InScope No11 Spring 2019

The official journal of the Queensland Nurses and Midwives’ Union

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Spring 2019

Ratios are saving lives in Queensland

PLUS!

CPD CONTENT ON CONSENT IN DEMENTIA CARE, HAND HYGIENE, NURSING AND PARAMEDICINE DUAL REGISTRATION

G S IN ER M ONEMB COSOMU M N

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C MMUNITY

YOUR ISSUES YOUR DISCUSSIONS OUR PROFESSIONS

An exciting new online community is coming for QNMU members‌ Connect with thousands of nurses and midwives across Queensland no matter where you are.

Ask your burning questions, hear from peers and experts, and chat about the issues that matter to you.

Read industry updates, get work-related advice, and find out what other nurses and midwives are doing around the state.

Share ideas, images, videos and documents in your private online community

QNMU Community will be launching soon.

Keep an eye on your emails for more information.

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Spring 2019

INDEPTH

Hollywood calling: Nursing with the stars

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.

INDEPTH

14 18 22 26 31 32 34 38

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Ratios are saving lives in Queensland Nurse Practitioners.

Leading through excellence Going digital. The road to modern patient safety

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CPD

Closing the cultural gap Green Warriors take on climate change The Rapid Results Program: A quiet achiever Hollywood calling: Nursing with the stars 2019 QNMU Annual Conference

PRINTED BY Kingswood Print Signage, 80 Parramatta Rd Underwood 4119

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ED staff stressors: Challenges and opportunities

54 58 60 64

Blood collection: Hand hygiene practice guidelines

Consent in dementia care Dementia and delirium Wound, medication and pain management in aged care settings

RUOK? Day: Ask the question.

Maintaining dual registrations in nursing and paramedicine The value of advocacy

REGULARS

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INSIGHT

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TEA ROOM

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WINS

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JUST IN

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NOTES FROM THE NORTH

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IN VIEW

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INCOMING

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CALENDAR

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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.

Cover photo: Mother and daughter Nadine Vinson (left) and Judy Toplis, Townsville Hospital. Nadine was also an Annual Conference new grad scholarship recipient.

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insight

Sally-Anne Jones QNMU President

Getting our voice heard

I

N JULY this year we celebrated the 38th Annual QNMU and ANMF QNMU Branch Conference – the theme of which was Getting our voice heard –Ratios and beyond.

It was a special event this year, as Conference was able to acknowledge and honour the 90th birthday of Uncle Bob (Dr Robert Anderson) – a treasured union colleague and respected Elder who welcomes us to Country each year.

As always, Conference is the mechanism by which the Delegates representing Branches from across the State in all sectors come together to shape the actions, direction and focus of our union for the next 12 months and into the future.

A range of excellent speakers provided us with much to contemplate as we take our next steps into the 4th Industrial Revolution – the Digital Age. In the month that marks 50 years since humans first stepped on the moon, we reflected on the changes in technology that got them there and contemplated our emerging reality, technology being developed right now – a helping robot that will bathe and hug you; and a humanoid clinic “nurse” who converses using algorithms.

When we are confronted with such things, it is our voice that is essential to keep the system human and safe.

Nursing and midwifery values – professionalism, caring, advocacy and holism – are irreplaceable no matter how much technology is injected into our lives.

And though it is sometimes hard to articulate, apart from clinical skills, safety and therapeutic interventions, nursing and midwifery holds space for others’ healing and provides presence

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that cannot be measured or audited or reported upon.

It is only by getting our voice heard by being constant, persistent, telling powerful personal stories with which our professions are rich, designing solutions and building economic literacy that we can continue to keep patients, the communities we serve, and nursing and midwifery strong and leading health reform.

We have done this with ratios around the world, we have done this in our aged care campaign around the country, we have done this in our EBs, we have done this in our workload concern reporting, we have done this in our wards, tearooms and at Conference!

Although we don’t always succeed, we do know how to get our voice heard with each other but it is time to bust out and beyond!

Getting our voice heard - Ratios and beyond is not how much you say, it’s the clarity with which you say it – how often, how connected to our purpose and how authentic. Our collective voices are louder than a sonic boom!

In getting our voice heard, our role as nurses and midwives AND unionists is to make the successes and failures of the system visible; to highlight the stake in it that we share

by growing our membership and understanding within the community; to be constantly looking for possibility and opportunity; to tell others about the consequences of inaction so it is truly understood; to present the value proposition of nursing and midwifery.

We are more than care: nurses deliver nursing; midwives deliver midwifery – knowledge, skills, critical thinking, safety, advocacy and presence… so much more than care.

Raising our voice is easy… getting it heard is harder. The path ahead of us is full of possibility if we are willing to be everywhere speaking our truth.

QNMU COUNCIL secretary :

Beth Mohle

assistant secretary : president :

Sandra Eales

Sally-Anne Jones

vice president :

Lucynda Maskell

councillors :

Julie Burgess Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Michael Hall Raquel How Shelley Howe 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

Beth Mohle QNMU Secretary

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T SEEMS like a long time ago that Queensland became only the fourth jurisdiction in the world to make minimum ratios law.

patient outcome data from hundreds of thousands of Queensland patients.

We also need vigilance to ensure proper implementation.

And the results speak for themselves.

From the beginning, our campaign was ambitious. We had a staggered, evidence-based plan to establish minimum staffing numbers and skill mix… and the mechanism to achieve this was ratios.

Since July 2016, ratios have resulted in:

I know it is exhausting and disappointing that we must fight for what is needed (and indeed legislated), but that is the nature of the struggle.

Ratios are about securing a guaranteed safety net. No nurse or midwife wants to fight for safe staffing every shift. What we do want is for our professional judgement about what is safe to be valued and respected.

So on 1 July 2016 legislated ratios began rolling out in 27 prescribed medical and surgical wards in Queensland Health – just three short years ago.

The campaign for ratios across all sectors is ongoing today.

But three years on, we have reason to pause, reflect and celebrate what we’ve achieved.

We now know in no uncertain terms that ratios have not only saved lives, they have also saved money.

A critical component of ratios in Queensland Health was an independent evaluation of the roll out.

This first-of-its kind ’gold standard’ prospective evaluation was conducted

by University of Pennsylvania’s (UPenn) Centre for Health Outcomes and Policy Research, and Queensland University of Technology (QUT).

The evaluation involved establishing a baseline prior to ratios implementation then an evaluation one year and two years post implementation.

It involved surveying thousands of nurses and analysing de-identified

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255

deaths avoided

readmissions avoided

29,200

Up to

hospital days avoided

$81m saved

To read more of the findings, turn to page 14.

Evidence is our friend and we now have some remarkable evidence from Queensland that will form the next phase of our ratios campaign, which will be launched in advance of next year’s Queensland election.

The evidence is clear and backs up what nurses and midwives know through our daily lived experience and expert clinical judgement.

Unfortunately, some will try to undermine both these findings and your expertise. This is a highly contested space and powerful forces will vigorously oppose our ratios campaign, especially those whose predominant interest is in the short term and the dollar bottom line.

We need to be ready for this, armed with the evidence and our own stories about how we save lives every day.

We need confidence and courage to do this.

Things are rarely conceded or handed to us on a plate. It is impossible to fight these battles alone and that’s why unions exist. We are stronger when we fight together.

So many brave members are already taking a stand to ensure compliance with both the BPF and ratios. For example, in the last 12 months alone there have been 36 local workload disputes across the state that secured over 170 additional FTE staff, costing an estimated $17 million per annum.

The campaign for ratios is also gathering pace in other sectors, especially in aged care.

As a result of our campaign, the Queensland government has already committed to implement ratios in its 16 State Government nursing homes and in its acute mental health facilities. They have also committed to establishing public reporting of staffing numbers and skill mix for private nursing homes, and those facilities that do not report will be publicly ‘named and shamed’.

This transparency around staffing numbers is another key component of our Ratios Save Lives campaign that we firmly believe will greatly assist to advance our campaign in the private sector.

These are exciting times and the momentum is building. Let’s pause and celebrate together what we have achieved to date before we prepare for our next phase of this essential campaign.

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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.

Working short shifts? Know your rights MANY NURSES and midwives are reporting to the QNMU that their employer has started introducing six-hour shifts. This in turn increases the number of days you work. Concerningly, members still end up working a full eight-hour shift (or more) anyway, due to having to stay back thanks to unreasonable workloads.

Q: What can I do if my employer is rostering me on six-hour shifts?

A: Some nurses and midwives do in fact like six-hour shifts. If able to leave on time, it allows flexibility around other commitments.

But for nurses and midwives who usually work eight hours but management starts imposing sixhour shifts, the change might feel artificial and unnecessary. That’s often because it is. Although the roster states a six-hour shift, the expectation and the reality is that the work goes well beyond six hours and management just expects you to stay.

This is an unfair and unreasonable way of running a unit and is not best practice rostering.

Take these steps to address unreasonable rostering of short shifts: 1. Look at the roster pattern. Note which shifts have been shortened.

2. Check with your colleagues. Is their work also continuing beyond six hours and are they being required to stay beyond the end of the rostered shift? Which shifts and for how long?

3. Arrange a meeting with your Nurse/Midwife Unit Manager.

Clearly outline the issue, including:

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i. When the roster is issued with six-hour shifts, advise the relevant manager in writing that you will not be available to work beyond the six hours rostered.

Also notify any other relevant staff. ii. At the beginning of the shift, again remind all relevant staff that you will be leaving at the end of your rostered shift. iii. Leave at the end of your rostered shift.

Q: What if the Manager says I can’t leave or there is no-one to replace me?

A: If you have taken all the steps outlined above, you have fulfilled your obligations as an employee. Unless something unforeseeable arises during the shift, you are perfectly entitled to leave at the end of your rostered shift. If your employer seeks to take any adverse action against you, immediately contact the QNMU for assistance.

Q: What is something that would be considered unforeseeable?

A: Something unforeseeable is something that could not be predicted or is something very unusual that does not normally occur in your area of work. It occurs without notice.

Examples of something unforeseeable might include: ■■ A fellow employee falls ill during the shift.

■■ A major complication that could not be predicted.

i. The number of shifts that are short.

Examples of something that is foreseeable:

ii. The hours you and others have worked beyond the shift.

■■ Theatre lists that regularly run over or are added to.

Reach an agreement: If you have questions about our Tea room column email memberconnect@ qnmu.org.au

provided with the evidence, take the following steps:

i. Request your future rosters reflect actual shift lengths. ii. Confirm the agreement for eight hour (or more) shifts in writing.

4. If your NUM/MUM refuses to alter the rosters even after being

■■ A nurse or midwife who has called in sick and given adequate notice for a replacement to be rostered.

Remember: An employee can be directed to work ‘reasonable’ overtime at overtime rates. You cannot be directed to work ‘ordinary hours’ beyond what is agreed on your roster.

wins

OVER $82,000 recovered in Nauseous Allowance

PERSONAL Care Workers at Arcare will finally receive the Nauseous Allowance – an entitlement they should have received since 21 March last year.

Members raised the questions about their right to the allowance in July 2018.

Nurse Navigators here to stay IN A WIN for nursing and midwifery excellence, Nurse Navigators – an innovative role unique to Queensland – are now permanently funded thanks to the QNMU’s lobbying.

Since we secured a commitment from the Palaszczuk government to introduce these roles in 2015, hundreds of Nurse Navigators have provided expert and specialised care across Queensland.

But until now, the future of these roles has remained in doubt, with many Nurse Navigators employed on temporary contracts.

Now the Queensland government has committed to ongoing funding for these roles, meaning the 400 Nurse Navigators will be permanently employed across Queensland.

These highly skilled roles are all about saving lives and improving patients’ health care journeys by creating a more streamlined and simpler experience, which in turn saves our health system vast amounts of money.

Already the Nurse Navigator program has proved successful, resulting in significant reductions in ED visits, total bed stays, readmissions and more.

The QNMU is proud to have campaigned for these roles since 2014, and are pleased our Nurse Navigator members will be able to continue their vital work with the benefit of job security.

Nurse Navigators (L – R): Nicole Bofinger, Shona Fitzpatrick, Claire Lake, Katie Howard, Karen Turner, Vena Beetson, Samantha Horgan and Maria Ronan.

The QNMU and Arcare agreed to seek guidance from the Fair Work Commission (FWC), where it was agreed the allowance would be backdated at a rate of 50% to the approval date of the Enterprise Agreement in March.

As of 31 July 2019, all PCWs have received their backpay.

We estimate the total amount paid to PCWs across Arcare was more than $82,000.

Arcare is currently arranging how it will be claimed on an ongoing basis.

This fabulous win is all thanks to members speaking up and pursuing what they knew was right.

This particular entitlement recognises the challenging nature of these carers’ work, and without their persistence and collective work, we wouldn’t have achieved this excellent result.

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 work with you to secure wins like the ones you’ve read today!

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Cairns ED crisis sees nurses close beds… and win T

HE IDEA of taking industrial action to resolve unsafe working conditions is not something that comes naturally to us nurses and midwives. Typically, we prefer to negotiate and work with management to find a common-ground solution.

But following months of delays in the face of extreme workloads, fatigue and compromises to patient safety, nurses at Cairns Hospital Emergency Department were left with no choice but to act – including taking the significant step of closing beds.

Now, patients are safer and nurses are able to deliver quality care, thanks to our members securing an extra 8.6 FTE nurses.

Crisis point The situation goes back more than a year, when Cairns Hospital ED began experiencing a dramatic influx of patients.

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After the QNMU reviewed the Business Planning Framework (BPF) – which calculates a unit’s supply and demand, and informs safe workloads – it became clear the department was suffering chronic understaffing.

In fact, the ED was operating under the 2016/17 BPF, and presentations had increased by 4% since then.

QNMU Delegate and Enrolled Nurse David Beckham described the stress of not being able to care for his patients due to insufficient beds.

“Patients were getting upset and aggressive, so [the situation] was putting everyone else at risk as well as ourselves.”

Nurses were working excessive overtime and double shifts, rosters were being published with significant deficits (in particular, one roster contained 219 deficits for a four-week period for 180 staff), and there was no backfill for emergent leave.

At its worst point, members reported there being 40 to 50 patients in the waiting room with just one nurse.

Workload forms, petitions Eventually, nurses decided enough was enough and, through the QNMU, decided to act.

David said the decision was always driven by the safety of the patients.

“As nurses we advocate on a daily basis for our patients, it wasn’t like we were advocating for a pay increase,” David said.

“It was all about trying to give the community the care they required.”

It didn’t take long for the message to get around that something needed to be done.

“Every handover we’d discuss it, staff would discuss it in their own time, there were emails and Facebook messages going around.

wins “As a collective we decided we’d do workload forms and start a petition.

“There were definitely a lot of staff who were worried about the consequences of what would happen, especially when you start putting your name to workload forms and petitions.

“It took a bit of support and reassurance from our union to ensure people understood that members are protected and we do have rights.”

The petition received 107 signatures in the first hour alone. But it still wasn’t enough to make management listen and act.

Closing beds The decision to close beds – something that all nurses and midwives have the right to do if patient safety is compromised – was not taken lightly.

“We were heavily supported by union staff and our Organiser was contactable around the clock,” David said.

With the support of medical staff, nurses closed beds in both the short stay area and the discharge stream.

The priority was to get more staff in the acute areas.

“It was a big decision to take, but we had to because as a group we knew we had to prioritise certain patients.”

Management then put on an extra two nurses, which led to staff reopening another four beds.

Unfortunately, this was just a temporary solution that still did not address the underpinning problem of understaffing.

Getting results While nurses were closing beds, the QNMU simultaneously took the case to a stage five grievance in the Queensland Industrial Relations Commission. Numerous members flew to Brisbane to participate in the many hours of conciliation.

“There’s no way in the world we would’ve moved forward without that reassurance that what we were doing was the right step.

Ultimately, another review of the BPF determined that an extra 8.6 FTE were required for the ED. Management agreed to fund the positions. By June they were fully recruited.

“We followed a step-by-step process that the union supplied to us – you contact management and advise them that you’ll be closing beds due to the number of patients and deficits, and for the safety of everyone.”

It goes without saying that none of this could have been achieved if it weren’t for the collective efforts of all nurses in the Department. Closing beds and achieving an extra 8.6 FTE is not something that can be accomplished through the actions

of a few individual nurses – nor is it something the QNMU can achieve without members acting on the ground.

“We’ve always been good at supporting each other, but I don’t think anyone realised how far we could go,” David said.

“It was quite a proud moment to be part of a team where we came together as a group and made such a big difference.

“So much responsibility is placed on our shoulders to advocate for our patients and really push to ensure we get what we deserve.

“If this shows anything, hopefully it’s that we don’t have to sit back – we can stand up to get what the community deserves.”

