TQN Vol 34 [3] Jun15 by Queensland Nurses and Midwives' Union

VOL. 34 ■ NO. 3 ■ JUNE 2015

THE QUEENSLAND NURSE

Page 26

2014 winners, left to right: Outstanding Graduate: Zoe Sabri, Nurse of the Year: Stephen Brown, and Team Innovation: Prof Jeanine Young representing the Pepi-pod速 Program.

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Conte nt s The ofﬁcial journal of the Queensland Nurses’ Union 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 qnu@qnu.org.au W www.qnu.org.au ISSN 0815-936X ABN No. 84 382 908 052 Editor Beth Mohle, Secretary, QNU Production QNU Communications team Published by the Queensland Nurses’ Union of Employees Printed by Fergies Print and Mail REGIONAL OFFICES Toowoomba 66 West St, Toowoomba Q 4350 (PO Box 3598, Village Fair, Toowoomba Q 4350) T 07 4659 7200 F 07 4639 5052 E qnutwmba@qnu.org.au Bundaberg 44 Maryborough St, Bundaberg Q 4670 (PO Box 2949, Bundaberg Q 4670) T 07 4199 6101 F 07 4151 6066 E qnubberg@qnu.org.au Rockhampton Suite 1, Trade Union Centre 110 Campbell Street, Rockhampton Q 4700 (PO Box 49, Rockhampton Q 4700) T 07 4922 5390 F 07 4922 3406 E qnurocky@qnu.org.au Townsville 1 Oxford Street, Hyde Park Q 4812 (PO Box 3389, Hermit Park Q 4812) T 07 4772 5411 F 07 4721 1820 E qnutsvle@qnu.org.au Cairns Suite 2, 320 Sheridan St, North Cairns Q 4870 (PO Box 846N, North Cairns Q 4870) T 07 4031 4466 F 07 4051 6222 E qnucairns@qnu.org.au DISCLAIMER Statements expressed in articles in The Queensland Nurse are those of the contributor and do not necessarily reﬂect the policy of the Queensland Nurses’ 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 QNU’s ethical standards, such acceptance does not imply endorsement.

PRIVACY STATEMENT The QNU collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information please contact your nearest QNU ofﬁce. If you are still not satisfied that your privacy is being maintained you can contact the Privacy Commissioner whose 1800 number is in the phone book.

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VOL. 34 ■ NO. 3 ■ JUNE 2015

28 FEATURE Ethics in nursing

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RATIOS SAVE LIVES

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Tea room Queensland news National news

JUNE 2015 TQN 1

YOUR UNION

Truly remarkable professions! We recently celebrated the nursing and midwifery professions by reflecting on our impact on global health.

YOUR COUNCIL

The themes for this year’s International Nurses Day and International Day of the Midwife were ‘Nurses: a force for change: care effective, cost effective’, and ‘Midwives: for a better tomorrow’. Nurses and midwives are well placed to deliver on the clinical aspects of evidence-based, person-focused care, and influence the business of health service delivery to achieve great health outcomes for citizens around the world. Critical to that success is the meaning that nurses and midwives attribute to their own effect—what difference they make, what outcomes they achieve for their patients or residents, and what nursing or midwifery means to them personally. I have the privilege of being a nurse leader in an acute setting, with nurses, as well as some who have gone on to study midwifery, in my team. In conversation, I’ve asked them what being a nurse or a midwife means to them and what made them choose their career path. Some of them said they had family members who were nurses, and some speak with passion about their work or practicum experiences and the team they work with. And despite most mentioning the challenges facing them in their current work environment, they all speak with professional pride and certainty about the difference they make to the people they care for and the community they live in.

Every single one can recount a patient experience that impacted them in a way that words could not capture. And all had no plans to change out of nursing in the immediate future. So I would like to share—in their own words—why my team wanted to become nurses and midwives and what their work means to them.

SALLY-ANNE JONES QNU PRESIDENT

“It means caring.”

“Caring works for me.”

“Changing people’s lives for good.”

“You can’t separate nursing and caring.”

“Helping people.”

“My family experiences made me do it.”

“Always wanted to be a nurse.” “Felt right once I got into it.” “I enjoy helping people.” “I feel good about myself.” “I’m a caring person anyway.” “It’s the scientiﬁc approach that attracts me.” Whether or not your workplace celebrated International Nurses Day or International Day of the Midwife this year in style with a breakfast, morning tea or lunch, we should join together to celebrate nursing and midwifery every day because of the incredible contribution we make to the health and wellbeing of others.

“Personal goal achievement.” “I make a difference.” “Opportunity for travel and learning.” “I am interested in human anatomy and how the body breaks and gets better.” Nursing and midwifery are truly remarkable professions that continue to grow beyond the bedside caring role into custodians of the safe delivery of quality health care. Wishing you a belated International Nurses Day and International Day of the Midwife!

Sally-Anne

Secretary Beth Mohle ■ Assistant Secretary Sandra Eales ■ President Sally-Anne Jones ■ Vice President Stephen Bone Councillors Julie Burgess ■ Christine Cocks ■ Karen Cooke ■ Dianne Corbett ■ Jean Crabb ■ Barbara Hastie ■ Shelley Howe Phillip Jackson ■ Damien Lawson ■ David Lewis ■ Lucynda Maskell ■ Simon Mitchell ■ Fiona Monk ■ Sue Pitman Dan Prentice ■ Karen Shepherd ■ Katy Taggart ■ Kym Volp ■ Di Webb ■ Charmaine Wicking ■ Julie Wilson

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EDITORIAL

Advocates for patient safety

BETH MOHLE SECRETARY One of our four core nursing and midwifery values is advocacy. Nurses and midwives are central to keeping our health and aged care system safe by advocating at the individual and “whole of health system” levels. Working across all settings 24-7, we are lynchpins of the health system. But as we know too well, there must be enough of us with the right skills and in the right place at the right time to ensure the system is safe. The evidence has repeatedly demonstrated the clear link between quality outcomes for patients and having the right number of skilled nurses and midwives. This evidence underpins our Ratios Save Lives campaign. In a nutshell, we help to keep the system both human and safe by caring for the whole person when they are at their most vulnerable. This is both a great privilege and a considerable responsibility. Having the courage to speak out when something is wrong or unsafe is fundamental to our professional ethics and advocacy. Yet taking a stand can be difficult, especially when there are conflicting priorities and the work environment is unsupportive. The decline in permanent work arrangements is something we should all be concerned about.

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Not only is care fragmented through insecure work arrangements, but workers in such arrangements often lack the power and authority to safely speak out when they see something wrong. And as many know from personal experience, the system doesn’t always support us when we raise concerns about not having the resources to provide the level of care we know we should. This is why standing and taking action together through our union is so powerful. The QNU is a powerful voice for advocating for patient and resident safety by virtue of the fact that we are the

...THROUGH OUR UNION, YOU CAN TAKE A STAND AND BE FORMALLY IDENTIFIED AS AN ADVOCATE FOR PATIENT SAFETY. collective voice of Queensland’s nurses and midwives. Now, through our union, you can take a stand and be formally identified as an advocate for patient safety. As part of our Ratios Save Lives campaign we are launching a new role of ‘Patient Safety Advocate’. As you are our eyes and ears at the workplace level, we need to identify those nurses and midwives who are prepared to take a stand on patient safety and proudly identify as QNU Patient Safety Advocates. These advocates will work with QNU branches, workplace representatives,

local QNU Organisers and other officials to improve the focus on patient safety. Building a strong state-wide network of Patient Safety Advocates will enhance our capacity to work together to improve quality and safety in our health system. Together we can start reframing the system so the primary focus is on safety and quality, and of course providing genuine patient-centred care. Please consider submitting an expression of interest to become a QNU Patient Safety Advocate today. More information is available at www.ratiossavelives.com.au Keeping the system both safe and patient centred is an endless challenge. There is a lot of work to do, but the task will be easier when there are many of us committed to making a difference.

Beth

Calling all RNs! The Nursing and Midwifery Board of Australia is reviewing the national competency standards for RNs. The NMBA is conducting public consultation on the review, and is seeking feedback from RNs. It’s important RNs engage in this consultation to ensure the feedback reflects the breadth and depth of RN clinical and non-clinical practice. To undertake the survey, visit www.nursingmidwiferyboard.gov.au/ News/Current-Consultations.aspx The link also provides a copy of the revised standards to consider before completing the survey. Closing date for your feedback is 3 July 2015.

JUNE 2015 TQN 3

Yo ur s ay

Facebook

hear, how about asking the ones at the coal face what is needed and how to do it, we have heaps of ideas! Lisa Nicol

On the Abbott government’s cuts to paid parental leave Public servants went without payrises to gain paid maternity leave. In the private sector, it is usually part of a salary package. The government maternity leave is for every new mother. We are not double dipping. Kallista Gleghorn

On Health Minister Sussan Ley’s announcement of a further review of Medicare Could we PLEASE have a health minister with a medical or nursing background, (not someone with a heap of degrees and no practical knowledge either) business people running hospitals etc like businesses drives me crazy. Yes there has to be a budget and some spending constraints however, health issues need to be overseen by health experts. I hear these ministers say that they consult with doctors etc but ultimately the dollar is the interest and those they ask give them the answers they want to

Letter of thanks follows difficult circumstances One of our members unexpectedly passed away during the difficult process of claiming back pay for unpaid wage entitlements. The QNU continued to pursue the claim on behalf of the Estate, which resulted in the deceased member’s relative receiving a significant sum of money—a well deserved outcome. With permission from the author, we can share this letter addressed to the QNU.

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On Tyrone and Maria Sevilla Thank you Australia my second homeland for 30 years. Maria will be nursing just like me heaps of Australian of different diverse backgrounds. We are Filipino Australians. Cheers. Lutgarda Pendleton

An excellent outcome. Thank you Beth and the QNU for standing strong for yet another member. Christopher Johnson

YAY! I’m glad common sense, decency and compassion prevailed at last! Thank you, QNU for your efforts in supporting Maria, Tyrone and the Townsville community and uniting the nursing fraternity to stand up against this injustice. Donna Spindler

On International Nurses Day / International Day of the Midwife Nurses, ambulance, police, fire brigade, doctors they are the silent heroes in our society they are truly not recognised enough for what they do to help you and me. Their work can be pretty overwhelming some times but they are professional in what they do. I thank them all for being who they are.

This makes me happy, it is as it should be. I think we should remember though that the only reason the minister stood up was because of our voice, he should get no credit. Dawson Woods

Gosh I can’t stop crying. Good tears though . So so happy for all involved in this situation. Bless you all and especially this nurse and her son. May there journey now be blessed with good life ahead and many more years to come. Robyn Page

“Thank you for all of your hard work and particular special attention you have given to our family under the circumstances. “I cannot tell you how much we appreciate it. This money comes at a time when our younger daughter is in year 12 and deciding what university she wants to go to next year. “Before your call I was busy planning and researching funding for her in the form of scholarships or something similar and hoping I wouldn’t have to take out a second mortgage. “Your persistence and tenacity, compassion and professionalism have been phenomenal and I am so grateful. “In some small way, the timing of this resolution reminds me that [member’s name] is still taking care of us even though [they are] not here.”

Lloyd Wilson

Have your say tqn welcomes letters for publication. Letters should be no more than 200 words. Anonymous letters will not be published (we will consider withholding names, but do not accept unsigned letters). Photos may be colour or black and white. Send all material in the ﬁrst instance to: The Editor, The Queensland Nurse, GPO Box 1289, Brisbane 4001 or by email to dsmith@qnu.org.au tqn also sources Your Say comments from the QNU’s social media accounts in the public domain. The views contained in the ‘Your say’ page do not necessarily reﬂect the views of the QNU. For more information and guidance on writing and submitting a letter for inclusion in the ‘Your Say’ section refer to the QNU’s Letter to the Editor policy at www.qnu.org.au/letters-policy

/qldnursesunion

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Te a room 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 covering 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 QNU Connect information service.

Know your sick leave!

 relevant Award and/or Enterprise

With winter well and truly here, it’s a good idea to know your sick and carer’s leave entitlement. The entitlements are fairly standard, but as always we encourage you to be familiar with your relevant award or enterprise agreement. You should also keep a regular check on your leave balance (shown on your payslip). If you feel unwell and unable to attend work, or a member of your immediate household requires your care or support, you must notify your supervisor before the commencement of your next shift or expected work period. There is no need for you to contact colleagues to find a replacement— supervisors are paid to co-ordinate unexpected absences. If you are absent for more than three days, you will need to provide your supervisor with a doctor’s certificate (depending on your enterprise agreement).

Agreement. If you have any questions about your contract of employment, you can contact QNU Connect.

Don’t underestimate the value of your contract of employment

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

ROVDPOOFDU QI 41::4321

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It is essential to retain a copy of your contract of employment. Within Queensland Health, this is sometimes referred to as an offer letter or commencement form. Members are often unable to locate their contract of employment or are unsure if they even have one! Be aware that if you contact QNU Connect with a problem or question, we may ask for a copy of your contract of employment so we can properly assist you. Your contract of employment is a legal document which, once agreed to and signed, should be kept with your personal records. The contract confirms your:  pay and classification level  position and employment type (eg. full-time, part-time, casual)  hours of work  shift penalties and loadings  leave entitlements  termination of employment notice periods, and

Paper pay advice phasing out Queensland Health is phasing out any paper pay advices from the pay day of 17 June 2015. Nurses and midwives employed by QH can access their pay advice through Streamline, which is available on the internet 24/7. Streamline provides information such as payment summaries, overpayments, and loan details. If you do not have access to the internet, you can apply for a Streamline user exemption to receive hardcopies of your pay advice as well as receive line manager and administration support. To request an exemption, you must contact Workforce Policy and Performance, HR Services to discuss whether you are eligible. For Gold Coast University Hospital employees call (07) 5687 9066 or email GCHWorkforcePolicyProject@health.qld. gov.au. All other employees should call 1800 239 074.

Remember to record your Continuing Professional Development Now that we have commenced a new registration period, remember that AHPRA conducts random audits of nurses and midwives to ensure mandatory registration standards are upheld. From 1 June, it’s essential to keep good records of your CPD, which must be retained for at least three years. For further information, the NMBA website provides fact sheets on registration requirements and FAQs: www.nursingmidwiferyboard.gov.au/ Codes-Guidelines-Statements/FAQ/CPDFAQ-for-nurses-and-midwives.aspx Members are also reminded that andatory training should be done during paid work time. If you’re on leave, mandatory training should be scheduled when you return to work.

