneath all the science and injuries, it’s just love and happiness that we’re trying to create.”

Check out these hilarious social media pages that are all about nursing…

www.facebook.com/ ilovenursing23/ www.facebook.com/ allnursescom Follow ‘nurselifern’ on Instagram

Laughter Yoga classes are now offered in locations right across Queensland.

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The experience of a

lifetime Nurses in Kenya

Pictured: Clinical Nurse and QNMU member Belinda Densley in Kenya on World Youth Internationalâ&#x20AC;&#x2122;s Nurses in Action program.

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Eleven nurses in a house

with no hot water, no fans, no refrigerator and minimal solar power in humid weather. It might sound like an uncomfortable trip for some, but for QNMU members Emma and Belinda – who recently journeyed to Kenya as part of World Youth International’s Nurses in Action program – it was the experience of a lifetime!

Special.

That’s how Registered Nurse Emma Hayes and Clinical Nurse Belinda Densley described their recent month-long trip to Kenya alongside nine other health professionals, all from a variety of backgrounds and walks of life.

The group made the 10,000km journey as part of World Youth International’s Nurses in Action program, which enables nurses and allied health professionals to provide primary health care services in remote communities. Having always longed to travel, Emma and Belinda both jumped at the opportunity to volunteer for the program and expand their nursing skills. What awaited them in Kenya was both eye-opening and confronting, but no less an experience they’ll remember for life.

“It was an every day home and while basic, it certainly had what you needed. There were four of us to a bedroom with bunk beds and it was a bit of a squish but it was okay. Accessing power could be an issue as the solar power would drop out sometimes and we didn’t have access to hot water. “Some of us weren’t overly keen on the pit latrines either when the toilets weren’t working properly, but I’ve lived in the bush so I could handle it every now and again!” Belinda said the camaraderie shared between the group helped make the trip a memorable one. “We all came from vastly different backgrounds in health care so we all took away something different from this trip,” Belinda said. “It was great that we would debrief at the end of each day and have a chat about things we’d seen that affected or upset us, to unload and just check in with each other.”

A different health care landscape The group undertook placements at a range of local health centres and hospitals in community health, undertaking antenatal and postnatal clinics, helping out in operating theatres and emergency departments, assisting with medical camps in rural communities, conducting presentations with local nursing and medical staff as well as at schools, and even helping out in the delivery rooms. As a new graduate working in Ipswich Hospital’s emergency department, it was a surprise to Emma to discover Kenyans rarely presented to a hospital for treatment because of the financial cost involved – something we in Australia rarely need to concern ourselves with thanks to our universal health system. “Money is such a big issue there,” Emma said.

Home away from home Kenya is home to more than 50 million people, making it the 27th most populated country in the world. Due to its vast landscape and the remote location of its cities, plumbing and access to clean water are luxuries that many homes and health care facilities in the country aren’t fortunate enough to enjoy. While Emma and Belinda’s group of volunteer nurses were comfortably accommodated, it still took a bit of getting used to without the small luxuries of everyday Australian life. “I had it in my mind we would be living in a mud shack but it certainly wasn’t like that!” Belinda laughed.

indepth “Everything gets billed up – how many injections they’ve received, how many bags of fluid they’ve had, even how many gloves or pieces of gauze have been used – they or their family will have to foot the entire bill. “Those are the sorts of things we take for granted in Australia. We just pick up another pair of gloves when we need to. But for them every item costs a patient money.” To provide more health care opportunities for people, the Nurses in Action team regularly conduct house visits and run medical camps. “We took some supplies and went out with local doctors and nurses to two rural villages and set up camp there,” Emma said. “People from the community and the villages came to seek medical assistance. We took vitals, checked for fevers, handed out Panadol when it was needed and also did on-site Malaria testing. “Because distance is such a big issue in Kenya the people really rely on small health care facilities and med camps like these for health checks or immunisations, rather than have to travel to a hospital in one of the big cities.”

A learning circle For CN Belinda, the trip was a dream come true. She had always wanted to experience nursing overseas, and the reciprocal learning

Registered Nurse an d QNMU member Emma Hayes with Ke nyan school children.

nature of the Nurses in Action program called out to her. “I always knew there was so much more out there and visiting Africa has always been a dream of mine,” she said. “I did a lot of research on volunteer programs and really liked the fact that we would have the opportunity to learn from the Kenyan nurses and they from us. “And indeed they taught us a lot about their practices, especially how they managed diseases like HIV or malaria which aren’t as common in Australia.” As she currently works in the diabetes service at Toowoomba Base Hospital and has Type 2 diabetes herself, Belinda was interested in how Kenyan nurses conducted diabetes education. “Diabetes is becoming more prevalent in Kenya and in the African continent,” Belinda said.

Money is such a big issue there.... We just pick up another pair of gloves when we need to. But for them every item costs a patient money. Emma Hayes, Registered Nurse

“They don’t have the resources we do so I was keen to help them learn about supporting patients in preventing diabetes from a dietary perspective, rather than just relying on medicine to treat it.”

Making it work Cost plays a big part in food and drink decisions for many Kenyans. With a 500ml bottle of soft drink costing 50 shillings (about 71 Australian cents) and a bottle of water double the cost, most will reach for the cheaper option at the expense of their health. Belinda said the key to managing diabetes in the country was identifying strategies that worked for them and their limited resources. “In Australia we’re fortunate to have clinics with blood glucose monitors and we’re able to send patients home with things like fact sheets and a blood glucose monitor,” Belinda explained. “Kenyans don’t have access to that sort of equipment and will only come into a clinic if they feel like something’s not right in their bodies. Even then, they’ll limit coming in unless they can afford to.” On top of tackling the issue of limited resources, Kenyan health care workers must also contend with a lack of access to clean, running water, something many of us couldn’t imagine providing health care without. “Water is a big commodity in Kenya. The way houses are set up it’s like they’ve popped up on a vast landscape in the middle of nowhere and plumbing just isn’t a possibility,” Emma said.

indepth “It’s extremely expensive to get running water and western toilets are rare. So Kenyans rely on the wonderful groundskeepers and sometimes even kids who go down to the dam and carry buckets of water on their heads or on the backs of donkeys back to where it’s needed. “It’s just their way of life and they make it work. Again, these are things we take for granted every day in Australia – to turn on the tap and be able to wash our hands or even just to flush the toilet.”

The human aspect of nursing For both Emma and Belinda the trip was more than just an educational experience, it was also an emotional one. A shared experience with a stillborn baby left both feeling heartbroken yet with a renewed understanding of the Kenyan culture. Both Emma and Belinda felt privileged to have been asked to dress

the sleeping baby and return him to his mother. “It was a beautiful moment we shared but when we brought him back to his mum she just didn’t really want to interact with the baby, she didn’t want to hold him,” Belinda recalled. “Her family had a cardboard box waiting and he was simply placed inside then put on the floor. Later, once a coffin was made for him, he would be buried. “It was heartbreaking because it brought to light how Kenyan women feel they can’t be attached to their children until it is actually born alive and breathing.” Belinda said complications like pregnancy-induced hypertension were often treated with termination of the pregnancy regardless of gestation, all because families were unable to afford medication. “After we walked outside Emma broke down and started crying which set me off,” Belinda said.

“Ultimately, we were there to support the family and even though I wanted so much to go and pick that box off the floor and place it on the bed or something, we have to respect their culture and how they show respect may be different to us. “All you can do is pat Mum on the shoulder and say ‘it’s going to be okay’.” The experience was tough, but it brought home for Emma what nursing is all about, and that amid the hustle and the bustle of our professional lives we have to remember the human aspect of the work we do. “Coming from an ED environment I’m used to being on the go all the time but in Kenya I was glad to be able to take a step back and just hold someone’s hand and ask how their day was,” Emma said. “It was such an eye-opening experience and it hit home how lucky we are to live in a society where health care and treatment is easily accessible. “That’s something we really need to be thankful for. No one gets turned away from health care in Australia.”

Did you know? QNMU financial members who undertake volunteer work overseas for short periods of time are fully covered under our market-leading professional indemnity insurance.* Contact Member Connect on (07) 3099 3210 to find out more. *QNMU’s professional indemnity insurance does not apply to volunteer work undertaken in North America (USA and Canada).

How it all began WORLD Youth International was founded by Aussie Robert Hoey in 1988 when he was just 21 years old. He was passionate about providing young people with opportunities to become involved in the global community. When Robert was just 28 years old he contracted Cryptococcus Meningitis

while leading a teenage exchange program in the USA and tragically passed away in his mother’s arms on a flight home. His family decided they couldn’t let his dream die with him and stepped up to lead World Youth International and continue to build on Robert’s vision.

Today, they have created volunteer opportunities for thousands of Australians and provided access to basic services such as health care and education for more than 40,000 people across the globe. Find out more at https://worldyouth.org.au

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Feeling SICK ? DONâ&#x20AC;&#x2122;T BE PRESENT

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PICTURE THIS: You wake up for your early shift and you’re shivering. You’ve got a fever. You ring work to let them know you can’t make it in today. Okay, that’s fine… but when your next pay cheque arrives, you’ve been paid significantly less than the previous fortnight. Suddenly, you’re wondering how you’re going to pay that electricity bill due next week. And what about those new school shoes your child needs? Something else will have to give…

hankfully, today's full-time or parttime workers avoid this thanks to sick leave entitlements. Prior to 1935 however, paid sick leave didn’t exist. Why should you get paid for not working, right? If you got sick, you’d suffer financially, too. But over many decades, unions argued the case for paid sick leave (along with annual leave), and between 1935 and the 1970s, paid sick leave was gradually introduced into federal awards until 10 days’ sick leave became standard.

Understanding your sick leave Today, the Industrial Relations Act 2016 provides Queensland’s public sector nurses and midwives, excluding casuals, a minimum 10 days’ paid sick leave each year (pro rata for part timers).

This leave accumulates from year to year. So, if you are sick for an extended period of time (ie more than 10 days), you will still be paid your base rate, provided you have enough leave accumulated. Private sector nurses and midwives are provided the same leave under the Fair Work Act 2009. Similarly, all nurses and midwives who are not employed casually are also entitled to carer’s leave, which exists for situations where you need to provide care or support to a member of your immediate family or household due to an illness, injury or unexpected emergency. This comes out of the sick leave balance. Public sector nurses and midwives must show their employer a medical certificate (or a statutory declaration) if taking three or more consecutive

days of sick leave or carer’s leave, or two or more consecutive days for most private sector agreements. It seems simple enough, but accessing sick leave is an issue the QNMU frequently assists members with. From being unfairly asked to explain why and how sick leave has been used, to misinterpreting entitlements and how sick leave operates in practice, the issues are far-ranging and often distressing for members. But perhaps the biggest issue – and one that typically flies under the radar – is nurses and midwives not using their sick leave when they need it.

