Issuu

2020

M ID

A R OF TH

WI F E

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SE AND

The official journal of the Queensland Nurses and Midwivesâ€™ Union

Summer 2020

n the learning journey

LEADING THE

INNOVATION CHARGE Debunking the activism myths

PLUS!

CPD CONTENT ON DRUG THERAPY PROTOCOLS, PREVENTING PRESSURE INJURIES, FUNDAMENTAL CARE AND MORE

ANGELA

My mum worked as an Assistant-in-Nursing, and she loved working in aged care looking after the elderly. She loved talking to them and listening to their stories. I remember having the privilege of doing work experience and working alongside my mum as she taught me how important it was to have fun at work and to treat the residents with respect as I was in their home. I enjoyed my time and have always loved helping and looking after people, but nursing was not what I wanted to do. I wanted to be a vet nurse and look after animals and I did this for a number of years before following in my mum’s footsteps. I will never forget the nurses who looked after my mum while she was in the palliative care ward. I watched them for weeks as they looked after her and I even saw them cry after my mum passed away while they were washing her body. This shocked me, as for the last few weeks the nurses seemed so strong and just got on with their work. To see them cry gave me comfort and at that point made me want to be a nurse. I have been a Registered Nurse for 12 years and have witnessed life and death, and now understand why the nurses looking after my mum shed some tears after her passing. From cradle to grave, nurses witness the full spectrum of life. This is a beautiful and staggering gift, one that shouldn’t be taken for granted. Angela Fischer, Anaesthetic Nurse at Logan Hospital and QNMU member

Something

SPECIAL is coming your way

Ask a nurse or midwife to tell you a story and they’ll have plenty to say… Keep an eye on your emails for your special Christmas gift from the QNMU.

Summer 2020

INDEPTH

On the learning journey

THE OFFICIAL JOURNAL OF THE QUEENSLAND NURSES AND MIDWIVES’ UNION ISSN 2207-6018 ABN 84 382 908 052

INDEPTH

Get well soon! Are you tickled pink by hospital flowers or are they just a thorn in your side?

Debunking the activism myths. What does it mean to be a nurse leader?

22 24 32

An election defined by public health and safety

Cool or cosy, passive design is an eco-friendly way to keep your home comfortable

Leading the way for burns care in Queensland. Spotlight on the Professor Stuart Pegg Adult Burns Centre, RBWH

From General Certificate to PhD. A path in clinical nursing less followed

The value of mentoring

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, Cameron Gledhill, Stephanie Lim, Lou Robson, Luke Rutledge PUBLISHED BY The Queensland Nurses and Midwives’ Union AUTHORISED BY B. Mohle, Secretary, Queensland Nurses and Midwives' Union, 106 Victoria St West End 4101. PRINTED BY Kingswood Print Signage, 80 Parramatta Rd Underwood 4119

Leading the innovation charge What did the Victorian aged care COVID-19 outbreak reveal, and what needs to change?

58 REGULARS

INSIGHT

TEA ROOM

WINS

JUST IN

Improving stress in the workplace: A clinician informed approach

NOTES FROM THE NORTH

INCOMING

A better way to problem solve

IN VIEW

Exploring fundamental care

CALENDAR

Educating patients about preventing pressure injuries

ADVERTISING

CPD

The consequences of noncompliance. A case study on why protocols matter

Permission to supply and administer: Drug Therapy Protocol – Communicable Diseases Program

48 50 52 55

DISCLAIMER: Statements expressed in articles in InScope are those of the contributor and do not necessarily reflect the policy of the Queensland Nurses and Midwives’ Union unless this is so stated. Copyright of articles remains with the contributor and may not be reproduced without permission. Statements of facts are believed to be true but no responsibility for inaccuracy can be accepted. Other material may be reproduced only by written arrangement with the Union. Although all accepted advertising material is expected to conform to the QNMU’s ethical standards, such acceptance does not imply endorsement. Visit www.qnmu.org.au/privacy to read our privacy statement.

Cover photo: QNMU member Gwen Blom

insight

Collegial generosity now more important than ever Sally-Anne Jones QNMU President

HIS YEAR has been extremely challenging for Queensland’s nurses and midwives.

COVID-19 and this extremely trying year have raised temperatures and caused some unrest.

There have been long hours and very real concerns for our wellbeing and the wellbeing of loved ones and the Queensland community.

There have been incidents of tension and in some cases, harassment, between colleagues and staff.

The global pandemic asked much of our frontline workforce and put pressure on a health system already experiencing chronic demand. COVID-19 turned the spotlight squarely on Queensland’s hospitals, health systems and aged care facilities... And we responded. Nurses and midwives stepped up and delivered in the midst of a oncein-a lifetime crisis. Whether working in Queensland or interstate, the pressure was intense. Add an election, and the need to secure job security for our valuable workforce and ongoing investment in ratios and other commitments, and the pressure increased. There was no opportunity to formally celebrate the International Year of the Nurse and the Midwife, though the community reached out with messages of support, acts of love like cooking and shopping for health care workers, and art from local students. These acts let us know our work and sacrifices were valued. There was also some backlash from a small number of the community towards those manning the frontline. This backlash, including some heated incidents experienced in fever clinics and elsewhere, were largely born of fear. While these incidents were few and far between, there’s no doubt

We are human, but no level of ongoing harassment or intimidation is acceptable – even during a pandemic.

2020 YEAR OF THE

NURSE MIDWIFE AND THE

200 years

of making a difference

We must put this behind us, replacing anger or frustration with tensions and focus on safe, collegial and productive conversations and workplaces.

Never before has there been a greater need for unity, comradery and the peaceful exchange of ideas in our ranks. a focus on the future and calm and clear communication. Never before has there been a greater need for unity, comradery and the peaceful exchange of ideas in our ranks. The pandemic and our world-class response have boosted the profile of nurses and midwives and increased our power. We should use this power to work together and secure common goals. In order to successfully achieve this, we must try and reduce any residual

It is my hope the festive season and New Year will be a chance for hard-working nurses and midwives to reflect and regroup, and work together in 2021 using our collective insight, knowledge and power to turn one hell of a year into positive future outcomes for our workplaces and the greater Queensland community. I am so proud of Queensland’s nurses and midwives and I wish them a very Merry Christmas and safe and happy New Year.

QNMU COUNCIL president :

Sally-Anne Jones

vice president : secretary :

Lucynda Maskell

Beth Mohle

assistant secretary :

Sandra Eales

councillors :

Julie Burgess Christine Cocks Karen Cooke Tammy Copley Dianne Corbett Jean Crabb Michael Hall Raquel How Shelley Howe Christopher Johnson Damien Lawson David Lewis Dallas Meyers Fiona Monk Sue Pitman Melanie Price Karen Shepherd Katy Taggart Janelle Taylor Kym Volp Deborah Watt Charmaine Wicking

insight

An opportunity for positive disruption Beth Mohle QNMU Secretary

S 2020 comes to a close, I can hear a collective sigh of relief and predict there will be an abundance of New Year’s Eve celebrations to bid this year farewell. It is hard to begin to even process all that has taken place this year. It started with horrendous bushfires and droughts and is ending with the world still gripped in a frightening pandemic. For me there are some recurring themes of 2020: wellbeing, safety, evidence, social solidarity, civility and fairness. The focus has been on keeping people safe first and foremost and then working on what unites us rather than divides us. In other words, the common good. We framed the Queensland election as a wellbeing election – the wellbeing of both our community and nurses and midwives deserved to be at the forefront of people’s minds. We lobbied all political parties to deliver policies for nurses and midwives on the issues that matter to them. A summary of the commitments given by the Palaszczuk government can be found at www.qnmu.org.au/commitments We are establishing processes centrally and on the ground to ensure these promises are delivered over the next four years. But elections are merely punctuation points, not destinations in their own right. Sustaining the three Ps is critical – perseverance, passion and a plan. Our plan is all about advancing the common good, but this requires sharing of power. Some will not be keen to do this!

There are great opportunities for positive disruption if we remain organised and focused on the collective good, rather than what is in it for me. These are challenging times and those who have different views or priorities will seek to thwart us. There is sure to be a particular focus on the dollar bottom line and the default position of too many to focus on short-term costs rather than longterm value. Our future will be a contested space and we need the skills and courage to be able to disagree well and stay focused on outcomes by proving our value and contribution. Conversely, there are great opportunities for positive disruption if we remain organised and focused on the collective good, rather than what is in it for me. Australians have demonstrated in the pandemic response that we are capable of doing this. Recent events in the USA have shown a very different, frightening picture, what with the heart-breaking failure of the pandemic response and the divisive Presidential election contest. We have been rightly focused on these things because what happens in the USA matters to the whole world. It is a deeply divided country confronting complex challenges. The shrill partisanship, gross inequality, the echo chamber of social (and mainstream) media, untested opinions being given the same status as evidence along with too much unchecked anger and easy access to guns.

What’s more, a strong individualist tradition and the decline in union density over the last 50 years to just 10% have all contributed to diminished social cohesion and a shift in power to the top few percent. True, here in Australia we have our challenges and differences, but we also have a stronger commitment to the collective. Problems like growing inequality and an increase in insecure work are better mitigated by our stronger social safety net and minimum wage. Our universal health system is also a potent symbol of this social solidarity. And these social staples were all fought for and won by our union movement. Our democracy is imperfect. But we should be thankful for the ways that it does deliver for our society. Perfect cannot be the enemy of the good. As 2020 – the International Year of the Nurse and the Midwife – comes to an end, let’s reflect on and be grateful for what we have. I am so grateful for our highly skilled, hard-working, compassionate and caring nurses and midwives who are committed to enhancing the health of our community. Thank you for the vital work you do every day that keeps us safe and our health system human.

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.

Should I make a telephone statement to AHPRA? In no uncertain terms should members provide any statements to AHPRA over the telephone. After a complaint has been received by AHPRA regarding a registered health practitioner, it is common for AHPRA to make telephone contact with that practitioner. The practitioner is often caught unaware and uninformed on how to proceed. The practitioner may even be asked at this point to make a verbal statement and/or provide a verbal response to the subject matter of the notification. Making early statements to AHPRA may appear to the practitioner to help their cause, but this is often far from the truth. QNMU members are advised that in no circumstances should they make any verbal submissions or statements to AHPRA in relation to a notification. Making a statement over the phone to AHPRA can be detrimental to the member’s ongoing notification process. It is important to note that AHPRA has the power to (and do) record telephone conversations. File notes and transcripts of telephone conversations made at an early juncture in the notification process can be produced and used in determining whether action against a practitioner’s registration is necessary. Members should understand that this is not the only opportunity to provide a response to the notification and share your side of the story. AHPRA will invite the practitioner to provide written submissions as part of the course of any investigation process.

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

In no uncertain terms should members provide any statements to AHPRA over the telephone.

Members should contact the QNMU urgently to secure appropriate legal advice prior to any direct dealings with AHPRA.

Should I get that in writing? At some stage over the course of everyone’s working life, they will almost inevitably be on the receiving end of information or advice from management that causes them to think, “Hmm, that doesn’t sound quite right”. Regardless of whether such information relates to your rights or your responsibilities as an employee, the best thing you can do in these circumstances is to ask whoever it is that is providing the information to put it in writing. Requesting the information in writing has three primary benefits. Firstly, people are appropriately wary about the contents of written correspondence. Someone who is prepared to offer advice verbally may well think twice about the accuracy of such advice when asked to put it in writing. Secondly, having the advice in writing provides ‘insurance’ for a worker. It helps avoid the dreaded situation where a worker has acted on incorrect advice but only has their recollection of a conversation to rely on in support of their actions. Having the advice in writing is one way to reduce the risk of a matter of importance becoming the subject of a ‘he said/she said’ debate. Finally, requesting the advice in writing provides an opportunity for both parties to ensure they are of the same understanding in respect to a particular matter. It may be the case that on receipt of the written advice, there is a need for further clarification on a particular point. Ensuring both parties are on the same page regarding what was said (or what was agreed) during the course of conversation benefits everyone.

wins

Going permanent at Robina ED IN A WIN for job security, nurses at Robina Hospital ED have secured more permanent positions that, until recently, had only been temporarily funded. Back in 2019, QNMU members submitted 400 workload forms to address the chronic understaffing and influx of patients to the ED. The matter ultimately escalated to a Stage 3 Workload Grievance. After many meetings between members, nursing leadership and the QNMU, it was eventually agreed that an additional 34.33 FTE nurses would be recruited – a huge win. However, many of these positions were not permanently funded and were subject to review in the coming budget cycles. These temporary positions included 8.32 FTE nurses for acute and short stay clinical pods, including a transfer nurse to support increasing transfers from Robina ED to GCUH. Unfortunately, it soon became apparent that those temporary positions had not received funding in the next budget.

But members insisted the ED still required these extra FTE if nurses were to keep up with patient demand and provide quality care. This pressure resulted in all temporary positions being permanently funded. In other words, all 34.33 FTE originally promised in 2019 are now here to stay! These new permanently funded positions include: ■ 8 FTE for winter bed funding ■ 8 FTE for maternity leave appointments ■ 8 FTE for results pending unit ■ 3 FTE for QAS patients ■ 1.5 FTE for triage ■ Additional CN Team Leader in SSU ■ An additional RN in SSU ■ An additional two RNs in acute pod ■ Transfer Nurse on all PM shifts. Congratulations to our hardworking nurses at Robina ED. This win would not be possible had our nurses not been prepared to stand together and work with management to get such a great outcome.

Containing the outbreak at Ipswich Hospital WHEN THERE was a COVID-19 outbreak in the West Moreton region in September, the QNMU worked closely with HHS management to contain the outbreak. We knew things had to move rapidly and decisions had to be made quickly to get ahead of the outbreak and thanks to the co-operation of all involved, the situation remained under control It wasn’t without its challenges, though. More than 200 staff were placed into quarantine, an enormous operation that required health workers from neighbouring districts to be brought into Ipswich Hospital. Members also expressed concerns with the level of PPE being distributed. The QNMU wrote to Queensland’s Chief Health Officer seeking to have PPE advice changed so that it aligned with Victoria’s advice – namely, that masks and fit testing be mandatory in areas with confirmed or suspected COVID-19. Soon after, staff in these areas were provided with N95 and P2 masks (complete with proper fit testing). There was also much confusion regarding management’s ‘modified quarantine’ arrangements, with little information given on what this looked like and how leave arrangements would apply. Following QNMU intervention, it was determined that staff would either be fully quarantined or not quarantined at all.

Nurses from Robina Hospital ED

Overall, it was a swift response and a terrific example of all parties working together – not to mention the professionalism of our nurses and midwives – to get on top of the outbreak.

wins

Senate rejects government’s proposed ban on mobile phones in detention For refugees locked up in Brisbane’s Kangaroo Point detention centre, mobile phones are a lifeline to the outside world including, for Saif (bottom), loved ones.

