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NurseClick A PRIL 2 0 16

Pathology cuts and the consumer:

A blood bath or a lifeline?

Reflections of a not-soRemote Area Nurse

ACN voices – meet our representatives

The life of a travelling country nurse

Breast cancer nursing: A fulfilling career


In this edition

Welcome

Snapshot

Policy @ACN

Adjunct Professor Kylie Ward FACN, CEO of ACN

The latest health care news

Pathology cuts and the consumer: A blood bath or a lifeline?

In focus @ACN

Engagement @ACN

Education @ACN

Reflections of a not-soRemote Area Nurse

ACN voices – meet our representatives

Breast cancer nursing: A fulfilling career

Leadership

FIRST

This highly interactive two day short course for early and mid-career nurses enables participants to build their confidence as leaders and further develop their leadership skills. DATES: 18–19 April 2016 Perth WA 3–4 May 2016 Launceston TAS 10–11 May 2016 Canberra ACT 17–18 May 2016 Darwin NT 24–25 May 2016 Brisbane QLD 1–2 June 2016 Melbourne VIC

In focus @ACN The life of a travelling country nurse

Professional development @ACN CPD short courses @ACN

NMBA update Renew your registration by 31 May

For more information visit www.acn.edu.au


Welcome

Welcome Adjunct Professor Kylie Ward FACN, CEO of ACN

Welcome to the April edition of NurseClick. The Australian College of Nursing (ACN) was deeply saddened to hear of the death of Remote Area Nurse Gayle Woodford. The tragedy has brought nurse safety to the fore, prompting Minister for Rural Health, Senator the Hon Fiona Nash to hold a remote area health stakeholder meeting on 6 April. I had the opportunity to represent ACN at this meeting and put forward insights on remote health worker safety from a nursing perspective. ACN will continue to advocate for the safety of all nurses working in remote communities and across the health care sector. Gayle’s death has also prompted many health workers to consider their own experiences, both positive and negative. Rural and remote locum Lauri Buckingham talks about her life as a nomadic nurse in the article, ‘The life of a travelling country nurse’, while ACN Nurse Educator Cherry Millar MACN offers her perspective on nursing in ‘the Outback’ in her piece, ‘Reflections of a not-soRemote Area Nurse’. We also feature another of our Nurse Educators, Trish Lowe MACN, in this issue’s representation profile. Trish shares her experience of representing ACN in the Re-entry to the Register Midwife Accreditation Standards 2016 expert advisory group and the importance of these groups in influencing health care decision making.

Once again our policy team tackles an important issue affecting health professionals and consumers with a discussion on the proposed removal of pathology testing bulk-billing incentives. Anita Pak and Liza Edwards MACN take a look at whether the cuts can reduce spending without compromising health, especially that of groups already experiencing significant inequity within health care in Australia. With breast cancer being the most commonly diagnosed cancer among women in Australia, ACN is proud to play a part in training nurses who offer vital support to the many women (and men) who are affected. This support is offered prominently through our Graduate Certificate in Breast Cancer Nursing course and the administration of the McGrath Foundation Scholarship. In this issue, we hear from two previous recipients of the McGrath Foundation Scholarship on how studying ACN’s Graduate Certificate in Breast Cancer Nursing has benefited their career and patient outcomes. If you are interested in this opportunity, please don’t hesitate to apply. Applications close 12 April 2016. We’re gearing up for the July intake for our graduate certificate courses. Enrolments are now open. Please visit our website to view the selection of specialty courses on offer.

Sarah believes everybody deserves respect, including the homeless.

Publishing details

She fights for their rights to quality health care.

Publisher Australian College of Nursing

She becomes a familiar face for those that need help.

Editors Karina Piddington Wendy Hooke Designers Nina Vesala Emma Butz Enquiries t 02 6283 3400 publications@acn.edu.au © Australian College of Nursing 2016 The opinions expressed within are the authors’ and not necessarily those of ACN or the editor. No part of this publication can be reproduced without permission from ACN. Information is correct at time of print. All files marked ‘file photo’ or credited to iStock are representative only and do not depict the actual subjects and events described in the articles.

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Snapshot

In the news Nat ional Magnetic treatment for depression

High demand expected during first year of legal medical cannabis in Australia A study by the University of Sydney has estimated that Australians will consume up to 8,000kg of medical cannabis during the first year of its legalisation, potentially creating a $100 million industry during the first year alone. University of Sydney Business School associate lecturer Michael Katz says Australia is in a unique position to become one of the world's leading exporters of the new therapeutic good.

Using magnetic fields to stimulate the brain through the scalp and skull while awake and alert has emerged as a new powerful weapon in the battle against major depression. Stimulating the brain in this way could prove life-changing, for those with treatment-resistant depression who had tried a range of antidepressant medications where none had worked. It also applied to those who experienced unwanted disabling drug-related side effects such as weight gain, sexual dysfunction or diminished work performance.

Australian researchers believe they are close to being able to use stem cells to regrow human bone and tissue damaged by injury, illness or old age. The team from the University of New South Wales said the stem cell repair system works in a similar way to how a salamander is able to regrow a leg or its tail when they are removed. It is a technique that has the potential to heal wounds, chronic back injuries and bad bone fractures.

Read more

Read more

Thunderous rock music improves cancer drug delivery

New surgery to control asthma

The case for an Australian sugar tax has just gotten stronger, with the results of a new University of Sydney study showing that 55 per cent of the population consumes more added sugar per day than the maximum level recommended by the World Health Organization (WHO).

Rock music is being used to maximise the efficiency of cancer drug delivery. Vibrations caused by rock music have been found to increase a drug’s therapeutic window by creating a Teflon-like coating over the micro particles used in drug delivery. Researchers from the University of South Australia used AC/DC’s Thunderstruck to cause porous silicon micro particles to bounce in the air, which allowed for the entire structure to be coated with a plasma polymer overlay. Senior research author Professor Nico Voelcker said completely coating a micro particle was difficult but essential in ensuring the optimal amount of a drug was delivered to the cancer cell.

