Remote possibilities Incentives for rural relocation
ICN 25th Congress edition
and access Meeting the challenges of universal healthcare
Paediatrics The argument for specialisation
Australia independe â€™s nt voice of nursing Issue 4 May 2013 www.nursingreview.com.au
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Cervical screening for nurses. Optimal collection techniques for a quality Pap test
Meet Rebecca Rebecca, a 25-year-old student presents to your clinic for her regular Pap test. She recently discovered her ex-boyfriend infected one of her friends with chlamydia. She is worried that she may have been infected as well. When you take the Pap test you also test for relevant STI’s and tell Rebecca you will call her with the results. The results of the test are unsatisfactory so you contact Rebecca to make another appointment to undertake another test.
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Go to www.mdBriefCase.com.au Login or register if it is your first visit (it’s free and confidential) Complete the Cervical screening for nurses. Optimal collection techniques for a quality Pap test program listed under the “Specialist Programs” tab This activity has been endorsed by APNA according to approved criteria.Completion of this educational activity entitles eligible participants to claim 2 CPD hours. Attendance attracts 2 RCNA CNE points as part of RCNA’s Life Long Learning Program (3LP).
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contents EDITOR Amie Larter (02) 9936 8610 email@example.com Subeditor Jason Walker firstname.lastname@example.org Journalist Aileen Macalintal email@example.com production manager Cj Malgo firstname.lastname@example.org Graphic Design Ryan Salcedo email@example.com SALES Adele Flint Elkins 02 9936 8664 firstname.lastname@example.org Nicola Mohtram 02 9936 8619 email@example.com SUBSCRIPTION ENQUIRIES Heather Walsh (02) 9936 8666 firstname.lastname@example.org ACN ADDRESS CHANGE email@example.com 1800 061 660 PUBLISHED BY APN Educational Media (ACN 010 655 446) PO Box 488 Darlinghurst, NSW 1300 ISSN 1326-0472 PP236785/00005 PUBLISHER’S NOTE © Copyright. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media. The mention of a product or service, person or company in this publication, does not indicate the publisher’s endorsement. The views expressed in this publication do not necessarily represent the opinion of the publisher, its agents, company officers or employees.
Audited 15,635 as at Sept 2012
news 04 Call for attention
31 Opinion: Trudi Mannix
06 Alarm-related fatigue
32 Pass the remote
08 Stop norovirus outbreak
clinical practice 38 Seasonal influenza vaccines:
10 HIV pioneer awarded
40 Vision loss
12 Remote area model
workforce 42 Beyond the future
Dealing with parents of pre-term babies
SA nurses launch Facebook petition
Nurses reveal the best places to go
Report warns nurses are desensitised
Why aren’t more workers vaccinated?
Nurse calls healthcare professionals to act
Macular degeneration is on the rise
Victorian nurse recognised Nurses to perform x-rays
14 Best hospital practice
Survey: Flushing practice for intravenous catheters
16 Crisis averted
Using honey in wound management
Changing roles in nursing
46 ICN 2013 preview
Priority: Equity and access to healthcare
48 Q&A with Phillip Della
ICN conference, nursing in Australia and more
18 New health facility opens
Hobart training centre to improve education outcomes
50 Have your say
Travel health – an important specialty
19 Expos and events
Keep your diary up to date
policy & reform 20 Great debate
legal corner 52 Posthumous sperm harvesting
24 NDIS shortfall?
technology 54 Remote opportunities
Ethical and legal issues explained
Who should fund the health system How the bill will affect over 65s
Factoring distance into healthcare
26 State by state
56 Post treatment support
Brett Holmes on nursing in NSW
New app helps cancer survivors
specialty focus 29 Paediatric nursing
Should specialisation be
Nursing-Review_May_Horizontal.pdf 1 29/04/13 compulsory?
58 Win for Australian telehealth
Global recognition for IT innovation
Nursing Lectures on-the-go
May 2013 | 3
SA nurses campaign
Nurses and midwives in South Australia are turning to Facebook in a bid to capture the attention of state treasurer, Jay Weatherill. By Amie Larter
he South Australian branch of The Australian Nursing and Midwifery Federation (ANMFSA) has launched an online Facebook petition in attempt to secure funding for the employment of graduate nurses and midwives throughout the state. Only 50 per cent of the nurses who graduated in South Australia last year have been employed, and of those, only 30 per cent remained in the state. Adjunct associate professor Elizabeth Dabars, CEO of the ANMFSA, believes that by 2025 South Australia will be approximately 25,000 nurses short if this issue is not addressed now. She said the only way to avoid this is to capture graduates now. “It’s already clear from the projections of workforce that we are going to be in dire straits in the next five to ten years and if we don’t address this issue and we don’t employ these people now then we will be in a worse predicament. “We believe that if we fail to do that we simply won’t have the numbers of nurses and midwives who are needed in order to 4 | May 2013
provide important services.” The ANF is hoping to make the government realise that money can be saved by investing now, rather than in five years time in a crisis scenario. “If they ignore the industry workforce now they will be having to throw significant amounts of money at the issue in order to attract people to the system,” she said. Nurses and midwives have targeted the man responsible for the state’s purse strings in a hope money will be invested into an employment strategy that will see graduates through a transition to professional practice program and then into ongoing employment. This followed what has been described as “a lack of commitment” from both the former and current health ministers. According to Dabars, nurses are getting really frustrated after being actively encouraged to pursue nursing and midwifery as a career path. She said they are distressed after investing so much time, energy and money into their education, which they don’t believe they will be able to use in
the foreseeable future. “It’s very frustrating for people to know that the shortage is there, to know their jobs will be needed, but that they can’t start utilising those skills now. “It’s really unfair and unacceptable to ask people to wait for another five years and come back. They just definitely won’t be there.” A two-fold problem – the ANF is also calling for more connection between the education, immigration and employment sectors. “There is no integrated strategy that looks at each of those three prongs and ensures that we will actually have an appropriate workforce,” said Dabars. “We have also called on the state and federal government to cooperate and speak to each other in order to develop a strategy that would address those three strands and then our aim would be to ensure that there is an appropriate integrated strategy.” Nursing Review contacted Jay Weatherill for comment, however received no response. n
2010 winners, left to right: 2012 winners, left to right: Chris McGowan Jan Wright and Raeline George representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.
Know someone in the aged care sector who deserves an award? Recognise aged care professionals for their outstanding care by nominating them in one of three categories: Individual Organisation
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Cause for F
A new report reveals constant alarms are desensitising nurses, and contributing to patient deaths. By Amie Larter
McKee goes on to recommend that hospitals need to make alarm safety a priority, stating that alarm-related injuries are known to be underreported, and occur in all health care settings. “Hospitals that don’t properly assess their alarm systems and put practices in place to correct any issues they may have, increase their patients’ risk for harm from adverse events such as falls, delays in treatment, ventilator use and medication errors – some of which could prove fatal,” she said. Technological advancement contributes significantly to the problem, with 85-99 per cent of clinical alarm signals not requiring intervention. For example, when alarm conditions are set too tight, default settings are not adjusted or ECG electrodes have dried out. McKee suggests that as a result, “clinicians become desensitised or immune to the sounds coming from the alarms”. The University of Sydney professor of Nursing (Social Sciences and Humanities) Trudy Rudge and associate professor Sandra West have studied the wellbeing
of nurses in the workplace. Rudge doesn’t agree that nurses are becoming desensitised. “I suppose there is always a level of habituation that occurs in any environment but they are worried about it – they aren’t ignoring it.” She does confirm that increased technology has meant more work, as nurses are constantly checking medical equipment when alarms beep to find the reason behind the alert. “You don’t have the ability not to pursue that noise if you are concerned about maintaining quality care. I think that it would be reasonable to say that some would feel that some of the noises would be irrelevant at times and they probably are – but you can’t not check.” This particularly affects nurses on night shift says associate professor Sandra West from the University of Sydney – as hospitals often decrease staff levels overnight. She said that even though there are less staff on shift, they get the “the same level of alarm and the same calls to machines than during the day”. n
igures from the report released by US independent accrediting organisation Joint Commission suggests there were 98 alarm-related events between 2009 and 2012. Eighty of these resulted in death, 13 in permanent loss of function, and five in unexpected additional care or extended stay. This was considerably less than figures reported by the US Food and Drug Administration (FDA), which suggests there were 560 alarm-related deaths alone in the US between 2005-2010. The Joint Commission found that “alarm fatigue” – caused by large numbers of alarms emitting warning noises in patient care areas – is contributing to these figures. “Alarm fatigue can result in clinicians turning down the volume of the alarm, turning it off or adjusting the alarm settings to limits that are unsafe and inappropriate for a patient – all of which can have serious, often fatal, consequences due to delayed or improper treatments,” said the commission’s executive vice president and chief medical officer Dr Ana McKee.
6 | May 2013
Vaccines bundled into one jab
• Australian kids will only require one needle to be fully protected from measles, mumps, rubella and chickenpox starting July 1. The new vaccine – known as MMRV vaccine – replaces the measles, mumps and rubella (MMR) vaccine currently given to four-year-olds, and the varicella vaccine for chicken pox given to 18-month-olds. To coincide with this news, the Australian government also released a new handbook for nurses, doctors and other health professionals to keep them updated with the most accurate information. Minister for Health Tanya Plibersek said the tenth edition of the Australian Immunisation Handbook will enable all those delivering immunisation to explain the benefits to their patients.
Experts urge bowel screening rollout
• Health experts from Flinders University are urging the federal government to accelerate the rollout of the national Bowel Cancer Screening Program following a report revealed it will lead to a decrease in colorectal cancer mortality. The study, published in the Medical Journal of Australia, shows the program is one of the most effective weapons in the fight against this cancer. The government’s recent budget outlined a slow expansion of the program – starting with 50and 60-year-olds being invited to join now, then including 70-year-olds in 2015.
Successful heart tweet-ment • Twitter can be a powerful tool to help prevent heart disease and improve health practices, according to a group of University of Sydney researchers.
Results from a study that surveyed 15 international health-focused twitter accounts showed that through inherent networking, social media has the potential to enhance overall education, awareness and management of cardiovascular disease.
Researchers examined the reach of health-related tweets via the retweeting trend. “The popularity and rise of Twitter has made it a readily available, free, and user-friendly tool to disseminate information rapidly to a diverse audience, for example, to engage health professionals and heart attack survivors,” said associate professor Julie Redfern, of The George Institute for Global Health and the University of Sydney.
Nursing shifts in watch houses get funding boost
• Adam Giles, Chief Minister for the Northern Territory has announced $1.2 million worth of funding to improve nursing services in police watch houses. The nurse watch house service places nurses in police watch houses to assess, treat and triage people in custody, and Giles believes additional funding will make the process quicker.
However, Graeme Young, professor of Global Gastrointestinal Health at the university said the program allowed more patients to be diagnosed at an earlier stage of the disease, and therefore treated sooner.
The additional funding will see an extra seven shifts added per week, six in Alice Springs and Darwin watch houses, and an extra shift cover in Katherine. This plan is aimed at decreasing the strain on emergency hospital resources, as well as tackling alcohol abuse.
N om i N tE NoWa ! Nomin
2012 winners, left to right: Chris McGowan representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.
2010 winners, left to right: Jan Wright and Raeline George
Know someone in the aged care sector who deserves an award? Recognise aged care professionals for their outstanding care by nominating them in one of three categories: Individual
atio 31 May ns close 2013
s tickEatlE s oN
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Proudly presented by:
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May 2013 | 7
19/03/13 2:34 PM
norovirus in its tracks Naomi Cook
Healthcare professionals must actively engage the general population in preventing norovirus outbreaks, says nurse Naomi Cook. By Amie Larter
niversity of NSW researchers last year discovered the highly contagious ‘Sydney 2012’ strain, which health experts predict could infect up to 400,000 Australians this winter. This relatively new strain, to which very few people are immune, will spread quickly through closed areas like hospitals, restaurants, aged care facilities, office spaces and schools. Cook, a mother of two, noticed the norovirus pandemic hitting the headlines back in January and could see that people around her had no idea on how infectious the virus was, or how to limit its spread. Concerned, she started a community campaign ‘Stop Gastro Spread’ to educate community members and organisations on how we can all play an active role in reducing the spread of norovirus. This led to Cook starting her own Nurse Naomi blog where she writes health and well-being articles. Now she is ramping up the campaign, reminding doctors and nurses of state and national guidelines for the management of norovirus – so they can pass it on to local communities. “The most obvious piece of information 8 | May 2013
that I saw was lacking were the government guidelines of recommending a waiting period of 48 hours before returning back to work, day care and so on after gastro,” she said. “If we as health professionals can encourage people to stay at home for 48 hours after the last symptoms of gastro … we can have a significant impact on reducing the spread of infection. “Surely we have a chance of avoiding a massive epidemic if people just stick to the guidelines?” Cook believes that looming on the horizon are bigger, more serious issues of antibiotic resistance, and the accelerated speed of infection across the world. “Doctors and nurses are in a great position to educate, not only their patients but everyone around them, on the government recommendations. “Its time we started practicing good old-fashioned methods of infection control, so that we are more prepared for these serious diseases that will most certainly impact upon us in our own lifetime.” Cook suggests methods including handwashing, isolation, quarantine and most obsolete convalescence.
People only need 10-20 virus particles to contract the virus, millions of which are in just 1ml of vomit. Given the highly infectious nature of this virus, Cook encourages nurses to remember the following: 1. Norovirus particles are aerolised during a bout of vomiting or during a toilet flushing, thus there is a need for protective face gear if dealing with vomiting patients at work. 2. Hand washing is the best way to remove the germ from your hands, antimicrobial rubs can be a good hand wash but they may not actually kill the virus due to its external structures, so they don’t rely on that. 3. The only product that has been proven to inactivate norovirus is a bleach solution. 4. Be careful when handling sheets with vomit on in case you agitate virus particles. Wear protective face gear. 5. Check the ‘return back after gastro’ guidelines for your place of work. Internationally, 48 hours is the usual recommendation – however, some bodies ask for a 72-hour window, particularly if you are handling food. n
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Liz Crock, who pioneered the role of HIV resource nurse, is one of this year’s Human Rights and Nursing awardees. By Aileen Macalintal
10 | May 2013
he Human Rights and Nursing Award is given to those whose accomplishments have international significance in human rights, and have subsequently influenced health care or nursing practice. Nursing Review talked to Crock about her advocacy for people with HIV. Liz Crock is a clinical nurse consultant in HIV at the Royal District Nursing Service. She has developed and promoted a model of care that could be adapted and applied abroad. She has also expanded the field by introducing a mental health, drug and alcohol nursing role into the HIV team. She said she has chosen to be part of the advocacy because the illness remains poorly understood, and sufferers are still stigmatised. “As many people living with HIV are ageing and will require more mainstream services, it is important for nurses working in the HIV sector to highlight some of the special issues,” Crock said. She said health workers need to consider and understand those issues if they are to provide the best possible care. “There are many nurses working in HIV who recognise advocacy as key to their roles.” Human rights has been her focus in tackling HIV in the community as she believes that this is central to the practice of nurses in that field.
news “We are all very cognisant that people living with HIV have experienced discrimination from many sources, or are fearful of this occurring,” she explained. “For example, some gay men with HIV may have lost contact with family if their family did not accept their sexuality and their HIV status. For women with HIV, in some cultures they are seen as blameworthy and ostracised from their communities,” said Crock. Self-stigma and shame could make anyone living with HIV hide their diagnosis, she said. “Many people can be extremely isolated for reasons and community health nurses are key in helping them to overcome barriers to accessing services and to helping make other services accountable for their practice,” she said. Thus, Crock has ensured that RDNS develop a formal partnership agreement with the non–governmental Victorian AIDS Council/Gay Men’s Health Centre (VAC/ GMHC). “Through the partnership, our clients have access to the full range of services provided through VAC/GMHC, including volunteer support,” she said. Some examples of support she provided are transport to medical appointments, counselling, legal services,
funding, peer support groups, lunches, dinners and outings. These are aimed at improving people’s mental health, wellbeing and social inclusion. They also conduct close coordination between RDNS and VAC/GMHC, where they regularly discuss mutual clients’ needs and review care plans, as well as strategic issues within the HIV sector. Part of her advocacy is to combat bureaucracy, which impedes continuous care for their clients with the virus. “Sometimes, policies that purport to ‘treat everybody equally’ or ‘the same’ can actually end up discriminating against people living with HIV. “For example, if you have a policy that says all clients must receive a phone call from an operator to assess risks before a nurse visits, or that nurses must wear a uniform at all times, then this might discourage them from accepting a home nursing visit at all, if they are fearful that a call from a service means that others know of their HIV diagnosis. “A nurse arriving in uniform may, even unintentionally, imply to their family or neighbours that they are sick and therefore might have HIV,” she explained.
