The Lamp March 2006 by NSW Nurses and Midwives' Association

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magazine of the NSW Nursesâ&#x20AC;&#x2122; Association

volume 63 no.2 March 2006

RAMSAY NURSES WIN

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2 THE LAMP MARCH 2006

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ABOUT THE LAMP

C O N T E N T S

Contacts NSW NURSESâ&#x20AC;&#x2122; ASSOCIATION For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office. SYDNEY OFFICE 43 Australia Street Camperdown NSW 2050 PO Box 40 Camperdown NSW 1450 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9550 3667 E gensec@nswnurses.asn.au W www.nswnurses.asn.au HUNTER OFFICE 120 Tudor Street Hamilton NSW 2303 ILLAWARRA OFFICE L1, 63 Market Street Wollongong NSW 2500

Cover story

LAMP THE

MAGAZINE OF THE .37 .URSES !SSOCIATION

VOLUME NO -ARCH

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Ramsay nurses win pay parity and protection 14

News in brief Hospital sackings cost $420,000 Call to spend surplus on Medicare Families WorkChoicesâ&#x20AC;&#x2122; losers Jilted RNSH nurses rally against cost cutting Rights at Work campaign targets marginals Training to help you get union active Needlestick injuries pose unnecessary risk Chief nurse thanks nurses and bows out Self-manage arthritis online Breast Cancer Institute of Australia Motherâ&#x20AC;&#x2122;s Day appeal 12 From maternity ward to skate park 13 Volunteer nurses bring relief to Acehâ&#x20AC;&#x2122;s homeless

8 9 9 9 10 10 11 11 12 12

NSWNA education program 13 Whatâ&#x20AC;&#x2122;s on this month

Professional issues 20 Productivity Report: extended nursing role â&#x20AC;&#x201C; a remedy for fraying health system 22 What health leaders say about the report 23 Brave new nursing role 24 The bush deserves a better health deal 26 Hunter nurses pioneer triage phone service

Nurses who dare 28 Dedicated nurses Our Australians of the Year

Occupational health and safety 35 Old, falling apart and unsafe!

Tips from members 38 Tips for a great photo

Lifestyle 41 All you need to know about love 43 Book me

Obituaries 47 Janet Ausling: a caring advocate for children and families

Regular columns 5

Editorial by Brett Holmes 6 Your letters to The Lamp 37 Ask Judith 45 Our nursing crossword 46 Diary dates

Competition 33 Win a night of fun with Dusty â&#x20AC;&#x201C; The Original Pop Diva

Special offer 41 5 double passes to The Manual of Love

Industrial issues 32 Nurses win action to beat heat

The Lamp COMMUNICATIONS COORDINATOR Noel Hester T 8595 2153 COMMUNICATIONS OFFICER Olivia Nassaris T 8595 1263 EDITORIAL For all editorial enquiries, letters and diary dates: Salim Barber T 8595 1234 E SBarber@nswnurses.asn.au M PO Box 40 Camperdown NSW 1450 PRODUCED BY Lodestar Communications T 9698 4511 PRESS RELEASES Send your press releases to: T 9550 3667 E gensec@nswnurses.asn.au THE LAMP EDITORIAL COMMITTEE Brett Holmes, NSWNA General Secretary Judith Kiejda, NSWNA Assistant General Secretary Coral Levett, NSWNA President John Lyons, Coonabarabran District Hospital Jonathan Farry, RPA Hospital Mark Kearin, Wyong Hospital Roz Norman, Tamworth Base Hospital Stephen Metcalfe, Lismore Base Hospital Therese Riley, St George Hospital ADVERTISING Patricia Purcell T 8595 2139 or 0416 259 845 F 9550 3667 E ppurcell@nswnurses.asn.au RECORDS AND INFORMATION CENTRE - LIBRARY To find old articles in The Lamp, or to borrow from the NSWNA libraryâ&#x20AC;&#x2122;s nursing and health collection, contact: Jeannette Bromfield, RIC Coordinator T 8595 2175 E gensec@nswnurses.asn.au General disclaimer The Lamp is the official magazine of the NSW Nursesâ&#x20AC;&#x2122; Association. Views expressed in articles are contributorsâ&#x20AC;&#x2122; own and not necessarily those of the NSW Nursesâ&#x20AC;&#x2122; Association. 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 NSW Nursesâ&#x20AC;&#x2122; Association takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised. Privacy Privacy statement: The NSWNA 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 NSWNA office. If you are still not satisfied that your privacy is being maintained you can contact the Privacy Commission. Subscriptions Free to all Association members. Ex-members can subscribe to the magazine at a reduced rate of $44. THE LAMP Individuals $60, Institutions $90,MARCH Overseas2006 $100.3

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A good job is one thing. Finding a job you really love is another thing altogether. For the largest choice of healthcare jobs, simply log on to the Internet and go to seek.com.au to our healthcare section. Then SEEK and you shall find. 4 THE LAMP MARCH 2006

E D I T O R I A L BY BRETT HOLMES GENERAL SECRETARY

Ramsay offers pay parity and protection g Members now to vote on ‘in-principle’ agreement

ur members working in the private hospital sector for Ramsay Health Care are about to consider a pay offer from their employer after a determined workplace campaign (see page 14). The Ramsay offer, if accepted by members, means that the campaign goal of pay parity with public hospital nurses will be achieved for the life of this agreement. The imminent arrival of WorkChoices has seen aggressive employers throughout the country present their workforces with ‘agreements’ that will cut pay and conditions or, as with Qantas, are backed up by the threat of relocating jobs to low wage economies like China. In this context achieving our second campaign objective of protecting workplace conditions until September 2008 is also a serious accomplishment. In our wide consultations with members workloads were clearly a major concern. Ramsay has now agreed to a process for discussing workload issues and with the higher level of involvement and activism in our branches arising from our campaign there is now a way forward to resolve these problems. The Ramsay offer deserves to be viewed in a constructive way by private hospital nurses especially in light of the alternative: no agreement and the uncertainty of the new federal system. Ramsay has negotiated this agreement in good faith. They have listened to their nurses and their representatives, the NSWNA. Their offer sets the benchmark for other private hospital employers. I’m confident members will see it in a positive light. I will be recommending that members vote in favour of the agreement.