Read more

Read more

Read more

More than half of Australia consumes too much sugar

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Stem cell research on the brink of regrowing damaged human bone and tissue

A radical approach that involves applying a heated tube inside the airways of asthmatics is being hailed as a revolution in treatment. Recent research advocates bronchial thermoplasty as a safe, effective and affordable treatment with the potential to transform people with uncontrolled asthma. The surgery, done in hospital under general anaesthetic, uses a catheter guided into the patient’s airway with the help of a camera. The catheter is heated to 65C for 10 seconds, which reduces excessive smooth muscle and widens the air passages, cutting the chances of an asthma attack. Read more

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Snapshot

World Vitamin D 'heals damaged hearts' A trial on 163 heart failure patients found supplements of the vitamin, which is made in the skin when exposed to sunlight, improved their hearts' ability to pump blood around the body. The Leeds Teaching Hospitals team, who presented at a meeting of the American College of Cardiology, described the results as “stunning”. Read more

Postgraduate Certificate courses

Promising lab-grown skin sprouts hair and grows glands

Terminally ill patients may live longer if they die at home People dying of a terminal cancer could experience a few more days of life if they opt to spend their last days at home instead of in a hospital, according to international evidence. Japanese researchers have investigated whether there’s a difference between home and hospital-based palliative care in prolonging life, following a cultural assumption that a terminallyill patient would rapidly decline if they received care outside a hospital. They conducted a large study, involving 2,000 terminal cancer patients, a quarter of which opted to die in the comfort of their own home while receiving palliative care services. Read more

Scientists in Japan have successfully transplanted mice with lab-grown skin that has more of the organ's working parts in place than ever before. Starting with stem cells made from a mouse's gums, they managed to craft skin with multiple layers – as well as hair follicles and sweat glands. Eventually, the team hopes their system will lead to perfectly functioning skin that can be grown from the cells of burns victims and transplanted back on to them. Read more

Scientists identify the structure of Zika virus Researchers have identified the structure of the Zika virus, laying the foundation for further study into the ways it infects healthy cells. The finding could guide development of a possible cure or a vaccine in the future, the scientists said. A team from Purdue University and the National Institutes of Health used cryo-electron microscopy to take extremely highresolution images of the mature virus. Read more

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Diabetes drug linked to bladder cancer A diabetes drug can increase a person's risk of bladder cancer, researchers have found. The antidiabetic drug pioglitazone helps to control blood sugar levels in patients with type 2 diabetes. But new research, published in The BMJ, has found that taking the drug is linked to a 63 per cent increased risk of bladder cancer. Read more

Global obesity predicted to reach 20 per cent by 2025 Over 12 per cent of adults are now obese, a ratio that has more than doubled since 1975 and will swell to 20 per cent by 2025, a major survey has reported. Of about five billion adults alive in 2014, 641 million were obese, the data showed, and projected the number would balloon past 1.1 billion in just nine years. Read more

The Australian College of Nursing’s postgraduate courses are designed specifically for nurses and midwives by nurse educators. We offer a range of accredited graduate certificate courses that deliver advanced knowledge and clinical expertise. Our graduate certificate courses are available online, studied over four terms of ten weeks each. They have a strong clinical focus and include leadership subjects that help you prepare for a leadership position in your chosen specialty.

JULY ENROLMENTS NOW OPEN


Snapshot

Aus tr alian C ollege of Nur sing update Nurses integral to successful roll-out of health reforms

Opportunity to become a presenter with ACN

The Australian College of Nursing (ACN) believes nurses will have a key role in the implementation of major healthcare reforms announced by the Federal Government.

Are you a skilled presenter? We want to hear from you. ACN is seeking expressions of interest from members and the broader nursing profession who would be interested in facilitating and presenting face to face or online CPD short courses on a variety of topics.

“The reforms are designed to improve outcomes for people living with chronic disease or complex conditions,” said Adjunct Professor Kylie Ward, CEO of ACN. “This is a continuing opportunity for nurses who already play a key role in preventative care for people with chronic, complex and multiple conditions.” “Nurses and Nurse Practitioners will embrace the opportunity to be involved and use their scope of practice in the management of these patients and reduce the barriers patients face across fragmented health services, with the aim of keeping them well at home and out of hospital,” Adjunct Professor Ward said. Read the full media release here.

ACN attends stakeholder meeting on remote health worker safety Following the death of remote area nurse Gayle Woodford in late March, Minister for Rural Health, Senator the Hon Fiona Nash held a remote area health stakeholder meeting on Wednesday, 6 April. ACN CEO Adjunct Professor Kylie Ward represented ACN at the meeting to put forward insights on remote health worker safety from a nursing perspective.

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Free entry!

ACN NURSING & HEALTH EXPOS 2016

Presenters will have an opportunity to contribute to the nursing profession through leadership and education as well as contributing to their own professional development. If you are interested, please fill out this expressions of interest form.

Improve your chronic and complex care skills with ACN’s new contemporary subject Are you working with patients who have chronic and complex health needs? ACN’s new Chronic and Complex Care subject focuses on the contemporary principles that underpin current and emerging practice within this dynamic area of nursing. The subject will provide students with the skills, knowledge and attitudes to work effectively with clients experiencing chronic and complex health needs through care coordination using a contemporary multidisciplinary approach. This single unit of study commences in July. Visit Chronic and Complex Care subject page for more information and to enrol.

NSW Ministry of Health scholarships available to study ACN postgraduate courses Nurses employed by the NSW Ministry of Health (MOH) who meet the eligibility criteria can apply for ACN graduate certificate courses that are supported by NSW MOH. Visit ACN’s MOH Scholarships webpage for more information.

