SAFE STAFFING
AGED CARE
REGULARS
More nurses critical for global health
Community protest halts ward merger plan
Royal commission counsel recommends ratios
page 14
page 20
page 22
Your rights and entitlements at work p.42 Nursing research online p.43 Crossword p.45 Reviews p.47
INTERNATIONAL YEAR OF THE NURSE AND THE MIDWIFE
THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 77 NO. 2 APRIL / MAY 2020
COVID-19
A HEALTH SYSTEM UNDER STRESS Print Post Approved: PP100007890
F lorence Nightingale (12 MAY 1820 – 13 AUGUST 1910)
“ I attribute my success to this: I never gave or took any excuse.” Florence Nightingale was a statistician and a trailblazing figure in nursing, who was instrumental in reforming 19th and 20th century polices on medical care. She was put in charge of nursing British and allied soldiers in Turkey during the Crimean War. Nightingale’s many hours in the wards and night rounds caring for the wounded established her image as the ‘Lady with the Lamp.’ Her efforts to formalise nursing education led to the establishment of the first scientifically based nursing school, the Nightingale School of Nursing, at St Thomas’ Hospital in London (1860). She was also instrumental in setting up training for midwives and nurses in workhouse infirmaries. She was the first woman awarded the Order of Merit (1907). International Nurses’ Day, observed annually on 12 May, commemorates her birth and celebrates the important role of nurses in health care around the globe.
torics al nurses hisw g ive n i d at d mi r b n Cele a
Authorised by B.Holmes. General Secretary, NSWNMA
CONTENTS Contacts NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including The Lamp subscriptions and change of address, contact our Sydney office. Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E gensec@nswnma.asn.au W www.nswnma.asn.au
VOLUME 77 NO. 2 APRIL / MAY 2020
Hunter Office 8–14 Telford Street, Newcastle East NSW 2300
8
NSWNMA Communications Manager Janaki Chellam-Rajendra T 1300 367 962 For all editorial enquiries, letters and diary dates T 8595 1234 E lamp@nswnma.asn.au 50 O’Dea Avenue, Waterloo NSW 2017
COVER STORY Coronavirus highlights lack of ICU nurses and equipment
Produced by Hester Communications T 9568 3148
Hospital staff struggle to cope with existing patient loads even before COVID-19 peaks.
Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au Editorial Committee Brett Holmes, NSWNMA General Secretary Judith Kiejda, NSWNMA Assistant General Secretary O’Bray Smith, NSWNMA President Michelle Cashman, Long Jetty Continuing Care Richard Noort, Justice Health Liz McCall, Byron Central Hospital Diane Lang, South East Regional Hospital, Bega Valley Printed by Ovato Print Pty Ltd 37-49 Browns Road, Clayton VIC 3168 Advertising Danielle Nicholson T 8595 2139 or 0429 269 750 F 9662 1414 E dnicholson@nswnma.asn.au Information & Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Adrian Hayward, Coordinator. T 8595 2175 E gensec@nswnma.asn.au The Lamp ISSN: 0047-3936 General Disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised. Privacy Statement The NSWNMA 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 the NSWNMA office. If you are still not satisfied that your privacy is being maintained, you can contact the Privacy Commission. Subscriptions for 2019 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $30. Individuals $84, Institutions $140, Overseas $150.
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COVER STORY
Coronavirus stress tests world’s health systems Lessons have been learned from previous epidemics, but the weakness of many countries’ health systems leaves everyone vulnerable.
14
I NTERNATIONAL YEAR OF THE NURSE AND MIDWIFE
More nurses critical for global health, says WHO WHO has designated 2020, the bicentenary of the birth of the founder of modern nursing, Florence Nightingale, as The Year of the Nurse and the Midwife.
18
REGULARS
5 6 36 38 42 43 45 47 49 50
Editorial Your letters NSWNMA Education News in brief Ask Judith Nursing Research Online and Professional Issues Crossword Book Club At the Movies Diary Dates
SAFE STAFFING
Outrage over jobs cut forces LHD re-think The town of Murwillumbah rallies in defence of its hospital and its nurses.
20
SAFE STAFFING
22
Community protest halts ward merger plan A plan to merge wards at Maclean District Hospital has been “deferred” in the face of growing community opposition.
SAFE STAFFING
AGED CARE
REGULARS
More nurses critical for global health
Community protest halts ward merger plan
Royal commission counsel recommends ratios
page 14
page 20
page 22
Your rights and entitlements at work p.42 Nursing research online p.43 Crossword p.45 Reviews p.47
INTERNATIONAL YEAR OF THE NURSE AND THE MIDWIFE
THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 77 NO. 2 APRIL / MAY 2020
AGED CARE
Royal commission counsel recommends ratios The legal team assisting the aged care royal commission has proposed sweeping changes to raise the numbers, skills and pay of the aged care workforce.
COVID-19
A HEALTH SYSTEM UNDER STRESS Print Post Approved: PP100007890
THE LAMP APRIL / MAY 2020 | 3
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An industry fund for all read our product disclosure statement before making a decision about First State Super. Call us or visit our website for a copy. Issued by FSS Trustee Corporation ABN 11 118 202 672, AFSL 293340, the trustee of the First State Superannuation Scheme ABN 53 226 460 365. *Our Growth option for super returned 7.7%. 1 year ending 30 June 2019. Chant West 2019 ‘Super Funds deliver record-breaking 10th straight positive year’. Investment returns are not guaranteed. Past performance is not indicative of future performance.
4 | THE LAMP APRIL / MAY 2020
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EDITORIAL
BRETT
Holmes GENERAL SECRETARY
The lessons of Covid-19 A well-resourced, robust health system is essential to combat pandemics. If the COVID-19 outbreak tells us anything it is the critical importance of public health preparedness. Three months ago it was a completely unknown virus, now it has spread globally, there is no known vaccine and many of the world’s health systems are ill equipped to deal with the clinical consequences. From a biological point of view outbreaks of new pathogens are inevitable. Over the last fifteen to twenty years there have been similar outbreaks: SARS, H1N1, Ebola, MERS and Zika. We should be much better prepared for these epidemics. Although some lessons have been learnt from previous outbreaks, many haven’t. Both China and the World Health Organization learnt from the SARS outbreak. China enforced drastic measures to contain COVID-19 near its epicenter in Wuhan for as long as possible. This gave WHO valuable time to bolster the weak health systems of the most vulnerable countries in Africa and Latin America (see pp 12-13). COVID-19 has exposed deeper deficiencies in the preparedness and funding of global health systems. As one expert has said: “Fewer than one in three countries are close to being prepared to confront an epidemic which leaves the vast majority of the world’s population vulnerable. That in turn leaves us all vulnerable because we are only as safe as the least safe place.” Even before the COVID-19 outbreak the World Health Organization (WHO) had made the spread of universal health systems its key priority. Tellingly, it identified nurses and midwives as the key to their spread and effectiveness. It is a major reason why it declared 2020 the Year of the Nurse and Midwife (see pp 14-15).
‘ I applaud you all for your calm, measured and professional response to these unprecedented challenges. We are with you every step of the way.’ WHO has a very clear message for governments and policy makers everywhere: more nurses are critical for global health and governments need to invest more in the nursing and midwifery workforce. WHO estimates that there is a global shortage of 18 million health workers including 9 million nurses. While Australia has an excellent health system we are not immune to this problem. The NSWNMA and the ANMF have campaigned relentlessly over a long period of time to alert governments and the public about the vulnerability of our own health services (and aged care). Even though it is the early days of the epidemic our health system is already under stress with nurses facing drastic increases in demand, shortages of equipment and a climate of fear and uncertainty among the public. I applaud you all for your calm, measured and professional response to these unprecedented challenges. I want to assure you, we’re doing everything we can to support all of our members. Whether that’s negotiating special leave with your employer, enforcing Work Health and Safety, especially around Personal Protective Equipment (PPE), answering your questions, or providing updates with the latest information. Your union is here for you and we’re working hard to keep you safe. As frontline workers during this health crisis, there’s no doubt nurses and midwives are going to experience unprecedented demand.
This is why the NSWNMA is urging the New South Wales Government to expedite its planned five thousand health ‘workforce boost’ promised at the last election and allocate extra nursing staff immediately. We’re making headway. Our ongoing negotiations alongside other unions we have won New South Wales Health employees access to 20 days of special paid leave for COVID19. We’re also in discussions with multiple private sector and aged care employers around special leave; isolation strategies and frameworks similar to the public sector. The Federal Government has implemented restrictions on visitors to aged care facilities and many LHDs are also limiting non-essential meetings. In light of this, and to ensure NSWNMA staff do not place unnecessary pressure on the health system, we will not be visiting hospitals or facilities unless the visit relates to a WHS matter and is urgent. We’ve increased the number of officers available to answer your questions and we are changing our systems to do that in light of the new circumstances we face. We’re also sending regular updates regarding your rights and entitlements. Given the increase in demand for advice and the need for members to contact us outside business hours, we’re working on improved methods to speed up our response times. We are making changes internally to ensure we can continue to provide members the essential assistance you all need from your union in unprecedented times. n THE LAMP APRIL / MAY 2020 | 5
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LETTER OF THE MONTH Grateful for help I am writing on behalf of the imaging nurses of John Hunter Hospital. We have been fighting a battle for safer staffing levels and better patient outcomes for a number of years. This letter is to express our thanks to NSWNMA. A particular mention goes to our organiser and our branch officers Suzanne McNeil and David Pfanner who have represented us fantastically. Each of these people have gone over and above in helping us fight for a very good outcome. I can’t express easily how much your help is appreciated, but please take this as a sincere thank you from a group of nurses who were ready to walk away from their workplace. We could not have achieved what we have without the help of these three people who made themselves available, even outside of work hours to help us with our fight. Maureen Fulmizi
Letter of the month The letter judged the best each month will win a $50 Coles Group & Myer gift card! Union Shopper offers members BIG savings on a wide range of products! unionshopper.com.au 1300 368 117
WIN The Lamp is offering NSWNMA members the chance to win a $750 travel voucher To enter the competition, simply provide your name, address and membership number and email your entry with the subject: Union Shopper competition to lamp@nswnma.asn.au *Conditions apply. Competition entries from NSWNMA members only and limited to one entry per member. Competition opens 1 April 2020 and closes 31 May 2020. The prize is drawn on 1 June 2020. If a redraw is required THE LAMP APRIL / MAY for6 an |unclaimed prize it must be held up to 32020 months from the original draw date. NSW Permit no: LTPM/19/04224
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Solidarity between city and bush
To the amazing RPA and Concord bushfire relief nurses who came to help us at SERH Bega after the fires – you were amazing! And as your thank-you letter to us said, you’re richer both professionally and personally for the experience. That goes both ways, as we are also richer for working side by side with you. Having you arrive when you did, not only brought relief to the physical workload, it also brought some sense of compassion, support and solidarity. To know that nurses from a large city hospital were happy to put their lives on hold and come to support us was heartwarming. It is surprising how easily you were able to just blend in and be part of the team. Reflecting, we were a very tired and traumatised workplace, considering the events of New Year’s Eve and 4 January had taken such a toll on our workforce. Your presence supported us to not feel we had to be at work to cover the shifts; your presence facilitated us to take the time off and look after ourselves and families. It was a true blessing and I for one am truly grateful. So again, a heartfelt thanks from the nurses at SERH. Thank you for the lifeline. Diane Lang
The following messages from nurses and midwives impacted by the bushfires were sent to the NSWNMA. I am completely overwhelmed and grateful for your gesture of support. This will help so much and is so appreciated. Lesley I’m absolutely speechless, wow! Thank you so much. This is such an amazing thing of you guys to do! I appreciate it so much. Thank you, thank you, thank you! Meg
WANT TO GET MORE INVOLVED? Join NSWNMA Activist Facebook page: https://www. facebook.com/groups/nswnmaActivists/
To have my fees waived for 12 months was an amazing help, to find that we are being offered further money is an extraordinary gift. I can't thank you enough for providing this assistance at this devastating time. We are humbled at the generosity and want to extend our sincere gratitude. Karen I thank you very much for your assistance and support. On a personal level although my house is standing and I consider myself one of the lucky ones. I have been struggling every day and my neighbours and I are finding it hard to move forward. This financial assistance will take away some of the stress I am experiencing. I have had trouble trying to comprehend how I’m feeling. I feel guilt for feeling upset about where I am when so many have lost more. I think my way of coping is while I’m at work to work like nothing is different. I think this is because at the moment this is the only part of my life I can control. Anne-Maree I am so grateful for your support and assistance with my union fees. My circumstances are not nearly as bad as those of others. My home was saved due to courageous efforts of firefighters. I only lost the back boundary fences and the last of my pasture and fences in my paddocks near my home. My workplace has been incredibly supportive and even permitted me to sleep on the premises during one of my two evacuations from home. I did not lose wages. My real sadness is that my little old dog went missing after our second evacuation and as we were together for 16 years it was a huge loss. The bushfire people brought me a bale of hay and as I had incoming wages I have been able to purchase hay and protein pellets to keep things going. Helen While I didn't loose my house, I lost approximately $150,000 worth of property. We have land that we
are hoping to build on and had two shipping containers full of tools to start building, a tractor and personal possessions - furniture, photos of my wedding dress. We also had our boat stored on the land. Due to it being on a vacant lot we were unable to obtain insurance on the property stored there. Sadly this was all lost in the fires. I'm very grateful to the Association for this financial help. Kelly It has been a very strange time; how quickly smoky skies and a blackened landscape become the new normal. Our community is both incredibly traumatised and also caring and strong. The stories we hear every day would make your hair curl, its incredible that more people didn't die. Emily Thank you for your support with funds during this time. Unfortunately we did lose our home, shed and all our belongings for a family of six people so this will help us with the immediate cost, so thank you. Donna
After the bushfires The NSWNMA is offering membership fee assistance to those nurses and midwives who were impacted by the bushfires that devastated our state during the summer. If you, or a member you know, has lost their home and are in need of support, contact the Association on 1300 367 962 or email gensec@nswnma.asn.au for more information. So far: •4 1 members have been financially assisted following the loss of their homes or who have sustained property damage following the bushfires. These members were also assisted with a waiver of their membership fees for twelve months. •A nother ten members received membership fee waivers.
THE LAMP APRIL / MAY 2020 | 7
COVER STORY
Coronavirus highlights lack of ICU nurses and equipment Hospital staff struggle to cope with existing patient loads even before COVID-19 peaks.
