The official journal of the Queensland Nurses and Midwives’ Union
04
Summer 2017
Fear IN AGED CARE
Healthy choices for shift workers
Making a difference
one crisis zone at a time
PLUS! CPD CONTENT on MENTAL HEALTH, DIGITAL HOSPITALS & more
Loads and loads of CPD! As the professional and industrial organisation for Queensland’s nurses and midwives, we’ve got you covered! The QNMU offers plenty of opportunities to help members meet their Continuing Professional Development requirements, and we’re excited to add to our unrivalled suite of CPD offerings.
COMING SOON FOR MEMBERS Brand new CPD Portal
Inaugural CPD Workbook
QNMU members will soon have access to our brand new CPD Portal — your one stop online shop for all your CPD needs.
Members will soon receive the very first edition of the QNMU’s CPD Workbook.
Featuring: ■■ A new online Record of CPD ■■ Past webinars with reflective questions ■■ Educational podcasts with reflective questions ■■ Our new kickstart program offering heavily subsidised education, training and seminars such as conflict management and assertiveness skills
The book offers a collection of interesting educational articles relevant to your working life to help grow your professional development and help meet the CPD requirements you need for registration. Articles range from legal and clinical pieces to articles on wellbeing and workplace culture… plus you might recognise some the more popular journal articles of the past few years!
■■ Loads more free activist education ■■ Access to QNMU publications with heaps of CPD content and reflective questions, including our journal InScope, our annual Health and Safety Handbook and Nurses and the Law book.
PLUS! QNMU members get access to the Australian Nursing and Midwifery Federation’s new clinical CPD Portal FREE.
CPD
WORKBOOK
2017
04
32
Summer 2017
INDEPTH
Making a difference one crisis zone at a time
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, Luke Rutledge Published by The Queensland Nurses and Midwives’ Union Printed by Fergies Print and Mail
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INDEPTH
CPD
14 16 19 20 24 30 32 38 42 48 50
55 56 58 60
PIV failure – how effective is your clinical practice?
62 64 66
The Belbin Team Role Model – What role are you?
Have nursing degree, will travel Navigating the pregnancy journey Ageism: an ongoing issue Fear in aged care: The unspoken truth
09
The age of injection Mental health a forgotten issue Novel dressing and securement techniques for PICC in paediatrics
REGULARS
02
INSIGHT
04
TEA ROOM
05
wins
08
JUST IN
68
IN VIEW
70
INCOMING
Ratios: the next stepping stone
72
CALENDAR
Extending the social branch
73
ADVERTISING
Fuelling the day for shift workers EB10: Your work, your voice Making a difference one crisis zone at a time Your guide to feel-good gifts this Christmas Women power to the people
56
Health care digital technology and information systems Positive mental health in the workplace
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.
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insight
Branches:
Sally-Anne Jones QNMU President
the building blocks of the QNMU
The democratic structure of the QNMU is absolutely vital for our success, the roots of which are our members and the branches to which we belong.
to resolve workplace issues, explain and implement policy on nursing and midwifery issues at a local level, and to improve communication between the union and members.
But for many members, particularly those who are new to the union, the branch structure and how it operates may be unfamiliar.
But above all, branches are about connectedness and collectivism.
Our branches represent every sector, from large public acute care facilities, to private hospitals and residential care facilities, to community health and offender health, to name just a few. Each branch is made up of members from a workplace who nominate and elect local leadership representatives. Representatives then become your delegates at the QNMU annual conference. Branch meetings all over Queensland are very diverse. Each workplace will have different experiences to discuss and debate… and it’s at our annual conference that all these issues come together — through motions submitted for debate by each branch. The conference is policy-forming for the QNMU and so the involvement of branches in this very important process is critical to shaping the union’s strategic direction and response going forward. Branches can be established in any workplace where there are 10 or more members working. With the local QNMU Organiser, the branch sends a nomination to the QNMU Council who endorses and welcomes the new branch to the structure.
But what are branches? Branches are our opportunity to get together with other members
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Health is a challenging environment to work in and getting together with nurses and midwives who care about our patients, our professions and the future of health care helps keep us supported. Branch meetings can be a place to debrief, to talk about challenges and new ideas, to seek advice, and to make decisions that relate to union activity in your workplace… and they are only as strong and as functional as you make them! Branches do not exist without members, and the QNMU cannot exist without members in the branches to determine its work.
Branch competition Currently, the QNMU has 152 branches, and all are invited to participate in our Star Branch competition. The competition is an opportunity for you to tell the QNMU how your branch contributes to the union and what amazing things you’re doing. The first round has now closed, and the winning branch will be announced shortly… but round two is open until June 2018. The winning branch will receive a package that includes sponsorship for a local Branch event (theme and topics of your choice). Secretary Beth Mohle and other expert staff will attend… and yes, there will be freebies and cake!
PLUS the QNMU will sponsor a member of your choice to attend our 2018 Annual Conference as an observer in Brisbane. Visit http://bit.ly/ starbranchcomp for details. You can also read a little about the history of branches, including some of the fun activities our branches have hosted over the years, on page 50.
Star Branch Competition Please submit your applications for draw 2 by: 4 June 2018 For more information visit http://bit.ly/starbranchcomp
QNMU Council secretary :
Beth Mohle
assistant secretary : president :
Sandra Eales
Sally-Anne Jones
vice president :
Lucynda Maskell
councillors :
Janet Baillie (on leave) Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Maddi Heathfield Shelley Howe Leanne Jiggins Christopher Johnson Damien Lawson David Lewis Dallas Meyers Fiona Monk Sue Pitman Melanie Price Karen Shepherd Katy Taggart Janelle Taylor Kym Volp Deborah Watt Charmaine Wicking
insight
Our voice in the political area Beth Mohle QNMU Secretary
The 2017 Queensland election has been noteworthy for a number of reasons, with voters sending clear messages to all political parties both major and minor. The campaign reflected the trend in political volatility that has been a feature of so many democracies around the world in recent years. It appeared to me that the community was crying out for four things this election: ■■ Authenticity – politicians who say what they mean and do what they say ■■ Competence – being up to the job of governing well and fairly ■■ Decency – acting ethical, having a heart and understanding the tough times many are facing ■■ Role clarity – a government that delivers high quality health and education services, as well as keeping our assets in public hands. Many people are tired of “politics as usual” and voted to “shake things up” a bit, even if that may not be in their best interests in the long run. They needed to be heard because they felt their issues were not front and centre. We did our best to put our key issues at the forefront — be this the need for more nurses and midwives, continuing to implement legislated minimum nurse and midwife to patient ratios, defending penalty rates, or improving workplace culture so that members are safe, respected and have a genuine say at work. These were key issues for Queensland’s nurses and midwives, as you told us through thousands of oneon-one conversations.
Although not aligned to any political party, we are political — we must be if we are to advance our professions and our communities. These conversations were very important and powerful, and the themes of anger, fear and disappointment rang true. These emotional responses must be examined if we are to rebuild faith in our democratic political system. We believe this starts with knowing what is important to us — our nursing, midwifery and union values. It is an uncomfortable truth that there are those who do not want to strengthen nursing and midwifery as it is not in their interests to do so. Some do not want to share power or collaborate, and it’s a simple reality of politics that there are always powerful competing interests at play. Unions are an essential mechanism for ensuring power is shared equally. The QNMU’s grassroots democratic structure means our policies and direction are determined by members at all levels. Although not aligned to any political party, we are political — we must be if we are to advance our professions and our communities. Politics is all about power. Some nurses and midwives are uncomfortable with the very notion of power. But taking responsibility for shifting power is what we need to do if we are to change “politics as usual”.
Please, I hear you say, not another thing to do! I hear you — this is hard work and there never seems to be enough hours in the day. But if we are angry, fearful or disappointed, we must take positive action to move us from our current situation. And that’s where our place in politics comes in. Nurses and midwives should influence how policy is developed and implemented — that’s how good policy is made. Nurses and midwives have an important role to play in re-shaping politics so our values and interests are front and centre. We are up to that task.
The QNMU purpose: The purpose of the QNMU is to grow power, confidence and capacity to improve the industrial and professional interests and wellbeing of nurses and midwives and the health of our community.
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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.
I’ve arrived at my shift but there aren’t enough staff rostered on. What do I do?
I’m returning to work from maternity leave. What are my rights?
Often we know we’re in for a busy shift before we’ve even started. Perhaps one of your colleagues has called in sick but hasn’t been replaced. Or perhaps your manager simply hasn’t rostered enough staff to safely care for your patients or residents.
Both the Queensland Industrial Relations Act 2016 and the Fair Work Act 2009 include provisions regarding returning to your substantive position after a period of maternity or parental leave, as well as provisions to request a flexible work arrangement to care for a dependent child.
The first thing to do in this situation is call your line manager and say there aren’t enough staff on shift for you to deliver safe care. After speaking to your manager you should also fill out a workload reporting form — it’s the best way to put in writing what is happening, and it creates a paper trail that could protect you should anything happen on shift and help show if there is a trend. Remember to write on the form that you called your line manager and note what their response was to your request for sufficient staff or skill mix. Give a copy of the form to management, send a copy to your QNMU Organiser, and keep a copy for your own records. When completing the workload reporting form, you will need to identify which low-priority tasks you will not do so that you can put patient/resident safety first. Examples of low priority activities may include entering data, attending meetings, managing calls and enquiries, making beds, re-stocking and re-ordering supplies. Visit www.qnmu.org.au/ workloads to download workload reporting forms for your sector and the low priority checklist. Remember, the more workload forms you and your colleagues submit the harder it will be for your employer to ignore them as it will show a clear picture of the problem.
If you have questions for our Tea room column email memberconnect@ qnmu.org.au
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The QNMU can work with you to escalate a matter further if necessary, but having these forms as historical evidence will make this process much easier.
Following maternity or parental leave, you are entitled to return to your substantive position or the permanent position you held prior to commencing your leave. If that position no longer exists, you are entitled to an available position for which you are qualified and suited and is nearest in status and pay to your substantive position. You are also entitled to request to return to work under a ‘flexible working arrangement’. You must request this in writing before you return to work. Your request can include: ■■ a change to your work hours or the pattern of your work (eg. to fit in with child care arrangements), or a reduction in the number of hours you work, and/or ■■ a change to your workplace or location. Your employer can decide to accept the request, grant the request in part or with certain conditions, or refuse the request. Their decision must be in writing and the employer must give reasons for a refusal. The organisation may only refuse based on ‘reasonable business grounds’. To request a flexible work arrangement, you must be the primary caregiver for your child. The QNMU can assist members returning to work, or if your employer has unreasonably refused you a flexible work arrangement.
How are you covered? ■■ Public sector: Queensland Industrial Relations Act 2016 ■■ Private sector: Fair Work Act 2009. Also check your Enterprise Agreement or local policy.
wins
Hospital car parking on the up
It pays to know your agreement A QNMU member received a $11,500 windfall recently, after she discovered she had been paid incorrectly for two years. Unaware she was even covered by an enterprise agreement, the former Healthscope member was surprised to find out that her agreement entitled nurses working 12 hour shifts to two breaks. Furthermore, if staff didn’t take the second break, they were entitled to overtime until the end of shift. “There were only two nurses rostered on from 3.30pm and it was impossible to get that second break,” the member said. “It was only after I became a NUM and was doing the timesheets that I realised I should’ve been getting a second break.” The member contacted the QNMU to see if she had a case and was assisted by the QNMU Servicing team to get correctly paid. “It’s obviously worked out very well for me, but it’s a shame it’s allowed to get to that stage in the first place.
Staff, patients and families will benefit from an additional 100,000 free and discounted car parks to be made available at public hospitals across Queensland. The additional spaces will be rolled out over the next four years as part of the state government’s four-point plan to improve hospital parking in the state, which also includes a new patient and carer car parking concessions policy. We’re seeing planned improvements thanks to the state government’s decision to build a multi-storey car park at Redcliffe Hospital, which will be the first publicly-owned car park in the state. The QNMU has been lobbying for car parking solutions for years, and
we welcome this progress toward addressing the problem.
“For me it was a point of principle. I was never looking for something I wasn’t entitled to.”
Are you familiar with your agreement?
While the parking situation differs at each hospital, we’ll be working closely on the roll-out of initiatives and we’ll continue to do everything we can to ensure hospital car parking is as affordable, safe and fair as possible.
The majority of QNMU members are covered by an enterprise agreement. When it comes to the private and aged care sectors, they’re all different.
Each HHS is currently considering potential solutions for staff car parking pressures.
QNMU members have access to their Award or enterprise agreement at their fingertips.
In the meantime, Queensland Health nurses and midwives are encouraged to put forward ideas and potential solutions for hospital car parking through their local branch meetings. This is an opportunity to have your say in driving car parking solutions so make sure you get involved!
Visit www.qnmu.org. au/wages_conditions to search for your enterprise agreement. You never know, it could pay off! Note: Members should be aware there is a six-year limit to making a claim (ie: you can be back paid a maximum six years).
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wins
Nurses secure extra shift for QEII theatre Nurses at QEII operating theatres have achieved a major victory by securing an extra late shift on weekends. “We were having issues with workloads particularly on weekends since the opening of the new emergency department in 2013,” Registered Nurse Leanne Durrington said. “It pretty much tripled the amount of work we were doing on weekends, which impacted our overtime. “It got to the point where it was unsafe for our patients and ourselves. “In August 2015, we worked 14 hours on Saturday, had our 10-hour break, then due to an increase in patient load we had to work another 20 hours.” The team contacted the QNMU and agreed to submit workload reporting forms whenever they worked overtime. Using the Award process, it eventually escalated to a level four grievance and a specialist panel. Ultimately, the specialist panel agreed staff did indeed need an extra shift. “Since then it’s been wonderful,” Leanne said.
You can’t do something like this with just one person, you need the collective to really hammer it home… Leanne Durrington, RN, QEII
“We’re far less fatigued and our patients are much safer.
three years, it’s amazing we kept going at all.
“It was great working with our Organiser, who got everyone on board, got us all enthused and made us come together as a unit.”
“Once we had access to the previous service profiles we were amazed that our funded FTE (full time employee) numbers decreased each year, even though our workloads had dramatically increased.”
The proper way to build a service profile Jennie Edwards, an RN who was also instrumental in leading the team to this win, said workloads would not have become unmanageable had nurses been consulted when building the unit service profile. “We didn’t even know it existed. It was a revelation!” Jennie said. “Looking at the data produced about the increased overtime over
Need some support? QNMU members needing advice or support can contact Member Connect on (07) 3099 3210 or 1800 177 273 (toll-free). We’ll do our best to help you secure wins like the ones you’ve read today!
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Despite nurses securing the extra late shift, work continues on ensuring the service profile is fair and adapts to changing trends. “Nurses have a voice in this process as we are the workers doing the patient care. “Give us enough staff and hours to do it safely for all. That’s best practice.”
wins
Cairns Emergency nurses close unsafe mental health pod After 17 staff assaults in three months, nurses at Cairns Hospital Emergency Department approached the QNMU and collectively decided it was time to close an unsafe mental health pod. The pod was a secure area staffed by one nurse where three patients could be held. It was comprised of two interview rooms and an acute behavioural assessment room. Nurses reported the ward suffered some of the worst bed block in the state, and therefore staff had to accommodate patients in that area for extended periods of time. A Workplace Health and Safety audit deemed the pod unsafe.
Taking matters into their own hands
Common sense wins after payment confusion
With the assistance of the QNMU, staff went to Executive and had an extraordinary meeting with the Chief Operating Officer. Not backing down, nurses continued to assert it was a matter of patient and staff safety, executive conceded it needed to be closed. Staff recognised the knock-on effect the immediate closure of the pod would have elsewhere and proposed a plan to minimise the risk to patients and staff. The plan included upgrading the duress alarms, implementing procedures and educating staff on managing acute behaviourally disturbed patients.
Putting own safety first
Nursing and medical staff in the ED decided to act.
The pod closed in March this year and the number of assaults since then has fallen to five.
They got together and had a series of meetings, which were organised through text messaging, and used their huddles at the beginning of shifts to talk about their issues.
While any assault on a nurse is one too many, this is a vast improvement and is testament to these members working together and standing up for their own safety.
Should I be paid for mandatory training? According to Robina Private Hospital management, the answer was initially ‘no’ — that was until nurses began asking questions. Members assumed the issue would be black and white — a simple matter of reading the workplace enterprise agreement. Sure enough, the agreement stated clearly “mandatory training will be provided and undertaken in paid time”. However, management claimed they didn’t need to pay nurses because staff were not directed to attend and the training was not mandatory. But our members weren’t ready to give up and further digging into the Clinical Services Capability Framework (CSCF) revealed that ALS training was in fact mandatory for a Level 3 service, meaning it was mandatory for these nurses and therefore should be paid. Management returned volley again a little later saying ALS training was only mandatory for a level 5 facility, and after looking at the CSCF again we discovered this time management were correct… but only because the framework had been amended the previous week! Ultimately, it was agreed nurses would be paid for attending training because the framework was changed after members attended the training. A win for common sense.
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just in
Election 2017: Queenslanders decide Queenslanders have voted, and they voted for more nurses, midwives, and better health care.
During the election, the QNMU secured the following commitments from the Labor Party:
The Labor Party also announced the following health commitments during the election campaign:
At the time of going to print, neither the Labor Party nor the LNP had won enough seats for the election to be called outright, but it looked increasingly likely Labor would win at least 47 seats, enough to govern in their own right.
■■ Ongoing implementation of legislated ratios in the public sector
■■ Employ an additional 3000 nurses over the next four years
■■ Introduce minimum nurse staffing levels in State Government Nursing Homes
■■ Immediately recruit 100 additional midwives state-wide
For Queensland’s nurses and midwives, this means much of the work we have been doing over the past three years to restore frontline jobs and health services will continue, including the rollout of legislated ratios.
■■ Legislate public reporting in public, private and aged care sectors ■■ Employ more nurses and midwives (including more permanent employment for graduates and more Nurse Navigators and Nurse Practitioners ■■ Support penalty rates.
■■ Permanently extend the Nurse Navigator program by employing 400 positions (240 are already employed) ■■ Expand nurse-to-patient ratios to acute public mental health wards ■■ Expand nurse-to-patient ratios to Queensland Health aged care facilities ■■ Lobby the federal government to introduce legislated ratios in private aged care facilities ■■ Introduce public reporting in state government aged care facilities ■■ Maintain the nurse and midwife graduate program ■■ Refurbishments and expansions of Logan Hospital (192 additional beds and expanding maternity services), Caboolture Hospital (130 additional beds), and Ipswich Hospital (new mental health facilities and MRI suite). ■■ $14.3m for a 42-bed residential rehabilitation facility for ice users in Rockhampton. We’ll be holding the government to account and will work closely with them to ensure they stay true to their commitments.
Green thumbs up for QNMU We’re proud to announce our head office in Brisbane has once again received the thumbs up for its eco-friendly efforts. QNMU was awarded five stars for energy efficiency and an impressive five and a half stars for water saving under the National Australian Built Environment Rating System (NABERS), with six stars being the maximum. An impressive feat for a commercial building! If you’ve visited our office in the past, you may have noticed it’s been fitted with a number of resource-saving and eco-friendly features, which are complemented by the enviro-smart habits of staff. It’s all part of our ongoing commitment to the environment.
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just in
Australians confirm support for marriage equality
Christmas closure arrangements QNMU The QNMU offices in Brisbane, Toowoomba, Bundaberg, Rockhampton, Townsville, Cairns, Sunshine Coast and Gold Coast will close from 5.00pm on Friday 22 December 2017 and will reopen at the regular starting time of 8.30am on Tuesday 2 January 2018.
After a lengthy and unnecessarily expensive survey, we now know what the polls had always indicated: Australians overwhelmingly support marriage equality.
During this time members who need emergency advice or assistance should ring the Brisbane office on (07) 3840 1444 or 1800 177 273 (toll free outside Brisbane) and leave a message.
With a return rate of 79.5% (that’s 12.7 million people), 61.6% of Australians voted ‘yes’ while 38.4% voted ‘no’ in the national survey.
