The Lamp July 2016

lamp THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION

VOLUME 73 No.6 JULY 2016

SUPPORT OUR AGED CARE NURSES UNDERSTAFFING IN REGIONAL HOSPITALS Print Post Approved: PP100007890

QLD RATIOS WIN

A PRESCRIBED DEATH

COVER STORY

We do everything as if you are here You work hard caring for others; we work hard to care for you.

Your needs, your goals, your future.

You wouldn’t have it any other way. Neither would we.

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CONTENTS

CONTACTS NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office.

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

VOLUME 73 No.6 JULY 2016

Hunter Office 8-14 Telford Street, Newcastle East NSW 2300 NSWNMA Communications Manager Janaki Chellam-Rajendra T 1300 367 962

COVER STORY

12 | Support our aged care nurses Delegates call for support to aged care nurses 24/7.

g retreat at

Styles 5 6 8 33 34 39 41 43 45 46

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

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QUEENSLAND has become the fourth government in the world – and the second Australian state – to legislate for minimum nurse to patient ratios.

REGIONAL HOSPITALS

16 | Regional dilemma: new hospitals and not enough staff New hospitals have been opening throughout regional New South Wales but they are struggling to cope with increased demand due to poor workforce planning.

PRIVATE HOSPITALS

24 | Time machine takes Ramsay backwards Nurses at Australia’s biggest private hospital chain are in revolt against a new time and attendance system.

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Produced by Hester Communications T 9568 3148 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au

Jan Dilworth and Louise Stammers PHOTOGRAPH: SHARON HICKEY

REGULARS

For all editorial enquiries letters and diary dates T 8595 1234 E lamp@nswnma.asn.au M 50 O’Dea Avenue, Waterloo NSW 2017

HEALTH AND INEQUALITY

28 | A prescribed death

Editorial Committee • Brett Holmes, NSWNMA General Secretary • Judith Kiejda, NSWNMA Assistant General Secretary • Coral Levett, NSWNMA President • Peg Hibbert, Hornsby & Ku-Ring-Gai Hospital • Michelle Cashman, Long Jetty Continuing Care • Richard Noort, Justice Health Advertising Danielle Nicholson T 8595 2139 or 0429 269 750 F 9662 1414 E dnicholson@nswnma.asn.au Information and Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Jeannette Bromfield, Coordinator T 8595 2175 E gensec@nswnma.asn.au The Lamp ISSN: 0047-3936 General disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised.

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The United States is experiencing an overdose epidemic driven by the abuse of painkillers.

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THE LAMP JULY 2016 | 3

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4 | THE LAMP JULY 2016

EDITORIAL

BY BRETT HOLMES GENERAL SECRETARY

We all stand beside aged care RNs We have a major battle on our hands to retain registered nurses in aged care and we need everyone in the nursing and midwifery professions to stand with our colleagues in the aged care sector if we are to succeed.

“We can’t just leave it to nurses working in aged care to carry the burden of resisting these changes.”

For some time now the Association has been raising the alarm about the consequences for vulnerable older Australians of losing RNs in aged care.

Our analysis of what is happening in the sector as a result of federal legislative changes that flow to NSW was endorsed by a thorough and considered NSW parliamentary inquiry.

Now, even aged care providers are coming out and confirming that they will not be able to hold on to RNs as a result of cuts to funding.

Scalabrini Village CEO Chris Rigby told Australian Ageing Agenda: “As a matter of policy we have registered nursing staff on 24/7.

Consequently we are able to care safely and well for people with high complex care needs. In the future, I don’t know what we are going to do.

We wouldn’t be able to accept such residents and we wouldn’t be able to afford to employ the registered staff at the levels that we currently employ them.”

In a state like NSW where aged care is almost entirely dependent on private providers the double whammy of reduced funding and the removal of the legal requirement for RNs opens up a very frightening scenario for older Australians with high care needs.

The policy of the Baird government will facilitate this exit of RNs. It is a position that is difficult to fathom and it is tempting to see it as a callous abrogation of responsibility in light of the overwhelming evidence that has been presented to it from a diverse range of knowledgeable sources about the consequences of its actions.

VICTORIA’S GOVERNMENT CARES ABOUT AGED CARE, WHY CAN’T OURS? In stark contrast, the Victorian government is currently injecting significant resources into aged care. In Victoria the government still owns and operates 185 nursing homes. Most are located in rural and regional Victoria to allow old people access to residential aged care within their local community.

It has also just announced plans for a $56 million publicly owned nursing home in Melbourne – a first step towards government owned residential aged care in Melbourne over the next decade.

These publicly owned aged care facilities are also staffed according to ratios that are set out in law along with public hospitals. These ratios put aged care in NSW to shame.

THERE ARE RAMIFICATIONS FOR OUR PUBLIC HEALTH SYSTEM We cannot stand by and let this disgraceful trajectory in aged care continue. We owe it to older Australians who have paid their dues to society and are entitled to a dignified old age.

Nor can we just leave it to nurses working in aged care to carry the burden of resisting these changes. The entire nursing and midwifery professions need to stand by our colleagues in aged care.

At our last COD delegates in the public health system resolved to take whatever action they could to help aged care nurses in their campaign including persuading their management to make their views know to the Ministry of Health about the removal of the requirement to have an RN on duty 24/7 and to contact their local MPs. I would urge nurses and midwives in the public health system to support your colleagues in aged care in this way.

Their fight is everyone’s fight. It is not hard to imagine a policy of reducing the role of the RN eventually seeping through to the public hospital system. We already know our EDs are being put under more unneeded pressure as sick elderly residents are transfered to the public system because there is no RN available in an aged care facility.

THE LAMP JULY 2016 | 5

YOUR COVERLETTERS STORY

Here are some letters from members who wrote to the Ministry of Health, which had invited comments on the change to the Public Health Act that would remove the requirement for registered nurses around the clock in nursing homes.

LE T T E R OF T H E M ONT H

Defend the rights of the frail and sick I am a retired RN with extensive past experience in management in aged care and palliative care. As an ageing Australian with the knowledge and background I have I am very concerned at the possibility of aged care residents not having access to the care of registered nurses 24 hours a day.

I am very aware as a past manager in aged care that even in not for profit organisations, cost cutting and ‘efficiencies’ have the potential to and do result in inadequate care levels.

It is well known that residents are now admitted to residential care in increasingly frail condition, often with only months to live. These residents are highly likely to be suffering from conditions such as arthritis, cancer and respiratory disorders.

These patients need pain and symptom relief which is carefully monitored for effectiveness. This can only be done by an experienced and qualified registered nurse. Many drugs such as morphine can only be administered by a registered nurse. The drugs are required regularly over a 24-hour period.

Many of these patients are highly likely to have dementia and potential behavioural issues, particularly if they have unrecognised and untreated pain. The assessment and management skills of a registered nurse are essential for these patients night and day.

These patients are extremely vulnerable and we as a society are ultimately responsible for their welfare. They cannot defend themselves.

The worst situation is that untrained staff are unable to manage the symptoms and behaviours of sick and distressed elderly patients and they are then admitted to hospital instead of receiving the care that they need in the existing care home.

Hospital admission is not a suitable environment for the frail and distressed aged person who must endure long waits and an unfamiliar environment and invasive treatments. Care and treatment should ideally be available for them in their residential care home.

Lack of adequate care constitutes elder abuse and I for one would rather die than be admitted to a care facility where my needs will not be recognised or managed competently and with compassion at the end of my life.

I trust that this submission will assist you to make the right decision to defend the rights of the frail and sick aged in nursing homes by ensuring adequate funding levels and legislation that ensures that registered nurses are available to all nursing home residents 24 hours a day.

Jill Ellen, Retired RN

6 | THE LAMP JULY 2016

Torpedoing the aged care sector Having an RN 24/7 on site in nursing homes is vital for quality aged care. However it also makes economic and legal sense.

Many studies have shown that having RNs on duty decreases negative outcomes. It only stands to reason: 3-4 years of professional training, and in the case of aged care, often several years of on-the-job and CPD education means RNs are astute at proactive management of good health.

If you weaken the requirement to have RNs, most service providers will rush to the bottom line. The result will be lowered standards across the industry, and increased preventable hospital admissions.

Legally, it is a potential minefield. Relatives may be far more inclined to sue if they perceive care as being sub-optimal, and of course with an increase in preventable adverse outcomes, lawyers would be keen to encourage litigation.

I’ve worked as an enrolled nurse in aged care for 30 years. I’ve studied the theoretical aspects of health care, and obtained a doctorate, but I have never felt I had either the dedication or the intellectual ability to be an RN. I can see though, in my day-to-day practice, that it is the RNs more so than any other asset in our health system, who ensure good care.

If you wipe out RNs, you are essentially torpedoing the aged care sector.

You need to ask yourself the ethical question: if it was one of my loved ones, would I want to needlessly expose them to practices that are not focussed on their individual wellbeing, purely for the sake of profit?

Please act wisely, responsibly and ethically.

Ensure it remains mandatory to have an RN on duty 24/7 in aged care.

Dr Niko Leka, EN.

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YOUR LETTERS

Undermining the aged Dear Minister, I urge you and the Premier to reverse your decision to drop the legal requirement for registered nurses to be rostered in aged care 24/7. As you will be aware, there is an increasing number of elder people now requiring high level care in their old age - it might even effect you one day! As a nurse myself, I would like to think that, should I require high level nursing care in my older years, that I would get the same service that I currently give to patients that I have looked after.

As you will be well aware the Upper House Inquiry recommended keeping this requirement, but for some reason you believe you know better. I would question why you feel their recommendation is not valid and why you feel you can undermine the needs of our older and often-frailer aged people, who may, like myself, have contributed to others’ health care needs in a time of need.

We have a duty to ensure there is no dilution of skill mix in nursing and this should include aged care facilities. Why should we be more at risk in our older age and treated as second class? We would have given to society and expect that when we need high level residential care in the future, we can get this and not have to wait until someone who is qualified to come on duty.

As our elected government, I would expect you to adhere to standards that protect all individuals and keep residents of aged care facilities safe and not be left to the untrained care staff, good as they may be. It is very evident to me; having worked in aged care previously, that Registered Nurses are pivotal to leading to higher standards of continuous care within residential aged care settings.

Erika (name withheld) RMN, RN.

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HAVE YOUR SAY

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

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Letters may be edited for clarity and space.

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NEWS IN BRIEF

Australia

Psychiatrists speak out on gun control Psychiatrists say gun availability and gun ownership, not severe mental illness, determines most gun homicides reinforcing the need for tighter gun control.

In an article published in the Medical Journal of Australia psychiatrists Professor Alan Rosen and Dr Michael Dudley call for tighter gun control measures, and suggest efforts to focus the gun control debate on people with mental illness is “futile and deceptive dog-whistling” that whips up stigma and discrimination.

“The twentieth anniversary of the Australian National Firearms Agreement (NFA) offers ample lessons for mental health and public health authorities and governments, both in Australia and internationally, demonstrating how firearms regulation can reduce firearm mortality and morbidity,” they wrote.

“The NFA has wrought highly significant and enduring decreases in gun deaths and injuries. Meanwhile, gun proponents insist that mental illness should be a key focus in tackling gun violence.

In fact, there is only a minor but notable link between mental disorders and community violence.

“Contrary to media depictions, most mentally ill people, rather than being perpetrators of violence, are victims of it, and of suicide. Most violent people are not mentally ill, and the majority of mass murderers do not have identifiable severe mental illnesses.”

The authors warn of “complacency as guns are proliferating in Australia again.

“Our gun laws are being undermined by the powerful parliamentary and regional gun lobbies,” they said.

Canada

Big tobacco and food companies target the poor via mobile phones Corporations are actively targeting chat-rooms and online communities to undermine government health messages.

Canadian researchers have found that, contrary to expectations, there is a high level of mobile phone use in poorer communities.

They also found that these users are the targets of harmful marketing from tobacco and food companies.

“EFFORTS TO FOCUS THE GUN CONTROL DEBATE ON PEOPLE WITH MENTAL ILLNESS ARE ‘FUTILE AND DECEPTIVE DOGWHISTLING’ THAT WHIPS UP STIGMA AND DISCRIMINATION.” “The latest evidence in low socio-economic communities is that communications technology is up there with food and shelter in terms of priority – they are very heavily socially networked,” Canadian health data science expert Professor Nate Osgood told the online health blog Croakey.

On the down side, Professor Osgood says it appears that big business is actively targeting lower income groups by populating forums expressing scepticism that smoking causes harm, or by encouraging people to buy sugary snacks, or by promoting these products to children.

“BIG BUSINESS IS POPULATING FORUMS EXPRESSING SCEPTICISM THAT SMOKING CAUSES HARM, OR BY ENCOURAGING PEOPLE TO BUY SUGARY SNACKS.” Professor Osgood’s research at the Departments of Computer Science, Community Health, Epidemiology and Bioengineering at the University of Saskatchewan involves linking the vast amounts of data on human behaviour collected from technology like smartphones, social media, Fitbits and administrative records.

He says corporate entities often collect information on people’s behaviours without them realising but health authorities and researchers can use big data to fight back.

“With more nimble adversarial corporate actors who are running circles around health authorities by tapping into social networking and the latest technologies, this is urgently needed,” he says.

8 | THE LAMP JULY 2016

Australia

Australia

First chair of family violence prevention announced

No link between mobile phones and brain cancer

Professor Kelsey Hegarty has been named as Australia’s first chair of Family Violence Prevention.

Her appointment is jointly supported

by The University of Melbourne and the Royal Women’s Hospital.

The appointment came as the World Health Organisation (WHO) adopted a global plan of action to strengthen the role of the health system to address interpersonal violence, in particular against women and girls and against children.

Australia was one of 44 member states that adopted the resolution at the 69th World Health Assembly. The new chair of Family Violence Prevention will work closely with the WHO over coming months as an expert advisor.

Professor Hegarty is a leading researcher on the role of the health system in preventing family violence in Australia and globally.

