The Lamp October 2021 by NSW Nurses and Midwives' Association

PRIVATE NURSES

PHS

COVID-19

REGULARS

Nurses volunteer for West’s pandemic battle

ICU nurses struggle to maintain standards

The science behind COVID-19 vaccines

page 12

page 18

page 26

Your rights and entitlements at work p.32 Nursing research online p.41 Crossword p.43 Reviews p.45

THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 78 NO. 5 OCTOBER / NOVEMBER 2021

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CONTENTS Contacts NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including The Lamp subscriptions and change of address, contact our Sydney office. Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E gensec@nswnma.asn.au W www.nswnma.asn.au

VOLUME 78 NO. 5 OCTOBER / NOVEMBER 2021

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 Shaye Candish, NSWNMA Assistant General Secretary O’Bray Smith, NSWNMA President Michelle Cashman, Long Jetty Continuing Care Richard Noort, Justice Health Liz McCall, Byron Central Hospital Diane Lang, South East Regional Hospital, Bega Valley

COVER STORY

Delta unmasks rural neglect The Berejiklian government plays the blame game as Sydney’s Delta outbreak spreads to regional areas with underresourced healthcare facilities.

Printed by Ovato Print Pty Ltd, 37–49 Browns Road, Clayton VIC 3168 Advertising Danielle Nicholson T 8595 2139 or 0429 269 750 F 9662 1414 E dnicholson@nswnma.asn.au Information & Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Adrian Hayward, Coordinator. T 8595 2175 E gensec@nswnma.asn.au The Lamp ISSN: 0047-3936 General Disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised. Authorised by B.Holmes, General Secretary, NSW Nurses and Midwives’ Association, 50 O’Dea Avenue Waterloo NSW 2017 Privacy Statement The NSWNMA collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information, please contact the NSWNMA office. If you are still not satisfied that your privacy is being maintained, you can contact the Privacy Commission. Subscriptions for 2021 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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REGULARS

WHS

ICU nurses struggle to maintain standards Politicians say hospital staff are “coping” during the pandemic, but ICU nurses tell a different story.

5 6 30 32 36 41

Editorial Your letters What’s on Ask Shaye News in brief Nursing Research Online and Professional Issues 43 Crossword 45 Book Club 46 Your Health

RATIOS RESEARCH

Pandemic exposes the vulnerability of under resourced health systems A new US study highlights how COVID-19 battered what was already a poorly resourced and vulnerable health system.

AGED CARE

Independents push to turn commission’s recommendations into law Independent Senator Rex Patrick introduced a new bill last month calling for a national law requiring registered nurses 24/7 in nursing homes.

PRIVATE NURSES

PHS

COVID

REGULARS

Nurses volunteer for West’s pandemic battle

ICU nurses struggle to maintain standards

The science behind COVID-19 vaccines

page 12

page 18

page 26

Your rights and entitlements at work p.32 Nursing research online p.41 Crossword p.43 Reviews p.45

THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 78 NO. 5 OCTOBER / NOVEMBER 2021

VACCINES

THE SCIENCE BEHIND COVID-19 VACCINES In a recent NSWNMA webinar, Dr Jessica Stokes-Parish (PhD, RN), who works in an ICU, and Romy Blacklaw (IPN, RN), a clinical nurse in a COVID-19 vaccination hub, responded to common questions and concerns about COVID-19 vaccines.

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COVER: Photographed by Alys Marshall

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THE LAMP OCTOBER/NOVEMBER 2021 | 3

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EDITORIAL

BRETT

Holmes GENERAL SECRETARY

There’s no going back It can’t just be business as usual post-COVID-19, lessons need to be learnt and applied. If there is one glaring lesson to be learnt from the pandemic it is that science needs to be restored to its proper place at the centre of our decision-making processes. This is particularly true in respect to health. The idea that health can be managed with a minimal workforce and a “just in time” system of procurement has been badly exposed by COVID-19. The signs, evidence and warnings were always there that the public health system needed to be more robust and better resourced and there needed a to be a plan-inwaiting for the manufacture, procurement and distribution of vaccines. The slavish belief in a global market protected by so called free trade agreements resulted in insufficient manufacturing capability in areas like essential personal protective equipment. This placed our members lives at risk. COVID-19 didn’t come out of the blue. There have been several pandemics on our doorstep in Asia over the last few decades. Many Asian countries heeded the warnings from SARS and MERS and strengthened their public health systems and prepared their public health responses. All these countries responded much more quickly, decisively and effectively to the outbreak. Our lack of preparedness and the extended fight needed to get agreement to even fit test for respirator masks was an indictment of a system focused elsewhere. Australia’s response, like many countries in the western world, has been shaped by an immediate concern for the economy coming before life and the health of the community. It is now clear that a lack of worldwide supply of respirator

Nurses everywhere are telling us that they are barely coping. masks delayed the acceptance of the immediate need for communities to adopt face masks as an early defence to an airborne pathogen. Our capacity as an island to close borders meant there was complacency in securing adequate early supplies of vaccines. Deep into the pandemic, with a year to prepare and numerous vaccines on tap, vulnerable frontlines like quarantine and aged care were unconscionably neglected and left exposed. Underpinning this neglect of public health is the misguided idea that health is somehow not a top economic priority. That it is an expense not an investment.

SOLIDARITY IS NEEDED TO GET US THROUGH At another level the pandemic has shown how important collective action and solidarity is to deal with a public health emergency. At least some of the vaccine hesitancy that has proved an obstacle to resolving the crisis has its roots in a culture of individualism and a narrow interpretation of freedom. I am deeply saddened by the loss of nurses and midwives who have made choices to end their employment rather than be vaccinated. They have a strong belief in their own individual choice which overrides the greater good of a vaccinated society where nurses and midwives do every reasonable thing to protect themselves and their patients from serious harm. It has been jarring to hear some of our leaders harping on about individual responsibility when

a sense of solidarity and civic mindedness, a caring for each other as well as for self is the only way out of this predicament. Which brings us to the here and now. For as long as I have been the General-Secretary of this union the Association has been warning successive NSW governments of the vulnerability of our public health system and the need for it to be strengthened and properly staffed and resourced. In this month’s Lamp we look at how the public health system in rural and regional areas has been allowed to degrade to the point where it is leaving local communities dangerously vulnerable. It is equally true of the city where the current outbreak of the Delta strain has put our ICUs and EDs on the brink. Nurses everywhere are telling us that they are barely coping. And it is only because of their heroic sacrifices that the system itself is hanging on. But this state of affairs is totally unsustainable. This month we also look at the latest ratios research from the United States. It documents how ill prepared US hospitals were for the pandemic. We know that there are parallels here in Australia. It concluded that “a robust nursing workforce is essential for addressing the current and future outbreaks”. This is something we have relentlessly fought for in our ratios campaigns and something we will relentlessly continue to fight for. n

THE LAMP OCTOBER/NOVEMBER 2021 | 5

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YOUR LETTERS

Have your

Say

Taking advantage of nurses Very recently, I was admitted to South East Regional Hospital on the morning of a pretty difficult day in the Emergency Department. Locally, there had been a dreadful two-car accident, requiring victims to be helicoptered out to tertiary hospitals, another to ICU, and the full attention and care of all staff there. As I lay in my bed, it was obvious to see the stress that this placed on the department and hospital at large. Despite the ensuing crisis, though, the remaining patients received nothing but stellar care, and when this attention was difficult to render in quantity, I was so impressed by the communication of nursing and medical staff alike. I can only imagine the missed breaks and pit stops that they had to endure. What really concerned me in all of my stay was the number of staff, who at personal expense were working double or extra shifts and continued to provide highlevel care. I know how much this takes from you on a personal level. A young night shift nurse put it most succinctly when she said to me in tired resignation: “I don’t think I even care about the money anymore; I just wish we had decent nurse-patient ratios.” My heart sank hearing this, not because it was a new state of condition nurses had to work under, but because it has been this way since I began nursing in the ’70s. It occurred to me that despite the constancy of this situation and having supported the too-numerous attempts of nurses and their representatives over all those years, not much has changed in this picture.

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I am so saddened and angry to realise that our governments, both federal and state, still don’t value or support our nurses in a personally and professionally tolling industry. I think they take advantage of the common nature of nurses to care about what happens to their patients if they were to strike. Nurses are forgotten then, placed in lower consideration behind economy and politics. So, I doff my hat to those who keep stepping up, but in a perverse way, I really hope you don’t. I hope you learn and allow yourselves the “luxury” of looking after yourselves and those who support you. You are entitled to a private life that isn’t interfered with by the profession you chose. You are also entitled not to feel guilty about that, too. You must look after yourselves, or you’ll have nothing left to give to your precious relationships nor to your patients. I am so grateful for your professionalism and care during my recent hospital stay. Now, I hope you extend that precious observance to yourselves. Jacqui Ashworth, Retired Member

*Conditions apply. Competition entries from NSWNMA members only and 6limited oneOCTOBER/NOVEMBER entry per member. Competition opens 1 October 2021 | THE to LAMP 2021 and closes 10 November 2021. The prize is drawn on 12 November 2021.

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.

LETTER OF THE MONTH Staff shortages are not negativity but a fact Union [also known as a trade union] noun: an organisation of employees for mutual aid and protection, and for dealing collectively with employers. (Macquarie Dictionary, 2021) Mr Hazzard, nurses and midwives on the frontline, and working across our public health system are the NSW Nurses and Midwives’ Association. We are the union. And just to clarify, not only have the NSW AMA and the NSWNMA voiced concerns about staff shortages, but so too has the HSU Ambulance Division. This is not negativity, this is a fact! Frontline workers have been calling on the NSW state government to deliver safe staffing ratios for our state. Our public health system does not have appropriate staffing levels. Our workloads are not sustainable. We were under pressure before the pandemic, and we are under even more pressure during a pandemic! What will it take for the NSW government to listen to frontline workers? It’s time the NSW government listened to the evidence that is literally in front of them, and properly staffed and resourced our health system. Skye Romer, EN

Letter of the month If there’s something on your mind, send us a letter and have your say. The letter of the month will WIN a gift card. The letter judged best each month will receive a $50 Coles Group and Myer gift card.

Incompetence kills I’ve worked in ICUs and ED for over 40 years. From 2000 to 2017, I worked at one of Sydney’s biggest and busiest hospitals. In ED, I would get a four to five patient load, but at times would look after eight beds. As long as you didn’t go on a break, you had a chance with the turnover. Take a break, and you had six new patients and were “behind the 8-ball”. If you were quick, you had a chance to welcome them to the unit, ask their symptoms, get them comfortable while doing their obs, cannulate if needed, start IV fluids, take bloods, and then get a doctor to prescribe pain relief immediately (never let the system tell you the patient “hasn’t been taken up by a doctor yet”). That said, back then, you could offer the patient a pillow and a blanket, and ask the family if they wanted a cuppa. I still work those areas. However, we now have less staffing, a greater workload and less time. On nights, no one has a break through a 10-hour shift. I frequently come on to find sick patients who haven’t had obs done for six to eight hours. Frequent clinical review calls and rapid response calls are becoming almost a daily event. Not having safe ratios is killing people, and this means that the NSW government is killing people through incompetence, apathy and inaction. But don’t worry – “it’s only one in 350,000 who are dying” – seems to be the common phrase these days, and no longer “sadly, a 45-year-old woman (with small children, a husband, a family, a job) has died tragically”! Safe staffing ratios are essential in ED, as they are everywhere. Bernhard Racz, RN

Government arrogance towards nurses is a disgrace Striking is a last resort, but professional nurses have waited long enough! Enough is enough! I’ve had enough of the arrogant ignorance displayed for many years by federal and state governments towards nurses. It’s a disgrace. Politicians are not special; they choose to enter politics for all the reasons nurses and general public are well aware of. The Women’s March this year has certainly highlighted what politicians should not be doing at taxpayers’ expense. Politicians should bow their heads in shame. Honour our requests for improved work conditions and salaries. We deserve every cent we earn. Increased salaries and safety ensure we have the stamina, physically and mentally, to care for others. Claudea Donlan, RN THE LAMP OCTOBER/NOVEMBER 2021 | 7

COVER STORY

Delta unmasks rural neglect The Berejiklian government plays the blame game as Sydney’s Delta outbreak spreads to regional areas with under-resourced healthcare facilities.

ccording to the NSW government, the Delta variant emerged on 16 June, when an air-crew driver working under lax NSW Public Health Orders that did not require him to wear a mask or be vaccinated, was diagnosed. By then, the driver had visited a dozen sites in Sydney’s eastern suburbs. Gladys Berejiklian waited until 25 June before imposing a light lockdown on parts of the city’s east. The virus seeded into Western Sydney. Loose reg ulations a llowed movement between Sydney and the rest of NSW: for work, to look at real estate, to get COVID-19-tested, or to visit a second residence, for example. Delta subsequently spread across the state. Rural communities with limited and under-resourced healthcare facilities have been grappling with the consequences. Healthcare services for people outside of Sydney were dire even before COVID-19. This was made clear in a December 2020 submission from the NSWNMA to a state parliamentary inquiry into health care in rural, regional and

8 | THE LAMP OCTOBER/NOVEMBER 2021

‘ The NSW government’s response has been a blame game.’ — Anne Davies, The Guardian remote NSW. The NSWNMA submission said: “It is not acceptable that residents in the rest of NSW are provided with an inadequately resourced, substandard system of hea lt hca re while metropolitan Sydney residents enjoy far superior access and outcomes.” It made 24 specific recommendations for improvements, i nclud i ng b o o s t i ng nu r si ng numbers at sites with no doctor to ensure a minimum of three per shift – two of whom would be RNs. It also recommended better staffing of emergency departments and recruiting more nurse practitioners. Remote indigenous communities with higher rates of chronic illnesses such as diabetes or kidney disease and shamefully low vaccination rates – a shared federal and NSW responsibility – are particularly vulnerable to COVID-19. “Indigenous Australians were one of our greatest concerns at the start of this pandemic,” Prime Minister

Scott Morrison said in December. Morrison’s actions failed to match his rhetoric. Despite Aboriginal people over 12 being prioritised as 1B in the rollout, only 6.3 per cent of the Aboriginal population in Western NSW was fully vaccinated by 26 August, compared to 26 per cent of the nonIndigenous population in the region, ABC News reported.