JUNE 2015 TQN 5

Q u e e n s lan d ne ws Maria and Tyrone

MARIA AND TYRONE SEVILLA – a victory for compassion After months of campaigning and a 125,000 signature petition, Maria Sevilla and her son Tyrone will be allowed to remain in Australia.

Late last year, Maria—who came to Australia from the Philippines to work as a nurse at Townsville Hospital—was told her visa would not be renewed and she and her ten-year-old son would have to move back to the Philippines. The reason? Some time after arriving in Australia, Tyrone was diagnosed with autism— and this was deemed by the Australian government too much of a “financial burden” on the health system. This decision, which was first handed down by the Immigration Department and later backed by the Migration Review Tribunal, failed to take into account Maria having private health insurance and her doctor promising to treat Tyrone for free until he turned 18. What’s more, it ignored the invaluable service Maria provides as a nurse to her local community. Maria’s work involves helping patients rebuild their lives who have lost limbs and suffered spinal and brain injuries.

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It also failed to consider the significant contribution people with autism can and do make to the Australian community.

Online petition draws overwhelming support With the support of her friends, family, colleagues, and the QNU, Maria launched a Change.org petition asking the Immigration Minister, Peter Dutton, to exercise his ministerial power to override the decision. After extensive media coverage, including stories on The Project and a discussion on the ABC’s Q&A, Maria’s petition attracted 125,000 signatures. State and federal MPs from all political sides also wrote letters to Mr Dutton in support of Maria and Tyrone. Maria continues to receive financial support from local community members, most notably $11,000 from a group of local doctors to start a fund to support Tyrone’s medical expenses.

Petition delivery puts pressure on Minister On the day her visa was due to expire, Maria and Tyrone flew to Brisbane to deliver the 4000-page petition to Mr Dutton’s electorate office in Strathpine. The event received nationwide coverage, including on all commercial channels and the ABC. Upon delivering the petition, Maria said her son, who does not speak Filipino, would find it difficult to adjust to living in the Philippines. “A move to the Philippines would create greater difficulties for Tyrone and increase his chances of regression,” she said. “I want to continue to work and build a future for my son in the country where we have lived and contributed for eight years.”

Minister grants permanency One month after delivering the petition, Maria finally received the news she had been anxiously waiting for.

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QUEENSLAND NEWS

“This support and love is what makes Australia great and this is why Tyrone and I want to spend

our lives here helping others.”

Mr Dutton announced he had reconsidered Maria’s case and would be granting her and her son permanent residency. The QNU has welcomed the decision as a challenge to the stigma surrounding autism spectrum disorders. “As a mother, you want to do anything for your children,” Maria said. “My Tyrone can’t say anything or fight for his rights so I have been doing that for him.”

Maria overwhelmed by community support Although Maria is yet to receive the formal paperwork, she said she had been overwhelmed by the public support she received from her community throughout her campaign. “I am so relieved the Immigration Minister has said he will allow Tyrone and me to stay in Australia,’’ Maria said. “We now await formal confirmation from the Minister’s office and the official finalisation of our visa process.

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Maria and QNU Secretary Beth Mohle speaking with the media after delivering the 4000-page petition in support of Maria and Tyrone’s plight to Peter Dutton’s ofﬁce.

“Our future in Australia would not have been possible without the QNU, who helped me get free legal representation from Hall Payne Lawyers and also provided assistance and advice every step of the way. “There were times when I was fearful for my and Tyrone’s future but the efforts of the union, union members, my family, friends, my church, my GP Dr Praveen, the media and the community have raised support for our story heard in countries as far away as Russia and China. “This support and love is what makes Australia great and this is why Tyrone and I want to spend our lives here helping others. “I am telling all my colleagues to talk to the nurses’ union if they have any problems because they are there for us 150 per cent and want to help.’’ Maria and the QNU also thanked Hall Payne Lawyers in Brisbane for providing pro bono legal representation,

Change.org for Maria’s petition which generated 125,000 signatures, as well as MPs from the Australian Labor Party, the Liberal National Party, Katter’s Australian Party, and the Palmer United Party for support.

Thank you Maria’s doctors have set up a fund to help pay for Tyrone’s medical expenses until he turns 18. If you would like to donate to the trust fund, which is held by Wilson Ryan and Grose Lawyers, please donate to: Account: 2231 8268 BSB: 124 389

JUNE 2015 TQN 7

QUEENSLAND NEWS

PLENTY TO CELEBRATE AT LABOUR DAY! Hundreds of nurses and midwives turned out across Queensland to march proudly at this year’s Labour Day celebrations. The mood this year was far removed from last year’s marches. With the Newman government banished by voters and nurse-to-patient ratios on the new government’s agenda, there were calls for some real celebrating of the union movement and all we have achieved in such a short time. This year also marked the last time nurses and midwives will have to march on a Sunday, with Labour Day returning to its rightful place as a public holiday in May next year. Right across the state, nurses, midwives and their families marched in Brisbane, Bowen, Bundaberg, Cairns, the Gold Coast, Ipswich, Mackay, Maryborough, Rockhampton, the Sunshine Coast, Thursday Island, Toowoomba, Townsville, and many more. Our bright yellow ratios t-shirts stood out in the crowds, and our chants for safe ratios were heard loud and clear as we marched right past some of our local politicians!

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QUEENSLAND NEWS

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JUNE 2015 TQN 9

QUEENSLAND NEWS

Queenslanders run for breast cancer awareness Once again, thousands of people, including many nurses and midwives, spent their Mother’s Day morning running up to 8km to raise money and awareness for breast cancer— the most common cancer for Australian women. The Mother’s Day Classic annual walk and run saw people complete courses right across Queensland, including in Brisbane, the Gold Coast, Mackay, Townsville, Toowoomba, Cairns and the Sunshine Coast. Approximately 10,000 people turned out in Brisbane alone, including a gathering of QNU folk wearing their yellow Ratios Save Lives t-shirts, which stood out in a sea of pink. The Brisbane event began with an energetic aerobic warmup, followed by a run through South Bank and along the Brisbane River, and ended with live entertainment, hot coffee and a sausage sizzle. A fun morning for a great cause that is very close to the hearts of so many Queenslanders.

Qld patients to join cannabis trials The QNU has cautiously welcomed the state government’s announcement it will participate in scientific trials of medical cannabis for patients with terminal and lifethreatening conditions. The trials will continue to be conducted by the NSW government, but will now be open to patients from both Queensland and Victoria. In Queensland, the focus will be on children who suffer from lifethreatening seizures. There is a growing body of evidence that certain cannabinoids are an effective treatment for chronic pain and illnesses such as Dravet Syndrome, which causes severe seizures.

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While cannabis extracts have been licensed for use in Canada, the US, Great Britain, Holland, Israel, and Germany, the substance remains illegal in Australia. The trials should help provide scientific evidence about the effectiveness of the treatment.

More information needed on trials While the QNU welcomes the announcement, more information about the administration of the trials is needed. Specifically, the QNU wants to ensure pharmaceutical companies producing medicinal cannabis follow the same pathway for accessing the Pharmaceutical Benefits Scheme— including gaining approval and being

regulated by the Therapeutic Goods Administration. In February this year, QNU Council endorsed clinical trials of medicinal cannabis in Australia under these conditions. The QNU also strongly supports prescribing rights for medicinal cannabis to be inclusive of nurse practitioners.

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QUEENSLAND NEWS

Honouring wartime nurses The dedication and bravery of Australia’s wartime nurses were front and centre at a moving twilight vigil in Brisbane on Anzac Day eve, as Australia prepared to mark the 100th anniversary of the Gallipoli landings. About 300 people gathered in Brisbane’s Anzac Square on 24 April for the second annual Nurses Memorial Candlelight Vigil and wreath-laying ceremony. With much of the commemorative spotlight turned on the diggers this year, it was nice to see nurses past and present recognised for their courage and sacrifice, as serving and former military nurses took the crowd on a journey through the history of nurses in conflict. Colonel Julie Finucane OAM spoke of the stoicism of nurses in WWI, who saved thousands of wounded Gallipoli diggers despite disease, critical supply shortages, and horrendously unsanitary conditions at the military hospitals on the Greek island of Lemnos. Retired Ipswich theatre RN Mary Purser, who served as an army nurse in South Vietnam, described the impressive capacity of field nurses to get on with the job despite facing the worst a war could throw at them. Gulf War I veteran Group Captain Geoff Robinson from the Health Services Wing at RAAF base Amberley painted

Kerry Robertson

a dramatic picture of nurses working at speed and under pressure while the threat of attack loomed. Theatre nurse OIC Captain Lee-Ann Pine from 1st Surgical Company, 2nd General Health Battalion, Enoggera rounded off the historical flashback with a portrait of today’s military nurses that spoke of the same values, commitment and selflessness that drove nurses to Gallipoli a century ago. The annual nurses vigil is organised by the Defence Service Nurses RSL Sub Branch Queensland, the Centaur Memorial Fund for Nurses and the Australian Catholic University, with the support of the Queensland Government. Make sure you mark it in your diaries for next year.

(l-r) Keeping it in the family, three generations of nurses Nicole Atkinson, Rosslyn Hero and QNU member Josephine Atkinson, with Martine Hero.

History remembered in Centaur anniversary This year marks the 72nd anniversary of the sinking of the Centaur, an Australian hospital ship that was attacked by a Japanese submarine during World War 2. Memorial services were held around Australia on 14 May, including at Caloundra and Point Danger, where plaques have been erected in memory of those who died in the attack. The Centaur only completed two voyages with patients before the attack—which was a war crime—in which 268 people died, including nurses, doctors, field ambulance staff, and crew.

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

JUNE 2015 TQN 11

QUEENSLAND NEWS

Anti-worker policies shown the door The new government has lost no time reversing a number of antiworker and anti-union policies implemented by the previous LNP government. Two policies are of particular importance to public sector nurses and midwives and apply to Queensland Health effective immediately.

Employment security The first policy aims to maximise permanent employment by introducing new requirements for government employers. Government employers will now have to seek cabinet approval before implementing any changes that significantly impact employees, such as job losses or relocations. Employers will also have to demonstrate that any significant organisational change or restructure will clearly benefit the government or the community, and discussions with unions must occur as early as possible.

Union encouragement As part of the previous LNP government’s agenda to minimise union involvement in workplaces, they removed ‘union encouragement’ policies.

This made it much harder for workers to join their union and for union members to get paid leave to attend training. It also became difficult for union delegates to speak with their colleagues, something that has now been reversed by the current government. Under the new Union Encouragement Policy, the QNU will be able to attend inductions and more easily access members in their workplaces. In short, it’s a return to a mature and professional approach to industrial relations—one that lets us get on with the job of delivering the best possible care.

Verdict in “extraordinary” unfair dismissal case backs nurse After working at a Sunshine Coast doctor’s surgery for 11 years, an EN was told by her employer they could no longer employ her, as they had received legal advice that ENs were required to be supervised by RNs. This was despite the doctor’s surgery already employing RNs who could have provided such supervision. The employer insisted the EN was not being sacked, but offered her no notice, redundancy payments, or other entitlements. Naturally, the QNU demanded the EN be paid out her full entitlements. Three weeks later, the employer’s legal representative claimed the EN had been terminated for serious misconduct. Bizarrely, they claimed the EN had failed “to have in place a written supervision agreement with a Registered Nurse”.

QNU lodges unfair dismissal application Upon hearing the EN had been terminated for ‘serious misconduct’, the QNU lodged an unfair dismissal application with the Fair Work Commission.

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However, this was well after the 21-day post-dismissal period that is imposed to lodge an application. As a result, the QNU had to prove to a formal hearing that there were ‘exceptional circumstances’ as to why the extension of time application was lodged after 21 days.

Court rules in favour of nurse Deputy President Sams accepted the QNU’s case for ‘exceptional circumstances’ and granted the EN an extension of time, labelling the case “extraordinary”. DP Sams listed various reasons why the EN’s dismissal was unfair, including that she had been given no warning, had an “unblemished record of employment”, and was given “two diametrically opposed and inconsistent reasons” for being dismissed. He added that “it is incomprehensible and illogical that a RN can simply refuse to supervise an EN”. DP Sams also recommended the employer reconsider its position and settle the claim, “if only to avoid further criticism and embarrassment for its conduct”. Unfortunately, the employer has rejected the QNU’s settlement offer for both the unfair dismissal and unpaid entitlements. The QNU will now proceed with the unfair dismissal claim, and do everything necessary to secure the EN’s full entitlements.

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QUEENSLAND NEWS

New website brings you even closer to the QNU In our last edition we announced an overhaul of the QNU website. We had hoped to go live with the new look in April, but the addition of some extra bells and whistles, including separate home pages for members and the public, have pushed back our launch date. That launch date hasn’t been fixed yet but we’ll certainly be shouting it from the rooftops (well, through email, qnews and tqn anyway) when we are ready to share our bright and beautiful new webpage. The new website is part of a huge overhaul of the QNU’s communications system, which, through the use of new technology, will be far more efficient and user-friendly. We can’t wait to share it all with you!

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Private Sector – Tactics to overcome hostility

18 Aug

Brisbane

Professional Advocacy - We’re in charge

19 Aug

Brisbane

Creating a safe workplace (WH&S)

20 Aug

Brisbane

COURSE

AUGUST

25-26 Aug

Brisbane

QH - Consultative Committees - How to make them work

27 Aug

Brisbane

Conflict Management Skills

28 Aug

Brisbane

Being a QNU Contact in the workplace

8 Sep

Brisbane

QH 2015 - Ratios Save Lives

9 Sep

Brisbane

Building teams to grow our voice (Peter Twist)

10 Sep

Brisbane

QH - Ratios Save Lives

16 Sep

Gold Coast

The QNU’s Robina Branch recently held a barbeque on World AntiBullying Day.

Private Sector - Ratios Save Lives

17 Sep

Gold Coast

Aged Care - Building power in your workplace

15 Sep

Brisbane

Handling grievances in the workplace

16 Sep

Brisbane

The focus of the BBQ was providing over 300 staff with the opportunity to mingle with their Local Branch delegates while enjoying a few snags and vegie patties. The welcoming attitude from hospital management was a refreshing change from the last three years, where union activity was discouraged. Despite being one of the hottest days in March, staff enjoyed light-hearted banter and a back-to-business confidence boost across the campus.

