The Lamp November 2019 by NSW Nurses and Midwives' Association

SAFE STAFFING

AGED CARE

POLICE GAMES

REGULARS

Leeton nurses win extra staff

Unacceptable levels of staffing

“Keep Calm and Nurse On” at Police and Emergency Services games

Your rights and entitlements at work Nurse Uncut – your stories What nurses and midwives said Nursing research online

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THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 76 NO. 10 NOVEMBER 2019

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THE NEXT EVOLUTION OF the lamp IS COMING… From 2020, we’ll be launching Lamp Online, covering all the issues that are important to you. But don’t worry, you’ll still get your print copy 6 times a year.

Keep an eye out for more details in the coming lamp

REGIONAL HOSPITALS

Rural towns fight to save services page 10

PRIVATE HOSPITALS

WORKPLACE VIOLENCE

Leave rights protected at St Vincent’s Health

Time for action on violence

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REGULARS at work Your rights and entitlements Nurse Uncut – your stories said What nurses and midwives Nursing research online

NSW NURSES THE MAGAZINE OF THE ION AND MIDWIVES’ ASSOCIAT 2019 VOLUME 76 NO. 6 JULY

NURSES RE

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 76 NO. 9 NOVEMBER 2019

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 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au Editorial Committee Brett Holmes, NSWNMA General Secretary Judith Kiejda, NSWNMA Assistant General Secretary O’Bray Smith, NSWNMA President Michelle Cashman, Long Jetty Continuing Care Richard Noort, Justice Health 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.

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Privacy Statement The NSWNMA collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information, please contact the NSWNMA office. If you are still not satisfied that your privacy is being maintained, you can contact the Privacy Commission. Subscriptions for 2019 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $30. Individuals $84, Institutions $140, Overseas $150.

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COVER STORY Tram plan derailed by community campaign

Cumberland Hospital’s NSWNMA branch want to know how a large acute psychiatric hospital will operate with a busy tram line running through it.

10 12

SAFE STAFFING Staffing breakthrough at Bankstown

ED nurses win action to fill vacancies and continue to push for staffing review.

SAFE STAFFING

Alone no longer A committed group of rural nurses have forced management to promise extra staff – ensuring they will no longer have to work alone.

SAFE STAFFING

Cooma wins extra staff Sustained pressure leads to more staff and more consultation.

AGED CARE An “unacceptable level of staffing”

in aged care homes Australia ranks poorly for aged care staffing in international comparisons.

REGULARS

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Editorial Your letters Competition News in brief NSWNMA Education Ask Judith Nurse Uncut Facebook Nursing Research Online and Professional Issues Crossword Book Club At the Movies Diary Dates

SAFE STAFFING

Leeton nurses win extra staff page 12

AGED CARE

POLICE GAMES

REGULARS

Unacceptable levels of staffing

“Keep Calm and Nurse On” at Police and Emergency Services games

Your rights and entitlements at work Nurse Uncut – your stories What nurses and midwives said Nursing research online

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page 26

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AGED CARE

Cultural divisions prevalent in health and aged care A new report by the NSWNMA finds high levels of discrimination in health and aged care settings and a reluctance to report incidents.

FUTURE READY

Champ deplores ‘lack of expectation’ for people with disabilities Kurt Fearnley, Australia’s most famous wheelchair racer, says it is unacceptable that people with disabilities should have to spend their time “looking at life go by”.

THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 76 NO. 10 NOVEMBER 2019

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On the cover Luke Muller, Warwick Lahner and Maryann Geelan Image by Sharon Hickey THE LAMP NOVEMBER 2019 | 3

2020 NSW Nurses and Midwives’ Association Election of Branch Delegates and Alternate Delegates

Pursuant to the Industrial Relations Act, 1996, Mr Neale Dawson will be the Returning Officer for the election of branch delegates and alternate delegates to the Annual Conference and the Committee of Delegates of the New South Wales Nurses and Midwives’ Association.

Nominations Nominations in writing are hereby invited on and from 1 January 2020 for the following positions: Branch delegates and alternate delegates to the Annual Conference and the Committee of Delegates. Each branch shall be entitled to elect such delegates according to the number of financial members in that branch as at 31 December 2019, as follows: (information as to the number of financial members in each branch is available from each branch secretary, or the New South Wales Nurses and Midwives’ Association, telephone 1300 367 962) 50 financial members or less

1 delegate

51-130 (inclusive) financial members

2 delegates

131-300 (inclusive) financial members

3 delegates

301-500 (inclusive) financial members

4 delegates

501-750 (inclusive) financial members

5 delegates

751-1000 (inclusive) financial members

6 delegates

1001-1250 (inclusive) financial members

7 delegates

1251-1500 (inclusive) financial members

8 delegates

1501-1750 (inclusive) financial members

9 delegates

1751-2000 (inclusive) financial members

10 delegates

And one additional delegate for every additional 250 financial members thereafter. Each branch shall be entitled to elect alternate delegates equal to the delegate entitlement of that branch, provided that a branch shall be entitled to elect at least two alternate delegates. Note: A person may nominate for one of these positions only. Candidates for election to the position of branch delegate or alternate delegate are required to be financial members of the Association at the date of opening of nominations 1 January 2020. A person is not eligible to nominate for, be elected to, or hold any office in the Association, Committee of Delegates or branch thereof if: (i) such person holds any office in any other registered trade union or a like or kindred nature or having objects similar to the objects of the New South Wales Nurses and

4 | THE LAMP NOVEMBER 2019

Midwives’ Association other than the Australian Nursing and Midwifery Federation, (ii) such person has been, within the period of two years immediately preceding the date of nomination or election, dismissed from any office or position in accordance with rule 14 of the Association’s Rules. Nomination forms may be obtained from the returning officer, Mr Neale Dawson, NEW Law, 50 O’Dea Avenue, Waterloo 2017 or from NSW Nurses and Midwives’ Association (telephone 1300 367 962) or from the member only section of the Association’s website (www.nswnma.asn.au).

Close of nominations Signed Nominations must be received by the returning officer, Mr Neale Dawson, not later than 5pm, Thursday 13 February 2020. They may be hand delivered to Returning Officer, Mr Neale Dawson, NEW Law, 50 O’Dea Avenue, Waterloo 2017; scanned and emailed to returningofficer@newlaw.com.au, faxed to (02) 9662 1463, or posted to Returning Officer, Mr Neale Dawson, PO Box 6373, Alexandria 2015. Nominations received after the time and date specified will not be accepted. Nominations cannot be lodged with the NSW Nurses and Midwives’ Association. Any defect in a nomination must be rectified by the candidate prior to the close of nominations. A candidate may only withdraw his/her nomination in writing so as to be received by the returning officer prior to the close of nominations. Should more than the required number of nominations be received a draw will be conducted to determine the order of candidates’ names on the ballot paper at 50 O’Dea Avenue, Waterloo at 10am, Tuesday 18 February 2020. Candidates or their representatives are invited to witness the draw.

Voting If the election is contested a postal ballot will be conducted. All members of the relevant branch of the New South Wales Nurses and Midwives’ Association financial as at 10am, Tuesday 18 February 2020 and entitled to vote will be sent a ballot paper on Monday 24 February 2020. The ballot will open on Monday 02 March 2020 close at 5pm, Friday 13 March 2020. The method of voting to be observed for this election will be first past the post. Any candidate in a contested election may nominate another person to act as their scrutineer at the counting of the ballot. Candidates should ring the Association to ascertain the date and time of counting. Members should ensure that the NSW Nurses and Midwives’ Association has been advised of their current residential address as voting material will be posted to each member’s residential address. Any enquiries concerning this election should be in writing or by fax and be addressed to the Returning Officer Mr Neale Dawson. Neale Dawson, Returning Officer for the 2020 Election Term New South Wales Nurses and Midwives’ Association Election

EDITORIAL

Brett

Holmes GENERAL SECRETARY

Our community campaigns pay dividends According to documents leaked to the opposition the state government has earmarked $150 million in funding cuts to LHD budgets this financial year. This will inevitably put more pressure on staffing. Here is a delicious challenge for those of you who love brain teasers. How do you inject an extra 5000 nurses and midwives into the public health system over the next four years – as the state government promised at the state election early this year – and at the same time cut LHD budgets by $150 million a year? The Berejiklian government’s apparent solution is the health equivalent of the magic pudding. You can have your cake and eat it too. Norman Lindsay’s children’s classic has often been used as a metaphor for ridiculous political promises and wishful thinking. It is the perfect metaphor for NSW health policy. When you demand $150 million in cost savings from the state’s 15 Local Health Districts and three Specialty Health Networks, clearly, it will spill into current staffing vacancies as well as cuts to frontline staff. We have been seeing the consequences of these cuts for some time. Months ago we were told Hunter New England Health had to find widespread savings, when we raised issues of understaffing concerns. We were also told Western NSW Local Health District had to find positions it could cut. At the same time Central Coast Local Health District has been targeting nursing positions under a radical ‘staffing our service’ plan. When we asked questions of NSW Health directly, we were given the normal mantra: there had been a 4.5 per cent increase in the state’s health budget and record health investment. We were assured that the Agency “Efficiency

‘ The Berejiklian government’s apparent solution is the health equivalent of the magic pudding. You can have your cake and eat it too.’ Dividends” or “Treasury Cap” would be managed by procurement efficiencies. It now appears to our members that LHD’s consider non-replacement of staff a procurement efficiency. We were then asked: “Why couldn’t we just be happy with 5,000 extra nurses and midwives over the next four years?”

A SELF-DELUSIONAL MINDSET As nurses and midwives we cannot afford to share the government’s self-delusional mindset. We need to make them accountable for their election promise to significantly increase the nursing and midwifery workforce. We owe that to our patients as well as ourselves. Those extra nurses and midwives are needed now and we are not going to get them unless we keep this government honest. This requires us to take a stand and to get the community behind us. The good news is, that is happening now and it is paying dividends. Throughout the state NSWNMA branches are mobilising when inadequate staffing has impacted on safe patient care and the welfare of our patients. They have engaged with the community and educated them about what is really happening at the frontline of our health system. They have won the community’s support and this has led to favourable outcomes.

In this month’s Lamp we report on how committed groups of nurses at rural hospitals like Leeton and Cooma have forced management to fulfil their responsibilities and find extra staff. Likewise, at a larger metropolitan hospital like Bankstown nurses and midwives have achieved similar results. For months now The Lamp has reported similar battles and similar wins. These wins don’t come easy. They require some heavy lifting. Data needs to be collected, analyses need to be made, workplaces need to be organised, the community needs to be engaged. Management needs to be challenged. The leadership and staff of this union are always here to provide assistance and backup to branches who are fighting to improve their workplace. When the government says, on the one hand they recognise the need for more frontline nurses and on the other they take to LHD budgets with a scalpel, it is an insult to our intelligence and the intelligence of the public. Someone needs to call out this fantasy. Let’s keep taking the truth to the public about the true state of our health system. The community has shown they will back us. n

THE LAMP NOVEMBER 2019 | 5

YOUR LETTERS

Have your

Say

LETTER OF THE MONTH A tram line through a mental health facility? Ridiculous! Mental Health is in crisis in our rapidly expanding society. The state government has really dropped the ball and the bureaucrats have allowed State Transport to build a light rail corridor right through the middle of Western Sydney’s Cumberland Hospital, one of the largest mental health facilities in Sydney. You don’t need a PhD in rocket science to quickly assess the risks that this ridiculous planning issue causes to the hospital’s most vulnerable population and the staff who care for them. Rubbing salt on the wounds, there has been no consultation with staff about the risks this infrastructure will cause and staff have been left in the dark in almost every aspect of the state’s planning procedures. The issue is compounded because there is no direct department responsible and the project is shared between Transport NSW, Health Infrastructure and the LHD, making any inquiries for information a mammoth merry-go-round. In this modern age of communication and technology, and work health and safety laws the best they have ever been, how does anybody in any of the government departments think that a light rail running through a mental health facility is a step forward for civilised society?

Luke Muller

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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.

Changes at the ENPA This year the Enrolled Nurse Professional Association of New South Wales (ENPANSW) celebrated its 25th anniversary at Noahs on the Beach in Newcastle in September. The two-day conference had key speakers from all aspects of the nursing field, such as theatres, the NSW Westpac helicopter, as well as the Study into the Enrolled Nurse to just name a few. This year also marks the change of the committee of the association and an injection of youth into the association management team. In its 25 years of operation the association has only had four presidents and now also has its first male vice president. The tenure of the previous President Rebecca Rosebery has ended with her making the painstaking decision to step down this year. Rebecca has been involved in the ENPA since its inception in 1994, as well as representing the enrolled nurses of NSW on other boards such as NMC council. The ENPA NSW was formed in 1994 by enrolled nurses who believed a higher standard of their career status was achievable in the current and future career climate and by joining together as ENPA NSW, an association to pursue our professional standing. The new committee has its members ranging from year one nurses to experienced nurses. The new association president Angela Hand and Vice President Brett Sutherland both agreed that “the contribution that had been made by the previous president and committees were invaluable to the association and the barriers that had been overcome were to be commended”. Some of the issues the ENPA NSW has been fighting for include a pay rise and the reintroduction of the Enrolled Nurse Special Grade position. Brett Sutherland

WANT TO GET MORE INVOLVED? Join NSWNMA Activist Facebook page: https://www. facebook.com/ groups/ 1057749161039258/

Preventing pressure ulcers in aged care I was honoured to be invited by the Royal Commission into Aged Care Quality and Safety to speak in the Supreme Court of the Northern Territory, Darwin, in July this year. My brief was to talk about pressure ulcers in residential aged care facilities (RACFs). I have been involved in the aged care system in Australia since 1997, at the same time working in various hospitals in Sydney. I have practised as a self-employed pressure ulcer prevention, wound management and infection control consultant in approximately 200 RACFs and several community centres in Sydney. Pressure ulcers are caused by unrelieved pressure between the skin and the bony skeleton, over a period of time. That time is different in each person but tissue death can start between the skin and bone in as little as 30 minutes. Pressure ulcers are predominantly the result of an ischaemic event. Even in more commonly occurring pressure damage (such as sacral or heel damage), the ulcer is caused by degradation of ischaemic tissue. Both sacral and heel pressure ulcers may manifest as black necrotic caps or thick dead tissue over the pressure ulcer. In my experience these pressure ulcers can hide a bag of very offensive pus. A resident with heel pressure ulcers may not be able to put shoes on or walk due to the serious pain caused by the pressure ulcers. Residents must be provided with pressure relief the moment they are unable to reposition themselves to relieve pressure. When residents are unable to reposition themselves, usual practice is for nursing and care staff to reposition them every two hours. Pressure ulcers are foreseeable, easy to prevent, and can be prevented by relieving pressure on all parts of the body in contact with a static surface (e.g. a mattress or chair). Catherine Anne Sharp

THE LAMP NOVEMBER 2019 | 7

COVER STORY

Tram plan derailed by community campaign Cumberland Hospital’s NSWNMA branch wants to know how a large acute psychiatric hospital will operate with a busy tram line running through it.

larmed for their patients’ safety, nurses at Western Sydney’s biggest acute psychiatric hospital are trying to stop a tram line being built through the hospital grounds. The state government plans to run the Parramatta Light Rail corridor through the middle of Cumberland Hospital, which has about 200 patients, many with depression and schizophrenia. Members of Cumberland Hospital’s NSWNMA branch voted to take workplace action and held a public rally to oppose the plan. Branch members have tried unsuccessfully to get details about the project’s potential impact on the hospital ever since it got the go-ahead in 2018. After site works started in September 2019 without any risk assessment or consultation with hospital staff, branch members voted to take action. This included refusing to operate the patient flow portal – a task assigned to nurses after hours – and refusing to accept singlenurse escorts to take patients to medical appointments. About 70 people attended a community protest rally addressed by union and community speakers including NSW NM A Genera l Secretary, Brett Holmes. “There’s got to be a better way than driving (the tram) right through the middle of this hospital,” Brett said. 8 | THE LAMP NOVEMBER 2019

‘ If we need to get an ambulance or fire truck from one side of the road to the other, or get staff to come to an emergency, response times will be delayed.’ — Luke Muller “I understand your level of concern about how the hell do you make sure that nobody’s going to jump in front of those trams.”

