Aboriginal and Torres Strait Islander peoples deserve a Voice to Parliament about the issues that impact them.
The QNMU supports the 2023 Voice to Parliament referendum and will be proudly campaigning ‘Yes’.
Find out more on page 14.
#UnionsForYes #yes23
THE OFFICIAL JOURNAL OF THE QUEENSLAND NURSES AND MIDWIVES’ UNION
ISSN 2207-6018
ABN 84 382 908 052
106 Victoria Street
West End Q 4101 (GPO Box 1289
Brisbane Q 4001)
T 07 3840 1444
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E inscope@qnmu.org.au
W www.qnmu.org.au
EDITOR
Beth Mohle, Secretary, QNMU
PRODUCTION
QNMU Communications
Team: Linda Brady, Melissa Campbell, Cameron Gledhill, Rose Pascoe, Lou Robson, Luke Rutledge, Jannine Sione, Analiza Smart
PUBLISHED BY
The Queensland Nurses and Midwives’ Union
AUTHORISED BY
B. Mohle, Secretary, Queensland Nurses and Midwives' Union, 106 Victoria St West End 4101.
PRINTED BY
Kingswood Print Signage, 80 Parramatta Rd
Underwood 4119
14 The Voice. A path to selfdetermination for Aboriginal and Torres Strait Islander peoples
20 Nurse Navigators: Good for patients, good for our health system
24 After the floods
28 Ratios: It's much more than a numbers game
32 Strikes, solidarity & rock 'n' roll
Acknowledgement of Country:
The QNMU would like to acknowledge the traditional custodians of the lands on which we all work and live. We pay our deepest respects to their elders past and present, and acknowledge their sovereignty and unbroken connection to these lands.
DISCLAIMER:
Statements expressed in articles in InScope are those of the contributor and do not necessarily reflect the policy of the Queensland Nurses and Midwives’ Union unless this is so stated.
Copyright of articles remains with the contributor and may not be reproduced without permission. Statements of facts are believed to be true but no responsibility for inaccuracy can be accepted. Other material may be reproduced only by written arrangement with the Union.
Although all accepted advertising material is expected to conform to the QNMU’s ethical standards, such acceptance does not imply endorsement.
Where individuals in this publication are described as registered health practitioners and/or QNMU members, this was accurate, to the best of our knowledge, at the time of writing.
No representation is made as to the current status of the individuals’ registration.
For the current status of an individual’s registration, please refer to the NMBA register, at www.ahpra.gov.au Visit www.qnmu.org.au/privacy to read our privacy statement.
Cover photo: Jason Coombes, Gunai/ Kurnai man, QNMU member and remote area nurse.
Photo: Veronica Sagredo
This year we will be holding a nation-defining referendum in Australia to change our constitution. The referendum question we will vote on is whether we support establishing a representative voice for Aboriginal and Torres Strait Islander peoples to inform government decision making.
Changes to our constitution can only occur via a referendum, and since Federation only eight of the 44 proposals for constitutional change have passed. The last referendum (on whether Australia should become a republic) was held in 1999. The last successful referendum was held in 1977, so many Australians have not participated in a referendum process.
The other significant successful referendum to be highlighted in the current context is the 1967 referendum when more than 90% of Australians voted to remove references in our constitution that discriminated against Aboriginal and Torres Strait Islander peoples. It was the single most unifying moment in Australia’s democratic history. Now 55 years later we are being asked build upon this by voting on another matter of fundamental principle.
At the time of writing, the date of the referendum has not been confirmed. Prime Minister Anthony Albanese has stated it will take place sometime between August and October this year. A “double majority” of those voting must be achieved for a referendum question to pass. This means the majority of those voting
nationwide must vote yes AND a majority of the states must also vote yes. This requirement, in part, explains why most referendum proposals have to date been unsuccessful. Political support from major political parties for a yes vote is usually seen as a prerequisite to achieving a yes outcome.
Getting to this referendum has been a very long journey involving many inquiries and years of broad community consultation. There have been ten reports on constitutional recognition since 2010 and lengthy deliberative processes including a Referendum Council, a joint federal parliamentary inquiry and a co-design process established by the previous Morrison government. The ground has been well and truly covered. What is needed now is action.
A working group has also been established to advance the significant work already undertaken and outline clear principles to define the body that will provide the voice. This body1:
■ provides independent advice to the Parliament and Government
■ is chosen by First Nations peoples based on the wishes of local communities
■ is representative of Aboriginal and Torres Strait Islander communities
■ is empowering, community led, inclusive, respectful, culturally informed and gender balanced, and includes youth
■ is accountable and transparent
■ works alongside existing organisations and traditional structures.
There are a lot more details about the referendum process members need to be aware of, and myths to be busted. We will provide this in the coming months so members can make an informed decision. This detail, although important, is not the main game in my view. Rather it is the principle at the core of this deliberation.
I want to focus this column on the need for Voice.
The lack of voice is central to the significant disadvantage that Aboriginal and Torres Strait Islander peoples have experienced since the British colony was established in Australia. Their displacement and resultant trauma and disadvantage must be acknowledged if we are to reconcile our past and move forward together. In doing so we can make practical improvements to the lives of Australia’s First Nations peoples.
For me the slogan used widely by disability activists, “nothing about us without us”, neatly sums up what is at the heart of this referendum. This resonates strongly with nurses and midwives. Given the entrenched power imbalances in our health and aged care system, we have first-hand experience of not being at tables where decisions are made that directly impact upon our lives.
Having a say and being heard is fundamental to addressing the root cause of problems to bring about systemic change. We experience the powerlessness related to not being heard and our concerns not being acted upon, so the call of First Nations peoples should resonate with us.
Recognising the need for a proper voice in our constitution for First Nations peoples provides the necessary fundamental structural change to ensure they can improve the decisions, policies and laws that affect them. Change starts with listening.
At our 2020 annual conference QNMU adopted a position to support the Uluru Statement from the Heart, a statement that includes a call to provide First Nations peoples with a voice in our constitution The other two elements of the Statement are a Makarrata Commission to supervise the making of agreements or treaties, and a process to oversee truth telling for our nation - Voice. Treaty. Truth.
Annual conference is our union’s annual democratic policy making forum, involving hundreds of delegates representing members from across our state. This resolution was subsequently ratified by the QNMU Council, the elected body charged ensuring delivery of our union’s strategic priorities.
So QNMU members, through our democratic processes, had a voice in advancing this strategic priority for our union, the Australian union movement and our country as a whole. As unionists we know the importance of having our collective voices heard in the various places where decisions that impact upon us in our working and personal lives are made.
Since our 2020 conference, we have worked with the QNMU First Nations Branch to advance the campaign for constitutional
recognition of the Voice. This forms the bedrock for reconciliation.
Now we will turn to engage our broader membership and the wider community to advance the “yes vote” campaign. This campaign involves a wide cross section of Australian society including trade unions, representatives of civil society, business and political parties along with grassroots community campaigners.
As nurses and midwives, we see the significant health disadvantage experienced by First Nations peoples and know that the gap in disadvantage is not closing quickly enough. We have a vital role to play in closing this gap that arises from systemic disadvantage. Voice and co-design are central to this, and as the principal health union and the largest union in Queensland we have a leadership role to play in the “yes vote” campaign.
Now is the time to listen, learn and then act. By voting yes in the upcoming referendum we can accept the gracious invitation that ends the Uluru Statement from the Heart.
“We invite you to walk with us in a movement of the Australian people for a better future.”
1. Agreed principles outlined in a Communique of the Referendum Working Group (September 2022). http://bit.ly/3XTjV4P.
QNMU members frequently contact us with questions about their wages, entitlements and other workplace conditions.
Being informed about your agreement, workplace policies and procedures, and any other professional and industrial issues, is the first step to ensuring nurses and midwives receive what you are due.
Our Tea room series, which appears in every edition of InScope, explains some of the common queries we receive from members.
If you have any topics you’d like covered, we’d love to hear your suggestions – email inscope@qnmu.org.au
almost time for registered nurses and midwives to renew their NMBA registration.
When you renew your registration, you’ll need to answer a number of important questions.
The wording of the questions may change slightly year-to-year, so it is important to read the questions carefully.
If you are unsure about how to answer a particular question, it’s important to get advice before submitting your application. Give the QNMU a call. Complicated matters will be referred to QNMU Law for specific advice, as a benefit of your union membership.
The renewal form may ask: “Do you have an impairment that detrimentally affects, or is likely to detrimentally affect, your capacity to practise the profession?”
An “impairment” is a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect your capacity to practise the profession.
However, an illness or health condition that is safely managed is not the same as an impairment. In our view, if you have a health condition that is safely managed, and does not affect your capacity to carry out your role, this is not something that is required to be declared when you renew your registration.
How individual practitioners should answer the impairment question will depend on a number of factors applicable to the individual at the time of making the declaration. If you are unsure how you should answer this question, contact the QNMU. Do I have to declare a criminal charge?
There is a broad definition of “criminal history”, and it even includes charges that were dropped, and matters where a conviction was not recorded. If you have had any charges against you, we recommend seeking specific advice regarding whether or not you are required to make a disclosure when seeking renewal.
and midwives, though again, seek advice if you’re unsure.
What other questions do I need to answer?
To meet the recency of practise requirements, nurses and midwives must have practised for a minimum of 450 hours in the past five years.
The professional indemnity insurance question is an easy one – if you're a financial member of the QNMU for the relevant period (i.e. are up to date with your payments and paying the correct rate), then you are covered!
With regard to CPD, nurses and midwives are required to complete a minimum of 20 hours per year, though more may be required if you hold dual registration, or an endorsement.
If you are unsure how to answer any of the questions on the renewal form, seek advice before you submit it.
The due date for applying for registration renewal is 31 May 2023. However, there is also a ‘late period’, until 30 June 2023, where practitioners can apply to renew their registration, but will also need to pay a late fee.
If you have applied to renew your registration, you are able to keep practising while the NMBA considers your renewal application, even if the date for registration expiry has passed. If a practitioner is on the register, they can practise (so long as their registration is not suspended, etc).
If you have not applied to renew your registration by 30 June 2023, you will be removed from the NMBA register. If you are not on the register, you can’t practise.
If you have questions about our Tea room column, email memberconnect@qnmu.org.au
The question about right to practise generally applies to practitioners in private practise, rather than employed nurses
If you forget to renew your registration, you must cease practise immediately –there are serious penalties that can apply if you practise without holding appropriate registration. To return to practise, you will need to reapply for registration, and wait until your registration has been granted by the NMBA. There may be a ‘fast track’ application process available for re-registration, but you’ll need to stop practising until it is processed.
Don’t forget to renew! And if you have any questions, get in contact with the union!
Some of you may not be aware that as a member of the Queensland Nurses and Midwives' Union you are also a member of a Branch of the Australian Nursing and Midwifery Federation. The ANMF is a highly regulated union made up of state and territory self-governing branches, some of which, such as the Queensland (QNMU) Branch, also have counterpart state registered unions. If you are a member of one of the state or territory branches, you’re a member of the national union too. Collaboratively, we are the largest union in Australia with over 320,000 members. Together we work to advance the nursing, midwifery and care professions and fight for the conditions required to deliver safe, quality care.
In February, elections were held for the Secretary, Assistant Secretary, President and Vice-President federal positions and those who were in those positions, Annie Butler, Lori-Anne Sharp and James Lloyd, and myself as the Federal President were elected unopposed for another term.
The ANMF and the Branches were very active in the lead up to last federal government election, lobbying to secure long-needed change to the broken health and aged care system in Australia. This includes promoting how nurses, midwives and care workers can contribute to fixing the issues and ensuring safe care.
Our strategic priorities as a Federation include:
Equipping nursing and midwifery professions to deliver safe, quality care in all settings and being prepared for the future through work with NMBA and other national groups in aged care, rural health, and the Coalition of National Nursing and Midwifery Organisations. The ANMF supports the professional growth of all levels of the nursing and midwifery professions, from early-career nurses and midwives to Nurse Practitioners; and supports exploring opportunities from digital health, and rural and remote practice, to the use of medicines and more.
Ensuring professional and personal safety and wellbeing of nurses, midwives and carers in all environments through lobbying and campaigning for pandemic
leave and other protections through the Fair Work Commission and other cases to change law in work health and safety regulation; family and domestic violence leave; the Aged Care Work Value Case and updates to the Nurses Award 2020
Positioning nursing and midwifery as informed, expert commentators and advocates on health and change, early learning reform and most particularly aged care. The ANMF and members from around the country have been front and center in all stages of the Royal Commission into Aged Care, and now lobby the federal government to commit to reform of the health system as a whole.
Developing evidence to inform and influence national health and aged care policy, and promote alternative policy where needed through the ANMF National Policy Research Unit which analyses the impact of key national health workforce and funding policies, develops submissions and reports on matters relating to nursing, midwifery or care work at the national level.
As we enter a new term, and working closely with the staff of the federal office and the elected officials of the state and territory branches, the ANMF will remain focused on releasing capacity of nurses and midwives to support health service delivery in all settings in Australia.
We will continue lobbying and campaigning nationally for safe staffing and safe workloads for nurses, midwives and carers in all settings, prioritising our national focus on aged care; lobbying for legislative and policy reforms to support the full use of the nursing, midwifery and carer workforce, advocating for innovation in workforce models, scope of practice, the preparation of nurses and midwives educationally, and committing to assist the growth and training of a culturally safe and diverse nursing, midwifery and carer workforce.
The recent change of federal government presents us with an opportunity to be heard… lobbying for the change we need to see in federal health planning, reform, funding and policy for the future health of all Australians. Together, when we raise our voice, we will be heard!
QNMU COUNCIL
president :
Sally-Anne Jones
vice president :
Lucynda Maskell
secretary :
Beth Mohle
assistant secretary :
Kate Veach
councillors :
Julie Burgess ■ Christine Cocks
Madonna Cameron ■ Karen Cooke
Tammy Copley ■ Nikki Emblen
Michael Hall ■ Chris Johnson
Damien Lawson ■ David Lewis
Simon Mitchell ■ Fiona Monk
Emma Murphy ■ Sue Pitman
Cathy Rose ■ Ashleigh Sullivan
Michelle Sunderland ■ Kym Volp
Janelle Taylor ■ Kelly Trudgen
Samantha Woodhouse
ANMF FEDERAL COUNCIL
federal president :
Sally-Anne Jones
federal vice president :
James Lloyd
federal secretary : Annie Butler
federal assistant secretary : Anne Sharp
branch presidents :
Athalane Rosborough (ACT)
O’Bray Smith (NSW)
Trevor Bason (NT)
Sally-Anne Jones (QNMU)
Jocelyn Douglass (SA)
James Lloyd (Tas)
Maree Burgess (Vic)
Trish Fowler (WA)
branch secretaries :
Matthew Daniel (ACT)
Shaye Candish (NSW)
Cath Hatcher (NT)
Beth Mohle (QNMU)
Elizabeth Dabars (SA)
Emily Shepherd (Tas)
Lisa Fitzpatrick (Vic)
Janet Reah (WA)
NURSE PRACTITIONERS who live and work in rural and remote Australia will have their Higher Education Loan Program (HELP) debt reduced under new Federal legislation passed in February.
The new legislation applies to Nurse Practitioners who have an outstanding HELP debt when they start eligible work in an eligible location on or after 1 January 2022.
For Nurse Practitioners the legislation applies to HELP debts accumulated while undertaking an approved Nursing and Midwifery Board of Australia (NMBA) program of study leading to endorsement as a nurse practitioner (Master’s Degree level minimum).
It is subject to certain criteria including the length of the study program, the location and length of the rural or remote work.
For more information visit https://bit.ly/HELPDebt
THE LATEST data from the Australian Bureau of Statistics shows workers who are union members earn on average about $300 more per week than their nonunion counterparts.
Data shows the median weekly earnings for unionised employees in August 2022 was $1520 per week, compared with $1208 for employees who were not a trade union member.
The news comes as no surprise to us.
“The recent EB11 outcome for public sector nurses and midwives is a good example of how unions can help workers secure better wages,” QNMU Assistant Secretary Kate Veach said.
“The wage increase of 11% over three years plus a cost of living allowance represents the most significant wage increase from any public sector employer in the country.”
THE QNMU’S online Notices of Motion portal is now open and taking submissions.
IMPROVEMENTS TO superannuation for Queensland’s public sector employees, which were first announced in mid-2022, will start from July 2023
These changes, which have come about thanks to years of agitation from the QNMU, may significantly improve your super in retirement, particularly for shift workers whose penalty rates make up a substantial portion of their income.
For more information visit: www.qnmu.org.au/super
A Notice of Motion is a written submission from a Local QNMU Branch which is put to state delegates to vote on during Annual Conference.
It is opportunity to put forward ideas about how we as a collective can improve our working lives through the work of our union.