While this is a significant win, we understand there are still various ongoing issues in Cairns Hospital regarding infrastructure and overcrowding. We are working with members and management to resolve these issues.

It was quite a proud moment to be part of a team where we came together as a group and made such a big difference.

David Beckham, EN

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AINs & PCs refuse to do kitchenhands’ jobs AINS AND PCs at Carinity Wishart Gardens have collectively refused management’s instruction to do the work of kitchenhands after some kitchen staff were made redundant.

activity. However, management claimed the activity was illegal, and applied to the Fair Work Commission (FWC) for an order against the QNMU and members.

The kitchenhands’ work included taking food from a bain-marie, putting it on plates, and delivering it to residents.

After hearing evidence from QNMU Workplace Representative Julie Morris, the FWC dismissed management’s claim, deciding that the AINs and PCs had continued to do their work and that the collective refusal was not illegal industrial action.

AINs and PCs circulated a document for each carer to sign to say they would not take on this work, as it would interfere with their role of providing essential nursing care, such as showering residents. It was decided that the collective refusal would be implemented if at least 70% of AINs and PCs signed.

That target was quickly achieved, and the QNMU notified management of the collective refusal and noted that it was protected industrial

As a result, AINs and PCs are continuing to hold their ground by refusing to take on the work of kitchen staff.

This is a great win for the residents of Wishart Gardens and for our members, who are already hardpressed for time caring for those residents.

Higher casual penalty rates confirmed in Nurses Award A NEW BENCHMARK has been set for how casual penalty rates are calculated under the Nurses Award for weekends, public holidays and overtime.

That’s thanks to the QNMU pursuing a fairer agreement for Opal Aged Care members through an appeal in the Fair Work Commission (FWC).

In April this year the QNMU lodged a formal objection to the agreement Opal was offering staff, largely on the grounds that their agreement still contained provisions inferior to the Award.

One of the key sticking points was the calculation of casual penalty rates in Opal’s agreement, which we argued was based on a flawed interpretation of the Award and ultimately resulted in less pay than the Award.

We argued that the “ordinary rate” for casual workers, to which the penalty rate must be added, is the base rate plus casual loading, not

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just the base rate or ordinary rate for permanent staff.

The FWC initially approved the agreement with all its flaws, but we took the matter on appeal. Not only did the full bench quash the agreement on appeal, finding it was substandard, it also confirmed our compounding calculation of casual penalty rates.

As a result, this new and improved interpretation sets a new standard for all employers of nursing staff employed outside the Queensland government.

Ultimately, it means higher wages now for casual nurses and AINs who do not have an enterprise agreement (EA), and potentially higher wages for members under an agreement in their next EA. We encourage all members to check the wage rates they are being paid according to their payslip, and that those rates are no less than the entitlements in the applicable

agreement or Award. The QNMU will also urge employers and the FWC to ensure all future aged care agreements entitle casual employees to penalty rates that are no less than Award rates, calculated on the proper (higher) method.

Other unions keeping watch The FWC’s ruling also has flowon effects for other industries.

Another union is prosecuting a case in the FWC arguing that the same standard for calculating casual penalty rates should be applied to the Award that covers workers in hospitality, restaurants and licenced clubs.

It’s an issue that, according to a FWC issues paper, could extend to industries such as education, aviation (cabin crew), security, cleaning, agriculture and hospitality.

We hope workers in these other industries share in our success and achieve a fair outcome.

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ATTACK ON WORKERS’ RIGHTS The research is in…

A WORLD-FIRST evaluation of the effects of ratios has revealed since July 2016 there have been:

145 deaths avoided

29,200 hospital days avoided

255

readmissions avoided

Up to

$81m

Going behind the scenes WE WERE PLEASED to welcome this year’s Anna Stewart program winners – Aged care activist and AIN Sherree Clarke and Rail Tram and Bus Union activist Kristee Helm.

Sherree and Kristee spent a week with us visiting different workplaces, experiencing our dayto-day work and going behind the scenes of the QNMU to see how the wheels turn in our union.

saved

Proof that ratios do save lives and money.

Ratios for stateowned nursing homes

Speaking on the ABC’s 7.30 program, Federal Manager of Opposition Business Tony Burke said the proposed Bill would have wide-ranging consequences for all workers, including nurses and midwives.

Under the proposed Bill, the same extreme standards would not apply to employers or businesses, despite ongoing instances of wage theft and worker exploitation.

Kristee Helm

The International Centre for Trade Union Rights also slammed the Bill in a report last year, arguing that it violated two separate international laws, had no equivalent in an industrial democracy, and was most akin to laws that exist in authoritarian, anti-democratic regimes.

The state government has agreed to legislate for 3.64 hours of nursing per resident per day, with a required skill mix of 30% RNs, 20% ENs and 50% AINs. More info on page 17.

The proposed Bill, which failed to pass federal Parliament last year, would give the government, employers, or any other party with ‘sufficient interest’ the power to intervene in the running and work of unions, disqualify people from union leadership, block union mergers, and more easily deregister unions.

“It will make a difference to a group of nurses if they took unprotected industrial action for nurse-to-patient ratios. The entire nurses’ union could face deregistration under the Bill that’s in front of us.”

Turn to page 14 for more details about the research and our campaign.

IN AN AUSTRALIAN-FIRST, Queensland Premier Annastacia Palaszczuk announced at our recent QNMU Annual Conference that the state government will introduce legislated minimum nurse-to-resident ratios in stateowned nursing homes.

THE FEDERAL government is pushing ahead with its agenda to weaken workers’ rights by progressing its so-call ‘Ensuring Integrity Bill’.

ke Sherree Clar

The QNMU strongly opposes this Bill and will continue to work with our federal office the ANMF and the union movement to ensure workers’ rights are protected.

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VOLUNTARY ASSISTED DYING S

INCE 19 June 2019, Victorians at the end of life who are suffering and meet strict eligibility criteria will be able to seek access to Voluntary Assisted Dying (VAD).

In Queensland, the Parliament’s Health Committee is seeking community and health practitioner views on VAD, as part of an inquiry into the delivery of aged and palliative care services.

The QNMU made a detailed submission to this inquiry and appeared at the public hearing on 4 July. We supported VAD legislation subject to various safeguards to protect vulnerable persons and health practitioners.

These safeguards included a nurse or midwife’s right to exercise conscientious objection to involvement in VAD practices.

While the QNMU has made its position on aged and palliative care well known through various campaigns and submissions, VAD

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is a separate, sensitive matter requiring respectful discussion and deliberation.

◆◆ The assessment of two medical practitioners from a relevant specialty is required.

Our major recommendations in respect to VAD, aged care and palliative care are listed below:

◆◆ The legitimacy of the request is valid.

VAD The QNMU recommended the Queensland government: ■■ draft a discrete legislative framework contained in a standalone Act making VAD legal in Queensland subject to the following:

◆◆ The patient is making an informed choice and is legally competent to make that choice. ◆◆ Only the person seeking to access VAD can request it. ◆◆ There is an appropriate cooling off period between the time a request to access VAD is made and it being carried out.

◆◆ The person seeking access to VAD has initiated the conversation and has an advanced and progressive terminal or chronic or neurodegenerative illness that is causing grievous and irremediable suffering.

◆◆ The legislation specifically excludes VAD for persons diagnosed with a mental illness or mental disorder.

◆◆ There is no prescribed timeline.

Death must be reasonably foreseeable as a consequence of the condition.

◆◆ It is not an offence for a nurse or midwife to confidentially advise, assist, support or be present when a patient is exercising their choice.

◆◆ Nurses and midwives are able to exercise conscientious objection to involvement in VAD practices.

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◆◆ No individual, group or organisation is compelled against their will to either participate or not participate in VAD. ◆◆ It is an offence to coerce, threaten or intimidate another person into accessing VAD. ◆◆ An individual’s wishes or a lawful Advance Health Directive (AHD) must prevail over the family’s or any other person’s wishes. ◆◆ There should be a review period set out in the legislation. ◆◆ There are strict eligibility criteria.

AGED CARE The QNMU recommended the Queensland government: ■■ pursue at all opportunities (such as the Council of Australian Governments) the introduction of evidence-based legislated minimum staffing and skill-mix requirements for all residential aged care facilities.

■■ investigate its powers and/or authority under its public health

mandate to legislate that all residential aged care facilities that fall within Queensland borders must have a registered nurse on site 24 hours per day, seven days a week as minimum.

PALLIATIVE CARE The QNMU recommended: ■■ the Queensland government and Department of Health develop a state palliative care and end-of-life care strategic plan as a matter of urgency that is funded, resourced and sustainable in the long term.

■■ the Queensland government review the coordination of service delivery for palliative care services (and other intersectoral issues such as aged care), across the hospital/ acute, private, primary care and aged care sectors.

FORMING OUR POSITION It was vital the QNMU formed a position on this important issue, as the debate is likely to continue into

the future and is something that directly affects the role of nurses and midwives as health professionals.

The QNMU has a rigorous process for formulating policy of this kind.

Our submission was guided by the Victorian legislation, the report of the West Australian Joint Select Committee on End of Life Choices, the QNMU policy committee, the QNMU Council, and relevant literature.

We engaged members through Facebook and we encouraged individual nurses and midwives to make their own submissions through our monthly Qnews.

The QNMU makes hundreds of submissions to state and federal parliaments and enquiries every year.

To see our VAD submission visit https://bit.ly/2JKzDfx To see a full list of our recent submissions visit https://bit.ly/2y4w65c

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Earle Haven closure sets N

URSES and midwives were horrified to learn of the sudden closure of Earle Haven Retirement Village on the Gold Coast, which left 68 residents homeless (many with dementia) and staff without work.

The closure was the major focus of the week of hearings for the Aged Care Royal Commission in Brisbane. As more evidence came to light, it was revealed that HelpStreet – the subcontractor employed by Earle Haven to operate the facility – began removing computer servers, beds and other items the day before the closure.

Closing an entire aged care facility without an appropriate plan for staff and residents is an unprecedented and disgraceful situation that should never have been allowed to occur.

It was also a timely example of how our aged care sector is woefully under-regulated thanks to consecutive federal governments failing to act and allowing the system to reach this point.

Incredibly, police later confirmed they would not be pursuing a criminal investigation, but as a result of intense lobbying the federal government has since announced a full investigation into the crisis.

QNMU goes to Fair Work It wasn’t long before the QNMU wrote to HelpStreet demanding our members be paid their correct entitlements, including wages for the time worked before the facility’s closure on 11 July 2019.

Unfortunately, HelpStreet argued they were not required to pay wages because, according to them, nursing staff were still employed, but were simply “stood down without pay”.

The QNMU decided to take the matter to the Fair Work Commission (FWC).

FWC decides in our favour The FWC soon recommended that employees could not be stood down without pay because HelpStreet could not establish it was not responsible for the stoppage of work.

While the FWC cannot order HelpStreet to pay their employees, this recommendation demonstrates that management was wrong to stand down their workers without pay.

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We are currently considering all options to achieve the best outcome for our members as we assist them every step of the way through this difficult process.

At the time of going to print, the QNMU understands some members have received some payment from HelpStreet. However, the QNMU is continuing to work with members to ensure all entitlements are paid.

At the QNMU’s recent Annual Conference, 353 delegates passed an urgency motion in support of Earle Haven nursing staff. Below is an extract of the motion.

Delegates to the 2019 QNMU Annual Conference note with extreme concern the recent unprecedented action taken by management at Earle Haven Residential Aged Care Facility at Nerang on the Gold Coast.

The closure of this facility on Thursday 11 July with no notice to residents and their families and staff was extraordinary and callous […]

We condemn in the strongest possible terms management’s abandonment of residents and staff and the significant failure of their duty of care.

This situation demonstrates the woefully inadequate aged care regulatory framework in Australia, where opaque contractual arrangements present significant additional risks and fundamentally fail to meet community expectations around transparency and accountability […]

We call upon the federal government to act immediately to address the significant issues arising from this system failure that has caused so much distress to residents, their families and staff affected. […We] cannot wait until the current Royal Commission into Aged Care provides its final report in April 2020 for action to prevent future such disasters.

The full motion can be read at https://bit.ly/31DsXpJ

just in

Royal Commission agenda Letter from a QNMU Earle Haven member

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Ratios are saving lives in Queensland Pictured: Mother and daughter Nadine Vinson (left) and Judy Toplis, Townsville Hospital.

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The results are in, and they tell a remarkable story.

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Since July 2016, when the Palaszczuk government legislated minimum nurse-to-patient ratios in 27 prescribed public hospitals, there have been:

145 deaths avoided

255

readmissions avoided

T

HE QNMU campaigned strongly for ratios, recognising their potential to improve patient care and safety... and the results bear this out.

Thanks to legislated ratios, the average medical/surgical nurse has seen a workload reduction of:

1-2

patients during the day

1-3

patients on night shift

Reductions of one patient per nurse were associated with: ■■ 9% less chance of dying in hospital

29,200 hospital days avoided

What’s more, they are consistent with findings from more than 30 other studies around the world conducted by the UPenn team on the relationship between nurse staffing and patient outcomes.

Up to

$81m saved

patient added to a nurse’s workload was associated with:

In other words, the evidence is undeniable.

Over 27,000 nurses from across all sectors participated in surveys over three years, as well as hundreds of thousands of Queensland patients.

This is the first evaluation in the world to apply a method of research that studied the effect of ratios both pre and post rollout.

Thanks to the pre-ratios evaluation, we now know that each additional

12%

odds of death

2%

length of stay

19%

odds of nurse burnout

32%

odds of poor care quality

■■ 6% less chance of readmission within seven days ■■ 3% reduction in length of stay ■■ 7% reduction in nurse burnout ■■ 16% reduction in inadequate time to complete necessary care ■■ 13% reduction in inadequate time to detect patient changes ■■ 8% reduction in job dissatisfaction.

No other jurisdiction with ratios had the wisdom to build the independent evaluation from the beginning, and it’s absolutely key and is one of the ways that Queensland has really

A ‘gold standard’ for research

demonstrated itself as a model for

The findings are based on extensive international research undertaken by University of Pennsylvania (UPenn), Queensland University of Technology, and Queensland Health.

patient safety community.

the international research and Dr Matthew McHugh, University of Pennsylvania

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indepth Dr Matthew McHugh from UPenn said the Queensland evaluation represented the “gold standard for future studies”.

“One of the things that distinguished the research we did in Queensland was the fact that, built into the legislation was the independent evaluation that allowed us to collect data in the baseline and also one year and two years out,” Dr McHugh said.

“No other jurisdiction with ratios had the wisdom to build the independent evaluation from the beginning, and it’s absolutely key and is one of the ways that Queensland has really demonstrated itself as a model for the international research and patient safety community.”

Significantly, the data will be invaluable to the QNMU’s longterm goal of seeing nurse-to-patient ratios implemented across all health and aged care facilities in Queensland.

“I can’t stress this enough, here in Queensland you have created a model for evidence-based policy. There is very little incentive for a government to invite external evaluators to scrutinise their policy choices and to make that public.”

Congratulations to all nurses and midwives who participated in the various ratios surveys over the past few years. Your responses have contributed to the indisputable evidence we now have to argue the case for the continued rollout of ratios across other areas.

The final report of the evaluation has been provided to Queensland Health and UPenn researchers will be presenting their final report in Brisbane in December.

For more information on the campaign, visit www.qnmu.org.au/RatiosSaveLives Pictured: QNMU member Alyce Townsend, Townsville Hospital.

Taking a moment to celebrate

It has reduced the amount of pressure injuries by allowing more time to attend to those cares. It has also reduced the number of injuries from falling because I’m not going from room to room.

Jenny Bennett, Enrolled Nurse

While it’s tempting to look to the future and focus on what’s next, it’s also important we take a step back and look at how far we’ve come.

In just a few short years, ratios have already saved precious lives, saved health care dollars, and helped us deliver high quality nursing…

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There's more nurses on the floor, there’s more nurses around that are able to act more swiftly, more quickly. So harms have certainly been reduced in terms of incidents where there are clinical areas using the ratios.

Samantha Woodhouse, Nurse Educator

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The rollout continues to aged care FOLLOWING months of consultation with the QNMU - and in an Australian first – Queensland Premier Annastacia Palaszczuk announced the state government would legislate minimum ratios in Queensland’s 16 state-run nursing homes, as well as public reporting of staffing levels.

Under the proposed bill currently before parliament, the state government is legislating for 3.65 hours of nursing per resident per day, with a required skill mix of 50% AINs, 30% RNs and 20% ENs. As 3.65 hours of nursing per resident per day is the state-wide average, any facility currently under this will be required to increase its nursing hours, and any facility that currently provides more than 3.65 hours will have their current hours maintained.

