The Lamp February 2024 by NSW Nurses and Midwives' Association

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AGED CARE

NSWNMA STRATEGIC PLAN

REGULARS

Call to promote nurseled primary health care

Bupa residents shortchanged on care time

A health system where nurses and midwives thrive

page 16

page 18

page 29

Your letters Professional Perspectives Health & Wellbeing Crossword

p.06 p.40 p.44 p.46

THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 81 NO 1 FEBRUARY MARCH 2024

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CONTENTS

Contacts NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including The Lamp subscriptions and change of address, contact our Sydney office. Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E gensec@nswnma.asn.au W www.nswnma.asn.au Hunter Office 8–14 Telford Street, Newcastle East NSW 2300

VOLUME 81 NO. 1 FEBRUARY / MARCH 2024

NSWNMA Communications Manager Gia Hayne T 02 8595 1234 (metro) T 1300 367 962 (regional) For all editorial enquiries, letters and diary dates T 8595 1234 E lamp@nswnma.asn.au 50 O’Dea Avenue, Waterloo NSW 2017 Produced by Hester Communications T 0414 550 376 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au

COVER STORY Members vote on ratios rollout plan Historic proposal is the fruit of a determined campaign by nurses and midwives for safe staffing in the public health system.

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 Karen Hart, Wagga Wagga Base Hospital Printed by Printed by IVE Group Sydney Advertising Danielle Nicholson T 8595 2139 or 0429 269 750 F 9662 1414 E dnicholson@nswnma.asn.au

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Information & Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Adrian Hayward, Coordinator. T 8595 2175 E gensec@nswnma.asn.au The Lamp ISSN: 0047-3936 General Disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised. Authorised by S. Candish, General Secretary, NSW Nurses and Midwives’ Association, 50 O’Dea Avenue Waterloo NSW 2017 Privacy Statement The NSWNMA collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information, please contact the NSWNMA office. If you are still not satisfied that your privacy is being maintained, you can contact the Privacy Commission. Subscriptions for 2024 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $30. Individuals $84, Institutions $140, Overseas $150.

REGULARS

Call to promote nurse-led primary health care The NSW public would be in better health if nurses had a greater role in primary health care, health promotion and disease prevention, the NSWNMA has told a state government inquiry.

5 Editorial 6 Your letters 20 Branch Beat 22 Ask Shaye 24 Education calendar 35 Competition 36 News in brief 40 Professional Perspectives 41 Nursing Research 44 Your Health & Wellbeing 46 Crossword

Bupa residents short changed on care time Residents and staff of Bupa aged care facilities are paying the price of the British multinational’s failure to comply with mandatory care minutes.

29 32

STRATEGIC PLAN

Building a health system where nurses and midwives thrive The NSWNMA has released its latest threeyear Strategic Plan. GAZA

AGED CARE

NSWNMA STRATEGIC PLAN

REGULARS

Call to promote nurseled primary health care

Bupa residents shortchanged on care time

A health system where nurses and midwives thrive

page 16

page 18

page 29

Your letters Professional Perspectives Health & Wellbeing Crossword

FUNDING SUBMISSION

p.06 p.40 p.44 p.46

THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 80 NO. 6 FEBRUARY MARCH 2024

WHO on Gaza: hunger at disease at catastrophic levels Hunger is ravaging Gaza, rates of infectious diseases are soaring, and the health system is on its knees, says the World Health Organization (WHO).

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THE LAMP FEBRUARY / MARCH 2024 | 3

Registered Nurses working in NSW Public Mental Health Services

BOB FENWICK MENTORING GRANTS PROGRAM Can help towards your CPD hours

Applications open 1 February 2024 close 31 March 2024

Applications are open to registered nurses who want a unique opportunity to further their mental health nursing career by participating in this innovative Program.

OPPORTUNITY FOR CAREER DEVELOPMENT What is it?

The Program aims to encourage less experienced mental health nurses to take the opportunity to be mentored by a more experienced colleague, assisting them to achieve their mental health professional practice goals.

Who can apply?

Any registered nurse currently working in NSW public mental health services is eligible to apply. Mental health nurses with less than two years’ experience or working in NSW rural and remote areas as well as Aboriginal or Torres Strait Islander nurses currently working in mental health are all strongly encouraged to apply.

What will each mentoring grant include?

n Matching with a mentor in a Local Health District (LHD) other than their own for up to five consecutive days to pursue their mental health areas of interest. n Being provided with travel, accommodation and meal allowance, while remaining a fully paid employee of their regular mental health service during their placement.

Seeking mentors for the Program

If you are a senior mental health nurse, you can help build the specialty of mental health nursing by nominating yourself to become a mentor. Simply use the Mentor Details Form or contact the Program Manager for more information.

How do I apply?

More detailed information about the Program (including a video interview of past participants) can be found on the NSW Nurses and Midwives’ Association website www.nswnma.asn.au 2024 EXPRESSION OF INTEREST FORMS WILL BE AVAILABLE FROM 1 FEBRUARY 2024. Contact the Program Manager for more information by email: mhmgrant@nswnma.asn.au or Cathy Matias on 1300 367 962.

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EDITORIAL

SHAYE

Candish GENERAL SECRETARY

A foundation but more to do The rollout of ratios is complex and at every step we will need to be vigilant, but phase one delivers significant improvements while giving us a strong platform to campaign robustly for further progress across the entire system. As The Lamp goes to press members were voting on a plan that constitutes phase one of the roll out of ratios throughout the public health system. That plan is the culmination of more than eight months of negotiations between the Ministry of Health and the NSWNMA. We were cautious about moving to that first phase because we wanted to make sure the implementation of ratios is successful. The details of the roll out were expected to be published in October, but we continued to push for improvements that we thought were necessary. When we reached the point that the Ministry would no longer negotiate, we felt that it was the appropriate time for public sector members to collectively express their will on whether to accept or reject the plan. This first phase was endorsed by your 23-member NSWNMA Council in December because they believed the ratios proposal from the Safe Staffing Levels Taskforce would bring about “a shift-by-shift staffing system that is transparent, accountable, and enforceable for the first time in NSW, and will create a strong foundation as we campaign to have other specialties included”. In phase one, our emergency departments will get the significant increase in staffing they desperately need, with some set to benefit from upwards of 20 to 50 additional FTE under the reform. A, B, and C peer group hospitals will see their NHPPD wards and units convert to shift-by-shift ratios, ensuring that the complex averaging of staff numbers is gone and the correct numbers of staff are provided on each and every shift. Many wards will also see critical improvements to the number of supernumerary in charge roles. All patients requiring critical care in ICUs and HDUs will be nursed by an RN, except in Level 4 ICUs where ENs currently employed will continue to be counted in the 1:1 or 1:2 ratio and additional access nurses will see many ICUs able to receive the vital support they were seeking.

The onus will now be on management, up to and including the ministry, to address any ratio shortfalls in a ward or unit within a 24-hour to 48-hour period, under an agreed escalation process. A STRONGER COMPLIANCE PROCESS On balance we think this initial plan provides significant staffing improvements in these areas. It is instructive to compare these proposed ratios with other states. In Queensland, specialty areas including ED, ICU and maternity do not yet have ratios. In Victoria, resus staffing in ED on a morning shift is 1:3 (compared to 1:1 in NSW) and there are no legislated ICU ratios. It took Victoria 20 years to achieve their level of ratios. We are attempting to overhaul our entire staffing system and achieve comparable ratios to Victoria in a space of less than four years. We should recognise that this is a remarkable and challenging reform to achieve. An important component of the first phase is a compliance process that is much stronger than what we have been working with till now. The onus will now be on management, up to and including the ministry, to address any ratio shortfalls in a ward or unit within a 24-hour to 48-hour period, under an agreed escalation process.

MECHANISMS TO PROTECT SKILLS MIX We know the complexity of the NHPPD system gave management too many opportunities to rort the system. We wanted to see that system overhauled. Changes to the Public Health System Nurses’ and Midwives’ (state) Award will give additional protections to staffing numbers and skill mix. These changes ensure that any current staffing profile number and/or skill mix in a ward/unit which is better than what the Safe Staffing Levels Taskforce recommendations call for will be maintained.

Under this clause on any ward or unit where Safe Staffing Levels are implemented: • staffing numbers can’t be reduced • AiNs can’t be introduced into a staffing profile where they don't currently exist, and • the percentage of RNs can't be reduced. The existing safeguards such as Reasonable Workload Committees remain, giving us additional capacity to run local campaigns around staffing issues. The issue of AiNs counted within ratios was a sticking point in our talks with the ministry and has been the source of many concerns voiced to us by members. While we haven’t got everything we want, the proposed plan does, for the first time, give us a strong mechanism to regulate the number of AiNs on any one shift. There are about 1800 AiNs currently working in the public health system. If they were all to be counted as supernumerary now, nearly threequarters of the 2023 budget allocated by the state government for additional FTE nurses would go to replacing these AiNs. That would greatly reduce the impact of the first phase of the roll out. It’s clear that we need to continue our campaign for ratios to spread further, and for our entire claim to be funded, we remain committed to that campaign, and we know members are as well.. The SSLT will now focus on phase two, addressing our claim for MPS, Maternity and Level 2 EDs. n

THE LAMP FEBRUARY / MARCH 2024 | 5

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Feature d Letter 12-hour shifts provide a work–life balance Shift work is a double-edged sword. It allows nurses and midwives time to deal with errands during the week that 9-to-5 workers have to wait for the weekend to do. On the other hand, shift workers often miss out on weekends and family activities. Penalty rates are great, but different working hours throughout the week can wreak havoc on one’s health. A compromise to this is the 12-hour shift as the alternative. These 12-hour shifts provide a work–life balance that 8-hour shifts can’t. Working three to four shifts a week can give you three to four days off work, which gives nurses and midwives more time to rest and more time to enjoy life. It also provides more time to spend with family. Another benefit of working 12-hour shifts is avoiding peak-hour traffic. When you leave at 7:00 pm, most likely, you will have a clear trip home. Another advantage of 12-hour shifts is the continuity of care you can provide to your patients. As attested by a new-mum nurse, it helped that she had continuity of care when she had her baby. It meant she had one midwife caring for her while she was still in labour until she gave birth. Above all else, this should be at the forefront of the 12-hour shift advantages: Continuous patient care not only to provide the care, but also provide support to soon-tobe mothers. This is why midwives at Westmead Hospital fought to get 12-hour shifts reinstated, after losing them without any consultation. They won back 12-hour shifts through the IRC. There are still more negotiations to ensure their 12-hour shifts can be made permanent. But if we look at the benefits for midwives and soon-

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EMAIL YOUR LETTERS TO: Editorial Enquiries at lamp@nswnma.asn.au Please include a high-resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.

to-be mothers, there is no argument beyond those benefits. For now, let us celebrate this small win and hope we can make this permanent in the future for our midwives. Wing Besilos, RN