Assertiveness Skills

17 Sep

Brisbane

Private Sector – Tactics to overcome hostility

7 Oct

Townsville

Building teams to grow our voice (Peter Twist)

8 Oct

Townsville

QH - Ratios Save Lives

9 Oct

Townsville

Being a QNU Contact in the workplace

7 Oct

Bundaberg

QH - Ratios Save Lives

8 Oct

Bundaberg

Private Sector - When bargaining goes wrong!

13 Oct

Brisbane

QH - Ratios Save Lives

14 Oct

Brisbane

Conflict Management Skills

15 Oct

Brisbane

20-21 Oct

Toowoomba

Robina BBQ a sign of changing times

Knowing your entitlements and understanding the award!

SEPTEMBER

OCTOBER

Knowing your entitlements and understanding the award! Private Sector – Tactics to overcome hostility Someone should do something about that! Private Sector - Scope, practice and workloads

22 Oct

Toowoomba

21-22 Oct

Brisbane

23 Oct

Brisbane

TO ENROL IN THESE COURSES—  visit the QNU website at www.qnu.org.au/qnu-training OR  contact your local QNU office and ask them to send you a form OR  ring the training unit in Brisbane on 3840 1431 or toll free 1800 177 273

www.qnu.org.au

JUNE 2015 TQN 13

QUEENSLAND NEWS

Guest speaker Susanna de Vries signing copies of her books at the QNU Brisbane breakfast.

Nurses and midwives— proud and strong The beginning of May always provides an opportunity for nurses and midwives right around the world to proudly celebrate our professions. International Day of the Midwife (5 May) and International Nurses’ Day (12 May) is our day to shine, and with our Ratios Save Lives campaign still firmly on the government’s agenda, there was plenty to celebrate this year. The QNU celebrated both days by delivering cakes to hospitals and aged care facilities right across Queensland. A fund raising breakfast was also held at the Brisbane office on 6 May. Profits from the breakfast and the raffle—which raised $946— will be donated to the 139 Club, an organisation supporting homeless people. The breakfast also featured guest speaker Susanna de Vries, an author and historian whose work focuses on the role of nurses and midwives during World War 1 and the bravery they showed in truly horrific circumstances. And to highlight some examples of the wonderful work that goes on every day in our professions, we’ve been posting stories and pictures from Queensland nurses and midwives about what their job means to them. Head to our Facebook page www.facebook.com/ qldnursesunion to check out some of the great stories we’ve already received.

14 TQN JUNE 2015

NURSES AND

A POWERFULIDWIVES: F O RC E

It’s the personal side that you give to the resident that makes their day.

5 M AY I N TERNATIO N A L DAY 1 2 M AY I N OF THE M TERNATIO IDWIFE NAL NURS E S ’ DAY

www.qnu.org.au

QUEENSLAND NEWS

What does the future hold for nurses and midwives under Premier Palaszczuk? There are four key planks of the government’s recent election commitments for nursing and midwifery in Queensland.

WORKLOADS The government has committed to legislating safe nurse/midwife-to-patient ratios in Queensland Health facilities. This will be a major boost to the health and wellbeing of all Queenslanders—but it is absolutely vital we get this right. A big part of getting it right is using our current workloads tool, the Business Planning Framework (BPF). The QNU is working closely with Queensland Health to ensure both ratios and the BPF are implemented correctly.

GRADUATES Before being elected, Annastacia Palaszczuk promised to introduce up to 4000 graduate places over four years for newly qualified Registered Nurses and Midwives in public hospital and health services. The QNU expects the government to begin offering graduate nurses and midwives jobs within the public health system from July this year.

WHO KNOWS THE SYSTEM BEST? WE DO! The government has also publicly committed to employing 400 ‘Nurse Navigators’ to help patients along their entire care journey—from their GP, through hospital-based care, and back home again. Using their extensive knowledge, skills, and clinical judgement, Nurse Navigators will break down barriers across a complex and fragmented health system.

SCHOOL NURSES Lastly, the government has promised to re-establish school nurses for primary schools. From July there should be 20 school nurses employed in primary schools across the state. The QNU understands eight of these positions will replace the eight positions cut from Metro South by the LNP government.

Delegates gear up for Annual Conference One of the biggest events on the QNU calendar—Annual Conference— fast approaches. Annual Conference is the primary decision-making forum for the QNU, and sees the democratic processes of your union in action. Nurses and midwives from all around the state will gather in Brisbane from 15-17 July to discuss and vote on dozens of organisational priorities. These priorities, as voted on by delegates, will then be sent to QNU Council to be implemented, and will form the basis of the union’s future activities. Remember, your delegates are there to represent you and all the members in your Local Branch, so it’s important to meet before conference to discuss what your branch’s position is on motions. This year’s keynote speakers will include former Attorney-General Dame Quentin Bryce, who will focus on domestic violence, and Dr Matthew McHugh from the University of Pennsylvania, who will talk about ratios. A webspace dedicated to Annual Conference is now active, visit www.qnu.org.au Delegates should have already received their login details and can now access resources required for the conference as well as view notices on motion.

www.qnu.org.au

JUNE 2015 TQN 15

QUEENSLAND NEWS

WORKLOADS

Nurses leading nurses The following stories all represent signiﬁcant workload wins for our hardworking nurses and midwives. In each case, hospital management planned to abolish various DON, ND and NUM positions.

Each of these cuts would have been a step backwards for staff seeking their right to be fairly represented at a decision-making level. Part of the role of a DON, ND and NUM is to sit on a monthly consultative forum—a meeting where every workload reporting form submitted is discussed. The DON, ND and NUM therefore have direct influence in escalating any workload issues—including staffing levels—raised by nurses and midwives. They are in a position to negotiate changes, form strategies and solutions to workload issues, and contribute to rostering. The loss of these positions would greatly affect the opportunity for nurses and midwives to have their voice heard. Thankfully, these positions were either retained or reinstated in the following recent cases.

Return of Beaudesert DON eases workloads Beaudesert Hospital will reinstate a Director of Nursing after it scrapped the position of Nursing, Midwifery and Facility Director (Rural Division) as part of a staffing restructure mid last year. The decision to scrap the position followed an external review, which was in response to events involving the birthing service. Despite the review finding the midwives had acted in an exemplary fashion and in no way contributed to the outcome, the hospital decided to replace the Nursing Director position with a Director of Clinical Services, as well as implement changes to Grade 7 positions. The QNU was not satisfied with this decision, and felt it impacted unfairly on staff at the hospital—notably, losing a Grade 9 position inevitably burdened staff with an increased workload. On behalf of the nurses and midwives at Beaudesert Hospital, the QNU provided feedback on this and a number of associated issues.

16 TQN JUNE 2015

This feedback was largely ignored, with the hospital claiming the QNU did not provide a “compelling enough case” to warrant keeping the Nursing Director position. However, they conceded it was appropriate to undertake a consultative review of all Grade 7 positions, and they were pleased to have the QNU participate in this process. Following these meetings, the Logan Beaudesert Health Network Executive Committee reconsidered the QNU’s concerns regarding the Grade 7 nurses and midwives’ increased workloads. After much persistence and lengthy negotiations, Beaudesert Hospital nurses and midwives finally had a win, and the hospital decided to reinstate a Director of Nursing. While this is not the same position that was lost last year, it is still a very significant win for midwives at the hospital, as well as the Beaudesert community.

Nurses take charge at Gold Coast Last year the Gold Coast Hospital and Health Service decided they would scrap the position of Nurse Unit Manager in the ICU at the Gold Coast University Hospital and replace it with two Associate NUM positions. This decision was made without any consultation with local nurses or the QNU. It seems incredible that management could expect such a large ICU to operate without a NUM for staff to report to. The proposed restructure not only posed significant risks to the nurses’ professional practice, it also undermined the governance structures put in place to ensure the safety of patients and staff. By definition, Associate NUMs must report to their NUM, meaning this staffing restructure should never have been proposed in the first place.

www.qnu.org.au

WORKLOADS

QUEENSLAND NEWS

Horror workload see patients in corridor

After the QNU vehemently opposed the proposal and numerous staff expressed their concerns to hospital management, the hospital asked to meet with the QNU to consider other options. A great win for a group of proactive and brave nurses!

Sunshine Coast Mental Health retains Nursing Director Management at the Sunshine Coast Hospital and Health Service recently proposed a significant staffing restructure that would have sacrificed the Nursing Director (mental health) position. While local nurses welcomed the overall restructure, they were rightfully troubled by the potential and unnecessary loss of such a vital leadership position. The QNU worked closely with four different groups of nurses from various mental health services. Significantly, three of those groups decided to draft their own letters to management. They provided their own signatures and stated their reasons why the ND position should remain. These reasons included the fact that mental health nursing is a specialist area demanding unique skills and training, and that losing the ND would result in a loss of advocacy and identity for mental health nurses. On behalf of members, the QNU also wrote to management expressing concerns about patient safety and workload impacts as a result of losing such a senior position. As a result of such strong leadership and coordinated action from QNU members, management reconsidered and decided to keep the ND. Interestingly, management’s response letter to the QNU included an extract from one of the nurses’ letters—a strong indication that their decision to retain the ND was influenced by the nurses’ actions.

www.qnu.org.au

In a show of what nurses can achieve when they work together, staff at The Prince Charles Hospital have overcome some horrific workload issues and gained more staff. The QNU was originally alerted to unsafe workload issues occurring at TPCH after a number of nurses rang the union with some truly concerning stories.

Workloads affecting patient safety As a result of job cuts under the previous LNP government, workloads had become so unmanageable that patients were being assessed and treated in a public corridor outside the emergency department. A single nurse was rostered on to cover this corridor, which often saw the nurse single-handedly caring for up to 18 patients. With a shortage of beds, patients arriving in ambulances were often unable to be offloaded. As a result of over-capacity—and with no plans in place to deal with it—staff reported feeling unsafe, were highly stressed, and concerned for patient safety. Staff weren’t getting their meal breaks, there were high levels of sick leave (with nurses often not being replaced), and frequent resignations.

Power in numbers Fortunately, nurses at the hospital were willing to take a stand.

Following meetings with the QNU, approximately 20 staff decided to run a campaign. It was decided that for each workload issue, staff would submit a workload grievance, beginning late November 2014 and ending in January 2015. The QNU received up to five workload grievances per week—and this doesn’t include internal grievances lodged with the hospital.

Hospital responds positively to grievances Once the consultative forum received the grievances, hospital management were eager to address the problems and openly consulted with staff and the QNU. TPCH has since set up working parties involving all staff to identify problems and help implement solutions. Significantly, a new model of care for the triage team has been developed to address the ‘corridor’ issue, and a RAMS unit has opened to ease patient flow from ED. More nurses have also been employed, including an extra Clinical Nurse Consultant, and extra beds have been opened in the ED during the night. Despite the hospital being cooperative during this process, such positive outcomes would not have occurred had it not been for the nurses taking such firm action and standing united.

JUNE 2015 TQN 17

QUEENSLAND NEWS

PRIVATE SECTOR

This article has been removed for legal reasons.

18 TQN JUNE 2015

www.qnu.org.au

PRIVATE SECTOR

QUEENSLAND NEWS

Time to remove the confusion on leave Bargaining for new enterprise agreements is now well underway with several private hospital employers, and QNU members are in the process of ﬁnalising or serving their log of claims to their employers. Aside from wages, a major focus for this round is annual leave and public holidays. Nurses and midwives want to rid themselves of the complex mess of Option A and Option B—which outline the different amounts of annual leave and public holiday penalties. These two options are often misinterpreted or applied incorrectly by employers. As a result, staff are seeking the clear and simple annual leave and public holiday provisions from the Nurses Award 2010. The time is well and truly overdue to have some straightforward and fair entitlements for annual leave and public holidays included in the private hospital enterprise agreements. Employers too have long expressed their frustration and confusion in dealing

with the current Option A and Option B provisions.

Know your entitlements! We survey almost all of our private hospital nurses and midwives when major rounds of enterprise bargaining are about to begin. We find that some of the conditions members seek already exist in their enterprise agreements but they are just not aware of them. The best way to know what you are entitled to is to have a copy of your enterprise agreement and read it. You can also attend a QNU training session on knowing your entitlements. If you are not sure about what something in your agreement means contact QNU Connect on 07 3099 3210 and they’ll help you.

Lots of QNU members mbers h have ave ve b been een ee n en for successful in securing back payments unpaid entitlements with the help and support of the QNU. Lastly, please make sure your membership details are up to date— particularly the sites you work at—so you receive all the information. It’s your enterprise agreement—make it a good one this year.

Electronic rostering must work both ways The QNU will be keeping a close eye on Healthscope’s proposal to introduce an electronic log in / log out system, which will monitor staff working hours. Electronic time sheet systems have previously been used in workplaces as a way of monitoring staff attendance and ensuring people are working to their set hours. The electronic system is replacing the current manual paper-based system of rosters and time sheets, and will eventually be rolled out in all Healthscope hospitals. In the future, employees will ‘touch on’ and ‘touch off ’ at the start and end of shifts. But to ensure transparency and fairness, the system has to work both ways. If employers are going to dock pay from people for arriving to work five minutes late, they should also be made to pay staff for working five minutes overtime.

www.qnu.org.au

It cannot be used as an unfair method for cutting wages and increasing profits. And although Healthscope management says the system, which has already been rolled out in Victoria, New South Wales

and South Australia, should be well received, the QNU will be speaking with nurses and midwives on the ground to ensure they are not being negatively affected.

Heathscope EB reps with QNU organiser Vicky Stewart (front, middle)

JUNE 2015 TQN 19

QUEENSLAND NEWS

AGED CARE

PresCare nurses demand fair pay Nurses at PresCare are negotiating with management to receive wages that are on par with what other aged care facility nurses receive. PresCare claims to spend about 70% of its revenue on wages—but their nurses know those wages include larger amounts paid to executives and managers and large bonuses. The truth is, PresCare nurses are among the lowest paid in Queensland. That’s why nurses have twice rejected unacceptable offers from PresCare, including one proposal for an enterprise agreement that would have prevented nurses from having any other wage increase for a year. A well-attended rally was held by members outside the Vela facility to send a message that nurses aren’t happy with sub-standard wages. The QNU has also written to the Presbyterian Church, taking our message all the way in while members consider the next step.