For information on how to draft and submit a motion visit www.qnmu.org.au/motions
The submissions portal will close on 19 April. Any motions lodged after that cutoff date will be held over to next year’s conference.
THE NEW Nurse Practitioner
Allowance introduced under the Nurses and Midwives Certified Agreement (EB11) will be paid earlier than planned.
The allowance along with applicable back payments will now be paid in the pay run of Wednesday, 29 March 2023 to all Nurse Practitioners at the Nurse Grade 8 level; and to those people required to practice as a Nurse Practitioner as part of another role at Nurse Grade 8 level and above.
The allowance is designed to help recruit and retain Nurse Practitioners in Queensland Health and recognises the importance of their skills and experience.
We are thrilled to announce the QNMU now has more than 1000 members who identify as First Nations nurses and midwives!
The milestone was reached in the final weeks of January with QNMU records for February 1 showing 1009 members had identified as Aboriginal or Torres Strait Islander people. QNMU Councillor and First Nations Branch Delegate Kelly Trudgen described hitting the milestone as a “very emotional, spinetingling” moment.
“I was a member of the original First Nations Reference Group back in 2016/17 before I moved overseas, and now seeing the Branch come to fruition and achieving such a milestone with membership, I feel being a little emotional is just reflective of how proud I am that we have the opportunity to identify and be valued as First Nations nurses and midwives,” she said.
“This is also an important milestone for the QNMU as a whole, demonstrating that our branch members have chosen to be affiliated with a state-wide branch that represents First Nations nurses and midwives across all sectors of the health system, and with a focus on First Nations people first.
“As Branch Delegate, I am encouraging all our First Nations Nurses and Midwives to help continue this growth in numbers so we can empower each other and eradicate racist attitudes and behaviours in health; embed a culture of belonging, support and mentoring to ‘grow our own’ dedicated health workforce; and, to foster and achieve key activist goals such as supporting the “YES” vote for a Voice to Parliament.
“This is only the beginning,” she said.
If you have not identified as an Aboriginal and/ or Torres Strait Islander member with QNMU and wish to do so, simply log into your member profile via our website at www.qnmu.org.au and update your details.
First Nations members can also choose to be part of their local branch or to join the QNMU First Nations Branch.
To change or check your branch affiliation contact our Member Connect team on (07) 3099 3210 or 1800 177 273 (toll-free outside Brisbane).
Aregional member is celebrating a win for work-life balance after QNMU helped her secure a 12-month flexible working arrangement to manage childcare responsibilities.
Our member, who is the primary carer for her two children under two, works part time while her husband works full time with early starts running a small business.
Returning from maternity leave after the birth of her second child, management initially granted our member a three-month Flexible Work Arrangement (FWA) however as that agreement neared expiry, she requested a new arrangement based on the same, unchanged need to manage childcare and family responsibilities.
Management refused and instead offered only another three-month FWA.
With no other family or support persons to help and with only two days of childcare available, three months offered no capacity for long term childcare planning and the member feared she would have no choice but to resign.
Under pressure from management to comply, the member turned to QNMU and we were able to bring both parties to the table to negotiate a compromise.
This is a great outcome for our member and highlights the entitlement under the Nurses and Midwives (Queensland Health) Award - State 2015 which is replicated in the Queensland Health, Flexible Work Arrangements policy.
To be clear, managers can refuse an FWA request or decide to grant only a partial one, but “only on reasonable grounds” and must provide clear written reasons within 21 days.
QNMU MEMBERS at Yarrabah Hospital in the Cairns and Hinterland HHS had a little more cash in the kitty for Christmas after receiving back pay for unpaid annual leave.
Nine members received annual leave backpay or annual leave accrual
Recently, the QNMU has noticed managers in QH arguing “rosters must be equitable for all” as “reasonable grounds” for a refusal.
We are of the view however that each request for an FWA should be judged on its own merit and encourage members to speak to the QNMU if you believe your manager is not being reasonable.
In our experience, members can usually be assisted without disadvantaging colleagues and managers, and employees’ circumstances often change over time.
Meanwhile, for members in the private sector, the Federal government recently recognised limitations in the flexible work provisions in current federal laws, and has taken steps to address this in the new Secure Jobs, Better Pay legislation (see page 53 in our story on legislative changes).
adjustment after their contracts were reviewed.
Total backpay was $4,241, while the addition to the accruals resulted in members receiving over 314 additional hours or approximately $14,600 in entitlements.
For members who face complaints matters at work, the QNMU can be a tremendous source of support helping nurses and midwives navigate everything from the emotional stress to the mountains of paperwork and difficult meetings that are so often part of the resolution process.
We recently received a letter from a very grateful member who received assistance from our Servicing Organiser Susan Lines and Wellness officer Janet Baillie as they supported her while she worked through her matter.
Our member has given us permission to publish extracts from her letter, to share just how how much that support meant to her and the importance of having QNMU in your corner.
I’m writing to compliment the absolutely outstanding effort of Susan Lines. She is the biggest credit to her profession. The passion and drive, her commitment and kindness towards me in a difficult time was incredible.
No matter what time of day, her support and advice was outstanding, even when I was a blubbering mess.
From the start of our professional relationship all the way through to the final document being submitted not once did I not feel like the centre of Susan’s care. She always put in the time and effort to really get to know me, my challenges, strengths, my limits and needs.
A special mention also to Janet from the Wellbeing team who called me …to ensure a was in a good space. She did not have to, but she made that call.
I have been so impressed with their care and passion for their job and dedication they both have in their own unique way.
From the moment the events occurred, I encountered nothing but a cohesive and collegial, supportive, encouraging and respectful group of staff from QNMU. I felt as though my contribution, questions and concerns were heard and met with respect and patience.
This was highly complex and extremely challenging (matter) from a clinical and emotional point of view; and the fact this was my first complaint in 25 years of midwifery, (and that I was unfamiliar) with the processes and people, could have been a recipe for me not wanting to return to the place I loved and the job I did with pride and passion.
I honestly believe the camaraderie displayed by Susan meant the difference between a highly traumatic experience and one where I felt as though I received the best care and communication possible given the circumstances.
Thank you from a humble heart
QNMU members working for Churches of Christ aged care had a win against wage theft recently after they were underpaid for working public holidays over the Christmas period.
One of our members contacted QNMU after management said she and her colleagues were not entitled to the public holiday pay rate for working on Christmas Day because the state government had declared Tuesday, 27 December a public holiday instead.
While the State Government had indeed declared Tuesday a public holiday, together with Tuesday 2 January, these were additional public holidays for the state, not substitutes for Christmas Day and New Year’s Day, which both fell on a Sunday.
Management also tried to shortchange our member on overtime, saying she wasn’t entitled to be paid the seven extra overtime hours she worked over the festive season because 15 of the 76 ordinary fortnight hours she had worked had been sick leave.
After indicating our intention to take these matters to the Fair Work Commission, management acknowledged their error, issued an apology and promised to rectify the error in the following pay run.
Wage theft resulting from poorly (or disingenuously) interpreted public holiday clauses is not an uncommon complaint among QNMU members, which is why we urge members to read their payslips carefully.
Well done to our savvy member for noticing the discrepancy on her payslip and ensuring she and her colleagues received their proper entitlements.
#UnionsForYes #yes23
We say yes'
Aboriginal and Torres Strait Islander peoples deserve a Voice to Parliament about the issues that impact them.
The QNMU supports the 2023 Voice to Parliament referendum and will be proudly campaigning ‘Yes’.
QNMU MEMBERSHIP reached the 70,000-member mark in January keeping us firmly in the top position as the largest and strongest union in Queensland, and one of the biggest in Australia.
Our solid membership base means QNMU members advocate and negotiate from a position of strength
70,000
for their professional, industrial and social rights. It also means we are better positioned to provide best practice for the people we care for.
The QNMU is unmatched when it comes to advancing the standing of nurses and midwives in Queensland. So thank you for being part of it.
SOMETIMES IT just takes a quick word or a little reminder to ensure members are getting their proper entitlements.
A South-east Queensland private sector member recently contacted QNMU questioning a clause in her enterprise agreement which stated nurses should receive the same back pay entitlements as Queensland Health nursing staff. She believed she wasn’t being paid those entitlements.
The facility’s CEO and pay officer told the QNMU they were unaware of the clause, but after the QNMU explained the EA’s terms, they promised to rectify the oversight.
All nursing staff at the facility will now be paid the correct entitlements and back paid from the 1 April 2022, which should mean quite a windfall for members.
Apparently our member was so excited with the news she screamed with excitement.
Well done to our member for the great pick-up and having the good sense to call the QNMU for clarification and support.
It took a QNMU threat of a formal dispute hearing to jolt a private hospital payroll department into action after more than 18 months of failing to rectify a member’s unpaid annual leave loading.
A Brisbane-based member who discovered errors in her annual leave loading, thought her matter would be resolved quickly after her HR department reviewed the hospital’s enterprise agreement and conceded she’d not been properly paid.
What followed was months of silence as HR did nothing to rectify the error and the payroll department failed repeatedly to respond to her inquiries.
Turning to the QNMU for support, officials were able to confirm the error with HR, and secured a three-month leave loading audit as proof.
Payroll still failed to act, so officials worked the member to lodge a grievance and requested an audit for the past six years (the maximum legal period permitted).
When HR failed to provide the audit data by the due date, we moved to lodge a formal dispute in the Fair Work Commission, and suddenly, the unpaid leave ($7772) loading appeared in our member’s account.
It is pleasing that our member finally received a positive outcome, but we are appalled this employer, with their unwarranted delays, took 18 months to make good on their error.
It pays to know your entitlements
The first Friday in February saw Gold Coast University Hospital hosting their sixth annual Loud Shirt Fairy Floss Friday event with Robina Hospital hosting their second. It was their biggest yet! Loud Shirt Fairy Floss Friday was created to encourage healthcare workers to shed light on mental illness in the healthcare community, support each other and tell depression to #getflossed! Such a bold, colourful and spirited way to face an all-too-often hidden and isolating illness.
Big thanks to Toni-Anne Taylor for sending in such fun pics!
For more info visit www.fairyflossfriday.com
In the interests of hygiene we don’t usually recommend reading in the loo but clearly InScope is such a fantastic magazine Elfy just couldn’t put it down – well, that’s how we’re choosing to interpret this pic from our Rocky office anyway!
A shout out to Caboolture Hospital Branch Alternate Delegate Meleitta Lowrey (pictured right) who held a workplace raffle late last year to raise the Branch’s profile and encourage engagement among newly graduated members. As part of the raffle promotion Meleitta put posters up in all areas of her facility inviting members who’d graduated in the past three years to update their details with her and go into a free raffle draw. Among those who answered the call (and won some goodies to boot!) was Selina Tyzack (also pictured).
Hats off to Townsville Hospital for their fabulous Christmas Decorations. Each decoration is handmade by nursing staff and young people over a period of about six weeks leading up to December.
Well over 100 hours of crafting goes into these decorations and it is often tied into an opportunity to build relationships with young people and for them to have ownership over the process. We love their world celebration doors which were a great way to bring a little international flavour to the festive season.
Women in solidarity: QNMU staff and members shared a lovely brekky with like-minded women at the Queensland Council of Union’s Women’s Breakfast in Brisbane in November. It was an opportunity to network, share and hear from inspiring speakers including Kara Keyes (From the Heart), Janelle Fawkes (Respect Inc) and the RTBU’s Jodie Wickens.
QNMU officers Ann-Maree
Daly and Kellie Dwyer visited Norfolk Island Hospital and Residential Aged Care Service Recently.
The support service for the Hospital transitioned from South-East Sydney to Metro North HHS at the beginning of 2022 bringing its nurses and midwives under the wing of the QNMU.
It was great to be able to catch up with some of our most far-flung members in such a gorgeous location.
There were plenty of new faces at Townsville University Hospital’s recent Orientation Day, and lots of questions from new student members with a number seeking QNMU help to answer questions about PII requirements for NMBA registration. A big thanks to those who helped our newest members find their feet, and welcome to each and every one!
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Boy Swallows Universe by Trent Dalton
A novel of love, crime, magic, fate and coming of age, set in Brisbane’s violent working class suburban fringe. Boy swallows universe is a story of brotherhood, true love and the most unlikely of friendships.
From life in the desert to growing up on a mission, enduring devastating policies in the 1930s to bravely seizing new opportunities in the 1960s, these are fifteen true stories reflecting a diverse range of Australian Aboriginal experiences.
Email full-size pics and image details to inscope@qnmu.org.au for our 'in view' pages for your chance to win.
Bronwyn Seehusen, QNMU’s Kellie Dwyer and Ann-Maree Daly, and Maria Christian.
It’s not often Australians are asked to participate in a national referendum. Since federation, there have been 44 referendums, only eight of which were successfully carried.
Referendums can be divisive. They can (and should) trigger a national debate.
But they can also mark a unifying moment in our country’s history.
Later this year, Australians will be asked a simple question:
It is a simple, if not uncomplicated principle. The idea of constitutional recognition for Aboriginal and Torres Strait Islander peoples has, in fact, been around for decades and supported by most governments and shadow governments since the early 2000s.
However, as QNMU First Nations Strategy, Policy and Research Officer Sye Hodgman explains, there is an important difference between ‘constitutional recognition’ and the Voice.
“The Voice embeds a mechanism for self-determination for Aboriginal and Torres Strait Islander peoples, whereas constitutional recognition is simply an acknowledgement of Aboriginal and Torres Strait Islander peoples’ existence in the constitution,” Sye said.
Essentially, a Voice to Parliament is a body enshrined in the constitution that would enable Aboriginal and Torres Strait Islander peoples to provide advice to the parliament on policies and projects that impact their lives.
While such bodies have existed at various points outside the constitution in the past, they have been established and dissolved at the whim of the government in power at the time.
“This constitutional change would simply establish the necessity to continue this mechanism,” Sye said.
“This is about self-determination for Aboriginal and Torres Strait Islander peoples on matters that affect them.
“Obviously, Australians should care about this because at its core it’s about a fair go for Aboriginal and Torres Strait Islander peoples.
“But at the end of the day, this referendum will not impact 97% of Australian people in any tangible way … however it will have a huge impact on Aboriginal and Torres Strait Islander communities.”
One of Australia’s eight successful referendums was in 1967, in which Australians overwhelmingly voted in support of changing the constitution to recognise Aboriginal and Torres Strait Islander peoples as part of the Australian population, allowing the Commonwealth to make laws for them and include them in the census.
Over 90% of Australians voted in favour, with all states recording a ‘yes’ result.
Sye described it as the “single most unifying moment in Australian democratic history”.
“Whereas the 1967 referendum was about ‘seeing’ First Nations peoples, this referendum is all about ‘hearing’ us,” Sye said.
“It is, essentially, a culmination of the spirit of the original referendum in allowing Aboriginal and Torres Strait Islander peoples the opportunity to have meaningful input into Aboriginal and Torres Strait Islander matters and a mechanism for self-determination.”
Gunai/Kurnai man Jason Coombes has worked for 10 years as a remote area nurse in Far North Queensland, the Northern Territory, Victoria and South Australia. He currently works for Remote Area Health Corps and is a QNMU member.
Jason said the time for a Voice to Parliament was long overdue.
“We need the Voice now more than ever – it is time for Aboriginal peoples to take control of their outcomes, including their education, health and future,” Jason said.
“I have observed that when it comes to the big decisions, these things get handballed back and forth depending on who is in the decision-making seat.
“We need to be the ones to make the big decisions moving forward, we are at a stalemate with how the system is currently working.
“We need to try and do things the Blackfella way – take health care to the people, not demand the people come to the clinic.
“I am a 53-year-old proud Aboriginal man, and the cycle should have well and truly been broken by now. Sadly, it is the same if not worse and that breaks my heart.
“It’s why I am still out there working remote with these disadvantaged communities.”
As with any national debate, there are competing views and priorities, and there will always be those who seek to politicise the issue.
But it is up to every Australian to educate themselves and not get side-tracked by arguments that are deliberately intended to confuse or muddy the waters.
One of the main counter-arguments to the Voice to Parliament is that it lacks any detail. Notwithstanding the fact that Australia’s constitution is made up of foundation ‘principles’, there is plenty of information and detail on the Voice that is available for all Australians to peruse.
Visit www.yes23.com.au to read about the Voice.
“To people who say there’s no detail, I draw a parallel to voting on whether there should be a new trainline built,” said Sye.
“When voting on something like that, it’s important to understand things like how it will impact on homes along the new railway line, and what the environmental impact will be.
“But we rely on experts to actually implement it and decide things like, how fast will the train go, what will the railway sleepers be made from, who will drive the trains, and so on.”
It is also important to note that not every Aboriginal or Torres Strait Islander has endorsed the Voice to Parliament.
