THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION
VOLUME 72 No.11 DECEMBER 2015 – JANUARY 2016
Cumberland nurses stand up to serial violence RPA CAR PARK FIASCO Print Post Approved: PP100007890
PARLIAMENTARY SUPPORT FOR AGED CARE RNS
NURSING IN THE ICE AGE
More people in health and community services choose HESTA for their super Supports your industry | Low fees
| A history of strong returns
Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Investments may go up or down. Past performance is not a reliable indicator of future performance. Product ratings are only one factor to be considered when making a decision. See hesta.com.au for more information. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk).
CONTENTS
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 72 No.11 DECEMBER 2015 – JANUARY 2016
Hunter Office 8-14 Telford Street, Newcastle East NSW 2300 NSWNMA Communications Manager Janaki Chellam-Rajendra T 1300 367 962
COVER STORY
12 | Cumberland nurses stand up to serial violence
For all editorial enquiries letters and diary dates T 8595 1234 E lamp@nswnma.asn.au M 50 O’Dea Avenue, Waterloo NSW 2017
Action by mental health nurses has forced management to reduce bed numbers and adopt other measures to improve safety at Cumberland Hospital in Western Sydney.
Produced by Hester Communications T 9568 3148 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au
Nursing unit manager Debi Malcolm PHOTOGRAPH: SHARON HICKEY
REGULARS
5 6 8 37 39 43 45 47 48 50
Editorial Your letters News in brief Ask Judith Social media Crossword Nursing research online Books Movie of the month Diary dates
CAR PARKING
22 | Uproar over parking
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
COVER STORY
16 | Western Sydney gets raw deal
NSWNMA branch officials have called on the state government to reverse the long-term neglect of the district’s mental health services.
KIDS IN DETENTION
24 | Clinicians call for release of children in detention A huge crowd of nurses, midwives, doctors and other health professionals gathered outside Sydney Children’s Hospital Randwick and Westmead.
COMPETITION
34 | Christmas giveaway
NURSING AND ICE
Advertising Sarah Emms T 8595 2139 or 0429 269 750 F 9662 1414 E saemms@nswnma.asn.au Information and Records Management Centre To find archived 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 2015 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $30. Individuals $80, Institutions $135, Overseas $145.
28 | Ice needs more evidence and less fear Nurses and other health workers face “very worrying” risks in trying to manage people badly affected by the drug ice, the NSWNMA has warned.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 3
Nurses and midwives have unique stories to tell
Conditions of Entry Z Z Z Z Z
Z Z Z Z Z
FIRST PRIZE OF $2000
2 RUNNER-UP PRIZES OF $500
READERS CHOICE AWARD OF $500
How to enter Z Z Z Z Z Z
Deadline Winners
Entries close 5 pm Friday 18 March 2016 Winners will be announced on 3 May 2016. Readers Choice winner will be notiďŹ ed on 10 June 2016.
www.nswnma.asn.au
EDITORIAL BY BRETT HOLMES GENERAL SECRETARY
A high price to pay for neglect Serial violence at Cumberland Hospital in Western Sydney is a consequence of the neglect of acute inpatient mental health services in the area. The government needs to urgently address this intolerable situation.
“This intolerable level of violence towards Cumberland nurses is a consequence of many years of neglect of acute inpatient health services in Western Sydney.”
In this month’s Lamp we look at the shocking level of violence that has scarred Western Sydney’s Cumberland Hospital over the past few years, culminating in a horrific attack on NUM Debi Malcolm (see pages 14-15). The Yaralla psychiatric intensive care unit where Debi works has recorded 45 assaults causing injuries to nurses in the 34 months to August – a shocking rate of 1.3 nurses injured every month. Two NSWNMA branches – the Western Sydney Mental Health Managers’ Branch and the Cumberland Hospital Branch have expressed “a deep concern for the welfare and safety of Yarallla staff and patients”. I share their concern. This intolerable level of violence towards Cumberland nurses is a consequence of many years of neglect of acute inpatient health services in Western Sydney. In October the New South Wales government unveiled Stage 1 details of a $900 million redevelopment for the Westmead Hospital precinct, yet made no mention of any acute inpatient mental health services for the area. Cumberland Hospital is the largest public mental health inpatient facility in Western Sydney, with three acute mental health units and a psychiatric intensive care unit, yet, no major capital works have been carried out on the site for many years. The facilities at Cumberland Hospital are archaic and no planning has been released or funding allocated to redevelop the units to the appropriate standard that should be expected in a 21st century, world-class health system. Our members have described repeated instances of overcrowding in the acute mental health units and substandard infrastructure at Cumberland, such as hired air conditioning units housed in metal cages outside the buildings and no backup generator for power during blackouts. Deteriorating buildings and temporary infrastructure create a poor environment with impacts on the safe care of both inpatients and nursing staff.
We recognise that integrated community care is the preferred model of the NSW Ministry of Health and the Mental Health Commission of NSW. However the evidence suggests that that model fails to accommodate for acute psychotic illnesses that require inpatient care. Patients with an acute psychotic illness deserve a suitable and safe environment to assist their recovery and enable them to reach a point where it is safe to progress to community-based care. Some psychotic patients do require intensive care and treatment. They need a state of the art facility that provides a therapeutic caring environment to enhance their recovery. PARLIAMENTARY INQUIRY CHARTS WAY FORWARD FOR AGED CARE Aged care is another sector in dire need of attention. The recent NSW Upper House Inquiry into registered nurses in NSW nursing homes has released a fine report that identifies the principal issues confronting the industry and makes some excellent recommendations to take the sector forward. We particularly welcome the recommendation to retain the requirement for an RN to be on duty round the clock in facilities with high care residents. This is a seminal issue for nurses and the Association has campaigned hard to retain this requirement in law. The report is broad in scope and other recommendations support positions that the NSWNMA has championed for many years, such as the introduction of ratios into aged care and closing the wages gap between aged care and the public health system. We now await Minister Skinner’s response to the Inquiry’s response – due before the end of the year. I encourage the Minister to adopt the Upper House’s recommendations in full, for the betterment of aged care service delivery throughout NSW.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 5
Another great reason to make TUH your number one choice. When it comes to the best cover for you and your family, there’s really only one choice. Which is perhaps why CHOICE has recommended TUH for our Total Care Hospital cover. With no restrictions or exclusions for medically necessary procedures, TUH’s Total Care Hospital gives you peace of mind for life’s unexpected events. What’s more, you can also have Total Care Hospital with or without an excess – it’s your choice! To learn more, visit tuh.com.au/lamp or call 1300 360 701 today.
Queensland Teachers’ Union Health Fund Limited ABN 38 085 150 376 438 St Pauls Terrace, Fortitude Valley QLD 4006.
YOUR LETTERS
LE TTE R OF THE MONTH
RNs crucial in aged care 24/7 A four-month inquiry by a New South Wales Legislative Council committee received more than 160 written submissions. There were more than 24,000 signatures gathered, calling on the NSW government to retain the requirement for registered nurses to be on duty 24/7 in aged care facilities. Thousands of community members across the state spoke up about the issue. A number of community and professional organisations – the Country Women’s Association, Combined Pensioners and Superannuants Association, National Seniors Australia, the Cancer Council and Palliative Care NSW – supported the campaign. As a registered nurse who works in an aged care facility I also feel compelled to speak up. It is part of my role as a nurse to advocate for the safety of all residents in aged care facilities. The threat to the delivery of safe quality care to our vulnerable residents is further intensified by the state government contemplating the removal of the legal requirement that a registered nurse must be on duty 24 hours a day seven-days-a-week in NSW nursing homes. Registered nurses assess, plan and implement the nursing care delivered to our residents. They provide leadership by directing, supporting and supervising the care given by assistants in nursing and unregulated care workers. Registered nurses liaise with doctors, allied health specialists and family members and manage complex clinical procedures like wound dressings, catheterisations, peritoneal dialysis procedures, peg tube feedings and the management of pain relief when someone is chronically ill. We also provide palliative and end-of-life care. Without registered nurses who will the carers call to administer first aid when a resident falls, chokes or gasps for breath? Who will administer pain relief when they are in pain? Who will relieve their discomfort because of a blocked catheter? Who will withhold certain medications when adverse effects have been identified? Who will call for allied health assistance? Who will call the medical practitioner about new adverse symptoms? Who will speak to their family members? Will our residents be sent to the emergency department instead for assessment and treatment? Our ambulance services and emergency department are already stretched to the limit. I fear that removing registered nurses in aged care will result in a sharp erosion of care standards. Will our Health Minister Jillian Skinner listen to the registered nurses, enrolled nurses, care workers and community members who have voiced their concerns? Will the Minister adopt the committee’s 17 recommendations? Jocelyn Hofman RN Hazelbrook
YOUR LETTERS
Passionate about stopping climate change As a midwife I see many newborn babies every day and I am left wondering what legacy we will leave for these new little people and what their world will be like in 50 years. We now know that climate change is a real threat to human health. The effects of pollution have built up and created increases in carbon dioxide, oceans that are warming and weather that is unpredictable. We are seeing increasing temperatures, more regular violent storms, earthquakes and tsunamis. In the near future, in Australia, tropical diseases like malaria will be more prevalent through increased temperatures, while rising sea levels will cause many islands in the Pacific to disappear. Most nurses and midwives know about the dangers of climate change and want to do something about it. We are involved in campaigns and rallies still going on in New South Wales to stop the pollution and destructive effects of coal mining, coal seam gas and fracking, especially right now in the little town of Bulga in the Hunter Valley. For those of our colleagues living in the Northern Rivers, Shoalhaven, the Hunter Valley and other parts of NSW, the fight goes on to protect our natural resources. In order to change this scenario we need to empower and mobilise the health profession. Nurse and midwife members of the Association want to get the word out to the public about how climate change can affect health and that health can be improved through the reduction of greenhouse gas emissions. Our Association marched with thousands of other concerned community members and health practitioners in the Sydney People’s Climate March on Sunday November 29. Hopefully standing up as health professionals at events like this will provide the catalyst for Australia to increase its low emissions targets. Jacquie Myers RM Avoca Beach
ADVERTISE IN THE LAMP AND REACH MORE THAN 64,000 NURSES AND MIDWIVES. To advertise please contact SARAH EMMS 02 8595 2139 // 0429 269 750 // saemms@nswnma.asn.au
Please don’t make our jobs any harder I have been a nurse for 42 years and love it; I am proud of the profession and what we do. Nurses accept that shift work is part of the profession and are compensated for it with penalty rates. If I am made to work unsocial hours with no penalty rates I will be forced to leave the profession. Let’s face it, no one wants to work unsocial hours and who wouldn’t rather be spending Christmas Day with loved ones? We are having trouble enticing and retaining people to nursing because of the low pay and conditions for such responsibility. Please don’t make it even harder – we need nurses! Barbara Hodges RN Gingkin
Big thank you Today I received my American Tourister Zenonlite suitcases won through the September Lamp competition. I would like to thank the Association for this wonderful prize. Deanne from Samsonite was extremely helpful in arranging delivery. The suitcases are beautiful and will get a lot of use. Thank you once again. Marisa Sbona RN Austral
HAVE YOUR SAY Send your letters to: Editorial Enquiries email lamp@nswnma.asn.au fax 9662 1414 mail 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.
Letter of the month The letter judged the best each month will win a $50 Coles Group & Myer gift card!
unionshopper.com.au 1300 368 117
THE LAMP DECEMBER 2015 – JANUARY 2016 | 7
NEWS IN BRIEF
Britain
NHS sacrifices patient safety to cut costs English National Health Service (NHS) management have told hospitals they no longer have to ensure that one nurse is caring for no more than eight patients at a time.
World
Ebola persists beyond blood
The guidelines for a 1:8 ratio were introduced following a scandal at the Mid-Staffordshire health service, which was largely attributed to a shortage of nurses. A letter sent to all hospital chiefs makes clear that, when deciding how many nurses should be on duty, financial considerations are deemed as important as the safety and quality of care patients receive. The NHS faces a “£2 billion black hole” that has left 80 per cent of hospitals facing deficits of up to £100m each, reports the Guardian. The letter, signed by NHS England, the Care Quality Commission, and the National Institute for Health and Care Excellence (NICE) recommends that hospitals ask health professionals, such as physiotherapists, to help care for patients and use technology to monitor their condition, reducing the need for nurses on duty. The new advice is a significant backtracking on guidelines produced last year by NICE, which set out that no nurse should look after more than eight patients to ensure good, safe care. The Labour opposition said the NHS letter showed that patient care could be put at risk as a result of the rising deficit. “It is yet further evidence that the financial crisis in the NHS is now a real threat to patient care,” said shadow health secretary Heidi Alexander. Ian Wilson from the British Medical Association said: “The solution is not to stretch existing staff even further, but to ensure the NHS has the resources needed to deliver safe care.”