SUPPORT FROM RESIDENT GROUP AND OTHER UNIONS Representatives of the Rail, Tram and Bus Union and North Parramatta Residents’ Action Group attended the rally in support of nurses. Action group spokesperson, Suzette Meade said the light rail was “just an excuse to uplift and re-zone the (hospital) land for sale”. “It’s a no-win situation for anyone bar developers,” she said. NSWNMA branch secretary Luke Muller said nurses were concerned for the safety of “a very vulnerable population of patients”. Luke said there was a real danger of patients walking in front of trams. “It’s going to be a double tram line and it’s going to be running every seven minutes between 7am and 7pm,” he said. “The line will run in both directions and trams won’t come at the same time. So theoretically there could be a tram every three and a half minutes.

“It will cut the hospital in half and there is talk of a tram station being built in the middle of the campus. “If we need to get an ambulance or fire truck from one side of the road to the other, or get staff to come to an emergency, response times will be delayed. “Any medical emergencies, any aggressive emergencies, we’ve now got to wait for a light rail to pass through before we can access the other side of the campus.”

MEMBERS LAUNCH ONLINE PETITION Branch members have started an online petition via change.org to get the tram re-routed and are lobbying politicians. After the branch voted to take industrial action, Western Sydney Local Health District took the issue to the NSW Industrial Relations Commission. The commission recommended industrial action be abandoned and the LHD and union enter into talks. The NSWNMA has since met with LHD representatives and Transport for NSW reportedly has agreed to halt its planned works until issues

COVER STORY

MARYANN GEELAN , WARWICK LAHNER AND LUKE MULLER FROM CUMBERLAND HOSPITAL

raised by the NSWNMA are addressed and further staff consultations and risk assessments occur. Ho we ve r, s it e prepa rat ion work by Hea lt h Infrastr ucture has gone ahead, with a mental health unit and four cottages being demolished. Luke said members wanted to know how the hospital would operate with a tram running through it. “There are several government departments involved and when we try to get answers we keep getting pushed from one service to another,” he said. “I’ve been at the hospital for 17 years and there has always been talk of moving the hospital somewhere else, because it is a prime development site. “Several years ago, a company made a play to redevelop half the hospital as a residential complex. “ No w, a p p a r e n t l y, S yd n e y University want to use the site as a uni precinct with emphasis on health. They have until November next year to develop a business plan.” n

Sign the petition Help stop the Parramatta Light Rail going through Cumberland Hospital: http://chng.it/NRrvHzpb

No consultation, plenty of safety concerns Cumberland Hospital’s NSWNMA branch has tried to get details about the potential impact of the Parramatta light rail project ever since it got the go-ahead in 2018. NSWNMA Assistant General Secretary, Judith Kiejda, said branch representatives were ignored when they tried repeatedly to raise legitimate concerns about the project. “At first, we were reassured the state government had thoroughly investigated the proposal and plans were being developed to relocate services into new mental health facilities within the expanding Westmead Hospital precinct nearby,” Judith said. “However, this proposal was scrapped and our members were advised the current Cumberland Hospital site would instead be redeveloped. “Several months ago, nursing staff finally received an overview of the state government’s plans to locate a light rail corridor through the middle of the campus, impacting several acute mental health units, as well as daily operations, safety and security measures across the facility.

‘ Transport for NSW reportedly has agreed to halt its planned works until issues raised by the NSWNMA are addressed.’ “Not to mention the implications for nursing staff responding to an emergency if they’re located on the opposite side of the light rail corridor when a tram is approaching.” Judith said members had been raising concerns about safety standards, serious short staffing and isolation issues at the hospital since the beginning of 2019. “These issues have all been compounded by the lack of proper consultation processes relating to this significant workplace change, including the closure of some mental health units due to the redevelopment and the deletion of several nursing positions.” THE LAMP NOVEMBER 2019 | 9

SAFE STAFFING

Staffing breakthrough at Bankstown ED nurses win commitment to fill vacancies and continue to push for staffing review.

ankstown-Lidcombe Hospita l emergency department nurses are getting results in their campaign for adequate staffing. Management have agreed to fill all 9.46 FTE (full-time equivalent) vacancies and employ an additional nurse educator. Interviews with applicants were held in October. A joint union–management working party is negotiating other issues put forward by the hospital’s NSWNMA branch. Among other claims, the branch wants a review of ED staffing based on increased presentations and acuity and a cap on treatment spaces unless more nurses are provided. A branch resolution said ED nurses had been “understaffed and overworked for a substantial period. We believe the vacancies and lack of resources is putting patients and staff at risk.” Branch steward Natalie Dalton said the ED found it hard to hold onto staff due to extreme workload pressures. “Often the hospital is bedblocked, ED is full and the waiting

10 | THE LAMP NOVEMBER 2019

‘ Often the hospital is bed-blocked, ED is full and the waiting room nurse is looking after 20 or more patients.’ — Natalie Dalton room nurse is looking after 20 or more patients,” she said. “We have had several people leave the department or go casual because they are sick of being overworked. New grads who rotate through the department have said they won’t return until the staffing issues are fixed. “Our nurses are spread way too thin and it’s dangerous. The branch feels management must take urgent action because we can’t continue like this.” In 2018, the NSWNMA took Bankstown ED staffing concerns to the hospital’s Reasonable Work lo a d s C om m it t e e , but discussions achieved little. In July 2019, members asked the NSWNMA for further help and the union ran a campaign planning session for members. In September, a branch meeting

endorsed the campaign and organised a well-attended rally outside the hospital (see box, p11).

BRANCH SEEKS STAFFING REVIEW In addition to recruitment currently underway to fill vacancies, the branch wants a staffing review because the number and acuity of patients has increased, particularly in categories one and two. “Our staffing profile says we are staffed for 19 treatment spaces but at times we are actually running 41 treatment spaces,” Natalie said. The branch is seeking the employment of additional nurses for the waiting room, where a single nurse is sometimes required to care for over 20 patients on morning shift. The branch wants extra staff for the Rapid Intervention Treatment Zone, which has six chairs and two exam beds staffed by only one

SAFE STAFFING

‘Quite often you’ll have nine sub-acute to acute patients by yourself, which is not safe.’ — Chloe Nicol

nurse in the morning and two in the afternoon and night. In paediatrics, the ratio often is one nurse to five patients. “When you have children who are very unwell and needing Ventolin for asthma every 20 minutes plus obs every 20 minutes, it can become dangerous in there,” Natalie said. The branch is also asking for a wardperson or equipment nurse, a pathology assistant, a radiology nurse after hours and more security staff. According to management, security staff are supposed to walk through the department every hour but this is not happening, branch members say. I nc or re c t re c ord ke epi n g is another issue raised by the branch. It says incorrect data has been entered into the FirstNet application, which tracks patients’ progress through the department. At times, patients have been recorded as being treated even before they are seen by a doctor or nurse – and having left the department even when they are still under the care of the ED. n

Rally demands urgent action Nurses have held a public rally outside Bankstown-Lidcombe Hospital to call for urgent improvements to ED staffing. “Quite often you’ll have nine sub-acute to acute patients by yourself, which is not safe,” said NSWNMA branch member and ED nurse Chloe Nicol. “You might have a patient who is having a stroke, a patient having a heart attack and a patient with internal bleeding, and another patient with sepsis. “How is one nurse supposed to take care of all of that at the same time? It’s not safe.” Speakers at the rally included the mayor of Canterbury-Bankstown, Khal Asfour, and NSWNMA General Secretary, Brett Holmes. Mr Asfour called for better staffing and said nurses “should have every resource available to you to be able to do your job”. Brett Holmes said the ED had been understaffed and overworked for some time, despite ongoing attempts to raise the issues with South Western Sydney Local Health District. He said there had been an 11.5 per cent increase in ED presentations in the April-June quarter alone. “ED nurses are constantly working short staffed, poor skills mix is contributing to a high turnover of staff and unexpected leave is not being replaced. “That results in excessive workloads for the remaining staff who are trying to treat the increased presentations.”

THE LAMP NOVEMBER 2019 | 11

SAFE STAFFING

Alone no longer A committed group of rural nurses have forced management to promise extra staff – ensuring they will no longer have to work alone.

‘ We held more branch meetings and got more organisers out to the hospital, which showed people that the union really care for us out in the bush.’ — Robyn Whittaker

urses at Leeton District Hospital will no longer be put in unnecessary danger by having to work alone at night. The hospital’s NSWNMA branch has won a long campaign to employ more staff at the 76-bed hospital in southern NSW. Murrumbidgee Local Health District management has promised to roster an additional enrolled nurse overnight seven days a week and a nurse practitioner (NP) 10 hours per day, every day. “We are happy that we have achieved this commitment and we expect it to be implemented as soon as possible,” said branch secretary Leeanne Driscoll. The branch has pushed for safer staffing for several years. Only three nurses have been rostered to cover the upstairs ward and downstairs ED from 7.30 pm – 11 am. As a result, nurses have had to answer the ED door and attend to

12 | THE LAMP NOVEMBER 2019

emergency presentations on their own. Or, send two nurses to ED and leave one nurse on the ward. On a night shift, the ward can have as many as 24 patients. When one nurse is working in ED, the other two nurses can only check on her welfare via a monitor.

BIG ICE PROBLEM Leeton has one of the state’s worst rates of use of the drug ice and the hospital is a declared mental health site. Menta l hea lt h pat ient s are dropped at the hospital despite it being on COSOPS (no doctor) overnight.

The hospital has only one HASA (health and security assistant) who mainly works morning shifts five days a week and the town does not have a 24-hour police presence. La st yea r, t he NSW NM A inspected the hospital after a patient assaulted a nurse and another patient. “There is clear potential for a serious injury to staff or patients to occur,” the union’s inspection report warned. “Rostering a sole nurse to work in isolation is in breach of NSW Health policy as set out in chapter 26 of the Protecting People and Property manual.”

SAFE STAFFING

LEETON HOSPITAL’S NSWNMA BRANCH WON A COMMITMENT FROM MANAGEMENT FOR MORE STAFF AFTER A LONG CAMPAIGN THAT INCLUDED A PUBLIC RALLY IN AUGUST 2018 TO ALERT THE COMMUNITY TO UNSAFE STAFFING OF THE HOSPITAL’S ED.

‘We had to make sure we had the data to prove we needed extra staff, because that’s what management focus on.’ — Leeanne Driscoll

Ma nagement responded by implementing some union recommendations – mainly physical improvements to the ED – while ignoring the staffing issue. Improvement s included an upgrade of CCTV cameras, advertising a casual security position to backfill planned leave and installation of swipe card access in the ED and other clinical areas. However, as branch president Robyn Whittaker pointed out at the time: “Design changes will help but won’t resolve the issue of nurses working in isolation.” Robyn said a union workshop on how to run a campaign gave Leeton branch members a “pathway” on how to handle the staffing issue. “We held more branch meetings

and got more organisers out to the hospital, which showed people that the union really care for us out in the bush.” she said.

IMPORTANT TO COLLECT DATA In August 2018, staff held a public rally to alert the community to unsafe staffing of the ED. During 2019, the branch wrote to management about ED staffing at least monthly. In August 2019 the ED experienced four aggressive episodes including an attempted assault on a female nurse by a large, male mental health patient. Leeanne said the branch collected information to show ED presentations had risen in the past year with an increase in mental

health and ice-related patients. “We had to make sure we had the data to prove we needed extra staff, because that’s what management focus on,” she said. “However, if you work alone in ED you realise very quickly you need more than just one pair of hands.” Leeanne said the employment of an NP would lead to patients being diagnosed and treated quicker. “We won’t get so many blockages waiting for a local doctor or waiting for someone to review the patient remotely. “Like all small country hospitals, we don’t have enough doctors on the on-call roster. “We often have to get advice from doctors at Griffith (a 40minute drive from Leeton) or Wagga (1.5 hours away) hospitals. “An NP will help a lot, especially with diagnosing categories 4 or 5 presentations. The NP can order X-rays and prescribe medications without having to wait to contact a doctor off-site.” ■ THE LAMP NOVEMBER 2019 | 13

SAFE STAFFING

Cooma wins extra staff Sustained pressure leads to more staff and more consultation.

fter campaigning for almost a year, nurses and midwives at Cooma Hospital have won a battle with hospital management over workloads, with nurses, midwives, clerks and health and security assistants (HASAs) now rostered for additional shifts throughout the hospital. “We fought hard for an extra health and security assistant on the night shift in the emergency department, when just one nurse is rostered,” said Eileen Pevere, Cooma Hospital branch president and delegate. “We now also have a second RN or midwife rostered in the maternity ward on afternoon and evening shifts, when previously there was one midwife working alone. In the general wards, management has agreed to increase nursing hours per patient day from five hours to six hours from 27 October, bringing us up to city hospital standards.” The branch won these changes after many months of campaigning, after first raising their concerns with the reasonable workload committee and passing branch resolutions. “The Local Health District didn’t listen to our concerns, so we created a community campaign around safe patient care,” Eileen says. “We held three rallies, we letterboxed, and we took our message to the local show and markets that we were concerned that without adequate staffing levels, safe patient care was at risk.” The campaign ramped up during the state election, when the branch held stalls to send a clear message to both parties, particularly the local 14 | THE LAMP NOVEMBER 2019

‘We held three rallies, we letterboxed, and we took our message to the local show and markets.’ member and the Deputy Premier John Barilaro.