Professor Hegarty said she was honoured to be Australia’s first chair of Family Violence.

“This will give me the support and resources to continue researching how health practitioners and the holistic health care system can support women and children facing family violence,’’ she said.

“We know family violence is incredibly complex and so often the victims are isolated, so we need to tap into new technologies and ensure that doctors, nurses and the health care system are supported to assist families where violence is occurring.”

A large Australian study has found that the massive increase in mobile phone use over the past 30 years was not matched by a similar rise in brain cancer cases.

Since the 1980s, mobile phone use has rocketed in most countries, including Australia, where more than 90% of the adult population use them today.

Mobile phones have been dogged by consistent and high profile concerns that the electromagnetic radiation they give off might cause or contribute to cancer.

“WE NEED TO TAP INTO NEW TECHNOLOGIES AND ENSURE THAT DOCTORS, NURSES AND THE HEALTH CARE SYSTEM ARE SUPPORTED TO ASSIST FAMILIES WHERE VIOLENCE IS OCCURRING.”

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This ecological study was carried out by researchers from the University of Sydney and the University of New South Wales and published in the peer-reviewed journal, Cancer Epidemiology.

It found an explosion in Australian mobile phone ownership since the 1980s coincided with relatively little change in brain cancer rates, suggesting mobile phone ownership is unlikely to cause brain cancer.

This conclusion is based on assuming there would be a 10-year lag between mobile phone use and cancer, and 1.5 and 2.5 times risk increases due to mobile phone use.

The researchers had mobile phone accounts dating between 1987 and 2014, and brain cancer diagnoses of 19,858 male and 14,222 females between 1982 and 2012.

The researchers concluded that: “After nearly 30 years of mobile phone use in Australia among millions of people, there is no evidence of any rise (in brain cancer) in any age group that could be plausibly attributed to mobile phones.”

“AFTER NEARLY 30 YEARS OF MOBILE PHONE USE IN AUSTRALIA AMONG MILLIONS OF PEOPLE, THERE IS NO EVIDENCE OF ANY RISE (IN BRAIN CANCER) IN ANY AGE GROUP THAT COULD BE PLAUSIBLY ATTRIBUTED TO MOBILE PHONES.” THE LAMP JULY 2016 | 9

NEWS BRIEF COVERINSTORY

USA

Onya bike! And reduce the risk of cancer

“INTERESTINGLY, FOR MANY CANCERS, EXERCISE REDUCES THE RISK EVEN IN OVERWEIGHT PEOPLE.”

Recent studies show that there is a strong link between doing physical exercise and lower levels of a number of cancers.

Exercise is already known to reduce the risk of breast, colon and endometrial cancer by between 10% and 40%.

Now, a pooled analysis of data from studies looking at 1.4 million adults between the ages of 19 and 98 has found that exercise reduces the risk of an additional 10 cancers, including oesophageal, stomach, bladder and kidney. Interestingly, for many cancers, exercise reduces the risk even in overweight people.

Dr Marilie Gammon, an epidemiologist from the Gillings School of Global Public Health, North Carolina, wrote in the peer reviewed journal JAMA Internal Medicine that exercise may help to repair DNA when it is damaged by cancer-promoting substances.

Exercise may also alter hormone levels and reduce inflammation.

The study showed that the risk of oesophageal cancer for those taking the most exercise was 42% lower than for those taking the least. For seven of the cancers, the risk reduction was one-fifth or more. Gammon says the data was based on four hours of activity a week – the standard recommendation to prevent heart disease.

A second study of lifestyle and cancer (published in JAMA Oncology) which took data from 136,000 Americans, found that anyone who quits smoking; does two and a half hours of moderate exercise a week; has no more than one drink a day if a woman or two if a man; and keeps to a Body Mass Index between 18.5 and 27.5 is likely to reduce their risk of bowel cancer by 30% and breast cancer by 12%.

Britain

Review for global action on antibiotic resistance Superbugs could kill 10 million people a year by 2050 according to a review commissioned by the British government.

The review, chaired by economist Jim O’Neill, warns that wide-ranging action is required at a global level to prevent a post-antibiotic future reports NHS Choices.

The report stressed there must be urgent action to stop the use of highly critical antibiotics in animals, which are the last line against infection in humans.

“In some parts of the world, probably in the largest emerging economies and almost definitely in the United States, the use of antibiotics in animals is greater than in humans and that means the misuse is probably higher too,” said Jim O’Neill.

The review made 10 recommendations: • Launch a massive global public awareness campaign • Improve hygiene and prevent the spread of infection • Reduce unnecessary use of antibiotics in agriculture • Improve global surveillance of drug consumption and resistance • Promote new rapid diagnostic tests to reduce unnecessary use of antibiotics • Promote the development and use of vaccines and alternatives • Improve the number, pay and recognition of people working in infectious diseases • Establish a Global Innovation Fund for early-stage and noncommercial research • Provide better incentives to promote investment for new drugs and improve existing ones • Build a global coalition for real action.

10 | THE LAMP JULY 2016

“IN SOME PARTS OF THE WORLD, PROBABLY IN THE LARGEST EMERGING ECONOMIES AND ALMOST DEFINITELY IN THE UNITED STATES, THE USE OF ANTIBIOTICS IN ANIMALS IS GREATER THAN IN HUMANS.”

NEWS IN BRIEF

“THIS DISGRACEFUL EFFORT TO PRIVILEGE TOBACCO BUSINESS INTERESTS OVER PUBLIC HEALTH HAS RIGHTLY FAILED UTTERLY.”

Britain

A “crushing defeat” for big tobacco The British high court has thrown out an appeal from tobacco companies trying to stop the introduction of plain packaging laws.

The high court’s decision was hailed by anti smoking campaigners.

“This landmark judgment is a crushing defeat for the tobacco industry and fully justifies the government’s determination to go ahead with the introduction of standardised packaging,” Deborah Arnott, chief executive of the charity Ash (Action on Smoking and Health) told the Guardian.

“Millions of pounds have been spent on some of the country’s most expensive lawyers in the hope of blocking the policy. This disgraceful effort to privilege tobacco business interests over public health has rightly failed utterly.”

Sir Harpal Kumar, chief executive of Cancer Research UK, said the judgement was an important milestone.

“It’s the beginning of the end for packaging that masks a deadly and addictive product. It’s taken many years to get to this point and it reflects a huge effort aimed at protecting children from tobacco marketing,” he said.

The high court judge who heard the appeal, Mr. Justice Green, said: “The essence of the case is about whether it is lawful for states to prevent the tobacco industry from continuing to make profits by using their trademarks and other rights to further what the World Health Organisation describes as a health crisis of epidemic proportions and which imposes an immense clean up cost on the public purse.

“In my judgment the regulations are valid and lawful in all respects.”

Britain

TB and scarlet fever back from the dead Victorian era diseases are making a comeback in Britain.

Incidences of scarlet fever have hit a 50-year high in Britain.

About 600 cases a week have been diagnosed across England after a steep rise in infections, with 6,157 cases from September 2015 to March 2016, according to Public Health England (PHE).

In 2010-11, there were 1,457 infections diagnosed over the same period, jumping to 5,010 in 2014-15. In England and Wales in 1969, there were 16,093 cases followed by a long dip. Cases began to rise dramatically in 2014, and in 2015 there were 17,586 cases.

Tuberculosis, another major killer in Victorian times is also making a comeback. There were 6,520 cases of TB in England during 2014.

Experts say there are two major reasons why such diseases are returning. One, the pathogens that cause them are constantly evolving and two, because inadequate numbers of people are being vaccinated.

Once immunisation falls below a critical threshold within a population, “herd immunity” is lost and the virus is able to take hold and spread.

“When we think about the return of Victorian illnesses, one thing we need to bear in mind is that it is actually a relatively small number of cases that get media attention, because we’re not used to seeing these diseases any more,” Dr Matthew Snape, a paediatrician and vaccines expert at Oxford university, told the Guardian.

“ONCE IMMUNISATION FALLS BELOW A CRITICAL THRESHOLD WITHIN A POPULATION, “HERD IMMUNITY” IS LOST AND THE VIRUS IS ABLE TO TAKE HOLD AND SPREAD.”

THE LAMP JULY 2016 | 11

COVER STORY

Support our aged care nurses Delegates call for support to aged care nurses 24/7

NSWNMA delegates have urged the union’s public sector branches to oppose the NSW government’s decision to drop the requirement for nursing homes to employ a registered nurse 24/7.

The statewide Committee of Delegates unanimously resolved to ask branches to call on their hospital managements to write to the Ministry of Health expressing concern.

The committee also asked branch members to contact their local state MPs to outline how the decision will impact the health system.

“The most vulnerable people in our community will now be left even more vulnerable by this government’s decision,” said Lismore Base Hospital RN Gil Wilson.

Gil moved the motion at the delegates’ committee, which was seconded by Royal Prince Alfred Hospital branch delegate Jan Dilworth.

‘EVERY DAY I SEE FRAIL ELDERLY PEOPLE TAKEN OUT OF THEIR HOMES AND PUT IN THE BUSY, NOISY AND BRIGHT ENVIRONMENT OF A HOSPITAL WITH ITS UNFAMILIAR FACES.’ – Gil Wilson The resolution said the decision would increase ED admissions, increase bed block, and extend hospital stays for the elderly.

It would also lead to significant cost shifting from aged care providers who are funded for residents with complex and high care needs, to public hospitals.

“This decision removes from the roster the only registered and qualified health professional able to assess residents’ needs,” said Gil, a NSWNMA branch secretary and councillor.

12 | THE LAMP JULY 2016

“The ones who suffer will be the weakest members of our society – the frail elderly.”

In giving the green light to the removal of RNs the government ignored appeals from a wide range of nursing, seniors and health advocacy groups – and a 25,000-signature petition circulated by the NSWNMA. NSW Health Minister Jillian Skinner said aged care facilities were now regulated by federal law and it would “duplicate regulatory process” to keep the NSW rule.

Her decision ignored the recommendation of a parliamentary inquiry which found that NSW should retain a 24/7 nursing rule because the current federal regulation fails to ensure safe staffing levels and registered nurse care for residents.

“If there is nobody on duty qualified to give PRN medication to someone in chronic pain, the remaining staff will try to do the right thing and send the resident to hospital,” Gil said.

“Waiting for an ambulance to arrive will prolong their pain unnecessarily.

“I have a roaming role as a resource nurse and I can already see the impact that unnecessary admission of aged care residents is having on the hospital.

“Every day I see frail elderly people taken out of their homes and put in the busy, noisy and bright environment of a hospital with its unfamiliar faces.

“The result is an overcrowded ED when so much of the treatment the person need could be given in a nursing home if an RN was on duty.

“These people deserve to be treated with respect and dignity at this time in their lives.

“Why would the government choose to treat someone like that?

“This is all about cutting costs – it has nothing to do with care.”

Greater needs but fewer qualified nurses

“WE NEED MORE REGISTERED NURSES, WITH BETTER TRAINING AND SUPPORT.” – Louise Stammers

Louise Stammers RN says the quality of residential aged care has deteriorated since she started nursing in the sector 17 years ago.

Government funding cuts, staff shortages and “a focus on saving money rather than giving care” are to blame, says Louise, who has worked at several residential facilities via an agency.

“There has been a huge increase in the care needs of residents without a corresponding increase in staff – including skilled RNs who can oversee and co-ordinate the care of people with multiple medical problems,” she says.

“Some facilities have no RN at all for multiple shifts. Others have only one registered nurse to large numbers of residents.

“I do not believe the need for RNs is any different in nursing homes, where residents have ‘high care’ needs, than it is in any acute hospital’s geriatric ward.

“The RN in both places is constantly monitoring residents’ condition and liaising with doctors; assessing for preventable problems, optimising health care or pain management and palliative care.”

She says the condition of the elderly can change very fast and it takes an RN to know what could be happening, and how urgently attention is needed.

“Those less qualified are more likely to send to hospital for minor problems or to miss the early signs of a serious problem.

“It takes an RN to make the clinical decision to withhold an ordered medication, such as when a resident is unusually drowsy.

“It takes an RN to make the decision about withholding an aspirin when a resident is bleeding or a diuretic for someone who is showing signs of dehydration.

“I have seen medication inappropriately crushed by minimally trained care staff. The consequences could be serious – a crushed slow release tablet for diabetes could result in a serious hypoglycaemia.

“Other medications lose their effectiveness when crushed, still others can cause harm to the upper gastrointestinal tract.”

“Aged care residents should not have to suffer because untrained staff don’t recognise problems, or are not able to quickly assess pain and provide relief.”

Louise says that rather than doing without RNs, “I think we need more of them, with better training and support.

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COVER STORY STORY COVER

Older Australians deserve more respect Jan Dilworth, an RM/RN at a major tertiary hospital with previous experience of working part time and as a casual in the aged care sector says it is important that public health system nurses and midwives understand the wider implications of not having RNs 24/7 in aged care.

“RNs shoulder much of the responsibility for delivery of care in determining individual residents’ care plans,” she says.

“They organise family case conferences; discuss end of life plans in conjunction with family members; administer medications plus manage accreditation and ongoing assessments.

“I’d be concerned that if RNs are removed from the aged care sector that this has the potential to devalue the care for residents who deserve the utmost dignity with the best care possible. The RN is the linchpin that holds the team of AiNs and care service employees together and who determines ongoing care. Who will determine the care of the resident who has a fall or a stroke? There is no back up on site for immediate assessment by a qualified medical practitioner. RNs are essential – why on earth should they be removed?

“I don’t think a lot of public health system nurses or midwives fully understand the impact of removing RNs unless they have experience of family members in aged care or have worked in the aged sector. It is a sensitive environment requiring RNs who genuinely respect and value the role in caring for the aged and more frail residents.”

Jan seconded a resolution at the most recent Committee of Delegates calling on public hospital nurses and midwives to actively support the campaign to maintain RNs in aged care.

“This resolution sends a message that as health professionals we will not tolerate a lack of respect for our aged population. The resolution also demonstrates how important it is to all nurses and midwives to maintain RNs 24/7 within the aged care sector.”