An independent evaluation will be conducted to establish an evidence-based minimum standard

Since ratios have been mandated, we’ve had a marked decrease in the amount of workload reporting concerns probably to the amount that I could count them on both of my hands over a 12-month period. During that period of time, the amount of sick leave has also decreased, and the staff morale has increased.

Robyn Cameron, Nurse Unit Manager

Left to right: QNMU Councillor Janelle Tay lor, Dr Matthew McHu Secretary Beth Mohle gh, QNMU , Queensland Premie r Annastacia Palaszcz QNMU Delegate Deb uk and Ranson at the press conference announcin government's plans g the for legislated ratios in state-run nursing homes.

for Queensland’s state government nursing homes.

The government also plans to establish a public register for all Queensland aged care facilities to report their staffing levels, and will name and shame private aged care

facilities that fail to publicly report requested data. Private hospitals will also be required to publicly report.

This legislation for public reporting and ratios has now been introduced into the Queensland parliament and is being considered by all MPs.

I feel that I have the time to provide adequate hygiene care, spend more time on wound care, and I have the time to provide emotional support and education as well.

Megan O’Brien, Registered Nurse

Staff reported to me that they lost that lump of anxiety in their gut that related to unmanageable workloads and they finally felt happy to come to work.

Janelle Taylor Nurse Unit Manager

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NURSE

Practitioners

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Leading through excellence T

he road to becoming a Nurse Practitioner is a long one… and once you’re there, it’s a continuous journey to self-improvement and clinical excellence.

But ask any Nurse Practitioner about their work and the nursing they are able to deliver for their patients and they’ll tell you the rewards are well worth it.

First introduced in Australia in 2000 and in Queensland in 2006, Nurse Practitioners are highly specialised roles that work in both hospitals and community settings.

Nurse Practitioners are able to work both autonomously and directly with their patients to assess, diagnose, teach, treat and provide expert care, as well as develop and implement a personcentred plan of care, including referrals to other health professionals.

Along with a Master’s degree and a minimum five years’ prior experience in their chosen field, Nurse Practitioners must also stay up-todate by continually broadening their skills, knowledge and awareness of best practice in health.

More than a qualification Faye Tomlin has been a Palliative Care Nurse Practitioner for three years working for Central Queensland HHS in Rockhampton.

“The work you can do as a Nurse Practitioner is not what you ever expect – every day I’m surprised by that,” Faye said.

“The Nurse Practitioner role is different in that we don’t come out with a qualification that allows us to do just one thing.

“As a Nurse Practitioner, I have the freedom to redefine myself, both from a professional and clinical perspective.

“We all come with our own experiences and over time create the flexibility needed to practise to the very limits of (our) professional scope of practice within all the domains of nursing.

“When I started three years ago as a novice, I was very focused on what I thought my role was in terms of doing the specialty work that I’d been trained to do.

This makes Nurse Practitioners true clinical leaders within the broader health care team.

As a Nurse Practitioner, I have the freedom to redefine myself, both from a professional and clinical perspective.

Faye Tomlin, Nurse Practitoner

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Nurse Practitioners are clinical leaders.

That’s what we’re taught as part of the course, the skills to aspire to be nursing leaders.

Toni Simpson, Nurse Practitoner

What does a Nurse Practitioner do?

■■ Perform advanced health assessments ■■ Initiate and interpret diagnostic investigations ■■ Diagnose health problems ■■ Design, implement and monitor therapeutic regimens in collaboration with patients, families/carers and other health professionals ■■ Prescribe medications ■■ Initiate and receive appropriate referrals to and from other health professionals.

Where do Nurse Practitioners practice?

In Queensland, Nurse Practitioners practice across the public, private, aged care and community sectors. Areas include: ■■ emergency ■■ aged care and palliative care ■■ private practice ■■ drug and alcohol ■■ medical ■■ surgical ■■ rural and remote ■■ women’s health ■■ community ■■ and more.

“But what I’ve come to understand is that the challenge for Nurse Practitioners is really about how to work innovatively within the existing health care system to ensure better access to care for those people who may be vulnerable in our community.”

Empowering families One of the benefits of working in a nurse-led model of care is empowering the patients and families to be active in their own health care.

Toni Simpson is a Nurse Practitioner specialising in dementia and works in the Gold Coast community sector.

Toni spoke about her six-year journey caring for one of her dementia patients. Through her specialised role, Toni was able to ensure her patient’s end of life was dignified, comfortable and, ultimately, led by the family themselves.

“I initially saw Margaret (not her real name) every three months, which is fairly standard, and over a period of six years I built up a relationship and trust with her husband, who was her primary carer, about what I was able to offer that would benefit both him and his wife,” Toni said.

“But most significantly, we were able to keep Margaret in her home right until the very end.

“She had a Level 4 community service, whose staff were wonderful, and I was able to provide support from the side because Margaret’s husband and family were able to do all the care.

“Her husband rang me a few times and said he thought Margaret needed to go to the hospital, and I listened and talked him through what was happening and what would happen if we sent Margaret to the hospital.

“So he made the decision to keep her at home and manage the situation, which was a better outcome for everyone.”

Autonomy to lead While this broader scope of practice and increased autonomy are indeed defining characteristics of the Nurse Practitioner, there is another less talked about element that is a part of their nursing practice.

“Three years in, when it was becoming more difficult for Margaret to leave the home, the local GP said they were no longer able to do home visits.

“Nurse Practitioners are clinical leaders,” Toni said.

“I was able to explain my role to the GP, and we agreed I would prescribe the patient’s medications.

Of course, all nurses are aspiring leaders regardless of their classification. We are all advocates for our patients and residents.

“Through discussions with the family and the GP, we were able to decrease a lot of Margaret’s medications

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– she went from taking six to two medications a day.

“That’s what we’re taught as part of the course, the skills to aspire to be nursing leaders.”

But working in nurse-led models of care provides a unique environment

indepth for Nurse Practitioners to champion true nursing leadership.

Indeed, it wasn’t until Faye started working as a Nurse Practitioner that she finally felt she was truly nursing to her full capability.

“As a Registered Nurse, I felt like I was working to a mould,” Faye said.

“I was always very restricted in what I could do, what I could say and how I could work.

“But I’ve since come to better understand what nursing can deliver within the extended and autonomous clinical role of the Nurse Practitioner in both general and specialist areas of care.

“We spend time with our clients to ensure they understand how a disease process is affecting them as an individual and more importantly how they cope with it.”

support their ongoing requistion of skills and experience.

But Faye said there was still much to be done. And with Nurse Practitioners recently forming their own QNMU Branch, members are using their collective voice to make change.

Challenges

“Among other things, we’re looking to have our post-graduate nursing qualifications acknowledged to enable the existing qualification allowance for nurses to be paid to eligible Nurse Practitioners,” Faye said.

That’s not to say that Nurse Practitioners do not face any barriers.

The ‘gem’ of health care

With only 484 Nurse Practitioners across Queensland (NMBA 2019), workloads are excessive. Toni alone has around 55 patients at any given time.

One of the main challenges is finding the time to invest in ongoing education to keep up with current practices.

While Nurse Practitioners are required to complete 40 hours of CPD each year, Toni claims most will complete many more hours just to maintain their knowledge let alone expand and invigorate their clinical practice.

“It’s difficult tearing yourself away from your clinical work to do the non-clinical,” Toni said.

“It’s finding the balance of prioritising your professional development with the fact that you’ve got patients waiting to see you.”

Over the past decade, the QNMU has made steady progress in changing and building industrial mechanisms that support these unique roles.

For example, a third pay point was secured during EB9 negotiations with Queensland Health to recognise the significant financial commitment these nurses must make to obtain their necessary qualifications and ongoing professional development.

In EB10, the QNMU negotiated one day per week (pro rata) of time offline to

The Nurse Practitioner role is, in many ways, all about creating a pathway to true excellence for nursing.

But Faye said she believed the health system was yet to “recognise the gem that is the Nurse Practitioner”.

“Nurses have more of an understanding of the experience a person may go through in health than any other health care professional,” Faye said.

“Every nurse should be given every opportunity to aspire to work to their fullest capability.”

By valuing and supporting our nurse and midwife leaders – and by extension creating opportunities for more nurse/midwife-led care – we stand a better chance of keeping patients at the centre of health care decision-making.

Toni believes Nurse Practitioners play a critical role in achieving this.

“Having role models in our own profession is very important, because it keeps us grounded in that our roles exist for the patients,” Toni said.

“Because the Nurse Practitioner is all about patient-centred care, our roles keep patients at the core of what we all do.

“It reminds us all of why we’re here.”

Get involved The QNMU Nurse Practitioner Reference Group meets monthly via teleconference to discuss issues and solutions specific to their practise.

To get involved, email Grant Burton at GBurton@qnmu.org.au

References:

Australian College of Nurse Practitioners (2019) History of Nurse Practitioners, www. acnp.org.au/about-acnp/history/ NSW Government (2017) Becoming a Nurse Practitioner, www.health.nsw.gov.au/nursing/ employment/Pages/nurse-practitioner.aspx Nursing and Midwifery Board of Australia (2019) www.nursingmidwiferyboard.gov.au/ About/Statistics.aspx Queensland Health (2019) Marking ten years of Queensland Nurse Practitioners, www.health.qld.gov.au/news-alerts/news/ marking-ten-years-of-queensland-nursepractitioners

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Going digital The road to modern patient safety

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W

HETHER we like it or not, technology is working its way into every aspect of our lives.

The future is now, and health is no exception.

Digital technologies are changing (and in many workplaces have already changed) how we communicate with other nurses, midwives and other health professionals.

Data is transforming how we plan for the future.

And despite the frustrations some nurses and midwives might feel when initially introduced to new technologies in the workplace, the literature does suggest that digital technologies can improve quality of care, patient safety, and patient outcomes.

Of course, all these things are entirely dependent on how the technology is implemented and used.

No technology is perfect. But technology should also be seamless, and definitely not a burden on nurses and midwives as we continue to do what we do best: provide high quality care.

According to the Health Foundation (2018), “Technology must be designed to meet the needs and aspirations of the people who use services […] and technology-based approaches need to be incorporated into how services work, rather than being seen as ‘bolt on’”.

Sounds reasonable enough. But depending on where they work, nurses and midwives give very different accounts of their experiences with new digital technologies if you ask them.

Which is exactly what the QNMU did…

That instant ability to look at a handover sheet that’s digital, being able to look at pathology results instantly… people are starting to realise it is actually a net benefit if it’s used properly.

Anthony Wilson

Digital technologies in Queensland’s public hospitals In June 2019, QNMU public sector members were invited to participate in a comprehensive survey on the current state of play with respect to digital technology systems across Queensland Health’s Hospital and Health Services.

Here’s what you told us…

Top challenges: ■■ Workloads and time issues ■■ Functionality and usability issues ■■ Decreased clinical time ■■ Design and implementation issues ■■ Backup and offline issues

Your reactions:

■■ 85% said digital technology increased workloads ■■ 47% said digital technologies enhanced care ■■ 44% said digital technologies enhanced patient safety ■■ 41% said digital technologies assisted early detection of possible adverse events ■■ 49% said training was adequate Full survey findings will be published on the QNMU website in the near future. Members will be notified through our monthly qnews.

Seamless integration If these results tell one thing it’s that there is a long way to go before we

all experience the benefits that come from digitalised health systems.

For many, digital technologies are already part and parcel of the way we do our job. For instance, some nurses and midwives have never used a paper chart.

For others, the digital transition may seem like an unnecessary disruption that causes more pain than gain.

But the reality is this transition is happening in health all across the world.

When technology is seamlessly integrated with health care, the benefits make it clear why we cannot afford to be left behind.

Anthony Wilson is a Nurse Manager and QNMU member who currently holds a Nursing Informatics role covering the Darling Downs HHS. Through his informatics position, Anthony has seen some of the tangible benefits that technology has brought to health care delivery in Queensland, including improved communication between clinicians and more efficient handovers.

“People are now able to access information very quickly and readily, which we couldn’t do in the past,” Anthony said.

“They are getting tangible benefits right at the bedside.

“That instant ability to look at a handover sheet that’s digital, being able to look at pathology results instantly… people are starting to realise it is actually a net benefit if it’s used properly.”

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Data, data, data The potential benefits of digital technology systems aren’t just limited to the bedside.

It’s also about the data these systems can collect, and the significant opportunities this can present for patient safety and outcomes.

Then there is the question of what good data actually looks like. How can we best collect the data nurses and midwives need to ensure decisions made at the top are in the best interests of patient safety?

That’s partly what Anthony’s Nursing Informatics role is all about.

“We’re collecting more data than ever before in health, so it’s more critical than ever for nurses to be able to interpret and communicate that data to people who are non-nurses and articulate our needs as health clinicians,” Anthony said.

“Health informatics is the future for nursing and any clinician moving forward.

“With increasing demands on the health budget, you have to be able to demonstrate your resourcing needs, and if you can’t demonstrate that need, you risk missing out on acquiring that health dollar.”

Fortunately, the more validated data we have, the easier it is for nurses and midwives to put forward the case for our patients’ needs, such as better staffing.

“The biggest buy-in I’ve had here at Darling Downs is our executive team’s commitment to utilise our validated data to inform and enhance our nursing and midwifery resourcing through our annual BPF cycles,” Anthony said.

“For example, some of the wards at Toowoomba Hospital have five extra nurses per day just due to the good data that has been collected.”

A voice at the table Wins such as this are not just the result of having the data, but also having a nursing voice at the table to argue the case.

Clinical Informatics Manager at Elsevier Health Sciences Australia and QNMU member Lis Herbert has a career in health IT spanning 30 years. She has seen numerous digital systems rolled out across all health sectors.

She said digital health care systems are often fraught with issues because the project teams simply do not consult with nurses and midwives when it matters.

“No system is perfect, but ideally during implementation if clinicians are involved right from the start – including when deciding which system to go with – there’s a lot more buy-in from them,” Lis said.

“When we implemented changes on the Gold Coast, I spent 18 months just wandering around the wards talking to people so that everyone knew

No system is perfect, but ideally during implementation if clinicians are involved right from the start – including when deciding which system to go with – there’s a lot more buy-in from them.

Lis Herbert

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what was going on and people were involved.

“And we did make changes based on the end user requirements.

“Nurses are very well-respected and know all the other clinicians and allied health people, because you’re dealing with them all the time. So why wouldn’t you consult with nurses?”

Yet, incredibly, many still do not.

Predictably, the consequences are frustrating.

Anthony said one of the most common issues with new technology systems was around workflow.

“Often when clinicians haven’t been consulted properly, it isn’t realised that patient care follows a certain sequence, and so without consultation this sequence is misinterpreted,” Anthony said.

“This results in dysfunctional and inefficient workflows which is very frustrating for clinicians when we just want to look after our patients to our best capacity.”

Becoming the norm Similarly, extensive education is also needed to achieve the necessary buyin from nurses and midwives when undertaking such dramatic change.

“Education is paramount to success,” Anthony said.

“Employers need to tailor education to the type of staff and give them time to become familiar with the system.

“What I’ve found from touring around the state is that if this is done correctly, then the new systems are generally accepted quite well by staff.”

Implementation challenges aside, Lis Herbert said the rollout of digital health systems was like any significant change – it takes time, patience, and a willingness to be open-minded.

“I remember when we used to have passbooks and you’d have to go into a bank to get money, and then we went to cards, then we went to internet banking, and that was a huge deal at the time,” Lis said.

“Now people don’t even think twice about it because that’s just what you do.

indepth “As an end user of these new digital systems, [nurses and midwives] can’t afford to resist these changes, because this technology is not going away.

“To have up-to-date information when you need it, to not have to go looking for a paper chart, to have multiple people accessing the same patient information at the same time – it’s an expensive and long exercise, but the benefits far outweigh the negatives.”

Anthony agreed, adding the ultimate goal of the entire digital transition was to improve patient safety.

“It’s the ability for us to be informed about our patients and to be able to make clinical decisions and guide our care for patients with the correct tools,” Anthony said.

“The research shows that there are better patient outcomes from moving from paper-based systems towards digital platforms, and that’s our primary goal obviously as nurses and midwives, to get the best outcomes for our patients.”

Queensland’s first digital hospital Many might think Brisbane’s Princess Alexandra Hospital (PAH) was the first to go completely digital in Queensland, but it was actually St Stephen’s Hospital in Hervey Bay. In fact, this small private hospital was Australia’s first ever fully digitalised hospital when it opened in 2014.

Run by UnitingCare Health, St Stephen’s Hospital computerises everything from diet to dialysis using more than 300km of fibre-optic cables.

