The Lamp - February 2021

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Healthscope gets thumbs down page 12



More staff the key

Solidarity is at the heart of COVID success

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Your rights and entitlements at work p.35 Nursing research online p.37 Crossword p.45 Reviews p.47




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CONTENTS Contacts NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including The 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


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Blacktown goes after safer staffing Taking action has helped midwives and nurses secure a promised staffing increase for Blacktown Hospital’s maternity service.



HEALTHSCOPE GETS THUMBS DOWN Nurses and midwives vote for improved staffing by rejecting Healthscope’s enterprise agreement.

Information & Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Adrian Hayward, 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.


Privacy Statement The NSWNMA collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information, please contact the NSWNMA office. If you are still not satisfied that your privacy is being maintained, you can contact the Privacy Commission. Subscriptions for 2019 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $30. Individuals $84, Institutions $140, Overseas $150.


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More staff the key to better rural healthcare The NSWNMA has given MPs a set of proposals to improve the dire condition of rural and regional healthcare.


Solidarity is at the heart of our COVID success The pandemic shows that when union voices are listened to, the country benefits.



5 6 35 36 37 38 45 47 49

Editorial Your letters Ask Judith What’s on Nursing Research Online and Professional Issues News in brief Crossword Book Club At the Movies


Federal government ‘pokes another hole in super’ The Morrison government has flagged the prospect of ‘opt-in super’ when the whole point of superannuation is that it is compulsory.




Royal Commission’s aged care report imminent The Lamp spoke to two members about their hopes for the sector in the wake of the commission.


Healthscope gets thumbs down page 12



More staff the key

Solidarity is at the heart of COVID success

page 16

page 24

Your rights and entitlements at work p.35 Nursing research online p.37 Crossword p.45 Reviews p.47




Violence gets worse – but incident reporting is flawed Physical violence in NSW hospitals has significantly increased and nurses are disproportionately affected. However, NSW Health’s system for reporting incidents is flawed.


OUR COVER: Rachel O’Donnell & Katie Conciatore Photographed by Irina Troitskaya THE LAMP FEBRUARY/MARCH 2021 | 3

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Collective action is vital as we navigate a pathway out of the pandemic Solidarity has been at the heart of our success against COVID and we’ll need a lot more of it to deal with the financial and political consequences of the coronavirus. A commitment to collectivism is what helped to protect us during the pandemic and it also gave us “a glimpse of what is possible”. This was the stirring message ACTU Secretary Sally McManus gave us in a recent speech to the National Press Club (see p. 24). Sally was talking of the social contract that has always existed in Australia – the notion that when any of us stumble the rest of us will be there to help them back up. This has led to Australians accepting the need for lockdowns, mask wearing and social distancing during COVID so the wider population is protected from the virus. In the United States, with its more individualistic culture, these measures have not been so readily accepted and the tragic consequences have been chaos and more than 400,000 deaths. The economic measures implemented during COVID to alleviate some of the poverty and economic stress and to save jobs have also shown what governments can do when they show the necessary political will. While 2020 focused on meeting the clinical challenges of beating the virus, 2021 is likely to see the economic and political consequences manifest themselves more clearly. There are ample signs appearing that our work will be cut out for us as unionists if we are to maintain our standards of living and protect our hard-earned safety nets. A recent report by the respected economic forecaster Deloitte Access Economics paints a positive future for Australian companies as

we attempt to rebound out of the pandemic but at the same time it predicts a dire outlook for wages. Deloitte says Australian workers could be waiting up to five years for a return to 2 per cent wage growth. This is a shift in power from workers to employers and it doesn’t happen on its own – it is driven by politics. It is a choice made by governments. The Morrison government has flagged its intentions to help facilitate this shift in power with the introduction of a new industrial relations bill (see p. 26).

accessible to all as priorities for government spending. Converting to renewables and fighting climate change as well as adequately resourcing our public health and aged care systems are also important priorities. Reich says it is not a question of affordability. “Such an agenda won’t burden future generations. It will reduce the burden on future generations. It is a question of political will.”

It is a bill which “favours employers over employees” according to IR experts.

Nurses and midwives must continue to show strength and will to protect the health system that has served the country so well during COVID.

It will allow employers to cut pay and wipe out claims for back pay for casuals. It also proposes new flexibility for part timers which would see them lose overtime rates.

In this month’s Lamp we feature members who have stood tall in these difficult days defending the rights of our patients and our professions.

It doesn’t have to be this way. It is clear that things cannot go back to what they were before the pandemic but as the former US Secretary of Labor Robert Reich has eloquently described:

At Blacktown Hospital our members took action to force management to confront the chronic staff shortages across maternity services after the tragic loss of a number of babies (see p.8).

“The moment calls for public investment on a scale far greater than necessary for COVID relief or stimulus – large enough to begin the restructuring of the economy.”

Taking such action is a drastic measure but when babies’ lives are at stake there is a moral imperative and professional obligation to act.

Reich cites universal early childhood education, universal access to the internet, world-class schools and public universities

Standing together has been a prerequisite for combatting COVID. Strong collective action will be needed even more as we navigate a pathway out of the pandemic. n

‘ Taking such action is a drastic measure but when babies’ lives are at stake there is a moral imperative and professional obligation to act.’ THE LAMP FEBRUARY/MARCH 2021 | 5



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The World Health Organization has designated 2021 as the Year of Health and Care Workers – an acknowledgement of the great work that the health workforce has done through the COVID-19 pandemic. While that’s all well and good, it makes me wonder when the accolades will finally turn into real action, which actually improves the lives of health workers. What material benefit does this recognition have on our professions? In the Year of the Nurse and Midwife, our professions faced a cruel wage cut and rampant understaffing, as well as being forced to fight for the necessary PPE required to do our jobs. Will this year bring more cuts, more freezes and more insults to workers who have literally put their lives on the line? Governments have become experts at patronising rhetoric. Thanking nurses and midwives while attacking our professions and our conditions simply does not cut it.

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The credit is welcome, but ultimately that doesn’t pay the bills.

Brett Sutherland, EN

Sign up to improve aged care The Royal Commission into Aged Care is due to hand down its findings in late February. The findings will include recommendations aimed at improving the state of Australia’s aged care sector. However, the government is under no obligation to implement the recommendations. Aged care members of the NSWNMA, like me, have begun a campaign to raise awareness about the importance of issues such as safe staffing. We hope the campaign will generate the momentum needed to convince our government that voters want to see change. In recent weeks, aged care nurses have met to kickstart a series of actions to draw publicity to the issues in the sector. Our group has been meeting fortnightly via Zoom, which has enabled us to discuss a plan of action. So far, the members involved have campaigned to draw attention to nurse-to-resident ratios and transparency of government funding. The next phase will involve branches holding a week of action in the lead-up to the Royal Commission findings, to raise awareness of the findings. We are keen to include as many nurses and midwives as possible, so please sign up to the campaign if you would

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.

like to get involved: The groups will continue to meet via Zoom on a fortnightly basis. It’s a great platform to network and support each other in our efforts to improve the state of aged care. We urge you to please join in! If you are interested in getting involved, contact blewer@

Helen Auld, AiN

NSWNMA members invited to join Hunter Jobs Alliance On 27 October 2020, The Climate of the Nation report was released, showing that 71 per cent of Australians think our country should be a world leader on climate action. Are you one of these people? Have you ever wondered how you can help, beyond changing your light bulbs and moving your super out of fossil fuel investments? The good news is that NSWNMA members now have a unique opportunity to help shift the debate on climate change in this country. Around the world, communities have successfully transitioned away from the fossil fuel industry, while building up alternative avenues of employment and retraining employees so that no worker is left behind. However, this doesn’t happen without a plan that involves workers at the outset. When left up to the market, mining companies routinely make a quick exit from dependent communities, without any thought for the future livelihoods of their employees. It is only when unions and government advocate for workers that they are protected from the shocks of the fossil fuel market. We already know that the age of coal is coming to an end. Enter the Hunter Jobs Alliance. The HJA is a newly formed organisation, uniting unions with environmental groups who want to see a plan for low-carbon jobs in the Hunter Valley. Workers in the Hunter urgently need a plan that will protect their livelihoods, and work on this plan needs to start right now. As NSWNMA members, we are eligible to join the HJA and start the outreach to coal workers and communities, helping to formulate and fight for a transition plan.

Erin Killion-Delcastillo, RN

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WANT TO GET MORE INVOLVED? Join NSWNMA Activist Facebook page: https://

LETTER OF THE MONTH Healthscope members are united! I was lucky enough to be asked to be part of the NSWNMA bargaining team for our new Healthscope Agreement. The bargaining process was delayed due to COVID-19, but after a few months of stasis, Healthscope decided to take their revised EBA to their nurses and midwives for a vote. It was important for us to get a NO vote, as Healthscope was offering us nothing. We needed to win so we could get back to bargaining and get Healthscope to LISTEN to our real needs. Healthscope worked hard to promote their agreement by telling staff how lucky they were with their new wage rise, and as a bonus if we voted Yes, we would be back paid our 1 per cent to last July. They started with lovely posters showing public hospital wage tiers and our comparisons. However, we were ready to fight back. We spoke with our staff and asked how they were feeling. We explained that Healthscope had not been listening to our claims and concerns, including staffing issues, lack of meal breaks and the amount of overtime worked. As the vote came to a head, hospital executives were telling staff that if they voted against the proposal, they would get nothing. However, we countered that a successful NO vote would give us more power and we would be going back to bargaining. Our NO vote won! This was exciting and it showed Healthscope that we are a united team across all NSW hospitals. We proved that they needed to listen to their nurses and midwives, be more flexible and give us a safer, happier working environment. Healthscope, let’s get back to bargaining so you can fix our issues! Julie Goss, RM CME

23/02/15 11:53 AM



Blacktown goes after safer staffing Taking action has helped midwives and nurses secure a promised staffing increase for Blacktown Hospital’s maternity service.


More than 150 midwives and nurses walked out during afternoon shift, after a vote by members of the NSWNM A’s Blacktown Hospita l bra nch work ing in maternity services. More than 80 per cent of members at the meeting voted to act. They were joined by nurses from across the hospital who walked off the job in a show of support for their colleagues, who were advocating for safe patient care. Members ensured enough staff stayed at work to keep affected units open and functioning. The vote followed the deaths of five newborns at the hospital over the previous 18 months. The number of babies delivered has increased rapidly over recent years, with an average of 11.5 births every 24 hours. About 20 obstetricians had threatened to resign over unsafe staffing shortly before the midwives and nurses took action. NSWNMA General Secretary Brett Holmes said management had failed to act decisively to improve patient safety. Midwives had been “understandably traumatised by tragic deaths and believe the staffing issue has become untenable, putting their registration at risk," he said. Management of Western Sydney Local Health District (WSLHD) immediately took the dispute to the NSW Industrial Relations Commission (IRC), which, as expected, ordered staff to go back to work.


‘ More needs to be done to ensure improvements across the service and hospital and together, we can do this.’ — NSWNMA General Secretary, Brett Holmes The IRC also ordered that no action be taken by any NSWNMA member working in the NSW public health system for three months. But the action gained wide media attention for the midwives’ safety concerns and got the issue into the IRC, where management had to commit to resolve the midwife shortage. As a result, the hospital has started advertising for an additional 15 full-time-equivalent midwives, an after-hours clinical midwifery educator and backfilled the vacant skin-to-skin midwife position. Data collection for Birthrate Plus – the tool NSW Health uses to determine maternity staffing levels – is also underway and is expected to be completed in February/March 2021. Management agreed to expedite the Birthrate Plus review by six months, after members highlighted the 30 per cent increase in birth numbers at Blacktown Hospital. Midwives hope this will lead to further midwifery positions being created. Brett said the commitments achieved were “a great outcome” for all nurses and midwives at Blacktown Hospital.

