The Lamp February 2022 by NSW Nurses and Midwives' Association

COVID-19

AGED CARE

PUBLIC HEALTH SYSTEM

REGULARS

Omicron rips through aged care

Albo signs aged care pledge

Push for mandatory ICU standards

page 10

page 20

page 24

Your rights and entitlements at work Crossword Reviews Nursing research online

THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 79 NO. 1 FEBRUARY/MARCH 2022

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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 79 NO. 1 FEBRUARY / MARCH 2022

Hunter Office 8–14 Telford Street, Newcastle East NSW 2300 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 Produced by Hester Communications T 9568 3148

COVER STORY Nurses left to clean up Perrotet’s “shambolic mess”

Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au Editorial Committee Brett Holmes, NSWNMA General Secretary Shaye Candish, 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. Authorised by B.Holmes, General Secretary, NSW Nurses and Midwives’ Association, 50 O’Dea Avenue Waterloo NSW 2017 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 2022 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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10 12 14 20 24

COVID-19

REGULARS

Federal government goes missing as Omicron rips through aged care COVID and the federal government’s incompetence is putting elderly Australians living in residential aged care facilities in grave danger. COVID-19

A fatal approach to Omicron NSW’s “Let it rip” strategy will condemn many people to death – especially among the vulnerable – and has placed an enormous strain on an already exhausted health system, says the independent expert group OzSAGE.

5 6 29 30 34 39 41 42 45

Editorial Your letters What’s on Ask Shaye News in brief Crossword Book Club Your Health Nursing Research Online and Professional Issues

COVID-19

We need practical help, not platitudes The NSWNMA’s Liverpool Hospital branch has called on the NSW government to take concrete steps to alleviate the staffing crisis impacting many of the state’s hospitals. AGED CARE

Push for mandatory Intensive Care standards Critical care nurses take staffing case to health minister.

COVER: Mirabel Nelson and Melissa Mansell Photographed by Sharon Hickey

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4 | THE LAMP FEBRUARY/MARCH 2022

EDITORIAL

SHAYE

Candish

NSWNMA ACTING GENERAL SECRETARY

Patients, nurses and midwives deserve better The first responsibility of any government is to protect its citizens from harm. By this measure, the federal and NSW governments have failed badly. At every moment in the COVID crisis the federal and NSW governments have been behind the game and slow to listen to and act upon health advice. The vaccine “strollout”’ and the rolling calamities in aged care were particularly inexcusable. But with the arrival of the Omicron variant, things have gone from bad to worse, with both governments abandoning the health advice that successfully underpinned Australia’s pandemic response for the first 18 months. Independent experts have been brutal in their assessment of the federal and NSW governments’ response to Omicron. The respected multidisciplinary group OzSAGE has described their strategy as a “shambolic mess … that will condemn many people to death”, especially among the vulnerable (see page 12). “The only example Australia is providing to the world now is a warning about what not to do with the COVID-19 pandemic,” said Dr Kerryn Phelps, a former president of the AMA and an OzSAGE member. In aged care the federal government’s hands-off approach has had “heartbreaking consequences”, say experts. (see p10). Even Scott Morrison’s and Dominic Perrotet’s economic arguments for “letting it rip” have been skewered by experts. “Letting people that are at high risk of having or spreading the infection return to work quickly helps the labour supply this week, and harms the labour supply in the coming weeks when it spreads. This is the definition

It is only nurses’ commitment and goodwill holding our public health and aged care systems together and it will be our collective actions that can bring change. of short-termism (and) we now have a COVID-induced labour supply problem,” said Richard Deniss, chief economist at the Australia Institute. NURSES SPEAK OUT Many nurses have shown remarkable courage to speak out about what is happening in our public hospitals and our aged care system. Since the start of the year, at least 40 members have spoken to the media. This has led to hundreds and hundreds of stories on radio, online, TV and in newspapers making sure all our communities know what nurses are going through right now and the impact that has on patient care. I know the situation in hospitals and aged care facilities is incredibly tough and I’ve heard from members how exhausted, frustrated and angry they are feeling. Nurses are absolutely right to be furious with the NSW and federal governments. Their actions and inactions have led us to this crisis. Their persistence in saying the system is coping reveals a complete disregard for the truth. It is outrageous that NSW Premier Dominic Perrottet continues

to spin the lie that our public healthcare system is ‘strong’. He repeats this lie while you are exhausted, working excessive overtime and are short-staffed. Patient care is suffering. It is unforgivable that aged care nurses are struggling to have access to appropriate PPE with many not even fit tested. It is outrageous that the Morrison government asks people to rely on RATs, knowing ordinary working families can’t get access to them. It is diabolical that RATs are not available in nursing homes while many aged care residents still await their booster. We need to challenge the dishonest government narrative that our hospitals are “coping”. It is only nurses’ commitment and goodwill holding our public health and aged care systems together and it will be our collective actions that can bring change. I encourage all of you to get active, speak out and share your stories and experiences. The public needs to know the truth about the dire state of our health system and the threat this poses to our patients. n

THE LAMP FEBRUARY/MARCH 2022 | 5

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I’m a registered nurse and have worked in health for 40 years. I am tired. Tired of being told we have adequate staffing (we don’t), tired of being told the system is coping well (it isn’t), tired of fighting for safe patient ratios that never seem to come. 8/11/21 12:05 pm Then COVID came and it all got worse. I currently work six shifts per week and get daily texts offering me up to 10 different shifts per day. The staff are tired due to leave cancellations and extra shifts. I don’t want to get flogged on every shift, but the system is overwhelmed and understaffed. The NSW health system needs to dramatically increase 8/11/21 12:05 pm the FTE of nurses. I just want to provide safe patient care. Tod Adams, RN

It’s unsustainable 8/11/21 12:05 pm

COVID-19 has shown how vulnerable our public health system is – and nurses and midwives are crucial to keeping it running. However, our current workloads are just not sustainable. We’re tired, we’re burning out, and we don’t feel supported at work. The system is at breaking point. Nurses and midwives like me have been fighting for safe staffing ratios for over a decade, but our stubborn state government refuses to listen. A nurse-to-patient ratio is the number of nurses working on a ward or unit in relation to the number of patients they care for. There aren’t enough nurses to patients, and it’s risking lives. Research has shown time and again that the number of patients allocated to a nurse or midwife on a shift is directly related to patient safety, mortality and quality of care. To put it simply, safe staffing ratios save lives. It’s time the NSW government stopped patting us on the back and calling us heroes. They need to listen to us as trusted health professionals and deliver the health system we all deserve. Together, we can help deliver the public health system NSW deserves. Skye Romer, EN

SEND YOUR LETTERS TO: Editorial Enquiries EMAIL lamp@nswnma.asn.au fax 9662 1414 MAIL 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high-resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.

We need community support Emergency nursing has always been a very complicated and demanding job. Over the past two years, this pandemic has made it even more complicated. For example, many nurses must dress in uncomfortable PPE to protect ourselves and our patients. It has also made staffing more complicated, because when a nurse becomes a close contact, whether it’s in the ED or in the community, they need to isolate. This can really affect the number of nurses we have working at any time. It can also impact on the range of necessary skills that we have in our ED while staff are in isolation. What would really help us in our EDs is if we had mandatory ratios of one nurse to three patients. Safe staffing ratios would ensure we can offer the best possible patient outcomes for our community. Emergency nurses like me are doing our best to deliver quality healthcare during this pandemic. Now we need our community to support us with our fight for ratios of 1:3 in ED. Steven Zorgios, RN

LETTER OF THE MONTH Better listen up The last two years have been tough, particularly for nurses and midwives, and most particularly in NSW. Interminably hailed as heroes and angels, but still not many people get it. Not the NSW government, not the federal government and not most of the general public. It’s been consistently too little, too late, with both government jurisdictions on the back foot. It has taken the Omicron variant to at last get us the media coverage we have been seeking. To articulate the anger and frustration, knowing that if we’d had nurse/midwife patient ratios when we first requested them years ago, at least we’d have a bit of padding in the health system now. To tell the heart-wrenching stories of the day in, day out slog, stress and anxiety of every shift, knowing that patient safety and your registration are both on the line. What it’s like actually wearing

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PPE until you are dehydrated and depleted by shift’s end, your face wearing the scars of yet another eight hours in an N95 mask. Fearful for the professional future of the undergrads and new grads, who will be deprived of mentorship when they most need it due to the attrition rates in our professions. Describing what it’s like to see another colleague take early retirement, or leave to find work outside a system that has never looked after us, never cared for us, never wanted to understand that our professions are labour intensive because they need to be. It doesn’t mean we’re any less worthy of reasonable workloads and equitable pay rates and conditions commensurate with our knowledge, skills and qualifications. It means that everyone had better listen up – finally. What I say is this: never again. When the pandemic is finally over, I implore every member to stand together and fight for our professions. Liz McCall, Byron Central Hospital NSWNMA branch assist sec/delegate

Advertise in The Lamp and reach more than 70,000 nurses and midwives. To advertise contact Danielle Nicholson 02 8595 2139 / 0429 269 750 dnicholson@nswnma.asn.au

THE LAMP FEBRUARY/MARCH 2022 | 7

COVER STORY

Nurses left to clean up Perrottet’s ‘shambolic mess’ The nursing workforce barely has its head above water trying to manage a disaster of our governments’ making.

report by an independent, multidisciplinary group of experts has laid bare the disastrous strategies of the NSW and federal governments to deal with the Omicron outbreak. The OzSAGE report (see pp 12–13), compiled by an advisory group of experts in epidemiology, health and economics, is scathing of both governments’ “let it rip” policy, which it says will condemn vulnerable Australians to death. One member of the group, Dr Kerryn Phelps, a former president of the AMA, told The Guardian that after an initially sound response to the coronavirus, “the only example Australia is providing to the world now is a warning about what not to do with the COVID-19 pandemic”. “How did Australia go from being the envy of the world, with our best practice public health measures, low case numbers, a prepared health system and an economy ticking along nicely, to what can only be described as a shambolic mess?” she said. Dr Phelps was highly critical of the governments’ misleading public announcements. 8 | THE LAMP FEBRUARY/MARCH 2022

‘It is outrageous that NSW Premier Dominic Perrottet continues to spin the lie that our public healthcare system is ‘strong’.’ — NSWNMA Acting Secretary

General Shaye Candish “The population was softened up with a false narrative that ‘Omicron causes mild disease’, ‘this could be the gift we have been waiting for’, and ‘this could end the pandemic’. “Perhaps the most insidious piece of messaging was the pronouncement that ‘everyone in Australia is going to get it’. In other words, why bother trying to prevent transmission? “In one previously unimaginable act, the premier, in a double act with Scott Morrison, announced a lifting of all restrictions, including mandatory mask wearing and QR code check-ins. “Despite the warnings that the health system was under pressure and that party season was about to kick off, the message to the

community was: ‘Go out there and spend, head to the pub and get back to normal.’”

