VOL. 34 ■ NO. 6 ■ DECEMBER 2015
THE QUEENSLAND NURSE
Bringing our hospitals into the 21st century RATIOS ON TRACK FOR ROLLOUT
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Conte nt s The official journal of the Queensland Nurses’ Union 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 qnu@qnu.org.au W www.qnu.org.au ISSN 0815-936X ABN No. 84 382 908 052 Editor Beth Mohle, Secretary, QNU Production QNU Communications team Published by the Queensland Nurses’ Union of Employees Printed by Fergies Print and Mail REGIONAL OFFICES Toowoomba 66 West St, Toowoomba Q 4350 (PO Box 3598, Village Fair, Toowoomba Q 4350) T 07 4659 7200 F 07 4639 5052 E qnutwmba@qnu.org.au Bundaberg 44 Maryborough St, Bundaberg Q 4670 (PO Box 2949, Bundaberg Q 4670) T 07 4199 6101 F 07 4151 6066 E qnubberg@qnu.org.au Rockhampton Suite 1, Trade Union Centre 110 Campbell Street, Rockhampton Q 4700 (PO Box 49, Rockhampton Q 4700) T 07 4922 5390 F 07 4922 3406 E qnurocky@qnu.org.au Townsville 1 Oxford Street, Hyde Park Q 4812 (PO Box 3389, Hermit Park Q 4812) T 07 4772 5411 F 07 4721 1820 E qnutsvle@qnu.org.au Cairns Suite 2, 320 Sheridan St, North Cairns Q 4870 (PO Box 846N, North Cairns Q 4870) T 07 4031 4466 F 07 4051 6222 E qnucairns@qnu.org.au DISCLAIMER Statements expressed in articles in The Queensland Nurse are those of the contributor and do not necessarily reflect the policy of the Queensland Nurses’ 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 QNU’s ethical standards, such acceptance does not imply endorsement.
PRIVACY STATEMENT The QNU collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information please contact your nearest QNU office. If you are still not satisfied that your privacy is being maintained you can contact the Privacy Commissioner whose 1800 number is in the phone book.
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VOL. 34 ■ NO. 6 ■ DECEMBER 2015
22 FEATURE Election issue 2: Bringing our hospitals into the 21st century
8
2 3 4 5 6 14 15 16
18
34
Your union
18
Ratios Save Lives special
32
Midwifery
Editorial
22
Feature
33
Industrial
Your say
26
Professional
34
Opinion
Tea room
27
Nursing and midwifery research
36
Health and safety
28
Continuing professional development
37
Your super
31
Building better workplaces
38
Calendar
38
Advertising
Queensland news National news International news Campaign news
DECEMBER 2015 TQN 1
YOUR UNION
Nurses and midwives will not be silenced In October this year, the 12th Biennial National Delegates Conference for the Australian Nursing and Midwifery Federation was held in Adelaide.
YOUR COUNCIL
Representatives from every state and territory joined together to debate motions that guide the activity and direction of the ANMF for the next two years, in much the same way as our own Annual Conference. Biennial Conference covers federal issues such as aged care, health in detention centres, and skilled migrant workforce. The theme of this conference was We will not be silenced: the power of nurses and midwives. Biennial Conference is an opportunity to collectively strengthen our power: the power of research, thought, action, personal power, industrial power, and professional power. The power of many voices and the power of one... One of the most important features of this year’s conference was the ANMF Reconciliation Action Plan, which outlines our commitments and actions to support reconciliation with Indigenous and Torres Strait Islander Australians. We also congratulated the ANMF Victorian Branch on the passing of their ratios legislation in October—a matter close to our own hearts, with our own
bill being tabled in parliament just this month! Rosie Batty, 2015 Australian of the Year and tireless domestic and family violence advocate, showed us again how the power of a tragedy turned into a phenomenon that has touched the lives of millions of people across the Australia, and galvanised many of us into action. Conference delegates also declared nurses and midwives will not be silenced on things that matter to us – access to quality public health care and basic human rights whether they are in our workplaces, our communities or detention centres. Across the globe, nurses and midwives are coming together, demonstrating the success that we can have together in reversing the power of the privileged and prevailing, with a shared vision, a shared voice, and shared union and nursing and midwifery values. As trusted professions we must harness the power of our knowledge and global brand to educate and support the communities we live and work in—to defend access to public health care, penalty rates, aged care, the National Disability Insurance Scheme, paid parental leave, and issues relating to border protection. We heard about the power of direct quotes from nurses and midwives. We were cautioned on complacency relating to the change of Prime Minister—that the power of publicly promoting issues that are real to us is vital, but that it must compete with the
SALLY-ANNE JONES QNU PRESIDENT established dialogue about the state of decline of our nation. We have to be louder. We have to be united. We also heard a compelling presentation by Human Rights lawyer Graeme Edgerton and paediatrician Elizabeth Elliott who have been visiting children and families in detention centres. They talked to us about the efforts of the government to silence the voice of health professionals and others who seek to advocate for those in detention, especially the vulnerable and impressionable—the women and children. Every nurse or midwife is a professional leader. But leadership, however or whatever brings you to it, is NOT being silent. By speaking out, being direct and challenging the status quo we have opportunity to truly make a difference. Being passionate about your cause is not enough. There must be action. Your voices contribute to the power for change. Nurses and midwives will not be silenced.
Sally-Anne
Secretary Beth Mohle ■ Assistant Secretary Sandra Eales ■ President Sally-Anne Jones ■ Vice President Stephen Bone Councillors Julie Burgess ■ Christine Cocks ■ Karen Cooke ■ Dianne Corbett ■ Jean Crabb ■ Gillian Gibbs ■ Phillip Jackson Leanne Jiggins ■ Damien Lawson ■ David Lewis ■ Lucynda Maskell ■ Simon Mitchell ■ Fiona Monk ■ Sue Pitman Dan Prentice ■ Karen Shepherd ■ Katy Taggart ■ Kym Volp ■ Di Webb ■ Charmaine Wicking
2 TQN DECEMBER 2015
www.qnu.org.au
EDITORIAL
When the AHPRA auditor calls...
BETH MOHLE SECRETARY
Last month I received a letter from AHPRA advising I was being audited. My immediate reaction was:
You’ve got to be joking— not another thing to do! I guess that is the standard response from most nurses and midwives given how time-poor we are and how many competing demands we face every day. But that immediate gut reaction was quickly replaced by an appreciation that this audit process is so central to maintaining the integrity of our professions. As nurses and midwives, we are accountable to both our professions and our broader community. The audit required me to demonstrate that I met the requirements set by the Continuing Professional Development (CPD) and Professional Indemnity Insurance (PII) standards. The requirements of the Recency of Practice Standard is satisfied by my fulltime employment as the Secretary of the QNU, a position that requires me to be registered with the NMBA and act as Chief Executive of the union. The PII requirement was easy to meet given this essential insurance is included with our QNU membership.
www.qnu.org.au
The QNU provides a statement that can be provided to AHPRA confirming a nurse or midwife had PII for the audit period. The requirement to demonstrate 20 hours of CPD was also easy given my attendance at a number of QNU conferences and seminars. These covered a range of professional, industrial, political and social matters relevant to nursing and midwifery practice. I also provided evidence of my attendance at governance and other training relevant to my specific practice as Secretary of the QNU. The QNU provides other CPD activities such as the CPD article and reflective practice exercise included in every edition of this journal, as well as online CPD resources. This audit process also allowed me to reflect on a few other issues. Firstly, I thought about how much has changed recently in the external environment that impacts so much on our practice. For example, our campaign for adequate workloads and skill mix across all sectors is beginning to pay dividends, with the ratios bill having been introduced into the Queensland Parliament on 1 December 2015. I also thought about the need to update our career and classification structures to mirror nurses’ and midwives’ current breadth of practice. These bedrock structures must be kept contemporary so new and emerging roles are appropriately incorporated. The audit process also made me think about the critical work our union does every day supporting members in professional and legal practice matters. In the 2014/15 financial year our union supported members in 253 Australian
THE QNU PROVIDES A STATEMENT THAT CAN BE PROVIDED TO AHPRA CONFIRMING A NURSE OR MIDWIFE HAD PII FOR THE AUDIT PERIOD. Health Practitioner Regulation Agency and Office of the Health Ombudsman matters, as well as 241 PII matters including 38 coronial matters. This work protects our members’ registration to practise, and hence their livelihoods. We all know mistakes can happen in our jobs, especially when the system does not support us to practise safely. We have an obligation to take a stand when workloads are excessive and skill mix is inadequate. Collectively we do this through our campaigning activity, but individually the QNU is here for you when you need legal and professional support. So this random AHPRA audit of my practice as a RN made me take stock of so many things. We have come so very far during my working life, but we still have so much to accomplish together. As we approach the festive season and the end of another year, take the time to reflect on all we have achieved. We have a lot to be proud of. I look forward to working together with you to achieve many more of our objectives in 2016.
Beth
DECEMBER 2015 TQN 3
Yo ur s ay Lady Cilento Children’s Hospital I cannot thank ALL the staff at LCCH enough. We will be eternally grateful. We left Toowoomba at 6pm by the RACQ Careflight helicopter and their amazing team set about saving our son’s life when we arrived. We didn’t truly understand how close we were to losing our little man, until the professor and a member of his team found us and sat down at about 2am explaining the situation. We have experienced many areas of this hospital from ICU, Surgical Ward, Stoma Nurses, Day Surgery and many other areas. Put it this way—there are not many levels we haven’t been to yet. The staff have all been amazing. A special mention to the surgical team and the staff on Level 5. Truly amazing people. We are now an outpatient who has follow up appointments in different areas. We always visit the Starlight room while we’re there to create a memory of that day’s visit. Thank you again LCCH you are the best. Sharon Hill
The need for reflection I am pleased to say that I won the QNU doll in a raffle. Our team are still deciding what her name will be. Our area of work can be mentally draining and challenging at times but having a good nursing team and support from one another helps reduce our stress levels. I have been working with management and other QNU members in running onthe-ward weekly reflection sessions. Reflection is an important component of continuing professional development with the nursing profession. Reflective practice is simply where an individual thinks critically about an action, thought, or experience. This thinking enables the individual to increase their self-awareness and professional ability.
4 TQN DECEMBER 2015
It is a purely personal response to situations, events, experiences, or new information. Reflective practice critically examines not only the what, but also the why. I am putting together with other QNU members a reflection room in which the Union Doll will be taking a proud place.
Janette (centre) with QNU Organiser Carol Lewis and the Union Doll.
Janette French
Power of kindness Reading tqn gives perspective. We see that nurses and midwives collectively meet challenges in diverse work environments every day. It’s uplifting for us to have professional and industrial interests addressed in our journal. In October’s edition I was encouraged as early as page 3 by “The Power of Kindness.” On first opening my copy I enjoyed reading this column twice and then again within a week. A gentle reminder that kindness is indeed a powerful quality we can aspire towards every day, for those within our care and also for colleagues with whom we share responsibilities throughout each shift. Yes, everyone is buoyed by “deliberate acts of kindness” and this virtue is most definitely “all the more valuable” when displayed under demanding circumstances. Motivating us to make kindness a perspective visible to all, Beth nailed it. Janet Baillie
Winners are grinners I just wanted to send a quick email to thank you once again for the $500 Book Bursary I received this semester. It is greatly appreciated and I just wanted to update you all with how I have used the bursary. I used the money to purchase my nursing and midwifery textbooks for this semester and I also was able to purchase 2 prac uniforms for my upcoming placement, something I had been putting off as it was an expense I couldn’t afford and I had been unable to purchase any second-hand. Thank you QNU!
Have your say tqn welcomes letters for publication. Letters should be no more than 200 words. Anonymous letters will not be published (we will consider withholding names, but do not accept unsigned letters). Photos may be colour or black and white. Send all material in the first instance to: The Editor, The Queensland Nurse, GPO Box 1289, Brisbane 4001 or by email to dsmith@qnu.org.au tqn also sources Your Say comments from the QNU’s social media accounts in the public domain. The views contained in the ‘Your say’ page do not necessarily reflect the views of the QNU. For more information and guidance on writing and submitting a letter for inclusion in the ‘Your Say’ section refer to the QNU’s Letter to the Editor policy at www.qnu.org.au/letters-policy
/qldnursesunion
Emma Kendall
www.qnu.org.au
Te a room 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 covering 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.
If you have questions for our Tea room column email qnu@qnu.org.au
ROVDPOOFDU
The following questions are frequently asked of our QNU Connect call centre.