Officials will be on call to deal with emergencies such as dismissals, and they will contact you.
At the time of going to print, our federal politicians had not yet voted on a bill for marriage equality, but with such a resounding endorsement from the Australian people, we expect the legislation to be passed before Christmas.
We wish all our members a safe and enjoyable festive season!
The QNMU has formally supported marriage equality since 2014. As the peak professional body for nurses, midwives and health in Queensland, we recognise that embracing diversity and opposing discrimination against LGBTI people are important and necessary steps towards equality and health for all members of society.
Queensland Health has released compulsory closure and leave arrangements for the 2017/18 Christmas New Year period.
The QNMU’s marriage equality policy was developed by the QNMU Policy Committee (QPC) and was voted up by QNMU Delegates at our 2014 Annual Conference. It was then endorsed by QNMU Council.
However, at the time of going to print, the QNMU understands the dates below cover all QH employees.
All Delegates, QPC and Council positions are democratically elected by QNMU members.
Queensland Health
Please note that as prescribed employers, Hospital and Health Services may now set their own closure dates.
If new information is received, we will update members via email. Please note part-time employees are only entitled to the concessional leave day when Wednesday 27 December would be one of their regular, ordinary days of work. Day
Date
Leave
Monday
25/12/17
Christmas Day public holiday
Tuesday
26/12/17
Boxing Day public holiday
Wednesday
27/12/17
Concessional day (leave on full pay without debit)
Thursday
28/12/17
Employee’s own leave (e.g. recreation (annual) leave; TOIL; or accrued hours/ flex-time
Friday
29/12/17
Employee’s own leave (e.g. recreation (annual) leave; TOIL; or accrued hours/ flex-time
Monday
01/01/18
New Year’s Day public holiday
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just in
Domestic violence SUPPORT –
QNMU member Alice Hungerford with a sample of the drawstring bags she sewed and filled.
calling for donations As a not-for-profit organisation, DV Connect relies on the Queensland government and the generosity of the community to fund its important work.
of their lives and often have to bring children with them or have to leave them behind.”
The power of a small donation
As we did last Christmas, we’re partnering with the Queensland Country Women’s Association to provide care packs for those in refuges.
Alice said during her time as a rural nurse she frequently saw women who had fled domestic violence.
Last year we were overwhelmed by the generosity of members putting together care packs.
“One woman came back and thanked me a year and a half later, and she was still using the care pack I’d given her,” Alice said.
QNMU member and Registered Nurse Alice Hungerford decided to contribute by sewing 20 drawstring bags. Alice, who is a domestic violence survivor herself, raised $450 and filled the bags with toiletries and other items. “I put the word out to a few friends and they came up with the cash. I started shopping for some goods, sewed up 20 bags, got my family together and we packed up the bags ourselves,” Alice said. “Having been a nurse in rural Queensland where there isn’t much domestic violence support, nurses are often called upon to provide that support. “The number of women escaping violent and life-threatening situations in their homes is really scary. I’ve put together 20 bags, but I can assure you one service would use them in a single week. “We think we’re a pretty well-off country, pretty well serviced in health and mental health, but there are problems. These women are in fear
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“That was the first and only thing she had of her own when she left her home of 16 years with her 10-year-old child. “She said to me it made all the difference and gave her hope that she could start a new life. “I don’t think any of us really understand — unless we’re refugees — what it’s like to just up and run in fear of your life.”
QNMU Councillor Tammy Copley with a car load of donations from her generous colleagues.
What can you do?
Where to get help
■■ Make a tax deductable donation to DV Connect at www.dvconnect.org/donate
If you are in immediate danger, phone the police on 000.
■■ Donate a care pack to the Queensland Country Womens’ Association (who deliver them to women’s refuges). Items can include (but are not limited to) toothbrush, toothpaste, soap, shampoo/ conditioner, deodorant, sanitary items, hair brushes, face washer or hand towel. Contact dsmith@qnmu.org.au for more information.
■■ DV Connect Womensline – 1800 811 811
For help and advice, call:
■■ DV Connect Mensline – 1800 600 636 ■■ Sexual Assault Helpline – 1800 010 120 ■■ Elder Abuse Helpline – 1300 651 192
just in
Historical strike action for Bupa nurses in Victoria Bupa nurses and carers in Victoria began unprecedented industrial action across 26 Bupa nursing homes in late October in an attempt to negotiate a fairer agreement. ANMF Victoria members held grave concerns for their residents due to understaffing and were worried about the care that was being missed. In response, they took industrial action which included rolling stop work meetings, a 400-strong rally and strike action for entire shifts, as they sought increased staffing levels and a commitment to replace all unplanned leave. This was the first action of its kind in the private and not-for-profit aged care sectors in Victoria, and perhaps Australia.
Following 37 days of protected industrial action, Bupa proposed a vastly improved settlement which included a wage rise and back pay, and maintained conditions in its existing agreement.
Pay increases will be: ■■ 2.75% – 1 August 2017 ■■ 2.5% – 1 July 2018 ■■ 2.5% – 1 July 2019 and an additional 1% – 1 October 2019 ■■ 2.5% – 1 July 2020.
staff and residents desperately need change in aged care. The QNMU has and will continue to work closely with the ANMF and our nursing colleagues across the nation to improve the situation in aged care with a major campaign planned in 2018. As part of phase two of our Ratios Save Lives campaign, we’re calling for legislated minimum staff-to-resident ratios in aged care. Find out more on page 48.
The result was a success for Bupa nurses and carers, who voted to support the proposed settlement and ceased all industrial action.
Aged care members are also encouraged to speak out and add their voice to the cause by writing to Federal Aged Care Minister Ken Wyatt or their local MP.
This trailblazing campaign has raised awareness about staffing levels, and demonstrated that nursing
It’s by all of us standing together and speaking out that we can create real change.
Photo: Les O’Rourke
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just in
NUMs and MUMs take centre stage Hundreds of public sector nurse and midwife leaders took a brief break from the wards in October for NUM/MUM Summits in Townsville and Brisbane. The two-day sessions were hosted jointly by the QNMU and Queensland Health, giving NUMs and MUMs a rare opportunity to network and share ideas. The NUM/MUM Summit was negotiated by the QNMU through EB9 to facilitate consultation with NUMs and MUMs regarding workplace initiatives.
Proserpine Hospital NUM Lisa Milne said she hoped this forum would be the first of many. “NUMs and MUMs really don’t have many forums which allow us to get together to share ideas and different ways of doing things,” she said. “There seems to be opportunities at other levels of nursing and midwifery but this was really the first time we had something which was solely based on our needs and requirements — and that was really appreciated.” The forum featured, among other things, sessions on leadership,
NUM MUM Summit, Brisbane
rostering, workload management and quality initiatives, and included group work around the NUM/MUM framework. “I learned something from every session,” Lisa said. “And it gave me an opportunity to find out what was happening outside my own little world. We are often so busy we get stuck in our own space and don’t get time to look up and see what else is going on. “I think it was particularly good for those new to the NUM or MUM role, as opportunity to make professional connections.” Event speakers included QNMU Secretary Beth Mohle; Chief Nursing and Midwifery Officer Shelley Nowlan; NUM/MUM Project Officer Jenny Goodwin; author, former ADF nurse and chopper crash survivor Sharon Bown who spoke about overcoming adversity; and motivational speaker Robbi Mack who focussed on using humour to build resilience.
Are you familiar with the new NMBA codes of conduct? The NMBA has published new codes of conduct for nurses and midwives, which take effect from 1 March 2018.
■■ The codes of conduct apply to all nurses and midwives across all areas of practice.
The March start date means nurses and midwives have plenty of time to familiarise themselves with the new codes of conduct and reflect on their application in the workplace.
■■ The codes of conduct are founded on evidence-based practice.
Visit http://bit.ly/1qW3bKy to view the two codes of conduct. Between now and 1 March 2018, the current codes of conduct for nurses and midwives still apply.
What you need to know The two codes of conduct integrate professional boundaries, reflect current nursing and midwifery practice in all contexts, and include the following features: ■■ Conduct is framed around seven principles, each with a supporting values statement. ■■ The principles are categorised into four domains. ■■ ‘Person’ is used to refer to those in a professional relationship with a nurse. ■■ ‘Woman’ is used to refer to those in a professional relationship with a midwife.
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■■ The codes of conduct are designed to be read in conjunction with NMBA standards, codes and guidelines.
Who do the NMBA principles apply to? The NMBA principles of the codes apply to all types of nursing and midwifery practice in all contexts. This includes any work where a nurse and/or midwife uses nursing and/or midwifery skills and knowledge, whether paid or unpaid, clinical or non-clinical, in the areas of clinical care, clinical leadership, clinical governance responsibilities, education, research, administration, management, advisory roles, regulation or policy development. The codes also apply to all settings where a nurse and/or midwife may engage in these activities, including face-toface, publications, or via online or electronic means.
codes of conduct
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2018 QNMU TPCH BRANCH PROFESSIONAL SEMINAR
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workplace health Occupational violence and bullying in the workplace
keynote speaker: sidney Dekker is a professor in the school of humanities, languages and social science at Griffith University, where he teaches safety leadership, accountability and ethics. He won worldwide acclaim for his groundbreaking work in human factors and safety, and has published numerous books on issues around human error, system failure, organisational justice, and complexity science.
other speakers: ■ The ‘Performing Nurse’ lisa smith ■ adjunct associate professor alanna Geary, Executive Director Nursing & Midwifery Services, Royal Brisbane and Women’s Hospital & Metro North Hospital and Health Service ■ Beth Mohle, Secretary, Queensland Nurses and Midwives’ Union
Wednesday, 14 March 2018 5.00 – 9.00pm Kedron-Wavell Services Club 21 Kittyhawk Dr, Chermside $65 Enquiries to Branch Delegates Moira Purcell, Deb Ranson, Janelle Taylor or QNMU Organiser Kim Ramsdale on KRamsdale@qnmu.org.au
BOOk eARly to secure your table/s (tables of 10)
https://tpchbranchseminar.eventbrite.com.au 11/17
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Have nursing degree, will travel Pictured: Wendy Tout (left) and Michelle Smith Photo: Kasun Ubayasiri
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to visit when she retires with her stash of frequent flyer points.
Both women are repatriation nurses for Allianz Global Assistance, and it’s their job to look after people who have become sick or injured while abroad.
“In reality the repat jobs start before you even leave Australia,” Michelle said.
risbane RN’s Michelle Smith and Wendy Tout have one of the coolest nursing jobs around.
Repatriation is part of a medical assistance service provided under various travel insurance policies, and the bulk of the work is based in the office, on the phones, making sure clients who need medical assistance are getting the care they need. “We are usually speaking to a patient or a loved one about their medical situation, advising them of options and getting updates on their condition,” Michelle said. “If they’re admitted to hospital we talk to the doctors and nurses and get medical reports, so our doctors can make call on whether the level of care is appropriate or whether the patient needs to be moved or repatriated.” At other times it’s simply about dispensing sound health advice and reassurance, or giving patients or loved ones advice on coverage and claims. But it’s the part of the job that involves travelling overseas to escort a patient home, that puts this job in a class of its own. Each trip usually includes at least 24 hours on the ground in-country before the patient needs to be picked up. “It’s definitely a perk of the job,” Michelle said. “But how much time you actually have depends on how far you have to travel to your patient, what their clinical condition is, and what time you leave the next day. “If you are lucky you can sometimes squeeze in sightseeing, as long as you are back in plenty of time and are fit for duty — after all that’s your job.” In the past year, Michelle has managed a three-hour cycle tour of Paris; a visit to Peter Jackson’s aviation museum in Blenheim, New Zealand; and some window shopping in the glitzy malls of Dubai. Wendy jokes the trips are like reconnaissance missions where she gets to road test places she might like
But when leisure time is over, it’s strictly down to business.
“You do an assessment over the phone to gauge the clinical status of your patient — mobility, medication, pain levels, that sort of thing — and the doctor looks at all the medical reports to determine what type of escort is required. Do we need a stretcher? Can they fly economy?...” “But you learn to expect the unexpected anyway, because by the time you get there, their condition is often quite different.” Wendy said Allianz medical teams constantly review patient care plans. “I had a case recently where the patient had become very ill by the time I arrived, and I could have cancelled the evacuation. But because of my critical care experience, I pushed myself to get her home. She was so alone and frightened and I felt if I left her behind, she might die of sadness,” she said. The gulf between the preliminary assessment and the reality on the ground can also be caused by incomplete medical records, language barriers and even different approaches to nursing and care. “One of my patients was on a stretcher because nursing wisdom in that country kept him off his feet — in Australia we put a greater emphasis on physio and we’d have had him up and moving about,” Michelle said. “In France I picked up a lady who was really miserable, she’d been in hospital for two weeks and had never had a hairwash — so I shouted her a wash and blowdry in the airport lounge and it made a big difference.” While the highly sought after overseas trips are rotated among the nurses as fairly as possible, like any good rostering system, skill sets and the needs of the patient are the primary considerations. A former RFDS nurse with expertise in critical care and child health, Wendy’s repatriations tend to be those needing high clinical care.
It’s a tight squeeze for a stretcher patient on a commercial international flight.
“In some cases you are awake for 40 hours, by yourself, with a limited medical kit and a patient who is relying on you completely to get them home,” she said. “It can be pretty stressful and exhausting, but also exciting. “Your in-transit nursing care can include anything from medication administration and pain managment to assistance with mobility, suction, pressure care, fluids — even using coathangers in business class to set up an IV.” “I’ve learned almost anything you can do on the ward, you can do on a plane.” Both Wendy and Michelle said as the sole carer during a flight they felt a huge weight of responsibility for their patients. “It’s really intense, and the night before, I find myself going over all the things that can go wrong and running through the nursing procedures I might need,” Michelle said. “I wasn’t expecting it to be such a challenging job, I was expecting a lot of gastro, but it’s so much more.” The all-consuming nature of the repat also means saying goodbye could sometimes be a little emotional. “You spend up to 36 hours with a person and get to know them very well, when they are most vulnerable and just want to get home to their families — and some of them really do see you as their saviour,” Wendy said. “I guess that’s why I still keep in touch with some of my patients, it’s nice to know how they are going.”
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Navigating the pregnancy journey Pregnancy is a journey that can be filled with uncertainty and, let’s face it, is often quite scary.
Midwife Navigator Bee Schaeche with new mum
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n continuity of care models, the care an expectant mum receives from her midwife does not simply start or finish at birth. Midwives are about so much more. Ideally, a woman will be engaged with the health system from early in her pregnancy to months after birth. Of course, part of this journey is about knowing which services to access and how to interpret the ‘medical speak’ from countless health professionals… and all this can add unnecessary stress. In the Winter edition of InScope we profiled the new Nurse Navigator role currently being rolled out across Queensland. By 2018/19, 400 Nurse Navigators will be employed. This ‘navigator’ idea — which is essentially about guiding a patient through the complexities of our health system by providing a single point of contact — is closely linked to the continuity of care models that midwives have developed over the years. A Midwife Navigator program is now being formally introduced in various Queensland public hospitals, and operates along a similar line to the ‘continuity of care’ concept. It assists vulnerable pregnant women from falling between the cracks in our complex maternity care system.
Helping vulnerable women So far there are seven Midwife Navigators across four Queensland locations: the Gold Coast, Cairns, Toowoomba and Rockhampton. These Midwife Navigators focus on pregnant women with particular risks or complications (such as gestational diabetes and rural pregnancies).
pregnancy, or they come in for labour without any prior antenatal care,” Bethan said. “Our aim is to engage with these women earlier so we can make a difference to their outcomes. “Some of the women are homeless, some may not have transport and either can’t get to the hospital or afford $16 to park.” To address some of these issues, the Midwife Navigator works flexibly in the community to provide care that is more appropriate for these women. “We have set up community based clinics which are more accessible for these women as well as provide home visits if required,” Bethan said. Offering telehealth services will also become part of the Midwife Navigator role. “If a woman needs to have a consultation with an obstetrician but can’t come into the hospital, the Navigator can be with the woman in her home or in a community clinic. “The woman can have a telehealth consult with the obstetrician on her laptop and the Midwife Navigator can do the physical hands-on examination and assessment.”
“If she’s been recommended to have all these appointments with obstetricians and maternal foetal medicines and social work and so on, we can be the advocate for the woman to make sure all those health professionals know her story and know her lived experience and why it’s impossible for her to come up here six times a week. “It’s about making sure the health professionals know there’s more to this woman than just the specific obstetric complication… it’s about the holistic care.” The Midwife Navigator also connects women to support services they may be unaware of. “There are a lot of support services around, organisations that help with household needs, set them up with groceries or a bond for a house… lots of services are there to help put those building blocks in place,” Diane said. “The sad thing is they often don’t get women coming to them until they’ve had their baby, but they really want to assist women while they’re pregnant. “So what we’re trying to do is really a life-long thing. By starting this service now, we’re hoping it’s just the first step to helping them forever.”
Building trust in the system
Meeting the needs of rural mums-to-be
Bethan’s colleague and fellow Midwife Navigator Diane Tamariki said there was also a large co-ordination element to the role.
The Midwife Navigator program is also being rolled out in regional locations across Queensland, including Cairns, Rockhampton and Toowoomba.
“It’s about being a point of contact for the woman so she can develop trusting relationships,” Diane said.
Simone Naughton is the Midwife Navigator in Cairns whose specialty is gestational diabetes.
“We’re essentially an advocate for the woman.
“The demographics of far north Queensland means there are higher
On the Gold Coast, three Midwife Navigators (two FTE) assist pregnant women with drug and alcohol addiction and mental health problems. Midwife Navigator Bethan Townsend said the roles targeted women who were not already engaged with a midwifery service. “Frequently women with substance abuse, for example, don’t engage with the hospital until later on in their
We’re essentially an advocate for the woman. Diane Tamariki, Midwife Navigator
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indepth than national average rates of diabetes in pregnancy,” Simone said. “Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy, and is associated with induced labour, operative birth, preeclampsia and postpartum haemorrhage. “For the baby, it can increase the risk of hypoglycaemia, premature birth, and in the longer term impaired glucose tolerance and development of type two diabetes. “Women with a pregnancy complicated by GDM should have increased surveillance by health professionals, so that’s where the Midwife Navigator role is so important.” Simone said the Navigator role was particularly crucial in regional and rural areas given health services were so spread out. “For example, there are no birthing facilities in the Cape so all remote women must relocate for birthing usually around 36 weeks,” Simone said. “Some rural facilities also don’t have the service capability to provide care for women with complex pregnancies so some women with GDM will be recommended to birth in Cairns. “This means there are often multiple teams of health professionals in multiple locations involved in a woman’s care.
“Through phone conversations from her home, a relationship developed and the woman’s needs and priorities for care were discussed, barriers to accessing care were identified, education to increase health literacy was provided, and a plan was made to facilitate her coming to Cairns for review.” As the Navigator, Simone coordinated multiple specialist appointments on the one day and provided support and advocacy. “In the words of one woman I worked with, ‘All women who find it difficult to access health care should have a Midwife Navigator’,” Simone said. “Especially for women who are coming from rural areas, it can be quite confronting for them coming into a bigger service, and having that person with them to rely on can make all the difference.” According to Diane, that’s what the role was all about.
Who are the Midwife Navigators? ■■ Gold Coast: Bee Schaeche, Bethan Townsend, Diane Tamariki supporting women with alcohol and drug addiction and mental health issues ■■ Cairns: Simone Naughton supporting women with gestational diabetes ■■ Toowoomba: Imelda Chandler supporting women with gestational diabetes Peta Debney (rural women) ■■ Rockhampton: Mary-Clare Reilly supporting all-risk women.
“We’ve talked to a lot of midwives at other hospitals and they just wish they had the Navigator service there because they’ve got no one to send these women to and they do get lost,” Diane said. “For women who we can’t get into those continuity models, it’s about having a known midwife, someone who’s constant and who they can build a rapport with.”
Gold Coast Midwife Navigators Bee, Diane and Bethan
“Through care co-ordination the Midwife Navigator improves communication and creates partnerships between regional, rural and remote health service teams to improve outcomes for women and their babies.”