“Residents’ families expect and pay for a high standard of care lead by the RN with cover for the 24/7 period.

Residents in a high care facility often have chronic complex physical; mental and emotional health needs.

The families expect and need reassurance that a RN is there to provide optimal care.”

14 | THE LAMP JULY 2016

“WE PUT UP THAT RESOLUTION TO SHOW HOW IMPORTANT IT IS TO ALL NURSES AND MIDWIVES TO MAINTAIN RNS IN THE AGED CARE SECTOR.” – Jan Dilworth, Midwife

Providers sound the alarm on aged care A leading NSW provider has admitted the government’s $1.8 billon in cuts could lead to less registered nurses in aged care.

Scalabrini Village CEO Chris Rigby told Australian Ageing Agenda that changes to the Aged Care Funding Instrument (ACFI) will lead to an 11.3 per cent reduction in annual funding for the facility, which could be countered by decreasing registered nursing staff and rejecting residents with high complex care needs.

“We would have to change our models of care. We would have to change our staffing. As a matter of policy we have registered nursing staff on 24/7.

We support those registered nurses with clinical nurse specialists and with a clinical nurse educator,” he said.

“Consequently we are able to care safely and well for people with very high complex care needs. In the future, I don’t know what we are going to do.

We wouldn’t be able to accept such residents and we wouldn’t be able to afford to employ the registered nursing staff at the levels that we currently employ them.”

John Watkins, chair of Calvary Health Care also hit out at the government’s funding cuts.

“Aged care is a compassion business and that can only be delivered by the touch, tone, respect and love provided by professional staff. That is why the decisions taken by the federal government in recent months to make the $1.2 billion budget savings from residential aged care so difficult to fathom,” he told the Sydney Morning Herald.

‘WE WOULDN’T BE ABLE TO AFFORD TO EMPLOY THE REGISTERED NURSING STAFF AT THE LEVELS THAT WE CURRENTLY EMPLOY THEM.’ – Scalabrini Village CEO Chris Rigby

What you can do The most recent Committee of Delegates passed a motion asking NSWNMA public sector branches to meet “as a matter of urgency” and to pass a resolution that: •C alled on their hospital management to write to the Ministry of Health and to express our concern about the removal of the legal requirement to retain a RN 24/7 in our nursing homes • Requesting that all branch members contact their local NSW MPs to outline how this problem will affect the health system.

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REGIONAL HOSPITALS COVER STORY

Regional dilemma: new hospitals and not enough staff New hospitals have been opening throughout regional New South Wales but they are struggling to cope with increased demand due to poor workforce planning.

Wagga Wagga, Dubbo, Tamworth, Bega and Kempsey have all benefited from new hospitals in the last year but they are all under the pump with a shortage of nurses and midwives.

NSWNMA Assistant General Secretary, Judith Kiejda, said there were widespread staffing issues at many new major hospitals across the state, leading to unsustainable overtime, bed block and the implementation of escalation plans.

“Our nurses and midwives are finding it increasingly difficult to do their jobs safely and efficiently. The lack of staff is having a major impact on regional hospitals,” she said.

“Patient numbers at the new hospitals tend to increase, as does the footprint of the facility, yet the budget and staff do not. While the nurses are glad to see the new health facilities open, what they really need is an increase in funding to allow for additional recruitment.

“Concerns about impacts to patient safety at these new regional hospitals were raised by our members well before relocations to the new facilities. Yet in the past six months, poor planning has led to unfunded beds being shut down at Wagga Wagga, breaches of minimum safe staffing at Dubbo Base Hospital, unsustainable overtime at Tamworth and ongoing staffing issues at Kempsey District Hospital.”

OVERTIME LEVELS ARE UNSUSTAINABLE At the end of May, Dubbo Base Hospital had 27 full time vacancies that needed to be filled in order to meet minimum requirements and staff were working excessive overtime.

Judith Kiejda says that level of average overtime worked per week was astounding and unsustainable.

“To try and run a hospital 27 staff short is just not possible. The exhaustion caused by working such

“OUR NURSES AND MIDWIVES ARE FINDING IT INCREASINGLY DIFFICULT TO DO THEIR JOBS SAFELY AND EFFICIENTLY.” – Judith Kiejda

16 | THE LAMP JULY 2016

“IF THEY TAKE MONEY OUT OF THE SYSTEM WE’VE GOT NO HOPE OF GETTING OUR SERVICES AS GOOD AS THEY ARE IN THE CITY.” – Zoe Guinea, RN, Tweed Heads

unacceptable hours of overtime is creating high levels of fatigue and leading to increased sick leave, which makes the whole situation much worse,” Ms Kiejda said.

“Staff in the operating suites were putting in 120 hours of overtime a week. Those kinds of conditions are clearly unsafe and put the Dubbo community and hospital staff at risk.

“It’s a case we’ve seen many times before when new hospitals are built with a much larger footprint, yet management fail to recruit appropriately because they don’t have the funding. We need the federal government to take responsibility and start providing the funding our public hospitals need, instead of cutting it by $57 billion and pushing management and staff to their absolute limits.”

Zoe Guinea addresses the media outside the National Party state conference.

Nationals told to raise their game on regional health NSWNMA members gathered outside the National Party’s state conference in Tweed Heads last month to tell party delegates about the impact of cuts to public hospital funding and the loss of registered nurses in aged care on regional Australia’s health.

Cuts to public hospital funding and Medicare, staffing shortages in regional hospitals and the impact of losing RNs in aged care were a dangerous cocktail that would have a negative impact on the health of regional Australia says Zoe Guinea, an RN at Tweed Heads Hospital.

“The cuts impact on us. If they take money out of the system we’ve got no hope of getting our services as good as they are in the city,” she said.

“We’re really concerned about registered nurses being taken out of aged care. If you look at Tweed – there are about a dozen aged care facilities in the area. If you take the RN out of those that will really increase the load on our ED. “There will be old people on gurneys waiting in a queue to be seen by a very busy ED. Tweed Heads has a very good ED but it is very busy. It will just get busier and get bogged down.”

Judith Kiejda says that without action things will only get worse in the bush.

“Australia’s regional areas have a higher than average proportion of baby boomers. It seems only logical that health should be a strong focus for the National Party, yet there has been no commitment from them or the Liberal Party towards any funding or forward planning for our growing aged care industry,’ she says.

“Many of these older Australians also rely on bulk-billing for affordable access to healthcare.

The latest Medicare cuts to bulk-billing incentives will mean more financial strain on those who can least afford it. It’s hard enough to get to the doctor in regional areas, so increasing costs will just result in poorer rates of early intervention and more admissions to hospital emergency departments.”

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REGIONAL HOSPITALS

“SOME OF THE NURSES CAME FROM WITHIN THE SAME LHD BUT IT CAN TAKE 6 WEEKS BEFORE THEY CAN START ON THE FLOOR.” Lauren Lye, NSWNMA branch secretary, Dubbo Base Hospital

“There is no point having this facility and not being able to provide the service” Lauren Lye, NSWNMA branch secretary at Dubbo Base Hospital, says although the new hospital “is a beautiful big facility” it has also become a big pressure cooker for nurses and midwives because “it just hasn’t been staffed appropriately”.

“There is no point having this facility and not being able to provide the service.

The issue of staffing was flagged before it opened. There was a push to open 5 theatres – previously there were three and one procedure room. There wasn’t enough staff to go into these extra theatres so the existing nurses were doing their best with extra shifts to try and accommodate the push.

“To begin with staff were happy to do it but it went on for a long time and it just became unsustainable. They were tired from doing double shifts not just a few hours overtime.”

Lauren says management started to respond to staff shortages after the branch had a stop work meeting at the end of May. “They’ve turned some things around. They have brought in agency staff as relief that has helped. Overtime has decreased. We have recruitment for some full time positions in progress. They’ll be starting in July. Ten of them will be new graduate nurses.”

She says that pressure by the Association led to educators being freed up to support the new grads.

“That was another really big win for us. Educators were consistently working on the floor. They were allocated patients to make up for the roster shortfalls and staffing vacancies. Now they will no longer be taking a patient load unless it is an emergency situation as outlined by the award.”

Lauren says one of the major stumbling blocks to resolving the staffing shortfall has been the painfully slow recruitment process.

“It is absolutely ridiculous - the paper work and the paper trail. Some of the nurses I have talked to came from within the same LHD so it should be a streamlined process but it can take 6 weeks before they can start on the floor.”

18 | THE LAMP JULY 2016

Isolated and overworked Deborah Walganski says nurses and midwives have endured chronic understaffing at the new Tamworth Rural Referral Hospital since it opened in July 2015. She says inadequate staffing levels to meet the design of the hospital also raises safety issues.

“It is a huge, vacuous space and it’s quite separated with dividing walls and firewalls that leave the birthing units very isolated. NSW Health policy says nurses and midwives are not to work in isolation,” she said.

“It was a big problem for staff safety. The birthing unit can be a volatile place. Sometimes partners do get upset. There are these huge corridors within the unit dividing areas.”

Now the maternity unit has four staff on night shift. This was won after a sustained campaign by midwives, including a community forum and two trips to the Industrial Relations Commission.

Deborah says inadequate numbers of staff for the demand created by the new hospital is an issue.

“The birthrate has increased astronomically. There was a 20-25% increase in birthing. It should have been known that it was going to happen. It happened at North Shore Hospital when the new birthing unit was built there.

“The first three months in the new hospital at Tamworth were terrible for the nurses and midwives. They were isolated and overworked. At that point they only had three staff on the night shift for a 26-bed post natal and birthing unit.

“In February the maternity unit was 10 permanent midwifery staff short. Shift deficits were backfilled with an alternative

skill mix: ENs and RNs that had never worked in the maternity ward before.

“Other areas of the hospital are problematic too. Recently the wards have had breaches where the Nursing Hours Per Patient Day hasn’t been met that have been highlighted at the reasonable workloads committee.

“The Rehabilitation Ward has been chronically understaffed.

While a medical ward is currently being renovated the Rehabilitation Unit has received up to 50 per cent acute patients.”

Deborah says there has been a reliance on overtime including double shifts, and the use of part-time nurses and midwives working above the agreed FTE to cover the shortages. They have still not met the Nursing Hours Per Patient Day or Birthrate Plus recommendations.

“It is absolutely unsustainable with the fatigue, the burnout and the safety of practice. The attrition rate is terrible. There are midwives leaving because their registration is at risk.

It makes things even more difficult to meet staffing levels,” she says.

Deborah says it is very frustrating to have a brand new hospital but inadequate numbers of nurses and midwives to staff it.

“It’s actually bitter sweet. There is a lot of money going into public infrastructure and it can’t be utilised effectively.

The walls don’t nurse the patient. You can have as much hardware and rooms as you like but you have to have a nurse or midwife to care for and nurse that woman or patient.”

“YOU CAN HAVE AS MUCH HARDWARE AND ROOMS AS YOU LIKE BUT YOU HAVE TO HAVE A NURSE OR MIDWIFE TO CARE FOR AND NURSE THAT WOMAN OR PATIENT.” – Deborah Walganski, RN and RM,

Tamworth Assistant Branch Secretary

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COVER RATIOS STORY

Moira Purcell (left) and Beth Mohle (right)

Ratios now law in Queensland Queensland has become the fourth government in the world – and the second Australian state – to legislate for minimum nurse to patient ratios.

Queensland Health expects to recruit an additional 250 nurses to meet nurse and midwife to patient ratios being phased in throughout the state from July 1.

Queensland became the second state after Victoria to legislate for minimum ratios in public hospitals.

The state Labor government amended the Hospital and Health Boards Act by establishing a legislative framework which ensures safe nursing and midwifery staff numbers, according to the Queensland 20 | THE LAMP JULY 2016

Nurses Union (QNU).

The QNU says ratios will increase staff satisfaction, decrease attrition rates, reduce service variation and improve equality across the health service.

These improvements will boost productivity, help make hospitals more efficient and provide greater continuity of patient care, the union predicts.

Under the legislation and regulations, prescribed medical, surgical and mental health wards are required to maintain a minimum of one nurse to four patients

for morning and afternoon shifts, and one nurse to seven patients for night shifts.

Health Minister Cameron Dick said the government would review the Act next year to consider whether ratios should be extended to other wards and facilities, or different ratios should be developed.

He said the law was the product of a broad consultation process including with the QNU.

RATIOS SAVE LIVES QNU State Secretary Beth Mohle said the introduction of minimum nurse to patient ratios would save lives.

“International evidence concludes patient mortality rates and outcomes are directly linked to nurse numbers and the level of care each patient receives,” she said.

“Health services with a higher percentage of registered nurses and increased nursing hours per patient will have lower patient mortality, reduced length of stay, improved quality of life and less adverse events such as failure to rescue, pressure injuries and infections.”

“According to international research, an increase in a nurse’s workload by one patient increases the likelihood of an inpatient dying by seven per cent.

‘PATIENT MORTALITY RATES AND OUTCOMES ARE DIRECTLY LINKED TO NURSE NUMBERS.’ – Beth Mohle “For every patient added to a nurse’s workload, readmission within 15-30 days increased 11 per cent for a child with a medical condition and 48 per cent for a child who had undergone surgery.

“Ratios will also result in significant cost savings through reduced health care costs, retaining staff and reducing patient complications and adverse events.”

Ms Mohle said the QNU would continue to work with Queensland Health to make the transition to ratios as smooth as possible.

Nurse ratio legislation was passed in the Victorian parliament in October 2015 and in Wales in February this year.

California became the first government in the world to introduce the laws in 2004 after a 13-year campaign by the California Nurses’ Association.

New York nurses are campaigning to have similar laws adopted in their state.

Only the LNP opposed ratios Queensland’s move to improve patient safety by adopting ratios was supported by all parties and independent Members of Parliament except the Liberal National Party.

The former LNP government slashed 1800 nursing jobs across Queensland Health between 2012 and 2015 – including positions in operating theatres, intensive care units, emergency medicine, maternity services and mental health.