She said RDNS recognises this and the HIV team staff usually do all initial phone calls to introduce the service, visiting in unmarked cars and no uniforms, at the nurses’ discretion. “Within the HIV sector, experts including peer workers recognise that people living with HIV still experience barriers to access to services and thus standard approaches may not succeed in engaging them and gaining their trust,” she said. Zooming in on the role of nurses in dealing with people living with HIV, she said nursing is “very much about support and advocacy” in the community. “We need to stay up to date with new developments in the sector including novel medications, rapid HIV testing, post exposure and pre-exposure prophylaxis, drug trials, treatment as prevention, prevention of mother to child transmission and research, while providing care coordination, education for other staff and volunteers, and consultancy to staff and other services.” Crock said that ultimately, the role of the nurse is important in health promotion, empowerment as well as helping to work against stigmatisation. n
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26/03/2013 3:40:08 PM
new x-ray model
More nurses in Victoria will be trained to perform x-rays as rural health services express interest in developing alternative remote models.
nder the new scheme, more nurses in remote areas will be responsible for performing x-rays of distal limbs, or any part of the body in an emergency situation. Hospitals in remote areas will be able to apply for a permit to train and use nurses, an alternative to using more expensive radiographers. This follows a trial in Lorne Community Hospital in 2010, where registered nurses performed basic triage x-rays in emergency situations. Independent review of the trial found it added value to the local community, allowing for patient’s conditions to be managed effectively, saving unnecessary travel. Upon assessment of image quality, it was concluded that the x-rays taken by nurses were all of acceptable clinical diagnostic quality and did not compromise patient safety. According to a spokesman for the Victorian Department of Health, before the rollout of any schemes, the government will be developing guidelines to ensure a safe service, and to incorporate lessons learnt from the Lorne pilot. Through this development stage, appropriate training courses will also be identified. One South Australia-based program has already made the approved list – used to train the nurses in the initial trials. Joanne Page, president of the Australian Institute of Radiography said that patient safety could be compromised if the person performing the x-rays was not properly trained.
She confirmed AIR doesn’t oppose the scheme, so long as service delivery is being given by properly credentialed professionals in a genuine area of need. “If it is at all avoidable, patients should never be given a dose of x-rays by a person with only minimal understanding of the long-term effects of radiation. “It’s a matter of balancing risk against benefit, and a one-hour car trip to the nearest appropriately staffed x-ray department will, ninety-nine times out of one hundred, be preferable to an inappropriate or doubled dose of radiation.” She said there was an abundance of radiographers looking for work and plenty more were coming from universities. “If a radiographer is available then they should be performing the x-ray because they are the appropriately qualified and credentialed people to do so. “The nursing federation is behind us in this, they understand their role and our role. It’s just ensuring for the patients’ safety that the appropriate people do the work.” Past president of the AIR Bruce Harvey doesn’t believe that Victoria requires such a scheme – as everyone is close enough to access radiographers at nearby hospitals. The department confirmed there is no intention to implement limited x-ray operator services in metropolitan or regional health services. “The program and guidelines are intended for small rural health services only,” the spokesman said. n
Emu’s the good oil A delaide researchers have found that emu oil has therapeutic potential, not only for the treatment of various common bowel diseases, but for intestinal damage caused by chemotherapy. New research from the University of Adelaide not only supports emu oil’s claimed anti-inflammatory properties, but has also shown that it can help repair damage to the bowel. Experiments revealed repair was accelerated by stimulating growth of the intestinal crypts, the part of the intestine that produces the villi that absorbs food. Research leader professor Gordon Howarth confirmed that longer crypts and villi meant a healthier bowel that was able to absorb food more effectively. “We have done sufficient studies in the laboratory to show that emu oil has
12 | May 2013
the potential to reduce the debilitating symptoms of these conditions and to enhance intestinal recovery,” he said. Howarth said the next step will be to conduct further work looking at emu oil dosages, and whether the beneficial effects can be reproduced in clinical trials. Physiology PhD candidate Suzanne Mashtoub, who conducted the laboratory experiments, believes that between 40– 60 per cent of cancer patients undergoing chemotherapy experience symptoms of mucositis – inflammation and ulceration of the bowel lining. “The variable responsiveness of treatments to these diseases shows the need to broaden approaches, to reduce inflammation, prevent damage and promote healing,” she said. She confirmed there are currently no effective treatment options. n
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Clearing the lines
A record number of nurses will be surveyed on the finer points of flushing intravenous catheters. By Aileen Macalintal
riffith University researchers are looking for best hospital practices that can improve comfort and treatment, as well as reducing the cost of healthcare. The university’s National Centre for Research Excellence in Nursing continues their observational study, audit and survey on improving how 15 million IVs are used in Australian hospitals each year. Research leader Dr Samantha Keogh said their research aims to describe current nursing practice related to IV flushing and identify gaps in knowledge, practice and guiding policy. “The results will inform practice development and the format for follow-on trial research that will hopefully yield firm evidence to base best practice on,” said Keogh. “We anticipate publication of the observational study in the coming months and the results of the state survey by September,” she said. 14 | May 2013
Varying anecdotes of different IV flushing practices, as well as secondary results from a large trial of peripheral IV catheter replacement, prompted the research, said Keogh. It has been identified that 30 per cent of device failure rate is related to occlusion (blocking) and dislodgement. Thus, “patients would be the main beneficiaries of improved IV flushing practice with reduced occlusions and related re-cannulations that means reduced patient discomfort and interruptions to treatment,” said Keogh. Efficient use of staffing time and equipment would also reduce health care costs, she said. Asked what could happen if nurses neglect IV flushing, Keogh said current occlusion rates, which are approximately 20 per cent, will continue to rise, along with related patient discomfort and healthcare costs. “There are also other potential, yet unquantified, issues related to infection control and quality and safety management,” she said. Nursing Review asked Keogh if there really is a best way to flush. She said “there is little empirical evidence on which to base best IV flushing practice. “Current recommendations are derived from physics theories related to the use of a pulsatile delivery action and reduced
pressure of delivery through a larger syringe (i.e: >10ml diameter) to optimise flush outcomes and minimise damage to the vein.” Currently, there are no studies comparing different flushing regimes nor studies comparing practice associated with preparation and administration of manually prepared flushes against pre-filled flushes. “Indeed, the current status of flushing practices is not known, though there is certainly variation between various organisational guidelines. Also, little is known about the quality of infection control measures used during the flush administration,” she said. Keogh said the research is particularly relevant and important to nurses, who are the main clinician to initiate and administer IV flushing. “Care of a patient with an intravenous devise is a kept nursing responsibility in the acute care setting. We would not accept such a high failure rate for any other device,” she said. “Therefore, we need to identify the best way to minimise IV catheter occlusion to optimise the safety and viability of peripheral intravenous devices.” The centre’s $100,000 funding to conduct the IV flushing research is from Griffith, the Australian College of Critical Care Nurses and the medical technology company BD. n
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4th Annual Reducing Hospital Readmissions & Discharge Planning Conference 25 - 26 July 2013 Novotel Melbourne on Collins 5th Annual Operating Theatre Management Conference 22 - 23 August 2013 Dockside, Cockle Bay Wharf at Darling Park
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EMERGENCY DEPARTMENT MANAGEMENT 22–23 July 2013 Novotel on Collins, Melbourne Showcasing Innovation And Exploring Improvement Strategies
National Hospital Procurement Conference 22 – 23 July 2013 | Hilton on the Park, Melbourne
5th Annual Emergency Department Management Conference 22 - 23 July 2013 Novotel Melbourne on Collins 3rd Annual National Hospital Procurement Conference 22 - 23 July 2013 Hilton on the Park, Melbourne
Correctional Services Healthcare Summit 2013
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Assistants in Nursing Conference A conference for organisations and managers looking to better understand and utilise the assistant in nursing role.
4th Annual Correctional Services Healthcare Summit 29 - 30 August 2013 Novotel Melbourne on Collins 2nd Annual Assistants in Nursing Conference 29 - 30 August 2013 Sydney Harbour Marriott at Circular Quay
For further event listings visit: www.healthcareconferences.com.au Acknowledging the quality of our conference programs and demonstrating our commitment to professional development and excellence in nursing. IIR Conferences proudly holds Royal College of Nursing, Australia APEC (Authorised Provider of Endorsed Courses) status. (APEC number 090810001)
May 2013 | 15
healing With a rise in antibiotic resistance, a crisis in chronic wound management has been averted with a new treatment. By Aileen Macalintal
ew research from the University of Technology Sydney has shown that the most effective type of honey for the treatment of chronic wounds is manuka honey, a natural product of the leptospermum scoparium plant that has unique healing properties. UTS professor Elizabeth Harry, who led the study, said what prompted her to focus on honey in wound management research is the huge threat of antibiotic resistance to human health. She said antibiotic resistance has been growing since antibiotics have first been used. “We were unaware of how bacteria become resistant but now we understand the problem. We realise just how dangerous it is to use them if it is not necessary. Antibiotic resistance can be traced back to the first widespread use of disinfectants by humans,” she said. For thousands of years, honey has been used medicinally without the bacteria developing resistance to it, said Harry. Most likely, this is due to the physical and phytochemical properties of the honey that work against bacteria. Researchers have not been able to isolate particular bacteria resistant to honey, but they continue to work on this as cases of chronic wounds escalate with rapidly increasing ageing population and chronic diseases. “Because chronic wounds are exposed to bacteria for longer time periods and because these people tend to have compounding co-morbidities, wound infection is a significant issue in this group of Australians,” she said. She said it is imperative to address
16 | May 2013
these issues now as the overuse and misuse of antibiotics in treating infections add to antibiotic resistance, while other desirable options for treating wound infection are getting fewer. “The antibiotic pipeline is dry,” she said. “Medicinal honey is already approved by health regulatories and available on the market at a competitive price.” In collaboration with Comvita, a New Zealand-based supplier of medicinal honey, researchers found that honey can kick-start stalled wounds and can control odour of malodorous wounds. “Honey can be used as a first line topical antimicrobial for wounds with a high bio-burden contributing to a stalled wound,” Harry said. This is particularly relevant in poorly perfused wounds, where any systemic antibiotic therapy is not effective. “Honey dressings can also be used in conjunction with systemic antibiotics. This may reduce the dose/class of antibiotic needed, and may help to combat antibiotic resistance,” she said. Harry said honey has also found a valid place in the wound care armoury as an odour control dressing since honey significantly reduces the bacterial burden in the wound. Wound odours from ammonia and sulphur byproducts are eliminated, reducing the need for odour masking products such as charcoal. The attitudes of health professionals to honey as a conventional wound care product are polarised. Harry identified four primary responses to the suggestion of honey as an option for wound care: those who believe it has
a valid place in wound care based on successful clinical experience; those who believe honey is an antiquated treatment, a step backwards from advanced wound care; those who are unaware of any research to support their judgment; and those who refuse to use it due to what they believe as insufficient evidence. “Some of the ways to overcome these objections are to present honey not as a miracle treatment for wounds but as a conventional treatment that has a place alongside other product options,” she said. Wound Management CRC head Stephen Prowse said “Honey is just one possible therapeutic amongst a number of others. “There seems to be good evidence that honey enhances healing in particular wounds, it is not clear just what that wound type/condition is,” Prowse said. “Honey does have potential both as a topical antibacterial and in promoting wound healing. Clinicians will view this more favourably as controlled trials are conducted rather than marketing trials,” he said. In the five or so years that Harry has been researching honey, she said the health professionals’ view toward the use of honey in the clinic has significantly changed, that is, toward accepting it as a valid option in wound care. “I think we need to be more broadminded about alternative anti-infective options as we are not going to solve it by just using antibiotics, and we may have no choice in the not-so-distant future,” she said. n
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nursingreview.com.au nursingreviewau May 2013 | 17
Hobart facility to improve
health outcomes The ANF’s recently-opened health education and research facility in Tasmania is offering that state’s nurses a chance to broaden their skill base. By Aileen Macalintal
he Australian Nursing Federation has just opened a facility in Hobart that will prepare Tasmania’s health professionals for the rapid changes in the health care system. ANF branch secretary Neroli Ellis said, “The Health Education and Research Centre (HERC) is central to the longterm ANF vision to improve quality health outcomes for Tasmanians and this positions us perfectly to provide quality training to our valued students, members and partners in Tasmania.” The facility was designed to equip health professionals with a comfortable learning environment for a development program. “The $2.5 million Health Education and Research Centre, established with the assistance of a $900,000 federal government funding grant, is an innovative training and research facility,” said Ellis. Dr Lisa Dalton, nurse education manager, said the facility offers almost endless possibilities to provide quality and innovative training assessment. “Such interprofessional and collaborative approaches to resource sharing are crucial,” she said. “The facilities are custom-built for the purpose of supporting training, education and research for health professionals,” said Dalton. “It is now well recognised 18 | May 2013
that health professionals best develop competencies when they are able to apply and practice their knowledge and skills in realistic settings.” She said the state-of-the-art simulation facilities will allow training for healthcare individuals and teams. Here they can develop skills from simple dressings to responding to realistic high-level emergency situations. She said that while some people romanticise the technical aspects of computer-operated mannequins, simulation-based health professional education is much more than dummies speaking, breathing, and responding to medications. “It is actually the authenticity of the teaching and learning environment and the interaction between a realistic nursing situation and the student that create the conditions for high quality and effective learning to occur through simulation,” she said. Aside from training, the facilities also allow for a research profile to be established at HERC. “Through collaborative partnerships with other health agencies, departments and education providers, we can begin to develop state-wide approaches to better
understand the requirements of our existing and future health professionals,” said Dalton. “The benefit of this type of emerging work at HERC is the potential for improved graduate outcomes, competent and support health professionals through ongoing professional development opportunities, which can only contribute to improved health outcomes for Tasmanians.” She also emphasised that the health system is changing, and HERC will address this. “No longer is it acceptable to wait for people to become unwell to offer health care services: more and more energy, expenditure and expertise is being invested in promoting health and preventing illness,” she said, “and HERC is committed to contributing to local, state and national activities that are driving these changes to create more efficient and sustainable system in Tasmania and beyond.” In the next five years, ANF wants HERC to emerge as the state’s leader in quality education and training for nurse. They also plan to extend their services and facilities to other health professions and emerge as an important research institute that produces high-level local research for Tasmania. n
2013 Diary Dates MAY
• Spinal Health Week
• 7th Australian Womens’
Health Conference Gender Matters 7-10 May Sofitel Sydney Wentworth, NSW womenshealth2013.org.au Australian Association Maternal, Child and Family Health Nurses 9 May National Convention Centre, Canberra, ACT connections2013.org.au
• 3rd Biennial National Falls
Prevention Summit National Falls 16-17 May Prevention Summit Stamford Plaza, Brisbane, QLD healthcareconferences.com.au/falls Register by 28 March and SAVE $440!