He said it came as a result of branch members taking action, attending meetings and rallies, speaking to media and giving evidence at the IRC. “More needs to be done to ensure improvements across the service and hospital and together we can do this,” he said. NSWNMA members still had to apply further pressure to hold management to its commitment to increase the number of midwives by 15 FTE positions. They rallied in their own time outside Blacktown Hospital to demand that WSLHD advertise the positions without delay and act on other staffing issues, rather than referring them to a sub-committee for further delay. The NSWNMA then filed a dispute in the IRC, which caused management to advertise the new positions just hours before the IRC hearing began. Talks over maternity services cont inued at t he hospita l’s Reasonable Workload Committee in January. NSWNMA reps said there was a more open discussion and “management were willing to discuss items that were previously off the table.” n


‘Everyone is over being short-staffed and under-resourced.’ — Katie Conciatore

Hospital-wide support for maternity staff Members across all services strongly supported the stand taken by Blacktown maternity unit staff.


lacktown Hospital branch president Katie Conciatore said the deaths of newborns had affected all parts of the hospital. “Obviously, dealing with death in a hospital is a part of the job,” she said. “However, when it’s in an area that doesn’t see death often, you wouldn’t find many unaffected by that and looking to do something to improve the situation. “People are happy to support each other because we have been having these same fights over staffing across different departments for years and got nowhere. “Everyone is over being shortstaffed and under-resourced. “The infant deaths just capped it off – particularly because staff

in maternity services have been warning management about this for years. Many nurses from areas such as theatres, emergency, surgical and aged care attended the branch meeting and supported us, Katie said. “After the vote, in the time it took me to walk over to the hospital executive to hand them the resolution and notice that we were walking, the crowd of nurses and midwives in Hospital Street was probably double the number I expected,” she said. “Some of them came with signs such as ‘Aged Care Nurses Support Midwives’. “ They d id n’t sta nd to immediately benefit from showing solidarity. Everyone was saying, it’s the midwives now but we are next.”

STEWARDS’ VITAL ROLE Blacktown branch laid the groundwork for cross-hospital solidarity by building a network of stewards in all services. The branch has 20 stewards across the hospital, including a number in maternity services at the time of the action. “Each time we have issues affecting a particular service – ICU, ED, surgical ward, aged care ward – we can alert stewards across the hospital,” Katie said. “They can quickly share info to members and go around their units to talk to people. “This allows us to get people to a meeting quickly. The meeting was called in the morning and held with a huge attendance in the afternoon.” n



Walkout sends a strong message Blacktown Hospital midwives take strong action to protect the health and safety of mothers and babies in their care.


SWNMA branch steward Rachel O’Donnell said members discussed the pros and cons of action before the NSWNMA branch meeting vote. “How would we go about it? And how would it benefit us? “Once we understood how it would work, and how we could ensure it would not leave the wards without any staff, people were worked up enough to support it,” Rachel said. “There wasn’t a lot of trust in management because we had been trying to work with them to solve staffing issues for at least 18 months. They had made a lot of empty promises and none of us wanted it to drag on any longer.” Representatives of midwives and the branch met with Western Sydney Local Health District management on the morning of the action. Management offered to employ another 15 midwives but would not commit to a time frame. The LHD


also wanted to send all other issues off to a committee of managers and midwives for more discussion.

at the day sheets and worked out the numbers who needed to stay behind during the action.

The branch called a meeting where “the feeling was that we had to send a clear message that we were ready to stand together to fight for what was right for patients and staff.”


“We wanted to keep the issue in the spotlight so management couldn’t keep delaying things.” The walkout covered the birthing unit and maternity ward along with members from outside the maternity service such as theatres and general medical wards. “We did a lot of work to spread the word and gain support throughout the hospital,” Rachel said. “We already had a lot of support from theatres because we work closely with them. Our branch officials were always really supportive; they sent messages to other wards and got positive feedback from them. Union reps on the wards looked

The vote took place at the end of morning shift and was overwhelmingly in favour. The afternoon staff walked out as a group and gathered outside the hospital for a short, lively meeting. “It was a very positive atmosphere,” Rachel said. She and others expected to be ordered back to work by the Industrial Relations Commission. “But when the order finally came, it was a blow to some of the midwives and created some uncertainty. Some of them were asking, does this mean we’ve lost? “However, most knew they had sent a strong and unified message to management. I think it was cathartic for the midwives to stand up and tell management they had had enough.” Rachel says the dispute has strengthened ties between midwives


‘It was cathartic for the midwives to stand up and tell management they had had enough.’ — Rachel O’Donnell

and their union, the NSWNMA.

and that was always our goal.”

“Before this dispute we knew the union was there but didn’t really know how we could engage with them or how exactly they could help us,” she said.

Rachel said the new, modern maternity wing was welcomed by all and it was a relief to now see new positions finally being advertised that were needed to staff it properly.

“Now there is a more positive feeling that the union can help us when we’re really stuck. “A lot of the staff see the union as more accessible and realise together we are the union. “The people from the union office were great. They were there for us when we needed them and they let us make our own decisions. “They helped us advocate for the staffing levels we know mums and babies need. Without their guidance and support we definitely wouldn’t have got anything like we did. “There’s still a lot of work to do but this whole process will help to improve the care we can provide to mothers and babies

“The birthing unit is quite excited about the prospect of getting an after-hours clinical midwifery educator. It will help relieve the pressure on midwives in terms of educating students and provide better support for students. “It is also important to have achieved an agreement that the Midwifery Unit Manager 1 will not be expected to perform MUM 3 duties while she is on leave because we can now have the NUM 1 working effectively.” n

Staffing lags behind births Since 2015, births at Blacktown Hospital have increased 52 per cent, while staffing has only risen 11 per cent. Blacktown was averaging 11.5 births every 24 hours last November, with often only seven midwives rostered per shift. Meanwhile, at Westmead Hospital, midwives were assisting with an average 13.7 births in 24 hours, with 10 midwives rostered per shift. Blacktown midwives were being rostered for multiple day and night shifts of up to 64 hours over seven days despite 56 hours being the maximum allowed. THE LAMP FEBRUARY/MARCH 2021 | 11


Healthscope gets thumbs down Nurses and midwives vote for improved staffing by rejecting Healthscope’s enterprise agreement.


ealthscope nurses have voted to reject a company proposa l for a new enterprise agreement that offered no solution to widespread understaffing of its hospitals.

A slightly improved offer that went to the vote included back pay of 1 per cent from July 2020 and 1 per cent from July 2021, plus a 10-hour break after overtime but not between shifts.

Healthscope arranged the secret ballot in December. It was run by an independent organisation called Elections Australia.


Healthscope did not disclose the voting numbers but feedback from NSWNMA members suggests the ‘No’ vote advocated by the union achieved a comfortable majority. Owned by Brookfield, a Canadian company, Healthscope operates 12 hospitals and clinics in NSW. The current enterprise agreement expired in February 2020 and a pay increase was due in July 2020. Bargaining between Healthscope and NSWNM A representatives started in September, after a long delay due to COVID-19. Healthscope initially offered a 1 per cent pay increase from October, and 1 per cent from October 2021, with no other major improvements. 12 | THE LAMP FEBRUARY/MARCH 2021

NSW NM A Act ing G enera l Secretary, Judith Kiejda, said members in all Healthscope facilities were looking for staffing improvements, which the company failed to offer. She said the NSWNMA decided its position after consulting with members every step of the way. “Members told us they were sick of not having enough staff rostered on to take meal breaks and needed a 10-hour break between shifts and after overtime,” she said. “Members said their priorities were staffing improvements, a fair wage increase and protection of existing conditions for Northern Beaches ‘migrating employees’.” Bargaining reached an impasse

when Healthscope refused to consider the NSWNM A’s safe staffing claims. There were no improvements to staffing, no solution to missed meal and tea breaks, and no 10-hour break between shifts. Healthscope’s “final” offer also included less leave for part-time shift workers than the legal minimum. For “migrating employees”, Hea lt h scop e’s of fer sla she d their conditions by removing nursing-hours-per-patient-day ratios and eliminating 10-hour breaks between shifts. There were cuts to parental and other forms of leave, removal of accrued days off and cuts to redundancy pay.

STAFF TOOK DIM VIEW OF OFFER Staff generally took a dim view of Healthscope’s enterprise agreement offer, said Rohini Kiran, a member of the NSWNMA’s Healthscope EA leadership team. “Some said it was a joke, others called it an insult, so I


More nurses are a priority

‘Some said it was a joke, others called it an insult, so I wasn’t surprised by the No vote.’ — Rohini Kiran wasn’t surprised by the ‘No’ vote,” Rohini said. “With all the work we do, what is a 1 per cent pay rise with no staffing improvements?” She said, “On a positive note, I love working for Healthscope” but added that inadequate staffing is the biggest concern among nurses. “In my case, I work night shift with a 12-patient load alongside an RN or EN, also with 12 patients. “Also, I am sometimes ‘hospital in charge’, with overall responsibility for about 100 patients. “If something happens on another ward, I have to leave my colleague on their own to attend to the

Theatre nurses at Newcastle Private Hospital want improved staffing arrangements and a reasonable pay increase as priorities in the next enterprise agreement, said NSWNMA branch steward and theatre RN Sheoni Corrigan. “We don’t have the number of staff we need to run our theatres efficiently,” Sheoni said. “We need to find a way to staff our theatres better, or not do so many operations. “We need more nurses on shift and ‘like-for-like’ replacement of nurses on leave, to reduce excessive workloads. We need our meal breaks enforced.” Sheoni said theatre staff believe an increase in parental leave – currently 10 weeks – is also important. “Our staff are pretty much on the same page and generally disappointed that Healthscope didn’t offer anything that reflected our hard work and dedication. “The overwhelming feeling was that the company offer was inadequate, and I believe that feeling is shared by other areas of the hospital, which are all short-staffed.”

problem. That’s a potentially dangerous situation. “Some wards do not have an AiN on night shift to help with heavy patients. “When the patient load goes down to 23 on the ward, they start cutting staff. They look at numbers, not the acuity of patients.” She said excessive workloads often cause staff to miss out on breaks. Rohini said insufficient breaks

‘Our staff are generally disappointed that Healthscope didn’t offer anything that reflected our hard work and dedication.’ — Sheoni Corrigan

between shifts is “a huge issue”. “Before I started night shift, I worked evenings and sometimes I’d be asked to stay back and work a night shift. By the time 7.30 am comes around, your feet are burning. And then they’d still expect you to come in at 4 pm. “If you are tired and exhausted and make a mistake, who does it fall on? I wonder if management will take the blame. It’s the nurse who will lose their registration.” n THE LAMP FEBRUARY/MARCH 2021 | 13


Staff commitment goes unrewarded Northern Beaches Hospital nurses and midwives are united in seeking safer staffing ratios.

Mandator y ratios would make everyone’s job safer and more manageable,” says Nor t hern Beaches Hospital branch secretary Felicity Melville.

“P ublic nurses have had minimum staffing levels for years. That’s what all our people want, whether they are classified as migrating staff or work under a Healthscope agreement. “We all want a safe working environment that allows us to give excellent care to patients.” Northern Beaches staff include nurses and midwives who transferred from Mona Vale and Manly public hospitals. Known as “migrating employees”, they are covered by an award copied from the Public Health Award. This award generally provides better conditions than those applying to other Northern Beaches nurses who work under a Healthscope enterprise agreement. 14 | THE LAMP FEBRUARY/MARCH 2021

Copied award conditions include minimum nursing hours per patient day, like-for-like replacement of staff and ACORN standards for operating theatres.

MIGRATING EMPLOYEES’ CONDITIONS UNDER THREAT Migrating employees also have 14 weeks parental leave (compared to 10 in the Healthscope agreement), a higher rate of long service leave accrual, and 10-hour breaks between shifts and after overtime. The copied award applies for five years (from October 2018) unless Healthscope replaces it with another agreement, which it is now seeking to do. Felicity, who came to Northern Beaches from Manly hospital, says staff in both categories have worked well together for two years and are united in seeking a better deal than Healthscope’s offer. She points out that some of the migrating staff worked in public

hospitals for up to 30 years. “They committed to come across and build the new privately-operated hospital, which was a difficult process, especially in the first six months. “We worked really hard to get the new hospital where it is, so we were disappointed to find out that Healthscope undervalued that contribution and wanted to take away conditions the migrating staff had had for a long time. “The branch believes Healthscope should extend at least some of those conditions to all Northern Beaches nurses, who have worked together to create a fantastic environment to provide excellent patient care.”

HEALTHSCOPE DIDN’T LISTEN In an email to all nurses, Healthscope said it was disappointed that staff rejected its offer. Felicity says the email suggests Healthscope did not hear nurses’ concerns.


