TQN Vol35 [3] Jun16

VOL. 35 ■ NO. 3 ■ JUNE 2016

THE QUEENSLAND NURSE

HISTORY MADE!

Ratios to become a reality

ELECTION WRAP – the key issues for nurses and midwives

BRISBANE

BRISBANE

nov

Workplace Representatives 1

BRISBANE

TOWNSVILLE

TOWNSVILLE

Thurs 15

BRISBANE

Health and Safety Representative training for nurses and midwives

Mon 21 - Fri 25

GOLD COAST

Conflict Management Skills

Thurs 27

CAIRNS

Professional Culpability – Where do I stand?

Wed 12

BRISBANE

Coaching & Mentoring Skills – helping others succeed

Thurs 15 BUNDABERG

Assertiveness Skills

Courses are extremely popular and book out quickly.

Avoid being disappointed.

Get your enrolment in early.

CAIRNS

Being a QNU Contact in the workplace

Thurs 13

BUNDABERG

Private Sector – Tactics to overcome hostility

Wed 14

AUGUST - DECEMBER 2016

To enrol visit http://bit.ly/qnueducation or phone 3840 1431

Tues 15 - Thurs 17

Thurs 3

GOLD COAST

Professional Culpability – Where do I stand?

Wed 2

BRISBANE

Private Sector – Tactics to overcome hostility

Mon 31

GOLD COAST

QH – How make the BPF work for nurses & midwives

Wed 26

CAIRNS

QH – Consultative Committees – How to make them work

ROCKHAMPTON

ROCKHAMPTON

Fri 28

Work Matters – How to play to your strengths & manage your weaknesses

Knowing your entitlements & understanding the Award!

Wed 26 - Thurs 27

BRISBANE

BRISBANE

Professional Culpability – Where do I stand?

Tues 25

Wed 19 - Thurs 20

Knowing your entitlements & understanding the Award!

Tues 18

SUNSHINE COAST

SUNSHINE COAST

QH Rostering – Equity & work life balance

oct QH Rostering – Equity & work life balance

Tues 11

Wed 12 Handling grievances in the workplace

Tues 11

BRISBANE

Wed 14

QH – Consultative Committees – How to make them work

BRISBANE

Creating a safe workplace (WH&S)

Thurs 18

BRISBANE

Being a QNU Contact in the workplace

BRISBANE

BRISBANE

Work Matters – How to play to your strengths & manage your weaknesses

Tues 13

Fri 9

Handling grievances in the workplace

Tues 6 - Wed 7

TOOWOOMBA

TOOWOOMBA

Someone should do something about that!

sept

Wed 7 Assertiveness Skills

Mon 5 - Tues 6

BRISBANE

BRISBANE

Someone should do something about that!

Private Sector – How to bargain & what to do when bargaining goes wrong!

Wed 31 - Thurs 1 Sept

Assertiveness Skills

Being a QNU Contact in the workplace

Private Sector – Everything you wanted to know about your agreement but were afraid to ask!

Tues 23

AuG

Wed 17

Tues 16

Union Training Program

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 Gold Coast 14 Ashmore Road, Bundall Q 4217 (PO Box 5648, Gold Coast MC Q 9726) T 07 3099 3101 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.

www.qnu.org.au

VOL. 35 ■ NO. 3 ■ JUNE 2016

28 FEATURE Election wrap – the key issues for nurses and midwives

11

2 3 4 5 6 20 24 25

Your union Editorial Your say Tea room Queensland news National news International news Campaign news

22

28 32 33

40

Feature

40

Opinion

Professional

42

Profile

Nursing and midwifery research

44

Social

45

Library

46

Your super

Midwifery

47

Calendar

Health and safety

48

Advertising

34

Continuing professional development

37 38 39

Building better workplaces

JUNE 2016 TQN 1

YOUR UNION

If you don’t care ... we can’t care In the lead up to any federal election, the activities of the Australian Nursing and Midwifery Federation build apace.

YOUR COUNCIL

This year the ANMF is working very hard raising awareness, educating Australians, and lobbying those contesting a seat in parliament to keep health a major topic on the election agenda.

This forms the basis of the ANMF federal election campaign: If you don’t care…we can’t care.

In the white noise of the political marketing and polling in the lead up to July, not too many people are talking about health as a key election issue.

But there is much at stake.

Fifty-seven billion dollars was removed from national health funding in the 2014/15 federal budget … and it seems no one has plans to replace that funding.

To be clear, there are a raft of issues that should all be topics of debate this election. These include our universal health care system and how it should be funded, regulation of aged care workers and safe staffing levels, consumerdirected care, and nursing workforce recruitment and retention.

Issues around tackling climate change, closing the gap and reconciliation, rural and remote health, asylum seeker health, and penalty rates are also important.

We should care enough to be asking about them—as citizens and as nurses and midwives.

ANMF Federal Secretary Lee Thomas and Assistant Federal Secretary Annie Butler, as well as the campaign and professional teams, seek appointments with political leaders and spokespersons from political parties throughout the year. The QNU also meets with Queensland politicians to discuss issues that are specific to Queensland nurses and midwives.

This is one of the best ways we can promote to our key policy makers the positions of nurses and midwives in every sector across Australia.

These positions are always about safe patient care and protecting the public.

WE SHOULD CARE ENOUGH TO BE ASKING ABOUT THEM—AS CITIZENS AND AS NURSES AND MIDWIVES. However, in the lead up to an election, efforts are redoubled to meet with as many politicians and representatives as possible to discuss key health related issues, to gauge the parties’ responses, and influence their opinions. Through the QNU, many members are currently involved in meeting local MPs and candidates to talk about our issues.

The fact that this year hails a double dissolution election means there are more candidates to contact to discuss the issues of health, nursing, and midwifery.

SALLY-ANNE JONES QNU PRESIDENT It’s important for the ANMF to make the case for health and why it must be a major election issue.

The alternative, unfortunately, is the real risk that health could be overshadowed by other competing issues ... and health is too important to every Australian for that to happen.

People have to care about this.

Unless the public and politicians care about health, we will not be able to care for our patients and residents.

The community and our members want real policy and leadership on health care, not just rhetoric and statements unsupported by funding initiatives.

As our political leaders compete for our vote this election, the QNU and ANMF are urging them to use the campaign to show all Australians they do care about health care.

To understand more about where each of the major political parties stands on health issues, visit www.abc.net.au/news/201605-13/election-2016-policy-bigissues/7387588 www.qnu.org.au

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 JUNE 2016

www.qnu.org.au

EDITORIAL

Together we can make a difference

BETH MOHLE SECRETARY

Thursday 12 May 2016, International Nurses Day, was an historic day for Queensland nurses and midwives.

Just after 9.30pm, after more than four hours of debate, legislation enshrining minimum nurse/midwife-to-patient ratios in Queensland Health facilities became law.

This was indeed a fitting way to celebrate International Nurses Day! Those of us who sat in the Queensland Parliament gallery for the long debate struggled to contain our emotions.

After so many years of campaigning and political lobbying for safe workloads, an important milestone had been reached.

The daily work of nurses and midwives and our focus on delivering the highest quality of patient care possible was recognised in the parliamentary inquiry report into ratios and the resulting debate.

But it was our collective work through our union—our campaigning and political lobbying over so many years— that delivered this tangible recognition.

There are so many who contributed to this outcome.

Firstly, our local activists, those who had the courage to take a stand to highlight and address unsafe workloads in their workplaces.

These vital local campaigns are supported by the expertise and resources

www.qnu.org.au

of our union—Organisers, Professional Officers, Industrial Officers, Researchers, Communications, Campaigning and Training officials, and other staff.

Our union provides us with collective strength and common purpose to achieve outcomes that individuals working alone cannot.

Our democratic structure provides each and every member with the opportunity to be involved in determining the QNU’s direction and priorities.

We have grown our political power through our ratios campaign.

Our work was recognised and respected in the hours of debate.

I am not aware of another occasion when our work was the subject of so much attention in our Queensland Parliament.

For me, that is a key point of reflection— in order to improve our working lives and outcomes for patients we must use political processes.

We have to understand who has the power to both positively and negatively affect us. And we must be prepared to roll our sleeves up and become involved in processes that may be outside our comfort zone.

We are nurses and midwives, not politicians. But the decisions politicians make directly affect our working lives and the lives of our patients and residents.

To ignore this obvious reality and take the easy path of being cynical and disengaged about politics not an option.

We must focus our energies on making politics real by campaigning around the key issues that are deeply and widely felt by members.

To make a real difference we must lobby all political parties and hold them to

account for their policy positions, actions and inactions—both during elections and beyond.

This is exactly how the ratios legislation came to fruition—by the QNU gaining commitments from all political parties except the LNP during the 2015 state election, and then ensuring they honoured those commitments.

But it doesn’t end here.

Yes, the ratios legislation has passed. But now we all have a role to play to ensure ratios are implemented properly, along with the BPF, in Queensland Health.

This will not be ‘big bang’ change.

Local QNU activists will be central to successful implementation, so too will properly functioning local consultative forums.

Once ratios are bedded down in the public sector we will then in turn propel our ratios campaign through to the private and aged care sectors.

But this won’t happen without your help.

So join us and make a difference for nursing and midwifery and our local communities.

Beth

JUNE 2016 TQN 3

Yo ur s ay The case for recycling in hospital Waste.

Hospitals make a lot of it and as a nurse I see where a lot of it goes, and sadly, that is to general landfill.

Yes, there is recycling of larger items— cardboard boxes, office paper for example. And this is a good start.

Meanwhile, a culture of using disposable items for food service from plastic dishes, cups and containers combined with a HUGE range of packaging that clean medical supplies come in (glove, tissues, medications and needle boxes etc) create large amounts of waste that isn’t recycled.

The issue is access to bins. There are no comix recycling bins around the hospital from the café to the wards. The ones available are too large and outside the hospital thus virtually inaccessible.

I have approached the powers that be but there is nothing else available. We have provided our own recycling bins, but cleaning staff have no directive to dispose of it appropriately.

We are in an age where proper waste management should be a basic responsibility and, as a large public organisation creating large amounts of waste, we should show initiative and be proactive.

While we foster the health of the human race at the forefront, we should also foster the health of the human race in the background and towards the future, by practicing and promoting the reduction of waste into our environment.

I commend the QNU on achieving the five star NABERS rating and your clean and green philosophy.

Wouldn’t it be great if the health system strove for the same?

Of course there is much that cannot be recycled in a hospital.

But we already know about safe segregation of dangerous products, we’ve been doing it for years.

This is a step in a different direction.

We recycle at home and in many public places because we’re used to it now.

Let’s make it second nature in health care too.

On violence in the workplace “At Ipswich, we organise the training of staff in dealing with verbal and physical violence, we also had notice in the dept. which said that we had a zero tolerance to any violence and ensured that Senior Medical staff would intervene when there was an incident in the dept. as well as

With the QNU’s new website and integrated IT system, the details you need to log in to your member account have now changed.

If you are encountering difficulty, it could be that your browser is blocking access. Try signing on with a different browser.

4 TQN JUNE 2016

SB

On Anzac Day “Great to see nurses being remembered for the part they played in all of the wars and proud of my mother Elizabeth Von Dohren who laid a wreath in honour of my great uncle Garth Aitchison who perished on the Centaur, he would be proud that his three great nephews are all nursing now. Lest We Forget.”

DVD

Irena Rymar

How to log in to your member account Instead of entering your membership number, you need to use the email address you’ve given us.

call the police and support all staff to lay assault charges. We also had a cut-out of a policeman near the notice in the patients’ waiting room. These strategies worked however the staff had to be reminded that they were empowered to deal with the situation.”

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

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.

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

I am a Registered Nurse operating as an individual contractor to nursing agencies, working in the hospital environment. Do I have Professional Indemnity Insurance (PII) through QNU?

However, under the name ‘Jane Smith Ltd’ you are not covered. Any work carried out in a trading name, company, trust, partnership, joint venture or any other business name or entity is specifically excluded under the QNU’s PII policy.

You do. PII is a benefit of your membership of the QNU. It covers you as long as you:  maintain your financial status with the QNU  provide nursing/midwifery services†  are an employee or an independent contractor*  are a student member undertaking a clinical placement as a nurse or midwife. († Please note that midwives in private (independent) practice, self-employed or not working under a contract of employment are not eligible for cover. * Professional indemnity insurance for independent contractors is conditional.)

If I have a current ABN registered to a business name, how can I be covered under the QNU’s PII policy?

I am an independent contractor, I have an ABN in my own name, and operate under my own name. Do I have PII cover through QNU? You do. Private work carried out in your own name is covered but not in a business name of any kind.

For example, if your ABN is registered under the name ‘Jane Smith’ you are covered.

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

ROVDPOOFDU QI 41::4321

www.qnu.org.au

You need to cancel your existing ABN and register a new one in your name only and then operate alone. If you wish to continue to practise under a business name, you will need separate insurance.

The QNU can refer you to our insurance broker for advice and/or quotes.

I know I have PII with the QNU, but what about Public Liability Insurance?

The QNU’s PII policy includes Public Liability Insurance cover. The limit of liability is $10 million for each and every claim, and $70 million in the aggregate.

What other type of things does my PII cover?  Working in a voluntary capacity.  Acting as a nurse for the Sports Injury Nursing Association.  Working or volunteering as a nurse anywhere in the world except North America (i.e. USA and Canada and their Territories and Protectorates).  Providing some ancillary or related services such as podiatry and/or pedicure services, aromatherapy, naturopathy, massage, and reflexology as recognised by the QNU. Further information can be found on the QNU’s website.

Note: Professional Indemnity Insurance does not cover you for criminal offences.

For further information, view the QNU’s Professional Indemnity Insurance information sheet at http://bit.ly/pii-infosheet

If you are still unsure whether you are covered by the QNU’s PII policy, please http://bit.ly/qnu-rfr go online at and submit a Member Request for Representation form.

JUNE 2016 TQN 5

Q u e e n s lan d ne ws

Attacks on nurses spark calls for policy overhaul More than 130,000 people have signed a petition to end single nurse posts following the tragic death of Remote Area Nurse (RAN) Gayle Woodford in South Australia last month.

The Gayle’s Law petition also demands nurses are accompanied by a colleague or a chaperon when attending after-hours calls.

The QNU has long campaigned around this issue and recently met Health Minister Cameron Dick to call for urgent action.