16–17 May 2013 | Stamford Plaza, Brisbane
Research and practical case studies for falls prevention in hospital, residential aged care and community settings Topics to be addressed:
Featuring presentations from:
• Falls prevention in the acute hospital setting: Overview of the 6-PACK project • In-hospital fall injuries: Where, when and how do they occur? • My 6-PACK: Facilitating a culture change in falls prevention • Falls Prevention and Wellbeing Program: Something different? • Raising the profile of fall injury prevention • Falls prevention knowledge for community-dwelling people living with dementia • Fear of falling: Does it increase hospital length of stay? • COTA SA’s 2 tier category system for Strength for Life (SFL) • Exercise for falls prevention in residential aged care • Development of a falls prevention framework for Bethanie Residential Aged Care • Does podiatry have a role in falls prevention? • Medication management and falls in the elderly • Falls prevention in remote aboriginal communities
• Anna Barker, The CREPS, Monash University
• Renata Morello, The CREPS, Monash University • Jeanette Richards, COTA SA
• Prof Hylton Menz, La Trobe University • Kathy Marshall, Eastern Health (PJC) • Emma Davies, Eastern Health (PJC)
• Tracy Nowicki, The Prince Charles Hospital • Stephanie Gettens, The Prince Charles Hospital • Jennie Hewitt, The University of Sydney
• International Conference for Nursing
• Claudia Meyer, La Trobe National Ageing Research Institute
23 – 24 May 2013 | Novotel on Collins, Melbourne
A Nurse Oriented Program Packed with Comprehensive Case Studies to Improve HITH Services and Maximise Hospital Efficiency throughout Australia an innovative agenda, including; • State-Wide HITH Program updates from NSW Ministry of Health, Victorian Department of Health & Queensland Health
• 10 Year Review of Calvary Mater HITH Program • Creating & Sustaining Best Practice through HITH Service Expansion
• Warfarin Administration and Using Coaguchek in the Home • Self-care Home IV Therapy
• Maintaining HITH Staff Safety Whilst Working Alone Outside the Hospital • The use of Standardised Paediatric HITH Management • Advanced Care Planning and HITH
• OBI Dashboards to Improve Hospital in the Home Services • A Review of the Geriatric Flying Squad • Utilising Point of Care Testing & Mobile Technology
• 2013 Nurses and Midwives Wellness Endorsed by:
Australia’s leading healthcare conference provider
This conference is endorsed by APEC No 090810001 as authorised by Royal College of Nursing, Australia (RCNA) according to approved criteria. Attendance attracts 9.5 RCNA CNE points as part of RCNA’s Life Long Learning Program (3LP).
Conference 24 May Exhibition Centre, Melbourne, VIC nmhp.org.au TO REGISTER:
VISIT: www.healthcareconferences.com.au/hith2013 T:+61 2 9080 4090 E: firstname.lastname@example.org
• 2nd Annual PCEHR: the Journey
Towards National eHealth Adoption 27 May Sydney Harbour Marriott, NSW healthcareconferences.com.au
• Felicity Beaulieu, The Bethanie Group
• Solange Rousset, WA Country Health Service • Tony Petta, North Metropolitan Area Health Service, WA • Paul Hannan, Meditrax
This conference is endorsed by APEC No 090810001 as authorised by Royal College of Nursing Australia (RCNA) according to approved criteria. Attendance attracts 11 RCNA CNE points as part of the RCNA’s Life Long Learning Program (3LP).
VISIT: www.healthcareconferences.com.au/falls2013 T:+61 2 9080 4090 E: email@example.com
• 4th Heart Foundation Conference
• 2nd Annual Transition Care:
Improving Outcomes for Older People 30-31 May Pullman Sydney, Hyde Park, NSW healthcareconferences.com.au
• 6th Annual Pharmaceutical Law
Conference 31 May Radisson Blu Plaza Hotel, Sydney, NSW healthcareconferences.com.au
• The International
Council of Nurses 25th Quadrennial Congress 18-23 May Melbourne, VIC 5 1 1 8 0 7 1 icn.ch
in the Home Hospital in Conference the Home Conference 23-24 May Novotel Melbourne on Collins, VIC healthcareconferences.com.au
• Grzegorz Tomczak, Royal Prince Alfred Hospital
Ethics, 14th Annual conference 16-17 May Melbourne, VIC deakin.edu.au/health/research/aci/ icne-conference/index.php 16-18 May Adelaide Convention Centre, Adelaide, SA heartfoundation.org.au
Conference 4-6 June Sydney, NSW nswiop.nsw.edu.au
• 13th Annual Hospital
• 5th Biennial Conference of the
Australia’s leading healthcare conference provider
• National Clinical Supervision
21-27 May Nationwide chiropractors.asn.au
• Bowel Cancer
Awareness Month 1-30 June Nationwide 2 0 1 3 - 0 4 - 1 8 T 1bowelcanceraustralia.org 2 : 4 8 : 4 3 + 1 0 : 0 0
• 2nd Annual
with very high and Younger People complex care needs with Very High & Complex Care Needs Conference 17-18 June Novotel Melbourne on Collins, VIC healthcareconferences.com.au Monday 17th and Tuesday 18th June 2013 Novotel Melbourne on Collins
International Perspective: angela Gifford, Able Community Care Limited
Speaker Faculty Includes: • L orna sullivan, Disability ACT
• Rachel Barton, Department of Health, Victoria
• Jennifer cullen, Synapse Queensland
• astrid Reynolds, Summer Foundation
• J acqui Pierce, Karingal Life Options; Team Paul
• natalie Melanik, Transport Accident Commission (TAC) • doug Mcdonald, Transport Accident Commission (TAC)
• P enny Paul, Summer Foundation
• Jo Watson, Scope; Deakin University
• s ue Hodgson, HOPES Inc.
• c hristine Laurie, MS Australia (ACT/NSW/VIC) • H elen Redfern, Royal Brisbane and Women’s Hospital • d eborah Frith, ReNew
• Vanda Fear, Parent
• Robyn Lieblich, Sir Charles Gairdner Hospital • Lucy Knox, La Trobe University
• di Winkler, Summer Foundation
• a nna cox, YoungCare
• Vicki Wilkinson, Consumer
• s teve alexander, Disability Services, Community and Home Support SA
• Michelle newland, Consumer
• J anet Wagland, Brightwater Care Group
• Grayden Moore, Consumer
• L isa Gill, Caulfield Hospital, Alfred Health
• anj Barker, Consumer
Proudly Supported by:
This conference is endorsed by APEC No 090810001 as authorised by Royal College of Nursing, Australia (RCNA) according to approved criteria. Attendance attracts 12.5 RCNA CNE points as part of RCNA’s Life Long Learning Program (3LP).
Australia’s leading healthcare conference provider
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• Mens Health Week
rrtt Incorporated 1997 poo uppp Su Op O aS pttiio on Exxttrra ns sP gE ng Prro diin ov viid
TO REGISTER: VISIT: www.healthcareconferences.com.au/complexcare
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17-23 June Nationwide menshealthweek. org.au
• 1st Australasian
Mental Health and Addiction Nursing Conference 19-21 June Auckland, New Zealand conference.co.nz
• 5th Annual Obstetric
Malpractice Conference 20-21 June Novotel Melbourne on Collins, VIC healthcareconferences.com.au
• ACN Nursing
and Health Expo NSW 23 June Sydney Town Hall, NSW rcna.org.au
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May 2013 | 19
policy & reform
The ceaseless topic of who should pay for nursing continues to be argued in the halls of power. By Louis White
he dual questions of how should we fund our health services and who should pay for nursing are being asked of our politicians and policymakers every day. After all, the medical profession offers invaluable services that seemed, especially in the area of nursing, to have a less than handsome price. But it is a complex issue that involves federal and state governments, private health insurance companies, with the basis of the health system being encompassed by the National Health Act (see breakout box over page). 20 | May 2013
The system constantly sees both federal and state governments in conflict over funding and treatments. Both triumph their spending feats, but ignore the areas that are too difficult to deal with happily blaming the other. Health expenditure, though, is increasing at a steady rate. According to the Australia Institute for Health and Welfare report Health Expenditure Australia 2010-11, Australia spent $130.3 billion in 2010-11. This was a steady increase from $77.5 billion spent in 2000-1. In 2010-11, health expenditure as
a percentage of Australiaâ€™s GDP was 9.3 per cent. (It was 8.2 per cent in 2000-1). In 2010-11, the estimated national average level of recurrent expenditure on health was $5,796 per person. In that year, expenditure in New South Wales ($5,356 per person) was 2.7 per cent below the national average, while the Northern Territoryâ€™s average spending ($7,339 per person) was 33.4 per cent higher than the national average. Governments funded 69.1 per cent of total health expenditure during 2010-11, with the Australian government contributing 42.7 per cent and the respective state governments spending 26.4 per cent. Spending on public hospital services in 2010-11 was estimated at $38.9 billion or 31.5 per cent of recurrent expenditure.
policy & reform Healthcare funding needs to benefit patients rather than a craft group of clinicians ... we know that if nurses’ workloads and work environments are good, then patients are safer.
ng Expenditure on medical services ($22.5 billion or 18.2 per cent) and medications ($18.4 billion or 14.9 per cent) were the other major contributors. The Australian government’s share of public hospital funding was 40.3 per cent in 2010-11 with the state’s and territory government’s share of public hospital funding at 49.5 per cent in the same year. It is public hospital funding where most disputes occur, especially when it comes to salaries and conditions. There was a series of strikes before the recent WA state election by the Australian Nursing Federation resulting in a 14.5 per cent pay increase over three years. A year earlier, Victorian nurses won a 14–21 per cent pay rise over four years after nine months of www.nursingreview.com.au
fighting with the Victorian state government. “As part of our national ‘Stop passing the buck, Australia’s nursing grads need jobs’ campaign, the ANF is calling on federal, state and territory governments to stop the blame game over health funding,” ANF federal secretary Ms Lee Thomas says. “This ongoing wrangling has resulted in billions of dollars being slashed from public health systems across the country in order to achieve so-called budget savings. “Cuts to health budgets have seen highly-educated nurses and midwives lose their jobs with the continued underemployment of Australian-trained nursing and midwifery graduates. “We’re urging federal, state and territory governments to work together to find funding solutions to fix critical issues, such as the country’s growing shortage of nurses and midwives, to ensure safe patient care across the community.” The federal government cut $107 million from the Victorian government’s health budget last year, which was – according to a senate inquiry – based on “dodgy”, outdated population data. After a public outcry, they reversed the decision earlier this year to reinstate the money, bypassing the state government and directly allocating it to hospital boards. “Without a doubt, government funding must be injected straight into workforce strategies and policies which will deliver quality, frontline care,” Thomas says. “Australia continues to suffer a shortfall of highly-educated nursing and midwifery staff, with a predicted shortage of 109,000 nurses and midwives by 2015. “In the aged care sector alone, the country urgently needs 20,000 nurses to cope with a rapidly ageing population. “As a matter of urgency, governments must work together to start funding a future nursing and midwifery workforce to replace the current staff who will be retiring over the
next 15 to 20 years.” The ANF is campaigning hard to create greater employment opportunities for locally-elected graduate nurses and midwives to meet the challenges of this nursing and midwifery workforce shortage and the provision of the right staffing levels to ensure the delivery of safe patient care. “The ANF is calling on the Gillard government, the coalition and key independents to commit to making health and aged care a funding priority in their election campaigning,” Thomas says. “At a time of ever-growing demand for health services, we believe there must be a COAG-led process to address the country’s significant healthcare issues, irrespective of political persuasion. “As part of the ANF’s election health platform, we have identified four areas of concern that must be addressed by all of our politicians, irrespective of political persuasion, including Australia’s shortage of nurses and midwives; experienced nurses and midwives losing their jobs due to health budget cuts; providing the right staffing levels for nurses and midwives to ensure the delivery of safe patient care, and delivering on funding for aged care reforms.” The NSW state government has recently publicised the fact that 4,000 extra nurses are working across the state – both in rural and regional hospitals – since they won office. (They had made an election pledge to recruit 2,475 nurses). For the first time in the state’s history there are 47,500 nurses working in NSW. “Nurses are at the very heart of our hospitals and more nurses means better experiences for patients and their families,” Jillian Skinner, NSW Health minister says. The Australian Practice Nurse Association (APNA) is a big advocate of funding for nurses in primary health care being maintained. May 2013 | 21
policy & reform “APNA supports and represents nurses working in primary health care, which is primarily funded by the federal government,” Kathy Bell, chief executive officer, says. “Financing for primary health care, including general practice, needs to be structured in a way that supports quality, holistic team care. Primary health care nurses make up an increasingly significant proportion of the workforce, and play a key role in delivering care to our ageing community with its growing burden of chronic disease.” APNA is the peak professional body for nurses working in primary health care including general practice. It has more than 3000 members. “It is critical that financing systems support the recruitment and retention of nurses in primary health care, and support the optimal use of the nurse’s skills in the delivery of care by the team,” Bell says. “It is also critical to develop and put in place an education and career framework that ensures we have an adequate workforce of skilled primary health care nurses into the future. We hope that the federal government will address these issues in the forthcoming budget.” But problems will always remain no matter what political party is in charge at
a federal and/or state level due to funding and what is a priority for that particular government at the time to win an election. It is a basic truth that the general public are very aware of. “We need one government to take overall responsibility for health,” professor Julie Considine, chair in nursing at Deakin University Nursing and Midwifery Research Centre, says. “As long as health is co-funded by state and federal governments, there will always be blame shifting and buck passing. “If healthcare was truly patient-centred, then the flow-on effect would be efficient hospitals and happy staff. We need to look at more creative systems that deliver care not only in hospitals but a range of other settings including patient’s homes and also systems that better involve families and significant others in care delivery. “Healthcare funding needs to benefit patients rather than a craft group of clinicians although we know that if nurses’ workloads and work environments are good then patients are safer. I think we also need to have high levels of engagement in evidence-based practice so we can be sure that we are using healthcare funding for the most effective interventions and models of care.” n
How Australia’s health system works The healthcare system in Australia is a complex mix of commonwealth and state government-funded services, and services funded by private health insurance. How do doctors, physiotherapists, optometrists, dentists and other health professionals fit into this framework of public and private health services? The essence of the system is based on the National Health Act, which was passed in 1953 to regulate the provision of pharmaceutical, sickness and hospital benefits and medical and dental services. The Act covers nursing homes, the Pharmaceutical Benefits Scheme and the registration of health funds. Medicare Medicare has been the commonwealth government’s universal health insurance scheme since 1984. Medicare provides Australian residents with free treatment as a public patient in a public hospital and free or subsidised treatment for some optometrist services, some dental care
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22 | May 2013
policy & reform services, some psychology services, and treatment by doctors. In some circumstances, Medicare rebates are available for a certain number of treatments by allied health professionals such as physiotherapists, dietitians and speech pathologists. Medicare is partially funded by an income tax surcharge — all Australian taxpayers earning over a certain threshold pay a Medicare levy (currently 1.5 per cent of their taxable income or 2.5 per cent for those on high incomes who don’t have private health insurance). Medicines and prescriptions The Pharmaceutical Benefits Scheme (PBS) provides Australian residents with access to prescription medicines. Most prescription medicines are subsidised under the PBS. In September 2010, the PBS provided access to over 2600 brands of prescription medicine. The Repatriation Pharmaceutical Benefits Scheme — the RPBS — provides pharmaceutical benefits to holders of Repatriation health cards. Card holders usually pay a concession rate for prescriptions. Private health The private health system is funded by
a number of private health insurance organisations. The largest of which is Medibank Private, which is governmentowned, but operates as a government business enterprise under the same regulatory regime as all other registered private health funds. Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007.