Public health promise was broken

‘We all want a safe working environment that allows us to give excellent care to patients.’ — Felicity Melville She was not surprised to see the Healthscope offer voted down after the company refused to give any concessions on members’ requests for improvements. “In the emergency department, where I work, we had almost daily discussions about what we wanted to do about the company’s offer,” she says. “We came to a consensus that it would be a ‘no’ vote and that position was very well supported throughout the wards.

an insult. However, it wasn’t the main focus for either group of employees. “There was a positive mood in our branch meetings because everyone was on the same page and we were all fighting for the same things, such as better staffing and non-wage entitlements that were either going to be taken away or not put in place.” n

Healthscope has failed to live up to its commitments to the community served by Northern Beaches Hospital, said NSWNMA General Secretary, Brett Holmes. He said the Berejiklian government promised locals their new hospital would offer the same level of care as any equivalent public hospital in NSW. “The Berejiklian government’s claims have turned out to be false,” he said. “Healthscope is shifting away from the government’s promise, just two years into their 20-year contract. “It wants to remove minimum staffing requirements inside the hospital, pulling the rug out from under nurses and midwives who transferred across from the publicly run former Manly and Mona Vale hospitals. “This means removing the protections of minimum nursing care numbers from the local community, which all other NSW residents receive.” Brett said Healthscope was also refusing a 10-hour break between shifts, which aims to keep patients safe by reducing fatigue among the staff. “Our members have also told us they’re constantly missing breaks within their shifts now that elective surgery is returning to pre-COVID-19 levels. “Healthscope also wants to strip back a host of other working conditions, including maternity and carers leave. “The nurses and midwives at Northern Beaches Hospital want to continue providing a safe level of care to their community, but Healthscope’s plans will only make that harder. “Research clearly tells us that reducing the numbers of qualified nursing hours leads to poorer patient outcomes.”

“Offering only a 1 per cent increase in the Year of the Nurse and the year of COVID-19 was THE LAMP FEBRUARY/MARCH 2021 | 15


More staff the key to better rural healthcare The NSWNMA has given MPs a set of proposals to improve the dire condition of rural and regional healthcare.


NSW NM A submission to a state parliamentary inquiry into rural and regional healthcare says people outside of Sydney ex per ience hea lt h outcome s “substantially poorer” than their Sydney counterparts. “It is not acceptable that residents in the rest of NSW are provided with an inadequately resourced, substandard system of healthcare while metropolitan Sydney residents enjoy far superior access and outcomes,” the submission says. T he NSW NM A represent s 35,000 nurses and midwives employed in Local Health Districts outside Sydney. The submission says rural and regional members are concerned about poor healthcare, not only from a professional perspective. Their concerns also flow from “a deep commitment to their community and the reality that they and their families are also reliant on a system they know is under-resourced.” People living in regional, rural and remote parts of NSW have higher rates of coronary heart disease, stroke, chronic kidney disease, mental ill-health and diabetes, but less access to health services. Their hea lth ser vices are characterised by poor staffing and skill mix, with nurses and midwives routinely working in isolation.


They have limited access to continuing education, rely on colleagues to provide unpaid on-call support, suffer from inadequate security and transport services, and lack of medical cover.

about inappropriate skill mix, such as large numbers of new graduates working in high-risk areas with insufficient supervision and support, or assistants in nursing (AiNs) being used to replace RNs.

Changing population numbers cause fluctuations in demand for care in regional, rural and remote health services. These spikes in demand have implications for workload, staffing and patient safety.

Many rural and remote services can only operate because staff provide on-call coverage in the event of emergencies.

Some hea lth ser vices are impacted by transient employment models such as fly-in, fly-out (FIFO) workers in the mining industry. Similarly, large tourist events, festivals and “grey nomads” all rely on regional, rural and remote healthcare services.

STAFFING IS THE NUMBER ONE ISSUE Staffing is the number one issue raised by NSWNMA members trying to deliver care in regional, rural and remote parts of NSW, the submission says. “On a routine shift they are expected to care for more patients than they have capacity to attend to safely, and when emergencies arise, they are woefully unsupported. “There is also limited access to a casual workforce, which means that it is difficult to replace nurses and midwives who require shortterm leave.” There are significant concerns

This is almost always unpaid – a “flagrant breach” of Award entitlements, the submission says. “If a service cannot operate without a reliable on-call roster, then this needs to be formalised and the cost of paying these allowances must be factored into operating costs.” The submission says a nursehours-per-patient-day (NHPPD) st a f f i ng for mu la ha s b e en implemented in parts of the health system with good effect. The submission recommends that NSW Health adopts the NSWNMA 2018 Ratios claim as the minimum nursing numbers required on each shift. It a lso recommends t hat every aged care facility have a minimum of one RN on duty 24/7.

BURDEN OF DOCTOR SHORTAGE FALLS ON NURSES The lack of on-site medical coverage puts “a huge burden of responsibility” on NSWNMA members, who ex perience


People living in regional, rural and remote parts of NSW have higher rates of coronary heart disease, stroke, chronic kidney disease, mental ill-health and diabetes, but less access to health services.

Afraid to speak out widespread problems with accessing on-call and telehealth doctors. The submission acknowledges that the virtual model of care is a necessity in circumstances where no medical coverage is available. However, facilities that rely on virtual medical officer coverage must have the option of calling in an on-call RN who is within 15 minutes of the site, for support, it argues. The submission notes that, while nurse/health managers are on call, they are often not physically available when needed in the emergency department (ED). Also, unreliable internet coverage impedes access to clinical information systems, telehealth consultations and the delivery of safe, high-quality health care. The submission recommends recruitment of more nurse practitioners to work in rural and regional areas, particularly at

sites that rely on virtual medical officer coverage. It says every ED open 24/7, regardless of how it is classified or described, should have at least three nursing staff rostered on duty, two of whom are qualified to attend to an acute emergency presentation.

ACCESS TO EDUCATION DIFFICULT Rural, regional and remote practice requires nurses to manage higher complexity inter vent ions such as chemotherapy and dialysis while maintaining generalist skills, including “low frequency, high-risk clinical capability such as trauma response”, the submission says. However, nurses find it difficult to access continuing education outside of metropolitan areas. Most signif icantly, the degree of understaffing means that staff cannot be relieved to attend professional development opportunities. n

The NSWNMA submission to parliament’s rural health inquiry includes statements from members across the state. These firsthand reports move beyond official statements and statistics by capturing the experiences of the people on the ground. The submission says it is a fundamental principle of safety and quality in health care that individuals feel empowered to raise concerns about issues that impact on patient safety. However, the submission says many contributors were worried about potential repercussions including “a punitive response from management” if they raised concerns. This was despite the NSWNMA’s “assurances that advocacy is included in both the nursing and midwifery codes of conduct”. For this reason, the submission does not identify individuals.



Inferior staff ratios challenge regional nurses Regional hospitals don’t receive the higher staffing levels that apply to metropolitan hospitals and it’s usually harder to attract nurses to work in smaller towns.


ocated in the town of Bega, South East Regional Hospital services a 300-kilometre stretch of coastline from Mallacoota to Batemans Bay. South East Regional has an emergency department, medical and surgical beds, a maternity unit, paediatric unit, critical care unit, operating theatres including day surgery, renal dialysis chairs, an oncology area, a mental health unit, a sub-acute rehabilitation unit and hospital in the home. It opened in 2016 and will provide 135 beds when at full capacity. As a Group C1 hospital, its staffing ratio is set at five nursing hours per patient day (NHPPD) as compared to six NHPPD for most metropolitan general surgical wards.

“Compared to a metro hospital, we don’t have auxiliary nurses ded icated to ECG s, wou nd dressings and patholog y, for example,” says Diane Lang, president of the NSWNMA’s South East Regional branch. “Our nurses on the wards have to do the ECGs, the complex dressings, cannulation and bloods. “We don’t have an X-ray nurse, which means the ward is shortstaffed when someone takes a patient to radiology. “We don’t have 24-hour cleaning, so nurses have to clean beds in the middle of the night, and there’s no after-hours clerical support aside from one person in ED to do admissions and discharges.

That means nurses at Bega and other regional hospitals are expected to care for five patients – one more than nurses in many bigger hospitals.

“Our after-hours managers on afternoon and night shifts run the whole hospital and are also required to support the MET calls, the code blacks, and the ED when it gets busy.

The disparity goes beyond mere numbers.

“These factors add to the staff workload and disadvantage our


patients compared to patients in metro hospitals.”

INADEQUATE MEDICAL COVERAGE Medical coverage is also inferior, Diane points out. “Most metro hospitals have a ward doctor, but we have one junior medical officer covering three wards on weekends and no medical support after 8 pm aside from ED or ICU. “That makes it difficult for our nurses if, for example, they want to get a fluid order or they are chasing a review of a patient. “Like most non-metropolitan hospitals, we rely on VMOs. They are usually short stays, which makes continuity difficult and adds to the workload of nurses who have to provide extra support. “That also adds to the workload of the clerical staff, who have to organise doctors’ accommodation. The accommodation itself is very costly and eats into our budget.”


‘ You never know what is going to come through the emergency door – you could have a quiet evening, or all hell could break loose. Management doesn’t plan for all hell breaking loose.’ — Diane Lang

Inadequate staffing means work is often exhausting. “You walk out feeling like you haven’t accomplished what you needed to do,” Diane says. “You’re not getting job satisfaction because you’re rushing, and not actually spending time with the patient.” “A lot of nurses get burnt out and leave the profession, or transfer to something different.” Diane says improved staffing ratios would make a “huge difference” to patient care and safety. The ED, for example, would be funded for 1:3 plus a triage nurse. At South East Regional, the triage nurse also cares for ED patients. South East Regional’s NSWNMA branch has been working to get better staffing in the ICU for about two years.

HARD WORK PAYS OFF The hard work recently paid off when the ICU secured an extra nurse on afternoon and night shift,

in the form of a supernumerary, or nurse in charge without a patient load. “We put in a lot of proposals to get that extra nurse. It really helps because the ICU lost a nurse when they had to respond to met calls, which meant someone else had to cover the shift.” The branch is now trying to get additional funded staff in ED. “You never know what is going to come through the emergency door – you could have a quiet evening, or all hell could break loose. Management doesn’t plan for all hell breaking loose.” There is no agency service nearby, so the hospital relies on casuals or overtime when wards are suddenly short-staffed. The hospital has improved its casual pool by setting up a bank nurse group, who are not assigned to a specific ward and can be deployed where needed for a month or two.

“It’s getting harder to attract and retain nurses in the area, and adequate staffing would make the job more attractive.” Diane says incentives are needed to attract more nurses and doctors to regional areas. “We are a beautiful town of about 6000 people on the coast, but there are disadvantages for nurses looking to come here. “We are three hours from Canberra and five to six hours from Sydney or Melbourne, and you have to travel to metro areas to get extended education. “Rental accommodation is in short supply and getting expensive and employment opportunities are limited: you can miss out on a good nurse moving here because there are limited job opportunities for family members.” n



Country nurses hardest hit by violence Anti-violence measures in NSW hospitals are ineffective and nurses are increasingly exposed to more severe forms of violence, MPs told.


he NSWNMA submission to the parliamentary inquiry into rural, regional and remote health services has called on NSW Health to review duress arrangements outside the big cities. The submission says staff at rural and remote services experience higher rates of violence and aggression than those in metropolitan areas. Rural and remote facilities often have too few staff to provide an internal duress response. They often do not have security staff, or if they do, they do not cover all shifts. And they may not have ready access to police. The submission says a review should consider staff numbers across each shift, the availability of security staff by shift, and the availability of external security companies and police. The submission draws on research into violence at work, conducted by the NSWNMA in collaboration with researchers from the University of Technology Sydney (UTS).


The research involved more than 3500 nurses and midwives, making it one of the largest studies undertaken on this topic worldwide. It found that 80 per cent of nurses and midwives had experienced violence at work in the six months before completing the survey. Seventy-six per cent said violent episodes were becoming more frequent.

MENTAL HEALTH UNITS MOST VIOLENT According to NSW Health, about 40 per cent of violent episodes occur in mental health units. Prevention and early intervention into mental health disorders is an important part of reducing exposure to violence, the submission says. From there, providing treatment early and preventing relapses is also critical. NSWNMA members in more isolated areas are worried about an increase in inappropriate drop-offs of intoxicated people for mental health assessments. The submission says that “behav ioura lly disturbed,

intoxicated people are being taken to an ED or mental health unit by police for mental health assessment, even though they are unable to be assessed until they are no longer intoxicated.” This leaves an aggressive person to sober up in hospital rather than at a police station. “If intoxicated persons are to be managed in a hospital setting, this needs to be a secure environment with suitable staffing arrangements in place to manage the risk.” The submission ca lls for improvements to mental health services in regional, rural and remote areas at all levels, from communitybased care through to paediatric intensive care units. It says NSW Health should develop plans to address shortages in mental health nursing staff, including increased opportunities for mental health nurse practitioners.