Presenteeism QNMU Occupational Health and Safety Officer James Gilbert said nurses and midwives often felt guilty about taking their sick leave. “It’s called presenteeism – so instead of absenteeism, people come to work when they shouldn’t,” James said.

It’s called presenteeism – so instead of absenteeism, people come to work when they shouldn’t. James Gilbert, QNMU Occupational Health and Safety Officer

“That happens for a variety of reasons, one being that they feel guilty in terms of their colleagues being left understaffed because they know they won’t be replaced, and even if they are replaced, they might not be replaced with staff who are as skilled in their area.” QNMU member and Registered Nurse Jessica Heffernan, who recently called upon the QNMU to help reclaim her sick leave (see page 31) said it was true nurses often felt guilty about taking sick leave.

indepth “I think the biggest thing is staffing, and feeling like you’re letting your team down by not being there,” Jessica said. “I’ve absolutely felt that guilt myself. Of course if I’m very sick or if one of my little ones has been sick, I don’t go to work. But in saying that, sometimes you do still go to work when you should probably stay at home.”

Absent vs present James said the other factor behind presenteeism was employers’ emphasis on managing absenteeism. “People get intimidated and don’t want to be scrutinised in terms of how much leave they’ve taken, so they come to work sick,” he said. Unfortunately, while many employers see absenteeism as an added cost to business and workplace efficiency, very little attention is placed on managing presenteeism. That’s a problem, considering presenteeism costs the Australian economy upwards of $34 billion every year. That’s according to a 2016 report commissioned by Pathology Awareness Australia, which identifies decreased productivity and the spread of illness around the workplace as the top contributing factors. Significantly, the Australian Family Physician states the economic cost of presenteeism exceeds that of absenteeism for many disorders. This is particularly the case for depression, which accounts for 80% of the total lost productive time costs.

‘Triggering’ absenteeism Employers are, of course, entitled to manage absenteeism if there is an ongoing issue, and in most instances employers do this appropriately. But often, the process of identifying a potential ‘problem’ is derived by an algorithm, which flags the higher level of leave and the employee is requested to attend an absenteeism discussion. Typical triggers include absence trends, regular sick leave, recreation leave in lieu of sick leave, and sick leave without pay. Unsurprisingly, these triggers do not take into account the nuances of an

individual’s circumstances, which can land members in stressful situations. “If you use all your 10 days of sick leave, for example, that’s a trigger,” James said. “But clearly you only need one bad infectious respiratory condition, which you can’t come to work with, and you’ll use all your sick leave.” The QNMU recently assisted one member who was required to take extended time off work due to an injury. Under her superannuation cover, the member was required to exhaust all her sick leave before being able to access her income protection policy. Unfortunately, the member then became sick with influenza after returning to work. With no sick leave left, the member asked to use her annual leave in lieu of sick leave. This triggered the absence management process, and the member was called to account. Once the member explained the extenuating circumstances, her leave application was eventually signed off.

Why presenteeism matters The problem with presenting to work with an illness, of course, is the potential risk you pose to yourself, your colleagues and your patients or residents. Under the Work Health and Safety Act 2011, while at work nurses and midwives must “take reasonable care for his or her own health and safety, and take reasonable care that his or her acts or omissions do not adversely affect the health and safety of other persons”. Clearly, attending work while sick may expose patients or residents to your illness while they are already in a weakened state. And in terms of your own health, research shows that working when sick can increase adverse health events such as cardiovascular disease, poorer self-rated health, and future sickness absence. There is never a convenient time to get sick, and there will always be pressures at work and reasons to push on.

Which is why incentives for not using sick leave – such as an entitlement where your sick leave is paid out upon retirement – goes against the very purpose of sick leave: to ensure we are kind to ourselves and allow our bodies time to recover. If we are to overcome the problem of presenteeism we need to address factors such as guilt and fear of scrutiny. And we need to continually look at our sick leave entitlements and challenge whether they are working for us. For example, is 10 days a year enough for health care shift workers? Could there be a pool of sick leave for those who have run out? Should we increase pro rata sick leave in line with workers’ age? Most importantly, employers need to play their part by addressing presenteeism, just as they do absenteeism. Because we all know the most efficient and productive workforce is a healthy one.

If taking sick leave, remember… ■■ Notify your employer or line manager that you will be absent from work. Give as much notice as possible and try to provide an estimation of how long you will be absent. ■■ Provide a medical certificate (or statutory declaration) to your employer if you take three (public sector) or two (most private sector) or more consecutive days off work. Some enterprise agreements vary, so check your agreement at www.qnmu.org.au/ wages_conditions You should always follow your employer’s policy about reporting if you are sick and absent from work. If you are called to a meeting regarding your absenteeism, make sure you read and ensure management are following the employer’s absenteeism policy correctly. Call the QNMU early to seek advice.

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Presenteeism costs the Australian economy upwards of $34 billion every year.

Are you receiving your correct sick leave entitlements? QNMU members at a private hospital recently recovered more than $7000 in sick leave.

“So I wrote an email to payroll but they told me I wasn’t entitled to be paid for that day.

Management was denying nurses and midwives their paid sick leave if they had already taken more than four single days of sick leave in the previous 12 months without providing a medical certificate.

“That’s when I called my QNMU Organiser, and before I knew it I had that day of sick leave paid back to me.

That was in line with the hospital’s sick leave policy, but fortunately for members, a workplace policy can never override an enterprise agreement or legislation to the employees’ detriment. Registered Nurse Jessica Heffernan said she noticed she had not been paid her sick leave when she received her payslip. “I consulted with my union representative, who told me that wasn’t right and that the agreement – which came out not that long before – overrides the policy,” Jessica said.

“If it weren’t for the union I probably would’ve let it go.” It turned out many other nurses at the hospital had also been denied their sick leave due to management applying the policy instead of the agreement. Fortunately, the QNMU was able to recover 20 days of paid sick leave, which equates to at least $7000 for members. “Having those entitlements is so important, especially for parents if your little ones get sick and knowing you’ll still get paid,” Jessica said. “Without paid sick leave I’d probably be more likely to go to work sick.”

REFLECTION Reading and reflecting on this article may count towards your Continuing Professional Development. Be sure to record the hours on your Record of CPD at www.qnmu.org.au/CPD

References:

Fair Work Ombudsman (n.d.) Australia’s industrial relations timeline, viewed March 2019, www.fairwork.gov.au/about-us/ legislation/the-fair-work-system/ australias-industrial-relationstimeline Fair Work Ombudsman (n.d.) Paid sick and carer’s leave, viewed March 2019, www.fairwork.gov.au/ leave/sick-and-carers-leave/paidsick-and-carers-leave Queensland Government (2016) Industrial Relations Act 2016: Sick leave, viewed March 20109, www. legislation.qld.gov.au/view/html/ inforce/2018-03-02/act-2016063#ch.2-pt.3-div.6-sdiv.2

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Sexual harassment THE SILENT TRUTH

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HE PATIENT is looking forward to his shower.

The man in his eighties tells the Registered Nurse (RN) he can’t wait for “shower time” and raises his eyebrows suggestively. At every opportunity, the man touches the RN who is in her late twenties. He puts a hand on her arm and then her lower back. He leans in for a hug, which wasn’t offered, and comments on the smell of her hair. It’s behaviour the man doesn’t display towards the male and female doctors who enter the room. Yet he seems to feel no shame making the nurse-centric comments while other staff and even his family are present. “Dad’s always had a thing for nurses,” says a young relative smiling.

But in the wake of the #MeToo movement, and growing community awareness of what constitutes sexual harassment, more and more nurses are pushing back. It’s simply not OK. Another nurse describes being shown photos of a patient’s penis. “He was right there, just lying in bed and felt it was OK to whip out his phone and show me a pic of his penis,” the RN told the QNMU. “He held the screen up in front of my face and grinned at me. I told him I didn’t want any of that and walked away. “But when I walked out of the room I felt humiliated and angry if I’m honest. I stood in the hall and felt angry, my face was red, and I realised what happened was incredibly demeaning.

He pulled the covers down and said, ‘Meet my Johnson’. uniforms torn, buttons ripped off and more. It is rare to meet a nurse who doesn’t have a story. Yet almost all incidents go unreported. QNMU Secretary Beth Mohle said the culture of silence around sexual harassment and assault in nursing and midwifery must change. “Nurses and midwives are hardworking, lifesaving professionals who dedicate their careers to helping others,” Beth said.

However, the man’s behaviour is a form of sexual harassment. The nurse continues to do her work but braces against the unwanted touches, the lingering hand on the back above her bra strap, the unoffered hugs and suggestive comments.

“In the days that followed, I thought about all the other times patients had behaved inappropriately. I realised it was very common and to be honest I got pretty mad.”

Keeping the peace

Raise the subject of sexual harassment or “touchy feely” patients in a group of nurses and the stories are rife. It seems most nurses have at some time been groped, insulted or sexualised by patients - or patients’ friends or family or other health workers.

The QNMU advises any employees who experience sexual harassment in the workplace to:

The sexualisation and assault of nurses, the life-saving workforce on the frontline of Australian health, is a common occurrence.

■■ Make a verbal or written complaint to a supervisor/manager as soon as possible

However, like thousands of other nurses, she absorbs the behaviour in order to provide professional care and keep the peace. And because the behaviour is so common, were she to report the behaviour, she would have to stop work and report it daily – and sometimes multiple times a day. In fact, the sexual harassment of Australian nurses, 90 per cent of whom are women, is so common many don’t recognise the behaviour for what it is.

He was right there, just lying in bed and felt it was OK to whip out his phone and show me a pic of his penis.

A common occurrence

In fact, research from the Australian Human Rights Commission suggests one in three Australian employees have been sexually harassed at work since 2013. Numerous nurses and midwives have told the QNMU about their own experiences of being harassed at work, including one member who detailed how she was “introduced” to a patient’s genitalia. “He pulled the covers down and said, ‘Meet my Johnson’,” the RN said.

“They are health professionals who are with patients 24/7. When you or someone you love receives care after an operation, it is a nurse that detects and reacts to any deterioration. “Our important, frontline nurses deserve better.”

■■ Keep contemporaneous notes of incidents ■■ Read your organisation’s sexual harassment policy (if there is one)

■■ In your complaint, clearly name the behaviour as sexual harassment, indicating that it was unwelcome, uninvited, and offensive, humiliating or intimidating ■■ Require and expect your employer to investigate the matter immediately ■■ If you wish, request that the employer make arrangements to ensure you will not have contact with the harasser

“I pulled the sheet up and carried on with my work like it hadn’t happened.”

■■ Understand your rights to make an external complaint under various industrial and anti-discrimination laws

Others have been grabbed, pushed, sworn at, propositioned, had their

■■ Contact the QNMU on 3099 3210 or 1800 177 273 for advice.