Food is ordered and managed electronically, medication dispensed without any hardcopy paperwork, and patient allergies and medical conditions are electronically recorded and communicated to other relevant areas of the hospital.

In 2015, the PAH became Australia’s first largescale hospital to go fully digital.

Following an 18-month pre-implementation process, including 32,000 hours of training with 5384 staff, as well as numerous dress rehearsals with mock patients, the digital conversion occurred over two weeks.

REFLECTIVE QUESTIONS Reflect on your use of digital technology in your workplace: 1. How much has become digitised during your working life?

2. How comfortable and competent are you using new technologies?

3. How do you think new technology can improve your practice?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

The Health Foundation (2016) How to implement digital health, viewed August 2019, . https:// personcentredcare. health.org.uk/personcentred-care/shareddecision-making-0/ digital-health/howimplement-digital-health Shaw T, Hines M, KiellyCarroll C (2017) Impact of Digital Health on the Safety and Quality of Health Care. University of Sydney: ACSQHC.

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CLOSING THE

CULTURAL

GAP Having to be bare below the elbows is something many of us in health care take in our stride, but for our Muslim nursing and midwifery colleagues, clinical requirements like these can conflict with cultural or religious beliefs.

However, Western Sydney University recently released a new suite of resources and a new addition to their nursing uniform, both designed to tackle the issue head on.

E

VERY morning before starting her shift, Registered Nurse Aisha (not her real name) visits the hospital’s chapel to conduct her morning prayers.

She will do the same at midday, then again later in the afternoon, and will complete her remaining two prayers at home in the evening.

These 10-minute prayers are an essential part of the Islam religion, and Aisha’s daily prayer routine isn’t an uncommon one.

Islam is one of the fastest growing religions in Australia.

In 2016, more than 600,000 people in Australia identified as Muslims from all forms of the Islamic faith – that’s 2.5% of the total Australian population

and an increase of more than 15% from the previous year.

While Australia is undoubtedly a multicultural nation, health care can be a daunting field for people of faith and migrants who face work practices that may conflict with their cultural beliefs.

This is certainly true for our Muslim colleagues.

BREAKING THE ICE Aisha first arrived in Australia in the 1990s with almost 15 years of overseas nursing experience under her belt.

Despite a solid background in nursing, being a foreigner in a new country wasn’t easy and back then,

Photo: Sally Tsoutas

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indepth Muslim nurses and midwives were few and far between.

Unsure if she would be allowed to wear a head scarf at work, Aisha stepped out of her comfort zone to broach a conversation about her religion with her manager.

“You’re in a new country and you’re surrounded by people who are not like you and don’t know you, so you have to make the effort,” Aisha said.

“I think finding people within the organisation you can speak with is the first thing you need to do. When I approached my manager about wearing my head scarf he said ‘oh I’ve actually never encountered this! I’ll have to go and find out.’

“He came in the next day and said it wouldn’t be a problem. It can be hard to take that first step to talk about it but it’s so important in order to overcome that fear and worry.”

CULTURAL CONFLICTS

Religious views can have an impact on a range of health care services from immunisation to abortion and reproductive health.

Some well-known faith-based complications include Jehovah’s Witnesses and their refusal to accept blood transfusions, the Amish not

■■ having to be bare below the elbows ■■ having to provide care for the opposite gender ■■ having to take regular meal breaks to attend to obligatory prayers five times a day

Dr Rakime Elmir is a Registered Midwife and lecturer in the School of Nursing and Midwifery at Western Sydney University.

■■ and uniform requirements that do not meet cultural dress codes.

She said for nursing and midwifery students on first time clinical placements, that fear is amplified as they worry about the repercussions of potential cultural conflicts with their supervisors.

FAITH AND HEALTH CARE WHILE cultural issues like uniform requirements and breaks for prayer times can be negotiated to a satisfactory resolution, there are other religious issues affecting health care that often seem insurmountable.

Some of the issues Muslim students can encounter while undertaking clinical practice include:

allowing heart transplants and in some cases heart surgery, and the Hindu faith which does not condone the use of any drugs, implants, skin grafts or medical dressings that contain parts of pigs or bovines.

Dr Elmir said an increasing number of Muslim students were concerned that their religious and cultural beliefs were incompatible with nursing and some even chose to drop out. “(For example) it’s important for Muslims to wear modest clothing. For some students that means wearing a skirt instead of pants because pants can be quite form-fitting and reveal more of the figure,” she explained.

“But we’ve had concerns from facilitators at clinical placements that students attending clinical practice are not wearing the correct clinical uniform and not adhering to the clinical standards set by NSW Health and the university.

While health care professionals have a right to conscientious objection, we must remember that as nurses and midwives we first and foremost have a duty of care to our patients.

“Students are in a very vulnerable position. They sometimes feel their position in the course may be jeopardised or they might be further alienated if they speak up, and even if they do, that no one will listen to them.”

If you are in doubt about your rights and obligations, please contact the QNMU.

FINDING COMMON GROUND Dr Elmir said the rising drop-out rate of Muslim nursing students prompted the university to act.

Photo: Sally Tsoutas

With the uni’s support, Dr Elmir has recently released a suite of cultural resources aimed at providing workplaces and Muslim students with guidelines to navigate procedures or practices that may present cultural challenges.

Source: CNN Health, https://edition.cnn.com/2018/02/07/health/religion-medical-treatment/index.html

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The resources were developed through a working party of Muslim community leaders and both Muslim and non-Muslim academics. They provide clarity and act as a point of reference for students.

“It was important for me to seek community support and the

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Students are in a very vulnerable position. They sometimes feel their position in the course may be jeopardised or they might be further alienated if they speak up, and even if they do, that no one will listen to them.

Dr Rakime Elmir, Registered Midwife and lecturer, Western Sydney University Photo: Sally Tsoutas

authorisation from a community leader in relation to the guidelines so students know it’s authentic,” Dr Elmir said.

“In fact, Muslim students can wear pants as long as they are not tight fitted and they can wear long sleeves underneath their tunic, again as long as it is not tight fitted. But all students are required to roll up sleeves and engage in infection control procedures when in direct patient contact. A hijab must also be tucked into the uniform for infection control.

“It was really about clarifying the areas of concern which were largely in relation to uniform requirements, as well as providing an avenue for students to get the support they need.”

Dr Elmir said Muslim community leaders were forthcoming and welcomed the idea of supporting more Muslims entering the health workforce.

“They were prepared to work very closely with me. The guidelines required quite a bit of work and a few iterations but we wanted to ensure that any issues were being demystified and clarified,” she said.

“Students now know where to go to seek support. As a Muslim academic myself, they’re also able to reach out to me and very openly discuss any issues they have.”

Alongside the resources, Western Sydney University also launched Australia’s first branded hijab for nursing students… and it’s been a huge hit.

“It’s been welcomed by many students – it’s something they can wear very proudly and promotes a sense of belonging to the university,” Dr Elmir said.

“It really is a form of recognition, diversity and inclusivity, and that really means a lot not just to the students but the Muslim community too.”

FOSTERING INCLUSIVITY The launch of the resources has yielded positive results for the university – it’s helped minimise feelings of alienation for Muslim students and increased retention.

Clinical facilitators have also become more knowledgeable about Muslim beliefs and practices, helping create a more inclusive environment.

“It’s really helped students with their confidence and self-esteem so they’re no longer anxious when attending clinical placements,” Dr Elmir said.

“They now want to stay in their course and pursue their passion.

They’re even encouraging other family members to enter the nursing and

midwifery workforce so we’re also seeing an intergenerational effect that’s helping create more Muslim nurses and midwives.”

RN Aisha said while the topic can be contentious, it pays to have conversations with workplaces and with the Muslim community.

“There is flexibility in the religion and it’s important we speak with our religious leaders to find out what we can or can’t do,” Aisha said.

“I’ve lived through these challenges and when I spoke with my religious leader he understood that nursing is a very important job and certainly doesn’t want to see Muslim nurses quit due to cultural issues.

“Certainly, more support and resources are needed in workplaces.

We are a very multicultural country and have patients from all walks of life. We have to be inclusive because this is the future.”

Members can obtain a copy of the resources by contacting Dr Rakime Elmir at R.Elmir@westernsydney.edu.au

References

Australian Bureau of Statistics, 2016. Religion in Australia. https://web.archive.org/web/20170710020910/ http://abs.gov.au/ausstats/abs@.nsf/Lookup/by%20 Subject/2071.0~2016~Main%20Features~Religion%20 Data%20Summary~25

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TACKLING CULTURAL ISSUES AT WORK FOR NEARLY 20 years Registered Nurse and QNMU member Aisha (not her real name) had a verbal agreement with her workplace to not be rostered on Friday.

Fridays were when Aisha would help out at her mosque with midday prayers.

But after a change in management, Aisha was informed that due to resourcing issues she would have to begin working Fridays again on eighthour shifts instead of her current tenhour shifts.

Months of negotiation with her manager proved futile.

“It was a humiliating and traumatising time for me,” Aisha recalled.

“I rarely discuss my religion at work and have never made it my excuse or my agenda, but since this issue came up I’ve constantly had to explain my religion and why I require Fridays off.

“I’ve been with this organisation for decades and couldn’t believe this was happening. It caused so much stress that I took time off work.”

Aisha said she felt she had no choice but to quit her role.

had been prepared to quit a job that I loved,” she said.

“It’s something I will never forget – the union helped me so much that I got my confidence back and it’s the reason I’m still here.”

Desperate, she reached out to the union.

“I’d begun looking for other jobs when my QNMU Organiser walked in,” Aisha said.

“After listening to my situation he immediately helped draft a letter to my workplace on my rights and escalated my matter to the QNMU Servicing Team.”

Eventually, an executive decision was made by Aisha’s workplace to allow her to continue having Fridays off and to continue her ten-hour shifts.

“If not for the union there’s no way I would’ve survived this. I didn’t even know where to go or what to do and I

REFLECTIVE QUESTIONS As you've read, trying to balance the job they love with cultural religious beliefs can push some nurses and midwives out of our professions.

With this in mind, how does your workplace measure up in terms of balancing the needs of the service and accommodates the needs of the employees. Explain.

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

WHAT IS A HIJAB? HEAD COVERINGS for Muslim women can take many forms.

They vary in size, shape and colour depending on who is wearing it and where.

For many Muslim women this is as crucial to their cultural identity as it is to religious freedom.

The three most common types of covering are:

NIQAB

■■ Hijab: The hijab is a headscarf that covers the head and neck.

■■ Niqab: The niqab is a veil that covers the face and leaves the area around the eyes clear. It is worn with a headscarf and may be worn with a separate eye veil.

■■ Burqa: The burqa is a veil that covers the entire body and face with a crocheted mesh over the eyes.

BURQA

Source: SBS News, https://www.sbs.com.au/news/university-aims-to-close-the-cultural-gap-for-muslim-nursing-and-midwifery-students

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HIJAB

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Green Warriors take on climate change T

ACKLING the problem of a polluted planet can seem a little daunting but Toowoomba Base Hospital’s Green Warriors are taking it on one plastic bottle at a time.

friendly materials and put in a water refill station for water bottles and in the canteen we got rid of all the Styrofoam and replaced it with recyclable cardboard.

Green Warriors is a staff-driven initiative which launched in November last year and is part of the Darling Downs HHS’s commitment to act on climate emergency.

“We don’t have a hospital-wide composting scheme but one of the AOs in the mental health community brought her own composting kit in – just a small one you get from Bunnings.”

Toowoomba mental health nurse Angela Kain is a keen member of Green Warriors and a founding member of the QNMU’s Health and Environmental Reference Group (HERG).

She said the ‘Warriors’ not only embrace the broader organisational eco-friendly commitment but are encouraged to develop their own initiatives.

“There are quite a few things going on all around the hospital,” Angela said.

“We implemented a plastic bottle recycling project with the support of the Hospital Foundation – the patients are particularly good at participating in that – there are boxes all around the place they can pop them in.

“When we refurbished the staff dining room we looked at eco-

The compost is used in the mental health veggie patch.

“Every little bit counts,” she said.

“You don’t realise it until you sit back and think about how much you do, how many plastic bottles and coffee cups you’ve saved from landfill.”

Hospital staff even have a pen amnesty program where staff can secretly return and reuse all those pens that end up squirrelled away in bags and pockets.

Pioneering change Acting director of Strategy and Planning Michelle Cleary said the Darling Downs was the first HHS to undertake a review of its operations to identify elements that may be

affected by the climate emergency and look at strategies to improve environmental performance.

“Climate change is now deemed a ‘foreseeable risk’ so we decided to take a proactive approach in planning for the future needs of our operations and the environment,” Michelle said.

“We found we were doing quite a bit already – working with Origin Energy to install solar panels on some of our buildings, putting tanks out in Kingaroy to collect rainwater.”

She said the service is focusing on the three key areas of water, energy and waste, and said the Green Warriors came out of a staff push to reduce waste within the facility.

“We put out an EOI across Toowoomba Hospital and the interest was huge,” Michelle said.

“I’m extremely proud of what has been achieved so far… and it’s largely been on the back of people’s passion and excitement for change.”

Pictured above: Angela Kain (back row, left) with her fellow Green Warriors.

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The Rapid Results Program: A QUIET ACHIEVER

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BOUT a year ago Queensland’s Health Minister Steven Miles brought together health stakeholders from a wide range of community organisations and government offices to discuss health care initiatives.

“They may have been operational in only one HHS but now we’ve expanded it across more.”

It saw the likes of Diabetes Queensland and the Heart Foundation sitting in a two-day workshop alongside Queensland Health specialist teams and HHS administrators.

“This is a project adapted from the NHS (UK) ‘Getting It Right First Time’ program,” Ms Schofield said.

“For example in the first priority area one of the key projects was to establish the health promotions agency Health and Wellbeing Queensland – well that’s been done and it’s now business as usual,” she said, noting that some projects had “natural conclusion points”.

GIRFT is a UK program to improve medical care by reducing unwarranted variations in service delivery, and by sharing best practice between services.

For ongoing projects, success may be measured statistically – a reduction in hospital admissions, shorter stays, increased participation rates.

Led by two orthopaedic surgeons and a team of nurses, and supported

by Clinical Excellence Queensland, the program has now been rolled out across almost every public orthopaedic service in the state, saving money and improving outcomes for patients by reducing unnecessary procedures, ensuring consistency of care and reducing costs.

While some of these projects have benefited from an injection of up-front funding mostly drawn from funds already budgeted, the QNMU has been most interested in the focus on operational efficiencies that reduce duplication and waste, harness the skills and scope of the nursing workforce, and recognise the value of collaborating with stakeholders to get the best outcomes for both patients and staff.

The aim of the workshop was to identify a body of work that, with special attention, tweaking or an injection of resources, could be fasttracked to achieve rapid results.

The outcome was a program of work, with projects grouped under eight priority areas and ranging from initiatives to increase the rates of immunisation across the state or improve QAS clinical handover in emergency departments, to those that would develop an Aboriginal and Torres Strait Islander health workforce career structure.

The results so far have been positive.

Head of the Rapid Results Transformation Team that oversees implementation, Dawn Schofield, explained many of the projects had already been “bubbling along” but the program found ways to “accelerate good work” or to “to scale it up and out”.

“This might mean the level of consumer engagement and clinical leadership has been heightened on these projects to accelerate how quickly they are being implemented or where they are being implemented,” Ms Schofield said.

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An example of this is project ‘2.1: Drive improved outcomes and reduce clinical variation in Orthopaedics’.

Another project includes greater use of Geriatric Emergency Department Innovation (GEDI) nurses in frail and elderly care (2.5).

GEDI nurses are specialist clinical nurses in the emergency department who streamline care for all patients over 70 years of age, particularly those transferring to hospital from residential aged care facilities.

The GEDI nurses are a single point of contact within the ED for the patient’s aged care provider and other hospital departments, and provides rapid, comprehensive geriatric assessment and management on presentation.

Under the Rapid Results program the GEDI nurse placement program is being expanded from one HHS to all HHSs across the state.

Ms Schofield said the success milestones differ for each project.

“This is the kind of collaborative approach we have always advocated for,” QNMU Secretary Beth Mohle said.

“The fact that we are starting to see some positive results in such a short period of time is indicative of what can be done when there is a genuine will to engage with consumers and those at the coalface, and make a conscious decision to work smarter.

“Our hope is that this becomes a template and that the QNMU will have a seat at the table in the next round.”

The Rapid Results program is governed by a delivery board which includes two health consumer representatives and has the Director General of Health as chair.