LIMITED OR NO ON-SITE SECURITY The U TS–NSW NM A study showed that exposure to violence is not restricted to nurses working in emergency departments or in mental


80% 40% of nurses and midwives had experienced violence at work in the six months before completing the survey

of violence occurs in mental health units

health, with workers in a wide range of clinical and specialty areas reporting exposure to violence in the last six months.

receiving reports of worsening ice-related aggression across all areas of nursing, most notably in cardiology.

Rural and regional facilities often have limited or no access to on-site security, the submission says.

Methamphetamine is cardiotoxic and causes damage to heart muscles and arteries.

Use of security personnel across NSW Health facilities “lacks consistency or any clear rationale”. The union recommends that visible, uniformed, unarmed security staff be positioned near emergency departments, psychiatric units and other areas where violent incidents may occur.

ICE AGGRESSION WORSE The submission says methamphetamine use appears to disproportionately affect some regional areas in NSW. These areas are least likely to have access to training, security or sufficient staff to allow for a duress response in an emergency. In addition to the traditional areas of concern – EDs, drug and alcohol services and mental health units – the union is also

It can also cause heart arrhythmias and endocarditis. “Ice users are a very different patient cohort than traditional cardiology patients and wards are less likely to be designed with the management of violence as a key consideration,” the submission says. It points out that duress alarms are not routinely provided in cardiology and nurses in cardiology are unlikely to have appropriate training in the management of violence and aggression.

CONCERN FOR SAFETY The submission conveys the union’s “deep concern” for the safety of community nurses and midwives in rural and remote areas.

The submission conveys the union’s “deep concern” for the safety of community nurses and midwives in rural and remote areas.

duress response. “Nurses visiting patients and mental health consumers, and midwives visiting new mothers and babies in their homes, are often working in isolation in environments not controlled by NSW Health,” it says. “Risk can vary markedly from one visit to the next” and the risk of violence “often relates to the presence of friends and family members”. The submission says the union receives reports of “incredibly unsafe practices” including poor or no initial risk assessment before home visits and no access to duress beyond a mobile phone, which cannot always be accessed in an emergency and does not always have signal coverage. Nurses work in isolation in highrisk environments and there is no system to ensure they have safely exited the home. n

It points out that they are unlikely to have access to security or sufficient staffing numbers for a THE LAMP FEBRUARY/MARCH 2021 | 21


Staffing breakthrough – but nurses still work in isolation The hospital in the Murray River town of Corowa illustrates staffing and safety problems that plague health facilities in rural NSW.


orowa District Hospital’s emergency department (ED) is staffed by a single nurse working in isolation overnight after 8 pm. The hospital has no security guard, and the local police knock off at midnight. Two locked doors separate the ED from the acute ward, where understaffed nurses rarely have time to monitor the CCTV link to the ED. Just one nurse was rostered to the ED across all shifts until December, when the hospital’s NSWNMA branch won funding for a second ED nurse from 11 am–8 pm, usually the busiest period. Murrumbidgee Local Health District agreed to fund the second ED nurse for three months while the hospital’s Reasonable Workloads Committee (RWC) worked out a permanent arrangement for safer staffing. NSWNMA Assistant General Secretary Judith Kiejda said it was an important breakthrough for the branch, which spent 18 months collecting data and building a case for safer staffing. “The branch’s hard work and persistence has paid off and we will continue to support their efforts to get a lasting solution,” Judith said. Corowa Hospital has 18 acute beds including cardiac monitor beds, four ED beds and 31 residential aged care beds. 22 | THE LAMP FEBRUARY/MARCH 2021

‘ We had a great turnout at the branch meeting and the decision to go into dispute restored people’s faith in the process.’ — Erin McMahon As a ‘D’-rated hospital there is no mandatory minimum staffing ratio. However, t he nursing allocation for the acute ward is less than five nursing hours per patient day (NHPPD).

potentially the most dangerous shift,” she said.

Though the branch worked through the RWC to prove the need for a second ED nurse, the Local Health District (LHD) did not approve a staff increase until after NSWNMA branch members voted to lodge a dispute with the LHD.

“Corowa police service a huge area and are generally not on duty after midnight. After that time, we have to call the area police station, which is about 45 minutes’ drive away.

“We had a great turnout at the branch meeting and the decision to go into dispute restored people’s faith in the process,” said branch president, Erin McMahon. “We knew we were potentially going to get somewhere instead of going around in circles.” Erin said to operate safely, the ED must permanently retain the second nurse from 11 am–8 pm and roster a second nurse on night shift to “float” between the ED and the acute ward. “It’s an incredibly risky thing to be working in the ED in isolation, especially overnight, which is

“We can call a security contractor who can supply someone within the hour. It’s a long time to wait if you’ve got a dangerous situation.

“At times, the ED nurse is actually in charge of the hospital. So, when a patient is deteriorating, the ward nurses might have to consult the ED nurse. That means she has to leave the ED unstaffed.” Getting a second ED nurse from 11 am–8 pm is a welcome improvement but it has unintentionally created a staffing problem in the acute ward. The hospital has been forced to fill the ED position by taking nurses off the acute ward because agency nurses have been unobtainable for several months. n

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Solidarity is at the heart of our COVID success The pandemic shows that when union voices are listened to, the country benefits.


‘ I hate to think what this year would have been like without JobKeeper, without paid pandemic leave, without the protections of our safety net of awards and workplace rights.’

o beat COVID, Australians have put individual needs aside to protect others, to protect strangers, to protect the whole, says ACTU Secretary, Sally McManus. “At the heart of Australia’s social contract is a commitment to collectivism – a notion that when any of us stumble, the rest of us will be there to help them back up,” she told the National Press Club (NPC). “And Australians overwhelmingly did this – we did this together. The success of the Victorian lockdown, in which 6.5 million people committed to collective action that would protect not only themselves and their families, but the whole of Australia, is testament to this.” Sally said the response to the pandemic had also given us “a glimpse of what is possible”.

“For a brief period of time we came close to eliminating poverty by lifting JobSeeker; we cancelled punitive work for the dole in indigenous communities; we introduced free childcare for all, ended homelessness by housing people in hotels, and radically increased job security for the majority of the workforce with 24 | THE LAMP FEBRUARY/MARCH 2021

— Sally McManus JobKeeper,” she said. Yanis Varoufakis, a former finance minister of Greece, says this hitherto hidden capacity of the state is an important insight coming out of the pandemic. “What we discovered in 2020 is that governments had been choosing not to exercise their enormous powers. “Governments that proclaimed their impecunity whenever called upon to pay for a hospital here or school there, suddenly discovered oodles of cash to pay for furlough wages, to nationalise railways, take over airlines, support carmakers, and even pop-up g yms and

hairdressers,” he wrote on the Project Syndicate website.

THE HEROISM OF NURSES Sally McManus told the NPC that, for her, the heroes of 2020 were essential workers: “hard working, brave and humble”. Even though they could see what was happening overseas “with ICUs full and health workers getting the virus, and many dying. They knew what they were facing and yet they kept calmly planning, preparing and turning up for work”. Sally spoke of the many nurses in Victoria who came out of retirement and “volunteered to go into the


‘(Nurses) are absolute heroes. Their bravery is something we must never forget as a nation.’ aged care homes when the crisis was raging, people were sick and dying, and existing staff had been put into isolation”. “What (they) experienced was horrifying and traumatic – but day after day, nurses put their hands up to step into these roles. They are absolute heroes. Their bravery is something we must never forget as a nation.”

UNION REPS STEP UP Sally said that union reps in workplaces all around the country also deserve praise for the way they have stepped up during the pandemic “to protect not only their members but the whole community”. “ They worked with their employers to make the necessary changes to see through shutdowns and adjust to the new COVID reality – to make workplaces safe, fairly manage reduced hours and rapidly transition to working from home. “During this pandemic, the voice and role of unions has been central to the national interest.” Sally says Australia’s unique indust r ia l relat ion s system

“delivered when needed”. “It balances fairness and flexibility, and it showed it was capable of changing rapidly and delivering both. This is something we should pause to acknowledge. “The next time an employer lobbyist wants to say the system is inflexible, it should be understood that this is demonstrably untrue.”

PAID PANDEMIC LEAVE HELPED STOPPED THE SPREAD Early in the pandemic, unions recognised there was a huge hole in our pandemic defence. On 3 March – before any restrictions or shutdowns – the ACTU called for paid pandemic leave for all working people. “We knew that people would not have the leave needed for this crisis – leave to stay at home when sick, or when waiting for test results, or because a close contact was positive, or when required to quarantine. And because they did not have this leave, the virus would be spread in workplaces,” says Sally McManus. “The only way to address this was to give all workers paid leave to isolate. This was the way to

significantly reduce the risk of the virus spreading with sick people going to work.”

SUBSIDISING WAGES: A UNION IDEA THAT SAVED JOBS Similarly, on 25 March the ACTU publicly called for a wage subsidy. The federal government initially rejected the idea. “We got together a coalition of economists and academics who argued our point – that the only way through this pandemic was to commit to a historic level of government support for workers in the form of a wage subsidy to keep them in their jobs during lockdown and downturns,” said Sally McManus. “Over 3.5 million workers and sole traders have kept an income and kept their jobs because of JobKeeper. “I hate to think what this year would have been like without JobKeeper, without paid pandemic leave, without the protections of our safety net of awards and workplace rights.”n



Morrison’s new IR bill will weaken worker protections The federal government’s new IR “omnibus” bill, along with attacks on industry superannuation, will weaken the safety net that has served Australia so well during the pandemic. After a token effort at consultation, the federal government has resorted to type with the introduction of its highly partisan industrial relations omnibus bill, say experts.

The five key themes in the bill

In June 2020, Prime Minister Scott Morrison announced the formation of five working groups of employers, unions and government bureaucrats to review IR reform. The groups met over several months.

Employers initially argued for removing penalty rates, overtime pay, and other payments.

The product of these groups is a new IR bill that reflects the five themes of the working parties. According to David Peetz, Professor of Employment Relations at the Centre for Work, Organisation and Wellbeing at Griffith University, the outcome of these “consultations” is a big win for employers. “Like most industrial relations reforms it is principally about affecting who gains income and power in the workplace. “The bulk of the bill ‘favours employers over employees’,” he wrote on The Conversation website. In The Guardian, Paul Karp commented: “The bill creates a path for employers to cut pay due to the impact of Covid-19 on their business, wipes out backpay claims for misclassified casuals, and proposes new flexibility for part-time workers to pick up shifts without overtime rates.”



Peetz says that “haunted by the loss of the 2007 WorkChoices election” the government watered this down slightly to a focus on “award flexibilities”. “The bill enables hours for part-time employees to be increased without any overtime premium. Parttime employees take on the hours’ flexibility that casuals currently have, but at lower pay rates. “The bill also allows employers to give ‘flexible work directions’ to employees to perform new types of work, or at new locations.”

CASUAL EMPLOYMENT Employers wanted to overturn two Federal Court decisions that gave a legal entitlement to annual leave to many long-term employees.

They also wanted a definition of casuals that avoided any possibility of a leave entitlement, and retrospective voiding of any previous entitlement. Karp says this latter measure “could wipe out claims worth up to $39 billion”. Peetz says: “The bill meets employer demands. It enables employers to define any employee as a casual, with no leave entitlements or job security, at the time employment commences, provided certain conditions were met. This is more about power than genuine flexibility in work.”

ENTERPRISE BARGAINING Some employers had called for the “better off overall test” (BOOT) to be abolished. The BOOT means an agreement has to make any worker better off compared to under their award. Peetz says: “The main complexity in the enterprise bargaining system is the


What the ACTU says about the bill “We will not accept workers being worse off – cuts to pay or the taking away of rights. And finally, the changes have to make a start in tackling the biggest problem facing working people as exposed by the pandemic: the unacceptably high number of casual, insecure jobs.

barriers put to unions seeking agreements. The bill addresses none of these, instead aiming to make non-union agreements easier to make.” Unions and Labor argue that suspending the BOOT will result in cuts to take-home pay for one in four workers covered by enterprise agreements.

WAGE THEFT The bill criminalises serious wage theft – where an employer dishonestly engages in a deliberate and systematic pattern of underpaying one or more employees. The bill sets out penalties of four years in prison and up to $1.1 million for an individual and up to $5.6 million for a corporation. Peetz says: “The biggest problem is not that the maximum penalty is too low. Already the maximum is rarely used, and many offences are ignored. Not many are caught, and punishments are light. If you think you won’t be caught, let alone punished, you’ll keep on doing what you’re doing.”