THE FEDERAL government’s attempt to ban refugees in detention centres from accessing mobile phones failed to pass the Senate in October. QNMU members of the ‘Nurses and Midwives for Refugees and Asylum Seekers’ (NaMRAS) group argued against the government’s Migration Amendment (Prohibiting Items in Immigration Detention Facilities) Bill 2020 by signing online petitions. While the government claimed the ban on “prohibited items” like mobile phones was to stop the spread of drugs and contraband items in detention centres, civil rights organisations argued any ban on phones could prevent detainees from speaking to lawyers and would further isolate people from family and friends. Ultimately, the vote came down to Senator Jacqui Lambie, who ran a community poll that received over 100,000 responses, 96% of which opposed the government’s Bill. Labor, the Greens and other crossbenchers also voted against the Bill. The QNMU’s asylum seekers and refugees policy affirms the union’s position that “those seeking asylum within Australia have the right to receive appropriate health care devoid of discrimination, regardless of citizenship, visa status, or ability to pay. Like all seeking health care, those seeking asylum in Australia should be treated with compassion, respect and dignity”. Members can read the full policy at https://bit.ly/3nY2deT

Team Leader recruited at Redcliffe 4/5 East IT MIGHT seem obvious to nurses and midwives why Team Leaders are an essential part of any team - they are there to provide shift coordination and direction, as well as assist with workload management. But up until recently, Team Leaders only existed at Redcliffe Hospital’s 4 and 5 East (internal medicine) wards during normal business hours from Monday to Friday. While the Clinical Nurse unofficially undertook the work of Team Leader (while also working on the floor with a patient load), it was not a sustainable

arrangement, and workloads were becoming unmanageable. For 12 months, QNMU members submitted more than 100 workload reporting forms. The QNMU took the matter to a Stage 3 grievance, and management ultimately agreed to recruit a 3.78 FTE Team Leader role, allowing a Team Leader to be appointed for every am and pm shift, seven days a week, including public holidays. Congratulations to QNMU members for sticking together and achieving this excellent outcome!

Nurses at Redcliffe 4/5 East celebrate recruiting a 3.78 FTE Team Leader.

just in

New/old role for Sandra QNMU Assistant Secretary Sandra Eales is stepping down from her union post. After five and a half years of helping grow and guide our union Sandra has decided not to renominate for the Assistant Secretary role in the next QNMU elections, but to return to her first love – midwifery. “As a vocational midwife I’ve missed the intrinsic reward inherent in the partnership relationship with women. The vital role of a midwife is about empowerment in a time of vulnerability - to facilitate and hold safe space for women to find their strength and wellbeing through the profound life event of pregnancy and transition to early parenthood,” Sandra said. “It was never actually my ambition to become a full-time union leader. The reason I took on the union leadership role was really because of Campbell Newman. We’d had almost three years of that LNP government

Sandra at a rally at Cooinda Aged Care in 2018

Sandra (far right) with Kym Volp, Genoveva Phillips, Lauren Picker, Celia Volp, QNMU Secretary Beth Mohle, Merewyn Janson, at Parliament House witnessing the historic moment for nurses and midwives when the ratios bill was introduced into parliament (December 2015)

attacking us, stripping jobs from the public health system, and attempting to annihilate unions.

QNMU Secretary Beth Mohle said Sandra’s strength and insight would be missed.

“Workloads were really unsafe and nurses and midwives were afraid to speak up for fear of losing their jobs.”

“Sandra has campaigned fiercely over many years to advance our professions, and to enhance health services for our community and improve the lives of all working people.

A QNMU member since 1980 with a strong history as a workplace activist and councillor, and a passion for positive practice environments and psychological safety, Sandra stepped into the Assistant Secretary role in early 2015. She continued her advocacy for women and babies by driving the development of the Safe Workloads in Midwifery (SWiM) Standards and has represented workers on the Queensland Work Health and Safety Board since 2017.

"Her passion for midwifery, nursing and social justice and her long history of community campaigning and workplace activism are such strong defining characteristics of Sandra." Beth said.

Sandra speaking at a press conference ou tside Blue Care's head off ice in 2020

just in

What COVIDrelated leave should I apply for?

Exploring equity of access to abortion IN SEPTEMBER 2020, the QNMU invited midwives, sexual health nurses and school-based nurses to share their views on the elective termination of pregnancy in a research project with James Cook University. Currently there is very little published information available that reflect the views of our professional group on this issue, so thank you to all of those who participated. The results of this study may have the potential to influence provision of and access to reproductive health services for women across Australia. In the meantime, a non-profit organisation called Children by Choice are running the Regional Rural and Remote Abortion Access Project to address the current abortion access inequity in Queensland.

IT’S IMPORTANT for Queensland Health (QH) members to know the difference between sick leave, paid special pandemic leave and discretionary special leave, and which one may apply at any given time. QH recently wrote to the QNMU to clarify the following: ■ If you are unwell with an actual (or suspected) viral infection requiring a COVID-19 test, you should use your sick leave first, and then paid special pandemic leave if you do not have any sick leave left. ■ If you are not sick with a viral infection but you are required to selfisolate on health advice (eg: if you have been in contact with a suspected case), you should apply for paid discretionary special leave. Read more at www.qnmu.org.au/covidleave Private sector members should also be familiar with their leave options. This will largely depend on your employer, but members are encouraged to read our Leave Entitlements FAQs at www.qnmu.org.au/Coronavirusfaqs for more information. Our FAQs also contain information for casual employees, as well as a QH leave flowchart.

Since August 2018, the project has provided financial support to more than a hundred people from regional, rural and remote Queensland to access abortion care (including cost of procedure, transport and accommodation costs). They have also delivered training and information sessions to more than 500 regional, rural and remote health and community workers. If you live in regional, rural or remote Queensland and you or your client need financial support to access abortion care, you can contact rachaels@childrenbychoice. org.au for more information about this project. The survey results and study from James Cook University are expected in February 2021.

just in

Messages of support for our southern friends

THE QNMU sent heartfelt messages to our ANMF colleagues in Victoria and South Australia in November as COVID-19 continued to make itself felt around our country. As Victorians began to emerge from six weeks of strict lockdown, news broke of a COVID cluster in Adelaide, prompting South Australian authorities to follow Victoria’s lead and impose its own lockdown protocols. QNMU Secretary Beth Mohle sent a message of support to the ANMF SA acknowledging the difficulties they face and the impact the additional work during lockdown has on nurses, midwives and other health workers. “You are in the midst of this right now and it can appear overwhelming. But you are up to the task,” she assured them. “(You) have done and are doing such a magnificent job in keeping your community safe. “We are so very proud of your efforts and are ready to assist you in any way we can.” Beth also sent a message to the people of Victoria thanking them for their lockdown efforts calling it a “sacrifice for the common good”. “We acknowledge your unbelievable tenacity, courage and hard work and are in awe of the outcomes you have achieved this year,” she said. “Just saying thank you is not enough acknowledgment for your unbelievable efforts, but we want to say it for the record! We are safer in Queensland because of what you have done. We will not forget this.” Australia has fared significantly better than many countries around the world, but for those who have been affected by loss of loved ones, sickness and the emotional and financial toll of necessary lockdowns and border closures it’s still been a very tough year.

In November, QNMU First Nation Reference Group members met face-to-face during NAIDOC Week for the very first time this year and since COVID-19. Over two days the group undertook important work to set the agenda for 2021, to advance Torres Strait Islander and Aboriginal nursing and midwifery outcomes.

just in

Record environmental rating for QNMU

What commitments did we secure this election? DURING the Queensland election, the QNMU sought a raft of commitments from all major political parties around the issues that matter to you staffing, job security and ratios. We’ve collated a list of some of the major health commitments made by the Palaszczuk Labor government during the election, many of which we were able to secure through our lobbying. View the full list at www.qnmu.org.au/ commitments

Multicultural Connect Line A NEW Queensland-wide service is providing vital support and information to people from multicultural backgrounds whose lives have been affected by the COVID-19 pandemic. Helpline staff manning the Multicultural Connect Line are multilingual and work with interpreters to ensure support is available for our multicultural community, including people seeking asylum, international students and migrant workers. The service is funded by Queensland Health through the COVID-19 immediate support measures. The Multicultural Connect Line is 1300 079 020 and is open Monday to Friday 9am to 4.30pm.

ACT government commits to ratios OUR COLLEAGUES in the Australian Capital Territory are pushing ahead to get mandated minimum nurse/midwife-topatient ratios in their public hospitals. During the recent ACT election campaign, numerous Labor and Greens candidates committed their support for minimum ratios. With the re-election of a Labor minority government (with the support of the Greens), the ANMF ACT branch will now work to ensure this becomes a reality. If successful, the ACT will join Queensland and Victoria as the only jurisdictions in Australia to have mandated nurse-topatient ratios in their public hospitals. ACT Branch Secretary Matthew Daniel acknowledged the QNMU for their ongoing support with their ratios campaign, saying, “This support has been instrumental in the ratios work that has been undertaken by the Branch.”

THE QNMU’S head office building in West End, Brisbane has achieved the highest possible rating of six out of six stars for water saving under the National Australian Built Environment Rating System (NABERS)! We also again achieved a stellar five stars for energy efficiency. We’re always working to reduce our environmental footprint, so we’re thrilled at this excellent result. It’s green thumbs up for the QNMU!

just in

Christmas closure arrangements THE QNMU offices in Brisbane, Toowoomba, Bundaberg, Rockhampton, Townsville, Cairns, Sunshine Coast and Gold Coast will close from 3.30pm on Thursday 24 December 2020 and will reopen at the regular starting time of 8.30am on Monday 4 January 2021. During this time members who require 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. Officials will be on call to deal with emergencies such as dismissals, and they will contact you. We wish all our members a safe and enjoyable festive season!

Queensland Health Queensland Health has released compulsory closure and leave arrangements for the 2020/21 Christmas New Year period. These arrangements do not apply to continuous shift workers.

Queensland Health Christmas closure arrangments Fri 25 Dec 2020 Christmas Day public holiday

Mon 28 Dec 2020 Boxing Day public holiday

Tue 29 Dec 2020 Concessional Day (leave on full pay without debit)

Wed 30 Dec 2020 Annual/recreational leave, TOIL or accrued hours or COVID response leave

Thu 31 Dec 2020 Annual/recreational leave, TOIL or accrued hours or COVID response leave

Fri 1 Jan 2021 New Year’s Day public holiday

Leading advocacy for Nurse Practitioners CONGRATULATIONS to QNMU member Jason Harrison on his new role as National Secretary of the Australian College of Nurse Practitioners (ACNP). Jason is currently employed as a Drug and Alcohol Nurse Practitioner at Central Queensland’s Mental Health, Alcohol and Other Drug Service. Jason said he hoped to continue in his predecessors’ footsteps in being a strong advocate and leader for Nurse Practitioners. “I want to continue developing our next generation of Nurse Practitioner leaders and advocate for the Nurse Practitioner role within the Australian health sector through opportunities to participate in national health priorities, submissions and committees to improve access to health care for all Aussies,” he said. Congrats Jason!

Part-time employees are only entitled to the concessional leave day when Tuesday 29 December 2020 would be one of their rostered ordinary days of work. QH members can read more about Christmas/ New Year public holiday arrangements at bit.ly/QHholidayguide

GREETINGS from the

QNMU 11

qnmu

C MMUNITY FOR QNMU MEMBERS

YOUR ISSUES YOUR SOLUTIONS YOUR COMMUNITY OF PROFESSIONAL PRACTICE QNMU Community is a safe online space that facilitates member-to-member connections. Share information Ask a question Find out what issues nurses and midwives are grappling with around the state Get connected.

mycommunity.qnmu.org.au

just in

QNMU election dates set THE AUSTRALIAN Electoral Commission (AEC) has confirmed the QNMU Branch elections will be held across the first quarter of next year, with nominations due to open on 29 January 2021 and postal balloting to begin from 26 March. The AEC, the independent body that oversees the ANMF and QNMU polls, opted to delay the 2020 elections due to the COVID-19 disruptions, but confirmed the new dates in late November. The AEC will publish the formal Election Notice on 15 January 2021.

What are these elections for? The QNMU is a democratic organisation which gives every member a say in who leads their union. The QNMU Council is the governing body of the union and is made up of members elected by you. Every four years, members participate in independent elections

for the offices of President, VicePresident, Secretary, Assistant Secretary and Councillors. By long standing practice made possible by an exemption under section 802 of the Industrial Relations Act 2016 (Qld), the QNMU elections are officially held as the QNMU (Queensland) branch of the ANMF (our Federal Union). The office bearer results are then replicated at the state level to ensure consistent decision making between the two bodies, and to save us from having to hold two elections. Nomination forms are accessible on the AEC portal (from 29 January 2021) at https://bit.ly/2J1gpok If you have any questions please contact the QNMU via email at governance@qnmu.org.au

Nominations close at 11am (AEST) Friday, 12 February 2021.

QSuper insurance premiums to rise in January QNMU MEMBERS are being urged to check their superannuation fund’s insurance premiums after QSuper announced it was increasing the price of its insurance cover next year. As of 1 January 2021, most QSuper members will pay about 31% more for income protection cover, and between 40-45% more for death and total and permanent disability (TPD) cover. QSuper says the price increases were necessary because claims had increased significantly over the past year and were “materially higher than expected”. They said in the 2019-2020 financial year the fund paid out more than 7,500 claims worth about $350 million. The fund has also made changes and clarifications around its default insurance coverage and members are urged to download the ‘product and legislation update November 2020’ from the QSuper website for more information. https://bit.ly/3nOkwmA Meanwhile, we strongly recommend all members check and monitor their superannuation insurance premiums as it is likely other funds have or will soon follow QSuper’s lead.

indepth

Get well SOON ! SOON! Are you tickled pink by hospital flowers or are they just a thorn in your side?

merican Botanist Luther Burbank once claimed: “Flowers always make people better, happier, and more helpful; they are sunshine, food and medicine to the mind”. It’s a lovely sentiment, but it’s fair to say Burbank never had to deal with a patient sneezing their sutures open thanks to a bunch of day lilies.

But then Burbank was a botanist, not a nurse. 14

The science of flowers The presence of floral arrangements by a patient’s hospital bedside is nothing new. In fact, go to any reasonable-sized public hospital and you’ll find at least one florist-cum-giftshop within striking distance of the main entrance – some even securing real estate in the foyer itself. And there they are… bunches of pink carnations for baby girls, bright cheerful gerberas for broken bones and white disbud chrysanthemums and pretty peonies for grandma’s

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dicky hip. A dazzling array of colour and perfume designed to bring a little joy to someone feeling poorly. Flowers can cheer you up by triggering the ‘happy’ chemicals in your brain: dopamine, serotonin and oxytocin. The dopamine hit can apparently be traced back to our hunter-gatherer ancestry – where the scent of flower blossoms in Spring suggested the end of a lean winter and the coming of abundance. Fragrant bouquets today tap into that ancient memory and arouse feelings of reward and good fortune.

Serotonin, which stabilises our mood and promotes feelings of wellbeing and inclusion, arises from our pleasure of being part of a social ritual. And the warm rush we feel when a loved one gives us flowers is the release of oxytocin, the ‘bonding’ hormone associated with love, empathy and trust. There is also research to support the therapeutic benefit of plants and flowers in a clinical setting – including shorter hospital stays, the reduced use of painkillers, and lower levels of pain and anxiety. 1,2

But some nurses say there is also a downside to flowers by a patient’s bedside. While floral arrangements are already banned from sensitive areas like ICU and burns units where patients are vulnerable or immunocompromised, these nurses argue flowers also pose a risk to patients in a general ward and it’s time to revisit hospital policies.

Put down that posy In his 2009 editorial in the British Medical Journal, medical

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...the issue of flowers triggering patients’ allergies is a risk, and there is scientific evidence to back it. anthropologist Simon Cohn offered a list of reasons why flowers are increasingly unwelcome in hospital wards throughout the UK.3 It included the risk of broken glass or water being spilled onto floors or electrical equipment, the depletion of oxygen in the room when blooms decompose, and even the workload associated with maintaining and disposing of floral arrangements. But it is the clinical concerns around infection risk and allergic responses that are the strongest justification for banning cut flowers in general wards, with some nurses even prepared to act autonomously to protect their patients in the absence of official workplace policy.

Pesky pathogens On the surface it seems logical - bringing flowers from a garden filled with dirt into a highly sanitised environment full of sick people seems counterintuitive. Even more so when we consider the prospect of organic matter rotting away in stagnant water by the bedside. But in reality, research over the past 50 years reveals a startling lack of evidence to support the idea that flowers pose an infection risk in a general ward. A number of studies conducted in the 1970s show vase water can certainly become heavily contaminated with gram negative bacteria, and that crosscontamination is possible, but they failed to prove the water was the source of hospital acquired infection (HAI).4 For example, one 1975 study demonstrated that pathogens found in flower water from nine wards at a Liverpool hospital were

not the same strains as the bacteria causing HAI. Indeed, the hospital’s overall incidence of postoperative wound infections for the study’s six-month duration was below the national average.5 Research since shows a similar dearth of evidence. A 1986 research project, which took bacterial samples from 29 plants in high-traffic areas on six surgical wards, found no relationship between the plant samples and 235 samples taken from patients.6 A 1991 study of water in 60 flower vases in various settings, including hospitals, showed the water contained about 40 types of antibiotic-resistant bacteria, including 12 species of pseudomonas. Yet none were linked to cases of HAI.7 In 2004, Gould et al conducted a literature review into five decades worth of research into the infection risk of hospital flowers and confirmed only that flower water can indeed be a reservoir for “pathogenic bacteria”

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problems with their potent smells.

Some researchers suggest the lack of correlation may be due to the difficulty of undertaking randomised controlled trials.

In a closed environment with little ventilation – like a hospital ward - they can cause headaches and nausea for people who are sensitive to fragrance.

However, most conclude that the risk to a general patient population is so low as to be negligible and conclude that adhering to solid infection control protocols, including good hand hygiene, is enough to keep patients safe from theoretical risks without the need to ban blooms.

Pollen and perfume But before you reach for the roses, there is a compelling argument against floral arrangements, and it relates to pollen and perfume and their impact on patients with allergies, respiratory ailments or sensitivity to heavy scents. According to the Center for Disease Control and Prevention, allergies are on the rise and pollen allergy is one of the most common, with about 20% of the American and Australian population affected. So the issue of flowers triggering patients’ allergies is a risk, and there is scientific evidence to back it. A 1998 survey of 387 patients in a tertiary level hospital that allowed flowers at the bedside showed 13% of patients developed new-onset rhinitis linked to the blooms.9 It is consistent with a study conducted in Auckland this year in which 38% of patients said the flowers in the ward made their breathing or hay fever symptoms worse.10 The problem is the ease with which airborne pollen can be transferred from bedside to patient, or from one patient to the next through cross contamination. When pollen enters a patient’s respiratory system it can trigger an allergic reaction in which the body’s immune system releases chemicals that fight the allergen, but may also cause inflammation leading to symptoms like sneezing, phlegm and coughing. This can cause complications and delay recovery for patients who are already unwell or in pain. And if the pollen isn’t enough to trigger respiratory distress, then there is the perfume. Highly scented flowers that may not aggravate allergies can still create

So what’s the solution? Critics of floral bans say flowers have fallen victim to “new definitions of care” and to increasingly bureaucratised health systems that develop policy out of an overabundance of caution. They say the therapeutic benefits and cultural and social value of flowers outweigh what they believe are largely manageable risks. But are the risks really worth taking?

We’d like to hear your thoughts. Where do you stand on flowers in a general ward?

References

How do you balance the therapeutic good and the potential pitfalls?

2. Park, S. H., & Mattson, R. H. (2008). Effects of flowering and foliage plants in hospital rooms on patients recovering from abdominal surgery. HortTechnology, 18(4), 563-8.

Email us at InScope@qnmu.org.au and let us know.

1. Park, S. H., & Mattson, R. H. (2009). Therapeutic influences of plants in hospital rooms on surgical recovery. HortScience, 44(1), 102-5.

3. Cohn, S. (2009). Where have all the hospital flowers gone? BMJ,339, b5406. 4. Taplin, D., & Mertz, P. (1973). Flower vases in hospitals as reservoirs of pathogens. The Lancet, 302(7841), 1279-1281. 5. Barzokas, C. A., Holley, M. P., & Sharp, C. A. (1975) Bacteria in flower vase water: incidence and significance in general ward practice. Journal of Surgery, 62, 295-7. 6. Siegman-Igra, Y., Shalem, A., Berger, S. A., Livio, S., & Michaeli, D. (1986) Should potted plants be removed from hospital wards? Journal of Hospital Infection 7, 82-5. 7. Kates, S. G., McGinley, K. J., Larson, E. L., & Leyden, J. J. (1991). Indigenous multiresistant bacteria from flowers in hospital and nonhospital environments. American Journal of Infection Control, 19(3), 156-161. 8. Gould, D., Chudleigh, J., Gammon, J., & Ben Salem, R. (2005). The evidence base and infection risks from flowers in the clinical setting. British Journal of Infection Control, 6(3), 18-20. 9. Manian, F. A., (2001) New onset rhinitis symptoms among hospitalised patients: are flowers a culprit? Infection Control & Hospital Epidemiology, 22, 111113. 10. Hussein, S. (2020). To have or not to have flowers? The New Zealand Medical Student Journal, 31, 20-22.

Sherree

Suzanne

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Debunking the activism myths 18

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T CAN BE A daunting thing to hear the word ‘leader’ or ‘activist’ used in the context of our work as nurses and midwives. “Activism isn’t for me,” you might say. “I just want to get on with my job of caring for my patients. “Besides, isn’t ‘activism’ what the union is for?”

Allan

Well, yes and no. True, the QNMU does exist to defend and champion your rights and interests wherever we can. Yes, the QNMU does sit at the bargaining table and negotiate with your employer for a better agreement. And yes, the union does shine a light on the issues that affect our professions, whether that be in the media or through legal representations. But that’s not the whole picture. So much of our members’ wins are just that: members’ wins – by which we mean members themselves achieved the outcome, with the support and guidance of the QNMU. Because, at the end of the day, members are our union. For example, it was nurses themselves at Cairns ED who closed beds and enforced a low-priority list to make management understand they needed more staff. Likewise, it was nurses who, over many months, submitted workload forms at Redcliffe Orthopaedics to demonstrate there was a consistent problem.

What does it mean to be a nurse leader?

Time and time again, wins happen because members took action. And more often than not, these actions were led by nurses and midwives who were prepared to lead, educate and empower their colleagues to make the change they wanted to see. There are thousands of QNMU members who do this every day – many without even recognising it as a form of leadership. So what, then, does ‘activism’ actually look like, and is it as daunting as you think? We spoke to three QNMU members to find out.

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HERREE’S path to being an activist in her workplace was born from a deep sense of frustration with management.

“It was a very toxic workplace culture, things had broken down between management and the team, and I was ready to walk,” Sherree said. “So I joined the QNMU and became a Workplace Representative and did various union training courses, which taught me a lot about my EB and entitlements. “The training gave me a proactive approach to dealing with management and skills that I took back to the workplace.” At the same time, there was a change in management, which allowed Sherree to work more constructively to get better outcomes for her team. “The new manager asked me what I wanted to see more of in the workplace and I said more support for the staff. “He came back with the idea of starting a Care Support Team, which we’ve worked together to get up and running.” When it was originally established, the Care Support Team conducted orientations for new staff, creating consistency for training and ensuring new staff were properly upskilled and supported.

“The ability to use my own voice” SHERREE CLARK

AIN, OPAL AGED CARE

Now, these teams have been adapted into ‘working parties’, providing all staff members an active voice on the issues that affect them. It’s a win that highlights what can be achieved when we manage to turn our anger into action. “The union acknowledged my frustration and turned it into something proactive – the ability to use my own voice. “The more you know about your rights, the easier it is to say ‘no’. “For example, at one facility I worked at, the manager often put a particular drug that could only be administered by a RN on the trolley. But I always handed it back and said, ‘Nope, that’s not my scope of practice, I’m not trained or qualified to do that’. “I never once got into trouble for doing that.”

“Activism is the small, everyday things” SUZANNE BROWN

RN, GYMPIE HOSPITAL

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LLAN became active in his workplace when an individual matter, in which he sought representation from the QNMU, taught him the importance of staff having an even playing field with management. Years later, Allan worked with the QNMU to obtain a win that benefited the rest of his colleagues: reversing new rostering arrangements that only provided an eight-hour break after night shifts. “Yes, the union is there to step in and help you fix things, but they’re primarily there to work with you to help you stand up for your rights,” Allan said. “Ultimately, the person it affects is you and your colleagues, so at some stage you’ve got to say to yourself, I’ve had enough, I’m going to do something about it myself. “You lead that.” Allan said one of the best ways to be ‘active’ in the workplace was to maintain an open dialogue with management wherever possible. “The biggest thing you can get from your employer is good communication, where they don’t feel like they need to be combative with you,” Allan said.

A REGISTERED NURSE in the public sector, Suzanne said she has always been active in her workplace, but never had a big issue to get involved in. “It was just little things here and there to assist with my colleagues,” Suzanne said. “Things like turning up to branch meetings, getting information to colleagues about their entitlements – I’ve always kept myself reasonably knowledgeable about our industrial rights.” Suzanne said it was this knowledge, as well as new information acquired through a QNMU training course, that helped her formally raise

“In other words, they feel like you’re genuinely engaging, you’re willing to sit down with them, negotiate and discuss and come to a happy compromise. “That’s what I did with the eight-hour break issue – it was a conversation with management in which I asked them if they thought it was safe for the ward, for the staff, for the patients.” Allan said it’s also useful to re-think our perceptions of what winning actually looks like. “Winning in the workplace doesn’t necessarily have to mean getting more FTE or recouping an entitlement. “It’s not about ‘one-upping’ management, it’s about bringing things to a more even playing field and achieving a general sense of empowerment.” And advice for nurses and midwives who can see there’s a problem but don’t know how to fix it? “Talk to your colleagues about it, get some feedback from them to see if what you’re feeling is actually a broader feeling. “If it is, bring it to the attention of your QNMU Organiser, and be prepared to get involved.”

“It’s not about ‘one-upping’ management” ALLAN WHITE

EN, ROCKHAMPTON BASE HOSPITAL

the workload issues she and her colleagues had been experiencing for months. “It came down to knowledge – understanding the process you can follow to bring about change. “Without that knowledge, you’re on the back foot because you don’t have the confidence to know that what you’re doing is the right way or whether you can be challenged by management. “We use the term ‘empowerment’ a lot, but it truly was empowering for us staff to speak up and see that management were listening.” When asked what the term ‘activism’ meant to her, Suzanne said

it was about the “small, everyday things”. “It’s not always about leading the charge on these big workload grievances, it’s all about the little things you can do day-to-day to support your colleagues. “Activism is about ensuring we contribute to the change by having our say, rather than being scared of that change but not doing anything about it.” “It might be something as simple as asking a question in a staff meeting that everyone’s thinking, or distributing union information around the hospital.”

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An election defined by public health and safety DR LIZ TODHUNTER, QNMU SENIOR RESEARCH AND POLICY OFFICER

N SATURDAY 31 OCTOBER, Queensland voters returned the Labor government to office. This was an important outcome for Queenslanders on many levels. It validated the government’s response to the COVID-19 pandemic and its consistent emphasis on closing the borders to keep Queenslanders safe. This was no easy decision and one on which the Premier, Annastacia Palaszczuk, was prepared to risk losing the election. Such high stakes and such profound consequences. The pandemic threw several unexpected challenges into the political mix and the outcome of the Queensland election in many ways reflected the Palaszczuk government’s response to these trials. Among other concerns, the pandemic brought into focus traditional values around health care, employment, family and community. It confronted the government and the Queensland people with serious questions around priorities for social and economic stability. In seeking answers, we had to reflect on what is more important… Do lives prevail over livelihoods? Do individual rights prevail over collective rights? Is job ‘flexibility’ a euphemism for job ‘insecurity’? Is high unemployment just the new norm?

indepth The progress of the pandemic exposed the many conflicts between individual rights and collective rights. An individual’s human right to protest versed not only the right to population health but also the right for nurses and midwives to have a safe workplace. There were many ‘rights’ and many interests to balance. In the end, governments must act in the public interest and put the health of their citizens first. In doing so, the safety and wellbeing of the health workforce is paramount. These questions have made all of us reflect on our own beliefs and most certainly have called on health unions in particular to bridge the gap between the welfare of the community and the health and safety of their members. Unions representing frontline workers rose to this challenge as did their members, politicians and all Australians. How strange, then, that when the contest for political power arose during the election, our sense of unity and purpose dissipated into a war of words over border closure and economic recovery. When it came to the state election we had to decide whether to retain the government that had virtually kept COVID-19 out of Queensland but in the process weakened the economy or to elect a new government that claimed to have all the answers for an economic recovery yet prevaricated on its border closure stance.

The Premier put health care first and did not waiver despite the many protests in the media and from business. Yes, many individuals, businesses and the economy have suffered. But Queenslanders have also been able to enjoy freedoms that our interstate counterparts have not. We are almost free from COVID-19, but economically we are living in a state of inertia. Nurses and midwives were among the essential workers who kept this state safe and the government’s action on border closure reflected its commitment to ensuring the health and safety of these workers at a time of great personal risk. Other countries have taken a different path. But how can it be right for anyone to say we must keep the economy going at all costs even if that means we endanger our citizens, our health workers and burden our health system? Where is the morality and indeed pragmatism in that? It was this focus on health care first that reflects the common good. We should all be thankful for it because we all benefitted from it. Unions play an important role in influencing health policy development by governments on both sides. This is not always obvious nor is it recognised.

It is quiet diplomacy where union officials make measured, evidencebased submissions to parliamentary inquiries and hold many discussions with health advisers. It is a long game and at times unsuccessful. More often than not though, this type of collaborative, low-key approach will bring about results. The Labor government has committed to employing 5800 more nurses and midwives and we must hold it to account in delivering on this promise. This is a four-year parliamentary term, which should allow for greater planning and implementation of electoral promises. It should enable more thorough health policy development with greater emphasis on staff welfare, infrastructure and forward-thinking initiatives. Hopefully, we will not see a pandemic for another hundred years, but we must be ready if there is one in another two years. We must expect governments to have learnt from this disruptive era and ensure there are protections in place for all workers and citizens. The economic recovery could be prolonged, but perhaps it may not. At least here in Queensland the good health of its citizens will mean it is well placed to face the challenges that lie ahead.

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LEADING THE

INNOVATION CHARGE Clinical Midwife Consultant Gwen Blom

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CHILD DEVELOPMENT CNC

HEN IT comes to research and innovation, nurses and midwives can face structural roadblocks prohibiting them from unlocking their full potential. Some of these roadblocks may include workloads, lack of protected time for research, lack of funding and opportunities outside the academic sphere, or a tendency for senior nursing and midwifery roles to focus on management instead of research. If we want a more innovative and efficient health system (and who doesn’t?) then the system itself needs to acknowledge that nurses and midwives are the key to achieving this.

Thanks to EB10 negotiations between the QNMU and Queensland Health, the Innovation Fund was established specifically to develop health initiatives in areas of need that made the most of nursing and midwifery excellence.

“It will allow a more time-efficient appointment if paediatric input is required and earlier access to care for all families.”

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INNOVATE IF EVER THERE WAS

AN UNDERTAKiNG THAT SHOWCASED THE VALUE OF NURSiNG AND MiDWiFER Y iNNOVATiON, THEN THE EB10 INNOVATiON FUND PROGRAM iS iT.

attendance, a 50% reduction in pre-term births and improved birth weights.

The Child Development CNC project improved the timeliness of and access to care for rural and vulnerable patients. There have also been significant achievements around improved cultural safety, development of education packages, streamlined discharge, patient empowermen t, cost reductions, improved staff satisfaction, and more. “These nursing and midwifery led models produced tangible results that not only improved clinical outcomes

THE 19 EB10 INNOVATION FUND PROJECTS ■ Waijungbah - Innovation: Integration of Birthing on country and first 1000 days Australia models of care ■ Gold Coast Mental Health and Specialist Service (GCMHSS) and Gold Coast Local Ambulance Service Network (GCLASN) Co Responder Model of Service ■ Maximising scope of practice – Mental Health Nurse Practitioners addressing community clinical complexity and unmet customer need ■ Nurse Practitioner Innovation Project ■ Community Maternity Hubs Model ■ Shared Care for Opioid Treatment (SCOT) Project ■ Child Development CNC ■ Trauma Informed Care ■ Enhanced General Practice STI Testing Initiative ■ Pregnancy on Palm

In September 2019, following a rigorous application and selection process, 19 projects kicked off across the state – each funded for a maximum of one year (see sidebar for the full list). These projects are now drawing to an end, giving us an opportunity to assess the success of each one. “Every one of these projects produced outstanding results,” QNMU Secretary Beth Mohle said. “In many cases these projects not only reached anticipated benchmarks but exceeded them.” For example, the Community Maternity Hubs Model resulted in improvements in antenatal

and patient experiences, but positively addressed the social determinants of health,” Beth said. “Every project validates what we have been saying for years – that nurses and midwives are innovators and drivers of change if given the scope to do so.” The QNMU together with Queensland Health has produced a series of documents summarising the outcomes of each of the 19 EB10 Innovation Fund projects for broad distribution. They highlight the value of nursing and midwifery innovation and support our claim for the continuation of these kind of health initiatives into the future.

Anticipated long-term benefits also included minimising impact of developmental issues, increased health literacy and parenting capabilities, reductions in wait times and failure to attend, and increased patient and staff satisfaction.

“If the position becomes permanent, it would hopefully move to a model where the CNC assesses the patient or family first and, based on this assessment, commence early intervention, referrals and individualised support.

Our last edition of InScope included a summary report of these 19 projects, which can be viewed at www.qnmu.org.au/ EB10innovation

The transition framework from paediatric to adult health care project saw reduced ED presentations and improved health literacy for patients and families.

The new role is called the Child Development CNC, and Nicole Stephenson has led the project since its inception.

“The CNC works throughout our district, including in Toowoomba, which is the main hub, but also in Dalby, Warwick and Kingaroy.

And that’s exactly what the $10 million Innovation Fund was all about.

PERMISSION TO

large number of eligible clients across the four centres.

“It was brought about to see if nurses could start to address the behaviour and parenting concerns of these families that generally sit on our wait list for periods of up to 12 months, despite not all of them needing to be medically managed,” Nicole said.

Which is not how it should be.

N 2018, under clause 44.6 of the Nurses and Midwives (Queensland Health and Department of Education) Certified Agreement (EB10), a $10 million Innovation Fund was established to fund projects that “improve, scale up/scale across, enhance, develop or implement models of care” that are innovative, flexible and which address emergent or unmet health care needs where nurses and midwives significantly contribute to and lead care outcomes. This rather wordy and lofty goal in simple terms meant there was money available through EB10, earmarked by Queensland Health with the support of the QNMU, to develop health initiatives in areas of need that make the most of nursing and midwifery excellence.

A NEW ROLE was introduced in the Darling Downs district to address the large cohort of triage category three patients on the paediatric or child development service waiting list with behavioural concerns.

(PoP) ■ Transition framework from paediatric to adult health care ■ Healing Wounds Building Lives - a collaborative wound care capacity building project ■ Routine Preventative Screening ■ Enhanced Aboriginal and Torres Strait Islander Infant and Maternal Care ■ ReViving Rural Dementia Care ■ Improving Access for Displaced Patients ■ Wearable Device at Home ■ Midwifery Community Access Program ■ Nurse Navigator Refugee

Health

Visit www.qnmu.org.au/ EB10innovation to read about each of the projects.

Early findings from the trial saw more timely care (including early access to specialised services for rural clients and improved access for vulnerable clients on a medical waitlist) and high engagement from a

At the time of the project’s reporting, there were 324 referrals across the district, with 146 of those seen by the CNC.

Nicole said the project had changed how she saw innovation in nursing. “Now that I see the early results of this role, I just think, how come we didn’t do this earlier? “If it’s about improving patients’ access to care then it’s only going to be a good thing. “Nurses are at the forefront to be able to deliver innovative ideas, but we often don’t work to our full scope. “These EB10 projects are showing just what we can do as nurses and midwives, and it helps increase our value and highlights what amazing things we can do to make positive change in health care.” Excitingly, the project has been given the green light to extend until June 2021. Going forward, Natalie Rummell (pictured with Nicole) will continue in the role of Child Development CNC and drive the project.

Now that I see the early results of this role, I just think, how come we didn’t do this

But now we take a deeper dive into three of the projects and see exactly how they delivered direct benefits to patients and the broader communities.

earlier? Nicole Stephenson, Clinical Nurse and QNMU member

Nicole Stephenson (L) and Natalie Rummell (R) have led the Child Development CNC project since its inception.

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ROUTINE PREVENTATIVE CANCER SCREENING – PRISON HEALTH SERVICES AT THE CORE of the Mandela Law – and aligning with Queensland’s Human Rights Act 2019 – is a principle that states incarcerated men and women must receive the same level of care as people living in the community. The Routine Preventative Cancer Screening project was underpinned by this same principle. Proposed by Nurse Practitioner and QNMU member Sarah Hesse, the program was about ensuring incarcerated men and women received access to preventative screenings for bowel and breast cancer. “While working in the correctional environment, I realised cancer screening was very ad hoc and only occurred if the clinicians remembered to ask the patient, or if a family member received a patient’s national bowel screen kit and sent it in,” Sarah said. “So not everybody was receiving that same opportunity, and that’s where the idea came from.” The project established a formal breast and bowel cancer screening program for incarcerated men and women in West Moreton Health’s Prison Health Service, with dedicated CNCs Deborah Bonney and Kim Williamson assisting with implementation, follow-up checks, and delivering education to both health staff and patients. “At its inception, there were approximately 3900 men and women, of which there were about 400 who met the criteria for cancer screening,” Sarah said.

Nurse Practitioner Sarah Hesse (centre) originally proposed the Routine Preventative Cancer Screening project.

“Those men and women who accepted were given bowel cancer screening kits, and for those women who accepted the breast cancer screening, we negotiated to have the local breast screening service mobile van come onsite.” Nurses and midwives know early detection is everything when it comes to health – and the early results from the program prove why it’s so important to invest in preventative measures. “Statistically, for bowel cancer screening, we had a higher participation rate and a higher positivity rate than the national average,” Sarah said. The participation rate was 52% compared to the community’s 42%. The positivity rate was 11% compared to the community’s 7%. Most importantly, through the program both breast and colorectal cancer was detected. “The cost of a bowel cancer screening kit is about $52 to screen someone, but the cost of treating colorectal cancer is more like $70,000,” Sarah said. “But it’s not just the upfront costs either – it’s also the holistic approach to care. For example, cancer often comes with depression and mental health issues, which need to be treated.” While funding for the program has not been renewed, the work of the CNCs to ensure routine preventative screen will continue.

The cost of a bowel cancer screening kit is about $52 to screen someone, but the cost of treating colorectal cancer is more like $70,000. Sarah Hesse, Nurse Practitioner and QNMU member

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ENHANCED ABORIGINAL AND TORRES STRAIT ISLANDER INFANT AND MATERNAL CARE PROVIDING culturally safe care to some of Australia’s most vulnerable women and helping them build trusting relationships with the health system was the driving idea behind the Enhanced Aboriginal and Torres Strait Islander Infant and Maternal Care project at West Moreton Health. Project Lead and Indigenous Clinical Midwife Consultant (ICMC) Gwen Blom said the vision for the project was to prevent adverse outcomes for mothers and babies that were disengaging from Obstetric Clinics and clinically at higher risk of morbidity and mortality. The role would address the community’s unmet needs and potentially increase the number of babies born healthier. “We wanted an additional service for Aboriginal and Torres Strait Islander pregnant women who were not accessing the Midwifery Group Practice for various reasons,” Gwen said. “That may have been due to the criteria or they were being referred to obstetrics because they were high-risk, then disengaging from that.” The project was consistent with what the Indigenous Hospital Liaison team at West Moreton had determined through consultation with the local community – that women wanted a midwife who identified so they felt culturally safe. “There aren’t many Aboriginal and Torres Strait Islander midwives out there, so that’s where the cultural vulnerability comes in,” Gwen said. While part of Gwen’s role was to reach out to women who were disengaging, the other aspect of the project involved collaboration with Ipswich Hospital’s existing cultural services, such as Mums and Bubs, Yarning Circle and Welcome Baby to Community.

“My role as the ICMC was to bridge those professional and community relationships, which helped with referrals and communication with other midwives, health workers and Kambu midwives who were also supporting some of these women,” Gwen said. The results of the project have been promising. “We achieved consistent antenatal visits – and not just with me, but with obstetrics. We also received positive feedback from the community and the women who were coming through what we called our ‘cultural pathway’. “The women’s narrative feedback was they felt like they had more trust and support, which helped them feel they could come back.” While it is too early to know some of the long-term benefits of the service, other anticipated benefits from the project include a decrease in the rate of women who smoke, increased vaccination rates, and reductions in the number of infant mortalities, low birth weight babies, and women who discharge against medical advice.

This kind of opportunity is great for every midwife or nurse who may not think they have the ability to become innovators. GwenBlom, Indigenous Clinical Midwife Consultant and QNMU member

We can all be innovators While Gwen will not continue in the ICMC role, she said the innovation fund had enabled her to make a difference in a way she’d always dreamed. “This kind of opportunity is great for every midwife or nurse who may not think they have the ability to become innovators. “If you’ve got passion there is no doubt you can put something together that may actually better your community. “When I studied at university, I used to dream of being able to provide the cultural safety and the clinical understanding to help our most vulnerable women.” “It just brings me to tears to think I’ve had the opportunity to do that.”

Clinical Midwife Consultant Gwen Blom was the lead on the Enhanced Aboriginal and Torres Strait Islander Infant and Maternal Care project.

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n the learning journey 28

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Plodding off to school may not be every kid’s idea of fun. But for those in hospital or affected by hospitalisation, it’s a welcome distraction and an important part of their journey to recovery.

LASSROOMS aren’t something you’d normally expect to find in a hospital. Quietly tucked away on level eight of the Queensland Children’s Hospital (QCH), a multi-purpose school delivers world-class educational programs for children who are inpatients, outpatients or family members of those hospitalised. It’s a little different to your regular school. Not only does it cater for kids at vastly different stages of learning, many of its students tackle longterm health challenges and require specialised learning to support their journey to recovery.

Inspire, believe, achieve QCH School teacher Amanda Esposito has worked as a hospital school teacher for more than 15 years, and leans on the school’s motto of ‘inspire, believe, achieve’ to make a difference for her students. “A lot of our students have experienced trauma. Many of them have missed a lot of school due to either medical or mental health reasons,” she said. “Because of this they can sometimes disconnect themselves from others and it can be tricky to reconnect them with not just school and friends, but life in general. “Each day I remind them of our motto ‘inspire, believe, achieve’ – not only do they inspire others and be inspired in return, but they need to believe in themselves to achieve success.”

Students commonly attend QCH School for a term or two, however this depends on their individual treatment needs – children undergoing rehabilitation may attend the school for an entire year while oncology patients attend on and off throughout the year. A key goal is to enable the children to eventually return to their regular school and continue their learning journey, rather than feel anxious about what they’ve missed. “We aim to provide learning that aligns with the Australian curriculum, with a focus on English, HASS (Humanities and Social Sciences) and STEM (Science, Technology, Engineering and Mathematics). It will often reflect what the students have or would have been learning in their usual school,” Amanda explained. “We ensure students experience a variety of learning opportunities with access to robotics, e-learning, excursions, high engaging art programs, as well as physical education including swimming for our classroom students.”

The journey to recovery In the sub-acute rehabilitation ward at the QCH, many of the children are long-stay patients with an acquired disability. Nurse Unit Manager Denise Mitchell said one of the main responsibilities of the ward’s nursing and allied health team is to support the children in adapting to their changed condition and in reintegrating into their family and community.

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For a lot of these children being able to still participate in school and maintain friendships can be the difference between them being able to cope with their changed circumstances or not. Denise Mitchell, Nurse Unit Manager (sub-acute rehabilitation ward)

“Most children undertaking a rehabilitation program have suffered a catastrophic illness or injury that has resulted in some form of residual cognitive deficit or physical impairment. This means they now have a new normal that they must learn to navigate and live with,” Denise said. “An integral part of this journey is for these kids to continue schooling – we want to try and normalise their routine and provide an opportunity to practice what their home life will be like in the context of their changed condition, as well as eventually reintegrate them back into their regular school where possible.” The school additionally supports kids to work towards goals that extend beyond education. For some children, the learning focus must shift from educational outcomes to life skills. This can range from working on socialisation skills and rebuilding confidence and self-esteem, to developing fine motor skills and re-learning to write. “We’re talking about children who have suffered spinal cord injuries and are now paralysed, children with severe brain injuries resulting in loss of muscle control or inability to understand speech, or those who may have lost a limb or limbs,” Denise said. “These are really significant impairments that may or may not be visible, but will definitely impact on their ability to self-care, learn and engage in a social environment.

“It’s absolutely vital that we set them up for success and QCH School provides them with a safe environment and opportunity to practice all the skills they’re now going to need in life. “For a lot of these children being able to still participate in school and maintain friendships can be the difference between them being able to cope with their changed circumstances or not.”

A multidisciplinary collaboration Collaboration is key to achieving the best outcomes for the children. A multidisciplinary team of liaison teachers, health professionals (including nurses), guidance officers and psychologists work closely together to develop personal learning plans tailored to each child’s unique health circumstances. Amanda said individual learning goals are collaboratively identified by the student, teachers and health professionals to take into consideration medical procedures, treatments, physical and intellectual capabilities, and the emotional wellbeing of the student. “There are numerous variables to consider – certain medications can affect memory, treatments or procedures can cause pain and fatigue, and brain injuries or contact precautions can limit the resources available for use,” she said.

“Our experienced liaison teachers attend multidisciplinary medical meetings each week and act as the bridge between medical and educational staff. “During these meetings feedback and information about the children is exchanged and the liaison teachers communicate this back to the teaching team. This often gives us a heads up on new diagnoses or treatments, and possible complications which could impede learning.” Additionally, QCH School teachers play a pivotal role in identifying potential challenges the children may face in transitioning back to a regular school. Denise said the teachers bring a different perspective to that of clinicians. “They provide insight into how the kids are functioning, their behaviour at school, what their interpersonal skills are like. “This gives us a more accurate picture of how the child might fare when they return to their usual school and what modifications or adaptations may be required. “Our school teachers are an essential part of the team and we couldn’t do our work without them. We really adore them and we’re grateful to have the opportunity to work alongside them.”

Forging a bond While the role comes with its own unique set of challenges, Amanda said it’s those very challenges that make her job as a QCH school teacher that much more rewarding. “It can be a real challenge to re-engage some of the students but we’ve got a very passionate, dedicated team of teachers who will go out of their way to brainstorm solutions,” she said. “We really have to problem solve and get creative and resourceful to engage our more vulnerable students.” Inevitably, the teachers often forge close bonds with students and their families, particularly so with those who attend the school long-term.

indepth Amanda said it’s a privilege to share precious time with the families and she cherishes the pieces of artwork and gifts students have presented her with over the years.

It can be a real challenge to re-engage some

“You really feel for the families and the struggles they’ve been through. They all touch your heart in some way,” she said. “I once received a pen as a gift from a mum and printed on it were the words ‘the ink may fade but never our thanks’. It is so special to me and every time I pull out that pen it’s a reminder of why I do this job. “As time goes on the children become adults and to me that’s what’s amazing to see – it’s such an honour to have been a part of their lives and I think a lot of teachers would feel the same way.”

of the students but we’ve got a very passionate, dedicated team of teachers who will go out of their way to brainstorm solutions. Amanda Esposito, QCH School teacher

Queensland Children's Hospital School The Queensland Children’s Hospital (QCH) School has provided vital learning support and educational continuity for school-aged children since its origins as The Sick Children’s Provisional School in the early 1900s. Today, students from Years 5 to 12 are taught in the classrooms on level eight, and students from Prep to Year 4 are taught in the Junior Campus on Stanley Street (located right beside the hospital). A bedside service is also available to children unable to leave their ward. The school also hosts campuses located at Mater Health Services (South Brisbane), Royal Brisbane and Women’s Hospital (Herston), Jacaranda Place (Chermside) and Act for kids Pre-Prep (Wooloowin).

QCH School senior campus classroom

QCH School Junior Campus Prep 1 classroom. Robyn Rowe (Teacher Aide) and Bridget Hudson ( P-1 Classroom Teacher)

The scope of Queensland hospital education extends from the Brisbane campuses to programs throughout the state, including students in general paediatric wards and adolescent mental health units. Find out more at https://qchschool.eq.edu.au

QCH School junior campus classroom

QCH School junior cam pus playground

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What did the Victorian aged care COVID-19 outbreak reveal, and what needs to change?

COVID-19

USTRALIAN and overseas experience during the COVID-19 pandemic has clearly shown that older community members, particularly those living in residential facilities, are highly vulnerable to significant morbidity and mortality should a COVID-19 outbreak occur. While enormous work was undertaken by federal and state governments to prepare the acute sector to care for those requiring hospitalisation, all the evidence sadly points to a widespread lack of preparation by the aged care sector and a failure of regulatory oversight and national government consideration during this critical time. On 30 September, 2020 the Royal Commission into Aged Care Quality and Safety (the Commission) released a report relating to aged care and COVID-19. The Commission held hearings for this report from 10-13 August. At this time, the significant COVID-19 outbreak in Victoria had spread to a number of aged care facilities in that state. Unfortunately, the Commission acknowledges in its report that

they did not have the resources to conduct a comprehensive inquiry on the impact of COVID-19 on aged care at this time. However, the report addresses a number of issue areas that have been highlighted as a result of the aged care COVID-19 outbreaks in Sydney earlier in the year and the widespread outbreaks in Victoria’s aged care facilities. These issues include: ■ the impact of balancing protecting older Australians and the impact on their mental, emotional and physical health resulting from visiting restrictions placed on family and friends ■ the need to facilitate increased provision of allied health services, including mental health services, during the pandemic ■ the need for a national aged care advisory body to address aged care sector pandemic planning, coordination between state, territory and the Australian governments, and processes around hospital transfers and use of hospital in-the-home services

■ the need for infection control resources and expertise to be available in aged care facilities and the critical issues of personal protective equipment (PPE) availability and training.

Commission report recommendations From their investigation, the Commission made numerous recommendations in this report, including: The Australian Government 1 should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in RACFs by their families and friends. The Australian Government 2 should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic. Any barriers, whether real or perceived, to allied health professionals being able to enter RACFs

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should be removed unless justified on genuine public health grounds. The Australian Government 3 should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector. This plan should: ■ establish a national aged care advisory body ■ establish protocols between the Australian Government and the states and territories based on the NSW Protocol but having regard to jurisdictional differences ■ maximise the ability for people living in aged care homes to have visitors and to maintain their links with family, friends and the community ■ establish a mechanism for consultation with the aged care sector about use of hospital in-the-home programs in residential aged care ■ establish protocols on who will decide about transfers

to hospital of COVID-19 positive residents, having regard to the protocol proposed by Aged and Community Services Australia ■ ensure that significant outbreaks in facilities are investigated by an independent expert to identify lessons that can be learnt. All residential aged care 4 homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body. The Australian Government 5 should arrange with the states and territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.

Clearly, much work remains to be done – and the question needs to be asked: why were some (if not all) of these recommendations, such as a national COVID-19 aged care plan, not already in place? Certainly, there needs to be a full inquiry into the Victorian aged care COVID-19 outbreak and it is hoped the final report and recommendations expected from the Commission will address the many aged care systemic vulnerabilities identified as a result of the pandemic. If there is any criticism of this report it could be that the Commission opted not to conduct a more comprehensive investigation. Moreover, while the report did recommend more staff, it was underpinned by the rationale of allowing greater access to residential facilities rather than addressing the chronic understaffing in the sector more generally. How the infection control resources will be implemented remains unclear at this time, but the QNMU and our national body the ANMF will continue to push for sector-wide reforms.

COVID-19

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HETHER you are looking to take up the federal government’s homebuilder grant for a new build or big reno job, or just thinking of closing in a veranda or making a granny flat downstairs, adopting ‘passive design’ elements can shave hundreds off the heating and cooling costs of your new space. Put simply, passive design takes advantage of your environment and climate to help keep the temperature in your space comfortable, reducing the need for artificial cooling and heating like air-conditioners and heaters.

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The elements of passive design Most passive design experts suggest there are seven key elements to passive design – that’s seven elements homeowners should consider if they are keen to maximise the environment and climate to support natural temperature control.

Orientation

Where you position your building on your site in relation to natural breezeways, the path of the sun, and insolation (not to be confused with insulation), which is the amount of solar radiation reaching your site or the level of solar energy your building receives. The insolation factor is important because good orientation means rooftop solar panels will get maximum exposure.

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2 Spatial zoning Laying out your building or space to maximise comfort during use. You should consider the orientation and location not only of living spaces and bedrooms but also the position and construction of windows and internal doors, hallways, ceiling height, staircases and so on, to make use of light, morning and afternoon sun, shade, crossbreezes etc.

Thermal mass The ability of your building materials to absorb, store and release heat energy as required. Materials with high thermal mass like concrete and brick store heat longer than the materials like timber and bamboo, which have low thermal mass. Smart use of thermal mass helps regulate indoor temperatures by reducing heat losses when itâ€™s cold and preventing heat inputs when itâ€™s warm, which evens out temperature extremes.

Ventilation

Making use of wind, breezes and ventilation systems to deliver fresh air into buildings. Fresh air is very important for occupant health and wellbeing. It eliminates odours, delivers oxygen and improves thermal comfort. Good ventilation also relies on well-designed internal spaces, which allows air to enter and circulate freely, as well as the size and placement of openings (windows, doors, vents) in the building.

Insulation

A barrier to heat flow in and out of your building keeping it warm in winter and cool in summer. The type of insulation you use will be determined by the climate zone you live in. Insulation can also be used as a moisture barrier. In addition to roofs and ceilings, insulation can also be applied to veranda roofs (particularly those over outdoor living spaces) bulkheads, external walls, concrete slabs and the underside of suspended floors.

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Shading

Includes verandas, tree shade, window awnings, shutters and tinted glass, but it must be designed properly so you don’t block the sun you need to warm the house in winter. This may require calculating sun angles, choosing seasonal plantings and using retractable shutters or awnings.

Why is passive design worth considering? It’s good for the planet Reducing the need for artificial temperature control means using less electricity, which means less greenhouse gas emissions from coal fire power plants and a reduced need for non-renewables.

It’s good for your health Maintaining thermal comfort levels using sunlight and good airflow through the intelligent use of ventilation systems also helps ensure pollutants and odours are removed from the house. Indoor air pollution and dampness has been linked to respiratory conditions, allergies, and heart diseases, while higher levels of carbon dioxide can increase feelings of fatigue.

Glazing and glass

This can include windows and skylights, and how much light, air and heat they let in or out of a space. Choosing the right glazing system, positioning, location and relation to building orientation and climate is critical. Get it wrong and you could lose as much as 40% of your muchneeded heating during winter and contribute up to 80% of a house’s heat in summer.

Each of these elements work together to deliver comfortable temperatures and good indoor air quality all year round. However, Australia is a vast country and how these elements are incorporated into design will differ significantly between snowy Tasmania and tropical Townsville. So, step one of passive design is to ensure you are designing for your own climate. The easiest way to do this is to check out the Australian government’s guide to environmentally sustainable homes at www.yourhome.gov. au/passive-design/designclimate This website is dedicated to helping you create a comfortable home that has a low impact on the environment. Another thing to note about passive design is that it works best in conjunction with ‘active’ occupant behaviour - that is, the householders themselves need to engage in maximising the benefits of the design (ie: they open windows or close shutters as required). It’s not a setand-forget house design.

It’s good for the hip pocket Heating and cooling accounts for about 40% of energy use in the average Australian home. That means you can make serious savings on your electricity bill if you can cut back on how much you use appliances like fans, heaters and aircons. Passive design features may also mean better prices when you sell your property, as homebuyers are becoming increasingly savvy about the benefits of eco-friendly features. A number of overseas studies show these ‘greener’ homes sell for about 4–10% more than standard homes.

Want more info? www.liveability.com.au www.modscape.com. au/blog/creatingsustainable-homepassive-design/ www.renew.org.au www.yourhome.gov.au/ passive-design/designclimate

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Leading the way for burns care in Queensland Spotlight on the Professor Stuart Pegg Adult Burns Centre, RBWH

HE PROFESSOR Stuart Pegg Adult Burns Centre, located at the Royal Brisbane and Women’s Hospital (RBWH), is the state-wide burns service for Queensland, in addition to servicing northern NSW to Lismore and the Pacific Rim.

“Regardless of the type of burns, the criteria for being admitted to the burns unit remains the same and is dependent on total body surface area (TBSA) of the burn, its depth, the location of injury and if any airway involvement.”

The Centre leads the way in treating a comprehensive range of burns injuries and has been involved in the care of patients from several disasters, including the Bali Bombing, Ashmore Reef boat explosion, Ravenshoe Café explosion and most recently, the Moranbah mine explosion.

When a patient presents to the burns unit, nurses, alongside the wider clinical team, play a critical role in providing successful treatment.

The 18-bed unit contains stateof-the-art equipment and facilities, including 10 single rooms and two four bed bays, along with three burns baths. It also accommodates a custom designed physiotherapy gym and occupational therapy splint/garment room to aid in patient treatment and rehabilitation. RBWH Burns Clinical Nurse and QNMU member Allison Hill said the scope of injuries seen by the RBWH burns unit is vast, including flame, scald, contact, electrical, chemical and cold. “Flame is the most common injury we see here, while our geographical location in the Sunshine State means frostbite is the least common,” Allison said.

After the initial first aid treatment and assessment, the nurses are responsible for monitoring for signs of infection, wound healing and skin graft success, then making the decision on the appropriate dressing for optimal healing.

Evolving treatments Over the years, the dressings and treatments of burns has evolved and improved with the introduction of different surgical methods and dressing products. “As pain can be a major component for many patients with a burn injury, dressing choice can help to reduce this stressor,” Allison said. “With early surgical debridement and intervention, the RBWH Burns Centre has had great success with large TBSA cases, proven by low mortality rates.

“Some of our cases require more involved treatment such as the use of skin substitutes, allograft (donated cadaver skin) and cultured skin cells in conjunction with autograft. “Nurses at the RBWH Burns Centre are highly skilled at using these dressings to optimise the healing of the wound, some of which can take up to two hours to change. “Complex wounds such as necrotising fasciitis are also cared for in the burns unit, as the nursing staff are experts in caring for larger wounds and the medical staff surgically treat these wounds with the same methods as some burn wounds.”

Psychological wounds The RBWH Burns team understands that burns injuries expand far beyond the physical wounds and takes a multi-disciplinary approach to ensure the optimal physical, psychological and social recovery of the patient. “During these stressful events in a person’s life, not only are they dealing with the physical injury but also the psychological trauma, for example body image and scarring, ability to return to work and financial concerns,” Allison said. “These issues can arise at any time during admission, and we as

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nurses are aware and vigilant in monitoring the patient’s behaviour and demeanour to involve the appropriate support services when needed. “This support extends throughout their admission and into discharge until full physical and emotional function is sustained. “Our multidisciplinary team consists of medical and nursing staff, physiotherapists, occupational therapists, dieticians, speech pathologists, psychologists and social workers.”

Telehealth service Due to the unit’s large catchment area, it has recently started offering a telehealth email referral service. This allows medical practitioners in regional and rural areas to email photos of presenting burn injuries, which can then be discussed with RBWH Burns Centre medical staff regarding treatment options and dressing choices. “I also work as the RBWH Nursing Care Co-ordinator where I am available for regional patients to contact to ensure that they are coping with the care of their burn wound,” Allison said. “Every burn injury, regardless of size and depth, can be traumatic

for the patient and answering questions about cleansing, dressing and movement of the burn can help alleviate their concerns.” Like many health-related fields, working with burns patients is incredibly rewarding but at times, can also be confronting for staff. Allison said the RBWH Burns Centre team promotes a supportive and inclusive environment that prioritises regular staff debriefs, supportive leadership and staff psychology services to assist the team with coping skills and strategies. “It can often be a turbulent journey that we embark on with our patients, but it is with great satisfaction that we watch our patients walk out when they’re discharged home, knowing that we have been an integral part of their recovery.”

REFLECTION Reading and reflecting on this article may count towards your Continuing Professional Development. Be sure to record the hours on your Record of CPD at www.qnmu.org.au/CPD

Every burn injury, regardless of size and depth, can be traumatic for the patient and answering questions about cleansing, dressing and movement of the burn can help alleviate their concerns. Allison Hill, RBWH Burns Clinical Nurse and QNMU member

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From General Certificate to PhD A PATH IN CLINICAL NURSING LESS FOLLOWED BY PAULINE ROSE RN PHD, CLINICAL NURSE CONSULTANT AND QNMU MEMBER

AM A HOSPITAL-TRAINED RN. In 1985 I obtained a position at the then Queensland Radium Institute (QRI) – thus beginning my passion for radiation oncology nursing. In the 1980s radiation oncology nursing was very much ad hoc, based on a series of tasks within a medical model. Nurses supported the medical care of the patient and attended to patients’ needs as required: organising transport, doing dressings, and other activities to maintain the smooth running of the department. In 1993, after completing my Bachelor of Nursing degree at USQ, I met nursing scholar Professor Patsy Yates through the Queensland Cancer Council Oncology Nursing Group and was introduced to academic nurses throughout Australia. It was 1994 and Patsy was about to introduce the first Master of Nursing (Oncology) at QUT.

indepth I had no choice, I had to enrol. I felt excited to be undertaking a Masters degree! It was so new and I wasn’t sure if I could do it. But I loved the challenge, despite the endless photocopying of journal articles from an actual library – there were no readily-available computers in those days!