20 TQN JUNE 2015

Regis attempts to reduce working conditions The QNU is currently negotiating a better agreement for nurses at Regis Aged Care—something that began with difficulty when Regis proposed to strip back current working conditions while refusing to increase wages. Regis already pays its nurses far less than other aged care facilities. Instead of increasing wages, Regis told the QNU it wants to reduce a number of working conditions, including no longer needing to have a ‘mutual agreement’ in writing. This would make it easier for the employer to falsely claim nurses verbally agreed to reduced conditions. Regis also proposed allowing days off per fortnight to be non-consecutive and cutting the rate for the third hour of overtime from double-time to timeand-a-half. After fierce opposition by the QNU to these reductions, Regis has dropped their attack on them. However, Regis continues to propose that nurses won’t be paid personal (sick) leave for many circumstances unless they provide a medical certificate or similar. Regis is also proposing nurses won’t be paid for overtime unless they have previously had it approved by their manager. This proposal fails to recognise the often extreme circumstances under which nurses and midwives work. A vague new classification structure for RNs is also proposed by Regis, and the QNU has asked for more details. From the outset, Regis has bargained with the intention of increasing their profits rather than improving the working conditions of their nurses to the levels they deserve. As discussions alone have proven unlikely to change management’s position, nurses are being encouraged to take protected industrial action.

www.qnu.org.au

N a t i ona l ne w s

The Great Tax Debate

A new paper ﬁnally kick-starts the much-needed discussion on tax reform, while another shows Australia’s unusually strong wage outcomes are linked to union wins.

The ‘great tax debate’ has now started with the release of the federal government’s Re:think Tax discussion paper. In launching the discussion paper, Federal Treasurer Joe Hockey said the paper would examine the fairness of the tax system including tax on superannuation. The discussion paper is seeking feedback on improving concessional tax arrangements for superannuation and will consider the differential earnings tax rate across the accumulation and retirement phases on income. Mr Hockey confirmed Australians will have to pay increasing amounts of tax unless welfare entitlements are cut. The paper compares Australia’s state and federal taxation systems with international trends.

www.qnu.org.au

It considers how economic growth and living standards are affected by the tax system and the importance of fairness.

Unions make all the difference in wage outcomes The government’s paper coincides with the release of a report by the progressive think tank Per Capita. The Per Capita report indicates that since the turn of the century Australia’s median earnings have not kept pace with our productivity gains and that lack of union presence at the workplace is likely to exacerbate the difference. The report looks at real median earnings since 2000 to counter the continuing claim from business leaders such as Gina Rinehart that Australian wages are too

high for Australian companies to remain competitive. Australia’s real wages growth has been strong for some time, unlike many other nations including the US where median real wages have not increased in 40 years. The report argues the main reason Australian median wages have fared better than other countries is because Australia maintains a strong minimum wage and employee protection framework. These are measures trade unions have fought for and maintained over the last century. This is why union membership is so important in protecting and advancing nurses and midwives’ pay and conditions.

JUNE 2015 TQN 21

NATIONAL NEWS

B U D G E T 2 01 5

Writing off 2014 with a U-turn

These sweeteners include a 1.5% tax cut for small businesses and a boost to childcare funding. But these sweeteners also come at a significant cost.

Public hospital funding slashed by $57 billion

The delivery of this year’s federal budget initially left many Australians scratching their heads. This time last year, the government’s mantra was all about “budget emergency” and the “end of the age of entitlement”. Savage cuts to vital services, as well as the proposal of the GP co-payment, were said to be justified because of record spending and debt. Twelve months later, the government is singing a very different tune. Looking a little deeper into the budget, it’s clear why. This is a budget designed to save Prime Minister Tony Abbott’s political career, not

BUDGET WINNERS Parents with young children Childcare will get a $3.5 billion boost over the next four years, though at the expense of cuts to the Family Tax Beneﬁt. Families earning less than $65,000 will get 85% of their childcare fees subsidised, while families earning more than $170,000 will get 50% of their fees subsidised. Small businesses A 1.5% tax cut will be given to businesses with annual turnover less than $2 million. There will be tax deductions on all assets under $20,000 to encourage businesses to invest in new machinery. Medical research The medical research future fund will get an initial injection of $440 million. However, this money will come from other cuts in the health budget.

22 TQN JUNE 2015

deliver the changes needed to strengthen our declining post-boom economy.

So what’s changed? With the next federal election looming large, the government is now focusing on winning back the votes it lost. Previously, the government was trumpeting billions in savings through cuts and wildly proposing revenue raisers without consultation. This year’s budget is all about providing sweeteners to mend the political damage.

The government is still pushing ahead with its plan to move to a new public hospital funding model. Under the new model, public hospitals will receive funding based on population growth and inflation rather than the services they provide. As a result, states and territories will be $57 billion worse off over 10 years—or $11.8 billion for Queensland. On top of this, the budget paves the way for a further $1 billion in health cuts by “rationalising and streamlining” many vital programs. These cuts will primarily come from the Health Portfolio Flexible Funds, which cover a range of programs including HIV treatment, developing responses to pandemic threats, and chronic disease treatment.

BUDGET LOSERS Public hospitals States will lose $57 billion over 10 years as the federal government pushes ahead with its new funding model based on population growth and inﬂation rather than the services they provide. New parents If the proposal passes the Senate, new parents will no longer be able to claim paid parental leave from the government if their employer offers a more generous scheme. Parents with access to a less generous employer scheme will be able to access the gap between the two. School education While an extra $4.1 billion has been allocated over the next four years, no funding has been provided for the

final two years of the six-month trial of the Gonski reforms. Tertiary education The budget hints at another attempt to deregulate universities, though no detail is provided. No matter what form the policy takes, we won’t accept $100,000 degrees. Middle income earners Families who receive pay increases due to inflation may feel more cost pressure if they cross over to a higher tax bracket. Tax brackets are normally adjusted to offset inflation, but this budget will rely on ‘bracket creep’—pushing people into a higher-paying category—to pay down debt.

www.qnu.org.au

NATIONAL NEWS

B U D G E T 2 01 5 Other services that will be affected include those working towards Closing the Gap for Indigenous Australians, child dental programs, and axing any GP super clinics not yet built.

No clear vision for education With $100,000 degrees still on the agenda and no funding provided for the final two years of Gonski, there isn’t much good news for the education sector. After two catastrophic attempts to push through his tertiary education reforms, Christopher Pyne is continuing his fight to deregulate universities. No detail has been provided yet on what these plans will involve, but with deregulation still the endgame, it’s becoming apparent the government has no alternative positive plan for university students.

Boosts for Pharmaceutical Beneﬁts Scheme (PBS), medical research fund and childcare $1.6 billion will be spent over five years on new and amended listings on the PBS, including medicines for melanoma and bowel cancer. The much-criticised Medical Research Future Fund will go ahead, despite being originally tied to the co-payment. $400 million will initially be put into the fund—this money will be taken from health services already in place.

Co-payment in another form? Just before the budget, the federal government announced an extension on the freeze on rebates for GPs— described by some as ‘a co-payment by another name’. In the post-budget wrangling, we wait to see how this measure will be received— already there are signs GPs will oppose the move.

in effect, passing the cost for increasing health care costs on to their patients. The move was interpreted by some as a way of recovering money expected to be received by the GP co-payment—and perhaps also deflecting public anger onto doctors, who would now be seen to be ‘charging more’ for the same service.

What is the freeze?

GPs release alternative funding model

The federal government helps keep GP fees down for patients by paying doctors a rebate for each consultation. The previous Labor government introduced a freeze on rebates in 2013. Since then, GPs have received $37.05 for each consultation. With the cost of medical services going up, GPs had reasonably hoped for a ‘thaw’ on the rebate. However, in late April this year, health minister Sussan Ley announced an extension of the rebate freeze until 2018. The ongoing freeze may pressure GPs to increase the charges for their services—

Shortly after the government announced the extension, the Royal Australian College of General Practitioners released a paper arguing for an end to the freeze. The paper listed ‘the continued freeze on indexation’ as the first barrier to improved health outcomes, and proposed a move to a funding model based on Practice Incentive Payments and Service Incentive Payments. The paper also proposed full indexation of the Medicare Benefits Schedule to create ‘true sustainability’ in GP services.

Family Tax Beneﬁt (FBT) cuts pay for childcare subsidy $3.5 billion will also be spent on a boost to childcare. Families earning less than $65,000 will have 85% of their childcare fees subsidised. This subsidy will decrease as the household income rises, capped at a 50% subsidy for those earning over $170,000. However, these changes will only happen at the expense of cuts to the FTB, including stopping FTB payments to single-income households when children turn six.

www.qnu.org.au

JUNE 2015 TQN 23

NATIONAL NEWS

B U D G E T 2 01 5

Paid parental leave— Tony Abbott’s biggest backﬂip In a stunning about-face from previous commitments, the federal government’s changes to paid parental leave will see tens of thousands of new parents lose. Under the government’s proposal, new parents with workplace schemes that are more generous than the federal scheme won’t be able to access public funds. Up to 100,000 Australian nurses and midwives could lose access to publically funded PPL. In an extraordinary attack, the government labelled women who access both their employer’s PPL and the government’s scheme as ‘double dippers’. Federal Treasurer Joe Hockey described the system as ‘fraud’, while Social Services Minister Scott Morrison said it was a ‘rort’.

The importance of PPL The government seems to have missed the point entirely on why PPL is vital to Australia’s future. A good PPL scheme provides significant economic benefits because it more efficiently returns employees who have been on parental leave to their jobs. QNU Assistant Secretary Sandra Eales said the government’s commentary on scaling back the current PPL scheme to crack down on ‘double-dippers’ was flatout wrong. “Paid parental leave is not some scam or loophole which new mums exploit to sit idly on welfare while others are working,” she said. “It’s a societal recognition of the value of a mother’s work to nourish and nurture the next generation.” The PPL scheme introduced by the former Labor government was designed to complement an employer scheme—not replace it. While the current scheme only offers 18 weeks’ leave, the intention is for parents

24 TQN JUNE 2015

to actually access closer to 26 weeks when combined with their employer’s contribution—a period recommended by the World Health Organisation.

From one extreme to another Prior to the 2013 election, Tony Abbott proposed a scheme that allowed a woman to access 26 weeks’ paid leave at her actual wage, with a cap of $150,000. Many criticised this proposal as a taxpayer subsidy for wealthy Australians who did not need it, and under public outcry it was later scaled back to $100,000. Mr Abbott then abandoned the scheme altogether after admitting his government was not prepared to fund it. Now it seems Mr Abbott has gone in completely the opposite direction. His current PPL plan is not only at odds with the scheme he took to the election— which favoured the wealthy over those on minimum wage—it is now less than what the current scheme provides.

Unions stand against the cuts Unions have moved quickly—not just to condemn the cuts, but to form a united front to campaign against them. Australian workers have given up a great deal to secure paid parental leave. This is a valuable social and economic policy which should be strengthened, not cut. The QNU has joined with other branches of the Australian Nursing and Midwifery Federation as well as the Queensland Council of Unions to stand against the cuts. The QNU and other unions joined new mothers at a protest in Brisbane’s CBD in early June, where Sandra addressed the crowd. “Women should not be financially punished for responding to the biological imperative to perpetuate human existence and survival, and to protect newborns and the young,” she said. QNU Assistant Secretary Sandra Eales addresses the crowd at the Brisbane rally.

www.qnu.org.au

I nte rna t i ona l ne ws

Concern is growing over the health implications for the millions of people affected by the twin earthquakes that struck Nepal in April and May.

www.qnu.org.au

Nepalese people carry aid shelter kits back to the remains of their homes

With people living in constant fear of another earthquake and not wanting to return to their homes, the psychological trauma will result in more people being displaced. If you would like to donate towards the recovery effort in Nepal, visit www.apheda.org.au Visit http://edition.cnn.com/2015/05/21/ health/nepal-earthquake-medics-health/ to read the full CNN story.

Shan clinic to receive annual funds from QNU The QNU has once again donated $10,000 towards the Shan Health Clinic, a service in northern Thailand that provides free medical assistance to Shan refugees fleeing persecution in Burma. The clinic, which is currently expanding to treat growing patient numbers, treats the refugees for diseases and injuries such as malaria, respiratory tract infections, TB, HIV, ulcers and landmine injuries. Some of the horrors facing Shan citizens include rape, torture,

Nepalese children

Photo: Heinrich Plum (Flickr)

More than 8600 people were killed in the 7.8 and 7.3 magnitude earthquakes, the first hitting on 25 April and the second just three weeks later on 12 May. More than 17,000 injuries have been recorded, and about three million people displaced. The immediate concerns have been on medical services treating the injured for broken bones, spinal and head injuries, and other trauma wounds—a task made even more difficult after the majority of health facilities were destroyed in the earthquakes. But as reported by CNN, attention is turning to other health impacts such as malnutrition and infections facing communities where millions of people find themselves homeless. As Jesse Hartness from Save the Children explains, “In Nepal, you already have more than 50% of children malnourished. This was already a nutritional emergency.” Millions of people currently being crowded into temporary shelters also risk catching infections, such as measles. Pneumonia rates have risen due to large numbers of people sleeping outdoors, with 817 cases of acute respiratory infections reported between 2 and 8 May. Another key priority is ensuring people have enough access to clean water to maintain sanitation and hydration, and avoid cholera, skin and other infections. The often-overlooked mental health impacts will also put significant pressure on health systems.

Photo: Russell Watkins/DFID (Flickr)

Devastating earthquakes in Nepal bring major health concerns

extrajudicial killings, forced labour, and land confiscation. The service also runs educational, nutrition and vaccination programs, as well as training for medics. There is a strong focus on women and children’s needs in the camp, with the service providing free contraception to women and food supplements to pregnant and breastfeeding women and underweight children. QNU Secretary Beth Mohle said the $10,000 donation, which is donated through the ACTU’s Union Aid Abroad - APHEDA program, will ensure these much-needed services continue. “The work being done by those medics at the clinic is making a huge difference to some truly vulnerable people, and it’s vital that they continue to receive basic quality health care.”

JUNE 2015 TQN 25

C am p ai g n n e ws

HOW FAR AWAY ARE RATIOS? It’s been all hands on deck since the QNU secured a commitment from the new government to introduce nurse/midwife-to-patient ratios in Queensland Health facilities. Since the state election in January 2015, the QNU has been working in partnership with Queensland Health to ensure ratios are delivered as soon as possible. The QNU has identified the basic requirements for establishing ratios and skill mix levels that deliver an appropriate level of care. We continue to insist upon these basic requirements in our discussions with Queensland Health.