It’s the QNU’s position that minimum safe staffing requires two nurses rostered on at all times in rural and remote settings.

After outcry from the nursing community the Senate threw its support behind calls for a federal government review.

In late April, Independent Senator Nick Xenophon introduced a motion into parliament, calling on the government to review the adequacy of current safety measures for RANs and to abolish single nurse posts in remote areas.

The motion fittingly demands RANs attend out-of-hours emergencies with another person—either another nurse, a community member, or a security guard.

Additionally, all emergency services vehicles are to be fitted with GPS technology.

Nurses overwhelmingly support change

Fighting violence against health care workers

There were 3300 reported assaults on health care workers in Queensland last year alone.

You may have seen the confronting ads on TV or the internet depicting violent scenes in our hospitals.

It’s part of a $1.35 million campaign from the Queensland government to stop violence against health care workers.

The ads don’t shy away from what happens all too often in many workplaces.

In fact, some of the footage is so confronting it comes with a warning.

6 TQN JUNE 2016

According to media reports, about 800 regional nurses completed a Change.org survey on safety issues, with 42 per cent of regional nurses saying they’d quit if single nurse posts were retained.

Disturbingly, the survey also found 60 per cent of nurses working in remote single nurse posts had been assaulted, and up to 70 per cent said threats to their safety had increased in the past year.

The QNU conducted its own survey and we reported similar results which we hope to present to a new steering committee being formed by Queensland Health to consider remote area issues.

The QNU will be an active participant in this group.

“The constant threat of violence is driving people away from the profession,” QNU Secretary Beth Mohle said.

“This is especially problematic in light of the fact that there are already staff shortages in remote regions.

Have your say on rural and remote accommodation Secure accommodation is another safety issue for rural and remote nurses and midwives—a point we raised when the QNU met Minister for Housing, Mick De Brennie recently to discuss nurse and midwife housing availability and security.

If you have issues with the security of rural and remote housing, now’s your chance to take your concerns to the government directly.

The Queensland government has released a discussion paper on better housing and sustainable communities [www.hpw.qld.gov.

au/SiteCollectionDocuments/ HousingDiscussionPaper.pdf], and they’re seeking your input at a local community engagement forums.

Visit www.qld.gov.au/housing/

public-community-housing/ housing-strategy-communityconsultation-sessions/ to see the list of locations and dates in June.

Being punched, bitten, slapped, kicked and even spat on is an unfortunate yet growing reality for staff working in health facilities.

The graphic campaign is rolling out on social media, television, and billboards across the state. https://www.youtube.com/ Visit watch?v=-GfSL3L1kis to view one of the

ads.

Nurses and midwives are urged to spread the message: there’s just no excuse for violent or anti-social behaviour.

www.qnu.org.au

QUEENSLAND NEWS

$5000 scholarship for postgrad nursing research

Towards gender equality in the workplace The QNU has lodged its annual public report on the gender profile of its paid workforce, with the Workplace Gender Equality Agency (WGEA).

The Joan Hardy scholarship is now open to any student studying nurses, nursing culture or practices, or historical aspects of nursing.

The scholarship is worth $5000, and applications close 29 July 2016. www.nteu.org.au/myunion/ Visit scholarships/joan_hardy for more information and to apply.

The National Tertiary Education Union established this scholarship in memory of Joan Hardy to recognise the contribution she made in her 30 years as a higher education and union activist.

Workforce in Diabetes Education Survey – Be a part of this important project The Australian Diabetes Educators Association is conducting its first survey into Workforce in Diabetes Education.

The report, which is a requirement of the Workplace Gender Equality Act 2012 (Act), is available for QNU members to read at http://bit.ly/23Jopbb.

QNU members can also make comments on the report by contacting the Agency.

Visit the agency’s website at www.wgea.com.au for guidelines on providing feedback.

The WGEA is an Australian Government agency that works to promote and improve gender equality in Australian workplaces.

It provides information on minimum standards and works with employers to help them comply with the Act.

STOP PRESS

Your help is needed to create a national compilation of information related to the employment status of health professionals who provide services to Australians with diabetes.

The survey will collect information about:  Employment in diabetes education by geographical location and profession  Education level and diabetes education experience  Emerging workforce trends and challenges.

Visit www.adea.com.au/projects/ workforce-in-diabetes-education for more information and to complete the survey.

After a lengthy discussion about the current unacceptable levels of occupational violence across Australia, the ANMF Federal Executive passed the following resolution on 30 May 2016.

MOTION The Federal Executive acknowledges and is alarmed at the large and growing issue of occupational violence and aggression. This issue is of such national importance to nurses and midwives that it should be placed on the COAG agenda for health ministers to discuss and agree on a national strategy in response to this issue.

This plan must be developed and implemented in consultation with key stake holders.

www.qnu.org.au

JUNE 2016 TQN 7

QUEENSLAND NEWS

Public holiday stand downs – what’s reasonable?

When is it reasonable for a nurse or midwife to be required to work on a public holiday?

And when is it reasonable to refuse?

The QNU has had numerous enquiries from members regarding their entitlement to have the day off on a public holiday.

In general, if you are rostered to work on a public holiday you will be paid a public holiday penalty rate.

However, if you work in a unit or service that closes on public holidays or if you perform a job where you generally only work Monday to Friday (such as a Nurse Educator or Nurse Unit Manager), things aren’t as straightforward.

Private sector nurses and midwives The Fair Work Act 2009, which covers private sector employees, says (in summary) an employee is entitled to be absent on a public holiday but an employer may make a reasonable request for an employee to work on the public holiday.

An employee may refuse a request to work if the request is unreasonable and it is reasonable to refuse to work.

To determine this, a number of factors must be taken into account, including: ■ the nature of the employer’s workplace ■ the nature of the work performed by the employee ■ the employee’s personal circumstances, including family responsibilities ■ the amount of notice given by the employer when making the request to work and the amount of notice given by the employee when refusing the request to work.

Public sector nurses and midwives The Industrial Relations Act 1999, which covers Queensland Health employees, contains an identical provision that will apply from the

8 TQN JUNE 2016

date when the EB9 agreement is certified by the Queensland Industrial Relations Commission.

For nurses and midwives who work shifts across seven days of the week, it would generally be expected that nurses work on public holidays because of the nature of the work and the nature of the workplace.

However, for employees who work in services that close on a public holiday or who generally only work Monday to Friday, the QNU argues it is unreasonable for the employer to expect an employee to work on every public holiday.

It could be considered reasonable, however, to expect a nurse or midwife who works in connection with a hospital to occasionally work on a public holiday.

Notice provided must be considered The amount of notice given by an employer when making a request to work on a public holiday must be taken into account.

Therefore, receiving one hour’s notice to work is unreasonable under the terms of the industrial legislation.

But that is exactly what has been occurring in some areas in Queensland Health.

The QNU is working with nurses and midwives in various HHSs to stop this from happening and to establish fair and reasonable arrangements for public holidays.

Furthermore, family responsibilities must also be taken into account in determining if it is reasonable for an employer to insist you work on a public holiday, and the amount of notice given.

We’re here to help If you’re experiencing problems with any aspect of work or payment on public holidays, please contact your QNU Organiser in the first instance.

www.qnu.org.au

QUEENSLAND NEWS

Donna Green (left) and Kim Ive (right)

MAKING CHANGES THROUGH LOCAL BRANCHES Nurses at Herberton in North Queensland are using the power of their local branch to make a real difference at their workplaces.

While the Tableland Community Health Branch was registered with QNU and had technically existed for many years, it had dropped off the radar after a long period of inactivity.

But when staff started complaining about unpaid meal breaks, bullying, and other safety concerns, QNU members Kim Ive and Donna Green took it upon themselves to revitalise the local branch and take action.

Both Kim and Donna attended a QNU branch development training session, which provided them with strategies and ideas on how to best communicate with their colleagues and bring people together to create change.

“We hunted through old branch member lists, and from there we rang around to the 13 community health centres that are tied in with us,” said Donna Green, a Registered Nurse at Herberton Hospital.

Donna and Kim then wrote and distributed a newsletter explaining who they were and why they were attempting to re-start the branch.

Donna said the aim of re-energising the branch was initially to tackle basic issues like unpaid meal breaks, before moving on to other issues.

“People have worked up there for 30 years and nothing’s ever really changed. Safety for the members and patients is a big thing for us.”

www.qnu.org.au

Remote location poses challenges The Tableland Community Health Branch is spread across 13 different workplaces— some separated by a few hours’ drive.

This poses challenges that are unique to branches in rural and remote locations.

As a result, meetings are held via teleconference.

“We’ve been trying to get people to realise they’re not on their own,” said Donna.

“There are 13 other centres out here all with similar issues that we can talk about and try and do something about.”

We think this is a great message, and one that goes to the heart of what local branches are all about.

SAFETY FOR THE MEMBERS AND PATIENTS IS A BIG THING FOR US.

New HHS board positions announced Health Minister Cameron Dick has announced the new Hospital and Health Service CEOs and Board members.

The recent appointments were made

by Queensland Governor Paul de Jersey AC, acting by and with the advice of the Executive Council and under the provisions of the Hospital and Health Boards Act 2011.

More information about key personnel for all Queensland Health hospitals can be found on the QH website: www.health.qld.gov.au/systemgovernance/health-system/ key-people/hhs-ceo-board/ members/

JUNE 2016 TQN 9

QUEENSLAND NEWS

Griffith Complex Nursing Intervention Symposium Griffith University’s NHMRC Centre for Research Excellence in Nursing is hosting the 2016 Complex Nursing Interventions Symposium.

The symposium will be held on Friday 30 September at the Brisbane Convention and Exhibition Centre.

It will explore nurse-led interventions for acute and critical care patients, knowledge translation of nurse-led interventions, and patient and family engagement in nurse-led interventions.

Registration is open to nurses, midwives, allied health professionals employed in hospital settings, and students.

Early bird registration is due by 30 June and full registration by 9 September.

NHMRC Centre of Research Excellence in Nursing (NCREN)

Complex Nursing Interventions Symposium Friday 30 September 2016 • Brisbane Convention & Exhibition Centre Friday 30 September 2016 • Brisbane Convention & Exhibition Centre

WHO SHOULD REGISTER? Nurses, Midwives, allied health professionals employed in hospital settings, and students.

Early bird by 30 June 2016 $120 plus GST (i.e. $132 total) Full registration by 9 September 2016 $150 plus GST (i.e. $165 total)

EAR BIRDLY PRIC E

REGISTER ONLINE www.griffith.edu.au/complex-nursing-interventions

Graduate Diploma of Strategic Leadership BSB80215 Develop contemporary and strategic healthcare leadership skills by studying with the Australian Nursing and Midwifery Education Centre.

Topics covered include: • • •

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This nationally recognised course is 12 months full time (blended learning) utilising the latest in evidence e based practice. Progress your nursing career today!

For more information, visit www.anmec.edu.au or call 08 8334 1900 The Australian Nursing and Midwifery Education Centre is a service of the Australian Nursing and Midwifery Federation (SA Branch) (RTO code 40064) Authorised by Adj Assoc Professor Elizabeth Dabars AM, CEO/Secretary, ANMF (SA Branch) ABN 95 969 485 175, 191 Torrens Road, Ridleyton, SA 5008 08

10 TQN JUNE 2016

www.qnu.org.au

QUEENSLAND NEWS

QNU adds a little sunshine yellow to Labour Day in Queensland There was a great turnout for Labour Day across the state this year.

Queensland workers enjoyed their moment in the sun after the state government last year returned the celebration of worker’s rights to its rightful place in May. After a string of rainy days leading up to the march in Brisbane, the weather held as workers and union supporters in their thousands made their way through Spring Hill and Fortitude Valley to the RNA Showgrounds, where they were rewarded with a sausage and drink for their efforts.

Elsewhere around Queensland, marches and celebrations were held in rain, hail or shine in Bundaberg, Ipswich, Toowoomba, Cairns, Sunshine Coast, Gold Coast, Maryborough, Townsville, Bowen, Mackay, Rockhampton, Gladstone, and Barcaldine.

Everywhere, marchers wore their bright yellow Ratios Save Lives t-shirts and caps, gathering momentum for the historic ratios legislation that would pass in parliament 10 days later.

BRISBANE

www.qnu.org.au

JUNE 2016 TQN 11

QUEENSLAND NEWS

LABOUR DAY IN PICS BRISBANE

12 TQN JUNE 2016

www.qnu.org.au

QUEENSLAND NEWS

BARCALDINE CAIRNS

MORANBAH GOLD COAST

CAIRNS

IPSWICH

TOOWOOMBA www.qnu.org.au

JUNE 2016 TQN 13

QUEENSLAND NEWS

Nurses and midwives celebrate their day

Rockhampton

Midwives were celebrated across Australia and the world as part of International Day of the Midwife on 5 May. Observed since 1991, IDM raises awareness of the important job midwives do and the quality care they provide to mums and bubs in the community.

Of course, we already know they are fantastic!

“Midwives are an integral part of health systems all across the world,” QNU Secretary Beth Mohle said.

“And while this day is certainly about celebrating them, as it is also about supporting the work they do.

“This means policymakers and health providers must ensure midwifes have the resources they need to provide safe, quality, affordable care for mothers and babies, in the birth setting mums want.”

A week later it was the nurses’ turn in the spotlight.

The theme for the 12 May International Nurses Day celebrations was improving our health systems’ resilience to ensure the best outcomes for patients.

“This theme dovetailed neatly with our ratios campaign,” Beth said.

“It recognises that in order for nurses to provide safe quality care, we need robust appropriately funded health systems that embrace growth and innovation, and focus on patients care.”

As always, cake is always a highlight of these annual celebrations for our members Nurses and midwives dug in to some delicious chocolate cakes, which QNU staff delivered to sites across the state— and well, we think the photos speak for themselves!

14 TQN JUNE 2016

St George

Rockhampton

Logan

Celebrations marked by ratios legislation This year’s Nurses’ Day celebrations were particularly exciting for Queensland nurses and midwives, as they coincided with the passing of the historic nurse/ midwife-to-patient ratios legislation by the Queensland parliament.

It’s an acknowledgement of the hard work nurses and midwives do that this legislation was made a reality during the week that honours them.

For more on the Ratios legislation turn to page 26.

www.qnu.org.au

QUEENSLAND NEWS

QNU Nurses pay their respects at ANZAC Cove It’s great to see our nurses and midwives taking a moment to honour the sacrifices of our ANZACs. Two QNU nurses, Andrea Brooks and Beth Morgan, placed wreaths at the dawn service at Anzac Cove on April 25—leaving a little piece of QNU on the other side of the world.