ABORIGINAL COMMUNITIES DANGEROUSLY EXPOSED Human Rights Watch accused bot h t he federa l a nd NSW governments of leaving Aboriginal people “dangerously exposed to COVID-19 with limited access to vaccines”. The Maari Ma Aboriginal health service in the Far West warned both the NSW and federal governments in March 2020 that they needed to urgently prepare for an outbreak. However, t he Bereji k l ia n government ref used to ta ke

COVER STORY

COVID-19 floors 30 per cent of remote community

any responsibility. Hea lt h Minister Brad Hazzard agreed the v a c c i n a t ion r ol lout to Aboriginal communities had been “challenging”, but said it was a federal government responsibility. As The Guardian’s Anne Davies wrote: “The NSW Government’s response (to the worsening Delta crisis) has been a blame game … When it comes to the state’s role there is a stubborn reluctance to admit there may be a better way.” On Aboriginal health, the NSWNMA submission says Aboriginal people in regional, rural and remote parts of NSW should have access to Aboriginal Community Controlled Health Services. Epidemiologist Dr Peter Malouf, from the Aboriginal Health and Medical Research Council of NSW, told a parliamentary inquiry into the pandemic that the state government was “very lacking in engagement, particularly listening to the voices of Aboriginal people”. n

The remote settlement of Enngonia in north-west NSW has no hospital, no resident nurse, and no shop. Its mostly Aboriginal residents must travel 97 kilometres to Bourke for health care and groceries. By the third week of September, COVID-19 had infected 25 – or about one third – of the township’s indigenous population, said Tannia Edwards, CEO of the Murrawarri Local Aboriginal Land Council in Enngonia. The virus had also claimed the life of a beloved elder. Ms Edwards told The Lamp that vaccinations were not provided at Enngonia until shortly before the township’s first infection, which followed positive cases in Bourke and Dubbo. She said vaccination should have started once the virus reached Dubbo, almost 500 kilometres away, because Enngonia residents often travelled there on public transport. She said government health messaging on COVID-19 had been poor. “It’s not people’s fault they weren’t getting vaccinated. We needed

better messaging, because not everyone can understand what’s happening on TV.” She said it was hard to self-isolate when as many as 12 people could be living in a four-bedroom home. “It’s not possible to tell small children they’ve got to stay in a room for 14 days. It’s not possible, and it’s cruel.” She said rural fire service volunteers were doing a great job, delivering food parcels to the community. Health service manager for the Bourke Aboriginal Health Service, Claire Williams, told The Guardian the public health response to Delta was “chaotic” and said it wasn’t clear who was in charge. The Aboriginal Health Service is running a vaccination clinic in Enngonia and delivering medicines. Western NSW Local Health District said it was doing “routine COVID-19 testing” in Enngonia and had begun “a household-by-household assessment of the community’s health and social needs”. It said COVID-19 vaccination of indigenous Australians was a federal responsibility. n

‘It’s not our people’s fault they weren’t getting vaccinated. We needed better messaging, because not everyone can understand what’s happening on TV.’ — Tannia Edwards, Enngonia Murrawarri Local Aboriginal Land Council

THE LAMP OCTOBER/NOVEMBER 2021 | 9

COVER STORY

Neglected bush pays for Berejiklian’s bungling Delta exposes the inadequacies of NSW health services and pandemic response planning for remote Aboriginal communities.

he coronavirus hotspot of Wilcannia is 1000 km by road from Sydney, located on the Barrier Highway to Broken Hill. When the Berejiklian government refused to immediately lock down Sydney hotspots in June, then dithered on travel restrictions to the regions, Wilcannia nurses began to fear the worst. “In the first weeks of the so-called lockdown, people were leaving Sydney and coming out here in convoys,” said RN Suzy Pluker, president of the NSWNMA’s Far West Rural and Remote Branch, who works at Wilcannia MultiPurpose Service (MPS). By early August, the virus was spreading among the Aboriginal community in Dubbo, a day’s drive east of Wilcannia. “That’s when we knew Wilcannia would be in for it,” Suzy said. “Indigenous communities are highly mobile and family obligation is everything. “For instance, if one of your family members dies, you’re obliged to go to the funeral, and you will travel big distances for it. “Pandemic response planning could have recognised that if the virus gets into any rural town with an indigenous population, it will spread to other communities. “Howe ver, ef fe c t ive r i sk assessments appear not to have been done. 10 | THE LAMP OCTOBER/NOVEMBER 2021

‘ In the first weeks of the socalled lockdown, people were leaving Sydney and coming out here in convoys.’ — Suzy Pluker “On paper, there may have been plans to stop the spread, but they had no practical effect. “It’s not enough to say to people ‘don’t travel’; you have to put up checkpoints along the highway and other routes.”

SOUTH AUSTRALIA’S TOUGHER APPROACH MORE SUCCESSFUL Suzy points to the tougher, more successful approach taken over the border in South Australia, where authorities blocked the highway from Broken Hill and side roads. “The police effectively blocked dirt roads that cross people’s properties, by giving owners padlocks for their gates and putting up cameras. You can’t sneak into SA.” Wilcannia MPS includes a twobed ED and an eight-bed residential aged care unit. Before the virus hit the town, the MPS usually had only four senior RNs plus junior nurses to provide 24/7 coverage and crew the local ambulance. There was no resident doctor.

For a time, only two senior RNs were available – and they had to work 12-hour shifts. Perpetual understaffing made it difficult for nurses to travel to the nearest supermarket in Broken Hill, 200 km away, or to take booked leave. Suzy’s home is over the border in South Australia, but she hasn’t been able to take time off to get back there since November 2020. Advice on pandemic preparation sent by the Ministry of Health to Wilcannia MPS included a surge process that gave nurses permission to work 12-hour shifts. “We laughed at that because we’ve been having to do 12-hour shifts for ages,” Suzy said. “We were begging for staff.” She says the staffing situation at Wilcannia typified Sydney’s neglect of remote health sites.

WARNINGS NOT HEEDED As early as April 2020, The Lamp reported a warning from Pat Turner, CEO of the National Aboriginal Community Controlled

COVER STORY

Isolation dilemma exposes housing scandal “Almost every house has beds in the lounge room. I picked one guy up who was sleeping in an armchair in the laundry. “I haven’t seen any home building happening in the four years I’ve been here.” Ministry of Health plans originally identified caravan park cabins and motel rooms to be used for isolation. However, there are only about 10 cabins and the motel rooms proved impractical, Suzy says. “Like the surge control advice, they didn’t reflect the reality of the town.” Authorities were forced to rush a fleet of 30 motor homes to the town, while some residents slept in tents in their yards or on Wilcannia Oval. n

JENNY EVANS / STRINGER

Health Organisation (NACCHO), that indigenous communities need “resources, equipment and guidelines out on the ground – yesterday” to prepare for COVID-19. When The Lamp spoke to Suzy 17 months later in early September 2021, one in six of Wilcannia’s 650 people had already been infected. National and international media were focused on Wilcannia’s plight and authorities were frantically rushing resources to the town. “Broken Hill sent a team to do hospital in the home and they are checking on people every day. Swab teams and vaccination teams are going house to house,” Suzy said. “We’ve even got a doctor on deck.” “The teams are skilled and motivated and they’re really putting in. Community members I’ve spoken to are pleased that they’re getting hospital in the home and other support. “Telstra has put up a mobile tower and suddenly we can get decent internet and phone calls don’t drop out. It’s amazing what international headlines can do for you.” Suzy hopes all the attention will lead to long-term staffing improvements. “For instance, we have been pushing like hell to get a nurse practitioner. We haven’t got a permanent health service manager and we haven’t got the NUM position filled.” n

In Wilcannia, a long-term housing shortage has made safe home isolation impossible for most residents. Overcrowded homes contribute to poor hygiene, which helps spread the virus. Alcohol and drug abuse and a high rate of illiteracy also make it harder to fight the spread of COVID-19. ABC News reported that the first COVID-19-positive residents of Wilcannia were instructed by Far West Local Health District to isolate in their own homes. But as Suzy Pluker points out, three generations live in twobedroom and three-bedroom houses. Often, more than a dozen people live under one roof. “I crew the ambulance and I’ve been to damn near every house in town,” she says.

THIRTY MOTORHOMES HAVE BEEN SET UP AT THE COUNCIL-OWNED CAMPERVAN SITE IN WILCANNIA TO HELP LOCAL RESIDENTS SAFELY ISOLATE AS THE SMALL REGIONAL TOWN IN FAR-WEST NSW BATTLES WITH A GROWING COVID-19 OUTBREAK. THE LAMP OCTOBER/NOVEMBER 2021 | 11

COVER STORY

Nurses volunteer for West’s pandemic battle Wearing PPE is uncomfortable at the best of times. The level of discomfort goes up a notch when you’re outdoors in hot weather and flies are crawling under your face shield.

ush flies were among the challenges faced by Sydney nurse Lyn Whitlam when she joined the fight against COVID-19 in the outback town of Broken Hill. Lyn, the Branch Secretary and delegate at Ramsay Health Care’s North Shore Private Hospital, flew to the state’s Far West in response to an urgent call for volunteers. “I wanted to do my bit to assist a very remote area of NSW that was struggling to deal with the pandemic,” she said. Lyn was one of five nurses in the first Ramsay team to go to Broken Hill. She did an online COVID-19 vaccination course before starting her 10-day stint in late August. She was seconded to the public health system and divided her time between an indoor vaccination centre and a drive-through testing 12 | THE LAMP OCTOBER/NOVEMBER 2021

clinic on Broken Hill Memorial Oval. “At the testing clinic, I had my Ramsay uniform on with a thin blue apron, N95 respirator, face shield and gloves,” she said. “It was hot, despite it being winter, and I expected someone to swallow a fly every time I asked them to open their mouth wide to obtain the throat swab.”

NOT ENOUGH PPE The out-of-town nurses helped move Broken Hill Hospital’s small immunisation clinic into the town’s civic centre, which enabled an expansion of the vaccination program. The Sydney outbreak had been spreading for two months, yet Broken Hill could not supply enough PPE for the vaccination team, which typically comprised two nurses drawing up the vaccine, four

vaccinating, two in the observation area, and a team leader. “We had to ask Ramsay to send extra PPE, including N95 masks and face shields,” Lyn said. “ There were not enoug h computers and only one printer, and the internet was very poor.” At the drive-through testing clinic, data collection was slow and error-prone due to a lack of computers and QR codes. “The admin staff had to write down all the information – names, addresses, birth dates, Medicare numbers, etc. – then transfer it onto pathology forms, then hand the forms to me or another RN to do the tests. We would get the visitor to check the details and about 10 per cent of forms had incorrect information. “All tests had to be sent back to Sydney for pathology and at one

COVER STORY

DARRIEA TURLEY AM, BROKEN HILL CITY COUNCIL

Bring a cheque, Hazzard told

‘ We had to ask Ramsay to send extra PPE, including N95 masks and face shields.’ — Lyn Whitlam

stage, we were told it was taking five days to get results back.” During the weekend Lyn spent at the testing clinic it received only 148 visitors including locals, truck drivers and other motorists passing through town.

