The Lamp October 2013

lamp THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION

VOLUME 70 No.9 OCTOBER 2013

Print Post Approved: PP100007890

RATIOS ON THE WORLD STAGE

2013 winners, left to right: Kathy Kirby representing Understanding Dementia, Sarah Lohmeyer and Annabel Pike.

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CONTENTS

lamp THE

CONTACTS NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office.

VOLUME 70 No.9 OCTOBER 2013

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 Hunter Office 8-14 Telford Street, Newcastle East NSW 2300 NSWNMA Communications Manager Janaki Chellam-Rajendra T 8595 1258

COVER STORY

12 | Ratios on the world stage Our latest push to improve and extend ratios was part of a global day of action in support of universal health care as a human right.

On the Sydney Opera House forecourt

5 6 8 37 39 42 43 45 47 50

Editorial Your letters News in brief Ask Judith Social Media Nursing research online Crossword Books Movie of the month Diary dates

RESEARCH

24 | The metro-rural divide

COVER STORY

20 | Austerity: a weapon to attack public services Australia came through the global financial crisis largely unscathed. Not so other countries, where austerity policies were introduced in the wake of the GFC.

32 | Win 2 nights at Jenolan Caves

Editorial Committee • Brett Holmes, NSWNMA General Secretary • Judith Kiejda, NSWNMA Assistant General Secretary • Coral Levett, NSWNMA President • Roz Norman, Tamworth Base Hospital • Elsie May Henson, Barraba Multi Purpose Service • Peg Hibbert, Hornsby & Ku-Ring-Gai Hospital • Michelle Cashman, Long Jetty Continuing Care • Richard Noort, Justice Health Advertising Patricia Purcell T 8595 2139 or 0416 259 845 or F 9662 1414 E ppurcell@nswnma.asn.au Records and Information Centre – Library To find old articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Jeannette Bromfield, RIC Coordinator T 8595 2175 E gensec@nswnma.asn.au

COVER STORY

22 | Around the world, nurses stand together Global Nurses United is only two months young but the fledgling movement showed it could walk the walk on September 17.

COMPETITION

Produced by Hester Communications T 9568 3148 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au

PHOTOGRAPH: SHARON HICKEY

REGULARS

FOR ALL EDITORIAL ENQUIRIES, LETTERS AND DIARY DATES: T 8595 1234 E lamp@nswnma.asn.au M 50 O’Dea Avenue, Waterloo NSW 2017

PROFESSIONAL DAY

28 | When “efficiency” is code for “cuts”

Our public sector suffers the plight of the anorexic.

No matter how thin it gets there are voices saying it is too fat.

The Lamp ISSN: 0047-3936 General disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised.

Privacy 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 2013 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $50.

Individuals $78, Institutions $130, Overseas $140.

THE LAMP OCTOBER 2013 | 3

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EDITORIAL

BY BRETT HOLMES GENERAL SECRETARY

We are determined to continue our campaign for safe patient care The O’Farrell Government thinks that by unilaterally setting the wages of public health system nurses and midwives our pay and ratios campaign is done and dusted. They couldn’t be more wrong.

We need to maintain our resolve to keep the government honest.

We have yet to win the whole campaign but nurses and midwives, along with other public sector workers won a significant battle last month when the New South Wales parliament voted to stop the O’Farrell Government slashing your take home pay. The ALP, the Greens and the Shooters and Fishers’ Party combined to block the Coalition’s attempt to legislate away its responsibility to pay an extra 0.25% in superannuation.

Those three parties responded to the arguments advanced by Unions NSW, the NSWNMA and other New South Wales unions and their vote reflected the support our arguments have garnered in the community.

The Shooters Party said “our expectation when we discussed (legislating the pay cap) with the government, was that 2.5% means 2.5% in [workers’] wages, in their pay packets. Not 2.25% plus a quarter of a per cent in their superannuation.”

After the vote, and not for the first time when their dictatorial impulses have been challenged, the government immediately flagged that they would move the goal posts if they could.

Treasurer Mike Baird said, “we must look at every option available, whether it be a legal appeal or whether it be taking additional savings measures to ensure we remain living within our means”.

We should look at this development within a bigger picture. The government thinks that by gutting the power of the NSW Industrial Relations Commission and legislating a cap on public sector wages – effectively by repealing many of your workplace rights – it can do whatever it wants.

Thankfully, we live in a democracy and it cannot do whatever it wants. The parliamentary block of its attempt to cut your take home pay is evidence of that.

We are in a serious struggle with the government for safer patient care and our campaign to extend and improve ratios will be a long game. We need to be patient, innovative and determined to win.

It needs more than what we have done in the past because we can no longer rely as much on the machinery of industrial relations.

We can still use what industrial processes we have at our disposal to enforce our wins of the past.

As things now stand the Award has been varied to pay a 2.27% wage increase. Meetings with the Ministry of Health have stopped. It is reasonable to expect that the next award pay increase is due in July 2014.

The award is still active so there is an opportunity for the government to improve and extend ratios between now and July 2014.

There are also opportunities for nurses and midwives to put pressure on the government to do the right thing. But we cannot confine our efforts to the industrial arena. We also have to fight the good fight in the political domain and in the court of public opinion.

All year we have been building that pressure with workplace activities, MP visits and paid advertising. We need to maintain that momentum, albeit strategically timed, between now and 2015.

What is crucial here is the support of the community and we must double and redouble our efforts to win the support of the public for our campaign for safer patient care through improved and extended ratios.

We need to maintain our resolve to keep the government honest. Each day that the government stonewalls is another day closer to the next state election. That makes it vulnerable if they continue to defy the support we have in the community.

We are not alone. We have allies – lots of them.

The vote on superannuation shows that from time to time we have diverse allies in parliament.

Our affiliation with Global Nurses United (see pp 12) links us with nurses and midwives around the world who share our ambition for better public health systems.

And last, but certainly not least, we have the support of a public that consistently expresses its desire for a world class public health system.

Any government who ignores that community aspiration does so at its peril.

THE LAMP OCTOBER 2013 | 5

YOUR LETTERS

LETTER OF THE MONTH

Introduction of AiNs to acute areas As the state government and local health districts hurtle towards a model of replacing skilled staff with unskilled staff, I am astounded by the speed at which the issues brought up by the Garling Report have been forgotten.

At the time I testified against trainee Enrolled Nurses in the workforce. The trainee EN replaced a skilled, trained EN on our ward. So the patient team allocation could have two RNs, an RN and an EEN, an RN and unendorsed EN or an RN and a trainee. It was a “numbers” only model and skill, or lack of it, made no difference.

On our ward the RN/trainee allocation became the subject of a SAC1 critical incident. The supervising RN was so traumatised by the inadequate care that she and the trainee could give, it nearly destroyed both their careers.

The implications of hurtling down the unskilled path are obvious clinically. Never ever underestimate the information an RN can gain from a person in a shower, from doing the observations yourself (yep we can all do a pulse rate on a machine, but is it accurate)? Does the patient have AF and the machine reading is false, is the BP really that high or low, is the O2 SAT probe really picking up a true SAT level on a peripherally shut down 80 year old?

As an RN you can only be as good as the information you are given if someone else is doing the tasks. It looks like we are going back to that model where I do medications all day, complex discharge planning and sitting behind a desk, while the unskilled worker runs around doing the showers and obs.

We can talk about teams but at the end of the day it is going to be all about tasks. I started my career with the task nursing model. It was dull and immensely boring. It suited the hospital-based training days as you progressed through the ranks. But what a breath of fresh air when Total Patient Care came in, and hospital-based training ceased.

I don’t want to look at all my tasks on a piece of paper and tick them off as “done”. I want to hold a dying patient’s hand, get an orthopaedic patient to walk and do the little picture stuff as well as the big stuff.

There is a school of thought from academics and senior management that this is demeaning for an RN and a waste of skills. They couldn’t be more wrong.

I have been a bedside nurse for 33 years. I have nine years until retirement. I was going to go casual after I accessed my superannuation. But this will be unlikely if we go back to task nursing. So my skill set will be lost too early. How many others will be too? And the people who will really miss out will be the patients.

IIMS documentation will never be critical. Document, document, document. We live in a patient world that is so much more complex than it was 30 years ago. The model is not about teams. It is about tasks and money-saving.

An AiN absolutely has a role in the acute care setting. We use them for nurse “specialling” and they are fantastic. They have a place as an adjunct to our present FTE profile as well.

But to replace skilled with unskilled is unforgivable.

Mandy Short, RN

6 | THE LAMP OCTOBER 2013

Support for Bahraini nurses I’ve seen some photos of your campaign in solidarity with the victimised medic staff in Bahrain and I’d like to say that it really touched my heart and made me happy. For me that level of support is better than a statement by a politician like the prime minister or the foreign affairs minister because it is pure and genuine, right from the bottom of your hearts.

It really revives the hope that, regardless of the boundaries and borders, nationalities and religions, races and ethnicities, we remain kindheartedly connected and share core values that transcend all sorts of differences.

I’m originally from Bahrain and have been living and working in Australia for three years; before that I was in New Zealand. I’m neither a refugee nor an activist, but I haven’t been able to return to Bahrain since 2008 because it could be a one-way journey.

Merely because I sometimes express my opinion in the media about what is going on in Bahrain.

When the uprising broke out in 2011, my younger brother participated in the peaceful protests and saw his friends being arrested and shot at by the police and the army. He managed to flee to Malaysia and was planning to stay there temporarily until things settled down a bit. I convinced him to seek asylum in Australia because we don’t know how long the situation will remain like that in Bahrain.

I applied for a visitor visa for him and he booked a flight from Malaysia to Australia and sought asylum at the airport. He was afraid. I told him “don’t be, just tell them the truth, don’t lie, don’t exaggerate, just tell them what happened to you and your friends”. He was detained at Villawood Detention Centre for two or three months and then was granted asylum.

I’d like to thank Australia and the Australian people for providing such protection and shelter for him. He’s now studying and working in Perth.

In Arabic, we call nurses the Angels of Mercy. Your support and solidarity was a true reflection of that.

Thank you, Abraham Alawi

Thank you!

I would like to express my gratitude to the NSWNMA and NEW Law Pty Ltd. I experienced a particularly difficult situation at my workplace.

I contacted the NSWNMA for advice and spoke to an information officer, who was supportive and listened attentively to my situation. The officer referred me to NEW Law, where they dealt with my difficulties professionally and precisely.

It was a great relief to me to be able to consult with professionals who took on my workplace cause. It has now been resolved with great success.

Prior to this episode I was contemplating resigning from the Association, thinking that I wouldn’t require their services as I worked in the public system, and I thought that the system would adhere to the rules and regulations.

This was not so. So, again, I am truly thankful to the Association and NEW Law. Without them I don’t know where I would be now.

M.Webb, RN

NO TIME

YOUR LETTERS

Fix this problem Mr O’Farrell (A nurse who attended a community cabinet meeting at Broken Hill sent this letter about the importance of ratios to Premier O’Farrell.)

Mr O’Farrell, I ask you why you feel that the patients in our community deserve less than in your community when they are sick and unwell; I ask why we don’t deserve the same number of nurse-to-patient ratios as that of the city hospitals.

An Emergency Department in a country hospital is exactly the same as any hospital in the city; it deals with emergencies the same as any other. Ratios work Mr O’Farrell.We have showed you that in areas like medical and surgical wards of hospitals across the state we need ratios extended to ensure that there is appropriate staffing.

You have showed us that you are aware of the shortfalls and that extra staff was needed.

We hear constantly of the 4000 extra nurses your government has put in place but we need to remember that this is only 2700 full time equivalent positions and, although fantastic, doesn’t account for the large number of staff that have left or the shortfall there was prior to this recruitment.

Our hospital was some 30+ FTE down and relying on agency staff to fill gaps, a bulk of these new positions were newly graduated nurses or novice nurses who required support for at least the first 12 months of their employment.

The commitment your government has made to recruit nursing education and nursing support roles is fantastic, but these education roles take senior nurses off the floor leaving us short of senior nurses. Ratios across all areas of our health system will ensure patient safety as staff will be able to deliver the care that they are trained to do, and cope with the emergencies that pop up.

Mrs Skinner’s comment that nurses can go from one ward to the other and help out is a fantastic idea but very unrealistic. Ratios mean that there is the right amount of nurses in each area for the number of patients.

You talk about the wrongs the previous government made in their term. Fix this Mr O’Farrell and make New South Wales’ hospitals safe. Set the benchmark for the rest of our nation and show the citizens of New South Wales that you care.

Help nurses do what we are trained to do by providing us with a work environment that is safe not only for staff but for our patients.

Thank you for your time and for visiting our great city.

Zoe Tonkin, RN

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NEWS IN BRIEF

Australia

Self harm by young women increasing The number of women aged between 15 and 24 who have injured themselves so badly they need hospital treatment has increased by more than 50% since 2000.

According to figures released by the Australian Institute of Health and Welfare, in the 2010-11 financial year more than 26,000 people were hospitalised for self-harm. Of those the majority, 42%, were aged between 25 and 44. Nearly one in five were women aged 15-24.

Self-harm and assaults helped drive an overall rise in serious injuries needing hospitalisation.

Experts say the statistics could underestimate the true extent of the problem.

Robert Tait, a senior research fellow at the National Drug Research Institute at Curtin University, told the Sydney Morning Herald that the figures were the tip of the iceberg.

“This is a rigorous examination of how many people end up in hospital, but the problem is much bigger than that,” he said. “Most people who self-harm don’t seek help.”

The institute’s James Harrison said overdoses were the form of self-harm most strongly linked to hospital admission. He said it was not known whether increases in self-harm were linked to greater access to dangerous drugs and other methods, or mental ill health.

“The type of drugs available does have a big effect on suicide,” he said.

“RACISM IS A SIGNIFICANT STRESSOR IN THE LIVES OF AFRICANAMERICAN WOMEN.”

8 | THE LAMP OCTOBER 2013

United States

United States

Racism is bad for your health

Questioning the annual checkup

Stress resulting from exposure to racist behavior has been linked to an increase in asthma among black women, according to a US study published in the journal Chest.

The study followed 38,142 African-American women, participants in the Black Women’s Health Study between 1997 and 2011.

The women completed health questionnaires every two years.

In 1997 and 2009 they provided information on their experiences of “everyday” racism, like poor service in stores or restaurants, and “lifetime” racism, which was discrimination encountered on the job, in housing, and by police.

As experiences of everyday and lifetime racism increased, the incidence of adult-onset asthma also rose, up to a 45% increase in women in the highest compared to the lowest category of the racism measures.

“Racism is a significant stressor in the lives of African-American women, and our results contribute to a growing body of evidence indicating that experiences of racism can have adverse effects on health,” Patricia Coogan, research professor of epidemiology at Boston University said.

In the United States annual checkups account for more than 8% of doctor visits and cost the health care system $8 billion annually—more than the total health care spending of several states, says the online magazine Slate.

Each visit takes around 23 minutes, meaning doctors in the United States spend approximately 17 million hours each year running their stethoscopes over 45 million completely healthy people.

Effectively, 177,000 Americans will visit a doctor, even though they have absolutely no symptoms.

Only one-half of annual checkups actually include a preventive health procedure such as a mammogram, cholesterol testing, or a check for prostate cancer.

Only 20% of the preventive health services provided in the United States are delivered at annual checkups.

NEWS IN BRIEF

Australia

Midwife-led care is better: study A study by the Cochrane Collaboration – an international authority for assessing medical evidence – has found that women who give birth under the primary care of a midwife are more likely to have full-term births and fewer medical interventions.

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The Cochrane review examined the evidence of 13 trials involving more than 16,200 women randomly assigned to either midwife-led care or other models, such as having an obstetrician in charge.

Women treated by midwives were 23% less likely to give birth prematurely, and foetal death before 24 weeks was 19% less likely, the review found. It found several benefits of midwife-led care and no negative effects, concluding “most women� should be offered midwifeled care and be encouraged to ask for it, the Sydney Morning Herald reported.

Australian College of Midwives spokeswoman Hannah Dahlen said the high-level review was significant. “We are one of only two countries in the developed world that has such a huge amount of private obstetric care,� she said. “Yet this is high-level evidence showing midwife-led care is linked to a significant reduction in pre-term birth.�

Professor Dahlen said obstetricians were still very much needed, but should assist more high-risk and fewer low-risk births.

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NEWS IN BRIEF

Austria

A cultivated brain Researchers at the Institute of Molecular Biotechnology in Vienna have grown “organoids” resembling embryo brains, in the laboratory.

A cross-section of a brain organoid shows neural stem cells in red, and neurons in green

They started with stem cells and grew them into brain cells in a nourishing gel-like matrix that recreated conditions similar to those inside the human womb, reported the Guardian newspaper. After several months the cells had formed spheres measuring about 3-4mm in diameter.

The scientists say the organoids will be useful for biologists who want to analyse how conditions such as schizophrenia or autism occur in the brain.

The organoids are also expected to be useful in the development and testing of drugs in more human-like settings.

“The cerebral organoids display discrete regions that resemble different areas of the early developing human brain. These include the dorsal cortex identity – the largest part of the human brain. They also include regions representing the ventral forebrain and even the immature retina,” said one of the researchers, Madeline Lancaster.

Zameel Cader, a consultant neurologist at the John Radcliffe Hospital in Oxford, was enthusiastic about the study.

“This is a fascinating and exciting piece of research extending the possibilities of stem-cell technologies for understanding brain development, disease mechanistics and therapy discovery, as well as hopes for regenerative medicine.”

He said the organoid was “audacious and the similarities with some of the features of a human brain really quite astounding”.

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10 | THE LAMP OCTOBER 2013

NEWS IN BRIEF

Canada

Roxon travels with tough stance on tobacco Australia’s former Attorney-General Nicola Roxon has been spreading her message on “plain packaging” for cigarettes to a receptive Canadian audience.

In December last year Australia imposed legislation requiring cigarettes to be sold in packs with 75% of the front and 90% of the back covered by graphic photos illustrating the dangers of smoking.

The High Court later ruled against three multinational tobacco companies that had sought to block the cigarette-packaging law.

Nicola Roxon was in Quebec to address a National Assembly committee studying possible revisions to the Quebec Tobacco Act, at the invitation of the Coalition Québécoise pour le Contrôle du Tabac.

“I’m here to help their campaign urging Quebec and Canada to consider taking the next step in tobacco control,” Roxon told the local Montreal Gazette. “We know that people who are already addicted find it difficult to give up. The real game is about stopping new people from getting addicted. And obviously, if you can also encourage people to quit, that’s great.”

Canadian legislators were impressed by Australia’s outcomes in lowering the level of smoking. In Australia, 20.4% of men smoked in 2011-12, down from 23% in 2007-08, according to the National Health Survey. Among Australian women, 16.3% smoked in 2011-12, down from 19% in 2007-08.

Asia

Britain

Exporting death

Private hospitals price gouging

The smoking rate has been dropping for decades in the United States but a new, secretive trade deal being negotiated by the US government will prevent Asian countries from achieving such good outcomes.

The proposed trade agreement will reduce tariffs on tobacco in poor Asian countries to zero, opening the floodgates to an influx of cheaper cigarettes.

With the smoking rate in the US reaching an all time low of 18%, the US government is pushing to help tobacco companies find new customers overseas, by allowing them easier access to developing countries in Asia, according to the Washington Post.

“If those markets are transformed, you are going to see an epidemic of enormous proportions among those least prepared to pay for it,” Greg Connelly, director of the Center for Global Tobacco Control at Harvard University told the Post.

“We’re basically turning around and siding with the actual agents of that disease and enhancing their ability to claim a billion lives in a century.”

The world’s four biggest cigarette manufacturers — Altria (formerly Philip Morris), British American Tobacco, Japan Tobacco and R.J. Reynolds — have been looking to new markets to offset their domestic losses.

The new plan also allows tobacco companies to sue countries over their public health measures on the grounds that they violate free trade rules.

Australia and Uruguay were the first targets of this Big Tobacco aggression when they were sued over new laws that required cigarettes to be sold in packaging that graphically illustrates the harmful effects of smoking.

A British Competition Commission investigation of the private healthcare sector has found significant instances of anti-competitive behaviour, and criticised four of the five biggest operators for generating excessive profits according to the Guardian newspaper.

“IF THOSE MARKETS ARE TRANSFORMED, YOU ARE GOING TO SEE AN EPIDEMIC OF ENORMOUS PROPORTIONS AMONG THOSE LEAST PREPARED TO PAY FOR IT.”

The Commission found that: • Most patients in UK private hospitals are paying more than they should for treatment because of a lack of local competition.

• Private hospital operators, on average, charge somewhat higher prices in local areas where they face fewer competitive constraints.

• More than 100 private hospitals around the country were in areas with little rival healthcare provision.

The provisional findings of the inquiry called for up to 20 hospitals to be sold off from the three largest private hospital groups – HCA, Spire and BMI – in 11 locations across the country. It found that between 2009 and 2011, the three firms had used their market power to amass half a billion pounds, to the detriment of consumers.

There has been substantial growth in the use of private hospitals, to provide publicly funded services, by the NHS in recent years.

Studies have shown that spending on private services by the NHS reached a record £8.7 billion last year, a jump of more than £3 billion since 2006.

THE LAMP OCTOBER 2013 | 11

COVER STORY

Ratios on the Our latest push to improve and ext of action in support of universal

12 | THE LAMP OCTOBER 2013

world stage

end ratios was part of a global day health care as a human right.

THE LAMP OCTOBER 2013 | 13

COVER STORY

THE O’FARRELL GOVERNMENT MAY THINK THE 2013 PUBLIC HEALTH system pay and ratios claim is over, but rallies for ratios as part of a Global Nurses United (GNU) day of action would suggest otherwise.

Hundreds of nurses rallied outside Parliament House on September 17 to deliver petitions with more than 70,000 signatures which will be presented to the government, before taking their message to the public outside the Sydney Opera House and on Sydney Harbour.

The action kicked off a wave of activities around the world as nurses took to the streets to send a message to their governments that they were going to stand up for universal health care as a human right.

The global day of action coincided with a meeting of the United

14 | THE LAMP OCTOBER 2013

Nations General Assembly to determine its millennial goals for 2015.

One of the principal goals is to improve health for the most disenfranchised in society through strengthened national health systems.

NSWNMA Assistant Secretary Judith Kiejda says an international nurses’ organisation, which coordinates support between nurses and midwives throughout the world, adds to strength to our campaign for a better public health system in Australia.

“The NSWNMA now has the support of Global Nurses United as we campaign to have safer nurse-to-patient ratios extended throughout New South Wales’ public hospitals and community health services,” she said. “We also have the support of GNU for

our campaign against state and federal government policies of privatising public hospitals.

“Global Nurses United’s member unions have vowed to work together to guarantee the highest standards of universal healthcare as a human right for all, to secure safe patient care, especially with safe nurse-to-patient ratios, and safe workplaces.

“Global Nurses United has only just started, but it is a big, important and positive step for nurses and midwives here in New South Wales, the rest of Australia and around the world, as we step up our resistance to those vested interests that want to put profits before patient care and those governments that support them,” she said.

Judith says there is no doubt working people need a global capacity to respond to the excesses of global capital and its bullying of workers and governments.

“To have an international nursing organisation, with this strong social justice and protection of public services focus, has been an objective of the NSWNMA for many years. It is vital that working people, including nurses and midwives, have global capacity not just state and national capacity here in Australia.

“One of the biggest groups of public sector workers in Australia is nurses and midwives, who keep our free public hospital and community health services going.”

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COVER STORY

DAY OF ACTION IN OUR REGIONAL BRANCHES

Many nurses and midwives couldn’t get to Sydney for the main rally but rallies, marches and other events were held throughout country and regional New South Wales and thousands of signatures collected on our petition. Nurses and midwives sent a clear message to the O’Farrell Government that the fight to improve and extend ratios continues.

Disability nurses from Stockton Branch show their support for public health system nurses and their campaign for better ratios.

Coffs Harbour Branch members with Assistant Ge and candidate for Cowper Alfredo Navarro.

Nowra Nurses Group at Nowra School of Arts.

Gathering signatures in Nowra.

Griffith nurses go bowling for ratios.

Wagga Wagga, Griffith, Gundagai and Lockhart n

16 | THE LAMP OCTOBER 2013

eneral Secretary Judith Kiejda (left)

nurses: bowling for ratios.

Rupert Murdoch rants against public sector Rupert Murdoch says that Australia’s nurses, police officers, teachers and other public sector workers are “sucking the life” out of the nation’s economy.

Coffs Harbour nurse Kim Jones showing support at the Big Banana.

The media mogul, now a United States citizen but still with control of more than 65% of Australia’s metropolitan newspapers, attacked Australia’s 1.7 million public sector workers, lumping them with “welfare scroungers” as he praised the Coalition’s victory in the federal election.

“Aust election public sick of public sector workers and phony [sic] welfare scroungers sucking life out of economy. Others nations to follow in time,” Murdoch tweeted.

The 14 countries of Global Nurses United GNU was formed in June this year. The founding members are unions from: Argentina, Australia, Brazil, Canada, Costa Rica, the Dominican Republic, Guatemala, Honduras, Ireland, Israel, the Philippines, South Africa, South Korea and the United States.

GOALS OF GNU > To work collectively to protect our professions, our patients, our communities, our work, our health, our environment, and our planet.

> To work collectively to guarantee the highest standards of universal healthcare as a human right for all, to secure safe patient care, especially with nurse-to-patient ratios, and safe workplaces. > To oppose the adverse effects of income and resource inequality, poverty, attacks on public sector workers and the ravages of climate change. > To provide international solidarity among nurses and to offer one another support and assistance.

The worldwide actions of September 17 coincided with the opening of the next session of the United Nations General Assembly.

Later, in a second tweet the day after the election, Murdoch accused public sector workers of taking more sick days than their private sector counterparts.

“Small item: apart from higher pay, public workers in Australia take many more sick days than those in hard working private sector!” Murdoch tweeted.

Murdoch’s position on the public sector seems, unsurprisingly, to be shared by new Prime Minister Tony Abbott.

Mr Abbott pledged to axe 12,000 public service jobs during the federal election campaign.

If you want to give Rupert Murdoch your own analysis about being a nurse and public sector worker you can do so at Twitter: @rupertmurdoch THE LAMP OCTOBER 2013 | 17

COVER STORY

OUR MEMBERS’ SAY

“IT’S RIGHT TO MAKE RATIOS THE #1 ISSUE.” “I was fortunate to have the opportunity to attend today’s rally. A lot of nurses are so busy doing shift work and long hours that they can’t get to a rally like this. Nursing is not the kind of occupation you can easily step away from, but I think it’s important that we stand up and make our voices heard.

I think it’s right for the union to be making ratios the number one issue at the moment. If we don’t get improved staffing and reasonable workloads everyone will suffer. Patients and their families won’t get the care they need and the government will lose public support. Nurses will leave the workforce in droves.

Nurses are dedicated people and it’s not a job you can half do. Everyone puts in their utmost, but it’s hard to see how people can go home exhausted at the end of each day, year after year, without getting burnt out. It’s well documented that nursing burnout can happen at quite an early stage in someone’s career.

Beth Hetherington RN Paediatric Intensive Care Unit Westmead Children’s Hospital

18 | THE LAMP OCTOBER 2013

“WITHOUT ACTION THINGS WON’T CHANGE.” “The energy at today’s rally is fantastic – it shows we can all pull together and fight for ratios and safe patient care.

We have pretty good ratios in ICU yet I still struggle to get my work done and there are times we are under stress. However our ratios are not mandated so they could easily be taken away.

It’s harder to demand something that’s not mandated and patients will be the ones to suffer if we lose them.

We need a guarantee that won’t happen.

Talking to nurses in other departments and hospitals without ratios, I just can’t believe the conditions they have to work under every day.

I went on strike to attend the rally in July. We were a very busy unit that day and it was very hard to step away from the bedside knowing that there weren’t a lot of people to cover. I was just very lucky I could represent our hospital – if we don’t take action things will never change.”

Nikki Low RN Paediatric Intensive Care Unit Westmead Children’s hospital

“RATIOS ARE ESSENTIAL TO PATIENT SAFETY.” “I came to the rally because I want the community to know that nurse-to-patient ratios are essential for patient safety. We are nurses because we care and we really want to care for our patients in the right way. We need safe care for everybody, not just in the metro hospitals but also in regional New South Wales.

Privatisation is another big issue for me. Management have told us that when the new northern beaches hospital opens under a private operator, Mona Vale will be just a rehab centre – all acute patients will go to the new hospital.

Privatised health care will be more profit driven and more expensive. People who are chronically ill – like the aged at Mona Vale and Manly – will miss out because many can’t afford expensive health care. Most of my patients are not well off.

I feel our rally today is connected to a global movement because nurses around the world face similar problems.

Everything is becoming money driven and care for people and the environment is disappearing. I used to work as an RN in the Philippines at a private hospital, mostly for wealthy people, so I know about the problems of privatised health care.”

Sonia Malar RN Mona Vale Hospital assessment and rehabilitation unit

“INADEQUATE STAFFING IS A GLOBAL ISSUE.” “As a former South African nurse I wanted to take part in this day of international action because I know that nurses in Australia and South Africa face similar battles.

Inadequate staffing is an issue common to both countries.

In acute surgical we are fortunate to have got the 5.5 hours per patient day, so we are better off than other areas of Mona Vale Hospital that don’t have the ratios.

I’m here at the rally for all nurses who are still fighting for ratios, and their patients.

We see a lot of patients from the country where ratios don’t apply. Our orthopaedic VMOs do clinics at Dubbo and Orange so if they can’t get surgical time there they bring patients to Mona Vale.

I feel very strongly that the Australian public is being hard done by privatising the public health system. Our new northern beaches hospital will be handed over to a private operator who will run it in the interests of their shareholders and the bottom line, not people’s welfare.

They haven’t outlined how it’s going to work but it doesn’t look good for public patients.”

Robyne Brown CNS Mona Vale Hospital surgery and orthopaedic unit

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COVER STORY

Austerity: a weapon to attack public services Australia came through the global financial crisis largely unscathed. Not so other countries, where austerity policies introduced in the wake of the GFC are being used to dismantle public services including healthcare systems.

20 | THE LAMP OCTOBER 2013

“The unity and determination of nurse and healthcare worker unions to come together and push to protect all our people is a profound expression of how deeply the neoliberal agenda is devastating countries and lowering standards worldwide.”

— RoseAnn DeMoro, Executive Director National Nurses United

FOR MANY NURSING UNIONS THROUGHOUT the world, the dominant theme of the Global Nurses United day of action on September 17, was opposing their government’s austerity policies, which are corroding their public health systems.

In New York, members of National Nurses United led a large coalition of community organisations opposing austerity and advocating for an alternative economic strategy, including the implementation of a financial services tax. This “Robin Hood” tax would reduce the volatility of the financial markets and provide a substantive revenue stream for governments to fund decent public health systems.

“The unity and determination of nurse and healthcare worker unions to come together and push to protect all our people is a profound expression of how deeply the neoliberal agenda is devastating countries and lowering standards worldwide,” said RoseAnn DeMoro, executive director of National Nurses United.

This sentiment was echoed across the Pacific in the Philippines.

“Filipinos and others in developing countries can never have healthy living with the worsening economic and political situation that further deprives them of their right to health. Health, being a basic right, should never be used for profit and should remain mainly as a state responsibility,” said Jossel Ebesate, national president of the Alliance of Health Workers (Philippines).

Nursing unions in Europe, Latin America, Asia and Africa face similar threats and challenges arising from austerity.

A RESPONSE TO THE GFC Austerity policies were implemented as a response to the global financial crisis, which began in 2007 and remains unresolved today in many countries. In the following four years, according to the International Monetary Fund, systemic banking crises occurred in 17 countries. The initial strategy in response to the GFC was stimulus spending by governments. However, from 2010 on, austerity became the core policy in many places.

According to a new report by the European Strategies Unit at the University of South Australia, austerity was intended to rapidly reduce public debt by a combination of cuts to public spending, reducing or freezing labour costs, tax increases and

privatisation, alongside reconfiguring public services and the welfare state.

“This was despite the fact that the crisis was essentially a private sector failure caused by a failure of markets and deregulation, not by excessive government spending,” says the report.

“Austerity agreements brokered by the International Monetary Fund and the European Union include public spending cuts, tax increases, wage and pension cuts, public sector reform and privatisation. Public sector cuts account for 75% of austerity measures in the UK between 2010-11 and 2014-15.

The economic and social effects of austerity 2.2 million public sector job losses have followed deep cuts in public spending in Britain, the United States and Spain.

5.5 million young people are unemployed in the European Union.

Cuts in wages, benefits and pensions have reduced take home earnings by up to 20%.

The financial crisis led to the bankruptcy of several US towns and cities including Detroit, once an icon of US industry.

10-31% of mortgages were in negative equity in Britain, US, Spain and Ireland in 2012-13.

Austerity has increased poverty and widened inequality.

Public services and the welfare state are being reconfigured to embed marketisation and privatisation in parallel with austerity.

“The socialisation of losses and privatisation of profits is the prime political and economic objective of austerity. Working people and the poor are made to pay for the failure of the banks, financial institutions and regulatory regimes.”

ATTACKS ON PAY AND PENSIONS Austerity policies have reduced the take home earnings of workers by between 5% and 20% in most European countries since 2008. They include pay cuts, reducing the starter pay of new workers, pay freezes, the withdrawal or reduction in allowances, bonuses and overtime payments.

Ireland imposed a pension levy equivalent to an average of 7.5% of pay, changed pension arrangements, raising the minimum retirement age from 65 to 66, and based pension payments on career average earnings instead of final salary.

In the United States the iconic industrial city of Detroit filed for bankruptcy in 2013 with $18.5 billion debt.The city of Stockton in California and Jefferson County in Alabama preceded it. Another 28 utilities, water districts, hospital authorities and other municipal bodies went bankrupt in the same period.

Bankruptcy and financial crisis has meant renegotiation of employment contracts, drastic cuts in services, reduction of pension fund obligations for current workers, outsourcing and privatisation.

HEALTH SYSTEMS DEVASTATED Many European countries have reduced per capita spending on healthcare. According to the World Health Organisation health systems have suffered closures, increases in a wide range of patient charges, and longer waiting times. Spain shifted health coverage from a universal to an employment-based system in 2012.

Recession has led to increased suicide rates in Europe and the US. A long-term decline in infant mortality in Greece has reversed since 2008, with two consecutive years of increases. The number of stillbirths increased by 38% since 2008 (WHO 2013).

The internationally renowned health economists Stuckler and Baus concluded that not only did “the IMF underestimate austerity’s economic harms but it overlooked the even greater damage that resulted from cutting public health.”

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COVER STORY

CANADA The Canadian Federated Nurses Union and United Nurses of Alberta held a rally in Calgary, opposing attempts by the government to impose cutbacks in the health care system.

Aro the w nurses toge UNITED STATES In the United States National Nurses United held a major demonstration in New York City, opposite the United Nations centre, demanding an end to austerity policies and passage of the Robin Hood tax.

The proposed tax – a tiny impost on financial transactions – would reduce volatility in financial markets and provide governments with much needed revenue to fund social services including public health.

American nurses marched from the UN to the world headquarters of JP Morgan Chase, one of the world’s largest investment banks. From there they marched to the New York City Metropolitan Transit Authority (which has been cutting services and cutting workers), then to the State University of New York to demand that they stop closing hospitals in the city.

More than 35 unions and community and student groups marched in support of nurses.

HONDURAS The National Association of Nurse Auxiliaries of Honduras held picket lines at hospitals throughout the country and a major rally in front of government house in Tegucigalpa.

They demanded an improvement to patient care in public hospitals, more nurses and fully funded nurse pensions.

22 | THE LAMP OCTOBER 2013

BRAZIL The Brazilian Nurses’ Union – Federação Nacional dos Enfermeiros – used the global day of action to call on the Minister of Health and the President to vote on a draft law that regulates the working hours of all nursing professionals at 30 hours a week. They also launched the National Forum of Nursing Organisations to broaden the debate on issues related to working conditions and professional status.

Global Nurses United is the fledgling movement walk on September 17 around the world, New York and Korea of healthcare as

und world, s stand ether only two months young but showed it could walk the with coordinated actions from Sydney to to Brazil, in support a human right.

SOUTH KOREA The Korean Health and Medical Union rallied to save the Jinju Medical Centre, to fight against austerity and for the rights of health workers.

The fight to save Jinju Medical Centre is seen as a test of the commitment to public health care by the government of South Gyeongsang Province. The hospital has 102 years of history of delivering health care to the poor in the area and is one of the oldest hospitals in the country.

Earlier this year three employees were hospitalised after a hunger strike protesting against the closure.

A senior member of the government told the Korean Times newspaper that the hospital was to close because it “lags behind in terms of profitability”.

QUEENSLAND The Queensland Nurses’ Union held morning teas at hospitals across the state on September 17. They published an ad in newspapers in Queensland on the vital role of nurses and midwives in providing universal health care. They also held a tree-planting ceremony at the union’s Brisbane office to mark the first Global Nurses United day of action.