GREENFIELDS AGREEMENTS Greenfields agreements are agreements that cover a new project, usually in construction, but can also cover workplaces like a new hospital. Peetz says: “For up to eight years, any employees recruited to a new “major” project initially approved by a chosen union will be unable to negotiate better conditions through industrial action. A major project is anything worth above $250 million that the minister declares to be “major”. Unions argue locking workers into lengthy pay deals prevents them exercising the right to strike for better pay, and that the threshold has been set so low it will apply to projects like hospitals, not just giant oil and gas projects. n

‘ Any taking away of rights, any attempt to weaken workers’ protections, is a weakening of our social contract and will be resisted by the union movement.’ — Sally McManus, ACTU Secretary

Do Australian workers need another body blow? The Morrison government has unveiled its workplace intentions at a moment when workers are reeling from the impact of the pandemic: • almost a million are unemployed and 1.4 million are underemployed • many have exhausted all their sick leave, annual leave and long service leave • 3 .3 million people have raided their super account.



Federal government ‘pokes another hole in super’ The Morrison government has flagged the prospect of ‘opt-in super’ when the whole point of superannuation is that it is compulsory.


he Morrison government continues to bob and weave as it tries to renege on its election promise to increase the super guarantee to 12 per cent. The super guarantee is scheduled to rise from 9.5 per cent to 10 per cent this year, and then to 12 per cent by 2025. These increases are already legislated and in the leadup to the 2019 federal election the Liberal government promised to implement them. Last year the government indicated that the increases were unaffordable and would hurt wages and jobs. A prominent group of Liberal MPs called for t he ca ncellation of t he increases completely. Now the government is proposing that the additions above 10 per cent be optional. Under this “option”, workers could choose to take additional payments as extra wages rather than as a superannuation contribution. Critics from the superannuation sector, the union movement, economic commentators – and two former prime ministers – have savaged the government’s proposals.


‘ If you want to fix wages growth, fix wages growth. And if you want to improve retirement incomes, don’t instead seek to destroy superannuation because you hate industry funds.’ — economics commentator Greg Jericho Paul Keating, the architect of industry super, said the opt-in, optout approach would require the government to “legislate to compel employers to pay the 2.5 per cent as wages, because the enterprise bargaining system cannot pay them, as the last eight years (of little wages growth) have demonstrated”, the Sydney Morning Herald reported. Industry Super Australia Deputy Chief Executive, Matthew Linden, said the federal government should follow through on the legislated rise rather than “exploring underhanded ways to renege on it”. “Removing the guarantee in the super guarantee to make it ‘optional’ is a recipe for higher taxes, lower

lifetime incomes, and a red-tape nightmare for business,” Mr Linden said. “This isn’t choice – it’s a sneaky tax grab that will leave people worse off and rip up one of the system’s founding principles.”

THE GOVERNMENT IS BEING DISINGENUOUS In The Guardian, economics commentator Greg Jericho branded the government’s proposals as “disingenuous”. “If this government truly wanted to increase wages it would not institute a policy to reduce public servants’ wage growth. It would also not seek to reduce the bargaining power of workers as it has continually sought to do,” he said.


Opt-in, optout will hit workers with higher taxes

‘ This isn’t choice – it’s a sneaky tax grab that will leave people worse off and rip up one of the system’s founding principles.’ — Industry Super Australia Deputy Chief Executive, Matthew Linden

“If you want to fix wages growth, fix wages growth. And if you want to improve retirement incomes, don’t instead seek to destroy superannuation because you hate industry funds.” Former Prime Minister Kevin Rudd was also highly critical of the proposal, describing it as a Liberal Party “ideological obsession”. “(Superannuation) delivers a private benefit for individuals, who are helped to invest for decent retirement, and a public benefit by reducing pressure on the aged pension, creating a strategic pool of investment funds and stabilising the economy against international shocks,” he said.

AC T U S e c r e t a r y, S a l ly McManus, said any delay to the compu lsor y supera n nuat ion guarantee rise would not lead to higher wages. “At a time of great uncertainty and after hundreds of thousands of people emptied their super accounts under the early access scheme, the government should be focused on helping workers rebuild their super balances for a dignified retirement,” she said. “ We c a n not a l low t he pandemic to be the opportunity the government uses to attack the very social institutions and safety nets that we should be treasuring.” n

The federal government’s secret plan to tear up compulsory super by making the increase to 12 per cent optional would be a $20,000 tax grab on the average Australian family, which could also leave them with up to $200,000 less super by retirement, says Industry Super Australia (ISA). Wages are taxed at a higher rate than super contributions, leaving little for workers once the tax office takes its cut. An ISA analysis shows that up to two-thirds of an increase could be lost in higher taxes and reductions in other government support payments. “Figures from the government’s own Retirement Income Review reveal such a plan would leave all income groups worse off – with lower lifetime disposable incomes. It would also be an administrative nightmare to manage an opt-out system – wrapping small business in yet another layer of red tape,” said the superannuation peak body. “Any Budget boost would be short-lived, as the super savings grab would lead to a far higher pension bill for future generations.”



Royal Commission’s aged care report imminent The Royal Commission into Aged Care Quality and Safety is due to deliver its final report on the experiences of residents in the sector, the management of residential homes, and recommendations for reforms by 26 February. The Lamp spoke to two members, RN Angelin Maharaj and AiN Veera Bakthavachalem, about their hopes for the sector in the wake of the commission.

Get involved The NSWNMA will be holding events in the lead up to the release of the Royal Commission’s aged care report. If you would like to get involved contact the NSWNMA at 8595 1234 (metro) or 1300 367 962 (non-metro). Or, register your support at https://


The commission should mandate minimum staffing levels A system that puts profits before residents’ needs has to change, says Angelin Maharaj. During the COVID lockdowns of aged care homes, admissions and bed numbers at the large high-care nursing facility in western Sydney where RN Angelin Maharaj works dropped noticeably. The facility’s operators seized the opportunity to reduce staff. “An order came in from head office to not replace the first three AiNs who might call in sick on any one day,” Angelin explains. “We were not hiring any new staff, and if RNs were sick or on holidays, staff not working on the floor had to fill in. The ACFI [the Aged Care Funding Instrument] staff member, who is an RN, had to come onto the floor. “Staff are burning out from overwork. If they call in and can’t be replaced, it then puts more pressure on everyone else. We have been seeing it even more during the pandemic.” Over the seven years working at the 135-bed nursing home, Angelin has seen a steady decline in staff hours. She is hoping that the final report of the aged care royal commission will mandate minimum staffing levels.

‘ We all need to raise our voices to protect vulnerable residents.’ — Angelin Maharaj


‘Listen to what residents want’ The commission needs to recognise the need for better staffing, meals and training in our aged care facilities.

Since she started work at the centre, Angelin says that the hours of the 20 AiNs on staff have been reduced, with five now working shifts just four hours long, even though the work has become more demanding. Angelin has also seen more newly qualified RNs being thrown into specialist care environments without sufficient mentoring and training. “When I started, we employed many qualified RNs, year three and four and above, but more recently we are hiring all the new grads, and they have no knowledge of psychotropic medications or how to cater for all the dementia care and palliative care. We need to educate and mentor the new grads, but we don’t have the experienced RNs to do that.” Angelin is hoping the royal commission will address staff qualifications levels, and mandate “qualified RNs in all facilities 24/7. I know there are some facilities that don’t have RNs on a nightshift. If RNs aren’t there, AiNs have to administer medication, which is dangerous when there is noone there to oversee them.” “We have to abandon the Aged Care Act 1997, which has allowed the needs of residents to come second to making a profit. I can see what the residents are paying now, and it is not reaching the floor. We are all going to be old one day. We all need to raise our voices to protect vulnerable residents.”

When she first began working at a medium-sized nursing home in Sydney, AiN Veera Bakthavachalem was able to walk at least two residents around the facility every day. Nine years later that’s no longer possible, as staff reductions mean that instead of having two AiNs caring for 11 residents, two AiNs are caring for 16 residents. “Five or six years ago I still had time in the afternoon where I could walk with one or two residents around the facility, and now I don’t have time to finish my work,” says Veera. Like RN Angelin Maharaj, declining staff-to-resident ratios is the biggest issue she is hoping the royal commission will tackle in its final report. “Nine years ago we had reasonable ratios; nowadays each company sets the rules and regulations for their company. Now there is work overload; we can’t provide the good care that residents need.” One RN is rostered to care for 32 residents, and Veera says they are under enormous pressure, too. “They are there to do the medications and the dressings, and to write reports and care plans. RNs are really stressed, and we can understand that because everyone is asking them questions, asking for help.” Last year workloads and stress levels increased further due to COVID, she says. The hours of allied health workers who once regularly worked in the centre have dropped dramatically, too. A physiotherapist now attends just once a week. Now Veera has noticed residents are losing their mobility, and their health is deteriorating much more rapidly. “It is really sad to see the residents nowadays.”

‘ It is really sad to see the residents nowadays.’ — Veera Bakthavachalem Less mobile patients means that the work is much more physically strenuous for nurses. Veera is also hoping that the Commission’s final report will make recommendations about meals in nursing homes. “I feel the residents aren’t eating properly and are losing weight because they give the same food for everyone, instead of listening to what residents want.” Like Angelin, Veera also wants to see younger staff receive more training. “I want to teach them how to look after older people, how to look after people living with dementia.” “Aged care has become a business, for profit, but we are not working with a machine, we are working with people.” n THE LAMP FEBRUARY/MARCH 2021 | 31


Violence gets worse – but incident reporting is flawed Physical violence in NSW hospitals has significantly increased and nurses are disproportionately affected. However, NSW Health’s system for reporting incidents is flawed.


ental health wards are easily the most violent health system workplaces, experiencing 39.5 per cent of all incidents of physical violence in NSW hospitals. The next most dangerous are emergency departments (9 per cent of physical violence) and aged care wards (4.5 per cent). The numbers are published by the NSW Auditor-General, Margaret Crawford, in a report titled Managing the health, safety and wellbeing of nurses and junior doctors in high demand hospital environments. The report says nurses are disproportionately affected by violence. Nurses make up about 40 per cent of the total hospital workforce in NSW and were impacted by 85.5 per cent of hospital health and safety incidents during the first half of 2019. Physical violence in hospitals increased by over 13 per cent from 2017 to 2018 (more recent data was unavailable due to the re-deployment of ministry staff to deal with COVID-19).

INCIDENT REPORTING The Auditor- General finds that the hospital information management system known as IIMS or IMS+ is not capable of rapidly recording multiple risks in wards where incidents are common. The report recognises that in areas such as mental health wards and EDs, incidents occur in high 32 | THE LAMP FEBRUARY/MARCH 2021

‘ NSW Health’s incident management system is not designed for rapid reporting.’ — NSW Auditor-General numbers and incident reporting can be extensive. “In these wards, staff are required to manage clinical workloads along with all incident reporting requirements,” it says. “N S W He a lt h’s i nc ide nt management system is not designed for rapid reporting. A number of screens must be navigated, and a range of classification details must be completed to progress through each stage of the system and ultimately finalise a record.”

MANUAL HANDLING EQUIPMENT The report finds that nurses do not always have access to essential safety equipment – particularly manual handling equipment. Nurses report that equipment is sometimes poorly located or hard to find, and sometimes they lack training in how to use new equipment. In some hospitals, staff advised that equipment was broken or there was insufficient equipment for all hospital wards.

UNPAID OVERTIME The report says NSW Health’s rostering system is designed so that staff working hours comply with

health and safety regulations. It says the system sends alerts to managers when staff hours fail to comply with health and safety guidelines. However, all nurses interviewed for the audit explained they do not log excess hours in the HealthRoster system “because it is not customary for nurses to claim overtime for administrative tasks, so they do not record, claim or seek remuneration for excess hours.” “As there are no records of their hours, there is no information for managers to understand the levels of overtime.” Almost 90 per cent of nurses interviewed for the audit reported working unpaid overtime and almost one-third did so on a daily basis. “When asked why they do not claim overtime, all nurses we spoke to advised that they are not permitted to claim overtime to complete outstanding administrative tasks,” it said. “Any overtime requires preapproval from more senior managers, and these approvals are only made for overtime that is for clinical overflow tasks.” n


US working families now prey to twin epidemics With two epidemics now raging at once, life expectancy is set to fall markedly in the United States in 2021.


y the end of 2020 the United States had reached the frightening milestone of 20 million coronavirus cases with a national death toll of over 350,000 people.