WINTER ROSTER EXTENDED The accumulated pressure of the branch’s community campaign has now paid off. “Management has also agreed to extend the winter roster of three nurses in the emergency department on the afternoon shift to the entire year. Previously just two nurses were rostered in the afternoon in the nonwinter months,” said Eileen. “We are seeing an increase in patient acuity; people attending the hospital are getting older and have more complex issues. We were getting to the point where if staffing levels didn’t improve at all, we would

almost no longer be able to function.” On top of the increase in nursing and midwifery hours, Cooma management has also agreed to roster a ward clerk to the emergency department for four hours each Saturday and Sunday (previously there was no clerical assistance in the ED on weekends). Management has also agreed that the hospital’s staffing escalation plan will be updated to assist with more appropriate admissions to the ward. The branch has welcomed the turnaround in the hospital’s approach to the union. “We are pleased that management is now keen to have regular monthly catchups with the branch,” Eileen said. n

INDUSTRIAL ISSUES

Win on mixed shifts NSW Health nurses and midwives who work mixed shifts will be better off under a new method of calculating Additional Days Off (ADOs), negotiated by the NSWNMA.

he NSWNMA and NSW Health have negotiated a better way of working out accrued ADOs.

From 21 October, the ADO accrual method for full-time nurses and midwives is based on hours worked, rather than counting shifts. This represents an important win for members who work ‘mixed shifts’ – that is, shifts of varying lengths – in a roster cycle. The NSWMA has argued for years that these workers were disadvantaged by NSW Health’s method of working out ADO accruals. Under the previous system, the ADO calculation was based on a rostered shift count and assumed a fixed shift length of eight hours. One ADO was added to the ADO balance after every 19 shifts. Under the new system, the ADO calculation is based on actual hours rostered. It ensures that five per cent of the hours rostered for each shift contribute towards the ADO balance. For example, an employee who works a 40-hour week now accrues two hours towards an ADO. NSWNMA General Secretary Brett Holmes said the previous 19-shift count system was only effective for those who work either an eight or 10-hour shift system. However, it disadvantaged people doing mixed shifts. He said the union identified the problem during a dispute before the NSW Industrial Relations Commission several years ago. “Members were contacting us and

‘Members were contacting us and saying something was not right, and they were correct.’ — Brett Holmes saying something was not right, and they were correct,” Brett said.

for nurses and midwives working a rotating shift).

“This is a very significant outcome and one that has taken years of patient and diligent work.

• P ublic Holiday Credit (leave credited for nurses and midwives, excluding rotating shifts, when they work on a public holiday).

“It came about due to the persistence of a great number of members who did not stop raising their concerns just because Health agencies had an unshakeable belief that the IT system in place could not be wrong. “I congratulate those members for their dogged pursuit of this issue, and I’m proud that the Association was able to convert these concerns into a practical solution, in cooperation with the Ministry of Health and NSW HealthShare. “It will directly benefit many of our members.”

ADDITIONAL TYPES OF LEAVE CONTRIBUTE TO ADO ACCRUAL He said the union was confident that for the overwhelming majority of nurses and midwives on mixed shifts, the transition to the new system would either validate the accuracy of their ADO balance or result in a better outcome. In a further win, additional types of leave now contribute to nurses’ and midwives’ ADO accrual. They are: • P ublic Holiday Leave (leave granted in lieu of public holidays

• E xtra Leave (additional leave credited for working Sundays and public holidays). Transition to the new ADO accrual method started from 21 October 2019. It involves a retrospective reconciliation of hours worked and ADOs taken to arrive at a new ADO balance. NSW Health said there will be a period from 21 October when balances will display as zero. NSW Health said it expected to take about a fortnight for all balances to be updated. “Employees’ ADO in Hours balances will be equal to, or greater than, their ADO in Days balances,” NSW Health said. Nurses and midwives will be able to access the audit records via StaffLink for three months after the reconciliation process. Only full-time nurses and midwives are eligible to accrue ADOs. Casual, part time and full-timereduced employees are not entitled to ADOs. n THE LAMP NOVEMBER 2019 | 15

AGED CARE

An ‘unacceptable level of staffing’ in aged care homes Australia ranks poorly for aged care staffing in international comparisons.

ore than half of all Australian aged care residents are in homes with staffing levels that would be rated one or two stars in the United States’ five-star rating system, according to new research. The Australian Health Services Research Institute at the University of Wollongong compiled the report for the Royal Commission into Aged Care. The study analyses staffing of Australian residential aged care homes compared to standards in other countries. In the US system, each aged care home is rated on a five-star scale. Three stars is the sector average, one to two stars is below average, and four to five stars is above average. The US star ratings are based on the amount of nurse and personal carer time per resident, adjusted for differences in residents’ care needs so that homes can be compared against one another. When the US system was applied to Australian data, the report found that 57.6 per cent of all Australian aged care residents are in homes with staffing that would only rate one or two stars in the US’s five-star rating system. Among Australian aged care

16 | THE LAMP NOVEMBER 2019

‘Underpinning so many of the problems that are being exposed across the aged care sector is systemic, chronic understaffing.’ — Annie Butler residents, 27 per cent are in threestar homes, while 14.1 per cent receive four stars and just 1.3 per cent are in homes with five stars. Raising the standard so that all Australian aged care homes are rated at least three stars would require an average increase of 37.3 per cent in total care staffing in the homes currently rated one or two stars. This would require an increase of 20 per cent in total residential aged care staffing across Australia. The researchers point out that the US model does not address allied health staffing levels. The study did make comparisons with other jurisdictions that do include allied health staffing levels such as the Canadian province of British Columbia. Only two per cent of Australian residents are in homes that currently meet the 22 minutes of allied health

services per day recommended in the British Columbia system. The current Australian average is eight minutes of allied health care per day. Achieving the level recommended in British Columbia would require a 175 per cent increase in allied health staffing. The researchers concluded that the American Nursing Home Compare system was “the best that is currently available internationally”. “Aged care homes that have a rating of one or two stars have an unacceptable level of staffing. Those with three stars have an acceptable level, those with four stars have a good level and those with five stars have best practice levels of staffing,” the researchers concluded. “The minimum amount of staff time per resident day for acceptable care is thus 30 minutes of RN time and 215 minutes of total care time (RNs and other care workers).” n

AGED CARE

‘ Standards of care for our elderly should not be compromised through restriction of resources or the budget bottom line.’ — Tony Bartone, AMA President

Nurses and doctors stand together for aged care Older Australians cannot wait for the conclusion of the Royal Commission into Aged Care for more funding and reforms say the Australian Medical Association (AMA) and the Australian Nursing and Midwifery Federation (ANMF). The two organisations have jointly called on the federal government to “make immediate and effective improvement to aged care, especially with ensuring a safe and quality skills mix of medical, nursing and care staff”. This can be done, they say, by providing: • a general funding increase • mandatory minimum staff-toresident ratios, including ensuring sufficient skilled nurses in residential aged care facilities • increased GP aged care Medicare rebates for patients to facilitate enhanced medical practitioner care of aged care residents and • expanded home care investment

to allow more older people to stay longer in their own homes and relieve pressure on residential aged care services. AMA President, Dr Tony Bartone, said: “Standards of care for our elderly should not be compromised through restriction of resources or the budget bottom line. “Ignoring the health and care needs of older Australians will lead to an increase in avoidable hospitalisations and excessive costs to the health system. “The aged care system urgently needs a safe and quality skills mix of medical, nursing, and care staff. The increased presence of doctors as part of the care team is vital.” ANMF Federal Secretary, Annie Butler, said: “Underpinning so many of the problems that are being exposed across the aged care sector is systemic, chronic understaffing, leading to unacceptable instances of

neglect, abuse, and too many preventable deaths. “We can’t wait for the Morrison government to act on recommendations of the Royal Commission to stop the suffering of our elderly; we simply cannot allow the government to continue to sit idly on the sidelines and watch the extent of this suffering unfold.”

Read the report The report can be downloaded from the Royal Commission into Aged Care’s website: https://agedcare. royalcommission.gov. au/publications/Pages/ default.aspx

THE LAMP NOVEMBER 2019 | 17

AGED CARE

Plenty of support for aged care ratios on Q&A NSWNMA puts aged care ratios front and centre on the ABC’s respected current affairs forum.

uring a special episode of the ABC panel show Q&A devoted to Australia’s aged care system, panellists and audience members debated how the sector might be reformed. Disc u s sion s ra nge d f rom introducing staff ratios and higher quality meals, to the urgent need for a large funding injection to create a world-class system for a rapidly ageing demographic. In the audience was Gabi Pearson, an NSWNMA organiser, and her question to panellists addressed the lack of ratios in the sector. Gabi cited a recent NSWNMA report that found 94 per cent of aged care workers in New South Wales had transferred a resident to hospital following a fall in the past year, putting an added burden on NSW’s already struggling public hospitals. Gabi told the panel that: “75 per cent of those same aged care workers said that falls could have been avoided if there were better staff ratios in their facilities.” She asked the Federal Minister for Aged Care, Richard Colbeck, “when will the government stop pandering to the profiteering aged care companies and introduce mandated staff-to-resident ratios?” While the minister said the federal government did not support ratios, calling them a “blunt instrument” and arguing there was 18 | THE LAMP NOVEMBER 2019

‘ When will the government stop pandering to the profiteering aged care companies and introduce mandated staff-to-resident ratios?’ — Gabi Pearson asks Federal Minister for Aged Care, Richard Colbeck

no evidence that ratios would lead to better care, other panellists were united in their support of ratios and increasing the numbers of highly qualified staff.

“A SYNONYM FOR BLUNT INSTRUMENT IS BARE MINIMUM” Sa ra h Hol la nd-Bat t , who recently gave evidence to the Royal Commission about the abuse and neglect of her father in an aged care home, rejected Colbeck’s position, saying “another synonym for blunt instrument is bare minimum”. Holland-Batt said her father broke his hip and ribs in care; injuries that were the result of falls that wouldn’t have occurred with appropriate staffing levels. She said “the fact that there’s not an RN on site in aged care facilities in Australia 24 hours a day is … outrageous. These are people with complex needs.” Julie Collins, the Shadow Minister for Ageing, agreed. “There should be a nurse on 24 hours a day on site. There’s a

community expectation … that, when something goes wrong, particularly in the middle of the night, that there will be a nurse there to help your loved one. There needs to be more staff. They need to be better trained and better paid,” she said. Sean Rooney, CEO of Leading Age Services Australia, a peak body representing aged care providers, agreed that “good-quality staff with the right skills, and the right training are fundamental to good care”. “Every provider I meet – whether it’s an RN, a facility manager, a care manager – I haven’t met one that hasn’t said to me, ‘We don’t want more staff, we don’t want them better skilled, and we don’t want them better remunerated’. “I am very concerned that some of the staff don’t get enough training and enough support, in aged care, to do their job. They want to do it really, really well, and they’re working so hard to do the best possible job.” The show also shone a spotlight on the plight of the approximately

AGED CARE

50 per cent of residents in aged care facilities suffering from dementia. Sarah Holland-Batt said she was concerned care is “being delivered by personal care workers who can have as little as a five-week TAFE certificate … these are not people who have medical expertise”.

FOOD BUDGETS AS LOW AS $4.50 A DAY The celebrity cook Maggie Beer made an impassioned argument for providing residents with the right kind of food to “help stave off cognitive decline”. Beer cited aged care homes where residents were involved with carers in shopping for food and cooking.

THE Q&A PANEL OF SEAN ROONEY, SARAH HOLLAND-BATT, RICHARD COLBECK AND HOST FRAN KELLY DISCUSS AGED CARE.

Beer also discussed her training program for aged care cooks and chefs, some of whom have budgets from “as low as four dollars fifty a day”. But she added that it’s not just more money that will make the difference. “What worries me is you cannot do real food without the scent of home cooking.” Beer explained that because our saliva decreased with age, the scent of food is increasingly important to give us cues to eat and to help us enjoy the “pleasure of eating”. She said that “at six or seven dollars a day, you can only have processed foods and frozen foods, and so it’s impossible to give the quality of life that we must give to our people in aged care homes”.