A PUBLIC HOSPITAL SYSTEM ON THE PRECIPICE The OzSAGE report found the burden placed on the public hospital system was alarming and underreported. “Our health system, stretched before COVID-19, has had its capacity eroded by staff resignations and a blow-out in waiting lists. The further impact on the health system, by the sheer number of Omicron cases, at this time of year especially, could be enormous. “A person who has been hospitalised for COVID-19 is no

COVER STORY

MEMO TO THE PREMIER: NURSES FROM WESTMEAD HOSPITAL MAKE IT CRYSTAL CLEAR WHAT THEY THINK OF THE NSW GOVERNMENT’S DANGEROUS AND DISHONEST PUBLIC MESSAGING ABOUT THE STATE OF OUR PUBLIC HOSPITALS.

longer counted in the hospital statistics once they have cleared the virus, even if they still require a high level of care. Therefore, the true number of hospitalisations for COVID-19 related disease accruing in the wards and ICU is not transparent to the public. “We note that the shortage of staff is such that they are now asked to work after shorter isolation and that there is concern for burnout and fatigue.” NSW NM A Act ing G enera l Secretary Shaye Candish says nurses and midwives are rightfully furious with the NSW and federal governments. “Their actions and inactions have led us to this. Their persistence in saying the system is coping reveals a complete disregard for the truth,” she said. “It is outrageous that NSW Premier Dominic Perrottet continues to spin the lie that our public healthcare system is ‘strong’. “He repeats this lie while nurses and midwives are exhausted, working excessive overtime and still remain short-staffed. Patient

care is suffering.”

VIRUS SPREADS LIKE WILDFIRE IN AGED CARE – AGAIN On 14 January, more than 1100 aged care homes across Australia had reported new COVID outbreaks, with 7014 active cases in residents and aged care workers. Experts have highlighted two failures that have left aged care residents and staff vulnerable: the “stroll out” of vaccine boosters and the scarcity of rapid antigen tests (see pp 10–11). Shaye Candish says aged care nurses are “desperate” and are telling the Association that residents and staff are being placed at significant risk due to the severe lack of preparation by providers and the

federal government. “They are reporting a staffing crisis, a lack of access to suitable PPE, substandard infection control practices, and with many residents and staff still awaiting their booster. Some aged care facilities are being forced to ration rapid antigen tests, only using them every 72 hours,” she said. “The Royal Commission into Aged Care identified significant issues with infection control across the sector. These issues have still not been addressed by the federal government, so it seems inevitable that residents without their booster shot and who are locked down in their facility will likely contract COVID-19.”

‘The only example Australia is providing to the world now is a warning about what not to do with the COVID-19 pandemic.’ — Dr Kerryn Phelps, OzSAGE THE LAMP FEBRUARY/MARCH 2022 | 9

COVER STORY

cott Morrison’s “live with COVID” strategy has put the lives of elderly people living in aged care homes in peril, say experts. On Christmas Eve, 105 aged care homes around Australia had an active outbreak. Two weeks later, the number of homes with COVID had exploded, more than quadrupling to 495 (168 in New South Wales), with 1465 residents and 1875 staff testing positive for COVID. A week later, on 14 January, the numbers had doubled again with more than 1100 aged care homes across Australia reporting outbreaks, and 7014 active cases in residents and aged care workers. Dr Sarah Russell, a public health researcher, told The Guardian that the booster vaccine ‘strollout’ and inconsistent infection control protocols had allowed the virus to spread like wildfire. She said the federal government inexplicably bypassed the existing st r uc t ure s t hat succe s sf u l ly administer the annual flu booster to residents and outsourced the COVID booster rollout to private companies. 10 | THE LAMP FEBRUARY/MARCH 2022

‘Sooner or later, our federal government must be held to account for the numerous preventable tragedies that have occurred in the aged care sector’ — Dr Sarah Russell “These ‘in-reach clinics’ had only visited around 50 per cent of aged care homes before Christmas. And then one of the private companies, Aspen Medical, took holidays over the Christmas break,” she said. On 15 August 2021, health minister Greg Hunt had announced rapid antigen tests would be available to aged care homes. “We anticipate that regular use of RAT to screen aged care employees and visitors will provide much greater reassurance,” he said. Sarah Russell argues that “many of the lockdowns could have been avoided if all staff had taken a rapid antigen test before each shift since August”.

“Yet some aged care homes have not had free access to the national stockpile of rapid antigen tests, while other homes have,” she said. On 23 and 24 December, a deployment of rapid antigen tests was finally distributed to primary health networks in NSW for distribution to aged care homes. “Once again, this was too little and far too late,” she said.

REGULATOR JUST AS “HANDS-OFF” An analysis by the NSWNMA has shown the government’s regulator – the Aged Care Quality and Safety Commission (ACQSC) – to be shockingly absent in their oversight of the sector during the pandemic.

COVER STORY

‘Aged care is a disaster waiting to happen.’ — NSWNMA Acting General Secretary Shaye Candish

The Association cross-checked 35 facilities listed with known COVID cases, with site visits by the ACQSC as documented on their website. The analysis made these findings: • S ome of the facilities currently reporting COVID outbreaks hadn’t received a site visit since 2017. • Ten of the 35 facilities reporting COVID cases were last visited in 2017 or 2018 and had been granted ‘exemptions’ from further visits. • A suite of ‘exemptions’ had been issued to facilities deemed ‘low risk’. This means they had been given a green light to continue to operate without having a site audit. • Nine of the 35 were not required under NSW legislation to have registered nurses on site 24/7. Of these, three were experiencing their second COVID outbreak. • One facility failed across all outcomes on 4 March 2021 but surprisingly passed Requirement 3(3)(g) ‘Infection Control’. It was deemed suitable to re-accredit until October 2022 with no further site visits recorded. It is now reporting COVID cases.

The aged care regulator was heavily criticised in the aged care royal commission findings over a year ago for their failure to ensure people received safe and dignified care. T he fe dera l gover n ment responded by committing to undertake a ‘capability review’ of the ACQSC but then deferred this until 2023.

“HEARTBREAKING CONSEQUENCES” NSW NM A Acting Genera l Secretary Shaye Candish says this failure to act by the federal government and its regulator means “aged care is a disaster waiting to happen”. “The Royal Commission into Aged Care identified significant issues with infection control across the sector. The federal government has still not addressed these issues,” she said. “Our members in aged care are reporting a staffing crisis, lack of access to suitable PPE with many still not fit tested to a P2/N95, substandard infection control practices, and with many residents

and staff still awaiting their booster. Some aged care facilities are being forced to ration rapid antigen tests, only using them every 72 hours.” Dr Sarah Russell agrees that “the lack of leadership” and the “hands-off approach” of the federal government and its regulator during the pandemic “has had heartbreaking consequences for many residents and families around the nation”. “Sooner or later, our federal government must be held to account for the numerous preventable tragedies that have occurred in the aged care sector,” she said. n

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COVER STORY

OzSAGE is a multidisciplinary group of infectious disease and public health experts, engineers, architects, economists and social scientists. Here is a summary of their critique of Australia’s COVID response:

REMOVAL OF RESTRICTIONS IN NSW HAS COST DEARLY

“DISTURBED” BY FALSE REASSURANCES IN MESSAGING

OzSAGE remains deeply concerned about COVID-19 in NSW, which is already affecting all of Australia. The decision to remove restrictions just as Omicron surged has cost us dearly.

There is a severe shortage of RATs nationwide. This means that even people who can afford them and could thus relieve the pressure on the laboratories, simply cannot buy a RAT kit.

All models to date assumed good testing capacity and adequate contact tracing. Without these, case numbers will blow out further. At this point in time there is no publicly available modelling to support a national plan that is based on public health principles, which will protect our hospital systems from collapse.

RATs are useful for screening of asymptomatic cases, but cannot serve as the backbone of the public health test-and-control system.

TESTING DISASTER Testing in NSW is failing, with many people turned away after waiting in queues for hours and many testing centres shut. Regional and remote areas have even less capacity. There are unacceptable delays in testing results being sent. Rather than investing in expanded testing capacity, the response of government is to restrict access to testing by changing the definition of close contacts and requiring PCR tests only for family contacts, health workers and a few other groups. This will reduce our surveillance capacity for new variants and give falsely low case numbers. 12 | THE LAMP FEBRUARY/MARCH 2022

We are disturbed by the repeated messaging that only symptomatic people should get (PCR) tested, when 40 to 45 per cent of transmissions are asymptomatic, and even in people who develop symptoms, the peak of infectiousness is in the two days before symptoms begin. The false reassurance of the messaging will result in more cases of viral transmission that otherwise would have been prevented.

CHANGES TO A DEFINITION OF ‘CLOSE CONTACT’ ARE NOT BASED ON SOUND PUBLIC HEALTH PRINCIPLES Close contact definitions need to be based on risk. Risk is related to the amount of exposure to virusladen aerosols. Risk is not limited to arbitrary four-hour time frames within households.

COVER STORY

Settings like nightclubs and restaurants have been sites of superspreading events, and if people exposed in these settings cannot get a PCR test, spread will accelerate. Introducing a narrower close contact definition when the test positivity rate is currently 13 per cent in NSW, is unlikely to improve the burden on the health care system and will instead fuel the outbreak. Limiting the amount of testing reduces pressure on the test-andtrace system in the short term, but will worsen the health system burden because it will result in chains of transmission that could otherwise have been stopped.

the health system, with regional services at particular risk. The trajectory of observed data suggest that hospitalisation and ICU occupancy are on a steeply rising trend and anticipated to exceed earlier peaks quite soon. In other words, optimistic assumptions about the impact of the Omicron variant on hospital admissions are unrealistic.

OMICRON CANNOT BE DESCRIBED AS MILD Preliminary data suggest that compared to the Delta variant, Omicron infections are 40 to 45 per cent less likely to result in hospitalisation.

Over the long term, these quick-fix adjustments for resource reasons and better optics will be detrimental.

This means that the Omicron variant is at least as virulent as the original strain of Sars-CoV-2, with far greater vaccine escape, and cannot be described as mild.

CASE NUMBERS MATTER – IT’S SIMPLE MATHS

LACK OF ACCESS TO HEALTH CARE AND DEATHS AT HOME

The rhetoric that case matters “do not matter” is incorrect – particularly in the face of the Omicron variant.

Our health system, stretched before COVID-19, has had its capacity eroded by staff resignations and a blowout in waiting lists.

Even if hospitalisation rates are lower with Omicron compared to Delta, a halving of hospitalisation rates with a 10-fold or 100-fold increase in cases will still translate to a high burden on the health system. This is likely to overwhelm

We remain deeply concerned that people with preventable and treatable complications of COVID-19 may die at home in NSW, without access to even the support of Hospital in the Home.

‘LET IT RIP’ KILLS The “let it rip” strategy and defeatist narrative that “we are all going to get it” ignores the stark lived reality of the vulnerable of our society. Despite three doses of vaccine, some patients with cancer and other immunosuppressed people have substantially reduced protection against Omicron. Similarly, people with co-existing health conditions (estimated to be 50 per cent of the adult population) are at increased risk of illness. The impacts of a fragmented testing system and disrupted health system will be felt most by our elderly, lower socio-economic groups, First Nations people, people with disability and regional populations.