“They did this despite research that showed Queensland would need more nurses to cope with our growing and ageing population over the next decade, not less,” said QNU state secretary Beth Mohle.

“All research shows that employing more nurses saves lives and offers better health outcomes for patients.

“Overworked nurses skip meal breaks, work excessive overtime, work double shifts and rush through their work to fit it all in.

“This is when accidents happen, when things get overlooked, when care is simply not as good as it should be.

“Mandatory ratios can help fix this.”

Ratios win followed a crisis The drive for ratios came from the crisis that arose after Premier Campbell Newman sacked thousands of nurses in 2012 says Queensland RN Moira Purcell.

“This led to a cull of all the experienced nurses with skill and knowledge. That was to the detriment of the patients and the stress for young nurses was unbearable. Most of them were unable to bear the strain. Many of them have left because they couldn’t handle the pressure,” she said.

“The wards were understaffed and over worked. Proper care was not possible. Proper monitoring and communication was not possible.

Mistakes and dangerous outcomes became inevitable. It had become a very worrying and dangerous situation.

“Patients see the effects of how hard nurses are working and they withhold vital pieces of information. They don’t want to trouble nurses and be a burden and that can be a burden in itself.

“It reached a state of crisis – a breaking point where it couldn’t continue.”

Moira says the announced ratios are just a beginning and “a lot more pressure will be required to maintain this momentum”.

“It’s actually only happening in a certain number of the main tertiary hospitals in the medical and surgery wards to begin with. It still needs to go more widespread than that. It certainly needs to be addressed in aged care and community nursing. Also the midwifery model as well – how will ratios apply there? There’s a lot more work to be done.”

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71 annual conference

PROFESSIONAL DAY

g n i g n Cha lth in a a e H

PROGRAM 9 – 9.15am

Introduction from MC Dr Norman Swan

Welcome to Country

Aunty Norma Shelley OAM 9.15 – 10am

Living Beyond Dementia Kate Swaffer 10 – 10.15am

Q&A

Dr Norman Swan 10.15 – 10.45am

Morning tea

10.45 – 11.20am

Why inequality is a really big deal and what can be done about it Peter Martin

11.20 – 11.55am

How come a country as rich as Australia can’t afford high quality healthcare?

Richard Denniss 11.55 – 12.30pm

g n i g n a Ch orld W Wednesday 20 July 2016 Rosehill Gardens Racecourse Grand Pavilion 9am to 5pm Registration opens at 7.30am COST members $100 non-members $150 students $20 (limited places)

Reducing Disparities in Life Expectancy – which factors matter?

Lesley Russell 12.30 – 1pm

Q&A

Dr Norman Swan 1 – 2pm

Lunch

2 – 3.15pm

Violence in healthcare settings

Panel: Karen Crawshaw, Prof Peter Miller, Dr Jacqui Pich (including questions) 3.15 – 3.30pm

Chief Nursing and Midwifery Officer address Ms Jacqui Cross

REGISTRATION CLOSES WEDNESDAY 13 JULY REGISTER ONLINE

www.nswnma.asn.au/education 22 | THE LAMP JULY 2016

3.30 – 4pm

Afternoon tea 4 – 5pm

Keynote Speaker Andrew Denton 5 – 5.10pm

Wrap up

Dr Norman Swan

is a multi-award winning, medicallyqualified broadcaster and journalist. He is the host of the Health Report on ABC Radio National, presenter of Health Minutes on ABC NewsRadio and health commentator, speaker and facilitator of ABC Television’s Catalyst.

Aunty Norma

is a Kamilaroi woman who moved to Liverpool 35 years ago. A retired Social Studies, Textile and Design teacher, Aunty Norma now donates her time to local community groups, including the Cerebral Palsy Association, Aboriginal Carers, South West Sydney Koori Interagency, NSW Justice Association and Liverpool Council Aboriginal Consultative Committee. Aunty Norma is a member of the Gandangara Land Council, the Heritage Committee and the Aboriginal Consultative Committee.

Kate Swaffer

commenced her professional career as a nurse specialising in dementia and operating theatres. She now works as an author, international speaker and activist for dementia and aged care. Kate regularly presents nationally and internationally on topics such as stigma and language and works to improve the lived experience for people with dementia.

In 2015, Kate was named Dementia Leader of the Year in the University of Stirling International Dementia Awards and Emerging Leader in Disability Awareness in the National Disability Awards, was winner of the Bethanie Education Medallion, and a state finalist in the 2016 Australian of the Year Awards. She is co-founder and Chair of Dementia Alliance International, a board member of Alzheimer’s Disease International, Chair of Alzheimer’s Australia Dementia Advisory Committee, and Co-chair of the Consumers Dementia Research Network.

Peter Martin

is economics editor of The Age and a contributor to the Sydney Morning Herald.

A former Treasury official with an honours degree in economics, he covered budgets and the economy for 30 years in newspapers and on ABC programs such as AM and PM and in segments on the ABC’s Life Matters and Nightlife. He understands the hard stuff, but makes it simple. He is the co-author (with Ross Gittins) of four economics textbooks.

Richard Denniss

has worked for the past 20 years in a variety of policy and political roles. He is an Adjunct Associate Professor at the Crawford School of Economics and Government at the Australian National University. Well known for his ability to translate economics issues into everyday language, Richard has published extensively in academic journals, has a fortnightly column in The Canberra Times and Australian Financial Review and was the coauthor the best-selling Affluenza (with Dr Clive Hamilton).

Dr Lesley Russell

is an Adjunct Associate Professor at the Menzies Centre for Health Policy (MCHP) at the University of Sydney. Her research interests include health care reform in Australia and America, mental health, Indigenous health, addressing health disparities and health budget issues.

Dr Russell has substantial experience working in health policy in America and Australia, both in and out of government. In 2009-12 she worked in Washington DC on a range of issues around the enactment and implementation of President Obama’s health care reforms. She was a health policy advisor to the Federal Australian Labor Party and worked for seven years as health policy advisor on the Energy and Commerce Committee in the US House of Representatives.

Andrew Denton

is a television broadcaster and producer, whose programs include Blah Blah Blah, the Money or the Gun, Enough Rope, CNNNN, Gruen Transfer and Hungry Beast.

Andrew has written for newspapers, acted in the theatre, been a top-rating radio host, and collected AFIs, Walkleys, Rawards, ARIAs, one Logie and a UN Peace Prize along the way. He also won the Sale of the Century – Comedy Series quiz, a moment many (himself included) view as his crowning achievement.

In 2016 he released a 17-part podcast series Better Off Dead which went straight to the top of the iTunes podcast charts.

Karen Crawshaw

has held various government legal positions, including NSW Health’s Director Legal and General Counsel. In 2007 Ms Crawshaw was appointed as a Deputy Director-General and in her current role as Deputy Secretary, Governance, Workforce and Corporate she has policy responsibility within NSW Health for corporate governance, workforce, industrial relations, business reform, asset management and procurement, strategic communications, ministerial and executive services and legal and regulatory services.

In 2012, Ms Crawshaw was awarded the Public Service Medal for her significant contributions to the public sector and appointed to the Management Committee of the Australian Practitioner Regulation Agency. She is also on the board of HealthShare NSW.

Prof Peter Miller

is a Professor of Violence Prevention and Addiction Studies at the School of Psychology, Deakin University. He was the Commissioning Editor of the journal Addiction from 2006-2016.

His research interests include alcoholrelated violence in licensed venues; predictors of violence (including family and domestic violence); and the behaviour of vested interests, especially the alcohol industry.

Peter has recently completed two of the largest studies ever conducted into licensed venues, comparing six Australian cities over 3 years and talking to more than 13,000 patrons.

He is currently running 19 projects focussed on alcohol, drugs and violence (including domestic violence) national and internationally. He was also presented the Excellence in Research Award at the 2013 Australian National Drug and Alcohol Awards.

Dr Jacqui Pich

is a dual university medal winner for her undergraduate and honours studies in her Bachelor of Nursing. She is currently employed as a lecturer at the University of Newcastle.

Her PhD was a national study on the experiences of emergency nurses with patient-related violence and she has presented these findings at domestic and international conferences. She is part of an international Cochrane review on the education and training for preventing and minimising workplace aggression directed toward healthcare workers. She is also involved in research on horizontal and vertical violence experienced by T H E Lnurses.

AMP JULY 2016 | 23 undergraduate

PRIVATE HOSPITALS

Time machine takes Ramsay backwards Nurses and midwives at Australia’s biggest private hospital chain are in revolt against a new time and attendance system.

‘IT IS TIME RAMSAY GAVE ITS STAFF THE SAME ACCESS AND TRANSPARENCY AS OTHER HOSPITAL OPERATORS.’ – Brett Holmes

24 | THE LAMP JULY 2016

Ramsay Health Care nurses and midwives in NSW are demanding changes to an electronic time and attendance system that has left them uncertain about the accuracy of their fortnightly pays.

The system known as MyTime was introduced in 2015 to replace paper time sheets.

It uses Kronos software, which is commonly used in the health care sector. However Ramsay staff say MyTime is inferior to other Kronos-based systems.

They are frustrated by the restricted online access to MyTime and corresponding lack of transparency.

Ramsay management promised MyTime would provide consistently accurate pays and save time taken up with filling in paper timesheets and chasing pay discrepancies.

However staff say the new system has failed to deliver on both counts and NSW Nurses and Midwives’ Association members at Ramsay are campaigning for changes.

The union says MyTime must provide online access for all employees and greater transparency.

“MyTime has actually seen the loss of a timesheet system where we can view and claim for all our hours, breaks and allowances. We no longer have certainty that our pay is accurate and it is harder for us to resolve pay discrepancies,” says a NSWNMA petition circulating among Ramsay employees.

SYSTEM LACKS PRIVACY Ramsay’s system can only be viewed on MyTime machines attached to hospital walls in common areas and lacks privacy.

The machines have a small screen, making them difficult to navigate and are not as user-friendly as a computer.

Members are angry about their personal timesheet and leave details being accessible to other colleagues that have MyTime administrator access that are not their manager.

Not having external access to MyTime makes it hard for staff to check the accuracy of their pay – especially if they are not rostered on at the end of a pay period.

Unlike the old paper timesheets, MyTime does not allow staff to claim or view all their entitlements, such as overtime, on-call and in-charge allowances And the machines do not allow staff to print hardcopy records.

NSWNMA General Secretary Brett Holmes says other employers who use Kronos software provide staff with online access at work and outside of work so they can view and print off timesheets, leave balances and rosters.

“Some even provide smart phone Apps to make information as accessible as possible.

“Ramsay nurses are uncertain if their pays are accurate and are increasingly telling us they are missing out on pay due to not being able to claim and view approved entitlements.

‘I CAN’T CHECK WHAT HAS BEEN SUBMITTED ON MY BEHALF AND I DON’T HAVE THE CHANCE TO QUERY ANY DISCREPANCIES.’ – Kerrie Harrington

Errors plague new system

“It is time Ramsay gave its staff the same access and transparency as other hospital operators.”

A CALL FOR FAIRER ACCESS NSWNMA branches at Ramsay hospitals have carried resolutions calling for fair online staff access to MyTime.

They received support from the union’s statewide Committee of Delegates, which resolved to support their “Make MyTime Fair” campaign.

The delegates’ committee called on Ramsay Health Care to give all its nurses “fair and transparent” online access to MyTime to allow them to: • view individual timesheet information when they need to, at home or work on computers or mobile devices; • enter claims for employee entitlements, including overtime, missed breaks and all allowances, payable for each shift; • reduce payroll errors by viewing what has been approved on timesheets in the current fortnight including ordinary hours, overtime, leave, missed breaks and all allowances; • resolve errors more quickly by raising a MyTime online query when needed; • view and print off timesheets, leave balances and roster schedules; and • apply for leave.

Kerrie Harrington, NSWNMA branch president at Kareena Private Hospital in southern Sydney, works part time in the hospital’s operating theatre.

She says that as a part timer the biggest problem with MyTime is the inability to view the time card other than at work.

“I can only access it at work on a tiny machine in a corridor where there is no privacy and when other nurses are also trying to use it to clock on or off or view their own timesheets.

“If I finish my shift on say, a Wednesday and the time sheet isn’t submitted until the following Monday, and it hasn’t been updated before I go off shift I’ve got no idea what has been submitted for me.

“I can’t check what has been submitted on my behalf and I don’t have the chance to query any discrepancies.

“I don’t know if my allowances, overtime etc. are correct or not.

“If we had online access and were able to print a copy I could view the time sheet at home. That was the system used by two other hospital operators where I’ve been employed.”

Kerrie said many nurses had complained of errors in their pay under the new system.

“They are very happy to be joining together in the union to win better access to our time sheets.”

Kerrie was a member of a five-person NSWNMA negotiating team that met Ramsay management in June.

She said it was essential to have representation of nurses direct from the hospital floor at the meeting.

“I think we put our case forward very well. Management listened to our explanations of how the new system is impacting on nurses. They could see that we feel strongly that the problems need to be addressed.”

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PRIVATE HOSPITALS

More work for Ramsay NUMs

‘I HAVE TO SPEND TIME ANSWERING QUERIES FROM NURSES BECAUSE THEY CAN’T GET THE INFORMATION THEY NEED FROM THE SYSTEM.’ – Anne Fletcher

26 | THE LAMP JULY 2016

Nurse Unit Managers say MyTime has had a big impact on their work by adding to their administrative workload and reducing their clinical management time.

In effect, work previously done by payroll staff is now the responsibility of the NUM, they say.

The union has proposed that Ramsay provide clinical support staff to help NUMs deal with the increased data entry workload.

Anne Fletcher is NUM of a surgical ward at Albury-Wodonga Private Hospital, where she is also NSWNMA branch president and delegate.

She describes MyTime as tedious, frustrating and at times, intimidating.

“I start work at 7am and each day I have to have MyTime up to date and correct by 9.30am.