Mackay

In spite of rain and increased security, thousands of people had gathered for the annual event on the Gallipoli Peninsula—this year marking the

101st anniversary of the allied forces amphibious landing at Gaba Tepe.

The crowd was entertained through the night by the Australian Army and Navy band, and Brisbane’s own St Joseph’s Gregory Terrace choir.

Just before dawn, the rhythmic tones of the didgeridoo were heard as the formal service began and the sun started to rise.

“Seeing Anzac Cove for the first time was a quiet and sobering moment,” Andrea told TQN. “Knowing some of the history, and then being immersed in it for over a week, the tears would gently flow.”

Andrea said the experience was one she would treasure.

“It’s an honour to be there. To lay a wreath was humbling.”

Biloela

Andrea Brooks placing a wreath at the Anzac Cove dawn service.

Beaudesert

Fallen workers remembered Tradies and nurses, teachers and miners rubbed shoulders at International Workers’ Memorial Day in April to commemorate those who have lost their lives while simply doing their jobs.

QNU Assistant Secretary Sandra Eales spoke at the Brisbane event, reaffirming the union movement’s commitment to improving workplace safety.

“Today we come together in the renewal of our shared commitment— as unionists and community members—to work together to

organise and campaign for safer, healthier, and more just workplaces for the sake of Queensland workers and their families,” Sandra told the crowd.

For nurses and midwives, this year’s event was tinged with particular sadness as we remembered Gayle Woodford—a South Australian Remote Area Nurse who was murdered just days before the event. Her funeral was due to take place the following day. It was a poignant reminder of the work that remains to be done to keep workers safe.

Toowoomba www.qnu.org.au

JUNE 2016 TQN 15

QUEENSLAND NEWS

WORKPLACE WINS

Health staff demand service stays open—and win!

Staff at Metro South’s Rapid Response@Home Service can breathe a sigh of relief.

There were short-lived plans from Metro South to shut down this vital service after the board decided it could no longer fund it.

Staff were rightfully concerned about the impact the closure would have on the local community, including shortterm disruptions to improving hospital flow during winter, and the long-term consequences of increased lengths of stay.

The Rapid Response@Home Service facilitates the discharge of clients aged over 65 with multiple complexities and some cognitive impairment.

It also works to prevent hospital readmissions.

In July 2015, Metro South stepped in temporarily to cover funding cuts made by the federal government, but money ran short.

In mid-May the QNU was told the facility would close.

But after a few days of intense lobbying, the decision was reversed.

So what happened?

Staff at the facility—which included nurses and other health professionals— joined together to talk strategy.

On Thursday night, QNU Secretary Beth Mohle met Health Minister Cameron Dick to discuss members’ concerns.

Importantly, it was noted that most of the staff—which included one NUM and four CNs—were already permanently employed by Queensland Health.

Had the service been closed, these staff would have simply been moved to another area in Metro South, as money for their positions had already been allocated.

The following day, Metro South announced it would continue funding

16 TQN JUNE 2016

Staff at Rapid Response@Home Service celebrate their win.

the Rapid Response@Home Service “while alternative funding sources are sought”.

Metro South also acknowledged the importance of the service. They said each referral to the service prevents between

one and five hospital bed stays, equating to between 82 and 410 bed days per month across all hospitals.

This is a terrific outcome for both the staff at the Rapid Response@Home Service and the community they serve.

Great news for Eventide!

It’s been a long time coming, but the future of Gannet House at Brighton Health Campus (formerly called Eventide) has been resolved—and it’s great news!

Gannet House will reopen to its full capacity of 40 beds, and will now be a specialised aged care facility to meet the needs of the community.

Last year the facility found itself overstaffed after the Palaszczuk government reversed the former LNP government’s decision to close the facility.

Despite Gannet House being staffed for 28 residents at the time, only 19 remained, which made the future of numerous AIN positions uncertain.

But things have turned around.

Management is now consulting with staff and the QNU, a refreshing change that’s leading to excellent outcomes.

And in other great news, the Ashworth House will also reopen as part of a strategy to provide extra beds throughout the winter season.

The QNU is hopeful this short-term operation may become a permanent one.

There’s a lot of encouraging news coming from the Brighton Health Campus.

It would appear this hard-fought campaign run by staff, the community, and the QNU is finally paying off !

www.qnu.org.au

WINS

QUEENSLAND NEWS

SAFETY FIRST FOR IPSWICH NURSES AND MIDWIVES Work is underway to address safety concerns around staff car parking at Ipswich Hospital.

A limited number of car spaces and an infrequent shuttle bus service would often result in nurses and midwives arriving late for shifts, which in turn left other staff working overtime.

The limited onsite parking was also a safety concern for staff finishing late shifts who were forced to walk long distances in the dark to their cars.

But things are starting to look up after hospital staff took action.

QNU members raised their concerns at their local Nursing and Midwifery Consultative Forums and QNU branch meetings. They even made it a formal notice of motion for the 2015 QNU Annual Conference.

As a result, management, staff, and the QNU worked together to find both temporary and long term solutions.

The hospital has now quarantined 30 car spaces on the top level of the new car park with temporary fencing, and discussions are under way to construct a permanent gated entry, which would allow staff access with a swipe card.

Significantly, there have also been changes to the ‘Park&Ride’ shuttle

www.qnu.org.au

bus service, including its route and frequency.

The bus now takes staff directly from the hospital to the Ipswich Health Plaza and Limestone Park where there is plenty of parking available.

Staff won’t have to wait more than 10 minutes in the mornings and 20 minutes in the afternoons for a bus to arrive, as opposed to a 30-minute wait previously.

Staff encouraged to use shuttle bus Nurses and midwives have also been working with management on strategies to encourage more staff to use the courtesy bus.

Staff recognise that people must use the shuttle bus not only to ensure the service continues, but also to alleviate parking issues for their colleagues, particularly those working afternoon shifts.

There’s still work to be done, but this is a great outcome and a terrific example for other nurses and midwives who may be experiencing similar issues.

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 staff—is here to help you when you have a workplace issue or need advice.

Mar/Apr figures

Members assisted (new matters)

Dollars recovered on behalf of members

$106,429

443 QNU Connect calls received

4633 JUNE 2016 TQN 17

QUEENSLAND NEWS

AGED CARE

Scope of practice for AINs in aged care The phrase ‘scope of practice’ is used regularly in the nursing profession. It refers to the authority, education and competence of a Registered Nurse or Enrolled Nurse in their provision of care.

Authority: A nurse must appear on the AHPRA Register of Practitioners in order to practice as a nurse.

This authority in turn also allows the nurse to administer medicines under the provisions contained in relevant drugs and poisons laws.

Education: A nurse’s scope of practice also depends on what study they completed to meet their registration standards, as well as any further studies or courses completed throughout their career.

Competency: Competency is defined as the nurse’s skill, knowledge and capacity to perform nursing work safely, confidently, and in accordance with best practice professional standards.

A nurse’s knowledge base, experiences and skill levels are constantly changing and developing, which is why competency is the single biggest variant in scope of practice.

Therefore, competency is a ‘presenttime’ concept and is determined by a combination of self and external assessment.

How does this differ for AINs? As Assistants in Nursing (however titled) are not registered as health practitioners, they do not have a ‘scope of practice’ in a health care sense of the phrase.

AINs, however, do have a defined skill set developed through education, on-the-job training, and clinical experiences.

This skill set is then assessed by an RN to determine the AIN’s ability to perform any given nursing activity for a particular resident.

18 TQN JUNE 2016

If deemed ‘competent’, the RN can then delegate the AIN to provide the required care.

This delegation must be agreed before the AIN delivers this care.

RNs and their authority Only the RN can assess the competency of an AIN to assist with implementing a resident’s care plan.

This applies to both nursing care and personal care.

Only the RN can determine what is within the scope of nursing practice.

Therefore, only they can state if a particular activity is not nursing care (ie: they may determine it is personal care).

The case for regulation Due to the close professional relationship between RNs, ENs and AINs, there is a case for a system where AINs have the authority to provide care, consistency in educational preparation, and a skill set that is measurable against standards for practice.

Through the ANMF, the QNU has made several recommendations to the federal government that AINs become regulated under the current nursing structure.

This would create a national standard for approved programs of study. It would also create codes of conduct and ethics as well as standards for practice that would define the scope of practice for AINs. AINs could then receive their welldeserved recognition as professional members of the nursing team.

Support growing for regulation The regulation of AINs has become a topical issue recently.

For the first time, an aged care provider association—the Aged Care Guild—has come out in support of the concept to regulate AINs. The QNU will continue to support the ANMF in lobbying political parties and state health ministers to endorse the regulation of AINs. This will help ensure high quality aged care continues to be delivered to our elderly Australians.

www.qnu.org.au

PRIVATE SECTOR

Private sector training QNU offers a full calendar of training courses for QNU members, including some which are designed specifically for private sector nurses and midwives.

31 August - 1 September (Brisbane)

Private Sector - How to bargain and what to do when bargaining goes wrong!

http://bit.ly/qnueducation

Private Sector - Everything you wanted to know about your agreement but were afraid to ask!

Are you getting the most out of your enterprise agreement?

We’ll then look at the options we have when the bargaining process starts and stalls and what we can do to get the process moving again.

This course will allow you to get really familiar with your own agreement through practical activities. We will answer the tricky questions and look at ways to address issues in this agreement and how we raise issues for the next agreement too.

We’ll look at some of the reasons that bargaining stalls, some of the claims that are at the centre of these bargaining disagreements and the range of activities available to us as part of the bargaining process.

Come along and find out how to make your agreement a good agreement and a quick agreement.

International study into spinal surgery outcomes

In an Australian first, leading Queensland neurosurgeons from Pindara Private Hospital are set to join an international research consortium to investigate and document world’s best practice in spinal surgery.

The project will focus on tracking outcomes of spinal surgery treatment as reported by patients and benchmarking these against other major international organisations.

The research will bring together specific outcomes of thousands of spinal treatments from around the world, enabling future spinal surgical patients to have high quality and quantitative information about the likely outcomes of procedures.

www.qnu.org.au

23 August (Brisbane)

A really important course for all private sector members. The course covers the enterprise bargaining process step by step with a focus on how we can achieve the best bargaining outcomes.

Unfortunately, bargaining processes appear to be more frequently running into problems. Resolving impasses early and quickly is the best way for members to achieve strong bargaining outcomes.

To see more QNU courses, and other CPD opportunities available through the QNU check out the Education and CPD page on our website:

QUEENSLAND NEWS

Understanding your new agreement and what you are entitled to is that final step in bringing your enterprise agreement to life.

14 September (Bundaberg) 31 October (Brisbane)

Private Sector – Tactics to overcome hostility This two-day course is designed to help us move members from complaining in the tearoom to actively dealing with workplace issues.

Pindara Private CEO Trish Hogan said the hospital had specialist expertise in spinal surgery.

She said collaborating with the International Consortium for Health Outcomes Measurement to measure patient outcomes would open up new opportunities to compare and improve performance globally.

“It’s a whole–of–organisation approach including patient input and the commitment of various departments within the hospital,” said Ms Hogan.

“We’ve seen a cultural shift among staff who are now collaborators, supporters and promoters of the research.”

JUNE 2016 TQN 19

N at i o n al n e w s B U D G E T 2 01 5

“Safe” budget paves way for election day Treasurer Scott Morrison’s first budget was always going to be a political document— how could it not be when the federal election is just around the corner?

On the surface, this is a very safe budget, one that only tinkers around the edges and doesn’t attempt any large-scale reforms.

In short, Malcolm Turnbull doesn’t want this budget to be an election issue.

But as is the case with all budgets, there are winners and losers. Unfortunately, health and education continue to suffer large-scale cuts, while businesses are due to receive further tax concessions.

And after all Mr Turnbull’s talk about the need for economic leadership, this budget fails to provide any sort of positive direction for the big issues facing Australia, including health.

Health misses out once again The $2.9 billion being re-injected into the health budget, which was negotiated with states and territories at COAG many months ago, does little to fill the $57 billion hole left from the government’s 2013/2014 budget (or $11.8 billion for Queensland).

Fortunately, there has been a shift away from the government’s previous stance of funding hospitals based on population and CPI growth, and towards funding based on activity—in other words, on services they provide.

However, the government has also continued to move away from the previous Labor government’s plan for the Commonwealth to fund 50% of efficient price growth for public hospitals.

What’s more, the government will continue to ‘freeze’ the Medicare rebate

20 TQN JUNE 2016

for GPs, saving $925 million over four years.

While there has been no impact on bulk billing rates yet, this will likely change as costs continue to rise and the ‘freeze’ on the rebate continues.

These costs will inevitably be passed on to consumers, resulting in what many are describing as a GP co-payment ‘by stealth’.

Welcomed health initiatives There will be a 12.5% tax increase to the cost of cigarettes each year for the next four years, a welcome decision given the significant cost burden smoking has on our health budget.

There will also be a trial of ‘health care homes’ in General Practice and Aboriginal Health Services, affecting 65,000 people with chronic or complex conditions across 200 practices.

However, no more information is known about how this initiative will actually operate.

Businesses to benefit Following last year’s 1.5% tax cut to businesses with an annual turnover of less than $2 million, the government is continuing this trend by extending the cut to those with an annual turnover of up to $10 million.

The plan is to gradually increase this threshold until it applies to all businesses by 2023/24. By 2026/27, the tax rate applied to all businesses will fall to 25%.

Spotlight on multinationals The government is, however, planning to ‘crack down’ on multinational corporations and high income earners who find ways to avoid paying their fair share of tax—or any tax at all.

The government will inject a further $678.9 million to set up a tax avoidance taskforce, and apply higher penalties to companies that fail to make appropriate disclosures to the ATO.

Paid parental leave—time to face the music In a temporary victory for new parents, the government has also quietly shelved its plans to stamp out so-call ‘double dippers’ of paid parental leave entitlements.

Prior to the budget, Social Services Minister Christian Porter admitted the government could not pass the changes they wish to make in this term of parliament.

Changes announced in December by the Prime Minister would prevent new parents from fully accessing both employer and government schemes, with the public scheme acting as a mere ‘top up’ to reach 18 weeks. (The World Health Organisation recommends 26 weeks to promote breast feeding and bonding with new babies).