I’m working over the Christmas/New Year period (again)—How much public holiday pay should I get? The festive season is almost upon us and it can be a confusing time in terms of public holidays, leave and wages. In Queensland Health, the HR Circular 5/15 outlines the compulsory closure and leave arrangements for 2015/2016. It provides information about which days are public holidays, the concessional day (Tuesday 29 December) and when your personal leave entitlements need to be utilised. If you work Christmas Day this year, you will be paid double time and a half. The applicable penalty rates for Boxing Day and New Year’s Day vary depending on which area of Queensland Health you work in. You should check your award or contact QNU Connect. If you are not required to work on a public holiday and you would normally work on that day (according to a set roster pattern), you should be paid ordinary time for that day. In the private and aged sectors, your enterprise agreement will outline public holiday and leave entitlements, and in some circumstances may provide information about the Christmas/New year period. The rate of pay to work a public holiday varies across agreements, but the baseline payment under the Nurses Award 2010 is double time. The Fair Work Act 2009 stipulates that you are entitled to be absent from work
www.qnu.org.au
on a public holiday, but your employer may ask you to work. This request must be reasonable. To determine if it’s reasonable, a range of issues need to be considered including your personal circumstances such as family responsibilities. If you have any questions about public holidays, please contact QNU Connect on (07) 3099 3210.
What do I do if I’m being asked to work excessive amounts of on call or recall? Many nurses and midwives work in departments that may require them to work reasonable on call hours. The QNU strongly encourages nurses and midwives to use their own individual professional judgement when accepting to be rostered on call. You need to take into account your personal circumstances, family commitments, and health and wellbeing when being asked by your manager to work on call. Individual nurses and midwives are responsible for determining their own level of fatigue. Likewise, managers are responsible for rostering in a way that doesn’t put staff or patients at risk. If you have been inappropriately rostered, raise your concerns with your manager. Remember, if you are feeling fatigued, you need to speak up and say ‘no’. The following sources contain information relevant to this issue and can assist you with queries:
QI 41::4321
Clauses from Queensland Health Nurses
and Midwives Award State 2012 (public sector). Clauses from your Award and Certified Agreement for rostering, breaks between shifts on call/recall and overtime entitlements (private and aged care sectors). QH guideline The principles of best practice rostering www.worksafe.qld.gov.au Health Practitioner Regulation National Law Act 2009
What protections do I have if I submit a workload reporting form? All nurses and midwives—including those working as casuals—are entitled to submit workload reporting forms and raise workload concerns with managers. Those working in the public system are protected by Freedom of Association laws. It is illegal for an employer to take action against an employee because they made (or proposed to make) an inquiry or complaint about their employment, or expressed dissatisfaction with their workplace conditions. Those working in the private sector have protections under the Fair Work Act 2009, which makes it illegal for an employer to dismiss or threaten to dismiss a nurse or midwife because they have made an inquiry or complaint about their employment. Heavy penalties apply to both individuals and corporations if found to have taken adverse action against an employee.
DECEMBER 2015 TQN 5
Q u e e n s lan d ne ws
Lady Cilento Children’s Hospital – nurses and midwives take action A lot has been happening at Lady Cilento Children’s Hospital (LCCH) in the past month, with nurses and midwives standing up to intense media scrutiny and ensuring their voices are heard at a public, political and workplace level. Following weeks of negative media attention, members from the LCCH QNU branch held a well-attended meeting to discuss the impact this reporting was having on patients and their families, as well as nurses and midwives. Members were particularly concerned overblown media reporting could put children at risk by discouraging people from seeking medical help at the hospital.
Branch members decided to write a letter to the editor, which was sent to all Queensland newspapers and radio and TV stations. The letter attracted unprecedented age, support on the QNU’s Facebook page, reaching more than 165,000 people, e, and generating a flood of comments, ‘likes’ kes’ and shares. It was great to read so many comments ments of support from the public, which highlighted the wonderful work nurses urses and midwives are doing, as well as the positive experiences people have had ad at the hospital.
Funding fast-tracked, health lth minister meets with nursess and midwives ked The state government has fast-tracked 70 its plans to provide an additional $70 million to fund more beds and staff ff at the LCCH over the next four years.. While there are plans to open an extra 31 permanent overnight beds, s, the QNU insisted more nurses and d midwives must be recruited before the beds are opened. s, Following a request from members, Health Minister Cameron Dick and Deputy Premier Jackie Trad also attended a branch meeting in November to hear about hospital operations and concerns directly from nurses.
Joint QNU/LCCH working group established QNU officials also met with LCCH management and agreed to establish a joint weekly working group to collaboratively devise solutions to address nursing shortages across the hospital. This working group will focus on recruitment, retention, escalation of identified issues, and strategies to promote nursing.
6 TQN DECEMBER 2015
To the Editor,
We are the hi ghly skilled an d experienced pa ediatric nurses of the Lady Cilent o Children’s Ho spital (LCCH). Our job is ph ysically and em otionally demanding bu t we have dedi cated our lives to w orking hard to care for our young pa tients. As paed iatric nurses we expe ct to have toug h days at work and be either elated or devastated by outcomes for those in our care. What we did not expect was to become the fo cus of inaccu rate and extremel y hurtful med ia. We are saddened and stressed by the impacts some recent report s are having on ou r patients, pr ospective patients and colleagues. We fear the co ntinued repo rting of unfounded al legations agai nst our hospital coul d discourage families from coming here—and liv e depend on this hospita l and the care we provide. In ad dition, these often inaccurate re ports are real ly hurting the staff that care for the st ate’s sick children.
The LCCH is a new service m ade up of two previo usly separate hospitals. Significant ch ange on this scale takes time an d we will cont inue to work with man agement to en sure any concerns are identified and addressed. LCCH has deliv ered thousand s of positive outc omes. Sadly th ese stories do no t attract the sa me amount of m edia scrutiny. We ask that the med ia and our fe llow Queenslande rs support ou r hospital and its staff w ho save youn g live on a daily basis. Yours sincerel y, Members of th e Queensland Nurses’ Union (QNU), LCCH branch.
www.qnu.org.au
QUEENSLAND NEWS
QNU Toowoomba Hospital Branch Conference BY KYM VOLP, QNU COUNCILLOR, TOOWOOMBA HOSPITAL BRANCH MEMBER
An evening with three informative speakers, supper on the deck of the local golf club, and an engaging Q&A panel has become a proven recipe for local nurses and midwives who look forward to their Local Branch conference each year. With more than 200 nurses, midwives and other guests attending, the fourth Toowoomba Hospital Branch conference marked another successful project in building QNU strength and visibility in the Toowoomba region.
Patient safety and ratios on agenda Darling Downs Executive Director of Nursing and Midwifery Robyn Henderson addressed practice governance with a focus on the meaning of human care. Robyn outlined the challenges of care in a complex system driven by community demand, in particular the nursing needs of older Australians. Patient safety expert Dr Fiona Hawthorne from the Gold Coast University Hospital clinical governance unit also returned by popular demand. Fiona presented coronial case studies in sepsis and foetal monitoring exposing risks in escalation and clinical handover. Finally, QNU researcher Kate Veach outlined the principles of our Ratios Save Lives campaign, clarifying the steps towards ratios legislation and the 2016 implementation phases.
As always, branch members excelled in the decorations and hospitality along with the professional event marketing and organisation. Proceeds will go to charities including APHEDA and the Hamlin Fistula Hospital. Funds are also allocated to new activists participating in next year’s QNU Conference. The Toowoomba Branch encourages and offers any assistance to other branches keen to strengthen their local profile. The branch ‘crew’ is proud to have grown the conference project now known widely as one ‘not to be missed’.
Jill Holloway,
RN (Downs Su perior Nursin Toowoomba) g Agency, winner of the Toowoomba Ho spital Branch quilt raffle.
Local conference draws big crowds Nurses and midwives from public, private and aged care sectors attended as did members from various QNU Local Branches, including the Gold Coast, Warwick, Dalby and Nanango. Also in attendance were QNU Secretary Beth Mohle and Assistant Secretary Sandra Eales, as well as other QNU staff from professional, industrial, organising and QNU Connect. We note with serious gratitude the generosity and support of the QNU and other branches.
www.qnu.org.au
QNU Secretary Beth Mohle (centre, in red) and QNU Assistant Secretary Sandra Eales (right) with members of the Toowoomba Hospital Branch.
DECEMBER 2015 TQN 7
QUEENSLAND NEWS
Women celebrated at 2015 Emma Miller Awards
Website up and running
Congratulations to QNU member Julie Ann Burgess for being the recipient of the 2015 Emma Miller Award.
The QNU’s lovely new website went live on 16 November and despite a few teething problems is now open for business.
The Queensland Council of Unions hosted the annual awards night in October to celebrate the achievements of female union members. Julie (pictured middle of photograph) works at Nambour General Hospital and is a QNU Councillor. She’s always at the forefront of any activity, and dedicates much of her time to defending and supporting nurses and midwives. Julie has played a pivotal role in numerous campaigns, not least the long-running campaign galvanising the Sunshine Coast community against the privatisation of the Sunshine Coast Public University Hospital. She has also been heavily involved in EB campaigns since EB5. QNU Secretary Beth Mohle said Julie was a worthy Emma Miller Award recipient.
There is plenty for visitors to explore including an expanded CPD section, so why not jump on and take a poke around? To log on to the member site you will need to: 1. Click the ‘Sign in’ button at the top of the QNU webpage—
Emma Miller Award recipient Julie Burgess (centre) with QNU Secretary Beth Mohle (left) and QNU Assistant Scretary Sandra Eales (right).
“Julie is certainly a dynamic and determined union member,” Beth said. “Her energy and enthusiasm makes a big difference to our campaigns and union activity.” The annual awards are held in honour of Emma Miller—a strong advocate for women’s and workers’ rights in Queensland in the last century. A Brisbane seamstress and suffragette, Emma Miller is best known for her work forming the first women’s union in Brisbane in 1890.
www.qnu.org.au
2. Click ‘Forgot My Password’. 3. Enter your email address as your user name (not your member number). 4. Click ‘Submit’. 5. You will then receive an automated email at this address with a link where you can create a new password. 6. If you have trouble, contact the QNU Membership Team on (07) 3840 1440.
CHRISTMAS CLOSURES ARRANGEMENTS Queensland Nurses’ Union
Queensland Health
The QNU offices in Brisbane, Toowoomba, Bundaberg, Rockhampton, Townsville and Cairns will close from 3.30pm on Thursday 24 December and will reopen at the regular starting time of 8.30am on Monday 4 January. During this time members who need emergency advice or assistance should ring the Brisbane office on (07) 3840 1444 or 1800 177 273 (toll free outside Brisbane) and leave a message. 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 has released compulsory closure and leave arrangements for the 2015-16 Christmas New Year period. Please note that as prescribed employers, Hospital and Health Services may now set their own closure dates. However, at the time of going to print, the QNU understands the dates below cover all QH employees. If new information is received, we will update members via email. Please note part-time employees are only entitled to the concessional leave day when Monday 29 December would be one of their regular, ordinary days of work.
8 TQN DECEMBER 2015
Day
Date
Leave
Fri
25 Dec 15
Christmas Day public holiday
Mon
28 Dec 15
Boxing Day public holiday (in lieu of Boxing Day 2015 falling on a Saturday)
Tue
29 Dec 15
Concessional day (leave on full pay without debit)
Wed
30 Dec 15
Annual/recreational leave, TOIL or accrued hours
Thu
31 Dec 15
Annual/recreational leave, TOIL or accrued hours
Fri
1 Jan 16
New Year’s Day public holiday
www.qnu.org.au
QUEENSLAND NEWS
Work progressing to improve career and classification structure The QNU has been working to refine the current career and classification structure for nurses and midwives employed by Queensland Health, to make it more innovative and responsive. There have been some significant achievements so far, including: developing new models and positions such as continuity models of midwifery, and ‘Nurse Navigators’ recognising the key role of senior nursing positions in governance acknowledging advanced practice nursing. However, there have also been some difficulties. A number of draft reports produced during EB7 remain in draft form and were never endorsed. During EB8, the QNU progressed work on the career and classification structure with a focus on providing a choice of
accessible and rewarding career paths, and effective succession planning and management. Unfortunately, this work stalled after the election of the Newman government in 2012. The achievements from EB8 were limited to re-drafting the relevant Queensland Health policy to reflect the change to Hospital and Health Services and the revised Clinical Services Capability Framework, as well as an agreement on a process for evaluating ENAPs.
EB9 presents new opportunities Recognising this important work was unfinished heading into EB9, the QNU and representatives of executive nurses in the public sector set up a workshop to progress the work done so far. What followed was an unprecedented step whereby the QNU and the public sector’s representatives engaged in a
progressive industrial relations process, adopting an interest-based problem solving approach in which both parties work collaboratively to reach a solution. This process, which set out to reconsider the EB8 objectives, was facilitated by federal and state industrial relations commissioners. The group explored the interests of both parties and brainstormed options to develop an evidence-based career and classification structure with a robust succession planning framework. The findings of recent research commissioned by the ANMF were also considered in relation to advanced practice in nursing—specifically for refining the grading and evaluation process across nursing and midwifery positions. The QNU holds great hopes for this new, revitalised approach to enhancing the career and classification structure. It will be a significant feature of EB9.
QNU and public sector executive nurse representatives at the November workshop.
www.qnu.org.au
DECEMBER 2015 TQN 9
QUEENSLAND NEWS
Talking about your workplace issues Our mission of standing up for nurses and midwives and getting our voices heard continues to be the major focus of the QNU. We have organised various activities over the past few months to engage and encourage nurses and midwives to stand up and speak out.
Activities at Logan Hospital Staff at Logan Hospital had the chance to speak with QNU Secretary Beth Mohle and Assistant Secretary Sandra Eales during a tour of the hospital. Local MP Shannon Fentiman also visited, and heard directly from staff about their workplace issues, including workloads and the importance of the ratios legislation. Staff also spoke about midwifery issues, including Community Midwifery Service provisions and continuity of care models for expectant mothers. This tour was in addition to a very successful QNU@Work day at the hospital. There was a steady flow of nurses and midwives visiting the QNU stall throughout the day to discuss their workplace issues with organisers. Several nurses from the Central Sterilising Services Department even won a boost to their pay packets after approaching QNU staff with a group grievance regarding their entitlements (see full story on page 13).
Shannon hle (2nd from left) and pital. QNU Secretary Beth Mo Hos an Log from ses with nur Fentiman MP (centre)
10 TQN DECEMBER 2015
Nurses from the Adm ission, Discharge & Tran sfer Ward at Toowoomb Hospital with QNU Org a Base aniser Jenni Ballantyn e (centre).
Toowoomba Hospital ratios blitz Following a successful professional conference from the Toowoomba Hospital branch (see page 7), members and QNU officials decided to conduct a blitz of the hospital the following day. Nurses and midwives spoke to hospital staff about ratios, and an impressive 61 members signed up to become Patient Safety Advocates. We spoke to well over 180 people. The response was overwhelmingly positive, and included a couple of new members joining the QNU.
NaMCFs give voice to nurses and midwives In late October, QNU Secretary Beth Mohle, along with Queensland’s Ch Nursing and Midwifery Chief Officer Dr Frances Hughes, O attended a Gold Coast HHS at Nursing and Midwifery N Consultative Forum (NaMCF). C The meeting was well attended by nurses and midwives, and staff n rraised a number of issues including rrostering and new graduates. NaMCFs provide an important N platform for QNU delegates and p hospital management to come h ttogether to resolve workplace issues at an early stage, and ensure nurses and midwives at every level have a voice.
Beth also spoke about ratios with staff at the Gold Coast and Robina hospitals, as part of our ongoing workplace information sessions.
Gold Coast raffle prompts member letter The Gold Coast University Hospital branch recently conducted a raffle, which raised money for the branch. The prize—a beautiful hand-made doll— was won by Janette French. Janette wrote the QNU an insightful letter about why reflecting on one’s work practice is so important, and what she intends to do with her raffle prize. You can read an edited version of her letter and a photo of Janette and herdoll in Your Say on page 4.
QNU Secretary Beth Mohle and Chief Nursing and Midwifery Officer Dr Frances Hughes speaking at the Gold Coast HHS NaMCF.
www.qnu.org.au
QUEENSLAND NEWS
Domestic violence leave for public sector employees Queensland public sector employees will have access to a minimum 10 days of paid leave for domestic and family violence related issues. Workers will be able to take these days either consecutively or individually, and will not need to supply supporting documentation. The QNU will be negotiating for private employers to include similar domestic and family violence leave arrangements in future enterprise agreements. Look out for full details in tqn February 2016.
Report highlights entrenched attitudes The initiative was announced as the federal government released a report highlighting disturbing attitudes towards domestic violence in the wider community. The research showed there were high levels of ‘victim blaming’, and a strong desire to avoid blaming men for violence against women. It also found many actions of domestic violence were considered ‘social misdemeanours’ rather than behaviours that should be corrected and modified. QNU Secretary Beth Mohle said Australia still had a long way to go to fixing this epidemic. “These disturbing attitudes are clearly entrenched in the way many people think, but this sort of research is vital if we are to break the cycle,” said Beth.
www.qnu.org.au
Union Training COURSE FEBRUARY Professional Culpability - Where do I stand? QH EB9. Better work. Better life. Being a QNU Contact in the workplace MARCH QH – How to make the BPF work for nurses and midwives Assertiveness Skills QH EB9. Better work. Better life. QH EB9. Better work. Better life. QH – How to make the BPF work for nurses and midwives Conflict Management Skills QH EB9. Better work. Better life. QH EB9. Better work. Better life. Assertiveness Skills Knowing your entitlements & understanding the Award! Creating a safe workplace (WH&S) Private Sector – Tactics to overcome hostility QH – How to make the BPF work for nurses and midwives Handling grievances in the workplace APRIL QH – How to make the BPF work for nurses and midwives Assertiveness Skills QH EB9. Better work. Better life. QH EB9. Better work. Better life. Building teams to grow our voice Branch Development 1 & 2 Professional Culpability-Where do I stand? Being a QNU Contact in the workplace MAY Private Sector – How to bargain and what to do when bargaining goes wrong! Someone should do something about that! Workplace Representatives 1 QH – How to make the BPF work for nurses and midwives Building teams to grow our voice QH – How to make the BPF work for nurses and midwives
Date
Location
23 Feb 24 Feb 25 Feb
Brisbane Brisbane Brisbane
1 Mar 1 Mar 2 Mar 8 Mar 9 Mar 10 Mar 8 Mar 10 Mar 11 Mar 15 & 16 Mar 17 Mar 22 Mar 23 Mar 23 Mar
Brisbane Gold Coast Gold Coast Toowoomba Toowoomba Toowoomba Cairns Townsville Townsville Brisbane Brisbane Sunshine Coast Sunshine Coast Brisbane
12 Apr 13 Apr 15 Apr 12 Apr 13 Apr 19 - 21 Apr 27 Apr 28 Apr
Mackay Mackay Rockhampton Hervey Bay Hervey Bay Brisbane Brisbane Brisbane
4 & 5 May
Brisbane
10 & 11 May 17 - 19 May 24 May 25 May 27 May
Brisbane Brisbane Cairns Cairns Townsville
TO ENROL IN THESE COURSES— visit the QNU website at www.qnu.org.au OR contact your local QNU office and ask them to send you a form OR ring the training unit in Brisbane on 3840 1431 or toll free 1800 177 273
DECEMBER 2015 TQN 11
QUEENSLAND NEWS
Blue Care appeal denied but QNU confirmed as union for Personal Carers The Fair Work Commission has dismissed the QNU’s appeal that the Blue Care/ Wesley Mission Brisbane nurses’ agreement applied to two of our Personal Carer (PC) members. The two members who were the subject of the long-running case were representatives of PCs working in residential aged care in Blue Care. The QNU argued they and other Blue Care employees doing the same work were actually doing the work of Assistants in Nursing, not PCs. Unfortunately, Blue Care’s decision to employ PCs instead of AINs, together with the outcome of the appeal decision, means PCs will get paid approximately $1.50 an hour less than they
would have if they remained classified as AINs under the nurses’ agreement.
PCs can join the QNU One positive outcome from the decision, however, is that it has been confirmed beyond doubt that PCs employed by Blue Care in residential aged care facilities can join the QNU. The QNU will now be actively pursuing improved entitlements for PCs, including trying to get them paid the same amount as AINs. The current Blue Care/Wesley Mission Brisbane Care and Support Agreement expires next year. The QNU will be at the bargaining table seeking better wages and conditions for PCs just as we have for AINs and nurses. What’s more, any employee who is classified as a PC and who works in a residential aged care facility doing the work traditionally done by AINs is eligible to become a QNU member. Contact QNU Connect on 3099 3210 for further details.
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12 TQN DECEMBER 2015
www.qnu.org.au
WORKPLACE WINS
QUEENSLAND NEWS
QNU members racking up the workplace wins Getting a workplace win isn’t always easy, but as the cases below show, with persistence and determination it can pay off.
Fatigued nurse wins $38k A Queensland nurse who lodged a claim for fatigue leave backpay has won $38,000 with assistance from the QNU. The claim was made under clause 6.7.2 of the Queensland Health Nurses and Midwives Award 2012, which states: “An employee is to be allowed a rest break of not less than 10 hours between the termination of one shift and the commencement of another provided that, upon agreement in writing between the employee and employer, this break may be reduced to 8 hours. Where the required break of 10 hours (or 8 hours by agreement in writing) has not occurred, the employee will be paid double rates until released from duty for such a duration.” The nurse did not receive 10 hours break after working a number of late and early shifts, and was not paid double rates even though there was no written agreement between the nurse and the employer that the break could be reduced to 8 hours. A lengthy paper trail had to be followed to establish the shifts worked and the circumstances around the breaks. Commendations must go to the member for persevering with the claim. The win shows the value of knowing your entitlements—sometimes it can pay off !
www.qnu.org.au
AINs receive correct penalties after raising concerns A group of AINs at Logan Hospital and Redlands Hospital have had a significant win after realising they weren’t being paid their correct penalty entitlements. AINs who hold a Certificate III in the Central Sterile Services Department had not been receiving their 15% loading for evening shifts or their full 100% penalty rate for shifts worked on Sundays. The group contacted the hospital’s payroll, but after no success tracked down some QNU Organisers during a QNU@Work day, held in October. The QNU sent hospital management a letter on behalf of the AINs outlining the award and what the AINs should be receiving. The good news is the members’ entitlements will be fully returned in their first December paypacket. Management have also agreed AINs will receive 12 months’ back pay, which they will receive within four to six weeks. We’ll be following this up to ensure members receive what they’re rightfully due!
How can we help? The QNU assists hundreds of nurses and midwives every week. Our team—consisting of Servicing, Industrial, Occupational Health and Safety, Professional and QNU Connect—is here to help you when you have a workplace issue or need advice.
September/October figures:
Dollars recovered on behalf of members
$156,558 Members assisted (new matters)
487
QNU Connect calls received
3310
#winning DECEMBER 2015 TQN 13
N at i o n al n e w s
Nurses and midwives say ‘free children from detention’ Nurses and midwives around Australia have rallied for the government to release children from immigration detention centres, claiming Australia’s detention policies are not good enough. About 300 health staff from the Lady Cilento Children’s Hospital, including nurses and midwives, rallied outside the hospital in October, unveiling a banner which read “No detention 4 kids” and “Detention harms children”. The event, which gained significant media attention, followed a similar demonstration in Melbourne a few weeks earlier. The rally in Melbourne was attended by about 1000 nurses, doctors and clinical support staff.
Rallies draw support from government The public protests prompted one member of the Turnbull government, Russell Broadbent, to speak out about his own government’s detention policies. “Women and children in detention, behind razor wire in this country
14 TQN DECEMBER 2015
or locked away on an island, is unacceptable,” Mr Broadbent said, adding that the views of hospital staff represented those of wider Australia. “When the people shift, the politicians will shift,” he said.
QNU stands against children in detention QNU Secretary Beth Mohle said the union strongly supported nurses and midwives protesting against keeping children in detention. “The safety, health and wellbeing of people is a test that any government policy must pass, and it’s clear that holding children in detention does not pass that test,” said Beth. “All children should be housed and cared for in the community with their family, and we call on the federal government to release all children from detention.” According to the Australian Border Force’s most recent report from 31 August, there are currently 93 children being held on Nauru and 104 children in detention in Australia.
Health funding cuts will impact services Pressure continues to mount on the federal government not to proceed with a new funding model which would see $57 billion ripped from the public health service. The government’s 2014/15 budget included plans to move to a new public hospital funding model, which would see money distributed based on population growth and the consumer price index rather than the current activity-based funding, which is calculated from services provided. This will result in $57 billion being cut from public hospitals by 2024/25— including $11.8 billion from the Queensland health budget.
FNQ to be hit hard The federal government’s cuts are expected to include $609 million stripped from northern Queensland’s health services. A Senate Select Committee looking into the new model heard evidence indicating the cuts would result in an annual reduction of 149 nurses, 43 allied health professionals, and 42 doctors for Cairns and the wider north Queensland region. The Chair of the committee, NSW Senator Deborah O’Neill, said the Turnbull government’s proposal went “against the evidence base and is constructing a perfect storm of rising health costs into the future”. QNU Secretary Beth Mohle said the cuts would have a dramatic impact on quality of care and universal access to healthcare. “As we approach the next federal election, the current government really needs to ask itself if cutting access to quality health care is a priority,” she said. “Hospital admissions, emergency presentations, outpatient services, and mental health placements—all these vital services will break under the proposed funding cuts.”
www.qnu.org.au
Inte rna t i ona l ne ws
New York nurses conference hears from Queensland It’s been two years since Jill Furillo, the Executive Director of the New York State Nurses Association (NYSNA), attended our Annual Conference and delivered an inspiring speech about the need to protect Medicare against privatisation. And the bond formed between our two unions at that time was clear to see in October this year, when the QNU had an opportunity to address the NYSNA 2015 convention and share with New York nurses the lessons we’ve learned in our campaigns to defend our professions and secure ratios. More than 700 New York nurses attended the conference to celebrate their union’s achievements. During a packed schedule, delegates also heard from QNU Secretary Beth Mohle via a video message in which she spoke of solidarity and support for the New Yorkers’ campaign to achieve legislated ratios. Beth spoke about the QNU’s ratios campaign and the need for nurses to stand together to protect universal health care.
Social justice leads agenda During the conference the New York nurses convened the first Committee for Social Justice and Civil Rights gathering, with special guest Dr Camara Jones, who is the research director on social determinants of health and equity at the American Public Health Association. Delegates also heard from one of the first nurses who treated an Ebola patient in New York. Nurses also lobbied US lawmakers for safe staffing and universal healthcare.
Nurses learn from each other Private and corporate ownership of hospitals in the US brings a range of challenges. For example, New York nurses often face hospital closures, staff cuts and dollardriven health care.
www.qnu.org.au
While Queensland nurses and midwives are working to defend the world-class system we currently have, New York nurses are campaigning to introduce a public single-payer system similar to our Medicare system. But both groups share the common goal of championing nursing and midwifery values, and we have much to learn from one another as we all aim to deliver the best possible care. New York State Nurses Association Annual Conference
New Zealand midwives take stand on pay equality In what is said to be New Zealand’s biggest equal pay challenge, hundreds of midwives have filed to sue the government for paying them less because they’re women. With no substantial pay increase in the past two decades, New Zealand midwives claim they earn 60% less than male-dominated professions requiring similar qualification levels. Midwives argue this is in breach of gender rules under the New Zealand Bill of Rights Act 1990. The College of Midwives claims that, despite self-employed midwives earning about $100,000 a year from the government, this amounts to just
$53,000 before tax due to the expense of running a business. In New Zealand, about half of all midwives work as Lead Maternity Carers, who are self-employed and community based. They are paid by the government but are classed as independent midwives, and deliver midwifery care throughout all stages of a woman’s pregnancy. The government has offered to give midwives $40 more for each child, but midwives say it’s not enough after 20 years of very little pay increases. For full details, visit www.sundaystartimes.co.nz
DECEMBER 2015 TQN 15
C am p ai g n n e ws
Campaign to save our penalty rates launches The federal government is facing increased pressure to keep its hands off penalty rates thanks to the Protect Our Penalty Rates campaign we launched last month.
“On a Sunday I earn an extra $127 in the pocket thanks to my penalty rates. That money is a grocery bill,” said Mary. “If we lose penalty rates, something else will have to give.”
Protecting penalty rates will be a major issue heading into the next federal election. Launching the campaign at a media conference last month, the QNU, together with the Queensland Council of Unions and other affiliated unions, sent a unified message to Malcolm Turnbull’s government that workers, including nurses and midwives, won’t allow our welldeserved penalty rates to be scrapped.
Remembering why we have penalty rates
QNU member speaks for all nurses and midwives During the launch, Mary Stranaghan, who has worked in aged care for more than 30 years, spoke about the importance of penalty rates to her and her colleagues. “We care for people that can’t care for themselves,” Mary told a crowd of workers. “Our work is physically hard and emotionally demanding. “I personally work on Sunday, and quite often I have to miss family barbecues and my grandchildren’s birthdays—time with my family I can’t replace because I am caring for others. “I’m working Christmas day this year and while I enjoy my job caring for my residents, my penalty rates make up for me not spending that time with my own family.” Mary said penalty rates can make up to 30% of a nurse or midwife’s fortnightly pay cheque.
QNU Secretary Beth Mohle said without penalty rates, many nurses and midwives could be forced to leave the jobs they loved. “Nurses and midwives do not down tools and walk away when the clock hits 5pm,” said Beth. “They are there for us 24 hours a day, seven days a week to birth babies and provide round the clock care for those on post-operative wards or in our Intensive Care Units, Emergency Departments and many other areas. “Without penalty rates these staff would not be able to work the unsociable hours expected of them and I fear our hospitals could become ghost towns.” So far, the Productivity Commission has refrained from recommending cuts to penalty rates for nurses and midwives— but we know it will be the beginning of a slippery slope if the government successfully abolishes penalty rates from other industries.
Campaign goes public Over the last month, nurses, midwives and QNU staff have been out and about at all hours of the day discussing the importance of penalty rates with the community. It’s all about making the issue visible to the public, and that’s why we’ve been
IMPORTANT NOTICE FOR MEMBERS Public holidays not worked Have you submitted a survey response to the QNU indicating you wish the QNU to investigate your employer’s failure to pay you for public holidays you have not worked or deducting your leave on public holidays? If you have, and you cease employment with that employer, you remain entitled to be paid properly, but you must remain a member of the QNU for us to investigate for you. If you are not working at all, you may become a passive member. You can check or change your membership by visiting the member’s section of the new QNU website. www.qnu.org.au and Just visit sign in with the email address you have registered with the QNU. visiting hospitals, QUT Gardens Point, and the Red Hill and Beenleigh markets. Feedback from the public has been overwhelmingly positive—people understand the importance of our penalty rates and believe we should be compensated for working unsociable hours. The real challenge is getting the government to listen and understand this.
Want to help? If you haven’t already, please sign our Change.org petition by visiting http://chn.ge/1QwKtme and add your name to the list of those who support penalty rates.
We also have a parliamentary petition cosponsored by Federal MP for Griffith Terri Butler, who will present it to parliament. Protect Our Penalty Rates rally in Brisbane.
16 TQN DECEMBER 2015
www.qnu.org.au
CAMPAIGN NEWS
EB
BETTER WORK. BETTER LIFE.
The campaign for a new public sector enterprise agreement is well under way. Award modernisation has wrapped up— so public sector nurses and midwives now have an updated award—and the QNU is meeting with Queensland Health every week to discuss EB9. The primary focus of EB9 is creating a more positive work experience for nurses and midwives, both at work, and in life. At work, this can be done by using the BPF and ratios to relieve heavy workloads, increasing the number of nurses and midwives, and improving on call, recall and fatigue management. In life, this can be done by reducing the factors which can negatively impact our lives outside work—things like workplace stress and rostering practices.
Award modernisation Award modernisation has finished, with the Queensland Health Nurses and Midwives Award – State 2015 and the Queensland Health Framework Award 2015 both updated. The modernisation has not been a major re-write. Nurses and midwives have lost no current conditions. Rather, the new awards have updated wording and a new more modern form. It is important to note that no modern award will apply until after EB9 is certified in 2016. Until then, the relevant awards for Queensland Health nurses and midwives will continue to be the Queensland Health Nurses and Midwives Award – State 2012 and the Queensland Health Framework Award 2012.
www.qnu.org.au
EB9 EB9 is being conducted using the Interest-Based Problem Solving (IBPS) framework, where parties identify mutually agreed interests, then work toward solutions and better practices. For nurses and midwives, the interests are determined at Annual Conference, with input from branch delegates from all around the state. In this way, the democratic process of the QNU ensures every public sector member has the opportunity to feed into the EB9 negotiations. As a result, the QNU has identified and presented at the negotiating table the following key priorities for nurses and midwives: strengthening nursing and midwifery governance and decision making enhancing job security evolving the career and classification structure for nurses and midwives improving workload management improving skill mix and quality of care improving reporting and accountability improving the industrial relations culture and environment improving workforce planning achieving acceptable wages maintaining existing entitlements and improving key working conditions and leave arrangements such as on call and recall arrangements, RANIP, and rostering.
... NO MODERN AWARD WILL APPLY UNTIL AFTER EB9 IS CERTIFIED IN 2016. As is always the case with enterprise bargaining, members—through their local branches—are encouraged to provide input and play an active role in determining the final outcomes of EB9.
Getting to the nitty gritty Many members will have already started receiving joint EB9 communiques from Queensland Health and the QNU. However, due to the nature of these early meetings where parties have been working to identify shared interests, our communications have been quite limited. The good news is we are now moving past these broader discussions and are starting to knuckle down into the nitty gritty part of negotiations. Therefore, in the New Year there will be more opportunities for us to communicate our progress.
EB
DECEMBER 2015 TQN 17
RATIOS SAVE LIVES
RATIOS ON TRACK EXCITING NEWS!
The Hospital and Health Boards (Safe Nurse-To-Patient and Midwife-To-Patient Ratios) Amendment Bill 2015 has officially been introduced into parliament. On 1 December, nurses and midwives watched from the gallery at Parliament House while Health Minister Cameron Dick introduced the ratios Bill for its first reading. This was a historic moment for nursing and midwifery in Queensland, and a significant milestone for our campaign to achieve legislated ratios in all sectors. The Bill will legislate for a minimum of one nurse to four patients during morning and afternoon shifts, and one nurse to seven patients during night shifts in prescribed locations in Queensland public health facilities.
Where will ratios be rolled out first?
Kym Volp, Genoveva Phillips, Lauren Picker, Celia Volp, QNU Secretary Beth Mohle, Merewyn Janson, and QNU Assistant Secretary Sandra Eales at Parliament House witnessing this historic moment for nurses and midwives.
If the Bill is passed, ratios will begin rolling out in a phased manner from 1 July 2016. See table 1 for locations. The government has said these locations will cover 80% of medical and surgical beds in Queensland. Although not everybody in the public sector is covered, this is a significant starting point. These prescribed locations can apply for an exemption of up to six months from the 1 July 2016 implementation date based on a number of factors, including financial viability or staff supply. This time would allow hospitals to ensure there is a correct balance between resource supply and service demand to meet the required ratios.
18 TQN DECEMBER 2015
Beth speaking at a joint press conference with Premier Annastacia Palaszczuk and Health Minister Cameron Dick prior to the ratios legislation being introduced into parliament.
www.qnu.org.au
RATIOS SAVE LIVES
FOR ROLLOUT TABLE 1
For those public sector services not covered Facilities proposed for first phase of implementation
Public sector health service facility
Acute wards Medical
Surgical
Atherton Hospital
Bundaberg Hospital
Caboolture Hospital
Cairns Hospital
Caloundra Hospital
Gladstone Hospital
Gold Coast University Hospital
Gympie Hospital
Hervey Bay Hospital
Innisfail Hospital
Ipswich Hospital
Logan Hospital
Mackay Hospital
Mareeba Hospital
Maryborough Hospital
Mount Isa Hospital
Nambour Hospital
Princess Alexandra Hospital
Queen Elizabeth II Jubilee Hospital
Redcliffe Hospital
Redland Hospital
Robina Hospital
Rockhampton Hospital
Royal Brisbane and Women’s Hospital
Prince Charles Hospital
Toowoomba Hospital
Townsville Hospital
Warwick Hospital
www.qnu.org.au
Mental Health
While introducing the Bill to parliament, Health Minister Cameron Dick reaffirmed the government’s commitment to seeing ratios rolled out across those areas not currently covered by the Regulation. “I also want to assure those nurses here today that this is not the end of our commitment to safe nurse to patient and midwife to patient ratios. This is just the first step,” said Mr Dick. “We will be working with nurses and their representatives to look at those areas not covered by the Regulation to consider the appropriate ratios for those areas.” In the meantime for those employed by Queensland Health who are not included in the initial ratios rollout, you still have the BPF as your workload management tool. In fact, all Queensland Health nurses and midwives are already covered by the BPF, which trumps the minimum ratios. Legislated ratios are a safety net, and can be improved using the BPF.
Where to from here? Submissions for the ratios parliamentary inquiry are due on 12 February, and hearings will be held on 16 March, with potential hearings in regions to be confirmed. It is vital nurses and midwives voices are heard. The parliamentary debating process will begin after the other two core elements of the legislation—the Regulation and the Standard— are finalised in March 2016.
The Bill was presented to Parliament for a first reading—this occurred on Tuesday, 1 December.
The Health and Ambulance Services Committee (made up of a group of government and non-government Members of Parliament) considers the Bill. The committee must prepare a report on the Bill by 29 April 2016, before the second reading debate.
If, after the second reading, the Bill is passed by Parliament then each clause of the Bill is debated and amendments can be made—this is known as “consideration—in-detail”.
A third and final reading of the Bill then occurs, which may incorporate any agreed amendments to the Bill made in the consideration-in-detail process outlined above.
The Bill is read a second time and the committee report considered - this is known as the “second reading” (this is expected to occur early in 2016).
Two copies of the Bill are presented to the Governor for Royal Assent. Upon assent, the Bill becomes an Act of Parliament—the Act becomes law (the Act for ratios is expected to commence on 1 July 2016).
DECEMBER 2015 TQN 19
RATIOS SAVE LIVES
RATIOS MYTH BUSTING How are ratios being funded? Unfortunately there is some misinformation out there regarding ratios funding. We’ve been hearing from nurses and midwives who have been incorrectly told the money to pay for ratios will come directly from individual NUMs’ and MUMs’ budgets. The truth is, it will be up to each Hospital and Health Service to allocate appropriate funds to implement the minimum ratios. If hospitals are already applying the BPF (as they should be), legislated ratios would not change anything, as they would already be meeting the required ratios. However, we know in many workplaces this is not the case. HHS annual reports show a number of organisations across the state are generating substantial surpluses—in some cases in excess of millions of dollars. While HHSs must operate within reasonable budgets, the drive to carry over budget surpluses must not be to the detriment of nurses and midwives or the quality of patient care. Finding money for ratios is about prioritising patient safety ahead of profits or other non-essential work.
The government’s other nursing commitments—including employing 400 Nurse Navigators and 4000 nursing and midwifery graduates over the next four years—will also help meet the ratios.
Who exactly is included in the ratios? The QNU has stated from the very beginning that only nurses and midwives providing direct care to patients should be included in the minimum ratio. Nurse/Midwifery Unit Managers, Clinical Nurse Educators/Facilitators, Clinical Nurse Consultants, and Nurse Practitioners should not be included in the ratio. However, the ratios Bill does not explicitly state this.
We’ll continue to pursue that only those providing direct care be included in the ratios.
Will midwives get ratios too? Eventually, yes. However, further consultation is still required to negotiate how ratios can work in conjunction with continuity of care models. As a result, maternity wards are not included in the initial rollout phase of ratios. Work is currently underway with Queensland Health and key maternity stakeholders, including the QNU, to work out how ratios can best be applied to meet the specific needs and requirements of midwifery practice.
Could services be reduced or staff taken from other wards to meet the required ratios? Introducing ratios is about ensuring there are enough nurses and midwives to meet patient and clinical demand— not reducing services to align with the number of nurses and midwives the service currently employs. The government says it will recruit an additional 250 nurses at a cost of $25.9 million to help meet the ratios.
20 TQN DECEMBER 2015
www.qnu.org.au
RATIOS SAVE LIVES
Ratios in the private and aged care sectors -
how are we going to get there? There’s been a lot of hype about legislated ratios being implemented in Queensland public health facilities—but what about nurses and midwives who work in the private and aged care sectors? We know workloads in many private hospitals and aged care facilities are becoming unmanageable, and ratios can’t come soon enough. There are a number of reasons why ratios are being introduced in the public sector first, the main one being the Queensland government’s commitment made prior to and after the January election. However, this was always intended to be a long-term campaign right from when we launched our original claims back in January 2015. No matter where Queenslanders are being cared for, we think they have the right to expect the same high quality care—and that includes in private hospitals and aged care facilities.
Will private and aged care employers ever adopt ratios? We believe once ratios are established in the public sector, other sectors will follow. With legislated ratios, conditions will start improving in the public sector and it will be much harder for other employers to resist following suit. In the US, private hospitals have learned the best way to get a competitive edge is to have better health and financial outcomes than rival hospitals.
www.qnu.org.au
The good news is all the research points to ratios producing better health and better financial outcomes—and this will ultimately be the biggest incentive for private employers.
QNU will be lobbying employers to adopt ratios… To help speed up this process, however, the QNU will be including ratios in future log of claims when it comes time to negotiate new agreements in private hospitals and aged care facilities. By that time, the process of rolling out ratios in the public sector will be well under way, so we’ll be in a much stronger position to make these claims.
…but it ultimately has to come from nurses and midwives Ultimately, though, our ability to lobby individual employers to include ratios in new agreements will largely be determined by the level of activity from staff working on the ground—nurses and midwives. Management will be more inclined to consider and implement ratios if their own staff present a united front at the negotiating table.
The QNU will of course be there to help with this process, and will guide members on the best ways to campaign for ratios.
What can we do now to prepare? If you’re currently working with unsafe workloads, the most important thing you can do right now is submit workload reporting forms whenever you have a workload problem. The more information we have about workload problems, the more evidence we will have to support our claim for safe ratios. Employers find it harder to ignore concerns when forms are submitted by a group of nurses or midwives—so you can also organise with your colleagues to submit forms on behalf of your team. You can also register as a Patient or Resident Safety Advocate. Once registered, you’ll join a growing list of over 1000 nurses and midwives who will receive updates from the QNU on what activities you can do to progress the road to ratios. To register phone 3099 3228 or email smckell@qnu.org.au Remember, it’s all about working together and being active in the campaign to achieve ratios in your workplace.
DECEMBER 2015 TQN 21
Fe at u re
Election issue
2
Bringing our hospitals into the 21st century 22 TQN DECEMBER 2015
www.qnu.org.au
ELECTION ISSUE 2: BRINGING OUR HOSPITALS INTO THE 21 ST CENTURY
Our last edition of TQN focused on fairness at work—namely the importance of our penalty rates—as one of the key issues for nurses and midwives heading into the next federal election. Another issue of equal importance is the project to make our health care system innovative and sustainable. It is vital we ensure our health care system is flexible and responsive, whether that be through technological advancements or new policies. Health care about people, not budgets Our public health care system—one of the best in the world—is a vital service to the Australian community, not a business run for profit. That’s why this federal election we’ll be asking all political parties to commit to policies that aim to strengthen our health care system, rather than simply look for ways to cut funds. And the best way to guarantee our health system is strong is to invest in our nursing and midwifery workforce and ensure they are part of the solution to challenges.
Shifting from acute to preventative The Australian health care system is predominately stuck in an expensive acute care model, which is indeed unsustainable. An acute care-focused model is impacting the nature of our health workforce. It may also cause health workforce shortages because more acute beds are needed to keep pace with population growth and increased sickness. There is an urgent need, therefore, to shift the focus from an acute to a preventative health model.
www.qnu.org.au
Investing in primary health care and health promotion will ultimately ease the burden on our hospitals and save money in the long run. Primary health care, through personal care and health promotion, supports the prevention of illness through community participation and development. Nurses and midwives are well placed to deliver health care services through new and innovative models of care—particularly those specialising in midwifery, community care, sexual health, occupational, mental, Indigenous and child health. However, despite being well equipped and qualified, nurses and midwives often have limited capacity to provide safe and competent primary health care due to limitations in prescribing and referral rights, and being undervalued and underutilised.
Investing in innovation There are numerous ways governments can strengthen nurses’ and midwives’ ability to deliver primary health care. And by enabling nurses and midwives to do what they do best, the innovation and sustainability of our health care system will naturally follow.
DECEMBER 2015 TQN 23
Fe at u re NURSE NAVIGATORS Nurses and midwives are the foundation of our health care system. Creating new nursing and midwifery roles is therefore a logical investment to help sustain our ability to deliver safe patient care. The Queensland government’s new Nurse Navigator model of care aims to do just that. An extra 400 nurses will be employed, all with expert clinical knowledge and an in-depth understanding of the health system. These new Nurse Navigators will work with patients who have complex care needs over the entire health care journey. Nurse Navigators will help patients navigate from their referring primary care provider, through hospital-based care, and back home again. A Nurse Navigator may assist patients with developing a care plan, being the
patient’s key point of contact, liaising with other care providers on the patient’s behalf to obtain information, and scheduling appointments. The required experience of each Nurse Navigator will depend on the scope of practice needed at individual hospitals. Staffing these positions is about matching demand with supply.
Room for new models at federal level There are also opportunities to implement Nurse Navigators in sectors funded by the federal government. It is vital the federal government invests in delivering genuine patient-centred health care in the aged care, primary health care, and community sectors. This means prioritising health maintenance and prevention rather than
cost cutting, which ultimately causes more problems in the long run. As we did during the state election, the QNU will be consulting with and seeking commitments from political parties in the upcoming federal election to ensure there is a plan to implement innovative ideas that look beyond the budget bottom line. The ANMF has already passed a motion to lobby all major political parties to “fund the creation of ‘Nurse Navigator’ positions to be employed in primary health and aged care settings”. Complementing the positions being introduced in Queensland, these Nurse Navigators would be responsible for improving the co-ordination of patient care across health care settings and sectors.
MIDWIFERY MODELS OF CARE Considering new midwifery models of care can also help create a more flexible health system. Giving expectant mothers access to primary maternity care managed by a midwife improves outcomes, especially for rural and disadvantaged women. It provides higher levels of satisfaction and safety, and reduces costs. Although federal measures introduced in November 2010 were a significant structural reform to enable autonomous midwifery practice, access has been restricted to a small number of privately practising midwives (PPM). As the 2010 legislation only applies to PPMs, it has done little to loosen the shackles on midwifery practice in the public sector.
Giving more power to midwives Midwives need more equitable arrangements to assist or, at the very least, not suppress their practice.
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For example, ‘Rights of Private Practice’ arrangements similar to salaried doctors would ensure midwifery models of care are not disadvantaged within the HHS structures. In many facilities primary midwife patients are required to be admitted under a doctor’s name despite all care being provided by a midwife. This de-legitimises midwifery practice and gives power to doctors over development of midwifery models of care. However, a small number of state salaried midwives in Queensland rural sites have been able to utilise Medicare Eligibility to provide antenatal and postnatal care. This type of ‘Right of Private Practice’ arrangement could and should be extended to support developing more Caseload Midwifery services by enabling midwives to practice to their full scope.
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ELECTION ISSUE 2: BRINGING OUR HOSPITALS INTO THE 21 ST CENTURY
DIGITAL HOSPITALS Advancements in technology are also changing the operation of our health care system. While technology can never replace the role nurses and midwives play in keeping patients safe, it can certainly alter how we go about our work—not to mention enhancing our ability to care for our patients and residents. Integrated digital hospitals are one example of this. While integrated digital hospitals pose challenges for nurses and midwives (they require extensive training and a significant adjustment to how hospitals operate), more hospitals around Australia are slowly making the transition. This is eventually going to have a significant impact on how nurses and midwives deliver patient care. Like any new development in the workplace, nurses and midwives will need the proper training and support to realise the full benefits of this new technology.
What it means for nurses and midwives St Stephen’s Hospital in Hervey Bay is Australia’s first fully integrated digital
hospital, and has now been open for one year. Teresa Skerrat, a Clinical Nurse, has worked at the hospital since it opened and said although it has been a challenge, digital hospitals were the way of the future. “Each computer we use is like a filing cabinet,” Teresa said. “We have every piece of information at our fingertips all the time—all the patient’s history, all of the doctor’s and nurse’s records, all the medications, the care plans, everything. “It was a real challenge because it changes everything, including the way you communicate with each other, with your patients, and it changes your time management. “But it just takes time to learn to do things differently.”
Reduced errors and better patient outcomes UnitingCare Health Executive Director Richard Royles said once nurses and midwives were properly trained, the new technology would lead to better
patient outcomes and improved efficiency. “We’re already seeing a reduction in medication and transcribing errors,” he said. “And there’s clearly going to be benefits in clinical quality outcomes. “It’s been shown around the world that you can reduce readmissions because you have a reduction in errors, and you can reduce length of stay by the seamless transition of information.” Mr Royles said the technology also led to efficiency improvements. “For example, all the equipment in the hospital is tracked through barcode scanning, so the nurse doesn’t have to do any ‘hunting and gathering’,” he said. “If they need to find a wheelchair, they simply touch the screen and they see on the layout of the ward where it is.” While these new technologies may take some getting used to in the short-term, it’s about bringing our hospitals into the twenty-first century and ensuring we make the most of what technology has to offer.
What is the vision for a sustainable and innovative future in health care? Nursing and midwifery has always been about finding new and better ways of delivering quality care. We know what a sustainable and innovative future looks like, and we’re working every day to make it a reality. This upcoming federal election is an opportunity to lay the groundwork for the future of our professions. This means asking the hard questions of politicians. Exactly how will they support nurses and midwives to work to our full scope of practice? What plans do they have for innovative models of care? What will they do to ensure our hospitals and aged care facilities are ready for the technological future? We need to know each party’s vision for the future of Australian health care. And we’ll keep asking until we get the answers we need.
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DECEMBER 2015 TQN 25
PROFESSIONAL
New Enrolled Nurse Standards for Practice New Enrolled Nurse Standards for Practice will come into effect on 1 January 2016. The new standards expand the scope of EN practice, but also clearly position a named and accessible RN as the sole supervisor and primary resource person for an individual EN. The new standards reflect the current content of NMBA-approved programs of study for Enrolled Nursing. Each standard has several indicators which outline what the EN must do to meet the standard.
The path to new standards The NMBA appointed Monash University to review the Enrolled Nurse Competency Standards in 2013. The QNU made a comprehensive submission regarding the content of the standards. There was general agreement among stakeholders that the Competency Standards should be renamed “Standards for Practice” to effectively distinguish nursing professional standards from workplace healthcare certificates that are not regulated by the NMBA.
ENs must still be supervised by RNs It is important to note the NMBA continues to reserve autonomous and independent nursing practice as the exclusive role of the RN. The NMBA states in the introduction to the EN Standards for Practice: “Core practice generally requires the EN to work under the direct or indirect supervision of the RN… The need for the EN to have a named and accessible RN at all times and in all contexts of care for support and guidance is critical to patient safety.”
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This places a mandatory requirement upon ENs, RNs and employers to ensure appropriate supervision is provided by a named and accessible RN at all times, so patient or resident safety is not compromised.
Professional and Collaborative Practice standards The new domain of Professional and Collaborative Practice contains three standards. There are some significant changes to practice, as well as better clarification of the EN role and responsibilities. Indicators include: Provides nursing care according to the agreed plan of care, professional standards, workplace policies and procedural guidelines. Recognises the RN as the person responsible to assist EN decisionmaking and provision of nursing care. One significant change in this domain is contained in Indicator 3.8, which now authorises the EN to supervise care provision by AINs or EN students: Provides support and supervision to assistants in nursing (however titled) and to others providing care, such as EN students, to ensure care is provided as outlined within the plan of care and according to institutional policies, protocols and guidelines.
Provision of Care standards The new domain of Provision of Care contains four standards, and also helps to clarify the role of the EN. Indicators include: Accurately collects, interprets, utilises, monitors and reports information
regarding the health and functional status of people receiving care to achieve identified health and care outcomes. Develops, monitors and maintains a plan of care in collaboration with the RN, multidisciplinary team and others. Prepares and delivers written and verbal care reports such as clinical handover, as a part of the multidisciplinary healthcare team.
Reflective and Analytical Practice standards The new domain of Reflective and Analytical Practice contains indicators that help understand the role of the RN in EN practice. For example: (The EN) refers to the RN to guide decision-making. Consults with the RN and other relevant health professionals and resources to improve current practice. Identifies learning needs through critical reflection and consideration of evidence-based practice in consultation with the RNs and the multidisciplinary healthcare team. The new EN Standards for Practice can be found on the NMBA’s Professional Standards webpage: www.nursingmidwiferyboard.gov. au/Codes-Guidelines-Statements/ Professional-standards.aspx
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NURSING AND MIDWIFERY RESEARCH
L ong-term c OGnitive impairment and delirium in I ntensive Care (LOGIC): A prospective cohort study
BY DR RACHEL WALKER AND ASSOCIATE PROFESSOR MARION MITCHELL
Dr Marion Mitchell (right), Associate Professor Critical Care, Princess Alexandra Hospital and Chelsea Davies (left) discuss CAM-ICU scores.
Published research has reported more than 50% of ICU cohorts experience deficits in memory, attention, concentration, processing speed and visual spatial abilities for up to two years following discharge from hospital (Jackson et al 2003, Hopkins et al 2005, Hopkins et al 2006). A review by Jackson et al (2004) found delirium, which is an acute and often fluctuating disturbance of consciousness and cognition, was a predictor of cognitive impairment. The reported incidence of delirium in ICU patients, has ranged 20%-45% in Australia (Roberts et al 2005, Shehabi et al 2008), and is linked to poorer clinical patient outcomes including prolonged mechanical ventilation, and increased ICU and hospital length of stay. Hence more research is needed to determine the association with patients at 3 and 6 months post-discharge.
The study A prospective cohort study was undertaken within a 25-bed ICU. Adult medical and surgical ICU patients who received 12 or more hours of mechanical ventilation were assessed daily for delirium using the Confusion Assessment Method (CAM-ICU). Cognitive testing was then conducted 3 and/or 6 months post-ICU discharge using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Mini Mental State
Examination (MMSE), and the timed Trail Making Tests (TMTA &B). Of the 148 participants recruited, 91 (60%) completed either one or two follow-up assessments at 3 and/or 6 months.
The findings The average age of participants was 57 years.
They received an average 2.2 days of mechanical ventilation and remained in ICU for 4.3 days. Delirium occurred in 14 participants (19%), although only 5 (7%) experienced delirium on multiple days. At 3 months post ICU discharge, 27 (36%) patients were assessed as cognitively impaired using the RBANS and 2 (2.3%) using the MMSE At 6 months 17 (22%) patients were assessed as cognitively impaired using the RBANS and 4 (5.1%) using the MMSE 24 (32%) were impaired using the TMT A at 3 months and 18 (27%) at 6 months. 36 (49%) were impaired using the TMT B at 3 months and 26 (38%) at 6 months. Delirium was associated with cognitive impairment at 6 months for the TMT A (Point Estimate =7.86[0.7-17.9], p=0.03) and the TMT B (Point Estimate =24.0 [0.9-59.5], p=0.04) assessments. The positive association of delirium with long-term cognitive impairment suggests strategies are needed to improve ICU care to reduce cognitive deficits.
References Hopkins RO, Weaver LK, Collingridge D, et al (2005) “Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome”, Am J Respir Crit Care Med 171(4), 340-7. Hopkins RO, Jackson JC (2006) “Long-term neurocognitive function after critical illness”, Chest 130(3), 869-78. Jackson JC, Gordon SM, Hart RP et al (2003) “Six-month neuropsychological outcome of medical intensive care unit patients”, Crit Care Med 31, 1226-34. Jackson JC, Gordon SM, Hart RP et al (2004) “The association between delirium and cognitive decline: a review of the empirical literature”, Neuropsychol Rev 14, 87-98. Roberts B, Rickard C, Rajbhandari D, et al (2005). “Multicentre study of delirium in ICU patients using a simple scoring tool” ACC 18(1), 6-16. Shehabi Y, Botha JA, Boyle MS et al (2008) “Sedation and Delirium in the intensive care unit: an Australia and New Zealand perspective”, Anaest Intensive Care 36, 570-78.
Acknowledgements Funding for this project was received from the Princess Alexandra Hospital Foundation, Australian College of Critical Care Nurses, and Griffith Health Institute.
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DECEMBER 2015 TQN 27
C A S E ST U DY
Continuing professional development
Getting sued in 140 characters or less GIRI SIVARAMAN AND ALANA HEFFERNAN, MAURICE BLACKBURN LAWYERS
Of late there have been a number of high profile figures using defamation proceedings to address adverse comments in the media.
Joe Hockey: Joe Hockey recently successfully sued Fairfax Media in relation to an article in The Age that had the headline, “Treasurer for Sale”. Interestingly, it was not the article itself that drew the ire of the Court, but rather the tweet which contained a hyperlink to it. The tweet read: “Treasurer for Sale”. The Court was also critical of the editor in the matter, claiming he had lost his objectivity in creating the headline and was motivated by malice. Mr Hockey received $200,000 in damages for the tweets. In awarding the damages, the Court noted that with Twitter, unlike the actual newspaper, a reader is less likely to go beyond the 140 character or less What is defamation? Defamation occurs where a statement: 1. is defamatory (ie. injures a reputation) 2. refers to the person or organisation being defamed, or the person or organisation’s identity is known to the recipients, and 3. is published. There is no longer any distinction between “libel” and “slander”, so the courts treat a verbal publication in the same manner they treat a written publication. In fact, the Defamation Act 2005 provides an extensive list of examples of “publications” which can be the subject of defamation proceedings, including:
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headline, and consider the context of the matter.
Bruce Flegg: In Queensland, former MP Bruce Flegg recently received a successful judgment in his defamation proceedings against his former media advisor, Graeme Hallett. Hallett had publicly alleged that Dr Flegg was, among other things, unfit to hold office. Dr Flegg subsequently resigned from his ministerial position. Dr Flegg was awarded a total of $775,000 in damages against Mr Hallett, which included $500,000 in respect of his resignation from his ministerial role, which he claimed he was forced to do following Mr Hallett’s public statements about him. 1. an article, report, advertisement or other thing communicated by means of a newspaper, magazine or other periodical 2. a program, report, advertisement or other thing communicated by means of television, radio, the Internet or any other form of electronic communication 3. a letter, note or other writing 4. a picture, gesture or oral utterance and 5. any other thing by means of which something may be communicated to a person. The courts have specifically considered the following examples to be “publications” for the purpose of defamation proceedings:
Teacher vs student: While it was the first high profile case involving Twitter, it was not the first social media case. Another example includes the case of Mickle v Farley [2013] NSWDC 295, where a teacher successfully sued her student for $105,000 damages in respect of defamatory Facebook posts, which were published on the belief that the teacher had been involved in the departure of his father—a former head teacher—from the school. As employees, colleagues and medical practitioners, it is important to know that comments you make, including and especially on social media, can give rise to defamation proceedings.
1. Newsletters 2. Campaign material (i.e. bumper stickers) 3. Speeches 4. Radio broadcasts 5. Social media posts 6. Photo-shopped images 7. Posters and signs In 2013, Senator Hanson-Young successfully sued Bauer Media Group, who published the magazine Zoo Weekly, in relation to a photo-shopped image of her face on the body of a bikini model next to a caption which read that the magazine would “house the next boatload of asylum seekers in the Zoo office” if Ms Hanson-Young agreed to a “tasteful” bikini or lingerie shoot.
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CONTINUING PROFESSIONAL DEVELOPMENT
What limitations are there on suing for defamation? It should be noted there are limitations on who can sue for defamation, and when they can sue. Government authorities and most corporations are excluded from initiating defamation proceedings. In particular, unless the corporation has fewer than 10 employees or the objects for which it is formed do not include financial gain, a corporation has no cause of action for defamation. Furthermore, a person alleging defamation must initiate proceedings within one year of the defamatory publication.
Hospitals and aged care facilities It is important to note that several aged care facilities and hospitals are non-profit organisations, which means they may not be excluded from initiating defamation proceedings. This means employees’ statements, including comments on social media, can be the subject of defamation proceedings— by both colleagues and employers.
Defamation and AHPRA Notifications to, and information given in the course of investigations by, the Australian Health Practitioner Regulation Agency can also be the subject of defamation proceedings. The Health Practitioner Regulation National Law Act 2009 provides a defence—where the notification was made honestly and in good faith. This ought to be kept in mind when making any notification or providing information against a practitioner. “Good faith” is not defined in the legislation, but notifications and
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information ought to be concise, factually accurate and not coloured by perception. Notifications and information should not be based on hearsay or capable of being perceived as serving an ulterior purpose.
Do not admit liability. The QNU or your lawyer can advise you as to whether the accusation has grounds and what, if any, remedial action should be taken.
Defences against defamation There are a number of other defences available to people who are accused of defamation, including honest opinion, contextual truth, triviality, innocent dissemination, qualified privilege, publication of public documents, fair reports of proceedings of public concern, justification and absolute privilege. Most of these defences are complex and involve technical legal considerations. If required to provide information in an investigation, or making a notification, seek advice from the QNU.
What should you do if you are accused of defamation? The first step to defamation proceedings is a “concerns notice”. This is usually in the form of a letter that outlines the alleged defamation, damage suffered by the person, and contains details of how the recipient can make amends. Before responding to a concerns notice, it is very important to seek advice. Concerns notices usually have deadlines for responses, so make sure the advice is sought within that deadline. You should immediately try to identify the people or groups of people that the publication may have been communicated to. Do not make any further publications which may, or may not, constitute defamation without first seeking legal advice.
Reflective exercise for case study over page
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C A S E ST U DY
CONTINUING PROFESSIONAL DEVELOPMENT
Completing this reflective exercise will contribute to your Continuing Professional Development (CPD) hours. The Nursing and Midwifery Board of Australia requires all nurses and midwives to complete a minimum of 20 hours CPD per registration year for each respective profession for which the individual holds current registration.
Reflective exercise: Defamation The NMBA states that continuing professional development includes activities that develop your personal as well as professional qualities. Reading and reflecting upon this article can assist you in both your private life and in the professional arena. Nurses and midwives discuss issues of relevance and reduce information to writing every day.
Many of our members also engage in social media. The NMBA provides good guidance on the use of social media by nurses and midwives, but it is also important to ensure you protect your personal liability as well.
Please refer to www.nursingmidwifery board.gov.au/ Registration-Standards. aspx for full details.
Questions
It should include:
looking for learning points/objectives within the content on which you reflect considering how you might apply these in other situations to enhance your performance changing or modifying your practice in response to the learning undertaken.
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6.
It is just as important to know what not to say or write, as well as what is required.
For example, an individual who is a Registered Nurse and a midwife must complete 40 hours of CPD.
Effective learning is not simply reading a journal article—it requires you to reflect on your readings and integrate new information where it is relevant to improve your practice.
5.
7.
8.
1. What are the three elements of defamation? 2. If you only stated a disparaging comment about a person, would that be the same as writing it? 3. If you wrote a subjective or sarcastic comment in the progress notes for a patient, could that be seen as defamation? Why or why not? 4. This would be an opportune time to add to your CPD hours by reading and reflecting on pages 89-90 of the QNU publication “Nurses and the Law” about documentation. This publication is free
for members and can be found on the members’ website. We all know not to write about patients or residents on social media, but what about commenting on your work colleagues or your employer? How can that be dangerous? If you have not already reviewed the NMBA’s policy on social media, doing it now will also contribute to your CPD hours. www.nursingmidwiferyboard.gov.au/ Codes-Guidelines-Statements/Policies/ Social-media-policy.aspx When stating or writing something about a person, does it matter that you didn’t mean to offend them? Why should your written words, both at work and at home, always be factual and objective? To meet the NMBA CPD standard it is important that you can produce a record of CPD hours, if requested to do so, by the board on audit. The time spent reading this article, reviewing the referenced material and then reflecting upon how to incorporate the information into your practice will contribute to your CPD hours. Please keep a record of time spent doing each activity in your CPD record.
THE FOLLOWING IS AN EXAMPLE ONLY OF A RECORD OF CPD HOURS (based on the ANMF continuing education packages): Date
Topic
Description
Learning Need OR Objective
Outcome
CPD hours
27-03-14
Coroner’s matter – workloads
Understanding the implications of the Coroner’s recommendations for the establishment of effective workload management strategies
To increase my knowledge about the consequences of workloads demands and skill mix deficits on patient safety
I have achieved a greater awareness of…..
2.5 hrs
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BUILDING BETTER WORKPLACES
Having time to care
SANDRA EALES ASSISTANT SECRETARY
When we talk about “good work environment”, we are talking about a culture that values and respects professional nursing and midwifery as a force for quality patient outcomes. We can measure the elements of the workplace which are attractive to nurses and midwives, and which keep patients safe. Each edition we will focus on one element of the Practice Environment Scale, Nursing Work Index. These are: 1. Enough nurses to provide care of reasonable quality. 2. Participation by nurses in hospital governance and decision-making. 3. Responsiveness of management in resolving problems in patient care. 4. Excellent communication and collaboration between doctors and nurses. 5. Investment in highly qualified nurse workforce. 6. Institutional commitment to quality and safety driven by nursing. This month let’s focus on the first element. Nurses and midwives must have time to care. Everywhere I go I hear nurses and midwives talking about being overwhelmed.
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They are anxious and frustrated by the unsafe workloads and lack of control they experience daily. They talk about lack of staff, increased activity, acuity, intensification of work, more tasks, less time, and no time to reflect or engage in critical communications. Nursing and midwifery is not simply “doing” tasks. There must also be time to think. Indirect care time is needed for aspects of nursing and midwifery which—while conducted away from the patient—are still focussing us on the patient and ensuring safety. There must be time to learn and teach. How does your workplace measure up? Is it attractive to nurses and midwives, and safe for patients? Do a quick scan to assess your work unit this week: Were there gaps in the roster when it was published? How many? How often are there shift gaps or skill mix deficits at time of publishing the roster? How many nurses have missed meal breaks? Have you had the correct nurse/ midwife:patient ratio on all shifts? How many shifts had inappropriate skill-mix? Any double shifts worked? How much unpaid overtime was done by nurses? Did you get all the work done which you knew needed to be done? Did you feel good about the quality of care you were able to provide? Did you participate in any indirect care activities which support patient safety? (e.g. case conference, peer supervision, unit meetings)
Taking time to sharpen the axe Two woodcutters, Bill and Ben, were competing to see who could fell the most trees in one day. They worked next to each other in the large forest and after an hour or two of swinging together, Bill paused. Ben recognised his chance to get ahead, and carried on chopping even harder. A short while later the sound of both men’s axes resumed in concert again. Another hour went by, and Bill again ceased work for a few minutes. Ben became more confident that he would win as Bill’s “stop and start” continued for the rest of the day. At the end of the day, however, Ben, who was drenched in sweat, hungry and exhausted, was surprised to discover that Bill had felled more trees. “How did you beat me when you kept stopping to have a break?” he asked. “Ah,” said Bill, “I wasn’t just having a break, I also sharpened my axe.” Our professional equivalent to sharpening the axe is taking time out for reflective practice.
DECEMBER 2015 TQN 31
MIDWIFERY
A separate career and classification structure for midwives The need for a separate career and classification structure for midwives has been identified and discussed within the nursing and midwifery profession over many years. The QNU has previously put this position forward through EB negotiations without success, but is hopeful that during EB9 the matter may be progressed as a structural adjustment aiming to empower midwives. Midwifery practice is misunderstood when viewed through the nursing frame and constrained in a medical model, and has an uphill battle to maintain the orientation, identity and function necessary to deliver on woman-centred primary maternity care.
Different scopes of practice Scope of practice and understanding of advanced practice is one significant point of differentiation between midwifery and nursing. For example, the practice elements needed to deliver comprehensive midwifery in a woman-centred model include being able to request diagnostic and pathology services and prescribing rights as part of provision of normal antenatal care. In nursing this element of practice has been fixed firmly in advanced practice, usually at Nurse Practitioner level.
Structural bias against midwives This bias in the established system acts as a barrier to midwives working to their full scope. Consider this, Health Management practices for Drug Therapy Protocols for midwives have existed to support full scope of practice since 2008. Yet relatively few midwives are able to utilise them as the local executive level will not sign off.
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Federal measures introduced in November 2010 to give midwives access to Medicare and the Pharmaceutical Benefits Scheme were a significant structural reform to enable autonomous midwifery practice. Yet access has been restricted—by medical interests—to a small number of privately practising midwives (PPMs). This means there has been minimal effect towards loosening the shackles on midwifery practice in the public sector.
More equitable arrangements needed More equitable arrangements are required to assist or, at the very least, not suppress midwifery practice. For example, ‘Rights of Private Practice’ arrangements similar to salaried doctors would ensure midwifery models of care are not disadvantaged within the Hospital and Health Service (HHS) structures. In many facilities, primary midwife patients are currently required to be admitted under a doctor’s name despite the midwife providing all care. This de-legitimises midwifery practice and in effect gives power to doctors over the development of midwifery models of care.
of worker which further fragments care by spreading midwives thinner. The QNU is concerned that at least one private hospital here in Queensland has already introduced an unskilled, unregulated level of worker into the space between the woman and the midwife, a “baby care assistant”.
Direct Midwifery pathways The direct pathway to midwifery (BMid) rather than via nursing is sometimes seen as problematic when viewed in the medical paradigm—but it is fit for purpose to deliver the best outcomes for women in a social model of health care. A direct and visibly achievable, stepped pathway to becoming a midwife is important for growing our future workforce—particularly if we want to improve outcomes for disadvantaged groups such as indigenous or ethnic minority groups who have the most to gain from having access to midwives grown out of their own communities. Work through EB9 negotiations on a separate career and classification structure will help address some of the issues identified here.
Workforce development There is a critical shortage of midwives and there have been varied responses to this. The optimal response is to plan, resource and facilitate employment and education arrangements to grow our own midwives. The other course is to carve off aspects of the midwife role for another, cheaper tier
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INDUSTRIAL
QNU submission for Queensland’s industrial relations review The QNU has lodged a submission for the review of Queensland’s industrial relations laws and tribunals. The review will affect workers employed by the Queensland government, including nurses and midwives in the public sector. The last comprehensive review occurred in 1998, and since that time the private sector has moved into a national workplace relations system. The government has established the Industrial Relations Legislative Reform Reference Group to examine (among other matters): The best arrangements for the regulation of industrial relations in the state public sector. How to support and balance the sustainable achievement of job security and fair wages and conditions. How to improve workplace productivity and best practice service delivery. The structure, role, functions, powers and independence of tribunals in the state industrial relations system. How best to deal with contemporary and emerging industrial relations matters (for example, workplace bullying, domestic and family violence, gender equality, work-life balance, and changes in standard working arrangements such as telecommuting and working from home).
Review to provide new opportunities The Reference Group includes representatives from the government,
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unions (including QNU Secretary Beth Mohle), employer groups, academics, and industrial relations experts. The review is an opportunity to consider the responsibilities of a public sector workforce operating in a global economy. Technology, climate change and international trading will have significant effects on all sectors. Therefore, the QNU made a comprehensive submission involving a raft of recommendations. Some of these included: Wages and conditions, including policies, should be standardised across HHSs. The relationship between directives and other instruments should be clearly articulated in legislation. The government should undertake a review of current public service arrangements to optimise permanent employment opportunities in line with government policy for job creation and security. Award parties should be able to request awards be made or varied at any time. The government wages policy sets the minimum amount of increase. The parties may agree on further efficiency or effectiveness measures for the delivery of public services providing this does not result in a reduction in staff numbers or skill mix. The government opens up further discussion about modernising and streamlining the Industrial Relations Act to give effect to objective, proportionate, appropriate and
consistent governance principles and financial reporting standards. The QNU’s submission also outlined that existing objects of the Act be amended to include specific provisions for: Domestic and Family Violence leave (becomes a legislated Queensland Employment Standard) consultation with the workforce the right to organise shared decision-making job security flexible work practices ‘best practice’ public sector governance principles of fairness, independence and integrity ministerial responsibilities in respect to industrial relations, including the importance of an impartial, permanent public service diversity in the workforce government as a ‘model’ employer implied trust in the employment relationship a requirement that new employees be provided with an information sheet an entitlement for employees to request flexible working arrangements an appeal mechanism where the right to request flexible working arrangements is not approved.
DECEMBER 2015 TQN 33
OPINION
CHANGING PATTERNS OF ILLICIT SUBSTANCE USE -
challenges of treatment BY JANE O’CONNOR, CNC
QNU BREAKING NEWS As tqn was going to print, the federal government announced a $300 million investment into drug prevention programs, specifically targeted at ice. While this is a promising development, more information is still needed about the extent of the ice problem in Australia.
34 TQN DECEMBER 2015
As a RN working in a specialist alcohol and drug outpatient service over the last 13 years, recent media exposure of the so called ‘ICE epidemic’ has left me wondering what it takes to gain the attention of politicians—not to mention the much needed funding into a sector that has been overstretched and overlooked for so long.
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OPINION
After all, it is well known that tobacco and alcohol contribute significantly to the overall burden of disease both in Australia and globally. Non-communicable (largely chronic) diseases accounted for about 85% of the total burden of disease in Australasia in 2010 (AIHW 2014a). The largest contributors were cancer at 16%, musculoskeletal disorder at 15% and cardiovascular disease at 14%. Cancer contributed 35% and cardiovascular disease 23% to the fatal burden in 2010 (AIHW 2015). It should be no surprise that alcohol and tobacco are significant contributors to both cancer and cardiovascular disease. The harms from alcohol cost Australians $15.3 billion a year in 2013 (alcohol taxes only generate $7 billion) (AIHW 2014b). The cost to the public health dollar of these often long-term chronic diseases is enormous and unfortunately too often this is money spent too late. Alcohol, cannabis and tobacco remain the three most common presentations to specialist outpatient services.
Changing trend in substance use However, there has been a change over the last five years or so—and it seems increasingly over the last 18-24 months— with more clients presenting with poly substance use. While not entirely new, it is common. Previously, clients would prefer to use either stimulant drugs or depressant drugs, but not usually both. It is not uncommon now for clients to report that they use cannabis to come down from their methamphetamine (ICE) use. Or that they use a number of drugs in dangerous combination to potentiate the effects of the substances they are using. It is also true there has been an increase in methamphetamine (ICE) presentations. While clients have sought assistance for stimulant use in the past there has been a shift to increasing numbers of individuals using the pure crystalline form of methamphetamines (ICE). The significance of this is the deterioration in mental health (often
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psychosis) and social chaos that often accompanies methamphetamine use. And this seems to be the key to the somewhat alarmist approach taken by the federal and various state governments over recent months.
Methamphetamine use is changing, but not increasing My anecdotal observations are supported by the statistics. While there was no increase in the number of Australians using methamphetamines between 2010 and 2013, there was a significant increase in the number of individuals using the crystalline form, compared to the less potent powder form. Use of powder (speed) decreased significantly (50.6% in 2010 to 28.5% in 2013). Use of crystalline methamphetamine (ICE) more than doubled (21.7% 2010 to 50.4% in 2013) (AIHW 2014b). It also seems to be the case that the demographic of users has changed or at least widened. Increasingly we see working people, including professionals and those in the mining industry, seeking assistance for methamphetamine use that has become out of control and often ruined relationships, broken families, caused the loss of jobs and enormous debt.