“Management have made it very clear that it is a KPI we must meet.

“We have to get it right and get it right on time.

“If there have been any schedule changes overnight, I have to make sure they are all accurately entered into the system by 9.30.

“If a nurse moves from morning to afternoon shift, for example, I have to go into MyTime and reschedule her. If I don’t it will come up as a mistake because she has clocked on at 2pm instead of 7am.

“The system sometimes slows down because everyone is trying to get it done by 9.30. Then it times out and you have to re-enter your user name and password and start all over again.

“I’m trained as a nurse not a pay mistress but I feel responsible for my staff getting their correct pay. I make every effort to ensure that staff are paid for the hours they work and their allowances.

“It cuts into the time available to do staffing and doctors’ rounds as well as consulting with nurses on things like wound management and discharge planning.

“Other NUMs are in a similar situation and some also have to carry a patient load.”

Anne says the old paper system only required her to check time sheets at the end of each fortnight.

Under MyTime, nurses wanting to check the accuracy of their pay must go to a NUM who has administrator access to the system.

“I have to spend time answering queries from nurses because they can’t get the information they need from the system,” Anne says.

“Many nurses find the MyTime clock confusing. For example, it doesn’t show the “in charges” – they come up as an extra one hour’s pay on a shift.

“Nurses need something they can look at home or on their phone and easily understand.”

3 steps to Make MyTime Fair

Ramsay pledges online access The “Make MyTime Fair” campaign achieved a breakthrough in June when Ramsay management responded to mounting pressure by agreeing to provide online access to MyTime.

Management promised to make changes that would allow staff to log on and check their timesheets from anywhere, anytime, using computers and mobile devices.

Management said it could take several months to make the changes.

It had not responded to the union’s other MyTime claims when this edition of The Lamp went to press.

Members are continuing their Make MyTime Fair campaign to ensure that Ramsay follows through with improved online access without delay.

1. M ake sure everyone on your ward signs the petition – print off a copy here www.nswnma.asn. au/ramsay-members-win-onlineaccess-for-all/ 2. Like your Ramsay Nurses and Midwives NSWNMA Facebook page and post a comment 3. Look out for Make MyTime Fair news and contact your organising team Karen Conroy and Matt Henderson on 8595 1234 Connect with us on Facebook

> www.facebook.com/ RamsayNursesandMidwives

The Edith Cavell Trust

Scholarships for the academic year 2017 Applications for the Edith Cavell Trust Scholarships are now being accepted for the academic year 2017.

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

All grants, awards or loans shall be made to financially assist nurses, midwives, assistants in nursing, assistants in midwifery (including students of those disciplines), and accredited nursing or midwifery organisations, schools and faculties in the furtherance of: (i) accredited nursing or midwifery studies; (ii) such academic research programs as are approved by the Trustees in the theory or practice of nursing or midwifery work; or (iii) clinical nursing education programs at graduate, post-graduate and continuing education professional development level; in accordance with a number of categories.

Full details of the scholarship categories, how to apply and to obtain the official application form is available from the NSWNMA website.

Prior to applying, please ensure you have read the Edith Cavell Trust Scholarship rules.

Applications close 5pm on 31 July 2016

Edith Cavell 2017.indd 1

WWW.NSWNMA.ASN.AU – click on ‘Education’ For further information contact: Scholarship Coordinator – The Edith Cavell Trust, 50 O’Dea Avenue, Waterloo, NSW 2017 T Matt West on 1300 367 962 E mawest@nswnma.asn.au T H E L A M P 22/02/2016 J U L Y 2 0 13:05 6 | PM 27

HEALTH AND INEQUALITY

A prescribed death The United States is experiencing an overdose epidemic driven by the abuse of painkillers.

The recent death of music legend Prince came as a shock to those close to him who were familiar with his healthy lifestyle and aversion to alcohol and recreational drugs.

But after a long career strutting around the stage in high-heel shoes the 57-year old had arthritic conditions in his joints which led him to the prescription painkillers that ended his life.

While Prince’s death was a high profile tragedy, the 47,000 other ordinary Americans who die annually from drug overdose have become a mere statistic. Most of those deaths involve an opioid.

Overdoses kill more Americans than car crashes or guns.

PAIN AND INEQUALITY Last year in a landmark study, Nobel laureate for economics Angus Deaton identified opioid abuse as a major factor in the rising mortality rate in white, middle-aged Americans (see The Lamp April 2016).

Deaton found that this group of Americans had significant increases in chronic pain, an inability to work and deteriorating liver function which “all point to increasing midlife distress”.

He noted a link between economic insecurity and the epidemic in pain which led to suicides and drug and alcohol poisonings.

One in three white Americans aged 45-54 reported chronic joint pain in the 2011-2013 period; one in five reported neck pain; and one in seven reported sciatica.

“The CDC (Centers for Disease Control) estimates that for each prescrip28 | THE LAMP JULY 2016

tion painkiller death in 2008, there were 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse, 130 people who were abusers or dependent, and 825 nonmedical users,” Deaton found.

OFF PAINKILLERS AND ON TO HEROIN A strong link has developed between painkiller abuse and heroin dependence.

“Tighter controls on opioid prescription brought some substitution into heroin and, in this period, the US saw falling prices and rising quality of heroin, as well as availability in areas where heroin had been previously largely unknown,”

says Angus Deaton.

Deaths from heroin overdose have quadrupled in the US since 2002 and use of the drug has increased by 63 per cent according to a report released last year by the CDC. “Over the past decade, we have found a significant increase in heroin use across almost all demographic groups,” said Dr Christopher M Jones, senior adviser at the Food and Drug Administration (FDA) and co-author of the report.

The greatest increases were seen among populations who historically had lower rates of heroin use, he said. Heroin use among women doubled between 2002 and 2013, the period of study, while use among non-Hispanic whites more than doubled.

Nearly all (96 per cent) of those who had reported using heroin in the past year also reported using at least one other drug, with a majority (61 per cent) reporting concurrent use of three or more substances, according to the report.

“There is evidence that as you increase the number of people addicted to opiates, either prescription drugs or heroin, you see more use of the other one. That’s why we refer to this as an intertwined epidemic. These things are feeding on each other,” said Dr Jay Unick, associate professor at the University of Maryland School of Social Work and author of a 2013 study on trends in heroin- and opioid-related overdoses.

HEROIN IS CHEAPER A 2014 study published in the Journal of the American Medical Association Psychiatry found that 75 per cent of those on heroin came to it via prescription opioids and noted a rise in heroin use as prescription opioid use decreased.

Much of this has been driven by price changes on the black market. As authorities cracked down on prescription opioids from 2010 onwards, the price of pills increased dramatically. At the same time there was a surge in heroin production and trafficking from Mexico.

According to the Pew Charitable Trust there has been a 300 per cent increase in heroin seizures from Mexico since 2007.

OPIOIDS ARE OF QUESTIONABLE EFFICACY Australian research has found that evidence for the effectiveness of opiate-based painkillers, such as tramadol and oxycodone, for chronic back pain was “lacking” according to NHS Choices.

The trials, conducted by researchers at the George Institute for Global Health at the University of Sydney, found opioids had a minimal effect on pain compared with an inactive placebo.

The findings suggest it is inadvisable for a person to rely solely on painkillers for non-specific lower back pain. Stronger opioids, such as fentanyl or oxycodone, are only advised for short-term use for severe pain.

Rates of past-year heroin abuse or dependence and heroin-related overdose deaths in the United States, 2002–2013 Rate of heroin abuse or dependence per 1,000 persons

Rate of heroin-related overdose deaths per 100,000 persons

3.0

3.0

2.5

2.5

2.0

2.0

1.5

1.5

1.0

1.0

0.5

0.5

0.0

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

0.0

n Past-year heroin abuse or dependence — Heroin-related overdose deaths

More information Vital Signs: Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013 – (by the Centers for Disease Control) http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6426a3.htm?s_cid=mm6426a3_w Public Safety Aspects of the Heroin Abuse Epidemic (by the Pew Charitable Trusts) http://www.pewtrusts.org/~/ media/assets/2015/07/public_safety_aspects_heroin_abuse_epidemic.pdf Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (by Anne Case and Angus Deaton) http://www.pnas.org/content/112/49/15078.full.pdf

Heroin seizures increased substantially starting in 2007 Authorities cite expansion of Mexican production and trafficking

6,000

5,691kg

5,000 4,000

2,486kg

3,000 2,000 1,000 0 2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Source: Office of National Drug Control Policy, 2014 National Drug Control Strategy, “Data Supplement, Table 71,” https://www.whitehouse.gov/sites/default/files/ondcp/policy-andresearch/ndcs_data_supplement_2014.pdf Pew Charitable Trust

THE LAMP JULY 2016 | 29

SHORT STORY COMPETITION THE WINNERS IN OUR SHORT STORY AND POETRY COMPETITION – SPONSORED BY FIRST STATE SUPER.

Roslyn Millar won first prize for her story Something About Mary. Roslyn is a community health nurse.

Emma Gedge, a midwife from Wollongong, won the first runner-up prize of $500 for her story Watchful Waiting.

Maxine Ross was the second runner-up for her series of poems One Short Life.

Maxine works in community health in Armidale.

30 | THE LAMP JULY 2016

Something about Mary There was a lot to notice about Mary. She was tiny, the top of her head barely reaching my shoulder. Curly wisps of pale pink hair escaped from beneath a silky floral scarf tied under her chin. Her face was almost entirely covered by a pair of large sunglasses, an unusual accessory given we were sitting in her dimly lit kitchen. “I’m allergic to the west wind” remarked Mary curiously, as if this single statement explained everything. But it was Mary’s hands that struck me the most. Though her body was small, her hands were huge, her grip strong despite the nobbled and twisted fingers. As she wrapped them around my own the promise of a warm greeting was quickly dispelled by an icy touch. “Excuse my cold hands” she remarked in a girlish voice. “Cold hands, warm heart.”

I’d gone to see Mary at the request of her neighbour. Accusations of banging on doors in the early hours of the morning, harassment and threatening behaviour. The first signs of possible cognitive decline? I checked myself. Many years in community nursing had taught me not to diagnose. I’d managed people like Mary countless times. Assess the need, develop a plan and implement strategies according to priority. Mary ended up challenging me in ways I could never have imagined.

The house was a worn California bungalow with wrap-around verandah and peeling casement windows. Two frangipani trees lined the broken concrete path, their bare branches just starting to bud. With no family or friends to call upon and no previous history to guide me I stood alone before her front door. Mary invited me in. It always surprises me how willingly people let strangers into their home. As I followed her up the hallway I glanced into almost empty rooms. The plane but functional interior was relatively clean and tidy, if a little shabby. A few scattered ornaments revealed nothing about the personality of the woman who inhabited the space.

No photographs, no memories from the past to tell tales.

We sat at the kitchen table exchanging the usual pleasantries, the chit-chat adopted by health professionals designed to gain trust and blunt the impact of difficult conversations. I mentally ticked off the checklist for the at-risk client; environment clean and uncluttered, a reasonable body weight, no agitation or signs of acute delirium. Her fridge contained the basics although the bathroom was too dry and orderly to have been recently used. Immediate action would not be required but I would have to dig deeper if I wanted to learn more about the woman sitting opposite me.

“Are you friendly with your neighbours, Mary?”

“Yes, but I don’t see much of them. I’m too busy.”

“Oh, what are you busy with?”

“Christopher.”

“Who is Christopher?” I asked, hopeful I’d found a lead into her life.

“My baby.”

“You have a baby,” I exclaimed, trying to dampen the scepticism in my voice. “Where is he?”

“In the bedroom. He’s asleep.”

Mary led me into her room. Her bed was carefully made with a white chenille quilt, the side table holding a discoloured lamp and a black Bakelite alarm clock. I looked for what I assumed was a dog or cat, anything that deserved the title of baby. But the room appeared empty. Mary offered no explanation and then I saw it; a small photograph propped against a pillow snugly wrapped in a lemon rug with just the face peeping out. It was a snapshot of a baby. I hesitated, searching for an appropriate response that was respectful of her reality when I wasn’t yet sure what that reality was.

“Is this Christopher?” I asked cautiously but somehow I already knew the answer.

Our brains are hard wired to create stories, to recognise and complete patterns that allow us to make sense of our world. We sift through the data, order it into a logical sequence and come up with a suitable explanation for our experience. When the brain is damaged the

data is scrambled, the patterns confused but the story must be completed so the brain fills in the gaps as best it can. It tells a story that clears up the ambiguity and helps us understand our world even if that explanation is wrong. Certainty gives us comfort. I could only imagine the untidy floor of Mary’s mind, the scattered scraps of memory that she’d subconsciously cobbled together. In medical terms Christopher was a delusion. To Mary he was her child and it was her story I needed to enter. * Mary didn’t remember much about that day other than pain and fear. The contractions started at about 1am. At first they were only uncomfortable but as the night wore on they increased in frequency and intensity. By morning Mary’s waters had broken. The dark colour meant nothing to her. By the time the midwife arrived the pain never seemed to end. It felt like she’d been in labour for days. Her room, her bed, the encouraging words of the midwife, all that was familiar to her was swallowed up, consumed in wave after wave of relentless pain.

Her body was being torn apart and there was no escape. Was it meant to be this bad? Surely God didn’t mean for her to suffer like this. She wasn’t even allowed to have Tom hold her hand to give her courage. He’d been ordered from the room such a long time ago. It would have helped just to be able to hold Tom’s hand.