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Navigating prison health

OU MAY already know a bit about Nurse Navigators – a new and innovative nursing and midwifery role unique to Queensland and first introduced in 2015 thanks to the QNMU’s efforts in securing a commitment from the Palaszczuk government. The Nurse Navigator program covers many areas of nursing and midwifery – from paediatrics and aged care, to patients from culturally diverse backgrounds and critical care outreach patients. These roles ensure some of our most vulnerable communities receive holistic nurse-led care and support by helping these individuals and families navigate our complex health care system. However, one area that is rarely discussed, is prison health. The health care provided to prison patients is often complex and more challenging than the care required for the general population. Of the approximately 3000 patients in the West Moreton HHS alone, about 40% have chronic conditions, while 52% have a disability of some kind. What’s more, these patients are often not well placed to make decisions in the best interests of their own health due to issues such as poor health literacy, poverty or addictions. Enter the Offender Health Nurse Navigator.

Optimising prison health care Nurse Practitioner Nurse Navigator Sarah Hesse has worked in her role for 18 months across four West Moreton HHS prisons. Her focus is on chronic disease, while the other three Offender Health Nurse Navigators focus on palliative care and disability (including chronic pain), blood born viruses and telehealth.

When they’re here I don’t ask what they’ve done, I’m here to treat them as a person, not to judge them for their crimes. Nurse Practitioner Nurse Navigator Sarah Hesse

Similar to other Nurse Navigators, Sarah said the role aims to ensure patients do not fall between the cracks in the health system. It also connects patients to the services they need and assists their return to the community, thus aiming to prevent reoffending. “When they’re here I don’t ask what they’ve done, I’m here to treat them

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Wolston Correctional Centre at Wacol

as a person, not to judge them for their crimes,” Sarah said. “I function on the principle that everyone’s entitled to equitable health care in keeping with the Mandela Rules established by the United Nations to ensure minimum expectations for the treatment of prisoners. “A lot of these individuals want to improve their health and are proactive and take the opportunity to understand and progress their health situation while they’re here.” The role of most other Nurse Navigators, who operate in an acute setting, is to provide end-to-end care and coordination along a patient’s entire health care journey, including help with self-management. In contrast, the Offender Health Nurse Navigator is a primary health care role. Sarah’s regular client base consists of anywhere between eight and 25 patients a day and is similar in nature to that of a General Practitioner, identifying clinical symptoms through active assessment, determining a care plan, monitoring, and often prescribing and referring patients to other health services. “I make sure that care is patientcentred so I ask them what their health goals are and what they’d like to do to achieve that,” Sarah said. “Some of the patients’ health goals might be to optimise their diabetes or prevent complications, others might be just wishing to maintain their

current health status or to understand it better because they’re happy where they are.”

other staff to take on that role and responsibility and decrease the health burden in the community.”

Preventative health

A rewarding career

The benefits of the wider Nurse Navigator program are twofold: the model creates a more streamlined experience for patients and it is better for our health system operationally as it improves relationships between the community and health services. This in turn results in fewer admissions, saving valuable health dollars.

While many nurses may have never considered working in prison health before, Sarah said it provided a platform for nurses to work to their full scope of practice, making for a very rewarding career.

For the Offender Health Nurse Navigator this is best realised through the focus on preventative health, such as bowel cancer screenings and mammograms, as well as ensuring the necessary resources are available so patients can be treated in prisons where possible. “It’s a truly nurse-led service, so we’re optimising patient care and decreasing bed utilisation in public hospitals by preventing a lot of unnecessary transfers,” Sarah said. “In years gone by, patients were transferred to the Secure Unit for care, whether it was emergent or not. “Through the new services provided by the Telehealth Nurse Navigator, we’re now able to discuss patient management more readily without having to transfer a patient and monitor them against the agreed treatment plans. “By introducing Nurse Navigator roles, we’re innovating and upskilling

“I don’t think correctional nursing has a big neon sign out front saying ‘come and work here’ … people don’t think it’s a very glamorous job,” Sarah said. “But it’s probably safer here than working in many emergency departments because it’s very structured. “Doors don’t open and close until it’s safe to do so, we all wear duress alarms so we can call for help, and we have Queensland Corrective Service officers in the centre who are very supportive.” In fact, perhaps the most rewarding aspect of the role for Sarah – and a majority of nurses would no doubt relate – is building a rapport with her patients and knowing she has made a difference in their lives. “It’s a very rewarding role, particularly those simple moments when patients thank you for listening and taking the time for them,” she said. “It’s those little things like a handshake when they get discharged that make a huge difference.”

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Fighting for I a career

N AUSTRALIA we’re fortunate to be

protected by strong industrial and working

rights, including our right to be part of a union. But our nursing colleagues in other parts of

Portuguese nurses unite for a better National Health System BY REGISTERED NURSES SAM NUNES AND ANABELA SAMPAIO

the world aren’t quite so lucky. Sisters Sam Nunes and Anabela Sampaio are Registered Nurses in Australia and have watched friends and family in their home country of Portugal fight for these very same rights for more than a decade. This is their story. Since the global financial crisis in 2008, Portuguese nurses have seen a cascade of events leading to the absolute destruction of their careers. Until this time, nursing in Portugal was comprised of five classification levels: Nurse, Graduate Nurse, Nurse Specialist, Nurse Supervisor and Director of Nursing. In 2009, the Portuguese Government made the decision to reduce nursing classifications to only two levels: Nurse and Head Nurse. This made progressing upward in classifications extremely difficult, and also means nurses have had no pay increments since 2009. Portuguese nurses today receive exactly the same salary as they did in 2011: 1201 Euros per month. In contrast, other professions that require similar qualifications – such as social work, nutrition or psychology – garner a base monthly salary of 1600 Euros per month. The unfairness is shockingly clear.

indepth The destruction of nursing

Time for change

On the surface, conditions for nurses in Portugal appear favourable.

Since 2009, more than 18,000 Portuguese nurses have immigrated to other countries for work.

Private hospitals have an average ratio of one nurse to 10 patients and public hospitals an average of one nurse to 15 patients.

The Portuguese National Health System is losing skilled nurses to countries that better recognise their value.

Under the Nurses Award, nurses should work no more than 35 hours a week.

A change is desperately needed, not only for the advancement of nursing in Portugal, but also for fair wages and conditions.

That doesn't sound too bad, you may think. But reality paints a vastly different picture. Many nurses in Portugal are forced to work 50 to 60-hour weeks, with many working more than 12 to 16hour shifts several days in a row. And nurses don’t get a say in this. If there isn’t a nurse available to cover a shift, management randomly selects a nurse for duty and that decision is final. Conditions of work have deteriorated in conjunction with the total lack of career progression opportunities. Any overtime is paid in time off, however this time is only to be taken when it best suits the hospital. By late last year, the Portuguese Government already owed more than two million hours of overtime work to nurses.

Ultimately, it is patient care that suffers when nurses are overworked and stretched too thin. In 2018, nurses in operating theatres worked with the union to coordinate an unprecedented extended strike across five major hospitals in the country. They guaranteed minimum services and made sufficient nurses available so urgent surgeries could be conducted. This strike was called basta in Portuguese, meaning enough. However what was meant as a show of solidarity and support for nurses was quickly turned against nurses. The Portuguese Prime Minister called the strike action “illegal” and labelled nurses as “savages”, with media portraying the strike as the reason surgeries had to be rebooked, placing the blame squarely on nurses’ shoulders.

The Prime Minister put forward a civil requisition to the Supreme Administrative Court in a bid to quell the strike action. But the Nurses’ Union fought back, presenting an injunction to stop the civil requisition. On International Women’s Day (8 March), 20,000 Portuguese nurses and their friends and families marched through the streets of Lisbon in a show of solidarity and unity. They called for better working conditions (and a better National Health System), progression in the nursing career, and expressed disappointment at how poorly the Portuguese Government had handled this long-running dispute. Despite a number of strikes over the course of many years, there has been no progress and little impact in the media. Sadly, negotiations, meetings and strikes are still ongoing. In the meantime, the Portuguese National Health System continues to suffer and Portuguese nurses and their patients along with it.

Enough is enough. We desperately need the support of our nursing colleagues from across the world to help spread the word. Send a message of solidarity to Portuguese nurses via grevecirurgicaj@gmail.com

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Guess who’s not at the table … AGAIN? OPINION BY DR LIZ TODHUNTER, QNMU RESEARCH AND POLICY OFFICER

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HE PARLIAMENTARY Education, Employment and Small Business Committee recently recommended the state parliament pass a bill to establish a health promotion agency to be known as Health and Wellbeing Queensland (HWQ). The proposed functions of the HWQ are to: ■■ facilitate and commission activities to prevent illness or promote health and wellbeing ■■ develop partnerships and collaborate across government and with organisations such as businesses, industry and community organisations, academics, local governments and individuals to further its objective or carry out is functions ■■ give grants for activities to further its objectives or carry out its functions ■■ monitor and evaluate activities to prevent illness or promote health and wellbeing ■■ develop policy and advise the Health Minister and government entities about illness prevention or promotion of health and wellbeing, and ■■ co-ordinate the exchange of information about activities to prevent illness or promote health and wellbeing. This is a timely initiative given primary care is the foundation of our health care system. However, increasingly for patients, doctors, nurses, midwives, allied health practitioners and indeed taxpayers, this foundation is under stress. A board comprised of chief executives and other persons with qualifications or experience in a range of areas will oversee HWQ. The composition of the HWQ board is of major importance to the QNMU and members, but the bill potentially allows HWQ to have no health practitioner on it at all. While we recognise the need for flexibility, we argued a Registered Nurse and a Midwife must be core members. Nurses and midwives work across all health sectors, geographic areas and settings. It is entirely appropriate that their presence, contribution and expertise are recognised by permanent status on the HWQ board. No other health cohort has anywhere near the size, depth, breadth or influence as nursing and midwifery. No other profession holds the same level of public respect.

It is vital nurses and midwives are included in all areas making decisions about public health, and their representation on the HWQ board should enable this. Unfortunately, and to the detriment of the Queensland public, the committee did not accept our recommendation that would see at least one Registered Nurse and one Registered Midwife as permanent members of the board. The QNMU further recommended HWQ: ■■ operate independently of Queensland Health and have a broad remit to consider the social determinants of health extending beyond a narrow health policy framework. ■■ develop clear understandings of its role in primary health, particularly given the ongoing debates around commonwealth/ state funding. ■■ liaise with the federal government on matters requiring integrated policy work, including primary care, mental health and aged care. ■■ consider ways to measure and evaluate progress in closing the service gaps in primary health care through more effective workforce planning, public education programs and whole-ofgovernment policy initiatives. ■■ prioritise ways to increase resourcing of perinatal preventative health strategies, and promote normal birth and breastfeeding as important measures to prevent long-term chronic disease. ■■ engage with the health workforce, their representatives, employers, community groups and the Queensland public as a first step in developing strategies promoting health and wellbeing through preventative measures. ■■ clearly articulate the relationship between the Office for Prisoner Health and Wellbeing and HWQ given prisoner health is also a public health issue. ■■ engage with nurses and midwives, their representatives and health and safety representatives regarding workplace health and wellbeing. Despite this setback, the QNMU will continue to lobby for nurses and midwives to take up leadership roles on statutory boards such as this. QNMU members can read our full submission at https://bit.ly/2GpI2DA

indepth

Turning clinical waste into gardening goodness

LAST EDITION WE WROTE ABOUT PVC RECYCLING PROGRAMS RUN IN HOSPITALS ACROSS THE STATE. THIS EDITION WE LOOK AT A PLAN TO TURN CLINICAL WASTE INTO FERTILISER.