Voice referendum and nuclear subs

I am concerned that for the Voice referendum, the NSWNMA took a partisan position Parking fees should be based on resolutions equitable passed at a delegates meeting in 2018. Given the outcome I am thankful to the state government and – a 60 per cent rejection of the parking company for question – this means that in all probability 45,000 members voted allowing nurses to against the proposal. receive free parking during the pandemic; Whilst generally agreeing with it was appreciated Michael Whaites’ comments in the through a challenging time in our December–January edition of The history. I am aware and understand Lamp, the difficulty of agreement that parking would not always be on constitutional change required free, but I would have expected a bipartisan approach and the the return to parking fees to be decision rests solely with members, equitable and fair. Not double the not just our delegates’ decisions. amount, so that the company can Regarding nuclear submarines, the re-coup its lost fees. At the last debate is far more complex than election, the Labor Party promised that put forward by the Union, all parking at regional hospitals based on a Westmead Hospital would be free, and we cannot trust branch motion. The defence of the government on its word, as it Australia is of vital importance, backflipped and broke its promise. given the great power clash in our We are living in dire times, with the area of the world and our reliance cost of living so expensive, and the on our main security partner, the added burden of exorbitant fees USA, whom we have relied upon impacting families even more. We since 1942. It is vitally important are struggling to make ends meet, that Australia has the appropriate with high interest rates, high rents, military assets, and that our and now high parking fees adding soldiers, sailors and airman are to high anxiety levels and stress. not placed at any more risk than I have encouraged people at work to necessary, given the massive sacrifices our troops had to bear in send emails regarding this, the last major conflict in our area and one of the responses was that there are alternative ways of coming and the unnecessary suffering and hardship that members of our own to the hospital, such as by train. profession underwent. But as a shift worker, this is not very reassuring. Brian Grant, retired member Parking around the hospital is limited, and the increased fees will send more staff to park on Advertise in The Lamp and the street, but it will also impact patients accessing health care at the reach more than 75,000 nurses and midwives. hospital and visitors. Edwina Jacobs, RN To advertise contact Danielle Nicholson 02 8595 2139 / 0429 269 750 dnicholson@nswnma.asn.au THE LAMP FEBRUARY / MARCH 2024 | 7

COVER STORY

Members vote on ratios rollout plan Historic proposal is the fruit of a determined campaign by nurses and midwives for safe staffing in the public health system.

plan to introduce shiftby-shift ratios in NSW public hospitals would sig nif ica nt ly increa se nurse numbers and create a strong platform to promote safe staffing throughout the public system, NSWNMA leaders said. NSWNMA General Secretary, Shaye Candish, and Assistant General Secretary, Michael Whaites, outlined the plan to members via email and webinars in January. The plan constitutes phase 1 of the rollout of ratios throughout the public system – a focus of a long NSWNMA campaign that included four statewide strikes in 2022. Phase 1 was finalised after about eight months of negotiations between NSWNMA officials, the Ministry of Health and Local Health District representatives in the government’s Safe Staffing Levels Taskforce, and the office of NSW Minister for Health Ryan Park. Phase 1 was endorsed by the 23-member NSWNM A Council in December. NSWNMA public sector branches were voting on whether to accept or reject it as this issue of The Lamp went to print. Phase 1 covers four clinical areas: EDs levels 3 to 6, medical/surgical NHPPD wards, mental health NHPPD wards, and ICU/critical care units.

8 | THE LAMP FEBRUARY / MARCH 2024

‘We are attempting to overhaul our entire staffing system and achieve comparable ratios (to Victoria) in less than four years – a pretty remarkable and quite challenging thing to achieve.’ – Shaye Candish For details of the ratios visit: https:// www.nswnma.asn.au/workplace/ phs_ratios/ If accepted by members, the ratios will be written into the Public Health System Nurses’ and Midwives’ (State) Award and commence from March 2024, starting with level 5 and 6 EDs. A transition period will allow services to recruit the additional staff needed to achieve the ratios. Shaye Candish told a webinar for members that the ratios proposal was “a strong safe staffing foundation” that would allow the union to work for staffing improvements needed across the public system.

EDS GET SIGNIFICANT STAFFING INCREASES For level 3 to 6 EDs, for example, the proposal is for a ratio of 1:1 in Resus on all shifts and 1:3 for other treatment spaces on all shifts.

“The closest comparison would be Victoria, which has 1:1 in Resus but only for their major hospitals on evening and night shifts. Queensland does not have ratios in ED at all – nor does the ACT. WA has a pilot that’s just started,” she said. She pointed out it had taken Victoria 20 years to achieve their current ratios after their initial introduction. “We are attempting to overhaul our entire staffing system and achieve comparable ratios (to Victoria) in less than four years – a pretty remarkable and quite challenging thing to achieve.” Regarding EDs, Shaye said the ratios proposal was designed to “engineer out of the system a situation where you constantly have chairs lined up in corridors with people receiving fluids or even cardiac monitoring with no allocated staffing.”

COVER STORY

Michael Whaites said that under the proposal, “Our EDs are going to get a significant increase in staffing, and they desperately need it.” For example, Blue Mountains Hospital’s level 3 ED would get an estimated minimum of seven staff on every shift, compared to current staffing of four in the morning, five in the afternoon and four at night. “In EDs the ratio is based on treatment spaces that are regularly used. You will have 1:3 applied to those spaces, no matter how big or small your unit is,” he said.

MEDICAL/SURGICAL WARDS GET 1:4 Regarding medical/surgical wards, Michael said A, B and C peergroup hospitals would generally get a ratio of 1:4 patients plus an in-charge nurse in the mornings and afternoons, with 1:7 at night. “For B and C, if there are less than 24 patients (the ward will get) only one in-charge per day. It’s up to the NUM and staff to work out whether they want the in-charge in the morning or afternoon. “If you go to 25 patients you not only get an extra nurse, you will also get a second in-charge.”n

Stop press As The Lamp goes to press members have voted “yes” to the first phase of the rollout of ratios in the public health system. 79% voted to accept.

SARAH MORTON AND BIANCA VERGOUW

Late negotiations strengthen ICU skill mix Following feedback from members, the Ministry of Health and the Health Minister agreed to amend the Safe Staffing Levels Taskforce recommendation concerning skill mix provisions for ICUs. The amendments also guarantee that no ward or unit will be worse off under the plan. In a message to members, General Secretary Shaye Candish and Assistant General Secretary Michael Whaites said a clause would be inserted into the Public Health System Nurses’ and Midwives’ (State) Award, to ensure that any current staffing profile number and/or skill mix in a ward/unit which is better than the Taskforce recommendation would be maintained. They said the clause meant that on any ward or unit where SSL is implemented, • staffing numbers cannot be reduced • AINs cannot be introduced into a staffing profile where they do not currently exist, and • the percentage of RNs cannot be reduced,

unless there is a review undertaken which considers clinical need. “If the NSWNMA doesn’t agree with the outcome of the review, the matter can be taken to a dispute, including to the NSW Industrial Relations Commission if necessary,” they added. “Safe staffing ratios are a minimum, wards and units which have higher staffing numbers and/or better skill mix should keep them.” Shaye and Michael said the amended Taskforce recommendation included a guarantee that all patients requiring ICU and HDU care would be nursed by an RN, except in Level 4 ICUs where ENs currently employed would continue to be counted in the 1:1 or 1:2 ratio. “AiNs will not count toward the safe staffing levels for ICUs,” they said. They added that all ICUs and HDUs would be covered by the general staffing and skill mix protections to ensure that any existing staffing which is better than the Taskforce recommendation would be maintained. n THE LAMP FEBRUARY / MARCH 2024 | 9

COVER STORY

Ratios plan would limit AiN numbers The proposed ratios aim to put an end to the current uncontrolled growth in the use of Assistants in Nursing (AiNs) in the public health system.

‘This reform will allow us the opportunity to regulate the number of AiNs for the very first time, rather than allowing the current approach, which is multiple AiNs on a shift.’

he staffing proposal put to NSWNM A members includes AiNs in ratio numbers in some wards, with a limit on how many AiNs can work on any one shift. On medical/surgical wards, the skill mix for acute wards is 80 per cent Registered Nurse (RN) and 20 per cent Enrolled Nurse (EN) or AiN, with a limit of one AiN per shift. In sub-acute wards such as rehab, the skill mix is 70 per cent RN and 30 per cent EN or AiN, with a maximum of two AiNs on any one shift. In emergency departments (EDs), the skill mix for level 5 and 6 EDs is 85 per cent RN and 15 per cent EN. AiNs may work in some of these EDs, as is already the case, but they won’t be part of the ratio count. Level 3 and 4 EDs would have 85 per cent RN and 15 per cent EN/AiN, with a limit of one AiN per shift. Speaking to members via a webinar before the vote, NSWNMA Assistant General Secretary, Michael Whaites, said the union spent months arguing with the Ministry of Health (the Ministry) about whether AiNs should be included in the count.

10 | THE LAMP FEBRUARY / MARCH 2024

— Michael Whaites

“The example we kept giving them was the repeated horror of a junior registered nurse being in charge of a ward with multiple AiNs on shift. “We said that must never be allowed to occur again, and the Ministry and the LHDs agreed, so we have a limit of one AiN per shift in the acute wards. “For example, in a large level 4 ED such as Wyong, there would be a maximum of one AiN with a minimum of 28 nursing staff on every shift.”

AN OPPORTUNITY TO REGULATE AINS Michael says that several factors i n f lue nc e d t he N S W N M A’s agreement to include AiNs in the ratios count in some units. The ALP government had given NSW Health a budget to recruit 2480 FTE additional nurses. The Ministry had shown that about 1800 AiNs were already working in the public health system.

COVER STORY

‘Many AiNs are

NSWNMA members and provide a benefit to the healthcare system.’

“To treat AiNs as supernumerary within our current ratio proposal would mean that we would have to spend close to 1800 of that 2480 FTE on replacing AiNs. “That would mean the breadth and depth of what we would be able to achieve in this first phase would be much shallower. In fact, we would probably only be looking at ratios in level 5 and 6 EDs. “I f we wa nt A i Ns to b e supernumerary, we will have to go out and fight for the budget for them to be supernumerary on top of the 2480 who we want to bring in with ratios. “This reform will allow us the opportunity to regulate the number

of AiNs for the very first time, rather than allowing the current approach, which is multiple AiNs on a shift.” He added that many AiNs are NSW NM A members who are welcomed by nurses for their contribution to patient care. However, no-one should be in a position where they are forced to work outside their scope of practice. Having multiple AiNs on any one shift in an acute ward creates that risk."

Also, AiN undergraduate nurses were getting valuable exposure to the workplace, which helped to bring more job-ready RNs into in the system. “The Ministry of Health argued initially that AiNs should just be part of the count – that there should be no limit to the number of AiNs that can be on a shift. We've pushed them to this point but they will go no further.” n

‘Transparent, accountable and enforceable’ NSWNMA Council said the ratios proposal from the Safe Staffing Levels Taskforce would bring about “a shift-by-shift staffing system that is transparent, accountable, and enforceable for the first time in NSW, and will create a strong foundation as we campaign to have other specialties included.” “Our fight for ratios has been about creating a better working life for members, and a better healthcare system for our communities. This fight has delivered almost $1 billion additional recurrent funding for an additional 2480 registered nurses, enrolled nurses and midwives, and will see ratios firmly embedded into the Public Health System Nurses' and Midwives' (state) Award.” n

THE LAMP FEBRUARY / MARCH 2024 | 11

COVER STORY

Compliance process puts onus on Ministry Any failure to meet shift-by-shift ratios at a ward or unit level must be addressed within 24 to 48 hours, under an agreed escalation process.

he Public Health System Nurses’ and Midwives’ (state) Award 2023 will include a written obligation to comply with ratios, the Safe Staffing Levels Taskforce agreed. Any non-compliance, once flagged, must be addressed within 24 to 48 hours via an agreed escalation process, said NSWNMA Assistant General Secretary, Michael Whaites. He told a union webinar that if members could not reach a solution with their unit manager to make the following shift compliant, they could take the issue to the local Director of Nursing and Midwifery within 24 hours. That step would involve the local NSWNMA branch and a union organiser. If the facility still did not comply with ratios, then the Local Health District (LHD) and/or Ministry of Health would be required to intervene – possibly by altering patient flow, including reducing services and surge beds, or by agreement with the NSWNMA. “Everything has to be addressed within 24 to 48 hours,” Michael said. He said the escalation process would require the employer to demonstrate its efforts to meet ratios via measures such as recruitment, extra hours, overtime and use of agencies. 12 | THE LAMP FEBRUARY / MARCH 2024

SARAH MORTON AND BIANCA VERGOUW

“Where there is a ward or unit or hospital where the situation is problematic, or the local management can’t fix it because they can’t recruit enough staff, or they are suddenly getting a big influx of patients over a period of time, then the issue can be escalated by the Association to the Ministry of Health.

