The Lamp April-May 2023

VOTE FOR THE FUTURE OF PUBLIC

CONTENTS

Contacts

NSW Nurses and Midwives’ Association

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Editorial Committee

Shaye Candish, NSWNMA General Secretary

Michael Whaites, NSWNMA Assistant General Secretary

O’Bray Smith, NSWNMA President

Michelle Cashman, Long Jetty Continuing Care

Richard Noort, Justice Health

Liz McCall, Byron Central Hospital

Diane Lang, South East Regional Hospital, Bega Valley

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The Lamp ISSN: 0047-3936

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Authorised by S. Candish, General Secretary, NSW Nurses and Midwives’ Association, 50 O’Dea Avenue Waterloo NSW 2017

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VOLUME 80 NO. 2

APRIL / MAY 2023

10

COVER STORY

Crucial moment for public hospitals

The people of NSW go to the polls on Saturday 25 March. In the following pages, NSWNMA local leaders tell The Lamp why the public health system is a vital election issue.

14

COVER STORY

COVID dramatically accelerated nurse and midwife shortage

Even before the pandemic there was a serious shortage of nurses, midwives and other essential workers but the situation has deteriorated markedly in the last few years, new research confirms.

16

WORKFORCE SURVEY Exit signs

Increasing work pressure is forcing many experienced nurses to quit their jobs, a union survey finds.

20 MEDICARE Medicare shake-up to give nurses, midwives a bigger role

The Strengthening Medicare Taskforce has recommended a major expansion of multidisciplinary primary health care.

24 AGED CARE Staff petition Allity for fair pay, ratios

Inadequate staffing and unsafe workloads are commonplace, and nursing staff have not had a pay increase for more than two years.

REGULARS

5 Editorial

6 Competition

6 Your letters

27 Branch Beat

30 What’s on

32 Ask Shaye

36 News in brief

41 Crossword

43 Book Club

45 Nursing Research Online and Professional Issues

46 Your Health & Wellbeing

Vanessa Smith, Tyrone Dallas & Shane Slade. Photographed by Sharon Hickey

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Candish

GENERAL SECRETARY

We need a new government to tackle NSW’s health crisis

The Perrottet government has shown itself incapable and unwilling to even try to fix a public health system crisis that has been getting worse year by year.

The empirical evidence of a critical staffing crisis in our public health system just keeps piling up, yet the NSW Government refuses to budge from its hands-off stance, even when we are on the cusp of a state election.

A study by Professor David Peetz, a highly respected labour market academic from Griffith University, shows that the nurse and midwife shortage in NSW has been getting progressively worse for the last decade but accelerated markedly during the pandemic (see p 14).

His research shows that the COVID-19 pandemic put special pressures on essential workers, especially nurses and midwives, compared to other occupations.

Internet vacancies for registered nurses in NSW trebled between 2012 and 2022, with a 125 per cent increase over the past five years and a 48 per cent increase over the two years to 2022, the report found.

Adverse conditions at work and poor pay were major determinants behind the shortages.

Another report released recently by the Rosemary Bryant AO Research Centre shows the dire consequences for nurses and midwives from the devastating loss of experienced clinical staff from the state’s public health system (see pp 16–19).

Over 15 per cent of nurses surveyed suffer from symptoms of posttraumatic stress at clinical levels. Overwork, exhaustion and burnout were identified as key contributors. The report found better pay, better workplace support and reduced

workloads were the top three retention measures needed to get nurses and midwives to stay in their jobs.

The Perrottet government’s track record and current position on wages and staffing do not bode well for nurses, midwives and the public health system if they are re-elected in the state election on 25 March. Poor pay, unbearable workloads and relentless stress have created a spiral in our public health system, with staff leaving the system to protect their own health and safety – leading to even more strain on the system and even more pressure on those left to prop it up.

This is unlikely to change if the current government is re-elected.

THERE IS AN ALTERNATIVE

The ALP opposition at least recognises the system needs help and an injection of resources. While they are still not committing fully to our ratios claim they are committing to a lot of it.

We will still have a lot to do to put our public health system back on solid, sustainable footings after more than a decade of appalling neglect. But it is reasonable to say that Labor historically has been committed to a strong, accessible

public health system.

We see that already in the actions of the Albanese government at the federal level in both aged care and with Medicare.

The Albanese government has moved quickly to start the rebuild of aged care. And its Strengthening Medicare Taskforce has recommended exciting roles for nurses and midwives in an expanded multidisciplinary primary health care system (see pp 20–23). It will take time to get aged care and Medicare to where they need to be for the future welfare of Australians. But there is one thing we can commend the Albanese government for: they have listened to what nurses and midwives have to say and have included the ANMF at the table where solutions are formulated and decisions are made.

This is what we need in NSW – a government that listens to those operating at the frontline of health and responds with concrete solutions to the glaring problems. We know ratios saves lives and are central to resolving many of the problems in the public health system. On 25 March, I would urge you to vote for candidates who support ratios. n

On 25 March, I would urge you to vote for candidates who support ratios.

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Have your Say

The status quo is a terrifying thought

Nurses and midwives are well aware of the ever-increasing pressures we work under and the troubling toll it has taken on our workforce – both in terms of staff retention and the personal impact on nurses and midwives.

It is because of my fears about the future of our health system I am compelled to engage in campaigning to change the government on 25 March.

It is not something I do because I enjoy it – frankly, I would far rather be enjoying my well-earned holiday. However, the thought that the current government could remain in office terrifies me for the sake of our health system, and us and the people it serves.

I understand the inertia that impedes many of my colleagues when it comes to campaigning in an election. The idea of expending the little remaining energy after a shift seems almost impossible. But I feel we must do what we can to move the needle on the election result.

The voting public cannot be expected to side with us if we remain quiet about our workplace crisis. We need to spread the message that, contrary to what the government spin is, we are not coping! Our workforce is buckling under the pressure! Change is becoming an increasingly urgent requirement. We must speak to our local parliamentarians, candidates and the community, to make them aware of the crisis we face. We need ratios and fixing the health system to be front and centre in the minds of all this election.

Stephen Mansfield, RN

An essential service treated as disposable COVID-19 has shown how vulnerable our public I work in ICU and since becoming involved in the union I am more aware about what is happening throughout hospitals and it is awful.

As with everywhere there is chronic understaffing, with RNs and ENs being replaced with AiNs or not being replaced at all. How can we provide safe, effective care when we are constantly understaffed?

It is so demoralising. Admitting patients in the corridor or at the nurses’ station is becoming the new normal – where is the dignity for incontinent patients having to be cleaned in a corridor? Management is not

addressing the cumulative effect understaffing and excessive workloads have on the workforce. There are increasing incidents of physical and verbal violence to nurses and midwives, which appears to be another thing we have to cope with. We are an essential service that’s being treated as disposable. Can you imagine if every nurse in NSW Health refused any extra hours or overtime for one week?

The whole system would collapse. I really hope whoever wins the next election is committed to ratios, as the current situation is not sustainable. I have no clue who I am going to vote for as Labor is being mealy-mouthed with regard to ratios and a fair pay rise. Why is Labor not taking ratios to the polls? It has for the past two state elections. I’m angry that the love I have for my job is being eroded by a government that shows no desire to improve conditions for staff and patients.

Laura Anderson, RN

Disappointed with the government

Throughout the last year we have heard the NSW Government state multiple times that the nurses and midwives of NSW Health are ‘coping’ with the increasing complexities and demands on the public healthcare system and of their patients. Mr Hazzard, you described the nurses and midwives striking over fair pay and better working conditions as “unfortunate” and “disappointing”. You stated it is “unfortunate” the strikes were going ahead after the government’s “efforts to try to work our way through their principal issues”.

But what do you see as our “principal issue”, Mr Hazzard? Is it the fact we want a pay rise to match the current rise of inflation, due to the pay cuts we have received over the past 12 years due to the wage cap? Is it the fact we want every single person we provide care for to be counted in our workloads? Or is it the fact we would like a system that gives our nurses and midwives more time with our patients, allowing for better and more suitable assessment of each patient’s condition, safer care, better risk management and a decrease in staff burnout and stress (aka ratios)?

Nurses and midwives are left feeling disappointed by the current government.

Jessica Plater, RN

LETTER OF THE MONTH Statement from the heart, at work

On Friday 17 February, I had the privilege of attending the inaugural NSWNMA First Nations Members’ meeting with my daughter Rebekah (a nurse/midwife) and 27 other amazing Aboriginal and Torres Strait nurses and midwives from a wide variety of Indigenous Nations across the state.

The Association has taken the proactive step of asking Aboriginal and Torres Strait Islander nurse and midwife members how the Association can support and develop our voice. This initial meeting aimed to create a supportive framework for Aboriginal and Torres Strait Islander nurses and midwives informed by our vision and experiences.

The collaborative, yarning format of the day created a safe space for us to share our experiences and encouraged us to explore our vision of culturally safe health care in Australia.

The day concluded with the proposed formation of a branch for Aboriginal and Torres Strait Islander nurses and midwives with no geographical boundaries. We also resolved to create a

collective for members who may not want to join the branch but still want to be connected to mob. This group will offer support, mentorship and collaboration on any issues that may arise in our practice or workplace.

With Shaye and Michael’s commitment to modelling inclusive collaboration with Aboriginal and Torres Strait Islander members, I feel positive that the Association is adopting the essence of the Uluru Statement from the Heart, respecting our voice on issues that impact us and our communities. They have made it clear the Association wants to work towards this in meaningful ways and by authentic actions.

I would like to thank Shaye Candish and Michael Whaites for this opportunity and acknowledge the deadly nurses and midwives who attended the meeting on the day and committed to the process.

Jo Burton RN, NP

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

Vote for the future of public health

The NSWNMA wants the NSW state election to be a referendum on shiftby-shift ratios, says General Secretary Shaye Candish.

“The election is both a moment for accountability and an opportunity to progress our campaign for ratios,” she said.