SERIOUS COMMUNICATION ISSUES She says this partly reflects in-adequate COVID-19-related planning and publicity for the outback. “There is a serious communication issue out west and people don’t have easy access to information,” Lyn said. “A lot of locals are in a lower socio-economic group. They don’t have smart phones – they use flip phones or land lines – and don’t have computers. They can’t make appointments

online and they can’t access their vaccination records. “The local newspaper is now only available online and the town is in lockdown, so meeting places like pubs and clubs are closed. “The word about testing and vaccination hasn’t been getting out. Very few of the local nurses had received their first dose of vaccine when we were there.” Lyn has told Ramsay she’s happy to volunteer again at a vaccination or testing centre, including in Broken Hill. “Hopefully they will move the testing centre indoors for summer, but I’d be taking a fly net just in case.”n

Broken Hill Mayor Darriea Turley urged Health Minister Brad Hazzard to commit to more support for health services in the Far West when he made a flying visit to the region in September. Cr Turley said local COVID-19 contact tracers were struggling to keep up. Addressing Hazzard via ABC Radio, she said: “Please bring some relief for these staff. And please make sure you review essential travel, and you review regional travel. “To come from a hotspot, two hotspots, and travel around – lovely of the minister, but please bring a cheque.” Cr Turley later told a parliamentary inquiry that the spread of the virus in overcrowded housing in the Far West should have been planned for, given how well known the problem was. She said decades of underfunding for health and housing services in Aboriginal communities had laid the groundwork for the crisis. “The deep cuts to funding, the disrespect these communities are being shown, the lack of planning, has made them vulnerable,” she said. Central Darling Shire administrator Bob Stewart told The Australian that the Wilcannia outbreak had “led to emergency management scrambling to find solutions to a long-term legacy issue”. “It represents a massive failure of government over many years to address the basic human right of shelter, despite the warning signs contained in various reports and submissions,” Stewart said. n THE LAMP OCTOBER/NOVEMBER 2021 | 13

COVER STORY

Understaffed rural hospitals brace for COVID-19 COVID-19 is yet to infect the twin townships of Harden and Murrumburrah, but the local hospital already struggles to find enough nurses.

urses at MurrumburrahHarden District Hospital, about 350 km south-west of Sydney, are in “a heightened state of preparedness” for any COVID-19 outbreak, says RN and clinical nurse educator Marilyn Wales. “We conduct ‘desktop’ scenarios all the time,” Marilyn says. “What do you do if you get a potentially positive presentation, or a staff member develops symptoms? What do you do if you see a breach of PPE?” “The reality is that COVID-19 is going to come out to small country hospitals like ours. Essential workers pass through our town all the time and stop for meals and fuel.” An “essential worker” who visited Harden-Murrumburrah, population 2000, later produced a positive result but there was no local transmission. Marilyn is secretary and delegate for the NSWNMA’s Harden branch. She shares ideas with NSWNMA members at hospitals across the state through fortnightly webinars and other teleconferencing. “Every facility talks about staff shortages and inadequate skill mix and how hard it is to attract staff – especially experienced nurses – to small rural hospitals. “M u r r u m b u r r a h - H a r d e n ’s casual pool is very limited, and 14 | THE LAMP OCTOBER/NOVEMBER 2021

‘ Our premier keeps saying our health system is coping. But staff are having to work 12- or 16hour shifts and work on their RDOs.’ — Marilyn Wales we often have difficulty engaging agency staff, partly because of COVID-19 restrictions. “The nursing population is ageing and we are losing senior nurses who are FLECC (first line emergency care course) trained. That training gives us the ability to use the rural adult emergency care guidelines and administer certain drugs in the absence of a doctor. “Senior nurses who leave are often replaced by RNs who have just completed their graduate year. They are put in charge of a hospital on weekends and nights with no doctor. That is just asking for trouble.” Murrumburrah-Harden Hospital has nine acute beds and 20

residential aged care beds. It has a VMO on call. Like many small sites, the RN in charge of the acute ward is also in charge of ED. “If we had a respirator y presentation and had to isolate that person, it would take a staff member away for the entirety of that presentation,” Marilyn says. “We don’t have the staff rostered on to manage that. “If we get a COVID-19 case, one or more staff members may have to isolate for the required 14 days. If we take out two or three staff, we could be at service failure, because we don’t have the clinical staff resources to replace them.

COVER STORY

Bush the poor cousin in Pfizer rollout

“My heart broke when I heard that the department was thinking of fast-tracking students into hospitals. It’s an awful atmosphere to ask someone to start their career – in a pandemic. “Students are already at risk of not being able to register with AHPRA (Australian Health Practitioner Regulation Agency) due to incomplete placements. “Another government proposal was to bring back retired nurses. People retire for a reason and to bring them back and put their physical and mental health at risk is a big ask. “Our Premier keeps saying our health system is coping. But staff are having to work 12- or 16-hour shifts and work on their RDOs. “We might be coping at the moment, but we are not functioning in the proper manner, to the best of our abilities. For us to function we need to have enough staff with the required skills.” Marilyn, who has nursed in Temora, Narrandera and Murrumburrah-Harden hospitals for 51 years, says she’s concerned for all nurses at this time. “I’m especially concerned for the girls in Sydney. I cannot comprehend what some of them are going through.”n

As COVID-19 spread from Sydney to regional NSW in late July, Gladys Berejiklian ordered 40,000 Pfizer doses to be redistributed from the regions to Sydney. Berejiklian wanted the vaccine for Sydney Year 12 students so they could return to classes for the HSC. With Pfizer in short supply due to the Morrison government’s bungled procurement process, Berejiklian’s decision did not go down well in the bush. “There are frontline healthcare workers who [still] haven’t been vaccinated [in regional areas],” Rural Doctors Association of Australia’s CEO Peta Rutherford told ABC News. Opposition came from the premier’s own side of politics. Member for Calare and federal minister Andrew Gee called for the Central West to be exempted from the reallocation of Pfizer doses.

“Having just come out of lockdown, it’s not the right time to be diverting the Pfizer doses to the city. We’re only out of lockdown for two days and we’ve got COVID-19 traces in the sewer at Molong,” warned the National Party MP. Roy Butler of the Shooters, Fishers and Farmers Party, whose state electorate of Barwon stretches from Walgett, Narrabri and Coonabarabran in the east to Broken Hill in the west, also expressed concern. “There’s a stack of people in Walgett who were booked in to get the vaccination, only for them to have their appointments unexpectedly cancelled,” Butler said. Less than a fortnight after Berejiklian’s announcement, health officials were rushing to send 1200 doses of Pfizer back to Walgett after the virus hit the town and large swathes of north-western NSW went into lockdown. n

‘ Having just come out of lockdown, it’s not the right time to be diverting the Pfizer doses to the city.’ — Andrew Gee

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COVER STORY

Country hospitals lose doctors and senior nurses What does it mean for a nurse to be made responsible for a hospital with no doctor?

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IMAGE: ALYS MARSHALL

ee Waa Community Ho s pit a l, 5 76 k m north-west of Sydney, is a 15-bed acute care hospital with a 24-hour ED. Like many small health facilities in NSW, it has no regular Visiting Medical Officer and has lost its on-call GP. Occasionally, a locum is found to cover weekends. At all other times, Wee Waa relies on nurses. The ratio is three on morning and afternoon shifts, and two on nights. Often, however, only two nurses can be found to cover mornings and afternoons because the hospital can’t recruit enough staff – a common problem in small towns. RN and NSWNMA member Susan Marshall has worked at Wee Waa hospital for 27 years. She says that since it lost its on-call GP, the hospital has found it harder to keep senior nurses and attract agency staff. “When there are only two nurses on the ward, and they attend an ED presentation, they sometimes have to ask the domestic staff to keep an eye on the high-care patients. “Two nurses are not enough, for example, to resuscitate a patient and cover the ward as well as make calls to a telehealth doctor.” Some senior nurses have FLECC (first line emergency care course) qualifications, which allow them to initiate higher levels of assessment and treatment. However, nurses often feel intimidated and vulnerable due to the absence of a doctor,

‘ It seems the government wants staff to be FLECC-trained to plug the gap left by the doctor, but it’s not entirely safe.’ — Susan Marshall, RN and NSWNMA member

COVER STORY

Susan says. “It seems the government wants staff to be FLECC-trained to plug the gap left by the doctor, but it’s not entirely safe. “If you must work outside your scope of practice to get the job done, you can feel insecure. “Not feeling professionally secure in the workplace can lead to unhappiness with the job – and many senior nurses have left. “I feel I’m doing a job that’s not always recognised – and I don’t always feel supported by the system.”

TELEHEATH NOT ENOUGH Susan does not believe that telehealth can always fill the gap created by the absence of a doctor. “There will always be cases when you need a doctor on site. “We are supposed to call the ED doctor in Tamworth, but they often don’t have time for a Wee Waa problem, though they are sympathetic to our predicament. “I have rung them with triage 1 and 2 patients, and they say, ‘I’m running a resus here and I haven’t got time for you.’ Their workload has increased because we no longer have a doctor.” Susan says having no medical coverage has led to more patient transfers – sometimes to Narrabri (30 minutes away) but mostly to Tamworth, which can be a sixhour round trip.

“This puts pressure on the ambulance service and leaves our community very exposed without ambulance cover.”

COVID-19 WOULD BE THE LAST STRAW It also puts more pressure on Wee Waa’s nurses, who are sometimes questioned by ambulance control over whether a transfer is necessary. “The ambulance coordinator will say, ‘Do you really need to transfer this patient? I don’t have an ambulance to do it and my staff are on overtime.’ “To have to debate this with the ambulance coordinator, who isn’t local, is frustrating and eats up time that we don’t have.” Wee Waa has so far been free of COVID-19 but if it strikes the hospital, “it could be the straw that broke the camel’s back,” Susan says. “If someone had to get all PPE’d up to look after a possible COVID-19 presentation in ED, they would not be able to float back to the ward. “If one or more nurses went into isolation, the department would have to draw staff out of a higher population area or reduce services. “Compensating within the current roster is just not possible – even with overtime.” Susan says the hospital has enough PPE, but staff are still waiting for fit testing to be provided. n

Barilaro forced to apologise Deputy Premier John Barilaro was forced to apologise for “highly offensive” comments he made comparing a funeral in the western NSW town of Wilcannia – attended by about 300 people in compliance with the health orders at the time – to “the 16 dickheads in Maroubra” who spread COVID-19 after having a party in breach of lockdown rules. Barilaro’s comments were made just days after the NSW Health Minister Brad Hazzard expressed regret for comparing the two gatherings. The Wilcannia funeral took place on 13 August. At that time the shire was not in lockdown, funerals were permitted, and police had confirmed the event was COVID-19-safe. The far-western Shooters, Fishers and Farmers MP Roy Butler said Barilaro’s statements were “devoid of fact, highly offensive and must be retracted immediately”. “There was not a single offence by Wilcannia residents detected by NSW police before, during or after the funeral. There were no breaches of the health orders by anyone living in Wilcannia,” Butler said. “The Wilcannia community have done everything in their power to protect themselves from COVID-19. They have made sacrifices in the past 18 months beyond anyone’s comprehension.” n THE LAMP OCTOBER/NOVEMBER 2021 | 17

PUBLIC HEALTH SERVICE

ICU nurses struggle to maintain standards Politicians say hospital staff are “coping” during the pandemic, but ICU nurses tell a different story.

undreds of intensive care nurses across NSW have signed an open letter to Gladys Berejiklian, pleading for more staff. “Given the chronic unsafe staffing conditions, exacerbated by COVID19, we cannot deliver the care you expect us to provide and the level of critical care our patients rightly deserve,” the letter said. More than 700 ICU nurses had signed the letter by early September. It said ICUs were in crisis even before the pandemic. “ We ex p er ienced ch ron ic understaffing, an increased junior skills mix as a result of senior staff leaving due to burnout, and everincreasing workloads. “The added demands of [COVID19]… are forcing our clinical workforce to the brink, placing our registration at risk on every shift and compromising safe patient care.” NSWNMA General Secretary Brett Holmes said members wanted assurances from Premier Berejiklian and Health Minister Brad Hazzard that a one-to-one nurse-to-patient ratio would be mandated for ICUs

18 | THE LAMP OCTOBER/NOVEMBER 2021

‘ We cannot deliver the care you expect us to provide and the level of critical care our patients rightly deserve.’ — Nurses’ letter to Berejiklian after the current health emergency. “Members have told the Association of the need for ACCCN staffing standards to be introduced as a minimum for all ICUs,” he said. Following media coverage of the letter, Hazzard met with a representative group of ICU nurses led by the NSWNMA and agreed to further meetings. Hazzard had earlier assured a media conference: “All the information given to me from the doctors and nurses and our public health staff is that the system is coping.” Premier Berejiklian predicted October would be the worst month for people needing intensive care, and added: “Once we start reopening, cases will go through the roof, but it won’t matter so much as we will be vaccinated.”