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RAPID RESULTS PRIORITY AREA PROJECT SUMMARY RRA 1

Keeping Queenslanders healthy and tackling obesity

1.1

Establish Health and Wellbeing Queensland (HWQ)

1.2

Healthy food and drink choices for staff and visitors of Queensland Health service facilities

1.3.1

Improve availability of heathy food in Indigenous communities

1.3.2

Improve clean water availability and affordability in Indigenous communities

RRA 2 Delivering what matters

RRA 5 Improving the rates of immunisation 5.1

Improve immunisation data quality

5.3

Enhance immunisation through catch-ups and home visits

5.4

Increase HPV vaccination uptake in Queensland adolescents

RRA 6 Maximising the benefits of digitalisations and capital investments 6.1

Rollout of the Integrated Electronic Medical Record (ieMR)

6.2

Rural and remote digital health strategy

6.3

Driving value through capital

2.1

Drive improved outcomes and reduce clinical variation in orthopaedics

2.2

Advancing kidney care 2026

2.3

Delivering better value care

RRA 7

Efficient and effective procurement

2.4

Delivering what matters in cardiac care

7.1

Supply Chain Operational Performance Excellence (SCOPE)

2.5

Frail and older persons

7.2.1

Procurement - Pharmaceuticals

2.6.1

Patient Reported Experience Measures (PREMs)

7.2.2

Procurement - Cardiology

2.6.2

Patient Reported Outcomes Measures (PROMs)

7.2.3

Procurement - Orthopaedics

RRA 4 Supporting Closing the Gap through an empowered Aboriginal and Torres Strait Islander health workforce

RRA 8 Queensland Ambulance Service (QAS) improvements

4.1

Aboriginal and Torres Strait Islander Health Practitioners

8.1

QAS clinical handover in emergency departments

4.2

Aboriginal and Torres Strait Islander career structures

8.2

Expanding non-hospital options

4.3

Chief Aboriginal and Torres Strait Islander health officer

4.4

Aboriginal and Torres Strait Islander health round table

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It’s not every day you get to rub shoulders with the likes of Leo DiCaprio and Hugh Jackman... unless you happen to be an on-set nurse. Registered Nurses Katie Harris and Carrie McLeod give us the scoop on what it’s like to nurse in one of the most glamorous industries… Hollywood!

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QUAMAN, Australia, The Great Gatsby, Pirates of the Caribbean, Superman Returns…

They’re just a few of the blockbuster movies that have graced our big screens in recent times.

Not only were they all filmed right here in beautiful Oz, their actors, directors, stuntpeople and extras – the whole film crew really – were all cared for by on-set nurse Katie Harris… and the big names she’s worked with would send any fan into a frenzy!

“I’ve worked on a few films with Nicole Kidman… Matthew McConaughey and Kate Hudson on the movie Fool’s Gold, Leonardo DiCaprio on The Great Gatsby, Jason Mamoa on Aquaman..,” Katie said.

“I’ve met a few movie stars but Hugh Jackman has to be my favourite – he’s the world’s nicest man and he’s really lovely!

I’ve worked with him a few times now on the X-men movies and on Wolverine which was filmed in Sydney.”

While she’s recently wrapped up work on Dora the Explorer on the Gold Coast, Katie said the job has taken her all over Australia and across the world.

Source: imdb.com

“I’ve been lucky enough to travel to China and Vietnam to work on films that were also already shooting here in Australia,” she said.

“But I also love travelling around Australia. I can be turning up to work at a different place every day – we can be shooting at Mount Tambourine or in the jungle one day, back in the studio the next and on the beach the following day.”

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indepth “Stuntmen and the special effects team are my most common patients – I see them so often that all their medical histories are embedded in my head! We try to be really careful not to put actors in risky situations but we just have to be prepared for anything.”

land Photo: Screen Queens

A veteran on-set nurse, Katie has worked in the industry for close to two decades.

It’s part of her job to make sure everyone on set keeps safe and healthy while filming in various locations… no mean feat when there can be a hundred people on a film set on any given day.

“There’s no job that I can really compare it to, but I guess the role of an on-set nurse is almost like an industrial medic,” Katie explained.

“It’s essentially being ready to administer first aid if it’s needed, but a large part of it is workplace health and safety – so tending to WorkCover claims and checking if anyone has any pre-existing injuries or isn’t feeling well.

“I’ll check in on the actors before they get into costume in case anyone needs to have their ankle strapped, for example. And if we have any children on set I also advocate for their wellbeing as there are very strict employment and workplace conditions for kids.”

A relative newbie to the industry, RN Carrie McLeod got her first gig as an on-set nurse four months ago working on French-American crime drama series Reef Break, which filmed on the Gold Coast.

She said the work of an on-set nurse can vary depending on whether she’s on location or in a studio, how many of the film crew are involved and what their needs are.

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Village Roadshow Studios

“We can be working very long hours on shoots so I assess the cast and crew’s overall wellbeing on a daily basis,” Carrie said.

“This could be anything from making sure people are well hydrated to looking after their immunity, especially during flu season.

“One of the days we were filming in Pinkenba in 40 degree heat and we had approximately 50 extras on set – some in full firefighter costumes who were definitely at risk of dehydration and heat exhaustion – so I was constantly monitoring the crew and triaging their care.

“It’s up to me to apply first aid if necessary and decide if anyone should be replaced on set, sent home or if paramedics need to be called.”

While meeting famous actors and travelling across the world for work sounds thrilling, it’s not all glitz and glam in the life of an on-set nurse.

On-set nurses work autonomously and there’s usually just one nurse for each film or TV production, so they’ve got to be prepared for anything that might come their way.

“While there are days where no one gets hurt or is ill, it can go from zero to everything in a heartbeat and if something does happen you’re the only nurse there,” Katie Harris said.

“We apply immediate first aid and treatment, communicate with the ambulance and ensure they know how urgent a situation is, and stabilise the patient as best we can.

Katie’s emergency skills were tested when a horrific explosion rocked one of the studios right next to where she was working.

“I think they were mixing powders for special effects and it just blew up,” Katie recalled.

“Luckily there were two other nurses on the lot that day working on separate projects and we all kind of rallied together to look after everyone that was injured.

Lots of people were rushed to the hospital but three sustained severe burns and two of them had to have extensive surgery.

“I just remember thinking one of them was actually going to die in front of me.”

Carrie McLeod has also had to leap into action while on the job when a gentleman in the transport department suddenly became unwell.

“He was sweating and vomiting when I got to him, and presenting as a cardiac patient,” she said.

“I quickly did a cardiac workup on him – checked his obs, gave him oxygen and aspirin – and monitored him closely while we waited for the ambulance to arrive.

“Anything can happen at any time so it’s why the on-set nurse is always the last to leave, we’ve got to make sure there’s at least one safety and medical person on set just in case.”

Also a professional photographer, Carrie found on-set nursing combined both her love of the creative and her passion for the film and TV industry.

“Everybody I work with is so passionate about what they do and they work beyond hard,” Carrie said.

indepth “We all know it’s not the glamourous environment people imagine it to be but everyone shows up every day with a smile on their face.

“I worked on set with Poppy Montgomery (star of Reef Break) who is an Aussie that’s done a lot of work overseas and she’s a wonderful ambassador for Australia.

“She’s done something pretty amazing by bringing this show to Queensland when she could’ve chosen just about anywhere in the world to do it. d (left) Carrie McLeo alian with Austr a Vidler. actress Melin

“Just to be able to work with an actress of her calibre was awesome.”

When filming breaks, Carrie enjoys returning to school nursing in the health centre at a Queensland College.

“I really love school nursing.

While working in general practice I developed an interest in working with teens and actually stepped out of nursing for a few years to do youth support work,” she said.

“It really spurred my passion for working with kids so I’ve been lucky that I can continue to do school nursing and take a hiatus to do on-set nursing when roles come up.”

Similarly, Katie Harris returns to hospital work in between on-set nursing on film projects.

She said Registered Nurses with emergency department or critical care experience were favourable skills for on-set nursing.

“I think it’s grounding to go back to hospital to keep up my scope of practice and maintaining my education is very important,” she said.

“As we work independently, I also think it’s critical to be a QNMU member to have that support and obviously the professional indemnity insurance is unbelievably helpful.”

Katie will soon be working on a new project – a martial arts movie to be filmed in South Australia, and Carrie’s prepped and ready for a new film beginning at the end of the year on the Gold Coast.

Carrie McLeod

Carrie McLeod (2nd from left) pictured wth her daughters an d actress Poppy Montogomery (2nd from right).

Anything can happen at any time so it’s why the on-set nurse is always the last to leave, we’ve got to make sure there’s at least one safety and medical person on set just in case.

Carrie McLeod, RN

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2019 QNMU ANNUAL CONFERENCE

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This year’s Annual Conference was a special one.

The results of a world-first evaluation of legislated ratios in Queensland were released, and hundreds of nurse and midwife delegates heard first-hand from members about how ratios have benefitted them.

We also welcomed Queensland Premier Annastacia Palaszczuk, who opened day three of conference with a special announcement – that the state government would introduce legislated minimum nurse-to-resident ratios in stateowned nursing homes and public reporting for all public and private hospitals and aged care facilities. Ratios are also set to roll out in public acute mental health facilities.

RATIOS AND BEYOND

While private aged care facilities cannot be forced to report, they will be named and shamed on a website if they don't.

These are fantastic developments for our Ratios Save Lives campaign and it was great to celebrate the results of our hard work at conference.

annual conference 38

We also passed a whopping 97 motions, which set the union’s agenda for the year ahead… democracy at its finest!

Find out more about the results of the ratios research on page 14.

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We always have fun with our yearly tradition‌ the steps pic! Thank you to all our delegates for another successful QNMU conference.

Check out our album of pics on Facebook www.facebook.com/qnmuofficial

PD ble C ila 5 va 6. urs a

Watch and learn

ho

Conference at a glance

Members can watch recordings of conference speaker presentations and answer reflective questions on our CPD Portal.

Visit www.qnmu.org. au/CPD and head to the recordings section.

QNMU President Sally-Anne Jones kicked off our 2019 Annual Conference with hundreds of nurses and midwives in attendance representing QNMU branches and members from across the state.

Continued over page...

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indepth Sandy McLaren and Annmarie Bawden

2019 QNMU ANNUAL CONFERENCE

Members heard from an amazing line-up of speakers on a diverse range of topics including Nurse Navigators, growing our power around the world, how to get our message across and more.

A very happy 90th birthday to Uncle Bob! For as long as we can remember, Uncle Bob (Dr Robert Anderson OAM) has opened our conference with a wonderful welcome to country, so we couldn’t be more pleased to celebrate his special day with him (a little early).

Dr Frances Hughes

Well done to our delegates, who unanimously passed an urgency motion to pursue a criminal investigation of Earle Haven.

This “canary in the coalmine” was later the focus of Royal Commission hearings, and highlighted the problems in aged care.

Dani Ang, Cairns Hospital

Russ Wolfe, Toowoomba Hospital

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Dr Matthew McHugh from the University of Pennsylvania delivered the results of a worldfirst evaluation of legislated ratios, based on extensive research undertaken by Queensland Health, Queensland University of Technology and University of Pennsylvania.

Shelley Nowlan

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WHY ARE YOU A UNION MEMBER?

Because I like to advocate for safety in the workplace. I think being a new grad I bring a fresh pair of eyes to the workplace and I think its good to try and advocate from that fresh career perspective.

Paula Pianta, Townsville Hospital

Lauren Schofield, RN, Rockhampton Hospital

Special guest Queensland Premier Annastacia Palaszczuk opened day three of conference with an announcement the state government would introduce legislated minimum nurse-to-resident ratios in state-owned nursing homes!

QNMU members participated in a panel discussion about ratios in real life.

We heard firsthand from members that prescribed wards where management have embraced ratios are the ones that have benefitted the most.

I believe there’s power in numbers and [the union] provides security as well work wise.

Jeroen Meerman, RN, Bundaberg Hospital

To help others in situations where they need help. It’s why I became a nurse and now I’m a union member to help other nurses and midwives.

Megan Sara, RN, Logan Hospital

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Notes

from the

North

Lucynda Maskell QNMU Vice President

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TYPICAL day in the life of a remote area nurse is varied and unpredictable.

It can involve caring for a paediatric patient, a chronic disease patient, an acute emergency patient, a mental health patient and an antenatal presentation, just to name a few.

It can focus on surveillance of the acute patient or surveillance of a community in a more public health/ community context.

Remote Area Nurses (RANs) are jacks of all trades, masters of a few of them, and sometimes inexperienced in other areas.

The days can be busy or may involve very few clinical cases and focus more on re-coordination of the emergency packs or recall lists for those due for HbA1C. The weather can be rain for weeks with no road access, or sunshine and glorious (and wishing you were out enjoying the sun).

The days can be spent treating patients you consider extended family or filled with tourists who come to visit the places we call home.

Working in a remote area can be rewarding, terrifying, autonomous, basic, complex and professionally challenging.

Never a dull moment

Living and working in remote Queensland is a unique experience.

It exposes nurses to a broad range of health conditions and metaspecialties of health, before potentially fine-tuning your skills on a particular area of interest.

Nurses are often able to use skills in remote areas they aren’t authorised to use in metropolitan areas.

The benefit of developing these skills and utilising them in clinical practice has multifaceted benefits to both our patients as well as our job satisfaction.

Where relevant qualifications exist, nurses can use their Rural and Isolated Practice Registered Nurse (RIPEN) to treat in accordance with a drug therapy protocol, initiate and complete x-rays, initiate and administer immunisations, insert and remove Implanon devices, suture wounds, plaster fractures… the list goes on.

While RANs absolutely collaborate with their medical colleagues, the nursing profession shines and really is the crux of why we all became nurses – to use our full scope of practice to help people improve their health on a daily basis.

The time to develop the skill set and qualifications is supported by various

entitlements that the QNMU has negotiated over the years, including Queensland Health’s Remote Area Nurse Incentive Package (RANIP) and the Study and Research Assistance Scheme (SARAS).

RANIP is currently being reviewed, but with the QNMU at the table we are well placed to make the package more flexible and expand it to other areas.

Skills aside, remote area nursing doesn’t come without its challenges, including some personal challenges.

Often RANs live in the small community they work in and therefore may be the only clinical person available to assess and treat friends and family.

This was certainly an unexpected challenge for me when I was confronted with the situation of needing to assess a close friend.

But all in all, I love living and working in remote Queensland.

I urge every nurse, no matter what stage they are in their nursing career, to work in a rural or isolated area.

I have learned many lessons that I will take with me wherever I go – rural, isolated or otherwise.

Confused?

Don’t be. I invite you to do a placement in a remote area and you will see what I mean!

With the incredible advances in technology, clinic staff now have access to TEMSU, a link to a 24-hour intensivist and other expert clinicians via video.

In other words, although in a remote location, you are never totally isolated when help is needed.

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With my fellow delegates at the 2019 Annual Conference. Left to right: Jola George (Cooktown Hospital), Kim Ive (Herberton Hospital), Peta Lyons (Cooktown Hospital) and Jess Stecko (Napranum Primary Health Care Centre).

FR EE

CPD portal…

FREE for QNMU members!

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

CPD

ED staff stressors: Challenges and opportunities

BY PROFESSOR JULIA CRILLY, BN, MEMERGN(HONS), PHD1,2; A/PROF JAIMI GREENSLADE, BPSYC(HONS), PHD3,4; AND DR AMY JOHNSTON, BN, BSC(HONS), MED, PHD4,5.

AFFILIATIONS: 1. MENZIES HEALTH INSTITUTE QUEENSLAND, GRIFFITH UNIVERSITY; 2. DEPARTMENT OF EMERGENCY MEDICINE, GOLD COAST HEALTH; 3. EMERGENCY AND TRAUMA CENTRE, THE ROYAL BRISBANE AND WOMEN’S HOSPITAL; 4. THE UNIVERSITY OF QUEENSLAND; 5. DEPARTMENT OF EMERGENCY MEDICINE, PRINCESS ALEXANDRA HOSPITAL.

W

ORKING in healthcare is undoubtedly stressful. This is especially the case in busy Emergency Departments (EDs) where there is high workload (Laposa et al., 2003), an increasing number of patients, violence directed at staff, and skill-mix and staffing deficits (Adriaenssens et al 2011).

Strategies used by ED staff to cope with stressors such as these are poorly understood.

This is an area important to understand, as poor (maladaptive) coping strategies are associated with adverse performance and job satisfaction while positive (adaptive) coping strategies are linked to staff wellbeing and reaching their professional goals (Brown et al., 2005).

We sought to understand the views of ED staff in terms of workplace stressors and coping strategies.

Identifying common stressors and coping strategies would allow us to work towards the development, implementation and evaluation of evidence-based strategies designed to enhance staff perceptions of their working environment and coping.