Productivity Commission report has something to say Reports on the health system come and go but the latest, Australia’s Health Workforce, commissioned by the Council of Australian Governments (COAG) and written by the Productivity Commission, could end up having a defining influence on the shape of our health system (see story p 14). The NSWNA carefully analysed and assessed the Commission’s report. On balance we believe it is well researched and if implemented in an honest and transparent way can significantly improve the delivery of healthcare services across Australia. The Commission endorsed policy positions that the NSWNA has advocated for years. It recognises that highly skilled nurses such as nurse practitioners and midwives have critical roles to play in delivering high quality health services. The extension of Medicare rebates to a wider range of health professionals will make it more viable for these services to be taken up by the community. We would support another of the Commission’s recommendations, the creation of a health workforce agency, as long as any workforce innovations were backed up by hard evidence that these new positions would improve the efficiency and quality of the health system. We would not support it if it

Ramsay has now agreed to a process for discussing workload issues ... there is now a way forward to resolve these problems. was just another way to cut costs at the expense of patient safety and care. Nurses, like all other health professionals, will need to prove the contemporary relevance of their roles. I have no doubt we will be able to meet this challenge. The report has now been referred by COAG to senior officials for further work on the recommendations and to report back in June 2006. One thing is certain. This latest report has more chances of avoiding the too hard basket, the fate of its numerous predecessors. After all it was written by economists – a group that is credible to governments of all persuasions.n THE LAMP MARCH 2006 5

L E T T E R S

LETTER of the month Anne Sheridan

Feeling undervalued but I keep on for my colleagues and patients I would just like to say that as a nurses working at St George Private Hospital, I felt a bit disillusioned at last weekâ&#x20AC;&#x2122;s rally attendance. In light of the new IR laws that are about to come into effect, nurses need to show a combined presence and show of numbers to those who try block us from receiving parity. As a nurse who has previously worked in public hospitals, it is hard to understand why nurses should be made to feel undervalued by their management in a private hospital, with private nurses not having the same overlap of shifts, paid maternity leave, parity of pay. The dilemma for many private hospital nurses is that you may feel the way I do: even though you know you are being treated unfairly â&#x20AC;&#x201C; you still stay there because of the friends youâ&#x20AC;&#x2122;ve made and the beautiful patients you attend to. Itâ&#x20AC;&#x2122;s true so many of us feel that way, but slowly over time or change of circumstances you quietly begin to move on, hoping to find a place within a public hospital. It becomes hard, though, when youâ&#x20AC;&#x2122;ve become attached to your workplace, as I am, to just pack up and leave. It becomes

really hard to believe that management wonâ&#x20AC;&#x2122;t necessarily change our conditions because they see the strong bonds that are made in their hospital, and know that the nurses will just keep taking it. When will they understand that a nurse should be paid on their qualification not their location? Finally I would also like to take this opportunity to thank the NSWNA for trying to give us parity in pay and conditions with the public nurses. Anne Sheridan, RN, St George Private Hospital

LETTER of the month The letter judged the best each month will be awarded a $50 Myer voucher, courtesy Medicraft, Australiaâ&#x20AC;&#x2122;s largest manufacturer of hospital beds and furniture. For more information on Medicraft products, visit www.medicraft.com.au or call 9569 0255.

Howardâ&#x20AC;&#x2122;s reforms are fearsome Recently, a colleague and I were invited to attend an ACTU activistsâ&#x20AC;&#x2122; training workshop in our area, Blacktown. The workshop showed us exactly what we, as a union and as individuals, are up against in regard to John Howardâ&#x20AC;&#x2122;s new IR legislation. These reforms are just about the most insidious thing to come out of this government and indicate to me that this government is all about bullying and thuggery and does not care about the hard-won rights and conditions that our parents and their parents fought for over many years. If we, as one of many organised unions, donâ&#x20AC;&#x2122;t unite, stay united and fight as a united front, I can only see this country, our country, sliding further down the toilet thanks to our fearsome leaders. Jon West and Alyson Chapman Community Mental Health, Blacktown

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6 THE LAMP MARCH 2006

Got something to say?

Send your letters to: Salim Barber email SBarber@nswnurses.asn.au fax 9550 3667 mail PO Box 40 Camperdown NSW 1450 Please include a photograph along with your name, address, phone and membership number. Letters may be edited for clarity and space.

MEMBER SUPPORT OFFICERS (2) Penny Freeman

Anne Bligh

Pregnant nurse refused light duties

Police nurses happy after long journey of negotiation

While reading the February issue of The Lamp I came across an article ‘Pregnant worker wins discrimination case’. During my last pregnancy (my daughter was born 26 March 2005), I was also refused light duties in my full-time position at the nursing home where I was employed. My employer stated that they had no legal requirement to offer light duties and they simply did not have the funds. The only option to me was to reduce my hours to three days a week, and I tell you even one day of eight hours on my feet, caring for totally dependent residents, showering and PAC was too much. Due to my family needing my income I worked until I was around seven months pregnant and only stopped because one day I got down to assist a resident with her shoes and could not get back up. I also was struck in the stomach by a confused gentleman. I filled out the appropriate paperwork and was told I would not be working in that area again … 10 points for guessing where I was rostered to work the following day. After working for this company for five years I was extremely disappointed that they simply did not care. And due to the fact that I had to leave earlier than planned I suffered great financial hardship, as I was determined not to return to work until my daughter slept through the night (being a day-worker). I resigned from my position once my maternity leave was up, and now work in a less physically demanding environment, but I wonder where it leaves young aged care nurses who want to start a family but are forced to put themselves and their babies at risk trying to earn a living? Do we have to legally fight our employer to get conditions that are safe to work in while pregnant? I’m glad Ms Jordan won her case. But if John Howard wants one for me, one for my husband and one for my country, he is going to have to implement some policies that support the pregnant worker!

We wish to express our thanks to the NSW Nurses’ Association, which successfully negotiated a new Award Agreement for the NSW Police Nurses. After 18 months of protracted negotiations we have finally come to our agreement with Police Management and NSW Public Employees Office on both pay and conditions. It has been a long journey to finally reach this outcome and without the unflagging support of the Association it would not have been achieved. There are currently only six permanent RNs employed by NSW Police and we fulfil a varied and demanding role within the organisation. Due to the lack of numbers working in this specialist field of nursing, we were unable to form a Branch of the Association. Despite this, you took up our case with gusto and guided us through the political minefield of award negotiations. At times it was a disappointing and frustrating journey but the NSWNA, in particular Chris Blair, always managed to remain positive and kept us focussed. Throughout the many meetings, offers made and rejected, reports requested to show the work value of the Police Nurses, the NSWNA was undeterred in getting pay parity with our nursing colleagues in other areas. I have no doubts that it was only through the efforts and negotiating skills of the NSWNA that we reached the final outcome this week. We also appreciate the support shown by all our nursing colleagues in the Air Ambulance Nurses and the NSW Police Association, who publicly showed their solidarity with the Police Nurses.

Penny Freeman, Royal Newcastle Hospital

Anne Bligh (on behalf of NSW Police Nurses) Every letter published receives a copy of the Australian Nurse Diary 2006. The diary includes weekly shift planners, reference materials and foreign language translations, and is available from hospital newsagents.