N
purchase more ventilators and medical equipment, establish acute respiratory clinics and shift elective surgeries to private hospitals.
SW hospita ls were already understaffed before COVID-19 struck.
Now, authorities are scrambling to strengthen health care services in anticipation of a flood of COVID-19 patients.
ALREADY DEPENDENT ON OVERTIME AND CASUALS Sydney’s Westmead Hospital, a designated infectious diseases c ent re, h a s b e en t re at i n g COVID-19 patients since the start of the outbreak.
NSW needs “a damn sight more doctors and nurses” Health Minister Brad Hazzard conceded in March. The need is especially great in intensive care. NSW Chief Health Officer, Kerry Chant, warned that up to 1.6 million people in NSW could be hit by the first wave of the outbreak, which could last for up to 22 weeks. About five per cent or as many as 80,000 people could need intensive care in the first wave, she said. Australia has 2000 ICU beds: 1485 in the public system and 538 in private hospitals. “There are not ICU beds lying idle,” said Stephen Duckett, a health economist with the Grattan Institute. “The public system is already operating pretty close to capacity. If it weren’t, we wouldn’t be seeing long waiting times for elective surgery.” The host of A BC radio’s Coronacast and the Health Report, Dr Norman Swan, said Italy’s shortage of beds meant “they are triaging so a 60-year-old with heart disease is not being resuscitated.” Swan said the “dominant message” from Australian authorities 8 | THE LAMP APRIL / MAY 2020
‘ We don’t have enough ICU-trained nurses and we find it hard to cope with our existing patient load.’ — Wing Besilos had been: “We want to calm everyone down; don’t panic, there’s no real risk to individuals here. But by calming people down we are not taking measures early enough potentially that would do that.” As part of its COVID-19 response, the state government announced $700 million extra funding for NSW Health in March. The government said this would help to double ICU capacity, prepare for more COVID-19 testing,
Westmead’s ICU has relied on overtime and the casual pool to fill its nursing roster for more than a year. NSWNMA branch delegate and state councillor Wing Besilos said the ICU was recently restructured with an additional 12 beds and 35 nurses shifted from the high dependency unit. “We don’t have enough ICUtrained nurses and we find it hard to cope with our existing patient load. Recently, team leaders and ACCESS nurses (Assistance, Coordination, Contingency, Education, Supervision and Support) are also having to take patients.” Staff shortages related to COVID19 are also being felt at Sydney’s Royal North Shore Hospital. “The virus has already put a huge strain on our ability to staff the hospital,” said branch secretary and NSWNMA state councillor, Edward Makepeace. “It’s clear that the biggest challenge will be finding the
COVER STORY
qualified staff to look after critically unwell COVID-19 patients requiring intensive care.
The infection rate among nurses will go up if they don’t have enough of the required protective equipment.
“There are not enough agency staff to meet demand and any nurse who can pick up extra shifts is being asked to do so.
Wing Besilos said Westmead ICU members were concerned about a shortage of masks, respirators and other protective equipment.
“Management is genuinely trying to do everything they can, but we are still having to work short-staffed at times.
E dw a rd M a ke p e a c e s a id personal protective equipment including masks and hand wash also appeared to be in short supply at Royal North Shore.
“It is very early days (in the pandemic) so it makes a lot of us nervous.”
SELF-ISOLATION EXACERBATES SHORTAGES Edward said the staff shortage was exacerbated by the requirement for nurses with any respiratory symptoms to stay away from the hospital until they are screened. Also, some staff were in self-isolation following overseas travel. He said members are also concerned that the hospital will be under even more pressure if schools shut and they have to stay home to look after children. The nurse shortage will get worse a s COV ID -19 spreads among the population and an unknown number of hospital staff who contract the virus have to be isolated. Early in the outbreak, 23 staff at Liverpool Hospital and 61 at Ryde Hospital were sent home to
‘ There are not enough agency staff to meet demand and any nurse who can pick up extra shifts is being asked to do so.’ — Edward Makepeace self-isolate after coming into contact with an infected doctor. NSW Chief Medical Officer, Kerry Chant, said doctors, nurses and allied health staff were called in from other hospitals to fill the gaps. Many were working longer hours or picking up extra shifts, she said.
“It is quite concerning that they are having trouble getting enough supply at this early stage in the pandemic,” he said. In early March, Federal Health Minister, Greg Hunt, said the government had secured an additional 54 million surgical masks and P2 and N95 respirators for the national medical stockpile. The federal government later appealed to Australian industry to step up the manufacturing of items such as surgical gowns, gloves, goggles and hand sanitisers. Victorian ma nufacturer Med-Con said it will increase production of face masks from five million to 15 million per year after the government sent army personnel to work in the factory until the company can recruit and train more staff. n
THE LAMP APRIL / MAY 2020 | 9
COVER STORY
In the firing line Coronavirus test clinics bear the brunt of public anger over long wait to be screened
BRING FORWARD THE 5000 NURSES PROMISED
People are frustrated, angry and sometimes abusive. They say, ‘We’ve been waiting in this f…ing line for two hours only to be told we’re not going to get tested.’”
At the testing clinic, patients are asked to describe their symptoms. If they meet the testing criteria, they fill out forms and join another queue to have their vital signs – respiratory rate, oxygen saturation level, blood pressure, temperature and heart rate – taken by a nurse or doctor. That’s followed by another wait to be swabbed by a nurse.
That’s how a nurse summed up the public mood at a Sydney COVID19 screening clinic, where a long line of worried people, many wearing masks, waited their turn to be seen. When the clinic opened in mid-March only about 50 people presented each day. Within a week the numbers had multiplied, and a permanent queue stretched along the street. “The numbers are soaring every day,” the nurse said. “We have four nurses, two doctors, three clerks and a NUM, all working together and keeping each other sane. “But we need more doctors and nurses to run it efficiently and reduce the public anger. “It’s very stressful when someone gets to the desk and starts abusing us when we tell them they don’t meet the testing criteria.” More than a week after opening, additional staff were provided and “things are running more smoothly,” he said. At the time of publication, testing was restricted to people with symptoms who had been in contact with confirmed cases or those with
10 | THE LAMP APRIL / MAY 2020
At first, only a small proportion met the testing criteria. A week later, more than half needed to be tested.
‘ Nurses are battling on, feeling under-resourced, unsupported and under mounting pressure.’ — Brett Holmes symptoms who had returned from overseas in the previous 14 days. Also tested are healthcare workers who have to be swabbed even if they have only mild symptoms and meet none of the other criteria. Test results usually are available 24 hours later for health workers and 72 hours for the general public.
“We think a lot of people are falsifying their symptoms to meet the testing criteria,” the nurse said. “They hear people in front of them arguing with our staff and figure out what the testing criteria are. Then they change their story to meet the criteria. “A l s o , GP clinics are inappropriately turning away people with chest infections and other issues and then they come to us. That adds to the aggression when we tell them they don’t meet the criteria.” Coronavirus testing clinics were established to take the pressure off emergency departments, which were under unprecedented strain even before the pandemic. NSW EDs had a record number of presentations between October and December last year.
COVER STORY
Virus would ‘devastate’ Aboriginal populations
I
f COVID-19 spreads through remote indigenous communities it will cause “absolute devastation, without a doubt,” a leading Aboriginal health official warned.
The NSWNMA has urged the state government to bring forward its promised recruitment of 5,000 more nurses and midwives to help deal with the spread of COVID-19 and increased pressures on EDs. “Nurses and midwives were already facing burn-out and fatigue after a difficult winter, but they pushed on through summer and the devastating bushfire season, only to be confronted with the pandemic,” said NSWNMA General Secretary Brett Holmes. “We implore the NSW government to acknowledge its own hospital data. Yet again, it shows just how much nurses are battling on, feeling underresourced, unsupported and under mounting pressure. “We appreciate the government’s broader public health response towa rd s t ack l i n g COV I D -19 but we have not seen enough towards boosting frontline nursing staff numbers.”n
More information The NSWNMA is providing advice and support to any member seeking information regarding COVID-19. For the latest COVID-19 updates and guidelines available for your sector go to www.thelamp.com.au.
Pat Turner, CEO of the National Aboriginal Community Controlled Health Organisation (NACCHO), said indigenous communities need “resources, equipment and guidelines out on the ground yesterday.” “We had today a passenger cruise ship dock in Broome,” Turner told ABC TV’s The Drum in mid-March. “The health department of WA didn’t even know about that ship docking. No screening, no nothing. In the highly vulnerable remote communities we want everyone screened and we don’t want people taking the virus into our communities.” The host of A BC radio’s Coronacast and the Health Report, Dr Norman Swan, said that due to their relatively poor general health, “What happens to a 65-70-year-old in a nonAboriginal community happens to a 45-year-old in an Aboriginal community. And many of them will not be near an ICU.” The No r t h e r n Te r r it o r y government acknowledged that the
risk to remote Aboriginal people is “severe” and made worse by “overcrowding in housing, poor hygiene and other environmental conditions that can increase disease transmission and raise attack rates”. NT Health said access to healthcare is often reduced due to a lack of transport and poor communications. On top of that, many ill people may present late. “ He a lt h worke r s s h o u ld encourage early presentation of all respiratory illnesses, particularly in vulnerable community members, and isolate all respiratory cases who fit the clinical case criteria and their close contacts,” NT Health recommended. Health workers should strongly promote flu vaccination to reduce the concurrent burden of COVID-19 and to reduce any potential “confusion regarding diagnosis/causes of outbreaks”. The federal government later announced almost $60million worth of additional health protection measures for remote communities to “minimise the likelihood of exposure to COVID-19, increase their capacity to evacuate early cases, and enable an effective response if an outbreak occurs.”n
‘ What happens to a 65-70-year-old in a non-Aboriginal community happens to a 45-year-old in an Aboriginal community. And many of them will not be near an ICU.’ — Dr Norman Swan, ABC Health Report THE LAMP APRIL / MAY 2020 | 11
COVER STORY
Coronavirus stress tests world’s health systems Some lessons have been learned from previous epidemics, but the weakness of many countries’ health systems leaves everyone vulnerable.
C
hina has taken a lot of flak in the media for its handling of the coronavirus (COVID19) but the World Health Organization (WHO) and health scientists applauded its strategy for containing the virus. WHO Assistant Director-General, Bruce Aylward, said the world could learn from China’s rapid response and “extraordinary mobilisation”. “China knows how to keep people alive," Aylward said. “It is staggering. Every person you talk to there has a sense of responsibility. They are mobilised like in a war against this virus.” WHO Director-General, Tedros Adhanom Ghebreyesus, says the drastic measures to shut down Chinese cities, particularly Wuhan, to contain COVID-19 gave other countries a window of opportunity to prepare for the virus. He sa id Ch i ne se hea lt h authorities had been “working tirelessly” to respond to and control the COVID-19 outbreak. This had given “countries around the world precious time needed to prepare for the possible arrival of the virus inside their borders”.
12 | THE LAMP APRIL / MAY 2020
‘ Pandemic preparedness has become a priority for the global health agenda.’ “Importantly, health authorities in China have paved the way for the international scientific community to join the fight,” he said. Ghebreyesus said that although C OV I D -1 9 was completely unknown a few months ago, “scientists are sprinting to outpace the novel coronavirus”. “China’s doctors laid the foundation for this mobilisation of scientific and research muscle by rapidly identifying the new coronavirus in the middle of the influenza season. Chinese scientists lifted obstacles to researching the virus by sharing its genome sequencing publicly,” he said. “The fact that this information was shared with networks worldwide is accelerating the design of vaccines and drugs targeted at the new coronavirus.” The global collaboration by scientists quickly revealed important characteristics about the hitherto unknown virus, he said.
“We have found that the proportion of severe cases increases with age. We know that SARSCoV-2 (aka COVID-19) came from an animal. “Researchers have also found that approximately 81 per cent of known infections can be classified as mild and that 2.3 per cent result in death.”
AFRICA IS PARTICULARLY VULNERABLE The respected medical journal The Lancet agreed that China had learned from its previous experiences during the SARS epidemic and that the country’s strong public health system was a bulwark in the fight to contain the virus. “It’s clear the large number of cases of COVID-19 is testing the health system in China. Yet, China was able to build a hospital for affected patients in a matter of days. “No other country could mobilise resources and manpower at such speed. While health systems in
COVER STORY
high-income countries would be stretched by the outbreak, the most devastating effects would be in countries with weak health systems, ongoing conf licts, or existing infectious disease epidemics,” it said in an editorial. WHO, using the narrow window of opportunity provided by the initial containment of the virus in China, moved quickly to bolster the capacity of these weaker health systems, particularly in Africa and Latin America, to meet the challenge of the spread of the virus. On 3 February 2020, Senegal and South Africa were the only African countries with laboratories that could test for severe acute respiratory syndrome coronavirus. A fortnight later, WHO had sent testing kits to 27 countries on the continent. By the end of February, the number of African countries able to detect COVID-19 was up to 40 with a further 27 in the Americas. “The importance of the ability to test for SARS-CoV-2 in poorer countries cannot be overstated. It gives them the best chance of containment before the virus can spread and devastate weak health
‘ Rather than thrashing around every time a new pathogen surprises us, we should simply deploy the same resources, organisation, and ingenuity that we apply to building and managing our military assets.’ systems. Reliable diagnostics are crucial in the response to the outbreak,” Ghebreyesus said.
PANDEMICS ARE DANGEROUS IN A GLOBALISED WORLD W hile lessons have been learned from previous epidemics such as SARS, Ebola and H1N1, the magnitude of the COVID-19 outbreak and its spread highlights the dangers of pandemics in a globalised world. W HO a nd t he scient if ic community agree that pandemic preparedness has become a priority for the global health agenda. Scientific and technological advances already provide the tools to prevent, manage, and contain global pandemics but the allocation of sufficient resources has been woeful, they say.
“Rather than thrashing around every time a new pathogen surprises us, we should simply deploy the same resources, organisation, and ingenuity that we apply to building and managing our military assets,” wrote Julie Sunderland, a former director of the Gates Foundation Fund in Project Syndicate. “Here, the first step is for governments to increase funding for Coa lit ion for Epidemic Preparedness Innovations (CEPI), which was created after the 2014 Ebola epidemic to develop and deploy vaccines. “The agency’s initial funding, provided by a coa lition of governments and foundations, totalled only $500 million, or about half the cost of a single stealth bomber. Its budget should be far, far larger.” n THE LAMP APRIL / MAY 2020 | 13
INTERNATIONAL YEAR OF THE NURSE AND THE MIDWIFE
More nurses critical for global health, says WHO More investment in nurses and midwives is critical to achieving universal health coverage says the World Health Organization.