In a partnership between Griffith University, the University of the Sunshine

44

Coast, the University of Queensland, and emergency clinicians from Queensland and Sweden, we started a program of research designed to understand the working environment of ED staff.

Firstly, we explored current evidence around working conditions in the ED. Our review of literature found that the impact of work environment stressors tended to be ameliorated by experience and autonomy, and that few studies explored interventions to improve the working environment in the ED (Johnston et al., 2016).

Following this, we undertook a pilot cross-sectional study, surveying staff from two different-sized EDs in a single Queensland Health Service.

This study revealed that despite the different-sized EDs, similar perceptions of stressors (around system and resource concerns) were reported (Abraham et al., 2018).

Staff used a wide range of coping mechanisms to deal with stressors, and most of these were positive in nature (Abraham et al., 2018).

CPD

If this article has brought up feeling of distress or concern for you, please contact your Employee Assistance Provider, Lifeline Australia (Ph: 131114), or Beyond Blue (1300 224 636).

We have extended this work internationally to survey medical and nursing staff from EDs, in Queensland and Sweden (Crilly et al., 2019).

We found that ED staff perceptions of the work environment differed based on age, sex, country and job (medical / nursing) (Crilly et al., 2019).

The most common stressors noted were the death or sexual abuse of a child, heavy workload and poor skill-mix (Crilly et al., 2019).

Our findings also indicated that generally, employees engaging in positive coping strategies had relatively positive perceptions of their working environment, whilst those engaging in maladaptive coping strategies reported negative perceptions of their work environment (Crilly et al., 2019).

This information highlights the continued organisational engagement and support required to reduce impacts of workload and skill-mix concerns.

This research may be used to guide managers and decision makers as well as inform interventions to improve the use of

beneficial coping strategies in response to stress.

Along with initial funding awarded from the Emergency Medicine Foundation, we are grateful to staff from the EDs who have supported this program of research thus far.

Moving forward, we are working on improving the survey we used, designing strategies to assist staff, and extending our research to other EDs interstate and overseas.

REFLECTIVE QUESTIONS 1. What factors in your working environment do you find most stressful? How often are you exposed to these stressors?

2. How do you cope with stressors in your workplace? If you use negative coping strategies, what positive coping strategies might better serve you?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Abraham L, Thom O, Greenslade J, Wallis M, Johnston A, Carlstrom E, Mills D, Crilly J. Morale, stress and coping strategies of staff working in the emergency department: A comparison of two different sized departments.

Emergency Medicine Australasia 2018;30(3):375-381.

Adriaenssens J, De Gucht V, Van Der Doef M, Maes S. Exploring the burden of emergency care: predictors of stress-health outcomes in emergency nurses. Journal of Advanced Nursing 2011;67:1317-1328.

Brown S, Challagalla G, Westbrook R. Good cope, bad cope: adaptive and maladaptive coping strategies following a critical negative work event. Journal of Applied Psychology 2005;90:792-8.

Crilly J, Greenslade J, Johnston A, Carlstrom E, Thom O, Abraham L, Mills D, Wallis M. Staff perceptions of the emergency department working environment: an international cross-sectional survey Emergency Medicine Australasia 2019, https://doi. org/10.1111/1742-6723.13325 Johnston A, Abraham L, Greenslade J, Thom O, Carlstrom E, Wallis M, Crilly J. Staff perceptions of the emergency department working environment: an integrative review of the literature.

Emergency Medicine Australasia 2016;28(1):7-26.

Laposa JM, Alden LE, Fullerton LM. Work stress and posttraumatic stress disorder in ED nurses/personnel.

Journal of Emergency Nursing 2003;29:23-28.

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C CPD

onsent

D

EMENTIA is the umbrella term for a number of neurological conditions, of which the major symptom is the decline in brain function due to physical changes in the brain. It is distinct from mental illness.

Dementia is categorised as a Neurocognitive Disorder (NCD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5). The NCD category is then further subdivided into Minor NCD and Major NCD (Dementia Australia).

The DSM-5 details six cognitive domains which may be affected in both Minor and Major NCD, one of which is ‘executive ability’, that involves planning, decision making, working memory, responding to feedback, error correction, overriding habits and mental flexibility.

This is the domain that is most relevant to the person’s ability to consent to care.

Given the variable and progressive nature of the disorder, the capacity for a patient or resident with dementia to consent to nursing care is not a short, black-and-white answer.

An employer cannot give a blanket directive that all patients or residents with dementia cannot consent to care or have the right to refuse care.

A person’s capacity to consent must be made on a case by case basis and

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IN DEMENTIA CARE

there are a number of complex factors to consider.

be assessed by an appropriately qualified medical practitioner.

We advise our members that they should arrange a cognitive assessment whenever they are providing care to a patient or resident who they suspect may be developing an impairment.

Once it is determined that the person does not have the mental capacity, one must look to the alternate decision-making authorities.

If some of those within your care already have a diagnosis of dementia, particularly if they are in the mild phase of neurocognitive disorder, they should be reassessed at regular intervals to determine if and when their cognitive impairment has progressed to the stage that their executive ability is compromised, and they are unable to provide informed consent.

Always be aware that it is possible to have a diagnosis of dementia and still have mental capacity and that a person’s capacity may vary from topic to topic, day to day or even at various times of day, depending upon the degree of NCD, the complexity of the information provided and the significance of the decision.

Nurses and midwives may raise doubts about a patient or resident’s capacity to provide informed consent, but the formal determination of mental capacity for informed decision-making, which will have significant legal impact, should

These will include whether or not the patient or resident has an Advance Health Directive, or an Enduring Power of Attorney for health matters.

If neither of these are present or enlivened, then you must seek consent from the Statutory Attorney or, if not appointed, the Public Guardian.

The only exceptions to the above are for ‘minor’ health care and ‘urgent’ health care. Relevant to aged care settings, if a competent resident, or an alternate decision-maker, is refusing the provision of care, the approved provider should obtain legal advice on what constitutes ‘minor’ or ‘urgent’ health care for that resident.

The issue of consent is a very important one for nurses and midwives. It has been long-held that providing healthcare to a person without valid, informed consent may result in criminal allegations of assault.

Therefore, it is very important to ensure your patient or resident has capacity for informed decisionmaking and consents to all of the care being provided.

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16-22 September 2019 is Dementia Action Week.

See calendar on page 70 for details.

REFLECTIVE QUESTIONS 1. In your own words what do you understand by the term “executive ability”?

2. Have you been in a situation where you believed a dementia patient/resident was not capable of consenting to care?

Did you know how to proceed? What did you do?

3. Using the specifics of your workplace, describe the current protocols and real-world practices for managing patients/ residents who are unable to consent to care. Are they appropriate or do they need realignment with the advice outlined in this article? How might you advocate for a more appropriate approach?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Dementia delirium AND

T

HE ROYAL Commission into Aged Care Quality and Safety has released a number of background papers to provide relevant information to the commission and the public at large to assist the process.

A recent paper titled Dementia in Australia Nature, Prevalence and Care Background Paper 3 provides research and insights into dementia in Australia.

The paper reveals that in 2016, 52% of people in residential aged care had a dementia related diagnosis.

What is dementia?

The paper defines dementia as “an umbrella disorder which describes symptoms associated with a group of neurocognition conditions and disorder of the brain”.

Whilst this recognises different causes of dementia, there are common behavioural and psychological symptoms for people with dementia (commonly abbreviated to BPSD). These include: ■■ memory loss ■■ difficulty in expressing and communicating through language ■■ spatial awareness (difficulty knowing how to find their way) ■■ apraxia (difficulty carrying out planned or learned patterns of movement) ■■ agnosia (difficulty recognising things and people, such as family members) ■■ insight (inability to plan or organise)

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CPD ■■ regulation (inability to control social behaviours) ■■ connection (angry responses, accusations of stealing).

Some of the more challenging behaviours associated with dementia include agitation, and physical and verbal aggression.

It is this type of behaviour that members regularly report to the QNMU, often describing a lack of action in managing problems associated with this by their employers. This is extremely disruptive and dangerous.

And in some cases, nurses, carers and residents are seriously injured.

Some of the well-recognised triggers for this more extreme agitation include health issues such as unmanaged pain, medication management practices, constipation etc. Other potential causes are fear, and loss of independence.

Delirium Delirium is a term used to describe acute confusion and affects a person’s mental ability (Dementia Australia 2015).

It is a condition that develops most often due to a pre-existing dementia or old age however, other cause factors include illness, surgery, dehydration etc.

Due to the similarity between the signs and symptoms of dementia and delirium, it is important that the two are not confused as management of each condition is different.

Dementia Australia recommends some simple interventions to manage this, including family visits, proper communication, adequate hydration and nutrition, reduction in stimulation, and regular monitoring of pain management.

Aggression The QNMU previously highlighted the issue of aggression in care at an investigation that identified

28 deaths due to resident-to-resident aggression in Australian nursing homes over a 14-year period.

development in de-escalation techniques that members can employ to help manage crisis situations.

Because of this and the frequent assaults on nursing and personal care staff in residential aged care, it is critical that aggression related to dementia and delirium is properly managed.

Training should also emphasise how the physical environment and potential injury to other residents might be considered.

The QNMU believes that in order to reduce the risks posed by aggression, adequate staffing and skills mix must be a priority.

Ratios While our ratios campaign is focused on the provision of proper nursing care, it is reasonable that management of aggression will also be enabled with adequate resourcing.

Recent experience in Queensland Health with the introduction of Aged Care Ambassadors into an aged dementia unit has seen a significant reduction in aggressive incidents.

There are plans to extend this program into other similar workplaces in Queensland Health.

WHS obligations Employers have a responsibility to minimise the risk posed by aggressive behaviour from residents suffering dementia.

They must do all that is ‘reasonably practicable’ to manage any potential risk before considering the financial implications of introducing controls.

An employer who responds to safety concerns by stating nothing can be done has failed to meet their obligations under the Work Health and Safety Act 2011.

Employers are legally obliged to provide adequate staffing to meet the needs of dementia residents.

This includes training to reduce occupational violence risks.

This training should include risk assessment processes for dementia sufferers with appropriate behavioural control measures for each individual, as well as a thorough education program.

While each resident should have an individual response, training programs in general should also include skill

It has been the QNMU’s experience that injuries from assaults where aged care members have responded, it is often as a result of lack of individual management strategies for residents and inadequate training for staff.

Given the importance of how a person interacts with residents with dementia, it is our view that proper training is a major health and safety control measure to protect staff and residents and that currently it is not being delivered.

If you are employed in residential aged care and your employer is not meeting their obligation, please contact the QNMU for assistance.

REFLECTIVE QUESTIONS 1. What are some of the wide range of conditions associated with dementia?

2. Is there a difference between dementia and delirium?

Describe it.

3. Why is it important to have proper individual behavioural care planning for people with dementia?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

B. Murphy et al 2017, “Deaths from Resident Aggression in Australian Nursing Homes”, Journal of American Geriatrics Society, Volume 65 Issue 12 Changed Behaviours and Dementia Aggressive Behaviour 7, 2015, Dementia Australia Dementia and Delirium Q&A – Dementia Australia 2015 Dementia in Australia: Nature, Prevalence and Care Background Paper 3 May 2019 https://www.dementia.org.au/files/helpsheets/HelpshetDementiaQandA21_Delirium_english.pdf Accessed 23 July 209 2.55pm https://www.demential.org.au/files/helpsheets/HelpsheetChangedBehavours07-AggressiveBehaviours_english.pdf Accessed 23 July 2019 2.58pm Royal Commission into Aged Care Quality and Safety Commonwealth of Australia

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Wound , medication AND

pain management IN

aged care settings

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THIS ARTICLE IS AN EXTRACT FROM THE ANMF’S SUBMISSION TO THE ROYAL COMMISSION INTO AGED CARE QUALITY AND SAFETY. THE QNMU CONTRIBUTED TO THIS SUBMISSION.

I

N REVIEWING the phenomenon of missed care in residential aged care in Australia, research suggests

activities such as wound care, medication management and pain management are care activities that are missed at least part of the time, with staffing levels and time constraints identified as the main causative factors.

Wound care Acute injuries such as skin tears and chronic wounds such as pressure ulcers, venous leg ulcers, diabetic foot ulcers and arterial ulcers are age related and therefore an issue in residential aged care settings with high prevalence rates particularly for pressure ulcers, skin tears and leg or foot ulcers.

According to the Australian Centre for Health Services Innovation (2017), at a macro level, significant best practice gaps in chronic wound treatment are impeding both health gains and cost savings.

Barriers identified include communication and co-ordination issues, awareness by health professionals, consumers and policy makers, education, access to specialty services and training and costs.

In relation to aged care, the Improving Wound Management for Residents in Residential Aged Care Facilities: National Dissemination and Implementation of the Evidence Based Champions for Skin Integrity Program final report funded by the Australian Government under the Encouraging Better Practice in Aged Care Program identified a range of issues impacting on the quality of wound care in aged care.

These included the significant growth in demand for aged care services, difficulties in recruiting and retaining skilled staff because of factors such as workloads, stressful work environments and poor remuneration, lack of specialised training and the skills of those entering the aged care workforce.

Other factors identified were the high proportion of staff who have English as a second language and culturally diverse backgrounds, education and literacy levels for the unregulated component of the aged care workforce, and lack of leadership and management skills for those who have clinical supervision roles.

Organisational issues identified included change-resistant organisational structures and cultures, and an unwillingness to resource new initiatives or provide access to staff training.

Medication management Registered Nurses play a key role in medication management in residential aged care facilities, ranging from ensuring that medications are ordered and available for residents, working with prescribers and pharmacies, to storing, administering and documenting correctly.

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CPD It is the view of the Australian Nursing and Midwifery Federation (ANMF) that there is a distinct difference between administration of, and assisting with, medication.

Only Registered Nurses, or Enrolled Nurses working under the supervision of a RN, have the required education, knowledge and skills to safely administer medication in this environment.

The ANMF notes the disturbing trend in residential aged care of moving medication administration tasks from registered and enrolled nurses to unregistered health care workers.

It is the policy of the ANMF that all aspects of medication management in aged care must be undertaken

by RN’s and EN’s and is outlined in the document Nursing Guidelines for Medication Management in Aged Care (2012) jointly developed by the ANMF and the then Royal College of Nursing Australia (now the Australian College of Nursing).

This professional standard is referenced in the Guiding principles for medication management in residential aged care facilities (2012) developed by the Australian Government Department of Health and Ageing and intended for aged care providers.

The role of unregistered health care workers must only be in assisting cognitively competent clients to take prescribed medications when they request assistance to do so.

The ANMF believes a reasonable definition of medication assistance means: ■■ reminding and/or prompting a resident/client to take the medicine, or

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■■ assisting (if needed) with opening of medicine containers for the client/ resident at his/her request and direction, or

the supervision of a registered nurse or enrolled nurse, however the administration role should remain within the domain of nursing practice.

■■ bringing packs of medicines to a person at their request so that the person can take the medicines, or

During the course of a three-year nursing undergraduate degree it is likely that students undertake hundreds of hours of theoretical and practical learning relating to pharmacology.

■■ reading labels aloud to the client/ resident and advising the time (e.g.

“3pm”) at the request of the person who is going to take the medicine, or ■■ ensuring the resident/client has a drink to take with his or her medicines.

A complicating factor in medication management in aged care is that medicines regulation is a state matter with some variation between jurisdictions in relation to the role of unregistered health care workers administering medications.

Anecdotal evidence from state branches indicates that aged care providers are progressively introducing medication administration by unregistered health care workers.

A report on medication management in residential aged care by the New South Wales Nurses and Midwives Association (NSWNMA) released in 2017 suggests over half of residential facilities in that state now have most medications administered by unregistered health care workers despite over 75% of residents requiring total help with medications.

The ANMF does believe that unregistered heath care workers (however titled) who have the appropriate education, skills and competencies can safely assist a resident to take medication under

This knowledge is what both the Australian Nursing and Midwifery Accreditation Council (ANMAC) and the Nursing and Midwifery Board of Australia (NMBA) regard as a minimum standard for safe medication management practice by registrants.

The ANMF is extremely concerned that aged care providers and the Aged Care Quality and Safety Commission believe that unregulated carers who have completed a short certificate course, can substitute for the skills and knowledge of a registered or enrolled nurse.

Medication management is also one of the top complaint areas reported.

This, and the vulnerable nature of those in residential aged care facilities and their significant medication use, highlights that medication management is a critical clinical process in aged care, just as it is in the acute sector.

If medication related errors and adverse events remain a high risk in the acute sector despite the availability of highly trained staff, comprehensive standards and wideranging medication safety processes, it is hard to believe that transferring medication administration tasks to unregistered health care workers will maintain safety in aged care.