Calling midwives for research
Better care, better outcomes
It was recognised that work needs to be undertaken to explore and articulate the differentiation of midwifery from nursing in practice development and career pathway.
Simone recalled one woman who lived more than 300 kilometres from Cairns whose circumstances made it difficult for her to access the care she needed. “The woman was referred to the Midwife Navigator program following several non-attendances at Cairns Hospital,” Simone said.
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Discussion during EB9 identified potential gaps and disparity in the career and classification structure for midwives, particularly in primary care services.
Many midwives who work in caseload models are already working as ‘navigators’ for women with complex social and/
or health care needs (or even with similar scope and skills as Nurse Practitioners) but may be classified as Grade 5 or 6. Issues of scope of practice and development and recognition of midwifery expertise is not well understood or articulated in the nursing frame. If you are interested in participating in research to explore and understand this issue please contact QNMU Professional Officer (Midwifery) Belinda Maier on BMaier@qnmu.org.au.
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Ageism: an ongoing issue When we think of discrimination, ageism may not be at the top of the list. But a report by Australia’s oldest charity, The Benevolent Society, reveals ageism is indeed alive and kicking in this country. Ageism is discrimination and stereotyping on the basis of age, particularly of the old and young, and as the report points out, unlike other forms of discrimination, ageism — at least with respect to old age — is essentially discrimination against our future selves. The report identifies that ageism is growing as a problem in Australia with the old often being seen in negative terms and as a burden, rather than for the many positive things they bring to society.
Interestingly, the report also found that attitudes towards older people shifts and become more positive the older we too become. Furthermore, the report showed the more contact people had with older members of society, the more positive their attitudes to older Australians became. There were four priority areas where the report indicates ageism should be addressed — the workplace, health care, aged care, and in families and local communities. This report supports the work the QNMU is currently doing through our aged care campaign. All too often in the aged care sector we see older Australians being denied
the safety, care and dignity they need and deserve. If the safety and quality of care issues QNMU members raise in aged care occurred in a hospital, there would be a public outcry. But as we know there is no such response to poor staffing levels and skill-mix in residential aged care. There is much work to be done, and the Benevolent Society is to be commended for helping to highlight the problem of ageism in its many forms. The report can be accessed at http://bit.ly/driversofageism The Society plans to undertake an EveryAGE Counts Campaign in 2018 to confront and counter ageism and its consequences.
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Fear IN AGED CARE:
The unspoken truth
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You gradually grow that confidence and go beyond the fear to acknowledge that someone’s got to do it, and you’ve got to be willing to risk that you’re not going to be liked.
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It’s the unspoken issue in aged care, one that nobody wants to talk about.
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But fear can be toxic in a workplace and can erode any sense of morale or confidence for workers.Fear of speaking out, fear of being targeted by your employer, fear of losing your job or regular hours… these are some of the very real fears many nurses experience in their workplace. But are they justified? What management says and what they do are often very different things.
A new ‘normal’? While it’s not confined to any one sector, fear is particularly widespread amongst aged care nursing staff, with very few nurses comfortable with the idea of speaking out when an issue arises. Many working conditions in aged care fall dismally below those in the public and private acute sectors. Take wages, for example. On average, RNs in aged care earn $300 to $400 a week less than public sector nurses. There is also a stark difference in workloads and nurse-to-patient/resident ratios. In aged care, it’s not uncommon for a Registered Nurse to be allocated up to 200 residents. Contrast this to the public sector, where new ratios legislation in some areas limits the number of patients that can be safely allocated to a single nurse. To make things worse, more aged care employers are shifting tasks like medication administration to carers. And to top it all off, we’re seeing cuts to care hours in Blue Care, Churches of Christ, Southern Cross Care and now Bupa. But how did it get to this point, and to what extent have fear and negative workplace cultures enabled employers to normalise these unacceptable conditions?
Assistant in Nursing Margaret Connolly said the problem starts with people going into the aged care sector knowing the conditions are substandard. “You go in knowing that it’s quite poor pay, but if you want a job, that is what you do,” Margaret said. “There’s always the hope you’ll get a new agreement and you’ll get a pay rise, but it’s not expected. “Because aged care is such a huge growth area, you’re going to get a lot of people being pushed into it, particularly with so many people unemployed.”
You are protected Fear of being disciplined, having hours cut or even being sacked for speaking out when an issue arises is understandable. We’re nurses and carers … we want to look after those in our care, not cause problems for management. But sometimes in order to care for our residents, we must speak up if something isn’t right. And that can be scary. The good news is unions have successfully secured legal protections for workers against employers who become hostile when workers speak out or stand up for their rights. Australia’s ‘freedom of association’ laws make it illegal for employers to punish or disadvantage workers for exercising their right to belong to a union or engage in union activity. Even your employer threatening to take prohibited action is just as illegal as them actually taking action. Employers can also be fined up to $63,000 (or $12,600 for individual managers) for taking adverse action — which is essentially action that discriminates or unfairly targets an employee. So if we have these protections, where does the ‘fear’ of speaking out come from? “In my experience, I’ve never known a staff member who has spoken up to be sacked or disciplined,” Margaret said. “It’s not a rational fear, it’s not a legitimate fear. “But you might find people are like that in life.
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indepth “People think it’s true just because management said it.” AIN Pauline Tau said nobody wanted to be a target at work, which was why collegial support was so important. “You do have rights, and there is power and safety in numbers,” Pauline said. “I’ve been a target for such a long time, and yet here I am, I’ve still got a job and I’ll keep fighting.” If management try to intimidate you, tell them to put their threat in writing and sign it. That will make them accountable and often results in empty threats disappearing.
Margaret Connolly “I was raised like that, actually — my mum and dad would say, ‘don’t make waves’. “My son says to me, ‘Mum, why can’t you just go to work and leave it be?’ Because it’s not fair, and I can’t leave it be.”
“Management may not be happy, but sometimes that’s what it takes.”
Intimidation… but no follow through
Knowing your rights and protections and standing up to management are two very different things, and it can take a lot of confidence to overcome the fear of speaking out.
AIN Sharon Taylor said many aged care workers are not aware they have access to strong legal protections, so management is able to intimidate them.
For Margaret, that fear disappeared long ago when she decided it was more important to put her residents’ safety first.
“That’s the most frustrating thing,” Sharon said.
“It’s human to want to be liked, it’s human to want to get along with management. But sometimes you just have to become a thorn in their side. “We’re not machines, we’re human beings. “And the older I’ve got the more outspoken and resilient I’ve become, to the point where I don’t really give a rat’s whether management like me or not because that’s not important.
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do it, and you’ve got to be willing to risk that you’re not going to be liked.
“People don’t realise it’s a nonthreat. They’re intimidated by management who use standover tactics, fancy words, they don’t give an answer but go around the topic. “Getting people to believe you’re not going to lose your job and they can’t touch you, and if they do they’ll be in trouble… it’s hard getting that message across.
“This is not just about me, this is about the people I care for.
“During our EBA, management told staff not to sign petitions, not to share things online because it breached our social media policy, even though it didn’t.
“You gradually grow that confidence and go beyond the fear to acknowledge that someone’s got to
“All management have to do is put the idea out there even if there’s no substance to their claims.
Persistence gets results As Pauline notes, there can be trying times, but in the end persistence usually wins. “I feel very strongly about advocating for residents’ rights,” she said. “I was once instructed to do something that was not in the resident’s best interest, and I refused to do it unless management put something else in place to ensure the resident’s safety. “They tried to turn it around and constantly called me in because they said I was refusing to follow a RN directive, which wasn’t what I was doing. “So they intentionally rostered me in that area because they knew I would refuse to follow the directive. “But eventually they moved me from that area because I stood my ground.”
Strength in numbers When intimidation from an employer does occur, it’s important for nursing staff to stand together. This is how victories are won. “If you are one person, it’s hard,” Margaret said. “You get a bunch of people, they’re going to start to notice. “You’ve got to keep encouraging people and say if we all get together then we can make a difference.”
indepth Margaret recalled arriving at work one morning to discover a nurse had been taken off the ward with no explanation from management. “So I wrote our manager a letter and said these residents were being neglected because we didn’t have enough staff,” Margaret said. “I just put it all down on paper then didn’t hear anything for weeks, even after following up a few times with management. “After talking with the other nurses in the staff room, I printed off another copy, signed it and left it on the table. I told them if they agreed with this then they’d sign it too. “People thought it was a great idea, and they all signed it. “The letter disappeared overnight — I still don’t know where it went — but a few days later we got our staff member back. “So I’d say management got a hold of it and thought, this isn’t just Margaret being a pain, this is everyone.”
Hand in hand: Caring for residents, ourselves Our biggest strength as nurses and carers can also be our biggest weakness: we care for our residents so much that we will go above and
Pauline Tau and Sharon Taylor
beyond to ensure they receive the care and dignity they deserve. But it is our ‘caring’ nature that management often rely on to push the envelope when it comes to workloads, skill mix and ratios. And this can sometimes do more harm than good. “Standing up for the people you’re caring for means you have to stand up for yourself,” Margaret said. “You can’t care properly for residents with an excessive workload, and you can’t go on caring for residents if your wages aren’t high enough to live decently on. “We might talk about our conditions or wages, but to me we’re standing up and advocating for the people we’re caring for who don’t have a voice. “Not one person has to stand up alone, you stand up together and you say, ‘These people have value’. “What I see happening is that old people don’t have value anymore in the eyes of many aged care companies. But these are people we value because we care for them the best we can, so we need to stand up for them. “Because if we don’t do it, who will?”
Did you
know
If your written contract doesn’t reflect the number of hours you actually work on a regular basis, you can request to have it upgraded to reflect the hours you actually work. Many aged care workers are currently employed on ‘contracts’ that state a minimum number of hours they must work per fortnight (eg. 16 hours). But in reality, you may regularly work more hours than your contract states. Once you’ve consistently worked more hours than your ‘contracted’ hours in a number of fortnights you can request that management upgrade your contract. By having your written contract reflect your usual number of hours worked, you will have greater job security should your employer ever want to think about reducing your hours. Most enterprise agreements provide a right for you to make such a request and many prevent the employer from unreasonably refusing to agree to that request. To find out more, contact your local Organiser on 3840 1444 or Member Connect on 3099 3210 or 1800 177 273 (toll free outside Brisbane).
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You really don’t feel rested or nourished when all you’re doing is jamming food down your throat. Catherine Keast, Registered Nurse
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Fuelling the day for shift workers L
et’s be honest – hospitals aren’t known for their culinary delights. In fact, they often get a bad rap when it comes to food. Whether you’re a patient, a staff member or sitting at the bedside of a loved one, when those tummy rumbles begin it’s likely you’ll be trekking across the road for some Nandos or Subway. But not all of us are fortunate enough to have alternate food options close at hand, let alone healthy and nutritious options to keep us well-fed and fuelled for those gruelling night shifts. And when you’re tackling back-to-back 12-hour stints, a stale Mars Bar from the bottom of your bag and a handful of crackers just don’t cut it… so it’s off to the vending machine we go.
Getting real about food But gone are the days when vending machines only offered Coca Cola and packets of chips. A new initiative sweeping across Brisbane is revolutionising the vending machine concept, serving up fresh, nutritious and wholesome meals faster than you can say ‘convenience’. All Real Food vending machines are stocked with superfood salads, wraps and sandwiches, nutritious breakfast jars and healthy snacks. Co-founder Daniella Stalling said her passion for healthy living and eating well was what led to the initiative. “There’s so much junk food available but there’s such a shortage of quick, healthy options in the market today,” she said. “We wanted to make healthy food not just easy for everyone to access, but also offer options so there’s something for everyone whether they’re vegan, vegetarian, gluten-free, diary-free and so on.”
The vending machines are currently available in the Princess Alexandra Hospital, the Prince Charles Hospital and QEII Jubilee Hospital. Meals are stocked fresh daily and unsold items are donated to local food banks. A Loyalty Program provides an added incentive for people to use the machines, with special offers and freebies available for regular customers. “We’re solving problems for hospitals as cafes aren’t open 24/7,” Daniella said. “It’s really exciting to be able to help hospitals have healthy, fresh food available all the time and it’s nice to be getting great feedback from people. “At the moment, we can only deliver as far as the Sunshine and Gold coasts but we’d like to make the machines available in as many hospitals around Brisbane and southeast Queensland as possible.”
Shaking things up The vending machines have already proven to be a hit at the Princess
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indepth Alexandra Hospital, where they are located on the ground floor and level four.
If I’m not eating right my energy levels are pretty low and I have trouble concentrating… It also increases my stress levels when I get hungry – I get hangry!
Clinical Nurse and QNMU member Shay Ellwood said patients and staff at the PAH have been hot-footing it to the machines thanks to its convenience and tasty meals. “It’s really good value for money. Most of the items cost around the $10 mark and that’s pretty comparable to a café or takeaway place. Plus everything tastes really nice and fresh,” Shay said. “We also really like that the containers they come in can be reused and the food isn’t just wrapped in paper. They’ve all got labels on them for dietary requirements as well as a nutrition panel.
Shay Ellwood, Clinical Nurse
“Everything is tap-and-go too so there’s no need to fumble around with coins or cash, it’s all very quick and convenient.” The machines were installed at the PAH as part of the Plane Tree initiative aimed at boosting patientcentred care. Feedback from patients, families and staff showed healthier food options and more access to food after hours were big ticket concerns. Shay said the initiative also included a revamp of the hospital’s public access cafeteria to encourage people to make healthier food choices. “When you walk into the cafeteria you now see the healthy food options first, such as juices and water. “You can still buy Coke and iced coffee and stuff but the fridges have now been moved so they’re not the first thing you see. These items are also positioned lower or higher above you so they aren’t in your line of vision. “Over time they’ve tried to take out the deep-fried stuff from the cafeteria too.”
When choices are limited Unfortunately not all hospitals have the luxury of improved food options. Despite lobbying for All Real Food vending machines to be installed at Redcliffe Hospital, Registered Nurse and QNMU member Catherine Keast was told the company’s HACCP food safety accreditation didn’t match up
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to Metro North Hospital and Health Service requirements.
they’re laden with gluten and not suitable for people with food allergies.
Which means she and her colleagues are often stuck for better food options.
“When you’re on night shift there just isn’t access to anything aside from the vending machines that really only contain junk food.”
“When I first started working at Redcliffe Hospital we didn’t even have a hospital canteen,” Catherine said. “I work 12-hour shifts so I pretty much had to have all my meals and snacks prepared at home. If I forgot to bring something that was it… The only other option was to walk down the road to the IGA and waste precious time off my 30-minute break – which is never really 30 minutes, it’s more like 10. “That left little time to actually have lunch and you really don’t feel rested or nourished when all you’re doing is jamming food down your throat.” Unfortunately, the recent opening of a new canteen within the hospital has brought little relief. Catherine said food options there are substandard and overpriced. “The new canteen only opened in the past year but a lot of the food is fried. There are some salads but
Straight to the ward The challenges of limited afterhours food options has led to some patients and staff turning to delivery food services as an alternative… and it’s popularity continues to grow. Catherine said occasionally staff at Redcliffe Hospital would club together and have food delivered, and she recalled a patient who once ordered a pizza to recovery. “I guess as long as the patient is happy and they’ve had something they like to eat then we’re happy,” she said. “Food is about the only thing they have control of when they’re in hospital – they get to pick from a menu. Everything else from when they go to sleep, have physio or take their meds is dictated for them.”
indepth For Shay, getting food delivered to the ward helps foster a positive team environment. “We’re pretty big foodies so we’ll often order one of everything, split the cost and get it delivered with Uber Eats,” she said. “We’ll sit in the main office – so we can still hear the buzzers going – and we’ll just have this smorgasbord of open food and it’s really nice to sit as a group and have dinner together.” However, food deliveries can cause logistical problems in metro hospitals. QNMU Secretary Beth Mohle recently spoke to media about the issue. “In big facilities they turn up and expect to deliver it to the front entrance,” Beth said. “This diverts resources away from things that need to be done with nurses’ jobs, to have to get the food delivered to the right rooms. “The underlying problem is that not all facilities have after-hours food services and that is a challenge for health services across the state.” Food delivery service Uber Eats Queensland said it wanted to make sure delivery services worked for carrier partners and hospitals, and is working with Lady Cilento Children’s Hospital in Brisbane to establish a designated delivery area for food. “We’re seeing patients in hospital enjoying being able to get restaurant-
quality and health foods delivered into hospitals,” Uber Eats Queensland General Manager Susan Anderson said.
options more easily accessible, it can’t be denied we health professionals just aren’t very good at looking after ourselves.
“They see it as something they can offer to the parents in a stressful environment and they’re actively encouraging patients to use it for food after hours.
Sometimes, there just isn’t time to prep that meal or dash across the road for something a little healthier.
“Our carriers only go to the areas that the public is able to get to and we encourage them to not go into places they shouldn’t be.”
Time to think about y-o-u While there’s still work to be done in our hospitals to make healthier food
There’s so much junk food available but there’s such a shortage of quick, healthy options in the market today. Daniella Stalling, All Real Food Co-founder
Both Catherine and Shay identified an energy slump if they haven’t been able to eat well before or during a shift. “If I’m not eating right my energy levels are pretty low and I have trouble concentrating. I start dropping things like charts and pens and I just get a bit clumsy,” Shay said. “It also increases my stress levels when I get hungry – I get hangry!” Catherine’s autoimmune issues means it takes a lot to push through and recover from if she hasn’t eaten well. “I love working in this area but you want mental clarity in a job like this and not be running on fumes,” she said. Unfortunate as it sounds, skipping meal breaks and working overtime are a dime a dozen in the industry. But this comes at a cost…
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The inner workings of our bodies
You snooze, you lose After crunching the numbers on more than 1000 participants in a study, researchers found that roughly eight hours of sleep correlates with a lower body mass index, lower levels of ghrelin (a hormone that triggers appetite) and higher levels of leptin (a hormone that signals that the body is full. Hours of sleep
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o what happens to our bodies when we aren’t getting the nutrients we need? Clinical Nutritionist Audra Starkey said as shift workers, many of us subject our bodies to an onslaught of little sleep and poor nutrition. This means our bodies are already biologically stressed before we even walk into a stressful workplace. “The body has a remarkable resilience to keep powering on. But eventually there’s a breaking point where it can no longer tolerate and endure a consistently poor lifestyle and that can manifest through various signs and symptoms over time,” Audra explained. “Research has identified shift workers are prone to various chronic conditions such as obesity, type 2 diabetes and cardiovascular disease… but it doesn’t stop there. “Shift workers often suffer from gastrointestinal complaints, mental health conditions and certain cancers.” Not nourishing our bodies with the right foods, coupled with insufficient hydration, also adds to fatigue. And this isn’t ideal when shift workers already run on limited sleep. Statistics show shift workers get on average two to three hours less sleep than those who work regular hours, and this consistent lack of sleep has a flow-on effect that causes us to not eat properly. “If we don’t eat well it can increase our feelings of tiredness because our bodies aren’t getting the fuel they need,” Audra said. “Sleep deprivation alone has been shown to impair the way our bodies respond to insulin, so we’re actually disadvantaged before we’ve even eaten anything!
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Body mass index
Leptin (satiety)
8hrs 5hrs
Gherlin (appetite)
14.9%
3.6% 15.5%
“Lack of sleep also disrupts our hunger hormones, leptin — which tells us when we’re feeling full — and ghrelin — which tells us when we’re feeling hungry.
But when we eat is just as important, if not more so, than what we’re eating. Our bodies respond differently to our food intake depending on the time of day.
“The problem when we’re sleep deprived is that we get an increase of leptin but we’re not getting the signal telling us that we’re feeling full, and we get an increase in ghrelin which tells us we’re feeling hungry. This can lead to overeating the wrong types of food. So it’s quite a catch 22!”
Audra likens shift workers’ bodies to clocks, made up of clock genes located in every tissue, cell and organ in our body.
There’s a big connection with not eating well and fatigue, and our immune systems become further weakened when we’re running on little sleep.
Audra Starkey is a Brisbane-based Clinical Nutritionist with a passion for helping shift workers. Her main focus is to help shift workers who are struggling with sleep deprivation to improve the quality of their sleep through personalised Better Sleep Programs.