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he World Health Organization (WHO) has designated 2020, the bicentenary of the birth of the founder of modern nursing, Florence Nightingale, as The Year of the Nurse and the Midwife. The UN agency responsible for improving global health is not only calling for increased recognition for nurses and midwives in this landmark year, but also for action and investment to bolster their effectiveness at the frontline of the world’s health systems. “Quite simply, the world will only achieve universal health coverage (UHC) by recognising the critical role nurses and midwives play and by investing more in the nursing and midwifery workforce,” it said. “Nurses and midwives play a vital role in providing health services. These are the people who devote their lives to caring for mothers and children; giving lifesaving immunisations and health advice; looking after older people and generally meeting everyday essential health needs. They are often the first and only point of care in their communities.” Establishing UHC in countries with weak health systems such as in Africa and Latin America is a key priority for WHO. The spread of COVID-19 has exposed the vulnerability of many developing countries lacking universal health care systems. “One of the concerns is if this virus makes it to countries with weaker health systems,” said Tedros Adhanom Ghebreyesus, the
14 | THE LAMP APRIL / MAY 2020
‘ It is not the year for more platitudes, lip service and pats on the back in lieu of genuine recognition of nurses’ and midwives’ work and honest and meaningful support for that work.’ — Annie Butler, Federal Secretary ANMF Director-General of WHO. “I can tell you straight away the capacity to manage a large number of patients is not there in many African countries. With the exception of large countries like Kenya and South Africa, most African hospitals have very limited intensive care facilities,” said Michel Yao, the WHO’s head of emergency services in Africa.
NINE MILLION MORE NURSES AND MIDWIVES NEEDED If UHC is to be achieved to strengthen health systems in all countries, robust financing structures will be the key, says WHO. In particular there will need to be an investment in the health workforce. “Improving hea lth ser vice coverage and health outcomes depends on the availability, accessibility and capacity of health workers to deliver quality peoplecentred integrated care,” it says. “To meet UHC targets, over 18 million additional health workers are needed by 2030 (including nine million nurses and midwives).” A key moment for WHO this year
will be the release of The State of the World’s Nursing Report, which will be launched on World Health Day on 7 April. ANMF Secretary Annie Butler said as the year of the nurse and midwife, 2020 made it “our year” and an opportunity for the voices of nurses and midwives to be heard in this country. “It is also the year for Australia’s politicians to recognise our value by investing in the nursing and midwifery workforce,” she said. “It is not the year for more platitudes, lip service and pats on the back in lieu of genuine recognition of nurses’ and midwives’ work, and honest and meaningful support for that work. “This will require politicians and governments to respond to the evidence before them and invest in staffing ratios in all sectors, and in creating safe working environments across the country. “It also requires us, Australia’s nurses and midwives, to take action to make this happen.” n
INTERNATIONAL YEAR OF THE NURSE AND THE MIDWIFE
‘ Quite simply, the world will only achieve universal health coverage by recognising the critical role nurses and midwives play, and by investing more in the nursing and midwifery workforce.’ — World Health Organization
Key Dates
Key Facts Universal Health Coverage: • At least half the world’s population still do not have full coverage of essential health services. • About 100 million people are still being pushed into extreme poverty because they have to pay for health care. • Over 930 million people – around 12 per cent of the world’s population – spend at least 10 per cent of their household budgets to pay for health care.
Nursing and midwifery: • Nurses and midwives account for nearly 50 per cent of the global health workforce and 50 per cent of the current global shortage in health workers. • The world will need an additional nine million nurses and midwives by the year 2030 if sustainable development goals on health and wellbeing are to be achieved. • WHO sees nurses and midwives as the key to achieving universal health coverage (UHC). (Source: World Health Organization)
In this International Year of the Nurse and the Midwife the World Health Organization has earmarked key dates in its campaign to boost the status and resourcing of the nursing and midwifery professions: • The State of the World’s Nursing Report will be released on World Health Day – April 7 • World Health Assembly – 17–20 May, Geneva For more information about the Year of the Nurse and the Midwife go to www.nswnma.asn.au
Editor’s note: At the time The Lamp goes to print events and initiatives mentioned in this article may be cancelled due to the COVID-19 pandemic. Please check the relevant websites. THE LAMP APRIL / MAY 2020 | 15
INTERNATIONAL YEAR OF THE NURSE AND THE MIDWIFE
The Nightingale Challenge: develop 20,000 young nurse and midwife leaders South East Sydney is the first NSW health district to heed an international call for health employers to provide leadership and development training for young nurses and midwives.
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‘ Our programs aim to help (nurses and midwives under 35) to understand and really explore their own values’ — Sally Peters
hen he announced the Year of the Nurse and the Midwife, Dr Tedros Adhanom Ghebreyesus, Director-General of WHO said: “Nurses and midwives are the backbone of every health system: in 2020 we’re calling on all countries to invest in nurses and midwives as part of their commitment to health for all.” Dr Ghebreyesus said strengthening nursing would have the additional benefits of promoting gender equity, contributing to econom ic development, a nd suppor ting other sustainable development goals. WHO wants both governments and employers to invest more in the nursing and midwifery workforce. The Nursing Now campaign, launched in collaboration with the WHO and International Council of Nurses, aims to improve health globally by raising the profile and status of nurses worldwide. It intends to do this by influencing policymakers and supporting nurses themselves to lead, learn and build a global movement. A key Nursing Now initiative is the Nightingale Challenge 2020, which calls on every health care employer to provide leadership 16 | THE LAMP APRIL / MAY 2020
and development training for 20 young nurses and midwives throughout 2020. The aim is to have employers worldwide invest in at least 20,000 young nurses and midwives and build the next generation of nursing and midwifery leaders, practitioners and advocates in health.
BECOME PART OF A GLOBAL MOVEMENT The South East Sydney Local Health District (SESLHD) is taking up the Nightingale Challenge with a plan to develop more than 100 young nurses and midwife leaders, says Sally Peters, a nurse manager for leadership development. “The International Year of the Nurse and the Midwife has really put a spotlight on emerging young leaders, and we want to give them opportunities that they might not
have had to this point,” Sally said. “We are offering really small one-day or two-day workshops, right up to a year-long effective and clinical leadership program. We are committing to putting through at least 100 young nurses and midwives, but it is likely that we will have more. “Our focus is on providing oppor tunities to nurses and midwives under 35 to develop leadership skills. “Our programs aim to help them understand and really explore their own values, and then, working with those values, identify the behaviours that sit behind those values and enable them to become effective leaders.” The effective and clinical leadership program is run in partnership with the University of Wollongong and the Clinical Excellence Commission, a nd
INTERNATIONAL YEAR OF THE NURSE AND THE MIDWIFE
Find out more about Nursing Now www. nursingnow.org
“participants receive 12 credit points towards a master’s or a graduate certificate in medical and health leadership,” Sally said. “By joining any one of these programs, young nurses and midwives will become part of the Nightingale Challenge, which will connect them to a global movement of emerging nursing and midwife leaders.
LEADING FOR THE FUTURE Coral Levett, the recent past president of the NSWNMA, and based with the SESLHD, said: “We were the first district in the NSW system to sign up, but since then there have been a few more districts coming on board.”
“The big focus of the program is nurses and midwives under the age of 35, but we’d also like to engage older nurses and harness their skills and knowledge by providing them with opportunities to be mentors to the younger nurses.”
More information about the program and application process is available here: www.seslhd.health.nsw.gov. au/nightingale-challenge
“It is very important to foster younger leaders coming through and not leave that to chance. It is about leading for the future. “Nurses and midwives play a critical role in the health system,” Coral said. “Health care has become more complex than ever, but it is often delivered with less budget, so nurses need to be on top of all the changes that are occurring. What we are trying to encourage is transformational leadership that is new and adaptive to the healthcare environment.” The SESLHD will list courses, programs and online modules on the district’s intranet.
Nurses and midwives are by far the biggest part of the health workforce, spend the most time with patients, their families and consumers, and have insights into their perspectives, Sally said. “Therefore, it is really important that they have a voice to speak up for the consumers of health services, advocate on behalf of patients, speak on policy matters and really inform the design and delivery of the services that we provide.”
Find out more about the SES LHD program
“Anyone interested can selfselect, and then there is an approval process that goes through their managers,” Sally said.
‘ What we are trying to encourage is transformational leadership’ — Coral Levett
Throughout the year, events will be organised to support nurses taking up the challenge, such as forums, road shows and webinars. Nursing and midwifery leaders aged over 35 will be invited to share their experience and expertise with SESLHD emerging leaders of the future. n Editor’s note: At the time The Lamp goes to print events and initiatives mentioned in this article may be cancelled due to the COVID-19 pandemic. Please check the relevant websites.
THE LAMP APRIL / MAY 2020 | 17
SAFE STAFFING
Outrage over jobs cut forces LHD re-think The town of Murwillumbah rallies in defence of its hospital and its nurses.
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public backlash against a proposed cut to emergency department nursing hours at Murwillumbah District Hospital has forced management to think again.
outraged by the cuts, announced a year after the Berejiklian government’s election commitment to hire 5000 extra nurses and midwives, including 282 for Northern NSW.
Northern NSW Local Health District announced it would strip 3.08 FTE (full-time equivalent) nursing positions from the ED roster, despite patient presentations continuing to rise.
“This decision is nothing short of shameful and flies in the face of the NSW Health Minister’s commitment last year to bolster nursing staff numbers across our regional hospitals,” Brett said.
This would have cut the morning and afternoon shifts from three nurses down to two – a cut in total ED nursing hours of more than 20 per cent.
LHD Chief Executive, Wayne Jones, claimed fewer people were using Murwillumbah’s ED and its deleted nursing hours would be transferred to Byron Central Hospital and Ballina District Hospital.
The hospital’s NSWNMA branch voiced its concern for patient safety, demanded to be consulted and took the issue to the media and the local community. As a public campaign against the cuts gathered strength, LHD management came back with a revised plan. It proposed a smaller cut of 1.88 FTE nursing positions, equivalent to losing one morning shift nurse Monday to Friday.
However, NSWNM A branch delegate A ngela Gittus sa id Murwillumbah’s presentations and acuity of patients had increased every year for the last five years. “Not only have we had no increase in nursing hours, we’re now looking down the barrel of even less nursing hours.” She said the need to increase staffing at one hospital should never result in cuts to another hospital.
The branch said it would continue to oppose any cuts, while taking part in talks with management via a Union Specific Consultative Committee (USCC).
“Our branch absolutely supports other EDs in the region having safe and appropriate staffing, but what we oppose is the LHD effectively robbing Peter to pay Paul.
NSWNMA General Secretary, Brett Holmes, said members were
“The LHD have not looked at the clinical needs of Murwillumbah, and
18 | THE LAMP APRIL / MAY 2020
asked themselves, how many nurses is safe?”
COMMUNITY IS PROTECTIVE OF ITS HEALTH SERVICES Angela said the nurses have very strong community support. “People here identify as a small country town and are very protective of their health services. “Community members took it upon themselves to distribute a petition, offered to organise rallies and community forums and set up a Save Murwillumbah Hospital Facebook page.” She said LHD management was “quite heavy handed in their first interaction, but after noting the community response they returned with a more consultative approach”. “It seems our determination not to be downgraded, and the incredible community support that we received, prompted the executive to listen. “They have agreed that we are in consultation and have held off making a firm decision until that is complete. “So we will be clear with them about the clinical risks of any loss of nurses and wait for the outcome.” The LHD executive will meet Byron and Ballina hospital nurses and then meet delegates from all three EDs along with NSWNMA officers in a USCC. n
SAFE STAFFING
‘It seems our determination not to be downgraded, and the incredible community support that we received, prompted the executive to listen.’ — Angela Gittus
Murwillumbah patients speak out
What the politicians say
Murwillumbah nurses say they’ve been “overwhelmed” by many messages of community support and stories of people’s experiences at the hospital. Rob Learmonth told The Weekly newspaper he went to the ED with chest and arm pain, which required two stents in his left coronary artery and three days in hospital. Rob said the ED staff were “really fast and so brilliant”. “Without a fully equipped and well-staffed ED at Murwillumbah Hospital I would have suffered irreparable heart damage and in the future a very poor quality of life. “Having a well-staffed ED close to you could save your life.” Eighty-year-old Edith Sisaric spent a night in the ED with severe bleeding and bruising. “(ED staff) were absolutely tops; they looked after me from head to toe,” she said. “It was so busy it was mayhem, but (ED nurses) really went above and beyond and they deserve better than this,” she said. Edith said she was outraged by the proposed cuts. “It’s criminal, it’s absolutely criminal. “When I saw on the local news that they were cutting the staff I literally screamed at the TV because I just came from there and I saw how understaffed and overworked they already are.”
Labor member for the state seat of Lismore, Janelle Saffin, has been out on the streets of Murwillumbah helping to collect signatures on a petition to stop the ED staff cuts. ‘It makes no sense to be targeting an ED that ranks second-best in the state for patient satisfaction and has a high ranking for meeting all of its clinical key performance indicators,’ she said. Labor member for the federal seat of Richmond, Justine Elliot, told federal parliament that “virtually every business in town” was promoting the community petition. She commended the NSWNMA’s Murwillumbah branch “for their incredible work as nurses providing outstanding care and also for their strong activism in fighting these staff cuts”.
‘ Having a well-staffed ED close to you could save your life.’ — Rob Learmonth
THE LAMP APRIL / MAY 2020 | 19
SAFE STAFFING
Community protest halts ward merger plan A plan to merge wards at Maclean District Hospital has been “deferred” in the face of growing community opposition.
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or t h e r n NSW Local Health District says it has postponed a decision on a plan to reconfigure Maclean Hospital by merging its acute and sub-acute wards. The proposal would have cut bed numbers by about one third and deleted two positions – nursing unit manager and ward clerk. Widespread public protest forced the LHD to announce it would set up a community advisory group. The group would “provide input into the ward reconfiguration proposal” and future healthcare plans, LHD Chief Executive, Wayne Jones, said. “We will delay any decisions around the proposed reconfiguration of wards at the hospital until the community has had further opportunity to provide input,” he said. “It’s clear that the Maclean community wants to be more involved with the plans for their local hospital. “We have listened to what the community and our staff have had to say, and we acknowledge that we need to improve our consultation processes.” The LHD is using local radio and its web page to call for expressions of interest from people interested in joining the advisory group. The LHD appears not to have 20 | THE LAMP APRIL / MAY 2020
‘ An increase in nursing hours per patient day should not be a reason to cut the number of experienced nurses.’ — Melissa McDonough
approached staff or NSWNMA branch members to be part of the group.