8 | THE LAMP DECEMBER 2015 – JANUARY 2016
Recent research published in the New England Journal of Medicine has found the Ebola virus can live on in the semen of male survivors and can be transmitted to their sexual partners. Ilhem Messaoudi, an associate professor of biomedical sciences at the University of California, told the ABC that scientists have very little understanding of the long-term health consequences of having survived Ebola. “This particular study clearly demonstrates that Ebola can be transmitted via sexual contact, which is a whole new mode of transmission that was completely under-appreciated until very recently,” he said. The Ebola virus is known to persist in some sites in the body including the testes, the spinal cord and the eye chamber, after it has cleared the bloodstream. Scientists are only now beginning to find out more about where it can survive and for how long, and when it might re-emerge. An example of how the deadly virus can hide inside the body of a survivor occurred in Britain when a nurse, who contracted Ebola while caring for patients in Africa, suffered a relapse of the disease. Pauline Cafferkey, who contracted Ebola in Sierra Leone, came close to death from meningitis caused by the lingering virus. Dr Mike Jacobs, an infectious diseases consultant at the Royal Free Hospital in London, said Cafferkey had not become reinfected with the virus since her recovery in January but it had persisted in her brain, which had led to viral meningitis.
“Scientists have very little understanding of the longterm health consequences of having survived Ebola.”
NEWS IN BRIEF
Australia
Bullying and sexual harassment common A new report by the Royal Australasian College of Surgeons (RACS) has found that nearly half of surgeons experience discrimination, bullying or harassment. The report included stories of surgeons being expected to provide sexual favours in return for tutorship, and instances of belittling, intimidation and public humiliation. The head of the expert advisory group set up by RACS, Rob Knowles, told the ABC he was shocked by the findings. “I was surprised and disturbed at the depth and the entrenched nature of bullying and harassment both across the profession and the health care system generally,” he said. The report found bullying was the most common, reported by almost 40 per cent of surgical fellows, trainees and international medical graduates. Almost 20 per cent of surgeons reported discrimination and workplace harassment, with seven per cent detailing instances of sexual harassment. The most prevalent form of discrimination was cultural, with one response reading: “They want you out of the country or they want you dead.” RACS president Professor David Watters wrote a formal apology to all those who suffered bullying, discrimination or sexual harassment. “I apologise to everyone of you who has suffered discrimination, bullying or sexual harassment by surgeons. I also apologise to all other health workers on whom surgeons have inflicted these behaviours,” Professor Watters wrote.
“I WAS SURPRISED AND DISTURBED AT THE DEPTH AND THE ENTRENCHED NATURE OF BULLYING AND HARASSMENT.”
World
“THE 1% owns half the world DISTRIBUTION OF WEALTH GAINS HAS SHIFTED IN FAVOUR OF THOSE AT HIGHER WEALTH LEVELS.”
Global inequality is on the rise, with half the world’s wealth now in the hands of just one per cent of the population, according to a new report by Credit Suisse. The report also found that there were more individuals in the middle classes in China (109m) than in the United States (92m). It defined middle classes by personal wealth, rather than profession, and wealth as the value of assets including property and stock market investments, but excluding debt. Credit Suisse says 14 per cent of adults worldwide are middle class, with $50,000$500,000 of assets. The report said wealth inequality had continued to increase since 2008, the year the global financial crisis began, with the top percentile of wealth holders now owning 50.4 per cent of all household wealth. “From 2008 onwards, wealth growth has not allowed middle class numbers to keep pace with population growth in the developing world. Furthermore, the distribution of wealth gains has shifted in favour of those at higher wealth levels. These two factors have combined to produce a decline in the share of middleclass wealth,” said Markus Stierli of the Credit Suisse Research Institute.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 9
NEWS IN BRIEF
India
Lancet slams Modi for neglect The British medical journal The Lancet has criticised Prime Minister Narendra Modi for ignoring India’s health sector and warned that India is on the verge of a collapse under the weight of its own ill health. The Lancet editor Richard Horton told the Times of India: “If PM Modi does not tackle health, India’s economy combined with rising population is not sustainable. “For India, health is an issue of national security. The government cannot protect the sovereignty of its nation, cannot ensure sustainability unless it has a healthy population. At present Modi has done nothing much to tackle the challenge. “At the moment, India is on the edge and it can take two routes. It can take a route of investing in health and investing in its people and creating a thriving and flourishing future for India, which has a part to play in world affairs, or it can do what it is doing now and ignore health in which case it will see epidemics sweep across the country creating an unsustainable future and destroying national security. I really think it is that serious.” The Lancet says the main issue is a lack of investment in the public health system and the growth of an unregulated private sector. India currently spends about one per cent of its gross domestic product (GDP) on public health.
PHOTO: GLOBALPRESSJOURNAL.COM
“Life’s Worth It”
TM
3G Safety Watch is your Personal Protector 24/7 on your wrist! • Monitored 24/7 by LIVE Operators • Silent SOS Alert through vibrations • Records audio of your surrounding • Locates you via GPS, GSM & Wi-fi • Tracks you when SOS is activated • Stand Alone Mobile Phone • Water Resistant (IP66) • Chaperone Service • Fall Detector and much more.
www.thesafetywatch.com
Our Timer Alert feature ensures you get to work and home within a set time, if you don’t an SOS alert will automatically activate!
NEWS IN BRIEF
Australia
Australia
Three workers killed every week
Look-alike packaging puts patients at risk
Safe Work Australia figures show there were 135 workplace fatalities in Australia in the year up to October. This equated to three fatalities each week on average. The highest number of recorded fatalities occurred in the transport, postal and warehousing sector, which accounted for 42 deaths so far in 2015. Data from the agency also shows 531,800 workers are injured each year – 118,000 of those seriously – costing Australia more than $60 billion annually. Michael Borowick Another serious concern about workers welfare, discussed at a recent ACTU conference on OHS, was workplace mental health and bullying, which remains under-regulated. The ACTU says it “affects both men and women causing long-term physiological issues and in the worst cases, death”. In 2012-13 (the latest data available) 9.4 per cent of all serious workers compensation claims made by women were for mental disorders and there was a 17 per cent increase in the number of serious claims caused by mental stress. ACTU assistant secretary Michael Borowick says with three workers losing their lives every week on average it’s an area that needs more attention from governments and employers, not less. “OH&S regulations and workers compensation rights are not prohibitive red tape to be cut in a misguided deregulation drive. They are a sensible, best-practice approach to ensuring workers can get on with their jobs without having to worry about the risk of injury or death,” he said.
“OH&S regulations and workers compensation rights are not prohibitive red tape to be cut in a misguided deregulation drive.”
Senior doctors have sent a report to the Therapeutic Goods Administration detailing a number of serious medication errors involving neuro-muscular drugs. “These medications paralyse patients, leaving them unable to move or breathe, whilst remaining fully conscious, and place them at risk of serious psychological trauma or death if administered accidentally,” Dr Bramley said. He outlined 12 cases of the wrong surgical drugs being used in Victorian hospitals in 2011, with more than 90 per cent of errors due to lookalike packaging.
Australia
New law opens door to more private health There are concerns that amendments to the Private Health Facilities Act will allow private facilities to compete against public health facilities and could lead to an unsustainable duplication of health services in some geographical or clinical areas. One amendment “removes the adequacy of current health services in an area as a ground for the refusal of a licence for a private health facility in that area”. A NSWNMA analysis says this would leave the NSW health ministry “unencumbered from the ‘requirement’ to contemplate possible duplications of service and the implications for current [public] service provision”. It adds that changes to the legislation “stifle the proper consideration of the impact of privately licenced facilities and undermine the proper role of government in regulating healthcare so as to provide viable, comprehensive and coordinated health services in NSW”. Jamie Parker, Greens MP for Balmain, says the previous provisions protected the public sector from private encroachment. “It needs to be clearly stated on the record that we will be able to defend the public sector in maintaining proper planning for health, not leading to a disjointed approach with private sector providers potentially affecting the way that we plan our healthcare system,” he told state parliament.
Anaesthetists are warning that labels on surgical drugs are too easy to mix up. The ABC reported that Dr David Bramley, from the Australian and New Zealand College of Anaesthetists, wrote to health authorities urging them to introduce clearer labels.
In 10 instances doctors injected a completely different type of drug into patients. “Without further intervention it’s likely these incidents will continue to cause serious outcomes for hospitalised patients,” he said.
Jamie Parker
“It needs to be clearly stated on the record that we will be able to defend the public sector in maintaining proper planning for health.”
A recent survey revealed that more than 75 per cent of doctors had experienced a “near miss” attributed to medication packaging. Doctors want labels similar to those used in the United States and Canada, where strong neuro-muscular agents have red warning labels on the top.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 11
COVER STORY
Cumberland nurses stand up to serial violence Action by mental health nurses has forced management to reduce bed numbers and adopt other measures to improve safety at Cumberland Hospital in Western Sydney.
UNION ACTION WAS PROMPTED BY A serious assault on Debi Malcolm, nursing unit manager of Cumberland Hospital’s Yaralla psychiatric intensive care unit (PICU). Yaralla receives some of the most violent and drug affected patients in the state. The unit recorded 45 assaults causing injuries to nurses in the 34 months to August – an average 1.3 nurses injured every month. Nurses are regularly punched, kicked, bitten, scratched and spat on. “We need a new intensive care unit and we need it in a hurry before someone gets seriously hurt or killed,” said Debi, who is still battling to overcome her injuries months after the attack (see story page 14). “The authorities have known for years that Yaralla is unfit to serve as a psychiatric ICU. But Western Sydney is not a big priority for them.” Reducing overcrowding can make the hospital safer but a long-term solution must include rebuilding Yaralla to a standard equal to PICUs in other parts of Sydney, Cumberland nurses say. Two NSWNMA branches – the Western Sydney Mental Health Managers’ Branch and the Cumberland Hospital Branch – met in September and expressed “deep concern for the welfare and safety” of Yaralla staff and patients. Their unanimous joint resolution called on Western Sydney Local Health District
to cut bed numbers from 12 (eight male and four female beds with a staffing profile of 6:6:4) to 10 without any staff reduction. The resolution said: “These two beds must remain closed until theYaralla staffing profile, inclusive of a multi-disciplinary team, and ward environment is comparative and equitable to mental health intensive care units across NSW.” MANAGEMENT ACCEPTS CONCERNS Both branches also demanded an end to the practice of sleeping acute patients overnight in empty rehabilitation cottage beds, leading to overcrowding at Yaralla on subsequent days. “Under no circumstances will this practice be revisited to create increased capacity of beds in the acute units,” the resolution warned. Management accepted both demands along with a call for an independent review of the Yaralla unit, including “the ward environment, staffing, models of care and admission criteria.” NSWNMA General Secretary Brett Holmes says the 45 reported assaults on Yaralla nurses between October 2012 and August 2015 have so far resulted in 38 weeks lost productive time, at a cost of more than $112,000. “Yaralla takes patients that other facilities find too hard to handle, as well as other very violent people brought directly to the
12 | THE LAMP DECEMBER 2015 – JANUARY 2016
unit by the police and ambulance,” he said. Brett said safety issues were aggravated by Yaralla’s age and design, not suited to a mental health ICU:“It is an ageing building that was not purpose built and falls way short of latest design standards for acute inpatient mental health units.” CALL FOR PURPOSE BUILT UNIT UNHEEDED Built in the 1960s as a geriatric unit, but never used as one,Yaralla originally served as an adult acute admission unit, until designated as the state’s first mental health ICU about 20 years ago. In 2011 the NSWNMA called for Yaralla to be replaced with a purpose built unit that meets current design standards. This followed a NSWNMA occupational health and safety inspection of the unit, which was prompted by the serious assault of a nurse in 2011. He suffered a head injury resulting in hospitalisation, on-
going attendance at an outpatient brain injury clinic and psychological trauma. A year later, in late 2012, Ministry of Health officials apparently prepared a business case to replace the unit but funding was denied. Management did implement some Association recommendations flowing from the health and safety inspection.These included creation of a dedicated assessment room for patient interviews (which had previously been carried out, with no privacy, in the nurses’ station), improvements to seclusion rooms, stronger safety glass, new furniture and replacement of the “shabby, malodourous and dirty” carpet, with linoleum. Despite its role as the facility of last resort for some of the state’s most violent mental health patients, Yaralla is the only psychiatric ICU in New South Wales without its own multi-disciplinary team of consultants, registrars, social workers and others.
The unit recorded 45 assaults causing injuries to nurses in the 34 months to August – an average1.3 nurses injured every month.
Yaralla nurses rely on Cumberland’s admission wards to supply these specialties. Aside from a recently recruited consultant, allied health and medical staff usually have to be brought to Yaralla from the Hainsworth and Paringa acute mental health units. The joint branch meeting also focused on overcrowding at Hainsworth, Paringa and a third acute mental health unit within the Cumberland complex, Riverview.The branches called on management to restrict patient numbers at these units to overcome the “unsafe practice … of being over their bed census during the day.” Though the LHD has not yet agreed to these measures, the branches have maintained their stance with a resolution affirming:“At no time within a 24-hour period will we tolerate these units to go over their respective bed numbers.” (see story page 19).
THE LAMP DECEMBER 2015 – JANUARY 2016 | 13
COVER STORY
One of Australia’s most dangerous workplaces A shocking assault on nurse unit manager Debi Malcolm was one in a long sequence of violent events at Cumberland Hospital.
