Lamp July 2014

lamp THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION

VOLUME 71 No.6 JULY 2014

Why don’t we have the same ratios as the city? +

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NURSING OUR CLIMATE

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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.

Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E gensec@nswnma.asn.au W www.nswnma.asn.au

VOLUME 71 No.6 JULY 2014

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

COVER STORY

12 | Country nurses quiz Nationals Nurses and midwives asked state National Party MPs: what are you doing to improve safe patient care in the country? We are still waiting for the right answer.

Alex Jones, RN PHOTOGRAPH: TIM DALBY

REGULARS

5 6 8 23 37 41 43 45 46 50

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

AGED CARE

24 | Improving the transfer into care

8 | Win a break at Port Stephens

Produced by Hester Communications T 9568 3148 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au Editorial Committee • Brett Holmes, NSWNMA General Secretary • Judith Kiejda, NSWNMA Assistant General Secretary • Coral Levett, NSWNMA President • Peg Hibbert, Hornsby & Ku-Ring-Gai Hospital • Michelle Cashman, Long Jetty Continuing Care • Richard Noort, Justice Health

FEDERAL BUDGET

20 | There is always another way The Abbott government promised its recent budget would spread the pain.

Instead, the poorest and most vulnerable have been hit hardest.

STAFFING

22| Blacktown beds go in budget crunch

Blacktown Hospital management heeded warnings about dangerous understaffing and closed eight beds.

COMPETITION

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

ENVIRONMENT

28 | Nurses join gas blockade

Advertising Patricia Purcell T 8595 2139 or 0416 259 845 or F 9662 1414 E ppurcell@nswnma.asn.au Information and Records Management Centre To find old articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Jeannette Bromfield, Coordinator T 8595 2175 E gensec@nswnma.asn.au The Lamp ISSN: 0047-3936 General disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised.

Privacy 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 2014 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $55.

Individuals $80, Institutions $135, Overseas $145.

Northern Rivers health workers have been at the forefront of a community mobilisation to defend land and water from dangerous coal seam gas mining.

T H E L A M P J U LY 2 0 1 4 | 3

EDITORIAL

BY BRETT HOLMES GENERAL SECRETARY

Nine months to build some pressure When it comes to spending our money governments have choices and we need to pressure them to make the right ones for public health.

We have seen federal and state budgets that have serious consequences for our health system, and which give us insight into the direction the Liberal Party wants to take public health.

An election is an event that focuses the minds of politicians and the public on what choices we want to make for our communities. With only nine months until the next election in New South Wales, nurses and midwives have a timeframe and an opportunity to be heard on what is required to improve our public health system.

We have seen federal and state budgets that have serious consequences for our health system, and which give us insight into the direction the Liberal Party wants to take public health.

The changes, as always, were given to us with a preface that there was no alternative; that they were determined by a bottomless, black budgetary hole that the poor government must grapple with.

There is no doubt that governments need sufficient revenue to fund public services, and that a volatile economic environment can impact those revenues.

But governments always have choices about where and from whom they get their revenue, and about how and where they spend it. There is always an alternative (see page 18).

The federal budget was a clear move towards user pays to raise revenue, as exemplified in the co-payment for GP services and similar measures in other sectors like education.

This was accompanied by a cut in spending on health and other public services.

Another choice would have been to raise revenue by taxing polluters, speculators and the mining sector, with its 40% return on investment in assets owned by the Australian people.

Or cuts could have been made to corporate welfare such as the diesel subsidy for mining, or by reducing or eliminating superannuation subsidies for the very well off, or the massive underwriting of private health insurance.

Ironically, the NSW budget proves that governments do have choices.

Although we have consistently been told in recent years “the bucket is empty” the state government has managed to find funds in the budget to offset millions of dollars in health funding cuts by the Commonwealth.

Nurses and midwives are right to be sceptical of the government’s timing to find this funding to temporarily patch up the Commonwealth’s health funding black hole, given the next state election is in sight.

In the state budget the government has made choices that we welcome, including the decision to honour the funding commitment to direct more nursing specialists into the community – a proposal first made by the NSWNMA. We also welcome the additional $1.3 billion in capital works, including the redevelopment of John Hunter Children’s Hospital paediatric and neonatal intensive care units.

But yet again the government has dodged the critical decision of how these units are to be staffed. It is still not prepared to commit to mandated staffing and ensure safe patient care inside these units.

The government has confirmed it is expecting a 3% increase in emergency department presentations – without factoring in the introduction of the federal government’s GP co-payment – yet there is still no commitment for nurse-to-patient ratios in EDs. Last month a contingent of country nurses showed us what we all need to do over the next nine months, when they gathered outside the NSW National Party conference in Queanbeyan (see pages 12-17).

They buttonholed MPs and engaged with the public in the streets, in the malls and in their homes, hammering home the message that we need improved ratios and a strong and wellresourced public health system.

It is only with this kind of pressure that politicians will make the right choices for our communities.

T H E L A M P J U LY 2 0 1 4 | 5

YOUR LETTERS

LETTER OF THE MONTH

Dishonouring Australia’s egalitarian principles

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I couldn’t agree more with Zoe-Anne Guinea – “Hockey makes history of health” Lamp June 2014. As a “baby boomer” this latest federal budget concerns me greatly and highlights the gross inequalities in Australia at the moment.

I have been in paid employment and paid tax since the age of 17. Stupidly, I had faith that when I retired the government of the day would honour both my contribution to Australian society and the taxes I had paid, by ensuring my security postretirement.

This federal government seems to blame the baby boomers for being born post-World War II, when the reason we were born was to increase a devastated population. Was there no forward planning in any government during the intervening years to ensure that we would have the same rights and recompense in our retirement that other Australians have rightly enjoyed previously?

Contrary to what this federal government believes, entitlement is just that – equitable remuneration and services for paying your dues over the course of your life.

This federal government dishonours the egalitarian principles of Australian society I have held so dear my whole life.

Elizabeth McCall RN RM MHSc Byron Bay

Fly Scoot to

Tale of two health care systems My sister has written a brief comparison of ratios and patient care in a Sydney city teaching hospital, versus her experience four days later in a large teaching hospital in Toronto, Canada.

Jacquie Myers RN RM, Avoca Beach In April, I rushed home to Sydney from Canada to visit my critically ill mother in Royal North Shore Hospital (RNSH).

The outcome: she rallied, albeit the long-term prognosis is not optimistic.

Arriving on the Unit after a 24-hour journey across the Pacific, I was greeted by a nurse who promptly introduced me to the gerontologist, the resident and the entire team who were critical to my mother’s care. From there I participated in a social work and occupational therapy assessment, as well as a resident meeting. Spending four days on the Unit it was evident that the nurses, although extremely busy, were able to attend to all my mother’s needs. The rooms were hygienic, meals of high quality and linens changed regularly, the nursing care exemplary. This is a good package, I thought to myself, and she is in a public hospital; the system works.

Fast-forward four days to Toronto, where I was admitted to a major teaching hospital for an operation scheduled months earlier. All went well with the admission, surgery and post-operative recovery room procedures. The operating room staff were masters of sensitivity and compassion.

Then I was transferred to the Unit for recovery and discharge. By contrast with RNSH the nursing team was exhaustingly busy, frequently tending to multiple patient demands at once. I consistently had to wait for pain control.

The nurses were caring, knowledgeable and true educators in my postoperative care. They inspired confidence in my ability to return home, even though their protocol was a bit aggressive. As to the facilities, daily hygiene could have been pumped up.

In summary, when you have a nurse-to-patient ratio that is manageable, patients receive excellent care. When this is abused, the opposite takes place. Fortunately, in the above two examples our respective families were attentive and omnipresent, so no catastrophic events transpired. This is not always the case.

Therefore, the nurses in the health care system play a pivotal role, which begs the issue of manageable nurse-patient ratios.

This is a prime example of the reasons unions exist in today’s society.

In New South Wales no one else seems willing to fight for your hospitals, your patients and the future of the health service.

Keep up the good fight NSWNMA, as the safety of the community is in your hands.

Maureen Wright,Toronto Canada

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6 | T H E L A M P J U LY 2 0 1 4

YOUR LETTERS

Thanks for getting us back pay Recently I embarked on a battle with management to secure the “in charge of shift” allowance. After being unsuccessful I contacted the NSWNMA. Since then the Association has provided amazing information, support and guidance. The issue was handed to our organiser at John Hunter Hospital (JHH) to follow up. I love that man and so do all the nurses in medical imaging. He has been phenomenal and has secured this payment with back pay for us.

We could not have done this without the support and guidance of the union. And we certainly would not have got there without our organiser.

That man has an amazing wealth of knowledge and an awesome way with people.

This was my first time working with the union, in all my years of nursing. The experience has been positive and immensely empowering.

I wanted to give you some positive feedback, because usually feedback is on the negative side.

Please pass on my thanks to all involved in this issue; you do an amazing job. And to our organiser: we in medical imaging at JHH will be eternally grateful and forever in your debt!

Keep up the awesome work.

Amanda Cox RN, Beresfield

Nursing homes need RNs! I am an AiN in a nursing home in Sydney’s south. I was very upset to hear that there is consideration to remove the requirement for RNs in nursing home care. I am an RN student and know the reliance AiNs have on RNs. I understand where the incentive is to remove RNs in saving money, as AiNs are a lot cheaper. However, the care provided, in my opinion, would be unsafe for the residents.

We rely on the RNs for medication administration, wound dressings, assessments of mobility and feeding and infection control As an RN student I also learn a lot from the RNs for my own practice, which I use on placement.

We need Registered Nurses in nursing homes.

Merryn Anderson AiN, Miranda

Every letter published receives a $20 Coles Group & Myer gift card.

We must unite for when it’s rough and tough It’s the working class who pump life into this country. Apart from income tax we are also levied 1.5% for Medicare and this will be increased to 2% this July. Having to pay $7 as a co-payment for every GP visit, and new charges for other medical services, is double kill. However, what really gets me most is the slashing of the health budget, which in consequence will downsize the number of staff, cutting the number of beds, merging of wards, etc. These kinds of changes obviously affect the delivery of care by nurses. I hope the union has contingency plans to protect all members in the event working conditions (workload, work environment, etc.) get rough and tough.

All of we nurses must unite and be one strong political voice to protect our rights and always be active advocates for our patients/clients.

I congratulate the RN who braved asking Joe Hockey some questions on Q&A (on ABCTV).

Maria Helena Liceralde RN, Carlton NSWNMA responds The Association is happy to run such campaigns but we need on the ground support from members to do it.You can show your opposition to the federal budget by coming to the Bust the Budget rally on Sunday 6 July, 1pm at Sydney Town Hall.

NOTICE NMA NSW Health has advised the NSW oll that there is a problem with the payr by uced prod es) ficat certi up (gro ies summar cial finan from m syste oll payr the Stafflink years 09/2010 to 12/2013. rs with: We have been advised of two erro t 12,000 • Payment summar ies which affec employees across the state and 0 • Superannuation which affects 10,60 employees across the state. errors Members who are affected by these are. will receive a letter from HealthSh ld If you have any enquiries you shou at ber num e phon d nate desig the contact will You nce. insta first the at HealthShare be supplied with a ticket number. the If you require further assistance after the first contact with HealthShare then a to ticket number should be provided NSWNMA Information Officer for escalation, if deemed necessary. for Please go to www.nswnma.asn.au more infor mation.

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HAVEYOURSAY Send your letters to: Editorial Enquiries email lamp@nswnma.asn.au fax 9662 1414 mail 50 O’Dea Avenue, Waterloo NSW 2017.

Please include a high resolution photo along with your name, address, phone and membership number.

Letters may be edited for clarity and space.

Anonymous letters will not be published.

T H E L A M P J U LY 2 0 1 4 | 7

COMPETITION

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NEWS IN BRIEF

Australia

“Temporary” workers preferred over nurse graduates The ACTU has called for tighter regulation of 457 visas in Australia in light of the “staggering numbers of nurse graduates that are shunned by employers”.

ACTU President Ged Kearney says the number of graduates who are turned away is about the same as the number of 457 temporary workers hired by Australian public and private hospitals and aged care providers each year.

“Each year thousands of local nurse graduates complete their degrees and can’t find an employer who will give them a chance, yet these same employers are hiring staff on 457 visas instead,” Ged Kearney said.

The Australian Nursing and Midwifery Federation (ANMF) “conservatively estimates” that in 2013/14:

• 60% of Tasmania’s nursing graduates were unable to find work • only 600 graduates out of 2500 were employed in Queensland • 800 graduates in Victoria could not get work • 400 nurses graduates in Western Australia could not get work • 280 nurse graduates in South Australia could also not secure positions

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Ged Kearney

“THE 457 VISA SCHEME MUST ONLY BE USED WHEN EVIDENCE SHOWS THAT LOCAL WORKERS ARE NOT AVAILABLE TO DO THE WORK.”

ANMF Acting Federal Secretary Annie Butler says the use of temporary workers in nursing has risen.

“The number of 457 visa nurses has increased by around 400% per year since 2005 and most recent figures show nearly 3100 temporary workers are being brought in to fill nursing positions annually,” she said.

Ged Kearney questions the integrity of the 457 visa scheme.

“The 457 visa scheme was created as an emergency and temporary stop gap. Obviously, it’s not being used correctly and we are very concerned that if the Abbott government has their way visa regulations will be loosened even further. The 457 visa scheme must only be used when evidence shows that local workers are not available to do the work.”

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NEWS IN BRIEF

Australia

Surgical bias leads to baby health problems: study Babies born to healthy mothers in private hospitals are more likely to suffer health problems and be readmitted to hospital in the weeks after birth than those delivered in the public system, a recent study has found.