SOUTH AFRICA The Democratic Nursing Organisation of South Africa (DENOSA) marked the day with a call for the enforcement of a Robin Hood tax by all governments that apply austerity measures, and to use the proceeds from that tax to specifically improve health infrastructure.

DENOSA also launched an online campaign in support of the Robin Hood tax.

PHILIPPINES The Alliance of Health Workers used the day to condemn the Aquino Government’s privatisation of public hospitals and other health services.

“This is nothing but a final step towards the abandonment of state responsibility for people’s health,” said Jossel Ebesate, the union’s national president. “Filipinos and others in developing countries can never have healthy living with the worsening economic and political situation that further deprives them of their right to health. Health, being a basic right should never be used for profit and should remain mainly as a state responsibility.”

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RESEARCH

A clearly discriminatory health environment exists between city and country in New South Wales, according to new research undertaken by the NSWNMA.

The metro-rural divide IN HER ADDRESS TO THE ASSOCIATION’S ANNUAL conference two months ago, health minister Jillian Skinner conceded that rural health suffers in comparison to metropolitan areas.

“Rural hospitals do not always have the level of access to professional infrastructure and support that might be available in metropolitan and major regional centres,” she said.

It was stating the obvious for rural nurses and midwives who participated in a recent research project undertaken by the NSWNMA. The study found that in the absence of the same level of medical staff and allied health professionals as in major metropolitan areas, rural nurses and midwives are required to multitask, and that this lack of resources can compromise care in a way that ripples through hospitals. This was consistent with previous academic research on the issue.

A nurse or a midwife has become the go-to person who picks up additional tasks and responsibilities in the absence of allied and ancillary staff. In rural and regional facilities, where there is less clinical support and inadequate numbers of allied, ancillary and medical staff, the situation is exacerbated.

The problem is significant, with more than 30% of the nursing and midwifery workforce working away from major cities.

Throughout the public health system unpaid overtime, working through lunch breaks, not being replaced on sick leave, or being replaced by a lower level staff member, has become the norm according to the study.

Across all peer groups surveyed there was a generalised sense of dissatisfaction with respect to the time available to provide patient care. However, these issues were more acute in the country.

Nurses working in District Group Hospitals (peer group C) reported an inadequacy of staffing and resources and high numbers of patients-per-nurse.

Nurses and midwives in D1b (Community Acute without surgery) facilities are spending considerable time on “other” tasks or responsibilities, with 55.2% of study respondents indicating that they had spent greater than two hours on their last shift undertaking “non-nursing” roles.

24 | THE LAMP OCTOBER 2013

KEY FINDINGS ACROSS THE FIVE PEER GROUPS SURVEYED NURSES AND MIDWIVES ARE STRUGGLING TO COPE WITH INCREASINGLY HEAVY WORKLOADS.

Unpaid overtime, working through lunch breaks and not being replaced when on sick leave have become normal features of the work environment.

Research builds on past work Nearly a thousand nurses and midwives participated in the study undertaken by the NSWNMA. The findings build on a previous study conducted for the Association’s 2010 wages and conditions claim.

The new study widens the focus to include nurses and midwives in Peer Group D and F3 facilities.

The study sought to investigate nurse and midwife perceptions of patient acuity and provision of service, and determine the range of staff, clinical and infrastructure resources available in New South Wales’ hospitals across the different peer groups.

The study also investigated nurses and midwives’ perceptions of the current health care environment and the factors that impact on the provision of care.

A nurse or a midwife has become the “go to” person to pick up additional tasks and responsibilities in the absence of allied and ancillary staff.

The situation is exacerbated for nurses and midwives in rural and regional facilities with higher patient-to-nurse ratios, inadequate skill mix, less clinical support and inadequate numbers of allied, ancillary and medical staff.

There is a strong belief among nurses and midwives that neither senior managers nor the Department of Health respects, values or is interested in supporting them.

What nurses and midwives had to say: ON COUNTRY WORKLOADS “We don’t have administration staff from 1700 to 0840 weekdays and none at weekends.

All admissions and discharges are done by nursing staff. All pathology is collected by nursing staff. Cannulation is done by RNs. Some of the RNs suture simple wounds. Most nights we don’t have a doctor on call and some weekends. — Country Hospital (D2) ON SECURITY “Security staff are not always provided … nurses are required to conduct searches of patients on admission and on return from leave with no security guard present.”

— Country Hospital (B Non-Metro facility) ON THE LACK OF CNEs “Our CNE is shared with three other hospitals, thus only see her once to twice a week.

She often takes a clinical role to help out when the ward is busy, ranging from triage, patient personal hygiene, medication administration to procedures like cannulating, catheter insertion, wound dressings, even attending to doctors’ rounds.”

— Country Hospital (D1a)

ON RURAL EDS “Our Emergency Department is staffed by one RN and one doctor. The doctor is called in from the local doctor’s surgery for any presentations. It is not unusual to have up to 15-21 presentations in six hours with only one RN and the VMO to do all the triaging assessments and care. There is a little bit of backup from the hospital coordinator when it’s really busy. This is very unsafe for patients and puts enormous pressure onto the ED staff.”

— Country Hospital

ON A MIDWIFE’S WORKLOAD “The post natal ward has 19 beds = 38 patients (mum and baby). Last week I had eight women and their babies to look after; 16 patients in my care. It’s dangerous. You are not physically able to provide quality care when you have that many patients in your care.

— Country Hospital (B Non-Metro facility)

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RESEARCH

ACCORDING TO THE RESEARCH: “… THE ETHOS OF CARE HAS BE THE PRIMACY OF FISCAL CONTAINMENT, AND A PICTURE EMERG COMPROMISE WHICH PLACES BOTH NURSES AND MIDWIVES, AN THEIR PATIENTS AT RISK. … THE FINDINGS REVEAL A HEALTH SY WHICH IS FAILING TO PROVIDE A SAFE ENVIRONMENT FOR BOTH EMPLOYEES AND THE POPULATION IT IS FUNDED TO SERVICE.”

Compromise cascades through wards A key objective of a recent research project was to assess the range of staff, clinical and infrastructure resources in New South Wales’ public hospitals and compare them across different peer groups.

ADMINISTRATIVE AND CLINICAL SUPPORT For nurses and midwives in F3 facilities (multi purpose services) there is virtually no administrative support outside of weekday mornings.

Nurses and midwives working outside of Peer Group A (principal referral and specialist hospitals) and B facilities (major metro and non-metro hospitals) are more likely to have no admin support at all.

46.5% of respondents in D1a (community acute with surgery) reported this.

It is not just RNs and RMs who lack administrative support. It is also true for unit managers.

“Administrative support for NUMs is still not provided routinely despite the recommendations of the Garling Report,” said a NUM from a metro hospital.

Similarly, nurses and midwives in the smaller, rural and regional facilities are less likely to have a team member without a patient load who is able to provide support when needed.

• 84.8% of respondents in F3 facilities reported no “in charge without a patient load”.

• 74.1% of nurses and midwives in D1b 26 | THE LAMP OCTOBER 2013

facilities reported no “in charge without a patient load”.

• The level of clinical support from a CNE/CME in these facilities is minimal or non-existent. In some D1b facilities a CNE/CME is available on some weekday mornings although 56.6% of respondents in this group reported no availability of a CNE/CME. A respondent from a country Hospital said “the CNE is shared with three other hospitals, thus only see her once to twice a week”.

• 92.3% of respondents in Peer Group D2 have no access to a CNE/CME on site.

ANCILLARY STAFF Participants in the study were questioned about the availability of ancillary staff such as a wards person, cleaners, security personnel, blood collectors and ECG technicians.

An ECG technician is rarely reported outside the metropolitan hospitals and is not found at all in D1a and D1b facilities.

One would expect to find a cleaner in all facilities but this was not so. One respondent from a metro hospital said “cleaners only work half days on weekends – patient care activities and waiting rooms

have the same traffic. The place is just grubby and dirty”.

Wards people/porters were also not found across all facilities.

There were concer ns about the availability of security personnel across all the peer groups.

“Security for our hospital is provided by the campus and it sometimes takes a long while for them to show up as they could be with an aggressive patient (on another part of the campus),” said a respondent from a metro hospital.

In the absence of ancillary staff, nurses and midwives are required to multitask and incorporate non-nursing duties or indirect patient care into their workloads.

“The worst thing is having to clean and make our own beds, including the birth suites following a birth. It takes a lot of time and is not a clinical task,” said a country midwife.

ALLIED HEALTH PERSONNEL Participants were also questioned about the availability of allied health personnel such as radiographers, physiotherapists, occupational therapists, social workers and pharmacists.

ECOME SUBSUMED TO ES OF A CASCADE OF ND YSTEM H ITS

The overall trend of these roles is to be less frequently found outside of weekday mornings and less frequently found at all time periods, or not available at all, in peer group D and F3 facilities.

The lack of allied health staff has implications for patient outcomes and for the workloads of nurses and midwives.

“Our occupational therapist is in another town and comes after a referral is sent – maybe in the next week. The physio is also on an arrangement and comes twice a week, so rehab is essentially up to the nursing staff,” commented a respondent from a country hospital (D1a).

MEDICAL STAFF D1b, D2, and F3 facilities have little access to medical specialists, registrars or residents. The medical support at such facilities is provided by a VMO/GP. “I cannot stress how understaffed the medical department is here. There is no doctor on site after 6pm weekly and difficulties arise as to who will make medical decisions on these patients out of hours,” wrote a nurse from a country hospital.

What nurses and midwives had to say: ON FAILING THEIR PATIENTS “You do not get time to spend on patients’ emotional and psychological needs or [to] just be with them. All our time is spent on reports and the patients’ physical needs, stocking up, tidying rooms …” — Country MPS (F3) ON ANCILLARY STAFF “Ancillary staff, such as equipment officers, are not replaced for annual leave thereby the responsibilities are left to the nursing staff on top of their existing workload and the stores ordering is sent into chaos. Restocking and unpacking of stores falls to senior staff with no patient load, such as NUM3 and CNC – not very cost effective.” — Metro ON ALLIED HEALTH WORKERS “No speech pathologist to assist with swallowing problems in patients … especially post-stroke. No social worker or local mental health provider means that psychosocial issues also have to be managed by clinical staff (often on the run). — Country (D1b)

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ANNUAL CONFERENCE 2013 PROFESSIONAL DAY

When “efficiency” is code for “cuts” Our public sector suffers the plight of the anorexic. No matter how thin it gets there are voices saying it is too fat.

THE WORD “EFFICIENCY” IS OFTEN MISUSED to mean “cuts” and some cuts can end up costing as much as they save, says Christopher Stone, research director at the Centre for Policy Development.

Now we have a Liberal government at the federal level as well as state in New South Wales, and both governments are strongly committed to reducing the size of the public service in the name of efficiency.

Efficiency is a buzzword that is often bandied about when it comes to restructuring and reforming the public service.

Christopher Stone says every Australian needs to understand what politicians mean when they say “efficiency” so they can demand an efficient government.

“Unfortunately the word ‘efficiency’ is often misunderstood or misused, leading to decisions that cause waste. In public services the two most common kinds of false economies are inappropriate cuts or savings, and inappropriate privatisation or outsourcing,” he says.

“When it comes to privatisation or outsourcing, many politicians have tunnel vision. They only see the private sector as efficient and are blind when it fails. Yet markets regularly mess up.”

efficiency that end up costing more than they save.

“These are usually staff cuts such as promises to reduce the number of public servants by a certain amount or general budget cuts such as the so-called ‘efficiency dividend’ which requires most federal government departments to spend 1.25% less to meet the same responsibilities each year.

“Cutting spending on activities that deliver more benefits than they cost, or failing to invest in projects that should be undertaken, can make government less efficient not more.”

Stone says a lot of the debate around public sector efficiency is really rhetoric using phrases like “doing more with less” to advocate doing more work with fewer resources.

“There is often a misuse of the word efficiency because the proposed plans focus on the resources being used and don’t sufficiently consider the outputs being produced.

“The cuts are usually measured in detail and get strong media attention, but the services are not so well measured and so decreases in quality or accessibility of the services are not so noticeable.”

INAPPROPRIATE SAVINGS Stone argues that false economies result from short-term, narrow-minded thinking on Australia’s public services. These false economies, he says come from “muddled thinking” – decisions made in the name of

HOWARD CUT THEN HIRED Cuts to the public sector seem to be a central goal of the Liberal Party in government. Pre-election Joe Hockey mentioned figures of 12,000 and 20,000 jobs in the federal public service that could go. Barry

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What your money buys in public services The average household pays about a quarter of its income in taxes. With this money governments: • Teach 65% of our children and substantially co-fund the other 35%.

• Co-fund nearly all Australian university students.

• Provide 67% of hospital beds – and co-fund the private beds.

• Co-fund medical services and medications.

• Provide and police the entire justice system.

• Undertake all diplomatic and national security tasks.

• Provide infrastructure such as the majority of roads.

• Supply essential community services and provide help when bushfires, floods or other emergencies occur.

• Give financial assistance to those in need e.g. aged pensions.

• Run trusted information sources such as the ABC and the Bureau of Meteorology.

O’Farrell has intimated that 5000 are to go in the New South Wales public service.

12,000 is the stated goal of Campbell Newman’s Queensland government.

The Howard Government also entered government with a similar zeal to wield the razor to public sector jobs. It cut the Australian public service by 32,000 in its first four years. It then found that it had insufficient capacity to deliver services and hired 42,000 extra public service servants in the next four years.

Christopher Stone says our public services do a lot for us and there needs to be a consideration of results as well as resources when considering privatisation or outsourcing.

“Our public services need to be efficient, effective and fair. But we won’t achieve that by endless cuts or blind faith in market solutions.”

Christopher Stone speaking at the NSWNMA 68th Annual Conference on Professional Day.

Strong views on the public service People have strong opinions about the public service and those views are often insightful.

“I respect the professionalism of the public service. In the longer term, though, we have to rely less on bureaucrats and put more trust in the common sense of the Australian people. We need smaller, more efficient government.”

— Tony Abbott

“It’s not ‘efficiency’ to default on your social obligations. It’s not ‘waste’ to treat your people with respect.”

— Kim Carr, ALP

“The reality is that government employees around the world are known not to be as efficient as the private sector. What the public sector can learn from the private sector is the need for a constant focus on efficiency.”

— Paul Fletcher, Liberal Party, member for Bradfield

“It was public servants that did so much to get us through the global financial crisis with a temporary, timely, targeted fiscal stimulus program that was recognised by international economic authorities, such as the IMF, as being a worldbeating fiscal stimulus program because it was put into place quickly and efficiently.”

— Andrew Leigh, ALP, member for Fraser.

THE LAMP OCTOBER 2013 | 29

ANNUAL CONFERENCE 2013 PROFESSIONAL DAY

Bringing death to life We need to acknowledge death and dying and include quality of life in end-of-life care, says Joanne Lewis.

MODERN MEDICINE HAS GIVEN WESTERN society what palliative care nurse Joanne Lewis calls a “death denying culture where death is seen as a failure.”

Joanne, a lecturer in palliative care, primary health care, aged care and ethics at the University of Technology Sydney, spoke at the 2013 NSWNMA Professional Day. She says health professionals and junior medical staff members are eager to learn ways to communicate better with patients at the end of their lives, but much more is needed in terms of public policy.

“Palliative care in Australia needs more 30 | THE LAMP OCTOBER 2013

community home care, more education, particularly around communication in endof-life discussions, and more support for aged care facilities for end-of-life care,” Joanne said.“There’s a failure to recognise that often prolongation of life may fail to support an acceptable level of quality of life and we often don’t even begin to discuss that in our health systems.

“The challenge is to acknowledge death and dying and include quality of life in treatment management and care.

“Often we give the task of end-of-life decision discussions to the most junior doc-

tors to do. Whenever I’ve done rounds with the palliative care team I’ve made a big effort to grab a couple of junior doctors and say ‘do you want to hear a good end-of-life care discussion, a good goals-of-care discussion?’

And they come along gladly; they really want to know how to do this well.”

Her students are also eager to learn how to provide better end-of-life care: “They feel unprepared to do it, they feel the system doesn’t sustain good end of life care and they want to communicate better.”

Joanne told delegates at the professional day that in the UK, many Gen Xers and

“People study for weeks for a birth.

Why not study for death?”

Gen Ys seek conversations and information about death and dying at Death Cafes (deathcafe.com), where participants are invited to “drink tea, eat cake and discuss death”.

“Many of them have had an experience of a death at quite a young age and there’s no avenue in their social network to have these conversations,” Joanne said.

In Australia, Advanced Care Directives (ACDs) are an important aspect of end-oflife planning but more is needed.

Between 19 to 29% of aged care facility residents die in hospital, despite having ACDs. And overwhelmingly the discussions of care

that take place for this group are reactive to their sudden deterioration, taken without the time to consider the issues and certainly too late for many of the planning aspects to be effective.

“Improved quality of end-of-life care requires moving from a single focus, such as ACDs, to public policy on multi-faceted interventions,” Joanne said.“This is a complex social systems problem and it requires a range of interventions.”

Until early in the 20th century, death and dying commonly occurred at home, surrounded by friends and relatives.

“There has been a change in the place of death, it occurs in institutions overwhelmingly. Certainly that shapes how we perceive the naturalness of death.”

Joanne remembers a patient, a young woman dying of an advanced bone cancer, who told her she had suffered a social death long before her dying days.

“She told me ‘I watched my friends withdraw, fearful. They weren’t sure what I had done to bring this on myself. They were uncomfortable with death and dying so they were uncomfortable with me’.”

When discussions about end of life decisions do occur, communication is confused and the medical language is even more confusing.

“Numbers of times I’ve walked back in a room to talk to a patient and family about what they understood and they have said they had no idea what was said.”

She says even a simple change in language can be effective. A study this year looked at responses to the terms Do Not Resuscitate (DNR) and Allow Natural Death (AND).

The focus on using CPR fell from 60 to 49% with AND. “DNR implies you’re taking something from somebody. But is it right to offer it in the first place if it is unethical and causes harm? Use the D word and people are very clear what you’re talking about. So we need to consider the language we use.”

Joanne has been a nurse for 24 years, 15 of them in palliative care.

“What I’ve learned in caring for the dying is that death overall is peaceful, acceptable and dignified; that we cannot guarantee a good death, but where we do it well we can guarantee good end-of-life care.”

Joanne recommends the book Dying to Know: Bringing Death to Life published by Igniting Change (formerly Pilot Light Australia) www.ignitingchange.org.au.

“Read it and rush into the daylight to get on with the more challenging work of living,” Joanne told delegates. “People study for weeks for a birth.Why not study for death?”

THE LAMP OCTOBER 2013 | 31

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Relax at the cafe or cosy bar. Dine on modern Australian cuisine in the magnificent ‘grand dining room’, Chisholm’s Restaurant. You won’t want to go home! The Lamp is offering a magical prize – an escape for 2 adults, including: c a ‘Grand Classic’ room in Caves House for 2 nights c 2 dinners (2-course) & 2 full breakfasts - both days c 2 Plughole Adventure tickets c 2 ‘Jewels’ Passes & 2 ‘Magic’ Passes for guided cave tours c Self-guided Nettle Cave tours.

To enter the competition, simply write your name, address & membership number on the back of an envelope & send it to: Jenolan Caves Competition 50 O’Dea Avenue, Waterloo, NSW, 2017

Nurses and midwives rally outside the ‘San’ at Wahroonga in response to management’s “insulting” pay offer and attempts to cut allowances and benefits.

Competition closes 31 October 2013. Only one entry per member will be accepted. Valid Mondays to Thursdays only. Unavailable long weekends, public holidays & NSW school holidays. Stays are subject to room availability.

Historic rally for pay justice Nurses and midwives from the Sydney Adventist Hospital held a public protest for the first time in the hospital’s 110-year history to push for a better agreement An “insulting” pay offer led Sydney Adventist Hospital nurses and midwives to mount a strong community campaign, including the first protest rally in the hospital’s long history.

The NSW Nurses and Midwives’ Association recruited more than 100 new members during the campaign, during which staff wore t-shirts and badges with the slogan “Value our San nurses and midwives”.

Known colloquially as “The San” the hospital opened in 1903 as a sanitarium.

Today it is one of the state’s biggest private hospitals with more than 50,000 inpatients and 175,000 outpatients each year.

Following the campaign Adventist Health Care Limited (AHCL) made an improved offer, including a 6% pay rise over two years. AHCL had previously offered a 1.75% increase in the first year and 2% the next.This would have left San nurses way behind other major private hospitals.

“Members were surprised and angry [at the initial offer]. We told management we felt insulted by their very low pay offer,” clinical nurse specialist Julia Taylor, the NSWNMA branch secretary at the San, said. She said members responded by campaigning at work and recruiting new members.

“We formed a great bargaining team including members from the main campus at Wahroonga, the San day surgery at Hornsby and Dalcross Adventist Hospital at Killara and we all pulled together,” Julia said. “We held lots of meetings to keep members informed about the progress of negotiations.

“Management started calling its own meetings to put their case to the wards, because I think they were concerned we were getting our message across very well and wanted to counteract us.

“It took management about seven pay offers to get us up to the final pay offer of

Employees were voting on the AHCL offer as The Lamp went to press.

The offer included: • A 6% pay rise over two years with no cuts to allowances.

• Parental leave entitlement upfront when taking leave.

• 100% salary sacrifice protection.

• Paid compulsory competencies and training.

• ADON pay rate increase to NUM 3 rate.

• More flexible personal/carers leave.

3% in year one and 3% in year two, plus the 0.25% superannuation increase.

“It was a difficult bargaining process which should have taken three months but actually took six months to finalise.

“Our union organiser was inspirational and kept us working together through endless meetings towards a good result.”

As members built their numbers and influence in the workplace, AHCL retaliated by putting salary packaging and allowances on the bargaining table. Salary packaging arrangements for mortgages, health funds, shopping cards etc were hospital policy but, unlike other big notfor-profit hospitals, were not written into the collective agreement.

AHCL sought to cut 100% salary sacrificing by half – in effect withholding half the tax benefit from salary packaging – and to abolish the laundry allowance.

“That really fired everybody up,” Julia said.“We realised we had to protect 100% salary sacrificing by getting it written into the agreement. It is worth quite a bit of money to us and we knew other facilities

like the Mater had it in their bargaining agreement.”

The branch also decided to push for parental leave to be paid in full up front instead of the hospital’s archaic practice of withholding half the payment until staff returned to work.

AHCL’s move to cut allowances and fringe benefits prompted the NSWNMA branch to launch a campaign to win support from the local community. It featured t-shirts and badges, a petition that garnered almost 800 signatures, and a series of reports and letters in local papers.

More than 200 nurses and supporters attended a two-hour protest rally opposite the hospital, which drew enthusiastic support from passing motorists.

“Nurses who attended said the rally was uplifting – it demonstrated our capacity to stand up together and not be taken for granted,” Julia said.

As branch secretary Julia was particularly pleased by a big jump in union membership as the campaign wore on.

This built on a substantial membership increase during the previous bargaining round two years earlier.

“Nurses realised we had to stand up together and the only way you could do that was to become a member of the union and have a say in what was going on.

“We allowed non-members to come to our meetings to hear what we were doing, so they weren’t only getting management’s point of view. That encouraged them to join up.

“As the campaign went on we got many more active members from all our work areas across the hospital. These activists kept everyone in their area informed about campaign developments.”

Julia said the final offer still left San pay rates behind comparable hospitals, such as St Vincent’s and the Mater, “but we are creeping up there.”

THE LAMP OCTOBER 2013 | 33

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NSWNMA announces a hot new pr product! oduct!

Hoodies!

You’ll o be seeing your yo colleagues who attended our recent Annual Conference wearing these out and about.

Show you are a proud NSWNMA member and order your hoodie.

These hoodies are snug and warm and only $30. Avvailable in red or navy. 89% cotton.

Sizes: Ladies 10, 12, 14, 16 and Unisex S, M, L, XL, XXL and XXXL. NSWNMA merchandise is not only stylish and comfortable, it is affordable and sold at cost to members. order form to To orderr, fax the o Glen Ginty, (02) 9662 1414 or post to: NSWNMA, 50 O’Dea Avenue, v Wa aterloo NSW 2017 Merchandise order forms also available on www.nswnma.asn.au

ORDER FORM

Keep warm this season in NSWNMA merchandise

Navy Hoodies $30. Quantity: Size: 10 12 14 16 S M L XL XL XXL

XXXL

Red Hoodies $30. Quantity: Size: 10 12 14 16 S M L XL XL XXL

XXXL

Navy Bonded Polar Fleece Vests $25.

Quantity: Size: S M L XL XXL

XXXL

Red Heron Jackets $40. Quantity: Size: L XL Navy Heron Jackets $40. Quantity: Size: L XL Navy Layered Vests $40. Quantity: Size: S M L XL XXL

Bonded Polar Fleece Zip Front Jackets

$30

available in S, M, L, XL, XXL and XXXL

XXXL

Bonded Polar Fleece Zip Front Jacket $30.

Quantity: Size: S M L XL XXL XXXL Tootal cost of order $ Please include postage and handling of $5 per order.

Name Address Postcode

on

$40

N Navy Layered Vests

Navy Bon Polar Flee Vests

$40 $25 available in S, M, L, XL, XXL and XXXL

available in S, M, L, XL, XXL and XXXL

(w)

Phone (h) (mob)

METHOD OF PAYYMENT Cheque Visa Bankcard Money Order Name of card holder Card number

Expiry date

/

Signature

Mastercard

ASK JUDITH On call in-charge I am an RN in the public sector working a set rostered shift. I am paid an in-charge allowance and am also required to be on call. If I am directed to be in-charge while on call, should I receive an additional in-charge allowance while being on call?

The Public Health System Nurses’ and Midwives’ (State) Award 2011 does not provide for an in-charge allowance to be paid while on call. Any time worked after the conclusion of a normal rostered shift will be paid as overtime if you have not left the premises or, if you have left the premises and are called back, the oncall allowance and the overtime is paid. All matters that arise should be referred to the supervisor who is in charge of that shift.

Maternity leave for contractors I have been working ongoing 26week, temporary full-time contracts for the past 12 months.

I have just advised my manager that I am expecting a child and intend to go on maternity leave 14 weeks prior to the birth of my child, which is four days prior to the completion of my current contract. My NUM has told me that, as my child will be born after my contract has expired, I am not entitled to maternity leave, and as I am having a baby the Ministry does not have to offer me another contract. Am I entitled to maternity leave?

Yes, you are entitled to maternity leave. Clause 34 A (i) of your award states that once you have completed 40 weeks of continuous service you are eligible for maternity leave and clause 34 A (iii) of your award allows

for you to go on maternity leave up to 14 weeks prior to the birth of your child. Further, there is a precedent set where the Ministry must not fail to re-engage a temporary employee simply because they took maternity leave; please see the matter of Lyndal Van Eeede (NSWIRC Com 1072).

Sick while on leave As a public hospital employee, if I am on annual or long service leave and fall ill or injure myself and am prevented from returning to work, can I have my leave recredited?

Yes, you can have your leave recredited. See the Public Health System Nurses’ and Midwives’ (State) Award 2011: Clause 37 (vi) Subject to the provision of a satisfactory medical certificate and sick leave being due, annual leave or long service leave (extended leave) shall be re-credited where an illness of at least one week’s duration occurs during the period of annual or long service leave: Provided that the period of leave does not occur prior to retirement, resignation or termination of services, and provided further that the employer is satisfied on the circumstances and the nature of the incapacity.

Carers’ leave I work in the public sector as an RN and recently accessed carers’ leave to take care of my sick child. I ensured my GP wrote a medical certificate for his illness to hand to my NUM but she is refusing to accept this, stating that it needs to say what sort of illness he had. Is this correct?

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

Your NUM has the right to request a medical certificate or statutory declaration but does not need to know the exact nature of your child’s illness. I refer you to the Public Health System Nurses’ and Midwives’ (State) Award 2011: 32. Family and community services leave and personal/carer’s leave B Personal/Carer’s Leave The employee shall, if required, establish either by production of a medical certificate or statutory declaration that the illness of the person concerned is such as to require care by another person.

The employee is not required to state the exact nature of the relevant illness on either a medical certificate or statutory declaration.

Additional pay for public holidays I am an EN working full time on a seven-day rotating shift roster in a public hospital and am entitled to six weeks annual leave. If additional public holidays are gazetted does this mean I get additional days added to my annual leave?

Yes you are entitled to additional days. Where an additional public holiday is gazetted, nurses entitled to six weeks annual leave under the Public Health System Nurses’ and Midwives’ (State) Award 2011 have one day added to their annual leave for each additional gazetted public holiday as per sub clause (ii) (b) of clause 30, Annual Leave.

THE LAMP OCTOBER 2013 | 37

It’s time Order your NSWNMA campaign scrub uniforms for conference and rally times, and make an impression!

Over the past few months, NSWNMA and Total Image Group have been working together to create a new fit for purpose scrubs range. The new campaign uniform range endorses a modern appearance and offers both comfort and durable features, while still embracing NSWNMA image.

SCRUB TOP

The new range consists of a Unisex Scrub Top and Unisex Classic Pant. Both made from 65% polyester,

With With every purchase purchase op, you of a Scrub TTop, o y rreceive e eceive this campaign cam TT-Shirt --Shirt for

FREE!

35% cotton. This fabric blend is durable and of superior quality. The scrub campaign uniform also has number of functional features, including jet pockets, pen partition, drawstring front on pants and brushed fabric coating for added comfort.

Sizes range from XS-5XL to ensure various body shapes and sizes are catered. Most importantly,

Size (cm)

XS

S

M

L

XL

2XL

3XL

4XL

5XL

Half Chest Circumference

53

56

59

62

66

69

73

77

81

Half Hem Circumference

54

74

78

82

General Guide for Female 8/10 SCRUB PPANTS ANTS A

to scrub up for 2013!

57

60

63

67

70

10/12

12/14

14/16

16/18

18/20

20/22 22/24 24/26

Half Waist (Relaxed)

29

33

37

40.5

43.5

46.5

50.5

54.5

58.5

Half Waist (Stretched)

47

51

55

58.5

61.5

64.5

68.5

72.5

76.5

Half Hip

55

59

63

66

69

72

76

80

84

Out Seam Length

103

105

107

109

111

112

113

114

115

the range has been designed to ensure a comfortable fit every time.

Scrub top and pant are $20 each incl GST. You can place your order by the following methods: 2

Shop online, online, by registering as a user on www.totalimagegrouponline.com/nswnurses on our tailored NSWNMA online store. catalogue, 2 Browse through the customised catalogue complete the order form and send back to Total Image by: email sales@totalimagegroup.com.au Fax: 9569 6200 or Post PO Box 199, Westgate NSW 2048 Total Image accepts credit card payment

by Visa, MasterCard, and AMEX (3.5% surcharge on AMEX) or cheque/money order.

Delivery by Australia Post within 10-14 working days and charged at $5 incl GST.

For more information please contact TTotal otal Image on (02) 9569 6233 or email uniforms@totalimagegroup.com.au

WHAT’S

SOCIAL MEDIA

HOT

NURSE UNCUT

THIS MONTH

A BLOG FOR AUSTRALIAN NURSES AND MIDWIVES www.nurseuncut.com.au

@nurseuncut

Sign up for the weekly email that alerts you to new posts.

Nurse Uncut is also on Facebook: www.facebook.com/NurseUncutAustralia. And on Twitter @nurseuncut

Keep calm and... www.nurseuncut.com.au/keep-calm-and/

Now that the party that brought us WorkChoices is back in power, encourage everyone you know to join their union.

Cambodia – nurse volunteers needed www.nurseuncut.com.au/cambodia-nurse-volunteers-needed/

Self-funded nurse volunteers are needed for a medical clinic in a severely disadvantaged slum community near Phnom Penh.

Family of strangers in the NICU www.nurseuncut.com.au/family-of-strangers-in-the-nicu/

Read Tamara’s poem of thanks to the nursing staff that cared for her miracle twins in the NICU.

Solidarity with Bahraini health workers www.nurseuncut.com.au/solidarity-with-bahraini-healthworkers-thank-you/

After seeing photos of the NSWNMA Bahrain solidarity campaign, Abraham wrote to thank us and tell us his brother’s story.

Embrace social media — carefully www.nurseuncut.com.au/nurses-should-embrace-social-media-carefully/

Victorian nurse Tara Nipe reflects on the growing presence of social media in our lives and what that means for nurses and midwives.

Aged care nurses to lose under Coalition www.nurseuncut.com.au/aged-care-nurses-to-lose-under-coalition/

The new coalition government’s Aged Care Policy shows major cuts to sector funding and no guaranteed wage rises for aged care nurses.

NEW ON SUPPORT NURSES CHANNEL

68th Annual Conference highlights From the conference train ride to Professional Day and Jillian Skinner’s visit, this is a fun look at the conference.

Bob Fenwick Memorial Mentoring Grants Program Some of the mental health nurses who participated in the 2012/13 program as mentors and mentees discuss their experience. youtu.be/qdhBKJSZ9SQ

youtu.be/b9kRs_UBc5I

Follow us on Twitter >> NSWNurses & Midwives @nswnma Watch us on YouTube >> SupportNurses Connect with us on Facebook New South Wales Nurses and Midwives’ Association >> www.facebook.com/nswnma Aged Care Nurses >> www.facebook.com/agedcarenurses Ratios put patient safety first >> www.facebook.com/safepatientcare

NEW! Share photos with us on Instagram @nswnma THE LAMP OCTOBER 2013 | 39

Switch to Direct Debit’ Prizewinner (drawn 30/6/13) – Trip to Norfolk Island: HL, Gosford NSW. ‘Recruit a Member’ Prizewinner (drawn 30/6/13) – Trip on the Indian Pacific: GH, Hawks Nest NSW. February Lamp Competition – Hunter Valley Escape: MK, West Wodonga VIC.

Competition Prize Winners

March Lamp Competition – Ascent Shoes: MC, French’s Forest; LG, Chester Hill; TS, Surry Hills; AMcC, Picnic Point; CE, Kogarah; LG, Teralba; VG, Condoblin; JH, Nowra; MD, Hassall Grove; TC, Wyoming NSW. April Lamp Competition – Suitcases: JS, Wombarra; KL, Kings Cross NSW.

Congratulations to all the prize winners this year who have received prizes for our monthly Lamp competitions, ‘Switch to Direct Debit’, and ‘Recruit a member’ prizes.

May Lamp Competition – Central Coast Escape: RMcC, Tullamore NSW. June Lamp Competition – MBTs Shoes: CE, Easterbrook; JF, Freshwater; LF, Caringbah; LMcL, Basin View; JvdB, Wagga Wagga (NSW).

July Lamp Competition – Eurobodalla Escape: LB, Gilgandra NSW. August Lamp Competition – Mercure Sydney: KB, Valentine NSW.

LIONS NURSES’ SCHOLARSHIP Looking for funding to further your studies in 2014?

TThe he tr trustees ustees es of the Lions Nurses’ Scholarship F Foundation cations for scholarships for 2014. invite applications Enrolled and registered red nurses eligible el for these scholarships must be resident and employed loyed within the State of NSW or ACT You must currently bee registered with w the Nursing and Mid Board of Australia and the nursing profession nd working within w in NSW or the ACTT, annd must have experience in the nursing rsing profession profess in NSW or the ACT Applicants must alsoo be able to produce evidence that p your employer will grant ant leave for the required period of the scholarship.

Details of eligibility and the scholarships available scho (which include study projects either eith within Australia or overseas), and application cation forms are available from: The Honourary Secretary Lions Nurses’ Scholarship arship Foundation Found 50 O’Dea AAvenue, venue, Waterloo aterloo NSW 2017 or contact Ms Glen Ginty on 1300 130 367 962 or gginty@nswnma.asn.au www www.nswnma.asn.au .nswnma.asn.au Completed applications must be in the hands of the secretary no later than 29 November 2013.

40 | THE LAMP OCTOBER 2013

SOCIAL MEDIA Keep me logged in

WHAT

Forgot your Password?

NURSES & MIDWIVES SAID & LIKED on facebook

www.facebook.com/nswnma

Penalty rates During the election campaign the Coalition’s workplace relations spokesman supported trading pay rises for conditions, effectively putting penalty rates on the table.

iLamp There were calls for a mobile and online version of The Lamp.

Community support for ratios campaign More than 200 community members turned up to support Cobar nurses – brilliant!

Workplace policy Liberal candidate, Ann Sudmalis, told a nurse that she couldn’t respond to a question about workplace policy until after the election.

I like my job but not for the pittance it would be without penalties. Raise the hourly rate by about $7-$10 however and I might change my mind.

I wouldn’t trade penalty rates for a wage rise myself. As time passes and the cost of living increases it is quite possible that the wage rises won’t meet those daily cost increases, placing you in a worse off position. I think if you lose these hard won entitlements it would be a step backwards.

Imagine having an app that has The Lamp in it! It would save you guys a fortune.

Come on, modernise please.

Come on … be the first as you always have been. Grab the opportunity.

It will start slow but you will reap the rewards later!

Wow, what great support.

Great to see communities standing together for what’s important. :) Good question, poor answer. Tony needs to spell out exactly what he has in mind for IR if he is PM. Out of the mouth of the south coast Liberal candidate... It’s all on the table AFTER the election!

We still have someone who takes the cars to wash them every now and then. But don’t know how long for now, reading this!

Car wash Community nurse Vicky found out she is expected to take her work car through a carwash each month and wondered what happens elsewhere?

Aged care investigation ABCTV’s Lateline broadcast a second investigation into the mistreatment of residents in aged care.

We were given the responsibility to wash our cars some time ago.

I was disgusted that the leaders of the two major parties had no idea during the election debate. Oh yeah “reduced paperwork”, like that will fix the entire sector.

Centrelink needs to stop pushing unemployed people into doing Cert III in aged care. Just because someone is unemployed does not mean they will make a great aged care nurse.

If RN/ENs are found to be in breach of their code of practice they can lose their registration and I believe the same should be in place for AiNs; having a national body overseeing every nurse, regardless of their level of education, would surely help us to weed out those that are mistreating residents.

If the government really wants to get the right people into aged care they need to think about the wages …When someone can get more money working at the local supermarket it is hard to get people to look at aged care nursing, considering the heavy nature of the job, both physically and emotionally.

Aged care will never be seen as “sexy” medicine but that doesn’t mean it shouldn’t be rewarding. Aged care is not easy and to attract quality staff we need to improve the conditions such as ratios and pay. I know some carers who earn so little that they are eligible for public housing. We need to wake up and start implementing what was in the Productivity Commission ASAP.

THE LAMP OCTOBER 2013 | 41

NURSING RESEARCH ONLINE

The latest edition of the Australian Journal of Advanced Nursing (ajan.com.au) has published an interesting article regarding open access to nursing journals, among many others.

Open access to nursing journals: an audit of the 2010 ERA journal list Kasia Bail, Jamie Ranse, Roger Clarke, Ben Rattray, University of Canberra.

Nurses work in a wide range of settings, with variations in resources, including hardware and software, and in non-patient-load (supernumerary) time for educational and research endeavours. In most settings, uninhibited access to professionally relevant information is valuable. A scan of lists of open access journals shows that many journals that are categorised as openly accessible are not available in English, or are not peer-reviewed. www.ajan.com.au/Vol30/Issue4/30-4.pdf.

A view from the outside: nurses’ clinical decision making in the 21st century Joan Deegan, Lecturer Acute Care School of Nursing and Midwifery Faculty of Health Sciences, La Trobe University Clinical decision making is an integral part of nurses’ work and vital to health outcomes for patients. If based on reliable decision making criteria, it can constitute a legally defensible position for the nurse in the event of a malpractice accusation. However, when handling large volumes of rapidly changing clinical information, coupled with organisational imperatives, nurses need to consider a range of factors to guide and support the decision making processes. Using the findings from a small qualitative study on the experiences of a culturally and linguistically diverse (CALD) group of nurses enrolled in competency based assessment programs in Melbourne; this paper highlights observations of clinical decision making processes made by CALD nurses, in relation to elderly patients in particular. It explores the professional and legal implications for nurses when there is an over reliance on experiential knowledge and routine tasks, without mindful application of evidence and consideration of ethico-legal imperatives. www.ajan.com.au/Vol30/Issue4/30-4.pdf

Career choices and destinations of rural nursing students undertaking single and double degrees in nursing Noelene Hickey, The University of Newcastle and Linda Harrison, Charles Sturt University.

Trans-disciplinary undergraduate double degrees (DDs) involving nursing were introduced at a time (2002–08) when the 42 | THE LAMP OCTOBER 2013

Australia federal government had increased the number of nursing funded places to universities. By 2007 in Australia more than one third of nursing students were studying via a DD mode. Numerous studies in Australia and overseas have investigated the career choices and preferences of Bachelor of Nursing (or equivalent) students. Earlier studies showed that nursing career specialty preferences did not change significantly during a degree. Yet, later studies demonstrate that positive clinical experiences impact on career preference decisions. It is unknown however, if these latter factors are equally relevant for nursing students in a DD program. The aim of this study was to identify and compare the location and career preferences of students enrolled in single and DD programs in nursing at a rural university, and to gain an understanding of what influenced and motivated these students to enrol in nursing. www.ajan.com.au/Vol30/Issue4/30-4.pdf

Diabetes – a significant contributor to complications in cardiac surgery: how and when to optimise glycaemic control Melissa Penrose, Intensive Care Unit, Alfred Hospital, Melbourne and Geraldine A Lee, King’s College London As well as the potential complications of renal dysfunction/failure, peripheral neuropathy and blindness; those with diabetes (especially poorly controlled) are at an increased risk of coronary artery disease (CAD). However, one of the problems with diabetes is the lack of symptoms (in particular angina) from CAD due to neuropathy and thus these patients present later and with more severe CAD that often requires coronary artery bypass surgery (CABS) for multi-vessel disease. Surgical revascularisation is the most commonly performed cardiac surgical procedure with approximately one third of persons undergoing CABS having diabetes.

Optimising care in those with diabetes should be a priority and given the number of undiagnosed cases, any patient who presents with hyperglycaemia and a suspected coronary event should undergo diagnostic tests for diabetes. The aim of this paper is i) to present the association between hyperglycaemia and post-operative complications and ii) to review the current interventions (pre surgery, peri /intra-and post-operatively) that have been undertaken in those in diabetes undergoing cardiac surgery. www.ajan.com.au/Vol30/Issue4/30-4.pdf

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Across 1. A bursa between the skin and the lower part of the patella (11.5) 9. Made possible or easy (7) 10. The lower jawbone (8) 11. Relating to a single germ (11) 13. Cut on a hard surface, like metal to create a design (4) 14. Strictly accurate (5) 15. Graft (10) 18. Triple (10) 20. A brief, diffuse erythema of the face and neck (5) 23. A pair of organs of respiration (5)

25. The part of the hand between the wrist and fingers (10) 27. The position of most importance (9) 30. The male sex organs (6) 31. Abnormally slight or infrequent urination (8) 32. Any substance giving origin to a coloring matter (9)

Down 1. Before puberty (11) 2. Protrusion of some part or organ from its normal position (11) 3. Any disease, physical disorder, or complaint, generally of a chronic, acute, or mild nature (7) 4. The mucous membrane lining the uterus (11) 5. A threshold or boundary (5) 6. Pertaining to the kidney (5) 7. Made up of a single cell, as the bacteria (11) 8. Attachments of individual DNA molecules to each other (9)

12. One of nursing classification (1.1.1) 16. Adjustment of the pupil to light (10) 17. The symbol for the element silicon (2) 19. Sword-shaped; xiphoid (8) 21. An institute for the treatment of the sick (8) 22. A deficiency of carbon dioxide in the blood (7) 24. Upper airway obstruction (1.1.1) 26. Hairy (6) 27. A colloquial term for the product of a flocculation (4) 28. A hind part (4) 29. Overdose (1.1)

THE LAMP OCTOBER 2013 | 43

Quality legal advice for NSWNMA members 2 Compensation and negligence claims 2 Motor vehicle claims 2 Wage loss claims 2 Industrial and Employment law

2 First Free Consultation for all members 2 Discounted rates for members on all matters 2 Free Standard Wills 2 No win – no charge*

Call the NSWNMA on 1300 367 962 and find out how you can access this great service.

Offices in Sydney, Newcastle and visiting offices in regional areas (by appointment). *Conditions apply

44 | THE LAMP OCTOBER 2013

BOOKS

BOOK ME Stewart’s Guide to Employment (4th ed.)

Understanding Pain: Exploring the Perception of Pain

Andrew Stewart Federation Press www.federationpress.com.au RRP $79.95 j ISBN 9781862879119 This new edition includes extensive references to the outcomes of the 2012 Fair Work Act Review. It details changes already made by the Fair Work Amendment Act 2012 (including the renaming of Fair Work Australia as the Fair Work Commission) and explains proposed reforms that may be introduced in 2013.The purpose of the book is to provide an overview of current law that is accessible to those who are not already experts in the field. It has been updated to deal with case law on matters such as the formation and performance of employment contracts, the variation of modern awards, enterprise bargaining, unfair dismissal and the general protections against wrongful treatment at work.

Child, Youth and Family Health: Strengthening Communities (2nd ed.)

Margaret Barnes and Jennifer Rowe Churchill Livingstone (via Elsevier Health Australia) www.elservierhealth.com.au RRP $79.95 j ISBN 9780729541558 The contributors to this text have asked questions relating to current family support systems and approaches and whether they are meeting the needs of families. Embedded in the chapters is the message that we need to invest more time and energy in the continuing process of constructing shared frameworks of goals and values, and in developing a shared understanding of where we want to go.

Chronic Fatigue Syndrome/ME: Support for Family and Friends Elizabeth Turp Jessica Kingsley Publishers (via Footprint Books) www.footprint.com.au/ RRP $18.95 j ISBN 9781849051415 Useful advice for families and caregivers of people with chronic fatigue syndrome/ME, including coping mechanisms, symptom management and advice addressing the emotional, social and practical aspects. This book is about adults with CFS/ME and, while some of the information is relevant to children and young people, their needs are very different and merit a separate book.

Fernando Cervero MIT Press Books (via Footprint Books) www.footprint.com.au/ RRP $39.95 j ISBN 9780262018043

SPECIAL INTEREST

Understanding Pain explores the mechanisms and the meaning of pain. We all know that if you touch something hot your brain triggers a reflex action that causes you to withdraw your hand, protecting you from injury. That kind of pain is good for us; it acts as an alarm that warns us of danger and keeps us away from harm. But, (Cervero tells us), there is another kind of pain that is more like a curse: chronic pain unrelated to injury. It is the kind of pain that fills pain clinics and makes people’s lives miserable. The idea of pain as a test of character, or a punishment to be borne, is changing; prevention and treatment of pain are increasingly important to researchers, clinicians, and patients. Cervero’s account brings us closer to understanding the meaning of pain.

Mentoring, Learning and Assessment: A Guide for Nurses, Midwives and Other Health Professionals (3rd ed.)

Ci Ci Stuart Churchill Livingstone (via Elsevier Health Australia) www.elservierhealth.com.au RRP$46.36 j ISBN 9780702041952 A book for the practice educators of clinical practice in the nursing, midwifery and other healthcare professions, who seek to understand, and develop, skills of supporting, supervising, facilitating learning and assessing students to achieve validity and reliability in assessment.

This new edition contains up-to-date references to educational theory and recent work on the support of learning and assessment of clinical practice. It places greater emphasis on assessment to achieve “fitness to practice”; how to avoid “failure to fail”; and how to work and learn as a member of the multi-professional team.

The Palliative Approach: A Resource for Healthcare Workers Erica Cameron-Taylor M&K Publishing www.mkupdate.co.uk/books.htm RRP £19.00j ISBN 9781905539673 This book is not a medical text, but is intended to provide a simple commonsense introduction to the care of patients in the generalist setting, where a palliative approach is deemed appropriate. These patients may be living at home or in care homes, and may be months or even years away from the terminal phase of their illness. Real-life case studies assist in giving a wide range of healthcare professionals an understanding of, and competence in, the provision of holistic, supportive care that is focused on comfort and quality of life.

All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here, and many more, from our Records and Information Centre (RIC).

Contact Jeannette Bromfield gensec@nswnma.asn.au or Cathy Matias 8595 2121 cmatias@nswnma.asn.au. All reviews by NSWNMA RIC Coordinator/Librarian Jeannette Bromfield. Some books are reviewed using information supplied and have not been independently reviewed.

THE LAMP OCTOBER 2013 | 45

Working in health care you’ll know it’s important to have an eye on the future.

That’s why Sydney Nursing School is introducing a new primary health care program in 2014.

From graduate certificate to master’s level, the Primary Health Care degrees have been designed to give registered nurses the knowledge and skills to care for people with complex health needs and practise effectively within a variety of community and hospitalbased settings, now and in the future.

PRIMARY HEALTH CARE

You can find out more about this new program and Sydney Nursing School’s full suite of postgraduate coursework programs, at our Postgraduate Information Evening, Thursday 17 October 2013, 5.30-8pm.

For more information visit:

sydney.edu.au/nursing

NEW IN 2014 CRICOS PROVIDER 00026A

SYDNEY NURSING SCHOOL

Keep up your CPD Enhance your skills with practical, flexible CPD courses including Venepuncture, Cannulation, ECG and Spirometry.