“Various animal studies have shown that if there’s genetic mutations in some of these clocks it can lead to metabolic syndrome,” she explained. “So if our clocks are not functioning under the normal circadian rhythms — which is often the case for shift workers — it can lead to weight gain.”
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Audra’s top tips for healthy shift eating
Queensland Nurses and Midwives’ Union
Planning your meals Planning meals in advance should be a number one priority for shift workers. This could mean allocating time to grocery shopping or scheduling time in the kitchen to prep nutritious meals, like casseroles.
Choosing protein-rich foods Choose foods that keep you feeling full for longer. Protein-rich foods will keep you feeling full for about four to six hours, versus carbohydraterich meals that will leave you feeling hungry about an hour later. That’s when we end up gravitating to the (not-so-healthy) vending machine for those chocolate bars and muffins! To improve satiety levels or that feeling of fullness, Audra recommends eating more protein-rich foods like: ■■ Free-range eggs ■■ Chicken ■■ Cottage cheese ■■ Greek yoghurt These can be eaten in conjunction with healthy fats such as avocado,
Talking hospital food 17 hrs .
A maternity ward in Japan recently made headlines for its scrumptious-looking meals. nuts and seeds (such as chia seeds), olive oil and fatty fish.
Having some healthy snacks on hand These could be protein balls or crackers with veggie dips like beetroot, hummus or guacamole.
Eating minimally on night shift Night shifters are more prone to gastrointestinal complaints because our bodies aren’t geared up for night time eating. Even though we are awake, our digestive system is trying to sleep and literally doesn’t know how to process food at night! We’re essentially catching our cells off guard, and forcing them to process and store glucose and fat when they’re unprepared.
We took to social media and here’s what you had to say about hospital food in Oz… AT I just had three nights in the Wesley in Brisbane and when I was off clear fluids, the food was lovely and no trouble with accommodating my Coeliac needs. The meals tasted like they had been made from scratch - lamb stew, savoury mince etc… Like · Reply
MJB When I was in hospital there was no beef, pork or lamb. It was all steamed chicken or fish. No flavour at all and despite eating adequate amounts I couldn’t get my blood sugars up enough to take my insulin at all... Like · Reply
Making the most of those Zs
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adly, sleep deprivation is part and parcel of working 24/7. This consistent lack of sleep can create a flow on effect of not eating properly. Because it’s harder for us to grab those Zs for the optimal seven to eight hours, we’ve got to make the most of them when we can! Audra recently launched her Better Sleep Program exclusively for shift workers. She works one-on-one with them to improve the quality of their sleep by helping them fall asleep more quickly, along with reducing ‘broken bits’ or intermittent awakenings that can steal some of our precious sleep. This could involve supplements or different pathological testing, changing environment or lifestyle factors and more. To find out more about the Better Sleep Program visit www.healthyshiftworker.com
LB The vegetarian patient food at the PA is diabolical. A slice of mock-meat on bread is not a sandwich! No vegetarian in their right mind eats the veggie food they offer, it’s not the 1970’s anymore. Like · Reply
TC Patients get no food at all or simply a piece of bread or toast if they are admitted after the kitchen closes. NOT good enough. No matter how much we advocate as nurses and midwives it doesn’t change. I’ve had patients going out at midnight to get their loved ones McDonalds at both public and private hospitals, or getting chips and chocolates from the machine. Flies in the face of health care really. Like · Reply
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indepth
It doesn’t seem that long ago that Queensland Health nurses and midwives voted up their EB9 agreement. Two years later, it’s back to the bargaining table to negotiate EB10. Bargaining with Queensland Health kicked off on 8 November 2017… and as always, we’ve got an ambitious agenda. We achieved a lot during EB9, including a 2.5% increase to wages and allowances, $12 million in funding for NUM/MUM initiatives, 228 more ENAS positions for existing ENs, and new pay rates for Nurse Practitioners, just to name a few. This time around, we’re negotiating for (among other things) enhanced job security, improved
Our bargaining process is… special…
workload and fatigue management, improved reporting and accountability, and improved wages and conditions. Remember, engaged members means more power in the workplace. Queensland Health nurses and midwives should keep an eye on their emails (look for ‘EB10’ in the subject line), or regularly visit our EB10 campaign page on our website for updates.
Visit www.qnmu.org.au/EB10
Since EB6, the QNMU and Queensland Health have taken a unique approach to bargaining — it’s called Interest Based Bargaining (IBB), and it’s an approach that has seen us achieve some significant outcomes over the years for public sector nurses and midwives. Deputy President of Fair Work Australia Anna Booth said IBB was best understood by contrasting it to ‘positional’ or ‘traditional’ bargaining. “In IBB, instead of looking at claims, demands or positions, you look at the interests or underlying needs and concerns that all parties have, and from that you derive a list of issues for bargaining,” DP Booth said. “There are different ways those issues could be met, so you work through a process of evaluating different options. “The best option is going to be the one that best meets the needs and concerns of all parties.” Since adopting the IBB approach, we’ve managed to achieve some great outcomes for public sector nurses and midwives. “A very big issue I recall was in 2006 where we had an issue around professional development,” DP Booth said. “Clearly you could have a claim for weeks of professional development leave with an associated claim for costs for
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indepth attending conference. (But) that would be a ‘claim’. “Instead of dealing with it that way, we looked at the underlying needs and concerns that related to professional development for both parties. “For Queensland Health, that included a highly skilled and contemporary workforce that was confident in deploying skills, making good judgements and keeping up to date with new clinical practice. “From the nurses’ perspective, it was about all of that but without compromising their own work-life balance and being able to maintain their standard of living. “From that we generated a range of options, and the outcome wasn’t as simple as saying we’ll pay for three conferences a year, which is a fairly blunt approach. It was much more creative than that.” In the end the parties arrived at the arrangements that are in place today. Nurses and midwives can access up to three days a year for PDL and receive an allowance paid twice annually to meet associated costs.
Leading the way for more than a decade Not only does IBB ensure the relationship between the QNMU and Queensland Health remains one of mutual respect (which is essential for our day-to-day dealings with Queensland Health outside bargaining), it also gives us the best chance of negotiating an agreement that is fair for nurses and midwives. “Queensland Health and the QNMU are unique in that they have a history of using IBB beyond purely enterprise bargaining,” DP Booth said. “With the foundation of mutual respect of both organisations and the recognition of the QNMU as the voice for the workforce, it’s the most comprehensive and holistic example of the use of IBB in Australia to date.” Deputy President of the Queensland Industrial Relations Commission (QIRC) Adrian Bloomfield agreed, saying while other parties had experimented with IBB, the QNMU and QH were the exception to the rule.
“Queensland Health could not operate if it didn’t have the full cooperation and commitment of the nurses and midwives,” DP Bloomfield said. “We’ve got lines of communication that have opened up as a result of the continued trust between the organisations.” In fact, it’s largely because of our unique approach that the Industrial Relations Act was recently changed to allow for new approaches to conflict resolution. “The Act as it was written before was pretty constrained,” DP Bloomfield said. “The new provisions let the parties request the assistance of the QIRC when they want it, so it’s a very informal process.
Anna Booth, Deputy President, Fair Work Australia
“Parties don’t have to notify an industrial dispute, they don’t have to get into the trenches. They can inform the industrial commission that they’ve got a problem that they need to work through and they might need the assistance of someone to help work through that process. “It doesn’t involve conflict, it doesn’t involve singling people out.”
An extension of our nature It’s no coincidence that this style of negotiating is reflective of how we as nurses and midwives operate in our day-to-day work. “In the workplace if someone in a NUM’s team, for example, wants to change rosters or have a day off and there’s a standoff about it, rather than saying ‘yes’ or ‘no’, the idea is to step back and ask why you need this and what else can we do to solve the problem,” DP Booth said.
Adrian Bloofield, Deputy President, QIRC
“It might be that some nurses take a whole day off work when they have one thing that will take an hour because it doesn’t fit neatly into the rules. “If you can actually identify that and agree to come in late that day to meet that need, then you’ve solved the problem. “You often find there’s a simple solution that’s evident to everybody but wouldn’t have come about if you were in a standoff about your respective demands.”
Beth Mohle, QNMU Secretary address parties during EB10 opening address.
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Making a difference
one crisis zone at a time
Man on a mission: Allen Murphy, RN: Médecins Sans Frontières (Doctors Without Borders) Allen is an Emergency Nurse and from 2006-2016 also worked as a qualified QFS firefighter.
O
n 5 December every year aid agencies around the world tip their hats to the thousands of volunteers who make their organisations tick. It’s International Volunteers Day and everyone from the mighty United Nations and International Committee for the Red Cross (ICRC) through to community-run relief agencies, thank their volunteers for bringing hope, health and dignity to the poor, sick and the vulnerable. Here meet two QNMU members who have made international volunteering part of their lives... Have you got what it takes to join them?
A
llen Murphy barely bats an eyelid as he describes the graphic reality of a ‘stink tent’.
“It’s where we put the patients with badly infected and gangrenous limbs,” he says. “The rotting smell was so bad we just couldn’t keep them in with the other patients.” For Allen, the stink tent in a remote, largely forgotten part of South Sudan is just part of his world as a Médecins Sans Frontières (MSF) nurse. It’s a million miles away from the sterile environs of a Queensland hospital, but it’s the kind of place Allen has found himself drawn to time and again in his 22-year nursing career. “I grew up during the Ethiopian famine, so I saw all those starving skinny babies on the television ads for Red Cross… and I remember thinking, ‘why is this happening to these people?’ and ‘who’s doing something about it?’.” “I guess that always stayed with me.” Driven to help people, Allen trained as an emergency nurse, and in 1997 he moved to Mornington Island where he gained experience in remote area nursing that helped him secure a placement with MSF. “My first mission was in the northern Sudan in 1999. Every 10 to 12 years they get what they call the meningitis belt across the top of sub-Saharan Africa where they have a massive meningococcal meningitis outbreak. “I remember walking in the only hospital in the area and there were patients everywhere, lying on the bare concrete floors, all of them with meningitis. “Almost everyone I’d looked after in Australia with meningitis had died, so I remember thinking, ‘my god,
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AllEn Murphy all these people are going to die too’… but we treated them with Chloramphenicol and the next day they were all sitting up, eating.” When he wasn’t treating meningitis patients, Allen was also learning to appreciate the true meaning of “mass vaccination”. “If you set it up properly it’s actually very simple. You have someone register the people lining up, someone else wiping their arm, and two people drawing up vaccines and putting them on an iceblock. Then the vaccinator just stands there and goes bang, bang, bang — one after another.” “Each vaccinator can vaccinate a thousand people an hour, so with five teams we were doing 5000 an hour for weeks.” Since that first mission, Allen has returned to Africa four times including six months in Sierra Leone during the civil war where he contracted malaria, and six months at a therapeutic feeding centre for under-fives in drought-ravaged Kenya. “Kenya was tough, but for a malnutrition mission ours wasn’t the worst — there were horrendous stories going around of other missions where the nurse had to go out in the morning and squeeze the breast of each woman who was waiting, to see if she had any breastmilk. If she did then she’d have to wait while the supplies were given first to those who couldn’t produce.”
Allen said the cyclical nature of the malnutrition problem made Kenya a particularly frustrating post. “We couldn’t fix the bigger environmental and infrastructure problems. We’d fatten the children up and send them back out into the community, but there was still no food and no crops, so they’d starve and come back to us.” On his trip to South Sudan last year Allen was made an MSF field co-ordinator with the added responsibility of looking after 15 expats and 130 local staff in a largely forgotten, insecure area, in a country crippled by civil war. He said standard third world problems like disease and malnutrition were compounded by intergenerational fighting within tribal groups and guerilla warfare, which means his team saw a lot of traumatic injuries including gunshot wounds. “They used to fight with sticks but now everyone has a gun.” “The population we were working for were attacked multiple times… and occasionally the insurgents would take pot shots at our car. “There were times we were on the precipice of evacuating on a daily basis – all our emergency gear was packed… and we had contingency plans about what we were going to do if the (insurgents) came, how we were going to evacuate these people… it was incredibly stressful.”
But the difficult conditions haven’t dampened Allen’s enthusiasm for humanitarian work and he encourages anyone thinking about it, to take the plunge. “You’ll always regret not doing it,” he said. “It’s tough, it’s physically and mentally demanding, but if you can handle it, you can make a real difference.” In the next few weeks Allen will be heading to Maiduguri in Nigeria – which he has learned is the northeastern stronghold of Boko Haram. “I also read they had two female suicide bombers blow themselves up at a food distribution point a couple of weeks back.” “I’m kind of wishing I hadn’t Googled it now.”
It’s tough, it’s physically and mentally demanding, but if you can handle it, you can make a real difference. Allen Murphy
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Helen zahos
Witness to history: Helen Zahos, RN: Works with in-country NGOs and smaller aid agencies. Helen is also a fully qualified paramedic.
H
elen Zahos still cries when she talks about the tiny bodies being pulled from the Aegean Sea during the Syrian refugee exodus. It was September 2015 and Helen, like all the volunteers at the Moria refugee registration camp that day, had been called urgently to the beach. A wooden boat full of people fleeing Isis had capsized. “It was awful, there were hundreds of people down there and we were desperately trying to bring them ashore,” she recalled. “There were kids, just babies… and there was such a sense of fear — these people were clearly terrified. “Some of the survivors told us how the smugglers had forced them onto the boats at gunpoint when they tried to change their minds about travelling in such a dodgy vessel in bad weather… it was horrendous.” Helen said at that moment she felt like she was a witness to history. “I felt it was important their story be captured. I didn’t want them to be forgotten so I started taking photos with my phone.” Helen had been on Lesbos for five weeks before the boat sunk, working with French NGO Medecine Du Monde. “It was relentless, 5000 people were landing every day, can you imagine that? “And they were in a bad way - there were fractures and wounds which is fairly normal for people who’ve been beaten with batons and boots, but we also saw a lot of chemical burns,” she said “That’s what happens when you get people sitting in leaked petrol and engine oil on the floor of a rickety boat, then trekking 96 km inland to Moria without being able to wash the chemicals from their backsides, legs and groin — it was horrendous, it was cruel. “There were all sorts of presentations, including complication from missed medication — we even had one woman who came to us with her chemo treatment in a bag
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begging us to administer it then and there. She wouldn’t wait – she was desperate to keep going.” Helen returned to Greece again in January this year, this time volunteering with local Greek NGO Perichoresis who were working with refugees in Ktima Iraklis on the mainland. But her work with refugees made her very unpopular with some of her Greek countrymen. “My background is Greek and I had extended family members brand me a traitor because I dared to help these ‘illegals’.” She received death threats from Greek fascists and one of her doctor colleagues was physically attacked. “They don’t realise I was also there helping Greeks during the financial crisis too, but… you know…,” she shrugged. In fact Helen’s humanitarian work more or less started around that time. “I was going to Greece for a holiday and there was a lot of talk about the financial crisis, a lot of destitute people on the streets, and I didn’t feel comfortable just going to pose on a beach,” she said. “So I thought I’d go and volunteer for a couple of weeks at a clinic for pensioners who couldn’t afford medical care — it just seemed like the thing to do.”
Extending a helping hand has now become a huge part of Helen’s life and it’s taken her to the Philippines after Typhoon Haiyan in 2013, to Nepal after the 2015 earthquake, and most recently to a refugee camp in Iraq.
for hugs… I listened to stories from the women about how they came to be there and… well, there were a lot of tears shed and within 24 hours my preconceived ideas flew out the window.
She’s also worked on Christmas Island and at the Nauru detention centre.
“Since then I feel like I’ve traced their journey backwards, — I’ve seen refugees in detention under Australian guard, then when I was in Greece I saw them in flight and terrified, and on my last tour to Iraq, I saw where it all begins.
“I’ve kind of come full circle,” she said. “When I was working as a paramedic my work partner had a real issue with refugees arriving by boat, he’d carry on about how bad they were, and I think I got it into my head that these were bad people. “But after I changed jobs I got contract work on Christmas Island, and on the very first day I saw little kids poking their heads up and waving their hands through the fence, calling to me and running up
“I feel very privileged to have been able to do that, it’s pretty special. “And I encourage anyone with a humanitarian streak to seriously consider this kind of work. “You don’t even need to be nurse or midwife — I always say if you can hand someone a blanket, sit with someone in distress or give a thirsty person water then you can volunteer.”
You don’t even need to be nurse or midwife — I always say if you can hand someone a blanket, sit with someone in distress or give a thirsty person water then you can volunteer. Helen Zahos
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So you wanna be a volunteer? T
he day-to-day activities of a humanitarian health worker is well within the skill set of most qualified nurses and midwives. But this kind of work isn’t just about administering a vaccine or dressing a wound. Humanitarian nursing requires an X-factor… it takes fortitude and resilience, self-sufficiency and courage. So… do you have what it takes?
Resilience Allen Murphy reckons crisis nursing is about as raw and rewarding as the job can get, but he warns it’s not for the fainthearted. “I think some people have a romanticised idea of humanitarian work, but in reality it’s a really tough environment.” “My last trip to Sudan was the hardest for me so far. We were looking after the most marginalized, most forgotten people in the country, surrounded by warring tribes on all sides, in the poorest state, in the least resourced country in the world, and it was dangerous. “In these sort of harsh environments you have to be adaptable, you have to be flexible, there are going to be days where there is no power, no running water and… you eat rice and bean staples every day for a week because the supply plane couldn’t land after rain turned the airstrip to mud. “And we did have volunteers who just couldn’t cope — I had to send people home because they couldn’t manage — one girl was in tears every single day. “There are certainly days where you just go “you know what I just want to be home in my nice comfy house”, but you suck it up. “Whenever I was having a bad day I’d just go to the hospital… we had surgical capacity at this hospital so we could do C-sections for women with obstructed
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labour which was a big thing because we were saving babies’ lives. “So going there reminded me that I was making a real difference to this community.”
Courage Working in dangerous or hostile locations comes with the territory for crisis nurses and midwives. Four years ago when earthquakes devastated large swathes of Nepal, Helen Zahos was among one of the first teams in. “I’d gone in with the Non-Resident Nepalese Association (NRNA), a bunch of Nepalese Australian doctors and nurses with me thrown in the mix, and we were up on a steep mountain road when second earthquake hit. “A landslide up ahead had blocked our way and I remember hanging on to the bullbar of the car we were in wondering why everyone below was running across into the fields. “Then the quake came and it was massive, I’ve never been through anything like it. I actually texted my mum and said goodbye because, I looked down into the ravine beside me and thought “this is it” because huge cracks were appearing on the road. “It was terrifying, but we didn’t have time to dwell on it – we made our way to a nearby army base and as soon as they realized they had medical personnel they started choppering patients in.”
ResourcefulNESS For Helen self-sufficiency is an essential attribute for crisis nursing. “When I land I have enough food to survive for at least a week, protein bars, basic stuff… and a sleeping bag because often the sleeping arrangement is just a tarp on the ground.” “And you shouldn’t turn up empty handed- it’s a bit of an unwritten
rule. Find out what’s needed before you come, pack dressings, bring a defibrillator, be useful… this is particularly true if you are working with smaller NGO’s, they are often poorly resourced.” She said it’s also important to be affiliated with a group before landing in a crisis zone. “One thing I’ve seen over the years is that people turn up to help out of the blue and they are not registered anywhere,” she said. “So suddenly you’ve got thousands of people turning up to volunteer, totally unprepared and under-resourced, but you don’t have the capabilities or the infrastructure to co-ordinate them and they become another headache. “And it’s not just about resources — in Greece we had unvetted people faking medical credentials which is not only a risk to the patients, but also a security concern because we worry about unaccompanied minors being stolen and sold on the black market — it sounds far-fetched, but we saw that in the Philippines and Nepal.”
