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The big silence on ratios

Housing is a job changer

The case for more nurse prescribing

page 8

page 14

page 18

REGULARS Your rights and entitlements at work Nurse Uncut – your stories What nurses and midwives said Nursing research online

p.37 p.39 p.41 p.43




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2 | THE LAMP JUNE 2017



In 2016, we were recognised for our passion. For our communications, our advice, for standing up for what matters and the fact our products are tailored specifically for our members. It's nice to know we're getting it right.

CONTENTS Contacts NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office. Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E W

VOLUME 74 NO. 5 | JUNE 2017

Hunter Office 8-14 Telford Street, Newcastle East NSW 2300


NSWNMA Communications Manager Janaki Chellam-Rajendra T 1300 367 962 For all editorial enquiries letters and diary dates T 8595 1234 E 50 O’Dea Avenue, Waterloo NSW 2017


The big silence

Produced by Hester Communications T 9568 3148

Critical issues for our public health system like improved ratios, increasing the number of clinical nurse educators and solving the problems around specialling and rosters don’t seem to be a priority for the NSW government.

Press Releases Send your press releases to: F 9662 1414 E Editorial Committee Brett Holmes, NSWNMA General Secretary Judith Kiejda, NSWNMA Assistant General Secretary Coral Levett, NSWNMA President Peg Hibbert, Hornsby Ku-ring-gai Hospital Michelle Cashman, Long Jetty Continuing Care Richard Noort, Justice Health Advertising Danielle Nicholson T 8595 2139 or 0429 269 750 F 9662 1414 E Information & Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Jeannette Bromfield, Coordinator. T 8595 2175 E The Lamp ISSN: 0047-3936 General Disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised.

10 14

COVER STORY Short-notice rosters a bugbear for many

A survey reveals widespread nurse dissatisfaction with NSW public health rosters.

HOUSING AFFORDABILITY Housing is a job changer


Nurses and midwives are enduring inflated house prices, exorbitant rents, and increasingly long commutes.

SCOPE OF PRACTICE The case for more nurse prescribing

Extending the scope of nurses and midwives to prescribe medicines would lead to more efficient and cost effective ways of delivering patient care say experts.


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Nursing in the industrial age Three decades in the making Nurses at Work is a fascinating history of occupational health nursing.


An international shame Sydney nurse Alanna Maycock shared a New York stage with world leaders who were horrified by her account of the abuse she witnessed on Nauru.





Billions to be lost if penalty rate cut spreads As the second biggest category of weekend workers, health care workers would be hit hard by cuts to penalty rates.




The big silence on ratios

Housing is a job changer

The case for more nurse prescribing

page 8

page 14

page 18

REGULARS Your rights and entitlements at work Nurse Uncut – your stories What nurses and midwives said Nursing research online

p.37 p.39 p.41 p.43



Ransomware throws hospitals into chaos A ‘cyber weapon’ stolen from American spies was used in a global ransomware attack that disrupted British hospitals.



Global commitment to public health care International conference agrees on central role of public system and need to invest in health care workforce.

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OUR COVER: Shania Ali Photographed by Sharon Hickey THE LAMP JUNE 2017 | 3

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KEYNOTE SPEAKER Hahrie Han Organising for social change in health

GUEST SPEAKERS Janine Mohamed & Melissa Sweet The impact of colonisation on health outcomes for Aboriginal & Torres Strait Islander People

Kate Lappin Local, regional and international advocacy to advance women´s rights George Megalogenis How migration and multiculturalism have helped make Australia great Prof. Yin Paradies Unconscious bias and healthcare Jacqui Cross Chief Nursing & Midwifery Officer address

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Respect nurses and midwives The state government has responded to our public health system log of claims and on the big staffing issues they have nothing to say. We are often told we are living in a dynamic world of constant change which requires adaptability and nimbleness to meet contemporary challenges. These are qualities that the NSW government seems to lack – at least when it comes to health. As The Lamp goes to print we have just received an offer from the government in response to our log of claims for the NSW public health system. As they have done over the last six years the government has ignored a carefully crafted document, put together after months of consultation with the many members we have in the public health system who, every day and night and weekend, hold together our public hospitals and health services the length and breadth of the state. These hardworking, dedicated nurses and midwives have an instinctive feel for the issues, challenges and shortcomings of public health from their daily experiences at the frontline of the system. Our log of claims is a distillation of their collective analysis of what needs to be done to improve the system so that the people of NSW can continue to get the world-class care they deserve. The government’s disappointing response is to ignore the informed voices of nurses and midwives and to offer a 2.5 per cent pay increase without any consideration of the critical issues facing health that we have put before them.

Heading the list of those issues is ratios. Effectively there has been no significant improvement to ratios since 2011 when we achieved ratios after a hard-fought campaign. The government tells us there are more nurses but our members are constantly telling us they are run off their feet – all over the state. There is overwhelming evidence that ratios work. Over the years we have documented in The Lamp, and we have presented to the government, the mountain of international evidence that shows lives are saved when hospitals employ more nurses.

extra staff were provided to look after these patients who require oneon-one care. And when staff were provided they tended to be AiNs. A second survey showed widespread dissatisfaction with rosters and the lack of advance notice makes it very difficult for nurses and midwives to have normal lives. An International Labour Organisation conference attended by our Assistant General Secretary Judith Kiejda showcased a different way that governments, unions and employers can work together to improve health systems than what we have become accustomed to in New South Wales. At this important United Nations meeting unions were recognised for their role in representing the global health workforce and their concerns listened to and acted upon. All the parties – unions, governments and employers agreed to two important positions: • P ublic spending on the health workforce should be seen as an investment and not a cost and

‘These hardworking, dedicated nurses and midwives have an instinctive feel for the issues, challenges and shortcomings of public health from their daily experiences at the frontline of the system.’ RATIOS, SPECIALLING AND ROSTERS NEED TO BE ADDRESSED Of course, there are many other issues besides ratios that need to be resolved. In this issue of The Lamp we highlight two that our members tell us are of critical importance – specialling (see pp 12-13) and rosters (see pp 10-11). A survey conducted by the NSWNMA showed the heavy burden specials put on our wards. Almost half the nurses surveyed said no

• Mandated staffing is the only way to guarantee decent working conditions in health services. This government is not listening to nurses and midwives and they need to listen to the people who measure the pulse of our public health system every day. They should show some respect to those who understand what needs to be done to improve its health. ■

THE LAMP JUNE 2017 | 5


Win one of 5 x $200 eBook Vouchers To celebrate the arrival of two new editions of our bestselling nursing textbooks Wolters Kluwer & The Lamp are offering NSWNMA members the chance to win one of five $200 eBook vouchers to use on our new e-store!

Have your

Say Concerns about 457 visas

Recent news about changes to 457 temporary Australian worker visas alarms me. I would hope that politicians are very careful about populist policy on the run that may have undesired outcomes. I was equally concerned about Ronald Bangalando’s letter (May Lamp) which indicated that our Federal Government had reneged on a guideline entitling him to apply for citizenship after five years working as a nurse in Australia. I encourage Ronald and other international nurses to contact NSWNMA and be assured of confidential professional advocacy with these confusing law changes. I am extremely lucky to have worked with countless highly skilled nurses educated in other countries. I have benefited greatly from their collegiality, professional abilities and friendship over the years. There is no need to pit locally born nurses against those who originated elsewhere. If the aged care sector was staffed to the level most Australians expect, there should be plenty of job opportunities for all suitable applicants.   Mark Quealy RN, Botany

Practice nurses deserve better Browse the latest Nursing titles on today. Win!

The Lamp is offering NSWNMA members the chance to win one of five $200 eBook vouchers To enter the competition, simply provide your name, address and membership number and email your entry with the subject: ‘Lippincott’ to *Conditions apply. Not redeemable with any other offer and not redeemable for cash. Valid for internet purchases only on shop.lww. com. Prices are in USD. Available for purchases in Australia and New Zealand only. Only one eBook voucher available per person, with a total of 5 to giveaway. Competition entries from NSWNMA members only and limited to one entry per member. Competition opens 1 June 2017 and closes 30 June 2017. The prize is drawn on 1 July 2017. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/17/01625

I want you to look at the disparity in the wages for Practice Nursing. We are at the forefront of prevention. We see all of the hospital discharges. We do the majority of childhood immunisation. We are at the baseline of chronic disease and its management and aged care and its management. All the acute diagnosis that then has to be referred elsewhere. We are a critical loop – the chain before and after hospital. Why are we not compensated financially compared to hospital staff? We love our jobs in primary care, but are not recognised because we don’t work in hospitals or aged care.  This is not right. Ellen Gaggin RN, Valley Heights NSWNMA responds: The NSWNMA agrees with you that it is not right that practice nurses are paid less than other nurses for the valuable care you deliver to the community through primary care. The industrial landscape has changed significantly since we had State Awards. Since 2010, the federal Nurses Award 2010 has provided a very minimum set of wages and conditions in a system that promotes enterprise bargaining. Despite requests to bargain, only one corporate medical centre employer, Healthscope, has agreed to bargain for an enterprise agreement with the NSWNMA. The NSWNMA Model Contract for Practice Nurses is negotiated with the AMA every few years and is available for nurses to use in negotiations. If most nurses are NSWNMA members and are willing to take action there are avenues to pursue an Agreement through the Fair Work Commission. Otherwise we continue to work on a case-by-case basis with practice nurses across NSW.

6 | THE LAMP JUNE 2017

If there’s something on your mind, send us a letter and have your say. The letter of the month will WIN a gift card

Letter of the month No RNs in aged care drains ED resources Dear Minister Hazzard, I am a registered nurse working in the Emergency Department at Blacktown Hospital. Aged care residents are regularly brought to the hospital by ambulance with a wide range of illnesses and severity. These residents are treated and either admitted to the hospital or returned to their facility, again by ambulance or patient transport services. Some of the issues we see each day with regard to residents from facilities without a registered nurse on site include: • Residents being sent into the ED at all times of the day and night with very minor issues. This is because there is not a skilled clinician on site to assess and treat the patient. The facility protocol is to then send the person to hospital for assessment or treatment. • Ambulance resources tied up transporting patients with avoidable presentations, thereby tying up another valuable resource. • A number of these presentations are reviewed while still on the ambulance stretcher, treated and returned to their facility by the same ambulance crew to minimise the drain on resources, again tying up an ambulance crew for longer periods. • Residents who have been reviewed and treated in the ED then deemed safe to go home need to wait for transport services to take them back.  This can be many hours, depending on the time of day. • When the Patient Transport Service stops at 2300hrs, the unfinished work is handed over to NSW Ambulance to complete when available. In recent months, NSW Ambulance no longer does “take-homes” on night shift unless the ED is in bed block and unable to offload another patient. It is then handed back to PTS at 0600hrs to be allocated again depending on workloads. We have patients regularly

SEND YOUR LETTERS TO: Editorial Enquiries EMAIL fax 9662 1414 
 MAIL 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high-resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.

waiting over 10 hours for transport back to their aged care facility. Some mornings, we have had 4 patients in the ED overnight waiting for transport back to their aged care facility. Considering we only have 18 beds in the department, this is an extraordinary drain on our capacity. These issues can be avoided if facilities employ a registered nurse 24/7. An additional issue is that some facilities refuse to accept their residents back into the facility after a certain time (some 1700hrs, others 2000hrs) because there is not a registered nurse on site to accept the person back into the facility.  It is their “policy” and they cite safety issues as the reason. This means that any patient seen and treated in the ED after their cut-off time must stay in an ED bed until the following morning. All of these presentations and delays result in beds being full unnecessarily and for long periods. They stop other ill patients from being treated in beds that they clinically need. With Ambulance Offload Times and Emergency Treatment Process Times under the spotlight and very hard to attain, the additional drain on our resources caused by this issue is tremendous.  It is unfair on the aged care residents and it is unfair on the wider community. Please discuss these issues with your fellow parliamentarians and ensure that the Bill is passed through the Lower House for the benefit of all. Thank you for your time. Regards, Steve McGuirk RN CNUM Blacktown Note: This letter to the Minister for Health was written before the recent defeat of the RN 24/7 bill.

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THE LAMP JUNE 2017 | 7


The big silence Critical issues for our public health system like improved ratios, increasing the number of clinical nurse educators and solving the problems around specialling and rosters don’t seem to be a priority for the NSW government.


he NSW government has replied to the NSWNMA public health system log of claims which was the culmination of months of consultation with members. The government has offered a 2.5 per cent pay increase and is completely silent on all other claims. The proposed pay offer is for 12 months. All other elements of our comprehensive claim – overwhelmingly endorsed by nurses and midwives working in the NSW public health system – were refused. NSWNMA General Secretary Brett Holmes says “the NSW public health system is now being hamstrung by the government’s robotic application of its public sector wages law”. “We have a law for public sector workers’ wages and conditions that limits any increase to 2.5 per cent. Anything additional to this must come through productivity increases or trade-offs. “Effectively they are telling nurses and midwives that any improvements to the health system that improve safety and quality of care must come out of your pockets.