“The rise in deaths that we describe (from deaths of despair) is concentrated almost entirely among those without a bachelor’s degree, a qualification that also tends to divide people in terms of e mp loy m e n t , r e mu n e r a t io n , morbidity, marriage, and social esteem – all keys to a good life.

As The Lamp went to print, the death toll had reached 430,000. More than 10,000 people died in the US in the last three days of 2020 alone, according to data collected by John Hopkins University. One expert, Ashish Jha, dean of Brown University’s school of public health, has warned that “several hundred thousand more people” would die in 2021 if the chaotic roll out of vaccines was not resolved. W hile t he coronavir us is wreaking havoc on American lives it is also accelerating changes in the nature of employment that will exacerbate another epidemic that had been running rampant in the United States well before COVID19 struck. Nobel Prize winner Angus Deaton and his wife, economist Prof Anne Case had previously shown how life expectancy has been dropping for years among the American white working class through “deaths of despair” – suicides, accidental drug overdoses and alcoholic liver disease. There were 164,000 deaths from these sources in 2019. W hile less-educated white workers have borne the brunt of this first epidemic, AfricanAmericans and Hispanics have

been disproportionately killed by COVID-19 according to the US Centers for Disease Control and Prevention (CDC). The CDC says the evidence clearly points to higher rates of hospitalisation or death from COVID-19 among non-Hispanic black persons, Hispanics and Latinos, and American Indians/Alaska Natives than among non-Hispanic white persons.

STARK CLASS DIFFERENCES IN FATALITIES Deaton and Case say that “while educated elites live longer and more prosperous lives, less-educated Americans – two-thirds of the population – are dying younger and struggling physically, economically, and socially”.

“The COVID-19 pandemic is playing out similarly. Many educated professionals have been able to work from home – protecting themselves and their salaries – while many of those who work in services and retail have lost their jobs or face higher occupational risk. When the final tallies are in, there is little doubt that the overall losses in life and money will divide along the same educational fault line,” they wrote on the website Project Syndicate. Deaton and Case say: “It is now entirely plausible that deaths in the US will rise again as the structure of the economy shifts after the pandemic”. “The US economy has long been experiencing large-scale disruption, owing to changes in production techniques (especially automation) and, to a lesser extent, globalisation. “The inevitable disturbances to employment, especially among less-educated workers who are most vulnerable to them, have been made vastly worse by the inadequacy of social safety nets and an absurdly expensive health-care system.” n


COVID-19 Member Assistance As the COVID-19 pandemic continues, we want you to know: your union is here for you. We are working hard to support all members, including negotiating special leave with your employer, enforcing Work Health and Safety and access to adequate PPE, answering your questions and providing regular updates. Our ongoing negotiations won NSW Health employees access to 20 days of special paid leave for COVID-19. Emergency legislation has also been amended to cover COVID-19 exposure for essential workers. This means all nurses and midwives in NSW will not have to prove the source of a COVID-19 infection when making a workers’ compensation claim. If you are worried or concerned during this time, rest assured, we are here for you and you have our full support. To ensure we can meet your needs, we have improved processes to speed up responses and adopted new operational measures.

Authorised by J.Kiejda, Acting General Secretary, NSWNMA

These are extraordinary times and as health professionals, it’s critical for us to remain well informed and decrease anxiety within the community. Take care of yourself and each other. We are with you every step of the way.

The latest COVID-19 Updates & Guidelines are available from 34 | THE LAMP FEBRUARY/MARCH 2021




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

Looking a bit like 2020 so far ...

Maximum shift length

Well, a new year but with a distinctly familiar 2020 feel. As we approached Christmas, the Northern Beaches cluster (then joined by Berala and Croydon) sent the Greater Sydney area into varying degrees of restrictions, from lockdown to mask wearing. This was soon matched by outbreaks in Victoria, and then followed in Brisbane by concerns of possible community transmission of the more virulent UK strain of COVID-19. The hunger for some peace and quiet, and an opportunity to catch up with family and friends to celebrate the season, remained unsatiated for many. Instead, mass testing was required and, as has been the case in 2020, nurses were in the frontline, whether at testing clinics, border entry or quarantine hotels. It is no different overseas – except in many countries, clinicians of all persuasions are confronting demand that is overwhelming and placing their hospital systems on the verge of actual collapse. Vaccinations are now being rolled out in a number of countries; let’s hope their efficacy can demonstrate that a return to a safe, non-pandemic reality is possible. The next six months will certainly be telling.

I work full time under the federal Nurses Award. What’s the maximum shift length I can be rostered for my usual working hours? In Clause 21.2 of the Nurses Award 2010, it mandates that “The shift length or ordinary hours of work per day will be a maximum of 10 hours exclusive of meal breaks.”

Timing of employer super contributions How often does my employer have to pay their superannuation contributions to my super fund? The ATO via relevant super guarantee laws only requires employer super guarantee contributions for each eligible employee to be made on a quarterly basis. Some awards or agreements, however, may require the employer to make super contributions for their employees more regularly than these quarterly payments.

Disciplinary process at Ramsay I work at a hospital run by Ramsay. I was told that a concern had been raised about my behaviour. However, a few days have now passed and I have not received anything as yet. What should happen now? Clause 2.5 of the Ramsay Health Care Australia Pty Ltd & NSW Nurses & Midwives’ Association and ANMF NSW Branch Enterprise Agreement 2018–2020 sets out that the employer will ensure that any suspected unsatisfactory behaviour is managed in a timely and fair manner in accordance with the principles of natural justice. This includes the opportunity for an employee to respond to any allegations against them [Clause 2.5.6]. You are entitled to receive the details of any complaint made, with the right of reply before any decision is made [Clause 2.5.7]. Remember, employees have the right to have a support person present at any disciplinary/ investigative meeting, which may include an Association representative [Clause 2.5.4].

12-hour shifts I am a registered nurse in a public hospital. Recently there has been talk about introducing 12-hour shifts. Can’t say I am keen. Does the hospital need to let the Association know?

Clause 5 of the Public Health System Nurses’ and Midwives’ (State) Award requires the Association to be notified in writing no later than four weeks prior to the start of any proposed commencement of a 12-hour shift system, to enable consultation with all potentially affected employees. In any event, participation in a 12-hour shift system is entirely voluntary. Alternative shifts must be made available to you if you do not agree to participate.

Probationary period at Australian Red Cross Is there a limit to a probationary period if working for Australian Red Cross? Clause 8.2 of the Australian Red Cross Blood Service Nurses Enterprise Agreement New South Wales and Australian Capital Territory 2018 sets out that an employee may be employed on a probationary period for the first three months; however, this may be extended up to six months in individual circumstances. The total probationary period, however, cannot be for a period longer than six months.”

Rosters at Healthe Care I work at a hospital operated by Healthe Care. When is the roster supposed to be posted for staff? Clause 14 of the Healthe Care Pty Ltd (New South Wales Hospitals) and the NSWNMA/ ANMF NSW Branch Enterprise Agreement 2017 sets out that rosters shall be displayed in a place convenient to employees four weeks in advance where practicable, but certainly not less than two weeks in advance of the first day of the roster.





onNSW i t a c u d e / y .l bit

Webinars: Law in Nursing and Midwifery Practice Wed 3 Feb, 7-8pm Documentation Thu 11 Feb, 4-5pm Professional Obligations for nurses and midwives Mon 22 Feb, 7-8pm Assertive Communication Thu 25 Feb, 7-8pm Nursing and Midwifery Board of Australia (NMBA) – Code(s) of Conduct Wed 3 March, 12-1pm Ethics in Nursing and Midwifery Practice Fri 12 March, 10-11am Communication: Clinical Handovers and Assessments Tue 16 March, 11am-12pm Medications: High-risk medications and medication regulation Mon 22 March, 4-5pm Continuing Professional Development (CPD) – your annual obligations Tue 30 March, 12-1pm

Webinar for newly graduating nurses and midwives: Student to New Graduate Tue 16 & Wed 17 Feb, 10am-12pm. This webinar is held in 2 parts over 2 days.

PROFESSIONAL EDUCATION We are resuming face-to-face education in a number of locations in 2021, starting with some sessions in our Waterloo office in a reduced capacity. As the situation with COVID-19 continues to evolve in NSW, we will continue to tailor the education we provide. Clinical Communication and Documentation Wed 3 February, 9am to 4pm, 6 CPD Hours, Members $95 / Non-members $190 The Deteriorating Patient Thu 18 February, 9am to 4pm, 6 CPD Hours, Members $95 / Non-members $190 Medications: How we do it better Thu 11 March, 9am to 4pm, 6 CPD Hours, Members $95 / Non-members $190 Know where you stand with Law, Ethics and Professional Standards in nursing and midwifery Wed 24 March, 9am to 4pm, 6 CPD Hours, Members $95 / Non-members $190 Numbers on these courses have been reduced and are strictly limited. Venue: 50 O’Dea Avenue, Waterloo.

Search the date and times for the range of upcoming education at

CPD hours for these courses can be calculated by the time you spend actively learning. This will vary between individuals, as further

36 | THE LAMP FEBRUARY/MARCH 2021 learning can be included (e.g. reviewing the associated resources and completing the reflective questionnaires). self-directed

NURSING RESEARCH AND PROFESSIONAL ISSUES The final report of the five-year long review of the Medicare Benefits Schedule (MBS) was quietly released in December. This process was established to ensure the MBS remains fit for purpose as health needs evolve. The final report’s recommendations in relation to nurse practitioners are deeply disappointing and we are working with the profession to ensure they are not implemented.

A perverse, offensive and oppressive rejection of nurses Mary Chiarella & Jane Currie, 17 December 2020 Published 14 December 2020, the Medicare Benefits Schedule Review Taskforce (MBSRT) Final Report endorsed none of the 14 recommendations of its own Nurse Practitioner Reference Group (NPRG) Report. Instead, the report proposed three unrelated recommendations that further restrict the practice of nurse practitioners (NPs) who provide services subsidised by the MBS: a decision not to endorse any of the 14 recommendations can only be viewed as a decision not to invest in nursing and the health of Australian communities. The NPRG (one of five different professional groups established by the Taskforce) was multidisciplinary, comprising a range of practising NPs, both public and private; consumers; registered nurses; a medical practitioner from the MBSRT who was an ex-officio member; and professional and industrial nursing group representatives. Many of the recommendations focused on adjusting items that were already working well, or expanding recently introduced items through increased access or expanded scope. Fourteen evidence-based recommendations presented by the reference group sought to broaden the range of NP services subsidised through the MBS, and thereby encourage the growth of this much-needed nursing workforce. The review drew on various types of MBS data. It also used evidencebased data from the literature and clinical guidelines of peer-reviewed nursing and medical journals and other sources, such as government reports and professional societies, to address its remit from the MBSRT. Research evidence tells us that NPs provide quality care, that patients are highly satisfied with their care

and that NPs have increased access to health services, particularly for marginalised populations in community settings. Other studies have demonstrated that NPs prevent representations to ED and that their expertise is drawn on significantly by the multidisciplinary teams. mary-chiarella-and-jane-curriea-perverse-offensive-andoppressive-rejection-of-nurses/

Medicare Benefits Schedule Review Taskforce Final Report ©2020 Commonwealth of Australia (Department of Health) The Australian Government established the Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) in mid-2015 to review the more than 5700 items on the MBS. This has been the most comprehensive review of Medicare since its inception in 1984. The Taskforce is pleased to report it has completed its work, providing the government with more than 1400 recommendations to strengthen, modernise and protect Australia’s world-class health system. The Taskforce focused on ensuring MBS items meet the goals of affordable and universal access, best practice healthcare, and value for both the individual patient and the health system. Within the Taskforce’s brief, there was also considerable scope to review and provide advice on all aspects that would contribute to a modern, transparent and responsive system. This included not only making recommendations about consolidating, amending and updating MBS items, but also about an MBS structure that could better accommodate changing health service models. This Final Report outlines the Taskforce’s approach and its key achievements to date, as well as the need for continuous review and reform of the MBS, and the challenges and opportunities that lay ahead to improve the MBS

within the broader health system. The Taskforce recommends implementing all MBS Review recommendations made to date. au/resources/publications/ medicare-benefits-schedulereview-taskforce-final-report