Retired QNMU member Linda Shields hates waste. A perioperative nurse by trade, and past Professor of Rural Health at Charles Sturt University’s Institute of Land, Water and Society, Linda is on a mission to clean up our hospitals. “I’ve always been distressed about the enormous amount of waste that gets thrown out from operating theatres,” she said. “And it’s not just the soiled items – think of those operating theatre packs that have stacks of stuff in them… you might only use one or two things, but once they’re opened everything has to go out, it’s put into big bin bags then it’s picked, steam treated, compressed and put into landfill… tonnes of it, it’s wicked, absolutely wicked.” For the past few years, Linda has been working with Townsville Hospital and researchers from Charles Sturt University, James Cook University and The University of Queensland on a new way to break down hospital waste to produce a safe, ash-like material which can be used for agriculture.

“In the most promising process we’ve been testing, waste is basically cooked and comes out as a fine biochar,” she said. Trials show that when applied to fertiliser, this biochar can improve soil health by storing water and nutrients. The “cooking” process works on all kinds of waste, meaning collection could be as simple as picking up unsorted garbage bags directly from the operating theatre. According to a study conducted on operating theatre rubbish bags at Townsville Hospital last year, this could include waste like bronchoscopes which contain fibre optics; bone graft filler with silicate calcium phosphate; wooden tongue depressors; bougie dilators made of a rigid plastic with lead inside; tungsten tip laparoscopic scissors and forceps; soda lime used to filter CO2 from patient to the anaesthetic machine; prosthetics including metal cabling for fractures; blood pressure cuffs with Velcro and rubber and more.

“The cooking process works well in our initial tests, but now we need to do further testing so we can register it with the Food and Drug Administration of America. Then hopefully we can get some commercialisation or big-scale funding to actually get it happening in hospitals. “In an ideal world, and this may be optimistic, eventually each hospital would have a processing unit powered by their own little solar cell patch so they’d be completely eco-friendly.” But getting someone interested is proving difficult. “When I approach a potential commercial partner, they ask ‘have you done the safety testing’ and we say no, because the grant bodies won’t give us the funds to do the safety testing unless we’ve got a commercial partner. So it just goes round in circles,” she said. “This has been going on for years and years, dragging on as I go from little tiny pot of funding to a nickel pot. I’m hoping Bill Gates or someone is going to hear me.”

Keeping remote area nurses safe O

VER THE past few years security measures in remote clinics have vastly improved. The introduction of swipe cards has made it possible for staff to retreat to a safe zone if necessary or if under duress. While a straight forward solution such as this works well within the clinic and hospital environments, keeping nurses and midwives safe during community work continues to remain a challenge. Whether this work is in urban, rural or remote areas, safety is a priority area for the QNMU. This is why a commitment was negotiated in Queensland Health's EB10 agreement to review conditions where nurses and midwives work in isolation collectively with Queensland Health.

Ntohtees

from

North

Lucynda Maskell QNMU Vice President

We are currently reviewing great work done by CRANA Plus, and while this is in particular reference to remote area nurses, it is possible that this will lay the ground work for principles and policy across all sectors where nurses work in communities.

Recently, my colleagues and I attended a QNMU education course and between this and the inspiration gained from seeing what other QNMU Branches were doing in their local areas at Annual Conference, our Cape York Branch has been revitalised.

This committee of QNMU and Queensland Health representatives will make recommendations with the ultimate goal of mandating protections in an agreement such as EB11.

Our workplace representatives have increased, the Branch meets regularly and in May, we celebrated Labour Day at Weipa with a traditional road march, the first in 10 years!

Industrial agreements, however, must be well understood. Which leads me to QNMU education and training courses. These courses were fundamental to my growth as a union activist and in becoming a better-informed nurse.

Working collectively in our union helps achieve outcomes at work, builds networks and community support and can also be a whole lot of fun. I encourage you to get involved in our union. If you donâ&#x20AC;&#x2122;t have a Branch, consider contacting your Organiser to discuss options for forming one.

Labour Day celebrations in Weipa.

Winter 2019 | 10 |

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Priority-setting in wound care WHAT ARE YOUR CHALLENGES IN CLINICAL PRACTICE? PROFESSOR B.M. GILLESPIE, DR R. WALKER, DR F. LIN & PROFESSOR W. CHABOYER ON BEHALF OF THE WOUND PRIORITIES GROUP

p to 9.5% of surgical procedures result in wound complications, including surgical site infection (SSI) (ECDC 2013). Yet, SSI is one of the most preventable hospital acquired infections (Haley et al, 2011).

In these two-hour workshops, we used a modified nominal group technique (Potter et al, 2004) to build consensus in ranking the top five priority questions identified by workshop participants.

Acute wounds, including simple and complex wounds are the most common wounds seen in hospitals, but there is still a lot of variation in practice (Gillespie et al, 2014). A lack of robust evidence, alongside a plethora of product choice, fragmented care and complex patient needs, creates practice conundrums for bedside clinicians (Gillespie et al, 2012).

Priority rankings were based on four round-robins. Participants were asked to publicly rank their ‘number one’ and ‘number two’ questions in each of five groups of questions (there were five questions per group, with a total 25 questions).

Therefore it is important we establish what priorities in wound management matter to health professionals.

Consensus-building workshops In partnership with senior clinical colleagues at the Gold Coast University and Princess Alexandra Hospitals, our research group conducted two interactive workshops with health professionals from nursing, allied health and medicine. The purpose of these workshops was to rank health professionals’ priorities and/or challenges in wound management.

Participants were also encouraged to state why they chose that particular question in each group. Preliminary analysis of wound care priorities suggests that patient education, decision-making and wound care documentation were ranked highly among workshop participants. Results of the final rankings were fed back to participants prior to the end of the workshops. We are currently writing up the results of these workshops for wider dissemination.

Next steps The next step in this research program is to interview health consumers and their families about

what matters to them in relation to priorities in wound management. Understanding priorities helps health managers and researchers systematically identify important target areas of research and implementation. For more information about this research, contact Professor Brigid Gillespie at b.gillespie@griffith.edu.au

REFLECTIVE QUESTIONS 1. How do you assess the quality of the information on wound care? 2. Are there any wound care practices or treatments that you think are ineffective? 3. In what ways can nurses get patients more involved in managing their wounds? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

European Centre for Disease Prevention and Control, (2013). Surveillance of surgical site infections in Europe 2010–2011 Stockholm: ECDC. Gillespie BM, Chaboyer W, Niewenhoven P, & Rickard, C. (2012). Drivers and Barriers of Surgical Wound Management in a Large Healthcare Organisation: Results of an Environmental Scan. Journal of Wound Care Practice and Research, 20(2), 90-102. Gillespie, BM, Chaboyer W, St John W, Nieuwenhoven P, et al. (2014). Health professionals’ decision-making in wound management: A grounded theory. Journal of Advanced Nursing, 2014. 71: p. 1238-1248. Haley R, Culver Allegranzi B, Bagheri Nejad S, et al. (2011). Burden of endemic health-care associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377:228-41.

First workshop research team members (L to R): Wendy Chaboyer, Claudia Bull, Frances Lin, Paul Nieuwenhoven, Brigid Gillespie & Rachel Walker.

Potter, M., S. Gordon, and P. Hamer. (2004). The nominal group technique: A useful consensus methodology in physiotherapy research. NZ Journal Physio, 32: p. 125-30.

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Restraint in aged care

Changes from 1 July 2019

MONASH University study published in 2017 revealed that several deaths in residential aged care were avoidable because they were caused by the resident being subject to restraint. Since then, a number of reports to government have recommended the use of restraint be intensely regulated. The Department of Health recently held meetings to discuss issues around restraint and to develop protocols and precautions to regulate the use of restraint in aged care. The QNMU, other state Branches and the ANMF Federal Office were represented at those meetings.

prescribe medication that will form the basis of chemical restraint.

trained in the care of residents with dementia.

These new changes come into effect on 1 July 2019.

We remind all nurses working in aged care that, when it comes to your manager’s decisions about staffing and skill mix, the NMBA Code of Conduct requires Registered Nurses and Enrolled Nurses to “document and report concerns if they believe the practice environment is compromising the health and safety of people receiving care”.

The legislation will place conditions upon when physical or chemical restraint can be used, who has the authority to initiate restraint and the procedures to be followed once a form of restraint has been engaged. Residential aged care nurses will be required to document (within the consumer’s care plan) the behaviours that are relevant to the need for the restraint, the alternatives to restraint that have been used, and reasons the restraint is necessary.

The main points we made focused on the lack of clear direction on the criteria or circumstances where the use of restraint might be appropriate, the process members should follow once restraint had been engaged, and the lack of protections in the law for members who were directed to restrain residents.

Members should become familiar with these conditions and request their employers provide training, so they do not make themselves liable to allegations of unlawful application of restraint, or neglect to ensure the required documentation and procedures are followed when a resident is restrained.

This resulted in standards, criteria and protocols being introduced into the Quality of Care Principles 2014 (the Principles), the legislation that governs the care provided in residential aged care.

Members should also remain vigilant regarding their workloads and report any instances that result in residents being restrained because the facility is understaffed. It is of the utmost importance that restraint is used as a last resort, due solely to resident behaviour that places them or others at high risk of injury.

The Principles now stipulate the conditions that must be met before restraint can be used, including assessment by an approved health practitioner such as a Registered Nurse (physical restraint) or assessment by a medical practitioner or nurse practitioner who intends to

Restraint must not be used because there is insufficient staff to monitor residents and engage appropriate nursing surveillance, or because not enough staff are

This can be done through workload reporting forms and is a mandatory obligation placed upon all nurses and failure to comply with the Code could amount to unprofessional conduct.