“At that point they need to look at either reducing services or changing flows within the LHD to meet the ratios requirement.”

RWCs STILL AN OPTION Reasonable Workload Committees would not be involved in the escalation process but the safe staffing principles of Award Clause 53 would remain.

COVER STORY

Ratios proposal ‘positive and helpful’ for EDs

“We will still be able to take cases of what we say are poor workloads to management and run a campaign or dispute around those clauses. That opportunity will remain everywhere, even where the ratios are being complied with.” The compliance framework would include a provision borrowed from the Victorian ratio system that considers the impact of long standing difficulty in being able to recruit enough staff to meet ratios. “In such cases, we may agree a temporary ratio until such point that the recruitment has caught up. “That is the extreme and in Victoria it has never been used. But it prevents a hospital being closed simply because it is not meeting ratios as a by-product of significant recruitment deficits.” NSWNMA General Secretary, Shaye Candish, said the “positive onus” on the Ministry to comply with Award ratios would assist nurse managers and local directors of nursing to resist budget decisions such as a recruitment freeze or ban on agency staff. “They can push back and say no, that can’t be tolerated because we now have an Award provision that requires us to comply with staffing ratios,” she said. n

Sarah Morton, an RN at Wollongong Hospital emergency department, described the ratios proposal as “a pretty good offer that seems to have been fought hard for at the bargaining table”. “A lot of EDs that are really badly off are going to improve under these new ratios,” said Sarah, who is a NSWNMA delegate for Wollongong Hospital. “The feedback I’m hearing from other EDs is also quite positive and having those set ratios is going to be really helpful.” The state's EDs will see over 1,300FTE additional nurses as they grow to meet the ratios, with some growing by as many as 20 to 50FTE. ED ratios are calculated on the basis of regularly used treatment spaces. Sarah said this means that providing nursing care in the ED waiting room during very busy periods will likely remain a problem after the rollout. “As good as the ratios proposal is, we can’t predict or control how many people are going to be sitting in the waiting room or the acuity. Sometimes we have two nurses to 50 patients and people waiting over 12 hours for treatment. “In these situations, we usually have a float nurse and one or two extra CIN nurses to get us through the busy periods.” Sarah said the government would not have agreed to the ratios rollout without the campaign of industrial action waged by members. “It gives us a platform to take the ratios campaign forward. “We haven’t used up all our bargaining power and the fight for better conditions and patient safety never ends. “We know that things get randomly taken away all the time if we don’t fight. “We need to take the wins (on ratios) while we can and work up the energy for the next big fight, which is going to be over pay and for free parking.” n

‘A lot of EDs that are really badly off are going to improve under these new ratios.’ – Sarah Morton, NSWNMA delegate Wollongong Hospital

THE LAMP FEBRUARY / MARCH 2024 | 13

COVER STORY

Access nurse will lighten ICU load Bianca Vergouw, ICU nurse and president of the NSWNMA branch at Wollongong Hospital, described the Phase 1 ratio offer as “a very hopeful improvement on what we currently have”.

‘At the moment all ICU nurses are carrying a patient load. Having an access nurse as a separate identified role and enforced as such will really help staff on the floor.’ —Bianca Vergouw, NSWNMA Branch president Wollongong Hospital

ianca said the fact that ICUs would get an access nurse included in the award as a protected position was an important step forward. “At the moment all ICU nurses are carrying a patient load. Having an access nurse as a separate identified role and enforced as such will really help staff on the floor.” She said the initial inclusion of enrolled nurses in the staffing ratios for ICUs sparked a lot of debate among members. Following feedback from members the NSWNMA subsequently got a guarantee from the Ministry of Health that all patients requiring ICU 14 | THE LAMP FEBRUARY / MARCH 2024

and HDU care would be nursed by an RN, except in Level 4 ICUs where ENs currently employed would continue to be counted in the ratios.

“Also, it’s really refreshing to have a government that is brave enough to really listen (to nurses) and make changes.

“The debate was actually really good because it got people talking and thinking about their workplace and what that might look like with the proposed ratios,” Bianca said.

“We haven't had that for so long.”

“Members spoke up and by doing so, stopped the ENs from being counted in the numbers. It reaffirmed to people that if you have any issues you should speak up – they will be addressed. “The feedback also strengthened the hand of our union reps at the negotiating table. “We need to support them because they are the bridge between us at the coalface and those (in the government) who make the final decisions. It’s really important that we keep them up to date with what is acceptable to us and what is not.

She said staffing improvements in EDs and wards would have a flow on effect that benefited ICUs. “If people in ED waiting rooms are able to be seen and managed appropriately in time there's a good chance that some of them may not even need to be admitted to hospital – or may not need to go to ICU. “And if there are more staff on the wards there is a good chance we will see a drop in the number of patients who deteriorate to the point where they require intensive care." n

COVER STORY

Talks continue over Maternity and multi-purpose services ratios ‘I want to assure all the midwives … that we haven’t forgotten you.’ — Michael Whaites

Negotiations on the introduction of ratios in maternity services and Multi-Purpose Services (MPS) are continuing. NSWNMA Assistant General Secretary Michael Whaites said he hoped the Safe Staffing Levels Taskforce would agree to recommendations to be put to members soon. “I want to assure all the midwives … that we haven’t forgotten you. Our claim was for a review of Birthrate

Plus and minimum ratio of 1:3 on post-natal wards. There is a separate Taskforce working group going through those numbers.” Regarding MPS staffing, NSWNMA General Secretary Shaye Candish said Taskforce negotiations were continuing on the Union’s claim for a minimum of three nurses (including at least two RNs) on every shift at small facilities, without reducing any superior staffing currently applying to larger MPS facilities.

“The workforce challenges are at their most critical (in some MPS facilities) and it really does need a careful, considered approach. “We want to make sure the ratios rollout is successful. Rolling out ratios to a site where they’ve had long-term recruitment issues and no plan for how they are going to fix those issues is not going to be in anyone’s interest.” n

‘Positive start’ towards safer staffing The Phase 1 ratios proposal is “a good start” in the process of achieving safe staffing levels, said NSWNMA member Wanda Gray, an RN on a medical ward at Wollongong Hospital. “The ratios proposal shows that something positive is being done by the union and the government to improve conditions. Hopefully, it will help retain staff in the system,” she said. Wanda, who has been a nurse for 44 years, is concerned that inadequate staffing and low wages are causing young nurses to leave the profession a lot earlier than nurses of previous generations. “When a shift is not staffed according to the roster it puts a lot of extra responsibility and pressure onto all staff and particularly onto young and inexperienced nurses.

“A lot of young nurses do a very good job but it is a big responsibility, especially if you have acute patients.” She said her ward’s current rostering is already in line with the WANDA GRAY, RN proposed ratios. However, “Our big problem is finding enough staff to fill the roster.” She said her managers did their utmost to find staff to fill the roster and the position of managers would be strengthened once ratios become mandatory. “Mandatory ratios will mean that someone in the hospital administration or ministry will have to answer to the manager as to why they are not getting the required staffing support.” n THE LAMP FEBRUARY / MARCH 2024 | 15

FUNDING SUBMISSION

he NSWNMA has argued for greater investment in nurse and midwifeled preventat ive a nd com mu n it y he a lt h s er v ice s in a submission to the Special Commission of Inquir y into Healthcare Funding. Led by Commissioner Richard Beasley SC, the inquiry is reviewing the funding of health services in NSW, including: • the existing governance and accountability structure of NSW Health

• the way NSW Health funds health services delivered in public hospitals and community settings • strategies available to address escalating costs, limit wastage and identify areas of improvement in financial management. The NSWNMA submission cites the Ministry of Health’s Future Health: Guiding the next decade of care in NSW 2022–2032 Report, which reveals that more than one-third 16 | THE LAMP FEBRUARY / MARCH 2024

‘Nurses and midwives, employed and utilised effectively within primary healthcare settings, have the potential to transform the delivery of care to people in NSW.’ of the current disease burden is preventable and also due to modifiable risk factors. The Future Health report further shows that two-thirds of the disease burden in NSW is caused by conditions that could be managed outside of an acute care setting. However, 85 per cent of NSW Health spending is concentrated in hospitals. Activities related to prevention and promotion currently only receive 10 per cent of NSW Health expenditure, and a mere 5 per cent is invested in community or other care settings. Therefore, a renewed focus on, and investment in, prevention and promotion at the primary healthcare level is crucial, the union submission says. It points out that nurses form the largest occupational group in the primary healthcare sector. Nurses “are best placed to provide broad support at a population level

to increase health literacy, provide education to improve self-care, and to enable people to age in place longer by living in their own homes”. “Nurses and midwives, employed and utilised effectively within primary healthcare settings, have the potential to transform the delivery of care to people in NSW and have a major role to play in hospital avoidance.” The submission calls for increased funding of primary health care, and health promotion, with nurses and midwives central to this workforce, to improve health outcomes of the population and thereby lower the cost of health care in the acute care sector.

NEW COMMUNITY CARE MODELS It says NSW Hea lth should investigate and trial new nurse-led models of community-based care, such as the Buurtzorg model, to reduce the costs to the health budget while keeping more people in their own homes and communities. It points out that existing models of care and lack of recognition of nurses’ full scope of practice restricts their contributions. “Nurses and midwives are already leading care and undertaking ev idence -ba sed practice a nd person-centred care in their local communities. “Still, they are constrained by medical funding models that

FUNDING SUBMISSION

promote supervision by GPs, stifling their ability to work autonomously. “Additionally, they may be subject to further restrictions as a result of jurisdictional or organisational policies that constrain their practice, despite their education and experience.” The submission recommends that NSW Health lobby for legislative f unding reform, as well as jurisdictional and organisational policy reforms to enable nurses and midwives to work to their full scope of practice and expand the delivery of nurse and midwife-led primary healthcare services.

WALK-IN CENTRES The submission says NSW Health should consider establishing Canberra-style walk-in centres, which “demonstrate significant progress in the delivery of nurseled primary health care, enabling nurses to work to an expanded scope of practice”. It advocates greater use of the Midwifery Group Practice (MGP) model, the “gold standard of care”, which allows midwives to work autonomously and to their full scope. MGP, the submission argues, demonstrates cost savings for health departments due to reduced intervention rates and hospital stays, and results in better rates of normal birth compared to standard hospital care and private obstetric care. In mental health, the submission calls on NSW Health to develop a caseload management system for community mental health workers. This is needed so “caseloads are maintained at levels that allow good support for consumers while also managing the psychosocial hazards associated with role overload for nurses to prevent psychological injury and burn out”. n

Ratios are a good investment Public hospital staffing ratios are “the single most effective measure” to improve efficiency and reduce unnecessary cost in NSW Health, the NSWNMA submission says. It adds there is “substantial research” that shows ratios lead to improved health outcomes for patients, and higher rates of recruitment and retention of nurses and midwives. “Improved retention results in efficiencies, because the cost of advertising for, employing, and training new staff is significantly diminished.” It says ratios have been shown to

‘It has been clearly demonstrated that the widespread implementation of ratios is not a ‘cost’ to the system; it’s an investment in patient care and the wellbeing of workers that will more than fund itself.’

reduce unplanned readmissions to hospital (estimated to cost $1.5 billion per year Australia wide), length of stay and avoidable deaths. “Ratios also were associated with a reduction in hospital-acquired health conditions such as pneumonia, pressure areas (commonly known as bed sores), urinary tract infections and falls, all of which add considerable (and avoidable) cost to the health system.” The submission notes that the current NSW Government has committed to implement a ratios system in five key areas of public hospitals. “While we strongly welcome this and continue to work closely with MoH on its implementation, we believe ratios or equivalent safe minimum staffing systems should be implemented in all clinical areas of the health system. “It has been clearly demonstrated that the widespread implementation of ratios is not a ‘cost’ to the system; it’s an investment in patient care and the well-being of workers that will more than fund itself.” n