Treatment of methamphetamine (ICE) use Presentations to outpatient services like the service I work in often follows an earlier presentation to the emergency department in acute distress, and often with an episode of psychosis. This is the presentation that the media and the public have been made so aware of—however has little to do with addressing the long-term use. Treatment of substance use and support provided for users to reintegrate into the community, regain their health and the trust of family and loved ones, occurs over a much longer period of time as clinicians work with them in a therapeutic environment of trust and respect. This can be slow, difficult work, often with relapses.
THERE IS NOTHING NEW ABOUT WHAT WE ARE SEEING TODAY. Increasingly, these presentations are complex, often with dual diagnoses and high acuity and associated high risk. It occurs out of the public gaze and many in the community do not want to know about it. However, we know that substance use remains a reality for many in the community. While those presenting at the acute end may be gaining increasing public and media attention, at the community treatment level the flow of clients seeking treatment continues. Specialist services continue to work with clients to develop sustained change to meet their long-term goals.
Changing the political focus to relapse prevention It is here in the relapse prevention phase of treatment and in upstream prevention initiatives that we need to encourage our politicians to place their focus for increasing funding. Substance use affects all sections of the community and has been a reality for centuries. There is nothing new about what we are seeing today. Perhaps what is new is the increased public awareness of the distress and dysfunction it can cause. But for workers in the sector, we hope this increased awareness will lead to an improved understanding of the complexities of substance use and its indiscriminate reach, and increased funding to treatment services to match public concern.
References: Australian Institute of Health and Welfare (2014a) Australia’s Health 2014, 4.1 Burden of Disease. Australian Institute of Health and Welfare (2014b) National Drug Strategy Household Survey detailed report 2013, Canberra. Australian Institute of Health and Welfare (2015) Australian Burden of Disease Study: fatal burden of disease 2010.
DECEMBER 2015 TQN 35
HEALTH AND SAFETY
QNU regains access to workplaces for health and safety QNU officials are now able to investigate suspected health and safety breaches without delay, after workplace entry restrictions implemented by the previous government were rolled back. Under previous legislation introduced by the Newman government, QNU officials who wished to enter workplaces to investigate suspected health and safety contraventions were required to give the employer 24 hours’ notice. At the time, our officials were made aware of circumstances when employers made superficial changes to the workplace to make them appear safer when our officials finally gained access. But that’s now a thing of the past. Once again, QNU officials who hold authorisation under the Work Health and Safety Act 2011 will be able to enter the workplace as soon as possible.
This is a very powerful tool to have at our disposal and is a particularly important development for your health and safety. That being said, the QNU has rarely needed to use this authority since we believe working with the employer co-operatively usually results in the best outcome. And of course, the knowledge that a QNU official may show up for an investigation without notice can itself be very effective.
HSRs also regain power to request immediate assistance Another legislative change made by the Palaszczuk government will allow Health and Safety Representatives (HSRs) to request the immediate assistance of others in addressing health and safety in their work area. This power had also been subject to the 24 hour notice period.
The real cost of workplace injuries is rising A new report from Safe Work Australia shows the cost of injuries and illness to Australian workers is not only disproportionate, but also increasing over time. According to The Cost of Workrelated Injury and Illness for Australian Employers, Workers and the Community 2012-2013, only 5% of the costs for workplace injuries fall to employers, while the remaining 95% is borne by workers (74%) and the community (21%). These figures show the heavy burden of workplace injury and illness on employees. The report, when compared with two previous reports, also shows the cost to workers is increasing over time.
36 TQN DECEMBER 2015
The QNU is very happy with these changes, having argued strongly against the previous government’s move to introduce the 24 hour notice period. Should members have any concerns around their safety in the workplace, do not hesitate to contact the QNU and we will assist.
New laws may see injured workers compensated Were you injured at work between 15 October 2013 and 31 January 2015?
These statistics confirm workers and their representatives must continue to work towards greater workplace health and safety protections and fair workers’ compensation systems. This has become particularly important in recent years, when governments at both federal and state levels have sought to water down protections.
QNU members who sustained a workplace injury that resulted in a permanent impairment of less than 5% between these dates may now be entitled to make a claim under a new Statutory Adjustment Scheme. This scheme has been established to compensate workers for loss of rights during this time. If you sustained an injury during this time and were denied access to common law remedy because of the LNP government’s changes, please contact QNU Connect immediately on 3099 3210 or 1800 177 273 (toll free for members outside Brisbane).
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YOUR SUPER
What’s the difference between salary sacrifice and employee after-tax contributions? Salary sacrifice (or before-tax contributions) is an arrangement between you and your employer. You consent to reduce your gross salary by a nominated amount, which your employer uses to increase their super contributions for you. Most employees entering a salary sacrifice arrangement expect their employer to continue making award or Super Guarantee (SG) contributions based on their pre-sacrifice salary. You should confirm this with your employer. Employee after-tax contributions are amounts paid from your after-tax income. You and your employer can arrange for these contributions to be deducted from your after-tax income and paid directly to HESTA on your behalf. We can only accept after-tax contributions if we have your tax file number (TFN). Government legislation requires an employer to pay after-tax contributions deducted from an employee’s salary to HESTA within 28 days of the end of the month in which the deduction was made. The government imposes substantial penalties on employers who fail to meet this legislative requirement. Salary sacrifice and after-tax contributions may have different tax benefits for you, depending on your personal circumstances.
How does divorce affect my super? It’s a sad statistic that over one-third of marriages in Australia end in divorce. However, the end of a relationship doesn’t have to mean the end to the retirement you’ve been dreaming of. Here’s what you can do now to make sure you’re prepared for the unexpected: • Check if you’re on track – our retirement income calculator is an easy way to work out how much income you can expect to receive and how long your savings are likely to last. • Make up for lost time by making voluntary contributions – you’ll be surprised the impact adding just 1% extra to your super has on your balance by the time you retire. After-tax contributions aren’t subject to the 15% contributions tax because you’ve already paid income tax on this money. And depending on your income, you may also be eligible for a government co-contribution. • Get us to search for any lost super you may have and consolidate it into your QSuper account – it’s a quick way to boost your super and save on extra fees and charges. • Review your investment strategy – we offer a range of options that not only let you choose your strategy, they let you choose how involved you get too. So whatever phase of life you’re in, we’ve got something to suit.
Get advice If you’re going through a separation or just want some advice, as a QSuper member you can access affordable personal advice from QInvest.1 You’re with a Fund that’s been awarded 2016 Fund of the Year by SuperRatings2.
We offer HESTA members personal advice about which contribution strategy might be appropriate for them — at no extra cost. If you require advice about making contributions, you can speak to a HESTA Superannuation Adviser. Call 1800 813 327 to make an appointment.
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With more than 25 years of experience and $32 billion in assets, more people in health and community services choose HESTA for their super.
2 SuperRatings does not issue, sell, guarantee or underwrite this product. Go to www. superratings.com.au for details of its rating criteria. Past performance is not a reliable indicator of future performance
This material is issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Information provided is of a general nature. It does not take into account your objectives, financial situation or specific needs. You should look at your own financial position and requirements before making a decision and may wish to consult an adviser when doing this. This information contains H.E.S.T. Australia Ltd’s interpretation of the law but should not be relied upon as advice. For more information, call 1800 813 327 or visit hesta.com.au for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products.
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If you want to talk through any of this information, we’re always here to help on the phone. Just call us on 1300 360 750 to get in touch. 1 QInvest is a separate legal entity responsible for the financial services and credit services it provides. Advice fees apply.
We need to let you know that this information is provided QInvest Limited (ABN 35 063 511 580, AFSL and Australian Credit Licence Number 238274) which is ultimately owned by the QSuper Board (ABN 32 125 059 006) as trustee for the QSuper Fund (ABN 60 905 115 063). All QSuper products are issued by the QSuper Board as trustee for the QSuper Fund. When we say ‘QSuper’, we’re talking about the QSuper Board, the QSuper Fund, QSuper Limited or QInvest Limited, unless the context we’re using it in suggests otherwise. We’ve put this information together as general information only so keep in mind that it doesn’t take into account your personal objectives, financial situation, or needs, shouldn’t be relied on as legal or taxation advice, and doesn’t take the place of this type of advice. Before you make any decision to acquire a product, or to keep hold of one you already have you should consider the PDS, which you can download at qsuper.qld.gov.au, or call us on 1300 360 750 for a copy. © QSuper Board of Trustees 2015. 8894 08/15.
DECEMBER 2015 TQN 37
C ale n d ar FEBRUARY World Cancer Day We Can. I Can. 4 February 2016 www.worldcancerday.org/ Chinese New Year 8 February 2016 Anniversary of the Apology (2008) 13 February 2016 Lung Health Promotion Centre at The Alfred 12-13 February 2016 - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au National Disability Services Conference 18-19 February 2016, Sydney www.nds.org.au/events/1413497081 4th National Elder Abuse Conference Ageism, rights and innovation 23-25 February 2016, Melbourne http://elderabuseconference.org.au/ QNU Union Training 23 February - Professional CulpabilityWhere do I stand? (Brisbane) 24 February - QH EB9. Better work. Better life. (Brisbane) 25 February - Being a QNU Contact in the workplace (Brisbane) www.qnu.org.au
2nd Annual National Family & Domestic Violence Summit 25-26 February 2016, Sydney www.informa.com.au/conferences/ health-care-conference/nationaldomestic-violence-conference Women’s Cancer Foundation – Ovarian Cancer Institute We Can Walk it Out 28 February 2016 www.womenscancerfoundation.org.au
MARCH QNU Union Training 1 March - QH – How to make the BPF work for nurses and midwives (Brisbane) 1 March - Assertiveness Skills (Gold Coast) 2 March - QH EB9. Better work. Better life. (Gold Coast) 8 March - QH EB9. Better work. Better life. (Toowoomba) 8 March - QH EB9. Better work. Better life. (Cairns) 9 March - QH – How to make the BPF work for nurses and midwives (Toowoomba) 10 March - Conflict Management Skills (Toowoomba) 10 March - QH EB9. Better work. Better life. (Townsville)
11 March - Assertiveness Skills (Townsville) 15 & 16 March - Knowing your entitlements & understanding the Award! (Brisbane) 17 March - Creating a safe workplace (WH&S) (Brisbane) 22 March - Private Sector – Tactics to overcome hostility (Sunshine Coast) 23 March - QH – How to make the BPF work for nurses and midwives (Sunshine Coast) 23 March - Handling grievances in the workplace (Brisbane) www.qnu.org.au Australasian Cardiovascular Nursing College Conference Celebrating 10 years 4-5 March 2016, Melbourne www.acnc.net.au/ Lung Health Promotion Centre at The Alfred 4-6 March 2016 - Asthma Educator’s Course 19-20 March 2016 - Smoking Cessation Course P: (03) 9076 2382 E: lunghealth@alfred.org.au Australian Dermatology Nurses’ Association Minor Skin Surgery 5-6 March 2016, Gold Coast, Qld www.dnea.com.au/gold-coast-5th6th-march-2016-minor-skin-surgery/
ADMA Evidence-based Primary & Secondary Prevention of Chronic Disease Seminar 11 March 2016, Melbourne www.adma.org.au 3rd Commonwealth Nurses and Midwives Conference Toward 2020: Celebrating nursing and midwifery leadership 12-13 March 2016, London UK www.commonwealthnurses.org/ conference2016/ Australian Pain Society 36th Annual Scientific Meeting Pain: Meeting the Challenge 13-16 March 2016, Perth www.dcconferences.com.au/aps2016/ 21st World Council of Enterostomal Therapists Biennial Congress Embrace the circle of Life 13-16 March 2016, Cape Town, South Africa www.wcet2016.com/ 6th Florence Nightingale Foundation Annual Conference 17-18 March 2016, London www.florence-nightingale-foundation. org.uk/ National Close the Gap Day 17 March 2016 Earth Hour 19 March 2016
If you would like to see your conference or reunion on this page, let us know by emailing your details to tqn@qnu.org.au
38 TQN DECEMBER 2015
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Be super confident with Australia’s Fund of the Year. QSuper was recently named SuperRatings1 Fund of the Year for 2016 – just another reason to feel secure that your future is in safe hands.
1 SuperRatings does not issue, sell, guarantee or underwrite this product. Go to www.superratings.com.au for details of its ratings criteria. This product is issued by the QSuper Board (ABN 32 125 059 006) as trustee for the QSuper Fund (ABN 60 905 115 063) so please consider how appropriate this product is for your personal needs. You can do this by downloading a copy of the product disclosure statement at qsuper.qld.gov.au or calling us on 1300 360 750 and asking for a copy. © QSuper Board of Trustees 2015. 9143 11/15.