“When nurses and midwives cast their ballot on 25 March, we would like you to remember what your lived experience has been like in the workplace over recent years and to vote for candidates who support ratios so we can make things better. “There is a clear choice between parties that support safe staffing and an incumbent government that clearly does not.

“The Perrottet government does not even listen to nurses and midwives – witness the conspicuous silence after four massive statewide strikes over the last 12 months –and this must change. Without a government that is prepared to listen and to respond to nurses’ and midwives’ warnings, the public

health system has a grim future.”

WHAT LABOR HAS COMMITTED TO

The ALP hasn’t committed to the NSWNMA’s full ratios claim but they have signed up to five key areas, starting with emergency departments. Under a Labor Minns government:

• All existing NHPPD wards will convert to a shift-by-shift system. For those currently at 6 NHPPD, a minimum of 1:4, 1:4, 1:7 enforceable on every shift will apply – with an additional nurse designated as “in charge of shift”/“clinical coordinator” on at least two shifts. Assistants in nursing will be additional to the minimum

• In EDs there will be a move to a shift-by-shift minimum of 1:3 + triage; 1:1 in resus; 1:3 in EMUs and 1:4 in MAUs. A clinical initiative nurse and assistants in nursing are to be additional to the minimum

• In Maternity there will be a full review of Birthrate Plus® in consultation with NSWNMA;

shift-by-shift minimum of 1:3 in postnatal wards. Midwifery group practice/midwifery-led models of care will continue

• ICUs will be staffed to the latest Professional Standards outlined by the Australian College of Critical Care Nurses, as relevant to the department

• Multi-Purpose Services with Level 2 ED open 24/7 will get a shift-byshift minimum of three nurses, two of whom must be registered nurses and two must be FLECC or ENECC trained.

THE PERROTTET GOVERNMENT’S POSITION

As The Lamp went to print, the NSW Government hasn’t moved beyond its announcement from last year’s June state budget when it claimed it would enhance the public health system with 10,148 additional fulltime-equivalent staff.

NSWNMA Assistant General Secretary Michael Whaites says there has never been any clarity about how many new nurses and midwives are within this figure, where they will be

The state election on 25 March will be a critical moment in our campaign for ratios.

When nurses and midwives cast their ballot on 25 March, we would like you to remember what your lived experience has been like in the workplace over recent years.

— NSW General Secretary, Shaye Candish

ratios4nsw.com.au

allocated, or when they will be recruited, and there still isn’t.

“These numbers include a rehash of previous announcements and include the NSW Ambulance service as well as at least 1600 nurses and midwives from a 2019 announcement.

“There’s no guarantee how many will actually be recruited because the government said it would allocate funds to Local Health Districts to use at their own discretion.

“What we do know is ratios are completely off the table as far as the Perrottet government is concerned.”

OTHER PARTIES

Both the Greens, and the Shooters, Fishers and Farmers Party have committed to support mandated safe staffing ratios. n

Learn more

Visit our election website to out find which candidates support ratios.

https://ratios4nsw. com.au/

“Ahead of the state election, we are raising awareness of our ratios campaign in the area around St George Hospital, where I am NSWNMA Branch President.

Understaffing is the number one issue for members, along with excessive workloads. People are being pushed over the edge and doing jobs in excess of nursing. There is an incredible incidence of overtime in the ICU, and it is really hard to fill the gaps because you need someone trained.

“There are some critical seats in and near the hospital, such as Kogarah, held by the Labor leader Chris Minns, and the seats of Rockdale and Oatley, and we are trying to speak with as many candidates and sitting MPs as possible about ratios. We are hitting the ground with letterbox drops and going to train stations and handing out flyers there, and having a chat with anyone who has a minute to stop. We are also using

social media: our members at St George are putting messages on Facebook, Instagram and Twitter to share with their families and friends.

“We’ve spoken to all the Greens candidates in the area, and they are very committed to supporting ratios if they win. The Labor candidates have committed to five areas, and they call for ‘safe staffing’, so it is a good start, but there is a long way to go. We’re advising people to ask their local candidates and MPs to support ratios fully, and then ask which candidates best support those.

“It is critically important to set up the public system for the next decade. The result of this election will probably either make or break the health system.

“We are generally receiving quite a positive reaction, and there is a lot of public support for nurses and midwives.” n

‘The result of this election will probably either make or break the health system’ — Shane Slade, RN

Crucial moment for public hospitals

The people of NSW go to the polls on Saturday 25 March. In the following pages, NSWNMA local leaders tell The Lamp why the public health system is a vital election issue.

“I think the poor state of public health services will be a big issue at the election, especially given what we’ve been through during the pandemic,” says Elise, Delegate, NSWNMA Wollongong Hospital Branch.

“At some level everyone has felt the impact of the system’s weaknesses – the care deficit is definitely on people’s radar.” Achieving mandatory staff-to-patient ratios is the most important issue for midwives, she believes.

“Heavy workloads are causing a great deal of mental frustration and a lot of burnout for me, my colleagues and among midwives across the state.

“The pressure is so intense that a lot of staff are leaving. Retaining staff is now a real challenge.”

The ALP has promised to introduce maternity ratios of one midwife to three mothers and to review Birthrate Plus to ensure babies count.

“Under the current system, maternity doesn’t have any staffing safeguards – not even the minimal protection of nursing hours per patient day” Elise says.

“We do have Birthrate Plus but each LHD gets to decide how they use the allocated hours. Hospitals can allocate a lot of that time to educator or policymaker roles, for example, rather than putting sufficient people on the floor.

“I might have eight mothers on an average shift, but because babies aren’t counted, that means writing 16 sets of notes, a minimum of 16 obs, and everything else.

“That workload is not reflected in the current staffing system.”

As a NSWNMA local leader Elise has met politicians from different parties over the last few years.

“It’s been very obvious the Liberal Party has no intention of even speaking with us or trying to understand where we are coming from.

Midwife Elise Spanner and fellow NSWNMA members in Wollongong plan to hold a public forum and community picnic to focus attention on health care, including maternity services, in the lead up to the state election.

“Other parties have at least been willing to have a conversation with us.”

“The poor state of public health services will be a big issue at the election”

The ALP has promised to introduce maternity ratios of one midwife to three mothers and to review Birthrate Plus to ensure babies count.

Whoever wins this month’s state election needs to think differently about public health services and funding, says Michelle Rosentreter, a senior intensive care nurse and Delegate, NSWNMA Hornsby and Ku-ring-gai Hospital Branch.

“Governments will always face budget constraints, but now they need to ask themselves whether they can afford to maintain the current approach and do nothing,” she says.

“By tolerating constant short staffing and the ridiculous workload demands placed on clinicians, the current government has shown a complete disregard and disrespect for healthcare professionals. “I don’t know why they feel it’s okay to be as inactive as they have been.”

Michelle says the election is a great opportunity for the next government to step up and invest in public health and the workforce.

She says this can be achieved via a payrise to make nursing a more attractive career and “a staffing footprint that must be recruited to above what we currently have”.

“The next government has got to understand there needs to be incentives and empowerment of the existing workforce.” Labor has promised to adhere to the latest professional standards laid down by the Australian College of Critical Care Nurses, including access nurses.

Michelle believes the pandemic has helped bring about greater community awareness of public health issues and the system’s limitations.

She says members of the public she speaks to can’t believe that some politicians deny or make light of the system’s failings. “People can see how busy nurses are when they go to visit their relatives in hospital. Patients don’t want to ring the bell because they can see the nurses are understaffed and overworked.

“And because nurses and midwives took a united stand in support of four massive rallies and lots of independent stopwork actions, they showed the public that short staffing and unsafe workloads are a problem in every community.”

Nurses and midwives should take every opportunity to speak to anyone regarding the system’s challenges and solutions, such as staffing ratios and a pay rise to retain and incentivise the highly trained workforce.

“The public needs to know the health system has a smart and dedicated workforce that is being undermined by government inaction.

“We need everyone to understand that investment is the key – and we need a government that will start to fix things, not just talk.”

“The current government has shown a complete disregard and disrespect for healthcare professionals”

‘The public needs to know the health system has a smart and dedicated workforce that is being undermined by government inaction.’

— Michelle Rosentreter, Delegate NSWNMA Hornsby and Ku-ring-gai Hospital Branch

“Mental health nursing is built around engagement with, and observation of patients,” says Nick Howson, a mental health nurse and NSWNMA Delegate, Cumberland Hospital Branch.

“If you don’t have time to engage with patients and observe them, they will suffer and the health system will suffer.”

Nick says that over the past six years, documentation requirements for mental health nurses in NSW have dramatically changed from short, narrative, handwritten entries and rounding checklists to continuous observational documentation.

“These changes have far outstripped the staffing calculations developed a decade prior and still in use today.”

To ensure acute mental health wards are adequately staffed, the NSWNMA is seeking ratios of 1:3 on morning and afternoon shifts and 1:5 on night shifts.

However, the Liberal government will not even discuss ratios, Nick says.

“The Liberals keep making false and empty promises that something is coming to alleviate the staffing crisis, but have yet to actually announce anything,” he adds.

The ALP has promised to convert all NHPPD wards to shift-byshift staffing, which Nick agrees is a better system.

However, Labor’s promised ratio of 1:4 would leave mental health acute wards slightly worse off, he says.*

“Currently under the NHPPD the ratio is about 1 to 3.3, though we are rarely staffed to it.

“As a branch and an interest group we have spoken with Labor’s shadow health minister Ryan Park, but we haven’t had much movement on that unfortunately. I don’t believe Labor understands the situation and I think they really need to.

“It wouldn’t cost a great deal more to slightly increase the ratio in mental health and the benefits of that additional bit of time would outweigh the cost.

“In mental health an extra 15 minutes or half an hour with an individual is a huge benefit to them.

“Our patients require significant resources and take up the most time in EDs as repeat presentations and sitting around waiting for beds in mental health units.

“Properly staffing mental health units would have a flow-on effect in making sure there is less stress on EDs.

“Discussions about health care should not be about political parties – they should be about safety of patients and nurses and the benefits to the state.”

*Editor’s note: Labor is promising no unit or ward will be worse off following the implementation.