Funding for ratios Following a more detailed analysis of the cost of delivering ratios across Queensland Health, submissions have been made by the Department of Health for the 2015/16 Queensland budget process.

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How money for ratios is secured The following is an extract from Queensland Treasury:

1. Strategic and budget planning The Cabinet Budget Review Committee (CBRC) considers an overall strategy for the budget. CBRC identifies key areas for resource allocation that respect the government’s priorities, fiscal principles and key budget decisions. (The QNU, for the first time, has consulted and collaborated with Queensland Health in this process, resulting in the Department of Health making a submission to the CBRC regarding the delivery of ratios and other government nursing policy commitments.)

2. Forward estimates update With information from agencies, Queensland Treasury updates the forward estimates, that is, the budget for the current year and next four years. The forward estimates include expenditure estimates and revenue forecasts which are updated on a ‘no-policy change’ basis, before any budget decisions are made. This information forms the baseline for CBRC consideration of budget submissions.

3. Budget submissions Departments set their service delivery priorities for the coming budget, taking into account factors such as the government’s priorities, their own strategic plans, intergovernmental relations, and community and Ministerial feedback. Departments prepare budget submissions outlining existing activities and new policy proposals for the coming budget. Treasury and Department of the Premier and Cabinet brief CBRC on agency budget submissions.

(The Department of Health has produced its preliminary submission regarding the government’s nursing policy commitments including ratios following considerable discussion with the QNU.)

4. CBRC meetings CBRC considers departmental budget submissions to decide which proposals are to be implemented. CBRC may choose to meet with each Minister to discuss their budget submission.

5. Budget development and forward estimates update The budget for the current year and next four years is updated to incorporate budget decisions of CBRC. Budget numbers are then finalised.

6. Budget day On budget day, the Treasurer tables budget documents and introduces annual appropriation bills to the Queensland Parliament.

7. Budget approval Budget documents are reviewed through a series of parliamentary estimates committees, which comprise government and opposition members. This process informs general parliamentary debate on the budget and ensures the accountability and transparency of the overall budget process. The budget is usually approved and appropriation bills passed. This year budget week is in July. Note the budget process doesn’t currently measure savings achieved in reduction of adverse patient outcomes and cutting unnecessary costs through ratios. The Ratios Save Lives campaign endorses a process to capture evidence that demonstrates the positive longterm benefit of ratios.

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CAMPAIGN NEWS

Turning ratios into law

Momentum for ratios building around the world

Work is also under way to put ratios into law. Legislating ratios makes compliance a legal requirement. This law needs to set out how ratios are monitored and reported, and how health services are complying with ratios and skill mix levels against quality of care indicators and governance frameworks. The QNU understands Cabinet will consider submissions regarding ratios legislation in June and July.

Who gets ratios ﬁrst? The QNU believes ratios should be implemented in a staged and agreed approach where new nurses and midwives will be allocated against set criteria targeting the greatest areas of need first. QNU Council has prioritised regional, rural and remote areas because there are known significant deficits in health care services and poorer health outcomes in many of these communities. Specific areas of need in metropolitan areas should also be prioritised. Speciality services with an identified state-wide staffing deficit (such as mental health, maternity, and paediatrics) and services with higher levels or frequency of adverse events should also be prioritised during the first phase. A state-wide escalation system must also be developed to support frontline staff in the reporting and responsive management of unsafe workloads.

So what can you do right now? Make sure the Business Planning Framework (BPF) is properly applied. The BPF can improve ratios and skill mix levels so nurse and midwife staffing levels match patient needs as they change. You should be aware of the notional nurse/midwife-to-patient ratio which applies to each shift you work. To ﬁnd out more visit www.qnu.org.au/workloads

RATIOS

SAVE LIVES www.qnu.org.au

Private hospitals and aged care ratios Achieving ratios in the private sector won’t be easy—but we are firmly focused on ensuring you can provide the same level of care to your patients and residents no matter where you work. Once we achieve ratios in Queensland Health, our opportunity to achieve change in the private sector will be greatly strengthened. Currently we are seeking to include ratios in future enterprise agreements for nurses and midwives in the private sector. Members are starting to get active in these campaigns. If you would like to know more about the status of your enterprise agreement, please contact your local organiser or representative. In aged care, the QNU has learned the Department of Social Services will undertake a pilot study on residential aged care facilities from May to September. The QNU will seek to actively engage with this project, particularly on the importance of adequate staffing numbers and skill mix to high quality care. For more information visit www.ratiossavelives.com.au

On International Nurses Day, the global trade union federation Public Services International (PSI)—which represents 20 million workers in 160 countries—called on governments, the UN, and health service operators to implement safe staffing policies. Safe staffing through nurse-patient ratios is a proven method to ensure that the necessary staff are available when needed. There is ample evidence that patients are exposed to unnecessary health and vital risks when nurseto-patient ratios fall below safe levels. Mandated minimum staff-topatient ratios save lives, by setting standards below which care must not fall.

Be proud to be a Patient or Resident Safety Advocate We need eyes and ears in every ward, area, and unit in every workplace to help ensure nurses and midwives and those in your care are safe. Find out more about becoming a Patient or Resident Safety Advocate at www.ratiossavelives.com.au

JUNE 2015 TQN 27

Fe at u re

ETHICS IN NURSING

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ETHICS IN NURSING

Ethical decision-making is fundamental to nursing and midwifery. Nurses and midwives constantly make decisions about the provision of care and many involve ethical considerations. These ethical factors might be considered through a formal discussion with colleagues, or they may come from the nurse’s or midwife’s existing knowledge and experience. However they are made, ethical decisions are moral decisions, grounded in the basic principles of patientcentred care and ‘doing the right thing’. The principles of ‘justice’, ‘beneﬁcence’, ‘non-maleﬁcence’, and ‘autonomy’ help to guide the debate that goes on internally within us and also any larger theoretical debate with colleagues.

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What are ethical decisions? Most often, ethical decisions present themselves on the spot and have to be made quickly and correctly. In practical terms, nursing and midwifery ethics means doing the right thing by the patient. Note that we have not said doing the right thing for the patient. This is because stating that might indicate the basis for the ethical decision was the health care imperative to prolong life. However, ethical decisions are not necessarily based on the nurse or midwife’s values, but instead should primarily be based upon the values and beliefs of the patient.

What happens when value systems conflict? Ethical conflicts between a nurse or midwife’s and patient’s value systems become obvious when we consider patients who refuse treatment for a terminal illness or for a life-saving procedure. Dilemmas can also arise when patients make a decision, or provide an advance health directive, that becomes a ‘do not resuscitate’ order.

When do ethical dilemmas arise? In modern times, these dilemmas are being discussed at the professional level and there is a better understanding that the patient’s values and belief systems are at the core of good ethical decision-making. The ethical decisions you make every day will be apparent in the outcomes for the people in your care. For example, every day you decide how and when to distribute your time across your patients. If you make good decisions, patient outcomes will be good. However, poor decisions often result in adverse outcomes. You may be required to formally justify the reasons for your decisions. The following scenarios pose difficult ethical decisions—difficult because each has potential to cause conflict with the economic imperatives of the employer. Unfortunately these scenarios have been selected because they are very similar to real-life events that have resulted in nurses having to justify their decisions to Coroners or Nursing Tribunals— usually to the detriment of those who made the wrong ethical decision.

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Fe at u re SOME COMMON SCENARIOS Working short-staffed Consider a common scenario where your unit is working short-staffed due to the sick leave of one of your colleagues. Many nurses and midwives might think having to work short-handed is an industrial matter that needs to be raised with the union. Certainly there is a workload issue that needs to be dealt with at an industrialmanagerial level. However, when coming on shift to a situation of short-staffing, there is an ethical decision that must be made right away. When you’re one staff member down, an immediate situation is created where the overall time given to each patient will be less. Many nurses and midwives will try to pick up the extra workload so that all patients can still be attended to.

Patient transfer Another common hospital scenario might be the transfer of a patient to another unit because of pressure for beds in your high dependency unit. Whether a patient should be transferred out of a close observation unit is an ethical decision as well as a professional one. Doing the right thing by the patient means ensuring they receive appropriate care for presenting symptoms. Pressure for beds should not enter into the ethical considerations. If you have responsibility for the patient on the given shift, then it is up to you to consider the ethical aspects of the request to transfer the patient. Whenever there is a real risk the other unit will not be able to provide the level of observation and care the patient’s condition requires, the right thing to do by the patient is to not transfer them to that other unit.

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As a result, they make time and workload management decisions that inevitably put a strain on the quality of their practice. But is accepting eight patients to care for instead of six doing the right thing by your patients? Is allowing the facility to save the cost of a casual or overtime nurse doing the right thing by your patients? The answer to both questions is no.

How to manage stafﬁng At the very outset of the shift, there should be a discussion with your clinical team leader about the ethical considerations of working shortstaffed. The focus of this discussion should be the rights of patients to receive safe and quality care and the team’s ethical responsibility to provide it. Once this discussion has happened and a good ethical decision made, workload management tools that postpone non-clinical work—such as the QNU Workload Management Reporting Form— should be used until additional staff are provided. Remember, the Tribunal has never accepted excessive workload as an excuse for a nurse or midwife failing to provide safe and quality care.

How to manage patient transfer Such a decision may bring you into conflict with managers requesting the transfer. It is vital you articulate your ethical concerns to your manager and make clear their ethical conduct could be called into question if they direct the inappropriate transfer of a patient. Always document such discussions in a diary or personal journal. If you find you are being pressured to conduct the transfer against your ethical judgment, raise the matter with the treating team, especially your supervisor and the treating physician. As with all ethical decisions, it is important to remember your professional responsibility to make them and to raise concerns. A recent coronial matter regarding the transfer of a patient from a surgical

unit to a rehab unit saw the bed manager and the treating physician both place blame for the inappropriate transfer upon the nurse on shift who transferred the patient.

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ETHICS IN NURSING

Medication management— Carers checking S8 medicines In aged care, medication management is a common ethical dilemma, specifically who the most appropriate person is to prepare and administer S8 medicine. Many aged care facility managers encourage their RNs and ENs to allow carers and AINs to check S8 medicines. If you are the RN responsible, whether onsite or not, you have a duty of care to each and every resident in the facility to ensure they receive the correct medication. Controlled (S8) drugs are so designated due to their potential to cause harm or dependence in the patient. It is standard professional nursing practice that when an S8 drug is to be administered, two nurses independently check the 7R’s of medicine administration prior to the drug being administered. This has always been done by two RNs or an RN and an EN (without notation). The administration of an S8 drug is just as dangerous in an aged care facility as in a hospital—in fact it arguably carries even greater risk due to aged body systems and the high prevalence of multiple co-morbidities. If you worked in a hospital and asked an AIN to check the morphine with you, it is likely you would be asked to show cause as to why your employment should not be terminated. Poor skill mixes in aged care facilities, where the nurse will find themselves as the only RN or EN on duty, creates problems for nurses seeking to comply with their mandatory obligations to display both ethical and professional conduct.

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How to manage checking S8 medicines Ethical conduct in doing the right thing by the resident means ensuring S8 checks are done according to professional standards. This means an independent check completed by another nurse with an NMBA-approved qualification in medicine administration. However, with only carers to assist you, there will be an obvious ethical conflict here. In this circumstance, you are being asked to compromise your professional obligations due to facility staffing and medication management policies that have been created to accommodate the cost restrictions imposed by the employer. Ethical conduct in this situation is to challenge the facility policies that created the ethical dilemma. This can be done through collaborative discussions with the facility managers in a way that identifies your mandatory obligations, exposes the ethical conflict of duty-versuseconomics, and highlights the potential dangers of carers conducting S8 checks. A recent Coronial matter heard that just prior to a resident’s death, an RN used a carer to check an S8 medicine administered to the resident, as instructed by the facility manager. The RN gave a dose that was ten times the prescribed dose. Unfortunately, that RN no longer appears on the AHPRA register of practitioners.

Conclusion Whether we realise it or not, we make ethical decisions about patient care during each and every shift. The way we manage ethical conflicts inevitably affects patient care. Never assume your managers will solve the problem, because they are often partly to blame by complying with their senior managers’ instructions. Instead, raise your concerns, articulate the risks to patient care, engage in an ethical discussion, and ask your manager to take action. Only then can an ethical conflict be resolved—through the decision-making that is an essential and everyday part of safe and quality patient care.

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PROFESSIONAL

Federal report on mental health services released The federal government’s response to the National Mental Health Commission’s review into mental health services has caused concern among mental health stakeholders—including the QNU. The review assessed the efficiency and effectiveness of programs and services in promoting productive and satisfying community engagement for individuals experiencing mental ill-health and their families and support persons. The review indicates we are faced in 2015 with the same “disturbing picture” of failures of care and support for ordinary Australians living with mental illness. This is despite the numerous national and state mental health plans spanning more than a decade where the need for reform was a recurring priority. While the review found many examples of innovative and effective strategies at a service level, there is still a ‘patchwork’ of services, programs and systems for supporting mental health.

Worrying political response In the commission’s report, the chairman stated there is “an extraordinarily high degree of consensus as to the directions needed to create a system which promotes good mental health and wellbeing”. However, federal health minister Sussan Ley has made clear this is “a report to government and while many recommendations offer positive ideas, others are not considered conducive to a unified national approach or others require further investigation by experts”. Stakeholders have raised concerns about what the minister’s statement means about the Abbott government’s commitment to acting on the report’s recommendations. For more information, visit https://mhaustralia.org/tags/nationalmental-health-commission

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Timeframes remain unspecified and implementation of the recommendations relies on further “expert investigation”. It is still unknown what recommendations the federal government will support and when these will be delivered.

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NURSING AND MIDWIFERY RESEARCH

Pressure injury prevention pilot study: a follow-up BY DR RACHEL WALKER AND PROFESSOR LEANNE AITKEN FOR NCREN

The June 2014 issue of tqn reported on a pilot study testing the feasibility of silicone foam border dressings to reduce pressure injuries (PI) in high risk hospitalised general medical-surgical patients. This article reports on initial data from the study. More information about the study protocol can be found at Walker et al. (2015). Although there is evidence to indicate silicone foam border dressings can reduce PI in critical care and high dependency patients, their benefit in the hospitalised general medical-surgical patient population is less clear. Eighty patients assessed as being high risk for PI were recruited and randomly allocated to either a control group (routine care) or an intervention group (routine care and a sacral prophylactic dressing). At each 72 hour point following recruitment, de-identified high resolution digital photographs were taken of each participant’s sacrum and emailed to a blind assessor for evaluation. The study aimed to assess feasibility criteria to inform a larger study. In total, 67 participants completed the study.