Resilience Courage Resourcefulness
Sign me up ■■ www.msf.org.au/join-our-team/ work-overseas ■■ www.icrc.org/en/who-we-are/ jobs/health-profiles ■■ https://mercyships.org.au/ volunteer/ ■■ http://dfat.gov.au/people-topeople/avid/pages/avid.aspx ■■ www.projects-abroad.com. au/projects/medicine-andhealthcare/nursing/
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Dispatches by
DEB rays
Registered Nurse and QNMU member Deb Rays has been working in the Rohingya refugee camps on the Bangladesh-Myanmar border. She posted this account recently on her Facebook page.
Deborah Rays
November 12 at 6:10am . Cox’s Bazar, Bangladesh . Yesterday was exhausting. The heat drained sweat in buckets from my skin, as we climbed towards the outer edges of the camp. There at Block H and Block I, the people were yet unreached by medical care, or any NGOs. On the crest of every steep hillside, all you could see were thousands more plastic shanties, sea upon vast sea of desperation. It was quite disheartening. An old thin man with a white goatee and tender brown eyes had been walking beside me for a while. When we stopped in the shade of some bamboo to report to the military checkpoint, he tapped my interpreter’s arm. He wanted to tell me about the massacres. He said he was from Buthidang. He said the Myanmar army had come upon their village suddenly, without warning or explanation. He said they killed the adults with machine guns.
They didn’t kill the children that way, though. He said they cut their throats, motioning with his finger across his throat. Tears flowed silently down my face. We stopped to rest at the single doctor tepee run by International Organisation for Migration.
Deb featured in the Winter edition of InScope. Saving lives, one post at a time
He told me refugees were still arriving at the rate of 10-15,000 a day, some days, and that he often received victims of gunshot wounds and bombs. We (also) talked with a feeding centre, who had found hundreds of kids with acute malnutrition. We reached the edge of Block H mid-afternoon.
... Deb spends all her annual leave in refugee cam ps abroad, and she uses Facebook to save lives.
FEATURE inde pth
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ESLEY Hosp ital RN Deb Rays loves Facebook.
She can spend hours on there every day and has more than 1700 Facebook friend s. But you won’t find any cheez burger cats, food porn or duckface selfies on her timeline. You see Deb spends all her annual leave in refug ee camps abroa d, and she uses Faceb ook to save lives. “On my secon d morning in the Katsikas camp in Greece some one told me there was a really sick little kid,” Deb said. “We searched about 100 tents and when we found him he was lying on a blanket on rough stone s and it was one of the worst thing s you could see up in the remote mountains with hardly any medical backu p— his abdomen was swollen, he was groaning with pain, he was breathing rapidly and he was scratching himself all over, so I figured it was his liver… and he was blue.” When the boy’s medical evacu fell through, ation Deb and her friends hit Facebook and, boosted by a group of Spanish firefig hter volunteers whipped up who a petition of 191,0 00 signatures, mana ged to get the boy medical treatm ent in Spain. “He needed a liver transplant and so did his broth er — after some months, we got them both out,” she said. The boy’s story went viral and prompted dozen s of volunteers , including nurse s and midwives to volunteer for the Greek camp s. “We had young people pullin g up in VWs, and arriving from all over Europe, Spain , the US,” Deb said. “It was amaz ing and by the time I got back to Austr alia I had half a dozen people askin g to go back with me.” Deb’s journey to refugee activi began abou sm t 4½ years ago when she opened her home to two boys — one Rohingyan and one Afgha — under the n Federal gover nmen t’s homestay progr am helping refug migrants integr ee ate into the Australian community. “When they came I starte d writing a blog on the Home stay website …
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The sick and old were produced and we noted their details and took pictures. We found a man acutely ill, but could not convince him to be stretchered to the main road. We will return with doctors today, hopefully, this will be the first of many mobile medical trips to the edges.
He said they cut their throats, motioning with his finger across his throat.
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Your guide to feel-good gifts this
Christmas
Pictured: (l-r) Saleena, Chelsea, Khalia and Elissa from Lush Mount Gravatt. Photo: Kasun Ubayasiri
Scrambling for those last few Christmas prezzies?
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ith those sleigh bells already a-ringing, we’re doing some frantic last-minute shopping and we’re sure you are too! There are a plethora of options… enough to make one’s head spin. So it’s a good thing we’re here to point you in the right direction. We know nurses and midwives want to support businesses that in turn support their workers. And that means protecting their hard-
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earned penalty rates, especially over Christmas! As we know, penalty rates are vital to family budgets for the lowest-paid workers in fast food, hospitality, retail stores and pharmacies. Though the Fair Work Commission has slashed penalty rates for thousands of Aussie workers in these industries, businesses across the nation have stepped up to protect penalty rates for their staff.
So who are they? Well if you log on to businesses4penaltyrates.com.au you’ll see a list of Queensland businesses that have committed to protecting penalty rates for their staff. By supporting these businesses, you’re making sure your money goes to fair wages. And that makes for a very Merry Christmas all round!
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We asked some of the shops on the businesses4penaltyrates website why they felt it was important to maintain penalty rates. In the end it came down to fairness and recognising the value of their staff. Check out their responses, or better still, show them some retail love…
Lush
The holiday season is about pampering yourself, and your families and friends! What better way to do that than with delicioussmelling soaps and heavenly bath bombs? What’s even better, the friendly staff at Lush are being properly compensated for sacrificing their time to work over the holidays!
Photo: Kasun Ubayasiri
Lush Australia will not be apply ing the Fair Work Commission’s reductions to the award wages paid to employees on Sundays and Pu blic Holidays. We believe that those making the sacrifice to work on Saturdays, Sundays and Publi c Holidays deserve to be fairly compensated. Applying the Fair Work’s ruling on penalty rates is a choice. The happiest and most produ ctive employees are those wh o feel safe, valued and listened to by their employers. We encourage other employe rs to carefully consider the implications on their employe es before making the choice. Peta Granger and Ma rk Lincoln, Lush Australia and Ne w Zealand Directors
Find Lush locations at www.au.lush.com
There’s nothing like a good book and a cup of hot chocolate for some me time these hols. Gift someone a page-turner from Avid Reader Bookshop, and get the warm and fuzzies knowing their staff are getting paid what they deserve.
n to We made a business and philosophical decisio in place. keep our staff’s retail award and conditions l society and We believe in creating and supporting a civi ns paying we do this by valuing our staff and that mea ncially above award conditions. This has cost us fina should pay but we believe all businesses large or small the case with penalty rates, but we know this is not always retailers. port the local We hope that our customers will always sup g by workers. Australian businesses that do the right thin
kshop owner
Fiona Stager, Avid Reader Boo
Avid Reader Bookshop Find them at: 193 Boundary Street, West End
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Yeppoon Central Meats Photo: Rhodes Watson
In sunny Queensland, Christmas means cranking up the barbie with some mates. Grab your meat from a local butcher that’s supporting families this Christmas. And don’t forget the Christmas ham!
We chose not to drop penalty rates for our staff because they’re all family me n. They give up their weekends to come and work for us and not see their families. Why should we take away mo ney they’ve always earned, yet not give anything back in return? It didn’t seem fair an d made no sense. Our staff depend on this incom e every week, and protecting their penalty rates means the y’re still able to afford incidentals for their families, to go out on weekends and have a lifestyle that’s more tha n just work. Otherwise we’d be taking their lifestyle away from them. Zen Kona, Yeppoon Ce
ntral Meats owner
Find them at: Yeppoon Central Shopping Centre, 42 Park Street, Yeppoon
For a full list of Queensland businesses that have committed to protecting penalty rates for their staff, visit businesses4penaltyrates.com.au
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Shopping ethical this Christmas?
There’s an app for that! No idea if the gift you’re buying comes in recyclable packaging, or if that mascara you’re looking to purchase for a friend was tested on animals? You know what they say… There’s an app for everything! The Shop ethical! app gives you the low-down on the environmental and social record of companies behind common brands in Australia. The app provides instant access to over 4,000 products with related company information so you can make an informed and ethical decision wherever and whenever you choose to shop. By shopping ethically, you’ll be sending a strong message for change and helping support the practices that make our world a better place to live in. Not to mention you can take comfort in the knowledge that your good intentions (and dollars) aren’t hurting the planet or the animals that live within it. How’s that for Christmas spirit?
Our wish list for nurses and midwives this Christmas... Not feeling guilty for taking lunch breaks, or toilet breaks.
A workplace where I feel safe.
Getting paid what I deserve.
Colleagues who support me‌ and management who listen.
Respect for my professional expertise.
Enough nurses and midwives on shift so I can do my job safely.
Because we’re worth looking after. Wishing you a Merry Christmas. Thank you for
making a difference. Pictured: QNMU members Fae Morgan, Daryll McKenna, Debra Clark, Kerrie Green, Pauline Tau and Sharon Taylor.
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WOMEN POWER TO THE PEOPLE
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hen it comes to unionists, most Aussies are likely to imagine a burly construction worker in a yellow hard hat, his fists raised to the sky. But unionism is no longer predominantly blokey nor bluecollar. Today’s unionists come from a variety of backgrounds, cultures and workplaces. Importantly, women now play a leading role in Australia’s trade unions.
Who run the world? Girls! Well, maybe not yet. But women are certainly playing an increasing role in unions, with latest research by Griffith University showing there are more women union members than ever before. And strong, dedicated women are at the helm of creating change for everyday Aussie workers by stepping up as leaders and drivers of their unions. Our ‘man-in-a-hard-hat’ is fast morphing into a scarf-wearing Rosie the Riveter. Even though our modern day women union leaders and activists might look a little different to the iconic Rosie, they continue to embrace the legacy and values she embodied. According to ACTU President Ged Kearney, the male unionist stereotype still exists but that image is slowly shifting. “The majority of union members now are women and our biggest unions are in fact female-dominated ones, like the QNMU,” she said. “When you ask the community who they think is most likely to take strike action they often say teachers and nurses. This shows they associate industrial action with women and we know our women members don’t shy away from stepping up to the activist plate when they have to.” Queensland Council of Unions (QCU) Secretary Ros McLennan said she’s
When you ask the community who they think is most likely to take strike action they often say teachers and nurses. Ged Kearney, ACTU President
found women to be wholly generous with their time when it comes to committing themselves to a cause. “Our women members and women who are active in their community are strong and intelligent, and absolutely unstinting with their time if a cause is just,” she said. “I think women like to consider every angle and possibility and that’s a thoughtfulness they bring to organising and campaigning that may be different to their male counterparts but no less powerful.”
Rose led her nursing colleagues in standing together on a marathon three-year campaign against Mater’s proposed cuts to their wages and conditions in a shameful round of enterprise bargaining. “They were going to cut virtually everything out, we would have lost many conditions like our penalty rates and taken a huge cut to our wages,” she said.
Stepping up
“When Mater tried to stop us from taking industrial action we went to the Fair Work Commission and managed to have our right to take the industrial action upheld.
QNMU member and Clinical Nurse Rose Voyzey knows firsthand the power of collective strength and a united front, and what it takes to step up as an activist.
“It was a big battle and we went to ballot three times but we held on for three whole years until we were successful in getting Mater to drop their proposed changes.”
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I think women like to consider every angle and possibility and that’s a thoughtfulness they bring to organising and campaigning that may be different to their male counterparts but no less powerful. Ros McLennan, QCU Secretary
Rose’s efforts in the campaign were recognised with an Emma Miller Award in 2013, which Rose attributes to the collective efforts of all members involved. Rose said her drive as an activist stems from a passion to help others, which has led her to become a strong advocate for nurses both in and outside the workplace. “I think there are benefits of being a female-dominated union and there is strength in the fact that we are many,” she said. “I don’t think we are as vocal as some of the more male-dominated unions, but women certainly don’t take a step back in terms of activism as compared to their male counterparts… quite the opposite!
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“If people are passionate and they know you’re doing things for the right reasons they really get behind the cause and get active.”
They’re everybody’s issues This year the ACTU elected its first ever female Secretary Sally McManus, who is already making waves with some refreshing straight talk, reminding us all that creating a fairer, better society is an issue for everyone. At the recent QNMU Annual Conference in Brisbane, Sally reminded hundreds of nurses and midwives of the importance of working as a collective on all campaigns and issues. “People often look at domestic violence leave and paid parental leave
as women’s issues, but that just isn’t true,” she said. “They’re everybody’s issues because they affect all of us.” Ged echoed the belief, and agreed women are continuing to change the idea of trade unions. “Historically the union movement hasn’t really fought hard for women’s agendas,” Ged said. “But at a grassroots level a majority of our members are women and they’re doing a really good job in changing the nature of the union movement, to the point where two of our biggest campaigns at the moment — access to family and domestic violence leave and paid parental leave — both have a gender aspect.” Rose believes nurses have a responsibility to champion the issues of our community, and the nature of our work gives us an opportunity few people have to make a genuine difference. “We have a big union and good members within it, and that gives us the ability to create change. It goes beyond just altering healthcare… It’s the whole gamut of professional,
indepth industrial and social issues and we have the power and opportunity as a large group to improve the quality of people’s lives,” Rose said. “People need to realise the union isn’t there only in case we have a problem. Being part of a union isn’t about fixing issues, it’s about making things better and creating something good for our next generation of nurses. “I believe having open conversations is the first step to getting active and involved in the union, and being a part of creating real change.” Ros McLennan believes relationships play a key role in ensuring members continue to be connected with their union’s campaigns and agendas, and women have the opportunity to participate. “We need to always check back in with our members to make sure the issues we’re campaigning for are relevant to their work and their life,” she said. “I am also particularly mindful to make sure we are welcoming and inclusive, and women — particularly women with children — can participate in events. We’ve got a plastic bucket of kids’ toys in the QCU meeting room so as not to exclude those who come to a meeting with kids in tow. “As a mother, my two kids are a big reason why I do what I do, because they’re the ones who will be the beneficiaries of a fair society which we’re working to create.”
What does a unionist really look like? “I don’t think we are as vocal as some of the more male-dominated unions, but women certainly don’t take a step back in terms of activism as compared to their male counterparts… quite the opposite!” Rose Voyzey, Clinical Nurse and 2013 Emma Miller Award winner
You can help break the union stereotype by sharing your pics of what being a unionist really looks like via Queensland Unions’ online competition. The entrant with the best photo of the year will be presented a $1,500 gift certificate to Flight Centre to use toward any sort of holiday they like, and monthly cash prizes are also up for grabs! Visit www.queenslandunions. org/unionist
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Why aren’t there more women leaders? Breaking down the research Despite the number of women in unions growing, a Women in Unions survey showed women are underrepresented on national councils, at national conferences and at ACTU Congress. ACTU data shows the representation of women in leadership roles has improved over the past decade, but this increase still isn’t representative of the massive jump in women’s participation in the labour force and the changing dynamics of union membership. Associate Professor Dr Rae Cooper from the University of Sydney’s Business School is a leading researcher in gender and work. Her study into the gender gap in union leadership in Australia also revealed senior and key decisionmaking roles within the union movement are overwhelmingly dominated by men. And this problem is widespread.
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“The under-representation of women is occurring across many occupations, sectors and roles, and not just in unions,” Dr Cooper said.
norms of what a good leader is are not responded to or treated in the same way a man would be,” Dr Cooper explained.
“It is a pervasive gender-based disadvantage that women face which goes to the culture of organisations and the ways in which leadership is constructed.”
“A man who is strong and powerful is seen as being directive and decisive. But you hear very different words about a woman who does the same thing, and they can sometimes start with a ‘b’!
What do we see as good leadership? What is perceived as good leadership differs across workplaces and sectors. But the characteristics commonly associated with good leadership can include being strategic, a good communicator, having a vision or a plan, and being charismatic. While these traits may sound gender neutral, we often tend to associate them with men. And when women exhibit those characteristics, they can be viewed in a slightly different light. “Research shows women who strive to meet those socially constructed
“However if you took the gender aspect away, they’re essentially exhibiting the same behaviours.” Dr Cooper said women fall prey to what is essentially a leadership trap around the gender norms of being a woman or a man, and the gender norms of being a good leader. “There are many different types of leaders and we have to consider how much of these leadership norms are actually socially constructed,” she said. “I don’t think there is an ideal way for women or men to lead. But there are different ways in which men and women lead and the way
indepth organisations respond to those behaviours. “What’s more socially acceptable for women leaders is to be softer, collaborative, empathetic and to be good communicators. But these characteristics don’t exactly line up with the sorts of things we expect a leader to do. “So there’s sort of a bind there for women. If they go with the leadership norm they’re seen as being inauthentic and bossy, or if they go with the stereotypical women’s traits they’re seen as being too soft.”
Facing the challenges for women Women with ambitions of stepping into a leadership role face additional challenges men don’t necessarily have to contend with. “What people normally reach for is when women have children and take breaks from work, and that makes them less able to participate and take on those leadership roles,” Dr Cooper explained. “To a point that’s true. Often when women are taking breaks from their career it’s also when they’re at their steepest career gradient. “This means they have less time to do things they’re not paid to do. So if they are unpaid workplace reps for their union that’s often something that will drop off because they just don’t physically have the time to be able to attend to those roles. This then has an impact on their capacity to move into leadership roles.” Dr Cooper said the fact women aren’t being promoted into leadership roles means there are more men in senior roles who get paid a higher wage, and so the gender pay gap persists at a leadership level. “Research conducted by Harvard University suggests women are asking for more pay rises and putting themselves forward for development and training, but they get told pretty early on in certain organisations that this isn’t appropriate. “It’s almost like they are being ‘punished’ for asking and are treated differently to men. So it all boils back
down to those gender norms and how we respond to or treat women when they behave in certain ways.”
Bridging the divide You don’t have to be loud to be powerful. Union members and activists no longer conform to traditional stereotypes, and it isn’t the loudest person who is necessarily seen as the leader. While it might be difficult to find a solution to the gender problem in leadership, as a society we can begin to unscramble the perceptions we have of leaders. “Trying to make women look like the stereotypical union activist isn’t how we solve the problem,” Dr Cooper said. “We need to make unionism more reflective of our work and the societies of people who are its members. I think it’s great for the
union movement to be led by people like Ged Kearney, a nurse, and Sally McManus, who spent much of her time in a union which is in part of social workers. “Nursing and midwifery are some of the most highly unionised professions in the country, and I think it’s great that the faces of those who care for our children and our parents are the faces of a union.” We can also adopt the approach of ‘fixing’ our organisations by making them friendlier toward people we want to see in senior roles. “That means aligning with the care needs people have and looking at ways we can build participation of those we want to push along into leadership roles,” Dr Cooper said. “It’s about fixing the culture within organisations, rather than trying to fix individuals.”
Research shows women who strive to meet those socially constructed norms of what a good leader is are not responded to or treated in the same way a man would be. Associate Professor Dr Rae Cooper, University of Sydney
Associate Professor Rae Cooper (PhD) is Associate Dean (Undergraduate) and Acting Associate Dean (Programs) at the University of Sydney Business School. Dr Cooper is a leading researcher on the world of work and has a particular interest in gender and work, women’s careers and flexible employment.
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Ratios E
ver since we successfully legislated nurse-topatient ratios in prescribed Queensland public health facilities, we’ve said our ultimate goal was to get ratios fully rolled out in all sectors. It’s a big task. It’s something that can only be achieved with every key stakeholder working together, including government, health management, and of course nurses and midwives. It’s not something we as a union can achieve on our own, but we are leading the way. Which is why in October we officially launched the next phase of our Ratios Save Lives campaign – ‘Extending the Care Guarantee’. In a nutshell, the next phase of our campaign seeks to: ■■ refine and expand legislated minimum ratios in the public sector ■■ legislate minimum ratios in the private and aged care sectors ■■ legislate for at least one RN to be present 24/7 in all Queensland residential aged care facilities ■■ improve application and compliance with the BPF in the public sector ■■ legislate public reporting of safety and quality performance indicators in all sectors. So there’s a bit of work to do! It’s an ambitious agenda, but ambition is how we secured legislated ratios in prescribed public health facilities on 1 July 2016. It was a good start, and paved the foundation for the years of work we have ahead of us. We’ve learned many lessons about the application of minimum ratios since the legislation came into effect. The feedback we’ve received from frontline staff, as well as new evidence and research, will now inform the work we will continue to do to improve how ratios are applied. But with ratios already legislated in a large section of public hospitals, we’re in a better position than ever to get them rolled out to the rest of the public sector, and private and aged care facilities. Visit www.qnmu.org.au/ratios for more information on our ratios campaign.