Nick Howson on what ratios mean to an inpatient mental health nurse: https://medium.com/@nick.howson/ nurse-to-patient-ratios-what-theymean-to-an-inpatient-mental-healthnurse-bd65ab4a630a

‘If you don’t have time to engage with patients and observe them, they will suffer and the health system will suffer.’

— Nick Howson, Delegate, NSWNMA Cumberland Hospital Branch

Healthcare should not be about political parties, it should be about the safety of patients

We have some clout and we need to use it

This state election may be the last opportunity to rescue the NSW public health system from its understaffing crisis, says ED nurse Colette Duff, Delegate, NSWNMA Sutherland Hospital Branch.

“I think we have a very small window to make some progress,” she says. “If we don’t get some significant change and some hope into this environment very soon, the resignations will keep mounting up.

“Almost every day, our nurses are leaving or saying they are looking for other jobs. I’m looking elsewhere too. I need some hope and at the moment the current government offers me no hope that anything is going to be fixed.

“We are really overworked and the staff is extremely junior. We don’t have enough senior nurses to support the new grads and look after our own patients.

“I want the juniors to be supported like I was supported when I started my career 27 years ago.

“I remember all these fantastic nurses who mentored me, answered my questions, gave me a hug when I needed it, and I feel bad because I just don’t have the time to give today’s new grads the same support.”

Colette says nurses who raise staffing problems are usually told to “make do” or “reprioritise”.

“That’s insulting – I have a master’s degree in critical care nursing and many years’ experience, and if I say I don’t have enough staff to do the job, then the government should be listening to me and other nurses.

“I can prioritise everyone over the person with the broken leg, but that person is still sitting in the corner with a broken leg and they are a human being who deserves better.”

The ALP has pledged to introduce nurse-to-patient ratios of 1 to 3 in all EDs if it wins government.

Sutherland Shire is regarded as a Liberal Party stronghold, but Colette says locals are increasingly aware the hospital staffing crisis needs to be fixed.

“As nurses we need to use our votes far more carefully. We are a fairly big and influential group of people; we have some clout and we need to use it.

“We need to remind our MPs they are accountable to us, the electorate, and not to the premier or the Liberal Party, who are not listening to us.

“We have to show our MPs that if they don’t look after our interests, we will vote them out.” n

‘As nurses we need to use our votes far more carefully.’

— Colette Duff, Delegate, NSWNMA Sutherland Hospital Branch

COVID dramatically accelerated nurse and midwife shortage

Labour shortages have been on the rise in Australia but dramatically so in essential occupations like nursing, midwifery and teaching, a report by respected labour market academic Professor David Peetz from Griffith University says.

The research he compiled found that by 2022, the number of internet vacancies for “essential” occupations – such as nursing and midwiferywas 98 per cent higher than it had been in 2018. For other occupations the number was just 26 per cent higher than in 2018.

In NSW there has been a progressive worsening in the shortage of registered nurses for more than a decade, with an acceleration over the last five years and in particular during the pandemic.

Internet vacancies for registered nurses trebled between 2012 and 2022 – rising by 205 per cent, with a 125 per cent increase over the past five years and a 48 per cent increase over the two years to 2022.

The report notes a strong gender dimension to essential work: 75 per cent of workers in essential occupations are female, compared to 47 per cent in the workforce as a whole. Some 46 per cent work parttime, compared to 34 per cent in the economy as a whole.

The shortages of essential workers are particularly marked in regional areas, the report says.

Between 2017 and 2022, all internet vacancies grew by 22 per cent in Sydney but by 117 per cent in provincial and rural regions. Vacancies in essential occupations grew by 74 per cent in Sydney but trebled – growing by 203 per cent –in provincial and rural regions, with the fastest growth in the North Coast and Riverina-Murray regions.

“Vacancies for essential occupations are more consequential in provincial and rural regions than they are in metropolitan regions and, in some non-metropolitan regions, advertised vacancies for essential occupations disproportionately

dominate vacancies in that region,” it says.

The report notes there have been high rates of dissatisfaction with aspects of work, and high rates of attrition leading to a worsening of shortages. Some job-related factors such as work intensity, burnout and stress may also be contributors, it says.

Conditions of employment – in particular pay – also help to explain labour shortages.

“When employers say there is a labour shortage, it sometimes is better interpreted as a shortage of wages they are willing to offer to attract labour,” the report says.

“As recent public sector pay policies have led to declines in real wages for many people in essential occupations, it is highly likely this has depressed the supply of labour to essential occupation labour markets and thereby promoted labour shortages.”

“An easing of public sector wage

Even before the pandemic there was a serious shortage of nurses, midwives and other essential workers but the situation has deteriorated markedly in the last few years, new research confirms.

‘The report clearly shows that NSW nurses and midwives are stretched to the limit. We know that puts lives at risk. We also know ratios save lives.’

— NSWNMA Assistant General Secretary Michael Whaites

restraint could not be the only solution to shortages of essential workers. There is no single solution. But it is difficult to see shortages being overcome in the absence of appropriate changes to wages policy.”

NSWNMA Assistant General Secretary Michael Whaites says the Peetz report is the latest in a long line of studies that reinforce the need for ratios.

“The report clearly shows that NSW nurses and midwives are stretched to the limit. We know that puts lives at risk. We also know ratios save lives.

“The election on 25 March will be pivotal for our public health system going forward. It is vital we all support candidates who support our ratios claim.” n

The community’s shock about our conditions is palpable

RN Skip Blofield and colleagues from Westmead Hospital have been spreading the word about ratios in Parramatta.

“Any time you have someone’s attention for any extended period, I find the same pattern – when told about the conditions that nurses and midwives have experienced over the last few years, people overwhelmingly support our claims,” he says.

“Several times when the ratios claim is explained in contrast to workloads of six, eight, or ten patients without breaks or support, the shock is palpable.

“A young woman was reminded that in that same year during the Delta wave, when we were called the ‘Heroes of the Pandemic’, our wages were frozen. At that point she then pledged to change her long-standing party allegiance and to instead vote for another candidate friendlier to our claims, in an effort to change the state government.

“In truth, this is our great strength in speaking our demands to power –when the community understand the state of their healthcare system, they readily come on side with us.”

Campaigning for change makes me excited

Rachel Hughes from John Hunter Hospital says she has been meeting with local candidates with her colleagues, “talking about our real life experiences”.

“We also talk about ratios and why it is just so important. We’ve been letterboxing and approaching local businesses to display posters and flyers. Campaigning for change makes me excited: I want to make things better for all nurses and midwives.

“This election will be a catalyst for so many nurses and midwives. We will either retain the staff we currently have and entice more to the profession or we’ll see the largest exodus of nurses and midwives we have ever seen. As a profession we cannot deal with any more of this.”

“It is difficult to see shortages being overcome in the absence of appropriate changes to wages policy.”

Exit signs

Increasing work pressure is forcing many experienced nurses and midwives to quit their jobs, a union survey finds.

Asurvey of NSWNMA members in public health suggests more than half intend to leave their current nursing and midwifery positions within the next five years.

The survey of workforce conditions, safety and wellbeing was conducted for the NSWNMA by the Rosemary Bryant AO Research Centre in mid-2022.

A total of 2305 nurses and midwives responded to the survey.

NSWNMA General Secretary Shaye Candish said the union commissioned the survey out of concern for its members’ health and wellbeing during the COVID-19 pandemic.

“A further reason was the risk of workers’ rights being neglected or abused due to system pressures aggravated by the pandemic,” she said.

“The current pressure NSW health services are under means there is a significant risk to the occupational and mental health of the health workforce.

“There are indications that a concerningly large number of staff are experiencing symptoms of fatigue, burnout, stress, anxiety, depression and posttraumatic stress.”

The survey showed 13.3 per cent of respondents intended to retire in the next five years.

Respondents were also asked when they intended to leave their current position.

A majority – 58.2 per cent – did intend to leave.

Of those who intended to leave their current position, 37.4 per cent planned to do so within the next 12 months.

Of those who intended to leave their current position, 22.2 per cent intended to get out of nursing, 36.3 per cent intended to stay in the profession and 41.4 per cent were undecided.

Over 400 respondents indicated that they had applied for other positions in the past six months. More than a quarter of them had applied for a position in another profession.

A total of 194 respondents were then currently working in a COVID-19 vaccination clinic or screening clinic. When asked how likely they were to return to the clinical setting, more than half (53.1 per cent) were either “not at all likely” or only “somewhat likely” to do so.

The report noted that nurses working in COVID-19 settings are “potentially highly experienced nurses whose skills and experience would be a loss for current generations of junior

nurses and emerging nurse leaders should they not return.”

INCENTIVES TO STAY

Respondents planning to leave nursing were asked what would incentivise them to stay.

The top three responses were better pay, better workplace supports, and reduced workload.

Factors pushing members to leave the profession were associated with “the emotional drain of work”, “work–life conflict”, and an insufficiently supportive work environment, the survey found.

Other push factors were “associated with leadership” the survey noted.

“To this end, it is important that the healthcare system and services give consideration to supporting stronger representation (and visibility of representation) of nursing or midwifery leadership.” n

‘The current pressure NSW health services are under means there is a significant risk to the occupational and mental health of the health workforce.’

— Shaye Candish

Key findings

13.3% of respondents intended to retire in the next five years

58.2% of respondents intend to leave their current position within five years.

37.4% of those planned to do so within the next 12 months

Of those who intended to leave their current position, 22.2 per cent intended to get out of nursing, 36.3 per cent intended to stay in the profession and 41.4 per cent were undecided.

The top three incentives to stay in the profession were better pay, better workplace supports, and reduced workload.

About the survey

The NSW public health sector workforce wellbeing survey was conducted during mid-2022.

Almost all survey respondents were NSWNMA members.

Of the 2305 nurses and midwives who responded to the survey, 88 per cent were women and 76 per cent were RNs.

Ages ranged from 18 years to 76 years and the mean age of respondents was 46.5 years.

More than one-third of respondents had caregiver responsibilities for children and one in five had other caregiver responsibilities at home.

The survey was conducted by the Rosemary Bryant AO Research Centre, which is a partnership between the University of South Australia, the Australian Nursing and Midwifery Federation (SA Branch), and the Rosemary Bryant Foundation. n

Read the report

https://www.nswnma.asn.au/wp-content/ uploads/2023/02/Impacts-of-COVID-19-andworkloads-on-NSW-nurses-and-midwivesmental-health-and-wellbeing_final.pdf

Work-related exhaustion and disengagement – key indicators of burnout – are major causes of post-traumatic stress.

About 15 per cent of nurses and midwives in NSW public healthcare facilities are suffering post-traumatic stress at a clinical level, the Rosemary Bryant AO Research Centre survey of NSWNMA members found.

The survey reinforces a growing body of literature indicating that healthcare workers are at real risk of post-traumatic stress symptoms and post-traumatic stress disorder (PTSD).

The survey sought to gauge the possible extent of post-traumatic stress and workplace factors that may contribute to it.

It assessed post-traumatic stress using a Department of Veteran Affairs checklist.

“Results indicated that while the majority did not have post-traumatic stress at a clinical level, there was still a sizeable proportion (approximately 15 in every 100) who did,” the survey report said.

“There were a number of organisational factors that contributed to this; in particular, concerns regarding workload, skill mix and staffing levels, as well as job demand and lack of availability

of job resources important to the working environment for nurses and midwives.”

The report said there was a “strong, positive relationship between the two measures of burnout – exhaustion and disengagement – with PTSD”.

The survey results “showed that the higher the burnout, the higher the proportion of people with posttraumatic stress scores above the clinical cut-off”.

“People with post-traumatic stress were also more likely to have a poorer quality of life.”

The survey report notes that PTSD requires a psychological diagnosis from a qualified health practitioner.

The report adds: “While this research used a validated instrument to explore the presence of symptoms of PTSD among the nursing and midwifery cohort, it is not valid to conclude that these people have PTSD; rather that they have

expressed symptoms of PTSD at a level that, according to the publisher of the instrument, are comparable to others who have been diagnosed with PTSD.”

INCREASING WORKLOAD

Survey respondents were asked to indicate how their workload had changed during the pandemic.

The vast majority (90.1 per cent) said it had either slightly, moderately or significantly increased. Very few (4.5 per cent) said their workload had decreased.

Respondents were asked whether, as part of the pandemic response, they had been asked to work outside of their usual scope of practice – and, if so, whether they received appropriate education and training to do so.

Nearly half of respondents (44.8 per cent) had been asked to work outside of their usual scope of practice.

About three-quarters (74.5 per cent)

‘The higher the burnout, the higher the proportion of people with post-traumatic stress scores above the clinical cut-off.’

15% of NSW nurses and midwives suffer post-traumatic stress “at a clinical level”

Working for multiple employers

Some respondents (n = 464) indicated they worked at more than one workplace. Of those who indicated they did, approximately one-third (n = 149) indicated they were asked to give up working at one of them.

Of these respondents, nearly two thirds (63.1%) indicated they gave up working at both workplaces. Only one-fifth (22.1%) sought advice on the situation and approximately one-quarter (26.8%) reported at the time, the situation was still not resolved.

said they did not receive appropriate education and training to do so.

WORKPLACE RATINGS

Survey respondents were asked to rate their workplace across a range of areas related to policies and procedures. Ratings were scored on a six-point scale from “very poor” through to “excellent”.

Ability to deploy more staff was the policy and procedure that nurses and midwives rated most poorly.

The top five areas where organisational policies and procedures were frequently rated fair, poor or very poor were:

· Ability to deploy more staff if required (86.7 per cent)

· Access to alternative accommodation to stay between shifts (80.4 per cent)

· Debriefing processes (79.7 per cent)

· Managing staff abuse (73.1 per cent)

· Access to workplace psychological or mental health support (69.8 per cent).

respondents, followed by managing workload, and access to and frequency of taking breaks.

“Personal factors were not rated at as high levels of concern based on frequency response analysis,” the survey reported.

Across five of the seven factors, perceptions of concerns had improved from lockdown to the time of completing the survey.   These changes were “significant, yet modest” the survey found.

However, for staffing levels and skill mix, perceptions of concern had “significantly worsened”.

“It is evident in the results that perceptions of adequate staffing levels is poor and that it has declined over the course of the pandemic,” the survey found.

Staffing was the area most in need of improvement, the survey reported.

Other areas identified as needing improvement including addressing skill mix and being able to access paid leave.

“Redeployment to ED and ICU without proper training, poor staffing, increased patient workload, being verbally abused by patients and relatives, feeling unsupported by executive.”

Respondents were asked to indicate if, as part of the pandemic response, they had been asked to work outside of their usual scope of practice, and if so, whether they received appropriated education and training (Figure 18) Nearly half of respondents (44.8%) had been asked to work outside of their usual scope of practice. Of those who had, approximately three-quarters (74.5%) indicated they did not receive appropriate education and training to do so.

Respondents were also asked to rate their level of concern about seven factors related to work and personal/family life at the height of the 2021 lockdown. The seven factors were:

· My physical health

· My psychological wellbeing

· Keeping my family or people I live with safe

· Managing my workload

· Staffing levels

· Skill mix

· Access to and frequency of taking breaks. Results showed that staffing levels and skill mix were the factors of most concern to

The report noted that these concerns “are interrelated and associated with the lack of staff”.

Other policies and procedures identified as needing improvement include debriefing processes and managing staff abuse.

Respondents also reported they were “moderately, very or extremely concerned” about the following:

· The welfare of my colleagues (68.6 per cent)

· Having access to paid leave (61.4 per cent)

· Managing the personal needs of my family/ the people I live with (53.9 per cent). n

Figure 17. Perception of change to workload during the COVID-19 pandemic.

top three work environment factors based on level of concern were explored with respect to career experience (Figure 38) Results showed early career respondents reported higher levels of concern with respect to staffing levels (

=

p<.001), skill mix (χ

= 23.7, p<.001) and

Frequency of high concern for key work environment factors by career experience.

Medicare shake-up to give nurses, midwives a bigger role

The Strengthening Medicare Taskforce has recommended a major expansion of multidisciplinary primary health care.

Aprimary healthcare system in which nurses, midwives and nurse practitioners work to their full scope of practice in multidisciplinary teams delivering complex care.

This scenario is a likely outcome of a major overhaul of Medicare being considered by the federal government.

The Strengthening Medicare Taskforce recommended a major expansion of multidisciplinary care in its report to federal health minister Mark Butler in February.

The Taskforce includes nurse and midwife, doctor and allied health representatives.

Mark Butler set it up to advise on reforms to the 40-year-old Medicare system, which all industry groups agree is no longer fit for purpose.

GP bulk-billing rates are falling, Australians are paying more and waiting longer to see a doctor, and emergency departments are overflowing.

At the same time, the current fee-forservice model is failing communities with restricted access to care, including Aboriginal and Torres Strait Islander Australians, people in many rural and remote areas, and people on low incomes.

“After nine years of cuts and neglect by the former government, primary care is in the worst shape it has been

in 40 years,” Mark Butler said. He described an expansion of multidisciplinary care as “the key to managing the health of an older population with more complex and chronic disease”.

NEW FUNDING MODELS

“The Taskforce report recommends supporting this with new, blended funding models, integrated with the existing fee-for-service model, allowing teams of GPs, nurses, midwives and allied health professionals to work together to deliver the care people need,” he said.

“The Taskforce found that strengthening primary care with a greater range of health professionals working to their full scope of practice will optimise use of the health workforce across a stretched primary care sector.”

Annie Butler, Federal Secretary of the Australian Nursing and Midwifery Federation (ANMF), was a member

of the Taskforce, which operated for six months (the NSWNMA is the NSW branch of the ANMF).

She described the Taskforce recommendations as “very positive and very promising”.

“There was strong agreement for an increased role for nurses, midwives and a range of allied health professionals in a genuinely multidisciplinary model that does not rely only on a single clinician,” she said.

The ANMF will work to “make sure the intent of the recommendations doesn’t get lost” as industry groups lobby the government over the specifics of its reforms in the next few months.

HISTORIC OPPORTUNITY FOR REFORM

“The Albanese government and state and territory leaders must work together and not waste this historic opportunity for reform,” she said.

“They need to ensure that nurses

‘After nine years of cuts and neglect by the former government, primary care is in the worst shape it has been in 40 years.’

— Federal health minister Mark Butler

and midwives are at the centre of patient care in the community.

“Nurses, nurse practitioners and midwives provide quality care in every setting in Australia, including in rural and remote settings where often, there are no GPs.

“It’s just common sense to allow them to work to their full scope of practice in these settings.

“With appropriate standalone ‘block funding’ for nurses working in general practice, people would be able to see an RN for a whole range of healthcare and chronic disease management checks, wound care, immunisations, sick certificates and health promotion and prevention.

“This would certainly reduce the number of people having to go to hospital for these everyday care episodes.

“We also want to see outcomebased funding for keeping people well and out of hospital.”

Annie said reform could build on existing models of multidisciplinary care, such as nurse-led clinics in the ACT.

“The ACT clinics are not federally funded but they are a model that we could modify and use.

“They are taking an enormous load off GPs and EDs, while also working really well with a lot of GPs in the area.

“With appropriate policy and the right funding to incentivise the appropriate policy direction, we could see models similar to the ACT clinics spread all over the country.” n

What the Taskforce recommended

When setting up the Strengthening Medicare Taskforce, health minister Mark Butler asked it to advise on:

• improving patient access to general practice

• improving patient access to GP-led multidisciplinary team care, including nursing and allied health

• making primary care more affordable for patients

• improving prevention and management of ongoing and chronic conditions

• reducing pressure on hospitals.

The Taskforce recommended:

• removal of regulatory barriers that stop nurses and allied health workers from using all their skills

• more investment to foster multidisciplinary care teams, including within GP practices

• more investment for regional primary health networks to deploy nurses and allied health workers to GP clinics

• a move to “blended” funding models that combine visit fees with other types of payments, such as a flexible budget for each patient

• voluntary patient registration, where patients are linked with a “home” practice, so they build a relationship with one or more healthcare providers.

‘There was strong agreement for an increased role for nurses, midwives and a range of allied health professionals in a genuinely multidisciplinary model that does not rely only on a single clinician.’

— Annie Butler, ANMF

A seat at the table

Under federal Labor, nurses now have a say in the formulation of health policy.

The voices of nursing and midwifery unions and their members were rarely heard in Canberra’s corridors of power during the nine years of Liberal/National governments before May 2022.

The Morrison government and its Liberal/National predecessors typically failed to include nursing and midwifery professionals in consultations with health stakeholders.

“Nurses and midwives weren’t represented at the table and therefore their voices and input weren’t recognised in the formulation of health policy,” says Annie Butler, ANMF federal secretary.

Things have changed since the election of the Albanese Labor government last May.

Annie got a meeting with federal health minister Mark Butler within a week of him being sworn in and has since spoken with him often.

She said her appointment to the Strengthening Medicare Taskforce last year showed that the new government “recognises the importance of nurses and midwives in these critical discussions, shaping long-overdue health reforms”.

“In my view the minister totally understands the problem and solutions (regarding Medicare) including the need to enhance the

roles of nurses and midwives to reduce duplication of services and unnecessary additional costs.

“It is such a different relationship with this government than the one we had during the previous nine years.”

She says greater access to the government “doesn’t mean everything is rosy all the time – we’ve still got to fight our case pretty hard”.

“But this government’s starting point is fundamentally different to their predecessors – they are much more about trying to ensure equal access to care for everybody.”

MEMBER INVOLVEMENT IS VITAL

The ANMF has taken groups of NSWNMA members and union members from other states to see Mark Butler about reforms to Medicare and aged care.

“No one puts the issues more eloquently than our members themselves,” Annie says.

“They are in the best position to explain the ridiculousness of the way the system is currently set up

and the barriers it creates to effective primary health care.

“Without member involvement, stories about the failings and frustrations of the current system just don’t make any sense.”

Annie joined a range of health professionals on the Strengthening Medicare Taskforce, including the Australian Medical Association and the Royal Australian College of General Practitioners, the main doctor organisations.

She says the government will need “political courage” to manage “predictable opposition” from the AMA and RACGP and craft a new Medicare that faithfully reflects the Taskforce recommendations.

“People across the health system know the solutions that are urgently needed but we’ve got to find a way to make reforms that can’t be undone by a future government with a different view.”

She hopes to further involve nurse union members in discussions with the government as it formulates policy based on the Taskforce report.

‘It is such a different relationship with this government than the one we had during the previous nine years.’

PM ‘COMMITTED’ TO AGED CARE REFORMS

Annie has twice met Prime Minister Albanese in her capacity as ANMF federal secretary. They talked mainly about aged care reform.

“The PM is deeply committed to the aged care program that his government has started to set in place,” she says.

“Aged care reform is really hard because it is very complicated and will take time.

“However, the legislation the government has put in place has laid down a framework to build on.

“For many years, our union has been calling for RNs in nursing homes 24/7 – we have now got that.

“We’ve got a law that mandates minimum care hours. It’s not perfect, but it has given us a starting point and we have started to build on it.

“We’ve also got a commitment from the government to fund the outcomes of the current work value case.

“We’ve already got a stage 1 decision to award a 15 per cent increase to award rates – that’s a great start.

“It is likely to lead to really meaningful wage increases for aged care staff, who are some of the lowest paid workers in the country.” n

Biggest change in generations –Grattan Institute

The Strengthening Medicare Taskforce recommendations “amount to the biggest change to general practice in generations” says the Grattan Institute, a leading public policy think tank.

The Institute’s director for health and aged care, Peter Breadon, said Australians have got older and sicker since Medicare was designed 40 years ago.

“Many of us require longer consultations (and) there is strong evidence that people will be healthier and live longer if they have ongoing relationships with their care team, not just one-off visits.

“Today, we have a fee-for-service model that rewards doctors for seeing lots of patients for short, one-off visits.

“There are many primary care workforces, such as nurses and allied health workers, whose training means they can help GPs manage a growing and more complex caseload.

“But as it stands, our rules, regulations and funding model limit the help they can provide.”

‘This government’s starting point is fundamentally different to their predecessors – they are much more about trying to ensure equal access to care for everybody.’

— Annie Butler, ANMF

Staff petition Allity for fair pay, ratios

Inadequate staffing and unsafe workloads are commonplace, and nursing staff have not had a pay increase for more than two years.

NSWNMA members at aged care provider Allity came armed with a petition signed by more than 650 Allity employees when they met management to discuss a new enterprise agreement.

The petition called on the company to start bargaining for an agreement with a fair pay increase, staffto-resident ratios and improved conditions.

The agreement expired two years ago and Allity nursing staff have not had a pay increase since January 2021. Now, management is trying to push through a “rollover” agreement with minimal changes.

When this edition of The Lamp went to press, the company was offering a low 2 per cent annual pay rise backdated to January 2022.

The NSWNMA has served a log of claims on the company based on responses to a workplace survey conducted by the union.

“The survey revealed widespread workload issues across the company and showed members are desperate for a substantial pay increase to address the rising cost of living,” said NSWNMA Assistant National Secretary Michael Whaites.

The NSWNMA bargaining team negotiating with manage-

ment includes four Allity union member leaders.

STAFF DON’T FEEL VALUED

One of the four, RN Lalita Bhandari, said she found strong support for a better agreement while collecting petition signatures from fellow workers.

“Almost everyone was very happy to sign the petition,” Lalita said.

“No-one is happy with a 2 per cent pay increase, and with the company offering nothing to improve staffing and to reduce our workloads.

“Staff think it’s unfair that the agreement expired long ago and it’s been so long since we had a pay rise.

“Staff feel they are never valued at Allity. For example, Allity did not even communicate with staff about the enterprise agreement

‘No one is happy with a 2 per cent pay increase, and with the company offering nothing to improve staffing and to reduce our workloads.’ — Lalita Bhandari

expiring and the process of bargaining.

“Allity employees deserve more pay with better staffing. The workload is impossible for anyone to sustain – that is true for RNs, ENs and AiNs.

“I don’t think any of the staff will back down now. They know they can go and work somewhere else – in hospitality, for example –where the pay is higher.

“And people can see that the union is really fighting for our rights.”

Lalita said the NSWNMA bargaining team showed management a video of 22 nursing staff at Redleaf Manor Aged Care in Concord holding the 600 plus petitions signed by Allity staff outside the facility.

“The video showed manage-

Allity staff won higher wages after ‘No’ vote

Allity nurses have a history of standing together to win a better deal.

In 2017 and 2018, Allity made two unsuccessful attempts to push staff onto a substandard agreement.

A majority of staff voted ‘No’ to Allity’s offers in two secret ballots arranged by the company.

As a result, the company was forced to improve its pay rise offer from 1.8 per cent to 3 per cent.

ment we are united behind the union and the union is supporting a better deal for the staff,” she said.

She said workloads at her facility are getting worse, with a single RN having to look after as many as 58 residents on night shift.

“It’s getting harder and harder to replace staff who call in sick and people are doing double shifts almost every day. On multiple occasions, care teams are working short staffed.”

RNs had raised staffing and work-load issues with the facility’s general manager, but “our concerns are just ignored.”

“Why doesn’t management treat this staffing crisis as a priority? They need to pay much more attention to the safety of their staff.” n

The current NSWNMA log of claims for Allity includes shift-by-shift staff-to-patient ratios and a fair pay increase.

It also includes a minimum of two RNs on site 24 hours a day for any facility with 90 beds or more. n

Six owners in 20 years

Allity operates 45 residential facilities in four states, including 14 facilities in NSW.

The business has had six owners in the past 20 years.

Four have been private equity firms, which typically attract money from outside investors to buy companies, restructure them to cut costs and boost profits, then sell them.

Allity’s current owner, the aged care provider Bolton Clarke, bought it from private equity firm Archer Capital for a reported $700 million in December 2021.

Archer made a tidy profit, having paid $270 million to buy Allity from Lendlease in 2013.

‘Members are desperate for a substantial pay increase to address the rising cost of living.’ — Michael Whaites

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Meeting your Continuing Professional Development (CPD) obligations is now even easier with this great new benefit for NSWNMA members. As a financial member you have access to over 200 CPD modules – all part of your Association membership.

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St Vincent’s and Mater Branches rescue ADOs

How nurses and midwives at St Vincent’s Health Australia won back their entitlement to ADOs.

Rights under the Enterprise Agreement

Under the enterprise agreements (EA) covering St Vincent’s Private Hospital Darlinghurst, Mater North Sydney and St Vincent’s Griffith, full time nurses have long been entitled to work a monthly roster of 19 x 8-hour days plus one accrued day off (ADO).

The EA also says that by mutual agreement, nurses may opt to work 20 x 7.6-hour days in a 28-day calendar roster with no ADO. However, from 2018, nurses were told the 20 days of 7.6-hour shifts was the only contract on offer.

Similarly, staff who were changing positions and required new contracts (permanent or temporary) were told 7.6-hour shifts were the only option available.

In this way, the right to an ADO was denied to all RNs who signed employment contracts from 2018 through to 2022.

What the branches did

Sinead Keane, assistant secretary of the NSWNMA branch at St Vincent’s Private, said the changed approach to ADOs in 2018 came with a new executive leadership team when “the focus on reducing staffing costs seemed to intensify”.

Members raised the issue during branch discussions over a new EA last year.

“The union was gaining more momentum and a higher profile within the hospital,” Sinead said.

a

“People felt more empowered to bring up the ADO issue at meetings or by approaching a branch official.”

To determine the extent of the problem, NSWNMA member leaders at the hospital asked recent starters whether they had been offered a contract with ADOs. None had.

“The branch advised members who wished to keep their ADOs to contact the union office, and to push back and not sign any contract that did not include an ADO,” Sinead said.

Branch officials identified members who had been put on 7.6-hour contracts, told them they were entitled to a monthly ADO, showed them the relevant EBA clause and asked them if they wanted an ADO. All said yes.

The branch got them all to sign a form requesting an ADO roster starting on a common date and lodged the forms

with management.

Meanwhile, NSWNMA head office prepared to lodge a dispute with the Fair Work Commission.

The win

Management finally agreed to reinstate ADOs for all RNs who met the criteria and applied for ADOs. Management must now, as a default, offer all new full time starters with a roster with an ADO every 28 days. Failure to do this is a breach of the enterprise agreement provisions.

“We’ve definitely had a win due to constant pressure from the branch pointing out that management was not following the agreement,” Sinead says.

In total, more than 100 nurses across the three sites have got back their ADOs. n

‘People felt more empowered to bring up the ADO issue at meetings or by approaching

branch official.’ — Sinead Keane

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Diabetes in Aged Care

Tue 16 May, 9am–3pm, 5 CPD Hrs

Tamworth

The Deteriorating Patient

Thu 18 May, 9am–4pm, 6 CPD Hrs

Newcastle

Medications: How we do it better

Thu 8 June, 9am–4pm, 6 CPD Hrs

Orange

Medications: How we do it better

Tue 25 July, 9am–4pm, 6 CPD Hrs

We have revamped a number of sessions for 2023 and will also be holding various one-off series from external guest presenters.

Keep an eye on the education page and our education emails for updates and additions. Go online for more information about each course, registration & searching our webinar CPD education options. bit.ly/educationNSWNMA

Specialty Seminars

The NSWNMA is resuming our range of specialty seminars in 2023 in Waterloo!

Hear from a range of speakers, network and share experiences with professional colleagues.

Aged Care Nurses Seminar

Friday 28 April 2023

For RNs, ENs and AINs in residential, community and hospital aged care settings, across private and public sectors, or anyone with an interest in the aged care sector in NSW.

Midwifery Seminar

Friday 19 May 2023

Midwives and Assistants in Midwifery – join the NSWNMA for an inspiring and educational day.

Environmental Health Seminar

Friday 2 June 2023

Climate change is the biggest health challenge of this century –our health is intrinsically linked to the health of the planet. We are already seeing the impacts firsthand, and we need urgent action, and a move toward a more sustainable healthcare system.

TIME: each seminar will commence at 9am and conclude around 4pm.

2023 ASSOCIATION MEMBER TRAINING CALD Branch Essentials

TRADE UNION TRAINING FOR NSWNMA MEMBERS

3 – 4 May OR

20 – 21 September

9am – 5pm

NSWNMA Office

50 O’Dea Avenue, Waterloo

Let’s get active to tackle workplace bullying and racism. Sign up for this course and learn how to make the most of your Union. Help solve workplace issues that are important to you, learn how to take bystander action to address racism and bullying and learn skills to have effective conversations challenging racism. This course is open to all NSWNMA members and is free. You may also be eligible for free travel, overnight accommodation and pay for any missed work.

Scan the QR code or go to

Ask Shaye

A chance to make a difference

The daily struggle members face with inadequate staffing levels or poor skill mix unfortunately remains endemic. As a profession we continue in various ways to stand up for our patients and residents, as well as for our own wellbeing and safety. We continue to mobilise as union members to have our voice heard in every available forum. Some progress is being made federally in aged care. But at a state level, the concerns of public health members remain ignored. In the coming state election, members must seize the opportunity to make sure political parties across the spectrum accept that change is necessary. Make sure your vote counts on 25 March by making it a referendum on who will best deliver safe patient care in a safe workplace. But first, let’s answer some questions about your existing workplace entitlements; some old, some new. Enforcing your current rights is the bedrock to build your future rights on.

Important new research:

Check out the breakthrough research completed by Dr Anne Summers AO using never before released ABS data entitled The Choice violence or poverty: A report into domestic violence and its consequences in Australia today.

The research provides a damning but conclusive link between domestic violence and poverty at levels unimagined.

The link to the full report is here: https://www. violenceorpoverty.com/

Replacing like for like – public health

I work in a public hospital and often work in a ward where rostered staff are missing. How are these vacancies supposed to be dealt with?

This is an all-too-familiar problem. Under Clause 53, Section I of the Public Health System Nurses’ and Midwives’ (State) Award, it has been a longstanding requirement that when nurses are absent at short notice, they should be replaced by another nurse of the same classification where possible. Who is responsible for replacing the staff member?

As soon as an unplanned absence occurs, the NUM should immediately review the roster and decide whether to replace the absence, based upon the clinical requirements of the ward and the effect that not replacing the absence would have on workloads. (Note: Any NHPPD requirements would also need to be considered).

Should they be replaced with another nurse?

When an absence is replaced it should, by default, be replaced by a nurse of the same classification. A registered nurse should be replaced with a registered nurse, an enrolled nurse with an enrolled nurse, and an assistant in nursing with an assistant in nursing. This is what we call “like-for-like” replacement.

What happens if a like-forlike nurse can’t be found?

Only when all avenues to backfill the absence with a like-for-like nurse are exhausted should the NUM consider filling the

absence with a nurse of a lower classification. This should only be done if it is clinically safe to do so. If a NUM replaces an unplanned absence with a nurse of a lower classification, then they must keep a record of this decision, together with the reasons.

Family and domestic violence leave

I work in a medical practice and believe that paid family and domestic violence leave has been extended to the private sector. Is that correct? Last year, the Commonwealth Government moved to replace the existing employee entitlement under federal legislation to five days of unpaid family and domestic violence leave with an entitlement to 10 days of paid leave in a 12-month period for full-time, part-time and casual employees. The changes come into effect via two dates: employers with 15 or more employees on 1 February 2023; and employers with fewer than 15 employees on 1 August 2023. These now form part of the National Employment Standards under the Fair Work Act.

Pre-term parental leave

I work in a public hospital. One of my colleagues said something about extra leave if I give birth early. Can you fill me in?

Additional leave is now available in such a situation for government sector workers. Where an employee gives birth to a pre-term child, the parent with caring responsibility is entitled to paid special pre-term parental leave from the date of birth up to the end of 36 weeks. At the commencement of 37

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

weeks, paid parental leave then kicks in. Check out Section 5.15.2 of PD2023_006 (Leave Matters for the NSW Health Service) for the specifics.

Aged care changes

I work in a nursing home and am wondering when the changes to RNs begin?

From 1 July 2023, aged care providers must have at least one RN on site and on duty 24 hours a day, seven days a week, for each facility.

What about care minutes; when do they start?

The initial care minutes target of a sector-wide average of 200 minutes of care per resident per day (including 40 minutes by an RN) will kick in on 1 October 2023. This then increases to 215

minutes (including 44 minutes by an RN) from 1 October 2024. But it should be noted that each RACF will have its own careminute targets based on the mix of residents in that service. For example, services with residents who mainly have low-care needs will have lower average care minutes targets, while those with high-care needs will have higher average care minutes targets.

Some big changes ahead!

Rural incentive scheme

I work in a public hospital with chronic vacancies, but we are told the site cannot use the new incentives being rolled out. Isn’t there anything we can do?

Under the Rural Health

Workforce Incentive Scheme [PD2022_025] rolled out last year, in general it is only those locations in NSW outside the metropolitan and regional cities and their immediate surrounds that are eligible for the incentive payments. The Ministry of Health may deem other locations “rural and remote” after taking into account unique location attributes that present challenges to attraction and retention of the health workforce.

A number of other criteria are also used to determine the provision and quantum of any incentive, including vacancies being identified as hard to fill or being critical to service delivery.

SCHOLARSHIPS FOR THE ACADEMIC YEAR 2024

Applications for the Edith Cavell Trust Scholarships are being accepted from 1 May 2023, closing 31 July 2023, for studies being undertaken in the academic year 2024.

Members or Associate Members of the NSW Nurses and Midwives’ Association or the Australian Nursing and Midwifery Federation (NSW Branch) are invited to apply.

All grants, awards or loans shall be made to financially assist nurses, midwives, assistants in nursing, assistants in midwifery (including students of those disciplines), and accredited nursing or midwifery organisations, schools and faculties in the furtherance of:

(i) accredited nursing or midwifer y studies;

(ii) such academic research programs as are approved by the Trustees in the theory or practice of nursing or midwifery work; or

(iii) clinical nursing education programs at graduate, post-graduate and continuing education professional development level; in accordance with a number of categories.

Full details of the scholarship categories, how to apply and to obtain the official application form is available from the NSWNMA website. Prior to applying, please ensure you have read the Edith Cavell Trust Scholarship Rules.

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AUSTRALIA

Deaths from COVID-19 in aged care pass 5000

Between 22 December and 25 January, 597 deaths from COVID occurred.

More than 5000 Australian aged care residents have died with COVID-19 since the start of the pandemic. There was a sharp increase in the number of deaths from the end of last year, with 597 deaths nationally between 22 December and 25 January. An update of Department of Health (DoH) data on 27 January recorded 291 active outbreaks in as many aged care facilities. About 1220 active cases were recorded among residents and 432 among staff.

The report revealed staff shortages at dozens of facilities. In the week leading up to 25 January, a surge workforce filled 817 shifts at 46 residential aged care homes.

The temporary surge workforce is a Commonwealth initiative that allows approved facilities to call on a reserve workforce.

Tom Symondson, Chairman of the Aged & Community Care Providers Association, told The Guardian that “the community might be living with COVID, but the pandemic remains very much a reality in aged care”.

The DoH update also revealed high levels of vaccination among aged care residents.

“As at 27 January 2023, there are currently 157,833 residents eligible for fourth doses. In total 134,929 residents, or 85.5 per cent of eligible residents, have received a fourth dose,” the update said.

WHO: World is likely at an ‘inflection point’ on COVID-19

The pandemic still constitutes a public health emergency, the world health body concludes.

WHO extended the Public Health Emergency of International Concern (PHEIC) on 27 January, reported the British Medical Journal (BMJ).

A PHEIC is the highest level of global health alert the WHO can make.

WHO’s Director-General, Tedros Adhanom Ghebreyesus, said countries have made great strides in increasing protection against the coronavirus.

“As we enter the fourth year of the pandemic, there is no doubt we are in a far better situation now than we were a year ago, when the Omicron wave was at its peak,” he said.

However, the number of government-reported deaths has been increasing each week since December 2022, which is concerning WHO experts. At least 170 ,000 people died from COVID-19 in December and January, according to official figures, and the actual number is probably higher because of underreporting.

A surge in infections in China after the country relaxed strict COVID restrictions in December is one driver of the global increase in deaths.

An adviser to the WHO expert committee told the news agency Reuters that the uncertainty surrounding COVID in a country of 1.4 billion people increased the likelihood of WHO extending the PHEIC.

WHO identified several challenges before the PHEIC could be declared over, with vaccination rates in low- and middle-income countries and among the highest risk demographics still insufficient, it said.

‘The community might be living with COVID, but the pandemic remains very much a reality in aged care.’

— Aged & Community Care Providers Association Chairman, Tom Symondson

At least 170 ,000 people died from COVID-19 in December and January.

UNITED KINGDOM

Britain plunged into mass strikes over cost of living

Britain has been rocked by the biggest wave of industrial action in a generation, with nurses and midwives leading the way.

Over 500,000 workers took part in industrial action in Britain on 1 February.

Teachers, ambulance staff and public servants, train drivers, the Royal Mail, university staff, and officials at border posts followed the lead of nurses and midwives, who had struck several times in the previous months and continued to do so through February.

On 6 February, nurses, midwives and ambulance staff stopped work simultaneously, with hundreds of thousands of nurses striking in what is believed to be the biggest strike in the NHS’s history.

Health Secretary Steve Barclay, who had called on unions to call off the strikes, had not held talks with the health unions in the month prior to the strike and had made no attempt to restart negotiations, according to The Guardian.

Polls suggested that nurses and public servants received widespread public support for their strike action despite any inconveniences.

“There is a bedrock of public recognition that people who provide essential services do so from vocation, not to get rich. They expect remuneration and working conditions that are adequate, and that allow them to do the job safely,” editorialised The Guardian.

After visiting picket lines around London and addressing a rally, Mark Serwotka, General Secretary of the Public and Commercial Services union (PCS), described striking members as “very young, very vibrant, very diverse. Lots of first-time strikers, and a real sense from many of them that they felt quite empowered”.

In Latin America and the Caribbean, 131 million people cannot access a healthy diet

UN report shows a clear relationship between the inability to afford a healthy diet and variables such as a country’s income level, the incidence of poverty, and the level of inequality.

A new United Nations report has found that 22.5 per cent of the Latin American and Caribbean population cannot afford a healthy diet. In the Caribbean this figure reaches 52 per cent, in Central America 27.8 per cent, and in South America 18.4 per cent.

This represents an increase of 8 million compared to 2019 and is due to the higher average daily cost of healthy diets in Latin America and the Caribbean compared to the rest of the world’s regions.

The UN said food insecurity will continue to rise due to the food and fuel price crisis caused by the conflict in Ukraine and the aftermath of COVID-19.

“We are talking about the region of the world with the most expensive healthy diet, which particularly affects vulnerable populations – small farmers, rural women, and indigenous and Afro-descendant populations – who allocate a greater percentage of their income to the purchase of food,” said Rossana Polastri from the International Fund for Agricultural Development.

Between 2019 and 2021, the number of hungry people in the region increased by 13.2 million, reaching 56.5 million hungry people in 2021.

In 2021, 40.6 per cent of the regional population experienced moderate or severe food insecurity, compared to 29.3 per cent worldwide.

‘There is a bedrock of public recognition that people who provide essential services do so from vocation, not to get rich.’

Between 2019 and 2021, the number of hungry people in the region increased by 13.2 million, reaching 56.5 million hungry people in 2021.

Australia on track to eliminate cervical cancer by 2035

Free school program reduces infection rate by 92 per cent.

Cervical cancer vaccination levels are on the rise and experts are “highly optimistic” the disease can be eliminated in a little more than a decade.

Australia will become the first country in the world to eliminate cervical cancer if it hits its 2035 target.

Prior to the vaccine, it is estimated up to 90 per cent of Australians were infected with the human papillomavirus (HPV) at some point. HPV causes almost all cervical cancers, as well as a range of other cancers.

The free school vaccination program, which began in 2007, has reduced the HPV infection rate by 92 per cent, which in turn has reduced the rate of cervical abnormalities.

Prof Marion Saville, executive director of the Australian Centre for the Prevention of Cervical Cancer, told The Guardian the latest statistics – up to and including 2020 when the first COVID lockdowns began –show “coverage has been stable and slowly rising”.

“Despite the pandemic, we’re seeing pretty good coverage,” she said.

Prof Saville said the Pharmaceutical Benefits Advisory Committee had recommended the vaccination be available on the Pharmaceutical Benefits Scheme for men and women up to 25 years of age.

In many cases, HPV goes away within a couple of years.

“At a certain point our message is that your better protection is screening rather than vaccination,” Prof Saville said.

‘Historic’ new paid family and domestic violence leave

New laws to provide 10 days’ paid family and domestic violence (FDV) leave came into force on 1 February for workers in businesses with 15 or more employees. For workers in small businesses, with fewer than 15 employees, the entitlement will start from 1 August this year.

Under the new laws:

• all workers – full time, part time and casual – will have access to 10 days’ FDV leave, regardless of whether they work a 38-hour week or fewer hours

• the full 10-days is available immediately when a worker needs it, rather than accumulating over a period like annual and sick leave does

• there are rules in place to keep workers’ information private including that FDV leave must not be included on an employee’s pay slip

• full-time and part-time employees can take paid FDV leave at their full pay rate for the hours they would have worked if they weren’t on leave, while casual employees will be paid at their full pay rate for the hours they were rostered to work in the period they took leave.

Workers in small businesses continue to have access to five days of unpaid FDV leave until their inclusion in the paid scheme from 1 August.

ACTU President Michele O’Neil said: “Paid family and domestic violence leave builds on the long legacy of the union movement winning new rights for workers.”

‘Despite the pandemic, we’re seeing pretty good coverage’

— Professor Marion Saville

AUSTRALIA

‘Paid family and domestic violence leave builds on the long legacy of the union movement winning new rights for workers.’

— ACTU President Michele O’Neil

AUSTRALIA

New legislation aims for pay transparency

The federal government has introduced a Bill that will force companies to publicly disclose the difference between male and female workers’ earnings.

The Workplace Gender Equality Amendment (Closing the Gender Pay Gap) Bill 2023 requires companies with 100 or more employees to disclose how much they are paying their workers.

Prime Minister Anthony Albanese took to Twitter to announce the introduction of the Bill into parliament, saying: “Women should be paid the same as men. It’s as simple as that.”

Reporting will begin in 2024, using data already provided by employers. Companies’ gender pay gaps are to be published on the Workplace Gender Equality Agency website, for all to see.

Currently, the average Australian woman has to work an extra 61 days a year to earn the same pay as the average Australian man. The gender pay gap currently sits at 14.1 per cent, with women on average earning $263.90 per week less than men.

The ACTU said that Australia has had a poor record in closing the gender gap compared to other countries.

“For too long, individual companies with significant gender pay gaps have been able to evade scrutiny and avoid having to address problems within their workplaces, which has led to women workers being undervalued,” it said.

“That is why this legislation to provide greater transparency is so important.”

Quality legal advice for NSWNMA members

• Workers Compensation Claims

• Litigation, including workplace related claims

• Employment and Industrial Law

• Workplace Health and Safety

• Anti-Discrimination

• Criminal, including driving offences

• Probate / Estates

• Public Notary

• Discounted rates for members including First Free Consultations for members

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

‘Women should be paid the same as men. It’s as simple as that.’

— Prime Minister Anthony Albanese

CROSSWORD SOLUTION

ACROSS

1. A severe systemic reaction to an allergen that occurs in hypersensitive individuals (12.5)

11. Crone (3)

12. A glycoprotein that binds and transports iron (11)

14. The bony projection of the ulna at the elbow (9)

15. The process of holding back or keeping in a position (9)

19. Having needle-like structure (11)

21. Lacking the sense of smell (9)

22. Sweat gland (12.5)

26. Rationale, reasoning (5)

28. Health maintenance organisation (1.1.1)

29. Congenital absence of most of the brain and spinal cord (11)

32. Rapid successions of short, sharp sounds (7)

33. Symbol for erbium (2)

34. Having an additional (third) chromosome (7)

36. A member of the senate (7)

38. Coagulate (4)

39. Dyspnea (9.2.6)

DOWN

1. Hardening of the arteries (8.9)

2. Spine-shaped (9)

3. Hydroxyethyl starch (1.1.1)

4. A strong solution of sodium or potassium hydroxide (3)

5. A common condition which often related to cigarette smoke (7.10)

6. Cauda (4)

7. Produced under conditions involving intense heat (7)

8. A mark left on the skin after a surface injury (4)

9. Descriptive anatomy of the teeth (12)

10. Eager (4)

13. The adipose tissue of the body (3)

16. Expressed in numbers (9)

17. Insulin shock therapy (1.1.1)

18. Ocular protection index (1.1.1)

20. Unreal (9)

23. Apertures frequently closed by membrane (9)

24. A surgical procedure for treating severe sleep apnea (1.1.1.1)

25. Tinea cruris (5.4)

27. Become involved in (3.4)

30. Symbol for neon (2)

31. Cannabis (4)

35. One of the pair of forearm long bones (4)

37. A small child (3)

BLUEBACK

Tim Winton Penguin Random House

RRP $22.99

ISBN 9780143779155

Blueback is an achingly beautiful story about family, belonging, and living a life in tune with the environment, from Tim Winton, one of Australia’s best-loved authors.

Abel Jackson’s boyhood belongs to a vanishing world. On an idyllic stretch of coast whose waters teem with fish, he lives a simple, tough existence. It’s just him and his mother in the house at Longboat Bay, but Abel has friends in the sea, particularly the magnificent old groper he meets when diving.

The War Nurses

Anthea Hodgson

Penguin Random House

RRP $32.99

ISBN 9780143779100

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

S PECIAL INTERES T SPECIAL INTEREST

Inspired by the author’s own family story, this is an unforgettable novel of enduring friendship and boundless courage, based on the shocking true events of the Bangka Island Massacre. It is both a riveting tale and an important tribute to our brave nurses who sacrificed so much during WWII.

In 1941, country girls Minnie Hodgson and Margot McNee set sail from Perth for Singapore in search of adventure, full of excitement and keen to do their part working as nurses to the fallen soldiers in a time of war. What they encounter is an army of new friends and the terrors of a city under siege. When the Japanese attack and Singapore falls, they are forced to flee aboard the Vyner Brooke. The ship is bombed, resulting in utter devastation.

APHRODITE’S BREATH

Susan Johnson

Allen & Unwin

RRP $34.99

ISBN 9781760876562

What happens when you take your 85-year-old mother to live with you on a Greek island?

A strikingly original, funny, and forensic examination of love and finding home, from the author of From Where I Fell.

In life, as in myth, women are the ones who are supposed to stay home, like Penelope, weaving at their looms, rather than leaving home like Odysseus. Meet eighty-five-year-old Barbara and her sixty-two-year-old writer-daughter, Susan, who asks her mother – on a whim – if she wants to accompany her to live on the Greek island of Kythera. What follows is a moving unravelling of the mother-daughter relationship told in irresistible prose.

We have four copies of THE WAR NURSES to give away, with thanks to Penguin Random House. Email your name and membership number to lamp@nswnma.asn.au by 31 May to be in the draw to win!

ATLAS OF THE HEART

Brené Brown Penguin Random House

RRP $45.00

ISBN 9781785043772

Mapping meaningful connection and the language of human experience. This major new work from the international bestselling author of Gifts of Imperfection and Dare to Lead examines the 87 emotions and experiences that define us and provides a compelling framework to help us all become more emotionally fluent and connected.

For NSWNMA Members

The NSWNMA is committed to protecting the interests of nurses and midwives by purchasing a range of insurances to cover members.

Journey Accident Insurance provides cover for members who are injured as a result of an accident while travelling between their home and their regular place of employment.

Professional Indemnity Insurance* provides legal representation and protection for members when required.

Make sure your membership remains financial at all times in order to access the insurance and other benefits provided by the NSWNMA.

Times have changed and rostering practices are increasingly recognised as a critical factor to be considered in discussions about retention in the nursing and midwifery workforces.

A new Medicare: strengthening general practice Grattan Institute

Australia’s universal healthcare system has failed to keep up with changes to Australians’ health needs since it started four decades ago.

GPs’ work has become much more complex, as the population has grown older and rates of mental ill-health and chronic disease have climbed. But the way we structure and fund general practice hasn’t kept up. Despite patient care becoming more complex, appointments have been stuck at an average length of 15 minutes for the past two decades. GPs are struggling to meet their patients’ needs, and they lack the support of a broader team of health professionals to do so.

Other countries have reformed general practice, and their rates of avoidable hospital visits for chronic disease are falling. But Australia is spending more on hospitals while neglecting general practice: the best place to tackle chronic disease.

Patients suffer the consequences. People with chronic disease live shorter lives, with more years of ill-health, and lower earnings. Poorer Australians suffer the most: they are twice as likely to have multiple chronic diseases as wealthy Australians.

Australia’s healthcare workers are also struggling. Hospital staff are overwhelmed with demand. And GPs tell us they are stressed, disrespected and disillusioned.

To bring Medicare into the 21st Century, the report recommends big changes.

https://grattan.edu.au/report/anew-medicare-strengtheninggeneral-practice/

Strengthening Medicare Taskforce Report Department of Health and Aged Care

Australians enjoy access to a world-class healthcare system with primary care at its centre. Our vital and valued primary care workforce includes Australia’s hard-working general practitioners, allied health professionals, primary care nurses, nurse practitioners and midwives, pharmacists, Aboriginal health workers, practice managers and other practice staff.

Primary care provides the foundation for universal health care, working hard to keep all Australians healthy and well in the community, and to deliver care that meets the needs of people and communities at all stages of life, no matter where they live. This is a strong basis to build on, driven by a skilled and dedicated workforce, but our funding models, infrastructure and systems need strengthening to better enable highquality, integrated and personcentred care for all Australians.

To ensure our primary care system can meet the current and future challenges and reflect the new models of care of the 21st century, the Australian Government brought together a group of health leaders to form the Strengthening Medicare Taskforce. The taskforce was charged with identifying the most pressing investments needed in primary care, building on the direction outlined in Australia’s Primary Health Care 10 Year Plan 2022–2032 (the 10-Year Plan).

This report reflects the consensus view of the individual members of the Taskforce.

https://www.health.gov. au/resources/publications/ strengthening-medicaretaskforce-report

What is primary healthcare nursing? Australian Primary Health Care Nurses Association

Primary health care is any medical service that is provided outside the four walls of a hospital, including general practice, aged care, schools, community health and other primary healthcare settings.

Primary healthcare nurses play a critical role in disease prevention and control to keep people healthy. They provide proactive care and health promotion to keep Australians well.

With Australia’s ageing population and deteriorating health, a strong and accessible primary health care system is vital to keep people well and out of hospital.

Primary health care is the first level of contact that individuals, families and communities have with the healthcare system. In Australia, this:

• incorporates personal care with health promotion, the prevention of illness and community development

• includes the interconnecting principles of equity, access, empowerment, community selfdetermination and inter-sectoral collaboration

• encompasses an understanding of the social, economic, cultural and political determinants of health.

https://www.apna.asn.au/

Mental Health Reference Group – call

for papers

The NSWNMA Mental Health Reference Group will be convening a seminar at NSWNMA Head Office in Waterloo on Friday 13 October 2023. The theme of this seminar will be practice innovations. This is an opportunity to present your work in a supportive atmosphere, with plenty of opportunities for networking and professional engagement.

We invite all interested mental health, and drug and alcohol nurses who are engaged in innovative projects, to submit a short abstract to be considered for inclusion in this program. For further information contact MHRG@nswnma.asn.au.

wellbeing

Nurse & Midwife

Support provides free and confidential support 24/7 to nurses, midwives and students Australian wide. If you would like to speak to someone call 1800 667 877.

Mindfulness

Nurses and midwives are increasingly using mindfulness to offset some of the pressures experienced in the workplace and at home. Here are some of the benefits of mindfulness and how to get started.

What is mindfulness?

Mindfulness is a way of living with greater attention and intention and less reactivity and judgement. Many of us are on ‘automatic pilot’ — our bodies operate in a routine pattern while our minds are somewhere else, anticipating future events or ruminating over something that has happened. This ‘mindless’ way of living can limit how we experience life, the choices we make, the quality of our relationships and can exacerbate feelings of stress.  Practising mindfulness can help you to bring awareness to the present with an attitude of openness and curiosity. Many people who practise mindfulness, report that they feel calmer and more clear-headed.

Why practise mindfulness

Mindfulness helps you focus on the present moment, which can assist you to cope more effectively with stress and reduce the risk of professional burnout. Being more mindful and bringing receptivity to whatever is happening can deepen your understanding of your relationships with your friends, family, colleagues, and ultimately yourself.

Physical benefits

The physical benefits of practising mindfulness include:

• lowering high blood pressure by reducing cortisol secretions when stressed — fight or flight stress response

• reducing physical health symptoms such as headaches, insomnia, muscle and joint problems

• improving the immune system, and

• increasing energy levels.

Mental benefits

Mental benefits of practising mindfulness include:

• reduced anxiety

• improved emotional stability

• increased creativity

• greater happiness

• strengthened intuitive thinking, and

• improved clarity of thought.

In daily life

Some worry that mindfulness practice will be time consuming, when already time poor. Others worry they will not have the ability or the skills to learn mindfulness meditation practices. Mindfulness meditation can be done in any location and at any time of the day. It is not necessary to practise for long periods — it can be as little as one minute of your time.

Getting started

You can try any of the following to get started:

• Pay greater attention to routine activities – while brushing your teeth, in the shower or walking the dog, try to notice and bring curiosity to these routine activities, as if you were doing it for the first time. Explore with all senses; sight, smell, sound, touch or taste.

• Feel your breath – set aside 10 minutes each day (or fewer) to focus on your breathing. Notice the sensations of the breath travelling in and out of your body. Simply notice your breathing as it happens. Your mind may begin to wonder, that is normal. Mindfulness invites your attention back to the breath. Taking a few slow, mindful breaths can activate the parasympathetic nervous system, causing a ‘relaxation response’ helping you feel more centred and present.

• Tune into your body – If your mind becomes agitated with self-criticism or worry, bring your attention to the physical sensations of your feet as they rest against the floor. You can practise this attention to body sensations anywhere to help settle your distracted mind.

• Use movement – bringing awareness to moving your body mindfully can include gentle stretches in the morning during a break in your day. Mindful movement can slow the busy mind and increase your sense of feeling grounded.

Lenders Mortgage Insurance waived for eligible nurses and midwives1.

Eligible Nurses and Midwives could borrow up to 90% and have their Lenders Mortgage Insurance (LMI) waived with RAMS. Applicants usually require a deposit of 20% to avoid LMI. Registered Nurses and Midwives provide an incredible service to our communities, so we’re waiving LMI for those with a 10% deposit that earn $90,000 or more a year2. This applies to both owner occupier and investment properties, on principal and interest loan repayments.

You’ll also have your own local home loan specialist who will:

• Understand your situation and tailor their expert help to support you with your home loan.

• Take the ‘hard’ out of the process for you. They’ll sort out your approval in days, not weeks, wherever possible.

• Make it convenient by providing their mobile number and meeting you at a time and place that suits you best.