The ﬁndings Only three participants were assessed as having a PI—these patients all had significant co-morbidities (two were allocated to the dressing group) and all PIs were assessed as Stage 1. The low incidence rate may be due to the impact of PI prevention and management strategies and guidelines which provide

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Professor Leanne Aitken (NCREN), Mr Sean Birgan (Director of Nursing, Division of Surgery), and Ms Elizabeth Garrahy (Assistant Director of Nursing, Division of Surgery ) from the Princess Alexandra Hospital with new joint-appointee Research Fellow Dr Rachel Walker.

advice on assessment, prevention and treatment strategies, staff education and ongoing evaluation (Australian Commission on Safety and Quality in Health Care (ACSQHC) 2011, Australian Wound Management Association 2012, National Pressure Ulcer Advisory Panel 2014). The blind assessor was able to correctly identify participants in the dressing group 67% of the time due to atraumatic markings left on the skin from the dressing. While the majority of patients found the study dressing comfortable, there were challenges associated with length of time the dressing remained in situ due to:  the edges of the dressing rolling-up as participants mobilised  reduction of adherence during hygiene cares  removal of the dressing during lumbar surgery or spinal block . Although a program of information sessions was undertaken to prepare nursing staff in the participating wards prior to the commencement of the study, evaluation feedback indicated many clinicians were not aware of the study before it started.

This suggests more time is needed to prepare nursing staff for research studies. Given the very low incidence of PI, a sample size of 1500 (750 in each group) will be required to test the effectiveness of these dressings in reducing the incidence of PI. Nursing leaders and clinicians at the Princess Alexandra Hospital provided support for this study. This commitment to nursing research was recently progressed with the creation of a Research Fellow position jointly funded by NCREN and the Division of Surgery.

References Australian Commission on Safety and Quality in Health Care (2011) National Safety and Quality Health Service Standards, Sydney. Australian Wound Management Association (2012) Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury Abridged Version, Osborne Park, WA, Cambridge Printing. National Pressure Ulcer Advisory Panel (2014) Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, in E. Haesler (Ed.), Perth, Australia, Cambridge Media. Walker R, Aitken LM, Huxley L, & Juttner M (2015) “Prophylactic dressing to minimize sacral pressure injuries in high-risk hospitalized patients: a pilot study”, Journal of Advanced Nursing 71(3), 688-696.

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C A S E ST U DY

Continuing professional development

Violence in our health sector BY JESSICA GADD

This article is an edited extract. The full article can be found in Australian Nursing and Midwifery Journal, Vol. 22, No. 10, 2015.

Compensation claims for the health sector reveal a disturbing truth— nursing is one of the most dangerous professions in Australia. Safe Work Australia records that during the years 2000-2013 hospitals (10%) and residential care services (12%) together account for 22% of violent incidences in the workplace that resulted in an accepted compensation claim for physical or mental injury. But that is just the successful compensation claims. The Australian Nursing and Midwifery Federation (ANMF) believes that only a fraction of aggressive and violent incidents are actually reported. A more accurate indication of violence levels might be reflected in a recent Monash University study involving 5,000 nurses, which found that an average of 38 nurses are assaulted every day. This equates to more than one nurse being assaulted per hour, every day, every night, 365 days a year.

High-risk hot spots James Gilbert, Health and Safety Officer at the Queensland Nurses’ Union, also reports an increase in violence and aggression towards nurses. “We have seen an increase in nurses coming to us reporting assaults in recent years. I recently attended a police station with a member who wanted to report an assault. “He’d been spat in the face by a mental health patient who was unhappy about being discharged. “In 2013 we had an extreme situation where there was almost a riot in a mental health institution, where a number of patients conspired to attack the nurses.

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“And the other problem, of course, is issues around patience. Often workloads mean long waiting times, and perhaps it’s a reflection of our culture, but many people don’t like to wait—the reactions can be a bit like road rage.”

Spotlight on assaults Safe Work Australia’s data reveals that violence and aggression towards nurses has risen steadily over the past 12 years, going from about 400 healthcare and Social Assistance sector compensation claims in 2000-2001, to more than 1,200 in 2012-2013. The types of assaults being committed vary but many are extremely serious— some of the violent incidents recently reported to the ANMF Vic Branch include a nurse being left unconscious following an assault by a patient who then dragged the nurse away from the area, a nurse strangled and dragged down a hospital corridor, a nurse concussed after receiving a blow to the head from a patient. Sue Cowling, ED Nurse Unit Manager at Melbourne’s St Vincent’s Hospital says that while a rise in assaults is a worrying trend, and a rise in Code Greys is not necessarily a negative. “If a hospital shows an increased number of Codes that is not necessarily a reflection of an increase in violence—it could be a decrease in staff tolerance to aggression and an increase of staff awareness and confidence to call a Code.”

Law and order The Queensland state government introduced tougher penalties for harming health workers in 2014, as part of its Safe Night Out Strategy. But QNU’s James Gilbert says that past experience has shown this is not necessarily an effective deterrent.

“Our concern with that is that the horse has already bolted. “As far back as 2008 the Queensland Nurses’ Union got the previous government to change the law so that offenders could be charged with serious rather than common assault—but we didn’t see it used. “People on drugs and alcohol just don’t think like that.”

Combating a culture of under-reporting “There is a system for reporting—but the official level of reports has stayed the same for a long time, even though we have seen an increase in the number of nurses speaking to us about the issue,” says QNU’s James Gilbert. “For example, I recently visited a workplace that we’d been told had a number of incidents but when asked the employer could only give me five incident reports. So we don’t think it’s accurate.” Mr Gilbert believes there is a culture of not reporting violent incidents; in part due to the extra time required to report, but in Queensland exacerbated by confusion about which reporting system to use. He says that many nurses report incidents using the patient-focused, clinical Prime Incident System—which is right and proper, but often the incident should also be reported via the Incident Management System (IMS), which is specifically for the reporting of occupational violence. Given they need to make two reports, it’s little wonder nurses don’t bother, Mr Gilbert says. Not only that, the Incident Management System does not give the nurse a copy of the report made, which makes it difficult for them, their workplace, and the QNU

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CONTINUING PROFESSIONAL DEVELOPMENT

to keep track of the amount of reports being made. “Nurses say they get on the computer and have to fill out four or five screens only to find once submitted they do not get a copy—and there have been incidents of the reports going missing too.”

Training NSWNMA General Secretary Brett Holmes believes that nurses are being asked to deal with situations for which they are not always equipped or trained. “When it comes to responding to or managing violent incidences, the minimum training we would recommend is two full days, face-to-face.” “But that’s a minimum—in reality nurses need more training than that to deal with these sorts of violent situations.”

Where to from here? ANMF Victoria OH&S Unit CoordinatorKathy Chrisfield says she feels positive about the Victorian government and the future handling of the issue of violent behaviour in the health sector. “We need to see some guidelines and to see facilities held to account, and we need this from WorkSafe Victoria as well. I am hopeful that there will be a different approach.” James Gilbert is less positive, but still hopeful about the prospects for the new QLD state government to address this issue. “We are hoping the new government will work with us strategically to address occupational violence in the healthcare sector. “We want improved public awareness, barriers within the physical environment and government commitment to transparency about when assaults occur.”

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Reﬂective exercise for case study over page

JUNE 2015 TQN 35

C A S E ST U DY

CONTINUING PROFESSIONAL DEVELOPMENT

Completing this reﬂective exercise will contribute to your Continuing Professional Development (CPD) hours. The Nursing and Midwifery Board of Australia requires all nurses and midwives to complete a minimum of 20 hours CPD per registration year for each respective profession for which the individual holds current registration. For example, an individual who is a Registered Nurse and a midwife must complete 40 hours of CPD. Please refer to www.nursingmidwifery board.gov.au/ Registration-Standards. aspx for full details. Effective learning is not simply reading a journal article—it requires you to reﬂect on your readings and integrate new information where it is relevant to improve your practice. It should include:

 looking for learning points/objectives within the content on which you reﬂect  considering how you might apply these in other situations to enhance your performance  changing or modifying your practice in response to the learning undertaken.

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Reﬂective exercise: Violence in our health sector The following questions are offered as a guide to assist you in identifying your learning from reading and analysing the content of the article. Explain and analyse the following questions: 1. Does your facility provide regular training specific to managing aggression and/or protecting yourself from workplace assault? If so, consider whether the training they provide is sufficient or frequent enough to allow you to identify and manage potential aggressive incidents. If it isn’t sufficient, what could you do to improve this vital safety initiative? 2. Any patient has potential to be aggressive. The anxiety of being admitted to hospital, or an altered mood from being ill, can trigger aggression. Aggression risk assessments are standard procedure in psychiatric facilities, but do you think general medical facilities should conduct aggression risk assessments at admission? What sort of criteria would you consider important in such an assessment, or in determining whether an assessment should be conducted? 3. In your facility, when is it necessary to call a Code Black? What is the difference between a Code Black and a Code Grey, and why is there a difference? What criteria in your specific work environment would warrant a Code Grey to be called? 4. Violence from visitors can be more concerning that that from health-

compromised patients. Does your facility have a policy on non-clinical aggression and how to manage it? 5. Do you agree that bullying and harassment is a form of workplace violence? Does your facility provide regular training on bullying and harassment? Does the policy and training allow you to easily recognise bullying? If you or another staff member were being bullied, how would you manage that? Remember, the QNU provides extensive professional advice for all work sectors through our information sheets. These can be accessed on the members-only section of our website, or by calling QNU Connect. What inﬂuence will these changes have on your professional practice? To meet the NMBA CPD standard it is important that you can produce a record of CPD hours, if requested to do so, by the board on audit. The time spent reading this article, reviewing the referenced material and then reﬂecting upon how to incorporate the information into your practice will contribute to your CPD hours. Please keep a record of time spent doing each activity in your CPD record.

THE FOLLOWING IS AN EXAMPLE ONLY OF A RECORD OF CPD HOURS (based on the ANMF continuing education packages): Date

Topic

Description

Learning Need OR Objective

Outcome

CPD hours

27-03-14

Coroner’s matter – workloads

Understanding the implications of the Coroner’s recommendations for the establishment of effective workload management strategies

To increase my knowledge about the consequences of workloads demands and skill mix deﬁcits on patient safety

I have achieved a greater awareness of…..

2.5 hrs

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MIDWIFERY

Power in partnership – maternity reform over the past decade BY SANDRA EALES, QNU ASSISTANT SECRETARY

Recently I attended a 20-year celebration at the Royal Brisbane and Women’s Hospital where I met with activists from groups working alongside the QNU to advance and protect midwifery over many years. These groups include Friends of the Birth Centre, Maternity Choices Australia, and the Australian College of Midwives. Conversations on the day recalled events in 2005, when the QNU joined with midwives, mothers and families to defend the Birth Centre following the Australian Medical Association’s public attack outrageously labelling it the “killing fields”. This type of alliance has been necessary to defend many of the midwifery services developed across the state in the last 10 years, as the dominant medical profession continues attempts to suppress midwifery practice. The state of midwifery was put in the spotlight when, in 2004, the Beattie government commissioned an independent review of maternity and birthing services in Queensland, led by Dr Cherrell Hirst. The review came in response to lobbying by consumers and midwives and after 36 of the state’s 84 maternity services in the public sector were closed in the space of 10 years. Dr Hirst released her “Rebirthing Report” in 2005, which contained numerous recommendations to improve access to primary midwifery services and identified the need to make structural adjustments to allow midwives more control over their professional practice. Unfortunately, some of the fundamental problems identified by Dr Hirst remain unresolved today. As the report highlighted then, “Even if a midwife provides almost all (care), a doctor will still be named in hospital records as the responsible officer for

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Midwives past and present at RBWH Birth Centre 20 year celebration.

care. Such unclear role delineation sits uncomfortably for both doctor and midwife and needs to be resolved as a matter of priority”. Additionally, though Medicare is now available for private midwifery services, the majority of midwives are employed by hospitals and have little authority over their practice due to barriers within a doctor-centric system.

Working towards a stronger profession Earlier this year Queensland Health awarded a contract to the Australian College of Midwives to develop a Midwifery Practice Scheme (MPS). The MPS is to provide a framework of processes, policies and guidelines supporting the ongoing development of midwives, with the aim of assisting a professional indemnity insurance product becoming available for private practice

midwives, covering all the services they provide. Individual midwives can contribute to its development by participating in advisory groups and surveys, which will inform the final scheme. The QNU also convenes the Midwifery Stakeholder’s Group, with key members representing the Australian College of Midwives, Maternity Choices, Midwives in Private Practice, and the Department of Health. By building political influence and working alliances, the QNU works towards the ultimate goal of strengthening midwifery options for the benefit of women and midwives. We have made some progress towards our shared goals over the past 10 years, and through our partnerships with women and other midwives we will find ourselves in an even stronger position over the next decade.

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HEALTH AND SAFETY

Workers’ compensation in Queensland to be restored Prior to the recent state election, Annastacia Palaszczuk made an election commitment to “restore the rights of Queenslanders injured at work”. The state government has now commenced a review of workers’ compensation legislation, including discussions between government, unions, employers and legal representatives. QNU Secretary Beth Mohle is one of three Queensland Council of Unions representatives on this review. The commitments given by the government include: 1. Removing the 5% degree of permanent impairment threshold to access common law damages. 2. Removing the ability of an employer to ask a worker applying for a job to access their workers’ compensation history. 3. Enhanced mechanisms to assist injured workers with rehabilitation and return to work. The QNU fully supports these changes. Many QNU members have been affected adversely by the LNP government’s laws, and anything that can be done to help those disadvantaged by this appalling legislation should be investigated.

Returning powers to your unions and HSRs There is also action on making all workplaces safer with the removal of the previous LNP government’s legislation that restricted your union’s ability to enter the workplace on health and safety issues. The bill being considered by parliament will also

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reinstate the important power of an elected Health and Safety Representative to order that unsafe work cease. There is also a proposal to require employers to advise Workplace Health and Safety Queensland of any injuries that cause a worker to be off work for more than four days. Again the QNU supports this proposal and will be making a submission backing the proposed changes.