SHORT-STAFFED BEFORE COVID-19 NSW NM A member Louise Nakkan is a 30-year veteran of Westmead Hospital Cardiothoracic ICU, where she is a clinical nurse educator (CNE). Louise says there is “a huge disparity between what we are seeing on the front line and what the government and top management are saying.” “I’ve never seen it this tough before. We’re hanging in there, but some days are dire.” Westmead’s ICU has a 36-bed General ICU section divided into three “red” pods for COVID-19 patients. A separate, 10-bed cardiothoracic pod cares for “green” nonCOVID-19 patients and “amber” patients who are in isolation and awaiting COVID-19 test results.

PUBLIC HEALTH SERVICE

‘ There is a huge disparity between what we are seeing on the front line and what the government and top management are saying.’ — ICU nurse and NSWNMA member Louise Nakkan

Louise said ICU had serious staffing and management issues even before COVID-19. “NSW Health didn’t do enough to recruit and to keep the staff they already had. “Going into a pa ndemic desperately short-staffed, they decided everyone had to rotate through shifts. This took people away from shift patterns they’d worked for many years, and it led a lot of them to resign. “Some retired and others went to vaccination hubs, where if you’re working for a private enterprise it’s good money and a lot less stress. “In my pod, cardiothoracic, we have lost nine mostly part-time staff over the last three months. That’s a huge resource of knowledge lost to the system. “Management just doesn’t listen to what people want – things like safe staffing, fair rostering, ability to take annual leave and fair pay.”

SOME SHIFTS ARE CHAOS Louise said that on any given shift, General ICU could be short eight or more nurses, based on already inadequate staffing ratios. “You can’t just pull eight nurses out of thin air, so it’s just a matter of surviving from one shift

to the next.” Additional staff were upskilled to become critical care nurses last year, but Louise says they are no longer available. “We’ve had to start again, with staff from theatres, recovery and the casual pool frantically being upskilled.” Louise works mainly in the cardiothoracic pod, with nurses who have worked alongside each other for up to 20 years. “It’s a real team approach and we always try to have each other’s backs, but some shifts are chaos. “Yesterday, the nurse unit manager, clinical consultant and the other CNE were all on the floor because we were down staff. “We try to look out for each other, but everyone is exhausted and fearful about what comes next in the pandemic. “Nurses working in the red pods are in full PPE – P2/N95 respirator, goggles, hair net and fluid-impervious gown – nearly all the time and it’s exhausting. They come out drenched in sweat.” Nurses are also under the strain of trying to comfort very sick people who cannot have visitors. “We’ve had a lot of deaths and

you feel very sad, but you don’t have time to debrief. You clean the room and send the patient to the morgue and you’re setting up again for the next patient.” Louise adds that Westmead’s emergency department “is in its own world of pain. Some days there are a dozen ambulances parked outside waiting to offload patients.” The pandemic has thrown up issues such as PPE, fit testing and staffing for safe workloads, which has led to more ICU nurses getting involved with the NSWNMA at the local level. “People have become much more aware they need to be informed and have their say,” Louise says. “We’ve had big turnouts of staff logging on to see what’s happening and what issues the union is taking forward for us. “People realise the union is there to help us keep ourselves safe and our patients safe.” Meanwhile, the NSWNMA has filed a dispute in the Industrial Relations Commission over unsafe staffing of Westmead’s COVID-19 wards, where nurse-to-patient ratios are well below those comparable with other major hospitals. n

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RATIOS RESEARCH

Pandemic exposes the vulnerability of under resourced health systems A new US study highlights how COVID-19 battered an already poorly resourced and vulnerable health system.

ven before the arrival of COVID-19, US hospital nurses were already struggling with high patient workloads and frequent operational failures, including missing supplies and missing or broken equipment, according to new research. The study covered over 250 hospitals from November 2019 to February 2020 – before the surge in COVID-19 cases – and the findings were published in the British Medical Journal. Nurses surveyed in the study gave a damning assessment of the state of their hospitals prior to COVID-19. “Nearly half give their hospitals unfavourable grades on patient safety, a third give unfavourable grades on infection prevention and almost 70 per cent would not definitely recommend their hospitals,” researchers found. “The majority of nurses report their work was frequently interrupted or delayed by insufficient staff and a third of nurses report interruptions or delays from missing supplies including medications and missing/ broken equipment.” The study found that half of nurses were experiencing high burnout, and one in four planned to leave their job within a year. Over two-thirds of nurses would not recommend their hospitals to family and friends needing care, and almost half reported unfavourable patient safety ratings.

20 | THE LAMP OCTOBER/NOVEMBER 2021

‘ A robust nursing workforce is essential for addressing the current and future outbreaks.’ Patients corroborated this assessment. A third of patients rated their hospitals less than excellent and said they would definitely not recommend them. The researchers describe the COVID-19 pandemic as “a realtime example of the public health implications of chronic hospital nurse understaffing”. “Indeed, the pandemic has highlighted some of the pre-existing realities and inequities within the US healthcare system – among them: understaffed hospitals, a

burned-out clinician workforce and poorer health outcomes among racial minorities,” it said. The study cites other research into the public health implications of nurse understaffing for patients with COVID-19, which found that countries with higher workforce concentrations of RNs had lower COVID-19 mortality rates. This, it concludes, highlights that “a robust nursing workforce is essential for addressing the current and future outbreaks”. n

RATIOS RESEARCH

Sign an open letter to NSW Government’s premier and health minister The NSWNMA has launched an online community campaign in support of nurses, midwives and ratios. Nurses, midwives and community members are encouraged to sign an open letter to Gladys Berejiklian and Brad Hazzard. The letter asks them to value the extraordinary contribution of nurses and midwives, and to support them at work and improve patient outcomes by implementing shiftby-shift ratios. To sign the letter, go to:

AUSTRALIAN NURSING & MIDWIFERY FEDERATION FEDERAL OFFICE

Financial Report

From 20 October 2021, the ANMF Federal Office Financial Report for the year ended 30 June 2021 will be available at www.anmf.org.au. Members without internet access may obtain a hard copy of the report by applying in writing to: Australian Nursing & Midwifery Federation Finance Officer Level 1, 365 Queen Street Melbourne VIC 3000

There are also several videos of nurses talking about conditions on the frontline: Skye Romer https://www.facebook.com/ watch/?v=3231079470446542 Jodi Gough https://www.facebook.com/nswnma/ videos/278685583706975

ACTU TV advert in support of essential workers The ACTU has launched a television advertisement encouraging the public to support essential workers like nurses by getting vaccinated. You can watch the ad at: https://www.youtube.com/watch?v=M4Qesf_M4xQ

Australian Nursing & Midwifery Federation NSW Branch

FINANCIAL STATEMENTS & DISCLOSURES From 21 October 2021, the Australian Nursing and Midwifery Federation New South Wales Branch will make available to members the following reports and disclosures for the year ended 30 June 2021: • Audited Financial Statements • Officer & Related Party Disclosures They will be available on Member Central’s Member Resources – Governance page at online.nswnma.asn.au. Members without internet access may obtain a hard copy of the statements by applying in writing to: Brett Holmes, Branch Secretary ANMF NSW Branch 50 O’Dea Avenue, Waterloo NSW 2017 THE LAMP OCTOBER/NOVEMBER 2021 | 21

NURSING EDUCATION

Pandemic sows chaos in nursing education Thousands of final year nursing students may not graduate this year as placements are cancelled and rosters disrupted.

public hea lt h system that was already underresourced and under stress before the pandemic, and which is now at breaking point with the outbreaks in NSW and Victoria, will face additional pressures in the future as many nursing students may be ineligible to graduate this year. The Australian College of Nursing estimates that almost 20,000 nurses across Australia are due to graduate at the end of their final semester. Surveys conducted by the NSWNMA indicate that at least 40 per cent of students are at risk of being ineligible to complete the placements required of their threeyear degrees, as COVID-19 disrupts the healthcare system. In a report released earlier this year, the International Council of Nurses (ICN) warned that such disruptions “risk delaying or restricting the workforce supply, which on top of the predicted shortages resulting from the effect of COVID-19 could further exacerbate existing workforce shortages”. “The strength of the future nursing workforce depends on a

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‘ The strength of the future nursing workforce depends on a continuous flow of new registered nurses from the nursing education pipeline. Delays in the education sector will lead to failures into the future.’ — International Council of Nurses

continuous flow of new registered nurses from the nursing education pipeline. Delays in the education sector will lead to failures into the future,” it said. “Investment in nursing education and jobs is needed to improve retention of the current nursing workforce and address the global nurse shortage.” The ICN report found that, one year on from the World Health Organization declaring COVID-19 a pandemic, nearly one in five of the national nursing associations surveyed reported an increase in the number of nurses leaving the

profession. Ninety per cent of those leaving cited heavy workloads, insufficient resources, burnout and stress as factors that were driving them out of the profession. In Australia, the 2020 Aged Care Workforce Census reported that 29 per cent of employees had left their jobs in the 12 months up to November 2020 and there were almost 10,000 vacant roles in aged care alone. That was before the current COVID-19 outbreaks in Victoria and New South Wales. n

NURSING EDUCATION

Nursing students face anxiety, financial stress and an uncertain future NSWNMA Assistant Secretary Shaye Candish says the COVID-19 pandemic is causing havoc for NSW nursing students.

“

Final year students are trying to complete their practical placements; they are suffering financial stress from funding travel and accommodation to unpaid placements, and their eligibility to graduate is uncertain,” she said. “Every nursing student has to complete a minimum 800 hours of placements to register. You can’t register and become an RN without those hours. “If students can’t graduate, it is also going to have an impact on the workforce next year, which is already suffering from staff shortages.” Shaye says students have told the Association they are often being placed in hospitals far from where they live, potentially breaching COVIDsafe policies. “Students who live in the inner city are being sent into the eastern suburbs, and people in the eastern suburbs are being sent into the inner city,” she said. There is also come confusion about whether placements in vaccination centres will count towards a student’s 800-hours requirement. “While up to 40 hours of work in a COVID-19 vaccination clinic can be counted towards a degree as clinical placement, there have been many instances of people spending two-

week or four-week placements in a COVID-19 vaccination hub, with uncertainty over whether those hours count,” says Shaye. After her practical placements were disrupted by COVID-19, Emilie Heath, a second-year international Master of Nursing student at the University of Sydney, is concerned that she will not be able to complete her degree before she has to return home to Canada. “My very first placement in 2020 was cancelled, and I have been behind ever since,” says Emilie, whose year group has been faced with constant cancellations and interruptions to their placement since they commenced their two-year degrees in 2020. “I need a minimum of 860 hours to graduate, and I have 140 hours of placement left to complete. AHPRA has changed the hours to 800, but the University of Sydney adheres to their own rule of law, which is 860, which I think is completely unfair.” n

STUDENT NURSE, EMILIE HEATH, FACES AN UNCERTAIN FUTURE

‘ If students can’t graduate, it is also going to have an impact on the workforce next year, which is already suffering from staff shortages.’ — Shaye Candish, NSWNMA Assistant Secretary

An uncertain future for the graduating class of 2021 A recent NSWNMA survey of nearly 500 nursing students found that:

46% were unclear when their placement would take place

26%

had their placement cancelled

39%

were unclear when they would graduate

26%

were suffering from general stress and anxiety

14%

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AGED CARE

even months after the roya l commission into aged care handed down its final report, the Morrison Government is still not fully committing to the recommendations around staffing. The government requirement of 16 hours of care from a registered nurse does not meet the commission’s recommended 24 hours. Independents have taken action in both houses of parliament to have the recommendations enshrined in law with the urgency they warrant. Senator Patrick’s bill effectively seeks to ensure a registered nurse is on site in an aged care facility at all times. When introducing his bill in early September, Senator Patrick said “residents, their families, the aged care workforce and the wider Australian community cannot wait any longer”. “I’m concerned aged care residents are not getting the care they need, and the care is varied depending on where they are located