Read more The NSWNMA submission to the Special Commission of Inquiry into Healthcare Funding covers many areas of health policy and practice and runs to 388 pages. Members can access the NSWNMA submission here: https://healthcarefunding.specialcommission.nsw.gov.au/assets/Uploads/ publications/Listing-of-Submissions-48/Submission-113-NSW-Nurses-andMidwives-Association.pdf THE LAMP FEBRUARY / MARCH 2024 | 17

AGED CARE

Bupa residents short-changed on care time Residents and staff of Bupa aged care facilities are paying the price of the British multinational’s failure to comply with mandatory care minutes.

y early January, almost 400 Bupa Assistants in Nursing (AiNs), Enrolled Nurses (ENs) and Registered Nurses (RNs) in NSW had signed a petition calling on the company to put an end to chronic understaffing by adhering to government-legislated care minutes. NSWNMA members collected the signatures at more than half of Bupa sites in less than eight weeks. The petition, initiated by NSWNMA members, says Bupa nursing homes in NSW are missing an average of 35 minutes of care per resident daily. “Stop ignoring our clinical and safety concerns; one AiN is often left to care for 10 to 35 residents. Comply with care minutes now,” the petition says. The petition calls on Bupa to acknowledge the clinical and safety concerns raised by nursing staff a nd follow a “like -for-like” replacement policy to avoid inappropriate skill mix. It calls for more RNs to be on shift and for direct care staff not to be directed to do non-clinical work such as cleaning and laundry. The petition lists some of the worst cases of non-compliance, such as Bupa Bankstown. It was short 20 AiNs per day and residents were missing out on 62 minutes of daily care on average, based on late 2023 data. Bupa Queens Park was short nine AiNs per day (costing residents 55

18 | THE LAMP FEBRUARY / MARCH 2024

RAJ SUBEDI AND HIS COLLEAGUES SONG AND RAJ

minutes of care per day on average), Bateau Bay was short 12 AiNs per day (54 minutes) and Maroubra was short 10 AiNs (53 minutes). These numbers as of late 2023 are despite the federal government paying providers since 1 October 2022 to help them voluntarily meet the target of 200 care minutes per resident per day, on average. The target, which includes 40 minutes of RN care, became mandatory on 1 October 2023.

LETTER TO CEO In a letter to Nick Stone, CEO of Bupa Asia Pacific, NSWNMA General Secretary, Shaye Candish, s a id t he p et it ion re su lte d from "concerns that Bupa is not

meeting the required amount of mandated care minutes". Shaye’s letter said Bupa nurses "feel they are not able to provide an adequate level of care to patients." Shaye said "our members own health and safety are being affected from the stress of trying to deliver proper care to patients without enough time between all of their other duties (i.e. kitchen and laundry duties). " Shaye added "Our members need sufficient time and resources to care for their residents safely." Her letter pointed out that in light of the federal funding model and the mandatory nature of care minutes, "we do not believe it is reasonable for Bupa to continue to not meet their required care minutes quota."

AGED CARE

‘Stop ignoring our clinical and safety concerns; one AiN is often left to care for 10 to 35 residents. Comply with care minutes now.’ — Bupa staff petition

Meanwhile, NSWNMA members at Bupa report that facilities have failed to replace staff on leave. Also, facilities have not employed additional staff to compensate for restrictions on student hours, which came into effect on 1 July 2023.

TAXPAYER SUBSIDIES WORTH BILLIONS The government is handing providers billions of taxpayer dollars to pay for major aged care reforms. It allocated $5.4 billion over four years for the additional nursing and care staff needed to meet mandatory minimum care times – including new minimums sta r ting on 1 October 2024. At that time, mandatory minimum average daily care will increase from 200 to 215 minutes, including 44 minutes by an RN. Other federally subsidised reforms include RNs on duty 24/7 and a 15 per cent increase in award wages. Both measures came into effect on 1 July 2023. The government will spend $11.3 billion to cover the wage increase – the biggest ever achieved in aged care. n

Bupa’s history of underpayment Bupa describes itself as one of Australia’s largest private residential aged care providers, with over 50 nursing homes and 5000 residents nationally. Bupa aged care Australia is part of UK-based Bupa, an international health and aged care, and health insurance group. In 2021, a compliance review revealed Bupa underpaid more than a third of its Australian workforce by as much as $75 million. About 18,000 current and former employees lost money as a result, the Australian Financial Review reported. Workers were underpaid across the business, including in its aged care, insurance and retail operations. Bupa has promised to pay back all workers. n

Rapid growth in NSWNMA membership NSWNMA membership at Bupa grew strongly in 2023, as nursing staff formed new branches of the union. For example, members at Bupa Baulkham Hills formed a NSWNMA branch in October 2023. By Christmas, branch numbers had already grown significantly. Branch secretary Raj Subedi said staffing RAJ SUBEDI, RN had deteriorated and workloads had increased, despite additional government funding to enable aged care providers to employ more staff. “Our residents should be receiving a higher level of care with more staff to attend to their needs. They are not getting the care they deserve, which they and the government have paid for,” he said. “If the mandatory care minutes requirement is fully implemented, then most of our staffing problems would be solved.” n

‘If the mandatory care minutes requirement is fully implemented, then most of our staffing problems would be solved.’ — Raj Subedi, NSWNMA Branch secretary Bupa Baulkham Hills

THE LAMP FEBRUARY / MARCH 2024 | 19

COVER STORY BRANCH BEAT

Branch

Beat

Branch Beat with NSWNMA Assistant General Secretary Michael Whaites

COVID, unprecedented floods and the surging cost of living: Lismore has seen more than its share of scourges over the last few years, which borders on the biblical. Throughout these difficult times nurses and midwives in private and public hospitals, and health services, have been the rock of the community. In return there is very strong community support for these nurses and midwives. So, late last year, it came as a shock to our branch members at St Vincent’s Private Hospital in Lismore when new management at the hospital pulled a pay offer that the branch was on the cusp of accepting and replaced it with a vastly inferior offer. Shock has given way to resolve, however, and the branch has mobilised within and reached out to the community to support them in their quest for a fair pay deal. This month, Branch Beat looks at how the branch has garnered support among the staff, the community, local media, politicians, and colleagues in other hospitals, for their claim for a livable pay rise.

“COVID, floods; we’ve had our share. Pay us what we know is fair” Branch members at St Vincent’s Private Hospital in Lismore were devasted last year when management suddenly withdrew an offer that would have seen staff receive a pay rise of 4 per cent from October 2023 and back pay of 2.53 per cent dated from October 2022.

on 25 October, and our next meeting was scheduled for 26 October,” Janelle said. The decision to withdraw the pay rise offer came when the newly appointed CEO of St Vincent’s Lismore made a last-minute decision to offer only a 2.3 per cent increase, backdated to July 2023.

“He thought that we were already excessively paid. We had been paid a little bit more than the public sector but our conditions, including maternity leave and long service leave, haven’t kept up with the public sector.” “We just think it is a really unfair thing to do. We think it is just so wrong. How many instances are there that a hospital makes an offer, and then they take it back?” said Janelle, a clinical nurse specialist. Branch members have since been actively organising, creating a WhatsApp group to communicate with all branch members and involve them in the campaign. Members circulated a petition that was signed by 170 members and supporters. “We did a lot of petitions, and we sent those petitions to the CEO, the board and the bishop, and we had no success there so we held a rally,” Janelle said. On 8 January, more than 50 members rallied at the Lismore Transit Centre about management’s failure to reinstate the offer of 2.53 per cent

NSWNMA Lismore Branch Secretary, Janelle Hospers, told The Lamp that the previous Enterprise Agreement expired in October 2022, but the start of negotiations was delayed by the hospital until August 2023. Nursing staff at the 84-plusbed day surgery hospital have now not received a pay rise since October 2021, she says. Last year’s backdown blindsided staff, who had already made plans for how they would spend the money over the holiday season. “We voted on management’s pay offer, and we were going to accept it and finalise negotiations, but St Vincent’s emailed union officials the next day saying: ‘We are taking the deal off the table.’” The email came BRANCH MEMBERS AT LISMORE TRANSIT CENTRE 20 | THE LAMP FEBRUARY / MARCH 2024

COVER STORY BRANCH BEAT

“I encourage St Vincent’s to come back to the negotiating table and work with the nurses to reach an outcome.” — Janelle Saffin, MP for Lismore

and 4 per cent. At the rally, members chanted: “COVID, floods; we’ve had our share. Pay us what we know is fair” and “Nurses show up day and night; pay us what we know is right”.

Support gives confidence to fight The support from the community and media coverage of the rally has given branch members a lot of confidence to continue fighting for a fair deal.

BRANCH MEMBERS AT LISMORE TRANSIT CENTRE

The rally was covered by a number of media outlets, including the Daily Telegraph, ABC radio, NBN News Channel 7, Lismore City News, and the Lismore news site Echo.

“Quite a few people at St Vincent’s do have a second job to get by,” Janelle said. Janelle Hospers said branch members have been buoyed by the backup they’ve received from members at other branches, and they have recently written to thank members at St Vincent’s Darlinghurst and the Lifeblood branch for their support. n

The ALP member for Lismore, Janelle Saffin, also released a statement saying she stood in solidarity with St Vincent’s nurses. “ They work incredibly hard, provide excellent care to locals and give themselves endlessly to their patients. They deserve decent pay and working conditions. I encourage St Vincent’s to come back to the negotiating table and work with the nurses to reach an outcome.” Without a pay rise in nearly two-anda-half years, the rapid increases in cost of living in that time has seen St Vincent’s nurses’ pay packets substantially decrease in real terms. The floods in Northern NSW have also had a devasting impact on those members whose homes were affected.

‘How many instances are there that a hospital makes an offer, and then they take it back?’ — NSWNMA Lismore Private Hospital Branch Secretary, Janelle Hospers

THE LAMP FEBRUARY / MARCH 2024 | 21

YOUR RIGHTS

Ask

Shaye

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

A new year and new opportunities to seize … We’re one month into the new year and the magic of Christmas is a distant memory – but maybe not so distant for those who had to work through the festive season. The year 2023 was a period of exciting action and wins for NSWNMA members, with the implementation of federal legislation requiring RNs 24/7, and nurses and midwives in private health campaigning for workplace and staffing improvements in new ways. In the public health system, members advanced in their intense struggle for improved staffing levels, conditions and pay. Improvements in parental leave and domestic violence leave provisions were implemented, just to name a few other significant gains. In 2024, we hope to achieve more positive workplace change, and new opportunities to win abound. In public health, pay rises and staffing levels will be our focus and in private health, improved pay and extending ratios remain a priority. When we achieve new workplace rights it is essential we enforce them, and key to doing that is knowing your rights, so let’s talk about your rights …

Independent medical examinations

Long service leave for casuals

I work at a public hospital, and I was required to attend an Independent Medical Examination (IME). I don’t agree with the outcome. Can I appeal it?

I am a long-term casual employee. Can casuals access long service leave?

Yes, you can. If an employee does not agree with the outcome of an IME or believes there is conflicting evidence about their fitness for duty, they can appeal the IME assessment. In this circumstance, you and your employer should agree on a different medical practitioner with expertise in the medical field that is relevant, to carry out a further and final review of your ability to return to work. An employee always has access to the grievance and disputes resolution procedure in the relevant award or agreement, if the matter is still not resolved.

22 | THE LAMP FEBRUARY / MARCH 2024

The short answer is yes! As long as you have reached 10 years of continuous service with no significant gaps, you are entitled to take long service leave. You may also have a pro-rata entitlement if your employment ends, provided you have at least five years of continuous service. It can be complicated to work out casual long service leave entitlements, particularly if there have been breaks in your employment. If you are a longterm casual employee and are unsure of your long service leave entitlements, I would encourage you to contact us for advice specific to your circumstances.

Workers compensation for COVID-19-related illness I have been diagnosed with COVID-19 and am unsure of how or where I caught it. I’ve heard that I can claim workers compensation because I’m a health worker. Yes, if you are a nurse or midwife and contract COVID-19, there is a legal presumption that you contracted it in the workplace, unless it can be proven otherwise. You are therefore eligible to claim workers compensation for any hours of work missed, as per s19B of the Workers Compensation Act 1987 (NSW). If you have COVID-19, keep a record of your positive test result, including the date and time. If you’ve taken a RAT, take a photo of the result. You will then need to consult your general practitioner and request a SIRA Certificate of Capacity. Submit the certificate, along with evidence of your positive test result, to your employer as soon as possible. Your employer is then legally obliged to pass the claim on to its insurer to make a decision about the claim. Please contact the Association should you have any questions or require further information on lodging a claim for workers compensation. You should also contact us if your claim is declined.

Returning to work after a non-work-related injury I have recently been off work due to a non-work-related injury. Since then, I have provided a medical clearance to return to work, but my manager is not letting me back to work. Should I still be paid?

adjustments to the conditions of employment, including the duties, of an employee who has a health condition, to enable them to participate equally in the workforce.

Yes. If you are ready, willing and able to work, and your ability to work is supported by a medical clearance provided to your employer, then your employer must pay your wages in accordance with your employment contract. You should write to your employer and request its reasons in writing for not allowing you to return to work, and contact the Association immediately for assistance.

Redeployment after a nonwork-related injury Can I be temporarily redeployed if I cannot perform my full duties following a non-work-related illness? Under anti-discrimination legislation in NSW, employers are required to make reasonable

An employee who is not able to upgrade to full unrestricted duties and hours immediately after their return to work, could be redeployed temporarily to another position or area where the duties are more appropriate, and where they can receive more support and the operational impact upon the service can be minimised. A return-to-work plan should be in place with a view to a graduated return to full duties and hours in the employee’s original position, as the employee recovers. Please contact the Association for assistance if your employer is

considering redeploying you after your recovery from a health condition.

Award free? I’m employed as a registered nurse at a private dialysis provider, but my contract says I’m ‘Award Free’. Is that correct? It is not correct. If you are working as a registered nurse in the private sector, you are covered by the Nurses Modern Award 2010, or by an enterprise agreement made with your employer. The Nurses Award contains the minimum pay and conditions for your role. If an employer says you are ‘Award Free’, you should let the Association know, as they are potentially breaching the Fair Work Act by misrepresenting your workplace rights.

NSWNMA’s podcast Keith’s Closet with Mental Health Nurse Keith Donnelly Summer Series Nursing during an inland tsunami with Grace Langlands

Out now!

Listen on THE LAMP FEBRUARY / MARCH 2024 | 23

PROFESSIONAL EDUCATION CALENDAR – TO 31 MAY 2024

Register via nswnma.info/education Go online to register for these education sessions and our free range of live webinars. Use the dropdown search fields to search by topic (Professional Courses, WHS Courses and Webinars), suburb or month.

Waterloo

The Deteriorating Patient Wed 21 Feb, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190 Wound Care: Wound Debridement Thu 7 Mar, 9am-4.30pm, 6 CPD Hrs. Members $95 / non-members $190 Chronic Conditions of the Foot Wed 13 Mar, 8.45am-4.30pm Thu 14 Mar, 8.45am-4.30pm Cost: Free1 Law, Ethics and Professional Standards in nursing and midwifery Thu 21 Mar, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190 Disarming unacceptable workplace behaviours: Practical tools for culturally and linguistically diverse nurses and midwives Fri 22 Mar, 9am-4pm, 6 CPD Hrs. Members $75 / non-members $150 Standard Mental Health First Aid, 2-day course Wed 27 & Thu 28 Mar, 9am-4pm, 12 CPD Hrs. Members $250 / non-members $350 Aged Care Seminar Fri 12 Apr, 9am-4pm, 6 CPD Hrs. Members $75 / non-members $150

Midwifery Seminar Fri 10 May, 9am-4pm, 6 CPD Hrs. Members $75 / non-members $150 Law, Ethics and Professional Standards in nursing and midwifery Thu 23 May, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190

Bega

The Deteriorating Patient Tue 7 May, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190 Understanding your annual CPD obligations Wed 8 May, 9am-1pm, 3 ½ CPD Hrs. Members $50 / non-members $100

Blacktown

Clinical Communication and Documentation Thu 18 Apr, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190

Broken Hill

Medications / Work Health and Safety Wed 24 Apr, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190

1 This program is supported by funding from the Australian Government Dept of Health under the Chronic Disease Support Project. The NSWNMA is the host venue only and is not involved with enrolment, presenting or running of the course. CPD Hrs may vary as there is pre-and-post education that may be undertaken by participants.

Dubbo

Medications: How we do it better Tue 5 Mar, 9am-4pm, 6 CPD Hrs. Members $95 / non-members $190 Professional Obligations and Boundaries Wed 6 Mar, 9am-1pm, 3.5 CPD Hrs. Members $50 / non-members $100

Newcastle

Providing safe and quality care in a holistic framework Wed 3 Apr, 9am-3pm, 5 CPD Hrs. Members $95 / non-members $190

Nowra

Wound Care: Wound Essentials Wed 14 Feb, 9am-4.30pm, 6 CPD Hrs. Members $95 / non-members $190

Penrith

Dementia Management Training Thu 30 May, 9am-5pm, 7 CPD Hrs. Members $95 / non-members $190

Wollongong

Wound Care: Leg Ulcers and Compression Dressing, 2-Day Course Thu 9 & Fri 10 May, 9am-4.30pm, 12 CPD Hrs. Members $190 / non-members $380

UPCOMING SEMINARS

LOCATION NSWNMA, 50 O’Dea Avenue, Waterloo NSW 2017 COST Per seminar: members $75 / non-members $150

Lunch and refreshments are provided and there will be time throughout the day to network with colleagues.

Disarming unacceptable workplace behaviours: Practical tools for culturally and linguistically diverse nurses and midwives Friday 22 March, 9am-4pm – 6 CPD Hrs. This seminar explores: • How to recognise and respond to psychosocial workplace hazards • Skills to challenge microaggressions and navigate difficult conversations • Breaking through organisational barriers to career advancement

Aged Care Seminar Friday 12 April, 9am-4pm – 6 CPD Hrs. Hear from a range of speakers, network with colleagues and share experiences across the aged care sector. For RNs, ENs and AINs in residential, community and hospital aged care settings, across private and public REGISTER NOW sectors, or anyone with an interest in the aged care sector in NSW. Program under development.

Welcome to The new online CPD portal

for NSWNMA members

Access to online CPD FREE for NSWNMA members and student members Hundreds of hours of FREE CPD online 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. FEATURING

FREE access to over 200 CPD modules online Highly visual and interactive modules you can do at your own pace New modules added regularly Your own personalised ePortfolio and CPD tracker so you can provide evidence to the Nursing and Midwifery Board of Australia (NMBA) of participation in CPD annually.

nswnma.info/ilearn LOGGING ON

MEMBERS New users create a ONE-TIME login to Member Central

NON-MEMBERS Join at www.nswnma.asn.au and receive access to hundreds of FREE CPD hours online!

NSWNMA fee waiver

for members on parental leave

Did you know,

if you’re going on parental leave, paid or unpaid, we’ll waive your Association fees until you return to work? You’ll still be entitled to access advice and receive The Lamp. Contact the Association and let us know when you plan to take parental leave so we can set up your waiver. Call 1300 367 962 or email gensec@nswnma.asn.au

www.nswnma.asn.au Authorised by S. Candish, General Secretary, NSWNMA

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Recruitment incentive scheme

Our collective strength is in our numbers – the larger the membership, the louder our voice. You can help build the NSWNMA by recruiting a member.

HOW THE SCHEME WORKS

T IFFT -GGI EED ARRD CCA

Once you have recruited 4 new members you will be entitled to an $80 e-gift card. For every new member you sign up after that, you will receive a $20 e-gift card. Digital gift cards are emailed to recruiters at the end of financial year and valid for 3 years. Gift cards are not deemed to be income for the purposes of taxation.

*Conditions apply. To participate in this recruitment incentive scheme, you must be a financial member of the NSWNMA (Associate Members are not eligible to enter). Every new member’s application form must be accompanied by some form of payment – cheque, money order, direct debit, credit card authorisation form. Recruiter’s name and membership number must be written in the space provided on each new member’s application form. New recruits must remain as financial members for at least 3 months before being recognised by the scheme.

STRATEGIC PLAN

Building a health system where nurses and midwives thrive The NSWNMA has released its latest three-year Strategic Plan.

he plan focuses on building a stronger, more equitable healthcare system that delivers a fairer workplace for nurses and midwives, and improved health care delivered to where it is most needed. “At the heart of our strategy for the next three years is ensuring a health system that provides decent jobs with conditions that attract and retain nurses and midwives, and an environment where they can thrive,” said the Association’s General Secretary, Shaye Candish. “Raising pay rates to reflect the contributions of nurses and midwives, which are competitive with those offered in other states and that address the gender pay gap of traditionally feminised professions, is key,” Shaye said. The plan also commits the union to influence broader political policy. “ We w i l l b e work i n g for superannuation reform, to ensure members can retire comfortably, and for affordable housing policies that can give members greater security and wellbeing.” The Strategic Plan was developed through extensive discussions and resolutions at the delegate committee level and at Annual Conference. The Association’s elected Council endorsed the plan after analysing progress during the previous three years and considering the challenges and opportunities ahead.

‘An active, engaged and growing membership is essential for the Union to achieve its goals.’ — NSWNMA General Secretary, Shaye Candish. BUILDING UNION STRENGTH, DIVERSITY AND INCLUSION, AND MEMBERSHIP VOICE “Members took unprecedented levels of industrial action during the previous Strategic Plan period, and it is vital we build on this strength to ensure the collective voice of members is heard,” Shaye said. “The 2024–2026 Plan includes a com m it ment to d iversit y and inclusion, making sure all Association members’ voices are heard within the union structure, and reflected in the leadership structure, regardless of their country of birth, language, ethnicity, race, or religion. “An active, engaged and growing membership is essential for the Union to achieve its goals, and the Association will also be working to increase participation and engagement at every level and in every sector.”

PAY, CONDITIONS, RATIOS AND CARE MINUTES Control of working conditions and hours in stressful work environments is a critical emerging issue, Shaye said. “Nurses and midwives need job control in the form of roster flexibility, job sharing and other flexible arrangements. An important goal of the plan is for members to have access to enforceable and meaningful job control clauses.” Safe staffing levels, delivered though ratios and care minutes, are also required to provide quality care, Shaye said. “The Union will continue to campaign for members in public and private hospitals, and aged care, to work in environments with functional and compliant care ratios and care minutes.” Addressing the critical shortage of midwives in NSW is another key focus.

THE BIGGER PICTURE A universal healthcare system that provides equitable access to quality care for all Australians is fundamental to the new Strategic Plan, Shaye said. “We can achieve the goals in our Strategic Plan with a strong, unionised workforce, and active and engaged members,” Shaye said. “I thank all the members, delegates and officials who have worked hard to develop this plan, to guide us through the challenges of the next three years and bring about a fairer, better health system for everyone.” n THE LAMP FEBRUARY / MARCH 2024 | 29

NSW Nurses and Midwives’ Association

STRATEGIC PLAN Vision

Mission

The New South Wales Nurses and Midwives’ Association exists to be a strong and influential union of members, that is respected as a contemporary leader for its innovation and achievements.

To win better pay and conditions, and improved health and aged care services for our communities, by increasing the collective power of nurses and midwives’ voices.

Strategic Pillars PAY

CONDITIONS

PAY STANDARDS Nurses and midwives in NSW deserve fair pay that reflects their valuable contributions to the health and aged care systems. Pay rates in NSW are not competitive enough with those in other states, and there is a gender pay gap that disadvantages the female-dominated nursing and midwifery professions. Our goal is to win pay rises that reflect the value of the work of nurses and midwives across all sectors, and allows NSW to recruit and retain a sustainable workforce, to act on housing affordability, and superannuation reform.

JOB CONTROL Nurses and midwives need job control in the form of roster flexibility, job sharing, and other flexible arrangements to ensure appropriate work/life balance. There is a workforce shortage in NSW, and many nurses and midwives are working under stressful conditions with limited control over their working conditions. We will advocate for members to have access to enforceable job control clauses.

RATIOS/CARE MINUTES Nurses and midwives need safe staffing levels delivered through ratios and care minutes to provide quality patient/ resident care. We will ensure members in private hospitals, public hospitals and aged care are operating under functional, compliant ratios/care minutes.

MIDWIFERY Midwives play a critical role in providing high-quality maternity care. There is a critical shortage of midwives in NSW, which can limit access to care for women and families. We will win policy changes to grow the number of midwives in NSW.

How we will win

30 | THE LAMP FEBRUARY / MARCH 2024

Focus intentionally on building powerfully unionised Focus intentionally on building workplaces and strong powerfully unionised networks of active and engaged members. workplaces and strong networks

Build confidence in the power of collective Build confidence in action the to win change and enforce power of collective action workplace rights. to win change and enforce

2024 | 2026 Australian Nursing and Midwifery Federation NSW Branch

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SOCIAL JUSTICE

ACTIVE MEMBERS

UNIVERSAL HEALTH CARE

An active, engaged and growing membership is essential for us to achieve our goals and strengthen our collective voice.

We believe in a universal healthcare system that provides equitable access to quality care for all Australians.

We will grow our power by achieving density targets in our key sectors and work to increase member participation and engagement at every level (leader to active member).

We are committed to closing the health gap between Aboriginal and Torres Strait Islander peoples and the wider Australian population.

DIVERSITY / INCLUSION We are committed to creating a diverse and inclusive organisation that reflects the communities we serve. We will strive to ensure our structures and leadership reflect the diversity of our membership, including our culturally and linguistically diverse (CALD) members. We will ensure our structures (branches/ networks) are representative of our CALD membership.

Ensure our members have seats themembers table where Ensureatour have they can influence policy seats at the table where and decision makers. they can influence policy and

We will advocate for transparency in public funding for privatised healthcare, ensuring taxpayer dollars are used effectively and efficiently.

CLIMATE / ENVIRONMENT Climate change poses a significant threat to public health. We will advocate for strong government action on climate change, highlighting the health impacts and the need for sustainable healthcare practices.

Be a well-resourced financially sound union that canfinancially invest in Be a well-resourced winning campaigns. sound union that can invest in winning campaigns.

Position the NSWNMA as a trusted leading voice Position and the NSWNMA as a on nursing, midwifery and health. trusted andFEBRUARY leading voice on| 31 THE LAMP / MARCH 2024 nursing, midwifery and health.

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

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GAZA

WHO on Gaza: hunger and disease at ‘catastrophic levels’ Hunger is ravaging Gaza, rates of infectious diseases are soaring, and the health system is on its knees, says the World Health Organization (WHO).

HO, Médecins Sans Frontières (MSF) and UNICEF, the United Nat ion s ch i ld ren's agency, have sounded the alarm bells about the lethal health situation in Gaza, with “catastrophic levels of food insecurity” and “a lack of sanitation and hygiene and a collapsing health system” creating a toxic mix. WHO says Gaza faces crisis levels of hunger, with insufficient food and high levels of malnutrition. “Gaza is already experiencing soaring rates of infectious diseases. Over 100,000 cases of diarrhoea have been reported since mid-October (to the end of 2023). Half of these are among young children under the age of five years; case numbers that are 25 times what was reported before the conflict,” it said. “Over 150,000 cases of upper respiratory infection, and numerous cases of meningitis, skin rashes, scabies, lice and chickenpox have been reported. “Hepatitis is also suspected, as many people present with the tell-tale signs of jaundice.”

A WAR ON CHILDREN – UNICEF More than a million children in the Gaza Strip are caught in a devastating situation marked by widespread destruction, relentless attacks, displacement, and severe 32 | THE LAMP FEBRUARY / MARCH 2024

Image credit: UNICEF

‘The near total breakdown and attacks on medical and healthcare services across Gaza threatens the lives of every child in the Strip.’ — UNICEF Executive Director, Catherine Russell shortages of essential necessities such as food, water and medicine, says UNICEF. The Gaza Strip is the “most dangerous place in the world to be a child”, Catherine Russell, Executive Director of UNICEF told the UN Security Council. By the end of 2023, the Palestinian death toll in Gaza had passed 20,000,

including about 8000 children and 6200 women, while more than 52,000 people had been injured, according to the territory’s government. UN officials and human rights groups say these numbers are reliable. An article in The Lancet medical journal said there was “no evidence of inflated rates”.

GAZA

Image credit: UNICEF

‘[It’s] very confronting for colleagues trying to provide healthcare when it’s possible to be shot through the window of the hospital’ — Dr Natalie Thurtle, Médecins Sans Frontières

PREMATURE BABIES AT IMMINENT RISK OF DEATH RELOCATED FROM AL-SHIFA HOSPITAL TO AL-HELAL AL-EMARATI HOSPITAL IN RAFAH

“In Gaza, the effects of the violence perpetrated on children have been catastrophic, indiscriminate and disproportionate,” said Ms Russell. She said the near total breakdown and attacks on medical and healthcare services across Gaza threatens the lives of every child in the Strip.

UNDER FIRE, THE HEALTH SYSTEM HAS COLLAPSED Gaza’s hospitals are barely operating, says WHO. Al-Shifa, the largest referral hospital in Gaza, now houses only a handful of doctors and a few nurses, working under what WHO staff describe as “unbelievably cha llenging circumstances,” and calling it a “hospital in need of resuscitation”. The operating theatres and other major ser vices rema in nonfunctional due to lack of fuel, oxygen, specialised medical staff, and supplies. The first major assault on a hospital by the Israeli army (IDF) was on al-Shifa. The IDF said five of the hospital’s buildings were directly involved in Hamas activities, directed from tunnels underneath the hospital. A subsequent investigation by The Washington Post discredited the army’s claims that Hamas

had been using the hospital as a command-and-control centre after analysing open-source visuals, satellite imagery and all the publicly released IDF materials (see https://www.washingtonpost.com/ world/2023/12/21/al-shifa-hospitalgaza-hamas-israel/). The Post’s analysis showed that: • the rooms connected to the tunnel network discovered by IDF troops showed no immediate evidence of military use by Hamas • none of the five hospital buildings identified by the IDF appeared to be connected to the tunnel network • there was no evidence the tunnels could be accessed from inside hospital wards. Dr Natalie Thurtle, an Australian doctor who coordinated medical aid for MSF in Gaza, told The Guardian it was “very confronting for colleagues trying to provide health care when it’s possible to be shot through the window of the hospital”. Thurtle said it was “impossible to set up a meaningful response to this catastrophe because of the ongoing military activity”. She said clinicians were operating in an “incredibly chaotic environment” that was “extremely difficult to manage”.

Thur t le said hea lthcare infrastr ucture had been “systematically targeted”. She said between 150 and 200 patients were arriving at al-Aqsa hospital in central Gaza each day, but “about a third of those patients are dead on arrival, which is very hard because many of them are children”. “Certainly, from speaking to colleagues and seeing the images that they’re seeing, the volume of children killed or mutilated in this conflict is very extreme,” she said. “Unfortunately, there’s a lot of misinformation around that, but that is certainly what we’re witnessing on the ground – that there’s a huge proportion of children being killed or maimed for life in this conflict. “No t h i n g can e xc u s e t he consistent and relentless targeting and decimation of healthcare infrastructure in Gaza,” she said. Thurtle said MSF was speaking up because it felt it had a responsibility to explain what its staff were seeing and experiencing, given that “there’s a huge volume of commentary from people who are not directly witnessing what’s happening on the ground”. n

THE LAMP FEBRUARY / MARCH 2024 | 33

The Edith Cavell Trust is now able to receive non-tax deductable donations/bequests. The Trust – named in honour of Edith Cavell – assists in the advancement of NSW nurses, midwives and assistants in nursing/midwifery through further studies and research, made available through scholarship. The knowledge and expertise gained by nurses, midwives and assistants in nursing/ midwifery, supported by the Edith Cavell Scholarships, is an asset to the care of their patients and clients. Bequests to the Trust continue to support this important work. Edith, a British nurse serving in Belgium in WW1, is a hero to most nurses and midwives. She helped some 200 Allied soldiers escape from German-occupied Belgium. Her actions saw her arrested, accused of treason, found guilty by a court-martial and sentenced to death. Despite international pressure for mercy, she was shot by a German firing squad. NAME ADDRESS

Cavell Edith

TRUST BEQUESTS

PHONE

BEQUEST/ DONATION AMOUNT

PREFERRED METHOD OF PAYMENT Electronic Fund Transfer Account name: Edith Cavell Trust Bank: Commonwealth Bank BSB: 062-017 Account no: 10017908 Credit Card I authorise the Edith Cavell Trust (processed via NSWNMA) to debit my credit card for the amount of Mastercard

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NEWS IN BRIEF

AUSTRALIA

Australia becomes first country to ban engineered stone

UNITED STATES

The anxious country Suicides, depression and anxiety are at an all-time high in the United States and these mental disorders should be seen not as personal disorders but as social disorders, says former US Secretary of Labour Robert Reich. The US suicide rate is at its highest since 1941. Recently, a panel of American medical experts recommended that doctors screen all patients under 65, including children and teenagers, for anxiety disorders. Robert Reich, a highly respected public policy expert, says the country must face these hard truths about US society. “Maybe the widespread anxiety and depression, along with the near record rate of suicide, should not be seen as personal disorders,” he wrote in The Guardian. “Maybe they should be seen – in many cases – as rational responses to a society that’s becoming ever more disordered. “After all, who’s not concerned by the rising costs of housing, and the growing insecurity of jobs and incomes? “Who doesn’t worry about mass shootings at their children’s or grandchildren’s schools? “Who isn’t affected by the climate crisis? “Consider all this and it would almost be stranger if you weren’t anxious, stressed and often depressed.” Without dealing with the underlying reasons for these disorders “no number of mental health professionals, and no amount of medications or hotlines, will be enough to substantially reduce the stress, anxiety, depression and suicidal thoughts that so many Americans are now experiencing”, he says.

‘It would almost be stranger if you weren’t anxious, stressed and often depressed.’ — Robert Reich, US public policy expert

36 | THE LAMP FEBRUARY / MARCH 2024

The ban is the culmination of a yearslong campaign by unions, clinicians and workers. Experts say that engineered stone “exploded” through the mid-2000s as a cheaper and more durable alternative to marble and granite. It is used predominantly in kitchens and bathrooms. The campaign started after problems were identified around 2015, as silicosis cases rose among those involved in its cutting and handling. In December last year, federal and state work health and safety ministers implemented a full ban after Safe Work Australia released a report recommending a complete prohibition on the use of all engineered stone in Australia. Experts estimate that 15 to 20 per cent of people who work in this field have silicosis or will develop it. Unions, public health experts, and health and safety specialists had been warning governments about the risks associated with engineered stone for years. ACTU Assistant Secretary Liam O’Brien said Australia had learned its lesson from asbestos, which took decades to ban. “Australia’s got a pretty horrible legacy with asbestos, so I think we know very well what happens if you don’t take action early,” he said. “The ban on engineered stone is a direct result of workers and their unions, like the CFMEU, and public health organisations who have demanded that we take the strongest possible action to keep workers safe.”

‘Australia’s got a pretty horrible legacy with asbestos, so I think we know very well what happens if you don’t take action early.’ — ACTU Assistant Secretary Liam O’Brien

NEWS IN BRIEF

AUSTRALIA

AI can already diagnose depression better than a doctor AI shows substantial promise in the management of depression, researchers say. In recent years there has been a surge in research applying AI to illnesses like depression, which can be difficult to diagnose and treat. Scientists have compared ChatGPT diagnoses and medical recommendations to those of real-life doctors with surprisingly positive results, Sarah Hellewell, a research fellow at Curtin University, wrote in the online journal The Conversation. “When given information on fictional patients of varied depression severity, sex and socioeconomic status, ChatGPT mostly recommended talk therapy. In contrast, doctors recommended antidepressants,” she said. US, British and Australian guidelines recommend talk therapy as the first treatment option ahead of medication. “This suggests ChatGPT may be more likely to follow clinical guidelines, whereas GPs may have a tendency to oversubscribe antidepressants. “ChatGPT is also less influenced by sex and socioeconomic biases, while doctors are statistically more likely to prescribe antidepressants to men, especially those in blue-collar jobs.” Hellewell says that combining functional and structural information from magnetic resonance imaging data (MRI) correctly predicts depression in over 93 per cent of cases. “This suggests using multiple brain-imaging techniques for AI to detect depression may be the way forward,” she said. MRI-based AI tools are currently only used for research purposes.

UNITED KINGDOM

Visiting your grandmother once a month can prolong her life A study based on more than 400,000 people found that older people who receive frequent visits from family and friends have a 39 per cent lower chance of dying. Researchers from the University of Glasgow examined how human connection can reduce the risk of death and found that regular visits from friends and family was the most important factor in extending life. The study, published in the journal BMC Medicine, found that visits from family often prompt people to seek health care, meaning they live longer. There is also a link with behaviour: socially isolated people have more unhealthy habits, such as smoking or heavy alcohol consumption. They also cease or reduce healthy habits like exercising, keeping a regular schedule and sleeping more than seven hours a day. Among the factors that determine how isolated a person may feel are whether or not they participate in group activities, whether they live alone or with someone, and whether they receive visits from friends or family. Interestingly, the study found that visiting grandparents more than once a month doesn’t offer any additional benefit in terms of mortality risk. Visiting grandma once a month can be a good protective measure, but it is not an altruistic act: the protective effect could be bidirectional.

‘ChatGPT may be more likely to “We are social animals. And that is regardless of our age,” follow clinical guidelines, whereas said Prof. Hamish Foster, one of the researchers. GPs may have a tendency to ‘We are social animals. And oversubscribe antidepressants.’ that is regardless of our age’ — Sarah Hellewell, Curtin University

— Prof. Hamish Foster

THE LAMP FEBRUARY / MARCH 2024 | 37

NEWS IN BRIEF

AUSTRALIA

WORLD

Boost for consumer knowledge on aged care An expanded resource has been developed by nurses, doctors, industry experts and consumer groups to help people navigate the complexities across the aged care sector. The 10 Questions to Ask series was launched at Parliament House in Canberra by Federal Assistant Minister for Health and Aged Care, Ged Kearney. Ged said she welcomed the translated resources for people seeking residential and in-home aged care, which was developed by the NSW Aged Care Roundtable in collaboration with the NSWNMA. The NSW Aged Care Roundtable includes medical, clinical and consumer representatives, who used their expertise to collaborate on a series of 10 Questions to Ask leaflets, each providing a ‘top 10’ of suggested aged care-related questions and answers. The information series have been endorsed by credible professional and advocacy organisations. Each leaflet focuses on an individual aspect of aged care to increase consumer knowledge and make the journey into residential or in-home aged care simpler. Following input from the Department of Health and Aged Care translation service, the leaflets have also been translated into 15 different languages, as well as six Aboriginal and Torres Strait Islander languages, with support from the Multicultural Communities Council of Illawarra, and the Partners in Culturally Appropriate Care (PICAC) NSW & ACT. The information is targeted at consumers searching for a highquality residential aged care facility, or reviewing the quality of a current residential aged care facility, or deciding between similar service providers, in order to provide them with the tools to find the best service available. More information: The leaflets can be found at: www.10questions.org.au 38 | THE LAMP FEBRUARY / MARCH 2024

Being poor triples risk of early onset dementia New study finds people from lower socioeconomic backgrounds are more than three times as likely to experience early onset dementia. The study, published in The Lancet Healthy Longevity journal and conducted by researchers at the Huazhong University of Science and Technology in China, used UK BioBank data of more than 440,000 participants aged between 37 and 73. The study collected data of these individuals’ household income, highest education qualification and employment status, to determine their socioeconomic status. The data also looked at the extent of a participant’s healthy lifestyle, assessed through a score that looked at smoking status, alcohol consumption, physical activity and diet. The results found that individuals of a lower socioeconomic status had a three-times-higher risk of developing early onset dementia in comparison to their counterparts from a higher socioeconomic background. Of these results, less than 12 per cent of cases could be explained by lifestyle factors, suggesting that individuals from a lower socioeconomic background living a healthier lifestyle wouldn’t necessarily mitigate the risk of developing early onset dementia. The research also found that people from a lower socioeconomic background who lived an unhealthy lifestyle had a 440 per cent higher risk of developing early onset dementia compared with those from a higher socioeconomic background who lived a healthy lifestyle.

People from a lower socioeconomic background who lived an unhealthy lifestyle had a 440 per cent higher risk of developing early onset dementia compared with those from a higher socioeconomic background who lived a healthy lifestyle.

NEWS IN BRIEF

AUSTRALIA

Corporate Australia booms at the expense of their customers and staff Experts say the rising cost of living is causing “growing anguish” among working people, while business profits and executive pay soars. Australian banks and other financial institutions have spent $6 billion in share buybacks this financial year, effectively transferring this money from customers to shareholders, reported The Guardian. This follows strong profit results that were locked in during late 2022 and early 2023, a period marked by high inflation, rising interest rates and steep price increases in everything from airfares to groceries and mortgages. According to the Australian Bureau of Statistics, retail trade profits surged by 25.6 per cent, and

non-mining profits grew 15.7 per cent over the past 12 months. Meanwhile, Carly Dober, a Melbourne psychologist who has made a submission to the ACTU inquiry into pricing practices led by Prof. Allan Fels, told The Guardian that rising rents, mortgages and other living costs were causing growing anguish among working Australians. She said the large profits and pay packets generated in parts of the economy exacerbated the problem. “When they see and read the stories about banks profiting billions, there’s a real sense of despair, rage

and helplessness,” said Dober. “There’s a sense of injustice.” More information: Visit the website of the ACTU’s Inquiry into price gouging and unfair pricing practices: https://pricegouginginquiry.actu. org.au/

“When they see and read the stories about banks profiting billions, there’s a real sense of despair, rage and helplessness.” — Carly Dober, psychologist

AUSTRALIA

Extreme heat might make MDMA riskier

A study in rats showed a moderate dose of MDMA that is typically nonfatal in cool, quiet environments can be fatal in rats exposed to conditions that mimic the hot, crowded settings where people often use the drug.

Hot weather might intensify the risks of drug use, say researchers. Summer and music festivals go hand in hand, and we know that the use of recreational drugs at live music festivals is common. Researchers from the University of Sydney and UNSW have warned that while drug use is dangerous no matter the circumstances, extremely hot weather may make it even more risky.

Harm-reduction measures, including pill testing, should play a vital role in educating music festival attendees about the dangers of drug use, especially in hot conditions.

The researchers say harm-reduction measures, including pill testing, should play a vital role in educating music festival attendees about the dangers of drug use, especially in hot conditions. “MDMA (or ecstasy) triggers the release of substances that interfere with our temperature regulation, leading the body to generate more heat than usual,” Milad Haghani and Pegah Varamini wrote in The Conversation.

CROSSWORD SOLUTION

“This elevation in body temperature happens even if the person using drugs is not exerting themselves and not in a hot environment. In this context, the effect can still cause dehydration. “However, the effects may be greater if a person is exerting themselves in hot, crowded settings.” In extreme cases, a sharp increase in body temperature can lead to organ failure and even death, they say. THE LAMP FEBRUARY / MARCH 2024 | 39

YOUR RIGHTS

Professional Perspectives I am a midwife. How many CPD hours do I require to keep my registration? Midwives must complete a minimum of 20 hours of Continuing Professional Development (CPD) per year, relevant to their context of practice. The 20 hours of CPD must be completed every year between 1 June and 31 May, for the practitioner to meet mandatory registration requirements. This requirement is in addition to CPD hours required as a registered nurse if you hold dual registration. I am a nurse and I’m thinking about completing my midwifery degree. What would be my CPD requirements once I am dual registered? All nurses and midwives must complete at least 20 hours of CPD every year between 1 June and 31 May, relevant to their context of practice for each registration they hold. For those registered as both a nurse and midwife, 20 hours of CPD is required for each registration. It should be noted there can be crossover of CPD, if relevant to both professions. For example, a medication module could count towards both nursing and midwifery CPD hours and can be recorded under each registration. I am an EN working in aged care. I have heard there is no funding for ENs in aged care anymore – is this true? ENs make up a vital part of the clinical workforce and although minutes of care provided by ENs cannot currently be counted towards RN-specific care minutes, the direct care they provide to residents is included in the total care minutes. The federal government has asked 40 | THE LAMP FEBRUARY / MARCH 2024

The Association’s professional team answer your questions about professional issues, your rights and responsibilities.

providers to report separately on their EN care minutes. These minutes will be published on My Aged Care as part of the overall Star Rating from October 2023. This shows that they see the EN role as an important part of the aged care workforce. I was stopped for a random breath test and found to be driving with a mid-range Prescribed Concentration of Alcohol. I must go to court in two weeks’ time. This isn’t related to my registration. How can the NSWNMA help me? Under the Nursing and Midwifery Board of Australia (NMBA) Standards for Practice and Code of Conduct, your conduct in your personal life can impact your professional life and your registration. As a registered health practitioner, if you are charged, found guilty or convicted of a criminal offence, including a serious driving offence with a possible penalty of 12 months’ imprisonment, there are mandatory notification requirements to AHPRA within seven days. This is a very short timeframe at a stressful time. Following a review of your circumstances, our legal officers can assist you to meet your reporting obligations. In addition, they can also advise, assist and represent you through any disciplinary process that may follow, including any declaration you may be required to make at your registration renewal.

I am interested in being engaged in political rallies and activities – what do I need to consider? When engaging in political activities, it is important to consider your obligations as an employee, and professionally as a nurse or a midwife. From an employee perspective, you must ensure you don’t breach any relevant workplace code of conduct (e.g. don’t wear your work uniform to a protest or rally, and don’t identify your workplace to the media). From a professional perspective, the Nursing and Midwifery Board of Australia (NMBA) professional standards outline the practice and behaviour expectations of all nurses and midwives (https:// www.nursingmidwiferyboard. gov.au/Codes-GuidelinesStatements/Professionalstandards.aspx). These professional standards outline that nurses and midwives should promote health and wellbeing, and understand and apply the principles of public health. Nurses and midwives should also participate in health advocacy for community and population health in a way that addresses health inequality. Nurses and midwives must not participate in unlawful behaviour, and understand that unlawful behaviour may be viewed as unsatisfactory professional conduct or professional misconduct and have implications for their registration.

Being politically active is often necessary in order for our voices to be heard, and our standards indicate that we should speak out when things aren't right. Doing so in a professional manner strengthens our voice.