Engaged in her own internal war, Mary didn’t notice the concerned look on the midwife’s face, the opening and closing of doors as people entered the room, the arrival of the doctor or the desperate efforts to unwrap the cord from around her son’s neck. It was the silence that dragged Mary back. She’d imagined joyful congratulations, maybe the first wailing cries of a newborn, not suffocating silence. Just a few furtive whispers, pity and empty platitudes. No warm, sweet-smelling body as reward. Her baby boy never took a breath. * Over the next few months I visited Mary regularly. Sometimes she didn’t answer the door but I suspected she was home. She didn’t own a phone. She was always dressed the same, silk scarf tied around her head, sunglasses in place. I wondered if the glasses were less about protection from the spring weather and more a deliberate ploy to prevent me looking into her eyes and reading her thoughts. It left me relying on questions that gently probed her mind, sensitive to any signs of repetitive speech, anxiety or agitation, suspiciousness, paranoia, anything that would help me to understand. Mary would talk of her childhood in Yorkshire, the farm she grew up on, the snow in winter. She had immigrated to Australia with her husband, Tom, in the 60s. She’d been a dressmaker with a shop in Oxford Street. Tom had died many years ago.

An accident with a lorry, Mary said. There didn’t seem to be any adult children. Sometimes the details would vary, her memory unreliable or was she just cagey about her past, reluctant to let me get too close? Of course I asked about Christopher. The photograph was faded, slightly wrinkled. Who was this baby in a pale blue matinee jacket? I was curious, I wanted to know so I searched for clues. Was there a lost child somewhere in Mary’s past, the grief too painful to acknowledge? But there was nothing for Mary to tell. He simply existed, always asleep wrapped in his blanket on her bed.

I wondered how Mary filled her days. She rarely went out, she said, and only to shop. She couldn’t leave the baby for too long. He needed feeding. Time and companionship must have brought a level of trust for Mary eventually confided in me that sometimes she worried she didn’t have enough milk for Christopher. In her private moments did she actually try to breast feed her baby? I could only imagine the intensity of her delusion, the struggle to make sense of her fragmented thoughts, her aching need. As her cognitive capacity diminished, so had her world. It was just her and Christopher. It’s all her mind could deal with. But she couldn’t hide from the outside forever and she was fragile. It wouldn’t be long before Mary’s reality would start to unravel.

This is an abridged version of the winning entry in our Short Story and Poetry competition. To read the full version go to: http://www.nswnma.asn.au/wp-content/uploads/2015/09/Something-about-Mary.pdf

THE LAMP JULY 2016 | 31

EDUCATION@NSWNMA

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WINTER

n Thursday 25 August, Wagga Wagga n Wednesday 7 September, Coffs Harbour Members $40 | Non-members $85

LEGAL AND PROFESSIONAL ISSUES FOR NURSES AND MIDWIVES – ½ Day n Friday 26 August, Wagga Wagga n Thursday 8 September, Coffs Harbour Members $40 | Non-members $85

POLICY AND GUIDELINE WRITING FOR NURSES AND MIDWIVES – 1 Day n Thursday 28 July, Parramatta Members $85 | Non-members $170

PRACTICAL SKILLS IN MANAGING DIFFICULT AND AGGRESSIVE CLIENTS – 2 Days

n Thursday 4 August & Thursday 8 September, Waterloo Members $160 | Non-members $250

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APPROPRIATE WORKPLACE BEHAVIOUR FOR NURSES AND MIDWIVES – 1 Day

n Thursday 1 September, Gymea Members $85 | Non-members $170

MENTAL HEALTH AND DRUG & ALCOHOL NURSES’ FORUM – 1 Day

n Friday 9 September, Waterloo Members $30 | Non-members $50

MANAGING OVERTHINKING – 1 Day n Monday 19 September, Parramatta Members $85 | Non-members $170

FOOT CARE FOR NURSES – 2 Days

Bonded Polar Fleece Zip Front Jacket $30. Quantity: Size: S M L XL XXL XXXL Postage and Handling $5 per item. Total cost of order $ Name Address Postcode Phone (h)

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32 | THE LAMP JULY

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www.nswnma.asn.au

ASK JUDITH WHEN IT COMES TO YOUR RIGHTS AND ENTITLEMENTS AT WORK, NSWNMA ASSISTANT GENERAL SECRETARY JUDITH KIEJDA HAS THE ANSWERS. Changes to ‘Working with Children’ checks I am a Registered Nurse in a public hospital. Recently I read about the working with children check changes in The Lamp. I have just received a letter from the District saying I need to get one. I’m not sure though that I deal with children that much.

How do I find out if I really need one?

The rollout of requirements under the Child Protection (Working with Children) Act 2012 (‘WWCC’) has commenced.

Half of the NSW Health Service will be required to obtain a WWCC this year, while remaining employees will complete the process in 2017. This requirement extends to all workers and volunteers in the state who may be involved in providing services of some sort to children. It is not dissimilar to requirements in other states.

In public health, each position (or class of positions) must be subject to proper review – designed to identify those that provide health services in hospitals or elsewhere that may include the provision of services to children, including paediatrics and adolescent services, or other roles that involve the provision of a health service to under 18 year olds (the definition of a child under the Act).

In some instances, such as rural and regional settings, adult services may routinely deal with those over 16 but under 18 years of age. In that case you would be ‘caught’ by the legislative framework. PD2013_028 was issued by the Ministry of Health to govern the implementation of this new statutory regime and is a useful source of further information. The Association and other unions fought unsuccessfully to prevent the cost shift to employees.

Losing one of my two roles I am a Registered Nurse in a Local Health District and work two different roles at the hospital with different classifications.

I have heard a rumour that one of these roles may be deleted as a result of a mooted restructure. How does that work out for me if it is true?

It would appear that your employment is on the basis of multiple assignments, reflecting that your differing roles have a specific classification (and rate of pay) for each (see Clause 4A of the Public Health System Nurses’ and Midwives’ (State) Award). If one of your roles or

BREAKING NEWS AT LAST, CONSULTATION OVER THE NDIS The rollout of the NDIS – and its impact on nursing staff who currently provide such services via FACS – has long been characterised by a lack of consultation and information from the Department and the NSW Government. The Association at every opportunity has expressed its dissatisfaction with the level of consultation that has occurred so far.

Some members and workplaces instigated industrial action but even this had no impact on the Department.

However, the Association has persisted and recently demanded that a specific consultative forum be established between the parties to facilitate transparency and genuine consultation.

If the Department refused to yield to this request, we made it clear that we would seek the assistance of the Industrial Relations Commission of NSW. Pleasingly, if surprisingly, the Department agreed to establish the requested consultative forum. As a result, members withdrew industrial action. The first meeting has been held and had some promise, as dialogue occurred and some information was made available. It is expected that the first NGO providers could be selected by the end of 2016 following an Expression Of Interest and tender process. Transfer of employees to the private sector could be staged, dependent upon the selection and readiness of NGOs. The Department indicated it is not likely any nursing staff will transfer before April 2017.

The Association reiterated a number of claims including: choice for our members; an increase to the transfer payment (currently a maximum of eight weeks’ pay depending on length of service); and maintenance of public sector redundancy provisions. The Department indicated that these would be referred to NSW Industrial Relations (Treasury).

One is left wondering, why on earth a change as significant as the rollout of the NDIS would be left hanging for so long without the benefit of feedback and input from nurses and their representatives.

We all want the NDIS to be adequately resourced and to succeed. The question is, however, can that occur in the absence of a public provider – even if as a last resort for the most complex or demanding cases – or will this only result in a consequent increased reliance on the public health system which will be poorly placed to respond to such demands?

assignments were to be deleted, you would only be declared excess from the assignment deleted and remain employed in your other assignment.

Remember you should only be declared excess if there is no other suitable vacant role in which you could be placed in – temporary or substantive (check out Section 4 of PD2012_021).

What am I entitled to if I am sent home early?

I work as a Registered Nurse in a private hospital and employed as permanent part time. Sometimes when demand is low or the surgical list finishes earlier, I am ‘encouraged’ to go home and am consequently not paid those hours, or alternatively use paid leave to top up for the early finish. Is that right?

As a general principle, permanent parttime employees are to be permanently contracted to a minimum number of ordinary hours each week/fortnight and will have reasonably predictable hours of work. It is not open to the employer to ‘reduce’ your minimum contracted hours for a particular pay period in the manner described.

Some agreements make provision for time off in lieu of additional time (overtime) worked or a banking of hours system (finish late on some shifts and leave early on others) but these must be by mutual agreement and does not seem to be applicable to the circumstances you describe. If an Association Branch is present in the workplace, discuss it with Branch officials, as it may be a widespread issue that can be addressed collectively.

Mandatory training rules I am employed in a public hospital and am required to complete mandatory training by the Local Health District. There seems to be an assumption that I will complete some of this in my own time. Is that correct?

Training that is required by the employer to be completed should be undertaken in work time, and such time and resources (i.e. IT access) should be made available. PD2014_029 (Leave Matters for the NSW Health Service) notes that “... staff are considered to be “on-duty” [in relation to]: “in-house” courses or activities [and] Mandatory training and education.”

THE LAMP JULY 2016 | 33

www.facebook.com/ NurseUncutAustralia @nurseuncut

OUR NURSE UNCUT BLOG HAS A DYNAMIC NEW LOOK! Nurse Uncut is a community blog for Australian nurses and midwives to share experiences, advice and opinions on subjects close to our hearts.

The blog is a place where we can vent about the frustrations and challenges – and the rewards – of the job.

After six years, the blog has an energetic new design.

But Nurse Uncut will keep delving into the areas our readers want to go – from ‘Shift work is not a lifestyle choice’ to ‘Why I love being in the casual pool’. All posts are written by everyday nurses and midwives and the blog invites your contribution.

CHECK OUT THE NEW LOOK AT WWW.NURSEUNCUT.COM.AU

34 | THE LAMP JULY 2016

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

WHAT’S HOT THIS MONTH

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

We welcome your ideas at nurseuncut@nswnma.asn.au

My mother had to retire early – so I’m thinking about superannuation Nurse Nicole’s mother was also a nurse, until physical strain forced her into early retirement – without much super. www.nurseuncut.com.au/ my-mothers-had-to -retire - early/

A journey with my mother through aged care Jewel describes her experience as a daughter whose mother spent 12 years in a nursing home – the good and the bad. www.nurseuncut.com. au/a-journey-with-my-mother-throughaged-care/

A day in the life of a remote continence nurse Anita, a continence nurse in the far west of the state, describes her typical day, with catheters playing a leading role. www.nurseuncut.com.au/a-dayin-the-life-of-a-remote-continencenurse/

Dying with dignity – end-of-life issues Smashing the stigma on mental health – it starts with us Paramedic student Jess reckons that in order to quell soaring suicide rates, we must work to smash the stigma. www.nurseuncut.com.au/smashingthe-stigma-it-starts-with-us/

Only 14% of Australians die at home – does this reflect a ‘life at all costs’ approach? www.nurseuncut.com.au/ visionstatements3/

Combining nursing and holistic medicine to find more answers Coreena, a young registered nurse, is now studying to become a nutritionist after she contracted a mysterious condition. www.nurseuncut.com. au/combining-nursing-and-holisticmedicine-to-find-more-answers/

New on SupportNurses YouTube channel NURSE CONFRONTS TURNBULL And questions him about cuts to aged care in a south coast shopping centre. bit.ly/langturnbull

POLITICS IN THE PUB Blue Mountains residents turn out for a feisty evening. http://bit.ly/ politicspub

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Share your photos by tagging @nswnma and don’t forget to use the hashtag #nswnma!

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Follow us on Twitter @nswnma @nurseuncut

Look for your local branch on our website

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THE LAMP JULY 2016 | 35

Family Planning NSW

Upcoming courses for nurses Well Women’s Screening Course: Newcastle, Goulburn, or Ashfield 40 CPD hours

This 12 week course helps registered nurses, midwives and enrolled nurses develop confidence and competence in the provision of cervical screening. History taking and breast awareness will also be covered.

IUD Insertion Training: September 2016, Ashfield 20 CPD hours

Develop competence and skill in IUD insertion techniques. Online study, workshop, and clinical training under direct supervision of an experienced IUD insertion clinician.

Pregnancy Options: November 2016, Ashfield 7 CPD hours

Half-day workshop building knowledge and skills to support and work with women (and their partners where relevant) presenting with an unintended pregnancy using a non-directive approach to decision-making.

Now taking enrolments. For more information or to enrol now, visit www.fpnsw.org.au or email 132 mm x 200education@fpnsw.org.au mm

Cleveland Clinic Abu Dhabi is now hiring!

Cleveland Clinic Abu Dhabi (CCAD), part of Mubadala’s network of world-class healthcare facilities, is a multispecialty hospital on Al Maryah Island in Abu Dhabi, UAE. Cleveland Clinic Abu Dhabi is a unique and unparalleled extension of US-based Cleveland Clinic’s model of care, specifically designed to address a range of complex and critical care requirements unique to the Abu Dhabi population.

VACANCIES: Ophthalmic Techs, Wound/Stoma Nurses, Critical Care, Ambulatory Care Critical Care: This is an exciting challenging environment at CCAD offering world class innovative experiences and opportunities for nurses. You will be challenged with high acuity critical patients, work with a world class team and receive support to provide patient centered care. While patients are complex, CCAD will support your professional growth and offer mentorship. The team is growing and as they expand over this year they would like you to join them in Abu Dhabi.

Ambulatory Care: This is a unique realm of specialized practice. You will be working in multidisciplinary teams, using critical care thinking skills to help care for patients across the continuum of care. CCAD offers multiple ambulatory clinic settings including: • Medical Sub-specialties including rheumatology, dermatology, nephrology, endocrinology, infusion center, infectious disease, hematology, and general medicine • Surgical sub-specialties including ENT, plastics and urology • Digestive disease including gastroenterology, colon-rectal, and general surgery • Neurology, neurosurgery and pain management • Ophthalmology • Heart and vascular including cardiothoracic surgery • Pulmonology including allergy and immunology

Benefits: In addition to being part of an international clinical team, successful applicants will receive accommodation, a transportation allowance, health insurance, annual travel allowance to home country and generous annual leave package.

To apply, please email: Dawn at dawn@ccmrecruitment.com.au or Raquel at raquel@ccmrecruitment.com.au or by phone at AUS: 1800 818 844, Free Phone NZ: 0800 700 839 www.ccmrecruitment.com 3 6 | T H E L A M P J U L YFree 2 0 1Phone 6

SOCIAL MEDIA | facebook

WHAT NURSES & MIDWIVES

SAID & LIKED on facebook www.facebook.com/nswnma Smoking madness An old photo of cigarettes being sold at the bedside sparked gasps of disbelief but also memories.