Read the full report Dismantling health resources and infrastructure is not a solution to the pandemic. https://uploads.guim. co.uk/2021/12/30/Advice_ Omicron_December_30_2021_(1). pdf

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COVER STORY

iverpool Hospital Branch secretary Mirabel Nelson says south-west Sydney’s hospitals, including Liverpool, are experiencing an “unofficial emergency response”. “I say unofficial because politicians are refusing to actually acknowledge this current disaster. “We are told we are coping well. I wish our government would ask us – the frontline COVID nurses – if we are coping, instead of speaking for us,” she said. Premier Dominic Perrottet has repeatedly asserted that hospitals are in a “strong position” and Chief Health Officer Dr Kerry Chant claimed the health system was “very well placed” to cope with rising hospitalisation rates. Mirabel said the government should acknowledge the extent of staffing shortfalls and their effect on nurses, midwives and patients. “We’re definitely not OK, our health system is not OK, and our patients are not OK.” She challenged Premier Perrottet and Prime Minister Scott Morrison to “throw on a pair of scrubs and 14 | THE LAMP FEBRUARY/MARCH 2022

‘By telling us we have to live with the virus, and not taking extra steps to support us, the government is taking advantage of nurses’ goodwill.’ — Mirabel Nelson work a double shift” in the hospital’s emergency department. “ED is just jammed with patients, who sometimes have to wait 12 hours or more for a bed on a ward.”

DANGEROUS STAFFING LEVELS “Our hospitals are crippled with dangerous staffing levels and our staff have hit a level of exhaustion that is mostly incompatible with basic functioning.” When The Guardian newspaper visited Liverpool Hospital in early January, it found the main ED waiting room was full and would-be patients were spilling out into the street in 30-degree heat. The Guardian said a 70-year-old woman with stomach pain had been waiting four hours to be seen and a

young woman was vomiting into a plastic bag as she waited. Mirabel said Liverpool Hospital was understaffed even before the pandemic and called for mandatory staffing ratios “to make management accountable for safe staffing”. “If we had strict staffing ratios in place before the pandemic, we would be far better off now. “The fact that we don’t have ratios like Queensland and other states gives management too much leeway to make us work short. “On my ward pre-COVID, when we were down to four staff instead of the five or six we normally had, we would just have to wear it. “It doesn’t matter if we are run off our feet, stressed or missing out on

COVER STORY

‘If we had strict staffing ratios in place before the pandemic, we would be far better off now.’ — Mirabel Nelson breaks. We just get told there is no other option, that we just don’t have the staff.”

INCIDENT REPORTS NEEDED Mirabel urged her colleagues to lodge incident management reports whenever their shift is understaffed. “Our patients’ safety and our own safety is threatened by a poor working environment. “We need to be strong enough to make incident reports without worrying that there could be any backlash.” At Liverpool, five general wards and two ICU wards had been set aside for COVID patients by mid-January. Mirabel usually works in Liverpool’s oncology and palliative care ward but has been regularly deployed to a COVID respiratory ward. “We are all working huge amounts of overtime, we are spending more time at work than with our own families. It’s been going on for at least two years and we are not coping, that’s for sure. “We obviously weren’t trained to

work in a pandemic but we feel an obligation to help out even when we are dead tired. “As nurses we care about our patients, and we care about each other. I will always agree to do a double shift because I want to make sure my patients are safe and my colleagues are safe.”

OVER-RELIANT ON JUNIORS She said many senior nurses were taking early retirement. “They haven’t seen any progress on staffing in many years of nursing and they are sick of it, which is sad. “Their departure is leaving us over-reliant on junior nurses, who are working without adequate support. “Our educators are having to take patient loads, and other senior nurses who would normally mentor new grads are leaving or taking on in-charge roles or NUM roles for others who are off on COVIDrelated leave. “An email went out to all the new grads saying if you have your registration now and are willing to start, we will take you now, without

waiting for your official intake. “It’s too much for a new grad to be thrown in at the deep end when we don’t have the support system we normally would have.” M i r a b el s a id t he NS W government has had two years to put adequate measures in place to help staff handle the current surge in patient numbers. “By telling us we have to live with the virus, and not taking extra steps to support us, the government is taking advantage of nurses’ goodwill.” She criticised the Perrottet government’s attempt to strip nurses and other essential workers of their automatic right to workers compensation cover for COVID-19. Mirabel said it is very hard for nurses to know and prove exactly where they caught the virus. n

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COVER STORY

Juniors unsupported as hospital bleeds staff An exodus of nurses from Tweed Hospital in the far north of NSW tells a tale of two health systems.

weed Hospital lost 18 nurses from its Emergency Department (ED) between December 2021 and midJanuary 2022. Many of these nurses were the hospital’s most experienced ED nurse clinicians. Most of those 18 left to take jobs at Gold Coast University Hospital and other Queensland health facilities within a 45-minute drive from Tweed Heads, which is one kilometre from the state border. Their departure comes as no surprise to senior nurse Kristin Ryan-Agnew, president of the Tweed Hospital branch of the NSWNMA. “In Queensland, a Labor government gives nurses guaranteed staffing ratios, COVID bonuses, an $1800-a-year education allowance with dedicated fixed times for education, and maximum salary sacrificing,” Kristin says. “Here in New South Wales, we get none of that. We are bleeding staff who are burnt out and looking for better employment.” Tweed is a Level 5 referral hospital serving a hinterland that includes the major tourist destination of Byron Bay. It has the busiest ED outside of Greater Sydney/Newcastle, with the same UDG level of presentations as St Vincent’s in the heart of Sydney. However, long-term understaffing and over-reliance on junior nurses 16 | THE LAMP FEBRUARY/MARCH 2022

‘In Queensland, a Labor government gives nurses guaranteed staffing ratios, COVID bonuses, an $1800-a-year education allowance with dedicated fixed times for education, and maximum salary sacrificing.’ — Kristin Ryan-Agnew has been made worse by pandemicrelated staff shortages. “People are doing double shifts every day with just one day off after night duties,” Kristin says. “This week we are supposed to have 18 nurses per shift, but we only have 10 nurses to staff morning and afternoon shift. The junior nurses are out of their depth and freaking out completely.”

INCREASINGLY RELIANT ON JUNIOR NURSES Tweed ED is increasingly reliant on junior nurses, yet has just one nurse educator for an FTE (full timeequivalent) staff of 150. “We have been pleading for three years to get a second nurse educator in ED, because most of the new

staff appointments have been second- and third-years with no emergency experience.” Many of Tweed’s junior nurses unsuccessfully applied for graduate positions, which are in short supply. “As a graduate you come into a designated position in the hospital for 12 months and you are supported by a clinical nurse educator (CNE) for the year. “Those who missed out on graduate positions have been working in nursing homes or on the wards, but very few have acute experience. “A lot of them are straight out of uni and did at least part of their study remotely during COVID – so how much practical experience did they get?

COVER STORY

Byron hurting from refusal to adopt ratios “If management is going to put junior people out there, it has to have someone there to show them how to do the job and back them up. “But management won’t give juniors the support they need.”

STAFF SHORTAGES PRE-DATE COVID Kristin says inadequate staffing and unsustainable workloads predate COVID. “We have been raising these issues for years and COVID has pushed the situation over the edge. “Our hospital executive says they have escalated our request for a second CNE to Northern NSW LHD executive and their response was ‘no’. “The Tweed branch (of the NSWNMA) prides itself on its philosophy of working with the hospital executive for the best possible outcomes for the nursing staff. “If both parties are committed to a common goal, the relationship needs to be bipartisan. It just won’t work if we are working with one hand tied behind our back.” Kristin says local National Party MP Geoff Provest has never actively supported nurses and midwives. “We have appealed for his support previously. Our branch executive has sat with him in his office to explain how dire the

situation is – all to no avail.” She says NSW has gone from “one of the best paid nursing and midwifery services in the country to the worst.” As an example, she cites the Queensland Health Service policy of allowing nurses and midwives to salary sacrifice to the full extent permitted under the tax system. “We have never received a single pay rise above CPI, but the NSW Government has continued to take 50 per cent of nurses’ and midwives’ potential salary sacrificing and put it into government coffers.” Kristin says the rapid escalation of COVID has seen a severe deterioration of working conditions for all nursing staff. This is compounded in regional areas by delayed transportation of critical equipment, resulting, for example, in shortages of some PPE. “Some nurses and midwives can’t access the masks they were fitted for because the trucks are not delivering. These nurses and midwives are worried – some have got children at home and the masks they now have to wear are not safe.” n

Byron Bay Hospital is another Northern NSW health facility losing experienced nurses due to unsustainable workloads. Senior Byron nurse Liz McCall, a member of the NSWNMA State Council, said the state government’s refusal to set minimum nurse- and midwife-topatient ratios as they exist in Queensland and Victoria had left NSW more exposed to COVID pressures. In media interviews, Liz said that while hospital services in Byron had long operated with skeleton staff, conditions had become increasingly worse. The loss of experienced nurses meant new graduates and junior staff would not be adequately mentored. “The loss to the profession and the loss to our communities is immeasurable, absolutely immeasurable,” she said. THE LAMP FEBRUARY/MARCH 2022 | 17

COVER STORY

Sleeping on floors while waiting for beds ED clinicians at Western Sydney’s largest tertiary referral hospital say they will no longer accept “relentless, unsafe working conditions” as the standard.

t Westmead Hospital in Western Sydney, patients suffering heart attacks, strokes, and major trauma must often be treated in hallways and waiting rooms due to bed shortages and severe access block. Westmead nurses have been calling for more resources and increased staffing for almost three years, with no result. In November, Westmead’s emergency department nurses initiated an open letter to the NSW Premier, Dominic Perrottet, and Health Minister, Brad Hazzard. Signed by more than 200 nurses, registrars, senior medical officers, administration staff, orderlies and security guards, the letter called for a “significant and immediate” increase in funding. The letter prompted Graeme Loy, Chief Executive of Western Sydney Local Health District, to meet with ED staff representatives, including NSWNMA members. Loy referred concerns raised by staff to hospital-level working groups. NSWNMA General Secretary, Bret t Holmes, sa id it wa s unacceptable the ED of Western Sydney’s largest tertiary referral hospital was consistently one of the poorest performers. “While our members will try to work with local management on this, they are concerned the working groups will not deliver the changes 18 | THE LAMP FEBRUARY/MARCH 2022

‘ Patients are treated without dignity, when staff are forced to provide treatment in hallways and patients need to sleep on the floor.’ — Westmead staff letter to Perrottet and Hazzard.

that are needed within a suitable time frame,” he said. “The Health Minister needs to step in and provide assurances that the LHD will get the additional funding needed to match the growing demand being placed on this facility.”

STAFF ARE PHYSICALLY AND MENTALLY EXHAUSTED Brett said expert advice is also required to develop effective longer term strategies to fix access block and relieve constant congestion in the ED. The staff open letter said conditions had steadily deteriorated, despite recommendations from a December 2019 Health Ministry review of the ED and numerous staff meetings with hospital management. “Advertised registrar positions remain unfilled and staff deficiencies remain a chronic problem for all levels of medical and nursing staff,” the letter said. “The recent surge in COVID presentations has added additional

risk and safety concerns to an already overwhelmed department. “It is common to have 30 to 50 admitted patients within the ED at the start of the day, for patients to leave while still unwell, and admitted patients sitting in the waiting room for 15 to 20 hours. “ED staff feel strongly that patients are treated without dignity, when staff are forced to provide treatment in hallways and patients need to sleep on the floor.” The letter said the consequences of management’s inaction included extended ED stays, poor patient outcomes, increased risk of violence and low staff morale. “These relentless workplace conditions have taken a massive toll on staff wellbeing, mental health and morale, with an increase in sick leave, overtime and resignations. “Staff are physically and mentally exhausted from having to endure these relentless unsafe working conditions and can no longer accept them as the standard.” n

COVER STORY

WESTMEAD NSWNMA MEMBERS PROTEST AGAINST THE UNSUSTAINABLE CONDITIONS THEY ARE EXPECTED TO WORK UNDER WITH EXCESSIVE OVERTIME, UNREASONABLE WORKLOADS AND A CRITICAL LACK OF STAFF.

United stand ‘gets wheels in motion’ A NSWNMA representative in ‘Sometimes your heart breaks for these Westmead Hospital’s ED, RN Farah Ismail, said the hospital-level nursing poor patients; it’s just not fair.’ — Farah Ismail working group includes three experienced and senior ED nurses. “They are all NSWNMA members, and they will definitely get our message across,” she said. She said the united stand by nurses, doctors and other staff “seems to have got the wheels in motion”, with reports that management was considering the early opening of a planned Psychiatric Emergency Care Centre unit attached to the ED. “Management needs to come up with solutions now, because the department is losing senior nurses due to the appalling, unsafe working conditions. “Some nurses who were hired at the start of the pandemic have already applied for other jobs because our ED isn’t what they thought it would be and they are not coping. “On my last shift on a Thursday, we

had 37 unplaced admissions with no allocated beds, and throughout that shift there was a page saying ‘the hospital is at capacity, please prioritise discharges’. “It is common for medically cleared psychiatric patients who are not critically unwell or in need of a telemetry bed to sit in the corridor for up to 18 hours, or sleep on the floor while waiting for a psychiatric assessment. “Sometimes your heart breaks for these poor patients; it’s just not fair. Even geriatric admissions were sitting in our waiting room for nine to 12 hours last week. “After patients are eventually admitted by a psychiatrist or psych CNC, they might have to wait two days for a bed at Cumberland Hospital, which is where most of

our psych patients go. Or wait up to 16 hours for transport.” Farah says such conditions are a “recipe for increased aggression”. “We have had multiple incidents where staff were badly assaulted, and we now have at least two security guards in ED at all times. “But if it wasn’t for a regular police presence in our department we would sometimes really be in trouble.” In October, a 26-year-old man who attacked a Westmead ED nurse, escaped jail when he was sentenced to two years and six months to be served under supervision in the community. The nurse's scalp was split to her skull during the attack, and she needed 16 stitches. n

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AGED CARE

“Fixing aged care will be a central priority of an Albanese Labor Government” Opposition leader Anthony Albanese talks to The Lamp about his commitment to improving aged care and public health. You’ve signed the ANMF/ NSWNMA pledge to support reform in aged care. What motivated you to make this commitment? I have had the opportunity to meet many ANMF/NSWNMA members in the aged care sector. You are hardworking, dedicated and inspirational in your commitment to quality aged care. Labor appreciates you but we don’t just want to say ‘thank you’ – we will show our appreciation in a real way. Would you expect the rest of your team to sign up to the pledge? Your pledge has my support and the support of my Shadow Minister for Health and Ageing, Mark Butler. We encourage all of our caucus and candidates to get on board because Labor is committed to the principles of reform ANMF/NSWNMA members are campaigning so hard for. Nurses have been campaigning hard for many years to improve the care of older Australians in the aged care sector and despite the numerous inquiries and commissions not much has changed. What sense of urgency will you bring to this task? The challenges the aged care sector faces are not new – as you know better than anyone. However, the combination of the Royal 20 | THE LAMP FEBRUARY/MARCH 2022

‘ We absolutely need minimum staffing ratios in residential aged care so that residents get the care they deserve.’ — Opposition leader Anthony Albanese

Commission and the coronavirus outbreak can leave no question in the mind of any Australian that we have a crisis on our hands. And this isn’t a theoretical concept – most Australians have a loved one in aged care or headed towards it. This is a very real experience for us all. We are working with the ANMF/ NSWNMA and other aged care unions on finalising our aged care election policy, which will address the priorities set out in your pledge. Fixing aged care will be a central priority of an Albanese Labor Government. The Gillard government in its last days linked aged care funding to staffing and wages to ensure taxpayers’ money was allocated by providers as it should be. Would an Albanese Labor government consider a similar approach to make the sector more transparent and accountable?

Labor agrees that transparency and accountability measures are needed to ensure resources devoted to the sector are translated to better patient outcomes, and not greater financial returns for unscrupulous providers. Mandated staffing, increased care hours and better skills are at the heart of what nurses at the front line see as necessary to provide proper care for our elderly. Do you share that analysis and how would your government respond? We absolutely need minimum staffing ratios in residential aged care so that residents get the care they deserve. In its response to the Royal Commission recommendations, the MorrisonJoyce Government failed to properly address ratios or any workforce matters. COVID has wreaked havoc on the economy as well as on public health. Do you recognise increased investment

AGED CARE

‘ You – on the frontline – are heroes and the world’s best at what you do.’ in public health as an economic imperative as well as a public health necessity?

Only Labor can be trusted to have Medicare at the heart of our health care system.

It is very clear that if you don’t get the health response right, it has a consequence for the economy and for jobs.

What is your assessment of how the federal government has handled the COVID crisis? What would you have done differently?

We are seeing businesses unable to open because staff are isolating. There has been a massive withdrawal of economic activity as a result of the Morrison-Joyce Government’s failure to get the health response right. All Australians are suffering because of the Morrison-Joyce Government’s failure to plan. What lessons have you derived about our public health system from the pandemic? Above all that you – on the frontline – are heroes and the world’s best at what you do. Our public health system has been let down by the MorrisonJoyce Government – we know nurses, doctors and health workers are exhausted, and we know hospitals are overwhelmed. Further, it is clear that primary health care has been neglected by this Government.

Australians are still paying the price for Scott Morrison’s “it’s not a race” approach. Scott Morrison had two jobs last year: a speedy effective rollout of the vaccine and quarantine. He failed at both. At the start of 2021 he said his number one priority for the year was to ‘suppress the virus and deliver the vaccine’. If his failures weren’t so serious, it would be laughable. It is inexcusable that in the third year of this pandemic we have such serious testing and vaccine rollout issues. The Morrison-Joyce Government has been complacent, particularly in aged care and once again we are seeing aged care residents struggling to receive their booster shot. If I were Prime Minister, I would have taken responsibility. I

wouldn’t have waited until there was a crisis to act. I would have secured vaccines earlier – as we said at the time. If we had done that, people would have received their booster shots well and truly by now. What’s more, Labor would have made rapid tests free right at the time that we needed them the most. Nobody should be denied a test because they can’t afford one. We are only months away from a federal election. What would you like nurses and midwives to know about you before they vote? A Labor Government will not allow older Australians to grow old alone, deprived of proper care and dignity. We will not forget the dedicated, mostly female staff who care for our elderly, almost uniformly understaffed and underpaid. We value you. Thank you for work during pandemic. Labor will rebuild broken aged care system. Labor will put Medicare at the centre of the health system – only Labor can be trusted to strengthen Medicare. n

THE LAMP FEBRUARY/MARCH 2022 | 21

AGED CARE

Jocelyn and Maria speak truth to power Jocelyn Hofman, an RN in aged care, and Maria O’Neill, a retired aged care RN and honorary NSWNMA member, met with Leader of the Opposition, Anthony Albanese, to give him a firsthand account of how the sector is suffering.

‘I’m relieved that a major political leader is listening to our concerns in aged care.’ Jocelyn Hofman says she is encouraged by Anthony Albanese’s support for reform in aged care. “He seems to know the issues surrounding aged care. He signed our pledge, which asks him to support 24/7 RNs in aged care facilities, minimum mandated care hours and the right skills mix, greater transparency in the system (which means Commonwealth funding is tied to care), and improved wages and conditions for staff. “I’m relieved that a major political leader is listening to our concerns in aged care. With the federal election coming up, we really need a true leader who stands up for aged care residents and staff,” she said. She says there is still a lack of political leadership to fix the sector nearly a year after the Royal Commission handed down its report.

“This current government is still dragging its feet on fixing aged care. It has proposed an RN for 16 hours in a 24-hour cycle. That means from 10.30pm there is no guaranteed RN on the floor. I worry about that. Who will assess the resident who has had a fall? Who will administer the pain relief? We still haven’t seen any transparency on where the extra money that the government committed to the sector is being spent. Residents and people who work on the floor are being neglected again.” Jocelyn says the federal election – due to be held in the coming months – will be crucial for aged care. “This will be a very significant election, because our aged care system is collapsing, and we need a government that will really take this issue seriously; we really need a leader who will take action. Our society is judged by the way we treat our vulnerable people, and this process needs to start from the top. Mr Albanese is the first leader of a major party who has committed to meaningful aged care reforms. “We need to know where every member of parliament stands on aged care. We are all going to age. This election, I urge our NSWNMA members to vote wisely.”

‘ With the federal election coming up, we really need a true leader who stands up for aged care residents and staff.’ — Jocelyn Hofman

22 | THE LAMP FEBRUARY/MARCH 2022

AGED CARE

Next step: implement the pledge Maria O’Neill says it is great for the Leader of the Opposition to sign up to our aged care campaign goals, but the ALP now needs to turn that into action. “I think he knows the issues, but Labor has talked the talk, but not walked the walk. Labor has promised reform but hasn’t done anything yet. “I wanted to talk to him about the absurd situations in aged care. For example, towards the end of my working life, I saw one woman in aged care with heart failure admitted to hospital because there was no RN to take over her care when she went back to the nursing home. She spent six weeks in hospital. This was financially absurd, and it was inhumane, because she was on the edge of dementia and couldn’t really understand why she couldn’t go back to her home and why she was in this busy, crazy environment. “An acute bed in a public hospital is not relaxing for anyone, let alone someone old and fragile. We know

that people with heart failure, with correct medication and nutrition they can be stabilised. But people are not getting regularly assessed and their medicines titrated in aged care, which needs to be done by the RN on site.” Maria says it is important that we get the rest of the ALP federal candidates to sign the pledge. “When I receive letters from Labor candidates in my area asking for my support, I’ve written back listing the issues they need to listen to and fix. I say ‘I am happy to support you as soon as you do something about this’. “I also think personal visits are a good thing. I think these kinds of actions are very useful to get politicians to focus on the issues.” Maria says she finds the latest outbreak of COVID in aged care heartbreaking. “I am hearing from women working on the aged care campaign about how the staff don’t have enough PPE. They are fighting to keep people safe. Access to RATs is going to be a huge issue, and we don’t have enough now.”

‘ I wanted to talk to him about the absurd situations in aged care.’ — Maria O’Neill

Leader of the Opposition Anthony Albanese signs the pledge to support reform in aged care: • RN24/7 – at least one registered nurse on site at all times • Minimum mandated care hours and the right skills mix • Greater transparency – funding tied to care • Improved wages and conditions

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PUBLIC HEALTH SYSTEM

Push for mandatory Intensive Care standards Critical care nurses take staffing case to health minister.

urses seeking solutions to the staffing crisis that is hammering intensive care units across NSW are due to meet Health Minister Brad Hazzard for a fourth time in February. The nurses want practice and workforce standards set by the Australian College of Critical Care Nurses (ACCCN) to be made mandatory and uniform across NSW ICUs. Crit ica l ca re nurses, led by NSWNM A members, have campaigned for three years to have ACCCN standards accepted as the benchmark for critical care and staffed accordingly. The campaign took a step forward in September when media publicity highlighted the ICU staffing crisis and around 750 critical care nurses signed a letter to then Premier Berejiklian and Minister Hazzard, calling for permanent staffing improvements to ensure safe patient care (see story page 26). “We desperately want you to meet with our representative group so that you will understand the problems and work with us to fix them urgently,” the letter said. Mr Hazzard accepted the invitation and had three meetings with a sub-group of a statewide ICU nurses’ network late last year. 24 | THE LAMP FEBRUARY/MARCH 2022

NSWNMA officials including Brett Holmes (General Secretary), Shaye Candish (Assistant General Secretary) and Michael Waites (Manager, Public Health Organising Team) also attended meetings.

ICUS ARE OPERATING TO DIFFERENT STANDARDS M ichelle Rosent reter wa s among the experienced ICU nurse delegates from Level 5 and Level 6 ICUs, who met with Mr Hazzard and met separately with his ministerial advisers. “The meetings were a bit frustrating because we had to repeatedly explain the functions of the various nursing roles – what a clinical coordinator is, what a team leader is, what an ACCESS nurse is, et cetera,” she said. “I was taken aback to discover that the people who decide workforces for hospitals and advise the minister, do not even understand what their own clinicians do every day. “We are encouraged that the minister is actually meeting with ICU nurses rather than only listening to district and local executives, who are trying to meet their KPIs and produce reports that don’t reflect the challenges resulting from inadequate staffing. “We hope the next meeting will

discuss how ACCCN standards can be implemented as a mandatory requirement, especially for levels 4, 5 and 6 ICUs. “At the outset, we asked the minister to take the appropriate time to analyse what we were saying and meet us with a prepared response. “We didn’t want rolling meetings for the sake of it; we wanted to reach some sustainable solutions. “At the third meeting, the minister appeared to agree with us that it is unsatisfactory for every ICU in the state to operate according to different standards, which allows LHDs and local hospital executives to not honour the safe staffing profile we need on every shift.” With at least one Sydney public hospital offering cash bonuses to nurses who agree to cut short their annual leave, and efforts to bring in more overseas nurses, Michelle says such “band aid” solutions can’t last forever. “NSW hospitals have had a deplorable record of working under-resourced and over-census for many years. “There needs to be the political will to lift budgetary restraints and allow hospitals to be adequately staffed and recruit the people they need.” n

PUBLIC HEALTH SYSTEM

‘I was taken aback to discover that the people who decide workforces for hospitals and advise the minister, do not even understand what their own clinicians do every day.’ — Michelle Rosentreter

‘Mass exodus’ from ICUs Australian hospitals are experiencing a “mass exodus” of experienced ICU nurses, the Australian College of Critical Care Nurses (ACCCN) has warned. “They are not taking sick leave or annual leave, they are working extra hours, and at the end of all this we are seeing lots of senior people, who have worked in intensive care for years, leaving ICUs at a time when they are so valued, and we need them so much,” the college’s chief executive, Rand Butcher, told The Guardian news site. Sydney ICU nurse Michelle Rosentreter oversaw a shift when a nurse collapsed shortly after starting work. “She had been feeling unwell but came to work because she didn’t have any sick leave,” Michelle said. “We sent her to Emergency, and she was diagnosed with

viral endocarditis. “It is appalling that hospital administrators are sending out letters warning nurses their sick leave is becoming excessive, while more and more nurses are presenting to Emergency with acute and chronic issues. “This is the real face of burnout.” After almost 20 years of nursing – 10 as an ICU nurse – Michelle had her own frightening experience of burnout in September. “I was working a night shift looking after a ventilated patient and I felt sicker and sicker,” she said. “I found I couldn’t raise my arms, or move them from the elbows up, and the pain was excruciating. “I assumed it was dehydration, took Panadol, and managed to drive myself home, where the pain hit my chest.

“I had to call an ambulance and be taken to Emergency, was given pain relief and anti-inflammatories, and after a couple of months seeing specialists, I have been diagnosed with fibromyalgia, resulting from chronic fatigue and stress. “The way to manage that is with a regular routine and good sleep, so for 2022, I’ve reduced my nursing hours and will be working in a nonclinical role three days a week. “I’m hoping this will help me balance my health and avoid flare-ups. “I love my job as an ICU nurse, but I have to find a way to look after myself.” n

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PUBLIC HEALTH SYSTEM

Pressure mounts on government over ICUs NSWNMA survey shows ICU staffing levels fall way short of key ACCCN standards.

ixty per cent of NSWNMA members who work in ICUs say they will leave critical care nursing within five years. Most of them will leave within three years. The disturbing finding comes from a union survey of members in 37 of the 40 ICUs in NSW. Sevent y-f ive per cent of respondents said they are at “breaking point” due to the chronic staffing crisis. When asked whether they can deliver safe patient care at all times, 88 per cent of respondents answered no. The union outlined the survey findings in a letter to Health Minister Brad Hazzard during talks about critical care nursing standards (see story page 24). In the letter, NSWNMA General Secretary Brett Holmes said the implementation of standards set by the Australian College of Critical Care Nurses (ACCCN) would deliver a “significant and rapid” improvement in working conditions and raise the standard of care delivered. “This will in turn allow nurses to continue working in our ICUs across the state,” Brett said. 26 | THE LAMP FEBRUARY/MARCH 2022

‘We do not want to be harmed, just by attending work. We do not want to see our patients die as a result of understaffing.’ — ICU nurses’ letter to NSW Government

In September, around 750 critical care nurses signed a letter to then Premier Berejiklian and Minister Hazzard calling for permanent staffing improvements to ensure safe patient care. The letter said ICUs were in crisis before the COVID-19 pandemic. “ We ex p er ienced ch ron ic understaffing, an increased junior skill mix as a result of senior staff leaving due to burnout, and everincreasing workloads. “The added demands of the COVID-19 pandemic, testing capacity and surging admissions, is forcing our clinical workforce to the brink, placing our registration at risk on every shift and compromising safe patient care,” it said.

NURSES GET SUPPORT FROM CICM The letter added that critical care nurses’ health and safety “are

constantly being placed at risk both physically and mentally by the current inadequate staffing levels. The pandemic has only multiplied these impacts.” “We believe that the Local Health Districts, the Ministry of Health and your government are failing to consider or meet your obligations in relation to our mental health and wellbeing, as well as the impact this pandemic is having on an already overstretched system. “We do not want to be harmed, just by attending work. We do not want to see our patients die as a result of understaffing.” Michelle Rosentreter, an ICU nurse delegate taking part in talks with Mr Hazzard and ministry officials, said the nurses’ position was strengthened when the NSWNMA secured a letter of support from the College of Intensive Care Medicine (CICM), which oversees the training

PUBLIC HEALTH SYSTEM

What nurses need to stay safe

‘ICU nurses are once again working excessive hours of double shifts and overtime.’ — Brett Holmes

and education of intensive care specialist doctors. “ I nt e n s iv i s t s f i nd it incredibly frustrating when they cannot accept a patient with a life-threatening illness, because they don’t have enough nurses with the required skills to deliver the high level of care associated with intubation, dialysis, ECMO et cetera,” Michelle said. In January, Brett Holmes authored an article in the Sydney Morning Herald that outlined the strains being placed on nurses in all areas of the NSW hospital system. Regarding ICU nurses, Brett wrote that they “are once again working excessive hours of double shifts and overtime. They are caring for a combination of ventilated and high-dependency patients, some with COVID-19 and some without.

“Over the weekend, ICU nurses at an outer-metropolitan hospital declared, ‘we are falling like flies’. In the state’s north, an ICU nurse said, ‘we’ve had two years to prepare for this, and it’s still shit everywhere’, while another reflected, ‘there’s nothing left in the tank’. “Staffing has become so bad that many ICUs are working without team leaders or the nurses they need in addition to bedside nurses, to keep the units working seamlessly. “Nurse educators have been forced to stop offering clinical supervision to take on patients of their own. Meanwhile, ICU teams are still attending to medical emergency calls from other parts of their hospitals.” n

In their letter to NSW government ministers, ICU nurses called for the following improvements to staffing to ensure provision of safe patient care: • ICU: one RN to one ICU patient. • HDU: one RN to two patients, • An in-charge RN (however titled), plus an ACCESS nurse per pod/unit on all shifts without a patient load. • Nurses who are part of a response team (however named) to be provided in addition to the minimum ratios. The ratios will apply to patients who are clinically assessed as requiring critical nursing care, even if they are not situated in a designated ICU or HDU (however named). • A clinical nurse consultant and nurse practitioner, as appropriate, to be provided in addition to the minimum ratios. • One clinical nurse educator per 30 nurses – in compliance with the Award provision without a patient load. • One RN to two patients (doubled patients) to be no more than one room maximum apart, maintaining visual line of sight at all times. “In addition to this base staffing, we require a COVID float nurse (however titled) without a patient load to assist in the current pandemic,” the nurses said.

THE LAMP FEBRUARY/MARCH 2022 | 27

FRE

Untitled-1 1

8/11/21 12:05 pm

SIN

XPO

March 16th - 17th | International Convention Centre, Sydney

Empowering Nurses & Midwives to Drive Care Quality Improvement with Informatics and to Become Change Leaders

END OR ACN SED BY T H & NS WNM E A

EARN 1 CPD 2 FREE POIN TS!

LEARN MORE & REGISTER YOUR FREE EXPO SEAT TODAY! 28 | THE LAMP FEBRUARY/MARCH 2022

NSWNMA

RS A N I B E W E LIV The NSWNMA has released a series of free webinars on a range of subjects relevant to nursing and midwifery practice. We have a suite of regular topics, such as Medications, Communication and Documentation, Professional Obligations and many more.

PROFESSIONAL EDUCATION

bit.ly/educationNSWNMA

We also arrange other additional one-off webinars facilitated by external presenters on interesting and topical subjects. Keep an eye on the education page and our education emails for updates and additions. Go to the Education page of our website to search our face-toface and webinar CPD education options.

PROFESSIONAL EDUCATION

NSWNMA CALD Symposium

FRIDAY 1 APRIL 2022 | 9AM – 4.30PM | WATERLOO

Promoting cultural diversity & inclusivity in the nursing & midwifery workforce SPEAKERS Shoba Nepali, RN, MCN, MN Multicultural Communities Council of Illawarra Jay Balante, The Daffodil Centre Cancer Care Research Unit, The University of Sydney

Dr Virginia Mapedzahama, Director of Research, African Women Australia Dr Maria Koleth and Rosalie Atie, Australian Human Rights Commission Ms Sophie Cotsis, Shadow Minister for Industrial Relations & Shadow Minister for Work Health and Safety

To view the complete program & register to attend go to

nswnma.info/cald-edu THE LAMP FEBRUARY/MARCH 2022 | 29

YOUR RIGHTS

Ask

Shaye Not a great start, and simply not good enough ... Well, a new year, but like a bad amalgam of the past two. A year barely a month old and already full of records – but all the wrong ones. Record numbers of COVID-19, with recordhigh hospitalisations and deaths, all accompanied by unprecedented nursing and midwifery shortages. A PCR testing system that was all but crushed through sheer demand. Another clunky vaccination rollout. And solutions reduced to not much more than to waive the rules on close contacts, sending back to the front line health and other workers who would have been (and should have been) at home, isolating. Keeping COVID out of facilities has become a far more ethereal concept in year three of the pandemic. The one constant, sadly, was the unrelenting pressure and demand placed upon all health workers, but especially nurses and midwives. Leaders and bureaucrats often offer platitudes but there is no tangible recognition and support beyond those words. Will any one of them remember this when determining your pay, working conditions, or required safe staffing levels when award or agreement discussions become due? Or will they, true to form, simply develop negotiation amnesia. We must ensure they never forget.

COVID-19 EDITION – WORKERS COMPENSATION* Transmission in the workplace There was a COVID-19 outbreak in the facility I work in. I then got it. What leave am I entitled to?

This is an important question. Certain prescribed workers, including those in aged and disability care facilities, along with those in the healthcare sector (public and private), are 30 | THE LAMP FEBRUARY/MARCH 2022

When it comes to your rights and entitlements at work, NSWNMA Assistant General Secretary Shaye has the answers.

presumed to have contracted the virus at work or while working. This reflects changes to the NSW legislation made in 2020 to make it easier for frontline workers to establish the link between work and contracting COVID-19. Of course, this presumption will not apply if there is evidence that proves a worker contracted COVID-19 outside of work. Accordingly, any transmission that is likely to have occurred in the workplace should be approached as eligible for workers compensation.

Progressing a claim How do I progress a claim for workers compensation? My manager has said it is my problem to make a claim.

Despite the presumption applying to prescribed workers, in which it is presumed transmission of COVID-19 occurred at work, you will still need to get a Certificate of Capacity from your doctor. This is the same documentation that a doctor would fill in for any workplace injury. You should provide the completed form to your employer, who is obliged to forward this on in a timely fashion to their insurer.

Claim process I provided the completed form to my workplace last week but nothing much seems to have happened. What can I expect?

An employer is obliged to notify their insurer within 48 hours of becoming aware that a worker has received a COVID-19 diagnosis, whether the diagnosis will lead to a workers compensation claim or not. A claim received from a worker should be provided immediately

by the employer to their insurer/ claims manager. Noting the presumption involved, the insurer will just need to be reasonably satisfied that the worker contracted COVID-19 at work. The insurer must start provisional weekly payments of compensation within seven days of notification, unless they have a reasonable excuse not to. This is to minimise the disruption to your life while the insurer fully assesses your claim (if such time is needed). If the insurer subsequently does not accept your claim, you will not be required to pay back the provisional payments.

Proof of positive status What proof will I need for any claim that I was COVID-19 positive?

With the certificate of capacity from your doctor, you will also need to have a positive PCR or rapid antigen test result. A rapid antigen test no longer will need to be verified by a PCR for this purpose.

Worker’s leave used I have put in my claim but have been put on sick leave. Do I get that back?

While you may be placed on sick leave/personal leave initially, this should be recredited to you when the claim is accepted.

WORKERS COMPENSATION BENEFITS If my claim for workers compensation is accepted, what am I covered for?

YOUR RIGHTS

Normal workers compensation entitlements would apply, including medical expenses and weekly payments for time lost. There is no additional or special payment for COVID-19 as part of a workers compensation claim.

Winding back I see from Association updates last year that the NSW Government was trying to remove the presumption and prescribed worker category. Is that still being pursued?

Sadly, yes. The NSW Government, in a very tight vote, was successful in passing an amendment in the Lower House late last year removing the prescribed worker list and presumption that COVID-19 transmission occurred in the workplace. And why? This is what the NSW Government said

itself in the parliament: “The amendment proposed by the bill is aimed at ensuring the sustainability of the workers compensation scheme by minimising premium increases for employers and ensuring a more consistent customer experience for policyholders, workers with an injury and other stakeholders of the workers compensation scheme … The most significant driver of the anticipated cost is the legislative presumption, which has the potential to turn a large volume of COVID-19 cases into workers compensation claims.” In other words, we wouldn’t want to make it too easy for frontline workers to make such claims, we want to keep costs down for employers instead, and somehow making claims

so much harder to prove will make for an improved customer experience. Maybe, but certainly not for workers. The good news is that the Upper House has sent the proposed amendment to an Inquiry. So, a slight reprieve till later this month when the Committee hands down its findings and there is a vote in the Upper House. Our message to the premier and health minister; it is not too late to show some respect and common decency for health, aged care and disability care workers. Scrap the amendment! * The above general advice is targeted to our members who work in prescribed employment and are covered by NSW legislation. It does not apply to workplaces under the Comcare (self-insured) system. Family members or friends not in such employment would need to seek alternative advice regarding their rights if transmission in their workplace is suspected.

MIDWIFERY REFERENCE GROUP The NSW Nurses and Midwives’ Association is seeking members to join the Midwifery Reference Group. The group meet 4-6 times per year to discuss current issues and challenges in the midwifery sector. Meetings are held in a blended Zoom/ face-to-face format to allow members to be involved regardless of geographical location. Current NSWNMA midwifery members are invited to join.

Being a member of the Midwifery Reference Group gives you the opportunity to: be a voice for the issues impacting midwives and the midwifery profession assist in the development and reviewing of policies be a link between members and the Association

MORE INFORMATION + EXPRESSION OF INTEREST: email education@nswnma.asn.au THE LAMP FEBRUARY/MARCH 2022 | 31

Registered Nurses working in NSW Public Mental Health Services

OPPORTUNITY FOR CAREER DEVELOPMENT What is it?

The Program aims to encourage less experienced mental health nurses to take the opportunity to be mentored by a more experienced colleague, assisting them to achieve their mental health professional practice goals.

BOB FENWICK MENTORING GRANTS PROGRAM Can help towards your CPD hours

Who can apply?

Any registered nurse currently working in NSW public mental health services is eligible to apply. Mental health nurses with less than two years’ experience or working in NSW rural and remote areas as well as Aboriginal or Torres Strait Islander nurses currently working in mental health are all strongly encouraged to apply.

What will each mentoring grant include? n Matching with a mentor in a Local Health District (LHD) other than their own for up to five consecutive days to pursue their mental health areas of interest. n Being provided with travel, accommodation and meal allowance, while remaining a fully paid employee of their regular mental health service during their placement.

Seeking mentors for the Program

If you are a senior mental health nurse, you can help build the specialty of mental health nursing by nominating yourself to become a mentor. Simply use the Mentor Details Form or contact the Program Manager for more information.

APPLICATIONS OPEN 1 FEBRUARY 2022 CLOSE 13 MARCH 2022

How do I apply?

More detailed information about the Program (including a video interview of past participants) can be found on the NSW Nurses and Midwives’ Association website www.nswnma.asn.au 2022 EXPRESSION OF INTEREST FORMS WILL BE AVAILABLE FROM 1 FEBRUARY 2022. If you require more information contact the Program Manager by email: mhmgrant@nswnma.asn.au or contact Cathy Matias on 1300 367 962.

Applications are open to registered nurses who want a unique opportunity to further their mental health nursing career by participating in this innovative Program.

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

Card no Signature of Cardholder 32 | THE LAMP FEBRUARY/MARCH 2022

Name on Card Expiry Date

PROGRESS YOUR NURSING CAREER IN 2022 Apply now for an online graduate certificate Enrol in an online graduate certificate to pursue your passion, become a specialist in your area of practice and increase your earning potential. Choose from 18 nursing specialties such as Cosmetic Nursing and Perioperative Nursing. Complete your course online in one year while studying part-time, FEE-HELP is available. acn.edu.au/study TEQSA Provider ID: PRV14001 Institute of Higher Education 11.11.21

THE LAMP FEBRUARY/MARCH 2022 | 33

NEWS IN BRIEF

SPAIN

Spain bins its version of WorkChoices New labour laws aim to reduce precarious employment. Spanish workplace laws that gave disproportionate power to employers, eroded workers’ rights and stunted wage growth have been consigned to the scrap heap with the introduction of a new labour code. The old laws were introduced in 2012 by the conservative government of Mariano Rajoy following pressure by the country’s European Union creditors and the International Monetary Fund in the wake of the GFC, which led to a severe economic crisis in Spain. The new laws are aimed at bolstering job security and ending the precarious work that led to millions of people in Spain losing their jobs every time there was an economic downturn. At 20 per cent, Spain has the highest share of temporary workers in Europe – double the EU average. Unions welcomed the new changes. Even employers have accepted that a new formula was needed to eradicate “unfair competition”. “We want to recover the balance in labour relations that deteriorated under the previous reform,” Unai Sordo, head of Comisiones Obreros, Spain’s biggest union, told Reuters.“Collective bargaining cannot be aimed at making wages more precarious,” said Rosa Santos, the lead negotiator for CEOE – Spain’s employer association. Spain’s Labour minister and deputy prime minister, Yolanda Díaz, said the labor reform was the fruit of nine months of negotiation between the government, unions and business groups. “This agreement improves the lives of the workers in this country,” she said.

‘ This agreement improves the lives of the workers in this country.’ — Spanish Minister of Labour, Yolanda Díaz

34 | THE LAMP FEBRUARY/MARCH 2022

WORLD

Obesity levels balloon in children Many poor countries are now facing a “double epidemic” of malnutrition and obesity. Childhood obesity has accelerated in many countries during the pandemic as children sit still at home for longer, often in front of a screen. A global study published in 2017 in The Lancet projected that if the trends seen at the time continued, by 2022 obesity in children and adolescents aged 5 to 19 years would surpass for the first time the share who were underweight. That prediction now appears to have come true, reports The Economist. Where obesity in children is most prevalent is somewhat surprising. More than a quarter of the world’s overweight children under the age of five live in Africa and 48 per cent are in Asia. Children’s eating habits and levels of physical activity have changed for the worse during the pandemic. In Germany, for example, 28 per cent of three- to five-year-olds engaged in less physical activity and 20 per cent consumed more sugary snacks during the pandemic. In rich countries, childhood obesity is concentrated in poor families. In poor countries, however, it is a middleclass problem – so as average incomes rise, more children are moving into the overweight zone. Many poor countries are now facing a “double epidemic” of malnutrition and obesity.

‘Of overweight children under five, 27% live in Africa and 48% are in Asia.’

NEWS IN BRIEF

AUSTRALIA

Diabetes rises globally by 16 per cent during COVID Ten per cent of the world’s population aged between 20 and 79 now live with diabetes. New figures show global diabetes has increased by 16 per cent in the past two years, with 537 million adults (aged 20 to 79) now estimated to be living with the chronic condition. Researchers say COVID has stopped us doing some of the things that help prevent and manage diabetes, leading to an increase in sedentary behaviour that they say was already at dangerous levels pre-COVID. Some estimates indicate the pandemic has added an average three hours to our sitting time each day. Data from the International Diabetes Federation’s 10th Diabetes Atlas (https://diabetesatlas.org/) shows about 10 per cent of the world’s population aged 20 to 79 now live with diabetes, and diabetes prevalence is predicted to

steadily increase to around 784 million adults by 2045. According to the atlas, the poorest are hit hardest by diabetes and it “is spiralling out of control”. The global survey found that: • more than three in four adults with diabetes live in low- and middle-income countries • diabetes has caused at least $US966 billion dollars in health expenditure – a 316 per cent increase over the last 15 years • diabetes was responsible for 6.7 million deaths in 2021 – one person every five seconds. Researchers from the Baker Heart and Diabetes Institute, writing in The Conversation, said regular movement is the key way to help manage diabetes and help prevent complications.

CROSSWORD SOLUTION

“Getting moving effectively improves glucose control, blood pressure, vascular health and memory,” they wrote.

‘The pandemic has added an average three hours to our sitting time each day.’ Quality legal advice for NSWNMA members • Workers Compensation Claims • Litigation, including workplace related claims • Employment and Industrial Law • Workplace Health and Safety • Anti-Discrimination • Criminal, including driving offences • Probate / Estates • Public Notary • Discounted rates for members including First Free Consultations for members

Call the NSWNMA on 1300 367 962

and find out how you can access this great service

Offices in Sydney and Newcastle with visiting offices in regional areas (by appointment) THE LAMP FEBRUARY/MARCH 2022 | 35

NEWS IN BRIEF

UNITED KINGDOM

Time to rein in “Wild West” aged care operators Vulture private equity firms prioritise profit over care. A BBC investigation has exposed sharp practices among Britain’s largest aged care providers leading to calls for accountability – even from a former Conservative health minister. The BBC exposé was based on a financial analysis by Australian campaigner Jason Ward – from the Centre for International Corporate Tax Accountability and Research (CICTAR) – who has done similar work in Australia for the ANMF and NSWNMA. Jason used forensic accounting techniques to show that three of Britain’s biggest care home groups owned by private equity firms, with intricate corporate structures based in the Cayman Islands, were saddled with massive amounts of debt. WORLD

Omicron – the most contagious virus in history? The new variant conquered the planet in less than a month. A comparison between measles – until now a candidate with strong claims to being the most infectious disease – and Omicron is instructive. According to Roby Bhattacharyya, an expert in infectious diseases at Massachusetts General Hospital, one person with measles infects another 15 on average in the absence of vaccination, compared to the six infected by Omicron. The key, however, is in the so-called generation time: the days that elapse from when the first person is infectious until those infected by it are also infectious. About 12 days go by with measles. In the case of Omicron, it only takes four or five days. It is explosive. “A case of measles would give rise to 15 cases within 12 days. A case of Omicron would originate another six at four days, 36 cases at eight days and 216 at 12 days,” Bhattacharyya told the Spanish daily El País. In 35 days there would be 280,000 Omicron cases and 2,700 of measles in the absence of vaccines. Medical historian Anton Erkoreka told El País that Omicron “is the most explosive virus with the most rapid diffusion in history”. The black plague of the sixteenth century and cholera in the nineteenth century (both bacterial infections) took years to expand globally. The original COVID variant detected in 2019 took three months to cross the planet. “The Omicron variant has beaten that record of expansion,” said Erkoreka.

‘ A case of measles would give rise to 15 cases within 12 days; Omicron – 216 at 12 days.’ 36 | THE LAMP FEBRUARY/MARCH 2022

He found that a significant amount of the revenue that came out of the pockets of the vulnerable aged or from subsidies from cash-strapped local authorities ended up in this tax haven, or in outsized dividends, or were used to pay off this debt rather than being spent on care. Jason said it is a “a common private equity tactic” to move “money out of the operating companies and to the ultimate investors in a way that maximises their profit”. Former health minister Jeremy Hunt described the sector to the BBC as “the Wild West” and “the unacceptable face of capitalism”.

Watch the BBC exposé You can watch the BBC Panorama report, ‘Crisis in care: Follow the money’ at: https://www.bbc. co.uk/programmes/m0012cbj

NEWS IN BRIEF

AUSTRALIA

Telehealth cuts cause ‘mayhem’ Federal government puts money before care. Again. At the moment when Omicron exploded in late December, the federal government responded with changes to the Medicare Benefits Schedule that restricted phone consultations for a long list of specialist items, which impacted on patients most vulnerable to COVID. These changes will limit telehealth for cancer patients, psychiatry patients, the elderly and people in remote areas, clinicians have warned. President of the Clinical Oncology Society of Australia (COSA) and medical oncologist, Professor Fran Boyle, told The Guardian that the timing of the changes was “appalling” considering the dramatic increase in COVID cases across the nation. She said the changes to MBS item numbers, intended to help people with cancer and other illnesses, would limit access to care for vulnerable demographics, particularly in remote areas. The government says the changes were intended to encourage the take-up of video consultations and reduce the number of phone consultations.

Professor Boyle said “overwhelmingly” patients took up phone consultations as video added a “layer of complexity” and wasn’t an option for many – notably older people and others with limited access to technology and reliable internet in regional and rural Australia. The AMA said “acknowledging we are still in a pandemic” would have seen the availability of item numbers extended, not reduced. AMA President, Dr Omar Korshid, said the health department had been “very much of the mind” that phone consultations should be limited. “Presumably with concern they’ll cost more money,” he said.

‘ The changes will limit telehealth for cancer patients, psychiatry patients, the elderly and people in remote areas.’ SPAIN

Study finds green space alleviates PMS Another health benefit associated with natural environments. Scientists from the Barcelona Institute for Global Health and the University of Bergen found that women living in neighbourhoods with more green space had fewer premenstrual syndrome (PMS) symptoms and were less likely to experience anxiety, depression, difficulty sleeping, breast tenderness or abdominal bloating. The study, published in Environment International, adds to a growing body of evidence of the health benefits associated with natural environments. Lead author Kai Triebner, a researcher at the University of Bergen, told The Guardian: “Three of the four symptoms that improved with exposure to green space were psychological, which is consistent with what we already knew: contact with nature helps to reduce stress and improve mental health.” Triebner said green space lowered levels of cortisol. “Stress can worsen PMS symptoms and increase levels of the hormone cortisol, and in turn could be associated with an increased release of progesterone, which has been linked to the occurrence of PMS symptoms,” he said. The research is “another building block” in understanding of what the best conditions are to live healthily. The research found that women needed to be exposed to green space for a long time to get the most benefits. “Our research underscores the importance of long-term exposure to green space, which is where benefits against PMS symptoms were found,” said Payam Dadvand from the Barcelona Institute for Global Health, another researcher involved in the study. THE LAMP FEBRUARY/MARCH 2022 | 37

RECRUIT A NEW MEMBER AND GO INTO THE DRAW TO WIN A REJUVENATING HOLIDAY AT THE SEBEL SYDNEY MANLY BEACH THE 2021– 22 NSWNMA MEMBER RECRUITMENT SCHEME PRIZE Enjoy a stylish retreat just steps from the water in Sydney’s vibrant seaside suburb at The Sebel Sydney Manly Beach. Located a short 30-minute ferry ride from Sydney CBD, Manly offers laidback vibes and plays host to one of Sydney’s most stunning beaches. Stay in a recently refurbished Studio Ocean View room, offering a stylish furnished balcony – the perfect spot for morning coffee. You’ll be within walking distance of Manly’s many restaurants, cafés, bars and shops and the area’s picturesque coastal walks. You and a friend will experience: • 4 nights’ accommodation in a Studio Ocean View Room • Welcome bottle of wine • Daily a la carte breakfast for two adults • Complimentary parking • Complimentary WiFi • The NSWNMA will arrange return flights for two to Sydney (if flights are required)

PRIZE DRAWN 1 JULY 2022 RECRUITERS NOTE: Join online at www.nswnma.asn.au Every member you sign up over the year gives you an entry in the draw! 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 1 July 2023 and is subject to room availability. Voucher must be presented upon request. Voucher is not transferrable nor redeemable for cash. Block-out dates may apply. The prize will be drawn on 1 July 2022. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. 38 | THE LAMP FEBRUARY/MARCH 2022

CROSSWORD

test your

Knowledge 1

18 19

20 21

26 27 29

ACROSS 1. A broad-spectrum antibiotic used in treating many bacterial and rickettsia infections (17) 10. A major cause of infant diarrhoea (9) 11. A type of ballroom dance (5) 12. A city in central Victoria (7) 14. Right of possession or proprietorship (9) 15. A rare, slowly growing glioma that occurs most frequently in the cerebrum of adults (17) 18. The symbol for europium (1.1) 19. A leukocyte with coarse, round granules present (11) 21. A flightless Australian bird (3) 23. Disability (10) 26. Powdery (5) 28. A muscle that connects the mandible to the hyoid bone (10)

30. The hard substance covering the tooth (6) 31. Rapid breathing (10) 34. Arouse, provoke (6) 35. Marginal awareness, stupor, grogginess (17) DOWN 1. An inflammation of the brain and its membranes (17) 2. The states of being inactive (9) 3. Increase the number of rotations per minute (3) 4. The fleshy lower part of the external ear (7) 5. React (7) 6. Relating to the skin (9) 7. Consolidated (11) 8. Occurring during the same time (11) 9. Inflammation of the brain and

spinal cord (17) 13. An antibody that is produced by one individual and reacts with isoantigens found in othermembers of the same species (11) 16. An intermediate-acting insulin (1.1.1) 17. Connected; associated (7) 20. Proopiomelanotropin (1.1.1) 22. A change in the genetic material of an organism (8) 24. Terror, scare (5) 25. The self (3) 27. A net or mesh foundation for lace (6) 29. Relating to the distal portion of the small intestine (5) 32. High-definition imaging (1.1.1) 33. Not (3) THE LAMP FEBRUARY/MARCH 2022 | 39

TRAVEL

Take a look at these fabulous holiday offers

Never pay full price for a holiday again Ubookdirect offers all NSWNMA members discounted rates 1000's of hotels Australia wide. Fill in a quote request Free ontoday to save on your next getaway. Book your school $20 holidays now to get the best discounted rates. voucher UBOOKDIRECT is giving members a $20 voucher to use on any already discounted member package when booking through the Concierge. To book one of these fantastic destinations log on to https://travelbenefits.ubookdirect.com and click on the ENQUIRY tab or call 1300 959 550

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Valid for travel 1 March 2022 until 1 September 2022. Rate based on 2 adults and subject to availability. For full t&c’s go to https://travelbenefits.ubookdirect.com 40 | THE LAMP FEBRUARY/MARCH 2022

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REVIEWS

book club

T AL

S PE

Hachette Australia RRP $32.99 ISBN 9781472284891 7

IN T E

Sarah Steele

INTE IAL

ST RE

THE Schoolteacher of Saint-Michel

SPE C

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.