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The next stepping stone Ratios Q&A How will we get ratios in the private/aged care sectors? Ratios will largely be achieved in private and aged care facilities through negotiating enterprise agreements. And for this to happen, we need nurses and midwives in the workplace arguing the case for ratios. That means QNMU members engaged in the enterprise bargaining process. There are also other mechanisms we’re looking to pursue at a legislative level, namely public reporting. We’ve been lobbying the state government to legislate a public reporting framework, which will put pressure on private and aged care facilities to enforce ratios that put patient and resident safety first, rather than the budget bottom line.
Legislated ratios already apply in my workplace. Does ‘phase 2’ apply to me? Yes. In areas where legislation already applies there is still work to do to iron out issues with how the ratios are applied. In many areas, ratios are working well because the Business Planning Framework (BPF) is being applied correctly. However, in some areas this is not the case. Earlier this year Queensland Health conducted a joint state-wide review of the BPF (following lobbying from the QNMU) to identify how it can be improved and consistently applied across all HHSs. The Director-General of Health recently signed off on the recommendations.
These recommendations will go a long way to ensuring ratios are applied as the legislation originally intended.
The SWiM standard has seven key principles, one of which refers to the need for:
How exactly are we seeking to refine the current ratios legislation?
■■ 1:30-1:40 ratio for caseloads
Feedback from nurses in areas where ratios already apply has identified various issues that we’re now working to address. We’re working to ensure: ■■ ratios indicate a maximum patient load, and are not averaged across the ward ■■ minimum ratio calculations are rounded up, not down ■■ team leaders are not included in the direct care ratios ■■ legislation defines the parameters determining a prescribed ward ■■ legislation defines a framework for publicly reporting ratios compliance (ie. what, where and when).
What about ratios in midwifery? Unfortunately, maternity wards were not included in the initial roll out of ratios. The QNMU had argued for trials of ratios as occured for mental health. Since then, the QNMU has been active in developing the minimum requirements for safe staffing in midwifery. Through consultation with frontline midwives, midwifery leaders, academics and consumers, we developed the Safe Workloads in Midwifery (SWiM) standard.
■■ 1:1 ratio in active labour ■■ 1:4-1:6 ratio for inpatient units ■■ 1:5 ratio for postnatal home visits/ day ■■ Newborns must count in staffing calculations in postnatal wards.
Where else are we campaigning to get legislated ratios? The initial roll out of legislated ratios applied to certain medical and surgical wards, units and facilities in the public sector. In addition to rolling out ratios in the private and aged care sectors, our new document outlines ratios sought in the following areas: ■■ critical care (adult and paediatric) ■■ neonatal intensive care ■■ emergency department (adult and paediatric) ■■ perioperative services ■■ general adult inpatient wards ■■ short stay wards ■■ multi-purpose/integrated health services ■■ paediatrics ■■ maternity services ■■ inpatient mental health ■■ rehabilitation and geriatric evaluation management ■■ community health and community mental health services caseloads ■■ drug and alcohol units ■■ outpatient clinics – hospital setting ■■ clinical nurse/clinical midwife facilitators.
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e h t g n i d n e t Ex h c n a r b l a i c so After 37 years of dedicated service to the QNMU, our office manager and local branch guru Jenny Gett recently retired. While it was sad to see her go, it got us thinking about the QNMU’s history and the role our local branches have played over the decades in bringing members together both professionally and socially. Flicking through old photographs for Jenny’s farewell slideshow, we were reminded of some of the memories our branches have created and how they have kept our nursing and midwifery community strong.
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indepth We nurses and midwives are social beings. Who doesn’t like a good dance, coffee catchup, or even just a chat in the tearoom at work? We often like to hang out together, whether it’s work related or not. And it’s no accident that some of the best memories we create during our careers as nurses and midwives stem from those moments when we come together for a common purpose.
The glue that binds us together Social meet-ups, patty cakes and themed lunches may not be the first things that spring to mind when you think about QNMU Local Branches. You might have heard Local Branches formally described as the ‘democratic building blocks’ of our union.
The famous Bundaberg Branch stall... no conference was the same without the rum punch!
And it’s true. Our branch structure enables members in a workplace to gather, discuss and ideally resolve local issues, as well as giving every member a voice in deciding the QNMU’s direction and focus. But branches can (and should) be so much more than that. Whether it’s a comedy night, raising money for a local charity, or taking the meeting offsite to the local pub, branches can help bring colleagues together and foster good relationships in the workplace. Just ask retired nurse Cheryl Dorron, who was instrumental in establishing the QNMU’s very first branch, the Bundaberg Branch (which later became the Bundaberg Aged Care Branch). “I don’t think you can ever underestimate the social aspect of meetings,” Cheryl said. “We used to do heaps of fundraising. “We’d put on workshops and professional nights, seminars, oneday events, that kind of thing. “We used to do a lot of community stuff like putting a QNMU team in a fun run, we did a lot for the Cancer Council, including a yearly cabaret to raise money.
“One year we had a whole week on ageing and we hosted an evening with guest speaker Geoffrey Atherden, who was the script writer of the show Mother and Son, which was a really fun night. “So a lot of the things we did weren’t necessarily about nursing, they were also about building that sense of community.” Nurses and midwives who’ve attended Annual Conference over the years may also remember the famous Bundaberg rum punch the Bundy branch would generously supply. “We used to go down to the New South Wales nurses conference every year with a Bundaberg Aged Care Branch stall and serve the delegates our Bundaberg rum punch,” Cheryl said. “Then we started serving it at the Queensland conference. It became a
bit of an icon, certainly down in New South Wales where they couldn’t have a conference without the punch.”
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indepth The ‘Chunda Bucket Express’ For those Queensland nurses and midwives who have been involved in QNMU branches for a long time, there are some things that will forever stay in our minds. The ‘Chunda Bucket Express’ is one of them. Outraged by a politician’s ignorant comment that the only thing nurses were good for was holding vomit buckets and bed pans, QNMU members took to the road and organised a bus trip to Queensland Parliament to set the record straight. Long time member Theresa Dunne, who retired from The Prince Charles Hospital only recently, remembers the trip fondly.
Bucket The Chunda her glory Express in all
“The bus came down from Cairns and picked up all the branch representatives from right across Queensland,” she said. “Then the Brisbane nurses met them all at the end and we walked up to Parliament House. “It was about nurses sticking together and showing the public we were a force. “It was a very fun day and very social… because nurses are very social.”
The value of the social Today one of the most active QNMU branches is our Toowoomba Branch,
which pioneered the concept of an annual professional night. Every year the Toowoomba Branch hosts a professional evening, which sees members from every QNMU branch in the district join with other health professionals to discuss key health issues. They also host an annual trivia night which brings nurses, midwives and their families and community together for a night of lighthearted fun.
“Putting on these kinds of events really normalises the idea of collective power where otherwise people can be shy or wary of it,” said QNMU Councillor and key Toowoomba activist Kym Volp. “It makes it part of the way we do things as professional nurses, the coming together on issues that matter to us and the communities that we serve. “Branches are a community of support and connections, and these events help balance things so that the branch isn’t just being contacted when there’s trouble.” But it’s not always about the big ticket events. Sometimes small things can go a long way to keeping members engaged with their branch. “We also do morning tea rounds and make baskets of patty cakes and leave campaign materials in the tearooms,” Kym said.
We survived the Chu nda Bucket Express... and all we got was this lousy sh irt 52
“Branches are really about the basic stuff like knowing you’re part of a larger group, and that gives people a sense of security in knowing there’s a positive presence from the QNMU in their professional community. “At the end of the day, everyone’s looking for some sort of protection, no one wants to be isolated or vulnerable.”
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nch... The Toowoomba Bra
and the TPCH B ranch...
host their own professional evenings. Building confidence Recognising the value of the Toowoomba professional night, many other QNMU branches around Queensland now host their own professional evenings, including The Prince Charles Hospital branch in Brisbane and branches on the Gold Coast. The Prince Charles Hospital branch hosted their first professional evening in 2016. Not having hosted such a big event before, members were initially worried the event might flop and they’d fail to get the 50 attendees they hoped for. “But we got about 110 in the end, and I think we’re going to aim for 200 in 2018,” Theresa said. “The feedback was incredible and gave the branch so much confidence. “To link nursing and education and the law and all the issues nurses and midwives are involved with and turn it into a fun night was great.” And that really is the point: your Local Branch can be whatever you want. It’s up to you what your branch focuses on, whether it’s the social functions or the professional issues… or both. But at the end of the day, we all want to be part of a community where we can feel safe and supported, and Local Branches can facilitate that community.
Get involved in your local branch You may not realise it, but most QNMU members are already in a branch (if there is a local branch established in your workplace). You don’t need to have a specific title to have your say in your branch – anybody who is a QNMU member can get involved.
QNMU Loca l Branch and Workpla Representati ce ves Ha n d b o o k 7th EDI TIO N
Talk to your Delegates/ Alternate Delegates in your workplace to discuss what activities you might like to do. For more information on local branches and how to get involved, visit www.qnmu.org.au/ branch_handbook
Star Branch Competition
Please submit your applications for draw 2 by: 4 June 2018 For more information visit http://bit.ly/starbranchcomp
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fun times with other branches...
A little history about branches Recently retired QNMU office manager Jenny Gett said she remembered the day back in 1991 when then QNMU Secretary Denis Jones first pitched the idea for the union’s branch structure.
Midwives Goondiwindi 9) Branch (200
Gympie Community Branch (2009)
“We all used to get nervous when he went on long trips, because he always came back with some bright idea that we’d then be asked to implement,” Jenny said. “We did already have some groups that were calling themselves branches, but it was just people who identified they wanted to be involved in the union. There were no rules or structure around it. “So on this one particular day Denis pitched the idea that it would be Delegates from branches that would form this group of people who would help with our communications. “The utopia was that every member was in a branch and was represented. “The idea was that you’d have a branch and you’d get people in that branch to be represented at Conference or MODs or whatever it was, so that if every member was assigned to a branch, they’d be represented by one in 25.”
The Prince Charles Hospital Branch (2011)
Implementing this was no easy feat, given there were no computers or databases. “The workplace lists were in boxes of cards back then, so it was a manual task to find out how many people worked where,” Jenny said. But once the structure was established it enabled the union — in an era before bulk emails and social media — to more effectively communicate with members. “It gave us a communications structure — a tier of people who we communicated to, who we sent the newsletters to, and they spread the message. So instead of contacting every member, they became our communicators.” Things have progressed a lot since then, of course, with technology enabling much more sophisticated ways of communication.
GCUH Mental Health Branch (2015)
But the essence of why the branch structure was introduced in the first place is still just as relevant today as it was in the early 90s. “The branch structure allowed all different types of members to be represented, and branches really underpin the collective nature of what unions are all about,” Jenny said. “It’s about members working together, discussing the issues at branch meetings, and then taking it up as a group.”
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PIV failure –
how effective is your clinical practice? By Nicole Marsh RN, BN, MadvPrac, Kaye Rolls RN ACC BAppSc (Sydney) DN The Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital; School of Nursing and Midwifery, Griffith University; The Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute; Sydney Nursing School, University of Sydney.
Based on an observational study of peripheral intravenous catheter outcomes in adult hospitalised patients – a multivariable analysis of peripheral intravenous catheter failure, Journal of Hospital Medicine (published online October 2017). Marsh, N., Webster, J., Larsen, E., Cooke, M., Mihala, G. & Rickard C.M.
Nurses can expect to care for patients with a peripheral intravenous catheter (PIV) on a daily basis. Of significant concern however is that up to 69% of PIV may fail before therapy is complete, exposing patients to unacceptable risks. To improve patient outcomes there is a need to identify patient, and insertion and maintenance factors that can be improved. A prospective cohort study (including patients aged over 18 years in medical surgical wards) was undertaken in a large tertiary hospital in Queensland Australia between October 2014 and December 2015. One thousand patients with 1578 PIVs were recruited with 32% (512) of catheters failing (any cause), (136 per 1000 catheter days; 95% CI 125 to 148); including phlebitis 17% (267), occlusion/infiltration 14% (228), and dislodgement 10% (154). Insertion practices or factors associated failure included: ■■ Bruising at the insertion site doubled the risk of phlebitis (HR 2.16, 95% CI1.26-3.71)
■■ PIV insertion in the pre-hospital setting almost doubled the risk of dislodgement (HR 1.78, 95% CI 1.033.06) ■■ A size 22 gauge catheter increased the risk of occlusion /infiltration by 1.5 (HR 1.43, 95% CI 1.02-2.003), and ■■ When the PIV was inserted in the patient’s dominant side the risk of phlebitis increased 1.5 times (HR 1.39, 95% CI 1.09-1.77). By contrast the use of secondary securement improved the life of a PIV by halving the risk for all types of failure including: ■■ Use of non-sterile tape in addition to the primary PIV dressing [Occlusion/ infiltration (HR 0.46, 95% CI 0.330.63); phlebitis, (HR 0.63, 95% CI 0.48-0.82); dislodgment (HR 0.44, 95% CI 0.31-0.63)] ■■ An elasticised tubular bandage (occlusion/infiltration HR 0.49, 95% CI0.35-0.70), and ■■ Any form of additional securement [occlusion/infiltration (HR 0.35, 95% CI 0.26-0.47; phlebitis (HR 0.53, 95% CI 0.39-0.70); dislodgment (HR 0.32, 95% CI 0.22-0.46). Two practices increased the risk of PIV failure: ■■ Intravenous flucloxacillin doubled the risk of both occlusion/infiltration (HR 1.98, 95% CI 1.19-3.310) and phlebitis (HR 2.01, 95% CI 1.26-3.21) ■■ Frequent PIV access also increased the risk of failure including occlusion /infiltration (HR 1.12, 95% CI 1.041.21), phlebitis. (HR 1.14, 95% CI 1.081.21) and dislodgment (HR 1.14, 95% CI 1.08-1.21).
Lessons for practice ■■ To minimise bruising, prior to insertion of a PIV clinicians should evaluate how difficult the procedure may be, and seek assistance or escalate to a more experienced PIV inserter.
■■ Clinicians must ensure that the PIV is well-secured and protected by correct application of sterile dressing and consider the use of secondary securement. ■■ To reduce the risk of occlusion/ infiltration and phlebitis related to IV flucloxacillin, clinicians should adhere to correct administration regimes.
Reflective questionS 1. After reading this article, do you feel there are areas for improvement in your clinical area in relation to PIV insertion and maintenance? 2. How do you dress and secure PIVs in your clinical practice? Do you think it is adequate? Don’t forget to make note of your reflections for your record of CPD. References Bausone-Gazda, D., C.A. Lefaiver, and S.A. Walters,. Journal of Infusion Nursing, 2010. 33(6): p. 371-84. Rickard, C.M., et al.,. Lancet, 2012. 380(9847): p. 1066-74. Webster, J., et al., British Medical Journal, 2008. 337: p. a339.
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The age of injection By Evonne Smyth, Roberts & Kane Solicitors
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on-invasive anti-aging cosmetic procedures have become an increasingly popular option for both men and women in their pursuit of eternal youth. In turn, the number of clinics offering these services has increased exponentially over the past few years. In direct proportion to this growth are the number of nurses choosing to enter the cosmetic industry. The incentives for nurses can be significant. Clinics typically offer substantial salary packages, regular working hours, free or at-cost products, training, and travel to seminars and conferences across Australia. These incentives may seem very attractive, but be sure to read the fine print in your employment contract. Are you required to pay back the cost of training if you choose to resign your employment from the clinic? Are the costs of the training proportionate to the costs borne by the employer? In recent years, we have encountered situations where an employer has sought to have a former employee pay back the cost of the training provided to them. The cost of the training required to be repaid has been entirely disproportionate to the real cost borne by the employer. In some instances, employers have sought to be reimbursed for training which they received at no-charge from a pharmaceutical supplier. Another clause common to these contracts is the “restraint of trade” clause. Typically, these will seek to prevent an employee from moving to a competitor’s business, working at another clinic in a similar role within a certain geographical area, and restriction on solicitation of clients. In some instances, these clauses can be appropriate. If an employee seeks to move to a clinic which is very close to their former employer and in doing so take their current clients with them, it is reasonable for the employer to protect their business.
Seek the assistance of the QNMU if your employer is engaging in unprofessional, unlawful, or bullying conduct. In other instances, employers have sought to impose restrictions on their former employees which are entirely disproportionate to the risk they seek to obviate. An example being where the geographical area of exclusion is so large as to virtually cover the entire state of Queensland. Although it is essential to read the employment contract prior to signing and preferably have it reviewed by the QNMU, even after the point of signing certain industry employers have sought to unilaterally change the employment contract without any negotiation, consultation or agreement by the employee. Industry employers have also been accused of employing unsafe practices, employing bullying and intimidatory practices to force staff to undertake procedures that are beyond their scope of practice, which they are not qualified to perform, or are in conflict with requisite regulations.
within a geographical area after the termination of your employment. ■■ Look out for any clause that purports to allow your employer to deduct monies or seek payment from you at the end of your employment. ■■ Don’t sign documents that are collateral to your employment contract. If you don’t have the opportunity to negotiate the terms or reject the offer, don’t be forced to sign. ■■ Seek the assistance of the QNMU if your employer is engaging in unprofessional, unlawful, or bullying conduct. ■■ If you already find yourself in a compromised position, call the QNMU for advice before continuing to sign contracts that compromise you. ■■ If you have been served with a claim by your employer, make sure you seek the advice of the QNMU and don’t get bullied into a settlement without first obtaining advice.
The risk is real As a nurse, not only do you face serious financial risk by not doing your research and having your employment contract reviewed by a lawyer, you face the possibility of having very onerous conditions placed on your registration if you are found to be engaging in unprofessional conduct, or professional conduct of a lesser standard than that which might reasonably be expected of you by the public or your professional peers.
Our advice to you… ■■ Always read your employment contract carefully and if you have any questions seek the advice of the QNMU or a legal professional prior to signing. ■■ Look out for restraint of trade clauses, clauses that typically purport to prevent you from working for a period of time or
Reflective questionS 1. How well informed are you of the conditions/restrictions contained within your work contract or workplace agreement? 2. What access to training and development do you have under your workplace contract/ agreement? 3. If you find yourself being urged to work outside your scope of practice at work, do you know how to resolve the situation without compromising your professional obligations and putting your registration at risk? Don’t forget to make note of your reflections for your record of CPD.
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Mental health a forgotten issue
BY Dr Frances Hughes RN, DNurs, CMHN FACMHN, FNZCMHN, CEO, International Council of Nurses (ICN)
REVIEW: Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
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his ground-breaking, challenging report notes that mental health has been a forgotten issue for far too long, leaving far too many people to suffer human rights abuses within mental health services. It calls out the ‘global burden of obstacles’ which are preventing our mental health systems from adopting a human rights-based approach which would guarantee the right to mental health for all. “For decades, mental health services have been governed by a reductionist biomedical paradigm that has contributed to the exclusion, neglect, coercion and abuse of people with intellectual cognitive and psychosocial disability, persons with autism and
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those who deviate from prevailing cultural, social and political norms.” The report makes three claims regarding the global burden of obstacles: 1. Dominance of biomedical model. The science of biomedical psychiatry is both dominant and reductionist. “We have been sold a myth on the evidence.” 2. Power asymmetrics. The promotion and protection of human rights in mental health is reliant upon redistribution of power in the clinical, research and public policy settings. The asymmetry disempowers users and undermines their rights, “laws allowing psychiatric profession to
CPD treat and confine by force legitimise that power and misuse”. 3. Biased use of evidence in mental health. Powerful actors influence the research domain which shapes policy due to biomedical bias, thus evidence in support of psychosocial, recovery orientated services, support and non–coercive alternatives have not been given significant voice. The Special Rapporteur’s call for a shift in paradigm away from isolating mental health services which are coercive and medicalised, in line with the UN Convention on the Rights of Persons with Disabilities, to one that is recovery and community-based, promotes social inclusion and offers a range of rights-based treatments and psychosocial support at primary and specialized care levels. The Special Rapporteur also recognises the human rights imperative to invest in prevention and promotion. We endorse the Special Rapporteur’s further comments that: “...a reductive neurobiological paradigm causes more harm than good, undermines the right to health, and must be abandoned….” There is a need of a shift in investments in mental health, from focusing on “chemical imbalances” to focusing on “power imbalances and inequalities.” For the first time we have a global report that clearly articulates that mental health is wider than disease and disorder and what we should do at multiple levels. It recognises that health is also a matter of social justice. Inequalities, poverty and abuse all impact on our physical and mental health, and the solutions are political and social as well as technical. The criticism that there is no public health approach challenges us to consider why we treat mental health the way we do. The balance needs to come back and we need to focus on the primary prevention of suffering and ill-health, as well as the care and recovery of people who experience ill-health or distress.