still claim from the government if they are covered by the Medicare Benefits Schedule. More information: www.mydr.com.au www.aihw.gov.au
State programs Each state in Australia is responsible for the operation of public hospitals. Each state also regularly establishes state based projects to target specific problems such as breast cancer screen programs, indigenous health program and school dental health for example. Both federal and state governments contribute to state hospital funding. Anyone who works in a state hospital is covered under the state awards such as doctors and nurses. Non-government organisations The Australian Red Cross collects blood donations and provides them to Australian healthcare providers. Other health services such as medical imaging (MRI and so on) are often provided by private corporations, but patients can
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May 2013 | 23
policy & reform
The shortcomings in the federal government’s NDIS bill highlight the lack of a national disability scheme. By Flynn Murphy
t has drawn strong multi-party support and has even been heralded as an “idea whose time has come” by opposition leader Tony Abbott. However, seniors groups are incensed that the federal government’s $13.6 billion National Disability Insurance Scheme (NDIS) will not assist those who develop a disability after the age of 65. Prime minister Gillard’s recent move to increase the Medicare levy by 0.5 per cent to fund the disability scheme has finally gone before parliament as the election looms. The amendment to the NDIS Bill introduced by Disability Reform minister Jenny Macklin will ensure that those with an existing disability are not forced off the scheme when they reach 65. They will, however, need to choose between the aged care and disability support systems. The scheme will force those who have not joined by age 65 to rely on the existing aged care system. National Seniors chief
24 | May 2013
executive Michael O’Neill has called it a “cruel lottery for older Australians”, saying that while those who acquire a disability at 64 will be covered, those aged 65 will be “shunted into the second-rate user-pays aged care system”. National Seniors called the move “discriminatory”. But Griffith University senior lecturer and convenor in disability studies Donna McDonald calls it a “straw man argument”, saying it was about the quality of the aged care system, and not the NDIS. “There’s already an aged care system in place. It might have some flaws, it might be clunky, and there might be areas that can be significantly improved. But Australia doesn’t have a national disability scheme. “My approach to the argument is ‘let’s get some runs on the board, let’s try and get a national disability scheme up and running’.” McDonald, who has thirty years’ experience as a social policy analyst, said one of the policy principles underlying the
NDIS was to help those with a disability to re-enter the labour market. She said this was likely why the age cut-off was aligned with the pension age. “If the government was moving to increase the pension age to 70, then the cut-off would probably be 70,” she said. McDonald said reforming the aged care system needed to be “the next policy task on the agenda”. Council of the Ageing (COTA) national policy manager Jo Root said people should not be forced to choose between disability care and aged care once they reached the age of 65. Root said there was a lack of training of aged care staff around disability, and that the aged care system lacked specialised disability services for seniors. “Residential aged care is very poorly funded for aids and equipment, and most residential aged care facilities are not required to provide more specialised customised aids.”
policy & reform Root said that because of the disconnect between the two systems, disability aids and equipment often could not be taken into residential aged care facilities. Greens spokesperson on disability services and ageing, Rachel Siewert, told Nursing Review this disconnect was a serious problem, not only because of the inefficiency and waste around equipment, but because of the differing ways each system approached disability. “Disability care, especially with the NDIS, is all about functionality and rehabilitation. The aged care system doesn’t necessarily work like that.” “If you’re over 65 and you’ve just had a stroke, the aged care system is more focused on keeping you alive and comfortable, rather than on rehabilitation. You get better access to rehabilitation through NDIS care.” Siewert said her party was pushing for the aged care reforms to focus more on “positive ageing”. “The government is saying they are reforming aged care [through its $3.7 billion dollar Living Longer, Living Better package] but they’re not reforming it enough to deal with this cohort of people.” While giving the federal government credit for the NDIS, Siewert says the age cut-off was “unfair”. “There is a group of older people who have a disability that are over 65, who will miss out because the support’s not there in the aged care system.” McDonald said more attention should have been paid to a Productivity Commission recommendation that those with a disability be able to utilise the support which best met their needs. “Regardless of whether the aged care system is fantastic, if you’re over 65, it might be that the NDIS best meets your need. “We need to have a discussion about who gets to decide that and how it would happen, because nobody really knows yet what the NDIS is going to look like on the ground.” McDonald says any decisions need to be made by individual plans and care, on a case-by-case basis. Assuming the legislation passes the Senate, the NDIS will come into effect in mid-2013, and support around 10,000 people with permanent disabilities. This number will increase to 20,000 in mid-2014. The government has committed $1 billion to the first stage of the scheme. A review will take place after two years of operation. Root says this review was vital if the scope of the NDIS was to be broadened. “We need to make sure that review involves consumers ... of disability care and aged care being involved in actually designing the review, rather than just putting in submissions,” she says. n
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May 2013 | 25
policy & reform NSW Nursing and Midwives Association general secretary Brett Holmes talks about what matters most â€“ from nurse-patient ratios to wage claims, and how the NSWNMA can help nursing graduates pursue their chosen profession. By Aileen Macalintal
Holmes on nursing
26 | May 2013
policy & reform
SW has seen a rise in the numbers of nurses and midwives of about 4,000, but other areas remain to be addressed. Nursing Review spoke to Brett Holmes of the NSWNMA about what the organisation is focusing on.
How would you sum up the current state of NSW nursing? Nursing and midwifery in the public health system has seen an increase of nearly 1582 full-time equivalent (FTE) positions as a result of the introduction of nurse to patient ratios/ nursing hours, as mandated in the NSW Public Health System Award.
How has this been possible and how much has the number of nurses and midwives increased in the recent years? The current state government has kept its promise to honour the award negotiated with the previous state Labor government. Minister Skinner is rightfully proud that the NSW Health system has seen the head count of nurses and midwives rise in NSW by nearly 4,000 to meet the FTE requirements of the nurse to patient ratios/ nursing hours.
Are improvements to the nursing and midwifery staff ratios enough? The increased nursing and midwifery numbers has already seen nurses report improvements in patient care and their satisfaction with their ability to deliver safer and better levels of care to their patients. However, the areas where there is no mandated nursing hours to deliver better ratios are now demanding that they be given the same level of improvements to patient care.
What are these areas?
These include paediatrics, neonatal and special care units, community health, and emergency departments. Also, the associated medical assessment units, emergency assessment units, critical care areas and mental health areas not yet covered by nursing hours /ratios. Importantly, nurses in smaller rural hospitals are also demanding improvements in their nursing hours to match the care provided to city patients.
Why is improving nurse-to-patient ratios important?
A growing body of national and international research is demonstrating that getting the ratios and the skill mix right, delivers better, safer outcomes for patients reducing adverse outcomes saves lives and saves health dollars overall.
S: LTH T U eA H
Do you think nurses are sufficiently well-paid?
Nurses in 214 of our public health system branches have voted to claim a very modest 2.5 per cent pay increase, and to concentrate on achieving their goals for the delivery of safer patient care. Nurses in the aged care system continue to be paid less in many cases than their public health system colleagues, but the federal government is now making more money available via the Living Longer Living Better wages compact. This has the potential to deliver some improvements in pay for those nurses who are employed by aged care providers who are prepared to bargain and give some priority to ensuring they have a viable aged care workforce.
What are some of the current challenges that nursing graduates should prepare themselves for? Nursing graduates are entering a health and aged care system that is always challenging, with expectations that they will take on their responsibilities to build their level of expertise and participate in continuous learning.
What is the NSWNMA doing to help them with these challenges and responsibilities? The NSWNMA is doing everything it can to try and make the workloads they face reasonable and safe for them and their patients. We are calling on the NSW government and employers to provide more clinical nurse educators to support new practitioners as well as the current nurses in that learning environment.
Why should the government invest in nursing and midwifery? The government needs to continue investing in improving the numbers and skills of its nursing and midwifery workforce to meet its obligations to the people of NSW in the delivery of safe patient care. Research shows that patients reap the benefits of the increased nursing numbers with better outcomes less deaths, decreased complications and faster recovery. This is an investment that pays off in lower health costs and better productivity in our community.
What are your plans in the months ahead?
The NSWNMA has launched a major campaign for the next award claim, and our members across the state are visiting their local members of parliament, letting them know about our claim for better nurse to patient ratios, and there will be growing public awareness of the issues. n
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Healing the child The time has come for nurses to specialise in specific categories. Should paediatric nursing be one of them? By Louis White
or a parent, there is nothing more precious than the welfare of their children. This care escalates off the scale should that child develop any kind of illness. While the first port of call is a doctor, it is often the nurse that spends the greatest amount of time with a patient – in this case, a child. As it stands in Australia at the moment, both registered nurses and specialist paediatric nurses care for an ill child. While all nurses are suitably qualified to care for all ill patients, paediatric nurses specialise in the care for babies, children and adolescents. They work in schools, hospitals and community centres around the country caring for not only a sick child but comforting the family as well. Unfortunately, around the world more and more new diseases are spreading almost quicker than the medical profession can diagnose them. This being the case, the time has arisen for more nurses to specialise in specific illness and specific categories, just as doctors do. Should all nurses who work in paediatrics have specialist qualifications? “Paediatrics is very different to adult nursing,” Linda Shields, professor of Nursing – Tropical Health Research Unit for Nursing and Midwifery from James Cook University, says. “Children’s physiology means they have different physical requirements to adults, such as drugs work much more rapidly and anesthetics wear off much more quickly. “They are at different stages of development, as they grow, their physiology changes in relation to developmental stage. This doesn’t happen in adults. Emotionally of course things are very different to adults – psychology, emotional
needs, and social needs, legal, ethical – think of a three-year-old in hospital compared with a 30-year-old. “They need their parents close by, or at least a family member. And they need them at all hours, not just visiting hours. Check out John Bowlby’s 1952 film A Two-Year Old Goes to the Hospital to see what happens to kids whose parents aren’t with them.” Professor Shields has spent a long time in involved in working and researching in paediatric and child health nursing. She believes it is time to overhaul university degrees. “In undergraduate nursing courses, paediatrics often gets left out because the three year degree in Australia means that a lot of things get left out (not just paediatrics) – we need a four-year degree. So post-graduate qualifications
in paediatrics are the only way to get the knowledge needed to work in paediatrics.” There are several specialty areas in paediatric nursing such as intensive care, oncology, mental health and child development. Some employers require nurses to have specialist paediatric nursing qualifications before they can work. “Qualified nurses are aware of the complex needs of both children and their parents and other family members such as siblings and grandparents,” professor Shields says. “Without specialist knowledge, these needs are often overlooked. Nurses who do not have paediatric qualifications and begin work in children’s wards are often very confused because they’ve not come across these highly specific needs before. “We also need specialist knowledge about communication with children May 2013 | 29
specialty focus relevant to developmental stage; how to communicate with parents and then there’s the legal side of children who cannot consent for themselves, which leads to the ethics around that.” Dr Mary Casey established the Casey Centre 20 years ago, specialising in nursing, education, training and counseling services. She believes that all nurses are capable of working in paediatrics and that “on the job learning” is often more relevant and practical than what is taught in the classroom. “While qualifications help, there is no need for them to be a requirement,” Casey says. “When a nurse enters a specialty he/ she learns from their handson experience, which in my eyes is quite often far more valuable than sitting in a classroom. “Every registered nurse has ample knowledge to care for a child. In fact in most instances the nurses have children of their own and as a result have extra sensory perception, something that others may not possess.” Casey is of the belief that nurses with other specialist qualifications can be of equal significance working with children. “If nurses are specialising in a special area such as palliative care or brain injury then a qualification in this sector will stand them in good stead,” she says. “We place our students in a simulated environment, allowing students to learn what it’s like to be a patient and to provide a better understanding of what’s expected of them as a nurse. “Registered nurses attend university for three years and spend time doing practicum therefore they never approach any job with zero knowledge. Nurses are always highly qualified professionals.” Naturally, the Australian Nurses Federation is in agreement with Casey that all nurses are suitably qualified to work with children but they do understand the need and desire by nurses and medical practices to have specialist qualifications. ‘Registered nurses are suitably qualified to work in paediatrics,” a spokesperson for the ANF says. “But it is becoming more commonplace that on some occasions nurses are employed in areas where graduate certificates or extra education is required and paediatrics is no exception. “This is reasonable provided there is good orientation and ongoing support. Often this exposure leads the nurse to make decisions about commencing a relevant course in the area of practice.” The ANF has fought many hard and long battles to improve nursing conditions such as pay and believe that specialisation in a field of nursing offers many benefits to patients and the medical profession. 30 | May 2013
“As with all fields of nursing, an individual nurse or midwife makes decisions about their career based on a range of issues and paediatric nursing is no exception,” one ANF spokesperson says. “Paediatrics involves medical and surgical nursing including ICU and the like, just as adult nursing does. “Specialisation generally is chosen because of an interest in the area. Generally, those who complete a graduate diploma or further study in the area are often able to attract a qualification allowance on top of their regular base salary.” How we can structure university courses to cater for the growing need of specialisation qualifications for nurses? Nurses shouldn’t be weighed down with a hefty HECs bill for undertaking post-graduate courses that benefit the community in general. Changing a university course for four years would take years of negotiation over course material and structure, federal
government funding and would also impact upon post-graduate degrees. Paediatrics is a vital area of concern and an area that all nurses should be taught in their undergraduate degrees. “I have been pushing for post-graduation qualifications for nurses specialising in paediatrics,” professor Shields says. “Even better would be a degree in paediatric/ child health nursing, but I tried to float that idea a few years ago and got nowhere. “Governments wouldn’t fund it – too costly – and many think it would limit working opportunities for graduates who want to work in rural and regional areas and need to be able to nurse a range of ages in smaller country hospitals. “The midwives now have direct entry midwifery courses – you don’t have to be a nurse as well – so it will be interesting to see how that goes and if we could translate it into paediatrics. I don’t like my chances in my lifetime.” n
of pre-term babies to cope The trauma of preterm delivery on the family unit cannot be underestimated. By Trudi Mannix
ollowing the birth of a pre-term baby, parental stress levels are high. Emotions are mixed; parents are grateful that their baby is alive, but at the same time they face the fear that their baby will die, or suffer permanent long-term damage. Mothers may feel guilt that the pregnancy was not carried to term, and both parents feel a sense of powerlessness which leads to a loss of confidence in their ability to provide care for their baby. The cuts and bruises, colour, size and weak appearance of the infant does not compare to the image of the baby that parents have built up in their minds, and is source of distress to mothers in particular. The NICU environment is alien, with constant noise from ventilators, monitors and alarms. Parents feel added stress when they don’t know what is happening to their baby, and when they receive conflicting information. For up to two years after delivery, the long-term effects of this stress may manifest in depression, post-traumatic stress syndrome and mental illness, with effects on the infant’s long-term cognitive and psychomotor development. In addition, early disruptions to bonding between parents and their pre-term infant disrupts parent-infant interaction and adds pressure to the marital relationship. Neonatal nurses are at the forefront of best practice around the world in helping parents cope with this stress. At international centres of excellence, neonatal nurses are working with their medical and allied health colleagues and families to intervene early to reduce the stress that parents feel when a pre-term delivery is imminent and babies are admitted to the NICU. Some examples include: • The COPE (Creating Opportunities for Parent Empowerment) program By educating parents about their preterm baby’s appearance and behaviour, parents learn the best time to interact, and how to interact with their baby
in a developmentally sensitive way. Randomised controlled trials of the COPE Program have shown that parents subsequently gain confidence, feel less helpless and more empowered, and this reduces their stress levels and rates of depression. • The FIC (Family Integrated Care) program. In this intensive parentfocused program, one parent acts as the primary giver for eight hours a day, and provides all care except administering medications and IV fluids, and adjusting ventilation requirements. Neonatal nurses stand alongside parents offering continual support, education and coaching. • The March of Dimes Family Support Program (FSP). Former NICU families provide information (in the form of a parent care kit) and offer one-onone support to parents, siblings, grandparents and the extended family. The parent care kit contains information about the staff that work in the unit, common procedures and equipment, and the likely conditions that effect pre-term infants. The FSP also provides professional development for staff. Parents also participate in their baby’s care and through this positive parental interaction, bonding is improved, and consequently there are promising long term impacts on the infant’s cognitive development. • The NIDCAP (Neonatal Individualised Developmental Care & Assessment Program). Following systematic observations of a pre-term infant at 7-10 day intervals for 10-15 minutes before, during and after a procedure, an individualised care plan is formulated. How the infant responds to the procedure is assessed according to their colour,
heart rate, posture, facial expressions and these observations help to determine their capacity to interact. Changes can then be made to the environment, the timing of care, aids for self-regulation etc. The results are also used to teach parents to interact more successfully with their baby. The NIDCAP has been shown to have lasting beneficial effects on brain function into school age. • The Maternal-Infant Transaction program (MITP) comprises seven one-to-one sessions conducted in the week before hospital discharge and four home visits within the next three months. Training sessions are designed to enhance the quality of mother–infant interaction by teaching the mothers of low-birth-weight infants to be more sensitive and responsive to their babies’ physiological and social cues. By structuring all aspects of the environment (including interactions) to suit the infant’s ability to cope, the MITP aims to help the infant to never (or rarely) be allowed to become so stressed as to be disorganised, with long-term positive impacts on the infant’s cognitive development. Aspects of these programs have been implemented in Australia with varying success. Neonatal nurses have a responsibility to find out more about these examples of best practice, and work together with their neonatal colleagues to translate these potentially simple, clear and effective interventions into national practice. High quality large research studies in the area of reducing parental stress in neonatal units need to be undertaken to further develop and test these interventions. n Dr Trudi Mannix is an academic in the School of Nursing and Midwifery at Flinders University in Adelaide. May 2013 | 31
There is a desperate need for nurses in rural areas, but there’s also a great sense of potential for the nurses who do relocate. By Flynn Murphy
32 | May 2013
was at Royal Hobart, and I’d been there for 15 months,” recalls specialist ED nurse Jerildene Smith. “I got a phone call the day my contract expired which said ‘you can finish up the roster, but after that, there’s no more work for you’.” Smith’s was just one of hundreds of nursing positions slashed during a particularly savage round of cuts in the 2011-12 financial year. After failing to find work locally, Smith signed up with a nursing agency. There was a spot available up in Leonora, around
2.5 hours’ drive north of Kalgoorlie in WA. An immediate start. “So four or five weeks after I’d been told there was no work in Hobart, I left to take up a three month position [in Leonora].” Smith admits she was forced to make the leap. But she’s glad she was. “I had no idea of what I was diving into, or what to expect. It was $700 one-way [for the flight to Kalgoorlie], and I had to pay that up front – though I got it back at tax time. You can go overseas and back again for that amount of money.” Having qualified as a registered nurse in
2008, Smith says it was frightening to find herself in charge on a night shift at Leonora District Hospital, which is classified as “very remote”. But while noting it was difficult to get time off for professional development, Smith calls her decision “the best I’ve made … I learnt bucket-loads about the things you just don’t see, like rheumatic heart fever … and I saw more bad ear infections than I’ve ever seen in my life.” Smith was always made to feel welcome at Leonora and at ‘neighbouring’ Laverton Hospital (one hour north), where she took occasional shifts. “Even though they had a high staff turnover, they were incredibly supportive.” Her critical care skills diminished due to lack of practice, but she gained valuable competency in triage and suturing, she says. “My health assessment skills went off the chart. You’ve got to decide whether you can manage something yourself … and that improved my professional confidence. You ask yourself, do I need to ring the doctor, or do I need to get the director
of nursing involved? Is it going to blow up in my face? And you’re making these decisions at 2.30am. You can’t afford to drag somebody out of bed at that time for a cut finger.” Smith made $6000 more than the EBA rate at Royal Hobart Hospital just by virtue of being in Western Australia. In addition, she was paid $170 dollars a fortnight by the government.