Medium-term contracts (min. 2 years)/secondments The NSWNA is a dynamic and focused trade union that will offer you the opportunity to make a real difference to the nurses of NSW. These positions are being offered in a number of medium-term contracts or secondments. If you have worked as an organiser in another union this could be the job for you. You need to demonstrate: c A strong belief and commitment to trade unionism and the nursing profession and a desire to learn to assist and represent members on work related matters. c A broad knowledge of industrial issues affecting nursing in NSW. c An ability to think and articulate on your feet. c Excellent communication skills – verbal and written. c Computer know how – Microsoft Word, Internet and email the bare minimum. c Basic knowledge of the state and federal industrial environment. We will provide the necessary training so you can work in a highlyskilled and committed team who will celebrate your wins and support you when the going gets tough. Ideally, applicants will have experience dealing with workplace grievances &/or member issues – individual or collective. Knowledge or experience in the nursing industry will be an advantage. These positions are based in Sydney, some travel may be necessary. A current (full) NSW driver’s licence is essential. Your expression of interest, including a letter of application and CV, must be received no later than COB, 31 March 2006. Brett Holmes, NSWNA General Secretary, PO Box 40, Camperdown NSW Phone: 8595 1234 (metro) 1300 367 962 (non-metro) Email: ranson@nswnurses.asn.au THE LAMP MARCH 2006 7

N E W S I INN BBRRI IEEFF

Pizza trap costs AHS $420,000 Deputy President Sams said he was ‘deeply troubled’ by the video evidence. He said there were ‘very obvious conflicts’ between the video evidence and notes taken by agents of Websters. There were ‘serious and disturbing discrepancies’ in video evidence against the guards, with ‘unexplained gaps in the video tapes at crucial times’. ‘The surveillance was clumsy, incomplete, inaccurate and had the hallmarks of a Keystone Cops episode,’ he said. The guards claimed they were set up after speaking out against management. They said they had been enticed offsite by phone calls telling them there was a free pizza for them at Dominos. When they got there there was no free pizza but they were filmed.

g Guards re-hired after ‘Keystone Cops’ investigation

n Area Health Service wasted more than $420,000 investigating, sacking and later reinstating nine hospital security guards. The guards who patrolled Blacktown and Mount Druitt hospitals were sacked for ‘misconduct’ – picking up take-away food during their 12-hour shifts. Two directors of the then Western Sydney Area Health Service ordered an investigation, using private detectives who secretly filmed the guards collecting food from McDonald’s, Domino’s Pizza and a Chinese restaurant. But the NSW Industrial Relations Commission ruled the ‘honest, hardworking and decent’ men had been unfairly dismissed and ordered their reinstatement. Commission Deputy President, Peter Sams, said he had serious concerns that the men were entrapped into leaving their rounds for free pizza so they could be followed and filmed. 8 THE LAMP MARCH 2006

Deputy President Sams found that health service bosses broke the law and wasted taxpayers’ money in a ‘Keystone Cops’ exercise. The huge cost of the operation to the taxpayer was revealed in documents obtained by The Daily Telegraph. The illegal surveillance operation cost more than $22,000 and court costs totalled almost $109,000, the paper reported recently. Payments to reinstated guards totalled more than $172,000 and staff replacement costs came to $117,000. Deputy President Sams described the health service’s engagement of Websters Investigations Group, without a tender and without any budget for the project, as ‘highly suspect and outside any acceptable standards for the expenditure of public monies’. Websters’ agents conducted covert video surveillance outside the specifications ordered by the magistrate and in breach of the Workplace Surveillance Act.

The investigation was ‘outside any acceptable standards for the expenditure of public monies.’ One guard said he received a call from a manager wanting to discuss a job offer. The manager failed to show and the guard was captured on film ‘I have very serious concerns that a person or persons unknown were attempting to entrap the applicants,’ Deputy President Sams said. Deputy President Sams said there were no fixed meal breaks and it was established practice for guards to buy take-away food offsite. They sometimes even picked up personal items from local shops for senior hospital staff. He said it was a ‘gross overreaction’ to claim the officers abandoned their posts. They collected the food while carrying out external patrols and ‘the real extent of their indiscretion was likely to be two or three minutes.’ In any case they remained in communication with the hospital by pager, two-way radio and phone. n

CALL TO SPEND

SURPLUS ON

Medicare he Save Medicare Alliance has called on the federal government to use its record budget surplus to restore Medicare to world-class standards. While the big end of town clamber for yet another tax cut, federal government under-funding continues to threaten our healthcare system, in particular Medicare, the Alliance said. The Alliance, a coalition of community and health groups, points out that opinion polls consistently show the vast majority of Australians would rather see increased funding on health than yet another tax cut for the wealthy. ‘Far from preserving the basic principles of Medicare – universality, equity, access, efficiency and simplicity – the Howard Government is taking us down the road to an American system of mostly private health spending, leading to inflated costs and reduced quality,’ said Alliance spokesman Bruce Childs. ‘The Save Medicare Alliance is distributing leaflets across NSW as part of our campaign to regain universal access to a world-class healthcare system that is affordable and equitable while providing the highest quality of care,’ he said.

FAMILIES THE LOSERS study by Marian Baird of the University of Sydney’s Business School reveals that family time will take a hammering from Howard’s IR changes. ‘The proposed changes are likely to undermine and alter employment rights and entitlements and will impact on the ability of workers to participate in families and communities,’ the study said. ‘Less regulation of working hours and removal of penalty rates means less chance of maintaining, even notionally, a “day of rest” for the community. ‘The industrial relations system made Australia somewhat special and the undoing of it is commensurate with the undoing of Australia’s social fabric,’ she said.

Jilted RNSH nurses rally against cost cutting

hanges to the recruitment processes for nursing vacancies at Royal North Shore Hospital (RNSH) have increased nurse workloads, placing patients’ safety at risk, according to members of the RNSH branch. RNSH members rallied in front of the hospital to protest against nursing cuts due to alleged budgetary shortfalls. Rallying nurses held a banner featuring hundreds of nurses with broken hearts – befitting the jilted on Valentines’ Day. Each nurse represented an hour of nursing care lost over the past few weeks. Members voted unanimously to hold the lunchtime rally on 14 February after management refused to repeal changes to the recruit processes for nursing vacancies. Nurses had put a resolution to management asking that the changes be repealed. Cost cutting measures implemented by management at RNSH include changing the approval process for Individual Patient Specials – taking the decision-making away from nurses’ hands and into the hands of an off-site manager. There are also restrictions on the use of casuals, with agency staff not being given shifts if they have not previously worked at the hospital, or not being employed for the full eight-hour shift but restricted to six hours on morning and evening shifts

and eight hours on night shifts, rather than the normal 10 hours. In addition to restrictions on the recruitment process and use of casuals, Clinical Nurse Educators at Ryde Hospital – also within the Northern Sydney Central Coast AHS – are also required to take on a patient load two days a week. Brett Holmes, NSWNA General Secretary, said, ‘The Association is concerned about the removal of delegated authority from Nurse Managers to make decisions about their nurses’ reasonable workloads. The cost-cutting measures are a threat to their reasonable workloads and patient safety. ‘Nurses are rallying because they are concerned about the impact these decisions are having on the quality of patient care.’ Nurses have requested an urgent meeting of the Reasonable Workloads Committee to discuss the impact of the changed staffing and recruitment processes. Meetings on 17 and 21 February between hospital management, NSW Health and NSWNA saw some positive steps towards resolution of the issues. However, the branch position remains firm that nurses need to have the delegated authority to manage nurses workloads to ensure patient safety. Negotiations were continuing as The Lamp went to print.n THE LAMP MARCH 2006 9

N E W S I INN BBRRI IEEFF

RIGHTS AT WORK

Training to help you CAMPAIGN get union active

TARGETS

MARGINALS he job security of politicians who don’t support workers rights is being put at risk by a union campaign targeting marginal seats in NSW. These marginal seats have been identified as a battleground for the Rights at Work campaign to protect the wages and conditions of nurses and other workers. Unions, including the NSWNA, acting through Unions NSW, are offering training courses run by the ACTU education campaign centre for activists who want to become involved in the Rights at Work campaign. The next courses being offered are in the Lindsay electorate on 6, 7 and 8 March 2006, and in the Dobell and Robertson electorates there will be courses held at the Central Coast on 14, 15 and 16 March 2006.

could go about opposing the reforms.’ Florence said she now feels more confident as a union delegate and is better equipped to deal with issues that arise. ‘The training gave me the skills I need to go back to the members and say this is how we should go about doing this. The training addresses issues like “why do you need to join a union?” and they also teach you how to identify issues and develop a plan.’