Introducing professional radiation oncology nursing As radiation oncology nurses, we were not permitted to provide verbal or written information to patients, or be autonomous in decision-making for patient care, so our nursing role remained limited. But undertaking the Masters degree provided me with a level of credibility among medical and other radiation oncology colleagues. I had read about various models of care internationally, so became an ‘onco-tourist’ – travelling overseas to attend oncology conferences and meeting many esteemed oncology nurses whose work I had read and cited. In 1995 the nurses introduced the Primary Nursing/Collaborative Practice (PN/CP) model into our department. This required many change management strategies to convert entrenched attitudes, as well as upskilling nurses to be primary nurses. I invited myself to meet various colleagues who were publishing books and articles on radiation oncology nursing. No one ever knocked me back! My dear friend and mentor, then and now, Professor Deborah Bruner from Emory University gave me confidence that we were providing high-level radiation oncology nursing care for our patients. The people I admired most in my field overseas all had doctorates. It was inevitable that I eventually decided to give it a go. In 2000 Professor Patsy Yates agreed to supervise my PhD thesis. It seemed like a natural progression to base my dissertation on the Primary Nursing / Collaborative Practice model of care (MOC) within a person-centred approach.

in national and international committees, and support other nurses undertaking higher degrees. I also clinically co-ordinate a specific group of patients.

The people I admired most in my field overseas all had doctorates. It was inevitable that I eventually decided to give it a go. The implementation of the MOC and the research surrounding it at another institution was very much a longitudinal design due to the nature of implementing a change process. But finally, after data collection was completed and after what seemed like an eternity of ‘writes and rewrites’ of chapters, I was given the green light to submit my dissertation. Following a seminar presentation at QUT, where there were questions from the audience, the examiners invited me to join them for feedback and discussion. Following this process there was more work to be done on the dissertation to improve certain aspects. This is standard procedure for any student undertaking doctoral degrees. It is part of the learning process and encourages critical thinking which is, after all, the end game.

From then to now… Completing my PhD has underpinned my confidence as a researcher and educator, including my role leading multidisciplinary research in Cancer Services. I confidently review journal articles in a variety of professional journals, publish my work in peerreviewed journals, participate

There is an increasing number of allied health and radiation therapy professionals with doctorates. Nurses need to be able to work in partnership with our multidisciplinary colleagues in the clinical area and have a voice for nursing issues and patient safety. However, nurses with doctorates in Australia remain somewhat invisible, and it was difficult to source numbers in Australia, as reported by Wilkes & Mohan1. Yet, in the USA, 7944 doctorally-prepared nurses graduated in 2019 alone2. Currently, there is no remuneration for a doctorally-prepared RN in the clinical area beyond the Masters degree. But in coming years it is likely more Australian nurse clinicians with doctorates will make a difference in their speciality field of practice. RNs who complete the basic Master of Nursing course may well progress to a doctorate once they establish a speciality area, almost as a matter of professional evolution. It may be time for unions and hospital executives to consider remunerating this level of nurse in line with the Nurse Practitioner to encourage participation.

REFLECTION Reading and reflecting on this article may count towards your Continuing Professional Development. Be sure to record the hours on your Record of CPD at www.qnmu.org.au/CPD

References 1. Wilkes LM & Mohan S. (2008). Nurses in the clinical area: Relevance of a PhD. Collegian. 15:135-141. 2. https://campaignforaction.org/resource/ number-people-receiving-nursing-doctoraldegrees-annually/

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The value of mentoring I

strategies to survive workplace adversity.

Recognising the importance of this connection, the QNMU will be launching a Mentoring Program in 2021 to uplift our members’ professional relationships and are currently seeking nurses and midwives who are keen to mentor and/or be a mentee.

Unsurprisingly, peer mentoring was recognised as resilience-enhancing.2

F YOU reflect back on your career, it’s likely the people you value most are those with whom you share mutual, easy going encouragement.

The QNMU Mentoring Program will promote opportunities for members to receive and offer support, validation and encouragement vital for the development of professional expertise.

Why participate in mentoring? Connecting with like-minded souls enriches our lives. Supportive mentors also help us manage anxiety in demanding healthcare settings. To maintain hope and achieve expertise throughout our careers, it is imperative we have purpose and are understood within supportive mentoring networks. Research indicates that having a safe place (for example, among peers) to disclose accounts of adversity helps to gain insight and develop resilience.1 Clearly it is the sharing of our stories within safe mentoring relationships that can empower us. On this there is agreement between the literature and the lived experiences of care providers coping with anxiety in the workplace. A 2015 article published in the Journal of Nursing Management titled ‘Surviving workplace adversity: a qualitative study of nurses and midwives and their strategies to increase personal resilience’ identified

Three major influences were noted: support networks, personal characteristics and an ability to organise work for personal resilience.

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C MMUNITY If you value collegial generosity and are willing to share with like-minded colleagues within our new Mentoring Program, please send your expression of interest to community@ qnmu.org.au

In her recent article, Florence Nightingale’s values, vision and voice still relevant today and for the future University of Calgary nursing academic Dr Lorelli Nowell states: Mentorship truly crosses all borders – disciplinary, hierarchical – and provides opportunities for positive, mutually beneficial, and fruitful conversations that support growth and development. Discussing the value of mentoring relationships for clinical practice, Davey, Jackson and Henshall3 refer to increased opportunities through the expansion of professional networks and “increased confidence and competence at problemsolving, and higher levels of resilience, wellbeing, and self-confidence”.

Why participate in QNMU mentoring? QNMU is establishing a Mentoring Program based on the understanding that mentoring relationships strengthen individuals personally and professionally. Step one will be to complete an online workshop which will be offered throughout 2021. On completion of the Mentoring Program Workshop nurses and midwives will be able to indicate their specific interests and availability to connect and share with like-minded mentors and mentees via the QNMU Online Community.

References 1.

East L, Jackson K, O’Brien L, Peters K (2010) Storytelling: an approach that can help to develop resilience. Nurse Researcher 17, 3, 17-25

2. McDonald G, Jackson K, Vickers M, Wilkes L (2015) Surviving workplace adversity: a qualitative study of nurses and midwives and their strategies to increase personal resilience. Journal of Nursing Management DOI: 10.1111/jonm.12293, 1-9. 3. Davey Z, Jackson D, Henshall C, (2020) The value of nurse mentoring relationships: Lessons learnt from a work-based resilience enhancement programme for nurses working in the forensic setting, International Journal of Mental Health Nursing (2020) 29, 5, 992–1001

Battling La Niña in the North

Ntohtees

from

North

Lucynda Maskell QNMU Vice President

HE BUREAU OF METEOROLOGY recently announced Australia was entering a La Niña period, one that brings more rain, generally very welcome in on our dry continent, but also increases the frequency of flooding and cyclones in North Queensland. As I write, wet season preparations are in full swing. On publication it is likely we will be enjoying a monsoonal wet season and hopefully not testing out that preparation in any real fashion. But it happens, and who can forget the recent devastating and widereaching flooding in Townsville? Local disaster management committees meet to discuss such advice as given by the Bureau. These committees involve councils, health providers, police and the Department of Aboriginal and Torres Strait Islander Partnership (DATSIP), as well as other important local service providers.

Preparations in remote communities can mean having amounts of safe drinking water and staples if an event renders water no longer potable.

this is a challenge year-round for our counterparts nursing on islands.

Generators are secured with fuel, torches, tarpaulins, and satellite phones are checked and re-checked.

In response to wetter conditions, health conditions such as melioidosis need to be considered and we certainly saw this condition develop post flooding in Townsville.

It can mean updating the vulnerable person list – for example, those on dialysis who may need evacuation in the event of weather catastrophe, or elderly living alone.

Mosquito-borne conditions also plague the north with wetter conditions, although excitingly dengue has been possibly eradicated with the introduction of wolbachia bacteria.

This is an advantage for rural nursing and for communities where we know each other.

Media has suggested that since COVID-19 and a reduction of primary health services, Australia could see a cancer spike.

A metropolitan disaster would be so much more complex in those terms, but of course a response can be generally raised quicker in the town than in the bush. Wet stores orders for pharmaceutical and clinical supplies need to be attended and capacity to store reviewed. Mainland community road access can be (and usually is) severed. Of course,

Health clinicians face the uncertainties confronting our communities, because we are part of it and often play a huge role in the wellbeing of our communities.

While that is likely media speculation, reduction in engagement can lead to poorer health outcomes. Weather can also affect this, with difficulties accessing local services and even community members electing to delay flights to a tertiary health centre for fear of flying during storms. Health clinicians face the uncertainties confronting our communities, because we are part of it and often play a huge role in the wellbeing of our communities. This is what nurses and midwives did throughout this year – our Year of the Nurse and the Midwife. QNMU President Sally-Anne Jones so articulated this when she declared we may not have been able to celebrate our year through planned social events, but we celebrated it through our practice. On a final note, please do not forget to practice self-care – it is okay not to be okay and it is most definitely okay to ask for help. Take care and may La Niña be kind to us.

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The consequences of non-compliance A CASE STUDY ON WHY PROTOCOLS MATTER R

EGARDLESS of the context of care, evidence-based protocols are present in every area of practice and they are there for a reason, that being safe and quality patient care. They also establish a professional standard from a nursing and midwifery perspective. If standards or protocols are not being complied with, or excessive workloads are creating a practice environment that has the potential to compromise patient care, it must be reported. The Nursing and Midwifery Board of Australia (NMBA) Codes of Conduct place a mandatory obligation upon all nurses and midwives to document and report such concerns. For QNMU members, this includes workload reporting forms and raising such issues with management, then following up to see if appropriate action is being taken. Nursing and midwifery managers must also accept that if they do not take, or attempt to take, remedial action in response to such reports, they too could potentially be in breach of NMBA Standards. Remember, QNMU Workload Reporting forms are available for all public, private and aged care areas of practice, and can be accessed at www.qnmu.org.au/workloads If you need help with reporting concerns or obtaining forms, contact the QNMU.

The NMBA Standards are there to enhance safe health care, but they also empower nurses and midwives to be the leaders in ensuring practice environments have a positive practice culture.

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CASE STUDY The following case study, which occurred within a prison (not in Queensland), highlights the tragic outcomes that can occur from ‘workarounds’ due to unsafe workloads and inadequate funding.

The Coroner’s Inquest made several findings. Firstly, there were established evidence-based protocols in place to ensure prisoners at risk were promptly assessed and the risk mitigated through a management plan.

The patient was charged with a serious crime and remanded in custody at a correctional centre. An initial assessment could not be completed due to his distressed state, but he was identified as being at high risk of self-harm.

A risk intervention team attempted to assess the patient on the second day but abandoned the assessment because he was so distressed. Nevertheless, the team completed a risk assessment management plan.

Unsuccessful attempts were made to assess him on his second day in custody to mitigate the risk, and mid-morning of the third day he was found unresponsive in the cell. Resuscitation was attempted but ultimately unsuccessful.

Secondly, the established protocols for a risk assessment management plan, which required them to be reviewed within 24 hours, were not followed.

What happened? Due to being identified as at risk of self-harm upon reception into prison custody, the risk intervention team was immediately alerted to his need for assessment and he was placed in a shared assessment cell. After a routine review by a Registered Nurse that evening, he was placed in a single assessment cell for his safety, with a safety blanket and limited possessions. The next morning, the patient was reviewed by a risk assessment team. However, he began to cry inconsolably, was not able to continue the interview and was returned to his cell. The team agreed that he remained at high risk of self-harm and noted that a further attempt to review would be made in 48 hours’ time. This was despite risk management protocols stating high risk prisoners must be reviewed within 24 hours. Mid-morning the next day, CCTV recorded the patient laying down on the bed with something in his hand and pulling the blanket over his head. Staff assumed he was asleep. Almost an hour and a half later, a custodial officer entered the cell and found him unresponsive and all attempts to resuscitate him were unsuccessful.

The management plan developed for this patient stated that he was to be reviewed in 48 hours. Evidence emerged that it had become “the norm” for risk assessments to be done within 48 hours instead of 24 “due to very high volume of inmates assessed to be at risk of selfharm”. Thirdly, the decision of the risk intervention team to schedule his review after 48 hours was not in accordance with established protocols, given he was in an assessment cell and should have been reviewed within 24 hours. Finally, the evidence established that reviews were occurring every 48 hours rather than every 24 hours, due to workload demands placed on the risk assessment team. The Coroner noted that the practice of delaying these reviews was unique to this correctional facility, which was a reception and remand facility. The Coroner also noted there was capacity for a second risk assessment team to be formed, which could have ensured that established timeframes for review were attainable. However, the workforce profile and budget meant there were insufficient mental health nurses to enable a second team to be formed. During the Coroner’s investigation, the relevant departments reviewed their resources with a view to forming a second assessment team.

Reflective questions 1. Read the relevant NMBA Code of Conduct and Standards for Practice and any professional standards from colleges or professional associations relevant to your area of practice, then consider your practice environment: Are all relevant codes, practice standards and protocols being complied with? 2. Are there any ‘workarounds’ happening in your area and, if so, are they because protocols or standards can’t be complied with? Is it due to understaffing or underfunding? 3. If any of the above are occurring in your area of practice, have you documented and reported it? 4. Read the QNMU Positive Practice Environment Standards, available at www.qnmu.org. au/Standards, and compare them to your practice area. How does your area compare to these Standards, and how might your area improve? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org. au/CPD

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Permission to supply and administer: DRUG THERAPY PROTOCOL – COMMUNICABLE DISEASES PROGRAM

NMU MEMBERS may have seen some communication earlier in

the year about Registered Nurses (RNs) being able to supply and administer certain drugs related to COVID-19.

These drugs include Oseltamivir phosphate, Zanamir, the Influenza vaccine and the Coronavirus vaccine when available. These new administering rights fall under the Drug Therapy Protocol – Communicable Diseases Program (DTP-CDP), and are part of the public health response to COVID-19. The DTP-CDP gives special authority to all RNs (subject to conditions) who practice under the Primary Clinical Care Manual (PCCM) during a declared public health emergency in relation to an infectious medical condition. Under the DTP-CDP, RNs are authorised to supply and administer certain named drugs.

A closer look at the protocol Under the new Appendix 3, a RN practising in an ‘institution’ (defined as a detention centre, hospital, nursing home or prison) is authorised to supply or administer a medicine that is a restricted drug under the following conditions: ■ It is in accordance with the health management plan outlined in the PCCM. ■ The RN has been credentialed by their facility or service. ■ Each episode of supply must be communicated to the person’s treating health practitioner (which can be a Nurse Practitioner) within seven days.

■ All medicines are recorded, labelled, and stored according to the relevant section of the Health (Drug and Poisons) Regulation 1996. While the Nursing and Midwifery Board of Australia has stated that all RNs are adequately prepared in their undergraduate preparation, this may not mean that all RNs are able to ‘supply and administer under protocol’ in all situations. As such, there may be a requirement for additional education and training. In making an assessment, consider whether there are any professional or industry standards or expectations

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Reflective questions 1. How does the DTP-CDP affect your practice? for education and training to prepare for the new role, including accredited education programs leading to formal qualifications. Before the protocol can be implemented, the institution must allow the PCCM to be used within the service, have policies that set out the scope of practice of the RN working under the protocol, have a credentialing protocol, and have appropriate training processes for the RN. The expansion of the DTP-CDP is a big step forward in recognising the expertise and competency of RNs to work to their full scope of practice. It brings us one step further to ensuring

equity of access to health care for all Queenslanders. The DTP-CDP can be accessed at http://bit.ly/DTP-CDP

Further information is currently being developed by Queensland Health, in consultation with the QNMU, to provide supporting documentation and further guidance in the form of an education program. These will be published on the Queensland Health website in the near future.

2. Does the service you work for have policies, protocols and training in place to allow RNs to supply and administer under the DTP-CDP in your workplace? Discuss what these are. 3. What further planning and preparation would your organisation and employees need to undertake to enable RNs to supply and administer under the DTP-CDP in your workplace? Donâ€™t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

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Improving stress in the workplace: A clinician informed approach BY ELIZABETH GAYE ELDER, AMY JOHNSTON AND PROFESSOR JULIA CRILLY. AFFILIATIONS: GRIFFITH UNIVERSITY (SCHOOL OF NURSING & MIDWIFERY, MENZIES HEALTH INSTITUTE), PRINCESS ALEXANDRA HOSPITAL (DEPARTMENT OF EMERGENCY MEDICINE), UNIVERSITY OF QUEENSLAND (SCHOOL OF NURSING MIDWIFERY AND SOCIAL WORK) AND GOLD COAST HOSPITAL AND HEALTH SERVICE (DEPARTMENT OF EMERGENCY MEDICINE)

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orking in health care is stressful. It always has been and it seems to be getting worse.1 Increased patient numbers2, higher patient acuity3 and key performance indicators4 all contribute the stress experienced by clinicians working in health care. In more recent times, the pressures associated with COVID-19 outbreaks and pandemic responses have also been associated with occupational stress experienced by clinicians5. Although clinicians working in most areas across health care describe themselves as having experienced occupational stress, the emergency department (ED) is reportedly one of the most stressful working environments in health care6-7. Despite there being variation in stressors reported by ED clinicians working at different EDs, workload, patient acuity, and poor skill mix are among some of the commonly reported stressors that occur with relatively high frequency8-10. Prolonged and unaddressed exposure to occupational stress can lead to, in some instances, feelings of demoralisation in the workplace11. A perceived lack of support, a mismatch of organisational, societal and clinician expectations, a lack of resources, and workload and departmental activity have all been associated with perceptions of demoralisation11. Job satisfaction and quality of work decreases when staff feel demoralised12. Empowering clinicians to identify the stressors they experience in the workplace and how they cope are essential first steps in helping to reduce occupational stress and improve coping. Once the priority areas are identified, strategies can be developed and implemented to improve the working environment and/or coping of clinicians. This approach was used as part of a Griffith University doctoral project. It led to a modified-nominal group technique (NGT) study where clinicians were engaged to establish the core components of a workplace-based strategy to reduce exposure to and/or help improve coping

with increased workload, poor skill mix and high patient acuity. Findings of the NGT indicated that improving team synergy and psychological safety were essential elements in improving perceptions of the working environment and clinician coping in the ED13. To achieve both a psychologically safe working environment and improved team synergy, the participants identified the need for: i. increased individual and team support ii. development of professional resilience, and iii. maximising opportunities for social connection13. The findings of this research can be used by ED clinicians and health service managers working in high stress areas to inform strategies to help improve perceptions of local working environments and coping among clinicians. The key is to identify current stressors that may be of concern and coping strategies being used, and then to develop and implement (with clinicians) locally appropriate and tailored interventions. This approach will help ensure the focus of strategies and solutions are relevant to the workspace, as one size does not necessarily fit all. Aspects of research reported herein was made possible by a Griffith University Research Training Scholarship. We are also thankful to the ED clinicians who have contributed their time and support.

Reflective questions 1. What are the main occupational stressors you experience in your working environment? 2. What strategies could be implemented in your workplace to help ameliorate occupational stress and help improve coping among clinicians? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD

If this article has brought up feelings of distress or concern for you, please contact your Employee Assistance Provider, Lifeline Australia (13 11 14) or Beyond Blue (1300 224 636).

References

1. Ruotsalainen JH, Verbeek JH, Marine A, Serra C. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2015(4):CD002892. 2. Yılmaz EB. Resilience as a strategy for struggling against challenges related to the nursing profession. Chinese Nursing Research. 2017;4(1):9-13. 3. Ko W, Kiser-Larson N. Stress levels of nurses in oncology outpatient units. Clin J Oncol Nurs. 2016;20(2):158-64. 4. Agency for Healthcare Research and Quality. Physician burnout AHRQ Pub. No. 17-M018-1-EF Rockville, MD2017 [Available from: https://www.ahrq.gov/prevention/ clinician/ahrq-works/burnout/ index.html 5. Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1-8. 6. Portero de la Cruz S, Cebrino J, Herruzo J, Vaquero-Abellán M. A Multicenter Study into Burnout, Perceived Stress, Job Satisfaction, Coping Strategies, and General Health among Emergency Department Nursing Staff. Journal of Clinical Medicine. 2020;9(4):1007. 7. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-85. 8. Elder E, Johnston A, Wallis M, Greenslade JH, Crilly J. Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study. Int Emerg Nurs. 2019;45:17-24. 9. Xu HG, Johnston A, Greenslade JH, Wallis M, Elder E, Abraham L, et al. Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study. Australasian Emergency Care. 2019;22(3):180-6. 10. Crilly J, Greenslade JH, Johnston A, Carlström E, Thom O, Abraham L, et al. Staff perceptions of the emergency department working environment: An international cross-sectional survey. Emerg Med Australas. 2019;31(6):108291. 11. Elder E, Johnston A, Wallis M, Crilly J. The demoralisation of nurses and medical doctors working in the emergency department: A qualitative descriptive study. Int Emerg Nurs. 2020;52:100841. 12. 1Tsang KK, Lui D. Teacher Demoralization, Disempowerment and School Administration. 2016;5(2):200-25. 13. Elder E, Johnston A, Byrne JH, Wallis M, Crilly J. Core components of a staff wellness strategy in emergency departments: A clinician-informed nominal group study. Emerg Med Australas. 2020.

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A better way to

problem solve I

NTEREST Based Problem Solving (IBPS) is a negotiation technique that has been used for decades, and yet much of it is plain, common sense.

Instead of win-lose, the technique searches for win-win outcomes. It requires vulnerability, honesty, preparation and discipline.

The issue is that we can find negotiation really uncomfortable because we don’t know how to behave.

Our instincts may scream “no!” when we think about working in this way with a party that has competing or conflicting interests.

Should I be a good cop or a bad cop? Should I be direct or indirect? IBPS techniques take all the uncertainty away and leave us with a collaborative and sustainable way of resolving problems in our working and “real” lives. The Harvard Negotiation Institute defines IBPS as “a method of negotiation explicitly designed to produce wise outcomes efficiently and amicably”. This method can be reduced to four main points: ■ People: Separate people from the problem. ■ Interests: Focus on interests, not positions.

Over the past year the QNMU has run joint training with Queensland Health on how to use the technique. Below are some of the key takeaways both parties have found work really well.

Explain your why know your interests The number one rule of IBPS is to focus on interests, not positions. Your position tells us what you want but not necessarily why you want it. Your interests tell us what is important to you – the need, hope, fear, motivation that underlies the position.

■ Options: Generate a variety of possibilities to meet interests before deciding what to do.

When we express our needs in this way it means we can be open to different options or solutions to meet them.

■ Criteria: Insist that the result be based on some objective standard.

The classic example is two chefs quarrelling over one remaining orange.

Time is short and the orange is the key ingredient in both their dishes. After arguing over the entire orange, they split it in half, and neither one of them is satisfied with their dish. If they had been open with each other they would have discovered that one wanted the juice, and the other needed the peel. Instead, the chefs had focused on each other’s position (the what) and not on each other’s interest (the why).

Tackle the problem, not the person Negotiation can get really personal and damage relationships. In a workplace, a negotiation is not going to be the last time you see that person. You will come across each other in the hallways, or even have to work side by side, so the way we behave is extremely important. Ideally you should come to see yourselves as working side by side and tackling the problem together. IBPS also encourages you to critically analyse relationships before you enter the negotiation instead of running on your feelings.

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Knowing what your relationship with the party is and where you would like it to be can be really powerful. It’s okay to acknowledge there is room to improve a relationship, and when these processes are conducted effectively, they can really improve the way you work together going forward. It helps to have the thought of “tackle the problem, not the person” in mind and if you are able to, you have won half the battle. It’s worth the constant discipline!

You can use the technique even when the other side doesn’t want to A common objection is that it won’t work if only one side wants to use IBPS. The techniques are useful in every negotiation, whether the other party wants to work collaboratively or not.

Ultimately, you can only control your own behaviour. By conducting yourself in a principled manner, you gain respect and trust over time.

Sometimes Positional Bargaining is appropriate It can be okay to haggle! While it’s not appropriate for important things like Enterprise Agreements, sometimes it works. Think about buying a new car. I start high, you start low, and we end up somewhere in the middle. For a transaction of that nature it’s fine. You don’t have a long-term working relationship with the salesperson, it’s efficient, and the stakes aren’t that high. You can go and buy a car somewhere else.

Reflective questions 1. Consider a time when you have had a winwin outcome. How did you manage to achieve this? 2. Think about a situation where someone you were negotiating with took a positional approach. How could IBPS have helped? Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/ CPD

Conclusion

IBPS teaches you to be thoroughly prepared, demand and provide evidence, question effectively, behave in a principled manner and more!

IBPS techniques can take years to master and this is just a taste. It requires hard work, self-awareness, and constant discipline.

These tools are useful in every arena, regardless of buy-in or understanding from the other party.

The pay offs are huge and it can get amazing results when parties work side by side to resolve issues.

Further reading Getting to Yes: Negotiating Agreement Without Giving In by Roger Fisher and William L. Ury.

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Exploring fundamental care BY ALEXANDRA MUDD, DR REBECCA FEO AND DR TIFFANY CONROY

Fundamental care is at the heart of nursing. Identifying the complexity involved in getting this care right highlights the expert skills and practices of nurses.

Clinical nurse leaders required for research interview Researchers are looking for clinical nurse leaders to take part in a research interview about how they facilitate fundamental care within their clinical area. Interviews will not exceed 1 hour, and participants receive a $30 gift voucher for taking part. For more information, please contact Tiffany Conroy, tiffany.conroy@flinders.edu.au or (08) 8201 3246.

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Fundamental care One of the primary responsibilities of nurses is to provide fundamental care. By fundamental care, we mean the actions of the nurse “to respect and focus on a person’s essential needs to ensure their physical and psychosocial wellbeing”1. Fundamental care is central to quality care delivery and, when done well, can have positive outcomes for patients, their families and nurses. The need to ensure delivery of high-quality fundamental care can also be viewed in the context of the Australian Charter of Healthcare Rights, which outlines how patients should expect safe, respectful and partnership-based care2. However, too often, fundamental care is seen as basic or common sense and is delegated away from Registered Nurses in favour of more specialist or ‘exciting’ areas of nursing practice. However, there is a growing understanding that, far from being basic, fundamental care is complex and requires expert skills to get right.

Yet it can be challenging to clearly identify and describe what this care looks like in the ‘real world’ of practice, particularly when nurses are providing care in increasingly complex and challenging healthcare environments. This is where conceptual frameworks can help nurses to disentangle this complexity, and to envisage, plan and undertake high-quality fundamental care.

The Fundamentals of Care Framework Following concerns about the poor standards in fundamental care delivery globally, an international group of healthcare clinicians, educators, researchers, and consumers formed the International Learning Collaborative (ILC). The ILC specifically focuses on promoting high-quality fundamental care through research and education. In 2013, the ILC developed the Fundamentals of Care Framework (the Framework)3. The central message of the Framework is that fundamental

CPD care is complex, multi-dimensional and multi-faceted. Instead of thinking of fundamental care as a discrete list of tasks for the nurse to complete for the patient (such as washing, toileting, eating and drinking), the Framework depicts fundamental care as an integrated activity centred around a trusting relationship between the nurse and the patient and taking place within a dynamic environment. The Framework describes three main dimensions to fundamental care: 1. The nurse-patient relationship 2. Integration of care 3. Context of care

The nurse-patient relationship

At the heart of high-quality fundamental care is a trusting relationship between the nurse and the patient. There are five main aspects to developing and maintaining this relationship: ■ Building trust ■ Focusing on the individual (patient) ■ Anticipating their needs ■ Getting to know the individual and what is important to them ■ Reflecting upon the relationship, evaluating it and seeking to continually improve it. There might be situations where it is difficult to build a relationship with the individual, for example, where the patient is unconscious, or is unable to respond due to illness, disability or their cognitive state. In these situations, nurses will have to be creative and engage with family and relatives. A key aspect of the relationship is that it is not static; a relationship can be established, but a single act of neglect, or disrespect, can have significant negative effects.

Integration of care

Instead of viewing fundamental care as a list of physical tasks, the Framework reconceptualises these as several interrelated physical, psychological and relational activities. Nurses need to be sensitive to, and work to meet, the numerous unique and changing needs an individual might have.

For example, assisting a patient with toileting is not simply a physical task, but requires the nurse to take account of the patient’s values and beliefs, safety, privacy and dignity, and for the nurse to be respectful and effectively communicate throughout. This integration of physical, psychological and relational needs contradicts the idea that delivering fundamental care is ‘basic’ and instead emphasises the need for consultation, planning, consideration and evaluation on the part of the nurse.

Context of care

The Framework identifies that nurses need to have awareness and understanding of the context in which they work, as this inevitably impacts upon their relationships with patients and how they deliver care. Context can refer to the immediate environment or broader organisational, state or national policies/practices. Of course, the individual nurse has a limited ability to impact upon some of these aspects, however, their professional duty to advocate for their patients, means that they should be aware of these factors and take action where necessary.

Summary Delivering high-quality fundamental care requires nurses to possess and demonstrate a range of complex skills.

Reflective questions 1. When you first meet a patient, how do you create a therapeutic connection or relationship with them? If a nursing student asked you what they needed to do, what would you advise? 2. Have you experienced a situation where you had a good relationship with a patient, but this broke down? Reflecting on the situation, and using the Fundamentals of Care Framework, revisit this breakdown and consider what you could do differently next time. 3. Think about a time when you have been providing fundamental care. Using the integration of care dimension of the Fundamentals of Care Framework, reflect upon how you could improve this in the future. Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/ CPD

Yet, it has been misunderstood as basic and is therefore often undervalued. The Fundamentals of Care Framework is a useful tool to help nurses conceptualise fundamental care as a complex, integrated activity. Understanding and using the Framework can help nurses to better understand, plan, deliver and evaluate the care they provide. When nurses identify and articulate the complexity of their actions, they are more able to effectively advocate for their patients’ needs. For more details, please see the International Learning Collaborative website https://intlearningcollab.org/

References 1. Feo, R., Conroy, T., Jangland, E., Muntlin Athlin, Å., Brovall, M., Parr, J., Kitson, A. (2018). Towards a standardised definition for fundamental care: A modified Delphi study. Journal of Clinical Nursing, 27(11-12), 2285-2299. doi:10.1111/jocn.14247 2. Australian Commission on Safety and Quality in Health Care (2019) Australian Charter of Healthcare Rights (second edition). https://www.safetyandquality. gov.au/sites/default/files/2019-06/ Charter%20of%20Healthcare%20 Rights%20A4%20poster%20 ACCESSIBLE%20pdf.pdf 3. Kitson, A., Conroy, T., Kuluski, K., Locock, L., & Lyons, R. (2013). Reclaiming and redefining the Fundamentals of Care: Nursing’s response to meeting patients’ basic human needs. Adelaide, SA: School of Nursing, the University of Adelaide. https://thesis.library.adelaide.edu.au/ dspace/bitstream/2440/75843/1/ hdl_75843.pdf

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Educating patients about preventing pressure injuries BY DR SHARON LATIMER (PHD, RN), JODIE DEAKIN (RN), PROFESSOR BRIGID M GILLESPIE (PHD, RN), PAUL NIEUWENHOVEN (RN) AND PROFESSOR WENDY CHABOYER (PHD, RN).