REFLECTIVE QUESTIONS Consider your workplace in the recent past. 1. Would it have been compliant with this legislation? What, if anything, might need to change to ensure your facility’s practices are consistent with legislation after 1 July? 2. Do you foresee problems with applying the legislation’s conditions? Whose responsibility is it to ensure compliance? 3. What is your role? What role might your professional judgement play, if at all? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Positive Practice Environments GETTING THE BALANCE RIGHT

URSES and midwives are in the midst of a global health workforce crisis. The International Council of Nurses (ICN) – a federation representing more than 20 million nurses worldwide – recognises the reasons for the global health workforce crisis are varied and complex. The ongoing under-investment in the health sector, coupled with difficult employment conditions and poor policies and support – such as discrimination, physical and psychological violence, unfavourable work life balance, unreasonable workloads, and limited career development opportunities – have resulted in working conditions deteriorating in many countries. There is clear and consistent evidence globally that this has a negative effect on the recruitment and retention of health professionals, the productivity and performance of health facilities, and ultimately on the safety and quality of patient care and outcomes. The ICN describes the characteristics of unhealthy professional practice environments as higher levels of stress from heavy workloads, lengthy hours, low professional status, challenging relations in the workplace, and difficulty conducting professional roles.

International research conducted by Aitken, Sloane and Clarke et al (2011) associated nursing and midwifery shortages and ongoing attrition with an unhealthy negative professional practice environment. In Australia we are not immune to this global health workforce crisis. Health Workforce Australia has predicted there will be a potential shortage of up to 110,000 nurses by 2025. Nurses and midwives need to work collectively and collaboratively to get the health workforce balance right.

the motivation, productivity and performance of individuals and organisations”. PPE is characterised by the ICN as innovative policy frameworks focused on recruitment and retention, strategies for continuing education and upgrading, adequate employee compensation, recognition programs, enough equipment and supplies, and a safe working environment. A 2014 study by Twigg and McCullough reviewed strategies to create and enhance PPE in order to properly retain nurses and midwives.

If we as health professionals are to thrive as individuals then we must adequately grow and sustain appropriately qualified nursing and midwifery workforces to meet the health service demands both now and into the future.

Critical thinking and autonomous practice and decision making were identified as elements that improve PPEs for nurses and midwives and, ultimately, quality of care for patients.

To do this, we need to understand what a positive practice environment (PPE) looks like. Then we can look at how to move from an unhealthy negative practice environment to a healthy and sustainable PPE.

The QNMU recognises that developing, promoting and maintaining a PPE is multifactorial, and occurs at many levels of a health care organisation, supported by governments, employers, regulatory bodies and the union.

What makes a Positive Practice Environment? The ICN defines a PPE as “settings that support excellence and decent work". In particular, they strive to ensure the health, safety and personal wellbeing of staff, support quality patient care and improve

QNMU working towards PPE

We’re actively working with members to get the balance right so we can meet current and future workforce demands. Our work is far-reaching and includes embedding continuing nursing and midwifery workforce enhancement into the Queensland

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Health EB10 agreement (including innovations and professional engagement), and modelling transformational activism through branch professional evenings. The QNMU Professional Practice Advocate Program is also a good example of how we are striving to establish PPEs for members – the program engages early career nurses and midwives and has demonstrated increased confidence in participants’ abilities to value and articulate their professional judgment, and an increased desire for professional reflections, connections and networking. The QNMU will soon deliver one-day seminars titled ‘Creating a Positive Practice Environment’. Keep an eye out on our website for more details soon.

References:

Aiken, L., Sloane, D., Clarke, S., et al. Importance of work environments on hospital outcomes in nine countries. International Journal for Quality in Health Care 2011; 23: 357-364. Health Workforce Australia. Health Workforce 2025 Doctors, Nurses and Midwives. Retrieved https://submissions.education.gov.au/forms/ archive/2015_16_sol/documents/Attachments/ Australian%20Nursing%20and%20Midwifery%20 Accreditation%20Council%20(ANMAC).pdf International Council of Nurses. (2007). Positive Practice Environments. Retrieved from http:// www.wpro.who.int/topics/nursing/ichrn_fact_ sheet.pdf Twigg, D. & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51, 85-92.

REFLECTIVE QUESTIONS The ICN defines a PPE as settings that strive to ensure the health, safety and personal wellbeing of staff, support quality patient care and improve the motivation, productivity and performance of individuals and organisations. 1. How do you think your workplace meets these goals? 2. Where is it strongest, what are the areas that need improvement, and how might these be improved? 3. How might you get involved in being part of developing a PPE in your workplace? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Sexual harassment or bullying? T

HE AUSTRALIAN Council of Trade Unions recently made a submission to the Human Rights Commission, which is conducting a national inquiry into sexual harassment in the workplace. The submission highlighted that there is no agreed position or uniform definition throughout Australia as to what constitutes or defines sexual harassment. The submission did, however, note that current regulatory regimes dealing with workplace bullying do not adequately address sexual harassment in the workplace. So what is the difference between sexual harassment and bullying?

Sexual harassment Queensland’s Anti Discrimination Commission defines sexual harassment as “any form of unwanted, unwelcome or uninvited sexual behaviour which is or might be offensive, humiliating or intimidating. It can include an unwelcome sexual advance, unwelcome request for sexual favours or other unwelcome conduct of a sexual nature”. Sexual harassment can take various forms, can be obvious or indirect, physical or verbal. It also includes behaviour and practices that create a sexually hostile or intimidating environment. Examples of sexual harassment include: ■■ unwelcome physical touching ■■ sexual or suggestive comments, jokes or innuendo ■■ unwelcome requests for sex ■■ intrusive questions about a person’s private life ■■ the display of sexually explicit material such as posters or pictures

■■ unwanted invitations ■■ staring or leering ■■ sex-based insults or taunts ■■ offensive communications, including telephone calls, letters, faxes, email and computer screen savers. Sexual harassment does not have to be repeated or continuous to be against the law – some actions or remarks may be so offensive they constitute sexual harassment in themselves, even if they are not repeated. Other isolated incidents such as an unwanted invitation or compliment may not be harassment if they are not repeated. Some forms of sexual harassment, including assault, physical molestation, stalking, sexual assault and indecent exposure, are also criminal offences. You can read more about sexual harassment, including case studies, on the Anti Discrimination Commission website at https://bit.ly/2XcE8Dy

Workplace bullying Workplace Health and Safety Queensland defines workplace bullying as “repeated and unreasonable behaviour directed towards a worker or a group of workers, that creates a risk to health and safety”.

humiliating, intimidating or threatening. Examples of bullying behaviour may include: ■■ abusive, insulting or offensive language or comments ■■ unjustified criticism or complaints ■■ deliberately excluding someone from workplace activities ■■ withholding information that is vital for effective work performance ■■ setting unreasonable timelines or constantly changing deadlines ■■ setting tasks that are unreasonably below or beyond a person’s skill level ■■ denying access to information, supervision, consultation or resources to the detriment of the worker ■■ spreading misinformation or malicious rumours ■■ changing work arrangements such as rosters and leave to deliberately inconvenience a particular worker or workers. You can read more about workplace bullying on the Workplace Health and Safety Queensland website at https://bit.ly/2YW9QXm

What you need to know

‘Repeated behaviour’ refers to the persistent nature of the behaviour and can involve a range of behaviours over time.

Clearly these types of behaviours are unacceptable and perpetrators can be subject to sanctions by their employer, the Anti Discrimination Commission, and either the Queensland Industrial Relations Commission or the Fair Work Commission.

‘Unreasonable behaviour’ means behaviour that a reasonable person, having considered the circumstances, would see as unreasonable, including behaviour that is victimising,

Members should be mindful that an employer or manager does have the right to engage in reasonable action, but this should also be conducted in a reasonable way.

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For example, an employer is obliged to investigate a complaint made about an employee and may ask you to attend a meeting â&#x20AC;&#x201C; this is reasonable management action. However, the employee who has had the complaint made against them must also have the opportunity to fairly respond to the complaint. Nurses or midwives should also be mindful that bullying and harassment is recognised in the NMBA Code of Conduct as behavior that is contrary to our professions. The QNMU advises members to document circumstances they believe could be bullying or harassment and notify their employer. If you do not get a satisfactory response to your complaints, you should contact the QNMU for assistance.

REFLECTIVE QUESTIONS 1. In what circumstance would a notification be made to the NMBA around bullying and harassment? 2. What policies does your employer have in place to manage psychological risk from bullying? 3. If you observe someone being sexually harassed or bullied what are your obligations as a nurse or midwife? Donâ&#x20AC;&#x2122;t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

Think you understand workplace sexual harassment or bullying? Take the quiz on the next page.

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Take the quiz: Understanding unlawful or inappropriate workplace behaviour BY WORKPLACE CONFLICT RESOLUTION

As outlined earlier, it can be difficult to differentiate between what constitutes bullying or sexual harassment. This quiz presents a number of scenarios that could occur in a workplace.

Are the following statements true of false? 1

Workplace legislation does not apply to any work-related events that occur after work hours and away from the work premises.

T/F

Tom made a false complaint about a colleague to his manager. Because Tom apologised he can’t be disciplined for his behaviour.

T/F

Sexual harassment only occurs when a male touches a female.

T/F

Bullying can involve one incident so long as it is a serious incident.

T/F

A worker can be personally liable for costs relating to damages from sexually harassing a work colleague.

T/F

It’s harmless fun to make a joke (in an Indian accent) about the smell of Randeshi’s Indian curry every lunch time.

T/F

Geoff doesn’t have a girlfriend. Every Monday Liam and Sam ask Geoff if he ‘picked up’ a girlfriend on the weekend. Geoff doesn’t seem to mind so there are no issues.

T/F

Three workers, on a daily basis, talk about Afzan’s poor work performance and how it impacts on their work. Afzan works in the same area and because they are careful to watch out for her and stop the bullying when she comes near them there are no issues.

T/F

It is appropriate that all emails and conversations at work containing any sexual references are banned.

T/F

10 Ben holds a very senior and high-pressure

T/F

position and gets stressed easily. He yells a lot but – he’s just letting off steam and it’s not personal – so that’s OK.

Everyone knows that Nick has a long-term relationship with a male partner. Nick applies for a team leader position and in the interview is asked what his male partner thinks about the extra hours of work required. Nick doesn’t get the new role. Nick has a discrimination case.

12 Mei forgets to invite Jane to a meeting.

T/F

13 Every time Troy tries to offer his opinion

T/F

14 Anne believes she has been sexually

T/F

Jane is offended. This is bullying by Mei. in a meeting, Li Li interrupts him with her ideas. Troy is feeling very frustrated and belittled. This is victimisation by Li Li. harassed by Bill. She hasn’t put in a complaint - she’s trying to talk through this with her colleagues to make sure she’s not overreacting. A number of staff are now avoiding Bill and he’s hearing rumours that Anne has complained about him. Bill can’t do anything but wait to see if Anne does put in a complaint. Discrimination laws in Australia only address discrimination against age, race and gender.

16 Uday is Kon Lee’s immediate supervisor.

T/F

At least once per week Uday will make a comment to Kon Lee about her work. Kon Lee is embarrassed and humiliated. This is bullying by Uday.

Answers: 1. False 2. False 3. False 4. False 5. True 6. False 7. False 8. False 9. True 10. False 11. True 12. False 13. False 15. False 16. False 17. False

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The challenges of preventing in-hospital falls for older people with cognitive impairment BY LAURIE GREALISH RN PHD, MENZIES HEALTH INSTITUTE QUEENSLAND, GRIFFITH UNIVERSITY & GOLD COAST HEALTH

LDER people occupy 48% of hospital bed days (AIHW, 2017) with around 30% having dementia and/or delirium (Travers et al., 2013). Furthermore those aged 65 years and over are at higher risk of developing delirium. Research conducted in Queensland suggests that the application of falls prevention strategies to older people with confusion or cognitive impairment is challenging for nurses. Direct observation or frequent monitoring is the most common approach, often moving the person to the room closest to the nursing desk, ordering a special nurse for continuous observation, and/or using motion sensors (Grealish et al., 2019). However, each of these strategies had limitations. Being close to the desk means continuous exposure to noise and activity, which may be frightening for an older person, contributing to further confusion. Special nurses ordered are often Assistants in Nursing, with minimal nursing training, who may try to keep the person in bed to avoid falls, subsequently reducing muscle tone and balance. Motion sensors are triggered with movement and can signal nurses to attend the patient but sometimes the fall occurs before nurses arrive. There is a paradox in nursesâ&#x20AC;&#x2122; accounts of falls. Several nurses share stories of having instructed people with confusion to use the call bell, then reported genuine surprise when the person did not call for assistance. This

reflects a lack of knowledge about what confusion is (Grealish et al., 2019).

which does not directly address falls prevention.

A deeper understanding about confusion that is associated with delirium and dementia is critical.

We suggest that these new guidelines must be critically applied, rather than simply followed, considering the person and the context, in order to prevent falls.

In a further study, we found pain assessment in people with cognitive impairment was conducted only around a third of the times it was expected (Grealish et al., in press). A commonly reported fall, the impulse related fall, characterised by quick and seemingly unplanned movements, can be associated with irritation and discomfort. We recommend using pain assessment instruments specific to people with cognitive impairment, such as the PAIN-AD or Abbey Pain Scale, to titrate analgesics and help people feel more comfortable and settled as a fall prevention strategy. We also noted that assessing and acting to reduce constipation was missed about one-third of the time (Grealish et al., in press), indicating that bowel management could also be improved. Careful titration of aperients is required to achieve regularity without painful symptoms of cramping and bloating, which can create urgency and seemingly impulsive movement. Promoting mobility could also be improved, and this was observed approximately two-thirds of the times it was appropriate (Grealish et al., in press).

At Gold Coast Health, nurses are practising how to critically apply guidelines in simulated learning classes, using actors.

REFLECTIVE QUESTIONS 1. Do you recall caring for a person with dementia. How did you manage pain, constipation and mobility? 2. What could you do differently next time? Donâ&#x20AC;&#x2122;t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Australian Institute of Health and Welfare, 2017. Admitted patient care 2015-16: Australian Hospital statistics. Health services series no. 75. Cat. No. HSE 185. Australian Commission for Safety and Quality in Health Care, 2016. Delirium Clinical Care Standard. Sydney: ACSQHC. Grealish, L., Chaboyer, W., Darch, J., Real, B., Phelan, M., Soltau, D., Lunn, M., Brandis, S., Todd, J., Cooke, M., 2019. Caring for the older person with cognitive impairment in hospital: qualitative analysis of nursing personnel reflections on fall events. Journal of Clinical Nursing 28(7-8), 13461353.doi:10.1111/jocn.14724

Promoting mobility with regular walks during the day contributes to the maintenance of muscle tone and balance which may prevent falls, even when movement was unexpected.

Grealish, L., Real, B., Todd, J., Darch, J., Soltau, D., Phelan, M., Lunn, M., Brandis, S., Cooke, M., Chaboyer, W. Implementing evidence-based guidelines for falls prevention: observations of nursing activities during the care of older people with cognitive impairment. Worldviews on Evidence-based Nursing. Accepted for publication, 30 September 2018.

In 2016, the Australian Commission for Safety and Quality in Health Care released Delirium Care Guidelines,

Travers, C., Byrne, G., Pachana, N., Klein, K. & Gray, L., 2013. Prospective observational study of dementia and delirium in the acute hospital setting. Internal Medicine Journal 43(3), 262-269.

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Therapeutic nursing observation in psychiatric care

ATIENT observation is central to nursing care. It informs us about the patient’s current presentation and, most importantly, it informs clinical decision-making. A psychiatric inpatient unit will be caring for patients with a wide range of mental health conditions. Some will have serious, florid psychosis upon admission, others will be in assessment or recovery phases, and some will be preparing for discharge. Each will require different levels of observation. But nursing observation in psychiatric care is much more than quietly watching the patient’s behaviour and activity. It requires active engagement to gain an understanding of the schema, thought processes, and any pathological disorders of thought that govern or misdirect the patient’s thinking. This engagement process is also essential for the nurse to demonstrate empathy and attempt to establish rapport with the patient, which can in turn enable progressively deeper engagement and non-threatening enquiry. However, all too often we see some elements of nursing observation in psychiatric units reduced to a risk assessment process where the patient is ticked on a list as being

physically present and safe with the unit. Members often advise the QNMU that this practice is often employed by psychiatric units, where patients considered to be ‘at risk’ are checked off every 15 minutes.

It must be a process of therapeutic engagement by qualified, experienced and skilled nurses who can engage the patient and assess their needs in a complex, critical and sometimes volatile situation.

Of course, many nurses who have attended patient suicides will attest that it can take as little as three minutes for someone to die, or suffer irreversible brain damage, from selfharm.

Duty of care

Therefore, the practice of nursing observation in psychiatric care must be much more than simply checking for the presence, and confirming the safety, of each patient. This is especially important overnight. The clinical recommendation is that the frequency of night shift observations be congruent with daytime observations, unless otherwise decided and documented. The QNMU is also aware that when a patient at high risk is ‘specialled’ – meaning they are assigned a staff member that always remains by their side – that person is often an Assistant in Nursing with no qualifications or competence in psychiatric nursing assessment. Observation in this context is much more than remaining by the patient’s side to prevent them from selfharming.

Every nurse has a professional and legal duty of care to their patients. Once the duty of care is enlivened, the nurse must engage a standard of care that is consistent with recognised professional standards and, in Queensland, compliant with provisions of the Civil Liability Act 2003 (Qld). This Act states that a professional is not in breach of their duty if the standard of care they provide is widely accepted as competent professional practice by a significant number of respected practitioners in the field. This is consistent with the Nursing and Midwifery Board of Australia (NMBA) codes and guidelines, which require all nurses to “practise in accordance with the standards of the profession”. Therefore, any form of nursing care must be provided according to accepted professional standards, otherwise the individual nurse is not only in breach of the NMBA codes and guidelines, but they might also be subject to a negligence action in court.

CPD Whatever the area of nursing practice, the QNMU recommends members always investigate the relevant standards in that area and comply with them. If employers or managers create barriers to this, members should document and report that direction in a workload reporting form (also a mandatory professional requirement) and seek the QNMU’s assistance.

Purpose The purpose of nursing observation in psychiatric care must be to gain insights into the patient’s illness or disorder to inform clinical decisionmaking and assist the patient onto the path to recovery. To gain insight, observation must include human contact with the patient, talking to them, listening and paraphrasing to ensure accurate understanding of their issues, making professional enquiry that will elicit their form of thought, whether that be disordered or not, and thereby assessing their current mental state.

This is essential regardless of whether they are a voluntary or involuntary patient, even if they have a complete lack of insight of their reasons for admission. That too will provide critical information for the team’s decision-making about treatment and levels of observation.

Passive observation may elicit that a person could be experiencing auditory or visual hallucinations, or perhaps the presence of psychomotor retardation. But only skilled engagement through conversation (if possible) will enable the nurse to determine exactly what’s going on in the patient’s mind.

Once engagement with the patient has commenced, it must be consistent and thorough.

Therapeutic engagement is a skill that must be employed, especially with psychotic patients, because only this engagement will enable the nurse to determine if there is a disorder of thought present (e.g. delusions, hallucinations), or if the patient is suffering from a formal thought disorder (e.g. derailment, tangentiality) and whether the disorder is positive (e.g. flight of ideas) or negative (e.g. thought blocking).

Even if the patient refuses to engage therapeutically, respectfully repeat the offer each time you speak, emphasising you are ready to help them when they feel comfortable to do so. This will help to develop the patient’s trust and foster a belief that you are there for them, and not because of them.

Engagement Simple observation of a person’s behaviour can inform the nurse about the potential for abnormal thinking, but only engagement can determine the depth, nature and degree of the pathology at hand.

The purpose of nursing observation in psychiatric care must be to gain insights into the patient’s illness or disorder to inform clinical decisionmaking and assist the patient onto the path to recovery. 52

We must not forget that most of our patients do not live in isolation. It is important to collaborate not only with the patient, but also their carers, especially during initial assessment and discharge planning. One aspect of engaging observation that is often overlooked is discussing

CPD with the patient the reasons they are being observed and how the observations will occur. This ensures the patient is fully informed about their observation status and knows what to expect and why.

Levels of observation QNMU staff are often asked questions about the levels of psychiatric observation and the roles of various staff members in that process. There are four accepted levels of observation in psychiatric care.

Constant (close): in this level, the patient is under one-toone nursing observation and must always be within an arm’s length of an experienced nurse.

Constant (visual): the patient is still under one-to-one nursing observation by an experienced nurse, with the patient always within the nurse’s sight/vision.

Intermittent: this is where the nurse engages with the patient at a frequency that is determined by their identified risk factors and current mental state.

Negotiated: for patients without any risk factors warranting one of the above levels of observation, the frequency of observation and engagement is negotiated with the patient.

It cannot be emphasised enough that when a mentally ill patient requires observation in the ‘constant’ level, they will be in an acute and unstable phase of their condition and at high risk of injury to themselves or others. Whenever a patient requires constant observation, that observation must be performed by a nurse highly skilled in caring for the mentally ill, preferably with qualifications in mental health nursing. Constant observation must never be performed by an Assistant in Nursing or unregulated health care worker. They will not be able to assess the patient’s mental state and will not

identify physical or verbal cues that may indicate imminent risk. Such inappropriate practices put both the patient and staff member at risk.

Workloads Of course, appropriate observation and engagement takes a lot of nursing time. In Queensland’s public sector, the Business Planning Framework (BPF) has a mental health addendum that applies to every mental health unit in the state. The service profiles developed under the BPF must ensure that observation and engagement is included as a critical factor in productive hours. The BPF mandates that the nurses working on mental health units and providing the care are consulted when developing the BPF and that their professional judgment is considered when it comes to staffing and skill mix. This is essential because acuity in mental health units is always dynamic and can change from day to day, or even from shift to shift. Mental health members in the private sector must also remain aware of their workloads and be familiar with the provisions within their respective enterprise agreements that assist them to manage their workloads, which includes therapeutic observation. QNMU workload reporting forms in both the public and private sectors enable nurses to report and manage inappropriate workloads. They also ensure nurses are complying with their mandatory professional conduct obligation to the NMBA to “document and report concerns if they believe the practice environment is compromising the health and safety of people receiving care”. If you believe your workloads are compromising the health of your patients, you must document and report it. For QNMU workload resources visit www.qnmu.org.au/workloads

REFLECTIVE QUESTIONS 1. Have you reviewed and critically analysed your facility’s policies observation levels and specialling of mental health patients? You should do so and if they are not consistent with professional nursing practice in mental health, raise any areas of divergence with management. 2. The Australian Commission on Safety and Quality in Health Care has published national standards for mental health services. They have also published documents on medication safety in mental health. Have you read them? If not, you should as these constitute professional standards in mental health care. Go to www.safetyandquality. gov.au The time you spend undertaking review and analysis of the above policies and documents also contributes to your CPD hours, so be sure to enter it into your CPD record. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Nursing Observation Guidelines, Department of Health, Victoria, 2013

CPD

Swapping your shift? It’s a win-win for hospitals BY PAUL LOCKWOOD, CODELLO

USTRALIAN nurses and midwives often feel they have no option but to take unplanned leave. Why? Because the current processes in place for swapping shifts are all too hard. Last year nurses and midwives across Australia were asked to complete a survey on how they balanced their shift work requirements and their personal lives. A total of 755 nurses and midwives responded, including hundreds of QNMU members through the QNMU's monthly qnews email. The major research findings centred around how necessary shift swapping is to nurses and midwives, what happens when swaps can’t be made, and the reasons for this breakdown.

How much shift swapping is needed? There are a substantial number of shifts that need to be swapped every year. Ninety-eight per cent of responders said they needed to swap at least one shift a year, with 92% needing to swap at least four shifts per year. Forty-two per cent said they needed to swap at least one shift a month. On average, the survey found nurses and midwives needed 8.11 shift swaps a year to support their work/ life balance.

What happens when a swap isn’t made? Seventy-one per cent of responders said they had to call in sick at least once a year to manage their personal commitments. On average, nurses and midwives take 2.96 sick days a year for this reason. For a large-sized hospital of 5,000 nurses this is equal to 14,800 sick days a year.

Isolating the data of just those who said they needed to use sick leave for work/life balance, the average need increased to 4.17 days a year. This practice takes its toll on nurses and midwives, as almost all felt they had no other option but to take unplanned leave and reported feeling ‘bad’ or ‘very bad’ about it. Many shared feelings of guilt for letting their team down.

What’s stopping swaps being made?

About this study The results from this study are being used to inform potential solutions to issues associated with nurses and midwives’ work/life balance. Already, the researchers are in discussions with Victorian metropolitan and regional hospitals to run pilot studies to determine how to improve the lives of nurses and midwives, as well as their patient experiences. To stay up-to-date with this research, visit fb.com/CodelloSwap or linkedin.com/company/ codello You can also see the full study outcomes by visiting https://bit.ly/2IZGvrg

Seventy-eight per cent of responders said the main reason for this unplanned leave was they couldn’t find a colleague to replace them. Almost none said they just wanted to use their remaining sick leave. Results also found Nurse Unit Managers were very positive towards shift swapping. However, nurses and midwives generally thought their NUMs had a more negative perception about shift swapping. Finally, the survey found there has been little to no technological advancements in helping nurses and midwives swap shifts. Ninety-two per cent of responders said they must manually find a colleague to swap a shift. In only 1% of responses was there a software initiative in place to facilitate this process.

So, what needs to change? By providing better ways for nurses and midwives to swap shifts, win-win outcomes can be achieved. Nurses and midwives can regain the work/life balance that shift-working interferes with, while hospitals can reduce their unproductive labour costs, as well as cultivating a far happier and more engaged workforce.

Codello Research Team (L to R): Paul Lockwood, Lisa Stephenson, Jaxon Hickey.

REFLECTIVE QUESTIONS 1. How conscious is your hospital’s management of the importance of supporting shift swapping between nurses and midwives? 2. What processes are in place to help you swap a shift with a colleague? 3. Are these processes supportive or do they pose barriers? 4. What can be done to overcome these barriers? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Professionalism is the key to a healthy workplace

Sandra Eales QNMU Assistant Secretary

ROFESSIONALISM. It’s how we maintain standards and ensure a healthy work environment. We need to be conscious of the link between environment and individual practice as it impacts patient outcomes. In a chaotic world of constant change with restructures, imposed technology and disrupted work processes driven by a system manager in search of economy, efficiency or “risk management” from their perspective, it is a challenge for individual nurses and midwives to maintain professionalism. In the face of critical and sometimes unachievable workloads and an organisational structure and culture which does not hear us, it is a challenge to our competence and confidence to assert professional judgement. Characteristics of a profession mean that individuals within it employ intellectual skill (specific knowledge and critical thinking), accept individual responsibility and are connected to a well-developed group consciousness (Flexner 1915 cited in RNOA). In order to protect the integrity of the professions as well as the individual integrity of the nurse or midwife we must have a healthy practice environment. In order to maintain a healthy work environment nurses and midwives must focus on the attributes of professionalism. That means: ■■ growing and communicating our body of knowledge ■■ maintaining a spirit of inquiry ■■ accountability ■■ advocacy ■■ having autonomy ■■ practicing collegiality and collaboration

■■ being innovative and visionary and ■■ being strongly grounded in ethics and values of our professions. (RNOA 2007, Wynd 2003) We must cultivate competence and confidence to be able to assert professional judgement. “Critical thinking in nursing means going beyond obvious findings to make informed judgments, and is considered to be the most distinguishing attribute of the professional nurse. Inexperienced nurses think in terms of steps and procedure while the more experienced nurse thinks more in patterns based on previous experience grounded in knowledge.” (RNOA 2007) Professionalism is a prerequisite to control over practice – to achieve autonomy we must be accountable and self-regulated. The community relies upon the professionalism of nurses and midwives to deliver flexibility and diversity in response to change and community needs and offer access to safe, quality health care. That requires collaboration and collegiality – professional practice should be peer influenced and connected to the wider profession through networks and associations outside the employer. Nurses and midwives maintain their professional integrity through the collective. The commitment that nurses feel towards their patients and residents, and that midwives feel to mothers and babies in their care, should extend to commitment to one another. “Collegiality, such as taking part in professional organisations, mentoring, role modelling, assisting

researchers is an important professional attribute” (Kittrell Chitty 2005 cited in cited in RNOA) Collegial generosity is a habit to be cultivated by all of us to ensure psychologically safe workplaces. Developing professionalism is a life-long learning quest that offers opportunities for personal growth as well as contributing to and strengthening our professional community.

References

Flexner, A. (1915) Is social work a profession? Research on Social Work Practice, 1(26): 901. Kittrell Chitty, K. (2005). Professional Nursing: Concepts and Challenges, 4th edition. St. Louis: Elsevier Saunders Nursing and Midwifery Board of Australia (2016 – 2018) https://www.nursingmidwiferyboard.gov. au/Codes-Guidelines-Statements/Professionalstandards.aspx Registered Nurses’ Association of Ontario (2007). Professionalism in Nursing. Toronto, Canada: Registered Nurses’ Association of Ontario https:// rnao.ca/sites/rnao-ca/files/Professionalism_in_ Nursing.pdf Wynd, C (2003) “Current factors contributing to professionalism in nursing.” Journal of Professional Nursing Vol. 19, Issue 5, pp 251-261

REFLECTIVE QUESTIONS 1. Review your workplace to consider and understand the relationships among the key factors involved in healthy work environments. 2. Self-reflect on your own values, behaviours and relationships. Which professional attributes do you need to develop over the next 12 months? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

Solidarity at 2019 Labour Day

in view

What an amazing show of solidarity at Labour Day marches across Queensland this year! A big thank you to everyone who joined us as we marched to Change the Rules in health and aged care, including calling for ratios across all sectors of health care. More pics in our Labour Day Facebook album.

in view

Nurses and midwives rock! We had a wonderful time celebrating the hard work and contributions of nurses and midwives this International Day of the Midwife (5 May) and International Nurses Day (12 May). Itâ&#x20AC;&#x2122;s great to see our members being appreciated with our little thank you postcards.

Growing our professions Our recent professional seminars for our Gold Coast and The Prince Charles Hospital branches were a huge hit! It was a fantastic opportunity for nurses and midwives to network and discuss key issues affecting our professions, as well as hear from some wonderful guest speakers.

BOOK PRIZE ER WINN

in view

TPCH Seminar

It’s a good read… We reckon QNMU member Laura’s two year-old son Mac has really great taste in reading material… perhaps a nurse or midwife in the making?

Excellence in nursing recognised Congrats to QNMU member Kate Hahn who received the Amy Enderlin Excellence Award for a Registered Nurse at the recent Gold Coast University Hospital Nursing Excellence Awards. Our GCUH and GCUH mental health branches were proud to supply the celebratory cake and delegates were also in attendance. Gold Coast professional night

Pictured: Kate cutting the cake with QNMU Organiser Carol Lewis and Mr Enderlin – husband of Amy Enderlin who the award is named after.

incoming On QH's EB10 second pay rise kicking in JT Thank you QNMU for working for better pay and conditions for their members and non-members as well! Be proud to be a unionist and work with your union to change the rules. Like Âˇ Reply

DH Thank you QNMU your dedication to us is greatly appreciatedđ&#x;&#x2DC;&#x160; Like Âˇ Reply

NBL Great news, every cents helps very much. Great job QNMU!

đ&#x;&#x17D;&#x2030;đ&#x;?ž

Like Âˇ Reply

AL What a time to be a nurse, and to become a RN. We deserve it Like Âˇ Reply

NS Thank you QNMU for doing so much for us! Like Âˇ Reply

LL Oh yeah! Every little bit helps. Like Âˇ Reply

COMMENT OF THE MONTH A thank you to nurses: We were fortunate to have some incredible paediatric nurses in our then 4 year-oldâ&#x20AC;&#x2122;s journey through sepsis. Two in particular just shone with the light of a thousand suns and our little girlâ&#x20AC;&#x2122;s hospital experience was more positive than we could ever have imagined. Theyâ&#x20AC;&#x2122;re never there when we go back to say thanks, but hopefully they at least get the lollies we take! KA

JL It will help me pay for school fees. đ&#x;&#x2DC;&#x160; Like Âˇ Reply

On a new housing trial where students live in aged care homes LS What a great initiative! They do this is some European countries quite successfully tooâ&#x20AC;Ś I hope itâ&#x20AC;&#x2122;s a resounding success! Like Âˇ Reply

LMR This has been done in the Netherlands some years back. By all accounts, itâ&#x20AC;&#x2122;s been a smashing success! Like Âˇ Reply

ALB At least someone has come up with an idea to improve aged care. I hope it is of benefit to all involved. Like Âˇ Reply

LB Great to see this replicated in Australia. Like Âˇ Reply

On why we deserve our penalty rates HW I believe nurses deserve their penalty rates for all shifts. They have worked long and hard to achieve them so I now ask those politicians who would remove them to do so at their own risk. Like Âˇ Reply

DM We have worked for years to gain a decent level of pay and penalties for the unsociable hours that have to be worked as nurses. We cannot afford to lose our conditions now. Like Âˇ Reply

JS Absolutely vital that penalty rates are maintained for nurses and all emergency services. Like Âˇ Reply

GT I have been working for 16 years as a permanent Assistant-in-Nursing and could not survive if they take our penalty rates. I would have to find another job or leave the nursing industry and many people would follow. Like Âˇ Reply

LB Solidarity from across the miles. Nurses in the UK have also had to fight to keep enhanced payments for unsocial hours. Good luck. Like Âˇ Reply

On the 2019 Labour Day march MR What a wonderful turnout, wish I could have been there đ&#x;&#x2DC;&#x20AC; Like Âˇ Reply

PM I am in spirit! Wore my Ratios T-shirt today for support... Like Âˇ Reply

LH Glorious weather for Labour Day â&#x153;&#x160;đ&#x;?ź Like Âˇ Reply

TC Undoubtedly my favourite day of the year.

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

Like Âˇ Reply

MA You nurses are my angels. Like Âˇ Reply

See pages 56-57 to see Labour Day in pics

/qnmuofficial

incoming If you could change one rule at work, what would it be?

Linda Byrne RN (SCUH)

I would see nurse-to-patient ratios installed everywhere - from rehab to post op - because ratios mean better outcomes for everyone. They would allow nurses to provide the kind of care they truly want to give.

WIN

Salome Fox PC (Agency)

I would love to see ratios put in place because everywhere I work there are so many patients and not enough nurses to ensure the best outcomes for patients. Ratios would also ensure nurses are safe at work and nurses deserve to feel protected and supported in the workplace.

May Vun,

Mental Health Professional (QH) It would have to be ratios in all sectors - public, private and aged care. Conditions in aged care are horrific because there are no laws and not enough nurses and carers to properly look after the elderly. It is the same everywhere and it’s time the government made ratios law for all patients and residents.

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CALENDAR

June International Council of Nurses (ICN) Congress Beyond Healthcare to Health 27 June - 1 July 2019, Singapore www.icn.ch/events/icn-congress2019-singapore

The Museum of Nursing History Heritage Trail & Devonshire Tea

30 June, The Museum of Nursing History, Building 19, Central Dr, RBWH The Heritage Trail begins and ends at The Museum of Nursing History and visits sites such as the Lady Lamington Nurses' Home and “The Quarries”. Reasonable level of fitness required. Bookings essential. Email: rbhnursesassn@gmail.com or phone: 3636 8702

July NAIDOC Week

Get involved! 7-14 July 2019 ww.naidoc.org.au/

QNMU Annual Conference 17-19 July 2019, Brisbane

Enrolled Nurse Student Study Day Better understand the transition to clinical practice 19 July 2019, Melbourne www.anmfvic.asn.au/events-andconferences/2019/07/19/enrollednurse-student-study-day-2019

Medicinal Cannabis Conference & Masterclass Mental Health, Medicinal Cannabis and Nutritional Medicine 20 July 2019, Melbourne www.globalhealthinitiative.life/ healthcare-practitioner-trainingand-education/

The Museum of Nursing History Heritage Trail & Devonshire Tea

38 July, The Museum of Nursing History, Building 19, Central Dr, RBWH The Heritage Trail begins and ends at The Museum of Nursing History and visits sites such as the Lady Lamington Nurses' Home and “The Quarries”. Reasonable level of fitness required. Please bring a hat, water bottle and wear comfortable walking shoes. Bookings essential. Email: rbhnursesassn@gmail.com or phone: 3636 8702

August QNMU education

QH Rostering – Equity & work life balance 19 August, Brisbane QH – BPF for NUMs & MUMs 20 August, Brisbane Creating a safe workplace (WH&S) 20 August , Brisbane Ethical decision making 21 August, Brisbane No excuse for abuse! 21 August, Brisbane Professional Culpability – Where do I stand? 28 August, Brisbane Being protected at work 28 August, Brisbane Handling grievances in the workplace 29 August, Brisbane Aged Care & Private Hospitals – Knowing your entitlements & how to enforce them 29 August , Brisbane

Being a QNMU Contact in the workplace 30 August, Brisbane Work Matters – How to play to your strengths & manage your weaknesses 30 August, Brisbane (Cost $100) www.qnmu.org.au/education

Australian College of Nursing National Nursing Forum Nursing now - Power of policy 21-23 August 2019, Hobart https://www.acn.edu.au/event/ national-nursing-forum-2019

The Museum of Nursing History Heritage Trail & Devonshire Tea

25 August, The Museum of Nursing History, Building 19, Central Dr, RBWH The Heritage Trail begins and ends at The Museum of Nursing History and visits sites such as the Lady Lamington Nurses' Home and “The Quarries”. Reasonable level of fitness required. Bookings essential. Email: rbhnursesassn@gmail.com or phone: 3636 8702

September Australian College of Nurse Practitioners National Conference

Transforming Healthcare 2-5 September 2019, Melbourne https://www.acnp.org.au/ conference-2019

QNMU education

Handling grievances in the workplace 3 September, Cairns No excuse for abuse! 4 September, Cairns Ethical decision making 5 September, Cairns QH Rostering – Equity & work life balance 10 September, Townsville QH – How to make the BPF work for nurses & midwives 11 September, Townsville Being protected at work 12 September,Townsville QH – How to make the BPF work for nurses & midwives 12 September, Bundaberg Emotional Intelligence 12 September, Brisbane (Cost $100) Ethical decision making 13 September, Bundaberg Think on Your Feet 16-17 September, Brisbane (Cost $495) www.qnmu.org.au/education

QNMU Meeting of Delegates 3 September – Brisbane 5 September – Gold Coast 10 September – Sunshine Coast 11 September – Townsville 12 September - Cairns 17 September – Toowoomba 24 September – Rockhampton 25 September – Mackay 30 September - Bundaberg www.qnmu.org.au/mod

Australian Nurses and Midwives Conference 12-13 September 2019, Melbourne www.anmfvic.asn.au/events-andconferences/2019/09/12/2019australian-nurses-and-midwivesconference

22nd Australian College of Midwives Conference

Power, Passion and Politics 17-19 September 2019, Canberra https://midwives.eventsair.com/ QuickEventWebsitePortal/acm2019-national-conference/nationalconference

International Council of Nurses (ICN) 21st International Conference on Nursing 25-26 September 2019 London United Kingdom www.icn.ch/

The Museum of Nursing History Heritage Trail & Devonshire Tea

29 September, The Museum of Nursing History, Building 19, Central Dr, RBWH. The Heritage Trail begins and ends at The Museum of Nursing History and visits sites such as the Lady Lamington Nurses' Home and “The Quarries”. Reasonable level of fitness required. Bookings essential. Email: rbhnursesassn@gmail.com or phone: 3636 8702

October QNMU education

Knowing your entitlements & understanding the Award! 8-9 October, Brisbane Positive Practice Environment 10 October, Brisbane QH Rostering – Equity & work life balance 15 October, Toowoomba Dealing with difficult behaviour 15 October, Brisbane (Cost $100) QH – BPF for NUMs & MUMs 16 October, Toowoomba Professional Culpability – Where do I stand? 17 October, Toowoomba

Someone should do something about that! 17-18 October, Mackay Workplace Representatives 1 22-24 October, Brisbane Someone should do something about that! 30-31 October, Brisbane QH – BPF for NUMs & MUMs 31 October, Rockhampton www.qnmu.org.au/education

QNMU Meeting of Delegates 1 October - Hervey Bay www.qnmu.org.au/mod

45th International Mental Health Nursing Conference Integrated Care: People, Practice, Policy 8-10 October 2019, Sydney www.acmhn2019.com/

The Australian and New Zealand Society of Occupational Medicine (ANZSOM) Annual Scientific Meeting 2019 27-30 October 2019, Adelaide www.anzsom.org.au/asm-2019

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

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NOV

OCT

SEPT

AUG BRISBANE

Thurs 29

BRISBANE

Tues 20

QH – BPF for NUMs & MUMs

Thurs 12

CAIRNS

Wed 11

Handling grievances in the workplace

CAIRNS

BRISBANE

Wed 6 – Thurs 7 QNMU Branch Development 1

BRISBANE

Thurs 14

Tues 22 – Thurs 24 Workplace Representatives 1

BRISBANE

Fri 1 Ethical decision making

ROCKHAMPTON

Wed 13 No excuse for abuse!

GOLD COAST

Thurs 17 – Fri 18

Someone should do something about that!

MACKAY

Thurs 31 Oct

QH – BPF for NUMs & MUMs

ROCKHAMPTON

Tues 12

Being protected at work

GOLD COAST

SUNSHINE COAST

QH Rostering – Equity & work life balance

Someone should do something about that!

Wed 30 – Thurs 31

TOOWOOMBA

BRISBANE

Wed 28 BRISBANE

Professional Culpability – Where do I stand?

TOOWOOMBA

Professional Culpability – Where do I stand?

Thurs 17

BUNDABERG

Ethical decision making

Fri 13

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

BRISBANE

No excuse for abuse!

Wed 21

AUGUST – NOVEMBER 2019

SUNSHINE COAST

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

Fri 15

BRISBANE

QNMU Branch Development 2

Fri 8

BRISBANE

Health & Safety Representatives training for nurses & midwives

Mon 25 – Fri 29

Enrol now www.qnmu.org.au/education

TOOWOOMBA

QH – BPF for NUMs & MUMs

Wed 16

Tues 15 QH Rostering – Equity & work life balance

Thurs 10 Positive Practice Environment

BUNDABERG

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

Thurs 12

BRISBANE

Being a QNMU Contact in the workplace

Fri 30

BRISBANE

Ethical decision making

Wed 21

TOWNSVILLE

Tues 8 – Wed 9

TOWNSVILLE

Being protected at work

Ethical decision making

Thurs 5

Knowing your entitlements & understanding the Award!

TOWNSVILLE

QH Rostering Equity & work life balance

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

No excuse for abuse!

Tues 3

Tues 10

CAIRNS

Wed 4

BRISBANE

Being protected at work

Aged Care & Private Hospitals – Knowing your entitlements & how to enforce them

Thurs 29 Handling grievances in the workplace

Wed 28

Creating a safe workplace (WH&S)

Tues 20

Mon 19

QH Rostering Equity & work life balance

Union Training Program