In memory ACN would like to acknowledge the following members who recently passed away: Mrs Natashia Scully MACN Mrs Bronwyn Simic MACN

Attend the Expos to expand your nursing and health career! Saturday 16 April 2016 8.30am – 2.30pm Melbourne Convention & Exhibition Centre Sunday 19 June 2016 8.30am – 1.30pm Perth Convention & Exhibition Centre


Policy @ACN

Pathology cuts and the consumer: A blood bath or a lifeline? By Anita Pak and Liza Edwards MACN, ACN Policy Team

Pathology testing can be of enormous benefit in health care by providing health professionals with valuable clinical data to inform both diagnostic and therapeutic decisions. Testing also plays an important role in both screening for disease and in monitoring a person’s response to treatment. Australia’s ageing population and rising levels of chronic disease has helped to drive increasing costs related to pathology testing over a number of years and is an issue the Australian Government is now urgently seeking ways to address. The Mid-Year Economic and Fiscal Outlook (MYEFO), released in December 2015, announced the government’s intention to again seek significant savings across health with the predominant savings to be made by the removal of bulk billing1 incentives for pathology providers (worth between $1.40 and $3.40 for each test). Estimates predict this measure will save the government approximately $650 million over a period of four years.2 These changes are scheduled to take effect from July 1 2016, however are yet to pass through the Senate. Predictably, the announcement has generated dissatisfaction between the pathology sector and the government, particularly in light of the expiration in July 2016 of the Pathology Funding Agreement, which currently

Many pathologists are claiming the proposed removal of bulk-billing incentives for pathology tests will adversely affect the disadvantaged who would be left out of pocket.

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1 Bulk billing occurs when a health professional, such as a pathologist, accepts the amount of money assigned as the Medicare benefit as full payment for a service in full settlement of that service and does not charge the patient an additional co-payment. 2 Medhora, S 2016, Pap smears will cost after changes to pathology rebates say Labor and Greens, The Guardian, viewed 4 March 2016, < http://www. theguardian.com/australia-news/2016/jan/06/pap-smears-will-cost-after-changesto-pathology-rebates-say-labor-and-greens>

governs arrangements around Medicare funded pathology.3 Introduced in 2009-10 by the Rudd Labor Government, the bulk billing incentive was designed to partially offset a reduction in the fee assigned to Medicare items for pathology services and, in turn, maintain bulk billing rates. The bulk billing incentive is an additional payment made to pathology providers that bulk bill patients in non-hospital settings, which assists patients to avoid incurring out-of-pocket costs associated with services that are not bulk billed.45 The proposed removal of bulk-billing incentives for pathology testing has angered various sectors of the health system. Consumers are understandably concerned about the possibility of incurring increasing health care related costs, should pathology providers choose to recover these costs by increasing out of pocket costs to patients. Currently, 98.7% of pathology tests are bulk billed.6 Over the past decade the average number of pathology tests performed has risen by 40% from around 3.9 per person in 2004-05 to 5.4 in 2014-15.7 Advances in technology, resulting in widespread automation in the pathology laboratory setting, 3 Biggs, A 2015, Changes to bulk billing incentives for pathology and diagnostic imaging face resistance, Flag Post, viewed 7 March 2015 <http://www. aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/ FlagPost/2015/December/Changes_to_bulk_billing_incentives> 4 Department of Health 2009, More Support for Bulk Billing Pathology and Diagnostic Imaging Tests, viewed 4 March 2016, <http://www.health.gov.au/ internet/budget/publishing.nsf/Content/budget2009-hmedia14.htm> 5 Biggs, A 2015, Changes to bulk billing incentives for pathology and diagnostic imaging face resistance, Flag Post, viewed 7 March 2015 <http://www. aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/ FlagPost/2015/December/Changes_to_bulk_billing_incentives> 6 Concerns that cuts to bulk billing could be harmful to patients 2016, radio program, http://www.3aw.com.au/news/concerns-that-cuts-to-bulk-billing-couldbe-harmful-to-patients-20160229-gn6ypr.html 7 Davey, M 2016, Government could save $175m a year by ending pathology companies’ ‘free ride’, The Guardian, 21 February, viewed 4 March 2016, < http:// www.theguardian.com/australia-news/2016/feb/21/government-could-save-175ma-year-by-ending-pathology-companies-free-ride>


Policy @ACN

has led to significant advances in test efficiency and reduction in the cost per test in recent years. However, interestingly, the Medicare rebates for pathology services has remained fixed for approximately 20 years. Fixed pricing per test allows providers to accrue all the benefits of the volume related decline in cost, resulting in greater profits for greater volumes, with returns of about 13-15%.8 The Grattan Institute has devised its own proposal for revamping pathology services in Australia. The report titled Blood Money: paying for pathology services, proposes changes to the current provision of pathology services in Australia. The institute suggests the government could save even more money with the proposed removal of bulk billing incentives.9 The report indicates that Medicare pays a fixed price for each test, with each subsequent test costing pathology laboratories less due to machine automation. It argues that both the government and patient could make significant savings by reforming existing funding arrangements to share the benefits of this scale of economy. Abolishing the bulk billing incentive for providers requires all services to be bulk billed rather than giving the option to charge a private gap fee after a Medicare payment for the service has been received.10 The report highlights the government could save $175 million per year by changing how it pays for pathology testing.11 Minister for Health, Sussan Ley believes that cutting the co-incentive payments will not change the rate at which pathology services would bulk bill patients, however this is disputed by pathologists who 8 Duckett, S & Romanes, D 2016, Blood money: paying for pathology services, Grattan Institute. 9 Duckett, S 2016, Blood money: pathology cuts to reduce spending without compromising health, viewed 8 March 2016, < https://grattan.edu.au/news/bloodmoney-pathology-cuts-can-reduce-spending-without-compromising-health/> 10 Lee, J 2016, Government should overhaul pathology sector: Grattan Institute report, The Sydney Morning Herald, viewed 7 March 2016, < http://www.smh.com. au/federal-politics/political-news/government-should-overhaul-pathology-sectorgrattan-institute-report-20160220-gmz7x2.html> 11 Lee, J 2016, Government should overhaul pathology sector: Grattan Institute report, The Sydney Morning Herald, viewed 7 March 2016, < http://www.smh.com. au/federal-politics/political-news/government-should-overhaul-pathology-sectorgrattan-institute-report-20160220-gmz7x2.html>

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“The proposed cuts have the potential to cause inevitable health disparity if not undertaken in a measured way that ensures sustainable and reasonable funding mechanisms that protect access to and the quality of Australia’s pathology services.”

maintain they will be forced to pass the loss onto the consumer by charging patients a co-payment (further payment charged by the company), which may discourage patients from undergoing important testing.12 Grattan Institute Health Program Director Dr Stephen Duckett further proposes that enormous savings in the pathology sector could be made should the government implement an open tender process through which pathology services would have to compete for contracts to provide pathology services. This would open the sector to competition, forcing companies to ‘name their price’ for pathology tests, rather than continuing to receive a government regulated, and perhaps over-inflated, price. Some public hospitals already procure pathology services through a tendering process. For example, Victoria has tendered regional pathology services for more than 20 years with prices negotiated at 65% to 75% Medicare fees, which results in a 10% to 20% saving13 for the government. Tendering does not come without criticism, with the quality of pathology services questioned if tendering leads to the lowest bidder. Furthermore, access to services in rural areas may decline with specimens being sent to major metropolitan areas.