Federal government moving us backwards on safety While these things are being fixed, the federal government is busily working on ways to allow employers in state-based workers’ compensation schemes to move to the federal scheme. Coupled with this, they have introduced further bills to parliament that would make this workers’ compensation scheme, commonly known as Comcare, the worst in the country. The ACTU has considered the proposed changes and believes they will mean injured workers—particularly older workers with pre-existing conditions— will be severely disadvantaged by restricting eligibility for certain injuries to compensation. This is particularly important for Queensland nurses and midwives. We are an ageing workforce, and many of us have age-related degenerative conditions. If any Queensland Health employer moved into the Comcare scheme, you could be subject to these laws if they pass. This could mean where you were previously covered, you no longer would be. The QNU and other unions are actively engaging with non-coalition senators to try and stop this legislation becoming a reality. The changes proposed by the Abbott government are so bad, even the Newman Government opposed them!

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SOCI AL

CLOSING THE GAP – a Queensland nurse’s tale In March of this year, I was honoured to be nominated by the QNU to attend the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) parliamentary event held in Canberra. It was a wonderful opportunity to meet Janine Mohamed, Chief Executive Officer of CATSINaM, along with other key guest speakers including parliamentarians from both sides of government. Of course, it was also a great occasion to meet with nurses and midwives from all over Australia who are collectively are working towards ‘closing the gap’ on indigenous health issues. The three main purposes of the parliamentary event were:  Raise the profile and secure ongoing funding for CATSINaM and its role in health within the government’s Indigenous Affairs agenda.  Engage all sections of parliament on the role and effort of all nurses and midwives to close the Aboriginal and Torres Strait Islander health equality gap.  Engage all sections of parliament on the continued need to recruit Aboriginal and Torres Strait Islander nurses and midwives. Katarina Keeler, one of the key speakers at the breakfast event, is an inspiring

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BY TERESA MCGORM, PUBLIC HEALTH NURSE, DARLING DOWNS PUBLIC HEALTH UNIT

young Aboriginal and Torres Strait Islander woman. She grew up in rural South Australia, and has recently realised her dream by graduating as a Registered Nurse. Katarina’s wish is to be able to make a difference in the lives of her family, her community, and all Indigenous peoples. Katarina will commence work at the Darwin Hospital in April.

Indigenous Childhood Immunisation Strategy in the Darling Downs The Darling Downs Public Health Unit’s Indigenous Childhood Immunisation Strategy aims to close the gap between Indigenous and non-Indigenous children at the 12-month immunisation milestone. The key objectives:  Identify all Indigenous children born within the Hospital and Health Service prior to discharge from hospital.  All Indigenous children to have their first immunisation appointment booked by the time they are 28 days of age.  All carers of Indigenous children are sent a reminder prior to the child’s immunisation appointment. Collaboration with key stakeholders such as Indigenous Health Workers, Maternity Units, Aboriginal Medical Services and the Medicare Local Closing the Gap

Team are integral to improving the immunisation coverage rates. Education on Indigenous childhood immunisation is provided to all staff in antenatal clinics, maternity units and vaccine service providers to ensure knowledge is current. It is essential that all Indigenous children are identified at birth and certainly prior to discharge from hospital to enable prompt follow up. This information is then entered into a database with the child’s details and their carer’s details. The Indigenous Health Worker contacts the child’s carer when the child is 28 days old to provide information on immunisation and make an appointment for the child’s first vaccination at six weeks of age. Prior to the scheduled appointment, a reminder is sent via text message. The Indigenous Health Worker checks the immunisation database after the scheduled appointment—if there is no record of vaccinations being administered, follow up is undertaken by phone call or letter. There is still a long way to go before we truly close the gap—but collaborative efforts between a range of health care providers such as this are a step in the right direction. Acknowledgement to our colleagues at the Hunter New England Public Health Unit in New South Wales.

JUNE 2015 TQN 39

PROFILE

The pathway to becoming a QNU Organiser When a workplace issue arises, the ﬁrst point of contact nurses and midwives often make with their union is with a workplace Organiser. QNU Organisers are themselves experienced nurses and midwives, who work closely with members on the ground to guide the process of resolving issues and supporting them to enact change. In the following Q&A, four of our Organisers speak about their role and how they made the transition from an activist to an Organiser.

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What made you become active in the QNU? Sarah Beaman: I could see that there were things happening on wards that weren’t right, and I wanted to know how to fix them. And that’s often the hard part—knowing where to get that information so you can take the next step. So I did some training through the QNU which taught me how to develop a local branch, what my entitlements were, and what the role is of a workplace representative. That led to me putting myself forward as a delegate. As a delegate, I worked hard to explain to my colleagues that they were the union, and that any change ultimately has to come from them.

Kate Snowball: When I was a nurse I always felt comfortable meeting with management and bringing issues to the table. So long as the issue was reasonable, I had no problem speaking up. While I was working as a RN in a private hospital there were a number of issues going on and they needed more attention and involvement to fix them. After undertaking some training, I became more active in my workplace,

which then led to me becoming a workplace representative.

Susan Lines: I became active right from day dot, really. The QNU spoke to us when I was at uni, and very early on in my nursing career a QNU member took me under her wing and supported me. As a graduate, I had 21 patients in a cardiac surgical ward—really scary stuff. So I developed an awareness of what was going on and I didn’t like what I saw. The more knowledge I had the more active I became.

Linda Fuller: I have never been afraid to question things and I always assisted my colleagues when they had difficulties. After becoming more knowledgeable about the role of unions, I wanted to become more active, so it felt natural for me to become a workplace representative. I really enjoyed the role, and would quite happily question management and their decisions if I felt they weren’t quite right. I found it very rewarding to be part of a process where you can make a difference in your workplace.

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PROFILE

What made you decide to become an Organiser? Sarah Beaman:

Susan Lines:

Complaining without providing a solution isn’t my thing—I never wanted to be that union rep that just whinged about everything without providing an alternative. So I applied for the job as an Organiser because I wanted to be part of that change process.

I have a strong sense of social justice and have seen lots of injustices happening against nurses. I sought assistance from the QNU a few times when I was a nurse. When I had an issue in my workplace I put in a grievance, which opened the floodgates from the rest of the staff and we had a win. So seeing that work in action and what I could achieve for my colleagues led me to becoming an Organiser.

Kate Snowball: As a nurse I managed to get many members involved at the hospital to address the ongoing issues there. From those experiences, and after more training, I was encouraged to consider becoming an Organiser. Because I’d been nursing for 32 years, nursing was very much who I was, and making that change was a difficult choice. But having given so much of myself to supporting patient care, I decided it was time that I made that change and instead focus on the nurses themselves.

Linda Fuller: For me it was all about the challenge and a new career goal. It was a big decision to make— nursing was all I’d known since I was 19 and I’m very passionate about my nursing career. I felt I could still stay in touch with nursing and nursing issues, as well as assist my colleagues achieve better conditions and better outcomes.

What do you enjoy most about being an Organiser? Sarah Beaman: All the things I feel passionate about— ensuring there’s proper nurse and patient safety, access to quality care for all, proper resources—I work towards all those things every day. When I started working for the union, many people said to me, “Well what are you going to do when you finish at the union?” But I don’t see this job as a finishing point to my career, I see it as development, and it’s extremely rewarding.

Kate Snowball: Recently I had a group of nurses who weren’t getting their meal breaks. So I met with members and worked with them through the information they needed to take action, and in the end they got compensation. That sort of outcome is extremely rewarding because you see the members themselves driving the issue. The Organiser is there to support and guide them, but at the end of the day you can’t enact change without the members working together as the driving force.

Susan Lines:

Sarah Beaman Public Sector

Kate Snowball Private Hospitals

Helping others go from a state of panic to a state of calm and feeling confident to challenge and overcome the problems that are going on. In aged care, workloads and skill mix are horrendous… it’s a massive concern for me. It’s like 40 patients or residents to two AINs and not a RN in sight. And I feel a great responsibility to make change and make sure residents are safe.

Linda Fuller:

Susan Lines Aged Care

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Linda Fuller Regional

The challenge—every day is different. It’s very rewarding to work every day to make sure our nurses are getting a fair deal and processes are being followed, and not just being railroaded and disciplined for no reason. Every day you have to decide how you’re going to achieve your goals, and it’s a privilege to be able to help our members gradually make changes that ultimately improve the profession.

JUNE 2015 TQN 41

OPINION

Voter ID – a solution to a non-existent problem The recent Queensland state election was the first in Australia that required voters to produce ID to cast a vote. Voter proof of identity was promoted by former LNP Attorney General Jarrod Bleijie as a necessary measure to reduce the potential for electoral fraud—a claim made without substance or evidence.

Problem? What problem? Time and time again parliamentary inquiries have shown that electoral fraud is almost non-existent in Australia. At the 2012 Queensland election there were over 2.45 million votes cast and the Acting Electoral Commissioner advised parliament that he had referred only one person to the Queensland Police for multi-voting. At the 2013 federal election, of the 13.7 million votes cast, 65 people were referred to the Director of Prosecutions for multi-voting—but not one person was prosecuted. After most elections, the electoral commission finds a number of recordings of voters having cast more than one vote but later identifies administrative errors by polling booth staff. With a paper-based roll system it is easy for the wrong name to be crossed off, especially where there are a number of voters with the same name.

42 TQN JUNE 2015

Voter ID laws discourage voting Despite these facts, an analysis of the 2015 state election revealed the impact of requiring voter ID to be far reaching and discriminatory, especially towards those who are most marginalised in our society. Instead of ensuring integrity in our electoral system, it did the exact opposite by discouraging people without a current ID from voting. Evidence suggests the 2015 election had the lowest voter turnout of any election in the past 35 years, with only 89.89% of Queenslanders casting a vote. Coupled with the 15,000 people at booths who did not have ID with them, up to a possible 30,000 Queenslanders could not vote directly. And all to stop one or two people from multi-voting.

Real solution for a real problem Voter ID at best can only prevent a voter impersonating another—it cannot stop someone from voting more than once in their own name. Under the current paper-based system of electoral rolls, it is impossible to know if a voter has already voted elsewhere. Having real-time electronic rolls has been identified as the most effective way of avoiding errors and preventing multiple voting.

BY LINDA LAVARCH

Australia should learn from Queensland’s mistakes Thankfully, the Palaszczuk government has since repealed these voter ID laws. Unfortunately, the issue of voter ID has not been consigned to the dustbin of history as it should be. A federal parliamentary committee has now recommended changing the federal electoral laws to require voters to present identification when they vote. Therefore, there is real potential for it to be introduced at a federal level. The lessons learnt from Queensland should be told to all Australians to ensure the same mistakes are not repeated at federal elections. Instead of ensuring integrity, this socalled voter ID ‘solution’ is actually harmful to our democracy, as it undermines universal suffrage—the very hallmark of our democracy. Linda Lavarch is the QNU Director of Member and Specialist Services. She has served as Queensland’s Attorney-General from 2005-2009 and was a member of the Queensland parliament from 1997-2009.

Photo: Australian Electoral Commission

www.qnu.org.au

LIBRARY

QNU Library: a world of knowledge at your ﬁngertips QNU members have access to thousands of medical and nursing texts through the union’s very own library. Based in Brisbane but servicing members all over the state, the library is a great resource and just one of the many benefits of being a QNU member.

Loans from the QNU collection Books and videos are available for loan to all QNU members at no charge. Books can be ordered online, by phone, by fax, or by visiting the library. There is a maximum of 4 items per request.  Postage to members is paid for by the QNU with return postage being the responsibility of the member.  Periodicals are not available for loan but articles may be photocopied in the library.

Interlibrary Loans The QNU Library belongs to a network of health libraries (GRATISNET). Requests for photocopies of journal articles or books should be submitted on copyright request forms giving full citations. If requested, books can be supplied outside the GRATISNET network as an interlibrary loan. A fee of $6 may apply.

Samples of the citation required:  Journal articles NURSING MANAGEMENT Vol. 30 (9) Sep. 1999: pp. 16-17 KEELING, Bett. How to allocate the right staff mix across shifts.

 Books WATSON, Jean. Postmodern nursing and beyond. London: Churchill Livingstone, 1999.

Access to CINAHL Plus with full text Members are welcome to visit the library to access CINAHL, a database which indexes more than 4000 journals from nursing and allied health subject areas. Many but not all are full text. Until the beginning of October 2015, we are conducting an online trial of this database. During this time members will have remote online access to CINAHL and are urged to make use of this not only as a source of information but also as a way of developing online searching skills. Visit www.qnu.org.au/library to access CINAHL (members only).

Literature searches Charges for literature searches no longer apply. We encourage members to hone their library search skills, but if you have trouble finding relevant articles for assignments or accessing nursing information generally, the QNU librarian can conduct searches to find suitable citations.