“AT $6 OR $7 A DAY, YOU CAN ONLY HAVE PROCESSED FOODS AND FROZEN FOODS, AND SO IT’S IMPOSSIBLE TO GIVE THE QUALITY OF LIFE THAT WE MUST GIVE TO OUR PEOPLE IN AGED CARE HOMES.” MAGGIE BEER

Watch the show

NSWNMA Assistant General Secretary, Judith Kiejda, said Q&A did a good job of highlighting the problems in a system, which is desperately in need of reform. “We know that residents aren’t receiving the kind of care and attention that they need. When there are residential aged care facilities with only one registered nurse employed for over 150 residents, problems are unavoidable.” Judith supported Beer’s calls for improved food quality, but she also noted a recent NSWNMA study, which found 35 per cent of Association members in aged care reported that competing workloads meant they didn’t have enough time to help a resident eat or drink. n

“GOOD QUALITY STAFF WITH THE RIGHT SKILLS, AND THE RIGHT TRAINING ARE FUNDAMENTAL TO GOOD CARE.” SEAN ROONEY

You can watch the program, which aired on the ABC on Monday 7 October, on ABC iview, or online at www.abc.net.au/qanda/

Support our ratios in aged care campaign “THE FACT THERE IS NOT AN RN ON SITE 24 HOURS A DAY IS OUTRAGEOUS.” SARAH HOLLAND-BATT

Go to: www.ratiosforagedcare.com.au

THE LAMP NOVEMBER 2019 | 19

AGED CARE

Aged care providers shift burden to public hospitals Avoidable hospitalisations and unnecessary delays in transferring patients back to residential homes are putting significant pressure on our public health system, a new survey confirms.

nderstaffing and a lack of qualified nursing staff in NSW residential aged care facilities is responsible for a deluge of costly and distressing transfers of residents to hospitals, a new report has found. The report, from the NSW Aged Care Roundtable, found that half of hospital doctors surveyed witnessed avoidable hospitalisations on a daily basis. A lack of national data about the problem prompted 11 clinical, medical and advocacy groups from the Roundtable, including the NSWNMA, to survey their members about the issue. The report authors write that avoidable hospitalisations are occurring because of both “systemic” and “incidental” problems in residential aged care facilities. More than 1600 NSWNM A members responded to the survey, with 42 per cent saying there were employed on a ratio of one registered nurse to between 50 to 100 residents on each shift. Nearly one in ten (9 per cent) had a ratio of one registered nurse to between 100 and 150, and 3 per cent worked in facilities with one registered nurse to over 150 residents/patients. One respondent wrote: “If RN coverage couldn’t be found for night 20 | THE LAMP NOVEMBER 2019

shift in one facility, there was one RN to two facilities with approximately 260 residents.” Those surveyed cited falls, p a l l i a t i ve care, b e h av i o u r management of people living with dementia, catheterisation and pain management as the main reasons why people are transferred to hospital. Other causes of avoidable hospitalisations included simple wound care, medication errors and pain relief.

DOCTORS DIAGNOSE TRANSFER PROBLEM Just over half (54 per cent) of hospital doctors surveyed by the Australian Salaried Medical Off icers Federation (A SMOF) said they witnessed avoidable hospitalisations from aged care facilities daily. 44 per cent of ASMOF doctors cited insufficient staffing at aged care facilities and 35 per cent nominated registered nurse workload as factors in avoidable hospitalisations. Members of the Australia & New Zealand Society for Geriatric Medicine identified the most common reasons for avoidable hospitalisations as: behaviour management (78 per cent); falls (62 per cent); urinary tract infections (62 per cent); dehydration and/or

poor nutrition (53 per cent); upper respiratory infections (50 per cent); simple wound care (including pressure sores) (47 per cent); and pain relief (47 per cent). Elder abuse – including neglect and/or attack by another resident – was also identified as a cause of avoidable hospitalisations. ASMOF members also reported unnecessary delays in residents being transferred back to residential homes, with 92 per cent experiencing delays in discharging a person back to an aged care facility. The length of delay ranged from between several hours to several weeks. Some 46 per cent of ASMOF members surveyed said delays were caused by relatives refusing to have a resident returned to a facility with insufficient staffing levels, while 43 per cent attributed the delay to the absence of a registered nurse at the facility and 31 per cent to lack of staff knowledge at the facility. O ne memb er of T he Au s t r a l i a & Ne w Z e a l a nd Society for Geriatric Medicine noted that: “Certain facilities in our area will not accept residents back on Friday or over the weekend.” Another wrote that residential c a re fac i l it ie s were of ten unwilling to accept patients with

MOST COMMON REASONS FOR AVOIDABLE HOSPITALISATIONS

78%

50%

62%

47%

Behaviour management

Falls

62%

Urinary tract infections

53%

Dehydration and/ or poor nutrition complex needs. Over 90 per cent had experienced delayed discharges to RACFs ranging from a day or two up to 120 days.

GPs ABANDONING FACILITIES Genera l pract it ioners sur veyed said they were increasingly unlikely to visit residentia l ca re facilities in the future because they a re p o orly remu ner ate d and there is a lack of qualified staff for them to liaise with. An enrolled nurse at a not-forprofit RACF noted that: “Quite often residents are transferred to hospital (on family request and staff request) when doctors are unavailable to give orders for treatment to commence e.g. (for) antibiotics.” One GP noted the crucial role of RNs in aged care facilities: “RNs are able to recognise and ensure early intervention and management in response to changes in an individual’s health, thus reducing the risk of deterioration and potentially reducing the need for unplanned admissions to acute facilities or transfer to emergency departments. This not only assists in maintaining

qua lit y of life for ca re recipients but also reduces overall costs to the health system.” NSWNMA General Secretary, Brett Holmes, said: “Improved staffing in residential aged care is paramount, with 74 per cent of our members stating hospital transfers could have been prevented if more nursing staff were rostered on, while 49 per cent said a lack of GP availability was a contributing factor.” n

Read the report The report, Joint report on avoidable hospitalisations from residential aged care facilities in NSW and delayed discharge, is available on the NSWNMA website https://www.nswnma. asn.au/nsw-agedcare-roundtablehospitalisations-report/

Upper respiratory infections

Simple wound care (including pressure sores)

47% Pain relief

Source: The Australia & New Zealand Society for Geriatric Medicine

The Roundtable’s recommendations The Aged Care Roundtable member groups called for the following improvements to the residential aged care sector: • improvements to staffing levels and the qualifications and training of RACF staff • access to specialist nursing services and other health professionals needs to be improved • medication management needs improvement • national clinical care benchmarking for residential aged care is needed to reduce avoidable hospital presentations • clinical care benchmarking needs to be supported by the national collection of data on hospital admission and discharges of RACF residents • RACFs should be considered healthcare providers and better integrated within primary care services • cultural competency should be part of an ongoing development plan across all staffing levels within RACF.

THE LAMP NOVEMBER 2019 | 21

DISCRIMINATION IN THE WORKPLACE

Cultural divisions prevalent in health and aged care A new report by the NSWNMA finds high levels of discrimination in health and aged care settings and a reluctance to report incidents.

ne in four nurses and midwives experience racial discrimination monthly, and one in ten report daily experiences of racial discrimination, a new report from the NSWNMA has found. The Cultural Safety Gap report, based on a survey of more than 1200 members, also found that two in three nurses and midwives did not report incidents, while almost 90 per cent were unaware of any cultural support programs in their workplace. NSWNMA General Secretary, Brett Holmes, said that while health workplaces valued culturally and linguistically diverse nurses and midwives for their ability to communicate with patients and clients, unfortunately the same nurses and midwives didn’t always receive the same respect from colleagues and managers. “Historically, the focus has often been on workers being aware of patients’ or residents’ cultural backgrounds or sensitivities, while little has been done to encourage inclusiveness between work colleagues.” Brett said members reported discrimination ranging from direct

22 | THE LAMP NOVEMBER 2019

‘ The focus has often been on workers being aware of patients’ or residents’ cultural backgrounds or sensitivities, while little has been done to encourage inclusiveness between work colleagues.’ — Brett Holmes verbal attacks, to isolation and unfair scheduling of work assignments. “Workplace discrimination is also not confined to one specific area of the health sector. These issues are prevalent across the public health system, private sector and in aged care.” Accent or language discrimination is also widespread. “Thirty per cent of nurses and midwives confirmed they had been instructed not to speak languages other than English in the workplace,” Brett said. This most commonly occurred in residential aged care.

STEREOTYPING COMMON The most common kind of racial discrimination members reported was stereotyping, with 54 per cent of respondents subjected to stereotyping based on their culture, language or appearance. Members also reported culturally offensive language (34.11 per cent), being isolated (32.27 per cent) and being passed over for promotion (19.40 per cent). Nurses and midwives who identified as Aboriginal reported higher rates of racial discrimination and stereotyping than respondents from other groups. They were also more than twice as likely to be

DISCRIMINATION IN THE WORKPLACE

A reluctance to report Rema Elhassan, a midwife, recalls two Muslim students on placements complained to her about a senior midwife’s racist comments. The midwife asked them if they needed “their husband’s permission to work” and made comments about “Muslim women being oppressed”. “My advice to them was to escalate the complaint in writing and that I would assist. However, they were hesitant to proceed. They feared retribution in the form of being disqualified or targeted by the midwife and her social peers if they proceeded.”

employed on a casual basis. Less than a third of members surveyed said they reported incidents of discrimination, with other respondents saying they either did not feel comfortable reporting incidents or did not know how to. When they did report an incident, less than 15 per cent of the nurses and midwives received counselling or personal support. Less than 25 per cent found the response they did receive fully helpful. “For some, the option [to report an incident] was negated by the attitude of their manager, or the fact that their manager or immediate supervisor was the source of the discrimination,” the authors wrote.

ALL WORKPLACES AFFECTED Members who completed this survey came from 100 different cultural and linguistic backgrounds, the most common being Indian, Filipino, African countries, Chinese and Nepalese. Respondents worked in public and private hospitals; primary

healthcare; residential aged care facilities; e-health and justice health, in NSW metro locations as well as rural and remote locations. The report authors found that the workplace and work role made no significant difference to the experiences of culturally diverse nurses and midwives: respondents described positive and negative experiences at every level and type of workplace. “The report clearly shows we need to close the cultural safety gap for nurses and midwives,” Brett Holmes said. The report authors noted t hat: “Member re spon se s showed a distinct lack of cultural competence that was not limited to any particular workplace or location in NSW.” Brett said the NSWNMA will be using the survey results in its work with SafeWork NSW, Anti-Discrimination NSW and the Multicultural Communities Council of Illawarra to promote inclusiveness and build cultural safety in workplaces. ■

What nurses and midwives had to say “I have been called ‘the wog nurse’ by other nurse colleagues. Despite being born, raised, and educated in Australia. I speak English with an Australian accent.” “There are the staff who come out with the generic ‘all Aboriginals’ stuff. That we drink too much, smoke too much, don’t work and get everything for free.” “One resident sometimes yells or swears at me. He often tells me to leave his room. Another female resident commented that I should be a cleaner not a nurse because of my race.” “Almost 40 per cent of the total nursing staff are from India in my workplace, but none of them were chosen to be in any managerial position on a permanent basis.” “It sometimes feels like I don’t exist.”

THE LAMP NOVEMBER 2019 | 23

DISCRIMINATION IN THE WORKPLACE

or Kurt Fearnley, the defining moments of his life are the moments few people will ever see. They are found not in his Paralympics and Commonwealth Games triumphs but his interactions with other people with disabilities. Kurt, 38, started wheelchair racing when he was 14. He has won three Paralympic gold medals and two Commonwealth Games gold medals. Competition has been a big part of his life for the past 25 years but his next 20 years will be defined by “the moments that happened en route to competition,” he told the conference. Moments like spending time in a Middle East refugee camp with parents of children with disabilities. “It is the very first time in their lives that they have spent a moment with a person with a disability who has power in their life and education behind them,” he said. “You see them look at you and realise it turns on its head the way 24 | THE LAMP NOVEMBER 2019

‘ Lack of expectation of disabled people rips the life out of people, rips the hope out of them.’ — Kurt Fearnley they will see their child from then on.

A PRODUCT OF KINDNESSES

“All of their hopes and fears that they saw in their child for the first few years of their life just get challenged in a moment.”

Kurt, a teacher and father of two young children, grew up in the small NSW town of Carcoar and lives in Newcastle.

Or, moments like seeing an African teenager with a disability put on a school uniform and go through the school gates for the very first time – just as his siblings have always done.

His achievements include crawling the entire 96km length of the Kokoda Track to raise awareness for men’s health, crewing the winning yacht in the 2011 Sydney to Hobart race and being appointed an Officer of the Order of Australia for distinguished service to people with a disability.

“You experience their moment when they feel that dignity of being able to learn. And it’s the first day they’ve received it, even though they’re a teenager,” Kurt said. “I think that if I’ve done something of worth over the last 25 years or so, that is actually the thing I’m proud of, that is the moment I will define myself by.”

His work i nclude s t he Kurt Fearnley Centre in the Kenyan capital Nairobi, which provides education opportunities for African children. “Lack of expectation of disabled people rips the life out of people, rips the hope out of them,” he said.

DISCRIMINATION IN THE WORKPLACE

KURT FEARNLEY SPEAKS TO THE NSWNMA FUTURE READY CONFERENCE.

Despite being born with lumbar sacral agenesis – missing the lower part of his spine – Kurt would crawl around paddocks and race his wheelchair with his siblings growing up in Carcoar. One day, his father carried him inside the house and showed him wheelchair athletes on TV. “He showed me what was out there for me,” Kurt said. He has described himself as a product of a culmination of the kindnesses given by many people over many years. One of those who strived to help him reach his potential was his school principal, who insisted on his right to receive a public education. “Expectation is where drive, where spark is born,” Kurt told the Future Ready conference. “And I feel a mixture of guilt and gratitude that I grew up in a place where expectation was hammered into me. “Struggling is where we find who we are, struggling is where we

become who we’re meant to be. “The building blocks of my past are always the ones with a bit of struggle in them, a bit of substance in them.”

EMOTIONS GALORE ON THE KOKODA TRACK He says the 11 days he spent crawling the Kokoda Track, when his weight dropped from 54kg to 46kg, were the hardest time of his life. Before leaving for the trek, a teacher who knew Paua New Guinea told him he would find that people with disabilities were looked after and given love but also kept isolated, because people assumed they did not want to interact with the community. The teacher told Kurt: “While you’re crawling through these villages you’re going to make people question that. Every step you take on the track, every person with a disability is going to be on your shoulders.” Stopping at the first village on the track, Kurt found locals were “a bit terrified of me – they had never

seen a guy in a wheelchair propelling himself before and it just didn’t click with their reality.” Kurt found a boy with a disability in the village, “naked, isolated, crawling in the mud underneath one of the houses”. “I would push over to this kid and he was afraid of me. That was the first time I interacted with the reality that two thirds of the world who require a wheelchair will never see one. “Hanging around with this kid was one of the most emotional points of my life. Emotional for me, my family and his family.” It was also emotional for one of the PNG porters who helped to carry gear for Kurt’s party. At the sight of Kurt with the disabled village boy, the porter “starts to tear up and disappears into the bush,” Kurt said. “And when he walked back into camp that night he walked up to the boss of the trek and said, ‘Kurt’s my brother and I’m his’, and he never left my side for the next 11 days.” n THE LAMP NOVEMBER 2019 | 25

POLICE AND EMERGENCY SERVICES GAMES

“Keep Calm and Nurse On”

Emergency workers, including nurses and midwives, were invited to take part in the Police Games this year. A number of members took up the challenge to join the 43 sporting events that make up the games, now called the NSW Police and Emergency Services Games. The sporting event, which ranged from soccer and surfing to a half marathon, was held in October in Wollongong, with the equestrian events held in Camden. JUSTICE NURSES HAD A BALL Sev Yenyil, an after hours nurse manager at Justice Health, organised nurses from correctional centres and youth justice centres to field a softball team. “My husband is a policeman, so I’ve got a soft spot for the police operations,” Sev told The Lamp. “I thought, this is a great opportunity, b e c au s e of ten t he nu r s e s aren’t regarded as being in the emergency services.” “There were six nurses on our team all up. We filled the team with seven men who were in the fitness industry and one who was a police officer. “It was a fun day and most people didn’t know each other on our team and it was like we were long lost friends. The sportsmanship was fantastic. I lost my voice from shouting and laughing, it was very, very comical.” As the statewide after hours nurse manager, Sev oversees clinical operational matters within NSW correctional centres and youth 26 | THE LAMP NOVEMBER 2019

‘ The sportsmanship was fantastic. I lost my voice from shouting and laughing.’ — Sev Yenyil justice centres, supporting nursing staff from her office at Long Bay Correctional Centre. “I hadn’t met two of the nurses on the team from Justice Health, because I always talk to them over the phone about matters and patients and emergencies. It was a good opportunity to get on the field and have fun. At work they are talking to me as a boss, but we were working together as a team.”

PENELOPE MCMILLAN AND JEDLEA

network were joined by Sandy Cryer, a nurse at the Sydney Adventist Hospital, and her husband, both softball players. “They basically orientated the rest of the team who hadn’t played softball for years. The first game we were rusty and the second, third and fourth game we gave it our best and we gave them a run for their money.”

Sev describes the day as a contrast to her often stressful work environment. “You get so many phone calls that you need to prioritise, and [playing softball] - the only thing we prioritised was the running home to home base.”

She is looking forward to joining the competition again in 2020. “Next year is going to be the Australasian games and I have already prepped the team. Our team name was Keep Calm and Nurse On. The problem is that we only had six nurses, so someone suggested we call ourselves Twisted Sisters and Misters.”

Sev and nurses from justice health and the forensic mental

“If anyone is interested in participating, they can let us know.”

POLICE AND EMERGENCY SERVICES GAMES

BACK IN THE SADDLE First year nursing student Penelope McMillan grew up riding horses in the south coast coastal township of Nunbaa. “I’ve been riding since I was very, very little, pretty much since I could walk, and then I stopped when I did my HSC to focus on my studies.” “I picked it up again for the games, especially since the firstyear nurses and midwives students are being invited,” says Penelope, who has competed at the Sydney Royal Easter Show and state interschool championships. She will be riding Jedlea, a thoroughbred ex racehorse, in the dressage event. “When the games came up a friend offered me Jedlea. I’ve ridden him for a few years on and off, so I’ve just got that connection with him.” After completing her Bachelor of Nursing at the University of Wollongong, Penelope hopes

to continue her studies in paramedicine. “I’d like to do some first response work, so I’d like to do paramedicine after I’ve finished my degree.” “I’ve gone through a few things in my life that made me want to help other people and make a difference I’ve gone through health issues with family members. And I went to a music festival once and I watched a girl get carried out and she ended up passing away in hospital. She was the same age as me. That really stuck with me.

you’ve also got that background in first response or nursing or police, sharing the love of the sport. “Just being in the environment with like-minded people and where I want to go in my degree – I’m definitely looking forward to getting out there and competing.”

“So I’m a really passionate about mental health and trying to make even a small difference in other people’s lives. It only takes one person to make a big difference.” Penelope is looking forward to competing at the games, with her event scheduled for the weekend after The Lamp went to press. “I think because obviously everyone has got a passion for sport, but obviously

Join in the fun If you’re interested in participating in the 2020 Australasian Games, register at apandesgames.com.au.

DIABETES UPDATE EVENING for nurses

Your NDSS agent in NSW & ACT is

Learn while you earn CPD points Thursday 14 November 2019 Ulladulla Wednesday 12 February 2020 Coffs Harbour Wednesday 11 March 2020 Albury

Ticke ts $20

More dates and locations available on our website. Diabetes NSW & ACT is offering a diabetes evening workshop (including a light dinner) for nurses working within a hospital, medical practice, community health or aged care setting. The training will provide participants with an increased understanding of diabetes and the services available to their patients. This session is suitable for Enrolled Nurses and Registered Nurses. CPD points for this seminar will be available with the Australian College of Nursing (ACN) and Australian Primary Health Care Nurses Association (APNA).

For more information or to register visit diabetesnsw.com.au/events or call 1300 136 588. The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. The NDSS agent THE LAMP NOVEMBER 2019 | 27 in New South Wales and the ACT is Diabetes NSW & ACT.

NEWS IN BRIEF

UNITED KINGDOM

Radical proposal to green the NHS The British Labour Party has pledged to transform the National Health Service from the country’s biggest polluter to the greenest health service in the world. The shadow health minister, Jonathon Ashworth, announced an ambitious plan that would see an “NHS forest” of a million trees planted at hospitals throughout Great Britain at the party’s annual conference in September. “The NHS is one of the biggest polluters in the country, representing 6.3 per cent of the carbon footprint in England. It’s more than the annual emissions from passenger aircraft departing from Heathrow. But I want to move to a net zero, greenest health service in the world,” he said. AUSTRALIA

Australia leads global cancer survival rates Impressive results attributed to early detection by primary care practitioners but room for improvement remains. A study, published in The Lancet Oncology journal by the International Cancer Benchmarking Partnership, reviewed 3.9 million cancer cases from Australia, New Zealand, the UK, Norway, Ireland, Canada and Denmark. It compared the one-year and five-year survival rates for seven types of cancer: bowel, oesophageal, pancreatic, stomach, rectum, lung and ovarian. Australia had the highest five-year survival rate in all but lung and ovarian cancer. The five-year survival rate in Australia for oesophageal cancer was 23.5 per cent, stomach cancer 32.8 per cent, colon cancer 70.8 per cent, rectal cancer 70.8 per cent and pancreatic 14.6 per cent. The chief executive of Cancer Council Australia, Professor Sanchia Aranda, told The Guardian the higher survival rates could be attributed to earlier detection, which she said was due to the management of referral and screening services in Australia. Australia had the densest per capita availability of imaging services for the seven cancers represented in the study, she said. Prof Aranda said there was still a sharp divide in survival rates between wealthy people and those from lower socioeconomic groups. “People in the lowest socioeconomic group have a 37 per cent higher mortality from cancer than people in the highest economic group,” she said. “So we shouldn’t be complacent about being number one. It should spur us on to make sure that those outcomes are equitable across the population.”

‘ People in the lowest socioeconomic group have a 37 per cent higher mortality from cancer than people in the highest economic group.’ — Cancer Council Australia 28 | THE LAMP NOVEMBER 2019

“Air pollution kills up to 40,000 people in England every year costing society more than £20 billion. We have one of the highest rates of asthma deaths for young people in Europe.” The plan also contains initiatives to provide therapeutic spaces for patients and staff, to help recovery and promote wellbeing. Hospitals would get green makeovers as ageing buildings were upgraded and repaired, prioritising solar panels and energy efficiency. Procurement would be done “ethically and sustainably”. Labour said it will declare a climate emergency in the NHS and was committed to help the health service meet a net zero carbon emissions target, including the installation of 150,000 solar panels and replacing polluting ambulances with low-emission vehicles.

‘The NHS is one of the biggest polluters in the country, representing 6.3 per cent of the carbon footprint in England.’

NEWS IN BRIEF

AUSTRALIA

Australia’s love affair with codeine curbed Switching the painkiller codeine to a prescription-only medicine has led to a 50 per cent drop in overdoses and sales. A study published in the journal Addiction by researchers from the University of Sydney also debunks fears that making codeine only available on prescription would lead to people misusing stronger painkillers. The study found that following the 2018 switch there was no increase in overdoses with stronger opioids or high-strength codeine, as some had feared. The researchers point out the widespread use of codeine in Australia prior to 2018.

EUROPE

EU approves medical cannabis product for epilepsy The European Union gives the green light to medical cannabis product for childhood epilepsy. The European Medicines Agency (EMA) and the European Commission has approved the cannabis product Epidyolex for seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome, for patients aged two years and older. The approval means the medicine – an oral solution that is taken twice a day and lacks the THC that gives the “high” usually associated with cannabis – can be prescribed across Europe. Up to 50,000 children and young adults in Europe have one of the two syndromes. The drug is already on the market in the US, where about 15,000 young people have been treated. It has been filed for approval in Switzerland and Israel. Ley Sander, Medical Director at the Epilepsy Society and Professor of Neurology at University College London, told the BBC: “This new drug will bring hope for some families and EU approval feels like a positive step. Medicinal cannabis, however, still remains a medical minefield and there are many hurdles ahead. “It is important that the pharmaceutical industry continues to work with the medical advisory body to ensure that drugs are cost effective and that its long-term effects are clear.”

“Australia has a love affair with codeine. It has historically been our most-used opioid, and 2013 data showed we took more codeine as a country than the USA, despite having roughly seven per cent of the population,” the researchers wrote in the online journal The Conversation. “The 2016 National Drug Strategy Household Survey reported codeine available from behind the counter at a pharmacy was the most misused legal opioid in Australia and misuse was particularly common in adolescents.” The researchers argue that limiting the availability of codeine works. “Prescription drug misuse and overdoses are problems that are very much driven by drug availability. And when the availability of other medicines in Australia and internationally have been restricted, we’ve seen the benefits, namely reductions in misuse and poisoning,” they said.

‘2013 data showed we took more codeine as a country than the USA, despite having roughly seven per cent of the population.’

‘ This new drug will bring hope for some families and EU approval feels like a positive step.’ THE LAMP NOVEMBER 2019 | 29

NEWS IN BRIEF

WORLD

Employers have the power to reduce anaemia in developing countries Anaemia – a silent killer of women in developing countries – can be significantly reduced with the provision of micronutrient foods in factory meals. Anaemia is the world’s most common nutritional disorder, affecting more than 1.6 billion people. The majority of those affected are women of child-bearing age: in 2011, 29 per cent of non-pregnant women worldwide (496 million people) and 38 per cent of pregnant women (32.4 million people) aged 15-49 were anaemic. The disorder was most prevalent in South Asia and Central and West Africa. Its consequences are serious. Iron-deficiency anaemia alone – representing about half of all cases – causes about a million deaths per year, some three-quarters of which occur in Africa and Southeast Asia. Moreover, anaemia contributes significantly to maternal and perinatal mortality: in Asia, it is the second leading cause of maternal death. A recent study – conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh and reported by the online news site Project Syndicate – found that employers in developing countries – especially those that provide lunch to workers – have the power to boost micronutrient consumption significantly among their labour forces, thereby reducing the incidence of anaemia. The implementation of a full nutrition package in factories with a lunch program reduced the prevalence of anaemia by 32 per cent. Even just the inclusion of iron-folic acid (IFA) supplements brought a 12 per cent decline.

‘Iron-deficiency anaemia causes about a million deaths per year, three-quarters of which occur in Africa and Southeast Asia. 30 | THE LAMP NOVEMBER 2019

AUSTRALIA

Childhood obesity is rising exponentially Only one in 10 countries has even a 50 per cent chance of meeting WHO targets on child obesity. The number of obese children globally is predicted to reach 250 million by 2030, up from 150 million now. Only one in 10 countries has even a 50 per cent chance of meeting the World Health Organization target of no rise in child obesity from 2010 to 2025. The chances of 156 of the 191 countries studied achieving the target are less than 10 per cent, according to the World Obesity Federation, which has compiled the data in the first Childhood Obesity Atlas. “The continuing increase in childhood obesity will overwhelm the health services of many countries. The increase shows a critical failure of government to respect and protect our children’s rights to good health,” said the federation. Tim Lobstein, one of the authors of the report, told The Guardian that governments were acting slowly or not at all and there was strong resistance to intervening against commercial interests. “There may be a certain fatigue in listening to these figures getting worse and worse, but doing nothing is going to cost an awful lot more than making serious interventions in the marketplace to reduce the global marketing of soft drinks and ultra-processed foods,” he said.

‘ The continuing increase in childhood obesity will overwhelm the health services of many countries.’

NEWS IN BRIEF

AUSTRALIA

“Do more on climate change”

More cheese, less meat

A global group of investment funds that includes AustralianSuper and HESTA has told the Minerals Council to up its game on climate change.

The Heart Foundation has released new eating guidelines to lower the risk of heart disease.

AustralianSuper and HESTA are members of Climate Action 100+, an organisation of 370 investment funds, which also include BT, global bank HSBC and California’s massive state pension fund, Calpers. The group’s members, between them, control more than $35 trillion in assets. Climate Action 100+ targets more than 100 of the world’s largest listed corporate greenhouse gas emitters to encourage emissions reduction, strengthen climate-related financial disclosures and improve governance on climate change risks. AustralianSuper’s head of environmental, social and governance issues, Andrew Gray, who sits on the Climate Action 100+ steering committee, says the Mineral Council needs to do more to meet the commitments it made to the principles of the Paris agreement on climate change. “Generally speaking the climate policy positions of industry associations aren’t where they need to be, they’re not as strong as they need to be. The Minerals Council, I think, is a good example,” he said. “It’s important that industry associations of which companies are a member have consistent positions with their members. If that’s not the case that represents a business risk for us.” The Minerals Council has been wracked with internal divisions, with two of its largest members, BHP and Rio Tinto, expressing their unhappiness with its advocacy for coal.

‘ Generally speaking the climate policy positions of industry associations aren’t where they need to be.’

The new advice – based on a two-year review of Australian and international research – says the effect of “full fat milk, cheese and yoghurt on heart disease (is) really quite neutral”. While advising that full fat dairy is generally fine, there are exceptions. “There is the caveat that if you have heart disease or you have high cholesterol, we still recommend low-fat options,” it said. The Heart Foundation's chief medical adviser, cardiologist Professor Garry Jennings, told the Sydney Morning Herald: “Butter, cream, ice-cream and dairy-based desserts are not recommended as hearthealthy, as they contain higher fat and sugar levels and less protein.” The Heart Foundation has also removed the limit on the recommended number of eggs healthy people consume per week, but suggest those with high cholesterol and those with Type-2 diabetes stick to seven. It advises a limit to the consumption of unprocessed beef, lamb, pork and veal to 350g a week – about three lean red-meat meals. The Heart Foundation said it ultimately hoped Australians would eat plenty of plant-based foods. That includes lots of vegetables, fruits and whole grains, along with proteins such as beans, lentils and tofu, as well as some fish and seafood.

MEMBERSHIP FEES 2020 NSW Nurses & Midwives’ Association – in association with the Australian Nursing & Midwifery Federation Year

Quarter

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$195.75

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Registered Nurse & Midwife $783.00 Enrolled Nurse $665.00

Assistant in Nursing & Assistant in Midwifery +

$548.00

$137.00

$45.66

$21.06

Undergraduate Bachelor of Nursing /Midwifery or Diploma of Nursing^ $274.00

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Membership fees are tax deductible Trainee AIN’s have fees waived for the duration of their traineeship Students working in a nursing role undertaking fulltime studies in an undergraduate Bachelor of Nursing/Midwifery or Diploma of Nursing for the duration of the bachelor/diploma *All membership fees include GST ABN 63 398 164 405 + ^

THE LAMP NOVEMBER 2019 | 31

PROFESSIONAL EDUCATION

NSW REGIONAL

SYDNEY METRO

November to December 2019 Education

Waterloo

Clinical Communication and Documentation Thursday 7 November, $95 / $190, 6 CPD Hours Know where you stand with Law, Ethics and Professional Standards in nursing and midwifery Wednesday 13 November, $95 / $190, 6 CPD Hours

Student to New Graduate: What You Need to Know Thursday 12 December, $30 / $60, 6 CPD Hours, New grad / final year nursing and midwifery students

Gymea

Palliative Care Workshop – NEW Wednesday 6 November, $95 / $190, 6 CPD Hours

Your Annual CPD Obligations Thursday 21 November, $50 / $100, 4 CPD Hours, RN, MW, EN

Hornsby

HUNTER NEW ENGLAND Newcastle

MURRUMBIDGEE Wagga Wagga

Student to New Graduate: What You Need to Know Wednesday 20 November, $30 / $60, 6 CPD Hours, New grad / final year nursing and midwifery students

ILLAWARRA SHOALHAVEN Shoalhaven Heads

Medications: How we do it better Wednesday 11 December, $95 / $190, 6 CPD Hours

MID NORTH COAST Macksville

Know where you stand with Law, Ethics and Professional Standards in nursing and midwifery Wednesday 4 December, $95 / $190, 6 CPD Hours

Dementia Management Training Thursday 28 November, $95 / $190, 7 CPD Hours

Aged Care Nurses’ Seminar Thursday 14 November, $60 / $120, 6 CPD Hours

Young

Know where you stand with Law, Ethics and Professional Standards in nursing and midwifery Wednesday 27 November, $95 / $190, 6 CPD Hours Your Annual CPD Obligations Thursday 28 November, $50 / $100, 4 CPD Hours, RN, MW, EN

NEPEAN BLUE MOUNTAINS Springwood

Wound Care: Understanding Wound Care Products COURSE FULL Thursday 14 November, $95 / $190, 6 CPD Hours

The 2020 education calendar is under development. An email will be sent to members once the 2020 education calendar is released and promo will also be able to be found in each edition of the Lamp!

For full details of courses including course content, venue & times, please go to www.nswnma.asn.au CPD

Attendance at NSWNMA education sessions may count towards your Continuing Professional Development (CPD) hours. The number of hours noted beside each course is the maximum amount of claimable CPD hours. Unless otherwise noted, our courses are suitable for all Nurses, Midwives and Assistants in Nursing/Midwifery. 32 | THE LAMP NOVEMBER 2019

PROFESSIONAL EDUCATION

2019

Student to New Graduate: What You Need to Know Wednesday 20 November NEWCASTLE, Wests New Lambton, Bowls Club 1a Tauranga Rd, New Lambton Thursday 12 December WATERLOO, NSWNMA 50 O’Dea Ave, Waterloo Thursday 23 January 2020 WATERLOO, NSWNMA 50 O’Dea Ave, Waterloo Thursday 6 February 2020 BLACKTOWN, Blacktown RSL Second Ave, Blacktown 9am to 4pm CPD

EDUCATION@MACKSVILLE

Members $30 Non-members $60 New Grad RNs, ENs and Midwives Lunch & refreshments provided

Objectives: to provide new grad registered and enrolled nurses and midwives with basic skills to start their professional journey transitioning to the workplace. • Know your Award; • Rostering; • Clinical Handover; • Nurse and Midwife Registration Board and AHPRA Codes and Standards (Decision Making Framework); • Documentation; • How to record your CPD.

Macksville Ex-Services Club 16 Cooper Street CPD

Know where you stand with Law, Ethics and Professional Standards in Nursing and Midwifery $

Wed 4 December 9am to 4.30pm All Members $95 Non-members $190 Lunch and refreshments provided

NUMBERS STRICTLY LIMITED!

PROGRAM: • • • • • • • • •

Cover the Australian legal system and laws that can effect nurses and midwives; Explore the co-regulatory system of nursing and midwifery within NSW; Breakdown how complaints and notification processes work within NSW; Unpack the confusion around consent; Gain a better understanding of where and how restraint can and cannot be used; Gain an understanding of ethics in our everyday practice; Develop a better understanding of how the Code of Conduct fits into your practice; The importance of documentation and escalation within the health care environment; Q&A.

For full details of courses including course content, venue & times, please go to www.nswnma.asn.au CPD

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Advance your career with a Master of Nursing | A flexible, distance education program | Lead and shape the future of health care | Specialise in Clinical Teaching, Clinical Nursing or Leadership and Management

Advance your career with a Bachelor of Nursing | A highly practical degree | Choose between full-time or part-time to suit your needs | Study on the grounds of the Sydney Adventist Hospital To find out more about our courses or to apply online visit avondale.edu.au/nursing phone +61 2 4980 2377 or email study@avondale.edu.au Avondale College Ltd trading as Avondale College of Higher Education CRICOS Provider No: 02731D | TEQSA: PRV12015 | ABN: 53 108 186 401

Are you a nursing or midwifery student? APPLY TO BE PART OF THIS FULLY PAID INTERNSHIP PROGRAM!

The program will run from 28 January – 14 February, and will see you placed at the NSW Nurses and Midwives’ Association for three weeks. Be quick – applications close on 20 November!

APPLY AT unionsummer.org.au 34 | THE LAMP NOVEMBER 2019

YOUR RIGHTS

Ask

Judith Breaking News ADO WIN … AT LAST By the time you receive this edition of The Lamp, the long running saga of the incorrect accrual of Additional Days Off (ADOs) for full-time nurses and midwives who work mixed shifts will have been resolved. Members may recall that the application within StaffLink of the 19-shift count system to determine ADO accrual, whilst effective for those who work either an eight or 10-hour shift regime, was identified as being inadequate in a mixed shift roster setting. After some years, a solution has been reached so that the ADO calculation will be based on actual hours rostered for nurses and midwives eligible for ADOs and this will ensure ADO accruals are accurate and up-to-date. The transition to this new methodology commenced on 21 October 2019, and involved a retrospective reconciliation of hours worked and ADOs taken to arrive at the new ADO balance. Using this new approach, full time nurses and midwives will either have their current ADO balance validated or alternatively increased, which should rectify any current negative balance due to the 19-shift counter system. This is a significant outcome and one years in the making, and only came about due to the persistence of a number of nurses and midwives who did not stop raising their concerns because the computer said no. It is refreshing to now have an IT system fitting in with rostering and workplace practices rather than the other way around, where the software solution was at odds with workplace reality.

Refusing overtime I work in a public hospital and our department is so short staffed we are constantly being harassed to work overtime on top of the rostered shift already worked. Can we say no? Clause 25(i) of the Public Health System Nurses’ and Midwives’ (State) Award sets out that an employer may require an employee to work overtime but also the circumstances to determine if any request to work overtime is unreasonable and

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

accordingly can be refused by an employee. These grounds include: whether a risk to health and safety arises; the employee’s personal circumstances; needs of the workplace; and the notice provided by the employer of the overtime and the notice by the employee of their intention to refuse it. AiN Team Leader at BUPA I work as an Assistant in Nursing in a Bupa nursing home. What is the criteria to become a Team Leader? Schedule B of the Bupa Aged Care Australia, NSWNMA, ANMF (NSW Branch) and HSU NSW Branch, New South Wales Enterprise Agreement 2018 sets out the definition of an assistant in nursing team leader. It includes holding at least a Certificate Level Ill in aged care work or other appropriate qualifications or acceptable experience. The role will also be expected to carry out designated duties, including responsibility for co-ordinating the work of other AiNs and/or performing specialist functions such as, for example, orientation of new staff, mentoring, specialist wound care or continence management. Accessing maternity leave I am a registered nurse working in a public hospital. I have been off on maternity leave and am now pregnant with my second child. Do I need to work for 40 weeks again to be eligible for a second round of paid maternity leave? Clause 34A(i) of the Public Health System Nurses’ and Midwives’ (State) Award sets out that having once met the conditions for paid maternity leave (i.e. 40 weeks continuous service), an employee will not be required to work another 40 weeks to qualify for a further period of paid maternity

leave. The only exceptions are if your employment ended and you subsequently are re-employed or you have completed a period of 40-plus weeks of leave without pay (excluding sick leave without pay, maternity leave without pay or leave without pay associated with illness or injury under workers compensation). Replacement of absences I work at a private hospital run by Ramsay. When an RN is off sick or on leave, do they need to replace them with another RN? Clause 4.2.1 of the Ramsay Health Care Australia Pty Limited and NSW Nurses & Midwives' Association and ANMF NSW Branch Enterprise Agreement 2018-2020, states clearly that “Leave absences including sick leave will be replaced by the same skilled level of nurse/midwife or a nurse/midwife of a higher classification e.g. RN with RN, EN with EN as far as practicable”. Increasing part time hours I work part time at a hospital run by Healthscope and have been doing lots more hours. Can I increase my permanent contracted hours to reflect this? Clause 23(xi) of the Healthscope Group – NSWNMA/ANMF – NSW Nurses and Midwives’ – Enterprise Agreement 2015–2019, states that a part time employee can request to have their hours worked reviewed annually. If you are regularly working more than your contracted hours, then it can be agreed to change this to reflect the hours regularly worked. While agreement by the employer is not to be unreasonably withheld, it would not apply to hours arising from the absence of employees on, for example, long service leave, maternity leave or workers compensation nor any temporary increase in hours to meet the needs of a specific patient. THE LAMP NOVEMBER 2019 | 35

SOCIAL MEDIA

Do you have a story to tell? An opinion to share? Nurse Uncut is a blog written by everyday nurses and midwives. We welcome your ideas at nurseuncut@nswnma.asn.au

New on our Support Nurses YouTube channel

BANKSTOWN RALLY FOR SAFE STAFFING Nurses and midwives at Bankstown-Lidcombe Hospital came together to fight for increased staffing in their Emergency Department. http://bit.ly/bankstownoct-rally. http://bit.ly/ bankstown-oct-rally OCTOBER IS SAFE WORK MONTH NSWNMA General Secretary Brett Holmes speaks about the Association’s actions for Safe Work Month, which will highlight the issues of violence in healthcare. http://bit.ly/safework-2019

Connect with us on Facebook Nurse Uncut www.facebook. com/NurseUncutAustralia New South Wales Nurses and Midwives’ Association www.facebook.com/nswnma Ratios put patient safety first www.facebook.com/ safepatientcare Aged Care Nurses www.facebook.com/ agedcarenurses Look for your local branch on our Facebook page www.facebook.com/nswnma

Summer Internship for nursing and midwifery students Applications are now open for Union Summer! https://www.nurseuncut. com.au/summer-internship-fornursing-and-midwifery-students-2/

What causes Alzheimer’s disease? What we know, don’t know and suspect Alzheimer’s affects so many of our patients, yet there is plenty that we don’t know about it. Researchers from the Florey Institute of Neuroscience and Mental Health give us some insight about this disease. https://www.nurseuncut.com.au/ what-causes-alzheimers-diseasewhat-we-know-dont-know-andsuspect/

Nurse Blake’s 5 top tips for New Grads Influencer and Blogger Nurse Blake shares his top tips for new nurses. https://www.nurseuncut.com.au/ nurse-blakes-5-top-tips-for-newgrads/

Removing Barriers – a tool for breaking down stigma The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine has released this tool for nurses and midwives, so that they can better interact with patients living with HIV and blood-borne viruses. https://www. nurseuncut.com.au/removingbarriers-a-tool-for-breaking-downstigma/

How rising temperatures affect our health

Listen to our podcast

Share on Instagram by tagging @nswnma and don’t forget to use the hashtag #nswnma!

Liz Hanna writes about how global warming will affect health. https://www.nurseuncut.com.au/ how-rising-temperatures-affectour-health/

Infant Mental Health – Fran Chavasse http://bit.ly/ infant-mh-1

36 | THE LAMP NOVEMBER 2019

SOCIAL MEDIA

your

Say

Mothers and babies carry the risk of inadequate staffing We posted about the incredible shortage of midwives at Campbelltown Hospital. You were up in arms about the risks that this leads to for mothers and babies. Campbelltown need more nurses and doctors in general. They are so understaffed. Emergency had over seven hour’s wait on Thursday night. It’s not good enough for any of our public hospitals at the moment. Staff and patients are at risk. How many health professionals does it take to save a life? Yep, It’s not a joke! I had my 4th child on Sunday at Campbelltown. The midwives did such an amazing job and were very supportive. For anyone due to give birth soon, don’t be concerned because although they’re understaffed these men and women ensure top quality care is provided even if it is at their own expense. They miss their breaks and do UNPAID overtime. They deserve so much credit for what they do.

What nurses and midwives said and liked on Facebook www.facebook.com/nswnma

This is terrible. I am pregnant and I had to go to emergency not long ago. I had to wait five hours until I was first seen by a doctor who was actually a student. Waiting five hours in an emergency room, pregnant, without any medical assistance, is life threatening. This is so sad, but I will say good on the midwives who are there. I have had the privilege of being at six of my grandkids’ births and the midwives who are there are always so busy as most rooms are full with mums having babies. They do a great job! C’mon federal and state governments – do something for once. Honestly, this is terrible. I feel for those trying to recruit, retain and ensure safe patient care. It’s about time the local members, both state and federal, used their political influence in seeking funding, look at the provision of flexible family friendly hours, childcare for midwives after hours, and staff parking. Recruit semi-retired nurses and midwives with accessible professional development done in work hours. This area has a huge population. It has plenty of young families and expanding housing development. Staffing ratios are crucial, so over to the state and federal pollies to ensure change happens.

the gallery /1

Strong feelings about anti-vaxers We shared a video from the anti-vax capital of NSW – and you were shocked about why parents were refusing to have their children protected from preventable diseases. I’m a registered nurse and worked at Mullumbimby Hospital for many years. It is ironic the number of parents who would bring their children in to be treated with mainstream medicines when all their remedies failed their children and themselves. It is devastating to nurse a young child with whooping cough. I’ve seen the same thing. These fools don’t understand the consequences because they live in a vaccinated world where they didn’t get to see the death and suffering. God help us all when they bring it all back. The poor children will pay the price for the hippy-dippy parents. I’m amazed that people think they know more than medical experts. I feel so bad for the kids. The parents grew up with the benefits of vaccines, and yet they deny them the same benefits? Is this a form of abuse?

/5 1/ Cumberland Hospital Branch and local community members rally to stop a light rail line being built across their hospital 2/ N SWNMA General Secretary Brett Holmes presents in a panel at the recent Global Nurses United Conference in San Francisco 3/ M embers of BankstownLidcombe Hospital Branch stand together for safe staffing in their Emergency Department 4/ B rett Sutherland on his experiences as a new nurse at the recent Enrolled Nurses Professional Association conference in Newcastle 5/ E rin, front left, from the NSWNMA Council joined unionists from across the Asia Pacific at APRECON in Bali

THE LAMP NOVEMBER 2019 | 37

Australian Nursing and Midwifery Federation New South Wales Branch Summary of Financial Information for the Year Ended 30 June 2019

he financial statements of the Australian Nursing and Midwifery Federation New South Wales Branch have been audited in accordance with the provisions of the Industrial Relations Act, 1991 and the following summary is provided for members in accordance with Section 517(2) of the Act, as applied by section 282(3) of the Industrial Relations Act, 1996. A copy of the Financial Statements, including the independent Audit Report, will be supplied free of charge to members upon request. Certificates required to be given under the Act by the Committee of Management have been completed in accordance with the provisions of the Act and contain no qualifications.

SUMMARY STATEMENT OF PROFIT OR LOSS OR OTHER COMPREHENSIVE INCOME FOR THE YEAR ENDED 30 JUNE 2019 Service fee – NSW Nurses and Midwives’ Association (NSWNMA) Interest income Other income Total income Less total expenditure Result for the year Remeasurement of retirement benefit obligations Total comprehensive income for the year SUMMARY BALANCE SHEET AS AT 30 JUNE 2019 Total equity Represented by: Current assets Non-current assets Total assets Current liabilities Non-current liabilities Total liabilities Net assets INFORMATION TO BE PROVIDED TO MEMBERS OR REGISTRAR In accordance with the requirements of the Industrial Relations Act, 1991 [NSW] the attention of members is drawn to the provisions of Sub-Sections (1) and (2) of Section 512 which read as follows: (1) A member of an organisation, or the Industrial Registrar, may apply to the organisation for specified information prescribed by the regulations in relation to the organisation. (2) An organisation must, on the making of such an application, make the specified information available to the member or the Industrial Registrar in the manner, and within the time, prescribed by the regulations. 38 | THE LAMP NOVEMBER 2019

2019 ($)

2018 ($)

22,770,065

21,038,636

182,271 55,355 23,007,691 (22,734,230) 273,461 (195,104) 78,357

164,607 46,332 21,249,575 (21,106,604) 142,971 52,265 195,236

243,729

165,372

9,500,359 9,500,359 8,279,732 976,898 9,256,630 243,729

8,548,790 8,548,790 7,674,682 708,736 8,383,418 165,372

REPORT OF THE INDEPENDENT AUDITOR ON THE SUMMARY FINANCIAL STATEMENTS TO THE MEMBERS OF THE AUSTRALIAN NURSING AND MIDWIFERY FEDERATION NEW SOUTH WALES BRANCH Opinion

The summary financial statements, which comprise the summary balance sheet as at 30 June 2019 and the summary statement of profit or loss and other comprehensive income for the year then ended are derived from the audited financial report of Australian Nursing and Midwifery Federation New South Wales Branch for the year ended 30 June 2019. In our opinion, the accompanying summary financial statements are a fair summary of the audited financial report.

Summary Financial Statements

The summary financial statements do not contain all the disclosures required by Section 510 of the Industrial Relations Act, 1991 [NSW] or Australian Accounting Standards. Reading the summary financial statements and the auditor’s report thereon, therefore, is not a substitute for reading the audited financial report and the auditor’s report thereon.

The Audited Financial Report and Our Report Thereon

We expressed an unmodified audit opinion on the audited financial report in our report dated 1 October 2019. Our Independent Auditor’s Report to the members on the Financial Report did not contain any particulars of any deficiency, failure or shortcoming as referred to in the Industrial Relations Act 1991 [NSW], as applied by Section 282(3) of the Industrial Relations Act, 1996.

Committee of Management’s Responsibility for the Summary Financial Statements

The Committee of Management is responsible for the preparation of the summary financial statements.

Auditor’s Responsibility

Our responsibility is to express an opinion on whether the summary financial statements are a fair summary of the audited financial report based on our procedures, which were conducted in accordance with Auditing Standard ASA 810 Engagements to Report on Summary Financial Statements.

Daley & Co

Chartered Accountants

Stephen Milgate

Partner

1 October 2019, Wollongong Liability limited by a Scheme approved under Professional Standards Legislation

A copy of the Financial Report, including the Independent Audit Report, may be found on the Members page of the website www.nswnma.asn.au or can be obtained upon written application to: Brett Holmes, Branch Secretary Australian Nursing and Midwifery Federation NSW Branch 50 O’Dea Avenue, Waterloo 2017

NURSING RESEARCH AND PROFESSIONAL ISSUES The Australian Journal of Advanced Nursing aims to provide a vehicle for nurses to publish original research and scholarly papers about all areas of nursing. Papers will develop, enhance, or critique nursing knowledge and provide practitioners, scholars and administrators with well-tested debate.

Side effects of chemotherapy in children with cancer: effects of nursing training administered to caregivers Zeynep Uzun, Sibel Kucuk Chemotherapy for the treatment of cancer is associated with a wide range of side effects (Carelle et al. 2002; De BoerDennert et al. 1997; Griffin et al. 1993). A multidisciplinary approach that involves nurses and other healthcare personnel is recommended for the management of cancer treatment processes and potential complications, and the importance of the caregiver responsible for the care of the child has been emphasised (Kutulu et al. 2007; Holm et al. 2003). Patients must be prepared, and training must be provided by the attending nurse before initiating a chemotherapy program (Aranda et al. 2012). As caregivers bear the primary responsibility for looking after the child, they should be trained in the prevention, detection and control of side effects associated with the chemotherapy (Kutulu et al. 2007). The most significant symptoms and side effects seen in cancer patients could be prevented or minimised through effective and conscious nursing interventions and training programs (Aslan et al. 2006). http://www.ajan.com.au/Vol36/ Issue4/4Kucuk.pdf

Exploring life history methodology in chronic illness: a study in Relapsing Remitting Multiple Sclerosis Therese Burke, Joanna Patching Multiple Sclerosis (MS) is a progressive inflammatory disease of the central nervous system (CNS) with the most common form

of MS at diagnosis being RRMS, affecting 85 per cent of people living globally with the disease (Compston and Coles 2008). Recent data from Multiple Sclerosis Research Australia (MSRA) suggests that there may be 25,600 people living in Australia with MS (MSRA 2018). RRMS is characterised by unpredictable relapses (exacerbations or attacks), which usually last several weeks before the individual returns to baseline functioning (Lublin et al. 2014). Aside from a highly variable disease state and multitude of possible neurological symptoms, MS can also cause numerous secondary and tertiary effects. Issues may develop in highly personal areas of intimacy and sexuality, mental health, relationships and employment. Although there exists an abundance of literature examining many different aspects of MS and MS symptoms, there is a paucity of literature exploring the whole life experience of living with MS, and more specifically, RRMS. The aim of this study was to gain insights and understanding into the lived experience of RRMS, so that nurses may have a deeper understanding of the patient experience and be able to plan and adjust their nursing care accordingly. To address these specific aims, the study sought to answer the research question, “What is the experience of living with Relapsing Remitting Multiple Sclerosis?” http://www.ajan.com.au/Vol36/ Issue4/5Burke.pdf

Evaluating the efficacy and impact of the Nursing and Midwifery Exchange Program: a study protocol Amy-Louise Byrne, Clare Harvey, Adele Baldwin, Brody Heritage, Diane Chamberlain, Elspeth Wood

The pressures of cost and space associated with acute hospital admissions have placed an increasing focus on community services in an attempt to reduce unnecessary and avoidable admissions (Australian Health Minister’s Advisory Council 2017). This has compounded existing challenges related to health service provision in areas geographically removed from major metropolitan centres, where the difficulties associated with recruitment and retention of the workforce and access to services require special consideration. Community nursing, an area that rural/remote nurses work collaboratively across, is of particular importance to health service provision as it supports home care and hospital avoidance. In spite of this knowledge, community nursing is largely invisible, and is not seen as an attractive career choice because of its generalist nature (Gray et al. 2011; Kennedy et al. 2008). Exposure to living in regional, rural and remote areas is therefore fundamental to attracting a suitable nursing workforce. It is a well-known fact that nurses who have grown up in, or have clinical experience in a particular region, are more likely to engage with it, and return to it for work. This research study builds on work that is currently being undertaken in Queensland Health, to develop strategies that support early transition into specialty practice, professional development and the encouragement of lifelong learning including experience in rural and remote health (Fox et al. 2015). One such project is the Nursing and Midwifery Exchange Program (NMEP). http://www.ajan.com.au/Vol36/ Issue4/2Byrne.pdf THE LAMP NOVEMBER 2019 | 39

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 40 |

IMPORTANT NOTE From 1 December 2018 the insurance benefits have changed as follows: • Journey Accident Insurance: the waiting period for benefits is now 14 days • Professional Indemnity Insurance: the limit per claim is now $5 million THE LAMP NOVEMBER 2019

CROSSWORD

test your

Knowledge 1

ACROSS 1. Relating to the articulation between the clavicle and the scapula and its ligaments (17) 10. Grown abnormally into the flesh (7) 11. Very powerful (9) 12. Paddle (3) 13. Costa (3) 14. High-density lipoprotein (1.1.1) 15. A city in Japan (5) 17. Lysinuric protein intolerance (1.1.1) 18. A naturally occurring hormone involved in regulating the body’s “internal clock” (9) 19. Sexually transmitted infection (1.1.1) 20. Relating to or caused by trauma (9)

22. Dilation of a tubular structure (7) 23. Resulting from the conversion of heat into other forms of energy (13) 26. A type of protein in blood plasma that acts as an antibody to activate allergic reactions(1.1.1) 27. Spontaneous, improvised (9) 30. Relating to milk (7) 33. A considerable range of antiviral protein substances produced by cells that have been invaded by viruses (11) 34. Spleens (5) 35. A serious complication of pregnancy (9) 36. Loss of the ability to interpret sensory stimuli (7)

DOWN 1. An inhibitor of cholesterol metabolism, used in the treatment of Cushing's syndrome (17) 2. To expel the contents of the stomach in small amounts, short of vomiting (11) 3. A graphical recording of muscle activity (7) 4. Obscured, blurred (11) 5. A vascular channel that transports lymph (9) 6. A state of being attentive or alert (9) 7. Relating to the division of the cytoplasm during the division of eukaryotic cell (11) 8. Fetal attitude (3) 9. To reason methodically and logically (11) 16. Extreme compulsiveness (13) 21. X-ray film of the soft tissue of the breast (9) 24. A tumour or new growth largely made up of nerve cells and nerve fibers (7) 25. A patchy pigmentation of sun-exposed skin, seen most commonly in pregnancy (7) 28. A division of the corolla (5) 29. To compress or squeeze (5) 31. Large intestine extending from the caecum to the rectum (5) 32. Rabies (5)

THE LAMP NOVEMBER 2019 | 41

Welcome to

Improved communication channels and engagement

MEMBER CENTRAL

Seamless access to membership details Functionality at your fingertips

THE NEW ONLINE SYSTEM FOR NSWNMA MEMBERS

Unique NSWNMA member login with email

Create your new member login account & you could win a trip to Bali! Log on to online.nswnma.asn.au and create your login to be automatically entered in the draw to win a 5 night holiday to

THE TRANS RESORT BALI, SEMINYAK

You and a friend will enjoy: • Five nights’ accommodation in a Premier Room • Return airport transfer • Breakfast daily for two • One x Friday night buffet or set dinner for two • One x Sunday Yum Cha for two • One x 30 minute massage for two • 20% off Food & Beverage.

The NSWNMA will arrange and pay for return flights for two to Denpasar, Bali.

online.nswnma.asn.au

log on and create your login from 1 Feb 2019 – 31 Jan 2020 and you will automatically be entered in the draw to win.