8 | THE LAMP JUNE 2017

“The government needs to wake up and progress the many issues that are holding back our public health system. “At the top of those issues is the need to extend ratios into areas that are crying out for them and improving them in areas where they are falling short. “The government can afford it and international evidence shows ratios work.”

IGNORING VOICES FROM THE FRONTLINE Brett says nurses and midwives are at the frontline of the public health system and understand what these issues are and their consequences. “The government also needs to tackle other issues that our members have identified such as specialling and rosters. Our survey on specialling found many wards are not getting additional staff and when staff are provided they are mainly AiNs who cannot necessarily provide the whole clinically-assessed care needed. These problems are about to compound with the increased demand that comes with winter.”


What the government doesn’t want to talk about In the government’s response to our log of claims there was:


Nothing about introducing ratios into paediatric and neonatal ICUs or EDs, EMUs or MAUs.


Nothing about a ratios-equivalent system for community and community mental health.


Nothing about guaranteed staffing arrangements for non-Birthrate Plus maternity services or for outpatient clinics.


Nothing about the much needed Clinical Nurse/ Midwifery Educators to keep transitional RNs in the system and to retain experienced RNs and RMs.


Nothing about staffing for specials to be separate and in excess of mandated ratios.

‘The NSW public health system is now being hamstrung by the government’s robotic application of its public sector wages law.’ — Brett Holmes NSW HAS STRONG ECONOMIC GROWTH Brett says the government can afford to fix our public health system. “The Premier and Treasurer say NSW is in a good financial position with economic growth the strongest in Australia and with budget surpluses forecast for the next four years. “The government needs to use some of these resources to improve safe patient care. Every patient in NSW deserves to receive the best care at the right time no matter their postcode. “The government’s proposal takes us closer to the next election

– a time when politicians are afraid for their jobs. This gives us a strong opportunity to build a campaign to change this policy. “We need to put maximum pressure on this government between now and the next state election in March 2019. Our 2011 ratios win was a result of a successful campaign with a Labor government. This government has done nothing to improve it. Similarly Victorian and Queensland nurses won their ratios during an election campaign. History tells us that with commitment and perseverance we can turn these moments into an opportunity to improve the public health system.” ■

Things you can do Like our Ratios put patient safety first Facebook page: https://www.facebook. com/safepatientcare?ref=hl Sign up to get regular information about our ratios campaign: http:// page/s/ratios-put-patientsafety-first-newsletter For more information THE LAMP JUNE 2017 | 9


Short-notice rosters a bugbear for many A survey reveals widespread nurse dissatisfaction with NSW public health rosters.

It’s horrible to not know what’s happening only two weeks away. I can’t plan anything.” That comment is typical of responses to a sample survey conducted by the NSWNMA which aimed to find out how public health system rosters are arranged and what members think of them. Eighty per cent of respondents were registered nurses and/or midwives and the biggest group – 28 per cent – worked in medical or surgical wards. More than 78 per cent of members said they wanted their rosters to be published four weeks or more in advance. However, four-week rosters applied to only 18.92 per cent of members. Even fewer – 8.59 per cent – enjoyed rosters more than four weeks in advance. The majority of members were saddled with rosters of two weeks or less. “Most of the time they are not done within the two weeks before the current roster ends,” wrote one nurse. “More often than not rosters are taken back and changed after being gazetted.” Another nurse described the roster system as “ridiculous” and said she was put on five, 12-hour night shifts in eight days. “I have to change my permanent position to casual as it is not the first time I have had a roster like that.” Many nurses pointed out that inadequate notice of rosters made it almost impossible to plan to attend school events.

10 | THE LAMP JUNE 2017

‘More than 78 per cent of members said they wanted their rosters to be published four weeks or more in advance.’ A member who called for rosters to be published one to two months in advance, wrote: “It is so difficult to plan anything with only two weeks’ notice. Then lots of emergency changes to the roster have to be negotiated, meaning the manager gets swamped and annoyed, then responds by limiting roster changes.” Other nurses said the short notice for rosters played havoc with family commitments, made it difficult to commit to university timetables and made it hard to stick to an exercise routine. “There is no consideration in my workplace around important times like Christmas and Easter,” complained one member. “The managers refuse to release a roster early so you can plan something properly. It is very hard to explain this to your family.” Some nurses said their managers made it easier to cope with short-notice rosters. Wrote one: “It can be difficult being a shift worker, but if your manager is open to reasonable and honest requests it can be worked out.” More than 22 per cent of members said they were unaware of any process that might allow them to request changes to the roster after it is published. A slim majority – 52.62 per cent – said a formal process existed to request roster changes and it was applied. ■


18.92% of members had four weeks notice of rosters.


of members had more than four weeks notice of rosters.

Short roster notice hinders planning Shania Ali would still be nursing full-time if hospitals were required to give longer notice when publishing rosters. The Sydney-based RN frequently needs to visit her sick father in Queensland. The current two-week minimum notice for displaying rosters did not give her enough time to arrange shift swaps with colleagues at a major teaching hospital. Shania had to take up part-time work with set shifts supplemented by casual shifts at a second hospital. “My father is quite sick and I need to attend medical appointments with him. The two-week notice roster meant it was too late if I needed to swap shifts with anyone,” she says. “I would look at the roster and by the time I flagged someone down they would already have made plans.

“If we had a month’s notice like the union is seeking I could have managed it and stayed full time.” The limited notice also made it near impossible for Shania to purchase cheaper air tickets in advance. “I once paid $300 just to fly to Brisbane one way. Sometimes I had to drive up one day and drive back the next.” She also misses out on the penalty rates and annual leave that went with her full-time role.

‘If we had a month’s notice like the union is seeking I could have stayed full time.’ — Shania Ali

THE LAMP JUNE 2017 | 11


‘Specials’ require extra staff Failure to provide extra staff for specials is an additional burden on the public health workforce.


lmost half of NSW public sector nurses say they are not provided with additional staff to look after patients who require one-on-one care, or ‘specials’ according to an NSWNMA survey. When additional staff are provided for specials they are mostly assistants in nursing (AiNs) the survey shows. NSWNMA General Secretary Brett Holmes said the union ran the survey to help campaign for improved workloads. More than 73 per cent of respondents were RNs and more than 42 per cent of respondents worked in medical or surgical wards. Brett said some survey respondents were asked to perform extra duties to cover the lack of additional qualified staff for specials. Almost 61 per cent reported that patients required specials during the previous week but more than 48 per cent said additional staff were not provided, thereby adding to staff workloads. Where extra staff were provided, more than 56 per cent said they were AiNs.

Experienced RNs were provided in only 16.33 per cent of cases and experienced enrolled nurses in 12.93 per cent of cases.

COMPROMISED QUALITY OF CARE “AiNs often do not meet the standards required of specials, which can compromise the quality of health care,” Brett said. The areas of demand for specials were behavioural management (65.85%), mental health (42.16%), increased level of care for monitoring haemodynamic instability (21.41%), nursing care interventions (17.97%), and medical interventions (12.75%). Some patients needed specials from two or more fields. There was no consistency across facilities in the methods of allocating additional nurses for specials. In facilities where policies were implemented, they mostly covered mental health (69.92%), aged care (45.13%), medical (43.31%), surgical (31.48%), and emergency (26.04%). “The survey suggests that other areas such as paediatric and maternity services are very poorly managed when it comes to use of specials,” Brett said. ■

‘AiNs often do not meet the standards required of specials, which can compromise the quality of health care.’ — Brett Holmes 12 | THE LAMP JUNE 2017



of nurses said patients required specials during the previous week.


said extra staff were not provided.


of extra staff when provided were AiNs.


of extra staff when provided were RNs.


‘Specials’ take a toll on understaffed wards Winning the union’s claim for additional nursing hours to cover patient ‘specials’ would be a major advance in patient care, says John Hunter Hospital RN Brad Phillips. Brad, a NSWNMA delegate, works on John Hunter’s gastro and cardiac ward. “On average we have one special a week and at times we can have two specials at the same time,” he says. “Patients who need specialling can be there for two to three weeks or even longer. This really does take a toll on the nursing staff who are on the clinical frontline. “On some shifts we have had two nurses looking after 11 patients, which puts huge pressure on staff. “You’re already looking after really acute patients and they expect you to pick up an extra load when specials are needed. “The pressure can be horrendous, especially if you’re a senior nurse and you’ve got juniors and AiNs working with you. “We need experienced and qualified staff to ensure safe care when specialling a patient.” SPECIALS NEED CAREFUL MONITORING Brad says patients needing specials may be disoriented, are likely to escape, at high risk of falling, and inclined to violence. “On our ward, we sometimes have to ‘special’ anorexia patients who have complicated behavioural issues that need careful monitoring. Patients are inclined to pull out nasogastric tubes and that needs careful management. “When we ask for extra staff to deal with these situations we are often told no staff are available because other wards are also short on numbers. “It frustrates you to know you are not able to give the care you should be giving. A lot of experienced staff are leaving because they’ve had enough.” Brad says staffing for patients deemed to require a ‘special’ should be in addition to ratios or rostered staffing. If you knew the specials would be taken care of on every shift, it would take a lot of pressure off, especially when you’re team leader.”

‘It frustrates you to know you are not able to give the care you should be giving.’ — Brad Phillips

THE LAMP JUNE 2017 | 13


Housing is a job changer Nurses are enduring inflated house prices, exorbitant rents, and increasingly long commutes.


hirty six per cent of NSWNMA members moved home or changed jobs in the previous 12 months because of housing affordability issues, a union survey shows. Forty nine per cent of members said housing affordability was very important to them to the extent that they would be prepared to change jobs so they could live in a more affordable area. Fewer than three per cent of members said they did not consider the price of housing when applying for jobs. Around 1,000 members responded to the survey designed to gauge the impact of rising house prices and rents. Sydney house prices climbed almost 19 per cent in the 12 months to March, according to CoreLogic RP Data. NSWNMA general secretary, Brett Holmes, said the lack of affordable housing was having a major impact on Sydney nurses in particular. “Limited affordable housing is pushing nurses and midwives to move further away from the hospitals and services they work in and locking them into long commutes,” he said. “It is causing difficulties in recruiting and retaining nursing staff.” Of those who answered the survey, 64.5 per cent were renting compared to 24.5 per cent who were homeowners. Just over seven per cent lived with their parents.

AFFORDABLE HOUSING NEEDED FOR ESSENTIAL WORKERS The NSWNMA’s 2016 annual conference adopted a position 14 | THE LAMP JUNE 2017

‘Limited affordable housing is pushing nurses and midwives to move further away from the hospitals and services they work in.’ — Brett Holmes statement on affordable housing, which noted that rents in many areas are increasing at twice the rate of inflation. “Housing affordability is a major concern for many nurses and midwives in many areas, including metropolitan, rural and regional areas, where the income of the household is not sufficient to pay market rent close to where they work,” the statement noted. “Public policy and planning must address the need for affordable housing for all essential workers.” The Sydney Olympic Park Master Plan 2030 (2016 Review) is an example. The area’s residential dwellings are planned to increase from 6,350 to 10,700. Three per cent of apartments are to be set aside for essential services workers (police, teachers and nurses) who work exclusively or predominately at Sydney Olympic Park. Rents will be set at 74.9 per cent of the market rate and applicants must pass a means test. The NSWNMA has written to the Sydney Olympic Park Authority urging it to increase the three per cent target and expand the eligibility criteria to include key workers, such as nurses, midwives and aged care staff working at nearby facilities. “Sydney Olympic Park is well

situated near many hospitals including Concord, Westmead, Ryde, St John of God Burwood and Auburn hospitals, and many aged care facilities,” the submission says. “Increasing the percentage of affordable housing in the master plan will greatly assist assistants in nursing, enrolled nurses, registered nurses and midwives and other key workers to live in the communities where they provide essential services.” ■ THE CONSEQUENCES OF UNAFFORDABLE HOUSING: MOVE JOBS OR MOVE HOME


of NSWNMA members moved house or changed jobs in the previous 12 months because of the cost of housing.


of members were prepared to change jobs to live in a more affordable area.


fewer than 3 per cent did not consider the price of housing when applying for jobs.


Thwarted by investors Martin Good might be considered a relatively fortunate participant in Sydney’s daunting house-hunting stakes. The 44-year-old clinical nurse specialist had sufficient funds to put down a deposit on an apartment when he set out to buy a property not too far from his workplace at Royal North Shore Hospital. But each time he found a suitable place he was outbid by a property investor. “I looked at properties for almost two years; it was doing my head in,” Martin said. “I was beaten by investors 10-15 times. It was very disheartening. “I knew they were investors because a lease sign would go up outside the property immediately after it was sold.”

OBTAINING FINANCE WAS ANOTHER OBSTACLE “My mortgage broker was shopping around for months to try to get me a loan. Most of the banks will not factor in penalty rates, when deciding how much to lend you. They use your base rate which in my case was probably $25,000 less than my actual wage.” Martin was forced to take out a loan jointly with his father, an ambulance worker, in order to meet bank requirements. In January, he finally secured an apartment about half an hour’s drive from work. “Even though I’m paying it back myself I had to get dad involved otherwise no bank was going to lend me enough. “The alternative was to rent, which would have cost me almost as much as I pay on the mortgage. “And you can’t set your life up when you’re renting and having to move every year. “High-rise apartment blocks are going up near the hospital because they are building a new train line in. Prices are prohibitive – you would be lucky to get a two-bedroom flat for under seven figures and you have to have a 20 per cent deposit.” Martin supports the union’s call for authorities to set aside affordable housing for nurses and other essential service workers such as ambulance staff and police.

‘I looked at properties for almost two years; it was doing my head in.’ The ordeal of finding affordable housing in Sydney is a common talking point among RNSH nurses, he says, “People talk about it a lot more than they did even five or six years ago. A lot of our staff travel an hour and a half to work every day, from as far away as the Blue Mountains and Central Coast. They would prefer to live closer to work but can’t afford to. “Some of our nurses have had to leave the hospital because they can no longer afford to live in Sydney. So they try to get a job in a town with affordable housing. “I’ve written a few references for RNSH people seeking jobs in areas where they can afford to buy or rent.”

Clinical Nurse Specialist, Martin Good

MINISTER ADMITS NURSES AND MIDWIVES NEED HOUSING HELP The pressure from organisations like the NSWNMA and the Sydney Alliance on affordable housing seems to be working. NSW Minister of Housing, Hon. Anthony Roberts MP, has conceded essential workers like nurses need government assistance to find housing close to their jobs. “Key worker housing is critical for our communities of the future,” Mr Roberts told the ABC. “I don’t want nurses travelling an hour and a half to go to their shift at Royal North Shore [Hospital] from the Central Coast. “We’ll make it a key priority of this government to make sure we have our teachers, our nurses, our ambos, our firies, and our police officers having the opportunity to live and work within the communities they serve.” The next Sydney Alliance assembly to discuss affordable housing will be held on 20 July.

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Housing trends undermine retirement system Australia’s declining rate of home ownership threatens to sink our superannuation and pension systems.


ome-owning retirees will increasingly be forced to use some or all of their superannuation to pay off their mortgages. An increasing proportion of retirees will live in privately rented housing and be forced to spend a higher proportion of their income on rent. As a result, fewer Australian retirees will be able to support themselves without relying on the age pension and governments will face growing pressure to raise the age pension and Commonwealth rent assistance. These are the main findings of a report written by economist Saul Eslake for the Australian Institute of Superannuation Trustees (AIST), a lobby group for not-for-profit super funds. The report, No Place Like Home: The Impact of Declining Home Ownership on Retirement, says Australia’s retirement income system is based on the assumption that the vast majority of retired people will have very low housing costs. It presumes most of them will own their own homes, with mortgage debt fully paid off, and that those who rent will typically be accommodated in cheap government housing. “These presumptions have allowed successive Australian governments to maintain age pensions at lower levels than in most other ‘advanced’ economies without resulting in higher levels of poverty among retirees,” it notes. These assumptions are under-

16 | THE LAMP JUNE 2017

mined by three trends that have emerged over the past two decades: • D eclining rates of home ownership among people of working age, especially those in their late 20s and early 30s; • A rising proportion of home owners, particularly among those in their late 50s or early 60s, who still have mortgage debt outstanding; • A declining proportion of people aged 65 and over living in accommodation rented from state or territory housing authorities, and an increasing proportion living in private rental accommodation.

“squeezed out” of the housing market by investors over the past 25 years. “In 1991–92, both groups accounted for around 17% of total lending for housing (with the balance being for existing home owners ‘trading up’). “By 2014–15, the share of housing finance commitments going to investors had risen to 53%, while that going to first home buyers had declined to less than 10%.” The report argues state and federal governments could help more people to become home owners

‘Australia’s retirement income system is based on the assumption that the vast majority of retired people will have very low housing costs.’ These trends are likely to leave more retirees wholly or partially dependent on the age pension than is currently assumed. That will generate political pressure for increases in the level of Commonwealth rent assistance, in the age pension itself, or both. “These prospects should encourage Australia’s current generation of political leaders to give more thought to what can and should be done to ameliorate or reverse the long-term decline in home ownership rates among people currently aged between their mid-20s and their mid-50s,” the report says. It says there is “little doubt” that first home buyers have been

by increasing the supply of homes and affordable rental housing, and using the tax system to reduce competition between first home buyers and investors. It recommends: • A bolishing or modifying negative gearing and the capital gains tax discount; • Requiring regulators to force a reduction in growth in lending to property investors; • F urther tightening rules for foreign investors; • P ressuring state governments to exempt pensioners from stamp duty when ‘downsizing’. ■







Australia’s rate of home ownership peaked at around 73% in the mid-1960s and has declined to roughly 68%, with half of the decline occurring since 2001.




The proportion of homeowners who have fully paid off their mortgages has declined even more, from a peak of 61.7% at the 1996 census to 47.9% at the 2011 census.

High rents forcing nurses out of Sydney Clinical nurse consultant Marie Coughlan has rented homes in Sydney since she arrived from her native England in 1985. Following steep rent rises in recent years she now pays about half her wage to a landlord and is considering moving to a cheaper city. “I was paying $250 per week for a one bedroom flat in 2004 and the same place today would probably be around $650,” says Marie. “Our wages haven’t kept up with the cost of living and though I’m on a fairly good wage now it’s not helpful if half of it goes in rent. “I specialise in drug and alcohol and I’m also qualified as a nurse practitioner. If I could find a similar specialised position in a cheaper location I would seriously consider moving. “I am nearing the age at which I should be able to retire, but if I stay in Sydney I will never be able to retire.” Marie’s $700-per-week apartment is a 30-minute bus ride from her workplaces at Prince of Wales and Sydney hospitals. A superannuation payout in 2001 gave her enough for a deposit on a studio apartment but no bank would give her a loan. “They gave two reasons: first, I was a single woman and second, they required me to purchase a place bigger than

40 squares which I would have been unable to afford on my wages at that time.” She subsequently did two work stints in the United States plus overseas voluntary work and rents skyrocketed in her absence. “Since returning to Sydney I have never been able to save enough to get a deposit together and pay the rent.” Marie welcomes the NSWNMA’s attempts to give the issue of housing affordability for essential services workers a higher profile. “Younger nurses are definitely feeling the pinch, but also older nurses who are still renting will be in trouble if they don’t have massive superannuation. If nothing is done I think Sydney will become another London, where most people cannot afford to live decently.”

‘I am nearing the age at which I should be able to retire, but if I stay in Sydney I will never be able to retire.’ — Marie Coughlan THE LAMP JUNE 2017 | 17


The case for more nurse prescribing Extending the scope of nurses and midwives to prescribe medicines would lead to more efficient and cost-effective ways of delivering patient care, say experts.


he only nurses who can currently prescribe medicines in Australia are nursing practitioners and midwives with an endorsement for scheduled medicines. Chief Nursing and Midwifery Officer Debra Thoms believes it’s time we opened up  the  debate about nurse and midwife prescribing more broadly.   Adjunct Professor Thoms described the issue in terms of giving patients safe and t imely access to medicines in  a  background paper released by the Department of Health (DoH) earlier this year for a symposium on the issue. “In order to ensure that the Australian community continues

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to receive high quality care, it is necessary to consider the contribution that nurses and midwives can make to the strategies and models of health service delivery across all sectors. “Internationa lly there has been a steady increase in models of nurse prescribers within health systems and... within Australia we have seen specific roles incorporate prescribing.” Professor Lisa Nissen, head of

the Clinical Sciences School at QUT, told The Lamp that increasing nurse  prescribing roles “can assist nursing professionals to work at the full scope of their practice, facilitating better access to care for patients, easier navigation of hea lthcare, and collaboration between health professionals”. Professor Nissen has been an expert adviser for the National Prescribing Service on prescribing competency standards, and she’s

‘Internationally there has been a steady increase in models of nurse prescribers within health systems.’ — Debra Thoms, Chief Nursing and Midwifery Officer


been closely involved in the training and development of nurse practitioners who have been able to prescribe for more than 15 years. In Professor Nissen’s view, nurse prescribing is about “putting patients across the whole sector with health professionals who can assist with the management of their medications.” Changing Australia’s framework of prescribing medicine should mean giving patients access to “the right person with the appropriate skill set available in the right setting at the right time.”

EFFICIENCY AND COSTEFFECTIVENESS A FACTOR As the DoH background paper notes: “Health systems worldwide are looking for ways to develop more efficient and effective models of service delivery designed to manage workforce shortages, improve access to medicines and increase patient choice”. Nurse and midwife prescribing is already in place in the US, Sweden, UK, Canada, Ireland, and NZ. While prescribing medications has traditionally been the domain of the medical profession in Australia (with the exception of some midwives and nurse practitioners – see box) discussions are building about whether this is sustainable. In 2015, the Nursing and Midwifery Board of Australia commissioned a literature review to better understand the evidence a round registered nurse a nd midwife prescribing. The benefits

of nurse prescribing identified by the review included: • Enhancement of RN’s ‘skills’ and facilitating continuity of patient care • I mproved access to timely treat ment including medications • Improved cost effectiveness • Potential for improved relationships among RNs, medical practitioners and pharmacists • O pportunities for nurses to have increased professional recognition and respect, enhanced career development and increased nursing autonomy. The review also found that patients generally appeared satisfied with RN prescribing  in terms of accessibility, timeliness and convenience and quality of relationships with the RN. Several studies reported that a high proportion of patients who experienced RN prescribing had no preference in terms of who they see in future; an RN or medical practitioner. Professor Nissen sees opportunities for nurses to develop and expand their skill base by offering prescribing services in a range of health areas “from paediatrics to aged care or mental health to oncology”. With the right “systems to support people to operate in their scope of practice” the ability of nurses to care for patients through prescribing can be expanded, Professor Nissen says. “Nurses and midwives already play a major role in the health sector around the management of medicines across a range of areas,” says Professor Nissen. “It is important that this opportunity is based on appropriate competency and training”. ■

‘(Greater nurse prescribing) would give patients access to “the right person with the appropriate skill set available in the right setting at the right time”.’ — Professor Lisa Nissen, QUT

Current nurse and midwife prescribing in Australia Nurse prescribing was first introduced in Australia in 2000 with the creation of nurse practitioner (NP) roles. Now prescribing is established practice for midwives with an endorsement for scheduled medicines; other health professions in areas such as dentistry, podiatry, pharmacy, and optometry now hold varying authorisations to prescribe. Nurses and midwives who prescribe and manage medications are subject to Nursing and Midwifery Board of Australia (NMBA) regulatory requirements, and they must complete

an approved post-graduate education program.  Since 1 November 2010, NPs and midwives with a scheduled medicines endorsement have been able to prescribe medicines subsidised by the Pharmaceutical Benefits Scheme (PBS). Medicines that NPs and midwives may prescribe independently within the PBS are listed and others are identified as medicines NPs may prescribe for ‘continuing therapy only’ after a medical officer makes the first prescription.

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Nursing in the industrial age Three decades in the making, Nurses at Work is a fascinating history of occupational health nursing.


n 1961, after Nancy Bundle completed her general nurse training at the Royal North Shore and midwifery training at Hornsby, she took an unusual step for a newly qualified nurse. When a careers adviser asked if she’d like to work in a factory, she thought it “sounded different”, and she was soon employed as an occupational health nurse at British Automotive Industries at Campsie. On the factory floor Na ncy reca lls being “thrown in the deep end”. She dealt with injuries ranging from burns and skin dermatitis from the oils the workers were exposed to, to treating a “tool maker using a grinding wheel which broke and exploded and (so did) parts of his eye”. At the time, the hazards of asbestos weren’t properly understood. “No one was concerned for the lady process worker who each day was covered in asbestos dust, or the cleaner who swept it up,” Nancy writes in a new book on the history of occupational health nursing in New South Wales, Nurses at Work.

As long as people have been making pottery and glass, dyeing fabric, preparing leather and painting buildings, workers have been using chemicals at work, Nancy notes in her book’s introduction. Men who worked in the felt hat factories using chemicals such as mercuric nitrate “experienced symptoms affecting the gums, mouth and skin… Drowsiness and depression could set in, together with hallucinations and delusions; this led to the expression ‘as mad as a hatter’.” Industrial nursing may be a small nursing speciality, but Nurses at Work outlines a fascinating history. Nancy estimates that between 1911 and 2011 more than 1,400 registered nurses have worked as occupational nurses. What makes the role unique is that few “other health practitioners… could be consulted by workers in the early stages of physical or mental ill health and consequently be referred for appropriate medical attention”.

‘No one was concerned for the lady process worker who each day was covered in asbestos dust, or the cleaner who swept it up.’

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ISBN 978-1-921326-12-7

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FROM LEFT: Sister Gardner discussing the prevention of RSI; Sister Irene Loughman – Monsanto chemicals Rozelle; the cover of Nurses at Work.


all worked alone, the only way they could achieve anything was in a group.”

Nancy left Automotive Industries when she was offered a job as an industrial nurse at the Email factory in Waterloo, an engineering company producing parts for gas and water meters. “While I was there I realised I really needed post graduate training in industrial nursing”. She took leave to study at the Royal College of Nursing, London. She returned to Australia and worked at Email newly qualified, but when the Occupational Health Nursing Adviser for NSW, Emmeline Roach, retired Nancy applied for the position and was appointed. “The job involved giving advice to nurses working in industry, arranging education programs for them,” she explains. “Ms Roach had started a short course. We developed that course and made it a bit longer and more intensive.” Na n c y also wrote the first guidelines for the employ ment of OHS nurses, and she worked to establish formal post graduate training for nurses in NSW. When a TAFE course commenced in 1981, Nancy applied for the teaching role and ran the course. Nancy had also become an active member of the occupational health nurse branch of the nurses’ union, serving in numerous roles, including president and committee member. The association was vital to developing professional ties and solidarity between nurses, Nancy says: “Because occupational nurses

THREE PERIODS OF INDUSTRIAL NURSING The book describes three time periods reflecting the changing nature of industrial health nurses in NSW. The first period, 1911 to 1939, was a time when “nurses were really appointed to workplaces as part of the welfare movement,” Nancy says. “In some companies, particularly retail stores such as Anthony Hordern and Farmers Ltd, managers came from the UK where industrial nurses were expected. Nurses were thrown in at the deep end and would have done whatever they thought they should do based on their nursing experience.” Nancy’s book tells the story of a nurse employed by Farmers (later Myer) who was advised to read a 1923 article by Janet Sorley, who had been

industries to employ a nurse.

A MOVE TO PREVENTION The third period covers 1960 on, when the industrial nurse role significantly changed. There was now an emphasis on injury prevention. “This was mainly due to the occupational health safety advisors who were changing the focus from treatment to preventions, identifying harmful factors in the workplace such as chemicals, loud noise and overuse work, strain injuries and things that caused back injuries.” The peak number of nurses were employed in occupational nursing around 1970. Today the number of nurses in industrial roles has significantly declined, as Jim Kitay, Nancy’s co-author, explains in the book’s final chapter. Factors behind the decline include the rise of neoliberal ideologies (which aim to minimise short term costs and regulations), and the emergence of related occupations, such as occupational therapists, safety advisors and OHS consultants. The decline in manufacturing industries has also played a role. More recently the focus on costs such as workers’ compensation premiums has “led to an emphasis on prevention (particularly on safety rather than illness prevention) and rehabilitation. To purchase a copy of Nurses at Work: A history of industrial and occupational health nurses in New South Wales, by Nancy Bundle AM and Jim Kitay, contact gensec@ ■

‘Nurses were really appointed to workplaces as part of the welfare movement’ a ‘senior sister in charge’ at Farmers, and “just do what she did”. Sorley’s article outlines treatments suggested for sick people at work and to prevent infectious diseases spreading. She also suggested the company should have a cottage somewhere in the country where people could recuperate. The second period (1940–1959) incorporated the Second World War, and was very much influenced by implementation of emergency legislation that compelled dangerous

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An international shame Sydney nurse Alanna Maycock shared a New York stage with world leaders who were horrified by her account of the abuse she witnessed on Nauru.


wo-and-a-half years after she worked as a nurse consultant at Nauru Island, Sydney-based registered nurse Alanna Maycock has shared a stage with speakers such as Hilary Clinton and Justin Trudeau to tell  the world about the shocking abuse she witnessed in Australia’s offshore detention centres. Alanna spoke at the Women in the World Summit at New York’s Lincoln Centre in April  on a panel called ‘Australia’s Shame’.  She described arriving at Nauru and seeing “high-rise fences and barbed wire and  rows and rows of tents, tents that were mouldy”. She saw open shower blocks where women have to shower and wash with their babies  behind “flimsy fabric curtains” in front of male guards. During her five days on the island, detainees told Alanna horrific tales of abuse. She told the New York audience about the Forgotten Children Report, which  found that “every two days there is assault on a child in offshore detention, and every thirteen days there’s a sexual assault, the majority involving children”. An audience of 4,000 in the Lincoln Centre, and an even larger audience watching the summit televised live across America, heard Alanna’s message. On the panel with her was Viktoria Vibhakar, a former aid worker with Save the Children, and the Australian human rights lawyer Jennifer Robinson.

NAURU IS “THE GUANTANAMO OF THE PACIFIC” Describing Nauru as the “Guantanamo of the Pacific”, Robinson said: “In Australia we are not locking up alleged terrorists, we are locking up 22 | THE LAMP JUNE 2017

people who are fleeing persecution and seeking our protection.” Acknowledging that Australian public opinion is still largely supportive of offshore detention centres, Alanna pointed to the “complete… shroud of secrecy over this situation”. With laws gagging detention centre workers from speaking out, whistleblowers such as Alanna her colleague, paediatrician David Isaacs, who visited Nauru with her, are rare and brave exceptions. “The problem with the Border Force Act is if you uphold your duty of care to your patients, you break the law,” she said.

‘Not even Donald (Trump) locks up children indefinitely’ The importance of Alanna’s session in New York was highlighted by the fact that the organisers – leading journalist and publisher Tina Brown and sponsors The New York Times – scheduled her to talk  between sessions by Clinton and the First Minister of Scotland, Nicola Sturgeon.  Earlier that morning Canadian Prime Minister Justin Trudeau spoke, repeating his now well-known words: “To those fleeing persecution, terror and war, Canadians welcome you, regardless of your faith.” Alanna says she was horrified by the contrast between Australia’s approach to asylum seekers and that of other nations. “I wanted the ground to swallow me up. I was absolutely mortified. Many of those

Alanna Maycock with First Minister of Scotland, Nicola Sturgeon watching said to me ‘not even Donald locks up children indefinitely’.” But the chance to speak to Nicola Sturgeon backstage was “an absolute inspiration” Alanna says. “She said to me: ‘You can’t do what is popular, you have to do what is right’.” Sturgeon has invited Alanna to visit the Scottish Parliament to discuss the  issue when she next visits the UK. The experience has given Alanna a new resolve to “do everything I can to advocate more [for those locked up in detention centres]. My conversations with these world leaders have given me a well-needed injection of enthusiasm.” Alanna was also encouraged by the international media’s response to her session. “Having the opportunity to take this to an international platform has given me the encouragement I need to keep pushing on with it. It becomes apparent when you take this issue to other nations that we are an international shame.” ■

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Billions to be lost if penalty rate cut spreads As the second biggest category of weekend workers, health care workers would be hit hard by cuts to penalty rates.


ustralia’s hospitals, residential care facilities and medical and other health care services employ more than 310,000 weekend workers, a report by the Centre for Future Work reveals. They are the second biggest category of weekend workers after retail workers who had their Sunday penalty rates cut by the Fair Work Commission in February. Saturday and Sunday work is worth an additional $658 million for residential care workers. Hospital staff earn an extra $524 million on weekends. These earnings from penalty rates and related provisions in awards and enterprise agreements are increasingly at risk, says the report’s author, Jim Stanford. “The Fair Work Commission’s decision to significantly reduce penalty rates for Sunday work in retail and hospitality sectors is important and damaging, but just the tip of the iceberg if the process of ‘normalising’ weekend work continues,” he says. “Our estimate suggests that merely cutting Sunday penalty rates in half (as the Fair Work Commission’s recent decision does for permanent retail, pharmacy, and fast food employees) would ultimately reduce cash compensation for Sunday workers by over $4.25 billion per year. “But the total loss, if weekend penalty pay disappears altogether (surely the ultimate goal of employer organisations) would be much larger, and would be experienced throughout all sectors of the economy.” The Centre for Future Work studied employment on Saturdays and Sundays in 108 different industries.

24 | THE LAMP JUNE 2017

‘After retail and hospitality, the hospital, aged care and medical services workers do the most weekend work.’ — Ged Kearney, ACTU President

It found an average of 2.75 million Australian employees are on the job on a typical weekend. The extra income generated by penalty rates and related provisions for their weekend work adds more than $14 billion per year to Australian pay packets, the Centre estimates. ACTU President Ged Kearney says the report confirms that if penalty rate cuts spread to other sectors the economic impacts for health care workers will be severe. “After retail and hospitality, the hospital, aged care and medical services workers do the most weekend work, making them extremely vulnerable to potential future cuts,” she says. “Legal advice obtained by the ACTU highlights the potential for the Fair Work Commission’s ruling to spill into other sectors.

75 ECONOMISTS SIGN LETTER AGAINST PENALTY CUTS Meanwhile, former Reserve Bank boss Bernie Fraser has savaged the Fair Work Commission’s cuts to penalty rates and the Turnbull government’s company tax cuts, saying the measures will further entrench inequality but do little to produce jobs and growth. Mr Fraser told Fairfax Media

that Australia is approaching a “danger point” where the gap between rich and poor becomes so vast it could have “awful” far-reaching consequences at every level of Australian society. Mr Fraser, who was the head of Treasury for five years before serving as RBA governor from 1989 to 1996, was one of 75 prominent Australian economists and academics to sign an open letter deeply critical of the cut to some Sunday penalty rates. The letter says the decision will not deliver any meaningful boost to employment. ■

2.75 million Australians work on a typical weekend.

$14 billion per year is added to Australian pay packets for this work.

5 years

of annual wage gains are needed to make up for the loss of weekend penalties.

THE LAMP JUNE 2017 | 25

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Ransomware throws hospitals into chaos A ‘cyber weapon’ built by American spies was used in a global ransomware attack that disrupted British hospitals.


housands of patients across England and Scotland had operations cancelled and hospitals were forced to divert ambulances when an international cyberattack hit computer networks of Britain’s National Health Service (NHS) last month. Patient data, test results, schedules and other vital files were encrypted by ‘ransomware’ known as WannaCry or WannaCrypt, causing chaos and paralysis. “At my hospital we are literally unable to do any x-rays, which are an essential component of emergency medicine,” a doctor told The Guardian. “ I know the staff will do their very best to keep looking after everyone but there are no robust systems in place to deal with blackouts like this,” he said. “It will… impact patient safety negatively, even if that impact can’t be clearly measured.” Nurses were unable to print identity tags to put round the wrists of newborns and new parents reportedly suffered delays in being discharged from the maternity ward at Royal London Hospital after computer systems went down. The opposition Labour Party accused the Conservative government of leaving the NHS vulnerable to cyber attack by starving it of funds to upgrade IT. Many NHS hospitals still use Windows XP, an outdated system that has not had tech support for two years. The WannaCry ransomware exploited vulnerabilities in older versions of Microsoft Windows. WannaCry locked users out of their computers and encrypted their files, demanding they pay US$300 – a price that doubled after three days – to receive a decryption key or risk having their files deleted.

RANSOMWARE WAS STOLEN FROM NSA Russia was the worst affected country with major attacks reported on its railway system, phone companies and banks. In China, traffic police and schools reported they had been targeted. Australia appeared to have escaped relatively lightly with only a few attacks reported. Microsoft has confirmed that the United States National Security Agency (NSA) was largely responsible for the chaos. The NSA discovered a major vulnerability in Microsoft’s operating systems, but instead of warning

‘An equivalent scenario… would be the US military having some of its Tomahawk missiles stolen.’ — Microsoft’s Brad Smith

Microsoft about it, they created, or bought, software to take advantage of it. It is not known whether the NSA ever used the software for a cyber attack. But a criminal hacking group stole pieces of WannaCry code known as “exploits” from the NSA earlier this year. Microsoft President and Chief Legal Officer Brad Smith criticised the NSA for their major role in spreading the ransomware epidemic. “We have seen vulnerabilities stored by the CIA show up on WikiLeaks, and now this vulnerability stolen from the NSA has affected customers around the world,” Smith said. “This attack provides yet another example of why the stockpiling of vulnerabilities by governments is such a problem.” The US government’s mishandling of “exploits” in their possession had allowed them to leak into the public domain and cause “widespread damage”, Smith wrote, adding that an “equivalent scenario… would be the US military having some of its Tomahawk missiles stolen.” Smith called on governments to “consider the damage to civilians that comes from hoarding these vulnerabilities and the use of these exploits. This is one reason we called in February for a new ‘Digital Geneva Convention’ to govern these issues, including a new requirement for governments to report vulnerabilities to vendors, rather than stockpile, sell, or exploit them.” ■ THE LAMP JUNE 2017 | 29


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Over 80 members, NSWNMA staff and family joined together to walk or run, and together WE RAISED OVER $1,500 to fund vital research in the prevention and cure of breast cancer. Thank you to everyone who donated and supported our team. 30 | THE LAMP JUNE 2017


Global commitment to public health care International conference agrees on central role of public system and need to invest in health care workforce.


overnments should not offload their responsibility for delivering health care to private operators. And public spending on the health care workforce should be seen as an investment rather than a cost. These were the key messages endorsed by governments, unions and employers at an international conference on ways to improve employment and working conditions in health services. Held by the International Labor Organisation in Geneva, Switzerland, it was the first tripartite meeting of its type in almost 20 years. Assistant General Secretary Judith Kiejda said it was an honour for the NSWNMA to be invited as one of only eight delegates representing unions that cover about 10 million health workers. Other union representatives came from France, Germany, Korea, South Africa, the USA and Argentina. They were matched by eight employer delegates – including an Australian – and representatives of 53 governments. The Australian government was invited but did not attend. Judith said the NSWNMA was invited partly in recognition of its work with the global union federation Public Services International (PSI). Judith has been the PSI’s Asia Pacific health coordinator since 2010 while NSWNM A staffer Michael Whaites is the PSI’s sub-regional secretary for Oceania. “The invitation also reflects

‘Conference decisions can now be used when lobbying governments in Australia.’ — Judith Kiejda the fact that Australia is the only regional country to have won mandated ratios or staffing levels in a number of models across various states,” Judith said. “The language of most government speakers was very helpful and in most discussions were very close to the worker perspectives. “Importantly, all three parties agreed that mandated staffing is the only way to guarantee decent working conditions in health services. “As the Brazilian government representative said, delivering safe and quality health care will be difficult without the right numbers of staff with the right skills in the right place at the right time. “The conference recognised that quality health care is a human right and its decisions can now be used when lobbying governments in Australia on issues of staffing and maintaining quality public health services. “The conference decisions will be particularly useful in our discussions with future governments which might be more in tune with our thinking on health matters than some current governments.” Judith said employer representatives spoke in favour of public private partnerships (PPPs) but unions

successfully argued against tripartite support for PPPs. “We all acknowledged there were private systems in every country that complemented the public system but we shouldn’t be handing over public services to private operators.” PSI General Secretary Rosa Pavanelli told the conference there was “a rich evidence base” for concluding that PPPs simply amount to the subsidising of private interests with public funds. “While private investments cannot be discountenanced, these have to be adequately regulated and should not be passed off as being in partnership with public health, which is the mainstay of universal access to health care,” she said. Judith said the NSWNMA would work to organise a similar tripartite meeting on health workforce issues to be attended by Asia-Pacific countries including Australia. “Through the PSI we are establishing a strong network of AsiaPacific health unions. We have the same issues everywhere – not enough staff, inappropriate skills, and governments seeking to privatise services.” ■

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Ged Kearney resigns from migration council The ACTU President quit the council after the Turnbull government’s “deeply flawed” changes to the 457 visa program. The Government’s Ministerial Advisory Council for Skilled Migration was set up to advise the Minister for Immigration and Border Protection Peter Dutton on Australia’s temporary and skilled migration programs. Ged Kearney quit the council in protest at the decision to replace the 457 visas and to cut 216 professions from the skilled migration list without any consultation with the council. She said the government had “done nothing to change the flawed visa labour market testing system nor had it done anything to protect the jobs of many Australians worried about job security”. “The Minister’s announcements in no way address the union movement’s concerns regarding the rampant exploitation by employers of temporary migrant workers,” she said. Ms Kearney said the lack of consultation rendered the council “completely irrelevant”. “The Minister would have been better off vastly increasing the barriers for employers to hire migrant workers as well as raising the penalties for their abuse. “The visa system is being rorted and workers are being exploited every day but the government only cares about its political survival. “Australians want to see a government that stands up for workers through stopping penalty rate cuts, supporting a decent increase to the minimum wage, stopping the casualisation of work and creating jobs.”

‘Too many nurses are struggling to make ends meet, turning to food banks and hardship grants in desperation.’ — Janet Davies, chief executive, Royal College of Nursing BRITAIN

British nurses “fund the NHS deficit from their own pay packets” A report by the Health Foundation has found NHS nurses and midwives will see their real wages cut by 12 per cent by 2020. The pay cut stems from a Conservative government policy that has limited pay increases for health workers to 1 per cent per year since 2010 – a policy that is to last until at least 2020.

‘The visa system is being rorted and workers are being exploited every day but the government only cares about its political survival.’ — Ged Kearney, ACTU President 32 | THE LAMP JUNE 2017

The Health Foundation also found that the government’s wage cap was exacerbating chronic understaffing. Its report found that England could face a shortfall of 42,000 nurses by 2020, and almost half of all nurses believe that current staffing levels are already dangerously stretched reported The Guardian. The thinktank argued that the pay cap is no longer sustainable and should be replaced if the organisation’s staff and skill shortages are to be addressed. The Royal College of Nursing is currently polling its 270,000 members about striking for the first time in their history in protest at the government holding down their pay. “Nurses should not have to fund the NHS deficit from their own pay packets. Every year that the government holds NHS pay below inflation, hundreds of thousands of nurses get another real-terms cut to their salary. Too many are struggling to make ends meet, turning to food banks and hardship grants in desperation,” said Janet Davies, the RCN’s chief executive and general secretary.




Labor promises to triple the cost of temporary work visas

Rural economies depend on health Rural health is not just an issue about equitable access to health care services; it’s an issue that impacts on local economies, according to a prominent academic.

The opposition has also pledged not to sign any trade deals that waive labour market testing.

In an address to the National Rural Health Conference Dr. Lesley Russell argued that: “the government isn’t investing enough in rural and remote health because of its failure to recognise the comprehensive impact of health care funding as a driver for local economic development”. Dr. Russell pointed to US research that showed that for every $US1 invested in community health centres an estimated $US11 is generated in economic activity. She says, “Australia has shown little interest in these sorts of analyses and economic justifications for changes in health policy to better service rural areas”. What little research has been done is consistent with the US results. For example, an Australian study showed investing $A1 in medium-level primary care (2–11 visits per year) for people with diabetes in remote Indigenous communities could save $A12.90 in hospitalisation costs. “What we do know is on the basis of health care costs alone, spending more money more wisely on rural and remote health could result in some significant savings,” she says. “Expenditure on rural and remote health is a wise use of government resources because it focuses on what private markets are unable to do. It also delivers on outcomes that can be measured in dollar benefits, as well as the social justice currency of a fair go for all Australians.”

Labor plans to increase the cost of a two-year temporary work visa from $575 a year to about $1,600 a year or $6,400 for a four-year visa. The money raised, it says, would be put into a training fund. “This is a strong price signal to employers that they should be looking for local workers first,” Labor leader Bill Shorten said. “Under Labor, putting local workers first won’t just be fairer – it will be cheaper.” At the same time, Shorten says he would introduce a new “Smart” visa for what he calls world leaders in science, medicine, academia, research and technology to ensure highly skilled migrants were still attracted to Australia. Migration expert Henry Sherrell, of the Crawford School of Public Policy at the Australian National University, told The Guardian: “Price signals are much more likely to change employer behaviour when it comes to workforce planning and hiring decisions”. “Other regulatory controls, like labour market testing and specifying occupations, are much harder to enforce as they are complicated and employers are able to circumvent the policy goal.”

‘US research shows that for every $US1 invested in community health centres an estimated $US11 is generated in economic activity.’

Diabetes Update Day 2017 Don’t miss this one-day seminar. Learn while you earn CPD points.

Saturday 7 October 2017 Rosehill Gardens Racecourse

‘Under Labor, putting local workers first won’t just be fairer – it will be cheaper.’ — Bill Shorten




Call 1300 136 588 to register or visit THE LAMP JUNE 2017 | 33



A helping hand for nurses and midwives A national helpline for nurses and midwives has been launched by Turning Point, an addiction treatment, research and education organisation. Nurse and Midwife Support (NM Support) is a telephone and online service that provides confidential advice and referral to nurses and midwives about their health and wellbeing. Callers to the service have 24/7 access to an experienced team who provide advice and referral to nurses and midwives on a wide range of health and wellbeing-related issues. The service also offers support to nursing and midwifery students, educators, employers and concerned family members. Turning Point Program Director Anthony Denham said that while nurses and midwives are recognised as the caregivers, they can also face health challenges and need support in getting care. “This may include stress caused by work, family problems, relationship issues, as well as alcohol and drug-related issues, or mental health concerns,” he said. Mr Denham said the service was all about providing anonymous, ‘no strings attached’ support that helps nurses and midwives deal with health issues that may be affecting their personal lives and their work. NM Support also has an educational element to teach those working in health how to support colleagues who might be facing health issues and help them address those concerns.

‘While nurses and midwives are recognised as the caregivers, they can also face health challenges and need support in getting care.’



One third of Australians short-changed on super Industry Super analysis of tax office data shows that, in 2013–14, almost one in three employees missed out on unpaid super entitlements totalling $5.6 billion. These figures were confirmed in a Senate committee report released last month bringing a strong response from industry funds and the ACTU. The senate report describes the Australian Tax Office’s reactive approach to unpaid super as ‘inadequate’ and ‘problematic’. Industry Super public affairs director Matt Linden welcomed the senate findings, describing them as a wake-up call not only for the ATO but also employers and government. “This is an issue that impacts the entire country by decimating personal savings; creating an uneven playing field for competing businesses; and ultimately driving up pension costs,” he said. Employers are required to pay 9.5 per cent in superannuation towards every employee over the age of 18 earning more than $450 (gross) a month. But an analysis of ATO data shows 2.76 million people were underpaid their super entitlements by an average of $2,025 per person in 2013-14. “This is nothing more than another case of wage theft that will impact workers for decades to come, decimating the right to dignity in retirement, to which all working Australians are entitled,” said ACTU Assistant Secretary Scott Connelly. “We need more resources and focus – increased penalties on employers will help. But we also need to look at avoidance, shams and contracting arrangements where super is either being missed or not paid at all.”

‘This is nothing more than another case of wage theft that will impact workers for decades to come, decimating the right to dignity in retirement.’ — Scott Connelly, ACTU Assistant Secretary



Private health insurance under fire A group of leading health experts has strongly criticised the role of private health insurance in the Australian health system. The views of 20 experts were published in Health Voices – the journal of the Consumer Health Forum (CHF) – and were overwhelmingly critical of the value and transparency of private health insurance. The CHF, which advocates for patients, and the Australian Healthcare Reform Alliance (ACHRA) have called on the federal government to extend the scope of its private health care review “to identify policy options to improve the efficiency and equity of health care without the high cost and waste associated with private health insurance”. Here are some of the critiques that were provided by the experts: “There are 1.3 million people living in outer regional and remote communities who are cross-subsidising the cost of private health insurance for people in metropolitan and inner regional Australia. These are the people who pay for private health insurance but get very little back for what they pay,” David Butt, CEO, National Rural Health Alliance. “Government incentives… have distorted consumers’ perceptions on the value of private health insurance, and clouded decisions on whether individuals should insure, and how much insurance to buy,” Dr Terrence Cheung, Senior Lecturer at the School of Economics at University of Adelaide. “Private health insurance is inequitable, wasteful and represents a grave threat to Medicare’s power to control health costs,”  John Menadue, former senior bureaucrat, business leader and author/publisher.

MORE INFORMATION “Is health insurance worth it?” – Health Voices April 2017 http://healthvoices.


Nationals turn backs on aged care The ongoing delivery of qualified, highly skilled nursing care in NSW residential aged care facilities has been dealt a significant blow, after the Berejiklian Government refused to keep one registered nurse on duty at all times in high care nursing homes. On the eve of International Nurses’ Day, lower house Nationals and Liberal Party MPs voted down a Shooters, Fishers and Farmers Party bill, which had passed the upper house unopposed the previous week. NSWNMA General Secretary Brett Holmes said the government’s decision was shameful and over time would erode the level of quality care provided to some of the state’s most vulnerable aged care residents. “This is a tragic outcome for families with loved ones in high care residential aged care facilities across NSW and is a clear abrogation of responsibility by the Health Minister and Nationals MPs purporting to represent rural communities,” he said. “Rather than ensuring a high standard of care is maintained throughout facilities with high care residents, the government has hidden behind an illinformed argument that small regional aged care facilities would close if the requirement to employ one registered nurse remained in the Public Health Act 2010. “This spurious argument ignores the fact that regional aged care facilities receive Commonwealth funding for complex and high care residents at the same rate as city-based facilities and at least 70 per cent of all residents are deemed to be high care before entering a site. Small rural or isolated facilities also receive additional special Commonwealth funding. “Nationals MPs have essentially said their constituents don’t deserve a registered nurse on site 24 hours a day and therefore can be transferred by ambulance to the local public hospital or Multi-Purpose Service to wait in the emergency department for assessment and treatment”.

‘Nationals MPs have essentially said their constituents don’t deserve a registered nurse on site 24 hours a day.”’ THE LAMP JUNE 2017 | 35



n LIVERPOOL Friday 9 June Members: $85 | non-members: $170


n WATERLOO Monday 19 June Target Group: New Managers, Senior Managers, Senior RNs/ RMs, DONs, DDONs Members: $125 | non-members: $225


n ARMIDALE Tuesday 20 June n DUBBO Wednesday 12 July n WAGGA WAGGA Thursday 27 July An essential ½ day workshop for all nurses and midwives to learn about CPD requirements and what’s involved in the process. Members: $40 | non-members: $85


n ARMIDALE Wednesday 21 June n DUBBO Thursday 13 July n WAGGA WAGGA Friday 28 July Learn about potential liability, disciplinary tribunals, NMC and HCCC complaints, Coroners Court, and more. Members: $40 | non-members: $85

APPROPRIATE WORKPLACE BEHAVIOUR FOR NURSES AND MIDWIVES – 1 Day n NEWCASTLE Wednesday 5 July Members: $85 | non-members: $170

FOOT CARE FOR NURSES – 2 Days n COFFS HARBOUR Thursday 6 and Friday 7 July This 2-Day course is designed to equip nurses, Registered, Enrolled and Assistants in Nursing with the knowledge and skills for maintenance of healthy, functioning feet. Members: $203 | non-members: $350 MANAGING OVERTHINKING – 1 Day n WAITARA (HORNSBY) Monday 10 July Members: $85 | non-members: $170 PREPPING FOR INTERVIEWS – ½ Day

n WATERLOO Friday 28 July To prepare undergraduate nurses and midwives for interviews Members: $10 | non-members: $30

Register online

FINANCIAL WELLNESS SEMINAR This free half day seminar is designed to assist people in their decision making regarding their financial future. Subjects covered on the day are detailed below and cater for all ages.


• Superannuation Guarantee • Government CoContributions Scheme • Contribution Limits • Salary Sacrifice • Consolidation of Multiple Accounts (Rolling Over) • Insurance (Income Protection / Death Cover / Total and Permanent Disability / Binding Nominations / Nominated Beneficiary) • Investments (Asset Classes / Volatility etc) • Transition to Retirement • Help Links (e.g. MyGov Website / Money Smart Website) • ASFA Retirement Standard (the difference between a modest and comfortable retirement) • Centrelink (General Information e.g. income asset tests) • Q&A •







Tuesday 13 June The Westport Club Thursday 15 June Parramatta RSL

Tuesday 1 August Noah’s on the Beach

Tuesday 29 August Dubbo RSL Thursday 21 September The Shellharbour Club Wednesday 1 November Ballina RSL

Time: 9am to 2pm Lunch & refreshments provided Nurses and midwives: this seminar will not attract CPD hours. Numbers are limited in some locations. Pre-registration is essential.

Click on the education tab. Scroll down to the education session you would like to register into and click Register Online. For enquiries contact NSWNMA • Metro: 8595 1234 • Rural: 1300 367 962



Judith Breaking News Update on Working with Children Checks (WWCC) Phase 1 of the WWCC implementation drew to a close on 31 March 2017 as per relevant legislation. The LHDs involved in Phase 1 were Hunter New England, Central Coast, Mid North Coast, South Eastern Sydney, Illawarra Shoalhaven, and Northern NSW. Phase 2 has now commenced for all remaining LHDs and Networks. Accordingly, if you work in one of these remaining LHDs, you will receive notification from them IF you are required to obtain a WWCC because of the position or duties you undertake. The Ministry of Health have provided to all LHDs a checklist to assist in determining whether a position should be classified as involving child-related work, and therefore requiring a WWCC. The Association has again reminded a number of LHDs that a blanket approach (i.e. all nurses need to get one) is not appropriate or consistent with the legislation or advice from the Ministry. NOTE: Some administrative difficulties occurred during Phase 1 when the name of the WWCC clearance was different to the name used for employment. In this situation ensure the clearance can be verified as relating to the person employed.

Available entitlements when caring for a family member I am a registered nurse working in a public hospital. My mother will require extensive support because of illness. Beyond FACS leave, what other leave entitlements do I have? Clause 32B of the Public Health System Nurses’ and Midwifes’ (State) Award 2015 recognises that in such situations, access to sick leave, and other forms of

When it comes to your rights and entitlements at work, NSWNMA Assistant General Secretary Judith Kiejda has the answers.

paid leave, may be available if one is required to provide care and support to a person. The definition of the connection between the person and the employee to trigger access to personal/carer’s leave is extensively set out in the clause, and is by design meant to encompass a wide range of situations and relationships.

Pathways for a CNS at a Healthscope hospital I am a registered nurse working in a hospital operated by Healthscope. I am interested in progressing to a Clinical Nurse Specialist position. Is there an approved pathway? Clause 5 of the Healthscope – NSWNMA/ANMF – NSW Nurses and Midwives’ Enterprise Agreement 2015–2019 contains the pathway to becoming a Clinical Nurse Specialist (Grades 1–2). In short, a Clinical Nurse Specialist Grade 1 applies a higher level of clinical nursing knowledge, experience and skills in providing complex nursing/ midwifery care directed towards a specific area of practice, a defined population or defined service area, with minimum supervision. The clause sets out the minimum criteria that must be met to demonstrate such additional competence and expertise. Additional criteria are set out for a Grade 2 role. Note that a Clinical Nurse Specialist position is a personal grading.

What is a “home base”? I have commenced work at a nursing home operated by Estia Health. When starting I was told that the home I work from will be my ‘home base’. What does that mean? Under Clause 13 of the Estia

Health NSW Enterprise Agreement 2016 Opal Aged Care (NSW) Enterprise Agreement 2016, employees mainly work at a particular Estia Home, which is called their “home base”. This appointment will be in writing. This, however, does not necessarily prevent you from working at other Estia homes as part of your regular duties. A temporary or permanent change in your home base must be mutually agreed.

The correct process after a patient complaint I work in a public hospital as an enrolled nurse. Recently my supervisor spoke me to about a complaint received from a patient’s relative. Not thinking much of it, I participated in the discussion and thought that was the end of it. However, I have just received a formal warning about the complaint. Is this right? In short, no. Under the relevant NSW Health policy directive, (PD2014_042 – Managing Misconduct), a well-established process is set out. This requires, amongst other things: written advice to the staff member about the allegations; reasonable notice of any interview; an opportunity to respond to any adverse findings, with access to relevant information that underpins the decision; and if a decision is subsequently made to apply a disciplinary outcome, an opportunity to respond and make representations to the decision maker. As your supervisor does not seem to have followed required process, you would have grounds to complain and take issue with the outcome. THE LAMP JUNE 2017 | 37


There are many benefits of being a financial member of the NSWNMA — did you know that

Authorised by B.Holmes, General Secretary, NSWNMA

YOUR MEMBERSHIP FEES COVER YOU FOR TRAVEL TO AND FROM WORK? If you are involved in an accident while travelling to or from work, NSWNMA’s Journey Accident Insurance provides you with peace of mind. In recent years this insurance has been a financial safety net for many members who have met unfortunate circumstances travelling to or from work. As a financial member of the NSWNMA you are automatically covered by this policy. It’s important to remember however, that it can only be accessed if you are a financial member at the time of the accident. So make sure your membership remains financial at all times by paying your fees by Direct Debit or Credit. Watch Alexis talk about Journey Accident Insurance


Your journey injury safety net

UNSURE IF YOU ARE FINANCIAL? IT’S EASY! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural). Change your payment information online at

38 | THE LAMP MARCH 2017


Do you have a story to tell? An opinion to share? Nurse Uncut is a blog written by everyday nurses and midwives. We welcome your ideas at

New on our Support Nurses YouTube channel

Letter from an 80-year-old about aged care RATIOS IN THE BUSH Country nurses want ratios!

Retired nurse Glennis lives in aged care and, with diabetes, she relies on registered nurses. glennis-letter-from-an-80-year-oldretired-nurse-about-aged-care/

Sarahjane in Kenya: “My career was never meant just for me” ED nurse Sarahjane grew up in foster care, so always wanted to give something back. au/sarahjane-in-kenya-my-nursingcareer-was-never-meant-just-for-me/

Letter from an aged care nurse to her MP Claire tells her National MP: ‘Vote with your heart and your values’.

NSWNMA GOES TO MAY DAY Unionists and kids. Connect with us on Facebook Nurse Uncut www.facebook. com/NurseUncutAustralia New South Wales Nurses and Midwives’ Association Ratios put patient safety first safepatientcare Aged Care Nurses agedcarenurses Look for your local branch on our Facebook page Follow us on twitter @nswnma / @nurseuncut Share on Instagram by tagging @nswnma and don’t forget to use the hashtag #nswnma!

Lauren: Working for the future of aged care A passionate young nurse set up the Aged Care Report Card, for reviews of aged care by staff and families. lauren-working-for-the-future-ofaged-care/

Midwife educator leads first LGBTI antenatal class Janet leads a safe, inclusive class for seven lesbian couples, three gay couples – and someone’s mum. http://www.

Listen to our podcast WENDY HARMER Talking to Brett Holmes

Liliana’s story: A nurse with breast cancer Lilliana was finishing her nursing degree as a mature student when she noticed a lump in her breast. lilianas-story-a-nurse-with-breastcancer/ THE LAMP JUNE 2017 | 39

Going to work shouldn’t mean stepping into this.

ARE YOU A VICTIM OF WORKPLACE VIOLENCE? Have you or a colleague been assaulted at work? Have you reported your incident?

Download the NSWNMA App and report your workplace violence incident. The NSWNMA has a new tool as part of our NSWNMA Toolkit App that allows you to quickly report an incident to the Association as soon as it happens. It’s an easy fillable form that you can submit from your mobile device and an officer of the Association will be in touch with you. Nursing is considered one of the most dangerous professions. HELP STOP VIOLENCE AT WORK!

40 | THE LAMP MARCH 2017

NSWNMA Toolkit App is FREE and available to download from iTunes and Google Play store




What nurses and midwives said and liked on Facebook

the gallery


Dealing with death An article about encountering death on a night shift spoke eloquently to our readers. It doesn’t matter how much death you’ve seen, a traumatic death is a traumatic death for everyone in the room. In the aged care facility it was my job to wash and prepare the body for the family... lippy, combed hair, but even though I’ve handled hundreds of corpses over the last 20 years I still wasn’t prepared for the first unexpected death on student placement, the fact it was a young person and the death was violent didn’t make it easier. I’m a midwife, waiting at the changeover of new life emerging from within to without, and sometimes those beautiful little souls don’t always make it to see the light of day. I’ve seen dying, despair, desperate disbelief and sadness beyond grasping. And when my (adult) brother was in a near fatal accident last year, the emergency services, paramedics, ED nurses and doctors, the ICU staff saved his life. Gratitude could never be expressed to match the depth of emotion I feel for every one of these individuals. Having to be the bringer of that news, that’s some unbelievable stuff to hold in your soul.

Anger at NSW government’s contempt for the aged The defeat of the Bill to keep the minimum requirement for an RN in nursing homes 24/7 sparked a huge discussion. Having now seen how our relatives are cared for makes me sad, not due to staff but due to lack of. It’s all for profit now. This should be mandatory and should never have come to a vote. How sad the Liberal Government cares so little for our senior citizens in their twilight years. I am an RN, have been for 40 plus years and it has never been this bad for our oldies, a disgrace that it would come to this! Wonder which providers put in the submissions. Wonder if any pollies are shareholders in aged care. Such a disgrace. Badly educated politicians making decisions about situations they aren’t qualified to make decisions on. So disappointing. If you’ve never worked in a nursing home you have no idea how poor the care is due to poor training of staff, cost cutting, poor time management. It’s a disgrace! I emailed my local member fir the first time ever and received the most ignorant and pathetic response that shows that he has absolutely no idea.

Improving end-oflife care A young man with bone cancer presented at ED – the staff quickly realised he did not know he was dying as it had never been discussed with him. How could we improve the way we provide end-oflife care? As an ED nurse, I have questioned medical staff countless times when a very elderly patient from a nursing home comes in in full cardiac arrest. At what point are you doing harm? Discussing death with our patients is not a failure, it’s a fundamental part of our role as caregivers. I’m a generalist nurse and see it all the time, when interventions will not improve quality of life for the patient. It is a sad reality that ‘we must save the patient at all costs’ is alive and well in the hospital system. A pain free and symptom free death is a wonderful gift to give to not only patients but their families. Nurses as well as medical staff need to be educated. When my elderly aunt was palliative last year the nursing staff couldn’t treat her as such because she didn’t have cancer. They insisted on having meals delivered to her bed even though she couldn’t swallow. The reason we were given was “we can’t starve her”. As a nurse, it was difficult to get them to accept she was dying.






INTERNATIONAL NURSES DAY 2017 1/ Mt St Joseph’s Nursing Home, Young 2/ Oncology nurses, RNSH 3/ Urbenville MPS 4/ University of Newcastle students 5/ Notre Dame, Darlinghurst campus 6/ Mona Vale Hospital 7/ M  ercy Care Centre, Young THE LAMP JUNE 2017 | 41

The Edith Cavell Trust

Scholarships for the academic year 2018 Applications for the Edith Cavell Trust Scholarships are now being accepted for the academic year 2018. Members or Associate Members of the NSW Nurses and Midwives’ Association or the Australian Nursing and Midwifery Federation (NSW Branch) are invited to apply. All grants, awards or loans shall be made to financially assist nurses, midwives, assistants in nursing, assistants in midwifery (including students of those disciplines), and accredited nursing or midwifery organisations, schools and faculties in the furtherance of: (i) accredited nursing or midwifery studies; (ii) such academic research programs as are approved by the Trustees in the theory or practice of nursing or midwifery work; or (iii) clinical nursing education programs at graduate, post-graduate and continuing education professional development level; in accordance with a number of categories. Full details of the scholarship categories, how to apply and to obtain the official application form is available from the NSWNMA website. Prior to applying, please ensure you have read the Edith Cavell Trust Scholarship Rules.

Applications close 5pm on 31 July 2017

42 | THE LAMP JUNE 2017

www.nSwnmA.ASn.Au – click on ‘Education’ For further information contact: Scholarship Coordinator – The Edith Cavell Trust, 50 O’Dea Avenue, Waterloo, NSW 2017 T 1300 367 962 E


The federal budget’s impact on health As always, there were winners and losers in Federal Budget 2017. A notable loser was aged care, with the absence of any meaningful measures to address the looming shortage of skilled aged care nurses as demand continues to rise in the sector. Health experts analyse the budget

No real guarantee on Medicare

Medicare rebate freeze unthawed

Stephen Duckett Treasurer Scott Morrison pulled a health-related rabbit out of his hat on budget night, announcing the government will “guarantee” the future of Medicare. It will do this by allocating any extra revenue from the recently increased Medicare levy, after paying for the NDIS, into a Medicare Guarantee Fund. The government will then cover the shortfall to cover the costs of Medicare – defined in these budget announcements as a combination of expenditure from the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). In Morrison’s words: Proceeds from the Medicare levy will be paid into the fund. An additional contribution from income tax revenue will also be paid into the Medicare Guarantee Fund to make up the difference. Based on the sketchy information so far available, this fund appears to be no more than an accounting trick. The size of the fund will be determined each year based on projected MBS and PBS expenditure. The balancing item, which is the extra proportion of non-NDIS revenue, will also be adjusted each year in line with those expenditure projections. The Medicare Guarantee Fund is nothing more than a rebadging exercise: it changes the badge on a policy in the hope people might think it is a new policy.

Stephen Duckett, Grattan Institute As foreshadowed in pre-budget leaks, the government is slowly unthawing the Medicare rebate freeze but at a snail’s pace. National Disability Insurance Scheme (NDIS) Helen Dickinson, Associate Professor, Public Service Research Group, UNSW Since its inception, a number of bitter political battles have been fought over how the National Disability Insurance Scheme should be funded. Many have been nervous that the current Productivity Commission review of the costs of the scheme could lead to a scaling back of the NDIS before it is fully operational.

Generic medicines

Chris Del Mar, Professor of Public Health, Bond University The government is set to save $1.8 billion over five years by extending or increasing the price reduction for medicines listed on the Pharmaceutical Benefits Scheme (PBS). This will be achieved in part by encouraging doctors to prescribe generic medicines that name the active ingredient. This has the effect of pharmaceutical companies selling the drug that is cheapest.

Aged care

Michael Woods, Professor of Health Economics, UTS The government has held the line on restraining growth in funding to residential aged care providers in this budget by implementing its pre-announced indexation freeze for the year, and a partial freeze in 2018–19. The freeze was in response to concerns some providers were wrongly over-claiming payments under the Aged Care Funding Instrument (ACFI). The instrument determines the level of funding the government pays to providers to care for their residents.

Mental health funding: too little, unfair and lacks strategy

Elizabeth Savage, Professor of Health Economics, UTS The budget has increased the Medicare levy (from 2.0% to 2.5%). It also has removed the 2% budget repair levy, which benefits individuals with taxable incomes above A$180,000. In 2014–15, only 3% of taxpayers had taxable incomes above $180,000. By contrast, the Medicare levy increase affects almost all taxpayers. This is a tax increase designed to generate revenue to fund the NDIS. The Medicare levy is essentially a flat tax, except for those at the lowest end of the distribution of taxable income.

Sebastian Rosenberg The federal budget allocated A$115 million in new funding to mental health over four years. This is one of the smallest investments in the sector in recent years. For instance, the Council of Australian Governments (CoAG) added more than $5.5 billion to mental health spending in 2006. The 2011–12 federal budget provided $2.2 billion in new funding. This compounds a situation in which, in 2014–15, mental health received around 5.25% of the overall health budget while representing 12% of the total burden of disease. There is no reason those figures should exactly match, but the gap is large and revealing. They speak to the fact mental health remains chronically underfunded. Mental health’s share of overall health spending was 4.9% in 2004–05. Despite rhetoric to the contrary, funding has changed very little over the past decade.

An inequitable budget

THE LAMP JUNE 2017 | 43



nline o s l i a ate your membership det aw to win r d e t o t n i & go

5-NIGHT BATEMANS BAY ESCAPE Eurobodalla, land of many waters, sits less than 4 hours’ drive south of Sydney and 2 hours east of Canberra on the NSW South Coast. Eurobodalla is over 110kms of unspoilt beauty. The region is known for award-winning Montague Island; home to thousands of fur seals and colonies of penguins, 83 spectacular beaches and ancient headlands, four major rivers and vast tracts of wilderness, national parks and forest. Abundant wildlife dominates the visitor experience, while vibrant communities and the picturesque historic and coastal villages connect the main towns of Batemans Bay, Moruya and Narooma. UPDATE YOUR DETAILS ONLINE AT WWW.NSWNMA.ASN.AU AND YOU WILL AUTOMATICALLY BE ENTERED IN THE DRAW TO WIN A 5-NIGHT ESCAPE FOR TWO TO BATEMANS BAY. You and a friend will stay at Corrigans Cove for 5 nights in a gorgeous pool view room with continental breakfast daily. This fantastic package also includes dinner for two on two nights of your stay at Corrigans Cove; entry for two to the fantastic Mogo Zoo; and a double pass to the Original Gold Rush Colony Mogo.

VALU ED AT $150 0.

For your chance to win, simply login online at to register or update your details. You can now change your details at a time that suits you, pay membership fees online, print a tax statement, or request a reprint of your membership card – it’s simple! All members who use our online portal from 1 December 2016 until 30 June 2017 will automatically be entered in to the draw to win this fantastic escape. *Conditions apply. Rooms subject to availability. Prize must be redeemed by June 2018 and is not valid for use during school holidays or public holidays. The prize is non-redeemable for cash or any unused portion of the prize. Competition entries from NSWNMA members only and limited to one entry per member. Competition opens 1 December 2016 and closes 30 June 2017. The prize is drawn on 1 July 2017. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/17/01625 44 | THE LAMP MARCH 2017


test your

Knowledge 1












13 14








21 24


26 27








34 36

35 37 38

39 40

ACROSS 1. A circumscribed spindle-shaped dilation of the lactiferous duct just before it enters the nipple (11.5) 9. Relating to the breasts (7) 11. Obtained from cinnamon (8) 13. Incisures (7) 14. Being recumbent; in a horizontal position (5) 15. A tiny or minute amount (4) 17. To set again (5)

18. An Eskimo hut (5) 19. A small patch of facial hair just below the lower lip and above the chin (7) 21. The state of being treelike in form and appearance (12) 24. An oily liquid with a pungent, irritating odour, used in the manufacture of DDT (7) 26. Electro-Optical (1.1) 27. Prefixes meaning self, same (4) 28. Dark grey rain-bearing clouds (5)

29. The body (trunk or torso), excluding the head and extremities (7) 33. Outward (5) 34. Any disease of wide prevalence or of excessive mortality (6) 35. To encounter (3.4) 37. Circumpapillary halo seen in choroidal atrophy of the aged (6.4) 38. Mineral deposits that can form a blockage in the urinary system (7) 40. Arranged according to a plan or scheme (12)

DOWN 1. A cataract in which the opacity is limited to the cortex (8.8) 2. The act of consigning a person to confinement (9) 3. Not consisting of an angle or angles (9) 4. The presence of erythroblasts in considerable numbers in the blood (16) 5. Arranged or controlled the elements of, as to achieve a desired overall effect (12) 6. To make hypersensitive or reactive to an antigen especially by a second or repeated exposure (9) 7. Marked by the absence or lessening of disease activity (8) 8. Douglas fold (12.4) 10. Renal oncocytoma (1.1) 12. That is (1.1) 16. The symbol for silver (2) 20. Initial Risk Assessment (1.1.1) 22. Flowing together; blended into one (9) 23. Graphic representations of a numeric relationship (9) 25. Belonging to oneself or itself (3) 30. A genus of cup fungi in the family Sarcosomataceae (6) 31. An enumeration of the population (6) 32. User Check Test (1.1.1) 36. Resistant to externally applied pressure (4) 39. Lymphocyte (2) THE LAMP JUNE 2017 | 45




THE 2016 – 2017 NSWNMA MEMBER RECRUITMENT SCHEME PRIZE The winner will experience all the style and comfort of a luxury retreat with the warmest of country welcomes. A four night (midweek) stay for two with: • Wine and Cheese plate on arrival; • Breakfast daily; • 2 x 2 course lunches; • 2 x 3 course dinners; • 2 x 60 minute facial or massage for 2 guests (4 in total) • 4 wheel drive tour for 2 guests. 46 | THE LAMP MARCH 2017

The NSWNMA will arrange return flights for two from Sydney to Brisbane and car hire for the duration of the prize. Spicers Retreat Hidden Vale is a gem, an uncomplicated escape just an hour’s drive from Brisbane. Experience the uniquely revitalising effect of spending time on 12,000 acres of true Australia bush. Space to relax. Space to listen, to laugh and to embark on an adventure amongst the abundant wildlife. Every member you sign up over the year gives you an entry in the draw!


Join online at If you refer a member to join online, make sure you ask them to put your name and workplace on the online application form. You will then be entitled to your vouchers and entry in the NSWNMA Recruitment Incentive scheme. SPICERSRETREATS .COM

Conditions apply. Prize must be redeemed by 30 June 2018 and is for stays outside of School Holiday periods, midweek (Monday to Thursday). Competition opens on 1 August 2016 and closes 30 June 2017. The prize will be drawn on 30 June 2017. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/17/01625.

REVIEWS DISCOUNT BOOKS FOR MEMBERS The Library is pleased to announce that McGraw Hill Publishers are now offering members a 25% discount off the RRP! The offer currently covers medical as well as a range of other professional series books. Please see the online Book Me reviews for a link to the promotion code and further instructions, or contact the Library directly for further information.



Beth McRae Penguin Random House RRP $22.99. ISBN 9780143780281


Outback Midwife: From City To The Bush. One Woman’s Labours Of Love S PE


book club

All the latest Book Club reviews from The Lamp can be read online at

Diverse Roles For Occupational Therapists Jane Clewes and Robert Kirkwood

M&K Publishing, an imprint of M&K Update Pty Ltd: https://www.mkupdate. RRP POA. ISBN 9781910451069

Diverse Roles for Occupational Therapists is a compilation of a range of roles for occupational therapists. The authors show how they have embraced opportunities, extended roles, and developed services along with the ever-changing world of statutory services policy. While many chapters allude to mental health fields, the book also includes topics relevant to general practice. The book is intended to inform and inspire the reader to share ways of dealing with hurdles whilst remaining resilient to prevailing pressures and difficulties borne out of our working lives as occupational therapists in a wide range of settings.

The Complete Guide To Asperger’s Syndrome Tony Attwood

Jessica Kingsley Publishers (available through Footprint Books): RRP $37.99. ISBN 9781843106692

The Complete Guide to Asperger’s Syndrome provides a personal perception of children, teenagers

and adults with Asperger’s syndrome based on the author’s extensive clinical experience. This book is both authoritative and extremely accessible. Chapters examine: causes and indications of the syndrome; the diagnosis and its effect on the individual; theory of mind; the perception of emotions in self and others; social interaction, including friendships; long-term relationships; teasing, bullying and mental health issues; the effect of Asperger’s Syndrome on language and cognitive abilities, sensory sensitivity, movement and coordination skills; career development.

Living With Fibromyalgia (3rd Edition) Christine Craggs-Hinton,

Sheldon Press (available through Fishpond): http://www.fishpond. RRP $17.95. ISBN 9781847093479

Fibromyalgia is a chronic condition characterised by pain in the muscles, tendons, ligaments and nerves. Other symptoms include fatigue, sleep problems, allergies, anxiety, irritable bowel syndrome, headaches, morning stiffness and problems with short term memory and concentration. Increasing recognition of fibromyalgia means that diagnosis and treatment are increasingly likely, but self-help is still key. As well as tried and tested advice on how to reduce pain, boost energy levels and help with regular sleep, this new edition includes the latest in treatments, such as the popular



Outback Midwife is the story of Beth McRae’s 40 CI years as a midwife, from her terrifying first day AL IN T E witnessing a birth as a naïve student nurse, to her training as a midwife to working in the outback. Beth’s career takes her from the city to the bush, bonding with people from all walks of life at one of the most important moments in their lives. But there was one more frontier she was determined to conquer. At a time when most people are thinking about slowing down, Beth decides to move to a remote Aboriginal community in Arnhem Land to embark on a whole new adventure.

therapy guaifenesin (sic). It also looks at how pain is experienced, explores the possibility that fibromyalgia may be due to a rogue gene, and clarifies the difference between fibromyalgia and chronic fatigue syndrome.

Nurse And Patient Language Helper With Midwife Supplement Published by Hand Picked Diaries: available from ANMF (Victorian Branch): RRP $ 5.00. ISBN 9780980522280

The new Nurse and Patient Language Helper is a wonderful new resource. With over 50 languages and a Midwife Supplement contained within, this book will facilitate communication with our non-English speaking patients and their families. The publication is an extension of the language materials trialled through the annual Victorian Nurse Diary. It includes translations for nurses and midwives to communicate with patients in 50 languages as well as an additional section for midwives in five of these languages. All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here via the Library’s Online Catalogue: visit http:// Call 8595 1234 or 1300 367 962, or email for assistance with loans or research. Some books are reviewed using information supplied and have not been independently reviewed. THE LAMP JUNE 2017 | 47







Autumn is here. Keep warm in NSWNMA winter favourites which are not only stylish & comfortable,but also affordable & sold at cost to members. 1 CLEARANCE! Navy Bonded Polar Fleece Vests $15. Quantity:





2 Navy Hoodies $45. Quantity: Size:

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FAX (02) 9662 1414 POST NSWNMA, 50 O’Dea Ave. Waterloo NSW 2017






Hampstead A love letter to England Susan Miles enjoys a lovely tale with an unlikely romance between a widowed American woman and a homeless Irishman on beautiful Hampstead Heath.

I took my expat friend Jackie to the preview of this totally “makes you fall in love with England” movie. Hampstead is based on the true story, of Harry Hallowes, also known as “Harry the Hermit”, a homeless man from Ireland who lived in a shack on Hampstead Heath for years. Diane Keaton plays Emily, a recently widowed, and recently cheated-on American. Emily finds unexpected romance with the hermit after she accidentally spies upon him whilst looking out her attic space with binoculars. Donald, (Brendan Gleeson) gets initially unwanted assistance from Emily in challenging developers who want the shack gone and romance follows. 

This charming tale plays out in a quintessential English village, with beautifully filmed twilight summer park scenes, and a musical score that features the sweet sounds of English birdsong. The film has a Notting Hill feel about it and Hampstead will probably feature on places to visit when next in the U.K. It is a film that takes you on a lovely journey. Jackie delighted in the sweet chirping of English birds, and it made her slightly homesick. This charming tale should be enjoyed on the big screen, to appreciate the loveliness of the English backdrop at its visual best.

Email The Lamp by the 12th of the month to be in the draw to win a double pass to Hampstead thanks to EntertainmentOne. Email your name, membership number, address and telephone number to lamp@nswnma. for a chance to win!















at the movies

Susan Miles, a Clinical Nurse Consultant, Mental Health PMBC, Royal Prince Alfred Hospital is this month’s reviewer. If you would like to be a movie reviewer, email



Agatha Christie’s Witness For The Prosecution It’s 1920’s London and the glamorous heiress Emily French (Kim Cattrall) has been found brutally murdered in her handsome townhouse. A young, handsome chancer, Leonard Vole, (Billy Howle) is accused of the crime and it seems like an open and shut case. His penniless solicitor, John Mayhew (Toby Jones), clings to the hope that Leonard’s wife Romaine (Andrea Riseborough), an enigmatic chorus girl, will provide the alibi to save his life; but she soon proves to be a far from reliable witness. As Mayhew starts to connect with Leonard, his need to prove the young man’s innocence becomes more than a professional obligation. Betrayed by his wife and with the odds stacked against him, all seems lost for Leonard until a piece of evidence surfaces that could change everything. Email The Lamp by the 15th of the month to be in the draw to win a DVD of Agatha Christie’s Witness for the Prosecution thanks to Acorn Media. Email your name, membership number, address and telephone number to lamp@nswnma. for a chance to win! THE LAMP JUNE 2017 | 49


make a date

Diary Dates for conferences, seminars, meetings, and reunions is a free service for members.

EVENTS: NSW Resus at the Park 1–2 June 2017, Luna Park, Sydney Psychosocial Dimensions of End Stage Kidney Disease 10 Thursday August, 2017 St George Hospital, Kogarah Renal Supportive Care Symposium 11 Friday August, 2017 St George Hospital, Kogarah Drug and Alcohol Nurses of Australasia’s Nursing Forum 11 August 2017, Sydney 4th International Collaboration of Perianaesthesia Nurses [ICPAN] Conference 1-4 November 2017, Luna Park, Sydney Australian College of Critical Care Nurses NSW Branch Seminar 17 November 2017 Colombo House Theatres, UNSW, Randwick event/nsw-critical-care-seminar-17november-2017 Westmead Hospital Critical Care Nursing Conference 3 November 2017 Jennifer Yanga: Jennifer.Yanga@health.nsw. EVENTS: INTERSTATE NIMAC Clinical Workshop, Conference and Trade Exhibition 7-9 June 2017 RACV Royal Pines Resort, Gold Coast Australian Faith Community Nurses Association “Dying Well” Conference 19-20 June 2017 ‘Nunyara’ Conference Centre, Belair, SA

50 | THE LAMP JUNE 2017

Please send event details in the format used here: event name, date and location, contact details – by the 5th of each preceding month. Send your event details to: Fax 02 9662 1414 Post 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space. Priority is given to non-profit professional events.

No More Harm National Conference 26-27 June 2017, Brisbane 4th National Eating Disorders and Obesity Conference 7-8 August 2017, Gold Coast 18th International Mental Health Conference 21-23 August 2017, Gold Coast The Art and Science of Spiritual Care October 2017, Adelaide 20th ACM National Conference 2017 30 October – 2 November Adelaide EVENTS: INTERNATIONAL Patient Safety Congress 4–5 July 2017, Manchester, UK 6th World Congress of Clinical Safety 6-8 September 2017, Rome, Italy 8th International Nursing and Midwifery Student Conference in Spiritual Care: Spiritual Care – A resource in nursing 21–22 September 2017 Copenhagen, Denmark IHF 41st World Hospital Congress 7 October – 9 November Taipei International Convention Centre, Taiwan https://ihfnews.files.wordpress. com/2017/01/ihf-taipei-call-for-abstracts11jan17.pdf 10th European Congress on Violence in Clinical Psychiatry 26–28 October 2017 Crown Plaza, Dublin, Ireland ECVCP/index.html 4th Commonwealth Nurses and Midwives Conference 12 March 2018, London UK conference2018 NCFI PACEA Conference ‘For such a time as this – Christian nursing in a troubled world’ 7-11 June 2018, Taipei, Taiwan ncfi-pacea-regional-conference EVENTS: REUNIONS Royal Prince Alfred Hospital PTS March 1976, 7 June 2017 Trish Walcott: 0402 159 352 Sydney Hospital Graduate Nurses’ Reunion Lunch 4 October 2017 Parliament House, Macquarie Street Jeanette Fox: (02) 4751 4829 or St George Hospital Graduate Nurses Association 70th Anniversary and Reunion, 22 October 2017, 12 noon The Gardens on Forest, 764 Forest Rd, Peakhurst Joan Wagstaff: 02 9771 2508 Prince of Wales, Prince Henry Hospitals and Eastern Suburbs NSW of UNSW 1973 PTS class 17 February 2018, 6 pm Malabar (Randwick) Golf Club Roslyn Kerr: Patricia Marshall (Purdy): tapric135@ Tamworth Base Hospital February 1984 Intake 30-year Reunion 25 November 2017 Tamworth Base Hospital February 1976 intake 40-year Reunion Sandra Cox: sandra.cox@hnehealth.nsw Sean O’Connor: 0408 349 126 Gerard Jeffery: 0417 664 993 CROSSWORD SOLUTION





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*Maximum recommended driveaway price for new models ordered between 1/5/2017 and 30/06/2017 and delivered by 31/07/2017 including dealer delivery and statutory charges. Prices may vary between dealers. Premium paint available at additional cost. Excludes Government, Rental and National Fleet customers. Nissan reserves the right to vary, extend or withdraw this offer. †Accessories offers on new models ordered between 1/5/17 and 30/6/17 and delivered by 31/7/17. Accessories are not redeemable for cash. Excludes Government, Rental and National Fleet customers. Not available in conjunction with any other offer. Nissan reserves the right to vary, extend or withdraw this offer. ^2.9% comparison rate for approved personal applicants and 2.9% annual percentage rate for approved business applicants of Nissan Financial Services (Australian Credit Licence Number 391464) only. Maximum term 36 months. Terms, conditions and fees apply. No deposit for approved applicants only. WARNING: This comparison rate is true only for the example given and may not include all fees and charges. Different terms, fees or other loan amounts might result in a different comparison rate. This comparison rate for the purpose of the National Credit Code is based on a 5 year secured loan of $30,000 although this offer relates to a 36 month term only. Offer available on new models purchased between 1/5/17 and 30/6/17 and delivered by 31/7/17. Excludes special editions. Excludes Government, Rental and National Fleet customers. Weekly offer based on a consumer loan for a non-premium paint vehicle with a driveaway price of (1) $25990 (2) $24,990 financed over 36 months with monthly repayments of (1) $408.74 (2) 366.41 and a balloon payment of (1) $12995 (2) 13,494.60 Total amount payable over the term (1) $27709.64 (2) $26,685.36. Nissan reserves the right to vary, extend or withdraw this offer. Not available in conjunction with any other offer.#$500 accessories valid with every new car sold and delivered between 1 – 30 June 2017. All offers end 30 June 2017. Highland Kackell Pty Ltd trading as Lander Nissan dealer license MD20305. YPA3185-FP


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Lamp June 2017  

In this issue of the Lamp: the big silence on ratios, short-notice rosters a bug-bear fr many, housing affordability, the case for more nurs...

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