The report rightly identifies a variety of effective practices and alternatives which situate mental health within a human rights and recovery-based paradigm and we agree that these must be scaled up and invested in. We should challenge business plans that continue to see investment in more beds rather than public and primary health strategies as the only option for those with mental illness and disabilities. The report concludes with hard hitting statements: ■■ Mental health has been neglected. Resources that are allocated are dominated by harmful, ineffective models, attitudes and imbalances. ■■ Failure to address human rights violations in mental health care systems is unacceptable. ■■ Crisis in mental health should be managed not as a crisis of individual conditions but as a crisis of social obstacles. Mental health policies should address the “power imbalance” rather than “chemical imbalance”. ■■ Shift approach to population level, targeting social determinants and abandon the medical model that seeks cure by targeting disorders. ■■ Scale up psychosocial interventions, to reach parity with physical health, mental health must be integrated in primary and general care. Recommendations are targeted at an international, country and practitioner level. It calls on leadership to confront the global burden of obstacles and it challenges medical education and psychiatry to discussion and change. It calls for the cessation of investment in institutional care and redirection into community care.
So what does this mean for nursing? It reinforces the evidence on social determinant of health. It challenges us to look at mental health in the public health framework not just as a disease and a disorder.
It validates us as nurses in so many ways. As a credentialed mental health nurse, this report is music to my ears. It highlights what we as mental health nurses have known. The system that service users and families are cared for and supported in is not therapeutic and largely harmful to them. There is no disease or disorder which should deny basic human rights. People in distress need support in primary and communities. The report validates the action of mental health nurses in ensuring our preparation and education is contemporary and adequately funded to deliver on psychosocial interventions. We need to have therapies in our education and we need to work more in primary and community health. Entry into mental health is at a specialist practice level. I look forward to following the reaction to this report at a global, national and state level. As nurses, we can do something. I look forward to a future where diagnosis does not define you as a person, nor make you have less rights as a citizen. We work together to provide a coherent, scientific, but humane and psychological vision; where we offer care rather than coercion, fight for social justice, equity and fundamental human rights, and to establish the social prerequisites for genuine mental health and wellbeing. Read the report here: http://bit.ly/2qXHNcQ
Reflective questionS 1. What are the obstacles of burden suggested in the report? 2. What are the social determinants identified that underpin mental illness? Don’t forget to make note of your reflections for your record of CPD.
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Novel dressing and securement techniques for PICC in paediatrics By Tricia Kleidon NP RN B Health Science (Nursing), Grad. Cert. Paediatrics, M Nursing Science, Dr Kaye Rolls RN ACC BAppSc(Sydney) DN The Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute; Sydney Nursing School, University of Sydney.
Establishing and maintaining vascular access is a vital but problematic component of caring for a paediatric patient. Peripherally inserted central catheters (PICCs) are being increasingly used to solve this clinical problem (Gibson, 2013), however, up to 30% may fail due to infective, vascular or mechanical complications (Chopra, 2012). PICC failure delays treatment, and prolongs hospitalisation. Furthermore replacing a catheter is distressing for the child and parent, detrimental to vessel health and consumes valuable and finite healthcare resources. The dressing and securement of a PICC has three objectives: 1. Provide stability to prevent catheter malposition and dislodgement, and minimise vessel injury by reducing micromotion at catheter insertion site. 2. Provide haemostasis. 3. Reduce microbial entry infection by covering the entry site. The unacceptably high rate of PICC failure suggests current dressing and securement techniques might be ineffective.
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Several new technologies have recently emerged to address this clinical problem, however at present this important clinical question remains unanswered.
Methods This single centre paediatric PICC study was a pilot, parallel, 3-arm randomised control trial (RCT) to test the feasibility of aspects of the Central venous Access device Securement And Dressing Effectiveness (CASCADE) trial.
Results One hundred and one children (aged 0-18 years) were randomised to receive standard care (bordered polyurethane dressing) [BPU] with suture-less securement device, tissue adhesive (TA) plus BPU or integrated securement dressing (ISD) with 95 patients included in the analysis. The study protocol was found to be feasible; 74% of patients screened met the inclusion criteria, 91% of eligible patients consented, minimal protocol violations occurred and only one patient withdrew. Overall 5% PICCs failed and there was a 16% complication rate (see figure1). Both parents
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Group 1 – standard care BPU + SSD (n=32)
Group 2 - ISD (n=31)
Group 3 - TA + BPU (n=32)
Dwell time¥ - 8 days (4.4-11.9)
Dwell time¥ - 7 days (5-11.8)
Dwell time¥ - 7.1 days (5-11.5)
Failure - 2 (1 dislodgementcomplete; 1 breakage)
Failure - 2 (1 dislodgementpartial; 1 breakage)
Failure - 1 (1 dislodgementcomplete)
PICC complications - 5 (16%)
PICC complications - 5 (16%)
PICC complications - 5 (16%)
Skin complications - 5 (16%)
Skin complications - 3 (10%)
Skin complications - 10 (31%)
Parental satisfaction# - 7.60 (3.8)
Parental satisfaction# - 9.20 (2.00)
Parental satisfaction# - 8.55 (3.05)
Clinician satisfaction#
Clinician satisfaction#
Clinician satisfaction#
Ease of application - 9.55 (2.15)
Ease of application - 9.70 (1.60)
Ease of application - 9.70 (1.25)
Difficulty in removal* - 7.35 (6.55)
Difficulty in removal* - 9.20 (2.10)
Difficulty in removal* - 6.05 (7.30)
BPU – bordered polyurethane dressing (Tegaderm 1614 or 1616,3M; SSD – Statlock VPPCSP;ISD – integrated securement device (SorbaView SHIELD SV254); TA – tissue adhesive (Histoacryl, B.Braun; ¥ – median and 25th/75th percentile shown; # 0 = very difficult/unsatisfied; 10 = very easy/satisfied; * p=0.002
and clinicians were satisfied with all interventions however clinicians found ISD to be significantly easier to remove than standard care or TA.
Conclusions Although firm conclusions cannot be made because this was a pilot study, the take home messages include: 1. The CASCADE protocol is feasible in this population, and, given fewer PICCs failed in this study compared to previous reports, these products appear safe and effective. 2. TA might provide a useful adjunct to post-insertion care by providing immediate haemostasis and reducing the need for early dressing change.
Reflective questionS 1. Reflect upon your current dressing and securement practice and consider how these options might add value or complement your current practice. 2. Considering participants in this pilot trial were children (aged 0-18), how does this population differ from your own patients and how might this impact your dressing and securement choices?
References Chopra, V., et al., The American Journal of Medicine, 2012. 125(8): p. 733-741. Gibson, C., et al.,. Journal of Vascular and Interventional Radiology, 2013. 24(9): p. 13231331. Kleidon, T.M., et al., Journal of Vascular and Interventional Radiology, 2017. 28(11): p. 15481556, e1. Ullman, A.J., et al.,. BMJ Open, 2016. 6(6).
Don’t forget to make note of your reflections for your record of CPD.
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The Belbin Team Role Model – What role are you? By Peter Twist, Mind Matters Training
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s part of its comprehensive training program for members, the QNMU delivers a course “Work matters: How to play to your strengths and manage your weaknesses”. This one-day workshop is underpinned by the psychometrically validated Belbin® Team Role Model which is the result of a nine-year study by Dr R. Meredith Belbin and his research team at Henley Management College in the UK. The research team identified separate clusters of behaviours, each of which formed specific contributions to the work environment. Attendees at this workshop receive an individual report indicating their preferred work style (or Belbin Team Role). A Belbin Team Role is defined as “a tendency to behavior, contribute and interrelate to others in a particular way”. Belbin and his team found different individuals displayed different team roles to varying degrees.
The Belbin team roles Team Role
Contributions
Allowable Weakness
Plant
Creative, imaginative, unorthodox. Solves difficult problems.
Ignores incidentals. Too preoccupied to communicate effectively.
Resource Investigator
Extrovert, enthusiastic, communicative. Explores opportunities. Develops contacts.
Over-optimistic. Loses interest once initial enthusiasm has passed.
Co-ordinator
Mature, confident, a good chairperson. Clarifies goals, promotes decisionmaking, delegates well.
Can be seen as manipulative. Offloads personal work.
Shaper
Challenging, dynamic, thrives on pressure. The drive and courage to overcome obstacles.
Prone to provocation. Offends people’s feelings.
Monitor Evaluator
Sober, strategic and discerning. Sees all options. Judges accurately.
Lacks drive and ability to inspire others.
Teamworker
Co-operative, mild, perceptive and diplomatic. Listens, builds, averts friction.
Indecisive in crunch situations.
Implementer
Disciplines, reliable, conservative and efficient. Turns ideas into practical actions.
Somewhat inflexible. Slow to respond to new possibilities.
Completer Finisher
Painstaking, conscientious, anxious. Searches out errors and omissions. Polishes and perfects.
Inclined to worry unduly. Reluctant to delegate.
Specialist
Single-minded, selfstarting, dedicated. Provides knowledge and skills in rare supply.
Contributes on only a narrow front. Dwells on technicalities.
The nine Belbin team roles There are nine Belbin team roles. The “allowable weaknesses” descriptors are the obverse side of the strength – essentially the price to be paid for the strength of the role. For example, a Completer Finisher tends to be weak on delegating because they are determined to see a task through and they will not be happy in passing it on to another. Additionally, a Monitor Evaluator who possesses analytical powers and objectivity may not be enthusiastic as it can interfere with assessment.
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Reproduced with kind permission from Belbin Associates, UK BELBIN® Team Role Accreditation Course Workbook
CPD Unpacking the roles We now have over 290 individual profiles from QNMU members who have attended the workshop. Based on this information, the following outlines in descending order the most preferred to the least represented of the team roles. ■■ Teamworker (19%) ■■ Specialist (18%) ■■ Completer Finisher (17%) ■■ Implementer (16%) ■■ Shaper (8%) ■■ Resource Investigator (7%) ■■ Monitor Evaluator (5%) ■■ Plant (4%) ■■ Co-ordinator (2%) There are some interesting findings that can be unpacked from these preferences. ■■ The most dominant role of Teamworker is a very caring, gentle role with a strong preference to provide dedicated care to the patient and is stressed when pushed to compromise on this.
■■ The Monitor Evaluator has very good analytical ability and combined with the Plant forms a powerful pairing when innovation is required. ■■ The Plant is a very creative and conceptual thinker who can think laterally in solving problems but needs a champion or sponsor who recognizes their thinking power. ■■ The Coordinator – the second of the two natural leadership roles – can be classed as a people focused leader. These findings indicate that in general, nurses and midwives who attended the training are caring, dedicated specialists who want to do their job with accuracy and time. These are the types of behaviours we expect from a professional cohort. Importantly, this information shows us why nurses and midwives become stressed and annoyed when their employer tries to push them into a role that compromises their ability to do their work to the highest of standards.
■■ The Specialist is a professionally dedicated and single-minded individual who is prepared to build up and pursue their knowledge in a specific field. The Specialist needs an employer who values their considerable body of knowledge and who respects the fact they prefer self-regulation. They can become stressed when not allowed to pursue their area of focused expertise. ■■ The Completer Finisher is focused on accuracy and perfectionism and will be stressed and frustrated if pushed for rushed action. Typically an anxious introvert (albeit this may be masked) this individual can fall victim to stress and burnout. ■■ The Implementer is focused on practicalities and getting the job done. They can be resistant to change as this can be perceived as disrupting a proven work process. ■■ The Shaper is one of the two natural leadership roles and can be a daring individual best suited to the activist role. ■■ The Resource Investigator is a natural negotiator, however they can lack focus.
Reflective questionS 1. What roles do you think you prefer? 2. In your workplace,who is your resident Shaper to represent members in challenging interactions with the employer? 3. If there is no Shaper – which is the next suitable role to do this? Don’t forget to make note of your reflections for your record of CPD.
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Health care digital technology and information systems
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lobal health care models are continually evolving in complexity and sophistication, placing demands on both digital health service innovation and clinical staff. This includes demands on nurses and midwives to efficiently and effectively navigate digital systems while providing safe and quality patient centred care. The Australian Government, and public and private hospitals have been working to keep pace with increasing digital maturity for decades. In the early 1970s the Australian Government argued that along with the need for universal health care, there was a need to improve the collection of health and health care data. More recently, the Australian Government has recognised that the digital transformation of hospital activities, processes and models of care is necessary to make the most of the changes and opportunities provided by digital technologies — including harnessing new types of health care innovation and creativity. Queensland Health has been delivering eHealth solutions since 2007. The eHealth Investment Strategy outlines a plan for 21st century health care and investing in digital health care into the future. The Information and Communications (ICT) systems are being designed in part to increase health literacy while upgrading core infrastructure to enable
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CPD cutting-edge health service delivery (Queensland Health, 2015).
required to take place in a Digital Hospital Program.
Queensland Health eHealth examples include: discharge summaries and radiology and endoscopy eReports which have laid the foundation for a fully interoperable integrated electronic Medical Records (ieMR).
The National Digital Health Strategy, developed by the Australian Digital Health Agency in 2017, outlines clear objectives for the health workforce to be achieved by 2022.
In November 2015, the Princess Alexandra Hospital became the first large scale digital hospital where patient’s medical records are accessed electronically rather than on paper based systems. A new digital bedside mobile device automatically uploads information to ieMR. The ieMR system is being rolled out to other public hospitals across Queensland. St Stephen’s Hospital in Hervey Bay was successful in securing funding from the Australian Government’s Health and Hospitals Fund, under the Health Reform Agenda in 2011, to build a state-of-the-art ‘hospital of the future’. This Australian-first fully digital hospital was opened in October 2014 with the aim of showing patients and clinicians how technology can transform the health care experience (St Stephen’s Hospital, 2017). Standards Australia has identified national standards to assist the further development of digital public and private hospitals in Australia; including the support of a new world-first Digital Hospitals Handbook (Marquardt T, 2017) released on 3 July 2017, as an initiative lead by the Australian Health Ministers Advisory Council (AHMAC) and the National Health Chief Information Officer Forum (NHCIOF). The handbook is a consolidated reference guide to health systems as they move to digital platforms and focuses on delivering more efficient hospital services using technology. This handbook provides guidance on what a digital hospital is and proposes a set of principles that provide the basis for the development of a Digital Hospital Program. The handbook further sets out the key phases required to deliver a digital hospital from the business case through design, implementation, golive and finally, to the handover that’s
These objectives require the health workforce, including nurses and midwives, to be confident and efficient in using digital technology (Australian Digital Health Agency, 2017). A QNMU long-term priority is the delivery of safe, high quality nursing and midwifery care which includes digital technology. QNMU members are aware that significant changes to the practice environment of nurses and midwives requires assessment and evaluation in terms of maintaining and or improving the delivery of health care services being provided. The Business Planning Framework (BPF) considers digital technology as an internal environmental factor that affects the role and function of health services and impacts on the productive hours of nurses and midwives. The QNMU is currently surveying public sector members regarding digital technology, with plans to survey members in the private sector as well. The survey will scope out the professional experience and member opinions on the effectiveness and efficiency of digital technology in their workplace. Members should check their emails for a link to this survey. It is expected the survey results will help provide insight into the real impact of digital technologies and information systems in terms of benefits and/or constraints on nursing and midwifery, health care, and optimal patient safety and quality of care, safety and outcomes in nurses and midwives workplace. The QNMU is also establishing two member groups around digital development — a Digital Technology and Information System (DTIS) Reference Group of about 12 members to discuss and work through the findings of the survey; and an online virtual Interest Group to advise the broader interested members of any relevant changes. Expressions of interest will be open soon.
Reflective questionS 1. What knowledge or experience do you have in your workplace of the Digital Hospital transformation process; business case through design, implementation, go-live and finally, to handover? Reflect on the benefits and barrier of impacts or possible impacts to your work and workplace. 2. How has your workplace BPF service profile been developed to be inclusive of the impacts from digital technology and information system changes at your workplace? 3. Consider digital technology and information systems that have changed or been introduced into your workplace in the past year. What are the advantages and disadvantages to providing nursing and midwifery care, health care, and optimal patient safety and quality of care, safety and outcomes in your workplace? Don’t forget to make note of your reflections for your record of CPD.
References: Australian Government 2017, Australian Digital Health Agency, Canberra, viewed 16 October 2017, https://www.digitalhealth. gov.au/australias-national-digital-healthstrategy. Marquardt, T (Public Affairs Officer) 2017, New digital hospitals handbook released, media release, Standards Australia, Sydney, 3 July. Queensland Government 2015, Queensland Health, Brisbane, viewed 16 October 2017, https://www.health.qld.gov. au/__data/assets/pdf_file/0031/442939/ ehealthinvestmentstrategy.pdf. St Stephen’s Hospital 2017, St Stephen’s Hospital, Hervey Bay, viewed 16 October 2017, http://ststephenshospital.com.au/ about-us/ehealth-and-the-digital-hospital.
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Positive mental health in the workplace
Sandra Eales QNMU Assistant Secretary
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CPD Everyone has a role to play in creating healthy workplaces. A culture of staff safety is a prerequisite to patient safety but evidence suggests health professionals have a particularly high risk of experiencing anxiety, depression and suicide. There are identified risks and protective factors which interact and contribute to the level of mental health in a workplace. To create healthier workplaces we need to implement strategies at the individual, team and organisational level to minimise the risk and maximise the impact of potential protective factors.
Known risk factors of work related stress include: ■■ high work demands (physical, emotional and cognitive) ■■ low control over how work is performed ■■ poorly managed relationships and bullying ■■ poor organisational change management ■■ regular exposure to trauma.
Protective factors are: ■■ control over practice ■■ adequate resourcing ■■ regular feedback and reflection ■■ connection with others (supportive relationships with supervisors and peers) ■■ effective leadership. Working in an environment where your best efforts are constrained by circumstances beyond your control, or where you can’t deliver best care because you simply don’t have enough resources, is likely to bring about moral distress and compassion fatigue. To protect ourselves in nursing and midwifery — which are inherently high demand jobs — we need control over our practice. Which is why we need to assert ourselves and demand safe workloads. We need to have a voice about the work.
Communicate It is important we participate in and build safe open communication
forums where nurses and midwives can express opinions and start thinking about new ideas. A team culture which is built on respect, recognition and reward can also be protective.
Be kind Kindness and civility costs nothing yet yields protective effect for those giving and receiving it. We also need to recognise the risk to nurses and midwives as the “second victims”, especially after an error is made or after a poor outcome. How do we deal compassionately with grief and loss in the workplace?
Grow resilience Focusing on individual resilience will also strengthen our professions. If more and more individuals burn out and leave, our profession grows weaker — so we have a professional responsibility to look after ourselves and each other.
Be healthy Take responsibility for your own health and wellbeing. You can start improving the way you feel through employing healthy sleeping habits, a good diet, exercise (both mental and physical) and practicing mindfulness. Nurses and midwives can also download the Nursewell smartphone app which supports self-care and wellbeing for health professionals, and promotes wellness and vitality. Activities and resources in the app have been designed to focus on elements of wellbeing that nurses can practice every day, either by themselves or with their nursing teams. Remember, you can influence your work environment through raising awareness in yourself and others. There are online resources available for individuals who want to influence or facilitate change and for managers and leaders at all levels. Visit www.headsup.org.au or www.worksafe.qld.gov.au for more information.