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‘ Residents, their families, the aged care workforce and the wider Australian community cannot wait any longer.’ — Senator Rex Patrick across Australia. “The inconsistent approach leads to variations in the level of care and quality provided to residents. Proper care for our elderly is critical and it requires aged care homes to have registered nurses on site at all times.” The previous week Dr Helen Haines, the Independent member for Indi, had put forward a motion in the House of Representatives that also called on the Morrison Government to mandate nursing levels and for a range of other reforms to improve aged care, particularly in rural and

regional areas. The parliamentary initiatives of the independents to progress the commission’s recommendations drew praise from the ANMF. “We applaud Senator Patrick for standing up for older Australians and the nurses and carers who care for them,” said ANMF Federal Assistant Secretary, Lori-Anne Sharp. “We ask all federal senators to support this new bill and the ANMF’s ongoing fight to address the failures in the aged care system.” n

AGED CARE

Meeting an RN opens Zali’s eyes to aged care Independent MP Zali Steggall stood up in parliament and spoke in support of having RNs present 24/7 in aged care after hearing the reality at the front line from NSWNMA member Dymphna Ryan.

ged care RN Dymphna Ryan recently spoke to her local member, Zali Steggall, the Federal MP for Warringah, about the desperate need for around-the-clock RNs in aged care. After the meeting, Steggall made a speech in parliament supporting a motion by former nurse and Independent MP, Helen Haines, for mandated 24/7 RN care in all aged care facilities. “Zali raised the issue of aged care and all the issues surrounding the royal commission into aged care,” said Dymphna. “I spoke to her as a constituent in Warringah, and I informed her of the issues I’ve come up against as an RN working in aged care.” Dymphna explained to the MP that while “many high-care nursing homes have RNs around the clock, low-care facilities can have RNs maybe five days a week on morning shift … there is usually never an evening RN or a night RN”.

“It is sad because I think a lot of people go to these places believing there are RNs looking after them. You have people who are diabetics, people in pain, people who need to be turned in the night; you still have the same set of illnesses to deal with as in high care.” Dymphna explained to Zali how, when an RN is off duty, aged care patients can be sent to hospitals, which end up “jammed with patients that shouldn’t be there”. She also explained how, when she began working in the system many years ago and there were RNs around the clock, there were not the same level of falls and urinary tract infections she sees today. Dymphna thinks meeting with her local MP “opened her eyes” to the situation in aged care. In her parliamentary speech, Zali Steggall said: “Just this week I met a local nurse working in aged care homes who detailed the continual staff shortages that have led to poor outcomes in the past, in the care of people.”

DYMPHNA RYAN, AGED CARE RN

“Currently – and this is a little mind boggling – there is no minimum staffing requirement or skills mix in the legislation. Whilst we do it for so many other industries, it is really astounding that we are not doing it for our most vulnerable and elderly.” n

Get involved Demand Senators support RN 24/7 Send an email in support of Senator Patrick’s bill at: https://nswnma.good.do/fixagedcare/ ac-rn247-senate/

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VACCINES

The science behind COVID-19 vaccines In a recent NSWNMA webinar, Dr Jessica Stokes-Parish (PhD, RN), who works in an ICU, and Romy Blacklaw (IPN, RN), a clinical nurse in a COVID-19 vaccination hub, responded to common questions and concerns about COVID-19 vaccines.

Vaccine development Conventional vaccines can take three to 10 years to develop. In the case of COVID-19 vaccines, researchers and developers, backed by huge private and government funding, were able to work quickly and collaborate globally to develop a safe vaccine. Scientists built on decades of coronavirus research (e.g. SARS and MERS), recent advances in mRNA therapies (for cancer and viruses), and early identification of the genome sequence of SARS-CoV-2, to quickly develop potential vaccine candidates.

Vaccine safety Both the AstraZeneca and Pfizer vaccines have had extensive safety testing. No shortcuts were made in what are acknowledged to have been gold standard vaccine trials. Tens of thousands of participants were enrolled in the clinical trials, some of the highest numbers ever seen.

Were COVID-19 vaccines rushed through? The Therapeutic Goods Administration (TGA) provisionally approved COVID-19 vaccines after assessing all available data. Provisional approval is a process 26 | THE LAMP OCTOBER/NOVEMBER 2021

that allows temporary registration of promising new medicines and vaccines where the need for early access outweighs any potential risks. The TGA engaged early with pharmaceutical companies about their vaccines, assessing clinical trial data as it became available, rather than at the end of the three clinical trial phases. This sped up the review process.

What about adverse effects?

What are the side effects of COVID-19 vaccines?

In any large-scale vaccination rollout, some people will experience a new illness or, sadly, pass away after vaccination. In some cases, these illnesses or deaths will be coincidental, and not caused by the vaccine. The TGA reviews all deaths reported in people who have received the vaccination, to assess whether the death was related to vaccine safety, or a side effect of the vaccine, or related to other causes.

The Pfizer vaccine is generally well tolerated by most people, but side effects may include aches, pains and fever. While these effects are not very pleasant, they are a very good sign that your immune system is working. These symptoms are more common in younger people, who generally have more robust immune systems. Side effects are also more common after a second dose of the Pfizer vaccine. Most side effects occur within 24 hours of getting the vaccine, with symptoms typically resolving within 48 hours. AstraZeneca vaccine has similar side effects. Again, they are more likely to occur in those who are younger, and most side effects occur within 24 hours of getting a vaccine, with symptoms typically resolving within 48 hours.

In safety reports from the TGA, (as of 27 July), doses of the AstraZeneca vaccine given were 6.1 million, with six deaths. That gives a vaccine mortality rate of 0.00009 per cent. In contrast, in the same timeframe there were a total of

A very rare adverse effect of the AstraZeneca vaccine is a rare type of blood clot – thrombosis with thrombocytopenia syndrome (TTS). Symptoms include nausea, blurred vision and pain in the head or legs that do not resolve with pain relief like paracetamol, and it is important to talk to your doctor immediately if you have any symptoms, as the condition is treatable. Fortunately, the risk of developing the syndrome is only 0.0002 per cent, based on the UK data.

VACCINES

LEFT: ROMY BLACKLAW (IPN, RN) RIGHT: DR JESSICA STOKES-PARISH (PHD, RN)

33,081 cases of COVID-19 infection in Australia, which resulted in 918 deaths – a case mortality rate of 2.78 per cent.

Myths about COVID-19

Vaccine monitoring After any vaccine is registered and administered to people, experts and regulators continue to monitor vaccine safety in several ways. Australia’s safety monitoring is robust, including passive and active measures of surveillance. This safety information is publicly shared via AusVaxSafety.org.au and TGA.gov.au.

Why two doses of vaccine? There is strong evidence that a second dose of either Pfizer or AstraZeneca increases your defence against COVID19. Clinical trials show the Pfizer vaccine provides 52 per cent protection 12 days after the first dose, with protection rising to 95 per cent after the second dose. AstraZeneca vaccine protection against symptomatic COVID-19 was estimated to be 76 per cent at 22 days after the first dose, rising to 81 per cent when a second dose was given 12 weeks after the first. Pfizer and AstraZeneca both appear to offer less protection against the Delta variant than for the Alpha variant, and a second dose is even more important to protect against Delta.n

MYTH: THE MRNA VACCINES ALTER DNA This is simply not possible. The mRNA vaccine cannot get into a cell’s nucleus. The flow of information from DNA to RNA to proteins – in that direction only – is one of the fundamental principles of molecular biology. The flow of information cannot go the other way, from mRNA to change DNA. MYTH: COVID-19 VACCINES AFFECT FERTILITY AND ARE DANGEROUS DURING PREGNANCY There is no mechanism for COVID-19 vaccines to affect fertility. The safety data on vaccines shows no fertility safety triggers. The animal data showed no fertility issues, and there was also no impact on sperm. On the other hand, vaccination has benefits to pregnancy and breastfeeding. We now have evidence that passive immunity

occurs as a mother’s antibodies cross to the milk. Research has also shown immune transfer by the placenta for Pfizer, and the vaccine does not cause problems with the placenta. The COVID-19 disease, however, does cause problems during pregnancy. The risk of COVID-19, particularly the Delta variant, for pregnant people is quite significant. COVID-19 disease increases the likelihood of a preterm delivery, and the risk of pre-eclampsia or eclampsia. MYTH: VACCINES CAUSE VIRAL SHEDDING Viral shedding refers to a process where virus is shed by an infected person. For a virus to shed, it must be intact and actively reproducing. COVID-19 vaccines are not live; they contain no virus that is capable of reproducing, and the vaccine’s mRNA and viral vector are non-replicating.

THE LAMP OCTOBER/NOVEMBER 2021 | 27

VACCINES

Rights and obligations around COVID-19 vaccination There are professional, industrial and work health and safety (WHS) perspectives that shape the rights and obligations nurses and midwives’ need to consider when making personal decisions about the COVID-19 vaccination.

NSWNMA supports vaccination and strongly encourages all healthcare workers to be vaccinated if there is no medical contraindication. NSWNMA is aware that some nurses and midwives have concerns about the safety of the vaccine. NSWNMA is also aware that some nurses, midwives, students and AiNs may decide for their own reasons that they will not receive a COVID-19 vaccination under any circumstances. The following information outlines the professional and legal perspectives that delineate the rights and obligations that should be considered when making a personal decision about vaccination:

Professional rights and obligations The Nursing and Midwifery Board of Australia Position statement on nurses, midwives and vaccination makes it clear that registered nurses, enrolled nurses and midwives who are promoting antivaccination statements to patients 28 | THE LAMP OCTOBER/NOVEMBER 2021

and the public via social media which contradict the best available scientific evidence are in breach of their professional obligations and may be subject to regulatory action. The National Boards and the Australian Health Practitioner Regulation Agency (AHPRA) have published a joint statement – Registered health practitioners and students: what you need to know about the COVID-19 vaccine rollout – to clarify their expectations in relation to giving, receiving and advising on and sharing information about COVID-19 vaccination. In this advice it is clear that all registered health practitioners and students (particularly those undertaking placements in various practice settings) are strongly encouraged to have the full COVID19 vaccination course as scheduled unless medically contraindicated. The National Boards also state that all regulated practitioners have a responsibility to participate in efforts to promote the health of communities and meet obligations with respect to disease prevention including vaccination, health

screening and the reporting of notifiable diseases. The National Boards recognise that while some health practitioners may have a conscientious objection to COVID-19 vaccination, all practitioners, including students on placement, must comply with local employer, health service or health department policies, procedures and guidelines relating to COVID19 vaccination. Any queries about these should be directed towards the individual employer, health service, state or territory health department and/or education provider for registered students.

Industrial rights and obligations Mandatory vaccination of workers in certain workplaces is not a new feature of the working and legal landscape. Currently in the NSW public health system, there are a number of well-established vaccination requirements for staff via NSW Ministry of Health policy directives. Private hospital providers also have developed similar expectations of their staff. These existing

VACCINES

More information

requirements have to date been relatively uncontroversial. In residential aged care, it is a legal requirement for its workers (as well as visitors) to have the influenza vaccination. In the absence of the influenza vaccination, the worker or visitor are not permitted to enter a Residential Aged Care Facility (‘RACF’) unless exceptional / special circumstances exist. This existing requirement for an influenza vaccination in RACFs has been extended to include a similar requirement for its workers to have a COVID19 vaccination as of midSeptember 2021. There have been three recent decisions by the Fair Work Commission regarding dismissals related to refusal of mandatory vaccinations, in the childcare sector and in aged care. In both cases the Fair Work Commission considered that it was a valid reason for the employers to dismiss the workers for refusing to have an influenza vaccination.