The University of Western Sydney study looked at nearly 700,000 “low-risk” births in New South Wales. It found that 5% of babies born in private hospitals suffered birth trauma such as damaged scalps, jaundice or broken bones, and were readmitted to hospital within 28 days. In public hospitals it was 3.6% of newborns.

Resuscitation at birth, feeding difficulties, sleep issues and behavioural disorders were also higher in babies born in private hospitals, according to the report published in the British Medical Journal.

Higher rates of medical intervention in private hospital births were the likely culprit, the study’s lead author, UWS midwifery professor Hannah Dahlen told The Guardian.

An earlier study found that delivery interventions such as the use of forceps or vacuums, induced or caesarian births and epidurals occurred 20% more often in the private system.

“It is this intervention that’s causing that morbidity,” Dahlen said.

Dahlen said the study had broader implications for “the current federal and state governments’ agenda around privatising of health”.

“The bottom line is, if you’re paying more for health in Australia, it doesn’t necessarily guarantee a better outcome for low-risk babies and women.”

“THE BOTTOM LINE IS, IF YOU’RE PAYING MORE FOR HEALTH IN AUSTRALIA, IT DOESN’T NECESSARILY GUARANTEE A BETTER OUTCOME FOR LOW-RISK BABIES AND WOMEN.”

United Kingdom

Centenarians on the rise The number of people living in the UK aged older than 100 has increased nearly fivefold in 30 years as better medical treatments, housing, nutrition and living standards, along with a decline in smoking, significantly improve the chances of surviving to a very old age.

According to the Office of National Statistics (ONS) there were an estimated 13,350 centenarians in Britain in 2012 – a 73% increase in a decade – and 660 of them were aged over 105.

The ONS says the UK, with 21 centenarians per 100,000 of population, lags behind countries such as Japan, with 40 per 100,000, and France with 30, the highest proportion in Europe. Russia has just more than four centenarians per 100,000.

In 2012, nearly three-quarters of British people aged 90 and over were women, although that balance is shifting. The gender ratio for centenarians fell from 828 women for every 100 men in 2002, to 588 women for every 100 men in 2012.

There were an estimated

13,350 centenarians in Britain in 2012 T H E L A M P J U LY 2 0 1 4 | 9

NEWS IN BRIEF

2012 United Kingdom

GFC-led antidepressant spike

1998

United States

Of mice, but not yet men Giving old mice young blood reverses agerelated declines in brain function, muscle strength and stamina, says new research.

Experiments on mice have demonstrated the dramatic rejuvenating effects of chemicals found naturally in young blood, which could lead to therapies that reverse harmful ageing processes in the brain, muscles, heart and other organs.

Researchers made an incision along the side of an old and a young mouse and let the wounds heal in a way that joined the animals together and the mice shared each other’s blood supplies.

Blood from three-month-old mice reversed some age-related changes in the brains of 18month-old mice. The animals grew more and stronger neural connections in the hippocampus, meaning the brain cells could talk to each other more effectively, according to a report in Nature Medicine. An 18-month-old mouse is considered to be equivalent in age to a 70-year-old person.

“There’s something about young blood that can literally reverse the impairments you see in the older brain,” Saul Villeda, one of the researchers told The Guardian.

But he stressed that mice are not humans.

“I wish our manuscript could come with a big caption that says ‘do not try this at home’. We need a clinical trial to see if this applies to humans, and to see if there are effects that we don’t want.”

1 0 | T H E L A M P J U LY 2 0 1 4

15M 40M

The use of antidepressants rose significantly in England during the financial crisis and the recession that followed, with 12.5 million more pills prescribed in 2012 than in 2007, according to a study by the Nuffield Trust and the Health Foundation.

Researchers identified a long-term trend of increasing prescription of antidepressants, rising from 15 million items in 1998 to 40 million in 2012. The yearly rate of increase accelerated to 8.5% during the banking crisis and recession, compared to 6.7% before it.

Nick Barber, director of research at the Health Foundation, told The Guardian that the rate of increase in prescribing had been static for some years but increased from 2008.

“It would suggest that recession and some of the associated problems such as unemployment could be part of it,” he said.

The report says a rise in unemployment and in the cost of living during the recession “could have an impact on the prevalence of mental health problems and require changes in the service delivered”.

Researchers also discovered that a 1% rise in unemployment over time typically meant one and a half more tablets were given out per person on a GP list per year.

3D printed food

by Biozoon Smoothfood.

Germany

Printer is running low on food?

German aged care homes have begun serving 3-D printed food.

According to the online news site Vice, the meals are made from fresh ingredients, which are puréed for patients who have difficulties chewing and swallowing.

The 3-D printer is like a normal inkjet printer except that it uses food material as “ink.” The printer cartridges are filled with liquefied vegetables, meat, and carbohydrates and the food “ink” is printed in layers on a special plate.

The printer software can be programmed to print the food in every kind of shape.

NEWS IN BRIEF

United States

Early bird loses the weight A new study has found that it is not just how long we sleep that can affect our weight, but also when we wake up.

Numerous studies have shown that chronic sleep deprivation can lead to weight gain. But a new paper in the Public Library of Science’s peer-reviewed resource PLOS One says it is not just how many hours of sleep you get each night that matters, but when you wake up too.

The study found that people who were exposed to bright light in the morning had lower body mass indexes (BMI) than those who were exposed to most of their light later in the day. The finding was independent of the amount of calories eaten.

Dr Phyllis C Zee, a senior author of the paper, said that even 20 to 30 minutes of outdoor light before midday could affect BMI. Less sleep increases appetite by raising levels of the hormone ghrelin and reducing physical activity.

The link between sleep deprivation and weight gain is strong. The Nurses Health Study found that women who slept five hours or less a night were 15% more likely to become obese over the course of the study than women who slept seven hours a night.

Women who slept five hours or less a night were

15% more likely to become obese…

A study in the Annals of Internal Medicine found that lack of sleep led to fat cells becoming less sensitive to insulin, which could, theoretically, increase chances of obesity and diabetes.

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T H E L A M P J U LY 2 0 1 4 | 1 1

COVER STORY

“WHY DON’T WE HAVE THE SAME RATIOS AS THE CITY?” — Alex Jones RN

1 2 | T H E L A M P J U LY 2 0 1 4

Country nurses quiz Nationals about improving patient care Nurses and midwives asked state National Party MPs: what are you doing to improve safe patient care in the country?

We are still waiting for the right answer.

IT WAS CHILLY AND GREY BUT A CONTINGENT of country nurses and midwives were undeterred as they buttonholed National Party MPs and delegates attending their annual conference in Queanbeyan, about improving nurse-to-patient ratios in country hospitals.

They also engaged the public with a stall in the Queanbeyan shopping mall and door knocked throughout the town.

A mobile billboard promoting the Association’s campaign for ratios and safe

patient care circulated through the town for the duration of the conference.

NSWNMA General Secretary Brett Holmes said nurses and midwives wanted to speak to the community about local public health services.

“As advocates for better health outcomes, our members strongly believe country patients deserve the same level of nursing care that patients in the city receive,” Brett said.

“Our members door-knocked

Better ratios for country: unfinished business There are many new threats to our public health system but for Orange RN Alex Jones improving ratios in country areas remains unfinished business.

“At Orange we have a high demand because we cover such a huge area. We find that we have a very high acuity in all levels of our hospital, which means our patients need more intensive, personalised care. We don’t have the same ratios as the city. Sometimes we have 1-to-4 which is fantastic but sometimes we have 1-to-5 or 6, which means those patients don’t get the sort of personalised care that they need.”

Alex says the cuts to health funding and the introduction of a GP co-payment will make things even worse.

“I think things are at risk of getting worse.

If we look at the federal budget there are real risks that we will be losing nursing hours. We’ve already seen wards cut,

we’ve already seen positions cut. Even now, we simply can’t deliver the care.

“I think we are going to see an exacerbation of the issues across the board in city and country, particularly in lower socio-economic areas. They won’t be able to come up with the money to go to a GP and rather than going to a GP they’ll end up going to an emergency department.

“We’re also looking at privatisation of our health system which is horrible to think of. I think this is probably my biggest fear – a more privatised system. If we look at the countries that have a privatised system; if patients go into an ED, if they can’t afford it they don’t get the care. They have really terrible patient outcomes and if we go down that way we’ll be facing much worse patient outcomes than we do currently.”

throughout Queanbeyan and spoke to the local community about their public health services and medical costs.”

The nurses and midwives made clear to MPs that they want the same nurseto-patient ratios for public hospitals in country electorates as those currently enjoyed in metropolitan areas. Currently, at many country hospitals, the ratio on a general surgical ward is 5-patients-to-1nurse (day and afternoon shifts). In major metropolitan hospitals, however, the ratio is 4-patients-to-1-nurse (day and afternoon shifts). In most country hospitals patients receive one hour less care from nurses than in city hospitals.

Leonie Keen, an EN at Queanbeyan Hospital, welcomed the opportunity to advocate on behalf of her patients while speaking to local MP for Monaro, John Barilaro.

“John hasn’t been able to talk to us for some time. I did talk to him this morning and handed him more than 10,000 signatures. We collected those signatures from concerned citizens throughout regional NSW,” she said.

“He said he was fully aware of the situation and he was working towards safe patient care. I have to say I wasn’t totally confident in his statement and I think safe patient care needs to be explained in terms of what it means – and it means we need more nurses. It’s as simple as that.”

The petition calls on the New South Wales government to put patient safety first by expanding legally enforceable, mandated nurse-to-patient ratios in public health facilities across the entire state.

T H E L A M P J U LY 2 0 1 4 | 1 3

COVER STORY

“WE HAVE TO CHIP AWAY AND HAVE OUR MESSAGE HEARD.” LEONIE KEEN, an EN at Queanbeyan Hospital, says nurses and midwives shouldn’t assume that politicians understand the needs of the public health system.

“I don’t think they have a good understanding of what the problem is and what steps need to be taken to get safe care for patients.

“I think it is a good idea that the NSWNMA comes to the National Party conference and reminds the delegates what it is that is important in the community; to the people who voted them in and who expect that they are going to be looked after.

“We have to keep lobbying even though it seems not much use sometimes. But it is. We have to chip away and chip away and have our message heard. Because we are advocates for patients and it is in our job description to fight for better care for our patients.”

Leonie says that improving ratios in country hospitals is vital.

“The main issue of course is enforcing safe patient care and to do that staff-to-patient ratios have to be implemented in country hospitals.

We need ratios similar to the metropolitan hospitals so all patients can benefit from safe patient care.

“It doesn’t make you feel good that the city has better ratios. Why are we any different to the city hospitals – to have less patient care?”

Leonie says she is also concerned about how the GP co-payment and cuts to health funding announced in the federal budget will impact on country hospitals.

“I don’t think people can afford it. It hits the poorest people – the ones who can least afford to pay. They’re going to delay going to the doctor and they’ll put more pressure on hospitals because they will be sicker.

It will put more pressure on nursing and how much more pressure can a nurse take before it’s all too much?

“The funding cuts will have a severe impact on rural areas. There’s not enough money as it is. More cuts will take us back years – there will be job losses, fewer nurses and that will make it even harder to provide safe patient care.”

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“OUR NUMBER ONE CONCERN IS THAT YOUR POSTCODE SHOULD NOT DETERMINE YOUR HEALTH CARE.”

“WE NEED AN EXTRA 13 NURSES.”

“OUR MP LISTENS BUT WE HAVEN’T SEEN MUCH ACTION.” ANGELA DITRICH, an RN at Casino Hospital, says it is important that we not only front up to MPs to put our case for improved ratios, but we also put pressure on them to act on our concerns.

“Other delegates from Casino have had contact with our local MP, Chris Gulaptis, and we have written letters to him and tried to engage him in the process.

“When we have tried to engage him, he listens, which is good, but we haven’t seen much action.

“We would like to see him come forward and say ‘righto, I’m going to help you, I’m going to put it forth down in Parliament and make sure that your voice is heard’. “That’s all that we want, we want to be heard.

“Our number one concern is that your postcode should not determine your health care and that our ratios are not equal with those in the city. We want to do something about that for our patients.

“Nurses want to provide a better health service for our community. We know how important it is to have equal care and to have ratios.

Angela works in ED and is alarmed by the impact GP co-payments might have on overstretched EDs. “On an already busy ED it’s going to get worse.

Waiting times are going to be longer, there are going to be issues with giving care. We’re not going to meet our timeframes if we’ve got a whole lot of category threes, fours and fives. There are going to be extended periods of waiting.”

“RATIOS WILL IMPROVE PATIENT CARE, REDUCE PATIENT DEATH AND KEEP NURSES IN THE WORKFORCE.”

MATHEW CARTON, an RN at Tamworth Base Hospital, says they are still trying to meet the standards of minimum safe patient care at his hospital.

“On our surgical ward sometimes we are down 20 hours a week, sometimes 30 hours a week. It is one of the largest surgical wards in northwest New South Wales with 28 beds. And in the acute medical ward we can be down 40 to 60 hours a week.

“We’re rushed off our feet on every morning and afternoon shift. People don’t leave till late because they leave their paperwork till last because we have too much patient care to attend to.

“We need an extra 13 nurses at Tamworth to get to the full Nursing Hours Per Patient Day. At the moment we don’t have enough staff. They’re not employing enough staff. People call in sick and we have to work understaffed because sometimes they won’t employ overtime staff.

They’ve been trying to employ more staff but trying to recruit people to the country is pretty hard.

“We have ratios but one to two staff less than the city people have, and one to two makes a difference in patient care.

“Ratios will improve patient care, reduce patient death and increase nurse happiness which will keep nurses in the workforce.”

Mathew says he is concerned about the impact privatisation of public health care would have in the country.

“There is talk of Mr Baird privatising New South Wales hospitals, and Mr Abbott wants to go to private healthcare. If they do people won’t be able to afford healthcare in the country. How many people can afford $1000 for a scan?”

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COVER STORY

10,000 signatures given to local MP

For some months now public health system nurses and midwives have been collecting signatures on a petition that calls on the state government to put patient safety first, by expanding legally enforceable nurse-to-patient ratios in public health facilities throughout the state. EN Leonie Keen presented 10,000 signatures to her state MP John Barilaro for presentation to the NSW Legislative Assembly.

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Acting PM gets his briefing Alex Brown from Orange Base Hospital and Lynn Sloane from Bathurst didn’t miss their opportunity to brief the Nationals’ federal leader Warren Truss about the need for ratios to improve public health services and patient care. They did it on the day Mr Truss was acting Prime Minister, as Tony Abbott was in the United States.

Door knocking to talk about public health Angela Ditrich and NSWNMA delegates in Queanbeyan took to the local streets door knocking and speaking to the local community about their public health services and medical costs. Queanbeyan is situated in the “bellwether” federal seat of Eden-Monaro. It is the quintessential swinging seat.

It is also located in the state seat of sitting member John Barilaro from the National Party.

Welcome … now stand up for country health Wherever they went in Queanbeyan the National Party delegates were met with messages from the NSWNMA on a mobile billboard: giving them a warm welcome from nurses and midwives to the conference and asking them to stand up for country health services.

TV ads take message to the community While NSWNMA members were engaging politicians and the public on the ground about our campaign to put patient safety first, we also took our campaign to the air with two TV ads.

One highlighted the enormous pressures now found in EDs that will be exacerbated by the federal government’s proposed GP co-payment, and the other advocated for the same ratios in metropolitan hospitals to be extended to country areas. It also warned of the consequences that cuts in federal health funding will have on country health.

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HEALTH

Universal health trumps user

COUNTRY RANKINGS

healthcare reforms, which have increased the number of Americans with health insurance coverage and improved access to care.

The report attributes some of the improvements driven by Obamacare to the adoption of health information technology and payment and delivery system reforms.

impressive considering that its expenditure on health per capita is one of the lowest among the countries examined. Only New Zealand and Britain spend less per capita on health than Australia.

The study included data from patients, doctors, the World Health Organisation and the Organisation for Economic Cooperation and Development. It measured performance in five key areas: quality of care, access, efficiency, equity and healthy lives.

Australia rated highly in all categories except for access, due to our relatively high out-of-pocket costs.

The report concluded that the United States’ largely privatised system lagged well behind the universal health care systems of comparable developed countries.

It says there have been some improvements in US performance since the introduction of President Obama’s

A STUDY CONDUCTED BY THE HIGHLY respected, Washington-based foundation, The Commonwealth Fund, has ranked Australia’s health care system fourth in a comparison of 11 developed nations.

The Commonwealth Fund, which supports independent research into high performance health care, found that Britain’s National Health Service (NHS) ranked first in the international comparison while the United States came last.

The UK’s NHS, which is even more government-funded than our own Medicare, ranked first in almost every category examined.

The study highlights the success of countries that have universal health insurance coverage. The US, with its predominantly privatised health system, came last or near last on measures of access, efficiency, and equity.

Australia’s high ranking was particularly

LESSONS FOR THE ABBOTT GOVERNMENT NSWNMA General Secretary Brett Holmes says the report is timely for Australia given the radical changes to our health system being proposed by the Abbott government.

“This internationally recognised study pays appropriate respect to the fine public health system that we have in Australia, irrespective of its shortcomings.

“What is clear is that the fundamentals of our own health system – strong public

OVERALL RANKING

Top 2* Middle Bottom 2* AUS

CAN

FRA

GER

OVERALL RANKING (2013)

4

Quality Care

2

Effective Care

10

9

5

5

7

7

3

9

8

7

5

4

11

10

4

7

9

6

5

2

11

10

Safe Care

3

10

2

6

7

9

11

Coordinated Care

4

8

9

10

5

2

Patient-Centered Care

5

8

10

7

3

8

9

11

2

Cost-Related Problem

9

5

10

Timeliness of Care

6

11

Efficiency

4

Equity Healthy Lives

Access

Health Expenditures/Capita, 2011**

NETH

NZ

NOR

SWE

SWIZ

UK

US

2

1

11

3

1

5

8

1

3

5

4

1

7

7

11

3

1

6

6

11

9

2

1

4

4

7

6

4

2

1

9

4

8

6

3

1

7

1

11

10

4

2

7

8

9

1

3

5

10

8

9

7

3

4

2

6

1

11

5

9

7

4

8

10

6

1

2

2

11

4

8

1

7

5

9

6

2

3

10

11

$3,800

$4,522

$4,118

$4,495

$5,099

$3,182

$5,669

$3,925

$5,643

$3,405

$8,508

Notes: * Includes ties. ** Expenditures shown in $US PPP (purchasing power parity); Australian $ data are from 2010.

Source: Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization; and Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, Nov. 2013).

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pays: study hospitals and universal access – are far superior in terms of health outcomes, costs and efficient use of resources, to an alternative model like the American system which is market-driven, user-pays and largely privatised,” he said.

“This study contains a lesson for our federal and state governments: put your ideology to the side and look at the empirical evidence.

Australia’s health care system has been ranked the fourth best in the world by an international panel of experts.

“Interestingly, the study found that ‘Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or followup care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, onethird or more of lower-income adults in

the US said they went without needed care because of costs in the past year’.

“This is powerful evidence that the user-pays model that the Abbott government has initiated with its GP co-payment is categorically wrong for Australia.

“Such an ideologically driven agenda in health is placing our world class system at risk.”

“What is clear is that the fundamentals of our own health system – strong public hospitals and universal access are far superior in terms of health outcomes, costs and efficient use of resources to an alternative model like the American system which is market-driven, user-pays and largely privatised.”

— Brett Holmes

Key findings QUALITY The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care.

For quality of care Australia scored highly, ranked second only to the UK.

ACCESS Not surprisingly – given the absence of universal coverage – people in the US go without needed health care more often than people do in the other countries, because of cost.

The report noted “there is a frequent misperception that trade-offs between universal coverage and timely access to specialised services are inevitable; however, the Netherlands, UK and

Germany provide universal coverage with low out-ofpocket costs while maintaining quick access to specialty services.”

Australia, with its relatively high out-of-pocket costs, ranked ninth.

testing. Patients in countries with a universal health care system are less likely to visit the emergency room for a condition that could have been treated by a regular doctor.

EQUITY EFFICIENCY On indicators of efficiency the US ranked last among the 11 countries, with the UK and Sweden ranking first and second respectively.

Australia’s health system was the fourth most efficient. The US had poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical

The US ranked a clear last on measures of equity.

Americans with belowaverage incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; not filling a prescription or skipping doses because of costs.

Australia ranked towards the middle in fifth place.

HEALTHY LIVES The goal of a wellfunctioning health care system is to ensure that people lead long, healthy, and productive lives. To measure this the report used three outcomes: deaths that could have been prevented with timely and effective care; infant mortality; and healthy life expectancy.

Australia again came in among the top performers in fourth place, bettered only by France, Sweden and Switzerland. The US ranked last on adult mortality, last on infant mortality, and second-to-last on healthy life expectancy at age 60.

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FEDERAL BUDGET

There is always another way The Abbott government promised its recent budget would spread the pain.

Instead, the poorest and most vulnerable have been hit hardest while big business and high-income earners have got off lightly.

THE ABBOTT GOVERNMENT CLAIMS that savage cuts to state health funding and increased health charges for consumers are needed to cut the budget deficit.

Yet big banks escaped higher charges and big mining companies got additional help courtesy of the taxpayer.

As The Lamp shows on these pages, the government could easily save money without destroying bulk billing, cutting pensions or making university more expensive.

For example, a levy of just 0.2% on the super profits of the big four banks would raise an estimated $7.9 billion over three years. That’s more than the estimated savings from the $7 Medicare co-payment, the tightening of eligibility for drugs on the Pharmaceutical Benefits Scheme and the cuts to concessions for pensioners and Seniors Card holders.

BIG BANKS CAN PAY MORE Australia’s big four banks are on track to post record annual profits of a staggering $30 billion after making more than $27 billion profit last year.

NAB, Commonwealth, ANZ and Westpac are among the world’s most profitable banks and can easily afford a tax levy to help slash the budget deficit.

Yet the big four escaped a super profits tax in the last budget, while putting their hands out for a taxpayer subsidy worth an estimated $4.5billion annually.

The subsidy is in the form of a government guarantee to bail them out in a financial crisis.

This gives the big four an unfair advantage because they can borrow funds more cheaply, says the Customer Owned Banking Association (COBA), which represents credit unions, building societies and small mutual banks. COBA has joined a growing list of organisations 2 0 | T H E L A M P J U LY 2 0 1 4

“INSTEAD OF DESTROYING UNIVERSAL HEALTHCARE AND BRINGING IN A NEW DEFICIT TAX — INSTEAD OF MAKING LIFE HARDER FOR FAMILIES, THE AGED, THE YOUNG AND UNEMPLOYED — THE ABBOTT GOVERNMENT SHOULD SIMPLY LEVY AN EFFECTIVE TAX ON BIG MINERS.” — Christine Milne, The Greens calling for a levy on the major banks.

The Greens say a levy of just 0.2% on bank assets over $100 billion will raise $7.9 billion over the next three years.

Instead of making the big banks surrender some of their super profits, the Abbott government is moving to boost their already fat profit margins at the expense of customers.

The government also wants to water down customer protection laws contained in the former Labor government’s Future of Financial Advice Act, which requires financial advisors to act in their

client’s best interests, rather than simply promoting bank-owned financial products.

CALL TO RESURRECT MINING TAX When it comes to sharing the budget burden the Liberal/National government has let the big mining companies off the hook.

The government wants to abolish the mining super-profits tax first put forward

by Labor when Kevin Rudd was prime minister.

From 1999 to 2009 the value of coal

and iron ore exports rose almost six-fold from $12 billion to $69.4 billion. The lion’s share of the boom went into the offshore accounts of the largely, foreignowned mining companies.

This prompted the Rudd government to propose a “resource super profit tax” to raise $22.5 billion in its first four years.

The tax was backed by a group of 20 top economists led by the former head of the Australian Competition and Consumer Commission, Professor Alan Fels, who said the existing tax system “does not adequately capture the excess profits that are presently being made by the mining industry.”

Rudd’s announcement triggered a ferocious lobbying campaign led by global mining giants Rio Tinto, BHP Billiton and Xstrata. In a six-week period during 2010, the mining industry spent $22 million advertising against the tax.

The campaign helped to sway Labor MPs to replace Rudd as prime minister and new PM Julia Gillard greatly watered down the tax until the big miners got what they demanded.

Now the Abbott government even wants to scrap Gillard’s modest levy.

This is despite new analysis from the Parliamentary Budget Office showing the government could raise $35 billion by restoring the mining super-profits tax to the level intended by Rudd.

As Australian Greens leader Christine Milne said: “Instead of destroying universal healthcare and bringing in a new deficit tax – instead of making life harder for families, the aged, the young and unemployed – the Abbott government should simply levy an effective tax on big miners.”

PROFITS TAX

Apple has shifted around $9 billion in profit overseas to minimise its tax bill.

“BUT WHAT DOES THE COMMISSION OF AUDIT DO? TELLS US TO HIT UP THE POOR, THE SICK AND THE AGED.” FUEL SUBSIDY DESPITE “EMERGENCY” Despite the alleged “budget emergency” the Abbott government has refused to consider scrapping multibillion-dollar fuel subsidies paid to the mining industry.

Instead it has indexed the rebate – meaning subsidies will go up in line with inflation.

The diesel fuel rebate will save mining companies roughly $2 billion in fuel excise every year – well above the $1.7 billion the government expects to save through changes to Medicare Benefits Schedule fees, the Medicare Levy Surcharge and the Private Health Insurance Rebate.

TECH GIANTS DODGE WHILE ABBOTT CHASES POOR The search engine company Google earns as much as $2 billion a year from advertising in Australia. Yet after deductions it paid a paltry $466,802 in tax last year.

Google achieved this magical result largely by “transfer pricing” – the process of shifting profits overseas to low-tax jurisdictions like Singapore and the Cayman Islands.

As Sydney Morning Herald business writer Michael West reported: “Google’s real profit – mostly booked in more amenable tax jurisdictions – is many times what it declared. Its ad revenue in Australia is as high as $2 billion.”

Google’s accounts were released the same day the Abbott government released

its Commission of Audit report, recommending higher health charges and cuts to pensions for the elderly and unemployed. The irony did not escape West, who added: “So we have multinationals paying minimal tax, massive government waste, a constellation of tax lurks for the wealthy, and taxpayer-backed banks racking up super profits.

“But what does the Commission of Audit do? Tells us to hit up the poor, the sick and the aged.”

Google is not the only technology giant to dodge tax. An analysis by the Australian Financial Review shows that while Australians have bought $27 billion worth of Apple products since 2002, the company has paid only $193 million to the Australian Tax Office – just 0.7% of its turnover.

The newspaper estimates that Apple has shifted around $9 billion in profit overseas to minimise its tax bill.

CARBON TAX COULD AVERT BUDGET CUTS If the Abbott government kept the carbon tax it could ditch its most controversial budget savings measures and still achieve the same improvement in the budget bottom line, says leading economist Ross Garnaut.

The carbon tax works by requiring 294 of Australia’s largest companies and organisations to buy a permit valued at $23 for every tonne of carbon pollution they emit into the atmosphere.

The more that is emitted, the higher the financial cost for the polluter. By reducing their emissions, big companies can also reduce their financial liability.

The government wants to repeal the carbon tax after the arrival of the new Senate on July 1.

Professor Garnaut, architect of Rudd and Gillard government climate policies, argues that keeping carbon pricing, and abandoning Abbott’s preferred $2.55 billion emissions reduction fund, would reduce the budget deficit by between $12 billion and $19 billion over the next four years, depending on the European carbon price.

That is about the same as the $12 billion to $18 billion in budgetary savings that the Greens and Labor have pledged to oppose in the Senate.

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STAFF SHORTAGES

Blacktown beds go in budget crunch Blacktown Hospital management heeded warnings from the NSWNMA branch about dangerous understaffing and closed eight beds.

MANAGEMENT OF THE WESTERN SYDNEY hospital also agreed to replace nurses on sick leave in line with award requirements and stop using nursing support staff to cover shortfalls.

The hospital’s director of nursing and Western Sydney Local Health District (LHD) management acted after the local NSWNMA branch decided that nurses would close beds themselves if management continued to tolerate persistent staff shortages.

A meeting of more than 40 branch members unanimously approved a resolution to tackle the nurse shortage across several wards, which branch president Shyam Kalia described as a threat to the safety of patients and staff.

The resolution called on management to observe the award by ensuring staff on sick leave and other leave were replaced.

The routine use of support staff such as Clinical Nurse Educators, Nurse Unit Managers and Clinical Curse Consultants to plug gaps must cease, it said.

The resolution demanded that wards be staffed according to nursing-hours-perpatient-day (NHPPD) ratios set out in the award. Areas of the hospital not covered by award ratios must be supplied with agreed staffing profile numbers.

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The branch said if these conditions were not met it would close beds to meet minimum staffing levels and conduct a community awareness campaign.

“We did not want to take this action but we believed it was necessary to protect the safety of both patients and staff members,” Shyam said.

NSWNMA General Secretary Brett Holmes said staff shortages were apparently due to a shortage of funds.

“It is unacceptable for management to put nursing staff in this position, let alone prolong the situation by citing widespread budget constraints across the LHD,” Brett said.

Shyam said wards that were supposed to be staffed at 5.5 NHPPD had to cope with staffing as low as 4.9 NHPPD. “We found significant variations when we collected the spot check data,” he said.

“People on leave were not being replaced, staff members were working short, and the increased workloads were compromising patient safety.”

“THERE HAVE BEEN SIGNIFICANT IMPROVEMENTS IN STAFFING LEVELS, THOUGH THERE IS STILL WORK TO BE DONE.” —Shyam Kalia He said management quickly decided to close eight beds in the medical assessment unit and surgical unit 2, and redeploy nurses to cover staff shortfalls.

“Since then the Director of Nursing has met with me on a weekly basis to review spot check data from the previous week,” Shyam said. “There have been significant improvements in staffing levels, though there is still work to be done.

“Management has given us an undertaking that if beds are reopened they will be staffed according to the award. Emergency cases will always be given priority.”

If you’d like to conduct a spot check of your ward download the NSWNMA Toolkit app from the Apple store.

ASK JUDITH Using my car for work I work in a home care role as an AiN and have recently purchased a new motor vehicle. Part of my duties is to transport clients to and from appointments and a number of clients need to use a rollator to aid their mobility. I have asked my manager if I am required to continue doing this in my new car and she advised that, as this was one of the terms of my employment, I am required to continue to do this.

Is she correct?

If one of the terms of your employment was using your own vehicle for the purpose of transporting clients to and from appointments and being reimbursed for related costs, then your manager is correct.

However, what you need to clarify with your employer is if, when using the rollators correctly, any damage occurs to your vehicle, what processes are in place to ensure proper repairs will be carried out without any additional cost to you.

You also need to discuss issues around insurance coverage in respect to ensuring you are appropriately covered should you be involved in an accident in the course of your work.

The other area that needs to be clarified is which type of car registration should be applied to your vehicle. If the higher

business rate applies then you need to discuss this with your employer to ensure you are reimbursed for these additional costs.

What break can I take?

I am employed as an RN in the public sector and have been requested to work an extra rostered shift of less than five (5) hours. Am I entitled to a break during this shift?

As you are engaged for less than a whole shift you will only be entitled to one tea break of 10 minutes duration.

The Public Health System Nurses & Midwives’ (State) Award 2011 clause 4, Hours of Work and Free Time of Employees other than Directors of Nursing and Area Managers, Nurse Educators, sub clause (x), (a) is the reference.

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

Award 2011 provides for a 10% casual loading at sub clause A (ii) of Part II of Clause 29, Part-time, Casual and Temporary Employees. On the weekend, the Saturday and Sunday loading applies instead.

Sub clause (iv) of Clause 15, Penalty Rates for Shift Work and Weekend Work, provides for Saturday loading of 50% and Sunday loading of 75%.

These rates apply to employees working less than 38 hours per week, “… but such employees shall not be entitled to be paid in addition any allowance prescribed by clause 29, Part-time, Casual and Temporary Employees, in respect of their employment between midnight on Friday and midnight on Sunday”.

Paid for learning What loading am I due?

I am a casual RN and I recently worked a casual shift in a public hospital on a Saturday. I was paid the 50% loading but not the 10% casual loading. Is this correct?

Yes, you have been paid correctly as casual employees do not receive the 10% loading on weekends.

The Public Health System Nurses’ and Midwives’ (State)

I am an RN and would like to know if I am entitled to be reimbursed by my employer when I attend external education programmes related to my employment and as part of my professional development.

It depends on the course. If your employer has directed you to attend the course, and if they say it’s a mandatory requirement to attend, then yes the employer should cover the associated costs and also pay

you as time worked for the time attended.

However, if your employer has not directed you to attend, and attendance is on a voluntary basis, then cost sharing becomes negotiable between employee and employer.

However, the employer is not compelled to pay or reimburse any of the associated costs.

If your employer does not agree to pay all or part of the costs, be sure to keep all related receipts and invoices because the costs associated with attendance at work-related courses continue to be tax deductable on your annual tax return.

On call without a car I am an RN working in a rural public hospital in the operating theatres. I live quite a distance from the hospital and don’t have a car or reliable transport. Can I still be placed on call?

If being on call was a requirement of your employment then yes you can be rostered on call. A possible solution is for your employer to provide overnight accommodation for you at the hospital on those occasions you are placed on call. Alternately, they could provide you with a hospital vehicle to enable you to travel to and from the hospital if you are called back.

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AGED CARE

Improving the transfer into care Alzheimer’s Australia NSW is working with providers to improve the transition into residential care for people with dementia and their carers.

ALZHEIMER’S AUSTRALIA (AA) NSW senior project manager Sally Lambourne and graduate project officer Evan Rollins told a recent NSWNMA seminar that moving into care was the single most difficult decision faced by both patients and carers.

Between 70 and 90% of dementia patients will end up in residential care and by 2050 more than one million people will be diagnosed with dementia.

AA’s Moving into Care project is working with small providers in New South Wales, those with less than five facilities, because they often have the least resources.

“Building on national and international research we’re finding out what’s working well and transferring that knowledge into good practice,” Sally told the NSWNMA. She said care plans were often focused on clinical needs with life history information tacked onto that, almost as an afterthought. Yet people working in care organisations would benefit themselves and their patients through knowing more about residents as individuals, not merely dementia patients.

“Instead of saying ‘this person has dementia’, say ‘this is Jill, what are her likes and dislikes, her preferences, when does she like to do certain things?’

“One of the difficulties is getting that information from admissions as quickly as possible to the people doing the caring.

It might be weeks where carers are wondering why certain behaviours are happening.”

To begin with the Moving into Care team meets with staff members at care facilities to discuss the scope and challenges of assessing how a facility can act to improve its transition process.

After that any documents related to 2 4 | T H E L A M P J U LY 2 0 1 4

“ALZHEIMER’S AUSTRALIA WANTED TO HEAR THE VOICE OF THE CARER WHO PLACED A PERSON INTO CARE.”

“INSTEAD OF SAYING ‘THIS PERSON HAS DEMENTIA’, SAY ‘THIS IS JILL, … WHEN DOES SHE LIKE TO DO CERTAIN THINGS?’” — Sally Lambourne

moving into care are reviewed, along with communication protocols, practices and any welcome packs being provided to carers and patients.

This is followed by a survey of carers who have moved someone into care in the past 12 months, a survey of all staff, from senior management to cleaners, an analysis of the data and presentation of a report. This is followed by a workshop of key people in the facility.

“We look at where you might be able to improve based on best practice and set some priorities and look at things you could do in the next few months that might change the situation for people moving in.

“This could be small things like creating life histories if you don’t have them, breaking up your admission documents into welcome packs and staggering these. “Staggering the admissions process and providing respite because it improves the experience for everybody.”

The team then develops an action plan that takes into account the financial resources of the facility.

The Moving into Care project grew out of 2012 research done in conjunction with Uniting Care and Baptist Community Services.

“Alzheimer’s Australia wanted to hear the voice of the carer who placed a person into care,” Sally said.The report The most difficult decision: Dementia and the move into residential aged care is available on AA’s website.

It found that while fee structures were explained well, carers said they could have benefitted from suggestions on how to contact support groups, either in house or community groups. They also told researchers that that, even if the ongoing care provider was very good, the moving in process was difficult and stressful.

“Carers told us by the time it came to moving someone into care they were stretched to the absolute limits, they were physically, mentally and emotionally exhausted,” Evan said .“It’s completely overwhelming, with too much to be done in such a short span of time and they’re already not in a good place.”

Carers also said it would be an easier adjustment if they had a contact person available to them on every shift, who they could ask about their relative.

“It can be a very difficult journey, if you’ve been with someone for a long time, to all of a sudden not be around them anymore,” Evan said.“Carers are also finding a lot of the activities that they could normally participate in with their loved one, that they did outside of residential care, aren’t provided and that the activities which interest the person in care are not quite there, that outings that were discussed [prior to the move] might not include the resident.

“Even being allowed an easily accessible outside space can be considered an outing and sometimes that isn’t available,” Evan said.

Steps need to be taken to achieve best practice, person-centred care, he said.

“We want to make sure people are recognised as the unique individuals they are and sharing life history is a most important part of that from day one.”

Sally says it is also important that activities are meaningful for residents.

“The group activities that are currently run can make a lot of people very happy and are very engaging,” Sally said. “But activities need to be goal directed as well, not just for killing time.

The residents need to feel they’re working toward something, that they’ve achieved something.”

T H E L A M P J U LY 2 0 1 4 | 2 5

AGED CARE

Attracting RNs into aged care

Bronwyn Arthur

South East Sydney Local Health District is offering RNs a unique career pathway in aged care nursing

2 6 | T H E L A M P J U LY 2 0 1 4

IT TOOK THREE YEARS OF HARD WORK BY a dedicated team to build an aged care career pathway through Sutherland Hospital, Garrawarra Residential Aged Care centre and Wollongong University.

Sutherland Hospital nurse consultant aged and extended care, Bronwyn Arthur, told a recent NSWNMA forum for aged care nurses: “We looked everywhere for a model and we couldn’t find anything. We wanted something that was sustainable and that required a lot of coming together of different stakeholders.

“We started looking at not just how to attract transitional registered nurses (TRNs) into aged care, but what we could do to build the workforce after the first year, to retain them.”

There was also the question of how to attract younger people without a lot of life experience who might be deeply affronted by what they saw at Garrawarra Residential Care Centre, in patients exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD).

This was evident in the first year from the reactions of some TRNs employed in equal numbers by Sutherland Hospital and Garrawarra (four in each facility) under a program that involved rotating between the two.

“The Sutherland staff were terrified about going to Garrawarra because its reputation preceded it,” Bronwyn said. “I had staff who came to aged care kicking and screaming … after six months they didn’t want to go anywhere else.”

TRNs were put into senior roles they could not otherwise expect to fill for many years in the inpatient unit.

“Again it was a terrifying experience for some of them, but some embraced it and thought it was fabulous.”

She said there were also many Sutherland employed TRNs who couldn’t wait to get back to the inpatient unit and some Garrawarra people who didn’t want to return for their second rotation.

“We were almost at the point of disbanding the program because we thought, if people are going to be terrified we’re not

“I HAD STAFF WHO CAME TO AGED CARE KICKING AND SCREAMING … AND AFTER SIX MONTHS THEY DIDN’T WANT TO GO ANYWHERE ELSE.” — Bronwyn Arthur

going to push this, we’ll work at a different type of career pathway,” Bronwyn said.

“Then the dynamic changed. Now we have people from the mental health stream who want to work at Garrawarra.We have people from the inpatient unit who want to come to Garrawarra because it’s a specialty and they’re recognising the skills they’re going to learn, especially around BPSD and behaviour management. They want that training.”

Two years after almost giving up on it Bronwyn is delighted to report the program is flourishing.

“It’s a three-year program. So we have the TRN program the first year, then two years of aged care career pathway.”

Bronwyn says only about 10% of nurses currently in aged care chose it as a career

pathway. In fact only about 20% of all nurses think about where they want to be in five years. The rest tend to “meander” through their career.

“When we do orientation with new nurses we talk about the different areas you can go into in nursing and you watch them beginning to get it a little bit – to say ‘oh I didn’t realise.’ Everyone looks at clinical and the other things only become apparent as you spend more time in an area of nursing.

“Sometimes in aged care we wonder if it is a career. I want to say it definitely is and it’s a specialty that’s becoming much more recognised for the depth of skill that’s required to manage the type of people we’re looking after.

“Effectively we have to manage every specialty at the end of life, which has its own unique qualities, and the skills are so different. I spent time in palliative care, but the oncology model for end of life is different to the non-malignant model for end of life.

“Everybody we look after has co-morbidity and so we bring in all the other specialties. In order to do the things we do well we have to be well educated, and have a broad range of knowledge around a lot of different specialities.”

Bronwyn trained at Prince of Wales Hospital and in the 80s and 90s worked for NGOs across the aged care sector. She then returned to the public hospital sector, working in transitional care managing sub-acute aged care patients. She spent five years doing palliative care and relief work with aged care emergency teams.

During her time in the public hospital system she met a nursing career adviser and by 2008 realised she wanted to return to aged care. In 2009 she joined Sutherland Hospital, attracted by the size of the aged care precinct and the fact they also ran a behavioural unit.

She told the audience attending the workshop it had been an extraordinary five years in terms of the opportunities to work with dedicated and passionate multidisciplinary teams.

T H E L A M P J U LY 2 0 1 4 | 2 7

ENVIRONMENTAL HEALTH

Nurses join gas blockade Northern Rivers health workers have been at the forefront of a community mobilisation to defend land and water from dangerous coal seam gas mining.

There were many nurses who wanted to come but had to work. Angie made a lot of ‘absent supporter’ figurines which were displayed at the blockade. photographs: david lowe

NURSES FROM SIX HOSPITALS IN THE Northern Rivers district joined thousands of protestors who successfully blockaded a proposed coal seam gas well at Bentley, near Lismore.

Staff from hospitals at Murwillumbah, Tweed, Lismore, Nimbin, Mullumbimby and Byron Bay held a “Health Carers for a Healthy Environment” day at the blockade, to highlight health risks posed by coal seam gas (CSG) mining.

They were undeterred by a state government decision to send up to 800 police – reportedly to be equipped with helicopters and water cannons – to break up the protest camp and allow the mining company, Metgasco, to enter the site and start drilling. Estimated cost of the planned police operation was $8 million.

However fears of a confrontation turned to joy when the government backed down in the face of mass opposition

and the reluctance of senior police to commit so many officers from around the state to such an unpopular operation.

Instead, the government suspended Metgasco’s exploration licence on the grounds that it had failed to undertake “genuine and effective consultation” with the community.

Metgasco said it would ask the Supreme Court to set aside the government’s decision to suspend drilling. … continued page 30

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“THERE’S NO POINT IN PATCHING PEOPLE UP IF WE ARE CONTAMINATING THEM AT THE VERY SOURCE.” – Angie Gittus, CNS

T H E L A M P J U LY 2 0 1 4 | 2 9

ENVIRONMENTAL HEALTH

Up to 50 health carers came, mostly nurses some wearing NSWNMA scrubs and campaign T-shirts and also a few doctors, paramedics, naturopaths and massage therapists. photographs: david lowe

… from page 28

The Health Carers for a Healthy Environment day was organised by Murwillumbah branch delegate Angie Gittus. She created an open invitation to health care professionals from all disciplines and promoted it via the many anti-CSG Facebook sites.

“I got a really positive response, including from a lot of people I had never met before,” said Angie, a clinical nurse specialist at Murwillumbah Hospital’s emergency department and a lifelong local resident.

“Up to 50 health carers came, mostly nurses wearing NSWNMA scrubs and also a few doctors, paramedics, naturopaths and massage therapists.

“There were many nurses who wanted to come but had to work. For them I made a lot of ‘absent supporter’ figurines which were displayed at the blockade.”

She said about 10 nurses came from Murwillumbah Hospital branch while nurses from Lismore Hospital branch arrived with a NSWNMA flag and banners to fly at the blockade.

“It was a wonderful moment to stand with my colleagues and associates in solidarity with those fighting invasive gas fields.

“It definitely meant a lot to people who had been on the blockade for many weeks to have that physical presence from the 3 0 | T H E L A M P J U LY 2 0 1 4

health professions. Us being there in such a big way lent a legitimacy to the action.”

Locals wanting to defend farmland and the environment set up the protest camp in March, as Metgasco prepared to start drilling.

“The camp grew to the size of a small village,” Angie told The Lamp. “Roads and streets were named. There were people doing traffic control, their first roster shift starting at 3am.”

Angie said the response showed the depth of anti-CSG feeling in the Northern Rivers district.

“It is one of those issues that’s crossed a lot of boundaries: I am pretty left leaning myself but there were a lot of quite conservative people, including senior doctors, at the blockade, who are concerned about the health risks and the loss of good farmland.”

Angie believes nurses in particular should be concerned about CSG mining.

“When we think about health and health promotion and disease prevention, that starts at the environmental level.There’s no point in patching people up if we are contaminating them at the very source.

“The CSG industry is really harmful to unborn babies, to our children, to the people unfortunate enough to be working in it – working with carcinogens, thyro-

toxins and other dangerous chemicals that are also ending up in our water.

“We don’t want to contaminate our water supply and our beautiful soil – we want to have farmland to grow healthy food to support healthy communities.”

Speaking at the protest site Lismore Base Hospital midwife Wendy Bostock described herself as “a local born and bred. This is my backyard and I want to protect it.

“I was fortunate enough to grow up in Lismore district and I’d like to see my grandchildren have the privilege of growing up in a clean environment. CSG is not going to provide us with that.”

Another Lismore nurse, Mary-Anne Hyde said: “My greatest fear is the health repercussions we will see in the future in our local hospitals.We are already struggling in the public health care system.The future of our children, community and health is more important than money.”

Angie said Metgasco’s licence suspension was not a permanent solution:“There’s still much work to be done for the region to be declared gas field free.

“CSG mining is still putting communities at risk right across New South Wales and I encourage nurses who see it happening in their own communities; do what you can to stop it.”

ARE YOU

FRACKING 3500+ 40,O00 KIDDING?

Injection of sand, water and chemicals

ACTIVE COAL SEAM GAS WELLS IN AUSTRALIA

WELLS PLANNED FOR QUEENSLAND

POTENTIAL

RISKS

• Groundwater contamination • Earthquakes

The Fracking Facts Australia has more than 3500 active Coal Seam Gas (CGS) wells, mostly in Queensland and the rest in New South Wales. Up to 40,000 wells are planned for Queensland alone, according to the ABC news online site “Coal Seam Gas by the Numbers”.

CSG is a type of unconventional gas (others include shale gas and tight gas) found in underground coal seams.

CSG is extracted by drilling a well vertically through rock strata until reaching the coal seam. Coal seams contain both water and gas. Water must be pumped out of the coal seam to lower the pressure and allow the gas to flow to the surface.

Hydraulic fracturing, commonly known as fracking, is used to accelerate the flow of CSG. The process involves high-pressured injection of sand, water and chemicals into the CSG well.

Aside from the loss of farmland, many farmers oppose the CSG industry because it is entitled to remove massive amounts of water from groundwater systems. Also fracking may contaminate water sources with toxic chemicals and could potentially cause earthquakes.

Communities throughout Britain and the United States are also fighting the incursion of fracking under their homes and throughout farmlands.

Delegates seek support for Coal Seam Gas fight NSWNMA delegates from around the state have sought union support for communities fighting to prevent coal seam gas mining.

The Association’s Committee of Delegates unanimously supported a motion from Murwillumbah Hospital branch calling on the NSWNMA to give support to nurses and their communities striving to protect their environment from coal seam gas operations.

“We ask that the NSWNMA add their voice to the growing movement condemning the forcing of the unconventional gas industry on communities who are united in their opposition to it,” the delegates said.

They asked that support include the use of NSWNMA flags and banners to fly at protest sites “and any other support the NSWNMA is able to offer.”

“We request this action because we believe that as health care providers we have a responsibility to advocate for the health of the environment and community to ensure the health of current and future citizens.”

T H E L A M P J U LY 2 0 1 4 | 3 1

ENVIRONMENTAL HEALTH

Reframing the climate debate around health US President Barack Obama has recast the debate about climate change by emphasising asthma and other respiratory and cardiovascular diseases rather than the environmental hazards of global warming. barack obama said americans would benefit from his climate change plan each year with an estimated

3700 150,000 180,000 2700 6600 3300 1800 310,000 fewer cases of bronchitis in children

fewer asthma attacks in children

fewer days of school missed to

fewer premature deaths

fewer heart attacks

avoided hospital stays for cardiovascular and respiratory illnesses

fewer lost work days.

3 2 | T H E L A M P J U LY 2 0 1 4

PRESIDENT BARACK OBAMA’S RECENTLY announced climate change plan includes a 30% cut in carbon emissions from coal-fired power stations by 2020.

Coal-fired power plants are the largest single source of carbon emissions that cause climate change. Obama’s emissions cut is the equivalent of removing carbon pollution from about two-thirds of all cars and trucks in the United States.

Obama framed the issue as being about cleaning the air we breathe to protect public health – particularly children, the elderly and people with heart or lung problems.

In Australia, groups calling for action to slow global warming have often built their arguments around the need to avoid global environmental disaster, such as melting ice caps and catastrophic storms and floods.

These arguments appear to have lost momentum: a recent poll found the number of Australians who think global warming is “a serious and pressing problem” has fallen from 68% in 2006 to 45% in 2014.

Prime Minister Tony Abbott has promised to scrap the previous government’s main measure to reduce greenhouse gas emissions, the price on carbon. Abbott once dismissed the whole idea of climate change as “crap”.

The Obama administration is stressing that the pollutants causing global warming are also having more immediate impacts on the air we breathe and our public health.

The Australian group Doctors for the Environment described Obama’s initiative as “one of the most important health statements ever made by a leader. It will save thousands of lives and much suffering.”

“Obama’s decision recognises the health and new economic reality of coal mining and combustion; that safer and cheaper alternatives exist,” the group said.

“Mining of coal produces dust and unseen particulates which are inhaled by those living in surrounding communities and near to coal corridors. Combustion of coal produces a cocktail of toxic gases, including sulphur dioxide and Volatile Organic Compounds, as well as particulates, the smallest (PM2.5) being inhaled and absorbed into the human body.”

Doctors for the Environment say particulate pollution exposure is linked to increased respiratory symptoms, decreased lung function, worsening of asthma, irregular heartbeat and increased risk of heart disease, lung cancer, stroke and premature death.

Nursing our climate back to health There’s bad news – a frightening amount of it —and good news on climate change and health.

SPEAKING AT A RECENT NSWNMA seminar on environmental health, Fiona Armstrong a registered nurse working in the area of climate and health policy, detailed the latest findings from the 2014 DARA climate vulnerability report Guide to the Cold Calculus of a Hot Planet.

Using 2010 data from the World Bank and global aid organisations DARA reported: • 400,000 deaths a year, mainly in children, mainly due to hunger and communicable diseases aggravated by climate change and mainly in developing countries.

• 4.5 million deaths worldwide from air pollution.

• $1.2 trillion dollars in annual losses to the global economy resulting from climate change and the carbon economy. That’s 1.6% of world GDP. The world is now one degree hotter above pre-industrial temperatures and, without effective action on climate change, global temperatures are predicted to reach seven degrees above pre-industrial levels this century.

“For people with chronic illnesses such as heart disease, diabetes, multiple sclerosis, people who are overweight, people who work outdoors, those working in hot environments, the elderly and infants and people taking illicit drugs, one degree can

be disastrous to their health,” said Fiona, who is founder of the Melbourne-based Climate and Health Alliance.

“Assorted diseases, disorders, distress and deaths will occur at much higher rates at the four degrees edge of the spectrum.And warming will not end there; we’ll be moving further into the unknown with potentially very damaging changes in social and environmental conditions.”

STOP REINVENTING THE WHEEL The good news is that the health sector is bringing the irrefutable health impacts of climate change to the attention of policy makers around the world.

The global organisation Health Care Without Harm (https://noharm.org), a partner of the Climate and Health Alliance, believes the health sector can lead the transition to low-carbon economies. Its custom-built computer platform allows people in the health care community to talk to each other about sustainability.

“You can join communities of people working on similar goals, ask questions of a network of experts, ask how to go about things and share your progress. It’s an opportunity to accelerate our collective pathway to sustainable healthcare and stop people having to re-invent the wheel,” Fiona said.

“At a time where it’s easy to feel demoralised about the lack of political leadership it’s important to remember what we can accomplish as civil society.

“I sometimes think that in addition to pressuring our politicians into doing things we need to think about what we can do without and despite them.There’s a lot we can accomplish.”

“WE’LL BE MOVING FURTHER INTO THE UNKNOWN WITH POTENTIALLY VERY DAMAGING CHANGES IN SOCIAL AND ENVIRONMENTAL CONDITIONS.” – Fiona Armstrong DARA (http://daraint.org) is an independent non-profit organisation committed to improving the quality and effectiveness of humanitarian action for vulnerable populations affected by armed conflict and natural disasters.

T H E L A M P J U LY 2 0 1 4 | 3 3

ON PO ET RY CO MP ET ITI SH OR T ST OR Y AN D

rses’ wives’ and International Nu

Mid t nurse Y. We celebrated International ition. Arch Sirodom, a studen THE WINNING ENTRral pet Com try Poe & ry Short Sto rt story

te Super— with his sho Days 2014 with our inaugu t prize — thanks to First Sta firs 00 $20 the d for “Those Were ime cla , am from Lewish e Ambulance”, Mary Perry “Th for rth Wu ine her Kat e wer “Her Smile”. Other winners Blom for “Serendipity”.

Choice Award went to Ariane s’ der Rea the and ys” Da the

HER SMILE

BY ARCH SIRODOM

It was her smile.

I will always remember it.

Her teeth weren’t perfect, but they didn’t need to be. When she smiled, her eyes laughed, challenging the world to try and bring her down. Her smile revealed her positivity. Her strength.

A power unique and untouchable captured in one simple gesture.

It was my final year and I was on my last clinical placement. She came into the ward from the Emergency Department, a brief handover to prepare her for theatre. I didn’t understand – or I don’t remember – exactly why she was presented to Emergency, but it was already five o’clock in the afternoon and she was being readied for surgery, so it must have been a threat that required immediate intervention. I thought to myself: surely she understands the seriousness of the situation. Surely the doctors have advised her. But still she continued to smile.

To be honest, I can’t even recall her name. I’m sure she introduced herself to me, or I heard it during the handover, but so captured was I in her positivity that I must have forgotten shortly after.

It was another busy shift on the ward. The nursing staff was stretched thin and there was always more work that needed seeing to. After the hand over was completed, the RN I was paired with had to move on to other patients and duties while I continued to prep her for theatre.

“Where are you from?” She asked cheerfully.

I started; I had been in the process of helping her take off her necklace and hadn’t expected her to initiate discussion so readily. No doubt she had noticed my accent.

“California.” I replied, cursing myself for not being proactive enough to start the conversation on my own.

“I’d love to go to California.” She said wistfully, staring off into the distance.

“You should. It’s such a beautiful place.”

She smiled again and something deep inside of me somersaulted. Why did such a routine conversation, one I had had with countless patients before her, hold so much weight within me.

“How long have you been a nurse?” She asked while I helped her into her gown.

“This is actually my last year of study.” I confided, proud to share my achievement with her.

“Nearly there.”

“Congratulations. I’m sure you’ll do well.”

I smiled back at her. She was ready for theatre now and I was unsure what else to say.

“Take care.” I finally said, lamely. But she smiled, nonetheless, and laid down to wait for her surgery.

I quickly moved on to help my RN with her other patients, all the while thinking to myself about her positivity; her bright, bubbly and upbeat nature. My brief time with her, in the midst of the busy day, had been a moment of joy and relief. She was so unlike any of the other patients I had ever prepped for surgery. She didn’t look like she had pain, didn’t even seem uncomfortable. In fact, much to the contrary, she seemed quite content.

But it was a busy ward, and there were more patients to attend to.

It was only a mere ten minutes after I had spoken to her last; I walked past her bed and noticed her tears.

3 4 | T H E L A M P J U LY 2 0 1 4

Her smile, so brilliant, had suddenly been replaced by a fear so real and tangible I could feel it in myself. Still, she was fighting it. Fighting and struggling with everything she had. But the tears continued to shine on her skin. She stared blankly up at the ceiling, her forlornness as beautifully terrifying as her smile had been uplifting.

I froze, my previous tasks forgotten in the blink of tear stained eyes. I was confused. For the first time, I looked around the room and noticed that every other patient was surrounded by family, friends and well wishers except her. Where was her family? Her children? Her husband? Did they exist? I had never asked her and she had never made mention of anything along those lines.

Unable to stand frozen any longer, I abandoned my long forgotten responsibilities to return to her bedside.

“Are you ok?” I timidly asked, immediately regretting the coarseness and insensitivity of the question. She jumped; no doubt so overwhelmed in her emotions she had not noticed my approach.

“I’m ok.” She lied, turning her head to spare me the sight of her tears.

I continued to stand by her bedside, awkward and unsure of how to proceed. The seconds stretched out for eternities while I frantically tried to come up with a response; some magic remedy to alleviate her of the distress she was denying existed. But I had nothing. No classroom had fully prepared me for the confronting reality of this situation. A seemingly endless river of good wishes, pure in intention but lacking of any substance, raced through my head and were immediately discarded, and still she lay with tears she couldn’t resist filling her hazel eyes.

Suddenly, in a flash across my mind, I recalled my first nursing facilitator responding to a similar situation. She had shown that human touch could exhibit a care that words could not. Touch would go deeper, where words, well meaning but ultimately useless, would only scratch the surface.

With no more hesitation, I reached out and grabbed her hand, squeezing hers in mine. I didn’t say anything, and neither did she. Words were suddenly useless, a fleeting meaningless entity.

The touch of our hands was genuine in a way that words could never be. She looked at me and I smiled, and, chasing away the tears, she returned the smile back. In that moment I felt a connection with the patient I had never experienced before, an affection that no one outside of the nursing world will ever understand or grasp.

The wardsman arrived and along with the RN, we escorted her to theatre. It was a long, quiet silence, but no longer awkward or gloomy. After handover to the anesthetic nurse, I turned to her and simply wished her all the best. She turned back to me and smiled before they wheeled her away.

Her smile was the last I ever saw of her. It wasn’t the smile of a defeated woman. It was her old smile, the smile I had first seen. It was the smile of a strong woman ready to face her journey.

I will never know what it actually was that made her breakdown and silently weep at the ceiling. Was she alone, missing her family and wishing she had them nearby? Or simply was it the fear of the unknown, the fear of the surgery? Sometimes I worry that I am just a student nurse, green and naïve, walking into a world of smiles and tears, fear and joy, life and death.

How do I find all the clues to figure out exactly what a patient is feeling? Sometimes, I don’t know what to say. What are the right questions? I stumble and struggle to find a way to prove to patients that I am there for them, that I care about them in ways that they might never understand or appreciate. I can’t answer all of the questions, but I can help them know that they are not alone in their fight or their journey.

I will never know exactly what she felt from my hand, but I know that in that moment, it was appreciated. My shift ended not long after walking her to theatre and I never saw her again.

But there was a connection, a deep intimacy that will linger on in my memory throughout the rest of my career. In that brief moment I was her family, her support and her rock – and in a strange way, she was mine. That moment is why I am a nurse, and why there is no other career that could suit me so perfectly.

I hope she never forgets me, because I will always remember her. And her smile.

Find more stories at www.nswnma.asn.au/nswnmamembers/short-stories-and-poems-2014/

T H E L A M P J U LY 2 0 1 4 | 3 5

NURSES AND MIDWIVES: IT’S IMPORT MPORT TA ANT TO NOTE

You Y o ou mus mustt be a

FINANCIAL MEMBER

of the NS NSW W Nurses and Midwives’ Midwives’ Association Association o: tto o ensur ensure e your your entitlement tto: » All Association Association servic services es ccident Journe y Insur ance »A Accident Journey Insurance Professional Indemnity » Professional Insur ance.

Insurance.

All these services are only available to members who are financial members. Make sure your membership remains financial by switching from payroll deductions to Direct Debit.

IT’S EASY! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural).

Download, complete and return your Direct Debit form to the Association.

SOCIAL MEDIA

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

Do you have a story to tell? An opinion to share? nurse uncut is written by everyday nurses and midwives.

Send us your ideas at nurseuncut@nswnma.asn.au

WHAT’S

HOT THIS MONTH

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

Securing a grad nursing position www.nurseuncut.com.au/securing-a-grad-nursing-position

2012 graduate Laurie Bickhoff gives some tips for getting a new grad position in a tight jobs market.

Health workers at the Bentley “fracking” Blockade www.nurseuncut.com.au/health-workers-at-the-bentley-fracking-blockade

Northern Rivers health workers stood up as carers for a healthy environment in a protest against coal seam gas extraction.

Every nursing home has an RN – but for how much longer? www.nurseuncut.com.au/every-nursing-home-has-an-rn-but-for-how-much-longer

Changes to state law could remove the requirement for RNs in nursing homes.

Debbie Lang asks all nurses to contact their MP.

Finn’s new grad diary part 3 – confused, frustrated, in therapy! www.nurseuncut.com.au/confused-frustrated-in-therapy-finns-new-grad-diary-3

In the third instalment of her new grad diary Finn has to deal with the confused elderly and an adamant colleague.

A post-Budget letter of appreciation www.nurseuncut.com.au/a-post-budget-letter-of-appreciation

David Gallan’s father died a few hours after the federal budget was delivered. David wrote a letter of appreciation to the public health nurses who cared for his father so well.

Unemployment and the 457 visa www.nurseuncut.com.au/new-grad-unemployment-and-the-457-visa

The use of temporary 457 visa nurses has increased at the same time as nursing graduate unemployment is rising.

New on SupportNurses YouTube channel we’re proud nurses and midwives — hear us ROOOAAAAARRR! > youtu.be/x9PU988mVgs kerry rodgers RN After appearing on ABCTV’s Q+A, Kerry Rodgers talks more about Medicare and Hockey. > youtu.be/9dwA9uMzDVA

NSWNMA on Instagram!

Yes, we’re on Instagram, so share your local photos with us @nswnma and #NSWNMAforce4change.

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 Look for your local Ratios put patient safety first >> www.facebook.com/safepatientcare Branch page on Aged Care Nurses >> www.facebook.com/agedcarenurses our website.

T H E L A M P J U LY 2 0 1 4 | 3 7

It’s time

to scrub up for 2014!

To orderr, fax the order form to Glen Gintyy, (02) 9662 1414, post to: NSWNMA, 50 O’Dea Avenue, venu v Waterloo NSW 2017 or email gensec@nswnma.asn.au

Order your NSWNMA campaign scrub unifor uniforms ms for conference and rally times, and make an impression!

Merchandise order forms also available on

www.nswnma.asn.au www.nswnma.asn.au

SCRUB UB P PANTS ANTS A

SCRUB TOP

ORDER FORM Size (cm)

XS

S

M

L

XL

2XL

3XL

4XL

Half Chest Circumference

53

56

59

62

66

69

73

77

Half Hem Circumference

54

57

60

63

67

70

74

78

General Guide for Female

8/10

10/12

12/14

14/16

16/18

18/20

20/22

22/24

Half Waist (Relaxed)

29

33

37

40.5

43.5

46.5

50.5

54.5

Half Waist (Stretched)

47

51

55

58.5

61.5

64.5

68.5

72.5

Half Hip

55

59

63

66

69

72

76

80

Out Seam Length

103

105

107

109

111

112

113

114

NSWNMA Scrub top $20.

Quantity: Size: XS S M L XL 2XL 3XL 4XL NSWNMA Scrub pant $20.

Quantity: Size: XS S M L XL 2XL 3XL 4XL To otal cost of order ord $ Please include postage and handling of $5 per order.

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NURSES & MIDWIVES

SAID & LIKED on facebook www.facebook.com/nswnma Q&A Kerry Rodgers’ question to Joe Hockey on ABCTV’s Q+A program, about the impact of his budget on Medicare, inspired an outpouring of congratulations and support.

Fruit picking

After the Budget opened the way for huge increases in university fees and debt, as well as taking unemployment benefits away from people in their 20s, employment minister Eric Abetz suggested that young people move to Tasmania to pick fruit.

Go Kerry! Thank you for being so informed, articulate and gutsy. You are there on the front line and you know what you’re talking about. Thank you for standing up for people who are unable to stand up for themselves. // Today it’s $7; tomorrow it will be $14 and so on. It’s the start of the erosion. // I hope these fighter jets can perform surgery and CPR and inform families they have lost their loved ones. // When you earn $350,000 plus a year, you tend to think that $7 isn’t very much. // My housemates were very impressed with Kerry – such a commanding speaker! // What is to become of our overcrowded ED departments. I can see nothing but crowded waiting rooms, angry public, staff run off their feet, confrontations, all leading to inefficient health care. // I gave a standing ovation in my lounge room. // You didn’t allow him to patronise or bully you. Your point is 100% correct. Thanks from all of us.

Good to see an intelligent nurse challenging an arrogant politician. And shame on the federal treasurer for giving a total non-answer. // This government doesn’t seem to understand that for those with complex and/or chronic diseases, presenting to their GP on a regular basis helps keep them out of the hospital system, saving huge amounts of money.

You highlighted the truth – we have a great healthcare system that we need to maintain properly. Selling out to private health will only see us going down the American path of expensive, inequitable and unattainable health care.

As a homecare worker, we will find more and more clients sick at home because they can’t afford to go to the doctor, hence, as our duty of care, we ring an ambulance; more resources wasted that could have been avoided. // Good on Kerry, showing exactly what nurse fundamentals are all about – patient advocacy.

Same agenda here in Canada. It feels like wolves at the door, salivating over the thought of breaking apart our system and rebuilding it around profits. Preserve your farmland, your healthy food and water and your healthcare. It is paramount.

Beautifully spoken and stated Kerry. Hats off to you!

Great to see what three years at uni and a HECS debt will get our new grads – a fruit picking job! // On the bright side, they’d never make enough to pay back their HECs debt.

I can’t get a new grad job and it’s so frustrating. // I’m not picking fruit. No way.

I was lucky to get a new grad job and complete it in January, but finding a job since has been crazy hard. Nearly 24 formal applications, several other “informal” applications and only one interview for casual work.

You mean Tasmania where there are 19,000 unemployed youth and only 500 jobs across all sources advertised each week? // These fools are frightening. Lobby your local members to stop allowing 457 visas for health care positions.

Better than that, our uni told us to go to WA and work in the mines.

Oh great. Because that’s just where we want our nurses. // And put all the backpackers out of work.

Why go and study for three years and have HECs to pay, only to be pushed by the government to pick fruit. Wonder what will come next under this government?

PHOTO GALLERY

Disability nurse Tahnee Rolph won a special commendation award from Hunter Health.

Nurses at Greenwich Hospital are fighting to keep several public rehab beds.

Members at New Horizons aged care facility at Ryde enjoy a branch barbecue.

Manly Hospital members don’t want their new Northern Beaches hospital to be privatised!

T H E L A M P J U LY 2 0 1 4 | 3 9

FULL-TIME, PART-TIME AND CASUAL POSITIONS AVAILABLE WOLPER JEWISH HOSPITAL is a private, 54 bed hospital situated in Woollahra, comprising a 32 bed Rehabilitation Ward and a 22 bed Medical/Palliative Care Ward. We currently have Full-time, Part-time and Casual positions available for RN’s and EEN’s on these wards.

To apply for nursing positions on the Rehabilitation Ward please email your CV to: JodieDominey@wolper.com.au To apply for nursing positions on the Medical/Palliative Care Ward please email your CV to: AndrewDriehuis@wolper.com.au

Intelligence Officers $68,568 to $87,300 (plus super) Canberra ASIO is looking for talented people to fill a number of critical roles in the collection and analysis of intelligence. As an Intelligence Officer you will identify and investigate patterns and anomalies, solve complex problems and produce high-quality advice for government.

You need to possess highly developed analytical and research skills, a keen intellect, flexibility and commitment. Applicants with qualifications across a range of disciplines, in particular international relations, law, science and counter-terrorism, or applicants with significant work experience across a range of industries will be highly regarded.

To apply for any of these positions you must be an Australian Citizen or Permanent Resident, or be able to independently and legally live and work in Australia.

For more information please go to: www.immi.gov.au

Keep up your CPD

Applicants must be Australian citizens and willing to undergo an extensive security vetting process.

Apply online

www.asio.gov.au

Opening date:

3rd July 2014

Quality legal advice for NSWNMA members c c c c c c c c c

Compensation and negligence claims Employment and Industrial Law Workplace Health and Safety Anti-Discrimination Criminal Law Free standard Wills for members Probate / Estates Public Notary Discounted rates for members including First Free Consultations for members on all matters.

Offices in Sydney and Newcastle with visiting offices in regional areas (by appointment).

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

4 0 | T H E L A M P J U LY 2 0 1 4

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

1300 366 044 www.adepttraining.com.au

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Across 1. Excess of cystathionine in the urine (16) 9. A salt resulting from the neutralisation of one of tartaric acid’s two acid groups (10) 12. Perceptible by the external senses (9) 13. A weak oestrogenic hormone secreted by the mammalian ovary (8) 14. Several straight muscles (5) 15. Alpha-fetoprotein (1.1.1) 16. Pit, stone (8) 17. An athletic supporter (9) 20. A tubular passage (4) 22. Perception by means other than through the ordinary senses, as in telepathy (1.1.1) 23. Being connected (7.2) 24. Motionless (8)

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26. Having the necessary power or resources (4) 28. Saliva (4) 29. Chronic inability to sleep (8) 30. Having resistance to infection by a specific pathogen (6) 32. Shin bone (5) 34. Dense networks of neurons and glia in the central nervous system (9) 35. Awakes (6) Down 1. A method of preserving tissues and organs in a viable state at extremely low temperatures (16) 2. Participants, people, animals, or events

selected for a study (8) 3. A type of exocrine secretion where lipid-rich droplets are enveloped by the apical plasma membrane (8) 4. Natural environments where an organism can live and grow (8) 5. Inflammation of a bone and its periosteum (16) 6. The egg of a louse (3) 7. To restore to life; resuscitate (9) 8. A circular pigmented area surrounding the nipple (6.10)

10. Intravenous (1.1) 11. A remainder; that remaining after removal of other substances (7) 18. One of the aspects or stages (5) 19. The deep, dreamless period of sleep (1.1.1.1.5) 21. Of sound mind; sane (8) 25. Any malignant, cellular tumor (6) 27. Lymphocytic choriomeningitis (1.1.1) 31. Urea reduction ratio (1.1.1) 32. Thallium (1.1) 33. Intraarterial (1.1)

T H E L A M P J U LY 2 0 1 4 | 4 1

EDUCATION@NSWNMA

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WHATâ&#x20AC;&#x2122;S ON JULY 2014 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Appropriate Workplace Behaviour â&#x20AC;&#x201C; 1 day

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9 July Albury 13 August Port Macquarie Topics include why bullying occurs; anti-discrimination law and NSW Health policies; appropriate behaviour in the workplace; what to do if subjected to unlawful harassment and bullying.

Members $85 Non-members $170 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Are you meeting your CPD requirements? â&#x20AC;&#x201C; ½ day 10 July Albury 14 August Port Macquarie 10 September Batemans Bay Suitable for all nurses and midwives to learn about CPD requirements.

Members $40 Non-members $85 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Legal and Professional Issues for Nurses and Midwives â&#x20AC;&#x201C; ½ day

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11 July Albury 15 August Port Macquarie 11 September Batemans Bay Topics include Health Practitioner Regulation National Law, potential liability, the importance of documentation, the role of disciplinary tribunals and writing statements.

Members $40 Non-members $85 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Mental Health and Drug and Alcohol Nurses Forum â&#x20AC;&#x201C; 1 day 18 July NSWNMA, Waterloo

Members $30 Non-members $50 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Stress and Burnout â&#x20AC;&#x201C; 1 day

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30 July Gymea

Members $85 Non-members $170 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Computer Essentials for Nurses and Midwives â&#x20AC;&#x201C; 1 day 6 August Prince of Wales Hospital, Randwick

Members $85 Non-members $170 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Basic Foot Care for Nurses â&#x20AC;&#x201C; 2 days 20 & 21 August Newcastle

Members $203 Non-members $350 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Enrolled Nurses Forum â&#x20AC;&#x201C; 1 day 22 August NSWNMA, Waterloo

Members $30 Non-members $50 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D;

Aged Care Seminar Series â&#x20AC;&#x201C; 1 day 28 August Batemans Bay

Members $75 Non-members $170 â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; â&#x20AC;˘ â&#x20AC;&#x201D;â&#x20AC;&#x201D;â&#x20AC;&#x201D; To register or for more information go to

www.nswnma.asn.au/education or phone Matt West on 1300 367 962

NURSING RESEARCH ONLINE

The Conversation (theconversation.edu.au) is an online Australian publication that combines journalism and academia to provide readers with a level of analysis rarely available in the mainstream media. It is an excellent free resource for anyone wishing to learn more about the issues of the day, including health.

Increasing inequality brings high social cost: report Michelle Grattan, 11 June 2014 The land of the fair go is disappearing, argues former Liberal leader John Hewson, on the release of a new report on wealth inequality. The report warns inequality is increasing rapidly in Australia, posing dangers to community well being, health, social stability, sustainable growth and long-term prosperity.

Entitled Advance Australia Fair? the report finds that in the wake of a declining resources boom “there is a growing gulf between those in the top range and those in the lower ranges of wealth and income distributions”.

The wealthiest 20% of households now account for 61% of total household net worth, while the poorest 20% account for only 1%.

“In recent decades the income share of the top 1% has doubled, and the wealth share of the top 0.001% has more than tripled. At the same time, poverty is increasing and many of those dependent upon government benefits, including the unemployment benefit, have fallen well below the poverty line,” according to the report.

A fiscal crisis? It’s about political priorities and neglected choices Ben Spies-Butcher, Macquarie University, 5 May 2014 It seems every few years our governments tell us that we are in such dire financial straits that we need to suffer cuts to services and payments. Such warnings inevitably come with even more drastic tales of woe for the future – usually based on the impact of an ageing population. The problem is, the evidence to support these claims is weak and points to alternative (often opposing) policy solutions.

The latest round of this gloomy budgetary talk comes from federal treasurer Joe Hockey and the government’s Commission of Audit. Already, Hockey has confirmed that the pension age will rise to 70 by 2035, affecting all Australians under the age of 50.

As with Labor’s previous changes to the pension, and other reforms introduced by the Howard government, these changes are justified by Australia’s ageing population. This is a story dating back to the 1980s and 1990s internationally and continued by a series of Intergenerational Reports produced by the Australian Treasury.

Yet most of the evidence simply doesn’t show the crisis that is being claimed in the lead-up to the May 13 budget. Australia’s pension system is very efficient by world standards. It costs less than almost any other.

Our main challenge has been aged poverty. This is why Australia recently increased the pension. What’s more, existing moves to raise the pension age are one of the main drivers of increased numbers of disability support payments. This is not surprising given disability is linked to age. So, for many, this change will simply move them onto more miserly payments and force them to look for jobs they are unlikely to get. https://theconversation.com/a-fiscal-crisis-its-about-political-prioritiesand-neglected-choices-25859

https://theconversation.com/increasing-inequality-brings-high-social-costreport-27867

Federal-state health relations: can anything be salvaged?

Stephen Duckett, 6 June 2014 Maybe there is a parallel universe where the Commonwealth and states work in harmony to improve the health and health care of Australians. But that is a vision unlikely to be realised in Australia for years to come, after the 2014 federal budget took a wrecking ball to trust in Commonwealth-state relations.

Instead, the blame game is back, and the states can now blame Commonwealth cuts for service shortfalls. But what if we could start again and redesign Australia’s system for delivering health care?

Ask clinicians and they will give you a litany of Commonwealth-state disjunctions that they see in day-to-day practice. Their panacea is often that a single level of government should be responsible for the whole health care system. That is usually the Commonwealth because of its access to more secure revenue growth. The benefits of state responsibility in terms of potential for innovation and local political accountability are forgotten.

Doctors often want the Commonwealth to take over responsibility for health care, because they see how tight state budgets are. These budgets are a victim of the federation’s endemic problem of vertical fiscal imbalance.

Transferring responsibility to the Commonwealth would better align revenue and expenses. The states opposed a greater Commonwealth role when the Rudd government suggested it. The Abbott government, however, is pursuing the reverse direction.

So the chances of the single government option occurring in Australia are slim. A continuation of the current dual responsibility is inevitable.

How, then, can it work better? https://theconversation.com/federal-state-health-relations-can-anythingbe-salvaged-27259

T H E L A M P J U LY 2 0 1 4 | 4 3

Nursing and Midwifery Superguide – now available The essential resource for THE SUPERG

guide The Superinuum for

ONTIN CON NC ON ISIO ERVISI ERV UIDE: A SUP

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Order Order online no now w www.heti.nsw.gov.au/nmsuperguideorder www.heti.nsw.gov.au/nmsuperguideorder ETTII HE HET

*this resource is available free for email download to all NSW Health employees

The Edith Cavell Trust

Scholarships for the academic year 2015 Applications for the Edith Cavell Trust Scholarships are now being accepted for 2015. Members or Associate Members of the NSW Nurses and Midwives’ Association or the Australian Nursing and Midwifery Federation (NSW Branch) are invited to apply.

Applicants should meet one of the following criteria: 1. Student nurses undertaking full-time courses leading to initial registration as a nurse or midwife.

2. Registered or enrolled nurses who wish to attend:

an accredited clinical nursing education course of six months or less, either full-time or part-time; an accredited nursing conference or seminar relevant to applicant’s clinical practice.

3. Properly constituted nursing organisations, faculties or schools of nursing or registered or enrolled nurses wishing to: attend full-time, relevant postbasic studies at an approved institution for a period or periods of more than six months;

undertake an academically approved research program in the theory and practice of nursing work; conduct or fund a relevant professional or clinical nursing educational program.

Applicants must be currently

registered with the Nurses and Midwives Board of Australia.

Applicants must use the official Edith Cavell Trust application form. Details of the Edith Cavell Trust Rules are available on request and will also be supplied with the application form.

For further information or forms, contact: The Secretary – The Edith Cavell Trust 50 O’Dea Ave, Waterloo, NSW 2017 T Mrs Glen Ginty on 1300 367 962 E gginty@nswnma.asn.au W www.nswnma.asn.au – click on ‘Education’

Applications close 5pm on 31 July 2014

BOOKS

BOOK ME

NEW!

Rural Public Health: Best Practices and Preventative Models Jacob Warren and K. Bryant Smalley Springer Publishing Company (available from Footprint Books) www.footprint.com.au RRP $82 ISBN 9780826108944 This book presents up-to-date research into specific diseases and disorders faced by rural populations in the United States, service delivery challenges and promising community health approaches and preventative measures. Chapters cover public health workforce issues in rural areas; ethics; integrated care and mental health; environmental and occupational hazards; minorities; migrants and the impact of ageing, with a focus on best-practice recommendations and evidence-based prevention programs.

Theories for Mental Health Nursing: A Guide for Practice Theo Stickley and Nicola Wright SAGE Publications (available from Footprint Books) www.footprint.com.au RRP $79 ISBN 9781446257401 (paperback) This book provides a summary of the key theories that shape and define mental health policy and practice. Topics include psychodynamics; cognitive behavioural therapy; compassion; mindfulness; recovery; public mental health; stress vulnerability and psychosis; solution-focused nursing and theoretical approaches to gaining and maintaining employment in mental health. Each chapter includes a detailed case study and an explanation of the advantages and disadvantages inherent in each approach. Although primarily aimed at students of mental health nursing it will also be of interest to qualified nurses seeking to expand their critical understanding of common approaches and practices in mental health.

Clinical Examination: A Systematic Guide to Physical Diagnosis (7th ed) Nicholas Talley and Simon O’Connor Elsevier Australia www.elsevierhealth.com.au RRP $127.23 ISBN 9780729541473 This new edition is fully updated with the latest clinical data, including specially commissioned research addressing the core principles and clinical skills that underpin diagnosis for safe, effective medical practice. Over 40 chapters in 10 sections address the body system using a logical framework, focusing on the history, clinical examination and correlation between physical signs and disease for each system. Appendices cover writing and presenting the history and physical examination, methods for rapid screening, and the preanaesthetic medical evaluation.

The NSWNMA Library Catalogue is now online!

Visit www.nswnma.asn.au/library-services-online-library-catalogue/ for the link to open the catalogue, plus instructions on how to use it. Once you have searched by keyword or browsed the subject areas available, you can send loan requests directly to the Library via a quick online form.

Many online resources can be accessed directly through web links included in the catalogue listing.

SPECIAL INTEREST A Super History: How Australia’s $1 trillion+ Superannuation Industry was Made Christine St Anne Major Street Publishing majorstreet.com.au RRP $39.95 ISBN 9780987084941

This book begins with the union struggle for superannuation, then follows the political struggle to legislate for compulsory superannuation and the phenomenal growth of the industry, in particular the industry funds. It discusses superannuation pioneers such as Paul Keating and Bill Kelty and puts Australia’s superannuation system, which is credited with protecting the country from greater fall-out from the global financial crisis, into an international context. Written by a Sydney financial journalist, with a foreword by Paul Clitheroe, this book draws on numerous interviews and has an engaging, anecdotal style. A must-read for anyone seeking a better understanding of why super exists, or questioning whether it has been a good thing for all Australians.

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 Information and Records Management Centre (IRMC). Contact Jeannette Bromfield gensec@nswnma.asn.au or Cathy Matias 8595 2121 cmatias@nswnma.asn.au. All reviews by NSWNMA IRMC Coordinator/Librarian Jeannette Bromfield.

Some books are reviewed using information supplied and have not been independently reviewed.

T H E L A M P J U LY 2 0 1 4 | 4 5

MOVIES

movies of the month The crux of this warm movie is a simple mistake in the delivery of a lunchbox, writes Murray James.

METROMEMBERGIVEAWAY Email The Lamp by the 5th of the month to be in the draw to win a double pass to The Lunchbox thanks to Madman Emtertainment. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!

4 6 | T H E L A M P J U LY 2 0 1 4

In Mumbai, India, deliverymen with great ingenuity cross the clogged city every morning to deliver hot meals from housewives to husbands working in offices. The lunchbox delivery service has a long honourable history and mistakes are rare.

Ila (Nimrat Kaur) decides to spice up her marriage by cooking a recipe with aphrodisiac ingredients to get her neglectful husband’s attention. But instead of it being delivered to his workplace office, the lunchbox is delivered to another office worker, Saajan (Irrfan Khan), a lonely man recovering from his wife’s death.

Curious about her husband’s lack of response Ila places a note in the next day’s lunchbox, which again is received by Saajan. What follows is a series of lunchbox notes between the two strangers and a friendship is forged as they share their concerns, loneliness, hopes and plans for the future. In so doing they discover a new side of themselves through this virtual relationship and this in turn opens them up to change and new possibilities.

Mumbai is India’s most populous city, with 18 million inhabitants, and provides a chaotic backdrop of congested streets and overcrowded trains and vehicles.

People seem to be imprisoned in their apartment and office blocks and the central characters in the film seem boxed in, as if they are on conveyer belts of mundane expectation of modernity.

The Lunchbox presents a fascinating kaleidoscope of Indian culture, with its colourful traditions, religion and class. The traditional lunchbox deliverymen, for example, known as the Dabbawallahs, some 5000 in number, are a hereditary group that has performed this service for more than 120 years.

The billing of this non-Bollywood film by its promoters as a romantic comedy does not do the story justice.

Rather it is a light drama that raises thoughtful themes about the changing face of modern India, sensitively evoked by director Ritesh Batra in his first major film.

The issues in this movie were reflected in recent Indian general election results with an age-old ruling party defeated by a new party promising economic reform and a freeing up of stifling bureaucracy.

Both Ila and Shaikh, a young colleague of Ila’s husband, represent in this film the yearning of a younger, aspirational generation, desperately wanting these changes. One hopes that some of this may be fulfilled in the continuing story of the world’s largest democracy.

Murray James is an RN in the Mood Disorders Unit at St John of God Health Services, Burwood.

IN CINEMAS JULY 10

DVD SPECIAL OFFER

METRO MEMBER GIVEAWAY Email The Lamp by the 12th of the month to be in the draw to win a double pass to The Keeper Of Lost Causes thanks to Madman Entertainment. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!

Revenge is said to be a dish best served cold, and it doesn’t get colder, or more bitter, than winter in Denmark, writes Sue Miles.

A difficult Danish detective reopens the case of a female politician who allegedly committed suicide. Directed by Mikkel Nørgaard (of the brilliant SBSTV Borgen series) this adaptation of the book by Jussi Adler-Olsen has been scripted by Dragon Tattoo screenwriter Nikolaj Arcel and has much to be applauded. On these facts alone the film is highly viewable.

The hero of the story, Inspector Carl Mørck (Nikolaj Lie Kaas) was shot in the line of duty and on his return to work finds he has been reclassified to the newly created Department Q. Mørck is told to classify 20 years of cold cases with just one assistant, Assad (Lebanese-born Swedish actor Fares Fares). This mismatched pair finds themselves in the police station

basement, the advantage for them being that they are out of sight of Jacobson, Carl’s boss, who has made it clear he is punishing Carl after a colleague was injured and another killed in a previous shooting.

Their first case involves Merete, a successful politician who five years earlier allegedly jumped from a ferry, leaving her mentally disabled younger brother behind.

The film continues with two parallel narratives, in the first Mørck and Assad hunt for clues, in the second Merete’s true ordeal is revealed.

The cinematography is magnificent and the story rushes headlong from start to end. The audience will be on the edge of their seat to the very end.

An excellent film that I would recommend to anyone prepared to view an edgy crime story but a warning; don’t go with a toothache.

Sue Miles is a Mental Health Nurse at the RPA IN CINEMAS JULY 31

The BAFTA-winning drama about romance and second chances Last Tango in Halifax returns for a second series with yet more secrets and surprises.

Following his heart attack scare, reunited childhood sweethearts Alan and Celia are determined to live life to the full.

However as they begin to move on and enjoy the next stages of their relationship, it becomes clear the rest of their family isn’t as content with their own lives.

Gillian finds herself spiralling into a dark place as old skeletons resurface, while Caroline’s fractious relationship with estranged husband John leads her to make bold decisions about her future with new partner Kate. Meanwhile, Caroline’s teenage son Lawrence struggles to accept his mother’s choice of partner, and Gillian’s son Raff breaks some news that will change his life forever.

As secrets from the past come tumbling out and family members adjust to changing relationships, can Alan and Celia find the long-awaited happiness they deserve?

RURAL MEMBER GIVEAWAY Email The Lamp by the 15th of this month to be in the draw to win a dvd of Last Tango In Halifax thanks to Roadshow Entertainment. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!

T H E L A M P J U LY 2 0 1 4 | 4 7

MOVIES

movies of the month

Australian actor David Gulpilil was awarded Best Actor in the Un Certain Regard section of the prestigious Cannes Film Festival for his role in the film Charlie’s Country.

It is the third collaboration between Gulpilil and director Rolf de Heer, forming a loose trilogy with Ten Canoes, the first film to be shot entirely in Aboriginal language, and The Tracker.

Gulpilil plays Charlie, an ageing blackfella who is frustrated by the Australian government’s Northern Territory intervention and other intrusive whitefella laws that are being enforced on his remote Australian community.

The movie was filmed in Gulpilil’s home country of Ramingining, Arnhem Land, where it also had its premiere at an outdoor bush screening.

Inspired by David Gulpilil’s own life experiences, the actor and the director also worked collaboratively on the screenplay.

The film received a standing ovation when it screened in Cannes in May where Rolf de Heer described the role as Gulpilil’s “greatest ever”.

IN CINEMAS JULY 17

METROMEMBERGIVEAWAY Email The Lamp by the 10th of the month to be in the draw to win a double pass to Charlie’s Country thanks to eOne Films. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!

4 8 | T H E L A M P J U LY 2 0 1 4

DIARY DATES

conferences, seminars, meetings diary dates is a free service for members. Please send event details in the format used here: Event name, Date and location, Contact details; by the 5th of each month.

Send event details to: Email: lamp@nswnma.asn.au Fax: 02 9662 1414 Post: 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space.

NSW APNA – Management of Medical Emergencies in the General Practice Setting 18 July Wollongong www.apna.asn.au NSW Urological Nurses Society seminar 18 July Charlestown urological_nurses@hotmail.com www.anzuns.org/nsw Through These Lines – a play about Australian nurses in WW1 24 July-5 August Newcastle www.civictheatrenewcastle.com.au/index.php 25th Annual Susan Ryan Neonatal Seminar 1-2 August Parramatta www.susanryanseminar.gofundraise.com.au Vascular Focus: Management of Peripheral Arterial Disease 8 August Liverpool Tanghua Chen tanghua.chen@sswahs.nsw.gov.au www.sswahs.nsw.gov.au/Liverpool/events.html 14th Rural Critical Care Conference 22-23 August Tweed Heads www.ruralcritalcare.asn.au Jayne@eastcoastconferences.com.au MHS Conference 2014 26-29 Perth • www.themhs.org Smart Strokes 2014 10 year anniversary: Are We Fit For The Future?

28-29 August Sydney www.smartstrokes.com.au smartstrokes@theassociationspecialists.com.au NSW Drug and Alcohol Nurses Forum 5 September Sydney www.danaonline.org darren.smyth@justicehealth.nsw.gov.au Neuro Bugs Seminar 5 September Westmead katherine.schaffarczyk@health.nsw.gov.au 4th Annual NSW Health and Ambulance Bowls Tournament 7 September St John’s Park Bowling Club Paul 9828 5391 (business hours) Paul.Sillato@swsahs.nsw.gov.au

Day Surgery Nurses NSW 2014 Conference Meeting the Challenge 13 September Darling Harbour conferencensw@adsna.info (02) 9799 1632 Children’s Hospital at Westmead Paediatric Perioperative Seminar 13 September Westmead claudia.watson@health.nsw.gov.au georgina.whitney@health.nsw.gov.au Enrolled Nurse Conference 18-19 September Tweed Heads EN Professional Association PO Box 775 Kingswood 2747 1300 554 249 Spiritual Care in Contemporary Nursing Practice Nurses Christian Fellowship NSW 20 September www.ncfansw.org 3rd Asia-Pacific International Conference on Qualitative Research in Nursing, Midwifery and Health 1-3 October Newcastle www.icqrnmh.info Pain — the nerve of it Pain Interest Group Nursing Issues Professional Development Day October 17 Sydney www.dcconferences.com.au/pigni2014 PANDDA 2014 Conference – Professional Association of Nurses in Developmental Disability Areas 15-16 October Parramatta www.pandda.net Nursing & Midwifery Unit Managers Society of NSW Annual Conference 17 October Ettalong www.numsociety.org.au Blacktown and Mount Druitt Hospital Nursing and Midwifery Research and Innovation Symposium 23 October • Abstracts due 8 August Abstracts: Michelle.Nehmer@health.nsw.gov.au Symposium: Caroline O’Donnell 0422 006 786 or Michelle Nehmer 0439 266 642

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APNA Continuing Education for Nurses in General Practice 24-25 October Sydney www.apna.asn.au/nigp Bones on the Beach – Orthopaedic Conference 25 October Wollongong karin.tarne@sesiahs.health.nsw.gov.au Australasian Society of Anaesthesia Paramedical Officers National Conference 1-2 November Albury www.asapo.org.au 6th Australian Rural & Remote Mental Health Symposium 12-14 November Albury www.anzmh.asn.au/rrmh/ Spotlight on Liverpool Lives A talk by Liverpool-born Dr Jennifer Harrison 13 November Liverpool City Library 10.30am-12.00pm

ACT 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference 16-17 October Canberra www.rcnmp.com.au Australia and New Zealand Society for Vascular Surgery Annual Scientific Conference 11-13 October Canberra www.vascularconference.com/2014/

INTERSTATE Australian Winter School Conference 2014 23-25 July Brisbane www.winterschool.info Nursing Informatics Australia 2014 Conference E-health is changing healthcare: Nurses meeting the challenges 11 August Melbourne www.hisa.org.au/page/hic2014nia @HISA_HIC 15th International Mental Health Conference 25-26 August Surfers Paradise www.anzmh.asn.au/conference conference@anzmh.asn.au Mental Health Service (MHS) Conference 26-29 August Perth www.themhs.org Australian Disease Management Association 10th Annual National Conference 11-12 September Melbourne www.adma.org.au/images/ConferenceFlyer2 014.pdf Paramedics Australasia International Conference 18-20 September Gold Coast www.paic.com.au Congress of Aboriginal and Torres Strait Islander Nurses and Midwives 16th National Conference 23-25 September Perth www.catsin.org.au ACMHN 40th International Mental Health Nursing Conference 7-9 October Melbourne 02 6285 1078 • www.acmhn2014.com events@acmhn.org

Australasian College for Infection Prevention and Control Conference 23-26 November Adelaide www.acipcconference.com.au

INTERNATIONAL 7th World Congress for Psychotherapy 25-29 August South Africa wcp2014.com secretariat@wcp2014.com 3rd World Congress of Clinical Safety: Clinical Risk Management 10-12 September Spain www.iarmm.org/3WCCS Nurses Christian Fellowship International PACEA Conference Compassion: The Cornerstone of care 10-14 October Fiji pacea-region@gmail.com 4th International Conference on Violence in the Health Sector 22-24 October USA www.oudconsultancy.nl/MiamiSite2014/index.html International Conference on Infectious and Tropical Diseases 16 -18 January 2015 Cambodia www.ictid.webs.com

REUNIONS St. Vincents Hospital PTS group August 1974 July 12 Sydney Cate Keast (Taylor) 0415 653 221 / 02 6653 6915 domxav@bigpond.com Royal Newcastle Hospital April/May 1974 RN graduates 40-year reunion 30 August Newcastle Wendy Lewis 0407 861 722 wlew12@bigpond.com Sue Carroll (nee Hetherington) 0404 083 429 susancarroll1953@gmail.com SVH Lismore Past Nurses Group 60th Reunion 30-31 August Marg McGrath 0439 092 333 Sue Felsch 0427 834 336 suefelsch@hotmail.com Mater Graduate Nurses’ Association Annual Reunion 19 October North Sydney Joan Taniane 0401 344 363 joans2458@yahoo.com Prince Henry Hospital PTS Jan 1964 meet-up at annual PHH reunion 25 Qctober Helen Millan (nee Flanagan) helenmillan@bigpond.com Prince Henry Hospital April 1964 Class Reunion 25 October, 1pm, Little Bay Reunion and dinner to follow Margaret Vincent (nee Dewick) margie.v@optusnet.com.au 0413 293 812 NEC Prince Henry/POW Hospitals Oct 1972-75 group 25-26 October Margret Brignall (Samuel) 0418 646 959 Sonia Keeling (Graf) 0407 221 407 Marcia Jarvis (Fitch) 0438 415 647 Dianne Walkden (Edwards) 0400 621 470 Gill Gillon (Horton) 0401 048 205 Waikato Polytechnic Nursing Graduates 87-89 1-2 November New Zealand Molly Forbes 0403 904 650 mollywoppie@gmail.com

diary dates is a free service for members.