Support for individuals experiencing mental health challenges is available through: ■■ Nurse and Midwife Support on 1800 667 877 – A 24/7 national support service for nurses and midwives providing access to confidential advice and referral. ■■ Beyondblue on 1300 224 636 – Learn more about anxiety, depression and suicide prevention, or talk through your concerns with the beyondblue Support Service. ■■ Lifeline on 13 11 14 – A free, confidential, 24-hour phone and online crisis support service. An Employee Assistance Scheme is also available through your employer.
What are the benefits of a healthy workplace? ■■ Positive work environments that attract and retain the best workers ■■ Better patient experience because nurses and midwives aren’t emotionally exhausted ■■ A good practice environment including supportive colleagues and managers ■■ Engaged staff who are more likely to be that extra bit more helpful, which results in improved outcomes for the organisation and individual patients.
References National Mental Health Commission and the Mentally Healthy Workplace Alliance report (2014) Developing a mentally healthy workplace: A review of the literature Superfriend Promoting positive mental health in the workplace. Guidelines for organisations. can be downloaded at https://www.superfriend.com.au/ resources/promoting-positive-mentalhealth-in-the-workplace/
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in view
You’re looking at a combined total of more than 200 years of dedicated service by staff at Birribi Disability Services Unit in Rockhampton. CQHHS recognised these loyal staff with staff service awards, presented by CEO Steve Williamson.
Rocky pride
Well done all!
Happy second birthday to Rocky’s Sub-Acute Geriatric Evaluation (SAGE) Unit! The unit celebrated its second year of providing excellent care to our elderly and supporting them and their families in navigating our aged care system.
BOOK PRIZE ER WINN
Pretty in Pink-tober Nurses and midwives at the Sunshine Coast Private Hospital in Buderim were decked out in pink this October in support of breast cancer awareness. As part of the hospital’s Cindy Mackenzie Breast Cancer Program PINKTOBER campaign, they certainly went all out in a bid to be crowned best dressed department!
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Have you seen us around? We’ve loved catching up with our members this year at our QNMU@Work stalls across Queensland.
in view
QNMU@Work is an opportunity for members to speak directly with us about any issues or concerns in your workplace. We’re looking forward to QNMU@Work in 2018 so if you see us around, grab a snap with us and share it on Facebook @qnmuofficial! BTP Conference
Innisfail
RBWH
Daffodils galore QNMU member and Theatre RN Angela Fischer volunteered her time selling fresh daffodils and merchandise on Daffodil Day this year, helping raise vital funds for Cancer Council Queensland.
Send us your pics AND WIN!
Support for our Victorian nursing colleagues
Angela!
QNMU delegates attended the Australian Nursing and Midwifery Federation Biennial Conference in Hobart. We unanimously passed a special resolution to stand in support of Bupa ANMF Vic Branch members, who faced intimidation from Bupa management while trying to undertake protected industrial action. Read more about this on page 11.
Got a great pic of nurses and midwives? Send it to us at inscope@qnmu.org.au for a chance to win a book prize. See page 67 for details.
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incoming On qnmu calling for ratios across all sectors of healthcare LD Well done QNMU... Much needed in ALL nursing care areas!
Ra ti os sa ve Liv es
Like · Reply
MH For the wellbeing of patients and the wellbeing of nurses.
Phase 2 Extending the care guarantee
Like · Reply
JAD Need it in aged care asap, so much burnout! Like · Reply
RATIOS
SAve lIve
S MS As well as ratios we need the acuity of care required reflected in the numbers as people entering aged care facilities are entering with much higher needs. As an ACAT assessor once told me recently there is no such thing as low and high care anymore.
Like · Reply
LW And while we’re at it, let’s work on counting babies in ratios :-) Babies are people too! Like · Reply
DRD Yes bring it into the private sector would be great! Like · Reply
On marriage equality MH Thanks QNMU for sharing. I’m a member. Your ongoing support makes me feel proud to be a member. I feel included and represented. Equality is important to most members of the LGBT+ community for a number of reasons. Thanks again.✌ Like · Reply
BR It’s funny that we are accepted when we’re nursing you back to good health but outside of the hospital walls we are treated like second class citizens. What if we started treating patients based purely on the basis of our own personal values and beliefs... it would be fair wouldn’t it? Like · Reply
Our mother, Ada Russell, is 92 and a Blue Care resident of two years. Prior to the restructure, our family was happy with the care given by staff at Pioneer Gardens. EENs kept us up to date and informed by phone or when we visited, and provided us with reassurance our mother was receiving optimum holistic care. After the restructure, our mum has had three falls over a short period of time — twice she was found on the floor at 6am, after sleeping in her recliner chair overnight and with the alarm mat under her bed. Our family were uninformed and we only found out… when we were told by mum. Management have stated on two occasions that at times, there is only one carer available in a high care section. The alarm mat is only in situ after families’ request to management. In mum’s section, two most caring professional EENs were made redundant.
On Victoria’s Voluntary Assisted Dying Bill LR Now we just need the rest of Australia to follow suit. Why prolong the suffering & anguish if the result is the same anyway? Like · Reply
SAH Awesome news! Hope other states follow! I tell u I would want it if I was dying in agony! On the record! Like · Reply
NC Omg thank you to the politicians willing to stand up and advocate for vulnerable people that just want an end to their suffering!
The impact of the restructure has been felt strongly by our family. We are alarmed by the staffing levels, lack of care, response time, inexperienced staff and lack of communication with our family. We are assured of mum’s safety and that her care is being communicated to staff, but this is not followed through. We have grave fears for our mother’s wellbeing and safety. Susan Russell Concerned family member
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.
Like · Reply
SG I hope it’s in place everywhere asap. People should have the right to die with dignity. Like · Reply
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Letter to the Editor
/qnmuofficial
incoming On nursing homes to be audited without warning SBT This can only bring about a much-needed higher standard of care! Since when has the provision of elder care been a massive profit mill? Like · Reply
GA Cannot shout FINALLY loud enough on this! Perhaps our residents might be granted a level of TRAINED STAFF and company standards that haven’t fallen waaay below the acceptable line! Bring it on! Like · Reply
JS Where is the woohoo! button on Facebook? Cheering for random audits in every healthcare facility of any type – about time! Like · Reply
PF Now to fix all the other problems in aged care. Small steps yet a great step forward. Would be great to have unannounced visits to public hospitals as well for accreditation. Like · Reply
TLD It’s about bloody time. Our most vulnerable deserve to be cared for. #fixagedcare Like · Reply
Win
Letter to the Editor I write to express my gratitude of the support afforded to me by the QNMU in a matter involving the Queensland Coroners Court. Through our union pre, during, and, post the three days of a Coroner’s Inquest, the QNMU legal team of Sally Robb (barrister) and Judy Simpson (solicitor) furnished me with outstanding professional council delivered in an utmost caring manner. Ms Robb and Ms Simpson’s empathetic, collective approach in ‘looking after’ me enabled me to more than ‘get through’ an extremely distressing time. As a career nurse of 44 years, I have been a member of the various unions across a number of states. I do my best to avoid situations which would require union aid however at times, beyond my control, I have needed to call upon my union. And the QNMU has met my needs every time. For me, the financial cost of union membership is cheap when compared to the many benefits I have and can gain access to, including legal representation, from my union. As a nurse currently working in the mental health sector, the truism “I have your back” means so much. I can say I am comforted, encouraged, and blessed knowing the Queensland Nurses and Midwives’ Union “has my back”. In closing I am mindful of the words of Samuel Gompers being, “where trade unions are most firmly organised, there are the rights of the people most respected”. Thank you QNMU. Mick Farrell QNMU member and RN
one of these great books for youR fab photo
Fight like a girl by Clementine Ford Personal and fearless — a call to arms for feminists new, old and as yet unrealised by one of our most outspoken feminist writers. Fight Like A Girl is an essential manifesto for feminists new, old and soon-to-be, and exposes just how unequal the world continues to be for women. Fight Like A Girl will make you laugh, cry and scream. But above all it will make you demand and fight for a world in which women have real equality and not merely the illusion of it.
Roar behind the silence: Why kindness, compassion and respect matter in maternity care by Sheena Byrom For many years there has been growing concern about the culture of fear that is penetrating maternity services throughout the world. The Roar Behind the Silence provides information, inspiration and practical suggestions to support maternity care workers, policy makers, and maternity care funders across the world in their quest to deliver sensitive, compassionate and high-quality maternity services.
One Woman’s War and Peace: A Nurse’s journey in the Royal Australian Air Force by Sharon Brown In 1999, idealistic 23-year-old Registered Nurse Sharon Bown left her comfortable life in Tasmania and joined the RAAF with the aim of providing humanitarian aid to the world. Sharon’s story is that of a sheltered civilian RN becoming a military Nursing Officer and a commander. Her military service was unique, varied and far-reaching but came at the cost of her physical and mental health.
Email full-size pics and image details to inscope@qnmu.org.au for your chance to win
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calendar
December
March
International Human Rights Day 10 December www.un.org/en/events/ humanrightsday/
2018 February Reunion: Royal Brisbane Hospital Group 81 - 1978 10 February, 2018, 12pm Kedron-Wavell RSL Club Contact Angela Natoli 0419778963 or Facebook: Royal Brisbane Hospital Group 81 -1978
Midwives on Board! The Panama Canal
An Education at Sea Event 16 February-2 March 2018. Calling all midwives… Education at Sea is bringing you a fabulous opportunity to be a part of a midwifery cruise on board the Norwegian Star. www.nursesfornurses.com.au/events
Reunion: Prince Henry, Prince of Wales and Eastern Suburbs hospitals NEC of UNSW Reunion planned for the February 1973 intake of PTS 17 February 2018, 6pm Malabar (Randwick) Golf Club Expressions of interest to: Roslyn Kerr phone: 0447472968 email: gert2@optusnet.com.au or Patricia Marshall (Purdy) email tapric135@bigpond.com
Nurse Practitioners Pharmacology and Prescribing Conference
47th Global Nursing & Healthcare Conference
Exploring latest innovations in nursing and healthcare 1–3 March 2018, London, UK http://global.nursingconference.com/ europe/
5th International Conference Global Network of Public Health Nurses 5 – 7 March 2018, Safari Park Hotel and Casino, Nairobi www.ion.ch/
QNMU Meeting of Delegates 6 March, Brisbane 8 March, Gold Coast 12 March, Bundaberg 13 March, Maryborough 20 March, Sunshine Coast 22 March, Toowoomba 27 March, Rockhampton 28 March, Mackay
9 March 2018, London UK www.commonwealthnurses.org/
4th Commonwealth Nurses and Midwives Conference 10-11 March 2018, London UK www.commonwealthnurses.org/
Advanced traumatic & emergency care 22-23 February 2018, Paris, France http://trauma-criticalcare. conferenceseries.com/
Lung Health Promotion Centre at The Alfred
Continuing Professional Development
Spirometry Principles & Practice 1 - 2 March 2018 Asthma Educator’s Course 7 – 9 March 2018 Smoking Cessation Course 15 – 16 March 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au
23rd Commonwealth Nurses and Midwives Federation Biennial Meeting
4th Annual Congress and Medicare Expo on Trauma & Critical Care
Perioperative Course 23 February 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au
Lung Health Promotion Centre at The Alfred
Skin Health Education Day
The program will cover a range of questions commonly encountered by healthcare professionals, beauticians and the general public. This one-day education program will be led by Assoc. Professor Rosemary Nixon. www.skincancer.asn.au/shed2018
Saturday 17 March 2018 What you always wanted to know about skin but were afraid to ask! Leading dermatologists and skin care experts will provide training and education on how to diagnose and how to treat and manage common skin complaints. Following the success of the 2017 Skin Health Education Day, this special one-day event will again run in 2018.
22-23 March 2018, Brisbane. Earn 11 Hours and 15 Mins of CPD (certificate awarded) www.ausmed.com.au/course/nursepractitioners-pharmacology-andprescribing
April QNMU Meeting of Delegates 11 April, Townsville 12 April, Cairns
Lung Health Promotion Centre at The Alfred Managing COPD – Acute/Chronic 19 – 20 April 2018 Respiratory Course (Modules A & B) 30 April – 3 May 2018 Respiratory Course (Module A) 30 April – 1 May 2018 Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au
May Australian College of Perioperative Nurses (ACORN) and joint Asian Perioperative Nurses Association (ASIORNA) Conference
23-26 May 2018 Adelaide Convention Centre, South Australia www.acorn.org.au/conference2018/
Care of the Older Person into the 21st Century – Alaska
What does the future look like as the population ages into the 21st Century and what are the implications for health care delivery? 27 May - 3 June 2018 This conference will offer the opportunity to discuss what ageing will look like into the 21st century
and how health care services will be delivered. For nursing, in particular, it will provide a platform to explore how nursing services across the health care spectrum may alter. https://goo.gl/XgJkmG
19th South Pacific Nurses Forum 15–19 October 2018, Cook Islands www.spnf.org.au
June QNMU Annual Conference 25-27 June, Brisbane
November 2018 Nursing Summit - Eastern Caribbean
The Latest Advances in Health Care Delivery and their Implication for Nursing Practice. 10 November-18 November 2018. The content will be both relevant and of interest to nurses working in the acute hospital setting, community health, public health, aged care, and doctor surgeries. As well as those nurses working in the area of policy development, health education, and nursing research. We will explore a number of different ports and you will spend time with fellow nurses in an exclusive setting, on one of the most exceptional ships sailing in the Caribbean - the Harmony of the Seas. www.nursesfornurses.com.au/events
December World Congress of Cardiology & Cardiovascular Health 5-8 December Dubai, United Arab Emirates www.world-heart-federation.org/ wcc-2018/
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
The Nursing and Midwifery Board of Australia requires all nurses and midwives to complete a minimum of 20 hours CPD per registration year for each profession for which they hold current registration. Time spent reading and reflecting on the CPD articles in this journal can contribute to your hours. However in order to satisfy NMBA that your learning has been effective you need to keep a record of your activity. The following table is an example of how you might record your CPD hours. The following is an example only of a record of CPD hours (based on the ANMF continuing education packages): Date
Source or provider details
Identified learning needs
Action Plan Type of activity
01-092017
InScope Journal
Increase knowledge re Delegation & Supervision
Read article and answer reflective questions
Description of topic/s covered during activity and outcome
SelfCriteria and resources directed relevant to delegation and required levels of supervision. Increased knowledge re delegation and supervision of EN/ AIN.
Reflection on activity and specification to practice
No./Title/ Description of evidence provided
CPD hours
Answered reflective exercise questions. Read relevant NMBA codes & guidelines. Translated knowledge into practice and discussed with colleagues.
Journal article with reflective exercise questions.
2.5 hrs
Please refer to www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx for full details of CPD requirements.
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VOX POP
How has QNMU training helped you in your role?
Julie Whitebrook NUM (RBWH)
QNU training has given me the information I need to better resource and support the staff in my role as a manager. I’m able to assist them with the needs they have in a much more meaningful way.
Dallas Meyers
Emma Babao
CN (Emerald Hospital)
NUM (RBWH)
It’s empowered me to help advocate for the rights of other staff who don’t know their Award or their rights, and who tend to get overtaken by management. So I don’t mind standing up for the other nurses in the hospital.
It’s given me the resources and the awareness to facilitate my staff getting all their entitlements, and to also help support and empower my staff.
Take a look at upcoming QNMU training courses at www.qnmu.org.au/education
Jillian ACU graduate Mental health nurse
Foster skills to cope to reconnect with hope. Australian Catholic University’s suite of mental health programs has a stream designed especially for nurses. Our mental health programs focus on recovery-oriented practice, which is a radical shift from pre-existing models of care, and is in line with contemporary global approaches to working with individuals experiencing mental ill health.
Study mental health (nursing) yourfuture.acu.edu.au
CRICOS registered provider: 00004G
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Great deals for members at
The Good Guys As a valued Union Shopper member you can now get exclusive access to a new online shopping site with The Good Guys Commercial. You will be able to see ‘live’ discounted pricing on the entire The Good Guys range – that’s great deals on over 4,000 products! And you will be able to make your purchases online – saving you time and money.
To register for online access to The Good Guys Commercial website, visit www.unionshopper.com.au/the-good-guys/ or phone 1300 368 117
1300 368 117 unionshopper.com.au
Enjoy right now, knowing you’ll be right later.
When you’re with QSuper, you know you’re with a fund that’s been looking after Queenslanders for over 100 years.
Welcome to the QSuper feeling. Make a plan with us today. © 2017 QSuper Board 74
Advertise in
The official journal of the Queensland Nurses and Midwives’ Union
03
Spring 2017
The 88-minute difference in aged care
Healing through pet therapy
The new car feeling without the new car cost? Yes please!
PLUS! CPD CONTENT ON EMANCIPATED TEENS, WHS & MORE
Published quarterly and reaching more than
55,000
nurses and midwives throughout Queensland! ADVERTISING ENQUIRIES: Denielle Smith (07) 3840 1444 inscope@qnmu.org.au
Now is a great time to take advantage of end-of-year sales on a new car. Plus with a RemServ novated lease you could also benefit from tax savings. Call 1300 73 14 29 remserv.com.au/offers Things you need to know: This general information doesn’t take your personal circumstances into account. Please consider whether this information is right for you before making a decision and seek professional independent tax or financial advice. Conditions and fees apply, along with credit assessment criteria for lease and loan products. The availability of benefits is subject to your employer’s approval. RemServ may receive commissions in connection with its services. RemServ does not act as your agent or representative in respect of the purchase of any vehicle. RemServ does not provide any advice or recommendations in relation to the purchase of any vehicle. Remuneration Services (Qld) Pty Ltd | ABN 46 093 173 089.
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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!
Karyn
Daniel
Nelda
Maree Terri
Dianne
Danielle
In the past three years, we’ve assisted more than 53,500 members through our Member Connect call centre on professional and industrial issues such as medication management, workload concerns, wages, leave allowances, bullying and more.
(07) 3099 3210 or 1800 177 273
(toll-free outside Brisbane)
Each and every day we’re making a difference for nurses and midwives. Be part of the strongest and most experienced voice around.
BE PART JOIN OF IT! NOW www.qnmu.org.au 11/17
More home. 0.35 less loan. 1
As a QNMU member you could get a discount off the variable rate with a new ME Basic Home Loan. Arrange a time to speak to our ME Relationship Manager Kym Chisholm
Kym.Chisholm@mebank.com.au | 0417 296 796 mebank.com.au/benefitsqnmu Apply through a ME mobile banking manager before 28 February 2018 and settle your loan by 28 April 2018. This offer is not available for investor or interest-only loans.
Things you should know. (1) Home loan discount offer terms and conditions. A 0.35% p.a. discount off the applicable standard variable interest rate for Basic Home Loans where the primary loan purpose at application is owner occupied. The discount is available to you as a QNMU member on new home loan applications received between 1-Nov-17 and 28-Feb-18 and settle by 28-Apr-18. The discount applies for so long as you have a Basic Home Loan and you remain an owner occupier. It is not available for interest-only loans, investment loans, internal refinances, top-ups or variations of existing ME home loans. This offer is only available on loans originated via a ME mobile banking manager. It is not available on applications made through an independent mortgage broker. This information is about products and services available to you as a union member. Your union and ME are not agents or representatives of one another. Your union does not accept responsibility or liability for any loss or damage caused by the products or services provided by ME. Your union does not receive any commissions as a result of members using ME products and services.Terms, conditions, fees and charges apply. Applications are subject to credit approval. Members Equity Bank Limited (ME) ABN 56 070 887 679 holds an Australian Credit Licence 229500 and is the provider of the Basic Home Loan.
good investments don’t cost the earth HESTA Eco Pool. Australia’s first socially responsible investment option. Now ranked number one for performance by SuperRatings.* hesta.com.au * SuperRatings Sustainable Fund Credit Ratings Survey, year ended 30 June 2017, found HESTA Eco Pool was top performing balanced SRI option over 1, 5 and 10 year timeframe. Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia ABN 64 971 749 321 (HESTA). Product ratings are only one factor to be considered when making a decision. Past performance is not a reliable indicator of future performance. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy).