THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION
VOLUME 71 No.4 MAY 2014
A strong vote for ratios +
NURSES CAN HELP FARMERS LISMORE TALKS CONTINUE PHI: POOR VALUE, POOR POLICY
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CONTENTS
lamp THE
CONTACTS NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office.
VOLUME 71 No.4 MAY 2014
Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E gensec@nswnma.asn.au W www.nswnma.asn.au Hunter Office 8-14 Telford Street, Newcastle East NSW 2300
COVER STORY
12 | Strong vote for safe ratios All but one of the NSWNMA public health system branches who voted have voted to pursue our claim to extend and improve safe nurse-topatient ratios and a 2.5% pay increase. Cathy Taylor, EEN, Martin Gray, CNE PHOTOGRAPH: SHARON HICKEY
REGULARS
5 6 8 33 37 39 43 44 45 47 48 50
Editorial Your letters News in brief Ask Judith Obituary Social media Crossword Nursing research online Obituary Books Movies of the month Diary dates
STAFFING
NSWNMA Communications Manager Janaki Chellam-Rajendra T 8595 1258 FOR ALL EDITORIAL ENQUIRIES, LETTERS AND DIARY DATES: T 8595 1234 E lamp@nswnma.asn.au M 50 O’Dea Avenue, Waterloo NSW 2017 Produced by Hester Communications T 9568 3148 Press Releases Send your press releases to: F 9662 1414 E gensec@nswnma.asn.au
STAFFING
18 | Understaffing takes theatres nurses to breaking point
Overworked theatre nurses are resigning from one of the state’s biggest hospitals due to serious understaffing.
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 Patricia Purcell T 8595 2139 or 0416 259 845 or F 9662 1414 E ppurcell@nswnma.asn.au Information and Records Management Centre To find old 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
PRIVATE HEALTH The Lamp ISSN: 0047-3936
21 | Lismore management withdraws from arbitration
24 | Private health rebate: poor value, poor policy
Moves towards a greater user-pays system are being mooted as the way to finance our national health system.
COMPETITION
8 | Win a relaxing stay at Hawkesbury
CLIMATE CHANGE
30 | Nurses can help drought-affected farmers
Nurses are being asked to start a conversation with farmers in their care in a bid to combat stress and prevent suicide.
General disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised. Privacy Privacy statement: The NSWNMA collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information please contact the NSWNMA office. If you are still not satisfied that your privacy is being maintained you can contact the Privacy Commission. Subscriptions for 2014 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $55. Individuals $80, Institutions $135, Overseas $145. T H E L A M P M AY 2 0 1 4 | 3
ANNUAL ANNUAL CONFERENCE C ONFERENCE 30 JULY, JUL LY, 31 JULY, JUL LY, 1 AUGUST AUGUST 2014 2014
whose responsibility? PUT THIS DATE R IN YORUY DIA
Professional Day
This year’s program seeks to explore current debates around where responsibility for health should rest. Should there be a further shift toward greater user-pays?
Wednesday 30 July 2014
Is universal insurance unsustainable?
TIME: 9am – 5pm, Registration from 7am. VENUE: Rosehill Gardens, James Ruse Drive, Rosehill.
Is a free market the best way to distribute health resources?
KEYNOTE SPEAKER: LISA WILKINSON For more than two decades, Lisa has blazed a trail through the Australian media landscape, first in publishing, then on to radio and television. For more information please contact the NSWNMA on 8595 2181 (metro)or 1300 367 962 (rural) or go to
www.nswnma.asn.au/education
Should the government intervene more to support healthy behaviours? We also intend to hear from speakers about structural barriers to good health such as sexism, racism and disability.
EDITORIAL BY BRETT HOLMES GENERAL SECRETARY
Medicare is under serious threat Private health insurers and healthcare providers are eyeing large chunks of the population covered by Medicare. It is critical we resist the dismemberment of Medicare for private profit.
Medicare is very cost effective and delivers a world class health system that is widely envied — one we should be proud of.
Some months ago, federal health minister Peter Dutton expressed his wish for a national conversation on the future of our public health system. He said that current spending was unsustainable and there was a need to look at doing things differently. The possibility of co-payments for visits to GPs and emergency departments was floated. A recent conference in Brisbane gives us some insight into the kind of conversation that has been going on between private insurers and providers and the federal government over other possible changes to our health system (see page 24). The ideas being considered are alarming and would lead to the virtual destruction of Medicare. Top of the wish list for private health insurers would be the extension of private health insurance to low paid workers through employment-based schemes. Effectively this would be the replacement of Medicare with the American model of healthcare. Following this pathway would be counterproductive to the goal of making our health system sustainable. Mr Dutton is making a habit of talking up the “unsustainability” of our current Medicare system. He is resorting to the timehonoured politician’s ruse of creating an artificial crisis that is to be followed by the predictable announcement of cuts to funding, or even more drastic measures, that are effectively an abrogation of government responsibility. Talk of the unsustainability of Medicare is overblown and ideologically self-serving. Medicare is very cost effective and delivers a world class health system that is widely envied — one we should be proud of. It costs 9% of GDP compared to the 18% of GDP that the privatised American system costs. In fact, Australian government spending on health only makes up 6% of GDP and the rest is made up of out-of-pocket expenses from patients. For a wealthy society like Australia, Medicare is absolutely affordable and sustainable.
PUBLIC HEALTH INSURANCE IS CORPORATE WELFARE If the government was sincere about making our health system more sustainable and robust the first place it should be looking to for savings is the massive government subsidies to private health insurers. Private health insurance is subsidised to the tune of $5 billion a year. This is corporate welfare on an industrial scale. By comparison, subsidies to the auto industry – much derided by Treasurer Joe Hockey have amounted on average to $1.5 billion per year. As the widely respected commentators John Menadue and Ian McAuley tell us in this month’s Lamp (see page 22) “subsidising the Private Health Insurance (PHI) industry is rooted in ideological beliefs rather than any rational analysis”. The record of PHI around the world, they say, should raise alarm bells: “The PHI industry relies on lobbying and political pressure rather than debate or logic to defend its interests. If public hospitals were better funded and there were better programs to provide health services outside hospitals, the case for private health insurance would decline dramatically. There is an ideological view that somehow markets will provide a better solution than Medicare. This view is not based on evidence.” The NSWNMA’s policy on the role of private healthcare – voted on at our annual conference – is clear: • Private sector has a role as an alternative choice for the provision of health care; however its expansion must not be at the expense of publicly provided services available to all. • The provision of private health services should remain, complementary to a viable and effective public health system. • The private sector should be an optional and unsubsidised adjunct to a well-resourced public system for all. The Association rejects the argument that Medicare should be reduced to a safety-net for the poor. This would inevitably lead to a two tier system, with substandard services for the poor, escalating demand and cost for private care, and the establishment of a permanent lobby for underfunding public care. We will not stand by and let this happen.
T H E L A M P M AY 2 0 1 4 | 5
YOUR LETTERS
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PROGRAMS: All programs are tailored to organisation (workplace) policies and procedures, and comply with Australian Standard 4083, Australian Standard 3745 and the Work Health and Safety Act and Regulations 2011.
Fire Safety & Emergency Management Training • First Attack Fire Fighting • ECO Training (Floor Warden) • Chief Warden Training • First Attack Firefighting and Evacuation
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Recertification • First Aid • Breathing Apparatus • Confined Space Entry and Work • Fire Safety Officer (Healthcare) • Fire Safety Manager (Healthcare) • Mandatory Health Care Series To arrange training or request further information send an email to comsafe@fire.nsw.gov.au or call 1800 78 78 48. To visit ComSafe Training Services website go to www.comsafe.com.au
LETTER OF THE MONTH
Ratios/nursing hours claim I would like to comment on the proposed recommended draft ratios/nursing hours claim highlighted in the March issue of The Lamp. This is great news for nursing stress levels, feasible workloads, workforce retention and patient safety. There is however one concern that needs clarification. We need to strictly differentiate between patient acuity levels in Acute Coronary Care Units as opposed to cardiology wards, which are often these days lumped under the one name. Most Acute Coronary Care Units (CCUs) house patients with the same acuity (sometimes higher) than High Dependency Units and we need to be very mindful of that now we have a chance to set these ratios up. Non-invasive ventilation, temporary pacing, left ventricular assist devices, invasive haemodynamic monitoring, vasoactive drugs and intra-aortic balloon pumps are all commonplace in these acute units and require a 1:2 ratio [which is what the NSWNMA claim calls for]. Australian Critical Care has just published a very interesting and relevant article on the changing models of care in today’s CCUs: Driscoll, A. Currey, J. Allen, J. George, M. & Davidson, P. New cardiac models of care reduce patient access to specialist nurses: A Victorian cross-sectional pilot study. Australian Critical Care 2014;27 (1) 17-27. John Rihari-Thomas CERS CNC, Bondi Junction EDITOR’S NOTE: We have noted the incorrect ratio for CCUs published in the March Lamp.The final claim endorsed by 205 NSWNMA branches and submitted to the Ministry of Health was for a ratio of 1:2 plus in charge of shift for morning afternoon and night, this equates to 13 NHPPD plus in charge.
SAYSOMETHING Send your letters to: Editorial Enquiries email lamp@nswnma.asn.au fax 9662 1414 mail 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space.
letter of the
month The letter judged the best each month will be awarded a $50 Coles Myer voucher. “Whatever your next purchase, remember Union Shopper. After all, who can think of a reason NOT to save.”
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YOUR LETTERS
I’m joining the union! I have just begun a Certificate III in aged care and am amazed at the info we have to absorb! I am really enjoying it and look forward to completing the course and getting started. Now I have a bit of an idea of what this job entails, I am astounded at the low rate of pay in proportion to what the job requires. The first thing I’ll do is join the union! Ian Alexander, Sydney
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NEWS IN BRIEF
COMPETITION
Australia
Abbott leaves workers vulnerable to financial rip offs
Win a relaxing stay AT
HAWKESBURY
Working Australians have reason to be worried about the Abbott government’s proposal to wind back reforms to financial advice, says former NSW Liberal leader Peter Collins. The federal government has flagged it will roll back the Future of Financial Advice laws (FOFA), introduced by the previous Labor government, which created an express legal requirement that financial planners act in the best interest of their clients. “There are very few industries in which you would see practices that are as unfair and detrimental to consumers as those that Future of Financial Advice laws set out to address,” Mr Collins, now chair of Industry Super Australia, said. Two practices FOFA set out to eradicate were: • On going commissions which are paid to financial advisers and eat away at people’s retirement savings often without them knowing. • Financial advisers recommending products they were receiving a commission for, without having to consider if those products were in the client’s best interest. Independent actuaries, Rice Warner, have estimated the FOFA reforms would result in more than $140 billion extra in the private savings of Australians across a 20-year period. Industry Super Australia told an Australian Securities and Investments Commission inquiry, that the wind-back of the laws would increase the risk of another scandal in the vein of the Storm Financial Group collapse, in which hundreds of people lost their life savings. Australia
Patients happy with public hospitals A Bureau of Health Information survey of 17,000 patients has found a large majority of hospital patients in New South Wales have had a positive experience in the public system. A large proportion reported being treated with dignity and respect, and receiving good quality and well-organised care. On the negative, one in five patients who were worried about their treatment were never able to discuss their concerns with their doctor, and more than one in 10 experienced problems such as not being able to find staff to talk to, not being able to be involved in medication choices, and not being given enough information. Health Minister Jillian Skinner said it was a credit to the system that 91% of patients rated their overall experience in a public hospital as either “very good” or “good”. “What we are seeing is an increase in activity for our public hospitals coupled with improved performance in many areas. “This is an incredible achievement by hard working staff in our hospitals across the state,” she said.
“THIS IS AN INCREDIBLE ACHIEVEMENT BY HARD WORKING STAFF IN OUR HOSPITALS ACROSS THE STATE.”— Health Minister Jillian Skinner Competition entries from NSWNMA members only. Competition opens 1 May 2014 and closes 31 May 2014. The prize is drawn on 1st of the month following the competition. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW permit no: LTPM/14/00042.
NEWS IN BRIEF
United States
Autism surge
1 IN 42 1 IN 189
AUTISM IS MUCH MORE COMMON IN BOYS THAN GIRLS
United Kingdom
No more British NHS pension transfers from 2015 On Wednesday 19 March this year the British Chancellor of the Exchequer, George Osborne, unveiled a radical reform of the UK pension regime.
There has been an alarming surge in the recorded number of children with autism in the United States, according to the Centres for Disease Control and Prevention (CDC). A review of records of eight year olds in 11 states found a 30% increase from one in 88 children two years ago to one in 68. The new estimates show a marked increase in the number of children with higher IQs who fall somewhere on the autism spectrum, and a wide range of results depending on where a child lives. Only one child in 175 was diagnosed with autism in Alabama, while one in 45 was found to have the disorder in New Jersey. Consistent with previous reports, the diagnosis is much more common in boys (1 in 42) than girls (1 in 189), and much more frequently found in whites than blacks or Hispanics. Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, told the Washington Post that the growing numbers could reflect better identification of children with autism spectrum disorders, and a growing number of intelligent children with autism. “It could be that doctors are getting better at identifying these children, there could be a growing number of children with high intelligence who are autistic, or it could be both,” she said.
THE BAN WILL PREVENT TRANSFERS TO AUSTRALIA FROM THE NHS PENSION SCHEME.
Changes to pensions, likely to be effective in April 2015, will ban transfers from all public sector final salary schemes, impacting health professionals such as nurses, doctors, dentists and specialists. The ban will prevent transfers to Australia from the NHS Pension Scheme. From April 2015 British nurses and midwives will no longer have the option of transferring their pension to Australia. If you’d like to find out more about these reforms and the UK pension situation you can call 1300 783 789 or visit the A Good Move website at www.agoodmove.com.au.
T H E L A M P M AY 2 0 1 4 | 9
NEWS IN BRIEF
India
Victory over polio in South East Asia The World Health Organisation (WHO) has announced that the Southeast Asian region is officially polio-free. Eleven countries in Southeast Asia, including India, have eradicated polio.
United States
Childhood hardship is bad for your health
Polio prevention in India photos: the global polio eradication initiative India hasn’t reported a case of the wild polio virus in three years, despite not long ago having more cases of polio than any other country in the world. National Public Radio (NPR) described India’s polio-free status as “the culmination of a gruelling battle that sent millions of health workers down alleys, up mountains and across deserts to reach every child in India during the course of the past 19 years”. Polio continues to exist in a handful of other countries. Reported cases have declined in Afghanistan and Nigeria however Pakistan, India’s neighbor, now has the highest number of cases in the world. WHO’s Assistant Director General for Polio and Emergencies, Dr Bruce Aylward, told NPR there could be no respite if the goal of global eradication of polio was to be achieved by 2018. “Now the big danger is switched to another virus, called complacency,” Aylward said. “And it’s as hard to get rid of, sometimes, as the polio virus was. So the challenge is maintaining coverage afterwards, until the whole world is certified polio-free.”
10 | THE LAMP OCTOBER 2013
A study published in the journal Science confirms previous research that hardship in early childhood has lifelong health implications. But it goes further, offering evidence that a particular policy might prevent it. In 1972, researchers in North Carolina began following two groups of babies from poor families. The first group of children was given full-time day care up to age five, which included most of their daily meals, talking, games and other stimulating activities. The other group, aside from baby formula, got nothing. The scientists were testing whether the special treatment would lead to better cognitive abilities in the long run. Forty-two years later, the researchers found something they had not expected: the group that got care was far healthier, with sharply lower rates of high blood pressure and obesity, and higher levels of so-called good cholesterol. “This tells us that adversity matters and it does affect adult health,” James Heckman, a professor of economics at the University of Chicago told the New York Times. “But it also shows us that we can do something about it, that poverty is not just a hopeless condition.” The research had already answered the original question about cognitive development: whether the children treated better would, for example, be less likely to fail in school. The answer was yes. Over all, the participants’ abilities as infants were about the same, but by age three they had diverged. By age 30, those in the group given special care were four times as likely to have graduated from college.
NEWS IN BRIEF
Spain
Cancer patients in maternity wards
“YOU SEE FAMILIES SUFFERING BECAUSE THEIR FAMILY MEMBER IS DYING AND YOU’RE HEARING THE CRIES OF NEWBORNS NEXT TO YOU.”
Nurses at a hospital in Madrid are warning of the risks to mothers and newborns when patients with cancer and respiratory infections are placed on the maternity ward, where there are empty beds due to Spain’s falling birth rate, reports the Guardian. SATSE, the union that represents nurses in Spain, says the Fuenlabrada Hospital increasingly resorts to shuffling patients between wards in an attempt to manage overcrowding. On some days up to 75% of the patients in the maternity wing should be on other wards, the union told Spanish daily newspaper 20minutos. The nurses were compelled to speak out after complaints from patients. One patient described the impact of having patients who are nearing the end of their lives in close proximity to those on the maternity ward. “You see families suffering because their family member is dying and you’re hearing the cries of newborns next to you,” she told 20minutos. The hospital blamed the practice on shifting demographics. The number of births at the hospital plunged from just less than 3000 six years ago, to around 2000 in 2013. It also pointed to the hospital’s shrinking budget. As part of Spain’s austerity measures the government cut 7 billion Euros from the country’s healthcare system two years ago.
Australia
Support for higher minimum wage About 60% of Australians are concerned about the emergence of a “working poor” in Australia and support an increase in the minimum wage, according to a new national survey conducted for the ACTU. And even though Australia’s minimum wage of $16.37 an hour, or $622.20 a week, is high by international standards, a third of those surveyed said they could not afford to live off that amount. Only 15% of those surveyed disagreed with the statement: “The government should support a higher minimum wage to ensure all Australians have a decent standard of living.” Most, 71%, agreed that a decent minimum wage was a way of ensuring Australia remains a good place to live, while only 17% agreed with the central argument by employers, that Australia’s minimum wage is too high and is preventing businesses from hiring people. The ACTU is seeking to increase the national minimum wage by 71c per hour to $17.08 per hour. ACTU Secretary Dave Oliver says the performance of Australia’s economy means the claim of $27 extra a week for the National Minimum Wage is affordable and reasonable. “Productivity has been growing at its fastest pace in over a decade, but wages have failed to keep up – especially the wages of the lowest paid. Workers’ share of national income has fallen, while the profits share is near an all-time high,” he said. The $27 claim would benefit about 750 000 workers.
United States
Research suggests autism starts in the womb New research published in the New England Journal of Medicine suggests that autism begins well before birth. The study describes how brain tissue, taken from autistic children who had died, revealed patches of disorganisation in the cortex, a thin sheet of cells that are critical for learning and memory. Tissue samples from children without autism didn’t have those characteristic patches. Organisation of the cortex begins in the second trimester of pregnancy, “so something must have gone wrong at or before that time,” Eric Courchesne, director of the Autism Center of Excellence at the University of California, San Diego, told National Public Radio. The new study appears to confirm previous research showing that people with autism tend to have genetic changes that could disturb the formation of layers in the cortex. These patches of disorganised cortex have different effects on the brain depending on where they occur and how many there are. This could help explain why the symptoms of autism vary so much.
T H E L A M P M AY 2 0 1 4 | 1 1
COVER STORY
Strong vote for safe ratios All but one of the NSWNMA public health system branches who voted have voted to pursue our claim to extend and improve safe nurse-to-patient ratios and a 2.5% pay increase.
1 2 | T H E L A M P M AY 2 0 1 4
NURSES AND MIDWIVES HAVE OVERWHELMINGLY endorsed the NSWNMA claim to put patient safety first in our 2014 pay and conditions campaign. Of 206 branches that voted, 205 gave a ringing endorsement to the claim in a vote that spanned several weeks in March and early April. Central to the claim is the introduction of ratios in paediatrics and neonatal intensive care units, EDs and emergency medical units. The claim also seeks an extension of a ratios equivalent system into community and community mental health nursing and to more mental health units and specialised mental health hospitals. The claim is similar to the one lodged last year. There is an additional claim to reduce the number of consecutive shifts that a nurse can be rostered to work to a maximum of six. NSWNMA General Secretary Brett Holmes says the campaign for improved ratios will be one of many that will be fought to defend our world-class public health system. “The new northern beaches hospital will be privatised and we are already seeing the disability sector and mental health services being outsourced to NGOs. “The federal government has Medicare in its sights and that will forever change the way we deliver patient care. It might not be long before we have to defend the ratios we’ve already achieved,” he said. PAY INCREASE WITHOUT TRADE OFFS Public health sector members also voted to claim a 2.5% pay increase for 2014. Brett Holmes says members have indicated they will accept this modest increase if it is unconditional and goes hand-in-hand with improvements to the public health system. “Members have made it clear that a 2.5% pay increase per annum without any trade offs is acceptable, if it is accompanied by a legally-enforceable award containing the necessary extensions and improvements to ratios,” he said. NSW unions including the NSWNMA are in a court battle with the state government to force it to respect the New South Wales Industrial Relations Commission (IRC) decision to uphold the full 2.5% wage increase owed to all public sector workers, rather than the 2.27% that was paid in 2013. The government is refusing to pay the full 0.25% federal increase in superannuation and has so far disregarded two IRC verdicts and two Upper House votes urging them to do so. “This government would rather spend money on expensive legal proceedings due to their stubborn ideological beliefs, than pay workers what they are owed,” Brett Holmes said.“We will continue to battle this out in court. Our goal is to force the government to pay you what you are rightfully owed.”
Key aspects of our claim > A 2.5% per year wage increase. > Improvements to ratios in all NSW hospitals to the same level as Group A city hospitals. > Introduction of ratios in paediatric and neonatal intensive care units. > Introduction of ratios in EDs, emergency medical units and medical assessment units. > Introduction of ratios in intensive and clinical care units. > Introduction of a ratios equivalent system in community and community mental health. > Extend ratios to more mental health units and improve ratios in specialised mental health hospitals. We are asking the government to employ additional Clinical Nurse Educators and Clinical Midwifery Educators and to only employ Assistants in Nursing when clinically appropriate. The claim also seeks to replace the midnight census for nursing hours calculations with a system that accurately reflects patient numbers and provides patient “specialling” in addition to mandated nursing hours or ratios. An additional claim this year is to reduce the number of consecutive shifts a nurse can be rostered to work to a maximum of six. This is a no cost claim that reflects common rostering practices.
THE GOVERNMENT IS REFUSING TO PAY THE FULL 0.25% FEDERAL INCREASE IN SUPERANNUATION AND HAS SO FAR DISREGARDED TWO IRC VERDICTS AND TWO UPPER HOUSE VOTES URGING THEM TO DO SO. T H E L A M P M AY 2 0 1 4 | 1 3
COVER STORY
“WE KNOW WE’LL HAVE A HARD YEAR OF CAMPAIGNING AHEAD BUT WE ARE UP FOR THE FIGHT.”
Comment from NSWNMA General Secretary Brett Holmes “T HE VOTE TO ENDORSE THE CLAIM FOR our Public Health System Award has just concluded and you have once again voted overwhelmingly to continue the campaign for ratios that we began in 2010. Last year nurses and midwives campaigned strongly for the extension and improvement of ratios in our public health system.We rallied and marched in our local communities. We took political action by visiting our local members of parliament. We took industrial action and we made it clear to this government that unless they took patient safety seriously this issue would not go away. Despite our campaigning efforts last year, this state government has yet to put an offer on the table that satisfies our position to keep our patients safe. To its credit, when the new government came to office it upheld the award which contained a legally enforceable ratios system, won after a long battle with the previous government. 1 4 | T H E L A M P M AY 2 0 1 4
But they must do more and step up to the plate and deliver safe patient care for everyone in this state. This will not be an easy fight to win. We know it never is when it comes to patient safety. As nursing and midwifery professionals we always have to be at the forefront of advocating for our patients. But it is inspiring to see how far we have come and what we can achieve if we put our minds to it. We must continue to keep the pressure on our local elected decision makers and build awareness in our local communities about ratios putting patient safety first. We know we’ll have a hard year of campaigning ahead but we are up for the fight where our patients are concerned and we must send a clear message to this government, or for that matter any alternative government, that we will continue to fight for our patients and our industrial rights, even after they are long gone.”
“PATIENT SAFETY SHOULD BE THE NUMBER ONE PRIORITY.” — CATHY TAYLOR, EEN, MACARTHUR MENTAL HEALTH, CAMPBELLTOWN HOSPITAL Cathy Taylor and her colleagues at Macarthur Mental Health have benefited from mandatory nurse-to-patient ratios, won in the Association’s 2010 award campaign under the previous state Labor government. She believes ratios are still the major issue facing nurses in 2014 under the Liberal Coalition government. “We were lucky enough to get ratios in 2010 so we know what a major difference they can make,” said Cathy, an Endorsed Enrolled Nurse. “We got 11.8 extra staff when ratios came in, which made a huge difference to us. We now have time to properly assess patients for their mental state and degree of risk. “We need to campaign to have ratios extended to areas that still don’t have them. It’s a question of patient safety and preventing staff burnout. “Patient safety should be the number one priority, no more so than in mental health. There are still mental health areas at Campbelltown Hospital that don’t have ratios – for example, the child and adolescent ward, and the PECC unit [Psychiatric Emergency Care Centre].” Cathy agrees with the campaign’s focus on winning ratios rather than campaigning for a substantial wage increase. She describes the union’s claim for a 2.5% pay increase this year as modest. And she supports the NSWNMA’s decision to also campaign on a range of non-wage issues related to the defence of public health services. “Privatisation of health is a huge issue, including for nurses’ working conditions,” she says. “It started with aged care and now it’s moving to disability services and even mental health.”
T H E L A M P M AY 2 0 1 4 | 1 5
COVER STORY
“THERE CAN’T BE MANY PROFESSIONS THAT PUT THE WELFARE OF OTHERS BEFORE WINNING A PAY INCREASE.” — MARTIN GRAY, CNE, PRINCE OF WALES HOSPITAL The NSWNMA should fight for patient “specialling” to be made an award condition in order to prevent nurse-to-patient ratios being undermined, says Prince of Wales Hospital nurse Martin Gray. “I am glad the union has made this an award claim because some hospitals get around the ratios by specialling in the numbers, which can be downright dangerous,” says Martin, a Clinical Nurse Educator and vice president of the NSWNMA’s Randwick branch. “With specialling we are talking about caring for patients who are often confused – and by confused, I don’t mean forgetting about a $3000 bottle of wine, I mean at risk of falls, disorientated, sometimes physically or verbally aggressive. “Some are so unwell they need constant round the clock observation and probably should be in a high dependency bed. “Expecting wards to ‘special within their numbers,’ means one of two things. Either the other nurses not specialling get bigger patient allocations. Or the nurse specialling a patient is also allocated some supposedly ‘self caring’ patient. “He or she then has to delicately balance providing care to an acutely sick or confused patient, while still attempting to care for other ‘stable’ patients. “This can compromise patient care or, at the very least, leave the poor nurse stressed out and physically exhausted.” Martin believes the Association must build upon what it has already gained. “We need to expand ratios enjoyed by major city hospitals such as Prince of Wales, to other hospitals outside the metropolitan area. A medical ward is a medical ward and whether you are in Sydney or Wagga Wagga, you should get the same standard of care.” He says the priority given to ratios in the NSWNMA’s 2014 campaign “shows what nursing is all about. “There can’t be many professions that put the welfare of others before winning a pay increase. “Our claim for a 2.5% increase is the bare minimum, which barely keeps up with inflation.
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“Ratios have been the main feature of our last two claims. It shows the integrity of our profession that our main focus is the quality of patient care. “We need ratios to do the job properly so that patients have a safe, quality journey through hospital or in the community.” What does Martin say to government claims that the extension of ratios is unaffordable? “That’s where the Robin Hood Tax comes in – it would more than cover the cost of mandatory ratios throughout the health system,” he said, referring to the global campaign for a small tax or levy on speculative financial transactions to fund public services (see April Lamp, page 18).
“EVERYONE DESERVES THE SAME SAFE STANDARD OF CARE REGARDLESS OF WHERE THEY LIVE.” — MARIKA SEREMETKOSKA, CNC, CORONARY CARE UNIT, BANKSTOWN HOSPITAL For Bankstown Hospital nurse Marika Seremetkoska, winning legally enforceable nurse-topatient ratios for the emergency medical unit and medical assessment unit would be the single most important gain from the NSWNMA’s 2014 award campaign.
“We wouldn’t have to rely on a management decision to get adequate staffing and it would take the onus off nurses to have to argue for the staff we need to do the job.”
“It’s good the union is going for mandatory ratios in emergency departments because you never know what’s coming through the door and a lot of times there is not enough staff to cope,” says Marika, a Clinical Nurse Consultant in the Coronary Care Unit. “Ratios would be good for us in cardiology too, because our numbers would increase from 1:3 to 1:2 under the current union claim. If mandated it would guarantee our patients were allocated a nurse for a good amount of time.
Marika believes nursing-hoursper-patient-day should be standard across all hospitals, regardless of their grade and location. That’s why she supports the NSWNMA claim to bring staff levels in rural and regional areas up to the level of big city hospitals. “Everyone deserves the same safe standard of care regardless of where they live,” she says. She also endorses the union push to change the midnight census time, which is used to determine nursing-hours-perpatient for the coming day.
“Midnight is usually the quietest part of the day. We could get several admissions in the period between midnight and the start of afternoon shift. “By six in the morning there are probably three people in ED ready to come up to the ward but there are not enough nurses because staff numbers have been allocated according to the midnight census. “We then have to push for extra staff to provide the level of care patients need.” Marika wants the union to continue to make the community aware of threats to the public health system “because changes to the system will affect the general public as much as they will affect our employment status. “It is very important to keep getting our message out on issues like privatisation because the public are not as aware as you may think they are. We really need to be out there talking to people because a lot of the time they just don’t know the facts.”
“RATIOS ARE A WIN FOR EVERYONE.” — ZOE TONKIN, RN, BROKEN HILL Extending nurse-to-patient ratios statewide throughout the health service would be the most effective way of building and retaining the nursing workforce, says Broken Hill Hospital nurse Zoe Tonkin. “We need to keep campaigning for ratios because ratios will make people want to become nurses and stay in the profession, rather than running for their lives after six months because the workload is overwhelming,” says Zoe, who is secretary of the Broken Hill branch of the NSWNMA. She wants the NSWNMA to continue to spread the message that ratios will guarantee patients get the care they need in a safe manner.
“Ratios are a win for everyone: they mean shorter admission times and less likelihood of representations because patients have had the right care. “If we can guarantee our patients are safe and nurses are not being left at the coalface with too few resources to look after patients properly, it is going to put our profession in good stead for the future.” Zoe says Broken Hill Hospital is fortunate because its leadership has implemented ratios across much of the facility, even where they are not mandated. “We are lucky because our DoN is very proactive and, together with the executive, has embraced and supported
adequate nursing-hours-perpatient-day pretty much everywhere we needed them. “However if circumstances change then that policy could change. If ratios are not mandated there is no guarantee things couldn’t go backwards at some stage in the future.” Zoe says she is in favour of the NSWNMA continuing to campaign to protect the public health system from government attempts to undermine it. “Anything that is going to guarantee better health for our communities and fair availability of services regardless of financial circumstances, has to be a good thing. If we don’t fight to defend public health services, who will?” T H E L A M P M AY 2 0 1 4 | 1 7
STAFFING
Understaffing takes theatres nurses to breaking point Overworked theatre nurses are resigning from one of the state’s biggest hospitals due to serious understaffing.
JOHN HUNTER HOSPITAL’S (JHH) operating theatres are understaffed by up to 37 full-time nurses – far below the minimum requirement recommended by the Australian College of Operating Room Nurses (ACORN). That was the finding of a report that is now the focus of talks between theatre nurses, their union representatives and management. The NSW Industrial Relations Commission ordered the talks after nurses, frustrated by management inaction on staffing, voted to ban clerical and non-nursing duties. Bans were targeted at hospital income, not patients. They focused on clerical tasks – such as completing the form for the rebate of prosthesis – as well as duties supposed to be performed by theatre assistants, such as transferring patients, cleaning tables and handling garbage. Industrial action was on hold when this issue of The Lamp went to press, pending the outcome of talks and further commission hearings. The staffing report by Kerry Rodgers RN, an acknowledged expert on ACORN standards, found shortfalls in every category of nursing throughout the operating theatre complex, which includes theatres at JHH and Royal Newcastle Centre. The biggest shortfall was at JHH. ACORN standards are officially accepted as the levels that are safe and adequate. Ms Rodgers found that more than 200 full-time equivalent (FTE) nurses were needed to staff the facility according to ACORN 2008 standards. “Yet management are currently running the complex with 177 nurses – far less than the minimum required by the award,” Brett Holmes, General Secretary 1 8 | T H E L A M P M AY 2 0 1 4
of the NSWNMA said. “And they are running the nurses they do have into the ground. “They are at breaking point and ready to take direct action to protect themselves and their patients. “Staff members are being worked past the point of exhaustion. Their health and welfare is in grave danger and safe patient care cannot be guaranteed with workers half dead from fatigue.” Brett said nurses were being denied annual leave because of understaffing and some had resigned as a result. “Some nurses haven’t had a holiday or decent break in years. We’ve had cases of nurses quitting their jobs from sheer exhaustion just to get a break. It’s an insane way to run something as critical as an operating theatre suite and a disgraceful way to fiddle hospital budgets.” He said management had claimed funding for the correct number of nurses to run the operating theatres while not allowing for their full award entitlements to annual leave, sick leave and long service leave in their budgets. The NSWNMA branch at JHH voted unanimously to condemn the executive of the Hunter New England Local Health District and the Ministry of Health “for the deliberate manipulation of the formula used to calculate nursing staff requirements for operating theatres”. It was this, the branch said, that had caused the understaffing. The branch said it considered the practice of calculating staff levels according to Hunter New England Local Health District accounting practices a “sham arrangement designed to deliberately avoid” ACORN staffing requirements.
In an earlier dispute, industrial action by JHH theatre nurses forced management to recruit seven FTE nurses late last year. Bans on non-nursing theatre duties led to the dispute going before the Industrial Relations Commission, which ordered the LHD to fast track recruitment of the seven nurses. Theatre nurse Suzanne McKay, an alternate delegate for the NSWNMA branch, said the seven positions were fully funded but went unfilled for months until the issue went to the commission. “The seven nurses were finally taken on late last year, but since then five other nurses have left without being replaced,” she said. “The escalation plan is not being used, so when we are being hammered we are supposed to stop electives and keep going with trauma surgery. But it’s just not working. Morale is really low at the moment.” Suzanne said one of the theatre complex’s two nurse educators (NE) had gone on long service leave for two years without being replaced, leaving the other NE to try to do both jobs. “We also don’t have enough Clinical Nurse Educators (CNE) for the number of clinical staff. The CNE is also expected to run training programs outside the unit and to train medical and student medical staff. “That leaves the unit without an educator to support novice staff on the floor. They are doing their best, however, the support required to retain staff for the future just isn’t there. “It is unsafe to have so many juniors and new, inexperienced, staff without adequate senior staff and educators to support them.”
Leave refused John Hunter Hospital theatre nurse Suzanne McKay last had a holiday in April 2013 and won’t get another until January 2015. That will be 20 months without any time off from an extremely busy and demanding job. Suzanne applied to take leave in April, June and October this year but was knocked back all three times. “I am just one of many in similar situations,” she said. Another nurse in the dangerously understaffed theatre complex resigned and went to another hospital because she couldn’t get any leave to care for a sick relative. “I was talking to two senior nurses today who are also looking for other jobs,” Suzanne said. “We can’t afford to lose any more senior staff, but people are so down about the situation here. “Their clinical judgement on issues like staffing is just thrown out the door by our management, who don’t want to listen to what we’ve got to say.” She said an endorsed enrolled nurse doing RN training had originally been allocated enough leave to finish practical training this year.
“WE CAN’T AFFORD TO LOSE ANY MORE SENIOR STAFF.” — SUZANNE MCKAY “However management have just pulled several weeks of that nurse’s practical leave, to give to other staff, so it is uncertain if that nurse will be able to finish RN training this year as planned.” NSWNMA branch delegate and operating theatre nurse David Pfanner told the Newcastle Herald he had built up 400 hours of annual leave and knew of people with more than 1000 hours. “The mood in that unit could be described as at boiling point,” said NSWNMA General Secretary Brett Holmes. “It’s not just the exhaustion. People have families and kids. Their reward for being highly trained, skilled and committed theatre nurses at John Hunter is they never get to have a holiday with their children.” Suzanne said that following coverage of the issue in the Newcastle Herald, JHH management had allowed leave for one more FTE nurse, raising the leave allocation from six to seven FTE at any one time, for 180 staff. T H E L A M P M AY 2 0 1 4 | 1 9
STAFFING
Seeking safe operating room standards Almost 40 years after founding ACORN, nurses are still fighting to have theatres staffed according to national standards. THE FIRST STEP TOWARDS NATIONAL standards for perioperative nursing was taken in 1975, when 10 senior operating room nurses from across Australia met at St Vincent’s Hospital in Melbourne. They founded what eventually became ACORN – the Australian College of Operating Room Nurses – dedicated to harmonising the divergent state-based policies, procedures and practices of theatre nursing. Operating theatre nurses from New South Wales were represented at that initial meeting by Judith Cornell, a lifelong advocate for safe staffing, education of perioperative nurses and the development of nationally recognised standards to enable nurses to provide quality patient care. “Sadly, Ms Cornell passed away on April 14 2014, and perioperative nurses lost an articulate, passionate leader and mentor,” said Kerry Rodgers RN, a leading expert on ACORN standards and a perioperative nurse since 1985. Kerry is a Nursing Unit Manager in a Sydney hospital operating suite, a former president of the NSW Operating Theatre Association and a councillor of the NSWNMA. ACORN’s founders regarded perioperative nursing as an evolving specialty, becoming increasingly complex due to advances in areas such as anaesthesia, instrumentation and sterilisation. They
identified a growing need for nationally recognised standards. Today ACORN standards are accepted by hospital administrators, health ministries, law courts, industrial awards and the medical profession. Most importantly, perioperative nurses across Australia base their practice around ACORN standards to ensure the provision of safe patient care. The NSW Public Health System Award for Nurses and Midwives has incorporated ACORN staffing standards as the tool for staffing operating suites since 2004. However, the application of ACORN staffing standards varies from hospital to hospital depending on the strength and vigilance of the facility’s perioperative nurses and branch members, Kerry says. The NSWNMA recently commissioned Kerry to investigate operating suites at John Hunter Hospital and the Royal Newcastle Centre to determine whether they complied with ACORN 2008 staffing standards as set out in the nurses’ award. In preparing her report Kerry met with LHD management, interviewed senior theatre managers and nurses and reviewed current staffing and theatre schedules. She found that John Hunter Hospital’s operating theatres fell short of minimum award requirements (see story page 18), in part because they failed to adequately provide for leave relief requirements. “The ACORN 2008 staffing standard unambiguously states that ‘Replacement of Non-Productive Hours’ must be based on the award for each state and territory,” Kerry said. “It is disgraceful that in 2014 we are still fighting to provide staffing according
to ACORN 2008 standards in our public hospitals, despite the standard being recognised in the 2010 award.” The 2010 award incorporates the ACORN minimum of three nurses to each operating room. Kerry describes this as a bare minimum – ACORN recommends at least 3.5 FTE (full time equivalent) nurses in order to adequately educate and support novice perioperative practitioners, staff moving between specialities within the operating suite and undergraduate nursing students. ACORN staffing standards are underpinned by descriptions of various roles such as anaesthetic nurse, circulating nurse, instrument nurse and recovery nurse and set out education and competency requirements for each role. The minimum number of nurses required for procedures may vary depending on the complexity of the procedure and the acuity and fragility of patients. “Research shows that as technology in the perioperative environment advances, in areas such as minimally invasive surgery and robotics, patient outcomes are improved and length of stay is reduced,” Kerry said. “However, the research also proves that there is a commensurate increase in the workload of perioperative nurses to safely manage these new technologies. “ACORN standards are highly respected by law courts and some are used for hospital accreditation purposes. “ACORN staffing standards are not yet written into private hospital agreements but in the main the private hospitals are very aware of the standards and look to observe them as much as possible.”
“THERE IS A COMMENSURATE INCREASE IN THE WORKLOAD OF PERIOPERATIVE NURSES TO SAFELY MANAGE THESE NEW TECHNOLOGIES.” — KERRY RODGERS RN 2 0 | T H E L A M P M AY 2 0 1 4
Lismore management withdraws from arbitration Talks continue on nurse numbers in Lismore mental health unit.
“A REDUCTION IN STAFF WILL COMPROMISE THE QUALITY OF CARE THAT PATIENTS RECEIVE.” — GILLIAN TURNBULL
MENTAL HEALTH NURSES ARE CONTINUING to maintain staff levels at Lismore Base Hospital after management pulled out of hearings in the Industrial Relations Commission. The Northern NSW Local Health District wants to reduce nurse numbers in the Adult Mental Health Unit, despite a unanimous resolution from nurses warning that the move would be unsafe for patients and staff. The NSWNMA mental health branch voted to close beds to match the numbers of staff provided, if management ignored the warning and reduced staffing. This prompted the LHD to file a dispute in the commission. However management withdrew its dispute notice before the commission was able to arbitrate on the issue. A management representative said the LHD wanted to continue discussions with the union and mental health unit staff. Lismore Mental Health Branch secretary Gillian Turnbull said the branch, assisted by NSWNMA officers, had put together “a very strong case” to present to the commission. The union’s case included the fact that management had ignored its own Review findings which stated that it would be unsafe to reduce staffing due to the design of the facility. “As the LHD has backed down from the dispute, our staffing levels remain reasonable,” Gillian said. “The nurses’ position on the matter hasn’t changed. The patients’ welfare is our primary concern and nurses believe a reduction in staff will compromise the quality of care that patients receive. “Reducing staff in an extremely busy unit would result in unreasonable workloads for nurses and an unsafe environment for patients and staff.” Management claims the unit has too many nurses because it is staffed above award provisions. The NSWNMA says the award provision of six NHPPD (nursing hours per patient day) is not a target but a minimum. It should not be used to calculate staffing for high dependency unit (HDU) beds and patients who require a higher level of care. T H E L A M P M AY 2 0 1 4 | 2 1
PRIVATE COVER STORY HEALTH INSURANCE
Low income workers the new target of private health insurers At a recent national private hospitals conference in Brisbane, the federal minister for health Peter Dutton and the private sector seemed to be on the same page.
Private health insurers and providers are waxing lyrical about the opportunities available to them with the new Abbott government and they have low paid workers in their sights as a demographic to boost their profits. In a recent speech in Brisbane Ramsay Healthcare CEO and president of the Australian Private Hospitals Association, Chris Rex, said the way forward for private health insurers to “grow the pie” and extend their market share beyond the 47% of the Australian population they now hold was via employment-based health insurance to capture the low paid. “Lower paid employees right across Australia aspire to have health insurance (according to every survey) but can’t afford to buy it. So if we can come up with a vehicle that doesn’t cannabilise the existing 47% participation, doesn’t load up Australian industry with significant costs that make products or services produced here less competitive, doesn’t cost – importantly given the current fiscal circumstances – the government a huge amount more than what it is already contributing to the health sector, then we really do have a chance to not only address this situation but in a managed way,” he said “We don’t have to go out and find two or three million people – we just have to find 10,000 or 20,000 employers and there is a whole series of vehicles that we can use to do that.” Chris Rex went on to suggest that this agenda was progressing and had been discussed with the federal government with positive feedback. “So this is something that is actively being worked on … If we can get it right 2 2 | T H E L A M P M AY 2 0 1 4
“THIS IS THE WAY THAT WE CAN STOP THE FLOW OF PATIENTS INTO PUBLIC HOSPITALS AND TAKE BACK WHAT WE MIGHT REGARD AS OUR OWN.” — CHRIS REX, CEO RAMSAY HEALTH CARE
then there’s a real opportunity, given that we’ve got a government that understands the value of addressing this opportunity, there is a real chance that we can make significant changes to participation levels in this country.” THREAT TO MEDICARE NSWNMA General Secretary Brett Holmes says the introduction of employment-based health insurance would sound another death knell for Medicare. “If private health insurers are successful in working with the government to target low paid workers with a private health insurance option then the notion of Medicare as a universal heath scheme is dead,” he said. “Employment-based health insurance leads to a range of inefficiencies. In the long run we can be sure that the costs of such a fringe benefit will come out of employees’ take home pay. “A second major shortcoming of employment-based health insurance is that it is only temporary. It is tied to a particular job in a particular company and it is lost with that job. A family, already down on its luck over a job loss, will also suffer the loss of its health insurance. Workers may be forced to suffer unacceptable employment conditions for fear of losing health coverage.” In the United States employmentbased health insurance has had major negative consequences for the broader economy. The subsidy from General Motors to its employee health scheme is widely acknowledged as a key factor that contributed to the company’s bankruptcy.
EDs AND PRIMARY CARE Another target identified by the APHA president and Ramsay chief Chris Rex, for the growth of the private health industry was the expansion into private emergency departments. “The vast majority of private patients who end up in public hospitals do so because they go to a public hospital emergency centre. In most places in Australia the private system is woefully underrepresented in emergency medicine and we need to fix it,” he said. “This is the way that we can stop the flow of patients into public hospitals and take back what we might regard as our own.” In a speech to the same conference federal health minister Peter Dutton signaled his support for extending private health insurance involvement into the primary care sector. “They [private health insurers] have been excluded from the primary care space for historical reasons and if insurers are prepared to work collaboratively with doctors and patients then we should welcome that development,” he told the conference. CLOSE RELATIONSHIP In his keynote address to the conference Chris Rex referred several times to the warm and positive relationship between the private sector and the new Abbott government. He talked of the “long six years that my client and I did spend traipsing the halls of parliament meeting people who really did not want to meet us.”. “It is easy to gain access. It is a pleasure to discuss opportunities to grow this industry with this government,” he said. He also set out a roadmap for capturing further influence for the private lobby with the Abbott government. “We’ve got to get a seat at the table and significantly increase our representation on ministerial advisory councils, health workforce committees etcetera. Given the change of government at the federal level we are hopeful that we will have far more meaningful representation at this level. “So now we have a real opportunity to work constructively with the new federal government, which we certainly didn’t have for a number of years before that. “The response so far has been very, very positive and we will continue to pursue the issues that I have outlined today.”
“IF PRIVATE HEALTH INSURERS ARE SUCCESSFUL IN WORKING WITH THE ABBOTT GOVERNMENT TO TARGET LOW PAID WORKERS WITH A PRIVATE HEALTH INSURANCE OPTION, THE NOTION OF MEDICARE AS A UNIVERSAL HEATH SCHEME IS DEAD. — BRETT HOLMES, NSWNMA GENERAL SECRETARY
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PRIVATE HEALTH INSURANCE
Private health rebate: poor value, poor policy The Abbott government claims that health spending in Australia is unsustainable. Moves towards a greater user-pays system are being mooted as the way to finance our national health system, including an increased role for private health insurance. LOCAL AND GLOBAL EVIDENCE SHOWS THAT the more private health insurance is used to fund health care, the more expensive that health system becomes, without any improvement in the quality of care. This is according to a submission to the government’s Commission of Audit by the Centre for Policy Development, co-authored by John Menadue, a former Secretary of the Commonwealth Department of Prime Minister and Cabinet, and Ian McAuley, a lecturer in Public Sector finance at the University of Canberra. 2 4 | T H E L A M P M AY 2 0 1 4
According to the authors there is a strong case to be made that Medicare is a markedly more cost effective way of financing health than through private insurance. “In Australia only 84 cents in every dollar collected by private insurers is returned as benefits, the rest going to administrative costs and corporate profits. By contrast Medicare returns 94 cents in the dollar, even after the cost of tax collection is taken into account,” they say. “In the United States, which is so
highly dependent on private insurance, only 69 cents in the dollar comes back as payment for health services.” There are other reasons, they say, why private health insurance is economically inefficient. “Competing private insurers have little ability to control prices demanded by powerful service providers. By contrast a single national insurer, usually a government agency, has the market power to put some discipline into prices and utilisation.” The US is the standout example of cost
blowouts in a system dominated by private insurance: its health-care costs are 18% of GDP, well above the OECD average of 9%. In fact, because it has yielded control of the market to private insurance, the US government now spends around 9% of GDP on its limited government welfare programs – Medicare and Medicaid – more than most European countries pay for universal or public insurance. These programs cover a small minority of Americans, predominantly pensioners and the destitute. Menadue and McAuley say the lesson from overseas experience is that the conversation we should be having in Australia about health-care costs, concerns what we pay from our pockets and what we share. “Unless we are to have a truly unaffordable health care system, that sharing should be through Medicare.” LOWEST HEALTH SPENDING IN THE WORLD Jeff Richardson, foundation director of the Centre for Health Economics at Monash University, dismisses the claim that government health spending in Australia is unsustainable.
“COMPETING PRIVATE INSURERS HAVE LITTLE ABILITY TO CONTROL PRICES DEMANDED BY POWERFUL SERVICE PROVIDERS.” “The Australian government kicks in less, as a percentage of GDP, than just about anywhere that we would normally compare ourselves with,” he said. “But the low share coming from government is because there’s high out-of-pocket [spending],” he told the Sydney Morning Herald. At 6% of GDP, Australia’s level of government health spending ranks 23rd out of 34 OECD countries. By contrast, according to World Health Organisation figures, out-of-pocket expenses in Australia rose 17% as a share of private health expenditure between 2003 and 2011 – the second biggest increase of any OECD country. And the proportion of Australians who spent $US1000 or more out of pocket in the past year (25%) was second only to the US (41%), according to a 2013 survey of 11 wealthy economies by the Commonwealth Fund, an American NGO.
Five facts about private health insurance Private health insurers are not healthcare providers. They are part of the finance sector along with companies like Merrill Lynch, Citibank, AIG Insurance and Lehmann Brothers. The private health insurance industry gets $5 billion in government support each year in Australia. This “corporate welfare” towers over the subsidies of $6 billion over four years that were given to the car industry. The administrative costs of private health insurers including profit margin are about three times that of Medicare. Australians pay $2.5 billion per year towards private health insurers’ administration fees and profits. In Australia only 84 cents in every dollar collected by private insurers is returned as benefits, the rest goes to administrative costs and corporate profits. By contrast Medicare returns 94 cents in the dollar. A survey conducted by Roy Morgan research found that up to 90% of individuals, with an annual income above $100,000, held private health insurance. These numbers are largely attributable to incentives to wealthier Australians to opt out of Medicare. Menadue and McAuley describe this as “akin to local government subsidising people to live in gated communities”.
Private insurance not the same as private hospitals A major misunderstanding in the role of private health in our overall health system is the tendency to conflate private health insurance with private hospitals. They are not the same thing. You don’t have to have private health insurance to use a private hospital, point out John Menadue and Ian McAuley. “One myth in Australia, a myth convenient to insurers, is that one must hold private insurance to be served in a private hospital. In a survey in 1998, the Australian Bureau of Statistics found that 25% of people with private health insurance held it because they believed they needed it to be treated as a private patient. “What this means is that the private hospitals, in the public mind at least, have tied their fortunes and survival to the fortunes of private insurance. Any criticism of private health insurance is construed as a criticism of ‘the private sector’.” Private hospitals would be up to $2 billion a year better off if part of the subsidy was paid directly to them by the federal government and not via high cost financial intermediaries like private insurance companies. There is a precedent for this alternative method of funding. The money to pay the health costs of Australian war veterans comes from the Department of Veteran Affairs and goes directly to a veteran’s choice of hospital, whether public or private. Two thirds of veterans choose private. Medicare once subsidised private hospitals, before subsidies were withdrawn, and McAuley and Menadue argue that these subsidies should be brought back. “They should be restored as a means to promote cooperation, rather than competition between public and private hospitals. It would be much better than churning the money through high cost private health insurance.” T H E L A M P M AY 2 0 1 4 | 2 5
PRIVATE HEALTH INSURANCE
Minister flags dramatic changes to health It’s not what we were told before the federal election, but increased privatisation, competition and user-pays are clearly on the Abbott government’s health agenda. IT BEGANWITH PROPOSALS FOR “MODERATE” changes to Medicare such as co-payments for GP and ED visits. Federal health minister Peter Dutton has since indicated that there are other more substantive changes in store. “In our public hospitals dramatic improvements in productivity and efficiencies, that are part and parcel of the private sector, are essential,” he told the journal Health Voices. “The public [health] sector can no longer be shackled by archaic practices that deliver the waiting lists that leave tens of thousands of Australians in pain and unable to access a service for extended periods of time. “The health care system as a whole must be open to the innovation and the bold new ideas that come from the private sector.” Peter Dutton has also voiced clear support for the greater involvement of private health insurers in primary care. “It seems sensible to me that private health insurers may want to involve themselves in the primary care of their members, particularly those with chronic disease and considerable needs for medical care or treatment,” he said. Both the ALP and the Greens say this is a major step towards the dismantling of Medicare. “Allowing insurers to cover general practice services will take the lid off the price of a doctor’s visit and everyone will end up paying more,” said Greens spokesperson Richard di Natale. “Private health insurance would become a necessity to see a GP, yet insurance premiums will skyrocket.” 2 6 | T H E L A M P M AY 2 0 1 4
The move by private health insurers into the delivery of primary care is “something Labor opposes as a matter of principle” says the ALP’s shadow health minister Catherine King. “For the millions of Australians who choose not to or cannot afford private health insurance, such a scheme would almost certainly be to their detriment. “Guaranteeing a level of access to health services for those who can afford it, while neglecting to improve services for Australia’s most marginalised, is the exact opposite of what Medicare is intended to do,” she said. PRIVATISING EDs These are not the only radical changes to public health and Medicare that the Abbott government is considering. It has made clear that health and disability care will be a central part of its “competition review”. The Guardian reports that review chair Professor Ian Harper has nominated funding rules covering accident and emergency services, as an example of what may be under consideration. “States are funded to deliver accident and emergency services in a way that gives public hospitals an incentive to demand to know whether you are privately insured and then treat you while charging the private insurer for the service,” he said. “A more level playing field might give the private sector more access to emergency rooms, perhaps by removing the prohibition of private insurance covering emergency care.”
What they have to say about private health insurance “Private insurance is in our DNA. It is an article of faith for the Coalition.” — Tony Abbott, Prime Minister. “The $5 billion corporate subsidy to private health insurance via government-subsidised premiums is one of the worst pieces of public policy it is possible to imagine.” — John Menadue, former head of the Department of Prime Minister and Cabinet and a former General Manager of News Limited. “Private health insurance is a competitor for Medicare. In the long run, community rated private health insurance cannot succeed unless Medicare fails, or at least becomes a third class system.” — Professor John Quiggin, economist and Australian Research Council Fellow. “PHI is essentially a privatised tax, collected by NIB, HCF or Medibank Private, rather than by the Australian Taxation Office, to fund our shared health care needs. We need to see PHI for what it is: an industry with a high bureaucratic overhead and with every incentive to see its market expand, rather than as part of our health care system.” — Ian McAuley, a Fellow at the Centre for Policy Development, specialising in health policy. “The $5 billion used to subsidise private health insurance should be redirected to our public hospitals. The rebate did not increase the uptake of private health insurance and did not relieve pressure on public hospitals.” — John Dwyer, Emeritus Professor of Medicine at the University of New South Wales.
Nine failures of private health insurance
12 3 45 6 78 9 IT FAVOURS THE WEALTHY IN THE CITIES Households in the top 20% income range spend four times as much on private health insurance (PHI) as the lowest 20%. Only 26% of private hospitals are outside the large cities. Prosperous urban dwellers are being subsidised by less well-off people in rural and outback Australia.
IT INCREASES THE USE OF HEALTH SERVICES The Productivity Commission found that PHI led to doctors treating and prescribing too much.
IT WEAKENS MEDICARE’S CAPACITY TO CONTROL COST AND QUALITY An OECD report found that in Australia “private funds do not exercise control over the quantity, quality and appropriateness of care provided. By contrast the Commonwealth, as the single buyer of pharmaceuticals under the PBS has been remarkably successful in containing costs.”
IT FAVOURS FINANCIAL INTERMEDIARIES The administrative cost of private health insurance funds include profit margins (16%) that are about three times that of Medicare (5.7%).
IT DOESN’T TAKE PRESSURE OFF PUBLIC HOSPITALS On the contrary it allows private hospitals to poach highly professional staff away from public hospitals, often at four to five times the rate of remuneration.
IT OPENS UP NEW AREAS OF DEMAND For example, increased and excessive rates of joint replacements.
IT HAS POTENTIALLY NEGATIVE CONSEQUENCES FOR THE WIDER ECONOMY In the United States, the subsidy by General Motors to its employees’ health scheme contributed to the company’s bankruptcy and there is widespread personal bankruptcy when people can’t afford to pay their medical bills.
IT MAKES US FEAR THE FUTURE Advertising is aimed at creating uncertainty. An Australian Bureau of Statistics health insurance survey revealed that “security, protection, and peace of mind” are twice as important as choice of doctor in decisions to hold private health insurance.
IT IS A DISHONEST AND INEFFICIENT WAY OF PROMOTING CHOICE Private hospitals in Australia would be up to $2 billion a year better off if part of the 30% private health insurance subsidy was paid directly to them and not to high cost financial intermediaries.
T H E L A M P M AY 2 0 1 4 | 2 7
CLIMATE CHANGE
Agents of change Hospitals are one of the largest contributors to climate change, a recent NSWNMA environmental health seminar heard, and nurses have a role to play in advocating for sustainability. REGISTERED NURSE TERESA LEWIS WOULD like to see “climate literacy” introduced as a mandatory requirement for all clinical education. Teresa, a Masters in Environmental Change Management, is in her final year of completing a doctoral thesis on climate-friendly hospitals at the University of Wollongong. “We need to know what we’re talking about when we go on to be informed advocates for our patients,” she said. “It’s no good talking about adverse weather events when we don’t know the appropriate language to use. “Our line of work is a wonderful vocation. We get to be advocates for our patients and we get to assist them in their hours of need. “We are definitely agents of change and, despite the workload we have to endure, we always seem to get things done, we are born leaders. “That’s why the World Health Organisation (WHO) and Health Care Without Harm (HCWH) are calling upon our profession to lead the way in trying to change mitigation strategies in our organisations.” 2 8 | T H E L A M P M AY 2 0 1 4
Teresa defines a healthy hospital as one that: “Contributes not only to the welfare of its internal community, but also takes responsibility and a leadership role in the prevention of harm to all of its external environments.” Hospitals are big energy consumers and hospital energy audits are becoming more common. “You can’t monitor what you can’t measure. If you want to conduct anything in your unit or ward please do a little audit on it first.” In two years, a regional hospital at Hervey Bay in Queensland reduced energy consumption by 20%, equivalent to taking 600 cars off the road, through auditing and then improving their lighting, looking at air conditioning and upgrading their computerised management system. Australia is a quiet achiever in green building codes with a national, built environment, rating system covering energy, water, waste and indoor environments. It is already applied in New South Wales to schools, hospitals and child support systems. Alternative energy generation in hospitals is already producing environmental
and financial benefits through the use of solar panels and gas-fired generators. “We’re beginning to see solar panels on the sides or roofs of hospitals that can provide up to 90% of energy for that hospital,” Teresa said. “Biomass boilers are being installed which can add the potential of cutting energy bills in half.” New hospitals are being built closer to public transport systems and the Australian Capital Territory is trialling electric ambulances. Yet nurses and other hospital workers still require access to transport when working unsociable hours. Food also needs to be addressed by hospitals, from its transport to its procurement from industrialised food systems that rely heavily on petrochemicals for food processing. Plastics account for one third of health care waste and a quarter of that is polyvinyl chloride (PVC). This includes PVC tubing, masks and more than 50 million IV fluid bags used every year. Hospitals in New South Wales and Victoria have launched a PVC recovery system in collaboration with the Vinyl Council of Australia, which has turned almost 15,000 kilograms of hospital PVC
Nature alone cures
Collaboration between the World Health Organisation and Health Care Without Harm has defined seven key elements to creating a healthy hospital: • energy efficiency • clean building design • alternative energy • transport • food • waste • water
Teresa Lewis, RN
waste into industrial hoses and non-slip floor mats. Hospitals are high volume water users and Australian hospitals are beginning to adopt water saving strategies. “Stop sensors on taps will be coming to your district soon,” Teresa Lewis told the NSWNMA. “Other measures coming your way are clean water harvesting, with water collected from roofs and car parks of hospitals and flowing to underground water containers. Teresa says nurses are seen as having an obligation to individuals and communities, particularly when it comes to instances brought about by adverse weather events. “What if you have an asthmatic patient and the only ventilation he has in his house is cross ventilation? He’s been admitted to your ward, he’s better, he goes home to a
drought stricken area, the only possible way of living in cool or fresh air is to open his windows for his cross ventilation. But he can’t do that because there’s a dust storm coming. Mr Jones is soon back in hospital because we haven’t assessed his case holistically.” But if nurses are to holistically address individuals like Mr Jones, or the key elements for green hospitals, they need appropriate frameworks “We’re all really passionate when we want to promote change but we often expect people to share our enthusiasm and it doesn’t often work that way. Reactions can vary from engagement to sheer hostility that causes added stress to the already stressful profession we work in. “Changing behaviours isn’t going to be easy – but we all have to start somewhere.”
Since Florence Nightingale nurses have led the way in recognising that nature plays a significant role in healing. She said: “It is often thought the medicine is the curative process. It is no such thing. Medicine is the surgery of functions, a surgery of limbs and organs. Neither can do anything but move obstructions, neither can cure. Nature alone cures.” “I don’t know if, as Florence Nightingale said, nature alone cures,” Teresa Lewis told the NSWNMA seminar on environmental health. “But it definitely has played a significant role in our history of healing and it’s going to continue to do so in the future.” Today, nursing organisations throughout the world are at the forefront of the call for recognition and action to stop climate change, in the interests of the health of their patients: “The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.” — International Council of Nurses “All health facilities should set goals and targets in relation to the reduction of general and clinical waste; energy usage; water and resource consumption; and levels of pollution generated by the facility.” — Australian Nursing and Midwifery Federation “Climate change poses many challenges for nurses and midwives in light of the impact on people’s health and on health systems and health care delivery.” — NSWNMA NSWNMA POLICY IS TO: • Support and participate in measures to mitigate the impact of climate change on the population, with a focus on groups particularly vulnerable to disease and injury, including the socially isolated, the elderly, the poor and those without access to primary health care. • Support purchasing decisions that favour energy efficient and environmentally sustainable products for use in health services. • Be involved in initiatives that raise awareness of the health implications of climate change. • Co-operate with other health profession organisations and non government organisations to exert pressure on governments to implement policies that address climate change.
T H E L A M P M AY 2 0 1 4 | 2 9
RURAL HEALTH
Nurses can help drought-affected farmers Nurses are being asked to start a conversation with farmers in their care in a bid to combat stress and prevent suicide.
NEEDING TO LEAVE THE FARM FOR TREATMENT CAN add to the severe stress being suffered by the state’s farmers due to drought – and nurses are being asked to be vigilant for signs of vulnerability. As a member of the New South Wales Farmers Mental Health Network (NSWFMHN), the NSWNMA is urging nurses to look more closely for signs of depression and stress in their patients from the state’s drought stricken areas. Despite recent rains 60% of New South Wales remains in drought. Men living outside major cities have a 33% higher rate of suicide than their inner city equivalents, according the Australian Institute of Health and Welfare. Drought and its associated pressures compound existing suicide factors such as stress and anxiety. The FMHN brings together key stakeholders in the area of rural mental health to discuss how best to address rural and remote mental health issues. Part of the job of the network is to raise the profile of issues affecting farmers, including drought. “The network is about helping the various stakeholders to understand the issues being faced by farmers and people in rural communities,” policy director for NSW Farmers, Angus Gidley-Baird, told The Lamp. But farmers, typically stoic, are often reluctant to admit to having mental health issues and accept treatment. “There are government programs with resources in place but that doesn’t always work because you need to have people that are trusted and involved, particularly around the area of mental health,” Angus said. “No one is going to walk into a shop with a glowing sign that says mental health services because all their mates might be looking from the other side of the street.”
He says many farmers in drought areas are on a treadmill and can see no way off. But being forced to leave the farm for treatment of a serious injury or illness can, ironically, break this cycle. “Ask a farmer how’s he’s doing and he’ll say he’s getting by. He’ll tell you, ‘I get up in the morning I check the water I feed the stock; at night I check the water, I go to bed. “He’s reluctant to leave the farm because he worries about who’s going to do the work. When your cash income is down you focus on the farm. Suddenly all the other things like personal health are pushed aside. “Like if you cut yourself, rather than travel somewhere to get stitches you’ll say ‘oh I’ll put a bandage on it’. You’re isolated and that becomes your entire life.The risk of injury definitely tends to go up when your mind’s not on the job. “People may be relocated to major regional centres or cities to get treated and suddenly they’re away from the farm, they’re away from what they need to be doing, they feel more guilty for being in hospital receiving treatment than if they were at home. “While being more difficult it also creates an opportunity for farmers, who are generally reluctant to say anything, to share the pressures they are facing. “Nurses can help by starting a conversation with them.” Angus said. It is as simple as asking how they are going. A stranger showing some concern for their situation helps break down some of that feeling of isolation. “Tell them ‘the work you do is very important and everyone here respects what you’re going through’. Once a conversation has been started, people may take up a number of the local on-ground services to keep the conversation going.
For more information on the Farmers Mental Health Network got to www.aghealth.org.au. For advice on how and when to initiate an intervention conversation on suicide go to conversationsmatter.com.au
3 0 | T H E L A M P M AY 2 0 1 4
FARMERS, TYPICALLY STOIC, ARE OFTEN RELUCTANT TO ADMIT TO HAVING MENTAL HEALTH ISSUES AND ACCEPT TREATMENT.
Rural suicides outstrip capital cities A Productivity Commission report earlier this year found that rates of mental illness and suicide remain dramatically higher for men, in rural areas and in indigenous communities. Between 2007 and 2011, 11,600 deaths by suicide were recorded in Australia. The suicide rate between 2007-2011 was higher in rural areas, with 13.1 suicides per 100,000 people compared with 9.6 in capital cities. The suicide rate was much higher for males, equivalent to 16.5 per 100,000 males, compared with 4.9 for females. For those aged over 75 to 84, and 85 years or over, the male suicide rate was about five or six times the female rate. The Northern Territory had a dramatically higher suicide rate than other states and territories, with more than 20 deaths to suicide per 100,000 people. Rates in NSW, the ACT and Victoria were all under 10. The national rate of suicide among Indigenous Australians was 22.3 per 100,000 compared with 10.3 among non-Indigenous Australians. The state with the largest gap was Western Australia which had 35.9 suicide deaths per 100,000 Indigenous Australians compared with 12.2 non-Indigenous.
T H E L A M P M AY 2 0 1 4 | 3 1
STATEMENT REGARDING HEALTH INDUSTRY PLAN (HIP) The NSWNMA is withdrawing from its position as a shareholder of the national industry-based superannuation fund, Health Industry Plan (HIP) and has formally relinquished its sponsoring organisation status. HIP is an industry super fund for employees in the private health sector. As the major representative body for employees in the sector, the NSWNMA has for many years recommended suitable employee representatives to the board of the trustee of HIP. In recent months HIP flagged its intention to merge with Prime Super — an industry fund for primary industries. This prompted the NSWNMA to consider its position as a sponsoring organisation. In December 2013 the NSWNMA Council took a decision to discontinue its role in recommending representative board members for the new, merged fund. The Council took the view that the new, merged fund was not a good fit with the purposes and objectives of the NSWNMA. The NSWNMA-nominated directors remain on the HIP board, and will do so until the two funds merge on 1 May, 2014, when they will no longer hold any positions in the merged entity. It has recently been announced that the former Chair has been removed from the Board and two other members of the HIP board have stood aside and also that the former CEO was dismissed. This followed preliminary investigations by the Australian Prudential Regulation Authority (APRA) into corporate expenses. NSWNMA General Secretary Brett Holmes says he wanted to emphasise that there is absolutely no suggestion that the three board members recommended by the NSWNMA are implicated in the concerns that led to the removal and standing aside of the other board members. “In fact, the three NSWNMA nominees are the only board members now remaining, following these events,” he said. “Those directors the NSWNMA nominated continue to serve diligently and they are working hard to make sure HIP operates in the best interests of its members. “Once the merger with Prime is complete and formalised, our nominees will discontinue, as we decided some months ago. Prime Super will be responsible for selecting suitable independent directors to represent the interests of health worker members of the merged fund. We wish the merged super fund well and trust it will protect the interests of the hard-working nurses and other health care workers who contribute to the fund.”
3 2 | T H E L A M P M AY 2 0 1 4
ASK JUDITH Pay deducted without permission I am a nurse working in the public health system. When I received my last pay slip the pay office had deducted a significant amount, leaving me unable to meet my financial commitments. When I rang I was advised I had been overpaid an allowance over a period of 12 months. Is the employer allowed to deduct the money from my pay without my permission? No, there are two documents that clearly lay out the procedural requirements for recovering overpayments. Firstly, a claim by the employer that you have been overpaid should always be checked. Secondly some overpayments may not be able to be recovered by the employer. Where recovery of an overpayment can occur, the NSW Health policy directive PD 2009_015, and the Public Health System Nurses’ and Midwives (State) Award 2011, clause 27, “Payment and Particulars of Salaries�, sub clause (v), part (b), provides guidance on the process to be followed. In brief the details are: You must be notified in writing, detailing circumstances surrounding the overpayment, the amount, and when recovery is to commence. One off overpayments can be deducted from the next normal pay, except where the employee can demonstrate this would cause undue hardship. Recovery will then be at 10% of the employee’s gross fortnightly base pay. The maximum rate for recovery of cumulative overpayments is equivalent to 10% of the employee’s gross fortnightly base pay, unless the employee agrees otherwise. The employee can elect to pay higher repayments or a lump sum, however if the employee can demonstrate that undue hardship will occur the 10% may be reduced by agreement. If an employee resigns or terminates
before the full overpayment is repaid, the balance of monies still owing can be deducted from the employees termination pay. The Local Health District chief executive or their delegate has discretionary powers in respect to recovery of overpayments. If you have problems in resolving this issue please contact the Association for assistance.
Roster has insufficient breaks I am employed in a New South Wales public hospital and our nurse manager (NM) interprets the Award so she can roster nursing staff up to a maximum of seven consecutive shifts, regardless of the start and finish times of those shifts. For example, the NM regularly rosters us for a combination four x 10-hour night shifts, followed by three day shifts, without days off in between. This is a regular rostering pattern in our facility. Does this meet with award requirements? No. Because your nurse manager is not allowing for a 20-hour break between changing from night duty to day duty she cannot put out a roster as you have described. Clause 4, “Hours of Work and Free Time of Employees Other Than Directors of Nursing and Area Managers, Nurse Educationâ€?, sub clause (xv) of the Public Health System Nurses’ and Midwives’ (State) Award 2011, states; â€œâ€Ś an employee changing from night duty to day duty or from day duty to night duty shall be free from duty during the 20 hours immediately preceding the commencement of the changed duty.â€? The award is specific on the rostering requirements in respect to breaks between shifts, and I suggest you and your colleagues read the above clause in full. If you find your rosters are not conforming to the award requirements you need to urgently bring this to your manager’s attention and, if they will
Rafflee 2014
When it comes to your rights and entitlements at work, NSWNMA Assistant General Secretary JUDITH KIEJDA has the answers.
not change the rosters accordingly, contact the Association and speak to one of our Information Officers.
Extra work must be approved I am a full-time nurse in the public health system and am thinking of working on a casual or part-time basis at the local nursing home. My manager has told me I need to seek official approval before accepting additional alternate work, is this correct? Yes this is correct, you must seek the approval of the CE or his/her delegate before accepting outside employment as per the Code of Conduct; PD2005_626, clause 2.4: “If I work full-time in a Health Service and want to undertake another paid job or participate in other business activities (including a family company or business) I will seek the approval of my Health Service Chief Executive or his or her delegate. If there is any real, potential or perceived conflict of interest, I will put the duties of my Health Service job first or reach an agreement on ways to resolve the conflict.�
Bullying ignored I am a nurse working in the private sector and have made a formal complaint to my employer in regard to bullying behaviour, but my employer has dismissed my complaint without a proper investigation. What can I do? You should contact the Association who will approach your employer and request them to investigate the complaint via an appropriate bullying complaints process. If you work in the private sector (private hospitals and aged care), the Association can take your bullying issue to Fair Work Commission (FWC), who can make an order against your employer to prevent you from being bullied at work. FWC will look at the way your employer has or has not investigated your complaint and must be satisfied any investigation was conducted “rigorously, impartially and independently�.
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The Edith Cavell Trust
Scholarships for the academic year 2015 Applications for the Edith Cavell Trust Scholarships are now being accepted for 2015. Members or Associate Members of the NSW Nurses and Midwives’ Association or the Australian Nursing Federation (NSW Branch) are invited to apply. Applicants should meet one of the following criteria: 1. Student nurses undertaking full-time courses leading to initial registration as a nurse or midwife. 2. Registered or enrolled nurses who wish to attend:
an accredited clinical nursing education course of six months or less, either full-time or part-time; an accredited nursing conference or seminar relevant to applicant’s clinical practice. 3. Properly constituted nursing organisations, faculties or schools of nursing or registered or enrolled nurses wishing to: attend full-time, relevant postbasic studies at an approved institution for a period or periods of more than six months;
undertake an academically approved research program in the theory and practice of nursing work; conduct or fund a relevant professional or clinical nursing educational program. Applicants must be currently
registered with the Nurses and Midwives Board of Australia. Applicants must use the official Edith Cavell Trust application form. Details of the Edith Cavell Trust Rules are available on request and will also be supplied with the application form.
For further information or forms, contact: The Secretary – The Edith Cavell Trust 50 O’Dea Ave, Waterloo, NSW 2017 T Mrs Glen Ginty on 1300 367 962 E gginty@nswnma.asn.au W www.nswnma.asn.au – click on ‘Education’
Applications close 5pm on 31 July 2014
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Get lost in Singapore
Are Are your workmates or friends members of the NSWNMA? Why Why not ask them. And, if not, invite them to sign up. up. Like Like you, they need the security of belonging to a strong and dynamic dynamic union. Not only will you be building your union by by signing up new members, you and a friend could win this fabulous holiday to Singapor Singapore. e. The more more members you sign up hances you have have to win! up,, the mor moree cchances The prize includes rreturn eturn airfar es for tw airfares twoo from Sydney with Scoot Airlines; 5-nights accommodation at the Shang ri-La Hotel, Shangri-La Singapor e; Attr actions Pass for 2; and taxi Singapore; Attractions tr ansfers from airport rreturn. eturn. transfers Remember ffor or every every new member you recruit/ha recruit/have ve recruited from 1 Jul Julyy 2013 to 30 June 2014 means you will ha have ve your name submitted to the dra draw. w.
RECRUITERS NO NOTE: TE: Nurses and midwives can now join online aatt www.nswnma.asn.au! www .nswnma.asn.au! .nswnma.asn.au If you refer a new member to join online, make sure you ask them to put your name and workplace on the online aapplication pplication form. form. You You will then be entitled to your vouchers and dra draw/s w/s in the NSWNMA Recruitment Incentive Scheme.
One of best wa ways ys to discover the Real Singapore Singapore is to do as the locals do. And one of the simplest wa ways ys is to get of offf the beaten beaten track and venture out to the suburbs (or heartlands as the theyy are called) to dine where most locals dine. There are numerous ha hawker wker centres and cof coffeeshops, feeshops, where the food food is fantastic and you can experience the noise, vibrancy and bustle of local life. Enjoy a wide selection of the best local delights such as chicken rice, pork ribs soup, fried hokkien mee and more. Trust Trust us, all the tra velling is well worth it as soon as you take a bite. Go to travelling www .yoursingapore.com/getlost www.yoursingapore.com/getlost Loca ted in the heart of the city ri-La Hotel, Singapore Singapore is just Located city,, Shang Shangri-La a short walk to the city’ city’ss main shopping, entertainment and dining district. The hotel is well situated situated within Singapore’s Singapore’s extensive network of buses and trains, and it is only only a 10-minute drive to the CBD and 30 minutes to Changi Changi International International Airport. Contact www .shangri-la.com/singapore www.shangri-la.com/singapore Introducing Australia’ Australia’ss newest low cost airline flying direct to Singa pore from Sydney Sydney and the Gold Coast. If you are looking Singapore ffor or the most cost ef fective way way to Asia, fly scoot and sa ve loot. effective save Book now aatt www.flyscoot.com www.flyscoot.com
VA L E
Natalie Ann Barby 1975 — 2013
[e\ The staff at Condobolin Health Service were shocked and saddened to hear of the passing of their colleague and friend Natalie Ann Barby, in September last year. Nat died after a short illness in the Orange Base Hospital ICU, surrounded by her family. She was 38 years old. Nat had many talents, not the least of which were her magnificent cream puffs and her skills as a brilliant cartoonist. She was even known to despatch the odd snake around the hospital! She travelled widely with her mother and her sisters and packed much into her short life. She quietly endured a chronic illness for the latter years of her life without complaint. Often, when she was at work, she would have been the sickest person in the hospital but she always delivered professional and supportive care to those in her charge. She joined our staff in the early nineties after completing her training as an EEN. The three most important things in her life were her family, her farm and her work colleagues. She looked on us as part of her extended family and we looked on her as another member of our own families.
The nursing staff considered it a privilege to be asked to take part in her funeral service, with Jill Brady and Lynne Hawley delivering eulogies and Wendy Sullivan and Pam Browne acting as pall bearers. Other members of the hospital staff, past and present, formed a guard of honour outside the church and at the cemetery. We deal with death on a daily basis – it is part of our job, part of what it means to be a nurse. But to lose one of our own, so young, so vital and still so active in our nursing environment was hard for the nurses to reconcile with. We consider Nat to be one of the most honourable nurses that we have ever had the privilege to work with. The following quote, read as part of Natalie’s eulogy, certainly summed her up: “As we walk through life we share the road with many people. Some smile as they pass, and are gone. Some touch our hands and walk with us for a time, and according to the degree of involvement, so our lives are influenced by each and every contact. Sometimes just a brief encounter, or an interlude soon forgotten. Sometimes, an impact so profound our lives are never quite the same again.” Natalie Ann Barby was certainly one of the latter.
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SOCIAL MEDIA
NURSE UNCUT
WHAT’S
HOT
A BLOG FOR AUSTRALIAN NURSES AND MIDWIVES
THIS MONTH
www.nurseuncut.com.au Do you have a story to tell? An opinion to share? nurse uncut is written by everyday nurses and midwives. Send us your ideas at nurseuncut@nswnma.asn.au
Nurse Uncut is also on Facebook: www.facebook.com/NurseUncutAustralia and on Twitter @nurseuncut
The scream – Finn’s new grad diary www.nurseuncut.com.au/the-scream-finns-new-grad-diary-2
Finn has finally commenced work as a new grad – and she’s already reached screaming point.
New grads need jobs! www.nurseuncut.com.au/grads-need-jobs
The federal government is reviewing regulations around bringing in offshore workers – the Australian Nursing and Midwifery Federation argues that jobs for new grads must come first.
New art for the NSWNMA www.nurseuncut.com.au/special-new-art-for-the-nswnma
Aboriginal inmates at Long Bay created five large paintings for our Gadigal auditorium at the NSWNMA offices in Waterloo.
Strength in numbers www.nurseuncut.com.au/strength-in-numbers
With 233,000 members the Australian Nursing and Midwifery Federation is now one of the Australia’s largest and strongest unions.
Six Q+As about funding Medicare www.nurseuncut.com.au/six-qas-about-funding-medicare
Is Medicare really unsustainable? Get the facts!
The minefield of Zoe’s Law www.nurseuncut.com.au/the-minefield-of-zoes-law
Coral Levett argues that a new bill has the potential to undermine women’s rights in New South Wales.
New on SupportNurses YouTube channel filmmaking workshop Nurses got creative at a NIDA workshop. > youtu.be/LcNiHuHnEpA newcastle community forum Hundreds came to discuss the privatisation of disability services. youtu.be/1ibBzRJqX38
NSWNMA on Instagram! Yes, we’re on Instagram, so share your local photos with us @nswnma and #NSWNMAforce4change.
Follow us on Twitter NSWNurses & Midwives @nswnma Watch us on YouTube SupportNurses Connect with us on Facebook
New South Wales Nurses and Midwives’ Association >> www.facebook.com/nswnma Ratios put patient safety first >> www.facebook.com/safepatientcare Aged Care Nurses >> www.facebook.com/agedcarenurses T H E L A M P M AY 2 0 1 4 | 3 9
It’s time
to scrub up for 2014! To orderr, fax the order form to Glen Gintyy, (02) 9662 1414, post to: NSWNMA, 50 O’Dea Avenue, venu v Waterloo NSW 2017 or email gensec@nswnma.asn.au
Order your NSWNMA campaign scrub unifor uniforms ms for conference and rally times, and make an impression!
Merchandise order forms also available on
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63
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55
59
63
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72
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103
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114
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NURSES & MIDWIVES
SAID & LIKED on facebook www.facebook.com/nswnma Dear diary Finn’s new grad diary on our Nurse Uncut blog struck a chord!
The graduates Everyone was in loud agreement with the Australian Nursing and Midwifery Federation that new grads must get jobs before regulations are relaxed to allow more workers in from overseas.
Revving up for ratios The ratios campaign, especially in the country, is revving up again.
Nurses silenced An NSWNMA stall at Maitland’s Steamfest was closed down by local politicians for being “too political”.
PHOTO GALLERY
Ryde was one of 205 branches which voted yes for our 2014 PHS claim.
Thanks so much for this, it was a great read. It’s nice to know others out there are going through the same emotions and struggles as I am. Reading Finn’s struggle makes me think that an employed year as an undergrad with less responsibility would still be a help, the ability to time manage takes time to develop. I am sure that will be me, a hopeless hot mess when I start in May! Lol I’m an “old” grad and I agree wholeheartedly. We should be looking after our homegrown nurses first. They deserve jobs and we need them. I’m an EEN in a rural community and have been out of work for 18 months while the hospital runs on skeleton crews and the nursing home is going down the gurgler! The doctors don’t have it any easier. And now you want overseas workers so you can pay them less and Australians suffer? Get a grip on reality! Nurses in the Hunter are overworked and pushed to the limits, nurses have to work short staffed as no appropriate replacements found, some are suffering from fatigue and unable to take annual leave as not enough staff to replace [them], patients are moved around the hospital multiple times to accommodate emergency admission times set by uncaring government, placing patients at risk. Aged care needs better ratios as well. Despite what people may think of Sydney hospitals, we are struggling too. Our emergency paediatrics often has one nurse to 12 patients with no extra staff. Not just in paediatrics but all across the department. Although yes we do have more resources, we are still struggling to cope with the increasing number of presentations. I can’t imagine how hard it would be for you guys out country. [Metro hospital, 2km from Sydney CBD.] I’m sure the public would be in uproar if they understood what this meant. Every day and every shift is a different nurse/patient ratio. Safety needs to be considered more often. Patient safety is relevant no matter what party is in power, it’s not political, it’s needed. Anyone who is in hospital or has a loved one in hospital wants a nurse who has the time and expertise to do their job properly. That does not change whether they vote for one party or another. I thought it was disgusting the council did this to nurses who were volunteering their time for the benefit of the local community. Clearly this was a political move. Shame, shame, shame! Last time I checked we still had freedom of speech in this great land. Are we to be kept in a bubble of only hearing what they want us to hear? In fact, this act was discrimination. There were other “political” parties getting signatures, e.g. the Save Our Rail group. Were they moved out? Nope! Shame! I guess we can take that as confirmation the new Maitland hospital will be privately run.
New England members agree that the minimum wage needs to go up! #raisethewage
Camden Nursing Home branch got 400 names on a petition supporting their enterprise agreement campaign.
Stay calm and ask for better pay – aged care members shared this meme in droves.
T H E L A M P M AY 2 0 1 4 | 4 1
Nurse Accountant Teacher Police Officer Librarian Doctor Policy Analyst Surveyor Scientist Barrister Solicitor Social Worker Welfare Worker Laboratory Technician Turner Plumber Electrician Zookeeper Cleaner Ambulance Officer Fitter Youth Worker Hospital Orderly Cleaner Fire Fighter Clerk Engineer Receptionist Labourer Caretaker Crossing Supervisor Ship's Engineer Nurse Police Officer Marine Transport Professionals Shipwright Curator Fitter Museum Guide Conservator Plant Operator Engineer Electrical Linesworker Solicitor Cable Jointer Plant Operator Ranger Teacher Nurse Librarian Advisor Warden Prison Officer Medical Practitioners Engineer Technician Administrator Train Driver Bus Driver Accountant Ship's Officer Master Policy Analyst Fitter Surveyor Scientist Nurse Barrister Solicitor Social Worker Welfare Worker Laboratory Turner Plumber Electrician Zookeeper Ambulance Officer Youth Worker Hospital Orderly Fire Fighter Clerk Receptionist Labourer Jointer Solicitor Caretaker Crossing Supervisor Ship's Engineer Ship's Officer Ship's Master Marine Transport Professionals Shipwright Curator Museum Guide Conservator Plant Operator Engineer Electrical Linesworker Cable Engineer Plant Operator Nurse Doctor Teacher Train Driver Accountant Librarian Policy Analyst Surveyor Scientist Barrister Solicitor Social Worker Welfare Worker Laboratory Technician Turner Plumber Electrician Social Worker Cleaner Fitter Fire Fighter Curator
People Matter 2014 NSW Public Sector Employee Survey
5th May 30th May 2014
Please give generously.
What is this Survey? The People Matter employee survey is an opportunity to make your workplace and the wider NSW public sector a better place to work. Completing the survey will ensure that each and every employee’s voice is heard. You will receive the survey via email from 5 May 2014. If you do not receive the survey by email or you require a paper copy, please email your HR department. For further information visit your intranet site or email employeesurvey@psc.nsw.gov.au or visit the Public Service Commission website at www.psc.nsw.gov.au/employeesurvey. CONFIDENTIALITY: The survey is conducted anonymously; no names are attached to the questionnaire responses. The survey is being conducted by an independent contractor.
Quality legal advice for NSWNMA members c c c c c c c c c
Compensation and negligence claims Employment and Industrial Law Workplace Health and Safety Anti-Discrimination Criminal Law Free standard Wills for members Probate / Estates Public Notary Discounted rates for members including First Free Consultations for members on all matters. Offices in Sydney and Newcastle with visiting offices in regional areas (by appointment).
Call the NSWNMA on 1300 367 962 and find out how you can access this great service.
4 2 | T H E L A M P M AY 2 0 1 4
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Across 1. An abnormal sensation, such as pins and needles, in the hands and fingers (16) 9. Shaped like a tooth (8) 10. A common seborrheic dermatitis of the scalp in infants (6.3) 11. The outline of the growth of hair on the head, especially across the front (8) 12. Oral Hygiene Index (1.1.1) 13. A remorseful awareness of having done something wrong (5) 14. A person without a permanent residence (8) 16. To use or follow as a model (7)
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18. Tissues relating to the lymphatic system (8) 20. Resembling a breast (9) 24. Combines with oxygen or removes hydrogen (8) 25. Any separating membrane or structure (9) 27. A toxin that is secreted or excreted by a living microorganism (8) 28. Sharp and clear in tone (9) 29. Any of the blastomeres from which the ectoderm develops (8) 31. The white of an egg (5) 32. Nuclear magnetic resonance (1.1.1)
Down 1. Peculiarity of the pulse wave (10) 2. Any theory maintaining that criteria of judgment vary with individuals and their environments (10) 3. A syndrome due to niacin deficiency (8) 4. Readily responsive to a stimulus (8) 5. An instrument for measuring the extent of eyeballâ&#x20AC;&#x2122;s protrusion (16) 6. The turning or bending movement toward or away from an external stimulus (7)
7. Producing or bearing spores (11) 8. Helpless; without aid (7) 15. An organised journey for a specific purpose (10) 17. Thyrotropin-releasing factor (1.1.1) 19. Shortness of breath (8) 21. Ankle-brachial index (1.1.1) 22. Ventilator (7) 23. A cardiac glycoside (7) 25. To find and correct errors in computer program (5) 26. The soul (5) 30. One of nursing classifications (1.1)
T H E L A M P M AY 2 0 1 4 | 4 3
NURSING RESEARCH ONLINE
Medicare has clearly been in the Abbott government’s sights since gaining office. The Minister for Health has repeatedly signalled that the government is looking for ways to cut health costs and for greater “user pays”. This month The Lamp looks at the opinions of some of Australia’s leading health economists, academics and public policy-makers. Are Private Health Subsidies Worth It? Ian McAuley and John Menadue, February 2012 Is there some special reason the private health insurance industry is worthy of such robust government support? When an industry has become dependent on a subsidy, it uses every means to justify its continuation, exaggerating the consequences if it is withdrawn. Political parties join the bandwagon, and governments, whatever their ideology, feel compelled to go on providing subsidies. We’re not referring to Alcoa, Toyota or GMH. There is at least some media exposure of subsidies to the aluminium and car industries, and there is some questioning of manufacturing assistance in both the ALP and the Coalition. Rather, it’s the private health insurance industry, which, for all the sound and fury about the meanstesting of the rebate for high income earners, has once again escaped any serious scrutiny of its economic contribution and its tax-funded support – support that costs $4 billion a year, even after the modest trimming associated with means testing. https://newmatilda.com/2012/02/16/are-privatehealth-subsidies-worth-it
Making the rich pay more isn’t the answer to a better Medicare Stephen Dutton, Director, Health Program, Grattan Institute, February 2014 Should the rich pay more for their health care? This question has raised its ugly head again after health minister Peter Dutton announced the Coalition government was considering more user-pays options – including a $6 co-payment for general practice visits – to get a hold on the rising health budget.
The argument is that government benefits should be tightly targeted to those who can’t pay. But there are a number of weaknesses with the argument. Australians already pay comparatively high rates of health costs, either directly or via health insurance. Increasing out-of-pocket expenses will make us a real international outlier in terms of equitable financing, and have significant consequences for many poorer households. About 16% of households report deferring visits to the doctor or not filling prescriptions because of costs; additional co-payments will worsen their plight. The rich already pay more out of their own pockets for medical services. When I visit my GP I don’t get bulk billed and pay roughly $30 out of my own pocket. More broadly, the wealthiest 20% of the population spend an average of $98 per week on health and medical services. Households designated by the Australian Bureau of Statistics as poorer, spend about $39 per week. http://theconversation.com/making-the-rich-paymore-isnt-the-answer-to-a-better-medicare-23477
Private Health Insurance: High in cost and low in equity John Menadue and Ian McAuley, January 2012 In this discussion paper John Menadue and Ian McAuley explain, in simple terms, why a single national insurer provides the most efficient and equitable way for Australians to share our health care costs. In our present system the vast majority of subsidies disproportionately benefit the well off. Country people, with poor access to private hospitals, subsidise high-income city dwellers with private hospitals around the corner. Richer people, who can afford private health insurance, are more likely to purchase it, and they get a disproportionately high subsidy as a result. Meanwhile basic
services like dental care are subsidised for Private Health Insurance policy holders, but barely accessible to people on low incomes. Private health insurance is an expensive and clumsy way to do what the tax system and Medicare do so much better – that is, to distribute funds to those who need health care. Nor has the increased uptake of private insurance succeeded in its claimed purpose of easing pressure on public hospitals. That was an impossible task, because while demand has indeed shifted to private hospitals, so too have health care staff. The main result has simply been a re-shuffling of the queues for limited resources, and that re-shuffling has put private insurance membership ahead of clinical needs. http://cpd.org.au/2012/01/private-healthinsurance/
Private insurance reliance means countries pay more for health care Ian McAuley, lecturer of public sector finance, University of Canberra Ahead of the May budget, health minister Peter Dutton has said he wants to start “a national conversation about modernising and strengthening Medicare”. But is that what the government really intends? Or are we simply being softened up for an expansion of private health insurance? If so, the government needs to be reminded of Australian and international evidence showing that the more private health insurance is used to fund health care, the more expensive the health system becomes, without any improvement in the quality of that care. http://blogs.crikey.com.au/croakey/2014/03/21/p rivate-insurance-reliance-means-countries-paymore-for-health-care/
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To apply for any of these positions you must be an Australian Citizen or Permanent Resident, or be able to independently and legally live and work in Australia. For more information please go to: www.immi.gov.au
4 4 | T H E L A M P M AY 2 0 1 4
NSWNMA MEMBERS: present this voucher to any of the attractions admissions desks to get 20% off discount. These offers cannot be used in conjunction with any other offer and only apply to single entry tickets.
VA L E
Janiece Helen McPhee (nee Pfeiffer) 1935 — 2013
[e\ During her career Janiece (Jan) was a mentor to many. She supported, encouraged and inspired those she worked with. She led by example and was generous in sharing her knowledge and experience. She commenced general nursing training at Scott Memorial Hospital, Scone, in March 1953. Following graduation she moved to Sydney where she joined a nursing agency and worked in different hospitals throughout the city. She also nursed patients in their private homes. In April 1958 Jan began midwifery training at the Royal Hospital for Women, Paddington. After training she returned to Scone and went back to work at the Scott Memorial Hospital. In November 1959, Jan married Colin McPhee, who she had first met during her general training. Together they had three children, Primrose, Leanne and Andrew. From May 1959 till November 1960, Jan worked as the Operating Theatre Charge Sister. Then for the next 12 years she worked on a casual basis. In 1973 she returned to full time work. Midwifery was Jan’s greatest passion. She conducted evening antenatal classes at the hospital for 12 years and was employed as Nurse Unit Manager of the maternity ward for eight years. She delivered many babies, one of them her first grandchild, while another baby Jan delivered was named in her honour. Jan firmly believed in the importance of ongoing education and throughout her career regularly attended lectures, short courses and conferences. In 1990 she completed the Child and Family Heath Certificate at the College of Nursing in Sydney. In 1979 Jan was appointed to the position of Senior Sister, later renamed Deputy Director of Nursing (DDON) a position she remained in until her retirement in 2001. When not working in administration Jan continued working on the maternity ward. In the late nineties she was presented with the New South Wales’ government Meritorious Service Medal for 40 years in nursing. At her retirement dinner a medical colleague said of Jan: “You
have a great ability to sum up a situation and to soothe, calm, and give reassurance to both patient and doctor alike.” Another remarked: “Jan McPhee’s retirement leaves an enormous void in the health care ranks in the Hunter Valley.” Following her retirement Jan joined an agency and for the next few years worked as a community nurse caring for Department of Veterans’ Affairs patients in their homes. Not only was Jan committed to her family, friends and patients, she was also committed to the community. She was a Justice of the Peace and involved herself in community groups and the lives of those who needed her. Jan was a warm, thoughtful and kind person who had the unique ability to say and do what was needed at the time someone needed it the most. As a friend of hers once said: “When I spoke to Jan I felt like I was the only person in the world.” During her career Jan was often approached by community groups to speak on various topics, often concerning the welfare of others. This she did willingly. In addition to public speaking Jan was an active member on numerous community and hospital committees. In 1986 she was appointed to the Board of the Upper Hunter Area Health Service. Jan also volunteered her time to local school reading groups; the children loved and looked forward to Jan’s visits, referring to her fondly as Nanny McPhee. For 15 years Jan fought melanoma with great courage and dignity. After having a leg amputated at the age of 74, Jan learnt to walk and drive with a prosthesis and continued to be an active member on community committees. In her final weeks Jan was cared for by her loving family, who were by her side when she passed away peacefully at home, on September 25, 2013. At her funeral in Scone the church was overflowing and 200 chairs were placed outside to accommodate mourners, an indication of the great love and respect felt for Jan. Her casket was given a guard of honour by Scott Memorial Hospital nurses and midwives. Jan McPhee was a very special and much-loved woman and will be greatly missed.
NURSES AND MIDWIVES: IT’S IMPORT MPORT TA ANT TO NOTE
You Y o ou mus mustt be a
FINANCIAL MEMBER
of the NS NSW W Nurses and Midwives’ Midwives’ Association Association o: tto o ensur ensure e your your entitlement tto: » All Association Association servic services es ccident Journe y Insur ance »A Accident Journey Insurance Professional Indemnity » Professional Insur ance. Insurance. All these services are only available to members who are financial members. Make sure your membership remains financial by switching from payroll deductions to Direct Debit.
IT’S EASY! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural). Download, complete and return your Direct Debit form to the Association.
BOOKS
BOOK ME Ethics and law for the health professions (4th ed.) Ian Kerridge, Michael Lowe and Cameron Stewart
Federation Press www.federationpress.com.au RRP $99 (paperback) ISBN 9781862879096 This new edition of Ethics and law for the health professions has been revised and expanded to take account of developments in law, biomedical science, health-care delivery and bioethics. Sections dealing with professionalism, negligence, standards of care, critical reasoning, problem solving, public health and emerging biosciences have been expanded, and entirely new chapters dealing with sexuality, culture, rural health, evidence and global care added.
Psychological Aspects of Functioning, Disability and Health David Peterson
Springer Publishing Company www.springerpub.com RRP $79 ISBN 9780826123442 This text will be useful to professionals learning about mental health and illness. The book explores the psychological aspects of functioning, disability and health as conceptualised by the World Health Organisationâ&#x20AC;&#x2122;s International Classification of Functioning, Disability and Health (ICF) and disorders as diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Readers will learn the effectiveness of the ICFs biopsychosocial approach for conceptualising and classifying mental health functioning (body functions and structures), disability (activity, limitations and participation restrictions), environmental barriers, and facilitators; collaborating with the person who is being assessed in determining these factors (personal factors), targeting interventions, and evaluating treatment efficacy.
What do we do now? A handbook for Nursing Assistants working in the General and Dementia Units (1st ed.) Cliff Wherry, Marina Spiller and Connor Wherry
ConJake Publications (email) e.quelch@yahoo.com.au RRP $POA ISBN 9780646900438 This book highlights the important role of the nursing assistant and covers rules, regulations, procedures and practice that govern health care, especially in the dementia field and the working environment.
A Primer of Clinical Psychiatry (2nd ed.) David J. Castle, Darryl Bassett, Joel King and Andrew Gleason
Churchill Livingstone/Elsevier (via Elsevier Australia) www.elsevierhealth.com.au RRP $87 ISBN 9780729541572 This second edition of A Primer of Clinical Psychiatry provides a comprehensive overview of the discipline of clinical psychiatry, as well as up- to-date information and clinical grounding. It also provides the core knowledge required for mastering skills such as performing a psychiatric interview and structuring a history, together with how to carry out a mental state examination, and the decisions that should be made on the relevant physical examinations and investigations.
Health Activism: Foundations and Strategies Glenn Laverack
SAGE Publications www.sagepublications.com RRP $POA ISBN 9781446249659 For anyone working to improve the health of groups and communities, this will be thought-provoking reading. It has particular relevance for postgraduate students and practitioners in public health and health promotion. Health activism is a growing area of interest for many who work to improve health, nationally and internationally, because it offers a more direct approach to achieving lasting social and political change. This book provides a clear foundation to the theory, evidence-base and strategies that can be harnessed to bring about change to improve the lives and health of others.
SPECIAL INTEREST Overcoming Baby Blues: A Comprehensive Guide to Perinatal Depression
Professor Gordon Parker, Kerrie Eyers and Professor Philip Boyce Allen and Unwin www.allenandunwin.com RRP $27.99 ISBN 9781743316771 This book takes the reader into the realm of perinatal mood disorders and offers pointers for when intervention and management are needed. Mothers share intimate stories of their experiences with depression, and other mood problems, during pregnancy and their babyâ&#x20AC;&#x2122;s first year. Also included are researchbased guidelines on assessing moods, causes of perinatal depression and effective management strategies. Safety of medications in pregnancy and breastfeeding are covered, as are suggestions for adapting lifestyle to reduce symptoms and advice for partners.
All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here, and many more, from our Information and Records Management Centre (IRMC). Contact Jeannette Bromfield gensec@nswnma.asn.au or Cathy Matias 8595 2121 cmatias@nswnma.asn.au. All reviews by NSWNMA IRMC Coordinator/Librarian Jeannette Bromfield. Some books are reviewed using information supplied and have not been independently reviewed. T H E L A M P M AY 2 0 1 4 | 4 7
MOVIES
movies of the month
Originally a stage musical based on the storytelling songs of Scottish twins Charlie and Craig Reid – The Proclaimers – this film version stars Jane Horrocks. Dubbed “MacMamma Mia” by the British media, Sunshine on Leith tells the story of lifelong mates Davy (George Mackay) and Ally (Kevin Guthrie) who are returning from duty in Afghanistan to their home in Leith, just outside Edinburgh. Back home the lads strike up romances – Ally with Davy’s sister Liz (Freya Mavor), Davy with Liz’s friend Yvonne (Antonia Thomas) – while Davy and Liz’s parents, Rab (Peter Mullan) and Jean (Jane Horrocks) are busy planning their twenty-fifth wedding anniversary. Love is in the air until a revelation from Rab’s past threatens to tear the family, and all three couples, apart. Screenwriter, and writer of the original stage musical, Stephen Greenhorn, says the idea for the story came from a bottle of whisky. In 2005, Greenhorn was trying to drum up an idea for a Scottish musical to workshop and develop with a friend, but the pair’s brainstorming had come to nothing. “One night I was getting drunk and listening to the first Proclaimers album, This Is The Story,” Greenhorn recalls. “Halfway through the album, they stop playing and start to talk. I thought, ‘This sounds like it’s from a musical’ and started thinking about all The Pro48 | THE LAMP APRIL 2014
claimers’ songs I knew and how they all could be from a musical. “I wrote ‘the Proclaimers musical’ on the back of an envelope and went to bed. The next morning, I’d completely forgotten about it until I saw the envelope.” When the first production was finally mounted in 2007, Sunshine on Leith acquired a spectacular momentum that would eventually carry it to the big screen. “Thank god I wrote the idea down!” laughed the writer. IN CINEMAS MAY 22
METRO MEMBER GIVEAWAY Email The Lamp by the 10th of the month to be in the draw to win a double pass to Sunshine on Leigh thanks to Entertainment One. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!
EDUCATION@NSWNMA
WHAT’S ON MAY 2013
DVD SPECIAL OFFER
——— • ———
Computer Essentials for Nurses and Midwives – 1 day 7 May Prince of Wales Hospital, Randwick 18 June Prince of Wales Hospital, Randwick
Members $85 Non-members $170 ——— • ———
Aged Care Nurses Forum – 1 day 9 May NSWNMA, Waterloo
Members $30 Non-members $50 ——— • ———
Appropriate Workplace Behaviour – 1 day 14 May Wagga Wagga 11 June Newcastle 9 July Albury Topics include why bullying occurs; antidiscrimination law and NSW Health policies; appropriate behaviour in the workplace; identifying unlawful harassment and bullying; what to do if subjected to unlawful harassment and bullying.
Members $85 Non-members $170 Following the disappearance of their father Beverly (Sam Shepard), the dysfunctional Weston clan descends upon the midwestern family home to help find him. This will not be an easy family reunion – and not just because of Beverly’s mysterious vanishing. His estranged daughters have been living divergent lives and are returning not only to the isolated home they grew up in, but the iron-fisted matriarch (Meryl Streep) who raised them. August: Osage County showcases the talents of Streep and Julia Roberts, who are supported by an exceptional cast that includes Ewan McGregor, Juliette Lewis, Benedict Cumberbatch and Dermot Mulroney. Playwright Tracy Letts received the 2008 Pulitzer Prize for Drama for the original stage version and adapted his play for the screen. This is a mesmerising film laced with black humour, jaw-dropping dialogue and unforgettable scenes.
——— • ———
Are you meeting your CPD requirements? – ½ day 15 May Wagga Wagga 12 June Newcastle 10 July Albury Suitable for all nurses and midwives to learn about CPD requirements.
Members $40 Non-members $85 ——— • ———
Legal and Professional Issues for Nurses and Midwives – ½ day 16 May Wagga Wagga 13 June Newcastle 23 June Parramatta 11 July Albury Topics covered include Health Practitioner Regulation National Law, potential liability, importance of documentation, role of disciplinary tribunals and writing statements.
Members $40 Non-members $85 ——— • ———
Aged Care Seminar Series – 1 day
RURAL MEMBER GIVEAWAY Email The Lamp by the 15th of this month to be in the draw to win the dvd of August: Osage County thanks to Roadshow Entertainment. email your name, membership number, address and telephone number to lamp@nswnma.asn.au for a chance to win!
20 June Parramatta Seminar is suitable for all RN, EN and AiNs.
Members $75 Non-members $170 ——— • ———
Policy and Guideline Writing 26 June Gymea
Members $85 Non-members $170 ——— • ——— To register or for more information go to
www.nswnma.asn.au/education or phone Matt West on 1300 367 962 T H E L A M P M AY 2 0 1 4 | 4 9
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 event details to: Email: 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.
NSW HIV Nursing Practice 5-8 May Surry Hills $550 02 9332 9720 education@thealbioncentre.org.au ACN Nursing and Health Expo NSW 10 May Sydney 1800 061 660 www.acn.edu.au/expos events@acn.edu.au Understanding Dementia for RN/EN Australian College of Nursing 12 May Bowral www.acn.edu.au Nurses Christian Fellowship workshop: Caring for their families 20 May Sydney www.ncfansw.org Save Our Sisters fundraising lunch for midwives in Ethiopia 25 May Port Hacking saveoursisters.aus@gmail.com www.hamlin.org.au Resus at the Park 28-30 May Sydney www.resusatthepark.com.au Jayne@eastcoastconferences.com.au Fundamentals of HIV and Sexual Health: Expanding the scope of primary health care nurses Online module plus 29 May Sydney www.ashm.org.au/courses Emilie.spencer@ashm.org.au Palliative care for RN/EN Australian College of Nursing 29-30 May Albury www.acn.edu.au Turning the Tide on Continence – education day 14 June Port Macquarie $50 morning tea/lunch provided Keynote speaker: local pharmacist Pauline Chiarelli jca43356@bigpond.net.au Ann 0413 992 468
Neurosurgical Nursing Professional Development Scholarship Committee 11th Annual Conference 27 June Milsons Point diane.lear@health.nsw.gov.au www.aci.health.nsw.gov.au/networks/neurosurgery NSW Urological Nurses Society seminar 18 July Charlestown urological_nurses@hotmail.com www.anzuns.org/nsw Through These Lines – a play about Australian nurses in WW1 24 July-5 August Newcastle www.civictheatrenewcastle.com.au/index.php Susan Ryan Neonatal Seminar 1 August Parramatta www.susanryanseminar.gofundraise.com.au 14th Rural Critical Care Conference 22-23 August Tweed Heads www.ruralcritalcare.asn.au Jayne@eastcoastconferences.com.au Smart Strokes 2014 10-year anniversary: Are We Fit For The Future? 28-29 August Sydney www.smartstrokes.com.au smartstrokes@theassociationspecialists.com.au NSW DANA Drug and Alcohol Nurses Forum 5 September Sydney darren.smyth@justicehealth.nsw.gov.au 4th Annual NSW Health and Ambulance Bowls Tournament 7 September St John’s Park Bowling Club Paul 9828 5391 (business hours) Paul.Sillato@swsahs.nsw.gov.au Children’s Hospital at Westmead Paediatric Perioperative Seminar 13 September Westmead claudia.watson@health.nsw.gov.au georgina.whitney@health.nsw.gov.au Enrolled Nurse Conference 18-19 September Tweed Heads EN Professional Association PO Box 775 Kingswood 2747 1300 554 249
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3rd Asia-Pacific International Conference on Qualitative Research in Nursing, Midwifery and Health 1-3 October Newcastle www.icqrnmh.info PANDDA 2014 Conference: Professional Association of Nurses in Developmental Disability Areas 15-16 October Parramatta www.pandda.net 6th Australian Rural & Remote Mental Health Symposium 12-14 November Albury www.anzmh.asn.au/rrmh/
ACT Australasian Neuroscience Nurses Association Conference 40-year anniversary: yesterday, today, tomorrow 7-9 May Canberra Leigh Arrowsmith 0400 927 022 leigh.arrowsmith@health.nsw.gov.au 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference 16-17 October Canberra www.rcnmp.com.au
INTERSTATE World Congress of Cardiology 4-7 May 2014 Melbourne www.world-heart-federation.org National Eating Disorders and Obesity Conference 26-27 May Gold Coast eatingdisordersaustralia.org.au ACMHN Consultation Liaison and Perinatal and Infant Mental Health annual conference 11-13 June Adelaide Jenni.Bryant@calvarymater.org.au Cultural Diversity in Ageing 2014 Conference: Shaping Inclusive Services 12-13 June Melbourne www.culturaldiversity.com.au/conference2014 03 8823 7979 Nursing Informatics Australia 2014 Conference E-health is changing healthcare: Nurses meeting the challenges 11 August Melbourne www.hisa.org.au/page/hic2014nia @HISA_HIC 15th International Mental Health Conference 25-26 August Surfers Paradise www.anzmh.asn.au/conference conference@anzmh.asn.au Mental Health Service (MHS) Conference 26-29 August Perth www.themhs.org Australian Disease Management Association 10th Annual National Conference 11-12 September Melbourne www.adma.org.au/images/ConferenceFlyer2 014.pdf Paramedics Australasia International Conference 18-20 September Gold Coast www.paic.com.au
ACMHN 40th International Mental Health Nursing Conference 7-9 October Melbourne 02 6285 1078 www.acmhn2014.com events@acmhn.org
INTERNATIONAL 7th World Congress for Psychotherapy 25-29 August South Africa wcp2014.com secretariat@wcp2014.com 3rd World Congress of Clinical Safety: Clinical Risk Management 10-12 September Spain www.iarmm.org/3WCCS Nurses Christian Fellowship International PACEA Conference Compassion: The Cornerstone of care 10-14 October Fiji pacea-region@gmail.com 4th International Conference on Violence in the Health Sector 22-24 October USA www.oudconsultancy.nl/MiamiSite2014/inde x.html International Conference on Infectious and Tropical Diseases 16 -18 January 2015 Cambodia www.ictid.webs.com
REUNIONS Sacred Heart Mercy Hospital Young 24-25 May Joy Cameron 6382 2762 / 0419 822 473 Ann Symons 6382 6334 Western Suburbs Hospital Graduate Nurses’ Reunion Luncheon 31 May Ryde-Eastwood Leagues Club Robyn Conliffe 02 9858 1102 robyn.conliffe@hotmail.com Helen Cooney 02 9744 8219 helencoon@gmail.com Tamworth Base Hospital Nurses July 74 -77 group (40-year reunion) 8-9 June Tamworth Bronwyn Johnson (nee Ashworth) 02 9315 7545 / 0431 446 114 johnsonsbronte@gmail.com St. Vincents Hospital PTS group August 1974 July 12 Sydney Cate Keast (Taylor) 0415 653 221 / 02 6653 6915 domxav@bigpond.com Royal Newcastle Hospital April/May 1974 RN graduates 40-year reunion 30 August Newcastle Wendy Lewis 0407 861 722 wlew12@bigpond.com Sue Carroll (nee Hetherington) 0404 083 429 susancarroll1953@gmail.com Mater Graduate Nurses’ Association Annual Reunion 19 October North Sydney Joan Taniane 0401 344 363 joans2458@yahoo.com Prince Henry Hospital PTS Jan 1964 meet-up at annual PHH reunion 25 October Helen Millan (nee Flanagan) helenmillan@bigpond.com NEC Prince Henry/POW Hospitals Oct 1972-75 group 25-26 October Margret Brignall (Samuel) 0418 646 959 Sonia Keeling (Graf) 0407 221 407 Marcia Jarvis (Fitch) 0438 415 647 Dianne Walkden (Edwards) 0400 621 470 Gill Gillon (Horton) 0401 048 205
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