Rural or remote?
There is nowhere ‘rural’ left in Australia. At least, not according to the Federal Health Department’s classification system. Since 2001, it has used the Australian Bureau of Statistics classification model, which splits Australia into ‘Remoteness Areas’ (RAs) based on population size and distance from urban centres. There are five zones, ranging from major cities (RA1) to “very remote” (RA5). Each zone sees government pay different incentives to contracted health professionals. The Rural Health Professionals Program, developed by Health Workforce Australia,
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Locum support for eligible nurses and Find help midwives in rural and remote Australia.
offers incentives to those who move to a location with a higher RA than the one they currently work in. The program has placed a total of 100 nurses since it began in January 2012 – just over half of which came from outside Australia. Seventy-nine of these nurses have been placed in the RA2 and RA3 category zones, which traditionally lack the drawing power of higher category areas. Carole Taylor, CEO of remote health professional advocacy group CRANAplus, says pay is not an issue for remote nurses, and that most are very well-paid. But she says many don’t receive the support they need. “They need to be properly oriented. When people are going into a remote community, whether it’s a mine, or an aboriginal community … you can’t just dump people into places.” Taylor says while the differences between metropolitan and RA2-3 are huge, the differences between RA2-3 and RA4-5 are even bigger – particularly when it comes GP support. “Most [RA2-3] hospitals have a strong
out how we can you with leave! May 2013 | 33
GP base, whereas GPs often don’t exist in remote areas.” She adds that when it comes to aboriginal health, “no such thing as generic cultural awareness” – but that cultural awareness is community-specific and needs to be treated as such.
Placement and agency contracts
For nurses seeking to take up an RA2-5 placement, there are two types of contract available – ‘placement contracts’, and ‘agency contracts’. Circumstances differ state to state, but the type of contract a nurse is on affects their rate of pay, entitlements and incentives.
34 | May 2013
A health facility such as a public hospital can choose which contract to hire nurses on, and both placement and agency contracts can be administered through nursing agencies. The key difference is that the rate of pay on an agency contract is generally higher than that on a placement contract (which is the same as that of the local permanent staff). The pay is traded for entitlements – an agency contract typically won’t offer sick leave, annual leave, long service leave or professional development leave entitlements. So placement contracts can be ideal for medium to long term stays. Typically, nurses on placement contracts
can carry these bonuses over to other sites. While private facilities have discretion about which contracts they hire nurses on, all contracts offered in public facilities in the NT, NSW and SA are placement contracts. In West Australia, the casual and agency nurse pool for public facilities is governed by the state government through NurseWest, but only agency contracts are available in the West Australian public system. There is great demand for RA2-5 nurses, and many agencies offer financial incentives to encourage take-up, such as a weekly stipend, travel assistance and
specialty focus accommodation (though many facilities provide this for free). Nursing Review spoke with Alison Allardyce, nurse enquiries manager with CQ Nurse nursing agency. “On the whole, agency work in Australia is in a downturn … [but] nurse applications have skyrocketed.” By offering access to education programs for contract nurses, CQ Nurse has been able to capitalise on the fact that Australian Health Practitioner Regulation Agency (APHRA) will be auditing nurses to ensure they are completing their required 20 points of Continuing Professional Development per qualification – education being something contract nurses can find difficult to access. So where are the most popular places to go? Allardyce gave Nursing Review the low down. On her list of hotspots right now are WA, NT and NSW for nurses, though she said midwives and emergency department nurses were in demand pretty much everywhere. In Queensland, however, a public health recruitment ban has cooled the market. Dry communities in WA and NT continue to be very popular places for remote work, and Alice Springs Hospital produces consistently positive feedback. Alice Springs is also a popular destination for nurses looking to transition into aboriginal health. When it comes to aged care nursing, NSW is a popular site for rural nurses seeking the more lucrative agency rates offered by private facilities there. Tully Hospital, a rural hospital in far north QLD, stands out as a consistently popular place due to its proximity to Cairns. Wherever the placement, Smith says she can’t recommend working nursing in rural and remote areas more highly. “It’s enhanced my practice, my skills, my ability to problem solve and deal with unexpected situations – and it’s probably made me better as a person as well.” n
ANF: Incentivise remote nursing With graduates finding it increasingly difficult to obtain jobs, many have weighed in on the issue pointing out that grads could be further encouraged to take up remote area placements. ANF federal secretary Lee Thomas says incentives such as reimbursing the course fees would be a “win win” for nursing and midwifery graduates and “high need” workforce areas, such as Australia’s rural and remote communities. “Highly trained nurses and midwives play a crucial role in delivering safe patient care in in remote and rural communities across Australian,” Thomas said. “As we’ve highlighted, the federal government offers a range of incentives to attract medical students into working in rural and regional communities, yet the same doesn’t apply to nurses and midwives. “Reimbursing course fees would help in attracting nurses and midwives to relocate to rural practice and at the same time, be providing them with clinical placement or in some cases a graduate year. “As we know, these communities are all too often shortstaffed and there would be great benefit to both the community and the nurse or midwife in offering these incentives.”
Maternity Emergency Care (MEC) Course
Maternity emergencies are challenging in any environment, but when they happen in the remote areas, the difficulties can be compounded. The Cranaplus Maternity Emergency Care Course (developed in 2003) and Midwifery Upskilling Course (developed in 2010) both aim to respond to the unique needs of remote area nurses and midwives dealing with maternity emergencies and presentations. “The course is based on the core principles of all national and international maternity emergency skills, but has a remote focus due to several realities of working 'out bush'. It factors in challenges like the tyranny of distance and hence the lack of expert physicians, midwives and staff, minimal equipment, no X-ray or pathology departments, most commonly no doctor on site and the time to reach specialist care,” says the national education manager for CRANAplus, Libby Bowell. Although these courses are aimed at all health professionals working in an isolated context, the main clientele are rural and remote area nurses and midwives. “We aim to ensure women are able to access maternity emergency care, irrespective of where they present to. A normal birth in a remote area with no resources, is in reality an emergency situation for non maternity staff” says Libby Bowell.
It is a full weekend starting on the Friday at 3pm, with a variety of lectures and hands on skill stations. This is an interactive, demanding yet rewarding course. The MEC course is developed for non-midwives by CRANAplus in close consultation with the Australian College of Midwives. The purpose is to help remote health practitioners who aren’t experienced in maternity care, to develop the basic skills they need to provide emergency maternal care in a remote setting should the need arise. The MEC course is endorsed by the Royal College of Nursing Australia (RCNA/ACN) and attracts 20 CNE points and is accredited by the Australian College of Rural and Remote Medicine (ACRRM). If you are a Registered Nurse, Aboriginal Health Practitioner, GP or Ambulance Personnel, with no or little maternity care experience, and you are interested in learning more about Midwifery in a rural/remote setting, you are encouraged to consider undertaking a MEC course.
MIDUS Course (Midwifery upskilling)
This course has been developed in response to the specific needs identified by midwives working in remote and isolated areas. This program aims to provide an overview of current practice in antenatal, intrapartum and postnatal care. This will include a discussion of complications in pregnancy and birth, and the emergency management of a pregnant woman and her baby, with an emphasis on care in the remote and isolated setting. The course includes skill stations where the participant has ample time to practice midwifery skills under guidance. The MIDUS course is endorsed by the Royal College of Nursing Australia and The Australian College of Midwives (MidPlus) and attracts 20 CNE points. It is also accredited by Australian College of Rural and Remote Medicine (ACRRM). Both the Maternity Emergency Care (MEC) Course and the Midwifery Upskilling Course (MIDUS) are delivered in all states and territories in remote locations and regional centres as defined by the target group, allowing for maximum access.
Please visit our website for further information, it is easy to register online and all the pre-readings will be sent to you for the course. www.crana.org.au For any enquiries please contact Michelle Bodington MEC Co-ordinator on 0427979663 or firstname.lastname@example.org
May 2013 | 35
Rural health: It’s time to
Now is the time for the government to direct incentives to the rural workforce. By Debra Thoms
36 | May 2013
ealth Workforce Australia (HWA) has released an online consultation paper, Nursing Workforce Retention and Productivity, to encourage further feedback and discussion in regards to strategies to improve nurse retention and productivity, as well as inform HWA of existing programs that are already successfully addressing these issues (HWA 2013b). This paper was prepared after preliminary consultation with key stakeholders. In my capacity as Australian College of Nursing CEO, I have been involved in a number of these preliminary discussions. One issue from the paper I would like to pay particular attention to in this editorial is that of rural health. The paper highlights the fact that the most significant workforce issue facing rural communities is the ageing nurse workforce, and that strategies need to be developed and implemented to ensure a sustainable rural nurse workforce. The paper provides examples of innovations in the rural nurse workforce, noting HWA’s own Rural Health Professionals Program designed to provide support services to international and local nurses and other health professionals practicing in rural and remote Australia, and in Aboriginal and Torres Strait Islander health services. Also mentioned is the government’s Nursing and Allied
Health Scholarship and Support Scheme which encourages the pursuit of a career in rural health and facilitates educational opportunities for nurses, midwives and allied health professionals (HWA 2013b, p. 29). If HWA is to properly address the issues affecting rural communities it’s important that messages from last year’s Senate Standing Committee on Community Affairs senate inquiry are carefully considered. The committee’s inquiry report, The factors affecting the supply of health services and medical professionals in rural areas, was released in August 2012 (SCACS 2012). The findings were noted by HWA; however, it is important to note that stakeholder feedback indicated that the inquiry’s recommendations could have gone further; a belief shared by ACN. The report included eighteen recommendations to address issues faced by rural and remote health services. Amongst these recommendations were: • The development of an accommodation strategy • The extension of the HECS Reimbursement Scheme to nurses and allied health professionals • The improvement of data collection • That ‘generalist’ medical skill-sets be encouraged. Notably, Royal College of Nursing, Australia (RCNA), now ACN, was cited substantially within the report as representatives from RCNA presented
their perspectives at the initial inquiry hearing. While the report largely focused on the medical profession, it had clear advice for the government that it’s time to direct incentives to the rural nurse workforce.
Accommodation and education
It is widely acknowledged that professional life in rural and remote areas can be challenging for health practitioners, particularly those who relocate for work purposes. The senate inquiry’s report recognises many of these personal and professional challenges for practitioners. Importantly, the inquiry recommended the development of an accommodation strategy for rural health workers as part of the federal government’s planned review of rural health programs. ACN was pleased to see the committee make this long overdue recommendation, as one of the major impediments met by nurses considering a rural nursing role is the lack of access to appropriate and affordable accommodation. Another significant challenge facing rural nurses is access to ongoing education; if nurses working in rural communities are not able to maintain and, indeed, enhance their practice skills this can only have a detrimental impact on both the nurse and the community they work for. While there are many issues to be considered when looking at reform of the rural nursing workforce, if the problems of adequate accommodation and access to education are not addressed as priorities for reform, tangible progress in the rural nursing workforce will not be fully reached.
Compared with the medical workforce
there are very few policy incentives in place, either financial or career – to attract and develop the rural nurse workforce. This has direct implications for the quality of health services available to rural communities, as in many rural areas the bulk of services are provided by nurses. That’s why the committee’s clear recommendation that the HECS Reimbursement Scheme, currently available for doctors, be extended to nurses and allied health professionals; another positive development in the right direction.
The report also acknowledged that data collection must be improved to provide a foundation for future strategies that will address gaps in service delivery. We know the nurse workforce in rural and remote areas is ageing, and in the past there has been a lack of ‘robust and meaningful’ data to inform a cohesive strategy to address the capacity and capability of the current and emerging rural nurse workforce. Pleasingly, the advent of the national registration scheme and the release of HWA’s Australia’s Health Workforce Series – Nurses in focus (HWA 2013a) are examples of positive advances to address this shortfall of data.
Generalist medical skill sets
In remote and very remote areas, there are small populations across large geographical distances, the implication being that there often is not enough demand for specialist medical services. The committee noted this and recommended a move towards a more ‘generalist’ skill-set in medical professionals working in remote areas, encouraging a higher education course which promotes the generalist skill set.
Equally, nurses working in rural and remote areas need to possess a high level of generalist skills. This raises some issues: how to develop and maintain such a broad skill-set when some of these skills may only be called upon occasionally; and recognition and career pathways for nurses are more commonly recognised through specialist areas of practice, rather than good generalist skills. These can be difficult to address but are very relevant in the rural and remote settings. While noting these recommendations, ACN does believe the committee missed an important opportunity to argue for incentives to expand the nurse practitioner model within rural health services. The committee made specific mention of the need to broaden the scope of skills and competencies of the existing workforce, noting nurse practitioners, but fell short of making a definitive recommendation. ACN is encouraged by the report’s findings as well as the additional work taking place through the HWA consultation process. However, it is crucial that these recommendations gain momentum and is followed up by both current and successive governments, for the issues affecting rural health services to be addressed in a meaningful way. In partnership and collaboration with ACN rural nurse leaders we will carry on representing the nursing profession at future HWA forums, and will continue to ensure the needs of rural nurses are not overlooked. Adjunct professor Debra Thoms is chief executive of the Australian College of Nursing. For a fully referenced version of this article see www.nursingreview.com.au
May 2013 | 37
Nurses not ta Despite risk of exposure to influenza and other infectious diseases, vaccine takeup rates among health professionals remains dangerously low. By Amie Larter
espite almost constant recommendations for an annual influenza vaccination, there has been little change in the levels of uptake among Australian healthcare workers. There is growing concern over these low levels, especially with Monash University researchers recently confirming the severity of hospital-acquired influenza. Lead researcher and associate professor at Monash University, Dr Allen Cheng said that although rare, hospital-acquired influenza tends to be very severe. Of 598 cases of influenza analysed from data from a Victorian hospital-based monitoring service, only 4.3 per cent were hospital acquired. “We only had 26 cases [of hospitalacquired influenza] over two years in the surveillance system, which for over 15 hospitals isn’t a whole lot of cases,” he said. “But one of the patients did die, and about six of them went to intensive care which is a pretty high proportion.” Researchers found a connection
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aking up vaccinations between nosocomial influenza and existing conditions, with results from the study suggesting patients that had acquired the flu in hospital were likely to be immuno-supressed or have an underlying malignancy. While it is not certain how the 26 patients got their infections; the concern remains that patients could contract influenza from hospital staff. Vaccination is particularly important for workers in acute care settings, as there may be patients with severe lung disease and suppression. “For most people, flu isn’t a dangerous infection, but for patients who are already in hospital for other reasons, it can be a disaster,” Cheng confirmed. He recommends healthcare professionals get the vaccine for the protections of themselves, their family and, of course, their patients. “It is thought that less than half of Australian health care workers receive the flu vaccine each season. “Although the flu vaccine isn’t completely
protective, it’s still better than not being vaccinated.” Dr Steve Hambleton, president of the Australian Medical Association, has had this year’s seasonal flu shot, and believes health professionals should lead by example. He supports policies of excluding un-immunised health care workers from patient-care areas. “Influenza is highly infectious and is droplet spread. The virus can spread by direct skin to skin contact – shaking hands or indirect via aerosols.” Hambleton and Cheng both agree that health professionals should be experts at cough etiquette, hand washing and social distancing, and must be prepared to isolate themselves from the workplace if they have an infectious disease that is putting their patients or co-workers at risk. Most states strongly recommend for health professionals to be vaccinated; however there are no compulsory legislations. South West Healthcare in rural Victoria
strongly advocates staff to have the flu vaccine, offering free influenza vaccines onsite for all staff. Having just completed its 2013 Workplace Influenza Vaccination campaign across its five rural campuses, this year’s figures are still unavailable. However its 2012 campaign resulted in 64 per cent of its staff being immunised – a 1.5 per cent increase from the previous year. Julieanne Cliff, South West Healthcare’s nursing director said they hopeful even more staff will follow suit this year, following health minister David Davis’ call for as many health workers to be immunised as possible. “Encouraging our staff to be immunised is foremost for the protection of our patients, clients and consumers,” she said. “We know that vulnerable older patients, especially those with significant medical conditions are particularly at risk of becoming very unwell or even dying should they contract the flu.” n
May 2013 | 39
Believed to affect over one million Australians, the incidence of macular degeneration is on the rise. By Amie Larter
ge-related macular degeneration is the leading cause of blindness and loss of vision in Australia and affects one in seven people over the age of 50. Estimated at costing the health system approximately $5 billion in 2010, the disease is said to affect a patient’s quality of life in an equivalent capacity to cancer or even coronary disease. Associate professor Alex Hunyor, retinal specialist at Sydney Eye Hospital and Macquarie University, believes there are two main reasons for the spike in AMD diagnosis. “[The increase] relates both to the ageing population and also increased awareness – so we are increasingly diagnosing the problem,” he said. “Rather than having lots of people who have it but don’t know about it, we now have a better handle on how many people have it.” There are two types of macular
40 | May 2013
degeneration. The first, commonly known as ‘dry form’, results in a gradual loss of central vision. Wet AMD, the more severe form, is characterised by a sudden loss of vision caused by abnormal blood vessels growing in the retina. Out of the 1 million people that have evidence of macular degeneration, 167,000 had late stage macular degeneration which included 57,000 with the dry form and 110,000 with wet AMD. Early detection is vital to managing the condition, and Hunyor believes that it is important for medical professionals to be aware if the impact and symptoms of macular vision impairment. According to the Macular Degeneration Foundation Australia key symptoms may include: • Difficulty with reading or any other activity that requires fine vision • Distortion, where straight lines appear wavy or bent
• Distinguishing faces become a problem • Dark patches or empty spaces appear in the centre of your vision. “People with macular disease often won’t look as though they are blind or visually impaired because their behavior looks otherwise – they can still see lots of things and to get around,” Hunyor said. “If they are describing problems with central vision – blurry patches or a crooked appearance to straight lines, they are very characteristic symptoms of macular disease. To work out what the macular problem is they just need to have their eyes tested by a specialist.” New research also suggests that the burden of AMD extends not only to patients but also to those who are caring for them. Statistics from MDFA has revealed that the depression rates amongst those caring for someone with vision loss from agerelated macular degeneration is triple those seen in the Australian population over 65 years.
clinical practice AMD risk factors Age • The rate of macular degeneration increases dramatically with age • Macular degeneration is not an inevitable consequence of ageing Family history • 50 per cent risk of developing macular degeneration if a family history is present • Up to 70 per cent of cases have a genetic link
MDFA encourages those dealing with AMD patients, to also consider the carer to ensure that people know they are not alone and can be guided in the right direction for support. “We know that it is a very challenging task for a carer looking after someone with low vision because there is a constant worry about accidents and falls – it is the relentless nature of having to have patience, and the continuous need to stay positive,” said Julie Heraghty, CEO of MDFA. Results revealed that over half of carers
believe the disease has had a negative impact on their life, while 38 per cent had felt frustrated and 28 per cent had experienced sadness. Of the carers, two thirds were contending with their own chronic conditions – arthritis, heart disease, cancer – and one in ten carers reported that there was no one to look after them if they were unwell. Heraghty suggests this could be attributed to the fact in most cases, it’s a spouse looking after the person with AMD. n
Smoking • 3–4 times the risk of macular degeneration if you smoke • Smokers get macular degeneration five to 10 years earlier, on average • 20 years after quitting, an exsmoker’s risk is the same as someone who has never smoked *Information sourced from the Macular Degeneration Foundation Australia
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42 | May 2013
the future The career path for nurses is now branching out in many directions, giving rise to new, and challenging, opportunities. By Terry Smyth
t’s an image thing. Nurses consistently rate as the most trusted profession, yet the public’s perception of a nurse has moved little beyond the stereotypical “handmaiden of the doctor” – an image that couldn’t be further from the truth. Hollywood doesn’t help. The typical TV medical drama has nurses merely standing by demurely while dedicated doctors make life-saving treatment decisions, perform delicate procedures using complicated technology, diagnosis, triage, roundthe-clock observation and intervention, administration of medication, defibrillation, dialysis, endoscopy, psycho-social assessment and many other jobs that in real life are carried out by nurses. In reality, the “Yes, doctor” image was never true. While nurses have too often been depicted as subordinates who simply follow doctors’ orders, they have always had their own knowledge base and autonomy. The nurse is, and has always been, the patient’s advocate. And by making independent decisions based on their knowledge, nurses save lives. As society has grown more diverse, more complex, the knowledge base of nursing theory and practice has expanded to meet society’s needs. That wider knowledge base brought a shift in the traditional career path for nurses, notably apparent in Australia since the move from hospital schools to diplomas in the late 1970s, then to bachelor degrees in the 1980s. Compared to the rigid, institutionalised old path from student nurse to ward nurse to charge nurse to matron, this was a seismic shift. In her 1989 book, Nursing For Life, Gael Knepfer predicted that future career paths
for nurses lay outside the mainstream – in health promotion and preventative education, and as independent practitioners of such disciplines as acupuncture, osteopathy and meditation. The future for nurses, according to Knepfer and likeminded others, was holistic. By the turn of the millennium, however, the path had shifted again, from the holistic approach back to task orientation, but with a difference. For nurses, the 21st century is the age of specialisation, not only at the bedside but increasingly beyond it. The nursing profession now has one of the fastest growing of all career paths. A high proportion of nurses have post basic degrees, including masters degrees and PhDs, and it seems – on the surface at least – that graduates are spoilt for choice. NSW Health lists current opportunities for registered nurses as including coronary care, child and family health, intensive care, midwifery, emergency nursing, mental health, occupational health, surgical nursing, rehabilitation, rural and remote community nursing, management, education and research. Meanwhile, new technology is bringing new roles. In a digital world, more and more nurses will be found processing test results and x-rays, and ordering medication. Specialised roles for nurses are opening in diabetes, obesity, pharmacology and other clinical fields. The future is also likely to see more nurses working as researchers, care coordinators and community liaisons, in anaesthetics, IVF, rehabilitation and oncology, while outside the hospital they may find careers as forensic nurses, clinic nurses, industrial nurses, legal nurse May 2013 | 43
workforce consultants, case managers for insurance and worker’s compensation, wound, ostomy and continence nurses, legal nurse consultants, flight nurses, academics, healthcare managers and administrators. The list of nursing career opportunities of the future could include jobs with titles such as patient care co-ordinator, patient safety officer, emergency management director, health coach or lifestyle coach. Already, nurses are publishing scientific research, developing healthcare policy, and, as nurse practitioners, hanging out their shingle in an expanding range of fields. But while overseas studies have found that nurse practitioner services have reduced the demand on acute hospital services, improved health care access and lessened the workload on GPs, the nurse practitioner career option remains contentious across Australia. With the exception of the outback, where many medicos fear to tread, doctors have voiced strong reservations about NP services, in particular the ability of the NP to prescribe medication. The 2008 Garling Report into acute care services in NSW hospitals recommended that: “NSW Health allocate funding for more nurse practitioner positions across NSW, particularly in rural and remote areas,
and in hospitals where it is hard to employ doctors. The NSW government promulgate regulations as to the clinical decisions and procedures that may be made and undertaken by nurse practitioners. Implementation of this recommendation will provide certainty as to the scope of the nurse practitioner role, and promote acceptance of it. NSW Health instruct managers to ensure that nurse practitioners are directed to work in all areas for which they are qualified and that they are not to be used as if they were stop-gap or second-best clinicians.’’ Internationally, NPs can now be found in intensive care, emergency, surgical, cardiology, neurology, general medicine, primary care and oncology services, managing complex patient conditions in both in-patient and out-patient settings. Studies have found no difference in health outcomes between NPs and doctors, and that NP services achieve greater patient satisfaction and compliance. So when will Australia catch up with the rest of the world and expand NP services? According to nurses’ online forums – an excellent source of unfiltered opinion at the coal face – that will only happen when our doctors get over themselves. The branching of the career path into specialties is apparent across all states
in Australia, and is evident, too, in New Zealand, the UK, the US and other developed nations. If research in the US applies similarly to Australia, the nursing speciality expected to show the strongest growth is gerontology. With the aging of the baby boomers, the average age of the typical patient is now 65, and it’s estimated that by 2050, nursing homes will need 66 per cent more registered nurses, 72 per cent more enrolled nurses and 70 per cent more assistants in nursing. And although caring for aged people in their homes rather than in institutions is widely agreed to be a laudable aim, it will require a massive 250 per cent increase in nurses of all levels. So the future is not all roses. The question arises: who will be left at the bedside? As nurses step up the career ladder to take on more specialised and responsible roles, what will be effect at the bottom of the ladder? Who will be on hand to make the beds and empty the bedpans? If by nurses we mean registered nurses, it seems that more and more traditional RN roles will be taken over by ENs and AINs, and, to lesser extent, by non-nursing staff. For example, the Garling Report suggests renal dialysis and transplant areas of nursing could be done by “technicians”.
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workforce Again, online forums reveal front-line nurses’ fears for the future. Speaking from the heart, an RN posts: “In all honesty I believe in the near future our health system will be run by unskilled carers, and many people will die as a result. It’s a bit like going back in time where hospitals were a place you went to die, before Florence Nightingale stepped in and opened the first school of nursing. What else can I say when many aged care facilities are run by AINs, and most private hospitals employ more ENs than RNs.” That nurse’s concerns, shared by many, are supported by studies. Internationally, a growing body of research shows a direct connection between the higher education of nurses and lower patient mortality rates. In other words, more RNs means fewer deaths. But tell that to the politicians and healthcare bureaucrats, nurses say. According to The Planning Institute of Australia, the future career opportunities for skilled health care workers is already low and expected to fall a further 4 per cent by 2015. Meanwhile, universities are producing skilled nursing graduates with little or no employment prospects. At the same time, a Department of Education, Employment and Workforce Relations report has found
that in 2011 – 2012, the health care sector employed more than 1.3 million nongraduate workers. The cynical view is that by increasing their skills, RNs have priced themselves out of a job. Strangely, it’s an accusation never hurled at any other profession. Experienced RNs have seen the role of the EN expand from strictly limited duties under direct supervision to almost everything an RN does except carry the locked drug keys, and they have seen the numbers of ENs at ward level grow accordingly, while RN numbers have shrunk. It seems likely that trend will continue. As RNs move to supervisory or specialist consultant roles, there will be even fewer RNs at the bedside. It’s already an old argument that patient care is being compromised in the cause of saving money. Of increasing concern to RNs is that under the existing system they are held responsible for mistakes made by ENs, such as medication errors. A lone RN in charge of several less-educated staff has only one pair of eyes. It’s not the EN’s fault – they are given too much responsibility and don’t have the knowledge to apply to their tasks – but it’s the RN who ends up in court. Then again, from many an EN’s point of view, university-trained nurses too often
avoid the bedside; as if making beds and taking obs is beneath them. Clearly, as the Garling Report recommended, the system has to change. What’s needed, the report says, is teamwork focused on the patient; an end to traditional roles and professional jealousies. To persist with a flawed template for patient care is to risk more lives. Florence Nightingale famously said, “The very first requirement in a hospital is that it should do the sick no harm.” Her dictum is as relevant now as it was then. Caring for the sick is becoming more and more complicated. Healthcare budgets are tight and predicted to get tighter. Hospitals are understaffed and likely to remain so, for the foreseeable future at least. Yet while resources shrink, the need for care continues to rise. As needs increase, the role of the nurse, at the bedside and beyond, will continue to evolve and diversify. On the career path, there will be more choices along the way, and with those choices a wider range of responsibilities. And it seems that while the future for nursing will bring many more opportunities than ever before, nursing will also be more competitive, more challenging and more politicised than ever before. n
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May 2013 | 45 18/03/13 11:05 AM
2013 ICN preview Equity and access to health are the key messages for nurses attending the ICN’s 25th Quadrennial Congress. By Amie Larter
urses from around the world will descend on Melbourne for six days from 18–23 May to learn the latest in evidence, experience and innovation, highlighting the role of nurses in creating equal access to, and quality of, health. President of the International Council of Nurses Rosemary Bryant believes that this theme is central to the nursing profession. “It is clear that governments cannot achieve healthy nations without universal access to health care. ICN believes that one of the best ways to achieve universal access is to maximise the potential of nurses through innovative models, expanded scope of practice and clear role in policy,” she said. “The question then for us — and for governments, employers and organisations throughout the world – is: how can we fully mobilise the nursing workforce to meet the health challenges and ensure universal access to quality care for all?” The congress will kick off on the Saturday evening with the opening ceremony – an event that includes a parade of nations, presentation of awards and special entertainment. Over the following days, dynamic keynote and main session speakers will aim to address the congress’ themes by focusing on the issues facing the international nursing community – including gender equity, the global epidemic of non-communicable diseases, ethics/human rights as well as clinical and patient care. “Imagine, if you can, a world without nurses, and it is not hard to see a different world with poor or no access to care and poor equity in health care,” Bryant said. “That is why nurses are often referred to as the backbone of health care.” To find out exactly what is in store for those attending, we have listed five keynote speakers and a preview of what you can expect to top the agenda at this year’s conference. 46 | May 2013
Michel Kazatchkine Keynote address: Equity and access to health care Before being appointed to his current role of United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, Dr Michel Kazatchkine has spent the last 25 years of his career fighting AIDS as a leading physician, researcher, administrator, advocate, policy maker and diplomat. Kazatchkine will set the scene for the event by highlighting the critical importance of equality and access for communities and individuals and also show why nurses are vital in making this happen. Expect to learn: Evidence, experience and innovations that are helping nurses globally improve access, care outcomes and reduce costs. When: Sunday 19 May Time: 9:00am – 9:50am
Leslie Mancuso Keynote address: Holding up more than half the sky As president and CEO of Jhpiego, Dr Leslie Mancuso has for many years been an advocate for women’s health – working tirelessly to prevent the needless death of women and their families. In her lecture, Mancuso highlights the growing evidence showing the importance of women in achieving safe, educated and successful societies. She will talk about ongoing issue of marginalisation of women in many countries where women are still being denied access to education and blocked from career promotion. Expect to learn: About current evidence on the contribution to, and impact of women on the wellbeing of society. When: Monday 20 May Time: 9:00am – 9:50am
Sheila Tlou Keynote address: MDGs: Running the final stretch An advocate for the development of national nursing and medical education curricula in Botswana, Sheila Tlou today is director of the UNAIDS regional support team for eastern and southern Africa. Tlou will speak on the Millennium Development Goals put together when 189 countries signed the Millennium Declaration back in 2000. She will highlight that while only three of the eight goals relate to health, equity and access in this area are vital if progress is to be made. Expect to learn: Why health is central to achieving all MDGs and the role nurses have to play in successfully reaching these goals. When: Tuesday 21 May Time: 9:00am – 9:50am www.nursingreview.com.au
Richard Visser Keynote address: Obesity: Personal or social responsibility? Richard Visser is the minister of Health, Welfare and Sport of Aruba and has extensive experience in the area of childhood obesity among various populations. In his address, Visser will discuss the shift towards the promotion of personal responsibility for eating and exercise choices and the limitations of this approach. He will then look at the argument that society is responsible for weight gain and whether we really have freedom of choice in what we eat. Both sides of the argument will be presented along with the role nurses can play in reducing obesity rates. Expect to learn: The increasing threat of obesity and the best methods to tackle the epidemic. When: Wednesday 22 May Time: 9:00am – 9:50am
Anne-Marie Rafferty Keynote address: The Virginia Henderson Lecture Dean of the Florence Nightingale School of Nursing and Midwifery at London’s King’s College, Anne-Marie Rafferty is also a fellow of the Royal College of nursing and the Queen’s Nursing Institute as well as an honorary professor at the London School of Hygiene & Tropical Medicine. Rafferty will wrap up the event by presenting the Virginia Henderson lecture – a keynote address that began in 1997 to honour the work of Miss Henderson. The lecture will illustrate exactly how Henderson’s work contributed to the conference’s theme of equity and access to health care. Expect to learn: Increased awareness of Henderson’s work and how her approach can be used to improve equality and access. Anticipate acquiring an improved understanding of the contribution nurses make to healthcare access and equality. When: Thursday 23 May Time: 4:00pm – 5:20pm n
May 2013 | 47
Constant changes Professor Phillip Della, head of School of Nursing & Midwifery at Curtin University talks to Aileen Macalintal about his vision for Australiaâ€™s nurses. As head of Curtinâ€™s School of Nursing and Midwifery, what do you think are the greatest challenges to nurses nowadays?
In the role of head of school, I see many challenges, opportunities and threats that have always and will continue to weigh down nurses and the profession. The call once again is for nurses and the profession to seize the opportunities and endeavour to minimise the threats. While this may be easy for a head of school to state, it is my firm belief that only when all nurses take up the opportunity to change the current status of the profession will we see real change. Unless this occurs, the control and dominance of the profession will largely remain in the hands of those outside of nursing. In the near future, nurses in the clinical area will continue to struggle to provide quality patient care in a financially constrained environment. The struggle is associated with the chronic under-funding of health despite the growing community demand for care. It is well known that the growing demand for health care is associated 48 | May 2013
with the Australian aging demographic and the increase in chronic disease in the community. This, combined with current financial constraints, will see the nursing workforce shortages increase and at times nurses may be willing to work, but will not be able to secure paid employment.
With constant government reforms, how should our nurses adapt to change?
While governments endeavour to balance their fiscal budgets, the emphasis on health system change and reforms will become the norm. Nurses are at the forefront of health systems reform and too often left to implement changes and new systems without the resources they require. Nurses must seize the opportunity to enhance and expand their roles. That will improve patient outcomes. There is abundance of evidence on the advantages of new nursing roles, including advanced practice roles, such as nurse practitioners that not only reduces fragmentation of patient care but also leads to improved health outcomes.
You will be speaking at ICN in May on changing scopes of practice in nursing â€“ can you tell us a little of what you intend to discuss?
Nursing scopes of practice are about what nurses do and this is always changing and adapting with the evolving health care environments. While the presentation at the ICN Symposium in May will discuss the components and the complexity of scopes of nursing practice, it will also challenge the status quo. This will include the changing scope of nursing with the introduction of advanced, extended and enhanced roles. While nurses have been educated and prepared for these roles, artificial barriers are often put in place that prevent full incorporation into health systems and thus limit their effectiveness. Artificial barriers are often developed and put into place by powerful groups outside of the nursing profession. Thus the presentation will examine how nurses and the nursing profession can challenge and limit artificial influences on scopes of nursing practice.
workforce Can you tell us more about the the importance of this event?
The ICN Congress is a global platform to allow international nursing leaders the opportunity to openly discuss debate and exchange ideas on the future directions. We are fortunate that this year the congress will be in Melbourne, which will afford many more Australian nurses the opportunity to actively participate. One of the major themes this year will be nursing contribution to the health of individual, families and communities. This is one area that I have great interest in and will be looking forward to being a part of the debate. The congress also will allow many nurses to present their work, research and scholarly projects to an international audience.
The first national research project focuses on clinical handover in a range of clinical settings. Professor Di Slade from the University of Technology, Sydney is leading the team, which involves nurses, doctors, linguists and clinical psychologists. The second continues research with professor Glenn Gairdner (Queensland University of Technology) and is studying the clinical outcomes of nurse practitioners in Australian emergency departments. I am fortunate to be working with professor Wendy Cross from Monash on reviewing the enrolled nurse competencies.
What inspired you to take this path?
changing role of health care, nurses and the profession.
What are the joys of being the head of School of Nursing and Midwifery?
The greatest joy of the role is the success of the students. This commences from their initial interest in the nursing program and their education journey and ultimately their graduation. The nursing graduates are the future workforce and will shape the future for the profession and health system.
What is your vision for Australia’s nurses?
I have a strong and positive vision for Australia’s nurses which include them taking full advantage of their education Prior to commencing the role of head preparation for advanced nursing roles of school, I gained experience in public in our health care system. administration in health care and patient This will see autonomous and safety and quality. What are you currently working collaborative practice with nurses My previous roles included the position on in terms of research or taking leadership roles in patient care, of the chief nursing officer, Western projects? management, education and research Australia and it was during this time My research continues to focus on that will improve patient care and health I decided to move to academia. changing and reforming health care outcomes of the community. While the head of school affords me systems and the nurse’s role. Nurses will also be positively and the opportunity to help shape the future I am currently a chief investigator on twoC Australian U H S 0 3 Research 0 8 . p d Council f P a projects g e 1 4 /of2nursing 4 / 1 3education, , 5 : 0 it8has : 4 also 8 allowed P M G M T +financially 0 8 : 0 0rewarded and recognised for their active contribution. n me to offer public comment on the with research colleagues.
“A postgrad nursing degree at Curtin has given me a lot more than I expected. I’ve improved my leadership and communication skills and opened the door for future opportunities in my nursing career.” Carrie Sprigg Master of Clinical Nursing Acting Staff Development Educator, Royal Perth Hospital
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A Canadian nurse, trained in travel health, has built a career on specialist counselling about vaccines, avoiding tropical disease and illness.
n 2012, 8.2 million Australians left Australia for a short-term trip. Ten years ago, this number was 3.5 million (ABS 2012). Many of these travellers are leaving without making adequate preparations. With this increase in travel comes the desire for adventurous and remote locations, whether for pleasure or working holidays. Trips associated with work such as IT and factory developments are now occurring in countries that would have been considered ‘high risk’ years ago. The mining industry is booming in southeast Asia and Africa, and Australians are relocating to these countries at short notice. Many people are also entering Australia as asylum seekers, and on humanitarian visas. All of these individuals need specialist counselling on appropriate vaccines, vector-borne diseases, tropical disease avoidance and discussions on specific signs and symptoms of potential illness to be on the lookout for upon return home, or while still abroad. Travel health encompasses a broad 50 | May 2013
number of needs such as migrant health, public health, occupational health, as well as wilderness and adventure sports such as altitude, diving and extreme sports. Nurses in Australia are an integral part of this specialty area. Many of us involved are avid travellers and enthusiasts of diving, altitude hiking and working overseas. Nurses are very familiar with the needs of travellers and what pitfalls can occur medically while away. Nurses have been involved in travel health in Australia since the 1990s. With the rise of specialist nursing and nurse practitioners, this area of preventative medicine is an excellent area for nurses to be working autonomously and collaboratively with their medical peers. Having a specialist nursing focus, nurses are able to provide services that include detailed health histories specific to each traveller, appropriate creation of treatment plans for all ages that include travel immunisations along with detailed teaching on numerous subjects specific to travel health.
The nurse’s ability to take complex information and teach it to clients at a level they can understand is one of the strengths of the profession. Information on subjects such as leptosporosis, schistosomiasis and Japanese encephalitis for instance can leave the average travellers’ head in a spin, but these are important areas of information that many clients need defined and to know if they are in fact at risk. Handouts also have been created to follow up on the information given. There are many specialist travel clinics across Australia. Umbrella groups such as Travel Medicine Alliance and Travel Medicine Vaccination Clinics have locations in every state. Within these clinics are doctors and nurses working together to provide a holistic service to clients. Many of the clinics are doctor-led; however an increasing number of them are becoming focused on their specialist nursing staff. It is imperative that a ‘cookie cutter’ approach is never taken for travellers, as
workforce their background of previous travel and immunisations, age, current health, travel itinerary and style of travel must be taken into account when considering the needs for these people and quite often either elderly or infant companions. I come from Canada, and have worked in this industry since 2002 as a specialist nurse in travel health. In North America, travel services were provided by public health units or councils. With cutbacks in the 1980s, the Canadian government no longer funded travel-related vaccines or consultations, and it was up to individuals to seek advice on what they would need for their own protection. Many doctors and nurses embarked on specialist training in travel health to ensure a high quality of service and counselling. I personally have undergone a high level of training, including a Certificate of Travel Health through the International Society of Travel Medicine (two years of consistent counselling to pass this exam), a Diploma of Travel Medicine through the Royal College of Physician and Surgeons Glasgow (a year of study at a Masters level in the UK), professional certificate of Immunisation through UniSA, and finally a Masters of Advanced Clinical Practice/ Nurse Practitioner from Flinders University. I also attend numerous international
conferences and on occasion share my specialist nursing knowledge. The specific travel medicine/ health courses are offered to nurses, pharmacists and doctors who are interested in this area of study. James Cook University in Australia offers similar courses. This exciting field is endless. It has been a long road, but one that has allowed the clients coming into our clinic in South Australia to realise that I have appropriate, detailed specialist training and knowledge that allows them a high quality of care. Clients coming to the clinic are pleased to see a nurse with a scope of practice that they can access and obtain all their travel needs at one location. Travellersâ€™ needs are varied across age groups, stages of life and many have chronic diseases and want to travel or work in remote settings. Working collaboratively to ensure these travellers have thought of everything and have covered all their bases before travel with both the specialist nurse and referral back to their GP or medical specialist is quite often necessary. Using nurses within either specialist clinics or general practice in this role will allow not only the clients to receive focused care, it frees up the doctors within their practices to deal with those who are ill, not those who are want to prevent illness while abroad.
Canada has embraced nurse practitioners and specialist nurses for years. Consumers have asked for changes in health care and for more convenient access to health care. This has led more professionals to seek specific knowledge and set up clinics specialising in travel medicine/ health or to have a dedicated practice nurse take over this important area within a general practice. Australia is slowly embracing this change. A high level of specialist training and understanding by nurses about travel health must be maintained to ensure quality of service and understanding. An outline for a scope of practice for travel health nursing such as those used in Canada or the UK should be created. With the increase of adventure travel, work overseas and more people coming from developing countries as asylum seekers or those on humanitarian visas, travel health as an area of specialty is growing, and with that is a need for specialist nursing within Australia. n Lani Ramsey works in Adelaide, South Australia at Travel-Bug Vaccination Clinic. She has been a nurse practitioner candidate since 2011, and is also vicechair of the Nursing Practice Group within the ISTM.
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May 2013 | 51
legal corner technology
Part one of a two-part article from our legal correspondent. Posthumous sperm harvesting continues to develop as an intriguing and contentious issue. By Scott Trueman
osthumous sperm retrieval (PSR) is a procedure in which spermatozoa (sperm) is extracted from a man after he has been pronounced legally deceased. What is the ethical and legal basis of undertaking such a procedure, often sanctioned by a court ruling? In such an eventuality, what are the legal rights of the child and surviving parent if the sperm is used for impregnation? Who determines, and on what basis, the â€˜interferenceâ€™ or invasion of the deceased when they are not alive to give informed consent related to their autonomy? Does a deceased person have any rights concerning their corpse anyway? How does a nurse or midwife respond, when confronted by a female partner of the deceased male seeking guidance on such issues? This is the first of a two-part article concerning these contentious issues which continue to legally develop through litigation but which remain vexing moral and ethical issues for individuals in society. In the first part we will refer to the most recent case which defines the current law concerning this topic. In the second article (next edition) the ethical and moral arguments will be canvased and explored. After a male becomes deceased, time is of the essence. To ensure the successful retrieval of viable sperm, the less time between death and collection the better, and after a very short
52 | May 2013
legal technology corner delay, the process becomes pointless due to irretrievable degradation of the sperm. Hence, most legal cases have been urgent applications to simply retrieve and store the sperm, with the longer-term questions as to the sperm’s actual usage, and in what manner, being postponed for later consideration. A recent 2012 South Australian case addressed this second line of inquiry and subsequent determination of reasoning. The applicant’s husband died in a motor vehicle accident in March 2011. Two days after his death his 28-year-old wife commenced urgent proceedings to retrieve sperm from the deceased. The court granted permission for the sperm to be removed, preserved and stored at the discretion of the coroner’s court. A further order was made preventing the sperm being used for any purpose without an order of the court. This first application and consequent orders were clearly a response to the medical necessities caused by sperm degradation through the passage of time. The wife sought further court orders in August 2011 entitling her to possession of the sperm and an order for its ‘release’ to her. She did not seek orders concerning the use to which the sperm would be used, although it was apparent that the sperm was to procure pregnancy by in vitro fertilisation.