Report from the Nurse Practitioner Reference Group 2018 Nurse practitioners (NPs) have been practising in Australia for 18 years and were admitted as eligible providers under the MBS nearly a decade ago. Since that time, the interaction between the MBS and the NP role has not been reviewed for functionality, its relevance to consumers, or its impact on the provision of and access to highquality health care. Models of care provided by NPs have the primary goal of improving access to care within the MBS, particularly in priority areas including aged care, Aboriginal and/or Torres Strait Islander peoples’ health, mental health, chronic condition management and primary health care. Within these models, NPs may be the primary health care provider for a consumer or may be working as part of a team. Despite the innovation and flexibility of these models, they remain curtailed by the limited number of items for which patients may receive MBS rebates when cared for by an NP. Rebates available to patients of NPs under the MBS do not reflect contemporary NP practice in Australia. This restricted access to MBS items limits consumer choice, affects accessibility, creates fragmentation and, at times, drives unnecessary duplication and costs throughout episodes of care. au/resources/publications/ taskforce-findings-nursepractitioner-reference-groupreport




Billionaires’ bonanza The pandemic has turbocharged the gap between rich and poor in Australia. The combined wealth of Australian billionaires has risen by more than 52 per cent over the past year, according to the Bloomberg Billionaires Index. By comparison, billionaires in the US and UK recorded an increase of about 25 per cent over the same period, the Bloomberg index shows. ALP shadow assistant Treasurer, Andrew Leigh, told The Guardian that the “increases were remarkable” and he contrasted it with the tough time that ordinary families were enduring. “Recessions often worsen inequality, but this one seems to have turbocharged the gap. High-paid workers can more easily work from home than low-paid workers. WORLD

Extreme poverty set to rise from pandemic Most of the “new destitute” will be in South Asia and sub-Saharan Africa. The World Bank predicts that COVID-19 will increase the ranks of the extremely poor – those living on less than $1.90 a day – by up to 150 million people, reports The Economist. From 1990 until 2019, the number of extreme poor fell from 36 per cent of the world’s population to 8 per cent. Now, numbers are increasing for the first time since 1998. The UN says 240 to 490 million people in 70 countries will be pushed into “multidimensional poverty”, a measure that includes lacking basic shelter or having children go hungry. The UN World Food Programme predicted that acute hunger would have doubled by the end of 2020, with an additional 130 million people not having enough to eat. The pandemic’s disruption of health care means more mothers will die in childbirth, and more people will die from chronic illnesses such as diabetes, and preventable diseases such as malaria, in 2021. Inequality throughout the world is also set to rise. Economic analysis of pandemics over the past century suggests that they lead to sharp rises in inequality. History shows that employment among the well educated barely changes, but among those with low levels of education employment typically declines by 5 per cent. “This time will be no different,” said The Economist.

‘ The UN says 240 to 490 million people in 70 countries will be pushed into “multidimensional poverty”.’ 38 | THE LAMP FEBRUARY/MARCH 2021

“While affluent Australians can ride the share market rollercoaster, more than one million people with insufficient assets have pulled money out of superannuation,” he said. Leigh pointed out that even before COVID-19 there had been “anaemic” wage growth, home ownership had been at its lowest level in six decades and household debt had skyrocketed. “The fact is for those who are struggling, (2020) has been a terrible year and 2021 will be a rough year indeed,” he said. Leigh said several Australian billionaires, including Solomon Lew, owned firms that had paid out significant dividends after receiving JobKeeper support from taxpayers. Lew is reported to have been paid $24.25 million in dividends after his retail empire, Premier Investments, received almost $70 million in wage subsidies during the coronavirus crisis.

‘For those who are struggling, 2020 has been a terrible year and 2021 will be a rough year indeed.’ — Andrew Leigh


destroyed by this,” Mr Agnello said.


Aged-care mogul facing legal action jets overseas

An independent review of Epping Gardens and another COVID-hit facility, St Basil’s Homes for the Aged, found multiple failings of “leadership and effective management” at both facilities.

A co-owner of Epping Gardens nursing home, which is being investigated over the deaths of 38 residents from COVID-19, has put his Melbourne mansion up for sale and flown to Greece.

The Age obtained emails it said showed management cut carers’ shifts in the weeks before coronavirus swept through Epping Gardens.

Multimillionaire Peter Arvanitis and his wife, Areti, left Melbourne about two weeks before Christmas after receiving a travel exemption from the Australian Department of Home Affairs, The Age reported. Their Toorak mansion could fetch up to $40 million, the paper said.

‘ We want him to come back to Melbourne and face up to the families who have been destroyed by this.’

Mr Arvanitis and business partner, Tony Antonopoulos, each own a 50 per cent stake in Heritage Care Pty Ltd, which operates 10 aged-care homes in NSW and Victoria, including Epping Gardens in Melbourne. The COVID-19 outbreak at Epping Gardens is under investigation by WorkSafe and the State Coroner. The Age said the departure of Peter Arvanitis “has incensed many victims of Epping Gardens”, where 103 residents and 86 staff were infected. Sam Agnello, who lost his mother Carmela at Epping Gardens and who is lead plaintiff in a class action involving Heritage Care, said he had never received any offer of condolences or an apology from the owners of the company or its management team. “[Mr Arvanitis] has never taken any responsibility or shown any compassion. We want him to come back to Melbourne and face up to the families who have been

Heritage Care residential aged care owner and managing director Tony Antonopoulos and his wife, Stacey, who between them own half the company. Image via Instagram

Quality legal advice for NSWNMA members • Workers Compensation Claims • Litigation, including workplace related claims • Employment and Industrial Law • Workplace Health and Safety • Anti-Discrimination • Criminal, including driving offences • Probate / Estates • Public Notary • Discounted rates for members including First Free Consultations for members

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Not enough nurses

Pandemic is driving down wages: ILO

The World Health Organization estimates an extra six million nurses are needed globally.

The International Labour Organization says the COVID-19 crisis is likely to inflict massive downward pressure on wages in the near future.

COVID-19 has exposed the world’s health systems to the ultimate stress test. Healthcare workers have accounted for around 10 per cent of COVID-19 cases globally, according to the International Council of Nurses, a federation of national nursing associations. The disease has killed at least 1500 nurses. The pandemic has also revealed the desperate shortages of nurses globally and the reliance of many rich countries, including Australia, on foreign-trained nurses, to the detriment of poorer countries. In Britain, foreign-trained nurses account for 15 per cent of the nursing workforce. Brexit has compounded the country’s nursing shortage. Last year fewer than 1000 European nurses registered to work in Britain, compared with 9389 four years earlier, reported The Economist. In Australia, a federal Department of Health report projected a shortfall of 85,000 nurses by 2025 and 123,000 by 2030. The Philippines and India are the world’s biggest exporters of nurses, but both countries face shortages too, even though both countries train more nurses than they need. In a developed nation like Britain, there are more than eight nurses per 1000 people, compared with less than five in the Philippines and two in India. The WHO calculates the Philippines will face a shortfall of almost 250,000 nurses by 2030. Nurses in these countries often face widespread unemployment, low wages and poor career opportunities, which encourages graduates to move abroad.

‘The Philippines and India are the world’s biggest exporters of nurses, but both countries face shortages too.’

A new report by the International Labour Organization (ILO), a United Nations body, has found that monthly wages fell or grew more slowly in the first six months of 2020 as a result of the COVID-19 pandemic, in two-thirds of countries for which official data was available. The Global Wages Report 2020/21 shows that not all workers have been equally affected by the crisis. The impact on women has been worse than on men. Estimates based on a sample of 28 European countries found that, without wage subsidies, women would have lost 8.1 per cent of their wages in the second quarter of 2020, compared to 5.4 per cent for men. The crisis has also severely affected lower paid workers. Those in lower skilled occupations lost more working hours than higher paying managerial and professional jobs. The report shows that, without temporary subsidies, the lowest paid 50 per cent of workers would have lost an estimated 17.3 per cent of their wages. “The growth in inequality created by the COVID-19 crisis threatens a legacy of poverty, and social and economic instability that would be devastating,” said ILO Director-General, Guy Ryder.

‘The growth in inequality created by the COVID-19 crisis threatens a legacy of poverty, and social and economic instability that would be devastating.’ — ILO Director-General, Guy Ryder ILO Flagship Report wcmsp5/groups/ public/---dgreports/--dcomm/---publ/documents/publication/ wcms_762534.pdf

Scrubs up OECD countries with the most foreign-trained nurses 2018 or latest, ’000

United States Britain Germany Australia Canada Italy France Switzerland New Zealand Belgium


50 100 150 200

Source: OECD



X Global

Wage Report 2020–21

Wages and minimum wages in the time of COVID-19



Australia needs a better national health plan for climate change At the national level, there is an unwillingness to speak about the damage climate change is doing to Australians’ health. Currently, what the World Health Organization calls one of the world’s greatest health risks doesn’t rate a mention in Australia’s Long Term National Health Plan, nor in the Department of Health’s Corporate Plan. The department’s $5 billion investment plan for the Medical Research Future Fund describes 20 funding initiatives for the next decade and identifies “areas of national priority”. But it doesn’t once mention climate change. Yet the five hottest years on record have occurred since 2015, according to The Lancet. Australia is predicted to have harsher heatwaves and more severe storms. Cyclones in the far north will be more intense, causing floods. The Grattan Institute has released a report that argues that the health sector must adapt to the reality of a warming Australia. “The coronavirus pandemic provides a model. Australia’s response to COVID-19 was led by a national cabinet and informed by the national and state chief medical and health officers,” the report’s authors, Stephen Duckett and Will Mackey, wrote in The Conversation. “Our political leaders listened to the science presented by these expert advisers. They used this evidence and advice to make unprecedented decisions in unprecedented times to protect the lives and livelihoods of millions of Australians. “They must do the same with climate change.” The report recommends: • establishing a national climate change and health forum •c learly communicating climate change health risks to the public • improving mental health support systems • reviewing health service resilience to climate disasters.

‘ The coronavirus pandemic provides a model.’ READ THE REPORT Climate-change-and-health-2020.pdf


COVID-19 will cost the global economy US$10 trillion The numbers are colossal and may still be an underestimate.

In an analysis based on World Bank statistics and economic assumptions, The Economist has calculated that the world economy probably shrank by 4.3 per cent in 2020, a setback it says is “matched only by the Depression and the two world wars”. But this dramatic figure still understates the cost. It measures the world economy’s fall from where it was before the pandemic, not from where it would have been had the virus not spread. Before the coronavirus, global GDP was expected to expand by 2.5 per cent in 2020 to US$86 trillion. Compared with that figure, the shortfall of global GDP last year was probably more like 6.6 per cent. That is equivalent to about US$5.6 trillion. The World Bank projects the world economy to grow strongly in 2021, helped by the roll-out of vaccines. But even if this expectation is met and no further calamities intrude, the level of output in 2021 will remain 5.3 per cent below the bank’s pre-pandemic projections: a further shortfall of almost US$4.7 trillion. Put these two numbers together and the cost of COVID-19 this year and last will amount to about US$10.3 trillion in lost output: goods and services the world could have produced had it remained unafflicted. “That is, to put it mildly, a big number,” says The Economist.

‘The world economy probably shrank by 4.3 per cent in 2020, a setback matched only by the Depression and the two world wars.’




Getting ready: WHO stockpiles global Ebola vaccine Four leading international health and humanitarian organisations have established a global Ebola vaccine stockpile The stockpile was created by the International Coordinating Group on Vaccine Provision, which includes the World Health Organization, UNICEF, the International Federation of Red Cross and Red Crescent Societies, and Médecins Sans Frontières, with financial support from Gavi, the Vaccine Alliance. The stockpile will allow countries, with the support of humanitarian organisations, to contain future Ebola epidemics by ensuring timely access to vaccines for populations at risk during outbreaks. The vaccine has already been administered to more than 350,000 people in Guinea and in the 2018–2020 Ebola outbreaks in the Democratic Republic of the Congo under a protocol for “compassionate use”. “The COVID-19 pandemic is reminding us of the incredible power of vaccines to save lives from deadly viruses,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This new stockpile is an excellent example of solidarity, science and cooperation between international organisations and the private sector, to save lives.” The stockpile is stored in Switzerland and is ready to be shipped to countries for emergency response. “We know that when it comes to disease outbreaks, preparedness is key. This Ebola vaccine stockpile is a remarkable achievement – one that will allow us to deliver vaccines to those who need them the most, as quickly as possible,” said Henrietta Fore, UNICEF Executive Director.

‘ This new stockpile is an excellent example of solidarity, science and cooperation between international organisations and the private sector, to save lives.’ — Dr Tedros Adhanom Ghebreyesus, WHO Director-General


Advertise in The Lamp and reach more than 70,000 nurses and midwives. To advertise contact Danielle Nicholson 02 8595 2139 / 0429 269 750


Join the health fund that’s all about you. Nurses & Midwives Health is dedicated to caring for the carers. We’re the only health fund exclusively for nurses, midwives and their families. When you’re a member, you’re part of our family. So that’s why your family members are also welcome to join us.