1300 366 044 www.adepttraining.com.au

46 | THE LAMP OCTOBER 2013

MOVIES

movies of the month

British-born Australian actress Naomi Watts stars as Diana, Princess of Wales in a film that focuses on the final two years of the Princess’s life.

It was then that Diana met British-Pakistani heart surgeon, Hasnat Khan (Naveen Andrews), and embarked on a relationship that stayed private and away from the eyes of the media for much of that time.

During the inquest into Diana’s death Hasnat Khan went on public record, confirming that he was the man who had stolen the heart of the Queen of Hearts, as Diana famously declared herself in a BBC interview following her divorce from Prince Charles.

The filmmakers use the relationship with Khan as the premise for showing Diana as a woman undergoing personal growth, becoming the more confident public face for humanitarian issues such as the victims of landmines.

The film purports that Diana finally found true love with Hasnat and through the love of a humble man, dedicated to his work and reluctant to be caught up in the glare of public scrutiny, she was able to discover her true self.

Diana the film is based on a book, Diana: Her Last Love, by journalist and documentary filmmaker Kate Snell, who is an associate producer of the film.

With much of the film portraying imagined, private scenes between Diana and Hasnat Khan, it will be up to the viewer to decide how accurate this version of Diana really is.

IN CINEMAS OCTOBER 10

MEMBER GIVEAWAY The Lamp has 15 in-season double passes to give away to Diana thanks to Becker Film Group.

The first 15 members to email their name, membership number, address and telephone number to lamp@nswnma.asn.au will win.

THE GREAT GATSBY It’s spring of 1922 and New York City is a decadent playground of

DVDGIVEAWAY

shifting morals, jazz, bootleg and skyrocketing stocks. Would-be writer Nick Carraway (Tobey Maguire) arrives from the Midwest and lands next door to Jay Gatsby (Leonardo Dicaprio), a mysterious millionaire whose estate overflows with endless parties. As Nick’s beautiful cousin Daisy (Carey Mulligan) and her blue-blooded husband Tom Buchanan (Australian performer, Joel Edgerton) fall into Gatsby’s orbit, Nick bears witness to a tragedy of impossible love and incorruptible dreams.

Based on F. Scott Fitzgerald’s timeless epic, The Great Gatsby mirrors the struggles of modern times in a dazzling visual journey from the mind of Australian director Baz Luhrmann.

To celebrate the film’s release on DVD The Lamp has three copies of The Great Gatsby to giveaway, thanks to Roadshow Entertainment. For your chance to win one of three DVDS write your name, address and membership number on the back of an envelope and post to: Great Gatsby DVD Competition 50 O’Dea Ave Waterloo NSW 2017 Only one entry per member

THE LAMP OCTOBER 2013 | 47

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POSTGRADUATE GRADUATE C COURSES OURSES IN MENTAL NTAL HEALTH HEALTH NURSING* NURSING* Developed specifically pecifically ffor or cli clinicians nicians entering entering ialist aarea rea o Mental H ealth into the specialist off Mental Health Contact information: mation: Ro Rose se M McMaster cMaster E: Rose.McMaster@acu.edu.au ster@acu.edu.au | T: T: (02) (02) 9739 9739 2369 2369

* SSubject ubject tto o fi final nal aapproval pproval

www.acu.edu.au/mental-health www.acu.edu.au/mental-health

Grow your career

by joining ACN! We W e believe believe that that e each ach a and nd e every ver y n nurse urse iin n Australia have opportunity Australia should should h ave tthe he o pportunit y tto o grow and ffurther grow ttheir heir career career and urther our our profession. profession. > Education Education tthat hat p pays ays > True True representation representation > M Membership embership beneďŹ ts beneďŹ ts to to help help you you grow grow

48 | THE LAMP OCTOBER 2013

For For membership information and online application visit: www.acn.edu.au www.acn.edu.au or freecall 1800 061 660 Australian College of Nursing

MOVIES

movies of the month

Even though he swore he’d never seen another cop movie, James Mabbutt couldn’t resist the great cast, the Australian setting and the Indigenous storyline of this film.

On face value this is another cop movie/murder mystery. But you can add to that Indigenous issues, small town and gun culture, plus a beautifully filmed and acted movie.

Jay (Aaron Pedersen) is the new detective, back in the town where he was raised. His first case is the brutal murder of a young Indigenous girl, who was friends with his daughter.

Jay encounters racism in the local police who question the importance of the crime given the victim. Plus, there are concerns of police corruption.

All of this hinders his investigation, which he is doing without help from the white or black communities.

Jay gets it from all sides, but seems to accept it; or is he defeated? Or simply a realist? It is hard to work out.

His own life is lonely. His ex-wife is drinking her life away and his daughter doesn’t want to speak to him.

Drug use is tearing this Indigenous community apart,

leading to under age sex work with the truckies that pass through the town.

The director and writer Ivan Sen, an Indigenous man himself, draws on his childhood to paint this story.

Sen is best known for Beneath the Clouds a slowpaced visual masterpiece released in 2002. Sen and Pedersen collaborated closely on Mystery Road to make sure the dialogue was authentic.

The film features a great cast of Australian actors, Hugo Weaving, Jack Thompson, Ryan Kwanten and Tasma Walton among them.

The scenery is bleak, bare and beautiful. I loved the aerial shots of the town. The real, but grim, insights into Indigenous communities in such towns, similar to that seen in Samson and Delilah, are challenging to watch.

The content of the movie is disturbing, young people being murdered and exploited and nothing being done. Have things really moved on from the past or is racism unchanged in certain areas?

This question, like others, is left unanswered.

MEMBER GIVEAWAY The Lamp has 15 in-season double passes to give away to Mystery Road thanks to Dark Matter.

The first 15 members to email their name, membership number, address and telephone number to lamp@nswnma.asn.au will win.

James Mabbutt is a Mental Health Nurse at Kincumber Community Health Centre IN CINEMAS OCTOBER 17

THE LAMP OCTOBER 2013 | 49

DIARY DATES

conferences, seminars, meetings NSW Nursing and Midwifery Unit Managers conference 11 October Sydney Tel 02 8970 0128 Fax 02 8011 1289 Family Planning NSW 2013 Nurse Education Day 11 October Hunter Valley www.fpnsw.org.au education@fpnsw.org.au Assessing and managing vascular access devices 11 October Burwood Australian College of Nursing www.acn.edu.au/education PANDDA 24th Conference 16-17 October Parramatta www.pandda.net Damian Heron 9842 2306 damian.heron@pandda.net Australian Nursing and Midwifery Conference 17-18 October Newcastle Amy McIntosh 0423 497 038 www.nursingmidwiferyconference.com.au 2013 Edna Ryan Awards 18 October Sydney Trades Hall www.ednaryan.net.au/ Teaching techniques for nurses 23-25 October Burwood Australian College of Nursing www.acn.edu.au/education 2013 Transplant Nurses’ Association Conference 24-25 October Sydney www.gemsevents.com.au/tna2013/ Palliative care 24-25 October Bega Australian College of Nursing www.acn.edu.au/education Karitane 2013 Gala Ball 26 October Sydney Vanilla Bean Events 9712 3861 amy@vanillabeanevents.com.au

Chronic and complex disease self-management 28-29 October Dubbo Australian College of Nursing www.acn.edu.au/educationNSW 2013 Hospital in the Home Conference 31 October - 1 November Sydney www.hithsociety.org.au/conference Sally.Bromley@ashm.org.au 02 8204 0723 NSW/ACT Branch Renal Society of Australasia Workshop 1 November Liverpool Imelda De Guzman (02) 8738 7114 Imelda.DeGuzman@sswahs.nsw.gov.au Stalking: Assessment, Treatment and Management One-day training by Dr Karl Roberts 12 November Sydney enquiry@crimesolutionsinternational.com Neuroscience Conference: Navigating Neuro 1 March 2014 Wollongong Jo McLoughlin 0422 418 255 Joanne.mcloughlin@sesiahs.health.nsw.gov.au NSW Urological Nurses Society Professional Development Day 1 November Burwood www.anzuns.org/nsw urological_nurses@hotmail.com 16th NSW Rural Mental Health Conference 11-13 November Albury nswrural@astmanagement.com.au (07) 5502 2068 conventionhouse.com.au/nswrural/

ACT Congress of Aboriginal and Torres Strait Island Nurses 15th National Conference and AGM 6-8 October Canberra www.catsin.org.au The National Nursing Forum Australian College of Nursing 20-22 October Canberra www.acn.edu.au/forum_program

P R E P U B E R T A L F L O C

R E V N A G N I N X A T R I O U N A O R E A H R

P A T E L L I N I B L E D M M O E G E R M I N N E C T T R A R D G E M I N A N U P G S M E T I A E F R O N T O D I R O O M O G E N

50 | THE LAMP OCTOBER 2013

A R E A N A A L I N S I L A A C A P N L I A

B U N D I C E L P L U B L A A R

R S P B L I T C I A N G U S

INTERSTATE Australian Day Surgery Nurses Association 2013 National Conference 12-13 October Melbourne www.adsna.info Michelle Berarducci 02 9799 1632 nswadmin@adsna.info 5th Australian Rural and Remote Mental Health Symposium 14-16 October Geelong (07) 5502 2068 hanzmh.asn.au/rrmh/ Dementia and Community Care Conference 30-31 October Melbourne Wayne Woff 03 9571 5606 office@totalagedservices.com.au www.totalagedservices.com.au Indigenous Allied Health Conference 26-27 November Adelaide iaha.com.au/events/2013-conference National Eating Disorders and Obesity Conference March 2014 Gold Coast eatingdisordersaustralia.org.au

OVERSEAS Australasian Nurse Educators Conference 2013 9-11 October New Zealand www.nursed.ac.nz/ Epidemiology and Social Psychiatry Meeting 2014 May 21-24 2014 Germany www.epa2014ulm.eu International Conference on Infectious and Tropical Diseases 16 -18 January 2015 Cambodia ictid.webs.com/

REUNIONS

Crossword solution A E H

Sydney Hospital Sydney Eye Hospital Graduate Nurses reunion lunch 2 October Sydney Jeanette Fox 02 4751 4829 Or bekysa@tpg.com.au Mater Graduate Nurses Association annual reunion 20 October North Sydney Liturgy 11.30am Lunch 12.30pm Joan Stort 0401 344 363 joans2458@yahoo.com Rydalmere Hospital Staff reunion lunch 25 October Rosehill Janice Sillett 02 9842 2404 Janice.Sillett@facs.nsw.gov.au St George Hospital Graduate Nurses Association AGM / annual reunion lunch 26 October Ramsgate Judith Cornell jcornell@netspace.net.au Wallsend District Hospital Graduate Nurses Association annual reunion 26 October Margaret 0431 042 849

T

H O P U S I P H A L L I A T G U R I A Y L

EDUCATION

WHAT’S ON OCTOBER 2013 ——— • ———

Appropriate Workplace Behaviour – 1 day 7 November Newcastle Topics include why bullying occurs; anti-discrimination law and NSW Health policies; appropriate behaviour in the workplace; identifying unlawful harassment and bullying; what to do if subjected to unlawful harassment and bullying; how to use workplace grievance procedures; identifying, preventing and resolving bullying.

Members $85 Non-members $170 ——— • ———

Practical, Positive Actions in Managing Conflict and Disagreement – 1 day 1 October Penrith 9 October Gymea

Members $85 Non-members $170 ——— • ———

Aged Care Nurses Forum – 1 day 18 October Waterloo

Members $30 Non-members $50 ——— • ———

Enrolled Nurses Forum – 1 day 25 October Waterloo

Members $30 Non-members $50 ——— • ———

diary dates is a free service.

Please send details of your event by the 5th of each month, in the format used here – event, date, contact details, website if applicable.

Email: lamp@nswnma.asn.au Fax: 9550 3667 Post: 50 O’Dea Ave, Waterloo NSW 2017

Basic Foot Care for RNs and ENs – 2 days 30 & 31 October Tamworth

Members $203 Non-members $350 ——— • ——— To register or for more information go to www.nswnma.asn.au/education or phone Matt West on 1300 367 962

Our look has changed but our commitment to our members hasn’t First State Super is committed to the ongoing support of nurses and midwives. What makes us different is that we exist to grow our members’ wealth, not our own. We work with our members to help them build and secure their financial future.

If you would like to be a member of the super fund that puts its members first, call 1300 650 873 today.

This is general information only. Consider our product disclosure statement before making a decision

FSS Trustee Corporation ABN 11 118 202 672 ASFL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365