NURSES GARNER COMMUNITY SUPPORT Earlier, the LHD announced it would shut the Level 2 acute ward and combine it with the Level 1 subacute and rehabilitation ward. It said the acute ward would remain available for “surge” capacity during peak periods. The acute ward’s nursing unit manager and ward clerk would be “displaced” and offered jobs elsewhere in the hospital. A meeting of the NSWNMA’s Clarence Valley branch unanimously rejected the proposal and resolved to launch a community awareness campaign including a public forum. The hospita l’s NSW NM A’s delegate, Melissa McDonough, said the branch feared that consolidating patients and staff into one ward would be difficult to manage and compromise patient safety, while staff would have to carry a greater workload.
“Our biggest concern is the mix of patients we will have to care for: acute, sub-acute, rehab and palliative care all in the one large ward,” she said. Under the LHD’s origina l proposal, level 1 would contain a 10-bed rehab facility plus 23 patients in acute, sub-acute, palliative care and infectious beds sharing toilets and showers in a ratio of 1:4.4 patients. That is more than double the toilet/shower-to-patient ratio of the present acute ward. Maclean Hospital was one of the first regional facilities to get increased nursing hours – from five to six nursing hours per patient day (NHPPD) – as a result of a state government election commitment.
ONLY ENS AND AINS FOR NEW POSITIONS The NHPPD increase came into effect on 24 February but the recruitment process had not started when The Lamp went to press. Nurses were doing extra shifts to cover the
SAFE STAFFING
additional hours. Also, the LHD plans to recruit only enrolled nurses and assistants in nursing (AiNs) to the new positions. NSWNMA Assistant Secretary Judith Kiejda said these new positions are being funded at RN level. “Why would facilities put in lower classifications except to save money,” she said. “An increase in nursing hours per patient day should not be a reason to cut the number of experienced nurses – especially when the additional hours are to be filled by less qualified nurses,” Melissa McDonough said. “The increased use of AiNs raises questions about the safety of the skills mix among the nurses on each shift.” Melissa said the proposed ward reconfiguration appeared to ignore the future need for expanded health services to meet population growth. The Clarence Valley region is getting several new housing estates, as well as the Clarence Correctional Centre. It will be Australia’s largest jail with 1700 inmates and 600 staff. Melissa said the branch had decided to postpone a planned street march and continue to participate in consultation meetings with the LHD to ensure it prioritised safe patient care and adequate staffing. n
‘ We have listened to what the community and our staff have had to say, and we acknowledge that we need to improve our consultation processes.’ — CEO, Wayne Jones
Locals pack town meeting About 200 Maclean residents attended a town forum organised by the hospital’s NSWNMA branch. Participants decided to take up a petition and organise a street march against the ward merger. NSWNMA delegate Melissa McDonough said the branch was “overwhelmed” by the public response to the forum. “The Maclean community has a real sense of ownership of their hospital,” she said. “The hospital auxiliary has raised a lot of money for the hospital over the years. “For example, it paid for the hospital’s first helipad and half the cost of its replacement. The ED was refurbished from a community member’s bequest and free TV sets for patients were donated by local service clubs.” The LHD executive rejected an invitation to address the NSWNMA-organised forum and instead hastily arranged its own community information session for the day prior. The LHD information session failed to pacify the community and the executive later announced the merger plan would be deferred.
THE LAMP APRIL / MAY 2020 | 21
AGED CARE
Royal commission counsel recommends ratios The legal team assisting the aged care royal commission has proposed sweeping changes to raise the numbers, skills and pay of the aged care workforce.
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awyers assisting the aged care royal commission have called for mandatory staffto-resident ratios in aged care facilities with a registered nurse on every shift. They recommended ratios that should give each resident at least three hours of high-quality care a day. Senior counsel assisting the commission, Peter Rozen QC, outlined the legal team’s recommendations to the commissioners. T hey i nclude m a nd ator y minimum qua lif ications a nd minimum levels of English for personal care workers. The recommendations cover residential care only. The home care workforce will be covered in separate recommendations later this year. Mr Rozen said the residential care workforce should be “better remunerated and should work in safe workplaces”. “The staff in our aged care homes are not well paid,” he said. “There are all too often not enough of them to provide the care they would like to – for example, to sit and have a chat over a cup of tea. “Many work in stressful and sometimes unsafe workplaces. Some are untrained; others have inadequate training. “As a community we owe these workers a lot. 22 | THE LAMP APRIL / MAY 2020
‘ The staff in our aged care homes are not well paid. As a community we owe these workers a lot.’ — Peter Rozen QC “These submissions are aimed at improving their working lives so that our elderly citizens can receive safe care of the quality that they should receive in a country as rich as ours.”
IMPROVEMENTS NEEDED TO ATTRACT AND RETAIN STAFF He said the legal team’s recommendations would, over time, make aged care a more attractive sector in which to work. “This will help to retain the current workforce and attract new workers to the sector.” Mr Rozen said a minimum staffing ratio should be set at a level necessary to achieve a 4-star rating under the United States CMS system as adjusted for Australian conditions. On average, that would require care of between 186 and 265 minutes per resident per day from a trained workforce comprising registered and enrolled nurses and personal care workers. Currently, only 15.8 per cent of Australian aged care residents are in homes staffed to this level, he said. He said he agreed with Victorian nursing union official Paul Gilbert, who said that when it comes to
staffing numbers in aged care, it is “time to stop kicking the can down the road”. Mr Rozen said commission hea rings had “revea led t he disturbing extent of the substandard care, that there are not enough staff, that there’s never enough time to do the work, that aged-care workers work in poor and sometimes unsafe conditions and lack the training they need to do the work required of them”. “Any redesign of the aged care system that does not remove the incentive that presently exists for providers to reduce the number of nurses they employ to cut their costs, will necessarily fail. “If the goal of this royal commission is to ma ke recommendations to achieve highquality, safe and person-centred aged care services,” he went on, “as it must be under the terms of reference, then the time for real action on staffing numbers and mix, skill levels, remuneration, conditions of work, and registration of the unregulated portion of the aged care workforce is now.” n
AGED CARE
‘The ANMF will continue to contribute to the commission’s proceedings.’ — Annie Butler
Major workforce recommendations Major recommendations from the royal commission legal team’s 160-page workforce submission include: MANDATORY MINIMUM STAFFING RATIOS Average total care per resident should be between 186 and 265 minutes a day, and include “a minimum of 30 minutes of registered nurse time per resident per day and at least 22 minutes of allied healthcare per resident per day”. Providers must provide the Department of Health and Ageing with quarterly staffing levels for registered and enrolled nurses, allied health and other care staff by shift in residential care. The department must publish this information with clear explanatory material to allow the public to compare services. REGISTERED NURSES 24/7 An RN should be present on each shift and available to direct or provide care subject to limited exceptions.
MORE NURSE PRACTITIONERS To increase the supply of nurse practitioners, the Australian Government should introduce scholarship programs (with aged care return-of-service obligations) for nurse practitioner training and advanced skill nursing. REGISTRATION FOR PERSONAL CARE WORKERS A registration scheme for personal care workers should be established, with: • mandatory minimum qualifications • ongoing training and continuing professional development requirements • minimum levels of English • criminal history screening requirements • a code of conduct and power for the registering body to investigate complaints about breaches of the code.
ANMF welcomes minimum staffing call The Federal Secretary of the Australian Nursing and Midwifery Federation (ANMF), Annie Butler, welcomed Peter Rozen QC’s “practical recommendations” to the aged care royal commission. She said the ANMF supported Mr Rozen’s recommendations to mandate the minimum numbers of nurses and qualified care staff to be rostered. She said better wages, training and regulation, would improve the quality of care and help to retain and recruit more staff. “The ANMF will continue to contribute to the commission’s proceedings as it works towards completing its final report and recommendations to government later in the year,” Annie said.
Commission suspends hearings The Royal Commission has suspended all hearings and workshops for the time being, subject to ongoing review. This decision is a consequence of the evolving coronavirus (COVID-19) pandemic, and affects all hearings and workshops scheduled until at least the end of May 2020. The deadline for submissions to the Royal Commission into Aged Care Quality and Safety will also be extended by two months to 30 June 2020. THE LAMP APRIL / MAY 2020 | 23
AGED CARE
Call to put nursing back into aged care Lawyers assisting the aged care royal commission say residential aged care needs an RN on every shift.
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awyers assisting the aged care royal commission say RNs – and nurse practitioners – should make up a greater proportion of the care workforce. Senior counsel assisting the commission, Peter Rozen QC, said an RN should be present on each shift and available to direct or provide care subject to limited exceptions. He told the commissioners that the proportion of RNs in the residential direct care workforce fell from 21 per cent in 2003 to 14.9 per cent in 2016 – a drop of more than 25 per cent. The proportion of enrolled nurses dropped from 14.4 per cent to 9.3 per cent over the same period. In contrast, the proportion of “unregistered and in many cases unqualified” personal care workers increased from 56.5 per cent to 71.5 per cent over the same period. “To be clear, the care work that was performed by qualified nurses, physiotherapists, speech pathologists, etc. is now being p er for me d by u nq u a l i f ie d , unregistered and in many cases 24 | THE LAMP APRIL / MAY 2020
‘ Perhaps it is time to accept that the term “nursing home” was the right one all along.’ — Peter Rozen QC
untrained personal care workers,” Mr Rozen said. “It is hardly surprising in these circumstances that the royal commissioners have received thousands of submissions by members of the public complaining about the substandard care being provided in residential aged care.” He said it may be no coincidence that the declining role of nurses in the aged care workforce has coincided with a change in name from the “comforting and familiar ‘nursing homes’ to the impersonal ‘residential aged care facilities’”. “Perhaps it is time to accept that the term ‘nursing home’ was the right one all along.”
Mr Rozen said the federal gover n ment shou ld prov ide “practical leadership” in aged care workforce reform including providing additional funding to implement the recommendations. He also blasted the Department of Health for an apparent “lack of leadership and expertise about aged care”. The “highest levels of the aged care bureaucracy” appeared to be “timid, risk averse (and) more worried about political risk than making a contribution to aged care reform”. n
AGED CARE
ACAT privatisation canned The Morrison government retreats from another attempt to sell a piece of the public health system
Strong opposition has forced the federal government to drop its plan to privatise Aged Care Assessment Teams (ACATs), which determine the level of care required by elderly Australians. The federal government backdown came via a joint statement by federal, state and territory health ministers, which said: “The Commonwealth has agreed to work with the states and territories to have a consistent, uniform, efficient and integrated aged care assessment process that meets the needs of senior Australians and their families. “The Commonwealth has confirmed that it is not proceeding with the current tender process. Over the longer term the Commonwealth will take advice from states and territories and from the royal commission about what the exact delivery mix should be.” Earlier, the Morrison government announced that private providers would take over the work of ACATs from April 2021, with tenders to be called this year. Health and aged care ministers from three states – including Liberal-led NSW – voiced concerns about ACAT privatisation and the royal commission rebuked the Morrison government over the issue.
The NSWNMA said privatisation threatened the jobs of highly skilled and experienced nurses who ensure appropriate care is provided based on individual needs. NSWNMA General Secretary, Brett Holmes, said the decision to scrap the tender process was sensible. “Privatising ACAT would have dramatically disrupted aged care assessments currently delivered by a skilled workforce of nurses, geriatricians, social workers and others,” he said. “These nurses are employed in the public health system and have no commercial interests; instead, they hold the interests of consumers as a top priority. “This proposal would have jeopardised the employment of hundreds of skilled clinicians and destroyed decades of expertise. “Consumers in need of aged care assessment support could potentially have been directed to a for-profit provider, who may not have been independent of the care provider. “Fortunately, the NSW Health Minister recognised the privatisation plan was illogical and voiced his concerns publicly. “Not only would the proposal have put additional pressure on our already overstretched public hospitals, it also pre-empted any outcomes of the royal commission into aged care, which is still underway.”
‘ Privatising ACAT would have dramatically disrupted aged care assessments currently delivered by a skilled workforce of nurses, geriatricians, social workers and others.’ — Brett Holmes
Nursing home rules ‘won’t shield elderly’ ANMF calls for ban on all non-essential visits to protect vulnerable residents from COVID-19. Federal government proposed time restrictions on visits to nursing homes to ensure they are of ‘short duration’ are unworkable given chronic understaffing. Lori-Anne Sharp, ANMF Assistant Federal Secretary said, “This is totally unrealistic when we already know that care staff are rushed off their feet trying to meet the basic needs of elderly residents.” Staff numbers are “dangerously low” and it would be “extremely difficult” to monitor visits and ensure that visitors followed advice on infection control procedures and social distancing protocols. “Understandably, there will need to be exemptions on certain compassionate grounds for palliative care and end-oflife situations and those visitors should also be properly health checked and supported before entering the nursing home.” Lori-Anne also called on providers to ensure they have enough stockpiles of personal protective equipment (PPE) and hand sanitiser. “Feedback from our members working on the ground in aged care is that there are unsatisfactory amounts and access to PPE,” she said. THE LAMP APRIL / MAY 2020 | 25
PANDEMIC
COVID-19 Member Assistance As the COVID-19 situation progresses, we want you to know: your union is here for you. We are working hard to support all members. Whether that’s negotiating special leave with your employer, enforcing Work Health and Safety, answering your questions or providing regular up-to-date information. Recently, our ongoing negotiations won NSW Health employees access 20 days of special paid leave for COVID-19. We are also in a range of discussions with multiple private sector and aged care employers around special leave and the adoption of isolation strategies and frameworks similar to the public sector. Many of you might be worried or confused during this time of uncertainty but rest assured, we are here for you and you have our full ongoing support. To ensure we can meet your needs, the NSWNMA will implement improved methods to speed up our response time and adapt new ways of operating to better service our members.
Authorised by B. Holmes, General Secretary, NSWNMA
These are extraordinary times and as health professionals, it’s critical for us to educate and decrease anxiety within the community. Take care of yourself and each other. We are with you every step of the way.
The latest COVID-19 Updates & Guidelines are available from 26 | THE LAMP APRIL / MAY 2020
thelamp.com.au
ADVERTORIAL
Welcome to Blood, Brain & Bone An important new seminar to empower nurses and midwives to become a ‘force for health’.