14 | THE LAMP DECEMBER 2015 – JANUARY 2016
“When you’ve got 12 of the most disturbed and dangerous people you will ever meet in your life in one small area, it’s a very volatile situation.” — Debi Malcolm NUM A SWOLLEN EYELID, BLURREDVISION and “a headache to end all headaches” still afflict NUM Debi Malcolm, 14 weeks after a patient assaulted her atYaralla psychiatric intensive care unit. The physical symptoms are accompanied by nightmares and panic attacks that leave her struggling to breathe. Debi is also frustrated and angry that authorities have allowed her unit at Cumberland Hospital to become one of Australia’s most dangerous workplaces. State governments crying poor have failed to act on several reports recommending that the ageing unit at Parramatta in Western Sydney be rebuilt. Yet they have found the money for new and upgraded mental health facilities in other Sydney local health districts. “I’m angry big time,” Debi said. “The authorities have known for years that Yaralla is unfit to serve as a psychiatric ICU. But Western Sydney is not a big priority for them. People out here don’t seem to matter that much.” On the morning Debi was assaulted, patients were queuing for breakfast. Debi, who is secretary of the NSWNMA’s Western Sydney Mental Health Managers’ Branch, asked one man who had collected his meal to move out of the queue to allow others to be served. “Who the f**k are you? You can’t tell me what to do,” he yelled, before jabbing a plastic knife into Debi’s stomach. “I grabbed the knife off him but he dropped the plate from his other hand and punched me several times in the head.Then he grabbed me by the hair and threw me to the ground. “I hit the back of my head on the floor and must have briefly lost consciousness because I don’t remember the next bit. “My staff said he tried to strangle me. There were marks around my neck after they pulled him off me.”
As three male nurses fought to restrain her attacker, Debi regained consciousness and phoned a “code black” to call for help from other wards. The team arrived and helped to get the patient into a seclusion room. They restrained him on the bed while Debi put in another call to order medication – a combined sedative and anti-psychotic. PAIN NEVER STOPS After making sure her staff were OK Debi called the police and was driven to Parramatta station for an interview. “I had a big headache and bruises were already coming up but I didn’t feel too bad – perhaps it was the adrenaline. It wasn’t until I got home and thought about what had happened that I just fell apart. “The fall apparently caused my brain to hit the front of my skull so I have bleeding in the brain and blurred vision in the right eye, which means I’m only allowed to drive short distances.” Along with the nightmares and panic attacks Debi says she is sometimes gripped by “a sense of impending doom, like I think I’m going to die.” Debi’s assailant is now in jail. He is a repeat offender with numerous violence-related convictions. When he attacked Debi he had pending court hearings for assaults on two of her staff. One suffered a black eye and four loosened teeth. Yaralla has a shocking safety record including 45 reported assaults causing injuries to nurses in the 34 months to August. Broken limbs are not uncommon; one nurse suffered a broken leg that took more than two years to heal. A 2011 assault left another nurse with a brain hemorrhage and permanent hearing difficulties. Debi has been assaulted three times in her six years at Yaralla. She suffered a broken nose when a patient attacked her during an on-site
hearing of the mental health review tribunal: “The tribunal didn’t even stop proceedings, they just went on hearing the evidence.” DESENSITISED Authorities and nurses themselves have become “desensitised” to violence towards mental health staff, Debi says. “There is a lot of under-reporting of violence towards nurses. We seem to accept a high level of violence, which is dehumanising and very dangerous. “In 2009 the local health district applied for a rebuild but the director general of health said no funds were available for capital works. “Yet while we are told there is no money for mental health in Western Sydney, they’ve built new units at Prince of Wales, Concord and Nepean and refurbished St George and Hornsby units. Cumberland Hospital does not even have backup generators to supply power to Yaralla or other units when hit by a blackout. “Nurses are expected to wander around in the dark with torches and lanterns to look after patients,” Debi said. “If power is disrupted and food is spoiled, staff are expected to use their own money to buy food for patients. “Their priorities are wrong. Western Sydney is the fastest growing part of the state and has the greatest need for mental health beds given the amount of ice and steroid abuse out here. “Yaralla was built as a geriatric unit in the 1960s and cannot function properly as a mental health ICU. It lacks the facilities you need to look after very violent patients. “When you’ve got 12 of the most disturbed and dangerous people you will ever meet in your life in one small area, it’s a very volatile situation.” “We need a new unit and we need it in a hurry before someone gets seriously hurt or killed.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 15
COVER STORY
Western Sydney gets raw deal NSWNMA branch officials representing mental health nurses in Western Sydney have called on the state government to reverse the long-term neglect of the district’s mental health services.
NSWNMA REPRESENTATIVES WANT TO ensure that 260-bed Cumberland Hospital – the centre of Western Sydney Local Health District’s mental health network – benefits from planned urban renewal and redevelopment of neighbouring Westmead Hospital. Westmead, the major tertiary referral hospital for Western Sydney, will get new operating theatres, extra inpatient beds and a new emergency department in a new acute services building as part of stage one of its redevelopment. Meanwhile the Parramatta North urban renewal plan, now under consideration by the Department of Planning and Environment, proposes a commercial centre and 4100 residential apartments at the Cumberland Hospital site. Neither project provides for improvements to Cumberland Hospital – parts of which date back to the 19th Century. The assistant secretary of Western Sydney Mental Health Managers’ Branch of the NSWNMA, Sharon McInerney, said
Cumberland had experienced a long period of neglect. Some buildings were too small and inappropriate for the latest models of care and were plagued by faulty plumbing, leaking roofs and inadequate air conditioning. “Cumberland needs major capital investment to work properly but we don’t seem to be able to get the ear of the department when it comes to spending priorities,” she said. “Our ICU, Yaralla, is on the risk register of priority areas for capital investment but there is no clarity about when that will happen. “The newest parts of the hospital date back to the 1960s yet there is huge investment going into Westmead which is only 35 years old.” NOT FIT FOR PURPOSE Reports by the state’s chief psychiatrist, the Official Visitors Program and the NSWNMA have all described Yaralla as not fit for purpose and
16 | THE LAMP DECEMBER 2015 – JANUARY 2016
recommended it be rebuilt. Sharon says the government’s failure to commit to improve services at Cumberland has led to uncertainty and low morale among staff. “When will we be permitted to look after our patients in modern facilities that allow us to provide better models of care?” she asked.“The staff work well with the resources they are given but can only do so much in the current physical environment.” Problems caused by inadequate facilities include difficulties in segregating male and female patients and a lack of “time out” rooms, low stimulus areas and family rooms. Unsuitable layouts make it difficult to observe patients in some areas.At Riverview, an early intervention and mood disorder unit, the lounge room and courtyard cannot be seen from the nurses’ station. “Riverview is gazetted for 20 beds but sometimes has 24 or 25 patients,” Sharon said. “It was originally built as a medical ward so it doesn’t even fit the purpose of an acute mental health unit.”
“The level of violence has reached a stage where we need to step back and say enough is enough.” — Sharon McInerney assistant secretary of Western Sydney Mental Health Managers’ branch of the NSWNMA
PATIENTS A TARGET OF VIOLENCE Sharon says overcrowding has contributed to an increase in violence against patients as well as staff. “Like nurses, patients have also suffered serious injuries as a result of assaults at Yaralla – for example a violent patient broke the leg of another patient.” The problem is made worse by delays in moving patients out ofYaralla once their health improves, Sharon said. “The doctor may deem them suitable to transfer to the less restrictive environment of an acute ward. But there is often a long delay in moving the patient because of the lack of available beds in acute wards. “That means people considered to be less unwell are exposed to more psychotic and violent patients for longer than is necessary, simply because there is nowhere else for them to go.” She said Cumberland Hospital received referred clients who couldn’t be managed in other facilities even though they had more modern high dependency units. “Due to the skill and experience of Cumberland’s caring and devoted staff, we’ve been
able to manage those people fairly well given our resources. “Our staff have a very high threshold of tolerance. But the level of violence has reached a stage where we need to step back and say enough is enough.” Yaralla has no separation areas – other than two seclusion rooms – for out-of-control patients. That means patients must sometimes be kept in seclusion rooms simply because there is nowhere else for them to go, says Debi Malcolm, Yaralla’s nursing unit manager who was seriously assaulted (see story page 14-15). “Intensive care units at other facilities have purpose built seclusion rooms with adjoining de-escalation areas,” she said. “That means as soon as you give a patient medication you can open the seclusion room door and the patient is quite safe in a de-escalation area away from other patients and staff. “All we get from the Ministry is criticism. They compare us to the brand new unit at Prince of Wales and say, ‘your seclusion rates are higher than theirs’.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 17
ARE YOU A VICTIM OF WORKPLACE VIOLENCE? Have you or a colleague been assaulted at work? Have you reported your incident?
Download the NSWNMA App and report your workplace violence incident The NSWNMA has a new tool as part of our NSWNMA Toolkit App that allows you to quickly report an incident to the Association as soon as it happens. It’s an easy fillable form that you can submit from your mobile device and an officer of the Association will be in touch with you. Nursing is considered one of the most dangerous professions. HELP STOP VIOLENCE AT WORK! NSWNMA Toolkit App is FREE and available to download from iTunes and Google Play store
COVER STORY
Cumberland’s acute wards also overcrowded As well as bed closures at Yaralla intensive care unit, the NSWNMA has sought to limit admissions to Cumberland Hospital’s three overcrowded acute wards — Hainsworth, Paringa and Riverview. NSWNMA GENERAL SECRETARY Brett Holmes says Hainsworth, with 33 bed spaces, had 46 patients during a 24-hour period in September. Paringa, also with 33 bed spaces, had 45 patients during another 24-hour period in September. He said these numbers were not reflected in official data because patients were counted at midnight. Patients who are on leave are not counted because they usually only attend hospital during the day. Jennifer Parnis, NSWNMA delegate for Cumberland Hospital branch, said union pressure had succeeded in limiting admissions to the acute wards. “We are still going over census during weekdays but we are not getting as many patients as we were a month ago,” she said. Jennifer works as a clinical nurse specialist at the Paringa unit, which is gazetted for 33 beds but had to care for 45 or more patients during the day earlier this year. The number of admissions fell after NSWNMA members applied pressure, but Paringa is still “over census” due to patients returning from leave to an already-full unit. “The current numbers don’t paint an accurate picture of what happened in the past and what we are afraid might happen again,” she said. “Closing some of theYaralla beds has an impact on all acute units.
Jennifer Parnis
Patients who ought to be in an ICU are now coming to the acute units, which adds to overcrowding and puts patients and staff at greater risk. “The branch will continue to monitor occupancy to ensure that numbers don’t increase to intolerable levels again. “We have a fantastic multi-disciplinary team who know there is increasing demand for mental health beds in Western Sydney. “They just want to do their best for their patients but we can’t provide safe and effective care if we’ve got 33 beds and another three patients coming back into the unit each day on average. “The unit gets very crowded. Patients have no personal space and sometimes have to store their bags in a bathroom. “We are already facing a high level of verbal and physical abuse including assaults on nurses. If we throw even more patients into the mix it’s natural we are going to cop even more abuse. “We are worried it is only a matter of time before a nurse is more seriously injured.” Jennifer said the closure of facilities for developmentally delayed patients had pushed many of them into the community. “Some of them end up in our acute wards which adds to overcrowding.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 19
AGED CARE
RNs needed 24/7 in aged care says parliamentary inquiry A New South Wales Upper House inquiry has recommended that RNs be on duty in nursing homes at all times and advocated for the introduction of ratios in aged care facilities. The NSWNMA’s RNs 24/7 in aged care campaign received a massive boost with a report into the role of registered nurses within residential aged care in NSW finding they are essential to high-quality care and recommending the retention of a legal minimum requirement to ensure RNs are on duty at all times. The Legislative Council Committee report confirms that RNs are pivotal to the skill-mix of staffing in residential aged
care facilities, particularly sites with high and complex care residents. NSWNMA General Secretary Brett Holmes welcomed the central recommendations of the report. “The volume of evidence supporting the minimum requirement for registered nurses to be on duty around the clock in facilities with high care residents speaks for itself and the Committee has diligently outlined how it can be retained and
“We encourage the Minister to adopt the Upper House Committee’s recommendations in full, for the betterment of aged care service delivery throughout NSW.”
20 | THE LAMP DECEMBER 2015 – JANUARY 2016
strengthened at the Commonwealth level. “The Committee has recognised the need for minimum staffing ratios to be established and recommends that the New South Wales government urge the Commonwealth to adopt ratios throughout the aged care sector. “We also welcome the recommendation that the government, through the Council of Australian Governments, address the wage disparity between registered nurses in aged care and their counterparts in the public health care system,” he said. Brett says he hopes the NSW government will seriously consider the report’s 17 recommendations. “If the state government abrogates its duty of care and removes the legal requirement for registered nurses in NSW, the state’s aged care sector will deteriorate and elderly residents and families, who rely on these services, will suffer. “It’s not good enough for the NSW Health Minister to divest herself of responsibility to the people of NSW – especially the elderly and frail who deserve a dignified journey through their final years,” he said. “We encourage the Minister to adopt the Upper House Committee’s recommendations in full, for the betterment of aged care service delivery throughout NSW.” The inquiry also recommended that aged care providers be able to “opt out” of providing registered nurses, on a case-bycase basis. The NSWNMA is concerned this could be used as a cost-cutting exercise by some aged care providers. Brett says the NSW government should carefully consider how this recommendation would be regulated.
Thrilled with the findings
Key recommendations of the NSW Upper House Inquiry • That the NSW government urge the Commonwealth to establish minimum staffing ratios in aged care facilities. • That the NSW government urge the Commonwealth to establish a licensing body for aged care workers. • That the NSW government retain the requirement in section 104 (1) (a) of the Public Health Act 2010 for registered nurses to be on duty in nursing homes at all times. • That the NSW government urge the Commonwealth to require aged care facilities to make information about their staffing skill sets available, including on the My Aged Care website. • That the NSW government establish a system to monitor, regulate and enforce section 104 (1) (a) of the Public Health Act 2010 (which mandates the requirement for an RN to be on duty 24/7).
Read the report online The four-month inquiry conducted by the NSW House General Purpose Standing Committee No.3 received more than 160 written submissions from community groups, local governments, aged care workers, relatives, health advocacy groups and aged care providers. A strong majority of the submissions called on the state government to retain the legal requirement to keep RNs in residential aged care 24/7 and highlighted the need to pay more attention to the future of aged care service delivery. The committee has given the government till 29 April 2016 to respond to the report, although Minister Jillian Skinner is expected to make a decision before the end of the year. A copy of the Legislative Council Committee’s report is available at: www.parliament.nsw.gov.au/prod/ parlment/committee.nsf/0/5617FD 421429545BCA257EEC008029E4?o pen&refnavid=CO4_1
Jocelyn Hofman, an RN working in aged care, says she is very happy with the Upper House inquiry report. “I am thrilled with the findings. It is a very thorough report and the recommendations they have made are forward looking. “If the Minister takes up these recommendations it will lead to a big improvement in the care of our elderly in nursing homes. It will make a very big difference.” Jocelyn says the ball is now in Minister Skinner’s court. “I’m hoping she will consider all of the recommendations. Especially the main ones like maintaining the legislation that keeps RNs in nursing homes 24/7, the recommendation for ratios and the recognition of aged care workers. “I’m hoping she will adopt this report and implement it in full. Especially now, with our ageing population, it’s urgent that aged care is fixed. ‘In a few years the number of people over 85 will increase four-fold. We really need to fix aged care and this is a very good beginning.” The RNs in aged care 24/7 campaign was crucial to winning this support, Jocelyn said. “Our campaign has been very, very important. All the steps we did: doing the petition, making the community aware, getting all the community organisations involved, Each and every person participating has really made a big difference. “But we’re not finished yet. We still need to maintain the pressure.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 21
CAR PARKING
Uproar over parking RPAH nurses and midwives are up in arms over a private car parking operator’s profit grab.
Left to right Eleanor Romney (RPA Branch), Kylie Tastula (RPA Branch), Brett Holmes (NSWNMA General Secretary), Jan Dilworth (RPA Branch), Gerard Hayes (HSU) and Emma Maiden (Unions NSW).
NURSES AND MIDWIVES AT ROYAL PRINCE Alfred Hospital in Sydney’s inner-west are furious at changes to staff car parking arrangements, including a steep rise in fees and a planned cut in the number of parking spaces. Car park operator Macquarie International Health Clinic increased the parking fee from $25.75 a fortnight to $5 a day ($50 per fortnight) with less than two weeks notice. Macquarie then flagged its intention to cut the number of parking spaces from 1200 to 600. It is not certain whether any of these remaining 600 spaces will be set aside for staff. The car park has a troubled history. In 1996 the then Central Sydney Area
Health Service signed a lease with Macquarie for a proposed private hospital and car park. In 1999 Macquarie partially built a car park on the site to service the proposed private hospital, however construction of the hospital never went ahead.With private health insurance coverage at a record low of 30 per cent, Macquarie decided the project was uneconomical, according to media reports. In April 2000 the area health service took over the cark park via a court order and finished its construction. In recent years, federal government support of private health insurance through tax incentives and rebates has meant an increased demand for private hospital
22 | THE LAMP DECEMBER 2015 – JANUARY 2016
services, meaning a private hospital on the public campus would be more lucrative, according to a Sydney Morning Herald report. Macquarie won a long-running legal battle against Sydney Local Health District to control the car park site and took over operation of car parking on November 2 this year. SERIOUS IMPLICATIONS The change in control has serious implications for staff, visitors and the RPAH itself, Kylie Tastula, secretary of the RPAH branch of the NSWNMA told The Lamp. She said 2000 people currently use the 1200 staff parking bays and another 1500 are on a waiting list to access parking.
Surrounding streets are metered or resident parking only and the nearest train station is a 20-minute walk. “Parking is already a nightmare without 600 more of us fighting for street parking every day,” she said. “Many staff members already have to park a half-hour walk from the hospital. People on afternoon shift can drive around for hours looking for a park.” Recent NSWNMA branch meetings to discuss the issue have drawn more than 150 nurses at a time. One meeting was so big it had to be moved to the staff canteen. Members unanimously resolved to reject the fee hike and called on Sydney Local Health District management to develop a detailed plan for alternate safe car parking options. General Secretary of the NSWNMA Brett Holmes said there was “no justifiable reason” for the fee increase, which appeared to be in breach of NSW Health policy. “There is no change in service delivery or operation – just a massive price hike well above the CPI for Sydney,” Brett said. “According to NSW Health Hospital Car Parking Fees Policy, parking fees are only supposed to be adjusted annually in line with inflation.” Brett says the changes will exacerbate the parking issues that already exist around the RPA hospital campus. “A recent survey of our RPA members found that 52 per cent of respondents spend more than 15 minutes looking for a parking spot. 61 per cent of respondents reported being late to work due to not being able to find a parking spot close by,” he said. “This is a major principal referral hospital in the heart of Sydney. It relies on the dedication of hardworking staff. In return these staff should have accessible and affordable parking.” PARKING SPOTS SLASHED Kylie says the biggest issue is the company’s intention to drastically slash the number of staff parking spots. “It seems they want to turn it into visitor parking, which is generally full by 9am or 10am and currently costs $25 per day, which few nurses can afford. “Public transport is not an option for many nurses especially those who do shift work. It is potentially dangerous to walk to a bus stop or train station in the dark. “Public transport is also unsuitable for staff members who bring their children to the hospital’s on-site child care centre.” She said the parking changes would make it harder for the hospital to recruit and retain staff. “People are already talking about leaving as a result.
Kylie Tastula, secretary of the RPAH branch of the NSWNMA
“We have staff who already take two hours or so to drive to work from the Blue Mountains and Central Coast. Some are likely to look elsewhere for work if parking gets even harder. “The issue of staff parking will also have a big impact on the general public.Visitors will find it even harder to get street parking if more staff are forced to park on the street.”
Macquarie International Health Clinic is owned by controversial medical entrepreneur Dr Thomas Wenkart, a former business partner of the disgraced Dr Geoffrey Edelsten. According to the Herald, Dr Wenkart’s companies run 12 hospitals including Manly Waters Private Hospital on Sydney’s northern beaches.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 23
KIDS IN DETENTION
Clinicians call for release of children in detention A huge crowd of nurses, midwives, doctors and other health professionals gathered outside Sydney Children’s Hospital Randwick and Westmead recently to tell the federal government to cease the ongoing detention of children.
“It is a national shame” Professor Nick Tally, President of the Royal Australian College of Physicians (RACP)
“I’m often asked why health professionals and organisations like the RACP are advocating for the health rights of refugees and asylum seekers. Refugees are patients. They are our responsibility and as doctors and health professionals, as physicians, we are duty bound to speak on behalf of our patients and on behalf of their human rights. I really want to remind people that refugees have human rights under Article 25 of the Universal Declaration of Human Rights. Motherhood and childhood are entitled to special care and assistance. And let me ask: ‘Are we providing special care and assistance to our patients who are children in detention?’.
I would argue that our governments have failed and I’m really disappointed that this is a bi-partisan failure. Frankly it is a national shame. Refugees do have unique physical and mental health needs, which reflect they are migrants and that they have escaped persecution. They have often survived physical and sexual violence. According to
24 | THE LAMP DECEMBER 2015 – JANUARY 2016
data recently released up to 20 per cent have had some kind of reported torture event. So it is no surprise that there are high rates of physical and mental illness amongst refugee adults and children. Detention harms children physically, mentally [and] developmentally. Imagine placing your child in a detention situation where many will start to bang their heads against the walls because they are depressed. Many will start to bed wet even though they have never done it before. Some will refuse to speak. Some will bite themselves or hurt themselves. Some will withdraw and others will be very sad every single day. Would you consider that to be a necessary evil? Would you accept it as a necessary evil ever? I certainly would not. It is not acceptable under any circumstances. No child should ever be held in detention or ever returned to detention. It must end from today.”
Children in detention – the figures The Department of Immigration and Border Protection’s (DIBP) statistics dated 30 September 30 2015 show: are held in immigration 113 children detention facilities within the
92 409 3,861
Australian mainland children are held in detention on Nauru children are detained in the community under residence determinations, a system referrred to as Community Detention children are living in the community on Bridging Visas which mean their parents generally have no work rights and very limited access to government support.
Sign the petition There is a petition from concerned clinicians and health professionals from around Australia that will be presented to the federal parliament to draw its attention to the escalating and increasingly desperate plight of the 205 children currently in immigration detention. The petition calls on parliament to immediately release these children together with their families from detention. The petition can be downloaded from: www.nswnma.asn.au/wpcontent/uploads/2015/10/Refugee-Clinician-Day-of-Action-Petition-General.pdf
“As health workers we know the impact of locking children up” Dr Karen Zwi, paediatrician, Associate Professor School of Women’s and Children’s Health “We not only believe, but we know from the evidence, from what we have seen and much that has been written, that detention harms children. Detention harms children in very many different ways. It impacts their health and development. It impacts their emotional health. It impacts their mental health. We’ve seen, as paediatricians, allied health workers and nurses, that children have been damaged by being in detention for more than 417 days on average. That’s a long time in a child’s life. A child needs to feel safe and welcome, to feel free to explore the environment, to be able to laugh and play, feel joy, freedom and security. As paediatricians and health workers we all know the impact of locking children up and giving them no sense of future, no sense of certainty and how that will impact on how they feel about the world around them. We see children who are fearful, children who are anxious. They can’t sleep at night. They have nightmares. They wet the bed. They regress. They have severe fears and anxieties about the world around them because all they have experienced in their short lives is the harshness, rather than the safety that they should be experiencing.”
“Nurses and other medical staff feel compelled to speak out” Brett Holmes, General Secretary NSWNMA “These people are experts in all facets of children’s health and they have witnessed the serious damage being caused to the mental and physical wellbeing of young patients being held in detention both in Australia and offshore. We are talking about the next generation of some of our world’s most diverse cultures and they are not being afforded the safe, supportive environment that many of us take for granted. Members of ours who have worked in some of these immigration centres have witnessed extremely distressing scenes: scenes of children in desperate need of nurture and comfort but instead living in a torturous situation. There is no wonder doctors, nurses and other medical staff feel compelled to speak out, as part of their professional obligations, regardless of the fact that the government has tried to silence them under elements of its Border Force Act 2015.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 25
NURSING ETHICS
Energising dissent
26 | THE LAMP DECEMBER 2015 – JANUARY 2016
From Florence Nightingale to the present nurses and midwives have always stood up for the vulnerable, often against the tide of politics and public opinion says nurse ethicist and Professor of Nursing Megan-Jane Johnstone of Deakin University, Melbourne.
The latest edition of your book Bioethics – a nursing perspective looks at nursing ethics and vulnerable populations. What prompted you to look at these issues?
I’ve always recognised that vulnerability lies at the heart of ethics.Vulnerability is a core driver of ethics.Vulnerability concerns the capacity of people to be hurt. Ethics is about preventing hurt. I looked at the literature on dehumanisation and the consequences of dehumanisation. I could see the link between vulnerability, dehumanisation and moral exclusion and then it became very clear how we could identify who we could regard as the “most” vulnerable. I wanted to make the issues at stake tangible and visible for nurses so they understand what they are up against, like the propaganda that exists in the media and the moral demand to counteract it. What are your conclusions?
Not to sit back. For example, the cruel and inhumane treatment of refugees and asylum seekers in Australia: how can we be moral bystanders and look the other way? We need to “energise dissent” against this treatment: expose the propaganda, expose the lies about what is really going on. I do think that nurses have for too long been focused on the internal issues that are generally located within the bricks and mortar of the hospitals. We should be extending our vision – which was the position of the early nursing scholars – to broader humanitarian and social justice concerns. That’s not to say that the nursing profession doesn’t have these broader, social justice concerns and indeed nursing organisations like the ANMF and the NSWNMA have been right out there voicing their concerns about refugees and asylum seekers. We have a responsibility to challenge the prejudices that are being perpetrated in the minds of the public and to live up to our reputation as one of the most trusted
professions in the country and the world and take a stand on these issues so we can say what has happened here is not acceptable. What are the implications for the future if governments are comfortable trampling all over the professional ethics and clinical judgments of health professionals?
We don’t need to look too far. If you look at societies that have repressive regimes, their political processes are treated with suspicion by their citizens. The societies themselves have become dysfunctional. Citizens feel completely disempowered and the societies don’t flourish. What we will end up with is a society in which perceptions of citizenship and civic responsibility and trust are corroded. We can’t allow that to happen. As a profession we need to buy into and support the narrative of cohesion, of citizenship, of multiculturalism. Not the narrative of fear, terror and suspicion. How does the Border Force Act impact on nursing?