12 Lee, J 2016, Government should overhaul pathology sector: Grattan Institute report, The Sydney Morning Herald, viewed 7 March 2016, < http://www.smh.com. au/federal-politics/political-news/government-should-overhaul-pathology-sectorgrattan-institute-report-20160220-gmz7x2.html> 13 Duckett, S 2016, Blood money: pathology cuts to reduce spending without compromising health, viewed 8 March 2016, < https://grattan.edu.au/news/bloodmoney-pathology-cuts-can-reduce-spending-without-compromising-health/>

Cuts to the Medicare rebate for pathology are likely to create a new cost barrier.14 This situation poses a potential risk to health outcomes. Consequences of patients incurring increasing health care related costs may influence their decision to undergo necessary tests, reduce their ability to comply with treatment and/or monitoring, and ultimately influence the decision to utilise health services when necessary, especially those within vulnerable populations. The Australian Bureau of Statistics (ABS) identified that in the period 2014-2015 one in 20 (5%) of individuals delayed seeing or did not see a GP once because of the cost of consultation. People living in outer regional, remote or very remote areas of Australia were more likely to delay or not see a GP due to cost than those living in major cities (6% compared with 5%).1516 Pathologists say it is likely that costs will be passed on to the consumer, with Pathology Australia Chief Executive Officer Liesel Wett saying the conclusions of the Grattan Report were incorrect and insisting the removal of the incentive payment will force providers to charge for critical tests.17

14 Consumers Health Forum 2014, Inquiry into Out of pocket costs in Australian healthcare, viewed 17 March 2016 <https://www.chf.org.au/pdfs/sub/Submission_ CHF_OutOfPocket.pdf> 15 Australian Bureau of Statistics 2011, Patient Experiences in Australia, catalogue number 4839.0 ,viewed 4 March 2016 , <http://www.abs.gov.au/ausstats/ abs@.nsf/mf/4839.0 16 Duckett, S, Breadon, P, Farmer, J 2014, Out of Pocket costs: Hitting the most vulnerable hardest, Grattan Institute. 17 Merhab, B 2016, Report urges more budget cuts to pathology, viewed 7 March 2016 , < http://www.news.com.au/national/breaking-news/report-urgesmore-budget-cuts-to-pathology/news-story/35eb8342a3959db6f7e4ec8fde6f47bc>

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Policy @ACN

There has been great uncertainty of how the changes proposed by the government will impact consumers. Consumer activist groups have been critical of the changes, highlighting that women will be particularly worse off if the proposed cuts are passed by Parliament. For example, the Pap test (Papanicolaou test) is one critical test that consumers may be forced to pay for under the proposed changes. The Pap test is the best available prevention of most cases of cervical cancer. Whilst most Pap tests are normal, in a very small number of cases, an abnormality may persist and develop into cervical cancer.18 A recent Change.org petition called upon Minister Ley to ensure Pap tests remained free.1920 The government has denied that there would be any changes regarding the cost of an examination or receiving a Pap test, nor reduction in the dollarvalue of the Medicare rebate a patient receives to undertake associated pathology tests.21 The proposed changes will also affect Australia’s ageing population, who often demonstrate higher utilisation rates within pathology services. The University of Sydney’s Family Medicine Research Centre reported that individuals aged 65 and older used health resources including GP visits; prescriptions and tests at twice the national average in 2014-15. This use of resources by individuals over 65 was significantly higher than in 2001, with referrals up 33%, problems managed in general practice up 30% and medications up 27%.22 Australia’s 18 Cancer Council Australia 2015, Understanding your Pap smear results, viewed 8 March 2016, < http://www.cancer.org.au/about-cancer/early-detection/earlydetection-factsheets/understanding-your-pap-smear-results.html> 19 Collins, SJ 2016, You may have missed the news – but you now have to pay for your pap smear, viewed 7 March 2016, < http://www.mamamia.com.au/medicarepap-smears-not-free/> 20 Medhora, S 2016, Pap smears will cost after changes to pathology rebates say Labor and Greens, The Guardian, viewed 4 March 2016, < http://www.theguardian. com/australia-news/2016/jan/06/pap-smears-will-cost-after-changes-to-pathologyrebates-say-labor-and-greens> 21 Anderson, S 2016, Medicare rebate for pap smears unchanged, Minister says, as petition gathers 17k signatures, Accessed 9 march 2016 < http://www.abc. net.au/news/2016-01-06/claims-over-$30-charge-for-pap-smears-false-ministersays/7070320> 22 Head, M 2016, Australian government unveils new cuts to healthcare, World Socialist Website, viewed 17 March 2016 < https://www.wsws.org/en/ articles/2016/01/21/heal-j21.html>

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“There has been great uncertainty of how the changes proposed by the government will impact consumers. Consumer activist groups have been critical of the changes, highlighting that women will be particularly worse off if the proposed cuts are passed by Parliament.” universal health system supported by Medicare has well supported the ageing population. The cuts may effectively restrict pathology services to more privileged populations who can afford to pay should out of pocket expenses be extended to this group. Aboriginal and Torres Strait Islander peoples have poorer health status and outcomes and lower levels of access to the health system than non-Indigenous and non-Torres Strait Islander peoples.23 The pathology payment reform may also disadvantage Aboriginal and Torres Strait Islander peoples who already experience significant inequity within health care in Australia. There is no question that pathology payment reform must be undertaken in Australia, however ACN believes it must not compromise the health of Australians. The proposed cuts have the potential to cause inevitable health disparity if not undertaken in a measured way that ensures sustainable and reasonable funding mechanisms that protect access to and the quality of Australia’s pathology services. Short term cuts to produce short term savings are unlikely to contribute to useful health reform.

23 Victoria Aboriginal Community Controlled Health Organisation Inc. 2015, service cuts reduces access by Aboriginal people. The assault continues on the Australia’s Universal Health Care System, viewed 8 March 2016 < http://www. vaccho.org.au/news-media/mr/diagnostic-service-cuts/>

CHOOSING WISELY Choosing Wisely is an initiative that enables health care providers, consumers and stakeholders to raise questions about tests, treatments or procedures where evidence shows they provide no benefit and in extreme cases may lead to harm. With an ever increasing number of tests available, health professionals including nurses frequently initiate tests that are often unnecessary resulting in suboptimal use of limited health resources. ACN believes nurses can lead change as consumer advocates by reflecting on clinical practice and improving the patient journey through the health system. To view ACN's recommendations go to acn.edu.au/choosing-wisely


In focus @ACN

Reflec tions of a not-so - Remote A rea Nur se By Cherry Millar MACN

The tragic death of Fregon Remote Area Nurse Gayle Woodford and the resultant Cherry Millar discussion surrounding single nurse postings has prompted me to consider the qualities and environment that many Remote Area Nurses work in. It has also encouraged me to reflect a little on some of my own solo work experiences and give consideration as to how these circumstances impacted upon me. Not surprisingly some were positive and some definitely not so. Working as a health professional in a remote location requires exceptional personal and professional qualities. The individual needs to be able to rise to the challenge, think laterally and, in many instances, work autonomously. Their personal and professional survival is dependent upon local peers (if available), support systems within the community or health network and their own personal and professional judgement. Infrastructure and emergency clinical support evident in tertiary centres is noticeably absent and while communication with the Royal Flying Doctor Service may be possible, attendance is often hours away (even then dependent on weather and environmental conditions). Characteristics such as adaptability, versatility, courage, enthusiasm to learn and embrace difference, as well as ability to accept limitations are essential qualities for the care-provider. This lifestyle, while not suited to everybody, does offer the opportunity for significant personal and 10

professional development, cultural enrichment and the forging of resilient relationships. Of course, with these advantages also comes drawbacks, including isolation from long-term friends, lack of urban infrastructure (some would argue an advantage), extreme temperatures and limited or, perhaps it should be said, varied culinary ingredients. So what attracts health professionals to this type of work environment? Answers are many and varied. Some are pulled by an altruism to ‘do good’, others feel the need to be a part of a community, some are escaping ‘the rat race’, while others are eager for a challenge, want to upskill or even seek financial benefits. Some come with delusions and dreams as to what work in ‘the Outback’ entails – they either cut and run or adapt and benefit, whereas others are ‘familiar hands’ that have worked extensively in rural and remote locations and have developed knowledge, skills and attitudes – some which can be shared and learnt and some which only evolve with consistent exposure and experience. My personal experience was triggered by a combination of the above factors and I was certainly one that needed to adapt and ultimately benefit. Some of the challenges included getting a handle on a Toyota LandCruiser – both emergency maintenance and driving, travelling solo for up to eight hours on unsealed and often unmarked roads, following up patients in remote communities (often ‘gone walkabout’), facilitating palliative care in a creek bed, lending a hand with whatever was happening at the clinic and using the LandCruiser as an ambulance. Each day brought opportunity for new personal and professional development. There were positive and not-so-positive experiences. A positive that stood out for me was the early morning

A land of opportunity – and isolation.

"So what attracts health professionals to this type of work environment? Answers are many and varied. Some are pulled by an altruism to ‘do good’..." starts; leaving town before first light and driving into the outback with thermos, fruit cake, emus and satellite phone for company. These were unique and spiritually uplifting experiences. Did I feel threatened or insecure? No way. And I wouldn’t have missed it for the world. However, going into some less than salubrious environments at 2am in order to locate and retrieve a patient destined for a rapid inter-hospital transfer was extremely confronting and, on reflection, far from sensible. Hopefully some policy has moved on since then.

Despite the negatives – and the positives did outweigh them – I consider myself extremely fortunate to have had exposure to Remote Area Nursing but, while I would frequently overnight in remote communities, I could never claim to be a true Remote Area Nurse. This accolade can only go to those that live and work out there and who face the adversity of distance, limited resources, isolation from family and, of course, flies on a daily basis. It is these people that have insight into the true circumstances and, if policy development and related legislation is to be truly collaborative and meaningful, these are some of the voices that should be heard.


Engagement @ACN

AC N voices – meet our represent atives “This ACN representation opportunity was extremely important to me, as it allowed me to participate in a process which is fundamental to the ongoing safety and efficiency of nurses and midwives.”

Everyday somewhere around the nation, an Australian College of Nursing (ACN) representative is making sure our collective voices are heard. ACN representatives ensure that the views of the nursing profession are at the forefront of health care decision making. We harness the expert knowledge, experience and insights of our members and through ACN representation activities we facilitate the vital conversations about health and aged care and the leading role that nurses play in designing health care models and giving care. One of our amazing member benefits is that you too can offer your expertise and become an ACN representative. Keep your eye out for our representation calls for expression of interest promoted through our weekly eNewsletter – we look forward to your future engagement with ACN Representation! Each month, we feature our valued member representatives who are making a difference through their active participation in ACN representation activities. If you are interested in future representation opportunities with ACN, please email engagement@acn.edu.au

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ethical practice, workforce mobility, flexibility, responsiveness and sustainability.

Trish Lowe MACN

Trish Lowe MACN What committee are you representing ACN on? The Australian Nursing and Midwifery Accreditation Council (ANMAC) Re-entry to the Register Midwife Accreditation Standards 2016 expert advisory group. What led to your interest in this area? I have been a registered nurse for 30 years and a registered midwife for 16 of those. The Australian Health Practitioners Regulation Agency (AHPRA) administered National Registration Accreditation Scheme (NRAS 2010) pursues important goals for the nursing and midwifery profession, such as protecting the public, ensuring suitable training,

Fundamental to the successful achievement of these goals is the accreditation of all awards and qualifications, leading to nursing and midwifery registration. I was honoured to be selected to represent ACN on the ANMAC panel of expert advisors, as the Re-entry to the Register Midwife Accreditation Standards 2016, were revised and updated. What is the most recent work out of the working group and what were the major items discussed? The expert advisory group examined stakeholder feedback, gathered as a result of ANMAC consultation. Thereafter, several rounds of discussion ensued, during which this feedback was examined, distilled, prioritised and integrated into the revised standards. The Re-entry to the Register Midwife Accreditation Standards 2016 were updated before being offered to the Nursing and Midwifery Board of Australia, for ratification. Can you highlight any benefits arising for the profession as a result of this working group?

The process of regularly revising mandatory registration standards ensures that the needs of all stakeholders engaged in the Australian health system are captured, the contemporary nature of nursing and midwifery practice reflected, and the NRAS aims achieved. How important is this ACN representation opportunity to you and how has this opportunity benefitted your career? This ACN representation opportunity was extremely important to me, as it allowed me to: • participate in a process which is fundamental to the ongoing safety and efficiency of nurses and midwives engaged in the Australian healthcare system; • observe the thought processes and insightful discussion initiated by more experienced expert advisory group members; • receive a valuable opportunity to be mentored by midwifery leaders from consumer advocacy, policy development, governance and academic backgrounds.


Education @ACN

G r aduate C er tificate in Brea s t C ancer Nur sing: Build a pathway to an emotionally f ulfilling and rewar ding career “The skills learned and knowledge gained have enabled me to be more comfortable with discussions about advanced care planning and end of life care.” Joanne Lovelock RN RM, The Bays Hospital Why did you choose to study and work in breast cancer nursing? Joanne Lovelock My own personal experiences of cancer in 2004. Working in a small health facility also enabled succession planning for breast cancer nursing. The Graduate Certificate in Breast Cancer Nursing course focus includes the continuum of breast cancer care, evidence based practice, future trends and the impact of breast cancer on individuals, their families and communities.

In Australia, seven women die from breast cancer every day (National Breast Cancer Foundation, n.d.). Every day, a child loses their mother, a parent loses their daughter or a partner loses their spouse to this debilitating disease. The Australian College of Nursing offers a Graduate Certificate in Breast Cancer Nursing that will lead you down a rewarding and emotionally fulfilling career path where you can make a difference to the lives of patients and their families. This 12-month course will expand your professional capabilities and broaden

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your scope of practice to support patients through their breast cancer journey. McGrath Foundation Scholarships are available to study this course from July 2016. This scholarship is open to registered nurses who want to improve patient outcomes and build a pathway to a higher grade position in breast cancer nursing. Hear from two recipients of the McGrath Foundation Scholarship who completed our course and joined the fight against breast cancer.

How did the McGrath Foundation Scholarship help you complete your studies and progress your career? The McGrath Foundation scholarship helped financially and encouraged me to further my education. The scholarship removed a barrier and gave me a kick start to study again. During the course, a McGrath Breast Care Nurse position became available, which I applied for and was successful. What were some of the key skills you learned while completing your graduate certificate? The graduate certificate increased my knowledge base and assisted in aligning theory with practice. It rekindled my love of education, which had, at

times, flagged. Some of the key skills I learned while completing this course included: time management, analysing research data, computer skills and analysing journal articles. How have you directly applied these skills in the workplace? I learned how to back-up day-to-day care with evidence. The Symptom Management in Advanced Disease States unit allowed me to refresh my knowledge on systems I hadn’t used as a midwife for years. Since completing the course and working in the field, I have utilised this knowledge in various ways. The sections on pain and pain management have been particularly useful. The skills learned and knowledge gained have enabled me to be more comfortable with discussions about advanced care planning and end of life care. The psychosocial aspects of care have always interested me and I feel better equipped to handle this. What has been a defining moment in your career in breast cancer nursing? Realising that you can only do what you can do with the resources you have at that moment in time.


Education @ACN

Teresa Clark Clinical Nurse, Princess Alexandra Hospital Why did you choose to work in breast cancer nursing? I was offered the opportunity to work in breast cancer nursing and found I really enjoyed it. I always had an interest in this area and really enjoyed the patient interactions. It was very rewarding being able to emotionally support patients going through care.

What has been a defining moment in your career? Being given the opportunity to work in breast cancer nursing was a great experience. This opportunity was definitely a defining moment in my career. References National Breast Cancer Foundation, n.d, Facts and Stats, viewed 29 March 2016, http://nbcf.org.au/about-national-breast-cancer-foundation/about-breastcancer/facts-and-stats/

“I developed a better sense of diagnosis and a better understanding of the emotional side of breast cancer nursing.” How did your scholarship help you complete your studies and progress your career? The scholarship was a big help financially. I already had experience in this area and the scholarship gave me the opportunity to combine everyday practice with theory. Was the scholarship a defining influence on your choice to undertake this graduate certificate? It was a factor that made it much easier for me to study. I was always interested in completing further studies and the scholarship pushed me to do it when I did. How have you directly applied the skills you learnt from completing a Graduate Certificate in Breast Cancer Nursing? I put the skills I learned during this course into practice every day. I developed a better sense of diagnosis and a better understanding of the emotional side of breast cancer nursing.

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26–28 October 2016

McGrath Foundation Scholarship Applications for the McGrath Foundation Scholarship close on 12 April 2016. Visit www.acn.edu.au/mcgrathfoundation for more information or call 1800 061 660. For more information about the Graduate Certificate in Breast Cancer Nursing, visit www.acn.edu. au/breast-cancer-nursing

THE NATIONAL NURSING FORUM THE POWER OF NOW Melbourne Park Function Centre

CALL FOR ABSTRACTS NOW OPEN


In focus @ACN

T he life of a tr avelling countr y nur se By Lauri Buckingham

I have been working as a rural and remote locum for more than two years now and I absolutely love it! My previous nursing experience was working in a busy rural hospital, where I had been serving as Nurse Unit Manager (NUM) for seven years, but eventually felt that the burden of administration swamped the joy and satisfaction of my job. After stepping down briefly I found I needed new challenges and new horizons. Prior to my management position, I had worked in Saudi Arabia, high in the mountains at a place called Khamis Mushayt, as a NUM for a busy 40-bed paediatric ward. That certainly was stimulating and challenging but too far away from home. The years before my position in Saudi Arabia, I mainly worked in specialty areas including intensive care units, paediatrics and emergency departments around the major hospitals in Sydney. One of my colleagues snagged my interest in the Nursing and Allied Health Rural Locum Scheme, an Australian Government funded locum support program, after relaying her experience of working for them for a few months. My problem was that I had cats and horses on a rural property that I felt committed to care for. Fortunately, I found a great friend who agreed to house sit, setting the wheels to roll into a new life. My first placement was not the happiest experience, mainly due to the intrinsic atmosphere of the hospital and the poor onsite accommodation, but before I knew it I was off to another location with marvellous accommodation and splendid hospital morale.

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One of the important lessons I learnt very quickly was the importance of first impressions and reassurance when first arriving at a new site. Many sites are reliant on other agency staff and are nervous when yet another unknown arrives at their door. My mantra is “the first three days are critical to turn the mood around completely”. Working hard, diligence and a clear message of preparedness to take on anything soon transforms looks of uncertainty into extended feelings of appreciation and welcome. The best aspect of this is that, when you return (which invariably you will), the welcome hits the ground running, as do you. One of the great pleasures I also find in this career is that, because it involves working with nurses all over the country, I have repeated experiences of inspiration at meeting so many genuinely lovely people. Nurses, after all, are some of the nicest people you are ever likely to meet and meeting them everywhere is delightful. It is endlessly fascinating to discover the great diversity of nursing backgrounds, both privately and professionally. Another great treat is the unforeseen opportunity to discover the plethora of little unknown country towns in this great sunburnt land that I never dreamed existed. Along the journey to placement, and particularly on days off, I am liberated to fossick along all the byways and highways and discover incredible little towns and villages that are often frozen in time. If you have a passion for nostalgia, this lifestyle is an insatiable feast for seeing rural historical Australia. In conventional life, I would never know of, let alone be able to explore, parts of the enormous tapestry of towns and villages that pepper this vast continent.

Lauri (second from right) with colleagues Cath, Joy, Barb, Kelly and Christy.

Sometimes it feels as if I am exploring a dream in which bygone rural Australia unravels its secrets endlessly towards the dusty horizon as I motor along, new contract underarm, to discover yet another hidden little countryside. To my delight I have discovered a great resurgence in many of these little communities brought on by the great Australian Grey Nomad mobilisation soon to become, no doubt, a part of great folk legend. In the middle of winter last year, while housed in a cabin on stilts overlooking the big river in Batemans Bay, a most curious event was unravelling. I noted the foreground, stretching in front of the row of cabins, was the site of a continuing stream of Winnebago caravans and the like. The occupants of these mobile homes would invariably stay for a few days and then move on. “Ah,” I would think to myself, “I am about to gain

an unspoiled vista of the river”. Not for long. No sooner had one left than another took its place. I was astounded that such a heavy traffic of campers should be holidaying in the heart of the coldest season. After a while I noted the similarity in this cascade of activity; a grey-haired man and woman, generally a bit overweight, accompanied by a small white dog. The momentum of this travelling throng struck home. This was the rejuvenating force that is striking life back into so many little towns all over Australia. Rather than being a burden to society, a message often echoed in political sentiments, retired folk are bringing many parts of the country back to life. I am poised and enthusiastic to see what other hidden gems will be uncovered, both at work and in the environments that I explore, that are all part of the life for a travelling country nurse.


Professional development @ACN

C PD shor t cour ses @AC N NT

QLD

CLICK HERE TO VIEW ALL COURSES

TAS

21–22 APRIL

14–15 APRIL

3–4 MAY

The toolkit of teaching techniques for educators

Palliative care 

Leadership First

RN/EN | 2 days | 14 CPD hours | Brisbane

2 days | 12 CPD hours | Launceston

RN/EN | 2 days | 14 CPD hours | Darwin 28–29 APRIL

Palliative care  RN/EN | 2 days | 14 CPD hours | Alice Springs 17–18 MAY

12–13 MAY

12–13 MAY

Wound management

Wound management

RN/EN | 2 days | 14 CPD hours | Cairns

RN/EN | 2 days | 14 CPD hours | Gold Coast 24–25 MAY

27 MAY

Clinical assessment for the older person

RN/EN | 1 day | 7 CPD hours | Hobart

Leadership First

2 days | 12 CPD hours | Brisbane

ACT

28–29 APRIL

Palliative care 

SA

31 MARCH – 1 APRIL

Infection prevention and control

Palliative care 

RN/EN | 2 days | 14 CPD hours | Adelaide 5–6 MAY

Leadership First 2 days | 12 CPD hours | Canberra

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WA

14–15 APRIL

RN/EN | 2 days | 14 CPD hours | Canberra 10–11 MAY

Access to the peer-reviewed publication is free for all ACN Members via the Life Long Learning Program portal, 3lp.acn.edu.au

12–13 MAY

Clinical assessment for nurses

Leadership First

2 days | 12 CPD hours | Darwin

RN/EN | 2 days | 14 CPD hours | Launceston

Read the latest in nursing research and practice in ACN’s digital journal, Collegian.