Prize drawn 1 Feb 2020

Full terms and conditions are available at www.nswnma.asn.au/nswnmamembers/contests-and-promotions Conditions apply. Prize must be redeemed by 31 January 2021 and is subject to room availability. Block out dates: 23 – 29 January 2020 , 21 – 31 May 2020, 1 June – 31 July 2020 and 23 December 2020 – 6 January 2021. Competition opens on 1 February 2019 and closes 31 January 2020. The prize will be drawn 42 | on THE LAMP NOVEMBER 2019 is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/18/02955 1 February 2020. If a redraw

REVIEWS

book club

S PE

Joanna Nell Hachette Australia: booktopia.com.au RRP $32.99: ISBN 9780733640377

INTE IAL

ST RE

The Last Voyage of Mrs Henry Parker

SPE C

All books can be ordered through the publisher or your local bookshop.

IA As the wife of retired ship’s doctor Dr Henry Parker, Evelyn is L IN T E living out her twilight years aboard the Golden Sunset. Every night she dresses for dinner – gown, tiara, runners – and regales her fellow passengers with stories of a glamorous life travelling the world in luxury as well as showing off her superior knowledge of everything from ships’ customs to biographical details of her heroine, Florence Nightingale. The crew treats her with deference. And forbearance.

But when Henry goes missing, Evelyn sets off to search every part of the ocean liner to find him. This book is a love letter to the memories we make over the course of a lifetime and how the heart remembers what matters, even when the mind has long forgotten.

Occupational Health Psychology – Work, Stress And Health Irvin Schonfeld and Chu-Hsiang Chang Springer Publishing: bookdeposity.com.au RRP $109.00: ISBN 9780826199676

This comprehensive text for undergraduate and graduate survey courses is the first to encompass a wide range of key issues in Occupational Health Psychology. It focuses on the theory and practice of protecting and promoting the health, wellbeing and safety of individuals in the workplace and improving the quality of work life. The text addresses key work issues that are often related to mental and physical health problems, including psychological distress, burnout, depression, accidental injury, obesity and cardiovascular diseases, examines leadership styles as they impact on organisational culture and it provides specific recommendations for reducing employee-related stress through improved leader practices.

Compassion Fatigue And Burnout In Nursing: Enhancing Professional Quality of Life Vidette TodaroFranceschi Springer Publishing: bookdepository.com.au RRP $56.99 ISBN 9780826155191

This book is for all nurses but especially those who suffer from issues such as job dissatisfaction, compassion fatigue, moral distress or burnout. Many nurses who choose to go back to school may suffer from some degree of compassion fatigue or burnout and not even know it. Told from a first-person perspective, the work is based on research and is designed to provide practical steps for the nurse or nurses reading this book.

Nurses Eat Their Young: Inside The Nurse Bullying Crises Olivia Thompson Independently published: bookdepository.com.au RRP $11.88: ISBN 9781091595941

Discover the dirty secrets of healthcare you didn’t learn about in school. Bullying causes a shocking amount of harm to nurses and patients alike – and can even turn deadly. In the face of looming nursing shortages, nurses are being driven out of the profession in droves because they are unprepared for the toxic work environments. Whether you are a nurse of 30 years, a student or just a curious outsider, this personal, real-life drama will keep you turning the page.

THE LAMP NOVEMBER 2019 | 43

Soft HANDS in 5 days

UREA 10%

CLINICALLY NON-GREASY PROTECTIVE PROVEN BARRIER

Available at Chemist Warehouse, Priceline and leading pharmacies

duit.com.au

l e g n i r K Kris e Awesom

NSWNMA Water Bottle $15

gift idea

Madrid Sunhat $25

NSWNMA Royal Blue or Red Cap $15

ORDER VIA

MEMBER CENTRAL

NO PARABENS DIABETIC NO LANOLIN FRIENDLY NO PETROLATUM

Spend over $6 to receiv0 e

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REVIEWS

at the movies

MEM AL

R BE

Email The Lamp by 20 November to be in the draw to win one of 10 double passes to Judy & Punch thanks to Madman Films. Email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!

Blood

It’s the mid-17th century in the tiny town called Seaside (incidentally, nowhere near the sea). Worn out and ruined by poverty and neglect, the lives of Seaside’s town folk have spiralled into violence, mob rule and God-fearing hysteria. Amidst the chaos, one glimmer of artistry remains: Punch and Judy’s marionette puppet theatre. While the townspeople revel in the drama and brutality of trials and executions, the charismatic Punch (Damon Herriman) and his prodigiously talented puppeteering wife Judy (Mia Wasikowska), endeavour to use their show to escape with their new baby to loftier means – a sentiment that is pushed by Punch and accepted by Judy. Judy is clearly the superior puppeteer and possesses the skill and dexterity of a great artist, but it is Punch who owns the limelight. A lovable narcissist with a dangerous penchant for the bottle, his ambition and egomania are the antithesis of Judy’s gentle, practical nature. Punch and Judy’s first marionette show back from a hiatus is a triumph but Punch, spurred on by the show’s success and the brutal celebration of witch-stoning day, succumbs to Seaside’s temptations and the local McDrinky’s tavern. Fuelled by ale and adulation, he is caught out by Judy in the tavern, drinking heavily and in the company of his apparent mistress, Polly (Lucy Velik). The next day, a slapstick chain of events comes to a tragic end while Punch continues his drinking binge. Hell-bent on vengeance and retribution, darkness descends over Judy, who must right the wrongs of Punch and the entire town of Seaside in an act of vengeance befitting her true nature. In cinemas 21 November.

GIV E

RUR

WIN

Judy & Punch

MEM RO

R BE

ME T

If you would like to be a movie reviewer, email lamp@nswnma.asn.au

GIV E

Families are bound by blood. And by secrets… Cat Hogan (Carolina Main, Unforgotten) is an isolated woman on the run from her past, a past she is forced to confront when the sudden death of her mother, Mary, draws her back to the family she has spent the last 10 years trying to avoid. Cat has always been the black sheep of the family and now this uncomfortable reunion awakens sinister demons and shines a suspicious light on her mother’s death. Her suspicions start to mount against her father, Jim (Adrian Dunbar, Line of Duty), when she begins to notice discrepancies in his story. Is Cat paranoid or has she discovered a terrible truth about her father? Nothing and no one can be taken at face value; the truth depends on who you ask. Blood is an intimate drama and psychological thriller about family, memory, and the impact the past can have on the present. Email The Lamp by the end of November to be in the draw to win one a copy of Blood thanks to Acorn. Email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win! THE LAMP NOVEMBER 2019 | 45

DIARY DATES

make a date

Diary Dates for conferences, seminars, meetings and reunions is a free service for members. lamp@nswnma.asn.au

NEW SOUTH WALES

INTERNATIONAL

2019 World Mental Health Congress

29 November 2019 Colombo House Theatres, UNSW, Randwick https://www.acccn.com.au/ events/event/nsw-critical-careseminar-29-november-2019

5–8 November 2019 Buenos Aires, Argentina wfmh.global/ world-congress-2019

EVENTS: INTERSTATE

Asbestos Safety Conference 2019 11–13 November 2019 Perth, WA https://www.asbestossafety. gov.au/events/ asbestosconference2019/ program

Movement Disorder Chapter Conference 2019 14 November 2019 Adelaide, SA https://members.anna.asn.au/ iCore/Events/Event_Display. aspx?EventKey=19MDCNOV& WebsiteKey=6788d953-9b77483d-8a64-fff21863280d

8th International Australasian College for Infection Prevention and Control Conference 17–20 November 2019 Perth, WA https://www.acipc.org.au/

The Alfred Pain Symposium 30 November 2019 Monash University, Melbourne, VIC https://painmedicine.org.au/

18th National Nurse Education Conference: Inspire, Motivate, Educate 28–30 October 2020 Gold Coast, Queensland https://www.ants.org.au

International Council of Nurses (ICN) Congress 2021 Abu Dhabi, UAE www.icn.ch/ EVENTS: REUNIONS

Hastings District Hospital (Port Macquarie) 25-year Reunion Saturday, 9 November 2019 Contact: Karen Slater 0408984864 k.c.slater@bigpond.com

Every dollar raised from this diary goes to clinical trials research that saves and improves the lives of people with breast cancer. Buy the diary and help to save lives today, tomorrow and forever.

LISA WILKINSON

100 years of Celebration: Blue Mountains District ANZAC Memorial Hospital – Reunion of all past employees

Co-host Ch10’s The Project, and mum of three

6 pm, 15 February 2020 $65 per head – 3-course meal Carrington House, Katoomba 2780 RSVP: 10 January 2020 janejohansen@y7mail.com

breastcancertrials.org.au

Advertise in The Lamp and reach more than 66,000 nurses and midwives. To advertise contact Danielle Nicholson 02 8595 2139 0429 269 750 dnicholson@nswnma.asn.au

46 | THE LAMP NOVEMBER 2019

BUY THE DIARY THAT SAVES LIVES

ER NC ’S LY CA LIA ON CER ST RA M AN EA ST OM C BR AU T C SED OS O M AG N DI

ACCCN NSW Critical Care Seminar

Please send event details in the format used here: event name, date and location, contact details – by the 5th of each preceding month. Send your event details to: lamp@nswnma.asn.au Fax 02 9662 1414 Post 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space. Priority is given to non-profit professional events.

18.95

from Newsagents, Woolworths and womenshealthdiary.com.au 1800423444

CROSSWORD SOLUTION

TRAVEL

Fabulous holiday offers Can’t find what you’re looking for? Contact the Member Concierge desk to discuss the world on sale. To book email bookings@ubookdirect.com.au or call 1300 959 550. For all other packages, head to unionshopper.ubookdirect.com

Plantation Island Resort – Mamanuca Islands, Fiji

Crowne Plaza Phuket Panwa Beach – Phuket, Thailand 5 star resort overlooking Makham Bay! Crowne Plaza Phuket Panawa Beach is a luxury hideaway located just a stone’s throw away from Phuket Town. The resort offers it’s own private beach and two beachfront pools, making Crowne Plaza one of the finest choices when staying in Phuket.

Situated in front of a long white sandy beach, Plantation Island offers palmfringed accommodation in Malolo Lailai’s blue lagoon.

Sea View Room – 5 nights $699*

• Stay 7 nights & pay for 5 nights • Kids eat free (for up to 2 kids, 12 years & under) • Free transfer via Malolo Cat (1 free child per 1 paying adult) • Welcome shell lei & 1lt bottle of water per person upon arrival • Complimentary Coconut Kids Club for children (aged 4-12 years), Lairo Club for teenagers (aged 13-16 years), use of standard kayaks, mini golf, tennis, table tennis & volleyball • Complimentary Fijian cooking lessons, coconut leaf basket weaving lessons & native medicine tours • Free use of kids waterpark (aged 5 – 16 years) & adults waterpark (17+ years)

(2 ADULTS)

• Guaranteed upgrade to Grand Andaman Sea View • Daily breakfast at Mosaic Restaurant for 2 persons • Welcome drink & fruit basket on arrival • Free shuttle service from resort to Phuket town twice per day based on schedule • 20% discount for Spa Treatment – A La Carte menu at Pawan Panwa Spa & 15% discount for F&B at all hotel outlets except alcohol & minibar.

Ocean View Hotel Room – 7 nights $1809* (2 ADULTS & 2 CHILDREN)

Christmas & New Year cruises – Departing Sydney Affordable South Pacific cruises are back! Cruise the pristine blue seas of the South Pacific where sunshine and smiles meet. You can take a dip in the crystal clear waters, be welcomed by the locals as you check out the markets and immerse yourself in village life, feel the white sand between your toes and just relax in this laid-back island paradise. There are a range of cruise options over this period, head over to unionshopper. ubookdirect.com to see all cabin types for even less! Limited offer, be quick so you don't miss out. T&C’s apply.

Balcony Cabin from $1899 pp – 11 nights* INCLUDING ENTERTAINMENT AND ON-BOARD MEALS!

• All cruises are from Sydney/to Sydney • All shipboard main meals (excluding specialty restaurants) • Most entertainment on-board • All port & government charges * All travel deals are subject to availability. Crowne Plaza Phuket Panwa Beach: valid until 30 June 2020. Rate based on 2 adults during low season (10 – 31 October 2019 and 1 April – 30 June 2020). High & peak season rates available, go to unionshopper.ubookdirect.com. Plantation Island Resort: valid for travel until 31 March 2021. Rate based on 2 adults & 2 children. Starting 1 April 2020 - 31 March 2021, transfer for free via Malolo Cat offer will be applicable for up to 3 kids. For black-out dates, high season surcharges & full T&C’s go to unionshopper.ubookdirect.com.

needed it. did it. loved it. Recruit a new member and go into the draw to win a 5 night Optimal Wellness Program for two at the Golden Door Wellness Retreat & Spa, Hunter Valley valued at over $6,000

THE 2019 – 2020

NSWNMA Member Recruitment scheme prize PRIZE DRAWN 30 JUNE 2020

The perfect place to reset your mind and body and gain a wealth of knowledge to create a healthier, happier and more motivated you. You and a friend will experience: • • • • • •

5 nights’ accommodation in a private villa Personal welcome consultation on arrival All nutritious meals and snacks Diverse selection of group ﬁtness activities, relaxation and mind-body classes Daily program of health education seminars and workshops Use of all the facilities including a heated indoor pool, outdoor pool, tennis courts, gymnasium, indoor activity studios and outdoor relaxation areas • Two luxurious spa treatments including one Classic Facial and one Swedish massage • One wellness consultation with your choice of: wellness coaching, meditation, yoga or standard personal training session • Access to all the spa facilities including steam room, spa bath and relaxation lounges. Guided by a team of health professionals, this program will give you a complete understanding of the art of skilful living and homegrown wellness – a results driven concept the Golden Door team is highly trained in. Optimise your goals to reach new heights in all aspects of your life.

Every member you sign up over the year gives you an entry in the draw! RECRUITERS NOTE: Join online at www.nswnma.asn.au If you refer a member to join online, make sure you ask them to put your name and workplace on the online application form, so you will be entered in the draw.

Conditions apply. Prize must be redeemed by 30 June 2021 and is subject to room availability. Block out dates include all Australian and NZ school holidays and Christmas / New Year period. The Optimal Wellness Program commences Sunday through Friday each week. The prize will be drawn on 30 June 2020. Authorised by unclaimed B. Holmes, General Secretary, Nurses and Midwives’ 50 O’Dea Ave,date. Waterloo NSWPermit 2017 If a redraw is required for an prize it mustNew beSouth heldWales up to 3 months fromAssociation, the original draw NSW no: LTPM/19/04224.