While these plans have been temporarily abandoned, the minister has already openly declared the government still intends to get its changes through if reelected, providing further uncertainty for women who are pregnant or planning to become pregnant.

www.qnu.org.au

NATIONAL NEWS

BUDGET WINNERS Dental care The government will invest $1.7 billion over four years to establish a new Child and Adult Public Dental Scheme. This new scheme—which will only apply to children and concession card holders—will introduce national efficient pricing in dental services, similar to the activity-based hospital funding model.

Middle income earners The middle income tax bracket has been increased from $80,000 to $87,000, meaning some 500,000 Australians will avoid entering the higher tax bracket of 37%.

NDIS The National Disability Insurance Scheme will continue to be funded, with the government injecting $2.1 billion into an NDIS ‘quarantined’ savings fund.

Small businesses With a 2.5% tax cut to small businesses on top of last year’s 1.5% tax cut, businesses with an annual turnover of up to $10 million will pay 27.5% tax. This will eventually be lowered to 25% and apply to all businesses, regardless of their monetary turnover.

BUDGET LOSERS Aged care The government will cut $1.2 billion over four years by revising the aged care funding instrument. (See page 22 for a detailed analysis.)

There will, however, be $102.3 million given over five years for rural and remote providers.

Hospital funding The $2.9 billion for hospital funding announced at COAG is welcomed, but doesn’t go far enough to address the $11.8 billion ripped from Queensland’s health budget in the 2013/14 budget.

Medicare By continuing the Medicare rebate freeze, GPs will eventually be forced to pass rising costs on to patients, undermining our bulk billing system.

Schools Despite promising to fund the Gonski reforms at the last election, the government has not reversed the $28 billion shortfall announced in the 2013/14 budget.

Parents with young children Last year’s budget saw the government announce a $3.5 billion boost for childcare. The plan included subsidising 85% of childcare fees for families earning less than $65,000. However, this plan has been shelved as the government could not get its cuts to the Family Tax Benefit through the Senate.

www.qnu.org.au

JUNE 2016 TQN 21

NATIONAL NEWS

AGED CARE TAKES ANOTHER HIT

We all know Australia has an ageing population, which means a growing demand for aged care health services.

Which is why it seems incomprehensible that the government would rip $1.2 billion from the aged care sector—and yet that’s just what they have done.

The cuts to the forecast growth of the Aged Care Funding Instrument is all in the name of ‘stabilising’ government subsidies paid to aged care providers, following higher than expected growth in spending.

22 TQN JUNE 2016

Impact will be felt long-term

We cannot afford more cuts

The instrument takes into account the frailty of patients to determine how much funding is given to individual aged care providers.

The government says the measure is all about preventing claims that deliberately rort the system.

In reality, this will unfortunately mean funding reductions, particularly in the areas of complex health care, including dementia care.

As this is a cut to the forecasted growth of funding, it will ultimately impact aged care providers over the next three to four years.

And as providers have not employed adequate numbers of Registered Nurses over the past few years, the cuts will further impact the capacity of providers to attract the numbers of Registered and Enrolled Nurses required to deliver complex care.

Nurses working in aged care facilities are rightfully troubled by this announcement.

The $1.2 billion proposed cut will follow the $800 million that has already been ripped from the sector in the government’s previous two budgets, according to an ABC report.

And no matter how the government attempts to justify their announcement, a cut of this magnitude to a sector already at breaking point will inevitably be felt by nurses and those in their care.

Aged care nurses are already stretched to the limit, with some RNs being required to care for more than 100 residents on every shift.

The only long term outcome of inadequate funding will be deterioration in the overall quality of care provided for our elderly Australians.

www.qnu.org.au

NATIONAL NEWS

Providers must shoulder some of the blame

Call for leadership on aged care

For many years, providers have been replacing RNs with cheaper unregulated carers and directing them to administer scheduled medicines (under the guise of ‘assisting’). Providers are also directing unregulated carers to do other nursing work such as taking examination observations like blood pressures, or managing the day-to-day cares for residents in dementia units.

This has allowed providers to continue increasing their complex health care funding without also increasing their staffing, skill mix or care hours.

Aged care regulators are not blind to this.

They know providers are using unregulated carers to deliver complex health care and yet still claim the subsidies for care that used to be delivered by RNs, all the while increasing their profits.

In fact, according to the Bentley report, profits of aged care homes increased by 40% in 2015, while operators cut the care hours provided by nurses.

It’s little wonder regulators think providers are claiming too much for what they deliver.

However, reducing the funding is not the answer.

We need a federal government that tackles the staffing and funding issues head on by mandating that complex health care must be delivered by RNs and ENs. We need a government that ensures providers employ an RN on every shift and that they receive comparative wages and working conditions.

And we need a government that mandates nurse-to-resident ratios in every aged care facility.

These steps will go a long way to securing the future of safe, quality aged care for the nation.

Aged care a focus for election Adequate funding to boost nursing numbers is one of the QNU’s key priorities this election.

Our Ratios Save Lives campaign to establish minimum ratios in public hospitals has always been a starting point, and we believe it should extend to aged care and private facilities as well.

QNU members have spoken loud and clear about the problems currently facing nurses working in aged care facilities.

“[Aged care facilities] are like a production line with no time to care properly, shower, dry, cream and asses skin,” said one nurse in her response to a QNU survey on ratios.

“I am unable to give clients enough one-on-one attention that they deserve to assess and manage their particular medical, physical and emotional needs,” said another nurse.

Patient care must be priority According to the Australian Nursing and Midwifery Federation, there is currently a shortfall of 20,000 nurses across Australia to care for elderly patients.

QNU Secretary Beth Mohle said the situation would only get worse unless we act to restore vital funding and services and provide our nurses with proper support.

“At a time where nurses are spread dangerously thin with unmanageable workloads, it’s troubling that the government’s solution is to cut more than a billion dollars from the sector,” Beth said.

“The cut is driven purely by financial interests and shows the government has no plan to address the challenges facing our ageing population beyond focusing on the budget bottom dollar.”

WE NEED A FEDERAL GOVERNMENT THAT TACKLES THE STAFFING AND FUNDING ISSUES HEAD ON BY MANDATING THAT COMPLEX HEALTH CARE MUST BE DELIVERED BY RNS AND ENS.

www.qnu.org.au

JUNE 2016 TQN 23

I n te rn at i o n a l ne w s

Calls for safe staffing – a worldwide phenomenon

Tentative agreement reached after historic health strikes After five strikes and the first walkout by junior doctors in English history, the British Medical Association has finally reached an agreement with the government on working conditions.

The fight for safe ratios is not limited to Queensland, or even Australia.

For months, 55,000 junior doctors— supported by nurses and other health professionals—stood strong against a government contract proposal, which doctors say failed to address rostering concerns and made Saturdays part of the normal work week.

Public support for the doctors remained strong throughout the dispute which contributed to the government’s willingness to negotiate.

Fate of deal in doctors’ hands Nurses and midwives across the world are pushing for change, including our friends in New York.

While on holiday in the US, QNU secretary Beth Mohle visited Albany, New York, and spoke at a rally that saw hundreds of health care workers demanding safe staffing in their hospitals.

Beth told the crowd about the QNU’s Ratios Saves Lives campaign.

“I am struck by the fact that nurses and midwives around the world are confronting the same challenges around the delivery of safe patient care and we have so much to learn from each other about successful campaign strategies,” she said.

“Links made through our Global Nurses United network help us to do this,” she said, referring to the international nurses’ solidarity organisation, of which the QNU is a member.

Queensland nurses and midwives should be proud of just how far we have progressed in our long term campaign to achieve minimum ratios in all sectors.

24 TQN JUNE 2016

... NURSES AND MIDWIVES AROUND THE WORLD ARE CONFRONTING THE SAME CHALLENGES AROUND THE DELIVERY OF SAFE PATIENT CARE ...

We are now the fourth jurisdiction in the world after California, Victoria, and Wales to have minimum staffing ratios enshrined in law.

New York Nurses Association members are focused on ensuring their state is the next jurisdiction to legislate safe nursing ratios!

The new settlement is based on a compromise regarding weekend pay.

Now, doctors who work more than six weekends a year will earn salary topups that increase the more weekends they work.

The new package also includes measures to support doctors returning from maternity leave, as well as increased pay premiums to attract doctors to understaffed areas such as emergency medicine.

The terms will be put to a vote of more than 40,000 BMA members in June.

Union leaders, however, fear getting a settlement might still be an uphill struggle since frontline junior doctors remain resistant and emotions continue to run high.

Months ago, 98% of BMA members voted in favour of taking strike action and have since indicated their willingness to fight on.

At the time of going to print, the vote was still to be held.

www.qnu.org.au

Ca m p a i gn ne w s

EB

YOUR VOICE, YOUR BALLOT

The proposed new Public Sector Enterprise Agreement is expected to be ready for ballot in the next few weeks.

Negotiations between the QNU and Queensland Health were officially finalised in March and the formal draft of the Nurses and Midwives (Queensland Health and Department of Education and Training) Certified Agreement 2016 (EB9) is now almost ready to vote on.

The QNU worked hard to ensure all existing entitlements were retained and that current wages and conditions for all Queensland Health nurses and midwives were improved.

In addition, the agreement will extend to nurses employed by the Department of Education and Training.

For the first time, nurses and midwives employed in Queensland’s public hospitals and schools will receive the same wages and professional development entitlements.

Members in Queensland Health and the Department of Education and Training should be on the lookout for the ballot information, which will be mailed shortly.

This time, there will be an electronic and phone ballot for Queensland Health, which means the voting process will be run differently than in the past.

In the information pack, Queensland Health members will receive a unique pin number that may be used for voting either electronically or by phone.

Department of Education and Training nurses will also vote using electronic ballot and information about this will be sent separately.

If the majority of the nurses and midwives in Queensland Health and the Department of Education and Training who participate

in the ballot vote in favour of the current proposed agreement (50% plus one of returned votes), then the agreement goes to the Queensland Industrial Relations Commission for certification.

Once the commission has certified the agreement, then Queensland Health and the Department of Education and Training payroll will take steps to implement the pay increases and determine back pay for wages and allowances from 1 April 2016.

Members will be advised of the timeframes for these payments after the agreement is certified.

Don’t forget, this ballot is about your pay and your conditions.

To ensure you don’t miss out on the wages and conditions you want, you need to vote.

MAKE SURE YOUR VOICE IS COUNTED!

EB www.qnu.org.au

BETTER WORK. BETTER LIFE. JUNE 2016 TQN 25

CAMPAIGN NEWS

HISTORY MADE!

Celebrating on the steps of Parliament House after the ratios bill was passed.

After years of campaigning, lobbying, and negotiating, the bill to legislate minimum nurse/midwifeto-patient ratios finally passed into law.

And what better moment for this to happen than on International Nurses Day! Queensland is now the fourth jurisdiction in the world to legislate minimum ratios after California, Victoria, and Wales.

Many nurses and midwives sat in Queensland Parliament to watch the four-hour debate, and at 9:30pm on 12 May, the bill was voted on and passed.

The bill passed with the support of the government, as well as all crossbench MPs, including Peter Wellington, Robbie Katter, Shane Knuth, Billy Gordon, and Rob Pyne.

26 TQN JUNE 2016

Ratios overview When: Ratios will begin rolling out from 1 July 2016 Where: Minimum safe ratios will be rolled out in prescribed acute wards in Queensland public health facilities (see table below).

What’s the ratio: Ratios will be set at 1:4 (morning and afternoon shifts) and 1:7 (evening shifts). These ratios can be improved using the workload management tool (the BPF) in areas where patients have

higher acuity (meaning the ratio could fall as low as 1:1). This legislation does not follow a “one size fits all” principle—it has been designed to legislate a safety net under which the ratio cannot fall.

Evaluating ratios: Internationally renowned researchers will be evaluating and measuring the success of the ratios program as it progresses. Then we can turn our attention to continuing the rollout in other locations.

Proposed facilities as contained in the draft regulation

Acute wards

Princess Alexandra Hospital, Royal Brisbane and Women’s Hospital

Medical, Surgical and Mental Health wards

Atherton Hospital, Bundaberg Hospital, Caboolture Hospital, Cairns Hospital, Gladstone Hospital, Gold Coast University Hospital, Hervey Bay Hospital, Ipswich Hospital, Logan Hospital, Mackay Hospital, Maryborough Hospital, Mount Isa Hospital, Nambour Hospital, Queen Elizabeth II Jubilee Hospital, Redcliffe Hospital, Redland Hospital, Robina Hospital, Rockhampton Hospital, Prince Charles Hospital, Toowoomba Hospital, Towsville Hospital, Warwick Hospital

Medical and Surgical wards ONLY

Caloundra Hospital, Gympie Hospital, Innisfail Hospital, Mareeba Hospital

Medical ward ONLY

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CAMPAIGN NEWS

Ratios to become a reality Ratios bill won’t fix everything overnight…

The QNU will now work collaboratively with Queensland Health over the next few months to ensure ratios are implemented smoothly.

This is going to take some time, however—it’s not an overnight fix, even for those facilities covered under the initial rollout.

Indeed, these services can apply for an exemption of up to six months from 1 July 2016 based on a number of factors, including financial viability or staff supply. This has been deliberately put in place to allow hospitals to ensure there is a correct balance between resource supply and service demand to meet the required ratios.

What’s more, legislation is only as good as its application.

We need to get the numbers and skills right from the outset. We also need to be diligent in holding up the guarantee, as well as reporting and addressing non-compliance.

We will do this with the support of the Business Planning Framework (BPF), the tool for managing nursing and midwifery workloads, but it will take time.

Private and aged care sectors QNU members working in the private and aged care sectors are rightfully asking, “What about us?”

All along, it’s been the intention of the QNU to fight for patient safety through ratios legislation, not just for public sector nurses but across the board.

Based on comments from members in the surveys we’ve conducted ahead of our submissions to government, we are all in agreement on this.

It’s not just public sector nurses and midwives that need ratios—it’s everyone.

But we have to start somewhere.

By bedding down ratios in the public sector first, it will be far more difficult for other employers to argue against offering their own staff what nurses and midwives are benefiting from elsewhere.

Midwives The ratios legislation does indeed reference midwives and midwifery.

However, maternity wards are not included in the initial rollout phase.

The QNU is currently working with Queensland Health and key maternity stakeholders to work out how ratios can best be applied to meet the specific requirements of midwifery practice, in particular how ratios can work in conjunction with continuity-of-care models.

What was said about nurses, midwives, and the historic legislation…

QNU Secretary Beth Mohle Queensland nurses, midwives, and the QNU have fought long and hard to better protect their patients, so this is a historic day for us. We welcome a new era of transparency under which hospitals will be required by law to install safe nurse-to-patient ratios and should be required to publicly report patient outcomes and adverse events.”

Registered Nurse Moira Purcell “As nurses, we know the risks associated with excessive workloads.

That’s why ratios legislation is so very close to our hearts. It’s been a refreshing change to have key policy makers actually listen to our concerns, consult with us, and most importantly take action.”

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Premier Annastacia Palaszczuk

MP and QNU member Joe Kelly

“This bill is a major election commitment of my government. At the outset, it gives me great pride to stand in this House tonight to implement an election commitment that we took to the people of Queensland and which the people of Queensland supported.”

“It’s a great outcome for nurses and midwives, but most importantly it’s a great outcome for patients. It will improve patient safety so much, and nurses and midwives will be able to deliver the care that they want to be able to deliver.”

Health Minister Cameron Dick “Our nurses and midwives truly are a force for change. The bill before the House is testament to the thoughtful and vigorous advocacy of the Queensland Nurses’ Union and the thousands of QNU members who work throughout Queensland […]

This moment would not have arrived without their dedication to developing an appropriate legislative framework to implement nurse-to-patient ratios.”

While this is certainly a good reason to celebrate now, it’s also great news for the continuation of our Ratios Saves Lives campaign.

Our ultimate goal is to rein in unsafe workloads and improve patient safety across all sectors and all settings.

Patients, nurses, and midwives in every private and public ward, in every mental health facility and maternity ward, every aged care home and children’s ward deserve an assurance they will be safe.

JUNE 2016 TQN 27

Fe at u re

ELECTION WRAP – the key issues for nurses and midwives

28 TQN JUNE 2016

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ELECTION WRAP – THE KEY ISSUES FOR NURSES AND MIDWIVES

Health is a hot issue for many Australians as we head to the polls, but as nurses and midwives we have an additional interest in where the political parties stand on health and our rights at work.

Inevitably it’s decisions made by our policy makers that affect our jobs every day.

This is why the QNU is seeking commitments from all political parties to strengthen and protect, not only our work, but also the very health system that makes our country great.

It’s a matter of priorities Every Australian deserves to receive high quality care when in hospital or an aged care facility.

But the ability of health care professionals—including nurses and midwives—to deliver this high quality care is largely determined by decisions made by governments of the day.

Over the past few years there’s been a lot of political talk about a ‘budget crisis’ and the need to wind back spending.

Unfortunately, health has been a victim of this so-called ‘crisis’, suffering devastating

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What commitments are we seeking this election?

Safe staffing and skill mix in aged care This includes a requirement for a Registered Nurse to be employed in residential aged care facilities 24 hours a day, seven days a week.

Defending and improving universal health care Ensuring access to health care is based on need and not capacity to pay by restricting the growth of Medicare co-payments (out of pocket expenses) and advancing nursing and midwifery roles which plug gaps in health care delivery (such as Nurse Navigators).

Restoring federal health funding Restore the $57 billion cut from federal health care funding to ensure the states and territories can meet demand for public health services.

cuts made by politicians who claim to understand the importance of a strong health care system.

True, federal budgets have many competing priorities, but health funding goes to the very heart of what we want our country’s future to look like.

Do we want to protect the world-class Medicare system we’ve worked so hard to build?

Do we want to empower health care professionals to be able to work to their full scope of practice and deliver worldleading quality care?

Maintaining penalty rates, existing entitlements and rights at work Maintaining penalty rates for all Australians, protecting and improving existing entitlements (such as paid parental leave), and guaranteeing the rights and conditions of all workers through a fair industrial relations framework.

Strengthening accountability for public funding Strengthening accountability and transparency for public funding provided to all health and aged care services through improved public reporting, including nursing and midwifery staffing numbers, skill mix and quality outcomes.

Do we want a fair work environment that values those who work unsociable hours?

And do we want a government that looks beyond the budget bottom line and instead invests in the future of our health care system?

The answer, of course, is yes.

A robust and well-funded health care system is an essential cornerstone of modern-day Australia.

The state of our health care system determines the health of our citizens, and should therefore be a key priority for any government serious about improving the quality of life for its citizens.

JUNE 2016 TQN 29

Fe at u re Actions speak louder than words All political parties claim health is an important issue for the future of Australia.

However, over the past few years we have not seen much evidence of a government with a plan to strengthen our health system.

With $57 billion cut from health spending in the Abbott government’s first budget and only $2.9 billion re-installed in this year’s budget, frontline health services are inevitably going to feel the pinch.

An ageing population and increasing health expenditure certainly present challenges for our health system and for budget-makers, but QNU Secretary Beth Mohle said cutting services now will only cost more later on.

“We need to develop smarter, more sustainable health budgets into the future by changing the way we think and what we prioritise,” she said.

“We need to focus on preventative health initiatives that keep people out of hospital.

“Most importantly, we need to move away from this idea that cutting frontline services in order to save money is somehow a long-term solution.”

Invest now, save later One way to build a stronger and more sustainable health care system is to reform how the system currently operates.

This means investing in nurses and midwives through better skill mix and numbers and bringing the focus back to the patient or resident.

This can be achieved, for example, by considering new midwifery models of care that empower midwives and lead to better outcomes for expectant mothers.

It can also be achieved by creating new nursing positions in the aged care, primary health care, and community sectors, similar to the Nurse Navigator positions the Queensland government is currently rolling out.

Such positions would focus on improving the co-ordination of patient care across health care settings and sectors.

30 TQN JUNE 2016

The key is empowering our health care professionals to deliver better services.

This results in reduced lengths of stay, better patient outcomes, and saves money in the long run.

Universal health care Australia’s health care system has long been underpinned by the simple principle that access to quality health care must be based on need, not capacity to pay.

And while we are indeed more fortunate than other countries, such as the US where the health system operates on the ‘user-pays’ principle, we cannot take this for granted.

If we did move to a user-pays system in which one’s ability to receive quality care is determined by their income, then we could expect drastic cuts to publically funded frontline services—and worryingly, that’s exactly what we have witnessed over the past few years.

The billions of dollars ripped from the health budget gives a clear indication of the current government’s agenda, and signals what’s to come if they are reelected.

Respecting our work We also want a system that respects the work we do.

Workers fought for penalty rates so those of us who work weekends or through the night are adequately compensated.

The Productivity Commission has recommended bringing Sunday penalty rates in line with Saturday wages for those working in the retail and hospitality sectors and Malcolm Turnbull has already said lower penalty rates are inevitable in a seven day economy.

In October last year, Mr Turnbull described Sunday penalty rates as a hallmark of the old economy.

“The only reason they’re different, I assume, is history,” said Mr Turnbull, demonstrating his government’s lack of understanding on the very purpose of penalty rates.

The QNU has been campaigning collectively with other unions since 2014 to ensure our penalty rates are protected.

A two-tiered system—which says one group of workers deserves to be compensated for working unsociable hours while another group does not—has no place in Australia.

Scrapping penalty rates for some workers would also signal the beginning of a slippery slope, where nurses and midwives could be next.

Use your vote wisely Nurses and midwives are a powerful force, not least of all because we are one of the largest frontline workforces in this country.

This election, we have the power to send a clear message to our politicians that we value our world-class health system.

Our vote can make a difference.

www.qnu.org.au

ELECTION WRAP – THE KEY ISSUES FOR NURSES AND MIDWIVES

We each have one vote and it is important OPINION BY DR LIZ TODHUNTER, QNU RESEARCH AND POLICY OFFICER

An essential feature of a liberal democracy is a democratic electoral system where: ■ ■

elections are consistent and fair votes have equal value—one vote one value ■ the will of the majority is achieved ■ the interests of minorities are recognised ■ there is a high level of voter participation ■ voting is accessible.

Australia achieves these through our Constitution, which provides for six-yearly Senate elections and three-yearly elections for the House of Representatives.

These elections are administered by the Australian Electoral Commission, an independent statutory authority that ensures elections are conducted properly and fairly.

Under our compulsory voting system, everyone over the age of 18 must enroll and vote.

Compulsory voting was introduced in 1924 and first used in the 1925 elections (although enrolment and voting for Aboriginal and Torres Strait Islander peoples only became compulsory in 1984).

Other nations with mandatory voting include Argentina, Belgium, Brazil, Chile, Ecuador, Greece, Singapore and Turkey.

Around election time, many people wonder if compulsory voting is fair when the whole idea of democracy is to give everyone the freedom to make their own choices.

Some Australians argue against compulsory voting.

However, the idea of civic responsibility, which lies at the heart of this practice, has produced a stable democracy that recognises the value of its electoral system.

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To vote or not to vote The main arguments in favour of compulsory voting centre on: ■ The importance of voter turnout: If only a portion of the population votes, then the principle of democracy is compromised when the government represents only some of the electorate.

■ A lesser need for politicians’ to have massive campaign funding because there is not the same imperative to entice people to vote.

■ Ensuring politicians represent the views of all citizens rather than targeting specific interest groups or certain people. If everyone votes, candidates must aim to appeal to all sectors of the community, thus promoting democracy.

■ Promoting political stability because popularly elected governments are more likely to have a transparent policy platform unaffected by crises or leaders with hidden agendas.

■ Valuing the right to vote. If people are obliged to vote, they are more likely to research candidates and/or policies to make sure they select the party or individual that meets their interests.

This forces candidates to be transparent and honest in their campaigning.

Those who oppose compulsory voting claim: ■ It violates freedom of choice. People should be free not to express their political views through voting.

■ Voting for the sake of it defeats the main purpose of an election which is to elect deserving candidates into key positions.

■ It is unfair to fine those who do not vote because they have not harmed anyone and the enforcement cost is a waste of money.

In the long run, apathy is not a reason not to vote. Governments are elected through the will of the majority.

Those who choose not to vote yet enjoy the benefits of democracy in some ways resemble those who choose not to be union members yet are willing to accept the pay increases and conditions of employment won through the efforts of those who stand up and are counted.

They see nothing wrong with watching as others take a stance only to benefit as a result of their efforts. In the case of non-union members, this is even more distasteful because they also happily fail to pay union fees.

Australia really is the lucky country— not just because we are blessed with so many natural resources and a peaceful, multicultural way of life—but because we maintain institutional structures and practices that safeguard our good fortune.

We each have one vote, and like the philosophy of trade unionism, it is the power of the collective that brings about change.

As citizens, it is one small civic duty we undertake that can affect our lives and our future.

The freedom of our liberal democracy should not be taken for granted. We each have one vote, and we should make it count.

JUNE 2016 TQN 31

PROFESSIONAL

NURSES WORKING IN COSMETIC PRACTICE An increasing number of Registered and Enrolled Nurses are finding work in private cosmetic practices, raising a number of professional issues around cosmetic nursing.

There are many different cosmetic procedures available in Australia, including dermal therapies and injectable cosmetic procedures.

RNs and ENs are only able to perform or assist in cosmetic procedures if they are deemed educated, competent, and authorised by the Nursing and Midwifery Board of Australia (NMBA) to do so.

Nurses need to consider whether they are able to include any or all of the individual cosmetic procedures undertaken in their cosmetic practice of employment as part of their scope of practice.

To determine your individual scope of practice, there are a number of specific considerations: ■ The Nursing and Midwifery Board of Australia: The NMBA regulates nursing and midwifery professions. All registrants must comply with codes, guidelines and registration standards of their profession. Professions are regulated in the public interest by contributing to public safety to ensure those who are authorised to make decisions are competent to do so.

■ Scope of practice of a profession: A profession’s scope of practice is the full spectrum of roles, functions, responsibilities, activities, and decision-making capacity that

32 TQN JUNE 2016

■

■

■

individuals within that profession perform. The scope of practice of all health professions is influenced by the wider environment, the specific setting, legislation, policy, education, standards, and the health needs of the population.

Scope of practice of an individual: The scope of practice of an individual may be defined more specifically than the profession’s scope of practice. It refers to the individual’s education, authority and their competency to perform. Practicing within one’s full scope of practice may require updating or increasing knowledge, skills, or competence through further education and training.

RNs delegating and supervising an EN: The NMBA’s professional practice framework requires RNs (not a medical officer or other staff member) to delegate and supervise ENs. Therefore, an EN may not practice nursing unless under the supervision of an 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.

Queensland, Health (Drugs and Poisons) Regulations 1996: In Queensland, the use of medicines

is controlled by the Health (Drugs and Poisons) Regulation 1996 (Qld) (HDPR). The RN and EN have differing roles in managing medicines. All nurses must ensure they administer medicines and treatments according to their respective endorsements in the HDPR. This includes cosmetic dermal therapies and injectable procedures.

Who decides scope of practice?

The NMBA consistently advises that registrants are responsible for their actions.

Moreover, the RN remains accountable for delegating nursing care to the EN, as well as supervising that care and evaluating outcomes.

The NMBA also states that RNs are exclusively responsible for determining the scope of nursing practice.

Therefore, ENs must take guidance from the responsible RN to ensure their activities remain within their scope.

If you have any questions regarding cosmetic nursing, contact the QNU on (07) 3099 3210.

You can also lodge an individual request for representation by visiting http://bit.ly/qnu-rfr

www.qnu.org.au

NURSING AND MIDWIFERY RESEARCH

Moving evidence into clinical practice: Implementing surgical safety checklists in the operating room

BY B.M GILLESPIE FOR THE NHMRC CENTRE FOR RESEARCH EXCELLENCE IN NURSING

Surgical safety checklists have been shown to improve teamwork and reduce the risk of wrong site surgery (WHO, 2008).

But despite the available research evidence supporting the benefit of using surgical checklists, there have been many difficulties associated with their uptake in clinical practice (Biffl et al, 2015 and Fourcade et al, 2012).

The challenge lies in bridging the ‘knowdo’ gap and making research findings more accessible to frontline clinicians (Graham, 2015).

An approach that is increasingly used to minimise the gap between research and clinical practice is Knowledge Translation (KT).

KT is about implementing strategies designed to raise awareness of research findings for end-users and help use those findings in clinical practice (Graham, 2015).

Pilot study Using a KT approach, clinical stakeholders at the Gold Coast University Hospital and NCREN researchers developed strategies to support clinicians’ use of the checklist in surgery.

The intervention, coined Pass the Baton, was designed to overcome workflow, which was identified by staff as a major barrier to using the checklist in surgery (Gillespie et al, 2016).

As part of implementing Pass the Baton, there were three KT strategies to support better use of the surgical checklist. These included:  social influence (opinion leaders, change champions)  audit and feedback (information, education, knowledge brokers)  reinforcement (prompts and reminders).

The implementation of Pass the Baton was nurse-driven. Their role was to

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Pass the Baton posters were placed in various locations in the operating room department of Gold Coast University Hospital to prompt and remind participants to use the surgical safety checklist.

initiate and lead the safety checks that make up the surgical checklist.

Positive results Pass the Baton is currently being evaluated but early results are promising.

We have observed improvements in surgical checklist participation and compliance.

Interviews with clinical stakeholders indicated that the KT strategies to support checklist use in surgery were feasible and acceptable.

Evaluation of the Pass the Baton intervention is ongoing and there are plans to refine the KT strategies that support it.

After further refinement, Pass the Baton will be rolled out on a larger scale, across several hospitals.

For more information about this and other NCREN KT projects, please contact Professor Brigid Gillespie at b.gillespie@griffith.ed.au

References Biffl W, Gallagher A, Pieracci F, Berumen C: Suboptimal compliance with surgical safety checklists in Colorado (2015): A prospective observational study reveals differences between surgical specialties.

Patient Saf Surg, 9:5.

Fourcade A, Blache JL, Grenier C, Bourgain JL, Minvielle E (2012): Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf, 20, 191-197.

Gillespie B, Marshall AP, Gardiner T, Lavin J, Withers T (2016): The impact of workflow on the use of the Surgical Safety Checklist: a qualitative study. ANZ J Surg, doi 10.1111/ans.13433.

Graham, I(2015): Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches. Canadian Institutes of Health Research: Accessed 10 May 2016: http://www.cihr-irsc. gc.ca/e/45321.html World Health Organisation: Implementation of the Surgical Safety Checklist (2008). In. Geneva: World Health Organisation, 1-28.

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C A S E ST U DY

Continuing professional development

Tying it all together – Ratios, the BPF and patient safety Nurses and midwives have a key role to play in maintaining patient safety.

This arises from professional standards established by the Nursing and Midwifery Board of Australia (NMBA), our commitment to nursing and midwifery values as identified by the QNU and other nursing organisations, and in our roles as members of the broader health care team based on the national quality and safety standards.

The most recent Morgan poll confirms the community considers nurses the most trusted professions. It therefore follows that the public expects us to strive to keep them safe and uphold standards that support positive health outcomes.

It is clear from the codes, guidelines and frameworks established by the NMBA that nurses and midwives play a key role as advocates for patients.

The national framework for the development of decision-making tools for nursing and midwifery practice (DMF) indicates that nurses and midwives are responsible for deciding whether their workplace has sufficient staffing levels and appropriate skill mix to uphold professional practice.

Nurses and midwives recognise through the Codes of Ethics that people are entitled to quality nursing and midwifery, and that we will strive to secure the best available care for them.

The QNU has identified values shared by nurses and midwives. These encompass caring (which is central to our identity as nurses and midwives), holism (keeping the system human), advocacy (keeping the system safe), and professionalism (being accountable to the community).

34 TQN JUNE 2016

As nurses and midwives, we stand up and speak out for what is right and necessary on behalf of those in our care and by engaging with those who have power to affect the way we provide quality care.

So it becomes clear that our values and professional practice standards confirm us as patient advocates.

Furthermore, we have a pivotal role in establishing, monitoring and improving health care outcomes as participants in the governance for quality and safety which underpin the National Quality and Safety Health Service Standards.

Nurses and midwives also recognise their role in supporting responsible spending in health care by contributing to the development of budgets that support the resources required to achieve health service priorities.

We engage in this process by determining the nursing or midwifery hours required based on a range of factors. These include history, evidence and research, legal requirements, experience, and critical analysis of the environment where care is delivered.

We rely on our education, experience, and the application of the evidence from research to underpin our decisions about what staffing is necessary to support safe care and uphold professional standards.

To ensure patient safety and advocate for improvements that support quality care, there must be sufficient nurses and midwives available with the necessary skills and experience. We must have opportunities, supported in the workplace, to continue our professional development so that the services delivered are based on the best available evidence.

Nurses and midwives recognise the importance of data sources to quantify their input. As health care professionals,

we use knowledge, experience and research evidence to analyse the performance of our ward, unit or service against quality and safety indicators. We then use this information to predict what staffing will be required for the future— whether this is the next shift or for the annual budget cycle.

The role of ratios and workload management tools In the public sector the Business Planning Framework (BPF) is the mandated workload management tool. It allows nurses and midwives to have a voice in determining staffing and skill mix and address shortfalls both when allocating resources to develop a roster and on a shift-by-shift basis.

In the private and aged care sectors, the QNU has achieved workload reporting processes as part of enterprise agreements. We’ve also negotiated nurses’ and midwives’ participation in safety and risk management systems and local consultative groups to provide a means for nurses and midwives to act in their workplace to promote patient safety.

Nurses and midwives need to be familiar with whatever mechanism is available in their workplace and take action to report workloads concerns.

In the absence of a recognised workload management process, nurses and midwives are encouraged to report these concerns in writing so management may work with them to rectify unsafe workloads.

So there are varying approaches to workload management across the public, private and aged care sectors.

The principles of safe staffing in relation to nurse/midwife numbers, adequate skill mix levels, and quality performance indicators, are inconsistent across health care services in Queensland.

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CONTINUING PROFESSIONAL DEVELOPMENT

New ratios legislation sets minimum guarantee The recent historic achievement of legislated minimum nurse/midwifeto-patient ratios in Queensland Health facilities provides the foundation—a minimum staffing guarantee, upon which nurses and midwives can build.

The evidence is clear regarding the value and benefits of minimum nurse/midwife-to-patient ratios.

National and international studies have proven the number of nurses, their skill mix, and their practice environment positively influence the safety and quality of health services.

Significant savings for the health system can also result from improving nursing and midwifery numbers and skill mix.

For your further reading, our Ratios Saves Lives website— www.ratiossavelives.com.au— provides links to the evidence and its relevance to improved patient outcomes, patient safety and cost savings.

The new legislation provides additional strength to the BPF. This applies in the public sector as it is set to become the standard for workload management in the new legislative framework.

The legislation requires public hospital and health services to fully implement the BPF, to demonstrate their compliance with it, and to publically report on their performance against standards determined in the legislation.

Whilst this legislation is a monumental achievement, this is just the beginning.

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It starts with the implementation of ratios across specified public sector services and a world-class research initiative conducted by leaders in this field. This will monitor the local impact and guide further implementation in the public sector.

Whilst the current evidence provides a compelling argument for other sectors to adopt ratios, the emerging evidence from other jurisdictions provides the impetus for the QNU to continue to lobby for ratios to be applied universally (ie: in all health care services).

The aim is to provide a reliable and enforceable workload management methodology for nurses and midwives in public, private, and aged care facilities, reinforced by the public reporting of ratios, skill mix levels, and quality outcomes.

Nurses and midwives believe Queenslanders have a right to receive safe, high quality health and aged care based on the best evidence available. We rely on the evidence which indicates that ratios and particular skill mix levels are an economically sound method to save lives and improve patient outcomes.

Establishing a minimum legislated ratio provides a safety net. It provides reassurance to the community that those responsible and accountable for the provision of health care—including governments, departments/ agencies, providers and practitioners—have considered the best available evidence to establish a minimum safety standard for nursing and midwifery care.

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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.

For example, an individual who is a Registered Nurse and a midwife must complete 40 hours of CPD. Please refer to www.nursingmidwifery board.gov.au/ Registration-Standards. aspx for full details.

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.

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.

36 TQN JUNE 2016

Reflective exercise: Tying it all together – Ratios, the BPF and patient safety Nurses and midwives enjoy the privilege of being the most trusted profession. Patients rely on nurses and midwives as their advocates to ensure that they receive safe care based on the best evidence.

To maintain safe quality care there must be adequate numbers of appropriately qualified and experienced nurses available on each shift. The staffing must allow for nurses and midwives to take necessary breaks, to have time to reflect and support each other and provide time in their working lives for learning and development to promote improved health outcomes.

1. With particular reference to the NMBA’s Codes of Ethics and DMF for nurses and midwives what are some of the professional responsibilities you need to consider when faced with inappropriate staffing?

2. As a patient advocate how can you influence decisions about staffing and workload management that support safe patient care in your workplace?

Consider your role in the organisation – what are your responsibilities for ensuring that there are adequate nursing and midwifery resources – for example as the nurse/midwife providing the direct care; the nurse or midwife managing ward/unit/ service; the nurse executive responsible for allocating resources?

3. Thinking about a recent shift –  Do you feel that patient safety was maintained?  What steps were necessary for you to achieve patient safety?

 Consider the workload – was there a balance between demand and supply?

 What caused changes in the balance – patient acuity or complexity, the number of presentations, the churn created by rapid turnover of patients, unexpected leave?  Were staff able to have breaks?  Was training or development deferred to maintain staffing numbers or skill mix?  Were you able to maintain the necessary surveillance to monitor for signs of deterioration or improvement in your patients?

4. What impact would a guaranteed minimum staffing ratio have had on that shift?

5. Considering the evidence that a minimum ratio of nurses/midwives to patients has significant benefits to patient outcomes, how can you influence decision makers to extend ratios as the minimum standard for all sectors?

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

27-03-16

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

CO M M U N I CAT I O N IS KEY IN ANY R E L AT I O N S H I P SANDRA EALES ASSISTANT SECRETARY A good work environment for nurses and midwives requires an institutional culture that values and respects professional nursing and midwifery as a force for quality patient outcomes.

Excellent communication and collaboration between doctors and nurses and midwives is an important element of a good work environment.

The nature of the relationships we have with the doctors we work with has a huge impact on the work life of nurses and midwives.

If the inter-professional relationship is flawed or ineffective then there is a greater possibility of adverse outcomes for patients.

Relationships in the workplace In 2004, Kramer and Shmalenberg identified five types of registered nurse/ medical officer relationships.

A hostile/adversarial relationship is characterised by anger, frustration, resignation or abuse, power is unequal, and outcomes for both nurses and patients are negative.

A friendly stranger relationship, though not adversarial, lacks trust and cooperation and is characterised by a formal exchange of information and unequal power.

Communication is minimal, perhaps with the doctor writing orders in notes and leaving them on the desk.

This relationship may remain stable, evolve into a more positive one, or it could deteriorate into hostility.

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In a student/teacher relationship, the nurse may be either teacher or student and the relationship may become collaborative.

A collaborative relationship, while marked by mutual respect, trust, and co-operation for the benefit of the patient, is also characterised by uneven power, whereby what the doctor says is more important than what the nurse/midwife says.

In collegial relationships, on the other hand, there is equal power and understanding that each has superb knowledge in their own sphere.

Responsibility without authority Frustration and risk to nurses and midwives can occur in the overlap of medical practice where nurses get the responsibility without the authority.

The inter-professional boundaries are fluid and change from one workplace to another as well as between individuals.

For example, in rural practice the relationship often requires a greater level of autonomous practice with associated responsibilities and challenges.

Nurses accept more responsibility and risk to maintain the relationships on a professional level (Blue and Fitzgerald 2002, p.315).

Confusion and lack of understanding of the concepts of clinical autonomy and control over practice can take their toll on midwives’ and nurses’ work environments and patient care.

Achieving clinical autonomy Clinical autonomy is “the freedom to act on what you know, to make independent clinical decisions that exceed standard nursing practice, in the best interest of the patient” (Kramer et al. 2004).

Kramer et al. (2007) identified structures enabling clinical autonomy, including renegotiating scope of practice—in other words, redefining practice boundaries in the criticality of clinical situations with peer support and confirmation.

Doctor confirmation is usually done sometime later and may be followed by developing protocols and guidelines to sanction the practice.

This process enables autonomy by reducing feelings of risk and providing nurses with the authority to make decisions.

Nurses and midwives must be able to trust in professional support that enables and validates autonomous decisions and actions. The safest and most professionally attractive work environments are built on collegiality and good communication.

References Blue, I. and Fitzgerald, M., 2002.

Interprofessional relations: case studies of working relationships between registered nurses and general practitioners in rural Australia. Journal of Clinical Nursing, 11(3), pp.314-321.

Kramer, M & Schmalenberg, C 2004, Essentials of a Magnetic Work Environment – Part 2, Nursing, vol. 34, no. 7, pp. 44-47 Kramer, M., Maguire, P. and Schmalenberg, C.E., 2006. Excellence through evidence: the what, when, and where of clinical autonomy. Journal of Nursing Administration, 36(10), pp.479-491.

Kramer, M., Maguire, P., Schmalenberg, C.E., Andrews, B., Burke, R., Chmielewski, L., Donohue, M.A.T., Ellsworth, M., Poduska, D., Smith, M.E. and Tachibana, C., 2007.

Excellence through evidence: structures enabling clinical autonomy. Journal of Nursing Administration, 37(1), pp.41-52.

JUNE 2016 TQN 37

MIDWIFERY

New Midwifery Group Practice model for Sunshine Coast Hospital and Health Service

Midwifery Group Practice

38 TQN JUNE 2016

Expectant mums in the Sunshine Coast now have access to greater birthing options.

Midwives from the Sunshine Coast Hospital and Health Service (SCHHS) and the Queensland Nurses’ Union (QNU) were excited to welcome the staged implementation of a new Midwifery Group Practice (MGP) from February 2016.

Previously, women were only able to access a traditional maternity service, which is modelled with a medical and hospital focus rather than client choice.

The SCHHS Women’s and Family Service Group (WFS) have been actively responding to the needs of women who want other birthing choices in their local area.

Following a number of investigations and project planning sessions, the group also established a Local Agreement for MGP midwives in consultation with the QNU, prior to the model’s implementation in February.

The SCHHS WFS’s aim was to incorporate contemporary best practice principles of midwifery in order to extend birth choices for women.

The MGP model provides greater choice, control, and continuity of care to women.

The move is away from a traditional fragmented medical model towards a woman- and family-centred model that is supported by a midwifery clinical governance framework, including mentoring and clinical supervision of midwives.

The SCHHS is also building a research and innovation culture.

The SCHHS recently partnered with Griffith University, the University of the Sunshine Coast, and the Midwifery Maternity Provider Organisation Australia (MMPOA) to undertake an action research study (research undertaken on-the-job), which will roll out alongside the MGP during 2016.

The first part of the research will set the foundation for developing a strong connection between practice, research, and education with a focus on how women access services and care is delivered across the childbirth continuum.

The second part will start when full implementation of the MGP model is completed and will assess midwives’ satisfaction.

Key stakeholders—including the QNU, gave the initial threemonth stage, which kicked off with four midwives in February 2016, a successful evaluation.

The second three-month stage will run through until August 2016 and will double capacity, giving women access to eight midwives.

It’s anticipated that full implementation of the model will be completed in late August 2016 with 16 midwives working to manage the care of 50% of the women utilising SCHHS maternity services.

The new model, the staged implementation, and the evaluation support the redesign of maternity services across the SCHHS. The MGP will expand the delivery of maternity services through 2016 and, following the move from Nambour Hospital to the new Sunshine Coast University Hospital when it opens in early 2017, will continue to provide safe, high quality continuity of care midwifery and bring greater birthing options for women on the Sunshine Coast.

www.qnu.org.au

HEALTH AND SAFETY

Single nurse posts The murder of South Australian Remote Area Nurse Gayle Woodford shocked the Australian public, triggering a nation-wide campaign to abolish single nurse posts.

Within a few days, Federal Minister for Rural Health Fiona Nash met with health and nursing stakeholders to discuss safety and security issues for RANs. Speaking to Ms Nash, the Australian Nursing and Midwifery Federation highlighted the raft of occupation violence dangers these nurses face while at work.

As part of a co-ordinated response from all states and territories, the QNU is conducting a review into single nurse posts and call-out procedures for remote and isolated nursing work in Queensland.

Significant issues yet to be addressed The QNU, which has long campaigned around this issue, does not support single nurse posts.

Queensland nurses and midwives remember the events of 2008 where a nurse was sexually assaulted in the Torres Straits.

Most recently the QNU has stated its opposition to single nurse posts at parliamentary inquiries into Tackling

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Alcohol-Fuelled Violence Amendment Act 2016 and the Safe Night Out Bill 2014.

As part of our review, the QNU organised a number of teleconferences with RAN members to hear their concerns around safety and security issues, particularly for on-call arrangements.

From these discussions, it’s clear that significant issues still remain.

Personal safety must not be compromised

QNU takes matters to health minister

Know your rights at work

As a result, the QNU wrote to Health Minister Cameron Dick seeking to have their issues addressed.

The QNU also raised concerns that safety around remote work might be impeded by the fragmented management structure of HHSs. We have therefore asked that an audit of each HHS’s approach to remote nursing safety be conducted, highlighting the significant risk that after hours callouts pose to nurses.

As part of the review the QNU has also surveyed members about accommodation standards for rural and remote nurses—a fundamental aspect to nurses’ security.

Prior to recent events, the state government did express their desire to improve housing for workers in these remote areas.

Nurses working in rural and remote areas often face challenges to ensure their safety while providing care to their communities.

However, care should never be delivered at the expense of personal safety.

What’s more, nurses in management positions must not place unreasonable expectations on nurses to deliver care to the detriment of personal safety.

Recently the QNU has become aware of some inappropriate models of care— including one employer who requires community nurses to perform after hours on-call.

This has nurses potentially visiting client homes alone in the middle of the night.

This practice carries serious risks and we remain unconvinced the safety of members is being managed properly.

It’s important to remember that the Work Health and Safety Act 2011 allows workers to refuse or cease work that would expose them to serious risk from an immediate or imminent hazard.

All of these issues have been raised in discussions in the Occupational Violence Taskforce committee in which the QNU is an active participant having lobbied for its establishment. The committee’s focus is to improve safety for the Queensland Heath workforce.

JUNE 2016 TQN 39

OPINION

Protect our health care system

BY ADAIR JONES, COMMUNITY MEMBER

40 TQN JUNE 2016

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OPINION

When I first arrived in Australia from the United States in 1996, I couldn’t get over how accessible health care was here.

With young children in a new country, it seemed I was constantly running to the doctor—for everything from ear aches and sprained ankles to more serious illnesses like chicken pox.

I soon found out, unlike in the US, the system here worked—and it was affordable.

Little did I suspect then that 15 years later this system would save my life.

In early 2011, I slowly became aware that something was different in my left breast.

There was no lump, no pain, no sensitivity, just a subtle awareness that something was different. Call it an inkling.

It couldn’t be cancer, I reasoned. There was no family history of cancer.

I had always been healthy—almost piously so. I ate right, drank little alcohol, exercised regularly. I had never smoked.

I had even breastfed three children two years each, something I knew was protective. And I was the ‘wrong’ age.

So it couldn’t be cancer. It had to be something else.

A little voice inside suggested I get a mammogram. I hesitated. Like everyone, my life was busy.

I had three kids at different schools, each with a packed schedule. My husband travelled a lot for work. And there were my own professional obligations. How could I possibly squeeze in a mammogram?

Even though at that stage I’d lived in Australia for well over a decade, because I’d grown up in the US I tended to model my expectations on the US health system.

My first thought was that there’d be a long wait time and that it would be hard to schedule the procedure so far in advance around everything going on with the kids. Should I even bother? The little voice persisted.

When I rang BreastScreen Queensland, I was surprised to get an appointment early the following week and on a day when I had room in my busy schedule.

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Ever doubtful, I asked about parking.

“There’s plenty of parking out front,” I was assured.

“And how much will it cost?” I asked, still sceptical.

“Why, it’s free, of course.”

Timing. Convenience. Cost.

These are real roadblocks to good healthcare—roadblocks encountered in the US every day by people needing simple procedures that could very well turn out to be lifesaving.

But for me, in early May 2011, the road was clear. I didn’t have to wait. Parking was available. The procedure was free.

There was no reason not to proceed.

I had the mammogram.

It was followed by a biopsy three days later, a cancer diagnosis the following week, and surgery later that month.

“AND HOW MUCH WILL IT COST?” I ASKED, STILL SCEPTICAL. “WHY, IT’S FREE, OF COURSE.” In the months that followed, I underwent radiation treatment at the Royal Brisbane and Women’s Hospital, cared for by a health system that worked well and by a staff that was skilled, well-trained, and sympathetic.

Every day as I pulled into the hospital carpark for my treatment, I felt a rush of gratitude.

I knew that if I had been facing this in the US, it would cost me many tens of thousands of dollars.

Here, though, I had wonderful care and support at the most stressful time of my life.

Not only had I detected my cancer early enough to save my breast and avoid chemotherapy, the cost of my treatment was completely covered by the healthcare system.

I was looked after by compassionate staff using state-of the-art treatments.

I was invited to participate in a clinical trial. And the follow-up care has been comprehensive.

I knew I was lucky. While my cancer was aggressive, I’d found it early. I’d listened to the little voice inside and taken action.

But I also knew that had I encountered even one of those roadblocks at any step along the way, the outcome might not have been the same. I might have ignored the little voice, and I wouldn’t be here now.

Not everyone is as lucky.

Last year, around 15,600 Australian women were diagnosed with breast cancer. That’s 42 women every day.

Each year around 2,800—seven Australian women on average every day—die of the disease.

Everyone knows that diagnosis at early stages is associated with better clinical and survival outcomes.

So if those 42 women every day miss out on having their cancers detected, more are going to die.

Not to mention the fact that associated costs rise starkly as treatments for more advanced stages are needed.

For me it’s a no brainer: early diagnosis saves both lives and the dollar bottom line.

That’s why I can’t understand the government tinkering with a system that is, for the most part, working well and protecting Australians.

The Australian health care system saves lives. It saved mine. But it’s in danger.

It seems that every time a new budget is announced, there are cuts to services.

New charges are issued. These changes— some coming, some already here—mean more sick people.

When prices go up, patient numbers go down. Fewer people see doctors and nurses. Fewer people get the tests, the scans, the medications, and the treatments they need to stay well.

When governments start treating health care like it’s something to be negotiated, we should all be worried.

Because what they are doing is creating roadblocks to care.

And roadblocks cost lives.

JUNE 2016 TQN 41

PROFILE

Bringing safe midwifery care – and hope – to remote PNG

Debbie Butters’ midwifery journey began in 1980 during training at the Royal Brisbane Hospital.

She later completed a graduate diploma in childbirth education, facilitated by one of Australia’s dynamic birth advocates, the late Andrea Robinson.

It was through this study that she learned Active Birth Principles and the notion of Informed Choice.

She began to understand the importance of being with women during their birth journey and is now thoroughly committed to bringing this knowledge to birth settings in developing countries.

BY DEBBIE BUTTERS

In 2008 with our children now young adults, my husband Neil and I decided to take off without them.

I was determined that if I was taking six months off work I needed to be doing something useful.

We first spent 10 weeks in Mongolia, which was both rewarding and exciting.

I worked at the Ulaanbaatar Number Two Maternity House, but we also had a couple of weeks to explore the amazing countryside and get to know the people.

I was still a bit of a ‘tourist volunteer’, but that trip was the catalyst for my love of midwifery in developing nations.

With an increasing understanding of various volunteer groups’ goals, our family have since been involved with

42 TQN JUNE 2016

groups that try hard to achieve outcomes for the local people.

I took part in three YWAM (Youth with a Mission) trips—to Fiji, the Philippines, and then Papua New Guinea (PNG).

The Townsville YWAM group now has a ship that takes up to 150 health workers to the remote parts of the Western Province, Gulf District, and Milne Bay provinces of PNG. Living on the boat and yet being able to bring health care to remote villages during the day was an exciting but reassuring way to shake off my initial worries.

PNG gained independence from Australia in 1974, and sadly there have been many problems since.

Corruption remains one of the biggest issues, with funds frequently not reaching the communities or projects they are promised to.

The standard of education, health care, and infrastructure has continued to deteriorate.

Geographically, it’s a difficult country to traverse because of rugged terrain and a multitude of rivers.

There are few roads and most people live in grass huts in small villages along the rivers or in mountainous areas reached only by foot.

Most of the population are subsistence farmers, requiring small plots of land to provide food for their families.

The women and children suffer most.

One in 20 die during childbirth, and 5.5% of babies don’t reach their second birthday.

Distressingly, women in rural communities usually give birth in their village without the support of skilled attendants.

With deep empathy for our closest neighbour, I now concentrate on

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PROFILE

improving maternal and infant wellbeing in remote and neglected parts of PNG. To achieve this, I’ve frequently accompanied Sara David, founder of the Australian charity Living Child Inc., and PNG midwife Rhondy Ktumusi to remote parts of the East Sepik Province.

We focus on education for mothers and village birth attendants, providing birth kits and family planning.

In 2015 I led a team on behalf of Living Child to Anguganak in the remote Sandaun Province in the North West corner of the country.

We provided safe motherhood awareness training to 64 mothers and village birth attendants.

We also trained 35 health workers in areas of midwifery care and obstetric emergencies and ran implant family planning clinics, training staff so this service could continue after we left.

This year I organised a return trip to Anguganak with support from the Australian charity Send Hope Not Flowers.

Jim McConochie, an experienced rural GP, and Kym Robinson, a nurse and midwife, joined me.

We partnered with the local health care centre to introduce the Anguganak Healthy Motherhood Project, providing education, family planning implant clinics and training, and birth kits for village birth attendants.

This year I introduced ‘baby bundles’, a collection of gifts for new mothers as an incentive to have a health care centre birth.

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We also donated blood pressure cuffs and stethoscopes—but, above all, we brought hope.

These health workers face problems we’d never face in Australia.

The Anguganak hospital has no electricity, because the generator broke two years earlier and the solar lighting was destroyed by rats chewing wires in the roof space.

TB patients are cared for in the same ward as maternity patients because there’s no money to complete the new maternity ward and the white ants are already attacking it.

Mothers and babies die from lack of services.

There’s no way to perform lifesaving caesarean sections.

There’s no steriliser because they’ve run out of kerosene, no blood transfusions, no pain relief, and mothers with severe anaemia, malaria, and tuberculosis are having their seventh baby.

Jim made visits to outlying villages. He addressed the men on issues such as women birthing without trained support, the role family planning plays in saving mothers’ lives, gender inequality and the need to value women and the importance of antenatal care.

He refuted the superstition that men will lose ‘strength’ if they touch a bleeding woman, as this fear results in men refusing to help women during childbirth emergencies.

Volunteering in remote PNG requires an adventurous spirit.

You need flexibility for when things just don’t go to plan, like the weather affecting flights.

You need courage to cope with rats, limited food options, no electricity, and primitive plumbing.

Such challenges don’t stack up when the mothers tell me how they’ve walked eight hours barefoot through the jungle, fording rivers with a toddler on their hip to come for a family planning implant so they can have children by choice not chance.

In doing this, they reduce the risk of dying during childbirth like so many women in their villages have done.

Our closest neighbour is only 150 kilometres away, but it’s another world.

We plan to visit Anguganak twice a year to address problems such as the broken generator and the unfinished maternity ward, as well as ongoing training, birth kits, and baby bundles.

If you’d like to support our efforts, please let me know via email: butters@exemail.com.au

Other ways you can help: YWAM Medical Ships ywamships.org.au Living Child Inc. www.livingchildinc.com Send Hope Not Flowers www.sendhope.org

We are looking to tell more of our members’ stories. If you’ve had interesting nursing or midwifery experiences you’d like to share, please let us know by emailing comms@qnu.org.au

JUNE 2016 TQN 43

SOCIAL

Landmark report examines indigenous health

QCA standing up for penalty rates This federal election the Queensland Community Alliance is fighting to save our weekends, ensuring we protect time spent for family and the community.

A new report has found that indigenous people often experience the same level of disadvantage in wealthy countries as they do in poorer ones.

Prestigious medical journal The Lancet collaborated with Australia’s national institute for Aboriginal and Torres Strait Islander health research, the Lowitja Institute, and 23 other countries, to publish a report the authors say should be used as a blueprint for international policy reforms to improve the outcomes for indigenous people worldwide.

The report captures the health status of more than 154 million indigenous and tribal peoples across 23 countries, making it the most comprehensive indigenous health report published.

Researchers assessed data such as population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, education, poverty, and economic status.

The data revealed indigenous people almost universally suffered poorer outcomes compared to non-indigenous people in their country, with poverty, poor employment and educational opportunities, racism and social exclusion all having an impact on health.

It’s no surprise that levels of disadvantage vary greatly between countries.

44 TQN JUNE 2016

What is surprising, however, is that the level of inequality did not necessarily coincide with the wealth of the country.

Put simply, being indigenous in a wealthy country does not necessarily lead to better outcomes

More consultation needed with indigenous communities The purpose of the study was to identify what needs to be done if the United Nations is to meet its 2030 goals of ending poverty and inequality.

It recommended the UN include Indigenous and tribal peoples from across the globe in policy and reform discussions, including those around improving health outcomes.

It noted that involving indigenous people may have a greater impact than simply investing more money into health services.

In this respect, Australia was ahead of the curve, having initiated the Close the Gap campaign in 2008, when Aboriginal and Torres Strait Islanders joined with health and social care organisations to achieve indigenous health equality by 2030.

The study also suggested that international collaboration and cooperation could be more effective at finding ways to improve indigenous health than problem-solving on a country-by-country basis.

The QCA is a coalition of churches, unions, faith and ethnic groups and other community organisations.

These groups work together to build power for the common good in south-east Queensland.

Dave Copeman from the QCA said penalty rates must be protected if we’re to maintain a fair society that compensates those who work unsociable hours, including weekends.

“As members of unions, churches and community organisations, we have a common interest in protecting the weekend and keeping Sunday special,” Dave said.

“If we are to protect family time against an ever encroaching market, we need to be involved in decisions around trading hours and penalty rates.

“Union members, churchgoers and community leaders all agree on this.

But we need to speak up so that community values are considered in the decisions that shape our society.”

A series of forums will be held for QCA members to meet and discuss these issues.

Brisbane forum: 11 June, 2pm at St John’s Cathedral Bracken Ridge forum: 16 June, 6.30pm at Bracken Ridge Catholic Parish (30 Eldorado St) Beenleigh forum: 21 June, 6.30pm (venue TBC) For more information, contact Dave Copeman by emailing dave@qldcommunityalliance.org

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LIBRARY

Book review

Abbott, B, De Vries SM (2016) Monitoring and administration of IV medications for the Enrolled Nurse, South Melbourne, Cengage Learning.

Achieving competency in Enrolled Nurse IV administration

BY KATE KUNZELMANN RN

The key to success for a book like this has to be its usefulness for both the student and the teacher.

Right from the introduction (a reminder about Scope of Practice) to the end (review questions), this book is directly and explicitly instructional.

The language is clear, concise, and familiar for the student, and gives clear direction to the teacher.

This book is written by two experienced nurse educators, who are familiar with the scope of practice and regulatory parameters in IV administration.

They provide clarity where there might have been some confused thinking about the role of IV medication for Enrolled Nurses.

The monitoring and administration of IV medications is placed within the legal,

anatomy and physiology, pathophysiology and practical administration contexts.

As such, it provides a complete guide, and is a very practical manual for gaining competency in HltEN519C – Administer and monitor intravenous medication in the nursing environment.

In all the chapters, we find case studies, tips and activities that enlighten and refresh, providing good information and practical skills.

The book shows the student how to engage with the free Cengage resources for students.

With a comprehensive index and glossary, this volume will contribute to the achievement of competency in what some students find to be a difficult area.

I have assessed this book as to whether it would be useful for a student on clinical placement. The answer is very much ‘yes’.

This manual is small enough to keep with the student, direct and practical, and a very handy guide.

This recommended manual is now available from Cengage online, and is also in ebook format.

This book is available at the QNU library

NORMAL LIBRARY HOURS Monday - Friday 9am–3pm (closed 1pm–2pm) T 07 3840 1480 E library@qnu.org.au W http://bit.ly/qnulibrary Small groups can book the library for study sessions. Contact the library for details.

www.qnu.org.au

JUNE 2016 TQN 45

YOUR SUPER

Winners of national nursing awards announced A Perth nurse that developed a blood management program, a NSW team that launched an innovative Indigenous meal range and a graduate nurse that improved patient communication strategies all received top honours at the 2016 HESTA Australian Nursing Awards.

HESTA CEO, Debby Blakey said this year’s winners exemplified the finest qualities of the nursing profession, and were leaders in their field.

“These winners stood out from an exceptional group of finalists for being instrumental in leading innovation and improved practices that provide the highest quality care to patients, Ms Blakey said.

“We are proud to acknowledge the winners of this year’s nursing awards for the life-changing work they do, this is national recognition each of the winners richly deserves.”

2016 Award winners 2016 Nurse of the Year- Angie Monk from Ramsay Health Care: Angie was recognised for her leadership in developing an innovative Patient Blood Management Program that has improved outcomes and recovery for patients undergoing surgery involving significant blood loss.

2016 Outstanding Graduate- Shelley Cook from Alfred Health: Shelley demonstrated leadership in advocating for patient care and played a leading role in developing a staff training project aimed at raising awareness about communication strategies when working with culturally and linguistically diverse patients.

2016 Team Excellence- Clinical Service Team from integratedliving Australia: The clinical team were recognised for identifying an opportunity to fulfil a community need with an innovative approach to meals provision for Aboriginal people aimed at reducing the higher prevalence of negative health outcomes related to diet and nutrition.

The winners shared a $30,000 prize pool, generously provided by our longstanding Awards supporter ME, the bank for you.

With more than 25 years of experience and $33 billion in assets, more people in health and community services choose HESTA for their super.

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 791 749 321. Terms and conditions apply. See hestanursingawards.com for details.

46 TQN JUNE 2016

Get ahead, get advice Studies show that people who access financial advice are better off financially as a result, even after the cost of advice is taken into account1.

It’s a popular misconception that financial advice is only for people with lots of money or complex finances – but it’s not true. Financial advice can benefit people of all ages in all situations. So whether you’re towards the end of your career or just starting out, it’s always a good time to get some expert assistance.

A little advice can go a long way Even small changes to your finances can make a substantial difference to your lifestyle – both today and in the future.

The types of things financial advisers can help with include whether to put your money into your mortgage or super, salary sacrificing super and making additional contributions, choosing the right investment mix for super, weighing up your insurance options, and other strategies to build your savings and other investments.

Tailored to suit your situation The best thing is that it doesn’t have to be a big commitment or a whole financial review, and can sometimes be done over the phone. As your circumstances change and priorities shift, you can then work with your adviser to review your situation and adjust your finances to suit.

Looking for guidance?

If you’re a QSuper member, you can access a range of personal advice options from QInvest2 and in many cases, you can pay part of the fee from your QSuper account3.

Call 1300 360 750 or visit qsuper.qld.gov.au/advice to find out more.

1. Report 224: Access to financial advice in Australia, Australian Securities & Investments Commission, December 2010. 2 QInvest is a separate legal entity responsible for the financial services and credit services it provides. Advice fees apply. 3 The amount eligible to be deducted varies depending on your situation and the nature of advice. The amount may only be deducted from a QSuper Accumulation or Pension account and is subject to minimum QSuper account balances being maintained. The deduction from your QSuper account is referred to by QSuper as the ‘advice fee’. Your adviser will be able to discuss this with you.

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 2016`

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Ca le nd a r JUNE International Dementia Conference 16-17 June 2016, Sydney NSW www.dementiaconference.com/ Lung Health Promotion Centre at The Alfred 20 June 2016 – Asthma Management Update 23-24 June 2016 – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au Art & Science of Relaxation Evidenced Based Relaxation Therapy: Physiological & Psychological Benefits 17 June 2016, Melbourne www.artandscienceofrelaxation.com Renal Society of Australasia Annual Conference From evidence to excellence: New heights in renal care 20-22 June 2016, Gold Coast www.renalsociety.org/ 13th Global Conference on Ageing 21-23 June 2016, Brisbane www.ifa2016.org.au 18th International Conference on Nursing Informatics and Technology 23-24 June 2016, London UK www.waset.org/conference/2016/06/ london/ICNIT 13th International Congress in Nursing Informatics eHealth for all Every level collaboration – From project to realization 25-29 June 2016, Geneva Switzerland http://ni2016.org/ Art & Science of Relaxation Evidenced Based Relaxation Therapy: Physiological & Psychological Benefits 27 June 2016, Thirroul, NSW www.artandscienceofrelaxation.com 9th World Congress on Active Ageing 28 June-1 July 2016, Melbourne http://wcaa2016.com.au/ Active Ageing Conference Wellness, reablement and restorative care in aged care 30 June 2016, Sydney www.activeageingconference.com.au

JULY Aboriginal Health Conference The youth of today, the elders of tomorrow 2–3 July 2016, Perth www.ruralhealthwest.com.au/ NAIDOC week 3 –10 July 2016 www.naidoc.org.au/ QNU Annual Conference 13–15 July 2016 www.qnu.org.au/conference2016

Lung Health Promotion Centre at The Alfred 13-15 July/17-18 August 2016 – Respiratory Course (Modules A & B) 13-15 July 2016 – Respiratory Course (Module A) 20-22 July 2016 - Asthma Educator’s Course 28-29 July 2016 - Smoking Cessation Course P: (03) 9076 2382 E: lunghealth@alfred.org.au Nurses for Nurses Network Beautiful Bali Member’s Retreat 8-15 July 2016, Kori Resort Ubud, Bali www.nursesfornurses.com.au/ events/147/Beautiful-Bali 21st International AIDS Conference 17-22 July 2016, Durban, South Africa. www.aids2016.org 4th Asia-Pacific Global Summit & Expo on Healthcare 18-20 July 2016, Brisbane http://healthcare.global-summit. com/asia-pacific/ Health Informatics Society of Australia 24th HIC Conference Digital health innovation for consumers, clinicians, connectivity, community 25-27 July 2016, Melbourne www.hisa.org.au/hic/ ANMF (Vic Branch) Mental Health Forum: Advocacy 29 July 2016, ANMF (Vic Branch) Carson Conference Centre www.anmfvic.asn.au/events-andconferences/2016/07/29/2016-anmfmental-health-conference Royal Brisbane Hospital (6-4 Group) Reunion It will be 30 years since we started nursing!

The fourth group in 1986 at the Royal Brisbane Hospital have organised a reunion. Sunday 31 July, 13:30 at Currumbin Surf Club For more information contact: Jane Bortolanza (O’Connor) 0417 648 984 jane.bortolanza@bigpond.com DonateLife Week 31 July - 7 August 2016 www.donatelife.gov.au

AUGUST Lung Health Promotion Centre at The Alfred 4-5 August 2016 – Influencing Behaviour Change – a formula 18-19 August 2016 – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au International Day of the World’s Indigenous People 9 August 2016 Cystic Fibrosis Australia and New Zealand (CFANZ) Nurses Conference 10-12 August 2016 Launceston, Tasmania Contact gaylene.bassett@ths.tas.gov.au

28th Aeromed Australasia & College of Air & Surface Transplant Nurses 24-26 August 2016 Queenstown, New Zealand. www.aeromedconference.com/ or www.flightnursesaustralia.com.au/ our-events-1 Meeting of Delegates 29 August 2016 - Brisbane 31 August 2016 – Gold Coast http://bit.ly/1QBxrVb

SEPTEMBER

CRANAplus 34th Annual Conference “GOING TO EXTREMES : How isolation, geography & climate, build resourcefulness & innovation in healthcare” 12-14th October,2016, Hobart, TAS https://crana.org.au/conference/callfor-abstracts 21st International Congress on Palliative Care 18-21 October 2016 Montreal, Canada www.mcgill.ca/palliativecare/congress

Midwives on Board! Education at Sea Riding the Waves of Contemporary Practice and Innovation 3-16 September 2016, NCL Jade: Greek Island cruise departing Venice. www.educationatsea.com.au/ conferences/midwives-on-board-2016

Transplant Nurses Association Conference 19-21 October 2016, Adelaide www.tnaconference.com.au

Meeting of Delegates 7 September – Cairns 8 September – Townsville 13 September - Rockhampton

International Mental Health Nursing Conference Nurses striving to tackle disparity in health care 25-27 October 2016 – Adelaide www.acmhn2016.com/

Australian Nurses and Midwives Conference 8 - 9 September, Melbourne https://www.anmfvic.asn.au/eventsand-conferences/2016/09/08/ australian-nurses-and-midwivesconference Palliative Care Nurses Australia 6th Biennial Conference 11-12 September 2016, Canberra ACT www.pcna.org.au/conference Polio Australia’s 2016 AustralasiaPacific Post-Polio Conference Polio: Life Stage Matters 20-22 September 2016, Sydney www.poliohealth.org.au/conferencesydney-2016 IARMM General Assembly jointly with 5th World Congress of Clinical Safety 21-23 September 2016, Harvard University Medical School, Boston, Massachusetts, USA www.iarmm.org Griffith University Complex Nursing Interventions Symposium 30 September 2016, Brisbane www.griffith.edu.au/complex-nursinginterventions

OCTOBER Lung Health Promotion Centre at The Alfred 6-7 October 2016 – Managing COPD 24-25 October 2016 – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au World Mental Health Day 10 October 2016 Australasian Rehabilitation Nurses’ Association 26th Annual Conference Hands, hearts and minds: Capturing the essence of rehabilitation 10-11 October 2016, Melbourne www.arna.com.au/

Birth and Beyond Conference 19-22 October 2016, Ontario Canada www.birthandbeyondconference.ca/

5th International Conference on Violence in the Health Sector 26-28 October 2016, Dublin, Ireland http://oudconsultancy.nl/dublin_5_ ICWV/index.html 18th South Pacific Nurses Forum Through Nursing Excellence for Universal Health 31 October-4 November 2016, Honiara, Solomon Islands www.spnf.org.au.

NOVEMBER The Lowitja Institute Indigenous Health and Wellbeing Conference 8-10 November 2016, Melbourne www.lowitja.org.au/conference 9th European Public Health Conference All for Health -Health for All 9-12 November 2016, Vienna, Austria www.ephconference.org/futureconferences-128 11th National Australian Wound Management Association Conference State of play 9-12 November 2016, Melbourne www.awma2016.com.au Lung Health Promotion Centre at The Alfred 16–18 November 2016 - Asthma Educator’s Course 24-25 November 2016 - Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au

DECEMBER World AIDS Day 1 December 2016 http://worldaidsdayworldwide.org/

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

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