InScope No7 Spring18

The official journal of the Queensland Nurses and Midwives’ Union

07

Spring 2018

2018 QNMU ANNUAL CONFERENCE

your foot health

Men in

midwifery

GIVE AWAY

S OF THREE PAIR SHOES BS. UP FOR GRA ge Details on pa

23.

PLUS! CPD CONTENT ON RIPEN CHANGES, PROFESSIONAL BOUNDARIES & MORE

Union Training Program SEPTEMBER–NOVEMBER 2018

SEP

Thu 20

Fri 21

QH Rostering – Equity & work life balance

Creating a safe workplace (WH&S)

ROCKHAMPTON

ROCKHAMPTON

OCT

Wed 10

Wed 17

Tue 23

QH Rostering – Equity & work life balance

Professional seminar

Aged Care – Building power

GOLD COAST

TOWNSVILLE

BRISBANE

NOV

Wed 24

Tues 30

Wed 31 - Thu 1

Creating a safe workplace (WH&S)

QH – How to make the BPF work for nurses & midwives

Knowing your entitlements & understanding the Award!

BRISBANE

BRISBANE

BRISBANE

Thu 8

Tues 20 - Wed 21

Thu 22

QH Consultative Committees – How to make them work

QNMU Branch Development 1

QNMU Branch Development 2

BRISBANE

BRISBANE

BRISBANE

Wed 7 Nov

Wed 14 - Thu 15 Nov

Assertiveness Skills

Think on your feet

BRISBANE

BRISBANE

Kickstart Education are heavily subsidised courses for QNMU members run by external educators.

Mon 8 - Fri 12 Oct

Mon 12 - Fri 16 Nov

Mon 12 - Fri 16 Nov

TOWNSVILLE

CAIRNS

MACKAY

OTHER TRAINING AVAILABLE: KICKSTART EDUCATION

SAFE WORK COLLEGE

Health & Safety Representative training for nurses & midwives

Mon 26 - Fri 30 Nov Health & Safety Representative training for nurses & midwives

BRISBANE

Health & Safety Representative training for nurses & midwives

Health & Safety Representative training for nurses & midwives

Safe Work College offers specific Health and Safety Representative (HSR) training for nurses and midwives.

The QNMU supports Safe Work as the preferred HSR training provider. To apply for this course, visit http://bit.ly/hsrtraining and complete the application form.

Courses are extremely popular and book out quickly.

Avoid being disappointed. Get your enrolment in early.

For all training courses available or to enrol visit www.qnmu.org.au/education or phone 3840 1431

07

14

Spring 2018

INDEPTH

Heartbreak and dust: Farm families continue battle against drought

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 1800 177 273 (toll free) F 07 3844 9387 E inscope@qnmu.org.au W www.qnmu.org.au EDITOR Beth Mohle, Secretary, QNMU PRODUCTION QNMU Communications team: Linda Brady, Melissa Campbell, Stephanie Lim, Lou Robson, Luke Rutledge 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

INDEPTH

CPD

11 18 24 29 32 34 37 38 44 62

49 50 54 55

What to do if you’re injured at work

56 57 58 60

PIV care: What you do (or don't do) matters to patients

Men in midwifery: the path less travelled Walking in a nurse's shoes A life in limbo Gay Hawksworth - a legacy Pledging support for aged care Nursing research: advocacy through evidence EB10: Voted up!

Plastic: it's not so fantastic Reinventing ageing: aged care of the future 2018 QNMU Annual Conference: Aged care on the agenda

18

53

Changes to national prescribing: What does it mean for RIPENs Bit by bit: Improving workers' comp Exploring medication reconciliation at hospital discharge

67 REGULARS

02

INSIGHT

Professional boundaries in contemporary midwifery

04

TEA ROOM

Your role as a witness

05

WINS

Collectivism and the social nature of trees

08

JUST IN

66

IN VIEW

70

INCOMING

72

CALENDAR

73

ADVERTISING

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. Visit www.qnmu.org.au/privacy to read our privacy statement.

1

insight

in our hands Sally-Anne Jones QNMU President

T

HE THEME of this year’s QNMU Annual Conference was “Power: Understanding it, using it, sharing it”.

As more and more members embrace our transformational activism message, we continue to grow our union’s strength and power.

The concept of ‘power’, however, is one many nurses and midwives struggle with. Many feel it is not a natural fit for them, but this fails to recognize the potential we have when we all work together.

Conference speakers challenged us to think differently about power.

Rather than avoid it as a vestige of socialized disempowerment of historical structures and roles, we must claim it and be comfortable with it.

We must also empower the communities we work and live in to reinvigorate our social mandate.

This means not only providing compassionate care, but also tending to the entire environment in which that care occurs, whether it be hospitals, clinics, nursing homes, prisons or the community.

our conditions and the care we deliver, but how we also work collectively to empower our communities and those who cannot speak for themselves.

But empowering our communities is not restricted to aged care. It goes to the heart of everything we do.

It means sharing the vivid human experience that we see on the ground as a result of the care we provide.

It means making visible the consequences of decisions made by managers, budget holders, politicians and others. Too often decisions are made without proper understanding of the real flow-on effects to us and the communities we care for. Too often we quietly deal with them without speaking up.

And finally, empowering our communities means learning the language that is required to strengthen our case that nursing and midwifery should be front and center.

A perfect example of this is our current campaign to get ratios legislated in aged care.

To invest in nursing and midwifery is to invest in health for all… we are not an unaffordable burden.

We have well and truly lifted the lid on the appalling conditions that many have experienced within the aged care industry.

A 2016 report from the All-Party Parliamentary Group on Global Health titled ‘The Triple Impact’ suggests investing in nursing generates improved health, promotes gender equality, and provides economic growth.

We continue to exercise our collective power to throw a spotlight on the severe understaffing, the skewed business models, and the social framework that perpetuates the problem.

And as we continue to challenge, the momentum builds for real change.

It’s an example of how we not only exercise our power to improve

2

What’s more, the worldwide ‘Nursing Now’ campaign, run collaboratively by the International Council of Nurses and the World Health Organisation, affirms that what we are asking here in Queensland is part of a global call to arms.

To know we can align to a worldwide strategy to empower nurses and midwives to change the status quo is putting true power back in our hands.

Yes, power may seem like a confronting concept for many nurses and midwives. Our instinct is to care for others, not fight.

But knowing we are part of a worldwide movement – and therefore a strong force for positive change – is perhaps the most reassuring thing of all.

QNMU COUNCIL secretary :

Beth Mohle

assistant secretary : president :

Sandra Eales

Sally-Anne Jones

vice president :

Lucynda Maskell

councillors :

Janet Baillie (on leave) Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Raquel How Shelley Howe Leanne Jiggins Christopher Johnson Damien Lawson David Lewis Dallas Meyers Fiona Monk Sue Pitman Melanie Price Karen Shepherd Katy Taggart Janelle Taylor Kym Volp Deborah Watt Charmaine Wicking

insight

It’s not about them, it’s about our elderly Beth Mohle QNMU Secretary

I

T IS EASY to despair about the state of federal politics at the moment. At the time of writing this column, Scott Morrison was just sworn in as the 30th Prime Minister of Australia, our sixth in 10 years.

The next federal election could take place any time from now until May next year.

While the focus is currently on politicians’ leadership ambitions and internal party-political machinations, they are not concentrating on the issues that really matter to us.

They have forgotten this isn’t about them. It’s about all of us.

We have so many pressing issues confronting us as a country.

What about record low wages growth, record high levels of household debt, increases to the cost of living, job insecurity, the lack of a coherent and long-term energy security policy, and stresses on essential public services like health and education?

They’re just a few of the many pressing concerns affecting our community as a whole.

But one of the most compelling is, of course, the current situation in aged care.

We need to prioritise addressing the current shameful state of affairs in aged care where there isn’t even the most basic requirement that a single RN be on site 24/7. This is a national disgrace.

As most of you are aware, a major current campaign for the QNMU and our national body the ANMF is our

campaign to establish safe staffing and skill mix in aged care through legislated minimum staffing ratios.

This is part of our broader long term Ratios Save Lives campaign that covers members across all sectors. It will be a key policy area of focus in the upcoming federal election.

Other critical policy areas of focus for members include: ■■ defending penalty rates ■■ access to high quality safe health services based on need ■■ changing the rules at work and in our communities to ensure fairness and address inequality.

This is not just a fight for our aged care members — we must unite across nursing and midwifery to make ratios in aged care a national priority and a reality for the nation’s elderly and those who care for them.

Turn to page 28 to find out how our campaign is uniting normally divided demographics and activating people who have never campaigned before.

As nurses and midwives, our focus goes beyond our professional and industrial interests to encompass the common good – the health of our community and patient and resident safety.

What we do for a job matters and is important to so many. We are respected and we are authentic.

That make us a force to be reckoned with. And in five marginal seats in Queensland our membership numbers alone are enough to determine the outcome.

But if we are to succeed we need to keep this pressure up.

We need members from all sectors to support our aged care campaign.

We need members engaged and informed and asking their sitting members and candidates where they stand on ratios in aged care and on other issues that are important to us.

Imagine if we could establish networks of nurse and midwife activists across the state who were prepared to help make aged care ratios a reality at the next federal election. Once established, these networks could continue to grow and help gain future political commitments.

These same networks could help ensure elected state and federal politicians kept their promises.

Remember, elections are simply punctuation points in time. The real work is making sure promises made during elections are kept, making politicians realise that it’s in their best interest to deliver for nurses and midwives.

This must come from you — because you vote for your local politicians and you must help hold them to account.

Yes, we are disappointed and frustrated about the current state of politics. But it is not someone else’s job to change this, we all have a role to play.

So let’s not stay cynical and disillusioned, let’s build the strong, vibrant and responsive democratic system we deserve.

3

tea room Q A

We sometimes take it for granted that everyone knows their entitlements.

However, for new entrants to the nursing and midwifery workforce it is often difficult to understand the plethora of entitlements and payslips across our profession.

In fact, many nurses and midwives are uncertain about which allowances, loadings and penalties they are entitled to given the diversity of their work and working hours.

The following questions are frequently asked of our Member Connect call centre.

Are you being paid the correct Super?

It’s important nurses and midwives regularly check they are receiving the correct superannuation contribution, particularly if they are a shift worker.

What am I entitled to?

The current superannuation guarantee for all employees is 9.5%, which is payable on ordinary time earnings (OTE).

This is the minimum superannuation an employee must receive from their employer. However, an employer may choose to pay more or be required under legislation to contribute at a higher rate.

Queensland Health contributes higher than 9.5% when an employee makes their own contributions.

For example, an employee contributing 5% of their base pay, which can be salary sacrificed, will receive a contribution from QH equal to 12.75% of base pay.

Base pay for QH nurses and midwives, which includes certain approved allowances, is lower than OTE. This means the superannuation contribution paid by the employer at the higher rate may still fall short of 9.5% of OTE. QH checks all its employees for a shortfall and, if required, makes a ‘top up’ contribution so they are at least receiving superannuation equal to 9.5% of OTE. OTE includes all hours worked, shift loading, annual leave and loading, sick leave and some allowances.

OTE does not include overtime, parental leave payments, reimbursements of travel and other costs, or workers compensation payments. Furthermore, allowances that represent a form of ‘compensation’ for money you may spend (for example, a meal allowance, tool allowance or travel allowance) are not included in OTE.

If you have questions for our Tea room column email memberconnect@ qnmu.org.au

4

However, allowances payable for enduring some particular difficulty or hardship during your working hours (such as a ‘freezer allowance’, ‘site allowance’, or some other type of ‘hazard’ associated with your work) are considered part of your OTE.

As most nurses and midwives’ income varies from fortnight to fortnight due to irregular hours, this variation should also be reflected in your employer’s contributions.

If you are working irregular hours but your superannuation contributions are staying the same each fortnight, you should speak to your line manager or call Member Connect for assistance.

Individual Flexibility Arrangements If you are employed under the Award or an Enterprise Agreement (EA), your employer may ask you to enter into an Individual Flexibility Arrangement (IFA).

IFAs are meant to be used to vary certain terms and conditions contained in an Award or EA to suit the individual flexibility needs of an employer and employee.

However, they are often used to reduce an employee’s rights that would otherwise be guaranteed by an Award or EB.

What can an IFA vary?

There are only five permitted terms or conditions that an IFA can vary: ■■ Arrangements for when work is performed, such as working hours ■■ Overtime rates ■■ Penalty rates ■■ Allowances ■■ Leave loading If your employer proposes to vary any of these terms to suit their, or your, individual circumstances, it must be to your benefit.

The overall effect of an IFA must be that you are better off overall with the IFA than without it. This ‘better off overall’ test includes an employee’s personal circumstances and any nonfinancial benefits that may result from changing any of the above five entitlements.

You cannot be forced to sign an IFA. There are fines for employers who insist on you doing so.

An IFA cannot be offered as a condition of employment. That is, you must be an existing employee to enter into an IFA. Importantly, employees must genuinely agree to the IFA and sign it.

wins

UCH members celebrate annual leave, leave loading recovery WITH ASSISTANCE from the QNMU, nurses and midwives at UnitingCare Health (UCH) have received significant annual leave loading backpay and crediting of annual leave.

While it is difficult to calculate the exact figure, we estimate the outstanding leave loading paid to all UCH shift workers amounts to hundreds of thousands of dollars.

The issue of incorrect leave calculations started in October 2015 when the new UCH enterprise agreement commenced.

The agreement contained a new definition for 'shift worker', as well as new provisions around annual leave and how leave loading is calculated.

During a routine QNMU site visit at Buderim Private Hospital in 2017, it became clear these new clauses were not being implemented. As a

result, Buderim members were not receiving the correct leave loading and were missing out on a week of annual leave.

Further investigation by the QNMU found incorrect leave loading calculations went beyond the Buderim site and extended to all UCH shift workers.

Following a lengthy process involving 26 site visits to Buderim Private Hospital, as well as numerous meetings with UCH management to ensure the correct definition of ‘shift worker’ was applied, the issue has finally been resolved.

Buderim members have now received an extra week of annual leave, and all outstanding leave loading has been paid to UCH members.

It just goes to show, it pays to belong to your union!

Regis backflips on AIN underpayments THANKS to pressure from the QNMU, Regis have said they will increase AIN hourly wage rates after some Regis wages fell below the Award.

Despite the QNMU raising the low AIN wages with management in recent enterprise bargaining meetings, management initially denied there was an issue.

We later emailed members about their rights, the existing situation and Regis’ legal obligation to pay the Award rate.

Although Regis claimed our newsletter was misleading and aimed to cause “distress and worry”, management soon changed their tune.

Regis has since committed to increase AIN wages for those pay points that had fallen below the Award — something they should have done back in July.

3.75% pay bump for aged care members Hats off to Bethany Christian Care management for acknowledging the importance of their nursing staff with an unexpected wage bump.

During EA negotiations, the negotiating team settled on a 3% pay increase for 2018 but management later decided to increase this to 3.75%, stating, “We see an ability/ opportunity right now to reward our staff […] Whilst some may feel it’s only a small gesture, it’s designed to show that when we say ‘our staff are our greatest asset’, we mean it”.

Buderim Private Hospital nurses (L-R): Jodie Hole, Sue Cheshire, Shirley Webb and Beth Patfull

We all know that nurses and carers are the biggest asset to any aged care employer, so proper recognition goes a long way to boost staff morale and satisfaction.

The QNMU welcomes this decision

by Bethany Christian Care. It sends a clear message to all employers that actions speak louder than words.

5

wins

Members resolve workloads at Robina Private MEMBERS at Robina Private Hospital have taken charge of their workload issues and achieved some terrific results.

Understaffing was a key problem for nurses from the moment the new hospital opened in 2016.

Registered Nurse Sue Lavender said nurses were unable to proactively care for or interact with their patients due to issues around workloads, rostering and meal breaks.

“Initially, the hospital didn’t have enough staff, they were using a lot of agency and casual staff,” Sue said.

“There was a culture of understaffing, and it became an expectation that if we had low numbers then you didn’t take your meal break.”

Through their Local Consultative Committee, members raised concerns with management and ultimately lodged a formal workload grievance in May this year.

Management agreed to conduct an audit into the workload issues.

Through working collaboratively, the QNMU, members and management have achieved the following: ■■ Increase of permanent staff and reduction of casual staff ■■ All meal breaks now being paid, or overtime if no meal break is taken ■■ Compliance with clinical services capability framework (CSCF) staffing requirements ■■ A new microwave to ensure nurses can heat meals on the ward

■■ Hospital-in-charge supernumerary no longer has a patient allocation or unit responsibilities ■■ Agreed number of RNs to be rostered to match CSCF patient occupancy levels on mental health ward ■■ One RN in charge of medical unit.

Embarking on a formal grievance can be a daunting process, particularly for members who have not taken on such an active role before.

“It was a bit intimidating initially, but I was extremely supported by the union,” Sue said.

“I felt very confident with the union behind me to forge forward with the grievance, and in the end it was a terrific outcome.”

Wellness program changes ED culture CONGRATULATIONS to Gold Coast Health Emergency Department (ED) staff for winning the inaugural Safety and Wellness Award.

The Safety and Wellness Award, in partnership with QSuper, recognises departments that are proactively promoting and improving staff safety in the workplace.

The team at the Gold Coast ED developed the One-ED Wellness Program to foster a supportive culture, implementing a series of initiatives to promote better work-life balance and ensure the work environment was as healthy and calm as possible.

The One-ED Program involves a weekly pause at morning handover for a guided meditation, a weekly 30-minute drop-in session for journaling, mindful listening and sharing, and flyers promoting mindfulness.

While the program’s effectiveness is difficult to measure, the goal was to normalise the conversation around wellness and struggle.

6

In their submission, the team wrote: “The goal of the One-ED program is to create a community that looks after and empowers its members, in order to create a highperforming team… Emergency care is truly a team sport, and patient care effectiveness and safety are enhanced when connection and communication with the team are made a priority”.

Many ED staff, including nurses, reported a positive change both during and outside work.

Importantly, the program has provided staff with tools to be able to take a step back from their stressful environment, employ some mindfulness techniques, and put things in perspective.

This is an important initiative that any nursing team can replicate. For more information on the One-ED Program, contact the Gold Coast Health WHS Unit on (07) 5667 3238 or GCHOHSAdmin@health.qld.gov.au

wins

Focus on NUM/MUM

wellbeing IMPROVING culture, happiness and wellbeing has been front and centre for Gold Coast NUMs and MUMs. Following the NUM/MUM summits organised through EB9, Professor of Nursing and Midwifery at Gold Coast HHS Dr Anita Bamford-Wade organised a one-day course in June to improve the wellbeing of NUMs and MUMs and to focus on their ability to handle challenges.

As nurses and midwives, we know our wellbeing can make or break the workplace culture. After all, our own health — both physical or emotional — affects our ability to deliver safe patient care.