CPD Pain management Chronic pain has been identified as a significant and widespread problem in residential aged care facilities with up to 80% of residents estimated to suffer from it.

In addition, a significant percentage of residents have dementia and require high levels of behaviour management care, resulting in a group of older Australians whose pain management is complicated by cognitive and communication impairment which risks misdiagnosis and inadequate treatment.

Untreated or poorly treated pain can have a significant impact on quality of life including function, relationships and mental health, e.g. depression.

For those with cognitive and communication difficulties, untreated or poorly treated pain can exacerbate the behavioural and psychological symptoms of dementia (BPSD) and the use of psychotropic medications and the risks associated with inappropriate use of these drugs.

Research evidence suggests that pain is often poorly managed in those in residential aged care facilities for a range of reasons including staff workloads, nursing and physician knowledge deficits and misconceptions and communication issues.

In the acute context, a range of issues and obstacles have been identified impacting on pain management of cognitively impaired older persons. This is significant given concerns around the level of inappropriate transfers to hospital emergency departments. These issues include: ■■ a lack of pain assessment tools, requiring greater reliance on the nurses’ knowledge, experience and clinical judgement ■■ pain management in the context of the physiological changes associated with old age and associated factors such as chronic illness, comorbidities and polypharmacy ■■ the stress of trying to achieve effective pain assessment and management, e.g. balancing analgesic regimes with potential side-effects such as further cognitive impairment ■■ the limitations of nurse-initiated pain management protocols and difficulties

communicating with prescribers in achieving effective pain management.

At a system level, Painaustralia has identified a number of issues affecting pain management in residential aged care facilities. These are: ■■ inadequate training and education for aged care staff leading to underreporting of pain with workloads implicated in lack of time for assessment as well as front-line staff knowledge deficits ■■ inadequate pain reporting standards and processes for aged care ■■ poor support for allied health and bestpractice pain management processes within the current aged care funding model ■■ the need for better education for aged care residents about best-practice pain management to combat perceptions that pain is a natural consequence of ageing, concerns around drug dependency, being seen as complaining and reluctance to seek help ■■ lack of a coordinated national approach to drive policy around best-practice pain management practices.

Caring for chronic wounds, ensuring medications are administered safely and pain is managed effectively are core quality of care and quality of life imperatives in providing high quality aged care.

The ANMF believes the problems identified around clinical care issues such as wound, medication and pain management are driven, at their core, by systemic staffing and skill-mix deficits across the aged care sector.

The ANMF believes there is considerable room for improvement in this regard.

REFLECTIVE QUESTIONS 1. Consider what you’ve just read.

What are the key take home messages for you?

2. Consider other clinical settings – how might staffing levels and skill mix affect wound care or pain management?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Australian Government, Aged Care Complaints Commissioner (2018) Annual Report 2017-18, retrieved from https://www.agedcarequality. gov.au/sites/default/files/media/ Aged%20Care%20Complaints%20 Commissioner%20%E2%80%93%20 Annual%20Report%20 2017%E2%80%9318.pdf Fry M, Cheonweth L, Arendts G (2015) Assessment and management of acute pain in the older person with cognitive impairment: A qualitative study, International Emergency Nursing, 24, pp. 54-60.

New South Wales Nurses and Midwives Association (2017), The state of medication in NSW residential aged care, retrieved from http:// www.nswnma.asn.au/wp-content/ uploads/2017/12/Medication-in-NSWRAS-FINAL-LR.pdf Painaustralia (2017), Submission to the Review of National Aged Care Quality Regulatory Processes, retrieved from https://www.painaustralia.org.au/ static/uploads/files/painaustraliasubmission-to-the-review-of-agedcare-quality-regulatory-processes-juwfksdnlbjavr.pdf Veal F, Mackenzie W, Bereznicki L, Cummings E, Thompson A, Peterson G, Winzerberg T (2017) Barriers to Optimal Pain Management in Aged Care Facilities: An Australian Qualitative Study, Pain Management Nursing, 19(2), pp. 177-185.

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Blood collection: HAND HYGIENE PRACTICE GUIDELINES

BACKGROUND During the collection of blood there is a risk of direct introduction of pathogens into a patient’s bloodstream.

Effective hand hygiene immediately prior to performing any procedure is the single most effective way to minimise the risk of transmission of microorganisms.

Hand Hygiene Australia (HHA) recommends the following guidelines for hand hygiene during the collection of blood specimens.

KEY CONSIDERATIONS AND GUIDING PRINCIPLES Equipment ■■ Gather all equipment for the venepuncture procedure and check against the pathology form before touching the patient.

■■ Only prepare the equipment once you have moved into the patient zone and performed hand hygiene.

Patient set up ■■ Hand hygiene must be performed before setting up the patient.

■■ Hand hygiene must be performed again, and gloves donned in preparation for commencement of the venepuncture procedure only once setup of patient and equipment is complete.

Glove use ■■ Gloves should not be applied (unless otherwise indicated) until hand hygiene has been performed IMMEDIATELY prior to performing the venepuncture procedure.

■■ If gloves are required earlier (e.g. Transmission Based Precautions) these will need to be removed, hand hygiene performed, and a new set of gloves applied IMMEDIATELY prior to venepuncture.

Additional equipment ■■ If additional equipment is required after the patient has been touched or gloves applied, gloves must be removed (if worn) and hand hygiene performed before touching the clean stock in/on the trolley.

Cleaning between each patient Reproduced with permission from Hand Hygiene Australia as part of the National Hand Hygiene Initiative (NHHI).

■■ Equipment which is potentially contaminated with patient’s flora (such as the tourniquet, injection tray, kidney dish, top of trolley or work bench) must be cleaned between every patient.

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BLOOD COLLECTION HAND HYGIENE METHOD

1

Receive/read blood collection slip and verify patient appropriateness for procedure.

13

Perform venepuncture. Loosen tourniquet during procedure when appropriate.

2

Gather venepuncture equipment and tubes (*If required, e.g. Transmission-Based Precautions, place all necessary equipment into a suitable container to take equipment into patient zone.)

14

Place tubes in an appropriate container e.g. kidney dish.

15

Remove needle and apply appropriate pad and pressure to site (where possible, ask patient to hold and apply pressure).

16

Remove tourniquet, discard sharps & dispose of waste.

17

Label tubes and place in pathology bag.

18

Doff gloves and perform hand hygiene.

19

Check patient’s venepuncture site for any sign of bleeding. Apply clean dressing and tape in place once bleeding has stopped.

20

Explain to the patient to monitor the site for a further 15 minutes and provide after care advice.

21

Clean all equipment touched during procedure – top of trolley, kidney dish, tourniquet and any other item or surface potentially contaminated with patient microorganisms.

22

Dispose of waste.

23

Perform hand hygiene.

3

Move into the patient zone and perform hand hygiene.

4

Introduce self to patient and gain consent, enquire if they have had blood test previously, if not – explain collection procedure.

5

Assemble/prepare venepuncture equipment.

6

Ensure patient is identified, request form and test conditions have been checked and position the patient appropriately.

7

Position equipment next to patient. DO NOT retrieve additional equipment from trolley – if required see Key Considerations regarding additional equipment.

8

Apply tourniquet. Palpate to identify vein position and direction.

9

Once appropriate vein has been located loosen tourniquet and ensure equipment and patient are ready for venepuncture to begin.

10

Perform hand hygiene and don gloves.

11

Tighten tourniquet, re-locate vein position and direction, clean area (as per organisation infection control policy) and allow to air dry. (Please see additional notes regarding tourniquet contamination.)

To ensure aseptic technique, do not repalpate or wipe the area with cotton wool.

12 56

If necessary to re-palpate repeat step 10.

Effective hand hygiene immediately prior to performing any procedure is the single most effective way to minimise the risk of transmission of microorganisms.

CPD VARIATIONS FOR CONSIDERATION Monitoring of venepuncture site ■■ Blood collectors may be required or choose to stay with the patient to closely observe the venepuncture site and apply a clean dressing before moving back to the trolley to discard of waste and label tubes.

■■ In this case final activities including after-care advice to the patient and cleaning of equipment should occur after sharps are discarded, waste is disposed of, gloves are doffed (removed), and hand hygiene has been performed.

Establishing an aseptic field Some blood collectors are trained to establish an aseptic field (using their trolley) for the venepuncture procedure. In this case the following must apply: ■■ the surface of the trolley must be completely clear of any items ■■ the surface of the trolley must not become contaminated at any time during the venepuncture procedure ■■ the surface of the trolley must be appropriately cleaned between every patient.

If an aseptic field is established for blood collection as above, collectors may return to the patient after labelling tubes without doffing gloves and performing hand hygiene.

When an aseptic field is not established If the surface of the trolley contains additional equipment/ items OR is not able to be completely and adequately cleaned between every patient, gloves must be removed, and hand hygiene performed before moving back to touch the patient, as it is likely hands have become contaminated by organisms on the trolley’s surface.

patients. Where practicable, a clean tourniquet should be used for each patient.

2. Touching an applied tourniquet after performing hand hygiene can re-contaminate the user’s hands (with the patient’s own skin flora).

3. After performing hand hygiene and donning gloves for needle insertion it is best practice NOT to manipulate the applied tourniquet, although this may be unavoidable due to individual patient or clinician needs.

4. As per the blood collection standard, tightened tourniquets should not be left in position for greater than 1 minute. The patient and equipment should be prepared prior to tightening the tourniquet.

5. If the tourniquet is touched after donning gloves (e.g. for tightening and releasing purposes) due to individual patient or clinician needs, contact should be kept to a minimum using only your nondominant hand.

ADDITIONAL NOTES:

6. Additional episodes of hand hygiene will be required if at any time prior to touching the patient, a collector touches the surrounding curtains.

1. Tourniquets are commonly used on multiple patients and have the potential to become highly contaminated. Tourniquets are non-critical items and require thorough cleaning between

7. Additional episodes of hand hygiene will be required if at any time during a procedure, the collector is in contact with contaminated items or their own hands are visibly soiled.

References:

Clinical and Laboratory Standards Institute. Procedures for the collection of diagnostic blood specimens by venipuncture; approved standard - sixth edition. CLSI document H3-A6.

Pennsylvania: Clinical and laboratory standards institute; 2007.

NHMRC. Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia; 2010.

World Health Organisation (WHO). WHO Guidelines on Hand Hygiene in Health Care. In: World Alliance for Patient Safety, editor. First Global Patient Safety Challenge Clean Care is Safer Care. 1 ed. Geneva: World Health Organisation Press; 2009.

REFLECTIVE QUESTIONS 1. Consider the process for blood collection in your workplace. Does it resemble the HHA’s guidelines?

If not, what is different? What might be the implication/s of this difference?

2. What role do soap and hand sanitiser play in hand hygiene? Is there a preference for one over the other? What are the pros and cons of each?

3. Why is it important to resist pressure to rush through the collection process during busy times?

4. These guidelines focus largely on the technical aspects of blood collection. As a nurse or midwife, how would you humanise the process and at what stage?

5. What information should you impart to your patient during this process?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Day:

Ask the question.

I

N AUSTRALIA, there are about eight suicides and 170 attempted suicides every day.

In its mission to minimise suicide rates, the RUOK suicide prevention charity encourages people to start life-changing conversations about moods, behavioural changes and mental health.

Nurses and midwives are in a unique position to be able to ask patients, mothers, residents and clients “RUOK?“ and we tend to do it instinctively.

But this simple query can be the ice breaker that could change the life of a work colleague.

If you’ve noticed some changes in the physical appearance and/or mood in one of your colleagues over the past couple of weeks, it may be a sign that things are not okay with them.

Don’t procrastinate, trust your gut and ask the question, “Are you ok?”.

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Asking the question can be somewhat daunting, because you might worry you’re not equipped to handle the answer, but the RUOK group has provided the following helpful guidelines on how to conduct the deeper conversation that may be generated by the answer:

Before asking, it’s important to be in the right headspace.

Be prepared to listen and have enough time to engage in the conversation.

You should find a good time to chat, pick somewhere private and informal and try to put aside at least an hour, so you have ample time for a meaningful conversation.

Be relaxed when you start the conversation.

Use open-ended questions like “What’s been happening?” or “How are you travelling?”.

You should also mention something specific you have noticed recently about their general demeanour to get the conversation started.

The most important thing to do is listen.

Don’t rush or interrupt the conversation and don’t be concerned by brief periods of silence – give them time to think. If you don’t quite understand something, ask them to explain.

If they get upset or angry don’t take it personally and let them know you’re only asking because of your concern for them.

Towards the end of the conversation it’s important to encourage action.

Ask them where they think they might go from here. What would be a good first step? Ask how you can help them.

CPD

Day falls on 12 September each year... but is something we should apply to every day of the year Their options might include talking with family, a trusted friend, their doctor or your employee assistance program.

Whatever the available options are, it is important the person chooses their next step, not you.

Finally, it’s also important you follow up and check in with them in a few days’ time.

Ask if they have found other supports and possibly better ways to manage their situation.

Be prepared for a response that they haven’t done anything. It often takes time and courage to get to the point where they are ready to seek help from a mental health professional.

When that happens, continue to gently encourage them to seek advice and remind them you’re here if they need a chat.

It can also tremendous courage to start an RUOK conversation, but the

benefits can be life-changing for both of you.

The RUOK organisation can help prepare you for that conversation through their website which has lots of information to help prepare and guide you.

www.ruok.org.au

If you or someone you know needs immediate help you can also contact Lifeline on 13 11 14 (24 hours a day).

REFLECTIVE QUESTIONS 1. If you saw behavioural changes with one of your colleagues, when, where and how might you initiate an RUOK conversation? Be specific.

2. How might you proceed if your colleague was not very responsive?

3. What support systems are in place in your workplace or region that might be an option for a colleague needing further help?

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

Maintaining dual registrations in nursing and paramedicine 60

CPD

G

IVEN the growth over the past decade in the number of universities offering double degrees in nursing and paramedicine, as well as the introduction of the Paramedicine Board in December last year (which sees paramedicine join nursing and midwifery as regulated professions), it is timely to review the obligations these registrants are required to meet and explore some important issues arising out of this specific type of dual registration.

This means registrants must complete, and be able to demonstrate, that they have met the recency of practice, continuing professional development (CPD) requirements, and have professional indemnity insurance relevant to both their practices.

Students who choose this type of degree do so for a variety of reasons – a wish to acquire a broad skill set, the desire to explore two disciplines of interest, a perception this will improve employment prospects and provide them with open career options.

Similarly, the Paramedicine board has the ‘Professional capabilities for registered paramedics’, which outlines the paramedic requirements.

The intent of a double degree is that graduates will practice across both professions, in this case nursing and paramedicine.

However, for the most part graduate programs and other health care positions lack flexibility and are still discipline specific.

Two professions With few exceptions, to complete a formal graduate program doubledegree graduates must choose to practice in one discipline, negating the intent of a double degree and resulting in suboptimal use of graduates’ skills and knowledge.

Both the Nursing and Midwifery Board of Australia (NMBA) and the Paramedicine Board of Australia recognise that nursing and paramedicine are two separate professions and those with dual registration are expected to meet the respective professional standards set out by the boards for each profession.

Dual registrants are also expected to pay the respective application fees, initial registration fees and annual renewal fees as dictated by each profession.

There are some commonalities in each profession’s standards, but it is vital registrants meet the individual professional standards in each profession.

Each board’s website provides the framework for assessing practice for each profession. The NMBA publishes the ‘Registered nurse standards for practice’, which outlines the nursing requirements.

These documents can assist in helping determine if the person has the recency of practice required for both professions.

Individual assessments The evidence that is required to be kept and presented to demonstrate that registration standards are met, both as a paramedic and RN, is assessed on an individual basis.

For example, to demonstrate recency of practice, registrants need to have evidence that shows their recent practice is up-to-date within the context/scope, knowledge and skills for each profession.

This can be difficult in an industrial landscape where “mainstream employment models that facilitate integrated graduate practice in both nursing and paramedicine are currently lacking” (Considine, 2015).

In fact, a concerted effort needs to be made by healthcare employers to develop unique roles that can cater for this, particularly in remote areas whose very remoteness can be barriers to recruitment and retention.

An example can be seen in the South West Hospital and Health Service (SWHHS).

The HHS has developed a program to attract the abundance of duel degree Paramedic/RN graduates who are leaving universities but are unable to utilise both their degrees.

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CPD

Working with the Queensland Ambulance Service (QAS), the SWHHS developed a program to ensure graduates are employed and undertake their post degree requirements for employment by both QAS and Queensland Health (QH) through an accredited program.

After completion, the Paramedic/ RN is employed by SWHHS into their hospital-based ambulance sites, enhancing pre-hospital treatment and experience.

This leads to a more seamless movement of staff from employment as a RN to Paramedic and vice versa.