Unions, including the NSWNA, are offering training courses run by the ACTU education campaign centre for activists who want to become involved in the Rights at Work campaign. These courses are designed to bring together activists from a range of unions who are part of the targeted seat network. The goal is for activists to become informed about the likely impact of WorkChoices on our communites, and to find out what they can do to voice their concerns in a practical and effective way. If you have any questions about the Rights at Work campaign or these courses, please contact Rita Martin on 8595 1234. 10 THE LAMP MARCH 2006

Calling all new delegates This new half-day program is aimed at newly-elected delegates and is run on the afternoon of the Committee of Delegates meetings on 21 March, 16 May and 19 September 2006. The program covers the structure and rules of Newly-formed Frenchmans Lodge Nursing Home branch the NSWNA, the role of the delegate and meeting re you a member who wants procedures for the Committee to be more involved with the of Delegates and the Annual Conference. union but you don’t know how? For further information, please BOAT is a training program contact Vicki Anderson on 8595 1234 that helps members and activists of the (metro) or 1300 367 962 (regional). n union build their skills so they can be better unionists. 2006 SCHEDULE OF TRAINING The NSWNA invites all interested members to join branch officials in the DATE VENUE BOAT training program. Florence Malofie, AiN at Frenchmans 3 & 4 May Coraki Lodge Nursing Home branch, participated 10 & 11 May Shellharbour in the program last year and said she 17 & 18 May NSWNA learnt about the role of unions in (Aged Care Specific improving society, and the importance of Training) nurses as advocates of the health system. ‘We formed a branch because we 24 & 25 May Newcastle were very worried about the proposed 31 May & 1 Jun Wagga IR reforms and we wanted to be 1 & 2 June NSWNA involved in a campaign to protest against the changes. We were all quite 7 & 8 June Dubbo new so the first thing we needed was to 14 & 15 June NSWNA get as much information about the role 21 & 22 June Queanbeyan of the union and how we, as members,

NEEDLESTICK

Chief nurse INJURIES UNNECESSARY RISK British survey showing nearly half of nurses live in daily fear of contracting HIV and hepatitis in the workplace confirms needlestick infection is the great unspoken crisis facing our profession. The Royal College of Nursing survey said an estimated 100,000 health workers suffer needlestick injuries each year, with at least five leading to HIV. In NSW, a needlestick injury hotline operated by NSW Health and the Albion St Centre reports that nurses make up a third of callers. Most callers come from area health services of high HIV and Hepatitis-C prevalence. Most people call for advice and reassurance. Routine patient care (38%) and cleaning (15%) are the most common situation where needlestick injuries occur. Invasive procedures such as injections, suturing and venepuncture are the most commonly reported causes of injury. The response of Federal Government in dealing with this problem has been inadequate. For instance, it withdrew vital funding for trials of retractable syringes, despite growing evidence and opinion around the world that these safety devices must be adopted for the sake of people working in the health industry. The Government’s response has been vastly different from the US approach, where legislation will soon come into place (the Needlestick Safety and Prevention Act) making it compulsory for employers to provide needles and sharps with built-in safety features that automatically retract, cover or blunt needles immediately after use. While nurses were skeptical about the attributes of some of the first-generation safety syringes, especially in terms of ease of use, assembly and blood-spray, there is now improved product available that is simple to use.

thanks nurses and bows out

SW Health has announced the retirement of Professor Kathy Baker, Chief Nurse Officer and head of nursing and midwifery

in NSW. NSW Health Director General, Robyn Kruk, said Professor Baker had made an invaluable contribution to public health in NSW over a career spanning 42 years. Kathy Baker enjoys an enormous reputation in the nursing profession, not only in NSW but nationally, Ms Kruk said. ‘Since her appointment as Chief Nurse in 2004, Professor Baker has provided the Health Department with high-level advice on strategies and policies to address a range of issues for the nursing profession, including how NSW responds to the ongoing nursing workforce shortage.’ Prior to joining NSW Health, Professor Baker had been at the forefront of change in the former Northern Sydney Area Health Service, driving reforms in workforce development, staff education, primary health care and nursing services. She facilitated the development of collaborative teaching and research in the development of the undergraduate and postgraduate nursing programs at the University of Technology, Sydney (UTS). As a mark of her contributions, Professor Baker was awarded an Adjunct Professor of the Faculty of Nursing, Midwifery and Health at UTS, followed by Honorary Fellowship, and in 2005 she was awarded an Adjunct Professor of the School of Nursing in the College of Health and Sciences, University of Western Sydney. When announcing her retirement, Professor Baker paid tribute to her nursing and midwifery colleagues. ‘Each of you has contributed differently but you have harnessed those differences, bringing together the variety and range of models of care that our patients experience today.

‘My experience last year with the models of care road shows around the state, where nurses and midwives presented their vision for the future of the profession, was a highlight in my time with the department. ‘These presentations were an extraordinary event at a time of significant change and uncertainty due to the restructure of NSW Health services. ‘It has been one of the greatest privileges of my professional career to have engaged in the discussions and debates about nursing and midwifery practice with my peers and I would like to thank our nurses and midwives for their generosity and enthusiasm. ‘I feel confident as I retire that we indeed have a forward-thinking, innovative, world-class team,’ she said. Professor Baker’s retirement takes effect from 28 April 2006. n

Chief Nurse Officer Kathy Baker THE LAMP MARCH 2006 11

N E W S I INN BBRRI IEEFF

Roseann Slattery-Quinn, Nurses’ Association branch secretary at Cowra Hospital.

SELF-MANAGE

ARTHRITIS ONLINE new online pilot program allows people with arthritis to self-manage the condition at minimal cost. The comprehensive program, the first of its kind, can be accessed at www.challengingarthritis.org Challenging Arthritis includes: c an online self-management program c accompanying diary and CDs c information sheets c a telephone advice line. The program helps people acquire the knowledge and skills to self-manage arthritis by participating in suggested activities and documenting progress in the diary provided. It costs just $28 to join the program, or $14 for pensioners.

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MOTHER’S DAY

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12 THE LAMP MARCH 2006

From maternity ward to skate park

he central NSW town of Cowra, population 13,100, desperately needs a skateboard park. That’s one possible conclusion to be drawn from the bizarre goings on at Cowra Hospital. The vacant top floor of the threestorey, 38-bed hospital was turned into an illicit skateboard park by local youths. ‘We think one person was taking the lift or stairs to the third floor, then letting their friends in via the outside fire escape door,’ said Roseann Slattery-Quinn, Nurses’ Association branch secretary at the hospital. ‘Some staff members chased them but couldn’t catch them,’ Roseann said. ‘They even pinched wheelchairs from lower floors and held wheelchair derbies up there, leaving tyre marks all over the lino. ‘The skateboarding was going on for months, though they seem to have dropped off now that there’s been publicity in the local press. ‘We have a CCTV camera up there but the monitor is not manned 24/7 because the security/wardsmen have a hundred other things to do. ‘The skateboarders put a condom over the camera one weekend so the film was all blurry and they couldn’t be identified.’ To combat skateboarders the lift no longer goes to third floor, unless manually operated by staff.

Roseann said the skateboarders migrated to the third floor after the hospital decided to fill in an empty swimming pool they were using as a skateboard ramp. The hospital’s ED, operating theatre, HDU, general ward and midwifery centre are located on the lower floors. The top floor has been empty for a year since midwifery moved downstairs. The hospital is waiting on the result of a request for funding to redevelop the top floor as a base for a community health service. ‘The third floor is isolated – no one ever goes up there so it’s a great place to hide,’ Roseann said. The hospital has also been hit by repeated thefts of equipment. Roseanne said the thefts have disgusted the local community and upset the ladies of the hospital auxilliary whose lamington drives helped pay for some of the stolen equipment. ‘People have stolen oxygen bottles, two wheelchairs and two brand new shower chairs,’ she said. ‘Staff actually saw someone load a wheelchair into a ute and drive off with it. ‘One man even stole a hands-free phone but left the charger case, so it was useless to them. The phone was donated by a family whose father had died. We eventually got that back – I tracked the culprit down and rang him and told him to return it or I’d ring the police.’ n

Volunteer nurses bring relief to Aceh’s homeless

cation progr u d e a am swn

WHAT’S ON THIS MONTH s Legal and Professional Issues for Nurses 15 March, NSWNA, ½ day Suitable for all nurses. Topics covered include the Nurses and Midwives Act 1991, potential liability, documentation, role of disciplinary tribunals including the NMB, writing statements. Members $39.50 Non Members $85.00 Branch Officials $28.00 Members of the Indonesian National Nurses’ Association.

ore than twelve months since a tsunami reaped havoc in Aceh, dedicated volunteer nurses – members of the Persatuan Perawat Nasional Indonesia (PPNI – the Indonesian National Nurses’ Association) – are still hard at work in camp clinics bringing relief and basic health care to 47,000 people still living in camps for internally displaced people. The earthquake and tsunami that struck on 26 December 2005 devastated most of the north and western coastlines of Aceh, leaving 170,000 dead and half a million people homeless.

Union Aid Abroad – APHEDA believes these very dedicated nurses are providing an invaluable service. The NSW Nurses’ Association immediately assisted with a donation of $25,000 to help the tsunami victims. The donation has helped to support the

nurses and visiting doctors on duty in these camps, by providing each of them with a daily allowance to cover fuel costs of the PPNI medical van used to transport patients and nurses. Zulfian, a nurse and coordinator of the camp, said he wanted to help the homeless people who live in the Internally Displaced Persons Camps. ‘The PPNI is the only organisation providing a six-day a week service, rather than a weekly clinic visit. To increase the services PPNI are able to provide, we would like to have more medicine for children and food for children with special dietary needs. The PPNI is also working to increase links with specialist doctors so we can provide better referrals rather than just sending people to the hospital.’ Union Aid Abroad – APHEDA believes these very dedicated nurses are providing an invaluable service, and will continue to support their work until the people in these camps have been able to rebuild and return to their homes. If you wish to make a donation for this work in Aceh, please contact Union Aid Abroad – APHEDA on (02) 9264 9343 or by email on office@apheda.org.au or visit the website at www.apheda.org.au n

s Basic Foot Care for RNs and ENs 27-28 March, Westmead, 2 days A VETAB-accredited course that aims to provide nurses with the competence to provide basic foot care. Members $203.00 Non Members $350.00 Branch Officials $175.00 For registration and more information: go to www.nswnurses.asn.au or ring Carolyn Kulling on 1300 367 962.

AWARD CLASSIFICATION REVIEW The Association will be holding meetings open to public health system CNS, CNE and NE at various sites around the state. The meeting sites and dates are listed below. Newcastle

9 March 5 – 7pm

Panthers, Newcastle

Camperdown

13 March NSWNA, 5 – 7pm Camperdown

Tamworth

15 March Best Western 5 – 7pm Motor Inn

Dubbo

20 March Dubbo RSL, 5 – 7pm Dubbo THE LAMP MARCH 2006 13

s NO C E W V ES R I SNT O BR Y I E F

RAMSAY NURSES WIN PAY Workplace pressure moves Ramsay g The federal government’s antiworker WorkChoices is on the cusp of becoming law. In this environment, winning a pay offer from major employer Ramsay that brings pay parity with public hospital nurses and protection of conditions is a big achievement – thanks to concerted action from private hospital nurses. 14 THE LAMP MARCH 2006

amsay, the biggest employer in private hospitals and a trendsetter for pay in the sector, has made an improved pay offer to NSWNA members after four months of talks. This follows strong action from NSWNA members in Ramsay facilities across the state. Ramsay’s final offer is a 4% wage increase from 1 September 2006, a 4% wage increase from 1 September 2007 and a 2.5% increase from 30 June 2008. These increases are in addition to the 3.5% Ramsay paid nurses from 1 November 2005. The increases bring private hospital nurses to the same pay levels as their public hospital colleagues over the length of the agreement that would end in September 2008. As The Lamp went to print, the NSWNA and Ramsay were putting the finishing touches to an in-principle agreement that will be put to members to vote on in the week of 6 March. Ramsay has also agreed to a process for dealing with reasonable workloads issues. This process will encourage employees and managers at the local level to discuss workload problems and, if no agreement is reached, a dispute can be taken to the Australian Industrial Relations Commission. Nurses’ rights such as the right for NSWNA delegates to conduct union business and for NSWNA organisers to enter workplaces to visit nurses are maintained.

Ramsay has also made a commitment to maintain existing state award conditions of employment until at least September 2008.

Offer brings certainty to both sides NSWNA General Secretary Brett Holmes said Ramsay has clearly seen the strength of members’ commitment to the campaign for better pay. ‘I think Ramsay was aware that our members in private hospitals were determined to get what they were entitled to: equality with their public hospital colleagues.’ He said that the proposed agreement is a very good one under the current circumstances. ‘I will be recommending that members vote in favour of the agreement,’ he said.

HAVING YOUR SAY ON THE CONDITIONS c NSWNA financial members will be sent a voting kit soon c The vote is to accept the whole package – pay and conditions c The vote needs to be conducted urgently – any agreement needs to be certified by the state industrial relations commission before Howard’s new laws come into effect.

PARITY AND PROTECTION Brett said these difficult talks were not helped by the confrontational nature of WorkChoices and the federal government’s lack of clarity over its implementation. ‘These talks occurred with the backdrop of the federal government’s new IR laws about to be implemented. This was a very uncertain environment to negotiate in. To reach an agreement that brings equality with public hospital colleagues, improves security by protecting conditions and brings some certainty for nurses is a formidable achievement.’ Brett Holmes said that even though the federal government has flagged that their new IR laws will be operational late in March, neither unions nor employers had seen the all-important regulations from the federal Minister of Workplace Relations that will be crucial to how the overall system operates. ‘An agreement in the state system with Ramsay will be a great outcome that will give some certainty going into uncertain times under WorkChoices.’

We need to maintain activism While Ramsay has indicated its willingness to be ‘a fair, competitive and predictable employer’, it is also keeping its options open. In correspondence with the NSWNA, Ramsay stated they are not in a position to respond on issues that are speculative at this point in time with the new IR laws at hand, especially in light of the high court challenge to the WorkChoices legislation. Brett Holmes said this gives a pointer to how some employers will wait and see how WorkChoices will pan out on a wider stage. ‘We can’t afford to let our guard down and it will be essential to maintain the level of activism we have built in private hospitals and build on it.’n

WHAT RAMSAY IS OFFERING NOW c 4% wage increase from 1 September 2006 c 4% wage increase from 1 September 2007 c 2.5% wage increase from 30 June 2008 c these increases are in addition to the 3.5% paid on 1 November 2005

c maintaining the legal rights of NSWNA organisers to enter workplaces to visit nurses c a commitment to maintain existing conditions of employment until 1 September 2008 c An agreed process for resolving workload issues.

WHERE THEY WON’T BUDGE

c Enrolled Nurses with medication endorsement get 2% above EN wage rate (approx $15 a week)

Ramsay won’t move from its existing paid parental leave provisions and rejected the claim for a continuing education allowance.

c recognition for NSWNA delegates to conduct union business

They also rejected a claim for oncall and in-charge allowances to be varied on par with wages.

WHY NURSES NEED A NSW ENTERPRISE AGREEMENT NOW Ramsay nurses will be covered by the federal system once legislation is passed this month. If we have a NSW Agreement: c the pay rises for 2005-2008 will all be legally enforceable c existing conditions in your state Award will be protected until September 2008 c the Agreement will carry over to the new federal system and be renamed a ‘Preserved State Agreement’. Without a NSW Agreement, none of these protections will be guaranteed and the pay rises will not be legally enforceable. THE LAMP MARCH 2006 15

RAMSAY NURSES WIN

PAY PARITY &

PROTECTION

PAY OFFER IS GOOD BUT WE NEED TO MAINTAIN THE PRESSURE g Emma Fisher, RN and NSWNA Branch Secretary at Kareena Private Hospital, believes the Ramsay pay offer is excellent but says private hospital nurses will need to keep active to improve conditions.

’T

he pay offer is good. But for most people in my workplace the conditions are the most important – especially paid parental leave and reasonable workloads,’ she said. ‘I’ve had a couple of friends who have left, not just because of the pay difference with the public hospitals but also because of the workloads. The fact we now have in place a process for resolving workloads issues is a big achievement.’ Emma said she understood the importance of getting an agreement with employers before the federal government’s new workplace laws kick in at the end of March.

‘WorkChoices is scary. We want things locked in so our conditions can’t be stripped away.’ Emma said this pay campaign has opened the eyes of many private hospital nurses to the value of being in the union. ‘There have been a lot of people who have been coming out wearing the badges and armbands. People are finding it easier getting problems solved if we approach it as a branch. ‘It will be important to maintain this activism. It improves morale if people can voice their concerns safely and we will need this involvement to protect our conditions in the future,’ she said. n

The NSWNA has developed a poster showing the steps to achieving a reasonable workload in private hospitals. Contact the NSWNA on 8595 1234 for posters to put up in your tea room. 16 THE LAMP MARCH 2006

DOCTORS SUPPORT OUR CLAIM FOR PAY PARITY g Members at Albury-Wodonga Private Hospital enlisted the support of doctors and other hospital staff to pressure management to provide a fair pay.

octors sported campaign badges and armbands as a mark of solidarity with the nurses they work along side, explained Branch President Anne Fletcher. ‘We have been seeking the support of the hospital community in our campaign. We spoke to the doctors and outlined our claim for

better pay and conditions and we asked for their support – and they have been sympathetic,’ said Anne. ‘They were shocked to realise there was such a big difference in pay between us and nurses in public hospitals. ‘One doctor has written to the CEO to express his concern and support.’ n

Members of Bega Valley Private Hospital Branch

Anne Fletcher pins a badge on surgeon John Russell

‘MY EMAIL REACHED THE HR MANAGER OF RAMSAY HEALTHCARE’

G 100% UNION AT BEGA g A recruitment drive by members at Bega Valley Private Hospital achieved an exceptional 100% NSWNA membership.

’W

e are only a small hospital but we were concerned about the new industrial relations legislation in relation to our conditions. We thought that if we improved our density and formed a branch we would be in better contact with the Association and be able to contribute to the campaign and be informed,’ said Robyn Lawler, RN and Assistant Branch Secretary at Bega Valley Private Hospital. ‘We spoke to nurses who weren’t members and discussed with them the reasons why we thought it was important to join and why it was crucial that we formed a branch. Everyone joined and we were able to form a branch that has 100% membership of nurses working at Bega Valley Private Hospital,’ she said. As a NSWNA branch, NSWNA members were able to be actively involved in the Private Hospital Nurses campaign. ‘All of our members strongly support the campaign for pay parity,’ said Robyn. ‘We do the same work as nurses in the public hospitals so we think we should receive the same pay and conditions. I’ve spent many years working in the public system and I know I do the same work now,’ said Robyn.n

ail Cooper, EN and Branch President of Port Macquarie Private Hospital, emailed Ramsay about her concerns that nurses deserve a fair pay rise for the hard work they do. ‘In my email I used the Ramsay motto, “People caring for people”, and said that if we do not receive a fair pay offer there will be no nurses left in the industry to do the caring for people. I also wrote that I was proud to be an Enrolled Nurse of 28 years! ‘I was very surprised when I was called into the hospital CEO’s office and the NSW Human Resources Manager of Ramsay Healthcare was sitting there. They said my email had been brought to their attention. The Ramsay representative assured me that he was aware and acknowledged my email. I’m pleased with the fact that my email prompted them to meet with me to discuss my concerns.’ n