There were a number of issues for the court to determine. Firstly, is the deceased’s sperm legal property or part of his estate? The beginning of this determination was that the common law historically did not recognise human tissue attracting the legal status of ‘property’. The relevant high court decision was over 100 years old, and therefore decided before advancements in science and technology existed, before such procedures were even contemplated. The court then looked to an exemption to the rule in that the retrieval and preservation of the sperm required “requisite work and skill” and on this basis, the sperm was treated as property to the extent that there was an entitlement to possession. After all, there is little point in collecting the sperm and storing it if it cannot be used. Secondly, who is entitled to possess the sperm? The deceased cannot for he is dead, the sperm laboratory cannot hang on to it forever – does it become part of the estate of the deceased, and hence can be bequeathed to another or possession passes to the person who sought the original order for retrieval (the partner). Can she take possession? The court was of the view the sperm could be possessed by the partner and does not form part of the deceased’s estate.
This is a far cry from earlier court decisions where it was held that there was no right to interfere with a corpse. Two earlier Queensland cases stated that those entitled to possession of a body have no right, other than the mere right of possession for the purpose of ensuring prompt and decent disposal (burial). Justification for this prohibition in interfering with a body (corpse) was based on the possibility of criminal prosecution in removing part of the body for whatever reason or motive being unlawful. The evolution of the law, through the passage of time (and consideration/ deliberation) means that the posthumous harvesting of sperm and the use of the same for vitro fertilisation to ‘create’ a child without their biological father, (being present during their life) is not only a real medical possibility, but a likely occurrence sanctioned by the courts. That said, the divergence between the ‘stated’ law does not quash nor quell the ethical and moral concerns and debates in relation to such pronouncements and ‘developments’. The follow-up article next month will explore this vexed argument. n Scott Trueman is a lecturer in the school of nursing, midwifery and nutrition at James Cook University.
NEW E T I S B E W OURCE RES
May 2013 | 53
Online video consulting is a new way forward for rural health that’s dispensing with the need for people to travel long distances. By Susan Currie
esidents of remote, regional and rural Australia all must factor in the tyranny of distance when accessing health care. Increasing access to specialist services for people in regional, rural and remote areas is the essential aim of the use of telehealth in practice. For the consumer and the specialist, there are also savings on the expense and inconvenience of travel from regional, rural and remote areas to specialist appointments in the metropolitan areas. Telehealth on-line video consultation occurs between a health consumer, a primary care provider, such as a nurse, nurse practitioner, midwife or aboriginal 54 | May 2013
health practitioner and a specialist healthcare provider through the use of audio and visual connection. Nurses and midwives play an essential role in supporting and promoting the use of telehealth in the provision of health care.
Paediatric case study: Jodie’s story
Jodie is two years old and has had moderate to severe eczema since she was eight months old. Jodie lives with her parents Joan and Pete, and seven-yearold sister in Blackwater, 865 km west of Brisbane. Dr Boag, a specialist dermatologist at the Brisbane Children’s Hospital (BCH),
has been seeing Jodie since she was four months old. Jodie had several admissions to BCH in her first year and now her eczema is moderately well controlled with oral medications and creams. Jodie has a review appointment with Boag every three months.
The visits to Brisbane are very disruptive to Jodie’s family. Joan does not drive and Pete works full-time. The family’s options for attending the three monthly appointments are that Pete has to take three days off work to drive the family to Brisbane, or Joan has to take the bus with her two children. This second option
appointment. The eldest daughter has to take time off school and the family has to arrange for accommodation near the hospital. They attend Jodie’s appointment, which is only 10 minutes in duration. Boag changes the topical cream Jodie uses. She also sends the family to another part of the outpatient department for the dressing to be reapplied and for Joan to be taught how to attend to the dressing at home. The family catch the bus back to Blackwater, and are exhausted by the time they get home. The specialist sends the GP a follow-up letter at the end of the week.
With telehealth involves a two night stay away from home. Joan and Pete have no family in Brisbane so they need to pay for accommodation.
While waiting in outpatients at BCH, Joan picked up a leaflet on telehealth consultations. Boag explains to Joan that she reviews many of her patients via a telehealth clinic every Monday morning. She suggests that Joan discuss the option with her local GP. The GP is keen to facilitate Jodie’s ongoing appointments via telehealth consultation in a dedicated room.
Joan and the children catch the bus to Brisbane. The trip takes 10 hours and they have to travel the day before the www.nursingreview.com.au
Joan and the children walk the eldest daughter to school and then Joan and Jodie walk to the GP clinic. The trip from home takes 10 minutes. They are met by the practice nurse who discusses how the telehealth consultation will be conducted. The GP, the practice nurse, Joan and Jodie all meet with Boag via a telehealth consultation. The practice nurse, with the assistance of Joan, moves the webcam over Jodie’s eczema patches so Boag can assess her skin. Boag discusses the new topical cream she wishes Jodie to use, and the GP writes the prescription before leaving the telehealth consultation room. Boag, the practice nurse and Joan discuss the most appropriate type of dressing for Jodie. A date is planned for the next telehealth consultation in one month’s time and Boag signs off. The
nurse attends to the dressing for Jodie’s eczema and shows Joan how to do these dressings. The family has time to call in at the pharmacy to have the prescription filled. The GP and practice nurse write their notes in Jodie’s history and complete Jodie’s care plan. Joan requests that all of Jodie’s follow-up appointments be conducted via telehealth consultation.
Review of Jodie’s story
Benefits of telehealth: • Joan and her family are able to continue with their daily routine around Jodie’s appointments. • Joan and the children do not have to travel 10 hours by bus each way to attend outpatients appointments. • The family do not have to pay for overnight accommodation in Brisbane. • Ability for all parties to ask questions in a real time situation. Who can “sit in “on an appointment? • The specialist • The GP • The practice nurse • The family Who can claim? • The specialist • The GP • The practice nurse n Susan Currie is the telehealth support officer at the Nursing and Midwifery Telehealth Project. May 2013 | 55
An app a day
Internet and smartphone technology is helping women who are cancer survivors maintain wellbeing. By Aileen Macalintal
he Queensland University of Technology leads the Women’s Wellness After Cancer Program, which teaches self-management via internet and smartphone technology. WWACP is one of the eleven projects that the National Health and Medical Research Institute funded with $7.9 million through its Partnerships for Better Health. Lead investigator Professor Debra Anderson from QUT said WWACP is “a 12-week program of structured health promotion incorporating physical activity, monitoring of diet, smoking, alcohol intake, sleep and psycho-educational strategies designed to decrease risk factors associated with health behaviours in women”. Anderson said the program includes messages on physical activity and healthy eating, goal setting planned with a registered nurse, and coaching. It also features motivational interviewing, feedback, relapse prevention and self-monitoring. Anderson said they chose women survivors for the program because women live longer with certain cancers. “For example, 90 per cent of women diagnosed with breast cancer will survive at least five years; 80 per cent are still alive 20 years later,” she said. She also noted how access is important for women who are at a geographical disadvantage. “Government health services do not currently offer post-treatment 56 | May 2013
support apart from selective surveillance-type follow up,” she said, “and while not-for-profit organisations provide valuable psychological support for women, once treated for breast cancer, they rarely provide structured health promotion programs.” She added many urban and rural women have no face-to-face programs due to constraints of cost, time, and distance. The program maximises the use of technology as the Internet and smartphones “enhance health outcomes for those at significant risk of chronic disease through an accessible, relatively simple, flexible, sustainable intervention available irrespective of place of residence,” she said. Put simply, the program’s tools are mobile gadget apps, a video conference platform, and an interactive website, which incorporates a weekly exercise planner and schedule, a community message board, and modules to monitor goals versus actual performance. As for the mobile device app, Anderson said, “the app monitors and provides continuous feedback on energy, water, macro- and micronutrient intake and body weight. “Data entered into the app or website will be stored on a central database and presented in ‘keeping on track’ tables and motivational charts which track participant’s progress against goals.” Consultations, on the other hand, will
be done through the virtual consultation platform. This features videoconferencing with a nurse trained in the intervention and based at the Princess Alexandria Hospital Brisbane, QLD. “This platform will enable remote access to advice and support from healthcare professionals in the participant’s primary residence, reducing the need for travel which can be a key barrier to adherence,” she said. To highlight the significance of technology in health promotion, Anderson said technology “provides easy access to decentralised, technology-enhanced healthy lifestyle intervention that best suits needs”. Janine Porter-Steele is the clinical nurse manager at partner organisation, Wesley Hospital Kim Walters Choices Program. Porter-Steele said the project would drive an innovative eHealth behavioural intervention to improve the quality of life and reduce chronic disease risk among women treated for cancer. “The WWACP is extremely promising, building on a strong research base and already established partnerships,” said Porter-Steele. “University partners will contribute critical expertise and research capacity in the development of behavioural interventions, health service design and evaluation, health professional education, eHealth interventions and cost effectiveness evaluation,” she said.
technology She said clinical partners would provide patient recruitment sites in QLD, WA, NSW and VIC. They will allocate experienced cancer care nurses to take on screening and recruitment of patients who are approaching the conclusion of their treatment. “Clinical partners will also play a key role in design and optimisation of the WWACP, through their representatives in the CI and AI team and Stakeholder Advisory Committee,” she said. She added that partners would in the near future translate the program into routine clinical practice. “Each health service partner has committed significant in-kind resources, which will be critical to enable the conduct of a clinical trial of this scale. “Each of these hospitals hosts major cancer treatment centres and their partnership is evidence of their commitment to improving post-treatment support services for cancer patients.” She said another partner would provide access to its extensive breast cancer patient database and member network to support recruitment into the trial. In cooperation with CanSpeak QLD, partners will also help to represent the perspectives of patients throughout all
stages of the project and “provide an important pathway for communication with the patient community.” Amanda McGuire, a registered nurse who currently works as the project manager for the Women’s Wellness Programs, was diagnosed and treated for breast cancer in 2011. “Following treatment, there was no support available to guide me how to get back to optimum health and wellness. “The treatment finishes, and you are left feeling physically and emotionally exhausted. However, you have to get
back to your life of work and family responsibilities and it is a very stressful period. I had no control over whether the cancer would recur, but what I could control was leading a healthy lifestyle with regular exercise, healthy eating and managing stress well.” Having WWACP back then could have helped her cope better, she said. She said access to a structured program such as the WWACP could provide clear, evidence-based information, support and structure during that difficult time after treatment. n
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A tele-consultation with Singapore’s minister of state from 6000km away showed just why Healthy, Happy and at Home picked up the award. By Amie Larter
n Australian nursing company has taken home one of four major awards at the first Asia Pacific Eldercare Innovation Awards in Singapore. The Royal District Nursing Service won the Outstanding “ICT” Innovation award for its senior-friendly telehealth solution Healthy, Happy and at Home. Aimed at maximising its nursing service as well as potentially enabling earlier hospital discharge for patients and the prevention of medicine mismanagement, the solution is the principal platform of RDNS’s move into delivering care using high-speed broadband technology. The project has been supported by the Victorian government under its BroadbandEnabled Innovation program. RDNS chief executive, adjunct professor Stephen Muggleton was delighted with the win, thanking the Department of State Development, Business and Innovation for its support, as well as the dedicated team at RDNS who delivered the solution. “The success of this project is opening up a range of other exciting solutions that build on the capacity of our nurse-led centre,” he said. “It’s a great example of how clever but 58 | May 2013
easy-to-use technology can provide better in-home support for consumers.” The win topped off an exciting day for the company, who had earlier held its first international broadband demonstration of the telehealth solution. From RDNS headquarters in Melbourne, nurse Amanda Murray held a mock consultation with the event’s guest of honour Mr Chan Chun Sing, Singapore’s senior minister of state who was over 6000 kilometres away. Throughout the video link, Murray took the minister through a conversation as though he was a real patient, hypothetically taking his blood pressure and ‘monitoring’ his medication – all part of a genuine teleconsult through the program. Over the last two years, RDNS has tested the effectiveness of the Healthy, Happy and at Home solution. A sample of 50 clients had a special monitor with a camera installed in their homes, allowing nurses to conduct two-way video calls. According to Stelvio Vido, executive general manager – projects and business development at the new solution will change RDNS’ traditional delivery of care. Services provided by the company have
up until now been delivered by sending a nurse into the home – quite labour intensive as consumers generally required daily visits. Healthy, Happy and at Home will substitute up to six of those daily visits with a video call. “We will deliver the video through a device that we put into the home – so it’s pretty straight forward to use for the client,” Vido said. “On at least one day a week we will still do what we might call the traditional visit … we don’t see technology completely replacing that – it is still very important for that to happen to see the client in the home.” This solution will allow RDNS to provide more services to more people in a more sustainable manner. “We recognise that delivering services remotely will be part of our service menu into the future – our technology offers us the opportunity to do that and secondly it also means that we can respond in a much better way to the demand that’s already upon us. “The ageing population means there is continuing increase in demand for services like ours, and so if we can reduce and eliminate some travel time – which is more than 20 per cent of our time – it does mean there is more nursing time available for actual nursing.” n
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Join the team and make a difference Demelza Hospice Care for Children supports almost 800 life-limited and life-threatened children and their families across the South East of England. Demelza has two hospices, one in Sittingbourne, Kent, one in Eltham, South East London as well as a community nursing team based in East Sussex. The charity offers respite, symptom control, end-of-life care and bereavement support for children and young people with lifelimiting or life-threatening conditions and their families which mean they need a lot of specialist care. Demelza has been providing high quality care and support for 15 years. Our 10 bedded Kent hospice is set in six acres of beautiful
countryside with easy access to the M2 and M20 motorways as well as good train links to London and the coast. We provide free parking for staff and good value meals as well as other benefits including a pension scheme and child care vouchers. Facilities for children, young people and families include a multisensory room, soft play area, a hydrotherapy pool, adventure playground and gardens. Our motto is ‘adding life to days when days cannot be added to life’, building memories and enabling quality family time. We offer extensive specialist training with the opportunity to develop clinical and management skills.
Children’s Palliative Care Nurses (Kent) Band 6 £23,914 - £32,530 ($35,340 - $48,073) + Enhancements We are seeking motivated children’s nurses to provide quality care whilst enhancing their clinical and bereavement support skills. You will be able to access extensive CPD through our dedicated education department. Utilising your core observation and nursing skills, you will adjust care and medication regimes for ultimate symptom control. You will be able to hone mentoring and tutoring skills alongside nursing students and care assistants.
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For more information and application packs visit our website: www.demelza.org.uk or email: firstname.lastname@example.org We are a happy to arrange an informal chat or interviews on Skype. Please contact Hayley on (0011) +44 1795 845203 Find us on facebook at www.facebook.com/ demelzahospice or follow us on twitter @demelzahospice
Enhanced Disclosure checks by the DBS will be undertaken for successful applicants. Demelza is an equal opportunities employer. Registered Charity No 1039651
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