Professional development For CPD activities, registrants must ensure these are relevant to the context of practice, develop competence, and build knowledge and expertise as both a RN and paramedic.

Each board requires different levels of CPD hours allocated to each profession. For RN registration the minimum requirement is 20 hours of CPD and a minimum of 30 hours of CPD is required for paramedicine.

There may be some CPD hours that can count towards both contexts of practice, but the NMBA and the Paramedicine Board would also expect to see separate activities specific to nursing and paramedicine.

Insurance In respect to professional indemnity insurance (PII), under the National

62

Law, nurses and paramedics must not practise their professions unless they hold appropriate PII in relation to their practice.

If someone is registered as both a nurse and paramedic, they must have PII relevant to all aspects of their practice in both nursing and paramedicine to demonstrate compliance with the respective boards’ PII arrangements registration standard.

The QNMU has long recognised that employer insurance policies vary widely with regard to the extent of cover they provide to nursing or midwifery employees, and insurance companies recognise that employer policies may not cover paramedics under certain circumstances.

As of this year, the QNMU's Professional Indemnity Insurance policy now covers nurse paramedics.

Union protection Nurses and paramedics are also covered by different unions and the primary employment position location should dictate which union to join.

The QNMU is happy to discuss the best fit for dual registrants.

Please contact Member Connect on (07) 3099 3210 or 1800 177 273 (toll free outside Brisbane).

Becoming a dual registered RN/ Paramedic is an exciting way forward to develop different skills and have open career options.

However, there are still various factors that should be considered when exploring this unique double role, including registration requirements, financial impacts, job opportunities and insurance coverage.

REFLECTIVE QUESTIONS 1. Why do you think it is necessary for dual registrants to meet the individual professional standards in each profession?

2. Are you familiar with the NMBA’s recency of practice requirements for nurse registration? Describe them. Why is recency of practice important?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

References

Considine, J, Walker, T and Berry, D. “Development, implementation and evaluation of an interprofessional graduate program for nursing-paramedicine double degree graduates” Australian Health Review, Vol.39,Iss 5 (2015): at https://clinicalexcellence.qld.gov.au/improvementexchange/paramedic-registered-nurse-dual-degree https://search-proquest-com.libraryproxy.griffith.edu.au/ docview/1778450274/fulltext/7402C9C981CA49F2PQ/1 ?accountid=14543 https://www.paramedicineboard.gov.au/News/2018-1019-Dual-registration-for-nurses-and-paramedics.aspx https://www.paramedicineboard.gov.au/Professionalstandards/FAQ/Fact-sheet-registration-as-aregistered-nurse-and-paramedic.aspx https://www.qnmu.org.au/CPD/CPD_Activities/CPD%20 Articles/CPD_PII_1218.aspx?WebsiteKey=73d710c469eb-452c-89dd-cafc66fd8ac5

G N ER SI B O TO CL O C

11

QNMU Scholarships now open The QNMU’s scholarship program provides financial assistance to members to help progress their studies, professional development and research, and grow our nursing and midwifery professions.

CURRENT SCHOLARSHIPS: ■■Christine Higgins Memorial scholarship - $1000 awarded to assist an Enrolled Nurse QNMU member to undertake a Bachelor of Nursing course.

■■Enrolled Nurse post-graduate scholarship - $1500 awarded to up to two Enrolled Nurses ($3000 total) to attend a relevant conference or seminar, or to undertake a relevant post-graduate course.

■■Registered Nurse/Midwife post-graduate scholarship - $1500 awarded to up to four QNMU members ($6000 total) to assist attending a relevant conference or seminar, or to undertake a relevant post-graduate course.

■■Leadership development scholarship – $5000 awarded whole or in part to assist QNMU members to undertake an accredited or post-graduate leadership course.

Apply online at www.qnmu.org.au/scholarships APPLICATIONS CLOSE 11 OCTOBER 2019

CPD

The value of

advocacy Advocacy To maintain professional integrity, safety and personal wellbeing we have to be able to balance the tensions inherent in our advocacy role – we must understand the moral obligations as well as the associated risks of the role and the challenges which must be overcome to maintain ethical practice in nursing and midwifery.

T

HE RECENTLY released ANMF National Aged Care Survey 2019 – Final Report reveals the stark reality of a system where nurses and carers feel powerless to support and protect their vulnerable residents.

In the context of the Aged Care Royal Commission there is raised community concern and increased awareness of situations where individuals may be blamed for failing to protect despite significant system failures, institutional powerlessness and distress experienced by those nurses and carers.

The need for patient* advocacy arises with the increase in vulnerability, whether that is an individual health condition which has weakened or whether it is the encounter with the system – the inherent risks of institution – which has placed the person in jeopardy (Mallik, 1997).

Aged residents in care, patients with illness or women in pregnancy and childbirth are “vulnerable” and may require someone stronger or with more knowledge to speak up for them.

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That act of speaking on behalf of someone else requires personal knowledge and a relationship – nursing and midwifery are profoundly based in the relationship, and when that is interrupted through job design, be that excessive workloads or a fragmented model of care, we lose our ability and authority to advocate.

Historically nurses and midwives have functioned in dominant medical and/or bureaucratic paradigms and our professional role has functioned as the critical link between vulnerable individuals and a complex and sometimes inhumane system where institutional demands may override the individual needs.

The nature and context of the therapeutic relationship affects how the nurse or midwife enacts the advocacy role or whether they accept it at all. In a fragmented system where the nurse or midwife is disconnected from the person, they are less likely to take on the risk and responsibility (Fahy, 1992).

Proximity and continuity of care within the patient relationship underpins advocacy.

On the one hand we must connect with the person whose self-advocacy is impaired and understand their needs so as to support or speak for them. But on the otherhand we are part of and subject to the dominant power in the institution which may expose the patient (and/or us) to inherent harmful processes or risks.

There can be a cost to advocacy when we challenge dominant power.

The reality for many in precarious employment is that speaking up may result in having work hours reduced, potentially losing the job or facing other threats to wellbeing.

When we ourselves are threatened do we support a system which ignores the needs of the patient or must we take on a risky role as we speak up and bear the consequences?

Safely fulfilling our advocate role within the system requires each of us to reflect on the pressures or barriers which prevent it and then work collectively to change it.

Though the focus of this article is on patient advocacy it is important to note that professional advocacy is also a significant factor in building and maintaining a psychologically

CPD

Sandra Eales QNMU Assistant Secretary

References

Fahy, K 1992, ‘Advocacy? Reflections on the risks and rewards’, The Australian Nurses Journal, vol. 21, no. 11, pp. 12 – 14 Mallik, M 1997, Advocacy in nursing – a review of the literature’, JAN, vol. 25, issue 1, pp 130138 Volp, K 2007 ‘Defending nursing in your workplace: Quality Workplaces = Quality Patient Care’ The Queensland Nurse. Vol. 26, no. 3, pp 8 – 9

safe practice environment where nurses and midwives may assert their professional judgement and voice concerns.

Ethical practice relies on nurses and midwives to: ■■ ensure reasonable workloads which allow individual patient needs to be understood and met ■■ recognise changes to work processes that take us away from being with patients ■■ reject imposed changes to professional practice which diminish the relationship ■■ build and maintain professional competence and confidence to assert professional judgement ■■ have a good practice environment through building and maintaining inter and intra-professional collegiality ■■ support models of care which protect the relational aspect of professional practice and provide increased proximity and continuity ■■ take collective action on identified practice concerns ■■ protect and defend each other when advocating and speaking up

That act of speaking on behalf of someone else requires personal knowledge and a relationship... for patients and the values which underpin our professional practice.

Advocacy is a potentially risky role and ultimately remains a moral choice which individual nurses and midwives must make — the integrity of the professions depend upon that choice.

Visit http://anmf.org. au/documents/reports/ ANMF_Aged_Care_Survey_ Report_2019.pdf to read the ANMF National Aged Care Survey 2019 - Final Report Visit www.qnmu.org.au/values to read the QNMU Declaration of nursing and midwifery and union values *Patient includes women in maternity care and residents in aged care

REFLECTIVE QUESTIONS 1. Identify the ethical challenges in your own practice environment.

2. What elements of your practice environment prevent you from being an effective voice for your patients?

3. Who else has an interest or shared responsibility?

How do you ensure the responsibility is shared with those entities?

4. What skills or supports enable you to maintain ethical practice?

5. What processes do you employ to mediate the competing demands of organisational requirements and patient needs you have identified?

Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

65

in view

annual conference Another successful conference where we were glad to share the results of the world-first evaluation of ratios, proof that ratios do save lives and money! Thank you to the hundreds of delegates who helped set our union’s agenda for the year ahead, and special shout out to our first-time conference goers.

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ANNUAL CONFERENCE

in view

Ratios loud and proud BOOK PRIZE ER WINN

Our members at Proserpine Nursing Home secured the approval of management to don their ratios t-shirts while at work on a number of occasions. It’s wonderful to have such supportive management. Well done ladies!

Eagle eyes!

QNMU member and RN Nikita Zimovets definitely reads InScope closely… so much so that he picked up an error in our recent edition – the numbering for our bullying and harassment quiz had skipped #14!

And since he’s such a dedicated reader we were pleased to offer him a book prize. Enjoy Nikita!

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incoming What was the #1 thing you took away from this year’s conference? annual conference TRH Ratios for aged care has been a tremendously successful campaign. The lobbying of politicians coupled with our Premier’s commitment to better the lives of our “elders�. The campaign continues as the private sector is encouraged to get on board. It’s powerful testament of union at work for the benefit of the community at large.

Like ¡ Reply

JS Ratios research!! Made me very proud to know how far we have come.

Like ¡ Reply

TLK That aged care nurses are supported by nurses in all sectors. đ&#x;?ž Like ¡ Reply

đ&#x;‘?

TP First-time attendee and found it inspirational to be surrounded by 400 likeminded nurses all focused on patient safety and the health and wellbeing of all members. I’ve returned to my workplace more positive and am hoping to get more of our local members involved in QNMU training and education.

Like ¡ Reply

TR How amazing it is to be in a room full of nurses who are passionate about making things better not just for themselves but for their fellow nurses and patients.

Like ¡ Reply

JB Just how much our union actually does [and] what’s involved in conference. Being a first-time attendee I left energised and with a head full of knowledge.

Like ¡ Reply

On the sudden closure of Earle Haven Nursing Home SS My parents and auntie lived in this retirement village and I chose another facility to look after them. The nursing home has lost accreditation at least once if not more to my knowledge. So very sorry for their patients.

Like ¡ Reply

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☚

MDF What I don’t fully understand is how a home can receive sanctions multiple times and still be open... If my memory serves me well this facility has had a history of sanctions.

QNMU members Sally Miller (left) and Nancy Granata (right), Gold Coast Integrated Mental Health Branch

CW This was the best conference I have been to and all the speakers this year were great! The one thing I took away from conference was listening to the nurses from different areas of nursing after ratios had been placed in their areas [and] how it helped with nurses’ workloads plus patient safety. The importance of putting in workload forms!

Like ¡ Reply

ONTH COMMENT OF THE M Well done to all. I really missed attending [conference] this year. I’m no longer a delegate as I’m not working at the moment but I will have to attend the third day next year. I’ve missed all my networks I have made over the years.

Even though there is work to be done in attending conference and so much work goes into it by our QNMU, I’ve [always] left feeling somewhat pampered and looked after by our union.

I loved seeing all the posts on Facebook. It meant a lot to me.

DW

Like ¡ Reply

JM Always the elderly that suffer. Very sad.

CK Care of our most vulnerable should never be left to private enterprise.

Like ¡ Reply

Like ¡ Reply

MS Simply not acceptable - feel for the residents, their families and the dedicated staff. Where is the governance in this facility?

These are very vulnerable people in our Gold Coast community.

SA Surely this would be grounds for a class action lawsuit? All these private “care� providers make a fortune on the lifetime savings of the residents and their kin alike. Where is the accountability?!

Like ¡ Reply

Like ¡ Reply

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 the state government introducing ratios in state-owned nursing homes RC Thank you. We may not be there yet but it is a step in the right direction. If state run [nursing] homes have ratios and care improves without breaking [the] budget we have the stats and facts to challenge the federal arguments.

Like · Reply

KR A step in the right direction.

Good work QNMU! Like · Reply

SG Hard to believe it [has] taken till now. It’s not like everybody suddenly got old.

Good work though QNMU.

Letter to the Editor Queensland

The official journ al of the Nurses and Midwives’ Union

08

Summer 2018

Dear Beth, In January this year on a Saturday evening I opened my work email. I was stunned to have received an email from the health complaint office that I had an anonymous complaint made against me. This had been referred to APHRA. I was absolutely thrown for 30 mins.

I then remembered an article from InScope about what to do. Good thing I read the journal! I asked the QNMU for representation that night and received a very quick response in the next week.

unpacking the aged care roy al commission

A

ngels IN THE HOSP

ITAL

Ask the ques tion:

How many nurses are on duty?

PLUS! CPD CONTENT ON HIDDEN CAME

RAS, DEALING

WITH POLIC E & MORE

I followed all the advice given to me by QNMU’s lawyers. I was still in the dark as to what the complaint was about until June when I received the notification from APHRA that no findings or action would be taken.

QNMU remained in contact during the five months I waited.

Anonymous

Like · Reply

TP Good start. Well done on a move in the right direction.

Seems it’s the states taking the action they can in the face of a stubborn, mean federal govt.

Like · Reply

RG Good start but we NEED minimum ratios everywhere.

Like · Reply QNMU Secretary Beth Mohle speaking at a press conference where the Palaszczuk government announced plans for legislated ratios in state-run nursing homes. See page 17 for more info.

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69

CALENDAR

September Dementia Action Week

Together in discovery and care 16-22 September 2019 Timed to include World Alzheimer’s Day on 21 September, Dementia Action Week exists to raise awareness of dementia and the issues that surround dementia.

The 2019 campaign will start a national conversation to understand community perspectives on discrimination toward people living with dementia. Dementia Australia seeks to reduce the impact of discrimination on people living with dementia, their families and carers.

Dementia Action Week 2019 will play a key role in achieving this goal. www.dementia.org.au

QNMU Meeting of Delegates 24 September - Townsville 25 September - Cairns 30 September - Hervey Bay www.qnmu.org.au/mod

International Council of Nurses (ICN) 21st International Conference on Nursing 25-26 September 2019 London United Kingdom www.icn.ch/

The Museum of Nursing History Heritage Trail & Devonshire Tea

Dr, RBWH. The Heritage Trail begins and ends at The Museum of Nursing History and visits sites such as the Lady Lamington Nurses' Home and “The Quarries”.

Reasonable level of fitness required.

Bookings essential.

Email: rbhnursesassn@gmail.com or phone: 3636 8702

14 November, Sunshine Coast QH – How to make the BPF work for nurses & midwives 15 November, Sunshine Coast Health & Safety Representatives training for nurses & midwives 25-29 November, Brisbane Sustaining Resilience 26 November, Brisbane (Cost $100) www.qnmu.org.au/education

October

19th International Prader-Willi Syndrome Organisation (IPWSO) Conference

QNMU education

13-17 November 2019, Havana, Cuba www.ipwso.org/conferences

Dealing with difficult behaviour 15 October, Brisbane (Cost $100) www.qnmu.org.au/education

QNMU Meeting of Delegates

World Mental Health Day

1 October - Bundaberg www.qnmu.org.au/mod

45th International Mental Health Nursing Conference Integrated Care: People, Practice, Policy 8-10 October 2019, Sydney www.acmhn2019.com/ 8-14 October www.mentalhealthvic.org.au/

The Australian and New Zealand Society of Occupational Medicine (ANZSOM) Annual Scientific Meeting 2019

29 September, The Museum of Nursing History, Building 19, Central

November QNMU education

National Mental Health Week

27-30 October 2019, Adelaide www.anzsom.org.au/asm-2019

10 October www.1010.org.au

Ethical decision making 1 November, Rockhampton QNMU Branch Development 1 6-7 November, Brisbane QNMU Branch Development 2 8 November, Brisbane Being protected at work 12 November, Gold Coast No excuse for abuse!

13 November, Gold Coast QH Rostering – Equity & work life balance

Remembrance Day 11 November

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.

MEET SOME OF THE TEAM!

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70

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71

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Our record speaks for itself IN 2018/19, THE QNMU: Assisted 28,834 members through our Member Connect call centre Provided expert representation for 3442 members Recovered $2.05 million for members Assisted 185 members with WorkCover claims Provided legal representation for a further 252 members including representation for coronial investigations and coronial inquests Provided legal representation for 260 members responding to OHO or AHPRA notifications or investigations QNMU member Julia Suarez