Spanking new hospital, shame there’s not enough nurses In early June there were almost 50 full-time equivalent registered nurse vacancies at the redeveloped hospital in Wagga, putting patient safety at risk.

Provider confesses: RN jobs to go An aged care provider admits that Budget cuts to aged care will see them shedding registered nurses.

PHOTO GALLERY

Signing up to the Association – nursing students at UTS

I remember cigarettes being sold to patients at Newcastle when I worked there in the early 1980s.

Today it is hard to believe patients frequently smoked while confined to bed in large shared wards.

The young mothers were allowed to smoke in the maternity hospitals in the 80s. Imagine those poor babies in those days.

I looked after a guy who tried to manage an oxygen mask, a cigarette and a urinal. Such a pity it was piped oxygen through the wall and we all know oxygen supports combustion. Bricks everywhere …

We were allowed to smoke in the Nurses’ station once all lights were out and it didn’t interfere with our work, early 70s!

Ahh, the good old days, come in for an appendix op, go home with lung cancer.

The doctors used to smoke as well.

Used to smoke in our nursing lectures.

Even smoking through their trachies.

People have told me doctors used to recommend smoking for people to help ‘calm their nerves’.

The movie ‘The Kings Speech’ illustrates this. Not surprisingly King George died from lung cancer.

In the 1960s and early 1970s part of our job was to empty the ashtrays on the patients’ bedside lockers! I also recall GPs smoking in their surgeries during a consultation!

There seems to be plenty of nurses and new grads keen for work at Wagga and other hospitals, with many stating admin is the cause of these shortages. Is this another deliberate ploy to #Demonise then#DefundDestroyPrivatise the Health System?

Just received a text from staffing and there are 9 different wards seeking someone to fill in for shifts for all 3 morning, afternoon and night shifts for tomorrow alone. It’s getting out of control.

These vacancies should’ve been recruited to before the hospital expansion.

Everything with public health takes months. My last position took 15 weeks from woe to go, it really isn’t acceptable.

Recruitment in NSW Health is a total joke...

I think it’s a disgrace that nurses are made the scapegoats of this greedy, corrupt NSW government.

Yet so many new grads unemployed. E-recruit very slow and agencies non-regulated. Surely there is a way to be commercial and compassionate!

Who will be legally liable when an adverse event has occurred? Who will administer restricted medications for people suffering from acute and chronic pain? Who will assess, plan and implement care suffering from complex chronic conditions. Who will the carers call when they choke, fall or gasp for breath? Who will liaise with the doctor or get orders by phone? These incidents do not occur only from 8-5! Who will determine dressing treatments on wounds? This is devastating news for aged care!

Pushing more people into the public hospital system and making that even more unviable. RNs end up looking after them anyway. They don’t save any money. Who are these boofheads really?

How will we meet the Quality Accreditation standards, particularly in areas such as infection control, complex care and dementia and behaviour management? Care assistants are not trained in these areas. Will these standards that we all strive so hard to constantly meet suddenly be revised?

Made lower? We all know who will be affected the most if that happens.

Proud to be part of the aged care nursing team in northwest Sydney.

Amanda Wilson and Linda Gahan receive awards for OT patient care in Tweed LHD.

Lucinda addresses a central coast Sydney Alliance meeting on penalty rates.

THE LAMP JULY 2016 | 37

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NURSING RESEARCH ONLINE The Association has adopted a strategic plan for the next 5 years to guide us forward as we face the challenges to our professions and the environments where we live and work. A key objective of the strategic plan is to promote a world class, well-funded integrated health system. Over the following months, this page will cover some of the issues we need your feedback on. Go online to NurseUncut to share your wisdom and experience. The links at the end of this article provide further reading. This month we look at consumer driven care (CDC).

The implications of consumer driven care Since the 1990s there has been a focus on giving elderly consumers more autonomy about what services they use and how they access them.

Community care packages have been traditionally provided in a block-funded, case-managed model. This approach enabled providers – usually charities, local governments and community groups – to deliver care to groups of recipients.

Some recipients with less intense packages essentially cross subsidised those who needed more intensive care.

By creating individual budgets, this cross subsidisation is no longer possible and some recipients will not have enough funding to retain their previous level of services. The introduction of CDC means that within an allocated budget, the consumer will now choose the services they want.

The shift to CDC reflects the very clearly expressed preference of most older Australians to be supported to stay in their own home as long as possible, with individualised support and to have some level of control of the design and delivery of the services they receive, including flexibility in the timing and scheduling of services.

CDC is an increasingly common feature of community care strategies around the OECD countries. The literature indicates that consumer choice is linked to increased satisfaction with services and relief for carers.

However there is limited research evidence with regard to the programmatic and contextual factors that influence outcomes.1,2 The CDC approach assumes that the recipient knows what they need and that they understand the repercussions of their choices.

well community based staff – largely an unregulated workforce – can be supervised and how effectively accreditation and audit processes will be able to monitor quality outcomes for people.

It is clear that an adequate regulatory framework to protect the public is absolutely necessary. It is a matter of great concern that the stated intention of the Government is to further reduce regulation of providers.

From 2017 individualised budgets will be attached to the consumer rather than the provider. Substantially increased expenditure on aged care and disability support should see an increase from 72,000 to 100,000 Home Care Packages by 2017/18, with more than 40,000 additional packages expected to be available between 2017/18 to 2021/22.3,4 There is strong support for this shift toward CDC in the home care sector and strong support from many consumer groups.

Undoubtedly these reforms are creating a more consumer driven, market orientated system. The market orientation assumes that consumers have adequate information to make informed choices.

CDC was a fundamental goal for consumers in the disability sector and framed as a human right that had up to then been largely denied them because care was structured around provider convenience.

Under CDC, the consumer has been placed at the centre of care and as nurses we are committed to patient centred care.

REGULATION NEEDED TO PROTECT PUBLIC Increased focus on community care provision inevitably means that people remaining at home will have increasingly complex care needs and higher vulnerability.

There will be challenges in terms of how

More information

Deloitte: How consumer driven care is reshaping the community care sector. http://www2.deloitte.com/content/dam/ Deloitte/au/Documents/life-sciences-healthcare/deloitte-au-lshc-consumer-driven-carereshaping-community-care-sector-180614.pdf

1. O ttmann, G., Mohebbi M., 2014 Self-directed community services for older Australians: a stepped capacity building approach, Health and Social Care in the Community (2014) 22(6), 598–611 2. C arlson, B. L., Foster, L., Dale, S. B., & Brown, R. (2007). Effects of Cash and Counseling on Personal Care and Well-Being. Health Services Research, 42(1 Pt 2), 467–487.

3. D epartment of Social Services, https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/home-carepackages 4. D eloitte. How consumer driven care is reshaping the community care sector, http://www2.deloitte.com/content/dam/Deloitte/ au/Documents/life-sciences-health-care/deloitte-au-lshc-consumer-driven-care-reshaping-community-care-sector-180614.pdf

28,000 extra Home Care Packages by 2017/18

40,000 additional packages between 2017/18 and 2021/22

We want to hear what you think Please go to Nurse Uncut to read more about the current state of consumer driven care issues and give us your feedback on our strategic plan:

www.nurseuncut. com.au/visionstatements4/ NSW NurSeS aNd midWiveS’ aSSociatioN

Strategic Plan

2015

to

2020 THE LAMP JULY 2016 | 39

NURSES & MIDWIVES: There are many benefits of being a financial member of the NSWNMA — did you know that

Authorised by B.Holmes, General Secretary, NSWNMA

YOUR MEMBERSHIP FEES COVER YOU FOR TRAVEL TO AND FROM WORK? If you are involved in an accident while travelling to or from work, NSWNMA’s Journey Accident Insurance provides you with peace of mind.

In recent years this insurance has been a financial safety net for many members who have met unfortunate circumstances travelling to or from work.

As a financial member of the NSWNMA you are automatically covered by this policy. It’s important to remember however, that it can only be accessed if you are a financial member at the time of the accident.

So make sure your membership remains financial at all times by paying your fees by Direct Debit or Credit.

Watch Alexis talk about Journey Accident Insurance

JOURNEY ACCIDENT INSURANCE

Your journey injury safety net

UNSURE IF YOU ARE FINANCIAL? IT’S EASY! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural).

Change your payment information online at

40 | THE LAMP JULY 2016

www.nswnma.asn.au

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Across 1. Maintenance of the viability of excised tissues or organs at extremely low temperatures 9. The upper segment of the sternum 10. Abnormal enlargement of the joint at the base of big toes 11. Baneberry 12. Sick 13. A preliminary or schematic plan, draft 15. Distributes and suspends small globules of fat in water 17. Complete or incomplete sagittal division of the spinal cord by an osseous or fibrocartilaginous septum 25. Electromagnetic unit (1.1.1) 26. Symbol for neodymium (1.1) 27. The condition of being abnormal

28. An elongated area; a passage or pathway 30. A supporting structure or tissue 31. To show to advantage 33. Having symptoms that develop slowly or appear long after inception 35. Ladies’ fingers (plant) 36. Douglas fold (12.4) Down 1. To reduce a dead body to ash by burning 2. Persons or things that opposes or hinders something 3. Look at again 4. Foreheads 5. Rhinophyma (3.7) 6. Incision of a gland 7. Without logic; senseless 8. The eggs produced by head or pubic lice

14. Outward 16. A noninvasive nuclear procedure for imaging tissues (1.1.1) 17. Any disorder characterized by excessive urine excretion 18. Lacking a centre 19. A definite or limited period 20. Clearly apparent to the senses 21. An adolescent 22. A permanent transmissible change in the genetic material 23. Electronic remittance advice (1.1.1) 24. Essential component, part of a whole 29. Symbol for columbium 32. The upper surface of an anatomical structure 34. Symbol for inosine (1.1.1)

THE LAMP JULY 2016 | 41

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SPONSORSHIP OF NOT-FOR-PROFIT ORGANISATIONS NSWNMA members involved in not-forprofit organisations, such as sporting clubs and youth and cultural organisations, are eligible to apply for sponsorship and support from the Association.

Applications are assessed on merit by the NSWNMA Council, based on their meeting the following criteria: n Applications must have the written support of a NSWNMA member who is prepared to attest to the organisation’s good standing and its positive attitude towards the principles of trade unions. n The applicant must agree to the messaging required by the NSWNMA on sponsored items for at least the period of the sponsorship. n The application must demonstrate relevance to current or future members of the NSWNMA, by providing such things as membership or participant numbers and ages and the expected public exposure opportunities, including estimated numbers, arising from the sponsorship. n The application must demonstrate a commitment to the promotion of healthy lifestyle and wellbeing. n The application must provide value for sponsorship dollar in comparison to traditional advertising opportunities.

Go to the members only page of the NSWNMA website WWW.NSWNMA.ASN.AU for the application form.

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ATTENTION MIDWIVES

18/04/2016 9:52 AM

Join our

MIDWIFERY REFERENCE GROUP

(MRG)

The NSWNMA are seeking expressions of interest from midwifery members to join our Midwifery Reference Group (MRG).

The MRG is made up of skilled and experienced midwives who meet on the first Wednesday of every second month to discuss a variety of topics related to midwifery practice and professional issues.

The midwives provide vital advice and assist the Association to accurately represent the interests of our members.

We are seeking midwives who also have membership with the Australian College of Midwives (ACM) and who have experience working in a rural setting as well as midwives who work clinically in either a private or public setting.

Teleconferencing facilities are available at meetings for those that cannot attend in person.

PLEASE DIRECT ENQUIRIES TO: Amy Hargreaves at ahargreaves@nswnma.asn.au or Dr Janet Roden at jroden@nswnma.asn.au 4 2 MRG | T Hadvert.indd E L A M P 1J U L Y 2 0 1 6

27/06/2016 10:35 AM

BOOK ME All the latest Book Me reviews from The Lamp can be read online at www.nswnma.asn.au/library-services/book-reviews.

Australia’s Rural, Remote & Indigenous Health, 3rd Edition Janie Dade Smith Elsevier (through JR Medical Books): www.medicalbooks.com.au.

RRP $79.95. ISBN 9780729542418 Australia’s Rural, Remote & Indigenous Health is a practical guide to the delivery of health care in rural and remote Australia. It discusses the economic, social and political forces that shape health care outside the capital cities, with reference to historical accounts, literature analysis and epidemiology. It also draws on the experiences of rural practitioners and remote area nurses, including leading Indigenous health professionals, from across rural and remote Australia. The material is presented using a variety of forms with a focus on plain English, including storytelling, video and audio links and discussion points at the end of each chapter.

Psychosocial Dimensions Of Medicine Jennifer Fitzgerald & Gerard Byrne IP Communications (through JR Medical Books): www.medicalbooks.com.au.

RRP $65. ISBN 9780992518189 This books aims to encourage health professionals to view a patient in his or her broad context, as a person, and as a person in a family, a cultural group, and in a society. Chapters address individual differences and developmental processes, relationships, the social determinants of health, existential and ethical issues, and prevention and promotion. In each chapter, to personalize and illustrate key points, the authors reflect on the examples of seven Australian and two New Zealand patients who have presented to their local generalpractice clinics.

Living Safely, Aging Well: A Guide To Preventing Injuries At Home Dorothy Drago Johns Hopkins University Press (through Footprint Books): www.footprint.com.au.

RRP $29.95. ISBN 9781421411521 This easy to read guide provides information to help older people, plus their spouses, children and other caregivers, keep older people safe from injury. Written by a safety expert, it covers cooking, gardening, sleeping, driving and walking around the house. The first part describes the causes of injuries by type and explains how to decrease the risk of each. Next the author explores the home environment room by room, pointing out potential hazards and explaining how to avoid or mitigate them. There are also chapters on managing with Alzheimer’s and dementia, navigating the medical care system and how to evaluate when it is no longer safe to continue driving.