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urses and midwives are being called on to take the lead on important public health issues such the rising incidence of rickets and micronutrient deficiencies in Australian mothers-to-be. Major changes must be made to the existing nutritional advice being given to pregnant women, medical experts say, and a new seminar – Blood, Brain & Bone – has been developed specifically to educate Australian nurses and midwives on this pressing issue. On 25 June in Sydney, nine expert speakers will gather to reveal the latest research, to discuss the significant health impacts these deficiencies can have on mother and child, and to educate and empower nurses and midwives to lead the charge in creating widespread change. The conference will tackle the rising problem of vitamin D, iodine, and iron deficiency, all of which can lead to significant reduction in quality of life – and in severe cases can lead to conditions such as rickets, intellectual impairment and osteoporosis. While these micronutrients are essential for everyone, the rate of deficiency is higher for females and causes the most negative health
effects during foetal development and infancy – in mother and baby. The fact that these deficiencies
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clinicians when it comes to tackling public health issues”, Dr Manocha says. “The World Health Organisation’s 2000 Munich Declaration called nurses and midwives ‘a force for health’ in terms of their current and potential capacity to achieve public health outcomes and urged authorities to better support them in this role. “Among the recommendations to achieve this were improvements to education and dissemination of information on public health issues, particularly those that fostered interdisciplinary work between nurses, midwives and physicians.”
Nurses and midwives are a neglected and under-recognised group of clinicians when it comes to tackling pubilc health issues.
are on the rise, even in developed countries like Australia, indicates that there is a clear role for public awareness-raising on the issue, and with this in mind, Blood, Brain & Bone delegates will find out how to identify and manage deficient patients, and also how to head off deficiencies before they develop. According to seminar organiser Healthed, nurses and midwives represent a crucial cog in the wheel when it comes to monitoring and maintaining healthy levels of micronutrients among expectant mothers. GP and Healthed CEO Dr Ramesh Manocha says that nurses and midwives have a key and increasing role in addressing this issue, along with many other public health challenges. “Nurses and midwives are a neglected and under-recognised group of
According to WHO, nurses and midwives have “key and increasingly important roles to play in society’s efforts to tackle the public health challenges of our time, as well as in ensuring the provision of highquality, accessible, equitable, efficient and sensitive health services which ensure continuity of care and address people’s rights and changing needs.” “This is precisely what we’re aiming to do with our new Blood, Brain & Bone seminar – empower nurses and midwives to become advocates for the kinds of public health measures required to address these vitamin deficiency issues,” Dr Manocha says. To find out more about Blood, Brain & Bone head to www.healthed.com.au/seminars THE LAMP APRIL / MAY 2020 | 27
ADVERTORIAL
Rickets is back More than half of Australia’s pregnant women are vitamin D deficient, putting them and their babies at serious risk.
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staggering 50 per cent of pregnant women being seen at Sydney’s Westmead Hospital are vitamin D deficient, and in South Australia, the numbers are even higher, according to Sydney paediatric endocrinologist Professor Craig Munns. As yet, however, only one hospital and one LHD in NSW has adopted the 2016 international guidelines for the prevention and treatment of rickets, he says. The alarming rate of vitamin D deficiency in Australia is a result of limited sun exposure and a lack of regular supplementation. According to Prof Munns, this is partly due to sun avoidance to reduce the risk
of skin cancer, a modern lifestyle that keeps us indoors more, and clothing that limits skin exposure. Prof Munns highlights that due to the difficulty of diagnosing deficiency, there is a clear case for further education of health professionals on this issue. “The majority of cases are completely asymptomatic, so if you’re waiting to see signs of deficiency you’ve missed the boat. In severe cases, symptoms can include tiredness or aches and pains, but these are also common in pregnancy, so can be easily missed,” he says. Prof Munns, who is a Professor of Paediatric Bone and Mineral Medicine at the University of Sydney, will be revealing the full
scale of the problem at an upcoming seminar called Blood, Brain & Bone which will be held on 25 June in Sydney. Prof Munns says he will also be offering strategies to help empower and educate nurses and midwives on how to become agents for change for this important patient group.
Featuring national and international experts in their field Blood, Brain & Bone is a comprehensive one-day seminar to update nurses and midwives on important new developments and clinical understandings regarding the key micronutrients for life, growth, health and wellbeing.
Fracture Prevention Clinics, Role of Vitamin D and Calcium
Klaus Sommer Endocrine Clinical Nurse Consultant, Concord Hospital, Sydney
Dietary Sources vs Supplementation for Vitamin D, Iron and Iodine
Melanie McGrice Fertility and Prenatal Dietitian; Founder of Nutrition Plus; Adjunct Academic, Swinburne University
Iodine, Fetal Brain Development and the National IQ
Prof Cres Eastman Clinical Professor of Medicine, USYD; Chairman of the Australian Centre for Control of Iodine Deficiency Disorders
Prof Craig Munns is a Professor of Paediatric Bone and Mineral Medicine at the University of Sydney.
Find out more about Blood, Brain & Bone at www.healthed.com.au/seminars 28 | THE LAMP APRIL / MAY 2020
ADVERTORIAL
“Every health professional that has the ability to influence vitamin D supplementation needs to do their bit,” he says. “Nurses and midwives have a lot of contact with women during pregnancy and the immediate antenatal period, so that‘s an opportunity to influence women toward supplementation during pregnancy, and then to discuss universal supplementation for their babies. “This can be changed through increased awareness and understanding, which we’ve shown through information sessions with nurses and midwives. After these sessions, the number of nurses and midwives who said they would supplement babies in the first 12 months of life doubled.”
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WHY ATTEND? The Blood, Brain & Bone seminar will provide practically-focused, evidence-based education on the common micronutrient deficiencies and their prevention and management, especially Vitamin D, Iron and Iodine. Here is a more detailed breakdown of what our expert presenters will cover:
• Symptoms and signs of deficiency, red flags, and what to do when you spot them • Causes – lifestyle, diet, culture • Appropriate tests and their interpretation • Evidence-based strategies to prevent and treat • Patient education strategies • Further resources to stay up to date • Practical advice to support inter-professional practice • Six hours of high-quality CPD education
The majority of cases are completely asymptomatic, so if you’re waiting to see signs of deficiency you’ve missed the boat.
The benefits of this supplementation, he says, are hard to overstate. Although the incidence of rickets is still relatively low, the consequences can be dire. The skeletal and other developmental deformities it can cause can take years to treat, and the most severe complication is cardiomyopathy, which can lead to death. And although there are certain additional risk factors such as a darker skin tone, Prof Munns flags that vitamin D deficiency can happen to anyone. “50 per cent of pregnant women coming to Westmead Hospital are vitamin D deficient. If you look at Adelaide, it’s 75 per cent. So, while there are risk factors, nobody is immune in our current lifestyle of sun-avoidance, which is
understandable given the risk of skin cancer in Australia.” The point Prof Munns says he really hopes to drive home to all health professionals, and especially nurses and midwives at Blood, Brain & Bone, is that nutritional rickets is entirely preventable. “By giving vitamin D to the mother, you’re helping her general and bone health, and then whatever the mum’s vitamin D is, that’s pretty well what the baby’s vitamin D is. “Then by giving supplementation for the first 12 months of life, which is completely safe to do, parents can prevent nutritional rickets in the baby, and we can eradicate it. It shouldn’t be a thing.” Healthed, one of Australia’s leading educators of health
professionals, has created Blood, Brain & Bone with the specific objective of educating nurses and midwives on this important public health issue. GP and Healthed CEO Dr Ramesh Manocha says that nurses and midwives have a key and increasing role in addressing this issue. “Training has traditionally been directed at doctors, but we have now realised that nurses and midwives are actually much more important. They hold the key to reversing this public health problem. “This is precisely why we have created our new Blood, Brain & Bone seminar for nurses and midwives.”
Find out more about Blood, Brain & Bone over the page. THE LAMP APRIL / MAY 2020 | 29
6 HOURS OF HIGH-QUALITY EDUCATION! 6 HOURS HIGH-QUALITY EDUCATION! Delivered byOF a multidisciplinary team of leading experts tailored to midwives and other professionals Deliverednurses, by a multidisciplinary team health of leading experts tailored to nurses, midwives and other health professionals
A comprehensive one-day seminar specifically tailored to nurses, midwives, “…nurses pharmacists and midwives have keytailored and increasingly and allied health professionals. A comprehensive one-day seminar specifically to nurses, midwives, “…nurses pharmacists and midwives have key and increasingly important roles to play in society’s efforts to tackle and allied health professionals. It will provide practically-focused evidence-based education on the major micronutrients
important roles to play in society’s efforts to tackle
the publicand health challenges essential for growth development, sucheducation as of Iron,our Iodine, Vitamin D. It will provide practically-focused evidence-based ontime” theand major micronutrients – Munich Declaration, Nurses and midwives: a force for health, World Health Organisation the public health challenges of our time” essential for growth and development, such as Iron, Iodine, and Vitamin D.
2020
– Munich Declaration, Nurses and midwives: a force for health, World Health Organisation
BLOOD, BRAIN & BONE BLOOD, BRAIN & BONE EVIDENCE-BASED
THE LATEST PRACTICE
TAILORED TO NURSES & MIDWIVES
EVIDENCE-BASED
THE LATEST PRACTICE
TAILORED TO NURSES & MIDWIVES
FREE WEBCAST 25 June, 7pm-8.30pm
A comprehensive one-day seminar specifically tailored to nurses and midwives It will provide practically-focused, evidence-based education on the major micronutrients essential for growth and development, such as Iron, Iodine, and Vitamin D
st!
This event is now a FREE webca
REGISTER AT healthed.com.au PROUDLY SUPPORTED BY SANOFI PROUDLY SUPPORTED BY SANOFI
There are some things you shouldn’t handle alone. Contact the NSWNMA if you are: Asked to attend a disciplinary or fact finding interview with your employer Threatened with dismissal Instructed to provide a statement for any reason Contacted by the Health Care Complaints Commission or the Nursing and Midwifery Council of NSW Contacted by police or solicitors in relation to a Coronial Inquest
Call us on 8595 1234 (metro) or 1300 367 962 (non-metro) Email gensec@nswnma.asn.au www.nswnma.asn.au
THE LAMP APRIL / MAY 2020 | 31
HEROIC NURSES AND MIDWIVES
A nursing life forged in war In this Year of the Nurse and the Midwife, The Lamp will celebrate nurses and midwives who created their own history. In this issue we look at the life of Vivien Bullwinkel.
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was a council member and later president of the College of Nursing, helping to usher in the change from hospital-based nurse training to university-based qualifications.
n 12 February 1942 an Australian nurse, Vivian Bullwinkel, wa s c a r i ng for injured soldiers on a beach on Bangka Island off the Sumatran coast. When they were discovered by Japanese sold ier s, t he Japa ne se separated the men and women and ordered Vivian, along with 21 other nurses, to wade into the ocean until they were waist deep in water.
As a member of the Nurses Wages Board, she worked to improve pay and working conditions for all nurses in Victoria. Now the ACN is raising funds for a sculpture to be erected in the grounds of the Australian War Memorial to honour her life.
Vivian described the Japanese opening fire: “They just swept up and down the line, and the girls fell.”
Bullwinkel was born in Kapunda in 1915, a small town in South Australia on the Light River near the Barossa Valley, and she devoted her life to serving her country and her profession. She trained as a nurse and midwife at the Broken Hill and District Hospital, and she joined the Australian Army Nursing Service when World War II broke out.
A bullet hit Bullwinkel above her left hip, and when she fell into the sea she feigned death and allowed the current to bring her back to shore. She was the only nurse to survive. The story of what has become known as the Bangka Island massacre is told in Ian Shaw’s On Radji Beach. Bullwinkel hid on the Island for 12 days, caring for an English private who had evaded capture, and helped by villagers who provided food. Realising there was little hope of rescue, the pair surrendered to the Japanese army and were taken to a POW camp. When she returned to Australia, Bullwinkel became a leader in the nursing profession. In the 1970s she 32 | THE LAMP APRIL / MAY 2020
‘ They just swept up and down the line, and the girls fell.’
“I just felt that if my friends were prepared to go a nd f ight for my c o u n t r y, then they deserved the best care we could give them,” she told a 2007 documentary Vivian Bullwinkel: An Australian Heroine.
HEROIC NURSES AND MIDWIVES
ONE OF THE LAST OUT OF SINGAPORE She was working at the Australian General Hospital in Singapore in December 1941. The Japanese attack on Pearl Harbour was quickly followed by the Japanese army’s invasion of Malaya. By January, Bullwinkel’s medical unit was forced to evacuate. Bullwinkel joined 65 nurses and 265 men, women and children on the last ship to leave Singapore, the SS Vyner Brooke, originally designed to carry just 12 passengers. Two days later, Japanese aircraft sank the ship and survivors made it ashore at Radji Beach. Bullwinkel was later reunited with some of the nurses on board the SS Vyner Brooke in the POW camp, but only 24 of the 65 nurses would return home. Twenty-one died on Banka Island, eight died in POW camps, and the rest drowned.
Vivian continued to serve with the army in Japan until 1947, and she re-joined the Citizen Military Forces in 1955 until 1970, retiring as a Lieutenant-Colonel. She worked as the matron and later as director of nursing at Melbourne’s Fairfield Hospital until 1977, when she married and moved to Perth. Fifty years after the massacre, Bullwinkel returned to Bangka Island with surviving nurses and unveiled a memorial on the beach to the nurses who had died there. In recognition of her leadership in the profession and philanthropic work, Bullwinkel was awarded the Florence Nightingale and Royal Red Cross Medals, and she was also appointed to the Member of the Order of the British Empire (MBE) and to the Order of Australia (AO). Trevor Capps, the director of philanthropy at the ACN, said the Australian War Memorial (AMW)
has agreed in principle to locating a commemorative sculpture in the AWM grounds. “We are looking to raise half a million dollars. We are currently about a quarter of the way there and the War Memorial is in the process of approaching artists at this moment.” n
Find out more To donate to the campaign for a commemorative sculpture visit acn.edu.au/ bullwinkelproject or contact ACN Director of Philanthropy Trevor Capps at trevor.capps@acn.edu.au.