For your free, side-by-side comparison, and our latest offers, visit or call 1300 344 000 Eligibility criteria and conditions apply. Nurses & Midwives Health Pty Ltd ABN 70 611 479 237 NMH-NSWNMA-02/21


The Edith Cavell Trust is now able to receive non-tax deductable donations/bequests. The Trust – named in honour of Edith Cavell – assists in the advancement of NSW nurses, midwives and assistants in nursing/midwifery through further studies and research, made available through scholarship. The knowledge and expertise gained by nurses, midwives and assistants in nursing/ midwifery, supported by the Edith Cavell Scholarships, is an asset to the care of their patients and clients. Bequests to the Trust continue to support this important work. Edith, a British nurse serving in Belgium in WW1, is a hero to most nurses and midwives. She helped some 200 Allied soldiers escape from German-occupied Belgium. Her actions saw her arrested, accused of treason, found guilty by a court-martial and sentenced to death. Despite international pressure for mercy, she was shot by a German firing squad. NAME ADDRESS


Cavell Edith





PREFERRED METHOD OF PAYMENT Electronic Fund Transfer Account name: Edith Cavell Trust Bank: Commonwealth Bank BSB: 062-017 Account no: 10017908 Credit Card I authorise the Edith Cavell Trust (processed via NSWNMA) to debit my credit card for the amount of Mastercard



Name on Card

Card no

Expiry Date

Signature of Cardholder


MENTORING GRANTS PROGRAM 2021 PROGRAM UPDATE As previously advertised, because of COVID -19, the 2020 round of the Bob Fenwick Mentoring Grants Program was postponed to 2021. We are hopeful that the next round of the Program will go ahead and if so will be advertised in The Lamp in late 2021.This will mean that the successful applicants from the 2020 round will now be completing their placements this year. If you have any questions, please contact us at 02 8595 1234 or email 44 | THE LAMP FEBRUARY/MARCH 2021



test your

Knowledge 1

















18 19















ACROSS 1. A spasm of the abdominal wall muscles to protect inflamed abdominal viscera from pressure (9.8) 10. Hard, rocklike structures formed by marine coelenterates (5) 11. The arrangement of red bloodcorpuscles when they unite to form columns like stacked-up coins (11) 12. Lurch, stumble (7) 13. One of the rare earth elements (9) 14. A foreigner or stranger (9) 15. Natural, chemical-free (7) 18. Mental age (1.1) 19. Small, single-celled fungi that are capable of fermenting carbohydrates into alcohol and carbon dioxide (5)

21. Hollowed like a bowl or a saucer (11) 22. An anesthetic used for topical and dental anesthesia, cardiac arrhythmias (9) 25. Argentum (6) 26. An element forming a part of the whole (9) 27. A scleroprotein that is the principal constituent of epidermis, hair, nails and horny tissues (7) 28. Involving little or no use of words (9) 32. Finger, toe (5) 33. Excessive exposure to a chemical element, causing nausea, vomiting, renal dysfunction, and cognitive disorders (8.9)

DOWN 1. A mass of placental tissue distinct from the main placenta (9.8) 2. Hibernating, inactive (7) 3. Cancerous, capable of invading nearby tissue and spreading to other parts of the body (9) 4. Not yielding or producing (13) 5. A medical product made from a certain type of seaweed that is physically placed near the cervix to cause it to dilate (9) 6. An instrument for cutting the uvula (9) 7. Prepared, arranged, organised (5) 8. Relating to iris (7) 9. The process where a gene is differentially expressed depending on whether it has been inherited from the mother or father (7.10) 16. Endangered plant or animal (4.7) 17. Association (11) 20. Stomach (7) 23. To make identical copies of a DNA sequence (5) 24. Inner, central (5) 29. Vigor (3) 30. To go quickly, to flee (3) 31. An upper limb (3)



For NSWNMA Members

Insurance protection when you need it most The NSWNMA is committed to protecting the interests of nurses and midwives by purchasing a range of insurances to cover members.

Journey Accident Insurance provides cover for members who are injured as a result of an accident while travelling between their home and their regular place of employment. Professional Indemnity Insurance provides legal representation and protection for members when required. Make sure your membership remains financial at all times in order to access the insurance and other benefits provided by the NSWNMA.

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 46 |

IMPORTANT NOTE From 1 December 2018 the insurance benefits have changed as follows: • Journey Accident Insurance: the waiting period for benefits is now 14 days • Professional Indemnity Insurance: the limit per claim is now $5 million THE LAMP FEBRUARY/MARCH 2021


book club





Dr Allie Reynolds Hachette Australia: RRP $32.99 ISBN 9780733644900





All books can be ordered through the publisher or your local bookshop. Call 8595 1234 or 1300 367 962, or email library@ for assistance with loans or research. Books are not independently reviewed or reviewed using information supplied by the publishers.


Dead Letters Madonna King Hachette Australia: RRP $32.99: ISBN 9780733646096

At 10, we know how girls are pigeonholing themselves into what they think they should be. Whether they see themselves as academic or not, if they are interested in boys, puberty is a reality, friendship fights are underway, and the influence of social media is impacting. With heightened pressure from what they see in the media, in movies and on TV, our girls are leaving childhood behind well before they hit their teens. Not surprisingly, emotions can be heightened and relationships can be fraught. So many parents struggle to understand the pressures our girls are under and how to deal with their emotional volatility. Journalist and social commentator Madonna King has an extraordinary ability to connect with experts, schools and the girls themselves, to deliver the answers parents need and the communication our girls want.


IA When Milla is invited to a reunion in the tiny resort that saw L IN T E the peak of her snowboarding career, she drops everything to go. While she would rather forget the events of that winter, the invitation comes from Curtis, the one person she can’t seem to let go. The five friends haven’t seen each other for ten years, since the disappearance of the beautiful and enigmatic Saskia. But when an icebreaker game turns menacing, they realise they don’t know who has really gathered them there or how far they will go to find the truth. In an isolated lodge high up a mountain, amid a looming snowstorm, the secrets of the past are about to come to light.

The Mind Of A Murderer Michael Brissenden Hachette Australia: RRP $32.99: ISBN 9780733637445

A dead politician. A decadesold unsolved murder. A hornet’s nest is

about to be stirred. Counterterrorism expert Sid Allen knows nothing good ever comes from a phone call at 5 am. Politician Dan LeRoi, Chairman of the Joint Committee on Intelligence and Security, has been shot. Four bullets to the head. The crime scene is chaotic. Homicide. Counter Terrorism. Media. And for Sid, hunting the killer is going to get complicated. Journalist Zephyr Wilde is complicated. She’s tenacious and she’s got Sid’s number. Sid knows the gossip: how Zephyr’s mother was murdered when Zephyr was a kid. He doesn’t know that Zephyr is still getting letters from her long-dead mother. But when he learns that Dan LeRoi was helping Zephyr look into her mother’s death, he realises that lines are going to be crossed. A cop should not be talking to a journalist.

Dr Richard Taylor Hachette Australia: RRP $32.99: ISBN 9781472268181

In his 26 years in the field, Richard Taylor has worked on well over a hundred murder cases, with victims and perpetrators from all walks of life. In this fascinating memoir, Taylor draws on some of the most tragic, horrific and illuminating of these cases – as well as dark secrets from his own family’s past – to explore some of the questions he grapples with every day: Why do people kill? Does committing a monstrous act make someone a monster? Could any of us, in the wrong circumstances, become a killer?




at the movies GIV E
















Serial procrastinator Teddy (RAFE SPALL) thinks he has all the time in the world, but after an odd encounter with a stranger (NONI HAZLEHURST), he wakes up the morning after his wedding to discover that he's jumped forward a year in his life to his first anniversary. His wife Leanne (ZAHRA NEWMAN) is now heavily pregnant, with a full year of marriage behind them that he doesn’t remember living. Trapped in a cycle of time jumps, transported another year ahead every few minutes, Teddy is faced with a race against time as his life crumbles around him. In Cinemas February 11.

The untold story of how a band of renegade surfer girls in the 1980s fought to create their own professional sport, changing surf culture forever. Featuring surfing greats Jodie Cooper, Frieda Zamba, Pauline Menczer, Lisa Andersen, Pam Burridge, Wendy Botha, Layne Beachley and more, Girls Can’t Surf is a wild ride of clashing personalities, sexism, adventure and heartbreak, with each woman fighting against the odds to make their dreams of competing a reality. In cinemas March, 2021.

Email The Lamp by 30 February to be in the draw to win one of 10 double passes to Long Story Short thanks to Studio Canal. Email your name, membership number, address and telephone number to for a chance to win!

Email The Lamp by 30 February to be in the draw to win one of 10 double passes to Girls can’t surf thanks to Madman. Email your name, membership number, address and telephone number to for a chance to win!





Penance follows the lives of Rosalie (Julie Graham) and Luke Douglas (Neil Morrissey) and their teenage daughter, Maddie (Tallulah Greive). Following the loss of their son, Rosalie and Luke find their marriage under immense strain. Maddie and Rosalie find themselves in the caring hands of Jed (Nico V IE A Mirallegro), a charming and charismatic young man that they encounter at GIV E bereavement counselling who is also suffering under the weight of his own grief. Jed rekindles a hope for the future within the Douglas household. But underneath, a deadly and morally corrupt triangle is taking shape. M

Email The Lamp by 30 February to be in the draw to win one of 10 dvds of Penance thanks to Acorn. Email your name, membership number, address and telephone number to for a chance to win! THE LAMP FEBRUARY/MARCH 2021 | 49


TAE Academy and NSWNMA have formed a partnership to offer NSWNMA members the TAE40116 Certificate IV in Training and Assessment at a discounted rate The program is delivered in 12 days over a period of 9 months. Alternatively we have an online program available to those that cannot attend the face-to-face workshops. LOCATION: 50 O’Dea Avenue, Waterloo NSW 2017 COST FOR ONLINE PROGRAM: $1,520 (or 4 x $380 installments) COST OF FACE-TO-FACE PROGRAM: $2,760 (6 x $460 installments)


Face-to-face program commences 8 March 2021


Develop and assess your medication dosage calculation skills with the world's leading resource for healthcare students and practitioners. Meet your CPD requirements •  •  •

Certificate of Completion Reflective Account Up to 21 CPD hours


Scan the QR code to visit our secure online store and be up and running with your new safeMedicate account in minutes!

This program is endorsed by ACN according to our Continuing Professional Development (CPD) Endorsed Course Standards. It has been allocated 7 CPD hours per module according to the Nursing and Midwifery Board of Australia – Continuing Professional Development Standard.

safeMedicate is brought to you in partnership with







Recruit a new member and go into the draw to win A luxury

holiday in

Vanuatu Valued at over $5,000

The 2020 – 2021 NSWNMA Member Recruitment scheme prize Tamanu on the Beach Resort & Spa is a peaceful, private and secluded boutique resort located on its own private white-sand beach, just 20-minutes from Port Vila. Voted as Vanuatu’s luxury resort of the year, you will enjoy luxurious, ocean-facing villas and some of the best cuisine on the island. You and a friend will experience the following: • 7 nights’ accommodation in a beach-view villa at Tamanu on the Beach • Welcome fruit cocktail or chilled coconut on arrival • Daily a la carte breakfast for two adults • Free daily shuttle to Port Vila • Free in-house movies • Complimentary use of the resorts island facilities • Complimentary Wi-Fi. The NSWNMA will arrange return flights for two to Vanuatu Every member you sign up over the year gives you an entry in the draw!


Prize drawn 1 July 20

RECRUITERS NOTE: 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, so you will be entered in the draw. Conditions apply. Prize must be redeemed by 30 June 2022 and is subject to room availability. Block out dates include 1 July - 30 September 2021 and 1 December 2021 - 31 January 2022. The prize will be drawn on 1 July 2021. 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/20/05518.

There are some things you shouldn’t handle alone. Contact the NSWNMA if you are: Asked to attend a disciplinary or fact finding interview with your employer Threatened with dismissal Instructed to provide a statement for any reason Contacted by the Health Care Complaints Commission or the Nursing and Midwifery Council of NSW Contacted by police or solicitors in relation to a Coronial Inquest

Call us on 8595 1234 (metro) or 1300 367 962 (non-metro) Email Authorised by B. Holmes, General Secretary, New South Wales Nurses and Midwives’ Association, 50 O’Dea Ave, Waterloo NSW 2017