The Border Force Act is an attack on nursing ethics. Part 6: 42(1) of the Act could see nurses gagged and even imprisoned for speaking out about the onerous conditions they have directly observed in Australia’s detention centres. Principles, policy and programs are what are really needed when we face the tragedies and tensions that now exist in the new world order: tensions and tragedies that are posed as terror. Once you start to suppress what are matters of principles of practice, of ethics, you get what I call a corrosion of our sense of professional and civic responsibility. Are there any historical examples we can draw on that show nurses in the forefront in the fight for social justice?
Historically nursing has always been at the forefront. In America you had nurses who fought for birth control for women.
There were nurses who came together and formed the International Council of Nurses, modeled on the International Council of Women. The rights of nurses were absolutely tied to the rights of women. Right now nurses are at the forefront of providing extraordinary support and advocacy for refugees and asylum seekers. Nurses have been advocates for vulnerable people such as the homeless, for people with substance addictions. Nurses are the ones who provide the majority of care to those men and women in prison. Nurses are out there but their work is not perhaps as visible as it needs to be. The modesty of nurses means that they are working because of their passion for their work not the notoriety. That is part of the mosaic of nurses working for the vulnerable. Attending a rally may not seem to achieve much but the symbolic value of that should not be underestimated. Such actions send a message to the public. One of the reasons Florence Nightingale was so successful was because she engaged the public. She used public media very successfully to get the public onside and I think there are valuable lessons to be learnt here. What do we do when an ethical position conflicts with public opinion?
Public opinion is just that, an opinion. It has no bearing on what is the right thing to do. Public opinion is a factor to be taken into consideration but it can also be extremely fickle. I think nursing organisations like the ANMF and the NSWNMA do a sterling job – they were among the first to get a response out to the Border Force Act – even though the climate was difficult. It is part of our civic and professional responsibility to ensure that the public is appropriately informed.You cannot equivocate over these issues.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 27
NURSING AND ICE
Ice needs more evidence and less fear Nurses and other health workers face “very worrying” risks in trying to manage people badly affected by the drug ice, the NSWNMA has warned.
“… a fear-based approach unfortunately can only increase the stigma associated with drug use …” — Assistant General Secretary Judith Kiejda
ASSISTANT GENERAL SECRETARY JUDITH Kiejda says nurses often have very limited resources to deal with ice-affected people, in environments that are not designed to manage patients who are out of control and violent. She told a NSWNMA education forum focusing on methamphetamines – particularly crystal meth or ice – that the union was working hard to make sure other patients and staff were given an adequate level of safety in order to prevent a tragedy. The NSWNMA has developed an app for members to download and use on their phones so they can inform the Association when and where violence is occurring. “Some ice-affected people are so physically and mentally unwell that the police don’t have the resources to manage them in their cells safely,” she said. “I am told they are quite often brought to the hospital by up to six or eight police. At that point the hospital staff take over their care and it’s up to the hospital to manage them. “NSW Health and local health districts need to ensure safer places for affected people to be properly cared for and safer working environments for their employees.” ICE USE IS STABLE Judith said that while the number of Australians taking amphetamines was “reasonably stable” users were tending to use the purer and more potent crystalised form known as ice. This meant a proportionally greater risk of experiencing adverse effects as shown by increased admissions to hospitals – up from 1269 in 2009-10 to 3134 in 201314, in New South Wales alone. “The Australian media and the politicians have been quick to claim we’re facing an ‘ice epidemic’,” she said.
28 | THE LAMP DECEMBER 2015 – JANUARY 2016
Judith questioned a $9 million television awareness campaign to combat use of ice, which features a user attacking hospital staff. She described it as “a fear-based approach that unfortunately can only increase the stigma associated with drug use and can drive people away from seeking treatment. “While it is crucial we don’t underestimate the effects this drug will have on individuals, their families and communities … evidence shows that fear based campaigns are not the best way to address the effects of harmful drug use. “We don’t want politicians to hijack the issue and overplay it for their own political purposes – that just causes more harm through fear and stigmatisation. FEAR CAMPAIGN COULD BACKFIRE “Some experts are concerned that a broadbased fear campaign could backfire and have even warned that a mass advertising campaign could potentially lead more young people to try ice. “Those working in drug and alcohol prevention are calling for a more researchbased approach, a public awareness campaign that emphasises that treatment is available. “We need to develop evidence-based approaches to this problem that will have a positive impact on services and treatment availability. “We need to look at what the Australian research evidence shows us will work for illicit drug use prevention here in Australia. “Australia is such a large and diverse country made up of many different cultures. Local communities need to decide what’s going to work best for them because, as we know, what may work in one may not work in another.”
“It’s vital to reduce the stigma attached to ice use.” Nurses’ ability to understand post traumatic stress is important in treating ice users, Annabel Mayo, a counsellor at St Vincent’s Hospital’s stimulant treatment program, told the NSWNMA’s recent ice forum.
“People who use drugs already feel bad enough about themselves — they don’t need society making it worse.” — Annabel Mayo
The St Vincent’s program is primarily a counselling service with medical support for clients over 18. “Some of our clients have lived lives that are so deeply traumatic, involving multiple instances of trauma, it is hard to understand how they managed to get through even one of them,” Ms Mayo said. Having already been traumatised by family members and society, some users appeared to be “re-traumatising themselves” with ice use. She said it was vital to reduce the stigma attached to ice use. “People who use drugs already feel bad enough about themselves – they don’t need society making it worse. The shame, the absolute mortification I see on the faces of my clients stands in the way of any recovery.” Ms Mayo says health workers should “look underneath the drug use and find the person there.” “A person who is overwhelmed by their failure to negotiate adult life, including an often traumatic past, and who has resorted to drug use, may value themselves as too low to deserve help. “This person may not see any future for himself/herself, may not see recovery as a possibility. How can this person heal? “Ultimately, the most therapeutic support may be given through relationships, through compassion. These qualities are stock in trade amongst nurses and can be powerful determinants of change.” She cited the example of US servicemen returning from the Vietnam War, many with some dependence on heroin. “Weirdly, very few had any long term addiction after they returned – and there is an argument that addiction is not a useful term. We certainly don’t use it. “The drug itself was not more powerful than jobs that were waiting, girlfriends and wives who were waiting, supportive family members and hopeful futures. All those things help people to find resources inside themselves to overcome substance use.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 29
NURSING AND ICE
Ice, pregnancy and parenting Health care workers can “turn life around” for users of ice if they are approachable and helpful, says registered nurse Josie Byrne of Drug and Alcohol Clinical Services in Newcastle.
“WE CAN HELP ICE USERS TO ACCESS SERVICES that can improve their quality of life, reduce harm to themselves and the community and make their children safer,” Josie Byrne RN told the NSWNMA forum. Ms Byrne works at John Hunter Hospital’s methadone clinic and its high-risk antenatal clinic that cares for mothers using drugs. “Lots of women we see can be really hard to engage in antenatal care so we try to be as flexible and accommodating as we can. My role is to educate and give them any help they need to stop using drugs,” she said in an address on the effects of ice in pregnancy and parenting. “Sometimes pregnancy is a fork in the road: there is no greater impetus to stop using than being pregnant.” Services in Newcastle include a stimulant treatment program that prioritises pregnant women and their partners.They can also access a detox unit at Belmont Hospital and get help from John Hunter obstetrics staff on the antenatal ward. “A lot of women feel they can’t do it on their own.We try to give them as much support as we can by phone and during visits to the clinic,” she said.
“Sometimes pregnancy is a fork in the road: there is no greater impetus to stop using than being pregnant.”
30 | THE LAMP DECEMBER 2015 – JANUARY 2016
TOO SICK TO CARE FOR THEIR CHILDREN She said ice sometimes made parents too sick to care for their children, who were also exposed to needle stick injuries – “I’ve seen kids playing imaginary games with sticks and tourniquets” – and the risk of ingesting drugs. Children were also at risk of physical and verbal abuse from intoxicated parents who had a lower threshold of tolerance for “crying
babies and tantruming toddlers”. Methamphetamines are also potentially damaging to the foetus – although the teratogenic side effects are not as severe as those caused by alcohol, Ms Byrne said. She has seen ice-induced cases of premature birth, placental abruption and bleeding and stillbirths – as well as “those amazing little fighting babies whose mums have used throughout the pregnancy” yet are born healthy. “I’m not sure how this happens but when it does it’s great because usually these babies have other social challenges to contend with.” ALCOHOL MORE DANGEROUS A survey that found 2.1 per cent of Australians had used methamphetamines recently, also found that over a quarter of the adult population drinks alcohol at risky levels. “It’s best not to be too quick to judge. Alcohol remains the most dangerous drug in pregnancy and also the most costly to our community. “We don’t want to demonise meth users; we want them to seek treatment without feeling stigmatised and judged. There are a lot of good mums I know who are still using a bit of ice – they are trying their best with the cards they’ve been dealt. “Of course kids’ safety is of the utmost importance. But I don’t think it’s my job as a nurse to feed into the hype and alarmist views and to demonise all ice users – especially when we don’t do that with our most dangerous and costly drug [alcohol].” She said ice users often were themselves victims of trans-generational parenting problems. They were sometimes estranged from their families due to their drug use and more likely to be single parents, victims of domestic violence or have partners in jail. “Some started using drugs at a young age and haven’t developed the ability to cope with stressful situations.” Ms Byrne says safe, healthy and happy children are always the priority. “Therefore it is imperative that we are accessible to these mums when they want help because we are not just helping them we are helping their kids too.”
Potent attraction for the young Use of crystal methamphetamine or ice more than doubled in the decade to 2013, while the use of lower-purity methamphetamine powder or speed almost halved.
“One of the criticisms of the shock campaigns is that teenagers in particular have a pretty acute radar when they’re only getting half the story.” — Kieran Palmer
This trend towards use of a purer more potent form of the drug poses a far higher risk of dependency, says psychologist Kieran Palmer, clinical services manager at the Ted Noffs Foundation. The foundation works with socially disadvantaged and disconnected young people. It has particular expertise in the treatment of young people with drug and alcohol problems and co-morbid mental health issues. Mr Palmer told the NSWNMA forum on ice that the tendency towards ice use was particularly strong among young people. In 2014, methamphetamine-type stimulants overtook cannabis to become the number one drug of presentation in the foundation’s two residential treatment and rehabilitation centres in the Sydney suburb of Randwick and Watson in the ACT. “About 55 per cent of our Sydney residents are in residential rehab primarily because of meth,” he said. In treating ice users it was important to acknowledge the “positive effects” experienced by users, including euphoria, greater stamina and heightened alertness and confidence. “One of the criticisms of the shock campaigns is that teenagers in particular have a pretty acute radar when they’re only getting half the story. “Young people take it once and say it’s the most insanely happy they’ve ever felt – like superman on top of the world.” Withdrawal from meth use could take up to 18 months during which time former users felt miserable and experienced a loss of motivation. “They think the only way they can feel good again is with more ice,” Mr Palmer said. It was therefore vital to explain to users that this depression was normal, while “shifting the focus onto the fact that it hasn’t changed you as a person forever, it hasn’t broken you, it’s just going to take time.” The foundation is training all staff – even administrative workers – in the Motivational Interviewing method. “This allows us to have targeted, evidence-based conversations with clients at any time day or night.”
THE LAMP DECEMBER 2015 – JANUARY 2016 | 31
FREE TRADE
Secret agreement bad for health The NSWNMA has called for an independent assessment of the health impacts of the Trans Pacific Partnership (TPP) agreement. THE TPP “FREE TRADE” AGREEMENT between 12 Pacific Rim nations including Australia, the United States, Japan, Canada and New Zealand, was recently made public after years of secret negotiations. Preliminary analysis of the TPP text leaves the Australian government with serious questions to answer, according to Assistant General Secretary of the NSWNMA Judith Kiejda. “The problem with the negotiation process for free trade agreements is there is no independent health impact assessment – we risk trading away access to affordable medicines for lucrative sugar exports,” Judith said. “What we now know about the TPP text, and what we are yet to learn, leaves us very concerned as health professionals. “Assurances by Trade Minister Andrew Robb that Australia’s health care system would not be impacted seem to have amounted to very little. “We need detailed information as to how the TPP will affect medicines in Australia – this needs full public disclosure and examination before federal cabinet sign off.” The text is still missing some important documents. Many of the side letters, with details of last minute bilateral deals between particular governments, have not been released. Spokesperson for the Australian Fair Trade and Investment Network Dr Patricia Ranald says these side letters are likely to favour the largest economies with greater bargaining power “and should have been released for public scrutiny with the main text.” MONOPOLY MEDICINES During TPP negotiations the US demanded that pharmaceutical companies be permitted to keep cheaper generic products off the market for eight years. Melbourne Age business writer Peter Martin said this demand for longer monopoly rights would cost Australia’s Pharmaceutical Benefits Scheme $100 million a year.
On the face of it the final text of the TPP only allows manufacturers a five-year protection on data from their drug trials – the same as under Australian law. However Judith Kiejda says the TPP appears to allow drug companies to drag the process out to eight years through administrative processes. “It’s not clear what this means exactly for Australia as the explanatory notes are not available,” Judith said. The chief executive of the Public Health Association of Australia, Michael Moore, agrees that the TPP opens the door for manufacturers to lobby the government to hold up their data for administrative reasons, taking longer for generic drugs to come to market. Mr Moore says this raises particular concerns about the new wave of expensive biologic drugs, which use human cells and tissue and are used to treat a range of conditions including rheumatoid arthritis and cancers. Added to this concern is a clause that would allow patents on existing drugs to be easily extended with new uses or forms. Peter Martin says this effectively prevents the Australian government from reducing a manufacturer’s monopoly rights over drugs, because Australian regulations will be overseen by an international TPP Commission “to prevent backsliding”. Judith Kiejda says this means access to generic, affordable medicines in Australia will reduce over time and individuals or the government will be forced to pay more for medicines. “While this is bad news for Australians, it will be even more devastating for developing nations. We know that transition periods for developing nations are too short,” she said. SUING THE GOVERNMENT Controversially, the TPP gives foreign companies the right to sue Australian governments if they introduce laws they say have harmed their investments. The process is called Investor State Dispute Settlement (ISDS).
32 | THE LAMP DECEMBER 2015 – JANUARY 2016
Sydney Morning Herald business columnist Michael West cited examples of multinational companies suing governments under ISDS clauses in other free trade pacts. Water and waste company Veolia is suing the government of Egypt for lifting the minimum wage. Other companies are suing Canada for a ban on fracking and Germany for phasing out nuclear power. “US corporations are the biggest litigants, having brought some 127 cases thus far against sovereign government decisions, which they claim have damaged their financial interests,” West wrote. “Taxpayers have the pleasure of footing the legal defence bills. Even worse, the authority of sovereign courts is ignored in favour of an international dispute tribunal.” West says the TPP is as much about free trade as it is about entrenching the interests of large multinational corporations. “It is no secret that while the citizens of the 12 signatory nations remained in the dark about the detail of the regional free trade pact, multinationals and their lobbyists had a large hand in shaping it.” Judith says there are many international examples of drug companies suing governments because of the decisions of their PBS systems. “If governments can’t make decisions about appropriate health care provision, for fear of being sued, we need to ask ‘In whose interest are these deals being negotiated?’” Michael Whaites, sub-regional secretary for Public Services International (PSI) says the TPP has serious implications for workers’ rights. He said there was concern the TPP text failed to uphold the rights of workers and core International Labour Organization standards. “We may well be in the same situation as Egyptian workers who won an increase in the minimum wage, only to see a foreign multi-national commence legal action against the government for having dared to try and improve the lives of workers,” he said.
“[Pharmaceutical companies’] monopoly rights would have cost Australia’s Pharmaceutical Benefits Scheme $100 million a year.” — Peter Martin Melbourne Age
THE LAMP DECEMBER 2015 – JANUARY 2016 | 33
easy!
BEING A MEMBER OF THE NSWNMA IS
Update your membership details online and go into the draw to
a
Hunter Valley
Escape
Condition apply: ^ Voucher expires 10 April 2016, non-transferable; *Dinner voucher excluding beverages Competition entries from NSWNMA members only. Competition opens 1 October 2015 and closes 31 December 2015. The prize is drawn on 1st of the month following the competition. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW permit no: LTPM/15/00192.
Log into the Association’s online portal at www.nswnma.asn.au to check your membership details are correct, and change if necessary. You will not only enjoy having the choice to do this at a time that suits you – but your name will automatically go in the draw to WIN A HUNTER VALLEY ESCAPE! So close to Sydney yet truly a world away, the Hunter Valley is the birthplace of Australian wine. Wine Country – as the Hunter Valley is known – is a dynamic wine region with more than 150 premium wine producers, 60 tempting restaurants and 180 inviting places to stay. It has all the ingredients for a perfect getaway, from gourmet regional produce, boutique breweries, indulgent spas and action-packed adventures, to acclaimed gardens, galleries and heritage towns. Wind your way between old delights and new surprises as you relax and unwind in this remarkable region. You and a friend will stay at Pokolbin Village for two-night midweek in a deluxe queen suite room^. This fantastic package also includes a bottle of Hunter Valley wine on arrival; late check-out of 12pm; discount vouchers for on-site shops and Audrey Wilkinson/Cockfighter’s Ghost; a 3 course dinner for two people* at the Mill Restaurant; entry for two people into Australia’s largest display gardens, the Hunter Valley Gardens; and to see the Hunter Valley from a different perspective, weaving in and out of the vines on a Segway tour, thanks to East Coast Corporate Xperiences. For a chance to win, simply register with your membership number, name and email address and create your own password. From then on use your member number and password to log in directly to the Members login area on the website. You can now change your details at any time – address, workplace, credit card number, mobile number, etc. You can pay fees online, print a tax statement or request a reprint of your membership card – it’s simple. All those who use our online portal from 1 October – 31 December 2015 will be automatically entered into the draw.
www.nswnma.asn.au MEMBERSHIP ONLINE VIA
ask judith
when it comes to your rights and entitlements at work, nswnma assistant general secretary JUDITH KIEJDA has the answers. Deleted on maternity leave I am a nursing unit manager in a public hospital currently on maternity leave. I have been contacted and told that, as a result of a restructure, my position will be deleted. Can they do that while I am on maternity leave? Under clause 34A (xiv) of the Public Health System Nurses’ and Midwives’ (State) Award 2015, an employee returning from maternity leave has the right to resume their former position. However, where this position no longer exists, the employee is entitled to be placed in a position nearest in status and salary to that of their former position for which the employee is capable or qualified to undertake. Under this same Award provision, the employer has an obligation to communicate to an employee on maternity leave any change proposed to their position/workplace and make all relevant information available to them. The employee is to be provided an opportunity to discuss any proposed change to their current position. Policy Directive PD2012_021 (Managing Excess Staff of the NSW Health Service) also sets out certain obligations on the employer prior to declaring a staff member excess. No affected staff member on maternity leave (whose position has been deleted) is to be declared excess until they return to work and the employer ensures that there are no other suitable vacant permanent or temporary positions in the organisation into which the staff member may be placed (Section 4).
Epilepsy examination I am an assistant in nursing working in a nursing home. I have epilepsy and recently had a seizure at work. Management have asked me to attend an independent medical examination. Is this reasonable? Where an employee has an illness or injury that may pose a risk to their own health or safety, or the health and safety of others at the workplace, available options to the employer and employee include: • Requesting the employee to provide medical advice from a registered medical practitioner; or • Directing the employee to proceed on sick leave while medical advice is being sought; or • Referring them for a medical assessment. Where there are valid concerns about the employee’s fitness to carry out their duties action may include seeking the employee’s consent to discuss their prognosis with the provider of the
medical certificate, or referring them for a further medical assessment. Other assessment options may include, but are not limited to, a return to work on normal or reduced hours/duties, job redesign, work in an alternative position temporarily or permanently, continued absence or medical retirement. Where
BREAKING NEWS The Association has made representations to the Ministry regarding the new version of the NSW Health Code of Conduct via policy directive PD2015_035. The Ministry said the new code came as part of an updating and clarification exercise only, and as a result they did not consult with the Association. It is therefore extremely disappointing that the revised version of the code has been found to contain changes that go beyond that which could reasonably be described as “updating” or “clarifying”. The Association has made it clear to the Ministry that these changes have expanded the reach of the previous code and as such should have been subjected to consultation to discuss their intent and practical application. For example, a new provision is contained at Section 4.4.3, which introduces a prohibition in relation to “industrial activities” and “campaigns”; creates ambiguity and uncertainty as to its practical application; as well as being at least in part at odds with award provisions and that of the Leave Matters Manual as it pertains to trade union activities. Discussions have now been opened and the Association has made it clear that, until this matter is resolved, if any member of the Association is sought to be subject of any possible sanction involving those aspects of the code that have been varied without consultation, we reserve our right to immediately dispute these with the relevant health organisation and/or seek the status quo to be put in place regarding those processes until the consultation process and dispute regarding the revised code with the Ministry is concluded.
there is disagreement or lack of clarity over the outcome of the medical assessment, there must be a review mechanism for employees. Seek further advice from the Association as situations
have arisen where members with highly manageable conditions have not received the level of support and accommodation they might reasonably expect.
Bullying stress requires action I feel I have been bullied by my employer and need to take time off work. Can I take stress leave? There is no such thing as “stress leave” however your options are to take sick leave or make a claim for workers compensation for psychological injury. In either case it is recommended that you see your doctor to discuss the circumstances at work and the impact they are having on your health. If your doctor believes a workers compensation claim is warranted they will need to complete a WorkCover certificate of capacity and provide a proper medical diagnosis, directly attributable to the workplace behaviour (for example, depression, anxiety). Further information is available from the Association or on the NSW WorkCover web page: www.workcover.nsw.gov.au/workerscompensation-claims/making-aclaim/worker-claims.
Service check register review I am an RN working at a public hospital. I have been placed on the service check register (SCR) following an allegation that was sustained in an investigation process. I also received a formal warning. I believe the entry on the SCR is over the top. Can I have this reviewed and removed? Ministry of Health policy directive PD2013_036 (Service Check Register for NSW Health) contains specific provisions for a review of SCR records when requested by an employee. Such a request can be made (under Section 7) on the basis that the record was created incorrectly or inappropriately; or that the risks that resulted in the record being created have changed or no longer exist. This latter point may include that remedial action has been completed. A review can also be requested if registration conditions originally imposed by the Nursing and Midwifery Council have been removed. Of course the health organisation also has a responsibility to ensure that the record remains valid and has not been overturned or changed by any subsequent review or re-investigation that varies the original reason for the record being made. A review by the Ministry can also be requested if a member was dissatisfied with any review undertaken by a health organisation. Members should seek advice from the Association on such reviews, as having such a record removed is not straight forward or easily achieved.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 37
&%$#"! "% "! "$ ! !!"! " " !" " % " ! !" " " " % " " $ " " ! " " "$%$ !" !!% #
% " " " " " % $%$#$ !! %
38 | THE LAMP DECEMBER 2015 – JANUARY 2016
NSW Nurses & Midwives’ Association – in association with the Australian Nursing & Midwifery Federation
ClassiďŹ cation
Membership Fees Year
Quarter
Month
Fortnight
Registered Nurse Registered Midwife
$709.00
$177.25
$59.08
$27.26
Enrolled Nurse
$602.00
$150.50
$50.16
$23.14
Assistant in Nursing+ $496.00 Residential Care Nurse
$124.00
$41.33
$19.06
Membership fees are TAX DEDUCTIBLE ABN 63 398 164 405 *All membership fees include GST +Trainee AiNs have their fees waived for the period of their traineeship
social media | nurse uncut
WHAT’S
A BLOG FOR AUSTRALIAN NURSES AND MIDWIVES www.nurseuncut.com.au Do you have a story to tell? An opinion to share?
HOT THIS MONTH
Nurse Uncut is also on Facebook: www.facebook.com/NurseUncutAustralia and on Twitter @nurseuncut
nurse uncut is written by everyday nurses and midwives.
We welcome your ideas at nurseuncut@nswnma.asn.au We remember
On Remembrance Day we honour those who have fought in wars and conflicts. Nurses and midwives have had a vital role during these conflicts. One was Alice Cashing, the first Australian nurse to be awarded the Royal Red Cross. www.nurseuncut.com.au/we-remember/#more-11354
Upper House backs need for RNs 24/7 A report into the role of registered nurses within residential aged care in NSW has found they are essential to high-quality care and recommended a legal minimum requirement to ensure RNs are on duty at all times. www.nurseuncut.com.au/upper-house-inquiry-backs-need-for-registered-nurses-in-aged-care/#more-11345
How a week in intensive care changed me Lisa Byrant discusses how a harrowing experience made a few things crystal clear: we are all in this together. www.nurseuncut.com.au/how-a-week-in-intensive-care-with-my-daughter-changed-me/#more-11327
Dying with dignity A NSW Parliamentary Working Group on Assisted Dying has been established with the key objective of achieving law reform on the issue. www.nurseuncut.com.au/dying-with-dignity/#more-11322
Inquiry into elder abuse Aged care nurse Mary invited other nurses to participate in the current NSW Parliamentary Inquiry into Elder Abuse. www.nurseuncut.com.au/inquiry-into-elder-abuse-in-nsw/#more-11195
Academy names first nurse fellow Griffith University Professor of Nursing Claire Rickard has become the first nurse to be made a Fellow of the Australian Academy of Health and Medical Sciences. www.nurseuncut.com.au/academy-of-health-and-medical-sciences-names-first-nursefellow/#more-11309
New on SupportNurses YouTube channel now add money The NSWNMA hosted a fundraising movie night for the Luke Batty Foundation with a special preview screening of the new Aussie comedy Now Add Honey. >>youtu.be/byUHnoPNLGQ detention harms children A huge crowd of health professionals including nurses and midwives gathered outside Sydney Children’s Hospital Randwick to send a message to the federal government. >> youtu.be/-dEX7UP4gz0
NSWNMA on Instagram! 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. THE LAMP DECEMBER 2015 – JANUARY 2016 | 39
Online Nurse Shop
FREE $10 Valid to January 31, 2016*
$19.50 Scrubs Pre-orders: Valid to Feb 29, 2016*
For the details on these promotions visit www.enurse.com.au/promotions
enurse.com.au/eshop 1300 886 814
TO ORDER FAX: Myrtle Finlayson, (02) 9662 1414 POST: NSWNMA, 50 O’Dea Avenue, Waterloo NSW 2017 EMAIL: gensec@nswnma.asn.au
www.nswnma.asn.au
WEB
ORDER FORM NSWNMA Navy Polo Shirt with embroidered logo $20 Quantity: Size: Ladies Size 14 (to fit sizes 8-10) Ladies Size 16 (to fit sizes 12-14) Unisex S Unisex M Unisex L Unisex XL Unisex XXL Unisex XXXL
NSWNMA Navy Polo Shirt with embroidered logo $20
NSWNMA Navy Canvas Duffle Bag $25 Quantity:
Available in Ladies size 14 (to fit sizes 8-10) and 16 (to fit sizes 12-14); and Unisex sizes S, M, L, XL, XXL, XXXL
NSWNMA Bone China Mug $10 Quantity: Total cost of order $ Please include postage & handling of $3/order for NSWNMA mug and $5/order for other merchandise. Bulk orders will be charged accordingly.