DISCOUNT BOOKS FOR MEMBERS! The Library is pleased to announce that McGraw Hill Publishers are now offering members a 25% discount off the RRP! The offer currently covers medical as well as a range of other professional series books. Please see the online Book Me reviews for a link to the promotion code and further instructions, or contact the Library directly for further information.

SPECIAL INTEREST More than medicine: a history of the feminist women’s health movement Jennifer Nelson New York University Press (through Footprint Books), www.footprint.com.au. RRP $51.95.

ISBN 9780814770665

More Than Medicine explores how American activists of the ‘60s and ‘70s applied the lessons of the new left and civil rights movements to generate a women’s health movement. Through their efforts “health” was redefined to encompass both traditional notions of medicine – including cures and the medical technologies used by expert practitioners – as well as less conventional ideas about “healthy” social and political environments. The goal of health care became both bodies free of disease and whole humans capable of working productively, raising healthy, educated children and living in communities free from violence and social inequalities. This excellent history moves from the campaign for legal abortion to the creation of community clinics and women’s health centres, showing how the movement successfully built effective solutions based on the empowerment model of health care.

ADHD Coaching: A Guide For Mental Health Professionals Frances Prevatt & Abigail Levrini American Psychological Association (through Footprint Books): www.footprint.com.au.

RRP $142. ISBN 9781433820144 Professional coaching aims to help people with ADHD who struggle with basic life skills, like time management, staying organized and maintaining relationships. This book describes the underlying principles of the new field of ADHD coaching, as well as providing step-by-step details for gathering information, conducting the intake, establishing goals and objectives, and working through all stages of coaching. Five richly detailed case studies illustrate how to help clients at different life stages, including adults, college students and adolescents, who present with a variety of ADHD symptoms and comorbid mood disorders.

All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here via the Library’s Online Catalogue: visit http://www.nswnma.asn.au/library-services. Call 8595 1234 or 1300 367 962, or email gensec@nswnma.asn.au for assistance with loans or research.

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

THE LAMP JULY 2016 | 43

Going to work shouldn’t mean stepping into this.

ARE YOU A VICTIM OF WORKPLACE VIOLENCE? Have you or a colleague been assaulted at work?

Have you reported your incident?

Download the NSWNMA App and report your workplace violence incident.

The NSWNMA has a new tool as part of our NSWNMA Toolkit App that allows you to quickly report an incident to the Association as soon as it happens. It’s an easy fillable form that you can submit from your mobile device and an officer of the Association will be in touch with you.

Nursing is considered one of the most dangerous professions.

HELP STOP VIOLENCE AT WORK!

44 | THE LAMP JULY 2016

NSWNMA Toolkit App is FREE and available to download from iTunes and Google Play store

MOVIE OF THE MONTH

Turkish delight – Mustang is a fresh coming of age film exposing the bonds of sisterhood and womanhood writes Cathie Montgomery.

Mustang is narrated by the free-spirited Lale, the youngest of five beautiful school aged sisters. Along with Sonay, Selma, Ece, and Nur, she has been raised by their grandmother, 1000km from Istanbul in a quiet village.

For Lale, ‘everything turns to shit’: innocent water play and swimming with classmates on the last day of school, followed by a walk through a symbolic apple orchard, is reported to their grandmother as ’obscene behaviour’.

The girls’ uncle, Erol, is heard to say ‘if they are sullied, it is your fault’ as he takes the eldest three to have a virginity check at the local hospital.

Their real offence is being spirited girls in a patriarchal culture. A lockdown of the house ensues.

Anything deemed likely to pervert the girls further, such as computer, telephone, magazines, ‘promiscuous’ clothing and chewing gum is confiscated or banned. The house becomes a wife factory. Cooking lessons and appropriate

clothing constraints are enforced.

The grandmother arranges a prospective match for the eldest girl, Sonay. When the intended family and match arrive she threatens to scream that she has a boyfriend if forced to comply.

The fast thinking grandmother swaps her for the second girl – Selma, who quietly obeys. A double wedding takes place, half celebratory, half sombre.

The humiliating ritual of a wedding night sheet check is intense and when no blood is found, another visit to the hospital follows, to again question the virginity of the downcast Selma.

Ece is the next to be matched, and a darker image takes hold.

The urgency to escape and outrage at the enforced arrangements for each girl becomes increasingly more palpable.

The group dynamic throughout is slowly stripped back as each sister faces her chosen match and reveals her individual response.

The relationships between the sisters, as portrayed by the young actresses are beautifully natural. It doesn’t have a specific year setting, and although set in Turkey, no definite religious affiliation is forced upon the viewer.

It has unexpected humour and warmth throughout, with the possibility of hope for the future.

Cathie Montgomery is a CNS at Concord Hospital.

METRO MEMBER GIVEAWAY EMAIL The Lamp BY THE 12TH OF THE MONTH TO BE IN THE DRAW TO WIN A DOUBLE PASS TO MUSTANG THANKS TO MADMAN ENTERTAINMENT ENTERTAINMENT. EMAIL YOUR NAME, MEMBERSHIP NUMBER, ADDRESS AND TELEPHONE NUMBER TO lamp@ nswnma.asn.au FOR A CHANCE TO WIN!

DVD SPECIAL OFFER Orphan Black (Season 4)

This season will see leader-of-the-pack, Sarah, reluctantly return home from her Icelandic hideout to track down an elusive and mysterious ally tied to the clone who started it all — Beth Childs.

Sarah will follow Beth’s footsteps into a dangerous relationship with a potent new enemy, heading in a horrifying new direction. Under constant pressure to protect the sisterhood and keep everyone safe, Sarah’s old habits begin to resurface. As the close-knit sisters are pulled in disparate directions, Sarah finds herself estranged from the loving relationships that changed her for the better.

RURALMEMBERGIVEAWAY EMAIL THE LAMP BY THE 15TH OF THIS MONTH TO BE IN THE DRAW TO WIN A DVD OF ORPHAN BLACK, SERIES 4 THANKS TO ROADSHOW ENTERTAINMENT RELEASES. EMAIL YOUR NAME, MEMBERSHIP NUMBER, ADDRESS AND TELEPHONE NUMBER TO LAMP@NSWNMA.ASN.AU FOR A CHANCE TO WIN! THE LAMP JULY 2016 | 45

COVER STORY DIARY DATES — CONFERENCES, SEMINARS, MEETINGS DIARY DATES IS A FREE SERVICE FOR MEMBERS Please send event details in the format used here: event name, date and location, contact details – by the 5th of each month. Send your event details to: lamp@nswnma.asn.au Fax 02 9662 1414 Post 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space.

DIARY DATES IS A FREE SERVICE FOR MEMBERS lamp @ nswnma.asn.au NSW

Dimensions of Cardiology Conference 8-9 July 2016 Harbourview Function Centre, Newcastle www.empowernurseeducaiton.com. au Declared Delirium Clinical and Research Days, 3rd Biennial Conference Australasian Delirium Association 14-15 July 2016 University of New South Wales Sydney, Australia www.delirium.org.au Active Ageing Conference 2016 4 August 2016 Swissotel Sydney www.activeageingconference.com.au ASPAAN Coffs Harbour Seminar 6 August 2016 Coffs Harbour Hospital, Coffs Harbour www.aspaan.org.au ANZSVS Vascular Conference 2016 5-8 August 2016 Sheraton on the Park, Sydney http://www.vascularconference.com/ registration/ DANA 2016 NSW Drug and Alcohol Nurses Forum 12 August 2016 Park Royal Hotel, Darling Harbour www.danaonline.org IASSIDD 15th World Congress 15-19 August 2016 Melbourne, Australia https://www.iassidd.org/conference/index.php/HPC/IWC/index The Children’s Hospital at Westmead Paediatric Perioperative Seminar 10 September 2016 Novotel Parramatta, Sydney claudia.watson@health.nsw.gov. au Innovations in Cancer Treatment and Care Conference 2016 16 September 2016 Australian Technology Park, Sydney www.cancerinstitute.org.au/ events/i/innovations-2016 4th Annual Anaesthetics & PARU Conference 16-17 September 2016 Harbourview Function Centre, Newcastle www.empowernurseeducation.com. au Diabetes Update Day 17 September 2016 Australian Technology Park www.diabetesupdate2016.eventbrite. com.au Australasia-Pacific Post-Polio Conference 20-22 September 2016 Four Seasons Hotel, Sydney www.polioaustralia.org.au/ ASPAAN Wollongong Twilight Seminar 22 September 2016 Wollongong Hospital, Wollongong www.aspaan.org.au Transforming our Landscape - Biennial State Conference 2016 13-15 October 2016 Broken Hill www.palliativecarensw.org.au Audiometry Nurses Association of Australia INC Annual Conference

46 | THE LAMP JULY 2016

and AGM 26-28 October 2016 Quality Noahs on the Beach, Newcastle http://anaa.asn.au 4th International Congress of PeriAnaesthesia Nurses [ICPAN] 1-4 November 2016 Luna Park, Sydney www.aspaan.org.au High Dependency Nursing Conference 4 November 2016 Westmead Hospital Katherine.Schaffarczyk@health.nsw. gov.au

INTERSTATE

2016 ANMF Health and Environmental Sustainability Conference 17th International Mental Health Conference 10-12 August 2016 Sea World Resort, Gold Coast, QLD www. http://anzmh.asn.au/ conference 26th Annual Spinal Injury Conference 25-26 August 2016 Hampstead Rehabilitation Centre, Northfield, SA jhebblewhite@bigpond.com 11th National Conference Australian College of Nurse Practitioners 30 August-2 September 2016 Alice Springs, NT www.dcconferences,com.au/ acnp2016 World Indigenous Women’s Conference 2016 14-16 September 2016 Stamford Beach Hotel Glenelg, Adelaide, SA www.indigenousconferences.com International Conference for Emergency Nurses 19-21 October 2016 Alice Springs Convention Centre, NT www.2016.icen.com.au The National Nursing Forum 26-28 October 2016 Melbourne Park Function Centre, VIC www.acn.edu.au/nnf2016 Nursing Network on Violence Against Women International Conference 2016 26-28 October 2016 InterContinental The Rialto, Melbourne, VIC www.latrobe.edu.au/jlc/newsevents/NNVAWI-Conference-2016 Hospital In The Home (HITH) 9th Annual Scientific Meeting 2016 2-4 November 2016 Stamford Grand, Glenelg, SA www.conference.hithsociety.org.au 5th Closing the Gap Indigenous Health Conference and 2016 World Indigenous Allied Health Conference 1-3 December 2016 Pullman Cairns International Hotel, Cairns, QLD www.indigenousconferences.com STOP Domestic Violence Conference 5-7 December 2016 Mercure Brisbane, QLD www.stopdomesticviolence.com.au ASPAAN Twilight Seminar 17 December 2016

Sir Charles Gairdner Hospital, Perth, WA www.aspaan.org.au

INTERNATIONAL

5th World Congress of Clinical Safety 21-23 September 2016 Joseph B. Martin Conference Center, Harvard University Medical School, Boston, USA www.iarmm.org/5WCCS/ BIT’S 3rd Annual World Congress of Orthopaedics 29 September-1 October 2016 Korea International Exhibition Center (KINTEX), Goyang-Si, South Korea www.bitcongress.com/wcort2016/ Heart Rhythm Congress 9-12 October 2016 International Convention Centre, Birmingham, United Kingdom www.heartrhythmcongress.org 5th International Conference on Violence in the Health Sector 26-28 October 2016 Dublin, Ireland www.oudconsultancy.nl/dublin_5_ ICWV/index.html Emergency Care Conference 6-10 February 2017 Rusutsu Resort, Hokkaidō, Japan www.emsconferences.com.au REUNIONS St Vincent’s Hospital Darlinghurst PTS Class June 1975 41 Year Reunion 9 July 2016 Janelle Schwager: 0407 107 357 or Janelleschwager@gmail.com Dubbo Base Hospital Graduate Nurses Reunion - Farewell to the George Hatch Building 6 August 2016 Sue O’Dea: 0438 845 225 Jenny Furney: 0419 480 259

Kempsey Hospital NSW Ex and Older Staff Reunion 10 September 2016 South West Rocks Country Club Trudy Lynch: 0265627794 Brenda: 0265674532 St Vincent’s Darlinghurst PTS Class March 1976-1979 40 Year Reunion 22 October 2016 Kerrie Maher: kerriefmaher@ hotmail.com or 0408464903 Tamworth Base Hospital February 1976 intake 40 Year Reunion Contacts: Sandra Cox: sandra.cox@ hnehealth.nsw Sean O’Connor: 0408 349 126 Gerard Jeffery: 0417 664 993 Auburn Hospital October 19761979 40th Reunion Sharon Byers: 0419 144 965 or sbyers01@bigpond.net.au Margaret Borg (Mueller): 0431 159 964 or margaret_borg@bigpond.com Royal Prince Alfred Hospital January 1977 (including Rachel Foster Hospital) 40 Year Reunion 3 Day Comedy Cruise P&O Pacific Pearl Cruise Number: P207 Booking Reference: GNVQXN Departs Sydney - 27 January 2017 Contact Michele Kristidis (nee ‘Lee’ Sweeney): michelekristidis@hotmail. com RAHC Royal Alexandra Hospital for Children PTS 1977- 40 Year Reunion 4-5 February 2017 Coleen Holland (Argall): bobandcolh@yahoo.com.au St Vincents Darlinghurst PTS Class March 1977- 40 Year Reunion 25 March 2017 Frances O’Connor (nee Pugh): 0415764131 or fgoconnor@optusnet. com.au

CROSSWORD SOLUTION

More people in health and community services choose HESTA for their super Supports your industry | Low fees

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Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Investments may go up or down. Past performance is not a reliable indicator of future performance. Product ratings are only one factor to be considered when making a decision. See hesta.com.au for more information. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk).

THE LAMP JULY 2016 | 47

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48 | THE LAMP JULY 2016

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