Gail Cooper

THE LAMP MARCH 2006 17

RAMSAY NURSES WIN

PAY PARITY &

PROTECTION

NEWCASTLE PRIVATE HOSPITAL NURSES SAY

‘EQUAL PAY

FOR SAME WORK’

urses from John Hunter Hospital and doctors joined forces with nurses from Newcastle Private Hospital in a rally on 17 February as a show of support for the private hospital nurses’ claim for equal pay and conditions with the public sector. ‘Nurses and supporters are here today to put pressure on our employers to offer us a fair pay and conditions deal,’ said Lynette Huckstadt, RN and President of the Newcastle Private Hospital Branch. Nurses at Newcastle Private are currently 6% behind in pay compared to nurses in the public sector. For example, in real terms this means an 8th year RN at Newcastle Private is earning approximately $200 less a fortnight than an 8th year RN at the public hospital next door, based on similar qualifications, hours worked and allowances. Andrew Rigg, RN at John Hunter Hospital, spoke on behalf of the NSWNA members at the John Hunter Hospital Branch in support of their private hospital colleagues and highlighted the importance of striking an agreement quickly so that private hospital nurses are under the protection of an agreement before the federal government’s WorkChoices legislation comes in effect in March. Dr Michael Jonker, Anaesthetist, attended the rally in support of the nurses he works with. ‘Nurses are the backbone of a hospital delivering care, attention, support and expertise. To attract, retain and promote nursing professionals, the community needs to pay nurses what they’re worth,’ he said. n

Active members at Newcastle Private Hospital

BRANCHES

GETTING

ACTIVE Strong attendance at branch meetings sends a message to your employer that you and your co-workers are serious about achieving a fair deal on pay and conditions. 18 THE LAMP MARCH 2006

1. BE AWARE OF ISSUES Go to communal areas like the café and tea room and talk to nurses. Ask them what aspects of their work and conditions they are dissatisfied with. 2. RECRUIT Make sure you ask every nonmember to join the NSWNA. Discuss the benefits of joining the union. 3. PRODUCE FLYERS Make a flyer specific to your

ST GEORGE PRIVATE RALLIES FOR EQUAL PAY g St George Public Hospital nurses joined their private hospital colleagues in a rally for better pay

branch to notify people about the meeting. Make sure the date, time and location is clear. Give them out to individuals and put them up in every ward. 5. THE DAY BEFORE Ring around the wards to remind staff about the meeting the next day. 6. ON THE DAY Do a walk around of the wards – a face-to-face reminder often works. Write a reminder note at the top of the day’s page in each ward diary.

STOP PRESS

t George Private Hospital nurses hit the streets at a lunchtime rally on 17 February to pressure Ramsay Healthcare to offer nurses equal pay and conditions with the public sector. Nurses from St George Public Hospital next door joined the rally in support of their private hospital colleagues. At the rally nurses loudly voiced their support for a decent pay rise. NSWNA President Coral Levett reminded those gathered for the rally of the profits recorded by Ramsay Healthcare in their 2004–2005 Annual Report. ‘The company experienced a core net profit up 27%. In dollar amounts, they had a record profit of $54.1 million dollars, up from $42.7 million the year before. They definitely can afford to give nurses working in private hospitals equal pay and conditions with the public sector. Private hospital nurses deserve improved conditions and pay in recognition of the extraordinary work they do everyday’ she said. The Annual Report says: The better than expected result was due to higher revenue and ongoing cost containment across the group. ‘Nurses here are the “cost containment” they are talking about. Every day the employer delays they save money and it leaves private hospital nurses even further out of pocket in comparison to nurses working in the public sector,’ said Coral. The nurses passed a resolution that ‘demands parity with the public sector’, requests that Mr Ramsay demonstrates his commitment to nurses by including a workloads clause in the award and that their wages and conditions claim be finalised as a matter of urgency. ‘We have resolved to implement industrial activities to escalate the campaign if the offer from Ramsay is unacceptable,’ said Coral. n

NSWNA President Coral Levett

St George Private Hospital members rally for equal pay

Now Healthscope comes to the party As The Lamp went to press, an initial offer has been received from Healthscope, another major private hospital employer. The NSWNA has responded on behalf of nurses requesting Healthscope to review and improve the offer. Further talks are scheduled for early March.

… as do the independents Intensive talks are also continuing with Leanna Street Consulting representing about 30 independent private hospitals. The NSWNA believes the talks are being conducted in good faith. Two further meetings have been scheduled for the first week of March. The NSWNA is hopeful of having an offer worthy of consideration to put to members in March. THE LAMP MARCH 2006 19

N RE O P WFSE SI S N I OB N RA I EL F I S S U E S

Extended nursing role – a remedy for fraying health system g Nurses are significant winners in the Productivity Commission’s report on the health workforce. It recommends a bigger role for nurse

autiously welcomed by a wide range of health organisations including the NSWNA, and slammed by one, the AMA, the report attempts to address the current health workforce shortages and anticipate future pressures facing the system. The report is limited to looking at blocks in the current system that reduce efficiency and responsiveness. Key issues such as federal funding, the use of preventative strategies to reduce health demand, an increase in education

and training and initiatives to retain staff, lay outside the ambit of the study. The Commission’s key recommendations are to: c extend Medicare payments beyond doctors to other health professionals including some categories of nurses and midwives c extend the role of nurse practitioners c create a health workforce improvement agency to establish new roles for health workers and facilitate the spread of local innovations nationally c create a single national accreditation board for health education and training.

practitioners and the extension of Medicare payments

KEY POINTS

IN THE REPORT

beyond the current monopoly of doctors.

Medicare payments 1 extend beyond doctors to other health professionals including some categories of nurses and midwives the role of nurse 2 extend practitioners

create a health workforce improvement agency to establish new roles for health workers and facilitate the spread of local innovations nationally

a single national 4 create accreditation board for health, education and training. 20 THE LAMP MARCH 2006

Patients would be able to bypass their GP and go straight to the relevant health worker for a Medicare-funded consultation. NSWNA General Secretary, Brett Holmes, said that despite the limitations in its scope the report was a watershed document that, if implemented in an honest and transparent way, could significantly improve the delivery of health care services across Australia. ‘There will always be professional boundaries and these are essential to the maintenance of safe, high-quality health services. However, to make sure we get the best out of the workforce it is essential that those boundaries be based

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on evidence, not scare mongering or professional “patch protection”,’ he said. ‘The introduction of nurse practitioners is an excellent example of how such an approach works for the benefit of everyone. It ensures skilled workers are fully utilised, without them overstepping their capability.’ One of the Commission’s key recommendations is to extend Medicare payments beyond doctors. Patients would be able to bypass their GP and go straight to the relevant health worker for a Medicare-funded consultation. ‘The extension of Medicare rebates to a wider range of health professionals will ensure we get the best out of the health workforce. This is a long overdue change,’ said Brett Holmes. The Commission recognised the need to train more health workers and to improve the retention and re-entry to the workforce of qualified health workers – policy positions that have been strongly advocated by the NSWNA for many years. One of the Commission’s most important and innovative recommendations was to create an agency that would establish new roles in the health workforce to ease pressures on the health system. n

nursing your future

A SNAPSHOT OF OUR HEALTH SYSTEM AS IT STANDS

FUTURE CHALLENGES

c expenditure on health care is 9.7% of GDP and growing

The Commission identified a number of trends that are expected to intensify the pressures on the health system including:

c $78 billion was spent on health care in Australia in 2003-2004

c rising incomes will increase public expectations of access to high-quality health services

c there are around 450,000 paid health professionals in Australia – more than half are nurses

c a change in the mix of disease burdens with a decline in the proportion of stroke victims and an increase in type 2 diabetes and dementia

c there are another 200,000 administrative and service workers employed in the health sector

c technological change acting as a driver for growing demand and expenditure on health care

c expenditure on the workforce accounts for two thirds of total health care spending.

c a change in Australia’s age profile significantly increasing health expenditure c an increase in the average age of health workers. The Commission estimates that these pressures will see health costs swell to 16% of GDP by 2045.