OSPITAL acquired pressure injuries (HAPI) are preventable adverse events that develop due to shear, unrelieved pressure or a combination of both1.

PREVENTING PRE

SSURE INJURIES

KEEP MOVING

Global HAPI incidence rates range between 0%-30%, with many considered preventable2. Clinicians implement several pressure injury prevention (PIP) strategies including support mattresses, repositioning and patient education. Increasing patients’ PIP knowledge on hospital admission and throughout their length of stay can reduce HAPI1. But having access to short, evidence-based patient education materials that are suitable for a diverse range of patients is a barrier some nurses face. ‘Care bundles’ are a set of interventions, including patient education, reminders and feedback, that when used together can reduce adverse events such as falls, sepsis and HAPI3. In 2014, an international team of nurse researchers, funded by the National Health and Medical Research Council, developed and tested a patient PIP education care bundle, including a sixminute video, a poster and brochure4. Available in eight languages outside of English, the bundle identifies three simple strategies that patients can easily use in their daily care to prevent HAPI: keep moving, look after your skin, and eat a healthy diet. This PIP education care bundle was recently introduced across the Gold Coast University Hospital, with the video uploaded onto the patient entertainment system (PES). Our team conducted a study of 80 medical patients to evaluate the PIP

1. How could the use of patient education care bundles help reduce adverse events such as pressure injuries? 2. Reflecting on your clinical practice, what strategies would you use to encourage patients to participate in an education-based care bundle?

LOOK AFTER YOU

R SKIN

EAT A HEALTHY DIET

Reflective questions

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

rsity 2014 Version 1, 28 March

2014

education care bundle in clinical practice, which was funded by Sigma Thea Tau International. Following engagement with the intervention, patients reported improvements to their PIP knowledge and subsequent participation in this aspect of their care. Patients were satisfied with the quality, messaging and ease of access of the care bundle video via the bedside PES. These factors increased their willingness to engage with the intervention. The PIP education care bundle provides clinicians with access to valuable teaching resources to help educate patients about PIP on hospital admission and throughout their stay. The PIP care bundle resources can be freely accessed at http://bit.ly/PIPtoolkit

References

1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. In E. Hasler (Ed.), The International Guideline (3 ed., pp. 1-408): EPUAP/NPIAP/PPPIA. 2. Li, Z., Lin, F., Thalib, L., & Chaboyer, W. (2020). Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and metaanalysis. International Journal of Nursing Studies, 105. doi:10.1016/j. ijnurstu.2020.103546 3. Borgert, M. J., Goossens, A., & Dongelmans, D. A. (2015). What are effective strategies for the implementation of care bundles on ICUs: A systematic review. Implementation Science, 10(1), 119-129. 4. Chaboyer, W., Bucknall, T., Webster, J., McInnes, E., Gillespie, B., Banks, M., . . . Wallis, M. (2016). The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): A cluster randomised trial. International Journal of Nursing Studies, 64, 6371. doi:http://dx.doi.org/10.1016/j. ijnurstu.2016.09.015

incoming On the State Governmentâ€™s nursing and midwifery commitments this Queensland election

Letter to the Editor QNMU member Jacqueline Wilkin was one of our recipients of the QNMU Assistant-in-Nursing/Personal Carer Scholarship last year.

KM Great news and effort from QNMU. In all honesty though that announcement doesnâ€™t mean much, nor if she will follow through. This is merely pre-election promises/ talk... Usually failed upon post-election and voting, letâ€™s be honest here! Thanks for speaking up though QNMU. Now wait â€˜nâ€™ see!

Iâ€™m so grateful for the scholarship. It helped me to complete a Certificate III in Sterilisation and I am currently working in CSSD (Central Sterile Services Department). I enjoy this role. It is a very structured and busy workplace, and I have to prioritise my work to create an efficient workflow. Iâ€™m currently studying nutrition which is a passion of mine. Iâ€™m hoping this will open up more opportunities for me in the future. Thanks QNMU!

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KTB Great outcome for Queenslanders, more health care providers to keep us safe and healthy.

Jacqueline Wilkin, AIN

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LR Great news for state nurses but we need the feds to do the same for aged care. Like Âˇ Reply

CE Excellent to see my union being acknowledged and heard! Like Âˇ Reply

KS A win win. đ&#x;˜ƒ Next for aged care! Letâ€™s not give up on that. Like Âˇ Reply

BU That will really improve conditions for staff and outcomes for patients! đ&#x;‘? Like Âˇ Reply

MO Please advocate for the majority of those positions to be for graduates, with funding for offline hours for experienced nurses to provide effective support and mentoring

On why we need to stand up for our Super SP Iâ€™m 59 and struggling. Thereâ€™s no way Iâ€™m going to make it to the end. Not everyone my age in nursing has an office job. Itâ€™s scary thinking about the future. Like Âˇ Reply

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On a new study finding aged care residents would eat more if offered larger meals

RC It varies on the individual. [Give] those living with dementia too much and they wonâ€™t eat it... Had one individual we served 3 small meals in an hour but if served [all] at once ate nothing. Itâ€™s about having time to know your elder. So many are still hungry but would be too embarrassed to ask for seconds. Although have worked at places [that] purposefully serve small meals to keep [a] tight budget.

AW Itâ€™s not the amount, itâ€™s that the food is terrible. Most of them never finish a meal. Personally I wouldnâ€™t either.

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DP I would be looking at what theyâ€™re actually offered to eat... Plus large portioned meals can be off putting and overwhelming. A lot of residents require more assistance which of course requires more time in an environment which is notoriously time poor. đ&#x;˜•

JOIN THE CONVERSATION Follow our social media pages and be a part of the conversation on hot topics and whatâ€™s important to nurses and midwives.

/qnmuofficial

incoming On dealing with COVID-19

Comment

KA Itâ€™s so hot in full scrubs within 10 mins my body is covered in sweat. I was getting headaches halfway into my shift, not getting enough water in me. I have had 6 COVID tests since it started because every time you have a symptom you need testing, more time off work waiting for test results. No more sick leave so have to use my holiday leave and not much of that left. Iâ€™m over it all, time to get out of health care!

I actually have my great-grandmotherâ€™s Queensland nursing registration badge. My grandmother gave it to me when I became a Registered Nurse and told me it belonged to my great-grandmother Jane Campbell (nee Swanson). Janeâ€™s mother Jemima Campbell (my great-great-grandmother) was also a nurse who emigrated from the Scottish Highlands at the age of 22 in 1882 and started a maternity home in Lutwyche, Brisbane.

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JM Changed my scrubs 4 times in one 12-hour shift because I was so hot.. Like Âˇ Reply

On Redcliffe Orthopaedics securing 4.42 FTE TF Thatâ€™s so good, well done 6W, will make a big difference to patient care and happy staff. Like Âˇ Reply

WB Well done. Stand together and stay strong. đ&#x;’Şđ&#x;‘Šđ&#x;?ť

OF THE MONTH

RW All private healthcare nurses: This shows why Workload Reporting Forms are so important. Keep filling them in! Like Âˇ Reply

Unfortunately I donâ€™t have any other details about the maternity home except that it may have been on Ernest Street. I also donâ€™t have any details of where my great-grandmother Jane worked but it must have been during the time of the Spanish flu epidemic.

BOOK PRIZE WINNER

I would love to dig through the archives and find out more about their work! Kym Mullen, Registered Nurse

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WIN

ONE OF THESE GREAT BOOKS FOR YOUR FAB PHOTO

The Courage to Care by Christie Watson

What Happened by Hillary Rodham Clinton

Atmosphere of Hope by Tim Flannery

Nurses have never been more important. We benefit from their expertise in our hospitals and beyond. When we feel most alone, nurses remind us we are not alone at all. In The Courage to Care, Christine Watson reveals the remarkable extent of nursesâ€™ work.

Hillary Clinton reveals what she was thinking and feeling as she ran against Donald Trump in one of the most controversial and unpredictable US presidential elections in history. A timely read!

Acclaimed scientist Tim Flannery argues the Earthâ€™s climate system is approaching a crisis. Atmosphere of Hope provides both a snapshot of the trouble we are in and an analysis of some of the innovative technologies that give cause for hope.

Email full-size pics and image details to inscope@qnmu.org.au for our 'in view' pages for your chance to win

in view

Did you catch us in your workplace? Our QNMU@Work stalls are an opportunity for us to catch up with members around any workplace concerns. We were at Bundaberg Hospital and Hervey Bay Hospital recently with some giveaways, including delicious morning tea trays for nurses and midwives to take back to their wards and share, because who doesnâ€™t love a spot of morning tea!

Bundaberg Hospital

Weâ€™ve come a long wayâ€Ś QNMU member Caroline Delaforce set up this fantastic display at Logan Integrated Mental Health as part of International Year of the Nurse and the Midwife celebrations. It not only showcases how far nurses and midwives have come but will serve as a good reminder to reflect on our practice and our mental health. Great effort Caroline.

Hervey Bay Hospital

Checking in Our fabulous members from the Central Queensland Mental Health Alcohol and Other Drugs branch and their colleagues in Allied Health recently put on a BBQ for R U OK Day on 10 September. Itâ€™s so important to take the time and ask the question, especially this year!

Team Rockhampton! Our QNMU team were at Rocky Hospital recently to check in with members and say thanks for doing a fabulous job. We paid a visit to all wards, had over 100 conversations with our members, and signed up some new reps in mental health! đ&#x;‘?đ&#x;?ť

CALENDAR

December Christmas Day

27-28 May 2021, Brisbane www.ausmed.com.au/event/all-events

26 May

Health and Environmental Sustainability Conference

Good Friday

25 December

Brisbane Nurses’ Conference

National Sorry Day

April 2 April

Boxing Day

Easter Sunday

New Years Eve

Easter Monday

6 May 2021 www.anmfvic.asn.au/events-andconferences/2021/05/06/healthand-environmental-sustainabilityconference

Anzac Day

5th Australian Nursing and Midwifery Conference 2021

26 December

4 April

31 December

5 April

January

25 April

Gold Coast Nurses’ Conference 2021

Medicines: Improve your knowledge

28-29 January 2021, Toowoomba www.ausmed.com.au/event/all-events

March

19-20 April 2021, Surfers Paradise www.ausmed.com.au/event/all-events

Trauma Nursing Seminar

22-23 April 2021, Brisbane www.ausmed.com.au/event/all-events

Port Douglas Nurses’ Conference

National Close the Gap Day 19 March

Diabetes: Nursing Management Seminar

11-12 March 2021, Brisbane www.ausmed.com.au/event/all-events

Clinical Deterioration: Identify, Assess, Prevent Seminar

18-19 March 2021, Brisbane www.ausmed.com.au/event/all-events

Wound Management: A Practical Guide Seminar

25-26 March 2021, Townsville www.ausmed.com.au/event/all-events

22-23 April 2021, Port Douglas www.ausmed.com.au/event/all-events

ACN Nursing & Health Expo

24 April 2021, Melbourne www.acn.edu.au/events/nursinghealth-expo

Brisbane Mental Health Conference

July

Riding the Waves of Change, Forging the Future: Nursing and Midwifery practice, research and education 6-7 May 2021, Newcastle, NSW www.nursingmidwiferyconference. com.au/

Respiratory Nursing Seminar

14-16 July 2021

PROFESSIONAL PRACTICE

Clnical Deterioration: Identify, Assess, Prevent Seminar 2021

10-11 May 2021, Maroochydore www.ausmed.com.au/event/all-events

10-11 May 2021, Brisbane www.ausmed.com.au/event/all-events

Wound Management: A Practical Guide Seminar

17-18 May 2021, Brisbane www.ausmed.com.au/event/all-events

24-25 May 2021, Brisbane www.ausmed.com.au/event/all-events

3 May

QNMU Annual Conference

6-7 May 2021, Brisbane www.ausmed.com.au/event/all-events

Midwifery Challenges Conference

Labour Day

5-9 June 2021, Abu Dhabi www.icn.ch

Nurse Management Challenges: CPD

29-30 April 2021, Brisbane www.ausmed.com.au/event/all-events

May

International Council of Nurses (ICN) Congress

OPENING EARLY 2020

www.qnmu.org.au/ Awards

IT’S GOOD TO KNOW YOU’RE IN SAFE HANDS

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

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!

(07) 3099 3210 or 1800 177 273

Nelda Lucy Anna Danielle Emily

Terri

Maree Daniel

Dianne

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.

(toll-free outside Brisbane)

Karyn 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

Transforming care and changing lives Griffith School of Nursing and Midwifery has industry leading professionals that can help advance your career. #1 Ranked University for Nursing and Midwifery*

Choose from a range of post graduate programs including Graduate Certificates and Masters programs in the following areas: • • • •

Acute Care Nursing Critical Care Nursing Emergency Nursing Paediatric Nursing

• Professional Nursing • Infection Prevention and Control • Primary Maternity Care

• Master of Philosophy

• Doctor of Philosophy (PhD)

If you’re not ready to commit to a full degree, why not consider a single course of study or continuing professional development modules. For more information 1800 677 728 or SoNM_Support@griffith.edu.au griffith.edu.au/griffith-health/school-nursing-midwifery *Shanghai Ranking’s Global Ranking of Academic Subjects 2020 #1 in Australia and #2 globally

CRICOS No. 00233E

Higher Degree Research

Get your super back on track How to rebuild your savings after an early super withdrawal QSuper has crunched the numbers here to show how you can rebuild an account balance if you have made an early withdrawal from super.

How early access to super may impact you Under the Australian Government’s early super access scheme, eligible people affected by coronavirus could apply to access up to $10,000 of their superannuation in 2019-20 and up to a further $10,000 in 2020-21.

How to make your super balance healthy again

The good news is that taking money out of super to help get you through the COVID-19 crisis doesn’t have to be a permanent withdrawal and by adding back to super you can rebuild retirement savings. The key is adding extra small amounts over time. How to recover your $10,000 early withdrawal

What happens if you withdraw $10,000 from super

Impact at age 65

Age 20

Age 40

About $25,000 less

About $17,000 less

Under 40 After-tax contribution per week until age 65

$10-15

Age

Over 40 $15-20

The more you add, the sooner you’ll get your retirement savings back on track. People who make after-tax contributions may be eligible to receive extra co-contribution money from the Australian Government.

QSuper is here to help

QSuper members have access to over-the-phone financial advice. Personal financial advice may help save money right now, build a better future retirement, and help you set your strategic financial goals. Simply call us at 1300 360 750.

1 Figures derived from ASIC’s MoneySmart Super Withdrawal Estimator. The figures are illustrative only and should not be relied upon as actual results will differ depending on the timing of contributions and returns and fees for each investment option. You should seek financial advice for your personal circumstances. The calculations are based on the assumptions used in the MoneySmart calculator for Accumulation accounts only and have been rounded to the nearest dollar. The estimates provided are shown in today’s dollars, which means they are adjusted for inflation by 4.0% p.a. (2.5% p.a. due to CPI inflation and a further 1.5% p.a. for the cost of rising community living standards). Investment returns are defaulted to an assumed rate of investment return before tax and fees of 7.5% p.a. Assumed tax on earnings is 7.0%. © QSuper Board. SPON-553.10/20.

Our record speaks for itself

IN 2019/20, THE QNMU:

Provided legal representation for 294 members responding to OHO or AHPRA notifications or investigations

Provided legal representation for 257 members including representation for coronial investigations and coronial inquests

Provided expert representation for 4003 members

Recovered $1.7 million for members

Assisted 188 members with WorkCover claims

Assisted 49,572 members through our Member Connect call centre

Provided wellbeing assistance for 412 members Pictured: QNMU member Lauren Schofield, RN