Location: Level 1, 106 Victoria Street West End, QLD, 4101 Phone: 3840 1480 / 3840 1443

NORMAL LIBRARY HOURS Monday - Friday 9am–3pm (closed 1pm–2pm) T 07 3840 1480 E library@qnu.org.au W www.qnu.org.au/library Small groups can book the library for study sessions. Contact the library for details.

www.qnu.org.au

JUNE 2015 TQN 43

C ale n d ar JUNE Lung Health Promotion Centre at The Alfred 18 June, Paediatric Respiratory Update 24 June, Asthma Management Update Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au 18th Cancer Nurses Society of Australia Annual Winter Congress Cancer nursing: expanding the possibilities 14-16 June, Perth www.cnsawintercongress.com.au/ Renal Society of Australasia Conference Digging deeper: Golden opportunities to advance renal care 15-17 June, Perth http://rsaannualconference.org.au/ 16th Institute of Continuing Education (ICE) meeting (Australian College of Critical Care Nurses) Let’s Get Clinical 19-20 June, Adelaide www.acccn.com.au/events/event/ ice2015-adelaide Medical Imaging Nurses Association National Conference 19-21 June, Sydney www.minanational.com/ International Council of Nurses (ICN) International Conference and Council of National Representatives (CNR) Global Citizen, Global Nursing 19-23 June, Seoul, Republic of Korea. www.icn2015.com/ World Refugee Day 20 June www.un.org/en/events/refugeeday/ 3rd International Conference on Ageing in a Foreign Land 24-26 June, Bedford Park, SA www.ﬂinders.edu.au/ehl/conferences/ ageing/ ACN History Conference Disrupting discourses: new views on nursing history 29 June, Sydney www.acn.edu.au/history 3rd Annual Worldwide Nursing Conference 29-30 June, Singapore www.nursing-conf.org/

JULY ACN QLD Matters ACN presents the opportunity to hear firsthand and discuss critical issues affecting health care provision in your state or territory. 7 July 2015, Cairns www.acn.edu.au/qldmatters ACN NT Matters ACN presents the opportunity to hear firsthand and discuss critical issues affecting health care provision in your state or territory. 9 July 2015, Darwin www.acn.edu.au/ntmatters Lung Health Promotion Centre at The Alfred 14 July, Educating & Presenting With Confidence 15-17 July, Asthma Educator’s Course

44 TQN JUNE 2015

23-24 July, Smoking Cessation Course 30-31 July, Creative Behaviour Change Coaching For Chronic Illness Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au QNU Annual Conference 15-17 July, Brisbane Summer Global Nursing Symposium Nursing Practice, Nursing Education, Nursing Management, and Disaster Management 17-18 July. Los Angeles, USA www.uofriverside.com/conferences/ global-nursing-symposium/2015summer-global-nursing-symposium/ International Confederation of Midwives (ICM) Asia Paciﬁc Regional Conference Midwifery care for every mother and their newborn 20-22 July, Yokohama, Japan. www.icmaprc2015.org/en/general_ information.html ACN ACT Matters ACN presents the opportunity to hear ﬁrsthand and discuss critical issues affecting health care provision in your state or territory. 23 July, Canberra www.acn.edu.au/actmatters VPNG (Victorian Perioperative Nurses’ Group) State Conference Strategies for Success: Safety and Quality in Perioperative Care 30- 31 July, Melbourne www.vpng.org.au

AUGUST Lung Health Promotion Centre at The Alfred 7 August, Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 20-21 August, Spirometry Principles & Practice Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au Drug and Alcohol Nurses of Australasia’s (DANA) annual conference Many Faces of Addiction Forum 13-14 August, Sydney www.danaconference.com.au 12th International Family Nursing Conference Improving Family Health Globally through Research, Education, and Practice 18-21 August, Odense, Denmark http://internationalfamilynursing. org/2013/07/11/2015-conference/ 25th Meeting of the International Society for Neurochemistry 23-27 August, Cairns www.neurochemistry.org/biennialmeeting.html The MHS Conference Translating Best Practice into Reality 25-28 August, Canberra www.themhs.org Australian Diabetes Educators Association Annual Scientiﬁc Meeting 26-28 August, Adelaide http://www.adea.com.au/

National Forensic Nursing Conference 26 August, Melbourne www.informa.com.au/conferences/ health-care-conference/nationalforensic-nursing-conference

SEPTEMBER 2015 QNU Professional Practice and Ethics Seminar 4 September, Brisbane 5th International Conference on Health, Wellness and Society 3-4 September, Madrid, Spain http://healthandsociety.com/theconference QNU Meeting of Delegates 21 September, Brisbane 22 September, Gold Coast 29 September, Sunshine Coast 30 September, Cairns Australian Nurses and Midwives Conference Hosted by the Australian Nursing & Midwifery Federation Victorian Branch 10-11 September, Melbourne www.tiny.cc/2015abstracts Australian College of Neonatal Nurses Inc 10th Annual Conference and Skin Care and Skin Injury Symposium 10-12 September, Sydney www.acnn.org.au/news-and-events/ acnn-national-conference/ World STI & AIDS Congress 13-16 September, Brisbane www.worldsti2015.com Lung Health Promotion Centre at The Alfred 16-18 September/14-15 October 2015, Respiratory Course (Mod A & B) 16-18 September, Respiratory Course (Module A) Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au Australasian HIV&AIDS Conference 16-18 September, Brisbane www.hivaidsconference.com.au (to be launched soon)

OCTOBER Lung Health Promotion Centre at The Alfred 5-6 October 2015, Spirometry Principles & Practice 14-15 October 2015, Respiratory Course (Module B) 22-23 October 2015, Managing COPD Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au 40th National Conference of the Australian Association of Stomal Therapy Nurses Proactive and Innovative Strategies in Stomal Therapy Nursing 5–7 October 2015, Melbourne www.stomaltherapy.com/conferences. php International Indigenous Women’s Convention Our families, our communities: nothing about us without us 6-9 October 2015, Sydney

http://dreamtimepr.com/save-thedate-international-indigenouswomens-convention-sydneyoctober-2015/ 13th International Conference for Emergency Nursing Emergency Care: Accept the Challenge, Lead the Change 7-9 October 2015, Brisbane ww.icen.com.au/2015/ Perioperative Nurses Week 12-19 October. www.acorn.org.au/events/ perioperative-nurses-week/ Australian College of Nursing National Nursing Forum Advancing nurse leadership 14-16 October 2015, Brisbane http://acn.edu.au/forum_2015 International Day of Rural Women 15 October 2015 www.timeanddate.com/holidays/un/ rural-women-day 2nd Australian Nursing and Midwifery Conference Aspiration, inspiration and imagination: nursing and midwifery quality, research and education 15-16 October, Newcastle www.nursingmidwiferyconference. com.au CRANAplus 33rd Annual Conference Telling tales - The power of the narrative 15-17 October, Alice Springs https://crana.org.au/about/ conference/2015-conference/ Australian Day Surgery Nurses Association Conference Surﬁng the waves of day surgery 17-18 October 2015, Gold Coast http://adsna.info/conference/

NOVEMBER Lung Health Promotion Centre at The Alfred 11–13 November 2015 Asthma Educator’s Course 19-20 November 2015 Smoking Cessation Facilitator’s Course Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au Australian & New Zealand Orthopaedic Nurses Association (ANZONA) Conference Climbing to the Summit: Bridging research and practice in orthopaedic nursing 11-13 November 2015, Sydney www.anzonaconference.net/ Australian and New Zealand Society for Vascular Nursing Conference Working Together for an Integrated Vascular Approach 13-14 November, Adelaide

If you would like to see your conference or reunion on this page, let us know by emailing your details to dsmith@qnu.org.au

www.qnu.org.au

YOUR SUPER

Recognising outstanding achievements in nursing and midwifery It’s said that small acts can make a big difference. This is certainly true when it comes to the HESTA Australian Nursing Awards, with each person nominated receiving a certificate of recognition. “This gesture is an important part of the HESTA Australian Nursing Awards,” says HESTA CEO, Debby Blakey. “Recognition plays a vital role in rewarding professional achievement. “A certificate lets all those who’ve been nominated know their work is appreciated.” A $30,000 prize pool — generously provided by ME Bank — will be shared among the winners in three award categories: Nurse of the Year, Outstanding Graduate and Team Innovation. “It’s a great opportunity for patients, their families, colleagues or employers to say ‘thank you’, and to tell the community about Australia’s exceptional nurses and midwives,” Ms Blakey says. “The achievements of Australia’s remarkable nursing professionals are inspirational, courageous and innovative — and our awards are an avenue to share their stories.” HESTA CEO, Debby Blakey Nominations are now open for the 2015 HESTA Australian Nursing Awards. Winners will be revealed at the Awards dinner, where all finalists will celebrate with their colleagues, friends and family. To make a nomination or find out more about the awards, visit hestaawards.com.au HESTA is the super fund for health and community services, with more than 800,000 members and $32 billion in assets. More people in health and community services choose HESTA for their super. H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No.235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Terms and conditions apply, see hestanursingawards.com.au for details.

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Get hands on with your super! Superannuation is commonly one of the biggest investments anyone will have in their life and for some people, having control is a priority. At QSuper we understand some members want to get hands on with their super and our direct investment option, QSuper Self Invest, allows you to do just that! A genuine alternative to an SMSF, QSuper Self Invest is like having the best of both worlds, with the backing of one of Australia’s most trusted funds. You’ll have control over how your retirement savings are invested, similar to a self-managed superannuation fund, but instead of you doing all the administration paperwork and reporting, QSuper takes care of it for you. QSuper Self Invest gives you flexibility and choice with a range of investment options including: • Australian shares, • a transactional cash hub, • exchange traded fund (ETFs), and • term deposits. Our Member Online service means you can transact 24 hours a day, seven days a week with access to up-todate market research and data, including watch lists and charting to help you make the best possible investment decision. Add to this no set up fees and the ability to switch to another QSuper investment option any time you like, and you really do have all the support you need to get hands on with your retirement savings. So if you’re looking for a genuine alternative to an SMSF, find out more about QSuper Self Invest at www.qsuper.qld.gov.au/selfinvest or call 1300 360 750. This information is provided by the fund administrator, QSuper Limited (ABN 50 125 248 286 AFSL 334546) which is ultimately owned by the QSuper Board (ABN 32 125 059 006) as trustee for the QSuper Fund (ABN 60 905 115 063). Unless stated otherwise, all products are issued by the QSuper Board as trustee for the QSuper Fund. This information has been prepared for general purposes only without taking into account your objectives, financial situation, or needs and should not be relied on as legal or taxation advice, nor does it take the place of such advice. Consider whether the product is appropriate for you and read the product disclosure statement (PDS) before making a decision. You can download the PDS from our website at qsuper.qld.gov.au, or call us on 1300 360 750 and we’ll send you a copy. Where the term ‘QSuper’ is used it represents the QSuper Board, the QSuper Fund or QSuper Limited (as applicable), unless the context indicates otherwise. © QSuper Board of Trustees 2015

JUNE 2015 TQN 45

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Health Ed Professionals® & OSCA Health Education® Course lecturers Heather James & Anne Evans-Murray

Acute Cardiac Care Course Gold Coast: Monday 6 to Saturday 11 July 2015 Gold Coast: Monday 7 to Saturday 12 December 2015

Acute Complex Care Course Gold Coast: Monday 29 June to Saturday 4 July 2015 Caboolture: Monday 23 to Saturday 28 November 2015 Gold Coast: Monday 30 November to Saturday 5 December 2015 For Registered & Enrolled Nurses, Ambulance Officers, Students. Recognised for credit articulation at Griffith & QUT Universities as one elective subject for:

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 Pre-Registration B. Nursing,  Post Graduate Certificate courses  Post Graduate Masters courses. These courses are presented in intensive mode (9.00 – 5.00) over 6 days plus assessments, and are equivalent to a one semester university course in teaching and study time. The Complex Care course includes adult ALS certification. Endorsed by RCNA for award of 45 CNE points. Undergraduate students (Residents) $775.00 Gold Coast - $800.00 Caboolture RN’s /EN’s, AO’s $1,500.00/$1,525.00, O/S students: $1,600.00

Adult Advanced Life Support Level 2 – 2 days 11-12 June, 13-14 July, 13-14 August, 7-8 September 2015 Course cost: RN/EEN $625.00 Undergrad students $425.00 Doctors $895.00 ACN, RACGP & ACRRM Accredited

Adult Advanced Life Support Recertification 13 June, 15 July, 15 August 2015 Course cost: RN/EEN $350.00 Undergrad students $210.00 Doctors $450.00

More course information available from: info@healtheducation.com.au Heather James: 0407 135 332 or Anne Evans-Murray: (07) 5563 3054 All details & secure registration: www.healtheducation.com.au

Health Ed Professionals® 2015 Seminars with Australasian presenter Anne Evans-Murray

Clinical Assessment Skills Brisbane – 19 & 20 June – Hotel Jen, 159 Roma St This two day seminar will is suitable for nurses in any clinical area; complex conditions presented by Anne Evans-Murray, author of “ECGs Simply” and ‘Chest X-rays Simply”

There’s never been a better time to talk to RemServ.

Full: $450.00 One day: $230.00

Respiratory & Cardiac Nursing Skills

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Brisbane – 4 & 5 September – Hotel Jen, 159 Roma St This two day seminar will is suitable for nurses in any clinical area; complex conditions presented by Anne Evans-Murray, author of “ECGs Simply” and ‘Chest X-rays Simply”

Full: $450.00 One day: $230.00

Cardiac Arrhythmias – Basic to Complex Brisbane – 30 & 31 October – Hotel Jen, 159 Roma St Suitable for nurses in any clinical area; complex conditions presented by Anne Evans-Murray, author of “ECGs Simply”

Full: $450.00 One day: $230.00

These seminars are held at a great venue and include full catering, seminar notes and attendance certificates issued. .

Important Information: This general information doesn’t take your personal circumstances into account. Please consider whether this information is right for you before making a decision and seek professional independent tax or ﬁnancial advice. Conditions and fees apply, along with credit assessment criteria for lease and loan products. The availability of beneﬁts is subject to your employer’s approval. RemServ may receive commissions in connection with its services. Remuneration Services (Qld) Pty Ltd. | ABN 46 093 173 089 | Authorised Representative (No. 293159) of McMillan Shakespeare Limited (AFSL 299054).

Information available from Health Ed Professionals Pty Ltd Ph: (07) 5563 3054

Email: info@healtheducation.com.au

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Details & secure registration: www.healtheducation.com.au www.qnu.org.au

JUNE 2015 TQN 47

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THE THIN EN D OF THE WEDG E:

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how the government’s Newman changes to legislation will affect you

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What will happen to Medicare?

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Mention this advertt prior to completing your contract and get a bonus Fitbit Charge HR or an iPad Mini when your new vehicle is delivered!

Did you know that as a nurse, you have priority access to salary packaging your next car? Let the team at Fleet Network show you how to save thousands when buying your next new car. It’s all about getting the most out of your salary and paying less in tax. It’s worth a call – it’s your salary, after all.

1300 738 601 www.ﬂeetnetwork.com.au/bonus Fleet Network Pty Ltd. To qualify for this offer you must mention this advertisement to Fleet Network prior to the completion of your initial contract. Vehicle must be new and supplied by Fleet Network. Not valid in conjunction with any other current Fleet Network offers. Employees should consult their employer’s salary packaging policy before entering into a contract. *Subject to Employer policy. Vehicle for illustration purposes only.

From conversation comes growth. Spend a few minutes talking with us and see what a good financial plan could do for you. 1800 643 893

qinvest.com.au

QInvest Limited (ABN 35 063 511 580, AFSL and Australian Credit Licence Number 238274) (QInvest) is ultimately owned by the QSuper Board (ABN 32 125 059 006) as trustee for the QSuper Fund (ABN 60 905 115 063), and is a separate legal entity responsible for the financial services and credit services it provides. Advice fees apply. ÂŠ QSuper Board of Trustees 2015. 8522 05/15.