“This referendum and the Uluru Statement does not and cannot represent the wants and needs of all Aboriginal and Torres Strait Islander peoples,” said Sye.
“Aboriginal and Torres Strait Islander peoples are not homogenous, and therefore don’t all have one singular voice or opinion.
“However, the statement and the proposed solutions outlined within have been generated through the largest and most considered consultative process that has ever been undertaken with Aboriginal and Torres Strait Islander peoples.
“It is fair to say, therefore, that most Aboriginal and Torres Strait Islander peoples are in support.”
Have discussions with your family, friends and community:
◆ Talk to people about the importance of the Voice and the impact this can have on real self-determination for Aboriginal and Torres Strait Islander peoples.
◆ Remind people that this referendum was asked for by Aboriginal and Torres Strait Islander peoples for a fair representation in their own affairs, and will not impact on non-Indigenous Australians negatively.
“We need to try and do things the Blackfella way – take health care to the people, not demand the people come to the clinic.”
Jason Coombes, QNMU member, Gunai/Kurnai man and remote area nurse
WHILE THE Voice to Parliament Referendum is the current focus of the Federal government, the Queensland government is progressing a truth-telling and treaty process at a state level, with the introduction of the Path to Treaty Bill.
The Palaszczuk state government introduced this historic Bill to state parliament in February laying the framework for establishing a First Nations Treaty Institute and a formal Truth Telling and Healing Inquiry to support the process of reconciliation and healing.
The Bill, which is the next phase of a commitment reached between Aboriginal, Torres Strait Islander and non-indigenous people in August last year, will outline the scope and composition of the Institute and the Truth Telling and Healing Inquiry.
Under the legislation, the Treaty Institute will be a statutory body, independent from government which will
The Voice to Parliament is a body enshrined in the constitution that would enable Aboriginal and Torres Strait Islander peoples to provide advice to the parliament on policies and projects that impact their lives.
The federal government has proposed the following wording be added to the constitution (although this wording is not yet finalised):
not negotiate treaties itself, but will provide the institutional support for truth-telling and treaty-making to proceed.
The treaty process will adopt a decentralised approach, with the government open to communityled negotiations and individual treaty making with different Indigenous groups.
The Truth-telling and Healing Inquiry will be a five-member team with the majority being Aboriginal or Torres Strait Islander people.
It will embrace a ‘non-adversarial’ inquiry style and will be tasked with examining and reporting on the impact and effect of colonisation on Aboriginal and Torres Strait Islander people.
It is expected to operate for three years.
The bill also includes provisions to remove offensive terms and outdated provisions within existing laws, including those controlling Indigenous people’s lives and movements.
In recognition of Aboriginal and Torres Strait Islander Peoples as the First Peoples of Australia:
1. There shall be a body, to be called the Aboriginal and Torres Strait Islander Voice
2. The Aboriginal and Torres Strait Islander Voice may make representations to Parliament and the Executive government on matters relating to Aboriginal and Torres Strait Islander Peoples
3. The Parliament shall, subject to this Constitution, have power to make laws with respect to the composition, functions, powers and procedures of the Aboriginal and Torres Strait Islander Voice.
“Whereas the 1967 referendum was about ‘seeing’ First Nations people, this referendum is all about ‘hearing’ us.”
Sye Hodgman, QNMU First Nations Strategy, Policy and Research Officer
Why do we need an Indigenous Voice enshrined in the constitution?
Previous attempts to embed selfdetermination for Aboriginal and Torres Strait Islander peoples have been dissolved at the discretion of previous governments. Enshrining a Voice in the constitution would ensure this cannot happen.
What influence would the Voice have on parliament and its decision-making abilities?
The Voice would be an advisory body to parliament and executive government. The exact mechanism is still to be decided.
However, there will be an expectation that any matters related to Aboriginal and Torres Strait Islander peoples will be consulted with the Voice, and this advice would be respected and impactful to the final resolution.
No. This was an off-handed comment made by federal MP Barnaby Joyce in 2017, but he has since retracted that statement and apologised for generating disinformation. The Voice is an advisory body that would ensure Aboriginal and Torres Strait Islander peoples are included in the lawmaking process, rather than having bureaucrats and politicians deciding what is best for them.
No. Several constitutional lawyers, including Aboriginal and Torres Strait
Islander constitutional lawyers, have been consulted on this, and all agree that the Voice would not and cannot cede sovereignty in any way – meaning Aboriginal and Torres Strait Islander peoples have never given up their right to land, sea and air.
It is also worth noting that 97% of this vote will be made by nonIndigenous Australians, and they do not have the authority to cede the sovereignty on behalf of any other nations or peoples.
No. Treaty is the next step in the process. The Albanese Government has committed to implementing the Uluru Statement from the Heart in full.
This includes a constitutionally enshrined Voice to Parliament, forming a Makarrata Commission to work towards Treaty, and a commitment to truth telling regarding Australia’s history and First Nations people.
The QNMU acknowledges that not everyone will agree with the idea of the Voice to Parliament. Indeed, there are some people within Aboriginal and Torres Strait Islander communities who are vocal opponents.
However, social justice is and has always been union business, and the Australian union movement is committed to supporting the Uluru Statement from the Heart.
The 1967 referendum was won in partnership with the union movement, and we remain in support of this social justice agenda.
Furthermore, the QNMU First Nations Branch has reached a consensus through democratic process to support the Uluru Statement, including the referendum for a Voice to Parliament, a Makarrata Commission to supervise the making of agreements or treaties, and a process to oversee truth telling for our nation. Delegates at Annual Conference endorsed the Uluru Statement from the Heart in 2020, and it was then ratified by Council.
When the Palaszczuk Labor Government committed to funding 400 Nurse Navigators back in 2016, we were thrilled our years of lobbying had finally reaped rewards.
As nurses and midwives, we know many of our patients find it challenging to navigate the complexities of the health system, that they can struggle to fully understand their care, or might feel overwhelmed by it when they are feeling vulnerable and anxious.
We have long recognised the important role Nurse Navigators can play in helping these patients steer their way through the fog to get the best out of their healthcare.
Last month the Office of the Chief Nursing and Midwifery Officer (Queensland) released a new report which indicated just how critical the Nurse Navigator program has been over the past seven years, the data showing impressive outcomes both for patients and the health system more broadly.
The Central Queensland University Australia (CQU) study, conducted in Queensland Hospital and Health Services (HHS) state-wide between 2018 and 2021, found Nurse Navigators improved quality of life, reduced Emergency Department stays and saved Queensland taxpayers $110 million a year.
The Queensland Health Nurse and Midwife Navigator Evaluation Report also found Nurse Navigators reduced patient hospital stays by 3.2 beds days
per patient and reduced readmission rates by 6%.
The cost and resource savings are certainly worth applauding, but the personal impact on patients and their care outcomes are equally noteworthy.
The report, which surveyed 7000 Queensland Health patients across the state, found Nurse Navigators significantly improved patient’s health literacy and helped patients feel more empowered to make decisions about their care.
Patients reported having an improved quality of life and an increased sense of general wellbeing and control following engagement with a Nurse Navigator.
For QNMU member and Disability Nurse Navigator Greg Parrott this kind of positive patient response is what makes his work worthwhile.
“Being a Nurse Navigator is an incredible role and I love it,” he said.
“I love getting to know patients and getting to see and guide them through a bit of their healthcare journey.”
A Nurse Navigator at the Princess Alexandra Hospital in Brisbane for more than five years, Greg says he is pleased the report documented the value of Navigator engagement from a patient perspective and said supporting patients to grow confidence as active participants in their own care is hugely rewarding.
“It makes you feel good, because you know you’ve accomplished something and made a real difference to someone’s life,” he said.
Nurse Navigators work directly with patients with chronic or complex health conditions to assist and streamline their health journey and enhance care co-ordination and condition management… (They) support and work across system boundaries and in close partnership with multiple health specialists and health service stakeholders to ensure patients receive the appropriate and timely care needed.
Queensland Health
“My role involves working with patients in the hospital (and) in the community to try and help them build their capacity to better manage their healthcare needs,” he said.
“I do a lot of visiting primary healthcare services with the patients to try and improve that relationship, and a lot of working with carers and families to help improve health literacy.”
“If you can deliver health literacy education at somebody’s level, you can actually get some buy-in…to help improve their health outcomes.”
Greg said being a Nurse Navigator allows him to work more completely to his full scope of practice, to draw on a broad skillset to deliver a highly personalised level of care not always possible in a standard clinical setting.
“As an example, I had a patient who was referred to me from a GP because he was taking too much Panadol. The patient had a background of intellectual impairment and he refused to stop
taking Panadol because he had back pain.”
“In his mind…if some Panadol is good, more must be better. Because I already had a relationship with the patient, I was able to go out to his home, look at what was causing his back pain, deliver some education to him about Panadol and why we take it and why we don’t.
“I also looked at his bed - he was actually sleeping on two mattresses stacked on top of each other, so he didn’t have any proper (spine) support – so I went through a community organisation and got him a new bed.”
“With the new bed and the education, he now no longer overdoses on Panadol - his back’s no longer sore and it means we won’t see him in a couple of years in the hepatology clinic.”
The Evaluation Report offers irrefutable evidence about the value of Nurse Navigators and will be put to good use as the QNMU continues
There’s way more need than resources at the moment so expanding the Nurse Navigator workforce would be a win-win … I don’t think we can ever have enough.
QNMU Member & Nurse Navigator Greg ParrottDisability Nurse Navigator and QNMU member Greg Parrott says seeing patients take greater control of their healthcare journey is one of the most rewarding parts of his job.
to press for an expansion of the Nurse Navigator approach as part of the Federal Government’s Medicare reforms.
The government outlined its plans for reform in the Strengthening Medicare Taskforce Report released on February 3 which recommends significant changes to how primary care is funded and delivered to ensure high quality, integrated and personcentred care for all Australians into the future.
The QNMU welcomed the report for recognising the important role nurses and midwives should play in a revised Medicare scheme, and for providing scope for greater nursing and midwifery leadership in healthcare.
“The next iteration of Medicare must focus on unleashing the potential of nurses and midwives,” QNMU Secretary Beth Mohle said.
“A reformed Medicare system must ensure all health workers can work with the community to better co-ordinate their care based on patient needs.”
Nurse Navigators are well positioned offer nurse-led, patient-centred care in the community and Greg says there is no shortage of demand.
“Just in the space I work in, one in 20 people in Metro South have a significant, profound disability and there are not enough nurses to provide that level of support,” he said.
“There’s way more need than resources at the moment so expanding the Nurse Navigators workforce would be a win-win, particularly into those areas that are (currently under-serviced) like mental health nurse navigators or psychosocial disability nurse navigators – we also really need more homeless nurse navigators … I don’t think we can ever have enough.”
In addition to the Medicare Reform process, the Evaluation Report also provides an evidencebased underpinning for the ANMF’s recommendations in the 20232024 Pre-Budget Submission to the Federal Government, which calls for the introduction of Aged Care Nurse Navigators and ring-fenced funding to “trial, evaluate and scaleup” innovative and multi-disciplinary models of care in the health system, including Nurse Navigators.
■ Navigator care resulted in an overall mean hospital utilisation cost reduction of $110,180,920 per annum based on 7000 navigated patients.
■ Alignment of outpatient patient appointments resulted in cost savings of $3350 per navigated patient per annum.
■ Readmission rates decreased by 6%.
■ Patient length of hospitals stays decreased by 3.2 days.
■ Estimated Emergency Department (ED) length of stay decreased by 25 minutes per patient.
■ Discharge against Medical Advice decreased by 1.7% to 0.2%
■ Patients identified improvement in the way they managed their condition after navigation.
■ Patients reported improved quality of life after navigation assistance
especially from the co-ordination of their appointments (geographic and schedule challenges).
■ Patients self-reported wellbeing improved following navigation even when experiencing a reduced quality of life resulting from disease progression.
■ Health literacy improved through navigation input and engagement with their GP and medical specialists.
■ Navigation supported the increase in patient’s engagement with their care providers. Patients were empowered to make informed decisions regarding their care, thus improving their experience.
■ Each HHS has adapted navigator roles to suit local health demographics and ensure person centred care in the right place at the right time.
The next iteration of Medicare must focus on unleashing the potential of nurses and midwives.
Beth Mohle QNMU SecretaryPhoto: Princess Alexandra Hospital.
When the floodwaters recede and the mud has been hosed away, that’s when the work of mental health trauma-focused nurses Iris Vukelic and Allison de Tina, kicks in.
About this time last year much of South-east Queensland was up to its knees in mud and debris.
Like many parts of the state, it wasn’t the first time in recent years the region had flooded.
In fact, in the past decade there’s barely been a community anywhere in Queensland that hasn’t faced the aftermath of floods, bushfire or cyclone.
But nothing prepared us for that three-day rain bomb that dumped almost 16 Sydney-harbour’s worth of water on Brisbane in one hit.
The Queensland Reconstruction Authority estimates the cost of that one weather event at $7.7 billion, and while the physical clean-up and damage to infrastructure was significant, the biggest cost was the intangible, often lifelong health and social costs –estimated at a huge $4.5 billion.
QNMU members Iris Vukelic and Allison de Tina understand exactly what’s meant by ‘intangible social and health costs’.
The pair are part of a multidisciplinary Disaster Flood Team which launched in November, to look after the health of people affected by that South-east Queensland flooding.
The team, which also includes a social worker, psychologist, peer worker, psychiatrist and administration officer, responds to disaster-related trauma, loss and psychological and emotional distress. They help people manage the financial, relational and emotional stress resulting from the floods.
They provide a stepped care, outreach model of recovery support and assistance, and cover all the Metro South areas affected by last year’s flooding.
The structure and scope of the Disaster Flood Team is an excellent example of a program with strong nursing input.
Nursing sits at its heart, drawing on Iris and Allison’s capacity to deliver not only highly specialist trauma-focused therapies and community engagement, but also to attend to the physical heath aspects of recovery.
“It’s like symbiosis, I guess,” Iris said.
“We embrace two spheres of nursing – the psychotherapeutic and then general, physical health nursing.”
Both Iris and Allison bring impressive skill sets and decades of mental health and trauma nursing experience to their work.
They are both trained in psychological intervention and able to deliver a range of different psychological and behavioural therapies.
Allison has worked with trauma for more than 20 years including many years as a forensic nurse examiner in mental health and addiction.
She took up the Clinical Nursing Consultant role with the Disaster Flood Team after a 12-month stint in community work and case management, and says she loves the diversity of her role and the opportunity to stretch the definition of nursing to its full potential.
“I really enjoy a nursing role that has a point of difference to general nursing,” she said.
“I really like working in those high acuity, trauma environments, it’s really rewarding work, so in a lot of ways this feels very natural for me.”
Iris who is currently ADON at the MSAMHS (Metro South Addiction and Mental Health Service) Disaster Flood
I love seeing the progress people make, you know, small gains like being able to go and get a haircut without having a panic attack.
Allison de Tina, QNMU member
Team has been a mental health nurse her entire career and has worked in previous disaster teams responding to Ex-Tropical Cyclone Debbie (Southeast Qld,2017) and the more recent COVID-19 pandemic.
“It sounds quite weird when I say it, but I really love working in the world of disasters,” she says.
“I have a real passion for it because it’s one of the few spaces where you experience tangible sense of hope and you have connection with the grassroots, with the community.”
Iris and Allison’s practice covers both individual post-disaster recovery support and community level, predisaster resilience building.
Their therapeutic work with individuals is not age-specific which means they can be dealing with children, the elderly and everyone in between, requiring flexibility and agility to respond to their client’s different needs and developmental or life stages.
“We are seeing children who are experiencing rain phobia or becoming quite anxious around different weather events.
“We have that middle-aged 40-60 group who have got more responsibilities with mortgages and children (whereby the flooding) has compounded the general stress they have in their lives,” Iris said.
“So, it’s not always about big mental health issues or disorders. Quite often it’s about normalising human reactions to loss and the distress associated with it.”
“Being nurses of course we always wear a clinical hat, but we do not pathologise normal grief experiences.”
“We try to build coping strategies around how people react to all consuming feelings of loss and grief – that’s what builds their self-esteem and self-confidence to function in the world again.”
Iris and Allison help people reduce anxiety by teaching them grounding and stabilising techniques and encouraging them to incorporate mindfulness into their everyday lives.
The one-on-one work also involves helping people build or rebuild their social ties – strengthening their connections with the community, and within their family and peer circles.
“There is a huge wealth of resources out in the community, and we are in a position to support individuals to link into those resources,” Iris said.
“We are also driving the link with the primary care, with GPs and other (health services).”
The second, and broader focus, of the Disaster Flood Team’s work is community engagement.
While the team usually have about 20 individual clients on their books, they engaged in an impressive 73 community activities in February alone – seeing more than 400 people.
The emphasis at this level is on collaborating with external agencies and driving capacity building.