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THE LAMP APRIL / MAY 2020 | 33
PROFESSIONAL DEVELOPMENT
Hints to help new grads prosper in the transition to work The NSWNMA runs courses for new graduate registered and enrolled nurses and midwives transitioning to the workplace. Here are some of the most common questions new graduates have, answered by the Association’s professional team:
Q. DO YOU HAVE TIPS FOR TIME MANAGEMENT? A. First look at the shift-orientated tasks you have to complete: medications, observations, documentation and so on. These need to take priority; the rest are nursing-orientated tasks that can be handed over if needed. It is also vital to ask for help and delegate early if you are struggling.
Q. IS IT NORMAL TO FEEL REALLY OVERWHELMED AND A LITTLE APPREHENSIVE? A. Remember this is a journey of transitioning from what was, to what is. It will be like an obstacle course: overwhelming. You can have high expectations and feel that you should be functioning more like an experienced nurse, but remember you can be your own worst critic, and don’t be too hard on yourself.
Q. WHAT ABOUT MEDICATIONS? A. It is going to take time to do your medication rounds – this is normal and makes you safe. If sharing a medication trolley a good tip is to use it last. This will reduce pressure to rush and decrease the risk of errors. It is going to take time to get the hang of it. Be nice to yourself. Q. WHAT DO I DO WHEN I AM ASKED TO DO THINGS I HAVEN’T DONE BEFORE? A. Your experience and level of knowledge will be influenced by the clinical placements you have had. So it is important to let people know what experience you have had and that it is ok to say I am a new grad, I have not been exposed to this, do you mind showing me as I am happy to have a go, I just need to be shown.
Q. POOR WORKPLACE CULTURE – WHAT DO I DO? A. It is important to stay true to yourself and your professional practice. Making sure you follow the professional standards guidelines and frameworks that govern your practice. Make sure you form good habits early as they will stay with you always. You will see practice that might not be appropriate and one of the best ways to address this is to ask for a rational explanation.
34 | THE LAMP APRIL / MAY 2020
Q. HOW DO I COPE WITH SHIFT WORK? A. This is one of the hardest things to get used to. You need to listen to your body and make time for yourself
as this next year is going to be pretty intense. Ensure you don’t say yes to too much overtime as you will become fatigued and this is when errors happen. Be aware of the toll the initial transition can take on your personal energy and time. Q. WHAT SHOULD I DO IF I AM BEING BULLIED? A. You need to raise the concern with your educator as well as the manager. If you are not confident doing this, find a senior staff member who might be an advocate for your concerns, or you can ring and ask for advice from the Association. The primary task of a new grad is to develop skills you are not expected to have. That’s why we call it a transition. It takes time and experience to become a proficient practitioner within a dynamic and intense workplace. So go easy on the self-criticism – it takes a long time to become an expert.
Take our courses The Association conducts courses for new graduates that cover topics such as the award, rostering, standards, clinical handover and documentation. There are no transition courses scheduled at present due to COVID-19.
PROFESSIONAL DEVELOPMENT
Sonia’s journey from study to professional Sonia Kokuru recently graduated from the Bachelor of Nursing at UTS. In March she will start a new graduate position at Bankstown Lidcombe Hospital. The Lamp spoke to her about this challenging but rewarding transition. Sonia says she is excited but also a bit nervous about her new position. “I am hoping to get a lot of support from my preceptor and colleagues and senior managers and educators,” she says. “At the transition course we talked about how new grads are often quite stressed and experience lots of different emotions, and how not to be too shy in the workplace, but to try and communicate openly with everyone in an assertive way. “I would love to be in a general medical or surgical ward to get up to speed in clinical skills and build my confidence. “And I hope to have a rotation in an emergency department, because it is fast paced and I really enjoyed my placement there when I was at UTS.” Sonia recently attended the Association’s transition program where she and other new graduates were able to ask questions about issues such as night shift, swapping rosters and when shifts are published. “We also talked about workplace violence, and what to do if a patient
‘ Just try to enjoy it, be a safe practitioner, learn as much as you can and don’t put too many expectations on yourself.’ — Sonia Kokuru is being aggressive, and how far can you go to defend yourself.” Other topics covered included professional indemnity insurance and accident insurance, which the NSWNMA offers to new graduates, Sonia said. What message does Sonia have for new graduates like herself? “Just try to enjoy it, be a safe practitioner, learn as much as you can and don’t put too many
expectations on yourself. Don’t compare yourself to others: have your own goals and maybe keep a journal to monitor how you go throughout the year. And join the union because they will support you. If you have issues they will speak up for you.” To convert your Student Membership to Full Membership go to www.nswnma.asn.au
THE LAMP APRIL / MAY 2020 | 35
COVER STORY
PROFESSIONAL EDUCATION
COVID-19 CONTINUING PROFESSIONAL DEVELOPMENT (CPD) We understand many members have concerns regarding how they will meet their CPD requirements, given that most face-to-face courses have been cancelled or postponed due to COVID-19. Self-directed / online learning will make up an important part of your CPD whilst face- to-face courses are not available. Self-directed learning could be in the form of: • The Australian Nursing and Midwifery Federation online education: http://anmf.org.au/cpe • Department of Health COVID-19 infection control training: www.health.gov.au/resources/ apps-and-tools/covid-19-infection-control-training
• NSWNMA podcasts: www.nswnma.asn.au/ professional-issues/podcasts/ • Reading and reviewing the Nursing and Midwifery Board of Australia’s (NMBA) codes and standards: www.nursingmidwiferyboard.gov. au/Codes-Guidelines-Statements/Professionalstandards.aspx • Any type of learning you have had to undertake to prepare you for COVID-19 (in-services, reviewing workplace policies, online learning modules, journal articles). Through your membership, you have access to CINAHL, which has thousands of journal articles. This can be accessed via Member Central.
Your CPD record You should maintain your own records of the CPD you complete. You must keep records of your CPD activities for a period of five years, from the date you completed the CPD. There is no required format for how to document your CPD. You should keep evidence of CPD activities completed, including certificates of attainment and notes from self-directed CPD activity such as a literature review or journal articles. Any notes submitted should provide a comprehensive summary of the key points of the review, and reflect your learning from the activity. Our CPD guide provides more comprehensive information on CPD: https://www.nswnma.asn.au/ education/cpd 36 | THE LAMP APRIL / MAY 2020
COVER STORY
What activities can count towards CPD? Your CPD activities must meet your identified individual learning needs, and be relevant to your context of practice. Your context of practice is influenced by the conditions that define your nursing and/or midwifery practice. There is no requirement for CPD activities to be face-to-face, or in the form of a formal course.
FURTHER INFORMATION ON CPD IS AVAILABLE FROM THE NMBA
A broad range of activities can be recognised as CPD, including:
We recommended you familiarise yourself with the following:
• In-services and education at your workplace
• Registration Standard: Continuing professional development – NMBA
• Tertiary and other accredited courses, including distance education • Webinars or online discussion groups
• Guidelines: Continuing professional development – NMBA
• Self-directed learning (e.g. – policy review, literature review, case study or journal articles)
• Fact Sheet: Continuing professional development – NMBA
IMPORTANT INFORMATION REGARDING ATTENDANCE AT NSWNMA COURSES: COVID-19 NSWNMA members are at the frontline managing COVID-19, and will be one of the most important workforces during this pandemic. Supporting you, your health and your wellbeing is critical for the NSWNMA. We have made the decision to cancel our education program, up to 30 June 2020. We will re-assess the situation in May. We are in
the process of contacting members who have already enrolled in courses, and full refunds will be available. Professional Day 2020 is also cancelled. We are currently working on alternative online education options – we will notify you about these options once they become available. THE LAMP APRIL / MAY 2020 | 37
NEWS IN BRIEF
UNITED STATES
American College of Physicians calls for universal health care America’s largest medical organisation calls for root-andbranch reform of US health and endorses a single-payer financing system or a robust public alternative. The American College of Physicians (ACP) outlines its vision in a series of policy papers titled “Better is Possible” in the Annals of Internal Medicine. Robert M. McLean, president of ACP, was blunt in his assessment of the existing US health system. “We believe that American health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and under invests in public health; spends too much on administration at the expense of patient care; and fosters barriers to care for and discrimination against vulnerable individuals,” he said. In one of the policy papers the ACP calls for the country to achieve universal insurance coverage through a move to a single payer financing healthcare system or a publicly financed coverage option with regulated private insurance. It also recommends increased payments for primary and cognitive care services, an end of discrimination and disparities in access, eliminating workforce shortages and understanding and working to improve social determinants of health. “We can and must imagine what a better health care system looks like and be committed to attaining it. We believe the status quo is an unsustainable model for our country and most importantly, our patients,” said Robert McLean.
‘We believe the status quo is an unsustainable model for our country and most importantly, our patients.’ — Robert McLean, ACP president 38 | THE LAMP APRIL / MAY 2020
UNITED STATES
AI produces powerful new antibiotic Artificial intelligence behind breakthrough in new drug discovery. A powerful new antibiotic called Halicin has been developed using computer technology that analyses vast digital libraries of pharmaceutical compounds, reports The Guardian. The breakthrough came when researchers at Massachusetts Institute of Technology (MIT) developed a “deep learning” algorithm to identify molecules that kill bacteria by feeding information on the atomic and molecular features of nearly 2500 drugs and natural compounds, and how well or not the substance blocked the growth of the bug E coli. They then applied it to a library of more than 6000 compounds under investigation for treating various human diseases. The algorithm focused on compounds that looked effective but were unlike existing antibiotics, to boost the chances that the drugs would work in radical new ways. Researchers say it only took hours for the algorithm to assess the compounds and come up with promising antibiotics including Halicin. Tests showed that Halicin wiped out a range of antibiotic-resistant strains of bacteria, including Acinetobacter baumannii and Enterobacteriaceae, two of the three high-priority pathogens that the World Health Organization ranks as “critical” for new antibiotics to target. “In terms of antibiotic discovery, this is absolutely a first,” said Regina Barzilay, a senior researcher on the project and specialist in machine learning at MIT. The researchers have since applied the algorithm to a massive digital database of 107 million compounds. The program returned a shortlist of 23 potential antibiotics, of which two appear to be particularly potent.
‘In terms of antibiotic discovery, this is absolutely a first.’
NEWS IN BRIEF
WORLD
Fossil fuel financier says climate change threatens humanity The world’s biggest financier of fossil fuels, JP Morgan, warns clients that without action on climate change there could be “catastrophic” outcomes. The warning came in a report prepared by two JP Morgan economists, David Mackie and Jessica Murray, which was strikingly candid in its analysis of the consequences of climate change. “We cannot rule out catastrophic outcomes where human life as we know it is threatened,” they said The analysis, leaked to the BBC, said carbon emissions in the coming decades “will continue to affect the climate for centuries to come in a way that is likely to be irreversible”. It added that climate change could affect economic growth, shares, health, and how long people live.
CHILE
Spectacular results from Chile’s anti-obesity drive Tough laws have led to a 23.7 per cent drop in sales of sugary drinks in two years. The measures introduced in 2016 restrict the marketing of junk food and sugary drinks and impose a ban on their sale in schools. Chile’s Ministry of Health also add labels that warn if the drinks and food are high in sugar, salt or fat. Sugary drinks, unhealthy snacks and packaged foods must carry these prominent labels aimed at warning and educating families about the health dangers of junk food and drinks for their children. Researchers from the University of North Carolina at Chapel Hill Gillings School of Global Public Health, publishing in the journal PLOS Medicine, said Chile’s anti-obesity campaign went further than any other country in the world. “This regulation is different because it is the first to require warning labels about excess levels of nutrients of concern, such as sugar or sodium, on the front of food and beverage packages,” said Lindsey Smith Taillie, assistant professor of nutrition at the Gillings School. “The regulation includes the world’s strictest limits on how and where food companies can advertise junk food to children. The reductions we observed in sugary drink purchases were markedly greater than those seen following the implementation of standalone policies – such as a tax on sugar-sweetened beverages – elsewhere in Latin America.”
It could put stresses on water, cause famine, and cause people to be displaced or migrate. Climate change could also cause political stress, conflict, and it could hit biodiversity and species survival, the report said. To mitigate climate change, net carbon emissions need to be cut to zero by 2050. To do this, there needed to be a global tax on carbon, the authors said. In 2019, the Rainforest Action Network released a study claiming that JP Morgan provided the most fossil fuel firm financing of any bank in the world from 2016 to 2018.
‘We cannot rule out catastrophic outcomes where human life as we know it is threatened.’ — JP Morgan economists David Mackie and Jessica Murray
‘ The regulation includes the world’s strictest limits on how and where food companies can advertise junk food to children.’ THE LAMP APRIL / MAY 2020 | 39
NEWS IN BRIEF
AUSTRALIA
The National Party’s $400k aged care pork barrel Department of Health says decision to bail out struggling Victorian aged care home “was made by the government not the department”. The federal government gave an “unprecedented” $400,000 to a Victorian aged care home in the electorate of Nationals MP Damien Drum, while other financially stressed homes in ALP electorates missed out. The 40-bed Murchison Community Care home had to shut down despite the cash injection, with residents relocated and staff made redundant. The ALP said the government needed to answer questions about the process that led to the grant being given. Labor’s shadow aged care minister, Julie Collins, said it was “deeply concerning” that residents had been forced out of the Murchison nursing home despite the “unprecedented funding”. “The Morrison government must come clean on why it has provided this unprecedented funding while other nursing homes across the country at risk of closure have not,” she said. AUSTRALIA
ACTU Executive raises $25,000 for bushfire victims The ACTU executive met in Merimbula last month and hosted a fundraiser while it was there for bushfire-affected union members, raising $25,000. “When we saw the extraordinary impact the bushfire crisis had on workers, their families and communities here on the south coast we thought one of the things we could do was to bring our executive out of the capital city and into this community to show our solidarity and support,” ACTU President Michele O’Neil told the Merimbula News. She said the ACTU was determined that workers impacted by the fires were not forgotten. “We’re concerned about the level of the DRA (Disaster Recovery Allowance) that is available for workers who have lost work as a result of the fires. It is obscenely low – $40 a day,” she said. “We’ve been calling on the government to increase this to the level of the minimum wage since January but it has not listened to that yet. It’s essential that workers have money in their pockets. It's good for them and the economy if they have money to live on.”
‘One of the things we could do was to bring our executive out of the capital city and into this community to show our solidarity and support.’ 40 | THE LAMP APRIL / MAY 2020
“The care of vulnerable older Australians in rural and regional Australia must be above politics.” The Department of Health told the Senate the decision to provide financial assistance to the Murchison centre was made by the government, not the department. “This was a decision of government. The department has not provided funding of this specific nature before,” the department said in response to a question on notice.