COVER STORY NURSING RESEARCH AND PROFESSIONAL ISSUES Recent original research and scholarly work relevant to nurses, midwives and other healthcare professionals.

A global comparison of nursing, midwifery and physician efficacy in preventing COVID-19 deaths during 2019–2022 W You, L Cusack, F Donnelly,

the community against COVID-19 deaths than that of physicians.

International Nursing Review, Volume 70, Issue 4, p.552–559, 17 September 2023

Critical consciousness of public health nurses: a descriptive, comparative survey A Pirsch, R Austin, L Martin, D Pieczkiewicz, K Monsen

This research aims to compare the roles of nurses, midwives and physicians in reducing COVID19 deaths, measured with a case fatality ratio. The roles and responsibilities of different health disciplines during the COVID-19 pandemic vary. While more difficult to measure, objective assessments of discipline contributions of nurses, midwives and physicians, can be viewed through statistical analysis. The role of nurses and midwives and physicians in protecting the community against COVID-19 deaths is explored and compared using competing effects of affluence, age and urbanisation. Nurses and midwives have reduced COVID-19 deaths significantly more than physicians. This difference remains, while controlling for physician care, economic affluence, median age and urbanisation individually or in combination. In contrast, the role of physicians in reducing COVID19 deaths is less independent than those of nurses and midwives. Unlike physicians, the nursing and midwifery workforce is bigger, and located throughout all healthcare system levels; therefore, it is more accessible to the community. This is an important point in explaining the contribution of nurses and midwives to reducing COVID-19 deaths when compared with physicians. This study suggests that, worldwide, the nursing and midwifery workforce may play a more significant role in protecting

https://doi.org/10.1111/inr.12887

Public Health Nursing, Volume 40, pp. 905-913, 7 August 2023 This study examines public health nurses (PHN) caring for vulnerable populations amid systemic inequality. They must navigate complex situations, and consequently, they may experience serious moral distress known to be detrimental to their well-being. Given PHN awareness of social inequities, the study aimed to determine if they were motivated to enact social change and engage in social and political action to address inequality. A survey of 173 PHNs was conducted. They were highly motivated to address inequities; however, social and political scores were much lower. High critical reflection and motivation among PHNs aligned with literature. https://onlinelibrary.wiley.com/doi/ epdf/10.1111/phn.13245

organisational and regulatory support, and professional characteristics are important prerequisites for nurses’ engagement and should be considered when determining work engagement. Work engagement, job performance, job satisfaction, and organisational commitment using validated scales were assessed. Data analysis included statistical procedures, such as correlation analysis and structural equation modelling. Positive relationships were found among engagement, performance, commitment, and job satisfaction. Satisfaction was strongly correlated with commitment, and moderately correlated with performance. Commitment played a mediating role in the relationship between satisfaction, engagement and performance. Enhancing job satisfaction and engagement can contribute to increased commitment and improved performance among nurses in healthcare settings. These findings highlight the importance of fostering a supportive work environment to optimise nursing outcomes. https://opennursingjournal. com/VOLUME/17/ELOCATOR/ e187443462308310/FULLTEXT/

Understanding the mediating effects of commitment and performance on the relationship between job satisfaction and engagement among nurses E Shdaifat, T Shudayfat, N Al-Shdayfat, A Alshowkan Open Nursing Journal, Volume 17, 2023 This research article investigates job satisfaction, engagement, and commitment as factors for caregiver well-being and workplace retention. Rewards, THE LAMP DECEMBER / JANUARY 2024 | 41

COVER STORY

There are some things you shouldn’t handle alone. Contact the NSWNMA if you are: Asked to attend a disciplinary or fact finding interview with your employer Threatened with dismissal Instructed to provide a statement for any reason Contacted by the Health Care Complaints Commission or the Nursing and Midwifery Council of NSW Contacted by police or solicitors in relation to a Coronial Inquest

Call us on 8595 1234 (metro) or 1300 367 962 (non-metro) Email gensec@nswnma.asn.au www.nswnma.asn.au 42 | THE LAMP FEBRUARY / MARCH 2024

INSURANCE BENEFITS

For NSWNMA Members

Insurance protection when you need it most 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.

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www.nswnma.asn.au * The Professional Indemnity Insurance policy also includes Public and Products Liability cover. THE LAMP FEBRUARY / MARCH 2024 | 43

YOUR

health+wellbeing Healthy eating

To provide the best possible care, nurses, midwives and nursing or midwifery students require healthy and nutritious food. What you eat while you are at work plays a substantial role in your diet. Paying attention to a healthy diet, and drinking enough water every day, are essential ways for you to maintain optimal physical, emotional and psychological health.

Challenges to healthy eating

Why healthy eating matters

Long hours, missed breaks and shift work can result in nurses, midwives and students not having time to prepare and eat healthy, nutritious foods.

By deciding to eat healthily you are helping to:

Rotating and night shifts and/ or 12-hour shifts can result in you drinking more caffeine and eating high-sugar foods to keep you awake and functioning throughout your shift.

• maintain a healthy weight • reduce major health risks such as heart disease, hypertension (high blood pressure), type 2 diabetes, osteoporosis, and certain types of cancer • improve bone health by ensuring adequate calcium • improve the immune system • increase energy levels • improve concentration and mood, to think more clearly and handle stress better, and • promote better quality sleep.

44 | THE LAMP FEBRUARY / MARCH 2024

BROUGHT TO YOU BY

The link between good nutrition and healthy weight, reduced chronic disease risk, and overall health is too important to ignore. By taking steps to eat healthily, you’ll be on your way to getting the nutrients your body needs to stay healthy, active and strong. Making small changes to your diet can go a long way – it’s easier than you think.

Achieving a healthier diet Australian healthy eating guidelines recommend adults choose from five food groups: 1. Vegetables and legumes as a source of vitamins, minerals and dietary fibre. The recommended daily intake is 5 serves (1 serve = 1 cup raw or ½ cup of cooked vegetables or legumes). 2. Fresh fruit as a source of vitamins and dietary fibre. Adults should have 2 pieces of fruit per day. 3. Grains and cereal foods (preferably wholegrain) are high in protein, dietary fibre, minerals and vitamins. The recommended amount is 6 or 7 serves per day (1 serve= 1 slice of bread or ½ cup of rice, oats, pasta or other grain or 30 grams of cereal). 4. Lean meat, poultry, fish, eggs, legumes, tofu, nuts and seeds provide a good source of protein, minerals and vitamins. Legumes, nuts and seeds are also a source of dietary fibre. The recommended number of serves for adult women is 2 ½ serves per day, and adult men 3 serves per day. Adults are recommended to not eat more than 500 grams of red meat per week. 5. Milk, cheeses and yoghurts provide protein, vitamins and calcium. The recommended daily intake for all adults is 2 ½ serves per day.

Staying hydrated

How much water?

Water makes up approximately 50–60 per cent of an adult’s body weight and every system in our body depends on water. Water flushes toxins out of vital organs, carries nutrients to cells. Most mature adults lose about 2.5 to 3 litres of water per day. Water loss may increase in hot weather and with prolonged exercise.

You should drink the recommended 2–3 litres water per day to ensure adequate hydration (of an average healthy adult). The amount required may vary if you are exercising, if your environment or the weather changes, and for other diagnosed health conditions.

Why drinking water is important Lack of water can lead to dehydration, a condition that occurs when you don’t have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired.

More info For more information contact Nurse and Midwife Health, a free and confidential support service available 24/7 to nurses, midwives and students Australia wide. If you would like to speak to someone, call 1800 667 877, or you can request support via https://www. nmsupport.org.au/support. If you would like to know a bit more about the service before getting in contact, take a look through https://www.nmsupport.org.au/ accessing-support. THE LAMP FEBRUARY / MARCH 2024 | 45

CROSSWORD

test your

Knowledge 1

14 15 17

22 24

25 26

27 29

28 30

31 33

ACROSS 1. Mental health issue affecting mood and behaviour (9.8) 9. A very long period of time (3) 10. Mental haziness or unclear thinking (9) 12. Help (3) 13. Guided learning sessions (9) 14. Mentally unstable person (7) 16. Wormlike, with few bristles (13) 22. Symbol for sodium (1.1) 23. Fluid component of blood (5) 24. Neurotransmitter for muscle contractions (13) 26. The egg of a louse (3) 29. Oesophagus (6) 30. Related to the body's defence against diseases (13) 33. A rare congenital disorder causing iron overload in the foetus and newborn (1.1) 46 | THE LAMP FEBRUARY / MARCH 2024

34. Space just below the roof (5) 35. Specialist in women's reproductive health (13) 37. Period of five years (7) 39. Displaying contempt or prejudice against women (12) DOWN 1. A medical device that records the heart's (17) 2. Amino acid involved in urea cycle (9) 3. Intense and widespread fire or turmoil (7) 4. Portion of the body on either side of the spine between the ribs and the hips (5) 5. Perfect or optimal (5) 6. Photosensitive protein in the retina (5) 7. Gap or space between two teeth (8) 8. Extensive surgical removal of breast tissue (7.10)

11. Grind the teeth together (5) 15. Surgical room (1.1) 17. French dessert, often layered (6) 18. A common procedure to visualize the inside of the colon (11) 19. Coding region of a gene (4) 20. Leave out (4) 21. Engages in conjecture (10) 25. Protective layer inside an organ (6) 27. A flat horizontal surface higher than the level of the areas around it (8) 28. Spiral or looped structure, often found in the inner ear (4) 29. Symbol for gallium (1.1) 31. Individuals under legal age (6) 32. Spicy pepper used in cooking (6) 36. Spherical objects (4) 38. Uterine Contraction (1.1)

Update your details and win Have you recently moved house or changed jobs? Changed your classification or email?

Log on to online.nswnma.asn.au Update your details Go into the draw to WIN A TWO-NIGHT WEEKEND STAY AT WILDES BOUTIQUE HOTEL, KANGAROO VALLEY for two adults including: 2-night stay in a Fitzroy studio Breakfast for two daily A 3-course dinner at Wildes dining room Late check-out Half day bicycle use for two WILDES BOUTIQUE HOTEL is Kangaroo Valley’s hippest boutique hotel, the perfect retreat for wilderness explorers to relax and unwind. With its laid-back contemporary Californian Feel, it’s the perfect getaway and escape. Everyone who uses our online portal from 1 April 2023 – 30 March 2024 to update their details will automatically be entered in the draw to win. *The winner must be a financial member of the NSWNMA. Prize valid until 30 December 2024 and excludes stays over long weekend and school holiday peak periods. Booking and stay conditions may apply.

Are you a dual-registered nurse/midwife?

Let us know now!

Keeping your membership details up to date is very important. If you’re a dual-qualified nurse/ midwife, you can now update your role in the NSWNMA member portal.

THE 2023 – 2024 NSWNMA MEMBER RECRUITMENT PRIZE

Recruit a new member and go into the draw to win a

$1,500

WORLDWIDE TRAVEL VOUCHER The NSWNMA has partnered with travlect to reward you! Recruit a new member and you could win a $1,500 travel voucher that can be used on accommodation anywhere around the world. Every member you sign up over the year gives you an entry in the draw! Travlect offers all NSWNMA members discounted rates on 1000s of hotels Australia wide and all around the world. Never pay full price for a holiday again. Visit travlect.com/partner/nswnma or call 1300 959 550. The NSWNMA will cover return flights for two from Sydney to the value of $3,000.

PRIZE DRAWN 1 JULY 2024 RECRUITERS NOTE: Join online at www.nswnma.asn.au

If you refer a member to join online, make sure you ask them to put your name and workplace on the online application form, so you will be entered in the draw. Conditions apply. Prize must be redeemed by 30 June 2025. Voucher is for accommodation only. Peak and high season dates may incur a surcharge. Voucher is not transferrable nor redeemable for cash and cannot be used in conjunction with any other offers.