“This creates quite a different and strategic narrative for our work because we are shifting the attention to risk reduction – to pre-disaster resilience building,” Iris said.
This includes the team delivering resilience building programs to schools across the four Local Government Areas primarily affected by the SEQ 2022 floods – Brisbane, Logan, Redland and the Scenic Rim.
Allison, who delivers the community engagement initiatives said the school program, for example, focuses on change, grief and loss.
“It’s a small group work – four to six students and it’s delivered at their level, to children in those communities that were significantly flood affected,” she said.
“These groups are for primary school children where we talk about understanding change –understanding the feelings that come with change and how we manage, those feelings.”
Allison also taps into community organisations, developing partnerships with the likes of neighbourhood
centres and community hubs to deliver resilience training.
“I love the outreach work in the community, meeting people where they are and doing group work - it’s really exciting for me to be able to do this sort of (preventative psychosocial) work – it’s not very common in a nursing role.”
While the Disaster Flood Team’s support response emphasises mental health care, one of the strengths of the strong nursing contingent is the added capacity to identify and treat emerging physical health issues.
These include respiratory conditions due to mould exposure, and conditions such as hypertension or cardiac problems brought on by stress or grief.
“We know there are links between stress and the exacerbation of chronic disease symptoms,” Allison said.
“For example, we know when people are stressed, anxious or depressed, they’re more sedentary, less likely to get up and be active and do the things they used to.”
“They might neglect to fill scripts or go to their GPs because they are too anxious to leave the house or are afraid to drive their car.”
“I actually just saw somebody last week who used to be a very active man relative to his age, but he’s no longer as active and has noticed a decline in his physical strength… and a worsening of his chronic disease symptoms.”
Allison said physical health can also be affected by changes in living circumstances after a disaster.
“They might not have the gardens they were out mowing, or they are not doing those little incidental things like carrying a basket downstairs to hang the washing out because they no longer have a washing line… and these are all important aspects to maintaining physical wellbeing.”
Despite the service being operational for only few months both Iris and Allison say they have already seen many of their clients make important progress.
“That’s the part I enjoy,” Alison said.
“I love seeing the progress people make, you know, small gains like being able to go and get a haircut without having a panic attack. I had a gentlemen do that just recently and he actually went out of his way to ring to tell me and to thank me because he felt good.”
For Iris, there is nothing more rewarding than seeing people’s lives improve.
She said the positive outcomes are evidence that nurses have right skills and are well placed to deliver high-level care if they are given an opportunity to work to the full scope of their practice.
“I think there is an attitude that anything trauma-related or disasterrelated requires professional
counsellors or professionals other than nurses,” she said.
“But hopefully we will continue to be recognised for the post-disaster mental health skills that we have and that people in the broader community will recognise the value nurses bring into this space.”
The Disaster Flood Team, is jointly funded by the Commonwealth and Queensland governments under the DRFA Category C and operates as part of the Metro South PostDisaster Mental Health Recovery Service. It is currently funded through to June 30 next year.
Hopefully we will continue to be recognised for the postdisaster mental health skills we have and for the value we, nurses, bring into this space.
Iris Vukelic, QNMU member
Across the world, nurses and midwives are taking to the streets to protest about a range of issues that affect both their work and private lives. Burnout, exhaustion, not enough staff, nurses and midwives leaving their profession, wages that aren’t keeping pace with the cost of living, and unsympathetic governments and employers are common complaints.
A recent ANMF National COVID-19 Survey Report has indicated that about 21% of nurses expressed a likely intention to leave their current job over the next 12 months. Worse still, 13% indicate they plan to leave direct care roles entirely (ANMF, 2022).
Concerns about nurse and midwife shortages are not new. Even before the COVID-19 pandemic, Health Workforce Australia had projected a shortage of up to 123,000 nurses in Australia by 2030, with the resulting impact this shortfall would have on the health system (Mannix, 2021).
Undoubtedly, the COVID-19 pandemic has exacerbated and complicated this picture. So, how did we get to this parlous state and what can be done about it?
While many of the issues currently being experienced were present prior to the pandemic, this worldwide event has magnified them considerably.
While previously, there was a lot of papering over the cracks, new initiatives and promises of change that kept the health system functioning, it’s now time for a fundamental rethink as we simply can’t just go back to the way it was before COVID-19 emerged.
Workplaces that support nurses, midwives and carers are an essential part of any change.
In 2022, a multinational study on the effects of COVID-19 on the nursing workforce, identified ‘doing meaningful work’ as the most significant factor influencing nurses to stay in their current role.
This finding held true for Australian nurses as well. Other important satisfiers included good health, positive interactions, caring and trusting teammates, engaged by work, work-life balance, safe work environment, manageable workloads and a sense of belonging (Berlin &
Essick et al., 2022). In other words, nurses were describing a positive practice environment (PPE).
The International Council of Nurses (ICN) describes positive practice environments as “… characterised by professional recognition, education, reflection, support structures, adequate resourcing, sound management practices and occupational health and safety” (ICN, 2021).
Importantly, these findings highlight that positive practice environments have many influencing factors, and all must be addressed to create workplaces where nurses and midwives can do meaningful work
An important part of creating positive practice workplaces has been the introduction of nurse to patient or resident ratios in significant portions of the public hospital system and in Queensland Health nursing homes.
As part of the Queensland State Government election commitments, work is ongoing to expand ratios into practice areas such as maternity, emergency departments, operating theatres and prisons.
What research has established, is the impact that ratios have on meeting the positive practice environment requirement of manageable workloads.
As a consequence, better staffing and manageable workloads as a result of ratios, led to safer care and better patient outcomes such as reduced mortality, decreased length of stay, lower rates of iatrogenically acquired infections, fewer readmissions, higher patient satisfaction, as well as significant cost savings, and helps to reduce nurse burnout (McHugh et al., 2021; McHugh et al., 2020).
However, while ratios are a core element of delivering effective and safe nursing and midwifery care, improving the wider work environment of nurses and midwives is fundamental to improving hospital safety and quality more generally (Olds et al., 2017).
In aged care too, better nurse work environments are associated with improvements in resident safety and reduced levels of nursing burnout and dissatisfaction (White et al., 2020).
These findings are critically important given the aged care reform process
underway in Australia following the damning findings of the Royal Commission into Aged Care Quality and Safety Report published in 2020 along with 148 recommendations for aged care reform.
There are a number of key elements that together, create and sustain positive work environments where nurses and midwives can do meaningful work.
These elements are outlined in the QNMU Positive Practice Environment Standards for Nursing and Midwifery (2020) which provide a holistic view of positive workplaces (QNMU, 2020).
These evidence-based standards encompass the six work environment characteristics that drive the achievement of supportive workplaces that accomplish excellence. These areas are:
■ safe staffing levels
■ physical, psychological and cultural safety
■ autonomous and collaborative practice
■ shared governance and decisionmaking
■ research and innovation
■ transformational leadership.
However, simply developing and publishing these standards is not enough to ensure their adoption across the health and aged care sectors in Queensland. Building on the success of the QNMUs Ratios Save Lives and Money campaign, the positive practice environment has been integrated into the Nurses and Midwives (Queensland Health and Department of Education) Certified Agreement (EB11) 2022
While this is a starting point with much work to be done, it reflects a broad recognition that positive practice environments for nurses, midwives and carers are the only way to meaningfully respond to the many health system issues being experienced by members in these COVID-19 pandemic times.
Ultimately, the positive practice environment focus agreed to by Queensland Health will flow to the private health and aged care sectors with the QNMU taking every opportunity to see these standards embedded across the board.
If you haven’t already done so, read through the Positive Practice Environment Standards you can see where your workplace achieves these standards and where further work needs to be done.
Visit www.qnmu.org.au/ PPEStandards to read the standards.
Talk to your colleagues and line manager about the standards, and to help become an advocate for positive practice workplaces, attend a QNMU Positive Practice Environment education session to find out more and how you can influence change in your own workplace.
Visit www.qnmu.org.au/Events to enrol in a education session.
An important way for the QNMU to find out what members think, and what affects them in both their work and personal life is the triennial Grow Your Voice member research survey which has recently been sent to all members.
This research survey collects information from members about a number of workplace issues that affect members such as physical, psychological and cultural safety, and workloads.
The findings of this research will inform the QNMUs strategic direction for promoting positive practice environments for the benefit of all members.
Achieving positive practice workplaces for nurses and midwives is a key role of the QNMU on behalf of members.
Unfortunately, there are no simple solutions as many factors contribute to what can be described as a positive practice environment. The implementation of ratios in much of the public hospital sector and state nursing homes is a good first step and has been followed up with recognition of the importance of positive practice workplaces in the latest Queensland Health Enterprise Agreement.
There is, however, much more to be done in the private health and aged care sectors, particularly now that the public sector has been established as a benchmark.
All nurses, midwives and carers should have the advantage of workplaces where they can do meaningful work, feel safe, can manage their workloads, feel supported and can finish a shift feeling a sense of accomplishment and satisfaction.
References:
ANMF. (2020). Australian Nursing and Midwifery Federation
National COVID-19 Survey 2022 – Public and Private Hospitals. Australian Nursing and Midwifery Federation. www. anmf.org.au/documents/reports/ ANMFCOVID-19Survey2022_ AustralianHospitals_FinalReport. pdf DOI:10.37464/ANMF.2532022.1
Berlin, G., Essick, C., Lapointe, M., & Lyons, F. (2022). Around the world, nurses say meaningful work keeps them going. McKinsey & Company. https://www.mckinsey. com/~/media/mckinsey/industries/ healthcare%20systems%20 and%20services/our%20insights/ around%20the%20world%20 nurses%20say%20meaningful%20 work%20keeps%20them%20going/ around-the-world-nurses-saymeaningful-work-keeps-themgoing-v3.pdf?shouldIndex=false
International Council of Nurses. (2021). The ICN Code of Ethics for Nurses. https://www.icn.ch/system/ files/2021-10/ICN_Code-of-Ethics_ EN_Web_0.pdf
Mannix, K. (2021). The future of Australia’s nursing workforce: COVID-19 and burnout among nurses. The University of Melbourne, Australia. https://www. unimelb.edu.au/__data/assets/ pdf_file/0004/4085194/katelyn_ mannix_report.pdf
McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurseto-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of The Lancet, 397(10288), 1905-1913. https://doi.org/10.1016/ S0140-6736(21)00768-6
McHugh, M. D., Aiken, L. H., Windsor, C., Douglas, C., & Yates, P. (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational BMJ open 10(9), e036264. http://dx.doi.org/10.1136/ bmjopen-2019-036264
Olds, D. M., Aiken, L. H., Cimiotti, J. P., & Lake, E. T. (2017). Association of nurse work environment and safety climate on patient mortality: A cross-sectional study. International journal of nursing studies 74 155-161. https://doi.org/10.1016/j. ijnurstu.2017.06.004
Queensland Nurses and Midwives’ Union. (2020). Positive Practice Environment Standards for Nursing and Midwifery. Brisbane. https://www.qnmu.org.au/Web/ Campaigns/PPE-Standards.aspx
White, E. M., Aiken, L. H., Sloane, D. M., & McHugh, M. D. (2020). Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction. Geriatric 41(2), 158-164. https://doi.org/10.1016/j. gerinurse.2019.08.007
While previously, there was a lot of papering over the cracks, new initiatives and promises of change that kept the health system functioning, it’s now time for a fundamental rethink as we simply can’t just go back to the way it was before COVID-19 emerged.
On January 9 this year, 7000 nurses took to the streets of New York City, frustrated by workplace negotiations that failed to address their biggest concern – a dire lack of nurses in two of the city’s major hospitals.
With placards and loud-hailers the nurses sang and chanted for three days, protesting against short-staffed hospital floors where crowded conditions were putting patients at risk and causing extreme stress and burnout.
In the days leading up to the protest, the New York State Nurses Association issued strike notices for 12
hospitals across the state – enough to motivate all but two to return to the negotiating table and offer better workplace contacts (agreements).
But nursing staff from Mount Sinai Hospital in Manhattan and Montefiore Medical Center in the Bronx stood firm – despite being offered a whopping 19% pay rise.
As NYSNA Executive Director Pat Kane explains, their grievance “wasn’t about money, it was about their communities”, as both hospitals struggled with serious overcrowding and understaffing, exacerbated by a combined shortfall of about 1200 unfilled nursing positions.
Photo: Katie Godowski/Media Punch/Alamy Live News
While management largely blamed a national nursing shortage for the vacancies, the union claimed not enough was being done to attract and retain nurses. Members also believed their poor, disadvantaged centres were losing resources and funding to more affluent districts.
For Montefiore, the protest centred around 700 unfilled roles, and a severely besieged emergency department struggling with failing infrastructure.
“Montefiore is in the South Bronx which has some of the poorest health outcomes in New York state. It also has the busiest, if not the busiest emergency rooms in New York City,” Pat explained.
“Part of the issue was that the emergency department itself really needs renovation and restructuring.
“Technically (infrastructure improvements) are not a mandatory subject for bargaining under United States labour laws but these nurses made it one.”
“Patients are literally toe-to-toe and nurses have a hard time just navigating through two patients – through the physical space – they were literally moving stretchers around so they could get to patients and do their job.”
The band aid solution to such diabolical, almost third-world conditions was to shuffle patients off to other units already struggling with bed shortages because of economy drives.
“To decompress the ER they would transfer patients, but there was no room– so they’d actually set up beds in hallways – we call them hallway patients.”
She said Montefiore nurses were also pushing for staffing ratios, currently in place in other departments, to be rolled out to emergency.
Mount Sinai on the other hand did not have staffing ratios at all. They also had more than 500 unfilled nursing positions.
“For Mount Sinai nurses, the strike was really about getting ratio and enforcement mechanisms in a contract
– it was about staffing and the need to provide proper care to the community,” Pat said.
The determination of Mount Sinai and Montefiore nurses to set aside pay increases and fight for their communities resonated strongly with the public, so when they took to the streets in January, they were not alone.
“They had so much community support,” Pat said.
“A lot of the protesters weren’t even nurses they were members of the community and other unions because they were really fighting for care in their community, for them.”
“There were even agency nurses who were working while the strike was on who ended up …joining us on the line even though they weren’t members –it was incredible.”
“It’s not easy for nurses to go out on the street, and we never want to discourage people from coming in for care either. But when conditions get to a certain point that it’s unsafe for them, we have this ethical obligation.”
A lot of the time it is scary for them to be out there striking in a very public way... But you know it was just so empowering for everyone, being among colleagues and feeling that sense of collective.
Pat Kane, New York State Nurses Association Executive Director
YOU KNOW things are bad when the UK’s Royal College of Nursing decides to strike for the first time in their 106-year history.
Chronic staffing shortages, crippling underfunding and cost of living pressures forced the UK’s peak nursing union to take to the streets for the first time in December, with follow up strike days in January and February.
The union is locked in a bitter wrangle with the UK government over working conditions and salaries within the state-run National Health Service (NHS).
The 6 February strike was particularly powerful as the tens of thousands of striking nurses and midwives were joined by striking ambulance officers, creating the biggest strike in the 75-year history of the NHS.
Standing on a picket line and protesting issues like workloads and overcrowding is serious stuff, but those who’ve taken part in this kind of action know it can also be wonderfully uplifting.
There is something invigorating about standing in unity with your colleagues, even if you are weary, hoarse, cold or even a little anxious at being defiant.
“We had a lot of nurses from all over the world, nurses who are immigrants who were worried about being deported, all kinds of crazy stuff – and a lot of the time it is scary for them to be out there striking in a very public way,” Pat said.
“But you know it was just so empowering for everyone, being among colleagues and feeling that sense of collective – there is just an energy and a feeling of being part of something important.
“You know there is a tradition here (in the US) called the block party, which really goes back to people of colour, and it isn’t just a party or a celebration, it is a neighbourhood coming together in solidarity to improve their community and be good neighbours.
“And this was similar to that, you know.”
She said while the purpose of the strike was serious, the nurses added a dash of fun to the proceedings which included pumping out tunes from a carefully selected playlist.
“When I first went to the Weiler site of Montefiore, there was a DJ playing, and the nurses were line-dancing and jumping up and down,” Pat laughs.
“Of course this is New York City so you better have some music – you better have something to keep people moving, otherwise you’re dead in the water, you know?
“And they were very clever with the music, clever about changing words to songs to fit the moment and (playing songs) that had lyrics that were very
RCN General Secretary Pat Cullen said the strikes were a “tragic first for nursing, the RCN and the NHS”. “Nursing staff on picket lines is a sign of failure on the part of governments,” she said.
The strikes were scheduled to continue until the UK government committed to engage in genuine negotiations to resolve unsafe staffing levels and low pay, which are blamed for the exodus of more than 25,000 nursing staff around the UK in 2022.