‘The care of vulnerable older Australians in rural and regional Australia must be above politics.’ — ALP shadow aged care minister, Julie Collins
NEWS IN BRIEF
AUSTRALIA
Workers comp “fragile” Report highlights cost blowouts and poor return-to-work outcomes.
A review of the NSW workers’ compensation scheme Nominal Insurer (NI) commissioned by the State Insurance Regulatory Authority (SIRA) and prepared by an independent reviewer Janet Dore has exposed serious issues with the claims model, reports the Sydney Morning Herald. The report highlights the financial fragility of the scheme and the poor outcomes in getting workers back to work. Icare, which manages NI, was set up in 2015 after the WorkCover Authority of NSW was abolished. In 2018, Icare set up a new claims model and reduced the number of claims agents from five to one. The Dore Report said “the new claims model led to a significant deterioration in the performance of NI, through poorer return-to-work rates, underwriting losses, no competition and therefore concentration of risk”. It said workers were not getting the prompt treatment they required to get them back to work early. It noted that the return-to-work rate plummeted from 96 per cent in 2016 to 73 per cent in 2019. Dore noted the new claims model was causing cost blowouts and, in financial terms, “the position is somewhat fragile”. In 2019, Icare posted a net loss of $874 million, almost double its forecast loss of $481 million. Dore warned that the poor underwriting position of NI “is a real risk to the NI’s sustainability”.
‘ The return-to-work rate plummeted from 96 per cent in 2016 to 73 per cent in 2019.’
AUSTRALIA
Australia cuts Pacific aid health funding Australia has reduced its Pacific aid health spending by a third in last five years despite health crises in the region including a massive measles outbreak, polio and drug-resistant tuberculosis. Health aid funding has been cut in the Cook Islands by 75 per cent, Fiji by 22 per cent and in the Solomon Islands by 13 per cent according to figures released in Senate estimates in response to ALP questions. In Samoa, health aid has been cut by 36 per cent despite a measles outbreak that has claimed the lives of more than 80 people. The Chief Executive of the Australian Council for International Development, Marc Purcell, told The Guardian that Australia had traditionally been a leader on preventive health, but “this leadership has been lost”. “Given the low resilience of the region against infectious diseases, the recent spread of measles in Samoa and the threat of coronavirus, there are widely held concerns across the Pacific,” he said. The cuts are not just being felt in health. Australia has significantly cut its overall aid program in the last five years. In the current financial year, it will spend just 21 cents on foreign aid for every $100 the nation earns, a historic low, down from a peak of 33 cents in 2013–2014 and well below the UN target for wealthy countries of 70 cents.
‘ Given the low resilience of the region against infectious diseases, the recent spread of measles in Samoa and the threat of coronavirus, there are widely held concerns across the Pacific.’ — Marc Purcell, Australian Council for International Development THE LAMP APRIL / MAY 2020 | 41
YOUR RIGHTS
Ask
Judith A fragile world When I last wrote to you, we were still in the midst of a bushfire crisis like no other. It was hard to find anyone who was not directly affected or didn’t know someone who had been. Then, all too late, came the rain and the storms but cruelly for some, flooding as well. Now as I pen these words, the world is in the midst of a global pandemic – COVID-19 (Novel coronavirus). The Australian response started with travel bans and self-isolating those returning from a handful of countries. But as COVID-19 spread, the number of countries impacted grew, and community transmission became more prevalent, the initial containment strategy within Australia evolved into a more generalised pandemic response. We will inevitably need to prioritise the care of those most seriously impacted by COVID-19 (mainly the elderly and those with co-morbidities) and for the remainder, support and care as you would if you had influenza. And as always, the nursing and midwifery professions were on the front line. Of course this meant that with any workforce surge towards priority clinical areas, it was nurses and midwives who carried the heaviest load, and were amongst the first to have leave capped or knocked back for the coming months. Clinical indispensability comes with a downside. As this crisis evolves, at times changing daily (if not hourly), the Association has and will continue to support members with their clinical practice and industrial rights as best we can in these fraught and challenging times. 42 | THE LAMP APRIL / MAY 2020
When it comes to your rights and entitlements at work, NSWNMA Assistant General Secretary Judith Kiejda has the answers.
Accessing long service leave
The future of Mona Vale Hospital
I work in a public hospital. I have applied for long service leave a little while ago but am yet to hear anything. Can they knock my application back?
I remained at Mona Vale Hospital after the opening of the Northern Beaches Hospital. Did the NSW parliamentary inquiry say anything about our future? The NSW Legislative Council commenced an inquiry last year to examine the Northern Beaches Hospital. The Committee’s Final Report was released at the end of February this year. One of its recommendations about Mona Vale Hospital’s future role included: “That the NSW Government take immediate steps to engage directly with Northern Beaches state Members of Parliament, community leaders and other stakeholders to investigate the ways and means to restore a public level three emergency department to the Mona Vale Hospital as soon as possible.” [Recommendation 9] The Committee also recommended that the sites of Mona Vale and Manly Hospitals remain in public hands for health and medical related activities [Recommendation 16] and that when asbestos has been removed, the demolition of the Mona Vale Hospital main building should cease so it can be retained for future use [Recommendation 17].
While the Ministry of Health has confirmed that any ‘new’ applications will not be subject to a blanket prohibition, it is clear that as the health system moves to a pandemic footing, it will place a priority on having the workforce in place to meet clinical demands, consistent with relevant pandemic plans. Having applied some months ago is a mitigating factor to take into consideration, as well as any reasons you have for the leave. However, Clause 33(vii) of the Public Health System Nurses’ and Midwives’ (State) Award does stipulate that “Long service leave shall be taken at a time mutually arranged between the employer and employee”. So, while the Association can and does argue on behalf of members regarding access to leave, it will be, as always, very dependent on the individual circumstances involved. Activation of the pandemic plan will certainly make achieving mutual agreement more challenging.
The NSW Government’s response to all the recommendations made (i.e., accept or decline) is yet to be tabled.
Minimum shift length at RSL LifeCare I work part time at a nursing home run by RSL LifeCare. What is the minimum rostered shift length? Clause 14.3(b)(i) of the RSL LifeCare, NSWNMA and HSU NSW Enterprise Agreement 2017–2020 states that part-time employees shall receive a minimum payment of three hours for a rostered shift. This minimum may be varied for things like training outside normal rostered hours.
Breaks between shifts The public hospital I work at often has only an eight-hour break between rostered shifts. Is that right? The minimum break between rostered shifts (excepting those working 12-hour shifts) is ten hours under clause 4(iv)(a) of the Public Health System Nurses’ and Midwives’ (State) Award – “unless agreed otherwise between an employee and local nursing management”. The minimum break between rostered shifts for a 12-hour shift system is 11.5 hours under clause 5 of the Award.
NURSING RESEARCH AND PROFESSIONAL ISSUES The sexual harassment experienced by nurses and midwives at work has been raised in a number of Association fora and a position statement is being development for endorsement by members. Five Women This American Life, March 2018 Following the Harvey Weinstein trial, we have a different kind of #MeToo story about several women who worked for the same man. They tell us not only about their troubling encounters with him, but also about their lives beforehand. Who were they when they entered the workplace, and how did their personal histories shape the way they dealt with his harassment? https://www.thisamericanlife. org/640/five-women
Guidelines: Special measures under the Sex Discrimination Act 1984 (Cth) (2018) Australian Human Rights Commission Over the last century, Australia has made significant progress towards achieving gender equality and creating a more inclusive society. The Australian Human Rights Commission welcomes these positive steps. However, recognising that some deeply embedded barriers to equality in certain areas of public life remain pervasive, a ‘positive discrimination’ mechanism known as ‘special measures’ was included in the Sex Discrimination Act 1984 (Cth) (SDA) to enable individuals and organisations to take steps to correct this inequality. The SDA recognises that some groups have suffered historical disadvantage and do not enjoy their human rights equally with others. The gender pay gap, the underemployment of women, barriers to leadership roles, reduced retirement savings and high rates of sexual harassment at work are examples of this continuing inequality. LGBTI persons continue to experience discrimination at work and experience higher than
average rates of violence, harassment and bullying. Increasingly, organisations are seeking to address this inequality by taking proactive measures. The SDA permits individuals and organisations to take special measures for the purpose of achieving substantive equality for disadvantaged groups. These guidelines are intended to assist organisations and individuals to understand and use the special measures provisions in the SDA. They are an important resource for organisations and individuals seeking to take positive steps to achieve gender equality and a more inclusive Australia. https://www.humanrights.gov. au/our-work/sex-discrimination/ publications/guidelinesspecial-measures-under-sexdiscrimination-act
Respect@Work: Sexual Harassment National Inquiry Report Australian Human Rights Commission, March 2020 From the early 1970s, Australia was at the forefront of tackling sexual harassment globally. However, Australia now lags behind other countries in preventing and responding to sexual harassment. Since 2003, the Australian Human Rights Commission has conducted four periodic surveys on the national experience of sexual harassment. The most recent survey conducted in 2018 showed that sexual harassment in Australian workplaces is widespread and pervasive. One in three people experienced sexual harassment at work in the past five years. As the 2018 National Survey revealed, almost two in five women (39 per cent) and just over one in four men (26 per cent) have
experienced sexual harassment in the workplace in the past five years. Aboriginal and Torres Strait Islander people were more likely to have experienced workplace sexual harassment than people who are non-Indigenous (53 per cent and 32 per cent respectively). Sexual harassment is not a women’s issue: it is a societal issue, which every Australian, and every Australian workplace, can contribute to addressing. Workplace sexual harassment is not inevitable. It is not acceptable. It is preventable. https://www.humanrights.gov. au/our-work/sex-discrimination/ publications/respectwork-sexualharassment-national-inquiryreport-2020
Australian nurses are sexually harassed by our patients. It’s not part of our job Simone Sheridan with Ailsa Wild, 2019 It was the night shift. I was a recent graduate nurse and had to attend to him over and over again that night. Every time I approached, he gripped my arm, yanked me towards him and said, “I’m gonna get my piece of meat into you,” in that dark, gravelly voice. His adult daughter was asleep on a chair beside him; when she was awake, she reached over to pat his arm and say, “There, there, Dad”. Her presence didn't make things better. It made them worse. I felt like I had to protect her from his behaviour. To stay quiet. To be professional. To reassure her that it was just the illness and it wasn’t impacting me. Oh no. I was fine. I was doing my job. This was my job. https://www.abc.net.au/ news/2019-04-23/australiannurses-sexual-harassment-metoo/11032406
THE LAMP APRIL / MAY 2020 | 43
INSURANCE BENEFITS
For NSWNMA Members
Insurance protection when you need it most The NSWNMA is committed to protecting the interests of nurses and midwives by purchasing a range of insurances to cover members.
Journey Accident Insurance provides cover for members who are injured as a result of an accident while travelling between their home and their regular place of employment. Professional Indemnity Insurance provides legal representation and protection for members when required. Make sure your membership remains financial at all times in order to access the insurance and other benefits provided by the NSWNMA.
Unsure if you are financial?
It’s easy! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural) Change your payment information online at www.nswnma.asn.au
www.nswnma.asn.au 44 |
IMPORTANT NOTE From 1 December 2018 the insurance benefits have changed as follows: • Journey Accident Insurance: the waiting period for benefits is now 14 days Professional Indemnity Insurance: the limit per claim is now $5 million THE LAMP APRIL /•MAY 2020
CROSSWORD
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ACROSS 1. Involving two or more separate branches of learning (17) 10. Conference, gathering (7) 11. Recreations, refreshments (11) 12. Novel plasminogen activator (1.1.1) 13. Symbol for orotic acid (3) 14. Ache (4) 15. Producing stolon (13) 19. Diacylglycerol (1.1.1) 20. Rotavirus (1.1) 21. Muscular layer of the throat wall (10.7)
24. Sensitive or responsive to stimulus (9) 26. Resembling cheese (7) 27. Murmur (9) 30. A ladderlike structure (5) 31. Symbol for actinium (2) 32. Any of various carbohydrates containing a ketone group (6) 33. Incapacity (9) 34. A prank, trick (5) 35. A genetic disease in which patients develop multiple soft tumours (17)
DOWN 1. Techniques to prevent transplant graft rejection by the body’s immune system (17) 2. Parasitic flatworms (9) 3. The branch of medical science concerned with the nose and its diseases (9) 4. Growing inward (9) 5. An enzyme that catalyses the degradation of collagen (11) 6. Having the form of a network; intricate or complex (9) 7. The arches, or highest part of the dorsums of the feet (7) 8. Relating to the belly (9) 9. A single-celled fungus that ferments sugar to produce alcohol and carbon dioxide (5) 16. Multitude (5.6) 17. Any hanging, fleshy mass (5) 18. Immunities (11) 23. Grow louder (9) 25. A large vessel (3) 26. The body of a vertebrae (7) 28. Small, sac-like of compound glands (5) 29. Electrokymogram (1.1.1) 30. Streptococcal superantigen (1.1.1)
THE LAMP APRIL / MAY 2020 | 45
The Edith Cavell Trust is now able to receive non-tax deductable donations/bequests. The Trust – named in honour of Edith Cavell – assists in the advancement of NSW nurses, midwives and assistants in nursing/midwifery through further studies and research, made available through scholarship. The knowledge and expertise gained by nurses, midwives and assistants in nursing/ midwifery, supported by the Edith Cavell Scholarships, is an asset to the care of their patients and clients. Bequests to the Trust continue to support this important work. Edith, a British nurse serving in Belgium in WW1, is a hero to most nurses and midwives. She helped some 200 Allied soldiers escape from German-occupied Belgium. Her actions saw her arrested, accused of treason, found guilty by a court-martial and sentenced to death. Despite international pressure for mercy, she was shot by a German firing squad. NAME ADDRESS
Cavell Edith
TRUST BEQUESTS
PHONE
BEQUEST/ DONATION AMOUNT
$
PREFERRED METHOD OF PAYMENT Electronic Fund Transfer Account name: Edith Cavell Trust Bank: Commonwealth Bank BSB: 062-017 Account no: 10017908 Credit Card I authorise the Edith Cavell Trust (processed via NSWNMA) to debit my credit card for the amount of Mastercard
Visa
$
Name on Card
Card no
Expiry Date
/
Signature of Cardholder
DIABETES UPDATE EVENING for nurses
Your NDSS agent in NSW & ACT is
Learn while you earn CPD points Wednesday 13 May 2020 Dubbo Thursday 14 May 2020 Tamworth Wednesday 3 June 2020 Nowra Thursday 18 June 2020 Woden More dates and locations available on our website.