A heart-rending and deeply moving story of love and hope in World War II from the USA Today bestselling author of The Missing Pieces of Nancy Moon. France, 1942. At the end of the day, the schoolteacher checks her pupils have their identity passes, and warns them not to stop until the German guards have let them through the barrier that separates occupied France from Free France. As the little ones fly across the border and into their mothers’ arms, she breathes a sigh of relief. No-one is safe now. Not even the children.

The Very Last List of Vivian Walker MEGAN ALBANY Hachette Australia RRP $32.99 ISBN 9780733646959

Vivian Walker is dying. This is not on her list of things to do. A darkly funny debut that proves even the most imperfect of lives is worth celebrating. Now that I’ve got cancer, I know I should be letting go and just being in the moment with my child but, seriously, what mother has got time to spend with their kids?

The Long Weekend Fiona Palmer Hachette Australia RRP $32.99 ISBN 9780733646119

Four perfect strangers. Three days. Can one weekend away change your life? The unputdownable new drama by one of Australia’s most beloved storytellers. Coming together for a writing workshop with bestselling author Jan Goldstein, four strangers converge upon a luxury forest retreat. But along with their notepads and laptops, each of the participants has brought some emotional baggage.

Anything Could Happen Lucy Diamond Hachette Australia RRP $32.99 ISBN 9781529419610

The sensational and uplifting new novel from The Sunday Times bestselling author of An Almost Perfect Holiday and The Beach Café. A chance encounter in New York City. A great love story on the cusp of beginning. And then he was gone. For Lara and her daughter, Eliza, it has always been just the two of them. But when Eliza turns eighteen and wants to connect with her father, Lara is forced to admit a secret that she has been keeping from her daughter her whole life.

THE LAMP FEBRUARY/MARCH 2022 | 41

YOUR HEALTH

fitness+wellbeing How to improve your posture in just 10 minutes a day Having a good posture is incredibly important for nurses and midwives. Vitruvian Health has provided the VH6 workout to assist with Side Clams improving your posture 10 REPS EACH SIDE and to fight off structural Lie on one side with your bottom leg straight, stack your top leg on top of the bottom leg. fatigue. •B ring both your knees forward 45 degrees and rest your head on your arm, so It is best to do these exercises either at the start or end of the day (or both!).

that your spine is straight or in a neutral position. •F rom there, lift your knee up as high as you can and back down, making sure your top hip is not moving. You should feel your glute mead working. If you can’t, try squeezing and holding your leg at the top of the movement for two seconds before bringing it back down. •R epeat this for 10 reps on each leg, rolling over to lie on your other side when switching legs.

Follow along with this workout through the following QR code.

Side Hover 30 SECOND HOLD EACH SIDE Lie on one side with your legs straight. Press your elbow into the ground and push yourself up into the side hover. •T he key is to push your hips up as high as you can with the elbow directly under the shoulder. • I f you are finding this challenging you can bend your bottom leg and place the foot on the floor in front of you to assist. Make sure to focus on keeping your hips level and not letting them drop or roll back. •H old for 30 seconds (if you don’t have a timer you can do 10 deep breaths). •T urn and repeat on the other side. 42 | THE LAMP FEBRUARY/MARCH 2022

Superman/Wonder Woman

McGill Sit Up

5 REPS Lying on your stomach, pull your shoulders back and lift your chest up as high as you can. • Reach forward with both arms as far as you can, and then bring them back down and in so that your elbows are bent and by your side. For this exercise, really focus on only using your upper back and pulling your shoulders back. You should not feel your lower back working and you want to avoid your shoulders moving up around your ears. • Repeat this movement five times.

6 REPS TOTAL Lie on your back, bending one knee and placing that foot on the ground. • Bring your fingers to your sternum and lift your elbows as high as you can. • Bring your chin to your chest, and then curl up so that your shoulders are off the floor. • Hold this for a second and then slowly roll back down. Focus on isolating the movement, elbows up, chin to chest and then roll up, roll back, head to floor and then drop your elbows. • Do three reps and then swap legs and repeat for three more reps.

Shoulder Taps 10 REPS EACH SIDE Set yourself up in a full plank position with your hips in line with your shoulders. • Bring your feet together and your hands directly below your shoulders. • Lift one hand and tap your shoulder on the opposite side. Focus on not swaying when lifting your hands up by pushing your hands and feet into the ground to keep yourself stable. • If you are struggling to stay balanced or keep yourself up off the ground while you are doing the arm taps, place your knees on the ground and lean forward. • Repeat 10 reps for each arm.

Glute Bridge 10 REPS Lie on your back with both feet flat on the floor, hip width apart, press your arms into the ground as hard as you can and then lift your hips up, and then slowly lower them. • If you find your stomach sticking out, or you feel like you are rolling or arching, focus on pulling your stomach in and doing the movement more slowly. • Repeat this for 10 reps. THE LAMP FEBRUARY/MARCH 2022 | 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 THE LAMP FEBRUARY/MARCH 2022 • Professional Indemnity Insurance: the limit per claim is now $5 million

NURSING RESEARCH AND PROFESSIONAL ISSUES Regulation of practitioners in the cosmetic industry has attracted significant attention with the recent exposure of substandard practice in Australia, and there is a growing participation in the industry by nurses as providers. This month, we look at the cosmetic industry. Position statement on nurses and cosmetic procedures Nursing and Midwifery Board of Australia (NMBA) January 2022 The Australian Health Practitioner Regulation Agency (AHPRA) and the National Boards have developed information and resources for consumers and registered health practitioners about expected standards when it comes to cosmetic procedures. They can be found in “publications” on the AHPRA & National Boards website. This statement captures the NMBA’s position on nurses working in the area of cosmetic medical and surgical procedures. The main focus of this position statement is minor (non-surgical) cosmetic medical procedures (‘cosmetic medical procedures’). Nurses practising in the area of major cosmetic medical and surgical procedures (‘cosmetic surgery’) work with a medical practitioner. https://www.nursingmidwiferyboard.gov.au/CodesGuidelines-Statements/ Position-Statements/nurses-andcosmetic-procedures.aspx

Cosmetic procedures: #besafefirst AHPRA Thinking of a cosmetic procedure or surgery? Get informed and make a safer choice. No matter how simple it may seem, every cosmetic procedure or surgery carries risk. Even if you’ve had a procedure before, it’s important that you think carefully about your decision every time. If you decide that a cosmetic procedure or cosmetic surgery is for you – be safe first. Know which questions to ask

and what to look out for, so you can make an informed decision. https://www.ahpra.gov.au/ Publications/Cosmetic-surgeryand-procedures.aspx

Thinking of getting a minor cosmetic procedure like Botox or fillers? Here’s what to consider first The Conversation July 2021 At a dinner party recently, my friend Kaity whispered, “I’ve been staring at my face in Zoom meetings and I look tired. I’m considering Botox. What are the risks?” I shouldn’t have been surprised; Kaity isn’t alone in thinking cosmetic procedures could fix Zoom-face fatigue. Our new research shows one in three Australians have new concerns about their appearance since the pandemic began. What’s more, Kaity is in the primary demographic: 35–50-year-old women. And she lives in Australia, where we have the highest cosmetic procedure rates per capita. We spend A$350 million to A$1 billion on cosmetic procedures per year – a figure expected to increase. For most people, cosmetic procedures lead to improved self-esteem, confidence and body image. I never thought Kaity was shy or had selfesteem issues, but she told me she’s different at work and after the last year, she craves some self-care. However, for a significant minority, there are negative outcomes. So before deciding if it was right for Kaity, she needed to consider afew things: https://theconversation.com/ thinking-of-getting-a-minorcosmetic-procedure-like-botox-

or-fillers-heres-what-to-considerfirst-161271

Cosmetic Cowboys ABC Four Corners, Oct 2021 “I would describe the cosmetic treatments industry as like the wild west, but without the sheriffs.” – Health regulation consultant Once upon a time, cosmetic surgery was only for the wealthy. Today, it’s advertised and marketed as a perfectly normal experience for anyone who can afford it. Cosmetic surgeons have become social media stars with followers in the millions. But behind the glitz and glamour lie some ugly truths. “It’s ruined a huge part of my life.” – Patient Four Corners, in a joint investigation with The Age and Sydney Morning Herald, exposed alarming practices in this multi-billion-dollar industry and revealed how the regulatory system is failing to protect Australians. “How can an individual ... treat another human being like that?” – Surgeon Cosmetic surgery is marketed as easy and safe, but as this investigation showed, the consequences can be devastating. “I’ve never seen anything like this. It’s staggering.” – Surgeon In this extraordinary and shocking report, Gold Walkley award winner Adele Ferguson investigates how this industry has been able to flourish. https://www.abc.net.au/4corners/ cosmetic-cowboys/13603636

THE LAMP FEBRUARY/MARCH 2022 | 45

NOTICE

NSWNMA FEE WAIVER for members on parental leave 1/

DID YOU KNOW,

if you’re going on parental leave, paid or unpaid, we’ll waive your Association fees until you return to work? You’ll still be entitled to access advice and receive The Lamp.

Contact the Association and let us know when you plan to take parental leave so we can set up your waiver. PHONE 8595 1234 • 1300 367 962 EMAIL gensec@nswnma.asn.au

www.nswnma.asn.au 46 | THE LAMP FEBRUARY/MARCH 2022

Authorised by B.Holmes, General Secretary, NSWNMA

UPDATE YOUR DETAILS

and Win Have you recently moved house or changed jobs? Changed your email or classification? Log on to online.nswnma.asn.au Update your details and go into the draw to win: • Two nights’ accommodation in a superior room at PARKROYAL Darling Harbour* • Breakfast for two at Barkers Restaurant • Dinner for two at ABODE Bistro. Bar • Valet Parking for 1 car

Dive in and discover Sydney! Situated on the city side of Darling Harbour, our hotel features 340 stylish rooms and suites with superior king-sized beds, widescreen TV, and in-room amenities. Dine in our award winning ABODE Bistro. Bar, relax in our Club Lounge, or explore iconic attractions on our doorstep. PARKROYAL Darling Harbour, Sydney – your harbour side sanctuary. Everyone who uses our online portal from 1 April 2021 – 30 March 2022 to update their details will automatically be entered in the draw to win. *Conditions apply. Prize must be redeemed by 30 March 2023 and is subject to room availability. he winner must be a financial member of the NSWNMA. 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/20/05518.

Nurses & Midwives Health is health insurance for nurses, midwives and their families.

Compare your health cover today at nmhealth.com.au/compare or call 1300 900 310 Eligibility criteria and conditions apply. Teachers Federation Health Ltd ABN 86 097 030 414 trading as Nurses & Midwives Health. A Registered Private Health Insurer. NMH-NSWNMA-1/22 Authorised by B. Holmes, General Secretary, New South Wales Nurses and Midwives’ Association, 50 O’Dea Ave, Waterloo NSW 2017

The Lamp February 2022

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