There are an estimated 47,000 unfilled NHS registered nursing posts unfilled in England alone.
Pay increases were offered in some jurisdictions, including Scotland and Wales, but members voted against them, saying it wasn’t enough and didn’t address their other concerns.
At the time of going to print, March strike action has been put on hold on the promise of a return to the negotiating table.
Photo: Sipa USA/Alamy Live Newsempowering or talking about people power.”
The social atmosphere was also an opportunity for nurses to build better relationships with each other as they stood shoulder-to-shoulder on the kerbside, or indeed, kicked up their heels.
“Often they’re so busy they don’t get to talk to each other - especially the more senior nurses and the new nurses… everyone is so busy.
“They work in such a stressful environment, they don’t get to take their breaks together, they don’t really get to talk, they don’t really get to know each other… but that was something that happened on the picket lines.
“We also saw nurses from departments that sometimes have issues with each other talk and see each other’s side of things, and I think through those actions, they built solidarity just like what we strive for in the union.
“I think their relationships with each other became so much more enriched – which of course will be pretty important going forward because their staffing issues aren’t immediately going to be fixed, it’s going to take time.
“But now walking back into the building, they have a sense that this isn’t the end, that the strike was the beginning and they know they are all in this together.”
Montefiore and Mt Sinai nurses ended their three-day strike on January 12 winning ratios provisions and a process which would not only fill the 1200-nurse shortfall, but promised an additional 150 nurses to help ease workload pressures.
Christina was part of a protest crowd of about 100 staff and supporters who rallied outside the Wesley Hospital in November as Uniting Care Health nurses called for ratios, fair pay and improved conditions during Enterprise Bargaining negotiations.
“There was a real sense of positivity there,” she said.
“Just knowing everyone who stood there cared about the issues and was prepared to stand up for it... there was a real energy.”
She described the rally as being “an incredible show of solidarity” and said even people who were a bit nervous about participating at first, soon felt empowered by the shared purpose of the collective.
“The best part was hearing the conversations about how much fun they were having, saying ‘I could do this every day!’,” she said.
“And seeing them experience the incredible support of the community.
“The horns didn’t stop honking and an ambo turned on sirens for support, much to everyone’s delight.”
“And at the end of the day, nothing bad came out of it, only good – and we all had a part in that.”
Taking strike or stop-work action is not something nurses and midwives take lightly – it’s always a last resort when good faith negotiations fail, and we go to great lengths to ensure we plan our actions
carefully so patient safety is never compromised.
But when the time calls for it, when something is felt widely and deeply enough and talk is getting nowhere, sometimes rally action is necessary.
And there is no reason you can’t embrace the moment while you do.
QNMU MEMBER organiser Christina Horne knows just what how energising a picket line can be.Just knowing everyone who stood there cared about the issues and was prepared to stand up for it... there was a real energy.
Christina Horne, QNMU Member OrganiserQNMU members (l-r) Mel Van Duikeren and Mary-Ellen Rodda ham it up on the picket-line during the Wesley Hospital rally.
Over the past 100 years in Australia, women have been subjugated by a patriarchal society and have given birth under oppressive circumstances where they’ve lacked control over their own bodies.
Indeed, this has been occurring around the world for centuries. Obstetric violence, post-traumatic stress disorder and traumatised women and persons who have given birth are on the rise, as are interventions in pregnancy and birth.
The prevalence of transgendered people giving birth will most likely rise as gender politics changes the landscape, and health care providers support and understand the health needs of all people choosing to have babies (Reis, 2020)
Language is an important part of social empowerment and social contract, and the change to womancentered care is neither to limit the rights of transgendered people to birth nor to diminish their intrinsic value.
While the QNMU unequivocally supports any person’s rights to selfdetermination and equitable access to culturally safe, high quality health care, the term woman and woman-centered care is not intended to exclude non gendered people.
It is an essential language that supports a human-centered philosophy of midwifery care that empowers and protects all women and persons who are accessing their care.
‘Woman’ cannot again be rendered invisible in society and health care. Sensitive debate is required to successfully and safely ensure all persons have a visibility and recognition of value in maternity spaces but not at the loss of the term woman.
There is an assumption that the term woman-centered care excludes persons, however the reality is womancentered care providers (midwives) are the most likely able to effectively and safely work in partnership with persons of any gender or identity to navigate maternity systems.
This article describes why midwifery harnesses the terms ‘women’ and ‘women and babies’ when describing who they partner with, and why we need to keep the term woman/women while also respecting people who birth who do not identify as woman.The term in and of itself empowers a discourse that embraces selfdetermination and empowerment.
Most transgender people giving birth, at this time, are those born with a uterus — transgender men, nonbinary people, gender fluid people, gender queer people, and others with uteruses who don’t identify as women.
Many transgender men, and other gender nonconforming individuals, retain their ovaries and uterus as well as the capacity to become pregnant.
Being transgendered does not necessarily mean the person has body dysmorphia or rejects their body.
Transgendered persons require health care providers that understand their health care needs and their individual ways of understanding their bodies, how they choose to transition and how they identify.
Moving forward, QNMU could consider working with transgendered people’s groups to work on ways midwives could provide care that reduces the current stigma, discrimination and substantial obstacles transgendered people face in accessing reproductive health care.
This can be done without the erasure of woman (Margaret Besse, 2020).
Since the 1970s there has been a move to return birth to women through midwives.
It has been a long struggle as the powerful discourse of medicine and nursing are highly resistant to returning women’s births rights back to women through midwifery care.
In 2010 midwifery was finally returned to being recognised as a profession in its own right (that is not nursing) under the Australian Health Practitioners Regulatory Agency (AHPRA).
The midwifery profession has worked tirelessly to situate pregnancy and childbirth within a more social and woman-centered paradigm. Key to this is to make the woman center of her care and to reject being termed as patients which comes from an illness model.
Midwives are nationally regulated and accountable to provide womancentered care (Nagle & Vogt, 2018), NOT to provide patient care.
To change to a patient-centered terminology sets midwifery back into an illness model which is not appropriate and not what the profession has fought hard to shift away from.
The ICM position statement Human Rights of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) People supports the right of all people to receive humanised and inclusive midwifery care regardless of their sexual orientation, gender identity, or gender expression.
ICM believes it is critical for midwives to honour and respect all people’s right to self-determination and their right to receive health care that is free from discrimination, homophobia, transphobia and prejudice (Midwifery, 2017).
According to the definition of the International Confederation of Midwives, which has also been adopted by the World Health Organization and the International Federation of Gynaecology and Obstetrics:
A midwife is a person who has successfully completed a midwifery education programme that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education and is recognized in the country where it is located; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical
There are ways the term woman can have person/s identified … however, womancentred care, woman centeredness and the role of midwives providing care to women cannot be and should not be altered as these have been hard fought for changes to the return of reproductive power and control to women.
care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units.
■ That the term patient/s be replaced with 'woman-centred or woman/women. It is inappropriate to use patient for women/ persons who access midwifery care. It was specifically targeted by the midwifery profession as inappropriate. Womancentred or woman/ women is the preferred term and sits in a ‘woman at the center’ wellness paradigm that has significant benefits for the care provision to anyone accessing midwifery care.
■ That consideration be made to add person/persons next to women/women in appropriate contexts without rendering woman invisible or affecting the regulatory, legislative, and philosophical underpinning of midwifery care that is woman-centred
■ That the NMBA Midwife Standards for Practice use the terms ‘woman’ and ‘women-centred’ rather than patient. Given that midwifery and nursing are separate professions, the QNMU should use terms appropriate to each rather than both. As the standards setting body for nurses and midwives, for the QNMU to change terminology would not only be cause for considerable distress for midwife members and consumer advocacy groups but would be potentially confusing.
There are ways the term woman can have person/s identified: woman/person, women/persons. However, woman-centred care, woman centeredness and the role of midwives providing care to women cannot be and should not be altered as these have been hard fought for changes to the return of reproductive power and control to women.
The ANMF quite clearly states that: Woman or women in these standards refers to the person giving birth. Woman or women is used to refer to those individuals who have entered into a therapeutic and/or professional relationship with a midwife
The QNMU supports the following tips for healthcare professionals and others coming into contact with pregnant women/people which are based on advice provided by Reproductive Endocrinologist Dr. Sara Pittenger Reid (as cited in Prager, 2020):
■ Ask a pregnant woman/person for their pronouns (i.e. he/him/his, she/her/hers, they/them/theirs) and consistently use the ones they tell you.
■ Ask for and use the pregnant woman/person’s preferred name, which isn’t necessarily their legal name.
■ Ask for gender identity (which is different than sex at birth or sexual orientation) on intake forms and have staff check what’s written before addressing the patient.
■ Provide single-stall genderneutral bathrooms.
■ Train all staff on the practices above and further cultural competency.
Besse, M., Lampe, N. M., & Mann, E. S. (2020). Focus: Sex & reproduction: Experiences with achieving pregnancy and giving birth among transgender men: A narrative literature review. The Yale Journal of Biology and Medicine 93(4), 517. Collins Dictionary. (n.d). Patient. In Collins Dictionary. https://www. collinsdictionary.com/dictionary/ english/patient
Fahy, K. (2007). An Australian history of the subordination of midwifery. Women and Birth 20(1), 25-29. Gray, M., Rowe, J., & Barnes, M. (2016). Midwifery professionalisation and practice: influences of the changed registration standards in Australia. Women and Birth 29(1), 54-61.
ICM. (2017). Core Document: Definition of Midwifery. International Council of Midwifery. https://www. internationalmidwives.org/assets/ files/definitions-files/2018/06/engdefinition_midwifery.pdf
ICM. (2017). Position Statement: Human Rights of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) People https://www. internationalmidwives.org/assets/ files/statement-files/2018/04/englgtbi.pdf
Kuhn, S. M., & Reidy, J. (Eds.). (1975). Middle English Dictionary, University of Michigan Press.
Nagle, C., Heartfield, M., McDonald, S., Morrow, J., Kruger, G., Bryce, J., ... & Hartney, N. (2017). A necessary practice parameter: Nursing and Midwifery Board of Australia Midwife standards for practice. Women and Birth 30 10-11.
Nagle, C., & Vogt, T. (2018). Midwife standards for practice: one size does fit all. Women and Birth 31 S51.
Prager, S. (2020). Transgender Pregnancy: Moving Past Misconceptions. Healthline parenthood. https://www. healthline.com/health/pregnancy/ transgender-pregnancy-movingpast-misconceptions
Reis, E. (2020). Midwives and pregnant men: labouring toward ethical care in the United States. CMAJ 192(7), E169-E170.
BY DANIEL PRENTICE, QNMU PROFESSIONAL RESEARCH OFFICER
The final report and recommendations of the Royal Commission into Aged Care Quality and Safety (the Royal Commission) released in 2020, along with a total of 148 recommendations, have provided the opportunity to significantly improve the Australian aged care system.
However, like any reform process, the best of intentions are no guarantee of good outcomes. This is why the QNMU and our national body – the ANMF –are spending considerable time and resources making sure the interests of our members and the older Australians they care for, are represented at every opportunity in the reform process.
The aged care reform process is extensive and daunting, and it will take time to achieve a high quality and safe aged care system for all who use it. The Royal Commission final report recommendations ranged over 20 aspects of aged care services and included everything from the need for a new Aged Care Act as the basis of reform, to workforce planning, recruitment and retention, standards of care, funding, regulation, and governance, as well as reporting by providers. There is a lot to do.
While a change of federal government in May 2022 has given the QNMU more confidence that the full range of recommendations from the Royal Commission will be implemented, it is imperative the QNMU, and ANMF nationally, continue to focus the government, regulators, policy makers, aged care providers, members and the public, on the many issues that remain in need of improvement.
There are a number of issues the QNMU/ANMF is focussed on.
In a move to ensure at least a minimum level of care, from 1 October 2022 aged care providers have been required to set a target of an average 200 minutes of care per resident per day with 40 minutes of RN time. Those targets will become mandatory from 1 October, 2023. In addition, from 1 July this year each facility must have an RN on site and on duty 24/7. Minutes of care requirements will increase to 215 minutes of care and 44 minutes of RN time from 1 October, 2024.
While welcome, these requirements are only the start. The ideal arrangement is one in which care mandates reflect the actual level of care required.
Another development has been the introduction of a new aged care funding model (the Australian National Aged Care Classification or AN-ACC) that replaced the ACFI funding model on 1 October last year.
A focus of the QNMU/ANMF has been to ensure this funding model reflects the actual cost of care.
As a recommendation of the Royal Commission, a Star Ratings system for all nursing homes came into effect from December 2022.
This scheme assigns facilities a star rating of between 1 and 5 for the following four areas; compliance, quality measures, residents’ experience and staffing, with ratings made publicly available. While it is early days yet, a number of organisations, including the ANMF, have questioned the accuracy of the first set of ratings. The QNMU/ANMF will be watching this scheme closely.
One area of concern has been the role of Enrolled Nurses (ENs) in aged care. While the Royal Commission made specific recommendations
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about the level of RN care, this was not done for ENs and the QNMU/ANMF is concerned that some aged care providers are reducing EN positions.
In Tasmania, Southern Cross Care has indicated that almost 50 EN positions will be lost and replaced with personal care worker positions.1 While the Federal Government has been critical of Southern Cross Care’s move, as yet there is no government commitment to mandate specific EN care requirements. The QNMU and ANMF will continue to advocate vigorously for this requirement.
ENs are an essential part of the direct care aged care workforce and the QNMU and ANMF will never stop advocating for this important role. This important role is recognised in the Queensland Health Aged Care Ratios where it is recommended that ENs constitute 20% of skill-mix in state nursing homes.
1 Australian Nursing and Midwifery Federation (2/12/2022), Stop the nursing cuts and protect the residents at Southern Cross Care Tasmania, retrieved from https://www.anmf.org.au/media-campaigns/ news/stop-the-nursing-cuts-and-protect-theresidents-at-southern-cross-care-tasmania
In conjunction with the ANMF, the QNMU has engaged in many consultations regarding aged care reform over the past year. Our submissions have included:
■ Review of the Aged Care Quality Standards
■ Building, Training and Supporting the Aged Care Workforce
■ A new model for regulating aged care
■ The new Code of Conduct for the aged care sector
■ The capability review of the aged care regulator, the Aged Care Quality and Safety Commission.
These are just of few of the issues the QNMU/ANMF have developed clear statements for on behalf of members and those older Australians they care for.
The aged care reform process will take time and continued vigilance by the QNMU and ANMF. Workforce
issues such as recruitment and retention will remain critical as the reform processes depend on a workforce that has the capacity and capability to deliver high quality safe care.
Regulation of the currently unregulated aged care workforce such as AINs and personal care workers is planned but how this will occur is currently unclear. The QNMU’s position is that this regulation must take place via the existing Australian Health Practitioner Regulation Agency (AHPRA) framework.
An exposure draft of a new Aged Care Act is expected in the first half of 2023. This legislation will lay the foundation for the aged care reform process, and it is imperative the government gets it right. The QNMU and ANMF will be taking every opportunity to ensure this happens.
This year will bring much change in aged care; however, it will take time to achieve a system that is safe, provides high quality care, and is responsive to the needs of older Australians.
(Mandatory minimum care) requirements are only the start. The ideal arrangement is one in which care mandates reflect the actual level of care required.
The educational pathway to become a mental health nurse in Australia is to attain either a Diploma in Nursing (Enrolled Nurse) or a Bachelor of Nursing (Registered Nurse). There is no regulatory requirement to attain an additional graduate diploma to practice in mental health, however, employers will often prefer candidates with an additional degree in mental health.
In 2019, Australian Nursing & Midwifery Accreditation Council (ANMAC) consulted on whether there should be a discrete unit of study devoted to mental health nursing incorporated into the accreditation standards for Registered Nurses.
Despite the majority of feedback supporting its inclusion, and ANMAC recognising its importance, they “decided to highlight mental health as a key national health priority and include it in the curriculum but not specify that a discrete unit of study be devoted to the subject” (Australian Nursing & Midwifery Accreditation Council, 2019).
Therefore, while most programs in Australia include mental health content because it is one of the national health priorities, this suggests there are universities which do not include a mental health nursing unit of study at all. Some students may therefore graduate without having studied any mental health coursework in-depth or completed a single mental health clinical placement.
There is no guidance to education providers about the level and extent of mental health content required in the undergraduate nursing degree curriculum. Mental health content is generally set by the individual institutions and may be dependent on staff resourcing, perceived demand for mental health content, and the availability of mental health clinical placements for students. Typically, there is only one unit/subject on mental health nursing during the entire undergraduate nursing degree and a single mental health clinical placement. Mental health content is generally not incorporated into other units.