Work Health and Safety (WHS) rights and obligations Employers are required to do what they can to eliminate or minimise the risks associated with exposure to COVID-19 for both their workers and patients/residents. The best way to eliminate exposure is to ensure people are not bringing the virus into the workplace. Personal protective equipment (PPE) certainly has a place, but it is a lower order control because it is attempting to minimise the risk of the virus spreading rather than stopping it getting into the facility in the first place. Workers must follow reasonable instructions and cooperate with policy and procedure. There is existing case law to say that vaccination is a reasonable requirement when working with vulnerable persons. n

NSWNMA Position statement on COVID-19 vaccination https://www.nswnma.asn.au/ wp-content/uploads/2021/08/ NSWNMA-Position-Statement-onCOVID-19-Vaccination.pdf NSWNMA Policy on Work Health and Safety https://www.nswnma.asn.au/ wp-content/uploads/2021/01/ NSWNMA-Policy-on-Work-Healthand-Safety.pdf ANMF Policy on Vaccination and Immunisation https://anmf.org.au/documents/ policies/P_Vaccination_and_ Immunisation.pdf AHPRA Position Statement: Registered health practitioners and students and COVID-19 vaccination: https://www.ahpra.gov.au/ News/COVID-19/Vaccinationinformation.aspx

KEY POINTS ON RIGHTS AND OBLIGATIONS Professional (National boards and APHRA): All practitioners, including students on placement, must comply with local employer, health service or health department policies, procedures and guidelines relating to COVID-19 vaccination. Industrial (Fair Work Commission): In three cases in child care and in aged care, the Fair Work Commission considered that it was a valid reason for the employers to dismiss the workers for refusing to have a mandatory vaccination. WHS Law: Workers must follow reasonable instructions and cooperate with policy and procedure. There is existing case law to say that vaccination is a reasonable requirement when working with vulnerable persons.

THE LAMP OCTOBER/NOVEMBER 2021 | 29

Do you have an interest or area of expertise in… Aged Care Drug & Alcohol Midwifery Mental Health Environmental Issues CALD Issues The NSWNMA is seeking expressions of interest from members to join these Reference Groups Each group meets between 4-6 times per year* to discuss practice and professional issues relevant to each area. Members provide vital advice and assist the Association to accurately represent the interests of our members. To submit an Expression of Interest please email your details and brief outline as to why you would like to be involved, and what you believe you could add to the Reference Group to education@nswnma.asn.au.

*Virtual / online attendance is available for members who are non-metro or not able to attend meetings in person.

30 | THE LAMP OCTOBER/NOVEMBER 2021 non-metro members to join to provide a regional perspective to each group. We encourage

STRESS TEMPERATURE Wellbeing Series PRESENTED BY: Samuel Eddy B.Bus (Marketing), MSc Psychology

& Sarah Kavanagh

B. Nursing (mental Health), CMHN

3 x FREE Webinars held across 3 Mondays, commencing 11 October

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This webinar series will be recorded and available to members for a strictly limited time in Member Central under Professional Education. You will also find in the Professional Education section a range of recorded webinars that members are able to view at any time.

PROFESSIONAL EDUCATION The NSWNMA has released a series of free webinars on a range of subjects relevant to nursing and midwifery practice. We have a suite of regular topics, such as Medications, Communication and Documentation, Professional Obligations and many more.

nswnma.info/wellbeing-webinar We also arrange other additional one-off webinars facilitated by external presenters on interesting and topical subjects. Keep an eye on our education emails for updates and additions to both face-to-face and webinar education opportunities.

THE LAMP OCTOBER/NOVEMBER 2021 | 31

YOUR RIGHTS

Ask

Shaye A big hello Well, I have some very large shoes to fill, with Judith’s recent retirement, but one part of the role I have been especially looking forward to is dealing with and hopefully answering your workplace questions. This is such a great way to get a real appreciation of the issues and challenges you face, big or small, every day in the workplace. It helps to remind us all that while we need to keep focused on the big claims and campaigns, it is also important to make sure those worker entitlements that have already been won and are now available in awards or agreements are complied with by employers. I know from my own workplace experiences that sometimes it’s getting the little things right that can make such a difference to a working day – and to your pay. So, members, let’s get to it!

Redeployment to another position I have been redeployed as part of the COVID-19 response from my managerial position into a hands-on clinical role but at a lower pay level. Do I keep my substantive wage?

In short, yes. If your employer has directed you to be redeployed as part of this workforce response, then the terms of your employment contract, along with your award or agreement, would continue to apply. Some awards or agreements have provisions for managing redeployments and ancillary issues if the redeployment requires you to 32 | THE LAMP OCTOBER/NOVEMBER 2021

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

relocate to another place of work. Take care as well, to ensure that the new role is within your scope of practice and that the required PPE is available.

Vaccination while on leave I am currently on maternity leave and won’t be returning to my job at a public hospital till March 2022. Do I still need to get vaccinated per the schedule set out in the Public Health Order (PHO)?

The Ministry of Health is encouraging staff on leave to still get vaccinated. They have indicated though, that the practical requirement would be that you would have both doses before you return to duty. You will be required to provide evidence of your vaccination status prior to commencing work to satisfy the hospital of your vaccination compliance with the PHO.

Support at a fact-finding interview Yesterday, I was handed a letter with some allegations and told to come to a meeting with the nursing home manager to explain. It said I could have a support person. Can the union help?

We certainly can. It is procedurally fair to give you an opportunity to have a witness or support person at any disciplinary interview. This could be a work colleague (if not involved in the incident) or a friend or family member. But the Association can provide you with support and assistance before and at the meeting to ensure that your rights are maintained. It is generally not the role of a witness or support person to speak for you at the

meeting and answer questions. This is an opportunity for you to relay in your own words what happened. But certainly, a timeout can be called so you can regroup, as these meetings can certainly be quite challenging.

Getting off the Service Check Register A while ago, I had my name put on the Service Check Register (SCR) for what I thought was a pretty trivial thing. With the new SCR policy, how does my name come off the register?

Certainly, moving forward, the SCR for NSW Health (PD2021_017) will be used only for the more serious matters. LHDs are required to undertake a two-stage process of review for those currently on the SCR, to ensure any existing record now meets the new definition of serious misconduct. It is hoped that this process, which in some instances involves a review of hard-copy files, would be completed by the end of 2021, COVID-19 permitting.

Clarifying an overpayment After returning from a stint at a vaccination clinic, back to my role at a public hospital, I had an overpayment recovered from my last pay packet, which I really don’t understand. How is this supposed to work, as I can’t tell whether I am out of pocket?

Clause 27(v)(b) of the Public Health System Nurses’ and Midwives’ (State) Award makes clear that in all cases of alleged overpayment, you should be informed as soon as possible and advised what it is about before any move is made for recovery. In this way you can be satisfied that it is genuine and discuss if a one-off recovery

YOUR RIGHTS

would cause undue hardship. If so, then a recovery schedule can be discussed. Ask for a detailed breakdown of the overpayment and if that is somewhat complex or difficult to decipher, contact the Association for assistance.

Single-site employment I am currently working at one nursing home because of COVID-19 and the single-site stuff. How long is this going to last, as I would really like to start back at the other nursing

home I work at?

adjust or realign rosters for staff returning to their usual working arrangements.

This is not so easy to answer. The technical answer is that the funding to support the single-site employment arrangements will continue until the Commonwealth Chief Medical Officer, based on certain parameters such as if any aged care facility in the LGA is COVID-19 impacted or if there is community transmission, removes the declaration. There would also be 14 additional days, to give time for facilities to

Payment for isolating I work in a public hospital and have recently been required to isolate for 14 days due to a workplace incidence of COVID-19. But I have already used up the 20 days of special leave due to previous episodes. Am I still covered?

If you meet the requirements for paid special leave (under Circular C2021-014)

– and being directed to self-isolate due to COVID-19 exposure is one of them – then yes, the LHD can (and should) grant additional paid leave, which is called Health Special Leave. NOTE: If you are unfortunate enough to contract COVID-19 in the workplace, workers compensation should be available thanks to laws that were passed last year following union action.

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THE LAMP OCTOBER/NOVEMBER 2021 | 33

AGED CARE REFERENCE GROUP

Are you a registered nurse, enrolled nurse or assistant in nursing currently working in the aged care sector? Are you a member of the NSWNMA? The NSW Nurses and Midwives’ Association is seeking members to join the Aged Care Reference Group. The group meet every second month to discuss current issues and challenges in the aged care sector. Meetings are held in a blended Zoom/face-to-face format to allow members to be involved regardless of geographical location. Current NSWNMA members working in the aged care sector are invited to join.

Being a member of the Aged Care Reference Group gives you the opportunity to: be a voice for the issues impacting nurses in the aged care sector provide feedback to the NSWNMA Professional Issues Committee assist in the development and reviewing of policies be a link between members and the Association

MORE INFORMATION + EXPRESSION OF INTEREST: Dean Murphy • EMAIL: dmurphy@nswnma.asn.au • PHONE: 0417 567 374

QACAG NEEDS YOU! QACAG Quality Aged Care Action Group Incorporated

The Quality Aged Care Action Group (QACAG) was established to advocate for quality aged care. We are a small group of like-minded individuals who meet every two months to campaign for quality aged care, including safe staffing. We lobby Government, make submissions and collaborate with other consumer advocacy organisations. Meetings are usually held every two months in Sydney and concurrently via Zoom to allow those in regional areas to be involved. However, you do not have to attend the meetings to be an active member. Most members are aged care nurses, people who have experiences of aged care, or who live in aged care themselves. Membership costs $20 a year for individuals and $50 a year for organisations. If you would like to join us please contact us in any of the following ways: 50 O’Dea Avenue, Waterloo NSW 2017 0417 567 374 dmurphy@nswnma.asn.au

34 | THE LAMP OCTOBER/NOVEMBER 2021

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THE LAMP OCTOBER/NOVEMBER 2021 | 35

NEWS IN BRIEF

ITALY

FRANCE

Getting a COVID-19 jab is an No jab, no fun says Macron French government’s decision to only allow the fully “act of love” says Pope Francis The vaccinated to enter restaurants, bars, trains and other The pontiff has urged people to get vaccinated against COVID-19.

The pope’s appeal appears in a video, which also features Catholic bishops from the United States and Central and South America. “Thanks to God and to the work of many, we now have vaccines to protect us from COVID-19,” the pope says in the video. “Vaccines bring hope to end the pandemic, but only if they are available to all and if we collaborate with one another.” Pope Francis says being inoculated with vaccines authorised by competent authorities was “an act of love”. “Vaccination is a simple but profound way of promoting the common good and caring for each other, especially the most vulnerable,” he said. The pope has previously spoken about the importance of vaccines, while emphasising that they must be distributed equally, especially to poor countries. Not all senior Catholic clergy, however, have been singing from the same hymn sheet. American cardinal Raymond Leo Burke has been an outspoken critic of vaccines and even of social distancing. Burke said that the coronavirus “has been used by certain forces, inimical to families and to the freedom of nations to advance their evil agenda”. Later, after a visit to Wisconsin, he tested positive for COVID-19, was admitted to hospital and was on a ventilator.

‘ Vaccination is a simple but profound way of promoting the common good and caring for each other, especially the most vulnerable.’ — Pope Francis

36 | THE LAMP OCTOBER/NOVEMBER 2021

spaces has led to a spike in inoculations.

The French have a well-deserved reputation for being vaccine-sceptic. A poll carried out last December found a remarkable 61 per cent of French citizens would not get vaccinated against COVID-19, compared with 30 per cent in America. In another poll in 2018, a third of respondents told the Wellcome Trust that they did not think vaccines were safe – more than in any other country out of 144 nations surveyed. On 12 July, faced with such hesitancy, France’s president Emmanuel Macron gave a serious incentive to encourage more people to get jabbed, reports The Economist. During a televised address watched by more than 22 million people, he said that from August, people who were not fully vaccinated would not be allowed into restaurants, bars, shopping centres, or travel on long-distance trains and flights. In the hours following his announcement, nearly one million people flocked to book vaccination appointments via Doctolib, the most popular online platform. More appointments were arranged via the website in the following 48 hours than had been over the previous 18 days. Three-fifths of the bookings were for people aged between 18 and 39 years. Macron also said that vaccination will be compulsory for all health workers, and enforced from September. Children aged 12 to 17 have been eligible for vaccination since 15 June.

‘ In the hours following President Macron’s announcement, nearly one million people flocked to book vaccination appointments.’

NEWS IN BRIEF

UNITED STATES

Shots for the unvaccinated more important than boosters, says WHO The rush by wealthy nations to provide a third vaccine booster has been condemned as immoral by the World Health Organization. World Health Organization (WHO) experts insist there is not enough scientific evidence to support the additional shot, reports The Guardian. And providing them while so many people are still waiting to be immunised is immoral, they argue. “We’re planning to hand out extra lifejackets to people who already have lifejackets, while we’re leaving other people to drown without a single lifejacket,” said Dr Mike Ryan, director of the WHO’s Health

Emergencies Programme. “The fundamental, ethical reality is we’re leaving millions and millions of people without anything to protect them.” The WHO called for a moratorium on COVID-19 vaccine booster shots, to help ease the drastic inequity in dose distribution between wealthy and poor countries. Some countries like the United States and Israel already have plans to add a third jab to try to contain the Delta variant.

the most vulnerable before boosters are rolled out. “The divide between the haves and have nots will only grow larger if manufacturers and leaders prioritise booster shots over supply to low- and middleincome countries.”

CROSSWORD SOLUTION

Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, said: “What is clear is that it’s critical to get first shots into arms and protect

‘ We’re planning to hand out extra lifejackets to people who already have lifejackets, while we’re leaving other people to drown.’ — Dr Mike Ryan, director of WHO’s Health Emergencies Programme

Quality legal advice for NSWNMA members • Workers Compensation Claims • Litigation, including workplace related claims • Employment and Industrial Law • Workplace Health and Safety • Anti-Discrimination • Criminal, including driving offences • Probate / Estates • Public Notary • Discounted rates for members including First Free Consultations for members

Call the NSWNMA on 1300 367 962

and find out how you can access this great service

Offices in Sydney and Newcastle with visiting offices in regional areas (by appointment) THE LAMP OCTOBER/NOVEMBER 2021 | 37

NEWS IN BRIEF

AUSTRALIA

UNITED STATES

Opening borders early is the “gambler’s option”

It’s the unvaccinated who are filling US hospitals

Grattan Institute modelling shows it would be dangerous for Australia to open up its international borders before at least 80 per cent of the population is vaccinated.

Almost all COVID-19 cases, hospitalisations and deaths in the United States have occurred among people who are unvaccinated or not yet fully vaccinated, according to a new study by the Kaiser Foundation.

The model simulates the spread of COVID-19 within a partially vaccinated population using hospitalisation and intensive care unit (ICU) admission rates from more than a year of COVID-19 data from Australian ICU units. It found the only scenario out of 12 where the virus is managed, with hospitalisations and deaths kept down to reasonable levels, is when at least 80 per cent of the population is vaccinated. The authors of the study describe scenarios with a 70 or 75 per cent vaccination rate as the “optimist’s and gambler’s scenarios”. “Opening the borders is a one-shot gamble: if you make the wrong call, the virus will quickly spread and all the good work and hard yards of living through lockdowns over the previous two years will have been wasted,” said Stephen Duckett, Director of the Grattan Institute’s Health and Aged Care Program. “The difference in virus spread, hospitalisations and deaths between opening at 75 per cent and at 80 per cent are big, but the wait between the two thresholds may only be a month or two. This is why we recommend an 80 per cent vaccination rate as the threshold for opening up.”

‘ The difference in virus spread, hospitalisations and deaths between opening at 75 per cent and at 80 per cent are big, but the wait between the two thresholds may only be a month or two.’

The researchers reviewed data from all 50 US states on “breakthrough cases” – fully vaccinated individuals who become infected, hospitalised or who have died. These cases are to be expected and are historically known to occur with other vaccines, as none are 100 per cent effective. The study found: • t he rate of breakthrough cases reported among those fully vaccinated is below 1 per cent in all reporting states, ranging from 0.01 per cent in Connecticut to 0.54 per cent in Arkansas • t he hospitalisation rate among fully vaccinated people with COVID-19 ranged from effectively zero (0.00 per cent) in California, Delaware, Washington DC, Indiana, New Jersey, New Mexico, Vermont, and Virginia to 0.06 per cent in Arkansas • t he rates of death among fully vaccinated people with COVID-19 were even lower, effectively zero (0.00 per cent) in all but two reporting states, Arkansas and Michigan, where they were 0.01 per cent. “This data indicates the vast majority of reported COVID-19 cases, hospitalisations, and deaths in US are among those who are unvaccinated or not fully vaccinated. These findings echo the abundance of data demonstrating the effectiveness of currently authorised COVID-19 vaccines,” the report concluded.

Read the report Download the report https://grattan.edu.au/report/race-to-80/ 38 | THE LAMP OCTOBER/NOVEMBER 2021

COVID-19 Vaccine Breakthrough Cases: Data from the States https://www.kff.org/policy-watch/ covid-19-vaccine-breakthroughcases-data-from-the-states/

NEWS IN BRIEF

AUSTRALIA

ACTU calls for vaccine leave for all Australian workers The ACTU has called on the Morrison Government to provide paid leave for every Australian worker, including casual workers, to get the jab and to recover from any routine side effects. The new leave would be a new universal entitlement through the National Employment Standards (NES). Unions have already been winning paid vaccination leave workplace by workplace, and 1.6 million people are already covered by a new entitlement to leave. But to ensure that all of Australia’s 13 million working people can access the new shipments of vaccines arriving there is a need to remove all the barriers people may have to getting vaccinated. ACTU Secretary Sally McManus says workers should not have to choose between getting the vaccine and getting paid. “Casual workers and anyone without leave will risk paying a price to get the vaccine due to routine

side effects, which means lost income because they have no paid leave. “This can be rectified with the federal government taking action to guarantee paid vaccination leave. This will give all working people an equal choice. “From September, the Morrison Government expects to vaccinate two million workers per week. We will not get the job done by Christmas if we expect working people to get the jab on lunch breaks and weekends.”

‘ Unions have already been winning paid vaccination leave workplace by work place, and 1.6 million people are already covered by a new entitlement to leave.’ UNITED STATES

Spending on health, not guns, would have made Afghanistan a better place

The United States could and should have fostered a more stable and prosperous Afghanistan by investing in health, schools, safe water, nutrition, and other social services, says prominent US economist Jeffrey Sachs. Afghanistan has only 172 hospitals and around a third of the 37 million population has no access to a functional health centre within two hours of their home, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). This is despite the fact the US invested roughly US$946 billion in the country between 2001 and 2021, according to a report by the Special Inspector General for Afghanistan Reconstruction. “Of that $946 billion, fully $816 billion, or 86 per cent, went to military outlays for US troops. And the Afghan people saw little of the remaining $130 billion, with $83 billion going to the Afghan Security Forces. Another $10 billion or so was spent on drug interdiction operations, while $15 billion was for US agencies operating in Afghanistan,” Sachs wrote in the online magazine Project Syndicate. “That left a meagre $21 billion in ‘economic support’ funding. In short, less than 2 per cent of the US spending on Afghanistan reached the Afghan people in the form of basic infrastructure or poverty-reducing services.” .

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‘ Less than 2 per cent of the US spending on Afghanistan reached the Afghan people in the form of basic infrastructure or povertyreducing services.’ THE LAMP OCTOBER/NOVEMBER 2021 | 39

40 | THE LAMP OCTOBER/NOVEMBER 2021

NURSING RESEARCH AND PROFESSIONAL ISSUES The Australian Health Review is the Australian Healthcare & Hospitals Association’s peer-reviewed journal, published six times a year. In response to the COVID-19 pandemic and the importance of sharing research, AHHA is providing free access to all research articles related to COVID-19. Links to the articles can be found below. You can find the full journal at https://www.publish.csiro.au/ah Psychological wellbeing of Australian hospital clinical staff during the COVID-19 pandemic Sara Holton, et al The work of health service staff can be emotionally demanding and they often experience high levels of occupational stress as a result of long work hours, heavy workload, irregular schedules, managing the emotional needs of patients and their families, and patient death. Compared with the general population, the prevalence of psychological distress tends to be higher among health service staff. For example, the recent National Health Survey found that approximately 13 per cent of adult Australians experienced high or very high levels of psychological distress, whereas a large cross-sectional survey of Australian midwives found that around 20 per cent reported symptoms of depression, anxiety and stress. To date there have been few studies about the psychosocial effect of COVID-19 on health service staff, particularly in Australia. Previous research about the experiences of health service staff during the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 indicated staff were fearful for their own health and that of their families, and that they experienced increased job stress, feelings of vulnerability, helplessness, stigmatisation, loss of control, uncertainty and emotional distress, especially those who had had contact with patients who had SARS. Emotional distress was experienced by approximately 25–35 per cent of hospital staff during the SARS outbreak, and nurses tended to experience more distress than other staff. The aim of this study was

to assess the psychological wellbeing of hospital clinical staff during the COVID-19 pandemic. The specific objectives of the study were to assess: (1) levels of depression, anxiety and stress; (2) the proportion of clinical staff in the mild, moderate, severe and extremely severe diagnostic categories for depression, anxiety and stress; (3) factors significantly associated with higher levels of depression, anxiety and stress; and (4) differences in psychological wellbeing between discipline groups (nursing and midwifery, AH and medical staff). https://www.publish.csiro.au/AH/ AH20203 Quality-adjusted life years in the time of COVID-19 Jane Hall The quality-adjusted life year (QALY) as a basis of valuing additional expenditure on health is widely accepted. Although early in the COVID-19 pandemic, several commentators called for a similar approach in resolving trade-offs between economic activity and reducing the burden of COVID-19, this has not occurred. The value of a QALY has not been used to deny all intervention, as the rule of rescue attests. Further, while there was no other way of managing the pandemic, there were other means available to mitigate the economic losses. Now that vaccine programs have commenced in several countries, it is interesting to consider whether economic evaluation should now be applied. However, the recognised complexities of the evaluation of vaccines, plus the challenge of measuring opportunity costs in the face of an economic recession and the severity of the consequences of

an outbreak, even though the probability of transmission is exceedingly low, mean its use will be restricted. COVID-19 has changed everything, even the way we should think about economic evaluation. https://www.publish.csiro.au/AH/ AH21010 Obligations of Australian health services as employers during COVID-19 Jessica M. Dean, et al. The COVID-19 pandemic has brought into strong focus the obligations for health services to protect the health and safety of their staff. These obligations arise from occupational health and safety (OHS) laws and the duty of care owed by a health service as an employer. Victoria’s ‘second wave’ COVID-19 outbreak demonstrated significant transmission risks within healthcare settings, with over 4000 coronavirus infections in healthcare workers, including 3573 cases in clinical healthcare workers, with 72.9 per cent of these infections acquired in a healthcare setting. An additional 596 non-clinical staff, including cleaners and administrative staff, contracted coronavirus, with 57.6 per cent of infections acquired in a healthcare setting. COVID-19 is therefore a significant risk for any healthcare employer due to the increased risk of clinical staff compared with the general population, combined with the potential for life-threatening outcomes. Furthermore, this risk can be relatively easily mitigated and thus imposes an obligation upon employers to be proactive in this regard. https://www.publish.csiro.au/ah/ Fulltext/AH20334

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LIONS NURSES’ SCHOLARSHIP Looking for funding to further your studies in 2022? THE LIONS NURSES’ SCHOLARSHIPS OPEN ON 1 AUGUST AND CLOSE ON 31 OCTOBER EACH YEAR The trustees of the Lions Nurses’ Scholarship Foundation invite applications for scholarships. Nurses eligible for these scholarships must be resident and employed within the State of NSW or ACT. You must currently be registered with the Nursing and Midwifery Board of Australia

and working within the nursing profession in NSW or the ACT, and must have a minimum of three years’ experience in the nursing profession – the last 12 months of which must have been spent in NSW or the ACT. Details of eligibility and the scholarships available (which include study projects either within Australia or overseas), and

application forms are available from: www.nswnma.asn.au/education Administration Liaison Lions Nurses’ Scholarship Foundation 50 O’Dea Avenue Waterloo NSW 2017 or contact Matt West on 1300 367 962 or education@nswnma.asn.au

COMPLETED APPLICATIONS MUST BE IN THE HANDS OF THE SECRETARY NO LATER THAN 31 OCTOBER

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42 | THE LAMP OCTOBER/NOVEMBER 2021

CROSSWORD

test your

Knowledge 1

23 25

29 30

11 12

35 36

39 40

ACROSS 1. Narrowing or stricture of any or all areas of the larynx (9.8) 10. The yolk of an egg (9) 11. A fleshy aggregate fruit such as a pineapple or mulberry (7) 12. Cell repository line (1.1.1) 14. Dichotomy (7) 16. Fitter (9) 17. A blood test performed to assess the body's production of immature red blood cells (12.5) 20. A contagious human disease affecting particularly the lungs (12) 25. The outermost layer of skin, especially that which forms the cuticle (9) 28. An agent that causes clotting (9) 30. A burning sensation, as of the sting of nettles (10) 32. Cosmetic surgery technique for removing focal fat deposits (11)

35. Very hot pepper (6) 36. Reduplication (11) 39. Echocardiography (1.1) 40. Mammography enhanced by a radioactive isotope study of healthy and malignant breast tissue (17) DOWN 1. A bluish mottling of the skin evoked by low temperatures and characterized by vasodilation (6.11) 2. To shrink, draw back, or pull apart (7) 3. Nothing (3) 4. Above the hyoid arch (7) 5. Bloodsucking worm (5) 6. An American electric vehicle and clean energy company (5) 7. The scientific study and engineering of atom-size objects (8) 8. Thin, membranous and dry (8) 9. A child's apprehension

associated with separation from a parent (10.7) 13. Trust, believe (4) 15. Heedless; careless; reckless (13) 18. A type of bacteria found in soil and in the intestinal tract (11) 19. Vitamin B1 (7) 21. A woman's undergarment (3) 22. Ultraviolet radiation that is found in sunlight (1.1.1) 23. Symbol for scandium (1.1) 24. Symbol for strontium (1.1) 26. Tastelessly showy (8) 27. Small crustaceans which are found in all the world's oceans (5) 29. Hard-shelled seed (3) 31. Toward (2) 33. The 21st letter of the Greek alphabet (3) 34. Crack, gap (5) 37. Toxic epidermal necrolysis (1.1.1) 38. Non-profit civil societies (1.1.1) THE LAMP OCTOBER/NOVEMBER 2021 | 43

INSURANCE BENEFITS

For NSWNMA Members

Insurance protection when you need it most The NSWNMA is committed to protecting the interests of nurses and midwives by purchasing a range of insurances to cover members.

Journey Accident Insurance provides cover for members who are injured as a result of an accident while travelling between their home and their regular place of employment. Professional Indemnity Insurance provides legal representation and protection for members when required. Make sure your membership remains financial at all times in order to access the insurance and other benefits provided by the NSWNMA.

Unsure if you are financial?

It’s easy! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural) Change your payment information online at www.nswnma.asn.au

www.nswnma.asn.au 44 |

IMPORTANT NOTE From 1 December 2018 the insurance benefits have changed as follows: • Journey Accident Insurance: the waiting period for benefits is now 14 days • Professional THE LAMP OCTOBER/NOVEMBER 2021 Indemnity Insurance: the limit per claim is now $5 million

REVIEWS

book club

T ES

S PE

James Patterson & Matt Eversman Penguin Random House RRP $32.99 ISBN 9781529125528 In this extraordinary work of nonfiction, we hear the unforgettable stories of everyday heroes who look after our families, our friends and ourselves in the most challenging circumstances imaginable. Around the clock, ER nurses dedicate their lives to helping us when we need it most. This book puts names and faces to these men and women who are there for us whenever we need them, who fight for our lives and never give up.

INTE IAL

ST RE

ER Nurses –True stories from the frontline

SPE C

All books can be ordered through the publisher or your local bookshop. Call 8595 1234 or 1300 367 962, or email library@nswnma.asn.au for assistance with loans or research. Books are not independently reviewed or reviewed using information supplied by the publishers.

IN T E

We have four copies of ER Nurses – True Stories from the Frontline to give away, thanks to Penguin Random House. Email your name and membership number to lamp@nswnma.asn.au by 30 November to be in the draw to win!

Note: August Special Feature Fighting For A Future: Trapped Behind The Border Shabnam (Shab) Ighani RRP: $29.95 ISBN 9781922532541 To purchase: please visit www.shabnamighani.com

The Tea Ladies Of St Jude’s Hospital Joanna Nell Hachette Australia RRP $32.99: ISBN 9780733642906

The heartwarming and hilarious new novel by the author of cherished bestsellers, The Single Ladies of Jacaranda Retirement Village and The Great Escape from Woodlands Nursing Home. The Marjorie Marshall Memorial Cafeteria has been serving refreshments and raising money at the hospital for over 50 years, long after anybody can remember who Marjorie Marshall actually was. Staffed by successive generations of dedicated volunteers, the beloved cafeteria is known as much for offering a kind word and sympathetic ear – and oftenunsolicited life advice – as it is for its tea and buns.

After the Tampa Abbas Nazari Allen & Unwin RRP $32.99 ISBN 9781988547640

The heartrending story of a Tampa child refugee who grew up to become a Fulbright scholar, highlighting the plight and potential of refugees everywhere. When the Taliban were at the height of their power in 2001, Abbas Nazari’s parents were faced with a choice: stay and face persecution in their homeland, or seek security for their young children elsewhere. A powerful and inspiring story for our times, After the Tampa celebrates the importance of never letting go of what drives the human spirit: hope.

Everyone In This Room Will Someday Be Dead Emily Austin Allen & Unwin RRP $39.99 ISBN 9781838953737

Meet Gilda. She cannot stop thinking about death. Desperate for relief from her anxious mind and alienated from her repressive family, she responds to a flyer for free therapy at a local church and finds herself abruptly hired to replace the deceased receptionist, Grace. It’s not the most obvious job – she’s queer and an atheist for starters – and so in between trying to learn mass, hiding her new maybe-girlfriend and conducting an amateur investigation into Grace’s death, Gilda must avoid revealing the truth of her mortifying existence.

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YOUR HEALTH

fitness+wellbeing Your COVID-19 Resistance Band Workout With COVID-19 leading to gym closures and lockdowns, it can be difficult to stay on track with keeping fit and active. However, this doesn’t mean you have to throw your summer body out the window! It’s still possible to undertake a full body workout with only one piece of equipment: a resistance band!

Upper body BANDED PULL-APARTS (15–20 REPS) Begin by standing up straight, holding the resistance band with hands shoulder-width apart in front of you, in line with your forehead. Pull your arms outwards and the band apart, so the band almost touches your chest. Return to the starting position.

BANDED UPRIGHT ROWS (15–20 REPS) Loop your resistance band under your feet, hip-width apart, and hold it in both hands, with your arms at your hips. Pull the band up to your chest, pushing your elbows out to the sides. Hold at the top then return to the starting position.

46 | THE LAMP OCTOBER/NOVEMBER 2021

BANDED BENT-OVER ROWS (15–20 REPS) Begin by standing with your feet inside your resistance band, feet shoulder-width apart. Hold the top of the band in both hands. Bend forward at the hips, making sure to keep your back flat and chest up. Pull your hands towards your chest with elbows extended back and outwards, focusing on bringing your shoulder blades together. Return to the starting position.

BANDED EXTERNAL ROTATIONS (15–20 REPS) Begin by holding the band in front of you, with palms facing up, shoulderwidth apart. Slowly rotate your shoulders outwards, pulling your arms outwards. Do not pinch your shoulder blades together, as this uses your rhomboids (the wrong muscle!). Return slowly back to the starting position.

Lower body BANDED LUNGES (10–15 REPS EACH SIDE) Begin by looping the band around your right foot, and over your right shoulder. Take a giant step backwards with your left foot, and lower yourself down until your left knee almost (but not quite) touches the ground. Drive through your right front heel and thigh to press yourself back up to a standing position.

BANDED SQUATS (12 REPS) Stand with your feet slightly more than hip-width apart, looping the resistance band underneath both feet and around both shoulders. Your toes should be pointed slightly outward with your hands on your hips or in front of you. Slowly push your hips back into a sitting position while bending your knees.

Keep your back flat and activate your core. Continue to lower yourself until your thighs are parallel to the floor. Your knees should be at a 90-degree angle. Hold the position for 2–3 seconds, then slowly return to the starting position. BANDED HIP EXTENSION (10–15 REPS) This exercise targets your glutes. To perform this exercise, lie on your back. Bring your feet up to your bottom, about hip-width apart. Place the resistance band across the front of your hips and hold down on either side with your hands. Pushing down through your heels, extend your hips up to the ceiling, hold at the top for 1–2 seconds, and slowly lower to the starting position.

extend backwards. Hold this position for a few seconds, then lower back down to the starting position and switch sides.

BANDED FACE PULL (10–15 REPS) This exercise targets smaller muscles that assist your shoulders and back. Begin by sitting on the floor, legs straight in front of you, and loop the band around your feet. Pull the band towards your face, keeping your feet pointed to ensure the band doesn’t flick up towards your face. Hold for 1–2 seconds, then slowly return to the starting position.

Core MODIFIED BIRD DOGS (15–20 REPS AT A SLOW PACE) Begin kneeling on the floor on all fours, holding the band in both hands. Raise your right arm forward and left leg behind, keeping your shoulders and hips parallel to the floor. Lengthen the back of your neck and tuck your chin into your chest to gaze down at the floor. The resistance band should challenge your arms and balance, as well as work the upper back. If you’re looking to work your glutes and legs a little bit more, wrap the band around your foot as you

You can follow this workout on the Vitruvian Health YouTube Channel.

THE LAMP OCTOBER/NOVEMBER 2021 | 47

NEW MEMBER BENEFIT

Access to online Professional Education ers!

b m e FREE for NSWNMA m Meeting your Continuing Professional Development (CPD) obligations* is now even easier with this great new offer for NSWNMA members. As a financial member you’ll have access to 61 online courses absolutely free.

FEATURING Access to over 20 hours of FREE CPD* 61 topics including those modules that are deemed mandatory annual competencies by large health organisations and nursing agencies* Free professional development portfolio to provide evidence to the Nursing and Midwifery Board of Australia (NMBA) of participation in CPD annually Access free webinars on a range of topics

LOGGING ON MEMBERS: New users create a ONE-TIME login to the website. NON-MEMBERS: Join the union at www.nswnma.asn.au and receive access to your 20 hours of FREE CPD!

bit.ly/NSWNMAMemberCentral * Nurses and midwives have various obligations in relation to CPD, which you can read more about on the NMBA website or here. The NMBA outlines that CPD must be relevant to your context of practice, and recommends nurses and midwives complete a range of CPD activities, e.g. – face-to-face, simulation, interactive e-learning, self-directed learning. The ANMF Education is developed for nurses and midwives working across Australia. For nurses and midwives practicing in NSW, it is important to ensure you follow relevant governance and legislative requirements.

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NOTICE

NSWNMA FEE WAIVER for members on parental leave DID YOU KNOW,

if you’re going on parental leave, paid or unpaid, we’ll waive your Association fees until you return to work? You’ll still be entitled to access advice and receive The Lamp. Contact the Association and let us know when you plan to take parental leave so we can set up your waiver. PHONE 8595 1234 • 1300 367 962 EMAIL gensec@nswnma.asn.au

www.nswnma.asn.au

Authorised by B.Holmes, General Secretary, NSWNMA THE LAMP OCTOBER/NOVEMBER 2021 | 49

UPDATE YOUR DETAILS

and Win Have you recently moved house or changed jobs? Changed your email or classification? 1/

Log on to online.nswnma.asn.au Update your details and go into the draw to win: • Two nights’ accommodation in a superior room at PARKROYAL Darling Harbour* • Breakfast for two at Barkers Restaurant • Dinner for two at ABODE Bistro. Bar • Valet Parking for 1 car 3/

Dive in and discover Sydney! Situated on the city side of Darling Harbour, our hotel features 340 stylish rooms and suites with superior king-sized beds, widescreen TV, and in-room amenities. Dine in our award winning ABODE Bistro. Bar, relax in our Club Lounge, or explore iconic attractions on our doorstep. PARKROYAL Darling Harbour, Sydney – your harbour side sanctuary. Everyone who uses our online portal from 1 April 2021 – 30 March 2022 to update their details will automatically be entered in the draw to win. 50 | THE LAMP OCTOBER/NOVEMBER 2021

*Conditions apply. Prize must be5/ redeemed by 30 March 2023 and is subject to room availability. he winner must be a financial member of the NSWNMA. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/20/05518.

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

PRIZE DRAWN 1 JULY 2022 RECRUITERS NOTE: Join online at www.nswnma.asn.au Every member you sign up over the year gives you an entry in the draw! If you refer a member to join online, make sure you ask them to put your name and workplace on the online application form, so you will be entered in the draw. Conditions apply. Prize must be redeemed by 1 July 2023 and is subject to room availability. Voucher must be presented upon request. Voucher is not transferrable nor redeemable for cash. Block-out dates may apply. The prize will be drawn on 1 July 2022. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date.

Search “Ausmed” in the app store.

Authorised by B. Holmes, General Secretary, New South Wales Nurses and Midwives’ Association, 50 O’Dea Ave, Waterloo NSW 2017

The Lamp October 2021

Articles inside

News in brief

Editorial