The course, which was delivered

by Evolve Yourself Institute, taught participants how to understand the effect stress has on the body and develop strategies to self-regulate their emotional states and recognise stress triggers.

Recognising the importance of a healthy and happy workforce, the Gold Coast HHS has now paid for more than 200 staff (mostly NUMs, MUMs and other Grade 7s) to complete the course, which also includes meditation and yoga classes.

Dr Bamford-Wade said it was critical employers took care of their nurses and midwives. “[The program] has been overwhelmingly successful in giving our staff the necessary skills to keep themselves well and to manage challenging situations.”

Need some support?

QNMU members needing advice or support can contact Member Connect on (07) 3099 3210 or 1800 177 273 (toll-free).

We’ll do our best to help you secure wins like the ones you’ve read today!

7

just in

Rally for the

ABC

NURSES and midwives were proud to stand in solidarity with our comrades at a rally to keep the ABC in public hands.

The federal government froze ABC funding in the last budget, and there are continued calls from within the Liberal Party to privatise the broadcaster.

Maggie Beer cookbook giveaway winner CONGRATULATIONS Julie Heath! You’ve won yourself a copy of Maggie’s Recipe for Life.

We loved reading your heart-warming memory of your mum’s pea and ham soup.

Thanks for taking part in our giveaway competition featured in the previous edition of InScope.

The ABC provides an invaluable service to our community and should remain a not-for-profit organisation.

To help keep the ABC in public hands, the Media, Entertainment and Arts Alliance have set up an email petition to the federal Communications minister which you can sign.

Visit www.meaa.org/ campaigns/hands-off-our-abc

Broadening the media landscape Furthermore, the recent announcement that Fairfax will merge with Nine isn’t the best news for media diversity in Australia.

But there are alternative news outlets available that we can support to ensure our media industry remains healthy and balanced.

Good journalism is, after all, the cornerstone of any functioning democracy.

QNMU members now receive a free online subscription to The New Daily — one of Australia’s fastest growing news services, delivered direct to your inbox every morning.

It features the day’s top stories in news, sport, weather, superannuation and personal finance.

Members who don’t want to receive this service can simply unsubscribe from the next email from The New Daily.

To read the news visit www.thenewdaily.com.au

Every winter I’d look forward to my Mum’s homemade pea and ham soup. I remember how much Dad loved it, and I don’t know if part of the attraction was my association of it to comfort and security, or the taste and consistency combining the best of bacon and stock!

Julie Heath

8

Rally to keep the ABC in public hands in Brisbane

just in

Meeting of Delegates (MODs) – Round 2

Know the facts

OUR SECOND round of Meetings of Delegates (MODs) have kicked off – Brisbane and Gold Coast meetings were held in early September, and will continue throughout other Queensland locations over the rest of September and October.

Visit www.qnmu.org.au/MOD to find out when and where your nearest MODs will be held.

QNMU MODs enable the QNMU Secretary or Assistant Secretary to report directly on the activities of the QNMU and to consult with branch delegates and members.

The MODs are also an opportunity for members to report and debate local issues and formulate recommendations to the QNMU’s Council. All members are encouraged to attend.

THERE has been a lot of hype in the media recently about the federal government’s My Health Record – a digital health record for all Australians.

The online record allows an individual’s doctor, hospital and other health care providers to view their health information, such as medicines, allergies, immunisations and treatments.

The QNMU supports the principle of a digital health record system – having a centralised point for health information can benefit patients, particularly during a medical emergency, as it enables health professionals to access your information in a timely manner.

However, when it comes to My Health Record, we believe Australians need better assurances around privacy.

The government has committed to changing the legislation so police and government agencies cannot access your health

information against your wishes without a court order.

On the other hand, My Health Record has reported nine data breaches in the past two years (though these did not relate to unauthorised viewing of any individual’s health information).

Australians have until 15 November to opt out of My Health Record.

Visit https://bit.ly/2KXekd9 to opt out.

The QNMU will form an official position on this issue through our usual democratic processes – QNMU Council (our peak governing body) and the QNMU Policy Committee. We will also make a submission to the Senate inquiry into My Health Record, which will be published on the QNMU website.

For more information on My Health Record, visit www.myhealthrecord.gov. au

Get the best deal with Union Shopper IF YOU’RE looking to buy a product, the Union Shopper can help you find the best deal… and as a QNMU member, you can access this service for free.

Union Shopper is the largest member benefits organisation in Australia, and is fully union-owned and proud.

As a union member, you have the collective buying power of 1.7 million members. That means you can access discounts and savings on a range of products, including groceries, accommodation, entertainment, movies, insurance, petrol, travel and liquor.

Other Union Shopper services and discounts include mortgage planners, health and pet insurance, travel, and more.

Visit www.unionshopper.com.au for more information and to start saving today!

9

just in

BITES

Aged care honours

AUSTRALIA’S most dedicated and innovative aged care organisations, teams and individuals were recognised at the 2018 HESTA Aged Care Awards.

Kudos to the Queensland finalists: STAR Community Services in Cleveland (Team Innovation) and Keith Cameron Smith from Mackenzie Aged Care Group (Individual Distinction).

RESOLVING METRO SOUTH RAPID TRANSFER ISSUES THE QNMU and Queensland Health are working to resolve potential noncompliance with the Rapid Transfer Procedure in Metro South Emergency Departments.

Shortly after members raised their concerns with the QNMU we escalated the matter to stage three in the grievance procedure. Member concerns included the number of rapid transfers and presentations, high acuity, the unsuitability of some patients being transferred, and non-

adherence to the nursing ratios (as outlined in the procedure).

Fortunately, QH acknowledged they shared these concerns and agreed to establish a working party to resolve the issues.

You can read the QNMU’s joint statement with QH at https://bit.ly/2vHeITl We’ll keep members updated on the progress of this work.

NEW IN THE CPD PORTAL ANMF CPE records

New graduate resources

If you’ve completed a course on the Australian Nursing and Midwifery Federation’s (ANMF) clinical CPE site, you’ll now automatically see this reflected in your CPD record on the QNMU’s CPD Portal when you next log in.

Transitioning into the practice environment for the first time can seem daunting, so we’ve put together some resources to help new graduates on their journey into the nursing and midwifery workforce.

This means you no longer have to manually input your ANMF CPE into your QNMU record, creating a streamlined and more user-friendly portal for all your CPD needs.

From tips on writing job applications to making sure you are fully prepared for registration as a nurse or midwife, you’ll find plenty of helpful resources on our CPD Portal.

Log on at www.qnmu.org.au/CPD

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International solidarity AFTER months-long industrial action and strong support from colleagues in Australia, nurses in New Zealand accepted a new pay deal which includes a greater commitment to quickly employ more staff at hospitals, and which retains previous benefits.

Massachusetts nurses call for ratios THE MASSACHUSETTS Nurses Association has proposed a ballot initiative to mandate nurse staffing ratios in Massachusetts hospitals.

The mandate calls for one nurse to be responsible for no more than four typical medical or surgical patients at a given time.

Celebrating 40 years of nursing research CONGRATS to The Queensland University of Technology (QUT) which recently celebrated four decades of nursing innovation, education and research. As the first School of Nursing in Queensland, it has contributed significantly to the development of the nursing profession in Australia and around the world.

Innovate, Integrate, Inspire HEALTH leaders from around the world will come together in Brisbane from 10 to 12 October for the 42nd World Hospital Congress. With global health systems in transition, they’ll be examining how healthcare needs to evolve to meet the demands of the 21st century. More info: www.hospitalcongress2018.com

indepth

Men in

midwifery: the path less travelled

F

OR MEN looking to build a career in the health profession, midwifery may not be the most obvious choice.

We all know the relationship between a midwife and mum-tobe is built on trust and respect – neither of which are defined by gender – and yet male midwives are still few and far between.

This is particularly true in rural Queensland.

11

indepth Working as a midwife in the central Queensland town of Charleville was not something QNMU member Robert Scheerer envisioned for himself at the start of his career.

But after years of working for a pharmaceutical company and in the agriculture industry, Robert realised he needed something more fulfilling.

“The company I worked for was primarily dollar-driven,” Robert said.

“You were measured on how many dollars you generated, and I got to a point where I didn’t feel I was getting enough out of that.

“My mother had been a nurse and a midwife for 46 years, so I made the decision to make the change while I was still relatively young.”

It didn’t take long for Robert to realise midwifery was the profession for him.

“I did a couple of pracs on maternity wards when doing my nursing,” Robert said.

“One of the things about midwifery that really struck a chord with me was that you’re dealing with well people, there isn’t that sickness paradigm.

“I found it hugely rewarding that the women and their families were so appreciative.

“I would come home and reflect on what I’d done and think, I actually made a real difference in someone’s life today.”

“The best midwife I can be”

IN AUSTRALIA Dual registrants (RN/RM)

27147

471

5032

19

5621

87

Registered Midwife only IN QUEENSLAND Dual registrants (RN/RM)

Source: http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx

“I had one midwife tell me I should consider going into men’s health.

“But rather than get my back up about that kind of attitude, I decided I just needed to be the best possible midwife I can, because it’s not about gaining acceptance from other midwives, it’s about gaining acceptance from the people you’re looking after.”

Robert said that approach was particularly necessary in a small town like Charleville, where health professionals “live and die by their reputation”.

In Australia, there are just 471 male dual registrants (Registered Nurses and Midwives), compared to 27,147 females. There are just 19 men in Australia who hold the standalone position of Registered Midwife, compared to 5,032 women (AHPRA, 2018).

“If you’re not trusted and not competent in what you’re doing, then people just don’t want to deal with you because word gets around town very quickly.

Robert is one of 87 male "dual" Registered Nurses and Midwives in Queensland.

“I’ve got women who are on their third or fourth babies and I’ve looked after them during their pregnancies each time because they’ve requested me as their midwife," he said.

And he admits that entering a female-dominated profession wasn’t without its challenges.

“I certainly had some midwives who weren’t very excited about a male coming into the profession,” Robert said.

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Perhaps most telling of Robert’s success is the relationships he has built with the women he has cared for.

Robert recalled one woman who initially had significant reservations about having a male midwife. Years later, her attitude had changed completely.

“I ran into her at the local show one night and she turned to her friends and said, ‘This is my midwife’. Then she told them to make sure they came to me when they had their babies.

“So it just shows that the care you deliver doesn’t have to be genderbased, it just has to be about how you are as a person and how well you deliver that care.”

Breaking the stereotype While some may feel there is an obvious advantage to having a female midwife, Robert believes gender does not factor into the care he delivers.

“I’d never presume to know what it’s like to give birth, I think that would be insulting to the women I look after,” Robert said.

“But there are lots of male obstetricians who haven’t given birth who women trust implicitly.

“One of the things I really fight against is this concept that men are not able to be caring and aren’t able to provide that emotional care.

“That sort of stereotype needs to be challenged because there’s a lot of men who are sensitive who can provide stellar quality care equally as well as women can.”

indepth And while Robert would like to see more male midwives in the profession to help break that stereotype, he did not think it should be “for the sake of having more male midwives”.

“It shouldn’t be about gender, it should be about what you can bring to the profession, and if you’re a really caring male who’s got a passion for looking after women and their families, then you should go for it.”

Cultural safety Navigating various cultural sensitivities within the communities Robert cares for — including in the remote town of Cunnamulla – has also been a factor in how Robert approaches his job.

Arriving in Charleville and Cunnamulla, Robert encountered a lot of trepidation from the community about a male midwife looking after Indigenous women.

“That trust is something I’ve had to build over time,” he said.

“What it’s come down to is delivering on what you promise and making the experience as valuable for the people you’re looking after as you can.

“When I first went to Cunnamulla, I made sure I gave women the option of having an Aboriginal health worker with me to ensure the care I was delivering was culturally safe for those women.

“Six years down the track, the women have still got those same options but nobody ever takes them up.”

Country life While Robert may be the only male midwife in Charleville, the real challenge for him — and a challenge for rural and remote communities more generally — is recruiting and retaining midwives in the bush.

“The thing about these small towns is that you’ve got to be part of the community,” Robert said.

“We’re fortunate here in Charleville because we’ve got a few local midwives, but recruitment is always a challenge.”

And while living in the bush may not be for everyone, it didn’t take long for Robert to view Charleville as his home.

“My wife is from Sydney and I’ve lived in Melbourne, so for us it’s wonderful being part of a small community.

“Working in a small rural hospital is so rewarding because you know people from the community, so it’s sort of like caring for your friends.

“And it’s wonderful to be able to go to the supermarket and run into so many parents I’ve looked after and see the babies I’ve helped bring into the world.”

The care you deliver doesn’t have to be gender-based, it just has to be about how you are as a person and how well you deliver that care.

Robert Scheerer

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indepth

Heartbreak and

dust

Farm families continue battle against drought

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W

HEN Dorothea McKellar penned her famous line “I love a sunburnt country….” she made our “wide brown land” sound romantic.

But if you’ve ever driven the long flat Barcaldine to Longreach stretch in summer, in the middle of a drought, the roo carcasses baking in the sun and the brown dust knocks the romance out of those lines pretty quickly.

There is nothing at all romantic about shooting poddy calves or an ewe weakened by lambing sickness.

There’s nothing delightful about empty tanks and dry wells, failed crops or rising debt as farmers struggle to feed their dwindling stock.

And as for the heartache and desperation among farm families, well….

“Three of my neighbours around here have taken their own lives.”

Longreach sheep farmer Joyce Roger’s statement hits you right between the eyes.

She’s not out to shock or sound dramatic — she’s simply telling you the sad, devastating reality of life in a drought-stricken corner of the state.

“It’s a sad fact of life out here — I wish we could stop it, but I just don’t know how,” she said.

Joyce and her husband Frank run the Toobrack sheep station about 70 clicks south-west of Longreach.

The station has been in Frank’s family since 1893 and Joyce has lived there since their marriage about 67 years ago.

“I’ve only seen three good seasons,” she said.

Three of my neighbours around here have taken their own lives.

Joyce Roger, Longreach sheep farmer

“That’s where you can say you’ve had four good years of top prices and rain.

“But this is the fourth drought I’ve seen — the fourth one as a drought for years on end.”

At its peak Toobrack can run 12,000 sheep and about 300 head of cattle, but when the drought started to bite a few years ago they reduced the flock to just 1000 ewes.

“Since then we’ve been gradually building it up and we now have 3000 sheep although if we don’t get rain

by December we’ll have to start destocking again.”

Last month New South Wales was officially declared 100% in drought.

As troubling as that is, the declaration came as a welcome relief to hundreds of struggling farm families and their communities, as it meant they could access lifelines like relief programs and subsidies to help keep them afloat until the rains come.

Here in Queensland 23 local councils and four part-council areas have been officially drought declared — which is about 57% of Queensland’s land area.

There are also 85 Individually Droughted Properties in 11 other shires.

For most of those shires and properties this drought is now in its sixth year.

To make matters worse, the Bureau of Meteorology has predicted a 50% chance of an El Nino weather pattern forming in the next few months, which could mean lower than usual rainfall through winter and spring.

Council In August the QNMU donate voted unanimously to ie Helpers $10,000 to the Auss farm charity in support of families.

“These families are really doing it tough and have been for a number of years,” QNMU Secretary Beth Mohle said.

“We’ve donated similar amounts previously, but this drought shows no signs of breaking, so we felt it was time to step up again.”

Mental Health Nurse and QNMU member Brian Riley says the

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WHAT DOES “DROUGHT DECL

ARED” MEAN?

WHEN THE State Government officially declares a shire or property in drought, people in those areas who are affected by the dry are eligible for relief payments, taxation concessions, and other benefits.

go almost two years before farmers start to worry.

A drought declaration is not simply based on an acute shortage of water.

“But here in Queensland, even when our grass dries off and is yellow it’s still got nutrients.”

The criteria for official declaration differs from state to state and can include availability of pasture and water, frequency of supplementary feeding, types of industry likely to be affected, and the condition of stock and crops.

As Joyce, who grew up on a dairy farm in NSW’s Hunter Valley explains, the quality of pasture is one of the reasons why NSW is drought declared at just six months without rain, while Queensland can

“In NSW if you don’t have rain for six months the grass starts to dry off, it loses its nutrients and is useless,” she said.

NSW also suffers from “green drought” in which a sprinkling of rain is just enough to send up green shoots and make pastures look green and decidedly un-droughtlike.

The reality is, the rapidly grown grass has little nutritional value and can actually be toxic to hungry cattle and sheep. It can also cause them to lose condition as they expend energy trying to find the green shoots which offer little nourishment in return.

There is a big issue with men being unable to express their feelings in terms of vulnerability and sadness instead of anger and power.

Brian Riley,Mental Health Nurse and QNMU member

drought filters into every aspect of life in a rural community.

“There’s a pervasive sadness,” he said.

“I use that word deliberately because I associate it with the depression and tears I see.

“It becomes so embedded that people actually don’t want to talk about it, and when I’m interviewing them in a clinical consultation, it’s the elephant in the room.

“They might be presenting with other issues, but underlying it is the ongoing stress of this relentless drought.”

The mental health implications of drought are well documented.

According to statistics from the Centre for Rural and Remote Mental Health (2017) suicide rates in the bush are 50% higher than in capital cities, while the Queensland Mental Health Commission statistics suggest rural and remote communities also have higher level of “risky” alcohol consumption.

Part of the problem is a reluctance of farmers, particularly men, to seek counselling for the stress generated by the battle to keep their farms afloat.

“There is a big issue with men being unable to express their feelings in terms of vulnerability and sadness instead of anger and power,” Brian said.

Source: https://www.longpaddock.qld.gov.au/drought/drought-declarations/

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“I see it all the time, when they finally seek help it is because the ‘missus’ has forced the issue.”

indepth

Joyce Rogers agrees and said country men don’t like talking about their troubles to strangers.

because they couldn’t be fed, or the crows had got to them, come back, have a cry and then go to school.”

To overcome the problem, farm families in her area hold neighbourly catch-ups every few months.

“They take on the burden of the drought as much as the parents do I think.”

“We’ll get our folding chairs and tables, make a quiche or grab whatever is in the fridge, then meet at someone’s boundary fence, light a campfire and just talk,” she said.

Drought is also a burden shared by the towns that service the local farming district as young people move away for work, water restrictions curb activities and there is less money being spent at local shops and businesses.

“It encourages the men to open up to their friends and fellow farmers, to understand they are not alone and we are all in this together.”

“It breaks down the entire social fabric of a community,” Brian said.

As a grandmother, Joyce’s biggest worry these days is how the drought affects farm kids.

“I used to do outreach at Quilpie where the local football club had to pack it in because there weren’t enough people anymore.

“The parents of course try and keep their children from worrying about the drought and the money, but kids are very perceptive and they feel it,” she said.

“In places where there are water restrictions how can the local pub wash the dishes properly, how does the local hairdresser get water to do shampoos?

“They grow up well ahead of their years and learn not to ask for things because they know there’s no money.

“And a hairdresser can be really important. Charleville was lucky and didn’t have water restrictions (and that would be great) for my farm clients… they’d say “yep, I came in yesterday and had my hair done — I feel bloody marvellous, got the dust out of it….”

“And of course, there is no hiding the cruel realities from them.

“They might have poddy calves that they’ve been hand rearing that eventually have to be killed, or they see their ponies go down and unable to get back up…

“My kids went through it — they’d get up, go out with their father and have to knock 10 to 15 lambs on the head

“It’s a little thing — but it matters.”

Joyce admits it can be heartbreaking watching the drought rip the heart from a community, but she insists walking away from it all is not an option.

“People who don’t understand life on the land ask us why we stay when things are so bad — but why does anyone stay anywhere, it’s home, it’s where family is, it’s what we know.”

CAN YOU HELP? If you’d like to join the QNMU in donating to Aussie Helpers contact https://aussiehelpers.org.au/ Please keep in mind cash donations are preferable to physical goods because it encourages the funds to stay in the local communities.

If you or someone you know needs help call Lifeline on 13 11 14.

For drought information visit www.lifeline.org.au and download Lifeline’s Drought Tool Kit.

RESOURCES Bureau of Meteorology drought info www.bom.gov.au/climate/ glossary/drought.shtml Drought declaration info www.longpaddock.qld.gov.au/ drought/drought-declarations/ Lifeline drought tool kit www.lifeline.org.au/supportlifeline/lifeline-campaigns/ drought-tool-kit Aussie Helpers https://aussiehelpers.org.au

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Walking in a nurse's shoes

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“OH, MY POOR ACHING FEET,” said EVERY NURSE AFTER A 12-HOUR SHIFT. A common feeling amongst us nurses, considering we walk a whopping 22 kilometres every shift.

That’s nearly 30,000 steps and akin to traversing the length of 250 football fields - eek!

By contrast, the average Aussie walks just 3.2 kilometres a day — the equivalent of around 4000 steps.

While we all know walking is great for our health, prolonged standing and walking can place additional stress on the feet and calf muscles, leading to a higher risk of developing severe foot problems.

It’s all in the feet So what’s all this traipsing about doing to our poor, tired feet?

A recent survey of more than 300 nurses working in a large Brisbane paediatric hospital revealed a high prevalence of foot problems.

Of the nurses surveyed, 71% had experienced lower back problems and 55% had experienced foot problems in the past 12 months.

Dr Lloyd Reed is a podiatrist at FootMotion and Adjunct Associate Professor at QUT who conducted the survey. He said health professionals commonly suffered from problems like:

WIN

EE PAIRS ONE OF THR SHOES. OF e 23.

g Details on pa

■■ plantar fasciitis (inflamed tissue running across the bottom of the foot) ■■ metatarsalgia (pain under the ball of the foot) ■■ neuromas (irritation of the nerve in the front of the foot) ■■ claw toes ■■ bunions ■■ heel spurs and heel pain

“Our survey found that nurses working in the ICU were around four times more likely to have a disabling foot problem compared to those working in the ward,” Dr Reed explained.

“At the time, the ICU was operating on 12-hour shifts that other parts of the hospital hadn’t as yet adopted, so it could be related to the duration of the shift as well as the nature of ICU work.

“Some research has found the type of nursing that involves prolonged standing for procedures — like in theatre — tends to cause more discomfort and pain in the feet, lower limbs and back.”

The survey also revealed nurses who were obese were five times more likely to develop the most severe type of foot problems than nurses of normal weight.

Interestingly, nurses who reported a history of foot conditions like plantar fasciitis or bunions were almost five and a half times more likely to report

step to it NURSE

30,000

steps per shift

AVERAGE AUSSIE

4000

steps per day

■■ and arch strain.

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indepth

Trade secrets

Our members took to social media to rave about their fave nursing shoes!

Algeria

shoes [was] invented by a nurse who knows that nurses need good supportive footwear that is also safe and lightweight.

They conform to any shape [of] foot and have great inner soles and are very durable. I have very happy feet. đ&#x;‘Łđ&#x;˜Š

Frankie4...

The most amazing work shoes I have ever owned.

Dawgs

I have NurseMates Dove shoes and I love them.

Athlete’s foot...

I have the and love them. So far though I have found I have to wear stockings with them or I get sweaty feet and blisters.

With stockings though they are the most comfortable shoes ever and have arches for my stupid feet that need them now.

Ascent. I have flat feet and they were sooo comfy!! Brookes black leather sports

shoe‌ Supports the arch and [has a] thick sole. Mine have lasted three years. $220 worth it.

Doc Martins 8 eye boots. Comfortable and lasting. Good for weak ankles.

Skechers are my favourites. So light weight and comfy!

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indepth having experienced a disabling foot condition.

understand how bad it can get with plantar fasciitis,” Richard said.

consider looking at a different occupation where I could sit down…

It’s no surprise, then, that nurses are at the top of the patient list for Dr Reed.

“Our ED is the size of two football fields and I’d constantly be running around getting medications from the other end of the hospital or caring for patients…

“I was totally devastated. I’ve worked in nursing for 25 years and it’s my passion. It was horrible to think that I might have to give it up.”

“Health professionals and teachers are two of the most common groups of workers that I see in my rooms,” he said.

“We treat nurses regularly and it really is ladies more so than men, I must say.”

The 22-kilometre shift If you’ve ever dragged yourself to work despite your throbbing and aching feet, you’re not alone.

QNMU member Richard (not his real name) suffered through 12 months of agonising plantar fasciitis.

As an AIN working full time in a busy emergency department, Richard would take painkillers throughout the day just to get through his shift.

“It was excruciating having to go to work with the pain – people don’t

“It made me cringe every time someone asked me to fetch something from another ward because I knew I’d have to walk almost a kilometre and back again.”

With no support from management at work and having been knocked back by WorkCover, Richard reached out to the QNMU for help.

On a typical 12-hour shift Richard could rack up around 30,000 steps on his pedometer, only sitting down when grabbing a quick bite to eat or to read emails.

“The union saved me. They helped me reclaim some of the wages I had lost from being away from work, and I was also able to have some of my annual leave, sick leave and long service leave returned,” Richard said.

His condition continued to deteriorate until he was put in a diabetic moon boot for three months to ease the strain on his foot.

“If it weren’t for the union I don’t know what I would have done… I think I would have had to go to court to attempt to get that back.”

“I couldn’t work during this time and I’d already used up all my sick leave and annual leave,” he said.

Grinning and bearing it

“I was tapping into my long service leave when they told me I should

According to Dr Reed, it isn’t uncommon for nurses to put up with pain while on the job.

It made me cringe every time someone asked me to fetch something from another ward because I knew I’d have to walk almost a kilometre and back again.

Richard (QNMU member)

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indepth

It’s a shoe in!

Podiatrist Dr Lloyd Reed’s top tips for picking not just a good shoe, but one that fits you just right.

You’ll want a shoe with...

A decent fit: Have your feet measured regularly to make sure you’re getting a shoe that is an adequate fit in length, depth and height. Our feet change shape over time and unfortunately most people (women in particular) fit their shoes one to two sizes too small or continue to use a shoe size from when they last had their feet measured — in some cases more than 10 years ago!

Good cushioning in the sole: Some nurses wear shoes that are fairly thin soled, and these aren’t really appropriate for those who are on their feet a lot.

Adequate heel support: The back of the shoe that wraps around the heel (called the heel counter) should be fairly stiff or firm to provide good support for the foot.

Lace-ups or Velcro: Nurses need the ability to adjust the shoe fit if your foot swells during the day or changes shape.

Soft leather in the upper material (resting on top of the foot): Soft leather is fairly accommodating and shapes comfortably to the foot, so it doesn’t cause excessive pressure on crooked toes or bunions.

Nurses are often guilty of “presenteeism” — basically the opposite of absenteeism — where we turn up to work even though we aren’t feeling well.

“One of the things that emerged from our study was that nurses are quite a stoic bunch,” Dr Reed said.

“They put up with a lot — even pain — and just put it down to being part of the job, so they’d go to work with crook feet.”

But there are real dangers to grinning and bearing it.

Continuing to work while suffering from underlying foot conditions like plantar fasciitis, bunions or neuromas can cause pain to rapidly progress.

“There may be a delay in recovery and increased damage to the area of the foot that is affected,” Dr Reed explained.

“When you continually put parts of the body under a lot of stress for a long period of time then you’re more likely to do damage through wear and tear — osteoarthritis is a good example of that.

“We often treat nurses who are experiencing pain and discomfort from the back down to the feet and they’ll often have trouble with alignment of their feet and legs, and problems with general muscle strength and tone.”

One step at a time

Nurses just do so much activity, I sort of liken them to endurance athletes.

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After two rounds of cortisone injections on both feet, the pain in Richard’s right foot finally abated and he now manages the pain in his left with specialised orthotics inside his shoe.

“Every day I would tape up my feet and after work I would soak them in an ice bath and do the stretches recommended by my physiotherapist,” he recalled.

Dr Lloyd Reed, podiatrist at FootMotion and Adjunct Associate Professor at QUT

“The first thing I tell everyone now is to have a good podiatrist and make sure you get a good shoe or orthotics. You can’t just get any old joe blow pair off the shelves and walk 30,000 steps every shift in cheap shoes.

indepth “It’s a worthwhile investment for us nurses who are on our feet all the time… if your feet don’t work you’re pretty much out of a job.”

While there isn’t a whole lot we can do about putting our feet up for a rest during a busy shift, there are strategies we can use to alleviate the pressure we put on them.

“People who stand for a long time may get swelling in their feet and legs that can cause pain, so we want to try to reduce that swelling as best we can,” Dr Reed said.

“Moving around when possible and the use of firmer stockings will help keep swelling at bay. In parts of some hospitals there are anti-fatigue rubber mats that help provide comfort when standing for long periods of time.

“When you do a lot of walking or standing the muscles in the back of the legs tend to become fairly tight as they are active in maintaining

posture, so regular stretching of the calf and hamstring muscles can be very helpful.”

“Nurses just do so much activity, I sort of liken them to endurance athletes,” Dr Reed mused.

Having well-fitting footwear with adequate support and cushioning is also key to keeping our feet happy.

“Their bodies are under a lot of stress for a long time so maintenance and proper care along the way is hopefully going to help you last the distance.

Fortunately, many foot conditions respond well to proper treatment and exercises can help prevent pain associated with those conditions.

Dr Reed said he often works with other health professionals particularly when patients have problems further up the limb and body.

He commonly refers patients to physiotherapists who can help boost core stability around the lower back and pelvis.

In for the long haul We nurses need our feet to keep on keeping on, so regular check-ups with our podiatrist and keeping on top of any foot problems should be high on our priority list.

“I currently treat a nurse who is well into her late 60s and has been nursing in a hospital setting for more than 40 years. She has some foot problems but has stayed on top of them by adopting the right strategies — like regular podiatry check-ups — and making sure her shoes are the best she can possibly get.

“Even though she’s had problems associated with an ageing foot she’s a stellar example of adopting good practice, and she’s managed to keep working in a ward environment.”

So there you have it, if you want to keep on your toes, you need to treat your feet to a little TLC.

WIN! THREE pairs of FRANKIE4 shoes All you’ve got to do is take part in a little Insta-challenge…

1

ie4footwear

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Easy-peasy! Each repost is a new entry and you can enter as many times as you like!

Winners will be announced on 2 November 2018 on QNMU’s Facebook and Insta page so keep an eye out for it.

@frankie4footwear

www.frankie4.com.au

23

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e f i l A o b m i l in

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In April this year the QNMU Council voted to donate $10,000 to the Logan Asylum Seeker Support group.

The funds will be used to support a Tamil family who’ve been living and working in the community for almost six years but are now at risk of being sent to indefinite detention on Manus Island.

Meet Srik, Sisha and Srisha….

F

OUR-and-a-half-year-old Srisha is a livewire.

Her deep brown eyes twinkle through a mop of dark curly hair like her dad’s as she squeals with delight at the smooth stones and pretty succulents in the glass terrarium on the table behind us.

“Piggy!” she cries excitedly, “it’s a piggy!”

You can see where she’s coming from. The oval shaped terrarium resting on four little glass feet does indeed look pig-like — clearly the kid’s got imagination.

She’s also got a good grasp of language, two languages actually — her home language of Tamil and the English she’s learning at playgroup and picking up from her friends and the Hairy MacLary books she loves.

As we chat with her mum and dad at the Kingston Neighbourhood Centre in Logan, Srisha plays on the chairs, snuggles up to her dad, wriggles, giggles and natters away to anyone who’ll listen.

She’s quite simply, adorable.

She’s also not wanted.

The Australian government wants Srisha and her parents to go away.

They don’t care where they go — they just want them gone.

Srisha’s dad Srikaran (Srik) Thevarasa, and mum Sishanthini (Sisha) Sivanayagam are Tamil refugees who fled Sri Lanka in the years just after the end of the civil war.

Photo: Kasun Ubayasiri

25

indepth “We’re doing what we can, but with the negative determinations only just starting to roll out, we expect we could have 200 to 400 families like this in Logan alone over the next 12 to 18 months.”

The Logan Asylum Seeker Support group is part of a collective of community organisations who’ve come together under the guidance of Logan Together to throw a lifeline to desperate refugee families.

Batticaloa, Sri Lanka where Srik and Sisha were born

They’ve lived in Australia for about six years, building relationships, working as farm labourers and starting a family — all the while patiently waiting for their asylum application to be processed.

But in March this year the Australian government rejected their claim for asylum, and in the space of a few days they were stripped of their right to work and their access to Medicare.

Cut adrift and with no means of putting food on the table, they were offered three choices — go into indefinite detention on Manus Island, go to another country, or go back to where they came from.

Srik and Sisha were devastated.

“We didn’t know what to do, how we could eat… how to feed the baby,” Sisha said.

“And I’m worried because I can’t go back to Sri Lanka.

“The war is ended but we have many problems there. I have evidence but they (immigration) don’t want to take it.”

By the time they sought help from the Logan Asylum Seeker Support Group, Srik and Sisha were in arrears with their rent, had been served with an eviction notice and were $800 in debt.

Volunteer Geoff Leeming says his group knows of about 23 families in the Logan area in a similar situation to Srik and Sisha.

“It’s inhumane. These are families, some with children who were born here, who were working and had put down roots and who, like all of us, just wanted to be safe,” he said.

It’s in the process of organising fundraising rallies in anticipation of the increased demand for help and seeking support wherever it can.

“When Srik and Sisha were told the QNMU had sponsored their living expenses.... they cried,” Geoff said.

“Actually, so did I.” “I can’t thank the QNMU enough — it really is a wonderful thing you’ve done.”

The donation will take care of the young family’s accommodation and basic needs for the next six months as they work out what their next move is.

Sisha’s English isn’t quite as good as her daughter’s yet, but her message to our members this week was clear.

“Thank you very much,” she said, “I can have peace now and look after my baby.”

The couple have appealed their negative determination and their appeal is due to be heard in September.

Photo: Kasun Ubayasiri

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? e r e h a h is S d n a Why are Srik Photo: Kasun Ubayasiri

FROM 1983 TO 2009 Sri Lanka was embroiled in a civil war between Sri Lankan government forces and the Liberation Tigers of Tamil Eelam (aka the Tigers).

As the winners assert their dominance, the losers are often bullied, threatened into submission and become targets of retribution.

The LTTE were seeking an independent state for the Tamil people in the north and east.

Tamils still living in the north and east were subjected to aggressive post-war sweeps, as military intelligence and police joined forces with local paramilitaries to track down the remnants of the LTTE.

Srik and Sisha were born and bred in the eastern city of Batticaloa — a thriving urban centre perched on a narrow strip of land along the Bay of Bengal which was regularly used as a gateway to the Tigers’ eastern strongholds.

Like many people who lived there, both Srik and Sisha had family members with LTTE links. It was almost impossible not to.

While there was support for the separatist movement among the Tamil population, the LTTE also ruthlessly extorted its own people for funds, soldiers and labour — and families in Batticaloa were easy pickings.

By the time the war ended in 2009, the fighting had claimed as many as 150,000 lives and its bloody last days remain the subject of war crimes allegations even today.

But as any student of conflict knows, the aftermath of war is often most perilous for those on the losing side.

This was the case for Srik and Sisha.

These operations gave local collaborators and fringe groups once targeted by the LTTE the opportunity to settle old scores with impunity and use their newly acquired status to establish pockets of power.

As international criticism of the postwar clean-up grew, the government’s response was simply to cut off foreign access to the north and east, meaning there was even less accountability.

As Sisha explains, tensions were high, and no-one felt safe.

“I had men knock on my door in the night, telling threats… they would touch me, my body, all over, ask questions and I became afraid,” she said.

and disappearances increasing, she was urged to get away.

So, she pooled what money she had, fled to Colombo and joined 71 other people crammed into a boat bound for Australia.

“It was very bad… I was scared for my life, anxious in my head,” she said, and it’s clear the memories still trouble her.

“We have just little food, everyone is sick and have no air... but I (have) hope.”

After 38 days of hell on the open seas with little food, no clean water, emotionally traumatised and vomiting blood, Sisha finally made it to Perth harbour.

She spent 11 months in detention in Darwin before being granted community release.

In Srik’s case, he was interrogated and harassed regularly as military and intelligence personnel targeted him for his brother’s activities during the war.

“I didn’t know if they were CID or soldiers, they wore these (civilian) clothes.”

When it became clear his life was in danger he too fled by boat and was picked up by the Australian navy after 28 days at sea.

She said the visits and threats escalated, and with stories of rapes

He spent three months bouncing between detention centres at

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indepth Christmas island, Manus Island and Weipa before being released.

Map of Tamil Eelam

He eventually found work in Melbourne, and through the refugee networks he met Sisha — a girl from his own home town, who’d been through a similar ordeal as he had.

As the asylum claim processing dragged on, the couple had no choice but to try and get on with their lives.

They fell in love, married and celebrated the arrival of little Srisha.

They felt happy, safe, and settled…. for a while.

What about now?

Since the end of the war in 2009, Sri Lanka has become a hot spot for Western tourists as the former wartorn areas have been opened up, and funds previously spent on military campaigns have been channelled into beautification projects, infrastructure and attracting commercial investment.

But while the razor-wire and checkpoints have been removed from the stunning colonial buildings that serve as embassies and government residences in the capital, the north and east still operates through a military framework.

Civilian operations such as police and councils are militarised, which means the Tamil population’s grievance processes are handled by the very people they’ve felt most threatened by.

Paramilitaries and fringe groups who created power niches in the years immediately after the war have built profitable side hustles in commerce and tourism (including war tourism) and have made connections that provide them with all manner of political protection.

And stories of persecution persist.

**Puttalam was once a Tamil area, but became because of the Sinhalization (prior to 1948) to a Singhalese dominated area. It was one of the important towns of the Jaffna Kingdom.

None of this suggests a safe homecoming for people who know they are already on the military radar, which is why Srik and Sisha are so fearful of returning home.

“I do miss Sri Lanka but there are many problems for us there,” Sisha said.

“Maybe one day we’d like to go back, but now it’s not safe.”

I had men knock on my door in the night, telling threats… they would touch me, my body, all over, ask questions and I became afraid.

Sisha

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What can I do?

If you want to help refugees like Srik, Sisha and Trisha you can make a tax deductible donation to: ■■ Account name: Logan Asylum Support Group ■■ BSB: 014279 ■■ Account Number: 308604847

indepth

Gay Hawksworth

A legacy

The race is not always to the swift, nor the battle to the strong

T

HE 36-YEAR history of the QNMU and all that has been achieved for Queensland’s nurses and midwives is one of remarkable achievement.

Many individuals have contributed to this success, none more so than our beloved former Secretary Gay Hawksworth.

Gay passed away in June and while we recognise her many personal attributes, it is timely to reflect on the incredible industrial and professional advances Gay’s leadership was instrumental in attaining.

Gay’s tenure was characterised by a fundamental understanding of the nursing and midwifery landscape – that the industrial and professional interests of nurses and midwives are inextricably linked.

This truism provided a valuable path to follow during her time as Secretary.

A time for reform For Gay, improving pay and conditions for nurses and midwives was a long game, one of patience and skill.

In 1982 when the Queensland Nurses’ Union of Employees (QNU) was formed, a new era began with Denis Jones as the first Secretary and Roy Drabble as its first President.

The QNU had numerous objectives and was inclusive of all categories of people performing nursing and midwifery work – an important difference from the nursing organisations that came before it in Queensland and elsewhere in Australia.

In April 1995, when Gay took over as Secretary of the QNU, the long struggle for a 38-hour week had been

resolved. However, her appointment came just prior to a tumultuous time in state and federal politics with conservative governments elected at both levels.

A significant period of change ensued with the first wave of industrial relations reforms.

The issues and campaigns in 1997 included: ■■ enterprise bargaining across all sectors – a shift away from centralised wage fixation ■■ significant changes to Workers Compensation legislation in Queensland ■■ refinements to the nursing career structure ■■ a shift towards privatisation of public health services by the Queensland government

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■■ reform in the aged care sector and campaigning against cuts in funding, excessive documentation, and decreasing accountability ■■ accessible and affordable child care ■■ strategies to improve work/life balance ■■ the No lifting by 2000 campaign launched at the 1997 QNU Annual Conference ■■ the introduction of new Health (Drugs and Poisons) Regulations in Queensland.

By 2002 the pace of change was frenetic and led to a watershed year for the QNU. Although the Beattie Labor government was in power in Queensland, a failure to adequately address the growing nursing and midwifery shortage crisis resulted in the acrimonious EB5 campaign.

This culminated in a massive rally outside parliament house where nurses and midwives from all sectors across the state gathered in an unprecedented display of unity and resolve.

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A new approach to bargaining EB5 demonstrated nurses and midwives were willing to use their collective strength to achieve better pay and conditions and a better health system.

It also forced QH to acknowledge nurses and midwives were central to rebuilding confidence in the public health system.

The QNU wanted to be a genuine partner in a new approach to delivering health services but this was predicated on our members being valued and treated equitably and with respect.

To re-establish trust in the employment relationship, the QNU and QH committed to an innovative, mutual gains approach known as interest-based bargaining (IBB).

Through this mechanism the parties negotiated the EB6 and all following public sector enterprise agreements.

Issues addressed through this new IBB approach included: ■■ wages/remuneration ■■ leave

■■ allowances ■■ workloads ■■ nursing career structure ■■ on call ■■ job security and employment status.

On a broader policy level, the QNU: ■■ made submissions to the Senate Inquiry into Nursing and a National Review of Nursing Education, the Pay Equity Inquiry, and the Work and Family Taskforce ■■ participated in the Queensland Nursing Recruitment and Retention Taskforce in which the QNU was instrumental in developing a tool to manage workloads in the public sector ■■ commissioned the first Your work, your time, your life research, a longitudinal study initially conducted by University of Southern Queensland researchers ■■ lobbied for various health and safety improvements including a campaign for Zero Tolerance to Violence Against Nurses, work and family initiatives such as paid maternity leave, appropriate and

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affordable child care for nurses, and improving superannuation payments ■■ jointly developed (with the Queensland Nursing Council) the Social Charter for Nursing in Queensland.

Key features included: ■■ a 12.5% pay rise over three years, making Queensland nurses and midwives amongst the highest paid in the country in most classifications for the first time ■■ 14 weeks paid parental leave

EB6 also opened IBB discussions around the QNU campaign Nurses: Worth looking after, which aimed to address the nursing and midwifery workforce crisis in all sectors and the problems around skill mix with increasing role substitutions.

■■ an increase to midwives’ annualised salary loading from 27.5% to 30%

Yet innovation continued in many areas. New roles, such as the nurse practitioner and primary care nursing, were developed, and midwifery models continued to advance, along with the nursing career structure.

■■ removal of junior pay rates for Enrolled Nurses (under 21 years of age)

During 2008 and 2009, Gay and the QNU negotiated and commenced implementation of the EB7 agreement for nurses and midwives in the public sector.

This was to be Gay’s last enterprise agreement.

■■ an increase for Enrolled Nurse (Advanced Practice) top of scale wage rate (plus wage increases on top)

■■ improved sick leave arrangements, and more.

The QNU continued to grow throughout this time, bucking the trend of declining union membership across Australia. This was a result of nurses and midwives working collectively, our democratic organisational structures, and the tireless work of our activists, officials and the QNMU leadership.

Our turn to take the reigns This brief history of achievement during Gay’s term as State Secretary is testimony to her commitment, foresight and resilience.

We celebrate Gay’s life by acknowledging not only her character and contribution, but also her vision.

Day to day, union life moves quickly and there is not always time to look to the future for fear of losing control of the present.

Yet Gay could envisage, plan and navigate a course of action. She took nursing and midwifery to new heights in Queensland with patience and imagination.

It is now our turn to build on her legacy and, in solidarity, continue the movement for social change through collective action.

With love and gratitude in our hearts — vale Gay Hawksworth.

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pledging support for aged care I

N A NORTH Queensland aged care facility, a nurse is helping an elderly resident. The Enrolled Nurse of 30 years bathes the woman, puts on a fresh nightie and smooths back her hair.

She talks to the mother-of-four who was born in the 1930s and lived through the second World War. She discusses the weather, the cold mornings and cloudless, sunny days while quietly monitoring her condition.

The woman is tired, her eyes closed and breathing laboured.

The nurse explains her family were just in the room, that her daughters and grandchildren came with flowers and photos and stories full of affection.

She says her daughters will be back any minute.

“It’s clear this woman is loved,” the nurse says.

“I’m extremely grateful to work in a facility that allows me the time to properly care for residents.

“But I know this is rare.

Understaffing in aged care facilities everywhere means most elderly Australians don’t get the love and dignity they deserve.

“Just imagine the clothes this woman has washed and the meals she’s cooked, not to mention the advice and hugs she has given her kids.

“She was a young woman once and one day we will be her. I hope we receive the care and dignity we deserve because at the moment, most people don’t.

“I’m lucky where I work, because we have enough staff to spend time with our residents. But I know that at most facilities the conditions are so bad

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one Registered Nurse can be left to look after more than 100 residents.

“That means little or no time for basic hygiene, let alone conversation. Aged care in Australia is a national disgrace and that’s why I’m campaigning for change.”

qnmu branches pledge support The nurse is one of many QNMU members campaigning to improve Australia’s aged care system.

In Queensland, more than 100 QNMU branches between Cape York and Coolangatta recently signed up to become community aged care activists. These branches were from every health sector, including aged care, public and private.

The pledge took place at our Annual Conference, where each branch was asked to commit to helping with the campaign by identifying activities they would conduct in their local areas.

Branches pledged to hand out bumper and wheelie bin stickers, host afternoon teas, and spread the word at the hairdresser and shops.

In fact, since the Australian Nursing and Midwifery Federation (ANMF) launched their Ratios for Aged Care – Make them Law campaign on 12 May, more than 5000 Queenslanders have signed up to become aged care activists.

That’s more campaign volunteers than any other state or territory — and the numbers continue to rise.

People are speaking out.

“i feel change is coming” Tired of inaction and the blame and shame culture in aged care — where aged care providers have

indepth At the 2018 Annual Conference, 117 QNMU Local Branches pledged to support our aged care campaign.

This map shows that if we all play our part, our call for ratios in aged care can be heard right across Queensland.

traditionally held all the power while distributing blame — aged care staff, residents, relatives, communities, suburbs, towns and cities are openly discussing and reporting elder neglect due to under staffing.

The media are following suit, running articles and stories aimed at the aged care providers and federal politicians responsible for the lack of laws around staffing in Australia’s 4000-plus privately run aged care facilities.

“For the first time I feel change is coming,” said Lorraine Rock, an Enrolled Nurse from Proserpine who recently signed the branch pledge at Annual Conference.

“I am lucky to work at a facility that is well-staffed, but we could always use more resources.

“Every aged care nurse knows there are elderly people out there who have lived long and productive lives, yet they’re growing old without the care, dignity and respect they deserve.

“These people helped build our nation so what kind of country are we if we don’t care for them properly?

“In many facilities there are not enough staff to feed people, not enough staff to properly wash people.

It’s unforgivable.

“The campaign for change in aged care underway right now is

invigorating. I signed the QNMU’s aged care pledge because I really want the elderly to receive the care they deserve.

“I want all aged care nurses to be able to give that care.”

groundswell of support Politicians are picking up on the groundswell of support as well.

Following Labor’s resounding victory in the recent Longman byelection, Opposition Leader Bill Shorten listed aged care as a priority issue ahead of the next federal election.

And on 25 July, just two months after the ANMF launched the campaign, Australian Medical Association President Tony Bartone detailed aged care understaffing as one of the major reasons one third of doctors were expected to stop or reduce visits to aged care facilities by 2020.

The situation can no longer be ignored. Our campaign is gaining momentum.

To join our campaign and become an aged care activist, visit www.morestaffforagedcare. com.au

what’s our campaign about?

Currently, there are no federal laws that state how many nurses or carers are required at any given time to deliver safe resident care. There’s not even a requirement for a single Registered Nurse to be on site.

As a result, many of Australia’s 4000-plus privately-run aged care providers staff their facilities as they see fit.

The QNMU has repeatedly stated elderly Queenslanders and Australians are experiencing unnecessary pain, suffering and premature death as a result of chronic understaffing.

The QNMU will not rest until the federal government, which has responsibility for the majority of Australia’s aged care facilities, makes safe staff levels law to protect the elderly and those who care for them.

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S

ITTING alone at a desk poring over academic papers, sifting through survey results and analysing data is not what most nurses imagine as being nurses' work.

It might however, be what we think of when we hear the term “nurse researcher” or “research nurse”.

Nursing research:

But those who live in the world of nursing research will be the first to tell you their job is much more than just solitary paperwork.

For them, it offers a diverse range of opportunities, from working in a team environment in research hubs, think tanks and labs; to securing evidence and developing new practices and innovations that make a real difference to how we as nurses and midwives care for our patients.

It can even lead to national and international distinction — something that recently happened to Distinguished Professor Patsy Yates, who is QUT’s Head of School of Nursing, director of Queensland’s Centre for Palliative Care Research and Education, and a QNMU member.

Earlier this year, QUT conferred the title of Distinguished Professor to Professor Yates in recognition of her outstanding achievements and ground-breaking research in cancer and palliative care nursing, becoming only the 10th academic to be awarded the title at QUT. Prof Yates also became the first researcher outside the United States to receive the prestigious Distinguished Researcher Award from the International Oncology Nursing Society.

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The award, which was presented in Washington DC, recognised her contributions and enhancements to oncology nursing.

“When I graduated I went to work in a respiratory ward, and a lot of my patients had lung cancer and so I quickly developed an interest in caring for people with cancer,” Professor Yates said, explaining the foundations of her interest in research.

“I then worked as a RN in the mid-80s in infectious diseases where we had some of our first patients with HIV AIDS.

indepth “At the time we didn’t have much to offer patients with HIV AIDS, so I really became aware of how important nurses are in palliative care because we provide that emotional and social support and comfort.”

where we need more research and evidence.”

From there, Professor Yates’ passion for research flourished. It’s a passion that has developed into a career spanning many decades of working to improve this specialised field of nursing.

“I was fortunate to have really good mentors early on who took me along the journey and showed me all about the research process.

Becoming a researcher Whether we realise it or not, research is part of every nurse and midwife’s role from as early as our undergraduate studies.

“Research is a core subject as part of undergraduate courses these days,” Prof Yates said.

“Even from the time you graduate, your contribution to research might be firstly as a user — to using research in your practice — to working with more experienced people.

“On the ground you’re seeing what the issues and problems are and

For Professor Yates, a key factor in pursuing her research career was the support she received from those around her.

“You grow over time in terms of your expertise and skills, and now a lot of my role is really about mentoring new researchers coming in so they can continue the next generation of building the evidence.”

A creative process “There’s a lot of creativity with research,” Prof Yates said.

“We work in big teams of other nurses, researchers and other disciplines. And that’s what makes it really exciting.

“The job involves a lot of problem solving, critical thinking, understanding and reading the literature, and of course working in teams to really

understand what the research problem is and what we need to do to test and identify new solutions.”

To help explain the diversity of her role, Professor Yates described a new study her team was undertaking to examine the side effects of a cancer treatment called peripheral neuropathy.

“We were recruiting patients and teaching them how to trial this different method we hope will improve the symptoms they get from peripheral neuropathy,” Professor Yates said.

“So it can range from teamwork and creative thinking right through to working with patients to test interventions.”

Then comes the stage of writing it up for publication and presenting findings to other sections of the academic and clinical community.

“The only piece of research you might do on your own is perhaps your PhD. “Particularly in the area that I work in, everything is so complex and if you really want to change, you’ve got

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indepth to have lots of people around the table with all the different perspectives.”

Informing decision makers As nurses and midwives, we strive to deliver what we commonly refer to as “evidence-based care”.

The evidence informs everything we do — which is a lot of pressure for our researchers, who provide much of the evidence we require to ensure our practice remains relevant and contemporary.

“At one level, when we’re talking about developing evidence for our clinical practice, the challenge there is how we get it embedded into organisational policies, assistance and training,” Prof Yates said.

“But when it comes to things like evaluating new nursing or specialist roles, it’s really about how we help influence decisionmakers to say that these sorts of services need to be funded.

“So part of my role is advocacy and developing the evidence to help inform decision makers.”

Future of research in Australia Fortunately, the future of research in Australia is looking bright, as long as we continue to demonstrate the value of nursing-led research and how funding translates into results.

“I do think the importance of nursing research is not as well understood or appreciated as it could be,” Prof Yates said.

“There are challenges around promoting the outcomes of our research, and that goes to resources and funding.

“Research isn’t really something that’s built into the day-to-day clinical practice for nurses… whereas in the medical profession, there’s a lot of time built in for research activity.”

Despite these challenges, Australia’s standing in the research profession is very high.

“Nursing research in Australia and Queensland is probably some of the best in the world.

“Nursing researchers in Australia are published in the best international journals, our work gets cited across many different countries, and we have lots of people who come from many other countries to be trained in nursing research here.”

Ultimately, a thriving nursing research profession is good news for the rest of us – it is nurses who best understand what needs to be improved, as we live it every day at work.

“We are really best placed to know what our patients need and where we need to develop new evidence.

“Those insights are so critical to the research process so that the questions we ask are relevant.”

Oncology research PROFESSOR Patsy Yates has dedicated much of her career to researching and improving nursing care in the area of oncology, particularly in palliative care.

Her team’s research has focused on understanding people’s experience of being diagnosed with cancer and having to live with the long-term effects of treatment, as well as how nursing interventions can address those effects and improve quality of life.

More recently, part of Prof Yates’ research has looked at breathlessness — a topic she profiled in her presentation in Washington DC. “A number of patients with cancer will experience breathlessness, so we tested in a clinical trial a nurse-led intervention where we taught patients breathing retraining, relaxation, and how to manage their activities,” she said.

“That clinical trial had some really positive outcomes, with patients saying their breathlessness had reduced and that they felt more in control when they were breathless.”

The effect of specialist nurse models has also been an area of attention, including identifying best models of care and organising the health care system to make better use of the nursing contribution.

“For example, we’ve done studies with specialist prostate cancer nurses — what difference does it have on patient outcomes when you introduce a specialist prostate nurse?

“We’ve made some important findings that when you’ve got skilled nurses who are part of multi-disciplinary teams, our patients’ outcomes and quality of life improve.”

While Professor Yates was the recipient of the Distinguished Researcher Award from the International Oncology Nursing Society, she said she had her whole team of researchers to thank.

Nursing research in Australia and Queensland is probably some of the best in the world.

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“Research is really about team work. Even though I was lucky enough to get the award, none of the research I’ve done has been on my own.

“So it’s also great recognition for everyone else.”

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EB 10

YOUR WORK YOUR VOICE

Voted up!

Congratulations to all Queensland Health and Department of Education nurses and midwives who voted in the EB10 ballot.

The agreement was voted up, with a ‘yes’ vote of 95.6%.

Arriving at EB10 has been a lengthy process (negotiations started in November 2017), but we’ve managed to achieve some great outcomes that will improve the working conditions of all public sector nurses and midwives.

The agreement is currently awaiting certification by the Queensland Industrial Relations Commission.

Once approved, all public sector members will receive a 2.5% increase to wages and allowances, backdated to 1 April 2018.

What’s more, any increase to the Queensland government’s wages policy during the life of the three-year agreement will be applied to those covered by this agreement.

EB10 key improvements: ■■ 2.5% minimum increase to wages and allowances. This will further increase if the Queensland Government wages policy increases beyond 2.5%.

■■ Improved allowances, including existing x-ray allowance extended

to become lead apron allowance, and on call allowance increased by further 2.5% (above minimum annual increase).

■■ Retention of existing conditions such as Christmas Day special loading, banked time, job security and Sunday night shift allowance (25%).

■■ Remote/telephone on call payments improved and brought into line with others in Queensland Health.

■■ Improved conditions when providing disaster relief.

■■ All nurses (inicluding NG10+) to be paid for all on call work performed out of hours.

■■ Guaranteed 10-hour break after all recalls regardless of the length or timing of the recall*.

■■ Minimum recall payment to be paid even when recall is cancelled.

■■ Rural and Remote DONs (NG9) to be paid for all work including overtime, weekend or after-hours work. Some Rural and Remote

EB10 voting results Queensland Health

DONs to be reclassified to reflect the changed nature of their role.

■■ RANIP to be reviewed to increase range of RANIP incentives no longer to be one size fits all.

■■ Wages and conditions parity for nurses in multidisciplinary teams.

■■ PDL and PDA extended to temporary staff (at least 12 months).

■■ $10 million Innovation Fund to advance nursing and midwifery excellence.

■■ Guarantee of permanent employment for 80% of graduates within their first 18 months.

■■ More flexible work options including 14 days notification of rosters, better access to leave at half pay. and cashing out of LSL. ■■ Funded projects, including around midwifery, flexible working arrangements, rostering, models of care, the BPF, and nursing and midwifery showcase. *Except where the first recall is up to three hours prior to the commencement of the ordinary shift.

g n i t o v r o f s k n Tha

Yes, 95.6%

No, 4.4%

Yes, 98.3%

No, 1.7%

Department of Education

www.qnmu.org.au/EB10 37

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PLASTIC it’s not so fantastic It's leeching into the food we eat and the water we drink… it’s time we rethink our love affair with plastic.

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B

Y THE time you read this, taking your reusable bags to the supermarket should be almost second nature.

Well done you!

Before the single-use plastic shopping bag ban was introduced in July, Queenslanders were using about one billion shopping bags every year.

Most of those bags ended up in landfill and the rest, about 16 million, found their way into our bushland, waterways and oceans.

But whether they are tucked away under piles of refuse, snagged on a mangrove bush, or choking a turtle who’s mistaken it for a jellyfish, those bags have a frighteningly long life ahead of them.

Scientists estimate it could take anywhere between 20 and 1000 years for a single-use bag to completely decompose, depending on what it’s made of and the conditions it's exposed to.

It’s a similar story for other types of plastic — it’s apparently 500 years for Styrofoam and about 40 years for nylon.

And if that isn’t bad enough, we continue to dump more plastic into our environment faster than the

stuff can break down — which means plastic waste is really mounting up.

In fact, international research published last year suggested most of the plastic ever made is “still present in the environment in some form”.

The most insidious of these are microplastics.

Microplastics are tiny plastic fibres and particles less than 1mm in size.

The vast majority are created when plastic products like synthetic clothes shed fibres or when single-use bags, nylon nets, and disposable cutlery degrade.

Systems (LEESU) conducted the world’s first study into atmospheric microfibres, suspecting the air we breathe could be dumping microplastics into our water and soil.

And they were right.

Air samples taken from Paris and its suburbs showed about 29% of the microfibers were synthetic plastics (as opposed to natural fibres) — most likely from the clothes we wear.

They estimated that anywhere between three and 10 tonnes of this tiny plastic material could be falling on the Paris district every year.

In the past five years, microplastics have been discovered in everything from shellfish and rice, to baby formula and pasta.

Scientists now believe this kind of atmospheric fallout may be one of the ways microplastics get into our drinking water.

A German study by Gerd and Elisabeth Liebezit back in 2014 even found it in 24 brands of German beer!

Last year independent public media organisation Orb Media joined forces with leading scientists from around the world, including the University of Minnesota School of Public Health, to find out if there was plastic in our tap water.

But perhaps the most troubling discovery is that we’ve now confirmed evidence of microplastics in the very elements that sustain us: our air and water.

Fibres, fibres everywhere In 2015 researchers at the Universite Paris-Est’s Laboratory for Water, Environment and Urban

In their fascinating study they examined tap water in a dozen cities on five continents, from Trump Tower, Manhattan to family homes in Jakarta, Indonesia. They found plastic microfibres in every one.

? w o n k u o y d i D

microplastics have been found in leading brands of bottled water.

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They even found them in three leading brands of bottled water in the US. In fact, 80% of the hundreds of samples they collected contained microfibre or particles as small as one tenth of a millimetre.

They also discovered that boiling water, a common practice for killing microorganisms and disease, is not helpful as it just makes the plastic fibres break up more.

For many in the scientific community the results from the Orb study were not surprising.

As Dr Mark Anthony Browne from the UNSW’s School of Biological, Earth and Environmental Sciences told InScope, scientists have been aware of plastic microfibres in tap water for a number of years now.

At the simplest level, plastic microfibre contamination is one of the reasons they have to keep cleaning their scientific apparatus.

Dr Browne, a pioneer in plastic research, was the researcher who first blew the lid on the prevalence of plastic microfibre in our environment.

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In 2011 after spending months testing water along beaches and sewage outflows around the world, he discovered the fibres were everywhere and in huge, unexpected quantities.

Tracing the fibres back to the source he realised they were coming from our washing machines and our manmade textiles such as acrylic and nylon, with some fabrics shedding as many as 1900 fibres in a single wash.

But when he tried to get industry support and funding for further research into fibre migration patterns and development of better textiles, no one was interested.

But the tide may be starting to turn.

With the help of an engaging multimedia website, the Orb study has captured popular attention, and the public are now a good deal more interested in microplastics and how we might reduce them.

air, and the danger this might pose to human health.

But one of the key health concerns researchers have agreed on is the ability for microplastics to act as carriers of toxins.

It makes sense.

For the past few years medical science has been looking at the potential of using plastic polymers to deliver medication directly into human cells, so we know plastics can absorb, or rather bind, chemicals.

Research on ocean waste shows microplastics can absorb chemicals and toxins present in the seawater including those we know to be harmful to human health such as pesticides and metals like mercury.

What are the health risks?

Studies have also found that when microplastics are ingested by animals including fish, the toxins can be released into the body. Even worse, the Orb researchers fear conditions in the gut might actually speed up the release process.

We are only just starting to understand the extent of microplastic contamination in our food, water and

It’s still unclear what this means for us as we ingest microplastics in our food, water and air.

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They estimated that anywhere between three and 10 tonnes of th is tiny plastic material could be fallin g on the Paris district every year.

But one thing we do know is that the pollutants present in the fish were also present in humans.

This has scientists very worried.

Assistant Professor Chelsea Rochman and her team at the The Department of Ecology and Evolutionary Biology at the University of Toronto said some of the chemicals carried and released by microplastics like pesticides and dioxins were linked to cancer.

The UK’s Chief Medical Officer, Professor Dame Sally Davies, said the leaking chemicals could cause gut blockages and hormone problems, while the US’s Environmental Protection Agency has raised concerns about the potential impact on reproduction and child development.

Frank Kelly, who is a professor of environmental health at King’s College in London, told a UK parliamentary inquiry in 2016 that microplastics inhaled by humans could potentially deliver toxins directly to the lungs.

Other scientists, including Dr Browne have suggested they could cause damage as a result of inflammation —

the body’s natural immune response to anything it recognises as ‘foreign’.

And as for the actual plastic particles themselves?

Well some studies indicate that some of the smaller ones may be able to pass through our intestinal wall and travel to the lymph nodes or deposit in our organs.

The fact is we are only just starting to consider that microplastic and plastic microfibres could be a genuine health hazard for the human population.

What can I do?

When you put this question to Dr Browne, you can hear the frustration in his answer.

He knows you want a nice easy checklist — a to-do list so people can satisfy themselves they are doing their bit to stem the microplastic menace.

But it’s just not that simple.

“The problem is, this space is occupied by very well-intentioned people with marketing degrees and they have a tendency to not understand the value of different

types of scientific evidence, so they get confused and prioritise the wrong thing,” he said.

He said the result is consumers get swamped with campaigns encouraging bans, boycotts, and swap-outs without evidence of their effectiveness or overall impact.

“They target the low-hanging fruit, the easy things for consumers to do, but they don’t encourage people to interrogate the evidence,” Dr Browne said.

“The evidence simply doesn’t suggest that microbeads are the biggest problem — yet we have campaigns calling for a ban on microbeads, and for their replacement with non-plastic alternatives that themselves have not undergone any safety testing.

“We don’t know what the environmental impact of supermarket reusable bags are. What of their manufacturing process? How do they break down and what do they release?

“Meanwhile microfibres from synthetics make up more than

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indepth 65% of microplastics and we aren’t looking at them.”

He is now seeking industry partners to come on board.

He concedes this can all sound a little dry for the average consumer, but he argues that if we really want to tackle microplastics and their health risks there is a need for honesty.

Until then, his ‘checklist’ for those people who want to do something substantial to reduce microplastics includes:

“There are more microfibres from synthetics in the environment than other microplastic combined... but we simply don’t have the scientific evidence yet to advise people on alternatives,” he said.

“There are well established ways in environmental studies and science to get that evidence — pilot studies, before and after intervention — sometimes it might be about how a product is used rather than the product itself…

“Advice can only come when the research has been completed.”

The good news is Dr Browne and his team have just secured an ARC Linkage grant to look at “avoiding, intercepting or redesigning synthetic clothes."

■■ Donate or leave a legacy to universities with a track record for research, testing and redesign: Help them get the evidence and be in a position to suggest credible alternatives or redesigns quicker.

■■ Lobby for testing legislation: More than 15,000 chemicals and compounds go on the market every day but only 1% are independently scientifically tested. Demand better from manufacturing and government.

■■ Ask questions about who is giving approvals for these new chemicals: Which standards body, which political portfolio and how can they prove they are safe?

■■ Interrogate the evidence: Demand to see the evidence of enviro claims like better washing machine filters,

biodegradability and safety. Is there really science behind it or is it a marketing ploy? Name and shame those who green-wash.

But what about those plastic bags?

The nuances of the microplastics problem, however, doesn’t just mean consumers should ditch all efforts to cut down on plastic waste — even Dr Browne agrees with that.

Plastic waste, the bags, the straws, the fishing nets and disposable cutlery remain a huge waste problem for our environment and we are chucking it into landfill and the sea at a rate that boggles the mind. For example Hong Kong with a population just over 7.3 million people throws away 25 million pieces of plastic cutlery every day.

The Great Pacific Garbage patch in the north Pacific Ocean alone covers an area of about 1.6 million square kilometres — that’s about the same size as Queensland.

Dr Mark Browne, UNSW School of Biological, Earth and Environmental Sciences, collecting water samples.

Photo: Gemma Deavin

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indepth This floating junk pile contains more than 78,000 tonnes of plastic.

Chung said it’s all about being a conscious consumer.

Commercial fishing nets and gear make up a huge proportion of that mass, but the next worst offender is single use plastics such as bags, cups and cutlery.

“I try to buy things that have no packaging or less packaging — although it can be hard to avoid it completely,” she said.

These kinds of plastics might not contribute to the microplastic problem as much as textiles, but thousands of marine animals are still killed by plastic debris in the sea every year — most are suffocated, tangle, or choke on it.

“I never use produce bags at the fresh fruit and veg section of the supermarket — I just refuse. It’s totally unnecessary.”

We need to ask ourselves: Do I need a bag (plastic or otherwise) at all? Do I really need individually wrapped cheese slices or coffee bags? Can I do without plastic dental flossers?

Gold Coast nurse and founding member of the QNMU’s new Health and Environment Reference Group Lorraine

Lorraine said she is pretty diligent when it comes to recycling and she makes the most of recycling schemes in her area, including soft plastic recycling at Coles and Woollies.

References:

“They claim they use it to make furniture for schools — so I hope that’s what they really do,” she said.

Andrady, Anthony L (2011) ‘Microplastics in the marine environment’, Marine Pollution Bulletin, vol. 62, issue 8, August, pp 1596-1605. (www. sciencedirect.com/science/ article/pii/S0025326X11003055)

And with plastics she can’t avoid — like milk and juice bottles — she reuses and recycles them by using them as pots and planters for her online succulent business.

Barboza, Luis Gabriel Antao, et al (2018) ‘Marine microplastic debris: An emerging issue for food security, food safety and human health’, Marine Pollution Bulletin, no 133, pp336-348.

She even makes sturdy shopping bags out of her dog’s dry food bags.

“It’s all about minimisation — if we all reduced our reliance on plastic altogether we might start to turn things around.”

Carrington, Damian (2017) ‘Plastic fibres found in tap water around the world, study reveals.’ The Guardian, 6 September. www.theguardian. com/environment/2017/sep/06/ plastic-fibres-found-tap-wateraround-world-study-reveals Carrington, Damian (2017) ‘We are living on a plastic planet. What does it mean for our health?’ The Guardian, 6 September. (www.theguardian. com/environment/2017/sep/06/ we-are-living-on-a-plasticplanet-what-does-it-mean-forour-health) Clean Ocean Foundation (2018) ‘Microplastics & outfalls – the elephant in the pipelines?’ 11 July. (www.cleanocean.org/news/ plastics-microplastics-outfalls) National Oceanic and Atmospheric Administration (2018) ‘What are Microplastics?’, National Ocean Service website, 25 June. (https://oceanservice. noaa.gov/facts/eutrophication. html) Queensland Government (2018) ‘Why the ban was introduced?’, August.(https://www.qld.gov. au/environment/pollution/ management/waste/plasticbags/about)

Photo: Chris Tyree

With the environmental impact of some of our popular plastic alternatives still untested — one of the best things we can do in terms of our plastic use right now is “think more, use less”, and reuse and recycle what we can.

THINK MORE, USE LESS

Tyree, Chris and Morrison, Dan (2017) ‘Invisibles: the plastics inside us’, Orb Media.(https:// orbmedia.org/stories/Invisibles_ plastics/multimedia) Yeung, Isobel (2018) ‘Plastic Oceans’ Vice News, 6 February. (https://youtu.be/74YQWthFz8g)

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REINVENTING Aged care of the future

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indepth

go into “I don’t want to have to ld.” o w ro g I n e h w re a c d e g a A phrase not uncommonly heard, and often punctuated by a shudder of apprehension.

Sadly, there’s a stigma attached to aged care that hasn’t made it appealing to those of us who may one day need it.

Continued reports in the media about the lack of quality care due to chronic understaffing have further fuelled our long-harboured fears of being institutionalised in old age.

Nonetheless, we’re faced with the harsh reality of an ageing population.

Currently, 3.7 million Australians are aged 65 years and over — that’s about one in every seven people.

By 2096, this number is projected to quadruple to 12.8 million.

With demand already outstripping supply and considering our reticence toward aged care, it’s past time we started thinking outside the box.

Unpacking the stigma The Australian Centre for Social Innovation (TACSI) is an organisation that tackles complex issues in our society with innovative ideas… issues like an ageing population.

Their studies confirm what we’ve already guessed. People actively don’t want to be in aged care and it’s not what they hope for themselves in the future.

TACSI’s Principal for Ageing, Disability and Partnerships, Kerry Jones, said while aged care facilities provide shelter and care, it isn’t enough when considering what people want in their lives.

“Our current aged care system is a medically driven model and we’re used to taking a very institutionalised approach to health as we age,” she said.

“We’ve got a competitive funding market and aged care has to be a viable and profitable business. In some cases that means those who are more vulnerable and on lower incomes are not able to access our system in the same way.

people’s attitudes toward entering aged care.

“There’s no flexibility to residents’ daily living and that’s why people relate it to being in a prison,” she said.

“We talk about resident-centred care but I think a lot of that isn’t being done due to staff shortages.

“I look around at the visiting families who are watching us and all they see is the rush, rush, rush. All we have time to do is put residents in the lounge room and that’s the entertainment for the afternoon.

“It just isn’t good enough and it’s not what we want for our folks.”

Building a home In tackling this problem TACSI directed their efforts toward truly understanding the diversity of the Baby Boomer population.

In particular, they explored which groups of people were at the highest risk of not ageing well and how that could be changed.

This work was key in identifying where the greatest need for innovation in aged care was... and it all pointed to ‘home’ and the role it plays in our lives as we age.

“That’s why we need to look at doing things differently and consider better alternatives to aged care.”

“Our home is critical to the way we express ourselves and is a key part of our identity,” TACSI’s Kerry Jones said.

Aged care member and AIN Michelle Flitton has witnessed the regimented nature of the industry firsthand, and said it’s a major factor affecting

“We want to know that we can not only wake up somewhere safe tomorrow, but that we can change it to meet our needs.

We don't need massive state-ofthe-art facilities to care for people in the right spaces and in the right way.

Kerry Jones, Principal for Ageing, Disability and Partnerships, TACSI Photo: The Australian Centre for Social Innovation (TACSI)

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All the research shows that people thrive in a home environment.

Tamar Krebs Group Homes Australia

Photo: Group Homes Australia

“We want to have control over that space and a real sense of ownership, and that’s something you don’t have in residential aged care.”

support person for the clinical needs of residents, but mainly aim to build rapport with residents, families and staff.

that embody four different ‘lifestyle’ categories — cosmopolitan, natureoriented, well-to-do and traditional Dutch.

It’s this very concept of home that’s led to the creation of a new initiative

by Group Homes Australia… share housing for our elderly.

“The whole concept is underpinned by engaging in life. Even for the families it’s a completely different experience to visiting their mum or dad in an aged care facility,” Tamar said.

They’re looked after by caregivers who cook, take them to social events, help them go grocery shopping in the village market and watch over them for their safety.

It’s the brain child of Registered Nurse and founder of Group Homes Australia, Tamar Krebs.

It’s a true-blue community and residents in Hogeweyk are reaping the benefits… they’ve been found to live longer and take fewer medications.

While share housing may sound common enough to a uni student, there’s a lot to consider when we’re talking about six to eight elderly Aussies with varying stages of dementia.

“When they stop in their mum might be doing some baking. And even if she’s being assisted by a homemaker you can see the model here is very much about doing things with the residents.

“All the research shows that people thrive in a home environment,” Tamar explained.

“We’ve put the focus back on person-centred care and it’s how we operate day-to-day.”

“Group Homes Australia sets elderly people up in a real home in a local suburb. The homes are run by homemakers who have qualifications in aged care, but critically they also know about looking after a home and purposeful, meaningful engagement with residents.”

Breaking down the gates

In fact, Hodgeweyk’s model has been so successful that we’ve quickly followed suit, with Tasmania announcing plans for Australia’s first dementia village encompassing 15 tailored houses, a supermarket, cinema, café, beauty salon and gardens.

This share housing concept was first pioneered by the Dutch through Hogeweyk, a nursing village located in the Netherlands.

These villages have begun to break down the ‘locked door’ approach Australia has thus far employed for those with the highest care needs.

It’s 152 residents all have mild to severe dementia and live in 23 houses (each with six to seven residents)

TACSI’s Kerry said Australia needs to tap into the opportunity that is in our communities.

Registered Nurses play a very different role here. They are a

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indepth “Research shows the longer we can be in place in the same community connected with the right support system around us and the more independent we are, the better quality of life we will have,” she said.

“We need to (metaphorically) break down the gates around our aged care facilities. That gated feeling is how we lose the richness of what it means to live intergenerationally.

“We don’t need massive state-ofthe-art facilities to care for people in the right spaces and in the right way.”

Indeed, Group Homes Australia’s share housing concept has helped residents with severe BPSD (behaviour and psychological symptoms of dementia) truly thrive.

Founder Tamar said residents who had been evicted from aged care facilities because of aggressive behaviour had unmet needs that continued to escalate.

“We’ve got an ex-tradie resident who was evicted from an aged care facility for becoming aggressive toward staff,” she said.

“When we unpacked the problem we found he was having to sit for hours playing bingo and having singa-long sessions. By the afternoon he was becoming severely agitated.

“We handed him a bucket of paint and a paintbrush, and for the next six weeks he woke up at 5am every day to paint the fence of his share house.

“He was a tradie and he desperately needed that physical activity, so rather than sit in judgement we need to pause and ask ourselves if there is a fundamental underlying unmet need, and how we move forward with that.”

The innovation age There’s no question about it… a singa-long session once a week with a man on a piano just won’t cut it for us.

Our generation will want to enter aged care armed with an iPad and a lifetime subscription to Netflix.

Fortunately we’ve seen aged care facilities both overseas and in Australia gradually begin to incorporate innovative initiatives aimed at meeting residents’ needs.

We talk about resident-centred care but I think a lot of that isn’t being done due to staff shortages.

Michelle Flitton, AIN QNMU member

UK’s first intergenerational care home in Wandsworth integrates both older residents and children into the delivery of the curriculum and elderly care, with children able to visit elderly residents on a daily basis.

In New South Wales, The Whiddon Group’s Australian-first trial of the Hensioners initiative showed health and wellbeing benefits for residents tasked with looking after hens.

And closer to home, residents at a Gold Coast aged care facility live sideby-side with horses and cows thanks to an on-site farm tended by a local school.

While these ideas have proven successful in enriching the lives of residents, Kerry said we all need to work alongside each other to ensure innovation in this space takes root.

“The whole process of innovation can be quite challenging… a lot of ideas remain ideas and don’t quite get off the ground,” she explained.

“We’ve seen a few situations where innovative ideas imported from overseas have failed as there wasn’t an understanding of the broader context culturally and policy-wise.

“We need to bring people with entrepreneurial ideas and the aged care sector together and leverage the best of both worlds to find sustainable innovation.”

AIN Michelle Flitton said even her facility has begun to tap into

the concept of home, renovating residents’ rooms to incorporate a homier feel and move away from a hospital look.

“The rooms have new timber flooring, lovely new furnishings, soft lighting that turns down, new hightech TVs and of course, internet,” Michelle explained.

“Residents and families love it.

Families feel like they are visiting their loved one in their own home and it makes a huge difference to residents’ attitudes and quality of life here.

“I hope we keep moving forward in meeting the needs of generations to come.”

References:

Australian Institute of Health and Welfare. (2017).

Older Australia at a glance. https://www.aihw. gov.au/reports/older-people/older-australiaat-a-glance/contents/demographics-of-olderaustralians/australia-s-changing-age-andgender-profile Business Insider. (2017). Inside the Dutch ‘dementia village’ that offers beer, bingo, and top-notch healthcare. https://www.businessinsider.com. au/inside-hogewey-dementia-village-20177?r=US&IR=T#/#hogeweyk-started-in-1993-asyour-typical-hospital-style-nursing-home-butthe-staff-soon-realized-there-was-a-bettermore-humane-way-to-offer-care-1 The Independent. (2018). UK’s first intergenerational care home. https://www. independent.co.uk/news/uk/home-news/ elderly-children-intergenerational-care-homenightingale-house-a8271876.html ABC News. (2017). Cows and horses bring joy to Gold Coast aged care home in unique school program. http://www.abc.net.au/news/2017-1114/cows-horses-aged-care-agricutural-schoolprogram/9146042

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FR EE

CPD portal…

FREE for QNMU members!

www.qnmu.org.au/CPD QNMU member Vanessa Kirunda

CPD

What to do if you’re injured at work OUR

1

8

GOLDEN RULES…

2

3

4

ALWAYS

DON’T

NEVER

ALWAYS

submit a workers’ compensation claim if you are injured at work or if the injury is severe enough to require you to have time off work or require medical treatment.

rely upon your employer to lodge your workers’ compensation claim for you.

give in if your employer tells you not to lodge a WorkCover claim – this is illegal.

see your own doctor, not the company doctor, for treatment of any work injuries.

You should do it yourself to ensure the claim is lodged in a timely manner.

You have a right to choose which doctor you see if you are injured at work.

This includes if you have been injured during your break or on your journey to or from work.

5

6

7

8

NEVER

REMEMBER,

NEVER

ALWAYS

allow an employer representative to sit in on your medical appointments, even for a work injury.

if your employer uses an outside organisation to manage workplace injuries and rehabilitation, they are working for your employer whose interests may not align with yours.

allow an employer representative to force you or your doctor to amend a medical certificate to say you are fit for light duties if your doctor has informed you that you are not.

contact the QNMU if you have any concerns or questions about your work injuries.

You can and should say no to this. It is your legal right.

REFLECTIVE QUESTIONS 1. What are the circumstances where you should submit a workers’ compensation claim?

2. Reflect on the eight golden rules above. Which rule resonates the most strongly with your own personal experience with being injured at work, and why?

3. Should you still lodge a WorkCover claim if your employer tells you not to? Why? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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C H A N G E S

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P R E S C R I B I N G :

Prescribing in Australia: A little history

In Australia, the Nursing and Midwifery Board of Australia (NMBA) endorses the registration of RNs and midwives as qualified to administer, obtain, possess, prescribe, supply or use scheduled medicines if they meet the requirements of the respective registration standards.

This endorsement falls under the Health Practitioner Regulation National Law Act (the National Law), and applies to all states and territories.

In 2013, state and territory health ministers approved the Health Professions Prescribing Pathway (HPPP), which provides a nationally recognised and consistent approach to prescribing by health professionals.

In 2013 and 2015 the NMBA conducted a review of the registration standard ‘Endorsement’, which applies to scheduled medicines for nurses (rural and isolated practice).

At this time, the NMBA flagged the removal of the Remote and Isolated Practice Endorsed Registered Nurse (RIPEN) qualification — a role that allows these senior nurses to administer and supply medications in areas that typically suffer from lack of medical officers, Nurse Practitioners, or Endorsed Midwives.

Feedback during consultation with key stakeholders was mixed.

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Queensland and Victoria did not support the removal of the RIPEN endorsement, as both states rely on this registration standard to allow RNs to supply medicines under protocol in rural and isolated areas.

However, the NMBA determined that RIPEN endorsement was no longer required, as the poisons legislation and associated policies in most jurisdictions facilitated the safe supply of medicines.

In October 2016, the Health Workforce Principles Committee (HWPC) recommended to the NMBA that the registration standard be continued for two more years to enable the NMBA to work with Queensland and Victoria to develop a workable solution.

In March 2017, a national prescribing symposium was held, allowing stakeholders, including the QNMU, to consider future nurse and midwife prescribing models in Australia.

Participants considered the development of a common

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understanding of ‘prescribing’, and the potential for a HPPP. The HPPP is the foundation for the proposed national prescribing model.

The HPPP has three model levels of prescribing: ■■ Model 1: Autonomous prescribing (NP or endorsed Midwife) ■■ Model 2: Prescribing in partnership (with an endorsement) ■■ Model 3: Prescribing via a structured prescribing arrangement.

In addition, the NMBA is consulting on a new endorsement for RNs called “endorsement for scheduled medicines for Registered Nurses prescribing in partnership”. This captures Model 2 of the HPPP.

RIPEN withdrawal Although the RIPEN withdrawal is yet to be finalised by the NMBA, this will occur once all states and territories have a solution to ensure rural and isolated communities are not disadvantaged by any changes to health service provisions.

The QNMU recently wrote to the NMBA seeking this assurance.

Below is an extract of the NMBA’s response: “Only once the standard and guidelines for the proposed model for RN prescribing in partnership has been agreed by the Council of Australian Governments (COAG) Health Council (Health Ministers) and accreditation standards for the education requirements for the units of study are established, can possible transition plans (which are likely to require additional education) be logically developed from the endorsement to supply to the Endorsement for scheduled medicines for registered nurses prescribing in partnership.”

Following recent discussions with the QNMU, the NMBA has prepared and release a fact sheet titled Registered Nurses: Endorsement for scheduled medicines nurses (rural and isolated practice), which can be accessed on the NMBA website at https://bit.ly/2KlUenG

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Changes ahead Despite this assurance from the NMBA, the continued uncertainty over the future of the RIPEN qualification has unfortunately already caused workforce concerns that need to be addressed.

With changes flagged as early as 2013, the RIPEN endorsement has been left in a state of limbo ever since.

Members have told the QNMU that many Registered Nurses have been deterred from signing up to the RIPEN qualification and undertaking the training.

While it seems inevitable that the NMBA will eventually remove the RIPEN endorsement, the QNMU has insisted from the beginning that these remote and isolated communities must not be disadvantaged in any way by a replacement model.

What’s more, any new model must be at least equivalent to the health services currently provided by RIPENs. The QNMU held discussions recently with the Office of the Chief Nursing and Midwifery Officer (OCNMO) to seek further clarity around how Queensland Health will lead statebased changes to nurse and midwife prescribing and the withdrawal of RIPEN. OCNMO, with key stakeholders, is finalising a RIPEN Transition Plan for consultation in the near future.

It is anticipated that the Health (Drugs and Poisons) Regulations 1996 (Qld) (HDPR) will be repealed once the Queensland parliament passes new legislation to regulate drugs and poisons.

We expect there will be changes made within the new legislation to support the NMBA’s proposed national prescribing model.

Further changes may also include a state-based solution that will provide an extended practice authority to groups of RNs who currently prescribe under the HDPR, such as RIPEN and authorised nurse immunisers and sexual and reproductive health nurses.

CPD

Delegates supporting RIPEN colleagues RECOGNISING the importance of RIPEN nurses, delegates unanimously passed the following urgency motion at this year’s Annual Conference:

That delegates attending the 2018 QNMU Annual Conference support the continuation of the current model of care provided by rural and isolated practice endorsed nurses (RIPEN) to Queensland’s rural and remote communities.

However, the Nursing and Midwifery Board of Australia's actions has signalled their intent to remove the RIPEN endorsement.

The QNMU requires any proposed replacement model of care in Queensland must be at least equivalent to the health service currently provided by RIPEN to rural and remote communities.

The QNMU calls on the Minister for Health to ensure that those communities are not disadvantaged by any change to the RIPEN model of care, and that a transition plan, including communication and consultation strategies, be developed as soon as possible, and by no later than 31 July 2018.

In consultation with the QNMU and other key stakeholders, OCNMO has developed a Transition Plan to achieve this resolution with forums to be held in September for members.

View the transition plan here: http://bit.ly/RIPENplan

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P R E S C R I B I N G :

RIPEN:

A matter of efficiency

THE REMOTE and Isolated Practice Endorsed Registered Nurse (RIPEN) qualification plays a vital role in delivering essential health services across Queensland’s rural and isolated communities. RIPEN nurses ensure patients receive timely, high quality care in areas where there is often a shortage of medical officers and nurse practitioners.

Under Queensland’s Health (Drugs and Poisons) Regulation 1996, RIPENs may obtain, supply and administer schedule 2, 3, 4 and 8 medicines.

RIPEN nurse Jessica Stecko said nurses with the RIPEN qualification undertook additional training to allow them more autonomy.

Training includes studying the legislative framework in which RIPENs practice, including drug therapy and health management protocols, pharmacodynamics and scope of practice, as well as written assessments and one-on-one mentoring.

“RIPENs reduce the time to treatment for the patient,” Jessica said.

“Working in a remote community in a sexual health role, for example, I was

able to assess and treat the patients immediately, I didn’t have to involve a medical officer.

“When you’re dealing with these sensitive health issues, not having to deal with that third party is really important to the patient.

“I don’t know how they would do that without the RIPEN nurse role […]

The level of treatment we’re giving to patients is quite significant, and I think it’s underestimated how many hours RIPENs save the medical officers.”

Torres and Cape RIPEN Kathryn Dougherty said without the RIPEN qualification, Registered Nurses would be required to call a medical officer for everything.

“One of the skills the RIPEN training covers is performing a thorough assessment,” Kathryn said.

“If a RN does not do this prior to calling a medical officer it is very disjointed clinical communication.

“Whereas with RIPEN, you can do a full assessment before you ring the doctor, you can do the chest x-ray (if licenced) and scan the results through, and check with the doctor

about what you think is required for the patient.”

But it’s not just remote and isolated communities that benefit from RIPENs. Many rural health facilities, such as Atherton, Mareeba, Warwick and Gatton, also rely on these nurses, particularly in Emergency Departments.

“The reason RIPENs are used a lot in the ED in places like these is because the doctors leave town on a Friday and don’t return until Monday,” Kathryn said.

“So on weekends you’re relying on RIPEN nurses to staff the emergency departments.”

Three-pronged governance To ensure the care provided by RIPENs is standardised, there is a three-pronged approach to the model: the legislative framework, which allows RIPENs to administer and supply medications, the course, and the primary clinical care manual.

“Together, those three things keep us safe and the care standardised,” Kathryn said.

The level of treatment we’re giving to patients is quite significant, and I think it’s underestimated how many hours RIPENs save the medical officers.”

Jessica Stecko, RIPEN nurse

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RIPEN nurses at 2018 QNMU Annual Conference:

Lucynda Maskell, Jola George, Shaun Cram, Jess Stecko and Kathryn Dougherty

In remote and isolated health facilities, such regulation is necessary to ensure consistency in patient care.

“Before the RIPEN model was introduced you’d get used to what doctor was on call and what they would prescribe for a certain condition, so there was no standardisation for the management of patient care,” she said.

“I was a RN and midwife and had a neonatal intensive care certificate before I went to a remote area to work and I thought I was safe.

“In a hospital, you’ve got other people around you that perform many of the roles that remote area nurses do, such as phlebotomy, venepuncture, x-rays, prescribing medicines, or making diagnosis from birth to death across many specialities.”

In a remote and isolated setting, however, the RIPEN qualification extends that scope of practice.

Removing the endorsement would leave a serious gap in patient care.

“There would be an increase to demand on medical officers, Nurse Practitioners and Endorsed Midwives to give telephone orders for medications,” Kathryn said.

“That could cause a decrease in quality use of medicines and supply of medications, as it wouldn’t be standardised.”

Replacing RIPEN Regardless of what a RIPEN replacement model may look like, it’s

clear that these remote and isolated communities will not stop requiring the unique care currently provided by these 800 Queensland nurses.

“I’m quite passionate about the RIPEN role and the use of it in rural and isolated areas,” Jessica said.

“In a place where we are quite low on numbers of medical officers and senior nursing staff, it allows those senior nurses with the RIPEN qualification to provide a holistic care episode for their patients.

“Without our qualification, there would need to be an increase in Nurse Practitioner roles or an increase in medical officer hours, whether they’re delivered by phone or face-to-face.”

Karen Cooke and Dianne Esen

References:

Nursing and Midwifery Board of Australia 2018, Fact sheet RN endorsement for scheduled medicines rural and isolated practice, NMBA, Melbourne, accessed 3 August 2018, http:// www.nursingmidwiferyboard.gov.au/CodesGuidelines-Statements/FAQ/Fact-sheet-RNendorsement-for-scheduled-medicines-ruraland-isolated-practice.aspx Nursing and Midwifery Board of Australia 2017, Registered nurse and midwife prescribing, discussion paper 30 October 2017 prepared by NMBA, Melbourne, accessed 13 July 2018, http:// www.nursingmidwiferyboard.gov.au/News/PastConsultations.aspx Nursing and Midwifery Board of Australia 2016, Registration standard: Endorsement as a nurse practitioner, NMBA, Melbourne.

Nursing and Midwifery Board of Australia 2017, Registration standard: Endorsement for scheduled medicines for midwives, NMBA, Melbourne.

Nursing and Midwifery Board of Australia 2011, Registration standard: Endorsement for scheduled medicines for registered nurses (rural and isolated practice).

REFLECTIVE QUESTIONS Looking at the registration requirements for NPs, RNs, midwives and endorsed midwives and RIPENs, as they relate to medication management: 1. How do they compare?

2. What are the differences?

3. How do these registration requirements affect your professional practice?

The Health Professional Prescribing Pathway is the foundation model for the NMBA proposed national prescribing.

1. How would you describe the three model levels of prescribing?

2. Why is the removal of RIPEN endorsement an issue for Queensland, and in particular in the context of your practice?

3. How will the proposed transition plan assist in moving away from RIPEN endorsement?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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CPD

BIT BY BIT:

Improving workers’ comp

T

HE QNMU regularly writes submissions when government, both state and federal, are considering legislative changes. This allows your union to argue in the political arena for law changes that benefit Queensland’s nurses and midwives.

We recently made a submission to the Five Year Review of the Workers’ Compensation Scheme.

One of the objectives considered in the review included whether the scheme provided “a balance between providing fair and appropriate benefits for injured workers” while ensuring reasonable cost levels for employers.

The effectiveness of return-towork programs, as well as other emerging issues impacting workers’ compensation, were also considered in the review.

The QNMU frequently assists members who have sustained workplace injuries and have then accessed workers’ compensation benefits.

As a result, the QNMU can monitor any issues and trends that arise for nurses and midwives who seek representation, and ensure your voice is heard when politicians are considering making legislative changes that ultimately impact workers.

This engagement in the political process is critical for protecting our members.

Members who have ever made an application for workers’ compensation will know that having financial support at this time is essential.

The QNMU is the only nursing and midwifery industrial and professional body that made a submission for this review.

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In our submission, we highlighted that members often suffer a financial loss when injured at work and require workers’ compensation.

We argued that the current definition and calculation surrounding incapacity benefits for shift workers should be changed to provide proper compensation.

Currently, the legislation provides for only 85% of normal weekly earnings for those workers who receive regular penalties and allowances for shift work.

Our submission recommended that workers should be paid the average weekly wage for the 12 months prior to the injury, rather than the current 85% of this average.

The final report was released to government in May 2018. Fortunately, it made numerous recommendations, which the QNMU believes would benefit members if they were adopted through legislative changes to the workers compensation scheme.

Notably, some of our arguments around the need for increased incapacity benefits were recognised in the recommendations within the report, including:

RECOMMENDATION 4.2: The calculation of normal weekly earnings should be changed, by removing references to modes and medians, and instead avoiding the influence of outliers on the statistics by averaging the middle half of pay periods for calculation purposes.

RECOMMENDATION 4.3: The government should hold consultation with stakeholders regarding the appropriate treatment, in the calculation of benefits over the

first 26 weeks, of award entitlements for payments for additional or unsocial hours, with a view to choosing one of three options: abolishing the distinction between award rates and NWE, with a new, intermediate replacement rate; creating a new distinction between overaward and award entitlements and establishing new replacement rates in such circumstances; or maintaining the status quo.

While this is a partial win, the QNMU will continue to advance the interests of our members in any consultation resulting from these recommendations.

REFLECTIVE QUESTIONS Read the Worksafe report and our submission at the following links: ■■ Worksafe report: www.worksafe.qld.gov.au/ laws-and-compliance/workerscompensation-laws/laws-andlegislation/five-year-reviewof-queenslands-workerscompensation-scheme-2018 ■■ QNMU submission: https://bit.ly/2Olf4pt Reflect on how these recommended changes to the workers’ compensation scheme would benefit you if you were required to apply for workers’ compensation.

Familiarise yourself with the process of applying for workers’ compensation by visiting www.worksafe.qld.gov.au Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

CPD

Exploring medication reconciliation at hospital discharge The interdisciplinary research team (L to R): J Hewitt, S Latimer, T Teasdale, C de Wet & BM Gillespie

BY THE INTERDISCIPLINARY RESEARCH TEAM (PICTURED RIGHT), GRIFFITH UNIVERSITY

P

ATIENT safety underpins all medication practice in the Australian healthcare system. However, avoidable medication errors still occur, with the potential to cause patient harm and increase Australian healthcare costs; estimated at $1.2 billion annually.

Medication reconciliation (Med Rec) is a clinical handover and communication process undertaken by nurses, doctors, pharmacists and allied health professionals at care transition points, such as hospital admission and discharge.

Med Rec aims to improve the completeness and accuracy of the patient’s medication list; reducing medication errors and increasing patient safety. Current Australian evidence suggests that although nurses and doctors in hospitals have a role in Med Rec, pharmacists tend to shoulder most of the responsibility.

When patients transition from hospital to the community, their continuity of care and safety relies on the timely, effective and complete communication of medication information between healthcare practitioners. Med Rec at hospital discharge informs the discharge summary and is the opportunity to identify and rectify any medication errors.

Despite the potential value of Med Rec at hospital discharge, little is known about the processes, about healthcare professionals’ perceptions or how this may be improved.

Research plan The overall aim of our three-phase, qualitative multisite study is to better understand the Med Rec process at hospital discharge and its interdisciplinary nature.

Undertaken in a large Queensland Health hospital and across 150 regional medical centres, we will describe nurses, doctors, pharmacists and general practitioners’ perspectives of their Med Rec role.

Phase 1 has two components: interviews and a survey.

First, we will interview healthcare professionals about their role in Med Rec at hospital discharge, identifying any barriers and facilitators.

Next, we will survey general practitioners to find out how they undertake Med Rec, and their perceptions of the accuracy and completeness of the hospital discharge summary medication list.

The results of Phase 1 will inform Phase 2, which involves collecting 60-hours of observational data on healthcare professionals’ Med Rec clinical practices at hospital discharge. Confirming healthcare professionals’ Med Rec clinical practice is important because it will help us to identify practice gaps and inefficiencies. Using the data from Phases 1 and 2, we will develop a process map on Med Rec at hospital discharge; a diagrammatic representation of this interdisciplinary practice.

Phase 3, involves inviting clinical leaders, managers and general practitioners from the hospital and community, to review the Med Rec process map. This expert group will be asked to identify clinical practice gaps and suggest strategies to improve this practice area.

We anticipate our research findings will provide clinicians and hospital managers with a deeper understanding of the complex nature of Med Rec at hospital discharge, and identify potential feasible solutions that can be translated into future clinical practice and improve patient safety and care quality.

References

Australian Commission for Safety and Quality in Healthcare. Medication reconciliation.

Australian Commission for Safety and Quality in Healthcare. Available at: https://www.safetyandquality.gov.au/our-work/medication-safety/medicationreconciliation/.

Manias E. Effects of interdisciplinary collaboration in hospitals on medication errors: An integrative review. Expert Opinion on Drug Safety. 2018.

Roughead E, Semple S, Rosenfeld E. Literature review: Medication safety in Australia.

Sydney: Australian Commission on Safety and Quality in Health Care; 2013: 1-126.

REFLECTIVE QUESTIONS 1. Critically reflect on a situation when you were involved in a medication error or near miss. List your thoughts, feelings and actions at that moment.

2. If you came across a similar situation in the future, what would you do differently?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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CPD

PIV CARE

What you do (or don’t do) matters to patients

BY MARIE COOKE RN, PHD, SCHOOL OF NURSING AND MIDWIFERY, GRIFFITH UNIVERSITY; THE ALLIANCE FOR VASCULAR ACCESS TEACHING AND RESEARCH GROUP, MENZIES HEALTH INSTITUTE OF QUEENSLAND.

Based on Cooke M, Ullman AJ, Ray-Barruel G, Wallis M, Corley A, Rickard CM (2018) Not “just” an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS ONE 13(2): e0193436. https://doi. org/10.1371/journal.pone.0193436

NURSES and midwives care for peripheral intravenous catheters (PIVs) daily in most health-care settings.

Rates of PIV failure before the end of treatment are high (Rickard et al.

2012) and this disrupts treatment and is distressing for patients.

Patient participation and engagement is a core aspect of maintaining safe, quality health service standards.

Understanding patients’ perspectives of the PIV insertion and care experience is a key to developing strategies to engage them in the care of their PIVC. This international, web-based, crosssectional survey was undertaken to establish patients’ PIV experiences.

The online survey consisted of nine likert-type and one open-ended questions.

There were 712 respondents: 570 adult and 142 paediatric (completed by adult carers of children [ACC]) from 25 countries.

■■ Significantly more ACC (82%) described insertion as moderately painful or greater than Adults (52.4%) p <0.001 and reported more difficulty with insertion than adults (ACC 68% vs adults 51%, p <0.001).

■■ There were significantly higher rates of first insertion attempt failures with ACC (64.0%) than adults (39.8%) p <0.001 with 23.0% of children requiring ≥ four attempts compared with 9.0% of adults (p<0.001) ■■ Only a little over half of the adults (66.6%) & ACC (56.2%) reported no cause for concern with PIV but ACCs reported more complications with

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their child’s most recent PIV (33.8%) compared to adults (25.7%) p=0.059 A good proportion (44%, n = 313) of the respondents included a comment about their PIV experiences.

The three themes that emerged from the responses were: ■■ Significance of safe and consistent PIV care — these comments related to concerns around the location of the PIV (eg. flexion sites), importance of infection control practices (eg. hand hygiene, aseptic non-touch technique, decontamination of connectors), inconsistency in PIV care (eg. medication administration), and removal (eg not removed when not needed).

■■ Importance of staff training and competence — responses highlighted importance of having standards for PIV inserters so patients feel safe, using technology guided insertions to improve insertion success and ensuring that staff that insert are expert to reduce number of attempts.

■■ Value of communication — participants identified the importance of assessing the patient’s previous experience with PIVs, however also commented that even when they raised concerns they were frustrated in not being heard and included in care processes.

Promoting active patient participation in relation to PIVs is important to improving outcomes and providing person-centred evidence based care.

We need to focus on outcomes important to patients and on ways to

Providing pain relief for PIV insertion should be standard practice... ensure we truly listen to them and take action to minimise pain, complications and repeated insertion attempts.

Providing pain relief for PIV insertion should be standard practice; site selection should include patient preference and previous history and daily assessment of PIV site should include the patient’s input.

REFLECTIVE QUESTIONS 1. After reading this article, do you feel there are areas for improvement in your practice in relation to PIV care?

2. How do you access PIVs in your clinical practice? Do you include the patient? Explain.

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Rickard CM, Webster J, Wallis MC, et al.

Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet.

2012;380(9847):1066-1074

CPD

Professional boundaries in contemporary midwifery PROFESSIONAL boundaries in contemporary maternity health care is an area of significant contention.

Historically, our understanding of midwifery professional capabilities has been restricted by traditional obstetric boundary control.

Lane (2006) argues that changes in professional boundaries are “driven by new discourses of globalisation, marketisation, managerialism and consumerism”, meaning “professional boundaries in health care are being blurred, reordered and reconstituted”.

While rhetoric around collaboration and interdisciplinary relationships is scattered with maternity service provision, conflicting interpretations of risk, women’s bodies and childbirth pose a significant barrier to midwives defining their own professional boundaries.

Furthermore, ongoing interprofessional power inequities — where decision-making remains within dominant obstetric power structures – presents further challenges to defining these boundaries.

Consequently, midwives are now redefining and challenging these longheld power inequities through changes to work practice and models of care.

Given these changes, it is important for midwives to understand their own professional boundaries.

The Nursing and Midwifery Board of Australia’s (NMBA) code of conduct

for midwives defines professional boundaries as “the limits of a relationship between a midwife and the woman and her infant(s) and any of the woman’s significant other persons.

These limits facilitate safe and appropriate practice and result in safe and effective midwifery care.

Limits of a relationship may include under‑or over‑involvement in the provision of midwifery care”.

Boundary crossings can occur at either end of the therapeutic relationship, where ‘over‑’ and ‘under‑’ involvement are the two extremes of the professional behaviour continuum.

As midwifery scope of practice and models of care continue to evolve and challenge traditional role delineations, the professional boundaries for midwives has become blurred.

Relationship boundaries are more easily interpreted, where we acknowledge the power inequity between the midwife and the woman and her significant others.

A sexual relationship, for example, would class as a clear crossing of professional boundaries. On the other hand, supporting and advocating for a woman who is declining a routine test is part of a midwife’s professional role, yet is often treated by others as crossing a boundary.

The NMBA provides guidance for midwives on professional boundaries, including awareness of relationshipbased woman-centred care and the inherent power inequity (in other words, not abusing that power inequity), awareness of the woman’s context and relationships, and knowing when the relationship ends.

The NMBA also advises that midwives should seek support and guidance from professional leaders when they have concerns relating to boundaries in care relationships.

REFLECTIVE QUESTIONS 1. Consider your current professional context.

What professional boundaries are specific to your working environment?

2. How do you ensure you maintain professional boundaries in your practice?

3. Where would you look to find further information or support on professional boundaries?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Lane, K (2006) The plasticity of professional boundaries: A case study of collaborative care in maternity services, Health Sociology Review, 15:4, pp341-352.

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CPD

Your role as a

witness

BY ROBERTS AND KANE SOLICITORS

A

S NURSES or midwives, we may be asked to give evidence in a range of legal proceedings during the course of our career.

The process of being called as a witness can be overwhelming.

It is normal to feel nervous or have concerns about giving evidence even where there is no question about the appropriateness of your professional actions.

This article will answer some frequently asked questions about being called as a witness, and hopefully alleviate some common concerns along the way.

WHY AM I BEING CALLED AS A WITNESS? Nurses and midwives can be asked to give evidence in a range of legal proceedings for a variety of reasons.

The QNMU can assist you in better understanding the nature and extent of your involvement as the case progresses.

WHEN MIGHT I BE CALLED AS A WITNESS? You may be called as a witness in a coronial inquest, a child protection matter, a civil or criminal case, or a

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Crime and Corruption Commission (CCC) investigation.

have been granted permission by the Coroner.

Similarly, if you have provided information to the Office of the Health Ombudsman (OHO) or the Australian Health Practitioner Regulation Agency (AHPRA) during an investigation into a health practitioner, you may be required to be a witness in the disciplinary proceedings.

As a QNMU member, you may be entitled to legal representation to assist in drafting an affidavit or a statement.

We can also guide you through the process of giving verbal evidence.

If you are asked to be a witness, you should contact the QNMU immediately for advice and support, and if necessary, legal representation.

WHAT WILL I BE ASKED TO DO AS A WITNESS? As a witness, you may be required to provide an affidavit. An affidavit is a written statement of facts for use as evidence in court, which is sworn under oath or affirmation.

You could also be asked to appear in court to give your evidence in person.

If you appear in person in a court proceeding, the parties to the proceeding may ask questions regarding your evidence.

As a witness in a coronial inquest, you may be asked questions by the Coroner, the lawyer assisting the Coroner and persons who have interests in the coronial inquiry who

DO I NEED TO ATTEND COURT? If you are issued with a subpoena, you must attend court on the date specified in the subpoena and provide evidence in person. A subpoena is a court order to produce documents or give evidence at a hearing or trial.

A request to attend a coronial inquest is also a court order that you must comply with.

There are serious consequences for not complying with a court order, such as a subpoena or request to attend an inquest. If you do not comply, you may be found guilty of contempt of court and a warrant may be issued for your arrest.

The process of being called as a witness can be overwhelming.

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WHAT ARE SOME TIPS TO REMEMBER WHEN GIVING EVIDENCE? ■■ Always answer questions truthfully — it is a crime to lie in court ■■ Listen carefully to the questions asked ■■ Take your time to answer questions ■■ Ask for clarification if a question is unclear ■■ Never make up an answer ■■ It is ok to not know an answer to a question ■■ It is ok to not remember an event.

DO I NEED TO GIVE EVIDENCE THAT IS SELFINCRIMINATING? Ordinarily, the privilege against selfincrimination means you cannot be compelled to answer a question that may incriminate yourself.

However, the CCC has special powers which override the privilege against self-incrimination. This means in a CCC investigation you can be compelled to answer a question that may incriminate you.

Similarly, a Coroner may require you to give evidence that would

incriminate yourself if it is in the public interest to do so.

Nevertheless, the self-incriminating evidence provided in the CCC investigation or coronial inquest cannot be used against you in any other legal proceeding, other than a proceeding for perjury.

DO I GET PAID FOR BEING A WITNESS? If you are subpoenaed to appear as a witness, you may be entitled to travel expenses to get to and from court, and to lost earnings as a result of appearing as a witness.

In the same way, witnesses in coronial inquests can be paid witness expenses which are determined by a set scale of fees.

SOME FINAL ADVICE… ■■ If you are called upon to be a witness, you should immediately contact QNMU for support, assistance and if necessary legal representation ■■ Remember that you have the right to seek legal representation before making any statements ■■ Even if your employer offers to provide you with legal

representation, you should insist on independent legal advice to determine whether or not a conflict might exist between your employer and yourself ■■ Finally, the practice of taking accurate, clear and contemporaneous notes is crucial when it comes to drafting affidavits and giving verbal evidence.

REFLECTIVE QUESTIONS 1. In what circumstances can you be called as a witness?

2. Why is gaining independent legal advice when called as a witness important?

3. What is the difference between an affidavit and a subpoena?

4. Describe the only circumstance where the privilege against self-incrimination can be overridden?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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CPD

COLLECTIVISM and the social nature of trees

T

HE QUALITY of workplace relationships determines the health and wellbeing of individuals.

That social connection can protect individuals from risks that may be inherent in work with high job demands or other challenges. On the other hand, poor relationships can be a source of significant long-term and costly injuries in a workplace that might otherwise be safe.

We know that the psychological safety of nurses and midwives directly affects patient safety. There is significant cost to employers, individual workers, families and society when our workforce is exposed to unsafe work environments.

It is estimated that workplace bullying costs Australiaâ&#x20AC;&#x2122;s economy more than $6 billion annually (WorkSafe 2018).

We need to work on prevention.

Fortunately, we donâ&#x20AC;&#x2122;t need to wait for someone more powerful to fix it.

We can start building personal and professional solidarity now.

The power of the collective gives us confidence to act individually to defend standards and advocate for those more vulnerable, whether they are residents, patients, or our colleagues.

Advocacy is not always easy.

Sometimes there is a cost to advocacy when we are challenging dominant power.

But to meet our professional obligations, a nurse or midwife must have the courage to speak out when something is wrong or a situation is unsafe.

Individual patients and the community rely on and trust us to assert ourselves to keep the system safe.

Hostile work environments and insecure employment can make this harder, but we can tap into the power of the collective.

For our professions to thrive we must build personal, industrial and professional solidarity.

Trees vs forests Peter Wohlleben spent his life as a forest manager in the Eiffel mountains in Germany.

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CPD In his beautiful book The Hidden Life of Trees he describes the social nature of trees and the importance of that connection that builds a forest.

extremes of weather, heat, cold or wind, generate humidity, and store water.

Trees are important but when they join together and unite in forests, the sum of the whole becomes greater than its parts.

Regular fatalities would leave gaps in the forest, allowing storms to penetrate and uproot more trees. The heat of summer would reach the forest floor and dry it out.

Forests matter at a more fundamental level than we may imagine.

Wohlleben’s description of them is a great metaphor for discussing our professions and the strengthening of our collective.

He describes trees in forests caring for others – tree parents living with and protecting their young, looking after the weak or struggling by sharing nutrients, and warning each other of impending dangers, even feeding some stumps for centuries after a special (well connected) tree has been cut down.

Of course, some species are individualistic. In other words, they need to be on their own without close neighbours competing for space and nutrients.

Others work as a collective and thrive only as a community, where they share nutrients and protect each other from the elements and other biological threats.

The reason trees share food and communicate with each other is that it takes a forest to create the microclimate suitable for tree growth and sustenance.

Isolated trees have far shorter lives than those living together connected in a forest.

On its own, one individual can’t establish a consistent local climate.

But many trees together can create an ecosystem, which can moderate

To achieve this stability the community must remain intact.

Sandra Eales QNMU Assistant Secretary

Doing better together Nurses and midwives are like forests — we do best with community.

We must rely on and support each other to maintain our professional integrity as well as build individual resilience and longevity.

It requires all of us to maintain standards of practice.

If one nurse gives up the responsibility of advocacy — whether that be ensuring safe workloads or speaking out when care is compromised — then that has a flow-on effect and can be infectious.

All individuals are sensitive to environmental cues. Behaviour can be escalated or de-escalated through the power of peers.

New nurses or midwives quickly learn the culture and the standard of care that is allowed to prevail.

QNMU Local Branches and broader professional networks are a source of strength for our union and should also be our focus to build individual resilience.

Each of us has a role to play in transforming our workplaces, our professions and our society.

Even small changes or actions can create and maintain the broad scale cultural change we need for a safe professional practice environment and thriving workforce.

Nurses and midwives are like forests — we do best with community. We must rely on and support each other to maintain our professional integrity as well as build individual resilience and longevity.

References

Wohlleben, Peter (2016) The Hidden Life of Trees: What They Feel, How They Communicate – Discoveries from a Secret World Black Inc., Schwartz Publishing Pty Ltd Australia Work Safe Australia (2018) Workrelated psychological health and safety: A systematic approach to meeting your duties

REFLECTIVE QUESTIONS 1. How does the psychological safety of nurses and midwives affect patients and patient safety?

2. How does the level of collectivism in your workplace strengthen your professional advocacy?

3. In what ways can you support good workplace culture and patient safety in your workplace?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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2018 QNMU ANNUAL CONFERENCE

indepth

aged care on the agenda A

S A DEMOCRATIC union we listen to what our members have to say. And there was no doubt one issue that stood head and shoulders above the rest for our members this yearâ&#x20AC;Ś aged care.

The QNMU has long campaigned to improve the situation in aged care, but we need our federal politicians to stand up and begin fixing the systemic problems within the industry.

Unfortunately, we can all agree the situation is now dire.

The time for change has well and truly arrived and this yearâ&#x20AC;&#x2122;s conference was the perfect opportunity for hundreds of nurse and midwife delegates from across Queensland to put our heads together and brainstorm solutions to this ever-growing problem.

Aged care was firmly on the agenda and reflected in our conference theme: How do we tap into our collective power as nurses and midwives to change the rules in aged care?

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indepth

6 CPD HRS

AVAILABLE

SEE PAGE 65 FOR DETAILS

SPEAKER HIGHLIGHTS safety and quality of aged care SPEAKER:

Professor Joseph Ibrahim,

Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University PROFESSOR Joe Ibrahim has been working in geriatric medicine since 1990 and undertook his PhD in quality of care in hospitals on readmission indicators.

During his time in the Victorian state coroner’s office, he helped set up the first clinical liaison service to investigate deaths in hospitals.

It wasn’t long before the focus shifted to residential aged care.

Prof Ibrahim said there have sadly been no shortage of cases since investigations first began in 2006.

“Of the 20,000 residential aged care deaths we reviewed, 3000 were injury or falls related,” he said.

“There were also deaths from choking on food, suicide, resident to resident assault… we’re going through cycles of seeing the same things happening over and over again.

“These deaths occurred over 13 years and we continue to see them across every state and in every aged care home and provider type.

“Yes, there are pockets of excellence but [as a nation] we are not delivering the care to people who are the most vulnerable.”

Despite giving evidence at both a Senate and a House of Representatives Inquiry, and sending in multiple submissions, very little action has been taken.

Professor Joseph Ibr ah

im

sitting right at the bottom end of the top 20.

“We’re not where we should be, but it doesn’t mean we can’t do better.”

“Why don’t we do anything? Why doesn’t the rest of the country do anything for the 200,000 older people who are our parents and grandparents?” Professor Ibrahim asked.

Prof Ibrahim said he was aware of the pressures nurses faced in standing up and speaking out.

“We live in a country that is incredibly rich with a healthcare system that is ranked in the top five in the world, but our aged care system is

“If you speak up in a hospital you’re seen as a leader, but if you speak up in aged care you’re more likely to be seen as a troublemaker.

“The nursing leadership is under enormous pressure just to get through the day,” he said.

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indepth

SPEAKER HIGHLIGHTS (CONT...)

“It’s hard to advocate for residents when you’re worried about your job and don’t have support.”

2018 QNMU ANNUAL CONFERENCE

So how do we begin to fix it?

In Professor Ibrahim’s opinion, our Nurse Practitioner workforce should be further developed within the aged care space.

“These are the people who have both the clinical skill set and the ability to work in teams.

They understand nursing care better than doctors who are at a distance,” he said.

power of nursing SPEAKER:

Professor Jill White,

Faculty of Nursing and Midwifery, University of Sydney; Faculty of Health, University of Technology, Sydney; Western Pacific Region Nursing Representative on the Board of the Nursing Now! Campaign

The power of nursing only comes from its social mandate: The provision of safe, quality, compassionate care to all, respectfully.

Professor Jill White explained our nurse power stemmed from two domains: 1. The notion of caring for the sick 2. The tending of the entire environment within which care happens.

We considered the mother of nursing, Florence Nightingale, and her work as an advocate and policy influencer.

She was someone who saw the big picture yet still had a grassroots understanding of nursing… and that’s where our heritage as nurses comes from.

Professor White took delegates on a journey of

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the way hospital culture had changed over the years.

■■ In the 1940s, nurses in the hospital outnumbered those in the community and there was a significant focus on preventative care.

■■ By the 1970s, stays in hospitals were lengthy and there was plenty of opportunity to get to know patients. Hospital outpatient departments provided a sense of continuity of a patient experience.

■■ Things took a turn in the 1980s as nursing began to be seen as a major cost. The language changed from a focus on care and continuity to efficiency and cost-benefit analysis. Unfortunately this was a language nurses had not learned.

■■ Through the 1990s things went downhill further including across comparable countries like the UK, the US, Canada and New Zealand.

In 2001, Claire Fagin from Milbank Memorial Fund was contracted to look at what was going on in hospitals that was making people so unhappy about their hospital experience.

This was identified as: 1. The changed nature of hospitalisation – decreased length of stay 2. Hospital reorganisation – safety and staffing issues 3. Lack of accepted expectations about caregiving – we had not helped the community understand the changes a decreased length of stay would bring.

The United Nations grew increasingly concerned about what was happening in healthcare worldwide.

At this time a new report on global health, called the Triple Impact Report, was released by the All-Party Parliamentary Group (APPG).

Professor Jill White

It made the simple point that: Universal health coverage cannot possibly be achieved without strengthening nursing globally.

Prof White said this was partly about increasing the number of nurses, but also about making sure our contributions were properly understood and enabling nurses to work to their full potential.

To achieve this, the Nursing Now! campaign was launched globally in four continents earlier this year, with the Duchess of Cambridge, Kate Middleton, as a patron.

“The campaign would take place over three years to implement recommendations from the Triple Impact Report,” Professor White said.

“We’ve now gone back to the time of Florence where we aim to influence politically and engage the community. We’re aiming to collect information and share best evidence and nursing stories.”

Priority areas for the campaign include: ■■ Investment in nursing ■■ Leadership, policy and professional development ■■ Evidence and research ■■ Sharing effective practice.

You can get involved with the campaign via www.nursingnow.org or www.facebook.com/ NursingNow2020

indepth

HOW IT ALL UNFOLDED... … And we’re off!

Aged care was front and centre for our diverse line-up of speakers...

We need to change the rules around aged care. If you leave it to multinationals to make decisions, they’ll make decisions to suit themselves and their shareholders.

QNMU President Sally-Anne Jones kicked off our 2018 Annual Conference. Hundreds of nurses and midwives from across Queensland joined us for three days of decision-making on key issues affecting our profession, inspirational speakers and networking.

I’m sick and tired of hearing from families how their grandparents are being treated [in aged care].

Sally McManus, ACTU Secretary

It’s better when achievements are reached based on interests rather than power. If you get an outcome by forcing the hand of one party, it’s not as stable as getting an outcome through shared interests.

Queensland Health Minister Steven Miles reminds us of the state government’s promise to implement legislated ratios in our state government nursing homes.

Anna Booth, Fair Work Commission Deputy President

Psychologist Penny Gordon delved into the topic of power - understanding it and how we can use it to create positive change.

Speaking out

6 CPD HOURS AVAILABLE

Members can watch recordings of conference speaker presentations and answer reflective questions on our CPD Portal.

www.qnmu.org.au/CPD

Some of our aged care members bravely spoke out about the crisis in our aged care facilities, and they all agree... we need EVERYONE - every nurse, midwife, health professional and community member - to support our call for ratios in aged care.

Only together can we hope to achieve real and tangible change.

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2018 QNMU ANNUAL CONFERENCE

in view

66

Thank you to all our delegates for another successful Annual Conference! Aged care was firmly on the agenda, and weâ&#x20AC;&#x2122;ll be spreading our message for ratios in aged care far and wide through our collective voice.

WHAT'S THE HARDEST PART OF BEING A NURSE?

in view

The emotional baggage we take home… you don’t realise it builds up, and often we don’t look after ourselves properly.

Tracy O’Sullivan, RN, Mater Private

Our photobooth was a big hit this conference…

Looks like we’ve got some models in the making!

Keep an eye out for it again at next year’s conference.

Standing up for what’s right without the fear of repercussion or negative consequences from management – particularly for new grads.

Esmee Duncan, RN, Townsville Hospital

Standing together and giving our patients a voice who can’t fend for themselves can be challenging, particularly our mental health patients, who are often the most marginalised patients that we have.

Wendy Frankish, Mental Health nurse

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in view

A trip down memory lane Nurses from the old Townsville General Hospital recently took a trip down memory lane! They toured the new Fulton Garden Apartments which has been built on the old TGH site, sharing memories of camaraderie and laughs from back in the day.

Happy first birthday!

Happy first birthday to Cairns Hospitalâ&#x20AC;&#x2122;s birth centre! Weâ&#x20AC;&#x2122;re super proud of all the mums who have brought their beautiful bubs into the world and all our amazing members who helped them.

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standing up for aged care

in view Aged care pop-up stalls You may have seen us out and about recently at the Bribie Island shopping centre with our ratios for aged care reusable bags!

Thanks to everyone who shared their aged care stories with us.

Blue Haven Lodge The more union members there are, the stronger our collective power! With about 80% of staff at Blue Haven Lodge signed up as QNMU members, they’re proving that we can achieve fantastic things when we stand together.

Proserpine Nursing Home Members at Proserpine Nursing Home have gone all out in their bid to support our ratios for aged care campaign. They’ve even signed up three local businesses to become aged care ambassadors in the Proserpine area – well done!

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incoming On our 2018 Annual Conference LJ Being a junior nurse it was not only a pleasure but also an honour to be surrounded by so many hardworking and knowledgeable nurses and midwives who shared the same common values and beliefs when it comes to safe nursing care.

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KW First conference for AMHU Toowoomba branch! We found the conference both inspiring and empowering, and look forward to being supportive advocates for the QNMU and its AMHU members. We found it so nice to be around positive, strong nurses.

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LK My first conference I think was in 1988 or 99 and this may have been the last. Such an inspiring experience each year. Very proud to be a part of such a fantastic group. Keep up the good fight QNMU. Like · Reply

JJ My first conference. Very impressed with the whole three days. The main thing I took away from the conference is that the collective can be extremely powerful. So very proud to be a nurse and a member of the QNMU. Like · Reply

On Queensland hospitals banning junk food and sugary drinks JH I’m not going to lie. I rely heavily on the vending machines to get me through night shift.

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SK This seems a bit OTT especially for the people stuck in there for long stays.

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PC Who is going to “police” the ban? I work in an open unit where our patients do their own shopping.

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TT Can’t hurt. A bottle of water quenches thirst better than a sugary drink.

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SO I wonder when they’ll cut down the carbs.

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ONTH COMMENT OF THE M As a virgin QNMU Conference-goer I reckon I lucked out as by all accounts this was the best one yet… I have a fire in my belly that I never knew I had and my squeak is becoming a ROAR!!

JOIN THE CONVERSATION Follow our social media pages and be a part of the conversation on hot topics and what’s important to nurses and midwives.

/qnmuofficial

incoming On whether the Lady Cilento Children’s Hospital should undergo a name change

Letter to the Editor

ML Don’t change the name. The money could be spent much more wisely elsewhere. With all the talk on radio and television I’m sure everyone who didn’t realise it was public does now.

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JT Change it! It’s basically called the Queensland Children’s Hospital anyway.

Just needs the signage changed.

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MMP Why not just add public into the name?

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AW As a nurse and the mother of a seriously ill child who has spent a lot of her life in LCCH, I can think of so many other ways the money it will cost to change the hospital’s name could be spent.

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To our comrades at The Prince Charles Hospital: Following your recent protests to encourage Queensland Health to make staff parking more fair and equitable, we would like to congratulate your team on their dedication to the cause.

We wish to thank you whole heartedly and assure you that your actions in this matter have been greatly appreciated by our branch and members.

We salute TPCH QNMU Branch and members for going above and beyond to help benefit Queensland’s nurses and midwives. We appreciate your stoic approach to this matter and reminding not only our state government but the people of Queensland that nurses and midwives have a strong voice and are not afraid to stand for what we believe.

Your branch should hold your heads high. The contribution of QNMU representatives Janelle Taylor and Deb Ranson are inspirational to many members throughout the state and motivates us all to stick to our guns and have faith in our strength as a union.

TO On ABC News last night parents of sick children said they would rather the money [be] spent on resources or opening up more beds rather than changing the name of the hospital.

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Please accept our kindest regards and congratulations.

LO I think they just need to educate parents and promote that it is a public facility.

QNMU Nambour/SCUH Branch

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CALENDAR Brisbane State High School Reunion

Graduating classes 1970 - 1974 There will be a gathering early next year of Brisbane State High School past students who attended our school between 1970 and 1974.

Our committee is chasing up email addresses for these past students so that we can organise this gathering.

If you are interested in attending please send your current email to bshs1974gathering@gmail.com

September Congress of Aboriginal & Torres Strait Islander Nurses & Midwives (CATSINaM) Professional Development Conference

33rd Euro Nursing & Medicare Summit

Accelerating Innovations & Fostering Advances in Nursing and Healthcare 8-10 October, Edinburgh, Scotland https://europe.nursingconference. com/

2018 National Employment Solutions Conference

8-9 October, Tweed Heads www.employmentsolutions.net.au/

National Mental Health Week 8-14 October www.mentalhealthvic.org.au/

QNMU Meeting of Delegates 9 October, Rockhampton 10 October, Mackay www.qnmu.org.au/MOD

19 September, Cairns 20 September, Townsville 25 September, Toowoomba 27 September, Birtinya www.qnmu.org.au/MOD

3rd International Conference on Pediatric Nursing and Healthcare

Exploring Innovations and Latest Advancements in Pediatric Nursing and Healthcare 21-22 September Vancouver, Canada https://pediatricnursing. nursingconference.com/

Australian Public Health Conference

26-28 September, Cairns www.phaa.net.au/events/ event/australian-public-healthconference-2018

2018 National Eating Disorders & Obesity Conference

26-28 September, Tweed Heads https://eatingdisordersaustralia.org.au/

22nd Nursing Network on Violence Against Women International Conference

Transforming Health Services, Policies and Systems through Research, Education, Innovation and Partnerships 26-28 September, Ontario, Canada www.nnvawi.org/

October 51st World Nursing Leadership & Management Conference Exploring the leadership practices in nursing and management 4-5 October, Moscow, Russia https://nursingleadership. nursingmeetings.com/

Australian and New Zealand Society of Occupational Medicine (ANZSOM) Annual Scientific Meeting 2018 Perspectives in Occupational Health 7th-10th October, Melbourne www.anzsom.org.au/annualscientific-meeting/asm2018

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Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 31 October–2 November Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

November Together Achieving Better Health Conference

2018 Nursing Summit - Eastern Caribbean

QNMU Meeting of Delegates

Leading primary healthcare in a challenging world 20-22 September, Cairns www.cranaconference.com/

Heading west: focus on children and young people’s health 25-26 October, Perth www.accypn.org.au/Conference/

7-9 November, Penrith, NSW www.nbmlhdconference.com.au/

17-19 September, Adelaide http://catsinam.org.au/

International Rural & Remote Nursing & Midwifery Conference in conjunction with CRANAplus 36th Annual Conference

Australian College of Children & Young Peoples’ Nurses Conference

World Mental Health Day 10 October www.1010.org.au/

42nd International Hospital Federation World Hospital Congress

10-12 October, Brisbane http://event.icebergevents.com.au/ whc2018

The Latest Advances in Health Care Delivery and their Implication for Nursing Practice.

10 November-18 November 2018.

The content will be both relevant and of interest to nurses working in the acute hospital setting, community health, public health, aged care, and doctor surgeries. As well as those nurses working in the area of policy development, health education, and nursing research. We will explore a number of different ports and you will spend time with fellow nurses in an exclusive setting, on one of the most exceptional ships sailing in the Caribbean - the Harmony of the Seas. www.nursesfornurses.com.au/events

15-17 October, Hobart https://anzmh.asn.au/rrmh/

Discover the difference 20-21 October, Launceston, Tasmania www.aansa.org.au/

2018 Transplant Nurses Association National Conference 24th – 26th October, Sydney www.tnaconference.com.au

44th International Mental Health Nursing Conference 24-26 October, Cairns www.acmhn.org/

Wounds Australia National Conference

Advancing Healing Horizons: Towards the cutting edge in wound care 24-26 October, Adelaide www.woundsaustralia.com.au/home/

December 2018 STOP Domestic Violence Conference

3-5 December, Gold Coast https://stopdomesticviolence.com.au/

World Congress of Cardiology & Cardiovascular Health 5-8 December, Dubai, United Arab Emirates www.world-heart-federation.org/ wcc-2018/

2019 42nd Australian Association of Stomal Therapy Nurses Conference

Power of connections – coming together 17-19 March 2019, Sydney www.stomaltherapyconference.com/

15th National Rural Health Conference

24-27 March 2019, Hobart Tasmania www.ruralhealth.org.au/15nrhc/

International Society of Nephrology’s Biennial World Congress of Nephrology

24th World Congress of Dermatology

21st Australian College of Nursing National Conference

4th Australian Association of Nurse Surgical Assistants Conference & AGM

14 November www.idf.org/worlddiabetesday

Enriched family - enhanced care 5-8 May 2019, Auckland, New Zealand www.coinn2019.com/

2018 Australian Rural & Remote Mental Health Symposium

Transforming leadership – Nurses as change agents for non communicable diseases in the Pacific 15–19 October. Rarortonga, Cook Islands www.spnf.org.au

World Diabetes Day

Council of International Neonatal Nurses Conference

9-19 October, Papua New Guinea https://goo.gl/EhA7qG

19th South Pacific Nurses Forum hosted by Cook Islands Nurses Association Aotearoa

28-20 November, Hobart, Tasmania https://anzfpconference.com.au/

12-15 April 2019, Melbourne www.isnwcn2019.org/

Perioperative Nursing Conference

Coming of age 15-18 October, Perth www.midwives.org.au/

8th Biennial Australian and New Zealand Falls Prevention Conference

A new era for global dermatology 10-15 June 2019, Milan, Italy www.wcd2019milan.org/

Remembrance Day 11 November

22nd International Conference on Global Nursing Education & Research Innovation & advancements in nursing education and research 12-13 November, Melbourne https://nursingeducation. conferenceseries.com/

Lung Health Promotion Centre at The Alfred Smoking Cessation Facilitator’s Course 15–16 November Spirometry Principles & Practice 22–23 November Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

Occupation, Health & Safety Conference

Friday 16 November, Melbourne Contact events@anmfvic.asn.au or call 03 9275 9333

Hospital in the Home 2018 Conference

21-23 November , Brisbane http://hithsocietyconference.com.au/

Lowitja Institute Indigenous Health & Wellbeing Conference

17-20 June 2019, Darwin, NT www.nirakn.edu.au/event/2019lowitja-institute-internationalindigenous-health-and-wellbeingconference/ or E: communications@ lowitja.org.au

International Council of Nurses (ICN) Congress 2019 19 June - 1 July, Singapore www.icn.ch

19th International Prader-Willi Syndrome Organisation (IPWSO) Conference 13-17 November 2019, Havana, Cuba www.ipwso.org/conferences

If you would like to see your conference or event on this page, let us know by emailing the details to inscope@qnmu.org.au

It’s gOOd tO knOw yOu’re In safe hands QNMU members benefit from FREE hotline support with Member Connect when you need assistance.

Our Member Connect team are all nurses or midwives with extensive experience and backgrounds in midwifery, mental health, aged care, education, paediatrics, surgical and cardiac nursing.

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