Ticke ts $20
Diabetes NSW & ACT is offering a diabetes evening workshop (including a light dinner) for nurses working within a hospital, medical practice, community health or aged care setting. The training will provide participants with an increased understanding of diabetes and the services available to their patients. This session is suitable for Enrolled Nurses and Registered Nurses. CPD points for this seminar will be available with the Australian College of Nursing (ACN) and Australian Primary Health Care Nurses Association (APNA).
For more information or to register visit diabetesnsw.com.au/events or call 1800 637 700. The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. The NDSS agent in New South Wales and the ACT is Diabetes NSW & ACT. 46 | THE LAMP APRIL / MAY 2020
REVIEWS
book club T
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All books can be ordered through the publisher or your local bookshop. Call 8595 1234 or 1300 367 962, or email library@nswnma.asn.au for assistance with loans or research. Books are not independently reviewed or reviewed using information supplied by the publishers.
IN T E
Women, Work And Migration – Nursing In Australia Jane van den Broek and Dimitria Groutsis: Taylor & Francis Ltd: RRP $81.50: ISBN 9780367140649
This book looks at the migration and work experiences of six women who have migrated to Australia from China, Zimbabwe, South Korea, the United Kingdom, India and the Philippines. It sets their journeys out into three distinct periods of migration, including the first period of their lives when they reflect on their experiences growing up with their immediate families and the factors that encouraged them to gravitate towards a nursing career. The second period covers time when each of these women begins to think about where their career in nursing might take them. During this phase, these women take their first steps to leave their home country and migrate to Australia, often after several countries in between. The final section allows the reader to understand how these women initially experienced Australia when they first arrived and how they faced challenges both personally and professionally.
Wild Fearless Chests Mandy Beaumont Hachette Australia RRP $28.99 ISBN 9780733643033 Brutal. Uncompromising. Magnificent. Complex. Unforgettable. A timely debut short story collection that breaks open the idea of women from a powerful new Australian literary voice.
The Testaments: The Sequel to The Handmaid's Tale Margaret Atwood Nan A. Talese: RRP $32.25 (Hardcover) ISBN 9781784742324
In this electrifying sequel to The Handmaid’s Tale, Margaret Atwood answers the question that has tantalised readers for decades: What happened to Offred? When the van door slammed on Offred’s future at the end of The Handmaid’s Tale, readers had no way of telling what lay ahead. With The Testaments, the wait is over. Margaret Atwood’s sequel picks up the story 15 years after Offred stepped into the unknown, with the explosive testaments of three female narrators from Gilead. ‘Dear Readers: Everything you’ve ever asked me about Gilead and its inner workings is the inspiration for this book. Well, almost everything! The other inspiration is the world we’ve been living in.’ – Margaret Atwood
On the Plain of Snakes: A Mexican Journey Paul Theroux: Houghton Mifflin Harcourt: RRP: $35.00 ISBN 9780241266687
Nogales is a border town caught between Mexico and the United States of America. A forty-foot steel fence runs through its centre, separating the prosperous US side from the impoverished Mexican side. It is a fascinating site of tension, now more than ever, as the town fills with hopeful border crossers and the deportees who have been caught and brought back. And it is here that Paul Theroux will begin his journey into the culturally rich but troubled heart of modern Mexico. Mexico is a country that has captured literary imaginations from D. H. Lawrence and Graham Greene to Aldous Huxley. Now Paul Theroux, master of travel writing, immerses himself, attending local language and culinary schools, driving through the country, getting under its skin.
THE LAMP APRIL / MAY 2020 | 47
INSTANT SAVINGS
e-gift cards
A on c ppl l 31 os ica JU e 5 tion LY PM s 20 20
Great discounts and deals for members on a huge range of products and services. Take advantage of Union Shopper’s collective buying power & be part of the savings!
1300 368 117 unionshopper.com.au
Scholarships for the academic year 2021
Applications for the Edith Cavell Trust Scholarships are being accepted from 1 May 2020, closing 31 July 2020, for studies being undertaken in the academic year 2021. Members or Associate Members of the NSW Nurses and Midwives’ Association or the Australian Nursing and Midwifery Federation (NSW Branch) are invited to apply. All grants, awards or loans shall be made to financially assist nurses, midwives, assistants in nursing, assistants in midwifery (including students of those disciplines), and accredited nursing or midwifery organisations, schools and faculties in the furtherance of: (i) accredited nursing or midwifery studies; (ii) such academic research programs as are approved by the Trustees in the theory or practice of nursing or midwifery work; or (iii) clinical nursing education programs at graduate, post-graduate and continuing education professional development level; in accordance with a number of categories.
www.nswnma.asn.au CLICK ON ‘EDUCATION’
Full details of the scholarship categories, how to apply and to obtain the official application form is available from the NSWNMA website. Prior to applying, please ensure you have read the Edith Cavell Trust Scholarship Rules.
FOR FURTHER INFORMATION CONTACT: SCHOLARSHIP COORDINATOR, THE EDITH CAVELL TRUST 50 O’Dea Avenue, Waterloo NSW 2017 T 1300 367 962 E edithcavell@nswnma.asn.au 48 | THE LAMP APRIL / MAY 2020
OBITUARY
REVIEWS
at themovies VA L E
Margaret Murray 1 9 3 4–2 0 1 9
Margaret wou ld v i sit each ward and got to know all the staff. She never refused a chocolate and although she h ad a tough exterior, everyone knew she cared. As one staff member said: “Sister Murray had a heart as big as the outback and had a genuine concer n for staff, patients, and the hospital as a whole.” Margaret started her nursing career in country NSW, training at Bathurst Hospital from 1952 to 1956. She travelled to Hobart for her midwifery training and then returned to country NSW, working at Oberon Hospital as a nursing sister and midwife. In late 1958, the lure of overseas travel and adventure saw Margaret and nursing friends travel to England. They worked as private nurses and travelled to many parts of Europe. They visited Amsterdam, Norway, Sweden, Germany, Paris, and many parts of Italy, including Venice.
M a rga ret was then appointed a s evening ADON and continued work ing in this role until her retirement in September 2000. Retirement did not last long – she happily accepted the offer of a casual position working as evening ADON until 15 June 2006. Margaret kept her nursing record of service ‘blue book’ which outlined her nursing record and her last payslip from Blacktown hospital in the front cover of her Bible. Margaret completed 40 years and one day of nursing service at Blacktown Hospital and achieved 54 years of paid nursing. Margaret loved nursing and caring for all around her. She inspired many to go into nursing and was always there to listen to staff and lend a hand.
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Margaret returned home to help her family when her father was diagnosed with end-stage lung cancer and did not have long to live. She resumed working in country NSW at Oberon Hospital. Soon after, her mother became unwell. Margaret moved to Sydney to support and care for her mother, younger sister and brother. Margaret started working at Mount Carmel Hospital, moving to the new local Blacktown Hospital on 14 June 1966. Working on the medical and surgical wards and in the coronary care unit. In 1976, she was appointed charge sister for the female and ma le medical ward.
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argaret was born November 1934 at Crown Street Sydney and passed away on 5 November 2019 at her beloved Blacktown Hospital. Blacktown Hospital was Margaret’s second home, having worked there 40 years and for many years as the evening ADON. Margaret was fondly known as Sister Murray, or when the hospital was busy, Sister Poorly.
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Agatha Raisin Series 3 A quiet village life can be murder – our favourite amateur detective is back. Starring Ashley Jensen (Catastrophe, Extras, Ugly Betty) Agatha Raisin is based on MC Beaton’s bestselling novels. Having consciously coupled at the end of series two, Agatha Raisin is optimistic that her future with James Lacey (Jamie Glover, Waterloo Road) is secure and their troubles are behind them. Newly qualified as a private detective and with her new investigations agency all set up and raring to go, things have never been better for the Cotswolds’ premier PI, but plans have a funny way of going awry in Agatha-land. Email The Lamp by 13 April to be in the draw to win one of five DVDs to Agatha Raisin Series 3 thanks to Acorn Media. Email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win! THE LAMP APRIL / MAY 2020 | 49
DIARY DATES
make a date
Diary Dates for conferences, seminars, meetings and reunions is a free service for members. lamp@nswnma.asn.au
NEW SOUTH WALES APNA National Conference 21–23 May 2020 International Convention Centre, Sydney https://10times.com/apnanational-conference-sydney ACORN 2020 International Conference: Vision for the future 28–30 May 2020 International Convention Centre, Sydney https://www.acorn.org.au 5th National LGBTIQ Women’s Health Conference 4–5 June 2020 NSW Teachers Federation Conference Centre, Sydney https://lbq.org.au Enrolled Nurses Professional Association NSW Annual Conference 2020 17–18 September 2020 Rydges Parramatta https://www.enpansw.net Enhancing Practice 2020 Conference: 20:20 Vision – Transforming our future through person-centred practices 11–13 November, 2020 Sage Hotel, Wollongong http://www. enhancingpractice2020. com.au/ehome/index. php?eventid=492510& Editor’s note: At the time The Lamp goes to print events and initiatives may be cancelled due to the COVID-19 pandemic. Please check the relevant websites.
INTERSTATE Australian Pain Society 40th Annual Scientific Meeting 5–8 April 2020, Hobart, Tasmania https://www.dcconferences. com.au/aps2020/ Palliative Care Nurses Australia Conference 3–4 May 2020 Pullman Albert Park, Melbourne, Victoria kt@asnevents.net.au Global Academic Programs (GAP) Conference: New Frontiers – Leading inspire cancer care 11–13 May 2020 Melbourne Convention and Exhibition Centre, South Wharf, Victoria jodi@laevents.com.au 7th Rural and Remote Health Scientific Symposium: Shaping the future 25–26 May 2020 Alice Springs Convention Centre, Northern Territory http://www.ruralhealth.org. au/7rrhss/home 23rd Cancer Nurses Society of Australia Annual Congress: Precision care everywhere 18–20 June 2020 Brisbane Convention and Exhibition Centre, Queensland https://www.cnsa.org. au/congressevents/ cnsa-annual-congress
Please send event details in the format used here: event name, date and location, contact details – by the 5th of each preceding month. Send your event details to: lamp@nswnma.asn.au Fax 02 9662 1414 Post 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space. Priority is given to non-profit professional events.
Renal Society of Australasia Annual Conference: Unite and ignite renal care for the next decade 25–27 June 2020 Melbourne, Australia https://www.renalsociety. org/education/2020-annualconference/ 18th National Nurse Education Conference: Inspire, Motivate, Educate 28–30 October 2020 Gold Coast, Queensland https://www.ants.org.au Wounds 2020 4–7 October 2020 Brisbane, Queensland https://wounds2020.com.au INTERNATIONAL International Conference on Nutrition Research 18–20 June 2020, Rome, Italy https://magnusconferences. com/nutrition-research/
TICKETS ONLY
$5 1ST PRIZE
$8000 TRAVEL VOUCHER
AIDS 2020 6–10 July, 2020 San Francisco, CA, USA https://www.aids2020.org/ Men’s Health World Congress 2020: United for men’s health 9–11 July, 2020 Borneo, Indonesia https://www.mhwc.my/ Alzheimer’s Association International Conference 26–30 July, 2020 Amsterdam, Netherlands https://www.alz.org/aaic/ overview.asp International Council of Nurses (ICN) Congress 2021 Abu Dhabi, UAE www.icn.ch/ REUNIONS 1981–1984 Westmead Nurses 40-year Reunion January 2021, Date and Venue TBC Freda Tomkinson on 0417 289 980
RAFFLE 2020 YOU COULD WIN A SHARE OF MORE THAN
$12,000
WORTH OF PRIZES!
CROSSWORD SOLUTION
2ND PRIZE
$1799 BIKE
Support the 2020 Solidarity Raffle to stand with workers around the world striving for justice and decent work!
3RD PRIZE
$500 BOOK VOUCHER
BOOK SELLERS' PRIZE
Sell three or more books and enter the bonus draw!
apheda.org.au/raffle 50 | THE LAMP APRIL / MAY 2020
needed it. did it. loved it. Recruit a new member and go into the draw to win a 5 night Optimal Wellness Program for two at the Golden Door Wellness Retreat & Spa, Hunter Valley valued at over $6,000
THE 2019 – 2020
NSWNMA Member Recruitment scheme prize PRIZE DRAWN 30 JUNE 2020
The perfect place to reset your mind and body and gain a wealth of knowledge to create a healthier, happier and more motivated you. You and a friend will experience: • • • • • •
5 nights’ accommodation in a private villa Personal welcome consultation on arrival All nutritious meals and snacks Diverse selection of group fitness activities, relaxation and mind-body classes Daily program of health education seminars and workshops Use of all the facilities including a heated indoor pool, outdoor pool, tennis courts, gymnasium, indoor activity studios and outdoor relaxation areas • Two luxurious spa treatments including one Classic Facial and one Swedish massage • One wellness consultation with your choice of: wellness coaching, meditation, yoga or standard personal training session • Access to all the spa facilities including steam room, spa bath and relaxation lounges. Guided by a team of health professionals, this program will give you a complete understanding of the art of skilful living and homegrown wellness – a results driven concept the Golden Door team is highly trained in. Optimise your goals to reach new heights in all aspects of your life.
Every member you sign up over the year gives you an entry in the draw! RECRUITERS NOTE: Join online at www.nswnma.asn.au If you refer a member to join online, make sure you ask them to put your name and workplace on the online application form, so you will be entered in the draw.
Conditions apply. Prize must be redeemed by 30 June 2021 and is subject to room availability. Block out dates include all Australian and NZ school holidays and Christmas / New Year period. The Optimal Wellness Program commences Sunday through Friday each week. The prize will be drawn on 30 June 2020. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/19/04224.
Join the health fund that’s all about you.
Nurses & Midwives Health is dedicated to caring for the carers. We’re the only health fund exclusively for nurses, midwives and their families. When you’re a member, you’re part of our family. So that’s why your family members are also welcome to join us.
For your free, side-by-side comparison, and our latest offers, visit nmhealth.com.au call 1300 344 000 Eligibility criteria and conditions apply. Nurses & Midwives Health Pty Ltd ABN 70 611 479 237 NMH-NSWNMA-03/20
Authorised by B. Holmes, General Secretary, New South Wales Nurses and Midwives’ Association, 50 O’Dea Ave, Waterloo NSW 2017