THE LAMP MARCH 2006 21

N RE O P WFSE SI S N I OB N RA I EL F I S S U E S

‘The NSWNA believes the Commission has mostly come up with a set of recommendations that will be good for health care in Australia.’ Brett Holmes, NSWNA General Secretary

‘This is a genuine attempt at national reform.We won’t achieve substantial reform and better healthcare with people jealously trying to hang on to professional boundaries.’ Morris Iemma, NSW Premier.

WHAT HEALTH LEADERS SAY ABOUT THE REPORT ‘The present structural and hierarchical arrangements of our health care system were established at a time when the health workforce, available technology and patient populations were very different to today. In those days, hospital nurses and midwives were not university educated and GPs were the lynchpin of health care. Those days have long gone.’ Professor Judy Lumby, Executive Director of the College of Nursing

‘Proposals to replace doctors with lesser-trained and lower-skilled health workers are unacceptable.’ Choong-Siew Yong, Vice President AMA 22 THE LAMP MARCH 2006

PRODUCTIVITY COMMISSION PUTS NATIONAL ACCREDITATION ON THE AGENDA n another wide-reaching recommendation, the Productivity Commission has proposed the establishment of a national accreditation regime in health to consolidate the current profession-based system. Brett Holmes says the NSWNA supports the development of national registration standards for health professionals. ‘But on a practical level we believe these bodies will work better if they are professionallybased rather than operating across the entire workforce as recommended by the Commission,’ he said. ‘For example, there should be a national nurses’ registration body rather than one board for the entire health workforce. As the Bundaberg Hospital Royal Commission shows, the quality of education and training and the process of registration are vital to the maintenance of quality.’

I Hannah Dahlen

Brave new nursing role

o deal with the predicted increased pressures on the health system the Productivity Commission has recommended the establishment of a new body – a health workforce improvement agency – to help establish new roles in the health workforce. It is anticipated the agency would be a non-partisan group of experts who would examine the evidence and support positive innovations that could be rolled out more widely. The NSWNA believes this could provide good opportunities for nurses to provide more cost effective and sensible solutions to many health problems. It will allow nurse practitioners and midwives to move up professionally and take on roles that are currently monopolised by doctors. These professionals could provide services that will be funded through Medicare and include the capacity to offer Medicare rebates without doctor referral. Midwife Hannah Dahlen believes the Productivity Commission report has some very good ideas.

‘There are some huge challenges but the Commission has been brave. The key will be if the federal government is brave enough to fight the AMA and put patient interests first,’ she said. Hannah believes the Commission is right about the need to change the skills mix in health and to open up Medicare funding to other health professionals like midwives. ‘If we shifted workloads so midwives were the lead professional for the majority of ‘low risk’ childbearing women, which is their area of expertise, and obstetricians used their expertise to focus on childbearing women who are ‘high risk’ we would have better outcomes for women and babies, a more cost effective maternity system and less of a workforce crisis,’ she said. ‘We have and are currently arguing the need for midwives to access Medicare funding and the productivity commission agrees. In New Zealand where midwives have access to public health funding, 79% of women opt for a midwife as their lead carer.’ Helen Bellchambers, an Clinical Researcher in aged care, agrees with the Commission’s position that well trained nurses could take on some roles now limited to doctors. ‘In aged care there is a chronic GP shortage and the scope of practice for RNs has altered in line with community needs over the past 10 years. Also, you don’t have the same back up you do in acute areas. A nurse practitioner or advanced gerentologist nurse is well placed as a conduit between other professions and patients and to give a more immediate response,’ she said.

While welcoming the new opportunities that the commission is recommending for highly skilled nurses, Helen says there needs to be caution about the way roles are defined for those who administer medications in aged care. ‘Medication management is a complex activity, no matter who is in charge. At present, in most facilities, there is a minimum regime that administration of medicine is done by a person with competency in the task. At all levels – assessment, planning, administration – a high level of understanding is required. Any change from that needs to be based on evidence not on costs,’ she said. Helen Bellchambers says she is puzzled by the resistance of the medical profession to the Commission’s report ‘I’m not convinced the doctors’ attitude is based on sound evidence. It is more of a turf war,’ she said. n THE LAMP MARCH 2006 23

N RE O P WFSE SI S N I OB N RA I EL F I S S U E S

The bush deserves a better health deal Nurse practitioner Lorna Scott

24 THE LAMP MARCH 2006

ne of the Productivity Commission’s principal concerns was the specific problems facing health care delivery in rural and remote areas. Lorna Scott, a nurse practitioner in community health, said the extension of the Medicare rebate to work done by nurse practitioners and midwives would make a big difference to the availability of health services in rural and remote areas. ‘The services just aren’t there. There aren’t the doctors and nurses are holding it together,’ she said. ‘I’d like to see more nurse practitioners out there. We’re very under resourced. Our women’s health clinics are already booked out until May. Extending the Medicare rebate will make a big difference. When people can’t get a rebate it often stops them using a service – from a midwife for example – because they can’t afford to pay out of pocket.’ Lorna said there were other

recommendations in the report that would make a difference in the bush. ‘Improving educational opportunities in rural areas and providing better support for rural health workers is very important.’ Lorna said that while opposition from groups like the AMA was disappointing, the attitude on the ground in rural areas was often different.

‘We’re very under resourced. Our women’s health clinics are already booked out until May.’ ‘At a local level I don’t have too many problems with doctors. The resistance has lessened and there is more rapport. Our work is seen as being complementary. In fact some GPs have turned around their attitudes completely and are asking us to work with them

because it makes their lives easier. It depends on whether they have had contact with us. A lot of doctors don’t have the opportunity to work with nurses and are still locked into a mindset of what it was like 20 years ago.’ Brett Holmes says the NSWNA has, over the years, devoted considerable time and energy to the issue of lack of health services in rural and remote areas. ‘The Commission rightly points out that nurses are the backbone of health care delivery in rural and remote areas. They are the only professional group with any real numbers in most of these areas. In fact, health services would completely collapse in rural and remote areas if it were not for nurses,’ he said. “The NSWNA agrees with the Commission that a more sustainable and responsive health workforce is necessary for health service delivery in rural and remote areas. New models of care are also essential to this and the introduction of nurse practitioners is a good example of such innovation.’n

Take advantage of our

member seminars

To book your place at one of the following seminars, either email or fax your name and telephone contact details to Lucy Melville at: Email: lucy_melville@ﬁrststatesuper.com.au Fax: (02) 9238 2599 Location

Date

• Sydney city

5 April 2006

Topic Growing your super – how much will you need?

• Blacktown

3 May 2006