A literature search by Currie, et al. (2019) noted “significant variation in the number of theoretical tuition hours devoted to mental health and the number of clinical placement hours.” The issue of shorter mental health clinical placements compared to placements for other subjects was echoed in the Federal Department of Health’s report Educating the Nurse of the Future: Report of the Independent Review into Nursing Education (Schwartz, 2019).
Commentators have suggested that the comprehensive system does not adequately prepare undergraduate students with the skills, knowledge and competence for mental health practice (Happell, et al., 2020). The quality of mental health training is generally considered to be of poorer quality, as it may be taught by someone with limited experience in mental health nursing, or there is not enough time to cover the topic in sufficient detail.
The majority of content in the degree is not geared towards mental health nursing, as educational programs tend to emphasise acute care content instead (Currie, et al., 2019). Mental health
nursing is instead seen as a specialty rather than a core component of overall nursing (Schwartz, 2019).
This creates and perpetuates a system where nurses must acquire additional skills through education to maintain excellence in the mental health nursing workforce, rather than being already equipped with work-ready skills (Hemingway, et al., 2016).
The ANMAC Registered Nurse accreditation standards merely require that the course curriculum contains “content related to mental health.” This provision leaves it to education providers to decide what content to include and is described as being merely “perfunctory” (Schwartz, 2019). Further, in literature about mental health nursing education, there is no clear articulation of exactly what mental health skills are required for students to acquire (Currie, et al., 2019).
This is problematic as there is no uniformity about what nursing graduates know about mental health nursing and what they are able to do upon initial registration as a nurse. Recent graduates from courses with limited mental health content are at a distinct disadvantage if they desire to pursue a career in mental health nursing.
As ENs also encounter patients with mental health issues, the EN accreditation standards should also require instruction in mental health. A study into a transition program for ENs in a forensic mental health hospital
Given the mainstreaming of mental health services into the general healthcare system... a basic knowledge of mental illness and its associated care and treatment is fundamental for all nurses.
may affect their perception and attitudes towards mental health nursing and mental health in general. Negative attitudes among students and educators towards people with mental illness perpetuates stigma towards mental health nursing. This can discourage students from pursuing mental health nursing as a specialisation (Happell, et al., 2020).
In a comprehensive program, the majority of students would not be interested in pursuing mental health nursing, and therefore those who do wish to become mental health nurses have fewer networking opportunities and support while studying.
Mental health nurses are the largest occupational group within the mental health workforce. There are about 24,000 mental health nurses working across Australia, of which 4800 are employed in Queensland (Australian Institute of Health and Welfare, 2023). Mental health nurses also make up the bulk of hospital-based mental health care and prison mental health services.
Across Australia, only 7% of nurses work in a mental health setting (Australian Institute of Health & Welfare, 2016). Workforce trends and projections suggests the current state and predicted growth of the mental health nursing workforce is insufficient to meet population needs now and for the future. There is projected to be an undersupply of 18,500 mental health nurses by 2030 based on data from 2014 (Health Workforce Australia, 2014). After factoring in current and future demand arising from global changes, population movement and the pandemic, the true deficit figure is likely to be much higher.
As described by some QNMU members, the integration of mental health nursing into a comprehensive degree designates it as merely a subject or unit to be taught, rather than acknowledging the range of specialist skills and different approach to patient care required, which some believe is eroding the mental health nurse identity. This perceived loss of identity has further led to the “perception that the mental health sector was not a great place to work – a perception that is still held by some” (Larouche, 2022).
This is echoed in studies showing that undergraduate nursing students routinely rank mental health nursing as one of the least preferred career options, a trend that has been largely unchanged in 50 years (Happell & Gaskin, 2012). More concerning, however, is that the change to comprehensive nursing education has apparently coincided with a decrease in the number of students motivated to undertake mental health nursing as a career choice (Hemingway, et al., 2016),
Given the mainstreaming of mental health services into the general healthcare system, non-mental health nurses come into contact with people with a mental illness much more frequently, meaning that a basic knowledge of mental illness and its associated care and treatment is fundamental for all nurses.
Therefore, ANMAC must set guidelines on minimum mental health nursing education requirements for all providers of nursing education, general nursing or mental health nursing. Reform to current educational programs, and development of future programs, ought not be bound by shortcomings of the past.
As it stands, many of the concerns towards nursing education could be managed by reforming the way mental health content is taught (for example, mandatory mental health units, guidelines on depth of mental health content, and mental health clinical placement requisite hours), and addressing the ongoing stigma towards mental health and mental health nursing within the nursing profession and in the wider community.
Australian Institute of Health & Welfare, 2016. Mental health nursing workforce 2016, Canberra: Australian Institute of Health & Welfare.
Australian Institute of Health and Welfare. (2023). Mental health: Workforce. Canberra: Commonwealth of Australia. Retrieved from https://www.aihw. gov.au/mental-health/topic-areas/ workforce
Australian Nursing & Midwifery Accreditation Council, 2019. Registered Nurse Accreditation Standards 2019, Canberra: ANMAC. Currie, J. et al., 2019. Topic 3: Clinical skill development, s.l.: Centre for Health Service Development.
Happell, B. et al., 2020. Mental health nursing education in undergraduate and postgraduate programs: Time for change. Australian Nursing & Midwifery Journal, 26(9), pp. 42-43. Happell, B. & Gaskin, C. . J., 2012. The attitudes of undergraduate nursing students towards mental health nursing: a systematic review. Journal of Clinical Nursing, Volume 22, p. 148–158.
Health Workforce Australia. (2014). Australia’s Future Health Workforce – Nurses Overview Report. Canberra: Commonwealth of Australia. Retrieved from https:// www.health.gov.au/sites/default/ files/documents/2021/03/ nurses-australia-s-future-healthworkforce-reports-overview-report. pdf
Hemingway, S., Clifton, A. & Edward, K.L., 2016. The future of mental health nursing. Journal of Psychiatric and Mental Health Nursing, Volume 23, p. 331–337.
Larouche, E., 2022. Attracting and retaining mental health nurses must start with early exposure to sector pathways, says UC Professor. [Online] Available at: https://www. canberra.edu.au/about-uc/media/ newsroom/2022/june/attractingand-retaining-mental-healthnurses-must-start-with-earlyexposure-to-sector-pathways,says-uc-professor
Masso, M. et al., 2019. Topic 1: Fit for purpose / work ready / transition to practice, s.l.: Centre for Health Service Development.
Schwartz, S., 2019. Educating the Nurse of the Future: Report of the Independent Review into Nursing Education, Canberra: Commonwealth of Australia.
January
General patients will pay 29% less for PBS prescriptions from 1 January, with the maximum co-payment dropping from $42.50 to $30.
It’s the first time in 75 years the co-payment under PBS has been reduced, and Federal Government figures suggest it could save families who rely on two or three regular medications as much as $450 or more every year.
The Pharmacy Guild of Australia says about 900,000 people failed to fill their scripts in 2020-2021 simply because they couldn’t afford them. This new legislation is designed to help more people get the medications they need.
The Guild is now advocating lowering the maximum co-payment even further to $19, which would see an additional 30% of PBS medicines covered.
Three new prescription drugs have been added to PBS medicine listings.
■ Trimbow (beclometasone with formoterol and glycopyrronium) which is used to treat severe asthma. Comparable treatments would cost around $1000 a year without the subsidy.
■ Vabysmo (faricimab) which combats diabetic macular oedema and neovascular (wet) age-related macular degeneration. More than 18,000 DMO patients and 62,000 people with nAMD accessed similar treatments through the PBS last year. Without the new subsidy, patients could face a $4000 medication bill each year.
■ Darzalex SC (daratumumab) to fight rare blood disorder called amyloid light-chain amyloidosis. About 160 Australians will benefit from this new treatment option which would cost more than $243,000 per course without the subsidy.
1 each year is usually the launch date for a raft of new state and federal laws and this year was no exception. To help members get across those most relevant to their work and industry, we’ve put together this handy list summarising the changes kicking off in this new year.
There have been notable changes to pricing practices within the Federal Government’s Home Care Packages Program – the program that provides subsidies to organisations providing home care services to eligible older people.
There are four levels of Home Care Packages – from level 1 for basic care needs to level 4 for high care needs.
From 1 January, home care providers can no longer charge additional costs for thirdparty goods or services (i.e. subcontractors, labour hire); or exit fees (when a client no longer wants or requires the providers’ services).
Care Management prices (for services directly related to care such as assessing and meeting health and wellbeing needs) will be capped at 20% of the package level; while Package Management prices (for more administrative services, including financial reporting, records and staff management) will be capped at 15% of the package level.
Furthermore, providers will no longer be allowed to impose management charges in any month
From 1 January the Better Access mental health initiative will be cut from 20 Medicare-subsided psychology sessions to 10.
The QNMU has concerns about this change and we are currently considering how we will respond to it.
The scheme was initially designed with only 10 sessions on offer but was expanded in the early days of the COVID-19 crisis to 20 sessions to assist people experiencing severe or enduring mental health difficulties as a result of the pandemic.
The Federal Government has decided to roll back the number of Medicare-supported sessions after
where a client only receives care management (except for the first month).
If, as a result of these new laws, there is any decrease in a client’s care package and management package prices and/or removal of separate third-party services, the provider must simply inform their client of the changes with 14 days prior notice.
However any increase in costs as a result of these new laws must be discussed and mutually agreed with clients and documented in the home care agreement before the new rates are charged.
The legislation states the prices and any price increases must be “reasonable and justifiable” – although there is no formal definition for this.
There are of course other changes in the Aged Care space due to be rolled out in 2023 including the requirement for aged care facilities to have an on-site and on-duty registered nurse 24/7 (from 1 July) and the introduction of 200 mandatory minutes of care per resident per day (starting 1 October).
In Queensland, new payroll tax changes came into effect on 1 January implementing a 2022-23 Queensland Budget provision. These tax changes will create a new mental health levy to improve mental health and combat substance abuse.
Large employers and employer groups with annual national payrolls of more than $10 million will be liable to pay a mental health levy of 0.25 cents in the dollar for wages over $10 million, and 0.75 cents per dollar for wages over $100 million, taxed at a marginal rate.
It’s expected about 6000 Queensland businesses will pay the new tax netting about $1.64 million over five years.
To clear up any confusion, a reminder that PCR tests remain free for everyone who needs one if their GP or nurse requests one for them, or at GP-led Respiratory Clinics or state- or territory-run COVID-19 testing centres.
a University of Melbourne review into the program concluded it had caused longer waiting times and had reduced access to new and low-income patients. There are serious concerns around equity of access.
Critics however said it was shortsighted to assume the pandemic is no longer having an impact on mental health and argue the report also stated the Federal Government should continue to fund the 10 additional sessions but target them towards those with complex mental health needs as a way of helping address a national shortage of psychological services.
Priority populations can access them free through state testing sites. Priority populations include the elderly, First Nations people, people with disability, people who are immunocompromised or with complex underlying health conditions, people living in remote communities and people from CALD communities.
Everyone else can continue to receive PCR testing free of charge through GPled respiratory clinics.
They are also free of charge when a GP or nurse practitioner requests a test from a pathology provider as part clinical management. In this situation the tests, provided out-of-hospital, must be bulk-billed by the pathology provider.
The aim is to encourage lower risk people to use home-use Rapid Antigen Tests (RATs) to determine contagion and then follow the normal COVID-19 control protocols of rest, isolation and good hygiene.
The QNMU joined forces with unions across Australia to demand vital changes to our industrial laws. This year we will see new laws to come into effect –many promising better wages and conditions for working Australians (predominantly those employed in the federal system) including greater gender equity, safer workplaces and more secure work.
Applies only to workers employed in the federal system.
Employees will have access to 10 days of paid family and domestic violence leave from 1 February this year, building on the five days of unpaid leave already included in the National Employment Standards.
The new leave allowances will apply to full-time, part-time, and casual employees, and will be paid at the rates workers would have earned on their rostered hours.
Leave will accrue over the course of each 12-month period, similar to personal or carer’s leave.
By the time this edition of InScope goes to print it will be illegal to advertise jobs offering wage packages lower than the minimum wage (effective 6 January). There will be new laws in place that explicitly prohibit sexual harassment in the workplace (6 March) and there will be two new panels established within the Fair Work Commission focussing on pay equity and the care and community sector (6 March).
One of the most significant changes in the industrial relations space for workers in the federal system will roll out on 6 June – increased access to the multi-employer bargaining system which represents a huge change to how workers negotiate workplace agreements.
This new legislation will allow workers across multiple companies to join together and collectively negotiate new agreements, which presents better opportunities for workers to secure improved wages and conditions above standard industry awards.
The new rules will apply automatically to companies with more than 50 employees, while those with less than 20 will be exempt. Businesses in between can go either way – with employees needing to engage in a common interest test process to make a case for why their employer should be included in multi-employer bargaining.
June will also see federal changes to unpaid parental leave, strengthening parents’ right to request leave
extensions and giving the Fair Work Commission the power to handle disputes. The new rules mean an employer cannot reject a request offhand and must provide reasons for refusal for writing; they will also be required to provide additional guidance around what can be considered “reasonable business grounds” for refusal.
This month also offers improvements to flexible working arrangements, with more employees in the national system – including those who are pregnant and those experiencing domestic or family violence – being able to access flexible work. Similar to the unpaid parental leave change, employers will have new obligations before they can reasonably refuse a request for flexibility.
As the year draws to a close we will welcome new federal laws that limit the use of fixed term contracts – a strategy designed to address the problem of insecure work by making it illegal to offer fixed term contracts of two years or more. There are also provisions that deal with underhand tactics employers might try to use to circumvent the new rules. Employers will now also be required to provide employees with a FWA Information Statement on Fixed Contracts which will provide prospective employees with impartial information about these the of employment arrangements; and the Fair Work Commission will also have new powers to deal with contract disputes.
Applies to workers employed in both state and federal systems, including Queensland Health and other public sector entities.
The QNMU welcomes the Respect@ Work legislation being fully installed in 2023 – this is a vital step in addressing workplace sexual harassment.
The Anti-Discrimination and Human Rights Legislation (Respect@Work) legislation is designed to change how employers and managers address and respond to sexual harassment and abuse in their workplaces.
It enshrines requirements for a proactive model whereby businesses must create safe, equitable workplaces and actively work to prevent and eliminate sexual harassment and abuse, instead of the previous model which generally operated reactively, responding only after complaints had been raised.
Under the legislation, businesses are required to take “reasonable and proportionate measures to eliminate sex discrimination, sexual
harassment and victimisation, as far as possible”, which includes actively stamping out hostile conduct and bias on the basis of sex.
The new rules also lower the threshold for what constitutes sexual harassment from unwelcome conduct of a ‘seriously demeaning’ nature to unwelcoming conduct of a ‘demeaning’ nature, which captures harassment in reference to someone’s sex, which is not necessarily sexual.
Employers have until the end of this year to make changes to their workplaces in order to be compliant with the new rules.
The Australian Human Rights Commission has been given investigative and enforcement powers to monitor and address employer compliance and will be able to seek a court order if they determine a business has failed in their duty to create a safe and equitable workplace.
Applies only to workers employed in the federal system.
The Federal Government’s most significant piece of industrial reform the Secure Jobs, Better Pay legislation has already made a number of changes to worker’s right from 7 December 2022, with the bulk of the new rules rolling out over the next 12 months.
Further amendments to industrial legislation are expected to be put to parliament later this year.
Key changes implemented last year include changes to the Fair work Act objectives, so they now include promoting job security and gender equality ; and in another step forward for gender equity at work, the introduction of new protected attributes in the anti-discrimination provisions of the Fair Work Act – namely breast feeding, gender identity and intersex status.
The Fair Work Commission now also has a handful of new powers. It can now unilaterally correct errors in enterprise agreements and terminate agreements after their nominal expiry date.
When nurses and midwives are safe in their workplaces, those in their care are safe and experience better health outcomes. This fact has been repeatedly demonstrated in research conducted here in Australia and across the world. However, many QNMU members tell us their safety is not being prioritised by their employer and this is directly impacting their ability to provide high quality nursing or midwifery to patients and families.
One of the issues noted is the narrow view some employers take to what encompasses work health and safety for nurses and midwives. These narrow views often prioritise physical safety over psychological safety or places limitations on where safety is prioritised, such as areas with high levels of electrical technology as opposed to a general ward or community outreach service. The shortsightedness of employers is not only disappointing from the humanistic perspective, but it is unlawful in accordance with the Work Health and Safety Act 2011 (Qld)
The QNMU has been a longtime campaigner for improving work health and safety laws and seeking better compliance from employers to those laws. We have taken a holistic approach to our campaigning based on the QNMU’s Positive Practice Environment (PPE) Standards which states that nurses and midwives must have safe workloads and work in an environment that ensures their physical, psychological, and cultural safety, at all times. We have taken the opportunity to be explicit about what
we mean by safe workloads as described in our Ratios Saves Lives and Money 3 campaign as well what we mean by cultural safety as per our Cultural Safety Definition Position Statement
Recently, after many years of lobbying in alliance with other unions, we successfully secured both a Regulation and a Code (Managing the risk of psychosocial hazards at work Code of Practice 2022) which comes into effect from 1 April 2023. The code will give workers, especially those employed in the health and aged care sectors in Queensland, some of the strongest protections in the country. We are pleased the code aligns with our safety expectations as set out in the QNMU’s PPE Standards. If implemented correctly by employers, the code may be the game changer we have been looking for to improve the work health, and safety of nurses of midwives across the state.
When the code commences, psychosocial hazards that will need to be actively managed by employers as listed by WorkSafe Qld includes, but is not limited to,:
■ High job demand – high physical, mental and emotional demands which can create risks to the health and safety of workers.
■ Low job control – refers to work in which workers have little or no control over that happens in their work environment.
■ Poor support – refers to tasks or jobs where workers have inadequate emotional and/practical support, inadequate training, or information to support their work performance or inadequate tools, equipment, or resources to do their job.
■ Poor organisational change management – refers to organisational change management that is poorly planned, communicated, supported, or managed.
■ Poor organisational justice – refers to work where there is a lack of procedural fairness, informational fairness, or interpersonal fairness.
Given the current workforce shortages, high workloads and increasing fatigue within the nursing and midwifery workforce, QNMU will be working with members to raise awareness of the new code and how it can be optimally applied in workplaces across the health and aged care sectors.
Health and Safety Representatives (HSRs) will play a significant role in this work. We encourage all members who are HSRs to join QNMU’s HSR reference group to assist them in gathering the most up-to-date information and remain connected within our networks.
If your workplace doesn’t have an HSR, it is time to speak with your local Organiser about how to establish one or more in your local area.
More information about HSRs can be found on the Health and Safety Representatives Information Sheet www.qnmu.org.au/HSRInfo
Remember, work health and safety legislation including the regulation and the code applies to all workplaces – public, private, and aged care – all employers must comply with the legislation and the code.
Online resources
Workplace Health and Safety Act 2011: https://bit.ly/WHSact2011
QNMU’s Positive Practice Environment (PPE) Standards: www.qnmu.org.au/ PPEStandards
QNMU’s Ratios Saves Lives and Money 3 policy: www.qnmu.org.au/ RatiosSaveLives
QNMU’s Cultural Safety Definition Position Statement: www.qnmu.org.au/ CulturalSafety
Queensland Government’s Managing the risk of psychosocial hazards at work Code of Practice 2022: https://bit.ly/pshcop22
QNMU’s Health and safety representatives information sheets: www.qnmu.org.au/HSRInfo
1. https://www.worksafe.qld.gov.au/ laws-and-compliance/codes-ofpractice/managing-the-risk-ofpsychosocial-hazards-at-work-codeof-practice-2022
The code may be the “game changer” we have been looking for to improve the work health, and safety of nurses of midwives across the state.
JANUARY - JUNE 2023
Make the most of your QNMU membership and enrol in our FREE education courses.
We have a huge line-up of courses scheduled over the coming year both online and face-to-face.
Check them out at www.qnmu.org.au/ events
In this powerful keynote, Wellness expert Mark Bunn explains why selfcare is now the single-most important skill for sustainable high-performance, as well as giving you some simple, ancient wisdom tips and tools to help you negate the potentially harmful effects of regular night shiftwork.
Mark will also discuss the 3 critical areas for recharging our mental health, wellbeing, motivation and morale.
2 CPD HRS FACE TO FACE
Toowoomba
18 April, 2.00pm - 4.00pm
Brisbane
19 April, 10.00am - 12.00pm
Cairns 18 May, 9.00am – 11.00am
Townsville 18 May, 5.30pm-7.30pm
In this workload management webinar, we’ll be discussing some of the industrial and professional mechanisms available to help you deal with workload issues, and practical strategies you and your colleagues can use.
You’ll hear about some great wins our members have achieved with workload issues!
1.5 CPD
Online 11 May, 4.30pm – 6.00pm 14 June, 9.00am – 10.30am
Positive practice environments are settings that strive to ensure safe, quality care, improve productivity and performance and protect the health, safety and personal wellbeing of staff. The purpose of this 1-day course is to enable QNMU members to discuss and develop their understanding of the importance of culture and professional practice in developing a practice environment that is conducive to safe, quality patient/resident care, as outlined in the Positive Practice Environment Standards.
6.5 CPD HRS FACE TO FACE
– 4.00pm
– 4.00pm
As nurses and midwives we deal with a lot of stress in their professional and personal lives. In caring for others we give a lot of ourselves in the process, often at the expense of our own mental and physical health. And unfortunately, we’re just not that great at looking after ourselves! This opens us up to a high risk of burnout.
Join us for this webinar to learn more from the presenter Michelle Gordon.
1 CPD HR ONLINE
Online
8 May, 6.00pm – 7.00pm
The BPF is a valuable tool for managing nursing and midwifery workload that is used by a NUM or MUM. The course will assist nurses and midwives with processes to manage nursing and midwifery workload supply and demand, as well as yearly planning, evaluation and negotiation required to provide quality frontline services.
The course works through the detail of developing a service profile, the seven steps to calculating nursing/midwifery hours per patient day and resource allocation. We will explore BPF notional ratios and legislated prescribed ratios as well as how to have the BPF signed off and operational within your unit.
4 CPD HRS FACE TO FACE Townsville
3 May, 8.00am – 12.00pm Cairns
23 May, 8.00am – 12.00pm
4 CPD HRS ONLINE Online
11 May, 12.00pm – 4.00pm
EB11 is now in place but what has changed? Find out how to make the most of your rights and conditions contained in your new Queensland Health (QH) EB11 Nursing and Midwifery Agreement. Knowledge is power and it is vital for members to understand, and more importantly ensure, agreement provisions are complied with across QH.
6 CPD HRS FACE TO FACE Gold Coast
8 May, 9.00am – 4.00pm
HRS ONLINEIt is only right and fair that nurses and midwives receive their full entitlements, are paid for all the work you do. We know many health care staff often miss meal breaks, work unpaid overtime, do handovers in your own time, and work beyond your finishing time.
Our Claiming what you are owed CPD event aims to empower members by ensuring you know what your entitlements are and how you can claim them.
2 CPD HRS ONLINE
Online
11 May, 9.00am – 11.00am
23 June, 1.00pm - 3.00pm
Crafting and debating motions at the QNMU’s Annual Conference forms a significant part of the democratic process of our union. Submitting a motion at Conference is one of the most powerful ways you and your fellow QNMU members can have a say in our union’s priorities and day to day work.
But what makes an effective motion, and what are some things your branch can do to ensure your motion has the best chance of success at Conference?
This workshop has been developed to assist Local Branches in bringing issues to the QNMU Annual Conference via the motions process.
2 CPD HRS ONLINE
Online
26 May, 10.00am – 12.00pm
This two-hour session is your chance to learn about how being active in the QNMU can help achieve real outcomes for nurses and midwives.
You will learn how you can work with your union to take collective action to improve your work environment, and what being a union member in your workplace is all about. Hear stories of your fellow members winning in their workplace - there are countless examples of QNMU members working together and securing great outcomes.
2
The BPRG are an important and critical resource for managers and supervisors to ensure an environment that provides safe and high-quality care. It is a pivotal function in the delivery of quality frontline services.
This training will assist you with the development of rosters to ensure there are the right staff available, and the necessary skills and training required to form the basis for decision making. Come along and find out how to improve the roster in your work unit.
4 CPD HRS FACE TO FACE Townsville
3 May, 12.30pm – 4.30pm
23 May, 12.30pm – 4.30pm
4 .5 CPD HRS ONLINE
17 May, 12.00pm – 4.00pm
Unions throughout Australia have made significant inroads into improving the health and safety for workers. This course aims to provide nurses and midwives with practical advice and tools to create a safe workplace and manage fatigue. A must for nurses and midwives concerned about unsafe workplaces.
Wondering what a Branch Delegate is, or keen to nominate as a Branch Delegate or Alternate Delegate? Or maybe you are already a Branch Delegate and want fresh ideas on how to run an effective Branch. This course has been specifically designed to explain the role of Delegates and Alternate Delegates and how these roles work to build power in workplaces.
The training objectives for this course are:
■ To prepare participants for death, grief, and loss in the workplace.
■ To support the development of resilience in the workplace.
■ To respond effectively and compassionately to grief and loss.
■ To provide strategies for moving forward after a grief and loss experience.
4.5 average rating
I feel like I’ve gained a lot of important information from this course and it has given me a lot of encouragement and direction. I feel empowered to take action in a positive way back in my workplace.
Online
14 June, 11.00am – 1.00pm
* Core activist course as per QNMU policy CPD HRS ONLINEQNMU members understand that collective action is critical to achieve the best outcomes for nurses and midwives and our communities.
Members are not just a part of the union, they are the Union.
Membership means many things to many people, but a core value of the QNMU is that the strength to improve the lives of nurses, midwives and our communities, comes from collective voice and action.
The QNMU values of Fairness, Equality, Collectivism and Opportunity reflect members’ commitments.
From time to time, members may face issues related to their employment or their registration that affect them individually.
Members will often be able to resolve these issues themselves in the first instance. If an issue relates to an industrial entitlement, such as pay, roster, leave or hours of work, members are encouraged to consult their contract, Award, or Enterprise Agreement first.
Award and Enterprise Agreements can be found by logging into the member portal on the QNMU website.
If there are relevant local workplace policies members may consider approaching their manager or local human resources team for copies of these, if they feel comfortable to do so.
For those matters where members require support or further advice on their rights, obligations or industrial entitlements, QNMU workplace representative/s, Branch activists or
delegates provide an excellent first source of assistance.
Members may also approach their QNMU organiser for advice, particularly if the issue affects more than one member.
Utilising the workplace representative structure is the best approach for resolving workplace issues in the first instance.
Members are also able to contact QNMU Member Connect for advice on workplace matters or professional issues. Member Connect can be reached on 3099 3210 or (toll-free) 1800 177 273.
If members have taken the above steps to try to resolve the issue, the QNMU may be able to provide individual member advice or representation.
The QNMU can advise and represent financial members on a range of industrial, employment, professional, legal and workplace health and safety issues, including:
■ employment issues
■ worker’s compensation
■ professional and disciplinary matters
■ award and agreement entitlements
■ contract of employment matters
■ coronial matters
■ civil matters *where the QNMU Professional Indemnity Insurance (PII) policy has been triggered
The QNMU is committed to providing cost effective, quality services which are appropriate, equitable and sustainable to eligible members.
Representation may be provided by either a QNMU official or QNMU’s external solicitors.
Over decades, QNMU members have received the benefit of representation for matters including:
■ Unfair dismissal
■ Discrimination
■ Underpayment of wages
■ Enforcement of leave entitlements
■ Employer breaches of contract
■ Notifications to AHPRA or the Office of the Health Ombudsman
■ Public Service Commission appeals on disciplinary matters
■ Flexible working arrangements
■ Disciplinary matters
■ Workers Compensation reviews
■ Medical assessment tribunal matters
■ Coronial matters
Some of the outcomes members have been able to secure with representation from the QNMU include reinstatement or compensation following unfair dismissal, settlements for workplace injuries, resolution of industrial disputes regarding pay, leave entitlements and rosters, and the reduction of disciplinary penalties.
The QNMU have also achieved wins for working parents in negotiating flexible working arrangements, wins for employees on temporary contracts wanting the security of permanent employment, and compensation for members who have experienced discrimination or other unlawful conduct by employers.
These matters are complex and often require expert advice and representation. The benefits of this representation are only available to financial members.
Members are eligible for QNMU representation if they were a financial member at the time the incident leading to the need for representation occurred, and they remain a full financial member throughout the period of representation.
There are a number of more serious matters for which the QNMU will generally not provide representation. These are:
■ criminal proceedings
■ boundary violations where proven
■ breach of conditions set by regulator
■ defamation claims initiated by the member
■ proceedings initiated against other members, or
■ general civil proceedings.
As a member-based organisation, the QNMU expects recipients of representation to comply with the QNMU Member Code of Conduct.
This means members who are being represented in individual matters need to conduct themselves in a way that reflects and supports the values of the QNMU, including professionalism,
integrity, honesty and respect for others.
The QNMU Member Code of Conduct also requires members to ensure that any information provided to the QNMU is accurate and to value the QNMU’s resources and use them wisely.
The QNMU may discontinue representation in circumstances where matter is inconsistent with the QNMU Member Code of Conduct or the object and values of the QNMU.
Members can apply for representation by the QNMU for an individual matter by logging into the member portal and filling in an online Request for Representation at www.qnmu.org.au/rfr
1. How well did you understand the QNMU member representation support mechanism before you read this article? What are the key points you’ve now learned?
2. Consider a situation where you notice you are being underpaid. Describe the steps you might take to resolve the issue yourself first, then identify the point where you should contact QNMU for support.
3. Why do you think it is important for members to comply with the QNMU Member Code of Conduct? What are the benefits of following it? What are the potential consequences for both member and the QNMU for breaching it?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
As nurses and midwives, it is our professional obligation to understand the roles and scope of practice of the health professionals operating in the multidisciplinary environment. This is especially so in the case of those who fall under our supervision and delegation authority. This can be somewhat confusing, particularly to our colleagues who come from international health communities, due to the existence of multiple roles that are unique to Australia and Aboriginal and Torres Strait Islander health.
There are two categories of Aboriginal and Torres Strait Islander health professional that are regularly employed in Queensland: Aboriginal and Torres Strait Islander Health Workers and Aboriginal and Torres Strait Islander Health Practitioners. Whilst these roles sound similar, they are in fact different in their duties and responsibilities.
When it comes to providing care to Aboriginal and Torres Strait Islander communities, it can be difficult to know who to turn to and when, particularly if you don’t understand the roles of the other health professionals around you.
Aboriginal and Torres Strait Islander Health Workers are an unregulated
yet vital part of the health workforce, similar to the Assistant in Nursing (AIN) workforce.
They are qualified to a minimum Cert II level, up to a Diploma level (usually Cert III or IV in Queensland) in primary health. The core role of a Health Worker is to build connections between the Aboriginal and Torres Strait Islander community and the health care system.
This is a two- or three- way relationship building role, where to be successful, the Health Worker requires trust to lead this process from the community as well as other professionals in the health care team.
Duties that Health Workers typically participate in include: admission processes and assisting with completing paperwork
discharge processes and follow-up planning follow-up care in community settings transport to and from appointments (often a great time to gain invaluable information and insight into patient’s health)
evaluation of social determinants of health
basic health assessment.
Duties that Health Workers should not be participating in include: administering or dispensing medications (however, under very specific circumstances, they may administer vaccines under the direct supervision of a Registered Nurse) providing clinical care to patients in an acute or critical care setting identifying or reporting a deteriorating patient in an acute setting.
Aboriginal and Torres Strait Islander
Aboriginal and Torres Strait Islander Health Practitioners are a regulated workforce, which means they are registered through a regulatory board via Ahpra.
They are subject to professional standards, checks and balances as per any other registered practitioner.
Health Practitioners are qualified to a minimum Cert IV to a Diploma Level Qualification in Primary Health Care Practice, including electives related to administration of medications.
The core of the Health Practitioner role is akin to that of the Health Worker in building connections between the community and the health care system.
Whilst Health Practitioners are regulated and therefore have increased scope of clinical practice over and above
the duties of a Health Worker, the qualifications for this position are also focused on primary healthcare and so are not well-suited to incorporation into an acute clinical setting.
Duties that Health Practitioners typically participate in include:
admission processes and assisting with completing paperwork
discharge processes and follow-up planning
follow-up care in community settings
transport to and from appointments
evaluation of social determinants of health
basic health assessment
providing basic health education to the community
administering certain medications under the direct clinical supervision of a registered nurse or medical practitioner.
Duties that isolated and remote practice Health Practitioners may participate in include:
suturing wounds
managing critical incidents until relieved
assisting with peritoneal and haemodialysis
managing patient primary care per the queensland primary clinical care manual
Duties that Health Practitioners should not be participating in include:
administering or dispensing medications without supervision providing clinical care to patients in an acute or critical care setting
identifying or reporting a deteriorating patient in an acute setting.
For a useful definition of Aboriginal and Torres Strait Island Health Workers and Health Practitioners visit: https://bit.ly/ABTSIhphw
It is important to value the roles of all of our Aboriginal and Torres Strait Islander workforce in creating connections between Aboriginal and Torres Strait Islander communities and their healthcare journey.
Unfortunately, unlike Health Workers and Health Practitioners, Aboriginal and Torres Strait Islander nurses and midwives are not held in the same esteem by some as experts in Aboriginal and Torres Strait Islander Health.
However, they do hold the same level of cultural knowledge and connection to community as Health Workers and Health Practitioners.
There are over 1000 Aboriginal and Torres Strait Islander nurse and midwife members of the QNMU, which is almost double the known Queensland workforce of Health Workers and Health Practitioners combined.
Aboriginal and Torres Strait Islander nurses and midwives work on a 24/7 roster, as opposed to our Health Worker and Health Practitioner workforce, who usually work a 9-5 roster.
This makes Aboriginal and Torres Strait Islander nurses and midwives an invaluable and more readily available resource in providing high quality care for Aboriginal and Torres Strait Islander communities.
It is important to note that unlike Health Workers and Health Practitioners, most Aboriginal and Torres Strait Islander nurses and midwives are not employed in Aboriginal and Torres Strait Islander health roles, and therefore will likely have a full clinical load outside of offering cultural advice and mentoring.
This is an important distinction, as this is called “cultural load” and on top of a full clinical load and lack of cultural support mechanisms in the leadership structure; can lead to burnout.
When caring for any patient, it is vital that we stop to consider who in your multidisciplinary team has the skills, knowledge and ability to help your patient connect with their healthcare in a tangible way and to seek them out where appropriate.
With the above information in mind, it is vital to note the importance that each of the above roles plays in the provision of high quality and culturally safe care to Aboriginal and Torres Strait Islander patients and communities.
It is important to value the roles of all of our Aboriginal and Torres Strait Islander workforce in creating connections between Aboriginal and Torres Strait Islander communities and their healthcare journey.
1. How many people can you turn to for advice in connecting Aboriginal and Torres Strait Islander patients with their care?
2. When would you turn to them for advice?
3. When is it not appropriate to turn to them for this advice and why?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
Post-operative complications affect one-in-four surgical patients within 14 days of hospital discharge (Kassin et al.,2012). Surgical site infection is the most common.
Delivering discharge education that is a two-way conversation; tailored to patient needs and preferences; and informative, increases patient confidence and ability to self-care once home (Rushton et al., 2017; Fredericks et al., 2010).
We wanted to describe patients’ surgical wound care education experiences and determine how these experiences impact their ability to self-manage their wounds after hospital discharge.
We recruited 330 surgical patients from two Queensland hospitals. Following surgery or hospital discharge, patients were contacted by phone and asked about postoperative wound education. Patients’ average age across the sample was 55 years. Most were females who had completed secondary education.
Most patients received surgical wound care instructions about follow-up arrangements (89.6%), who to contact if they had concerns about their surgical wound (86.6%), and what activities to avoid during wound healing (74.2%). Patients received less instructions about how to clean the wound (56.7%), wound
dressings to use at home (47.8%), and when and how to remove stitches/tape/ staples/steri-strips (44.0%).
Patients’ experiences and preferences differed; 94.8% patients wanted verbal instructions and 84.4% experienced this. 66.2% of patients wanted printed materials (e.g. information sheets), 44.4% patients experienced this. There was some interest for online education, despite only one patient experiencing this.
We found positive associations between patient participation and patients’ ability to manage their wounds at home. When staff had conversations about woundrelated pain management options, patients were four times more likely to manage their surgical wounds at home.
When patients felt involved in decisions about wound care, patients were six times more likely to manage their surgical wounds at home.
We found that providing patients with specific surgical wound care information (e.g., incision care dressings etc.), and providing both written and verbal education, could be areas for improvement.
Importantly, patients who feel more involved in wound conversations while in hospital, may manage better at home. This could be key to reducing postoperative complications.
BY G. TOBIANO, R.M. WALKER, W. CHABOYER, J. CARLINI, L. WEBBER, S. LATIMER, E. KANG, A. M. ESKES, T. O’CONNOR, D. PERGER & B. M. GILLESPIE.1. What types of activities/ strategies would help you feel confident giving patients specific information (e.g., how to clean, dressings) about managing their surgical wound once home?
2. Giving patients both written and verbal education enhances their recall. What existing resources (e.g. print outs) do you currently have available to provide patients with surgical wound discharge education?
3. In hospital, how could you make patients feel more involved in conversations about their surgical wound care?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
Fredericks, S., Guruge S., Sidani S., Wan, T. (2010). Postoperative patient education: a systematic review. Clin Nurs Res, 19(2), 144-164.
Kassin, M.T., Owen, R.M., Perez, S.D., et al. (2012). Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg, 215(3), 322- 330. Rushton, M., Howarth, M., Grant, M.J., Astin, F. (2017). Person-centred discharge education following coronary artery bypass graft: a critical review. J Clin Nurs, 26(23–24), 5206- 5215.
We don't enter the nursing and midwifery professions without a desire to care for others, to improve the quality of life and physical and mental health and wellbeing of our patients and their families.
However, this can come at a cost.
Dr Jean Watson, nurse theorist, nursing professor and author of more than 30 books on caring theory observes that this need to care for others is both a nurse’s greatest strength and fatal flaw.
When caring for others comes at the expense of caring for ourselves, combined with an increasingly demanding, COVID-19-impacted, overstressed workplace, the results can be devastating.
A recent global survey by McKinsey and Company (2021) looking into the impacts of COVID-19 on frontline staff, found that one-fifth of Australia’s registered nurses say they intend to leave their current role in the next 12 months.
Forty-one percent of these nurses say they are planning to leave directcare roles entirely or leave Australia.
Clearly there needs to be changes in the system to support those carrying the load in patient care.
A multifaceted approach is necessary to address complex issues when there are numerous barriers present.
While the task may seem too large and it may feel like, as nurses and midwives, we do not have any control, this is exactly when we can recognise we are powerful in our own lives.
Now is the time to exert your power for the care of yourselves.
Furthermore, your patients, their families, and your colleagues will all reap the benefits.
In both our personal and our professional life, we all have the power to set healthy boundaries regardless of what others around us do.
The concept of boundaries has been likened to a house and property surrounded by a fence.
This indicates where the property ends and where the neighbour’s property starts.
Your personal boundaries are like this and indicate what is yours and what you are responsible for and what belongs to others.
Healthy emotional and physical boundaries protect you from abusive relationships by showing what you will and will not tolerate.
You cannot change other people, including difficult colleagues, but you can teach people to respect you (EvanMurray 2012 & Whittington, 2005).
So in a busy, under-resourced, stressful work environment, how do we do that?
Communicating assertively is the key. Assertive communication, and positive communication, simply means to effectively express your needs, rights and opinions in an honest and open manner that is respectful of others and doesn’t violate their rights.
This includes speaking to those in authority.
It empowers us to be heard and to be able to have influence on our workplace. It can assist in stopping bullying and helps to equip us to control stress and anger and improve coping skills (Omura, et al., 2017).
Furthermore, as a nurse or midwife, it is vitally important to be able to respectfully express concerns about issues that could potentially impact patient safety.
It is recognised that communication errors and a hesitancy to speak up can lead to adverse patient outcomes.
Assertive communication has been shown to improve patient safety outcomes and the overall performance in healthcare teams (Omura, et al., 2017 & Kolbe, et al., 2012).
A key ingredient in assertive communication is the ability to say no. This is not easy in a work environment where there are often unfinished tasks and staff shortages. However, the alternative may be feeling overwhelmed, stressed and burnt-out.
If your employer is not supporting you to finish your shift on time, take your breaks, and prevent unmanageable workloads, then saying no is you protecting your ‘house and property’ and looking after what you are responsible for –yourself.
If your natural communication style is more passive, it may be a challenge to say no and use assertive language.
The good news is we can all practice assertiveness and develop this skill.
It can be helpful to practice saying statements aloud alone and rehearse what you want to say in preparation for a request you know you will have difficulty saying no to.
If you’re asked to do overtime or an extra shift that doesn’t suit you, practice your response: “No, I’m not available to do that.”
You do not have to give a reason or say sorry if you prefer not to.
If you’re asked why you can’t do it, a good strategy is to simply repeat firmly and politely, “I’m not available”.
To be a nurse or a midwife is to care .
Another important part of assertive communication is how you use your body language and tone.
If your natural communication style is more aggressive, you may tend to speak loudly and harshly and potentially come across as a bully who ignores the opinions of others.
Aggression can lead to a lack of trust, or people avoiding or opposing you because of the way you communicate.
Speaking slowly and calmly and holding a nonthreatening, relaxed posture with appropriate eye contact is often enough to bring trust and connection to even difficult conversations.
It is well established that tone and body language make up the greatest part of a person’s communication, with words alone accounting for less than 10% of personal communication.
1. Think of a recent work interaction with a difficult colleague where you responded in a verbally aggressively manner? How could you have responded differently?
2. What strategies and advice would you suggest to a colleague who has trouble saying no to management requests?
3. What steps can you take to develop healthy boundaries in your personal and professional life?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
Berlin G, Lapointe M, Murphy M, Viscardi M. (2021). Nursing in 2021: Retaining the healthcare workforce when we need it most. McKinsey & Company. www. mckinsey.com/industries/healthcaresystems-and-services/our-insights/ nursing-in-2021-retaining-thehealthcare-workforce-when-we-needit-most
Evans-Murray, Anne. (2012). Uncomplicating life, simply: recognising and avoiding destructive patterns in your life. Health Ed Professionals.
Kolbe, M., Burtscher, M. J., Wacker, J., Grande, B., Nohynkova, R., Manser, T., ... & Grote, G. (2012). Speaking up is related to better team performance in simulated anesthesia inductions: an observational study. Anesthesia & Analgesia 115(5), 1099-1108. https://doi:10.1213/ ANE.0b013e318269cd32
Nuance Communication. (2021). From Overload to Burnout. What Clinicians Think. https://www.nuance.com/asset/ en_uk/collateral/healthcare/whitepaper/wp-from-overload-to-burnoutwhat-clinicians-think.pdf
Omura, M., Maguire, J., Levett-Jones, T., & Stone, T. E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International journal of nursing studies 76, 120-128. https://doi. org/10.1016/j.ijnurstu.2017.09.001
Watson, Dr J. (2023). Watson Caring Science Institute [website]. www. watsoncaringscience.org
Whittington, M. (2005). How to Play the Game. Penfold Buscombe.
To be a nurse or midwife is to care.
The challenge is to celebrate and honour the gift and strength of caring, while not allowing this characteristic to become a fatal flaw.
Practicing positive communication and assertiveness is one way to help maintain the balance and show self-care and self-compassion.
Nurses are a unique kind. They have this insatiable need to care for others, which is both their greatest strength and fatal flaw.
Dr. Jean Watson
Have you ever been in a situation where you need to maintain your professionalism and composure but you’re struggling to keep your emotions under control?
Perhaps you’re trying to manage an emergency with a patient, feeling swamped by another demand on your time, or dealing with a confrontational manager? We’ve all been there!
While nothing can replace properly addressing the root cause of your distress, there are some techniques that can help you focus and regain control of the immediate situation.
Introducing TIPP.
TIPP is a set of techniques that can help us manage overwhelming emotions. It’s commonly taught as part of distress tolerance.
These techniques can be used during a state of heightened arousal, such as panic, frustration, or intense sadness, to get our emotions under control.
In a professional practice, it is not always easy to keep a level, calm mind to make rational decisions, especially when things start to go wrong.
TIPP techniques can help you regain composure at work or at home. If you find them helpful, you can also teach them to a patient, a colleague, or friends and family.
When we are emotionally overwhelmed, our heart rate increases and our body can start to feel uncomfortably hot. This can be countered by cooling down your body, for example:
■ splashing your face with cold water
■ taking a cold shower
■ holding an ice pack to your cheeks or the back of your neck for 20 seconds.
It can be helpful to release some builtup energy by doing a short 15-minute cardio work-out, for example:
■ going for a brisk walk or jog around the block
■ doing star jumps or jumping rope
■ lifting weights.
Slowing down your breathing can not only help to regain a sense of control, but also make you feel less stressed and your body more relaxed. An example of paced breathing you can follow is:
■ breathe in through the nose over four (4) seconds, then
■ breathe out through the mouth over six (6) seconds
■ repeat for 1-2 minutes.
The muscles in our body often tense up when we’re in a state of distress. Encouraging our body to relax can help with calming all the overwhelming emotions too. This is a simple relaxation exercise you can do even when you are sitting down:
■ starting at the top of your head, become aware of the muscles in your body
■ tighten them for five seconds, then relax
■ then gradually move down the body –to the face, the neck, and the shoulders
■ if you like, breathe in when you tense up the muscles and then relax them when you breathe out
■ don’t forget all parts of your body –the chest, stomach, back, arms and fingers, all the way down to your toes.
Using TIPP techniques can help you manage periods of emotional distress, but if you need support or advice on underlying workplace matters you believe are contributing to your distress you can contact QNMU Member Connect on 3099 3210 or 1800 177 273 (tollfree outside Brisbane) or email memberconnect@qnmu.org.au
1. Take a moment today to practice the Paced Breathing exercise. How do you feel?
2. You might also like to test the Progressive Muscle Relaxation technique so you know how to do it before you need to deploy it in a stressful situation.
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
LATEST RESEARCH FROM THE NHMRC CENTRE FOR NURSING EXCELLENCE
Delirium is a serious condition that is often underrecognised in the health care setting. In fact, it is the most common of hospital-acquired complications (HAC) identified by the Australian Commission on Safety and Quality in Health Care. In 2016 – 2017, the cost associated with delirium in Australia was estimated to be $8.8 billion.
Delirium is an especially concerning complication for the critically ill patient, as it occurs frequently but is often poorly recognised. In the ICU (Intensive Care Unit), delirium is associated with prolonged hospitalisation and an increased risk of mortality 1. Impairments related to delirium may persist well beyond hospital discharge and can impact the quality of life for the patient and their families 2
Prevention is better than treatment, and in the care of delirium, treatment has limited effect.
The A B C D E F bundle is a multidisciplinary care bundle that aims to prevent delirium and other common complications, ultimately improving recovery from critical illness. The bundle components are:
A SSESS, prevent, and manage pain;
B OTH spontaneous awakening trials and spontaneous breathing trials;
C HOICE of analgesia and sedation;
D ELIRIUM: assess, prevent, and manage;
E ARLY mobility and exercise; and
F AMILY engagement and empowerment.
The A B C D E F bundle differs from other ICU care bundles as it can be used with every ICU patient every day, regardless of mechanical ventilation status or admitting diagnosis.
So, given the complexity and challenges of the
A B C D E F bundle, what is the evidence for its use?
Our research team recently conducted a systematic review and meta-analysis to answer this question 3
The review showed that when compared with standard care, implementing the A B C D E F bundle resulted in a statistically significant reduced risk of delirium incidence and statistically significant reduced duration of delirium (mean difference 1.37 days).
We also identified American and European research supports implementing the A B C D E F bundle in its entirety for both ventilated and non-ventilated ICU patients. However, there is a need for high-quality research evidence relating to using the bundle in Australian ICUs.
The A B C D E F bundle is a complex intervention that requires considered strategies to ensure successful implementation in the ICU.
Our research team is taking on this challenge, embarking on a body of research to contribute high-quality evidence on the effect of the bundle on Australian patients and to explore the process of implementation and integration by ICU clinical teams.
1. State two negative outcomes from delirium?
2. How could you use the ABCDEF bundle to reduce the risk of delirium for your patients?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
Herridge, M. S., Tansey, C. M., Matté, A., Tomlinson, G., Diaz-Granados, N., Cooper, A., ... & Cheung, A. M. (2011). Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine, 364(14), 1293-1304.
Mitchell, M. L., Shum, D. H., Mihala, G., Murfield, J. E., & Aitken, L. M. (2018). Long-term cognitive impairment and delirium in intensive care: A prospective cohort study. Australian Critical Care, 31(4), 204-211.
Sosnowski, K., Lin, F., Chaboyer, W., Ranse, K., Heffernan, A., & Mitchell, M. (2022). The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis. International Journal of Nursing Studies, 104410.
1. an act or instance of uniting or joining two or more things into one
2. something that is made one
When the time comes to stand up for yourself, for a colleague or for a patient, having the support of more than 70,000 other QNMU members makes a difference. QNMU members are the union. Your participation makes all the difference. Not just for you, but for all of us.
To find out how you can get the most out of your QNMU membership, log into www.qnmu.org.au, check out the available resources, events and ways you can participate.
Eligible Nurses and Midwives could borrow up to 90% and have
waived with RAMS. Applicants usually require a deposit of 20% to avoid LMI. Registered
incredible service to our communities, so we’re waiving LMI for those with a 10% deposit that earn $90,000 or more a year2. This applies to both owner occupier and investment properties, on principal and interest loan repayments. You’ll also have your own local home loan specialist who will:
• Understand your situation and tailor their expert help to support you with your home loan.
• Take the ‘hard’ out of the process for you. They’ll sort out your approval in days, not weeks, wherever possible.
• Make it convenient by providing their mobile number and meeting you at a time and place that suits you best.