Clinical assessment for nurses

RN/EN | 2 days | 14 CPD hours | Port Lincoln

RN/EN | 2 days | 14 CPD hours | Perth 18–19 APRIL

Leadership First 2 days | 12 CPD hours | Perth

Visit www.collegianjournal.com

Community & Primary Health Care Nursing Week Nurses where you need them 19–25 SEPTEMBER 2016


Professional development @ACN

CLICK HERE TO VIEW ALL COURSES

NSW

28 APRIL

Radiotherapy update RN/EN | 1 day | 7 CPD hours | Parramatta 29 APRIL

ECG: introduction RN/EN | 1 day | 7 CPD hours | Newcastle 29 APRIL

CPD portfolio and documentation: meet your registration requirements RN/EN | 1 day | 7 CPD hours | Parramatta 5–6 MAY

20 MAY

17 JUNE

Organ and tissue donation awareness for perioperative nurses

Immunisation update

RN | 1 day | 7 CPD hours | Parramatta

RN | 1 day | 7 CPD hours | Batemans Bay 21 JUNE

Understanding dementia 26–27 MAY

RN/EN | 1 day | 7 CPD hours | Parramatta

Physical health care in mental health

23 JUNE

RN/EN | 2 days | 14 CPD hours | Parramatta

Immunisation update RN | 1 day | 7 CPD hours | Parramatta

27 MAY

Pressure injury prevention and management RN/EN | 1 day | 7 CPD hours | Batemans Bay

29–30 JUNE

Team dynamics and clinical leadership RN | 2 days | 14 CPD hours | Parramatta

7 JUNE

Day surgery nursing RN/EN | 1 day | 7 CPD hours | Parramatta

VIC 21–22 APRIL

RN | 2 days | 14 CPD hours | Parramatta

RN/EN | 2 days | 14 CPD hours | Coffs Harbour

Wound management

10–11 MAY

15 JUNE

28–29 APRIL

Legal issues for registered nurses

Physical health care in mental health 

Diabetes management and current guidelines RN/EN | 2 days | 14 CPD hours | Wagga Wagga 18–19 MAY

Infection prevention and control RN/EN | 2 days | 14 CPD hours | Dubbo 20 MAY

Understanding dementia RN/EN | 1 day | 7 CPD hours | Coffs Harbour

RN | 1 day | 7 CPD hours | Parramatta

RN/EN | 2 days | 14 CPD hours | Bendigo

17 JUNE

24–25 MAY

Perioperative anaesthetic nursing

Clinical assessment for nurses

RN | 1 day | 7 CPD hours | Parramatta 17 JUNE

Introduction to clinical facilitation RN | 1 day | 7 CPD hours | Port Stephens

NURSING IN GENERAL PRACTICE eral practice team A guide for the gen

RN/EN | 2 days | 14 CPD hours | Melbourne

RN/EN | 2 days | 14 CPD hours | Geelong 1–2 JUNE

Leadership First

2 days | 12 CPD hours | Melbourne 24 JUNE

Immunisation update

RN | 1 day | 7 CPD hours | Melbourne

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The handbook contains details about employing and supporting RNs and ENs, the current regulatory environment, how to maximise the benefits, including the Practice Nurse Incentive Program and the range of MBS items that support nursing services in general practice.

9–10 JUNE

Pain management

Advanced wound management

If you are a nurse working in a general practice setting, the Nursing in General Practice (NiGP) Handbook is essential reading, and it’s FREE.

Order your FREE printed copy or download a PDF version.


NMBA update

Renew your regis tr ation by 31 May The Nursing and Midwifery Board of Australia (NMBA) is launched its 2016 renewal campaign at the end of March. If you are a registered nurse, an enrolled nurse or midwife, you are due to renew your general or nonpractising registration by 31 May 2016, so look out for renewal reminders from the NMBA and Australian Health Practitioner Regulation Agency (AHPRA). During 2014/15, 97.5 per cent nurses and midwives renewed online. This rate of online renewal is remarkable considering in 2010 at the launch of this national online service the rate for nursing and midwifery was closer to 54 per cent. Look out for renewal reminders from the Australian Health Practitioner Regulation Agency (AHPRA) and the NMBA from late March. Hot tip! It is important that you read the online renewal mandatory disclosure questions carefully as they may have changed since the last time you renewed your registration. Renewing online is the best way to renew your registration – it’s quick and easy Accessing online renewal is as easy as 1, 2, 3 1. Go to www.ahpra.gov.au/login 2. Enter your AHPRA User ID: <UserID> 3. Enter your date of birth and password. Need to reset your password? Go to www.ahpra. gov.au/forgot-password and get a new one emailed within 15 minutes.

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A series of email and hard copy reminders will be sent to nurses and midwives throughout the renewal campaign. Make sure your email contact details as held by AHPRA are up to date so you don’t miss them. To update your contact details use AHPRA’s secure online services for health practitioners.

registration will lapse. Your name will be removed from the national register of nurses and midwives and you will not be able to practise without making a new application for registration.

If you do not renew your registration by 31 May, or within the following one-month late period, your registration will lapse. Your name will be removed from the national register of nurses and midwives and you will not be able to practise without making a new application for registration.

The NMBA has revised the following registration standards:

For more information check out our helpful tips and renewal fact sheet under Registration and endorsement at www.nursingmidwiferyboard. gov.au. Meeting registration requirements The role of the NMBA is to protect the public by ensuring that only nurses and midwives who are qualified, safe and competent to practise are registered. It is important for you to carefully read the renewal questions as some of these may have changed since last year. You should also read the NMBA’s registration standards to make sure that you understand the declarations you must make regarding mandatory registration standards. You have until 31 May 2016 to renew your registration, if you do not renew your registration by this date, or within the following one-month late period, your

Changes to registration standards

• Continuing professional development • Recency of practice • Professional Indemnity Insurance arrangements • Endorsement as a nurse practitioner, and • Endorsement for scheduled medicines for midwives. The NMBA released these revised standards on 1 February 2016 to give nurses and midwives time to understand the updated requirements before they come into effect. These revised standards do not apply to the renewal of registration in 2016.

Profile for ACN Australian College of Nursing

NurseClick April 2016  

NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles related to nursing practice, policy developmen...

NurseClick April 2016  

NurseClick is the Australian College of Nursing's monthly e-zine focusing on topical articles related to nursing practice, policy developmen...