Name Address
A NSWNMA Navy Canvas Duffle Bag $25
Large main zippered compartment; cotton webbing heavy duty double carry handles, removable adjustable shoulder strap, 1 side end slip pocket.
Postcode A
B
NSWNMA Bone China Mug $10
40 | THE LAMP DECEMBER 2015 – JANUARY 2016
B
Phone
H
W
MOB
Email Method of payment
Cheque Money Order
Name of card holder Card number Expiry date
/
Signature
Mastercard Visa
social media | facebook
WHAT NURSES & MIDWIVES
SAID & LIKED on facebook www.facebook.com/nswnma Facing death ABC’s Q&A recently dedicated an entire episode to the issues that arise when dealing with death.
Quick turnaround A condition of continued birthing services at Murwillumbah District Hospital is that mothers expect to be discharged four to six hours after giving birth.
Car park hike Nurses and midwives at Royal Prince Alfred Hospital in Sydney’s inner west have condemned plans by car park operators to increase staff parking fees.
Was great discussion still waiting for the cogent argument on why it can’t be the individual’s choice. Patients need to discuss this. Death is inevitable.
Giving birth should be the most cherished moment by forgetting everything else and focusing on the event, benefiting from being in a supportive, a medically safe and nurturing environment. Leaving hospital before 2-3 days can potentially put babies and mothers at risk. If women have the right midwifery support, home is the best place for them to be. 48hrs in hospital is all well and good for a post-natal stay but then no follow up care except by the GP. I wonder what the long-term breastfeeding rates are like for these women? Giving birth is the easy part – breastfeeding and everything that comes along with it … is the tough bit that women need help with immediately following birth. The women of my grandmother’s generation would be horrified. They fought long and hard for hospitalised childbirth to save lives. The government’s policy is also to discharge first time caesarean mothers within 24-48 hours. We see these women in our ED in the first week with problems with the baby.
Shocking to have to pay to park at work. Luckily so far parking is free at Kempsey. We should get a pay rise then! Most hospitals run on a lot of goodwill hours given by the people who work there, is it really wise to slug them in the hip pocket when they already give so much back for free? Six-year wait to even get into the car park at Children’s Hospital Westmead! Pay $16 a day or park in the next suburb. Not acceptable! For any hospital!
Working this Sunday? Tell the world how important penalty rates are to you.
Worked yesterday a Saturday afternoon. I couldn’t be at my son’s cricket match to see him and his team win. Today I miss my oldest son’s BBQ at his new house because I have to work. I don’t choose to work weekends – I do it for the penalty rates. I work every weekend, why? Because I can’t afford to live and pay my bills otherwise! I too would like a social life but until nurses receive decent pay in nursing homes people like myself have to be away from their families far too many hours just to keep their heads above water.
PHOTO GALLERY
We remember all who have served.
Nurses and midwives know climate change is bad for health. That’s why we marched in the Peoples’ Climate March in November!
The NSWNMA put forward a team to grow their mo’s and raise funds for men’s health.
The NSWNMA Facebook page is approaching 10,000 likes and we just wanted to thank you for helping us get there.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 41
test your knowledge
1
2
8
12
3
4
9
5
6
10
7
11
13
14
15
16
14
17
18
19
15
20
21
22
23
24
25
26
28
31
34
32
29
27
30
33
35
36
37
Across 1. A jerky pulse with forcible impulse but immediately collapse (5.6.5) 8. Dental index (1.1) 10. Thematic Apperception Test (1.1.1) 11. A distinctive style or form of clothing 12. Impairment of the sense of smell 14. A period of decline or diminution 15. A disorder distinguished by sudden attacks of brief deep sleep 16. Members of the phylum Mollusca, which includes snails, slugs 17. Foetal alcohol effects (1.1.1) 18. The dental specialty dealing with tooth extraction 22. Crackle 23. Causing obstruction or blocking
26. A formula for determining obesity (1.1.1) 28. A skin surface microscope that uses the technology of epiluminescence microscopy 31. Destructive to the liver 33. Relating to the mouth 35. An abnormal aversion to food 36. Dental tartar 37. Eardrum (8.8) Down 1. A third molar (6.5) 2. The innermost of the three primary germ layers of the embryo 3. Detachment of a portion of tissue, especially muscle, and reattachment at an advanced point
4. Rolando area (5.6) 5. Torticollis in which the spasm affects the posterior neck muscles (11.5) 6. Ointment 7. Organisms in its early stages of development 9. To inspire or influence thoroughly 13. The ego 19. Symbol for dalton 20. Symbol for neon 21. The basis of analytical epidemiology, the statistical comparison between groups 24. A small separating wall or partition
25. Small networks, especially protoplasmic networks in cells 26. Branchiootorenal (1.1.1) 27. Intraepithelial Lymphocyte (1.1.1) 29. The sixteenth letter of the Greek alphabet 30. An officer who holds inquests in regard to violent, sudden, or unexplained deaths 32. An egg-containing capsule, such as a Graafian follicle 34. Sheep cell agglutination test (1.1.1.1) 35. Sulphonylurea
THE LAMP DECEMBER 2015 – JANUARY 2016 | 43
NURSES & MIDWIVES: There are many benefits of being a financial member of the NSWNMA — did you know that
Authorised by B.Holmes, General Secretary, NSWNMA
YOUR MEMBERSHIP FEES COVER YOU FOR TRAVEL TO AND FROM WORK? If you are involved in an accident while travelling to or from work, NSWNMA’s Journey Accident Insurance provides you with peace of mind. In recent years this insurance has been a financial safety net for many members who have met unfortunate circumstances travelling to or from work. As a financial member of the NSWNMA you are automatically covered by this policy. It’s important to remember however, that it can only be accessed if you are a financial member at the time of the accident. So make sure your membership remains financial at all times by paying your fees by Direct Debit or Credit. Watch Alexis talk about Journey Accident Insurance
JOURNEY ACCIDENT INSURANCE
Your journey injury safety net
UNSURE IF YOU ARE FINANCIAL? IT’S EASY! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural). Change your payment information online at
www.nswnma.asn.au
nursing research online
The Turnbull government looks different to the Abbott administration, however in terms of health policy our concerns about the future of Medicare and the fundamental principle of universality remain. The Conversation published an excellent series examining the issue earlier this year. Explainer: why do Australians have private health insurance? Sophie Lewis, USyd; Karen Willis, ACU; Marika Franklin, USyd All Australian residents have access to Medicare, so why do half the population also decide to take out private health insurance? And what do they get out of it? The biggest users of private health insurance hospital benefits are 60 to 79-year-olds. Women in their 20s and 30s also have a higher claim rate for maternity care. Payments for extras are spread across all age groups, with the biggest component going to dental care, followed by optical, physiotherapy and chiropractic. Our research shows that some people purchase private health insurance because they want more control over their health care, choice about the services they use and choice of doctor. They perceive that private health insurance gives them benefits including shorter wait times, choice of the timing of appointments, better quality of care and security or “peace of mind”. theconversation.com/explainer-why-do-australianshave-private-health-insurance-38788
Can private health insurers justify a 6.2% premium increase? Terence Cheng, USyd The half of the Australian population that has private health insurance can expect higher bills, as premiums increase by an industry average of 6.18 per cent. The increase varies across different funds, ranging from 3.98 per cent to 7.92 per cent and will add around $200 to $300 a year to the average cost of hospital cover for families. The increase is two to three times higher than inflation. So, how can the government approve such a hike? And how much profit are private health insurance companies making? theconversation.com/can-private-health-insurersjustify-a-6-2-premium-increase-38390
Private health insurance ‘carrot and stick’ reforms have failed – here’s why Anne-Marie Boxall, USyd Some people baulk at the cost of private insurance – especially the relatively young and healthy – because they don’t see the value of it when they are already covered under Medicare. Others see a struggling public hospital system and wonder whether private health insurance is alleviating much of the burden. The challenge of sustaining a viable private insurance sector alongside Medicare is not a new one. Successive governments have largely ignored the issue, vainly
hoping that strengthening either Medicare or private health insurance will be enough to solve the problem. It won’t be. theconversation.com/private-health-insurancecarrot-and-stick-reforms-have-failed-heres-why38501
If the government wants price signals, it should stop supporting health insurance Ian McAuley, University of Canberra Whether by design or accident, the government seems to be undermining the principle of Medicare as a universal tax-funded program, paving the way for private health insurance to play a role in funding primary care. But private insurance, by its very nature, suppresses price signals and encourages over-servicing and cost escalation. It is an expensive way to fund health care. If the government wants more price signals in health care, it can start by standardising the mess of arbitrary co-payments in health care. If those copayments can be re-designed to carry meaningful price signals, they will guide wise choice and contribute to efficient resource allocation. theconversation.com/if-the-government-wantsprice-signals-it-should-stop-supporting-healthinsurance-38389
The debate we are yet to have about private health insurance Lesley Russell, University of Sydney Successive governments of both persuasions have failed to convincingly articulate why Australians need what is increasingly a duplicate health care system – with duplicate costs for many – and why the federal financial contribution to private health insurance should be so substantial. The 2014-15 Budget Papers show the cost of the private health insurance rebate will grow from $5.997 billion in 2013-14 to $7.187 billion by 2017-18. Private health insurance is variously seen as an essential feature of a “balanced” health care system comprising both publicly and privately funded and provided health care, or as an instrument of patient choice and responsibility that relieves the pressures in increasingly strained public services. Most recently, the National Commission of Audit (NOCA) has raised the possibility of requiring higher-income earners to take out private health insurance for basic health services in place of Medicare. Both the NCOA and the Harper Competition Policy Review advocate an expanded role and less regulation for the private health insurance sector. theconversation.com/the-debate-were-yet-to-haveabout-private-health-insurance-39249
THE LAMP DECEMBER 2015 – JANUARY 2016 | 45
Recruit a new member & go in the draw to visit
B g n i a z n a g m k a o k! e NSWNMA is pleased to announce the NSWNMA’s 2015 – 2016 Recruitment Incentive Scheme Travel Prize
The winner will be flying off to the amazing Bangkok! You and a friend will be flying Scoot’s brand new 787 Dreamliner from Sydney to Bangkok via Singapore, staying 5 nights in a superior room at Centara Watergate Pavillion Hotel Bangkok with breakfast each day, airport transfer and a city tour. Centara Watergate is a trendy modern hotel located in the heart of the shopping district of Pratunam and close to Siam Square. Attached to Watergate Shopping Mall, the Centara Watergate has perfect accommodation for couples and families, including rooms with double beds and family suites with bunk beds. Stunning outdoor bar and dining areas with roof top ‘Walk’ lounge bar with stunning views across Bangkok, resident DJ and huge outdoor screen. A short walk to the Airport train link station for easy access from Bangkok International Airport.
Every member you sign up over the year gives you a ticket in the draw! RECRUITERS NOTE: Nurses and midwives can now join online at
www.nswnma.asn.au! If you refer a new member to join online, make sure you ask them to put your name and workplace on the online application form. You will then be entitled to your vouchers and draws in the NSWNMA Recruitment Incentive Scheme.
PRIZE DRAWN 30 JUNE 2016
book me All the latest Book Me reviews from The Lamp can be read online at www.nswnma.asn.au/library-services/book-reviews. Each review includes a link directly to that item in the library catalogue plus instructions on how to request a loan.
Nothing About Us, Without Us! 20 Years of Dementia Advocacy
special interest
Christine Bryden Jessica Kingsley Publishers via Footprint Books www.footprint.com.au RRP $42.95 ISBN 9781849056717 Drawing on her own journey author Christine Bryden offers a compelling view of what it is like to walk in the shoes of a person with dementia and invites the reader to “aspire to a new paradigm of dementia survival with dignity”. This collection of forceful and inspiring presentations, addresses issues of stigma, care, hope and ways of living effectively, plus shows how much progress has been made in making the world more inclusive for people with dementia.
Yatdjuligin Aboriginal and Torres Strait Islander Nursing & Midwifery Care Odette Best and Bronwyn Fredericks Cambridge University Press via JR Medical Books www.medicalbooks.com.au RRP $79.95 ISBN 9781107625303 Yatdjuligin, meaning “talking in a good way”, is a book designed for both non-Indigenous and Indigenous nurses, midwives and psychiatric nurses who work with Aboriginal and Torres Strait Island patients. It addresses the relationship between Aboriginal and Torres Strait Island cultures and mainstream health services and aims to prepare health workers for a wide variety of situations and environments. It examines the impact of historical, political and sociological factors on the health of Indigenous Australians. It also has chapters on community controlled health services, remote area nursing, mental health and caring for Indigenous Elders.
Good Pharma: The Public-Health Model of the Mario Negri Institute Donald Light and Antonio Maturo Palgrave Macmillan www.palgravemacmillan.com.au RRP £59.50 ISBN 9781137388339 Good Pharma describes a working model of institutional integrity that bypasses the many ways that commercialised research has corrupted transparent science, valid results and trustworthy clinical practice. It recounts how a brilliant young researcher, Silvio Garattini, and a boldly imaginative philanthropist, Mario Negri, conceived of an independent, ethicsbased research institute to develop better medicines for patients. Drawing on its public health model, the Institute has successfully influenced the founding of the WHO Essentials Medicines List, nurtured the Cochrane Collaboration and the reform of European regulations to reduce commercial influences and increase transparency.
In The Kingdom of The Sick: A Social History of Chronic Illness In America Laurie Edwards Bloomsbury via Allen & Unwin www.allenandunwin.com RRP $19.99 ISBN 9781620406281 More than 133 million Americans now live with chronic illness, accounting for nearly threequarters of all health care dollars and untold pain, disability and heartbreak. This landmark book charts the growth in these chronic illnesses and investigates how science, technology and culture are impacting the lives of people who are sick. It argues that we must be wary of the limits of science, and confront our throwback beliefs that people who are sick have weaker character than those who are well. Through research and patient narratives the author explores patient rights, the role of social media in medical advocacy, the origins of our attitudes about chronic illness and much more.
The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care John Foot Verso via Allen & Unwin www.allenandunwin.com.au RRP $35 ISBN 9781781689264 In 1961, when Franco Basaglia was appointed as the new director of the grim Gorizia asylum, on the Italian border with Yugoslavia, it was, like many asylums across the world, a place of horror where the “mad” were incarcerated for life. However this new director, inspired by the writings of the radical philosophers and psychiatrists of his day, was convinced that the entire asylum system was morally bankrupt. So he decided to abolish it. This comprehensive book is a gripping account of one of the most influential psychiatrists of the twentieth century and his revolutionary approach to psychiatry and mental health.
All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow books via the Library’s Online Catalogue www.nswnma.asn.au/education/library-services Call 8595 1234 or 1300 367 962 or email gensec@nswnma.asn.au for assistance. Some books are reviewed using information supplied and have not been independently reviewed.
THE LAMP DECEMBER 2015 – JANUARY 2016 | 47
movies of the month
This is an achingly beautiful story about two women who fall in love and fight to follow their hearts, despite the conventional norms of their time, writes Jan Page. Carol is a powerful drama about a married woman who risks everything when she embarks on a romance with a young department store worker. Starring Cate Blanchett and Rooney Mara, the film is set against the glamorous backdrop of 1950s New York. It was a major Cannes Film Festival sensation – where Rooney Mara picked up a Best Actress prize and director Todd Haynes (Far From Heaven) won the Queer Palm – and the buzz is it is a firm contender for an Oscar. But which leading lady will take home the Oscar: the iconic and alluring Blanchett or the infatuating Mara? Mara plays Therese, an innocent single girl working as a sales clerk in the toy department of a large New York department store during Christmas. We don’t learn much about Therese except that she’s lonely, semi-orphaned and has moved to the city in the hope of becoming a photographer. Somehow she has managed to acquire a self-absorbed suitor, Richard (Jake Lacy), whose lumpish sexual overtures leave her dismayed. Things heat up dramatically when a beautiful, blonde sophisticated woman (Blanchett) visits the department store in search of a doll. For reasons she can’t yet understand, Therese is instantly, tumultuously, attracted to her. The watchful, half-amused and somewhat predatory stranger departs with a smile, but not before Therese has memorised her name, her address and found the gloves she leaves behind. Both women struggle with their increasing infatuation with each other and their respective unsatisfactory relationships. Richardthe-boyfriend (now badgering Therese to marry him) and Harge, Carol’s rich and boring husband (Kyle Chandler), grow suspicious of their intimacy. Over the Christmas holidays the two women embark, Thelmaand-Louise-style, on a cross-country road trip. This journey leads both women on a voyage of self-discovery and personal crises. Based on the 1952 novel The Price of Salt by Patricia Highsmith (The Talented Mr Ripley), the art direction in this film is on point, with special kudos to the costume, make-up, set and cinematography teams. A terrific supporting cast features a few familiar faces including Sarah Paulson, Cory Michael Smith and for fans of Portlandia, Carrie Brownstein. I thoroughly enjoyed the film. Jan Page is Immunisation Coordinator for the City of Ryde. IN CINEMAS JANUARY 14
48 | THE LAMP DECEMBER 2015 – JANUARY 2016
METRO MEMBER GIVEAWAY Email The Lamp by the 12th of this month to be in the draw to win a double pass to Carol thanks to Transmission Films. email your name, membership number, address and phone number to lamp@nswnma.asn.au for a chance to win!
movies of the month
This film is both beautiful and complex, writes Sue Miles. In the Belier family everyone is deaf except dutiful Paula (young French actor Louane Emera) who is the indispensable signing interpreter for her parents and her brother and also for the family’s business activities involved in the running of a dairy farm. When Paula joins the school choir, to be close to a boy she is keen on, the movie becomes a tale of leaving home and the journey into adulthood. This could be said to be a modern day Amelie as it turns out Paula has a magical voice and is given the opportunity to audition for a prestigious choir in Paris. The journey now involves leaving home, leaving parents, becoming an adult and obviously a fantastic song-filled finale. It’s cute, it’s sweet, it’s sometimes predictable, includes a latex allergy and also local French politics, but ultimately this is a charming film you should all go and see. It would have to be one of the best films I have reviewed to date and you’ll leave the cinema feeling happier about the world for doing so. Sue Miles works in Perinatal Mental Health at the Royal Hospital for Women, Randwick IN CINEMAS DECEMBER 26
METROMEMBERGIVEAWAY Email The Lamp by the 12th of this month to be in the draw to win a double pass to La Famille Bélier thanks to Palace Films. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!
This film about the struggle to attain the female vote is a moving and intense drama, writes Meg Collins. Suffragette displays the very foundations of Feminism in early twentieth century Britain. Women lived in a patriarchal society, subservient and obliged to the wishes of their husbands, regardless of their social class. If women were employed, they were usually uneducated, performing menial tasks and at times, had little choice but to fall to the sexual prey of their employers. Women knew their place. The story centres on the personal battle of Maud (Carey Mulligan) a young woman from the East End of London, who has worked since she was seven in a damp, dangerous laundry where injury and disease are rife. She becomes swept up in the cause – fighting to secure the vote for women – and has to make inordinate sacrifices along the way. She finds herself in situations and meeting people that she would never have dreamed possible. Carey Mulligan’s performance is wonderful: the working class girl fighting for a cause. The production design is perfect and the screenplay has a compelling narrative. The cinematography is clever and understated. There is a list of statistics at the end of the film that will induce pride, disbelief and alarm! If you have an interest in history, feminism and/or politics, this film is for you. Although at times voting can be difficult for us, this film, which also stars Helena Bonham Carter and Meryl Streep, is a poignant reminder that securing the vote for women was extremely dangerous for the women involved. It commemorates a watershed in the history of Feminism that is both inspirational and heartbreaking. Meg Collins is Patient Safety and Quality Manager at the Royal Prince Alfred Hospital IN CINEMAS DECEMBER 26
METROMEMBERGIVEAWAY Email The Lamp by the 12th of this month to be in the draw to win a double pass to Suffragette thanks to Transmission Films. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win! THE LAMP DECEMBER 2015 – JANUARY 2016 | 49
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 your event details to: lamp@nswnma.asn.au Fax 02 9662 1414 Post 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space.
diary dates is a free service for members NSW NSW Urological Nurses Society Professional Development Day 6 November 2015 Burwood www.nswurologicalnurses.com urological_nurses@hotmail.com 9990 4148 Australian & New Zealand Orthopaedic Nurses’ Association Conference Climbing to the Summit 11-13 November 2015 Sydney www.anzonaconference.net Perioperative Nursing Seminar 14 November 2015 Homebush www.acutecareeducation.com.au Beyond the Basics – High Dependency Nursing Conference 20 November 2015 Westmead Hospital Ryan.Thomas@health.nsw.gov.au Australian College of Critical Care Nurses (NSW) Seminar 20 November University of NSW www.acccn.com.au Nurses Christian Fellowship Professional Breakfast - Experience with AHPRA Audits 21 November 2015 West Ryde www.ncfansw.org Perioperative Nursing Seminar 21 November 2015 Wagga Wagga www.acutecareeducation.com.au Transfer of Care for Complex Consumers Conference 1 – 3 December 2015 Sydney www.akolade.com.au Inaugural Australasian AYA Oncology Congress 3-5 December 2015 Sydney www.youthcancerevent.com.au ASPAAN Seminar 5 December 2015 Wollongong www.aspaan.org.au Nurses Christian Fellowship Christmas BBQ 7 December 2015 Balls Head, Waverton www.ncfanw.org Digital Health Show 1-3 April 2016 Sydney www.digitalhealthshow.com.au/expo.html Australasia- Pacific Post-Polio Conference 20-22 September 2016 Sydney www.polioaustralia.org.au/
ACT Second National Complex Needs Conference 17-18 November 2015 Canberra complexneeds.org.au/events 2015 Australian STOP Domestic Violence Conference Australian & New Zealand Mental Health Association 7-9 December 2015 Canberra www.stopdomesticviolence.com.au
INTERSTATE 2015 Annual Scientific Alcohol and Drug Conference 8-11 November 2015 Perth www.apsadconference.com.au ASPAAN National Conference 13-14 November 2015 Melbourne www.aspaan.org.au 2015 National Indigenous Health Conference 1-3 December 2015 Darwin www.indigenousconferences.com
3rd Eating Disorders and Obesity Conference Collaboration, Education and Innovation 16 -17 May 2016 Gold Coast www.eatingdisordersaustralia.org.au Australian and New Zealand Addiction Conference 18 - 20 May 2016 Gold Coast ww.addictionaustralia.org.au
INTERNATIONAL EMS Conference (for paramedics and acute care nurses) 18-22 January 2016 Hokkaido, Japan www.emsconferences.com.au 2nd Asian Congress in Nursing Education Innovative Nursing Education for Universal Health Care 26-29 January 2016 Tainan, Taiwan www.2016acine.org NCFI Quadrennial International Conference Healthy Lives in a Broken World – a Christian response to nursing 6-10 June 2016 Tagaytay City, Philippines www.ncfi.org
REUNIONS Lewisham Hospital Graduate Nurses Association Annual Lunch 7 November Ryde. Chris Majewski 0401 866 377 chris.majewski@bunzl.com.au Luke Bohun 4371 7098 lukebohun@netkey.com.au War Memorial Hospital Waverley RNs and ENs Reunion 11am-3pm 14 November 2015 BYO picnic in hospital grounds Rosemary 0412 395 825 lechiyeem@gmail.com Bloomfield Hospital Annual Dinner 21 November 2015, 6pm Emu’s Rugby Club, Orange NSW Julie-Ann Rich richjulieann@yahoo.com.au 0458 999 930 RAHC Feb 1981 35-year reunion. 20 February 2016 Sally Aspinwall 0429 556 030 sallyaspinwall@gmail.com Louise Hay (Mann) 0468 461 196 4loual2@gmail.com Gladesville Hospital 5th Bi-Annual Reunion 21 February 2016 Gladesville Hospital Robert Harrop 0416 764 200 Warren Martin 0428 727 38, warrenjmartin@hotmail.com St Vincent’s Darlinghurst PTS Class January 1976 40-year reunion 19 March 2016 fnethery@gmail.com.au jacquie.scott@btopenworld.com Auburn Hospital October 1976-1979 40th Reunion Sharon Byers 0419 144 965 sbyers01@bigpond.net.au Margaret Borg (nee Mueller) 0431 159 964 margaret_borg@bigpond.com Tamworth Base Hospital February 1976 intake 40-year reunion Sandra Cox sandra.cox@hnehealth.nsw Sean O’Connor 0408 349 126 Gerard Jeffery 0417 664 993 Liverpool/Camden and Fairfield Hospitals Sept 1977 PTS Lindy Hewett (nee McCafferty) Lindyhewett@gmail.com 0416 150 020
50 | THE LAMP DECEMBER 2015 – JANUARY 2016
Cr osswor d solution W A
T
E R H A M M E R P U
I
N
S
D
I
D Y S O M O
I
E B B
D
O
V
T
A
O
L
U S C
T
A
E
E
C
S
M
O B S
T
R U E N T
T
E
H E
P
E A
T
N
T
G A R B
R
U
R
E
P S Y
C
R A
N
L
M
N
X O D O N T
O
S E
E
N A R C O L
M O L F
A
L
O I
E
C S O
L
B M
I
E
P
I
S C O P
E
T O T O X
I
C
O R A
L
S
R
I
S
U
C
C A
L
C U
A
U
T
Y M P
V S L
T O P H O B
I
U S
A
N
S
A
S
E
O
L A N
I
R
I
A
C M E M B R A N E
At First State Super we believe Australians who choose careers looking
Consider our product disclosure statement before making a decision about First State Super. Call us or visit our website for a copy. FSS Trustee Corporation ABN 11 118 202 672 ASFL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365.
LAM_Caring4People_275x200_0415
First State Super Caring for the people who care